Further Consolidated Appropriations Act, 2020
DIVISION A—DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCY APPROPRIATIONS ACT, 2020TITLE VGENERAL PROVISIONS(transfer of funds)
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(b) None of the funds appropriated in this Act, and none of the funds in any trust fund to which funds are appropriated in this Act, shall be expended for health benefits coverage that includes coverage of abortion.
(c) The term “health benefits coverage” means the package of services covered by a managed care provider or organization pursuant to a contract or other arrangement.
(1) if the pregnancy is the result of an act of rape or incest; or
(2) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a lifeendangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.
(b) Nothing in the preceding section shall be construed as prohibiting the expenditure by a State, locality, entity, or private person of State, local, or private funds (other than a State’s or locality’s contribution of Medicaid matching funds).
(c) Nothing in the preceding section shall be construed as restricting the ability of any managed care provider from offering abortion coverage or the ability of a State or locality to contract separately with such a provider for such coverage with State funds (other than a State’s or locality’s contribution of Medicaid matching funds).
(d) (1) None of the funds made available in this Act may be made available to a Federal agency or program, or to a State or local government, if such agency, program, or government subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.
(2) In this subsection, the term “health care entity” includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.
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Sec. 510 None of the funds made available in this Act may be used to promulgate or adopt any final standard under section 1173(b) of the Social Security Act providing for, or providing for the assignment of, a unique health identifier for an individual (except in an individual’s capacity as an employer or a health care provider), until legislation is enacted specifically approving the standard.
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Sec. 518 None of the funds appropriated in this Act shall be expended or obligated by the Commissioner of Social Security, for purposes of administering Social Security benefit payments under title II of the Social Security Act, to process any claim for credit for a quarter of coverage based on work performed under a social security account number that is not the claimant’s number and the performance of such work under such number has formed the basis for a conviction of the claimant of a violation of section 208(a)(6) or (7) of the Social Security Act.
Sec. 519 None of the funds appropriated by this Act may be used by the Commissioner of Social Security or the Social Security Administration to pay the compensation of employees of the Social Security Administration to administer Social Security benefit payments, under any agreement between the United States and Mexico establishing totalization arrangements between the social security system established by title II of the Social Security Act and the social security system of Mexico, which would not otherwise be payable but for such agreement.
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DIVISION N—HEALTH AND HUMAN SERVICES EXTENDERS
TITLE I—HEALTH AND HUMAN SERVICES EXTENDERS
Subtitle A—Medicare Provisions
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Sec. 105. laboratory access for beneficiaries.
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(b) Study and Report by MedPAC.—
(1) In general.—The Medicare Payment Advisory Commission (in this subsection referred to as the “Commission”) shall conduct a study to review the methodology the Administrator of the Centers for Medicare & Medicaid Services has implemented for the private payor rate-based clinical laboratory fee schedule under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
(2) Scope of study.—In carrying out the study described in paragraph (1), the Commission shall consider the following:
(A) How best to implement the least burdensome data collection process required under section 1834A(a)(1) of such Act (42 U.S.C. 1395m–1(a)(1)) that would—
(i) result in a representative and statistically valid data sample of private market rates from all laboratory market segments, including hospital outreach laboratories, physician office laboratories, and independent laboratories; and
(ii) consider the variability of private payor payment rates across market segments.
(B) Appropriate statistical methods for estimating rates that are representative of the market.
(3) Report to congress.—Not later than 18 months after the date of the enactment of this Act, the Commission shall submit to the Administrator, the Committee on Finance of the Senate, and the Committees on Ways and Means and Energy and Commerce of the House of Representatives a report that includes—
(A) conclusions about the methodology described in paragraph (1); and
(B) any recommendations the Commission deems appropriate.
