An act to amend title 4, United States Code, to provide for the flying of the flag at half-staff in the event of the death of a first responder in the line of duty
PL 115-123 (H.R.1892), enacted 02/09/2018

132 STAT. 64 
PUBLIC LAW 115–123—FEB. 9, 2018 
Public Law 115–123 
115th Congress 
An Act 
To amend title 4, United States Code, to provide for the flying of the flag at 
half-staff in the event of the death of a first responder in the line of duty. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Bipartisan Budget Act of 2018’’. 
DIVISION A—HONORING HOMETOWN 
HEROES ACT 
SECTION 10101. SHORT TITLE. 
This division may be cited as the ‘‘Honoring Hometown Heroes 
Act’’. 
SEC. 10102. PERMITTING THE FLAG TO BE FLOWN AT HALF-STAFF 
IN THE EVENT OF THE DEATH OF A FIRST RESPONDER 
SERVING IN THE LINE OF DUTY. 
(a) AMENDMENT.—The sixth sentence of section 7(m) of title 
4, United States Code, is amended— 
(1) by striking ‘‘or’’ after ‘‘possession of the United States’’ 
and inserting a comma; 
(2) by inserting ‘‘or the death of a first responder working 
in any State, territory, or possession who dies while serving 
in the line of duty,’’ after ‘‘while serving on active duty,’’; 
(3) by striking ‘‘and’’ after ‘‘former officials of the District 
of Columbia’’ and inserting a comma; and 
(4) by inserting before the period the following: ‘‘, and 
first responders working in the District of Columbia’’. 
(b) FIRST RESPONDER DEFINED.—Such subsection is further 
amended— 
(1) in paragraph (2), by striking ‘‘, United States Code; 
and’’ and inserting a semicolon; 
(2) in paragraph (3), by striking the period at the end 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new paragraph: 
‘‘(4) the term ‘first responder’ means a ‘public safety officer’ 
as defined in section 1204 of title I of the Omnibus Crime 
Control and Safe Streets Act of 1968 (34 U.S.C. 10284).’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply with respect to deaths of first responders occurring 
on or after the date of the enactment of this Act. 
Applicability. 
4 USC 7 note. 
4 USC 1 note. 
Honoring 
Hometown 
Heroes Act. 
42 USC 1305 
note. 
Bipartisan 
Budget Act 
of 2018. 
Feb. 9, 2018 
[H.R. 1892] 
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132 STAT. 65 
PUBLIC LAW 115–123—FEB. 9, 2018 
DIVISION B—SUPPLEMENTAL APPROPRIATIONS, TAX 
RELIEF, AND MEDICAID CHANGES RELATING TO CER-
TAIN DISASTERS AND FURTHER EXTENSION OF CON-
TINUING APPROPRIATIONS 
Subdivision 1—Further Additional Supplemental 
Appropriations for Disaster Relief Requirements Act, 2018 
The following sums in this subdivision are appropriated, out 
of any money in the Treasury not otherwise appropriated, for the 
fiscal year ending September 30, 2018 and for other purposes, 
namely: 
TITLE I 
DEPARTMENT OF AGRICULTURE 
AGRICULTURAL PROGRAMS 
PROCESSING, RESEARCH AND MARKETING 
OFFICE OF THE SECRETARY 
For an additional amount for the ‘‘Office of the Secretary’’, 
$2,360,000,000, which shall remain available until December 31, 
2019, for necessary expenses related to crops, trees, bushes, and 
vine losses related to the consequences of Hurricanes Harvey, Irma, 
Maria, and other hurricanes and wildfires occurring in calendar 
year 2017 under such terms and conditions as determined by the 
Secretary: Provided, That the Secretary may provide assistance 
for such losses in the form of block grants to eligible states and 
territories: Provided further, That the total amount of payments 
received under this heading and applicable policies of crop insurance 
under the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.) 
or the Noninsured Crop Disaster Assistance Program (NAP) under 
section 196 of the Federal Agriculture Improvement and Reform 
Act of 1996 (7 U.S.C. 7333) shall not exceed 85 percent of the 
loss as determined by the Secretary: Provided further, That the 
total amount of payments received under this heading for producers 
who did not obtain a policy or plan of insurance for an insurable 
commodity for the 2017 crop year, or 2018 crop year as applicable, 
under the Federal Crop Insurance Act (7 U.S.C. 1501 et seq.) 
for the crop incurring the losses or did not file the required paper-
work and pay the service fee by the applicable State filing deadline 
for a noninsurable commodity for the 2017 crop year, or 2018 
crop year as applicable, under NAP for the crop incurring the 
losses shall not exceed 65 percent of the loss as determined by 
the Secretary: Provided further, That producers receiving payments 
under this heading, as determined by the Secretary, shall be 
required to purchase crop insurance where crop insurance is avail-
able for the next two available crop years, and producers receiving 
payments under this heading shall be required to purchase coverage 
under NAP where crop insurance is not available in the next 
two available crop years, as determined by the Secretary: Provided 
further, That, not later than 90 days after the end of fiscal year 
2018, the Secretary shall submit a report to the Congress specifying 
the type, amount, and method of such assistance by state and 
territory and the status of the amounts obligated and plans for 
Reports. 
Further 
Additional 
Supplemental 
Appropriations 
for Disaster 
Relief 
Requirements 
Act, 2018. 
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132 STAT. 66 
PUBLIC LAW 115–123—FEB. 9, 2018 
further expenditure and include improvements that can be made 
to Federal Crop Insurance policies, either administratively or legis-
latively, to increase participation, particularly among underserved 
producers, in higher levels of coverage in future years for crops 
qualifying for assistance under this heading: Provided further, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
OFFICE OF INSPECTOR GENERAL 
For an additional amount for ‘‘Office of Inspector General’’, 
$2,500,000, to remain available until expended, for oversight and 
audit of programs, grants, and activities funded by this subdivision 
and administered by the Department of Agriculture: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
AGRICULTURAL RESEARCH SERVICE 
BUILDINGS AND FACILITIES 
For an additional amount for ‘‘Buildings and Facilities’’, 
$22,000,000, to remain available until expended, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
FARM SERVICE AGENCY 
EMERGENCY CONSERVATION PROGRAM 
For an additional amount for the ‘‘Emergency Conservation 
Program’’, for necessary expenses related to the consequences of 
Hurricanes Harvey, Irma, and Maria and of wildfires occurring 
in calendar year 2017, and other natural disasters, $400,000,000, 
to remain available until expended: Provided, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
NATURAL RESOURCES CONSERVATION SERVICE 
WATERSHED AND FLOOD PREVENTION OPERATIONS 
For an additional amount for ‘‘Watershed and Flood Prevention 
Operations’’, for necessary expenses for the Emergency Watershed 
Protection Program related to the consequences of Hurricanes 
Harvey, Irma, and Maria and of wildfires occurring in calendar 
year 2017, and other natural disasters, $541,000,000, to remain 
available until expended: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
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132 STAT. 67 
PUBLIC LAW 115–123—FEB. 9, 2018 
RURAL DEVELOPMENT PROGRAMS 
RURAL HOUSING SERVICE 
RURAL HOUSING INSURANCE FUND PROGRAM ACCOUNT 
For an additional amount for ‘‘Rural Housing Insurance Fund 
Program Account’’, $18,672,000, to remain available until Sep-
tember 30, 2019, for the cost of direct loans, including the cost 
of modifying loans as defined in section 502 of the Congressional 
Budget Act of 1974, for the rehabilitation of section 515 rental 
housing (42 U.S.C. 1485) in areas impacted by Hurricanes Harvey, 
Irma, and Maria where owners were not required to carry national 
flood insurance: Provided, That such amount is designated by the 
Congress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
RURAL UTILITIES SERVICE 
RURAL WATER AND WASTE DISPOSAL PROGRAM ACCOUNT 
For an additional amount for the ‘‘Rural Water and Waste 
Disposal Program Account’’, $165,475,000, to remain available until 
expended, for grants to repair drinking water systems and sewer 
and solid waste disposal systems impacted by Hurricanes Harvey, 
Irma, and Maria: Provided, That not to exceed $2,000,000 of the 
amount appropriated under this heading shall be for technical 
assistance grants for rural water and waste systems pursuant to 
section 306(a)(22) of the Consolidated Farm and Rural Development 
Act: Provided further, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
DOMESTIC FOOD PROGRAMS 
FOOD AND NUTRITION SERVICE 
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, 
AND CHILDREN (WIC) 
For an additional amount for the ‘‘Special Supplemental Nutri-
tion Program for Women, Infants, and Children’’, $14,000,000, to 
remain available until September 30, 2019, for infrastructure grants 
to the Commonwealth of Puerto Rico and the U.S. Virgin Islands 
to assist in the repair and restoration of buildings, equipment, 
technology, and other infrastructure damaged as a consequence 
of Hurricanes Irma and Maria: Provided, That such amount is 
designated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985. 
COMMODITY ASSISTANCE PROGRAM 
For an additional amount for ‘‘Commodity Assistance Program’’ 
for the emergency food assistance program as authorized by section 
27(a) of the Food and Nutrition Act of 2008 (7 U.S.C. 2036(a)) 
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132 STAT. 68 
PUBLIC LAW 115–123—FEB. 9, 2018 
and section 204(a)(1) of the Emergency Food Assistance Act of 
1983 (7 U.S.C. 7508(a)(1)), $24,000,000, to remain available until 
September 30, 2019, for necessary expenses of those jurisdictions 
that received a major disaster or emergency declaration pursuant 
to section 401 or 501, respectively, of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5170, 5191) related 
to the consequences of Hurricanes Harvey, Irma, and Maria or 
due to wildfires in 2017: Provided, That notwithstanding any other 
provisions of the Emergency Food Assistance Act of 1983, the Sec-
retary of Agriculture may provide resources to Puerto Rico, the 
Virgin Islands of the United States, and affected States, as deter-
mined by the Secretary, to assist affected families and individuals 
without regard to sections 204 and 214 of such Act (7 U.S.C. 
7508, 7515) by allocating additional foods and funds for administra-
tive expenses from resources specifically appropriated, transferred, 
or reprogrammed: Provided further, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
RELATED AGENCIES AND FOOD AND DRUG 
ADMINISTRATION 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
FOOD AND DRUG ADMINISTRATION 
BUILDINGS AND FACILITIES 
(INCLUDING TRANSFER OF FUNDS) 
For an additional amount for ‘‘Buildings and Facilities’’, 
$7,600,000, to remain available until expended, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria: Provided, That such amount may be transferred to 
‘‘Department of Health and Human Services—Food and Drug 
Administration—Salaries and Expenses’’ for costs related to repair 
of facilities, for replacement of equipment, and for other increases 
in facility-related costs: Provided further, That obligations incurred 
for the purposes provided herein prior to the date of enactment 
of this subdivision may be charged to funds appropriated by this 
paragraph: Provided further, That such amount is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
GENERAL PROVISION—THIS TITLE 
SEC. 20101. (a) Section 1501(b) of the Agricultural Act of 2014 
(7 U.S.C. 9081(b)) is amended— 
(1) in paragraph (1), in the matter before subparagraph 
(A), by inserting ‘‘sold livestock for a reduced sale price, or 
both’’ after ‘‘normal mortality,’’; 
(2) in paragraph (2), by striking ‘‘applicable livestock on 
the day before the date of death of the livestock, as determined 
by the Secretary.’’ and inserting the following: 
‘‘affected livestock, as determined by the Secretary, on, as 
applicable— 
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132 STAT. 69 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) the day before the date of death of the livestock; 
or 
‘‘(B) the day before the date of the event that caused 
the harm to the livestock that resulted in a reduced sale 
price.’’; and 
(3) by adding at the end the following new paragraph: 
‘‘(4) A payment made under paragraph (1) to an eligible 
producer on a farm that sold livestock for a reduced sale price 
shall— 
‘‘(A) be made if the sale occurs within a reasonable 
period following the event, as determined by the Secretary; 
and 
‘‘(B) be reduced by the amount that the producer 
received for the sale.’’. 
(b) Section 1501(d)(1) of the Agricultural Act of 2014 (7 U.S.C. 
9081(d)(1)) is amended by striking ‘‘not more than $20,000,000 
of’’. 
(c) Section 1501(e)(4)(C) of the Agricultural Act of 2014 (7 
U.S.C. 9081(e)(4)(C)) is amended by striking ‘‘500 acres’’ and 
inserting ‘‘1,000 acres’’. 
(d) Section 1501 of the Agricultural Act of 2014 (7 U.S.C. 
9081) is amended— 
(1) in subsection (e)(4)— 
(A) by striking subparagraph (B); and 
(B) by redesignating subparagraph (C), as amended 
by subsection (c), as subparagraph (B); and 
(2) in subsection (f)(2), by striking ‘‘subsection (e)’’ and 
inserting ‘‘subsections (b) and (e)’’. 
(e) Section 1501 of the Agricultural Act of 2014 (7 U.S.C. 
9081), as amended by this section, shall apply with respect to 
losses described in such section 1501 incurred on or after January 
1, 2017. 
(f) The amounts provided by subsections (a) through (e) for 
fiscal year 2018 are designated by the Congress as being for an 
emergency requirement pursuant to section 251(b)(2)(A)(i) of the 
Balanced Budget and Emergency Deficit Control Act of 1985. 
TITLE II 
DEPARTMENT OF COMMERCE 
ECONOMIC DEVELOPMENT ADMINISTRATION 
ECONOMIC DEVELOPMENT ASSISTANCE PROGRAMS 
(INCLUDING TRANSFERS OF FUNDS) 
Pursuant to section 703 of the Public Works and Economic 
Development Act (42 U.S.C. 3233), for an additional amount for 
‘‘Economic Development Assistance Programs’’ for necessary 
expenses related to flood mitigation, disaster relief, long-term 
recovery, and restoration of infrastructure in areas that received 
a major disaster designation as a result of Hurricanes Harvey, 
Irma, and Maria, and of wildfires and other natural disasters occur-
ring in calendar year 2017 under the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5121 et seq.), 
$600,000,000, to remain available until expended: Provided, That 
Applicability. 
Effective date. 
7 USC 9081 note. 
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132 STAT. 70 
PUBLIC LAW 115–123—FEB. 9, 2018 
the amount provided under this heading is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985: Provided further, That within the amount appro-
priated, up to 2 percent of funds may be transferred to the ‘‘Salaries 
and Expenses’’ account for administration and oversight activities: 
Provided further, That within the amount appropriated, $1,000,000 
shall be transferred to the ‘‘Office of Inspector General’’ account 
for carrying out investigations and audits related to the funding 
provided under this heading. 
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION 
OPERATIONS, RESEARCH, AND FACILITIES 
For an additional amount for ‘‘Operations, Research, and Facili-
ties’’ for necessary expenses related to the consequences of Hurri-
canes Harvey, Irma, and Maria, $120,904,000, to remain available 
until September 30, 2019, as follows: 
(1) $12,904,000 for repair and replacement of observing 
assets, Federal real property, and equipment; 
(2) $18,000,000 for marine debris assessment and removal; 
(3) $40,000,000 for mapping, charting, and geodesy services; 
and 
(4) $50,000,000 to improve weather forecasting, hurricane 
intensity forecasting and flood forecasting and mitigation 
capabilities, including data assimilation from ocean observing 
platforms and satellites: 
Provided, That the amount provided under this heading is des-
ignated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985: Provided further, That the 
National Oceanic and Atmospheric Administration shall submit 
a spending plan to the Committees on Appropriations of the House 
of Representatives and the Senate within 45 days after the date 
of enactment of this subdivision. 
PROCUREMENT, ACQUISITION AND CONSTRUCTION 
For an additional amount for ‘‘Procurement, Acquisition and 
Construction’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $79,232,000, to remain 
available until September 30, 2020, as follows: 
(1) $29,232,000 for repair and replacement of Federal real 
property and observing assets; and 
(2) $50,000,000 for improvements to operational and 
research weather supercomputing infrastructure and for 
improvement of satellite ground services used in hurricane 
intensity and track prediction: 
Provided, That the amount provided under this heading is des-
ignated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985: Provided further, That the 
National Oceanic and Atmospheric Administration shall submit 
a spending plan to the Committees on Appropriations of the House 
of Representatives and the Senate within 45 days after the date 
of enactment of this subdivision. 
Spending plan. 
Deadline. 
Spending plan. 
Deadline. 
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132 STAT. 71 
PUBLIC LAW 115–123—FEB. 9, 2018 
FISHERIES DISASTER ASSISTANCE 
For an additional amount for ‘‘Fisheries Disaster Assistance’’ 
for necessary expenses associated with the mitigation of fishery 
disasters, $200,000,000, to remain available until expended: Pro-
vided, That funds shall be used for mitigating the effects of commer-
cial fishery failures and fishery resource disasters declared by the 
Secretary of Commerce in calendar year 2017, as well those declared 
by the Secretary to be a direct result of Hurricanes Harvey, Irma, 
or Maria: Provided further, That the amount provided under this 
heading is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
DEPARTMENT OF JUSTICE 
UNITED STATES MARSHALS SERVICE 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $2,500,000: Provided, That the amount provided 
under this heading is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
FEDERAL BUREAU OF INVESTIGATION 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $21,200,000: Provided, That the amount provided 
under this heading is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
DRUG ENFORCEMENT ADMINISTRATION 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $11,500,000: Provided, That the amount provided 
under this heading is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
FEDERAL PRISON SYSTEM 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $16,000,000: Provided, That the amount provided 
under this heading is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
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132 STAT. 72 
PUBLIC LAW 115–123—FEB. 9, 2018 
BUILDINGS AND FACILITIES 
For an additional amount for ‘‘Buildings and Facilities’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $34,000,000, to remain available until 
expended: Provided, That the amount provided under this heading 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
SCIENCE 
NATIONAL AERONAUTICS AND SPACE ADMINISTRATION 
CONSTRUCTION AND ENVIRONMENTAL COMPLIANCE AND RESTORATION 
For an additional amount for ‘‘Construction and Environmental 
Compliance and Restoration’’ for repairs at National Aeronautics 
and Space Administration facilities damaged by hurricanes during 
2017, $81,300,000, to remain available until expended: Provided, 
That the amount provided under this heading is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
NATIONAL SCIENCE FOUNDATION 
RESEARCH AND RELATED ACTIVITIES 
For an additional amount for ‘‘Research and Related Activities’’ 
for necessary expenses to repair National Science Foundation radio 
observatory facilities damaged by hurricanes that occurred during 
2017, $16,300,000, to remain available until expended: Provided, 
That the amount provided under this heading is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985: Provided further, That the National 
Science Foundation shall submit a spending plan to the Committees 
on Appropriations of the House of Representatives and the Senate 
within 45 days after the date of enactment of this subdivision. 
RELATED AGENCIES 
LEGAL SERVICES CORPORATION 
PAYMENT TO THE LEGAL SERVICES CORPORATION 
For an additional amount for ‘‘Payment to the Legal Services 
Corporation’’ to carry out the purposes of the Legal Services Cor-
poration Act by providing for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria and of the 
calendar year 2017 wildfires, $15,000,000: Provided, That the 
amount made available under this heading shall be used only 
to provide the mobile resources, technology, and disaster coordina-
tors necessary to provide storm-related services to the Legal Serv-
ices Corporation client population and only in the areas significantly 
affected by Hurricanes Harvey, Irma, and Maria and by the cal-
endar year 2017 wildfires: Provided further, That such amount 
Spending plan. 
Deadline. 
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132 STAT. 73 
PUBLIC LAW 115–123—FEB. 9, 2018 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985: Provided further, That 
none of the funds appropriated in this subdivision to the Legal 
Services Corporation shall be expended for any purpose prohibited 
or limited by, or contrary to any of the provisions of, sections 
501, 502, 503, 504, 505, and 506 of Public Law 105–119, and 
all funds appropriated in this subdivision to the Legal Services 
Corporation shall be subject to the same terms and conditions 
set forth in such sections, except that all references in sections 
502 and 503 to 1997 and 1998 shall be deemed to refer instead 
to 2017 and 2018, respectively, and except that sections 501 and 
503 of Public Law 104–134 (referenced by Public Law 105–119) 
shall not apply to the amount made available under this heading: 
Provided further, That, for the purposes of this subdivision, the 
Legal Services Corporation shall be considered an agency of the 
United States Government. 
GENERAL PROVISION—THIS TITLE 
SEC. 20201. (a) In recognition of the consistency of the Mid- 
Barataria Sediment Diversion, Mid-Breton Sound Sediment Diver-
sion, and Calcasieu Ship Channel Salinity Control Measures 
projects, as selected by the 2017 Louisiana Comprehensive Master 
Plan for a Sustainable Coast, with the findings and policy declara-
tions in section 2(6) of the Marine Mammal Protection Act (16 
U.S.C. 1361 et seq., as amended) regarding maintaining the health 
and stability of the marine ecosystem, within 120 days of the 
enactment of this section, the Secretary of Commerce shall issue 
a waiver pursuant to section 101(a)(3)(A) and this section to section 
101(a) and section 102(a) of the Act, for such projects that will 
remain in effect for the duration of the construction, operations 
and maintenance of the projects. No rulemaking, permit, determina-
tion, or other condition or limitation shall be required when issuing 
a waiver pursuant to this section. 
(b) Upon issuance of a waiver pursuant to this section, the 
State of Louisiana shall, in consultation with the Secretary of 
Commerce: 
(1) To the extent practicable and consistent with the pur-
poses of the projects, minimize impacts on marine mammal 
species and population stocks; and 
(2) Monitor and evaluate the impacts of the projects on 
such species and population stocks. 
TITLE III 
DEPARTMENT OF DEFENSE 
DEPARTMENT OF DEFENSE—MILITARY 
OPERATION AND MAINTENANCE 
OPERATION AND MAINTENANCE, ARMY 
For an additional amount for ‘‘Operation and Maintenance, 
Army’’, $20,110,000, for necessary expenses related to the con-
sequences of Hurricanes Harvey, Irma, and Maria: Provided, That 
Louisiana. 
Consultation. 
Deadline. 
Waiver. 
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132 STAT. 74 
PUBLIC LAW 115–123—FEB. 9, 2018 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, NAVY 
For an additional amount for ‘‘Operation and Maintenance, 
Navy’’, $267,796,000, for necessary expenses related to the con-
sequences of Hurricanes Harvey, Irma, and Maria: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, MARINE CORPS 
For an additional amount for ‘‘Operation and Maintenance, 
Marine Corps’’, $17,920,000, for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria: Provided, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, AIR FORCE 
For an additional amount for ‘‘Operation and Maintenance, 
Air Force’’, $20,916,000, for necessary expenses related to the con-
sequences of Hurricanes Harvey, Irma, and Maria: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, DEFENSE-WIDE 
For an additional amount for ‘‘Operation and Maintenance, 
Defense-Wide’’, $2,650,000, for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria: Provided, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, ARMY RESERVE 
For an additional amount for ‘‘Operation and Maintenance, 
Army Reserve’’, $12,500,000, for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria: Provided, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, NAVY RESERVE 
For an additional amount for ‘‘Operation and Maintenance, 
Navy Reserve’’, $2,922,000, for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria: Provided, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
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132 STAT. 75 
PUBLIC LAW 115–123—FEB. 9, 2018 
OPERATION AND MAINTENANCE, AIR FORCE RESERVE 
For an additional amount for ‘‘Operation and Maintenance, 
Air Force Reserve’’, $5,770,000, for necessary expenses related to 
the consequences of Hurricanes Harvey, Irma, and Maria: Provided, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
OPERATION AND MAINTENANCE, ARMY NATIONAL GUARD 
For an additional amount for ‘‘Operation and Maintenance, 
Army National Guard’’, $55,471,000, for necessary expenses related 
to the consequences of Hurricanes Harvey, Irma, and Maria: Pro-
vided, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
PROCUREMENT 
OTHER PROCUREMENT, NAVY 
For an additional amount for ‘‘Other Procurement, Navy’’ 
$18,000,000, to remain available until September 30, 2020, for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
REVOLVING AND MANAGEMENT FUNDS 
DEFENSE WORKING CAPITAL FUNDS 
For an additional amount for ‘‘Defense Working Capital Funds’’ 
for the Navy Working Capital Fund, $9,486,000, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
OTHER DEPARTMENT OF DEFENSE PROGRAMS 
DEFENSE HEALTH PROGRAM 
For an additional amount for operation and maintenance for 
‘‘Defense Health Program’’, $704,000, for necessary expenses related 
to the consequences of Hurricanes Harvey, Irma, and Maria: Pro-
vided, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
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132 STAT. 76 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE IV 
CORPS OF ENGINEERS—CIVIL 
DEPARTMENT OF THE ARMY 
INVESTIGATIONS 
For an additional amount for ‘‘Investigations’’ for necessary 
expenses related to the completion, or initiation and completion, 
of flood and storm damage reduction, including shore protection, 
studies which are currently authorized or which are authorized 
after the date of enactment of this subdivision, to reduce risk 
from future floods and hurricanes, at full Federal expense, 
$135,000,000, to remain available until expended: Provided, That 
of such amount, not less than $75,000,000 is available for such 
studies in States and insular areas that were impacted by Hurri-
canes Harvey, Irma, and Maria: Provided further, That funds made 
available under this heading shall be for high-priority studies of 
projects in States and insular areas with more than one flood- 
related major disaster declared pursuant to the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 
et seq.) in calendar years 2014, 2015, 2016, or 2017: Provided 
further, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985: 
Provided further, That the Assistant Secretary of the Army for 
Civil Works shall provide a monthly report to the Committees 
on Appropriations of the House of Representatives and the Senate 
detailing the allocation and obligation of these funds, including 
new studies selected to be initiated using funds provided under 
this heading, beginning not later than 60 days after the enactment 
of this subdivision. 
CONSTRUCTION 
For an additional amount for ‘‘Construction’’ for necessary 
expenses to address emergency situations at Corps of Engineers 
projects, and to construct, and rehabilitate and repair damages 
caused by natural disasters, to Corps of Engineers projects, 
$15,055,000,000, to remain available until expended: Provided, That 
of such amount, $15,000,000,000 is available to construct flood 
and storm damage reduction, including shore protection, projects 
which are currently authorized or which are authorized after the 
date of enactment of this subdivision, and flood and storm damage 
reduction, including shore protection, projects which have signed 
Chief’s Reports as of the date of enactment of this subdivision 
or which are studied using funds provided under the heading ‘‘Inves-
tigations’’ if the Secretary determines such projects to be technically 
feasible, economically justified, and environmentally acceptable, in 
States and insular areas with more than one flood-related major 
disaster declared pursuant to the Robert T. Stafford Disaster Relief 
and Emergency Assistance Act (42 U.S.C. 5121 et seq.) in calendar 
years 2014, 2015, 2016, or 2017: Provided further, That of the 
amounts in the preceding proviso, not less than $10,425,000,000 
shall be available for such projects within States and insular areas 
that were impacted by Hurricanes Harvey, Irma, and Maria: Pro-
vided further, That all repair, rehabilitation, study, design, and 
Puerto Rico. 
Virgin Islands. 
Determination. 
Reports. 
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132 STAT. 77 
PUBLIC LAW 115–123—FEB. 9, 2018 
construction of Corps of Engineers projects in Puerto Rico and 
the United States Virgin Islands, using funds provided under this 
heading, shall be conducted at full Federal expense: Provided fur-
ther, That for projects receiving funding under this heading, the 
provisions of section 902 of the Water Resources Development Act 
of 1986 shall not apply to these funds: Provided further, That 
the completion of ongoing construction projects receiving funds pro-
vided under this heading shall be at full Federal expense with 
respect to such funds: Provided further, That using funds provided 
under this heading, the non-Federal cash contribution for projects 
eligible for funding pursuant to the first proviso shall be financed 
in accordance with the provisions of section 103(k) of Public Law 
99–662 over a period of 30 years from the date of completion 
of the project or separable element: Provided further, That up 
to $50,000,000 of the funds made available under this heading 
shall be used for continuing authorities projects to reduce the risk 
of flooding and storm damage: Provided further, That any projects 
using funds appropriated under this heading shall be initiated 
only after non-Federal interests have entered into binding agree-
ments with the Secretary requiring, where applicable, the non- 
Federal interests to pay 100 percent of the operation, maintenance, 
repair, replacement, and rehabilitation costs of the project and 
to hold and save the United States free from damages due to 
the construction or operation and maintenance of the project, except 
for damages due to the fault or negligence of the United States 
or its contractors: Provided further, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985: Provided further, That the Assistant 
Secretary of the Army for Civil Works shall provide a monthly 
report to the Committees on Appropriations of the House of Rep-
resentatives and the Senate detailing the allocation and obligation 
of these funds, beginning not later than 60 days after the enactment 
of this subdivision. 
MISSISSIPPI RIVER AND TRIBUTARIES 
For an additional amount for ‘‘Mississippi River and Tribu-
taries’’ for necessary expenses to address emergency situations at 
Corps of Engineers projects, and to construct, and rehabilitate and 
repair damages to Corps of Engineers projects, caused by natural 
disasters, $770,000,000, to remain available until expended: Pro-
vided, That of such amount, $400,000,000 is available to construct 
flood and storm damage reduction projects which are currently 
authorized or which are authorized after the date of enactment 
of this subdivision: Provided further, That such amount is des-
ignated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985: Provided further, That the 
Assistant Secretary of the Army for Civil Works shall provide 
a monthly report to the Committees on Appropriations of the House 
of Representatives and the Senate detailing the allocation and 
obligation of these funds, beginning not later than 60 days after 
the enactment of this subdivision. 
Reports. 
Reports. 
Time period. 
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132 STAT. 78 
PUBLIC LAW 115–123—FEB. 9, 2018 
OPERATION AND MAINTENANCE 
For an additional amount for ‘‘Operation and Maintenance’’ 
for necessary expenses to dredge Federal navigation projects in 
response to, and repair damages to Corps of Engineers Federal 
projects caused by, natural disasters, $608,000,000, to remain avail-
able until expended, of which such sums as are necessary to cover 
the Federal share of eligible operation and maintenance costs for 
coastal harbors and channels, and for inland harbors shall be 
derived from the Harbor Maintenance Trust Fund: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985: Provided 
further, That the Assistant Secretary of the Army for Civil Works 
shall provide a monthly report to the Committees on Appropriations 
of the House of Representatives and the Senate detailing the alloca-
tion and obligation of these funds, beginning not later than 60 
days after the enactment of this subdivision. 
FLOOD CONTROL AND COASTAL EMERGENCIES 
For an additional amount for ‘‘Flood Control and Coastal Emer-
gencies’’, as authorized by section 5 of the Act of August 18, 1941 
(33 U.S.C. 701n), for necessary expenses to prepare for flood, hurri-
cane and other natural disasters and support emergency operations, 
repairs, and other activities in response to such disasters, as author-
ized by law, $810,000,000, to remain available until expended: 
Provided, That funding utilized for authorized shore protection 
projects shall restore such projects to the full project profile at 
full Federal expense: Provided further, That such amount is des-
ignated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985: Provided further, That the 
Assistant Secretary of the Army for Civil Works shall provide 
a monthly report to the Committees on Appropriations of the House 
of Representatives and the Senate detailing the allocation and 
obligation of these funds, beginning not later than 60 days after 
the enactment of this subdivision. 
EXPENSES 
For an additional amount for ‘‘Expenses’’ for necessary expenses 
to administer and oversee the obligation and expenditure of 
amounts provided in this title for the Corps of Engineers, 
$20,000,000, to remain available until expended: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985: Provided 
further, That the Assistant Secretary of the Army for Civil Works 
shall provide a monthly report to the Committees on Appropriations 
of the House of Representatives and the Senate detailing the alloca-
tion and obligation of these funds, beginning not later than 60 
days after enactment of this subdivision. 
Reports. 
Reports. 
Reports. 
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132 STAT. 79 
PUBLIC LAW 115–123—FEB. 9, 2018 
DEPARTMENT OF ENERGY 
ENERGY PROGRAMS 
ELECTRICITY DELIVERY AND ENERGY RELIABILITY 
For an additional amount for ‘‘Electricity Delivery and Energy 
Reliability’’, $13,000,000, to remain available until expended, for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, including technical assistance related 
to electric grids: Provided, That such amount is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
STRATEGIC PETROLEUM RESERVE 
For an additional amount for ‘‘Strategic Petroleum Reserve’’, 
$8,716,000, to remain available until expended, for necessary 
expenses related to damages caused by Hurricanes Harvey, Irma, 
and Maria: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
GENERAL PROVISIONS—THIS TITLE 
SEC. 20401. In fiscal year 2018, and each fiscal year thereafter, 
the Chief of Engineers of the U.S. Army Corps of Engineers shall 
transmit to the Congress, after reasonable opportunity for comment, 
but without change, by the Assistant Secretary of the Army for 
Civil Works, a monthly report, the first of which shall be trans-
mitted to Congress not later than 2 days after the date of enactment 
of this subdivision and monthly thereafter, which includes detailed 
estimates of damages to each Corps of Engineers project, caused 
by natural disasters or otherwise. 
SEC. 20402. From the unobligated balances of amounts made 
available to the U.S. Army Corps of Engineers, $518,900,000 under 
the heading ‘‘Corps of Engineers—Civil, Flood Control and Coastal 
Emergencies’’ and $210,000,000 under the heading ‘‘Corps of Engi-
neers—Civil, Operations and Maintenance’’ in title X of the Disaster 
Relief Appropriations Act, 2013 (Public Law 113–2; 127 Stat. 25) 
shall be transferred to ‘‘Corps of Engineers—Civil, Construction’’, 
to remain available until expended, to rehabilitate, repair and con-
struct Corps of Engineers projects: Provided, That those projects 
may only include construction expenses, including cost sharing, 
as described under the heading ‘‘Corps of Engineers—Civil, 
Construction’’ in title X of that Act or other construction expenses 
related to the consequences of Hurricane Sandy: Provided further, 
That amounts transferred pursuant to this section that were pre-
viously designated by the Congress as an emergency requirement 
pursuant to the Balanced Budget and Emergency Deficit Control 
Act are designated by the Congress as an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985: Provided further, That the 
Assistant Secretary of the Army for Civil Works shall provide 
a monthly report to the Committees on Appropriations of the House 
of Representatives and the Senate detailing the allocation and 
Reports. 
Reports. 
33 USC 701n–2. 
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132 STAT. 80 
PUBLIC LAW 115–123—FEB. 9, 2018 
obligation of these funds, beginning not later than 60 days after 
the enactment of this subdivision. 
TITLE V 
INDEPENDENT AGENCIES 
GENERAL SERVICES ADMINISTRATION 
REAL PROPERTY ACTIVITIES 
FEDERAL BUILDINGS FUND 
For an additional amount to be deposited in the ‘‘Federal 
Buildings Fund’’, $126,951,000, to remain available until expended, 
for necessary expenses related to the consequences of Hurricanes 
Harvey, Maria, and Irma for repair and alteration of buildings 
under the custody and control of the Administrator of General 
Services, and real property management and related activities not 
otherwise provided for: Provided, That funds may be used to 
reimburse the ‘‘Federal Buildings Fund’’ for obligations incurred 
for this purpose prior to enactment of this subdivision: Provided 
further, That not more than $15,000,000 shall be available for 
tenant improvements in damaged U.S. courthouses: Provided fur-
ther, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
SMALL BUSINESS ADMINISTRATION 
OFFICE OF INSPECTOR GENERAL 
For an additional amount for the ‘‘Office of Inspector General’’, 
$7,000,000, to remain available until expended: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
DISASTER LOANS PROGRAM ACCOUNT 
(INCLUDING TRANSFER OF FUNDS) 
For an additional amount for the ‘‘Disaster Loans Program 
Account’’ for the cost of direct loans authorized by section 7(b) 
of the Small Business Act, $1,652,000,000, to remain available 
until expended: Provided, That up to $618,000,000 may be trans-
ferred to and merged with ‘‘Salaries and Expenses’’ for administra-
tive expenses to carry out the disaster loan program authorized 
by section 7(b) of the Small Business Act: Provided further, That 
none of the funds provided under this heading may be used for 
indirect administrative expenses: Provided further, That the amount 
provided under this heading is designated by the Congress as 
being 
for 
an 
emergency 
requirement 
pursuant 
to 
section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
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132 STAT. 81 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE VI 
DEPARTMENT OF HOMELAND SECURITY 
DEPARTMENTAL MANAGEMENT, OPERATIONS, 
INTELLIGENCE, AND OVERSIGHT 
OFFICE OF INSPECTOR GENERAL 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $25,000,000, to remain available until 
September 30, 2020, for audits and investigations of activities 
funded by this title: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
SECURITY, ENFORCEMENT, AND INVESTIGATIONS 
U.S. CUSTOMS AND BORDER PROTECTION 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $104,494,000, to remain available until 
September 30, 2019: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985: Provided further, That not more than 
$39,400,000 may be used to carry out U.S. Customs and Border 
Protection activities in fiscal year 2018 in Puerto Rico and the 
United States Virgin Islands, in addition to any other amounts 
available for such purposes. 
PROCUREMENT, CONSTRUCTION, AND IMPROVEMENTS 
For an additional amount for ‘‘Procurement, Construction, and 
Improvements’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, including for the 
reconstruction of facilities affected, $45,000,000, to remain available 
until September 30, 2022: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985: Provided further, That funds are pro-
vided to carry out U.S. Customs and Border Protection activities 
in Puerto Rico and the United States Virgin Islands, in addition 
to any other amounts available for such purposes. 
U.S. IMMIGRATION AND CUSTOMS ENFORCEMENT 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Puerto Rico. 
Virgin Islands. 
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132 STAT. 82 
PUBLIC LAW 115–123—FEB. 9, 2018 
Harvey, Irma, and Maria, $30,905,000, to remain available until 
September 30, 2019: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
PROCUREMENT, CONSTRUCTION, AND IMPROVEMENTS 
For an additional amount for ‘‘Procurement, Construction, and 
Improvements’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $33,052,000, to remain 
available until September 30, 2022: Provided, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
TRANSPORTATION SECURITY ADMINISTRATION 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $10,322,000, to remain available until 
September 30, 2019: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
COAST GUARD 
OPERATING EXPENSES 
For an additional amount for ‘‘Operating Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $112,136,000, to remain available until September 
30, 2019: Provided, That such amount is designated by the Congress 
as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
ENVIRONMENTAL COMPLIANCE AND RESTORATION 
For an additional amount for ‘‘Environmental Compliance and 
Restoration’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $4,038,000, to remain 
available until September 30, 2022: Provided, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
ACQUISITION, CONSTRUCTION, AND IMPROVEMENTS 
For an additional amount for Acquisition, Construction, and 
Improvements’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, Maria, and Matthew, $718,919,000, 
to remain available until September 30, 2022: Provided, That, not 
later than 60 days after enactment of this subdivision, the Secretary 
Deadline. 
Expenditure 
plan. 
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132 STAT. 83 
PUBLIC LAW 115–123—FEB. 9, 2018 
of Homeland Security, or her designee, shall submit to the Commit-
tees on Appropriations of the House of Representatives and the 
Senate a detailed expenditure plan for funds appropriated under 
this heading: Provided further, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
PROTECTION, PREPAREDNESS, RESPONSE, AND RECOVERY 
FEDERAL EMERGENCY MANAGEMENT AGENCY 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $58,800,000, to remain available until 
September 30, 2019: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
PROCUREMENT, CONSTRUCTION, AND IMPROVEMENTS 
For an additional amount for ‘‘Procurement, Construction, and 
Improvements’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $1,200,000, to remain 
available until September 30, 2020: Provided, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
DISASTER RELIEF FUND 
For an additional amount for ‘‘Disaster Relief Fund’’ for major 
disasters declared pursuant to the Robert T. Stafford Disaster Relief 
and Emergency Assistance Act (42 U.S.C. 5121 et seq.), 
$23,500,000,000, to remain available until expended: Provided, That 
the Administrator of the Federal Emergency Management Agency 
shall publish on the Agency’s website not later than 5 days after 
an award of a public assistance grant under section 406 or 428 
of the Robert T. Stafford Disaster Relief and Emergency Assistance 
Act (42 U.S.C. 5172 or 5189f) that is in excess of $1,000,000, 
the specifics of each such grant award: Provided further, That 
for any mission assignment or mission assignment task order to 
another Federal department or agency regarding a major disaster 
in excess of $1,000,000, not later than 5 days after the issuance 
of such mission assignment or mission assignment task order, the 
Administrator shall publish on the Agency’s website the following: 
the name of the impacted State, the disaster declaration for such 
State, the assigned agency, the assistance requested, a description 
of the disaster, the total cost estimate, and the amount obligated: 
Provided further, That not later than 10 days after the last day 
of each month until a mission assignment or mission assignment 
task order described in the preceding proviso is completed and 
closed out, the Administrator shall update any changes to the 
total cost estimate and the amount obligated: Provided further, 
That for a disaster declaration related to Hurricanes Harvey, Irma, 
Hurricane 
Harvey. 
Hurricane Irma. 
Hurricane Maria. 
Updates. 
Grants. 
Web postings. 
Deadlines. 
Missions. 
Cost estimates. 
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132 STAT. 84 
PUBLIC LAW 115–123—FEB. 9, 2018 
or Maria, the Administrator shall submit to the Committees on 
Appropriations of the House of Representatives and the Senate, 
not later than 5 days after the first day of each month beginning 
after the date of enactment of this subdivision, and shall publish 
on the Agency’s website, not later than 10 days after the first 
day of each such month, an estimate or actual amount, if available, 
for the current fiscal year of the cost of the following categories 
of spending: public assistance, individual assistance, operations, 
mitigation, administrative, and any other relevant category 
(including emergency measures and disaster resources): Provided, 
further, That not later than 10 days after the first day of each 
month, the Administrator shall publish on the Agency’s website 
the report (referred to as the Disaster Relief Monthly Report) as 
required by Public Law 114–4: Provided further, That of the 
amounts provided under this heading for the Disaster Relief Fund, 
up to $150,000,000 shall be transferred to the Disaster Assistance 
Direct Loan Program Account for the cost to lend a territory or 
possession of the United States that portion of assistance for which 
the territory or possession is responsible under the cost-sharing 
provisions of the major disaster declaration for Hurricanes Irma 
or Maria, as authorized under section 319 of the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act (42 U.S.C. 5162): 
Provided further, That of the amount provided under this paragraph 
for transfer, up to $1,000,000 may be transferred to the Disaster 
Assistance Direct Loan Program Account for administrative 
expenses to carry out the Advance of Non-Federal Share program, 
as authorized by section 319 of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5162): Provided 
further, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
RESEARCH, DEVELOPMENT, TRAINING, AND SERVICES 
FEDERAL LAW ENFORCEMENT TRAINING CENTERS 
OPERATIONS AND SUPPORT 
For an additional amount for ‘‘Operations and Support’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $5,374,000, to remain available until 
September 30, 2019: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
PROCUREMENT, CONSTRUCTION, AND IMPROVEMENTS 
For an additional amount for ‘‘Procurement, Construction, and 
Improvements’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $5,000,000, to remain 
available until September 30, 2022: Provided, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
Reports. 
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132 STAT. 85 
PUBLIC LAW 115–123—FEB. 9, 2018 
GENERAL PROVISIONS—THIS TITLE 
SEC. 20601. The Administrator of the Federal Emergency 
Management Agency may provide assistance, pursuant to section 
428 of the Robert T. Stafford Disaster Relief and Emergency Assist-
ance Act (42 U.S.C. 5121 et seq.), for critical services as defined 
in section 406 of the Robert T. Stafford Disaster Relief and Emer-
gency Assistance Act for the duration of the recovery for incidents 
DR–4336–PR, DR–4339–PR, DR–4340–USVI, and DR–4335–USVI 
to— 
(1) replace or restore the function of a facility or system 
to industry standards without regard to the pre-disaster condi-
tion of the facility or system; and 
(2) replace or restore components of the facility or system 
not damaged by the disaster where necessary to fully effectuate 
the replacement or restoration of disaster-damaged components 
to restore the function of the facility or system to industry 
standards. 
SEC. 20602. Notwithstanding section 404 or 420 of the Robert 
T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 
5170c and 8187), for fiscal years 2017 and 2018, the President 
shall provide hazard mitigation assistance in accordance with such 
section 404 in any area in which assistance was provided under 
such section 420. 
SEC. 20603. The third proviso of the second paragraph in title 
I of Public Law 115–72 under the heading ‘‘Federal Emergency 
Management Agency—Disaster Relief Fund’’ shall be amended by 
striking ‘‘180 days’’ and inserting ‘‘365 days’’: Provided, That 
amounts repurposed pursuant to this section that were previously 
designated by the Congress as an emergency requirement pursuant 
to the Balanced Budget and Emergency Deficit Control Act are 
designated by the Congress as an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
SEC. 20604. (a) DEFINITION OF PRIVATE NONPROFIT FACILITY.— 
Section 102(11)(B) of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5122(11)(B)) is amended to 
read as follows: 
‘‘(A) IN GENERAL.—The term ‘private nonprofit facility’ 
means private nonprofit educational (without regard to 
the religious character of the facility), utility, irrigation, 
emergency, medical, rehabilitational, and temporary or 
permanent custodial care facilities (including those for the 
aged and disabled) and facilities on Indian reservations, 
as defined by the President. 
‘‘(B) ADDITIONAL FACILITIES.—In addition to the facili-
ties described in subparagraph (A), the term ‘private non-
profit facility’ includes any private nonprofit facility that 
provides essential social services to the general public 
(including museums, zoos, performing arts facilities, 
community arts centers, community centers, libraries, 
homeless shelters, senior citizen centers, rehabilitation 
facilities, shelter workshops, broadcasting facilities, houses 
of worship, and facilities that provide health and safety 
services of a governmental nature), as defined by the Presi-
dent. No house of worship may be excluded from this 
definition because leadership or membership in the 
131 Stat. 1225. 
President. 
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132 STAT. 86 
PUBLIC LAW 115–123—FEB. 9, 2018 
organization operating the house of worship is limited to 
persons who share a religious faith or practice.’’. 
(b) REPAIR, RESTORATION, AND REPLACEMENT
OF DAMAGED 
FACILITIES.—Section 406(a)(3) of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5172(a)(3)) is 
amended by adding at the end the following: 
‘‘(C) RELIGIOUS
FACILITIES.—A church, synagogue, 
mosque, temple, or other house of worship, educational 
facility, or any other private nonprofit facility, shall be 
eligible for contributions under paragraph (1)(B), without 
regard to the religious character of the facility or the pri-
mary religious use of the facility. No house of worship, 
educational facility, or any other private nonprofit facility 
may be excluded from receiving contributions under para-
graph (1)(B) because leadership or membership in the 
organization operating the house of worship is limited to 
persons who share a religious faith or practice.’’. 
(c) APPLICABILITY.—This section and the amendments made 
by this section shall apply— 
(1) to the provision of assistance in response to a major 
disaster or emergency declared on or after August 23, 2017; 
or 
(2) with respect to— 
(A) any application for assistance that, as of the date 
of enactment of this Act, is pending before Federal Emer-
gency Management Agency; and 
(B) any application for assistance that has been denied, 
where a challenge to that denial is not yet finally resolved 
as of the date of enactment of this Act. 
SEC. 20605. (a) The Federal share of assistance, including direct 
Federal assistance, provided under section 407 of the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 
5173), with respect to a major disaster declared pursuant to such 
Act for damages resulting from a wildfire in calendar year 2017, 
shall be 90 percent of the eligible costs under such section. 
(b) The Federal share provided by subsection (a) shall apply 
to assistance provided before, on, or after the date of enactment 
of this Act. 
FEDERAL COST-SHARE ADJUSTMENTS FOR REPAIR, RESTORATION, AND 
REPLACEMENT OF DAMAGED FACILITIES 
SEC. 20606. Section 406(b) of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5172(b)) is amended 
by inserting after paragraph (2) the following: 
‘‘(3) INCREASED FEDERAL SHARE.— 
‘‘(A) INCENTIVE MEASURES.—The President may provide 
incentives to a State or Tribal government to invest in 
measures that increase readiness for, and resilience from, 
a major disaster by recognizing such investments through 
a sliding scale that increases the minimum Federal share 
to 85 percent. Such measures may include— 
‘‘(i) the adoption of a mitigation plan approved 
under section 322; 
‘‘(ii) investments in disaster relief, insurance, and 
emergency management programs; 
Applicability. 
Effective date. 
Effective date. 
42 USC 5122 
note. 
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132 STAT. 87 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(iii) encouraging the adoption and enforcement 
of the latest published editions of relevant consensus- 
based codes, specifications, and standards that incor-
porate the latest hazard-resistant designs and establish 
minimum acceptable criteria for the design, construc-
tion, and maintenance of residential structures and 
facilities that may be eligible for assistance under this 
Act for the purpose of protecting the health, safety, 
and general welfare of the buildings’ users against 
disasters; 
‘‘(iv) facilitating participation in the community 
rating system; and 
‘‘(v) funding mitigation projects or granting tax 
incentives for projects that reduce risk. 
‘‘(B) COMPREHENSIVE GUIDANCE.—Not later than 1 year 
after the date of enactment of this paragraph, the Presi-
dent, acting through the Administrator, shall issue com-
prehensive guidance to State and Tribal governments 
regarding the measures and investments, weighted appro-
priately based on actuarial assessments of eligible actions, 
that will be recognized for the purpose of increasing the 
Federal share under this section. Guidance shall ensure 
that the agency’s review of eligible measures and invest-
ments does not unduly delay determining the appropriate 
Federal cost share. 
‘‘(C) REPORT.—One year after the issuance of the guid-
ance required by subparagraph (B), the Administrator shall 
submit to the Committee on Transportation and Infrastruc-
ture of the House of Representatives and the Committee 
on Homeland Security and Governmental Affairs of the 
Senate a report regarding the analysis of the Federal cost 
shares paid under this section. 
‘‘(D) SAVINGS CLAUSE.—Nothing in this paragraph pre-
vents the President from increasing the Federal cost share 
above 85 percent.’’. 
SEC. 20607. Division F of the Consolidated Appropriations Act, 
2017, is amended by inserting the following at the end of Title 
V: 
‘‘SEC. 545. (a) PREMIUM PAY AUTHORITY.—During calendar year 
2017, any premium pay that is funded, either directly or through 
reimbursement, by the ‘Federal Emergency Management Agency— 
Disaster Relief Fund’ shall be exempted from the aggregate of 
basic pay and premium pay calculated under section 5547(a) of 
title 5, United States Code, and any other provision of law limiting 
the aggregate amount of premium pay payable on a biweekly or 
calendar year basis. 
‘‘(b) OVERTIME AUTHORITY.—During calendar year 2017, any 
overtime that is funded, either directly or through reimbursement, 
by the ‘Federal Emergency Management Agency—Disaster Relief 
Fund’ shall be exempted from any annual limit on the amount 
of overtime payable in a calendar or fiscal year. 
‘‘(c) APPLICABILITY
OF AGGREGATE LIMITATION
ON PAY.—In 
determining whether an employee’s pay exceeds the applicable 
annual rate of basic pay payable under section 5307 of title 5, 
United States Code, the head of an Executive agency shall not 
include pay exempted under this section. 
131 Stat. 433. 
Deadline. 
President. 
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132 STAT. 88 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(d) LIMITATION OF PAY AUTHORITY.—Pay exempted from other-
wise applicable limits under subsection (a) shall not cause the 
aggregate pay earned for the calendar year in which the exempted 
pay is earned to exceed the rate of basic pay payable for a position 
at level II of the Executive Schedule under section 5313 of title 
5, United States Code. 
‘‘(e) EFFECTIVE DATE.—This section shall take effect as if 
enacted on December 31, 2016.’’. 
TITLE VII 
DEPARTMENT OF THE INTERIOR 
UNITED STATES FISH AND WILDLIFE SERVICE 
CONSTRUCTION 
For an additional amount for ‘‘Construction’’ for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria, $210,629,000, to remain available until expended: Pro-
vided, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
NATIONAL PARK SERVICE 
HISTORIC PRESERVATION FUND 
For an additional amount for the ‘‘Historic Preservation Fund’’ 
for necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $50,000,000, to remain available until 
September 30, 2019, including costs to States and territories nec-
essary to complete compliance activities required by section 306108 
of title 54, United States Code (formerly section 106 of the National 
Historic Preservation Act) and costs needed to administer the pro-
gram: Provided, That grants shall only be available for areas that 
have received a major disaster declaration pursuant to the Robert 
T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 
5121 et seq.): Provided further, That individual grants shall not 
be subject to a non-Federal matching requirement: Provided further, 
That such amount is designated by the Congress as being for 
an emergency requirement pursuant to section 251(b)(2)(A)(i) of 
the Balanced Budget and Emergency Deficit Control Act of 1985. 
CONSTRUCTION 
For an additional amount for ‘‘Construction’’ for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria, $207,600,000, to remain available until expended: Pro-
vided, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
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132 STAT. 89 
PUBLIC LAW 115–123—FEB. 9, 2018 
UNITED STATES GEOLOGICAL SURVEY 
SURVEYS, INVESTIGATIONS, AND RESEARCH 
For an additional amount for ‘‘Surveys, Investigations, and 
Research’’ for necessary expenses related to the consequences of 
Hurricanes Harvey, Irma, and Maria, and in those areas impacted 
by a major disaster declared pursuant to the Robert T. Stafford 
Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 
et seq.) with respect to wildfires in 2017, $42,246,000, to remain 
available until expended: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
DEPARTMENTAL OFFICES 
INSULAR AFFAIRS 
ASSISTANCE TO TERRITORIES 
For an additional amount for ‘‘Technical Assistance’’ for finan-
cial management expenses related to the consequences of Hurri-
canes Irma and Maria, $3,000,000, to remain available until 
expended: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
OFFICE OF INSPECTOR GENERAL 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’ for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria, $2,500,000, to remain available until expended: 
Provided, That such amount is designated by the Congress as 
being 
for 
an 
emergency 
requirement 
pursuant 
to 
section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
ENVIRONMENTAL PROTECTION AGENCY 
HAZARDOUS SUBSTANCE SUPERFUND 
For an additional amount for ‘‘Hazardous Substance Superfund’’ 
for necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $6,200,000, to remain available until 
expended: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
LEAKING UNDERGROUND STORAGE TANK TRUST FUND PROGRAM 
For an additional amount for ‘‘Leaking Underground Storage 
Tank Fund’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, $7,000,000, to remain 
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132 STAT. 90 
PUBLIC LAW 115–123—FEB. 9, 2018 
available until expended: Provided, That such amount is designated 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
STATE AND TRIBAL ASSISTANCE GRANTS 
For an additional amount for ‘‘State and Tribal Assistance 
Grants’’ for necessary expenses related to the consequences of Hurri-
canes Harvey, Irma, and Maria for the hazardous waste financial 
assistance grants program and for other solid waste management 
activities, $50,000,000, to remain available until expended: Pro-
vided, That none of these funds allocated within Region 2 shall 
be subject to cost share requirements under section 3011(b) of 
the Solid Waste Disposal Act: Provided further, That such amount 
is designated by the Congress as being for an emergency require-
ment pursuant to section 251(b)(2)(A)(i) of the Balanced Budget 
and Emergency Deficit Control Act of 1985. 
ADMINISTRATIVE PROVISION—ENVIRONMENTAL PROTECTION AGENCY 
Of amounts previously appropriated for capitalization grants 
for the State Revolving Funds under title VI of the Federal Water 
Pollution Control Act or under section 1452 of the Safe Drinking 
Water Act to a State or territory included as part of a disaster 
declaration related to Hurricanes Irma and Maria, all existing 
grant funds that are available but not drawn down shall not be 
subject to the matching or cost share requirements of sections 
602(b)(2), 602(b)(3) of the Federal Water Pollution Control Act nor 
the matching requirements of section 1452(e) of the Safe Drinking 
Water Act and shall be awarded to such state or territory: Provided, 
That, notwithstanding the requirements of section 603(d) of the 
Federal Water Pollution Control Act or section 1452(f) of the Safe 
Drinking Water Act, the state or territory shall utilize the full 
amount of such funds, excluding existing loans, to provide additional 
subsidization to eligible recipients in the form of forgiveness of 
principal, negative interest loans or grants or any combination 
of these: Provided further, That such funds may be used for eligible 
projects whose purpose is to repair damage incurred as a result 
of Hurricanes Irma and Maria, reduce flood damage risk and vulner-
ability or to enhance resiliency to rapid hydrologic change or a 
natural disaster at treatment works as defined by section 212 
of the Federal Water Pollution Control Act or a public drinking 
water system under section 1452 of the Safe Drinking Water Act: 
Provided further, That any project involving the repair or replace-
ment of a lead service line shall replace the entire lead service 
line, not just a portion. 
RELATED AGENCIES 
DEPARTMENT OF AGRICULTURE 
FOREST SERVICE 
STATE AND PRIVATE FORESTRY 
For an additional amount for ‘‘State and Private Forestry’’ 
for necessary expenses related to the consequences of Hurricanes 
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132 STAT. 91 
PUBLIC LAW 115–123—FEB. 9, 2018 
Harvey, Irma, and Maria, $7,500,000, to remain available until 
expended: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
NATIONAL FOREST SYSTEM 
For an additional amount for ‘‘National Forest System’’ for 
necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, $20,652,000, to remain available until 
expended: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
CAPITAL IMPROVEMENT AND MAINTENANCE 
For an additional amount for ‘‘Capital Improvement and 
Maintenance’’ for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria, and the 2017 fire season, 
$91,600,000, to remain available until expended: Provided, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
GENERAL PROVISION—THIS TITLE 
SEC. 20701. Agencies receiving funds appropriated by this title 
shall each provide a monthly report to the Committees on Appro-
priations of the House of Representatives and the Senate detailing 
the allocation and obligation of these funds by account, beginning 
not later than 90 days after enactment of this Act. 
TITLE VIII 
DEPARTMENT OF LABOR 
EMPLOYMENT AND TRAINING ADMINISTRATION 
TRAINING AND EMPLOYMENT SERVICES 
(INCLUDING TRANSFERS OF FUNDS) 
For an additional amount for ‘‘Training and Employment Serv-
ices’’, $100,000,000, for the dislocated workers assistance national 
reserve for necessary expenses directly related to the consequences 
of Hurricanes Harvey, Maria, and Irma and those jurisdictions 
that received a major disaster declaration pursuant to the Robert 
T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 
5121 et seq.) due to wildfires in 2017, which shall be available 
from the date of enactment of this subdivision through September 
30, 2019: Provided, That the Secretary of Labor may transfer up 
to $2,500,000 of such funds to any other Department of Labor 
account for reconstruction and recovery needs, including worker 
protection activities: Provided further, That these sums may be 
used to replace grant funds previously obligated to the impacted 
areas: Provided further, That of the amount provided, up to 
Reports. 
Deadline. 
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132 STAT. 92 
PUBLIC LAW 115–123—FEB. 9, 2018 
$500,000, to remain available until expended, shall be transferred 
to ‘‘Office of Inspector General’’for oversight of activities responding 
to such hurricanes and wildfires: Provided further, That such 
amount is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
JOB CORPS 
For an additional amount for ‘‘Job Corps’’ for construction, 
rehabilitation and acquisition for Job Corps Centers in Puerto Rico, 
$30,900,000, which shall be available upon the date of enactment 
of this subdivision and remain available for obligation through 
June 30, 2021: Provided, That such amount is designated by the 
Congress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
GENERAL PROVISIONS—DEPARTMENT OF LABOR 
DEFERRAL OF INTEREST PAYMENTS FOR VIRGIN ISLANDS 
SEC. 20801. Notwithstanding any other provision of law, the 
interest payment of the Virgin Islands that was due under section 
1202(b)(1) of the Social Security Act on September 29, 2017, shall 
not be due until September 28, 2018, and no interest shall accrue 
on such amount through September 28, 2018: Provided, That such 
amount is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
FLEXIBILITY IN USE OF FUNDS UNDER WIOA 
SEC. 20802. (a) IN GENERAL.—Notwithstanding section 133(b)(4) 
of the Workforce Innovation and Opportunity Act, in States, as 
defined by section 3(56) of such Act, affected by Hurricanes Harvey, 
Irma, and Maria, a local board, as defined by section 3(33) of 
such Act, in a local area, as defined by section 3(32) of such 
Act, affected by such Hurricanes may transfer, if such transfer 
is approved by the Governor, up to 100 percent of the funds allocated 
to the local area for Program Years 2016 and 2017 for Youth 
Workforce Investment activities under paragraphs (2) or (3) of 
section 128(b) of such Act, for Adult employment and training 
activities under paragraphs (2)(A) or (3) of section 133(b) of such 
Act, or for Dislocated Worker employment and training activities 
under paragraph (2)(B) of section 133(b) of such Act among— 
(1) adult employment and training activities; 
(2) dislocated worker employment and training activities; 
and 
(3) youth workforce investment activities. 
(b) THE VIRGIN ISLANDS.—Except for the funds reserved to 
carry out required statewide activities under sections 127(b) and 
134(a)(2) of the Workforce Innovation and Opportunity Act, the 
Governor of the Virgin Islands may authorize the transfer of up 
to 100 percent of the remaining funds provided to the Virgin Islands 
for Program Years 2016 and 2017 for Youth Workforce Investment 
activities under section 127(b)(1)(B) of such Act, for Adult employ-
ment and training activities under section 132(b)(1)(A) of such 
Deadline. 
Time period. 
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132 STAT. 93 
PUBLIC LAW 115–123—FEB. 9, 2018 
Act, or for Dislocated Worker employment and training activities 
under section 133(b)(2)(A) of such Act among— 
(1) adult employment and training activities; 
(2) dislocated worker employment and training activities; 
and 
(3) youth workforce investment activities. 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT 
(INCLUDING TRANSFER OF FUNDS) 
For an additional amount for ‘‘CDC-Wide Activities and Pro-
gram Support’’, $200,000,000, to remain available until September 
30, 2020, for response, recovery, preparation, mitigation, and other 
expenses directly related to the consequences of Hurricanes Harvey, 
Irma, and Maria: Provided, That obligations incurred for the pur-
poses provided herein prior to the date of enactment of this subdivi-
sion may be charged to funds appropriated by this paragraph: 
Provided further, That of the amount provided, not less than 
$6,000,000 shall be transferred to the ‘‘Buildings and Facilities’’ 
account for the purposes provided herein: Provided further, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
NATIONAL INSTITUTES OF HEALTH 
OFFICE OF THE DIRECTOR 
For an additional amount for fiscal year 2018 for ‘‘Office of 
the Director’’, $50,000,000, to remain available until September 
30, 2020, for response, recovery, and other expenses directly related 
to the consequences of Hurricanes Harvey, Irma, and Maria: Pro-
vided, That obligations incurred for these purposes prior to the 
date of enactment of this subdivision may be charged to funds 
appropriated by this paragraph: Provided further, That funds appro-
priated by this paragraph may be used for construction grants 
or contracts under section 404I of the Public Health Service Act 
without regard to section 404I(c)(2): Provided further, That such 
amount is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
ADMINISTRATION FOR CHILDREN AND FAMILIES 
CHILDREN AND FAMILIES SERVICES PROGRAMS 
For an additional amount for ‘‘Children and Families Services 
Programs’’, $650,000,000, to remain available until September 30, 
2021, for Head Start programs, for necessary expenses directly 
related to the consequences of Hurricanes Harvey, Irma, and Maria, 
including making payments under the Head Start Act: Provided, 
That none of the funds appropriated in this paragraph shall be 
included in the calculation of the ‘‘base grant’’ in subsequent fiscal 
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132 STAT. 94 
PUBLIC LAW 115–123—FEB. 9, 2018 
years, as such term is defined in sections 640(a)(7)(A), 641A(h)(1)(B), 
or 645(d)(3) of the Head Start Act: Provided further, That funds 
appropriated in this paragraph are not subject to the allocation 
requirements of section 640(a) of the Head Start Act: Provided 
further, That funds appropriated in this paragraph shall not be 
available for costs that are reimbursed by the Federal Emergency 
Management Agency, under a contract for insurance, or by self- 
insurance: Provided further, That up to $12,500,000 shall be avail-
able for Federal administrative expenses: Provided further, That 
obligations incurred for the purposes provided herein prior to the 
date of enactment of this subdivision may be charged to funds 
appropriated under this heading: Provided further, That such 
amount is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
OFFICE OF THE SECRETARY 
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND 
(INCLUDING TRANSFERS OF FUNDS) 
For an additional amount for the ‘‘Public Health and Social 
Services Emergency Fund’’, $162,000,000, to remain available until 
September 30, 2020, for response, recovery, preparation, mitigation 
and other expenses directly related to the consequences of Hurri-
canes Harvey, Irma, and Maria, including activities authorized 
under section 319(a) of the Public Health Service Act (referred 
to in this subdivision as the ‘‘PHS Act’’): Provided, That of the 
amount provided, $60,000,000 shall be transferred to ‘‘Health 
Resources and Services Administration—Primary Health Care’’, for 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria for disaster response and recovery, for the Health Cen-
ters Program under section 330 of the PHS Act: Provided further, 
That not less than $50,000,000, of amounts transferred under the 
preceding proviso, shall be available for alteration, renovation, 
construction, equipment, and other capital improvement costs as 
necessary to meet the needs of areas affected by Hurricanes Harvey, 
Irma, and Maria: Provided further, That the time limitation in 
section 330(e)(3) of the PHS Act shall not apply to funds made 
available under the preceding proviso: Provided further, That of 
the amount provided, not less than $20,000,000 shall be transferred 
to ‘‘Substance Abuse and Mental Health Services Administration— 
Health Surveillance and Program Support’’ for grants, contracts, 
and cooperative agreements for behavioral health treatment, crisis 
counseling, and other related helplines, and for other similar pro-
grams to provide support to individuals impacted by Hurricanes 
Harvey, Irma, and Maria: Provided further, That of the amount 
provided, up to $2,000,000, to remain available until expended, 
shall be transferred to ‘‘Office of the Secretary—Office of Inspector 
General’’ for oversight of activities responding to such hurricanes: 
Provided further, That obligations incurred for the purposes pro-
vided herein prior to the date of enactment of this subdivision 
may be charged to funds appropriated under this heading: Provided 
further, That funds appropriated in this paragraph shall not be 
available for costs that are reimbursed by the Federal Emergency 
Management Agency, under a contract for insurance, or by self- 
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132 STAT. 95 
PUBLIC LAW 115–123—FEB. 9, 2018 
insurance: Provided further, That such amount is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
GENERAL PROVISION—DEPARTMENT OF HEALTH AND HUMAN 
SERVICES 
DIRECT HIRE AUTHORITY FOR CERTAIN EMERGENCY RESPONSE 
POSITIONS 
SEC. 20803. (a) IN GENERAL.—As the Secretary of Health and 
Human Services determines necessary to respond to a critical hiring 
need for emergency response positions, after providing public notice 
and without regard to the provisions of sections 3309 through 
3319 of title 5, United States Code, the Secretary may appoint 
candidates directly to the following positions, consistent with sub-
section (b), to perform critical work directly relating to the con-
sequences of Hurricanes Harvey, Irma, and Maria: 
(1) Intermittent disaster-response personnel in the National 
Disaster Medical System, under section 2812 of the Public 
Health Service Act (42 U.S.C. 300hh–11). 
(2) Term or temporary related positions in the Centers 
for Disease Control and Prevention and the Office of the Assist-
ant Secretary for Preparedness and Response. 
(b) EXPIRATION.—The authority under subsection (a) shall 
expire 270 days after the date of enactment of this section. 
DEPARTMENT OF EDUCATION 
HURRICANE EDUCATION RECOVERY 
(INCLUDING TRANSFER OF FUNDS) 
For an additional amount for ‘‘Hurricane Education Recovery’’ 
for necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria, or wildfires in 2017 for which a major 
disaster or emergency has been declared under sections 401 or 
501 of the Robert T. Stafford Disaster Relief and Emergency Assist-
ance Act (42 U.S.C. 5170 and 5190) (referred to under this heading 
as ‘‘covered disaster or emergency’’), $2,700,000,000, to remain avail-
able through September 30, 2022, for assisting in meeting the 
educational needs of individuals affected by a covered disaster or 
emergency: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985: Provided further, That— 
(1) such funds shall be used— 
(A) to make awards to eligible entities for immediate 
aid to restart school operations, in accordance with para-
graph (2); 
(B) for temporary emergency impact aid for displaced 
students, in accordance with paragraph (2); 
(C) for emergency assistance to institutions of higher 
education and students attending institutions of higher 
education in an area directly affected by a covered disaster 
or emergency in accordance with paragraph (3); 
Determination. 
Notice. 
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132 STAT. 96 
PUBLIC LAW 115–123—FEB. 9, 2018 
(D) for payments to institutions of higher education 
to help defray the unexpected expenses associated with 
enrolling displaced students from institutions of higher 
education directly affected by a covered disaster or emer-
gency, in accordance with paragraph (4); and 
(E) to provide assistance to local educational agencies 
serving homeless children and youth in accordance with 
paragraph (5); 
(2) immediate aid to restart school operations and tem-
porary emergency impact aid for displaced students described 
in subparagraphs (A) and (B) of paragraph (1) shall be provided 
under the statutory terms and conditions that applied to assist-
ance under sections 102 and 107 of title IV of division B 
of Public Law 109–148, respectively, except that such sections 
shall be applied so that— 
(A) each reference to a major disaster declared in 
accordance with section 401 of the Robert T. Stafford Dis-
aster Relief and Emergency Assistance Act (42 U.S.C. 5170) 
shall be to a major disaster or emergency declared by 
the President in accordance with section 401 or 501, respec-
tively, of such Act; 
(B) each reference to Hurricane Katrina or Hurricane 
Rita shall be a reference to a covered disaster or emergency; 
(C) each reference to August 22, 2005 shall be to the 
date that is one week prior to the date that the major 
disaster or emergency was declared for the area; 
(D) each reference to the States of Louisiana, Mis-
sissippi, Alabama, and Texas shall be to the States or 
territories affected by a covered disaster or emergency, 
and each reference to the State educational agencies of 
Louisiana, Mississippi, Alabama, or Texas shall be a ref-
erence to the State educational agencies that serve the 
states or territories affected by a covered disaster or emer-
gency; 
(E) each reference to the 2005–2006 school year shall 
be to the 2017–2018 school year; 
(F) the references in section 102(h)(1) of title IV of 
division B of Public Law 109–148 to the number of non- 
public and public elementary schools and secondary schools 
in the State shall be to the number of students in non- 
public and public elementary schools and secondary schools 
in the State, and the reference in such section to the 
National Center for Data Statistics Common Core of Data 
for the 2003–2004 school year shall be to the most recent 
and appropriate data set for the 2016–2017 school year; 
(G) in determining the amount of immediate aid pro-
vided to restart school operations as described in section 
102(b) of title IV of division B of Public Law 109–148, 
the Secretary shall consider the number of students 
enrolled, during the 2016–2017 school year, in elementary 
schools and secondary schools that were closed as a result 
of a covered disaster or emergency; 
(H) in determining the amount of emergency impact 
aid that a State educational agency is eligible to receive 
under paragraph (1)(B), the Secretary shall, subject to sec-
tion 107(d)(1)(B) of such title, provide— 
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132 STAT. 97 
PUBLIC LAW 115–123—FEB. 9, 2018 
(i) $9,000 for each displaced student who is an 
English learner, as that term is defined in section 
8101 of the Elementary and Secondary Education Act 
of 1965 (20 U.S.C. 7801); 
(ii) $10,000 for each displaced student who is a 
child with a disability (regardless of whether the child 
is an English learner); and 
(iii) $8,500 for each displaced student who is not 
a child with a disability or an English learner; 
(I) with respect to the emergency impact aid provided 
under paragraph (1)(B), the Secretary may modify the State 
educational agency and local educational agency application 
timelines in section 107(c) of such title; and 
(J) each reference to a public elementary school may 
include, as determined by the local educational agency, 
a publicly-funded preschool program that enrolls children 
below the age of kindergarten entry and is part of an 
elementary school; 
(3) $100,000,000 of the funds made available under this 
heading shall be for programs authorized under subpart 3 
of Part A, part C of title IV and part B of title VII of the 
Higher Education Act of 1965 (20 U.S.C. 1087–51 et seq., 
1138 et seq.) for institutions located in an area affected by 
a covered disaster or emergency, and students enrolled in such 
institutions, except that— 
(A) any requirements relating to matching, Federal 
share, reservation of funds, or maintenance of effort under 
such parts that would otherwise be applicable to that 
assistance shall not apply; 
(B) such assistance may be used for student financial 
assistance; 
(C) such assistance may also be used for faculty and 
staff 
salaries, 
equipment, 
student 
supplies 
and 
instruments, or any purpose authorized under the Higher 
Education Act of 1965, by institutions of higher education 
that are located in areas affected by a covered disaster 
or emergency; and 
(D) the Secretary shall prioritize, to the extent possible, 
students who are homeless or at risk of becoming homeless 
as a result of displacement, and institutions that have 
sustained extensive damage, by a covered disaster or emer-
gency; 
(4) up to $75,000,000 of the funds made available under 
this heading shall be for payments to institutions of higher 
education to help defray the unexpected expenses associated 
with enrolling displaced students from institutions of higher 
education at which operations have been disrupted by a covered 
disaster or emergency, in accordance with criteria established 
by the Secretary and made publicly available; 
(5) $25,000,000 of the funds made available under this 
heading shall be available to provide assistance to local edu-
cational agencies serving homeless children and youths dis-
placed by a covered disaster or emergency, consistent with 
section 723 of the McKinney-Vento Homeless Assistance Act 
(42 U.S.C. 11431–11435) and with section 106 of title IV of 
division B of Public Law 109–148, except that funds shall 
be disbursed based on demonstrated need and the number 
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132 STAT. 98 
PUBLIC LAW 115–123—FEB. 9, 2018 
of homeless children and youth enrolled as a result of displace-
ment by a covered disaster or emergency; 
(6) section 437 of the General Education Provisions Act 
(20 U.S.C. 1232) and section 553 of title 5, United States 
Code, shall not apply to activities under this heading; 
(7) $4,000,000 of the funds made available under this 
heading, to remain available until expended, shall be trans-
ferred to the Office of the Inspector General of the Department 
of Education for oversight of activities supported with funds 
appropriated under this heading, and up to $3,000,000 of the 
funds made available under this heading shall be for program 
administration; 
(8) up to $35,000,000 of the funds made available under 
this heading shall be to carry out activities authorized under 
section 4631(b) of the Elementary and Secondary Education 
Act of 1965 (20 U.S.C. 7281(b)): Provided, That obligations 
incurred for the purposes provided herein prior to the date 
of enactment of this subdivision may be charged to funds appro-
priated under this paragraph; 
(9) the Secretary may waive, modify, or provide extensions 
for certain requirements of the Higher Education Act of 1965 
(20 U.S.C. 1001 et seq.) for affected individuals, affected stu-
dents, and affected institutions in covered disaster or emergency 
areas in the same manner as the Secretary was authorized 
to waive, modify, or provide extensions for certain requirements 
of such Act under provisions of subtitle B of title IV of division 
B of Public Law 109–148 for affected individuals, affected stu-
dents, and affected institutions in areas affected by Hurricane 
Katrina and Hurricane Rita, except that the cost associated 
with any action taken by the Secretary under this paragraph 
is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985; and 
(10) if any provision under this heading or application 
of such provision to any person or circumstance is held to 
be unconstitutional, the remainder of the provisions under this 
heading and the application of such provisions to any person 
or circumstance shall not be affected thereby. 
GENERAL PROVISION—DEPARTMENT OF EDUCATION 
SEC. 20804. (a) Notwithstanding any other provision of law, 
the Secretary of Education is hereby authorized to forgive any 
outstanding balance owed to the Department of Education under 
the HBCU Hurricane Supplemental Loan program established 
pursuant to section 2601 of Public Law 109–234, as modified by 
section 307 of title III of division F of the Consolidated Appropria-
tions Act, 2012 (Public Law 112–74), as carried forward by the 
Continuing Appropriations Resolution, 2013 (Public Law 112–175). 
(b) There are authorized to be appropriated, and there are 
hereby appropriated, such sums as may be necessary to carry 
out subsection (a): Provided, That such amount is designated by 
the Congress as an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balance Budget and Emergency Deficit Control 
Act of 1985. 
Loan forgiveness. 
Waiver authority. 
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132 STAT. 99 
PUBLIC LAW 115–123—FEB. 9, 2018 
GENERAL PROVISIONS—THIS TITLE 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 20805. Funds appropriated to the Department of Health 
and Human Services by this title may be transferred to, and merged 
with, other appropriation accounts under the headings ‘‘Centers 
for Disease Control and Prevention’’ and ‘‘Public Health and Social 
Services Emergency Fund’’ for the purposes specified in this title 
following consultation with the Office of Management and Budget: 
Provided, That the Committees on Appropriations in the House 
of Representatives and the Senate shall be notified 10 days in 
advance of any such transfer: Provided further, That, upon a deter-
mination that all or part of the funds transferred from an appropria-
tion are not necessary, such amounts may be transferred back 
to that appropriation: Provided further, That none of the funds 
made available by this title may be transferred pursuant to the 
authority in section 205 of division H of Public Law 115–31 or 
section 241(a) of the PHS Act. 
SEC. 20806. Not later than 30 days after enactment of this 
subdivision, the Secretary of Health and Human Services shall 
provide a detailed spend plan of anticipated uses of funds made 
available in this title, including estimated personnel and adminis-
trative costs, to the Committees on Appropriations: Provided, That 
such plans shall be updated and submitted to the Committees 
on Appropriations every 60 days until all funds are expended or 
expire. 
SEC. 20807. Unless otherwise provided for by this title, the 
additional amounts appropriated by this title to appropriations 
accounts shall be available under the authorities and conditions 
applicable to such appropriations accounts for fiscal year 2018. 
TITLE IX 
LEGISLATIVE BRANCH 
GOVERNMENT ACCOUNTABILITY OFFICE 
SALARIES AND EXPENSES 
For an additional amount for ‘‘Salaries and Expenses’’, 
$14,000,000, to remain available until expended, for audits and 
investigations relating to Hurricanes Harvey, Irma, and Maria and 
the 2017 wildfires: Provided, That such amount is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
TITLE X 
DEPARTMENT OF DEFENSE 
MILITARY CONSTRUCTION, NAVY AND MARINE CORPS 
For an additional amount for ‘‘Military Construction, Navy 
and Marine Corps’’, $201,636,000, to remain available until Sep-
tember 30, 2022, for necessary expenses related to the consequences 
of Hurricanes Harvey, Irma, and Maria: Provided, That none of 
Updates. 
Deadlines. 
Spending plan. 
Cost estimates. 
Determination. 
Notification. 
Consultation. 
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132 STAT. 100 
PUBLIC LAW 115–123—FEB. 9, 2018 
the funds made available to the Navy and Marine Corps for recovery 
efforts related to Hurricanes Harvey, Irma, and Maria in this 
subdivision shall be available for obligation until the Committees 
on Appropriations of the House of Representatives and the Senate 
receive form 1391 for each specific request: Provided further, That, 
not later than 60 days after enactment of this subdivision, the 
Secretary of the Navy, or his designee, shall submit to the Commit-
tees on Appropriations of House of Representatives and the Senate 
a detailed expenditure plan for funds provided under this heading: 
Provided further, That such funds may be obligated or expended 
for planning and design and military construction projects not other-
wise authorized by law: Provided further, That such amount is 
designated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985. 
MILITARY CONSTRUCTION, ARMY NATIONAL GUARD 
For an additional amount for ‘‘Military Construction, Army 
National Guard’’, $519,345,000, to remain available until September 
30, 2022, for necessary expenses related to the consequences of 
Hurricanes Harvey, Irma, and Maria: Provided, That none of the 
funds made available to the Army National Guard for recovery 
efforts related to Hurricanes Harvey, Irma, and Maria in this 
subdivision shall be available for obligation until the Committees 
on Appropriations of the House of Representatives and the Senate 
receive form 1391 for each specific request: Provided further, That, 
not later than 60 days after enactment of this subdivision, the 
Director of the Army National Guard, or his designee, shall submit 
to the Committees on Appropriations of the House of Representa-
tives and the Senate a detailed expenditure plan for funds provided 
under this heading: Provided further, That such funds may be 
obligated or expended for planning and design and military 
construction projects not otherwise authorized by law: Provided 
further, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
DEPARTMENT OF VETERANS AFFAIRS 
VETERANS HEALTH ADMINISTRATION 
MEDICAL SERVICES 
For an additional amount for ‘‘Medical Services’’, $11,075,000, 
to remain available until September 30, 2019, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria: Provided, That such amount is designated by the Con-
gress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
MEDICAL SUPPORT AND COMPLIANCE 
For an additional amount for ‘‘Medical Support and Compli-
ance’’, $3,209,000, to remain available until September 30, 2019, 
for necessary expenses related to the consequences of Hurricanes 
Harvey, Irma, and Maria: Provided, That such amount is designated 
Deadline. 
Expenditure 
plan. 
Deadline. 
Expenditure 
plan. 
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132 STAT. 101 
PUBLIC LAW 115–123—FEB. 9, 2018 
by the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
MEDICAL FACILITIES 
For an additional amount for ‘‘Medical Facilities’’, $75,108,000, 
to remain available until September 30, 2022, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria: Provided, That none of these funds shall be available 
for obligation until the Secretary of Veterans Affairs submits to 
the Committees on Appropriations of the House of Representatives 
and the Senate a detailed expenditure plan for funds provided 
under this heading: Provided further, That such amount is des-
ignated by the Congress as being for an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985. 
