,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #dhbj ,,in ,,the ,,house ,,of ,,representatives ,january #ah1 #bjah,mr4 ,mc,eachin 7for himself1 ,ms4 ,roybal-,allard1 ,mr4 ,clay1 ,mr4 ,serrano1 ,mr4 ,espaillat1 ,mr4 ,deutch1 ,mrs4 ,napolitano1 ,mr4 ,pocan1 ,mr4 ,langevin1 ,mr4 ,richmond1 ,mr4 ,huffman1 ,mr4 ,schrader1 ,ms4 ,adams1 ,mr4 ,mc,nerney1 ,mr4 ,grijalva1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,carson of ,indiana1 ,mr4 ,sablan1 ,ms4 ,bonamici1 ,mr4 ,larson of ,connecticut1 ,ms4 ,judy ,chu of ,california1 ,ms4 ,del,bene1 ,ms4 ,norton1 ,mr4 ,scott of ,virginia1 ,mr4 ,cohen1 ,mr4 ,sean ,patrick ,maloney of ,new ,york1 ,ms4 ,barragn1 ,ms4 ,matsui1 ,ms4 ,schakowsky1 ,mr4 ,veasey1 ,mr4 ,soto1 ,ms4 ,jayapal1 ,mr4 ,keating1 ,mr4 ,al ,green of ,texas1 ,mr4 ,lowenthal1 ,ms4 ,wilson of ,florida1 ,ms4 ,hanabusa1 ,ms4 ,castor of ,florida1 ,ms4 ,sewell of ,alabama1 ,mr4 ,gomez1 ,mr4 ,loebsack1 ,ms4 ,wasserman ,schultz1 ,mrs4 ,watson ,coleman1 ,mr4 ,thompson of ,california1 ,mr4 ,courtney1 ,ms4 ,rosen1 ,mr4 ,takano1 ,ms4 ,pingree1 ,ms4 ,kuster of ,new ,hampshire1 ,mr4 ,khanna1 ,mr4 ,panetta1 and ,mr4 ,kihuen7 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 ,advancing ,seniors and ,kids ,act or the ,,ask ,act4 #b4 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title4 ,sec4 #b4 ,table of contents4 ,title ,i--,children's ,health ,insurance ,program ,sec4 #ajj4 ,short title4 ,sec4 #aja4 ,permanent extension of the ,children's ,health ,insurance ,program4 ,sec4 #ajb4 ,extension of certain programs and demonstration projects4 ,sec4 #ajc4 ,extension of outreach and enrollment program4 ,sec4 #ajd4 ,extension and reduction of additional ,federal financial participation for ,,chip4 ,title ,,ii--,medicare and ,other ,health ,extenders ,subtitle ,a--,medicare ,extenders and ,related ,policies ,sec4 #bja4 ,extension of work ,,gpci floor4 ,sec4 #bjb4 ,permanent repeal of the therapy caps4 ,sec4 #bjc4 ,ground ambulance services cost reporting requirement4 ,sec4 #bjd4 ,ground ambulance services cost reporting study4 ,sec4 #bje4 ,extension of ground ambulance services extenders4 ,sec4 #bjf4 ,extension of increased inpatient hospital payment adjustment for certain low-volume hospitals4 ,sec4 #bjg4 ,extension of the ,medicare-,dependent ,hospital 7,,mdh7 program4 ,sec4 #bjh4 ,specialized ,medicare ,advantage plans for special needs individuals4 ,sec4 #bji4 ,expanding supplemental benefits to meet the needs of chronically ill ,medicare ,advantage enrollees4 ,sec4 #baj4 ,extension of consensus-based entity funding4 ,sec4 #baa4 ,extension of certain ,,mippa funding provisions4 ,sec4 #bab4 ,extension of home health rural add-on4 ,subtitle ,b--,medicaid and ,public ,health ,extenders ,sec4 #bba4 ,extension for community health centers and the ,national ,health ,service ,corps4 ,sec4 #bbb4 ,extension for special diabetes programs4 ,sec4 #bbc4 ,reauthorization of program of payments to teaching health centers that operate graduate medical education programs4 ,sec4 #bbd4 ,extension for family-to-family health information centers4 ,sec4 #bbe4 ,extension of abstinence education2 extension of personal responsibility education program4 ,sec4 #bbf4 ,extension of health workforce demonstration projects for low-income individuals4 ,sec4 #bbg4 ,delay of reduction to ,medicaid ,,dsh allotments4 ,sec4 #bbh4 ,delay of ,bipartisan ,budget ,act of #bjac third-party liability provisions4 ,subtitle ,c--,continuing the ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program ,sec4 #bca4 ,continuing evidence-based home visiting program4 ,sec4 #bcb4 ,continuing to demonstrate results to help families4 ,sec4 #bcc4 ,reviewing statewide needs to target resources4 ,sec4 #bcd4 ,improving the likelihood of success in high-risk communities4 ,sec4 #bce4 ,option to fund evidence-based home visiting on a pay for outcome basis4 ,sec4 #bcf4 ,data exchange standards for improved interoperability4 ,sec4 #bcg4 ,allocation of funds4 ,title ,,iii--,strengthening ,protections for ,social ,security ,beneficiaries ,act of #bjah ,sec4 #cjj4 ,short title4 ,subtitle ,a--,strengthening ,oversight and ,beneficiary ,protection ,sec4 #cja4 ,stronger monitoring of representative payees4 ,sec4 #cjb4 ,reducing the burden on families4 ,sec4 #cjc4 ,protecting beneficiaries through information sharing4 ,sec4 #cjd4 ,clarifying overpayment liability for child in child welfare system4 ,sec4 #cje4 ,reports4 ,subtitle ,b--,improving ,payee ,selection and ,quality ,sec4 #caa4 ,advance designation of representative payees4 ,sec4 #cab4 ,prohibition on individuals convicted of certain crimes serving as representative payees4 ,sec4 #cac4 ,prohibition on individuals with representative payees serving as representative payees4 ,sec4 #cad4 ,reassessment of payee selection and replacement policies4 ,i ,children's ,health ,insurance ,program #ajj4 ,short title ,this title may be cited as the ,keeping ,kids' ,insurance ,delivery ,stable ,act or the ,,kids ,act4 #aja4 ,permanent extension of the ,children's ,health ,insurance ,program 7a7 ,funding 7#a7 ,in general ,section #bajd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a771 as amended by section #cbja7;a7 of the ,,chip and ,public ,health ,funding ,extension ,act 7division ,c of ,public ,law #aae-if71 is amended-- 7,a7 in paragraph 7#bj77;,b71 by striking 2 and and inserting a semicolon2 and 7,b7 by striking paragraph 7#ba7 and inserting the following new paragraphs3 7#ba7 for fiscal year #bjah1 #ba1ejj1jjj1jjj2 7#bb7 for fiscal year #bjai1 #bb1fjj1jjj1jjj2 7#bc7 for fiscal year #bjbj1 #bc1gjj1jjj1jjj2 7#bd7 for fiscal year #bjba1 #bd1hjj1jjj1jjj2 7#be7 for fiscal year #bjbb1 #be1ijj1jjj1jjj2 7#bf7 for fiscal year #bjbc1 #bg1jjj1jjj1jjj2 7#bg7 for fiscal year #bjbd1 #bh1ajj1jjj1jjj2 7#bh7 for fiscal year #bjbe1 #bi1bjj1jjj1jjj2 7#bi7 for fiscal year #bjbf1 #cj1cjj1jjj1jjj2 7#cj7 for fiscal year #bjbg1 #ca1djj1jjj1jjj2 and 7#ca7 for fiscal year #bjbh and each subsequent fiscal year1 the amount provided for the previous fiscal year1 increased by the product of-- 7,a7 #a plus the percentage increase in the projected per capita amount of ,national ,health ,expenditures from the calendar year in which the previous fiscal year ends to the calendar year in which the fiscal year involved ends1 as most recently published by the ,secretary before the beginning of the fiscal year2 and 7,b7 #a plus the percentage increase 7if any7 in the national population of children from ,july #a in the previous fiscal year to ,july #a in the fiscal year involved1 as determined by the ,secretary based on the most recent published estimates of the ,bureau of the ,census before the beginning of the fiscal year involved1 plus #a percentage point4 4 7#b7 ,prevention of duplicate appropriations for fiscal year #bjah ,notwithstanding any other provision of law1 insofar as funds have been appropriated under subsection 7a77#ba7 of section #bajd of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd71 as such subsection is in effect on the day before the date of the enactment of this ,act1 to provide allotments to ,states under the ,state ,children's ,health ,insurance ,program established under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 7whether implemented under title ,,xix1 ,,xxi1 or both1 of the ,social ,security ,act7 for fiscal year #bjah-- 7,a7 any amounts that are so appropriated that are not so allotted and obligated before the date of the enactment of this ,act1 are rescinded2 and 7,b7 any amount provided for ,,chip allotments to a ,state under this section 7and the amendments made by this section7 for such fiscal year shall be reduced by the amount of such appropriations so allotted and obligated before such date4 7b7 ,allotments ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m771 as amended by section #cbja7;b7 of the ,,chip and ,public ,health ,funding ,extension ,act 7division ,c of ,public ,law #aae-if71 is amended-- 7#a7 in paragraph 7#b77;,b7-- 7,a7 in the matter preceding clause 7i71 by striking 7#ai7 and inserting 7#ca72 and 7,b7 in clause 7ii7-- 7i7 in the matter preceding subclause 7,i71 by striking and paragraph 7#aj72 and 7ii7 in subclause 7,i71 by inserting 7or1 in the case of fiscal year #bjah1 under paragraph 7#d77 after clause 7i72 7#b7 in paragraph 7#e71 by striking 1 #bjag1 or #bjah and inserting or #bjag2 7#c7 in paragraph 7#g7-- 7,a7 in subparagraph 7,a71 by striking and ending with fiscal year #bjag2 7,b7 in subparagraph 7,b71 in the matter preceding clause 7i71 by inserting 7or1 in the case of fiscal year #bjah1 by not later than the date that is #fj days after the date of the enactment of the ,,kids ,act7 after before the ,august #ca preceding the beginning of the fiscal year2 and 7,c7 in the matter following subparagraph 7,b71 by striking or fiscal year #bjaf and inserting fiscal year #bjaf1 or any succeeding even-numbered fiscal year2 7#d7 in paragraph 7#i71 by striking 1 #bjag1 or #bjah and inserting or #bjag2 and 7#e7 by striking paragraph 7#aj74 7c7 ,extension of the ,child ,enrollment ,contingency ,fund ,section #bajd7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a77ii71 by striking #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf and inserting #bjaj through #bjad1 #bjaf1 #bjah1 and each subsequent fiscal year2 and 7,b7 in subparagraph 7,b71 by striking #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 and #bjaf and inserting #bjaj through #bjad1 #bjaf1 #bjah1 and each subsequent fiscal year2 and 7#b7 in paragraph 7#c77;,a71 in the matter preceding clause 7i71 by striking or a semi-annual allotment period for fiscal year #bjae or #bjag and inserting or in fiscal year #bjah or any subsequent fiscal year 7or a semi-annual allotment period for fiscal year #bjae1 or #bjag74 7d7 ,extension of qualifying states option 7#a7 ,in general ,section #baje7;g77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is amended-- 7,a7 in the heading1 by striking through #bjag and inserting and subsequent fiscal years2 and 7,b7 in subparagraph 7,a71 by striking for any of fiscal years #bjji through #bjag and inserting for fiscal year #bjji or any subsequent fiscal year4 7#b7 ,technical amendments ,section #bajd7;f77#b77;,b77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7f77#b77;,b77ii771 as amended by section #cbja7;c7 of the ,,chip and ,public ,health ,funding ,extension ,act 7division ,c of ,public ,law #aae-if71 is amended-- 7,a7 in subclause 7,i71 by striking for the month 7as defined in subclause 7,,ii77 and inserting 7as defined in subclause 7,,ii77 for the month2 7,b7 in subclause 7,,ii71 by inserting 1 as in effect on the day before the date of the enactment of the ,,kids ,act1 after section #baje7;g77#d77;,a72 and 7,c7 in subclause 7,,vi7-- 7i7 by inserting 1 as in effect on the day before the date of the enactment of the ,,kids ,act after 1 section #baje7;g77#d72 and 7ii7 by inserting 1 as so in effect after under section #baje7;g77#d74 7e7 ,extension of express lane eligibility option ,section #aijb7;e77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77 is amended by striking subparagraph 7,i74 7f7 ,assurance of affordability standard for children and families 7#a7 ,in general ,section #baje7;d77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7d77#c77 is amended-- 7,a7 in the paragraph heading1 by striking until ,october #a1 #bjai2 and 7,b7 in subparagraph 7,a71 in the matter preceding clause 7i7-- 7i7 by striking ,during the period that begins on and inserting ,beginning on2 7ii7 by striking and ends on ,september #cj1 #bjai2 and 7iii7 by striking ,the preceding sentence shall not be construed as preventing a ,state during such period and inserting ,beginning on ,october #a1 #bjai1 the preceding sentence shall only apply with respect to children in families whose income does not exceed #cjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved4 ,the preceding sentences shall not be construed as preventing a ,state during any such periods4 7#b7 ,conforming amendments ,section #aijb7;gg77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7gg77#b77 is amended-- 7,a7 in the paragraph heading1 by striking until ,october #a1 #bjai2 and 7,b7 by striking through ,september #cj1 #bjai1 and inserting 7but beginning on ,october #a1 #bjai1 only with respect to children in families whose income does not exceed #cjj percent of the poverty line 7as defined in section #baaj7;c77#e77 applicable to a family of the size involved74 7g7 ,,chip look-,alike plans 7#a7 ,blending risk pools ,section #bajg of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;gg7 is amended by adding at the end the following3 7g7 ,use of blended risk pools 7#a7 ,in general ,nothing in this title 7or any other provision of ,federal law7 shall be construed as preventing a ,state from considering children enrolled in a qualified ,,chip look-alike program and children enrolled in a ,state child health plan under this title 7or a waiver of such plan7 as members of a single risk pool4 7#b7 ,qualified ,,chip look-alike program ,in this subsection1 the term qualified ,,chip look-alike program means a ,state program-- 7,a7 under which children who are under the age of #ai and are not eligible to receive medical assistance under title ,,xix or child health assistance under this title may purchase coverage through the ,state that provides benefits that are at least identical to the benefits provided under the ,state child health plan under this title 7or a waiver of such plan72 and 7,b7 that is funded exclusively through non-,federal funds1 including funds received by the ,state in the form of premiums for the purchase of such coverage4 4 7#b7 ,coverage rule 7,a7 ,in general ,section #ejjj;,a7f77#a7 of the ,internal ,revenue ,code of #aihf is amended in subparagraph 7,a77iii71 by inserting or under a qualified ,,chip look-alike program 7as defined in section #bajg7;g7 of the ,social ,security ,act7 before the comma at the end4 7,b7 ,effective date ,the amendment made by subparagraph 7,a7 shall apply with respect to taxable years beginning after ,december #ca1 #bjag4 7h7 ,availability of unused fiscal year #bjah redistribution amounts ,any amounts that have been redistributed to ,states under subsection 7f7 of section #bajd of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7 for fiscal year #bjah that are not1 or will not be1 expended by the end of that fiscal year shall be-- 7#a7 adjusted by the ,secretary before the end of fiscal year #bjah to reflect an updated estimate of shortfalls under subsection 7f77#b77;,a7 of such section2 and 7#b7 available for redistribution under subsection 7f7 of such section for subsequent fiscal years4 #ajb4 ,extension of certain programs and demonstration projects 7a7 ,childhood obesity demonstration project ,section #aaci;,a7e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77 is amended-- 7#a7 by striking and #aj1jjj1jjj and inserting 1 #aj1jjj1jjj2 and 7#b7 by inserting after #bjag the following3 1 and #e1jjj1jjj for fiscal year #bjah and each subsequent fiscal year4 7b7 ,pediatric quality measures program ,section #aaci;,a7i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7i77 is amended-- 7#a7 by striking ,out of any and inserting the following3 7#a7 ,in general ,out of any 2 7#b7 by striking there is appropriated for each and inserting 8there is appropriated-- 7,a7 for each 2 7#c7 by striking 1 and there is appropriated for the period and inserting 82 7,b7 for the period 2 7#d7 by striking 4 ,funds appropriated under this subsection shall remain available until expended4 and inserting 2 and2 and 7#e7 by adding at the end the following3 7,c7 for fiscal year #bjah and each subsequent fiscal year1 #ae1jjj1jjj for the purpose of carrying out this section 7other than subsections 7e71 7f71 and 7g774 7#b7 ,availability ,funds appropriated under this subsection shall remain available until expended4 4 #ajc4 ,extension of outreach and enrollment program 7a7 ,in general ,section #baac of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is amended-- 7#a7 in subsection 7a77#a71 by striking during the period of fiscal years #bjji through #bjag2 and 7#b7 in subsection 7g7-- 7,a7 by striking and #dj1jjj1jjj and inserting 1 #dj1jjj1jjj2 and 7,b7 by inserting after #bjag the following3 1 and #bj1jjj1jjj for fiscal year #bjah and each subsequent fiscal year4 7b7 ,making organizations that use parent mentors eligible ,to receive grants ,section #baac7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7f77 is amended-- 7#a7 in paragraph 7#a77;,e71 by striking or community-based doula programs and inserting 1 community-based doula programs1 or parent mentors2 and 7#b7 by adding at the end the following new paragraph3 7#e7 ,parent mentor ,the term parent mentor means an individual who-- 7,a7 is a parent or guardian of at least one child who is an eligible child under this title or title ,,xix2 and 7,b7 is trained to assist families with children who have no health insurance coverage with respect to improving the social determinants of the health of such children1 including by providing-- 7i7 education about health insurance coverage1 including1 with respect to obtaining such coverage1 eligibility criteria and application and renewal processes2 7ii7 assistance with completing and submitting applications for health insurance coverage2 7iii7 a liaison between families and representatives of ,state plans under title ,,xix or ,state child health plans under this title2 7iv7 guidance on identifying medical and dental homes and community pharmacies for children2 and 7v7 assistance and referrals to successfully address social determinants of children's health1 including poverty1 food insufficiency1 and housing4 4 7c7 ,exclusion from modified adjusted gross income ,section #aijb7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77 is amended-- 7#a7 in the first paragraph 7#ad71 relating to income determined using modified adjusted gross income1 by adding at the end the following new subparagraph3 7,j7 ,exclusion of parent mentor compensation from income determination ,any nominal amount received by an individual as compensation1 including a stipend1 for participation as a parent mentor 7as defined in paragraph 7#e7 of section #baac7;f77 in an activity or program funded through a grant under such section shall be disregarded for purposes of determining the income eligibility of such individual for medical assistance under the ,state plan or any waiver of such plan4 2 and 7#b7 by striking 7#ad7 ,exclusion and inserting 7#ae7 ,exclusion4 #ajd4 ,extension and reduction of additional ,federal financial participation for ,,chip ,section #baje7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7b77 is amended in the second sentence by inserting and during the period that begins on ,october #a1 #bjai1 and ends on ,september #cj1 #bjbj1 the enhanced ,,fmap determined for a ,state for a fiscal year 7or for any portion of a fiscal year occurring during such period7 shall be increased by #aa4e percentage points after #bc percentage points14 ,,ii ,medicare and ,other ,health ,extenders ,a ,medicare ,extenders and ,related ,policies #bja4 ,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 #bjb4 ,permanent repeal of the therapy caps ,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 subparagraph3 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 year1 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 #bjc4 ,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 system for providers of services with respect to ambulance services to ensure that such system contains 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 supplier of ground ambulance services that furnishes such services for fewer than #bj individuals entitled to benefits under part ,a of title ,,xviii and enrolled under part ,b of such title in a cost reporting period 7as defined by the ,secretary71 the ,secretary may modify the requirements for inclusion of any information specified in subsection 7a7 in reports made in accordance with the uniform reporting systems established under this section with respect to such services4 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 finds 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 deem payments made under this subsection to such supplier for such period to be overpayments and recoup such overpayments4 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 ground ambulance services suppliers 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 #bjd of the ,advancing ,seniors and ,kids ,act regarding whether cost reports made by suppliers or a category of suppliers 7as specified for purposes of the report submitted under such section7 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#ag771 as added by subsection 7b7 of this section2 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 7#a7 ,in general ,there are hereby appropriated to the ,secretary 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 #ib1jjj1jjj 7of which not less than #aj1jjj1jjj 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 7#b7 ,funding for employees ,the ,secretary of ,health and ,human ,services shall provide for the transfer to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 from the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of the ,social ,security ,act 7#db ,u4,s4,c4 #aciet71 of such sums as may be necessary in order to directly hire no more than #b full-time employees to carry out the provisions of this section1 including the amendments made by this section4 7e7 ,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 #bjd4 ,ground ambulance services cost reporting study 7a7 ,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 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 7b7 ,contents ,the report described in subsection 7a7 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 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 paragraphs 7#a7 and 7#b74 #bje4 ,extension of ground ambulance services extenders ,section #ahcd7l7 of the ,social ,security ,act 7#db ,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 #bjf4 ,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 and for discharges occurring in fiscal year #bjbj and subsequent fiscal years2 7#b7 in subparagraph 7,c77i7-- 7,a7 by striking fiscal years #bjaa through #bjag each place it