#aaeth ,,congress #b;d ,session ,in the ,house of ,representatives1 ,u4 ,s41 ,february #f1 #bjah ,,house ,,amendment ,,to ,,senate ,,amendment3 ,that the ,house agree to the amendment of the ,senate to the bill 7,h4,r4 #ahib7 entitled ,an ,act to amend title #d1 ,united ,states ,code1 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 duty41 with the following ,at the end of the matter inserted by the ,senate amendment1 insert the following3 ,b ,further ,extension of ,continuing ,appropriations ,act1 #bjah #ajja4 ,the ,continuing ,appropriations ,act1 #bjah 7division ,d of ,public ,law #aae-ef7 is further amended-- 7#a7 by striking the date specified in section #ajf7c7 and inserting ,march #bc1 #bjah2 and 7#b7 by adding after section #aee the following3 #aef4 ,notwithstanding section #aja1 amounts are provided for ,department of ,commerce--,bureau of the ,census--,periodic ,censuses and ,programs at a rate for operations of #a1bea1jjj1jjj1 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 #bjbj ,decennial ,census ,program4 #aeg4 ,notwithstanding section #aja1 the matter preceding the first proviso and the first proviso under the heading ,power ,marketing ,administrations--,operation and ,maintenance1 ,southeastern ,power ,administration in division ,d of ,public ,law #aae-ca shall be applied by substituting #f1cgi1jjj for #a1jjj1jjj each place it appears4 #aeh4 ,as authorized by section #djd of the ,bipartisan ,budget ,act of #bjae 7,public ,law #aad-gd2 #db ,u4,s4,c4 #fbci note71 the ,secretary of ,energy shall draw down and sell not to exceed #cej1jjj1jjj of crude oil from the ,strategic ,petroleum ,reserve in fiscal year #bjah3 ,provided1 ,that the proceeds from such drawdown and sale shall be deposited into the ,energy ,security and ,infrastructure ,modernization ,fund 7in this section referred to as the ,fund7 during fiscal year #bjah3 ,provided further1 ,that in addition to amounts otherwise made available by section #aja1 and notwithstanding section #ajd1 any amounts deposited in the ,fund shall be made available and shall remain available until expended at a rate for operations of #cej1jjj1jjj1 for necessary expenses in carrying out the ,life ,extension ,,ii project for the ,strategic ,petroleum ,reserve4 #aei4 ,amounts made available by section #aja for ,the ,judiciary--,courts of ,appeals1 ,district ,courts1 and ,other ,judicial ,services--,fees of ,jurors and ,commissioners may be apportioned up to the rate for operations necessary to accommodate increased juror usage4 #afj4 7a7 ,in addition to amounts otherwise made available by section #aja1 there is appropriated for an additional amount for the ,small ,business ,administration--,disaster ,loans ,program ,account #bbe1jjj1jjj1 to remain available until expended1 for the cost of direct loans authorized by section #g7;b7 of the ,small ,business ,act3 ,provided1 ,that such amount is designated by the ,congress as an emergency requirement pursuant to section #bea7;b77#b77;,a77i7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 7b7 ,the amount designated in subsection 7a7 by the ,congress as an emergency requirement pursuant to section #bea7;b77#b77;,a77i7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe shall be available only if the ,president subsequently so designates such amount and transmits such designation to the ,congress4 4 ,this division may be cited as the ,further ,extension of ,continuing ,appropriations ,act1 #bjah4 ,c ,department of ,defense ,appropriations ,act1 #bjah ,that the following sums are appropriated1 out of any money in the ,treasury not otherwise appropriated1 for the fiscal year ending ,september #cj1 #bjah1 for military functions administered by the ,department of ,defense and for other purposes1 namely3 ,i ,military personnel ,military personnel1 army ,for pay1 allowances1 individual clothing1 subsistence1 interest on deposits1 gratuities1 permanent change of station travel 7including all expenses thereof for organizational movements71 and expenses of temporary duty travel between permanent duty stations1 for members of the ,army on active duty 7except members of reserve components provided for elsewhere71 cadets1 and aviation cadets2 for members of the ,reserve ,officers' ,training ,corps2 and for payments pursuant to section #aef of ,public ,law #ig-cgg1 as amended 7#db ,u4,s4,c4 #djb note71 and to the ,department of ,defense ,military ,retirement ,fund1 #da1dbg1jed1jjj4 ,military personnel1 navy ,for pay1 allowances1 individual clothing1 subsistence1 interest on deposits1 gratuities1 permanent change of station travel 7including all expenses thereof for organizational movements71 and expenses of temporary duty travel between permanent duty stations1 for members of the ,navy on active duty 7except members of the ,reserve provided for elsewhere71 midshipmen1 and aviation cadets2 for members of the ,reserve ,officers' ,training ,corps2 and for payments pursuant to section #aef of ,public ,law #ig-cgg1 as amended 7#db ,u4,s4,c4 #djb note71 and to the ,department of ,defense ,military ,retirement ,fund1 #bh1gjg1iah1jjj 7reduced by #b1jjj1jjj7 7increased by #b1jjj1jjj74 ,military personnel1 marine corps ,for pay1 allowances1 individual clothing1 subsistence1 interest on deposits1 gratuities1 permanent change of station travel 7including all expenses thereof for organizational movements71 and expenses of temporary duty travel between permanent duty stations1 for members of the ,marine ,corps on active duty 7except members of the ,reserve provided for elsewhere72 and for payments pursuant to section #aef of ,public ,law #ig-cgg1 as amended 7#db ,u4,s4,c4 #djb note71 and to the ,department of ,defense ,military ,retirement ,fund1 #ac1afe1gad1jjj4 ,military personnel1 air force ,for pay1 allowances1 individual clothing1 subsistence1 interest on deposits1 gratuities1 permanent change of station travel 7including all expenses thereof for organizational movements71 and expenses of temporary duty travel between permanent duty stations1 for members of the ,air ,force on active duty 7except members of reserve components provided for elsewhere71 cadets1 and aviation cadets2 for members of the ,reserve ,officers' ,training ,corps2 and for payments pursuant to section #aef of ,public ,law #ig-cgg1 as amended 7#db ,u4,s4,c4 #djb note71 and to the ,department of ,defense ,military ,retirement ,fund1 #bh1gch1cbj1jjj4 ,reserve personnel1 army ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,army ,reserve on active duty under sections #ajbaa1 #ajcjb1 and #cjch of title #aj1 ,united ,states ,code1 or while serving on active duty under section #abcja7;d7 of title #aj1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing reserve training1 or while performing drills or equivalent duty or other duty1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #d1gba1abh1jjj4 ,reserve personnel1 navy ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,navy ,reserve on active duty under section #ajbaa of title #aj1 ,united ,states ,code1 or while serving on active duty under section #abcja7;d7 of title #aj1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing reserve training1 or while performing drills or equivalent duty1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #a1ihg1ffb1jjj4 ,reserve personnel1 marine corps ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,marine ,corps ,reserve on active duty under section #ajbaa of title #aj1 ,united ,states ,code1 or while serving on active duty under section #abcja7;d7 of title #aj1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing reserve training1 or while performing drills or equivalent duty1 and for members of the ,marine ,corps platoon leaders class1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #gfb1gic1jjj4 ,reserve personnel1 air force ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,air ,force ,reserve on active duty under sections #ajbaa1 #ajcje1 and #hjch of title #aj1 ,united ,states ,code1 or while serving on active duty under section #abcja7;d7 of title #aj1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing reserve training1 or while performing drills or equivalent duty or other duty1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #a1hjh1dcd1jjj4 ,national guard personnel1 army ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,army ,national ,guard while on duty under sections #ajbaa1 #ajcjb1 or #abdjb of title #aj or section #gjh of title #cb1 ,united ,states ,code1 or while serving on duty under section #abcja7;d7 of title #aj or section #ejb7;f7 of title #cb1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing training1 or while performing drills or equivalent duty or other duty1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #h1beb1dbf1jjj4 ,national guard personnel1 air force ,for pay1 allowances1 clothing1 subsistence1 gratuities1 travel1 and related expenses for personnel of the ,air ,national ,guard on duty under sections #ajbaa1 #ajcje1 or #abdjb of title #aj or section #gjh of title #cb1 ,united ,states ,code1 or while serving on duty under section #abcja7;d7 of title #aj or section #ejb7;f7 of title #cb1 ,united ,states ,code1 in connection with performing duty specified in section #abcaj7;a7 of title #aj1 ,united ,states ,code1 or while undergoing training1 or while performing drills or equivalent duty or other duty1 and expenses authorized by section #afaca of title #aj1 ,united ,states ,code2 and for payments to the ,department of ,defense ,military ,retirement ,fund1 #c1djf1acg1jjj4 ,,ii ,operation and maintenance ,operation and maintenance1 army ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance of the ,army1 as authorized by law1 #ch1dhc1hdf1jjj 7reduced by #e1jjj1jjj7 7reduced by #e1fjj1jjj7 7reduced by #f1jjj1jjj73 ,provided1 ,that not to exceed #ab1dgh1jjj can be used for emergencies and extraordinary expenses1 to be expended on the approval or authority of the ,secretary of the ,army1 and payments may be made on his certificate of necessity for confidential military purposes4 ,operation and maintenance1 navy ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance of the ,navy and the ,marine ,corps1 as authorized by law1 #de1ihj1acc1jjj 7reduced by #eih1jjj7 7reduced by #g1jjj1jjj73 ,provided1 ,that not to exceed #ae1jee1jjj can be used for emergencies and extraordinary expenses1 to be expended on the approval or authority of the ,secretary of the ,navy1 and payments may be made on his certificate of necessity for confidential military purposes4 ,operation and maintenance1 marine corps ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance of the ,marine ,corps1 as authorized by law1 #f1hhe1hhd1jjj4 ,operation and maintenance1 air force ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance of the ,air ,force1 as authorized by law1 #ch1eib1gde1jjj3 ,provided1 ,that not to exceed #g1fii1jjj can be used for emergencies and extraordinary expenses1 to be expended on the approval or authority of the ,secretary of the ,air ,force1 and payments may be made on his certificate of necessity for confidential military purposes4 ,operation and maintenance1 defense-,wide 7including transfer of funds7 ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance of activities and agencies of the ,department of ,defense 7other than the military departments71 as authorized by law1 #cc1gga1gfi1jjj 7increased by #e1jjj1jjj7 7reduced by #aj1jjj1jjj7 7reduced by #ajj1jjj7 7increased by #ajj1jjj7 7reduced by #aid1hig1jjj7 7increased by #aid1hig1jjj7 7reduced by #bf1bjj1jjj7 7reduced by #bj1jjj1jjj7 7reduced by #f1jjj1jjj7 7reduced by #d1jjj1jjj7 7reduced by #bj1jjj1jjj7 7reduced by #a1jjj1jjj7 7reduced by #aj1jjj1jjj7 7reduced by #b1ejj1jjj7 7reduced by #b1jjj1jjj7 7reduced by #h1jjj1jjj7 7reduced by #f1bej1jjj7 7reduced by #aj1jjj1jjj7 7reduced by #aj1jjj1jjj7 7reduced by #cj1jjj1jjj7 7reduced by #cd1gcd1jjj7 7reduced by #fj1jjj1jjj73 ,provided1 ,that not more than #ae1jjj1jjj may be used for the ,combatant ,commander ,initiative ,fund authorized under section #aff;a of title #aj1 ,united ,states ,code3 ,provided further1 ,that not to exceed #cf1jjj1jjj can be used for emergencies and extraordinary expenses1 to be expended on the approval or authority of the ,secretary of ,defense1 and payments may be made on his certificate of necessity for confidential military purposes3 ,provided further1 ,that of the funds provided under this heading1 not less than #ch1deh1jjj shall be made available for the ,procurement ,technical ,assistance ,cooperative ,agreement ,program1 of which not less than #c1fjj1jjj shall be available for centers defined in #aj ,u4,s4,c4 #bdaa7a77;,d73 ,provided further1 ,that none of the funds appropriated or otherwise made available by this ,act may be used to plan or implement the consolidation of a budget or appropriations liaison office of the ,office of the ,secretary of ,defense1 the office of the ,secretary of a military department1 or the service headquarters of one of the ,armed ,forces into a legislative affairs or legislative liaison office3 ,provided further1 ,that #i1che1jjj1 to remain available until expended1 is available only for expenses relating to certain classified activities1 and may be transferred as necessary by the ,secretary of ,defense to operation and maintenance appropriations or research1 development1 test and evaluation appropriations1 to be merged with and to be available for the same time period as the appropriations to which transferred3 ,provided further1 ,that any ceiling on the investment item unit cost of items that may be purchased with operation and maintenance funds shall not apply to the funds described in the preceding proviso3 ,provided further1 ,that of the funds provided under this heading1 #dae1jjj1jjj1 of which #ajj1jjj1jjj to remain available until ,september #cj1 #bjai1 shall be available to provide support and assistance to foreign security forces or other groups or individuals to conduct1 support or facilitate counterterrorism1 crisis response1 or other ,department of ,defense security cooperation programs3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,operation and maintenance1 army reserve ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance1 including training1 organization1 and administration1 of the ,army ,reserve2 repair of facilities and equipment2 hire of passenger motor vehicles2 travel and transportation2 care of the dead2 recruiting2 procurement of services1 supplies1 and equipment2 and communications1 #b1hgj1afc1jjj4 ,operation and maintenance1 navy reserve ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance1 including training1 organization1 and administration1 of the ,navy ,reserve2 repair of facilities and equipment2 hire of passenger motor vehicles2 travel and transportation2 care of the dead2 recruiting2 procurement of services1 supplies1 and equipment2 and communications1 #a1jch1ejg1jjj4 ,operation and maintenance1 marine corps reserve ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance1 including training1 organization1 and administration1 of the ,marine ,corps ,reserve2 repair of facilities and equipment2 hire of passenger motor vehicles2 travel and transportation2 care of the dead2 recruiting2 procurement of services1 supplies1 and equipment2 and communications1 #bhb1ccg1jjj4 ,operation and maintenance1 air force reserve ,for expenses1 not otherwise provided for1 necessary for the operation and maintenance1 including training1 organization1 and administration1 of the ,air ,force ,reserve2 repair of facilities and equipment2 hire of passenger motor vehicles2 travel and transportation2 care of the dead2 recruiting2 procurement of services1 supplies1 and equipment2 and communications1 #c1bcc1gde1jjj4 ,operation and maintenance1 army national guard ,for expenses of training1 organizing1 and administering the ,army ,national ,guard1 including medical and hospital treatment and related expenses in non-,federal hospitals2 maintenance1 operation1 and repairs to structures and facilities2 hire of passenger motor vehicles2 personnel services in the ,national ,guard ,bureau2 travel expenses 7other than mileage71 as authorized by law for ,army personnel on active duty1 for ,army ,national ,guard division1 regimental1 and battalion commanders while inspecting units in compliance with ,national ,guard ,bureau regulations when specifically authorized by the ,chief1 ,national ,guard ,bureau2 supplying and equipping the ,army ,national ,guard as authorized by law2 and expenses of repair1 modification1 maintenance1 and issue of supplies and equipment 7including aircraft71 #g1bge1hbj1jjj4 ,operation and maintenance1 air national guard ,for expenses of training1 organizing1 and administering the ,air ,national ,guard1 including medical and hospital treatment and related expenses in non-,federal hospitals2 maintenance1 operation1 and repairs to structures and facilities2 transportation of things1 hire of passenger motor vehicles2 supplying and equipping the ,air ,national ,guard1 as authorized by law2 expenses for repair1 modification1 maintenance1 and issue of supplies and equipment1 including those furnished from stocks under the control of agencies of the ,department of ,defense2 travel expenses 7other than mileage7 on the same basis as authorized by law for ,air ,national ,guard personnel on active ,federal duty1 for ,air ,national ,guard commanders while inspecting units in compliance with ,national ,guard ,bureau regulations when specifically authorized by the ,chief1 ,national ,guard ,bureau1 #f1gce1icj1jjj4 ,united states court of appeals for the armed forces ,for salaries and expenses necessary for the ,united ,states ,court of ,appeals for the ,armed ,forces1 #ad1ech1jjj1 of which not to exceed #e1jjj may be used for official representation purposes4 ,environmental restoration1 army 7including transfer of funds7 ,for the ,department of the ,army1 #bae1hji1jjj1 to remain available until transferred3 ,provided1 ,that the ,secretary of the ,army shall1 upon determining that such funds are required for environmental restoration1 reduction and recycling of hazardous waste1 removal of unsafe buildings and debris of the ,department of the ,army1 or for similar purposes1 transfer the funds made available by this appropriation to other appropriations made available to the ,department of the ,army1 to be merged with and to be available for the same purposes and for the same time period as the appropriations to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,environmental restoration1 navy 7including transfer of funds7 ,for the ,department of the ,navy1 #bhh1iae1jjj 7increased by #cd1gcd1jjj7 7increased by #cj1jjj1jjj71 to remain available until transferred3 ,provided1 ,that the ,secretary of the ,navy shall1 upon determining that such funds are required for environmental restoration1 reduction and recycling of hazardous waste1 removal of unsafe buildings and debris of the ,department of the ,navy1 or for similar purposes1 transfer the funds made available by this appropriation to other appropriations made available to the ,department of the ,navy1 to be merged with and to be available for the same purposes and for the same time period as the appropriations to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,environmental restoration1 air force 7including transfer of funds7 ,for the ,department of the ,air ,force1 #cjh1gdi1jjj 7increased by #cj1jjj1jjj71 to remain available until transferred3 ,provided1 ,that the ,secretary of the ,air ,force shall1 upon determining that such funds are required for environmental restoration1 reduction and recycling of hazardous waste1 removal of unsafe buildings and debris of the ,department of the ,air ,force1 or for similar purposes1 transfer the funds made available by this appropriation to other appropriations made available to the ,department of the ,air ,force1 to be merged with and to be available for the same purposes and for the same time period as the appropriations to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,environmental restoration1 defense-,wide 7including transfer of funds7 ,for the ,department of ,defense1 #i1jjb1jjj 7increased by #aj1jjj1jjj71 to remain available until transferred3 ,provided1 ,that the ,secretary of ,defense shall1 upon determining that such funds are required for environmental restoration1 reduction and recycling of hazardous waste1 removal of unsafe buildings and debris of the ,department of ,defense1 or for similar purposes1 transfer the funds made available by this appropriation to other appropriations made available to the ,department of ,defense1 to be merged with and to be available for the same purposes and for the same time period as the appropriations to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,environmental restoration1 formerly used defense sites 7including transfer of funds7 ,for the ,department of the ,army1 #bcc1fgc1jjj1 to remain available until transferred3 ,provided1 ,that the ,secretary of the ,army shall1 upon determining that such funds are required for environmental restoration1 reduction and recycling of hazardous waste1 removal of unsafe buildings and debris at sites formerly used by the ,department of ,defense1 transfer the funds made available by this appropriation to other appropriations made available to the ,department of the ,army1 to be merged with and to be available for the same purposes and for the same time period as the appropriations to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 ,overseas humanitarian1 disaster1 and civic aid ,for expenses relating to the ,overseas ,humanitarian1 ,disaster1 and ,civic ,aid programs of the ,department of ,defense 7consisting of the programs provided under sections #dja1 #djb1 #djd1 #djg1 #beeg1 and #befa of title #aj1 ,united ,states ,code71 #ajg1ijj1jjj1 to remain available until ,september #cj1 #bjah4 ,cooperative threat reduction account ,for assistance1 including assistance provided by contract or by grants1 under programs and activities of the ,department of ,defense ,cooperative ,threat ,reduction ,program authorized under the ,department of ,defense ,cooperative ,threat ,reduction ,act1 #cbd1fjj1jjj1 to remain available until ,september #cj1 #bjai4 ,operation and ,maintenance1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #e1jjj1jjj1jjj1 for the ,operation and ,maintenance1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to operation and maintenance accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense4 ,,iii ,procurement ,aircraft procurement1 army ,for construction1 procurement1 production1 modification1 and modernization of aircraft1 equipment1 including ordnance1 ground handling equipment1 spare parts1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #d1def1ecc1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,missile procurement1 army ,for construction1 procurement1 production1 modification1 and modernization of missiles1 equipment1 including ordnance1 ground handling equipment1 spare parts1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #b1eha1fjj1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement of weapons and tracked combat vehicles1 army ,for construction1 procurement1 production1 and modification of weapons and tracked combat vehicles1 equipment1 including ordnance1 spare parts1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #c1eef1age1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement of ammunition1 army ,for construction1 procurement1 production1 and modification of ammunition1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including ammunition facilities1 authorized by section #bhed of title #aj1 ,united ,states ,code1 and the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #a1haa1hjh1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,other procurement1 army ,for construction1 procurement1 production1 and modification of vehicles1 including tactical1 support1 and non-tracked combat vehicles2 the purchase of passenger motor vehicles for replacement only2 communications and electronic equipment2 other support equipment2 spare parts1 ordnance1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #f1cef1jdd1jjj 7increased by #cj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjbj4 ,aircraft procurement1 navy ,for construction1 procurement1 production1 modification1 and modernization of aircraft1 equipment1 including ordnance1 spare parts1 and accessories therefor2 specialized equipment2 expansion of public and private plants1 including the land necessary therefor1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway1 #ag1ijh1bgj1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,weapons procurement1 navy ,for construction1 procurement1 production1 modification1 and modernization of missiles1 torpedoes1 other weapons1 and related support equipment including spare parts1 and accessories therefor2 expansion of public and private plants1 including the land necessary therefor1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway1 #c1chg1hbf1jjj 7increased by #bf1bjj1jjj71 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement of ammunition1 navy and marine corps ,for construction1 procurement1 production1 and modification of ammunition1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including ammunition facilities1 authorized by section #bhed of title #aj1 ,united ,states ,code1 and the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #gce1fea1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,shipbuilding and conversion1 navy ,for expenses necessary for the construction1 acquisition1 or conversion of vessels as authorized by law1 including armor and armament thereof1 plant equipment1 appliances1 and machine tools and installation thereof in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 procurement of critical1 long lead time components and designs for vessels to be constructed or converted in the future2 and expansion of public and private plants1 including land necessary therefor1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title1 as follows3 ,ohio ,replacement ,submarine 7,,ap71 #hdb1hec1jjj2 ,carrier ,replacement ,program1 #a1hfi1fdf1jjj2 ,carrier ,replacement ,program 7,,ap71 #b1efa1jeh1jjj2 ,virginia ,class ,submarine1 #c1cje1cae1jjj2 ,virginia ,class ,submarine 7,,ap71 #a1ibj1eif1jjj2 ,,cvn ,refueling ,overhauls1 #a1efi1ffi1jjj2 ,,cvn ,refueling ,overhauls 7,,ap71 #ge1hig1jjj2 ,,ddg-#ajjj ,program1 #afd1igf1jjj2 ,,ddg-#ea ,destroyer1 #c1dii1jgi1jjj2 ,,ddg-#ea ,destroyer 7,,ap71 #ij1ccf1jjj2 ,littoral ,combat ,ship1 #a1eff1iga1jjj2 ,expeditionary ,sea ,base1 #fce1jjj1jjj2 ,,lha ,replacement1 #a1fie1jgg1jjj2 ,,tao ,fleet ,oiler1 #ddi1dae1jjj2 ,,tao ,fleet ,oiler 7,,ap71 #ge1jfh1jjj2 ,ship to ,shore ,connector1 #cij1eed1jjj2 ,service ,craft1 #bc1iid1jjj2 ,towing1 ,salvage1 and ,rescue ,ship1 #gf1bjd1jjj2 ,,lcu #agjj1 #ca1hej1jjj2 ,for outfitting1 post delivery1 conversions1 and first destination transportation1 #edb1fbf1jjj2 and ,completion of ,prior ,year ,shipbuilding ,programs1 #aag1edb1jjj4;,in all3 #ba1ejc1gbf1jjj1 to remain available for obligation until ,september #cj1 #bjbb3 ,provided1 ,that additional obligations may be incurred after ,september #cj1 #bjbb1 for engineering services1 tests1 evaluations1 and other such budgeted work that must be performed in the final stage of ship construction3 ,provided further1 ,that none of the funds provided under this heading for the construction or conversion of any naval vessel to be constructed in shipyards in the ,united ,states shall be expended in foreign facilities for the construction of major components of such vessel3 ,provided further1 ,that none of the funds provided under this heading shall be used for the construction of any naval vessel in foreign shipyards3 ,provided further1 ,that funds appropriated or otherwise made available by this ,act for production of the common missile compartment of nuclear-powered vessels may be available for multiyear procurement of critical components to support continuous production of such compartments only in accordance with the provisions of subsection 7i7 of section #bbah;a of title #aj1 ,united ,states ,code 7as added by section #ajbc of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjag 7,public ,law #aad-cbh774 ,other procurement1 navy ,for procurement1 production1 and modernization of support equipment and materials not otherwise provided for1 ,navy ordnance 7except ordnance for new aircraft1 new ships1 and ships authorized for conversion72 the purchase of passenger motor vehicles for replacement only2 expansion of public and private plants1 including the land necessary therefor1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway1 #g1heb1ieb1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement1 marine corps ,for expenses necessary for the procurement1 manufacture1 and modification of missiles1 armament1 military equipment1 spare parts1 and accessories therefor2 plant equipment1 appliances1 and machine tools1 and installation thereof in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 vehicles for the ,marine ,corps1 including the purchase of passenger motor vehicles for replacement only2 and expansion of public and private plants1 including land necessary therefor1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title1 #a1hah1hdf1jjj 7increased by #bj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjbj4 ,aircraft procurement1 air force ,for construction1 procurement1 and modification of aircraft and equipment1 including armor and armament1 specialized ground handling equipment1 and training devices1 spare parts1 and accessories therefor2 specialized equipment2 expansion of public and private plants1 ,government-owned equipment and installation thereof in such plants1 erection of structures1 and acquisition of land1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes including rents and transportation of things1 #af1eec1aif1jjj 7increased by #af1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjbj4 ,missile procurement1 air force ,for construction1 procurement1 and modification of missiles1 rockets1 and related equipment1 including spare parts and accessories therefor2 ground handling equipment1 and training devices2 expansion of public and private plants1 ,government-owned equipment and installation thereof in such plants1 erection of structures1 and acquisition of land1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes including rents and transportation of things1 #b1bjc1aja1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,space procurement1 air force ,for construction1 procurement1 and modification of spacecraft1 rockets1 and related equipment1 including spare parts and accessories therefor2 ground handling equipment1 and training devices2 expansion of public and private plants1 ,government-owned equipment and installation thereof in such plants1 erection of structures1 and acquisition of land1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes including rents and transportation of things1 #c1baj1cee1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement of ammunition1 air force ,for construction1 procurement1 production1 and modification of ammunition1 and accessories therefor2 specialized equipment and training devices2 expansion of public and private plants1 including ammunition facilities1 authorized by section #bhed of title #aj1 ,united ,states ,code1 and the land necessary therefor1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 and procurement and installation of equipment1 appliances1 and machine tools in public and private plants2 reserve plant and ,government and contractor-owned equipment layaway2 and other expenses necessary for the foregoing purposes1 #a1caf1igg1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,other procurement1 air force ,for procurement and modification of equipment 7including ground guidance and electronic control equipment1 and ground electronic and communication equipment71 and supplies1 materials1 and spare parts therefor1 not otherwise provided for2 the purchase of passenger motor vehicles for replacement only2 lease of passenger motor vehicles2 and expansion of public and private plants1 ,government-owned equipment and installation thereof in such plants1 erection of structures1 and acquisition of land1 for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon1 prior to approval of title2 reserve plant and ,government and contractor-owned equipment layaway1 #ai1cah1had1jjj1 to remain available for obligation until ,september #cj1 #bjbj4 ,procurement1 defense-,wide ,for expenses of activities and agencies of the ,department of ,defense 7other than the military departments7 necessary for procurement1 production1 and modification of equipment1 supplies1 materials1 and spare parts therefor1 not otherwise provided for2 the purchase of passenger motor vehicles for replacement only2 expansion of public and private plants1 equipment1 and installation thereof in such plants1 erection of structures1 and acquisition of land for the foregoing purposes1 and such lands and interests therein1 may be acquired1 and construction prosecuted thereon prior to approval of title2 reserve plant and ,government and contractor-owned equipment layaway1 #e1bci1bci1jjj 7reduced by #aj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjbj4 ,defense production act purchases ,for activities by the ,department of ,defense pursuant to sections #ajh1 #cja1 #cjb1 and #cjc of the ,defense ,production ,act of #aiej 7#ej ,u4,s4,c4 #deah1 #deca1 #decb1 and #decc71 #fg1dja1jjj1 to remain available until expended4 ,procurement1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #ab1fbb1ica1jjj1 for the ,procurement1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to procurement accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act1 except for missile defense requirements resulting from urgent or emergent operational needs3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense4 ,,iv ,research1 development1 test and evaluation ,research1 development1 test and evaluation1 army ,for expenses necessary for basic and applied scientific research1 development1 test and evaluation1 including maintenance1 rehabilitation1 lease1 and operation of facilities and equipment1 #i1fgd1bbb1jjj 7increased by #f1jjj1jjj7 7increased by #d1jjj1jjj7 7increased by #ab1jjj1jjj7 7increased by #e1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjai4 ,research1 development1 test and evaluation1 navy ,for expenses necessary for basic and applied scientific research1 development1 test and evaluation1 including maintenance1 rehabilitation1 lease1 and operation of facilities and equipment1 #ag1aif1eba1jjj 7increased by #eih1jjj7 7increased by #bj1jjj1jjj7 7reduced by #b1ejj1jjj7 7increased by #bd1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjai3 ,provided1 ,that funds appropriated in this paragraph which are available for the ,v-#bb may be used to meet unique operational requirements of the ,special ,operations ,forces4 ,research1 development1 test and evaluation1 air force ,for expenses necessary for basic and applied scientific research1 development1 test and evaluation1 including maintenance1 rehabilitation1 lease1 and operation of facilities and equipment1 #cc1hgd1ihj1jjj 7increased by #e1jjj1jjj7 7increased by #f1jjj1jjj7 7increased by #aj1jjj1jjj7 7reduced by #cj1jjj1jjj7 7increased by #cj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjai4 ,research1 development1 test and evaluation1 defense-,wide 7including transfer of funds7 ,for expenses of activities and agencies of the ,department of ,defense 7other than the military departments71 necessary for basic and applied scientific research1 development1 test and evaluation2 advanced research projects as may be designated and determined by the ,secretary of ,defense1 pursuant to law2 maintenance1 rehabilitation1 lease1 and operation of facilities and equipment1 #bj1fih1cec1jjj 7reduced by #af1jjj1jjj7 7reduced by #ab1jjj1jjj7 7reduced by #b1ejj1jjj7 7reduced by #ab1ejj1jjj7 7increased by #bj1jjj1jjj7 7reduced by #bj1jjj1jjj7 7reduced by #d1ace1jjj7 7increased by #d1ace1jjj7 7reduced by #bg1ejj1jjj7 7increased by #aj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjai3 ,provided1 ,that1 of the funds made available in this paragraph1 #bej1jjj1jjj for the ,defense ,rapid ,innovation ,program shall only be available for expenses1 not otherwise provided for1 to include program management and oversight1 to conduct research1 development1 test and evaluation to include proof of concept demonstration2 engineering1 testing1 and validation2 and transition to full-scale production3 ,provided further1 ,that the ,secretary of ,defense may transfer funds provided herein for the ,defense ,rapid ,innovation ,program to appropriations for research1 development1 test and evaluation to accomplish the purpose provided herein3 ,provided further1 ,that this transfer authority is in addition to any other transfer authority available to the ,department of ,defense3 ,provided further1 ,that the ,secretary of ,defense shall1 not fewer than #cj days prior to making transfers from this appropriation1 notify the congressional defense committees in writing of the details of any such transfer4 ,operational test and evaluation1 defense ,for expenses1 not otherwise provided for1 necessary for the independent activities of the ,director1 ,operational ,test and ,evaluation1 in the direction and supervision of operational test and evaluation1 including initial operational test and evaluation which is conducted prior to1 and in support of1 production decisions2 joint operational testing and evaluation2 and administrative expenses in connection therewith1 #baj1ijj1jjj1 to remain available for obligation until ,september #cj1 #bjai4 ,research1 development1 test and evaluation1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #a1jjj1jjj1jjj1 for the ,research1 ,development1 ,test and ,evaluation1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to research1 development1 test and evaluation accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act1 except for missile defense requirements resulting from urgent or emergent operational needs3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense4 ,v ,revolving and management funds ,defense working capital funds ,for the ,defense ,working ,capital ,funds1 #a1ehf1eif1jjj4 ,,vi ,other department of defense programs ,defense health program ,for expenses1 not otherwise provided for1 for medical and health care programs of the ,department of ,defense as authorized by law1 #cc1ica1eff1jjj 7increased by #g1jjj1jjj7 7increased by #a1jjj1jjj7 7increased by #aj1jjj1jjj7 7increased by #b1jjj1jjj7 7increased by #b1jjj1jjj7 7increased by #aj1jjj1jjj7 7increased by #e1jjj1jjj7 7increased by #aj1jjj1jjj72 of which #ca1gce1ibc1jjj 7increased by #b1jjj1jjj7 7increased by #e1jjj1jjj7 shall be for operation and maintenance1 of which not to exceed one percent shall remain available for obligation until ,september #cj1 #bjai1 and of which up to #ae1cdi1gjj1jjj may be available for contracts entered into under the ,,tricare program2 of which #hie1cbh1jjj1 to remain available for obligation until ,september #cj1 #bjbj1 shall be for procurement2 and of which #a1cjj1cae1jjj 7increased by #g1jjj1jjj7 7increased by #a1jjj1jjj7 7increased by #aj1jjj1jjj7 7increased by #b1jjj1jjj7 7increased by #aj1jjj1jjj7 7increased by #aj1jjj1jjj71 to remain available for obligation until ,september #cj1 #bjai1 shall be for research1 development1 test and evaluation3 ,provided1 ,that1 notwithstanding any other provision of law1 of the amount made available under this heading for research1 development1 test and evaluation1 not less than #h1jjj1jjj shall be available for ,,hiv prevention educational activities undertaken in connection with ,united ,states military training1 exercises1 and humanitarian assistance activities conducted primarily in ,african nations3 ,provided further1 ,that of the funds provided under this heading for research1 development1 test and evaluation1 not less than #fbg1ajj1jjj shall be made available to the ,united ,states ,army ,medical ,research and ,materiel ,command to carry out the congressionally directed medical research programs4 ,chemical agents and munitions destruction1 defense ,for expenses1 not otherwise provided for1 necessary for the destruction of the ,united ,states stockpile of lethal chemical agents and munitions in accordance with the provisions of section #adab of the ,department of ,defense ,authorization ,act1 #aihf 7#ej ,u4,s4,c4 #aeba71 and for the destruction of other chemical warfare materials that are not in the chemical weapon stockpile1 #ifa1gcb1jjj1 of which #ajd1bcg1jjj shall be for operation and maintenance1 of which no less than #di1dja1jjj shall be for the ,chemical ,stockpile ,emergency ,preparedness ,program1 consisting of #ba1jde1jjj for activities on military installations and #bh1cef1jjj1 to remain available until ,september #cj1 #bjai1 to assist ,state and local governments2 #ah1jha1jjj shall be for procurement1 to remain available until ,september #cj1 #bjbj1 of which #ah1jha1jjj shall be for the ,chemical ,stockpile ,emergency ,preparedness ,program to assist ,state and local governments2 and #hci1dad1jjj1 to remain available until ,september #cj1 #bjai1 shall be for research1 development1 test and evaluation1 of which #gej1gjj1jjj shall only be for the ,assembled ,chemical ,weapons ,alternatives program4 ,drug interdiction and counter-,drug ,activities1 defense 7including transfer of funds7 ,for drug interdiction and counter-drug activities of the ,department of ,defense1 for transfer to appropriations available to the ,department of ,defense for military personnel of the reserve components serving under the provisions of title #aj and title #cb1 ,united ,states ,code2 for operation and maintenance2 for procurement2 and for research1 development1 test and evaluation1 #hed1had1jjj1 of which #ecb1fdh1jjj shall be for counter-narcotics support2 #abj1hac1jjj shall be for the drug demand reduction program2 and #bja1cec1jjj shall be for the ,national ,guard counter-drug program3 ,provided1 ,that the funds appropriated under this heading shall be available for obligation for the same time period and for the same purpose as the appropriation to which transferred3 ,provided further1 ,that upon a determination that all or part of the funds transferred from this appropriation are not necessary for the purposes provided herein1 such amounts may be transferred back to this appropriation3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority contained elsewhere in this ,act4 ,office of the inspector general ,for expenses and activities of the ,office of the ,inspector ,general in carrying out the provisions of the ,inspector ,general ,act of #aigh1 as amended1 #ccf1hhg1jjj1 of which #ccd1jhg1jjj shall be for operation and maintenance1 of which not to exceed #gjj1jjj is available for emergencies and extraordinary expenses to be expended on the approval or authority of the ,inspector ,general1 and payments may be made on the ,inspector ,general's certificate of necessity for confidential military purposes2 and of which #b1hjj1jjj1 to remain available until ,september #cj1 #bjai1 shall be for research1 development1 test and evaluation4 ,,vii ,related agencies ,central intelligence agency retirement and disability system fund ,for payment to the ,central ,intelligence ,agency ,retirement and ,disability ,system ,fund1 to maintain the proper funding level for continuing the operation of the ,central ,intelligence ,agency ,retirement and ,disability ,system1 #ead1jjj1jjj4 ,intelligence community management account ,for necessary expenses of the ,intelligence ,community ,management ,account1 #ebb1ajj1jjj4 ,,viii ,general provisions #aaja4 ,no part of any appropriation contained in this ,act shall be used for publicity or propaganda purposes not authorized by the ,congress4 #aajb4 ,during the current fiscal year1 provisions of law prohibiting the payment of compensation to1 or employment of1 any person not a citizen of the ,united ,states shall not apply to personnel of the ,department of ,defense3 ,provided1 ,that salary increases granted to direct and indirect hire foreign national employees of the ,department of ,defense funded by this ,act shall not be at a rate in excess of the percentage increase authorized by law for civilian employees of the ,department of ,defense whose pay is computed under the provisions of section #eccb of title #e1 ,united ,states ,code1 or at a rate in excess of the percentage increase provided by the appropriate host nation to its own employees1 whichever is higher3 ,provided further1 ,that this section shall not apply to ,department of ,defense foreign service national employees serving at ,united ,states diplomatic missions whose pay is set by the ,department of ,state under the ,foreign ,service ,act of #aihj3 ,provided further1 ,that the limitations of this provision shall not apply to foreign national employees of the ,department of ,defense in the ,republic of ,turkey4 #aajc4 ,no part of any appropriation contained in this ,act shall remain available for obligation beyond the current fiscal year1 unless expressly so provided herein4 #aajd4 ,no more than #bj percent of the appropriations in this ,act which are limited for obligation during the current fiscal year shall be obligated during the last #b months of the fiscal year3 ,provided1 ,that this section shall not apply to obligations for support of active duty training of reserve components or summer camp training of the ,reserve ,officers' ,training ,corps4 7transfer of funds7 #aaje4 ,upon determination by the ,secretary of ,defense that such action is necessary in the national interest1 he may1 with the approval of the ,office of ,management and ,budget1 transfer not to exceed #d1ejj1jjj1jjj of working capital funds of the ,department of ,defense or funds made available in this ,act to the ,department of ,defense for military functions 7except military construction7 between such appropriations or funds or any subdivision thereof1 to be merged with and to be available for the same purposes1 and for the same time period1 as the appropriation or fund to which transferred3 ,provided1 ,that such authority to transfer may not be used unless for higher priority items1 based on unforeseen military requirements1 than those for which originally appropriated and in no case where the item for which funds are requested has been denied by the ,congress3 ,provided further1 ,that the ,secretary of ,defense shall notify the ,congress promptly of all transfers made pursuant to this authority or any other authority in this ,act3 ,provided further1 ,that no part of the funds in this ,act shall be available to prepare or present a request to the ,committees on ,appropriations for reprogramming of funds1 unless for higher priority items1 based on unforeseen military requirements1 than those for which originally appropriated and in no case where the item for which reprogramming is requested has been denied by the ,congress3 ,provided further1 ,that a request for multiple reprogrammings of funds using authority provided in this section shall be made prior to ,june #cj1 #bjag3 ,provided further1 ,that transfers among military personnel appropriations shall not be taken into account for purposes of the limitation on the amount of funds that may be transferred under this section4 #aajf4 7a7 ,with regard to the list of specific programs1 projects1 and activities 7and the dollar amounts and adjustments to budget activities corresponding to such programs1 projects1 and activities7 contained in the tables titled ,explanation of ,project ,level ,adjustments in the explanatory statement regarding this ,act1 the obligation and expenditure of amounts appropriated or otherwise made available in this ,act for those programs1 projects1 and activities for which the amounts appropriated exceed the amounts requested are hereby required by law to be carried out in the manner provided by such tables to the same extent as if the tables were included in the text of this ,act4 7b7 ,amounts specified in the referenced tables described in subsection 7a7 shall not be treated as subdivisions of appropriations for purposes of section #hjje of this ,act3 ,provided1 ,that section #hjje shall apply when transfers of the amounts described in subsection 7a7 occur between appropriation accounts4 #aajg4 7a7 ,not later than #fj days after enactment of this ,act1 the ,department of ,defense shall submit a report to the congressional defense committees to establish the baseline for application of reprogramming and transfer authorities for fiscal year #bjah3 ,provided1 ,that the report shall include-- 7#a7 a table for each appropriation with a separate column to display the ,president's budget request1 adjustments made by ,congress1 adjustments due to enacted rescissions1 if appropriate1 and the fiscal year enacted level2 7#b7 a delineation in the table for each appropriation both by budget activity and program1 project1 and activity as detailed in the ,budget ,appendix2 and 7#c7 an identification of items of special congressional interest4 7b7 ,notwithstanding section #hjje of this ,act1 none of the funds provided in this ,act shall be available for reprogramming or transfer until the report identified in subsection 7a7 is submitted to the congressional defense committees1 unless the ,secretary of ,defense certifies in writing to the congressional defense committees that such reprogramming or transfer is necessary as an emergency requirement3 ,provided1 ,that this subsection shall not apply to transfers from the following appropriations accounts3 7#a7 ,environmental ,restoration1 ,army2 7#b7 ,environmental ,restoration1 ,navy 2 7#c7 ,environmental ,restoration1 ,air ,force2 7#d7 ,environmental ,restoration1 ,defense-,wide 7#e7 ,environmental ,restoration1 ,formerly ,used ,defense ,sites2 and 7#f7 ,drug ,interdiction and ,counter-drug ,activities1 ,defense4 7transfer of funds7 #aajh4 ,during the current fiscal year1 cash balances in working capital funds of the ,department of ,defense established pursuant to section #bbjh of title #aj1 ,united ,states ,code1 may be maintained in only such amounts as are necessary at any time for cash disbursements to be made from such funds3 ,provided1 ,that transfers may be made between such funds3 ,provided further1 ,that transfers may be made between working capital funds and the ,foreign ,currency ,fluctuations1 ,defense appropriation and the ,operation and ,maintenance appropriation accounts in such amounts as may be determined by the ,secretary of ,defense1 with the approval of the ,office of ,management and ,budget1 except that such transfers may not be made unless the ,secretary of ,defense has notified the ,congress of the proposed transfer3 ,provided further1 ,that except in amounts equal to the amounts appropriated to working capital funds in this ,act1 no obligations may be made against a working capital fund to procure or increase the value of war reserve material inventory1 unless the ,secretary of ,defense has notified the ,congress prior to any such obligation4 #aaji4 ,funds appropriated by this ,act may not be used to initiate a special access program without prior notification #cj calendar days in advance to the congressional defense committees4 #aaaj4 ,none of the funds provided in this ,act shall be available to initiate3 7#a7 a multiyear contract that employs economic order quantity procurement in excess of #bj1jjj1jjj in any one year of the contract or that includes an unfunded contingent liability in excess of #bj1jjj1jjj2 or 7#b7 a contract for advance procurement leading to a multiyear contract that employs economic order quantity procurement in excess of #bj1jjj1jjj in any one year1 unless the congressional defense committees have been notified at least #cj days in advance of the proposed contract award3 ,provided1 ,that no part of any appropriation contained in this ,act shall be available to initiate a multiyear contract for which the economic order quantity advance procurement is not funded at least to the limits of the ,government's liability3 ,provided further1 ,that no part of any appropriation contained in this ,act shall be available to initiate multiyear procurement contracts for any systems or component thereof if the value of the multiyear contract would exceed #ejj1jjj1jjj unless specifically provided in this ,act3 ,provided further1 ,that no multiyear procurement contract can be terminated without #cj-;day prior notification to the congressional defense committees3 ,provided further1 ,that the execution of multiyear authority shall require the use of a present value analysis to determine lowest cost compared to an annual procurement3 ,provided further1 ,that none of the funds provided in this ,act may be used for a multiyear contract executed after the date of the enactment of this ,act unless in the case of any such contract-- 7#a7 the ,secretary of ,defense has submitted to ,congress a budget request for full funding of units to be procured through the contract and1 in the case of a contract for procurement of aircraft1 that includes1 for any aircraft unit to be procured through the contract for which procurement funds are requested in that budget request for production beyond advance procurement activities in the fiscal year covered by the budget1 full funding of procurement of such unit in that fiscal year2 7#b7 cancellation provisions in the contract do not include consideration of recurring manufacturing costs of the contractor associated with the production of unfunded units to be delivered under the contract2 7#c7 the contract provides that payments to the contractor under the contract shall not be made in advance of incurred costs on funded units2 and 7#d7 the contract does not provide for a price adjustment based on a failure to award a follow-on contract4 ,funds appropriated in title ,,iii of this ,act may be used1 subject to section #bcjf;b of title #aj 1 ,united ,states ,code1 for multiyear procurement contracts as follows3 ,v-#bb ,osprey aircraft variants2 up to #ac ,,ssn ,virginia ,class ,submarines and ,government-furnished equipment2 and ,,ddg-#ea ,arleigh ,burke class ,flight ,,iii guided missile destroyers1 the ,,mk #da ,vertical ,launching ,systems1 and associated ,government-furnished systems and subsystems4 #aaaa4 ,within the funds appropriated for the operation and maintenance of the ,armed ,forces1 funds are hereby appropriated pursuant to section #dja of title #aj1 ,united ,states ,code1 for humanitarian and civic assistance costs under chapter #bj of title #aj1 ,united ,states ,code4 ,such funds may also be obligated for humanitarian and civic assistance costs incidental to authorized operations and pursuant to authority granted in section #dja of chapter #bj of title #aj1 ,united ,states ,code1 and these obligations shall be reported as required by section #dja7;d7 of title #aj1 ,united ,states ,code3 ,provided1 ,that funds available for operation and maintenance shall be available for providing humanitarian and similar assistance by using ,civic ,action ,teams in the ,trust ,territories of the ,pacific ,islands and freely associated states of ,micronesia1 pursuant to the ,compact of ,free ,association as authorized by ,public ,law #ii-bci3 ,provided further1 ,that upon a determination by the ,secretary of the ,army that such action is beneficial for graduate medical education programs conducted at ,army medical facilities located in ,hawaii1 the ,secretary of the ,army may authorize the provision of medical services at such facilities and transportation to such facilities1 on a nonreimbursable basis1 for civilian patients from ,american ,samoa1 the ,commonwealth of the ,northern ,mariana ,islands1 the ,marshall ,islands1 the ,federated ,states of ,micronesia1 ,palau1 and ,guam4 #aaab4 7a7 ,during the current fiscal year1 the civilian personnel of the ,department of ,defense may not be managed on the basis of any end-strength1 and the management of such personnel during that fiscal year shall not be subject to any constraint or limitation 7known as an end-strength7 on the number of such personnel who may be employed on the last day of such fiscal year4 7b7 ,the fiscal year #bjai budget request for the ,department of ,defense as well as all justification material and other documentation supporting the fiscal year #bjai ,department of ,defense budget request shall be prepared and submitted to the ,congress as if subsections 7a7 and 7b7 of this provision were effective with regard to fiscal year #bjai4 7c7 ,as required by section #aajg of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjad 7,public ,law #aac-ff2 #aj ,u4,s4,c4 #bceh note7 civilian personnel at the ,department of ,army ,science and ,technology ,reinvention ,laboratories may not be managed on the basis of the ,table of ,distribution and ,allowances1 and the management of the workforce strength shall be done in a manner consistent with the budget available with respect to such ,laboratories4 7d7 ,nothing in this section shall be construed to apply to military 7civilian7 technicians4 #aaac4 ,none of the funds made available by this ,act shall be used in any way1 directly or indirectly1 to influence congressional action on any legislation or appropriation matters pending before the ,congress4 #aaad4 ,none of the funds appropriated by this ,act shall be available for the basic pay and allowances of any member of the ,army participating as a full-time student and receiving benefits paid by the ,secretary of ,veterans ,affairs from the ,department of ,defense ,education ,benefits ,fund when time spent as a full-time student is credited toward completion of a service commitment3 ,provided1 ,that this section shall not apply to those members who have reenlisted with this option prior to ,october #a1 #aihg3 ,provided further1 ,that this section applies only to active components of the ,army4 7transfer of funds7 #aaae4 ,funds appropriated in title ,,iii of this ,act for the ,department of ,defense ,pilot ,mentor-,protg ,program may be transferred to any other appropriation contained in this ,act solely for the purpose of implementing a ,mentor-,protg ,program developmental assistance agreement pursuant to section #hca of the ,national ,defense ,authorization ,act for ,fiscal ,year #aiia 7,public ,law #aja-eaj2 #aj ,u4,s4,c4 #bcjb note71 as amended1 under the authority of this provision or any other transfer authority contained in this ,act4 #aaaf4 ,none of the funds in this ,act may be available for the purchase by the ,department of ,defense 7and its departments and agencies7 of welded shipboard anchor and mooring chain #d inches in diameter and under unless the anchor and mooring chain are manufactured in the ,united ,states from components which are substantially manufactured in the ,united ,states3 ,provided1 ,that for the purpose of this section1 the term manufactured shall include cutting1 heat treating1 quality control1 testing of chain and welding 7including the forging and shot blasting process73 ,provided further1 ,that for the purpose of this section substantially all of the components of anchor and mooring chain shall be considered to be produced or manufactured in the ,united ,states if the aggregate cost of the components produced or manufactured in the ,united ,states exceeds the aggregate cost of the components produced or manufactured outside the ,united ,states3 ,provided further1 ,that when adequate domestic supplies are not available to meet ,department of ,defense requirements on a timely basis1 the ,secretary of the service responsible for the procurement may waive this restriction on a case-by-case basis by certifying in writing to the ,committees on ,appropriations that such an acquisition must be made in order to acquire capability for national security purposes4 #aaag4 ,none of the funds available to the ,department of ,defense may be used to demilitarize or dispose of ,m-#a ,carbines1 ,m-#a ,garand rifles1 ,m-#ad rifles1 4#bb caliber rifles1 4#cj caliber rifles1 or ,m-#aiaa pistols1 or to demilitarize or destroy small arms ammunition or ammunition components that are not otherwise prohibited from commercial sale under ,federal law1 unless the small arms ammunition or ammunition components are certified by the ,secretary of the ,army or designee as unserviceable or unsafe for further use4 #aaah4 ,no more than #ejj1jjj of the funds appropriated or made available in this ,act shall be used during a single fiscal year for any single relocation of an organization1 unit1 activity or function of the ,department of ,defense into or within the ,national ,capital ,region3 ,provided1 ,that the ,secretary of ,defense may waive this restriction on a case-by-case basis by certifying in writing to the congressional defense committees that such a relocation is required in the best interest of the ,government4 #aaai4 ,of the funds made available in this ,act1 #bj1jjj1jjj shall be available for incentive payments authorized by section #ejd of the ,indian ,financing ,act of #aigd 7#be ,u4,s4,c4 #aedd73 ,provided1 ,that a prime contractor or a subcontractor at any tier that makes a subcontract award to any subcontractor or supplier as defined in section #aedd of title #be1 ,united ,states ,code1 or a small business owned and controlled by an individual or individuals defined under section #dbba7i7 of title #be1 ,united ,states ,code1 shall be considered a contractor for the purposes of being allowed additional compensation under section #ejd of the ,indian ,financing ,act of #aigd 7#be ,u4,s4,c4 #aedd7 whenever the prime contract or subcontract amount is over #ejj1jjj and involves the expenditure of funds appropriated by an ,act making appropriations for the ,department of ,defense with respect to any fiscal year3 ,provided further1 ,that notwithstanding section #aijf of title #da1 ,united ,states ,code1 this section shall be applicable to any ,department of ,defense acquisition of supplies or services1 including any contract and any subcontract at any tier for acquisition of commercial items produced or manufactured1 in whole or in part1 by any subcontractor or supplier defined in section #aedd of title #be1 ,united ,states ,code1 or a small business owned and controlled by an individual or individuals defined under section #dbba7i7 of title #be1 ,united ,states ,code4 #aabj4 ,funds appropriated by this ,act for the ,defense ,media ,activity shall not be used for any national or international political or psychological activities4 #aaba4 ,during the current fiscal year1 the ,department of ,defense is authorized to incur obligations