,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajfdj  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,octob] #a1 #bjbf,ms4 
,wat]s 7= h]self1 ,mr4 ,bell1 ,mr4      
,c>son1 ,ms4 ,cl>ke ( ,new ,york1 ,mr4  
,correa1 ,mr4 ,co/a1 ,mr4 ,davis (      
,ill9ois1 ,ms4 ,g>cia ( ,texas1 ,mr4    
,jackson ( ,ill9ois1 ,ms4 ,kelly (      
,ill9ois1 ,mr4 ,lyn*1 ,ms4 ,norton1 &   
,mrs4 ,ramirez7 introduc$ ! foll[+ bill2
 :i* 0 ref]r$ to ! ,committee on ,en]gy 
& ,comm]ce1 & 9 addition to ! ,committee
 on ,ways & ,means1 = a p]iod to be     
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title ,,xi 
( ! ,social ,security ,act to e/abli% an
 ,urban ,heal? ,trans=mation ,program4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,urban ,heal? ,trans=mation ,act (    
#bjbf4  #b4 ,urban heal? trans=mation   
program  7a7 ,9 g5]al ,"p ,a ( title    
,,xi ( ! ,social ,security ,act 7#db    
,u4,s4,c4 #acja et seq47 is am5d$ by    

ins]t+ aft] section #aaej;,c ! foll[+   
new section3  #aaej;,d4 ,urban ,heal?   
,trans=mation ,program  7a7             
,appropriation  7#a7 ,9 g5]al ,!re are  
appropriat$1 out ( any money 9 !        
,treasury n o!rwise appropriat$1 to !   
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices 79 ?is section ref]r$ 
to z ! ,adm9i/rator71 to provide        
allotm5ts to ,/ates = purposes ( c>ry+  
out ! activities describ$ 9 subsection  
7f7-- 7,a7 #aj1jjj1jjj1jjj = fiscal ye> 
#bjbg2  7,b7 #aj1jjj1jjj1jjj = fiscal   
ye> #bjbh2  7,c7 #aj1jjj1jjj1jjj =      
fiscal ye> #bjbi2  7,d7 #aj1jjj1jjj1jjj 
= fiscal ye> #bjcj2 &  7,e7             
#aj1jjj1jjj1jjj = fiscal ye> #bjca4     
7#b7 ,unexp5d$ or unobligat$ funds  7,a7
 ,9 g5]al ,any am\nts appropriat$ "u    
p>agraph 7#a7 t are unexp5d$ or         
unobligat$ z ( ,octob] #a1 #bjcc1 %all  
be return$ to ! ,treasury ( ! ,unit$    
,/ates4  7,b7 ,r$i/ribution ( unexp5d$  
or unobligat$ funds ,9 c>ry+ out        
p>agraph 7#a71 ! ,adm9i/rator %all1 n   

lat] ?an ,m>* #ca1 #bjbi1 & annually    
!reaft] ?r\gh ,m>* #ca1 #bjcc1 det]m9e !
 am\nt ( funds1 if any1 t are available 
"u su* p>agraph = a previ\s fiscal ye>1 
are unexp5d$ or unobligat$ ) respect to 
su* fiscal ye>1 & w n be available to a 
,/ate 9 ! curr5t fiscal ye>1 pursuant to
 subp>agraph 7,c74  7,c7 ,availability (
 funds  7i7 ,9 g5]al ,am\nts allott$ to 
a ,/ate "u ?is section = a ye> %all be  
available = exp5diture by ! ,/ate ?r\gh 
! end ( ! fiscal ye> foll[+ ! fiscal ye>
 9 :i* su* am\nts are allott$4  7ii7    
,availability ( am\nts r$i/ribut$       
,am\nts r$i/ribut$ to a ,/ate "u        
subp>agraph 7,b7 ) respect to a fiscal  
ye> %all be available = exp5diture by ! 
,/ate ?r\gh ! end ( ! fiscal ye> foll[+ 
! fiscal ye> 9 :i* su* am\nts are       
r$i/ribut$ 7except 9 ! case ( am\nts    
r$i/ribut$ 9 fiscal ye> #bjcc :i* %all  
only be available = exp5diture ?r\gh    
,septemb] #cj1 #bjcc74  7,d7 ,misuse (  
funds ,if ! ,adm9i/rator det]m9es t a   
,/ate is n us+ am\nts allott$ or        