appears and inserting fiscal years #bjaa through #bjai2 and 7,b7 by striking or portion of fiscal year2 and 7#c7 in subparagraph 7,d7-- 7,a7 in the heading1 by striking ,temporary applicable percentage increase and inserting ,applicable percentage increase beginning with fiscal year #bjaa2 7,b7 by striking fiscal years #bjaa through #bjag1 and inserting fiscal years #bjaa through #bjai2 and 7,c7 by striking or the portion of fiscal year each place it appears4 #bjg4 ,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 and 7#b7 in clause 7ii77,,ii71 by striking ,october #a1 #bjag and inserting ,october #a1 #bjai4 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 #bjh4 ,specialized ,medicare ,advantage plans for special needs individuals 7a7 ,permanent 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-- 7i7 establish 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 establish 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 ,the ,secretary shall solicit comment in developing such procedures from ,states1 plans1 beneficiaries and their representatives1 and other relevant stakeholders4 ,with respect to items and services described in the previous sentence1 appeals procedures established under this clause shall apply in place of otherwise applicable appeals procedures4 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 #bjbb 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 full integration for certain dual ,s,n,ps 7i7 ,requirement ,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 requirements for integration of benefits under this title and title ,,xix3 7,i7 ,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 program74 7,,ii7 ,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 ,to the extent the ,state does not allow for or require such a specialized ,,ma plan to enter into a capitated contract described in subclause 7,,ii71 enter into another type of integration arrangement1 as determined appropriate by the ,secretary after consultation with stakeholders1 such as by-- 7aa7 entering into a contract with the ,state that requires notifying the ,state in a timely manner of hospitalizations1 emergency room visits1 and hospital or nursing home discharges of enrollees or otherwise requires sharing data that would benefit the coordination of items and services under this title and the ,state plan under title ,,xix2 or 7bb7 being offered by a parent organization that also offers a ,medicaid managed care plan that provides long-term services and supports or behavioral health services to the same enrollees as under such specialized ,,ma plan4 7ii7 ,sanctions ,for #bjba and subsequent years1 if the ,secretary determines that a specialized ,,ma plan fails to comply with clause 7i71 the ,secretary may provide for the application against the ,medicare ,advantage organization offering the plan any of the remedies described in section #aheg7;g77#b74 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 responsible 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 responsible 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 ,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 redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively1 and indenting appropriately2 7,b7 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 7,c7 by striking all ,s,n,ps4--,the requirements and inserting 8all ,s,n,ps4-- 7,a7 ,in general ,subject to subparagraph 7,b71 the requirements 2 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 ,s,n,ps ,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 8who-- 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 capitated 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 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 such special needs individuals with such a condition having access to and being enrolled in such a plan1 as compared to access to and enrollment in other ,medicare ,advantage plans under this part1 it is projected that such individuals would improve health outcomes with respect to such condition1 that such individuals would have reduced overall costs under this title1 and that there would not be any increase in expenditures under this title for such 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 ,,gao ,study on ,health ,outcomes of ,individuals ,enrolled in ,specialized ,,ma plans ,not later than the date that is #c years after the date of the enactment of this paragraph1 the ,comptroller ,general of the ,united ,states shall conduct a study and submit to ,congress a report on the extent to which health outcomes can be compared across specialized ,,ma plans for special needs individuals 7as defined in section #ahei7;b77#f77 and other ,medicare ,advantage plans under this part across similar populations1 using existing measures and that identifies any potential limitations where new measures may need to be developed for such population4 4 7d7 ,quality measurement at the plan level for ,s,n,ps and determination of feasibility 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 ,s,n,ps 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 if quality measures are reported at the plan level1 ensure that ,,ma plans are not required to provide duplicative information2 and 7iii7 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 to 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 subparagraph4 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 paragraph 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#f77;,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-for-service4 7,e7 ,as1 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 ,barriers and opportunities for making further progress on dual integration1 as well as recommend legislation 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 #bji4 ,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 described in subsection 7b77#f7 of section #ahei1 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 with respect to supplemental benefits provided to a chronically ill enrollee under this subparagraph1 waive the uniformity requirement1 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 or 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 described in section #ahei7;b77#f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f774 ,such study shall be conducted in consultation with the ,centers for ,medicare ,medicaid ,services and ,medicare ,advantage plans as necessary and1 to the extent data is available1 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 ,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 #baj4 ,extension of consensus-based entity funding ,section #ahij7;d77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77#b77 is amended by striking #bjag and inserting #bjai4 #baa4 ,extension of certain ,,mippa funding provisions ,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 through #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 through #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 through #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 through #bjai1 of #ab1jjj1jjj4 4 #bab4 ,extension of home health rural add-on ,section #dba7;a7 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-aj71 is further amended by striking ,january #a1 #bjah and inserting ,january #a1 #bjbj each place it appears4 ,b ,medicaid and ,public ,health ,extenders #bba4 ,extension for community health centers and the ,national ,health ,service ,corps 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 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;,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 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#a7 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 out 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 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 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 #c 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 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 2 and 7#af7 in subsection 7s7 7as so redesignated7 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 subsection 7d7 of this section1 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 4 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 #bbb4 ,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 #bjai4 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 #bjai4 4 #bbc4 ,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 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 7b7 ,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 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 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 ,public ,law #aae-if1 shall continue to apply with respect to payments under such section for fiscal years before fiscal year #bjah4 #bbd4 ,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 #bbe4 ,extension of abstinence education2 extension of personal responsibility education program 7a7 ,abstinence education ,section #eaj of the ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is amended-- 7#a7 in subsection 7a71 in the matter preceding paragraph 7#a71 by striking #bjag and inserting #bjai2 and 7#b7 in subsection 7d7-- 7,a7 by striking #bjae and and inserting #bjae1 2 and 7,b7 by inserting after #bjag the following3 1 and an additional #ge1jjj1jjj for each of fiscal years #bjah through #bjai4 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 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 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 7#b7 ,effective date ,the amendments made by this subsection take effect on ,october #a1 #bjag4 #bbf4 ,extension of health workforce demonstration projects for low-income individuals ,section #bjjh7;c77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;g7c77#a77 is amended by striking #bjag and inserting #bjai4 #bbg4 ,delay of reduction to ,medicaid ,,dsh allotments ,section #aibc7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g77 is amended-- 7#a7 in paragraph 7#g77;,a7-- 7,a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking #bjah through #bjbe and inserting #bjbj through #bjbg2 and 7,b7 by amending clause 7ii7 to read as follows3 7,i7 #b1jjj1jjj1jjj for fiscal year #bjbj2 7,,ii7 #c1jjj1jjj1jjj for fiscal year #bjba2 7,,iii7 #d1jjj1jjj1jjj for fiscal year #bjbb2 7,,iv7 #e1jjj1jjj1jjj for fiscal year #bjbc2 7,v7 #f1jjj1jjj1jjj for fiscal year #bjbd2 7,,vi7 #g1jjj1jjj1jjj for fiscal year #bjbe2 7,,vii7 #h1jjj1jjj1jjj for fiscal year #bjbf2 and 7,,viii7 #h1jjj1jjj1jjj for fiscal year #bjbg4 2 and 7#b7 in paragraph 7#h71 by striking #bjbe and inserting #bjbg4 #bbh4 ,delay of ,bipartisan ,budget ,act of #bjac third-party liability provisions 7a7 ,in general ,section #bjb7;c7 of the ,bipartisan ,budget ,act of #bjac 7,public ,law #aac-fg2 #abg ,stat4 #aagg2 #db ,u4,s4,c4 #acif;a note71 as amended by section #baa of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic2 #abh ,stat4 #ajdg2 #db ,u4,s4,c4 #acif;a note7 and section #bbj of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj71 is amended by striking #bjag and inserting #bjbb4 7b7 ,effective date2 treatment ,the amendment made by subsection 7a7 shall take effect on ,september #cj1 #bjag1 and shall apply with respect to claims pending1 generated1 or filed after such date4 ,c ,continuing the ,maternal1 ,infant1 and ,early ,childhood ,home ,visiting ,program #bca4 ,continuing evidence-based home visiting program ,section #eaa7;j77#a77;,h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77#a77;,h77 is amended by striking fiscal year #bjag and inserting each of fiscal years #bjag through #bjbb4 #bcb4 ,continuing to demonstrate results to help families 7a7 ,require service delivery models ,to demonstrate improvement in applicable benchmark areas ,section #eaa of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7 is amended in each of subsections 7d77#a77;,a7 and 7h77#d77;,a7 by striking each of4 7b7 ,demonstration of improvements in subsequent years ,section #eaa7;d77#a7 of such ,act 7#db ,u4,s4,c4 #gaa7;d77#a77 is amended by adding at the end the following3 7,d7 ,demonstration of improvements in subsequent years 7i7 ,continued measurement of improvement in applicable benchmark areas ,the eligible entity1 after demonstrating improvements for eligible families as specified in subparagraphs 7,a7 and 7,b71 shall continue to track and report1 not later than #cj days after the end of fiscal year #bjbj and every #c years thereafter1 information demonstrating that the program results in improvements for the eligible families participating in the program in at least #d of the areas specified in subparagraph 7,a7 that the service delivery model or models selected by the entity are intended to improve4 7ii7 ,corrective action plan ,if the eligible entity fails to demonstrate improvement in at least #d of the areas specified in subparagraph 7,a71 as compared to eligible families who do not receive services under an early childhood home visitation program1 the entity shall develop and implement a plan to improve outcomes in each of the areas specified in subparagraph 7,a7 that the service delivery model or models selected by the entity are intended to improve1 subject to approval by the ,secretary4 ,the plan shall include provisions for the ,secretary to monitor implementation of the plan and conduct continued oversight of the program1 including through submission by the entity of regular reports to the ,secretary4 7iii7 ,technical assistance ,the ,secretary shall provide an eligible entity required to develop and implement an improvement plan under clause 7ii7 with technical assistance to develop and implement the plan4 ,the ,secretary may provide the technical assistance directly or through grants1 contracts1 or cooperative agreements4 7iv7 ,no improvement or failure to submit report ,if the ,secretary determines after a period of time specified by the ,secretary that an eligible entity implementing an improvement plan under clause 7ii7 has failed to demonstrate any improvement in at least #d of the areas specified in subparagraph 7,a71 or if the ,secretary determines that an eligible entity has failed to submit the report required by clause 7i71 the ,secretary shall terminate the grant made to the entity under this section and may include any unexpended grant funds in grants made to nonprofit organizations under subsection 7h77#b77;,b74 4 7c7 ,including information on applicable benchmarks in application ,section #eaa7;e77#e7 of such ,act 7#db ,u4,s4,c4 #gaa7;e77#e77 is amended by inserting that the service delivery model or models selected by the entity are intended to improve before the period at the end4 #bcc4 ,reviewing statewide needs to target resources ,section #eaa7;b77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;b77#a77 is amended by striking ,not later than and all that follows through section #eje7;a77 and inserting ,each ,state shall1 as a condition of receiving payments from an allotment for the ,state under section #ejb1 conduct a statewide needs assessment 7which may be separate from but in coordination with the statewide needs assessment required under section #eje7;a7 and which shall be reviewed and updated by the ,state not later than ,october #a1 #bjbj74 #bcd4 ,improving the likelihood of success in high-risk communities ,section #eaa7;d77#d77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;d77#d77;,a77 is amended by inserting 1 taking into account the staffing1 community resource1 and other requirements to operate at least one approved model of home visiting and demonstrate improvements for eligible families before the period4 #bce4 ,option to fund evidence-based home visiting on a pay for outcome basis 7a7 ,in general ,section #eaa7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;c77 is amended by redesignating paragraphs 7#c7 and 7#d7 as paragraphs 7#d7 and 7#e71 respectively1 and by inserting after paragraph 7#b7 the following3 7#c7 ,authority to use grant for a pay for outcomes initiative ,an eligible entity to which a grant is made under paragraph 7#a7 may use up to #be percent of the grant for outcomes or success payments related to a pay for outcomes initiative that will not result in a reduction of funding for services delivered by the entity under a childhood home visitation program under this section while the eligible entity develops or operates such an initiative4 4 7b7 ,definition of pay for outcomes initiative ,section #eaa7k7 of such ,act 7#db ,u4,s4,c4 #gaa7k77 is amended by adding at the end the following3 7#d7 ,pay for outcomes initiative ,the term pay for outcomes initiative means a performance-based grant1 contract1 cooperative agreement1 or other agreement awarded by a public entity in which a commitment is made to pay for improved outcomes achieved as a result of the intervention that result in social benefit and direct cost savings or cost avoidance to the public sector4 ,such an initiative shall include-- 7,a7 a feasibility study that describes how the proposed intervention is based on evidence of effectiveness2 7,b7 a rigorous1 third-party evaluation that uses experimental or quasi-experimental design or other research methodologies that allow for the strongest possible causal inferences to determine whether the initiative has met its proposed outcomes as a result of the intervention2 7,c7 an annual1 publicly available report on the progress of the initiative2 and 7,d7 a requirement that payments are made to the recipient of a grant1 contract1 or cooperative agreement only when agreed upon outcomes are achieved1 except that this requirement shall not apply with respect to payments to a third party conducting the evaluation described in subparagraph 7,b74 4 7c7 ,extended availability of funds ,section #eaa7;j77#c7 of such ,act 7#db ,u4,s4,c4 #gaa7;j77#c77 is amended-- 7#a7 by striking 7#c7 ,availability4--,funds and inserting the following3 7#c7 ,availability 7,a7 ,in general ,except as provided in subparagraph 7,b71 funds 2 and 7#b7 by adding at the end the following3 7,b7 ,funds for pay for outcomes initiatives ,funds made available to an eligible entity under this section for a fiscal year 7or portion of a fiscal year7 for a pay for outcomes initiative shall remain available for expenditure by the eligible entity for not more than #aj years after the funds are so made available4 4 #bcf4 ,data exchange standards for improved interoperability 7a7 ,in general ,section #eaa7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;h77 is amended by adding at the end the following3 7#e7 ,data exchange standards for improved interoperability 7,a7 ,designation and use of data exchange standards 7i7 ,designation ,the head of the department or agency responsible for administering a program funded under this section shall1 in consultation with an interagency work group established by the ,office of ,management and ,budget and considering ,state government perspectives1 designate data exchange standards for necessary categories of information that a ,state agency operating the program is required to electronically exchange with another ,state agency under applicable ,federal law4 7ii7 ,data exchange standards must be nonproprietary and interoperable ,the data exchange standards designated under clause 7i7 shall1 to the extent practicable1 be nonproprietary and interoperable4 7iii7 ,other requirements ,in designating data exchange standards under this paragraph1 the ,secretary shall1 to the extent practicable1 incorporate-- 7,i7 interoperable standards developed and maintained by an international voluntary consensus standards body1 as defined by the ,office of ,management and ,budget2 7,,ii7 interoperable standards developed and maintained by intergovernmental partnerships1 such as the ,national ,information ,exchange ,model2 and 7,,iii7 interoperable standards developed and maintained by ,federal entities with authority over contracting and financial assistance4 7,b7 ,data exchange standards for federal reporting 7i7 ,designation ,the head of the department or agency responsible for administering a program referred to in this section shall1 in consultation with an interagency work group established by the ,office of ,management and ,budget1 and considering ,state government perspectives1 designate data exchange standards to govern ,federal reporting and exchange requirements under applicable ,federal law4 7ii7 ,requirements ,the data exchange reporting standards required by clause 7i7 shall1 to the extent practicable-- 7,i7 incorporate a widely accepted1 nonproprietary1 searchable1 computer-readable format2 7,,ii7 be consistent with and implement applicable accounting principles2 7,,iii7 be implemented in a manner that is cost-effective and improves program efficiency and effectiveness2 and 7,,iv7 be capable of being continually upgraded as necessary4 7iii7 ,incorporation of nonproprietary standards ,in designating data exchange standards under this paragraph1 the ,secretary shall1 to the extent practicable1 incorporate existing nonproprietary standards1 such as the e,xtensible ,mark up ,language4 7iv7 ,rule of construction ,nothing in this paragraph shall be construed to require a change to existing data exchange standards for ,federal reporting about a program referred to in this section1 if the head of the department or agency responsible for administering the program finds the standards to be effective and efficient4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date that is #b years after the date of enactment of this ,act4 #bcg4 ,allocation of funds ,section #eaa7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77 is amended by adding at the end the following3 7#d7 ,allocation of funds ,to the extent that the grant amount awarded under this section to an eligible entity is determined on the basis of relative population or poverty considerations1 the ,secretary shall make the determination using the most accurate ,federal data available for the eligible entity4 4 ,,iii ,strengthening ,protections for ,social ,security ,beneficiaries ,act of #bjah #cjj4 ,short title ,this title may be cited as the ,strengthening ,protections for ,social ,security ,beneficiaries ,act of #bjah4 ,a ,strengthening ,oversight and ,beneficiary ,protection #cja4 ,stronger monitoring of representative payees 7a7 ,protection and advocacy for