DEPARTMENTAL ADMINISTRATION 
CONSTRUCTION, MINOR PROJECTS 
For an additional amount for ‘‘Construction, Minor Projects’’, 
$4,088,000, to remain available until September 30, 2022, for nec-
essary expenses related to the consequences of Hurricanes Harvey, 
Irma, and Maria: Provided, That such amount is designated by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985. 
GENERAL PROVISION—THIS TITLE 
SEC. 21001. Notwithstanding section 18236(b) of title 10, United 
States Code, the Secretary of Defense shall contribute to Puerto 
Rico, 100 percent of the total cost of construction (including the 
cost of architectural, engineering and design services) for the 
acquisition, construction, expansion, rehabilitation, or conversion 
of the Arroyo readiness center under paragraph (5) of section 
18233(a) of title 10, United States Code. 
TITLE XI 
DEPARTMENT OF TRANSPORTATION 
FEDERAL AVIATION ADMINISTRATION 
OPERATIONS 
(AIRPORT AND AIRWAY TRUST FUND) 
For an additional amount for ‘‘Operations’’, $35,000,000, to 
be derived from the Airport and Airway Trust Fund and to remain 
available until expended, for necessary expenses related to the 
consequences of Hurricanes Harvey, Irma, and Maria, and other 
hurricanes occurring in calendar year 2017: Provided, That such 
amount is designated by the Congress as being for an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. 
Puerto Rico. 
Expenditure 
plan. 
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132 STAT. 102 
PUBLIC LAW 115–123—FEB. 9, 2018 
FACILITIES AND EQUIPMENT 
(AIRPORT AND AIRWAY TRUST FUND) 
For an additional amount for ‘‘Facilities and Equipment’’, 
$79,589,000, to be derived from the Airport and Airway Trust 
Fund and to remain available until expended, for necessary 
expenses related to the consequences of Hurricanes Harvey, Irma, 
and Maria, and other hurricanes occurring in calendar year 2017: 
Provided, That such amount is designated by the Congress as 
being 
for 
an 
emergency 
requirement 
pursuant 
to 
section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
FEDERAL HIGHWAY ADMINISTRATION 
FEDERAL-AID HIGHWAYS 
EMERGENCY RELIEF PROGRAM 
For an additional amount for the ‘‘Emergency Relief Program’’ 
as authorized under section 125 of title 23, United States Code, 
$1,374,000,000, to remain available until expended: Provided, That 
notwithstanding section 125(d)(4) of title 23, United States Code, 
no limitation on the total obligations for projects under section 
125 of such title shall apply to the Virgin Islands, Guam, American 
Samoa, and the Commonwealth of the Northern Mariana Islands 
for fiscal year 2018 and fiscal year 2019: Provided further, That 
notwithstanding subsection (e) of section 120 of title 23, United 
States Code, for this fiscal year and hereafter, the Federal share 
for Emergency Relief funds made available under section 125 of 
such title to respond to damage caused by Hurricanes Irma and 
Maria, shall be 100 percent for Puerto Rico: Provided further, That 
such amount is designated by the Congress as being for an emer-
gency requirement pursuant to section 251(b)(2)(A)(i) of the Bal-
anced Budget and Emergency Deficit Control Act of 1985. 
FEDERAL TRANSIT ADMINISTRATION 
PUBLIC TRANSPORTATION EMERGENCY RELIEF PROGRAM 
For an additional amount for the ‘‘Public Transportation Emer-
gency Relief Program’’ as authorized under section 5324 of title 
49, United States Code, $330,000,000 to remain available until 
expended, for transit systems affected by Hurricanes Harvey, Irma, 
and Maria with major disaster declarations in 2017: Provided, 
That not more than three-quarters of one percent of the funds 
for public transportation emergency relief shall be available for 
administrative expenses and ongoing program management over-
sight as authorized under sections 5334 and 5338(f)(2) of such 
title and shall be in addition to any other appropriations for such 
purpose: Provided further, That such amount is designated by the 
Congress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985. 
Applicability. 
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132 STAT. 103 
PUBLIC LAW 115–123—FEB. 9, 2018 
MARITIME ADMINISTRATION 
OPERATIONS AND TRAINING 
For an additional amount for ‘‘Operations and Training’’, 
$10,000,000, to remain available until expended, for necessary 
expenses, including for dredging, related to damage to Maritime 
Administration facilities resulting from Hurricane Harvey: Pro-
vided, That such amount is designated by the Congress as being 
for an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
GENERAL PROVISION—DEPARTMENT OF TRANSPORTATION 
SEC. 21101. Notwithstanding 49 U.S.C. 5302, for fiscal years 
2018, 2019, and 2020 the Secretary of Transportation shall treat 
an area as an ‘‘urbanized area’’ for purposes of 49 U.S.C. 5307 
and 5336(a) until the next decennial census following the enactment 
of this Act if the area was defined and designated as an ‘‘urbanized’’ 
area by the Secretary of Commerce in the 2000 decennial census 
and the population of such area fell below 50,000 after the 2000 
decennial census as a result of a major disaster: Provided, That 
an area treated as an ‘‘urbanized area’’ for purposes of this section 
shall be assigned the population and square miles of the urbanized 
area designated by the Secretary of Commerce in the 2000 decennial 
census: Provided further, That the term ‘‘major disaster’’ has the 
meaning given such term in section 102(2) of the Disaster Relief 
Act of 1974 (42 U.S.C. 5122(2)). 
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 
COMMUNITY PLANNING AND DEVELOPMENT 
COMMUNITY DEVELOPMENT FUND 
(INCLUDING TRANSFERS OF FUNDS) 
For an additional amount for ‘‘Community Development Fund’’, 
$28,000,000,000, to remain available until expended, for necessary 
expenses for activities authorized under title I of the Housing 
and Community Development Act of 1974 (42 U.S.C. 5301 et seq.) 
related to disaster relief, long-term recovery, restoration of infra-
structure and housing, economic revitalization, and mitigation in 
the most impacted and distressed areas resulting from a major 
declared disaster that occurred in 2017 (except as otherwise pro-
vided under this heading) pursuant to the Robert T. Stafford Dis-
aster Relief and Emergency Assistance Act (42 U.S.C. 5121 et 
seq.): Provided, That funds shall be awarded directly to the State, 
unit of general local government, or Indian tribe (as such term 
is defined in section 102 of the Housing and Community Develop-
ment Act of 1974) at the discretion of the Secretary: Provided 
further, That of the amounts made available under this heading, 
up to $16,000,000,000 shall be allocated to meet unmet needs for 
grantees that have received or will receive allocations under this 
heading for major declared disasters that occurred in 2017 or under 
the same heading of Division B of Public Law 115–56, except 
that, of the amounts made available under this proviso, no less 
than $11,000,000,000 shall be allocated to the States and units 
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132 STAT. 104 
PUBLIC LAW 115–123—FEB. 9, 2018 
of local government affected by Hurricane Maria, and of such 
amounts allocated to such grantees affected by Hurricane Maria, 
$2,000,000,000 shall be used to provide enhanced or improved elec-
trical power systems: Provided further, That to the extent amounts 
under the previous proviso are insufficient to meet all unmet needs, 
the allocation amounts related to infrastructure shall be reduced 
proportionally based on the total infrastructure needs of all 
grantees: Provided further, That of the amounts made available 
under this heading, no less than $12,000,000,000 shall be allocated 
for mitigation activities to all grantees of funding provided under 
this heading, section 420 of division L of Public Law 114–113, 
section 145 of division C of Public Law 114–223, section 192 of 
division C of Public Law 114–223 (as added by section 101(3) 
of division A of Public Law 114–254), section 421 of division K 
of Public Law 115–31, and the same heading in division B of 
Public Law 115–56, and that such mitigation activities shall be 
subject to the same terms and conditions under this subdivision, 
as determined by the Secretary: Provided further, That all such 
grantees shall receive an allocation of funds under the preceding 
proviso in the same proportion that the amount of funds each 
grantee received or will receive under the second proviso of this 
heading or the headings and sections specified in the previous 
proviso bears to the amount of all funds provided to all grantees 
specified in the previous proviso: Provided further, That of the 
amounts made available under the second and fourth provisos of 
this heading, the Secretary shall allocate to all such grantees an 
aggregate amount not less than 33 percent of each such amounts 
of funds provided under this heading within 60 days after the 
enactment of this subdivision based on the best available data 
(especially with respect to data for all such grantees affected by 
Hurricanes Harvey, Irma, and Maria), and shall allocate no less 
than 100 percent of the funds provided under this heading by 
no later than December 1, 2018: Provided further, That the Sec-
retary shall not prohibit the use of funds made available under 
this heading and the same heading in division B of Public Law 
115–56 for non-federal share as authorized by section 105(a)(9) 
of the Housing and Community Development Act of 1974 (42 U.S.C. 
5305(a)(9)): Provided further, That of the amounts made available 
under this heading, grantees may establish grant programs to assist 
small businesses for working capital purposes to aid in recovery: 
Provided further, That as a condition of making any grant, the 
Secretary shall certify in advance that such grantee has in place 
proficient financial controls and procurement processes and has 
established adequate procedures to prevent any duplication of bene-
fits as defined by section 312 of the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5155), to ensure 
timely expenditure of funds, to maintain comprehensive websites 
regarding all disaster recovery activities assisted with these funds, 
and to detect and prevent waste, fraud, and abuse of funds: Provided 
further, That with respect to any such duplication of benefits, the 
Secretary and any grantee under this section shall not take into 
consideration or reduce the amount provided to any applicant for 
assistance from the grantee where such applicant applied for and 
was approved, but declined assistance related to such major 
declared disasters that occurred in 2014, 2015, 2016, and 2017 
from the Small Business Administration under section 7(b) of the 
Small Business Act (15 U.S.C. 636(b)): Provided further, That the 
Web posting. 
Records. 
Contracts. 
Determination. 
Certification. 
Deadlines. 
Determination. 
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132 STAT. 105 
PUBLIC LAW 115–123—FEB. 9, 2018 
Secretary shall require grantees to maintain on a public website 
information containing common reporting criteria established by 
the Department that permits individuals and entities awaiting 
assistance and the general public to see how all grant funds are 
used, including copies of all relevant procurement documents, 
grantee administrative contracts and details of ongoing procurement 
processes, as determined by the Secretary: Provided further, That 
prior to the obligation of funds a grantee shall submit a plan 
to the Secretary for approval detailing the proposed use of all 
funds, including criteria for eligibility and how the use of these 
funds will address long-term recovery and restoration of infrastruc-
ture and housing, economic revitalization, and mitigation in the 
most impacted and distressed areas: Provided further, That such 
funds may not be used for activities reimbursable by, or for which 
funds are made available by, the Federal Emergency Management 
Agency or the Army Corps of Engineers: Provided further, That 
funds allocated under this heading shall not be considered relevant 
to the non-disaster formula allocations made pursuant to section 
106 of the Housing and Community Development Act of 1974 (42 
U.S.C. 5306): Provided further, That a State, unit of general local 
government, or Indian tribe may use up to 5 percent of its allocation 
for administrative costs: Provided further, That the sixth proviso 
under this heading in the Supplemental Appropriations for Disaster 
Relief Requirements Act, 2017 (division B of Public Law 115– 
56) is amended by striking ‘‘State or subdivision thereof’’ and 
inserting ‘‘State, unit of general local government, or Indian tribe 
(as such term is defined in section 102 of the Housing and Commu-
nity Development Act of 1974 (42 U.S.C. 5302))’’: Provided further, 
That in administering the funds under this heading, the Secretary 
of Housing and Urban Development may waive, or specify alter-
native requirements for, any provision of any statute or regulation 
that the Secretary administers in connection with the obligation 
by the Secretary or the use by the recipient of these funds (except 
for requirements related to fair housing, nondiscrimination, labor 
standards, and the environment), if the Secretary finds that good 
cause exists for the waiver or alternative requirement and such 
waiver or alternative requirement would not be inconsistent with 
the overall purpose of title I of the Housing and Community 
Development Act of 1974: Provided further, That, notwithstanding 
the preceding proviso, recipients of funds provided under this 
heading that use such funds to supplement Federal assistance 
provided under section 402, 403, 404, 406, 407, 408(c)(4), or 502 
of the Robert T. Stafford Disaster Relief and Emergency Assistance 
Act (42 U.S.C. 5121 et seq.) may adopt, without review or public 
comment, any environmental review, approval, or permit performed 
by a Federal agency, and such adoption shall satisfy the responsibil-
ities of the recipient with respect to such environmental review, 
approval or permit: Provided further, That, notwithstanding section 
104(g)(2) of the Housing and Community Development Act of 1974 
(42 U.S.C. 5304(g)(2)), the Secretary may, upon receipt of a request 
for release of funds and certification, immediately approve the 
release of funds for an activity or project assisted under this heading 
if the recipient has adopted an environmental review, approval 
or permit under the preceding proviso or the activity or project 
is categorically excluded from review under the National Environ-
mental Policy Act of 1969 (42 U.S.C. 4321 et seq.): Provided further, 
That the Secretary shall publish via notice in the Federal Register 
Notice. 
Federal Register, 
publication. 
Deadline. 
Waiver authority. 
131 Stat. 1138. 
Plan. 
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132 STAT. 106 
PUBLIC LAW 115–123—FEB. 9, 2018 
any waiver, or alternative requirement, to any statute or regulation 
that the Secretary administers pursuant to title I of the Housing 
and Community Development Act of 1974 no later than 5 days 
before the effective date of such waiver or alternative requirement: 
Provided further, That the eighth proviso under this heading in 
the Supplemental Appropriations for Disaster Relief Requirements 
Act, 2017 (division B of Public Law 115–56) is amended by inserting 
‘‘408(c)(4),’’ after ‘‘407,’’: Provided further, That of the amounts 
made available under this heading, up to $15,000,000 shall be 
made available for capacity building and technical assistance, 
including assistance on contracting and procurement processes, to 
support States, units of general local government, or Indian tribes 
(and their subrecipients) that receive allocations pursuant to this 
heading, received disaster recovery allocations under the same 
heading in Public Law 115–56, or may receive similar allocations 
for disaster recovery in future appropriations Acts: Provided further, 
That of the amounts made available under this heading, up to 
$10,000,000 shall be transferred, in aggregate, to ‘‘Department of 
Housing and Urban Development—Program Office Salaries and 
Expenses—Community Planning and Development’’ for necessary 
costs, including information technology costs, of administering and 
overseeing the obligation and expenditure of amounts under this 
heading: Provided further, That the amount specified in the pre-
ceding proviso shall be combined with funds appropriated under 
the same heading and for the same purpose in Public Law 115– 
56 and the aggregate of such amounts shall be available for any 
of the purposes specified under this heading or the same heading 
in Public Law 115–56 without limitation: Provided further, That, 
of the funds made available under this heading, $10,000,000 shall 
be transferred to the Office of the Inspector General for necessary 
costs of overseeing and auditing funds made available under this 
heading: Provided further, That such amount is designated by the 
Congress as being for an emergency requirement pursuant to section 
251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985: Provided further, That amounts repurposed pursu-
ant to this section that were previously designated by the Congress 
as an emergency requirement pursuant to the Balanced Budget 
and Emergency Deficit Control Act are designated by the Congress 
as an emergency requirement pursuant to section 251(b)(2)(A)(i) 
of the Balanced Budget and Emergency Deficit Control Act of 1985. 
GENERAL PROVISIONS—DEPARTMENT OF HOUSING AND URBAN 
DEVELOPMENT 
SEC. 21102. Any funds made available under the heading 
‘‘Community Development Fund’’ under this subdivision that remain 
available, after the other funds under such heading have been 
allocated for necessary expenses for activities authorized under 
such heading, shall be used for additional mitigation activities 
in the most impacted and distressed areas resulting from a major 
declared disaster that occurred in 2014, 2015, 2016 or 2017: Pro-
vided, That such remaining funds shall be awarded to grantees 
of funding provided for disaster relief under the heading ‘‘Commu-
nity Development Fund’’ in this subdivision, section 420 of division 
L of Public Law 114–113, section 145 of division C of Public Law 
114–223, section 192 of division C of Public Law 114–223 (as 
added by section 101(3) of division A of Public Law 114–254), 
131 Stat. 1138. 
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132 STAT. 107 
PUBLIC LAW 115–123—FEB. 9, 2018 
section 421 of division K of Public Law 115–31, and the same 
heading in division B of Public Law 115–56 subject to the same 
terms and conditions under this subdivision and such Acts respec-
tively: Provided further, That each such grantee shall receive an 
allocation from such remaining funds in the same proportion that 
the amount of funds such grantee received under this subdivision 
and under the Acts specified in the previous proviso bears to the 
amount of all funds provided to all grantees specified in the previous 
proviso. 
SEC. 21103. For 2018, the Secretary of Housing and Urban 
Development may make temporary adjustments to the section 8 
housing choice voucher annual renewal funding allocations and 
administrative fee eligibility determinations for public housing 
agencies located in the most impacted and distressed areas in 
which a major Presidentially declared disaster occurred during 2017 
under title IV of the Robert T. Stafford Disaster Relief and Emer-
gency Assistance Act (42 U.S.C. 5170 et seq.), to avoid significant 
adverse funding impacts that would otherwise result from the dis-
aster, or to facilitate leasing up to a public housing agency’s author-
ized level of units under contract (but not to exceed such level), 
upon request by and in consultation with a public housing agency 
and supported by documentation as required by the Secretary that 
demonstrates the need for the adjustment. 
TITLE XII 
GENERAL PROVISIONS—THIS SUBDIVISION 
SEC. 21201. Each amount appropriated or made available by 
this subdivision is in addition to amounts otherwise appropriated 
for the fiscal year involved. 
SEC. 21202. No part of any appropriation contained in this 
subdivision shall remain available for obligation beyond the current 
fiscal year unless expressly so provided herein. 
SEC. 21203. Unless otherwise provided for by this subdivision, 
the additional amounts appropriated by this subdivision to appro-
priations accounts shall be available under the authorities and 
conditions applicable to such appropriations accounts for fiscal year 
2018. 
SEC. 21204. Each amount designated in this subdivision by 
the Congress as being for an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985 shall be available (or rescinded or 
transferred, if applicable) only if the President subsequently so 
designates all such amounts and transmits such designations to 
the Congress. 
SEC. 21205. For purposes of this subdivision, the consequences 
or impacts of any hurricane shall include damages caused by the 
storm at any time during the entirety of its duration as a cyclone, 
as defined by the National Hurricane Center. 
SEC. 21206. Any amount appropriated by this subdivision, des-
ignated by the Congress as an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency 
Deficit Control Act of 1985 and subsequently so designated by 
the President, and transferred pursuant to transfer authorities 
provided by this subdivision shall retain such designation. 
President. 
President. 
Consultation. 
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132 STAT. 108 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 21207. The terms and conditions applicable to the funds 
provided in this subdivision, including those provided by this title, 
shall also apply to the funds made available in division B of Public 
Law 115–56 and in division A of Public Law 115–72. 
SEC. 21208. (a) Section 305 of division A of the Additional 
Supplemental Appropriations for Disaster Relief Requirements Act, 
2017 (Public Law 115–72) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘(1) Not later than December 31, 2017,’’ 
and inserting ‘‘Not later than March 31, 2018,’’; and 
(B) by striking paragraph (2); and 
(2) in subsection (b), by striking ‘‘receiving funds under 
this division’’ and inserting ‘‘expending more than $10,000,000 
of funds provided by this division and division B of Public 
Law 115–56 in any one fiscal year’’. 
(b) Section 305 of division A of the Additional Supplemental 
Appropriations for Disaster Relief Requirements Act, 2017 (Public 
Law 115–72), as amended by this section, shall apply to funds 
appropriated by this division as if they had been appropriated 
by that division. 
(c) In order to proactively prepare for oversight of future dis-
aster relief funding, not later than one year after the date of 
enactment of this Act, the Director of the Office of Management 
and Budget shall issue standard guidance for Federal agencies 
to use in designing internal control plans for disaster relief funding. 
This guidance shall leverage existing internal control review proc-
esses and shall include, at a minimum, the following elements: 
(1) Robust criteria for identifying and documenting incre-
mental risks and mitigating controls related to the funding. 
(2) Guidance for documenting the linkage between the 
incremental risks related to disaster funding and efforts to 
address known internal control risks. 
SEC. 21209. Any agency or department provided funding in 
excess of $3,000,000,000 by this subdivision, including the Federal 
Emergency Management Agency, the Department of Housing and 
Urban Development, and the Corps of Engineers, is directed to 
provide a report to the Committees on Appropriations of the House 
of Representatives and the Senate regarding its efforts to provide 
adequate resources and technical assistance for small, low-income 
communities affected by natural disasters. 
SEC. 21210. (a) Not later than 180 days after the date of 
enactment of this subdivision and in coordination with the Adminis-
trator of the Federal Emergency Management Agency, with support 
and contributions from the Secretary of the Treasury, the Secretary 
of Energy, and other Federal agencies having responsibilities 
defined under the National Disaster Recovery Framework, the Gov-
ernor of the Commonwealth of Puerto Rico shall submit to Congress 
a report describing the Commonwealth’s 12- and 24-month economic 
and disaster recovery plan that— 
(1) defines the priorities, goals, and expected outcomes 
of the recovery effort for the Commonwealth, based on damage 
assessments prepared pursuant to Federal law, if applicable, 
including— 
(A) housing; 
(B) economic issues, including workforce development 
and industry expansion and cultivation; 
(C) health and social services; 
Coordination. 
Puerto Rico. 
Reports. 
Plan. 
Reports. 
Criteria. 
Disaster 
assistance. 
Deadline. 
Guidance. 
31 USC 501 note. 
Applicability. 
Deadline. 
131 Stat. 1227. 
Applicability. 
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132 STAT. 109 
PUBLIC LAW 115–123—FEB. 9, 2018 
(D) natural and cultural resources; 
(E) governance and civic institutions; 
(F) electric power systems and grid restoration; 
(G) environmental issues, including solid waste facili-
ties; and 
(H) other infrastructure systems, including repair, res-
toration, replacement, and improvement of public infra-
structure such water and wastewater treatment facilities, 
communications networks, and transportation infrastruc-
ture; 
(2) is consistent with— 
(A) the Commonwealth’s fiscal capacity to provide long- 
term operation and maintenance of rebuilt or replaced 
assets; 
(B) 
alternative 
procedures 
and 
associated 
pro-
grammatic guidance adopted by the Administrator of the 
Federal Emergency Management Agency pursuant to sec-
tion 428 of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5189f); and 
(C) 
actions 
as 
may 
be 
necessary 
to 
mitigate 
vulnerabilities to future extreme weather events and nat-
ural disasters and increase community resilience, including 
encouraging the adoption and enforcement of the latest 
published editions of relevant consensus-based codes, speci-
fications, and standards that incorporate the latest hazard- 
resistant designs and establish minimum acceptable cri-
teria for the design, construction, and maintenance of resi-
dential structures and facilities for the purpose of pro-
tecting the health, safety, and general welfare of the 
buildings’ users against disasters; 
(3) promotes transparency and accountability through 
appropriate public notification, outreach, and hearings; 
(4) identifies performance metrics for assessing and 
reporting on the progress toward achieving the Common-
wealth’s recovery goals, as identified under paragraph (1); 
(5) is developed in coordination with the Oversight Board 
established under PROMESA; and 
(6) is certified by that Oversight Board to be consistent 
with the purpose set forth in section 101(a) of PROMESA 
(48 U.S.C. 2121(a)). 
(b) At the end of every 30-day period before the submission 
of the report described in subsection (a), the Governor of the 
Commonwealth of Puerto Rico, in coordination with the Adminis-
trator of the Federal Emergency Management Agency, shall provide 
to Congress interim status updates on progress developing such 
report. 
(c) At the end of every 180-day period after the submission 
of the report described in subsection (a), the Governor of the 
Commonwealth of Puerto Rico, in coordination with the Adminis-
trator of the Federal Emergency Management Agency, shall make 
public a report on progress achieving the goals set forth in such 
report. 
(d) During the development, and after the submission, of the 
report required in subsection (a), the Oversight Board may provide 
to Congress reports on the status of coordination with the Governor 
of Puerto Rico. 
Time period. 
Time period. 
Updates. 
Certification. 
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132 STAT. 110 
PUBLIC LAW 115–123—FEB. 9, 2018 
(e) Amounts made available by this subdivision to a covered 
territory for response to or recovery from Hurricane Irma or Hurri-
cane Maria in an aggregate amount greater than $10,000,000 may 
be reviewed by the Oversight Board under the Oversight Board’s 
authority under 204(b)(2) of PROMESA (48 U.S.C. 2144(b)(2)). 
(f) When developing a Fiscal Plan while the recovery plan 
required under subsection (a) is in development and in effect, the 
Oversight Board shall use and incorporate, to the greatest extent 
feasible, damage assessments prepared pursuant to Federal law. 
(g) For purposes of this section, the terms ‘‘covered territory’’ 
and ‘‘Oversight Board’’ have the meaning given those term in section 
5 of PROMESA (48 U.S.C. 2104). 
This subdivision may be cited as the ‘‘Further Additional 
Supplemental Appropriations for Disaster Relief Requirements Act, 
2018’’. 
SUBDIVISION 2—TAX RELIEF AND MED-
ICAID CHANGES RELATING TO CER-
TAIN DISASTERS 
TITLE I—CALIFORNIA FIRES 
SEC. 20101. DEFINITIONS. 
For purposes of this title— 
(1) CALIFORNIA WILDFIRE DISASTER ZONE.—The term ‘‘Cali-
fornia wildfire disaster zone’’ means that portion of the Cali-
fornia wildfire disaster area determined by the President to 
warrant individual or individual and public assistance from 
the Federal Government under the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act by reason of wildfires 
in California. 
(2) CALIFORNIA WILDFIRE DISASTER AREA.—The term ‘‘Cali-
fornia wildfire disaster area’’ means an area with respect to 
which between January 1, 2017 through January 18, 2018 
a major disaster has been declared by the President under 
section 401 of such Act by reason of wildfires in California. 
SEC. 20102. SPECIAL DISASTER-RELATED RULES FOR USE OF RETIRE-
MENT FUNDS. 
(a) TAX-FAVORED WITHDRAWALS FROM RETIREMENT PLANS.— 
(1) IN
GENERAL.—Section 72(t) of the Internal Revenue 
Code of 1986 shall not apply to any qualified wildfire distribu-
tion. 
(2) AGGREGATE DOLLAR LIMITATION.— 
(A) IN GENERAL.—For purposes of this subsection, the 
aggregate amount of distributions received by an individual 
which may be treated as qualified wildfire distributions 
for any taxable year shall not exceed the excess (if any) 
of— 
(i) $100,000, over 
(ii) the aggregate amounts treated as qualified 
wildfire distributions received by such individual for 
all prior taxable years. 
Time period. 
President. 
Assessments. 
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132 STAT. 111 
PUBLIC LAW 115–123—FEB. 9, 2018 
(B) TREATMENT OF PLAN DISTRIBUTIONS.—If a distribu-
tion to an individual would (without regard to subpara-
graph (A)) be a qualified wildfire distribution, a plan shall 
not be treated as violating any requirement of the Internal 
Revenue Code of 1986 merely because the plan treats such 
distribution as a qualified wildfire distribution, unless the 
aggregate amount of such distributions from all plans main-
tained by the employer (and any member of any controlled 
group which includes the employer) to such individual 
exceeds $100,000. 
(C) CONTROLLED
GROUP.—For purposes of subpara-
graph (B), the term ‘‘controlled group’’ means any group 
treated as a single employer under subsection (b), (c), (m), 
or (o) of section 414 of the Internal Revenue Code of 1986. 
(3) AMOUNT DISTRIBUTED MAY BE REPAID.— 
(A) IN GENERAL.—Any individual who receives a quali-
fied wildfire distribution may, at any time during the 3- 
year period beginning on the day after the date on which 
such distribution was received, make one or more contribu-
tions in an aggregate amount not to exceed the amount 
of such distribution to an eligible retirement plan of which 
such individual is a beneficiary and to which a rollover 
contribution of such distribution could be made under sec-
tion 402(c), 403(a)(4), 403(b)(8), 408(d)(3), or 457(e)(16), 
of the Internal Revenue Code of 1986, as the case may 
be. 
(B) TREATMENT
OF
REPAYMENTS
OF
DISTRIBUTIONS 
FROM ELIGIBLE RETIREMENT PLANS OTHER THAN IRAS.—For 
purposes of the Internal Revenue Code of 1986, if a con-
tribution is made pursuant to subparagraph (A) with 
respect to a qualified wildfire distribution from an eligible 
retirement plan other than an individual retirement plan, 
then the taxpayer shall, to the extent of the amount of 
the contribution, be treated as having received the qualified 
wildfire distribution in an eligible rollover distribution (as 
defined in section 402(c)(4) of such Code) and as having 
transferred the amount to the eligible retirement plan in 
a direct trustee to trustee transfer within 60 days of the 
distribution. 
(C) TREATMENT
OF
REPAYMENTS
FOR
DISTRIBUTIONS 
FROM IRAS.—For purposes of the Internal Revenue Code 
of 1986, if a contribution is made pursuant to subparagraph 
(A) with respect to a qualified wildfire distribution from 
an individual retirement plan (as defined by section 
7701(a)(37) of such Code), then, to the extent of the amount 
of the contribution, the qualified wildfire distribution shall 
be treated as a distribution described in section 408(d)(3) 
of such Code and as having been transferred to the eligible 
retirement plan in a direct trustee to trustee transfer 
within 60 days of the distribution. 
(4) DEFINITIONS.—For purposes of this subsection— 
(A) QUALIFIED WILDFIRE DISTRIBUTION.—Except as pro-
vided in paragraph (2), the term ‘‘qualified wildfire distribu-
tion’’ means any distribution from an eligible retirement 
plan made on or after October 8, 2017, and before January 
1, 2019, to an individual whose principal place of abode 
during any portion of the period from October 8, 2017, 
Time periods. 
Deadline. 
Deadline. 
Time period. 
Effective date. 
Definition. 
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132 STAT. 112 
PUBLIC LAW 115–123—FEB. 9, 2018 
to December 31, 2017, is located in the California wildfire 
disaster area and who has sustained an economic loss 
by reason of the wildfires to which the declaration of such 
area relates. 
(B) ELIGIBLE
RETIREMENT
PLAN.—The term ‘‘eligible 
retirement plan’’ shall have the meaning given such term 
by section 402(c)(8)(B) of the Internal Revenue Code of 
1986. 
(5) INCOME INCLUSION SPREAD OVER 3-YEAR PERIOD.— 
(A) IN GENERAL.—In the case of any qualified wildfire 
distribution, unless the taxpayer elects not to have this 
paragraph apply for any taxable year, any amount required 
to be included in gross income for such taxable year shall 
be so included ratably over the 3-taxable-year period begin-
ning with such taxable year. 
(B) SPECIAL RULE.—For purposes of subparagraph (A), 
rules similar to the rules of subparagraph (E) of section 
408A(d)(3) of the Internal Revenue Code of 1986 shall 
apply. 
(6) SPECIAL RULES.— 
(A) EXEMPTION OF DISTRIBUTIONS FROM TRUSTEE TO 
TRUSTEE
TRANSFER
AND
WITHHOLDING
RULES.—For pur-
poses of sections 401(a)(31), 402(f), and 3405 of the Internal 
Revenue Code of 1986, qualified wildfire distributions shall 
not be treated as eligible rollover distributions. 
(B) QUALIFIED
WILDFIRE
DISTRIBUTIONS
TREATED
AS 
MEETING PLAN DISTRIBUTION REQUIREMENTS.—For purposes 
the Internal Revenue Code of 1986, a qualified wildfire 
distribution shall be treated as meeting the requirements 
of sections 401(k)(2)(B)(i), 403(b)(7)(A)(ii), 403(b)(11), and 
457(d)(1)(A) of such Code. 
(b) RECONTRIBUTIONS
OF
WITHDRAWALS
FOR
HOME
PUR-
CHASES.— 
(1) RECONTRIBUTIONS.— 
(A) IN GENERAL.—Any individual who received a quali-
fied distribution may, during the period beginning on 
October 8, 2017, and ending on June 30, 2018, make one 
or more contributions in an aggregate amount not to exceed 
the amount of such qualified distribution to an eligible 
retirement plan (as defined in section 402(c)(8)(B) of the 
Internal Revenue Code of 1986) of which such individual 
is a beneficiary and to which a rollover contribution of 
such distribution could be made under section 402(c), 
403(a)(4), 403(b)(8), or 408(d)(3), of such Code, as the case 
may be. 
(B) TREATMENT OF REPAYMENTS.—Rules similar to the 
rules of subparagraphs (B) and (C) of subsection (a)(3) 
shall apply for purposes of this subsection. 
(2) QUALIFIED
DISTRIBUTION.—For purposes of this sub-
section, the term ‘‘qualified distribution’’ means any distribu-
tion— 
(A) 
described 
in 
section 
401(k)(2)(B)(i)(IV), 
403(b)(7)(A)(ii) (but only to the extent such distribution 
relates to financial hardship), 403(b)(11)(B), or 72(t)(2)(F), 
of the Internal Revenue Code of 1986, 
(B) received after March 31, 2017, and before January 
15, 2018, and 
Time period. 
Definition. 
Applicability. 
Time period. 
Applicability. 
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132 STAT. 113 
PUBLIC LAW 115–123—FEB. 9, 2018 
(C) which was to be used to purchase or construct 
a principal residence in the California wildfire disaster 
area but which was not so purchased or constructed on 
account of the wildfires to which the declaration of such 
area relates. 
(c) LOANS FROM QUALIFIED PLANS.— 
(1) INCREASE IN LIMIT ON LOANS NOT TREATED AS DISTRIBU-
TIONS.—In the case of any loan from a qualified employer 
plan (as defined under section 72(p)(4) of the Internal Revenue 
Code of 1986) to a qualified individual made during the period 
beginning on the date of the enactment of this Act and ending 
on December 31, 2018— 
(A) clause (i) of section 72(p)(2)(A) of such Code shall 
be applied by substituting ‘‘$100,000’’ for ‘‘$50,000’’, and 
(B) clause (ii) of such section shall be applied by sub-
stituting ‘‘the present value of the nonforfeitable accrued 
benefit of the employee under the plan’’ for ‘‘one-half of 
the present value of the nonforfeitable accrued benefit of 
the employee under the plan’’. 
(2) DELAY OF REPAYMENT.—In the case of a qualified indi-
vidual with an outstanding loan on or after October 8, 2017, 
from a qualified employer plan (as defined in section 72(p)(4) 
of the Internal Revenue Code of 1986)— 
(A) if the due date pursuant to subparagraph (B) or 
(C) of section 72(p)(2) of such Code for any repayment 
with respect to such loan occurs during the period begin-
ning on October 8, 2017, and ending on December 31, 
2018, such due date shall be delayed for 1 year, 
(B) any subsequent repayments with respect to any 
such loan shall be appropriately adjusted to reflect the 
delay in the due date under paragraph (1) and any interest 
accruing during such delay, and 
(C) in determining the 5-year period and the term 
of a loan under subparagraph (B) or (C) of section 72(p)(2) 
of such Code, the period described in subparagraph (A) 
shall be disregarded. 
(3) QUALIFIED INDIVIDUAL.—For purposes of this subsection, 
the term ‘‘qualified individual’’ means any individual whose 
principal place of abode during any portion of the period from 
October 8, 2017, to December 31, 2017, is located in the Cali-
fornia wildfire disaster area and who has sustained an economic 
loss by reason of wildfires to which the declaration of such 
area relates. 
(d) PROVISIONS RELATING TO PLAN AMENDMENTS.— 
(1) IN GENERAL.—If this subsection applies to any amend-
ment to any plan or annuity contract, such plan or contract 
shall be treated as being operated in accordance with the terms 
of the plan during the period described in paragraph (2)(B)(i). 
(2) AMENDMENTS TO WHICH SUBSECTION APPLIES.— 
(A) IN GENERAL.—This subsection shall apply to any 
amendment to any plan or annuity contract which is 
made— 
(i) pursuant to any provision of this section, or 
pursuant to any regulation issued by the Secretary 
or the Secretary of Labor under any provision of this 
section, and 
Regulation. 
Applicability. 
Definition. 
Time period. 
Effective date. 
Time periods. 
Time period. 
Applicability. 
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132 STAT. 114 
PUBLIC LAW 115–123—FEB. 9, 2018 
(ii) on or before the last day of the first plan 
year beginning on or after January 1, 2019, or such 
later date as the Secretary may prescribe. 
In the case of a governmental plan (as defined in section 
414(d) of the Internal Revenue Code of 1986), clause (ii) 
shall be applied by substituting the date which is 2 years 
after the date otherwise applied under clause (ii). 
(B) CONDITIONS.—This subsection shall not apply to 
any amendment unless— 
(i) during the period— 
(I) beginning on the date that this section 
or the regulation described in subparagraph (A)(i) 
takes effect (or in the case of a plan or contract 
amendment not required by this section or such 
regulation, the effective date specified by the plan), 
and 
(II) ending on the date described in subpara-
graph (A)(ii) (or, if earlier, the date the plan or 
contract amendment is adopted), 
the plan or contract is operated as if such plan or contract 
amendment were in effect, and 
(ii) such plan or contract amendment applies retro-
actively for such period. 
SEC. 
20103. 
EMPLOYEE 
RETENTION 
CREDIT 
FOR 
EMPLOYERS 
AFFECTED BY CALIFORNIA WILDFIRES. 
(a) IN GENERAL.—For purposes of section 38 of the Internal 
Revenue Code of 1986, in the case of an eligible employer, the 
California wildfire employee retention credit shall be treated as 
a credit listed in subsection (b) of such section. For purposes of 
this subsection, the California wildfire employee retention credit 
for any taxable year is an amount equal to 40 percent of the 
qualified wages with respect to each eligible employee of such 
employer for such taxable year. For purposes of the preceding 
sentence, the amount of qualified wages which may be taken into 
account with respect to any individual shall not exceed $6,000. 
(b) DEFINITIONS.—For purposes of this section— 
(1) ELIGIBLE
EMPLOYER.—The term ‘‘eligible employer’’ 
means any employer— 
(A) which conducted an active trade or business on 
October 8, 2017, in the California wildfire disaster zone, 
and 
(B) with respect to whom the trade or business 
described in subparagraph (A) is inoperable on any day 
after October 8, 2017, and before January 1, 2018, as 
a result of damage sustained by reason of the wildfires 
to which such declaration of such area relates. 
(2) ELIGIBLE
EMPLOYEE.—The term ‘‘eligible employee’’ 
means with respect to an eligible employer an employee whose 
principal place of employment on October 8, 2017, with such 
eligible employer was in the California wildfire disaster zone. 
(3) QUALIFIED WAGES.—The term ‘‘qualified wages’’ means 
wages (as defined in section 51(c)(1) of the Internal Revenue 
Code of 1986, but without regard to section 3306(b)(2)(B) of 
such Code) paid or incurred by an eligible employer with respect 
to an eligible employee on any day after October 8, 2017, 
and before January 1, 2018, which occurs during the period— 
Effective date. 
Time periods. 
Time period. 
Effective date. 
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132 STAT. 115 
PUBLIC LAW 115–123—FEB. 9, 2018 
(A) beginning on the date on which the trade or busi-
ness described in paragraph (1) first became inoperable 
at the principal place of employment of the employee imme-
diately before the wildfires to which the declaration of 
the California wildfire disaster area relates, and 
(B) ending on the date on which such trade or business 
has resumed significant operations at such principal place 
of employment. 
Such term shall include wages paid without regard to whether 
the employee performs no services, performs services at a dif-
ferent place of employment than such principal place of employ-
ment, or performs services at such principal place of employ-
ment before significant operations have resumed. 
(c) CERTAIN RULES TO APPLY.—For purposes of this section, 
rules similar to the rules of sections 51(i)(1), 52, and 280C(a) of 
the Internal Revenue Code of 1986, shall apply. 
(d) EMPLOYEE NOT TAKEN INTO ACCOUNT MORE THAN ONCE.— 
An employee shall not be treated as an eligible employee for pur-
poses of this section for any period with respect to any employer 
if such employer is allowed a credit under section 51 of the Internal 
Revenue Code of 1986 with respect to such employee for such 
period. 
SEC. 20104. ADDITIONAL DISASTER-RELATED TAX RELIEF PROVISIONS. 
(a) TEMPORARY SUSPENSION OF LIMITATIONS ON CHARITABLE 
CONTRIBUTIONS.— 
(1) IN GENERAL.—Except as otherwise provided in para-
graph (2), subsection (b) of section 170 of the Internal Revenue 
Code of 1986 shall not apply to qualified contributions and 
such contributions shall not be taken into account for purposes 
of applying subsections (b) and (d) of such section to other 
contributions. 
(2) TREATMENT OF EXCESS CONTRIBUTIONS.—For purposes 
of section 170 of the Internal Revenue Code of 1986— 
(A) INDIVIDUALS.—In the case of an individual— 
(i) LIMITATION.—Any qualified contribution shall 
be allowed only to the extent that the aggregate of 
such contributions does not exceed the excess of the 
taxpayer’s contribution base (as defined in subpara-
graph (H) of section 170(b)(1) of such Code) over the 
amount of all other charitable contributions allowed 
under section 170(b)(1) of such Code. 
(ii) CARRYOVER.—If the aggregate amount of quali-
fied contributions made in the contribution year 
(within the meaning of section 170(d)(1) of such Code) 
exceeds the limitation of clause (i), such excess shall 
be added to the excess described in the portion of 
subparagraph (A) of such section which precedes clause 
(i) thereof for purposes of applying such section. 
(B) CORPORATIONS.—In the case of a corporation— 
(i) LIMITATION.—Any qualified contribution shall 
be allowed only to the extent that the aggregate of 
such contributions does not exceed the excess of the 
taxpayer’s taxable income (as determined under para-
graph (2) of section 170(b) of such Code) over the 
amount of all other charitable contributions allowed 
under such paragraph. 
Applicability. 
Definitions. 
Time periods. 
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132 STAT. 116 
PUBLIC LAW 115–123—FEB. 9, 2018 
(ii) CARRYOVER.—Rules similar to the rules of 
subparagraph (A)(ii) shall apply for purposes of this 
subparagraph. 
(3) EXCEPTION TO OVERALL LIMITATION ON ITEMIZED DEDUC-
TIONS.—So much of any deduction allowed under section 170 
of the Internal Revenue Code of 1986 as does not exceed the 
qualified contributions paid during the taxable year shall not 
be treated as an itemized deduction for purposes of section 
68 of such Code. 
(4) QUALIFIED CONTRIBUTIONS.— 
(A) IN GENERAL.—For purposes of this subsection, the 
term ‘‘qualified contribution’’ means any charitable con-
tribution (as defined in section 170(c) of the Internal Rev-
enue Code of 1986) if— 
(i) such contribution— 
(I) is paid during the period beginning on 
October 8, 2017, and ending on December 31, 2018, 
in cash to an organization described in section 
170(b)(1)(A) of such Code, and 
(II) is made for relief efforts in the California 
wildfire disaster area, 
(ii) the taxpayer obtains from such organization 
contemporaneous written acknowledgment (within the 
meaning of section 170(f)(8) of such Code) that such 
contribution was used (or is to be used) for relief efforts 
described in clause (i)(II), and 
(iii) the taxpayer has elected the application of 
this subsection with respect to such contribution. 
(B) EXCEPTION.—Such term shall not include a con-
tribution by a donor if the contribution is— 
(i) to an organization described in section 509(a)(3) 
of the Internal Revenue Code of 1986, or 
(ii) for the establishment of a new, or maintenance 
of an existing, donor advised fund (as defined in section 
4966(d)(2) of such Code). 
(C) APPLICATION OF ELECTION TO PARTNERSHIPS AND 
S CORPORATIONS.—In the case of a partnership or S corpora-
tion, the election under subparagraph (A)(iii) shall be made 
separately by each partner or shareholder. 
(b) SPECIAL RULES
FOR QUALIFIED DISASTER-RELATED PER-
SONAL CASUALTY LOSSES.— 
(1) IN GENERAL.—If an individual has a net disaster loss 
for any taxable year— 
(A) 
the 
amount 
determined 
under 
section 
165(h)(2)(A)(ii) of the Internal Revenue Code of 1986 shall 
be equal to the sum of— 
(i) such net disaster loss, and 
(ii) so much of the excess referred to in the matter 
preceding clause (i) of section 165(h)(2)(A) of such Code 
(reduced by the amount in clause (i) of this subpara-
graph) as exceeds 10 percent of the adjusted gross 
income of the individual, 
(B) section 165(h)(1) of such Code shall be applied 
by substituting ‘‘$500’’ for ‘‘$500 ($100 for taxable years 
beginning after December 31, 2009)’’, 
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132 STAT. 117 
PUBLIC LAW 115–123—FEB. 9, 2018 
(C) the standard deduction determined under section 
63(c) of such Code shall be increased by the net disaster 
loss, and 
(D) section 56(b)(1)(E) of such Code shall not apply 
to so much of the standard deduction as is attributable 
to the increase under subparagraph (C) of this paragraph. 
(2) NET DISASTER LOSS.—For purposes of this subsection, 
the term ‘‘net disaster loss’’ means the excess of qualified dis-
aster-related personal casualty losses over personal casualty 
gains (as defined in section 165(h)(3)(A) of the Internal Revenue 
Code of 1986). 
(3) QUALIFIED
DISASTER-RELATED
PERSONAL
CASUALTY 
LOSSES.—For purposes of this subsection, the term ‘‘qualified 
disaster-related 
personal 
casualty 
losses’’ 
means 
losses 
described in section 165(c)(3) of the Internal Revenue Code 
of 1986 which arise in the California wildfire disaster area 
on or after October 8, 2017, and which are attributable to 
the wildfires to which the declaration of such area relates. 
(c) SPECIAL RULE FOR DETERMINING EARNED INCOME.— 
(1) IN
GENERAL.—In the case of a qualified individual, 
if the earned income of the taxpayer for the taxable year 
which includes any portion of the period from October 8, 2017, 
to December 31, 2017, is less than the earned income of the 
taxpayer for the preceding taxable year, the credits allowed 
under sections 24(d) and 32 of the Internal Revenue Code 
of 1986 may, at the election of the taxpayer, be determined 
by substituting— 
(A) such earned income for the preceding taxable year, 
for 
(B) such earned income for the taxable year which 
includes any portion of the period from October 8, 2017, 
to December 31, 2017. 
(2) QUALIFIED INDIVIDUAL.—For purposes of this subsection, 
the term ‘‘qualified individual’’ means any individual whose 
principal place of abode during any portion of the period from 
October 8, 2017, to December 31, 2017, was located— 
(A) in the California wildfire disaster zone, or 
(B) in the California wildfire disaster area (but outside 
the California wildfire disaster zone) and such individual 
was displaced from such principal place of abode by reason 
of the wildfires to which the declaration of such area 
relates. 
(3) EARNED INCOME.—For purposes of this subsection, the 
term ‘‘earned income’’ has the meaning given such term under 
section 32(c) of the Internal Revenue Code of 1986. 
(4) SPECIAL RULES.— 
(A) APPLICATION TO JOINT RETURNS.—For purposes of 
paragraph (1), in the case of a joint return for a taxable 
year which includes any portion of the period from October 
8, 2017, to December 31, 2017— 
(i) such paragraph shall apply if either spouse 
is a qualified individual, and 
(ii) the earned income of the taxpayer for the pre-
ceding taxable year shall be the sum of the earned 
income of each spouse for such preceding taxable year. 
(B) UNIFORM APPLICATION OF ELECTION.—Any election 
made under paragraph (1) shall apply with respect to both 
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132 STAT. 118 
PUBLIC LAW 115–123—FEB. 9, 2018 
sections 24(d) and 32, of the Internal Revenue Code of 
1986. 
(C) ERRORS TREATED AS MATHEMATICAL ERROR.—For 
purposes of section 6213 of the Internal Revenue Code 
of 1986, an incorrect use on a return of earned income 
pursuant to paragraph (1) shall be treated as a mathe-
matical or clerical error. 
(D) NO EFFECT ON DETERMINATION OF GROSS INCOME, 
ETC.—Except as otherwise provided in this subsection, the 
Internal Revenue Code of 1986 shall be applied without 
regard to any substitution under paragraph (1). 
TITLE 
II—TAX 
RELIEF 
FOR 
HURRI-
CANES HARVEY, IRMA, AND MARIA 
SEC. 20201. TAX RELIEF FOR HURRICANES HARVEY, IRMA, AND MARIA. 
(a) MODIFICATION OF HURRICANES HARVEY AND IRMA DISASTER 
AREAS.—Subsections (a)(2) and (b)(2) of section 501 of the Disaster 
Tax Relief and Airport and Airway Extension Act of 2017 (Public 
Law 115–63; 131 Stat. 1173) are both amended by striking ‘‘Sep-
tember 21, 2017’’ and inserting ‘‘October 17, 2017’’. 
(b) EMPLOYEE RETENTION CREDIT.—Subsections (a)(3), (b)(3), 
and (c)(3) of section 503 of the Disaster Tax Relief and Airport 
and Airway Extension Act of 2017 (Public Law 115–63; 131 Stat. 
1181) are each amended by striking ‘‘sections 51(i)(1) and 52’’ and 
inserting ‘‘sections 51(i)(1), 52, and 280C(a)’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect as if included in the provisions of title V of the 
Disaster Tax Relief and Airport and Airway Extension Act of 2017 
to which such amendments relate. 
TITLE III—HURRICANE MARIA RELIEF 
FOR PUERTO RICO AND THE VIRGIN 
ISLANDS MEDICAID PROGRAMS 
SEC. 20301. HURRICANE MARIA RELIEF FOR PUERTO RICO AND THE 
VIRGIN ISLANDS MEDICAID PROGRAMS. 
(a) INCREASED CAPS.—Section 1108(g)(5) of the Social Security 
Act (42 U.S.C. 1308(g)(5)) is amended— 
(1) in subparagraph (A), by striking ‘‘subparagraph (B)’’ 
and inserting ‘‘subparagraphs (B), (C), (D), and (E)’’; and 
(2) by adding at the end the following new subparagraphs: 
‘‘(C) Subject to subparagraphs (D) and (E), for the period 
beginning January 1, 2018, and ending September 30, 2019— 
‘‘(i) the amount of the increase otherwise provided 
under subparagraphs (A) and (B) for Puerto Rico shall 
be further increased by $3,600,000,000; and 
‘‘(ii) the amount of the increase otherwise provided 
under subparagraph (A) for the Virgin Islands shall be 
further increased by $106,931,000. 
‘‘(D) For the period described in subparagraph (C), the 
amount of the increase otherwise provided under subparagraph 
(A)— 
Certifications. 
Time period. 
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132 STAT. 119 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(i) for Puerto Rico shall be further increased by 
$1,200,000,000 if the Secretary certifies that Puerto Rico 
has taken reasonable and appropriate steps during such 
period, in accordance with a timeline established by the 
Secretary, to— 
‘‘(I) implement methods, satisfactory to the Sec-
retary, for the collection and reporting of reliable data 
to the Transformed Medicaid Statistical Information 
System (T–MSIS) (or a successor system); and 
‘‘(II) demonstrate progress in establishing a State 
medicaid fraud control unit described in section 
1903(q); and 
‘‘(ii) for the Virgin Islands shall be further increased 
by $35,644,000 if the Secretary certifies that the Virgin 
Islands has taken reasonable and appropriate steps during 
such period, in accordance with a timeline established by 
the Secretary, to meet the conditions for certification speci-
fied in subclauses (I) and (II) of clause (i). 
‘‘(E) Notwithstanding any other provision of title XIX, 
during the period in which the additional funds provided under 
subparagraphs (C) and (D) are available for Puerto Rico and 
the Virgin Islands, respectively, with respect to payments from 
such additional funds for amounts expended by Puerto Rico 
and the Virgin Islands under such title, the Secretary shall 
increase the Federal medical assistance percentage or other 
rate that would otherwise apply to such payments to 100 per-
cent.’’. 
(b) DISREGARD
OF CERTAIN EXPENDITURES FROM SPENDING 
CAP.—Section 1108(g)(4) of the Social Security Act (42 U.S.C. 
1308(g)(4)) is amended— 
(1) by inserting ‘‘for a calendar quarter of such fiscal year,’’ 
after ‘‘section 1903(a)(3)’’; and 
(2) by striking ‘‘of such fiscal year for a calendar quarter 
of such fiscal year,’’ and inserting ‘‘of such fiscal year, and 
with respect to fiscal years beginning with fiscal year 2018, 
if the Virgin Islands qualifies for a payment under section 
1903(a)(6) for a calendar quarter (beginning on or after January 
1, 2018) of such fiscal year,’’. 
(c) REPORT TO CONGRESS.—Not later than July 1, 2018, the 
Secretary of Health and Human Services shall submit a report 
to the Committee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the Senate that— 
(1) describes the steps taken by Puerto Rico and the Virgin 
Islands to meet the conditions for certification specified in 
clauses (i) and (ii), respectively, of section 1108(g)(5)(D) of the 
Social Security Act (42 U.S.C. 1308(g)(5)(D)) (as amended by 
subsection (a) of this section); and 
(2) specifies timelines for each such territory to, as a condi-
tion of eligibility for any additional increases in the amounts 
determined for Puerto Rico or the Virgin Islands, respectively, 
under subsection (g) of section 1108 of such Act (42 U.S.C. 
1308) for purposes of payments under title XIX of such Act 
for fiscal year 2019, complete— 
(A) implementation of methods, satisfactory to the Sec-
retary, for the collection and reporting of reliable data 
to the Transformed Medicaid Statistical Information 
System (T–MSIS) (or a successor system); and 
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132 STAT. 120 
PUBLIC LAW 115–123—FEB. 9, 2018 
(B) the establishment of a State medicaid fraud control 
unit described in section 1903(q) of the Social Security 
Act (42 U.S.C. 1396d(q)). 
TITLE IV—BUDGETARY EFFECTS 
SEC. 20401. EMERGENCY DESIGNATION. 
This subdivision is designated as an emergency requirement 
pursuant to section 4(g) of the Statutory Pay-As-You-Go Act of 
2010 (2 U.S.C. 933(g)). 
SEC. 20402. DESIGNATION IN SENATE. 
In the Senate, this subdivision is designated as an emergency 
requirement pursuant to section 4112(a) of H. Con. Res. 71 (115th 
Congress), the concurrent resolution on the budget for fiscal year 
2018. 
Subdivision 3—Further Extension of Continuing 
Appropriations Act, 2018 
SEC. 20101. The Continuing Appropriations Act, 2018 (division 
D of Public Law 115–56) is further amended by— 
(1) striking the date specified in section 106(3) and 
inserting ‘‘March 23, 2018’’; and 
(2) inserting after section 155 the following new sections: 
‘‘SEC. 156. In addition to amounts provided by section 101, 
amounts are provided for ‘Department of Commerce—Bureau of 
the Census—Periodic Census and Programs’ at a rate for operations 
of $182,000,000 for an additional amount for the 2020 Decennial 
Census Program; and such amounts may be apportioned up to 
the rate for operations necessary to maintain the schedule and 
deliver the required data according to statutory deadlines in the 
2020 Decennial Census Program. 
‘‘SEC. 157. Notwithstanding section 101, the matter preceding 
the first proviso and the first proviso under the heading ‘Power 
Marketing Administrations—Operation and Maintenance, South-
eastern Power Administration’ in division D of Public Law 115– 
31 shall be applied by substituting ‘$6,379,000’ for ‘$1,000,000’ 
each place it appears. 
‘‘SEC. 158. As authorized by section 404 of the Bipartisan 
Budget Act of 2015 (Public Law 114–74; 42 U.S.C. 6239 note), 
the Secretary of Energy shall draw down and sell not to exceed 
$350,000,000 of crude oil from the Strategic Petroleum Reserve 
in fiscal year 2018: Provided, That the proceeds from such draw-
down and sale shall be deposited into the ‘Energy Security and 
Infrastructure Modernization Fund’ (in this section referred to as 
the ‘Fund’) during fiscal year 2018: Provided further, That in addi-
tion to amounts otherwise made available by section 101, any 
amounts deposited in the Fund shall be made available and shall 
remain available until expended at a rate for operations of 
$350,000,000, for necessary expenses in carrying out the Life Exten-
sion II project for the Strategic Petroleum Reserve. 
‘‘SEC. 159. Amounts made available by section 101 for ‘The 
Judiciary—Courts of Appeals, District Courts, and Other Judicial 
Services—Fees of Jurors and Commissioners’ may be apportioned 
up to the rate for operations necessary to accommodate increased 
juror usage. 
42 USC 6241 
note. 
Applicability. 
Ante, p. 30. 
131 Stat. 1141. 
Further 
Extension of 
Continuing 
Appropriations 
Act, 2018. 
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132 STAT. 121 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘SEC. 160. Section 144 of the Continuing Appropriations Act, 
2018 (division D of Public Law 115–56), as amended by the Further 
Additional Continuing Appropriations Act, 2018 (division A of Public 
Law 115–96), is amended by (1) striking ‘$11,761,000’ and inserting 
‘$22,247,000’, 
and 
(2) 
striking 
‘$1,104,000’ 
and 
inserting 
‘$1,987,000’. 
‘‘SEC. 161. Section 458(a)(4) of the Higher Education Act of 
1965 (20 U.S.C. 1087h(a)(4)) shall be applied by substituting ‘2018’ 
for ‘2017’. 
‘‘SEC. 162. For the purpose of carrying out section 435(a)(2) 
of the Higher Education Act of 1965 (HEA) (20 U.S.C. 1085(a)(2)), 
during the period covered by this Act the Secretary of Education 
may waive the requirement under section 435(a)(5)(A)(ii) of the 
HEA (20 U.S.C. 1085(a)(5)(A)(ii)) for an institution of higher edu-
cation that offers an associate degree, is a public institution, and 
is located in an economically distressed county, defined as a county 
that ranks in the lowest 5 percent of all counties in the United 
States based on a national index of county economic status: Pro-
vided, That this section shall apply to an institution of higher 
education that otherwise would be ineligible to participate in a 
program under part A of title IV of the HEA on or after the 
date of enactment of this Act due to the application of section 
435(a)(2) of the HEA. 
‘‘SEC. 163. Notwithstanding any other provision of law, funds 
made available by this Act for military construction, land acquisi-
tion, and family housing projects and activities may be obligated 
and expended to carry out planning and design and military 
construction projects authorized by law: Provided, That funds and 
authority provided by this section may be used notwithstanding 
sections 102 and 104: Provided further, That such funds may be 
used only for projects identified by the Department of the Air 
Force in its January 29, 2018, letter sent to the Committees on 
Appropriations of both Houses of Congress detailing urgently 
needed fiscal year 2018 construction requirements. 
‘‘SEC. 164. (a) Section 116(h)(3)(D) of title 49, United States 
Code, is amended— 
‘‘(1) in clause (i), by striking ‘During the 2-year period 
beginning on the date of enactment of this section, the’; 
inserting ‘The’; and inserting the following after the first sen-
tence: ‘Any such funds or limitation of obligations or portions 
thereof transferred to the Bureau may be transferred back 
to and merged with the original account.’; and 
‘‘(2) in clause (ii) by striking ‘During the 2-year period 
beginning on the date of enactment of this section, the’; 
inserting ‘The’; and inserting the following after the first sen-
tence: ‘Any such funds or limitation of obligations or portions 
thereof transferred to the Bureau may be transferred back 
to and merged with the original account.’. 
‘‘(b) Section 503(l)(4) of the Railroad Revitalization and Regu-
latory Reform Act of 1976 (45 U.S.C. 823(l)(4)) is amended— 
‘‘(1) in the heading by striking ‘Safety and operations 
account’ and inserting ‘National Surface Transportation and 
Innovative Finance Bureau account’; and 
‘‘(2) in subparagraph (A) by striking ‘Safety and Operations 
account of the Federal Railroad Administration’ and inserting 
‘National Surface Transportation and Innovative Finance 
Bureau account’. 
Applicability. 
Waiver authority. 
Applicability. 
131 Stat. 2044. 
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132 STAT. 122 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘SEC. 165. Section 24(o) of the United States Housing Act 
of 1937 (42 U.S.C. 1437v) shall be applied by substituting the 
date specified in section 106(3) for ‘September 30, 2017’.’’. 
This subdivision may be cited as the ‘‘Further Extension of 
Continuing Appropriations Act, 2018’’. 
DIVISION C—BUDGETARY AND OTHER 
MATTERS 
SEC. 30001. TABLE OF CONTENTS. 
The table of contents for this division is as follows: 
DIVISION C—BUDGETARY AND OTHER MATTERS 
Sec. 30001. Table of contents. 
TITLE I—BUDGET ENFORCEMENT 
Sec. 30101. Amendments to the Balanced Budget and Emergency Deficit Control 
Act of 1985. 
Sec. 30102. Balances on the PAYGO Scorecards. 
Sec. 30103. Authority for fiscal year 2019 budget resolution in the Senate. 
Sec. 30104. Authority for fiscal year 2019 budget resolution in the House of Rep-
resentatives. 
Sec. 30105. Exercise of rulemaking powers. 
TITLE II—OFFSETS 
Sec. 30201. Customs user fees. 
Sec. 30202. Aviation security service fees. 
Sec. 30203. Extension of certain immigration fees. 
Sec. 30204. Strategic Petroleum Reserve drawdown. 
Sec. 30205. Elimination of surplus funds of Federal reserve banks. 
Sec. 30206. Reemployment services and eligibility assessments. 
TITLE III—TEMPORARY EXTENSION OF PUBLIC DEBT LIMIT 
Sec. 30301. Temporary extension of public debt limit. 
TITLE IV—JOINT SELECT COMMITTEES 
Subtitle A—Joint Select Committee on Solvency of Multiemployer Pension Plans 
Sec. 30421. Definitions. 
Sec. 30422. Establishment of Joint Select Committee. 
Sec. 30423. Funding. 
Sec. 30424. Consideration of joint committee bill in the Senate. 
Subtitle B—Joint Select Committee on Budget and Appropriations Process Reform 
Sec. 30441. Definitions. 
Sec. 30442. Establishment of Joint Select Committee. 
Sec. 30443. Funding. 
Sec. 30444. Consideration of joint committee bill in the Senate. 
TITLE I—BUDGET ENFORCEMENT 
SEC. 30101. AMENDMENTS TO THE BALANCED BUDGET AND EMER-
GENCY DEFICIT CONTROL ACT OF 1985. 
(a) REVISED DISCRETIONARY SPENDING LIMITS.—Section 251(c) 
of the Balanced Budget and Emergency Deficit Control Act of 1985 
(2 U.S.C. 901(c)) is amended by striking paragraphs (5) and (6) 
and inserting the following: 
‘‘(5) for fiscal year 2018— 
‘‘(A) for the revised security category, $629,000,000,000 
in new budget authority; and 
‘‘(B) 
for 
the 
revised 
nonsecurity 
category 
$579,000,000,000 in new budget authority; 
Time periods. 
Applicability. 
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132 STAT. 123 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(6) for fiscal year 2019— 
‘‘(A) for the revised security category, $647,000,000,000 
in new budget authority; and 
‘‘(B) 
for 
the 
revised 
nonsecurity 
category, 
$597,000,000,000 in new budget authority;’’. 
(b) DIRECT SPENDING ADJUSTMENTS FOR FISCAL YEARS 2018 
AND 2019.—Section 251A of the Balanced Budget and Emergency 
Deficit Control Act of 1985 (2 U.S.C. 901a), is amended— 
(1) in paragraph (5)(B), in the matter preceding clause 
(i), by striking ‘‘and (11)’’ and inserting ‘‘, (11), and (12)’’; 
and 
(2) by adding at the end the following: 
‘‘(12) IMPLEMENTING
DIRECT
SPENDING
REDUCTIONS
FOR 
FISCAL YEARS 2018 AND 2019.—(A) OMB shall make the calcula-
tions necessary to implement the direct spending reductions 
calculated pursuant to paragraphs (3) and (4) without regard 
to the amendment made to section 251(c) revising the discre-
tionary spending limits for fiscal years 2018 and 2019 by the 
Bipartisan Budget Act of 2018. 
‘‘(B) Paragraph (5)(B) shall not be implemented for fiscal 
years 2018 and 2019.’’. 
(c) EXTENSION
OF DIRECT SPENDING REDUCTIONS THROUGH 
FISCAL YEAR 2027.—Section 251A(6) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 (2 U.S.C. 901a(6)) is 
amended— 
(1) in subparagraph (B), in the matter preceding clause 
(i), by striking ‘‘for fiscal year 2022, for fiscal year 2023, for 
fiscal year 2024, and for fiscal year 2025’’ and inserting ‘‘for 
each of fiscal years 2022 through 2027’’; and 
(2) in subparagraph (C), in the matter preceding clause 
(i), by striking ‘‘fiscal year 2025’’ and inserting ‘‘fiscal year 
2027’’. 
SEC. 30102. BALANCES ON THE PAYGO SCORECARDS. 
Effective on the date of enactment of this Act, the balances 
on the PAYGO scorecards established pursuant to paragraphs (4) 
and (5) of section 4(d) of the Statutory Pay-As-You-Go Act of 2010 
(2 U.S.C. 933(d)) shall be zero. 
SEC. 30103. AUTHORITY FOR FISCAL YEAR 2019 BUDGET RESOLUTION 
IN THE SENATE. 
(a) FISCAL YEAR 2019.—For purposes of enforcing the Congres-
sional Budget Act of 1974 (2 U.S.C. 621 et seq.) after April 15, 
2018, and enforcing budgetary points of order in prior concurrent 
resolutions on the budget, the allocations, aggregates, and levels 
provided for in subsection (b) shall apply in the Senate in the 
same manner as for a concurrent resolution on the budget for 
fiscal year 2019 with appropriate budgetary levels for fiscal years 
2020 through 2028. 
(b) COMMITTEE ALLOCATIONS, AGGREGATES, AND LEVELS.—After 
April 15, 2018, but not later than May 15, 2018, the Chairman 
of the Committee on the Budget of the Senate shall file— 
(1) for the Committee on Appropriations, committee alloca-
tions for fiscal year 2019 consistent with discretionary spending 
limits set forth in section 251(c)(6) of the Balanced Budget 
and Emergency Deficit Control Act of 1985, as amended by 
this Act, for the purposes of enforcing section 302 of the 
Congressional Budget Act of 1974 (2 U.S.C. 633); 
Time periods. 
Deadline. 
Effective date. 
Applicability. 
Effective date. 
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132 STAT. 124 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) for all committees other than the Committee on Appro-
priations, committee allocations for fiscal years 2019, 2019 
through 2023, and 2019 through 2028 consistent with the most 
recent baseline of the Congressional Budget Office, as adjusted 
for the budgetary effects of any provision of law enacted during 
the period beginning on the date such baseline is issued and 
ending on the date of submission of such statement, for the 
purposes of enforcing section 302 of the Congressional Budget 
Act of 1974 (2 U.S.C. 633); 
(3) aggregate spending levels for fiscal year 2019 in accord-
ance with the allocations established under paragraphs (1) 
and (2), for the purpose of enforcing section 311 of the Congres-
sional Budget Act of 1974 (2 U.S.C. 642); 
(4) aggregate revenue levels for fiscal years 2019, 2019 
through 2023, and 2019 through 2028 consistent with the most 
recent baseline of the Congressional Budget Office, as adjusted 
for the budgetary effects of any provision of law enacted during 
the period beginning on the date such baseline is issued and 
ending on the date of submission of such statement, for the 
purpose of enforcing section 311 of the Congressional Budget 
Act of 1974 (2 U.S.C. 642); and 
(5) levels of Social Security revenues and outlays for fiscal 
years 2019, 2019 through 2023, and 2019 through 2028 con-
sistent with the most recent baseline of the Congressional 
Budget Office, as adjusted for the budgetary effects of any 
provision of law enacted during the period beginning on the 
date such baseline is issued and ending on the date of submis-
sion of such statement, for the purpose of enforcing sections 
302 and 311 of the Congressional Budget Act of 1974 (2 U.S.C. 
633 and 642). 
(c) ADDITIONAL MATTER.—The filing referred to in subsection 
(b) may also include for fiscal year 2019 the deficit-neutral reserve 
funds contained in title III of H. Con. Res. 71 (115th Congress) 
updated by one fiscal year. 
(d) EXPIRATION.—This section shall expire if a concurrent reso-
lution on the budget for fiscal year 2019 is agreed to by the Senate 
and the House of Representatives pursuant to section 301 of the 
Congressional Budget Act of 1974 (2 U.S.C. 632). 
SEC. 30104. AUTHORITY FOR FISCAL YEAR 2019 BUDGET RESOLUTION 
IN THE HOUSE OF REPRESENTATIVES. 
(a) FISCAL YEAR 2019.—If a concurrent resolution on the budget 
for fiscal year 2019 has not been adopted by April 15, 2018, for 
the purpose of enforcing the Congressional Budget Act of 1974, 
the allocations, aggregates, and levels provided for in subsection 
(b) shall apply in the House of Representatives after April 15, 
2018, in the same manner as for a concurrent resolution on the 
budget for fiscal year 2019 with appropriate budgetary levels for 
fiscal year 2019 and for fiscal years 2020 through 2028. 
(b) COMMITTEE ALLOCATIONS, AGGREGATES, AND LEVELS.—In 
the House of Representatives, the Chair of the Committee on the 
Budget shall submit a statement for publication in the Congres-
sional Record after April 15, 2018, but not later than May 15, 
2018, containing— 
(1) for the Committee on Appropriations, committee alloca-
tions for fiscal year 2019 for discretionary budget authority 
at the total level set forth in section 251(c)(6) of the Balanced 
Congressional 
Record, 
publication. 
Time periods. 
Deadline. 
Applicability. 
Effective date. 
Deadline. 
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132 STAT. 125 
PUBLIC LAW 115–123—FEB. 9, 2018 
Budget and Emergency Deficit Control Act of 1985, as amended 
by this Act, and the outlays flowing therefrom, and committee 
allocations for fiscal year 2019 for current law mandatory 
budget authority and outlays, for the purpose of enforcing sec-
tion 302 of the Congressional Budget Act of 1974; 
(2) for all committees other than the Committee on Appro-
priations, committee allocations for fiscal year 2019 and for 
the period of fiscal years 2019 through 2028 at the levels 
included in the most recent baseline of the Congressional 
Budget Office, as adjusted for the budgetary effects of any 
provision of law enacted during the period beginning on the 
date such baseline is issued and ending on the date of submis-
sion of such statement, for the purpose of enforcing section 
302 of the Congressional Budget Act of 1974; and 
(3) aggregate spending levels for fiscal year 2019 and aggre-
gate revenue levels for fiscal year 2019 and for the period 
of fiscal years 2019 through 2028, at the levels included in 
the most recent baseline of the Congressional Budget Office, 
as adjusted for the budgetary effects of any provision of law 
enacted during the period beginning on the date such baseline 
is issued and ending on the date of submission of such state-
ment, for the purpose of enforcing section 311 of the Congres-
sional Budget Act of 1974. 
(c) ADDITIONAL MATTER.—The statement referred to in sub-
section (b) may also include for fiscal year 2019, the matter con-
tained in the provisions referred to in subsection (f)(1). 
(d) FISCAL YEAR 2019 ALLOCATION
TO
THE COMMITTEE
ON 
APPROPRIATIONS.—If the statement referred to in subsection (b) 
is not filed by May 15, 2018, then the matter referred to in sub-
section (b)(1) shall be submitted by the Chair of the Committee 
on the Budget for publication in the Congressional Record on the 
next day that the House of Representatives is in session. 
(e) ADJUSTMENTS.—The chair of the Committee on the Budget 
of the House of Representatives may adjust the levels included 
in the statement referred to in subsection (b) to reflect the budgetary 
effects of any legislation enacted during the 115th Congress that 
reduces the deficit or as otherwise necessary. 
(f) APPLICATION.—Upon submission of the statement referred 
to in subsection (b)— 
(1) all references in sections 5101 through 5112, sections 
5201 through 5205, section 5301, and section 5401 of House 
Concurrent Resolution 71 (115th Congress) to a fiscal year 
shall be considered for all purposes in the House to be ref-
erences to the succeeding fiscal year; and 
(2) all references in the provisions referred to in paragraph 
(1) to allocations, aggregates, or other appropriate levels in 
‘‘this concurrent resolution’’, ‘‘the most recently agreed to 
concurrent resolution on the budget’’, or ‘‘this resolution’’ shall 
be considered for all purposes in the House to be references 
to the allocations, aggregates, or other appropriate levels con-
tained in the statement referred to in subsection (b), as 
adjusted. 
(g) EXPIRATION.—Subsections (a) through (f) shall no longer 
apply if a concurrent resolution on the budget for fiscal year 2019 
is agreed to by the Senate and House of Representatives. 
Deadline. 
Congressional 
Record, 
publication. 
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132 STAT. 126 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 30105. EXERCISE OF RULEMAKING POWERS. 
Sections 30103 and 30104 are enacted by the Congress— 
(1) as an exercise of the rulemaking power of the Senate 
and the House of Representatives, respectively, and as such 
they shall be considered as part of the rules of each House, 
respectively, or of that House to which they specifically apply, 
and such rules shall supersede other rules only to the extent 
that they are inconsistent therewith; and 
(2) with full recognition of the constitutional right of either 
House to change such rules (so far as relating to such House) 
at any time, in the same manner, and to the same extent 
as in the case of any other rule of such House. 
TITLE II—OFFSETS 
SEC. 30201. CUSTOMS USER FEES. 
(a) IN GENERAL.—Section 13031(j)(3) of the Consolidated Omni-
bus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is 
amended— 
(1) in subparagraph (A), by striking ‘‘January 14, 2026’’ 
and inserting ‘‘February 24, 2027’’; and 
(2) in subparagraph (B)(i), by striking ‘‘September 30, 2025’’ 
and inserting ‘‘September 30, 2027’’. 
(b) RATE FOR MERCHANDISE PROCESSING FEES.—Section 503 
of the United States–Korea Free Trade Agreement Implementation 
Act (Public Law 112–41; 19 U.S.C. 3805 note) is amended by 
striking ‘‘January 14, 2026’’ and inserting ‘‘February 24, 2027’’. 
SEC. 30202. AVIATION SECURITY SERVICE FEES. 
Paragraph (4) of section 44940(i) of title 49, United States 
Code, is amended by adding at the end the following new subpara-
graphs: 
‘‘(M) $1,640,000,000 for fiscal year 2026. 
‘‘(N) $1,680,000,000 for fiscal year 2027.’’. 
SEC. 30203. EXTENSION OF CERTAIN IMMIGRATION FEES. 
(a) VISA WAIVER PROGRAM.—Section 217(h)(3)(B)(iii) of the 
Immigration and Nationality Act (8 U.S.C. 1187(h)(3)(B)(iii)) is 
amended by striking ‘‘September 30, 2020’’ and inserting ‘‘Sep-
tember 30, 2027’’. 
(b) L–1 AND H–1B VISAS.—Section 411 of the Air Transportation 
Safety and System Stabilization Act (49 U.S.C. 40101 note) is 
amended by striking ‘‘September 30, 2025’’ each place it appears 
and inserting ‘‘September 30, 2027’’. 
SEC. 30204. STRATEGIC PETROLEUM RESERVE DRAWDOWN. 
(a) DRAWDOWN AND SALE.— 
(1) IN
GENERAL.—Notwithstanding section 161 of the 
Energy Policy and Conservation Act (42 U.S.C. 6241), except 
as provided in subsection (b), the Secretary of Energy shall 
draw down and sell from the Strategic Petroleum Reserve— 
(A) 30,000,000 barrels of crude oil during the period 
of fiscal years 2022 through 2025; 
(B) 35,000,000 barrels of crude oil during fiscal year 
2026; and 
(C) 35,000,000 barrels of crude oil during fiscal year 
2027. 
42 USC 6241 
note. 
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132 STAT. 127 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) DEPOSIT OF AMOUNTS RECEIVED FROM SALE.—Amounts 
received from a sale under paragraph (1) shall be deposited 
in the general fund of the Treasury during the fiscal year 
in which the sale occurs. 
(b) EMERGENCY PROTECTION.—The Secretary of Energy may 
not draw down and sell crude oil under this section in quantities 
that would limit the authority to sell petroleum products under 
subsection (h) of section 161 of the Energy Policy and Conservation 
Act (42 U.S.C. 6241) in the full quantity authorized by that sub-
section. 
(c) STRATEGIC PETROLEUM DRAWDOWN CONDITIONS AND LIMITA-
TIONS.— 
(1) CONDITIONS.—Section 161(h)(1) of the Energy Policy 
and Conservation Act (42 U.S.C. 6241(h)(1)) is amended in 
subparagraph (B) by striking ‘‘shortage; and’’ and all that fol-
lows through ‘‘Secretary of’’ in subparagraph (C) and inserting 
the following: ‘‘shortage; 
‘‘(C) the Secretary has found that action taken under 
this subsection will not impair the ability of the United 
States to carry out obligations of the United States under 
the international energy program; and 
‘‘(D) the Secretary of’’. 
(2) LIMITATIONS.—Section 161(h)(2) of the Energy Policy 
and Conservation Act (42 U.S.C. 6241(h)(2)) is amended by 
striking ‘‘450,000,000’’ each place it appears and inserting 
‘‘350,000,000’’. 
SEC. 30205. ELIMINATION OF SURPLUS FUNDS OF FEDERAL RESERVE 
BANKS. 
Section 7(a)(3)(A) of the Federal Reserve Act (12 U.S.C. 
289(a)(3)(A)) is amended by striking ‘‘$10,000,000,000’’ and inserting 
‘‘$7,500,000,000’’. 
SEC. 30206. REEMPLOYMENT SERVICES AND ELIGIBILITY ASSESS-
MENTS. 
(a) IN GENERAL.—Title III of the Social Security Act (42 U.S.C. 
501 et seq.) is amended by adding at the end the following: 
‘‘SEC. 306. GRANTS TO STATES FOR REEMPLOYMENT SERVICES AND 
ELIGIBILITY ASSESSMENTS. 
‘‘(a) IN GENERAL.—The Secretary of Labor (in this section 
referred to as the ‘Secretary’) shall award grants under this section 
for a fiscal year to eligible States to conduct a program of reemploy-
ment services and eligibility assessments for individuals referred 
to reemployment services as described in section 303(j) for weeks 
in such fiscal year for which such individuals receive unemployment 
compensation. 
‘‘(b) PURPOSES.—The purposes of this section are to accomplish 
the following goals: 
‘‘(1) To improve employment outcomes of individuals that 
receive unemployment compensation and to reduce the average 
duration of receipt of such compensation through employment. 
‘‘(2) To strengthen program integrity and reduce improper 
payments of unemployment compensation by States through 
the detection and prevention of such payments to individuals 
who are not eligible for such compensation. 
‘‘(3) To promote alignment with the broader vision of the 
Workforce Innovation and Opportunity Act (29 U.S.C. 3101 
42 USC 506. 
42 USC 6241 
note. 
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132 STAT. 128 
PUBLIC LAW 115–123—FEB. 9, 2018 
et seq.) of increased program integration and service delivery 
for job seekers, including claimants for unemployment com-
pensation. 
‘‘(4) To establish reemployment services and eligibility 
assessments as an entry point for individuals receiving 
unemployment compensation into other workforce system 
partner programs. 
‘‘(c) EVIDENCE-BASED STANDARDS.— 
‘‘(1) IN
GENERAL.—In carrying out a State program of 
reemployment services and eligibility assessments using grant 
funds awarded to the State under this section, a State shall 
use such funds only for interventions demonstrated to reduce 
the number of weeks for which program participants receive 
unemployment compensation by improving employment out-
comes for program participants. 
‘‘(2) EXPANDING EVIDENCE-BASED INTERVENTIONS.—In addi-
tion to the requirement imposed by paragraph (1), a State 
shall— 
‘‘(A) for fiscal years 2023 and 2024, use no less than 
25 percent of the grant funds awarded to the State under 
this section for interventions with a high or moderate 
causal evidence rating that show a demonstrated capacity 
to improve employment and earnings outcomes for program 
participants; 
‘‘(B) for fiscal years 2025 and 2026, use no less than 
40 percent of such grant funds for interventions described 
in subparagraph (A); and 
‘‘(C) for fiscal years beginning after fiscal year 2026, 
use no less than 50 percent of such grant funds for interven-
tions described in subparagraph (A). 
‘‘(d) EVALUATIONS.— 
‘‘(1) REQUIRED EVALUATIONS.—Any intervention without a 
high or moderate causal evidence rating used by a State in 
carrying out a State program of reemployment services and 
eligibility assessments under this section shall be under evalua-
tion at the time of use. 
‘‘(2) FUNDING LIMITATION.—A State shall use not more than 
10 percent of grant funds awarded to the State under this 
section to conduct or cause to be conducted evaluations of 
interventions used in carrying out a program under this section 
(including evaluations conducted pursuant to paragraph (1)). 