r$i/ribut$ to ! ,/ate "u ?is section 9 a
 mann] consi/5t ) ! description provid$ 
by ! ,/ate 9 its application approv$ "u 
subsection 7b71 ! ,adm9i/rator may )hold
 paym5ts to1 or r$uce paym5ts to1 or    
recov] previ\s paym5ts f1 ! ,/ate "u ?is
 section z ! ,adm9i/rator deems         
appropriate1 & any am\nts s )held1 or t 
rema9 aft] any su* r$uction1 or s       
recov]$1 %all be return$ to ! ,treasury 
( ! ,unit$ ,/ates4  7b7 ,application    
7#a7 ,9 g5]al ,to be eligible = an      
allotm5t "u ?is section1 a ,/ate %all   
submit to ! ,adm9i/rator dur+ an        
application submission p]iod to be      
specifi$ by ! ,adm9i/rator 7b t ends n  
lat] ?an ,decemb] #ca1 #bjbf7 an        
application 9 su* =m & mann] z !        
,adm9i/rator may specify1 t includes--  
7,a7 a detail$ urban heal? trans=mation 
plan-- 7i7 to improve access to         
hospitals1 o!r heal? c>e provid]s1 &    
heal? c>e items & s]vices furni%$ to    
urban resid5ts ( ! ,/ate2  7ii7 to      
improve heal? c>e outcomes ( urban      

resid5ts ( ! ,/ate2  7iii7 to prioritize
 ! use ( new & em]g+ te*nologies t      
emphasize prev5tion & *ronic disease    
managem5t2  7iv7 to initiate1 fo/]1 &   
/r5g!n local & regional /rategic        
p>tn]%ips betwe5 urban hospitals & o!r  
heal? c>e provid]s 9 ord] to promote    
measurable quality improvem5t1 increase 
f9ancial /ability1 maximize economies ( 
scale1 & %>e be/ practices 9 c>e        
deliv]y2  7v7 to enhance economic       
opportunity =1 & ! supply (1 heal? c>e  
cl9icians ?r\gh enhanc$ recruitm5t &    
tra9+2  7vi7 to prioritize data &       
te*nology driv5 solutions t help urban  
hospitals & o!r urban heal? c>e provid]s
 furni% high-quality heal? c>e s]vices z
 close to a pati5t's home z is possible2
  7vii7 t outl9es /rategies to manage   
long-t]m f9ancial solv5cy & op]at+      
models ( urban hospitals 9 ! ,/ate2 &   
7viii7 t id5tifies specific causes driv+
 ! accel]at+ rate ( /&-alone urban      
hospitals becom+ at risk ( closure1     
conv]sion1 or s]vice r$uction2  7,b7 a  

c]tification t none ( ! am\nts provid$  
"u ?is section %all be us$ by ! ,/ate = 
an exp5diture t is attributable to an   
int]gov]nm5tal transf]1 c]tifi$ public  
exp5diture1 or any o!r exp5diture to    
f9ance ! non-,f$]al %>e ( exp5ditures   
requir$ "u any provision ( law1 includ+ 
"u ! ,/ate plan e/abli%$ "u title ,,xix1
 ! ,/ate plan e/abli%$ "u title ,,xxi1  
or "u a waiv] ( su* plans2 &  7,c7 su*  
o!r in=mation z ! ,adm9i/rator may      
require4  7#b7 ,deadl9e = approval ,n   
lat] ?an ,decemb] #ca1 #bjbf1 !         
,adm9i/rator %all approve or d5y all    
applications submitt$ = an allotm5t "u  
?is section4  7#c7 ,"o-"t application   
,if an application ( a ,/ate = an       
allotm5t "u ?is section is approv$ by ! 
,adm9i/rator1 ! ,/ate %all be eligible =
 an allotm5t "u ?is section = ea* (     
fiscal ye>s #bjbg ?r\gh #bjca1 except z 
provid$ 9 subsection 7a77#b77;,d74  7#d7
 ,eligibility ,! #ej ,/ates1 ! ,di/rict 
( ,columbia1 ,pu]to ,rico1 ! ,virg9     
,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1