beneficiaries with representative payees ,section #bje7;j77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#f77 is amended by adding at the end the following3 7,c7 7i7 ,the ,commissioner of ,social ,security shall make annual grants directly to the protection and advocacy system serving each of the ,states and the ,american ,indian consortium for the purpose of conducting reviews of representative payees in accordance with this subparagraph4 ,the total amount used by the ,commissioner for such grants each year-- 7,i7 shall be an amount sufficient1 as determined by the ,commissioner in consultation with each of the protection and advocacy systems1 to carry out all of the activities described in clause 7ii72 and 7,,ii7 shall not be less than #be1jjj1jjj4 7ii7 ,a protection and advocacy system awarded a grant under this subparagraph shall use the grant funds to-- 7,i7 conduct all periodic onsite reviews pursuant to this paragraph and such other reviews of representative payees as the ,commissioner may request1 including reviews conducted in response to allegations or concerns about the performance or suitability of the payee2 7,,ii7 conduct additional reviews that the protection and advocacy system has reason to believe are warranted2 7,,iii7 develop corrective action plans to assist representative payees in conforming to requirements specified by the ,commissioner2 7,,iv7 submit a report to the ,commissioner on each completed review containing such information as the ,commissioner shall require2 and 7,v7 conduct an initial onsite assessment of any organization that begins collecting a fee for its services as a representative payee to ensure that such organization is established as such a representative payee in accordance with requirements specified by the ,commissioner4 ,a protection and advocacy system may refer beneficiaries to other programs or services as the protection and advocacy system considers appropriate4 7iii7 ,to be eligible to receive grants under this section1 a protection and advocacy system shall submit an initial application to the ,commissioner at such time1 in such form and manner1 and accompanied by such information and assurances as the ,commissioner may require4 7iv7 7,i7 ,subject to subclause 7,,ii71 the ,commissioner shall ensure that any funds used for grants under clause 7i7 shall be allocated to the protection and advocacy systems serving each of the ,states and the ,american ,indian consortium in a manner such that the amount provided to each protection and advocacy system bears the same ratio to the total of such funds as the number of represented beneficiaries in the ,state or ,american ,indian consortium in which such protection and advocacy system is located bears to the total number of represented beneficiaries4 7,,ii7 ,the amount of an annual grant to a protection and advocacy system under clause 7i7 shall-- 7aa7 in the case of a protection and advocacy system serving ,american ,samoa1 ,guam1 the ,united ,states ,virgin ,islands1 or the ,commonwealth of the ,northern ,mariana ,islands1 or the ,american ,indian consortium1 not be less than #cj1jjj2 and 7bb7 in the case of a protection and advocacy system serving any other ,state1 not be less than #fj1jjj4 7,,iii7 ,funds provided to a protection and advocacy system through a grant under clause 7i7 for a one-year period shall remain available through the end of the following one-year period4 7,,iv7 ,for purposes of this clause1 the term represented beneficiary means an individual-- 7aa7 who is entitled to benefits under this title1 title ,,viii1 or title ,,xvi2 and 7bb7 whose benefits have been certified for payment to a representative payee4 7v7 7,i7 ,the ,commissioner shall make annual grants1 in an amount equal to #d percent of the total amount of grants awarded each year under clause 7i71 to an eligible national association for the provision of training and technical assistance1 administrative support1 and data collection services to protection and advocacy systems in connection with grants awarded under clause 7i74 7,,ii7 ,in this clause1 the term eligible national association means a national disability association with extensive knowledge and demonstrated experience in providing training1 technical assistance1 and administrative oversight to protection and advocacy systems that monitor representative payees4 7vi7 ,in conducting reviews under this section1 a protection and advocacy system shall have the same authorities1 including access to records1 facilities1 and persons1 as such system would have for purposes of providing services under subtitle ,c of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7vii7 ,whenever benefit amounts under this title are increased by any percentage effective with any month after ,november #bjah as a result of a determination made under section #bae7;i71 each of the dollar amounts specified in clauses 7i77,,ii7 and 7iv77,,ii7 shall be increased by the same percentage4 7viii7 ,no additional funds are authorized to be appropriated to carry out the requirements of this subparagraph4 ,such requirements shall be carried out using amounts otherwise authorized4 7ix7 ,in this subparagraph3 7,i7 ,the term ,american ,indian consortium means a consortium established under subtitle ,c of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7,,ii7 ,the term protection and advocacy system means a protection and advocacy system established under subtitle ,c of title ,i of the ,developmental ,disabilities ,assistance and ,bill of ,rights ,act of #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7,,iii7 ,the term ,state means the several ,states of the ,united ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 the ,united ,states ,virgin ,islands1 ,guam1 ,american ,samoa1 and the ,commonwealth of the ,northern ,mariana ,islands4 4 7b7 ,expansion of periodic onsite review requirements ,section #bje7;j77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#f77;,a77 is amended-- 7#a7 in clause 7ii71 by striking or2 7#b7 in clause 7iii71 by striking the period and inserting 2 or2 7#c7 by adding after clause 7iii7 the following3 7iv7 the representative payee collects a fee for its services4 2 and 7#d7 by adding after clause 7iv7 7as added by paragraph 7#c77 the following flush text3 ,the ,commissioner shall also conduct periodic onsite reviews of individual and organizational payees1 including payees who are related to the beneficiary and primarily reside in the same household1 selected on the basis of risk-factors for potential misuse or unsuitability associated with such payees or beneficiaries4 4 7c7 ,availability of grant funds 7#a7 ,protection and advocacy system grants ,grants described under clause 7i7 of subparagraph 7,c7 of section #bje7;j77#f7 of the ,social ,security ,act 7as added by subsection 7a77 shall be awarded on ,august #a1 #bjah1 and annually thereafter1 and funds provided by such grants to a protection and advocacy system may be used to reimburse the protection and advocacy system for amounts expended by the protection and advocacy system during the period beginning on ,may #a1 #bjah1 and ending on such date for hiring and start-up costs in preparation to carry out reviews of representative payees in accordance with such subparagraph4 7#b7 ,national ,association grants ,grants described under clause 7v7 of such subparagraph shall be awarded on ,may #a1 #bjah1 and annually thereafter4 #cjb4 ,reducing the burden on families 7a7 ,title ,,ii ,section #bje7;j77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#c77 is amended-- 7#a7 by redesignating subparagraphs 7,d7 through 7,g7 as subparagraphs 7,e7 through 7,h71 respectively2 7#b7 by inserting after subparagraph 7,c7 the following3 7,d7 7i7 ,subparagraph 7,a7 shall not apply in any case where the other person to whom such payment is made is-- 7,i7 a parent1 or other individual who is a legal guardian of1 a minor child entitled to such payment who primarily resides in the same household2 7,,ii7 a parent of an individual entitled to such payment who is under a disability 7as defined in section #bbc7;d77 who primarily resides in the same household2 or 7,,iii7 the spouse of the individual entitled to such payment4 7ii7 ,the ,commissioner of ,social ,security shall establish and implement procedures as necessary for the ,commissioner to determine the eligibility of such parties for the exemption provided in clause 7i74 ,the ,commissioner shall prescribe such regulations as may be necessary to determine eligibility for such exemption4 2 7#c7 in subparagraph 7,e7 7as so redesignated71 by striking and 7,c7 and inserting 7,c71 and 7,d72 and 7#d7 in subparagraph 7,f7 7as so redesignated71 by striking 7,d7 each place it appears and inserting 7,e74 7b7 ,title ,,viii ,section #hjg7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7;h77 is amended-- 7#a7 by redesignating paragraphs 7#c7 through 7#e7 as paragraphs 7#d7 through 7#f71 respectively2 and 7#b7 by inserting after paragraph 7#b7 the following3 7#c7 7,a7 ,paragraph 7#a7 shall not apply in any case where the other person to whom such payment is made is the spouse of the individual entitled to such payment4 7,b7 ,the ,commissioner of ,social ,security shall establish and implement procedures as necessary for the ,commissioner to determine the eligibility of such parties for the exemption provided in subparagraph 7,a74 ,the ,commissioner shall prescribe such regulations as may be necessary to determine eligibility for such exemption4 4 7c7 ,title ,,xvi ,section #afca7;a77#b77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,c77 is amended-- 7#a7 by redesignating clauses 7iv7 and 7v7 as clauses 7v7 and 7vi71 respectively2 7#b7 by inserting after clause 7iii7 the following3 7iv7 7,i7 ,clause 7i7 shall not apply in any case where the representative payee is-- 7aa7 a parent1 or other individual who is a legal guardian of1 a minor child entitled to such payment who primarily resides in the same household2 7bb7 a parent of an individual entitled to such payment who is under a disability who primarily resides in the same household2 or 7cc7 the spouse of the individual entitled to such payment4 7,,ii7 ,the ,commissioner of ,social ,security shall establish and implement procedures as necessary for the ,commissioner to determine the eligibility of such parties for the exemption provided in subclause 7,i74 ,the ,commissioner shall prescribe such regulations as may be necessary to determine eligibility for such exemption4 2 7#c7 in clause 7v7 7as so redesignated71 by striking and 7iii7 and inserting 7iii71 and 7iv72 and 7#d7 in clause 7vi7 7as so redesignated71 by striking 7iv7 each time it appears and inserting 7v74 7d7 ,effective date ,the amendments made by this section shall take effect on the date of the enactment of this ,act4 #cjc4 ,protecting beneficiaries through information sharing 7a7 ,information sharing ,to determine ,state foster care status 7#a7 ,in general ,section #bje7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77 is amended by adding at the end the following3 7#aa7 7,a7 ,the ,commissioner of ,social ,security shall-- 7i7 enter into agreements with each ,state with