of not to exceed #cej1jjj1jjj for purposes specified in section #bcej;j7c7 of title #aj1 ,united ,states ,code1 in anticipation of receipt of contributions1 only from the ,government of ,kuwait1 under that section3 ,provided1 ,that1 upon receipt1 such contributions from the ,government of ,kuwait shall be credited to the appropriations or fund which incurred such obligations4 #aabb4 7a7 ,of the funds made available in this ,act1 not less than #dc1ajj1jjj shall be available for the ,civil ,air ,patrol ,corporation1 of which-- 7#a7 #cj1hjj1jjj shall be available from ,operation and ,maintenance1 ,air ,force to support ,civil ,air ,patrol ,corporation operation and maintenance1 readiness1 counter-drug activities1 and drug demand reduction activities involving youth programs2 7#b7 #aj1fjj1jjj shall be available from ,aircraft ,procurement1 ,air ,force2 and 7#c7 #a1gjj1jjj shall be available from ,other ,procurement1 ,air ,force for vehicle procurement4 7b7 ,the ,secretary of the ,air ,force should waive reimbursement for any funds used by the ,civil ,air ,patrol for counter-drug activities in support of ,federal1 ,state1 and local government agencies4 #aabc4 7a7 ,none of the funds appropriated in this ,act are available to establish a new ,department of ,defense 7department7 federally funded research and development center 7,,ffrdc71 either as a new entity1 or as a separate entity administrated by an organization managing another ,,ffrdc1 or as a nonprofit membership corporation consisting of a consortium of other ,f,f,r,d,cs and other nonprofit entities4 7b7 ,no member of a ,board of ,directors1 ,trustees1 ,overseers1 ,advisory ,group1 ,special ,issues ,panel1 ,visiting ,committee1 or any similar entity of a defense ,,ffrdc1 and no paid consultant to any defense ,,ffrdc1 except when acting in a technical advisory capacity1 may be compensated for his or her services as a member of such entity1 or as a paid consultant by more than one ,,ffrdc in a fiscal year3 ,provided1 ,that a member of any such entity referred to previously in this subsection shall be allowed travel expenses and per diem as authorized under the ,federal ,joint ,travel ,regulations1 when engaged in the performance of membership duties4 7c7 ,notwithstanding any other provision of law1 none of the funds available to the department from any source during the current fiscal year may be used by a defense ,,ffrdc1 through a fee or other payment mechanism1 for construction of new buildings not located on a military installation1 for payment of cost sharing for projects funded by ,government grants1 for absorption of contract overruns1 or for certain charitable contributions1 not to include employee participation in community service and_/or development4 7d7 ,notwithstanding any other provision of law1 of the funds available to the department during fiscal year #bjah1 not more than #f1jjj staff years of technical effort 7staff years7 may be funded for defense ,f,f,r,d,cs3 ,provided1 ,that1 of the specific amount referred to previously in this subsection1 not more than #a1ahj staff years may be funded for the defense studies and analysis ,f,f,r,d,cs3 ,provided further1 ,that this subsection shall not apply to staff years funded in the ,national ,intelligence ,program 7,,nip7 and the ,military ,intelligence ,program 7,,mip74 7e7 ,the ,secretary of ,defense shall1 with the submission of the department's fiscal year #bjai budget request1 submit a report presenting the specific amounts of staff years of technical effort to be allocated for each defense ,,ffrdc during that fiscal year and the associated budget estimates4 7f7 ,notwithstanding any other provision of this ,act1 the total amount appropriated in this ,act for ,f,f,r,d,cs is hereby reduced by #baj1jjj1jjj4 #aabd4 ,none of the funds appropriated or made available in this ,act shall be used to procure carbon1 alloy1 or armor steel plate for use in any ,government-owned facility or property under the control of the ,department of ,defense which were not melted and rolled in the ,united ,states or ,canada3 ,provided1 ,that these procurement restrictions shall apply to any and all ,federal ,supply ,class #ieae1 ,american ,society of ,testing and ,materials 7,,astm7 or ,american ,iron and ,steel ,institute 7,,aisi7 specifications of carbon1 alloy or armor steel plate3 ,provided further1 ,that the ,secretary of the military department responsible for the procurement may waive this restriction on a case-by-case basis by certifying in writing to the ,committees on ,appropriations of the ,house of ,representatives and the ,senate that adequate domestic supplies are not available to meet ,department of ,defense requirements on a timely basis and that such an acquisition must be made in order to acquire capability for national security purposes3 ,provided further1 ,that these restrictions shall not apply to contracts which are in being as of the date of the enactment of this ,act4 #aabe4 ,for the purposes of this ,act1 the term congressional defense committees means the ,armed ,services ,committee of the ,house of ,representatives1 the ,armed ,services ,committee of the ,senate1 the ,subcommittee on ,defense of the ,committee on ,appropriations of the ,senate1 and the ,subcommittee on ,defense of the ,committee on ,appropriations of the ,house of ,representatives4 #aabf4 ,during the current fiscal year1 the ,department of ,defense may acquire the modification1 depot maintenance and repair of aircraft1 vehicles and vessels as well as the production of components and other ,defense-related articles1 through competition between ,department of ,defense depot maintenance activities and private firms3 ,provided1 ,that the ,senior ,acquisition ,executive of the military department or ,defense ,agency concerned1 with power of delegation1 shall certify that successful bids include comparable estimates of all direct and indirect costs for both public and private bids3 ,provided further1 ,that ,office of ,management and ,budget ,circular ,a-#gf shall not apply to competitions conducted under this section4 #aabg4 7a7 7#a7 ,if the ,secretary of ,defense1 after consultation with the ,united ,states ,trade ,representative1 determines that a foreign country which is party to an agreement described in paragraph 7#b7 has violated the terms of the agreement by discriminating against certain types of products produced in the ,united ,states that are covered by the agreement1 the ,secretary of ,defense shall rescind the ,secretary's blanket waiver of the ,buy ,american ,act with respect to such types of products produced in that foreign country4 7#b7 ,an agreement referred to in paragraph 7#a7 is any reciprocal defense procurement memorandum of understanding1 between the ,united ,states and a foreign country pursuant to which the ,secretary of ,defense has prospectively waived the ,buy ,american ,act for certain products in that country4 7b7 ,the ,secretary of ,defense shall submit to the ,congress a report on the amount of ,department of ,defense purchases from foreign entities in fiscal year #bjah4 ,such report shall separately indicate the dollar value of items for which the ,buy ,american ,act was waived pursuant to any agreement described in subsection 7a77#b71 the ,trade ,agreement ,act of #aigi 7#ai ,u4,s4,c4 #beja et seq471 or any international agreement to which the ,united ,states is a party4 7c7 ,for purposes of this section1 the term ,buy ,american ,act means chapter #hc of title #da1 ,united ,states ,code4 #aabh4 ,during the current fiscal year1 amounts contained in the ,department of ,defense ,overseas ,military ,facility ,investment ,recovery ,account established by section #biba7;c77#a7 of the ,national ,defense ,authorization ,act of #aiia 7,public ,law #aja-eaj2 #aj ,u4,s4,c4 #bfhg note7 shall be available until expended for the payments specified by section #biba7;c77#b7 of that ,act4 #aabi4 7a7 ,notwithstanding any other provision of law1 the ,secretary of the ,air ,force may convey at no cost to the ,air ,force1 without consideration1 to ,indian tribes located in the ,states of ,nevada1 ,idaho1 ,north ,dakota1 ,south ,dakota1 ,montana1 ,oregon1 ,minnesota1 and ,washington relocatable military housing units located at ,grand ,forks ,air ,force ,base1 ,malmstrom ,air ,force ,base1 ,mountain ,home ,air ,force ,base1 ,ellsworth ,air ,force ,base1 and ,minot ,air ,force ,base that are excess to the needs of the ,air ,force4 7b7 ,the ,secretary of the ,air ,force shall convey1 at no cost to the ,air ,force1 military housing units under subsection 7a7 in accordance with the request for such units that are submitted to the ,secretary by the ,operation ,walking ,shield ,program on behalf of ,indian tribes located in the ,states of ,nevada1 ,idaho1 ,north ,dakota1 ,south ,dakota1 ,montana1 ,oregon1 ,minnesota1 and ,washington4 ,any such conveyance shall be subject to the condition that the housing units shall be removed within a reasonable period of time1 as determined by the ,secretary4 7c7 ,the ,operation ,walking ,shield ,program shall resolve any conflicts among requests of ,indian tribes for housing units under subsection 7a7 before submitting requests to the ,secretary of the ,air ,force under subsection 7b74 7d7 ,in this section1 the term ,indian tribe means any recognized ,indian tribe included on the current list published by the ,secretary of the ,interior under section #ajd of the ,federally ,recognized ,indian ,tribe ,act of #aiid 7,public ,law #ajc-ded2 #ajh ,stat4 #dgib2 #be ,u4,s4,c4 #dgi;a-#a74 #aacj4 ,during the current fiscal year1 appropriations which are available to the ,department of ,defense for operation and maintenance may be used to purchase items having an investment item unit cost of not more than #bej1jjj4 #aaca4 ,none of the funds made available by this ,act may be used to-- 7#a7 disestablish1 or prepare to disestablish1 a ,senior ,reserve ,officers' ,training ,corps program in accordance with ,department of ,defense ,instruction ,number #abae4jh1 dated ,june #bf1 #bjjf2 or 7#b7 close1 downgrade from host to extension center1 or place on probation a ,senior ,reserve ,officers' ,training ,corps program in accordance with the information paper of the ,department of the ,army titled ,army ,senior ,reserve ,officers' ,training ,corps 7,,srotc7 ,program ,review and ,criteria1 dated ,january #bg1 #bjad4 #aacb4 ,the ,secretary of ,defense shall issue regulations to prohibit the sale of any tobacco or tobacco-related products in military resale outlets in the ,united ,states1 its territories and possessions at a price below the most competitive price in the local community3 ,provided1 ,that such regulations shall direct that the prices of tobacco or tobacco-related products in overseas military retail outlets shall be within the range of prices established for military retail system stores located in the ,united ,states4 #aacc4 7a7 ,during the current fiscal year1 none of the appropriations or funds available to the ,department of ,defense ,working ,capital ,funds shall be used for the purchase of an investment item for the purpose of acquiring a new inventory item for sale or anticipated sale during the current fiscal year or a subsequent fiscal year to customers of the ,department of ,defense ,working ,capital ,funds if such an item would not have been chargeable to the ,department of ,defense ,business ,operations ,fund during fiscal year #aiid and if the purchase of such an investment item would be chargeable during the current fiscal year to appropriations made to the ,department of ,defense for procurement4 7b7 ,the fiscal year #bjai budget request for the ,department of ,defense as well as all justification material and other documentation supporting the fiscal year #bjai ,department of ,defense budget shall be prepared and submitted to the ,congress on the basis that any equipment which was classified as an end item and funded in a procurement appropriation contained in this ,act shall be budgeted for in a proposed fiscal year #bjai procurement appropriation and not in the supply management business area or any other area or category of the ,department of ,defense ,working ,capital ,funds4 #aacd4 ,none of the funds appropriated by this ,act for programs of the ,central ,intelligence ,agency shall remain available for obligation beyond the current fiscal year1 except for funds appropriated for the ,reserve for ,contingencies1 which shall remain available until ,september #cj1 #bjai3 ,provided1 ,that funds appropriated1 transferred1 or otherwise credited to the ,central ,intelligence ,agency ,central ,services ,working ,capital ,fund during this or any prior or subsequent fiscal year shall remain available until expended3 ,provided further1 ,that any funds appropriated or transferred to the ,central ,intelligence ,agency for advanced research and development acquisition1 for agent operations1 and for covert action programs authorized by the ,president under section #ejc of the ,national ,security ,act of #aidg 7#ej ,u4,s4,c4 #cjic7 shall remain available until ,september #cj1 #bjai4 #aace4 ,notwithstanding any other provision of law1 funds made available in this ,act and hereafter for the ,defense ,intelligence ,agency may be used for the design1 development1 and deployment of ,general ,defense ,intelligence ,program intelligence communications and intelligence information systems for the ,services1 the ,unified and ,specified ,commands1 and the component commands4 #aacf4 ,of the funds appropriated to the ,department of ,defense under the heading ,operation and ,maintenance1 ,defense-,wide1 not less than #ab1jjj1jjj shall be made available only for the mitigation of environmental impacts1 including training and technical assistance to tribes1 related administrative support1 the gathering of information1 documenting of environmental damage1 and developing a system for prioritization of mitigation and cost to complete estimates for mitigation1 on ,indian lands resulting from ,department of ,defense activities4 #aacg4 7a7 ,none of the funds appropriated in this ,act may be expended by an entity of the ,department of ,defense unless the entity1 in expending the funds1 complies with the ,buy ,american ,act4 ,for purposes of this subsection1 the term ,buy ,american ,act means chapter #hc of title #da1 ,united ,states ,code4 7b7 ,if the ,secretary of ,defense determines that a person has been convicted of intentionally affixing a label bearing a ,made in ,america inscription to any product sold in or shipped to the ,united ,states that is not made in ,america1 the ,secretary shall determine1 in accordance with section #bdaj;f of title #aj1 ,united ,states ,code1 whether the person should be debarred from contracting with the ,department of ,defense4 7c7 ,in the case of any equipment or products purchased with appropriations provided under this ,act1 it is the sense of the ,congress that any entity of the ,department of ,defense1 in expending the appropriation1 purchase only ,american-made equipment and products1 provided that ,american-made equipment and products are cost-competitive1 quality competitive1 and available in a timely fashion4 #aach4 7a7 ,except as provided in subsections 7b7 and 7c71 none of the funds made available by this ,act may be used-- 7#a7 to establish a field operating agency2 or 7#b7 to pay the basic pay of a member of the ,armed ,forces or civilian employee of the department who is transferred or reassigned from a headquarters activity if the member or employee's place of duty remains at the location of that headquarters4 7b7 ,the ,secretary of ,defense or ,secretary of a military department may waive the limitations in subsection 7a71 on a case-by-case basis1 if the ,secretary determines1 and certifies to the ,committees on ,appropriations of the ,house of ,representatives and the ,senate that the granting of the waiver will reduce the personnel requirements or the financial requirements of the department4 7c7 ,this section does not apply to-- 7#a7 field operating agencies funded within the ,national ,intelligence ,program2 7#b7 an ,army field operating agency established to eliminate1 mitigate1 or counter the effects of improvised explosive devices1 and1 as determined by the ,secretary of the ,army1 other similar threats2 7#c7 an ,army field operating agency established to improve the effectiveness and efficiencies of biometric activities and to integrate common biometric technologies throughout the ,department of ,defense2 or 7#d7 an ,air ,force field operating agency established to administer the ,air ,force ,mortuary ,affairs ,program and ,mortuary ,operations for the ,department of ,defense and authorized ,federal entities4 #aaci4 7a7 ,none of the funds appropriated by this ,act shall be available to convert to contractor performance an activity or function of the ,department of ,defense that1 on or after the date of the enactment of this ,act1 is performed by ,department of ,defense civilian employees unless-- 7#a7 the conversion is based on the result of a public-private competition that includes a most efficient and cost effective organization plan developed by such activity or function2 7#b7 the ,competitive ,sourcing ,official determines that1 over all performance periods stated in the solicitation of offers for performance of the activity or function1 the cost of performance of the activity or function by a contractor would be less costly to the ,department of ,defense by an amount that equals or exceeds the lesser of-- 7,a7 #aj percent of the most efficient organization's personnel-related costs for performance of that activity or function by ,federal employees2 or 7,b7 #aj1jjj1jjj2 and 7#c7 the contractor does not receive an advantage for a proposal that would reduce costs for the ,department of ,defense by-- 7,a7 not making an employer-sponsored health insurance plan available to the workers who are to be employed in the performance of that activity or function under the contract2 or 7,b7 offering to such workers an employer-sponsored health benefits plan that requires the employer to contribute less towards the premium or subscription share than the amount that is paid by the ,department of ,defense for health benefits for civilian employees under chapter #hi of title #e1 ,united ,states ,code4 7b7 7#a7 ,the ,department of ,defense1 without regard to subsection 7a7 of this section or subsection 7a71 7b71 or 7c7 of section #bdfa of title #aj1 ,united ,states ,code1 and notwithstanding any administrative regulation1 requirement1 or policy to the contrary shall have full authority to enter into a contract for the performance of any commercial or industrial type function of the ,department of ,defense that-- 7,a7 is included on the procurement list established pursuant to section #b of the ,javits-,wagner-,o',day ,act 7section #hejc of title #da1 ,united ,states ,code72 7,b7 is planned to be converted to performance by a qualified nonprofit agency for the blind or by a qualified nonprofit agency for other severely handicapped individuals in accordance with that ,act2 or 7,c7 is planned to be converted to performance by a qualified firm under at least #ea percent ownership by an ,indian tribe1 as defined in section #d7;e7 of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b7e771 or a ,native ,hawaiian ,organization1 as defined in section #h7;a77#ae7 of the ,small ,business ,act 7#ae ,u4,s4,c4 #fcg7;a77#ae774 7#b7 ,this section shall not apply to depot contracts or contracts for depot maintenance as provided in sections #bdfi and #bdgd of title #aj1 ,united ,states ,code4 7c7 ,the conversion of any activity or function of the ,department of ,defense under the authority provided by this section shall be credited toward any competitive or outsourcing goal1 target1 or measurement that may be established by statute1 regulation1 or policy and is deemed to be awarded under the authority of1 and in compliance with1 subsection 7h7 of section #bcjd of title #aj1 ,united ,states ,code1 for the competition or outsourcing of commercial activities4 7rescissions7 #aadj4 ,of the funds appropriated in ,department of ,defense ,appropriations ,acts1 the following funds are hereby rescinded from the following accounts and programs in the specified amounts3 ,provided1 ,that no amounts may be rescinded from amounts that were designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism or as an emergency requirement pursuant to the ,concurrent ,resolution on the ,budget or the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe1 as amended3 ,aircraft ,procurement1 ,navy1 #bjaf_/bjah1 #bgd1jjj1jjj2 ,aircraft ,procurement1 ,air ,force1 #bjaf_/bjah1 #hb1gjj1jjj2 ,missile ,procurement1 ,army1 #bjag_/bjai1 #ai1cai1jjj2 ,procurement of ,weapons and ,tracked ,combat ,vehicles1 ,army1 #bjag_/bjai1 #i1gfd1jjj2 ,other ,procurement1 ,army1 #bjag_/bjai1 #aj1jjj1jjj2 ,aircraft ,procurement1 ,navy1 #bjag_/bjai1 #aje1fjj1jjj2 ,weapons ,procurement1 ,navy1 #bjag_/bjai1 #ed1abb1jjj2 ,shipbuilding and ,conversion1 ,navy1 #bjag_/bjba1 #de1aaf1jjj2 ,aircraft ,procurement1 ,air ,force1 #bjag_/bjai1 #fc1bic1jjj2 ,missile ,procurement1 ,air ,force1 #bjag_/bjai1 #ca1fci1jjj2 ,space ,procurement1 ,air ,force1 #bjag_/bjai1 #ae1jjj1jjj2 ,other ,procurement1 ,air ,force1 #bjag_/bjai1 #aje1jjj1jjj2 ,research1 ,development1 ,test and ,evaluation1 ,navy1 #bjag_/bjah1 #cd1abh1jjj2 ,research1 ,development1 ,test and ,evaluation1 ,air ,force1 #bjag_/bjah1 #da1gjj1jjj4 #aada4 ,none of the funds available in this ,act may be used to reduce the authorized positions for military technicians 7dual status7 of the ,army ,national ,guard1 ,air ,national ,guard1 ,army ,reserve and ,air ,force ,reserve for the purpose of applying any administratively imposed civilian personnel ceiling1 freeze1 or reduction on military technicians 7dual status71 unless such reductions are a direct result of a reduction in military force structure4 #aadb4 ,none of the funds appropriated or otherwise made available in this ,act may be obligated or expended for assistance to the ,democratic ,people's ,republic of ,korea unless specifically appropriated for that purpose4 #aadc4 ,funds appropriated in this ,act for operation and maintenance of the ,military ,departments1 ,combatant ,commands and ,defense ,agencies shall be available for reimbursement of pay1 allowances and other expenses which would otherwise be incurred against appropriations for the ,national ,guard and ,reserve when members of the ,national ,guard and ,reserve provide intelligence or counterintelligence support to ,combatant ,commands1 ,defense ,agencies and ,joint ,intelligence ,activities1 including the activities and programs included within the ,national ,intelligence ,program and the ,military ,intelligence ,program3 ,provided1 ,that nothing in this section authorizes deviation from established ,reserve and ,national ,guard personnel and training procedures4 #aadd4 7a7 ,none of the funds available to the ,department of ,defense for any fiscal year for drug interdiction or counter-drug activities may be transferred to any other department or agency of the ,united ,states except as specifically provided in an appropriations law4 7b7 ,none of the funds available to the ,central ,intelligence ,agency for any fiscal year for drug interdiction or counter-drug activities may be transferred to any other department or agency of the ,united ,states except as specifically provided in an appropriations law4 #aade4 ,none of the funds appropriated by this ,act may be used for the procurement of ball and roller bearings other than those produced by a domestic source and of domestic origin3 ,provided1 ,that the ,secretary of the military department responsible for such procurement may waive this restriction on a case-by-case basis by certifying in writing to the ,committees on ,appropriations of the ,house of ,representatives and the ,senate1 that adequate domestic supplies are not available to meet ,department of ,defense requirements on a timely basis and that such an acquisition must be made in order to acquire capability for national security purposes3 ,provided further1 ,that this restriction shall not apply to the purchase of commercial items1 as defined by section #ajc of title #da1 ,united ,states ,code1 except that the restriction shall apply to ball or roller bearings purchased as end items4 #aadf4 ,none of the funds made available by this ,act for ,evolved ,expendable ,launch ,vehicle service competitive procurements may be used unless the competitive procurements are open for award to all certified providers of ,evolved ,expendable ,launch ,vehicle-class systems3 ,provided1 ,that the award shall be made to the provider that offers the best value to the government4 #aadg4 ,in addition to the amounts appropriated or otherwise made available elsewhere in this ,act1 #dd1jjj1jjj is hereby appropriated to the ,department of ,defense3 ,provided1 ,that upon the determination of the ,secretary of ,defense that it shall serve the national interest1 the ,secretary shall make grants in the amounts specified as follows3 #bj1jjj1jjj to the ,united ,service ,organizations and #bd1jjj1jjj to the ,red ,cross4 #aadh4 ,none of the funds in this ,act may be used to purchase any supercomputer which is not manufactured in the ,united ,states1 unless the ,secretary of ,defense certifies to the congressional defense committees that such an acquisition must be made in order to acquire capability for national security purposes that is not available from ,united ,states manufacturers4 #aadi4 ,notwithstanding any other provision in this ,act1 the ,small ,business ,innovation ,research program and the ,small ,business ,technology ,transfer program set-asides shall be taken proportionally from all programs1 projects1 or activities to the extent they contribute to the extramural budget4 #aaej4 ,none of the funds available to the ,department of ,defense under this ,act shall be obligated or expended to pay a contractor under a contract with the ,department of ,defense for costs of any amount paid by the contractor to an employee when-- 7#a7 such costs are for a bonus or otherwise in excess of the normal salary paid by the contractor to the employee2 and 7#b7 such bonus is part of restructuring costs associated with a business combination4 7including transfer of funds7 #aaea4 ,during the current fiscal year1 no more than #cj1jjj1jjj of appropriations made in this ,act under the heading ,operation and ,maintenance1 ,defense-,wide may be transferred to appropriations available for the pay of military personnel1 to be merged with1 and to be available for the same time period as the appropriations to which transferred1 to be used in support of such personnel in connection with support and services for eligible organizations and activities outside the ,department of ,defense pursuant to section #bjab of title #aj1 ,united ,states ,code4 #aaeb4 ,during the current fiscal year1 in the case of an appropriation account of the ,department of ,defense for which the period of availability for obligation has expired or which has closed under the provisions of section #aeeb of title #ca1 ,united ,states ,code1 and which has a negative unliquidated or unexpended balance1 an obligation or an adjustment of an obligation may be charged to any current appropriation account for the same purpose as the expired or closed account if-- 7#a7 the obligation would have been properly chargeable 7except as to amount7 to the expired or closed account before the end of the period of availability or closing of that account2 7#b7 the obligation is not otherwise properly chargeable to any current appropriation account of the ,department of ,defense2 and 7#c7 in the case of an expired account1 the obligation is not chargeable to a current appropriation of the ,department of ,defense under the provisions of section #adje7;b77#h7 of the ,national ,defense ,authorization ,act for ,fiscal ,year #aiia1 ,public ,law #aja-eaj1 as amended 7#ca ,u4,s4,c4 #aeea note73 ,provided1 ,that in the case of an expired account1 if subsequent review or investigation discloses that there was not in fact a negative unliquidated or unexpended balance in the account1 any charge to a current account under the authority of this section shall be reversed and recorded against the expired account3 ,provided further1 ,that the total amount charged to a current appropriation under this section may not exceed an amount equal to #a percent of the total appropriation for that account4 #aaec4 7a7 ,notwithstanding any other provision of law1 the ,chief of the ,national ,guard ,bureau may permit the use of equipment of the ,national ,guard ,distance ,learning ,project by any person or entity on a space-available1 reimbursable basis4 ,the ,chief of the ,national ,guard ,bureau shall establish the amount of reimbursement for such use on a case-by-case basis4 7b7 ,amounts collected under subsection 7a7 shall be credited to funds available for the ,national ,guard ,distance ,learning ,project and be available to defray the costs associated with the use of equipment of the project under that subsection4 ,such funds shall be available for such purposes without fiscal year limitation4 #aaed4 ,none of the funds available to the ,department of ,defense may be obligated to modify command and control relationships to give ,fleet ,forces ,command operational and administrative control of ,united ,states ,navy forces assigned to the ,pacific fleet3 ,provided1 ,that the command and control relationships which existed on ,october #a1 #bjjd1 shall remain in force until a written modification has been proposed to the ,house and ,senate ,appropriations ,committees3 ,provided further1 ,that the proposed modification may be implemented #cj days after the notification unless an objection is received from either the ,house or ,senate ,appropriations ,committees3 ,provided further1 ,that any proposed modification shall not preclude the ability of the commander of ,united ,states ,pacific ,command to meet operational requirements4 7including transfer of funds7 #aaee4 ,of the funds appropriated in this ,act under the heading ,operation and ,maintenance1 ,defense-,wide1 #be1jjj1jjj 7increased by #aj1jjj1jjj7 shall be for continued implementation and expansion of the ,sexual ,assault ,special ,victims' ,counsel ,program3 ,provided1 ,that the funds are made available for transfer to the ,department of the ,army1 the ,department of the ,navy1 and the ,department of the ,air ,force3 ,provided further1 ,that funds transferred shall be merged with and available for the same purposes and for the same time period as the appropriations to which the funds are transferred3 ,provided further1 ,that this transfer authority is in addition to any other transfer authority provided in this ,act4 #aaef4 ,none of the funds appropriated in title ,,iv of this ,act may be used to procure end-items for delivery to military forces for operational training1 operational use or inventory requirements3 ,provided1 ,that this restriction does not apply to end-items used in development1 prototyping1 and test activities preceding and leading to acceptance for operational use3 ,provided further1 ,that this restriction does not apply to programs funded within the ,national ,intelligence ,program3 ,provided further1 ,that the ,secretary of ,defense may waive this restriction on a case-by-case basis by certifying in writing to the ,committees on ,appropriations of the ,house of ,representatives and the ,senate that it is in the national security interest to do so4 #aaeg4 7a7 ,the ,secretary of ,defense may1 on a case-by-case basis1 waive with respect to a foreign country each limitation on the procurement of defense items from foreign sources provided in law if the ,secretary determines that the application of the limitation with respect to that country would invalidate cooperative programs entered into between the ,department of ,defense and the foreign country1 or would invalidate reciprocal trade agreements for the procurement of defense items entered into under section #beca of title #aj1 ,united ,states ,code1 and the country does not discriminate against the same or similar defense items produced in the ,united ,states for that country4 7b7 ,subsection 7a7 applies with respect to-- 7#a7 contracts and subcontracts entered into on or after the date of the enactment of this ,act2 and 7#b7 options for the procurement of items that are exercised after such date under contracts that are entered into before such date if the option prices are adjusted for any reason other than the application of a waiver granted under subsection 7a74 7c7 ,subsection 7a7 does not apply to a limitation regarding construction of public vessels1 ball and roller bearings1 food1 and clothing or textile materials as defined by section ,,xi 7chapters #ej-fe7 of the ,harmonized ,tariff ,schedule of the ,united ,states and products classified under headings #djaj1 #dbjb1 #dbjc1 #fdja through #fdjf1 #feje1 #gjai1 #gbah through #gbbi1 #gcjd4da through #gcjd4di1 #gcjf4dj1 #gejb through #gejh1 #haje1 #hajh1 #haji1 #hbaa1 #hbae1 and #idjd4 #aaeh4 ,none of the funds appropriated or otherwise made available by this or other ,department of ,defense ,appropriations ,acts may be obligated or expended for the purpose of performing repairs or maintenance to military family housing units of the ,department of ,defense1 including areas in such military family housing units that may be used for the purpose of conducting official ,department of ,defense business4 #aaei4 ,notwithstanding any other provision of law1 funds appropriated in this ,act under the heading ,research1 ,development1 ,test and ,evaluation1 ,defense-,wide for any new start advanced concept technology demonstration project or joint capability demonstration project may only be obligated #de days after a report1 including a description of the project1 the planned acquisition and transition strategy and its estimated annual and total cost1 has been provided in writing to the congressional defense committees3 ,provided1 ,that the ,secretary of ,defense may waive this restriction on a case-by-case basis by certifying to the congressional defense committees that it is in the national interest to do so4 #aafj4 ,the ,secretary of ,defense shall continue to provide a classified quarterly report to the ,house and ,senate ,appropriations ,committees1 ,subcommittees on ,defense on certain matters as directed in the classified annex accompanying this ,act4 #aafa4 ,notwithstanding section #abcaj7;b7 of title #aj1 ,united ,states ,code1 a ,reserve who is a member of the ,national ,guard serving on full-time ,national ,guard duty under section #ejb7;f7 of title #cb1 ,united ,states ,code1 may perform duties in support of the ground-based elements of the ,national ,ballistic ,missile ,defense ,system4 #aafb4 ,none of the funds provided in this ,act may be used to transfer to any nongovernmental entity ammunition held by the ,department of ,defense that has a center-fire cartridge and a ,united ,states military nomenclature designation of armor penetrator1 armor piercing 7,,ap71 armor piercing incendiary 7,,api71 or armor-piercing incendiary tracer 7,,api-,t71 except to an entity performing demilitarization services for the ,department of ,defense under a contract that requires the entity to demonstrate to the satisfaction of the ,department of ,defense that armor piercing projectiles are either3 7#a7 rendered incapable of reuse by the demilitarization process2 or 7#b7 used to manufacture ammunition pursuant to a contract with the ,department of ,defense or the manufacture of ammunition for export pursuant to a ,license for ,permanent ,export of ,unclassified ,military ,articles issued by the ,department of ,state4 #aafc4 ,notwithstanding any other provision of law1 the ,chief of the ,national ,guard ,bureau1 or his designee1 may waive payment of all or part of the consideration that otherwise would be required under section #bffg of title #aj1 ,united ,states ,code1 in the case of a lease of personal property for a period not in excess of #a year to any organization specified in section #ejh7;d7 of title #cb1 ,united ,states ,code1 or any other youth1 social1 or fraternal nonprofit organization as may be approved by the ,chief of the ,national ,guard ,bureau1 or his designee1 on a case-by-case basis4 7including transfer of funds7 #aafd4 ,of the amounts appropriated in this ,act under the heading ,operation and ,maintenance1 ,army1 #ff1hha1ghj shall remain available until expended3 ,provided1 ,that1 notwithstanding any other provision of law1 the ,secretary of ,defense is authorized to transfer such funds to other activities of the ,federal ,government3 ,provided further1 ,that the ,secretary of ,defense is authorized to enter into and carry out contracts for the acquisition of real property1 construction1 personal services1 and operations related to projects carrying out the purposes of this section3 ,provided further1 ,that contracts entered into under the authority of this section may provide for such indemnification as the ,secretary determines to be necessary3 ,provided further1 ,that projects authorized by this section shall comply with applicable ,federal1 ,state1 and local law to the maximum extent consistent with the national security1 as determined by the ,secretary of ,defense4 #aafe4 7a7 ,none of the funds appropriated in this or any other ,act may be used to take any action to modify-- 7#a7 the appropriations account structure for the ,national ,intelligence ,program budget1 including through the creation of a new appropriation or new appropriation account2 7#b7 how the ,national ,intelligence ,program budget request is presented in the unclassified ,p-#a1 ,r-#a1 and ,o-#a documents supporting the ,department of ,defense budget request2 7#c7 the process by which the ,national ,intelligence ,program appropriations are apportioned to the executing agencies2 or 7#d7 the process by which the ,national ,intelligence ,program appropriations are allotted1 obligated and disbursed4 7b7 ,nothing in section 7a7 shall be construed to prohibit the merger of programs or changes to the ,national ,intelligence ,program budget at or below the ,expenditure ,center level1 provided such change is otherwise in accordance with paragraphs 7a77#a7-7c74 7c7 ,the ,director of ,national ,intelligence and the ,secretary of ,defense may jointly1 only for the purposes of achieving auditable financial statements and improving fiscal reporting1 study and develop detailed proposals for alternative financial management processes4 ,such study shall include a comprehensive counterintelligence risk assessment to ensure that none of the alternative processes will adversely affect counterintelligence4 7d7 ,upon development of the detailed proposals defined under subsection 7c71 the ,director of ,national ,intelligence and the ,secretary of ,defense shall-- 7#a7 provide the proposed alternatives to all affected agencies2 7#b7 receive certification from all affected agencies attesting that the proposed alternatives will help achieve auditability1 improve fiscal reporting1 and will not adversely affect counterintelligence2 and 7#c7 not later than #cj days after receiving all necessary certifications under paragraph 7#b71 present the proposed alternatives and certifications to the congressional defense and intelligence committees4 #aaff4 ,in addition to amounts provided elsewhere in this ,act1 #e1jjj1jjj 7increased by #e1jjj1jjj7 is hereby appropriated to the ,department of ,defense1 to remain available for obligation until expended3 ,provided1 ,that notwithstanding any other provision of law1 that upon the determination of the ,secretary of ,defense that it shall serve the national interest1 these funds shall be available only for a grant to the ,fisher ,house ,foundation1 ,inc41 only for the construction and furnishing of additional ,fisher ,houses to meet the needs of military family members when confronted with the illness or hospitalization of an eligible military beneficiary4 7including transfer of funds7 #aafg4 ,of the amounts appropriated in this ,act under the headings ,procurement1 ,defense-,wide and ,research1 ,development1 ,test and ,evaluation1 ,defense-,wide1 #gje1hjj1jjj shall be for the ,israeli ,cooperative ,programs3 ,provided1 ,that of this amount1 #ib1jjj1jjj shall be for the ,secretary of ,defense to provide to the ,government of ,israel for the procurement of the ,iron ,dome defense system to counter short-range rocket threats1 subject to the ,u4,s4-,israel ,iron ,dome ,procurement ,agreement1 as amended2 #bba1ejj1jjj shall be for the ,short ,range ,ballistic ,missile ,defense 7,,srbmd7 program1 including cruise missile defense research and development under the ,,srbmd program1 of which #abj1jjj1jjj shall be for co-production activities of ,,srbmd missiles in the ,united ,states and in ,israel to meet ,israel's defense requirements consistent with each nation's laws1 regulations1 and procedures1 subject to the ,u4,s4-,israeli co-production agreement for ,,srbmd1 as amended2 #bje1jjj1jjj shall be for an upper-tier component to the ,israeli ,missile ,defense ,architecture1 of which #abj1jjj1jjj shall be for co-production activities of ,arrow #c ,upper ,tier missiles in the ,united ,states and in ,israel to meet ,israel's defense requirements consistent with each nation's laws1 regulations1 and procedures1 subject to the ,u4,s4-,israeli co-production agreement for ,arrow #c ,upper ,tier1 as amended2 #aje1jjj1jjj shall be for testing of the upper-tier component to the ,israeli ,missile ,defense ,architecture in the ,united ,states2 and #hb1cjj1jjj shall be for the ,arrow ,system ,improvement ,program including development of a long range1 ground and airborne1 detection suite3 ,provided further1 ,that the transfer authority provided under this provision is in addition to any other transfer authority contained in this ,act4 7including transfer of funds7 #aafh4 ,of the amounts appropriated in this ,act under the heading ,shipbuilding and ,conversion1 ,navy1 #aag1edb1jjj shall be available until ,september #cj1 #bjah1 to fund prior year shipbuilding cost increases3 ,provided1 ,that upon enactment of this ,act1 the ,secretary of the ,navy shall transfer funds to the following appropriations in the amounts specified3 ,provided further1 ,that the amounts transferred shall be merged with and be available for the same purposes as the appropriations to which transferred to3 7#a7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjab_/bjah3 ,carrier ,replacement ,program #bj1jjj1jjj2 7#b7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjjh_/bjah3 ,,ddg-#ea ,destroyer #ai1dcf1jjj2 7#c7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjab_/bjah3 ,littoral ,combat ,ship #f1cid1jjj2 7#d7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjab_/bjah3 ,,lha ,replacement #ad1bjj1jjj2 7#e7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjac_/bjah3 ,,ddg-#ea ,destroyer #ca1ida1jjj2 7#f7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjad_/bjah3 ,litoral ,combat ,ship #bj1dga1jjj2 and 7#g7 ,under the heading ,shipbuilding and ,conversion1 ,navy1 #bjae_/bjah3 ,,lcac #e1ajj1jjj4 #aafi4 ,funds appropriated by this ,act1 or made available by the transfer of funds in this ,act1 for intelligence activities are deemed to be specifically authorized by the ,congress for purposes of section #ejd of the ,national ,security ,act of #aidg 7#ej ,u4,s4,c4 #cjid7 during fiscal year #bjah until the enactment of the ,intelligence ,authorization ,act for ,fiscal ,year #bjah4 #aagj4 ,none of the funds provided in this ,act shall be available for obligation or expenditure through a reprogramming of funds that creates or initiates a new program1 project1 or activity unless such program1 project1 or activity must be undertaken immediately in the interest of national security and only after written prior notification to the congressional defense committees4 #aaga4 ,the budget of the ,president for fiscal year #bjah submitted to the ,congress pursuant to section #aaje of title #ca1 ,united ,states ,code1 shall include separate budget justification documents for costs of ,united ,states ,armed ,forces' participation in contingency operations for the ,military ,personnel accounts1 the ,operation and ,maintenance accounts1 the ,procurement accounts1 and the ,research1 ,development1 ,test and ,evaluation accounts3 ,provided1 ,that these documents shall include a description of the funding requested for each contingency operation1 for each military service1 to include all ,active and ,reserve components1 and for each appropriations account3 ,provided further1 ,that these documents shall include estimated costs for each element of expense or object class1 a reconciliation of increases and decreases for each contingency operation1 and programmatic data including1 but not limited to1 troop strength for each ,active and ,reserve component1 and estimates of the major weapons systems deployed in support of each contingency3 ,provided further1 ,that these documents shall include budget exhibits ,,op-#e and ,,op-#cb 7as defined in the ,department of ,defense ,financial ,management ,regulation7 for all contingency operations for the budget year and the two preceding fiscal years4 #aagb4 ,none of the funds in this ,act may be used for research1 development1 test1 evaluation1 procurement or deployment of nuclear armed interceptors of a missile defense system4 #aagc4 ,notwithstanding any other provision of this ,act1 to reflect savings due to favorable foreign exchange rates1 the total amount appropriated in this ,act is hereby reduced by #bhi1jjj1jjj4 #aagd4 ,none of the funds appropriated or made available in this ,act shall be used to reduce or disestablish the operation of the #ecrd ,weather ,reconnaissance ,squadron of the ,air ,force ,reserve1 if such action would reduce the ,,wc-#acj ,weather ,reconnaissance mission below the levels funded in this ,act3 ,provided1 ,that the ,air ,force shall allow the #ecrd ,weather ,reconnaissance ,squadron to perform other missions in support of national defense requirements during the non-hurricane season4 #aage4 ,none of the funds provided in this ,act shall be available for integration of foreign intelligence information unless the information has been lawfully collected and processed during the conduct of authorized foreign intelligence activities3 ,provided1 ,that information pertaining to ,united ,states persons shall only be handled in accordance with protections provided in the ,fourth ,amendment of the ,united ,states ,constitution as implemented through ,executive ,order ,no4 #abccc4 #aagf4 7a7 ,none of the funds appropriated by this ,act may be used to transfer research and development1 acquisition1 or other program authority relating to current tactical unmanned aerial vehicles 7,t,u,a,vs7 from the ,army4 7b7 ,the ,army shall retain responsibility for and operational control of the ,,mq-#a;,c ,gray ,eagle ,unmanned ,aerial ,vehicle 7,,uav7 in order to support the ,secretary of ,defense in matters relating to the employment of unmanned aerial vehicles4 #aagg4 ,none of the funds appropriated by this ,act for programs of the ,office of the ,director of ,national ,intelligence shall remain available for obligation beyond the current fiscal year1 except for funds appropriated for research and technology1 which shall remain available until ,september #cj1 #bjai4 #aagh4 ,for purposes of section #aeec7;b7 of title #ca1 ,united ,states ,code1 any subdivision of appropriations made in this ,act under the heading ,shipbuilding and ,conversion1 ,navy shall be considered to be for the same purpose as any subdivision under the heading ,shipbuilding and ,conversion1 ,navy appropriations in any prior fiscal year1 and the #a percent limitation shall apply to the total amount of the appropriation4 #aagi4 7a7 ,not later than #fj days after the date of enactment of this ,act1 the ,director of ,national ,intelligence shall submit a report to the congressional intelligence committees to establish the baseline for application of reprogramming and transfer authorities for fiscal year #bjah3 ,provided1 ,that the report shall include-- 7#a7 a table for each appropriation with a separate column to display the ,president's budget request1 adjustments made by ,congress1 adjustments due to enacted rescissions1 if appropriate1 and the fiscal year enacted level2 7#b7 a delineation in the table for each appropriation by ,expenditure ,center and project2 and 7#c7 an identification of items of special congressional interest4 7b7 ,none of the funds provided for the ,national ,intelligence ,program in this ,act shall be available for reprogramming or transfer until the report identified in subsection 7a7 is submitted to the congressional intelligence committees1 unless the ,director of ,national ,intelligence certifies in writing to the congressional intelligence committees that such reprogramming or transfer is necessary as an emergency requirement4 #aahj4 ,none of the funds made available by this ,act may be used to eliminate1 restructure1 or realign ,army ,contracting ,command--,new ,jersey or make disproportionate personnel reductions at any ,army ,contracting ,command--,new ,jersey sites without #cj-;day prior notification to the congressional defense committees4 7rescission7 #aaha4 ,of the unobligated balances available to the ,department of ,defense1 the following funds are permanently rescinded from the following accounts and programs in the specified amounts to reflect excess cash balances in the ,department of ,defense ,acquisition ,workforce ,development ,fund3 ,from ,department of ,defense ,acquisition ,workforce ,development ,fund1 ,defense1 #aj1jjj1jjj4 #aahb4 ,none of the funds made available by this ,act for excess defense articles1 assistance under section #ccc of title #aj1 ,united ,states ,code1 or peacekeeping operations for the countries designated annually to be in violation of the standards of the ,child ,soldiers ,prevention ,act of #bjjh 7,public ,law #aaj-deg2 #bb ,u4,s4,c4 #bcgj;c-#a7 may be used to support any military training or operation that includes child soldiers1 as defined by the ,child ,soldiers ,prevention ,act of #bjjh1 unless such assistance is otherwise permitted under section #djd of the ,child ,soldiers ,prevention ,act of #bjjh4 #aahc4 7a7 ,none of the funds provided for the ,national ,intelligence ,program in this or any prior appropriations ,act shall be available for obligation or expenditure through a reprogramming or transfer of funds in accordance with section #ajb;,a7d7 of the ,national ,security ,act of #aidg 7#ej ,u4,s4,c4 #cjbd7;d77 that-- 7#a7 creates a new start effort2 7#b7 terminates a program with appropriated funding of #aj1jjj1jjj or more2 7#c7 transfers funding into or out of the ,national ,intelligence ,program2 or 7#d7 transfers funding between appropriations1 unless the congressional intelligence committees are notified #cj days in advance of such reprogramming of funds2 this notification period may be reduced for urgent national security requirements4 7b7 ,none of the funds provided for the ,national ,intelligence ,program in this or any prior appropriations ,act shall be available for obligation or expenditure through a reprogramming or transfer of funds in accordance with section #ajb;,a7d7 of the ,national ,security ,act of #aidg 7#ej ,u4,s4,c4 #cjbd7;d77 that results in a cumulative increase or decrease of the levels specified in the classified annex accompanying the ,act unless the congressional intelligence committees are notified #cj days in advance of such reprogramming of funds2 this notification period may be reduced for urgent national security requirements4 #aahd4 ,the ,director of ,national ,intelligence shall submit to ,congress each year1 at or about the time that the ,president's budget is submitted to ,congress that year under section #aaje7;a7 of title #ca1 ,united ,states ,code1 a future-years intelligence program 7including associated annexes7 reflecting the estimated expenditures and proposed appropriations included in that budget4 ,any such future-years intelligence program shall cover the fiscal year with respect to which the budget is submitted and at least the four succeeding fiscal years4 #aahe4 ,for the purposes of this ,act1 the term congressional intelligence committees means the ,permanent ,select ,committee on ,intelligence of the ,house of ,representatives1 the ,select ,committee on ,intelligence of the ,senate1 the ,subcommittee on ,defense of the ,committee on ,appropriations of the ,house of ,representatives1 and the ,subcommittee on ,defense of the ,committee on ,appropriations of the ,senate4 7including transfer of funds7 #aahf4 ,during the current fiscal year1 not to exceed #aa1jjj1jjj from each of the appropriations made in title ,,ii of this ,act for ,operation and ,maintenance1 ,army1 ,operation and ,maintenance1 ,navy1 and ,operation and ,maintenance1 ,air ,force may be transferred by the military department concerned to its central fund established for ,fisher ,houses and ,suites pursuant to section #bdic7;d7 of title #aj1 ,united ,states ,code4 7including transfer of funds7 #aahg4 ,not to exceed #ejj1jjj1jjj appropriated by this ,act for operation and maintenance may be available for the purpose of making remittances and transfer to the ,defense ,acquisition ,workforce ,development ,fund in accordance with section #agje of title #aj1 ,united ,states ,code4 #aahh4 7a7 ,any agency receiving funds made available in this ,act1 shall1 subject to subsections 7b7 and 7c71 post on the public website of that agency any report required to be submitted by the ,congress in this or any other ,act1 upon the determination by the head of the agency that it shall serve the national interest4 7b7 ,subsection 7a7 shall not apply to a report if-- 7#a7 the public posting of the report compromises national security2 or 7#b7 the report contains proprietary information4 7c7 ,the head of the agency posting such report shall do so only after such report has been made available to the requesting ,committee or ,committees of ,congress for no less than #de days4 #aahi4 7a7 ,none of the funds appropriated or otherwise made available by this ,act may be expended for any ,federal contract for an amount in excess of #a1jjj1jjj1 unless the contractor agrees not to-- 7#a7 enter into any agreement with any of its employees or independent contractors that requires1 as a condition of employment1 that the employee or independent contractor agree to resolve through arbitration any claim under title ,,vii of the ,civil ,rights ,act of #aifd or any tort related to or arising out of sexual assault or harassment1 including assault and battery1 intentional infliction of emotional distress1 false imprisonment1 or negligent hiring1 supervision1 or retention2 or 7#b7 take any action to enforce any provision of an existing agreement with an employee or independent contractor that mandates that the employee or independent contractor resolve through arbitration any claim under title ,,vii of the ,civil ,rights ,act of #aifd or any tort related to or arising out of sexual assault or harassment1 including assault and battery1 intentional infliction of emotional distress1 false imprisonment1 or negligent hiring1 supervision1 or retention4 7b7 ,none of the funds appropriated or otherwise made available by this ,act may be expended for any ,federal contract unless the contractor certifies that it requires each covered subcontractor to agree not to enter into1 and not to take any action to enforce any provision of1 any agreement as described in paragraphs 7#a7 and 7#b7 of subsection 7a71 with respect to any employee or independent contractor performing work related to such subcontract4 ,for purposes of this subsection1 a covered subcontractor is an entity that has a subcontract in excess of #a1jjj1jjj on a contract subject to subsection 7a74 7c7 ,the prohibitions in this section do not apply with respect to a contractor's or subcontractor's agreements with employees or independent contractors that may not be enforced in a court of the ,united ,states4 7d7 ,the ,secretary of ,defense may waive the application of subsection 7a7 or 7b7 to a particular contractor or subcontractor for the purposes of a particular contract or subcontract if the ,secretary or the ,deputy ,secretary personally determines that the waiver is necessary to avoid harm to national security interests of the ,united ,states1 and that the term of the contract or subcontract is not longer than necessary to avoid such harm4 ,the determination shall set forth with specificity the grounds for the waiver and for the contract or subcontract term selected1 and shall state any alternatives considered in lieu of a waiver and the reasons each such alternative would not avoid harm to national security interests of the ,united ,states4 ,the ,secretary of ,defense shall transmit to ,congress1 and simultaneously make public1 any determination under this subsection not less than #ae business days before the contract or subcontract addressed in the determination may be awarded4 7including transfer of funds7 #aaij4 ,from within the funds appropriated for operation and maintenance for the ,defense ,health ,program in this ,act1 up to #aae1eai1jjj1 shall be available for transfer to the ,joint ,department of ,defense-,department of ,veterans ,affairs ,medical ,facility ,demonstration ,fund in accordance with the provisions of section #agjd of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjaj1 ,public ,law #aaa-hd3 ,provided1 ,that for purposes of section #agjd7;b71 the facility operations funded are operations of the integrated ,captain ,james ,a4 ,lovell ,federal ,health ,care ,center1 consisting of the ,north ,chicago ,veterans ,affairs ,medical ,center1 the ,navy ,ambulatory ,care ,center1 and supporting facilities designated as a combined ,federal medical facility as described by section #gjf of ,public ,law #aaj-dag3 ,provided further1 ,that additional funds may be transferred from funds appropriated for operation and maintenance for the ,defense ,health ,program to the ,joint ,department of ,defense-,department of ,veterans ,affairs ,medical ,facility ,demonstration ,fund upon written notification by the ,secretary of ,defense to the ,committees on ,appropriations of the ,house of ,representatives and the ,senate4 #aaia4 ,none of the funds appropriated or otherwise made available by this ,act may be used by the ,department of ,defense or a component thereof in contravention of the provisions of section #acj;h of title #aj1 ,united ,states ,code4 #aaib4 ,appropriations available to the ,department of ,defense may be used for the purchase of heavy and light armored vehicles for the physical security of personnel or for force protection purposes up to a limit of #dej1jjj per vehicle1 notwithstanding price or other limitations applicable to the purchase of passenger carrying vehicles4 7including transfer of funds7 #aaic4 ,upon a determination by the ,director of ,national ,intelligence that such action is necessary and in the national interest1 the ,director may1 with the approval of the ,office of ,management and ,budget1 transfer not to exceed #a1ejj1jjj1jjj of the funds made available in this ,act for the ,national ,intelligence ,program3 ,provided1 ,that such authority to transfer may not be used unless for higher priority items1 based on unforeseen intelligence requirements1 than those for which originally appropriated and in no case where the item for which funds are requested has been denied by the ,congress3 ,provided further1 ,that a request for multiple reprogrammings of funds using authority provided in this section shall be made prior to ,june #cj1 #bjag4 #aaid4 ,none of the funds appropriated or otherwise made available in this or any other ,act may be used to transfer1 release1 or assist in the transfer or release to or within the ,united ,states1 its territories1 or possessions ,khalid ,sheikh ,mohammed or any other detainee who-- 7#a7 is not a ,united ,states citizen or a member of the ,armed ,forces of the ,united ,states2 and 7#b7 is or was held on or after ,june #bd1 #bjji1 at ,united ,states ,naval ,station1 ,guantnamo ,bay1 ,cuba1 by the ,department of ,defense4 #aaie4 7a7 ,none of the funds appropriated or otherwise made available in this or any other ,act may be used to construct1 acquire1 or modify any facility in the ,united ,states1 its territories1 or possessions to house any individual described in subsection 7c7 for the purposes of detention or imprisonment in the custody or under the effective control of the ,department of ,defense4 7b7 ,the prohibition in subsection 7a7 shall not apply to any modification of facilities at ,united ,states ,naval ,station1 ,guantnamo ,bay1 ,cuba4 7c7 ,an individual described in this subsection is any individual who1 as of ,june #bd1 #bjji1 is located at ,united ,states ,naval ,station1 ,guantnamo ,bay1 ,cuba1 and who-- 7#a7 is not a citizen of the ,united ,states or a member of the ,armed ,forces of the ,united ,states2 and 7#b7 is-- 7,a7 in the custody or under the effective control of the ,department of ,defense2 or 7,b7 otherwise under detention at ,united ,states ,naval ,station1 ,guantnamo ,bay1 ,cuba4 #aaif4 ,none of the funds appropriated or otherwise made available in this ,act may be used to transfer any individual detained at ,united ,states ,naval ,station ,guantnamo ,bay1 ,cuba1 to the custody or control of the individual's country of origin1 any other foreign country1 or any other foreign entity except in accordance with section #ajcd of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjaf 7,public ,law #aad-ib7 and section #ajcd of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjag 7,public ,law #aad-cbh74 #aaig4 ,none of the funds made available by this ,act may be used in contravention of the ,war ,powers ,resolution 7#ej ,u4,s4,c4 #aeda et seq474 #aaih4 7a7 ,none of the funds appropriated or otherwise made available by this or any other ,act may be used by the ,secretary of ,defense1 or any other official or officer of the ,department of ,defense1 to enter into a contract1 memorandum of understanding1 or cooperative agreement with1 or make a grant to1 or provide a loan or loan guarantee to ,rosoboronexport or any subsidiary of ,rosoboronexport4 7b7 ,the ,secretary of ,defense may waive the limitation in subsection 7a7 if the ,secretary1 in consultation with the ,secretary of ,state and the ,director of ,national ,intelligence1 determines that it is in the vital national security interest of the ,united ,states to do so1 and certifies in writing to the congressional defense committees that1 to the best of the ,secretary's knowledge3 7#a7 ,rosoboronexport has ceased the transfer of lethal military equipment to1 and the maintenance of existing lethal military equipment for1 the ,government of the ,syrian ,arab ,republic2 7#b7 ,the armed forces of the ,russian ,federation have withdrawn from ,crimea1 other than armed forces present on military bases subject to agreements in force between the ,government of the ,russian ,federation and the ,government of ,ukraine2 and 7#c7 ,agents of the ,russian ,federation have ceased taking active measures to destabilize the control of the ,government of ,ukraine over eastern ,ukraine4 7c7 ,the ,inspector ,general of the ,department of ,defense shall conduct a review of any action involving ,rosoboronexport with respect to a waiver issued by the ,secretary of ,defense pursuant to subsection 7b71 and not later than #ij days after the date on which such a waiver is issued by the ,secretary of ,defense1 the ,inspector ,general shall submit to the congressional defense committees a report containing the results of the review conducted with respect to such waiver4 #aaii4 ,none of the funds made available in this ,act may be used for the purchase or manufacture of a flag of the ,united ,states unless such flags are treated as covered items under section #becc;a7b7 of title #aj1 ,united ,states ,code4 #abjj4 7a7 ,of the funds appropriated in this ,act for the ,department of ,defense1 amounts may be made available1 under such regulations as the ,secretary of ,defense may prescribe1 to local military commanders appointed by the ,secretary1 or by an officer or employee designated by the ,secretary1 to provide at their discretion ex gratia payments in amounts consistent with subsection 7d7 of this section for damage1 personal injury1 or death that is incident to combat operations of the ,armed ,forces in a foreign country4 7b7 ,an ex gratia payment under this section may be provided only if-- 7#a7 the prospective foreign civilian recipient is determined by the local military commander to be friendly to the ,united ,states2 7#b7 a claim for damages would not be compensable under chapter #afc of title #aj1 ,united ,states ,code 7commonly known as the ,foreign ,claims ,act72 and 7#c7 the property damage1 personal injury1 or death was not caused by action by an enemy4 7c7 ,nature of payments ,any payments provided under a program under subsection 7a7 shall not be considered an admission or acknowledgement of any legal obligation to compensate for any damage1 personal injury1 or death4 7d7 ,amount of payments ,if the ,secretary of ,defense determines a program under subsection 7a7 to be appropriate in a particular setting1 the amounts of payments1 if any1 to be provided to civilians determined to have suffered harm incident to combat operations of the ,armed ,forces under the program should be determined pursuant to regulations prescribed by the ,secretary and based on an assessment1 which should include such factors as cultural appropriateness and prevailing economic conditions4 7e7 ,legal advice ,local military commanders shall receive legal advice before making ex gratia payments under this subsection4 ,the legal advisor1 under regulations of the ,department of ,defense1 shall advise on whether an ex gratia payment is proper under this section and applicable ,department of ,defense regulations4 7f7 ,written record ,a written record of any ex gratia payment offered or denied shall be kept by the local commander and on a timely basis submitted to the appropriate office in the ,department of ,defense as determined by the ,secretary of ,defense4 7g7 ,report ,the ,secretary of ,defense shall report to the congressional defense committees on an annual basis the efficacy of the ex gratia payment program including the number of types of cases considered1 amounts offered1 the response from ex gratia payment recipients1 and any recommended modifications to the program4 #abja4 ,none of the funds available in this ,act to the ,department of ,defense1 other than appropriations made for necessary or routine refurbishments1 upgrades or maintenance activities1 shall be used to reduce or to prepare to reduce the number of deployed and non-deployed strategic delivery vehicles and launchers below the levels set forth in the report submitted to ,congress in accordance with section #ajdb of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjab4 #abjb4 ,the ,secretary of ,defense shall post grant awards on a public ,website in a searchable format4 #abjc4 ,none of the funds made available by this ,act may be used to fund the performance of a flight demonstration team at a location outside of the ,united ,states3 ,provided1 ,that this prohibition applies only if a performance of a flight demonstration team at a location within the ,united ,states was canceled during the current fiscal year due to insufficient funding4 #abjd4 ,none of the funds made available by this ,act may be used by the ,national ,security ,agency to-- 7#a7 conduct an acquisition pursuant to section #gjb of the ,foreign ,intelligence ,surveillance ,act of #aigh for the purpose of targeting a ,united ,states person2 or 7#b7 acquire1 monitor1 or store the contents 7as such term is defined in section #beaj7h7 of title #ah1 ,united ,states ,code7 of any electronic communication of a ,united ,states person from a provider of electronic communication services to the public pursuant to section #eja of the ,foreign ,intelligence ,surveillance ,act of #aigh4 #abje4 ,none of the funds made available by this ,act may be obligated or expended to implement the ,arms ,trade ,treaty until the ,senate approves a resolution of ratification for the ,treaty4 #abjf4 ,none of the funds made available in this or any other ,act may be used to pay the salary of any officer or employee of any agency funded by this ,act who approves or implements the transfer of administrative responsibilities or budgetary resources of any program1 project1 or activity financed by this ,act to the jurisdiction of another ,federal agency not financed by this ,act unless explicity provided for in a ,defense ,appropriations ,act3 ,provided1 ,that this limitation shall not apply to transfers of funds expressly provided for in ,defense ,appropriations ,acts1 or provisions of ,acts providing supplemental appropriations for the ,department of ,defense4 #abjg4 ,none of the funds made available in this ,act may be obligated for activities authorized under section #abjh of the ,ronald ,w4 ,reagan ,national ,defense ,authorization ,act for ,fiscal ,year #bjje 7,public ,law #aab-ha2 #abe ,stat4 #afba7 to initiate support for1 or expand support to1 foreign forces1 irregular forces1 groups1 or individuals unless the congressional defense committees are notified in accordance with the direction contained in the classified annex accompanying this ,act1 not less than #ae days before initiating such support3 ,provided1 ,that none of the funds made available in this ,act may be used under section #abjh for any activity that is not in support of an ongoing military operation being conducted by ,united ,states ,special ,operations ,forces to combat terrorism3 ,provided further1 ,that the ,secretary of ,defense may waive the prohibitions in this section if the ,secretary determines that such waiver is required by extraordinary circumstances and1 by not later than #gb hours after making such waiver1 notifies the congressional defense committees of such waiver4 #abjh4 ,none of the funds made available by this ,act may be used with respect to ,iraq in contravention of the ,war ,powers ,resolution 7#ej ,u4,s4,c4 #aeda et seq471 including for the introduction of ,united ,states armed forces into hostilities in ,iraq1 into situations in ,iraq where imminent involvement in hostilities is clearly indicated by the circumstances1 or into ,iraqi territory1 airspace1 or waters while equipped for combat1 in contravention of the congressional consultation and reporting requirements of sections #c and #d of such ,resolution 7#ej ,u4,s4,c4 #aedb and #aedc74 #abji4 ,none of the funds provided in this ,act for the ,t-,,ao ,fleet ,oiler or the ,towing1 ,salvage1 and ,rescue ,ship programs shall be used to award a new contract that provides for the acquisition of the following components unless those components are manufactured in the ,united ,states3 ,auxiliary equipment 7including pumps7 for shipboard services2 propulsion equipment 7including engines1 reduction gears1 and propellers72 shipboard cranes2 and spreaders for shipboard cranes4 #abaj4 ,the amount appropriated in title ,,ii of this ,act for ,operation and ,maintenance1 ,army is hereby reduced by #ge1jjj1jjj to reflect excess cash balances in ,department of ,defense ,working ,capital ,funds4 #abaa4 ,notwithstanding any other provision of this ,act1 to reflect savings due to lower than anticipated fuel costs1 the total amount appropriated in title ,,ii of this ,act is hereby reduced by #a1jjg1bfg1jjj4 #abab4 ,none of the funds made available by this ,act may be used for ,government ,travel ,charge ,card expenses by military or civilian personnel of the ,department of ,defense for gaming1 or for entertainment that includes topless or nude entertainers or participants1 as prohibited by ,department of ,defense ,,fmr1 ,volume #i1 ,chapter #c and ,department of ,defense ,instruction #ajae4aj 7enclosure #c1 #ad;a and #ad;b74 #abac4 ,none of the funds made available by this ,act may be used to propose1 plan for1 or execute a new or additional ,base ,realignment and ,closure 7,,brac7 round4 #abad4 ,of the amounts appropriated in this ,act for ,operation and ,maintenance1 ,navy1 #bhi1bee1jjj1 to remain available until expended1 may be used for any purposes related to the ,national ,defense ,reserve ,fleet established under section #aa of the ,merchant ,ship ,sales ,act of #aidf 7#ej ,u4,s4,c4 #ddje73 ,provided1 ,that such amounts are available for reimbursements to the ,ready ,reserve ,force1 ,maritime ,administration account of the ,united ,states ,department of ,transportation for programs1 projects1 activities1 and expenses related to the ,national ,defense ,reserve ,fleet4 #abae4 ,none of the funds made available by this ,act for the ,joint ,surveillance ,target ,attack ,radar ,system recapitalization program may be obligated or expended for pre-milestone ,b activities after ,march #ca1 #bjah1 except for source selection and other activities necessary to enter the engineering and manufacturing development phase4 #abaf4 ,none of the funds made available by this ,act may be used to carry out the closure or realignment of the ,united ,states ,naval ,station1 ,guantnamo ,bay1 ,cuba4 7including transfer of funds7 #abag4 ,additional readiness funds made available in title ,,ii of this ,act for ,operation and ,maintenance1 ,army1 ,operation and ,maintenance1 ,navy1 ,operation and ,maintenance1 ,marine ,corps1 and ,operation and ,maintenance1 ,air ,force may be transferred to and merged with any appropriation of the ,department of ,defense for activities related to the ,zika virus in order to provide health support for the full range of military operations and sustain the health of the members of the ,armed ,forces1 civilian employees of the ,department of ,defense1 and their families1 to include3 research and development1 disease surveillance1 vaccine development1 rapid detection1 vector controls and surveillance1 training1 and outbreak response3 ,provided1 ,that the authority provided in this section is subject to the same terms and conditions as the authority provided in section #hjje of this ,act4 #abah4 7a7 ,none of the funds made available in this ,act may be used to maintain or establish a computer network unless such network is designed to block access to pornography websites4 7b7 ,nothing in subsection 7a7 shall limit the use of funds necessary for any ,federal1 ,state1 tribal1 or local law enforcement agency or any other entity carrying out criminal investigations1 prosecution1 or adjudication activities1 or for any activity necessary for the national defense1 including intelligence activities4 #abai4 ,notwithstanding any other provision of law1 any transfer of funds appropriated or otherwise made available by this ,act to the ,global ,engagement ,center pursuant to section #abhg of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjag 7,public ,law #aad-cbh7 shall be made in accordance with section #hjje or #ijjb of this ,act1 as applicable4 #abbj4 ,no amounts credited or otherwise made available in this or any other ,act to the ,department of ,defense ,acquisition ,workforce ,development ,fund may be transferred to3 7#a7 the ,rapid ,prototyping ,fund established under section #hjd7;d7 of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjaf 7#aj ,u4,s4,c4 #bcjb note72 or 7#b7 credited to a military-department specific fund established under section #hjd7;d77#b7 of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjaf 7as amended by section #hig of the ,national ,defense ,authorization ,act for ,fiscal ,year #bjag74 7including transfer fund7 #abba4 ,in addition to amounts provided elsewhere in this ,act for military personnel pay1 including active duty1 reserve and ,national ,guard personnel1 #bjf1djj1jjj is hereby appropriated to the ,department of ,defense and made available for transfer only to military personnel accounts3 ,provided1 ,that the transfer authority provided under this heading is in addition to any other transfer authority provided elsewhere in this ,act4 #abbb4 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #bce1jjj1jjj1 for an additional amount for ,operation and ,maintenance1 ,defense-,wide1 to remain available until expended3 ,provided1 ,that such funds shall only be available to the ,secretary of ,defense1 acting through the ,office of ,economic ,adjustment of the ,department of ,defense1 or for transfer to the ,secretary of ,education1 notwithstanding any other provision of law1 to make grants1 conclude cooperative agreements1 or supplement other ,federal funds to construct1 renovate1 repair1 or expand elementary and secondary public schools on military installations in order to address capacity or facility condition deficiencies at such schools3 ,providedfurther1 ,that in making such funds available1 the ,office of ,economic ,adjustment or the ,secretary of ,education shall give priority consideration to those military installations with schools having the most serious capacity or facility condition deficiencies as determined by the ,secretary of ,defense3 ,provided further1 ,that as a condition of receiving funds under this section a local educational agency or ,state shall provide a matching share as described in the notice titled ,department of ,defense ,program for ,construction1 ,renovation1 ,repair or ,expansion of ,public ,schools ,located on ,military ,installations published by the ,department of ,defense in the ,federal ,register on ,september #i1 #bjaa 7#gf ,fed4 ,reg4 #eehhc et seq473 ,provided further1 ,that these provisions apply to funds provided under this section1 and to funds previously provided by ,congress to construct1 renovate1 repair1 or expand elementary and secondary public schools on military installations in order to address capacity or facility condition deficiencies at such schools to the extent such funds remain unobligated on the date of enactment of this section4 #abbc4 ,none of the funds made available by this ,act may be used to carry out the changes to the ,joint ,travel ,regulations of the ,department of ,defense described in the memorandum of the ,per ,diem ,travel and ,transportation ,allowance ,committee titled ,,utd_/,,ctd for ,,map #aah-ac_/;,,cap #aah-ac - ,flat ,rate ,per ,diem for ,long ,term ,,tdy and dated ,october #a1 #bjad4 #abbd4 ,in carrying out the program described in the memorandum on the subject of ,policy for ,assisted ,reproductive ,services for the ,benefit of ,seriously or ,severely ,ill_/,injured 7,category ,,ii or ,,iii7 ,active ,duty ,service ,members issued by the ,assistant ,secretary of ,defense for ,health ,affairs on ,april #c1 #bjab1 and the guidance issued to implement such memorandum1 the ,secretary of ,defense shall apply such policy and guidance1 except that-- 7#a7 the limitation on periods regarding embryo cryopreservation and storage set forth in part ,,iii7,g7 and in part ,,iv7,h7 of such memorandum shall not apply2 and 7#b7 the term assisted reproductive technology shall include embryo cryopreservation and storage without limitation on the duration of such cryopreservation and storage4 ,,ix ,overseas contingency operations_/,global war on terrorism ,military ,personnel ,military ,personnel1 ,army ,for an additional amount for ,military ,personnel1 ,army1 #b1fce1cag1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,military ,personnel1 ,navy ,for an additional amount for ,military ,personnel1 ,navy1 #cgg1heg1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,military ,personnel1 ,marine ,corps ,for an additional amount for ,military ,personnel1 ,marine ,corps1 #ajc1hjj1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,military ,personnel1 ,air ,force ,for an additional amount for ,military ,personnel1 ,air ,force1 #iab1ggi1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,reserve ,personnel1 ,army ,for an additional amount for ,reserve ,personnel1 ,army1 #bd1idb1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,reserve ,personnel1 ,navy ,for an additional amount for ,reserve ,personnel1 ,navy1 #i1jia1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,reserve ,personnel1 ,marine ,corps ,for an additional amount for ,reserve ,personnel1 ,marine ,corps1 #b1cbh1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,reserve ,personnel1 ,air ,force ,for an additional amount for ,reserve ,personnel1 ,air ,force1 #bj1efi1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,national ,guard ,personnel1 ,army ,for an additional amount for ,national ,guard ,personnel1 ,army1 #ahd1ehi1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,national ,guard ,personnel1 ,air ,force ,for an additional amount for ,national ,guard ,personnel1 ,air ,force1 #e1jjd1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,military ,personnel1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #a1jjj1jjj1jjj1 for the ,military ,personnel1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to military personnel accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense3,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance ,operation and ,maintenance1 ,army ,for an additional amount for ,operation and ,maintenance1 ,army1 #af1abf1djc1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,navy ,for an additional amount for ,operation and ,maintenance1 ,navy1 #e1hge1jae1jjj1 of which up to #afa1hhe1jjj may be transferred to the ,coast ,guard ,operating ,expenses account3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,marine ,corps ,for an additional amount for ,operation and ,maintenance1 ,marine ,corps1 #a1aaf1fdj1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,air ,force ,for an additional amount for ,operation and ,maintenance1 ,air ,force1 #aj1bff1bie1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,defense-,wide ,for an additional amount for ,operation and ,maintenance1 ,defense-,wide1 #f1idd1bja1jjj3 ,provided1 ,that of the funds provided under this heading1 not to exceed #ijj1jjj1jjj1 to remain available until ,september #cj1 #bjai1 shall be for payments to reimburse key cooperating nations for logistical1 military1 and other support1 including access1 provided to ,united ,states military and stability operations in ,afghanistan and to counter the ,islamic ,state of ,iraq and the ,levant3 ,provided further1 ,that such reimbursement payments may be made in such amounts as the ,secretary of ,defense1 with the concurrence of the ,secretary of ,state1 and in consultation with the ,director of the ,office of ,management and ,budget1 may determine1 based on documentation determined by the ,secretary of ,defense to adequately account for the support provided1 and such determination is final and conclusive upon the accounting officers of the ,united ,states1 and #ae days following notification to the appropriate congressional committees3 ,provided further1 ,that funds provided under this heading may be used for the purpose of providing specialized training and procuring supplies and specialized equipment and providing such supplies and loaning such equipment on a non-reimbursable basis to coalition forces supporting ,united ,states military and stability operations in ,afghanistan and to counter the ,islamic ,state of ,iraq and the ,levant1 and #ae days following notification to the appropriate congressional committees3 ,provided further1 ,that funds provided under this heading may be used to support the ,government of ,jordan1 in such amounts as the ,secretary of ,defense may determine1 to enhance the ability of the armed forces of ,jordan to increase or sustain security along its borders1 upon #ae days prior written notification to the congressional defense committees outlining the amounts intended to be provided and the nature of the expenses incurred3 ,provided further1 ,that of the funds provided under this heading1 not to exceed #gej1jjj1jjj1 to remain available until ,september #cj1 #bjai1 shall be available to provide support and assistance to foreign security forces or other groups or individuals to conduct1 support1 or facilitate counterterrorism1 crisis response1 or other ,department of ,defense security cooperation programs3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,army ,reserve ,for an additional amount for ,operation and ,maintenance1 ,army ,reserve1 #bd1fii1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,navy ,reserve ,for an additional amount for ,operation and ,maintenance1 ,navy ,reserve1 #bc1ihj1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,marine ,corps ,reserve ,for an additional amount for ,operation and ,maintenance1 ,marine ,corps ,reserve1 #c1cfg1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,air ,force ,reserve ,for an additional amount for ,operation and ,maintenance1 ,air ,force ,reserve1 #eh1ebc1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,army ,national ,guard ,for an additional amount for ,operation and ,maintenance1 ,army ,national ,guard1 #ajh1aaa1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,air ,national ,guard ,for an additional amount for ,operation and ,maintenance1 ,air ,national ,guard1 #ae1djj1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,operation and ,maintenance1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #b1jjj1jjj1jjj1 for the ,operation and ,maintenance1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to operation and maintenance accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,afghanistan ,security ,forces ,fund ,for the ,afghanistan ,security ,forces ,fund1 #d1icg1eae1jjj 7reduced by #ab1jjj1jjj71 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such funds shall be available to the ,secretary of ,defense1 notwithstanding any other provision of law1 for the purpose of allowing the ,commander1 ,combined ,security ,transition ,command--,afghanistan1 or the ,secretary's designee1 to provide assistance1 with the concurrence of the ,secretary of ,state1 to the security forces of ,afghanistan1 including the provision of equipment1 supplies1 services1 training1 facility and infrastructure repair1 renovation1 construction1 and funding3 ,provided further1 ,that the ,secretary of ,defense may obligate and expend funds made available to the ,department of ,defense in this title for additional costs associated with existing projects previously funded with amounts provided under the heading ,afghanistan ,infrastructure ,fund in prior ,acts3 ,provided further1 ,that such costs shall be limited to contract changes resulting from inflation1 market fluctuation1 rate adjustments1 and other necessary contract actions to complete existing projects1 and associated supervision and administration costs and costs for design during construction3 ,provided further1 ,that the ,secretary may not use more than #ej1jjj1jjj under the authority provided in this section3 ,provided further1 ,that the ,secretary shall notify in advance such contract changes and adjustments in annual reports to the congressional defense committees3 ,provided further1 ,that the authority to provide assistance under this heading is in addition to any other authority to provide assistance to foreign nations3 ,provided further1 ,that contributions of funds for the purposes provided herein from any person1 foreign government1 or international organization may be credited to this ,fund1 to remain available until expended1 and used for such purposes3 ,provided further1 ,that the ,secretary of ,defense shall notify the congressional defense committees in writing upon the receipt and upon the obligation of any contribution1 delineating the sources and amounts of the funds received and the specific use of such contributions3 ,provided further1 ,that the ,secretary of ,defense shall1 not fewer than #ae days prior to obligating from this appropriation account1 notify the congressional defense committees in writing of the details of any such obligation3 ,provided further1 ,that the ,secretary of ,defense shall notify the congressional defense committees of any proposed new projects or transfer of funds between budget sub-activity groups in excess of #bj1jjj1jjj3 ,provided further1 ,that the ,united ,states may accept equipment procured using funds provided under this heading in this or prior ,acts that was transferred to the security forces of ,afghanistan and returned by such forces to the ,united ,states3 ,provided further1 ,that equipment procured using funds provided under this heading in this or prior ,acts1 and not yet transferred to the security forces of ,afghanistan or transferred to the security forces of ,afghanistan and returned by such forces to the ,united ,states1 may be treated as stocks of the ,department of ,defense upon written notification to the congressional defense committees3 ,provided further1 ,that of the funds provided under this heading1 not less than #aj1jjj1jjj shall be for recruitment and retention of women in the ,afghanistan ,national ,security ,forces1 and the recruitment and training of female security personnel3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,counter-,,isil ,train and ,equip ,fund ,for the ,counter-,islamic ,state of ,iraq and the ,levant ,train and ,equip ,fund1 #a1gfi1jjj1jjj1 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such funds shall be available to the ,secretary of ,defense in coordination with the ,secretary of ,state1 to provide assistance1 including training2 equipment2 logistics support1 supplies1 and services2 stipends2 infrastructure repair and renovation2 and sustainment1 to foreign security forces1 irregular forces1 groups1 or individuals participating1 or preparing to participate in activities to counter the ,islamic ,state of ,iraq and the ,levant1 and their affiliated or associated groups3 ,provided further1 ,that these funds may be used in such amounts as the ,secretary of ,defense may determine to enhance the border security of nations adjacent to conflict areas including ,jordan1 ,lebanon1 ,egypt1 and ,tunisia resulting from actions of the ,islamic ,state of ,iraq and the ,levant3 ,provided further1 ,that amounts made available under this heading shall be available to provide assistance only for activities in a country designated by the ,secretary of ,defense1 in coordination with the ,secretary of ,state1 as having a security mission to counter the ,islamic ,state of ,iraq and the ,levant1 and following written notification to the congressional defense committees of such designation3 ,provided further1 ,that the ,secretary of ,defense shall ensure that prior to providing assistance to elements of any forces or individuals1 such elements or individuals are appropriately vetted1 including at a minimum1 assessing such elements for associations with terrorist groups or groups associated with the ,government of ,iran2 and receiving commitments from such elements to promote respect for human rights and the rule of law3,provided further1 ,that the ,secretary of ,defense shall1 not fewer than #ae days prior to obligating from this appropriation account1 notify the congressional defense committees in writing of the details of any such obligation3 ,provided further1 ,that the ,secretary of ,defense may accept and retain contributions1 including assistance in-kind1 from foreign governments1 including the ,government of ,iraq and other entities1 to carry out assistance authorized under this heading3 ,provided further1 ,that contributions of funds for the purposes provided herein from any foreign government or other entity may be credited to this ,fund1 to remain available until expended1 and used for such purposes3 ,provided further1 ,that the ,secretary of ,defense may waive a provision of law relating to the acquisition of items and support services or sections #dj and #dj;,a of the ,arms ,export ,control ,act 7#bb ,u4,s4,c4 #bghj and #bghe7 if the ,secretary determines that such provision of law would prohibit1 restrict1 delay or otherwise limit the provision of such assistance and a notice of and justification for such waiver is submitted to the congressional defense committees1 the ,committees on ,appropriations and ,foreign ,relations of the ,senate and the ,committees on ,appropriations and ,foreign ,affairs of the ,house of ,representatives3 ,provided further1 ,that the ,united ,states may accept equipment procured using funds provided under this heading1 or under the heading1 ,iraq ,train and ,equip ,fund in prior ,acts1 that was transferred to security forces1 irregular forces1 or groups participating1 or preparing to participate in activities to counter the ,islamic ,state of ,iraq and the ,levant and returned by such forces or groups to the ,united ,states1 may be treated as stocks of the ,department of ,defense upon written notification to the congressional defense committees3 ,provided further1 ,that equipment procured using funds provided under this heading1 or under the heading1 ,iraq ,train and ,equip ,fund in prior ,acts1 and not yet transferred to security forces1 irregular forces1 or groups participating1 or preparing to participate in activities to counter the ,islamic ,state of ,iraq and the ,levant may be treated as stocks of the ,department of ,defense when determined by the ,secretary to no longer be required for transfer to such forces or groups and upon written notification to the congressional defense committees3 ,provided further1 ,that the ,secretary of ,defense shall provide quarterly reports to the congressional defense committees on the use of funds provided under this heading1 including1 but not limited to1 the number of individuals trained1 the nature and scope of support and sustainment provided to each group or individual1 the area of operations for each group1 and the contributions of other countries1 groups1 or individuals3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/ ,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement ,aircraft ,procurement1 ,army ,for an additional amount for ,aircraft ,procurement1 ,army1 #dbd1fhf1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,missile ,procurement1 ,army ,for an additional amount for ,missile ,procurement1 ,army1 #eeg1ehc1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement of ,weapons and ,tracked ,combat ,vehicles1 ,army ,for an additional amount for ,procurement of ,weapons and ,tracked ,combat ,vehicles1 ,army1 #a1aia1aci1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement of ,ammunition1 ,army ,for an additional amount for ,procurement of ,ammunition1 ,army1 #aic1dcf1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,other ,procurement1 ,army ,for an additional amount for ,other ,procurement1 ,army1 #dje1ege1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,aircraft ,procurement1 ,navy ,for an additional amount for ,aircraft ,procurement1 ,navy1 #aeg1cjj1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,weapons procurement1 navy ,for an additional amount for ,weapons ,procurement1 ,navy1 #acj1iid1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement of ,ammunition1 ,navy and ,marine ,corps ,for an additional amount for ,procurement of ,ammunition1 ,navy and ,marine ,corps1 #bbc1hdc1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,other ,procurement1 ,navy ,for an additional amount for ,other ,procurement1 ,navy1 #bjg1ihd1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement1 ,marine ,corps ,for an additional amount for ,procurement1 ,marine ,corps1 #fd1jga1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,aircraft ,procurement1 ,air ,force ,for an additional amount for ,aircraft ,procurement1 ,air ,force1 #eaj1hcf1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,missile ,procurement1 ,air ,force ,for an additional amount for ,missile ,procurement1 ,air ,force1 #cha1gjj1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,space ,procurement1 ,air ,force ,for an additional amount for ,space ,procurement1 ,air ,force1 #b1bef1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement of ,ammunition1 ,air ,force ,for an additional amount for ,procurement of ,ammunition1 ,air ,force1 #eja1eji1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,other ,procurement1 ,air ,force ,for an additional amount for ,other ,procurement1 ,air ,force1 #c1iih1hhg1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement1 ,defense-,wide ,for an additional amount for ,procurement1 ,defense-,wide1 #eaj1gda1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,national ,guard and ,reserve ,equipment ,account ,for procurement of rotary-wing aircraft2 combat1 tactical and support vehicles2 other weapons2 and other procurement items for the reserve components of the ,armed ,forces1 #a1jjj1jjj1jjj1 to remain available for obligation until ,september #cj1 #bjbj3 ,provided1 ,that the ,chiefs of ,national ,guard and ,reserve components shall1 not later than #cj days after enactment of this ,act1 individually submit to the congressional defense committees the modernization priority assessment for their respective ,national ,guard or ,reserve component3 ,provided further1 ,that none of the funds made available by this paragraph may be used to procure manned fixed wing aircraft1 or procure or modify missiles1 munitions1 or ammunition3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,procurement1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #f1jjj1jjj1jjj1 for the ,procurement1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to procurement accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,research1 ,development1 ,test and ,evaluation ,research1 ,development1 ,test and ,evaluation1 ,army ,for an additional amount for ,research1 ,development1 ,test and ,evaluation1 ,army1 #aai1cfh1jjj 7increased by #f1jjj1jjj71 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,research1 ,development1 ,test and ,evaluation1 ,navy ,for an additional amount for ,research1 ,development1 ,test and ,evaluation1 ,navy1 #abd1hfe1jjj1 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,research1 ,development1 ,test and ,evaluation1 ,air ,force ,for an additional amount for ,research1 ,development1 ,test and ,evaluation1 ,air ,force1 #add1ejh1jjj1 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,research1 ,development1 ,test and ,evaluation1 ,defense-,wide ,for an additional amount for ,research1 ,development1 ,test and ,evaluation1 ,defense-,wide1 #bbf1jif1jjj1 to remain available until ,september #cj1 #bjai3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,research1 ,development1 ,test and ,evaluation1 ,national ,defense ,restoration ,fund 7including transfer of funds7 ,in addition to amounts provided elsewhere in this ,act1 there is appropriated #a1jjj1jjj1jjj1 for the ,research1 ,development1 ,test and ,evaluation1 ,national ,defense ,restoration ,fund3 ,provided1 ,that such funds provided under this heading shall only be available for programs1 projects and activities necessary to implement the #bjah ,national ,defense ,strategy3 ,provided further1 ,that such funds shall not be available for transfer until #cj days after the ,secretary has submitted1 and the congressional defense committees have approved1 the proposed allocation plan for the use of such funds to implement such strategy3 ,provided further1 ,that such allocation plan shall include a detailed justification for the use of such funds and a description of how such investments are necessary to implement the strategy3 ,provided further1 ,that the ,secretary of ,defense may transfer these funds only to research1 development1 test and evaluation accounts3 ,provided further1 ,that the funds transferred shall be merged with and shall be available for the same purposes and for the same time period1 as the appropriation to which transferred3 ,provided further1 ,that none of the funds made available under this heading may be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that the transfer authority provided under this heading is in addition to any other transfer authority available to the ,department of ,defense3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,revolving and ,management ,funds ,defense ,working ,capital ,funds ,for an additional amount for ,defense ,working ,capital ,funds1 #adh1ief1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,other ,department of ,defense ,programs ,defense ,health ,program ,for an additional amount for ,defense ,health ,program1 #cie1hje1jjj1 which shall be for operation and maintenance3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,drug ,interdiction and ,counter-,drug ,activities1 ,defense ,for an additional amount for ,drug ,interdiction and ,counter-,drug ,activities1 ,defense1 #aif1cjj1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,joint ,improvised-,threat ,defeat ,fund 7including transfer of funds7 ,for the ,joint ,improvised-,threat ,defeat ,fund1 #dhc1jeh1jjj1 to remain available until ,september #cj1 #bjbj3 ,provided1 ,that such funds shall be available to the ,secretary of ,defense1 notwithstanding any other provision of law1 for the purpose of allowing the ,director of the ,joint ,improvised-,threat ,defeat ,organization to investigate1 develop and provide equipment1 supplies1 services1 training1 facilities1 personnel and funds to assist ,united ,states forces in the defeat of improvised explosive devices3 ,provided further1 ,that the ,secretary of ,defense may transfer funds provided herein to appropriations for military personnel2 operation and maintenance2 procurement2 research1 development1 test and evaluation2 and defense working capital funds to accomplish the purpose provided herein3 ,provided further1 ,that this transfer authority is in addition to any other transfer authority available to the ,department of ,defense3 ,provided further1 ,that the ,secretary of ,defense shall1 not fewer than #e days prior to making transfers from this appropriation1 notify the congressional defense committees in writing of the details of any such transfer3 ,provided further1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,office of the ,inspector ,general ,for an additional amount for the ,office of the ,inspector ,general1 #bd1fib1jjj3 ,provided1 ,that such amount is designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,,general ,,provisions--,,this ,,title #acja4 ,notwithstanding any other provision of law1 funds made available in this title are in addition to amounts appropriated or otherwise made available for the ,department of ,defense for fiscal year #bjah4 7including transfer of funds7 #acjb4 ,upon the determination of the ,secretary of ,defense that such action is necessary in the national interest1 the ,secretary may1 with the approval of the ,office of ,management and ,budget1 transfer up to #b1ejj1jjj1jjj between the appropriations or funds made available to the ,department of ,defense in this title3 ,provided1 ,that the ,secretary shall notify the ,congress promptly of each transfer made pursuant to the authority in this section3 ,provided further1 ,that the authority provided in this section is in addition to any other transfer authority available to the ,department of ,defense and is subject to the same terms and conditions as the authority provided in section #hjje of this ,act4 #acjc4 ,supervision and administration costs and costs for design during construction associated with a construction project funded with appropriations available for operation and maintenance or the ,afghanistan ,security ,forces ,fund provided in this ,act and executed in direct support of overseas contingency operations in ,afghanistan1 may be obligated at the time a construction contract is awarded3 ,provided1 ,that1 for the purpose of this section1 supervision and administration costs and costs for design during construction include all in-house ,government costs4 #acjd4 ,from funds made available in this title1 the ,secretary of ,defense may purchase for use by military and civilian employees of the ,department of ,defense in the ,united ,states ,central ,command area of responsibility3 7#a7 passenger motor vehicles up to a limit of #ge1jjj per vehicle2 and 7#b7 heavy and light armored vehicles for the physical security of personnel or for force protection purposes up to a limit of #dej1jjj per vehicle1 notwithstanding price or other limitations applicable to the purchase of passenger carrying vehicles4 #acje4 ,not to exceed #e1jjj1jjj of the amounts appropriated by this title under the heading ,operation and ,maintenance1 ,army may be used1 notwithstanding any other provision of law1 to fund the ,commanders' ,emergency ,response ,program 7,,cerp71 for the purpose of enabling military commanders in ,afghanistan to respond to urgent1 small-scale1 humanitarian relief and reconstruction requirements within their areas of responsibility3 ,provided1 ,that each project 7including any ancillary or related elements in connection with such project7 executed under this authority shall not exceed #b1jjj1jjj3 ,provided further1 ,that not later than #de days after the end of each #f months of the fiscal year1 the ,secretary of ,defense shall submit to the congressional defense committees a report regarding the source of funds and the allocation and use of funds during that #f-month period that were made available pursuant to the authority provided in this section or under any other provision of law for the purposes described herein3 ,provided further1 ,that1 not later than #cj days after the end of each fiscal year quarter1 the ,army shall submit to the congressional defense committees quarterly commitment1 obligation1 and expenditure data for the ,,cerp in ,afghanistan3 ,provided further1 ,that1 not less than #ae days before making funds available pursuant to the authority provided in this section or under any other provision of law for the purposes described herein for a project with a total anticipated cost for completion of #ejj1jjj or more1 the ,secretary shall submit to the congressional defense committees a written notice containing each of the following3 7#a7 ,the location1 nature and purpose of the proposed project1 including how the project is intended to advance the military campaign plan for the country in which it is to be carried out4 7#b7 ,the budget1 implementation timeline with milestones1 and completion date for the proposed project1 including any other ,,cerp funding that has been or is anticipated to be contributed to the completion of the project4 7#c7 ,a plan for the sustainment of the proposed project1 including the agreement with either the host nation1 a non-,department of ,defense agency of the ,united ,states ,government or a third-party contributor to finance the sustainment of the activities and maintenance of any equipment or facilities to be provided through the proposed project4 #acjf4 ,funds available to the ,department of ,defense for operation and maintenance may be used1 notwithstanding any other provision of law1 to provide supplies1 services1 transportation1 including airlift and sealift1 and other logistical support to allied forces participating in a combined operation with the armed forces of the ,united ,states and coalition forces supporting military and stability operations in ,afghanistan and to counter the ,islamic ,state of ,iraq and the ,levant3 ,provided1 ,that the ,secretary of ,defense shall provide quarterly reports to the congressional defense committees regarding support provided under this section4 #acjg4 ,none of the funds appropriated or otherwise made available by this or any other ,act shall be obligated or expended by the ,united ,states ,government for a purpose as follows3 7#a7 ,to establish any military installation or base for the purpose of providing for the permanent stationing of ,united ,states ,armed ,forces in ,iraq4 7#b7 ,to exercise ,united ,states control over any oil resource of ,iraq4 7#c7 ,to establish any military installation or base for the purpose of providing for the permanent stationing of ,united ,states ,armed ,forces in ,afghanistan4 #acjh4 ,none of the funds made available in this ,act may be used in contravention of the following laws enacted or regulations promulgated to implement the ,united ,nations ,convention ,against ,torture and ,other ,cruel1 ,inhuman or ,degrading ,treatment or ,punishment 7done at ,new ,york on ,december #aj1 #aihd73 7#a7 ,section #bcdj;,a of title #ah1 ,united ,states ,code4 7#b7 ,section #bbdb of the ,foreign ,affairs ,reform and ,restructuring ,act of #aiih 7division ,g of ,public ,law #aje-bgg2 #aab ,stat4 #bfha-hbb2 #h ,u4,s4,c4 #abca note7 and regulations prescribed thereto1 including regulations under part #bjh of title #h1 ,code of ,federal ,regulations1 and part #ie of title #bb1 ,code of ,federal ,regulations4 7#c7 ,sections #ajjb and #ajjc of the ,department of ,defense1 ,emergency ,supplemental ,appropriations to ,address ,hurricanes in the ,gulf of ,mexico1 and ,pandemic ,influenza ,act1 #bjjf 7,public ,law #aji-adh74 #acji4 ,none of the funds provided for the ,afghanistan ,security ,forces ,fund 7,,asff7 may be obligated prior to the approval of a financial and activity plan by the ,afghanistan ,resources ,oversight ,council 7,,aroc7 of the ,department of ,defense3 ,provided1 ,that the ,,aroc must approve the requirement and acquisition plan for any service requirements in excess of #ej1jjj1jjj annually and any non-standard equipment requirements in excess of #ajj1jjj1jjj using ,,asff3 ,provided further1 ,that the ,department of ,defense must certify to the congressional defense committees that the ,,aroc has convened and approved a process for ensuring compliance with the requirements in the preceding proviso and accompanying report language for the ,,asff4 #acaj4 ,funds made available in this title to the ,department of ,defense for operation and maintenance may be used to purchase items having an investment unit cost of not more than #bej1jjj3 ,provided1 ,that1 upon determination by the ,secretary of ,defense that such action is necessary to meet the operational requirements of a ,commander of a ,combatant ,command engaged in contingency operations overseas1 such funds may be used to purchase items having an investment item unit cost of not more than #ejj1jjj4 #acaa4 ,up to #ejj1jjj1jjj of funds appropriated by this ,act for the ,defense ,security ,cooperation ,agency in ,operation and ,maintenance1 ,defense-,wide may be used to provide assistance to the ,government of ,jordan to support the armed forces of ,jordan and to enhance security along its borders4 #acab4 ,none of the funds made available by this ,act under the heading ,counter-,,isil ,train and ,equip ,fund may be used to procure or transfer man-portable air defense systems4 #acac4 ,for the ,ukraine ,security ,assistance ,initiative1 #aej1jjj1jjj is hereby appropriated1 to remain available until ,september #cj1 #bjah3 ,provided1 ,that such funds shall be available to the ,secretary of ,defense1 in coordination with the ,secretary of ,state1 to provide assistance1 including training2 equipment2 lethal weapons of a defensive nature2 logistics support1 supplies and services2 sustainment2 and intelligence support to the military and national security forces of ,ukraine1 and for replacement of any weapons or defensive articles provided to the ,government of ,ukraine from the inventory of the ,united ,states3 ,provided further1 ,that the ,secretary of ,defense shall1 not less than #ae days prior to obligating funds provided under this heading1 notify the congressional defense committees in writing of the details of any such obligation3 ,provided further1 ,that the ,united ,states may accept equipment procured using funds provided under this heading in this or prior ,acts that was transferred to the security forces of ,ukraine and returned by such forces to the ,united ,states3 ,provided further1 ,that equipment procured using funds provided under this heading in this or prior ,acts1 and not yet transferred to the military or ,national ,security ,forces of ,ukraine or returned by such forces to the ,united ,states1 may be treated as stocks of the ,department of ,defense upon written notification to the congressional defense committees3 ,provided further1 ,that amounts made available by this section are designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 #acad4 ,funds appropriated in this title shall be available for replacement of funds for items provided to the ,government of ,ukraine from the inventory of the ,united ,states to the extent specifically provided for in section #ijac of this ,act4 #acae4 ,none of the funds made available by this ,act under section #ijac for ,assistance and ,sustainment to the ,military and ,national ,security ,forces of ,ukraine may be used to procure or transfer man-portable air defense systems4 #acaf4 7a7 ,none of the funds appropriated or otherwise made available by this ,act under the heading ,operation and ,maintenance1 ,defense-,wide for payments under section #abcc of ,public ,law #aaj-aha for reimbursement to the ,government of ,pakistan may be made available unless the ,secretary of ,defense1 in coordination with the ,secretary of ,state1 certifies to the congressional defense committees that the ,government of ,pakistan is-- 7#a7 cooperating with the ,united ,states in counterterrorism efforts against the ,haqqani ,network1 the ,quetta ,shura ,taliban1 ,lashkar e-,tayyiba1 ,jaish-e-,mohammed1 ,al ,qaeda1 and other domestic and foreign terrorist organizations1 including taking steps to end support for such groups and prevent them from basing and operating in ,pakistan and carrying out cross border attacks into neighboring countries2 7#b7 not supporting terrorist activities against ,united ,states or coalition forces in ,afghanistan1 and ,pakistan's military and intelligence agencies are not intervening extra-judicially into political and judicial processes in ,pakistan2 7#c7 dismantling improvised explosive device 7,,ied7 networks and interdicting precursor chemicals used in the manufacture of ,i,e,ds2 7#d7 preventing the proliferation of nuclear-related material and expertise2 7#e7 implementing policies to protect judicial independence and due process of law2 7#f7 issuing visas in a timely manner for ,united ,states visitors engaged in counterterrorism efforts and assistance programs in ,pakistan2 and 7#g7 providing humanitarian organizations access to detainees1 internally displaced persons1 and other ,pakistani civilians affected by the conflict4 7b7 ,the ,secretary of ,defense1 in coordination with the ,secretary of ,state1 may waive the restriction in subsection 7a7 on a case-by-case basis by certifying in writing to the congressional defense committees that it is in the national security interest to do so3 ,provided1 ,that if the ,secretary of ,defense1 in coordination with the ,secretary of ,state1 exercises such waiver authority1 the ,secretaries shall report to the congressional defense committees on both the justification for the waiver and on the requirements of this section that the ,government of ,pakistan was not able to meet3 ,provided further1 ,that such report may be submitted in classified form if necessary4 7including transfer of funds7 #acag4 ,in addition to amounts otherwise made available in this ,act1 #ejj1jjj1jjj is hereby appropriated to the ,department of ,defense and made available for transfer only to the operation and maintenance1 military personnel1 and procurement accounts1 to improve the intelligence1 surveillance1 and reconnaissance capabilities of the ,department of ,defense3 ,provided1 ,that the transfer authority provided in this section is in addition to any other transfer authority provided elsewhere in this ,act3 ,provided further1 ,that not later than #cj days prior to exercising the transfer authority provided in this section1 the ,secretary of ,defense shall submit a report to the congressional defense committees on the proposed uses of these funds3 ,provided further1 ,that the funds provided in this section may not be transferred to any program1 project1 or activity specifically limited or denied by this ,act3 ,provided further1 ,that amounts made available by this section are designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe3 ,provided further1 ,that the authority to provide funding under this section shall terminate on ,september #cj1 #bjah4 #acah4 ,none of the funds made available by this ,act may be used with respect to ,syria in contravention of the ,war ,powers ,resolution 7#ej ,u4,s4,c4 #aeda et seq471 including for the introduction of ,united ,states armed or military forces into hostilities in ,syria1 into situations in ,syria where imminent involvement in hostilities is clearly indicated by the circumstances1 or into ,syrian territory1 airspace1 or waters while equipped for combat1 in contravention of the congressional consultation and reporting requirements of sections #c and #d of that law 7#ej ,u4,s4,c4 #aedb and #aedc74 7rescissions7 #acai4 ,of the funds appropriated in ,department of ,defense ,appropriations ,acts1 the following funds are hereby rescinded from the following accounts and programs in the specified amounts3 ,provided1 ,that such amounts are designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe3 ,other ,procurement1 ,air ,force1 #bjag_/bjai1 #be1ajj1jjj2 ,afghanistan ,security ,forces ,fund1 #bjag_/bjah1 #ajj1jjj1jjj2 and ,counter-,,isil ,train and ,equip ,fund1 #bjag_/bjah1 #aab1eac1jjj4 ,operation and ,maintenance1 ,defense-,wide1 ,,dsca ,coalition ,support ,fund1 #bjag_/bjah1 #cej1jjj1jjj4 #acbj4 ,each amount designated in this ,act by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe shall be available only if the ,president subsequently so designates all such amounts and transmits such designations to the ,congress4 #acba4 7a7 ,not later than #cj days after the date of the enactment of this ,act1 the ,president shall submit to ,congress a report on the ,united ,states strategy to defeat ,al-,qaeda1 the ,taliban1 the ,islamic ,state of ,iraq and ,syria 7,,isis71 and their associated forces and co-belligerents4 7b7 ,the report required under subsection 7a7 shall include the following3 7#a7 ,an analysis of the adequacy of the existing legal framework to accomplish the strategy described in subsection 7a71 particularly with respect to the ,authorization for ,use of ,military ,force 7,public ,law #ajg-dj2 #ej ,u4,s4,c4 #aeda note7 and the ,authorization for ,use of ,military ,force ,against ,iraq ,resolution of #bjjb 7,public ,law #ajg-bdc2 #ej ,u4,s4,c4 #aeda note74 7#b7 ,an analysis of the budgetary resources necessary to accomplish the strategy described in subsection 7a74 7c7 ,not later than #cj days after the date on which the ,president submits to the appropriate congressional committees the report required by subsection 7a71 the ,secretary of ,state and the ,secretary of ,defense shall testify at any hearing held by any of the appropriate congressional committees on the report and to which the ,secretary is invited4 7d7 ,in this section1 the term appropriate congressional committees means-- 7#a7 the ,committee on ,foreign ,relations and the ,committee on ,armed ,services of the ,senate2 and 7#b7 the ,committee on ,foreign ,affairs and the ,committee on ,armed ,services of the ,house of ,representatives4 #acbb4 7a7 ,in addition to amounts provided elsewhere in this ,act1 there is hereby appropriated #a1ahd1aab1jjj1 for the following accounts and programs in the specified amounts for costs associated with ,operation ,freedom's ,sentinel3 7#a7 ,military ,personnel1 ,army1 #dh1cgg1jjj2 7#b7 ,military ,personnel1 ,marine ,corps1 #agi1jjj2 7#c7 ,military ,personnel1 ,air ,force1 #a1cdj1jjj2 7#d7 ,operation and ,maintenance1 ,army1 #hgb1dia1jjj2 7#e7 ,operation and ,maintenance1 ,navy1 #gf1bgd1jjj2 7#f7 ,operation and ,maintenance1 ,marine ,corps1 #bd1gcd1jjj2 7#g7 ,operation and ,maintenance1 ,defense-,wide1 #ha1afd1jjj2 7#h7 ,procurement of ,ammunition1 ,navy and ,marine ,corps1 #aj1hec1jjj1 to remain available until ,september #cj1 #bjbj2 7#i7 ,other ,procurement1 ,navy1 #ca1ejj1jjj1 to remain available until ,september #cj1 #bjbj2 and 7#aj7 ,research1 ,development1 ,test and ,evaluation1 ,navy1 #cg1bjj1jjj1 to remain available until ,september #cj1 #bjai4 7b7 ,amounts provided pursuant to this section are hereby designated by the ,congress for ,overseas ,contingency ,operations_/,global ,war on ,terrorism pursuant to section #bea7;b77#b77;,a77ii7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe4 ,x ,additional ,general ,provisions ,references to report #adja4 ,any reference to a report accompanying this ,act contained in this ,act shall be treated as a reference to ,house ,report #aae-bai4 ,such report shall apply for purposes of determining the allocation of funds provided by1 and the implementation of1 this ,act4 spending reduction account #adjb4 #j4 #adjc4 ,none of the funds appropriated or otherwise made available under the heading ,afghanistan ,security ,forces ,fund may be used to procure uniforms for the ,afghan ,national ,army4 #adjd4 ,none of the funds made available in this ,act may be used for the closure of a biosafety level #d laboratory4 #adje4 ,none of the funds made available by this ,act may be used to provide arms1 training1 or other assistance to the ,azov ,battalion4 #adjf4 ,none of the finds made available by this ,act may be used to purchase heavy water from ,iran4 #adjg4 ,none of the funds appropriated by this ,act may be used to plan for1 begin1 continue1 complete1 process1 or approve a public-private competition under the ,office of ,management and ,budget ,circular ,a-#gf4 #adjh4 ,notwithstanding any other provision of law1 with respect to the revised security category 7as that term is defined in section #bej7;c77#d77;,d7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe71 any sequestration order issued under such ,act for fiscal year #bjah shall have no force or effect4 ,this division may be cited as the ,department of ,defense ,appropriations ,act1 #bjah4 ,d ,miscellaneous #aeja4 7a7 ,section #abdj;,b of the ,food ,security ,act of #aihe 7#af ,u4,s4,c4 #chci;aa-#b7 is amended by striking subsection 7a7 and inserting the following3 7a7 ,establishment ,during each of the #bjjb through #bjai fiscal years1 the ,secretary shall provide payments to producers that enter into contracts with the ,secretary under the program4 4 7b7 ,section #abda of the ,food ,security ,act of #aihe 7#af ,u4,s4,c4 #chda7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in the matter preceding paragraph 7#a71 by striking #bjah and inserting #bjah 7and fiscal year #bjai in the case of the program specified in paragraph 7#e772 and 7,b7 in paragraph 7#e77;,e71 by striking fiscal year #bjah and inserting each of fiscal years #bjah through #bjai2 and 7#b7 in subsection 7b71 by striking #bjah and inserting #bjah 7and fiscal year #bjai in the case of the program specified in subsection 7a77#e774 ,e ,tax ,matters #afja4 ,repeal of shift in time of payment of corporate estimated taxes ,the ,trade ,preferences ,extension ,act of #bjae is amended by striking section #hjc 7relating to time for payment of corporate estimated taxes74 ,f ,health ,provisions #bajj4 ,short title ,this division may be cited as the ,strengthening and ,underpinning the ,safety-net to ,aid ,individuals ,needing ,care ,act of #bjah or the ,,sustain ,care ,act of #bjah4 ,i ,medicare ,extenders and ,related ,policies ,a ,medicare ,part ,a #baja4 ,extension of the ,medicare-dependent hospital 7,,mdh7 program 7a7 ,in general ,section #ahhf7;d77#e77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g77 is amended-- 7#a7 in clause 7i71 by striking ,october #a1 #bjag and inserting ,october #a1 #bjai2 7#b7 in clause 7ii77,,ii71 by striking ,october #a1 #bjag and inserting ,october #a1 #bjai2 and 7#c7 in clause 7iv7-- 7,a7 by amending subclause 7,i7 to read as follows3 7,i7 that-- 7aa7 is located in a rural area2 or 7bb7 for discharges occurring on or after ,october #a1 #bjag1 is located in a ,state with no rural area 7as defined in paragraph 7#b77;,d77 and satisfies any of the criteria in subclause 7,i71 7,,ii71 7,,iii71 or 7,,iv7 of paragraph 7#h77;,e77ii71 2 and 7,b7 by adding at the end1 after and below subclause 7,,iv71 the following flush sentence3 ,for purposes of applying subclause 7,,ii7 of paragraph 7#h77;,e77ii7 under subclause 7,i77bb71 such subclause 7,,ii7 shall be applied by inserting as of ,january #a1 #bjah1 after such ,state each place it appears4 4 7b7 ,conforming amendments 7#a7 ,extension of target amount ,section #ahhf7;b77#c77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,d77 is amended-- 7,a7 in the matter preceding clause 7i71 by striking ,october #a1 #bjag and inserting ,october #a1 #bjai2 and 7,b7 in clause 7iv71 by striking through fiscal year #bjag and inserting through fiscal year #bjai4 7#b7 ,permitting hospitals to decline reclassification ,section #aceja7;e77#b7 of the ,omnibus ,budget ,reconciliation ,act of #aiic 7#db ,u4,s4,c4 #acieww note7 is amended by striking through fiscal year #bjag and inserting through fiscal year #bjai4 #bajb4 ,extension of increased inpatient hospital payment adjustment for certain low-volume hospitals ,section #ahhf7;d77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is amended-- 7#a7 in subparagraph 7,b71 in the matter preceding clause 7i71 by striking fiscal year #bjah and inserting fiscal year #bjbj2 7#b7 in subparagraph 7,c77i71 by striking