,i #aaeth ,,congress #ast ,session ,h4 ,r4 #cibb ,,in ,,the ,,house ,,of ,,representatives ,october #c1 #bjag,mr4 ,walden introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to extend funding for certain public health programs1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,community ,health ,and ,medical ,professionals ,improve ,our ,nation ,act of #bjag or the ,,champion ,act4 #b4 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,title ,i--,extension of ,public ,health ,programs ,sec4 #aja4 ,extension for community health centers and the ,national ,health ,service ,corps4 ,sec4 #ajb4 ,extension for special diabetes programs4 ,sec4 #ajc4 ,reauthorization of program of payments to teaching health centers that operate graduate medical education programs4 ,sec4 #ajd4 ,extension for family-to-family health information centers4 ,sec4 #aje4 ,youth empowerment program2 personal responsibility education4 ,title ,,ii--,offsets ,sec4 #bja4 ,providing for qualified health plan grace period requirements for issuer receipt of advance payments of cost-sharing reductions and premium tax credits that are more consistent with ,state law grace period requirements4 ,sec4 #bjb4 ,prevention and ,public ,health ,fund4 ,i ,extension of ,public ,health ,programs #aja4 ,extension for community health centers and the ,national ,health ,service ,corps 7a7 ,community health centers funding ,section #ajejc7;b77#a77;,e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#a77;,e77 is amended by striking #bjag and inserting #bjai4 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 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 such 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 7l77#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;,b71 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 center2 7#g7 by striking subsection 7s72 7#h7 by redesignating subsections 7g7 through 7r7 as subsections 7h7 through 7s71 respectively2 7#i7 by inserting after subsection 7f71 the following3 7g7 ,new access points and expanded services 7#a7 ,approval of new access points 7,a7 ,in general ,the ,secretary may approve applications for grants under subparagraph 7,a7 or 7,b7 of subsection 7e77#a71 subsection 7h71 subsection 7i71 and subsection 7j7 to establish new delivery sites4 7,b7 ,special consideration ,in carrying out subparagraph 7,a71 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 7,c7 ,consideration of applications ,in carrying subparagraph 7,a71 the ,secretary shall approve applications for grants under subparagraphs 7,a7 and 7,b7 of subsection 7e77#a7 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 7,d7 ,service area overlap ,if in carrying out subparagraph 7,a7 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 7,a7 ,in general ,the ,secretary may approve applications for grants under subparagraph 7,a7 or 7,b7 of subsection 7e77#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 7,b7 ,priority expansion projects ,in carrying out subparagraph 7,a71 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 7,c7 ,consideration of applications ,in carrying out subparagraph 7,a71 the ,secretary shall approve applications for applicants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by such applicants is not less than two to three or greater than three to two4 2 7#aj7 in subsection 7i7 7as so redesignated7-- 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#aa7 in subsection 7l7 7as so redesignated7-- 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 and an application for a grant under subsection 7g7 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 7g77#a71 a demonstration that the applicant has consulted with appropriate ,state and local government agencies1 and health care providers regarding the need for the heath 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 7g7 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#ab7 in subsection 7m7 7as so redesignated71 by adding at the end the following3 ,funds expended to carry out activities under this subsection and operational support activities under subsection 7n7 shall not exceed three percent of the amount appropriated for this section for the fiscal year involved42 7#ac7 in subsection 7q7 7as so redesignated71 by striking grants for new health centers under subsections 7c7 and 7e7 and inserting operating grants under subsection 7e71 applications for new access points and expanded service pursuant to subsection 7g72 7#ad7 in subsection 7r77#d7 7as so redesignated71 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 and 7#ae7 in subsection 7s77#c7 7as so redesignated7-- 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 7r77#d74 4 7c7 ,national ,health ,service ,corps ,section #ajejc7;b77#b77;,e7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#b77;,e77 is amended by striking #bjag and inserting #bjai4 7d7 ,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 7e7 ,conforming amendments ,section #cjad7;h7 of title #ah1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#a71 by striking 1 as amended by section #bba of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae12 and 7#b7 in paragraph 7#d71 by inserting and section #aja7;d7 of the ,community ,health ,and ,medical ,professionals ,improve ,our ,nation ,act of #bjag after section #bba7;c7 of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae4 #ajb4 ,extension for special diabetes programs 7a7 ,special diabetes program for type ,i diabetes ,section #ccj;,b7b77#b77;,c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b77;,c77 is amended by striking #bjag and inserting #bjai4 7b7 ,special diabetes program for ,indians ,section #ccj;,c7c77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#c7;c77#b77 is amended-- 7#a7 in subparagraph 7,c71 by striking and at the end2 7#b7 in subparagraph 7,d71 by striking the period at the end and inserting and #aab1ejj1jjj for the period consisting of the second1 third1 and fourth quarters of fiscal year #bjah2 and2 and 7#c7 by adding at the end the following3 7,e7 #aej1jjj1jjj for fiscal year #bjai4 4 #ajc4 ,reauthorization of program of payments to teaching health centers that operate graduate medical education programs 7a7 ,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 for-- 7,a7 maintenance of 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 programs1 as appropriate4 