‘‘(e) STATE PLAN.— 
‘‘(1) IN GENERAL.—As a condition of eligibility to receive 
a grant under this section for a fiscal year, a State shall 
submit to the Secretary, at such time and in such manner 
as the Secretary may require, a State plan that outlines how 
the State intends to conduct a program of reemployment serv-
ices and eligibility assessments under this section, including— 
‘‘(A) assurances that, and a description of how, the 
program will provide— 
‘‘(i) proper notification to participating individuals 
of the program’s eligibility conditions, requirements, 
and benefits, including the issuance of warnings and 
simple, clear notifications to ensure that participating 
individuals are fully aware of the consequences of 
Effective date. 
Time period. 
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132 STAT. 129 
PUBLIC LAW 115–123—FEB. 9, 2018 
failing to adhere to such requirements, including poli-
cies related to non-attendance or non-fulfillment of 
work search requirements; and 
‘‘(ii) reasonable scheduling accommodations to 
maximize participation for eligible individuals; 
‘‘(B) assurances that, and a description of how, the 
program will conform with the purposes outlined in sub-
section (b) and satisfy the requirement to use evidence- 
based standards under subsection (c), including— 
‘‘(i) a description of the evidence-based interven-
tions the State plans to use to speed reemployment; 
‘‘(ii) an explanation of how such interventions are 
appropriate to the population served; and 
‘‘(iii) if applicable, a description of the evaluation 
structure the State plans to use for interventions with-
out at least a moderate or high causal evidence rating, 
which may include national evaluations conducted by 
the Department of Labor or by other entities; and 
‘‘(C) a description of any reemployment activities and 
evaluations conducted in the prior fiscal year, and any 
data collected on— 
‘‘(i) characteristics of program participants; 
‘‘(ii) the number of weeks for which program 
participants receive unemployment compensation; and 
‘‘(iii) employment and other outcomes for program 
participants 
consistent 
with 
State 
performance 
accountability 
measures 
provided 
by 
the 
State 
unemployment compensation program and in section 
116(b) of the Workforce Innovation and Opportunity 
Act (29 U.S.C. 3141(b)). 
‘‘(2) APPROVAL.—The Secretary shall approve any State 
plan, that is timely submitted to the Secretary, in such manner 
as the Secretary may require, that satisfies the conditions 
described in paragraph (1). 
‘‘(3) DISAPPROVAL AND REVISION.—If the Secretary deter-
mines that a State plan submitted pursuant to this subsection 
fails to satisfy the conditions described in paragraph (1), the 
Secretary shall— 
‘‘(A) disapprove such plan; 
‘‘(B) provide to the State, not later than 30 days after 
the date of receipt of the State plan, a written notice 
of such disapproval that includes a description of any por-
tion of the plan that was not approved and the reason 
for the disapproval of each such portion; and 
‘‘(C) provide the State with an opportunity to correct 
any such failure and submit a revised State plan. 
‘‘(f) ALLOCATION OF FUNDS.— 
‘‘(1) BASE FUNDING.— 
‘‘(A) IN GENERAL.—For each fiscal year after fiscal year 
2020, the Secretary shall allocate a percentage equal to 
the base funding percentage for such fiscal year of the 
funds made available for grants under this section among 
the States awarded such a grant for such fiscal year using 
a formula prescribed by the Secretary based on the rate 
of insured unemployment (as defined in section 203(e)(1) 
of the Federal-State Extended Unemployment Compensa-
tion Act of 1970 (26 U.S.C. 3304 note)) in the State for 
Time periods. 
Determination. 
Deadline. 
Notice. 
Determination. 
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132 STAT. 130 
PUBLIC LAW 115–123—FEB. 9, 2018 
a period to be determined by the Secretary. In developing 
such formula with respect to a State, the Secretary shall 
consider the importance of avoiding sharp reductions in 
grant funding to a State over time. 
‘‘(B) BASE
FUNDING
PERCENTAGE.—For purposes of 
subparagraph (A), the term ‘base funding percentage’ 
means— 
‘‘(i) for fiscal years 2021 through 2026, 89 percent; 
and 
‘‘(ii) for fiscal years after 2026, 84 percent. 
‘‘(2) RESERVATION FOR OUTCOME PAYMENTS.— 
‘‘(A) IN GENERAL.—Of the amounts made available for 
grants under this section for each fiscal year after 2020, 
the Secretary shall reserve a percentage equal to the out-
come reservation percentage for such fiscal year for out-
come payments to increase the amount otherwise awarded 
to a State under paragraph (1). Such outcome payments 
shall be paid to States conducting reemployment services 
and eligibility assessments under this section that, during 
the previous fiscal year, met or exceeded the outcome goals 
provided in subsection (b)(1) related to reducing the average 
duration of receipt of unemployment compensation by 
improving employment outcomes. 
‘‘(B) OUTCOME
RESERVATION
PERCENTAGE.—For pur-
poses of subparagraph (A), the term ‘outcome reservation 
percentage’ means— 
‘‘(i) for fiscal years 2021 through 2026, 10 percent; 
and 
‘‘(ii) for fiscal years after 2026, 15 percent. 
‘‘(3) RESERVATION FOR RESEARCH AND TECHNICAL ASSIST-
ANCE.—Of the amounts made available for grants under this 
section for each fiscal year after 2020, the Secretary may 
reserve not more than 1 percent to conduct research and provide 
technical assistance to States. 
‘‘(4) CONSULTATION AND PUBLIC COMMENT.—Not later than 
September 30, 2019, the Secretary shall— 
‘‘(A) consult with the States and seek public comment 
in developing the allocation formula under paragraph (1) 
and the criteria for carrying out the reservations under 
paragraph (2); and 
‘‘(B) make publicly available the allocation formula 
and criteria developed pursuant to subclause (A). 
‘‘(g) NOTIFICATION TO CONGRESS.—Not later than 90 days prior 
to making any changes to the allocation formula or the criteria 
developed pursuant to subsection (f)(5)(A), the Secretary shall 
submit to Congress, including to the Committee on Ways and Means 
and the Committee on Appropriations of the House of Representa-
tives and the Committee on Finance and the Committee on Appro-
priations of the Senate, a notification of any such change. 
‘‘(h) SUPPLEMENT NOT SUPPLANT.—Funds made available to 
carry out this section shall be used to supplement the level of 
Federal, State, and local public funds that, in the absence of such 
availability, would be expended to provide reemployment services 
and eligibility assessments to individuals receiving unemployment 
compensation, and in no case to supplant such Federal, State, 
or local public funds. 
‘‘(i) DEFINITIONS.—In this section: 
Deadline. 
Criteria. 
Deadline. 
Definition. 
Definition. 
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132 STAT. 131 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(1) CAUSAL
EVIDENCE
RATING.—The terms ‘high causal 
evidence rating’ and ‘moderate causal evidence rating’ shall 
have the meaning given such terms by the Secretary of Labor. 
‘‘(2) ELIGIBLE STATE.—The term ‘eligible State’ means a 
State that has in effect a State plan approved by the Secretary 
in accordance with subsection (e). 
‘‘(3) INTERVENTION.—The term ‘intervention’ means a 
service delivery strategy for the provision of State reemploy-
ment services and eligibility assessment activities under this 
section. 
‘‘(4) STATE.—The term ‘State’ has the meaning given the 
term in section 205 of the Federal-State Extended Unemploy-
ment Compensation Act of 1970 (26 U.S.C. 3304 note). 
‘‘(5) UNEMPLOYMENT COMPENSATION.—The term unemploy-
ment compensation means ‘regular compensation’, ‘extended 
compensation’, and ‘additional compensation’ (as such terms 
are defined by section 205 of the Federal-State Extended 
Unemployment Compensation Act of 1970 (26 U.S.C. 3304 
note)).’’. 
(b) REPORT.—Not later than 3 years after the date of enactment 
of this Act, the Secretary of Labor shall submit to Congress a 
report to describe promising interventions used by States to provide 
reemployment assistance. 
(c) ADJUSTMENT TO DISCRETIONARY SPENDING LIMITS.—Section 
251(b)(2) of the Balanced Budget and Emergency Deficit Control 
Act of 1985 (2 U.S.C. 901(b)(2)) is amended by adding at the 
end the following: 
‘‘(E) REEMPLOYMENT SERVICES AND ELIGIBILITY ASSESS-
MENTS.— 
‘‘(i) IN
GENERAL.—If a bill or joint resolution 
making appropriations for a fiscal year is enacted that 
specifies an amount for grants to States under section 
306 of the Social Security Act, then the adjustment 
for that fiscal year shall be the additional new budget 
authority provided in that Act for such grants for that 
fiscal year, but shall not exceed— 
‘‘(I) for fiscal year 2018, $0; 
‘‘(II) for fiscal year 2019, $33,000,000; 
‘‘(III) for fiscal year 2020, $58,000,000; and 
‘‘(IV) for fiscal year 2021, $83,000,000. 
‘‘(ii) DEFINITION.—As used in this subparagraph, 
the term ‘additional new budget authority’ means the 
amount provided for a fiscal year, in excess of 
$117,000,000, in an appropriation Act and specified 
to pay for grants to States under section 306 of the 
Social Security Act.’’. 
(d) OTHER BUDGETARY ADJUSTMENTS.—Section 314 of the 
Congressional Budget Act of 1974 (2 U.S.C. 645) is amended by 
adding at the end the following: 
‘‘(g) ADJUSTMENT
FOR REEMPLOYMENT SERVICES
AND ELIGI-
BILITY ASSESSMENTS.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ADJUSTMENTS.—If the Committee on Appropria-
tions of either House reports an appropriation measure 
for any of fiscal years 2022 through 2027 that provides 
budget authority for grants under section 306 of the Social 
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132 STAT. 132 
PUBLIC LAW 115–123—FEB. 9, 2018 
Security Act, or if a conference committee submits a con-
ference report thereon, the chairman of the Committee 
on the Budget of the House of Representatives or the 
Senate shall make the adjustments referred to in subpara-
graph (B) to reflect the additional new budget authority 
provided for such grants in that measure or conference 
report and the outlays resulting therefrom, consistent with 
subparagraph (D). 
‘‘(B) 
TYPES
OF
ADJUSTMENTS.—The 
adjustments 
referred to in this subparagraph consist of adjustments 
to— 
‘‘(i) the discretionary spending limits for that fiscal 
year as set forth in the most recently adopted concur-
rent resolution on the budget; 
‘‘(ii) the allocations to the Committees on Appro-
priations of the Senate and the House of Representa-
tives for that fiscal year under section 302(a); and 
‘‘(iii) the appropriate budget aggregates for that 
fiscal year in the most recently adopted concurrent 
resolution on the budget. 
‘‘(C) 
ENFORCEMENT.—The 
adjusted 
discretionary 
spending limits, allocations, and aggregates under this 
paragraph shall be considered the appropriate limits, 
allocations, and aggregates for purposes of congressional 
enforcement of this Act and concurrent budget resolutions 
under this Act. 
‘‘(D) LIMITATION.—No adjustment may be made under 
this subsection in excess of— 
‘‘(i) for fiscal year 2022, $133,000,000; 
‘‘(ii) for fiscal year 2023, $258,000,000; 
‘‘(iii) for fiscal year 2024, $433,000,000; 
‘‘(iv) for fiscal year 2025, $533,000,000; 
‘‘(v) for fiscal year 2026, $608,000,000; and 
‘‘(vi) for fiscal year 2027, $633,000,000. 
‘‘(E) DEFINITION.—As used in this subsection, the term 
‘additional new budget authority’ means the amount provided 
for a fiscal year, in excess of $117,000,000, in an appropriation 
measure or conference report (as the case may be) and specified 
to pay for grants to States under section 306 of the Social 
Security Act. 
‘‘(2) REPORT ON 302(B) LEVEL.—Following any adjustment 
made under paragraph (1), the Committees on Appropriations 
of the Senate and the House of Representatives may report 
appropriately revised suballocations pursuant to section 302(b) 
to carry out this subsection.’’. 
TITLE III—TEMPORARY EXTENSION OF 
PUBLIC DEBT LIMIT 
SEC. 30301. TEMPORARY EXTENSION OF PUBLIC DEBT LIMIT. 
(a) IN GENERAL.—Section 3101(b) of title 31, United States 
Code, shall not apply for the period beginning on the date of 
the enactment of this Act and ending on March 1, 2019. 
(b) SPECIAL RULE RELATING TO OBLIGATIONS ISSUED DURING 
EXTENSION PERIOD.—Effective on March 2, 2019, the limitation 
Effective date. 
31 USC 3101 
note. 
Time period. 
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132 STAT. 133 
PUBLIC LAW 115–123—FEB. 9, 2018 
in effect under section 3101(b) of title 31, United States Code, 
shall be increased to the extent that— 
(1) the face amount of obligations issued under chapter 
31 of such title and the face amount of obligations whose 
principal and interest are guaranteed by the United States 
Government (except guaranteed obligations held by the Sec-
retary of the Treasury) outstanding on March 2, 2019, exceeds 
(2) the face amount of such obligations outstanding on 
the date of the enactment of this Act. 
(c) RESTORING CONGRESSIONAL AUTHORITY OVER THE NATIONAL 
DEBT.— 
(1) EXTENSION LIMITED TO NECESSARY OBLIGATIONS.—An 
obligation shall not be taken into account under subsection 
(b)(1) unless the issuance of such obligation was necessary 
to fund a commitment incurred pursuant to law by the Federal 
Government that required payment before March 2, 2019. 
(2) PROHIBITION ON CREATION OF CASH RESERVE DURING 
EXTENSION PERIOD.—The Secretary of the Treasury shall not 
issue obligations during the period specified in subsection (a) 
for the purpose of increasing the cash balance above normal 
operating balances in anticipation of the expiration of such 
period. 
TITLE IV—JOINT SELECT COMMITTEES 
Subtitle A—Joint Select Committee on 
Solvency of Multiemployer Pension Plans 
SEC. 30421. DEFINITIONS. 
In this subtitle— 
(1) the term ‘‘joint committee’’ means the Joint Select Com-
mittee on Solvency of Multiemployer Pension Plans established 
under section 30422(a); and 
(2) the term ‘‘joint committee bill’’ means a bill consisting 
of the proposed legislative language of the joint committee 
recommended in accordance with section 30422(b)(2)(B)(ii) and 
introduced under section 30424(a). 
SEC. 30422. ESTABLISHMENT OF JOINT SELECT COMMITTEE. 
(a) ESTABLISHMENT OF JOINT SELECT COMMITTEE.—There is 
established a joint select committee of Congress to be known as 
the ‘‘Joint Select Committee on Solvency of Multiemployer Pension 
Plans’’. 
(b) IMPLEMENTATION.— 
(1) GOAL.—The goal of the joint committee is to improve 
the solvency of multiemployer pension plans and the Pension 
Benefit Guaranty Corporation. 
(2) DUTIES.— 
(A) IN GENERAL.—The joint committee shall provide 
recommendations and legislative language that will signifi-
cantly improve the solvency of multiemployer pension plans 
and the Pension Benefit Guaranty Corporation. 
(B) REPORT, RECOMMENDATIONS, AND LEGISLATIVE LAN-
GUAGE.— 
Recommenda- 
tions. 
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132 STAT. 134 
PUBLIC LAW 115–123—FEB. 9, 2018 
(i) IN
GENERAL.—Not later than November 30, 
2018, the joint committee shall vote on— 
(I) a report that contains a detailed statement 
of the findings, conclusions, and recommendations 
of the joint committee; and 
(II) proposed legislative language to carry out 
the recommendations described in subclause (I). 
(ii) APPROVAL OF REPORT AND LEGISLATIVE LAN-
GUAGE.— 
(I) IN GENERAL.—The report of the joint com-
mittee and the proposed legislative language 
described in clause (i) shall only be approved upon 
receiving the votes of— 
(aa) a majority of joint committee mem-
bers appointed by the Speaker of the House 
of Representatives and the Majority Leader 
of the Senate; and 
(bb) a majority of joint committee mem-
bers appointed by the Minority Leader of the 
House of Representatives and the Minority 
Leader of the Senate. 
(II) AVAILABILITY.—The text of any report and 
proposed legislative language shall be publicly 
available in electronic form at least 24 hours prior 
to its consideration. 
(iii) ADDITIONAL VIEWS.—A member of the joint 
committee who gives notice of an intention to file 
supplemental, minority, or additional views at the time 
of the final joint committee vote on the approval of 
the report and legislative language under clause (ii) 
shall be entitled to 2 calendar days after the day 
of such notice in which to file such views in writing 
with the co-chairs. Such views shall then be included 
in the joint committee report and printed in the same 
volume, or part thereof, and their inclusion shall be 
noted on the cover of the report. In the absence of 
timely notice, the joint committee report may be 
printed and transmitted immediately without such 
views. 
(iv) TRANSMISSION
OF
REPORT
AND
LEGISLATIVE 
LANGUAGE.—If the report and legislative language are 
approved by the joint committee pursuant to clause 
(ii), the joint committee shall submit the joint com-
mittee report and legislative language described in 
clause (i) to the President, the Vice President, the 
Speaker of the House of Representatives, and the 
majority and minority leaders of each House of Con-
gress not later than 15 calendar days after such 
approval. 
(v) REPORT
AND
LEGISLATIVE
LANGUAGE
TO
BE 
MADE PUBLIC.—Upon the approval of the joint com-
mittee report and legislative language pursuant to 
clause (ii), the joint committee shall promptly make 
the full report and legislative language, and a record 
of any vote, available to the public. 
(3) MEMBERSHIP.— 
Deadlines. 
Records. 
Public 
information. 
Web posting. 
Deadline. 
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132 STAT. 135 
PUBLIC LAW 115–123—FEB. 9, 2018 
(A) IN GENERAL.—The joint committee shall be com-
posed of 16 members appointed pursuant to subparagraph 
(B). 
(B) APPOINTMENT.—Members of the joint committee 
shall be appointed as follows: 
(i) The Speaker of the House of Representatives 
shall appoint 4 members from among Members of the 
House of Representatives. 
(ii) The Minority Leader of the House of Represent-
atives shall appoint 4 members from among Members 
of the House of Representatives. 
(iii) The Majority Leader of the Senate shall 
appoint 4 members from among Members of the 
Senate. 
(iv) The Minority Leader of the Senate shall 
appoint 4 members from among Members of the 
Senate. 
(C) CO-CHAIRS.—Two of the appointed members of the 
joint committee will serve as co-chairs. The Speaker of 
the House of Representatives and the Majority Leader of 
the Senate shall jointly appoint one co-chair, and the 
Minority Leader of the House of Representatives and the 
Minority Leader of the Senate shall jointly appoint the 
second co-chair. The co-chairs shall be appointed not later 
than 14 calendar days after the date of enactment of this 
Act. 
(D) DATE.—Members of the joint committee shall be 
appointed not later than 14 calendar days after the date 
of enactment of this Act. 
(E) PERIOD
OF
APPOINTMENT.—Members shall be 
appointed for the life of the joint committee. Any vacancy 
in the joint committee shall not affect its powers, but 
shall be filled not later than 14 calendar days after the 
date on which the vacancy occurs, in the same manner 
as the original appointment was made. If a member of 
the joint committee ceases to be a Member of the House 
of Representatives or the Senate, as the case may be, 
the member is no longer a member of the joint committee 
and a vacancy shall exist. 
(4) ADMINISTRATION.— 
(A) GENERAL
AUTHORITY.—For purposes of enabling 
the joint committee to exercise its powers, functions, and 
duties under this subtitle, and consistent with the Standing 
Rules of the Senate, there is authorized from the date 
of enactment of this Act through February 28, 2019, 
$500,000 to be allocated— 
(i) in total during the period October 1, 2017 
through September 30, 2018; and 
(ii) any remaining amounts shall be carried for-
ward for the period October 1, 2018 through February 
28, 2019. 
(B) EXPENSES.—Expenses of the joint committee shall 
be paid from the contingent fund of the Senate upon 
vouchers approved by the co-chairs, subject to the rules 
and regulations of the Senate. 
(C) QUORUM.—Nine members of the joint committee 
shall constitute a quorum for purposes of voting and 
Time periods. 
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132 STAT. 136 
PUBLIC LAW 115–123—FEB. 9, 2018 
meeting, and 5 members of the joint committee shall con-
stitute a quorum for holding hearings. 
(D) VOTING.—No proxy voting shall be allowed on 
behalf of the members of the joint committee. 
(E) MEETINGS.— 
(i) INITIAL MEETING.—Not later than 30 calendar 
days after the date of enactment of this Act, the joint 
committee shall hold its first meeting. 
(ii) AGENDA.—The co-chairs of the joint committee 
shall provide an agenda to the joint committee mem-
bers not less than 48 hours in advance of any meeting. 
(F) HEARINGS.— 
(i) IN GENERAL.—The joint committee may, for the 
purpose of carrying out this section, hold such hearings, 
sit and act at such times and places, require attendance 
of witnesses and production of books, papers, and docu-
ments, take such testimony, receive such evidence, and 
administer such oaths as the joint committee considers 
advisable. 
(ii) HEARING PROCEDURES AND RESPONSIBILITIES OF 
CO-CHAIRS.— 
(I) ANNOUNCEMENT.—The co-chairs of the joint 
committee shall make a public announcement of 
the date, place, time, and subject matter of any 
hearing to be conducted, not less than 7 days 
in advance of such hearing, unless the co-chairs 
determine that there is good cause to begin such 
hearing at an earlier date. 
(II) EQUAL REPRESENTATION OF WITNESSES.— 
Each co-chair shall be entitled to select an equal 
number of witnesses for each hearing held by the 
joint committee. 
(III) 
WRITTEN
STATEMENT.—A 
witness 
appearing before the joint committee shall file a 
written statement of proposed testimony at least 
2 calendar days before the appearance of the wit-
ness, unless the requirement is waived by the co- 
chairs, following their determination that there 
is good cause for failure to comply with such 
requirement. 
(G) MINIMUM
NUMBER
OF
PUBLIC
MEETINGS
AND 
HEARINGS.—The joint committee shall hold— 
(i) not less than a total of 5 public meetings or 
public hearings; and 
(ii) not less than 3 public hearings, which may 
include field hearings. 
(H) TECHNICAL ASSISTANCE.—Upon written request of 
the co-chairs, a Federal agency, including legislative branch 
agencies, shall provide technical assistance to the joint 
committee in order for the joint committee to carry out 
its duties. 
(I) STAFFING.— 
(i) DETAILS.—Employees of the legislative branch 
may be detailed to the joint committee on a nonreim-
bursable basis, consistent with the rules and regula-
tions of the Senate. 
Time period. 
Deadlines. 
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132 STAT. 137 
PUBLIC LAW 115–123—FEB. 9, 2018 
(ii) STAFF DIRECTOR.—The co-chairs, acting jointly, 
may designate one such employee as staff director 
of the joint committee. 
(c) ETHICAL STANDARDS.—Members on the joint committee who 
serve in the House of Representatives shall be governed by the 
ethics rules and requirements of the House. Members of the Senate 
who serve on the joint committee shall comply with the ethics 
rules of the Senate. 
(d) TERMINATION.—The joint committee shall terminate on 
December 31, 2018 or 30 days after submission of its report and 
legislative recommendations pursuant to this section whichever 
occurs first. 
SEC. 30423. FUNDING. 
(a) SPECIAL RESERVE.—To enable the joint committee to exercise 
its powers, functions, and duties under this subtitle, within the 
funds in the account for ‘‘Expenses of Inquiries and Investigations’’ 
of the Senate, not more than $500,000 shall be allocated from 
the special reserve established in S. Res. 62, agreed to February 
28, 2017 (115th Congress), for use by the joint committee. 
(b) EXPIRATION.—None of the funds made available by this 
section may be available for obligation by the joint committee after 
January 2, 2019. 
(c) AVAILABILITY REQUIREMENTS.—For purposes of the joint 
committee, section 20(b) of S. Res. 62, agreed to February 28, 
2017 (115th Congress), shall not apply. 
SEC. 30424. CONSIDERATION OF JOINT COMMITTEE BILL IN THE 
SENATE. 
(a) INTRODUCTION.—Upon receipt of proposed legislative lan-
guage approved in accordance with section 30422(b)(2)(B)(ii), the 
language shall be introduced in the Senate (by request) on the 
next day on which the Senate is in session by the Majority Leader 
of the Senate or by a Member of the Senate designated by the 
Majority Leader of the Senate. 
(b) COMMITTEE CONSIDERATION.—A joint committee bill intro-
duced in the Senate under subsection (a) shall be jointly referred 
to the Committee on Finance and the Committee on Health, Edu-
cation, Labor, and Pensions, which committees shall report the 
bill without any revision and with a favorable recommendation, 
an unfavorable recommendation, or without recommendation, no 
later than 7 session days after introduction of the bill. If either 
committee fails to report the bill within that period, that committee 
shall be automatically discharged from consideration of the bill, 
and the bill shall be placed on the appropriate calendar. 
(c) MOTION TO PROCEED TO CONSIDERATION.— 
(1) IN
GENERAL.—Notwithstanding rule XXII of the 
Standing Rules of the Senate, it is in order, not later than 
2 days of session after the date on which a joint committee 
bill is reported or discharged from the Committee on Finance 
and the Committee on Health, Education, Labor, and Pensions, 
for the Majority Leader of the Senate or the Majority Leader’s 
designee to move to proceed to the consideration of the joint 
committee bill. It shall also be in order for any Member of 
the Senate to move to proceed to the consideration of the 
joint committee bill at any time after the conclusion of such 
2-day period. 
Deadline. 
Deadline. 
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132 STAT. 138 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) CONSIDERATION
OF
MOTION.—Consideration of the 
motion to proceed to the consideration of the joint committee 
bill and all debatable motions and appeals in connection there-
with shall not exceed 10 hours, which shall be divided equally 
between the Majority and Minority Leaders or their designees. 
A motion to further limit debate is in order, shall require 
an affirmative vote of three-fifths of Members duly chosen 
and sworn, and is not debatable. 
(3) VOTE THRESHOLD.—The motion to proceed to the consid-
eration of the joint committee bill shall only be agreed to 
upon an affirmative vote of three-fifths of Members duly chosen 
and sworn. 
(4) LIMITATIONS.—The motion is not subject to a motion 
to postpone. All points of order against the motion to proceed 
to the joint committee bill are waived. A motion to reconsider 
the vote by which the motion is agreed to or disagreed to 
shall not be in order. 
(5) DEADLINE.—Not later than the last day of the 115th 
Congress, the Senate shall vote on a motion to proceed to 
the joint committee bill. 
(6) COMPANION
MEASURES.—For purposes of this sub-
section, the term ‘‘joint committee bill’’ includes a bill of the 
House of Representatives that is a companion measure to the 
joint committee bill introduced in the Senate. 
(d) RULES OF SENATE.—This section is enacted by Congress— 
(1) as an exercise of the rulemaking power of the Senate, 
and as such is deemed a part of the rules of the Senate, 
but applicable only with respect to the procedure to be followed 
in the Senate in the case of a joint committee bill, and supersede 
other rules only to the extent that they are inconsistent with 
such rules; and 
(2) with full recognition of the constitutional right of the 
Senate to change the rules (so far as relating to the procedure 
of the Senate) at any time, in the same manner, and to the 
same extent as in the case of any other rule of the Senate. 
Subtitle B—Joint Select Committee on 
Budget and Appropriations Process Re-
form 
SEC. 30441. DEFINITIONS. 
In this subtitle— 
(1) the term ‘‘joint committee’’ means the Joint Select Com-
mittee on Budget and Appropriations Process Reform estab-
lished under section 30442(a); and 
(2) the term ‘‘joint committee bill’’ means a bill consisting 
of the proposed legislative language of the joint committee 
recommended in accordance with section 30442(b)(2)(B)(ii) and 
introduced under section 30444(a). 
SEC. 30442. ESTABLISHMENT OF JOINT SELECT COMMITTEE. 
(a) ESTABLISHMENT OF JOINT SELECT COMMITTEE.—There is 
established a joint select committee of Congress to be known as 
the ‘‘Joint Select Committee on Budget and Appropriations Process 
Reform’’. 
Definition. 
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132 STAT. 139 
PUBLIC LAW 115–123—FEB. 9, 2018 
(b) IMPLEMENTATION.— 
(1) GOAL.—The goal of the joint committee is to reform 
the budget and appropriations process. 
(2) DUTIES.— 
(A) IN GENERAL.—The joint committee shall provide 
recommendations and legislative language that will signifi-
cantly reform the budget and appropriations process. 
(B) REPORT, RECOMMENDATIONS, AND LEGISLATIVE LAN-
GUAGE.— 
(i) IN
GENERAL.—Not later than November 30, 
2018, the joint committee shall vote on— 
(I) a report that contains a detailed statement 
of the findings, conclusions, and recommendations 
of the joint committee; and 
(II) proposed legislative language to carry out 
the recommendations described in subclause (I). 
(ii) APPROVAL OF REPORT AND LEGISLATIVE LAN-
GUAGE.— 
(I) IN GENERAL.—The report of the joint com-
mittee and the proposed legislative language 
described in clause (i) shall only be approved upon 
receiving the votes of— 
(aa) a majority of joint committee mem-
bers appointed by the Speaker of the House 
of Representatives and the Majority Leader 
of the Senate; and 
(bb) a majority of joint committee mem-
bers appointed by the Minority Leader of the 
House of Representatives and the Minority 
Leader of the Senate. 
(II) AVAILABILITY.—The text of any report and 
proposed legislative language shall be publicly 
available in electronic form at least 24 hours prior 
to its consideration. 
(iii) ADDITIONAL VIEWS.—A member of the joint 
committee who gives notice of an intention to file 
supplemental, minority, or additional views at the time 
of the final joint committee vote on the approval of 
the report and legislative language under clause (ii) 
shall be entitled to 2 calendar days after the day 
of such notice in which to file such views in writing 
with the co-chairs. Such views shall then be included 
in the joint committee report and printed in the same 
volume, or part thereof, and their inclusion shall be 
noted on the cover of the report. In the absence of 
timely notice, the joint committee report may be 
printed and transmitted immediately without such 
views. 
(iv) TRANSMISSION
OF
REPORT
AND
LEGISLATIVE 
LANGUAGE.—If the report and legislative language are 
approved by the joint committee pursuant to clause 
(ii), the joint committee shall submit the joint com-
mittee report and legislative language described in 
clause (i) to the President, the Vice President, the 
Speaker of the House of Representatives, and the 
Time period. 
Public 
information. 
Web posting. 
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132 STAT. 140 
PUBLIC LAW 115–123—FEB. 9, 2018 
majority and minority leaders of each House of Con-
gress not later than 15 calendar days after such 
approval. 
(v) REPORT
AND
LEGISLATIVE
LANGUAGE
TO
BE 
MADE PUBLIC.—Upon the approval of the joint com-
mittee report and legislative language pursuant to 
clause (ii), the joint committee shall promptly make 
the full report and legislative language, and a record 
of any vote, available to the public. 
(3) MEMBERSHIP.— 
(A) IN GENERAL.—The joint committee shall be com-
posed of 16 members appointed pursuant to subparagraph 
(B). 
(B) APPOINTMENT.—Members of the joint committee 
shall be appointed as follows: 
(i) The Speaker of the House of Representatives 
shall appoint 4 members from among Members of the 
House of Representatives. 
(ii) The Minority Leader of the House of Represent-
atives shall appoint 4 members from among Members 
of the House of Representatives. 
(iii) The Majority Leader of the Senate shall 
appoint 4 members from among Members of the 
Senate. 
(iv) The Minority Leader of the Senate shall 
appoint 4 members from among Members of the 
Senate. 
(C) CO-CHAIRS.—Two of the appointed members of the 
joint committee will serve as co-chairs. The Speaker of 
the House of Representatives and the Majority Leader of 
the Senate shall jointly appoint one co-chair, and the 
Minority Leader of the House of Representatives and the 
Minority Leader of the Senate shall jointly appoint the 
second co-chair. The co-chairs shall be appointed not later 
than 14 calendar days after the date of enactment of this 
Act. 
(D) DATE.—Members of the joint committee shall be 
appointed not later than 14 calendar days after the date 
of enactment of this Act. 
(E) PERIOD
OF
APPOINTMENT.—Members shall be 
appointed for the life of the joint committee. Any vacancy 
in the joint committee shall not affect its powers, but 
shall be filled not later than 14 calendar days after the 
date on which the vacancy occurs, in the same manner 
as the original appointment was made. If a member of 
the joint committee ceases to be a Member of the House 
of Representatives or the Senate, as the case may be, 
the member is no longer a member of the joint committee 
and a vacancy shall exist. 
(4) ADMINISTRATION.— 
(A) GENERAL
AUTHORITY.—For purposes of enabling 
the joint committee to exercise its powers, functions, and 
duties under this subtitle, and consistent with the Standing 
Rules of the Senate, there is authorized from the date 
of enactment of this Act through February 28, 2019, 
$500,000 to be allocated— 
Time periods. 
Deadlines. 
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132 STAT. 141 
PUBLIC LAW 115–123—FEB. 9, 2018 
(i) in total during the period October 1, 2017 
through September 30, 2018; and 
(ii) any remaining amounts shall be carried for-
ward for the period October 1, 2018 through February 
28, 2019. 
(B) EXPENSES.—Expenses of the joint committee shall 
be paid from the contingent fund of the Senate upon 
vouchers approved by the co-chairs, subject to the rules 
and regulations of the Senate. 
(C) QUORUM.—Nine members of the joint committee 
shall constitute a quorum for purposes of voting and 
meeting, and 5 members of the joint committee shall con-
stitute a quorum for holding hearings. 
(D) VOTING.—No proxy voting shall be allowed on 
behalf of the members of the joint committee. 
(E) MEETINGS.— 
(i) INITIAL MEETING.—Not later than 30 calendar 
days after the date of enactment of this Act, the joint 
committee shall hold its first meeting. 
(ii) AGENDA.—The co-chairs of the joint committee 
shall provide an agenda to the joint committee mem-
bers not less than 48 hours in advance of any meeting. 
(F) HEARINGS.— 
(i) IN GENERAL.—The joint committee may, for the 
purpose of carrying out this section, hold such hearings, 
sit and act at such times and places, require attendance 
of witnesses and production of books, papers, and docu-
ments, take such testimony, receive such evidence, and 
administer such oaths as the joint committee considers 
advisable. 
(ii) HEARING PROCEDURES AND RESPONSIBILITIES OF 
CO-CHAIRS.— 
(I) ANNOUNCEMENT.—The co-chairs of the joint 
committee shall make a public announcement of 
the date, place, time, and subject matter of any 
hearing to be conducted, not less than 7 days 
in advance of such hearing, unless the co-chairs 
determine that there is good cause to begin such 
hearing at an earlier date. 
(II) EQUAL REPRESENTATION OF WITNESSES.— 
Each co-chair shall be entitled to select an equal 
number of witnesses for each hearing held by the 
joint committee. 
(III) 
WRITTEN
STATEMENT.—A 
witness 
appearing before the joint committee shall file a 
written statement of proposed testimony at least 
2 calendar days before the appearance of the wit-
ness, unless the requirement is waived by the co- 
chairs, following their determination that there 
is good cause for failure to comply with such 
requirement. 
(G) MINIMUM
NUMBER
OF
PUBLIC
MEETINGS
AND 
HEARINGS.—The joint committee shall hold— 
(i) not less than a total of 5 public meetings or 
public hearings; and 
(ii) not less than 3 public hearings, which may 
include field hearings. 
Public 
information. 
Time periods. 
Time period. 
Deadline. 
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132 STAT. 142 
PUBLIC LAW 115–123—FEB. 9, 2018 
(H) TECHNICAL ASSISTANCE.—Upon written request of 
the co-chairs, a Federal agency, including legislative branch 
agencies, shall provide technical assistance to the joint 
committee in order for the joint committee to carry out 
its duties. 
(I) STAFFING.— 
(i) DETAILS.—Employees of the legislative branch 
may be detailed to the joint committee on a nonreim-
bursable basis, consistent with the rules and regula-
tions of the Senate. 
(ii) STAFF DIRECTOR.—The co-chairs, acting jointly, 
may designate one such employee as staff director 
of the joint committee. 
(c) ETHICAL STANDARDS.—Members on the joint committee who 
serve in the House of Representatives shall be governed by the 
ethics rules and requirements of the House. Members of the Senate 
who serve on the joint committee shall comply with the ethics 
rules of the Senate. 
(d) TERMINATION.—The joint committee shall terminate on 
December 31, 2018 or 30 days after submission of its report and 
legislative recommendations pursuant to this section whichever 
occurs first. 
SEC. 30443. FUNDING. 
(a) SPECIAL RESERVE.—To enable the joint committee to exercise 
its powers, functions, and duties under this subtitle, within the 
funds in the account for ‘‘Expenses of Inquiries and Investigations’’ 
of the Senate, not more than $500,000 shall be allocated from 
the special reserve established in S. Res. 62, agreed to February 
28, 2017 (115th Congress), for use by the joint committee. 
(b) EXPIRATION.—None of the funds made available by this 
section may be available for obligation by the joint committee after 
January 2, 2019. 
(c) AVAILABILITY REQUIREMENTS.—For purposes of the joint 
committee, section 20(b) of S. Res. 62, agreed to February 28, 
2017 (115th Congress), shall not apply. 
SEC. 30444. CONSIDERATION OF JOINT COMMITTEE BILL IN THE 
SENATE. 
(a) INTRODUCTION.—Upon receipt of proposed legislative lan-
guage approved in accordance with section 30442(b)(2)(B)(ii), the 
language shall be introduced in the Senate (by request) on the 
next day on which the Senate is in session by the Majority Leader 
of the Senate or by a Member of the Senate designated by the 
Majority Leader of the Senate. 
(b) COMMITTEE CONSIDERATION.—A joint committee bill intro-
duced in the Senate under subsection (a) shall be referred to the 
Committee on the Budget, which shall report the bill without any 
revision and with a favorable recommendation, an unfavorable rec-
ommendation, or without recommendation, no later than 7 session 
days after introduction of the bill. If the Committee on the Budget 
fails to report the bill within that period, the committee shall 
be automatically discharged from consideration of the bill, and 
the bill shall be placed on the appropriate calendar. 
(c) MOTION TO PROCEED TO CONSIDERATION.— 
(1) IN
GENERAL.—Notwithstanding rule XXII of the 
Standing Rules of the Senate, it is in order, not later than 
2 days of session after the date on which a joint committee 
Deadline. 
Deadline. 
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132 STAT. 143 
PUBLIC LAW 115–123—FEB. 9, 2018 
bill is reported or discharged from the Committee on the 
Budget, for the Majority Leader of the Senate or the Majority 
Leader’s designee to move to proceed to the consideration of 
the joint committee bill. It shall also be in order for any Member 
of the Senate to move to proceed to the consideration of the 
joint committee bill at any time after the conclusion of such 
2-day period. 
(2) CONSIDERATION
OF
MOTION.—Consideration of the 
motion to proceed to the consideration of the joint committee 
bill and all debatable motions and appeals in connection there-
with shall not exceed 10 hours, which shall be divided equally 
between the Majority and Minority Leaders or their designees. 
A motion to further limit debate is in order, shall require 
an affirmative vote of three-fifths of Members duly chosen 
and sworn, and is not debatable. 
(3) VOTE THRESHOLD.—The motion to proceed to the consid-
eration of the joint committee bill shall only be agreed to 
upon an affirmative vote of three-fifths of Members duly chosen 
and sworn. 
(4) LIMITATIONS.—The motion is not subject to a motion 
to postpone. All points of order against the motion to proceed 
to the joint committee bill are waived. A motion to reconsider 
the vote by which the motion is agreed to or disagreed to 
shall not be in order. 
(5) DEADLINE.—Not later than the last day of the 115th 
Congress, the Senate shall vote on a motion to proceed to 
the joint committee bill. 
(d) RULES OF SENATE.—This section is enacted by Congress— 
(1) as an exercise of the rulemaking power of the Senate, 
and as such is deemed a part of the rules of the Senate, 
but applicable only with respect to the procedure to be followed 
in the Senate in the case of a joint committee bill, and supersede 
other rules only to the extent that they are inconsistent with 
such rules; and 
(2) with full recognition of the constitutional right of the 
Senate to change the rules (so far as relating to the procedure 
of the Senate) at any time, in the same manner, and to the 
same extent as in the case of any other rule of the Senate. 
DIVISION D—REVENUE MEASURES 
SECTION 40001. TABLE OF CONTENTS. 
The table of contents for this division is as follows: 
DIVISION D—REVENUE MEASURES 
Sec. 40001. Table of contents. 
TITLE I—EXTENSION OF EXPIRING PROVISIONS 
Sec. 40101. Amendment of Internal Revenue Code of 1986. 
Subtitle A—Tax Relief for Families and Individuals 
Sec. 40201. Extension of exclusion from gross income of discharge of qualified prin-
cipal residence indebtedness. 
Sec. 40202. Extension of mortgage insurance premiums treated as qualified resi-
dence interest. 
Sec. 40203. Extension of above-the-line deduction for qualified tuition and related 
expenses. 
Waiver. 
Time period. 
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132 STAT. 144 
PUBLIC LAW 115–123—FEB. 9, 2018 
Subtitle B—Incentives for Growth, Jobs, Investment, and Innovation 
Sec. 40301. Extension of Indian employment tax credit. 
Sec. 40302. Extension of railroad track maintenance credit. 
Sec. 40303. Extension of mine rescue team training credit. 
Sec. 40304. Extension of classification of certain race horses as 3-year property. 
Sec. 40305. Extension of 7-year recovery period for motorsports entertainment com-
plexes. 
Sec. 40306. Extension of accelerated depreciation for business property on an In-
dian reservation. 
Sec. 40307. Extension of election to expense mine safety equipment. 
Sec. 40308. Extension of special expensing rules for certain productions. 
Sec. 40309. Extension of deduction allowable with respect to income attributable to 
domestic production activities in Puerto Rico. 
Sec. 40310. Extension of special rule relating to qualified timber gain. 
Sec. 40311. Extension of empowerment zone tax incentives. 
Sec. 40312. Extension of American Samoa economic development credit. 
Subtitle C—Incentives for Energy Production and Conservation 
Sec. 40401. Extension of credit for nonbusiness energy property. 
Sec. 40402. Extension and modification of credit for residential energy property. 
Sec. 40403. Extension of credit for new qualified fuel cell motor vehicles. 
Sec. 40404. Extension of credit for alternative fuel vehicle refueling property. 
Sec. 40405. Extension of credit for 2-wheeled plug-in electric vehicles. 
Sec. 40406. Extension of second generation biofuel producer credit. 
Sec. 40407. Extension of biodiesel and renewable diesel incentives. 
Sec. 40408. Extension of production credit for Indian coal facilities. 
Sec. 40409. Extension of credits with respect to facilities producing energy from 
certain renewable resources. 
Sec. 40410. Extension of credit for energy-efficient new homes. 
Sec. 40411. Extension and phaseout of energy credit. 
Sec. 40412. Extension of special allowance for second generation biofuel plant prop-
erty. 
Sec. 40413. Extension of energy efficient commercial buildings deduction. 
Sec. 40414. Extension of special rule for sales or dispositions to implement FERC 
or State electric restructuring policy for qualified electric utilities. 
Sec. 40415. Extension of excise tax credits relating to alternative fuels. 
Sec. 40416. Extension of Oil Spill Liability Trust Fund financing rate. 
Subtitle D—Modifications of Energy Incentives 
Sec. 40501. Modifications of credit for production from advanced nuclear power fa-
cilities. 
TITLE II—MISCELLANEOUS PROVISIONS 
Sec. 41101. Amendment of Internal Revenue Code of 1986. 
Sec. 41102. Modifications to rum cover over. 
Sec. 41103. Extension of waiver of limitations with respect to excluding from gross 
income amounts received by wrongfully incarcerated individuals. 
Sec. 41104. Individuals held harmless on improper levy on retirement plans. 
Sec. 41105. Modification of user fee requirements for installment agreements. 
Sec. 41106. Form 1040SR for seniors. 
Sec. 41107. Attorneys fees relating to awards to whistleblowers. 
Sec. 41108. Clarification of whistleblower awards. 
Sec. 41109. Clarification regarding excise tax based on investment income of pri-
vate colleges and universities. 
Sec. 41110. Exception from private foundation excess business holding tax for inde-
pendently-operated philanthropic business holdings. 
Sec. 41111. Rule of construction for Craft Beverage Modernization and Tax Reform. 
Sec. 41112. Simplification of rules regarding records, statements, and returns. 
Sec. 41113. Modification of rules governing hardship distributions. 
Sec. 41114. Modification of rules relating to hardship withdrawals from cash or de-
ferred arrangements. 
Sec. 41115. Opportunity Zones rule for Puerto Rico. 
Sec. 41116. Tax home of certain citizens or residents of the United States living 
abroad. 
Sec. 41117. Treatment of foreign persons for returns relating to payments made in 
settlement of payment card and third party network transactions. 
Sec. 41118. Repeal of shift in time of payment of corporate estimated taxes. 
Sec. 41119. Enhancement of carbon dioxide sequestration credit. 
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132 STAT. 145 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE I—EXTENSION OF EXPIRING 
PROVISIONS 
SEC. 40101. AMENDMENT OF INTERNAL REVENUE CODE OF 1986. 
Except as otherwise expressly provided, whenever in this title 
an amendment or repeal is expressed in terms of an amendment 
to, or repeal of, a section or other provision, the reference shall 
be considered to be made to a section or other provision of the 
Internal Revenue Code of 1986. 
Subtitle A—Tax Relief for Families and 
Individuals 
SEC. 40201. EXTENSION OF EXCLUSION FROM GROSS INCOME OF DIS-
CHARGE OF QUALIFIED PRINCIPAL RESIDENCE INDEBT-
EDNESS. 
(a) IN GENERAL.—Section 108(a)(1)(E) is amended by striking 
‘‘January 1, 2017’’ each place it appears and inserting ‘‘January 
1, 2018’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to discharges of indebtedness after December 31, 2016. 
SEC. 40202. EXTENSION OF MORTGAGE INSURANCE PREMIUMS 
TREATED AS QUALIFIED RESIDENCE INTEREST. 
(a) IN GENERAL.—Subclause (I) of section 163(h)(3)(E)(iv) is 
amended by striking ‘‘December 31, 2016’’ and inserting ‘‘December 
31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to amounts paid or accrued after December 31, 2016. 
SEC. 40203. EXTENSION OF ABOVE-THE-LINE DEDUCTION FOR QUALI-
FIED TUITION AND RELATED EXPENSES. 
(a) IN
GENERAL.—Section 222(e) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2016. 
Subtitle B—Incentives for Growth, Jobs, 
Investment, and Innovation 
SEC. 40301. EXTENSION OF INDIAN EMPLOYMENT TAX CREDIT. 
(a) IN
GENERAL.—Section 45A(f) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2016. 
SEC. 40302. EXTENSION OF RAILROAD TRACK MAINTENANCE CREDIT. 
(a) IN
GENERAL.—Section 45G(f) is amended by striking 
‘‘January 1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendment made by this section 
shall apply to expenditures paid or incurred in taxable years 
beginning after December 31, 2016. 
26 USC 45G 
note. 
26 USC 45A note. 
26 USC 222 note. 
26 USC 163 note. 
26 USC 108 note. 
26 USC 108. 
Applicability. 
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132 STAT. 146 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) SAFE
HARBOR
ASSIGNMENTS.—Assignments, including 
related expenditures paid or incurred, under paragraph (2) 
of section 45G(b) of the Internal Revenue Code of 1986 for 
taxable years ending after January 1, 2017, and before January 
1, 2018, shall be treated as effective as of the close of such 
taxable year if made pursuant to a written agreement entered 
into no later than 90 days following the date of the enactment 
of this Act. 
SEC. 40303. EXTENSION OF MINE RESCUE TEAM TRAINING CREDIT. 
(a) IN
GENERAL.—Section 45N(e) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2016. 
SEC. 40304. EXTENSION OF CLASSIFICATION OF CERTAIN RACE 
HORSES AS 3-YEAR PROPERTY. 
(a) IN GENERAL.—Section 168(e)(3)(A)(i) is amended— 
(1) by striking ‘‘January 1, 2017’’ in subclause (I) and 
inserting ‘‘January 1, 2018’’, and 
(2) by striking ‘‘December 31, 2016’’ in subclause (II) and 
inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40305. EXTENSION OF 7-YEAR RECOVERY PERIOD FOR MOTOR-
SPORTS ENTERTAINMENT COMPLEXES. 
(a) IN GENERAL.—Section 168(i)(15)(D) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40306. EXTENSION OF ACCELERATED DEPRECIATION FOR BUSI-
NESS PROPERTY ON AN INDIAN RESERVATION. 
(a) IN GENERAL.—Section 168(j)(9) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40307. EXTENSION OF ELECTION TO EXPENSE MINE SAFETY 
EQUIPMENT. 
(a) IN GENERAL.—Section 179E(g) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40308. EXTENSION OF SPECIAL EXPENSING RULES FOR CERTAIN 
PRODUCTIONS. 
(a) IN
GENERAL.—Section 181(g) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to productions commencing after December 31, 2016. 
SEC. 40309. EXTENSION OF DEDUCTION ALLOWABLE WITH RESPECT 
TO INCOME ATTRIBUTABLE TO DOMESTIC PRODUCTION 
ACTIVITIES IN PUERTO RICO. 
For purposes of applying section 199(d)(8)(C) of the Internal 
Revenue Code of 1986 with respect to taxable years beginning 
during 2017, such section shall be applied— 
26 USC 199 note. 
26 USC 181 note. 
26 USC 179E 
note. 
26 USC 168 note. 
26 USC 168 note. 
26 USC 168 note. 
26 USC 45N 
note. 
26 USC 45N. 
Time period. 
Deadline. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
(1) by substituting ‘‘first 12 taxable years’’ for ‘‘first 11 
taxable years’’, and 
(2) by substituting ‘‘January 1, 2018’’ for ‘‘January 1, 2017’’. 
SEC. 40310. EXTENSION OF SPECIAL RULE RELATING TO QUALIFIED 
TIMBER GAIN. 
For purposes of applying section 1201(b) of the Internal Rev-
enue Code of 1986 with respect to taxable years beginning during 
2017, such section shall be applied by substituting ‘‘2016 or 2017’’ 
for ‘‘2016’’. 
SEC. 40311. EXTENSION OF EMPOWERMENT ZONE TAX INCENTIVES. 
(a) IN GENERAL.— 
(1) EXTENSION.—Section 1391(d)(1)(A)(i) is amended by 
striking ‘‘December 31, 2016’’ and inserting ‘‘December 31, 
2017’’. 
(2) TREATMENT OF CERTAIN TERMINATION DATES SPECIFIED 
IN NOMINATIONS.—In the case of a designation of an empower-
ment zone the nomination for which included a termination 
date which is contemporaneous with the date specified in 
subparagraph (A)(i) of section 1391(d)(1) of the Internal Rev-
enue Code of 1986 (as in effect before the enactment of this 
Act), subparagraph (B) of such section shall not apply with 
respect to such designation if, after the date of the enactment 
of this section, the entity which made such nomination amends 
the nomination to provide for a new termination date in such 
manner as the Secretary of the Treasury (or the Secretary’s 
designee) may provide. 
(b) EFFECTIVE DATE.—The amendment made by subsection 
(a)(1) shall apply to taxable years beginning after December 31, 
2016. 
SEC. 40312. EXTENSION OF AMERICAN SAMOA ECONOMIC DEVELOP-
MENT CREDIT. 
(a) IN GENERAL.—Section 119 of division A of the Tax Relief 
and Health Care Act of 2006 is amended— 
(1) in subsection (d)— 
(A) by striking ‘‘January 1, 2017’’ each place it appears 
and inserting ‘‘January 1, 2018’’, 
(B) by striking ‘‘first 11 taxable years’’ in paragraph 
(1) and inserting ‘‘first 12 taxable years’’, and 
(C) by striking ‘‘first 5 taxable years’’ in paragraph 
(2) and inserting ‘‘first 6 taxable years’’, and 
(2) in subsection (e), by adding at the end the following: 
‘‘References in this subsection to section 199 of the Internal 
Revenue Code of 1986 shall be treated as references to such 
section as in effect before its repeal.’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2016. 
26 USC 30A note. 
26 USC 30A note. 
26 USC 1391 
note. 
26 USC 1391 
note. 
26 USC 1391. 
26 USC 1201 
note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
Subtitle C—Incentives for Energy 
Production and Conservation 
SEC. 40401. EXTENSION OF CREDIT FOR NONBUSINESS ENERGY PROP-
ERTY. 
(a) IN GENERAL.—Section 25C(g)(2) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40402. EXTENSION AND MODIFICATION OF CREDIT FOR RESIDEN-
TIAL ENERGY PROPERTY. 
(a) IN
GENERAL.—Section 25D(h) is amended by striking 
‘‘December 31, 2016’’ and all that follows and inserting ‘‘December 
31, 2021.’’. 
(b) PHASEOUT.— 
(1) IN GENERAL.—Section 25D(a) is amended by striking 
‘‘the sum of—’’ and all that follows and inserting ‘‘the sum 
of the applicable percentages of— 
‘‘(1) the qualified solar electric property expenditures, 
‘‘(2) the qualified solar water heating property expendi-
tures, 
‘‘(3) the qualified fuel cell property expenditures, 
‘‘(4) the qualified small wind energy property expenditures, 
and 
‘‘(5) the qualified geothermal heat pump property expendi-
tures, 
made by the taxpayer during such year.’’. 
(2) CONFORMING AMENDMENT.—Section 25D(g) is amended 
by striking ‘‘paragraphs (1) and (2) of’’. 
(c) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40403. EXTENSION OF CREDIT FOR NEW QUALIFIED FUEL CELL 
MOTOR VEHICLES. 
(a) IN GENERAL.—Section 30B(k)(1) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property purchased after December 31, 2016. 
SEC. 40404. EXTENSION OF CREDIT FOR ALTERNATIVE FUEL VEHICLE 
REFUELING PROPERTY. 
(a) IN
GENERAL.—Section 30C(g) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 40405. EXTENSION OF CREDIT FOR 2-WHEELED PLUG-IN ELEC-
TRIC VEHICLES. 
(a) IN
GENERAL.—Section 30D(g)(3)(E)(ii) is amended by 
striking ‘‘January 1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to vehicles acquired after December 31, 2016. 
26 USC 30D 
note. 
26 USC 30C note. 
26 USC 30B note. 
26 USC 25D 
note. 
26 USC 25C note. 
26 USC 25C. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 40406. EXTENSION OF SECOND GENERATION BIOFUEL PRODUCER 
CREDIT. 
(a) IN GENERAL.—Section 40(b)(6)(J)(i) is amended by striking 
‘‘January 1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to qualified second generation biofuel production after 
December 31, 2016. 
SEC. 40407. EXTENSION OF BIODIESEL AND RENEWABLE DIESEL 
INCENTIVES. 
(a) INCOME TAX CREDIT.— 
(1) IN GENERAL.—Subsection (g) of section 40A is amended 
by striking ‘‘December 31, 2016’’ and inserting ‘‘December 31, 
2017’’. 
(2) EFFECTIVE DATE.—The amendment made by this sub-
section shall apply to fuel sold or used after December 31, 
2016. 
(b) EXCISE TAX INCENTIVES.— 
(1) IN GENERAL.—Section 6426(c)(6) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(2) PAYMENTS.—Section 6427(e)(6)(B) is amended by 
striking ‘‘December 31, 2016’’ and inserting ‘‘December 31, 
2017’’. 
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to fuel sold or used after December 31, 
2016. 
(4) SPECIAL RULE FOR 2017.—Notwithstanding any other 
provision of law, in the case of any biodiesel mixture credit 
properly determined under section 6426(c) of the Internal Rev-
enue Code of 1986 for the period beginning on January 1, 
2017, and ending on December 31, 2017, such credit shall 
be allowed, and any refund or payment attributable to such 
credit (including any payment under section 6427(e) of such 
Code) shall be made, only in such manner as the Secretary 
of the Treasury (or the Secretary’s delegate) shall provide. 
Such Secretary shall issue guidance within 30 days after the 
date of the enactment of this Act providing for a one-time 
submission of claims covering periods described in the preceding 
sentence. Such guidance shall provide for a 180-day period 
for the submission of such claims (in such manner as prescribed 
by such Secretary) to begin not later than 30 days after such 
guidance is issued. Such claims shall be paid by such Secretary 
not later than 60 days after receipt. If such Secretary has 
not paid pursuant to a claim filed under this subsection within 
60 days after the date of the filing of such claim, the claim 
shall be paid with interest from such date determined by using 
the overpayment rate and method under section 6621 of such 
Code. 
SEC. 40408. EXTENSION OF PRODUCTION CREDIT FOR INDIAN COAL 
FACILITIES. 
(a) IN GENERAL.—Section 45(e)(10)(A) is amended by striking 
‘‘11-year period’’ each place it appears and inserting ‘‘12-year 
period’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to coal produced after December 31, 2016. 
26 USC 45 note. 
Guidance. 
Claims. 
Time periods. 
Deadlines. 
26 USC 6426 
note. 
26 USC 6426 
note. 
26 USC 40A note. 
26 USC 40 note. 
26 USC 40. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 40409. EXTENSION OF CREDITS WITH RESPECT TO FACILITIES 
PRODUCING 
ENERGY 
FROM 
CERTAIN 
RENEWABLE 
RESOURCES. 
(a) IN GENERAL.—The following provisions of section 45(d) are 
each amended by striking ‘‘January 1, 2017’’ each place it appears 
and inserting ‘‘January 1, 2018’’: 
(1) Paragraph (2)(A). 
(2) Paragraph (3)(A). 
(3) Paragraph (4)(B). 
(4) Paragraph (6). 
(5) Paragraph (7). 
(6) Paragraph (9). 
(7) Paragraph (11)(B). 
(b) EXTENSION OF ELECTION TO TREAT QUALIFIED FACILITIES 
AS
ENERGY
PROPERTY.—Section 48(a)(5)(C)(ii) is amended by 
striking ‘‘January 1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on January 1, 2017. 
SEC. 40410. EXTENSION OF CREDIT FOR ENERGY-EFFICIENT NEW 
HOMES. 
(a) IN
GENERAL.—Section 45L(g) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to homes acquired after December 31, 2016. 
SEC. 40411. EXTENSION AND PHASEOUT OF ENERGY CREDIT. 
(a) EXTENSION OF SOLAR AND THERMAL ENERGY PROPERTY.— 
Section 48(a)(3)(A) is amended— 
(1) by striking ‘‘periods ending before January 1, 2017’’ 
in clause (ii) and inserting ‘‘property the construction of which 
begins before January 1, 2022’’, and 
(2) by striking ‘‘periods ending before January 1, 2017’’ 
in clause (vii) and inserting ‘‘property the construction of which 
begins before January 1, 2022’’. 
(b) PHASEOUT OF 30-PERCENT CREDIT RATE FOR FIBER-OPTIC 
SOLAR, QUALIFIED FUEL CELL, AND QUALIFIED SMALL WIND ENERGY 
PROPERTY.— 
(1) IN GENERAL.—Section 48(a) is amended by adding at 
the end the following new paragraph: 
‘‘(7) PHASEOUT
FOR
FIBER-OPTIC
SOLAR, QUALIFIED
FUEL 
CELL, AND QUALIFIED SMALL WIND ENERGY PROPERTY.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), in the 
case of any qualified fuel cell property, qualified small 
wind property, or energy property described in paragraph 
(3)(A)(ii), the energy percentage determined under para-
graph (2) shall be equal to— 
‘‘(i) in the case of any property the construction 
of which begins after December 31, 2019, and before 
January 1, 2021, 26 percent, and 
‘‘(ii) in the case of any property the construction 
of which begins after December 31, 2020, and before 
January 1, 2022, 22 percent. 
‘‘(B) PLACED IN SERVICE DEADLINE.—In the case of any 
energy property described in subparagraph (A) which is 
not placed in service before January 1, 2024, the energy 
Time periods. 
26 USC 45L note. 
26 USC 45 note. 
26 USC 45. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
percentage determined under paragraph (2) shall be equal 
to 0 percent.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
48(a)(2)(A) 
is 
amended by striking ‘‘paragraph (6)’’ and inserting ‘‘paragraphs 
(6) and (7)’’. 
(3) CLARIFICATION RELATING TO PHASEOUT FOR WIND FACILI-
TIES.—Section 48(a)(5)(E) is amended by inserting ‘‘which is 
treated as energy property by reason of this paragraph’’ after 
‘‘using wind to produce electricity’’. 
(c) EXTENSION OF QUALIFIED FUEL CELL PROPERTY.—Section 
48(c)(1)(D) is amended by striking ‘‘for any period after December 
31, 2016’’ and inserting ‘‘the construction of which does not begin 
before January 1, 2022’’. 
(d) EXTENSION OF QUALIFIED MICROTURBINE PROPERTY.—Sec-
tion 48(c)(2)(D) is amended by striking ‘‘for any period after 
December 31, 2016’’ and inserting ‘‘the construction of which does 
not begin before January 1, 2022’’. 
(e) EXTENSION OF COMBINED HEAT AND POWER SYSTEM PROP-
ERTY.—Section 48(c)(3)(A)(iv) is amended by striking ‘‘which is 
placed in service before January 1, 2017’’ and inserting ‘‘the 
construction of which begins before January 1, 2022’’. 
(f) EXTENSION OF QUALIFIED SMALL WIND ENERGY PROPERTY.— 
Section 48(c)(4)(C) is amended by striking ‘‘for any period after 
December 31, 2016’’ and inserting ‘‘the construction of which does 
not begin before January 1, 2022’’. 
(g) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as otherwise provided in this sub-
section, the amendments made by this section shall apply to 
periods after December 31, 2016, under rules similar to the 
rules of section 48(m) of the Internal Revenue Code of 1986 
(as in effect on the day before the date of the enactment 
of the Revenue Reconciliation Act of 1990). 
(2) EXTENSION OF COMBINED HEAT AND POWER SYSTEM PROP-
ERTY.—The amendment made by subsection (e) shall apply 
to property placed in service after December 31, 2016. 
(3) PHASEOUTS
AND
TERMINATIONS.—The amendments 
made by subsection (b) shall take effect on the date of the 
enactment of this Act. 
SEC. 40412. EXTENSION OF SPECIAL ALLOWANCE FOR SECOND 
GENERATION BIOFUEL PLANT PROPERTY. 
(a) IN GENERAL.—Section 168(l)(2)(D) is amended by striking 
‘‘January 1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
SEC. 
40413. 
EXTENSION 
OF 
ENERGY 
EFFICIENT 
COMMERCIAL 
BUILDINGS DEDUCTION. 
(a) IN GENERAL.—Section 179D(h) is amended by striking 
‘‘December 31, 2016’’ and inserting ‘‘December 31, 2017’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to property placed in service after December 31, 2016. 
26 USC 179D 
note. 
26 USC 168 note. 
26 USC 48 note. 
26 USC 48. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 40414. EXTENSION OF SPECIAL RULE FOR SALES OR DISPOSI-
TIONS TO IMPLEMENT FERC OR STATE ELECTRIC 
RESTRUCTURING POLICY FOR QUALIFIED ELECTRIC 
UTILITIES. 
(a) IN GENERAL.—Section 451(k)(3), as amended by section 
13221 of Public Law 115–97, is amended by striking ‘‘January 
1, 2017’’ and inserting ‘‘January 1, 2018’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to dispositions after December 31, 2016. 
SEC. 40415. EXTENSION OF EXCISE TAX CREDITS RELATING TO ALTER-
NATIVE FUELS. 
(a) EXTENSION OF ALTERNATIVE FUELS EXCISE TAX CREDITS.— 
(1) IN GENERAL.—Sections 6426(d)(5) and 6426(e)(3) are 
each amended by striking ‘‘December 31, 2016’’ and inserting 
‘‘December 31, 2017’’. 
(2) OUTLAY PAYMENTS FOR ALTERNATIVE FUELS.—Section 
6427(e)(6)(C) is amended by striking ‘‘December 31, 2016’’ and 
inserting ‘‘December 31, 2017’’. 
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to fuel sold or used after December 31, 
2016. 
(b) SPECIAL RULE FOR 2017.—Notwithstanding any other provi-
sion of law, in the case of any alternative fuel credit properly 
determined under section 6426(d) of the Internal Revenue Code 
of 1986 for the period beginning on January 1, 2017, and ending 
on December 31, 2017, such credit shall be allowed, and any refund 
or payment attributable to such credit (including any payment 
under section 6427(e) of such Code) shall be made, only in such 
manner as the Secretary of the Treasury (or the Secretary’s dele-
gate) shall provide. Such Secretary shall issue guidance within 
30 days after the date of the enactment of this Act providing 
for a one-time submission of claims covering periods described in 
the preceding sentence. Such guidance shall provide for a 180- 
day period for the submission of such claims (in such manner 
as prescribed by such Secretary) to begin not later than 30 days 
after such guidance is issued. Such claims shall be paid by such 
Secretary not later than 60 days after receipt. If such Secretary 
has not paid pursuant to a claim filed under this subsection within 
60 days after the date of the filing of such claim, the claim shall 
be paid with interest from such date determined by using the 
overpayment rate and method under section 6621 of such Code. 
SEC. 40416. EXTENSION OF OIL SPILL LIABILITY TRUST FUND 
FINANCING RATE. 
(a) IN GENERAL.—Section 4611(f)(2) is amended by striking 
‘‘December 31, 2017’’ and inserting ‘‘December 31, 2018’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply on and after the first day of the first calendar month 
beginning after the date of the enactment of this Act. 
26 USC 4611 
note. 
Guidance. 
Claims. 
Time periods. 
Deadlines. 
26 USC 6426 
note. 
26 USC 6426 
note. 
26 USC 451 note. 
26 USC 451. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
Subtitle D—Modifications of Energy 
Incentives 
SEC. 40501. MODIFICATIONS OF CREDIT FOR PRODUCTION FROM 
ADVANCED NUCLEAR POWER FACILITIES. 
(a) TREATMENT OF UNUTILIZED LIMITATION AMOUNTS.—Section 
45J(b) is amended— 
(1) by inserting ‘‘or any amendment to’’ after ‘‘enactment 
of’’ in paragraph (4), and 
(2) by adding at the end the following new paragraph: 
‘‘(5) ALLOCATION OF UNUTILIZED LIMITATION.— 
‘‘(A) IN GENERAL.—Any unutilized national megawatt 
capacity limitation shall be allocated by the Secretary 
under paragraph (3) as rapidly as is practicable after 
December 31, 2020— 
‘‘(i) first to facilities placed in service on or before 
such date to the extent that such facilities did not 
receive an allocation equal to their full nameplate 
capacity, and 
‘‘(ii) then to facilities placed in service after such 
date in the order in which such facilities are placed 
in service. 
‘‘(B) UNUTILIZED NATIONAL MEGAWATT CAPACITY LIMITA-
TION.—The term ‘unutilized national megawatt capacity 
limitation’ means the excess (if any) of— 
‘‘(i) 6,000 megawatts, over 
‘‘(ii) the aggregate amount of national megawatt 
capacity limitation allocated by the Secretary before 
January 1, 2021, reduced by any amount of such limita-
tion which was allocated to a facility which was not 
placed in service before such date. 
‘‘(C) COORDINATION WITH OTHER PROVISIONS.—In the 
case of any unutilized national megawatt capacity limita-
tion allocated by the Secretary pursuant to this para-
graph— 
‘‘(i) such allocation shall be treated for purposes 
of this section in the same manner as an allocation 
of national megawatt capacity limitation, and 
‘‘(ii) subsection (d)(1)(B) shall not apply to any 
facility which receives such allocation.’’. 
(b) TRANSFER OF CREDIT BY CERTAIN PUBLIC ENTITIES.— 
(1) IN GENERAL.—Section 45J is amended— 
(A) by redesignating subsection (e) as subsection (f), 
and 
(B) by inserting after subsection (d) the following new 
subsection: 
‘‘(e) TRANSFER OF CREDIT BY CERTAIN PUBLIC ENTITIES.— 
‘‘(1) IN GENERAL.—If, with respect to a credit under sub-
section (a) for any taxable year— 
‘‘(A) a qualified public entity would be the taxpayer 
(but for this paragraph), and 
‘‘(B) such entity elects the application of this paragraph 
for such taxable year with respect to all (or any portion 
specified in such election) of such credit, 
the eligible project partner specified in such election, and not 
the qualified public entity, shall be treated as the taxpayer 
Definition. 
26 USC 45J. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
for purposes of this title with respect to such credit (or such 
portion thereof). 
‘‘(2) DEFINITIONS.—For purposes of this subsection— 
‘‘(A) QUALIFIED
PUBLIC
ENTITY.—The term ‘qualified 
public entity’ means— 
‘‘(i) a Federal, State, or local government entity, 
or any political subdivision, agency, or instrumentality 
thereof, 
‘‘(ii) a mutual or cooperative electric company 
described in section 501(c)(12) or 1381(a)(2), or 
‘‘(iii) a not-for-profit electric utility which had or 
has received a loan or loan guarantee under the Rural 
Electrification Act of 1936. 
‘‘(B) ELIGIBLE PROJECT PARTNER.—The term ‘eligible 
project partner’ means any person who— 
‘‘(i) is responsible for, or participates in, the design 
or construction of the advanced nuclear power facility 
to which the credit under subsection (a) relates, 
‘‘(ii) participates in the provision of the nuclear 
steam supply system to such facility, 
‘‘(iii) participates in the provision of nuclear fuel 
to such facility, 
‘‘(iv) is a financial institution providing financing 
for the construction or operation of such facility, or 
‘‘(v) has an ownership interest in such facility. 
‘‘(3) SPECIAL RULES.— 
‘‘(A) APPLICATION TO PARTNERSHIPS.—In the case of 
a credit under subsection (a) which is determined at the 
partnership level— 
‘‘(i) for purposes of paragraph (1)(A), a qualified 
public entity shall be treated as the taxpayer with 
respect to such entity’s distributive share of such 
credit, and 
‘‘(ii) the term ‘eligible project partner’ shall include 
any partner of the partnership. 
‘‘(B) TAXABLE
YEAR
IN
WHICH
CREDIT
TAKEN
INTO 
ACCOUNT.—In the case of any credit (or portion thereof) 
with respect to which an election is made under paragraph 
(1), such credit shall be taken into account in the first 
taxable year of the eligible project partner ending with, 
or after, the qualified public entity’s taxable year with 
respect to which the credit was determined. 
‘‘(C) TREATMENT
OF
TRANSFER
UNDER
PRIVATE
USE 
RULES.—For purposes of section 141(b)(1), any benefit 
derived by an eligible project partner in connection with 
an election under this subsection shall not be taken into 
account as a private business use.’’. 
(2) SPECIAL RULE FOR PROCEEDS OF TRANSFERS FOR MUTUAL 
OR COOPERATIVE ELECTRIC COMPANIES.—Section 501(c)(12) is 
amended by adding at the end the following new subparagraph: 
‘‘(I) In the case of a mutual or cooperative electric 
company described in this paragraph or an organization 
described in section 1381(a)(2), income received or accrued 
in connection with an election under section 45J(e)(1) shall 
be treated as an amount collected from members for the 
sole purpose of meeting losses and expenses.’’. 
(c) EFFECTIVE DATES.— 
26 USC 45J note. 
26 USC 501. 
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132 STAT. 155 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) TREATMENT OF UNUTILIZED LIMITATION AMOUNTS.—The 
amendment made by subsection (a) shall take effect on the 
date of the enactment of this Act. 
(2) TRANSFER OF CREDIT BY CERTAIN PUBLIC ENTITIES.— 
The amendments made by subsection (b) shall apply to taxable 
years beginning after the date of the enactment of this Act. 
TITLE II—MISCELLANEOUS 
PROVISIONS 
SEC. 41101. AMENDMENT OF INTERNAL REVENUE CODE OF 1986. 
Except as otherwise expressly provided, whenever in this title 
an amendment or repeal is expressed in terms of an amendment 
to, or repeal of, a section or other provision, the reference shall 
be considered to be made to a section or other provision of the 
Internal Revenue Code of 1986. 
SEC. 41102. MODIFICATIONS TO RUM COVER OVER. 
(a) EXTENSION.— 
(1) IN GENERAL.—Section 7652(f)(1) is amended by striking 
‘‘January 1, 2017’’ and inserting ‘‘January 1, 2022’’. 
(2) EFFECTIVE DATE.—The amendment made by this sub-
section shall apply to distilled spirits brought into the United 
States after December 31, 2016. 
(b) DETERMINATION OF TAXES ON RUM.— 
(1) IN GENERAL.—Section 7652(e) is amended by adding 
at the end the following new paragraph: 
‘‘(5) DETERMINATION OF AMOUNT OF TAXES COLLECTED.— 
For purposes of this subsection, the amount of taxes collected 
under section 5001(a)(1) shall be determined without regard 
to section 5001(c).’’. 
(2) EFFECTIVE DATE.—The amendment made by this sub-
section shall apply to distilled spirits brought into the United 
States after December 31, 2017. 
SEC. 41103. EXTENSION OF WAIVER OF LIMITATIONS WITH RESPECT 
TO 
EXCLUDING 
FROM 
GROSS 
INCOME 
AMOUNTS 
RECEIVED BY WRONGFULLY INCARCERATED INDIVID-
UALS. 
(a) IN GENERAL.—Section 304(d) of the Protecting Americans 
from Tax Hikes Act of 2015 (26 U.S.C. 139F note) is amended 
by striking ‘‘1-year’’ and inserting ‘‘3-year’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect on the date of the enactment of this Act. 
SEC. 41104. INDIVIDUALS HELD HARMLESS ON IMPROPER LEVY ON 
RETIREMENT PLANS. 
(a) IN GENERAL.—Section 6343 is amended by adding at the 
end the following new subsection: 
‘‘(f) INDIVIDUALS HELD HARMLESS ON WRONGFUL LEVY, ETC. 
ON RETIREMENT PLAN.— 
‘‘(1) IN
GENERAL.—If the Secretary determines that an 
individual’s account or benefit under an eligible retirement 
plan (as defined in section 402(c)(8)(B)) has been levied upon 
in a case to which subsection (b) or (d)(2)(A) applies and prop-
erty or an amount of money is returned to the individual— 
Determination. 
26 USC 139F 
note. 
26 USC 7652 
note. 
26 USC 7652 
note. 
26 USC 7652. 
Applicability. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) the individual may contribute such property or 
an amount equal to the sum of— 
‘‘(i) the amount of money so returned by the Sec-
retary, and 
‘‘(ii) interest paid under subsection (c) on such 
amount of money, 
into such eligible retirement plan if such contribution is 
permitted by the plan, or into an individual retirement 
plan (other than an endowment contract) to which a roll-
over contribution of a distribution from such eligible retire-
ment plan is permitted, but only if such contribution is 
made not later than the due date (not including extensions) 
for filing the return of tax for the taxable year in which 
such property or amount of money is returned, and 
‘‘(B) the Secretary shall, at the time such property 
or amount of money is returned, notify such individual 
that a contribution described in subparagraph (A) may 
be made. 
‘‘(2) TREATMENT AS ROLLOVER.—The distribution on account 
of the levy and any contribution under paragraph (1) with 
respect to the return of such distribution shall be treated for 
purposes of this title as if such distribution and contribution 
were described in section 402(c), 402A(c)(3), 403(a)(4), 403(b)(8), 
408(d)(3), 408A(d)(3), or 457(e)(16), whichever is applicable; 
except that— 
‘‘(A) the contribution shall be treated as having been 
made for the taxable year in which the distribution on 
account of the levy occurred, and the interest paid under 
subsection (c) shall be treated as earnings within the plan 
after the contribution and shall not be included in gross 
income, and 
‘‘(B) such contribution shall not be taken into account 
under section 408(d)(3)(B). 
‘‘(3) REFUND, ETC., OF INCOME TAX ON LEVY.— 
‘‘(A) IN GENERAL.—If any amount is includible in gross 
income for a taxable year by reason of a distribution on 
account of a levy referred to in paragraph (1) and any 
portion of such amount is treated as a rollover contribution 
under paragraph (2), any tax imposed by chapter 1 on 
such portion shall not be assessed, and if assessed shall 
be abated, and if collected shall be credited or refunded 
as an overpayment made on the due date for filing the 
return of tax for such taxable year. 
‘‘(B) EXCEPTION.—Subparagraph (A) shall not apply 
to a rollover contribution under this subsection which is 
made from an eligible retirement plan which is not a Roth 
IRA or a designated Roth account (within the meaning 
of section 402A) to a Roth IRA or a designated Roth account 
under an eligible retirement plan. 
‘‘(4) INTEREST.—Notwithstanding subsection (d), interest 
shall be allowed under subsection (c) in a case in which the 
Secretary makes a determination described in subsection 
(d)(2)(A) with respect to a levy upon an individual retirement 
plan. 
‘‘(5) TREATMENT OF INHERITED ACCOUNTS.—For purposes 
of paragraph (1)(A), section 408(d)(3)(C) shall be disregarded 
in determining whether an individual retirement plan is a 
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132 STAT. 157 
PUBLIC LAW 115–123—FEB. 9, 2018 
plan to which a rollover contribution of a distribution from 
the plan levied upon is permitted.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to amounts paid under subsections (b), (c), and (d)(2)(A) 
of section 6343 of the Internal Revenue Code of 1986 in taxable 
years beginning after December 31, 2017. 
SEC. 41105. MODIFICATION OF USER FEE REQUIREMENTS FOR 
INSTALLMENT AGREEMENTS. 
(a) IN GENERAL.—Section 6159 is amended by redesignating 
subsection (f) as subsection (g) and by inserting after subsection 
(e) the following new subsection: 
‘‘(f) INSTALLMENT AGREEMENT FEES.— 
‘‘(1) LIMITATION ON FEE AMOUNT.—The amount of any fee 
imposed on an installment agreement under this section may 
not exceed the amount of such fee as in effect on the date 
of the enactment of this subsection. 
‘‘(2) WAIVER OR REIMBURSEMENT.—In the case of any tax-
payer with an adjusted gross income, as determined for the 
most recent year for which such information is available, which 
does not exceed 250 percent of the applicable poverty level 
(as determined by the Secretary)— 
‘‘(A) if the taxpayer has agreed to make payments 
under the installment agreement by electronic payment 
through a debit instrument, no fee shall be imposed on 
an installment agreement under this section, and 
‘‘(B) if the taxpayer is unable to make payments under 
the installment agreement by electronic payment through 
a debit instrument, the Secretary shall, upon completion 
of the installment agreement, pay the taxpayer an amount 
equal to any such fees imposed.’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to agreements entered into on or after the date which 
is 60 days after the date of the enactment of this Act. 
SEC. 41106. FORM 1040SR FOR SENIORS. 
(a) IN GENERAL.—The Secretary of the Treasury (or the Sec-
retary’s delegate) shall make available a form, to be known as 
‘‘Form 1040SR’’, for use by individuals to file the return of tax 
imposed by chapter 1 of the Internal Revenue Code of 1986. Such 
form shall be as similar as practicable to Form 1040EZ, except 
that— 
(1) the form shall be available only to individuals who 
have attained age 65 as of the close of the taxable year, 
(2) the form may be used even if income for the taxable 
year includes— 
(A) social security benefits (as defined in section 86(d) 
of the Internal Revenue Code of 1986), 
(B) distributions from qualified retirement plans (as 
defined in section 4974(c) of such Code), annuities or other 
such deferred payment arrangements, 
(C) interest and dividends, or 
(D) capital gains and losses taken into account in deter-
mining adjusted net capital gain (as defined in section 
1(h)(3) of such Code), and 
(3) the form shall be available without regard to the amount 
of any item of taxable income or the total amount of taxable 
income for the taxable year. 
26 USC 7805 
note. 
26 USC 6159 
note. 
26 USC 6159. 
26 USC 6343 
note. 
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132 STAT. 158 
PUBLIC LAW 115–123—FEB. 9, 2018 
(b) EFFECTIVE DATE.—The form required by subsection (a) shall 
be made available for taxable years beginning after the date of 
the enactment of this Act. 
SEC. 41107. ATTORNEYS FEES RELATING TO AWARDS TO WHISTLE-
BLOWERS. 
(a) IN GENERAL.—Paragraph (21) of section 62(a) is amended 
to read as follows: 
‘‘(21) ATTORNEYS’ FEES RELATING TO AWARDS TO WHISTLE-
BLOWERS.— 
‘‘(A) IN GENERAL.—Any deduction allowable under this 
chapter for attorney fees and court costs paid by, or on 
behalf of, the taxpayer in connection with any award 
under— 
‘‘(i) section 7623(b), or 
‘‘(ii) in the case of taxable years beginning after 
December 31, 2017, any action brought under— 
‘‘(I) section 21F of the Securities Exchange 
Act of 1934 (15 U.S.C. 78u–6), 
‘‘(II) a State false claims act, including a State 
false claims act with qui tam provisions, or 
‘‘(III) section 23 of the Commodity Exchange 
Act (7 U.S.C. 26). 
‘‘(B) MAY NOT EXCEED AWARD.—Subparagraph (A) shall 
not apply to any deduction in excess of the amount includ-
ible in the taxpayer’s gross income for the taxable year 
on account of such award.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41108. CLARIFICATION OF WHISTLEBLOWER AWARDS. 
(a) DEFINITION OF PROCEEDS.— 
(1) IN GENERAL.—Section 7623 is amended by adding at 
the end the following new subsection: 
‘‘(c) PROCEEDS.—For purposes of this section, the term ‘proceeds’ 
includes— 
‘‘(1) penalties, interest, additions to tax, and additional 
amounts provided under the internal revenue laws, and 
‘‘(2) any proceeds arising from laws for which the Internal 
Revenue Service is authorized to administer, enforce, or inves-
tigate, including— 
‘‘(A) criminal fines and civil forfeitures, and 
‘‘(B) violations of reporting requirements.’’. 