fiscal years #bjaa through #bjag and inserting fiscal years #bjaa through #bjai each place it appears2 and 7#c7 in subparagraph 7,d71 by striking fiscal years #bjaa through #bjag and inserting fiscal years #bjaa through #bjai4 #bajc4 ,studies relating to hospital programs paid outside of prospective payment systems 7a7 ,med,p,a,c report ,using data from hospital programs with respect to which hospitals receive payment outside of the prospective payment systems under sections #ahcc and #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel2 #db ,u4,s4,c4 #acieww7 7such programs referred to in this subsection as ,,pps carve-out programs7 or other data1 as available1 not later than ,june #cj1 #bjai1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report that evaluates and recommends changes to ,,pps carve-out programs1 including with respect to amendments made by sections #baja and #bajb of this ,act1 sections #ahad1 #ahbj1 #ahhf7;d77#e77;,d77iii71 and #aaae7;,a7 of the ,social ,security ,act1 and such other sections of title ,,xviii of the ,social ,security ,act deemed appropriate4 ,to the extent feasible1 such report shall make recommendations on a payment methodology under the ,medicare program for hospital payments1 including with respect to ,,pps carve-out programs1 that differs from the payment methodology applicable to such programs as of ,september #cj1 #bjag4 7b7 ,med,p,a,c ,recommendations for possible alternative payments ,not later than #b years after the date by which the ,secretary of ,health and ,human ,services has collected #b years of data under sections #ahhf7;d77#e77;,g7 and #ahhf7;d77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g72 #db ,u4,s4,c4 #acieww7d77#ab771 as extended pursuant to sections #baja and #bajb of this ,act1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report1 including-- 7#a7 recommendations on payments1 including a technical prototype for payments for ,,pps carve-out programs1 if warranted2 7#b7 recommendations1 if any1 on which ,medicare fee-for-service regulations for hospital payments under title ,,xviii of the ,social ,security ,act should be altered 7such as the critical access hospital #if-;hour rule72 7#c7 an analysis of the impact of the recommended payments described in paragraph 7#a7 on ,medicare beneficiary cost-sharing1 access to care1 and choice of setting2 7#d7 a projection of any potential reduction in expenditures under title ,,xviii of the ,social ,security ,act that may be attributable to the application of the recommended payments described in paragraph 7#a72 7#e7 a review of the value of hospitals participating in ,,pps carve-out programs collecting and reporting to the ,secretary standardized patient assessment data with respect to inpatient hospital services2 7#f7 the types of rural hospital classifications and payment methodologies under the ,medicare program1 including information on each special payment structure such as eligibility criteria1 and any areas of overlap between such special payment programs2 7#g7 ,medicare spending on each ,,pps carve-out program2 7#h7 the financial aspects of hospitals participating in such ,,pps carve-out programs1 such as the share of discharges under the ,medicare and ,medicaid programs2 and 7#i7 whether such payment programs are empirically justified to support ,medicare beneficiary access to care4 #bajd4 ,extension of home health rural add-on 7a7 ,extension 7#a7 ,in general ,section #dba of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bbhc2 #db ,u4,s4,c4 #acie;fff note71 as amended by section #ebja7;b7 of the ,deficit ,reduction ,act of #bjje 7,public ,law #aji-aga2 #abj ,stat4 #df71 section #caca7;c7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh2 #abd ,stat4 #dbh71 and section #baj of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj2 #abi ,stat4 #aea7 is amended-- 7,a7 in subsection 7a71 by striking ,january #a1 #bjah and inserting ,january #a1 #bjai each place it appears2 7,b7 by redesignating subsections 7b7 and 7c7 as subsections 7c7 and 7d71 respectively2 7,c7 in each of subsections 7c7 and 7d71 as so redesignated1 by striking subsection 7a7 and inserting subsection 7a7 or 7b72 and 7,d7 by inserting after subsection 7a7 the following new subsection3 7b7 ,subsequent temporary increase 7#a7 ,in general ,the ,secretary shall increase the payment amount otherwise made under such section #ahie for home health services furnished in a county 7or equivalent area7 in a rural area 7as defined in such section #ahhf7;d77#b77;,d77 that1 as determined by the ,secretary-- 7,a7 is in the highest quartile of all counties 7or equivalent areas7 based on the number of ,medicare home health episodes furnished per #ajj individuals who are entitled to1 or enrolled for1 benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled for benefits under part ,b of such title 7but not enrolled in a plan under part ,c of such title7-- 7i7 in the case of episodes and visits ending during #bjai1 by #a4e percent2 and 7ii7 in the case of episodes and visits ending during #bjbj1 by #j4e percent2 7,b7 has a population density of #f individuals or fewer per square mile of land area and is not described in subparagraph 7,a7-- 7i7 in the case of episodes and visits ending during #bjai1 by #d percent2 7ii7 in the case of episodes and visits ending during #bjbj1 by #c percent2 7iii7 in the case of episodes and visits ending during #bjba1 by #b percent2 and 7iv7 in the case of episodes and visits ending during #bjbb1 by #a percent2 and 7,c7 is not described in either subparagraph 7,a7 or 7,b7-- 7i7 in the case of episodes and visits ending during #bjai1 by #c percent2 7ii7 in the case of episodes and visits ending during #bjbj1 by #b percent2 and 7iii7 in the case of episodes and visits ending during #bjba1 by #a percent4 7#b7 ,rules for determinations 7,a7 ,no switching ,for purposes of this subsection1 the determination by the ,secretary as to which subparagraph of paragraph 7#a7 applies to a county 7or equivalent area7 shall be made a single time and shall apply for the duration of the period to which this subsection applies4 7,b7 ,utilization ,in determining which counties 7or equivalent areas7 are in the highest quartile under paragraph 7#a77;,a71 the following rules shall apply3 7i7 ,the ,secretary shall use data from #bjae4 7ii7 ,the ,secretary shall exclude data from the territories 7and the territories shall not be described in such paragraph74 7iii7 ,the ,secretary may exclude data from counties 7or equivalent areas7 in rural areas with a low volume of home health episodes 7and if data is so excluded with respect to a county 7or equivalent area71 such county 7or equivalent area7 shall not be described in such paragraph74 7,c7 ,population density ,in determining population density under paragraph 7#a77;,b71 the ,secretary shall use data from the #bjaj decennial ,census4 7#c7 ,limitations on review ,there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise of determinations under paragraph 7#a74 4 7#b7 ,requirement to submit county data on claim form ,section #ahie7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7c77 is amended-- 7,a7 in paragraph 7#a71 by striking and at the end2 7,b7 in paragraph 7#b71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new paragraph3 7#c7 in the case of home health services furnished on or after ,january #a1 #bjai1 the claim contains the code for the county 7or equivalent area7 in which the home health service was furnished4 4 7b7 ,,oig review ,the ,office of the ,inspector ,general shall submit to ,congress1 not later than ,january #a1 #bjbj1 and annually thereafter through ,january #a1 #bjbd1 a report containing-- 7#a7 an analysis of payments made under section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7 increased under section #dba of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bbhc2 #db ,u4,s4,c4 #acie;fff note71 as amended by section #ebja7;b7 of the ,deficit ,reduction ,act of #bjje 7,public ,law #aji-aga2 #abj ,stat4 #df71 section #caca7;c7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh2 #abd ,stat4 #dbh71 section #baj of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj2 #abi ,stat4 #aea71 and subsection 7a72 and 7#b7 a recommendation on whether such payments should continue to be made based on county data4 ,b ,medicare ,part ,b #baaa4 ,ground ambulance services cost reporting requirement 7a7 ,in general ,section #aaba of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7 is amended-- 7#a7 in subsection 7a7-- 7,a7 by striking ,for the purposes of and inserting ,subject to subsection 7d71 for the purposes of2 7,b7 by inserting suppliers of ground ambulance services1 after health maintenance organizations12 and 7,c7 in the matter following paragraph 7#e71 by adding the following new sentence3 ,not later than ,december #ca1 #bjai1 the ,secretary shall modify the uniform reporting systems for providers of services with respect to ground ambulance services to ensure that such systems contain information similar 7as determined by the ,secretary7 to information required under the uniform reporting system for suppliers of ground ambulance services42 and 7#b7 by adding at the end the following new subsection3 7d7 ,in the case of a provider or supplier of ground ambulance services1 the ,secretary may modify the requirements for the inclusion of any data element specified in subsection 7a7 in reports made in accordance with the uniform reporting system established under this section with respect to such services for such provider or supplier4 4 7b7 ,suspension of payment for ground ambulance services2 deeming certain payments overpayments ,section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is amended by adding at the end the following new paragraph3 7#ag7 ,requirement to submit cost report and authority to suspend payments and deem certain payments overpayments for ground ambulance services 7,a7 ,in general ,with respect to ground ambulance services furnished by a supplier of such services during cost reporting periods 7as defined in subparagraph 7,i77 beginning on or after ,january #a1 #bjbj1 such supplier shall make reports to the ,secretary of information described in section #aaba7;a7 in accordance with the uniform reporting system established under such section for such suppliers and1 as may be required by the ,secretary1 of any of the information described in subparagraph 7,b74 7,b7 ,additional information ,the ,secretary may1 with respect to a supplier of ground ambulance services1 require the following information 7to be reported to the extent practicable under the uniform reporting system established under section #aaba7;a7 for such suppliers73 7i7 ,whether the supplier is part of an emergency services department1 a governmental organization1 or another type of entity 7as described by the ,secretary74 7ii7 ,the number of hours in a week during which the supplier is available for furnishing ground ambulance services4 7iii7 ,the average number of volunteer hours a week used by the supplier4 7,c7 ,suspension of payment ,subject to subparagraph 7,e71 in the case that the ,secretary determines that a supplier of ground ambulance services has not made to the ,secretary a timely report described in subparagraph 7,a7 with respect to a cost reporting period beginning on or after ,january #a1 #bjbj1 and before ,january #a1 #bjbb1 the ,secretary may suspend payments made under this subsection1 in whole or in part1 to such supplier until the ,secretary determines that such supplier has made such a report4 7,d7 ,deeming certain payments overpayments ,subject to subparagraphs 7,e7 and 7,f71 in the case that the ,secretary determines that a supplier of ground ambulance services has not made to the ,secretary a complete1 accurate1 and timely report described in subparagraph 7,a7 with respect to a cost reporting period beginning on or after ,january #a1 #bjbb1 the ,secretary may either-- 7i7 deem payments made under this subsection to such supplier for such period to be overpayments and recoup such overpayments2 or 7ii7 suspend payments made under this subsection to such supplier for such period4 7,e7 ,hardship delay ,the ,secretary shall establish a process whereby a supplier of ground ambulance services may request a delay in making a report described in subparagraph 7,a7 with respect to a cost reporting period for reason of significant hardship 7as determined by the ,secretary74 7,f7 ,authority to modify cost reporting elements and enforcement ,not earlier than ,january #a1 #bjbd1 the ,secretary may provide that subparagraph 7,d7 no longer applies to suppliers of ground ambulance services or a category of such suppliers after-- 7i7 taking into account the recommendation of the ,medicare ,payment ,advisory ,commission in the most recent report available to the ,secretary submitted under section #baaa7;g7 of the ,,sustain ,care ,act of #bjah whether cost reports made by suppliers or a category of suppliers 7as specified for purposes of the report submitted under such section7 of ground ambulance services should be required or modified2 and 7ii7 undertaking notice and comment rulemaking4 7,g7 ,audit of cost reports ,the ,secretary shall audit reports described in subparagraph 7,a7 made with respect to cost reporting periods beginning on or after ,january #a1 #bjba4 7,h7 ,appeals ,the ,secretary shall establish a process whereby a supplier of ground ambulance services may appeal a determination described in subparagraph 7,c7 or 7,d7 made with respect to a cost report required to be made by such supplier under subparagraph 7,a74 7,i7 ,definition ,in this paragraph1 the term cost reporting period means1 with respect to a year1 the #ab-month period beginning on ,january #a of such year4 4 7c7 ,stakeholder feedback 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall implement the provisions of this section1 including the amendments made by this section1 through notice and comment rulemaking and seek input from stakeholders4 7#b7 ,nonapplication of ,paperwork ,reduction ,act ,chapter #ce of title #dd1 ,united ,states ,code1 shall not apply with respect to-- 7,a7 the development and implementation of the uniform reporting system required under section #aaba7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7a77 for suppliers of ground ambulance services and reports required to be made under section #ahcd7l77#ag7 of such ,act 7#db ,u4,s4,c4 #aciem7l77#ag772 and 7,b7 the modification of the uniform reporting systems under such section #aaba7;a7 of such ,act for providers of such services and reports required to be made under section #ahfa7v77#a77;,f7 of such ,act 7#db ,u4,s4,c4 #aciex7v77#a77;,f774 7d7 ,implementation resources ,in addition to funds otherwise available1 there are appropriated to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 #h1jjj1jjj and from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet7 #acg1jjj1jjj 7of which not less than #ae1jjj1jjj shall be used to fulfill the auditing requirement under section #ahcd7l77#ag77;,g7 of such ,act1 as added by subsection 7b7 of this section7 to carry out the provisions of this section1 including the amendments made by this section1 to remain available through ,december #ca1 #bjbb4 ,of the amounts appropriated under the previous sentence1 the ,secretary shall use such sums as may be necessary to hire not less than #b full-time employees for purposes of carrying out such provisions1 including such amendments4 7e7 ,extension of rural add-on payments ,section #ahcd7l7 of the ,social ,security ,act 7#db4 ,u4,s4,c4 #aciem7l77 is amended-- 7#a7 in paragraph 7#ab77;,a71 by striking #bjah and inserting #bjbc2 and 7#b7 in paragraph 7#ac77;,a71 by striking #bjah each place it appears and inserting #bjbc4 7f7 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 a cost report made by a supplier of ground ambulance services with respect to a cost reporting period beginning before ,january #a1 #bjbb1 may not contain complete and accurate information on ground ambulance services furnished during such a period by the supplier2 and 7#b7 the ,secretary should take into account only the timeliness of such a report made with respect to such a period when determining whether to suspend payments to a supplier under section #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l774 7g7 ,ground ambulance services cost reporting study 7#a7 ,in general ,not later than ,march #ae1 #bjbc1 and as determined necessary by the ,medicare ,payment ,advisory ,commission thereafter1 such ,commission shall assess and submit to ,congress a report on cost reports of suppliers and providers of ground ambulance services carried out in accordance with sections #aaba7;a7 and #ahcd7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7a71 #aciem7l771 the adequacy of payments for such services made under section #ahcd7l7 of such ,act1 and geographic variations in the cost of providing such services4 7#b7 ,contents ,the report described in paragraph 7#a7 shall contain the following3 7,a7 ,an analysis of cost report data submitted in accordance with such sections4 7,b7 ,an analysis of any burden on providers and suppliers of such services associated with reporting such data4 7,c7 ,a recommendation on whether or not cost reports of ground ambulance services made by suppliers or a category of suppliers 7as specified by the ,secretary7 of such services1 or the ground ambulance portion of cost reports made by providers of such services1 should be required or modified1 taking into account the analyses described in subparagraphs 7,a7 and 7,b74 #baab4 ,extension of work ,,gpci floor ,section #ahdh7;e77#a77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is amended by striking ,january #a1 #bjah and inserting ,january #a1 #bjbj4 #baac4 ,repeal of ,medicare payment cap for therapy services2 replacement with limitation to ensure appropriate therapy ,section #ahcc7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking ,subject to paragraphs 7#d7 and 7#e7 and inserting 7,a7 ,subject to paragraphs 7#d7 and 7#e72 7,b7 in the subparagraph 7,a71 as inserted and designated by subparagraph 7,a7 of this paragraph1 by adding at the end the following new sentence3 ,the preceding sentence shall not apply to expenses incurred with respect to services furnished after ,december #ca1 #bjag42 and 7,c7 by adding at the end the following new subparagraph3 7,b7 ,with respect to services furnished during #bjah or a subsequent year1 in the case of physical therapy services of the type described in section #ahfa7p71 speech-language pathology services of the type described in such section through the application of section #ahfa7ll77#b71 and physical therapy services and speech-language pathology services of such type which are furnished by a physician or as incident to physicians' services1 with respect to expenses incurred in any calendar year1 any amount that is more than the amount specified in paragraph 7#b7 for the year shall not be considered as incurred expenses for purposes of subsections 7a7 and 7b7 unless the applicable requirements of paragraph 7#g7 are met4 2 7#b7 in paragraph 7#c7-- 7,a7 by striking ,subject to paragraphs 7#d7 and 7#e7 and inserting 7,a7 ,subject to paragraphs 7#d7 and 7#e72 7,b7 in the subparagraph 7,a71 as inserted and designated by subparagraph 7,a7 of this paragraph1 by adding at the end the following new sentence3 ,the preceding sentence shall not apply to expenses incurred with respect to services furnished after ,december #ca1 #bjag42 and 7,c7 by adding at the end the following new subparagraph34 7,b7 ,with respect to services furnished during #bjah or a subsequent year1 in the case of occupational therapy services 7of the type that are described in section #ahfa7p7 through the operation of section #ahfa7;g7 and of such type which are furnished by a physician or as incident to physicians' services71 with respect to expenses incurred in any calendar year1 any amount that is more than the amount specified in paragraph 7#b7 for the year shall not be considered as incurred expenses for purposes of subsections 7a7 and 7b7 unless the applicable requirements of paragraph 7#g7 are met4 2 7#c7 in paragraph 7#e7-- 7,a7 by redesignating subparagraph 7,d7 as paragraph 7#h7 and moving such paragraph to immediately follow paragraph 7#g71 as added by paragraph 7#d7 of this section2 and 7,b7 in subparagraph 7,e77iv71 by inserting 1 except as such process is applied under paragraph 7#g77;,b7 before the period at the end2 and 7#d7 by adding at the end the following new paragraph3 7#g7 ,for purposes of paragraphs 7#a77;,b7 and 7#c77;,b71 with respect to services described in such paragraphs1 the requirements described in this paragraph are as follows3 7,a7 ,inclusion of appropriate modifier ,the claim for such services contains an appropriate modifier 7such as the ,,kx modifier described in paragraph 7#e77;,b77 indicating that such services are medically necessary as justified by appropriate documentation in the medical record involved4 7,b7 ,targeted medical review for certain services above threshold 7i7 ,in general ,in the case where expenses that would be incurred for such services would exceed the threshold described in clause 7ii7 for the year1 such services shall be subject to the process for medical review implemented under paragraph 7#e77;,e74 7ii7 ,threshold ,the threshold under this clause for-- 7,i7 a year before #bjbh1 is #c1jjj2 7,,ii7 #bjbh1 is the amount specified in subclause 7,i7 increased by the percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c77 for #bjbh2 and 7,,iii7 a subsequent year1 is the amount specified in this clause for the preceding year increased by the percentage increase in the ,,mei 7as defined in section #ahdb7;i77#c77 for such subsequent year2 except that if an increase under subclause 7,,ii7 or 7,,iii7 for a year is not a multiple of #aj1 it shall be rounded to the nearest multiple of #aj4 7iii7 ,application ,the threshold under clause 7ii7 shall be applied separately-- 7,i7 for physical therapy services and speech-language pathology services2 and 7,,ii7 for occupational therapy services4 7iv7 ,funding ,for purposes of carrying out this subparagraph1 the ,secretary shall provide for the transfer1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 of #e1jjj1jjj for each fiscal year beginning with fiscal year #bjah1 to remain available until expended4 ,such funds may not be used by a contractor under section #ahic7;h7 for medical reviews under this subparagraph4 4 ,c ,miscellaneous #baba4 ,providing continued access to medicare advantage special needs plans for vulnerable populations 7a7 ,extension ,section #ahei7;f77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is amended by striking and for periods before ,january #a1 #bjai4 7b7 ,increased integration of dual ,s,n,ps 7#a7 ,in general ,section #ahei7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77 is amended-- 7,a7 in paragraph 7#c71 by adding at the end the following new subparagraph3 7,f7 ,the plan meets the requirements applicable under paragraph 7#h74 2 and 7,b7 by adding at the end the following new paragraph3 7#h7 ,increased integration of dual ,s,n,ps 7,a7 ,designated contact ,the ,secretary1 acting through the ,federal ,coordinated ,health ,care ,office established under section #bfjb of ,public ,law #aaa-adh1 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 subsection 7b77#f77;,b77ii7 under this paragraph and1 consistent with such role1 shall establish-- 7i7 a uniform process for disseminating to ,state ,medicaid agencies information under this title impacting contracts between such agencies and such plans under this subsection2 and 7ii7 basic resources for ,states interested in exploring such plans as a platform for integration1 such as a model contract or other tools to achieve those goals4 7,b7 ,unified grievances and appeals process 7i7 ,in general ,not later than ,april #a1 #bjbj1 the ,secretary shall establish procedures1 to the extent feasible as determined by the ,secretary1 unifying grievances and appeals procedures under sections #aheb7;f71 #aheb7;g71 #aijb7;a77#c71 #aijb7;a77#e71 and #aicb7;b77#d7 for items and services provided by specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 under this title and title ,,xix4 ,with respect to items and services described in the preceding sentence1 procedures established under this clause shall apply in place of otherwise applicable grievances and appeals procedures4 ,the ,secretary shall solicit comment in developing such procedures from ,states1 plans1 beneficiaries and their representatives1 and other relevant stakeholders4 7ii7 ,procedures ,the procedures established under clause 7i7 shall be included in the plan contract under paragraph 7#c77;,d7 and shall-- 7,i7 adopt the provisions for the enrollee that are most protective for the enrollee and1 to the extent feasible as determined by the ,secretary1 are compatible with unified timeframes and consolidated access to external review under an integrated process2 7,,ii7 take into account differences in ,state plans under title ,,xix to the extent necessary2 7,,iii7 be easily navigable by an enrollee2 and 7,,iv7 include the elements described in clause 7iii71 as applicable4 7iii7 ,elements described ,both unified appeals and unified grievance procedures shall include1 as applicable1 the following elements described in this clause3 7,i7 ,single written notification of all applicable grievances and appeal rights under this title and title ,,xix4 ,for purposes of this subparagraph1 the ,secretary may waive the requirements under section #aheb7;g77#a77;,b7 when the specialized ,,ma plan covers items or services under this part or under title ,,xix4 7,,ii7 ,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 7b77#f77;,b77ii7 under this title and title ,,xix4 7,,iii7 ,notices written in plain language and available in a language and format that is accessible to the enrollee1 including in non-,english languages that are prevalent in the service area of the specialized ,,ma plan4 7,,iv7 ,unified timeframes for grievances and appeals processes1 such as an individual's filing of a grievance or appeal1 a plan's acknowledgment and resolution of a grievance or appeal1 and notification of decisions with respect to a grievance or appeal4 7,v7 ,requirements for how the plan must process1 track1 and resolve grievances and appeals1 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 appeal4 7iv7 ,continuation of benefits pending appeal ,the unified procedures under clause 7i7 shall1 with respect to all benefits under parts ,a and ,b and title ,,xix subject to appeal under such procedures1 incorporate provisions under current law and implementing regulations that provide continuation of benefits pending appeal under this title and title ,,xix4 7,c7 ,requirement for unified grievances and appeals ,for #bjba and subsequent years1 the contract of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 with a ,state ,medicaid agency under paragraph 7#c77;,d7 shall require the use of unified grievances and appeals procedures as described in subparagraph 7,b74 7,d7 ,requirements for integration 7i7 ,in general ,for #bjba and subsequent years1 a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 shall meet one or more of the following requirements1 to the extent permitted under ,state law1 for integration of benefits under this title and title ,,xix3 7,i7 ,the specialized ,,ma plan must meet the requirements of contracting with the ,state ,medicaid agency described in paragraph 7#c77;,d7 in addition to coordinating long-term services and supports or behavioral health services1 or both1 by meeting an additional minimum set of requirements determined by the ,secretary through the ,federal ,coordinated ,health ,care ,office established under section #bfjb of the ,patient ,protection and ,affordable ,care ,act based on input from stakeholders1 such as notifying the ,state in a timely manner of hospitalizations1 emergency room visits1 and hospital or nursing home discharges of enrollees1 assigning one primary care provider for each enrollee1 or sharing data that would benefit the coordination of items and services under this title and the ,state plan under title ,,xix4 ,such minimum set of requirements must be included in the contract of the specialized ,,ma plan with the ,state ,medicaid agency under such paragraph4 7,,ii7 ,the specialized ,,ma plan must meet the requirements of a fully integrated plan described in section #ahec7;a77#a77;,b77iv77,,ii7 7other than the requirement that the plan have similar average levels of frailty1 as determined by the ,secretary1 as the ,,pace program71 or enter into a capitated contract with the ,state ,medicaid agency to provide long-term services and supports or behavioral health services1 or both4 7,,iii7 ,in the case of a specialized ,,ma plan that is offered by a parent organization that is also the parent organization of a ,medicaid managed care organization providing long term services and supports or behavioral services under a contract under section #aijc7m71 the parent organization must assume clinical and financial responsibility for benefits provided under this title and title ,,xix with respect to any individual who is enrolled in both the specialized ,,ma plan and the ,medicaid managed care organization4 7ii7 ,suspension of enrollment for failure to meet requirements during initial period ,during the period of plan years #bjba through #bjbe1 if the ,secretary determines that a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77ii7 has failed to comply with clause 7i71 the ,secretary may provide for the application against the ,medicare ,advantage organization offering the plan of the remedy described in section #aheg7;g77#b77;,b7 in the same manner as the ,secretary may apply such remedy1 and in accordance with the same procedures as would apply1 in the case of an ,,ma organization determined by the ,secretary to have engaged in conduct described in section #aheg7;g77#a74 ,if the ,secretary applies such remedy to a ,medicare ,advantage organization under the preceding sentence1 the organization shall submit to the ,secretary 7at a time1 and in a form and manner1 specified by the ,secretary7 information describing how the plan will come into compliance with clause 7i74 7,e7 ,study and report to ,congress 7i7 ,in general ,not later than ,january #a1 #bjbb1 and1 subject to clause 7iii71 biennially thereafter through #bjcb1 the ,medicare ,payment ,advisory ,commission established under section #ahje1 in consultation with the ,medicaid and ,,chip ,payment and ,access ,commission established under section #aijj1 shall conduct 7and submit to the ,secretary and the ,committees on ,ways and ,means and ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on7 a study to determine how specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 perform among each other based on data from ,healthcare ,effectiveness ,data and ,information ,set 7,,hedis7 quality measures1 reported on the plan level1 as required under section #aheb7;e77#c7 7or such other measures or data sources that are available and appropriate1 such as encounter data and ,consumer ,assessment of ,healthcare ,providers and ,systems data1 as specified by such ,commissions as enabling an accurate evaluation under this subparagraph74 ,such study shall include1 as feasible1 the following comparison groups of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii73 7,i7 ,a comparison group of such plans that are described in subparagraph 7,d77i77,i74 7,,ii7 ,a comparison group of such plans that are described in subparagraph 7,d77i77,,ii74 7,,iii7 ,a comparison group of such plans operating within the ,financial ,alignment ,initiative demonstration for the period for which such plan is so operating and the demonstration is in effect1 and1 in the case that an integration option that is not with respect to specialized ,,ma plans for special needs individuals is established after the conclusion of the demonstration involved4 7,,iv7 ,a comparison group of such plans that are described in subparagraph 7,d77i77,,iii74 7,v7 ,a comparison group of ,,ma plans1 as feasible1 not described in a previous subclause of this clause1 with respect to the performance of such plans for enrollees who are special needs individuals described in subsection 7b77#f77;,b77ii74 7ii7 ,discretionary additional reports ,beginning with #bjcc and every five years thereafter1 the ,medicare ,payment ,advisory ,commission1 in consultation with the ,medicaid and ,,chip ,payment and ,access ,commission shall1 at the discretion of the ,secretary1 conduct a study described in clause 7i74 4 7#b7 ,conforming amendment to responsibilities of federal coordinated health care office ,section #bfjb7;d7 of ,public ,law #aaa-adh 7#db ,u4,s4,c4 #acae;b7d77 is amended by adding at the end the following new paragraphs3 7#f7 ,to act as a designated contact for ,states under subsection 7f77#h77;,a7 of section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 with respect to the integration of specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 of such section4 7#g7 ,to be responsible1 subject to the final approval of the ,secretary1 for developing regulations and guidance related to the implementation of a unified grievance and appeals process as described in subparagraphs 7,b7 and 7,c7 of section #ahei7;f77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#h774 7#h7 ,to be responsible1 subject to the final approval of the ,secretary1 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 specialized ,,ma plans for special needs individuals described in subsection 7b77#f77;,b77ii7 of such section #ahei4 4 7c7 ,improvements to ,severe or ,disabling ,chronic ,condition ,s,n,ps 7#a7 ,care management requirements ,section #ahei7;f77#e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#e77 is amended-- 7,a7 by striking all snps4--,the requirements and inserting all ,s,n,ps4-- 7,a7 ,in general ,subject to subparagraph 7,b71 the requirements 2 7,b7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively1 and indenting appropriately2 and 7,c7 in clause 7ii71 as redesignated by subparagraph 7,b71 by redesignating clauses 7i7 through 7iii7 as subclauses 7,i7 through 7,,iii71 respectively1 and indenting appropriately2 and 7,d7 by adding at the end the following new subparagraph3 7,b7 ,improvements to care management requirements for severe or disabling chronic condition snps ,for #bjbj and subsequent years1 in the case of a specialized ,,ma plan for special needs individuals described in subsection 7b77#f77;,b77iii71 the requirements described in this paragraph include the following3 7i7 ,the interdisciplinary team under subparagraph 7,a77ii77,,iii7 includes a team of providers with demonstrated expertise1 including training in an applicable specialty1 in treating individuals similar to the targeted population of the plan4 7ii7 ,requirements developed by the ,secretary to provide face-to-face encounters with individuals enrolled in the plan not less frequently than on an annual basis4 7iii7 ,as part of the model of care under clause 7i7 of subparagraph 7,a71 the results of the initial assessment and annual reassessment under clause 7ii77,i7 of such subparagraph of each individual enrolled in the plan are addressed in the individual's individualized care plan under clause 7ii77,,ii7 of such subparagraph4 7iv7 ,as part of the annual evaluation and approval of such model of care1 the ,secretary shall take into account whether the plan fulfilled the previous year's goals 7as required under the model of care74 7v7 ,the ,secretary shall establish a minimum benchmark for each element of the model of care of a plan4 ,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 sentence4 4 7#b7 ,revisions to the definition of a severe or disabling chronic conditions specialized needs individual 7,a7 ,in general ,section #ahei7;b77#f77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77;,b77iii77 is amended-- 7i7 by striking who have and inserting who-- 7,i7 before ,january #a1 #bjbb1 have 2 7ii7 in subclause 7,i71 as added by clause 7i71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following new subclause3 7,,ii7 on or after ,january #a1 #bjbb1 have one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits overall health or function1 have a high risk of hospitalization or other adverse health outcomes1 and require intensive care coordination and that is listed under subsection 7f77#i77;,a74 4 7,b7 ,panel of clinical advisors ,section #ahei7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f771 as amended by subsection 7b71 is amended by adding at the end the following new paragraph3 7#i7 ,list of conditions for clarification of the definition of a severe or disabling chronic conditions specialized needs individual 7,a7 ,in general ,not later than ,december #ca1 #bjbj1 and every #e years thereafter1 subject to subparagraphs 7,b7 and 7,c71 the ,secretary shall convene a panel of clinical advisors to establish and update a list of conditions that meet each of the following criteria3 7i7 ,conditions that meet the definition of a severe or disabling chronic condition under subsection 7b77#f77;,b77iii7 on or after ,january #a1 #bjbb4 7ii7 ,conditions that require prescription drugs1 providers1 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-- 7,i7 as a result of access to1 and enrollment in1 such a specialized ,,ma plan for special needs individuals1 individuals with such condition would have a reasonable expectation of slowing or halting the progression of the disease1 improving health outcomes and decreasing overall costs for individuals diagnosed with such condition compared to available options of care other than through such a specialized ,,ma plan for special needs individuals2 or 7,,ii7 have a low prevalence in the general population of beneficiaries under this title or a disproportionally high per-beneficiary cost under this title4 7,b7 ,inclusion of certain conditions ,the conditions listed under subparagraph 7,a7 shall include ,,hiv_/,,aids1 end stage renal disease1 and chronic and disabling mental illness4 7,c7 ,requirement ,in establishing and updating the list under subparagraph 7,a71 the panel shall take into account the availability of varied benefits1 cost-sharing1 and supplemental benefits under the model described in paragraph 7#b7 of section #ahei7;h71 including the expansion under paragraph 7#a7 of such section4 4 7d7 ,quality ,measurement at the ,plan ,level for ,s,n,ps and ,determination of ,feasability of ,quality ,measurement at the ,plan ,level for ,all ,,ma ,plans ,section #ahec7o7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7o77 is amended by adding at the end the following new paragraphs3 7#f7 ,quality measurement at the plan level for snps 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary may require reporting of data under section #aheb7;e7 for1 and apply under this subsection1 quality measures at the plan level for specialized ,,ma plans for special needs individuals instead of at the contract level4 7,b7 ,considerations ,prior to applying quality measurement at the plan level under this paragraph1 the ,secretary shall-- 7i7 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 paragraph2 7ii7 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 ,,xix2 7iii7 if quality measures are reported at the plan level1 ensure that ,,ma plans are not required to provide duplicative information2 and 7iv7 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 data4 7,c7 ,application ,if the ,secretary applies quality measurement at the plan level under this paragraph-- 7i7 such quality measurement may include ,medicare ,health ,outcomes ,survey 7,,hos71 ,healthcare ,effectiveness ,data and ,information ,set 7,,hedis71 ,consumer ,assessment of ,healthcare ,providers and ,systems 7,,cahps7 measures and quality measures under part ,d2 and 7ii7 the ,secretary shall consider applying administrative actions1 such as remedies described in section #aheg7;g77#b71 at the plan level4 7#g7 ,determination of feasibility of quality measurement at the plan level for all ma plans 7,a7 ,determination of feasibility ,the ,secretary shall determine the feasibility of requiring reporting of data under section #aheb7;e7 for1 and applying under this subsection1 quality measures at the plan level for all ,,ma plans under this part4 7,b7 ,consideration of change ,after making a determination under subparagraph 7,a71 the ,secretary shall consider requiring such reporting and applying such quality measures at the plan level as described in such subparagraph 4 7e7 ,,gao ,study and ,report on ,state-,level ,integration ,between ,dual ,s,n,ps and ,medicaid 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct a study on ,state-level integration between specialized ,,ma plans for special needs individuals described in subsection 7b77#f7 7,b77ii7 of section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 and the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 ,such study shall include an analysis of the following3 7,a7 ,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 managed care program1 including the requirements under such ,state plan with respect to long-term services and supports4 7,b7 ,the types of such specialized ,,ma plans1 which may include the following3 7i7 ,a plan described in section #ahec7;a77#a77;,b77iv77,,ii7 of such ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,b77iv77,,ii774 7ii7 ,a plan that meets the requirements described in subsection 7f77#c77;,d7 of such section #ahei4 7iii7 ,a plan described in clause 7ii7 that also meets additional requirements established by the ,state4 7,c7 ,the characteristics of individuals enrolled in such specialized ,,ma plans4 7,d7 ,as practicable1 the following with respect to ,state programs for the delivery of long-term services and supports under such title ,,xix through a managed care program3 7i7 ,which populations of individuals are eligible to receive such services and supports4 7ii7 ,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-forservice4 7,e7 ,as practicable1 how the availability and variation of integration arrangements of such specialized ,,ma plans offered in ,states affects spending1 service delivery options1 access to community-based care1 and utilization of care4 7,f7 ,the efforts of ,state ,medicaid programs to transition dually-eligible beneficiaries receiving long-term services and supports 7,,ltss7 from institutional settings to home and community-based settings and related financial impacts of such transitions4 7,g7 ,barriers and opportunities for making further progress on dual integration1 as well as recommendations for legislation or administrative action to expedite or refine pathways toward fully integrated care4 7#b7 ,report ,not later than #b years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #babb4 ,extension of certain ,,mippa funding provisions2 ,state health insurance assistance program reporting requirements 7a7 ,funding extensions ,section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note7 is amended-- 7#a7 in subsection 7a77#a77;,b7-- 7,a7 in clause 7vi71 by striking and at the end2 7,b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after clause 7vii7 the following new clause3 7viii7 for each of fiscal years #bjah and #bjai1 of #ac1jjj1jjj4 2 7#b7 in subsection 7b77#a77;,b7-- 7,a7 in clause 7vi71 by striking and at the end2 7,b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after clause 7vii7 the following new clause3 7viii7 for each of fiscal years #bjah and #bjai1 of #g1ejj1jjj4 2 7#c7 in subsection 7c77#a77;,b7-- 7,a7 in clause 7vi71 by striking and at the end2 7,b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after clause 7vii7 the following new clause3 7viii7 for each of fiscal years #bjah and #bjai1 of #e1jjj1jjj4 2 and 7#d7 in subsection 7d77#b7-- 7,a7 in clause 7vi71 by striking and at the end2 7,b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after clause 7vii7 the following new clause3 7viii7 for each of fiscal years #bjah and #bjai1 of #ab1jjj1jjj4 4 7b7 ,state health insurance assistance program reporting requirements ,beginning not later than ,april #a1 #bjai1 and biennially thereafter1 the ,agency for ,community ,living shall electronically post on its website the following information1 with respect to grants to ,states for ,state health insurance assistance programs1 7such information to be presented by ,state and by entity receiving funds from the ,state to carry out such a program funded by such grant73 7#a7 ,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 program to each such entity for the period involved4 7#b7 ,information as the ,secretary may specify1 with respect to such programs carried out through such grants1 consistent with the terms and conditions for receipt of such grants4 #babc4 ,extension of funding for quality measure endorsement1 input1 and selection2 reporting requirements 7a7 ,in general ,section #ahij7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77 is amended-- 7#a7 in paragraph 7#b71 by adding at the end the following new sentence3 ,any of such amounts remaining available as of the date of the enactment of the ,,sustain ,care ,act of #bjah shall be used only for purposes under this section that are purposes other than funding a contract entered into under subsection 7a742 and 7#b7 by adding at the end the following new paragraph3 7#c7 ,for purposes of carrying out this section1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplemental ,medical ,insurance ,trust ,fund under #ahda1 in such proportion as ,secretary deems appropriate1 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account of #g1ejj1jjj for each of fiscal years #bjah and #bjai4 ,of the amount transferred under the previous sentence for a fiscal year1 there shall be used for the purpose of funding a contract entered into under subsection 7a7 with respect to carrying out section #ahij;,a 7other than subsections 7e7 and 7f77 for such fiscal year an amount that is not less than the amount used for such purpose for fiscal year #bjag4 4 7b7 ,annual report by ,secretary to ,congress ,section #ahij of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7 is amended by adding at the end the following new subsection3 7e7 ,annual report by ,secretary to ,congress ,by not later than ,march #a of each year 7beginning with #bjah71 the ,secretary shall submit to ,congress a report containing the following3 7#a7 ,a comprehensive plan that identifies the quality measurement needs of programs and initiatives of the ,secretary and provides a strategy for using the work performed by the entity with a contract under subsection 7a7 and the work of any other entity the ,secretary has contracted with to perform work associated with this section or section #ahij;,a to help meet those needs1 specifically with respect to the programs under this title and title ,,xix4 7#b7 ,the amount of mandatory funding provided under subsection 7d7 for purposes of carrying out this section and section #ahij;,a that has been obligated by the ,secretary1 the amount of funding provided that has been expended1 and the amount of funding provided that remains unobligated4 7#c7 ,a description of how the funds provided that are obligated have been allocated1 including how much of that funding has been allocated for work performed by the ,secretary1 the entity with a contract under subsection 7a71 and any other entity the ,secretary has contracted with to perform work related to this section or section #ahij;,a1 respectively4 7#d7 ,a description of the activities for which the obligated funds have been or will be used1 including any activities performed by the ,secretary1 task orders1 specific projects1 and activities assigned to the entity with a contract under subsection 7a71 and task orders1 specific projects1 and activities assigned to any other entity the ,secretary has contracted with to perform work related to carrying out this section or section #ahij;,a4 7#e7 ,the amount of funding allocated to each of the activities described in paragraph 7#d74 7#f7 ,estimates for1 and descriptions of1 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 #ahij;,a1 including any obligations that will require funds to be expended in a future year4 4 7c7 ,revisions to annual report from consensus-based entity to ,congress and the ,secretary 7#a7 ,in general ,section #ahij7;b77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77#e77;,a77 is amended-- 7,a7 by redesignating clauses 7i7 through 7vi7 as subclauses 7,i7 through 7,,vi71 respectively1 and moving the margins accordingly2 7,b7 in the matter preceding subclause 7,i71 as redesignated by clause 7i71 by striking containing a description of-- and inserting 8containing the following3 7i7 ,a description of-- 2 and 7,c7 by adding at the end the following new clauses3 7ii7 ,an itemization of financial information for the fiscal year ending ,september #cj of the preceding year1 including-- 7,i7 annual revenues of the entity 7including any government funding1 private sector contributions1 grants1 membership revenues1 and investment revenue72 7,,ii7 annual expenses of the entity 7including grants paid1 benefits paid1 salaries or other compensation1 fundraising expenses1 and overhead costs72 and 7,,iii7 a breakdown of the amount awarded per contracted task order and the specific projects funded in each task order assigned to the entity4 7iii7 ,any updates or modifications of internal policies and procedures of the entity as they relate to the duties of the entity under this section1 including-- 7,i7 specifically identifying any modifications to the disclosure of interests and conflicts of interests for committees1 work groups1 task forces1 and advisory panels of the entity2 and 7,,ii7 information on external stakeholder participation in the duties of the entity under this section 7including complete rosters for all committees1 work groups1 task forces1 and advisory panels funded through government contracts1 descriptions of relevant interests and any conflicts of interest for members of all committees1 work groups1 task forces1 and advisory panels1 and the total percentage by health care sector of all convened committees1 work groups1 task forces1 and advisory panels4 4 7#b7 ,effective date ,the amendments made by this subsection shall apply to reports submitted for years beginning with #bjah4 7d7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states shall conduct a study on health care quality measurement efforts funded under sections #ahij and #ahij;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa2 #acie;aaa-#a74 ,such study shall include an examination of the following3 7,a7 ,the extent to which the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 has set and prioritized objectives to be achieved for each of the quality measurement activities required under such sections #ahij and #ahij;,a4 7,b7 ,the efforts that the ,secretary has undertaken to meet quality measurement objectives associated with such sections #ahij and #ahij;,a1 including division of responsibilities for those efforts within the ,department of ,health and ,human ,services and through contracts with a consensus-based entity under subsection 7a7 of such section #ahij 7in this subsection referred to as the consensus-based entity7 and other entities1 and the extent of any overlap among the work performed by the ,secretary1 the consensus-based entity1 the ,measure ,application ,partnership 7,,map7 convened by such entity to provide input to the ,secretary on the selection of quality and efficiency measures1 and any other entities the ,secretary has contracted with to perform work related to carrying out such sections #ahij and #ahij;,a4 7,c7 ,the total amount of mandatory funding provided to the ,secretary for purposes of carrying out such sections #ahij and #ahij;,a1 the amount of such funding that has been obligated by the ,secretary1 and the amount of such funding that remains unobligated4 7,d7 ,how the obligated funds have been allocated1 including how much of the obligated funding has been allocated for work performed by the ,secretary1 the consensus-based entity1 and any other entity the ,secretary has contracted with to perform work related to carrying out such sections #ahij and #ahij;,a1 respectively1 and descriptions of such work4 7,e7 ,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 #ahij and #ahij;,a in a timely manner and with efficient use of available resources1 including the roles of the consensus-based entity1 the ,measure ,application ,partnership 7,,map71 and any other entity the ,secretary has contracted with to perform work related to such sections #ahij and #ahij;,a in helping the ,secretary achieve those objectives4 7#b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 ,,ii ,additional ,medicare ,policies ,relating to ,extenders #bbja4 ,home health payment reform 7a7 ,budget neutral transition to a #cj-;day unit of payment for home health services ,section #ahie7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 by striking payment4--,in defining and inserting payment4-- 7,a7 ,in general ,in defining 2 and 7,b7 by adding at the end the following new subparagraph3 7,b7 #cj-;day unit of service ,for purposes of implementing the prospective payment system with respect to home health units of service furnished during a year beginning with #bjbj1 the ,secretary shall apply a #cj-;day unit of service as the unit of service applied under this paragraph4 2 7#b7 in paragraph 7#c7-- 7,a7 in subparagraph 7,a71 by adding at the end the following new clause3 7iv7 ,budget neutrality for #bjbj ,with respect to payments for home health units of service furnished that end during the #ab-month period beginning ,january #a1 #bjbj1 the ,secretary shall calculate a standard prospective payment amount 7or amounts7 for #cj-;day units of service 7as described in paragraph 7#b77;,b77 for the prospective payment system under this subsection4 ,such standard prospective payment amount 7or amounts7 shall be calculated in a manner such that the estimated aggregate amount of expenditures under the system during such period with application of paragraph 7#b77;,b7 is equal to the estimated aggregate amount of expenditures that otherwise would have been made under the system during such period if paragraph 7#b77;,b7 had not been enacted4 ,the previous sentence shall be applied before 7and not affect the application of7 paragraph 7#c77;,b74 ,in calculating such amount 7or amounts71 the ,secretary shall make assumptions about behavior changes that could occur as a result of the implementation of paragraph 7#b77;,b7 and the case-mix adjustment factors established under paragraph 7#d77;,b7 and shall provide a description of such assumptions in the notice and comment rulemaking used to implement this clause4 2 and 7,b7 by adding at the end the following new subparagraph3 7,d7 ,behavior assumptions and adjustments 7i7 ,in general ,the ,secretary shall annually determine the impact of differences between assumed behavior changes 7as described in paragraph 7#c77;,a77iv77 and actual behavior changes on estimated aggregate expenditures under this subsection with respect to years beginning with #bjbj and ending with #bjbf4 7ii7 ,permanent adjustments ,the ,secretary shall1 at a time and in a manner determined appropriate1 through notice and comment rulemaking1 provide for one or more permanent increases or decreases to the standard prospective payment amount 7or amounts7 for applicable years1 on a prospective basis1 to offset for such increases or decreases in estimated aggregate expenditures 7as determined under clause 7i774 7iii7 ,temporary adjustments for retrospective behavior ,the ,secretary shall1 at a time and in a manner determined appropriate1 through notice and comment rulemaking1 provide for one or more temporary increases or decreases to the payment amount for a unit of home health services 7as determined under paragraph 7#d77 for applicable years1 on a prospective basis1 to offset for such increases or decreases in estimated aggregate expenditures 7as determined under clause 7i774 ,such a temporary increase or decrease shall apply only with respect to the year for which such temporary increase or decrease is made1 and the ,secretary shall not take into account such a temporary increase or decrease in computing such amount under this subsection for a subsequent year4 2 and 7#c7 in paragraph 7#d77;,b7-- 7,a7 by striking ,factors4--,the ,secretary and inserting ,factors4-- 7i7 ,in general ,the ,secretary 2 and 7,b7 by adding at the end the following new clause3 7ii7 ,treatment of therapy thresholds ,for #bjbj and subsequent years1 the ,secretary shall eliminate the use of therapy thresholds 7established by the ,secretary7 in case mix adjustment factors established under clause 7i7 for calculating payments under the prospective payment system under this subsection4 4 7b7 ,technical expert panel 7#a7 ,in general ,during the period beginning on ,january #a1 #bjah1 and ending on ,december #ca1 #bjah1 the ,secretary of ,health and ,human ,services shall hold at least one session of a technical expert panel1 the participants of which shall include home health providers1 patient representatives1 and other relevant stakeholders4 ,the technical expert panel shall identify and prioritize recommendations with respect to the prospective payment system for home health services under section #ahie7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b771 on the following3 7,a7 ,the ,home ,health ,groupings ,model1 as described in the proposed rule ,medicare and ,medicaid ,programs2 ,,cy #bjah ,home ,health ,prospective ,payment ,system ,rate ,update and ,proposed ,,cy #bjai ,case-,mix ,adjustment ,methodology ,refinements2 ,home ,health ,value-,based ,purchasing ,model2 and ,home ,health ,quality ,reporting ,requirements 7#hb ,fed4 ,reg4 #cebid through #ceccb 7,july #bh1 #bjag774 7,b7 ,alternative case-mix models to the ,home ,health ,groupings ,model that were submitted during #bjag as comments in response to proposed rule making1 including patient-focused factors that consider the risks of hospitalization and readmission to a hospital1 improvement or maintenance of functionality of individuals to increase the capacity for self-care1 quality of care1 and resource utilization4 7#b7 ,inapplicability of ,,faca ,the provisions of the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the technical expert panel under paragraph 7#a74 7#c7 ,report ,not later than ,april #a1 #bjai1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,ways and ,means and the ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report on the recommendations of such panel described in such paragraph4 7#d7 ,notice and comment rulemaking ,not later than ,december #ca1 #bjai1 the ,secretary of ,health and ,human ,services shall pursue notice and comment rulemaking on a case-mix system with respect to the prospective payment system for home health services under section #ahie7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b774 7c7 ,reports 7#a7 ,interim report ,not later than ,march #ae1 #bjbb1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress an interim report on the application of a #cj-;day unit of service as the unit of service applied under section #ahie7;b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#b771 as amended by subsection 7a71 including an analysis of the level of payments provided to home health agencies as compared to the cost of delivering home health services1 and any unintended consequences1 including with respect to behavioral changes and quality4 7#b7 ,final report ,not later than ,march #ae1 #bjbf1 such ,commission shall submit to ,congress a final report on such application and any such consequences4 #bbjb4 ,information to satisfy documentation of ,medicare eligibility for home health services 7a7 ,part ,a ,section #ahad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77 is amended by inserting before ,for purposes of paragraph 7#b77;,c71 the following new sentence3 ,for purposes of documentation for physician certification and recertification made under paragraph 7#b7 on or after ,january #a1 #bjai1 and made with respect to home health services furnished by a home health agency1 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 7in the case that home health services were furnished to an individual who was directly admitted to the home health agency from such a facility71 the ,secretary may use documentation in the medical record of the home health agency as supporting material1 as appropriate to the case involved44 7b7 ,part ,b ,section #ahce7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acien7a77 is amended by inserting before ,for purposes of paragraph 7#b77;,a71 the following new sentence3 ,for purposes of documentation for physician certification and recertification made under paragraph 7#b7 on or after ,january #a1 #bjai1 and made with respect to home health services furnished by a home health agency1 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 7in the case that home health services were furnished to an individual who was directly admitted to the home health agency from such a facility71 the ,secretary may use documentation in the medical record of the home health agency as supporting material1 as appropriate to the case involved44 #bbjc4 ,voluntary settlement of home health claims 7a7 ,settlement process for home health claims 7#a7 ,in general ,not later than one year after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall establish a settlement process under which a home health agency entitled to an eligible administrative appeal has the option to enter into a settlement with the ,secretary that is reached in a manner consistent with the succeeding paragraphs of this subsection4 7#b7 ,process and consideration of home health claims ,a settlement under paragraph 7#a7 with a home health agency that is with respect to an eligible administrative appeal may only be reached in accordance with the following process3 7,a7 ,a settlement under such paragraph with the home health agency shall be with respect to all claims by such agency1 subject to paragraph 7#d71 that1 as of the date of such settlement1 are under an eligible administrative appeal4 7,b7 ,for the duration of the settlement process with such agency1 an eligible administrative appeal that is with respect to any such claim by such agency shall be suspended4 7,c7 ,under the settlement process1 the ,secretary shall determine an aggregate amount to be paid to the home health agency with respect to all claims by such agency that are under an eligible administrative appeal