a plan approved under part ,e of title ,,iv for the purpose of sharing and matching data1 on an automated monthly basis1 in the system of records of the ,social ,security ,administration with each ,statewide and ,tribal ,automated ,child ,welfare ,information ,system to identify represented minor beneficiaries who are in foster care under the responsibility of the ,state for such month2 and 7ii7 in any case in which a represented minor beneficiary has entered or exited foster care or changed foster care placement in such month1 redetermine the appropriate representative payee for such individual4 7,b7 ,for purposes of this paragraph-- 7i7 the term ,state has the meaning given such term for purposes of part ,e of title ,,iv2 7ii7 the term ,statewide and ,tribal ,automated ,child ,welfare ,information ,system means a statewide mechanized data collection and information retrieval system described in section #dgd7;a77#c77;,c72 and 7iii7 the term represented minor beneficiary1 with respect to an individual for a month1 means a child 7as defined for purposes of section #dge7h77 entitled to benefits under this title for such month whose benefits are certified for payment to a representative payee4 4 7#b7 ,conforming change ,section #dga7;a77#h77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77#h77;,a77 is amended by inserting the program established by title ,,ii1 after ,,xx14 7#c7 ,,gao study and report 7,a7 ,evaluation ,as soon as possible after the date of the enactment of this ,act1 the ,comptroller ,general shall evaluate-- 7i7 the number of represented minor beneficiaries in foster care under the responsibility of a ,state for each month during the previous year2 7ii7 whether the representative payee for each represented minor beneficiary is-- 7,i7 a governmental child welfare agency2 7,,ii7 an organizational payee that is not a governmental child welfare agency2 7,,iii7 a foster parent or child-care institution 7within the meaning of part ,e of title ,,iv72 or 7,,iv7 another individual2 and 7iii7 whether funds were conserved1 used for direct expenses of the minor beneficiary1 or used to reimburse the ,state for foster care maintenance costs4 7,b7 ,report to ,congress ,not later than #cf months after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the results of the evaluation required under subparagraph 7,a74 7,c7 ,definitions ,for purposes of this paragraph-- 7i7 the term ,state has the meaning given such term for purposes of part ,e of title ,,iv of the ,social ,security ,act2 and 7ii7 the term represented minor beneficiary1 with respect to an individual for a month1 means a child 7as defined for purposes of section #dge7h7 of the ,social ,security ,act7 entitled to benefits under title ,,ii of such ,act for such month whose benefits are certified for payment to a representative payee4 7#d7 ,effective date 7,a7 ,in general ,the amendments made by this subsection shall apply with respect to months beginning on or after the date that is #a year after the date of the enactment of this ,act4 7,b7 ,exception if ,state legislation required ,in the case of a ,state plan under part ,e of title ,,iv of the ,social ,security ,act that 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 requirement imposed by the amendments made under this subsection1 such plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement 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 the 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 such session shall be deemed to be a separate regular session of the ,state legislature4 7b7 ,improving ,coordination with ,adult ,protective ,services 7#a7 ,in general ,the ,commissioner of ,social ,security shall study and test the administrative feasibility of improving information sharing1 in partnership with ,state agencies that provide adult protective services1 with respect to-- 7,a7 the assessment of an individual's need for a representative payee in connection with benefits to which the individual is entitled under title ,,ii or title ,,xvi of the ,social ,security ,act2 and 7,b7 oversight of individuals and organizations serving as representative payees4 7#b7 ,report ,not later than ,june #cj1 #bjbb1 the ,commissioner of ,social ,security shall conclude the study described in paragraph 7#a7 and 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 results of such study4 7c7 ,study on ,potential ,to ,coordinate with ,state ,courts 7#a7 ,in general ,the ,commissioner of ,social ,security shall enter into an agreement with the ,administrative ,conference of the ,united ,states to conduct a study that includes-- 7,a7 an overview of potential opportunities for information sharing between the ,social ,security ,administration and ,state courts and relevant ,state agencies2 7,b7 a detailed analysis of the barriers to such information sharing1 including any ,federal or ,state statutory barriers2 7,c7 a description of how such information sharing would be implemented1 including any additional infrastructure needed2 and 7,d7 a description of any risks or other factors that the ,social ,security ,administration and the ,congress should consider before implementing such information sharing4 7#b7 ,report ,not later than ,june #cj1 #bjbj1 the ,commissioner of ,social ,security shall submit to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate and make publicly available a report on the results of the study conducted under paragraph 7#a74 #cjd4 ,clarifying overpayment liability for child in child welfare system 7a7 ,amendment to title ,,ii ,section #bjd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #djd7;a77 is amended by adding at the end the following3 7#c7 7,a7 ,when any payment of more than the correct amount is made on behalf of an individual who is a represented minor beneficiary for a month in which such individual is in foster care under the responsibility of a ,state and the ,state is the representative payee of such individual1 the ,state shall be liable for the repayment of the overpayment1 and there shall be no adjustment of payments to1 or recovery by the ,united ,states from1 such individual4 7,b7 ,for purposes of this paragraph1 the term represented minor beneficiary has the meaning given such term in subsection 7j77#aa77;,b77iii74 4 7b7 ,amendment to title ,,xvi ,section #afca7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #afhc7;b77 is amended-- 7#a7 by redesignating paragraphs 7#c7 through 7#g7 as paragraphs 7#d7 through 7#h71 respectively2 and 7#b7 by inserting after paragraph 7#b7 the following3 7#c7 7,a7 ,when any payment of more than the correct amount is made on behalf of an individual who is a represented minor beneficiary for a month in which such individual is in foster care under the responsibility of a ,state and the ,state is the representative payee of such individual1 the ,state shall be liable for the repayment of the overpayment1 and there shall be no adjustment of payments to1 or recovery by the ,united ,states from1 such individual4 7,b7 ,for purposes of this paragraph1 the term represented minor beneficiary1 with respect to an individual for a month1 means a child 7as defined for purposes of section #dge7h77 entitled to benefits under this title for such month whose benefits are certified for payment to a representative payee4 4 7c7 ,effective date ,the amendment made by subsection 7a7 shall apply with respect to overpayment determinations made on or after the date of the enactment of this ,act and to any other overpaid amounts that have not been recovered as of such date4 #cje4 ,reports 7a7 ,report on benefits misused ,section #bje7;j7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j771 as amended by section #cjc7;a71 is further amended-- 7#a7 in paragraph 7#f7-- 7,a7 by striking 7,a7 ,in addition to and inserting ,in addition to2 and 7,b7 by striking subparagraph 7,b72 and 7#b7 by adding at the end the following3 7#ab7 7,a7 ,not later than ,january #ca of each fiscal year1 the ,commissioner 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 total number of individuals entitled to benefits under titles ,,ii1 ,,viii1 and ,,xvi1 respectively 7and the number of individuals concurrently entitled to benefits under more than one such title71 who have a representative payee1 the total number of such representative payees1 and the results of all reviews of representative payees conducted during the previous fiscal year in connection with benefits under this title1 title ,,viii1 or title ,,xvi4 ,such report shall summarize problems identified in such reviews and corrective actions taken or planned to be taken to correct such problems1 and shall include-- 7i7 the number of such reviews2 7ii7 the results of such reviews2 7iii7 the number of cases in which the representative payee was changed and why2 7iv7 the number of reviews conducted in response to allegations or concerns about the performance or suitability of the payee2 7v7 the number of cases discovered in which there was a misuse of funds1 and the total dollar amount of benefits determined by the ,commissioner during such fiscal year to have been misused by a representative payee 7regardless of the fiscal year in which such misuse occurred72 7vi7 the number of cases discovered in which such misuse of funds resulted from the negligent failure of the ,commissioner to investigate or monitor a representative payee2 7vii7 the final disposition of such cases of misuse of funds1 including-- 7,i7 any criminal1 civil1 and administrative penalties imposed2 7,,ii7 the total dollar amount of misused benefits repaid to beneficiaries and alternative representative payees under each of-- 7aa7 paragraph 7#e7 7on the basis of a negligent failure of the ,commissioner described in such paragraph72 7bb7 paragraph 7#e7 7on any other basis72 and 7cc7 paragraph 7#g72 and 7,,iii7 the total dollar amount of misused benefits recovered under each of-- 7aa7 paragraph 7#e72 and 7bb7 paragraph 7#g72 7viii7 any updates to prior year reports necessary to reflect subsequent recoveries and repayments pertaining to misuse determinations made in prior years2 and 7ix7 such other information as the ,commissioner deems appropriate4 7,b7 ,each report required under this paragraph for a fiscal year shall include the information described in clauses 7i7 through 7ix7 of subparagraph 7,a7 with respect to-- 7i7 all representative payees reviewed during such fiscal year2 7ii7 all such representative payees that are organizations1 separated by whether such organization collects a fee for its services as a representative payee2 7iii7 all such representative payees that are individuals serving #ae or more individuals2 and 7iv7 all such representative payees that are individuals serving less than #ae individuals1 separated by whether such representative payee is a family member4 4 7b7 ,report on elimination of the accounting form ,the ,commissioner shall-- 7#a7 conduct a study on the changes made by the amendments made by section #ajb of the ,strengthening ,protections for ,social ,security ,beneficiaries ,act of #bjah1 which shall include the impact of such changes on families1 beneficiaries1 and the operations of the ,social ,security ,administration2 and 7#b7 not later than ,january #a1 #bjba1 submit a report on the results of such study to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate4 7c7 ,report on the advanced designation policy ,the ,commissioner shall-- 7#a7 conduct a study on the changes made by the amendments made by section #bja of the ,strengthening ,protections for ,social ,security ,beneficiaries ,act of #bjah1 which shall include the impact of such changes on beneficiaries and the operations of the ,social ,security ,administration2 and 7#b7 not later than ,january #a1 #bjbe1 submit a report on the results of such study to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate4 ,b ,improving ,payee ,selection and ,quality #caa4 ,advance designation of representative payees 7a7 ,in general ,section #bje7;j77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#a77 is amended by adding at the end the following3 7,c7 7i7 ,an individual who is entitled to or is an applicant for a benefit under this title1 title ,,viii1 or title ,,xvi1 who has attained #ah years of age or is an emancipated minor1 may1 at any time1 designate one or more other individuals to serve as a representative payee for such individual in the event that the ,commissioner of ,social ,security determines under subparagraph 7,a7 that the interest of such individual would be served by certification for payment of such benefits to which the individual is entitled to a representative payee4 ,if the ,commissioner of ,social ,security makes such a determination with respect to such individual at any time after such designation has been made1 the ,commissioner shall-- 7,i7 certify payment of such benefits to the designated individual1 subject to the requirements of paragraph 7#b72 or 7,,ii7 if the ,commissioner determines that certification for payment of such benefits to the designated individual would not satisfy the requirements of paragraph 7#b71 that the designated individual is unwilling or unable to serve as representative payee1 or that other good cause exists1 certify payment of such benefits to another individual or organization1 in accordance with paragraph 7#a74 7ii7 ,an organization may not be designated to serve as a representative payee under this subparagraph4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect on the date that is #b years after the date of the enactment of this section4 7c7 ,regulations ,not later than #ah months after the date of the enactment of this section1 the ,commissioner of ,social ,security shall promulgate regulations specifying the information an individual is required to provide to the ,commissioner in order to designate another individual to serve as the individual's representative payee under section #bje7;j77#a77;,c7 of the ,social ,security ,act 7as added by subsection 7a774 7d7 ,notification to beneficiaries ,not later than ,january #a1 #bjbj1 and annually thereafter1 the ,commissioner of ,social ,security shall notify each individual entitled to a benefit under title ,,ii1 ,,viii1 or ,,xvi of the ,social ,security ,act of the name of any individual designated to serve as the individual's representative payee under section #bje7;j77#a77;,c7 of such ,act 7as added by subsection 7a774 #cab4 ,prohibition on individuals convicted of certain crimes serving as representative payees 7a7 ,amendments to title ,,ii ,section #bje7;j77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#b77 is amended-- 7#a7 in subparagraph 7,b7-- 7,a7 in clause 7i7-- 7i7 in subclause 7,v71 by striking and at the end2 7ii7 in subclause 7,,vi71 by striking the period and inserting 1 and2 and 7iii7 by adding at the end the following3 7,,vii7 determine whether such person has been convicted 7and not subsequently exonerated71 under ,federal or ,state law1 of a felony provided under clause 7iv71 or of an attempt or a conspiracy to commit such a felony4 2 and 7,b7 by adding at the end the following3 7iv7 ,the felony crimes provided under this clause1 whether an offense under ,state or ,federal law1 are the following3 7,i7 ,human trafficking1 including as prohibited under sections #aeij and #aeia of title #ah1 ,united ,states ,code4 7,,ii7 ,false imprisonment1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,,iii7 ,kidnapping1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,,iv7 ,rape and sexual assault1 including as prohibited under sections #bbda1 #bbdb1 #bbdc1 and #bbdd of title #ah1 ,united ,states ,code4 7,v7 ,first-degree homicide1 including as prohibited under section #aaaa of title #ah1 ,united ,states ,code4 7,,vi7 ,robbery1 including as prohibited under section #baaa of title #ah1 ,united ,states ,code4 7,,vii7 ,fraud to obtain access to government assistance1 including as prohibited under sections #bhg1 #ajja1 and #acdc of title #ah1 ,united ,states ,code4 7,,viii7 ,fraud by scheme1 including as prohibited under section #acdc of title #ah1 ,united ,states ,code4 7,,ix7 ,theft of government funds or property1 including as prohibited under section #fda of title #ah1 ,united ,states ,code4 7,x7 ,abuse or neglect1 including as prohibited under section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag of title #ah1 ,united ,states ,code4 7,,xi7 ,forgery1 including as prohibited under section #fdb and chapter #be 7except section #eab7 of title #ah1 ,united ,states ,code4 7,,xii7 ,identity theft or identity fraud1 including as prohibited under sections #ajbh and #ajbh;,a of title #ah1 ,united ,states ,code4 ,the ,commissioner of ,social ,security may promulgate regulations to provide for additional felony crimes under this clause4 7v7 7,i7 ,for the purpose of carrying out the activities required under subparagraph 7,b77i7 as part of the investigation under subparagraph 7,a77i71 the ,commissioner may conduct a background check of any individual seeking to serve as a representative payee under this subsection and may disqualify from service as a representative payee any such individual who fails to grant permission for the ,commissioner to conduct such a background check4 7,,ii7 ,the ,commissioner may revoke certification of payment of benefits under this subsection to any individual serving as a representative payee on or after ,january #a1 #bjai1 who fails to grant permission for the ,commissioner to conduct such a background check4 2 and 7#b7 in subparagraph 7,c7-- 7,a7 in clause 7i7-- 7i7 in subclause 7,,iv71 by striking or at the end2 7ii7 in subclause 7,v71 by striking the period at the end and inserting 1 or2 and 7iii7 by adding at the end the following3 7,,vi7 except as provided in clause 7vi71 such person has previously been convicted 7and not subsequently exonerated7 as described in subparagraph 7,b77i77,,vii74 2 and 7,b7 by adding at the end the following3 7vi7 7,i7 ,with respect to any person described in subclause 7,,ii7-- 7aa7 subparagraph 7,b77i77,,vii7 shall not apply2 and 7bb7 the ,commissioner may grant an exemption from the provisions of clause 7i77,,vi7 if the ,commissioner determines that such exemption is in the best interest of the individual entitled to benefits4 7,,ii7 ,a person is described in this subclause if the person-- 7aa7 is the custodial parent of a minor child for whom the person applies to serve1 7bb7 is the custodial spouse of the beneficiary for whom the person applies to serve1 7cc7 is the custodial parent of a beneficiary who is under a disability 7as defined in section #bbc7;d77 which began before the beneficiary attained the age of #bb1 for whom the person applies to serve1 7dd7 is the custodial court appointed guardian of the beneficiary for whom the person applies to serve1 7ee7 is the custodial grandparent of a minor grandchild for whom the person applies to serve1 7ff7 is the parent who was previously representative payee for his or her minor child who has since turned #ah and continues to be eligible for such benefit1 or 7gg7 received a presidential or gubernatorial pardon for the relevant conviction4 4 7b7 ,amendments to title ,,viii ,section #hjg of the ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#b7-- 7i7 in subparagraph 7,e71 by striking and at the end2 7ii7 in subparagraph 7,f71 by striking the period and inserting 1 and2 and 7iii7 by adding at the end the following3 7,g7 determine whether such person has been convicted 7and not subsequently exonerated71 under ,federal or ,state law1 of a felony provided under paragraph 7#d71 or of an attempt or a conspiracy to commit such a felony4 2 and 7,b7 by adding at the end the following3 7#d7 ,the felony crimes provided under this paragraph1 whether an offense under ,state or ,federal law1 are the following3 7,a7 ,human trafficking1 including as prohibited under sections #aeij and #aeia of title #ah1 ,united ,states ,code4 7,b7 ,false imprisonment1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,c7 ,kidnapping1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,d7 ,rape and sexual assault1 including as prohibited under sections #bbda1 #bbdb1 #bbdc1 and #bbdd of title #ah1 ,united ,states ,code4 7,e7 ,first-degree homicide1 including as prohibited under section #aaaa of title #ah1 ,united ,states ,code4 7,f7 ,robbery1 including as prohibited under section #baaa of title #ah1 ,united ,states ,code4 7,g7 ,fraud to obtain access to government assistance1 including as prohibited under sections #bhg1 #ajja1 and #acdc of title #ah1 ,united ,states ,code4 7,h7 ,fraud by scheme1 including as prohibited under section #acdc of title #ah1 ,united ,states ,code4 7,i7 ,theft of government funds or property1 including as prohibited under section #fda of title #ah1 ,united ,states ,code4 7,j7 ,abuse or neglect1 including as prohibited under section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag of title #ah1 ,united ,states ,code4 7,k7 ,forgery1 including as prohibited under section #fdb and chapter #be 7except section #eab7 of title #ah1 ,united ,states ,code4 7,l7 ,identity theft or identity fraud1 including as prohibited under sections #ajbh and #ajbh;,a of title #ah1 ,united ,states ,code4 ,the ,commissioner of ,social ,security may promulgate regulations to provide for additional felony crimes under this clause4 7#e7 7,a7 ,for the purpose of carrying out the activities required under paragraph 7#b7 as part of the investigation under paragraph 7#a77;,a71 the ,commissioner may conduct a background check of any individual seeking to serve as a representative payee under this subsection and may disqualify from service as a representative payee any such individual who fails to grant permission for the ,commissioner to conduct such a background check4 7,b7 ,the ,commissioner may revoke certification of payment of benefits under this subsection to any individual serving as a representative payee on or after ,january #a1 #bjai1 who fails to grant permission for the ,commissioner to conduct such a background check4 2 and 7#b7 in subsection 7d7-- 7,a7 in paragraph 7#a7-- 7i7 in subparagraph 7,d71 by striking or at the end2 7ii7 in subparagraph 7,e71 by striking the period at the end and inserting 1 or2 and 7iii7 by adding at the end the following3 7,f7 except as provided in paragraph 7#b77;,d71 such person has previously