7#b7 ,priority ,in making payments pursuant to 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 7b7 ,funding ,subsection 7g7 of section #cdj;,h of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;h7 is amended-- 7#a7 by striking ,to carry out and inserting the following3 7#a7 ,in general ,to carry out 2 7#b7 by striking and #ae1jjj1jjj for the first quarter of fiscal year #bjah and inserting 1 #ae1jjj1jjj for the first quarter of fiscal year #bjah1 #aaa1ejj1jjj for the period consisting of the second1 third1 and fourth quarters of fiscal year #bjah1 and #abf1ejj1jjj for fiscal year #bjai2 and 7#c7 by adding at the end the following3 7#b7 ,administrative expenses ,of the amount made available to carry out this section for any fiscal year1 the ,secretary may not use more than #e percent of such amount for the expenses of administering this section4 4 7c7 ,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 7d7 ,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 7e7 ,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 7f7 ,technical correction ,subsection 7f7 of the section #cdj;,h 7#db ,u4,s4,c4 #bef;h7 is amended by striking hospital each place it appears and inserting teaching health center4 7g7 ,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 this ,act1 shall continue to apply with respect to payments under such section for fiscal years before fiscal year #bjah4 #ajd4 ,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 such term 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 ,virgin ,islands1 and the ,northern ,mariana ,islands4 4 #aje4 ,youth empowerment program2 personal responsibility education 7a7 ,youth empowerment program 7#a7 ,in general ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended to read as follows3 #eaj4 ,youth empowerment program 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 and 7,d7 be based on adolescent learning and developmental theories for the age group receiving the education4 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 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 evaluation methodologies1 the ,secretary shall consult with relevant stakeholders4 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 ,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 7#b7 ,effective date ,the amendment made by this section takes effect on ,october #a1 #bjag4 7b7 ,personal responsibility education 7#a7 ,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-- 7i7 in subparagraph 7,a71 by striking #bjag each place it appears and inserting #bjai2 and 7ii7 in subparagraph 7,b7-- 7,i7 in the subparagraph heading1 by striking #c-year grants and inserting ,competitive ,,prep grants2 and 7,,ii7 in clause 7i71 by striking solicit applications to award #c-year grants in each of fiscal years #bjab through #bjag and insert continue through fiscal year #bjai grants awarded for any of fiscal years #bjae through #bjag2 7,c7 in subsection 7c71 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 7#b7 ,effective date ,the amendments made by this subsection take effect on ,october #a1 #bjag4 ,,ii ,offsets #bja4 ,providing for qualified health plan grace period requirements for issuer receipt of advance payments of cost-sharing reductions and premium tax credits that are more consistent with ,state law grace period requirements 7a7 ,in general ,section #adab7;c7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjhb7;c77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,b77iv77,,ii71 by striking a #c-month grace period and inserting a grace period specified in subparagraph 7,c72 and 7,b7 by adding at the end the following new subparagraphs3 7,c7 ,grace period specified ,for purposes of subparagraph 7,b77iv77,,ii71 the grace period specified in this subparagraph is-- 7i7 for plan years beginning before ,january #a1 #bjah1 a #c-month grace period2 and 7ii7 for plan years beginning on or after ,january #a1 #bjah-- 7,i7 in the case of an ,exchange operating in a ,state that has a ,state law grace period in place1 such ,state law grace period2 and 7,,ii7 in the case of an ,exchange operating in a ,state that does not have a ,state law grace period in place1 a #a-month grace period4 7,d7 ,state law grace period ,for purposes of subparagraph 7,c71 the term ,state law grace period means1 with respect to a ,state1 a grace period for nonpayment of premiums before discontinuing coverage that is applicable under the ,state law to health insurance coverage offered in the individual market of the ,state4 2 and 7#b7 in paragraph 7#c71 by adding at the end the following new sentence3 ,the requirements of paragraph 7#b77;,b77iv7 apply to an issuer of a qualified health plan receiving an advanced payment under this paragraph in the same manner and to the same extent that such requirements apply to an issuer of a qualified health plan receiving an advanced payment under paragraph 7#b77;,a74 7b7 ,report on aligning grace periods for ,medicaid1 ,medicare1 and ,exchange plans ,not later than two years after the date of full implementation of subsection 7a71 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on-- 7#a7 the effects on consumers of aligning grace periods applied under the ,medicaid program under title ,,xix of the ,social ,security ,act1 under the ,medicare program under parts ,c and ,d of title ,,xviii of such ,act1 and under qualified health plans offered on an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act1 including the extent to which such an alignment of grace periods may help to avoid enrollment status confusion for individuals under such ,medicaid program1 ,medicare program1 and qualified health plans2 and 7#b7 the extent to which such an alignment of grace periods may reduce fraud1 waste1 and abuse under the ,medicaid program4 #bjb4 ,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#c7 through 7#h7 and inserting the following new paragraphs3 7#c7 for fiscal year #bjah1 #ijj1jjj1jjj2 7#d7 for fiscal year #bjai1 #ejj1jjj1jjj2 7#e7 for fiscal year #bjbj1 #ejj1jjj1jjj2 7#f7 for fiscal year #bjba1 #ejj1jjj1jjj2 7#g7 for fiscal year #bjbb1 #ejj1jjj1jjj2 7#h7 for fiscal year #bjbc1 #ejj1jjj1jjj2 7#i7 for fiscal year #bjbd1 #ejj1jjj1jjj2 7#aj7 for fiscal year #bjbe1 #gej1jjj1jjj2 7#aa7 for fiscal year #bjbf1 #a1jjj1jjj1jjj2 and 7#ab7 for fiscal year #bjbg and each fiscal year thereafter1 #b1jjj1jjj1jjj4 4