in the following manner3 7i7 ,the ,secretary shall1 for purposes of applying clause 7ii7 with respect to all settlements under paragraph 7#a71 select a percentage4 ,in selecting such percentage1 the ,secretary shall consider the percentage used under the ,centers for ,medicare ,medicaid ,services hospital appeals settlement that began on ,august #bi1 #bjad4 7ii7 ,the ,secretary shall1 with respect to each denied claim for such agency that is under an eligible administrative appeal1 calculate an amount 7referred to in this subparagraph as an individual claim amount7 by multiplying the net payable amount for such claim by the percentage selected under clause 7i74 7iii7 ,such aggregate amount with respect to such agency shall be determined by calculating the total sum of all the individual claim amounts calculated under clause 7ii7 with respect to such agency4 7#c7 ,effect of process 7,a7 ,effect of settlement 7i7 ,further appeal ,as part of any settlement under paragraph 7#a7 between a home health agency and the ,secretary1 such home health agency shall be required to forego the right to an administrative appeal under section #ahfi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff7 or section #ahgh of such ,act 7#db ,u4,s4,c4 #acieoo7 7including any redetermination1 reconsideration1 hearing1 or review7 with respect to any claims for home health services that are subject to the settlement4 7ii7 ,judicial review ,there shall be no administrative or judicial review under such section #ahfi or otherwise of a settlement under paragraph 7#a7 and the claims covered by the settlement4 7,b7 ,effect of no settlement ,in the event that the process described in paragraph 7#b7 does not1 with respect to a home health agency1 result in a settlement under paragraph 7#a7 with such agency1 any appeal under such section #ahfi that is with respect to a claim by such agency that was suspended pursuant to paragraph 7#b77;,b7 shall resume under such section4 7#d7 ,coordination with law enforcement ,the ,secretary of ,health and ,human ,services shall establish a process to coordinate with appropriate law enforcement agencies in order to avoid the inadvertent settlement of cases that involve fraud or other criminal activity4 7b7 ,no entitlement to settlement process ,nothing in this section shall be construed as creating an entitlement to enter into a settlement process established pursuant to subsection 7a74 7c7 ,eligible administrative appeal defined ,for purposes of this section1 the term eligible administrative appeal means an appeal under section #ahfi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff7 7including any redetermination1 reconsideration1 hearing1 or review7-- 7#a7 that is with respect to one or more claims that-- 7,a7 are for home health services that were furnished on or after ,january #a1 #bjaa1 and before ,january #a1 #bjae2 and 7,b7 were timely filed consistent with section #ahad7;a77#a7 of such ,act 7#db ,u4,s4,c4 #acie;f7a77#a77 or sections #ahce7;a77#a7 and #ahdb7;b77#c7 of such ,act 7#db ,u4,s4,c4 #acien7a77#a71 #acieu7b77#c772 and 7#b7 either-- 7,a7 was timely filed consistent with section #ahfi of such ,act 7#db ,u4,s4,c4 #acie;ff7 and is pending2 or 7,b7 for which the applicable time frame to file an appeal has not expired4 7d7 ,conforming amendment ,section #ahfi of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff7 is amended by adding at the end the following new subsection3 7j7 ,application with respect to certain home health claims ,for the application of the provisions of this section with respect to certain claims for home health services that were furnished on or after ,january #a1 #bjaa1 and before ,january #a1 #bjae1 see section #ajf of the ,healthcare ,extension1 ,reauthorization1 and ,opportunities ,act of #bjag4 4 #bbjd4 ,extension of enforcement instruction on medicare supervision requirements for outpatient therapeutic services in critical access and small rural hospitals ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following new subsection3 7v7 ,extension of enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals ,for calendar year #bjag1 the ,secretary shall continue to apply the enforcement instruction described in the notice of the ,centers for ,medicare ,medicaid ,services entitled ,enforcement ,instruction on ,supervision ,requirements for ,outpatient ,therapeutic ,services in ,critical ,access and ,small ,rural ,hospitals for ,,cy #bjac1 dated ,november #a1 #bjab 7providing for an exception to the restatement and clarification under the final rulemaking changes to the ,medicare hospital outpatient prospective payment system and calendar year #bjji payment rates 7published in the ,federal ,register on ,november #ah1 #bjjh1 #gc ,fed4 ,reg4 #fhgjb through #fhgjd7 with respect to requirements for direct supervision by physicians for therapeutic hospital outpatient services71 as previously extended under section #a of ,public ,law #aac-aih1 as amended by section #a of ,public ,law #aad-aab and section #afjjd7;a7 of the #bast ,century ,cures ,act 7,public ,law #aad-bee74 4 #bbje4 ,technical amendments to ,public ,law #aad-aj 7a7 ,,mips transition ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7#a7 in subsection 7q7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,b71 by striking items and services and inserting covered professional services 7as defined in subsection 7k77#c77;,a772 and 7ii7 in subparagraph 7,c77iv7-- 7,i7 by amending subclause 7,i7 to read as follows3 7,i7 ,the minimum number 7as determined by the ,secretary7 of-- 7aa7 for performance periods beginning before ,january #a1 #bjah1 individuals enrolled under this part who are treated by the eligible professional for the performance period involved2 and 7bb7 for performance periods beginning on or after ,january #a1 #bjah1 individuals enrolled under this part who are furnished covered professional services 7as defined in subsection 7k77#c77;,a77 by the eligible professional for the performance period involved4 2 7,,ii7 in subclause 7,,ii71 by striking items and services and inserting covered professional services 7as defined in subsection 7k77#c77;,a772 and 7,,iii7 by amending subclause 7,,iii7 to read as follows3 7,,iii7 ,the minimum amount 7as determined by the ,secretary7 of-- 7aa7 for performance periods beginning before ,january #a1 #bjah1 allowed charges billed by such professional under this part for such performance period2 and 7bb7 for performance periods beginning on or after ,january #a1 #bjah1 allowed charges for covered professional services 7as defined in subsection 7k77#c77;,a77 billed by such professional for such performance period4 2 7,b7 in paragraph 7#e77;,d7-- 7i7 in clause 7i77,i71 by inserting subject to clause 7iii71 after clauses 7i7 and 7ii7 of paragraph 7#b77;,a712 and 7ii7 by adding at the end the following new clause3 7iii7 ,transition years ,for each of the second1 third1 fourth1 and fifth years for which the ,,mips applies to payments1 the performance score for the performance category described in paragraph 7#b77;,a77ii7 shall not take into account the improvement of the professional involved4 2 7,c7 in paragraph 7#e77;,e7-- 7i7 in clause 7i77,i77bb7-- 7,i7 in the heading by striking ,first #b years and inserting ,first #e years2 and 7,,ii7 by striking the first and second years and inserting each of the first through fifth years2 7ii7 in clause 7i77,,ii77bb7-- 7,i7 in the heading1 by striking #b years and inserting #e years2 and 7,,ii7 by striking the second sentence and inserting the following new sentences3 ,for each of the second1 third1 fourth1 and fifth years for which the ,,mips applies to payments1 not less than #aj percent and not more than #cj percent of such score shall be based on performance with respect to the category described in clause 7ii7 of paragraph 7#b77;,a74 ,nothing in the previous sentence shall be construed1 with respect to a performance period for a year described in the previous sentence1 as preventing the ,secretary from basing #cj percent of such score for such year with respect to the category described in such clause 7ii71 if the ,secretary determines1 based on information posted under subsection 7r77#b77;,i7 that sufficient resource use measures are ready for adoption for use under the performance category under paragraph 7#b77;,a77ii7 for such performance period42 7,d7 in paragraph 7#f77;,d7-- 7i7 in clause 7i71 in the second sentence1 by striking ,such performance threshold and inserting ,subject to clauses 7iii7 and 7iv71 such performance threshold2 7ii7 in clause 7ii7-- 7,i7 in the first sentence1 by inserting 7beginning with #bjai and ending with #bjbd7 after for each year of the ,,mips2 and 7,,ii7 in the second sentence1 by inserting subject to clause 7iii71 after ,for each such year12 7iii7 in clause 7iii7-- 7,i7 in the heading1 by striking #b and inserting #e2 and 7,,ii7 in the first sentence1 by striking two years and inserting five years2 and 7iv7 by adding at the end the following new clause3 7iv7 ,additional special rule for third1 fourth and fifth years of ,,mips ,for purposes of determining ,,mips adjustment factors under subparagraph 7,a71 in addition to the requirements specified in clause 7iii71 the ,secretary shall increase the performance threshold with respect to each of the third1 fourth1 and fifth years to which the ,,mips applies to ensure a gradual and incremental transition to the performance threshold described in clause 7i7 7as estimated by the ,secretary7 with respect to the sixth year to which the ,,mips applies4 2 7,e7 in paragraph 7#f77;,e7-- 7i7 by striking ,in the case of items and services and inserting ,in the case of covered professional services 7as defined in subsection 7k77#c77;,a772 and 7ii7 by striking under this part with respect to such items and services and inserting under this part with respect to such covered professional services2 and 7,f7 in paragraph 7#g71 in the first sentence1 by striking items and services and inserting covered professional services 7as defined in subsection 7k77#c77;,a772 7#b7 in subsection 7r77#b71 by adding at the end the following new subparagraph3 7,i7 ,information ,the ,secretary shall1 not later than ,december #cast of each year 7beginning with #bjah71 post on the ,internet website of the ,centers for ,medicare ,medicaid ,services information on resource use measures in use under subsection 7q71 resource use measures under development and the time-frame for such development1 potential future resource use measure topics1 a description of stakeholder engagement1 and the percent of expenditures under part ,a and this part that are covered by resource use measures4 2 and 7#c7 in subsection 7s77#e77;,b71 by striking section #ahcc7z77#b77;,c7 and inserting section #ahcc7z77#c77;,d74 7b7 ,physician-focused payment model technical advisory committee provision of initial proposal feedback ,section #ahfh7;c77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;ee7c77#b77;,c77 is amended to read as follows3 7,c7 ,committee review of models submitted ,the ,committee1 on a periodic basis-- 7i7 shall review models submitted under subparagraph 7,b72 7ii7 may provide individuals and stakeholder entities who submitted such models with-- 7,i7 initial feedback on such models regarding the extent to which such models meet the criteria described in subparagraph 7,a72 and 7,,ii7 an explanation of the basis for the feedback provided under subclause 7,i72 and 7iii7 shall prepare comments and recommendations regarding whether such models meet the criteria described in subparagraph 7,a7 and submit such comments and recommendations to the ,secretary4 4 #bbjf4 ,revised requirements for ,medicare intensive cardiac rehabilitation programs 7a7 ,in general ,section #ahfa7;eee77#d77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7eee77#d77;,b77 is amended-- 7#a7 in clause 7v71 by striking or at the end2 7#b7 in clause 7vi71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following new clauses3 7vii7 stable1 chronic heart failure 7defined as patients with left ventricular ejection fraction of #ce percent or less and ,new ,york ,heart ,association 7,,nyha7 class ,,ii to ,,iv symptoms despite being on optimal heart failure therapy for at least #f weeks72 or 7viii7 any additional condition for which the ,secretary has determined that a cardiac rehabilitation program shall be covered1 unless the ,secretary determines1 using the same process used to determine that the condition is covered for a cardiac rehabilitation program1 that such coverage is not supported by the clinical evidence4 4 7b7 ,ensuring ,future ,supervision ,level ,parity with ,cardiac ,rehabilitation ,programs ,section #ahfa7;eee77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7eee77#d77;,a77 is amended1 in the matter preceding clause 7i71 by striking physician-supervised program 7as described in paragraph 7#b77 and inserting program 7supervised as described in paragraph 7#b774 ,,iii ,creating ,high-,quality ,results and ,outcomes ,necessary to ,improve ,chronic 7,,chronic7 ,care ,a ,receiving ,high ,quality ,care in the ,home #bcja4 ,extending the ,independence at ,home ,demonstration ,program 7a7 ,in general ,section #ahff;,e of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc-#e7 is amended-- 7#a7 in subsection 7e7-- 7,a7 in paragraph 7#a7-- 7i7 by striking ,an agreement and inserting ,agreements2 and 7ii7 by striking #e-year and inserting #g-year2 and 7,b7 in paragraph 7#e7-- 7i7 by striking #aj1jjj and inserting #ae1jjj2 and 7ii7 by adding at the end the following new sentence3 ,an applicable beneficiary that participates in the demonstration program by reason of the increase from #aj1jjj to #ae1jjj in the preceding sentence pursuant to the amendment made by section #bcja7;a77#a77;,b7 of the ,,sustain ,care ,act of #bjah shall be considered in the spending target estimates under paragraph 7#a7 of subsection 7c7 and the incentive payment calculations under paragraph 7#b7 of such subsection for the sixth and seventh years of such program42 7#b7 in subsection 7g71 in the first sentence1 by inserting 1 including1 to the extent practicable1 with respect to the use of electronic health information systems1 as described in subsection 7b77#a77;,a77vi7 after under the demonstration program2 and 7#c7 in subsection 7i77#a77;,a71 by striking will not receive an incentive payment for the second of #b and inserting did not achieve savings for the third of #c4 7b7 ,effective date ,the amendment made by subsection 7a77#c7 shall take effect as if included in the enactment of ,public ,law #aaa-adh4 #bcjb4 ,expanding access to home dialysis therapy 7a7 ,in general ,section #ahha7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#c77 is amended-- 7#a7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7#b7 in clause 7ii71 as redesignated by paragraph 7#a71 by striking on a comprehensive and insert subject to subparagraph 7,b71 on a comprehensive2 7#c7 by striking ,with respect to and inserting 7,a7 ,with respect to2 and 7#d7 by adding at the end the following new subparagraph3 7,b7 7i7 ,for purposes of subparagraph 7,a77ii71 subject to clause 7ii71 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 #a1 #bjai1 via telehealth4 7ii7 ,clause 7i7 shall apply to an individual only if the individual receives a face-to-face clinical assessment1 without the use of telehealth-- 7,i7 in the case of the initial #c months of home dialysis of such individual1 at least monthly2 and 7,,ii7 after such initial #c months1 at least once every #c consecutive months4 4 7b7 ,originating site requirements 7#a7 ,in general ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is amended-- 7,a7 in paragraph 7#d77;,c77ii71 by adding at the end the following new subclauses3 7,,ix7 ,a renal dialysis facility1 but only for purposes of section #ahha7;b77#c77;,b74 7,x7 ,the home of an individual1 but only for purposes of section #ahha7;b77#c77;,b74 2 and 7,b7 by adding at the end the following new paragraph3 7#e7 ,treatment of home dialysis monthly ,,esrd-related visit ,the geographic requirements described in paragraph 7#d77;,c77i7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjai1 for purposes of section #ahha7;b77#c77;,b71 at an originating site described in subclause 7,,vi71 7,,ix71 or 7,x7 of paragraph 7#d77;,c77ii74 4 7#b7 ,no facility fee if originating site for home dialysis therapy is the home ,section #ahcd7m77#b77;,b7 of the ,social ,security 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 is amended-- 7,a7 by redesignating clauses 7i7 and 7ii7 as subclauses 7,i7 and 7,,ii71 and indenting appropriately2 7,b7 in subclause 7,,ii71 as redesignated by subparagraph 7,a71 by striking clause 7i7 or this clause and inserting subclause 7,i7 or this subclause2 7,c7 by striking site4--,with respect to and inserting 8site4-- 7i7 ,in general ,subject to clause 7ii71 with respect to 2 and 7,d7 by adding at the end the following new clause3 7ii7 ,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 7#d77;,c77ii77,x74 4 7c7 ,clarification regarding telehealth provided to beneficiaries ,section #aabh;,a7i77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7i77#f77 is amended-- 7#a7 in subparagraph 7,h71 by striking or at the end2 7#b7 in subparagraph 7,i71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new subparagraph3 7,j7 the provision of telehealth technologies 7as defined by the ,secretary7 on or after ,january #a1 #bjai1 by a provider of services or a renal dialysis facility 7as such terms are defined for purposes of title ,,xviii7 to an individual with end stage renal disease who is receiving home dialysis for which payment is being made under part ,b of such title1 if-- 7i7 the telehealth technologies are not offered as part of any advertisement or solicitation2 7ii7 the telehealth technologies are provided for the purpose of furnishing telehealth services related to the individual's end stage renal disease2 and 7iii7 the provision of the telehealth technologies meets any other requirements set forth in regulations promulgated by the ,secretary4 4 7d7 ,conforming amendment ,section #ahha7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#a77 is amended by striking paragraph 7#c77;,a7 and inserting paragraph 7#c77;,a77i74 ,b ,expanding ,innovation and ,technology #bcaa4 ,adapting benefits to meet the needs of chronically ill ,medicare ,advantage enrollees ,section #ahei of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is amended by adding at the end the following new subsection3 7h7 ,national testing of ,medicare ,advantage ,value-,based ,insurance ,design model 7#a7 ,in general ,in implementing the ,medicare ,advantage ,value-,based ,insurance ,design model that is being tested under section #aaae;,a7b71 the ,secretary shall revise the testing of the model under such section to cover1 effective not later than ,january #a1 #bjbj1 all ,states4 7#b7 ,termination and modification provision not applicable until ,january #a1 #bjbb ,the provisions of section #aaae;,a7b77#c77;,b7 shall apply to the ,medicare ,advantage ,value-,based ,insurance ,design model1 including such model as revised under paragraph 7#a71 beginning ,january #a1 #bjbb1 but shall not apply to such model1 as so revised1 prior to such date4 7#c7 ,funding ,the ,secretary shall allocate funds made available under section #aaae;,a7f77#a7 to design1 implement1 and evaluate the ,medicare ,advantage ,value-,based ,insurance ,design model1 as revised under paragraph 7#a74 4 #bcab4 ,expanding supplemental benefits to meet the needs of chronically ill ,medicare ,advantage enrollees 7a7 ,in general ,section #aheb7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77 is amended-- 7#a7 in subparagraph 7,a71 by striking ,each and inserting ,subject to subparagraph 7,d71 each2 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,expanding supplemental benefits to meet the needs of chronically ill enrollees 7i7 ,in general ,for plan year #bjbj and subsequent plan years1 in addition to any supplemental health care benefits otherwise provided under this paragraph1 an ,,ma plan1 including a specialized ,,ma plan for special needs individuals 7as defined in section #ahei7;b77#f771 may provide supplemental benefits described in clause 7ii7 to a chronically ill enrollee 7as defined in clause 7iii774 7ii7 ,supplemental benefits described 7,i7 ,in general ,supplemental benefits described in this clause are supplemental benefits that1 with respect to a chronically ill enrollee1 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 benefits4 7,,ii7 ,authority to waive uniformity requirements ,the ,secretary may1 only with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph1 waive the uniformity requirements under this part1 as determined appropriate by the ,secretary4 7iii7 ,chronically ill enrollee defined ,in this subparagraph1 the term chronically ill enrollee means an enrollee in an ,,ma plan that the ,secretary determines-- 7,i7 has one or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee2 7,,ii7 has a high risk of hospitalization or other adverse health outcomes2 and 7,,iii7 requires intensive care coordination4 4 7b7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct a study on supplemental benefits provided to enrollees in ,medicare ,advantage plans under part ,c of title ,,xviii of the ,social ,security ,act1 including specialized ,,ma plans for special needs individuals 7as defined in section #ahei7;b77#f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f7774 ,to the extend data are available1 such study shall include an analysis of the following3 7,a7 ,the type of supplemental benefits provided to such enrollees1 the total number of enrollees receiving each supplemental benefit1 and whether the supplemental benefit is covered by the standard benchmark cost of the benefit or with an additional premium4 7,b7 ,the frequency in which supplemental benefits are utilized by such enrollees4 7,c7 ,the impact supplemental benefits have on-- 7i7 indicators of the quality of care received by such enrollees1 including overall health and function of the enrollees2 7ii7 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 enrollees2 and 7iii7 the amount of the bids submitted by ,medicare ,advantage ,organizations for ,medicare ,advantage plans under such part ,c4 7#b7 ,consultation ,in conducting the study under paragraph 7#a71 the ,comptroller ,general shall1 as necessary1 consult with the ,centers for ,medicare ,medicaid ,services and ,medicare ,advantage organizations offering ,medicare ,advantage plans4 7#c7 ,report ,not later than #e years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #bcac4 ,increasing convenience for ,medicare ,advantage enrollees through telehealth 7a7 ,in general ,section #aheb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is amended-- 7#a7 in subsection 7a77#a77;,b77i71 by inserting 1 subject to subsection 7m71 after means2 and 7#b7 by adding at the end the following new subsection3 7m7 ,provision of additional telehealth benefits 7#a7 ,,ma plan option ,for plan year #bjbj and subsequent plan years1 subject to the requirements of paragraph 7#c71 an ,,ma plan may provide additional telehealth benefits 7as defined in paragraph 7#b77 to individuals enrolled under this part4 7#b7 ,additional telehealth benefits defined 7,a7 ,in general ,for purposes of this subsection and section #ahed3 7i7 ,definition ,the term additional telehealth benefits means services-- 7,i7 for which benefits are available under part ,b1 including services for which payment is not made under section #ahcd7m7 due to the conditions for payment under such section2 and 7,,ii7 that are identified for the year involved by the ,secretary as clinically appropriate to furnish using electronic information and telecommunications technology when a physician 7as defined in section #ahfa7r77 or practitioner 7described in section #ahdb7;b77#ah77;,c77 providing the service is not at the same location as the plan enrollee4 7ii7 ,exclusion of capital and infrastructure costs and investments ,the term additional telehealth benefits does not include capital and infrastructure costs and investments relating to such benefits4 7,b7 ,public comment ,not later than ,november #cj1 #bjah1 the ,secretary shall solicit comments on-- 7i7 what types of items and services 7including those provided through supplemental health care benefits1 such as remote patient monitoring1 secure messaging1 store and forward technologies1 and other non-face-to-face communication7 should be considered to be additional telehealth benefits2 and 7ii7 the requirements for the provision or furnishing of such benefits 7such as licensure1 training1 and coordination requirements74 7#c7 ,requirements for additional telehealth benefits ,the ,secretary shall specify requirements for the provision or furnishing of additional telehealth benefits1 including with respect to the following3 7,a7 ,physician or practitioner qualifications 7other than licensure7 and other requirements such as specific training4 7,b7 ,factors necessary for the coordination of such benefits with other items and services1 including those furnished in-person4 7,c7 ,such other areas as determined by the ,secretary4 7#d7 ,enrollee choice ,if an ,,ma plan provides a service as an additional telehealth benefit 7as defined in paragraph 7#b77-- 7,a7 the ,,ma plan shall also provide access to such benefit through an in-person visit 7and not only as an additional telehealth benefit72 and 7,b7 an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit4 7#e7 ,treatment under ,,ma ,for purposes of this subsection and section #ahed1 if a plan provides additional telehealth benefits1 such additional telehealth benefits shall be treated as if they were benefits under the original ,medicare fee-for-service program option4 7#f7 ,construction ,nothing in this subsection shall be construed as affecting the requirement under subsection 7a77#a7 that ,,ma plans provide enrollees with items and services 7other than hospice care7 for which benefits are available under parts ,a and ,b1 including benefits available under section #ahcd7m74 4 7b7 ,clarification regarding inclusion in bid amount ,section #ahed7;a77#f77;,a77ii77,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bd7;a77#f77;,a77ii77,i77 is amended by inserting 1 including1 for plan year #bjbj and subsequent plan years1 the provision of additional telehealth benefits as described in section #aheb7m7 before the semicolon at the end4 #bcad4 ,providing accountable care organizations the ability to expand the use of telehealth 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7 is amended by adding at the end the following new subsection3 7l7 ,providing ,a,c,os the ability ,to expand the use of telehealth services 7#a7 ,in general ,in the case of telehealth services for which payment would otherwise be made under this title furnished on or after ,january #a1 #bjbj1 for purposes of this subsection only1 the following shall apply with respect to such services furnished by a physician or practitioner participating in an applicable ,,aco 7as defined in paragraph 7#b77 to a ,medicare fee-for-service beneficiary assigned to the applicable ,,aco3 7,a7 ,inclusion of home as originating site ,subject to paragraph 7#c71 the home of a beneficiary shall be treated as an originating site described in section #ahcd7m77#d77;,c77ii74 7,b7 ,no application of geographic limitation ,the geographic limitation under section #ahcd7m77#d77;,c77i7 shall not apply with respect to an originating site described in section #ahcd7m77#d77;,c77ii7 7including the home of a beneficiary under subparagraph 7,a771 subject to ,state licensing requirements4 7#b7 ,definitions ,in this subsection3 7,a7 ,applicable ,,aco ,the term applicable ,,aco means an ,,aco participating in a model tested or expanded under section #aaae;,a or under this section-- 7i7 that operates under a two-sided model-- 7,i7 described in section #dbe4fjj7;a7 of title #db1 ,code of ,federal ,regulations2 or 7,,ii7 tested or expanded under section #aaae;,a2 and 7ii7 for which ,medicare fee-for-service beneficiaries are assigned to the ,,aco using a prospective assignment method1 as determined appropriate by the ,secretary4 7,b7 ,home ,the term home means1 with respect to a ,medicare fee-for-service beneficiary1 the place of residence used as the home of the beneficiary4 7#c7 ,telehealth services received in the home ,in the case of telehealth services described in paragraph 7#a7 where the home of a ,medicare fee-for-service beneficiary is the originating site1 the following shall apply3 7,a7 ,no facility fee ,there shall be no facility fee paid to the originating site under section #ahcd7m77#b77;,b74 7,b7 ,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 typically furnished in inpatient settings such as a hospital4 4 7b7 ,study and report 7#a7 ,study 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct a study on the implementation of section #ahii7l7 of the ,social ,security ,act1 as added by subsection 7a74 ,such study shall include an analysis of the utilization of1 and expenditures for1 telehealth services under such section4 7,b7 ,collection of data ,the ,secretary may collect such data as the ,secretary determines necessary to carry out the study under this paragraph4 7#b7 ,report ,not later than ,january #a1 #bjbf1 the ,secretary shall submit to ,congress a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #bcae4 ,expanding the use of telehealth for individuals with stroke ,section #ahcd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m771 as amended by section #bcjb7;b71 is amended-- 7#a7 in paragraph 7#d77;,c77i71 in the matter preceding subclause 7,i71 by striking ,the term and inserting ,except as provided in paragraph 7#f71 the term2 and 7#b7 by adding at the end the following new paragraph3 7#f7 ,treatment of stroke telehealth services 7,a7 ,non-application of originating site requirements ,the requirements described in paragraph 7#d77;,c7 shall not apply with respect to telehealth services furnished on or after ,january #a1 #bjba1 for purposes of diagnosis1 evaluation1 or treatment of symptoms of an acute stroke1 as determined by the ,secretary4 7,b7 ,inclusion of certain sites ,with respect to telehealth services described in subparagraph 7,a71 the term originating site shall include any hospital 7as defined in section #ahfa7;e77 or critical access hospital 7as defined in section #ahfa7mm77#a771 any mobile stroke unit 7as defined by the ,secretary71 or any other site determined appropriate by the ,secretary1 at which the eligible telehealth individual is located at the time the service is furnished via a telecommunications system4 7,c7 ,no originating site facility fee for new sites ,no facility fee shall be paid under paragraph 7#b77;,b7 to an originating site with respect to a telehealth service described in subparagraph 7,a7 if the originating site does not otherwise meet the requirements for an originating site under paragraph 7#d77;,c74 4 ,c ,identifying the ,chronically ,ill ,population #bcba4 ,providing flexibility for beneficiaries to be part of an accountable care organization ,section #ahii7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj7c77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively1 and indenting appropriately2 7#b7 by striking ,a,c,os4--,the ,secretary and inserting 8,a,c,os4-- 7#a7 ,in general ,subject to paragraph 7#b71 the ,secretary 2 and 7#c7 by adding at the end the following new paragraph3 7#b7 ,providing flexibility 7,a7 ,choice of prospective assignment ,for each agreement period 7effective for agreements entered into or renewed on or after ,january #a1 #bjbj71 in the case where an ,,aco established under the program is in a ,track that provides for the retrospective assignment of ,medicare fee-for-service beneficiaries to the ,,aco1 the ,secretary shall permit the ,,aco to choose to have ,medicare fee-for-service beneficiaries assigned prospectively1 rather than retrospectively1 to the ,,aco for an agreement period4 7,b7 ,assignment based on voluntary identification by ,medicare fee-for-service beneficiaries 7i7 ,in general ,for performance year #bjah and each subsequent performance year1 if a system is available for electronic designation1 the ,secretary shall permit a ,medicare fee-for-service beneficiary to voluntarily identify an ,,aco professional as the primary care provider of the beneficiary for purposes of assigning such beneficiary to an ,,aco1 as determined by the ,secretary4 7ii7 ,notification process ,the ,secretary shall establish a process under which a ,medicare fee-for-service beneficiary is-- 7,i7 notified of their ability to make an identification described in clause 7i72 and 7,,ii7 informed of the process by which they may make and change such identification4 7iii7 ,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 ,secretary4 4 ,d ,empowering ,individuals and ,caregivers in ,care ,delivery #bcca4 ,eliminating barriers to care coordination under accountable care organizations 7a7 ,in general ,section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj71 as amended by section #bcad7;a71 is amended-- 7#a7 in subsection 7b77#b71 by adding at the end the following new subparagraph3 7,i7 ,an ,,aco that seeks to operate an ,,aco ,beneficiary ,incentive ,program pursuant to subsection 7m7 shall apply to the ,secretary at such time1 in such manner1 and with such information as the ,secretary may require4 2 7#b7 by adding at the end the following new subsection3 7m7 ,authority ,to provide incentive payments to beneficiaries with respect to qualifying primary care services 7#a7 ,program 7,a7 ,in general ,in order to encourage ,medicare fee-for-service beneficiaries to obtain medically necessary primary care services1 an ,,aco participating under this section under a payment model described in clause 7i7 or 7ii7 of paragraph 7#b77;,b7 may apply to establish an ,,aco ,beneficiary ,incentive ,program to provide incentive payments to such beneficiaries who are furnished qualifying services in accordance with this subsection4 ,the ,secretary shall permit such an ,,aco to establish such a program at the ,secretary's discretion and subject to such requirements1 including program integrity requirements1 as the ,secretary determines necessary4 7,b7 ,implementation ,the ,secretary shall implement this subsection on a date determined appropriate by the ,secretary4 ,such date shall be no earlier than ,january #a1 #bjai1 and no later than ,january #a1 #bjbj4 7#b7 ,conduct of program 7,a7 ,duration ,subject to subparagraph 7,h71 an ,,aco ,beneficiary ,incentive ,program established under this subsection shall be conducted for such period 7of not less than #a year7 as the ,secretary may approve4 7,b7 ,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 ,,aco3 7i7 ,with respect to the ,track #b and ,track #c payment models described in section #dbe4fjj7;a7 of title #db1 ,code of ,federal ,regulations 7or in any successor regulation71 ,medicare fee-for-service beneficiaries who are preliminarily prospectively or prospectively assigned 7or otherwise assigned1 as determined by the ,secretary7 to the ,,aco4 7ii7 ,with respect to any future payment models involving two-sided risk1 ,medicare fee-for-service beneficiaries who are assigned to the ,,aco1 as determined by the ,secretary4 7,c7 ,qualifying service ,for purposes of this subsection1 a qualifying service is a primary care service1 as defined in section #dbe4bj of title #db1 ,code of ,federal ,regulations 7or in any successor regulation71 with respect to which coinsurance applies under part ,b1 furnished through an ,,aco by-- 7i7 an ,,aco professional described in subsection 7h77#a77;,a7 who has a primary care specialty designation included in the definition of primary care physician under section #dbe4bj of title #db1 ,code of ,federal ,regulations 7or any successor regulation72 7ii7 an ,,aco professional described in subsection 7h77#a77;,b72 or 7iii7 a ,federally qualified health center or rural health clinic 7as such terms are defined in section #ahfa7;aa774 7,d7 ,incentive payments ,an incentive payment made by an ,,aco pursuant to an ,,aco ,beneficiary ,incentive ,program established under this subsection shall be-- 7i7 in an amount up to #bj1 with such maximum amount updated annually by the percentage increase in the consumer price index for all urban consumers 7,united ,states city average7 for the #ab-month period ending with ,june of the previous year2 7ii7 in the same amount for each ,medicare fee-for-service beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b7 without regard to enrollment of such a beneficiary in a medicare supplemental policy 7described in section #ahhb7;g77#a771 in a ,state ,medicaid plan under title ,,xix or a waiver of such a plan1 or in any other health insurance policy or health benefit plan2 7iii7 made for each qualifying service furnished to such a beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b7 during a period specified by the ,secretary2 and 7iv7 made no later than #cj days after a qualifying service is furnished to such a beneficiary described in clause 7i7 or 7ii7 of subparagraph 7,b74 7,e7 ,no separate payments from the ,secretary ,the ,secretary shall not make any separate payment to an ,,aco for the costs1 including incentive payments1 of carrying out an ,,aco ,beneficiary ,incentive ,program established under this subsection4 ,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 ,program4 7,f7 ,no application to shared savings calculation ,incentive payments made by an ,,aco under this subsection shall be disregarded for purposes of calculating benchmarks1 estimated average per capita ,medicare expenditures1 and shared savings under this section4 7,g7 ,reporting requirements ,an ,,aco conducting an ,,aco ,beneficiary ,incentive ,program under this subsection shall1 at such times and in such format as the ,secretary may require1 report to the ,secretary such information and retain such documentation as the ,secretary may require1 including the amount and frequency of incentive payments made and the number of ,medicare fee-for-service beneficiaries receiving such payments4 7,h7 ,termination ,the ,secretary may terminate an ,,aco ,beneficiary ,incentive ,program established under this subsection at any time for reasons determined appropriate by the ,secretary4 7#c7 ,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-- 7,a7 determining eligibility for benefits or assistance 7or the amount or extent of benefits or assistance7 under any ,federal program or under any ,state or local program financed in whole or in part with ,federal funds2 or 7,b7 any ,federal or ,state laws relating to taxation4 2 7#c7 in subsection 7e71 by inserting 1 including an ,,aco ,beneficiary ,incentive ,program under subsections 7b77#b77;,i7 and 7m7 after the program2 and 7#d7 in subsection 7g77#f71 by inserting or of an ,,aco ,beneficiary ,incentive ,program under subsections 7b77#b77;,i7 and 7m7 after under subsection 7d77#d74 7b7 ,amendment to section #aabh;,b ,section #aabh;,b7b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77#c77 is amended-- 7#a7 by striking and at the end of subparagraph 7,i72 7#b7 by striking the period at the end of subparagraph 7,j7 and inserting 2 and2 and 7#c7 by adding at the end the following new subparagraph3 7,k7 an incentive payment made to a ,medicare fee-for-service beneficiary by an ,,aco under an ,,aco ,beneficiary ,incentive ,program established under subsection 7m7 of section #ahii1 if the payment is made in accordance with the requirements of such subsection and meets such other conditions as the ,secretary may establish4 4 7c7 ,evaluation and report 7#a7 ,evaluation ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall conduct an evaluation of the ,,aco ,beneficiary ,incentive ,program established under subsections 7b77#b77;,i7 and 7m7 of section #ahii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;jjj71 as added by subsection 7a74 ,the evaluation shall include an analysis of the impact of the implementation of the ,program on expenditures and beneficiary health outcomes under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#b7 ,report ,not later than ,october #a1 #bjbc1 the ,secretary shall submit to ,congress a report containing the results of the evaluation under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #bccb4 ,,gao study and report on longitudinal comprehensive care planning services under ,medicare part ,b 7a7 ,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 services4 ,such study shall include an analysis of the following to the extent such information is available3 7#a7 ,the frequency with which services similar to longitudinal comprehensive care planning services are furnished to ,medicare beneficiaries1 which providers of services and suppliers are furnishing those services1 whether ,medicare reimbursement is being received for those services1 and1 if so1 through which codes those services are being reimbursed4 7#b7 ,whether1 and the extent to which1 longitudinal comprehensive care planning services would overlap1 and could therefore result in duplicative payment1 with services covered under the hospice benefit as well as the chronic care management code1 evaluation and management codes1 or other codes that already exist under part ,b of the ,medicare program4 7#c7 ,any barriers to hospitals1 skilled nursing facilities1 hospice programs1 home health agencies1 and other applicable providers working with a ,medicare beneficiary to engage in the care planning process and complete the necessary documentation to support the treatment and care plan of the beneficiary and provide such documentation to other providers and the beneficiary or the beneficiary's representative4 7#d7 ,any barriers to providers1 other than the provider furnishing longitudinal comprehensive care planning services1 accessing the care plan and associated documentation for use related to the care of the ,medicare beneficiary4 7#e7 ,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 treatment decisions1 and what the challenges might be in implementing such options4 7#f7 ,stakeholder's views on the need for the development of quality metrics with respect to longitudinal comprehensive care planning services1 such as measures related to-- 7,a7 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 plan2 7,b7 the effectiveness and patient-centeredness of the care plan in organizing delivery of services consistent with the plan2 7,c7 the availability of the care plan and associated documentation to other providers that care for the beneficiary2 and 7,d7 the extent to which the beneficiary received services and support that is free from discrimination based on advanced age1 disability status1 or advanced illness4 7#g7 ,stakeholder's views on how such quality metrics would provide information on-- 7,a7 the goals1 values1 and preferences of the beneficiary2 7,b7 the documentation of the care plan2 7,c7 services furnished to the beneficiary2 and 7,d7 outcomes of treatment4 7#h7 ,stakeholder's views on-- 7,a7 the type of training and education needed for applicable providers1 individuals1 and caregivers in order to facilitate longitudinal comprehensive care planning services2 7,b7 the types of providers of services and suppliers that should be included in the interdisciplinary team of an applicable provider2 and 7,c7 the characteristics of ,medicare beneficiaries that would be most appropriate to receive longitudinal comprehensive care planning services1 such as individuals with advanced disease and individuals who need assistance with multiple activities of daily living4 7#i7 ,stakeholder's views on the frequency with which longitudinal comprehensive care planning services should be furnished4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,definitions ,in this section3 7#a7 ,applicable provider ,the term applicable provider means a hospice program 7as defined in subsection 7dd77#b7 of section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww77 or other provider of services 7as defined in subsection 7u7 of such section7 or supplier 7as defined in subsection 7d7 of such section7 that-- 7,a7 furnishes longitudinal comprehensive care planning services through an interdisciplinary team2 and 7,b7 meets such other requirements as the ,secretary may determine to be appropriate4 7#b7 ,comptroller ,general ,the term ,comptroller ,general means the ,comptroller ,general of the ,united ,states4 7#c7 ,interdisciplinary team ,the term interdisciplinary team means a group that-- 7,a7 includes the personnel described in subsection 7dd77#b77;,b77i7 of such section #ahfa2 7,b7 may include a chaplain1 minister1 or other clergy2 and 7,c7 may include other direct care personnel4 7#d7 ,longitudinal comprehensive care planning services ,the term longitudinal comprehensive care planning services means a voluntary shared decisionmaking process that is furnished by an applicable provider through an interdisciplinary team and includes a conversation with ,medicare beneficiaries who have received a diagnosis of a serious or life-threatening illness4 ,the purpose of such services is to discuss a longitudinal care plan that addresses the progression of the disease1 treatment options1 the goals1 values1 and preferences of the beneficiary1 and the availability of other resources and social supports that may reduce the beneficiary's health risks and promote self-management and shared decisionmaking4 7#e7 ,secretary ,the term ,secretary means the ,secretary of ,health and ,human ,services4 ,e ,other ,policies to ,improve ,care for the ,chronically ,ill #bcda4 ,,gao study and report on improving medication synchronization 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the extent to which ,medicare prescription drug plans 7,,ma-,,pd plans and stand alone prescription drug plans7 under part ,d of title ,,xviii of the ,social ,security ,act and private payors use programs that synchronize pharmacy dispensing so that individuals may receive multiple prescriptions on the same day to facilitate comprehensive counseling and promote medication adherence4 ,the study shall include a analysis of the following3 7#a7 ,the extent to which pharmacies have adopted such programs4 7#b7 ,the common characteristics of such programs1 including how pharmacies structure counseling sessions under such programs 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 pharmacies4 7#c7 ,how such programs compare for ,medicare prescription drug plans and private payors4 7#d7 ,what is known about how such programs affect patient medication adherence and overall patient health outcomes1 including if adherence and outcomes vary by patient subpopulations1 such as disease state and socioeconomic status4 7#e7 ,what is known about overall patient satisfaction with such programs and satisfaction with such programs1 including within patient subpopulations1 such as disease state and socioeconomic status4 7#f7 ,the extent to which laws and regulations of the ,medicare program support such programs4 7#g7 ,barriers to the use of medication synchronization programs by ,medicare prescription drug plans4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #bcdb4 ,,gao study and report on impact of obesity drugs on patient health and spending 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall1 to the extent data are available1 conduct a study on the use of prescription drugs to manage the weight of obese patients and the impact of coverage of such drugs on patient health and on health care spending4 ,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 7as defined in section #ahfj;,d-#a7;a77#c77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,c777 as a supplemental health care benefit4 ,the study shall include an analysis of the following3 7#a7 ,the prevalence of obesity in the ,medicare and non-,medicare population4 7#b7 ,the utilization of obesity drugs4 7#c7 ,the distribution of ,body ,mass ,index by individuals taking obesity drugs1 to the extent practicable4 7#d7 ,what is known about the use of obesity drugs in conjunction with the receipt of other items or services1 such as behavioral counseling1 and how these compare to items and services received by obese individuals who do not take obesity drugs4 7#e7 ,physician considerations and attitudes related to prescribing obesity drugs4 7#f7 ,the extent to which coverage policies cease or limit coverage for individuals who fail to receive clinical benefit4 7#g7 ,what is known about the extent to which individuals who take obesity drugs adhere to the prescribed regimen4 7#h7 ,what is known about the extent to which individuals who take obesity drugs maintain weight loss over time4 7#i7 ,what is known about the subsequent impact such drugs have on medical services that are directly related to obesity1 including with respect to subpopulations determined based on the extent of obesity4 7#aj7 ,what is known about the spending associated with the care of individuals who take obesity drugs1 compared to the spending associated with the care of individuals who do not take such drugs4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #bcdc4 ,,hhs study and report on long-term risk factors for chronic conditions among ,medicare beneficiaries 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study on long-term cost drivers to the ,medicare program1 including obesity1 tobacco use1 mental health conditions1 and other factors that may contribute to the deterioration of health conditions among individuals with chronic conditions in the ,medicare population4 ,the study shall include an analysis of any barriers to collecting and analyzing such information and how to remove any such barriers 7including through legislation and administrative actions74 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report containing the results of the study under subsection 7a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 ,the ,secretary shall also post such report on the ,internet website of the ,department of ,health and ,human ,services4 ,,iv ,medicare ,part ,b ,miscellaneous ,policies ,a ,medicare ,part ,b ,improvement ,act #bdja4 ,home infusion therapy services temporary transitional payment 7a7 ,in general ,section #ahcd7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7u77 is amended by adding at the end the following new paragraph3 7#g7 ,home infusion therapy services temporary transitional payment 7,a7 ,temporary transitional payment 7i7 ,in general ,the ,secretary shall1 in accordance with the payment methodology described in subparagraph 7,b7 and subject to the provisions of this paragraph1 provide a home infusion therapy services temporary transitional payment under this part to an eligible home infusion supplier 7as defined in subparagraph 7,f77 for items and services described in subparagraphs 7,a7 and 7,b7 of section #ahfa7;iii77#b77 furnished during the period specified in clause 7ii7 by such supplier in coordination with the furnishing of transitional home infusion drugs 7as defined in clause 7iii774 7ii7 ,period specified ,for purposes of clause 7i71 the period specified in this clause is the period beginning on ,january #a1 #bjai1 and ending on the day before the date of the implementation of the payment system under paragraph 7#a77;,a74 7iii7 ,transitional home infusion drug defined ,for purposes of this paragraph1 the term transitional home infusion drug has the meaning given to the term home infusion drug under section #ahfa7;iii77#c77;,c771 except that clause 7ii7 of such section shall not apply if a drug described in such clause is identified in clauses 7i71 7ii71 7iii7 or 7iv7 of subparagraph 7,c7 as of the date of the enactment of this paragraph4 7,b7 ,payment methodology ,for purposes of this paragraph1 the ,secretary shall establish a payment methodology1 with respect to items and services described in subparagraph 7,a77i74 ,under such payment methodology the ,secretary shall-- 7i7 create the three payment categories described in clauses 7i71 7ii71 and 7iii7 of subparagraph 7,c72 7ii7 assign drugs to such categories1 in accordance with such clauses2 7iii7 assign appropriate ,healthcare ,common ,procedure ,coding ,system 7,,hcpcs7 codes to each payment category2 and 7iv7 establish a single payment amount for each such payment category1 in accordance with subparagraph 7,d71 for each infusion drug administration calendar day in the individual's home for drugs assigned to such category4 7,c7 ,payment categories 7i7 ,payment category #a ,the ,secretary shall create a payment category #a and assign to such category drugs which are covered under the ,local ,coverage ,determination on ,external ,infusion ,pumps 7,,lcd number ,l#ccgid7 and billed with the following ,,hcpcs codes 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary73 ,j#jacc1 ,j#jbhe1 ,j#jbhg1 ,j#jbhh1 ,j#jbhi1 ,j#jhie1 ,j#aagj1 ,j#abej1 ,j#abfe1 ,j#acbe1 ,j#adee1 ,j#adeg1 ,j#aegj1 ,j#bage1 ,j#bbfj1 ,j#bbgj1 ,j#bbgd1 ,j#bbgh1 ,j#cjaj1 or ,j#cbhe4 7ii7 ,payment category #b ,the ,secretary shall create a payment category #b and assign to such category drugs which are covered under such local coverage determination and billed with the following ,,hcpcs codes 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary73 ,j#aeee ,,jb1 ,j#aeei ,,jb1 ,j#aefa ,,jb1 ,j#aefb ,,jb1 ,j#aefi ,,jb1 or ,j#aege ,,jb4 7iii7 ,payment category #c ,the ,secretary shall create a payment category #c and assign to such category drugs which are covered under such local coverage determination and billed with the following ,,hcpcs codes 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary73 ,j#ijjj1 ,j#ijci1 ,j#ijdj1 ,j#ijfe1 ,j#iajj1 ,j#iaij1 ,j#ibjj1 ,j#icfj1 or ,j#icgj4 7iv7 ,infusion drugs not otherwise included ,with respect to drugs that are not included in payment category #a1 #b1 or #c under clause 7i71 7ii71 or 7iii71 respectively1 the ,secretary shall assign to the most appropriate of such categories1 as determined by the ,secretary1 drugs which are-- 7,i7 covered under such local coverage determination and billed under ,,hcpcs codes ,j#ggii or ,j#giii 7as identified as of ,july #a1 #bjag1 and as subsequently modified by the ,secretary72 or 7,,ii7 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 7,a77i74 7,d7 ,payment amounts 7i7 ,in general ,under the payment methodology1 the ,secretary shall pay eligible home infusion suppliers1 with respect to items and services described in subparagraph 7,a77i7 furnished during the period described in subparagraph 7,a77ii7 by such supplier to an individual1 at amounts equal to the amounts determined under the physician fee schedule established under section #ahdh for services furnished during the year for codes and units of such codes described in clauses 7ii71 7iii71 and 7iv7 with respect to drugs included in the payment category under subparagraph 7,c7 specified in the respective clause1 determined without application of the geographic adjustment under subsection 7e7 of such section4 7ii7 ,payment amount for category #a ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #a described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifcfe plus three units of ,,hcpcs code #ifcff 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary74 7iii7 ,payment amount for category #b ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #b described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifcfi plus three units of ,,hcpcs code #ifcgj 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary74 7iv7 ,payment amount for category #c ,for purposes of clause 7i71 the codes and units described in this clause1 with respect to drugs included in payment category #c described in subparagraph 7,c77i71 are one unit of ,,hcpcs code #ifdac plus three units of ,,hcpcs code #ifdae 7as identified as of ,january #a1 #bjah1 and as subsequently modified by the ,secretary74 7,e7 ,clarifications 7i7 ,infusion drug administration day ,for purposes of this subsection1 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 supplier1 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 7as described in section #ahfa7;iii77#b77;,a77 were furnished to administer such drugs to such individual4 ,for purposes of the previous sentence1 an infusion drug administration calendar day shall include all such drugs administered to such individual on such day4 7ii7 ,treatment of multiple drugs administered on same infusion drug administration day ,in the case that an eligible home infusion supplier1 with respect to an infusion drug administration calendar day in an individual's home1 furnishes to such individual transitional home infusion drugs which are not all assigned to the same payment category under subparagraph 7,c71 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 drug1 among all such drugs so furnished to such individual during such calendar day1 for which the highest payment would be made under this paragraph4 7,f7 ,eligible home infusion suppliers ,in this paragraph1 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 infusion pump supplies and that maintains all pharmacy licensure requirements in the ,state in which the applicable infusion drugs are administered4 7,g7 ,implementation ,notwithstanding any other provision of law1 the ,secretary may implement this paragraph by program instruction or otherwise4 4 7b7 ,conforming amendment 7#a7 ,section #ahdb7;b77#f77;,i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#f77;,i77 is amended by inserting or1 in the case of items and services described in clause 7i7 of section #ahcd7u77#g77;,a7 furnished to an individual during the period described in clause 7ii7 of such section1 payment shall be made to the eligible home infusion therapy supplier after payment shall be made to the qualified home infusion therapy supplier4 7#b7 ,section #ejab7;d7 of the #bast ,century ,cures ,act is amended by inserting the following before the period at the end the following3 1 except that the amendments made by paragraphs 7#a7 and 7#b7 of subsection 7c7 shall apply to items and services furnished on or after ,january #a1 #bjai4 #bdjb4 ,orthotist's and prosthetist's clinical notes as part of the patient's medical record ,section #ahcd7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77 is amended by adding at the end the following new paragraph3 7#e7 ,documentation created by orthotists and prosthetists ,for purposes of determining the reasonableness and medical necessity of orthotics and prosthetics1 documentation created by an orthotist or prosthetist shall be considered part of the individual's medical record to support documentation created by eligible professionals described in section #ahdh7k77#c77;,b74 4 #bdjc4 ,independent accreditation for dialysis facilities and assurance of high quality surveys 7a7 ,accreditation and surveys 7#a7 ,in general ,section #ahfe of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;bb7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by striking or the conditions and requirements under section #ahha7;b72 and 7ii7 in paragraph 7#d71 by inserting 7including a renal dialysis facility7 after facility2 and 7,b7 by adding at the end the following new subsection3 7e7 ,with respect to an accreditation body that has received approval from the ,secretary under subsection 7a77#c77;,a7 for accreditation of provider entities that are required to meet the conditions and requirements under section #ahha7;b71 in addition to review and oversight authorities otherwise applicable under this title1 the ,secretary shall 7as the ,secretary determines appropriate7 conduct1 with respect to such accreditation body and provider entities1 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 entities3 7#a7 ,validation surveys referred to in subsection 7d74 7#b7 ,accreditation program reviews 7as defined in section #dhh4h7;c7 of title #db of the ,code of ,federal ,regulations1 or a successor regulation74 7#c7 ,performance reviews 7as defined in section #dhh4h7;a7 of title #db of the ,code of ,federal ,regulations1 or a successor regulation74 4 7#b7 ,timing for acceptance of requests from accreditation organizations ,not later than #ij days after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services shall begin accepting requests from national accreditation bodies for a finding described in section #ahfe7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;bb7a77#c77;,a77 for purposes of accrediting provider entities that are required to meet the conditions and requirements under section #ahha7;b7 of such ,act 7#db ,u4,s4,c4 #acierr7b774 7b7 ,requirement for timing of surveys of new dialysis facilities ,section #ahha7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#a77 is amended by adding at the end the following new sentence3 ,beginning #ahj days after the date of the enactment of this sentence1 an initial survey of a provider of services or a renal dialysis facility to determine if the conditions and requirements under this paragraph are met shall be initiated not later than #ij days after such date on which both the provider enrollment form 7without regard to whether such form is submitted prior to or after such date of enactment7 has been determined by the ,secretary to be complete and the provider's enrollment status indicates approval is pending the results of such survey44 #bdjd4 ,modernizing the application of the ,stark rule under ,medicare 7a7 ,clarification of the writing requirement and signature requirement for arrangements pursuant to the ,stark rule 7#a7 ,writing requirement ,section #ahgg7;h77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7h77#a77 is amended by adding at the end the following new subparagraph3 7,d7 ,written requirement clarified ,in the case of any requirement pursuant to this section for a compensation arrangement to be in writing1 such requirement shall be satisfied by such means as determined by the ,secretary1 including by a collection of documents1 including contemporaneous documents evidencing the course of conduct between the parties involved4 4 7#b7 ,signature requirement ,section #ahgg7;h77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7h77#a771 as amended by paragraph 7#a71 is further amended by adding at the end the following new subparagraph3 7,e7 ,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 parties1 such signature requirement shall be met if-- 7i7 not later than #ij consecutive calendar days immediately following the date on which the compensation arrangement became noncompliant1 the parties obtain the required signatures2 and 7ii7 the compensation arrangement otherwise complies with all criteria of the applicable exception4 4 7b7 ,indefinite holdover for lease arrangements and personal services arrangements