been convicted 7and not subsequently exonerated7 as described in subsection 7b77#b77;,g74 2 and 7,b7 in paragraph 7#b71 by adding at the end the following3 7,d7 7i7 ,with respect to any person described in clause 7,,ii7-- 7,i7 subsection 7b77#b77;,g7 shall not apply2 and 7,,ii7 the ,commissioner may grant an exemption from the provisions of paragraph 7#a77;,f7 if the ,commissioner determines that such exemption is in the best interest of the individual entitled to benefits4 7ii7 ,a person is described in this clause if the person-- 7,i7 is the custodial spouse of the beneficiary for whom the person applies to serve2 7,,ii7 is the custodial court appointed guardian of the beneficiary for whom the person applies to serve2 or 7,,iii7 received a presidential or gubernatorial pardon for the relevant conviction4 4 7c7 ,amendments to title ,,xvi ,section #afca7;a77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,b77 is amended-- 7#a7 in clause 7ii7-- 7,a7 in subclause 7,v71 by striking and at the end2 7,b7 in subclause 7,,vi71 by striking the period and inserting 1 and2 and 7,c7 by adding at the end the following3 7,,vii7 determine whether such person has been convicted 7and not subsequently exonerated71 under ,federal or ,state law1 of a felony provided under clause 7xv71 or of an attempt or a conspiracy to commit such a felony4 2 7#b7 in clause 7iii7-- 7,a7 in subclause 7,,iv71 by striking or at the end2 7,b7 in subclause 7,v71 by striking the period at the end and inserting 1 or2 and 7,c7 by adding at the end the following3 7,,vi7 except as provided in clause 7xvii71 such person has previously been convicted 7and not subsequently exonerated7 as described in clause 7ii77,,vii74 2 and 7#c7 by adding at the end the following3 7xv7 ,the felony crimes provided under this clause1 whether an offense under ,state or ,federal law1 are the following3 7,i7 ,human trafficking1 including as prohibited under sections #aeij and #aeia of title #ah1 ,united ,states ,code4 7,,ii7 ,false imprisonment1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,,iii7 ,kidnapping1 including as prohibited under section #abja of title #ah1 ,united ,states ,code4 7,,iv7 ,rape and sexual assault1 including as prohibited under sections #bbda1 #bbdb1 #bbdc1 and #bbdd of title #ah1 ,united ,states ,code4 7,v7 ,first-degree homicide1 including as prohibited under section #aaaa of title #ah1 ,united ,states ,code4 7,,vi7 ,robbery1 including as prohibited under section #baaa of title #ah1 ,united ,states ,code4 7,,vii7 ,fraud to obtain access to government assistance1 including as prohibited under sections #bhg1 #ajja1 and #acdc of title #ah1 ,united ,states ,code4 7,,viii7 ,fraud by scheme1 including as prohibited under section #acdc of title #ah1 ,united ,states ,code4 7,,ix7 ,theft of government funds or property1 including as prohibited under section #fda of title #ah1 ,united ,states ,code4 7,x7 ,abuse or neglect1 including as prohibited under section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag of title #ah1 ,united ,states ,code4 7,,xi7 ,forgery1 including as prohibited under section #fdb and chapter #be 7except section #eab7 of title #ah1 ,united ,states ,code4 7,,xii7 ,identity theft or identity fraud1 including as prohibited under sections #ajbh and #ajbh;,a of title #ah1 ,united ,states ,code4 ,the ,commissioner of ,social ,security may promulgate regulations to provide for additional felony crimes under this clause4 7xvi7 7,i7 ,for the purpose of carrying out the activities required under clause 7ii7 as part of the investigation under clause 7i77,i71 the ,commissioner may conduct a background check of any individual seeking to serve as a representative payee under this subsection and may disqualify from service as a representative payee any such individual who fails to grant permission for the ,commissioner to conduct such a background check4 7,,ii7 ,the ,commissioner may revoke certification of payment of benefits under this subsection to any individual serving as a representative payee on or after ,january #a1 #bjai1 who fails to grant permission for the ,commissioner to conduct such a background check4 7xvii7 7,i7 ,with respect to any person described in subclause 7,,ii7-- 7aa7 clause 7ii77,,vii7 shall not apply2 and 7bb7 the ,commissioner may grant an exemption from the provisions of clause 7iii77,,vi7 if the ,commissioner determines that such exemption is in the best interest of the individual entitled to benefits4 7,,ii7 ,a person is described in this subclause if the person-- 7aa7 is the custodial parent of a minor child for whom the person applies to serve1 7bb7 is the custodial spouse of the beneficiary for whom the person applies to serve1 7cc7 is the custodial parent of a beneficiary who is under a disability which began before the beneficiary attained the age of #bb1 for whom the person applies to serve1 7dd7 is the custodial court appointed guardian of the beneficiary for whom the person applies to serve1 7ee7 is the custodial grandparent of a minor grandchild for whom the person applies to serve1 7ff7 is the parent who was previously representative payee for his or her minor child who has since turned #ah and continues to be eligible for such benefit1 or 7gg7 received a presidential or gubernatorial pardon for the relevant conviction4 4 7d7 ,application to new appointments ,subject to subsection 7e71 the amendments made by subsections 7a71 7b71 and 7c7 shall apply with respect to any individual appointed to serve as a representative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 of the ,social ,security ,act on or after ,january #a1 #bjai4 7e7 ,application to prior appointments 7#a7 ,in general ,not later than ,january #a1 #bjbd1 the ,commissioner of ,social ,security shall conduct a review of each individual serving as a representative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 of the ,social ,security ,act1 to determine whether such individual has been convicted of a felony as described in section #bje7;j77#b77;,b77i77,,vii71 #hjg7;b77#b77;,g71 or #afca7;a77#b77;,b77ii77,,vii71 respectively 7as such provisions are added by this section74 ,except as provided in section #bje7;j77#b77;,c77vi71 #hjg7;d77#b77;,d71 or #afca7;a77#b77;,b77xvii7 7as so added71 any individual determined by the ,commissioner to have been so convicted may not serve as a representative payee on or after the date of such determination4 7#b7 ,priority ,in conducting reviews under paragraph 7#a71 the ,commissioner shall prioritize reviews of the following categories of individuals1 in the following order3 7,a7 ,an individual serving as representative payee for #ae or more individuals4 7,b7 ,an individual serving as representative payee for an individual who is not related to the representative payee4 7,c7 ,an individual serving as representative payee for an individual who has attained the age of #ah and is not the spouse of the representative payee4 7f7 ,periodic review ,not later than #a year after the date of enactment of this section1 the ,commissioner of ,social ,security shall issue regulations to establish a process for reviewing each individual serving as a representative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 of the ,social ,security ,act 7other than individuals with respect to whom an exemption has been granted under section #bje7;j77#b77;,c77vi71 #hjg7;d77#b77;,d71 or #afca7;a77#b77;,b77xvii77 not less than once every #e years to determine whether any such individual has been convicted of a felony as described in subsection 7e77#a7 of this section4 #cac4 ,prohibition on individuals with representative payees serving as representative payees 7a7 ,amendment to title ,,ii ,section #bje7;j77#b77;,c77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#b77;,c77i771 as amended by section #cab7;a77#b71 is further amended-- 7#a7 in subclause 7,v71 by striking or at the end2 7#b7 in subclause 7,,vi71 by striking the period and inserting 1 or2 and 7#c7 by adding at the end the following3 7,,vii7 such person's benefits under this title1 title ,,viii1 or title ,,xvi are certified for payment to a representative payee during the period for which the individual's benefits would be certified for payment to another person4 4 7b7 ,amendment to title ,,viii ,section #hjg7;d77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7;d77#a771 as amended by section #cab7;b77#b71 is further amended-- 7#a7 in subparagraph 7,e71 by striking or at the end2 7#b7 in subparagraph 7,f71 by striking the period and inserting 1 or2 and 7#c7 by adding at the end the following3 7,g7 such person's benefits under this title1 title ,,ii1 or title ,,xvi are certified for payment to a representative payee during the period for which the individual's benefits would be certified for payment to another person4 4 7c7 ,amendment to title ,,xvi ,section #afca7;a77#b77;,b77iii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,b77iii771 as amended by section #cab7;c77#b71 is further amended-- 7#a7 in subclause 7,v71 by striking or at the end2 7#b7 in subclause 7,,vi71 by striking the period and inserting 1 or2 and 7#c7 by adding at the end the following3 7,,vii7 such person's benefits under this title1 title ,,ii1 or title ,,viii are certified for payment to a representative payee during the period for which the individual's benefits would be certified for payment to another person4 4 7d7 ,effective date 7#a7 ,new appointments ,subject to paragraph 7#b71 the amendments made by this section shall apply with respect to any individual appointed to serve as a representative payee under title ,,ii1 title ,,viii1 or title ,,xvi of the ,social ,security ,act on or after ,january #a1 #bjai4 7#b7 ,prior appointments ,with respect to individuals serving as a representative payee whose benefits under this title1 title ,,viii1 or title ,,xvi are certified for payment to another representative payee as of ,january #a1 #bjai1 the ,commissioner shall take any steps necessary to terminate such individual's service as a representative payee as soon as possible1 but no later than ,january #a1 #bjbd4 #cad4 ,reassessment of payee selection and replacement policies 7a7 ,in general ,the ,commissioner of ,social ,security shall conduct1 with opportunity for public comment1 a review and reassessment of-- 7#a7 the appropriateness of its order of preference for selecting representative payees1 including payees who may be creditors of the beneficiary or who are private1 for-profit institutions2 and 7#b7 the effectiveness of its policy and operational procedures in properly determining when to change a representative payee1 including-- 7,a7 from a payee that has a higher order of preference 7such as a family member7 to a payee that has a lower order of preference 7such as a creditor72 or 7,b7 when a request to change payees arises from someone other than the beneficiary4 7b7 ,report ,not later than #ah months after the date of the enactment of this ,act1 the ,commissioner of ,social ,security shall submit to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate and make publicly available a report on the results of the review and reassessment under subsection 7a74