(2) CONFORMING AMENDMENTS.—Paragraphs (1) and (2)(A) 
of section 7623(b) are each amended by striking ‘‘collected pro-
ceeds (including penalties, interest, additions to tax, and addi-
tional amounts) resulting from the action’’ and inserting ‘‘pro-
ceeds collected as a result of the action’’. 
(b) AMOUNT OF PROCEEDS DETERMINED WITHOUT REGARD TO 
AVAILABILITY.—Paragraphs (1) and (2)(A) of section 7623(b) are 
each amended by inserting ‘‘(determined without regard to whether 
such proceeds are available to the Secretary)’’ after ‘‘in response 
to such action’’. 
(c) DISPUTED AMOUNT THRESHOLD.—Section 7623(b)(5)(B) is 
amended by striking ‘‘tax, penalties, interest, additions to tax, and 
additional amounts’’ and inserting ‘‘proceeds’’. 
(d) EFFECTIVE DATE.—The amendments made by this section 
shall apply to information provided before, on, or after the date 
26 USC 7623 
note. 
26 USC 62 note. 
26 USC 62. 
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132 STAT. 159 
PUBLIC LAW 115–123—FEB. 9, 2018 
of the enactment of this Act with respect to which a final determina-
tion for an award has not been made before such date of enactment. 
SEC. 41109. CLARIFICATION REGARDING EXCISE TAX BASED ON 
INVESTMENT INCOME OF PRIVATE COLLEGES AND 
UNIVERSITIES. 
(a) IN GENERAL.—Subsection (b)(1) of section 4968, as added 
by section 13701(a) of Public Law 115–97, is amended— 
(1) by inserting ‘‘tuition-paying’’ after ‘‘500’’ in subpara-
graph (A), and 
(2) by inserting ‘‘tuition-paying’’ after ‘‘50 percent of the’’ 
in subparagraph (B). 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41110. EXCEPTION FROM PRIVATE FOUNDATION EXCESS BUSI-
NESS HOLDING TAX FOR INDEPENDENTLY-OPERATED 
PHILANTHROPIC BUSINESS HOLDINGS. 
(a) IN GENERAL.—Section 4943 is amended by adding at the 
end the following new subsection: 
‘‘(g) EXCEPTION FOR CERTAIN HOLDINGS LIMITED TO INDEPEND-
ENTLY-OPERATED PHILANTHROPIC BUSINESS.— 
‘‘(1) IN
GENERAL.—Subsection (a) shall not apply with 
respect to the holdings of a private foundation in any business 
enterprise which meets the requirements of paragraphs (2), 
(3), and (4) for the taxable year. 
‘‘(2) OWNERSHIP.—The requirements of this paragraph are 
met if— 
‘‘(A) 100 percent of the voting stock in the business 
enterprise is held by the private foundation at all times 
during the taxable year, and 
‘‘(B) all the private foundation’s ownership interests 
in the business enterprise were acquired by means other 
than by purchase. 
‘‘(3) ALL PROFITS TO CHARITY.— 
‘‘(A) IN GENERAL.—The requirements of this paragraph 
are met if the business enterprise, not later than 120 
days after the close of the taxable year, distributes an 
amount equal to its net operating income for such taxable 
year to the private foundation. 
‘‘(B) NET
OPERATING
INCOME.—For purposes of this 
paragraph, the net operating income of any business enter-
prise for any taxable year is an amount equal to the gross 
income of the business enterprise for the taxable year, 
reduced by the sum of— 
‘‘(i) the deductions allowed by chapter 1 for the 
taxable year which are directly connected with the 
production of such income, 
‘‘(ii) the tax imposed by chapter 1 on the business 
enterprise for the taxable year, and 
‘‘(iii) an amount for a reasonable reserve for 
working capital and other business needs of the busi-
ness enterprise. 
‘‘(4) INDEPENDENT OPERATION.—The requirements of this 
paragraph are met if, at all times during the taxable year— 
‘‘(A) no substantial contributor (as defined in section 
4958(c)(3)(C)) to the private foundation or family member 
26 USC 4968 
note. 
26 USC 4968. 
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(as determined under section 4958(f)(4)) of such a contrib-
utor is a director, officer, trustee, manager, employee, or 
contractor of the business enterprise (or an individual 
having powers or responsibilities similar to any of the 
foregoing), 
‘‘(B) at least a majority of the board of directors of 
the private foundation are persons who are not— 
‘‘(i) directors or officers of the business enterprise, 
or 
‘‘(ii) family members (as so determined) of a 
substantial contributor (as so defined) to the private 
foundation, and 
‘‘(C) there is no loan outstanding from the business 
enterprise to a substantial contributor (as so defined) to 
the private foundation or to any family member of such 
a contributor (as so determined). 
‘‘(5) CERTAIN DEEMED PRIVATE FOUNDATIONS EXCLUDED.— 
This subsection shall not apply to— 
‘‘(A) any fund or organization treated as a private 
foundation for purposes of this section by reason of sub-
section (e) or (f), 
‘‘(B) any trust described in section 4947(a)(1) (relating 
to charitable trusts), and 
‘‘(C) any trust described in section 4947(a)(2) (relating 
to split-interest trusts).’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41111. RULE OF CONSTRUCTION FOR CRAFT BEVERAGE MOD-
ERNIZATION AND TAX REFORM. 
(a) IN GENERAL.—Subpart A of part IX of subtitle C of title 
I of Public Law 115–97 is amended by adding at the end the 
following new section: 
‘‘SEC. 13809. RULE OF CONSTRUCTION. 
‘‘Nothing in this subpart, the amendments made by this sub-
part, or any regulation promulgated under this subpart or the 
amendments made by this subpart, shall be construed to preempt, 
supersede, or otherwise limit or restrict any State, local, or tribal 
law that prohibits or regulates the production or sale of distilled 
spirits, wine, or malt beverages.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect as if included in Public Law 115–97. 
SEC. 41112. SIMPLIFICATION OF RULES REGARDING RECORDS, STATE-
MENTS, AND RETURNS. 
(a) IN GENERAL.—Subsection (a) of section 5555 is amended 
by adding at the end the following: ‘‘For calendar quarters beginning 
after the date of the enactment of this sentence, and before January 
1, 2020, the Secretary shall permit a person to employ a unified 
system for any records, statements, and returns required to be 
kept, rendered, or made under this section for any beer produced 
in the brewery for which the tax imposed by section 5051 has 
been determined, including any beer which has been removed for 
consumption on the premises of the brewery.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to calendar quarters beginning after the date of the 
enactment of this Act. 
26 USC 5555 
note. 
Time period. 
26 USC 263A 
note. 
26 USC 263A 
note. 
26 USC 4943 
note. 
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SEC. 41113. MODIFICATION OF RULES GOVERNING HARDSHIP DIS-
TRIBUTIONS. 
(a) IN GENERAL.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary of the Treasury shall modify 
Treasury Regulation section 1.401(k)–1(d)(3)(iv)(E) to— 
(1) delete the 6-month prohibition on contributions imposed 
by paragraph (2) thereof, and 
(2) make any other modifications necessary to carry out 
the purposes of section 401(k)(2)(B)(i)(IV) of the Internal Rev-
enue Code of 1986. 
(b) EFFECTIVE DATE.—The revised regulations under this sec-
tion shall apply to plan years beginning after December 31, 2018. 
SEC. 41114. MODIFICATION OF RULES RELATING TO HARDSHIP WITH-
DRAWALS FROM CASH OR DEFERRED ARRANGEMENTS. 
(a) IN GENERAL.—Section 401(k) is amended by adding at the 
end the following: 
‘‘(14) SPECIAL
RULES
RELATING
TO
HARDSHIP
WITH-
DRAWALS.—For purposes of paragraph (2)(B)(i)(IV)— 
‘‘(A) AMOUNTS WHICH MAY BE WITHDRAWN.—The fol-
lowing amounts may be distributed upon hardship of the 
employee: 
‘‘(i) Contributions to a profit-sharing or stock bonus 
plan to which section 402(e)(3) applies. 
‘‘(ii) Qualified nonelective contributions (as defined 
in subsection (m)(4)(C)). 
‘‘(iii) Qualified matching contributions described 
in paragraph (3)(D)(ii)(I). 
‘‘(iv) Earnings on any contributions described in 
clause (i), (ii), or (iii). 
‘‘(B) NO REQUIREMENT TO TAKE AVAILABLE LOAN.—A 
distribution shall not be treated as failing to be made 
upon the hardship of an employee solely because the 
employee does not take any available loan under the plan.’’. 
(b) CONFORMING AMENDMENT.—Section 401(k)(2)(B)(i)(IV) is 
amended to read as follows: 
‘‘(IV) subject to the provisions of paragraph 
(14), upon hardship of the employee, or’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to plan years beginning after December 31, 2018. 
SEC. 41115. OPPORTUNITY ZONES RULE FOR PUERTO RICO. 
(a) IN GENERAL.—Subsection (b) of section 1400Z–1 is amended 
by adding at the end the following new paragraph: 
‘‘(3) SPECIAL
RULE
FOR
PUERTO
RICO.—Each population 
census tract in Puerto Rico that is a low- income community 
shall be deemed to be certified and designated as a qualified 
opportunity zone, effective on the date of the enactment of 
Public Law 115–97.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1400Z–1(d)(1) 
is 
amended by inserting ‘‘and subsection (b)(3)’’ after ‘‘paragraph (2)’’. 
SEC. 41116. TAX HOME OF CERTAIN CITIZENS OR RESIDENTS OF THE 
UNITED STATES LIVING ABROAD. 
(a) IN GENERAL.—Paragraph (3) of section 911(d) is amended 
by inserting before the period at the end of the second sentence 
the following: ‘‘, unless such individual is serving in an area des-
ignated by the President of the United States by Executive order 
Certification. 
Effective date. 
26 USC 401 note. 
26 USC 401. 
Deadline. 
26 USC 401 note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
as a combat zone for purposes of section 112 in support of the 
Armed Forces of the United States’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
SEC. 41117. TREATMENT OF FOREIGN PERSONS FOR RETURNS 
RELATING TO PAYMENTS MADE IN SETTLEMENT OF PAY-
MENT CARD AND THIRD PARTY NETWORK TRANS-
ACTIONS. 
(a) IN GENERAL.—Section 6050W(d)(1)(B) is amended by adding 
at the end the following: ‘‘Notwithstanding the preceding sentence, 
a person with only a foreign address shall not be treated as a 
participating payee with respect to any payment settlement entity 
solely because such person receives payments from such payment 
settlement entity in dollars.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to returns for calendar years beginning after December 
31, 2017. 
SEC. 41118. REPEAL OF SHIFT IN TIME OF PAYMENT OF CORPORATE 
ESTIMATED TAXES. 
The Trade Preferences Extension Act of 2015 is amended by 
striking section 803 (relating to time for payment of corporate 
estimated taxes). 
SEC. 41119. ENHANCEMENT OF CARBON DIOXIDE SEQUESTRATION 
CREDIT. 
(a) IN GENERAL.—Section 45Q is amended to read as follows: 
‘‘SEC. 45Q. CREDIT FOR CARBON OXIDE SEQUESTRATION. 
‘‘(a) GENERAL RULE.—For purposes of section 38, the carbon 
oxide sequestration credit for any taxable year is an amount equal 
to the sum of— 
‘‘(1) $20 per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility before the date of the enactment of the Bipar-
tisan Budget Act of 2018, and 
‘‘(B) disposed of by the taxpayer in secure geological 
storage and not used by the taxpayer as described in para-
graph (2)(B), 
‘‘(2) $10 per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility before the date of the enactment of the Bipar-
tisan Budget Act of 2018, and 
‘‘(B)(i) used by the taxpayer as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery project 
and disposed of by the taxpayer in secure geological storage, 
or 
‘‘(ii) utilized by the taxpayer in a manner described 
in subsection (f)(5), 
‘‘(3) the applicable dollar amount (as determined under 
subsection (b)(1)) per metric ton of qualified carbon oxide which 
is— 
Time period. 
26 USC 6655 
note. 
26 USC 6050W 
note. 
26 USC 6050W. 
26 USC 911 note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility on or after the date of the enactment of the 
Bipartisan Budget Act of 2018, during the 12-year period 
beginning on the date the equipment was originally placed 
in service, and 
‘‘(B) disposed of by the taxpayer in secure geological 
storage and not used by the taxpayer as described in para-
graph (4)(B), and 
‘‘(4) the applicable dollar amount (as determined under 
subsection (b)(1)) per metric ton of qualified carbon oxide which 
is— 
‘‘(A) captured by the taxpayer using carbon capture 
equipment which is originally placed in service at a quali-
fied facility on or after the date of the enactment of the 
Bipartisan Budget Act of 2018, during the 12-year period 
beginning on the date the equipment was originally placed 
in service, and 
‘‘(B)(i) used by the taxpayer as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery project 
and disposed of by the taxpayer in secure geological storage, 
or 
‘‘(ii) utilized by the taxpayer in a manner described 
in subsection (f)(5). 
‘‘(b) APPLICABLE DOLLAR AMOUNT; ADDITIONAL EQUIPMENT; 
ELECTION.— 
‘‘(1) APPLICABLE DOLLAR AMOUNT.— 
‘‘(A) IN GENERAL.—The applicable dollar amount shall 
be an amount equal to— 
‘‘(i) for any taxable year beginning in a calendar 
year after 2016 and before 2027— 
‘‘(I) for purposes of paragraph (3) of subsection 
(a), the dollar amount established by linear inter-
polation between $22.66 and $50 for each calendar 
year during such period, and 
‘‘(II) for purposes of paragraph (4) of such sub-
section, the dollar amount established by linear 
interpolation between $12.83 and $35 for each cal-
endar year during such period, and 
‘‘(ii) for any taxable year beginning in a calendar 
year after 2026— 
‘‘(I) for purposes of paragraph (3) of subsection 
(a), an amount equal to the product of $50 and 
the inflation adjustment factor for such calendar 
year determined under section 43(b)(3)(B) for such 
calendar year, determined by substituting ‘2025’ 
for ‘1990’, and 
‘‘(II) for purposes of paragraph (4) of such sub-
section, an amount equal to the product of $35 
and the inflation adjustment factor for such cal-
endar year determined under section 43(b)(3)(B) 
for such calendar year, determined by substituting 
‘2025’ for ‘1990’. 
‘‘(B) ROUNDING.—The applicable dollar amount deter-
mined under subparagraph (A) shall be rounded to the 
nearest cent. 
Time periods. 
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132 STAT. 164 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(2) INSTALLATION OF ADDITIONAL CARBON CAPTURE EQUIP-
MENT ON EXISTING QUALIFIED FACILITY.—In the case of a quali-
fied facility placed in service before the date of the enactment 
of the Bipartisan Budget Act of 2018, for which additional 
carbon capture equipment is placed in service on or after the 
date of the enactment of such Act, the amount of qualified 
carbon oxide which is captured by the taxpayer shall be equal 
to— 
‘‘(A) for purposes of paragraphs (1)(A) and (2)(A) of 
subsection (a), the lesser of— 
‘‘(i) the total amount of qualified carbon oxide cap-
tured at such facility for the taxable year, or 
‘‘(ii) the total amount of the carbon dioxide capture 
capacity of the carbon capture equipment in service 
at such facility on the day before the date of the 
enactment of the Bipartisan Budget Act of 2018, and 
‘‘(B) for purposes of paragraphs (3)(A) and (4)(A) of 
such subsection, an amount (not less than zero) equal to 
the excess of— 
‘‘(i) the amount described in clause (i) of subpara-
graph (A), over 
‘‘(ii) the amount described in clause (ii) of such 
subparagraph. 
‘‘(3) ELECTION.—For purposes of determining the carbon 
oxide sequestration credit under this section, a taxpayer may 
elect to have the dollar amounts applicable under paragraph 
(1) or (2) of subsection (a) apply in lieu of the dollar amounts 
applicable under paragraph (3) or (4) of such subsection for 
each metric ton of qualified carbon oxide which is captured 
by the taxpayer using carbon capture equipment which is origi-
nally placed in service at a qualified facility on or after the 
date of the enactment of the Bipartisan Budget Act of 2018. 
‘‘(c) QUALIFIED CARBON OXIDE.—For purposes of this section— 
‘‘(1) IN
GENERAL.—The term ‘qualified carbon oxide’ 
means— 
‘‘(A) any carbon dioxide which— 
‘‘(i) is captured from an industrial source by carbon 
capture equipment which is originally placed in service 
before the date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) 
would 
otherwise 
be 
released 
into 
the 
atmosphere as industrial emission of greenhouse gas 
or lead to such release, and 
‘‘(iii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization, 
‘‘(B) any carbon dioxide or other carbon oxide which— 
‘‘(i) is captured from an industrial source by carbon 
capture equipment which is originally placed in service 
on or after the date of the enactment of the Bipartisan 
Budget Act of 2018, 
‘‘(ii) 
would 
otherwise 
be 
released 
into 
the 
atmosphere as industrial emission of greenhouse gas 
or lead to such release, and 
‘‘(iii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization, 
or 
Definition. 
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132 STAT. 165 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(C) in the case of a direct air capture facility, any 
carbon dioxide which— 
‘‘(i) is captured directly from the ambient air, and 
‘‘(ii) is measured at the source of capture and 
verified at the point of disposal, injection, or utilization. 
‘‘(2) RECYCLED CARBON OXIDE.—The term ‘qualified carbon 
oxide’ includes the initial deposit of captured carbon oxide 
used as a tertiary injectant. Such term does not include carbon 
oxide that is recaptured, recycled, and re-injected as part of 
the enhanced oil and natural gas recovery process. 
‘‘(d) QUALIFIED FACILITY.—For purposes of this section, the 
term ‘qualified facility’ means any industrial facility or direct air 
capture facility— 
‘‘(1) the construction of which begins before January 1, 
2024, and— 
‘‘(A) construction of carbon capture equipment begins 
before such date, or 
‘‘(B) the original planning and design for such facility 
includes installation of carbon capture equipment, and 
‘‘(2) which captures— 
‘‘(A) in the case of a facility which emits not more 
than 500,000 metric tons of carbon oxide into the 
atmosphere during the taxable year, not less than 25,000 
metric tons of qualified carbon oxide during the taxable 
year which is utilized in a manner described in subsection 
(f)(5), 
‘‘(B) in the case of an electricity generating facility 
which is not described in subparagraph (A), not less than 
500,000 metric tons of qualified carbon oxide during the 
taxable year, or 
‘‘(C) in the case of a direct air capture facility or 
any facility not described in subparagraph (A) or (B), not 
less than 100,000 metric tons of qualified carbon oxide 
during the taxable year. 
‘‘(e) DEFINITIONS.—For purposes of this section— 
‘‘(1) DIRECT AIR CAPTURE FACILITY.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
term ‘direct air capture facility’ means any facility which 
uses carbon capture equipment to capture carbon dioxide 
directly from the ambient air. 
‘‘(B) EXCEPTION.—The term ‘direct air capture facility’ 
shall not include any facility which captures carbon 
dioxide— 
‘‘(i) which is deliberately released from naturally 
occurring subsurface springs, or 
‘‘(ii) using natural photosynthesis. 
‘‘(2) QUALIFIED ENHANCED OIL OR NATURAL GAS RECOVERY 
PROJECT.—The term ‘qualified enhanced oil or natural gas 
recovery project’ has the meaning given the term ‘qualified 
enhanced oil recovery project’ by section 43(c)(2), by substituting 
‘crude oil or natural gas’ for ‘crude oil’ in subparagraph (A)(i) 
thereof. 
‘‘(3) TERTIARY INJECTANT.—The term ‘tertiary injectant’ has 
the same meaning as when used within section 193(b)(1). 
‘‘(f) SPECIAL RULES.— 
‘‘(1) ONLY QUALIFIED CARBON OXIDE CAPTURED AND DIS-
POSED OF OR USED WITHIN THE UNITED STATES TAKEN INTO 
Definition. 
Definition. 
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132 STAT. 166 
PUBLIC LAW 115–123—FEB. 9, 2018 
ACCOUNT.—The credit under this section shall apply only with 
respect to qualified carbon oxide the capture and disposal, 
use, or utilization of which is within— 
‘‘(A) the United States (within the meaning of section 
638(1)), or 
‘‘(B) a possession of the United States (within the 
meaning of section 638(2)). 
‘‘(2) SECURE GEOLOGICAL STORAGE.—The Secretary, in con-
sultation with the Administrator of the Environmental Protec-
tion Agency, the Secretary of Energy, and the Secretary of 
the Interior, shall establish regulations for determining ade-
quate security measures for the geological storage of qualified 
carbon oxide under subsection (a) such that the qualified carbon 
oxide does not escape into the atmosphere. Such term shall 
include storage at deep saline formations, oil and gas reservoirs, 
and unminable coal seams under such conditions as the Sec-
retary may determine under such regulations. 
‘‘(3) CREDIT ATTRIBUTABLE TO TAXPAYER.— 
‘‘(A) IN GENERAL.—Except as provided in subparagraph 
(B) or in any regulations prescribed by the Secretary, any 
credit under this section shall be attributable to— 
‘‘(i) in the case of qualified carbon oxide captured 
using carbon capture equipment which is originally 
placed in service at a qualified facility before the date 
of the enactment of the Bipartisan Budget Act of 2018, 
the person that captures and physically or contrac-
tually ensures the disposal, utilization, or use as a 
tertiary injectant of such qualified carbon oxide, and 
‘‘(ii) in the case of qualified carbon oxide captured 
using carbon capture equipment which is originally 
placed in service at a qualified facility on or after 
the date of the enactment of the Bipartisan Budget 
Act of 2018, the person that owns the carbon capture 
equipment and physically or contractually ensures the 
capture and disposal, utilization, or use as a tertiary 
injectant of such qualified carbon oxide. 
‘‘(B) ELECTION.—If the person described in subpara-
graph (A) makes an election under this subparagraph in 
such time and manner as the Secretary may prescribe 
by regulations, the credit under this section— 
‘‘(i) shall be allowable to the person that disposes 
of the qualified carbon oxide, utilizes the qualified 
carbon oxide, or uses the qualified carbon oxide as 
a tertiary injectant, and 
‘‘(ii) shall not be allowable to the person described 
in subparagraph (A). 
‘‘(4) RECAPTURE.—The Secretary shall, by regulations, pro-
vide for recapturing the benefit of any credit allowable under 
subsection (a) with respect to any qualified carbon oxide which 
ceases to be captured, disposed of, or used as a tertiary injectant 
in a manner consistent with the requirements of this section. 
‘‘(5) UTILIZATION OF QUALIFIED CARBON OXIDE.— 
‘‘(A) IN GENERAL.—For purposes of this section, utiliza-
tion of qualified carbon oxide means— 
‘‘(i) the fixation of such qualified carbon oxide 
through photosynthesis or chemosynthesis, such as 
through the growing of algae or bacteria, 
Definition. 
Consultation. 
Applicability. 
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132 STAT. 167 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) the chemical conversion of such qualified 
carbon oxide to a material or chemical compound in 
which such qualified carbon oxide is securely stored, 
or 
‘‘(iii) the use of such qualified carbon oxide for 
any other purpose for which a commercial market 
exists (with the exception of use as a tertiary injectant 
in a qualified enhanced oil or natural gas recovery 
project), as determined by the Secretary. 
‘‘(B) MEASUREMENT.— 
‘‘(i) IN GENERAL.—For purposes of determining the 
amount of qualified carbon oxide utilized by the tax-
payer under paragraph (2)(B)(ii) or (4)(B)(ii) of sub-
section (a), such amount shall be equal to the metric 
tons of qualified carbon oxide which the taxpayer dem-
onstrates, based upon an analysis of lifecycle green-
house gas emissions and subject to such requirements 
as the Secretary, in consultation with the Secretary 
of Energy and the Administrator of the Environmental 
Protection Agency, determines appropriate, were— 
‘‘(I) captured and permanently isolated from 
the atmosphere, or 
‘‘(II) displaced from being emitted into the 
atmosphere, 
through use of a process described in subparagraph 
(A). 
‘‘(ii) LIFECYCLE GREENHOUSE GAS EMISSIONS.—For 
purposes of clause (i), the term ‘lifecycle greenhouse 
gas emissions’ has the same meaning given such term 
under subparagraph (H) of section 211(o)(1) of the 
Clean Air Act (42 U.S.C. 7545(o)(1)), as in effect on 
the date of the enactment of the Bipartisan Budget 
Act of 2018, except that ‘product’ shall be substituted 
for ‘fuel’ each place it appears in such subparagraph. 
‘‘(6) ELECTION FOR APPLICABLE FACILITIES.— 
‘‘(A) IN GENERAL.—For purposes of this section, in the 
case of an applicable facility, for any taxable year in which 
such facility captures not less than 500,000 metric tons 
of qualified carbon oxide during the taxable year, the per-
son described in paragraph (3)(A)(ii) may elect to have 
such facility, and any carbon capture equipment placed 
in service at such facility, deemed as having been placed 
in service on the date of the enactment of the Bipartisan 
Budget Act of 2018. 
‘‘(B) APPLICABLE FACILITY.—For purposes of this para-
graph, the term ‘applicable facility’ means a qualified 
facility— 
‘‘(i) which was placed in service before the date 
of the enactment of the Bipartisan Budget Act of 2018, 
and 
‘‘(ii) for which no taxpayer claimed a credit under 
this section in regards to such facility for any taxable 
year ending before the date of the enactment of such 
Act. 
‘‘(7) INFLATION ADJUSTMENT.—In the case of any taxable 
year beginning in a calendar year after 2009, there shall be 
substituted for each dollar amount contained in paragraphs 
Definition. 
Definition. 
Determination. 
Consultation. 
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132 STAT. 168 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) and (2) of subsection (a) an amount equal to the product 
of— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the inflation adjustment factor for such calendar 
year determined under section 43(b)(3)(B) for such calendar 
year, determined by substituting ‘2008’ for ‘1990’. 
‘‘(g) APPLICATION OF SECTION FOR CERTAIN CARBON CAPTURE 
EQUIPMENT.—In the case of any carbon capture equipment placed 
in service before the date of the enactment of the Bipartisan Budget 
Act of 2018, the credit under this section shall apply with respect 
to qualified carbon oxide captured using such equipment before 
the end of the calendar year in which the Secretary, in consultation 
with the Administrator of the Environmental Protection Agency, 
certifies that, during the period beginning after October 3, 2008, 
a total of 75,000,000 metric tons of qualified carbon oxide have 
been taken into account in accordance with— 
‘‘(1) subsection (a) of this section, as in effect on the day 
before the date of the enactment of the Bipartisan Budget 
Act of 2018, and 
‘‘(2) paragraphs (1) and (2) of subsection (a) of this section. 
‘‘(h) REGULATIONS.—The Secretary may prescribe such regula-
tions and other guidance as may be necessary or appropriate to 
carry out this section, including regulations or other guidance to— 
‘‘(1) ensure proper allocation under subsection (a) for quali-
fied carbon oxide captured by a taxpayer during the taxable 
year ending after the date of the enactment of the Bipartisan 
Budget Act of 2018, and 
‘‘(2) determine whether a facility satisfies the requirements 
under subsection (d)(1) during such taxable year.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall apply to taxable years beginning after December 31, 2017. 
DIVISION E—HEALTH AND HUMAN 
SERVICES EXTENDERS 
SEC. 50100. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This division may be cited as the ‘‘Advancing 
Chronic Care, Extenders, and Social Services (ACCESS) Act’’ 
(b) TABLE OF CONTENTS.—The table of contents for this division 
is as follows: 
DIVISION E—HEALTH AND HUMAN SERVICES EXTENDERS 
Sec. 50100. Short title; table of contents. 
TITLE I—CHIP 
Sec. 50101. Funding extension of the Children’s Health Insurance Program through 
fiscal year 2027. 
Sec. 50102. Extension of pediatric quality measures program. 
Sec. 50103. Extension of outreach and enrollment program. 
TITLE II—MEDICARE EXTENDERS 
Sec. 50201. Extension of work GPCI floor. 
Sec. 50202. Repeal of Medicare payment cap for therapy services; limitation to en-
sure appropriate therapy. 
Sec. 50203. Medicare ambulance services. 
Sec. 50204. Extension of increased inpatient hospital payment adjustment for cer-
tain low-volume hospitals. 
Sec. 50205. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 50206. Extension of funding for quality measure endorsement, input, and se-
lection; reporting requirements. 
42 USC 1305 
note. 
Advancing 
Chronic Care, 
Extenders, and 
Social Services 
(ACCESS) Act. 
Applicability. 
26 USC 45Q 
note. 
Determination. 
Consultation. 
Certification. 
Time period. 
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132 STAT. 169 
PUBLIC LAW 115–123—FEB. 9, 2018 
Sec. 50207. Extension of funding outreach and assistance for low-income programs; 
State health insurance assistance program reporting requirements. 
Sec. 50208. Extension of home health rural add-on. 
TITLE III—CREATING HIGH-QUALITY RESULTS AND OUTCOMES 
NECESSARY TO IMPROVE CHRONIC (CHRONIC) CARE 
Subtitle A—Receiving High Quality Care in the Home 
Sec. 50301. Extending the Independence at Home Demonstration Program. 
Sec. 50302. Expanding access to home dialysis therapy. 
Subtitle B—Advancing Team-Based Care 
Sec. 50311. Providing continued access to Medicare Advantage special needs plans 
for vulnerable populations. 
Subtitle C—Expanding Innovation and Technology 
Sec. 50321. Adapting benefits to meet the needs of chronically ill Medicare Advan-
tage enrollees. 
Sec. 50322. Expanding supplemental benefits to meet the needs of chronically ill 
Medicare Advantage enrollees. 
Sec. 50323. Increasing convenience for Medicare Advantage enrollees through tele-
health. 
Sec. 50324. Providing accountable care organizations the ability to expand the use 
of telehealth. 
Sec. 50325. Expanding the use of telehealth for individuals with stroke. 
Subtitle D—Identifying the Chronically Ill Population 
Sec. 50331. Providing flexibility for beneficiaries to be part of an accountable care 
organization. 
Subtitle E—Empowering Individuals and Caregivers in Care Delivery 
Sec. 50341. Eliminating barriers to care coordination under accountable care orga-
nizations. 
Sec. 50342. GAO study and report on longitudinal comprehensive care planning 
services under Medicare part B. 
Subtitle F—Other Policies to Improve Care for the Chronically Ill 
Sec. 50351. GAO study and report on improving medication synchronization. 
Sec. 50352. GAO study and report on impact of obesity drugs on patient health and 
spending. 
Sec. 50353. HHS study and report on long-term risk factors for chronic conditions 
among Medicare beneficiaries. 
Sec. 50354. Providing prescription drug plans with parts A and B claims data to 
promote the appropriate use of medications and improve health out-
comes. 
TITLE IV—PART B IMPROVEMENT ACT AND OTHER PART B 
ENHANCEMENTS 
Subtitle A—Medicare Part B Improvement Act 
Sec. 50401. Home infusion therapy services temporary transitional payment. 
Sec. 50402. Orthotist’s and prosthetist’s clinical notes as part of the patient’s med-
ical record. 
Sec. 50403. Independent accreditation for dialysis facilities and assurance of high 
quality surveys. 
Sec. 50404. Modernizing the application of the Stark rule under Medicare. 
Subtitle B—Additional Medicare Provisions 
Sec. 50411. Making permanent the removal of the rental cap for durable medical 
equipment under Medicare with respect to speech generating devices. 
Sec. 50412. Increased civil and criminal penalties and increased sentences for Fed-
eral health care program fraud and abuse. 
Sec. 50413. Reducing the volume of future EHR-related significant hardship re-
quests. 
Sec. 50414. Strengthening rules in case of competition for diabetic testing strips. 
TITLE V—OTHER HEALTH EXTENDERS 
Sec. 50501. Extension for family-to-family health information centers. 
Sec. 50502. Extension for sexual risk avoidance education. 
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132 STAT. 170 
PUBLIC LAW 115–123—FEB. 9, 2018 
Sec. 50503. Extension for personal responsibility education. 
TITLE VI—CHILD AND FAMILY SERVICES AND SUPPORTS EXTENDERS 
Subtitle A—Continuing the Maternal, Infant, and Early Childhood Home Visiting 
Program 
Sec. 50601. Continuing evidence-based home visiting program. 
Sec. 50602. Continuing to demonstrate results to help families. 
Sec. 50603. Reviewing statewide needs to target resources. 
Sec. 50604. Improving the likelihood of success in high-risk communities. 
Sec. 50605. Option to fund evidence-based home visiting on a pay for outcome 
basis. 
Sec. 50606. Data exchange standards for improved interoperability. 
Sec. 50607. Allocation of funds. 
Subtitle B—Extension of Health Professions Workforce Demonstration Projects 
Sec. 50611. Extension of health workforce demonstration projects for low-income in-
dividuals. 
TITLE VII—FAMILY FIRST PREVENTION SERVICES ACT 
Subtitle A—Investing in Prevention and Supporting Families 
Sec. 50701. Short title. 
Sec. 50702. Purpose. 
PART I—PREVENTION ACTIVITIES UNDER TITLE IV–E 
Sec. 50711. Foster care prevention services and programs. 
Sec. 50712. Foster care maintenance payments for children with parents in a li-
censed residential family-based treatment facility for substance abuse. 
Sec. 50713. Title IV–E payments for evidence-based kinship navigator programs. 
PART II—ENHANCED SUPPORT UNDER TITLE IV–B 
Sec. 50721. Elimination of time limit for family reunification services while in fos-
ter care and permitting time-limited family reunification services when 
a child returns home from foster care. 
Sec. 50722. Reducing bureaucracy and unnecessary delays when placing children in 
homes across State lines. 
Sec. 50723. Enhancements to grants to improve well-being of families affected by 
substance abuse. 
PART III—MISCELLANEOUS 
Sec. 50731. Reviewing and improving licensing standards for placement in a rel-
ative foster family home. 
Sec. 50732. Development of a statewide plan to prevent child abuse and neglect fa-
talities. 
Sec. 50733. Modernizing the title and purpose of title IV–E. 
Sec. 50734. Effective dates. 
PART IV—ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A FOSTER 
FAMILY HOME 
Sec. 50741. Limitation on Federal financial participation for placements that are 
not in foster family homes. 
Sec. 50742. Assessment and documentation of the need for placement in a qualified 
residential treatment program. 
Sec. 50743. Protocols to prevent inappropriate diagnoses. 
Sec. 50744. Additional data and reports regarding children placed in a setting that 
is not a foster family home. 
Sec. 50745. Criminal records checks and checks of child abuse and neglect reg-
istries for adults working in child-care institutions and other group care 
settings. 
Sec. 50746. Effective dates; application to waivers. 
PART V—CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES 
Sec. 50751. Supporting and retaining foster families for children. 
Sec. 50752. Extension of child and family services programs. 
Sec. 50753. Improvements to the John H. Chafee foster care independence program 
and related provisions. 
PART VI—CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND LEGAL 
GUARDIANSHIP 
Sec. 50761. Reauthorizing adoption and legal guardianship incentive programs. 
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132 STAT. 171 
PUBLIC LAW 115–123—FEB. 9, 2018 
PART VII—TECHNICAL CORRECTIONS 
Sec. 50771. Technical corrections to data exchange standards to improve program 
coordination. 
Sec. 50772. Technical corrections to State requirement to address the develop-
mental needs of young children. 
PART VIII—ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN 
ADOPTION ASSISTANCE 
Sec. 50781. Delay of adoption assistance phase-in. 
Sec. 50782. GAO study and report on State reinvestment of savings resulting from 
increase in adoption assistance. 
TITLE VIII—SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY FOR 
RESULTS 
Sec. 50801. Short title. 
Sec. 50802. Social impact partnerships to pay for results. 
TITLE IX—PUBLIC HEALTH PROGRAMS 
Sec. 50901. Extension for community health centers, the National Health Service 
Corps, and teaching health centers that operate GME programs. 
Sec. 50902. Extension for special diabetes programs. 
TITLE X—MISCELLANEOUS HEALTH CARE POLICIES 
Sec. 51001. Home health payment reform. 
Sec. 51002. Information to satisfy documentation of Medicare eligibility for home 
health services. 
Sec. 51003. Technical amendments to Public Law 114–10. 
Sec. 51004. Expanded access to Medicare intensive cardiac rehabilitation programs. 
Sec. 51005. Extension of blended site neutral payment rate for certain long-term 
care hospital discharges; temporary adjustment to site neutral payment 
rates. 
Sec. 51006. Recognition of attending physician assistants as attending physicians 
to serve hospice patients. 
Sec. 51007. Extension of enforcement instruction on supervision requirements for 
outpatient therapeutic services in critical access and small rural hos-
pitals through 2017. 
Sec. 51008. Allowing physician assistants, nurse practitioners, and clinical nurse 
specialists to supervise cardiac, intensive cardiac, and pulmonary reha-
bilitation programs. 
Sec. 51009. Transitional payment rules for certain radiation therapy services under 
the physician fee schedule. 
TITLE XI—PROTECTING SENIORS’ ACCESS TO MEDICARE ACT 
Sec. 52001. Repeal of the Independent Payment Advisory Board. 
TITLE XII—OFFSETS 
Sec. 53101. Modifying reductions in Medicaid DSH allotments. 
Sec. 53102. Third party liability in Medicaid and CHIP. 
Sec. 53103. Treatment of lottery winnings and other lump-sum income for purposes 
of income eligibility under Medicaid. 
Sec. 53104. Rebate obligation with respect to line extension drugs. 
Sec. 53105. Medicaid Improvement Fund. 
Sec. 53106. Physician fee schedule update. 
Sec. 53107. Payment for outpatient physical therapy services and outpatient occu-
pational therapy services furnished by a therapy assistant. 
Sec. 53108. Reduction for non-emergency ESRD ambulance transports. 
Sec. 53109. Hospital transfer policy for early discharges to hospice care. 
Sec. 53110. Medicare payment update for home health services. 
Sec. 53111. Medicare payment update for skilled nursing facilities. 
Sec. 53112. Preventing the artificial inflation of star ratings after the consolidation 
of Medicare Advantage plans offered by the same organization. 
Sec. 53113. Sunsetting exclusion of biosimilars from Medicare part D coverage gap 
discount program. 
Sec. 53114. Adjustments to Medicare part B and part D premium subsidies for 
higher income individuals. 
Sec. 53115. Medicare Improvement Fund. 
Sec. 53116. Closing the Donut Hole for Seniors. 
Sec. 53117. Modernizing child support enforcement fees. 
Sec. 53118. Increasing efficiency of prison data reporting. 
Sec. 53119. Prevention and Public Health Fund. 
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132 STAT. 172 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE I—CHIP 
SEC. 50101. FUNDING EXTENSION OF THE CHILDREN’S HEALTH INSUR-
ANCE PROGRAM THROUGH FISCAL YEAR 2027. 
(a) IN GENERAL.—Section 2104(a) of the Social Security Act 
(42 U.S.C. 1397dd(a)), as amended by section 3002(a) of the 
HEALTHY KIDS Act (division C of Public Law 115–120), is 
amended— 
(1) in paragraph (25), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) in paragraph (26), by striking the period at the end 
and inserting a semicolon; and 
(3) by adding at the end the following new paragraphs: 
‘‘(27) for each of fiscal years 2024 through 2026, such 
sums as are necessary to fund allotments to States under 
subsections (c) and (m); and 
‘‘(28) for fiscal year 2027, for purposes of making two semi- 
annual allotments— 
‘‘(A) $7,650,000,000 for the period beginning on October 
1, 2026, and ending on March 31, 2027; and 
‘‘(B) $7,650,000,000 for the period beginning on April 
1, 2027, and ending on September 30, 2027.’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the Social Security 
Act (42 U.S.C. 1397dd(m)), as amended by section 3002(b) of 
the HEALTHY KIDS Act (division C of Public Law 115–120), 
is amended— 
(A) in paragraph (2)(B)— 
(i) in the matter preceding clause (i), by striking 
‘‘(25)’’ and inserting ‘‘(27)’’; 
(ii) in clause (i), by striking ‘‘and 2023’’ and 
inserting ‘‘, 2023, and 2027’’; and 
(iii) in clause (ii)(I), by striking ‘‘(or, in the case 
of fiscal year 2018, under paragraph (4))’’ and inserting 
‘‘(or, in the case of fiscal year 2018 or 2024, under 
paragraph (4) or (10), respectively)’’; 
(B) in paragraph (5)— 
(i) by striking ‘‘or (10)’’ and inserting ‘‘(10), or 
(11)’’; and 
(ii) by striking ‘‘or 2023,’’ and inserting ‘‘2023, or 
2027,’’; 
(C) in paragraph (7)— 
(i) in subparagraph (A), by striking ‘‘2023’’ and 
inserting ‘‘2027,’’; and 
(ii) in the matter following subparagraph (B), by 
striking ‘‘or fiscal year 2022’’ and inserting ‘‘fiscal year 
2022, fiscal year 2024, or fiscal year 2026’’; 
(D) in paragraph (9)— 
(i) by striking ‘‘or (10)’’ and inserting ‘‘(10), or 
(11)’’; and 
(ii) by striking ‘‘or 2023,’’ and inserting ‘‘2023, or 
2027,’’; and 
(E) by adding at the end the following: 
‘‘(11) FOR FISCAL YEAR 2027.— 
‘‘(A) FIRST HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (A) 
Computations. 
States. 
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132 STAT. 173 
PUBLIC LAW 115–123—FEB. 9, 2018 
of paragraph (28) of subsection (a) for the semi-annual 
period described in such subparagraph, increased by the 
amount of the appropriation for such period under section 
50101(b)(2) of the Advancing Chronic Care, Extenders, and 
Social Services Act, the Secretary shall compute a State 
allotment for each State (including the District of Columbia 
and each commonwealth and territory) for such semi- 
annual period in an amount equal to the first half ratio 
(described in subparagraph (D)) of the amount described 
in subparagraph (C). 
‘‘(B) SECOND HALF.—Subject to paragraphs (5) and (7), 
from the amount made available under subparagraph (B) 
of paragraph (28) of subsection (a) for the semi-annual 
period described in such subparagraph, the Secretary shall 
compute a State allotment for each State (including the 
District of Columbia and each commonwealth and territory) 
for such semi-annual period in an amount equal to the 
amount made available under such subparagraph, multi-
plied by the ratio of— 
‘‘(i) the amount of the allotment to such State 
under subparagraph (A); to 
‘‘(ii) the total of the amount of all of the allotments 
made available under such subparagraph. 
‘‘(C) FULL YEAR AMOUNT BASED ON REBASED AMOUNT.— 
The amount described in this subparagraph for a State 
is equal to the Federal payments to the State that are 
attributable to (and countable towards) the total amount 
of allotments available under this section to the State 
in fiscal year 2026 (including payments made to the State 
under subsection (n) for fiscal year 2026 as well as amounts 
redistributed to the State in fiscal year 2026), multiplied 
by the allotment increase factor under paragraph (6) for 
fiscal year 2027. 
‘‘(D) FIRST HALF RATIO.—The first half ratio described 
in this subparagraph is the ratio of— 
‘‘(i) the sum of— 
‘‘(I) the amount made available under sub-
section (a)(28)(A); and 
‘‘(II) the amount of the appropriation for such 
period under section 50101(b)(2) of the Advancing 
Chronic Care, Extenders, and Social Services Act; 
to 
‘‘(ii) the sum of— 
‘‘(I) the amount described in clause (i); and 
‘‘(II) the amount made available under sub-
section (a)(28)(B).’’. 
(2) ONE-TIME APPROPRIATION FOR FISCAL YEAR 2027.—There 
is appropriated to the Secretary of Health and Human Services, 
out of any money in the Treasury not otherwise appropriated, 
such sums as are necessary to fund allotments to States under 
subsections (c) and (m) of section 2104 of the Social Security 
Act (42 U.S.C. 1397dd) for fiscal year 2027, taking into account 
the full year amounts calculated for States under paragraph 
(11)(C) of subsection (m) of such section (as added by paragraph 
(1)) and the amounts appropriated under subparagraphs (A) 
and (B) of subsection (a)(28) of such section (as added by 
subsection (a)). Such amount shall accompany the allotment 
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132 STAT. 174 
PUBLIC LAW 115–123—FEB. 9, 2018 
made for the period beginning on October 1, 2026, and ending 
on March 31, 2027, under paragraph (28)(A) of section 2104(a) 
of such Act (42 U.S.C. 1397dd(a)), to remain available until 
expended. Such amount shall be used to provide allotments 
to States under paragraph (11) of section 2104(m) of such 
Act for the first 6 months of fiscal year 2027 in the same 
manner as allotments are provided under subsection (a)(28)(A) 
of such section 2104 and subject to the same terms and condi-
tions as apply to the allotments provided from such subsection 
(a)(28)(A). 
(c) EXTENSION
OF
THE
CHILD
ENROLLMENT
CONTINGENCY 
FUND.—Section 2104(n) of the Social Security Act (42 U.S.C. 
1397dd(n)), as amended by section 3002(c) of the HEALTHY KIDS 
Act (division C of Public Law 115–120), is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘and 2018 through 2022’’ and 
inserting ‘‘2018 through 2022, and 2024 through 2026’’; 
and 
(ii) by striking ‘‘and 2023’’ and inserting ‘‘2023, 
and 2027’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘and 2018 through 2022’’ and 
inserting ‘‘2018 through 2022, and 2024 through 2026’’; 
and 
(ii) by striking ‘‘and 2023’’ and inserting ‘‘2023, 
and 2027’’; and 
(2) in paragraph (3)(A), in the matter preceding clause 
(i)— 
(A) by striking ‘‘or in any of fiscal years 2018 through 
2022’’ and inserting ‘‘fiscal years 2018 through 2022, or 
fiscal years 2024 through 2026’’; and 
(B) by striking ‘‘or 2023’’ and inserting ‘‘2023, or 2027’’. 
(d) EXTENSION
OF
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4)), as 
amended by section 3002(d) of the HEALTHY KIDS Act (division 
C of Public Law 115–120), is amended— 
(1) in the paragraph heading, by striking ‘‘THROUGH 2023’’ 
and inserting ‘‘THROUGH 2027’’; and 
(2) in subparagraph (A), by striking ‘‘2023’’ and inserting 
‘‘2027’’. 
(e) EXTENSION OF EXPRESS LANE ELIGIBILITY OPTION.—Section 
1902(e)(13)(I) of the Social Security Act (42 U.S.C. 1396a(e)(13)(I)), 
as amended by section 3002(e) of the HEALTHY KIDS Act (division 
C of Public Law 115–120), is amended by striking ‘‘2023’’ and 
inserting ‘‘2027’’. 
(f) ASSURANCE OF ELIGIBILITY STANDARD FOR CHILDREN AND 
FAMILIES.— 
(1) IN GENERAL.—Section 2105(d)(3) of the Social Security 
Act (42 U.S.C. 1397ee(d)(3)), as amended by section 3002(f)(1) 
of the HEALTHY KIDS Act (division C of Public Law 115– 
120), is amended— 
(A) in the paragraph heading, by striking ‘‘THROUGH 
SEPTEMBER 30, 2023’’ and inserting ‘‘THROUGH SEPTEMBER 
30, 2027’’; and 
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132 STAT. 175 
PUBLIC LAW 115–123—FEB. 9, 2018 
(B) in subparagraph (A), in the matter preceding clause 
(i), by striking ‘‘2023’’ each place it appears and inserting 
‘‘2027’’. 
(2) CONFORMING AMENDMENTS.—Section 1902(gg)(2) of the 
Social Security Act (42 U.S.C. 1396a(gg)(2)), as amended by 
section 3002(f)(2) of the HEALTHY KIDS Act (division C of 
Public Law 115–120), is amended— 
(A) in the paragraph heading, by striking ‘‘THROUGH 
SEPTEMBER 30, 2023’’ and inserting ‘‘THROUGH SEPTEMBER 
30, 2027’’; and 
(B) by striking ‘‘2023,’’ each place it appears and 
inserting ‘‘2027’’. 
SEC. 50102. EXTENSION OF PEDIATRIC QUALITY MEASURES PROGRAM. 
(a) IN GENERAL.—Section 1139A(i)(1) of the Social Security 
Act (42 U.S.C. 1320b–9a(i)(1)), as amended by section 3003(b) of 
the HEALTHY KIDS Act (division C of Public Law 115–120), is 
amended— 
(1) in subparagraph (B), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) in subparagraph (C), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(D) for the period of fiscal years 2024 through 2027, 
$60,000,000 for the purpose of carrying out this section 
(other than subsections (e), (f), and (g)).’’. 
(b) MAKING REPORTING MANDATORY.—Section 1139A of the 
Social Security Act (42 U.S.C. 1320b–9a) is amended— 
(1) in subsection (a)— 
(A) in the heading for paragraph (4), by inserting ‘‘AND 
MANDATORY REPORTING’’ after ‘‘REPORTING’’; 
(B) in paragraph (4)— 
(i) by striking ‘‘Not later than’’ and inserting the 
following: 
‘‘(A) VOLUNTARY REPORTING.—Not later than’’; and 
(ii) by adding at the end the following: 
‘‘(B) MANDATORY
REPORTING.—Beginning with the 
annual State report on fiscal year 2024 required under 
subsection (c)(1), the Secretary shall require States to use 
the initial core measurement set and any updates or 
changes to that set to report information regarding the 
quality of pediatric health care under titles XIX and XXI 
using the standardized format for reporting information 
and procedures developed under subparagraph (A).’’; and 
(C) in paragraph (6)(B), by inserting ‘‘and, beginning 
with the report required on January 1, 2025, and for each 
annual report thereafter, the status of mandatory reporting 
by States under titles XIX and XXI, utilizing the initial 
core quality measurement set and any updates or changes 
to that set’’ before the semicolon; and 
(2) in subsection (c)(1)(A), by inserting ‘‘and, beginning 
with the annual report on fiscal year 2024, all of the core 
measures described in subsection (a) and any updates or 
changes to those measures’’ before the semicolon. 
Effective date. 
Effective dates. 
Time period. 
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132 STAT. 176 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 50103. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Security Act (42 
U.S.C. 1397mm), as amended by section 3004(a) of the HEALTHY 
KIDS Act (division C of Public Law 115–120), is amended— 
(1) in subsection (a)(1), by striking ‘‘2023’’ and inserting 
‘‘2027’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $120,000,000’’ and inserting ‘‘, 
$120,000,000’’; and 
(B) by inserting ‘‘, and $48,000,000 for the period of 
fiscal years 2024 through 2027’’ after ‘‘2023’’. 
(b) ADDITIONAL RESERVED FUNDS.—Section 2113(a) of the Social 
Security Act (42 U.S.C. 1397mm(a)) is amended— 
(1) in paragraph (1), by striking ‘‘paragraph (2)’’ and 
inserting ‘‘paragraphs (2) and (3)’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(3) TEN PERCENT SET ASIDE FOR EVALUATING AND PRO-
VIDING TECHNICAL ASSISTANCE TO GRANTEES.—For the period 
of fiscal years 2024 through 2027, an amount equal to 10 
percent of such amounts shall be used by the Secretary for 
the purpose of evaluating and providing technical assistance 
to eligible entities awarded grants under this section.’’. 
(c) USE OF RESERVED FUNDS FOR NATIONAL ENROLLMENT AND 
RETENTION STRATEGIES.—Section 2113(h) of the Social Security Act 
(42 U.S.C. 1397mm(h)) is amended— 
(1) in paragraph (5), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) by redesignating paragraph (6) as paragraph (7); and 
(3) by inserting after paragraph (5) the following new para-
graph: 
‘‘(6) the development of materials and toolkits and the 
provision of technical assistance to States regarding enrollment 
and retention strategies for eligible children under this title 
and title XIX; and’’. 
TITLE II—MEDICARE EXTENDERS 
SEC. 50201. EXTENSION OF WORK GPCI FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 
1395w–4(e)(1)(E)) is amended by striking ‘‘January 1, 2018’’ and 
inserting ‘‘January 1, 2020’’. 
SEC. 50202. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERV-
ICES; LIMITATION TO ENSURE APPROPRIATE THERAPY. 
Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) 
is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘Subject to paragraphs (4) and (5)’’ 
and inserting ‘‘(A) Subject to paragraphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted and designated 
by subparagraph (A) of this paragraph, by adding at the 
end the following new sentence: ‘‘The preceding sentence 
shall not apply to expenses incurred with respect to services 
furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new subpara-
graph: 
Time periods. 
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132 STAT. 177 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(B) With respect to services furnished during 2018 or a subse-
quent year, in the case of physical therapy services of the type 
described in section 1861(p), speech-language pathology services 
of the type described in such section through the application of 
section 1861(ll)(2), and physical therapy services and speech-lan-
guage pathology services of such type which are furnished by a 
physician or as incident to physicians’ services, with respect to 
expenses incurred in any calendar year, any amount that is more 
than the amount specified in paragraph (2) for the year shall 
not be considered as incurred expenses for purposes of subsections 
(a) and (b) unless the applicable requirements of paragraph (7) 
are met.’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘Subject to paragraphs (4) and (5)’’ 
and inserting ‘‘(A) Subject to paragraphs (4) and (5)’’; 
(B) in the subparagraph (A), as inserted and designated 
by subparagraph (A) of this paragraph, by adding at the 
end the following new sentence: ‘‘The preceding sentence 
shall not apply to expenses incurred with respect to services 
furnished after December 31, 2017.’’; and 
(C) by adding at the end the following new subpara-
graph:. 
‘‘(B) With respect to services furnished during 2018 or a subse-
quent year, in the case of occupational therapy services (of the 
type that are described in section 1861(p) through the operation 
of section 1861(g) and of such type which are furnished by a 
physician or as incident to physicians’ services), with respect to 
expenses incurred in any calendar year, any amount that is more 
than the amount specified in paragraph (2) for the year shall 
not be considered as incurred expenses for purposes of subsections 
(a) and (b) unless the applicable requirements of paragraph (7) 
are met.’’; 
(3) in paragraph (5)— 
(A) by redesignating subparagraph (D) as paragraph 
(8) and moving such paragraph to immediately follow para-
graph (7), as added by paragraph (4) of this section; and 
(B) in subparagraph (E)(iv), by inserting ‘‘, except as 
such process is applied under paragraph (7)(B)’’ before the 
period at the end; and 
(4) by adding at the end the following new paragraph: 
‘‘(7) For purposes of paragraphs (1)(B) and (3)(B), with respect 
to services described in such paragraphs, the requirements 
described in this paragraph are as follows: 
‘‘(A) INCLUSION OF APPROPRIATE MODIFIER.—The claim for 
such services contains an appropriate modifier (such as the 
KX modifier described in paragraph (5)(B)) indicating that such 
services are medically necessary as justified by appropriate 
documentation in the medical record involved. 
‘‘(B) TARGETED
MEDICAL
REVIEW
FOR
CERTAIN
SERVICES 
ABOVE THRESHOLD.— 
‘‘(i) IN
GENERAL.—In the case where expenses that 
would be incurred for such services would exceed the 
threshold described in clause (ii) for the year, such services 
shall be subject to the process for medical review imple-
mented under paragraph (5)(E). 
‘‘(ii) THRESHOLD.—The threshold under this clause 
for— 
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132 STAT. 178 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(I) a year before 2028, is $3,000; 
‘‘(II) 2028, is the amount specified in subclause 
(I) increased by the percentage increase in the MEI 
(as defined in section 1842(i)(3)) for 2028; and 
‘‘(III) a subsequent year, is the amount specified 
in this clause for the preceding year increased by the 
percentage increase in the MEI (as defined in section 
1842(i)(3)) for such subsequent year; 
except that if an increase under subclause (II) or (III) 
for a year is not a multiple of $10, it shall be rounded 
to the nearest multiple of $10. 
‘‘(iii) APPLICATION.—The threshold under clause (ii) 
shall be applied separately— 
‘‘(I) for physical therapy services and speech-lan-
guage pathology services; and 
‘‘(II) for occupational therapy services. 
‘‘(iv) FUNDING.—For purposes of carrying out this 
subparagraph, the Secretary shall provide for the transfer, 
from the Federal Supplementary Medical Insurance Trust 
Fund under section 1841 to the Centers for Medicare & 
Medicaid Services Program Management Account, of 
$5,000,000 for each fiscal year beginning with fiscal year 
2018, to remain available until expended. Such funds may 
not be used by a contractor under section 1893(h) for med-
ical reviews under this subparagraph.’’. 
SEC. 50203. MEDICARE AMBULANCE SERVICES. 
(a) EXTENSION OF CERTAIN GROUND AMBULANCE ADD-ON PAY-
MENTS.— 
(1) GROUND
AMBULANCE.—Section 1834(l)(13)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended 
by striking ‘‘2018’’ and inserting ‘‘2023’’ each place it appears. 
(2) SUPER RURAL AMBULANCE.—Section 1834(l)(12)(A) of the 
Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended, 
in the first sentence, by striking ‘‘2018’’ and inserting ‘‘2023’’. 
(b) REQUIRING GROUND AMBULANCE PROVIDERS OF SERVICES 
AND SUPPLIERS TO SUBMIT COST AND OTHER INFORMATION.—Section 
1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is amended 
by adding at the end the following new paragraph: 
‘‘(17) SUBMISSION OF COST AND OTHER INFORMATION.— 
‘‘(A) DEVELOPMENT OF DATA COLLECTION SYSTEM.—The 
Secretary shall develop a data collection system (which 
may include use of a cost survey) to collect cost, revenue, 
utilization, and other information determined appropriate 
by the Secretary with respect to providers of services (in 
this paragraph referred to as ‘providers’) and suppliers 
of ground ambulance services. Such system shall be 
designed to collect information— 
‘‘(i) needed to evaluate the extent to which reported 
costs relate to payment rates under this subsection; 
‘‘(ii) on the utilization of capital equipment and 
ambulance capacity, including information consistent 
with the type of information described in section 
1121(a); and 
‘‘(iii) on different types of ground ambulance serv-
ices furnished in different geographic locations, 
Evaluation. 
Time period. 
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132 STAT. 179 
PUBLIC LAW 115–123—FEB. 9, 2018 
including rural areas and low population density areas 
described in paragraph (12). 
‘‘(B) SPECIFICATION OF DATA COLLECTION SYSTEM.— 
‘‘(i) IN GENERAL.—The Secretary shall— 
‘‘(I) not later than December 31, 2019, specify 
the data collection system under subparagraph (A); 
and 
‘‘(II) identify the providers and suppliers of 
ground ambulance services that would be required 
to submit information under such data collection 
system, 
including 
the 
representative 
sample 
described in clause (ii). 
‘‘(ii) 
DETERMINATION
OF
REPRESENTATIVE 
SAMPLE.— 
‘‘(I) IN
GENERAL.—Not later than December 
31, 2019, with respect to the data collection for 
the first year under such system, and for each 
subsequent year through 2024, the Secretary shall 
determine a representative sample to submit 
information under the data collection system. 
‘‘(II) REQUIREMENTS.—The sample under sub-
clause (I) shall be representative of the different 
types of providers and suppliers of ground ambu-
lance services (such as those providers and sup-
pliers that are part of an emergency service or 
part of a government organization) and the 
geographic locations in which ground ambulance 
services are furnished (such as urban, rural, and 
low population density areas). 
‘‘(III) LIMITATION.—The Secretary shall not 
include an individual provider or supplier of 
ground ambulance services in the sample under 
subclause (I) in 2 consecutive years, to the extent 
practicable. 
‘‘(C) REPORTING OF COST INFORMATION.—For each year, 
a provider or supplier of ground ambulance services identi-
fied by the Secretary under subparagraph (B)(i)(II) as being 
required to submit information under the data collection 
system with respect to a period for the year shall submit 
to the Secretary information specified under the system. 
Such information shall be submitted in a form and manner, 
and at a time, specified by the Secretary for purposes 
of this subparagraph. 
‘‘(D) PAYMENT REDUCTION FOR FAILURE TO REPORT.— 
‘‘(i) IN GENERAL.—Beginning January 1, 2022, sub-
ject to clause (ii), a 10 percent reduction to payments 
under this subsection shall be made for the applicable 
period (as defined in clause (ii)) to a provider or sup-
plier of ground ambulance services that— 
‘‘(I) is required to submit information under 
the data collection system with respect to a period 
under subparagraph (C); and 
‘‘(II) does not sufficiently submit such informa-
tion, as determined by the Secretary. 
‘‘(ii) APPLICABLE PERIOD DEFINED.—For purposes 
of clause (i), the term ‘applicable period’ means, with 
respect to a provider or supplier of ground ambulance 
Effective date. 
Deadlines. 
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132 STAT. 180 
PUBLIC LAW 115–123—FEB. 9, 2018 
services, a year specified by the Secretary not more 
than 2 years after the end of the period with respect 
to which the Secretary has made a determination 
under clause (i)(II) that the provider or supplier of 
ground ambulance services failed to sufficiently submit 
information under the data collection system. 
‘‘(iii) HARDSHIP
EXEMPTION.—The Secretary may 
exempt a provider or supplier from the payment reduc-
tion under clause (i) with respect to an applicable 
period in the event of significant hardship, such as 
a natural disaster, bankruptcy, or other similar situa-
tion that the Secretary determines interfered with the 
ability of the provider or supplier of ground ambulance 
services to submit such information in a timely manner 
for the specified period. 
‘‘(iv) INFORMAL
REVIEW.—The Secretary shall 
establish a process under which a provider or supplier 
of ground ambulance services may seek an informal 
review of a determination that the provider or supplier 
is subject to the payment reduction under clause (i). 
‘‘(E) ONGOING DATA COLLECTION.— 
‘‘(i) REVISION OF DATA COLLECTION SYSTEM.—The 
Secretary may, as the Secretary determines appro-
priate and, if available, taking into consideration the 
report (or reports) under subparagraph (F), revise the 
data collection system under subparagraph (A). 
‘‘(ii) SUBSEQUENT DATA COLLECTION.—In order to 
continue to evaluate the extent to which reported costs 
relate to payment rates under this subsection and for 
other purposes the Secretary deems appropriate, the 
Secretary shall require providers and suppliers of 
ground ambulance services to submit information for 
years after 2024 as the Secretary determines appro-
priate, but in no case less often than once every 3 
years. 
‘‘(F) GROUND
AMBULANCE
DATA
COLLECTION
SYSTEM 
STUDY.— 
‘‘(i) IN GENERAL.—Not later than March 15, 2023, 
and as determined necessary by the Medicare Payment 
Advisory Commission thereafter, such Commission 
shall assess, and submit to Congress a report on, 
information submitted by providers and suppliers of 
ground ambulance services through the data collection 
system under subparagraph (A), the adequacy of pay-
ments for ground ambulance services under this sub-
section, and geographic variations in the cost of fur-
nishing such services. 
‘‘(ii) CONTENTS.—A report under clause (i) shall 
contain the following: 
‘‘(I) An analysis of information submitted 
through the data collection system. 
‘‘(II) An analysis of any burden on providers 
and suppliers of ground ambulance services associ-
ated with the data collection system. 
‘‘(III) A recommendation as to whether 
information should continue to be submitted 
through such data collection system or if such 
Recommenda- 
tion. 
Analysis. 
Assessment. 
Reports. 
Time period. 
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132 STAT. 181 
PUBLIC LAW 115–123—FEB. 9, 2018 
system should be revised under subparagraph 
(E)(i). 
‘‘(IV) Other information determined appro-
priate by the Commission. 
‘‘(G) PUBLIC AVAILABILITY.—The Secretary shall post 
information on the results of the data collection under 
this paragraph on the Internet website of the Centers 
for Medicare & Medicaid Services, as determined appro-
priate by the Secretary. 
‘‘(H) IMPLEMENTATION.—The Secretary shall implement 
this paragraph through notice and comment rulemaking. 
‘‘(I) ADMINISTRATION.—Chapter 35 of title 44, United 
States Code, shall not apply to the collection of information 
required under this subsection. 
‘‘(J) LIMITATIONS
ON
REVIEW.—There shall be no 
administrative or judicial review under section 1869, sec-
tion 1878, or otherwise of the data collection system or 
identification of respondents under this paragraph. 
‘‘(K) FUNDING FOR IMPLEMENTATION.—For purposes of 
carrying out subparagraph (A), the Secretary shall provide 
for the transfer, from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841, of $15,000,000 
to the Centers for Medicare & Medicaid Services Program 
Management Account for fiscal year 2018. Amounts trans-
ferred under this subparagraph shall remain available until 
expended.’’. 
SEC. 50204. EXTENSION OF INCREASED INPATIENT HOSPITAL PAY-
MENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOS-
PITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social Security 
Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter preceding clause 
(i), by striking ‘‘fiscal year 2018’’ and inserting ‘‘fiscal year 
2023’’; 
(2) in subparagraph (C)— 
(A) in clause (i)— 
(i) by striking ‘‘through 2017’’ the first place it 
appears and inserting ‘‘through 2022’’; and 
(ii) by striking ‘‘ and has less than 800 discharges’’ 
and all that follows through the period at the end 
and inserting the following ‘‘and has— 
‘‘(I) with respect to each of fiscal years 2005 
through 2010, less than 800 discharges during the 
fiscal year; 
‘‘(II) with respect to each of fiscal years 2011 
through 2018, less than 1,600 discharges of 
individuals entitled to, or enrolled for, benefits 
under part A during the fiscal year or portion 
of fiscal year; 
‘‘(III) with respect to each of fiscal years 2019 
through 2022, less than 3,800 discharges during 
the fiscal year; and 
‘‘(IV) with respect to fiscal year 2023 and each 
subsequent fiscal year, less than 800 discharges 
during the fiscal year.’’; and 
(B) in clause (ii)— 
Notice. 
Web posting. 
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132 STAT. 182 
PUBLIC LAW 115–123—FEB. 9, 2018 
(i) by striking ‘‘subparagraph (B)’’ and inserting 
‘‘subparagraphs (B) and (D)’’; and 
(ii) by inserting ‘‘(except as provided in clause (i)(II) 
and subparagraph (D)(i))’’ after ‘‘regardless’’; and 
(3) in subparagraph (D)— 
(A) by striking ‘‘through 2017’’ and inserting ‘‘through 
2022’’; 
(B) by striking ‘‘hospitals with 200 or fewer’’ and 
inserting the following: ‘‘hospitals— 
‘‘(i) with respect to each of fiscal years 2011 
through 2018, with 200 or fewer’’; 
(C) by striking the period at the end and inserting 
‘‘or portion of fiscal year; and’’; and 
(D) by adding at the end the following new clause: 
‘‘(ii) with respect to each of fiscal years 2019 
through 2022, with 500 or fewer discharges in the 
fiscal year to 0 percent for low-volume hospitals with 
greater than 3,800 discharges in the fiscal year.’’. 
(b) MEDPAC REPORT ON EXTENSION OF INCREASED INPATIENT 
HOSPITAL PAYMENT ADJUSTMENT FOR CERTAIN LOW-VOLUME HOS-
PITALS.— 
(1) IN GENERAL.—Not later than March 15, 2022, the Medi-
care Payment Advisory Commission shall submit to Congress 
a report on the extension of the increased inpatient hospital 
payment adjustment for certain low-volume hospitals under 
section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) under the provisions of, and amendments made 
by, this section. 
(2) CONTENTS.—The report under paragraph (1) shall 
include an evaluation of the effects of such extension on the 
following: 
(A) Beneficiary utilization of inpatient hospital services 
under title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(B) The financial status of hospitals with a low volume 
of Medicare or total inpatient admissions. 
(C) Program spending under such title XVIII. 
(D) Other matters relevant to evaluating the effects 
of such extension. 
SEC. 50205. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL 
(MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘October 1, 2017’’ and inserting 
‘‘October 1, 2022’’; 
(2) in clause (ii)(II), by striking ‘‘October 1, 2017’’ and 
inserting ‘‘October 1, 2022’’; and 
(3) in clause (iv), by striking subclause (I) and inserting 
the following new subclause: 
‘‘(I) that is located in— 
‘‘(aa) a rural area; or 
‘‘(bb) a State with no rural area (as defined in para-
graph (2)(D)) and satisfies any of the criteria in subclause 
(I), (II), or (III) of paragraph (8)(E)(ii),’’; and 
(4) by inserting after subclause (IV) the following new 
flush sentences: 
Time period. 
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132 STAT. 183 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘Subclause (I)(bb) shall apply for purposes of payment under clause 
(ii) only for discharges of a hospital occurring on or after the 
effective date of a determination of medicare-dependent small rural 
hospital status made by the Secretary with respect to the hospital 
after the date of the enactment of this sentence. For purposes 
of applying subclause (II) of paragraph (8)(E)(ii) under subclause 
(I)(bb), such subclause (II) shall be applied by inserting ‘as of 
January 1, 2018,’ after ‘such State’ each place it appears.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION OF TARGET AMOUNT.—Section 1886(b)(3)(D) 
of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
amended— 
(A) in the matter preceding clause (i), by striking 
‘‘October 1, 2017’’ and inserting ‘‘October 1, 2022’’; and 
(B) in clause (iv), by striking ‘‘through fiscal year 2017’’ 
and inserting ‘‘through fiscal year 2022’’. 
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION.— 
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act 
of 1993 (42 U.S.C. 1395ww note) is amended by striking 
‘‘through fiscal year 2017’’ and inserting ‘‘through fiscal year 
2022’’. 
(c) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on the medicare-dependent, small rural 
hospital program under section 1886(d) of the Social Security 
Act (42 U.S.C. 1395x(d)). Such study shall include an analysis 
of the following: 
(A) The payor mix of medicare-dependent, small rural 
hospitals (as defined in paragraph (5)(G)(iv) of such section 
1886(d)), how such mix will trend in future years (based 
on current trends and projections), and whether or not 
the requirement under subclause (IV) of such paragraph 
should be revised. 
(B) The characteristics of medicare-dependent, small 
rural hospitals that meet the requirement of such subclause 
(IV) through the application of paragraph (a)(iii)(A) or 
(a)(iii)(B) of section 412.108 of title 42, Code of Federal 
Regulations, including Medicare inpatient and outpatient 
utilization, payor mix, and financial status (including Medi-
care and total margins), and whether or not Medicare 
payments for such hospitals should be revised. 
(C) Such other items related to medicare-dependent, 
small rural hospitals as the Comptroller General deter-
mines appropriate. 
(2) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 
50206. 
EXTENSION 
OF 
FUNDING 
FOR 
QUALITY 
MEASURE 
ENDORSEMENT, INPUT, AND SELECTION; REPORTING 
REQUIREMENTS. 
(a) EXTENSION OF FUNDING.—Section 1890(d)(2) of the Social 
Security Act (42 U.S.C. 1395aaa(d)(2)) is amended— 
Recommenda- 
tions. 
Analysis. 
Applicability. 
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132 STAT. 184 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) in the first sentence— 
(A) by striking ‘‘2014 and’’ and inserting ‘‘2014,’’; and 
(B) by inserting the following before the period: ‘‘, 
and $7,500,000 for each of fiscal years 2018 and 2019’’; 
and 
(2) by adding at the end the following new sentence: 
‘‘Amounts transferred for each of fiscal years 2018 and 2019 
shall be in addition to any unobligated funds transferred for 
a preceding fiscal year that are available under the preceding 
sentence.’’ 
(b) ANNUAL REPORT BY SECRETARY TO CONGRESS.—Section 1890 
of the Social Security Act (42 U.S.C. 1395aaa) is amended by 
adding at the end the following new subsection: 
‘‘(e) ANNUAL REPORT
BY SECRETARY
TO CONGRESS.—By not 
later than March 1 of each year (beginning with 2019), the Secretary 
shall submit to Congress a report containing the following: 
‘‘(1) A comprehensive plan that identifies the quality 
measurement needs of programs and initiatives of the Secretary 
and provides a strategy for using the entity with a contract 
under subsection (a) and any other entity the Secretary has 
contracted with or may contract with to perform work associ-
ated with section 1890A to help meet those needs, specifically 
with respect to the programs under this title and title XIX. 
In years after the first plan under this paragraph is submitted, 
the requirements of this paragraph may be met by providing 
an update to the plan. 
‘‘(2) The amount of funding provided under subsection (d) 
for purposes of carrying out this section and section 1890A 
that has been obligated by the Secretary, the amount of funding 
provided that has been expended, and the amount of funding 
provided that remains unobligated. 
‘‘(3) With respect to the activities described under this 
section or section 1890A, a description of how the funds 
described in paragraph (2) have been obligated or expended, 
including how much of that funding has been obligated or 
expended for work performed by the Secretary, the entity with 
a contract under subsection (a), and any other entity the Sec-
retary has contracted with to perform work. 
‘‘(4) A description of the activities for which the funds 
described in paragraph (2) were used, including task orders 
and activities assigned to the entity with a contract under 
subsection (a), activities performed by the Secretary, and task 
orders and activities assigned to any other entity the Secretary 
has contracted with to perform work related to carrying out 
section 1890A. 
‘‘(5) The amount of funding described in paragraph (2) 
that has been obligated or expended for each of the activities 
described in paragraph (4). 
‘‘(6) Estimates for, and descriptions of, obligations and 
expenditures that the Secretary anticipates will be needed in 
the succeeding two year period to carry out each of the quality 
measurement activities required under this section and section 
1890A, including any obligations that will require funds to 
be expended in a future year.’’. 
(c) REVISIONS
TO ANNUAL REPORT FROM CONSENSUS-BASED 
ENTITY TO CONGRESS AND THE SECRETARY.— 
Estimate. 
Time period. 
Updates. 
Plan. 
Contracts. 
Effective date. 
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132 STAT. 185 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) IN GENERAL.—Section 1890(b)(5)(A) of the Social Secu-
rity Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended— 
(A) by redesignating clauses (i) through (vi) as sub-
clauses (I) through (VI), respectively, and moving the mar-
gins accordingly; 
(B) in the matter preceding subclause (I), as redesig-
nated by subparagraph (A), by striking ‘‘containing a 
description of—’’ and inserting ‘‘containing the following: 
‘‘(i) A description of—’’; and 
(C) by adding at the end the following new clauses: 
‘‘(ii) An itemization of financial information for 
the fiscal year ending September 30 of the preceding 
year, including— 
‘‘(I) annual revenues of the entity (including 
any government funding, private sector contribu-
tions, grants, membership revenues, and invest-
ment revenue); 
‘‘(II) annual expenses of the entity (including 
grants paid, benefits paid, salaries or other com-
pensation, fundraising expenses, and overhead 
costs); and 
‘‘(III) a breakdown of the amount awarded per 
contracted task order and the specific projects 
funded in each task order assigned to the entity. 
‘‘(iii) Any updates or modifications of internal poli-
cies and procedures of the entity as they relate to 
the duties of the entity under this section, including— 
‘‘(I) specifically identifying any modifications 
to the disclosure of interests and conflicts of 
interests for committees, work groups, task forces, 
and advisory panels of the entity; and 
‘‘(II) information on external stakeholder 
participation in the duties of the entity under this 
section (including complete rosters for all commit-
tees, work groups, task forces, and advisory panels 
funded through government contracts, descriptions 
of relevant interests and any conflicts of interest 
for members of all committees, work groups, task 
forces, and advisory panels, and the total percent-
age by health care sector of all convened commit-
tees, work groups, task forces, and advisory 
panels.’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to reports submitted for years beginning 
with 2019. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
shall conduct a study on health care quality measurement 
efforts funded under sections 1890 and 1890A of the Social 
Security Act (42 U.S.C. 1395aaa; 1395aaa–1). Such study shall 
include an examination of the following: 
(A) The extent to which the Secretary of Health and 
Human Services (in this subsection referred to as the ‘‘Sec-
retary’’) has set and prioritized objectives to be achieved 
for each of the quality measurement activities required 
under such sections 1890 and 1890A. 
Contracts. 
Applicability. 
42 USC 1395aaa 
note. 
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132 STAT. 186 
PUBLIC LAW 115–123—FEB. 9, 2018 
(B) The efforts that the Secretary has undertaken to 
meet quality measurement objectives associated with such 
sections 1890 and 1890A, including division of responsibil-
ities for those efforts within the Department of Health 
and Human Services and through contracts with a con-
sensus-based entity under subsection (a) of such section 
1890 (in this subsection referred to as the ‘‘consensus- 
based entity’’) and other entities, and the extent of any 
overlap among the work performed by the Secretary, the 
consensus-based entity, the Measure Applications Partner-
ship (MAP) convened by such entity to provide input to 
the Secretary on the selection of quality and efficiency 
measures, and any other entities the Secretary has con-
tracted with to perform work related to carrying out such 
sections 1890 and 1890A. 
(C) The total amount of funding provided to the Sec-
retary for purposes of carrying out such sections 1890 
and 1890A, the amount of such funding that has been 
obligated or expended by the Secretary, and the amount 
of such funding that remains unobligated. 
(D) How the funds described in subparagraph (C) have 
been allocated, including how much of the funding has 
been allocated for work performed by the Secretary, the 
consensus-based entity, and any other entity the Secretary 
has contracted with to perform work related to carrying 
out such sections 1890 and 1890A, respectively, and 
descriptions of such work. 
(E) The extent to which the Secretary has developed 
a comprehensive and long-term plan to ensure that it can 
achieve quality measurement objectives related to carrying 
out such sections 1890 and 1890A in a timely manner 
and with efficient use of available resources, including the 
roles of the consensus-based entity, the Measure Applica-
tions Partnership (MAP), and any other entity the Sec-
retary has contracted with to perform work related to such 
sections 1890 and 1890A in helping the Secretary achieve 
those objectives. 
(2) REPORT.—Not later than 18 months after the date of 
enactment of this Act, the Comptroller General of the United 
States shall submit to Congress a report containing the results 
of the study conducted under paragraph (1), together with 
recommendations for such legislation and administrative action 
as the Comptroller General determines appropriate. 
SEC. 50207. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR 
LOW-INCOME PROGRAMS; STATE HEALTH INSURANCE 
ASSISTANCE PROGRAM REPORTING REQUIREMENTS. 
(a) FUNDING EXTENSIONS.— 
(1) ADDITIONAL
FUNDING
FOR
STATE
HEALTH
INSURANCE 
PROGRAMS.—Subsection (a)(1)(B) of section 119 of the Medicare 
Improvements for Patients and Providers Act of 2008 (42 U.S.C. 
1395b–3 note), as amended by section 3306 of the Patient 
Protection and Affordable Care Act (Public Law 111–148), sec-
tion 610 of the American Taxpayer Relief Act of 2012 (Public 
Law 112–240), section 1110 of the Pathway for SGR Reform 
Act of 2013 (Public Law 113–67), section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113–93), and section 
Recommenda- 
tions. 
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132 STAT. 187 
PUBLIC LAW 115–123—FEB. 9, 2018 
208 of the Medicare Access and CHIP Reauthorization Act 
of 2015 (Public Law 114–10) is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new clauses: 
‘‘(viii) for fiscal year 2018, of $13,000,000; and 
‘‘(ix) for fiscal year 2019, of $13,000,000.’’. 
(2) ADDITIONAL FUNDING FOR AREA AGENCIES ON AGING.— 
Subsection (b)(1)(B) of such section 119, as so amended, is 
amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $7,500,000; and 
‘‘(ix) for fiscal year 2019, of $7,500,000.’’. 
(3) ADDITIONAL
FUNDING
FOR
AGING
AND
DISABILITY 
RESOURCE CENTERS.—Subsection (c)(1)(B) of such section 119, 
as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $5,000,000; and 
‘‘(ix) for fiscal year 2019, of $5,000,000.’’. 
(4) ADDITIONAL FUNDING FOR CONTRACT WITH THE NATIONAL 
CENTER
FOR
BENEFITS
AND
OUTREACH
ENROLLMENT.—Sub-
section (d)(2) of such section 119, as so amended, is amended— 
(A) in clause (vi), by striking ‘‘and’’ at the end; 
(B) in clause (vii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the following new 
clauses: 
‘‘(viii) for fiscal year 2018, of $12,000,000; and 
‘‘(ix) for fiscal year 2019, of $12,000,000.’’. 
(b) STATE HEALTH INSURANCE ASSISTANCE PROGRAM REPORTING 
REQUIREMENTS.—Beginning not later than April 1, 2019, and 
biennially thereafter, the Agency for Community Living shall elec-
tronically post on its website the following information, with respect 
to grants to States for State health insurance assistance programs, 
(such information to be presented by State and by entity receiving 
funds from the State to carry out such a program funded by such 
grant): 
(1) The amount of Federal funding provided to each such 
State for such program for the period involved and the amount 
of Federal funding provided by each such State for such pro-
gram to each such entity for the period involved. 
(2) Information as the Secretary may specify, with respect 
to such programs carried out through such grants, consistent 
with the terms and conditions for receipt of such grants. 
SEC. 50208. EXTENSION OF HOME HEALTH RURAL ADD-ON. 
(a) EXTENSION.— 
Effective date. 
Web posting. 
Grants. 
42 USC 1395b–3 
note. 