pursuant to the ,stark rule ,section #ahgg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7e77 is amended-- 7#a7 in paragraph 7#a71 by adding at the end the following new subparagraph3 7,c7 ,holdover lease arrangements ,in the case of a holdover lease arrangement for the lease of office space or equipment1 which immediately follows a lease arrangement described in subparagraph 7,a7 for the use of such office space or subparagraph 7,b7 for the use of such equipment and that expired after a term of at least #a year1 payments made by the lessee to the lessor pursuant to such holdover lease arrangement1 if-- 7i7 the lease arrangement met the conditions of subparagraph 7,a7 for the lease of office space or subparagraph 7,b7 for the use of equipment when the arrangement expired2 7ii7 the holdover lease arrangement is on the same terms and conditions as the immediately preceding arrangement2 and 7iii7 the holdover arrangement continues to satisfy the conditions of subparagraph 7,a7 for the lease of office space or subparagraph 7,b7 for the use of equipment4 2 and 7#b7 in paragraph 7#c71 by adding at the end the following new subparagraph3 7,c7 ,holdover personal service arrangement ,in the case of a holdover personal service arrangement1 which immediately follows an arrangement described in subparagraph 7,a7 that expired after a term of at least #a year1 remuneration from an entity pursuant to such holdover personal service arrangement1 if-- 7i7 the personal service arrangement met the conditions of subparagraph 7,a7 when the arrangement expired2 7ii7 the holdover personal service arrangement is on the same terms and conditions as the immediately preceding arrangement2 and 7iii7 the holdover arrangement continues to satisfy the conditions of subparagraph 7,a74 4 ,b ,additional ,provisions #bdaa4 ,making permanent the removal of the rental cap for durable medical equipment under ,medicare with respect to speech generating devices ,section #ahcd7;a77#b77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7a77#b77;,a77iv77 is amended by striking and before ,october #a1 #bjah14 #bdab4 ,increased civil and criminal penalties and increased sentences for ,federal health care program fraud and abuse 7a7 ,increased civil money penalties and criminal fines 7#a7 ,increased civil money penalties ,section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is amended-- 7,a7 in subsection 7a71 in the matter following paragraph 7#aj7-- 7i7 by striking #aj1jjj and inserting #bj1jjj each place it appears2 7ii7 by striking #ae1jjj and inserting #cj1jjj2 and 7iii7 by striking #ej1jjj and inserting #ajj1jjj each place it appears2 and 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking #b1jjj and inserting #e1jjj2 7ii7 in paragraph 7#b71 by striking #b1jjj and inserting #e1jjj2 and 7iii7 in paragraph 7#c77;,a77i71 by striking #e1jjj and inserting #aj1jjj4 7#b7 ,increased criminal fines ,section #aabh;,b of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7 is amended-- 7,a7 in subsection 7a71 in the matter following paragraph 7#f7-- 7i7 by striking #be1jjj and inserting #ajj1jjj2 and 7ii7 by striking #aj1jjj and inserting #bj1jjj2 7,b7 in subsection 7b7-- 7i7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking #be1jjj and inserting #ajj1jjj2 and 7ii7 in paragraph 7#b71 in the flush text following subparagraph 7,b71 by striking #be1jjj and inserting #ajj1jjj2 7,c7 in subsection 7c71 by striking #be1jjj and inserting #ajj1jjj2 7,d7 in subsection 7d71 in the flush text following paragraph 7#b71 by striking #be1jjj and inserting #ajj1jjj2 and 7,e7 in subsection 7e71 by striking #b1jjj and inserting #d1jjj4 7b7 ,increased sentences for felonies involving ,federal health care program fraud and abuse 7#a7 ,false statements and representations ,section #aabh;,b7a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7a77 is amended1 in the matter following paragraph 7#f71 by striking not more than five years or both1 or 7ii7 and inserting not more than #aj years or both1 or 7ii74 7#b7 ,antikickback ,section #aabh;,b7b7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7b77 is amended-- 7,a7 in paragraph 7#a71 in the flush text following subparagraph 7,b71 by striking not more than five years and inserting not more than #aj years2 and 7,b7 in paragraph 7#b71 in the flush text following subparagraph 7,b71 by striking not more than five years and inserting not more than #aj years4 7#c7 ,false statement or representation with respect to conditions or operations of facilities ,section #aabh;,b7c7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7c77 is amended by striking not more than five years and inserting not more than #aj years4 7#d7 ,excess charges ,section #aabh;,b7d7 of such ,act 7#db ,u4,s4,c4 #acbj;a-#g;b7d77 is amended1 in the flush text following paragraph 7#b71 by striking not more than five years and inserting not more than #aj years4 7c7 ,effective date ,the amendments made by this section shall apply to acts committed after the date of the enactment of this ,act4 #bdac4 ,reducing the volume of future ,,ehr-related significant hardship requests ,section #ahdh7o77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77;,a77 and section #ahhf7n77#c77;,a7 of such ,act 7#db ,u4,s4,c4 #acieww7n77#c77;,a77 are each amended in the last sentence by striking by requiring and all that follows through this paragraph4 #bdad4 ,coverage of certain ,,dna specimen provenance assay tests under ,medicare 7a7 ,benefit 7#a7 ,coverage ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7s77#b7-- 7i7 in subparagraph 7,,ff71 by striking and at the end2 7ii7 in subparagraph 7,,gg71 by inserting and at the end2 and 7iii7 by adding at the end the following new subparagraph3 7,,hh7 a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in subsection 7jjj772 and 2 and 7,b7 by adding at the end the following new subsection3 7jjj7 ,prostate ,cancer ,,dna ,speciment ,provenance ,assay ,test ,the term prostate cancer ,,dna ,specimen ,provenance ,assay ,test 7,,dspa test7 means a test that1 after a determination of cancer in one or more prostate biopsy specimens obtained from an individual1 assesses the identity of the ,,dna in such specimens by comparing such ,,dna with the ,,dna that was separately taken from such individual at the time of the biopsy4 4 7#b7 ,exclusion from coverage ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77 is amended-- 7,a7 in subparagraph 7,o71 by striking and at the end2 7,b7 in subparagraph 7,p71 by striking the semicolon at the end and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,q7 in the case of a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7;jjj771 unless such test is furnished on or after ,january #a1 #bjai1 and before ,january #a1 #bjbd1 and such test is ordered by the physician who furnished the prostate cancer biopsy that obtained the specimen tested2 4 7b7 ,payment amount and related requirements ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by section #bbjd1 is further amended by adding at the end the following new subsection3 7w7 ,prostate cancer ,,dna ,specimen ,provenance ,assay tests 7#a7 ,payment for covered tests 7,a7 ,in general ,subject to subparagraph 7,b71 the payment amount for a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7;jjj77 shall be #bjj4 ,such payment shall be payment for all of the specimens obtained from the biopsy furnished to an individual that are tested4 7,b7 ,limitation ,payment for a ,,dspa test under subparagraph 7,a7 may only be made on an assignment-related basis4 7,c7 ,prohibition on separate payment ,no separate payment shall be made for obtaining ,,dna that was separately taken from an individual at the time of a biopsy described in subparagraph 7,a74 7#b7 ,,hcpcs code and modifier assignment 7,a7 ,in general ,the ,secretary shall assign one or more ,,hcpcs codes to a prostate cancer ,,dna ,specimen ,provenance ,assay test and may use a modifier to facilitate making payment under this section for such test4 7,b7 ,identification of dna match on claim ,the ,secretary shall require an indication on a claim for a prostate cancer ,,dna ,specimen ,provenance ,assay test of whether the ,,dna of the prostate biopsy specimens match the ,,dna of the individual diagnosed with prostate cancer4 ,such indication may be made through use of a ,,hcpcs code1 a modifier1 or other means1 as determined appropriate by the ,secretary4 7#c7 ,,dna match review 7,a7 ,in general ,the ,secretary shall review at least three years of claims under part ,b for prostate cancer ,,dna ,specimen ,provenance ,assay tests to identify whether the ,,dna of the prostate biopsy specimens match the ,,dna of the individuals diagnosed with prostate cancer4 7,b7 ,posting on ,internet website ,not later than ,july #a1 #bjbb1 the ,secretary shall post on the ,internet website of the ,centers for ,medicare ,medicaid ,services the findings of the review conducted under subparagraph 7,a74 4 7c7 ,cost-sharing ,section #ahcc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is amended-- 7#a7 by striking and 7,,bb7 and inserting 7,,bb72 and 7#b7 by inserting before the semicolon at the end the following3 1 and 7,,cc7 with respect to a prostate cancer ,,dna ,specimen ,provenance ,assay test 7,,dspa test7 7as defined in section #ahfa7;jjj771 the amount paid shall be an amount equal to #hj percent of the lesser of the actual charge for the test or the amount specified under section #ahcd7w74 #bdae4 ,strengthening rules in case of competition for diabetic testing strips 7a7 ,special rule in case of competition for diabetic testing strips 7#a7 ,in general ,paragraph 7#aj7 of section #ahdg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;b77 is amended-- 7,a7 in subparagraph 7,a71 by striking the second sentence and inserting the following new sentence3 ,with respect to bids to furnish such types of products on or after ,january #a1 #bjai1 the volume for such types of products shall be determined by the ,secretary through the use of multiple sources of data 7from mail order and non-mail order ,medicare markets71 including market-based data measuring sales of diabetic testing strip products that are not exclusively sold by a single retailer from such markets42 and 7,b7 by adding at the end the following new subparagraphs3 7,c7 ,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 #a1 #bjai1 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 that will allow the entity to furnish such products in a manner consistent with its bid and-- 7i7 demonstrate to the ,secretary1 through letters of intent with manufacturers1 wholesalers1 or other suppliers1 or other evidence as the ,secretary may specify1 such ability2 or 7ii7 demonstrate to the ,secretary that it made a good faith attempt to obtain such a letter of intent or such other evidence4 7,d7 ,use of unlisted types in calculation of percentage ,with respect to bids to furnish diabetic testing strip products on or after ,january #a1 #bjai1 in determining under subparagraph 7,a7 whether a bid submitted by an entity under such subparagraph covers #ej percent 7or such higher percentage as the ,secretary may specify7 of all types of diabetic testing strip products1 the ,secretary may not attribute a percentage to types of diabetic testing strip products that the ,secretary does not identify by brand1 model1 and market share volume4 7,e7 ,adherence to demonstration 7i7 ,in general ,in the case of an entity that is furnishing diabetic testing strip products on or after ,january #a1 #bjai1 under a contract entered into under the competition conducted pursuant to paragraph 7#a71 the ,secretary shall establish a process to monitor1 on an ongoing basis1 the extent to which such entity continues to cover the product types included in the entity's bid4 7ii7 ,termination ,if the ,secretary determines that an entity described in clause 7i7 fails to maintain in inventory1 or otherwise maintain ready access to 7through requirements1 contracts1 or otherwise7 a type of product included in the entity's bid1 the ,secretary may terminate such contract unless the ,secretary finds that the failure of the entity to maintain inventory of1 or ready access to1 the product is the result of the discontinuation of the product by the product manufacturer1 a market-wide shortage of the product1 or the introduction of a newer model or version of the product in the market involved4 4 7b7 ,codifying and expanding anti-switching rule ,section #ahdg7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;b771 as amended by subsection 7a77#a71 is further amended-- 7#a7 by redesignating paragraph 7#aa7 as paragraph 7#ab72 and 7#b7 by inserting after paragraph 7#aj7 the following new paragraph3 7#aa7 ,additional special rules in case of competition for diabetic testing strips 7,a7 ,in general ,with respect to an entity that is furnishing diabetic testing strip products to individuals under a contract entered into under the competitive acquisition program established under this section1 the entity shall furnish to each individual a brand of such products that is compatible with the home blood glucose monitor selected by the individual4 7,b7 ,prohibition on influencing and incentivizing ,an entity described in subparagraph 7,a7 may not attempt to influence or incentivize an individual to switch the brand of glucose monitor or diabetic testing strip product selected by the individual1 including by-- 7i7 persuading1 pressuring1 or advising the individual to switch2 or 7ii7 furnishing information about alternative brands to the individual where the individual has not requested such information4 7,c7 ,provision of information 7i7 ,standardized information ,not later than ,january #a1 #bjai1 the ,secretary shall develop and make available to entities described in subparagraph 7,a7 standardized information that describes the rights of an individual with respect to such an entity4 ,the information described in the preceding sentence shall include information regarding-- 7,i7 the requirements established under subparagraphs 7,a7 and 7,b72 7,,ii7 the right of the individual to purchase diabetic testing strip products from another mail order supplier of such products or a retail pharmacy 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 individual2 and 7,,iii7 the right of the individual to return diabetic testing strip products furnished to the individual by the entity4 7ii7 ,requirement ,with respect to diabetic testing strip products furnished on or after the date on which the ,secretary develops the standardized information under clause 7i71 an entity described in subparagraph 7,a7 may not communicate directly to an individual until the entity has verbally provided the individual with such standardized information4 7,d7 ,order refills ,with respect to diabetic testing strip products furnished on or after ,january #a1 #bjai1 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 #ad days prior to dispensing a refill of such products to the individual4 4 7c7 ,implementation2 non-application of the paperwork reduction act 7#a7 ,implementation ,notwithstanding any other provision of law1 the ,secretary of ,health and ,human ,services may implement the provisions of1 and amendments made by1 this section by program instruction or otherwise4 7#b7 ,non-application of the paperwork reduction act ,chapter #ce of title #dd1 ,united ,states ,code 7commonly referred to as the ,paperwork ,reduction ,act of #aiie71 shall not apply to this section or the amendments made by this section4 ,v ,other ,health ,extenders #beja4 ,extension for community health centers1 the ,national ,health ,service ,corps1 and teaching health centers that operate ,,gme programs 7a7 ,community health centers funding ,section #ajejc7;b77#a7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#a771 as amended by section #caja of ,public ,law #aae-if1 is amended by amending subparagraph 7,f7 to read as follows3 7,f7 #c1fjj1jjj1jjj for each of fiscal years #bjah and #bjai4 4 7b7 ,other community health centers provisions ,section #ccj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b7 is amended-- 7#a7 in subsection 7b77#a77;,a77ii71 by striking abuse and inserting use disorder2 7#b7 in subsection 7b77#b77;,a71 by striking abuse and inserting use disorder2 7#c7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking subparagraphs 7,b7 through 7,d72 7,b7 by striking 7#a7 ,in general and all that follows through ,the ,secretary and inserting the following3 7#a7 ,centers ,the ,secretary 2 and 7,c7 in paragraph 7#a71 as amended1 by redesignating clauses 7i7 through 7v7 as subparagraphs 7,a7 through 7,e7 and moving the margin of each of such redesignated subparagraph #b ems to the left2 7#d7 by striking subsection 7d7 and inserting the following3 7d7 ,improving quality of care 7#a7 ,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 services1 which may include models related to-- 7,a7 improving the delivery of care for individuals with multiple chronic conditions2 7,b7 workforce configuration2 7,c7 reducing the cost of care2 7,d7 enhancing care coordination2 7,e7 expanding the use of telehealth and technology-enabled collaborative learning and capacity building models2 7,f7 care integration1 including integration of behavioral health1 mental health1 or substance use disorder services2 and 7,g7 addressing emerging public health or substance use disorder issues to meet the health needs of the population served by the health center4 7#b7 ,sustainability ,in making supplemental awards under this subsection1 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 expended4 7#c7 ,special consideration ,the ,secretary may give special consideration to applications for supplemental funding under this subsection that seek to address significant barriers to access to care in areas with a greater shortage of health care providers and health services relative to the national average4 2 7#e7 in subsection 7e77#a7-- 7,a7 in subparagraph 7,b7-- 7i7 by striking #b years and inserting #a year2 and 7ii7 by adding at the end the following3 ,the ,secretary shall not make a grant under this paragraph unless the applicant provides assurances to the ,secretary that within #abj days of receiving grant funding for the operation of the health center1 the applicant will submit1 for approval by the ,secretary1 an implementation plan to meet the requirements of subsection 7k77#c74 ,the ,secretary may extend such #abj-;day period for achieving compliance upon a demonstration of good cause by the health center42 and 7,b7 in subparagraph 7,c7-- 7i7 in the subparagraph heading1 by striking and plans2 7ii7 by striking or plan 7as described in subparagraphs 7,b7 and 7,c7 of subsection 7c77#a772 7iii7 by striking or plan1 including the purchase and inserting the following3 8including-- 7i7 the purchase 2 7iv7 by inserting 1 which may include data and information systems after of equipment2 7v7 by striking the period at the end and inserting a semicolon2 and 7vi7 by adding at the end the following3 7ii7 the provision of training and technical assistance2 and 7iii7 other activities that-- 7,i7 reduce costs associated with the provision of health services2 7,,ii7 improve access to1 and availability of1 health services provided to individuals served by the centers2 7,,iii7 enhance the quality and coordination of health services2 or 7,,iv7 improve the health status of communities4 2 7#f7 in subsection 7e77#e77;,b7-- 7,a7 in the heading of subparagraph 7,b71 by striking and plans2 and 7,b7 by striking and subparagraphs 7,b7 and 7,c7 of subsection 7c77#a7 to a health center or to a network or plan and inserting to a health center or to a network2 7#g7 in subsection 7e71 by adding at the end the following3 7#f7 ,new access points and expanded services 7,a7 ,approval of new access points 7i7 ,in general ,the ,secretary may approve applications for grants under subparagraph 7,a7 or 7,b7 of paragraph 7#a7 to establish new delivery sites4 7ii7 ,special consideration ,in carrying out clause 7i71 the ,secretary may give special consideration to applicants that have demonstrated the new delivery site will be located within a sparsely populated area1 or an area which has a level of unmet need that is higher relative to other applicants4 7iii7 ,consideration of applications ,in carrying out clause 7i71 the ,secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by the applicants is not less than two to three or greater than three to two4 7iv7 ,service area overlap ,if in carrying out clause 7i7 the applicant proposes to serve an area that is currently served by another health center funded under this section1 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 area4 7,b7 ,approval of expanded service applications 7i7 ,in general ,the ,secretary may approve applications for grants under subparagraph 7,a7 or 7,b7 of paragraph 7#a7 to expand the capacity of the applicant to provide required primary health services described in subsection 7b77#a7 or additional health services described in subsection 7b77#b74 7ii7 ,priority expansion projects ,in carrying out clause 7i71 the ,secretary may give special consideration to expanded service applications that seek to address emerging public health or behavioral health1 mental health1 or substance abuse issues through increasing the availability of additional health services described in subsection 7b77#b7 in an area in which there are significant barriers to accessing care4 7iii7 ,consideration of applications ,in carrying out clause 7i71 the ,secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants 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 two4 2 7#h7 in subsection 7h7-- 7,a7 in paragraph 7#a71 by striking and children and youth at risk of homelessness and inserting 1 children and youth at risk of homelessness1 homeless veterans1 and veterans at risk of homelessness2 and 7,b7 in paragraph 7#e7-- 7i7 by striking subparagraph 7,b72 7ii7 by redesignating subparagraph 7,c7 as subparagraph 7,b72 and 7iii7 in subparagraph 7,b7 7as so redesignated7-- 7,i7 in the subparagraph heading1 by striking abuse and inserting use disorder2 and 7,,ii7 by striking abuse and inserting use disorder2 7#i7 in subsection 7k7-- 7,a7 in paragraph 7#b7-- 7i7 in the paragraph heading1 by inserting unmet before need2 7ii7 in the matter preceding subparagraph 7,a71 by inserting or subsection 7e77#f7 after subsection 7e77#a72 7iii7 in subparagraph 7,a71 by inserting unmet before need for health services2 7iv7 in subparagraph 7,b71 by striking and at the end2 7v7 in subparagraph 7,c71 by striking the period at the end and inserting 2 and2 and 7vi7 by adding after subparagraph 7,c7 the following3 7,d7 in the case of an application for a grant pursuant to subsection 7e77#f71 a demonstration that the applicant has consulted with appropriate ,state and local government agencies1 and health care providers regarding the need for the health services to be provided at the proposed delivery site4 2 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by inserting or subsection 7e77#f7 after subsection 7e77#a77;,b72 7ii7 in subparagraph 7,b71 by striking in the catchment area of the center and inserting 1 including other health care providers that provide care within the catchment area1 local hospitals1 and specialty providers in the catchment area of the center1 to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments2 7iii7 in subparagraph 7,h77ii71 by inserting who shall be directly employed by the center after approves the selection of a director for the center2 7iv7 in subparagraph 7,l71 by striking and at the end2 7v7 in subparagraph 7,m71 by striking the period and inserting 2 and2 and 7vi7 by inserting after subparagraph 7,m71 the following3 7,n7 the center has written policies and procedures in place to ensure the appropriate use of ,federal funds in compliance with applicable ,federal statutes1 regulations1 and the terms and conditions of the ,federal award4 2 and 7,c7 by striking paragraph 7#d72 7#aj7 in subsection 7l71 by adding at the end the following3 ,funds expended to carry out activities under this subsection and operational support activities under subsection 7m7 shall not exceed #c percent of the amount appropriated for this section for the fiscal year involved42 7#aa7 in subsection 7q77#d71 by adding at the end the following3 ,a waiver provided by the ,secretary under this paragraph may not remain in effect for more than #a year and may not be extended after such period4 ,an entity may not receive more than one waiver under this paragraph in consecutive years42 7#ab7 in subsection 7r77#c7-- 7,a7 by striking appropriate committees of ,congress a report concerning the distribution of funds under this section and inserting the following3 8,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate1 and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report including1 at a minimum-- 7,a7 the distribution of funds for carrying out this section 2 7,b7 by striking populations4 ,such report shall include an assessment and inserting the following3 8populations2 7,b7 an assessment 2 7,c7 by striking and the rationale for any substantial changes in the distribution of funds4 and inserting a semicolon2 and 7,d7 by adding at the end the following3 7,c7 the distribution of awards and funding for new or expanded services in each of rural areas and urban areas2 7,d7 the distribution of awards and funding for establishing new access points1 and the number of new access points created2 7,e7 the amount of unexpended funding for loan guarantees and loan guarantee authority under title ,,xvi2 7,f7 the rationale for any substantial changes in the distribution of funds2 7,g7 the rate of closures for health centers and access points2 7,h7 the number and reason for any grants awarded pursuant to subsection 7e77#a77;,b72 and 7,i7 the number and reason for any waivers provided pursuant to subsection 7q77#d74 2 7#ac7 in subsection 7r71 by adding at the end the following new paragraph3 7#e7 ,funding for participation of health centers in ,all of ,us ,research ,program ,in addition to any amounts made available pursuant to paragraph 7#a7 of this subsection1 section #djb;,a of this ,act1 or section #ajejc of the ,patient ,protection and ,affordable ,care ,act1 there is authorized to be appropriated1 and there is appropriated1 out of any monies in the ,treasury not otherwise appropriated1 to the ,secretary #be1jjj1jjj for fiscal year #bjah to support the participation of health centers in the ,all of ,us ,research ,program under the ,precision ,medicine ,initiative under section #dih;,e of this ,act4 2 and 7#ad7 by striking subsection 7s74 7c7 ,national ,health ,service ,corps ,section #ajejc7;b77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#b771 as amended by section #caja of ,public ,law #aae-if1 is amended by amending subparagraph 7,f7 to read as follows3 7,f7 #caj1jjj1jjj for each of fiscal years #bjah and #bjai4 4 7d7 ,teaching health centers that operate graduate medical education programs 7#a7 ,payments ,subsection 7a7 of section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended to read as follows3 7a7 ,payments 7#a7 ,in general ,subject to subsection 7h77#b71 the ,secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for1 as appropriate-- 7,a7 maintenance of filled positions at existing approved graduate medical residency training programs2 7,b7 expansion of existing approved graduate medical residency training programs2 and 7,c7 establishment of new approved graduate medical residency training programs4 7#b7 ,per resident amount ,in making payments under paragraph 7#a71 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 residency training programs at teaching health centers4 7#c7 ,priority ,in making payments under paragraph 7#a77;,c71 the ,secretary shall give priority to qualified teaching health centers that-- 7,a7 serve a health professional shortage area with a designation in effect under section #ccb or a medically underserved community 7as defined in section #gii;,b72 or 7,b7 are located in a rural area 7as defined in section #ahhf7;d77#b77;,d7 of the ,social ,security ,act74 4 7#b7 ,funding ,paragraph 7#a7 of section #cdj;,h7g7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7g771 as amended by section #caja of ,public ,law #aae-if1 is amended by striking and #cj1jjj1jjj for the period of the first and second quarters of fiscal year #bjah and inserting and #abf1ejj1jjj for each of fiscal years #bjah and #bjai4 7#c7 ,annual reporting ,subsection 7h77#a7 of section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended-- 7,a7 by redesignating subparagraph 7,d7 as subparagraph 7,h72 and 7,b7 by inserting after subparagraph 7,c7 the following3 7,d7 ,the number of patients treated by residents described in paragraph 7#d74 7,e7 ,the number of visits by patients treated by residents described in paragraph 7#d74 7,f7 ,of the number of residents described in paragraph 7#d7 who completed their residency training at the end of such residency academic year1 the number and percentage of such residents entering primary care practice 7meaning any of the areas of practice listed in the definition of a primary care residency program in section #gdi;,a74 7,g7 ,of the number of residents described in paragraph 7#d7 who completed their residency training at the end of such residency academic year1 the number and percentage of such residents who entered practice at a health care facility-- 7i7 primarily serving a health professional shortage area with a designation in effect under section #ccb or a medically underserved community 7as defined in section #gii;,b72 or 7ii7 located in a rural area 7as defined in section #ahhf7;d77#b77;,d7 of the ,social ,security ,act74 4 7#d7 ,report on training costs ,not later than ,march #ca1 #bjai1 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 programs1 and the indirect expenses associated with the additional costs of teaching residents1 of qualified teaching health centers 7as such terms are used or defined in section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h774 7#e7 ,definition ,subsection 7j7 of section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended-- 7,a7 by redesignating paragraphs 7#b7 and 7#c7 as paragraphs 7#c7 and 7#d71 respectively2 and 7,b7 by inserting after paragraph 7#a7 the following3 7#b7 ,new approved graduate medical residency training program ,the term new approved graduate medical residency training program means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year 7other than pursuant to subsection 7a77#a77;,c774 4 7#f7 ,technical correction ,subsection 7f7 of section #cdj;,h 7#db ,u4,s4,c4 #bef;h7 is amended by striking hospital each place it appears and inserting teaching health center4 7#g7 ,payments for previous fiscal years ,the provisions of section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h71 as in effect on the day before the date of enactment of ,public ,law #aae-if1 shall continue to apply with respect to payments under such section for fiscal years before fiscal year #bjah4 7e7 ,application ,amounts appropriated pursuant to this section for fiscal year #bjah or #bjai are subject to the requirements contained in ,public ,law #aae-ca for funds for programs authorized under sections #ccj through #cdj of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;b-#bef74 7f7 ,conforming amendment ,paragraph 7#d7 of section #cjad7;h7 of title #ah1 ,united ,states ,code1 as amended by section #caja of ,public ,law #aae-if1 is amended by striking and section #caja7;d7 of the ,,chip and ,public ,health ,funding ,extension ,act and inserting and section #beja7;e7 of the ,,sustain ,care ,act of #bjah4 #bejb4 ,extension for special diabetes programs 7a7 ,special diabetes program for type ,i diabetes ,subparagraph 7,d7 of section #ccj;,b7b77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b771 as amended by section #cajb of ,public ,law #aae-if1 is amended to read as follows3 7,d7 #aej1jjj1jjj for each of fiscal years #bjah and #bjai1 to remain available until expended4 4 7b7 ,special diabetes program for ,indians ,subparagraph 7,d7 of section #ccj;,c7c77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#c7;c77#b771 as amended by section #cajb of ,public ,law #aae-if1 is amended to read as follows3 7,d7 #aej1jjj1jjj for each of fiscal years #bjah and #bjai1 to remain available until expended4 4 #bejc4 ,extension for family-to-family health information centers ,section #eja7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77 is amended-- 7#a7 in paragraph 7#a77;,a7-- 7,a7 in clause 7v71 by striking and at the end2 7,b7 in clause 7vi71 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following new clause3 7vii7 #f1jjj1jjj for each of fiscal years #bjah and #bjai4 2 7#b7 in paragraph 7#c77;,c71 by inserting before the period the following3 1 and with respect to fiscal years #bjah and #bjai1 such centers shall also be developed in all territories and at least one such center shall be developed for ,indian ,tribes2 and 7#c7 by amending paragraph 7#e7 to read as follows3 7#e7 ,for purposes of this subsection-- 7,a7 the term ,indian ,tribe has the meaning given to the term ,indian tribe in section #d of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afjc72 7,b7 the term ,state means each of the #ej ,states and the ,district of ,columbia2 and 7,c7 the term territory means ,puerto ,rico1 ,guam1 ,american ,samoa1 the ,united ,states ,virgin ,islands1 and the ,northern ,mariana ,islands4 4 #bejd4 ,extension for sexual risk avoidance education 7a7 ,in general ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended to read as follows3 #eaj4 ,sexual risk avoidance education 7a7 ,in general 7#a7 ,allotments to ,states ,for the purpose described in subsection 7b71 the ,secretary shall1 for each of fiscal years #bjah and #bjai1 allot to each ,state which has transmitted an application for the fiscal year under section #eje7;a7 an amount equal to the product of-- 7,a7 the amount appropriated pursuant to subsection 7e77#a7 for the fiscal year1 minus the amount reserved under subsection 7e77#b7 for the fiscal year2 and 7,b7 the proportion that the number of low-income children in the ,state bears to the total of such numbers of children for all the ,states4 7#b7 ,other allotments 7,a7 ,other entities ,for the purpose described in subsection 7b71 the ,secretary shall1 for each of fiscal years #bjah and #bjai1 for any ,state which has not transmitted an application for the fiscal year under section #eje7;a71 allot to one or more entities in the ,state the amount that would have been allotted to the ,state under paragraph 7#a7 if the ,state had submitted such an application4 7,b7 ,process ,the ,secretary shall select the recipients of allotments under subparagraph 7,a7 by means of a competitive grant process under which-- 7i7 not later than #cj days after the deadline for the ,state involved to submit an application for the fiscal year under section #eje7;a71 the ,secretary publishes a notice soliciting grant applications2 and 7ii7 not later than #abj days after such deadline1 all such applications must be submitted4 7b7 ,purpose 7#a7 ,in general ,except for research under paragraph 7#e7 and information collection and reporting under paragraph 7#f71 the purpose of an allotment under subsection 7a7 to a ,state 7or to another entity in the ,state pursuant to subsection 7a77#b77 is to enable the ,state or other entity to implement education exclusively on sexual risk avoidance 7meaning voluntarily refraining from sexual activity74 7#b7 ,required components ,education on sexual risk avoidance pursuant to an allotment under this section shall-- 7,a7 ensure that the unambiguous and primary emphasis and context for each topic described in paragraph 7#c7 is a message to youth that normalizes the optimal health behavior of avoiding nonmarital sexual activity2 7,b7 be medically accurate and complete2 7,c7 be age-appropriate2 7,d7 be based on adolescent learning and developmental theories for the age group receiving the education2 and 7,e7 be culturally appropriate1 recognizing the experiences of youth from diverse communities1 backgrounds1 and experiences4 7#c7 ,topics ,education on sexual risk avoidance pursuant to an allotment under this section shall address each of the following topics3 7,a7 ,the holistic individual and societal benefits associated with personal responsibility1 self-regulation1 goal setting1 healthy decisionmaking1 and a focus on the future4 7,b7 ,the advantage of refraining from nonmarital sexual activity in order to improve the future prospects and physical and emotional health of youth4 7,c7 ,the increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity4 7,d7 ,the foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families4 7,e7 ,how other youth risk behaviors1 such as drug and alcohol usage1 increase the risk for teen sex4 7,f7 ,how to resist and avoid1 and receive help regarding1 sexual coercion and dating violence1 recognizing that even with consent teen sex remains a youth risk behavior4 7#d7 ,contraception ,education on sexual risk avoidance pursuant to an allotment under this section shall ensure that-- 7,a7 any information provided on contraception is medically accurate and complete and ensures that students understand that contraception offers physical risk reduction1 but not risk elimination2 and 7,b7 the education does not include demonstrations1 simulations1 or distribution of contraceptive devices4 7#e7 ,research 7,a7 ,in general ,a ,state or other entity receiving an allotment pursuant to subsection 7a7 may use up to #bj percent of such allotment to build the evidence base for sexual risk avoidance education by conducting or supporting research4 7,b7 ,requirements ,any research conducted or supported pursuant to subparagraph 7,a7 shall be-- 7i7 rigorous2 7ii7 evidence-based2 and 7iii7 designed and conducted by independent researchers who have experience in conducting and publishing research in peer-reviewed outlets4 7#f7 ,information collection and reporting ,a ,state or other entity receiving an allotment pursuant to subsection 7a7 shall1 as specified by the ,secretary-- 7,a7 collect information on the programs and activities funded through the allotment2 and 7,b7 submit reports to the ,secretary on the data from such programs and activities4 7c7 ,national evaluation 7#a7 ,in general ,the ,secretary shall-- 7,a7 in consultation with appropriate ,state and local agencies1 conduct one or more rigorous evaluations of the education funded through this section and associated data2 and 7,b7 submit a report to the ,congress on the results of such evaluations1 together with a summary of the information collected pursuant to subsection 7b77#f74 7#b7 ,consultation ,in conducting the evaluations required by paragraph 7#a71 including the establishment of rigorous evaluation methodologies1 the ,secretary shall consult with relevant stakeholders and evaluation experts4 7d7 ,applicability of certain provisions 7#a7 ,sections #ejc1 #ejg1 and #ejh apply to allotments under subsection 7a7 to the same extent and in the same manner as such sections apply to allotments under section #ejb7;c74 7#b7 ,sections #eje and #ejf apply to allotments under subsection 7a7 to the extent determined by the ,secretary to be appropriate4 7e7 ,definitions ,in this section3 7#a7 ,the term age-appropriate means suitable 7in terms of topics1 messages1 and teaching methods7 to the developmental and social maturity of the particular age or age group of children or adolescents1 based on developing cognitive1 emotional1 and behavioral capacity typical for the age or age group4 7#b7 ,the term medically accurate and complete means verified or supported by the weight of research conducted in compliance with accepted scientific methods and-- 7,a7 published in peer-reviewed journals1 where applicable2 or 7,b7 comprising information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate1 objective1 and complete4 7#c7 ,the term rigorous1 with respect to research or evaluation1 means using-- 7,a7 established scientific methods for measuring the impact of an intervention or program model in changing behavior 7specifically sexual activity or other sexual risk behaviors71 or reducing pregnancy1 among youth2 or 7,b7 other evidence-based methodologies established by the ,secretary for purposes of this section4 7#d7 ,the term youth refers to one or more individuals who have attained age #aj but not age #bj4 7f7 ,funding 7#a7 ,in general ,to carry out this section1 there is appropriated1 out of any money in the ,treasury not otherwise appropriated1 #ge1jjj1jjj for each of fiscal years #bjah and #bjai4 7#b7 ,reservation ,the ,secretary shall reserve1 for each of fiscal years #bjah and #bjai1 not more than #bj percent of the amount appropriated pursuant to paragraph 7#a7 for administering the program under this section1 including the conducting of national evaluations and the provision of technical assistance to the recipients of allotments4 4 7b7 ,effective date ,the amendment made by this section takes effect on ,october #a1 #bjag4 #beje4 ,extension for personal responsibility education 7a7 ,in general ,section #eac of the ,social ,security ,act 7#db ,u4,s4,c4 #gac7 is amended-- 7#a7 in subsection 7a77#a77;,a71 by striking #bjag and inserting #bjai2 and 7#b7 in subsection 7a77#d7-- 7,a7 in subparagraph 7,a71 by striking #bjag each place it appears and inserting #bjai2 and 7,b7 in subparagraph 7,b7-- 7i7 in the subparagraph heading1 by striking #c-year grants and inserting ,competitive ,,prep grants2 and 7ii7 in clause 7i71 by striking solicit applications to award #c-year grants in each of fiscal years #bjab through #bjag and inserting continue through fiscal year #bjai grants awarded for any of fiscal years #bjae through #bjag2 7#c7 in subsection 7c77#a71 by inserting after youth with ,,hiv_/,,aids1 the following3 victims of human trafficking12 and 7#d7 in subsection 7f71 by striking #bjag and inserting #bjai4 7b7 ,effective date ,the amendments made by this section take effect on ,october #a1 #bjag4 ,,vi ,child and ,family ,services and ,support ,a ,family ,first ,prevention ,services ,act #bfja4 ,short title ,this subtitle may be cited as the ,family ,first ,prevention ,services ,act4 #a ,investing in ,prevention and ,family ,services #bfaa4 ,purpose ,the purpose of this chapter 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 services1 in-home parent skill-based programs1 and kinship navigator services4 ,a ,prevention ,activities under ,title ,,iv-,e #bfba4 ,foster care prevention services and programs 7a7 ,state option ,section #dga of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7 is amended-- 7#a7 in subsection 7a77#a71 by striking and and all that follows through the semicolon and inserting 1 adoption assistance in accordance with section #dgc1 and1 at the option of the ,state1 services or programs specified in subsection 7e77#a7 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 children1 in accordance with the requirements of that subsection22 and 7#b7 by adding at the end the following3 7e7 ,prevention and family services and programs 7#a7 ,in general ,subject to the succeeding provisions of this subsection1 the ,secretary may make a payment to a ,state for providing the following services or programs for a child described in paragraph 7#b7 and the parents or kin caregivers of the child when the need of the child1 such a parent1 or such a caregiver for the services or programs are directly related to the safety1 permanence1 or well-being of the child or to preventing the child from entering foster care3 7,a7 ,mental health and substance abuse prevention and treatment services ,mental health and substance abuse prevention and treatment services provided by a qualified clinician for not more than a #ab-month period that begins on any date described in paragraph 7#c7 with respect to the child4 7,b7 ,in-home parent skill-based programs ,in-home parent skill-based programs for not more than a #ab-month period that begins on any date described in paragraph 7#c7 with respect to the child and that include parenting skills training1 parent education1 and individual and family counseling4 7#b7 ,child described ,for purposes of paragraph 7#a71 a child described in this paragraph is the following3 7,a7 ,a child who is a candidate for foster care 7as defined in section #dge7ac77 but can remain safely at home or in a kinship placement with receipt of services or programs specified in paragraph 7#a74 7,b7 ,a child in foster care who is a pregnant or parenting foster youth4 7#c7 ,date described ,for purposes of paragraph 7#a71 the dates described in this paragraph are the following3 7,a7 ,the date on which a child is identified in a prevention plan maintained under paragraph 7#d7 as a child who is a candidate for foster care 7as defined in section #dge7ac774 7,b7 ,the date on which a child is identified in a prevention plan maintained under paragraph 7#d7 as a pregnant or parenting foster youth in need of services or programs specified in paragraph 7#a74 7#d7 ,requirements related to providing services and programs ,services and programs specified in paragraph 7#a7 may be provided under this subsection only if specified in advance in the child's prevention plan described in subparagraph 7,a7 and the requirements in subparagraphs 7,b7 through 7,e7 are met3 7,a7 ,prevention plan ,the ,state maintains a written prevention plan for the child that meets the following requirements 7as applicable73 7i7 ,candidates ,in the case of a child who is a candidate for foster care described in paragraph 7#b77;,a71 the prevention plan shall-- 7,i7 identify the foster care prevention strategy for the child so that the child may remain safely at home1 live temporarily with a kin caregiver until reunification can be safely achieved1 or live permanently with a kin caregiver2 7,,ii7 list the services or programs to be provided to or on behalf of the child to ensure the success of that prevention strategy2 and 7,,iii7 comply with such other requirements as the ,secretary shall establish4 7ii7 ,pregnant or parenting foster youth ,in the case of a child who is a pregnant or parenting foster youth described in paragraph 7#b77;,b71 the prevention plan shall-- 7,i7 be included in the child's case plan required under section #dge7a72 7,,ii7 list the services or programs to be provided to or on behalf of the youth to ensure that the youth is prepared 7in the case of a pregnant foster youth7 or able 7in the case of a parenting foster youth7 to be a parent2 7,,iii7 describe the foster care prevention strategy for any child born to the youth2 and 7,,iv7 comply with such other requirements as the ,secretary shall establish4 7,b7 ,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 understanding1 recognizing1 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 trauma's consequences and facilitate healing4 7,c7 ,only services and programs provided in accordance with promising1 supported1 or well-supported practices permitted 7i7 ,in general ,only ,state expenditures for services or programs specified in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 that are provided in accordance with practices that meet the requirements specified in clause 7ii7 of this subparagraph and that meet the requirements specified in clause 7iii71 7iv71 or 7v71 respectively1 for being a promising1 supported1 or well-supported practice1 shall be eligible for a ,federal matching payment under section #dgd7;a77#f77;,a74 7ii7 ,general practice requirements ,the general practice requirements specified in this clause are the following3 7,i7 ,the practice has a book1 manual1 or other available writings that specify the components of the practice protocol and describe how to administer the practice4 7,,ii7 ,there is no empirical basis suggesting that1 compared to its likely benefits1 the practice constitutes a risk of harm to those receiving it4 7,,iii7 ,if multiple outcome studies have been conducted1 the overall weight of evidence supports the benefits of the practice4 7,,iv7 ,outcome measures are reliable and valid1 and are administrated consistently and accurately across all those receiving the practice4 7,v7 ,there is no case data suggesting a risk of harm that was probably caused by the treatment and that was severe or frequent4 7iii7 ,promising practice ,a practice shall be considered to be a promising practice if the practice is superior to an appropriate comparison practice using conventional standards of statistical significance 7in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes1 such as mental health1 substance abuse1 and child safety and well-being71 as established by the results or outcomes of at least one study that-- 7,i7 was rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed2 and 7,,ii7 utilized some form of control 7such as an untreated group1 a placebo group1 or a wait list study74 7iv7 ,supported practice ,a practice shall be considered to be a supported practice if-- 7,i7 the practice is superior to an appropriate comparison practice using conventional standards of statistical significance 7in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes1 such as mental health1 substance abuse1 and child safety and well-being71 as established by the results or outcomes of at least one study that-- 7aa7 was rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed2 7bb7 was a rigorous random-controlled trial 7or1 if not available1 a study using a rigorous quasi-experimental research design72 and 7cc7 was carried out in a usual care or practice setting2 and 7,,ii7 the study described in subclause 7,i7 established that the practice has a sustained effect 7when compared to a control group7 for at least #f months beyond the end of the treatment4 7v7 ,well-supported practice ,a practice shall be considered to be a well-supported practice if-- 7,i7 the practice is superior to an appropriate comparison practice using conventional standards of statistical significance 7in terms of demonstrated meaningful improvements in validated measures of important child and parent outcomes1 such as mental health1 substance abuse1 and child safety and well-being71 as established by the results or outcomes of at least two studies that-- 7aa7 were rated by an independent systematic review for the quality of the study design and execution and determined to be well-designed and well-executed2 7bb7 were rigorous random-controlled trials 7or1 if not available1 studies using a rigorous quasi-experimental research design72 and 7cc7 were carried out in a usual care or practice setting2 and 7,,ii7 at least one of the studies described in subclause 7,i7 established that the practice has a sustained effect 7when compared to a control group7 for at least #a year beyond the end of treatment4 7,d7 ,guidance on practices criteria and pre-approved services and programs 7i7 ,in general ,not later than ,october #a1 #bjah1 the ,secretary shall issue guidance to ,states regarding the practices criteria required for services or programs to satisfy the requirements of subparagraph 7,c74 ,the guidance shall include a pre-approved list of services and programs that satisfy the requirements4 7ii7 ,updates ,the ,secretary shall issue updates to the guidance required by clause 7i7 as often as the ,secretary determines necessary4 7,e7 ,outcome assessment and reporting ,the ,state shall collect and report to the ,secretary the following information with respect to each child for whom1 or on whose behalf mental health and substance abuse prevention and treatment services or in-home parent skill-based programs are provided during a #ab-month period beginning on the date the child is determined by the ,state to be a child described in paragraph 7#b73 7i7 ,the specific services or programs provided and the total expenditures for each of the services or programs4 7ii7 ,the duration of the services or programs provided4 7iii7 ,in the case of a child described in paragraph 7#b77;,a71 the child's placement status at the beginning1 and at the end1 of the #a-year period1 respectively1 and whether the child entered foster care within #b years after being determined a candidate for foster care4 7#e7 ,state plan component 7,a7 ,in general ,a ,state electing to provide services or programs specified in paragraph 7#a7 shall submit as part of the ,state plan required by subsection 7a7 a prevention services and programs plan component that meets the requirements of subparagraph 7,b74 7,b7 ,prevention services and programs plan component ,in order to meet the requirements of this subparagraph1 a prevention services and programs plan component1 with respect to each #e-year period for which the plan component is in operation in the ,state1 shall include the following3 7i7 ,how providing services and programs specified in paragraph 7#a7 is expected to improve specific outcomes for children and families4 7ii7 ,how the ,state will monitor and oversee the safety of children who receive services and programs specified in paragraph 7#a71 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 maintained for the child under paragraph 7#d7 for the provision of the services or programs if the ,state determines the risk of the child entering foster care remains high despite the provision of the services or programs4 7iii7 ,with respect to the services and programs specified in subparagraphs 7,a7 and 7,b7 of paragraph 7#a71 information on the specific promising1 supported1 or well-supported practices the ,state plans to use to provide the services or programs1 including a description of-- 7,i7 the services or programs and whether the practices used are promising1 supported1 or well-supported2 7,,ii7 how the ,state plans to implement the services or programs1 including how implementation of the services or programs will be continuously 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 practices2 7,,iii7 how the ,state selected the services or programs2 7,,iv7 the target population for the services or programs2 and 7,v7 how each service or program provided will be evaluated through a well-designed and rigorous process1 which may consist of an ongoing1 cross-site evaluation approved by the ,secretary4 7iv7 ,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 programs1 including mental health and substance abuse prevention and treatment services1 and with other public and private agencies with experience in administering child and family services1 including community-based organizations1 in order to foster a continuum of care for children described in paragraph 7#b7 and their parents or kin caregivers4 7v7 ,a description of how the ,state shall assess children and their parents or kin caregivers to determine eligibility for services or programs specified in paragraph 7#a74 7vi7 ,a description of how the services or programs specified in paragraph 7#a7 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 #a and #b of part ,b4 7vii7 ,descriptions of steps the ,state is taking to support and enhance a competent1 skilled1 and professional child welfare workforce to deliver trauma-informed and evidence-based services1 including-- 7,i7 ensuring that staff is qualified to provide services or programs that are consistent with the promising1 supported1 or well-supported practice models selected2 and 7,,ii7 developing appropriate prevention plans1 and conducting the risk assessments required under clause 7iii74 7viii7 ,a description of how the ,state will provide training and support for caseworkers in assessing what children and their families need1 connecting to the families served1 knowing how to access and deliver the needed trauma-informed and evidence-based services1 and overseeing and evaluating the continuing appropriateness of the services4 7ix7 ,a description of how caseload size and type for prevention caseworkers will be determined1 managed1 and overseen4 7x7 ,an assurance that the ,state will report to the ,secretary such information and data as the ,secretary may require with respect to the provision of services and programs specified in paragraph 7#a71 including information and data necessary to determine the performance measures for the ,state under paragraph 7#f7 and compliance with paragraph 7#g74 7,c7 ,reimbursement for services under the prevention plan component 7i7 ,limitation ,except as provided in subclause 7ii71 a ,state may not receive a ,federal payment under this part for a given promising1 supported1 or well-supported practice unless 7in accordance with subparagraph 7,b77iii77,v77 the plan includes a well-designed and rigorous evaluation strategy for that practice4 7ii7 ,waiver of limitation ,the ,secretary may waive the requirement for a well-designed and rigorous evaluation of any well-supported practice if the ,secretary deems the evidence of the effectiveness of the practice to be compelling and the ,state meets the continuous quality improvement requirements included in subparagraph 7,b77iii77,,ii7 with regard to the practice4 7#f7 ,prevention services measures 7,a7 ,establishment2 annual updates ,beginning with fiscal year #bjba1 and annually thereafter1 the ,secretary 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 7#a73 7i7 ,percentage of candidates for foster care who do not enter foster care ,the percentage of candidates for foster care for whom1 or on whose behalf1 the services or programs are provided who do not enter foster care1 including those placed with a kin caregiver outside of foster care1 during the #ab-month period in which the services or programs are provided and through the end of the succeeding #ab-month period4 7ii7 ,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 programs1 respectively1 for1 or on behalf of1 each child described in paragraph 7#b74 7,b7 ,data ,the ,secretary shall establish and annually update the prevention services measures-- 7i7 based on the median ,state values of the information reported under each clause of subparagraph 7,a7 for the #c then most recent years2 and 7ii7 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 determines appropriate4 7,c7 ,publication of ,state prevention services measures ,the ,secretary shall annually make available to the public the prevention services measures of each ,state4 7#g7 ,maintenance of effort for ,state foster care prevention expenditures 7,a7 ,in general ,if a ,state elects to provide services and programs specified in paragraph 7#a7 for a fiscal year1 the ,state foster care prevention expenditures for the fiscal year shall not be less than the amount of the expenditures for fiscal year #bjad 7or1 at the option of a ,state described in subparagraph 7,e71 fiscal year #bjae or fiscal year #bjaf 7whichever the ,state elects774 7,b7 ,state foster care prevention expenditures ,the term ,state foster care prevention expenditures means the following3 7i7 ,,tanf2 ,,iv-,b2 ,,ssbg ,state expenditures for foster care prevention services and activities under the ,state program funded under part ,a 7including from amounts made available by the ,federal ,government71 under the ,state plan developed under part ,b 7including any such amounts71 or under the ,social ,services ,block ,grant ,programs under subtitle ,a of title ,,xx 7including any such amounts74 7ii7 ,other ,state programs ,state expenditures for foster care prevention services and activities under any ,state program that is not described in clause 7i7 7other than any ,state expenditures for foster care prevention services and activities under the ,state program under this part 7including under a waiver of the program774 7,c7 ,state expenditures ,the term ,state expenditures 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 ,government4 7,d7 ,determination of prevention services and activities ,the ,secretary shall require each ,state that elects to provide services and programs specified in paragraph 7#a7 to report the expenditures specified in subparagraph 7,b7 for fiscal year #bjad and for such fiscal years thereafter as are necessary to determine whether the ,state is complying with the maintenance of effort requirement in subparagraph 7,a74 ,the ,secretary shall specify the specific services and activities under each program referred to in subparagraph 7,b7 that are prevention services and activities for purposes of the reports4 7,e7 ,state described ,for purposes of subparagraph 7,a71 a ,state is described in this subparagraph if the population of children in the ,state in #bjad was less than #bjj1jjj 7as determined by the ,bureau of the ,census74 7#h7 ,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 paragraph 7#a7 shall not use any ,state foster care prevention expenditures for a fiscal year for the ,state share of expenditures under section #dgd7;a77#f7 for a fiscal year4 7#i7 ,administrative costs ,expenditures described in section #dgd7;a77#f77;,b7-- 7,a7 shall not be eligible for payment under subparagraph 7,a71 7,b71 or 7,e7 of section #dgd7;a77#c72 and 7,b7 shall be eligible for payment under section #dgd7;a77#f77;,b7 without regard to whether the expenditures are incurred on behalf of a child who is1 or is potentially1 eligible for foster care maintenance payments under this part4 7#aj7 ,application 7,a7 ,in general ,the provision of services or programs under this subsection to or on behalf of a child described in paragraph 7#b7 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 ,act4 7,b7 ,candidates in kinship care ,a child described in paragraph 7#b7 for whom such services or programs under this subsection are provided for more than #f months while in the home of a kin caregiver1 and who would satisfy the ,,afdc eligibility requirement of section #dgb7;a77#c77;,a77ii77,,ii7 but for residing in the home of the caregiver for more than #f months1 is deemed to satisfy that requirement for purposes of determining whether the child is eligible for foster care maintenance payments under section #dgb4 4 7b7 ,definition ,section #dge of such ,act 7#db ,u4,s4,c4 #fge7 is amended by adding at the end the following3 7#ac7 ,the term child who is a candidate for foster care means1 a child who is identified in a prevention plan under section #dga7;e77#d77;,a7 as being at imminent risk of entering foster care 7without regard to whether the child would be eligible for foster care maintenance payments under section #dgb or is or would be eligible for adoption assistance or kinship guardianship assistance payments under section #dgc7 but who can remain safely in the child's home or in a kinship placement as long as services or programs specified in section #dga7;e77#a7 that are necessary to prevent the entry of the child into foster care are provided4 ,the term includes a child whose adoption or guardianship arrangement is at risk