 & ,am]ican ,samoa %all be eligible = an
 allotm5t "u ?is section & all ref]5ces 
9 ?is section to a ,/ate %all be treat$ 
z ref]r+ to ! #ej ,/ates1 ! ,di/rict (  
,columbia1 ,pu]to ,rico1 ! ,virg9       
,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1
 & ,am]ican ,samoa4  7c7 ,allotm5ts     
7#a7 ,9 g5]al ,= ea* ( fiscal ye>s #bjbg
 ?r\gh #bjca1 ! ,adm9i/rator %all       
det]m9e "u p>agraph 7#b7 ! am\nt ( !    
allotm5t = su* fiscal ye> = ea* ,/ate ) 
an approv$ application "u ?is section4  
7#b7 ,am\nt det]m9$ ,subject to p>agraph
 7#c71 f ! am\nts appropriat$ "u        
subsection 7a77#a7 = ea* ( fiscal ye>s  
#bjbg ?r\gh #bjca1 ! ,adm9i/rator %all  
allot--  7,a7 #ej p]c5t ( ! am\nts      
appropriat$ = ea* su* fiscal ye> equally
 among all ,/ates ) an approv$          
application "u ?is section2 &  7,b7 #ej 
p]c5t ( ! am\nts appropriat$ = ea* su*  
fiscal ye> among all su* ,/ates 9 an    
am\nt to be det]m9$ by ! ,adm9i/rator 9 
accordance ) p>agraph 7#c74  7#c7       
,requirem5ts ,9 det]m9+ ! am\nt to be   

allott$ to a ,/ate "u subp>agraph 7,b7 (
 p>agraph 7#b7 = a fiscal ye>1 !        
,adm9i/rator %all-- 7,a7 ensure t n less
 ?an #a_/d ( ! ,/ates ) an approv$      
application "u ?is section = a fiscal   
ye> are allott$ funds f am\nts t are to 
be allott$ "u subp>agraph 7,b7 ( su*    
p>agraph2 &  7,b7 consid]-- 7i7 !       
p]c5tage ( ! ,/ate population t is      
locat$ 9 an urban area2  7ii7 !         
proportion ( urban heal? facilities 7z  
def9$ 9 p>agraph 7#d77 9 ! ,/ate        
relative to ! numb] ( urban heal?       
facilities nationwide2 &  7iii7 any o!r 
factors t ! ,adm9i/rator det]m9es       
appropriate4  7#d7 ,urban heal? facility
 def9$ ,= ! purposes ( p>agraph         
7#c77;,b71 ! t]m urban heal? facility   
means ! foll[+3 7,a7 ,a facility def9$ z
 a disproportionate %>e hospital "u     
section #aibc7;a77#a77;,a74  7,b7 ,a    
hospital ) an approv$ m$ical resid5cy   
tra9+ program 7z def9$ 9 section        
#ahhf7;h77#e77;,a774  7,c7 ,a subsection
 7d7 hospital 7z def9$ 9 section        

#ahhf7;d77#a77;,b77 t is 9 ! #ge?       
p]c5tile ) respect to inpati5t hospital 
s]vices furni%$ to--  7i7 individuals   
dually eligible "u titles ,,xviii &     
,,xix2 or  7ii7 subsidy eligible        
individuals 7z def9$ 9 section          
#ahfj;,d-#ad7;a77#c774  7,d7 ,a hospital
 t is locat$ 9 an urban area &1 bas$ ^u 
! det]m9ation ( ! ,/ate1 s]ves a l>ge   
numb] ( resid5ts :o are l[-income1      
un9sur$1 or receiv+ m$ical assi/ance "u 
a ,/ate plan 7or a waiv] ( su* plan7 "u 
title ,,xix4  7,e7 ,a ,f$]ally qualifi$ 
heal? c5t] 7z def9$ 9 section           
#ahfa7;aa77#d774  7,f7 ,a community     
m5tal heal? c5t] 7z def9$ 9 section     
#ahfa7;ff77#c77;,b774  7,g7 ,a heal?    
c5t] t is receiv+ a grant "u section    
#ccj ( ! ,public ,heal? ,s]vice ,act4   
7,h7 ,an opioid treatm5t program 7z     
def9$ 9 section #ahfa7;jjj77#b77 t is   
locat$ 9 an urban area4  7,i7 ,a        
sub/ance use disord] treatm5t program t 
is locat$ 9 an urban area4  7,j7 ,a     
c]tifi$ community behavioral heal? cl9ic