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132 STAT. 188 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) IN GENERAL.—Section 421 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108–173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as 
amended by section 5201(b) of the Deficit Reduction Act of 
2005 (Public Law 109–171; 120 Stat. 46), section 3131(c) of 
the Patient Protection and Affordable Care Act (Public Law 
111–148; 124 Stat. 428), and section 210 of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public Law 114–10; 
129 Stat. 151) is amended— 
(A) in subsection (a), by striking ‘‘January 1, 2018’’ 
and inserting ‘‘January 1, 2019’’ each place it appears; 
(B) by redesignating subsections (b) and (c) as sub-
sections (c) and (d), respectively; 
(C) in each of subsections (c) and (d), as so redesig-
nated, by striking ‘‘subsection (a)’’ and inserting ‘‘subsection 
(a) or (b)’’; and 
(D) by inserting after subsection (a) the following new 
subsection: 
‘‘(b) SUBSEQUENT TEMPORARY INCREASE.— 
‘‘(1) IN GENERAL.—The Secretary shall increase the pay-
ment amount otherwise made under such section 1895 for 
home health services furnished in a county (or equivalent area) 
in a rural area (as defined in such section 1886(d)(2)(D)) that, 
as determined by the Secretary— 
‘‘(A) is in the highest quartile of all counties (or equiva-
lent areas) based on the number of Medicare home health 
episodes furnished per 100 individuals who are entitled 
to, or enrolled for, benefits under part A of title XVIII 
of the Social Security Act or enrolled for benefits under 
part B of such title (but not enrolled in a plan under 
part C of such title)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 1.5 percent; and 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 0.5 percent; 
‘‘(B) has a population density of 6 individuals or fewer 
per square mile of land area and is not described in 
subparagraph (A)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 4 percent; 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 3 percent; 
‘‘(iii) in the case of episodes and visits ending 
during 2021, by 2 percent; and 
‘‘(iv) in the case of episodes and visits ending 
during 2022, by 1 percent; and 
‘‘(C) is not described in either subparagraph (A) or 
(B)— 
‘‘(i) in the case of episodes and visits ending during 
2019, by 3 percent; 
‘‘(ii) in the case of episodes and visits ending during 
2020, by 2 percent; and 
‘‘(iii) in the case of episodes and visits ending 
during 2021, by 1 percent. 
‘‘(2) RULES FOR DETERMINATIONS.— 
Applicability. 
Determination. 
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132 STAT. 189 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) NO SWITCHING.—For purposes of this subsection, 
the determination by the Secretary as to which subpara-
graph of paragraph (1) applies to a county (or equivalent 
area) shall be made a single time and shall apply for 
the duration of the period to which this subsection applies. 
‘‘(B) UTILIZATION.—In determining which counties (or 
equivalent areas) are in the highest quartile under para-
graph (1)(A), the following rules shall apply: 
‘‘(i) The Secretary shall use data from 2015. 
‘‘(ii) The Secretary shall exclude data from the 
territories (and the territories shall not be described 
in such paragraph). 
‘‘(iii) The Secretary may exclude data from counties 
(or equivalent areas) in rural areas with a low volume 
of home health episodes (and if data is so excluded 
with respect to a county (or equivalent area), such 
county (or equivalent area) shall not be described in 
such paragraph). 
‘‘(C) POPULATION DENSITY.—In determining population 
density under paragraph (1)(B), the Secretary shall use 
data from the 2010 decennial Census. 
‘‘(3) LIMITATIONS ON REVIEW.—There shall be no adminis-
trative or judicial review under section 1869, section 1878, 
or otherwise of determinations under paragraph (1).’’. 
(2) REQUIREMENT
TO
SUBMIT
COUNTY
DATA
ON
CLAIM 
FORM.—Section 1895(c) of the Social Security Act (42 U.S.C. 
1395fff(c)) is amended— 
(A) in paragraph (1), by striking ‘‘and’’ at the end; 
(B) in paragraph (2), by striking the period at the 
end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new paragraph: 
‘‘(3) in the case of home health services furnished on or 
after January 1, 2019, the claim contains the code for the 
county (or equivalent area) in which the home health service 
was furnished.’’. 
(b) HHS OIG ANALYSIS.—Not later than January 1, 2023, the 
Inspector General of the Department of Health and Human Services 
shall submit to Congress— 
(1) an analysis of the home health claims and utilization 
of home health services by county (or equivalent area) under 
the Medicare program; and 
(2) recommendations the Inspector General determines 
appropriate based on such analysis. 
Recommenda- 
tions. 
Deadline. 
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132 STAT. 190 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE 
III—CREATING 
HIGH-QUALITY 
RESULTS 
AND 
OUTCOMES 
NEC-
ESSARY 
TO 
IMPROVE 
CHRONIC 
(CHRONIC) CARE 
Subtitle A—Receiving High Quality Care in 
the Home 
SEC. 50301. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRA-
TION PROGRAM. 
(a) IN GENERAL.—Section 1866E of the Social Security Act 
(42 U.S.C. 1395cc–5) is amended— 
(1) in subsection (e)— 
(A) in paragraph (1)— 
(i) by striking ‘‘An agreement’’ and inserting 
‘‘Agreements’’; and 
(ii) by striking ‘‘5-year’’ and inserting ‘‘7-year’’; and 
(B) in paragraph (5)— 
(i) by striking ‘‘10,000’’ and inserting ‘‘15,000’’; and 
(ii) by adding at the end the following new sen-
tence: ‘‘An applicable beneficiary that participates in 
the demonstration program by reason of the increase 
from 10,000 to 15,000 in the preceding sentence pursu-
ant 
to 
the 
amendment 
made 
by 
section 
50301(a)(1)(B)(i) of the Advancing Chronic Care, 
Extenders, and Social Services Act shall be considered 
in the spending target estimates under paragraph (1) 
of subsection (c) and the incentive payment calculations 
under paragraph (2) of such subsection for the sixth 
and seventh years of such program.’’; 
(2) in subsection (g), in the first sentence, by inserting 
‘‘, including, to the extent practicable, with respect to the use 
of electronic health information systems, as described in sub-
section (b)(1)(A)(vi)’’ after ‘‘under the demonstration program’’; 
and 
(3) in subsection (i)(1)(A), by striking ‘‘will not receive an 
incentive payment for the second of 2’’ and inserting ‘‘did not 
achieve savings for the third of 3’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection 
(a)(3) shall take effect as if included in the enactment of Public 
Law 111–148. 
SEC. 50302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY. 
(a) IN GENERAL.—Section 1881(b)(3) of the Social Security Act 
(42 U.S.C. 1395rr(b)(3)) is amended— 
(1) by redesignating subparagraphs (A) and (B) as clauses 
(i) and (ii), respectively; 
(2) in clause (ii), as redesignated by paragraph (1), by 
striking ‘‘on a comprehensive’’ and insert ‘‘subject to subpara-
graph (B), on a comprehensive’’; 
(3) by striking ‘‘With respect to’’ and inserting ‘‘(A) With 
respect to’’; and 
(4) by adding at the end the following new subparagraph: 
42 USC 1395cc–5 
note. 
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132 STAT. 191 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(B)(i) For purposes of subparagraph (A)(ii), subject to clause 
(ii), an individual determined to have end stage renal disease 
receiving home dialysis may choose to receive monthly end stage 
renal disease-related clinical assessments furnished on or after 
January 1, 2019, via telehealth. 
‘‘(ii) Clause (i) shall apply to an individual only if the individual 
receives a face-to-face clinical assessment, without the use of tele-
health— 
‘‘(I) in the case of the initial 3 months of home dialysis 
of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once every 3 
consecutive months.’’. 
(b) ORIGINATING SITE REQUIREMENTS.— 
(1) IN GENERAL.—Section 1834(m) of the Social Security 
Act (42 U.S.C. 1395m(m)) is amended— 
(A) in paragraph (4)(C)(ii), by adding at the end the 
following new subclauses: 
‘‘(IX) A renal dialysis facility, but only for pur-
poses of section 1881(b)(3)(B). 
‘‘(X) The home of an individual, but only for 
purposes of section 1881(b)(3)(B).’’; and 
(B) by adding at the end the following new paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY ESRD-RELATED 
VISIT.—The geographic requirements described in paragraph 
(4)(C)(i) shall not apply with respect to telehealth services 
furnished on or after January 1, 2019, for purposes of section 
1881(b)(3)(B), at an originating site described in subclause (VI), 
(IX), or (X) of paragraph (4)(C)(ii).’’. 
(2) NO FACILITY FEE IF ORIGINATING SITE FOR HOME DIALYSIS 
THERAPY
IS
THE
HOME.—Section 1834(m)(2)(B) of the Social 
Security (42 U.S.C. 1395m(m)(2)(B)) is amended— 
(A) by redesignating clauses (i) and (ii) as subclauses 
(I) and (II), and indenting appropriately; 
(B) in subclause (II), as redesignated by subparagraph 
(A), by striking ‘‘clause (i) or this clause’’ and inserting 
‘‘subclause (I) or this subclause’’; 
(C) by striking ‘‘SITE.—With respect to’’ and inserting 
‘‘SITE.— 
‘‘(i) IN
GENERAL.—Subject to clause (ii), with 
respect to’’; and 
(D) by adding at the end the following new clause: 
‘‘(ii) NO
FACILITY
FEE
IF
ORIGINATING
SITE
FOR 
HOME DIALYSIS THERAPY IS THE HOME.—No facility fee 
shall be paid under this subparagraph to an originating 
site described in paragraph (4)(C)(ii)(X).’’. 
(c) CLARIFICATION REGARDING TELEHEALTH PROVIDED TO BENE-
FICIARIES.—Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 
1320a–7a(i)(6)) is amended— 
(1) in subparagraph (H), by striking ‘‘or’’ at the end; 
(2) in subparagraph (I), by striking the period at the end 
and inserting ‘‘; or’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(J) the provision of telehealth technologies (as defined 
by the Secretary) on or after January 1, 2019, by a provider 
of services or a renal dialysis facility (as such terms are 
defined for purposes of title XVIII) to an individual with 
end stage renal disease who is receiving home dialysis 
Applicability. 
Time periods. 
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132 STAT. 192 
PUBLIC LAW 115–123—FEB. 9, 2018 
for which payment is being made under part B of such 
title, if— 
‘‘(i) the telehealth technologies are not offered as 
part of any advertisement or solicitation; 
‘‘(ii) the telehealth technologies are provided for 
the purpose of furnishing telehealth services related 
to the individual’s end stage renal disease; and 
‘‘(iii) the provision of the telehealth technologies 
meets any other requirements set forth in regulations 
promulgated by the Secretary.’’. 
(d) CONFORMING AMENDMENT.—Section 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking ‘‘para-
graph (3)(A)’’ and inserting ‘‘paragraph (3)(A)(i)’’. 
Subtitle B—Advancing Team-Based Care 
SEC. 50311. PROVIDING CONTINUED ACCESS TO MEDICARE ADVAN-
TAGE SPECIAL NEEDS PLANS FOR VULNERABLE POPU-
LATIONS. 
(a) EXTENSION.—Section 1859(f)(1) of the Social Security Act 
(42 U.S.C. 1395w–28(f)(1)) is amended by striking ‘‘and for periods 
before January 1, 2019’’. 
(b) INCREASED INTEGRATION OF DUAL SNPS.— 
(1) IN
GENERAL.—Section 1859(f) of the Social Security 
Act (42 U.S.C. 1395w–28(f)) is amended— 
(A) in paragraph (3), by adding at the end the following 
new subparagraph: 
‘‘(F) The plan meets the requirements applicable under 
paragraph (8).’’; and 
(B) by adding at the end the following new paragraph: 
‘‘(8) INCREASED INTEGRATION OF DUAL SNPS.— 
‘‘(A) DESIGNATED
CONTACT.—The Secretary, acting 
through the Federal Coordinated Health Care Office estab-
lished under section 2602 of Public Law 111–148, shall 
serve as a dedicated point of contact for States to address 
misalignments that arise with the integration of specialized 
MA plans for special needs individuals described in sub-
section (b)(6)(B)(ii) under this paragraph and, consistent 
with such role, shall establish— 
‘‘(i) a uniform process for disseminating to State 
Medicaid 
agencies 
information 
under 
this 
title 
impacting contracts between such agencies and such 
plans under this subsection; and 
‘‘(ii) basic resources for States interested in 
exploring such plans as a platform for integration, 
such as a model contract or other tools to achieve 
those goals. 
‘‘(B) UNIFIED GRIEVANCES AND APPEALS PROCESS.— 
‘‘(i) IN GENERAL.—Not later than April 1, 2020, 
the Secretary shall establish procedures, to the extent 
feasible as determined by the Secretary, unifying griev-
ances and appeals procedures under sections 1852(f), 
1852(g), 1902(a)(3), 1902(a)(5), and 1932(b)(4) for items 
and services provided by specialized MA plans for spe-
cial 
needs 
individuals 
described 
in 
subsection 
(b)(6)(B)(ii) under this title and title XIX. With respect 
Applicability. 
Deadline. 
Procedures. 
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132 STAT. 193 
PUBLIC LAW 115–123—FEB. 9, 2018 
to items and services described in the preceding sen-
tence, procedures established under this clause shall 
apply in place of otherwise applicable grievances and 
appeals procedures. The Secretary shall solicit com-
ment in developing such procedures from States, plans, 
beneficiaries and their representatives, and other rel-
evant stakeholders. 
‘‘(ii) PROCEDURES.—The procedures established 
under clause (i) shall be included in the plan contract 
under paragraph (3)(D) and shall— 
‘‘(I) adopt the provisions for the enrollee that 
are most protective for the enrollee and, to the 
extent feasible as determined by the Secretary, 
are compatible with unified timeframes and 
consolidated access to external review under an 
integrated process; 
‘‘(II) take into account differences in State 
plans under title XIX to the extent necessary; 
‘‘(III) be easily navigable by an enrollee; and 
‘‘(IV) include the elements described in clause 
(iii), as applicable. 
‘‘(iii) ELEMENTS DESCRIBED.—Both unified appeals 
and unified grievance procedures shall include, as 
applicable, the following elements described in this 
clause: 
‘‘(I) Single written notification of all applicable 
grievances and appeal rights under this title and 
title XIX. For purposes of this subparagraph, the 
Secretary may waive the requirements under sec-
tion 1852(g)(1)(B) when the specialized MA plan 
covers items or services under this part or under 
title XIX. 
‘‘(II) Single pathways for resolution of any 
grievance or appeal related to a particular item 
or service provided by specialized MA plans for 
special needs individuals described in subsection 
(b)(6)(B)(ii) under this title and title XIX. 
‘‘(III) Notices written in plain language and 
available in a language and format that is acces-
sible to the enrollee, including in non-English lan-
guages that are prevalent in the service area of 
the specialized MA plan. 
‘‘(IV) Unified timeframes for grievances and 
appeals processes, such as an individual’s filing 
of a grievance or appeal, a plan’s acknowledgment 
and resolution of a grievance or appeal, and 
notification of decisions with respect to a grievance 
or appeal. 
‘‘(V) Requirements for how the plan must 
process, track, and resolve grievances and appeals, 
to ensure beneficiaries are notified on a timely 
basis of decisions that are made throughout the 
grievance or appeals process and are able to easily 
determine the status of a grievance or appeal. 
‘‘(iv) 
CONTINUATION
OF
BENEFITS
PENDING 
APPEAL.—The unified procedures under clause (i) shall, 
with respect to all benefits under parts A and B and 
Notices. 
Waiver authority. 
Notification. 
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132 STAT. 194 
PUBLIC LAW 115–123—FEB. 9, 2018 
title XIX subject to appeal under such procedures, 
incorporate provisions under current law and imple-
menting regulations that provide continuation of bene-
fits pending appeal under this title and title XIX. 
‘‘(C) REQUIREMENT
FOR
UNIFIED
GRIEVANCES
AND 
APPEALS.—For 2021 and subsequent years, the contract 
of a specialized MA plan for special needs individuals 
described in subsection (b)(6)(B)(ii) with a State Medicaid 
agency under paragraph (3)(D) shall require the use of 
unified grievances and appeals procedures as described 
in subparagraph (B). 
‘‘(D) REQUIREMENTS FOR INTEGRATION.— 
‘‘(i) IN GENERAL.—For 2021 and subsequent years, 
a specialized MA plan for special needs individuals 
described in subsection (b)(6)(B)(ii) shall meet one or 
more of the following requirements, to the extent per-
mitted under State law, for integration of benefits 
under this title and title XIX: 
‘‘(I) The specialized MA plan must meet the 
requirements of contracting with the State Med-
icaid agency described in paragraph (3)(D) in addi-
tion to coordinating long-term services and sup-
ports or behavioral health services, or both, by 
meeting an additional minimum set of require-
ments determined by the Secretary through the 
Federal Coordinated Health Care Office estab-
lished under section 2602 of the Patient Protection 
and Affordable Care Act based on input from stake-
holders, such as notifying the State in a timely 
manner of hospitalizations, emergency room visits, 
and hospital or nursing home discharges of 
enrollees, assigning one primary care provider for 
each enrollee, or sharing data that would benefit 
the coordination of items and services under this 
title and the State plan under title XIX. Such 
minimum set of requirements must be included 
in the contract of the specialized MA plan with 
the State Medicaid agency under such paragraph. 
‘‘(II) The specialized MA plan must meet the 
requirements of a fully integrated plan described 
in section 1853(a)(1)(B)(iv)(II) (other than the 
requirement that the plan have similar average 
levels of frailty, as determined by the Secretary, 
as the PACE program), or enter into a capitated 
contract with the State Medicaid agency to provide 
long-term services and supports or behavioral 
health services, or both. 
‘‘(III) In the case of a specialized MA plan 
that is offered by a parent organization that is 
also the parent organization of a Medicaid man-
aged care organization providing long term serv-
ices and supports or behavioral services under a 
contract 
under 
section 
1903(m), 
the 
parent 
organization must assume clinical and financial 
responsibility for benefits provided under this title 
and title XIX with respect to any individual who 
Contracts. 
Determinations. 
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132 STAT. 195 
PUBLIC LAW 115–123—FEB. 9, 2018 
is enrolled in both the specialized MA plan and 
the Medicaid managed care organization. 
‘‘(ii) SUSPENSION OF ENROLLMENT FOR FAILURE TO 
MEET REQUIREMENTS DURING INITIAL PERIOD.—During 
the period of plan years 2021 through 2025, if the 
Secretary determines that a specialized MA plan for 
special needs individuals described in subsection 
(b)(6)(B)(ii) has failed to comply with clause (i), the 
Secretary may provide for the application against the 
Medicare Advantage organization offering the plan of 
the remedy described in section 1857(g)(2)(B) in the 
same manner as the Secretary may apply such remedy, 
and in accordance with the same procedures as would 
apply, in the case of an MA organization determined 
by the Secretary to have engaged in conduct described 
in section 1857(g)(1). If the Secretary applies such 
remedy to a Medicare Advantage organization under 
the preceding sentence, the organization shall submit 
to the Secretary (at a time, and in a form and manner, 
specified by the Secretary) information describing how 
the plan will come into compliance with clause (i). 
‘‘(E) STUDY AND REPORT TO CONGRESS.— 
‘‘(i) IN GENERAL.—Not later than March 15, 2022, 
and, subject to clause (iii), biennially thereafter 
through 
2032, 
the 
Medicare 
Payment 
Advisory 
Commission established under section 1805, in con-
sultation with the Medicaid and CHIP Payment and 
Access Commission established under section 1900, 
shall conduct (and submit to the Secretary and the 
Committees on Ways and Means and Energy and Com-
merce of the House of Representatives and the Com-
mittee on Finance of the Senate a report on) a study 
to determine how specialized MA plans for special 
needs individuals described in subsection (b)(6)(B)(ii) 
perform among each other based on data from 
Healthcare Effectiveness Data and Information Set 
(HEDIS) quality measures, reported on the plan level, 
as required under section 1852(e)(3) (or such other 
measures or data sources that are available and appro-
priate, such as encounter data and Consumer Assess-
ment of Healthcare Providers and Systems data, as 
specified by such Commissions as enabling an accurate 
evaluation under this subparagraph). Such study shall 
include, as feasible, the following comparison groups 
of specialized MA plans for special needs individuals 
described in subsection (b)(6)(B)(ii): 
‘‘(I) A comparison group of such plans that 
are described in subparagraph (D)(i)(I). 
‘‘(II) A comparison group of such plans that 
are described in subparagraph (D)(i)(II). 
‘‘(III) A comparison group of such plans oper-
ating within the Financial Alignment Initiative 
demonstration for the period for which such plan 
is so operating and the demonstration is in effect, 
and, in the case that an integration option that 
is not with respect to specialized MA plans for 
Time period. 
Consultation. 
Determination. 
Evaluation. 
Compliance. 
Determination. 
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132 STAT. 196 
PUBLIC LAW 115–123—FEB. 9, 2018 
special needs individuals is established after the 
conclusion of the demonstration involved. 
‘‘(IV) A comparison group of such plans that 
are described in subparagraph (D)(i)(III). 
‘‘(V) A comparison group of MA plans, as fea-
sible, not described in a previous subclause of this 
clause, with respect to the performance of such 
plans for enrollees who are special needs individ-
uals described in subsection (b)(6)(B)(ii). 
‘‘(ii) ADDITIONAL REPORTS.—Beginning with 2033 
and every five years thereafter, the Medicare Payment 
Advisory Commission, in consultation with the Med-
icaid and CHIP Payment and Access Commission, shall 
conduct a study described in clause (i).’’. 
(2) CONFORMING AMENDMENT TO RESPONSIBILITIES OF FED-
ERAL COORDINATED HEALTH CARE OFFICE.—Section 2602(d) of 
Public Law 111–148 (42 U.S.C. 1315b(d)) is amended by adding 
at the end the following new paragraphs: 
‘‘(6) To act as a designated contact for States under sub-
section (f)(8)(A) of section 1859 of the Social Security Act (42 
U.S.C. 1395w–28) with respect to the integration of specialized 
MA plans for special needs individuals described in subsection 
(b)(6)(B)(ii) of such section. 
‘‘(7) To be responsible, subject to the final approval of 
the Secretary, for developing regulations and guidance related 
to the implementation of a unified grievance and appeals 
process as described in subparagraphs (B) and (C) of section 
1859(f)(8) of the Social Security Act (42 U.S.C. 1395w–28(f)(8)). 
‘‘(8) To be responsible, subject to the final approval of 
the Secretary, for developing regulations and guidance related 
to the integration or alignment of policy and oversight under 
the Medicare program under title XVIII of such Act and the 
Medicaid program under title XIX of such Act regarding special-
ized MA plans for special needs individuals described in sub-
section (b)(6)(B)(ii) of such section 1859.’’. 
(c) IMPROVEMENTS TO SEVERE OR DISABLING CHRONIC CONDI-
TION SNPS.— 
(1) CARE MANAGEMENT REQUIREMENTS.—Section 1859(f)(5) 
of the Social Security Act (42 U.S.C. 1395w–28(f)(5)) is 
amended— 
(A) by striking ‘‘ALL
SNPS.—The requirements’’ and 
inserting ‘‘ALL SNPS.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
requirements’’; 
(B) by redesignating subparagraphs (A) and (B) as 
clauses (i) and (ii), respectively, and indenting appro-
priately; and 
(C) in clause (ii), as redesignated by subparagraph 
(B), by redesignating clauses (i) through (iii) as subclauses 
(I) through (III), respectively, and indenting appropriately; 
and 
(D) by adding at the end the following new subpara-
graph: 
‘‘(B) IMPROVEMENTS TO CARE MANAGEMENT REQUIRE-
MENTS
FOR
SEVERE
OR
DISABLING
CHRONIC
CONDITION 
SNPS.—For 2020 and subsequent years, in the case of a 
specialized MA plan for special needs individuals described 
Effective dates. 
Consultation. 
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132 STAT. 197 
PUBLIC LAW 115–123—FEB. 9, 2018 
in subsection (b)(6)(B)(iii), the requirements described in 
this paragraph include the following: 
‘‘(i) The interdisciplinary team under subpara-
graph (A)(ii)(III) includes a team of providers with 
demonstrated expertise, including training in an 
applicable specialty, in treating individuals similar to 
the targeted population of the plan. 
‘‘(ii) Requirements developed by the Secretary to 
provide 
face-to-face 
encounters 
with 
individuals 
enrolled in the plan not less frequently than on an 
annual basis. 
‘‘(iii) As part of the model of care under clause 
(i) of subparagraph (A), the results of the initial assess-
ment and annual reassessment under clause (ii)(I) of 
such subparagraph of each individual enrolled in the 
plan are addressed in the individual’s individualized 
care plan under clause (ii)(II) of such subparagraph. 
‘‘(iv) As part of the annual evaluation and approval 
of such model of care, the Secretary shall take into 
account whether the plan fulfilled the previous year’s 
goals (as required under the model of care). 
‘‘(v) The Secretary shall establish a minimum 
benchmark for each element of the model of care of 
a plan. The Secretary shall only approve a plan’s model 
of care under this paragraph if each element of the 
model of care meets the minimum benchmark 
applicable under the preceding sentence.’’. 
(2) REVISIONS TO THE DEFINITION OF A SEVERE OR DISABLING 
CHRONIC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.— 
(A) IN GENERAL.—Section 1859(b)(6)(B)(iii) of the Social 
Security 
Act 
(42 
U.S.C. 
1395w–28(b)(6)(B)(iii)) 
is 
amended— 
(i) by striking ‘‘who have’’ and inserting ‘‘who— 
‘‘(I) before January 1, 2022, have’’; 
(ii) in subclause (I), as added by clause (i), by 
striking the period at the end and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the following new sub-
clause: 
‘‘(II) on or after January 1, 2022, have one 
or more comorbid and medically complex chronic 
conditions that is life threatening or significantly 
limits overall health or function, have a high risk 
of hospitalization or other adverse health out-
comes, and require intensive care coordination and 
that is listed under subsection (f)(9)(A).’’. 
(B) PANEL OF CLINICAL ADVISORS.—Section 1859(f) of 
the Social Security Act (42 U.S.C. 1395w–28(f)), as 
amended by subsection (b), is amended by adding at the 
end the following new paragraph: 
‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION OF THE DEFINI-
TION OF A SEVERE OR DISABLING CHRONIC CONDITIONS SPECIAL-
IZED NEEDS INDIVIDUAL.— 
‘‘(A) IN GENERAL.—Not later than December 31, 2020, 
and every 5 years thereafter, subject to subparagraphs 
(B) and (C), the Secretary shall convene a panel of clinical 
Deadlines. 
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132 STAT. 198 
PUBLIC LAW 115–123—FEB. 9, 2018 
advisors to establish and update a list of conditions that 
meet each of the following criteria: 
‘‘(i) Conditions that meet the definition of a severe 
or 
disabling 
chronic 
condition 
under 
subsection 
(b)(6)(B)(iii) on or after January 1, 2022. 
‘‘(ii) Conditions that require prescription drugs, 
providers, and models of care that are unique to the 
specific population of enrollees in a specialized MA 
plan for special needs individuals described in such 
subsection on or after such date and— 
‘‘(I) as a result of access to, and enrollment 
in, such a specialized MA plan for special needs 
individuals, individuals with such condition would 
have a reasonable expectation of slowing or halting 
the progression of the disease, improving health 
outcomes and decreasing overall costs for individ-
uals diagnosed with such condition compared to 
available options of care other than through such 
a specialized MA plan for special needs individuals; 
or 
‘‘(II) have a low prevalence in the general 
population of beneficiaries under this title or a 
disproportionally high per-beneficiary cost under 
this title. 
‘‘(B) INCLUSION OF CERTAIN CONDITIONS.—The condi-
tions listed under subparagraph (A) shall include HIV/ 
AIDS, end stage renal disease, and chronic and disabling 
mental illness. 
‘‘(C) REQUIREMENT.—In establishing and updating the 
list under subparagraph (A), the panel shall take into 
account the availability of varied benefits, cost-sharing, 
and supplemental benefits under the model described in 
paragraph (2) of section 1859(h), including the expansion 
under paragraph (1) of such section.’’. 
(d) QUALITY MEASUREMENT
AT
THE PLAN LEVEL
FOR SNPS 
AND DETERMINATION OF FEASABILITY OF QUALITY MEASUREMENT 
AT THE PLAN LEVEL FOR ALL MA PLANS.—Section 1853(o) of the 
Social Security Act (42 U.S.C. 1395w–23(o)) is amended by adding 
at the end the following new paragraphs: 
‘‘(6) QUALITY MEASUREMENT AT THE PLAN LEVEL FOR SNPS.— 
‘‘(A) IN GENERAL.—Subject to subparagraph (B), the 
Secretary may require reporting of data under section 
1852(e) for, and apply under this subsection, quality meas-
ures at the plan level for specialized MA plans for special 
needs individuals instead of at the contract level. 
‘‘(B) 
CONSIDERATIONS.—Prior 
to 
applying 
quality 
measurement at the plan level under this paragraph, the 
Secretary shall— 
‘‘(i) take into consideration the minimum number 
of enrollees in a specialized MA plan for special needs 
individuals in order to determine if a statistically 
significant or valid measurement of quality at the plan 
level is possible under this paragraph; 
‘‘(ii) take into consideration the impact of such 
application on plans that serve a disproportionate 
number of individuals dually eligible for benefits under 
this title and under title XIX; 
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132 STAT. 199 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(iii) if quality measures are reported at the plan 
level, ensure that MA plans are not required to provide 
duplicative information; and 
‘‘(iv) ensure that such reporting does not interfere 
with the collection of encounter data submitted by 
MA organizations or the administration of any changes 
to the program under this part as a result of the 
collection of such data. 
‘‘(C) APPLICATION.—If the Secretary applies quality 
measurement at the plan level under this paragraph— 
‘‘(i) such quality measurement may include Medi-
care Health Outcomes Survey (HOS), Healthcare 
Effectiveness Data and Information Set (HEDIS), Con-
sumer Assessment of Healthcare Providers and Sys-
tems (CAHPS) measures and quality measures under 
part D; and 
‘‘(ii) the Secretary shall consider applying adminis-
trative actions, such as remedies described in section 
1857(g)(2), at the plan level. 
‘‘(7) DETERMINATION OF FEASIBILITY OF QUALITY MEASURE-
MENT AT THE PLAN LEVEL FOR ALL MA PLANS.— 
‘‘(A) DETERMINATION OF FEASIBILITY.—The Secretary 
shall determine the feasibility of requiring reporting of 
data under section 1852(e) for, and applying under this 
subsection, quality measures at the plan level for all MA 
plans under this part. 
‘‘(B) CONSIDERATION
OF
CHANGE.—After making a 
determination under subparagraph (A), the Secretary shall 
consider requiring such reporting and applying such quality 
measures at the plan level as described in such subpara-
graph’’. 
(e) GAO STUDY
AND REPORT
ON STATE-LEVEL INTEGRATION 
BETWEEN DUAL SNPS AND MEDICAID.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on State-level integration between special-
ized MA plans for special needs individuals described in sub-
section (b)(6) (B)(ii) of section 1859 of the Social Security Act 
(42 U.S.C. 1395w–28) and the Medicaid program under title 
XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall 
include an analysis of the following: 
(A) The characteristics of States in which the State 
agency responsible for administering the State plan under 
such title XIX has a contract with such a specialized MA 
plan and that delivers long-term services and supports 
under the State plan under such title XIX through a man-
aged care program, including the requirements under such 
State plan with respect to long-term services and supports. 
(B) The types of such specialized MA plans, which 
may include the following: 
(i) A plan described in section 1853(a)(1)(B)(iv)(II) 
of such Act (42 U.S.C. 1395w–23(a)(1)(B)(iv)(II)). 
(ii) A plan that meets the requirements described 
in subsection (f)(3)(D) of such section 1859. 
(iii) A plan described in clause (ii) that also meets 
additional requirements established by the State. 
Analysis. 
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132 STAT. 200 
PUBLIC LAW 115–123—FEB. 9, 2018 
(C) The characteristics of individuals enrolled in such 
specialized MA plans. 
(D) As practicable, the following with respect to State 
programs for the delivery of long-term services and sup-
ports under such title XIX through a managed care pro-
gram: 
(i) Which populations of individuals are eligible 
to receive such services and supports. 
(ii) Whether all such services and supports are 
provided on a capitated basis or if any of such services 
and supports are carved out and provided through 
fee-for service. 
(E) As practicable, how the availability and variation 
of integration arrangements of such specialized MA plans 
offered in States affects spending, service delivery options, 
access to community-based care, and utilization of care. 
(F) The efforts of State Medicaid programs to transition 
dually-eligible beneficiaries receiving long-term services 
and supports (LTSS) from institutional settings to home 
and community-based settings and related financial 
impacts of such transitions. 
(G) Barriers and opportunities for making further 
progress on dual integration, as well as recommendations 
for legislation or administrative action to expedite or refine 
pathways toward fully integrated care. 
(2) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
Subtitle C—Expanding Innovation and 
Technology 
SEC. 50321. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRON-
ICALLY ILL MEDICARE ADVANTAGE ENROLLEES. 
Section 1859 of the Social Security Act (42 U.S.C. 1395w– 
28) is amended by adding at the end the following new subsection: 
‘‘(h) NATIONAL TESTING OF MEDICARE ADVANTAGE VALUE-BASED 
INSURANCE DESIGN MODEL.— 
‘‘(1) IN GENERAL.—In implementing the Medicare Advan-
tage Value-Based Insurance Design model that is being tested 
under section 1115A(b), the Secretary shall revise the testing 
of the model under such section to cover, effective not later 
than January 1, 2020, all States. 
‘‘(2) TERMINATION
AND
MODIFICATION
PROVISION
NOT 
APPLICABLE UNTIL JANUARY 1, 2022.—The provisions of section 
1115A(b)(3)(B) shall apply to the Medicare Advantage Value- 
Based Insurance Design model, including such model as revised 
under paragraph (1), beginning January 1, 2022, but shall 
not apply to such model, as so revised, prior to such date. 
‘‘(3) FUNDING.—The Secretary shall allocate funds made 
available under section 1115A(f)(1) to design, implement, and 
evaluate the Medicare Advantage Value-Based Insurance 
Design model, as revised under paragraph (1).’’. 
Revision. 
Deadline. 
Recommenda- 
tions. 
Recommenda- 
tions. 
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132 STAT. 201 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 50322. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE 
NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE 
ENROLLEES. 
(a) IN GENERAL.—Section 1852(a)(3) of the Social Security Act 
(42 U.S.C. 1395w–22(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘Each’’ and inserting 
‘‘Subject to subparagraph (D), each’’; and 
(2) by adding at the end the following new subparagraph: 
‘‘(D) EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE 
NEEDS OF CHRONICALLY ILL ENROLLEES.— 
‘‘(i) IN GENERAL.—For plan year 2020 and subse-
quent plan years, in addition to any supplemental 
health care benefits otherwise provided under this 
paragraph, an MA plan, including a specialized MA 
plan for special needs individuals (as defined in section 
1859(b)(6)), 
may 
provide 
supplemental 
benefits 
described in clause (ii) to a chronically ill enrollee 
(as defined in clause (iii)). 
‘‘(ii) SUPPLEMENTAL BENEFITS DESCRIBED.— 
‘‘(I) 
IN
GENERAL.—Supplemental 
benefits 
described in this clause are supplemental benefits 
that, with respect to a chronically ill enrollee, have 
a 
reasonable 
expectation 
of 
improving 
or 
maintaining the health or overall function of the 
chronically ill enrollee and may not be limited 
to being primarily health related benefits. 
‘‘(II) 
AUTHORITY
TO
WAIVE
UNIFORMITY 
REQUIREMENTS.—The Secretary may, only with 
respect to supplemental benefits provided to a 
chronically ill enrollee under this subparagraph, 
waive the uniformity requirements under this part, 
as determined appropriate by the Secretary. 
‘‘(iii) CHRONICALLY ILL ENROLLEE DEFINED.—In this 
subparagraph, the term ‘chronically ill enrollee’ means 
an enrollee in an MA plan that the Secretary deter-
mines— 
‘‘(I) has one or more comorbid and medically 
complex chronic conditions that is life threatening 
or significantly limits the overall health or function 
of the enrollee; 
‘‘(II) has a high risk of hospitalization or other 
adverse health outcomes; and 
‘‘(III) requires intensive care coordination.’’. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study on supplemental benefits provided to 
enrollees in Medicare Advantage plans under part C of title 
XVIII of the Social Security Act, including specialized MA plans 
for special needs individuals (as defined in section 1859(b)(6) 
of such Act (42 U.S.C. 1395w–28(b)(6))). To the extend data 
are available, such study shall include an analysis of the fol-
lowing: 
(A) The type of supplemental benefits provided to such 
enrollees, the total number of enrollees receiving each 
Analysis. 
Determination. 
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132 STAT. 202 
PUBLIC LAW 115–123—FEB. 9, 2018 
supplemental benefit, and whether the supplemental ben-
efit is covered by the standard benchmark cost of the 
benefit or with an additional premium. 
(B) The frequency in which supplemental benefits are 
utilized by such enrollees. 
(C) The impact supplemental benefits have on— 
(i) indicators of the quality of care received by 
such enrollees, including overall health and function 
of the enrollees; 
(ii) the utilization of items and services for which 
benefits are available under the original Medicare fee- 
for-service program option under parts A and B of 
such title XVIII by such enrollees; and 
(iii) the amount of the bids submitted by Medicare 
Advantage Organizations for Medicare Advantage 
plans under such part C. 
(2) CONSULTATION.—In conducting the study under para-
graph (1), the Comptroller General shall, as necessary, consult 
with the Centers for Medicare & Medicaid Services and Medi-
care Advantage organizations offering Medicare Advantage 
plans. 
(3) REPORT.—Not later than 5 years after the date of the 
enactment of this Act, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 50323. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE 
ENROLLEES THROUGH TELEHEALTH. 
(a) IN GENERAL.—Section 1852 of the Social Security Act (42 
U.S.C. 1395w–22) is amended— 
(1) in subsection (a)(1)(B)(i), by inserting ‘‘, subject to sub-
section (m),’’ after ‘‘means’’; and 
(2) by adding at the end the following new subsection: 
‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH BENEFITS.— 
‘‘(1) MA PLAN OPTION.—For plan year 2020 and subsequent 
plan years, subject to the requirements of paragraph (3), an 
MA plan may provide additional telehealth benefits (as defined 
in paragraph (2)) to individuals enrolled under this part. 
‘‘(2) ADDITIONAL TELEHEALTH BENEFITS DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this subsection and 
section 1854: 
‘‘(i) DEFINITION.—The term ‘additional telehealth 
benefits’ means services— 
‘‘(I) for which benefits are available under part 
B, including services for which payment is not 
made under section 1834(m) due to the conditions 
for payment under such section; and 
‘‘(II) that are identified for such year as clini-
cally appropriate to furnish using electronic 
information and telecommunications technology 
when a physician (as defined in section 1861(r)) 
or practitioner (described in section 1842(b)(18)(C)) 
providing the service is not at the same location 
as the plan enrollee. 
Recommenda- 
tions. 
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132 STAT. 203 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) EXCLUSION OF CAPITAL AND INFRASTRUCTURE 
COSTS AND INVESTMENTS.—The term ‘additional tele-
health benefits’ does not include capital and infrastruc-
ture costs and investments relating to such benefits. 
‘‘(B) PUBLIC COMMENT.—Not later than November 30, 
2018, the Secretary shall solicit comments on— 
‘‘(i) what types of items and services (including 
those provided through supplemental health care bene-
fits, such as remote patient monitoring, secure mes-
saging, store and forward technologies, and other non- 
face-to-face communication) should be considered to 
be additional telehealth benefits; and 
‘‘(ii) the requirements for the provision or fur-
nishing of such benefits (such as training and coordina-
tion requirements). 
‘‘(3) REQUIREMENTS
FOR
ADDITIONAL
TELEHEALTH
BENE-
FITS.—The Secretary shall specify requirements for the provi-
sion or furnishing of additional telehealth benefits, including 
with respect to the following: 
‘‘(A) Physician or practitioner qualifications (other than 
licensure) and other requirements such as specific training. 
‘‘(B) Factors necessary for the coordination of such 
benefits with other items and services including those fur-
nished in-person. 
‘‘(C) Such other areas as determined by the Secretary. 
‘‘(4) ENROLLEE CHOICE.—If an MA plan provides a service 
as an additional telehealth benefit (as defined in paragraph 
(2))— 
‘‘(A) the MA plan shall also provide access to such 
benefit through an in-person visit (and not only as an 
additional telehealth benefit); and 
‘‘(B) an individual enrollee shall have discretion as 
to whether to receive such service through the in-person 
visit or as an additional telehealth benefit. 
‘‘(5) TREATMENT
UNDER
MA.—For purposes of this sub-
section and section 1854, if a plan provides additional telehealth 
benefits, such additional telehealth benefits shall be treated 
as if they were benefits under the original Medicare fee-for- 
service program option. 
‘‘(6) CONSTRUCTION.—Nothing in this subsection shall be 
construed as affecting the requirement under subsection (a)(1) 
that MA plans provide enrollees with items and services (other 
than hospice care) for which benefits are available under parts 
A and B, including benefits available under section 1834(m).’’. 
(b) CLARIFICATION REGARDING INCLUSION IN BID AMOUNT.— 
Section 1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 
1395w–24(a)(6)(A)(ii)(I)) is amended by inserting ‘‘, including, for 
plan year 2020 and subsequent plan years, the provision of addi-
tional telehealth benefits as described in section 1852(m)’’ before 
the semicolon at the end. 
SEC. 50324. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE 
ABILITY TO EXPAND THE USE OF TELEHEALTH. 
(a) IN GENERAL.—Section 1899 of the Social Security Act (42 
U.S.C. 1395jjj) is amended by adding at the end the following 
new subsection: 
Determination. 
Deadline. 
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132 STAT. 204 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND THE USE OF 
TELEHEALTH SERVICES.— 
‘‘(1) IN GENERAL.—In the case of telehealth services for 
which payment would otherwise be made under this title fur-
nished on or after January 1, 2020, for purposes of this sub-
section only, the following shall apply with respect to such 
services furnished by a physician or practitioner participating 
in an applicable ACO (as defined in paragraph (2)) to a Medi-
care fee-for-service beneficiary assigned to the applicable ACO: 
‘‘(A) INCLUSION OF HOME AS ORIGINATING SITE.—Subject 
to paragraph (3), the home of a beneficiary shall be treated 
as an originating site described in section 1834(m)(4)(C)(ii). 
‘‘(B) NO APPLICATION OF GEOGRAPHIC LIMITATION.—The 
geographic limitation under section 1834(m)(4)(C)(i) shall 
not apply with respect to an originating site described 
in section 1834(m)(4)(C)(ii) (including the home of a bene-
ficiary under subparagraph (A)), subject to State licensing 
requirements. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE
ACO.—The term ‘applicable ACO’ 
means an ACO participating in a model tested or expanded 
under section 1115A or under this section— 
‘‘(i) that operates under a two-sided model— 
‘‘(I) described in section 425.600(a) of title 42, 
Code of Federal Regulations; or 
‘‘(II) tested or expanded under section 1115A; 
and 
‘‘(ii) for which Medicare fee-for-service beneficiaries 
are assigned to the ACO using a prospective assign-
ment method, as determined appropriate by the Sec-
retary. 
‘‘(B) HOME.—The term ‘home’ means, with respect to 
a Medicare fee-for-service beneficiary, the place of residence 
used as the home of the beneficiary. 
‘‘(3) TELEHEALTH
SERVICES
RECEIVED
IN
THE
HOME.—In 
the case of telehealth services described in paragraph (1) where 
the home of a Medicare fee-for-service beneficiary is the origi-
nating site, the following shall apply: 
‘‘(A) NO FACILITY FEE.—There shall be no facility fee 
paid to the originating site under section 1834(m)(2)(B). 
‘‘(B) EXCLUSION OF CERTAIN SERVICES.—No payment 
may be made for such services that are inappropriate to 
furnish in the home setting such as services that are typi-
cally furnished in inpatient settings such as a hospital.’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) 
shall conduct a study on the implementation of section 
1899(l) of the Social Security Act, as added by subsection 
(a). Such study shall include an analysis of the utilization 
of, and expenditures for, telehealth services under such 
section. 
(B) COLLECTION OF DATA.—The Secretary may collect 
such data as the Secretary determines necessary to carry 
out the study under this paragraph. 
Analysis. 
42 USC 1395jjj 
note. 
Applicability. 
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132 STAT. 205 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) REPORT.—Not later than January 1, 2026, the Secretary 
shall submit to Congress a report containing the results of 
the study conducted under paragraph (1), together with rec-
ommendations for such legislation and administrative action 
as the Secretary determines appropriate. 
SEC. 50325. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS 
WITH STROKE. 
Section 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)), as amended by section 50302(b)(1), is amended— 
(1) in paragraph (4)(C)(i), in the matter preceding subclause 
(I), by striking ‘‘The term’’ and inserting ‘‘Except as provided 
in paragraph (6), the term’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(6) TREATMENT OF STROKE TELEHEALTH SERVICES.— 
‘‘(A) NON-APPLICATION OF ORIGINATING SITE REQUIRE-
MENTS.—The requirements described in paragraph (4)(C) 
shall not apply with respect to telehealth services furnished 
on or after January 1, 2019, for purposes of diagnosis, 
evaluation, or treatment of symptoms of an acute stroke, 
as determined by the Secretary. 
‘‘(B) INCLUSION
OF
CERTAIN
SITES.—With respect to 
telehealth services described in subparagraph (A), the term 
‘originating site’ shall include any hospital (as defined in 
section 1861(e)) or critical access hospital (as defined in 
section 1861(mm)(1)), any mobile stroke unit (as defined 
by the Secretary), or any other site determined appropriate 
by the Secretary, at which the eligible telehealth individual 
is located at the time the service is furnished via a tele-
communications system. 
‘‘(C) NO
ORIGINATING
SITE
FACILITY
FEE
FOR
NEW 
SITES.—No facility fee shall be paid under paragraph (2)(B) 
to an originating site with respect to a telehealth service 
described in subparagraph (A) if the originating site does 
not otherwise meet the requirements for an originating 
site under paragraph (4)(C).’’. 
Subtitle D—Identifying the Chronically Ill 
Population 
SEC. 50331. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART 
OF AN ACCOUNTABLE CARE ORGANIZATION. 
Section 1899(c) of the Social Security Act (42 U.S.C. 1395jjj(c)) 
is amended— 
(1) by redesignating paragraphs (1) and (2) as subpara-
graphs (A) and (B), respectively, and indenting appropriately; 
(2) by striking ‘‘ACOS.—The Secretary’’ and inserting 
‘‘ACOS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the Secretary’’; 
and 
(3) by adding at the end the following new paragraph: 
‘‘(2) PROVIDING FLEXIBILITY.— 
‘‘(A) CHOICE OF PROSPECTIVE ASSIGNMENT.—For each 
agreement period (effective for agreements entered into 
or renewed on or after January 1, 2020), in the case where 
an ACO established under the program is in a Track that 
Contracts. 
Definition. 
Determination. 
Recommenda- 
tions. 
42 USC 1395jjj 
note. 
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132 STAT. 206 
PUBLIC LAW 115–123—FEB. 9, 2018 
provides for the retrospective assignment of Medicare fee- 
for-service beneficiaries to the ACO, the Secretary shall 
permit the ACO to choose to have Medicare fee-for-service 
beneficiaries assigned prospectively, rather than retrospec-
tively, to the ACO for an agreement period. 
‘‘(B) ASSIGNMENT BASED ON VOLUNTARY IDENTIFICATION 
BY MEDICARE FEE-FOR-SERVICE BENEFICIARIES.— 
‘‘(i) IN GENERAL.—For performance year 2018 and 
each subsequent performance year, if a system is avail-
able for electronic designation, the Secretary shall 
permit a Medicare fee-for-service beneficiary to volun-
tarily identify an ACO professional as the primary 
care provider of the beneficiary for purposes of 
assigning such beneficiary to an ACO, as determined 
by the Secretary. 
‘‘(ii) NOTIFICATION PROCESS.—The Secretary shall 
establish a process under which a Medicare fee-for- 
service beneficiary is— 
‘‘(I) notified of their ability to make an identi-
fication described in clause (i); and 
‘‘(II) informed of the process by which they 
may make and change such identification. 
‘‘(iii) SUPERSEDING CLAIMS-BASED ASSIGNMENT.—A 
voluntary identification by a Medicare fee-for-service 
beneficiary under this subparagraph shall supersede 
any claims-based assignment otherwise determined by 
the Secretary.’’. 
Subtitle E—Empowering Individuals and 
Caregivers in Care Delivery 
SEC. 50341. ELIMINATING BARRIERS TO CARE COORDINATION UNDER 
ACCOUNTABLE CARE ORGANIZATIONS. 
(a) IN GENERAL.—Section 1899 of the Social Security Act (42 
U.S.C. 1395jjj), as amended by section 50324(a), is amended— 
(1) in subsection (b)(2), by adding at the end the following 
new subparagraph: 
‘‘(I) An ACO that seeks to operate an ACO Beneficiary 
Incentive Program pursuant to subsection (m) shall apply 
to the Secretary at such time, in such manner, and with 
such information as the Secretary may require.’’; 
(2) by adding at the end the following new subsection: 
‘‘(m) AUTHORITY TO PROVIDE INCENTIVE PAYMENTS TO BENE-
FICIARIES WITH RESPECT TO QUALIFYING PRIMARY CARE SERVICES.— 
‘‘(1) PROGRAM.— 
‘‘(A) IN GENERAL.—In order to encourage Medicare fee- 
for-service beneficiaries to obtain medically necessary pri-
mary care services, an ACO participating under this section 
under a payment model described in clause (i) or (ii) of 
paragraph (2)(B) may apply to establish an ACO Bene-
ficiary Incentive Program to provide incentive payments 
to such beneficiaries who are furnished qualifying services 
in accordance with this subsection. The Secretary shall 
permit such an ACO to establish such a program at the 
Secretary’s discretion and subject to such requirements, 
Application. 
Determination. 
Determination. 
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132 STAT. 207 
PUBLIC LAW 115–123—FEB. 9, 2018 
including program integrity requirements, as the Secretary 
determines necessary. 
‘‘(B) IMPLEMENTATION.—The Secretary shall implement 
this subsection on a date determined appropriate by the 
Secretary. Such date shall be no earlier than January 
1, 2019, and no later than January 1, 2020. 
‘‘(2) CONDUCT OF PROGRAM.— 
‘‘(A) DURATION.—Subject to subparagraph (H), an ACO 
Beneficiary Incentive Program established under this sub-
section shall be conducted for such period (of not less 
than 1 year) as the Secretary may approve. 
‘‘(B) SCOPE.—An ACO Beneficiary Incentive Program 
established under this subsection shall provide incentive 
payments to all of the following Medicare fee-for-service 
beneficiaries who are furnished qualifying services by the 
ACO: 
‘‘(i) With respect to the Track 2 and Track 3 pay-
ment models described in section 425.600(a) of title 
42, Code of Federal Regulations (or in any successor 
regulation), Medicare fee-for-service beneficiaries who 
are 
preliminarily 
prospectively 
or 
prospectively 
assigned (or otherwise assigned, as determined by the 
Secretary) to the ACO. 
‘‘(ii) With respect to any future payment models 
involving two-sided risk, Medicare fee-for-service bene-
ficiaries who are assigned to the ACO, as determined 
by the Secretary. 
‘‘(C) QUALIFYING SERVICE.—For purposes of this sub-
section, a qualifying service is a primary care service, as 
defined in section 425.20 of title 42, Code of Federal Regula-
tions (or in any successor regulation), with respect to which 
coinsurance applies under part B, furnished through an 
ACO by— 
‘‘(i) an ACO professional described in subsection 
(h)(1)(A) who has a primary care specialty designation 
included in the definition of primary care physician 
under section 425.20 of title 42, Code of Federal Regu-
lations (or any successor regulation); 
‘‘(ii) an ACO professional described in subsection 
(h)(1)(B); or 
‘‘(iii) a Federally qualified health center or rural 
health clinic (as such terms are defined in section 
1861(aa)). 
‘‘(D) INCENTIVE
PAYMENTS.—An incentive payment 
made by an ACO pursuant to an ACO Beneficiary Incentive 
Program established under this subsection shall be— 
‘‘(i) in an amount up to $20, with such maximum 
amount updated annually by the percentage increase 
in the consumer price index for all urban consumers 
(United States city average) for the 12-month period 
ending with June of the previous year; 
‘‘(ii) in the same amount for each Medicare fee- 
for-service beneficiary described in clause (i) or (ii) 
of subparagraph (B) without regard to enrollment of 
such a beneficiary in a medicare supplemental policy 
(described in section 1882(g)(1)), in a State Medicaid 
plan under title XIX or a waiver of such a plan, or 
Time period. 
Determinations. 
Time period. 
Determination. 
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132 STAT. 208 
PUBLIC LAW 115–123—FEB. 9, 2018 
in any other health insurance policy or health benefit 
plan; 
‘‘(iii) made for each qualifying service furnished 
to such a beneficiary described in clause (i) or (ii) 
of subparagraph (B) during a period specified by the 
Secretary; and 
‘‘(iv) made no later than 30 days after a qualifying 
service is furnished to such a beneficiary described 
in clause (i) or (ii) of subparagraph (B). 
‘‘(E) NO SEPARATE PAYMENTS FROM THE SECRETARY.— 
The Secretary shall not make any separate payment to 
an ACO for the costs, including incentive payments, of 
carrying out an ACO Beneficiary Incentive Program estab-
lished under this subsection. Nothing in this subparagraph 
shall be construed as prohibiting an ACO from using shared 
savings received under this section to carry out an ACO 
Beneficiary Incentive Program. 
‘‘(F) NO
APPLICATION
TO
SHARED
SAVINGS
CALCULA-
TION.—Incentive payments made by an ACO under this 
subsection shall be disregarded for purposes of calculating 
benchmarks, estimated average per capita Medicare 
expenditures, and shared savings under this section. 
‘‘(G) REPORTING REQUIREMENTS.—An ACO conducting 
an ACO Beneficiary Incentive Program under this sub-
section shall, at such times and in such format as the 
Secretary may require, report to the Secretary such 
information and retain such documentation as the Sec-
retary may require, including the amount and frequency 
of incentive payments made and the number of Medicare 
fee-for-service beneficiaries receiving such payments. 
‘‘(H) TERMINATION.—The Secretary may terminate an 
ACO Beneficiary Incentive Program established under this 
subsection at any time for reasons determined appropriate 
by the Secretary. 
‘‘(3) EXCLUSION
OF
INCENTIVE
PAYMENTS.—Any payment 
made under an ACO Beneficiary Incentive Program established 
under this subsection shall not be considered income or 
resources or otherwise taken into account for purposes of— 
‘‘(A) determining eligibility for benefits or assistance 
(or the amount or extent of benefits or assistance) under 
any Federal program or under any State or local program 
financed in whole or in part with Federal funds; or 
‘‘(B) any Federal or State laws relating to taxation.’’; 
(3) in subsection (e), by inserting ‘‘, including an ACO 
Beneficiary Incentive Program under subsections (b)(2)(I) and 
(m)’’ after ‘‘the program’’; and 
(4) in subsection (g)(6), by inserting ‘‘or of an ACO Bene-
ficiary Incentive Program under subsections (b)(2)(I) and (m)’’ 
after ‘‘under subsection (d)(4)’’. 
(b) AMENDMENT
TO SECTION 1128B.—Section 1128B(b)(3) of 
the Social Security Act (42 U.S.C. 1320a–7b(b)(3)) is amended— 
(1) by striking ‘‘and’’ at the end of subparagraph (I); 
(2) by striking the period at the end of subparagraph (J) 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new subparagraph: 
Deadline. 
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132 STAT. 209 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(K) an incentive payment made to a Medicare fee- 
for-service beneficiary by an ACO under an ACO Bene-
ficiary Incentive Program established under subsection (m) 
of section 1899, if the payment is made in accordance 
with the requirements of such subsection and meets such 
other conditions as the Secretary may establish.’’. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Secretary’’) shall 
conduct an evaluation of the ACO Beneficiary Incentive Pro-
gram established under subsections (b)(2)(I) and (m) of section 
1899 of the Social Security Act (42 U.S.C. 1395jjj), as added 
by subsection (a). The evaluation shall include an analysis 
of the impact of the implementation of the Program on expendi-
tures and beneficiary health outcomes under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.). 
(2) REPORT.—Not later than October 1, 2023, the Secretary 
shall submit to Congress a report containing the results of 
the evaluation under paragraph (1), together with recommenda-
tions for such legislation and administrative action as the Sec-
retary determines appropriate. 
SEC. 50342. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHEN-
SIVE CARE PLANNING SERVICES UNDER MEDICARE 
PART B. 
(a) STUDY.—The Comptroller General shall conduct a study 
on the establishment under part B of the Medicare program under 
title XVIII of the Social Security Act of a payment code for a 
visit for longitudinal comprehensive care planning services. Such 
study shall include an analysis of the following to the extent such 
information is available: 
(1) The frequency with which services similar to longitu-
dinal comprehensive care planning services are furnished to 
Medicare beneficiaries, which providers of services and sup-
pliers are furnishing those services, whether Medicare 
reimbursement is being received for those services, and, if 
so, through which codes those services are being reimbursed. 
(2) Whether, and the extent to which, longitudinal com-
prehensive care planning services would overlap, and could 
therefore result in duplicative payment, with services covered 
under the hospice benefit as well as the chronic care manage-
ment code, evaluation and management codes, or other codes 
that already exist under part B of the Medicare program. 
(3) Any barriers to hospitals, skilled nursing facilities, hos-
pice programs, home health agencies, and other applicable pro-
viders working with a Medicare beneficiary to engage in the 
care planning process and complete the necessary documenta-
tion to support the treatment and care plan of the beneficiary 
and provide such documentation to other providers and the 
beneficiary or the beneficiary’s representative. 
(4) Any barriers to providers, other than the provider fur-
nishing longitudinal comprehensive care planning services, 
accessing the care plan and associated documentation for use 
related to the care of the Medicare beneficiary. 
(5) Potential options for ensuring that applicable providers 
are notified of a patient’s existing longitudinal care plan and 
that applicable providers consider that plan in making their 
Analysis. 
Recommenda- 
tions. 
Analysis. 
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132 STAT. 210 
PUBLIC LAW 115–123—FEB. 9, 2018 
treatment decisions, and what the challenges might be in imple-
menting such options. 
(6) Stakeholder’s views on the need for the development 
of quality metrics with respect to longitudinal comprehensive 
care planning services, such as measures related to— 
(A) the process of eliciting input from the Medicare 
beneficiary or from a legally authorized representative and 
documenting in the medical record the patient-directed care 
plan; 
(B) the effectiveness and patient-centeredness of the 
care plan in organizing delivery of services consistent with 
the plan; 
(C) the availability of the care plan and associated 
documentation to other providers that care for the bene-
ficiary; and 
(D) the extent to which the beneficiary received services 
and support that is free from discrimination based on 
advanced age, disability status, or advanced illness. 
(7) Stakeholder’s views on how such quality metrics would 
provide information on— 
(A) the goals, values, and preferences of the beneficiary; 
(B) the documentation of the care plan; 
(C) services furnished to the beneficiary; and 
(D) outcomes of treatment. 
(8) Stakeholder’s views on— 
(A) the type of training and education needed for 
applicable providers, individuals, and caregivers in order 
to facilitate longitudinal comprehensive care planning serv-
ices; 
(B) the types of providers of services and suppliers 
that should be included in the interdisciplinary team of 
an applicable provider; and 
(C) the characteristics of Medicare beneficiaries that 
would be most appropriate to receive longitudinal com-
prehensive care planning services, such as individuals with 
advanced disease and individuals who need assistance with 
multiple activities of daily living. 
(9) Stakeholder’s views on the frequency with which 
longitudinal comprehensive care planning services should be 
furnished. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study conducted 
under subsection (a), together with recommendations for such legis-
lation and administrative action as the Comptroller General deter-
mines appropriate. 
(c) DEFINITIONS.—In this section: 
(1) APPLICABLE PROVIDER.—The term ‘‘applicable provider’’ 
means a hospice program (as defined in subsection (dd)(2) of 
section 1861 of the Social Security Act (42 U.S.C. 1395ww)) 
or other provider of services (as defined in subsection (u) of 
such section) or supplier (as defined in subsection (d) of such 
section) that— 
(A) furnishes longitudinal comprehensive care planning 
services through an interdisciplinary team; and 
(B) meets such other requirements as the Secretary 
may determine to be appropriate. 
Recommenda- 
tions. 
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132 STAT. 211 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) COMPTROLLER GENERAL.—The term ‘‘Comptroller Gen-
eral’’ means the Comptroller General of the United States. 
(3) INTERDISCIPLINARY TEAM.—The term ‘‘interdisciplinary 
team’’ means a group that— 
(A) includes the personnel described in subsection 
(dd)(2)(B)(i) of such section 1861; 
(B) may include a chaplain, minister, or other clergy; 
and 
(C) may include other direct care personnel. 
(4) LONGITUDINAL COMPREHENSIVE CARE PLANNING SERV-
ICES.—The term ‘‘longitudinal comprehensive care planning 
services’’ means a voluntary shared decisionmaking process 
that is furnished by an applicable provider through an inter-
disciplinary team and includes a conversation with Medicare 
beneficiaries who have received a diagnosis of a serious or 
life-threatening illness. The purpose of such services is to dis-
cuss a longitudinal care plan that addresses the progression 
of the disease, treatment options, the goals, values, and pref-
erences of the beneficiary, and the availability of other resources 
and social supports that may reduce the beneficiary’s health 
risks and promote self-management and shared decision-
making. 
(5) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
Subtitle F—Other Policies to Improve Care 
for the Chronically Ill 
SEC. 50351. GAO STUDY AND REPORT ON IMPROVING MEDICATION 
SYNCHRONIZATION. 
(a) STUDY.—The Comptroller General of the United States (in 
this section referred to as the ‘‘Comptroller General’’) shall conduct 
a study on the extent to which Medicare prescription drug plans 
(MA–PD plans and stand alone prescription drug plans) under 
part D of title XVIII of the Social Security Act and private payors 
use programs that synchronize pharmacy dispensing so that individ-
uals may receive multiple prescriptions on the same day to facilitate 
comprehensive counseling and promote medication adherence. The 
study shall include a analysis of the following: 
(1) The extent to which pharmacies have adopted such 
programs. 
(2) The common characteristics of such programs, including 
how pharmacies structure counseling sessions under such pro-
grams and the types of payment and other arrangements that 
Medicare prescription drug plans and private payors employ 
under such programs to support the efforts of pharmacies. 
(3) How such programs compare for Medicare prescription 
drug plans and private payors. 
(4) What is known about how such programs affect patient 
medication adherence and overall patient health outcomes, 
including if adherence and outcomes vary by patient subpopula-
tions, such as disease state and socioeconomic status. 
(5) What is known about overall patient satisfaction with 
such programs and satisfaction with such programs, including 
within patient subpopulations, such as disease state and socio-
economic status. 
Analysis. 
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132 STAT. 212 
PUBLIC LAW 115–123—FEB. 9, 2018 
(6) The extent to which laws and regulations of the Medi-
care program support such programs. 
(7) Barriers to the use of medication synchronization pro-
grams by Medicare prescription drug plans. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study under sub-
section (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines appro-
priate. 
SEC. 50352. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS 
ON PATIENT HEALTH AND SPENDING. 
(a) STUDY.—The Comptroller General of the United States (in 
this section referred to as the ‘‘Comptroller General’’) shall, to 
the extent data are available, conduct a study on the use of prescrip-
tion drugs to manage the weight of obese patients and the impact 
of coverage of such drugs on patient health and on health care 
spending. Such study shall examine the use and impact of these 
obesity drugs in the non-Medicare population and for Medicare 
beneficiaries who have such drugs covered through an MA–PD 
plan (as defined in section 1860D–1(a)(3)(C) of the Social Security 
Act (42 U.S.C. 1395w–101(a)(3)(C))) as a supplemental health care 
benefit. The study shall include an analysis of the following: 
(1) The prevalence of obesity in the Medicare and non- 
Medicare population. 
(2) The utilization of obesity drugs. 
(3) The distribution of Body Mass Index by individuals 
taking obesity drugs, to the extent practicable. 
(4) What is known about the use of obesity drugs in 
conjunction with the receipt of other items or services, such 
as behavioral counseling, and how these compare to items 
and services received by obese individuals who do not take 
obesity drugs. 
(5) Physician considerations and attitudes related to pre-
scribing obesity drugs. 
(6) The extent to which coverage policies cease or limit 
coverage for individuals who fail to receive clinical benefit. 
(7) What is known about the extent to which individuals 
who take obesity drugs adhere to the prescribed regimen. 
(8) What is known about the extent to which individuals 
who take obesity drugs maintain weight loss over time. 
(9) What is known about the subsequent impact such drugs 
have on medical services that are directly related to obesity, 
including with respect to subpopulations determined based on 
the extent of obesity. 
(10) What is known about the spending associated with 
the care of individuals who take obesity drugs, compared to 
the spending associated with the care of individuals who do 
not take such drugs. 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to 
Congress a report containing the results of the study under sub-
section (a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines appro-
priate. 
Recommenda- 
tions. 
Analysis. 
Recommenda- 
tions. 
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132 STAT. 213 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 50353. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS 
FOR CHRONIC CONDITIONS AMONG MEDICARE BENE-
FICIARIES. 
(a) STUDY.—The Secretary of Health and Human Services (in 
this section referred to as the ‘‘Secretary’’) shall conduct a study 
on long-term cost drivers to the Medicare program, including obe-
sity, tobacco use, mental health conditions, and other factors that 
may contribute to the deterioration of health conditions among 
individuals with chronic conditions in the Medicare population. 
The study shall include an analysis of any barriers to collecting 
and analyzing such information and how to remove any such bar-
riers (including through legislation and administrative actions). 
(b) REPORT.—Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administra-
tive action as the Secretary determines appropriate. The Secretary 
shall also post such report on the Internet website of the Depart-
ment of Health and Human Services. 
SEC. 50354. PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A 
AND B CLAIMS DATA TO PROMOTE THE APPROPRIATE 
USE OF MEDICATIONS AND IMPROVE HEALTH OUT-
COMES. 
Section 1860D–4(c) of the Social Security Act (42 U.S.C. 1395w– 
104(c)) is amended by adding at the end the following new para-
graph: 
‘‘(6) PROVIDING PRESCRIPTION DRUG PLANS WITH PARTS A 
AND
B
CLAIMS
DATA
TO
PROMOTE
THE
APPROPRIATE
USE
OF 
MEDICATIONS AND IMPROVE HEALTH OUTCOMES.— 
‘‘(A) PROCESS.—Subject to subparagraph (B), the Sec-
retary shall establish a process under which a PDP sponsor 
of a prescription drug plan may submit a request for the 
Secretary to provide the sponsor, on a periodic basis and 
in an electronic format, beginning in plan year 2020, data 
described in subparagraph (D) with respect to enrollees 
in such plan. Such data shall be provided without regard 
to whether such enrollees are described in clause (ii) of 
paragraph (2)(A). 
‘‘(B) PURPOSES.—A PDP sponsor may use the data 
provided to the sponsor pursuant to subparagraph (A) for 
any of the following purposes: 
‘‘(i) To optimize therapeutic outcomes through 
improved medication use, as such phrase is used in 
clause (i) of paragraph (2)(A). 
‘‘(ii) To improving care coordination so as to pre-
vent adverse health outcomes, such as preventable 
emergency department visits and hospital readmis-
sions. 
‘‘(iii) For any other purpose determined appro-
priate by the Secretary. 
‘‘(C) LIMITATIONS ON DATA USE.—A PDP sponsor shall 
not use data provided to the sponsor pursuant to subpara-
graph (A) for any of the following purposes: 
‘‘(i) To inform coverage determinations under this 
part. 
Determination. 
Web posting. 
Recommenda- 
tions. 
Analysis. 
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132 STAT. 214 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) To conduct retroactive reviews of medically 
accepted indications determinations. 
‘‘(iii) To facilitate enrollment changes to a different 
prescription drug plan or an MA–PD plan offered by 
the same parent organization. 
‘‘(iv) To inform marketing of benefits. 
‘‘(v) For any other purpose that the Secretary 
determines is necessary to include in order to protect 
the identity of individuals entitled to, or enrolled for, 
benefits under this title and to protect the security 
of personal health information. 
‘‘(D) DATA
DESCRIBED.—The data described in this 
clause are standardized extracts (as determined by the 
Secretary) of claims data under parts A and B for items 
and services furnished under such parts for time periods 
specified by the Secretary. Such data shall include data 
as current as practicable.’’. 
TITLE IV—PART B IMPROVEMENT ACT 
AND OTHER PART B ENHANCEMENTS 
Subtitle A—Medicare Part B Improvement 
Act 
SEC. 50401. HOME INFUSION THERAPY SERVICES TEMPORARY TRANSI-
TIONAL PAYMENT. 
(a) IN GENERAL.—Section 1834(u) of the Social Security Act 
(42 U.S.C. 1395m(u)) is amended, by adding at the end the following 
new paragraph: 
‘‘(7) HOME INFUSION THERAPY SERVICES TEMPORARY TRANSI-
TIONAL PAYMENT.— 
‘‘(A) TEMPORARY TRANSITIONAL PAYMENT.— 
‘‘(i) IN GENERAL.—The Secretary shall, in accord-
ance with the payment methodology described in 
subparagraph (B) and subject to the provisions of this 
paragraph, provide a home infusion therapy services 
temporary transitional payment under this part to an 
eligible home infusion supplier (as defined in subpara-
graph (F)) for items and services described in subpara-
graphs (A) and (B) of section 1861(iii)(2)) furnished 
during the period specified in clause (ii) by such sup-
plier in coordination with the furnishing of transitional 
home infusion drugs (as defined in clause (iii)). 
‘‘(ii) PERIOD SPECIFIED.—For purposes of clause (i), 
the period specified in this clause is the period begin-
ning on January 1, 2019, and ending on the day before 
the date of the implementation of the payment system 
under paragraph (1)(A). 
‘‘(iii) 
TRANSITIONAL
HOME
INFUSION
DRUG 
DEFINED.—For purposes of this paragraph, the term 
‘transitional home infusion drug’ has the meaning 
given to the term ‘home infusion drug’ under section 
1861(iii)(3)(C)), except that clause (ii) of such section 
shall not apply if a drug described in such clause 
Determination. 
Determination. 
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132 STAT. 215 
PUBLIC LAW 115–123—FEB. 9, 2018 
is identified in clauses (i), (ii), (iii) or (iv) of subpara-
graph (C) as of the date of the enactment of this 
paragraph. 
‘‘(B) PAYMENT
METHODOLOGY.—For purposes of this 
paragraph, the Secretary shall establish a payment meth-
odology, with respect to items and services described in 
subparagraph (A)(i). Under such payment methodology the 
Secretary shall— 
‘‘(i) create the three payment categories described 
in clauses (i), (ii), and (iii) of subparagraph (C); 
‘‘(ii) assign drugs to such categories, in accordance 
with such clauses; 
‘‘(iii) assign appropriate Healthcare Common 
Procedure Coding System (HCPCS) codes to each pay-
ment category; and 
‘‘(iv) establish a single payment amount for each 
such payment category, in accordance with subpara-
graph (D), for each infusion drug administration cal-
endar day in the individual’s home for drugs assigned 
to such category. 
‘‘(C) PAYMENT CATEGORIES.— 
‘‘(i) PAYMENT
CATEGORY
1.—The Secretary shall 
create a payment category 1 and assign to such cat-
egory drugs which are covered under the Local Cov-
erage Determination on External Infusion Pumps (LCD 
number L33794) and billed with the following HCPCS 
codes (as identified as of January 1, 2018, and as 
subsequently modified by the Secretary): J0133, J0285, 
J0287, J0288, J0289, J0895, J1170, J1250, J1265, 
J1325, J1455, J1457, J1570, J2175, J2260, J2270, 
J2274, J2278, J3010, or J3285. 
‘‘(ii) PAYMENT CATEGORY 2.—The Secretary shall 
create a payment category 2 and assign to such cat-
egory drugs which are covered under such local cov-
erage determination and billed with the following 
HCPCS codes (as identified as of January 1, 2018, 
and as subsequently modified by the Secretary): J1555 
JB, J1559 JB, J1561 JB, J1562 JB, J1569 JB, or J1575 
JB. 
‘‘(iii) PAYMENT CATEGORY 3.—The Secretary shall 
create a payment category 3 and assign to such cat-
egory drugs which are covered under such local cov-
erage determination and billed with the following 
HCPCS codes (as identified as of January 1, 2018, 
and as subsequently modified by the Secretary): J9000, 
J9039, J9040, J9065, J9100, J9190, J9200, J9360, or 
J9370. 
‘‘(iv) INFUSION DRUGS NOT OTHERWISE INCLUDED.— 
With respect to drugs that are not included in payment 
category 1, 2, or 3 under clause (i), (ii), or (iii), respec-
tively, the Secretary shall assign to the most appro-
priate of such categories, as determined by the Sec-
retary, drugs which are— 
‘‘(I) covered under such local coverage deter-
mination and billed under HCPCS codes J7799 
or J7999 (as identified as of July 1, 2017, and 
as subsequently modified by the Secretary); or 
Determination. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(II) billed under any code that is implemented 
after the date of the enactment of this paragraph 
and included in such local coverage determination 
or included in subregulatory guidance as a home 
infusion drug described in subparagraph (A)(i). 
‘‘(D) PAYMENT AMOUNTS.— 
‘‘(i) IN
GENERAL.—Under the payment method-
ology, the Secretary shall pay eligible home infusion 
suppliers, with respect to items and services described 
in subparagraph (A)(i) furnished during the period 
described in subparagraph (A)(ii) by such supplier to 
an individual, at amounts equal to the amounts deter-
mined under the physician fee schedule established 
under section 1848 for services furnished during the 
year for codes and units of such codes described in 
clauses (ii), (iii), and (iv) with respect to drugs included 
in the payment category under subparagraph (C) speci-
fied in the respective clause, determined without 
application of the geographic adjustment under sub-
section (e) of such section. 
‘‘(ii) PAYMENT AMOUNT FOR CATEGORY 1.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 1 described in subparagraph (C)(i), are one 
unit of HCPCS code 96365 plus three units of HCPCS 
code 96366 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(iii) PAYMENT AMOUNT FOR CATEGORY 2.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 2 described in subparagraph (C)(i), are one 
unit of HCPCS code 96369 plus three units of HCPCS 
code 96370 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(iv) PAYMENT AMOUNT FOR CATEGORY 3.—For pur-
poses of clause (i), the codes and units described in 
this clause, with respect to drugs included in payment 
category 3 described in subparagraph (C)(i), are one 
unit of HCPCS code 96413 plus three units of HCPCS 
code 96415 (as identified as of January 1, 2018, and 
as subsequently modified by the Secretary). 
‘‘(E) CLARIFICATIONS.— 
‘‘(i) INFUSION DRUG ADMINISTRATION DAY.—For pur-
poses of this subsection, with respect to the furnishing 
of transitional home infusion drugs or home infusion 
drugs to an individual by an eligible home infusion 
supplier or a qualified home infusion therapy supplier, 
a reference to payment to such supplier for an infusion 
drug administration calendar day in the individual’s 
home shall refer to payment only for the date on which 
professional 
services 
(as 
described 
in 
section 
1861(iii)(2)(A)) were furnished to administer such 
drugs to such individual. For purposes of the previous 
sentence, an infusion drug administration calendar day 
shall include all such drugs administered to such indi-
vidual on such day. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) TREATMENT OF MULTIPLE DRUGS ADMINISTERED 
ON SAME INFUSION DRUG ADMINISTRATION DAY.—In the 
case that an eligible home infusion supplier, with 
respect to an infusion drug administration calendar 
day in an individual’s home, furnishes to such indi-
vidual transitional home infusion drugs which are not 
all assigned to the same payment category under 
subparagraph (C), payment to such supplier for such 
infusion drug administration calendar day in the 
individual’s home shall be a single payment equal to 
the amount of payment under this paragraph for the 
drug, among all such drugs so furnished to such indi-
vidual during such calendar day, for which the highest 
payment would be made under this paragraph. 
‘‘(F) ELIGIBLE HOME INFUSION SUPPLIERS.—In this para-
graph, the term ‘eligible home infusion supplier’ means 
a supplier that is enrolled under this part as a pharmacy 
that provides external infusion pumps and external infu-
sion pump supplies and that maintains all pharmacy licen-
sure requirements in the State in which the applicable 
infusion drugs are administered. 
‘‘(G) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this para-
graph by program instruction or otherwise.’’. 
(b) CONFORMING AMENDMENTS.—(1) Section 1842(b)(6)(I) of the 
Social Security Act (42 U.S.C. 1395u(b)(6)(I)) is amended by 
inserting ‘‘or, in the case of items and services described in clause 
(i) of section 1834(u)(7)(A) furnished to an individual during the 
period described in clause (ii) of such section, payment shall be 
made to the eligible home infusion therapy supplier’’ after ‘‘payment 
shall be made to the qualified home infusion therapy supplier’’. 
(2) Section 5012(d) of the 21st Century Cures Act is amended 
by inserting the following before the period at the end: ‘‘, except 
that the amendments made by paragraphs (1) and (2) of subsection 
(c) shall apply to items and services furnished on or after January 
1, 2019’’. 
SEC. 50402. ORTHOTIST’S AND PROSTHETIST’S CLINICAL NOTES AS 
PART OF THE PATIENT’S MEDICAL RECORD. 
Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) 
is amended by adding at the end the following new paragraph: 
‘‘(5) 
DOCUMENTATION
CREATED
BY
ORTHOTISTS
AND 
PROSTHETISTS.—For purposes of determining the reasonable-
ness and medical necessity of orthotics and prosthetics, docu-
mentation created by an orthotist or prosthetist shall be consid-
ered part of the individual’s medical record to support docu-
mentation created by eligible professionals described in section 
1848(k)(3)(B).’’. 
SEC. 50403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES 
AND ASSURANCE OF HIGH QUALITY SURVEYS. 
(a) ACCREDITATION AND SURVEYS.— 
(1) IN GENERAL.—Section 1865 of the Social Security Act 
(42 U.S.C. 1395bb) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), in the matter preceding 
subparagraph (A), by striking ‘‘or the conditions and 
requirements under section 1881(b)’’; and 
Deadlines. 
Determination. 
Applicability. 
42 USC 1395l 
note. 
Definition. 
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132 STAT. 218 
PUBLIC LAW 115–123—FEB. 9, 2018 
(ii) in paragraph (4), by inserting ‘‘(including a 
renal dialysis facility)’’ after ‘‘facility’’; and 
(B) by adding at the end the following new subsection: 
‘‘(e) With respect to an accreditation body that has received 
approval from the Secretary under subsection (a)(3)(A) for accredita-
tion of provider entities that are required to meet the conditions 
and requirements under section 1881(b), in addition to review and 
oversight authorities otherwise applicable under this title, the Sec-
retary shall (as the Secretary determines appropriate) conduct, 
with respect to such accreditation body and provider entities, any 
or all of the following as frequently as is otherwise required to 
be conducted under this title with respect to other accreditation 
bodies or other provider entities: 
‘‘(1) Validation surveys referred to in subsection (d). 
‘‘(2) Accreditation program reviews (as defined in section 
488.8(c) of title 42 of the Code of Federal Regulations, or 
a successor regulation). 
‘‘(3) Performance reviews (as defined in section 488.8(a) 
of title 42 of the Code of Federal Regulations, or a successor 
regulation).’’. 
(2) TIMING FOR ACCEPTANCE OF REQUESTS FROM ACCREDITA-
TION ORGANIZATIONS.—Not later than 90 days after the date 
of enactment of this Act, the Secretary of Health and Human 
Services shall begin accepting requests from national accredita-
tion bodies for a finding described in section 1865(a)(3)(A) of 
the Social Security Act (42 U.S.C. 1395bb(a)(3)(A)) for purposes 
of accrediting provider entities that are required to meet the 
conditions and requirements under section 1881(b) of such Act 
(42 U.S.C. 1395rr(b)). 
(b) REQUIREMENT FOR TIMING OF SURVEYS OF NEW DIALYSIS 
FACILITIES.—Section 1881(b)(1) of the Social Security Act (42 U.S.C. 
1395rr(b)(1)) is amended by adding at the end the following new 
sentence: ‘‘Beginning 180 days after the date of the enactment 
of this sentence, an initial survey of a provider of services or 
a renal dialysis facility to determine if the conditions and require-
ments under this paragraph are met shall be initiated not later 
than 90 days after such date on which both the provider enrollment 
form (without regard to whether such form is submitted prior 
to or after such date of enactment) has been determined by the 
Secretary to be complete and the provider’s enrollment status 
indicates approval is pending the results of such survey.’’. 
SEC. 50404. MODERNIZING THE APPLICATION OF THE STARK RULE 
UNDER MEDICARE. 
(a) CLARIFICATION OF THE WRITING REQUIREMENT AND SIGNA-
TURE REQUIREMENT FOR ARRANGEMENTS PURSUANT TO THE STARK 
RULE.— 
(1) WRITING REQUIREMENT.—Section 1877(h)(1) of the Social 
Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding 
at the end the following new subparagraph: 
‘‘(D) WRITTEN REQUIREMENT CLARIFIED.—In the case of any 
requirement pursuant to this section for a compensation 
arrangement to be in writing, such requirement shall be satis-
fied by such means as determined by the Secretary, including 
by a collection of documents, including contemporaneous docu-
ments evidencing the course of conduct between the parties 
involved.’’. 