of a disruption or dissolution that would result in a foster care placement4 4 7c7 ,payments under title ,,iv-,e ,section #dgd7;a7 of such ,act 7#db ,u4,s4,c4 #fgd7;a77 is amended-- 7#a7 in paragraph 7#e71 by striking the period at the end and inserting 2 plus2 and 7#b7 by adding at the end the following3 7#f7 subject to section #dga7;e7-- 7,a7 for each quarter-- 7i7 subject to clause 7ii7-- 7,i7 beginning after ,september #cj1 #bjai1 and before ,october #a1 #bjbf1 an amount equal to #ej percent of the total amount expended during the quarter for the provision of services or programs specified in subparagraph 7,a7 or 7,b7 of section #dga7;e77#a7 that are provided in accordance with promising1 supported1 or well-supported practices that meet the applicable criteria specified for the practices in section #dga7;e77#d77;,c72 and 7,,ii7 beginning after ,september #cj1 #bjbf1 an amount equal to the ,federal medical assistance percentage 7which shall be as defined in section #aije7;b71 in the case of a ,state other than the ,district of ,columbia1 or #gj percent1 in the case of the ,district of ,columbia7 of the total amount expended during the quarter for the provision of services or programs specified in subparagraph 7,a7 or 7,b7 of section #dga7;e77#a7 that are provided in accordance with promising1 supported1 or well-supported practices that meet the applicable criteria specified for the practices in section #dga7;e77#d77;,c7 7or1 with respect to the payments made during the quarter under a cooperative agreement or contract entered into by the ,state and an ,indian tribe1 tribal organization1 or tribal consortium for the administration or payment of funds under this part1 an amount equal to the ,federal medical assistance percentage that would apply under section #dgi;,b7d7 7in this paragraph referred to as the tribal ,,fmap7 if the ,indian tribe1 tribal organization1 or tribal consortium made the payments under a program operated under that section1 unless the tribal ,,fmap is less than the ,federal medical assistance percentage that applies to the ,state72 except that 7ii7 not less than #ej percent of the total amount expended by a ,state under clause 7i7 for a fiscal year shall be for the provision of services or programs specified in subparagraph 7,a7 or 7,b7 of section #dga7;e77#a7 that are provided in accordance with well-supported practices2 plus 7,b7 for each quarter specified in subparagraph 7,a71 an amount equal to the sum of the following proportions of the total amount expended during the quarter-- 7i7 #ej 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 #dga7;e77#a71 including expenditures for activities approved by the ,secretary that promote the development of necessary processes and procedures to establish and implement the provision of the services and programs for individuals who are eligible for the services and programs and expenditures attributable to data collection and reporting2 and 7ii7 #ej percent of so much of the expenditures with respect to the provision of services and programs specified in section #dga7;e77#a7 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 #dga7;e77#b7 and their parents or kin caregivers1 including on how to determine who are individuals eligible for the services or programs1 how to identify and provide appropriate services and programs1 and how to oversee and evaluate the ongoing appropriateness of the services and programs4 4 7d7 ,technical assistance and best practices1 clearinghouse1 and data collection and evaluations ,section #dgf of such ,act 7#db ,u4,s4,c4 #fgf7 is amended by adding at the end the following3 7d7 ,technical assistance and best practices1 clearinghouse1 data collection1 and evaluations relating to prevention services and programs 7#a7 ,technical assistance and best practices ,the ,secretary shall provide to ,states and1 as applicable1 to ,indian tribes1 tribal organizations1 and tribal consortia1 technical assistance regarding the provision of services and programs described in section #dga7;e77#a7 and shall disseminate best practices with respect to the provision of the services and programs1 including how to plan and implement a well-designed and rigorous evaluation of a promising1 supported1 or well-supported practice4 7#b7 ,clearinghouse of promising1 supported1 and well-supported practices ,the ,secretary shall1 directly or through grants1 contracts1 or interagency agreements1 evaluate research on the practices specified in clauses 7iii71 7iv71 and 7v71 respectively1 of section #dga7;e77#d77;,c71 and programs that meet the requirements described in section #dbg7;a77#a71 including culturally specific1 or location- or population-based adaptations of the practices1 to identify and establish a public clearinghouse of the practices that satisfy each category described by such clauses4 ,in addition1 the clearinghouse shall include information on the specific outcomes associated with each practice1 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 children4 7#c7 ,data collection and evaluations ,the ,secretary1 directly or through grants1 contracts1 or interagency agreements1 may collect data and conduct evaluations with respect to the provision of services and programs described in section #dga7;e77#a7 for purposes of assessing the extent to which the provision of the services and programs-- 7,a7 reduces the likelihood of foster care placement2 7,b7 increases use of kinship care arrangements2 or 7,c7 improves child well-being4 7#d7 ,reports to ,congress 7,a7 ,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 periodic reports based on the provision of services and programs described in section #dga7;e77#a7 and the activities carried out under this subsection4 7,b7 ,public availability ,the ,secretary shall make the reports to the ,congress submitted under this paragraph publicly available4 7#e7 ,appropriation ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated to the ,secretary #a1jjj1jjj for fiscal year #bjah and each fiscal year thereafter to carry out this subsection4 4 7e7 ,application to programs operated by ,indian tribal organizations 7#a7 ,in general ,section #dgi;,b of such ,act 7#db ,u4,s4,c4 #fgi;c7 is amended-- 7,a7 in subsection 7c77#a7-- 7i7 in subparagraph 7,c77i7-- 7,i7 in subclause 7,,ii71 by striking and after the semicolon2 7,,ii7 in subclause 7,,iii71 by striking the period at the end and inserting 2 and2 and 7,,iii7 by adding at the end the following3 7,,iv7 at the option of the tribe1 organization1 or consortium1 services and programs specified in section #dga7;e77#a7 to children described in section #dga7;e77#b7 and their parents or kin caregivers1 in accordance with section #dga7;e7 and subparagraph 7,e74 2 and 7ii7 by adding at the end the following3 7,e7 ,prevention services and programs for children and their parents and kin caregivers 7i7 ,in general ,in the case of a tribe1 organization1 or consortium that elects to provide services and programs specified in section #dga7;e77#a7 to children described in section #dga7;e77#b7 and their parents or kin caregivers under the plan1 the ,secretary shall specify the requirements applicable to the provision of the services and programs4 ,the requirements shall1 to the greatest extent practicable1 be consistent with the requirements applicable to ,states under section #dga7;e7 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 served4 7ii7 ,performance measures ,the ,secretary shall establish specific performance measures for each tribe1 organization1 or consortium that elects to provide services and programs specified in section #dga7;e77#a74 ,the performance measures shall1 to the greatest extent practicable1 be consistent with the prevention services measures required for ,states under section #dga7;e77#f7 but shall allow for consideration of factors unique to the provision of the services by tribes1 organizations1 or consortia4 2 and 7,b7 in subsection 7d77#a71 by striking and 7#e7 and inserting 7#e71 and 7#f77;,a74 7#b7 ,conforming amendment ,the heading for subsection 7d7 of section #dgi;,b of such ,act 7#db ,u4,s4,c4 #fgi;c7 is amended by striking for ,foster ,care ,maintenance and ,adoption ,assistance ,payments4 7f7 ,application to programs operated by territories ,section #aajh7;a77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;a77#b77 is amended by striking or #dac7;f7 and inserting #dac7;f71 or #dgd7;a77#f74 #bfbb4 ,foster care maintenance payments for children with parents in a licensed residential family-based treatment facility for substance abuse 7a7 ,in general ,section #dgb of the ,social ,security ,act 7#db ,u4,s4,c4 #fgb7 is amended-- 7#a7 in subsection 7a77#b77;,c71 by striking or and inserting 1 with a parent residing in a licensed residential family-based treatment facility1 but only to the extent permitted under subsection 7j71 or in a 2 and 7#b7 by adding at the end the following3 7j7 ,children placed with a parent residing in a licensed residential family-based treatment facility for substance abuse 7#a7 ,in general ,notwithstanding the preceding provisions of this section1 a child who is eligible for foster care maintenance payments under this section1 or who would be eligible for the payments if the eligibility were determined without regard to paragraphs 7#a77;,b7 and 7#c7 of subsection 7a71 shall be eligible for the payments for a period of not more than #ab months during which the child is placed with a parent who is in a licensed residential family-based treatment facility for substance abuse1 but only if-- 7,a7 the recommendation for the placement is specified in the child's case plan before the placement2 7,b7 the treatment facility provides1 as part of the treatment for substance abuse1 parenting skills training1 parent education1 and individual and family counseling2 and 7,c7 the substance abuse treatment1 parenting skills training1 parent education1 and individual and family counseling is provided under an organizational structure and treatment framework that involves understanding1 recognizing1 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 healing4 7#b7 ,application ,with respect to children for whom foster care maintenance payments are made under paragraph 7#a71 only the children who satisfy the requirements of paragraphs 7#a77;,b7 and 7#c7 of subsection 7a7 shall be considered to be children with respect to whom foster care maintenance payments are made under this section for purposes of subsection 7h7 or section #dgc7;b77#c77;,b74 4 7b7 ,conforming amendment ,section #dgd7;a77#a7 of such ,act 7#db ,u4,s4,c4 #fgd7;a77#a77 is amended by inserting subject to section #dgb7;j71 before an amount equal to the ,federal the first place it appears4 #bfbc4 ,title ,,iv-,e payments for evidence-based kinship navigator programs ,section #dgd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fgd7;a771 as amended by section #bfba7;c7 of this ,act1 is amended-- 7#a7 in paragraph 7#f71 by striking the period at the end and inserting 2 plus2 and 7#b7 by adding at the end the following3 7#g7 an amount equal to #ej 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 #dbg7;a77#a7 and that the ,secretary determines are operated in accordance with promising1 supported1 or well-supported practices that meet the applicable criteria specified for the practices in section #dga7;e77#d77;,c71 without regard to whether the expenditures are incurred on behalf of children who are1 or are potentially1 eligible for foster care maintenance payments under this part4 4 ,b ,enhanced support under ,title ,,iv-,b #bfca4 ,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 7a7 ,in general ,section #dca7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi;a7a77#g77 is amended-- 7#a7 in the paragraph heading1 by striking ,time-limited family and inserting ,family2 and 7#b7 in subparagraph 7,a7-- 7,a7 by striking time-limited family and inserting family2 7,b7 by inserting or a child who has been returned home after child care institution2 and 7,c7 by striking 1 but only during the #ae-month period that begins on the date that the child1 pursuant to section #dge7e77;,f71 is considered to have entered foster care and inserting and to ensure the strength and stability of the reunification4 ,in the case of a child who has been returned home1 the services and activities shall only be provided during the #ae-month period that begins on the date that the child returns home4 7b7 ,conforming amendments 7#a7 ,section #dcj of such ,act 7#db ,u4,s4,c4 #fbi7 is amended in the matter preceding paragraph 7#a71 by striking time-limited4 7#b7 ,subsections 7a77#d71 7a77#e77;,a71 and 7b77#a7 of section #dcb of such ,act 7#db ,u4,s4,c4 #fbi;b7 are amended by striking time-limited each place it appears4 #bfcb4 ,reducing bureaucracy and unnecessary delays when placing children in homes across ,state lines 7a7 ,state plan requirement 7#a7 ,in general ,section #dga7;a77#be7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77#be77 is amended-- 7,a7 by striking provide and inserting provides2 and 7,b7 by inserting 1 which1 in the case of a ,state other than the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 and ,american ,samoa1 not later than ,october #a1 #bjbg1 shall include the use of an electronic interstate case-processing system before the first semicolon4 7#b7 ,exemption of ,indian tribes ,section #dgi;,b7c7 of such ,act 7#db ,u4,s4,c4 #fgi;c7c77 is amended by adding at the end the following3 7#d7 ,inapplicability of ,state plan requirement to have in effect procedures providing for the use of an electronic interstate case-processing system ,the requirement in section #dga7;a77#be7 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 tribe1 tribal organization1 or tribal consortium that elects to operate a program under this part4 4 7b7 ,funding for the development of an electronic interstate case-processing system to expedite the interstate placement of children in foster care or guardianship1 or for adoption ,section #dcg of such ,act 7#db ,u4,s4,c4 #fbi;g7 is amended by adding at the end the following3 7g7 ,funding for the development of an electronic interstate case-processing system to expedite the interstate placement of children in foster care or guardianship1 or for adoption 7#a7 ,purpose ,the purpose of this subsection is to facilitate the development of an electronic interstate case-processing system for the exchange of data and documents to expedite the placements of children in foster1 guardianship1 or adoptive homes across ,state lines4 7#b7 ,requirements ,a ,state that seeks funding under this subsection shall submit to the ,secretary the following information3 7,a7 ,a description of the goals and outcomes to be achieved1 which goals and outcomes must result in-- 7i7 reducing the time it takes for a child to be provided with a safe and appropriate permanent living arrangement across ,state lines2 7ii7 improving administrative processes and reducing costs in the foster care system2 and 7iii7 the secure exchange of relevant case files and other necessary materials in real time1 and timely communications and placement decisions regarding interstate placements of children4 7,b7 ,a description of the activities to be funded in whole or in part with the funds1 including the sequencing of the activities4 7,c7 ,a description of the strategies for integrating programs and services for children who are placed across ,state lines4 7,d7 ,such other information as the ,secretary may require4 7#c7 ,funding authority ,the ,secretary may provide funds to a ,state that complies with paragraph 7#b74 ,in providing funds under this subsection1 the ,secretary shall prioritize ,states that are not yet connected with the electronic interstate case-processing system referred to in paragraph 7#a74 7#d7 ,use of funds ,a ,state to which funding is provided under this subsection shall use the funding to support the ,state in connecting with1 or enhancing or expediting services provided under1 the electronic interstate case-processing system referred to in paragraph 7#a74 7#e7 ,evaluations ,not later than #a year after the final year in which funds are awarded under this subsection1 the ,secretary shall submit to the ,congress1 and make available to the general public by posting on a website1 a report that contains the following information3 7,a7 ,how using the electronic interstate case-processing system developed pursuant to paragraph 7#d7 has changed the time it takes for children to be placed across ,state lines4 7,b7 ,the number of cases subject to the ,interstate ,compact on the ,placement of ,children that were processed through the electronic interstate case-processing system1 and the number of interstate child placement cases that were processed outside the electronic interstate case-processing system1 by each ,state in each year4 7,c7 ,the progress made by ,states in implementing the electronic interstate case-processing system4 7,d7 ,how using the electronic interstate case-processing system has affected various metrics related to child safety and well-being1 including the time it takes for children to be placed across ,state lines4 7,e7 ,how using the electronic interstate case-processing system has affected administrative costs and caseworker time spent on placing children across ,state lines4 7#f7 ,data integration ,the ,secretary1 in consultation with the ,secretariat for the ,interstate ,compact on the ,placement of ,children and the ,states1 shall assess how the electronic interstate case-processing system developed pursuant to paragraph 7#d7 could be used to better serve and protect children that come to the attention of the child welfare system1 by-- 7,a7 connecting the system with other data systems 7such as systems operated by ,state law enforcement and judicial agencies1 systems operated by the ,federal ,bureau of ,investigation for the purposes of the ,innocence ,lost ,national ,initiative1 and other systems72 7,b7 simplifying and improving reporting related to paragraphs 7#cd7 and 7#ce7 of section #dga7;a7 regarding children or youth who have been identified as being a sex trafficking victim or children missing from foster care2 and 7,c7 improving the ability of ,states to quickly comply with background check requirements of section #dga7;a77#bj71 including checks of child abuse and neglect registries as required by section #dga7;a77#bj77;,b74 4 7c7 ,reservation of funds to improve the interstate placement of children ,section #dcg7;b7 of such ,act 7#db ,u4,s4,c4 #fbi;g7b77 is amended by adding at the end the following3 7#d7 ,improving the interstate placement of children ,the ,secretary shall reserve #e1jjj1jjj of the amount made available for fiscal year #bjah for grants under subsection 7g71 and the amount so reserved shall remain available through fiscal year #bjbb4 4 #bfcc4 ,enhancements to grants to improve well-being of families affected by substance abuse ,section #dcg7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbi;g7f77 is amended-- 7#a7 in the subsection heading1 by striking increase the well-being of1 and to improve the permanency outcomes for1 children affected by and inserting implement ,,iv-,e prevention services1 and improve the well-being of1 and improve permanency outcomes for1 children and families affected by heroin1 opioids1 and other2 7#b7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,regional partnership defined ,in this subsection1 the term regional partnership means a collaborative agreement 7which may be established on an interstate1 ,state1 or intrastate basis7 entered into by the following3 7,a7 ,mandatory partners for all partnership grants 7i7 ,the ,state child welfare agency that is responsible for the administration of the ,state plan under this part and part ,e4 7ii7 ,the ,state agency responsible for administering the substance abuse prevention and treatment block grant provided under subpart ,,ii of part ,b of title ,,xix of the ,public ,health ,service ,act4 7,b7 ,mandatory partners for partnership grants proposing to serve children in out-of-home placements ,if the partnership proposes to serve children in out-of-home placements1 the ,juvenile ,court or ,administrative ,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 attention of the court due to child abuse or neglect4 7,c7 ,optional partners ,at the option of the partnership1 any of the following3 7i7 ,an ,indian tribe or tribal consortium4 7ii7 ,nonprofit child welfare service providers4 7iii7 ,for-profit child welfare service providers4 7iv7 ,community health service providers1 including substance abuse treatment providers4 7v7 ,community mental health providers4 7vi7 ,local law enforcement agencies4 7vii7 ,school personnel4 7viii7 ,tribal child welfare agencies 7or a consortia of the agencies74 7ix7 ,any other providers1 agencies1 personnel1 officials1 or entities that are related to the provision of child and family services under a ,state plan approved under this subpart4 7,d7 ,exception for regional partnerships where the lead applicant is an ,indian tribe or tribal consortia ,if an ,indian tribe or tribal consortium enters into a regional partnership for purposes of this subsection1 the ,indian tribe or tribal consortium-- 7i7 may 7but is not required to7 include the ,state child welfare agency as a partner in the collaborative agreement2 7ii7 may not enter into a collaborative agreement only with tribal child welfare agencies 7or a consortium of the agencies72 and 7iii7 if the condition described in paragraph 7#b77;,b7 applies1 may include tribal court organizations in lieu of other judicial partners4 2 7#c7 in paragraph 7#c7-- 7,a7 in subparagraph 7,a7-- 7i7 by striking #bjab through #bjaf and inserting #bjag through #bjba2 and 7ii7 by striking #ejj1jjj and not more than #a1jjj1jjj and inserting #bej1jjj and not more than #a1jjj1jjj2 7,b7 in subparagraph 7,b7-- 7i7 in the subparagraph heading1 by inserting 2 planning after approval2 7ii7 in clause 7i71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii72 and 7iii7 by adding at the end the following3 7iii7 ,sufficient planning ,a grant awarded under this subsection shall be disbursed in two phases3 a planning phase 7not to exceed #b years7 and an implementation phase4 ,the total disbursement to a grantee for the planning phase may not exceed #bej1jjj1 and may not exceed the total anticipated funding for the implementation phase4 2 and 7,c7 by adding at the end the following3 7,d7 ,limitation on payment for a fiscal year ,no payment shall be made under subparagraph 7,a7 or 7,c7 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 partnership4 2 7#d7 in paragraph 7#d7-- 7,a7 in subparagraph 7,b7-- 7i7 in clause 7i71 by inserting 1 parents1 and families after children2 7ii7 in clause 7ii71 by striking safety and permanence for such children2 and and inserting safe1 permanent caregiving relationships for the children22 7iii7 in clause 7iii71 by striking or and inserting increase reunification rates for children who have been placed in out-of-home care1 or decrease2 and 7iv7 by redesignating clause 7iii7 as clause 7v7 and inserting after clause 7ii7 the following3 7iii7 improve the substance abuse treatment outcomes for parents including retention in treatment and successful completion of treatment2 7iv7 facilitate the implementation1 delivery1 and effectiveness of prevention services and programs under section #dga7;e72 and 2 7,b7 in subparagraph 7,d71 by striking where appropriate12 and 7,c7 by striking subparagraphs 7,e7 and 7,f7 and inserting the following3 7,e7 ,a description of a plan for sustaining the services provided by or activities funded under the grant after the conclusion of the grant period1 including through the use of prevention services and programs under section #dga7;e7 and other funds provided to the ,state for child welfare and substance abuse prevention and treatment services4 7,f7 ,additional information needed by the ,secretary to determine that the proposed activities and implementation will be consistent with research or evaluations showing which practices and approaches are most effective4 2 7#e7 in paragraph 7#e77;,a71 by striking abuse treatment and inserting use disorder treatment including medication assisted treatment and in-home substance abuse disorder treatment and recovery2 7#f7 in paragraph 7#g7-- 7,a7 by striking and at the end of subparagraph 7,c72 and 7,b7 by redesignating subparagraph 7,d7 as subparagraph 7,e7 and inserting after subparagraph 7,c7 the following3 7,d7 demonstrate a track record of successful collaboration among child welfare1 substance abuse disorder treatment and mental health agencies2 and 2 7#g7 in paragraph 7#h7-- 7,a7 in subparagraph 7,a7-- 7i7 by striking establish indicators that will be and inserting review indicators that are2 and 7ii7 by striking in using funds made available under such grants to achieve the purpose of this subsection and inserting and establish a set of core indicators related to child safety1 parental recovery1 parenting capacity1 and family well-being4 ,in developing the core indicators1 to the extent possible1 indicators shall be made consistent with the outcome measures described in section #dga7;e77#f72 and 7,b7 in subparagraph 7,b7-- 7i7 in the matter preceding clause 7i71 by inserting base the performance measures on lessons learned from prior rounds of regional partnership grants under this subsection1 and before consult2 and 7ii7 by striking clauses 7iii7 and 7iv7 and inserting the following3 7iii7 ,other stakeholders or constituencies as determined by the ,secretary4 2 7#h7 in paragraph 7#i77;,a71 by striking clause 7i7 and inserting the following3 7i7 ,semiannual reports ,not later than ,september #cj of each fiscal year in which a recipient of a grant under this subsection is paid funds under the grant1 and every #f months thereafter1 the grant recipient shall submit to the ,secretary a report on the services provided and activities carried out during the reporting period1 progress made in achieving the goals of the program1 the number of children1 adults1 and families receiving services1 and such additional information as the ,secretary determines is necessary4 ,the report due not later than ,september #cj of the last such fiscal year shall include1 at a minimum1 data on each of the performance indicators included in the evaluation of the regional partnership4 2 and 7#i7 in paragraph 7#aj71 by striking #bjab through #bjaf and inserting #bjag through #bjba4 ,c ,miscellaneous #bfda4 ,reviewing and improving licensing standards for placement in a relative foster family home 7a7 ,identification of reputable model licensing standards ,not later than ,october #a1 #bjah1 the ,secretary of ,health and ,human ,services shall identify reputable model licensing standards with respect to the licensing of foster family homes 7as defined in section #dgb7;c77#a7 of the ,social ,security ,act74 7b7 ,state plan requirement ,section #dga7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77 is amended-- 7#a7 in paragraph 7#cd77;,b71 by striking and after the semicolon2 7#b7 in paragraph 7#ce77;,b71 by striking the period at the end and inserting a semicolon2 and 7#c7 by adding at the end the following3 7#cf7 provides that1 not later than ,april #a1 #bjai1 the ,state shall submit to the ,secretary information addressing-- 7,a7 whether the ,state licensing standards are in accord with model standards identified by the ,secretary1 and if not1 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 ,state2 7,b7 whether the ,state has elected to waive standards established in #dga7;a77#aj77;,a7 for relative foster family homes 7pursuant to waiver authority provided by #dga7;a77#aj77;,d771 a description of which standards the ,state most commonly waives1 and if the ,state has not elected to waive the standards1 the reason for not waiving these standards2 7,c7 if the ,state has elected to waive standards specified in subparagraph 7,b71 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 #dga7;a77#aj77;,d7 to quickly place children with relatives2 and 7,d7 a description of the steps the ,state is taking to improve caseworker training or the process1 if any2 and 4 #bfdb4 ,development of a statewide plan to prevent child abuse and neglect fatalities ,section #dbb7;b77#ai7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbb7;b77#ai77 is amended to read as follows3 7#ai7 document steps taken to track and prevent child maltreatment deaths by including-- 7,a7 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 7#a71 including gathering relevant information on the deaths from the relevant organizations in the ,state including entities such as ,state vital statistics department1 child death review teams1 law enforcement agencies1 offices of medical examiners1 or coroners2 and 7,b7 a description of the steps the ,state is taking to develop and implement a comprehensive1 statewide plan to prevent the fatalities that involves and engages relevant public and private agency partners1 including those in public health1 law enforcement1 and the courts4 4 #bfdc4 ,modernizing the title and purpose of title ,,iv-,e 7a7 ,part heading ,the heading for part ,e of title ,,iv of the ,social ,security ,act 7#db ,u4,s4,c4 #fgj et seq47 is amended to read as follows3 ,e ,federal ,payments for ,foster ,care1 ,prevention1 and ,permanency 4 7b7 ,purpose ,the first sentence of section #dgj of such ,act 7#db ,u4,s4,c4 #fgj7 is amended-- 7#a7 by striking #aiie7 and and inserting #aiie712 7#b7 by inserting kinship guardianship assistance1 and prevention services or programs specified in section #dga7;e77#a71 after needs12 and 7#c7 by striking 7commencing with the fiscal year which begins ,october #a1 #aihj74 #bfdd4 ,effective dates 7a7 ,effective dates 7#a7 ,in general ,except as provided in paragraph 7#b71 subject to subsection 7b71 the amendments made by this chapter shall take effect on ,october #a1 #bjah4 7#b7 ,exceptions ,the amendments made by sections #bfba7;d71 #bfda1 and #bfdc shall take effect on the date of enactment of this ,act4 7b7 ,transition rule 7#a7 ,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 legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this chapter1 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be deemed to be a separate regular session of the ,state legislature4 7#b7 ,application to programs operated by ,indian tribal organizations ,in the case of an ,indian tribe1 tribal organization1 or tribal consortium which the ,secretary of ,health and ,human ,services determines requires time to take action necessary to comply with the additional requirements imposed by the amendments made by this chapter 7whether the tribe1 organization1 or tribal consortium has a plan under section #dgi;,b of the ,social ,security ,act or a cooperative agreement or contract entered into with a ,state71 the ,secretary shall provide the tribe1 organization1 or tribal consortium with such additional time as the ,secretary determines is necessary for the tribe1 organization1 or tribal consortium to take the action to comply with the additional requirements before being regarded as failing to comply with the requirements4 #b ,ensuring the necessity of a placement that is not in a foster family home #bfea4 ,limitation on ,federal financial participation for placements that are not in foster family homes 7a7 ,limitation on ,federal financial participation 7#a7 ,in general ,section #dgb of the ,social ,security ,act 7#db ,u4,s4,c4 #fgb71 as amended by section #bfbb of this ,act1 is amended-- 7,a7 in subsection 7a77#b77;,c71 by inserting 1 but only to the extent permitted under subsection 7k7 after institution2 and 7,b7 by adding at the end the following3 7k7 ,limitation on ,federal financial participation 7#a7 ,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 institution1 no ,federal payment shall be made to the ,state under section #dgd7;a77#a7 for amounts expended for foster care maintenance payments on behalf of the child unless-- 7,a7 the child is placed in a child-care institution that is a setting specified in paragraph 7#b7 7or is placed in a licensed residential family-based treatment facility consistent with subsection 7j772 and 7,b7 in the case of a child placed in a qualified residential treatment program 7as defined in paragraph 7#d771 the requirements specified in paragraph 7#c7 and section #dge;,a7c7 are met4 7#b7 ,specified settings for placement ,the settings for placement specified in this paragraph are the following3 7,a7 ,a qualified residential treatment program 7as defined in paragraph 7#d774 7,b7 ,a setting specializing in providing prenatal1 post-partum1 or parenting supports for youth4 7,c7 ,in the case of a child who has attained #ah years of age1 a supervised setting in which the child is living independently4 7,d7 ,a setting providing high-quality residential care and supportive services to children and youth who have been found to be1 or are at risk of becoming1 sex trafficking victims1 in accordance with section #dga7;a77#i77;,c74 7#c7 ,assessment to determine appropriateness of placement in a qualified residential treatment program 7,a7 ,deadline for assessment ,in the case of a child who is placed in a qualified residential treatment program1 if the assessment required under section #dge;,a7c77#a7 is not completed within #cj days after the placement is made1 no ,federal payment shall be made to the ,state under section #dgd7;a77#a7 for any amounts expended for foster care maintenance payments on behalf of the child during the placement4 7,b7 ,deadline for transition out of placement ,if the assessment required under section #dge;,a7c77#a7 determines that the placement of a child in a qualified residential treatment program is not appropriate1 a court disapproves such a placement under section #dge;,a7c77#b71 or a child who has been in an approved placement in a qualified residential treatment program is going to return home or be placed with a fit and willing relative1 a legal guardian1 or an adoptive parent1 or in a foster family home1 ,federal payments shall be made to the ,state under section #dgd7;a77#a7 for amounts expended for foster care maintenance payments 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 placement4 ,in no event shall a ,state receive ,federal payments under section #dgd7;a77#a7 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 #cj-;day period that begins on the date a determination is made that the placement is no longer the recommended or approved placement for the child4 7#d7 ,qualified residential treatment program ,for purposes of this part1 the term qualified residential treatment program means a program that-- 7,a7 has a trauma-informed treatment model that is designed to address the needs1 including clinical needs as appropriate1 of children with serious emotional or behavioral disorders or disturbances and1 with respect to a child1 is able to implement the treatment identified for the child by the assessment of the child required under section #dge;,a7c72 7,b7 subject to paragraphs 7#e7 and 7#f71 has registered or licensed nursing staff and other licensed clinical staff who-- 7i7 provide care within the scope of their practice as defined by ,state law2 7ii7 are on-site in accordance with the treatment model referred to in subparagraph 7,a72 and 7iii7 are available #bd hours a day and #g days a week2 7,c7 to extent appropriate1 and in accordance with the child's best interests1 facilitates participation of family members in the child's treatment program2 7,d7 facilitates outreach to the family members of the child1 including siblings1 documents how the outreach is made 7including contact information71 and maintains contact information for any known biological family and fictive kin of the child2 7,e7 documents how family members are integrated into the treatment process for the child1 including post-discharge1 and how sibling connections are maintained2 7,f7 provides discharge planning and family-based aftercare support for at least #f months post-discharge2 and 7,g7 is licensed in accordance with section #dga7;a77#aj7 and is accredited by any of the following independent1 not-for-profit organizations3 7i7 ,the ,commission on ,accreditation of ,rehabilitation ,facilities 7,,carf74 7ii7 ,the ,joint ,commission on ,accreditation of ,healthcare ,organizations 7,,jcaho74 7iii7 ,the ,council on ,accreditation 7,,coa74 7iv7 ,any other independent1 not-for-profit accrediting organization approved by the ,secretary4 7#e7 ,administrative costs ,the prohibition in paragraph 7#a7 on ,federal payments under section #dgd7;a77#a7 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 section #dgd7;a77#c74 7#f7 ,rule of construction ,the requirements in paragraph 7#d77;,b7 shall not be construed as requiring a qualified residential treatment program to acquire nursing and behavioral health staff solely through means of a direct employer to employee relationship4 4 7#b7 ,conforming amendment ,section #dgd7;a77#a7 of such ,act 7#db ,u4,s4,c4 #fgd7;a77#a771 as amended by section #bfbb7;b7 of this ,act1 is amended by striking section #dgb7;j7 and inserting subsections 7j7 and 7k7 of section #dgb4 7b7 ,definition of foster family home1 child-care institution ,section #dgb7;c7 of such ,act 7#db ,u4,s4,c4 #fgb7;c77#a77 is amended to read as follows3 7c7 ,definitions ,for purposes of this part3 7#a7 ,foster family home 7,a7 ,in general ,the term foster family home means the home of an individual or family-- 7i7 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 approval2 and 7ii7 in which a child in foster care has been placed in the care of an individual1 who resides with the child and who has been licensed or approved by the ,state to be a foster parent-- 7,i7 that the ,state deems capable of adhering to the reasonable and prudent parent standard2 7,,ii7 that provides #bd-;hour substitute care for children placed away from their parents or other caretakers2 and 7,,iii7 that provides the care for not more than six children in foster care4 7,b7 ,state flexibility ,the number of foster children that may be cared for in a home under subparagraph 7,a7 may exceed the numerical limitation in subparagraph 7,a77ii77,,iii71 at the option of the ,state1 for any of the following reasons3 7i7 ,to allow a parenting youth in foster care to remain with the child of the parenting youth4 7ii7 ,to allow siblings to remain together4 7iii7 ,to allow a child with an established meaningful relationship with the family to remain with the family4 7iv7 ,to allow a family with special training or skills to provide care to a child who has a severe disability4 7,c7 ,rule of construction ,subparagraph 7,a7 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 care4 7#b7 ,child-care institution 7,a7 ,in general ,the term child-care institution means a private child-care institution1 or a public child-care institution which accommodates no more than #be children1 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 licensing4 7,b7 ,supervised settings ,in the case of a child who has attained #ah years of age1 the term shall include a supervised setting in which the individual is living independently1 in accordance with such conditions as the ,secretary shall establish in regulations4 7,c7 ,exclusions ,the term shall not include detention facilities1 forestry camps1 training schools1 or any other facility operated primarily for the detention of children who are determined to be delinquent4 4 7c7 ,training for state judges1 attorneys1 and other legal personnel in child welfare cases ,section #dch7;b77#a7 of such ,act 7#db ,u4,s4,c4 #fbi;h7b77#a77 is amended in the matter preceding subparagraph 7,a7 by inserting shall provide for the training of judges1 attorneys1 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 home1 after with respect to the child14 7d7 ,assurance of nonimpact on juvenile justice system 7#a7 ,state plan requirement ,section #dga7;a7 of such ,act 7#db ,u4,s4,c4 #fga7;a771 as amended by section #bfda of this ,act1 is further amended by adding at the end the following3 7#cg7 includes a certification that1 in response to the limitation imposed under section #dgb7k7 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 home1 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 system4 4 7#b7 ,,gao study and report ,the ,comptroller ,general of the ,united ,states shall evaluate the impact1 if any1 on ,state juvenile justice systems of the limitation imposed under section #dgb7k7 of the ,social ,security ,act 7as added by subsection 7a77#a7 of this section7 on foster care maintenance payments made on behalf of any child who is placed in a setting that is not a foster family home1 in accordance with the amendments made by subsections 7a7 and 7b7 of this section4 ,in particular1 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 result4 ,not later than ,december #ca1 #bjbd1 the ,comptroller ,general shall submit to ,congress a report on the results of the evaluation4 #bfeb4 ,assessment and documentation of the need for placement in a qualified residential treatment program ,section #dge;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #fge;a7 is amended by adding at the end the following3 7c7 ,assessment1 documentation1 and judicial determination requirements for placement in a qualified residential treatment program ,in the case of any child who is placed in a qualified residential treatment program 7as defined in section #dgb7k77#d771 the following requirements shall apply for purposes of approving the case plan for the child and the case system review procedure for the child3 7#a7 7,a7 ,within #cj days of the start of each placement in such a setting1 a qualified individual 7as defined in subparagraph 7,d77 shall-- 7i7 assess the strengths and needs of the child using an age-appropriate1 evidence-based1 validated1 functional assessment tool approved by the ,secretary2 7ii7 determine whether the needs of the child can be met with family members or through placement in a foster family home or1 if not1 which setting from among the settings specified in section #dgb7k77#b7 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 child1 as specified in the permanency plan for the child2 and 7iii7 develop a list of child-specific short- and long-term mental and behavioral health goals4 7,b7 7i7 ,the ,state shall assemble a family and permanency team for the child in accordance with the requirements of clauses 7ii7 and 7iii74 ,the qualified individual conducting the assessment required under subparagraph 7,a7 shall work in conjunction with the family of1 and permanency team for1 the child while conducting and making the assessment4 7ii7 ,the family and permanency team shall consist of all appropriate biological family members1 relative1 and fictive kin of the child1 as well as1 as appropriate1 professionals who are a resource to the family of the child1 such as teachers1 medical or mental health providers who have treated the child1 or clergy4 ,in the case of a child who has attained age #ad1 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 #dge7e77;,c77iv74 7iii7 ,the ,state shall document in the child's case plan-- 7,i7 the reasonable and good faith effort of the ,state to identify and include all such individuals on the family of1 and permanency team for1 the child2 7,,ii7 all contact information for members of the family and permanency team1 as well as contact information for other family members and fictive kin who are not part of the family and permanency team2 7,,iii7 evidence that meetings of the family and permanency team1 including meetings relating to the assessment required under subparagraph 7,a71 are held at a time and place convenient for family2 7,,iv7 if reunification is the goal1 evidence demonstrating that the parent from whom the child was removed provided input on the members of the family and permanency team2 7,v7 evidence that the assessment required under subparagraph 7,a7 is determined in conjunction with the family and permanency team2 7,,vi7 the placement preferences of the family and permanency team relative to the assessment that recognizes children should be placed with their siblings unless there is a finding by the court that such placement is contrary to their best interest2 and 7,,vii7 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 7,a71 the reasons why the preferences of the team and of the child were not recommended4 7,c7 ,in the case of a child who the qualified individual conducting the assessment under subparagraph 7,a7 determines should not be placed in a foster family home1 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 home4 ,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 home4 ,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 restrictive environment and how that placement is consistent with the short- and long-term goals for the child1 as specified in the permanency plan for the child4 7,d7 7i7 ,subject to clause 7ii71 in this subsection1 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 to1 or affiliated with1 any placement setting in which children are placed by the ,state4 7ii7 ,the ,secretary may approve a request of a ,state to waive any requirement in clause 7i7 upon a submission by the ,state1 in accordance with criteria established by the ,secretary1 that certifies that the trained professionals or licensed clinicians with responsibility for performing the assessments described in subparagraph 7,a7 shall maintain objectivity with respect to determining the most effective and appropriate placement for a child4 7#b7 ,within #fj days of the start of each placement in a qualified residential treatment program1 a family or juvenile court or another court 7including a tribal court7 of competent jurisdiction1 or an administrative body appointed or approved by the court1 independently1 shall-- 7,a7 consider the assessment1 determination1 and documentation made by the qualified individual conducting the assessment under paragraph 7#a72 7,b7 determine whether the needs of the child can be met through placement in a foster family home or1 if not1 whether placement of the child in a qualified residential 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 child1 as specified in the permanency plan for the child2 and 7,c7 approve or disapprove the placement4 7#c7 ,the written documentation made under paragraph 7#a77;,c7 and documentation of the determination and approval or disapproval of the placement in a qualified residential treatment program by a court or administrative body under paragraph 7#b7 shall be included in and made part of the case plan for the child4 7#d7 ,as long as a child remains placed in a qualified residential treatment program1 the ,state agency shall submit evidence at each status review and each permanency hearing held with respect to the child-- 7,a7 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 home1 that the placement in a qualified residential treatment program provides the most effective and appropriate level of care for the child in the least restrictive environment1 and that the placement is consistent with the short- and long-term goals for the child1 as specified in the permanency plan for the child2 7,b7 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 services2 and 7,c7 documenting the efforts made by the ,state agency to prepare the child to return home or to be placed with a fit and willing relative1 a legal guardian1 or an adoptive parent1 or in a foster family home4 7#e7 ,in the case of any child who is placed in a qualified residential treatment program for more than #ab consecutive months or #ah nonconsecutive months 7or1 in the case of a child who has not attained age #ac1 for more than #f consecutive or nonconsecutive months71 the ,state agency shall submit to the ,secretary-- 7,a7 the most recent versions of the evidence and documentation specified in paragraph 7#d72 and 7,b7 the signed approval of the head of the ,state agency for the continued placement of the child in that setting4 4 #bfec4 ,protocols to prevent inappropriate diagnoses 7a7 ,state plan requirement ,section #dbb7;b77#ae77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbb7;b77#ae77;,a77 is amended-- 7#a7 in clause 7vi71 by striking and after the semicolon2 7#b7 by redesignating clause 7vii7 as clause 7viii72 and 7#c7 by inserting after clause 7vi7 the following3 7vii7 the procedures and protocols the ,state has established to ensure that children in foster care placements are not inappropriately diagnosed with mental illness1 other emotional or behavioral disorders1 medically fragile conditions1 or developmental disabilities1 and placed in settings that are not foster family homes as a result of the inappropriate diagnoses2 and 4 7b7 ,evaluation ,section #dgf of such ,act 7#db ,u4,s4,c4 #fgf71 as amended by section #bfba7;d7 of this ,act1 is further amended by adding at the end the following3 7e7 ,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 #dbb7;b77#ae77;,a77vii74 ,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 practices4 ,not later than ,january #a1 #bjbj1 the ,secretary shall submit a report on the results of the evaluation to ,congress4 4 #bfed4 ,additional data and reports regarding children placed in a setting that is not a foster family home ,section #dgi;,a7a77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fgi;b7a77#g77;,a77 is amended by striking clauses 7i7 through 7vi7 and inserting the following3 7i7 with respect to each such placement-- 7,i7 the type of the placement setting1 including whether the placement is shelter care1 a group home and if so1 the range of the child population in the home1 a residential treatment facility1 a hospital or institution providing medical1 rehabilitative1 or psychiatric care1 a setting specializing in providing prenatal1 post-partum1 or parenting supports1 or some other kind of child-care institution and if so1 what kind2 7,,ii7 the number of children in the placement setting and the age1 race1 ethnicity1 and gender of each of the children2 7,,iii7 for each child in the placement setting1 the length of the placement of the child in the setting1 whether the placement of the child in the setting is the first placement of the child and if not1 the number and type of previous placements of the child1 and whether the child has special needs or another diagnosed mental or physical illness or condition2 and 7,,iv7 the extent of any specialized education1 treatment1 counseling1 or other services provided in the setting2 and 7ii7 separately1 the number and ages of children in the placements who have a permanency plan of another planned permanent living arrangement2 and 4 #bfee4 ,criminal records checks and checks of child abuse and neglect registries for adults working in child-care institutions and other group care settings 7a7 ,state plan requirement ,section #dga7;a77#bj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77#bj77 is amended-- 7#a7 in each of subparagraphs 7,a77ii7 and 7,b77iii71 by striking and after the semicolon2 7#b7 in subparagraph 7,c71 by adding and after the semicolon2 and 7#c7 by inserting after subparagraph 7,c7 the following3 7,d7 provides procedures for any child care institution1 including a group home1 residential treatment center1 shelter1 or other congregate care setting1 to conduct criminal records checks1 including fingerprint-based checks of national crime information databases 7as defined in section #ecd7;f77#c77;,a7 of title #bh1 ,united ,states ,code71 and checks described in subparagraph 7,b7 of this paragraph1 on any adult working in a child-care institution1 including a group home1 residential treatment center1 shelter1 or other congregate care setting1 unless the ,state reports to the ,secretary the alternative criminal records checks and child abuse registry checks the ,state conducts on any adult working in a child-care institution1 including a group home1 residential treatment center1 shelter1 or other congregate care setting1 and why the checks specified in this subparagraph are not appropriate for the ,state2 4 7b7 ,technical amendments ,subparagraphs 7,a7 and 7,c7 of section #dga7;a77#bj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77#bj77 are each amended by striking section #ecd7;e77#c77;,a7 and inserting section #ecd7;f77#c77;,a74 #bfef4 ,effective dates2 application to waivers 7a7 ,effective dates 7#a7 ,in general ,subject to paragraph 7#b7 and subsections 7b7 through 7d71 the amendments made by this chapter shall take effect on ,january #a1 #bjah4 7#b7 ,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 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments made by this chapter1 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 the 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 ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of the session shall be deemed to be a separate regular session of the ,state legislature4 7b7 ,limitation on ,federal financial participation for placements that are not in foster family homes and related provisions 7#a7 ,in general ,the amendments made by sections #bfea7;a71 #bfea7;b71 #bfea7;d71 and #bfeb shall take effect on ,october #a1 #bjai4 7#b7 ,state option to delay effective date for not more than #b years ,if a ,state requests a delay in the effective date provided for in paragraph 7#a71 the ,secretary of ,health and ,human ,services shall delay the effective date with respect to the ,state for the amount of time requested by the ,state not to exceed #b years4 ,if the effective date is so delayed for a period with respect to a ,state under the preceding sentence1 then-- 7,a7 notwithstanding section #bfdd1 the date that the amendments made by section #bfba7;c7 take effect with respect to the ,state shall be delayed for the period2 and 7,b7 in applying section #dgd7;a77#f7 of the ,social ,security ,act with respect to the ,state1 8on or after the date this paragraph takes effect with respect to the ,state0 is deemed to be substituted for 8after ,september #cj1 #bjai0 in subparagraph 7,a77i77,i7 of such section4 7c7 ,criminal records checks and checks of child abuse and neglect registries for adults working in child-care institutions and other group care settings ,the amendments made by section #bfee shall take effect on ,october #a1 #bjah4 7d7 ,application to ,states with waivers ,in the case of a ,state that1 on the date of enactment of this ,act1 has in effect a waiver approved under section #aacj of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#i71 the amendments made by this chapter shall not apply with respect to the ,state before the expiration 7determined without regard to any extensions7 of the waiver to the extent the amendments are inconsistent with the terms of the waiver4 #c ,continuing ,support for ,child and ,family ,services #bffa4 ,supporting and retaining foster families for children 7a7 ,supporting and retaining foster parents as a family support service ,section #dca7;a77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fca7;a77#b77;,b77 is amended by redesignating clauses 7iii7 through 7vi7 as clauses 7iv7 through 7vii71 respectively1 and inserting after clause 7ii7 the following3 7iii7 ,to support and retain foster families so they can provide quality family-based settings for children in foster care4 4 7b7 ,support for foster family homes ,section #dcf of such ,act 7#db ,u4,s4,c4 #fbi;f7 is amended by adding at the end the following3 7c7 ,support for foster family homes ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there are appropriated to the ,secretary for fiscal year #bjah1 #h1jjj1jjj for the ,secretary to make competitive grants to ,states1 ,indian tribes1 or tribal consortia to support the recruitment and retention of high-quality foster families to increase their capacity to place more children in family settings1 focused on ,states1 ,indian tribes1 or tribal consortia with the highest percentage of children in non-family settings4 ,the amount appropriated under this subparagraph shall remain available through fiscal year #bjbb4 4 #bffb4 ,extension of child and family services programs 7a7 ,extension of ,stephanie ,tubbs ,jones child welfare services program ,section #dbe of the ,social ,security ,act 7#db ,u4,s4,c4 #fbe7 is amended by striking #bjab through #bjaf and inserting #bjag through #bjba4 7b7 ,extension of promoting safe and stable families program authorizations 7#a7 ,in general ,section #dcf7;a7 of such ,act 7#db ,u4,s4,c4 #fbi;f7a77 is amended by striking all that follows #cde1jjj1jjj and inserting for each of fiscal years #bjag through #bjba44 7#b7 ,discretionary grants ,section #dcg7;a7 of such ,act 7#db ,u4,s4,c4 #fbi;g7a77 is amended by striking #bjab through #bjaf and inserting #bjag through #bjba4 7c7 ,extension of funding reservations for monthly caseworker visits and regional partnership grants ,section #dcf7;b7 of such ,act 7#db ,u4,s4,c4 #fbi;f7b77 is amended-- 7#a7 in paragraph 7#d77;,a71 by striking #bjab through #bjaf and inserting #bjag through #bjba2 and 7#b7 in paragraph 7#e71 by striking #bjab through #bjaf and inserting #bjag through #bjba4 7d7 ,reauthorization of funding for ,state courts 7#a7 ,extension of program ,section #dch7;c77#a7 of such ,act 7#db ,u4,s4,c4 #fbi;h7c77#a77 is amended by striking #bjab through #bjaf and inserting #bjag through #bjba4 7#b7 ,extension of ,federal share ,section #dch7;d7 of such ,act 7#db ,u4,s4,c4 #fbi;h7d77 is amended by striking #bjab through #bjaf and inserting #bjag through #bjba4 7e7 ,repeal of expired provisions ,section #dch7;e7 of such ,act 7#db ,u4,s4,c4 #fbi;h7e77 is repealed4 #bffc4 ,improvements to the ,john ,h4 ,chafee ,foster ,care ,independence ,program and related provisions 7a7 ,authority to serve former foster youth up to age #bc ,section #dgg of the ,social ,security ,act 7#db ,u4,s4,c4 #fgg7 is amended-- 7#a7 in subsection 7a77#e71 by inserting 7or #bc years of age1 in the case of a ,state with a certification under subsection 7b77#c77;,a77ii7 to provide assistance and services to youths who have aged out of foster care and have not attained such age1 in accordance with such subsection7 after #ba years of age2 7#b7 in subsection 7b77#c77;,a7-- 7,a7 by inserting 7i7 before ,a certification2 7,b7 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 #ba years of age42 and 7,c7 by adding at the end the following3 7ii7 ,if the ,state has elected under section #dge7h77;,b7 to extend eligibility for foster care to all children who have not attained #ba years of age1 or if the ,secretary determines that the ,state agency responsible for administering the ,state plans under this part and part ,b uses ,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 election1 the certification required under clause 7i7 may provide that the ,state will provide assistance and services to youths who have aged out of foster care and have not attained #bc years of age4 2 and 7#c7 in subsection 7b77#c77;,b71 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 #ba years of age 7or #bc years of age1 in the case of a ,state with a certification under subparagraph 7,a77i7 to provide assistance and services to youths who have aged out of foster care and have not attained such age1 in accordance with subparagraph 7,a77ii7744 7b7 ,authority to redistribute unspent funds ,section #dgg7;d7 of such ,act 7#db ,u4,s4,c4 #fgg7;d77 is amended-- 7#a7 in paragraph 7#d71 by inserting or does not expend allocated funds within the time period specified under section #dgg7;d77#c7 after provided by the ,secretary2 and 7#b7 by adding at the end the following3 7#e7 ,redistribution of unexpended amounts 7,a7 ,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 succeeding fiscal year1 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 year4 7,b7 ,redistribution 7i7 ,in general ,the ,secretary shall redistribute the amounts made available under subparagraph 7,a7 for a fiscal year among eligible applicant ,states4 ,in this subparagraph1 the term eligible applicant ,state means a ,state that has applied for additional funds for the fiscal year under subparagraph 7,a7 if the ,secretary determines that the ,state will use the funds for the purpose for which originally allotted under this section4 7ii7 ,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 ratio1 7as defined in subsection 7c77#d71 except that1 in such subsection1 all eligible applicant ,states 7as defined in subsection 7d77#e77;,b77i77 shall be substituted for all ,states74 7iii7 ,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 made4 7,c7 ,tribes ,for purposes of this paragraph1 the term ,state includes an ,indian tribe1 tribal organization1 or tribal consortium that receives an allotment under this section4 4 7c7 ,expanding and clarifying the use of education and training vouchers 7#a7 ,in general ,section #dgg7;i77#c7 of such ,act 7#db ,u4,s4,c4 #fgg7;i77#c77 is amended-- 7,a7 by striking on the date and all that follows through #bc and inserting to remain eligible until they attain #bf2 and 7,b7 by inserting 1 but in no event may a youth participate in the program for more than #e years 7whether or not consecutive7 before the period4 7#b7 ,conforming amendment ,section #dgg7;i77#a7 of such ,act 7#db ,u4,s4,c4 #fgg7;i77#a77 is amended by inserting who have attained #ad years of age before the period4 7d7 ,other improvements ,section #dgg of such ,act 7#db ,u4,s4,c4 #fgg71 as amended by subsections 7a71 7b71 and 7c7 of this section1 is amended-- 7#a7 in the section heading1 by striking ,independence ,program and inserting ,program for ,successful ,transition to ,adulthood2 7#b7 in subsection 7a7-- 7,a7 in paragraph 7#a7-- 7i7 by striking identify children who are likely to remain in foster care until #ah years of age and to help these children make the transition to self-sufficiency by providing services and inserting support all youth who have experienced foster care at age #ad or older in their transition to adulthood through transitional services2 7ii7 by inserting and post-secondary education after high school diploma2 and 7iii7 by striking training in daily living skills1 training in budgeting and financial management skills and inserting training and opportunities to practice daily living skills 7such as financial literacy training and driving instruction72 7,b7 in paragraph 7#b71 by striking who are likely to remain in foster care until #ah years of age receive the education1 training1 and services necessary to obtain employment and inserting who have experienced foster care at age #ad or older achieve meaningful1 permanent connections with a caring adult2 7,c7 in paragraph 7#c71 by striking who are likely to remain in foster care until #ah years of age prepare for and enter postsecondary training and education institutions and inserting who have experienced