 7z def9$ 9 section #aije7;jj77#b77 t is
 locat$ 9 an urban area4  7d7 ,no mat*+ 
paym5t ,a ,/ate approv$ = an allotm5t "u
 ?is section = a fiscal ye> %all n be   
requir$ to provide any mat*+ funds z a  
condition = receiv+ paym5ts f !         
allotm5t4  7e7 ,t]ms & conditions ,!    
,adm9i/rator %all specify su* t]ms &    
conditions = allotm5ts to ,/ates provid$
 "u ?is section z ! ,adm9i/rator deems  
appropriate1 includ+ ! foll[+3 7#a7 ,ea*
 ,/ate %all submit to ! ,adm9i/rator 7at
 a "t1 & 9 a =m & mann]1 specifi$ by !  
,adm9i/rator7--  7,a7 a plan = ! ,/ate  
to use its allotm5t to c>ry out #c or m 
( ! activities describ$ 9 subsection    
7f72 &  7,b7 annual reports on ! use (  
allotm5ts1 includ+ su* additional       
in=mation z ! ,adm9i/rator det]m9es     
appropriate4  7#b7 ,n m ?an #aj p]c5t ( 
! am\nt allott$ to a ,/ate = a fiscal   
ye> may be us$ by ! ,/ate = adm9i/rative
 exp5ses4  7f7 ,use ( funds ,am\nts     
allott$ to a ,/ate "u ?is section %all  
be us$ = #c or m ( ! foll[+ heal?-relat$

 activities3  7#a7 ,promot+             
evid5ce-bas$1 measurable int]v5tions to 
improve prev5tion & *ronic disease      
managem5t4  7#b7 ,provid+ paym5ts to    
heal? c>e provid]s = ! provision ( heal?
 c>e items or s]vices1 z specifi$ by !  
,adm9i/rator4  7#c7 ,promot+            
consum]-fac+1 te*nology-driv5 solutions 
= ! prev5tion & managem5t ( *ronic      
diseases4  7#d7 ,provid+ tra9+ &        
te*nical assi/ance = ! developm5t &     
adoption ( te*nology-enabl$ solutions t 
improve c>e deliv]y 9 urban hospitals1  
includ+ remote monitor+1 robotics1      
artificial intellig5ce1 & o!r advanc$   
te*nologies4  7#e7 ,recruit+ & reta9+   
cl9ical work=ce tal5t to urban areas1 ) 
commitm5ts to s]ve urban communities = a
 m9imum ( #e ye>s4  7#f7 ,provid+       
te*nical assi/ance1 s(tw>e1 & h>dw>e =  
significant in=mation te*nology advances
 design$ to improve effici5cy1 enhance  
cyb]security capability developm5t1 &   
improve pati5t heal? outcomes4  7#g7    
,assi/+ urban communities to "r size _! 

heal? c>e deliv]y sy/ems by id5tify+    
ne$$ prev5tative1 ambulatory1           
pre-hospital1 em]g5cy1 acute inpati5t   
c>e1 outpati5t c>e1 & po/-acute c>e     
s]vice l9es4  7#h7 ,support+ access to  
opioid use disord] treatm5t s]vices 7z  
def9$ 9 section #ahfa7;jjj77#a771 o!r   
sub/ance use disord] treatm5t s]vices1 &
 m5tal heal? s]vices4  7#i7 ,develop+   
projects t support innovative models (  
c>e t include value-bas$ c>e arrangem5ts
 & alt]native paym5t models1 z          
appropriate4  7#aj7 ,additional uses    
design$ to promote su/a9able access to  
high quality urban heal? c>e s]vices1 z 
det]m9$ by ! ,adm9i/rator4  7g7         
,def9itions ,9 ?is section3 7#a7 ,heal? 
c>e provid] ,! t]m heal? c>e provid]    
means a provid] ( s]vices or suppli] :o 
is enroll$ "u title ,,xviii1 title      
,,xix1 or title ,,xxi4  7#b7 ,urban area
 ,! t]m urban area means a metropolitan 
/ati/ical area ) a population (         
#a1jjj1jjj or m4  4  7b7 ,implem5tation 
,! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    

,m$icaid ,s]vices %all implem5t ?is     
section1 includ+ ! am5dm5ts made by ?is 
section1 by program in/ruction or o!r   
=ms ( program guidance4  7c7            
,implem5tation fund+ ,= ! purposes (    
c>ry+ out ! provisions (1 & ! am5dm5ts  
made by1 ?is section1 !re are           
appropriat$1 out ( any monies 9 !       
,treasury n o!rwise appropriat$1 to !   
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices1 #bjj1jjj1jjj = fiscal
 ye> #bjbf1 to rema9 available until    
exp5d$4