Determination. 
Time periods. 
Effective date. 
Survey. 
Determination. 
42 USC 1395bb 
note. 
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132 STAT. 219 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) SIGNATURE
REQUIREMENT.—Section 1877(h)(1) of the 
Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by 
paragraph (1), is further amended by adding at the end the 
following new subparagraph: 
‘‘(E) SPECIAL RULE FOR SIGNATURE REQUIREMENTS.— 
In the case of any requirement pursuant to this section 
for a compensation arrangement to be in writing and signed 
by the parties, such signature requirement shall be met 
if— 
‘‘(i) not later than 90 consecutive calendar days 
immediately following the date on which the compensa-
tion arrangement became noncompliant, the parties 
obtain the required signatures; and 
‘‘(ii) the compensation arrangement otherwise com-
plies with all criteria of the applicable exception.’’. 
(b) INDEFINITE HOLDOVER FOR LEASE ARRANGEMENTS AND PER-
SONAL SERVICES ARRANGEMENTS PURSUANT TO THE STARK RULE.— 
Section 1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) 
is amended— 
(1) in paragraph (1), by adding at the end the following 
new subparagraph: 
‘‘(C) HOLDOVER LEASE ARRANGEMENTS.—In the case of 
a holdover lease arrangement for the lease of office space 
or equipment, which immediately follows a lease arrange-
ment described in subparagraph (A) for the use of such 
office space or subparagraph (B) for the use of such equip-
ment and that expired after a term of at least 1 year, 
payments made by the lessee to the lessor pursuant to 
such holdover lease arrangement, if— 
‘‘(i) the lease arrangement met the conditions of 
subparagraph (A) for the lease of office space or 
subparagraph (B) for the use of equipment when the 
arrangement expired; 
‘‘(ii) the holdover lease arrangement is on the same 
terms and conditions as the immediately preceding 
arrangement; and 
‘‘(iii) the holdover arrangement continues to satisfy 
the conditions of subparagraph (A) for the lease of 
office space or subparagraph (B) for the use of equip-
ment.’’; and 
(2) in paragraph (3), by adding at the end the following 
new subparagraph: 
‘‘(C) HOLDOVER PERSONAL SERVICE ARRANGEMENT.—In 
the case of a holdover personal service arrangement, which 
immediately follows an arrangement described in subpara-
graph (A) that expired after a term of at least 1 year, 
remuneration from an entity pursuant to such holdover 
personal service arrangement, if— 
‘‘(i) the personal service arrangement met the 
conditions of subparagraph (A) when the arrangement 
expired; 
‘‘(ii) the holdover personal service arrangement is 
on the same terms and conditions as the immediately 
preceding arrangement; and 
‘‘(iii) the holdover arrangement continues to satisfy 
the conditions of subparagraph (A).’’. 
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132 STAT. 220 
PUBLIC LAW 115–123—FEB. 9, 2018 
Subtitle B—Additional Medicare 
Provisions 
SEC. 50411. MAKING PERMANENT THE REMOVAL OF THE RENTAL CAP 
FOR DURABLE MEDICAL EQUIPMENT UNDER MEDICARE 
WITH RESPECT TO SPEECH GENERATING DEVICES. 
Section 1834(a)(2)(A)(iv) of the Social Security Act (42 U.S.C. 
1395m(a)(2)(A)(iv)) is amended by striking ‘‘and before October 1, 
2018,’’. 
SEC. 50412. INCREASED CIVIL AND CRIMINAL PENALTIES AND 
INCREASED SENTENCES FOR FEDERAL HEALTH CARE 
PROGRAM FRAUD AND ABUSE. 
(a) INCREASED CIVIL MONEY PENALTIES AND CRIMINAL FINES.— 
(1) INCREASED CIVIL MONEY PENALTIES.—Section 1128A of 
the Social Security Act (42 U.S.C. 1320a–7a) is amended— 
(A) in subsection (a), in the matter following paragraph 
(10)— 
(i) by striking ‘‘$10,000’’ and inserting ‘‘$20,000’’ 
each place it appears; 
(ii) by striking ‘‘$15,000’’ and inserting ‘‘$30,000’’; 
and 
(iii) by striking ‘‘$50,000’’ and inserting ‘‘$100,000’’ 
each place it appears; and 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘$2,000’’ and inserting 
‘‘$5,000’’; 
(ii) in paragraph (2), by striking ‘‘$2,000’’ and 
inserting ‘‘$5,000’’; and 
(iii) in paragraph (3)(A)(i), by striking ‘‘$5,000’’ 
and inserting ‘‘$10,000’’. 
(2) INCREASED CRIMINAL FINES.—Section 1128B of such Act 
(42 U.S.C. 1320a–7b) is amended— 
(A) in subsection (a), in the matter following paragraph 
(6)— 
(i) by striking ‘‘$25,000’’ and inserting ‘‘$100,000’’; 
and 
(ii) by striking ‘‘$10,000’’ and inserting ‘‘$20,000’’; 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘$25,000’’ and inserting 
‘‘$100,000’’; and 
(ii) in paragraph (2), in the flush text following 
subparagraph (B), by striking ‘‘$25,000’’ and inserting 
‘‘$100,000’’; 
(C) in subsection (c), by striking ‘‘$25,000’’ and 
inserting ‘‘$100,000’’; 
(D) in subsection (d), in the flush text following para-
graph (2), by striking ‘‘$25,000’’ and inserting ‘‘$100,000’’; 
and 
(E) in subsection (e), by striking ‘‘$2,000’’ and inserting 
‘‘$4,000’’. 
(b) INCREASED SENTENCES FOR FELONIES INVOLVING FEDERAL 
HEALTH CARE PROGRAM FRAUD AND ABUSE.— 
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132 STAT. 221 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) FALSE
STATEMENTS
AND
REPRESENTATIONS.—Section 
1128B(a) of the Social Security Act (42 U.S.C. 1320a–7b(a)) 
is amended, in the matter following paragraph (6), by striking 
‘‘not more than five years or both, or (ii)’’ and inserting ‘‘not 
more than 10 years or both, or (ii)’’. 
(2) ANTIKICKBACK.—Section 1128B(b) of such Act (42 U.S.C. 
1320a–7b(b)) is amended— 
(A) in paragraph (1), in the flush text following 
subparagraph (B), by striking ‘‘not more than five years’’ 
and inserting ‘‘not more than 10 years’’; and 
(B) in paragraph (2), in the flush text following 
subparagraph (B), by striking ‘‘not more than five years’’ 
and inserting ‘‘not more than 10 years’’. 
(3) FALSE STATEMENT OR REPRESENTATION WITH RESPECT 
TO CONDITIONS OR OPERATIONS OF FACILITIES.—Section 1128B(c) 
of such Act (42 U.S.C. 1320a–7b(c)) is amended by striking 
‘‘not more than five years’’ and inserting ‘‘not more than 10 
years’’. 
(4) EXCESS CHARGES.—Section 1128B(d) of such Act (42 
U.S.C. 1320a–7b(d)) is amended, in the flush text following 
paragraph (2), by striking ‘‘not more than five years’’ and 
inserting ‘‘not more than 10 years’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to acts committed after the date of the enactment 
of this Act. 
SEC. 50413. REDUCING THE VOLUME OF FUTURE EHR-RELATED 
SIGNIFICANT HARDSHIP REQUESTS. 
Section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 
1395w–4(o)(2)(A)) and section 1886(n)(3)(A) of such Act (42 U.S.C. 
1395ww(n)(3)(A)) are each amended in the last sentence by striking 
‘‘by requiring’’ and all that follows through ‘‘this paragraph’’. 
SEC. 50414. STRENGTHENING RULES IN CASE OF COMPETITION FOR 
DIABETIC TESTING STRIPS. 
(a) SPECIAL RULE
IN CASE
OF COMPETITION
FOR DIABETIC 
TESTING STRIPS.— 
(1) IN GENERAL.—Paragraph (10) of section 1847(b) of the 
Social Security Act (42 U.S.C. 1395w–3(b)) is amended— 
(A) in subparagraph (A), by striking the second sen-
tence and inserting the following new sentence: ‘‘With 
respect to bids to furnish such types of products on or 
after January 1, 2019, the volume for such types of products 
shall be determined by the Secretary through the use of 
multiple sources of data (from mail order and non-mail 
order Medicare markets), including market-based data 
measuring sales of diabetic testing strip products that are 
not exclusively sold by a single retailer from such mar-
kets.’’; and 
(B) by adding at the end the following new subpara-
graphs: 
‘‘(C) DEMONSTRATION
OF
ABILITY
TO
FURNISH
TYPES 
OF
DIABETIC
TESTING
STRIP
PRODUCTS.—With respect to 
bids to furnish diabetic testing strip products on or after 
January 1, 2019, an entity shall attest to the Secretary 
that the entity has the ability to obtain an inventory of 
the types and quantities of diabetic testing strip products 
Determination. 
Applicability. 
42 USC 
1320a–7a note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
that will allow the entity to furnish such products in a 
manner consistent with its bid and— 
‘‘(i) demonstrate to the Secretary, through letters 
of intent with manufacturers, wholesalers, or other 
suppliers, or other evidence as the Secretary may 
specify, such ability; or 
‘‘(ii) demonstrate to the Secretary that it made 
a good faith attempt to obtain such a letter of intent 
or such other evidence. 
‘‘(D) USE
OF
UNLISTED
TYPES
IN
CALCULATION
OF 
PERCENTAGE.—With respect to bids to furnish diabetic 
testing strip products on or after January 1, 2019, in deter-
mining under subparagraph (A) whether a bid submitted 
by an entity under such subparagraph covers 50 percent 
(or such higher percentage as the Secretary may specify) 
of all types of diabetic testing strip products, the Secretary 
may not attribute a percentage to types of diabetic testing 
strip products that the Secretary does not identify by brand, 
model, and market share volume. 
‘‘(E) ADHERENCE TO DEMONSTRATION.— 
‘‘(i) IN GENERAL.—In the case of an entity that 
is furnishing diabetic testing strip products on or after 
January 1, 2019, under a contract entered into under 
the competition conducted pursuant to paragraph (1), 
the Secretary shall establish a process to monitor, on 
an ongoing basis, the extent to which such entity con-
tinues to cover the product types included in the 
entity’s bid. 
‘‘(ii) TERMINATION.—If the Secretary determines 
that an entity described in clause (i) fails to maintain 
in inventory, or otherwise maintain ready access to 
(through requirements, contracts, or otherwise) a type 
of product included in the entity’s bid, the Secretary 
may terminate such contract unless the Secretary finds 
that the failure of the entity to maintain inventory 
of, or ready access to, the product is the result of 
the discontinuation of the product by the product 
manufacturer, a market-wide shortage of the product, 
or the introduction of a newer model or version of 
the product in the market involved.’’. 
(b) CODIFYING AND EXPANDING ANTI-SWITCHING RULE.—Section 
1847(b) of the Social Security Act (42 U.S.C. 1395w–3(b)), as 
amended by subsection (a)(1), is further amended— 
(1) by redesignating paragraph (11) as paragraph (12); 
and 
(2) by inserting after paragraph (10) the following new 
paragraph: 
‘‘(11) ADDITIONAL SPECIAL RULES IN CASE OF COMPETITION 
FOR DIABETIC TESTING STRIPS.— 
‘‘(A) IN GENERAL.—With respect to an entity that is 
furnishing diabetic testing strip products to individuals 
under a contract entered into under the competitive acquisi-
tion program established under this section, the entity 
shall furnish to each individual a brand of such products 
that is compatible with the home blood glucose monitor 
selected by the individual. 
Determination. 
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132 STAT. 223 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(B) 
PROHIBITION
ON
INFLUENCING
AND 
INCENTIVIZING.—An entity described in subparagraph (A) 
may not attempt to influence or incentivize an individual 
to switch the brand of glucose monitor or diabetic testing 
strip product selected by the individual, including by— 
‘‘(i) persuading, pressuring, or advising the indi-
vidual to switch; or 
‘‘(ii) furnishing information about alternative 
brands to the individual where the individual has not 
requested such information. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) STANDARDIZED INFORMATION.—Not later than 
January 1, 2019, the Secretary shall develop and make 
available to entities described in subparagraph (A) 
standardized information that describes the rights of 
an individual with respect to such an entity. The 
information described in the preceding sentence shall 
include information regarding— 
‘‘(I) the requirements established under sub-
paragraphs (A) and (B); 
‘‘(II) the right of the individual to purchase 
diabetic testing strip products from another mail 
order supplier of such products or a retail phar-
macy if the entity is not able to furnish the brand 
of such product that is compatible with the home 
blood glucose monitor selected by the individual; 
and 
‘‘(III) the right of the individual to return 
diabetic testing strip products furnished to the 
individual by the entity. 
‘‘(ii) REQUIREMENT.—With respect to diabetic 
testing strip products furnished on or after the date 
on which the Secretary develops the standardized 
information under clause (i), an entity described in 
subparagraph (A) may not communicate directly to 
an individual until the entity has verbally provided 
the individual with such standardized information. 
‘‘(D) ORDER REFILLS.—With respect to diabetic testing 
strip products furnished on or after January 1, 2019, the 
Secretary shall require an entity furnishing diabetic testing 
strip products to an individual to contact and receive a 
request from the individual for such products not more 
than 14 days prior to dispensing a refill of such products 
to the individual.’’. 
(c) IMPLEMENTATION; NON-APPLICATION
OF
THE PAPERWORK 
REDUCTION ACT.— 
(1) IMPLEMENTATION.—Notwithstanding any other provi-
sion of law, the Secretary of Health and Human Services may 
implement the provisions of, and amendments made by, this 
section by program instruction or otherwise. 
(2) NON-APPLICATION OF THE PAPERWORK REDUCTION ACT.— 
Chapter 35 of title 44, United States Code (commonly referred 
to as the ‘‘Paperwork Reduction Act of 1995’’), shall not apply 
to this section or the amendments made by this section. 
42 USC 1395w–3 
note. 
Requirement. 
Time period. 
Deadline. 
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132 STAT. 224 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE V—OTHER HEALTH EXTENDERS 
SEC. 50501. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMA-
TION 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, Amer-
ican Samoa, the Virgin Islands, and the Northern Mariana 
Islands.’’. 
SEC. 50502. EXTENSION FOR SEXUAL RISK AVOIDANCE EDUCATION. 
(a) IN GENERAL.—Section 510 of the Social Security Act (42 
U.S.C. 710) is amended to read as follows: 
‘‘SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION. 
‘‘(a) IN GENERAL.— 
‘‘(1) ALLOTMENTS TO STATES.—For the purpose described 
in subsection (b), the Secretary shall, for each of fiscal years 
2018 and 2019, allot to each State which has transmitted 
an application for the fiscal year under section 505(a) an 
amount equal to the product of— 
‘‘(A) the amount appropriated pursuant to subsection 
(e)(1) for the fiscal year, minus the amount reserved under 
subsection (e)(2) for the fiscal year; and 
‘‘(B) the proportion that the number of low-income 
children in the State bears to the total of such numbers 
of children for all the States. 
‘‘(2) OTHER ALLOTMENTS.— 
‘‘(A) OTHER ENTITIES.—For the purpose described in 
subsection (b), the Secretary shall, for each of fiscal years 
2018 and 2019, for any State which has not transmitted 
an application for the fiscal year under section 505(a), 
allot to one or more entities in the State the amount 
that would have been allotted to the State under paragraph 
(1) if the State had submitted such an application. 
‘‘(B) PROCESS.—The Secretary shall select the recipi-
ents of allotments under subparagraph (A) by means of 
a competitive grant process under which— 
Deadlines. 
Definitions. 
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132 STAT. 225 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(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 pub-
lishes 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 volun-
tarily 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; 
‘‘(D) be based on adolescent learning and develop-
mental theories for the age group receiving the education; 
and 
‘‘(E) be culturally appropriate, recognizing the experi-
ences of youth from diverse communities, backgrounds, 
and experiences. 
‘‘(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 associ-
ated with personal responsibility, self-regulation, goal set-
ting, 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 relation-
ships and their impact on the formation of healthy mar-
riages 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 medi-
cally accurate and complete and ensures that students 
understand that contraception offers physical risk reduc-
tion, but not risk elimination; and 
‘‘(B) the education does not include demonstrations, 
simulations, or distribution of contraceptive devices. 
Notice. 
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132 STAT. 226 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(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 sup-
porting research. 
‘‘(B) REQUIREMENTS.—Any research conducted or sup-
ported 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 rig-
orous evaluation methodologies, the Secretary shall consult 
with relevant stakeholders and evaluation experts. 
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.— 
‘‘(1) Sections 503, 507, and 508 apply to 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 sub-
section (a) to the extent determined by the Secretary to be 
appropriate. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) The term ‘age-appropriate’ means suitable (in terms 
of topics, messages, and teaching methods) to the developmental 
and social maturity of the particular age or age group of chil-
dren or adolescents, based on developing cognitive, emotional, 
and behavioral capacity typical for the age or age group. 
‘‘(2) The term ‘medically accurate and complete’ means 
verified or supported by the weight of research conducted in 
compliance with accepted scientific methods and— 
‘‘(A) published in peer-reviewed journals, where 
applicable; or 
‘‘(B) comprising information that leading professional 
organizations and agencies with relevant expertise in the 
field recognize as accurate, objective, and complete. 
‘‘(3) The term ‘rigorous’, with respect to research or evalua-
tion, means using— 
Reports. 
Consultation. 
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132 STAT. 227 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) established scientific methods for measuring the 
impact of an intervention or program model in changing 
behavior (specifically sexual activity or other sexual risk 
behaviors), or reducing pregnancy, among youth; or 
‘‘(B) other evidence-based methodologies established by 
the Secretary for purposes of this section. 
‘‘(4) The term ‘youth’ refers to one or more individuals 
who have attained age 10 but not age 20. 
‘‘(f) FUNDING.— 
‘‘(1) IN GENERAL.—To carry out this section, there is appro-
priated, out of any money in the Treasury not otherwise appro-
priated, $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 admin-
istering the program under this section, including the con-
ducting of national evaluations and the provision of technical 
assistance to the recipients of allotments.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect as if enacted on October 1, 2017. 
SEC. 50503. EXTENSION FOR PERSONAL RESPONSIBILITY EDUCATION. 
(a) IN GENERAL.—Section 513 of the Social Security Act (42 
U.S.C. 713) is amended— 
(1) in subsection (a)(1)(A), by striking ‘‘2017’’ and inserting 
‘‘2019’’; and 
(2) in subsection (a)(4)— 
(A) in subparagraph (A), by striking ‘‘2017’’ each place 
it appears and inserting ‘‘2019’’; and 
(B) in subparagraph (B)— 
(i) in the subparagraph heading, by striking ‘‘3- 
YEAR
GRANTS’’ and inserting ‘‘COMPETITIVE
PREP 
GRANTS’’; and 
(ii) in clause (i), by striking ‘‘solicit applications 
to award 3-year grants in each of fiscal years 2012 
through 2017’’ and inserting ‘‘continue through fiscal 
year 2019 grants awarded for any of fiscal years 2015 
through 2017’’; 
(3) in subsection (c)(1), by inserting after ‘‘youth with HIV/ 
AIDS,’’ the following: ‘‘victims of human trafficking,’’; and 
(4) in subsection (f), by striking ‘‘2017’’ and inserting ‘‘2019’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall take effect as if enacted on October 1, 2017. 
42 USC 713 note. 
42 USC 710 note. 
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132 STAT. 228 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE VI—CHILD AND FAMILY 
SERVICES AND SUPPORTS EXTENDERS 
Subtitle A—Continuing the Maternal, In-
fant, and Early Childhood Home Visiting 
Program 
SEC. 50601. CONTINUING EVIDENCE-BASED HOME VISITING PROGRAM. 
Section 511(j)(1)(H) of the Social Security Act (42 U.S.C. 
711(j)(1)(H)) is amended by striking ‘‘fiscal year 2017’’ and inserting 
‘‘each of fiscal years 2017 through 2022’’. 
SEC. 50602. CONTINUING TO DEMONSTRATE RESULTS TO HELP FAMI-
LIES. 
(a) REQUIRE SERVICE DELIVERY MODELS TO DEMONSTRATE 
IMPROVEMENT IN APPLICABLE BENCHMARK AREAS.—Section 511 of 
the Social Security Act (42 U.S.C. 711) is amended in each of 
subsections (d)(1)(A) and (h)(4)(A) by striking ‘‘each of’’. 
(b) 
DEMONSTRATION
OF
IMPROVEMENTS
IN
SUBSEQUENT 
YEARS.—Section 511(d)(1) of such Act (42 U.S.C. 711(d)(1)) is 
amended by adding at the end the following: 
‘‘(D) DEMONSTRATION
OF
IMPROVEMENTS
IN
SUBSE-
QUENT YEARS.— 
‘‘(i) CONTINUED MEASUREMENT OF IMPROVEMENT IN 
APPLICABLE
BENCHMARK
AREAS.—The eligible entity, 
after demonstrating improvements for eligible families 
as specified in subparagraphs (A) and (B), shall con-
tinue to track and report, not later than 30 days after 
the end of fiscal year 2020 and every 3 years thereafter, 
information demonstrating that the program results 
in improvements for the eligible families participating 
in the program in at least 4 of the areas specified 
in subparagraph (A) that the service delivery model 
or models selected by the entity are intended to 
improve. 
‘‘(ii) CORRECTIVE
ACTION
PLAN.—If the eligible 
entity fails to demonstrate improvement in at least 
4 of the areas specified in subparagraph (A), as com-
pared to eligible families who do not receive services 
under an early childhood home visitation program, the 
entity shall develop and implement a plan to improve 
outcomes in each of the areas specified in subparagraph 
(A) that the service delivery model or models selected 
by the entity are intended to improve, subject to 
approval by the Secretary. The plan shall include provi-
sions for the Secretary to monitor implementation of 
the plan and conduct continued oversight of the pro-
gram, including through submission by the entity of 
regular reports to the Secretary. 
‘‘(iii) TECHNICAL ASSISTANCE.—The Secretary shall 
provide an eligible entity required to develop and 
implement an improvement plan under clause (ii) with 
technical assistance to develop and implement the 
Time period. 
Reports. 
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132 STAT. 229 
PUBLIC LAW 115–123—FEB. 9, 2018 
plan. The Secretary may provide the technical assist-
ance directly or through grants, contracts, or coopera-
tive agreements. 
‘‘(iv) NO
IMPROVEMENT
OR
FAILURE
TO
SUBMIT 
REPORT.—If the Secretary determines after a period 
of time specified by the Secretary that an eligible entity 
implementing an improvement plan under clause (ii) 
has failed to demonstrate any improvement in at least 
4 of the areas specified in subparagraph (A), or if 
the Secretary determines that an eligible entity has 
failed to submit the report required by clause (i), the 
Secretary shall terminate the grant made to the entity 
under this section and may include any unexpended 
grant funds in grants made to nonprofit organizations 
under subsection (h)(2)(B).’’. 
(c) INCLUDING INFORMATION ON APPLICABLE BENCHMARKS IN 
APPLICATION.—Section 511(e)(5) of such Act (42 U.S.C. 711(e)(5)) 
is amended by inserting ‘‘that the service delivery model or models 
selected by the entity are intended to improve’’ before the period 
at the end. 
SEC. 50603. REVIEWING STATEWIDE NEEDS TO TARGET RESOURCES. 
Section 511(b)(1) of the Social Security Act (42 U.S.C. 711(b)(1)) 
is amended by striking ‘‘Not later than’’ and all that follows through 
‘‘section 505(a))’’ and inserting ‘‘Each State shall, as a condition 
of receiving payments from an allotment for the State under section 
502, conduct a statewide needs assessment (which may be separate 
from but in coordination with the statewide needs assessment 
required under section 505(a) and which shall be reviewed and 
updated by the State not later than October 1, 2020)’’. 
SEC. 50604. IMPROVING THE LIKELIHOOD OF SUCCESS IN HIGH-RISK 
COMMUNITIES. 
Section 511(d)(4)(A) of the Social Security Act (42 U.S.C. 
711(d)(4)(A)) is amended by inserting ‘‘, taking into account the 
staffing, community resource, and other requirements to operate 
at least one approved model of home visiting and demonstrate 
improvements for eligible families’’ before the period. 
SEC. 50605. OPTION TO FUND EVIDENCE-BASED HOME VISITING ON 
A PAY FOR OUTCOME BASIS. 
(a) IN GENERAL.—Section 511(c) of the Social Security Act (42 
U.S.C. 711(c)) is amended by redesignating paragraphs (3) and 
(4) as paragraphs (4) and (5), respectively, and by inserting after 
paragraph (2) the following: 
‘‘(3) AUTHORITY TO USE GRANT FOR A PAY FOR OUTCOMES 
INITIATIVE.—An eligible entity to which a grant is made under 
paragraph (1) may use up to 25 percent of the grant for out-
comes or success payments related to a pay for outcomes initia-
tive that will not result in a reduction of funding for services 
delivered by the entity under a childhood home visitation pro-
gram under this section while the eligible entity develops or 
operates such an initiative.’’. 
(b) DEFINITION
OF PAY
FOR OUTCOMES INITIATIVE.—Section 
511(k) of such Act (42 U.S.C. 711(k)) is amended by adding at 
the end the following: 
‘‘(4) PAY
FOR
OUTCOMES
INITIATIVE.—The term ‘pay for 
outcomes initiative’ means a performance-based grant, contract, 
Updates. 
Deadline. 
Determinations. 
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132 STAT. 230 
PUBLIC LAW 115–123—FEB. 9, 2018 
cooperative agreement, or other agreement awarded by a public 
entity in which a commitment is made to pay for improved 
outcomes achieved as a result of the intervention that result 
in social benefit and direct cost savings or cost avoidance to 
the public sector. Such an initiative shall include— 
‘‘(A) a feasibility study that describes how the proposed 
intervention is based on evidence of effectiveness; 
‘‘(B) a rigorous, third-party evaluation that uses experi-
mental or quasi-experimental design or other research 
methodologies that allow for the strongest possible causal 
inferences to determine whether the initiative has met 
its proposed outcomes as a result of the intervention; 
‘‘(C) an annual, publicly available report on the 
progress of the initiative; and 
‘‘(D) a requirement that payments are made to the 
recipient of a grant, contract, or cooperative agreement 
only when agreed upon outcomes are achieved, except that 
this requirement shall not apply with respect to payments 
to a third party conducting the evaluation described in 
subparagraph (B).’’. 
(c) EXTENDED AVAILABILITY
OF FUNDS.—Section 511(j)(3) of 
such Act (42 U.S.C. 711(j)(3)) is amended— 
(1) by striking ‘‘(3) AVAILABILITY.—Funds’’ and inserting 
the following: 
‘‘(3) AVAILABILITY.— 
‘‘(A) IN GENERAL.—Except as provided in subparagraph 
(B), funds’’; and 
(2) by adding at the end the following: 
‘‘(B) FUNDS
FOR
PAY
FOR
OUTCOMES
INITIATIVES.— 
Funds made available to an eligible entity under this sec-
tion for a fiscal year (or portion of a fiscal year) for a 
pay for outcomes initiative shall remain available for 
expenditure by the eligible entity for not more than 10 
years after the funds are so made available.’’. 
SEC. 50606. DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPER-
ABILITY. 
(a) IN GENERAL.—Section 511(h) of the Social Security Act 
(42 U.S.C. 711(h)) is amended by adding at the end the following: 
‘‘(5) DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPER-
ABILITY.— 
‘‘(A) DESIGNATION AND USE OF DATA EXCHANGE STAND-
ARDS.— 
‘‘(i) DESIGNATION.—The head of the department 
or agency responsible for administering a program 
funded under this section shall, in consultation with 
an interagency work group established by the Office 
of Management and Budget and considering State 
government perspectives, designate data exchange 
standards for necessary categories of information that 
a State agency operating the program is required to 
electronically exchange with another State agency 
under applicable Federal law. 
‘‘(ii) DATA
EXCHANGE
STANDARDS
MUST
BE
NON-
PROPRIETARY AND INTEROPERABLE.—The data exchange 
standards designated under clause (i) shall, to the 
Consultation. 
Time period. 
Public 
information. 
Reports. 
Requirement. 
Evaluation. 
Determination. 
Study. 
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132 STAT. 231 
PUBLIC LAW 115–123—FEB. 9, 2018 
extent practicable, be nonproprietary and interoper-
able. 
‘‘(iii) OTHER REQUIREMENTS.—In designating data 
exchange standards under this paragraph, the Sec-
retary shall, to the extent practicable, incorporate— 
‘‘(I) interoperable standards developed and 
maintained by an international voluntary con-
sensus standards body, as defined by the Office 
of Management and Budget; 
‘‘(II) interoperable standards developed and 
maintained by intergovernmental partnerships, 
such as the National Information Exchange Model; 
and 
‘‘(III) interoperable standards developed and 
maintained by Federal entities with authority over 
contracting and financial assistance. 
‘‘(B) 
DATA
EXCHANGE
STANDARDS
FOR
FEDERAL 
REPORTING.— 
‘‘(i) DESIGNATION.—The head of the department 
or agency responsible for administering a program 
referred to in this section shall, in consultation with 
an interagency work group established by the Office 
of Management and Budget, and considering State 
government perspectives, designate data exchange 
standards to govern Federal reporting and exchange 
requirements under applicable Federal law. 
‘‘(ii) REQUIREMENTS.—The data exchange reporting 
standards required by clause (i) shall, to the extent 
practicable— 
‘‘(I) incorporate a widely accepted, nonpropri-
etary, searchable, computer-readable format; 
‘‘(II) be consistent with and implement 
applicable accounting principles; 
‘‘(III) be implemented in a manner that is 
cost-effective and improves program efficiency and 
effectiveness; and 
‘‘(IV) be capable of being continually upgraded 
as necessary. 
‘‘(iii) INCORPORATION OF NONPROPRIETARY STAND-
ARDS.—In designating data exchange standards under 
this paragraph, the Secretary shall, to the extent prac-
ticable, incorporate existing nonproprietary standards, 
such as the eXtensible Mark up Language. 
‘‘(iv) RULE
OF
CONSTRUCTION.—Nothing in this 
paragraph shall be construed to require a change to 
existing data exchange standards for Federal reporting 
about a program referred to in this section, if the 
head of the department or agency responsible for 
administering the program finds the standards to be 
effective and efficient.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall take effect on the date that is 2 years after the date of 
enactment of this Act. 
SEC. 50607. ALLOCATION OF FUNDS. 
Section 511(j) of the Social Security Act (42 U.S.C. 711(j)) 
is amended by adding at the end the following: 
42 USC 711 note. 
Consultation. 
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132 STAT. 232 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(4) ALLOCATION OF FUNDS.—To the extent that the grant 
amount awarded under this section to an eligible entity is 
determined on the basis of relative population or poverty consid-
erations, the Secretary shall make the determination using 
the most accurate Federal data available for the eligible 
entity.’’. 
Subtitle B—Extension of Health Profes-
sions Workforce Demonstration Projects 
SEC. 50611. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION 
PROJECTS FOR LOW-INCOME INDIVIDUALS. 
Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ‘‘2017’’ and inserting ‘‘2019’’. 
TITLE VII—FAMILY FIRST PREVENTION 
SERVICES ACT 
Subtitle A—Investing in Prevention and 
Supporting Families 
SEC. 50701. SHORT TITLE. 
This subtitle may be cited as the ‘‘Bipartisan Budget Act of 
2018’’. 
SEC. 50702. PURPOSE. 
The purpose of this subtitle is to enable States to use Federal 
funds available under parts B and E of title IV of the Social 
Security Act to provide enhanced support to children and families 
and prevent foster care placements through the provision of mental 
health and substance abuse prevention and treatment services, 
in-home parent skill-based programs, and kinship navigator serv-
ices. 
PART I—PREVENTION ACTIVITIES UNDER 
TITLE IV–E 
SEC. 50711. FOSTER CARE PREVENTION SERVICES AND PROGRAMS. 
(a) STATE OPTION.—Section 471 of the Social Security Act (42 
U.S.C. 671) is amended— 
(1) in subsection (a)(1), by striking ‘‘and’’ and all that 
follows through the semicolon and inserting ‘‘, adoption assist-
ance in accordance with section 473, and, at the option of 
the State, services or programs specified in subsection (e)(1) 
of this section for children who are candidates for foster care 
or who are pregnant or parenting foster youth and the parents 
or kin caregivers of the children, in accordance with the require-
ments of that subsection;’’; and 
(2) by adding at the end the following: 
‘‘(e) PREVENTION AND FAMILY SERVICES AND PROGRAMS.— 
‘‘(1) IN GENERAL.—Subject to the succeeding provisions of 
this subsection, the Secretary may make a payment to a State 
for providing the following services or programs for a child 
Time period. 
42 USC 622 note. 
42 USC 1305 
note. 
Bipartisan 
Budget Act of 
2018. 
Determination. 
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132 STAT. 233 
PUBLIC LAW 115–123—FEB. 9, 2018 
described in paragraph (2) and the parents or kin caregivers 
of the child when the need of the child, such a parent, or 
such a caregiver for the services or programs are directly related 
to the safety, permanence, or well-being of the child or to 
preventing the child from entering foster care: 
‘‘(A) MENTAL HEALTH AND SUBSTANCE ABUSE PREVEN-
TION AND TREATMENT SERVICES.—Mental health and sub-
stance abuse prevention and treatment services provided 
by a qualified clinician for not more than a 12-month 
period that begins on any date described in paragraph 
(3) with respect to the child. 
‘‘(B) IN-HOME
PARENT
SKILL-BASED
PROGRAMS.—In- 
home parent skill-based programs for not more than a 
12-month period that begins on any date described in para-
graph (3) with respect to the child and that include par-
enting skills training, parent education, and individual and 
family counseling. 
‘‘(2) CHILD DESCRIBED.—For purposes of paragraph (1), a 
child described in this paragraph is the following: 
‘‘(A) A child who is a candidate for foster care (as 
defined in section 475(13)) but can remain safely at home 
or in a kinship placement with receipt of services or pro-
grams specified in paragraph (1). 
‘‘(B) A child in foster care who is a pregnant or par-
enting foster youth. 
‘‘(3) DATE DESCRIBED.—For purposes of paragraph (1), the 
dates described in this paragraph are the following: 
‘‘(A) The date on which a child is identified in a preven-
tion plan maintained under paragraph (4) as a child who 
is a candidate for foster care (as defined in section 475(13)). 
‘‘(B) The date on which a child is identified in a preven-
tion plan maintained under paragraph (4) as a pregnant 
or parenting foster youth in need of services or programs 
specified in paragraph (1). 
‘‘(4) REQUIREMENTS RELATED TO PROVIDING SERVICES AND 
PROGRAMS.—Services and programs specified in paragraph (1) 
may be provided under this subsection only if specified in 
advance in the child’s prevention plan described in subpara-
graph (A) and the requirements in subparagraphs (B) through 
(E) are met: 
‘‘(A) PREVENTION PLAN.—The State maintains a written 
prevention plan for the child that meets the following 
requirements (as applicable): 
‘‘(i) CANDIDATES.—In the case of a child who is 
a candidate for foster care described in paragraph 
(2)(A), the prevention plan shall— 
‘‘(I) identify the foster care prevention strategy 
for the child so that the child may remain safely 
at home, live temporarily with a kin caregiver 
until reunification can be safely achieved, or live 
permanently with a kin caregiver; 
‘‘(II) list the services or programs to be pro-
vided to or on behalf of the child to ensure the 
success of that prevention strategy; and 
‘‘(III) comply with such other requirements as 
the Secretary shall establish. 
Compliance. 
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132 STAT. 234 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) PREGNANT OR PARENTING FOSTER YOUTH.—In 
the case of a child who is a pregnant or parenting 
foster youth described in paragraph (2)(B), the preven-
tion plan shall— 
‘‘(I) be included in the child’s case plan 
required under section 475(1); 
‘‘(II) list the services or programs to be pro-
vided to or on behalf of the youth to ensure that 
the youth is prepared (in the case of a pregnant 
foster youth) or able (in the case of a parenting 
foster youth) to be a parent; 
‘‘(III) describe the foster care prevention 
strategy for any child born to the youth; and 
‘‘(IV) comply with such other requirements as 
the Secretary shall establish. 
‘‘(B) TRAUMA-INFORMED.—The services or programs to 
be provided to or on behalf of a child are provided under 
an organizational structure and treatment framework that 
involves understanding, recognizing, and responding to the 
effects of all types of trauma and in accordance with recog-
nized principles of a trauma-informed approach and 
trauma-specific interventions to address trauma’s con-
sequences and facilitate healing. 
‘‘(C) ONLY
SERVICES
AND
PROGRAMS
PROVIDED
IN 
ACCORDANCE WITH PROMISING, SUPPORTED, OR WELL-SUP-
PORTED PRACTICES PERMITTED.— 
‘‘(i) IN GENERAL.—Only State expenditures for serv-
ices or programs specified in subparagraph (A) or (B) 
of paragraph (1) that are provided in accordance with 
practices that meet the requirements specified in 
clause (ii) of this subparagraph and that meet the 
requirements specified in clause (iii), (iv), or (v), respec-
tively, for being a promising, supported, or well-sup-
ported practice, shall be eligible for a Federal matching 
payment under section 474(a)(6)(A). 
‘‘(ii) GENERAL PRACTICE REQUIREMENTS.—The gen-
eral practice requirements specified in this clause are 
the following: 
‘‘(I) The practice has a book, manual, or other 
available writings that specify the components of 
the practice protocol and describe how to admin-
ister the practice. 
‘‘(II) There is no empirical basis suggesting 
that, compared to its likely benefits, the practice 
constitutes a risk of harm to those receiving it. 
‘‘(III) If multiple outcome studies have been 
conducted, the overall weight of evidence supports 
the benefits of the practice. 
‘‘(IV) Outcome measures are reliable and valid, 
and are administrated consistently and accurately 
across all those receiving the practice. 
‘‘(V) There is no case data suggesting a risk 
of harm that was probably caused by the treatment 
and that was severe or frequent. 
‘‘(iii) PROMISING
PRACTICE.—A practice shall be 
considered to be a ‘promising practice’ if the practice 
is superior to an appropriate comparison practice using 
Study. 
Compliance. 
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132 STAT. 235 
PUBLIC LAW 115–123—FEB. 9, 2018 
conventional standards of statistical significance (in 
terms of demonstrated meaningful improvements in 
validated measures of important child and parent out-
comes, such as mental health, substance abuse, and 
child safety and well-being), as established by the 
results or outcomes of at least one study that— 
‘‘(I) was rated by an independent systematic 
review for the quality of the study design and 
execution and determined to be well-designed and 
well-executed; and 
‘‘(II) utilized some form of control (such as 
an untreated group, a placebo group, or a wait 
list study). 
‘‘(iv) SUPPORTED
PRACTICE.—A practice shall be 
considered to be a ‘supported practice’ if— 
‘‘(I) the practice is superior to an appropriate 
comparison practice using conventional standards 
of statistical significance (in terms of demonstrated 
meaningful improvements in validated measures 
of important child and parent outcomes, such as 
mental health, substance abuse, and child safety 
and well-being), as established by the results or 
outcomes of at least one study that— 
‘‘(aa) was rated by an independent system-
atic review for the quality of the study design 
and execution and determined to be well- 
designed and well-executed; 
‘‘(bb) was a rigorous random-controlled 
trial (or, if not available, a study using a rig-
orous quasi-experimental research design); 
and 
‘‘(cc) was carried out in a usual care or 
practice setting; and 
‘‘(II) the study described in subclause (I) estab-
lished that the practice has a sustained effect 
(when compared to a control group) for at least 
6 months beyond the end of the treatment. 
‘‘(v) WELL-SUPPORTED PRACTICE.—A practice shall 
be considered to be a ‘well-supported practice’ if— 
‘‘(I) the practice is superior to an appropriate 
comparison practice using conventional standards 
of statistical significance (in terms of demonstrated 
meaningful improvements in validated measures 
of important child and parent outcomes, such as 
mental health, substance abuse, and child safety 
and well-being), as established by the results or 
outcomes of at least two studies that— 
‘‘(aa) were rated by an independent 
systematic review for the quality of the study 
design and execution and determined to be 
well-designed and well-executed; 
‘‘(bb) were rigorous random-controlled 
trials (or, if not available, studies using a rig-
orous quasi-experimental research design); 
and 
‘‘(cc) were carried out in a usual care or 
practice setting; and 
Studies. 
Time period. 
Study. 
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132 STAT. 236 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(II) at least one of the studies described in 
subclause (I) established that the practice has a 
sustained effect (when compared to a control 
group) for at least 1 year beyond the end of treat-
ment. 
‘‘(D) GUIDANCE
ON
PRACTICES
CRITERIA
AND
PRE- 
APPROVED SERVICES AND PROGRAMS.— 
‘‘(i) IN GENERAL.—Not later than October 1, 2018, 
the Secretary shall issue guidance to States regarding 
the practices criteria required for services or programs 
to satisfy the requirements of subparagraph (C). The 
guidance shall include a pre-approved list of services 
and programs that satisfy the requirements. 
‘‘(ii) UPDATES.—The Secretary shall issue updates 
to the guidance required by clause (i) as often as the 
Secretary determines necessary. 
‘‘(E) OUTCOME ASSESSMENT AND REPORTING.—The State 
shall collect and report to the Secretary the following 
information with respect to each child for whom, or on 
whose behalf mental health and substance abuse preven-
tion and treatment services or in-home parent skill-based 
programs are provided during a 12-month period beginning 
on the date the child is determined by the State to be 
a child described in paragraph (2): 
‘‘(i) The specific services or programs provided and 
the total expenditures for each of the services or pro-
grams. 
‘‘(ii) The duration of the services or programs pro-
vided. 
‘‘(iii) In the case of a child described in paragraph 
(2)(A), the child’s placement status at the beginning, 
and at the end, of the 1-year period, respectively, and 
whether the child entered foster care within 2 years 
after being determined a candidate for foster care. 
‘‘(5) STATE PLAN COMPONENT.— 
‘‘(A) IN GENERAL.—A State electing to provide services 
or programs specified in paragraph (1) shall submit as 
part of the State plan required by subsection (a) a preven-
tion services and programs plan component that meets 
the requirements of subparagraph (B). 
‘‘(B) PREVENTION SERVICES AND PROGRAMS PLAN COMPO-
NENT.—In order to meet the requirements of this subpara-
graph, a prevention services and programs plan component, 
with respect to each 5-year period for which the plan 
component is in operation in the State, shall include the 
following: 
‘‘(i) How providing services and programs specified 
in paragraph (1) is expected to improve specific out-
comes for children and families. 
‘‘(ii) How the State will monitor and oversee the 
safety of children who receive services and programs 
specified in paragraph (1), including through periodic 
risk assessments throughout the period in which the 
services and programs are provided on behalf of a 
child and reexamination of the prevention plan main-
tained for the child under paragraph (4) for the provi-
sion of the services or programs if the State determines 
Assessments. 
Determination. 
Time period. 
Plan. 
Deadline. 
Time periods. 
Determination. 
Deadlines. 
Time period. 
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132 STAT. 237 
PUBLIC LAW 115–123—FEB. 9, 2018 
the risk of the child entering foster care remains high 
despite the provision of the services or programs. 
‘‘(iii) With respect to the services and programs 
specified in subparagraphs (A) and (B) of paragraph 
(1), information on the specific promising, supported, 
or well-supported practices the State plans to use to 
provide the services or programs, including a descrip-
tion of— 
‘‘(I) the services or programs and whether the 
practices used are promising, supported, or well- 
supported; 
‘‘(II) how the State plans to implement the 
services or programs, including how implementa-
tion of the services or programs will be continu-
ously monitored to ensure fidelity to the practice 
model and to determine outcomes achieved and 
how information learned from the monitoring will 
be used to refine and improve practices; 
‘‘(III) how the State selected the services or 
programs; 
‘‘(IV) the target population for the services 
or programs; and 
‘‘(V) how each service or program provided 
will be evaluated through a well-designed and rig-
orous process, which may consist of an ongoing, 
cross-site evaluation approved by the Secretary. 
‘‘(iv) A description of the consultation that the 
State agencies responsible for administering the State 
plans under this part and part B engage in with other 
State agencies responsible for administering health 
programs, including mental health and substance 
abuse prevention and treatment services, and with 
other public and private agencies with experience in 
administering child and family services, including 
community-based organizations, in order to foster a 
continuum of care for children described in paragraph 
(2) and their parents or kin caregivers. 
‘‘(v) A description of how the State shall assess 
children and their parents or kin caregivers to deter-
mine eligibility for services or programs specified in 
paragraph (1). 
‘‘(vi) A description of how the services or programs 
specified in paragraph (1) that are provided for or 
on behalf of a child and the parents or kin caregivers 
of the child will be coordinated with other child and 
family services provided to the child and the parents 
or kin caregivers of the child under the State plans 
in effect under subparts 1 and 2 of part B. 
‘‘(vii) Descriptions of steps the State is taking to 
support and enhance a competent, skilled, and profes-
sional child welfare workforce to deliver trauma- 
informed and evidence-based services, including— 
‘‘(I) ensuring that staff is qualified to provide 
services or programs that are consistent with the 
promising, supported, or well-supported practice 
models selected; and 
Assessment. 
Consultation. 
Evaluation. 
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132 STAT. 238 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(II) developing appropriate prevention plans, 
and conducting the risk assessments required 
under clause (iii). 
‘‘(viii) A description of how the State will provide 
training and support for caseworkers in assessing what 
children and their families need, connecting to the 
families served, knowing how to access and deliver 
the needed trauma-informed and evidence-based serv-
ices, and overseeing and evaluating the continuing 
appropriateness of the services. 
‘‘(ix) A description of how caseload size and type 
for prevention caseworkers will be determined, man-
aged, and overseen. 
‘‘(x) An assurance that the State will report to 
the Secretary such information and data as the Sec-
retary may require with respect to the provision of 
services and programs specified in paragraph (1), 
including information and data necessary to determine 
the performance measures for the State under para-
graph (6) and compliance with paragraph (7). 
‘‘(C) 
REIMBURSEMENT
FOR
SERVICES
UNDER
THE 
PREVENTION PLAN COMPONENT.— 
‘‘(i) LIMITATION.—Except as provided in subclause 
(ii), a State may not receive a Federal payment under 
this part for a given promising, supported, or well- 
supported practice unless (in accordance with subpara-
graph (B)(iii)(V)) the plan includes a well-designed and 
rigorous evaluation strategy for that practice. 
‘‘(ii) WAIVER OF LIMITATION.—The Secretary may 
waive the requirement for a well-designed and rigorous 
evaluation of any well-supported practice if the Sec-
retary deems the evidence of the effectiveness of the 
practice to be compelling and the State meets the 
continuous quality improvement requirements included 
in subparagraph (B)(iii)(II) with regard to the practice. 
‘‘(6) PREVENTION SERVICES MEASURES.— 
‘‘(A) ESTABLISHMENT; ANNUAL
UPDATES.—Beginning 
with fiscal year 2021, and annually thereafter, the Sec-
retary shall establish the following prevention services 
measures based on information and data reported by States 
that elect to provide services and programs specified in 
paragraph (1): 
‘‘(i) PERCENTAGE OF CANDIDATES FOR FOSTER CARE 
WHO DO NOT ENTER FOSTER CARE.—The percentage of 
candidates for foster care for whom, or on whose behalf, 
the services or programs are provided who do not enter 
foster care, including those placed with a kin caregiver 
outside of foster care, during the 12-month period in 
which the services or programs are provided and 
through the end of the succeeding 12-month period. 
‘‘(ii) PER-CHILD
SPENDING.—The total amount of 
expenditures made for mental health and substance 
abuse prevention and treatment services or in-home 
parent skill-based programs, respectively, for, or on 
behalf of, each child described in paragraph (2). 
‘‘(B) DATA.—The Secretary shall establish and annually 
update the prevention services measures— 
Deadline. 
Updates. 
Time period. 
Time period. 
Evaluation. 
Assessment. 
Evaluation. 
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132 STAT. 239 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(i) based on the median State values of the 
information reported under each clause of subpara-
graph (A) for the 3 then most recent years; and 
‘‘(ii) taking into account State differences in the 
price levels of consumption goods and services using 
the most recent regional price parities published by 
the Bureau of Economic Analysis of the Department 
of Commerce or such other data as the Secretary deter-
mines appropriate. 
‘‘(C) PUBLICATION
OF
STATE
PREVENTION
SERVICES 
MEASURES.—The Secretary shall annually make available 
to the public the prevention services measures of each 
State. 
‘‘(7) MAINTENANCE
OF
EFFORT
FOR
STATE
FOSTER
CARE 
PREVENTION EXPENDITURES.— 
‘‘(A) IN GENERAL.—If a State elects to provide services 
and programs specified in paragraph (1) for a fiscal year, 
the State foster care prevention expenditures for the fiscal 
year shall not be less than the amount of the expenditures 
for fiscal year 2014 (or, at the option of a State described 
in subparagraph (E), fiscal year 2015 or fiscal year 2016 
(whichever the State elects)). 
‘‘(B) STATE FOSTER CARE PREVENTION EXPENDITURES.— 
The term ‘State foster care prevention expenditures’ means 
the following: 
‘‘(i) TANF; IV–B; SSBG.—State expenditures for 
foster care prevention services and activities under 
the State program funded under part A (including 
from amounts made available by the Federal Govern-
ment), under the State plan developed under part B 
(including any such amounts), or under the Social Serv-
ices Block Grant Programs under subtitle A of title 
XX (including any such amounts). 
‘‘(ii) OTHER STATE PROGRAMS.—State expenditures 
for foster care prevention services and activities under 
any State program that is not described in clause (i) 
(other than any State expenditures for foster care 
prevention services and activities under the State pro-
gram under this part (including under a waiver of 
the program)). 
‘‘(C) STATE EXPENDITURES.—The term ‘State expendi-
tures’ means all State or local funds that are expended 
by the State or a local agency including State or local 
funds that are matched or reimbursed by the Federal 
Government and State or local funds that are not matched 
or reimbursed by the Federal Government. 
‘‘(D) DETERMINATION
OF
PREVENTION
SERVICES
AND 
ACTIVITIES.—The Secretary shall require each State that 
elects to provide services and programs specified in para-
graph (1) to report the expenditures specified in subpara-
graph (B) for fiscal year 2014 and for such fiscal years 
thereafter as are necessary to determine whether the State 
is complying with the maintenance of effort requirement 
in subparagraph (A). The Secretary shall specify the spe-
cific services and activities under each program referred 
to in subparagraph (B) that are ‘prevention services and 
activities’ for purposes of the reports. 
Requirement. 
Reports. 
Definition. 
Definition. 
Deadline. 
Public 
information. 
Determination. 
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132 STAT. 240 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(E) STATE DESCRIBED.—For purposes of subparagraph 
(A), a State is described in this subparagraph if the popu-
lation of children in the State in 2014 was less than 200,000 
(as determined by the United States Census Bureau). 
‘‘(8) PROHIBITION
AGAINST
USE
OF
STATE
FOSTER
CARE 
PREVENTION
EXPENDITURES
AND
FEDERAL
IV–E
PREVENTION 
FUNDS FOR MATCHING OR EXPENDITURE REQUIREMENT.—A State 
that elects to provide services and programs specified in para-
graph (1) shall not use any State foster care prevention expendi-
tures for a fiscal year for the State share of expenditures 
under section 474(a)(6) for a fiscal year. 
‘‘(9) ADMINISTRATIVE
COSTS.—Expenditures described in 
section 474(a)(6)(B)— 
‘‘(A) shall not be eligible for payment under subpara-
graph (A), (B), or (E) of section 474(a)(3); and 
‘‘(B) shall be eligible for payment under section 
474(a)(6)(B) without regard to whether the expenditures 
are incurred on behalf of a child who is, or is potentially, 
eligible for foster care maintenance payments under this 
part. 
‘‘(10) APPLICATION.— 
‘‘(A) IN GENERAL.—The provision of services or pro-
grams under this subsection to or on behalf of a child 
described in paragraph (2) shall not be considered to be 
receipt of aid or assistance under the State plan under 
this part for purposes of eligibility for any other program 
established under this Act. 
‘‘(B) CANDIDATES IN KINSHIP CARE.—A child described 
in paragraph (2) for whom such services or programs under 
this subsection are provided for more than 6 months while 
in the home of a kin caregiver, and who would satisfy 
the 
AFDC 
eligibility 
requirement 
of 
section 
472(a)(3)(A)(ii)(II) but for residing in the home of the care-
giver for more than 6 months, is deemed to satisfy that 
requirement for purposes of determining whether the child 
is eligible for foster care maintenance payments under 
section 472.’’. 
(b) DEFINITION.—Section 475 of such Act (42 U.S.C. 675) is 
amended by adding at the end the following: 
‘‘(13) The term ‘child who is a candidate for foster care’ 
means, a child who is identified in a prevention plan under 
section 471(e)(4)(A) as being at imminent risk of entering foster 
care (without regard to whether the child would be eligible 
for foster care maintenance payments under section 472 or 
is or would be eligible for adoption assistance or kinship 
guardianship assistance payments under section 473) but who 
can remain safely in the child’s home or in a kinship placement 
as long as services or programs specified in section 471(e)(1) 
that are necessary to prevent the entry of the child into foster 
care are provided. The term includes a child whose adoption 
or guardianship arrangement is at risk of a disruption or dis-
solution that would result in a foster care placement.’’. 
(c) PAYMENTS UNDER TITLE IV–E.—Section 474(a) of such Act 
(42 U.S.C. 674(a)) is amended— 
(1) in paragraph (5), by striking the period at the end 
and inserting ‘‘; plus’’; and 
(2) by adding at the end the following: 
Time period. 
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132 STAT. 241 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(6) subject to section 471(e)— 
‘‘(A) for each quarter— 
‘‘(i) subject to clause (ii)— 
‘‘(I) beginning after September 30, 2019, and 
before October 1, 2026, an amount equal to 50 
percent of the total amount expended during the 
quarter for the provision of services or programs 
specified in subparagraph (A) or (B) of section 
471(e)(1) that are provided in accordance with 
promising, supported, or well-supported practices 
that meet the applicable criteria specified for the 
practices in section 471(e)(4)(C); and 
‘‘(II) beginning after September 30, 2026, an 
amount equal to the Federal medical assistance 
percentage (which shall be as defined in section 
1905(b), in the case of a State other than the 
District of Columbia, or 70 percent, in the case 
of the District of Columbia) of the total amount 
expended during the quarter for the provision of 
services or programs specified in subparagraph (A) 
or (B) of section 471(e)(1) that are provided in 
accordance with promising, supported, or well-sup-
ported practices that meet the applicable criteria 
specified for the practices in section 471(e)(4)(C) 
(or, with respect to the payments made during 
the quarter under a cooperative agreement or con-
tract entered into by the State and an Indian 
tribe, tribal organization, or tribal consortium for 
the administration or payment of funds under this 
part, an amount equal to the Federal medical 
assistance percentage that would apply under sec-
tion 479B(d) (in this paragraph referred to as the 
‘tribal FMAP’) if the Indian tribe, tribal organiza-
tion, or tribal consortium made the payments 
under a program operated under that section, 
unless the tribal FMAP is less than the Federal 
medical assistance percentage that applies to the 
State); except that 
‘‘(ii) not less than 50 percent of the total amount 
expended by a State under clause (i) for a fiscal year 
shall be for the provision of services or programs speci-
fied in subparagraph (A) or (B) of section 471(e)(1) 
that are provided in accordance with well-supported 
practices; plus 
‘‘(B) for each quarter specified in subparagraph (A), 
an amount equal to the sum of the following proportions 
of the total amount expended during the quarter— 
‘‘(i) 50 percent of so much of the expenditures 
as are found necessary by the Secretary for the proper 
and efficient administration of the State plan for the 
provision of services or programs specified in section 
471(e)(1), 
including 
expenditures 
for 
activities 
approved by the Secretary that promote the develop-
ment of necessary processes and procedures to estab-
lish and implement the provision of the services and 
Time periods. 
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132 STAT. 242 
PUBLIC LAW 115–123—FEB. 9, 2018 
programs for individuals who are eligible for the serv-
ices and programs and expenditures attributable to 
data collection and reporting; and 
‘‘(ii) 50 percent of so much of the expenditures 
with respect to the provision of services and programs 
specified in section 471(e)(1) as are for training of 
personnel employed or preparing for employment by 
the State agency or by the local agency administering 
the plan in the political subdivision and of the members 
of the staff of State-licensed or State-approved child 
welfare 
agencies 
providing 
services 
to 
children 
described in section 471(e)(2) and their parents or kin 
caregivers, including on how to determine who are 
individuals eligible for the services or programs, how 
to identify and provide appropriate services and pro-
grams, and how to oversee and evaluate the ongoing 
appropriateness of the services and programs.’’. 
(d) TECHNICAL ASSISTANCE AND BEST PRACTICES, CLEARING-
HOUSE, AND DATA COLLECTION AND EVALUATIONS.—Section 476 of 
such Act (42 U.S.C. 676) is amended by adding at the end the 
following: 
‘‘(d) TECHNICAL ASSISTANCE AND BEST PRACTICES, CLEARING-
HOUSE, DATA COLLECTION, AND EVALUATIONS RELATING TO PREVEN-
TION SERVICES AND PROGRAMS.— 
‘‘(1) TECHNICAL ASSISTANCE AND BEST PRACTICES.—The Sec-
retary shall provide to States and, as applicable, to Indian 
tribes, tribal organizations, and tribal consortia, technical 
assistance regarding the provision of services and programs 
described in section 471(e)(1) and shall disseminate best prac-
tices with respect to the provision of the services and programs, 
including how to plan and implement a well-designed and rig-
orous evaluation of a promising, supported, or well-supported 
practice. 
‘‘(2) CLEARINGHOUSE OF PROMISING, SUPPORTED, AND WELL- 
SUPPORTED PRACTICES.—The Secretary shall, directly or through 
grants, contracts, or interagency agreements, evaluate research 
on the practices specified in clauses (iii), (iv), and (v), respec-
tively, of section 471(e)(4)(C), and programs that meet the 
requirements described in section 427(a)(1), including culturally 
specific, or location- or population-based adaptations of the 
practices, to identify and establish a public clearinghouse of 
the practices that satisfy each category described by such 
clauses. In addition, the clearinghouse shall include information 
on the specific outcomes associated with each practice, including 
whether the practice has been shown to prevent child abuse 
and neglect and reduce the likelihood of foster care placement 
by supporting birth families and kinship families and improving 
targeted supports for pregnant and parenting youth and their 
children. 
‘‘(3) DATA COLLECTION AND EVALUATIONS.—The Secretary, 
directly or through grants, contracts, or interagency agree-
ments, may collect data and conduct evaluations with respect 
to the provision of services and programs described in section 
471(e)(1) for purposes of assessing the extent to which the 
provision of the services and programs— 
‘‘(A) reduces the likelihood of foster care placement; 
‘‘(B) increases use of kinship care arrangements; or 
Evaluation. 
Native 
Americans. 
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132 STAT. 243 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(C) improves child well-being. 
‘‘(4) REPORTS TO CONGRESS.— 
‘‘(A) IN GENERAL.—The Secretary shall submit to the 
Committee on Finance of the Senate and the Committee 
on Ways and Means of the House of Representatives peri-
odic reports based on the provision of services and programs 
described in section 471(e)(1) and the activities carried 
out under this subsection. 
‘‘(B) PUBLIC AVAILABILITY.—The Secretary shall make 
the reports to Congress submitted under this paragraph 
publicly available. 
‘‘(5) APPROPRIATION.—Out of any money in the Treasury 
of the United States not otherwise appropriated, there are 
appropriated to the Secretary $1,000,000 for fiscal year 2018 
and each fiscal year thereafter to carry out this subsection.’’. 
(e) APPLICATION TO PROGRAMS OPERATED BY INDIAN TRIBAL 
ORGANIZATIONS.— 
(1) IN GENERAL.—Section 479B of such Act (42 U.S.C. 679c) 
is amended— 
(A) in subsection (c)(1)— 
(i) in subparagraph (C)(i)— 
(I) in subclause (II), by striking ‘‘and’’ after 
the semicolon; 
(II) in subclause (III), by striking the period 
at the end and inserting ‘‘; and’’; and 
(III) by adding at the end the following: 
‘‘(IV) at the option of the tribe, organization, 
or consortium, services and programs specified in 
section 471(e)(1) to children described in section 
471(e)(2) and their parents or kin caregivers, in 
accordance with section 471(e) and subparagraph 
(E).’’; and 
(ii) by adding at the end the following: 
‘‘(E) PREVENTION SERVICES AND PROGRAMS FOR CHIL-
DREN AND THEIR PARENTS AND KIN CAREGIVERS.— 
‘‘(i) IN GENERAL.—In the case of a tribe, organiza-
tion, or consortium that elects to provide services and 
programs specified in section 471(e)(1) to children 
described in section 471(e)(2) and their parents or kin 
caregivers under the plan, the Secretary shall specify 
the requirements applicable to the provision of the 
services and programs. The requirements shall, to the 
greatest extent practicable, be consistent with the 
requirements applicable to States under section 471(e) 
and shall permit the provision of the services and 
programs in the form of services and programs that 
are adapted to the culture and context of the tribal 
communities served. 
‘‘(ii) PERFORMANCE
MEASURES.—The Secretary 
shall establish specific performance measures for each 
tribe, organization, or consortium that elects to provide 
services and programs specified in section 471(e)(1). 
The performance measures shall, to the greatest extent 
practicable, be consistent with the prevention services 
measures required for States under section 471(e)(6) 
but shall allow for consideration of factors unique to 
Requirements. 
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132 STAT. 244 
PUBLIC LAW 115–123—FEB. 9, 2018 
the provision of the services by tribes, organizations, 
or consortia.’’; and 
(B) in subsection (d)(1), by striking ‘‘and (5)’’ and 
inserting ‘‘(5), and (6)(A)’’. 
(2) CONFORMING AMENDMENT.—The heading for subsection 
(d) of section 479B of such Act (42 U.S.C. 679c) is amended 
by striking ‘‘FOR FOSTER CARE MAINTENANCE AND ADOPTION 
ASSISTANCE PAYMENTS’’. 
(f) APPLICATION TO PROGRAMS OPERATED BY TERRITORIES.— 
Section 1108(a)(2) of the Social Security Act (42 U.S.C. 1308(a)(2)) 
is amended by striking ‘‘or 413(f)’’ and inserting ‘‘413(f), or 
474(a)(6)’’. 
SEC. 50712. FOSTER CARE MAINTENANCE PAYMENTS FOR CHILDREN 
WITH PARENTS IN A LICENSED RESIDENTIAL FAMILY- 
BASED TREATMENT FACILITY FOR SUBSTANCE ABUSE. 
(a) IN GENERAL.—Section 472 of the Social Security Act (42 
U.S.C. 672) is amended— 
(1) in subsection (a)(2)(C), by striking ‘‘or’’ and inserting 
‘‘, with a parent residing in a licensed residential family-based 
treatment facility, but only to the extent permitted under sub-
section (j), or in a’’; and 
(2) by adding at the end the following: 
‘‘(j) CHILDREN PLACED WITH A PARENT RESIDING IN A LICENSED 
RESIDENTIAL FAMILY-BASED TREATMENT FACILITY FOR SUBSTANCE 
ABUSE.— 
‘‘(1) IN
GENERAL.—Notwithstanding the preceding provi-
sions of this section, a child who is eligible for foster care 
maintenance payments under this section, or who would be 
eligible for the payments if the eligibility were determined 
without regard to paragraphs (1)(B) and (3) of subsection (a), 
shall be eligible for the payments for a period of not more 
than 12 months during which the child is placed with a parent 
who is in a licensed residential family-based treatment facility 
for substance abuse, but only if— 
‘‘(A) the recommendation for the placement is specified 
in the child’s case plan before the placement; 
‘‘(B) the treatment facility provides, as part of the 
treatment for substance abuse, parenting skills training, 
parent education, and individual and family counseling; 
and 
‘‘(C) the substance abuse treatment, parenting skills 
training, parent education, and individual and family coun-
seling is provided under an organizational structure and 
treatment framework that involves understanding, recog-
nizing, and responding to the effects of all types of trauma 
and in accordance with recognized principles of a trauma- 
informed approach and trauma-specific interventions to 
address the consequences of trauma and facilitate healing. 
‘‘(2) APPLICATION.—With respect to children for whom foster 
care maintenance payments are made under paragraph (1), 
only the children who satisfy the requirements of paragraphs 
(1)(B) and (3) of subsection (a) shall be considered to be children 
with respect to whom foster care maintenance payments are 
made under this section for purposes of subsection (h) or section 
473(b)(3)(B).’’. 
Time period. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
(b) CONFORMING AMENDMENT.—Section 474(a)(1) of such Act 
(42 U.S.C. 674(a)(1)) is amended by inserting ‘‘subject to section 
472(j),’’ before ‘‘an amount equal to the Federal’’ the first place 
it appears. 
SEC. 50713. TITLE IV–E PAYMENTS FOR EVIDENCE-BASED KINSHIP 
NAVIGATOR PROGRAMS. 
Section 474(a) of the Social Security Act (42 U.S.C. 674(a)), 
as amended by section 50711(c), is amended— 
(1) in paragraph (6), by striking the period at the end 
and inserting ‘‘; plus’’; and 
(2) by adding at the end the following: 
‘‘(7) an amount equal to 50 percent of the amounts 
expended by the State during the quarter as the Secretary 
determines are for kinship navigator programs that meet the 
requirements described in section 427(a)(1) and that the Sec-
retary determines are operated in accordance with promising, 
supported, or well-supported practices that meet the applicable 
criteria specified for the practices in section 471(e)(4)(C), with-
out regard to whether the expenditures are incurred on behalf 
of children who are, or are potentially, eligible for foster care 
maintenance payments under this part.’’. 
PART II—ENHANCED SUPPORT UNDER TITLE 
IV–B 
SEC. 50721. ELIMINATION OF TIME LIMIT FOR FAMILY REUNIFICATION 
SERVICES WHILE IN FOSTER CARE AND PERMITTING 
TIME-LIMITED FAMILY REUNIFICATION SERVICES WHEN 
A CHILD RETURNS HOME FROM FOSTER CARE. 
(a) IN GENERAL.—Section 431(a)(7) of the Social Security Act 
(42 U.S.C. 629a(a)(7)) is amended— 
(1) in the paragraph heading, by striking ‘‘TIME-LIMITED 
FAMILY’’ and inserting ‘‘FAMILY’’; and 
(2) in subparagraph (A)— 
(A) by striking ‘‘time-limited family’’ and inserting 
‘‘family’’; 
(B) by inserting ‘‘or a child who has been returned 
home’’ after ‘‘child care institution’’; and 
(C) by striking ‘‘, but only during the 15-month period 
that begins on the date that the child, pursuant to section 
475(5)(F), is considered to have entered foster care’’ and 
inserting ‘‘and to ensure the strength and stability of the 
reunification. In the case of a child who has been returned 
home, the services and activities shall only be provided 
during the 15-month period that begins on the date that 
the child returns home’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 430 of such Act (42 U.S.C. 629) is amended 
in the matter preceding paragraph (1), by striking ‘‘time-lim-
ited’’. 
(2) Subsections (a)(4), (a)(5)(A), and (b)(1) of section 432 
of such Act (42 U.S.C. 629b) are amended by striking ‘‘time- 
limited’’ each place it appears. 
Time period. 
Determination. 
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132 STAT. 246 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 50722. REDUCING BUREAUCRACY AND UNNECESSARY DELAYS 
WHEN PLACING CHILDREN IN HOMES ACROSS STATE 
LINES. 
(a) STATE PLAN REQUIREMENT.—Section 471(a)(25) of the Social 
Security Act (42 U.S.C. 671(a)(25)) is amended— 
(1) by striking ‘‘provide’’ and inserting ‘‘provides’’; and 
(2) by inserting ‘‘, which, in the case of a State other 
than the Commonwealth of Puerto Rico, the United States 
Virgin Islands, Guam, or American Samoa, not later than 
October 1, 2027, shall include the use of an electronic interstate 
case-processing system’’ before the first semicolon. 
(b) EXEMPTION
OF INDIAN TRIBES.—Section 479B(c) of such 
Act (42 U.S.C. 679c(c)) is amended by adding at the end the fol-
lowing: 
‘‘(4) INAPPLICABILITY OF STATE PLAN REQUIREMENT TO HAVE 
IN EFFECT PROCEDURES PROVIDING FOR THE USE OF AN ELEC-
TRONIC
INTERSTATE
CASE-PROCESSING
SYSTEM.—The require-
ment in section 471(a)(25) that a State plan provide that the 
State shall have in effect procedures providing for the use 
of an electronic interstate case-processing system shall not 
apply to an Indian tribe, tribal organization, or tribal consor-
tium that elects to operate a program under this part.’’. 
(c) FUNDING FOR THE DEVELOPMENT OF AN ELECTRONIC INTER-
STATE CASE-PROCESSING SYSTEM
TO EXPEDITE
THE INTERSTATE 
PLACEMENT OF CHILDREN IN FOSTER CARE OR GUARDIANSHIP, OR 
FOR ADOPTION.—Section 437 of such Act (42 U.S.C. 629g) is 
amended by adding at the end the following: 
‘‘(g) FUNDING FOR THE DEVELOPMENT OF AN ELECTRONIC INTER-
STATE CASE-PROCESSING SYSTEM
TO EXPEDITE
THE INTERSTATE 
PLACEMENT OF CHILDREN IN FOSTER CARE OR GUARDIANSHIP, OR 
FOR ADOPTION.— 
‘‘(1) PURPOSE.—The purpose of this subsection is to facili-
tate the development of an electronic interstate case-processing 
system for the exchange of data and documents to expedite 
the placements of children in foster, guardianship, or adoptive 
homes across State lines. 
‘‘(2) REQUIREMENTS.—A State that seeks funding under 
this subsection shall submit to the Secretary the following: 
‘‘(A) A description of the goals and outcomes to be 
achieved, which goals and outcomes must result in— 
‘‘(i) reducing the time it takes for a child to be 
provided with a safe and appropriate permanent living 
arrangement across State lines; 
‘‘(ii) 
improving 
administrative 
processes 
and 
reducing costs in the foster care system; and 
‘‘(iii) the secure exchange of relevant case files 
and other necessary materials in real time, and timely 
communications and placement decisions regarding 
interstate placements of children. 
‘‘(B) A description of the activities to be funded in 
whole or in part with the funds, including the sequencing 
of the activities. 
‘‘(C) A description of the strategies for integrating pro-
grams and services for children who are placed across 
State lines. 
‘‘(D) Such other information as the Secretary may 
require. 
Deadline. 
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132 STAT. 247 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(3) FUNDING
AUTHORITY.—The Secretary may provide 
funds to a State that complies with paragraph (2). In providing 
funds under this subsection, the Secretary shall prioritize 
States that are not yet connected with the electronic interstate 
case-processing system referred to in paragraph (1). 
‘‘(4) USE OF FUNDS.—A State to which funding is provided 
under this subsection shall use the funding to support the 
State in connecting with, or enhancing or expediting services 
provided under, the electronic interstate case-processing system 
referred to in paragraph (1). 
‘‘(5) EVALUATIONS.—Not later than 1 year after the final 
year in which funds are awarded under this subsection, the 
Secretary shall submit to the Congress, and make available 
to the general public by posting on a website, a report that 
contains the following information: 
‘‘(A) How using the electronic interstate case-processing 
system developed pursuant to paragraph (4) has changed 
the time it takes for children to be placed across State 
lines. 
‘‘(B) The number of cases subject to the Interstate 
Compact on the Placement of Children that were processed 
through the electronic interstate case-processing system, 
and the number of interstate child placement cases that 
were processed outside the electronic interstate case-proc-
essing system, by each State in each year. 
‘‘(C) The progress made by States in implementing 
the electronic interstate case-processing system. 
‘‘(D) How using the electronic interstate case-proc-
essing system has affected various metrics related to child 
safety and well-being, including the time it takes for chil-
dren to be placed across State lines. 
‘‘(E) How using the electronic interstate case-processing 
system has affected administrative costs and caseworker 
time spent on placing children across State lines. 
‘‘(6) DATA
INTEGRATION.—The Secretary, in consultation 
with the Secretariat for the Interstate Compact on the Place-
ment of Children and the States, shall assess how the electronic 
interstate case-processing system developed pursuant to para-
graph (4) could be used to better serve and protect children 
that come to the attention of the child welfare system, by— 
‘‘(A) connecting the system with other data systems 
(such as systems operated by State law enforcement and 
judicial agencies, systems operated by the Federal Bureau 
of Investigation for the purposes of the Innocence Lost 
National Initiative, and other systems); 
‘‘(B) simplifying and improving reporting related to 
paragraphs (34) and (35) of section 471(a) regarding chil-
dren or youth who have been identified as being a sex 
trafficking victim or children missing from foster care; and 
‘‘(C) improving the ability of States to quickly comply 
with background check requirements of section 471(a)(20), 
including checks of child abuse and neglect registries as 
required by section 471(a)(20)(B).’’. 
(d) RESERVATION OF FUNDS TO IMPROVE THE INTERSTATE PLACE-
MENT OF CHILDREN.—Section 437(b) of such Act (42 U.S.C. 629g(b)) 
is amended by adding at the end the following: 
Consultation. 
Assessment. 
Public 
information. 
Reports. 
Web posting. 
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132 STAT. 248 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(4) IMPROVING
THE
INTERSTATE
PLACEMENT
OF
CHIL-
DREN.—The Secretary shall reserve $5,000,000 of the amount 
made available for fiscal year 2018 for grants under subsection 
(g), and the amount so reserved shall remain available through 
fiscal year 2022.’’. 
SEC. 50723. ENHANCEMENTS TO GRANTS TO IMPROVE WELL-BEING 
OF FAMILIES AFFECTED BY SUBSTANCE ABUSE. 
Section 437(f) of the Social Security Act (42 U.S.C. 629g(f)) 
is amended— 
(1) in the subsection heading, by striking ‘‘INCREASE THE 
WELL-BEING OF, AND TO IMPROVE THE PERMANENCY OUTCOMES 
FOR, CHILDREN AFFECTED BY’’ and inserting ‘‘IMPLEMENT IV– 
E PREVENTION SERVICES, AND IMPROVE THE WELL-BEING OF, 
AND IMPROVE PERMANENCY OUTCOMES
FOR, CHILDREN
AND 
FAMILIES AFFECTED BY HEROIN, OPIOIDS, AND OTHER’’; 
(2) by striking paragraph (2) and inserting the following: 
‘‘(2) REGIONAL PARTNERSHIP DEFINED.—In this subsection, 
the term ‘regional partnership’ means a collaborative agreement 
(which may be established on an interstate, State, or intrastate 
basis) entered into by the following: 
‘‘(A) MANDATORY
PARTNERS
FOR
ALL
PARTNERSHIP 
GRANTS.— 
‘‘(i) The State child welfare agency that is respon-
sible for the administration of the State plan under 
this part and part E. 
‘‘(ii) The State agency responsible for admin-
istering the substance abuse prevention and treatment 
block grant provided under subpart II of part B of 
title XIX of the Public Health Service Act. 
‘‘(B) MANDATORY PARTNERS FOR PARTNERSHIP GRANTS 
PROPOSING
TO
SERVE
CHILDREN
IN
OUT-OF-HOME
PLACE-
MENTS.—If the partnership proposes to serve children in 
out-of-home placements, the Juvenile Court or Administra-
tive Office of the Court that is most appropriate to oversee 
the administration of court programs in the region to 
address the population of families who come to the atten-
tion of the court due to child abuse or neglect. 
‘‘(C) OPTIONAL PARTNERS.—At the option of the partner-
ship, any of the following: 
‘‘(i) An Indian tribe or tribal consortium. 
‘‘(ii) Nonprofit child welfare service providers. 
‘‘(iii) For-profit child welfare service providers. 
‘‘(iv) 
Community 
health 
service 
providers, 
including substance abuse treatment providers. 
‘‘(v) Community mental health providers. 
‘‘(vi) Local law enforcement agencies. 
‘‘(vii) School personnel. 
‘‘(viii) Tribal child welfare agencies (or a consortia 
of the agencies). 
‘‘(ix) Any other providers, agencies, personnel, offi-
cials, or entities that are related to the provision of 
child and family services under a State plan approved 
under this subpart. 
‘‘(D) EXCEPTION FOR REGIONAL PARTNERSHIPS WHERE 
THE LEAD APPLICANT IS AN INDIAN TRIBE OR TRIBAL CON-
SORTIA.—If an Indian tribe or tribal consortium enters 
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132 STAT. 249 
PUBLIC LAW 115–123—FEB. 9, 2018 
into a regional partnership for purposes of this subsection, 
the Indian tribe or tribal consortium— 
‘‘(i) may (but is not required to) include the State 
child welfare agency as a partner in the collaborative 
agreement; 
‘‘(ii) may not enter into a collaborative agreement 
only with tribal child welfare agencies (or a consortium 
of the agencies); and 
‘‘(iii) if the condition described in paragraph (2)(B) 
applies, may include tribal court organizations in lieu 
of other judicial partners.’’; 
(3) in paragraph (3)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘2012 through 2016’’ and inserting 
‘‘2017 through 2021’’; and 
(ii) by striking ‘‘$500,000 and not more than 
$1,000,000’’ and inserting ‘‘$250,000 and not more than 
$1,000,000’’; 
(B) in subparagraph (B)— 
(i) in the subparagraph heading, by inserting ‘‘; 
PLANNING’’ after ‘‘APPROVAL’’; 
(ii) in clause (i), by striking ‘‘clause (ii)’’ and 
inserting ‘‘clauses (ii) and (iii)’’; and 
(iii) by adding at the end the following: 
‘‘(iii) SUFFICIENT
PLANNING.—A grant awarded 
under this subsection shall be disbursed in two phases: 
a planning phase (not to exceed 2 years) and an 
implementation phase. The total disbursement to a 
grantee for the planning phase may not exceed 
$250,000, and may not exceed the total anticipated 
funding for the implementation phase.’’; and 
(C) by adding at the end the following: 
‘‘(D) LIMITATION ON PAYMENT FOR A FISCAL YEAR.— 
No payment shall be made under subparagraph (A) or 
(C) for a fiscal year until the Secretary determines that 
the eligible partnership has made sufficient progress in 
meeting the goals of the grant and that the members 
of the eligible partnership are coordinating to a reasonable 
degree with the other members of the eligible partnership.’’; 
(4) in paragraph (4)— 
(A) in subparagraph (B)— 
(i) in clause (i), by inserting ‘‘, parents, and fami-
lies’’ after ‘‘children’’; 
(ii) in clause (ii), by striking ‘‘safety and perma-
nence for such children; and’’ and inserting ‘‘safe, 
permanent caregiving relationships for the children;’’; 
(iii) in clause (iii), by striking ‘‘or’’ and inserting 
‘‘increase reunification rates for children who have 
been placed in out-of-home care, or decrease’’; and 
(iv) by redesignating clause (iii) as clause (v) and 
inserting after clause (ii) the following: 
‘‘(iii) improve the substance abuse treatment out-
comes for parents including retention in treatment and 
successful completion of treatment; 
‘‘(iv) facilitate the implementation, delivery, and 
effectiveness of prevention services and programs 
under section 471(e); and’’; 
Determination. 
Time period. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
(B) in subparagraph (D), by striking ‘‘where appro-
priate,’’; and 
(C) by striking subparagraphs (E) and (F) and inserting 
the following: 
‘‘(E) A description of a plan for sustaining the services 
provided by or activities funded under the grant after the 
conclusion of the grant period, including through the use 
of prevention services and programs under section 471(e) 
and other funds provided to the State for child welfare 
and substance abuse prevention and treatment services. 
‘‘(F) Additional information needed by the Secretary 
to determine that the proposed activities and implementa-
tion will be consistent with research or evaluations showing 
which practices and approaches are most effective.’’; 
(5) in paragraph (5)(A), by striking ‘‘abuse treatment’’ and 
inserting ‘‘use disorder treatment including medication assisted 
treatment and in-home substance abuse disorder treatment 
and recovery’’; 
(6) in paragraph (7)— 
(A) by striking ‘‘and’’ at the end of subparagraph (C); 
and 
(B) by redesignating subparagraph (D) as subpara-
graph (E) and inserting after subparagraph (C) the fol-
lowing: 
‘‘(D) demonstrate a track record of successful collabora-
tion among child welfare, substance abuse disorder treat-
ment and mental health agencies; and’’; 
(7) in paragraph (8)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘establish indicators that will be’’ 
and inserting ‘‘review indicators that are’’; and 
(ii) by striking ‘‘in using funds made available 
under such grants to achieve the purpose of this sub-
section’’ and inserting ‘‘and establish a set of core 
indicators related to child safety, parental recovery, 
parenting capacity, and family well-being. In devel-
oping the core indicators, to the extent possible, indica-
tors shall be made consistent with the outcome meas-
ures described in section 471(e)(6)’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), by inserting 
‘‘base the performance measures on lessons learned 
from prior rounds of regional partnership grants under 
this subsection, and’’ before ‘‘consult’’; and 
(ii) by striking clauses (iii) and (iv) and inserting 
the following: 
‘‘(iii) Other stakeholders or constituencies as deter-
mined by the Secretary.’’; 
(8) in paragraph (9)(A), by striking clause (i) and inserting 
the following: 
‘‘(i) SEMIANNUAL
REPORTS.—Not later than Sep-
tember 30 of each fiscal year in which a recipient 
of a grant under this subsection is paid funds under 
the grant, and every 6 months thereafter, the grant 
recipient shall submit to the Secretary a report on 
the services provided and activities carried out during 
the reporting period, progress made in achieving the 
Determination. 