foster care at age #ad or older engage in age or developmentally appropriate activities1 positive youth development1 and experiential learning that reflects what their peers in intact families experience2 and 7,d7 by striking paragraph 7#d7 and redesignating paragraphs 7#e7 through 7#h7 as paragraphs 7#d7 through 7#g72 7#c7 in subsection 7b7-- 7,a7 in paragraph 7#b77;,d71 by striking adolescents and inserting youth2 and 7,b7 in paragraph 7#c7-- 7i7 in subparagraph 7,d7-- 7,i7 by inserting including training on youth development after to provide training2 and 7,,ii7 by striking adolescents preparing for independent 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 adult42 7ii7 in subparagraph 7,h71 by striking adolescents each place it appears and inserting youth2 and 7iii7 in subparagraph 7,k7-- 7,i7 by striking an adolescent and inserting a youth2 and 7,,ii7 by striking the adolescent each place it appears and inserting the youth2 and 7#d7 in subsection 7f71 by striking paragraph 7#b7 and inserting the following3 7#b7 ,report to congress ,not later than ,october #a1 #bjai1 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 adoption4 ,the report shall include the following3 7,a7 ,a description of the reasons for entry into foster care and of the foster care experiences1 such as length of stay1 number of placement settings1 case goal1 and discharge reason of #ag-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 #ag4 7,b7 ,a description of the characteristics of the individuals who report poor outcomes at ages #ai and #ba to the ,national ,youth in ,transition ,database4 7,c7 ,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 children transitioning from foster care4 7,d7 ,an analysis of the association between types of placement1 number of overall placements1 time spent in foster care1 and other factors1 and outcomes at ages #ai and #ba4 7,e7 ,an analysis of the differences in outcomes for children in and formerly in foster care at age #ai and #ba among ,states4 4 7e7 ,clarifying documentation provided to foster youth leaving foster care ,section #dge7e77;,i7 of such ,act 7#db ,u4,s4,c4 #fge7e77;,i77 is amended by inserting after ,,real ,,id ,act of #bjje the following3 1 and any official documentation necessary to prove that the child was previously in foster care4 #d ,continuing ,incentives to ,states to ,promote ,adoption and ,legal ,guardianship #bffe4 ,reauthorizing adoption and legal guardianship incentive programs 7a7 ,in general ,section #dgc;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #fgc;b7 is amended-- 7#a7 in subsection 7b77#d71 by striking #bjac through #bjae and inserting #bjaf through #bjbj2 7#b7 in subsection 7h77#a77;,d71 by striking #bjaf and inserting #bjba2 and 7#c7 in subsection 7h77#b71 by striking #bjaf and inserting #bjba4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect as if enacted on ,october #a1 #bjag4 #e ,technical ,corrections #bffg4 ,technical corrections to data exchange standards to improve program coordination 7a7 ,in general ,section #ddj of the ,social ,security ,act 7#db ,u4,s4,c4 #fbim7 is amended to read as follows3 #ddj4 ,data exchange standards for improved interoperability 7a7 ,designation ,the ,secretary shall1 in consultation with an interagency work group established by the ,office of ,management and ,budget and considering ,state government perspectives1 by rule1 designate data exchange standards to govern1 under this part and part ,e-- 7#a7 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 agency2 and 7#b7 ,federal reporting and data exchange required under applicable ,federal law4 7b7 ,requirements ,the data exchange standards required by paragraph 7#a7 shall1 to the extent practicable-- 7#a7 incorporate a widely accepted1 non-proprietary1 searchable1 computer-readable format1 such as the ,extensible ,markup ,language2 7#b7 contain interoperable standards developed and maintained by intergovernmental partnerships1 such as the ,national ,information ,exchange ,model2 7#c7 incorporate interoperable standards developed and maintained by ,federal entities with authority over contracting and financial assistance2 7#d7 be consistent with and implement applicable accounting principles2 7#e7 be implemented in a manner that is cost-effective and improves program efficiency and effectiveness2 and 7#f7 be capable of being continually upgraded as necessary4 7c7 ,rule of construction ,nothing in this subsection shall be construed to require a change to existing data exchange standards found to be effective and efficient4 4 7b7 ,effective date ,not later than the date that is #bd months after the date of the enactment of this section1 the ,secretary of ,health and ,human ,services shall issue a proposed rule that-- 7#a7 identifies federally required data exchanges1 include specification and timing of exchanges to be standardized1 and address the factors used in determining whether and when to standardize data exchanges2 and 7#b7 specifies ,state implementation options and describes future milestones4 #bffh4 ,technical corrections to ,state requirement to address the developmental needs of young children ,section #dbb7;b77#ah7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fbb7;b77#ah77 is amended by striking such children and inserting all vulnerable children under #e years of age4 #f ,ensuring ,states reinvest savings resulting from increase in adoption assistance #bffi4 ,delay of adoption assistance phase-in 7a7 ,in general ,the table in section #dgc7;e77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fgc7;e77#a77;,b77 is amended by striking the last #b rows and inserting the following3 #bjag through #bjbcb #bjbdb 7or1 in the case of a child for whom an adoption assistance agreement is entered into under this section on or after ,july #a1 #bjbd1 any age7 #bjbe or thereafterany age4 4 7b7 ,effective date ,the amendment made by this section shall take effect on ,january #a1 #bjah4 #bfgj4 ,,gao study and report on ,state reinvestment of savings resulting from increase in adoption assistance 7a7 ,study ,the ,comptroller ,general of the ,united ,states shall study the extent to which ,states are complying with the requirements of section #dgc7;a77#h7 of the ,social ,security ,act relating to the effects of phasing out the ,,afdc income eligibility requirements for adoption assistance payments under section #dgc of the ,social ,security ,act1 as enacted by section #djb of the ,fostering ,connections to ,success and ,increasing ,adoptions ,act of #bjjh 7,public ,law #aaj-cea2 #abb ,stat4 #cige7 and amended by section #bjf of the ,preventing ,sex ,trafficking and ,strengthening ,families ,act 7,public ,law #aac-ahc2 #abh ,stat4 #aiai74 ,in particular1 the ,comptroller ,general shall analyze the extent to which ,states are complying with the following requirements under section #dgc7;a77#h77;,d7 of the ,social ,security ,act3 7#a7 ,the requirement to spend an amount equal to the amount of the savings 7if any7 in ,state expenditures under part ,e of title ,,iv of the ,social ,security ,act resulting from phasing out the ,,afdc income eligibility requirements for adoption assistance payments under section #dgc 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 ,act4 7#b7 ,the requirement that a ,state shall spend not less than #cj percent of the amount of any savings described in paragraph 7#a7 on post-adoption services1 post-guardianship services1 and services to support and sustain positive permanent outcomes for children who otherwise might enter into foster care under the responsibility of the ,state1 with at least #b_/c of the spending by the ,state to comply with the #cj percent requirement being spent on post-adoption and post-guardianship services4 7b7 ,report ,the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,finance of the ,senate1 the ,committee on ,ways and ,means of the ,house of ,representatives1 and the ,secretary of ,health and ,human ,services a report that contains the results of the study required by subsection 7a71 including recommendations to ensure compliance with laws referred to in subsection 7a74 ,b ,supporting social impact partnerships to pay for results #bfha4 ,supporting social impact partnerships to pay for results ,title ,,xx of the ,social ,security ,act 7#db ,u4,s4,c4 #acig et seq47 is amended-- 7#a7 in the title heading1 by striking to ,states and inserting and ,programs2 and 7#b7 by adding at the end the following3 ,c ,social impact demonstration projects #bjea4 ,purposes ,the purposes of this subtitle are the following3 7#a7 ,to improve the lives of families and individuals in need in the ,united ,states by funding social programs that achieve real results4 7#b7 ,to redirect funds away from programs that1 based on objective data1 are ineffective1 and into programs that achieve demonstrable1 measurable results4 7#c7 ,to ensure ,federal funds are used effectively on social services to produce positive outcomes for both service recipients and taxpayers4 7#d7 ,to establish the use of social impact partnerships to address some of our ,nation's most pressing problems4 7#e7 ,to facilitate the creation of public-private partnerships that bundle philanthropic or other private resources with existing public spending to scale up effective social interventions already being implemented by private organizations1 nonprofits1 charitable organizations1 and ,state and local governments across the country4 7#f7 ,to bring pay-for-performance to the social sector1 allowing the ,united ,states to improve the impact and effectiveness of vital social services programs while redirecting inefficient or duplicative spending4 7#g7 ,to incorporate outcomes measurement and randomized controlled trials or other rigorous methodologies for assessing program impact4 #bjeb4 ,social impact partnership application 7a7 ,notice ,not later than #a year after the date of the enactment of this subtitle1 the ,secretary of the ,treasury1 in consultation with the ,federal ,interagency ,council on ,social ,impact ,partnerships1 shall publish in the ,federal ,register a request for proposals from ,states or local governments for social impact partnership projects in accordance with this section4 7b7 ,required outcomes for social impact partnership project ,to qualify as a social impact partnership project under this subtitle1 a project must produce one or more measurable1 clearly defined outcomes that result in social benefit and ,federal1 ,state1 or local savings through any of the following3 7#a7 ,increasing work and earnings by individuals in the ,united ,states who are unemployed for more than #f consecutive months4 7#b7 ,increasing employment and earnings of individuals who have attained #af years of age but not #be years of age4 7#c7 ,increasing employment among individuals receiving ,federal disability benefits4 7#d7 ,reducing the dependence of low-income families on ,federal means-tested benefits4 7#e7 ,improving rates of high school graduation4 7#f7 ,reducing teen and unplanned pregnancies4 7#g7 ,improving birth outcomes and early childhood health and development among low-income families and individuals4 7#h7 ,reducing rates of asthma1 diabetes1 or other preventable diseases among low-income families and individuals to reduce the utilization of emergency and other high-cost care4 7#i7 ,increasing the proportion of children living in two-parent families4 7#aj7 ,reducing incidences and adverse consequences of child abuse and neglect4 7#aa7 ,reducing the number of youth in foster care by increasing adoptions1 permanent guardianship arrangements1 reunifications1 or placements with a fit and willing relative1 or by avoiding placing children in foster care by ensuring they can be cared for safely in their own homes4 7#ab7 ,reducing the number of children and youth in foster care residing in group homes1 child care institutions1 agency-operated foster homes1 or other non-family foster homes1 unless it is determined that it is in the interest of the child's long-term health1 safety1 or psychological well-being to not be placed in a family foster home4 7#ac7 ,reducing the number of children returning to foster care4 7#ad7 ,reducing recidivism among juvenile offenders1 individuals released from prison1 or other high-risk populations4 7#ae7 ,reducing the rate of homelessness among our most vulnerable populations4 7#af7 ,improving the health and well-being of those with mental1 emotional1 and behavioral health needs4 7#ag7 ,improving the educational outcomes of special-needs or low-income children4 7#ah7 ,improving the employment and well-being of returning ,united ,states military members4 7#ai7 ,increasing the financial stability of low-income families4 7#bj7 ,increasing the independence and employability of individuals who are physically or mentally disabled4 7#ba7 ,other measurable outcomes defined by the ,state or local government that result in positive social outcomes and ,federal savings4 7c7 ,application required ,the notice described in subsection 7a7 shall require a ,state or local government to submit an application for the social impact partnership project that addresses the following3 7#a7 ,the outcome goals of the project4 7#b7 ,a description of each intervention in the project and anticipated outcomes of the intervention4 7#c7 ,rigorous evidence demonstrating that the intervention can be expected to produce the desired outcomes4 7#d7 ,the target population that will be served by the project4 7#e7 ,the expected social benefits to participants who receive the intervention and others who may be impacted4 7#f7 ,projected ,federal1 ,state1 and local government costs and other costs to conduct the project4 7#g7 ,projected ,federal1 ,state1 and local government savings and other savings1 including an estimate of the savings to the ,federal ,government1 on a program-by-program basis and in the aggregate1 if the project is implemented and the outcomes are achieved as a result of the intervention4 7#h7 ,if savings resulting from the successful completion of the project are estimated to accrue to the ,state or local government1 the likelihood of the ,state or local government to realize those savings4 7#i7 ,a plan for delivering the intervention through a social impact partnership model4 7#aj7 ,a description of the expertise of each service provider that will administer the intervention1 including a summary of the experience of the service provider in delivering the proposed intervention or a similar intervention1 or demonstrating that the service provider has the expertise necessary to deliver the proposed intervention4 7#aa7 ,an explanation of the experience of the ,state or local government1 the intermediary1 or the service provider in raising private and philanthropic capital to fund social service investments4 7#ab7 ,the detailed roles and responsibilities of each entity involved in the project1 including any ,state or local government entity1 intermediary1 service provider1 independent evaluator1 investor1 or other stakeholder4 7#ac7 ,a summary of the experience of the service provider in delivering the proposed intervention or a similar intervention1 or a summary demonstrating the service provider has the expertise necessary to deliver the proposed intervention4 7#ad7 ,a summary of the unmet need in the area where the intervention will be delivered or among the target population who will receive the intervention4 7#ae7 ,the proposed payment terms1 the methodology used to calculate outcome payments1 the payment schedule1 and performance thresholds4 7#af7 ,the project budget4 7#ag7 ,the project timeline4 7#ah7 ,the criteria used to determine the eligibility of an individual for the project1 including how selected populations will be identified1 how they will be referred to the project1 and how they will be enrolled in the project4 7#ai7 ,the evaluation design4 7#bj7 ,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 measured4 7#ba7 ,an explanation of how the metrics used in the evaluation to determine whether the outcomes achieved as a result of the intervention are independent1 objective indicators of impact and are not subject to manipulation by the service provider1 intermediary1 or investor4 7#bb7 ,a summary explaining the independence of the evaluator from the other entities involved in the project and the evaluator's experience in conducting rigorous evaluations of program effectiveness including1 where available1 well-implemented randomized controlled trials on the intervention or similar interventions4 7#bc7 ,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 project4 7#bd7 ,a description of whether and how the ,state or local government and service providers plan to sustain the intervention1 if it is timely and appropriate to do so1 to ensure that successful interventions continue to operate after the period of the social impact partnership4 7d7 ,project intermediary information required ,the application described in subsection 7c7 shall also contain the following information about any intermediary for the social impact partnership project 7whether an intermediary is a service provider or other entity73 7#a7 ,experience and capacity for providing or facilitating the provision of the type of intervention proposed4 7#b7 ,the mission and goals4 7#c7 ,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 intervention4 7#d7 ,experience working in a collaborative environment across government and nongovernmental entities4 7#e7 ,previous experience collaborating with public or private entities to implement evidence-based programs4 7#f7 ,ability to raise or provide funding to cover operating costs 7if applicable to the project74 7#g7 ,capacity and infrastructure to track outcomes and measure results1 including-- 7,a7 capacity to track and analyze program performance and assess program impact2 and 7,b7 experience with performance-based awards or performance-based contracting and achieving project milestones and targets4 7#h7 ,role in delivering the intervention4 7#i7 ,how the intermediary would monitor program success1 including a description of the interim benchmarks and outcome measures4 7e7 ,feasibility studies funded through other sources ,the notice described in subsection 7a7 shall permit a ,state or local government to submit an application for social impact partnership funding that contains information from a feasibility study developed for purposes other than applying for funding under this subtitle4 #bjec4 ,awarding social impact partnership agreements 7a7 ,timeline in awarding agreement ,not later than #f months after receiving an application in accordance with section #bjeb1 the ,secretary1 in consultation with the ,federal ,interagency ,council on ,social ,impact ,partnerships1 shall determine whether to enter into an agreement for a social impact partnership project with a ,state or local government4 7b7 ,considerations in awarding agreement ,in determining whether to enter into an agreement for a social impact partnership project 7the application for which was submitted under section #bjeb7 the ,secretary1 in consultation with the ,federal ,interagency ,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 project1 shall consider each of the following3 7#a7 ,the recommendations made by the ,commission on ,social ,impact ,partnerships4 7#b7 ,the value to the ,federal ,government of the outcomes expected to be achieved if the outcomes specified in the agreement are achieved as a result of the intervention4 7#c7 ,the likelihood1 based on evidence provided in the application and other evidence1 that the ,state or local government in collaboration with the intermediary and the service providers will achieve the outcomes4 7#d7 ,the savings to the ,federal ,government if the outcomes specified in the agreement are achieved as a result of the intervention4 7#e7 ,the savings to the ,state and local governments if the outcomes specified in the agreement are achieved as a result of the intervention4 7#f7 ,the expected quality of the evaluation that would be conducted with respect to the agreement4 7#g7 ,the capacity and commitment of the ,state or local government to sustain the intervention1 if appropriate and timely and if the intervention is successful1 beyond the period of the social impact partnership4 7c7 ,agreement authority 7#a7 ,agreement requirements ,in accordance with this section1 the ,secretary1 in consultation with the ,federal ,interagency ,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 project1 may enter into an agreement for a social impact partnership project with a ,state or local government if the ,secretary1 in consultation with the ,federal ,interagency ,council on ,social ,impact ,partnerships1 determines that each of the following requirements are met3 7,a7 ,the ,state or local government agrees to achieve one or more outcomes as a result of the intervention1 as specified in the agreement and validated by independent evaluation1 in order to receive payment4 7,b7 ,the ,federal payment to the ,state or local government 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 #aj years1 as determined by the ,secretary1 in consultation with the ,state or local government4 7,c7 ,the duration of the project does not exceed #aj years4 7,d7 ,the ,state or local government has demonstrated1 through the application submitted under section #bjeb1 that1 based on prior rigorous experimental evaluations or rigorous quasi-experimental studies1 the intervention can be expected to achieve each outcome specified in the agreement4 7,e7 ,the ,state1 local government1 intermediary1 or service provider has experience raising private or philanthropic capital to fund social service investments 7if applicable to the project74 7,f7 ,the ,state or local government has shown that each service provider has experience delivering the intervention1 a similar intervention1 or has otherwise demonstrated the expertise necessary to deliver the intervention4 7#b7 ,payment ,the ,secretary shall pay the ,state or local government only if the independent evaluator described in section #bjee determines that the social impact partnership project has met the requirements specified in the agreement and achieved an outcome as a result of the intervention1 as specified in the agreement and validated by independent evaluation4 7d7 ,notice of agreement award ,not later than #cj days after entering into an agreement under this section the ,secretary shall publish a notice in the ,federal ,register that includes1 with regard to the agreement1 the following3 7#a7 ,the outcome goals of the social impact partnership project4 7#b7 ,a description of each intervention in the project4 7#c7 ,the target population that will be served by the project4 7#d7 ,the expected social benefits to participants who receive the intervention and others who may be impacted4 7#e7 ,the detailed roles1 responsibilities1 and purposes of each ,federal1 ,state1 or local government entity1 intermediary1 service provider1 independent evaluator1 investor1 or other stakeholder4 7#f7 ,the payment terms1 the methodology used to calculate outcome payments1 the payment schedule1 and performance thresholds4 7#g7 ,the project budget4 7#h7 ,the project timeline4 7#i7 ,the project eligibility criteria4 7#aj7 ,the evaluation design4 7#aa7 ,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 measured4 7#ab7 ,the estimate of the savings to the ,federal1 ,state1 and local government1 on a program-by-program basis and in the aggregate1 if the agreement is entered into and implemented and the outcomes are achieved as a result of each intervention4 7e7 ,authority to transfer administration of agreement ,the ,secretary may transfer to the head of another ,federal agency the authority to administer 7including making payments under7 an agreement entered into under subsection 7c71 and any funds necessary to do so4 7f7 ,requirement on funding used to benefit children ,not less than #ej percent of all ,federal payments made to carry out agreements under this section shall be used for initiatives that directly benefit children4 #bjed4 ,feasibility study funding 7a7 ,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 #bjeb4 ,to be eligible to receive funding to assist with completing a feasibility study1 a ,state or local government shall submit an application for feasibility study funding addressing the following3 7#a7 ,a description of the outcome goals of the social impact partnership project4 7#b7 ,a description of the intervention1 including anticipated program design1 target population1 an estimate regarding the number of individuals to be served1 and setting for the intervention4 7#c7 ,evidence to support the likelihood that the intervention will produce the desired outcomes4 7#d7 ,a description of the potential metrics to be used4 7#e7 ,the expected social benefits to participants who receive the intervention and others who may be impacted4 7#f7 ,estimated costs to conduct the project4 7#g7 ,estimates of ,federal1 ,state1 and local government savings and other savings if the project is implemented and the outcomes are achieved as a result of each intervention4 7#h7 ,an estimated timeline for implementation and completion of the project1 which shall not exceed #aj years4 7#i7 ,with respect to a project for which the ,state or local government selects an intermediary to operate the project1 any partnerships needed to successfully execute the project and the ability of the intermediary to foster the partnerships4 7#aj7 ,the expected resources needed to complete the feasibility study for the ,state or local government to apply for social impact partnership funding under section #bjeb4 7b7 ,federal selection of applications for feasibility study ,not later than #f months after receiving an application for feasibility study funding under subsection 7a71 the ,secretary1 in consultation with the ,federal ,interagency ,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 project1 shall select ,state or local government feasibility study proposals for funding based on the following3 7#a7 ,the recommendations made by the ,commission on ,social ,impact ,partnerships4 7#b7 ,the likelihood that the proposal will achieve the desired outcomes4 7#c7 ,the value of the outcomes expected to be achieved as a result of each intervention4 7#d7 ,the potential savings to the ,federal ,government if the social impact partnership project is successful4 7#e7 ,the potential savings to the ,state and local governments if the project is successful4 7c7 ,public disclosure ,not later than #cj days after selecting a ,state or local government for feasibility study funding under this section1 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 funding4 7d7 ,funding restriction 7#a7 ,feasibility study restriction ,the ,secretary may not provide feasibility study funding under this section for more than #ej percent of the estimated total cost of the feasibility study reported in the ,state or local government application submitted under subsection 7a74 7#b7 ,aggregate restriction ,of the total amount made available to carry out this subtitle1 the ,secretary may not use more than #aj1jjj1jjj to provide feasibility study funding to ,states or local governments under this section4 7#c7 ,no guarantee of funding ,the ,secretary shall have the option to award no funding under this section4 7e7 ,submission of feasibility study required ,not later than #i months after the receipt of feasibility study funding under this section1 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 ,partnerships4 7f7 ,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 authorities4 #bjee4 ,evaluations 7a7 ,authority to enter into agreements ,for each ,state or local government awarded a social impact partnership project approved by the ,secretary under this subtitle1 the head of the relevant agency1 as recommended by the ,federal ,interagency ,council on ,social ,impact ,partnerships and determined by the ,secretary1 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 subtitle4 7b7 ,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 independent of the other parties to the agreement and has demonstrated substantial experience in conducting rigorous evaluations of program effectiveness including1 where available and appropriate1 well-implemented randomized controlled trials on the intervention or similar interventions4 7c7 ,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 reliable1 evidence-based research methodologies1 as certified by the ,federal ,interagency ,council on ,social ,impact ,partnerships1 that allow for the strongest possible causal inferences when random assignment is not feasible4 7d7 ,progress report 7#a7 ,submission of report ,the independent evaluator shall-- 7,a7 not later than #b years after a project has been approved by the ,secretary and biannually thereafter until the project is concluded1 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 agreement2 and 7,b7 before the scheduled time of the first outcome payment and before the scheduled time of each subsequent payment1 submit to the head of the relevant agency and the ,federal ,interagency ,council on ,social ,impact ,partnerships 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 outcome1 the challenges faced in attempting to achieve the outcome1 and information on the improved future delivery of this or similar interventions4 7#b7 ,submission to the ,secretary and ,congress ,not later than #cj days after receipt of the written report pursuant to paragraph 7#a77;,b71 the ,federal ,interagency ,council on ,social ,impact ,partnerships shall submit the report to the ,secretary and each committee of jurisdiction in the ,house of ,representatives and the ,senate4 7e7 ,final report 7#a7 ,submission of report ,within #f months after the social impact partnership project is completed1 the independent evaluator shall-- 7,a7 evaluate the effects of the activities undertaken pursuant to the agreement with regard to each outcome specified in the agreement2 and 7,b7 submit to the head of the relevant agency and the ,federal ,interagency ,council on ,social ,impact ,partnerships 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 agreement1 along with information on the unique factors that contributed to the success or failure of the project1 the challenges faced in attempting to achieve the outcome1 and information on the improved future delivery of this or similar interventions4 7#b7 ,submission to the ,secretary and ,congress ,not later than #cj days after receipt of the written report pursuant to paragraph 7#a77;,b71 the ,federal ,interagency ,council on ,social ,impact ,partnerships shall submit the report to the ,secretary and each committee of jurisdiction in the ,house of ,representatives and the ,senate4 7f7 ,limitation on cost of evaluations ,of the amount made available under this subtitle for social impact partnership projects1 the ,secretary may not obligate more than #ae percent to evaluate the implementation and outcomes of the projects4 7g7 ,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 authorities4 #bjef4 ,federal interagency council on social impact partnerships 7a7 ,establishment ,there is established the ,federal ,interagency ,council on ,social ,impact ,partnerships 7in this section referred to as the ,council7 to-- 7#a7 coordinate with the ,secretary on the efforts of social impact partnership projects funded under this subtitle2 7#b7 advise and assist the ,secretary in the development and implementation of the projects2 7#c7 advise the ,secretary on specific programmatic and policy matter related to the projects2 7#d7 provide subject-matter expertise to the ,secretary with regard to the projects2 7#e7 certify to the ,secretary that each ,state or local government 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 #bjee has access to ,federal administrative data to assist the ,state or local government and the evaluator in evaluating the performance and outcomes of the project2 7#f7 address issues that will influence the future of social impact partnership projects in the ,united ,states2 7#g7 provide guidance to the executive branch on the future of social impact partnership projects in the ,united ,states2 7#h7 prior to approval by the ,secretary1 certify that each ,state and local government application for a social impact partnership contains rigorous1 independent data and reliable1 evidence-based research methodologies to support the conclusion that the project will yield savings to the ,state or local government or the ,federal ,government if the project outcomes are achieved2 7#i7 certify to the ,secretary1 in the case of each approved social impact partnership that is expected to yield savings to the ,federal ,government1 that the project will yield a projected savings to the ,federal ,government if the project outcomes are achieved1 and coordinate with the relevant ,federal agency to produce an after-action accounting once the project is complete to determine the actual ,federal savings realized1 and the extent to which actual savings aligned with projected savings2 and 7#aj7 provide periodic reports to the ,secretary and make available reports periodically to ,congress and the public on the implementation of this subtitle4 7b7 ,composition of council ,the ,council shall have #aa members1 as follows3 7#a7 ,chair ,the ,chair of the ,council shall be the ,director of the ,office of ,management and ,budget4 7#b7 ,other members ,the head of each of the following entities shall designate one officer or employee of the entity to be a ,council member3 7,a7 ,the ,department of ,labor4 7,b7 ,the ,department of ,health and ,human ,services4 7,c7 ,the ,social ,security ,administration4 7,d7 ,the ,department of ,agriculture4 7,e7 ,the ,department of ,justice4 7,f7 ,the ,department of ,housing and ,urban ,development4 7,g7 ,the ,department of ,education4 7,h7 ,the ,department of ,veterans ,affairs4 7,i7 ,the ,department of the ,treasury4 7,j7 ,the ,corporation for ,national and ,community ,service4 #bjeg4 ,commission on social impact partnerships 7a7 ,establishment ,there is established the ,commission on ,social ,impact ,partnerships 7in this section referred to as the ,commission74 7b7 ,duties ,the duties of the ,commission shall be to-- 7#a7 assist the ,secretary and the ,federal ,interagency ,council on ,social ,impact ,partnerships in reviewing applications for funding under this subtitle2 7#b7 make recommendations to the ,secretary and the ,federal ,interagency ,council on ,social ,impact ,partnerships regarding the funding of social impact partnership agreements and feasibility studies2 and 7#c7 provide other assistance and information as requested by the ,secretary or the ,federal ,interagency ,council on ,social ,impact ,partnerships4 7c7 ,composition ,the ,commission shall be composed of nine members1 of whom-- 7#a7 one shall be appointed by the ,president1 who will serve as the ,chair of the ,commission2 7#b7 one shall be appointed by the ,majority ,leader of the ,senate2 7#c7 one shall be appointed by the ,minority ,leader of the ,senate2 7#d7 one shall be appointed by the ,speaker of the ,house of ,representatives2 7#e7 one shall be appointed by the ,minority ,leader of the ,house of ,representatives2 7#f7 one shall be appointed by the ,chairman of the ,committee on ,finance of the ,senate2 7#g7 one shall be appointed by the ranking member of the ,committee on ,finance of the ,senate2 7#h7 one member shall be appointed by the ,chairman of the ,committee on ,ways and ,means of the ,house of ,representatives2 and 7#i7 one shall be appointed by the ranking member of the ,committee on ,ways and ,means of the ,house of ,representatives4 7d7 ,qualifications of commission members ,the members of the ,commission shall-- 7#a7 be experienced in finance1 economics1 pay for performance1 or program evaluation2 7#b7 have relevant professional or personal experience in a field related to one or more of the outcomes listed in this subtitle2 or 7#c7 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 research4 7e7 ,timing of appointments ,the appointments of the members of the ,commission shall be made not later than #abj days after the date of the enactment of this subtitle1 or1 in the event of a vacancy1 not later than #ij days after the date the vacancy arises4 ,if a member of ,congress fails to appoint a member by that date1 the ,president may select a member of the ,president's choice on behalf of the member of ,congress4 ,notwithstanding the preceding sentence1 if not all appointments have been made to the ,commission as of that date1 the ,commission may operate with no fewer than five members until all appointments have been made4 7f7 ,term of appointments 7#a7 ,in general ,the members appointed under subsection 7c7 shall serve as follows3 7,a7 ,three members shall serve for #b years4 7,b7 ,three members shall serve for #c years4 7,c7 ,three members 7one of which shall be ,chair of the ,commission appointed by the ,president7 shall serve for #d years4 7#b7 ,assignment of terms ,the ,commission shall designate the term length that each member appointed under subsection 7c7 shall serve by unanimous agreement4 ,in the event that unanimous agreement cannot be reached1 term lengths shall be assigned to the members by a random process4 7g7 ,vacancies ,subject to subsection 7e71 in the event of a vacancy in the ,commission1 whether due to the resignation of a member1 the expiration of a member's term1 or any other reason1 the vacancy shall be filled in the manner in which the original appointment was made and shall not affect the powers of the ,commission4 7h7 ,appointment power ,members of the ,commission appointed under subsection 7c7 shall not be subject to confirmation by the ,senate4 #bjeh4 ,limitation on use of funds ,of the amounts made available to carry out this subtitle1 the ,secretary may not use more than #b1jjj1jjj in any fiscal year to support the review1 approval1 and oversight of social impact partnership projects1 including activities conducted by-- 7#a7 the ,federal ,interagency ,council on ,social ,impact ,partnerships2 and 7#b7 any other agency consulted by the ,secretary before approving a social impact partnership project or a feasibility study under section #bjed4 #bjei4 ,no ,federal funding for credit enhancements ,no amount made available to carry out this subtitle may be used to provide any insurance1 guarantee1 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 agreement4 #bjfj4 ,availability of funds ,amounts made available to carry out this subtitle shall remain available until #aj years after the date of the enactment of this subtitle4 #bjfa4 ,website ,the ,federal ,interagency ,council on ,social ,impact ,partnerships shall establish and maintain a public website that shall display the following3 7#a7 ,a copy of1 or method of accessing1 each notice published regarding a social impact partnership project pursuant to this subtitle4 7#b7 ,a copy of each feasibility study funded under this subtitle4 7#c7 ,for each ,state or local government that has entered into an agreement with the ,secretary for a social impact partnership project1 the website shall contain the following information3 7,a7 ,the outcome goals of the project4 7,b7 ,a description of each intervention in the project4 7,c7 ,the target population that will be served by the project4 7,d7 ,the expected social benefits to participants who receive the intervention and others who may be impacted4 7,e7 ,the detailed roles1 responsibilities1 and purposes of each ,federal1 ,state1 or local government entity1 intermediary1 service provider1 independent evaluator1 investor1 or other stakeholder4 7,f7 ,the payment terms1 methodology used to calculate outcome payments1 the payment schedule1 and performance thresholds4 7,g7 ,the project budget4 7,h7 ,the project timeline4 7,i7 ,the project eligibility criteria4 7,j7 ,the evaluation design4 7,k7 ,the metrics used to determine whether the proposed outcomes have been achieved and how these metrics are measured4 7#d7 ,a copy of the progress reports and the final reports relating to each social impact partnership project4 7#e7 ,an estimate of the savings to the ,federal1 ,state1 and local government1 on a program-by-program basis and in the aggregate1 resulting from the successful completion of the social impact partnership project4 #bjfb4 ,regulations ,the ,secretary1 in consultation with the ,federal ,interagency ,council on ,social ,impact ,partnerships1 may issue regulations as necessary to carry out this subtitle4 #bjfc4 ,definitions ,in this subtitle3 7#a7 ,agency ,the term agency has the meaning given that term in section #eea of title #e1 ,united ,states ,code4 7#b7 ,intervention ,the term intervention means a specific service delivered to achieve an impact through a social impact partnership project4 7#c7 ,secretary ,the term ,secretary means the ,secretary of the ,treasury4 7#d7 ,social impact partnership project ,the term social impact partnership project means a project that finances social services using a social impact partnership model4 7#e7 ,social impact partnership model ,the term social impact partnership model means a method of financing social services in which-- 7,a7 ,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 government and the ,secretary2 and 7,b7 the ,state or local government coordinates with service providers1 investors 7if applicable to the project71 and 7if necessary7 an intermediary to identify-- 7i7 an intervention expected to produce the outcome2 7ii7 a service provider to deliver the intervention to the target population2 and 7iii7 investors to fund the delivery of the intervention4 7#f7 ,state ,the term ,state means each ,state of the ,united ,states1 the ,district of ,columbia1 each commonwealth1 territory or possession of the ,united ,states1 and each federally recognized ,indian tribe4 #bjfd4 ,funding ,out of any money in the ,treasury of the ,united ,states not otherwise appropriated1 there is hereby appropriated #ib1jjj1jjj for fiscal year #bjah to carry out this subtitle4 4 ,c ,modernizing child support enforcement fees #bfia4 ,modernizing child support enforcement fees 7a7 ,in general ,section #ded7f77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fed7f77;,b77ii77 is amended-- 7#a7 by striking #be and inserting #ce2 and 7#b7 by striking #ejj each place it appears and inserting #eej4 7b7 ,effective date 7#a7 ,in general ,the amendment made by subsection 7a7 shall take effect on the #ast day of the #ast fiscal year that begins on or after the date of the enactment of this ,act1 and shall apply to payments under part ,d of title ,,iv of the ,social ,security ,act for calendar quarters beginning on or after such #ast day4 7#b7 ,delay permitted if state legislation required ,if the ,secretary of ,health and ,human ,services determines that ,state legislation 7other than legislation appropriating funds7 is required in order for a ,state plan developed pursuant to part ,d of title ,,iv of the ,social ,security ,act to meet the requirement imposed by the amendment made by subsection 7a71 the plan shall not be regarded as failing to meet the requirement before the #ast day of the #ast calendar quarter beginning after the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the preceding sentence1 if the ,state has a #b-year legislative session1 each year of the session is deemed to be a separate regular session of the ,state legislature4 ,d ,increasing efficiency of prison data reporting #bfii4 ,increasing efficiency of prison data reporting 7a7 ,in general ,section #afaa7;e77#a77;,i77i77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achb7;e77#a77;,i77i77,,ii77 is amended by striking #cj days each place it appears and inserting #ae days4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to any payment made by the ,commissioner of ,social ,security pursuant to section #afaa7;e77#a77;,i77i77,,ii7 of the ,social ,security ,act 7as amended by such subsection7 on or after the date that is #f months after the date of enactment of this ,act4 ,,vii ,offsets #bgja4 ,payment for early discharges to hospice care 7a7 ,in general ,section #ahhf7;d77#e77;,j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,j77 is amended-- 7#a7 in clause 7ii7-- 7,a7 in subclause 7,,iii71 by striking or at the end2 7,b7 by redesignating subclause 7,,iv7 as subclause 7,v72 and 7,c7 by inserting after subclause 7,,iii7 the following new subclause3 7,,iv7 for discharges occurring on or after ,october #a1 #bjbb1 is provided hospice care by a hospice program2 or 2 and 7#b7 in clause 7iv7-- 7,a7 by inserting after the first sentence the following new sentence3 ,the ,secretary shall include in the proposed rule published for fiscal year #bjbc1 a description of the effect of clause 7ii77,,iv742 and 7,b7 in subclause 7,i71 by striking and 7,,iii7 and inserting 7,,iii71 and1 in the case of proposed and final rules for fiscal year #bjbc and subsequent fiscal years1 7,,iv74 7b7 ,med,p,a,c evaluation and report on hospital to hospice transfers 7#a7 ,evaluation ,the ,medicare ,payment ,advisory ,commission 7in this subsection referred to as the ,commission7 shall conduct an evaluation of the effects of the amendments made by subsection 7a71 including the effects on-- 7,a7 the numbers of discharges of patients from an inpatient hospital setting to a hospice program2 7,b7 the lengths of stays of patients in an inpatient hospital setting who are discharged to a hospice program2 7,c7 spending under the ,medicare program under title ,,xviii of the ,social ,security ,act2 and 7,d7 other areas determined appropriate by the ,commission4 7#b7 ,consideration ,in conducting the evaluation under paragraph 7#a71 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 amendments4 7#c7 ,preliminary results ,not later than ,march #ae1 #bjbd1 the ,commission shall provide ,congress with preliminary results on the evaluation being conducted under paragraph 7#a74 7#d7 ,report ,not later than ,march #ae1 #bjbe1 the ,commission shall submit to ,congress a report on the evaluation conducted under paragraph 7#a74 #bgjb4 ,home health market basket reduction ,section #ahie7;b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,b77 is amended-- 7#a7 in clause 7iii71 in the last sentence1 by inserting before the period at the end the following3 and for #bjbj shall be #a4e percent2 and 7#b7 in clause 7vi71 by inserting and #bjbj after except #bjah4 #bgjc4 ,reduction for non-emergency ,,esrd ambulance transports ,section #ahcd7l77#ae7 of the ,social ,security ,act 7#db4 ,u4,s4,c4 #aciem7l77#ae77 is amended by striking on or after ,october #a1 #bjac and inserting during the period beginning on ,october #a1 #bjac1 and ending on ,september #cj1 #bjah1 and by #bc percent for such services furnished on or after ,october #a1 #bjah4 #bgjd4 ,extension of target for relative value adjustments for misvalued services and transitional payment rules for certain radiation therapy services under the physician fee schedule ,section #ahdh of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7 is amended-- 7#a7 in subsection 7b77#aa71 by striking #bjag and #bjah and inserting #bjag1 #bjah1 and #bjai2 and 7#b7 in subsection 7c77#b7-- 7,a7 in subparagraph 7,k77iv71 by striking #bjag and #bjah and inserting #bjag1 #bjah1 and #bjai2 and 7,b7 in subparagraph 7,o71 by striking #bjah and inserting #bjai4 #bgje4 ,delay in authority to terminate contracts for ,medicare ,advantage plans failing to achieve minimum quality ratings ,section #aheg7;h77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;h77#c77 is amended by striking #bjah and inserting #bjbg4 #bgjf4 ,medicare ,improvement ,fund ,section #ahih7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is amended by striking during and after fiscal year #bjba and all that follows through the period at the end and inserting during and after fiscal year #bjba1 #j44 #bgjg4 ,payment for outpatient physical therapy services and outpatient occupational therapy services furnished by a therapy assistant ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 as amended by sections #bbjd and #bdad1 is further amended by adding at the end the following new subsection3 7x7 ,payment for outpatient physical therapy services and outpatient occupational therapy services furnished by a therapy assistant 7#a7 ,in general ,in the case of an outpatient physical therapy service or outpatient occupational therapy service furnished on or after ,january #a1 #bjbb1 for which payment is made under section #ahdh or subsection 7k71 that is furnished in whole or in part by a therapy assistant 7as defined by the ,secretary71 the amount of payment for such service shall be an amount equal to #he percent of the amount of payment otherwise applicable for the service under this part4 ,nothing in the preceding sentence shall be construed to change applicable requirements with respect to such services4 7#b7 ,use of modifier 7,a7 ,establishment ,not later than ,january #a1 #bjai1 the ,secretary shall establish a modifier to indicate 7in a form and manner specified by the ,secretary71 in the case of an outpatient physical therapy service or outpatient occupational therapy service furnished in whole or in part by a therapy assistant 7as so defined71 that the service was furnished by a therapy assistant4 7,b7 ,required use ,each request for payment1 or bill submitted1 for an outpatient physical therapy service or outpatient occupational therapy service furnished in whole or in part by a therapy assistant 7as so defined7 on or after ,january #a1 #bjbj1 shall include the modifier established under subparagraph 7,a7 for each such service4 7#c7 ,implementation ,the ,secretary shall implement this subsection through notice and comment rulemaking4 4 #bgjh4 ,changes to long-term care hospital payments 7a7 ,extension ,section #ahhf7m77#f77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77#f77;,b77i77 is amended-- 7#a7 in subclause 7,i71 by striking fiscal year #bjaf or fiscal year #bjag and inserting fiscal years #bjaf through #bjai2 and 7#b7 in subclause 7,,ii71 by striking #bjah and inserting #bjbj4 7b7 ,temporary adjustment to site neutral payment rates ,section #ahhf7m77#f77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77#f77;,b77 is amended-- 7#a7 in clause 7ii71 in the matter preceding subclause 7,i71 by striking ,in this paragraph and inserting ,subject to clause 7iv71 in this paragraph2 and 7#b7 by adding at the end the following new clause3 7iv7 ,adjustment ,for each of fiscal years #bjah through #bjbf1 the amount that would otherwise apply under clause 7ii77,i7 for the year 7determined without regard to this clause7 shall be reduced by #d4f percent4 4 #bgji4 ,non-,budget ,neutral ,transitional ,pass-,through ,payment ,change for ,certain ,products 7a7 ,in general ,subsection #ahcc7t77#f77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#f77;,a77iv77 is amended by inserting 7except1 beginning as of ,april #a1 #bjah1 a biosimilar biological product 7as defined under section #ahdg;,a7c77#f77;,h777 after biological4 7b7 ,application ,the amendment made by subsection 7a7 shall apply with respect to biosimilar biological products beginning on ,april #a1 #bjah1 regardless of whether such products were receiving pass-through status for an additional payment under section #ahcc7t77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#f77 before such date4 ,in the case of a product that was receiving such an additional payment pursuant to clause 7iv7 of subparagraph 7,a7 of such section as of the day before such date and after application of the amendment under subsection 7a7 is not eligible for such an additional payment as of such date1 such product may not be eligible for such an additional payment pursuant to any other clause of such subparagraph 7,a74 #bgaj4 ,third party liability in ,medicaid and ,,chip 7a7 ,modification of third party liability rules related to special treatment of certain types of care and payments 7#a7 ,in general ,section #aijb7;a77#be77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77;,e77 is amended1 in the matter preceding clause 7i71 by striking prenatal or4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall take effect on the date of enactment of this ,act4 7b7 ,delay in effective date and repeal of certain ,bipartisan ,budget ,act of #bjac amendments 7#a7 ,repeal ,effective as of ,september #cj1 #bjag1 subsection 7b7 of section #bjb of the ,bipartisan ,budget ,act of #bjac 7,public ,law #aac-fg2 #abg ,stat4 #aagg2 #db ,u4,s4,c4 #acif;a note7 7including any amendments made by such subsection7 is repealed and the provisions amended by such subsection shall be applied and administered as if such amendments had never been enacted4 7#b7 ,delay in effective date ,subsection 7c7 of section #bjb of the ,bipartisan ,budget ,act of #bjac 7,public ,law #aac-fg2 #abg ,stat4 #aagg2 #db ,u4,s4,c4 #acif;a note7 is amended to read as follows3 7c7 ,effective date ,the amendments made by subsection 7a7 shall take effect on ,october #a1 #bjai4 4 7#c7 ,effective date2 treatment ,the repeal and amendment made by this subsection shall take effect as if enacted on ,september #cj1 #bjag1 and shall apply with respect to any open claims1 including claims pending1 generated1 or filed1 after such date4 ,the amendments made by subsections 7a7 and 7b7 of section #bjb of the ,bipartisan ,budget ,act of #bjac 7,public ,law #aac-fg2 #abg ,stat4 #aagg2 #db ,u4,s4,c4 #acif;a note7 that took effect on ,october #a1 #bjag1 are null and void and section #aijb7;a77#be7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77 shall be applied and administered as if such amendments had not taken effect on such date4 7c7 ,,gao study and report ,not later than #ah months after the date of enactment of this ,act1 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 7a77#a7 and 7b77#b71 including-- 7#a7 the impact1 or potential effect1 of such amendments on access to prenatal and preventive pediatric care 7including early and periodic screening1 diagnostic1 and treatment services7 covered under ,state plans under such title 7or waivers of such plans72 7#b7 the impact1 or potential effect1 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 ,act2 and 7#c7 the impact1 or potential effect1 on providers of services under such plans or waivers of delays in payment or related issues that result from such amendments4 7d7 ,application to ,,chip 7#a7 ,in general ,section #bajg7;e77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7e77#a77 is amended-- 7,a7 by redesignating subparagraphs 7,b7 through 7,r7 as subparagraphs 7,c7 through 7,s71 respectively2 and 7,b7 by inserting after subparagraph 7,a7 the following new subparagraph3 7,b7 ,section #aijb7;a77#be7 7relating to third party liability74 4 7#b7 ,mandatory reporting ,section #aijb7;a77#be77;,i77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#be77;,i77i77 is amended-- 7,a7 by striking medical assistance under the ,state plan and inserting medical assistance under a ,state plan 7or under a waiver of the plan72 7,b7 by striking 7and1 at ,state option1 child and inserting and child2 and 7,c7 by striking title ,,xxi7 and inserting title ,,xxi4 #bgaa4 ,treatment of lottery winnings and other lump-sum income for purposes of income eligibility under ,medicaid 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a77#ag71 by striking 7e77#ad71 7e77#ad7 and inserting 7e77#ad71 7e77#ae72 and 7#b7 in subsection 7e77#ad71 by adding at the end the following new subparagraph3 7,k7 ,treatment of certain lottery winnings and income received as a lump sum 7i7 ,in general ,in the case of an individual who is the recipient of qualified lottery winnings 7pursuant to lotteries occurring on or after ,january #a1 #bjah7 or qualified lump sum income 7received on or after such date7 and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph 7,a71 a ,state shall1 in determining such eligibility1 include such winnings or income 7as applicable7 as income received-- 7,i7 in the month in which such winnings or income 7as applicable7 is received if the amount of such winnings or income is less than #hj1jjj2 7,,ii7 over a period of #b months if the amount of such winnings or income 7as applicable7 is greater than or equal to #hj1jjj but less than #ij1jjj2 7,,iii7 over a period of #c months if the amount of such winnings or income 7as applicable7 is greater than or equal to #ij1jjj but less than #ajj1jjj2 and 7,,iv7 over a period of #c months plus #a additional month for each increment of #aj1jjj of such winnings or income 7as applicable7 received1 not to exceed a period of #abj months 7for winnings or income of #a1bfj1jjj or more71 if the amount of such winnings or income is greater than or equal to #ajj1jjj4 7ii7 ,counting in equal installments ,for purposes of subclauses 7,,ii71 7,,iii71 and 7,,iv7 of clause 7i71 winnings or income to which such subclause applies shall be counted in equal monthly installments over the period of months specified under such subclause4 7iii7 ,hardship exemption ,an individual whose income1 by application of clause 7i71 exceeds the applicable eligibility threshold established by the ,state1 shall continue to be eligible for medical assistance to the extent that the ,state determines1 under procedures established by the ,state 7in accordance with standards specified by the ,secretary71 that the denial of eligibility of the individual would cause an undue medical or financial hardship as determined on the basis of criteria established by the ,secretary4 7iv7 ,notifications and assistance required in case of loss of eligibility ,a ,state shall1 with respect to an individual who loses eligibility for medical assistance under the ,state plan 7or a waiver of such plan7 by reason of clause 7i7-- 7,i7 before the date on which the individual loses such eligibility1 inform the individual-- 7aa7 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 specified in section #ihja7;f77#c7 of the ,internal ,revenue ,code of #aihf 7relating to loss of ,medicaid or ,,chip coverage72 and 7bb7 of the date on which the individual would no longer be considered ineligible by reason of clause 7i7 to receive medical assistance under the ,state plan or under any waiver of such plan and be eligible to reapply to receive such medical assistance2 and 7,,ii7 provide technical assistance to the individual seeking to enroll in such a qualified health plan4 7v7 ,qualified lottery winnings defined ,in this subparagraph1 the term qualified lottery winnings means winnings from a sweepstakes1 lottery1 or pool described in paragraph 7#c7 of section #ddjb of the ,internal ,revenue ,code of #aihf or a lottery operated by a multistate or multijurisdictional lottery association1 including amounts awarded as a lump sum payment4 7vi7 ,qualified lump sum income defined ,in this subparagraph1 the term qualified lump sum income means income that is received as a lump sum from monetary winnings from gambling 7as defined by the ,secretary and including gambling activities described in section #aiee7;b77#d7 of title #ah1 ,united ,states ,code74 4 7b7 ,rules of construction 7#a7 ,interception of lottery winnings allowed ,nothing in the amendment made by subsection 7a77#b7 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 7#db ,u4,s4,c4 #acif et seq47 for medical assistance furnished to the individual4 7#b7 ,applicability limited to eligibility of recipient of lottery winnings or lump sum income ,nothing in the amendment made by subsection 7a77#b7 shall be construed1 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 7#db ,u4,s4,c4 #acif et seq47 7or a waiver of such plan7 made by applying modified adjusted gross income under subparagraph 7,a7 of section #aijb7;e77#ad7 of such ,act 7#db ,u4,s4,c4 #acif;a7e77#ad771 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 income 7as defined in subparagraph 7,k7 of such section #aijb7;e77#ad71 as added by subsection 7a77#b7 of this section74 #bgab4 ,modifying reductions in ,medicaid ,,dsh allotments ,section #aibc7;f77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g77;,a77 is amended-- 7#a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking #bjah and inserting #bjbj2 and 7#b7 in clause 7ii71 by striking subclauses 7,i7 through 7,,viii7 and inserting the following3 7,i7 #d1jjj1jjj1jjj for fiscal year #bjbj2 and 7,,ii7 #h1jjj1jjj1jjj for each of fiscal years #bjba through #bjbe4 4 #bgac4 ,medicaid ,improvement ,fund rescission ,section #aida7;b7 of the ,social ,security ,act 7#db ,u4,s4,c #acifw-#a7;b77 is amended-- 7#a7 in paragraph 7#a71 by striking #e1jjj1jjj and inserting #j2 and 7#b7 in paragraph 7#c77;,a7 7as added by section #cjjf7b77;,b7 of the ,helping ,ensure ,access for ,little ,ones1 ,toddlers1 and ,hopeful ,youth by ,keeping ,insurance ,delivery ,stable ,act 7,public ,law #aae-abj771 by striking #ihj1jjj1jjj and inserting #j4 #bgad4 ,sunsetting exclusion of biosimilars from ,medicare part ,d coverage gap discount program ,section #ahfj;,d-#ad;,a7g77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad;a7g77#b77;,a77 is amended by inserting 1 with respect to a plan year before #bjai1 after other than4 #bgae4 ,prevention and ,public ,health ,fund ,section #djjb7;b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #cjju-#aa7;b77 is amended by striking paragraphs 7#a7 through 7#i7 and inserting the following new paragraphs3 7#a7 for each of fiscal years #bjah and #bjai1 #ijj1jjj1jjj2 7#b7 for each of fiscal years #bjbj and #bjba1 #a1jjj1jjj1jjj2 7#c7 for each of fiscal years #bjbb through #bjbg1 #a1ajj1jjj1jjj2 and 7#d7 for fiscal year #bjbh and each subsequent fiscal year1 #b1jjj1jjj1jjj4 4 ,g ,budgetary ,effects #cjja4 ,budgetary effects 7a7 ,in general ,the budgetary effects of division ,d and each succeeding division shall not be entered on either ,,paygo scorecard maintained pursuant to section #d7;d7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj4 7b7 ,senate ,,paygo ,scorecards ,the budgetary effects of division ,d and each succeeding division shall not be entered on any ,,paygo scorecard maintained for purposes of section #dajf of ,h4 ,con4 ,res4 #ga 7#aaeth ,congress74 7c7 ,classification of budgetary effects ,notwithstanding ,rule #c of the ,budget ,scorekeeping ,guidelines set forth in the joint explanatory statement of the committee of conference accompanying ,conference ,report #aje-bag and section #bej7;c77#h7 of the ,balanced ,budget and ,emergency ,deficit ,control ,act of #aihe1 the budgetary effects of division ,d and each succeeding division shall not be estimated-- 7#a7 for purposes of section #bea of such ,act2 and 7#b7 for purposes of paragraph 7#d77;,c7 of section #c of the ,statutory ,pay-,as-,you-,go ,act of #bjaj as being included in an appropriation ,act4 ,clerk4