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132 STAT. 251 
PUBLIC LAW 115–123—FEB. 9, 2018 
goals of the program, the number of children, adults, 
and families receiving services, and such additional 
information as the Secretary determines is necessary. 
The report due not later than September 30 of the 
last such fiscal year shall include, at a minimum, data 
on each of the performance indicators included in the 
evaluation of the regional partnership.’’; and 
(9) in paragraph (10), by striking ‘‘2012 through 2016’’ 
and inserting ‘‘2017 through 2021’’. 
PART III—MISCELLANEOUS 
SEC. 50731. REVIEWING AND IMPROVING LICENSING STANDARDS FOR 
PLACEMENT IN A RELATIVE FOSTER FAMILY HOME. 
(a) IDENTIFICATION OF REPUTABLE MODEL LICENSING STAND-
ARDS.—Not later than October 1, 2018, the Secretary of Health 
and Human Services shall identify reputable model licensing stand-
ards with respect to the licensing of foster family homes (as defined 
in section 472(c)(1) of the Social Security Act). 
(b) STATE PLAN REQUIREMENT.—Section 471(a) of the Social 
Security Act (42 U.S.C. 671(a)) is amended— 
(1) in paragraph (34)(B), by striking ‘‘and’’ after the semi-
colon; 
(2) in paragraph (35)(B), by striking the period at the 
end and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(36) provides that, not later than April 1, 2019, the State 
shall submit to the Secretary information addressing— 
‘‘(A) whether the State licensing standards are in 
accord with model standards identified by the Secretary, 
and if not, the reason for the specific deviation and a 
description as to why having a standard that is reasonably 
in accord with the corresponding national model standards 
is not appropriate for the State; 
‘‘(B) whether the State has elected to waive standards 
established in 471(a)(10)(A) for relative foster family homes 
(pursuant to waiver authority provided by 471(a)(10)(D)), 
a description of which standards the State most commonly 
waives, and if the State has not elected to waive the 
standards, the reason for not waiving these standards; 
‘‘(C) if the State has elected to waive standards speci-
fied in subparagraph (B), how caseworkers are trained 
to use the waiver authority and whether the State has 
developed a process or provided tools to assist caseworkers 
in waiving nonsafety standards per the authority provided 
in 471(a)(10)(D) to quickly place children with relatives; 
and 
‘‘(D) a description of the steps the State is taking 
to improve caseworker training or the process, if any; and’’. 
SEC. 50732. DEVELOPMENT OF A STATEWIDE PLAN TO PREVENT CHILD 
ABUSE AND NEGLECT FATALITIES. 
Section 422(b)(19) of the Social Security Act (42 U.S.C. 
622(b)(19)) is amended to read as follows: 
‘‘(19) document steps taken to track and prevent child 
maltreatment deaths by including— 
Deadlines. 
42 USC 671 note. 
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132 STAT. 252 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) a description of the steps the State is taking 
to compile complete and accurate information on the deaths 
required by Federal law to be reported by the State agency 
referred to in paragraph (1), including gathering relevant 
information on the deaths from the relevant organizations 
in the State including entities such as State vital statistics 
department, child death review teams, law enforcement 
agencies, offices of medical examiners, or coroners; and 
‘‘(B) a description of the steps the State is taking 
to develop and implement a comprehensive, statewide plan 
to prevent the fatalities that involves and engages relevant 
public and private agency partners, including those in 
public health, law enforcement, and the courts.’’. 
SEC. 50733. MODERNIZING THE TITLE AND PURPOSE OF TITLE IV– 
E. 
(a) PART HEADING.—The heading for part E of title IV of 
the Social Security Act (42 U.S.C. 670 et seq.) is amended to 
read as follows: 
‘‘PART E—FEDERAL PAYMENTS FOR FOSTER 
CARE, PREVENTION, AND PERMANENCY’’. 
(b) PURPOSE.—The first sentence of section 470 of such Act 
(42 U.S.C. 670) is amended— 
(1) by striking ‘‘1995) and’’ and inserting ‘‘1995),’’; 
(2) by inserting ‘‘kinship guardianship assistance, and 
prevention services or programs specified in section 471(e)(1),’’ 
after ‘‘needs,’’; and 
(3) by striking ‘‘(commencing with the fiscal year which 
begins October 1, 1980)’’. 
SEC. 50734. EFFECTIVE DATES. 
(a) EFFECTIVE DATES.— 
(1) IN GENERAL.—Except as provided in paragraph (2), sub-
ject to subsection (b), the amendments made by parts I through 
III of this subtitle shall take effect on October 1, 2018. 
(2) EXCEPTIONS.—The amendments made by sections 
50711(d), 50731, and 50733 shall take effect on the date of 
enactment of this Act. 
(b) TRANSITION RULE.— 
(1) IN GENERAL.—In the case of a State plan under part 
B or E of title IV of the Social Security Act which the Secretary 
of Health and Human Services determines requires State legis-
lation (other than legislation appropriating funds) in order for 
the plan to meet the additional requirements imposed by the 
amendments made by parts I through III of this subtitle, the 
State plan shall not be regarded as failing to comply with 
the requirements of such part solely on the basis of the failure 
of the plan to meet such additional requirements 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 enactment of this Act. For purposes of the 
previous sentence, in the case of a State that has a 2-year 
legislative session, each year of the session shall be deemed 
to be a separate regular session of the State legislature. 
Determination. 
42 USC 622 note. 
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132 STAT. 253 
PUBLIC LAW 115–123—FEB. 9, 2018 
(2) APPLICATION TO PROGRAMS OPERATED BY INDIAN TRIBAL 
ORGANIZATIONS.—In the case of an Indian tribe, tribal organiza-
tion, or tribal consortium which the Secretary of Health and 
Human Services determines requires time to take action nec-
essary to comply with the additional requirements imposed 
by the amendments made by parts I through III of this subtitle 
(whether the tribe, organization, or tribal consortium has a 
plan under section 479B of the Social Security Act or a coopera-
tive agreement or contract entered into with a State), the 
Secretary shall provide the tribe, organization, or tribal consor-
tium with such additional time as the Secretary determines 
is necessary for the tribe, organization, or tribal consortium 
to take the action to comply with the additional requirements 
before being regarded as failing to comply with the require-
ments. 
PART IV—ENSURING THE NECESSITY OF A 
PLACEMENT THAT IS NOT IN A FOSTER FAM-
ILY HOME 
SEC. 50741. LIMITATION ON FEDERAL FINANCIAL PARTICIPATION FOR 
PLACEMENTS THAT ARE NOT IN FOSTER FAMILY HOMES. 
(a) LIMITATION ON FEDERAL FINANCIAL PARTICIPATION.— 
(1) IN GENERAL.—Section 472 of the Social Security Act 
(42 U.S.C. 672), as amended by section 50712(a), is amended— 
(A) in subsection (a)(2)(C), by inserting ‘‘, but only 
to the extent permitted under subsection (k)’’ after ‘‘institu-
tion’’; and 
(B) by adding at the end the following: 
‘‘(k) LIMITATION ON FEDERAL FINANCIAL PARTICIPATION.— 
‘‘(1) IN GENERAL.—Beginning with the third week for which 
foster care maintenance payments are made under this section 
on behalf of a child placed in a child-care institution, no Federal 
payment shall be made to the State under section 474(a)(1) 
for amounts expended for foster care maintenance payments 
on behalf of the child unless— 
‘‘(A) the child is placed in a child-care institution that 
is a setting specified in paragraph (2) (or is placed in 
a licensed residential family-based treatment facility con-
sistent with subsection (j)); and 
‘‘(B) in the case of a child placed in a qualified residen-
tial treatment program (as defined in paragraph (4)), the 
requirements specified in paragraph (3) and section 475A(c) 
are met. 
‘‘(2) SPECIFIED SETTINGS FOR PLACEMENT.—The settings for 
placement specified in this paragraph are the following: 
‘‘(A) A qualified residential treatment program (as 
defined in paragraph (4)). 
‘‘(B) A setting specializing in providing prenatal, post- 
partum, or parenting supports for youth. 
‘‘(C) In the case of a child who has attained 18 years 
of age, a supervised setting in which the child is living 
independently. 
‘‘(D) A setting providing high-quality residential care 
and supportive services to children and youth who have 
Effective date. 
Time period. 
Determination. 
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132 STAT. 254 
PUBLIC LAW 115–123—FEB. 9, 2018 
been found to be, or are at risk of becoming, sex trafficking 
victims, in accordance with section 471(a)(9)(C). 
‘‘(3) ASSESSMENT
TO
DETERMINE
APPROPRIATENESS
OF 
PLACEMENT
IN
A
QUALIFIED
RESIDENTIAL
TREATMENT
PRO-
GRAM.— 
‘‘(A) DEADLINE FOR ASSESSMENT.—In the case of a child 
who is placed in a qualified residential treatment program, 
if the assessment required under section 475A(c)(1) is not 
completed within 30 days after the placement is made, 
no Federal payment shall be made to the State under 
section 474(a)(1) for any amounts expended for foster care 
maintenance payments on behalf of the child during the 
placement. 
‘‘(B) DEADLINE FOR TRANSITION OUT OF PLACEMENT.— 
If the assessment required under section 475A(c)(1) deter-
mines that the placement of a child in a qualified residen-
tial treatment program is not appropriate, a court dis-
approves such a placement under section 475A(c)(2), or 
a child who has been in an approved placement in a quali-
fied residential treatment program is going to return home 
or be placed with a fit and willing relative, a legal guardian, 
or an adoptive parent, or in a foster family home, Federal 
payments shall be made to the State under section 474(a)(1) 
for amounts expended for foster care maintenance pay-
ments on behalf of the child while the child remains in 
the qualified residential treatment program only during 
the period necessary for the child to transition home or 
to such a placement. In no event shall a State receive 
Federal payments under section 474(a)(1) for amounts 
expended for foster care maintenance payments on behalf 
of a child who remains placed in a qualified residential 
treatment program after the end of the 30-day period that 
begins on the date a determination is made that the place-
ment is no longer the recommended or approved placement 
for the child. 
‘‘(4) QUALIFIED
RESIDENTIAL
TREATMENT
PROGRAM.—For 
purposes of this part, the term ‘qualified residential treatment 
program’ means a program that— 
‘‘(A) has a trauma-informed treatment model that is 
designed to address the needs, including clinical needs 
as appropriate, of children with serious emotional or behav-
ioral disorders or disturbances and, with respect to a child, 
is able to implement the treatment identified for the child 
by the assessment of the child required under section 
475A(c); 
‘‘(B) subject to paragraphs (5) and (6), has registered 
or licensed nursing staff and other licensed clinical staff 
who— 
‘‘(i) provide care within the scope of their practice 
as defined by State law; 
‘‘(ii) are on-site according to the treatment model 
referred to in subparagraph (A); and 
‘‘(iii) are available 24 hours a day and 7 days 
a week; 
‘‘(C) to extent appropriate, and in accordance with the 
child’s best interests, facilitates participation of family 
members in the child’s treatment program; 
Definition. 
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132 STAT. 255 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(D) facilitates outreach to the family members of the 
child, including siblings, documents how the outreach is 
made (including contact information), and maintains con-
tact information for any known biological family and fictive 
kin of the child; 
‘‘(E) documents how family members are integrated 
into the treatment process for the child, including post- 
discharge, and how sibling connections are maintained; 
‘‘(F) provides discharge planning and family-based 
aftercare support for at least 6 months post-discharge; and 
‘‘(G) is licensed in accordance with section 471(a)(10) 
and is accredited by any of the following independent, 
not-for-profit organizations: 
‘‘(i) The Commission on Accreditation of Rehabilita-
tion Facilities (CARF). 
‘‘(ii) The Joint Commission on Accreditation of 
Healthcare Organizations (JCAHO). 
‘‘(iii) The Council on Accreditation (COA). 
‘‘(iv) Any other independent, not-for-profit accred-
iting organization approved by the Secretary. 
‘‘(5) ADMINISTRATIVE COSTS.—The prohibition in paragraph 
(1) on Federal payments under section 474(a)(1) shall not be 
construed as prohibiting Federal payments for administrative 
expenditures incurred on behalf of a child placed in a child- 
care institution and for which payment is available under sec-
tion 474(a)(3). 
‘‘(6) RULE OF CONSTRUCTION.—The requirements in para-
graph (4)(B) shall not be construed as requiring a qualified 
residential treatment program to acquire nursing and behav-
ioral health staff solely through means of a direct employer 
to employee relationship.’’. 
(2) CONFORMING
AMENDMENT.—Section 474(a)(1) of the 
Social Security Act (42 U.S.C. 674(a)(1)), as amended by section 
50712(b), is amended by striking ‘‘section 472(j)’’ and inserting 
‘‘subsections (j) and (k) of section 472’’. 
(b) DEFINITION OF FOSTER FAMILY HOME, CHILD-CARE INSTITU-
TION.—Section 472(c) of such Act (42 U.S.C. 672(c)(1)) is amended 
to read as follows: 
‘‘(c) DEFINITIONS.—For purposes of this part: 
‘‘(1) FOSTER FAMILY HOME.— 
‘‘(A) IN GENERAL.—The term ‘foster family home’ means 
the home of an individual or family— 
‘‘(i) that is licensed or approved by the State in 
which it is situated as a foster family home that meets 
the standards established for the licensing or approval; 
and 
‘‘(ii) in which a child in foster care has been placed 
in the care of an individual, who resides with the 
child and who has been licensed or approved by the 
State to be a foster parent— 
‘‘(I) that the State deems capable of adhering 
to the reasonable and prudent parent standard; 
‘‘(II) that provides 24-hour substitute care for 
children placed away from their parents or other 
caretakers; and 
‘‘(III) that provides the care for not more than 
six children in foster care. 
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132 STAT. 256 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(B) STATE FLEXIBILITY.—The number of foster children 
that may be cared for in a home under subparagraph 
(A) may exceed the numerical limitation in subparagraph 
(A)(ii)(III), at the option of the State, for any of the following 
reasons: 
‘‘(i) To allow a parenting youth in foster care to 
remain with the child of the parenting youth. 
‘‘(ii) To allow siblings to remain together. 
‘‘(iii) To allow a child with an established meaning-
ful relationship with the family to remain with the 
family. 
‘‘(iv) To allow a family with special training or 
skills to provide care to a child who has a severe 
disability. 
‘‘(C) RULE OF CONSTRUCTION.—Subparagraph (A) shall 
not be construed as prohibiting a foster parent from renting 
the home in which the parent cares for a foster child 
placed in the parent’s care. 
‘‘(2) CHILD-CARE INSTITUTION.— 
‘‘(A) IN
GENERAL.—The term ‘child-care institution’ 
means a private child-care institution, or a public child- 
care institution which accommodates no more than 25 chil-
dren, which is licensed by the State in which it is situated 
or has been approved by the agency of the State responsible 
for licensing or approval of institutions of this type as 
meeting the standards established for the licensing. 
‘‘(B) SUPERVISED SETTINGS.—In the case of a child who 
has attained 18 years of age, the term shall include a 
supervised setting in which the individual is living 
independently, in accordance with such conditions as the 
Secretary shall establish in regulations. 
‘‘(C) EXCLUSIONS.—The term shall not include deten-
tion facilities, forestry camps, training schools, or any other 
facility operated primarily for the detention of children 
who are determined to be delinquent.’’. 
(c) TRAINING FOR STATE JUDGES, ATTORNEYS, AND OTHER LEGAL 
PERSONNEL IN CHILD WELFARE CASES.—Section 438(b)(1) of such 
Act (42 U.S.C. 629h(b)(1)) is amended in the matter preceding 
subparagraph (A) by inserting ‘‘shall provide for the training of 
judges, attorneys, and other legal personnel in child welfare cases 
on Federal child welfare policies and payment limitations with 
respect to children in foster care who are placed in settings that 
are not a foster family home,’’ after ‘‘with respect to the child,’’. 
(d) ASSURANCE OF NONIMPACT ON JUVENILE JUSTICE SYSTEM.— 
(1) STATE PLAN REQUIREMENT.—Section 471(a) of such Act 
(42 U.S.C. 671(a)), as amended by section 50731, is further 
amended by adding at the end the following: 
‘‘(37) includes a certification that, in response to the limita-
tion imposed under section 472(k) with respect to foster care 
maintenance payments made on behalf of any child who is 
placed in a setting that is not a foster family home, the State 
will not enact or advance policies or practices that would result 
in a significant increase in the population of youth in the 
State’s juvenile justice system.’’. 
(2) GAO STUDY
AND
REPORT.—The Comptroller General 
of the United States shall evaluate the impact, if any, on 
State juvenile justice systems of the limitation imposed under 
Evaluations. 
Certification. 
Definition. 
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132 STAT. 257 
PUBLIC LAW 115–123—FEB. 9, 2018 
section 472(k) of the Social Security Act (as added by section 
50741(a)(1)) on foster care maintenance payments made on 
behalf of any child who is placed in a setting that is not 
a foster family home, in accordance with the amendments made 
by subsections (a) and (b) of this section. In particular, the 
Comptroller General shall evaluate the extent to which children 
in foster care who also are subject to the juvenile justice system 
of the State are placed in a facility under the jurisdiction 
of the juvenile justice system and whether the lack of available 
congregate care placements under the jurisdiction of the child 
welfare systems is a contributing factor to that result. Not 
later than December 31, 2025, the Comptroller General shall 
submit to Congress a report on the results of the evaluation. 
SEC. 50742. ASSESSMENT AND DOCUMENTATION OF THE NEED FOR 
PLACEMENT IN A QUALIFIED RESIDENTIAL TREATMENT 
PROGRAM. 
Section 475A of the Social Security Act (42 U.S.C. 675a) is 
amended by adding at the end the following: 
‘‘(c) ASSESSMENT, DOCUMENTATION, AND JUDICIAL DETERMINA-
TION REQUIREMENTS FOR PLACEMENT IN A QUALIFIED RESIDENTIAL 
TREATMENT PROGRAM.—In the case of any child who is placed 
in a qualified residential treatment program (as defined in section 
472(k)(4)), the following requirements shall apply for purposes of 
approving the case plan for the child and the case system review 
procedure for the child: 
‘‘(1)(A) Within 30 days of the start of each placement in 
such a setting, a qualified individual (as defined in subpara-
graph (D)) shall— 
‘‘(i) assess the strengths and needs of the child using 
an age-appropriate, evidence-based, validated, functional 
assessment tool approved by the Secretary; 
‘‘(ii) determine whether the needs of the child can 
be met with family members or through placement in a 
foster family home or, if not, which setting from among 
the settings specified in section 472(k)(2) would provide 
the most effective and appropriate level of care for the 
child in the least restrictive environment and be consistent 
with the short- and long-term goals for the child, as speci-
fied in the permanency plan for the child; and 
‘‘(iii) develop a list of child-specific short- and long- 
term mental and behavioral health goals. 
‘‘(B)(i) The State shall assemble a family and permanency 
team for the child in accordance with the requirements of 
clauses (ii) and (iii). The qualified individual conducting the 
assessment required under subparagraph (A) shall work in 
conjunction with the family of, and permanency team for, the 
child while conducting and making the assessment. 
‘‘(ii) The family and permanency team shall consist of all 
appropriate biological family members, relative, and fictive kin 
of the child, as well as, as appropriate, professionals who are 
a resource to the family of the child, such as teachers, medical 
or mental health providers who have treated the child, or 
clergy. In the case of a child who has attained age 14, the 
family and permanency team shall include the members of 
the permanency planning team for the child that are selected 
by the child in accordance with section 475(5)(C)(iv). 
Lists. 
Determination. 
Deadline. 
Applicability. 
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132 STAT. 258 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(iii) The State shall document in the child’s case plan— 
‘‘(I) the reasonable and good faith effort of the State 
to identify and include all the individuals described in 
clause (ii) on the child’s family and permanency team; 
‘‘(II) all contact information for members of the family 
and permanency team, as well as contact information for 
other family members and fictive kin who are not part 
of the family and permanency team; 
‘‘(III) evidence that meetings of the family and perma-
nency team, including meetings relating to the assessment 
required under subparagraph (A), are held at a time and 
place convenient for family; 
‘‘(IV) if reunification is the goal, evidence dem-
onstrating that the parent from whom the child was 
removed provided input on the members of the family 
and permanency team; 
‘‘(V) evidence that the assessment required under 
subparagraph (A) is determined in conjunction with the 
family and permanency team; 
‘‘(VI) the placement preferences of the family and 
permanency team relative to the assessment that recog-
nizes children should be placed with their siblings unless 
there is a finding by the court that such placement is 
contrary to their best interest; and 
‘‘(VII) if the placement preferences of the family and 
permanency team and child are not the placement setting 
recommended by the qualified individual conducting the 
assessment under subparagraph (A), the reasons why the 
preferences of the team and of the child were not rec-
ommended. 
‘‘(C) In the case of a child who the qualified individual 
conducting the assessment under subparagraph (A) determines 
should not be placed in a foster family home, the qualified 
individual shall specify in writing the reasons why the needs 
of the child cannot be met by the family of the child or in 
a foster family home. A shortage or lack of foster family homes 
shall not be an acceptable reason for determining that the 
needs of the child cannot be met in a foster family home. 
The qualified individual also shall specify in writing why the 
recommended placement in a qualified residential treatment 
program is the setting that will provide the child with the 
most effective and appropriate level of care in the least restric-
tive environment and how that placement is consistent with 
the short- and long-term goals for the child, as specified in 
the permanency plan for the child. 
‘‘(D)(i) Subject to clause (ii), in this subsection, the term 
‘qualified individual’ means a trained professional or licensed 
clinician who is not an employee of the State agency and 
who is not connected to, or affiliated with, any placement 
setting in which children are placed by the State. 
‘‘(ii) The Secretary may approve a request of a State to 
waive any requirement in clause (i) upon a submission by 
the State, in accordance with criteria established by the Sec-
retary, that certifies that the trained professionals or licensed 
clinicians with responsibility for performing the assessments 
described in subparagraph (A) shall maintain objectivity with 
Certification. 
Definition. 
Determination. 
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132 STAT. 259 
PUBLIC LAW 115–123—FEB. 9, 2018 
respect to determining the most effective and appropriate place-
ment for a child. 
‘‘(2) Within 60 days of the start of each placement in 
a qualified residential treatment program, a family or juvenile 
court or another court (including a tribal court) of competent 
jurisdiction, or an administrative body appointed or approved 
by the court, independently, shall— 
‘‘(A) consider the assessment, determination, and docu-
mentation made by the qualified individual conducting the 
assessment under paragraph (1); 
‘‘(B) determine whether the needs of the child can 
be met through placement in a foster family home or, 
if not, whether placement of the child in a qualified residen-
tial treatment program provides the most effective and 
appropriate level of care for the child in the least restrictive 
environment and whether that placement is consistent with 
the short- and long-term goals for the child, as specified 
in the permanency plan for the child; and 
‘‘(C) approve or disapprove the placement. 
‘‘(3) The written documentation made under paragraph 
(1)(C) and documentation of the determination and approval 
or disapproval of the placement in a qualified residential treat-
ment program by a court or administrative body under para-
graph (2) shall be included in and made part of the case 
plan for the child. 
‘‘(4) As long as a child remains placed in a qualified residen-
tial treatment program, the State agency shall submit evidence 
at each status review and each permanency hearing held with 
respect to the child— 
‘‘(A) demonstrating that ongoing assessment of the 
strengths and needs of the child continues to support the 
determination that the needs of the child cannot be met 
through placement in a foster family home, that the place-
ment in a qualified residential treatment program provides 
the most effective and appropriate level of care for the 
child in the least restrictive environment, and that the 
placement is consistent with the short- and long-term goals 
for the child, as specified in the permanency plan for the 
child; 
‘‘(B) documenting the specific treatment or service 
needs that will be met for the child in the placement 
and the length of time the child is expected to need the 
treatment or services; and 
‘‘(C) documenting the efforts made by the State agency 
to prepare the child to return home or to be placed with 
a fit and willing relative, a legal guardian, or an adoptive 
parent, or in a foster family home. 
‘‘(5) In the case of any child who is placed in a qualified 
residential treatment program for more than 12 consecutive 
months or 18 nonconsecutive months (or, in the case of a 
child who has not attained age 13, for more than 6 consecutive 
or nonconsecutive months), the State agency shall submit to 
the Secretary— 
‘‘(A) the most recent versions of the evidence and docu-
mentation specified in paragraph (4); and 
‘‘(B) the signed approval of the head of the State agency 
for the continued placement of the child in that setting.’’. 
Time periods. 
Determination. 
Deadline. 
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132 STAT. 260 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 50743. PROTOCOLS TO PREVENT INAPPROPRIATE DIAGNOSES. 
(a) STATE PLAN REQUIREMENT.—Section 422(b)(15)(A) of the 
Social Security Act (42 U.S.C. 622(b)(15)(A)) is amended— 
(1) in clause (vi), by striking ‘‘and’’ after the semicolon; 
(2) by redesignating clause (vii) as clause (viii); and 
(3) by inserting after clause (vi) the following: 
‘‘(vii) the procedures and protocols the State has 
established to ensure that children in foster care place-
ments are not inappropriately diagnosed with mental 
illness, other emotional or behavioral disorders, medi-
cally fragile conditions, or developmental disabilities, 
and placed in settings that are not foster family homes 
as a result of the inappropriate diagnoses; and’’. 
(b) EVALUATION.—Section 476 of such Act (42 U.S.C. 676), 
as amended by section 50711(d), is further amended by adding 
at the end the following: 
‘‘(e) EVALUATION OF STATE PROCEDURES AND PROTOCOLS TO 
PREVENT INAPPROPRIATE DIAGNOSES OF MENTAL ILLNESS OR OTHER 
CONDITIONS.—The Secretary shall conduct an evaluation of the 
procedures and protocols established by States in accordance with 
the requirements of section 422(b)(15)(A)(vii). The evaluation shall 
analyze the extent to which States comply with and enforce the 
procedures and protocols and the effectiveness of various State 
procedures and protocols and shall identify best practices. Not later 
than January 1, 2020, the Secretary shall submit a report on 
the results of the evaluation to Congress.’’. 
SEC. 50744. ADDITIONAL DATA AND REPORTS REGARDING CHILDREN 
PLACED IN A SETTING THAT IS NOT A FOSTER FAMILY 
HOME. 
Section 479A(a)(7)(A) of the Social Security Act (42 U.S.C. 
679b(a)(7)(A)) is amended by striking clauses (i) through (vi) and 
inserting the following: 
‘‘(i) with respect to each such placement— 
‘‘(I) the type of the placement setting, 
including whether the placement is shelter care, 
a group home and if so, the range of the child 
population in the home, a residential treatment 
facility, a hospital or institution providing medical, 
rehabilitative, or psychiatric care, a setting special-
izing in providing prenatal, post-partum, or par-
enting supports, or some other kind of child-care 
institution and if so, what kind; 
‘‘(II) the number of children in the placement 
setting and the age, race, ethnicity, and gender 
of each of the children; 
‘‘(III) for each child in the placement setting, 
the length of the placement of the child in the 
setting, whether the placement of the child in the 
setting is the first placement of the child and 
if not, the number and type of previous placements 
of the child, and whether the child has special 
needs or another diagnosed mental or physical 
illness or condition; and 
‘‘(IV) the extent of any specialized education, 
treatment, counseling, or other services provided 
in the setting; and 
Reports. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(ii) separately, the number and ages of children 
in the placements who have a permanency plan of 
another planned permanent living arrangement; and’’. 
SEC. 50745. CRIMINAL RECORDS CHECKS AND CHECKS OF CHILD 
ABUSE 
AND 
NEGLECT 
REGISTRIES 
FOR 
ADULTS 
WORKING IN CHILD-CARE INSTITUTIONS AND OTHER 
GROUP CARE SETTINGS. 
(a) STATE PLAN REQUIREMENT.—Section 471(a)(20) of the Social 
Security Act (42 U.S.C. 671(a)(20)) is amended— 
(1) in subparagraph (A)(ii), by striking ‘‘and’’ after the 
semicolon; 
(2) in subparagraph (B)(iii), by striking ‘‘and’’after the semi-
colon; 
(3) in subparagraph (C), by adding ‘‘and’’ after the semi-
colon; and 
(4) by inserting after subparagraph (C), the following new 
subparagraph: 
‘‘(D) provides procedures for any child-care institution, 
including a group home, residential treatment center, 
shelter, or other congregate care setting, to conduct 
criminal records checks, including fingerprint-based checks 
of national crime information databases (as defined in sec-
tion 534(f)(3)(A) of title 28, United States Code), and checks 
described in subparagraph (B) of this paragraph, on any 
adult working in a child-care institution, including a group 
home, residential treatment center, shelter, or other con-
gregate care setting, unless the State reports to the Sec-
retary the alternative criminal records checks and child 
abuse registry checks the State conducts on any adult 
working in a child-care institution, including a group home, 
residential treatment center, shelter, or other congregate 
care setting, and why the checks specified in this subpara-
graph are not appropriate for the State;’’. 
(b) TECHNICAL AMENDMENTS.—Subparagraphs (A) and (C) of 
section 471(a)(20) of the Social Security Act (42 U.S.C. 671(a)(20)) 
are each amended by striking ‘‘section 534(e)(3)(A)’’ and inserting 
‘‘section 534(f)(3)(A)’’. 
SEC. 50746. EFFECTIVE DATES; APPLICATION TO WAIVERS. 
(a) EFFECTIVE DATES.— 
(1) IN GENERAL.—Subject to paragraph (2) and subsections 
(b), (c), and (d), the amendments made by this part shall 
take effect as if enacted on January 1, 2018. 
(2) TRANSITION RULE.—In the case of a State plan under 
part B or E of title IV of the Social Security Act which the 
Secretary of Health and Human Services determines requires 
State legislation (other than legislation appropriating funds) 
in order for the plan to meet the additional requirements 
imposed by the amendments made by this part, the State 
plan shall not be regarded as failing to comply with the require-
ments of part B or E of title IV of such Act solely on the 
basis of the failure of the plan to meet the additional require-
ments before the first day of the first calendar quarter begin-
ning after the close of the first regular session of the State 
legislature that begins after the date of enactment of this 
Act. For purposes of the previous sentence, in the case of 
a State that has a 2-year legislative session, each year of 
Determination. 
42 USC 622 note. 
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132 STAT. 262 
PUBLIC LAW 115–123—FEB. 9, 2018 
the session shall be deemed to be a separate regular session 
of the State legislature. 
(b) LIMITATION
ON FEDERAL FINANCIAL PARTICIPATION
FOR 
PLACEMENTS
THAT
ARE
NOT
IN
FOSTER
FAMILY
HOMES
AND 
RELATED PROVISIONS.— 
(1) IN
GENERAL.—The amendments made by sections 
50741(a), 50741(b), 50741(d), and 50742 shall take effect on 
October 1, 2019. 
(2) STATE OPTION TO DELAY EFFECTIVE DATE FOR NOT MORE 
THAN 2 YEARS.—If a State requests a delay in the effective 
date, the Secretary of Health and Human Services shall delay 
the effective date provided for in paragraph (1) with respect 
to the State for the amount of time requested by the State, 
not to exceed 2 years. If the effective date is so delayed for 
a period with respect to a State under the preceding sentence, 
then— 
(A) notwithstanding section 50734, the date that the 
amendments made by section 50711(c) take effect with 
respect to the State shall be delayed for the period; and 
(B) in applying section 474(a)(6) of the Social Security 
Act with respect to the State, ‘‘on or after the date this 
paragraph takes effect with respect to the State’’ is deemed 
to be substituted for ‘‘after September 30, 2019’’ in subpara-
graph (A)(i)(I) of such section. 
(c) CRIMINAL RECORDS CHECKS AND CHECKS OF CHILD ABUSE 
AND NEGLECT REGISTRIES FOR ADULTS WORKING IN CHILD-CARE 
INSTITUTIONS AND OTHER GROUP CARE SETTINGS.—Subject to sub-
section (a)(2), the amendments made by section 50745 shall take 
effect on October 1, 2018. 
(d) APPLICATION TO STATES WITH WAIVERS.—In the case of 
a State that, on the date of enactment of this Act, has in effect 
a waiver approved under section 1130 of the Social Security Act 
(42 U.S.C. 1320a–9), the amendments made by this part shall 
not apply with respect to the State before the expiration (determined 
without regard to any extensions) of the waiver to the extent 
the amendments are inconsistent with the terms of the waiver. 
PART V—CONTINUING SUPPORT FOR CHILD 
AND FAMILY SERVICES 
SEC. 50751. SUPPORTING AND RETAINING FOSTER FAMILIES FOR CHIL-
DREN. 
(a) SUPPORTING AND RETAINING FOSTER PARENTS AS A FAMILY 
SUPPORT SERVICE.—Section 431(a)(2)(B) of the Social Security Act 
(42 U.S.C. 631(a)(2)(B)) is amended by redesignating clauses (iii) 
through (vi) as clauses (iv) through (vii), respectively, and inserting 
after clause (ii) the following: 
‘‘(iii) To support and retain foster families so they 
can provide quality family-based settings for children 
in foster care.’’. 
(b) SUPPORT FOR FOSTER FAMILY HOMES.—Section 436 of such 
Act (42 U.S.C. 629f) is amended by adding at the end the following: 
‘‘(c) SUPPORT FOR FOSTER FAMILY HOMES.—Out of any money 
in the Treasury of the United States not otherwise appropriated, 
there are appropriated to the Secretary for fiscal year 2018, 
$8,000,000 for the Secretary to make competitive grants to States, 
Indian tribes, or tribal consortia to support the recruitment and 
Appropriation 
authorization. 
Effective date. 
Applicability. 
Effective date. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
retention of high-quality foster families to increase their capacity 
to place more children in family settings, focused on States, Indian 
tribes, or tribal consortia with the highest percentage of children 
in non-family settings. The amount appropriated under this 
subparagraph shall remain available through fiscal year 2022.’’. 
SEC. 50752. EXTENSION OF CHILD AND FAMILY SERVICES PROGRAMS. 
(a) EXTENSION OF STEPHANIE TUBBS JONES CHILD WELFARE 
SERVICES PROGRAM.—Section 425 of the Social Security Act (42 
U.S.C. 625) is amended by striking ‘‘2012 through 2016’’ and 
inserting ‘‘2017 through 2021’’. 
(b) EXTENSION OF PROMOTING SAFE AND STABLE FAMILIES PRO-
GRAM AUTHORIZATIONS.— 
(1) IN GENERAL.—Section 436(a) of such Act (42 U.S.C. 
629f(a)) is amended by striking all that follows ‘‘$345,000,000’’ 
and inserting ‘‘for each of fiscal years 2017 through 2021.’’. 
(2) DISCRETIONARY
GRANTS.—Section 437(a) of such Act 
(42 U.S.C. 629g(a)) is amended by striking ‘‘2012 through 2016’’ 
and inserting ‘‘2017 through 2021’’. 
(c) EXTENSION OF FUNDING RESERVATIONS FOR MONTHLY CASE-
WORKER
VISITS
AND
REGIONAL
PARTNERSHIP
GRANTS.—Section 
436(b) of such Act (42 U.S.C. 629f(b)) is amended— 
(1) in paragraph (4)(A), by striking ‘‘2012 through 2016’’ 
and inserting ‘‘2017 through 2021’’; and 
(2) in paragraph (5), by striking ‘‘2012 through 2016’’ and 
inserting ‘‘2017 through 2021’’. 
(d) REAUTHORIZATION OF FUNDING FOR STATE COURTS.— 
(1) EXTENSION OF PROGRAM.—Section 438(c)(1) of such Act 
(42 U.S.C. 629h(c)(1)) is amended by striking ‘‘2012 through 
2016’’ and inserting ‘‘2017 through 2021’’. 
(2) EXTENSION OF FEDERAL SHARE.—Section 438(d) of such 
Act (42 U.S.C. 629h(d)) is amended by striking ‘‘2012 through 
2016’’ and inserting ‘‘2017 through 2021’’. 
(e) REPEAL OF EXPIRED PROVISIONS.—Section 438(e) of such 
Act (42 U.S.C. 629h(e)) is repealed. 
SEC. 50753. IMPROVEMENTS TO THE JOHN H. CHAFEE FOSTER CARE 
INDEPENDENCE PROGRAM AND RELATED PROVISIONS. 
(a) AUTHORITY TO SERVE FORMER FOSTER YOUTH UP TO AGE 
23.—Section 477 of the Social Security Act (42 U.S.C. 677) is 
amended— 
(1) in subsection (a)(5), by inserting ‘‘(or 23 years of age, 
in the case of a State with a certification under subsection 
(b)(3)(A)(ii) to provide assistance and services to youths who 
have aged out of foster care and have not attained such age, 
in accordance with such subsection)’’ after ‘‘21 years of age’’; 
(2) in subsection (b)(3)(A)— 
(A) by inserting ‘‘(i)’’ before ‘‘A certification’’; 
(B) by striking ‘‘children who have left foster care’’ 
and all that follows through the period and inserting 
‘‘youths who have aged out of foster care and have not 
attained 21 years of age.’’; and 
(C) by adding at the end the following: 
‘‘(ii) If the State has elected under section 475(8)(B) 
to extend eligibility for foster care to all children who 
have not attained 21 years of age, or if the Secretary 
determines that the State agency responsible for admin-
istering the State plans under this part and part B uses 
Determination. 
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132 STAT. 264 
PUBLIC LAW 115–123—FEB. 9, 2018 
State funds or any other funds not provided under this 
part to provide services and assistance for youths who 
have aged out of foster care that are comparable to the 
services and assistance the youths would receive if the 
State had made such an election, the certification required 
under clause (i) may provide that the State will provide 
assistance and services to youths who have aged out of 
foster care and have not attained 23 years of age.’’; and 
(3) in subsection (b)(3)(B), by striking ‘‘children who have 
left foster care’’ and all that follows through the period and 
inserting ‘‘youths who have aged out of foster care and have 
not attained 21 years of age (or 23 years of age, in the case 
of a State with a certification under subparagraph (A)(i) to 
provide assistance and services to youths who have aged out 
of foster care and have not attained such age, in accordance 
with subparagraph (A)(ii)).’’. 
(b) AUTHORITY TO REDISTRIBUTE UNSPENT FUNDS.—Section 
477(d) of such Act (42 U.S.C. 677(d)) is amended— 
(1) in paragraph (4), by inserting ‘‘or does not expend 
allocated funds within the time period specified under section 
477(d)(3)’’ after ‘‘provided by the Secretary’’; and 
(2) by adding at the end the following: 
‘‘(5) REDISTRIBUTION OF UNEXPENDED AMOUNTS.— 
‘‘(A) AVAILABILITY OF AMOUNTS.—To the extent that 
amounts paid to States under this section in a fiscal year 
remain unexpended by the States at the end of the suc-
ceeding fiscal year, the Secretary may make the amounts 
available for redistribution in the second succeeding fiscal 
year among the States that apply for additional funds 
under this section for that second succeeding fiscal year. 
‘‘(B) REDISTRIBUTION.— 
‘‘(i) IN GENERAL.—The Secretary shall redistribute 
the amounts made available under subparagraph (A) 
for a fiscal year among eligible applicant States. In 
this subparagraph, the term ‘eligible applicant State’ 
means a State that has applied for additional funds 
for the fiscal year under subparagraph (A) if the Sec-
retary determines that the State will use the funds 
for the purpose for which originally allotted under 
this section. 
‘‘(ii) AMOUNT TO BE REDISTRIBUTED.—The amount 
to be redistributed to each eligible applicant State shall 
be the amount so made available multiplied by the 
State foster care ratio, (as defined in subsection (c)(4), 
except that, in such subsection, ‘all eligible applicant 
States (as defined in subsection (d)(5)(B)(i))’ shall be 
substituted for ‘all States’). 
‘‘(iii) TREATMENT OF REDISTRIBUTED AMOUNT.—Any 
amount made available to a State under this paragraph 
shall be regarded as part of the allotment of the State 
under this section for the fiscal year in which the 
redistribution is made. 
‘‘(C) TRIBES.—For purposes of this paragraph, the term 
‘State’ includes an Indian tribe, tribal organization, or 
tribal consortium that receives an allotment under this 
section.’’. 
Definition. 
Definition. 
Determination. 
Applicability. 
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132 STAT. 265 
PUBLIC LAW 115–123—FEB. 9, 2018 
(c) EXPANDING AND CLARIFYING THE USE OF EDUCATION AND 
TRAINING VOUCHERS.— 
(1) IN GENERAL.—Section 477(i)(3) of such Act (42 U.S.C. 
677(i)(3)) is amended— 
(A) by striking ‘‘on the date’’ and all that follows 
through ‘‘23’’ and inserting ‘‘to remain eligible until they 
attain 26’’; and 
(B) by inserting ‘‘, but in no event may a youth partici-
pate in the program for more than 5 years (whether or 
not consecutive)’’ before the period. 
(2) CONFORMING
AMENDMENT.—Section 477(i)(1) of such 
Act (42 U.S.C. 677(i)(1)) is amended by inserting ‘‘who have 
attained 14 years of age’’ before the period. 
(d) OTHER IMPROVEMENTS.—Section 477 of such Act (42 U.S.C. 
677), as amended by subsections (a), (b), and (c), is amended— 
(1) in the section heading, by striking ‘‘INDEPENDENCE 
PROGRAM’’ and inserting ‘‘PROGRAM FOR SUCCESSFUL TRANSI-
TION TO ADULTHOOD’’; 
(2) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘identify children who are likely 
to remain in foster care until 18 years of age and 
to help these children make the transition to self- 
sufficiency by providing services’’ and inserting ‘‘sup-
port all youth who have experienced foster care at 
age 14 or older in their transition to adulthood through 
transitional services’’; 
(ii) by inserting ‘‘and post-secondary education’’ 
after ‘‘high school diploma’’; and 
(iii) by striking ‘‘training in daily living skills, 
training in budgeting and financial management skills’’ 
and inserting ‘‘training and opportunities to practice 
daily living skills (such as financial literacy training 
and driving instruction)’’; 
(B) in paragraph (2), by striking ‘‘who are likely to 
remain in foster care until 18 years of age receive the 
education, training, and services necessary to obtain 
employment’’ and inserting ‘‘who have experienced foster 
care at age 14 or older achieve meaningful, permanent 
connections with a caring adult’’; 
(C) in paragraph (3), by striking ‘‘who are likely to 
remain in foster care until 18 years of age prepare for 
and enter postsecondary training and education institu-
tions’’ and inserting ‘‘who have experienced foster care 
at age 14 or older engage in age or developmentally appro-
priate activities, positive youth development, and experien-
tial learning that reflects what their peers in intact families 
experience’’; and 
(D) by striking paragraph (4) and redesignating para-
graphs (5) through (8) as paragraphs (4) through (7); 
(3) in subsection (b)— 
(A) in paragraph (2)(D), by striking ‘‘adolescents’’ and 
inserting ‘‘youth’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (D)— 
(I) by inserting ‘‘including training on youth 
development’’ after ‘‘to provide training’’; and 
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132 STAT. 266 
PUBLIC LAW 115–123—FEB. 9, 2018 
(II) by striking ‘‘adolescents preparing for inde-
pendent living’’ and all that follows through the 
period and inserting ‘‘youth preparing for a 
successful transition to adulthood and making a 
permanent connection with a caring adult.’’; 
(ii) in subparagraph (H), by striking ‘‘adolescents’’ 
each place it appears and inserting ‘‘youth’’; and 
(iii) in subparagraph (K)— 
(I) by striking ‘‘an adolescent’’ and inserting 
‘‘a youth’’; and 
(II) by striking ‘‘the adolescent’’ each place 
it appears and inserting ‘‘the youth’’; and 
(4) in subsection (f), by striking paragraph (2) and inserting 
the following: 
‘‘(2) REPORT TO CONGRESS.—Not later than October 1, 2019, 
the Secretary shall submit to the Committee on Ways and 
Means of the House of Representatives and the Committee 
on Finance of the Senate a report on the National Youth 
in Transition Database and any other databases in which States 
report outcome measures relating to children in foster care 
and children who have aged out of foster care or left foster 
care for kinship guardianship or adoption. The report shall 
include the following: 
‘‘(A) A description of the reasons for entry into foster 
care and of the foster care experiences, such as length 
of stay, number of placement settings, case goal, and dis-
charge reason of 17-year-olds who are surveyed by the 
National Youth in Transition Database and an analysis 
of the comparison of that description with the reasons 
for entry and foster care experiences of children of other 
ages who exit from foster care before attaining age 17. 
‘‘(B) A description of the characteristics of the individ-
uals who report poor outcomes at ages 19 and 21 to the 
National Youth in Transition Database. 
‘‘(C) Benchmarks for determining what constitutes a 
poor outcome for youth who remain in or have exited 
from foster care and plans the executive branch will take 
to incorporate these benchmarks in efforts to evaluate child 
welfare agency performance in providing services to chil-
dren transitioning from foster care. 
‘‘(D) An analysis of the association between types of 
placement, number of overall placements, time spent in 
foster care, and other factors, and outcomes at ages 19 
and 21. 
‘‘(E) An analysis of the differences in outcomes for 
children in and formerly in foster care at age 19 and 
21 among States.’’. 
(e) CLARIFYING DOCUMENTATION PROVIDED TO FOSTER YOUTH 
LEAVING FOSTER CARE.—Section 475(5)(I) of such Act (42 U.S.C. 
675(5)(I)) is amended by inserting after ‘‘REAL ID Act of 2005’’ 
the following: ‘‘, and any official documentation necessary to prove 
that the child was previously in foster care’’. 
Determination. 
Analyses. 
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132 STAT. 267 
PUBLIC LAW 115–123—FEB. 9, 2018 
PART 
VI—CONTINUING 
INCENTIVES 
TO 
STATES TO PROMOTE ADOPTION AND LEGAL 
GUARDIANSHIP 
SEC. 50761. REAUTHORIZING ADOPTION AND LEGAL GUARDIANSHIP 
INCENTIVE PROGRAMS. 
(a) IN GENERAL.—Section 473A of the Social Security Act (42 
U.S.C. 673b) is amended— 
(1) in subsection (b)(4), by striking ‘‘2013 through 2015’’ 
and inserting ‘‘2016 through 2020’’; 
(2) in subsection (h)(1)(D), by striking ‘‘2016’’ and inserting 
‘‘2021’’; and 
(3) in subsection (h)(2), by striking ‘‘2016’’ and inserting 
‘‘2021’’. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall take effect as if enacted on October 1, 2017. 
PART VII—TECHNICAL CORRECTIONS 
SEC. 50771. TECHNICAL CORRECTIONS TO DATA EXCHANGE STAND-
ARDS TO IMPROVE PROGRAM COORDINATION. 
(a) IN GENERAL.—Section 440 of the Social Security Act (42 
U.S.C. 629m) is amended to read as follows: 
‘‘SEC. 440. DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPER-
ABILITY. 
‘‘(a) DESIGNATION.—The Secretary shall, in consultation with 
an interagency work group established by the Office of Management 
and Budget and considering State government perspectives, by 
rule, designate data exchange standards to govern, under this part 
and part E— 
‘‘(1) necessary categories of information that State agencies 
operating programs under State plans approved under this 
part are required under applicable Federal law to electronically 
exchange with another State agency; and 
‘‘(2) Federal reporting and data exchange required under 
applicable Federal law. 
‘‘(b) REQUIREMENTS.—The data exchange standards required 
by paragraph (1) shall, to the extent practicable— 
‘‘(1) incorporate a widely accepted, non-proprietary, search-
able, computer-readable format, such as the Extensible Markup 
Language; 
‘‘(2) contain interoperable standards developed and main-
tained by intergovernmental partnerships, such as the National 
Information Exchange Model; 
‘‘(3) incorporate interoperable standards developed and 
maintained by Federal entities with authority over contracting 
and financial assistance; 
‘‘(4) 
be 
consistent 
with 
and 
implement 
applicable 
accounting principles; 
‘‘(5) be implemented in a manner that is cost-effective 
and improves program efficiency and effectiveness; and 
‘‘(6) be capable of being continually upgraded as necessary. 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this subsection shall 
be construed to require a change to existing data exchange stand-
ards found to be effective and efficient.’’. 
Consultation. 
Establishment. 
42 USC 673b 
note. 
42 USC 673b 
note. 
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132 STAT. 268 
PUBLIC LAW 115–123—FEB. 9, 2018 
(b) EFFECTIVE DATE.—Not later than the date that is 24 months 
after the date of the enactment of this section, the Secretary of 
Health and Human Services shall issue a proposed rule that— 
(1) identifies federally required data exchanges, include 
specification and timing of exchanges to be standardized, and 
address the factors used in determining whether and when 
to standardize data exchanges; and 
(2) specifies State implementation options and describes 
future milestones. 
SEC. 50772. TECHNICAL CORRECTIONS TO STATE REQUIREMENT TO 
ADDRESS THE DEVELOPMENTAL NEEDS OF YOUNG 
CHILDREN. 
Section 422(b)(18) of the Social Security Act (42 U.S.C. 
622(b)(18)) is amended by striking ‘‘such children’’ and inserting 
‘‘all vulnerable children under 5 years of age’’. 
PART VIII—ENSURING STATES REINVEST SAV-
INGS RESULTING FROM INCREASE IN ADOP-
TION ASSISTANCE 
SEC. 50781. DELAY OF ADOPTION ASSISTANCE PHASE-IN. 
(a) IN GENERAL.—The table in section 473(e)(1)(B) of the Social 
Security Act (42 U.S.C. 673(e)(1)(B)) is amended by striking the 
last 2 rows and inserting the following: 
‘‘2017 through 2023 .....................
2 
2024 ..............................................
2 (or, in the case of a child for 
whom an adoption assistance 
agreement 
is 
entered 
into 
under this section on or after 
July 1, 2024, any age) 
2025 or thereafter .......................
any age.’’. 
(b) EFFECTIVE DATE.—The amendment made by this section 
shall take effect as if enacted on January 1, 2018. 
SEC. 50782. GAO STUDY AND REPORT ON STATE REINVESTMENT OF 
SAVINGS RESULTING FROM INCREASE IN ADOPTION 
ASSISTANCE. 
(a) STUDY.—The Comptroller General of the United States shall 
study the extent to which States are complying with the require-
ments of section 473(a)(8) of the Social Security Act (42 U.S.C. 
673(a)(8)) relating to the effects of phasing out the AFDC income 
eligibility requirements for adoption assistance payments under 
section 473 of the Social Security Act, as enacted by section 402 
of the Fostering Connections to Success and Increasing Adoptions 
Act of 2008 (Public Law 110–351; 122 Stat. 3975) and amended 
by section 206 of the Preventing Sex Trafficking and Strengthening 
Families Act (Public Law 113–183; 128 Stat. 1919). In particular, 
the Comptroller General shall analyze the extent to which States 
are complying with the following requirements under section 
473(a)(8)(D) of the Social Security Act: 
Analysis. 
42 USC 673 note. 
Determination. 
Deadline. 
Regulations. 
42 USC 629m 
note. 
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132 STAT. 269 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) The requirement to spend an amount equal to the 
amount of the savings (if any) in State expenditures under 
part E of title IV of the Social Security Act resulting from 
phasing out the AFDC income eligibility requirements for adop-
tion assistance payments under section 473 of such Act to 
provide to children of families any service that may be provided 
under part B or E of title IV of such Act. 
(2) The requirement that a State shall spend not less 
than 30 percent of the amount of any savings described in 
paragraph (1) on post-adoption services, post-guardianship serv-
ices, and services to support and sustain positive permanent 
outcomes for children who otherwise might enter into foster 
care under the responsibility of the State, with at least 2⁄3 
of the spending by the State to comply with the 30 percent 
requirement being spent on post-adoption and post-guardian-
ship services. 
(b) REPORT.—The Comptroller General of the United States 
shall submit to the Committee on Finance of the Senate, the Com-
mittee on Ways and Means of the House of Representatives, and 
the Secretary of Health and Human Services a report that contains 
the results of the study required by subsection (a), including rec-
ommendations to ensure compliance with laws referred to in sub-
section (a). 
TITLE VIII—SUPPORTING SOCIAL IM-
PACT PARTNERSHIPS TO PAY FOR RE-
SULTS 
SEC. 50801. SHORT TITLE. 
This subtitle may be cited as the ‘‘Social Impact Partnerships 
to Pay for Results Act’’. 
SEC. 50802. SOCIAL IMPACT PARTNERSHIPS TO PAY FOR RESULTS. 
Title XX of the Social Security Act (42 U.S.C. 1397 et seq.) 
is amended— 
(1) in the title heading, by striking ‘‘TO STATES’’ and 
inserting ‘‘AND PROGRAMS’’; and 
(2) by adding at the end the following: 
‘‘Subtitle C—Social Impact Demonstration Projects 
‘‘PURPOSES 
‘‘SEC. 2051. The purposes of this subtitle are the following: 
‘‘(1) To improve the lives of families and individuals in 
need in the United States by funding social programs that 
achieve real results. 
‘‘(2) To redirect funds away from programs that, based 
on objective data, are ineffective, and into programs that 
achieve demonstrable, measurable results. 
‘‘(3) To ensure Federal funds are used effectively on social 
services to produce positive outcomes for both service recipients 
and taxpayers. 
‘‘(4) To establish the use of social impact partnerships 
to address some of our Nation’s most pressing problems. 
42 USC 1397n 
note. 
42 USC 1305 
note. 
Social Impact 
Partnerships to 
Pay for Results 
Act. 
Recommenda- 
tions. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(5) To facilitate the creation of public-private partnerships 
that bundle philanthropic or other private resources with 
existing public spending to scale up effective social interven-
tions already being implemented by private organizations, non-
profits, charitable organizations, and State and local govern-
ments across the country. 
‘‘(6) To bring pay-for-performance to the social sector, 
allowing the United States to improve the impact and effective-
ness of vital social services programs while redirecting ineffi-
cient or duplicative spending. 
‘‘(7) To incorporate outcomes measurement and randomized 
controlled trials or other rigorous methodologies for assessing 
program impact. 
‘‘SOCIAL IMPACT PARTNERSHIP APPLICATION 
‘‘SEC. 2052. (a) NOTICE.—Not later than 1 year after the date 
of the enactment of this subtitle, the Secretary of the Treasury, 
in consultation with the Federal Interagency Council on Social 
Impact Partnerships, shall publish in the Federal Register a request 
for proposals from States or local governments for social impact 
partnership projects in accordance with this section. 
‘‘(b) REQUIRED OUTCOMES
FOR SOCIAL IMPACT PARTNERSHIP 
PROJECT.—To qualify as a social impact partnership project under 
this subtitle, a project must produce one or more measurable, clearly 
defined outcomes that result in social benefit and Federal, State, 
or local savings through any of the following: 
‘‘(1) Increasing work and earnings by individuals in the 
United States who are unemployed for more than 6 consecutive 
months. 
‘‘(2) Increasing employment and earnings of individuals 
who have attained 16 years of age but not 25 years of age. 
‘‘(3) Increasing employment among individuals receiving 
Federal disability benefits. 
‘‘(4) Reducing the dependence of low-income families on 
Federal means-tested benefits. 
‘‘(5) Improving rates of high school graduation. 
‘‘(6) Reducing teen and unplanned pregnancies. 
‘‘(7) Improving birth outcomes and early childhood health 
and development among low-income families and individuals. 
‘‘(8) Reducing rates of asthma, diabetes, or other prevent-
able diseases among low-income families and individuals to 
reduce the utilization of emergency and other high-cost care. 
‘‘(9) Increasing the proportion of children living in two- 
parent families. 
‘‘(10) Reducing incidences and adverse consequences of child 
abuse and neglect. 
‘‘(11) Reducing the number of youth in foster care by 
increasing adoptions, permanent guardianship arrangements, 
reunifications, or placements with a fit and willing relative, 
or by avoiding placing children in foster care by ensuring they 
can be cared for safely in their own homes. 
‘‘(12) Reducing the number of children and youth in foster 
care residing in group homes, child care institutions, agency- 
operated foster homes, or other non-family foster homes, unless 
it is determined that it is in the interest of the child’s long- 
term health, safety, or psychological well-being to not be placed 
in a family foster home. 
Deadline. 
Consultation. 
Federal Register, 
publication. 
42 USC 1397n–1 
note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(13) Reducing the number of children returning to foster 
care. 
‘‘(14) Reducing recidivism among juvenile offenders, 
individuals released from prison, or other high-risk populations. 
‘‘(15) Reducing the rate of homelessness among our most 
vulnerable populations. 
‘‘(16) Improving the health and well-being of those with 
mental, emotional, and behavioral health needs. 
‘‘(17) Improving the educational outcomes of special-needs 
or low-income children. 
‘‘(18) Improving the employment and well-being of 
returning United States military members. 
‘‘(19) Increasing the financial stability of low-income fami-
lies. 
‘‘(20) Increasing the independence and employability of 
individuals who are physically or mentally disabled. 
‘‘(21) Other measurable outcomes defined by the State or 
local government that result in positive social outcomes and 
Federal savings. 
‘‘(c) APPLICATION REQUIRED.—The notice described in subsection 
(a) shall require a State or local government to submit an applica-
tion for the social impact partnership project that addresses the 
following: 
‘‘(1) The outcome goals of the project. 
‘‘(2) A description of each intervention in the project and 
anticipated outcomes of the intervention. 
‘‘(3) Rigorous evidence demonstrating that the intervention 
can be expected to produce the desired outcomes. 
‘‘(4) The target population that will be served by the project. 
‘‘(5) The expected social benefits to participants who receive 
the intervention and others who may be impacted. 
‘‘(6) Projected Federal, State, and local government costs 
and other costs to conduct the project. 
‘‘(7) Projected Federal, State, and local government savings 
and other savings, including an estimate of the savings to 
the Federal Government, on a program-by-program basis and 
in the aggregate, if the project is implemented and the outcomes 
are achieved as a result of the intervention. 
‘‘(8) If savings resulting from the successful completion 
of the project are estimated to accrue to the State or local 
government, the likelihood of the State or local government 
to realize those savings. 
‘‘(9) A plan for delivering the intervention through a social 
impact partnership model. 
‘‘(10) A description of the expertise of each service provider 
that will administer the intervention, including a summary 
of the experience of the service provider in delivering the pro-
posed intervention or a similar intervention, or demonstrating 
that the service provider has the expertise necessary to deliver 
the proposed intervention. 
‘‘(11) An explanation of the experience of the State or 
local government, the intermediary, or the service provider 
in raising private and philanthropic capital to fund social 
service investments. 
‘‘(12) The detailed roles and responsibilities of each entity 
involved in the project, including any State or local government 
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132 STAT. 272 
PUBLIC LAW 115–123—FEB. 9, 2018 
entity, intermediary, service provider, independent evaluator, 
investor, or other stakeholder. 
‘‘(13) A summary of the experience of the service provider 
in delivering the proposed intervention or a similar interven-
tion, or a summary demonstrating the service provider has 
the expertise necessary to deliver the proposed intervention. 
‘‘(14) A summary of the unmet need in the area where 
the intervention will be delivered or among the target popu-
lation who will receive the intervention. 
‘‘(15) The proposed payment terms, the methodology used 
to calculate outcome payments, the payment schedule, and 
performance thresholds. 
‘‘(16) The project budget. 
‘‘(17) The project timeline. 
‘‘(18) The criteria used to determine the eligibility of an 
individual for the project, including how selected populations 
will be identified, how they will be referred to the project, 
and how they will be enrolled in the project. 
‘‘(19) The evaluation design. 
‘‘(20) The metrics that will be used in the evaluation to 
determine whether the outcomes have been achieved as a result 
of the intervention and how the metrics will be measured. 
‘‘(21) An explanation of how the metrics used in the evalua-
tion to determine whether the outcomes achieved as a result 
of the intervention are independent, objective indicators of 
impact and are not subject to manipulation by the service 
provider, intermediary, or investor. 
‘‘(22) A summary explaining the independence of the eval-
uator from the other entities involved in the project and the 
evaluator’s experience in conducting rigorous evaluations of 
program effectiveness including, where available, well-imple-
mented randomized controlled trials on the intervention or 
similar interventions. 
‘‘(23) The capacity of the service provider to deliver the 
intervention to the number of participants the State or local 
government proposes to serve in the project. 
‘‘(24) A description of whether and how the State or local 
government and service providers plan to sustain the interven-
tion, if it is timely and appropriate to do so, to ensure that 
successful interventions continue to operate after the period 
of the social impact partnership. 
‘‘(d) PROJECT
INTERMEDIARY
INFORMATION
REQUIRED.—The 
application described in subsection (c) shall also contain the fol-
lowing information about any intermediary for the social impact 
partnership project (whether an intermediary is a service provider 
or other entity): 
‘‘(1) Experience and capacity for providing or facilitating 
the provision of the type of intervention proposed. 
‘‘(2) The mission and goals. 
‘‘(3) Information on whether the intermediary is already 
working with service providers that provide this intervention 
or an explanation of the capacity of the intermediary to begin 
working with service providers to provide the intervention. 
‘‘(4) Experience working in a collaborative environment 
across government and nongovernmental entities. 
‘‘(5) Previous experience collaborating with public or private 
entities to implement evidence-based programs. 
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132 STAT. 273 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(6) Ability to raise or provide funding to cover operating 
costs (if applicable to the project). 
‘‘(7) Capacity and infrastructure to track outcomes and 
measure results, including— 
‘‘(A) capacity to track and analyze program perform-
ance and assess program impact; and 
‘‘(B) experience with performance-based awards or 
performance-based contracting and achieving project mile-
stones and targets. 
‘‘(8) Role in delivering the intervention. 
‘‘(9) How the intermediary would monitor program success, 
including a description of the interim benchmarks and outcome 
measures. 
‘‘(e) FEASIBILITY STUDIES FUNDED THROUGH OTHER SOURCES.— 
The notice described in subsection (a) shall permit a State or 
local government to submit an application for social impact partner-
ship funding that contains information from a feasibility study 
developed for purposes other than applying for funding under this 
subtitle. 
‘‘AWARDING SOCIAL IMPACT PARTNERSHIP AGREEMENTS 
‘‘SEC. 2053. (a) TIMELINE IN AWARDING AGREEMENT.—Not later 
than 6 months after receiving an application in accordance with 
section 2052, the Secretary, in consultation with the Federal Inter-
agency Council on Social Impact Partnerships, shall determine 
whether to enter into an agreement for a social impact partnership 
project with a State or local government. 
‘‘(b) CONSIDERATIONS
IN AWARDING AGREEMENT.—In deter-
mining whether to enter into an agreement for a social impact 
partnership project (the application for which was submitted under 
section 2052) the Secretary, in consultation with the Federal Inter-
agency Council on Social Impact Partnerships and the head of 
any Federal agency administering a similar intervention or serving 
a population similar to that served by the project, shall consider 
each of the following: 
‘‘(1) The recommendations made by the Commission on 
Social Impact Partnerships. 
‘‘(2) The value to the Federal Government of the outcomes 
expected to be achieved if the outcomes specified in the agree-
ment are achieved as a result of the intervention. 
‘‘(3) The likelihood, based on evidence provided in the 
application and other evidence, that the State or local govern-
ment in collaboration with the intermediary and the service 
providers will achieve the outcomes. 
‘‘(4) The savings to the Federal Government if the outcomes 
specified in the agreement are achieved as a result of the 
intervention. 
‘‘(5) The savings to the State and local governments if 
the outcomes specified in the agreement are achieved as a 
result of the intervention. 
‘‘(6) The expected quality of the evaluation that would 
be conducted with respect to the agreement. 
‘‘(7) The capacity and commitment of the State or local 
government to sustain the intervention, if appropriate and 
timely and if the intervention is successful, beyond the period 
of the social impact partnership. 
‘‘(c) AGREEMENT AUTHORITY.— 
Determinations. 
Deadline. 
Consultation. 
Determination. 
42 USC 1397n–2 
note. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(1) AGREEMENT REQUIREMENTS.—In accordance with this 
section, the Secretary, in consultation with the Federal Inter-
agency Council on Social Impact Partnerships and the head 
of any Federal agency administering a similar intervention 
or serving a population similar to that served by the project, 
may enter into an agreement for a social impact partnership 
project with a State or local government if the Secretary, in 
consultation with the Federal Interagency Council on Social 
Impact Partnerships, determines that each of the following 
requirements are met: 
‘‘(A) The State or local government agrees to achieve 
one or more outcomes as a result of the intervention, as 
specified in the agreement and validated by independent 
evaluation, in order to receive payment. 
‘‘(B) The Federal payment to the State or local govern-
ment for each specified outcome achieved as a result of 
the intervention is less than or equal to the value of the 
outcome to the Federal Government over a period not to 
exceed 10 years, as determined by the Secretary, in con-
sultation with the State or local government. 
‘‘(C) The duration of the project does not exceed 10 
years. 
‘‘(D) The State or local government has demonstrated, 
through the application submitted under section 2052, that, 
based on prior rigorous experimental evaluations or rig-
orous quasi-experimental studies, the intervention can be 
expected to achieve each outcome specified in the agree-
ment. 
‘‘(E) The State, local government, intermediary, or 
service provider has experience raising private or philan-
thropic capital to fund social service investments (if 
applicable to the project). 
‘‘(F) The State or local government has shown that 
each service provider has experience delivering the inter-
vention, a similar intervention, or has otherwise dem-
onstrated the expertise necessary to deliver the interven-
tion. 
‘‘(2) PAYMENT.—The Secretary shall pay the State or local 
government only if the independent evaluator described in sec-
tion 2055 determines that the social impact partnership project 
has met the requirements specified in the agreement and 
achieved an outcome as a result of the intervention, as specified 
in the agreement and validated by independent evaluation. 
‘‘(d) NOTICE OF AGREEMENT AWARD.—Not later than 30 days 
after entering into an agreement under this section the Secretary 
shall publish a notice in the Federal Register that includes, with 
regard to the agreement, the following: 
‘‘(1) The outcome goals of the social impact partnership 
project. 
‘‘(2) A description of each intervention in the project. 
‘‘(3) The target population that will be served by the project. 
‘‘(4) The expected social benefits to participants who receive 
the intervention and others who may be impacted. 
‘‘(5) The detailed roles, responsibilities, and purposes of 
each Federal, State, or local government entity, intermediary, 
service provider, independent evaluator, investor, or other 
stakeholder. 
Deadline. 
Federal Register, 
publication. 
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132 STAT. 275 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(6) The payment terms, the methodology used to calculate 
outcome payments, the payment schedule, and performance 
thresholds. 
‘‘(7) The project budget. 
‘‘(8) The project timeline. 
‘‘(9) The project eligibility criteria. 
‘‘(10) The evaluation design. 
‘‘(11) The metrics that will be used in the evaluation to 
determine whether the outcomes have been achieved as a result 
of each intervention and how these metrics will be measured. 
‘‘(12) The estimate of the savings to the Federal, State, 
and local government, on a program-by-program basis and in 
the aggregate, if the agreement is entered into and implemented 
and the outcomes are achieved as a result of each intervention. 
‘‘(e) AUTHORITY
TO
TRANSFER
ADMINISTRATION
OF
AGREE-
MENT.—The Secretary may transfer to the head of another Federal 
agency the authority to administer (including making payments 
under) an agreement entered into under subsection (c), and any 
funds necessary to do so. 
‘‘(f) REQUIREMENT ON FUNDING USED TO BENEFIT CHILDREN.— 
Not less than 50 percent of all Federal payments made to carry 
out agreements under this section shall be used for initiatives 
that directly benefit children. 
‘‘FEASIBILITY STUDY FUNDING 
‘‘SEC. 2054. (a) REQUESTS
FOR
FUNDING
FOR
FEASIBILITY 
STUDIES.—The Secretary shall reserve a portion of the amount 
made available to carry out this subtitle to assist States or local 
governments in developing feasibility studies to apply for social 
impact partnership funding under section 2052. To be eligible to 
receive funding to assist with completing a feasibility study, a 
State or local government shall submit an application for feasibility 
study funding addressing the following: 
‘‘(1) A description of the outcome goals of the social impact 
partnership project. 
‘‘(2) A description of the intervention, including anticipated 
program design, target population, an estimate regarding the 
number of individuals to be served, and setting for the interven-
tion. 
‘‘(3) Evidence to support the likelihood that the intervention 
will produce the desired outcomes. 
‘‘(4) A description of the potential metrics to be used. 
‘‘(5) The expected social benefits to participants who receive 
the intervention and others who may be impacted. 
‘‘(6) Estimated costs to conduct the project. 
‘‘(7) Estimates of Federal, State, and local government 
savings and other savings if the project is implemented and 
the outcomes are achieved as a result of each intervention. 
‘‘(8) An estimated timeline for implementation and comple-
tion of the project, which shall not exceed 10 years. 
‘‘(9) With respect to a project for which the State or local 
government selects an intermediary to operate the project, any 
partnerships needed to successfully execute the project and 
the ability of the intermediary to foster the partnerships. 
‘‘(10) The expected resources needed to complete the feasi-
bility study for the State or local government to apply for 
social impact partnership funding under section 2052. 
Time period. 
Estimates. 
Cost estimate. 
42 USC 1397n–3 
note. 
Estimate. 
Criteria. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(b) FEDERAL SELECTION
OF APPLICATIONS
FOR FEASIBILITY 
STUDY.—Not later than 6 months after receiving an application 
for feasibility study funding under subsection (a), the Secretary, 
in consultation with the Federal Interagency Council on Social 
Impact Partnerships and the head of any Federal agency admin-
istering a similar intervention or serving a population similar to 
that served by the project, shall select State or local government 
feasibility study proposals for funding based on the following: 
‘‘(1) The recommendations made by the Commission on 
Social Impact Partnerships. 
‘‘(2) The likelihood that the proposal will achieve the 
desired outcomes. 
‘‘(3) The value of the outcomes expected to be achieved 
as a result of each intervention. 
‘‘(4) The potential savings to the Federal Government if 
the social impact partnership project is successful. 
‘‘(5) The potential savings to the State and local govern-
ments if the project is successful. 
‘‘(c) PUBLIC DISCLOSURE.—Not later than 30 days after selecting 
a State or local government for feasibility study funding under 
this section, the Secretary shall cause to be published on the website 
of the Federal Interagency Council on Social Impact Partnerships 
information explaining why a State or local government was granted 
feasibility study funding. 
‘‘(d) FUNDING RESTRICTION.— 
‘‘(1) FEASIBILITY STUDY RESTRICTION.—The Secretary may 
not provide feasibility study funding under this section for 
more than 50 percent of the estimated total cost of the feasi-
bility study reported in the State or local government applica-
tion submitted under subsection (a). 
‘‘(2) AGGREGATE RESTRICTION.—Of the total amount made 
available to carry out this subtitle, the Secretary may not 
use more than $10,000,000 to provide feasibility study funding 
to States or local governments under this section. 
‘‘(3) NO GUARANTEE OF FUNDING.—The Secretary shall have 
the option to award no funding under this section. 
‘‘(e) SUBMISSION OF FEASIBILITY STUDY REQUIRED.—Not later 
than 9 months after the receipt of feasibility study funding under 
this section, a State or local government receiving the funding 
shall complete the feasibility study and submit the study to the 
Federal Interagency Council on Social Impact Partnerships. 
‘‘(f) DELEGATION OF AUTHORITY.—The Secretary may transfer 
to the head of another Federal agency the authorities provided 
in this section and any funds necessary to exercise the authorities. 
‘‘EVALUATIONS 
‘‘SEC. 2055. (a) AUTHORITY
TO ENTER INTO AGREEMENTS.— 
For each State or local government awarded a social impact partner-
ship project approved by the Secretary under this subtitle, the 
head of the relevant agency, as recommended by the Federal Inter-
agency Council on Social Impact Partnerships and determined by 
the Secretary, shall enter into an agreement with the State or 
local government to pay for all or part of the independent evaluation 
to determine whether the State or local government project has 
achieved a specific outcome as a result of the intervention in order 
for the State or local government to receive outcome payments 
under this subtitle. 
Determination. 
42 USC 1397n–4 
note. 
Deadline. 
Deadline. 
Web posting. 
Deadline. 
Consultation. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(b) EVALUATOR QUALIFICATIONS.—The head of the relevant 
agency may not enter into an agreement with a State or local 
government unless the head determines that the evaluator is inde-
pendent of the other parties to the agreement and has demonstrated 
substantial experience in conducting rigorous evaluations of pro-
gram effectiveness including, where available and appropriate, well- 
implemented randomized controlled trials on the intervention or 
similar interventions. 
‘‘(c) METHODOLOGIES
TO BE USED.—The evaluation used to 
determine whether a State or local government will receive outcome 
payments under this subtitle shall use experimental designs using 
random assignment or other reliable, evidence-based research meth-
odologies, as certified by the Federal Interagency Council on Social 
Impact Partnerships, that allow for the strongest possible causal 
inferences when random assignment is not feasible. 
‘‘(d) PROGRESS REPORT.— 
‘‘(1) SUBMISSION OF REPORT.—The independent evaluator 
shall— 
‘‘(A) not later than 2 years after a project has been 
approved by the Secretary and biannually thereafter until 
the project is concluded, submit to the head of the relevant 
agency and the Federal Interagency Council on Social 
Impact Partnerships a written report summarizing the 
progress that has been made in achieving each outcome 
specified in the agreement; and 
‘‘(B) before the scheduled time of the first outcome 
payment and before the scheduled time of each subsequent 
payment, submit to the head of the relevant agency and 
the Federal Interagency Council on Social Impact Partner-
ships a written report that includes the results of the 
evaluation conducted to determine whether an outcome 
payment should be made along with information on the 
unique factors that contributed to achieving or failing to 
achieve the outcome, the challenges faced in attempting 
to achieve the outcome, and information on the improved 
future delivery of this or similar interventions. 
‘‘(2) SUBMISSION TO THE SECRETARY AND CONGRESS.—Not 
later than 30 days after receipt of the written report pursuant 
to paragraph (1)(B), the Federal Interagency Council on Social 
Impact Partnerships shall submit the report to the Secretary 
and each committee of jurisdiction in the House of Representa-
tives and the Senate. 
‘‘(e) FINAL REPORT.— 
‘‘(1) SUBMISSION OF REPORT.—Within 6 months after the 
social impact partnership project is completed, the independent 
evaluator shall— 
‘‘(A) evaluate the effects of the activities undertaken 
pursuant to the agreement with regard to each outcome 
specified in the agreement; and 
‘‘(B) submit to the head of the relevant agency and 
the Federal Interagency Council on Social Impact Partner-
ships a written report that includes the results of the 
evaluation and the conclusion of the evaluator as to 
whether the State or local government has fulfilled each 
obligation of the agreement, along with information on 
the unique factors that contributed to the success or failure 
of the project, the challenges faced in attempting to achieve 
Evaluation. 
Evaluation. 
Certification. 
Determination. 
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PUBLIC LAW 115–123—FEB. 9, 2018 
the outcome, and information on the improved future 
delivery of this or similar interventions. 
‘‘(2) SUBMISSION TO THE SECRETARY AND CONGRESS.—Not 
later than 30 days after receipt of the written report pursuant 
to paragraph (1)(B), the Federal Interagency Council on Social 
Impact Partnerships shall submit the report to the Secretary 
and each committee of jurisdiction in the House of Representa-
tives and the Senate. 
‘‘(f) LIMITATION
ON COST
OF EVALUATIONS.—Of the amount 
made available under this subtitle for social impact partnership 
projects, the Secretary may not obligate more than 15 percent 
to evaluate the implementation and outcomes of the projects. 
‘‘(g) DELEGATION OF AUTHORITY.—The Secretary may transfer 
to the head of another Federal agency the authorities provided 
in this section and any funds necessary to exercise the authorities. 
‘‘FEDERAL INTERAGENCY COUNCIL ON SOCIAL IMPACT PARTNERSHIPS 
‘‘SEC. 2056. (a) ESTABLISHMENT.—There is established the Fed-
eral Interagency Council on Social Impact Partnerships (in this 
section referred to as the ‘Council’) to— 
‘‘(1) coordinate with the Secretary on the efforts of social 
impact partnership projects funded under this subtitle; 
‘‘(2) advise and assist the Secretary in the development 
and implementation of the projects; 
‘‘(3) advise the Secretary on specific programmatic and 
policy matter related to the projects; 
‘‘(4) provide subject-matter expertise to the Secretary with 
regard to the projects; 
‘‘(5) certify to the Secretary that each State or local govern-
ment that has entered into an agreement with the Secretary 
for a social impact partnership project under this subtitle and 
each evaluator selected by the head of the relevant agency 
under section 2055 has access to Federal administrative data 
to assist the State or local government and the evaluator in 
evaluating the performance and outcomes of the project; 
‘‘(6) address issues that will influence the future of social 
impact partnership projects in the United States; 
‘‘(7) provide guidance to the executive branch on the future 
of social impact partnership projects in the United States; 
‘‘(8) prior to approval by the Secretary, certify that each 
State and local government application for a social impact 
partnership contains rigorous, independent data and reliable, 
evidence-based research methodologies to support the conclu-
sion that the project will yield savings to the State or local 
government or the Federal Government if the project outcomes 
are achieved; 
‘‘(9) certify to the Secretary, in the case of each approved 
social impact partnership that is expected to yield savings 
to the Federal Government, that the project will yield a pro-
jected savings to the Federal Government if the project out-
comes are achieved, and coordinate with the relevant Federal 
agency to produce an after-action accounting once the project 
is complete to determine the actual Federal savings realized, 
and the extent to which actual savings aligned with projected 
savings; and 
Certification. 
Certification. 
Certification. 
42 USC 1397n–5 
note. 
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132 STAT. 279 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(10) provide periodic reports to the Secretary and make 
available reports periodically to Congress and the public on 
the implementation of this subtitle. 
‘‘(b) COMPOSITION
OF COUNCIL.—The Council shall have 11 
members, as follows: 
‘‘(1) CHAIR.—The Chair of the Council shall be the Director 
of the Office of Management and Budget. 
‘‘(2) OTHER MEMBERS.—The head of each of the following 
entities shall designate one officer or employee of the entity 
to be a Council member: 
‘‘(A) The Department of Labor. 
‘‘(B) The Department of Health and Human Services. 
‘‘(C) The Social Security Administration. 
‘‘(D) The Department of Agriculture. 
‘‘(E) The Department of Justice. 
‘‘(F) The Department of Housing and Urban Develop-
ment. 
‘‘(G) The Department of Education. 
‘‘(H) The Department of Veterans Affairs. 
‘‘(I) The Department of the Treasury. 
‘‘(J) The Corporation for National and Community 
Service. 
‘‘COMMISSION ON SOCIAL IMPACT PARTNERSHIPS 
‘‘SEC. 2057. (a) ESTABLISHMENT.—There is established the 
Commission on Social Impact Partnerships (in this section referred 
to as the ‘Commission’). 
‘‘(b) DUTIES.—The duties of the Commission shall be to— 
‘‘(1) assist the Secretary and the Federal Interagency 
Council on Social Impact Partnerships in reviewing applications 
for funding under this subtitle; 
‘‘(2) make recommendations to the Secretary and the Fed-
eral Interagency Council on Social Impact Partnerships 
regarding the funding of social impact partnership agreements 
and feasibility studies; and 
‘‘(3) provide other assistance and information as requested 
by the Secretary or the Federal Interagency Council on Social 
Impact Partnerships. 
‘‘(c) COMPOSITION.—The Commission shall be composed of nine 
members, of whom— 
‘‘(1) one shall be appointed by the President, who will 
serve as the Chair of the Commission; 
‘‘(2) one shall be appointed by the Majority Leader of the 
Senate; 
‘‘(3) one shall be appointed by the Minority Leader of 
the Senate; 
‘‘(4) one shall be appointed by the Speaker of the House 
of Representatives; 
‘‘(5) one shall be appointed by the Minority Leader of 
the House of Representatives; 
‘‘(6) one shall be appointed by the Chairman of the Com-
mittee on Finance of the Senate; 
‘‘(7) one shall be appointed by the ranking member of 
the Committee on Finance of the Senate; 
‘‘(8) one member shall be appointed by the Chairman of 
the Committee on Ways and Means of the House of Representa-
tives; and 
Recommenda- 
tions. 
42 USC 1397n–6 
note. 
Reports. 
Public 
information. 
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132 STAT. 280 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(9) one shall be appointed by the ranking member of 
the Committee on Ways and Means of the House of Representa-
tives. 
‘‘(d) QUALIFICATIONS OF COMMISSION MEMBERS.—The members 
of the Commission shall— 
‘‘(1) be experienced in finance, economics, pay for perform-
ance, or program evaluation; 
‘‘(2) have relevant professional or personal experience in 
a field related to one or more of the outcomes listed in this 
subtitle; or 
‘‘(3) be qualified to review applications for social impact 
partnership projects to determine whether the proposed metrics 
and evaluation methodologies are appropriately rigorous and 
reliant upon independent data and evidence-based research. 
‘‘(e) TIMING OF APPOINTMENTS.—The appointments of the mem-
bers of the Commission shall be made not later than 120 days 
after the date of the enactment of this subtitle, or, in the event 
of a vacancy, not later than 90 days after the date the vacancy 
arises. If a member of Congress fails to appoint a member by 
that date, the President may select a member of the President’s 
choice on behalf of the member of Congress. Notwithstanding the 
preceding sentence, if not all appointments have been made to 
the Commission as of that date, the Commission may operate 
with no fewer than five members until all appointments have been 
made. 
‘‘(f) TERM OF APPOINTMENTS.— 
‘‘(1) IN
GENERAL.—The members appointed under sub-
section (c) shall serve as follows: 
‘‘(A) Three members shall serve for 2 years. 
‘‘(B) Three members shall serve for 3 years. 
‘‘(C) Three members (one of which shall be Chair of 
the Commission appointed by the President) shall serve 
for 4 years. 
‘‘(2) ASSIGNMENT OF TERMS.—The Commission shall des-
ignate the term length that each member appointed under 
subsection (c) shall serve by unanimous agreement. In the 
event that unanimous agreement cannot be reached, term 
lengths shall be assigned to the members by a random process. 
‘‘(g) VACANCIES.—Subject to subsection (e), in the event of a 
vacancy in the Commission, whether due to the resignation of 
a member, the expiration of a member’s term, or any other reason, 
the vacancy shall be filled in the manner in which the original 
appointment was made and shall not affect the powers of the 
Commission. 
‘‘(h) APPOINTMENT
POWER.—Members of the Commission 
appointed under subsection (c) shall not be subject to confirmation 
by the Senate. 
‘‘LIMITATION ON USE OF FUNDS 
‘‘SEC. 2058. Of the amounts made available to carry out this 
subtitle, the Secretary may not use more than $2,000,000 in any 
fiscal year to support the review, approval, and oversight of social 
impact partnership projects, including activities conducted by— 
‘‘(1) the Federal Interagency Council on Social Impact Part-
nerships; and 
42 USC 1397n–7 
note. 
President. 
President. 
Deadlines. 
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132 STAT. 281 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(2) any other agency consulted by the Secretary before 
approving a social impact partnership project or a feasibility 
study under section 2054. 
‘‘NO FEDERAL FUNDING FOR CREDIT ENHANCEMENTS 
‘‘SEC. 2059. No amount made available to carry out this subtitle 
may be used to provide any insurance, guarantee, or other credit 
enhancement to a State or local government under which a Federal 
payment would be made to a State or local government as the 
result of a State or local government failing to achieve an outcome 
specified in an agreement. 
‘‘AVAILABILITY OF FUNDS 
‘‘SEC. 2060. Amounts made available to carry out this subtitle 
shall remain available until 10 years after the date of the enactment 
of this subtitle. 
‘‘WEBSITE 
‘‘SEC. 2061. The Federal Interagency Council on Social Impact 
Partnerships shall establish and maintain a public website that 
shall display the following: 
‘‘(1) A copy of, or method of accessing, each notice published 
regarding a social impact partnership project pursuant to this 
subtitle. 
‘‘(2) A copy of each feasibility study funded under this 
subtitle. 
‘‘(3) For each State or local government that has entered 
into an agreement with the Secretary for a social impact part-
nership project, the website shall contain the following informa-
tion: 
‘‘(A) The outcome goals of the project. 
‘‘(B) A description of each intervention in the project. 
‘‘(C) The target population that will be served by the 
project. 
‘‘(D) The expected social benefits to participants who 
receive the intervention and others who may be impacted. 
‘‘(E) The detailed roles, responsibilities, and purposes 
of each Federal, State, or local government entity, inter-
mediary, service provider, independent evaluator, investor, 
or other stakeholder. 
‘‘(F) The payment terms, methodology used to calculate 
outcome payments, the payment schedule, and performance 
thresholds. 
‘‘(G) The project budget. 
‘‘(H) The project timeline. 
‘‘(I) The project eligibility criteria. 
‘‘(J) The evaluation design. 
‘‘(K) The metrics used to determine whether the pro-
posed outcomes have been achieved and how these metrics 
are measured. 
‘‘(4) A copy of the progress reports and the final reports 
relating to each social impact partnership project. 
‘‘(5) An estimate of the savings to the Federal, State, and 
local government, on a program-by-program basis and in the 
Estimate. 
Records. 
42 USC 
1397n–10 note. 
Termination 
date. 
42 USC 1397n–9 
note. 
42 USC 1397n–8 
note. 
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132 STAT. 282 
PUBLIC LAW 115–123—FEB. 9, 2018 
aggregate, resulting from the successful completion of the social 
impact partnership project. 
‘‘REGULATIONS 
‘‘SEC. 2062. The Secretary, in consultation with the Federal 
Interagency Council on Social Impact Partnerships, may issue regu-
lations as necessary to carry out this subtitle. 
‘‘DEFINITIONS 
‘‘SEC. 2063. In this subtitle: 
‘‘(1) AGENCY.—The term ‘agency’ has the meaning given 
that term in section 551 of title 5, United States Code. 
‘‘(2) INTERVENTION.—The term ‘intervention’ means a spe-
cific service delivered to achieve an impact through a social 
impact partnership project. 
‘‘(3) SECRETARY.—The term ‘Secretary’ means the Secretary 
of the Treasury. 
‘‘(4) SOCIAL
IMPACT
PARTNERSHIP
PROJECT.—The term 
‘social impact partnership project’ means a project that finances 
social services using a social impact partnership model. 
‘‘(5) SOCIAL IMPACT PARTNERSHIP MODEL.—The term ‘social 
impact partnership model’ means a method of financing social 
services in which— 
‘‘(A) Federal funds are awarded to a State or local 
government only if a State or local government achieves 
certain outcomes agreed on by the State or local govern-
ment and the Secretary; and 
‘‘(B) the State or local government coordinates with 
service providers, investors (if applicable to the project), 
and (if necessary) an intermediary to identify— 
‘‘(i) an intervention expected to produce the out-
come; 
‘‘(ii) a service provider to deliver the intervention 
to the target population; and 
‘‘(iii) investors to fund the delivery of the interven-
tion. 
‘‘(6) STATE.—The term ‘State’ means each State of the 
United States, the District of Columbia, each commonwealth, 
territory or possession of the United States, and each federally 
recognized Indian tribe. 
‘‘FUNDING 
‘‘SEC. 2064. Out of any money in the Treasury of the United 
States not otherwise appropriated, there is hereby appropriated 
$100,000,000 for fiscal year 2018 to carry out this subtitle.’’. 
TITLE IX—PUBLIC HEALTH PROGRAMS 
SEC. 50901. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE 
NATIONAL HEALTH SERVICE CORPS, AND TEACHING 
HEALTH CENTERS THAT OPERATE GME PROGRAMS. 
(a) 
COMMUNITY
HEALTH
CENTERS
FUNDING.—Section 
10503(b)(1)(F) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 254b–2(b)(1)(F)), as amended by section 3101 of Public 
Law 115–96, is amended to read as follows: 
42 USC 
1397n–13 note. 
42 USC 
1397n–12 note. 
Consultation. 
42 USC 
1397n–11 note. 
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132 STAT. 283 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(F) 
$3,800,000,000 
for 
fiscal 
year 
2018 
and 
$4,000,000,000 for fiscal year 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) in paragraph (1), 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 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 behav-
ioral health, mental health, or substance use disorder serv-
ices; and 
‘‘(G) addressing emerging public health or substance 
use disorder issues to meet the health needs of the popu-
lation 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 spe-
cial 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 aver-
age.’’; 
(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 Sec-
retary shall not make a grant under this paragraph 
Grants. 
Deadline. 
Implementation 
plan. 
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132 STAT. 284 
PUBLIC LAW 115–123—FEB. 9, 2018 
unless the applicant 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 
implementation plan to meet the requirements of sub-
section (k)(3). The Secretary may extend such 120- 
day period for achieving compliance upon a demonstra-
tion of good cause by the health center.’’; and 
(B) in subparagraph (C)— 
(i) in the subparagraph heading, by striking ‘‘AND 
PLANS’’; 
(ii) by striking ‘‘or plan (as described in subpara-
graphs (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 assist-
ance; 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 commu-
nities.’’; 
(6) in subsection (e)(5)(B)— 
(A) in the heading of subparagraph (B), by striking 
‘‘AND PLANS’’; and 
(B) by striking ‘‘and subparagraphs (B) and (C) of 
subsection (c)(1) to a health center or to a network or 
plan’’ and inserting ‘‘to a health center or to a network’’; 
(7) in subsection (e), by adding at the end the following: 
‘‘(6) NEW ACCESS POINTS AND EXPANDED 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 populated area, 
or an area which has a level of unmet need that 
is higher relative to other applicants. 
‘‘(iii) CONSIDERATION
OF
APPLICATIONS.—In car-
rying 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 pro-
vided by the applicants involved to the medically 
Time period. 
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132 STAT. 285 
PUBLIC LAW 115–123—FEB. 9, 2018 
underserved populations in urban areas which may 
be expected to use the services provided by the 
applicants is not less than two to three or greater 
than three to two. 
‘‘(iv) SERVICE AREA OVERLAP.—If in carrying out 
clause (i) the applicant 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. 
‘‘(B) APPROVAL OF EXPANDED SERVICE APPLICATIONS.— 
‘‘(i) IN
GENERAL.—The Secretary may approve 
applications for grants under 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 consider-
ation 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. 
‘‘(iii) CONSIDERATION
OF
APPLICATIONS.—In car-
rying 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 pro-
vided 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.’’; 
(8) in subsection (h)— 
(A) in paragraph (1), by striking ‘‘and children and 
youth at risk of homelessness’’ and inserting ‘‘, children 
and youth at risk of 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 subpara-
graph (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 dis-
order’’; 
(9) in subsection (k)— 
(A) in paragraph (2)— 
(i) in the paragraph heading, by inserting ‘‘UNMET’’ 
before ‘‘NEED’’; 
(ii) in the matter preceding subparagraph (A), by 
inserting ‘‘or subsection (e)(6)’’ after ‘‘subsection (e)(1)’’; 
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132 STAT. 286 
PUBLIC LAW 115–123—FEB. 9, 2018 
(iii) in subparagraph (A), by inserting ‘‘unmet’’ 
before ‘‘need for health services’’; 
(iv) in subparagraph (B), by striking ‘‘and’’ at the 
end; 
(v) in subparagraph (C), by striking the period 
at the end and inserting ‘‘; and’’; and 
(vi) by adding after subparagraph (C) the following: 
‘‘(D) in the case of an application for a grant pursuant 
to subsection (e)(6), a demonstration that the applicant 
has consulted with appropriate State and local government 
agencies, and health care providers regarding the need 
for the health services to be provided at the proposed 
delivery site.’’; 
(B) in paragraph (3)— 
(i) in the matter preceding subparagraph (A), by 
inserting ‘‘or subsection (e)(6)’’ after ‘‘subsection 
(e)(1)(B)’’; 
(ii) in subparagraph (B), by striking ‘‘in the 
catchment area of the center’’ and inserting ‘‘, including 
other health care providers that provide care within 
the catchment area, local hospitals, and specialty pro-
viders 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 fol-
lowing: 
‘‘(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); 
(10) in subsection (l), by adding at the end the following: 
‘‘Funds expended to carry out activities under this subsection 
and operational support activities 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 following: ‘‘Committee on Health, 
Education, Labor, and Pensions of the Senate, and the 
Committee on Energy and Commerce of the House of Rep-
resentatives, a report including, at a minimum— 
Waiver. 
Time period. 
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132 STAT. 287 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(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 semi-
colon; 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 estab-
lishing new access points, and the number of new access 
points created; 
‘‘(E) the amount of unexpended funding for loan 
guarantees and loan guarantee authority under title XVI; 
‘‘(F) the rationale for any substantial changes in the 
distribution of funds; 
‘‘(G) the rate of closures for health centers and access 
points; 
‘‘(H) the number and reason for any grants awarded 
pursuant to subsection (e)(1)(B); and 
‘‘(I) the number and reason for any waivers provided 
pursuant to subsection (q)(4).’’; 
(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 Protec-
tion and Affordable Care Act, there is authorized to be appro-
priated, and there is appropriated, out of any monies in the 
Treasury 
not 
otherwise 
appropriated, 
to 
the 
Secretary 
$25,000,000 for fiscal year 2018 to support the participation 
of health centers in the All of Us Research Program under 
the Precision Medicine Initiative under section 498E of this 
Act.’’; and 
(14) by striking subsection (s). 
(c) NATIONAL HEALTH SERVICE CORPS.—Section 10503(b)(2)(F) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 254b– 
2(b)(2)(F)), as amended by section 3101 of Public Law 115–96, 
is amended to read as follows: 
‘‘(F) $310,000,000 for each of fiscal years 2018 and 
2019.’’. 
(d) TEACHING HEALTH CENTERS THAT OPERATE GRADUATE MED-
ICAL EDUCATION PROGRAMS.— 
(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 Sec-
retary 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— 
Appropriation 
authorization. 
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132 STAT. 288 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(A) maintenance of filled positions at 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. 
‘‘(2) PER RESIDENT AMOUNT.—In making payments under 
paragraph (1), the Secretary shall consider the cost of training 
residents at teaching health centers and the implications of 
the per resident amount on approved graduate medical resi-
dency training programs at teaching health centers. 
‘‘(3) PRIORITY.—In making payments under paragraph 
(1)(C), the Secretary shall give priority to qualified teaching 
health centers that— 
‘‘(A) serve a health professional shortage area with 
a designation in effect under section 332 or a medically 
underserved community (as defined in section 799B); or 
‘‘(B) are located in a rural area (as defined in section 
1886(d)(2)(D) of the Social Security Act).’’. 
(2) FUNDING.—Paragraph (1) of section 340H(g) of the 
Public Health Service Act (42 U.S.C. 256h(g)), as amended 
by section 3101 of Public Law 115–96, is amended by striking 
‘‘and $30,000,000 for the period of the first and second quarters 
of fiscal year 2018,’’ and inserting ‘‘and $126,500,000 for each 
of fiscal years 2018 and 2019,’’. 
(3) ANNUAL REPORTING.—Subsection (h)(1) of section 340H 
of the Public Health Service Act (42 U.S.C. 256h) is amended— 
(A) by redesignating subparagraph (D) as subpara-
graph (H); and 
(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 resi-
dents 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 short-
age 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).’’. 
(4) REPORT ON TRAINING COSTS.—Not later than March 
31, 2019, the Secretary of Health and Human Services shall 
submit to the Congress a report on the direct graduate expenses 
of approved graduate medical residency training programs, and 
the indirect expenses associated with the additional costs of 
teaching residents, of qualified teaching health centers (as such 
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132 STAT. 289 
PUBLIC LAW 115–123—FEB. 9, 2018 
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 para-
graphs (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 program’ means an approved graduate med-
ical residency training program for which the sponsoring quali-
fied 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 inserting ‘‘teaching health center’’. 
(7) PAYMENTS FOR PREVIOUS FISCAL YEARS.—The provisions 
of section 340H of the Public Health Service Act (42 U.S.C. 
256h), as in effect on the day before the date of enactment 
of Public Law 115–96, shall continue to apply with respect 
to payments under such section for fiscal years before fiscal 
year 2018. 
(e) APPLICATION.—Amounts appropriated pursuant to this sec-
tion 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.—Paragraph (4) of section 
3014(h) of title 18, United States Code, as amended by section 
3101 of Public Law 115–96, is amended by striking ‘‘and section 
3101(d) of the CHIP and Public Health Funding Extension Act’’ 
and inserting ‘‘and section 50901(e) of the Advancing Chronic Care, 
Extenders, and Social Services Act’’. 
SEC. 50902. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 
(a) SPECIAL DIABETES PROGRAM FOR TYPE I DIABETES.—Section 
330B(b)(2)(D) of the Public Health Service Act (42 U.S.C. 254c– 
2(b)(2)(D)), as amended by section 3102 of Public Law 115–96, 
is amended to read as follows: 
‘‘(D) $150,000,000 for each of fiscal years 2018 and 
2019, to remain available until expended.’’. 
(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)), as amended by section 3102 of Public Law 115– 
96, is amended to read as follows: 
‘‘(D) $150,000,000 for each of fiscal years 2018 and 
2019, to remain available until expended.’’. 
TITLE X—MISCELLANEOUS HEALTH 
CARE POLICIES 
SEC. 51001. HOME HEALTH PAYMENT REFORM. 
(a) BUDGET NEUTRAL TRANSITION TO A 30-DAY UNIT OF PAY-
MENT FOR HOME HEALTH SERVICES.—Section 1895(b) of the Social 
Security Act (42 U.S.C. 1395fff(b)) is amended— 
Time periods. 
Applicability. 
42 USC 256h 
note. 
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132 STAT. 290 
PUBLIC LAW 115–123—FEB. 9, 2018 
(1) in paragraph (2)— 
(A) by striking ‘‘PAYMENT.—In defining’’ and inserting 
‘‘PAYMENT.— 
‘‘(A) IN GENERAL.—In defining’’; and 
(B) by adding at the end the following new subpara-
graph: 
‘‘(B) 30-DAY UNIT OF SERVICE.—For purposes of imple-
menting the prospective payment system with respect to 
home health units of service furnished during a year begin-
ning with 2020, the Secretary shall apply a 30-day unit 
of service as the unit of service applied under this para-
graph.’’; 
(2) in paragraph (3)— 
(A) in subparagraph (A), by adding at the end the 
following new clause: 
‘‘(iv) BUDGET NEUTRALITY FOR 2020.—With respect 
to payments for home health units of service furnished 
that end during the 12-month period beginning 
January 1, 2020, the Secretary shall calculate a 
standard prospective payment amount (or amounts) 
for 30-day units of service (as described in paragraph 
(2)(B)) for the prospective payment system under this 
subsection. 
Such 
standard 
prospective 
payment 
amount (or amounts) shall be calculated in a manner 
such that the estimated aggregate amount of expendi-
tures under the system during such period with 
application of paragraph (2)(B) is equal to the esti-
mated aggregate amount of expenditures that other-
wise would have been made under the system during 
such period if paragraph (2)(B) had not been enacted. 
The previous sentence shall be applied before (and 
not affect the application of) paragraph (3)(B). In calcu-
lating such amount (or amounts), the Secretary shall 
make assumptions about behavior changes that could 
occur as a result of the implementation of paragraph 
(2)(B) and the case-mix adjustment factors established 
under paragraph (4)(B) and shall provide a description 
of such assumptions in the notice and comment rule-
making used to implement this clause.’’; and 
(B) by adding at the end the following new subpara-
graph: 
‘‘(D) BEHAVIOR ASSUMPTIONS AND ADJUSTMENTS.— 
‘‘(i) IN
GENERAL.—The Secretary shall annually 
determine the impact of differences between assumed 
behavior changes (as described in paragraph (3)(A)(iv)) 
and actual behavior changes on estimated aggregate 
expenditures under this subsection with respect to 
years beginning with 2020 and ending with 2026. 
‘‘(ii) PERMANENT
ADJUSTMENTS.—The Secretary 
shall, at a time and in a manner determined appro-
priate, through notice and comment rulemaking, pro-
vide for one or more permanent increases or decreases 
to the standard prospective payment amount (or 
amounts) for applicable years, on a prospective basis, 
to offset for such increases or decreases in estimated 
aggregate expenditures (as determined under clause 
(i)). 
Deadline. 
Determination. 
Notice. 
Regulations. 
Applicability. 
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132 STAT. 291 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(iii) TEMPORARY ADJUSTMENTS FOR RETROSPECTIVE 
BEHAVIOR.—The Secretary shall, at a time and in a 
manner determined appropriate, through notice and 
comment rulemaking, provide for one or more tem-
porary increases or decreases to the payment amount 
for a unit of home health services (as determined under 
paragraph (4)) for applicable years, on a prospective 
basis, to offset for such increases or decreases in esti-
mated aggregate expenditures (as determined under 
clause (i)). Such a temporary increase or decrease shall 
apply only with respect to the year for which such 
temporary increase or decrease is made, and the Sec-
retary shall not take into account such a temporary 
increase or decrease in computing such amount under 
this subsection for a subsequent year.’’; and 
(3) in paragraph (4)(B)— 
(A) 
by 
striking 
‘‘FACTORS.—The 
Secretary’’ 
and 
inserting ‘‘FACTORS.— 
‘‘(i) IN GENERAL.—The Secretary’’; and 
(B) by adding at the end the following new clause: 
‘‘(ii) TREATMENT
OF
THERAPY
THRESHOLDS.—For 
2020 and subsequent years, the Secretary shall elimi-
nate the use of therapy thresholds (established by the 
Secretary) in case mix adjustment factors established 
under clause (i) for calculating payments under the 
prospective payment system under this subsection.’’. 
(b) TECHNICAL EXPERT PANEL.— 
(1) IN GENERAL.—During the period beginning on January 
1, 2018, and ending on December 31, 2018, the Secretary of 
Health and Human Services shall hold at least one session 
of a technical expert panel, the participants of which shall 
include home health providers, patient representatives, and 
other relevant stakeholders. The technical expert panel shall 
identify and prioritize recommendations with respect to the 
prospective payment system for home health services under 
section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)), 
on the following: 
(A) The Home Health Groupings Model, as described 
in the proposed rule ‘‘Medicare and Medicaid Programs; 
CY 2018 Home Health Prospective Payment System Rate 
Update and Proposed CY 2019 Case-Mix Adjustment Meth-
odology Refinements; Home Health Value-Based Pur-
chasing Model; and Home Health Quality Reporting 
Requirements’’ (82 Fed. Reg. 35294 through 35332 (July 
28, 2017)). 
(B) Alternative case-mix models to the Home Health 
Groupings Model that were submitted during 2017 as com-
ments in response to proposed rule making, including 
patient-focused factors that consider the risks of hos-
pitalization and readmission to a hospital, improvement 
or maintenance of functionality of individuals to increase 
the capacity for self-care, quality of care, and resource 
utilization. 
(2) INAPPLICABILITY OF FACA.—The provisions of the Fed-
eral Advisory Committee Act (5 U.S.C. App.) shall not apply 
to the technical expert panel under paragraph (1). 
Recommenda- 
tions. 
Applicability. 
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132 STAT. 292 
PUBLIC LAW 115–123—FEB. 9, 2018 
(3) REPORT.—Not later than April 1, 2019, the Secretary 
of Health and Human Services shall submit to the Committee 
on Ways and Means and the Committee on Energy and Com-
merce of the House of Representatives and the Committee 
on Finance of the Senate a report on the recommendations 
of such panel described in such paragraph. 
(4) NOTICE AND COMMENT RULEMAKING.—Not later than 
December 31, 2019, the Secretary of Health and Human Serv-
ices shall pursue notice and comment rulemaking on a case- 
mix system with respect to the prospective payment system 
for home health services under section 1895(b) of the Social 
Security Act (42 U.S.C. 1395fff(b)). 
(c) REPORTS.— 
(1) INTERIM REPORT.—Not later than March 15, 2022, the 
Medicare Payment Advisory Commission shall submit to Con-
gress an interim report on the application of a 30-day unit 
of service as the unit of service applied under section 1895(b)(2) 
of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as amended 
by subsection (a), including an analysis of the level of payments 
provided to home health agencies as compared to the cost 
of delivering home health services, and any unintended con-
sequences, including with respect to behavioral changes and 
quality. 
(2) FINAL REPORT.—Not later than March 15, 2026, such 
Commission shall submit to Congress a final report on such 
application and any such consequences. 
SEC. 51002. INFORMATION TO SATISFY DOCUMENTATION OF MEDI-
CARE ELIGIBILITY FOR HOME HEALTH SERVICES. 
(a) PART A.—Section 1814(a) of the Social Security Act (42 
U.S.C. 1395f(a)) is amended by inserting before ‘‘For purposes of 
paragraph (2)(C),’’ the following new sentence: ‘‘For purposes of 
documentation for physician certification and recertification made 
under paragraph (2) on or after January 1, 2019, and made with 
respect to home health services furnished by a home health agency, 
in addition to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute or 
post-acute care facility (in the case that home health services were 
furnished to an individual who was directly admitted to the home 
health agency from such a facility), the Secretary may use docu-
mentation in the medical record of the home health agency as 
supporting material, as appropriate to the case involved.’’. 
(b) PART B.—Section 1835(a) of the Social Security Act (42 
U.S.C. 1395n(a)) is amended by inserting before ‘‘For purposes 
of paragraph (2)(A),’’ the following new sentence: ‘‘For purposes 
of documentation for physician certification and recertification made 
under paragraph (2) on or after January 1, 2019, and made with 
respect to home health services furnished by a home health agency, 
in addition to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute or 
post-acute care facility (in the case that home health services were 
furnished to an individual who was directly admitted to the home 
health agency from such a facility), the Secretary may use docu-
mentation in the medical record of the home health agency as 
supporting material, as appropriate to the case involved.’’. 
Certification. 
Deadline. 
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132 STAT. 293 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 51003. TECHNICAL AMENDMENTS TO PUBLIC LAW 114–10. 
(a) MIPS TRANSITION.—Section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended— 
(1) in subsection (q)— 
(A) in paragraph (1)— 
(i) in subparagraph (B), by striking ‘‘items and 
services’’ and inserting ‘‘covered professional services 
(as defined in subsection (k)(3)(A))’’; and 
(ii) in subparagraph (C)(iv)— 
(I) by amending subclause (I) to read as fol-
lows: 
‘‘(I) The minimum number (as determined by 
the Secretary) of— 
‘‘(aa) for performance periods beginning 
before January 1, 2018, individuals enrolled 
under this part who are treated by the eligible 
professional 
for 
the 
performance 
period 
involved; and 
‘‘(bb) for performance periods beginning 
on or after January 1, 2018, individuals 
enrolled under this part who are furnished 
covered professional services (as defined in 
subsection (k)(3)(A)) by the eligible profes-
sional for the performance period involved.’’; 
(II) in subclause (II), by striking ‘‘items and 
services’’ and inserting ‘‘covered professional serv-
ices (as defined in subsection (k)(3)(A))’’; and 
(III) by amending subclause (III) to read as 
follows: 
‘‘(III) The minimum amount (as determined 
by the Secretary) of— 
‘‘(aa) for performance periods beginning 
before January 1, 2018, allowed charges billed 
by such professional under this part for such 
performance period; and 
‘‘(bb) for performance periods beginning 
on or after January 1, 2018, allowed charges 
for covered professional services (as defined 
in subsection (k)(3)(A)) billed by such profes-
sional for such performance period.’’; 
(B) in paragraph (5)(D)— 
(i) in clause (i)(I), by inserting ‘‘subject to clause 
(iii),’’ after ‘‘clauses (i) and (ii) of paragraph (2)(A),’’; 
and 
(ii) by adding at the end the following new clause: 
‘‘(iii) TRANSITION YEARS.—For each of the second, 
third, fourth, and fifth years for which the MIPS 
applies to payments, the performance score for the 
performance category described in paragraph (2)(A)(ii) 
shall not take into account the improvement of the 
professional involved.’’; 
(C) in paragraph (5)(E)— 
(i) in clause (i)(I)(bb)— 
(I) in the heading by striking ‘‘FIRST 2 YEARS’’ 
and inserting ‘‘FIRST 5 YEARS’’; and 
(II) by striking ‘‘the first and second years’’ 
and inserting ‘‘each of the first through fifth years’’; 
Time periods. 
Time periods. 
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132 STAT. 294 
PUBLIC LAW 115–123—FEB. 9, 2018 
(ii) in clause (i)(II)(bb)— 
(I) in the heading, by striking ‘‘2 YEARS’’ and 
inserting ‘‘5 YEARS’’; and 
(II) by striking the second sentence and 
inserting the following new sentences: ‘‘For each 
of the second, third, fourth, and fifth years for 
which the MIPS applies to payments, not less than 
10 percent and not more than 30 percent of such 
score shall be based on performance with respect 
to the category described in clause (ii) of paragraph 
(2)(A). Nothing in the previous sentence shall be 
construed, with respect to a performance period 
for a year described in the previous sentence, as 
preventing the Secretary from basing 30 percent 
of such score for such year with respect to the 
category described in such clause (ii), if the Sec-
retary determines, based on information posted 
under subsection (r)(2)(I) that sufficient resource 
use measures are ready for adoption for use under 
the 
performance 
category 
under 
paragraph 
(2)(A)(ii) for such performance period.’’; 
(D) in paragraph (6)(D)— 
(i) in clause (i), in the second sentence, by striking 
‘‘Such performance threshold’’ and inserting ‘‘Subject 
to clauses (iii) and (iv), such performance threshold’’; 
(ii) in clause (ii)— 
(I) in the first sentence, by inserting ‘‘(begin-
ning with 2019 and ending with 2024)’’ after ‘‘for 
each year of the MIPS’’; and 
(II) in the second sentence, by inserting ‘‘sub-
ject to clause (iii),’’ after ‘‘For each such year,’’; 
(iii) in clause (iii)— 
(I) in the heading, by striking ‘‘2’’ and inserting 
‘‘5’’; and 
(II) in the first sentence, by striking ‘‘two 
years’’ and inserting ‘‘five years’’; and 
(iv) by adding at the end the following new clause: 
‘‘(iv) ADDITIONAL SPECIAL RULE FOR THIRD, FOURTH 
AND
FIFTH
YEARS
OF
MIPS.—For purposes of deter-
mining MIPS adjustment factors under subparagraph 
(A), in addition to the requirements specified in clause 
(iii), the Secretary shall increase the performance 
threshold with respect to each of the third, fourth, 
and fifth years to which the MIPS applies to ensure 
a gradual and incremental transition to the perform-
ance threshold described in clause (i) (as estimated 
by the Secretary) with respect to the sixth year to 
which the MIPS applies.’’; 
(E) in paragraph (6)(E)— 
(i) by striking ‘‘In the case of items and services’’ 
and inserting ‘‘In the case of covered professional serv-
ices (as defined in subsection (k)(3)(A))’’; and 
(ii) by striking ‘‘under this part with respect to 
such items and services’’ and inserting ‘‘under this 
part with respect to such covered professional services’’; 
and 
Determination. 
Determination. 
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132 STAT. 295 
PUBLIC LAW 115–123—FEB. 9, 2018 
(F) in paragraph (7), in the first sentence, by striking 
‘‘items and services’’ and inserting ‘‘covered professional 
services (as defined in subsection (k)(3)(A))’’; 
(2) in subsection (r)(2), by adding at the end the following 
new subparagraph: 
‘‘(I) INFORMATION.—The Secretary shall, not later than 
December 31st of each year (beginning with 2018), post 
on the Internet website of the Centers for Medicare & 
Medicaid Services information on resource use measures 
in use under subsection (q), resource use measures under 
development and the time-frame for such development, 
potential future resource use measure topics, a description 
of stakeholder engagement, and the percent of expenditures 
under part A and this part that are covered by resource 
use measures.’’; and 
(3) in subsection (s)(5)(B), by striking ‘‘section 1833(z)(2)(C)’’ 
and inserting ‘‘section 1833(z)(3)(D)’’. 
(b) PHYSICIAN-FOCUSED PAYMENT MODEL TECHNICAL ADVISORY 
COMMITTEE PROVISION OF INITIAL PROPOSAL FEEDBACK.—Section 
1868(c)(2)(C) of the Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) 
is amended to read as follows: 
‘‘(C) COMMITTEE REVIEW OF MODELS SUBMITTED.—The 
Committee, on a periodic basis— 
‘‘(i) shall review models submitted under subpara-
graph (B); 
‘‘(ii) may provide individuals and stakeholder enti-
ties who submitted such models with— 
‘‘(I) initial feedback on such models regarding 
the extent to which such models meet the criteria 
described in subparagraph (A); and 
‘‘(II) an explanation of the basis for the feed-
back provided under subclause (I); and 
‘‘(iii) shall prepare comments and recommenda-
tions regarding whether such models meet the criteria 
described in subparagraph (A) and submit such com-
ments and recommendations to the Secretary.’’. 
SEC. 51004. EXPANDED ACCESS TO MEDICARE INTENSIVE CARDIAC 
REHABILITATION PROGRAMS. 
Section 1861(eee)(4)(B) of the Social Security Act (42 U.S.C. 
1395x(eee)(4)(B)) is amended— 
(1) in clause (v), by striking ‘‘or’’ at the end; 
(2) in clause (vi), by striking the period at the end and 
inserting a semicolon; and 
(3) by adding at the end the following new clauses: 
‘‘(vii) stable, chronic heart failure (defined as patients 
with left ventricular ejection fraction of 35 percent or less 
and New York Heart Association (NYHA) class II to IV 
symptoms despite being on optimal heart failure therapy 
for at least 6 weeks); or 
‘‘(viii) any additional condition for which the Secretary 
has determined that a cardiac rehabilitation program shall 
be covered, unless the Secretary determines, using the 
same process used to determine that the condition is cov-
ered for a cardiac rehabilitation program, that such cov-
erage is not supported by the clinical evidence.’’. 
Determination. 
Recommenda- 
tions. 
Deadline. 
Web posting. 
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132 STAT. 296 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 51005. EXTENSION OF BLENDED SITE NEUTRAL PAYMENT RATE 
FOR 
CERTAIN 
LONG-TERM 
CARE 
HOSPITAL 
DIS-
CHARGES; TEMPORARY ADJUSTMENT TO SITE NEUTRAL 
PAYMENT RATES. 
(a) EXTENSION.—Section 1886(m)(6)(B)(i) of the Social Security 
Act (42 U.S.C. 1395ww(m)(6)(B)(i)) is amended— 
(1) in subclause (I), by striking ‘‘fiscal year 2016 or fiscal 
year 2017’’ and inserting ‘‘fiscal years 2016 through 2019’’; 
and 
(2) in subclause (II), by striking ‘‘2018’’ and inserting 
‘‘2020’’. 
(b) TEMPORARY
ADJUSTMENT
TO
SITE
NEUTRAL
PAYMENT 
RATES.—Section 1886(m)(6)(B) of the Social Security Act (42 U.S.C. 
1395ww(m)(6)(B)) is amended— 
(1) in clause (ii), in the matter preceding subclause (I), 
by striking ‘‘In this paragraph’’ and inserting ‘‘Subject to clause 
(iv), in this paragraph’’; and 
(2) by adding at the end the following new clause: 
‘‘(iv) ADJUSTMENT.—For each of fiscal years 2018 
through 2026, the amount that would otherwise apply 
under clause (ii)(I) for the year (determined without 
regard to this clause) shall be reduced by 4.6 percent.’’. 
SEC. 51006. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS 
ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS. 
(a) RECOGNITION
OF ATTENDING PHYSICIAN ASSISTANTS
AS 
ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.— 
(1) IN GENERAL.—Section 1861(dd)(3)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(dd)(3)(B)) is amended— 
(A) by striking ‘‘or nurse’’ and inserting ‘‘, the nurse’’; 
and 
(B) by inserting ‘‘, or the physician assistant (as defined 
in such subsection)’’ after ‘‘subsection (aa)(5))’’. 
(2) CLARIFICATION OF HOSPICE ROLE OF PHYSICIAN ASSIST-
ANTS.—Section 1814(a)(7)(A)(i)(I) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting ‘‘or a physi-
cian assistant’’ after ‘‘a nurse practitioner’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to items and services furnished on or after January 
1, 2019. 
SEC. 51007. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPER-
VISION 
REQUIREMENTS 
FOR 
OUTPATIENT 
THERA-
PEUTIC SERVICES IN CRITICAL ACCESS AND SMALL 
RURAL HOSPITALS THROUGH 2017. 
Section 1 of Public Law 113–198, as amended by section 1 
of Public Law 114–112 and section 16004(a) of the 21st Century 
Cures Act (Public Law 114–255), is amended— 
(1) in the section heading, by striking ‘‘2016’’ and inserting 
‘‘2017’’; and 
(2) by striking ‘‘and 2016’’ and inserting ‘‘2016, and 2017’’. 
128 Stat. 2057. 
Applicability. 
42 USC 1395f 
note. 
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132 STAT. 297 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 51008. ALLOWING PHYSICIAN ASSISTANTS, NURSE PRACTI-
TIONERS, AND CLINICAL NURSE SPECIALISTS TO SUPER-
VISE CARDIAC, INTENSIVE CARDIAC, AND PULMONARY 
REHABILITATION PROGRAMS. 
(a) CARDIAC
AND INTENSIVE CARDIAC REHABILITATION PRO-
GRAMS.—Section 1861(eee) of the Social Security Act (42 U.S.C. 
1395x(eee)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘physician-supervised’’; and 
(B) by inserting ‘‘under the supervision of a physician 
(as defined in subsection (r)(1)) or a physician assistant, 
nurse practitioner, or clinical nurse specialist (as those 
terms are defined in subsection (aa)(5))’’ before the period 
at the end; 
(2) in paragraph (2)— 
(A) in subparagraph (A)(iii), by striking the period 
at the end and inserting a semicolon; and 
(B) in subparagraph (B), by striking ‘‘a physician’’ and 
inserting ‘‘a physician (as defined in subsection (r)(1)) or 
a physician assistant, nurse practitioner, or clinical nurse 
specialist (as those terms are defined in subsection (aa)(5))’’; 
and 
(3) in paragraph (4)(A), in the matter preceding clause 
(i)— 
(A) by striking ‘‘physician-supervised’’; and 
(B) by inserting ‘‘under the supervision of a physician 
(as defined in subsection (r)(1)) or a physician assistant, 
nurse practitioner, or clinical nurse specialist (as those 
terms are defined in subsection (aa)(5))’’ after ‘‘paragraph 
(3)’’. 
(b) 
PULMONARY
REHABILITATION
PROGRAMS.—Section 
1861(fff)(1) of the Social Security Act (42 U.S.C. 1395x(fff)(1)) is 
amended— 
(1) by striking ‘‘physician-supervised’’; and 
(2) by inserting ‘‘under the supervision of a physician (as 
defined in subsection (r)(1)) or a physician assistant, nurse 
practitioner, or clinical nurse specialist (as those terms are 
defined in subsection (aa)(5))’’ before the period at the end. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to items and services furnished on or after January 
1, 2024. 
SEC. 51009. TRANSITIONAL PAYMENT RULES FOR CERTAIN RADIATION 
THERAPY 
SERVICES 
UNDER 
THE 
PHYSICIAN 
FEE 
SCHEDULE. 
Section 1848 of the Social Security Act (42 U.S.C. 1395w– 
4) is amended— 
(1) in subsection (b)(11), by striking ‘‘2017 and 2018’’ and 
inserting ‘‘2017, 2018, and 2019’’; and 
(2) in subsection (c)(2)(K)(iv), by striking ‘‘2017 and 2018’’ 
and inserting ‘‘2017, 2018, and 2019’’. 
Applicability. 
42 USC 1395x 
note. 
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132 STAT. 298 
PUBLIC LAW 115–123—FEB. 9, 2018 
TITLE XI—PROTECTING SENIORS’ 
ACCESS TO MEDICARE ACT 
SEC. 52001. REPEAL OF THE INDEPENDENT PAYMENT ADVISORY 
BOARD. 
(a) REPEAL.—Section 1899A of the Social Security Act (42 U.S.C. 
1395kkk) is repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) LOBBYING COOLING-OFF PERIOD.—Paragraph (3) of sec-
tion 207(c) of title 18, United States Code, is repealed. 
(2) GAO STUDY AND REPORT.—Section 3403(b) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 1395kkk–1) is 
repealed. 
(3) MEDPAC REVIEW AND COMMENT.—Section 1805(b) of 
the Social Security Act (42 U.S.C. 1395b–6(b)) is amended— 
(A) by striking paragraph (4); 
(B) by redesignating paragraphs (5) through (8) as 
paragraphs (4) through (7), respectively; and 
(C) by redesignating the paragraph (9) that was 
redesignated by section 3403(c)(1) of the Patient Protection 
and Affordable Care Act (Public Law 111–148) as para-
graph (8). 
(4) NAME CHANGE.—Section 10320(b) of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148) is repealed. 
(5) RULE
OF
CONSTRUCTION.—Section 10320(c) of the 
Patient Protection and Affordable Care Act (Public Law 111– 
148) is repealed. 
TITLE XII—OFFSETS 
SEC. 53101. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS. 
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 subclause (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.’’. 
SEC. 53102. THIRD PARTY LIABILITY IN MEDICAID AND CHIP. 
(a) MODIFICATION OF THIRD PARTY LIABILITY RULES RELATED 
TO SPECIAL TREATMENT
OF CERTAIN TYPES
OF CARE
AND PAY-
MENTS.— 
(1) IN GENERAL.—Section 1902(a)(25)(E) of the Social Secu-
rity Act (42 U.S.C. 1396a(a)(25)(E)) is amended, in the matter 
preceding clause (i), by striking ‘‘prenatal or’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall take effect on the date of enactment of this Act. 
(b) DELAY IN EFFECTIVE DATE AND REPEAL OF CERTAIN BIPAR-
TISAN BUDGET ACT OF 2013 AMENDMENTS.— 
(1) REPEAL.—Effective as of September 30, 2017, subsection 
(b) of section 202 of the Bipartisan Budget Act of 2013 (Public 
Law 113–67; 127 Stat. 1177; 42 U.S.C. 1396a note) (including 
Applicability. 
42 USC 1396a 
note. 
42 USC 1395kkk 
note. 
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132 STAT. 299 
PUBLIC LAW 115–123—FEB. 9, 2018 
any amendments made by such subsection) is repealed and 
the provisions amended by such subsection shall be applied 
and administered as if such amendments had never been 
enacted. 
(2) DELAY IN EFFECTIVE DATE.—Subsection (c) of section 
202 of the Bipartisan Budget Act of 2013 (Public Law 113– 
67; 127 Stat. 1177; 42 U.S.C. 1396a note) is amended to read 
as follows: 
‘‘(c) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall take effect on October 1, 2019.’’. 
(3) EFFECTIVE DATE; TREATMENT.—The repeal and amend-
ment made by this subsection shall take effect as if enacted 
on September 30, 2017, and shall apply with respect to any 
open claims, including claims pending, generated, or filed, after 
such date. The amendments made by subsections (a) and (b) 
of section 202 of the Bipartisan Budget Act of 2013 (Public 
Law 113–67; 127 Stat. 1177; 42 U.S.C. 1396a note) that took 
effect on October 1, 2017, are null and void and section 
1902(a)(25) of the Social Security Act (42 U.S.C. 1396a(a)(25)) 
shall be applied and administered as if such amendments had 
not taken effect on such date. 
(c) GAO STUDY AND REPORT.—Not later than 18 months after 
the date of enactment of this Act, the Comptroller General of 
the United States shall submit a report to the Committee on Energy 
and Commerce of the House of Representatives and the Committee 
on Finance of the Senate on the impacts of the amendments made 
by subsections (a)(1) and (b)(2), including— 
(1) the impact, or potential effect, of such amendments 
on access to prenatal and preventive pediatric care (including 
early and periodic screening, diagnostic, and treatment services) 
covered under State plans under such title (or waivers of such 
plans); 
(2) the impact, or potential effect, of such amendments 
on access to services covered under such plans or waivers 
for individuals on whose behalf child support enforcement is 
being carried out by a State agency under part D of title 
IV of such Act; and 
(3) the impact, or potential effect, on providers of services 
under such plans or waivers of delays in payment or related 
issues that result from such amendments. 
(d) 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)) is amended— 
(A) by striking ‘‘medical assistance under the State 
plan’’ and inserting ‘‘medical assistance under a State plan 
(or under a waiver of the plan)’’; 
(B) by striking ‘‘(and, at State option, child’’ and 
inserting ‘‘and child’’; and 
(C) by striking ‘‘title XXI)’’ and inserting ‘‘title XXI’’. 
Applicability. 
42 USC 1396a 
note. 
42 USC 1396a 
and note, 1396k, 
1396p. 
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132 STAT. 300 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 53103. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP- 
SUM INCOME FOR PURPOSES OF INCOME ELIGIBILITY 
UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902 of the Social Security 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), by adding at the end the following 
new subparagraph: 
‘‘(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 occurring 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 
shall, in determining such eligibility, include such 
winnings 
or 
income 
(as 
applicable) 
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 income (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 income (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 addi-
tional month for each increment 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 or income is greater than or 
equal to $100,000. 
‘‘(ii) COUNTING IN EQUAL INSTALLMENTS.—For pur-
poses of subclauses (II), (III), and (IV) of clause (i), 
winnings or income to which such subclause applies 
shall be counted in equal monthly installments over 
the period of months specified under such subclause. 
‘‘(iii) HARDSHIP EXEMPTION.—An individual whose 
income, by application of clause (i), exceeds the 
applicable eligibility threshold established by the State, 
shall continue to be eligible for medical assistance to 
the extent that the State determines, under procedures 
established by the State (in accordance with standards 
specified by the Secretary), that the denial of eligibility 
of the individual would cause an undue medical or 
financial hardship as determined on the basis of cri-
teria established by the Secretary. 
‘‘(iv) NOTIFICATIONS AND ASSISTANCE REQUIRED IN 
CASE
OF
LOSS
OF
ELIGIBILITY.—A State shall, with 
respect to an individual who loses eligibility for medical 
Determination. 
Applicability. 
Determination. 
Time periods. 
42 USC 1396a 
note. 
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132 STAT. 301 
PUBLIC LAW 115–123—FEB. 9, 2018 
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 opportunity 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 Rev-
enue 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 assist-
ance under the State plan or under any waiver 
of such plan and be eligible to reapply to 
receive such medical assistance; and 
‘‘(II) provide technical assistance to the indi-
vidual 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 
described in paragraph (3) of section 4402 of the 
Internal Revenue Code of 1986 or a lottery operated 
by a multistate or multijurisdictional lottery associa-
tion, including amounts awarded as a lump sum pay-
ment. 
‘‘(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 monetary winnings from gambling (as defined 
by the Secretary and including gambling activities 
described in section 1955(b)(4) of title 18, United States 
Code).’’. 
(b) RULES OF CONSTRUCTION.— 
(1) INTERCEPTION
OF
LOTTERY
WINNINGS
ALLOWED.— 
Nothing in the amendment made by subsection (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 furnished to the individual. 
(2) APPLICABILITY LIMITED TO ELIGIBILITY OF RECIPIENT OF 
LOTTERY
WINNINGS
OR
LUMP
SUM
INCOME.—Nothing in the 
amendment made by subsection (a)(2) shall be construed, with 
respect to a 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 sec-
tion 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 lottery winnings or qualified lump-sum 
42 USC 1396a 
note. 
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132 STAT. 302 
PUBLIC LAW 115–123—FEB. 9, 2018 
income (as defined in subparagraph (K) of such section 
1902(e)(14), as added by subsection (a)(2) of this section). 
SEC. 53104. REBATE OBLIGATION WITH RESPECT TO LINE EXTENSION 
DRUGS. 
(a) IN GENERAL.—Section 1927(c)(2)(C) of the Social Security 
Act (42 U.S.C. 1396r–8(c)(2)(C)) is amended by striking ‘‘(C) TREAT-
MENT OF NEW FORMULATIONS.—In the case’’ and all that follows 
through the period at the end of the first sentence and inserting 
the following: 
‘‘(C) TREATMENT OF NEW FORMULATIONS.— 
‘‘(i) IN GENERAL.—In the case of a drug that is 
a line extension of a single source drug or an innovator 
multiple source drug that is an oral solid dosage form, 
the rebate obligation for a rebate period with respect 
to such drug under this subsection shall be the greater 
of the amount described in clause (ii) for such drug 
or the amount described in clause (iii) for such drug. 
‘‘(ii) AMOUNT 1.—For purposes of clause (i), the 
amount described in this clause with respect to a drug 
described in clause (i) and rebate period is the amount 
computed under paragraph (1) for such drug, increased 
by the amount computed under subparagraph (A) and, 
as applicable, subparagraph (B) for such drug and 
rebate period. 
‘‘(iii) AMOUNT 2.—For purposes of clause (i), the 
amount described in this clause with respect to a drug 
described in clause (i) and rebate period is the amount 
computed under paragraph (1) for such drug, increased 
by the product of— 
‘‘(I) the average manufacturer price for the 
rebate period of the line extension of a single 
source drug or an innovator multiple source drug 
that is an oral solid dosage form; 
‘‘(II) the highest additional rebate (calculated 
as a percentage of average manufacturer price) 
under this paragraph for the rebate period for 
any strength of the original single source drug 
or innovator multiple source drug; and 
‘‘(III) the total number of units of each dosage 
form and strength of the line extension product 
paid for under the State plan in the rebate period 
(as reported by the State).’’. 
(b) EFFECTIVE DATE.—The amendments made subsection (a) 
shall apply with respect to rebate periods beginning on or after 
October 1, 2018. 
SEC. 53105. MEDICAID IMPROVEMENT FUND. 
Section 1941(b) of the Social Security Act (42 U.S.C. 1396w– 
1(b)) is amended— 
(1) in paragraph (1), by striking ‘‘$5,000,000’’ and inserting 
‘‘$0’’; and 
(2) in paragraph (3)(A), by striking ‘‘$980,000,000’’ and 
inserting ‘‘$0’’. 
Applicability. 
42 USC 1396r–8 
note. 
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132 STAT. 303 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 53106. PHYSICIAN FEE SCHEDULE UPDATE. 
Section 1848(d)(18) of the Social Security Act (42 U.S.C. 1395w– 
4(d)(18)) is amended by striking ‘‘paragraph (1)(C)’’ and all that 
follows and inserting the following: ‘‘paragraph (1)(C)— 
‘‘(A) for 2016 and each subsequent year through 2018 
shall be 0.5 percent; and 
‘‘(B) for 2019 shall be 0.25 percent.’’. 
SEC. 53107. PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES 
AND OUTPATIENT OCCUPATIONAL THERAPY SERVICES 
FURNISHED BY A THERAPY ASSISTANT. 
Section 1834 of the Social Security Act (42 U.S.C. 1395m) 
is amended by adding at the end the following new subsection: 
‘‘(v) PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES 
AND OUTPATIENT OCCUPATIONAL THERAPY SERVICES FURNISHED BY 
A THERAPY ASSISTANT.— 
‘‘(1) IN GENERAL.—In the case of an outpatient physical 
therapy service or outpatient occupational therapy service fur-
nished on or after January 1, 2022, for which payment is 
made under section 1848 or subsection (k), that is furnished 
in whole or in part by a therapy assistant (as defined by 
the Secretary), the amount of payment for such service shall 
be an amount equal to 85 percent of the amount of payment 
otherwise applicable for the service under this part. Nothing 
in the preceding sentence shall be construed to change 
applicable requirements with respect to such services. 
‘‘(2) USE OF MODIFIER.— 
‘‘(A) ESTABLISHMENT.—Not later than January 1, 2019, 
the Secretary shall establish a modifier to indicate (in 
a form and manner specified by the Secretary), in the 
case of an outpatient physical therapy service or outpatient 
occupational therapy service furnished in whole or in part 
by a therapy assistant (as so defined), that the service 
was furnished by a therapy assistant. 
‘‘(B) REQUIRED USE.—Each request for payment, or bill 
submitted, for an outpatient physical therapy service or 
outpatient occupational therapy service furnished in whole 
or in part by a therapy assistant (as so defined) on or 
after January 1, 2020, shall include the modifier estab-
lished under subparagraph (A) for each such service. 
‘‘(3) IMPLEMENTATION.—The Secretary shall implement this 
subsection through notice and comment rulemaking.’’. 
SEC. 53108. REDUCTION FOR NON-EMERGENCY ESRD AMBULANCE 
TRANSPORTS. 
Section 1834(l)(15) of the Social Security Act (42. U.S.C. 
1395m(l)(15)) is amended by striking ‘‘on or after October 1, 2013’’ 
and inserting ‘‘during the period beginning on October 1, 2013, 
and ending on September 30, 2018, and by 23 percent for such 
services furnished on or after October 1, 2018’’. 
SEC. 53109. HOSPITAL TRANSFER POLICY FOR EARLY DISCHARGES 
TO HOSPICE CARE. 
(a) IN GENERAL.—Section 1886(d)(5)(J) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(J)) is amended— 
(1) in clause (ii)— 
(A) in subclause (III), by striking ‘‘or’’ at the end; 
Notice. 
Regulation. 
Deadline. 
Time period. 
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132 STAT. 304 
PUBLIC LAW 115–123—FEB. 9, 2018 
(B) by redesignating subclause (IV) as subclause (V); 
and 
(C) by inserting after subclause (III) the following new 
subclause: 
‘‘(IV) for discharges occurring on or after October 1, 2018, 
is provided hospice care by a hospice program; or’’; and 
(2) in clause (iv)— 
(A) by inserting after the first sentence the following 
new sentence: ‘‘The Secretary shall include in the proposed 
rule published for fiscal year 2019, a description of the 
effect of clause (ii)(IV).’’; and 
(B) in subclause (I), by striking ‘‘and (III)’’ and inserting 
‘‘(III), and, in the case of proposed and final rules for 
fiscal year 2019 and subsequent fiscal years, (IV)’’. 
(b) MEDPAC EVALUATION AND REPORT.— 
(1) 
EVALUATION.—The 
Medicare 
Payment 
Advisory 
Commission (in this subsection referred to as the ‘‘Commission’’) 
shall conduct an evaluation of the effects of the amendments 
made by subsection (a), including the effects on— 
(A) the numbers of discharges of patients from an 
inpatient hospital setting to a hospice program; 
(B) the lengths of stays of patients in an inpatient 
hospital setting who are discharged to a hospice program; 
(C) spending under the Medicare program under title 
XVIII of the Social Security Act; and 
(D) other areas determined appropriate by the Commis-
sion. 
(2) CONSIDERATION.—In conducting the evaluation under 
paragraph (1), the Commission shall consider factors such as 
whether the timely access to hospice care by patients admitted 
to a hospital has been affected through changes to hospital 
policies or behaviors made as a result of such amendments. 
(3) PRELIMINARY RESULTS.—Not later than March 15, 2020, 
the Commission shall provide Congress with preliminary 
results on the evaluation being conducted under paragraph 
(1). 
(4) REPORT.—Not later than March 15, 2021, the Commis-
sion shall submit to Congress a report on the evaluation con-
ducted under paragraph (1). 
SEC. 53110. MEDICARE PAYMENT UPDATE FOR HOME HEALTH SERV-
ICES. 
Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)(B)) is amended— 
(1) in clause (iii), in the last sentence, by inserting before 
the period at the end the following: ‘‘and for 2020 shall be 
1.5 percent’’; and 
(2) in clause (vi), by inserting ‘‘and 2020’’ after ‘‘except 
2018’’. 
SEC. 53111. MEDICARE PAYMENT UPDATE FOR SKILLED NURSING 
FACILITIES. 
Section 1888(e)(5)(B) of the Social Security Act (42 U.S.C. 
1395yy(e)(5)(B)) is amended— 
(1) in clause (i), by striking ‘‘and (iii)’’ and inserting ‘‘, 
(iii), and (iv)’’; 
(2) in clause (ii), by striking ‘‘clause (iii)’’ and inserting 
‘‘clauses (iii) and (iv)’’; and 
Deadline. 
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132 STAT. 305 
PUBLIC LAW 115–123—FEB. 9, 2018 
(3) by adding at the end the following new clause: 
‘‘(iv) SPECIAL
RULE
FOR
FISCAL
YEAR
2019.—For 
fiscal year 2019 (or other similar annual period speci-
fied in clause (i)), the skilled nursing facility market 
basket percentage, after application of clause (ii), is 
equal to 2.4 percent.’’. 
SEC. 53112. PREVENTING THE ARTIFICIAL INFLATION OF STAR 
RATINGS AFTER THE CONSOLIDATION OF MEDICARE 
ADVANTAGE PLANS OFFERED BY THE SAME ORGANIZA-
TION. 
Section 1853(o)(4) of the Social Security Act (42 U.S.C. 1395w– 
23(o)(4)) is amended by adding at the end the following new 
subparagraph: 
‘‘(D) SPECIAL RULE TO PREVENT THE ARTIFICIAL INFLA-
TION OF STAR RATINGS AFTER THE CONSOLIDATION OF MEDI-
CARE ADVANTAGE PLANS OFFERED BY A SINGLE ORGANIZA-
TION.— 
‘‘(i) IN GENERAL.—If— 
‘‘(I) a Medicare Advantage organization has 
entered into more than one contract with the Sec-
retary with respect to the offering of Medicare 
Advantage plans; and 
‘‘(II) on or after January 1, 2019, the Secretary 
approves a request from the organization to 
consolidate the plans under one or more contract 
(in this subparagraph referred to as a ‘closed con-
tract’) with the plans offered under a separate 
contract (in this subparagraph referred to as the 
‘continuing contract’); 
with respect to the continuing contract, the Secretary 
shall adjust the quality rating under the 5-star rating 
system and any quality increase under this subsection 
and rebate amounts under section 1854 to reflect an 
enrollment-weighted average of scores or ratings for 
the continuing and closed contracts, as determined 
appropriate by the Secretary. 
‘‘(ii) APPLICATION.—An adjustment under clause 
(i) shall apply for any year for which the quality rating 
of the continuing contract is based primarily on a 
measurement period that is prior to the first year 
in which a closed contract is no longer offered.’’. 
SEC. 53113. SUNSETTING EXCLUSION OF BIOSIMILARS FROM MEDI-
CARE PART D COVERAGE GAP DISCOUNT PROGRAM. 
Section 1860D–14A(g)(2)(A) of the Social Security Act (42 U.S.C. 
1395w–114a(g)(2)(A)) is amended by inserting ‘‘, with respect to 
a plan year before 2019,’’ after ‘‘other than’’. 
SEC. 53114. ADJUSTMENTS TO MEDICARE PART B AND PART D PRE-
MIUM SUBSIDIES FOR HIGHER INCOME INDIVIDUALS. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i) of the Social Security 
Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended— 
(1) in subclause (II), in the matter preceding the table, 
by striking ‘‘years beginning with’’; and 
(2) by adding at the end the following new subclause: 
‘‘(III) Subject to paragraph (5), for years begin-
ning with 2019: 
Effective date. 
Contracts. 
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132 STAT. 306 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘If the modified adjusted gross income 
is: .................................................................
The applicable 
percentage is:
More than $85,000 but not more than 
$107,000 ......................................................
35 percent
More than $107,000 but not more than 
$133,500 ......................................................
50 percent
More than $133,500 but not more than 
$160,000 ......................................................
65 percent
More than $160,000 but less than $500,000 
80 percent
At least $500,000 ...........................................
85 percent.’’. 
(b) JOINT RETURNS.—Section 1839(i)(3)(C)(ii) of the Social Secu-
rity Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by inserting before 
the period the following: ‘‘except, with respect to the dollar amounts 
applied in the last row of the table under subclause (III) of such 
clause (and the second dollar amount specified in the second to 
last row of such table), clause (i) shall be applied by substituting 
dollar amounts which are 150 percent of such dollar amounts for 
the calendar year’’. 
(c) INFLATION ADJUSTMENT.—Section 1839(i)(5) of the Social 
Security Act (42 U.S.C. 1395r(i)(5)) is amended— 
(1) in subparagraph (A), by striking ‘‘In the case’’ and 
inserting ‘‘Subject to subparagraph (C), in the case’’; 
(2) in subparagraph (B), by striking ‘‘subparagraph (A)’’ 
and inserting ‘‘subparagraph (A) or (C)’’; and 
(3) 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 2028.—In the case of 
any calendar year beginning after 2027, each dollar 
amount in paragraph (3) of $500,000 shall be increased 
by an amount equal to— 
‘‘(I) such dollar amount, multiplied by 
‘‘(II) the percentage (if any) by which the aver-
age 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 2026.’’. 
SEC. 53115. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ‘‘$220,000,000’’ and inserting 
‘‘$0’’. 
SEC. 53116. CLOSING THE DONUT HOLE FOR SENIORS. 
(a) CLOSING DONUT HOLE SOONER.—Section 1860D–2(b)(2)(D) 
of the Social Security Act (42 U.S.C. 1395w–102(b)(2)(D))— 
(1) in clause (i), by amending subclause (I) to read as 
follows: 
‘‘(I) equal to the difference between— 
Time periods. 
Applicability. 
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132 STAT. 307 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(aa) the applicable gap percentage (speci-
fied in clause (ii) for the year); and 
‘‘(bb) the discount percentage specified in 
section 1860D–14A(g)(4)(A) for such applicable 
drugs (or, in the case of a year after 2018, 
50 percent); or’’; and 
(2) in clause (ii)— 
(A) in subclause (IV), by adding ‘‘and’’ at the end; 
(B) by striking subclause (V); and 
(C) in subclause (VI)— 
(i) by striking ‘‘2020’’ and inserting ‘‘2019’’; and 
(ii) by redesignating such subclause as subclause 
(V). 
(b) LOWERING DISCOUNTED PRICE.—Section 1860D–14A(g)(4)(A) 
of the Social Security Act (42 U.S.C. 1395w–114a(g)(4)(A)) is 
amended by inserting ‘‘(or, with respect to a plan year after plan 
year 2018, 30 percent)’’ after ‘‘50 percent’’. 
SEC. 53117. MODERNIZING CHILD SUPPORT ENFORCEMENT FEES. 
(a) IN GENERAL.—Section 454(6)(B)(ii) of the Social Security 
Act (42 U.S.C. 654(6)(B)(ii)) is amended— 
(1) by striking ‘‘$25’’ and inserting ‘‘$35’’; and 
(2) by striking ‘‘$500’’ each place it appears and inserting 
‘‘$550’’. 
(b) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendments made by subsection 
(a) shall take effect on the 1st day of the 1st fiscal year 
that begins on or after the date of the enactment of this 
Act, and shall apply to payments under part D of title IV 
of the Social Security Act (42 U.S.C. 651 et seq.) for calendar 
quarters beginning on or after such 1st day. 
(2) DELAY PERMITTED IF STATE LEGISLATION REQUIRED.— 
If the Secretary of Health and Human Services determines 
that State legislation (other than legislation appropriating 
funds) is required in order for a State plan developed pursuant 
to part D of title IV of the Social Security Act (42 U.S.C. 
651 et seq.) to meet the requirements imposed by the amend-
ment made by subsection (a), the plan shall not be regarded 
as failing to meet such requirements before the 1st day of 
the 1st calendar quarter beginning after the first regular ses-
sion of the State legislature that begins after the date of the 
enactment of this Act. For purposes of the preceding sentence, 
if the State has a 2-year legislative session, each year of the 
session is deemed to be a separate regular session of the State 
legislature. 
SEC. 53118. INCREASING EFFICIENCY OF PRISON DATA REPORTING. 
(a) IN GENERAL.—Section 1611(e)(1)(I)(i)(II) of the Social Secu-
rity Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is amended by striking ‘‘30 
days’’ each place it appears and inserting ‘‘15 days’’. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
(a) shall apply with respect to any payment made by the Commis-
sioner of Social Security pursuant to section 1611(e)(1)(I)(i)(II) of 
the Social Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) (as amended 
by such subsection) on or after the date that is 6 months after 
the date of enactment of this Act. 
Applicability. 
42 USC 1382 
note. 
Time period. 
Determination. 
Applicability. 
42 USC 654 note. 
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132 STAT. 308 
PUBLIC LAW 115–123—FEB. 9, 2018 
SEC. 53119. PREVENTION AND PUBLIC HEALTH FUND. 
Section 4002(b) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 300u–11(b)), as amended by section 3103 of Public 
Law 115–96, is amended by striking paragraphs (4) through (9) 
and inserting the following: 
‘‘(4) for fiscal year 2019, $900,000,000; 
‘‘(5) for each of fiscal years 2020 and 2021, $950,000,000; 
‘‘(6) for each of fiscal years 2022 and 2023, $1,000,000,000; 
‘‘(7) for each of fiscal years 2024 and 2025, $1,300,000,000; 
‘‘(8) for each of fiscal years 2026 and 2027, $1,800,000,000; 
and 
‘‘(9) for fiscal year 2028 and each fiscal year thereafter, 
$2,000,000,000.’’. 
DIVISION F—IMPROVEMENTS TO AGRICULTURE 
PROGRAMS 
SEC. 60101. (a) TREATMENT OF SEED COTTON.— 
(1) DESIGNATION
OF
SEED
COTTON
AS
A
COVERED
COM-
MODITY.—Section 1111(6) of the Agricultural Act of 2014 (7 
U.S.C. 9011(6)) is amended— 
(A) by striking ‘‘The term’’ and inserting the following: 
‘‘(A) IN GENERAL.—The term’’; and 
(B) by adding at the end the following: 
‘‘(B) INCLUSION.—Effective beginning with the 2018 
crop year, the term ‘covered commodity’ includes seed 
cotton.’’. 
(2) REFERENCE PRICE FOR SEED COTTON.—Section 1111(18) 
of the Agricultural Act of 2014 (7 U.S.C. 9011(18)) is amended 
by adding at the end the following: 
‘‘(O) For seed cotton, $0.367 per pound.’’. 
(3) DEFINITION OF SEED COTTON.—Section 1111 of the Agri-
cultural Act of 2014 (7 U.S.C. 9011) is amended— 
(A) by redesignating paragraphs (20) through (24) as 
paragraphs (21) through (25), respectively; and 
(B) by inserting after paragraph (19) the following: 
‘‘(20) SEED
COTTON.—The term ‘seed cotton’ means 
unginned upland cotton that includes both lint and seed.’’. 
(4) PAYMENT YIELD.—Section 1113 of the Agricultural Act 
of 2014 (7 U.S.C. 9013) is amended by adding at the end 
the following: 
‘‘(e) PAYMENT YIELD FOR SEED COTTON.— 
‘‘(1) PAYMENT YIELD.—Subject to paragraph (2), the pay-
ment yield for seed cotton for a farm shall be equal to 2.4 
times the payment yield for upland cotton for the farm estab-
lished under section 1104(e)(3) of the Food, Conservation, and 
Energy Act of 2008 (7 U.S.C. 8714(e)(3)) (as in effect on Sep-
tember 30, 2013). 
‘‘(2) UPDATE.—At the sole discretion of the owner of a 
farm with a yield for upland cotton described in paragraph 
(1), the owner of the farm shall have a 1-time opportunity 
to update the payment yield for upland cotton for the farm, 
as provided in subsection (d), for the purpose of calculating 
the payment yield for seed cotton under paragraph (1).’’. 
(5) PAYMENT ACRES.—Section 1114(b) of the Agricultural 
Act of 2014 (7 U.S.C. 9014(b)) is amended by adding at the 
end the following: 
Effective date. 
Improvements to 
Agriculture 
Programs Act of 
2018. 
7 USC 9011 note. 
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132 STAT. 309 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(4) SEED COTTON.— 
‘‘(A) IN GENERAL.—Not later than 90 days after the 
date of enactment of this paragraph, the Secretary shall 
require the owner of a farm to allocate all generic base 
acres on the farm under subparagraph (B) or (C), or both. 
‘‘(B) NO RECENT HISTORY OF COVERED COMMODITIES.— 
In the case of a farm on which no covered commodities 
(including seed cotton) were planted or were prevented 
from being planted at any time during the 2009 through 
2016 crop years, the owner of such farm shall allocate 
generic base acres on the farm to unassigned crop base 
for which no payments may be made under section 1116 
or 1117. 
‘‘(C) RECENT HISTORY OF COVERED COMMODITIES.—In 
the case of a farm not described in subparagraph (B), 
the owner of such farm shall allocate generic base acres 
on the farm— 
‘‘(i) subject to subparagraph (D), to seed cotton 
base acres in a quantity equal to the greater of— 
‘‘(I) 80 percent of the generic base acres on 
the farm; or 
‘‘(II) the average number of seed cotton acres 
planted or prevented from being planted on the 
farm during the 2009 through 2012 crop years 
(not to exceed the total generic base acres on the 
farm); or 
‘‘(ii) to base acres for covered commodities 
(including seed cotton), by applying subparagraphs (B), 
(D), (E), and (F) of section 1112(a)(3). 
‘‘(D) TREATMENT OF RESIDUAL GENERIC BASE ACRES.— 
In the case of a farm on which generic base acres are 
allocated under subparagraph (C)(i), the residual generic 
base acres shall be allocated to unassigned crop base for 
which no payments may be made under section 1116 or 
1117. 
‘‘(E) EFFECT OF FAILURE TO ALLOCATE.—In the case 
of a farm not described in subparagraph (B) for which 
the owner of the farm fails to make an election under 
subparagraph (C), the owner of the farm shall be deemed 
to have elected to allocate all generic base acres in accord-
ance with subparagraph (C)(i).’’. 
(6) RECORDKEEPING REGARDING UNASSIGNED CROP BASE.— 
Section 1114 of the Agricultural Act of 2014 (7 U.S.C. 9014) 
is amended by adding at the end the following: 
‘‘(f) UNASSIGNED CROP BASE.—The Secretary shall maintain 
information on generic base acres on a farm allocated as unassigned 
crop base under subsection (b)(4).’’. 
(7) SPECIAL ELECTION PERIOD FOR PRICE LOSS COVERAGE 
OR AGRICULTURE RISK COVERAGE.—Section 1115 of the Agricul-
tural Act of 2014 (7 U.S.C. 9015) is amended— 
(A) in subsection (a), by striking ‘‘For’’ and inserting 
‘‘Except as provided in subsection (g), for’’; and 
(B) by adding at the end the following: 
‘‘(g) SPECIAL ELECTION.— 
‘‘(1) IN GENERAL.—In the case of acres allocated to seed 
cotton on a farm, all of the producers on the farm shall be 
given the opportunity to make a new 1-time election under 
Deadline. 
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132 STAT. 310 
PUBLIC LAW 115–123—FEB. 9, 2018 
subsection (a) to reflect the designation of seed cotton as a 
covered commodity for that crop year under section 1111(6)(B). 
‘‘(2) EFFECT OF FAILURE TO MAKE UNANIMOUS ELECTION.— 
If all the producers on a farm fail to make a unanimous election 
under paragraph (1), the producers on the farm shall be deemed 
to have elected price loss coverage under section 1116 for acres 
allocated on the farm to seed cotton.’’. 
(8) EFFECTIVE PRICE.—Section 1116 of the Agricultural Act 
of 2014 (7 U.S.C. 9016) is amended by adding at the end 
the following: 
‘‘(h) EFFECTIVE PRICE FOR SEED COTTON.— 
‘‘(1) IN GENERAL.—The effective price for seed cotton under 
subsection (b) shall be equal to the marketing year average 
price for seed cotton, as calculated under paragraph (2). 
‘‘(2) CALCULATION.—The marketing year average price for 
seed cotton for a crop year shall be equal to the quotient 
obtained by dividing— 
‘‘(A) the sum obtained by adding— 
‘‘(i) the product obtained by multiplying— 
‘‘(I) the upland cotton lint marketing year 
average price; and 
‘‘(II) the total United States upland cotton lint 
production, measured in pounds; and 
‘‘(ii) the product obtained by multiplying— 
‘‘(I) the cottonseed marketing year average 
price; and 
‘‘(II) the total United States cottonseed produc-
tion, measured in pounds; by 
‘‘(B) the sum obtained by adding— 
‘‘(i) the total United States upland cotton lint 
production, measured in pounds; and 
‘‘(ii) the total United States cottonseed production, 
measured in pounds.’’. 
(9) DEEMED LOAN RATE FOR SEED COTTON.—Section 1202 
of the Agricultural Act of 2014 (7 U.S.C. 9032) is amended 
by adding at the end the following: 
‘‘(c) SEED COTTON.— 
‘‘(1) IN GENERAL.—For purposes of section 1116(b)(2) and 
paragraphs (1)(B)(ii) and (2)(A)(ii)(II) of section 1117(b), the 
loan rate for seed cotton shall be deemed to be equal to $0.25 
per pound. 
‘‘(2) EFFECT.—Nothing in this subsection authorizes any 
nonrecourse marketing assistance loan under this subtitle for 
seed cotton.’’. 
(10) LIMITATION ON STACKED INCOME PROTECTION PLAN FOR 
PRODUCERS OF UPLAND COTTON.—Section 508B of the Federal 
Crop Insurance Act (7 U.S.C. 1508b) is amended by adding 
at the end the following: 
‘‘(f) LIMITATION.—Effective beginning with the 2019 crop year, 
a farm shall not be eligible for the Stacked Income Protection 
Plan for upland cotton for a crop year for which the farm is enrolled 
in coverage for seed cotton under— 
‘‘(1) price loss coverage under section 1116 of the Agricul-
tural Act of 2014 (7 U.S.C. 9016); or 
‘‘(2) agriculture risk coverage under section 1117 of that 
Act (7 U.S.C. 9017).’’. 
Effective date. 
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132 STAT. 311 
PUBLIC LAW 115–123—FEB. 9, 2018 
(11) TECHNICAL
CORRECTION.—Section 1114(b)(2) of the 
Agricultural Act of 2014 (7 U.S.C. 9014(b)(2)) is amended by 
striking ‘‘paragraphs (1)(B) and (2)(B)’’ and inserting ‘‘para-
graphs (1) and (2)’’. 
(12) ADMINISTRATION.—The Secretary of Agriculture shall 
carry out the amendments made by this subsection in accord-
ance with section 1601 of the Agricultural Act of 2014 (7 U.S.C. 
9091). 
(13) APPLICATION.—Except as provided in paragraph (10), 
the amendments made by this subsection shall apply beginning 
with the 2018 crop year. 
(b) MARGIN PROTECTION PROGRAM FOR DAIRY PRODUCERS.— 
(1) MONTHLY CALCULATION OF ACTUAL DAIRY PRODUCTION 
MARGIN.— 
(A) DEFINITIONS.—Section 1401 of the Agricultural Act 
of 2014 (7 U.S.C. 9051) is amended— 
(i) by striking paragraph (4); and 
(ii) by redesignating paragraphs (5) through (11) 
as paragraphs (4) through (10), respectively. 
(B) CALCULATION
OF
ACTUAL
DAIRY
PRODUCTION 
MARGIN.—Section 1402(b)(1) of the Agricultural Act of 2014 
(7 U.S.C. 9052(b)(1)) is amended by striking ‘‘consecutive 
2-month period’’ each place it appears and inserting 
‘‘month’’. 
(C) MARGIN PROTECTION PAYMENTS.—Section 1406 of 
the Agricultural Act of 2014 (7 U.S.C. 9056) is amended— 
(i) by striking ‘‘consecutive 2-month period’’ each 
place it appears and inserting ‘‘month’’; and 
(ii) in subsection (c)(2)(B), by striking ‘‘6’’ and 
inserting ‘‘12’’. 
(2) PARTICIPATION OF DAIRY OPERATIONS IN MARGIN PROTEC-
TION PROGRAM.—Section 1404 of the Agricultural Act of 2014 
(7 U.S.C. 9054) is amended— 
(A) in subsection (b)— 
(i) in paragraph (1), by inserting ‘‘, including the 
establishment of a date each calendar year by which 
a dairy operation shall register for the calendar year’’ 
before the period at the end; 
(ii) by redesignating paragraphs (2) and (3) as 
paragraphs (3) and (4), respectively; and 
(iii) by inserting after paragraph (1) the following: 
‘‘(2) EXTENSION OF ELECTION PERIOD FOR 2018 CALENDAR 
YEAR.—The Secretary shall extend the election period for the 
2018 calendar year by not less than 90 days after the date 
of enactment of the Bipartisan Budget Act of 2018 or such 
additional period as the Secretary determines is necessary for 
dairy operations to make new elections to participate for that 
calendar year, including dairy operations that elected to so 
participate before that date of enactment.’’; and 
(B) in subsection (c), by adding at the end the following: 
‘‘(4) EXEMPTION.—A limited resource, beginning, veteran, 
or socially disadvantaged farmer, as defined by the Secretary, 
shall be exempt from the administrative fee under this sub-
section.’’. 
(3) PRODUCTION
HISTORY
OF
PARTICIPATING
DAIRY
OPER-
ATIONS.—Section 1405(a) of the Agricultural Act of 2014 (7 
U.S.C. 9055(a)) is amended by adding at the end the following: 
Deadline. 
Determination. 
Applicability. 
Effective date. 
7 USC 9011 note. 
7 USC 9011 note. 
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132 STAT. 312 
PUBLIC LAW 115–123—FEB. 9, 2018 
‘‘(3) CONTINUED APPLICABILITY OF BASE PRODUCTION HIS-
TORY.—A production history established for a dairy operation 
under paragraph (1) shall be the base production history for 
the dairy operation in subsequent years (as adjusted under 
paragraph (2)).’’. 
(4) PREMIUMS FOR MARGIN PROTECTION PROGRAM.—Section 
1407 of the Agricultural Act of 2014 (7 U.S.C. 9057) is 
amended— 
(A) in subsection (b)— 
(i) by striking the subsection heading and inserting 
the following: ‘‘TIER I: PREMIUM PER HUNDREDWEIGHT 
FOR FIRST 5,000,000 POUNDS OF PRODUCTION.—’’; 
(ii) in paragraph (1), by striking ‘‘4,000,000’’ and 
inserting ‘‘5,000,000’’; and 
(iii) in paragraph (2)— 
(I) by striking ‘‘$0.010’’ and inserting ‘‘None’’; 
(II) by striking ‘‘$0.025’’ and inserting ‘‘None’’; 
(III) by striking ‘‘$0.040’’ and inserting 
‘‘$0.009’’; 
(IV) 
by 
striking 
‘‘$0.055’’ 
and 
inserting 
‘‘$0.016’’; 
(V) by striking ‘‘$0.090’’ and inserting ‘‘$0.040’’; 
(VI) 
by 
striking 
‘‘$0.217’’ 
and 
inserting 
‘‘$0.063’’; 
(VII) by striking ‘‘$0.300’’ and inserting 
‘‘$0.087’’; and 
(VIII) by striking ‘‘$0.475’’ and inserting 
‘‘$0.142’’; and 
(B) in subsection (c)— 
(i) by striking the subsection heading and inserting 
the following: ‘‘TIER II: PREMIUM PER HUNDREDWEIGHT 
FOR PRODUCTION IN EXCESS OF 5,000,000 POUNDS.— 
’’; and 
(ii) in paragraph (1), by striking ‘‘4,000,000’’ and 
inserting ‘‘5,000,000’’. 
(5) APPLICATION.—The amendments made by this sub-
section shall apply beginning with the 2018 calendar year. 
(c) LIMITATION
ON
CROP
INSURANCE
LIVESTOCK-RELATED 
EXPENDITURES.— 
(1) IN GENERAL.—Section 523(b) of the Federal Crop Insur-
ance Act (7 U.S.C. 1523(b)) is amended by striking paragraph 
(10). 
(2) CONFORMING AMENDMENTS.—Section 516 of the Federal 
Crop Insurance Act (7 U.S.C. 1516) is amended in subsections 
(a)(2)(C) and (b)(1)(D) by striking ‘‘subsections (a)(3)(E)(ii) and 
(b)(10) of section 523’’ each place it appears and inserting 
‘‘subsection (a)(3)(E)(ii) of that section’’. 
SEC. 60102. (a) Section 1240B of the Food Security Act of 
1985 (16 U.S.C. 3839aa–2) is amended by striking subsection (a) 
and inserting the following: 
‘‘(a) ESTABLISHMENT.—During each of the 2002 through 2019 
fiscal years, the Secretary shall provide payments to producers 
that enter into contracts with the Secretary under the program.’’. 
(b) Section 1241 of the Food Security Act of 1985 (16 U.S.C. 
3841) is amended— 
(1) in subsection (a)— 
Time period. 
Payments. 
Contracts. 
7 USC 9051 note. 
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132 STAT. 313 
PUBLIC LAW 115–123—FEB. 9, 2018 
LEGISLATIVE HISTORY—H.R. 1892: 
HOUSE REPORTS: No. 115–119 (Comm. on the Judiciary). 
CONGRESSIONAL RECORD: 
Vol. 163 (2017): May 16, 18, considered and passed House. 
Nov. 28, considered and passed Senate, amended. 
Vol. 164 (2018): Feb. 6, House concurred in Senate amendment with an 
amendment. 
Feb. 7, Senate considered concurring in House amendment 
with an amendment. 
Feb. 8, Senate concurred in House amendment with an 
amendment. House concurred in Senate amendment. 
(A) in the matter preceding paragraph (1), by striking 
‘‘2018’’ and inserting ‘‘2018 (and fiscal year 2019 in the 
case of the program specified in paragraph (5))’’; and 
(B) in paragraph (5)(E), by striking ‘‘fiscal year 2018’’ 
and inserting ‘‘each of fiscal years 2018 through 2019’’; 
and 
(2) in subsection (b), by striking ‘‘2018’’ and inserting ‘‘2018 
(and fiscal year 2019 in the case of the program specified 
in subsection (a)(5))’’. 
This division may be cited as the ‘‘Improvements to Agriculture 
Programs Act of 2018’’. 
DIVISION G—BUDGETARY EFFECTS 
SEC. 70101. BUDGETARY EFFECTS. 
(a) IN GENERAL.—The budgetary effects of division A, subdivi-
sion 2 of division B, and division C and each succeeding division 
shall not be entered on either PAYGO scorecard maintained pursu-
ant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary effects of divi-
sion A, subdivision 2 of division B, and division C and each suc-
ceeding 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.—Notwithstanding 
Rule 3 of the Budget Scorekeeping Guidelines set forth in the 
joint explanatory statement of the committee of conference accom-
panying Conference Report 105–217 and section 250(c)(8) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of division A, subdivision 2 of division B, and 
division C and each succeeding 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. 
Approved February 9, 2018. 
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