Sec. 106. *** non-application of medicare fee-schedule adjustments for certain wheelchair accessories and cushions
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(b) Non-application of Medicare Fee Schedule Adjustments for Wheelchair Accessories and Seat and Back Cushions When Furnished in Connection With Complex Rehabilitative Manual Wheelchairs.—
(1) In general.—Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, during the period beginning on January 1, 2020, and ending on June 30, 2021, use information on the payment determined under the competitive acquisition programs under section 1847 of the Social Security Act (42 U.S.C. 1395w–3) to adjust the payment amount that would otherwise be recognized under section 1834(a)(1)(B)(ii) of such Act (42 U.S.C. 1395m(a)(1)(B)(ii)) for wheelchair accessories (including seating systems) and seat and back cushions when furnished in connection with complex rehabilitative manual wheelchairs (as determined by the Secretary), and certain manual wheelchairs (identified, as of October 1, 2018, by HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any successor to such codes).
(2) Implementation.—Notwithstanding any other provision of law, the Secretary may implement this subsection by program instruction or otherwise.
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Subtitle B—Medicaid Provisions
Sec. 202. medicaid funding for the territories.
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(e) Application of Certain Data Reporting and Program Integrity Requirements to Northern Mariana Islands, American Samoa, and Guam.—* * *
(3) Reevaluation of waivers of medicaid fraud control unit requirement.—
(A) In general.—Not later than the date that is 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall reevaluate any waiver approved (and in effect as of the date of enactment of this Act) for Guam, the Northern Mariana Islands, or American Samoa under subsection (a)(61) or subsection (j) of section 1902 of the Social Security Act (42 U.S.C.1396a) with respect to the requirement to establish a State medicaid fraud control unit (as described in section 1903(q) of such Act (42 U.S.C. 1396b(q))).
(B) Rule of construction.—Nothing in this paragraph shall be construed as requiring the Secretary of Health and Human Services to terminate or refuse to extend a waiver described in subparagraph (A).
(f) Additional Program Integrity Requirements.—
(1) Definitions.—In this subsection:
(A) Inspector general.—The term “Inspector General” means the Inspector General of the Department of Health and Human Services.
(B) Puerto rico’s medicaid program.—The term “Puerto Rico’s Medicaid program” means, collectively, Puerto Rico’s State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and any waiver of such plan.
(2) Report on contracting oversight and approval.—Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall issue, and submit to the Chair and Ranking Member of the Committee on Energy and Commerce of the House of Representatives and the Chair and Ranking Member of the Committee on Finance of the Senate, a report on contracting oversight and approval with respect to Puerto Rico’s State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan). Such report shall—
(i) the process used by Puerto Rico to evaluate bids and award contracts under such plan (or waiver);
(ii) which contracts are not subject to competitive bidding or requests for proposals under such plan (or waiver); and
(iii) oversight by the Centers for Medicare & Medicaid Services of contracts awarded under such plan (or waiver); and
(B) include any recommendations for Congress, the Secretary of Health and Human Services, or Puerto Rico relating to changes that the Comptroller General determines necessary to improve the program integrity of such plan (or waiver).
(3) Audits of managed care payments.—Not later than the date that is 1 year after the date of enactment of this Act, the Inspector General shall develop and submit to Congress—
(A) a report identifying payments made under Puerto Rico’s Medicaid program to managed care organizations that the Inspector General determines to be at high risk for waste, fraud, or abuse; and
(B) a plan for auditing and investigating such payments.
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(5) Appropriation.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated to the Secretary of Health and Human Services $5,000,000 for each of fiscal years 2020 through 2021 to carry out this subsection.
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Sec. 204. extension of spousal impoverishment protections.
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(b) Rule of Construction.—Nothing in section 2404 of Public Law 111–148 (42 U.S.C. 1396r–5 note) or section 1902(a)(17) or 1924 of the Social Security Act (42 U.S.C. 1396a(a)(17), 1396r– 5) shall be construed as prohibiting a State from—
(1) applying an income or resource disregard under a methodology authorized under section 1902(r)(2) of such Act (42 U.S.C. 1396a(r)(2))—
(A) to the income or resources of an individual described in section 1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) (including a disregard of the income or resources of such individual’s spouse); or
(B) on the basis of an individual’s need for home and community-based services authorized under subsection (c), (d), (i), or (k) of section 1915 of such Act (42 U.S.C. 1396n) or under section 1115 of such Act (42 U.S.C. 1315); or
(2) disregarding an individual’s spousal income and assets under a plan amendment to provide medical assistance for home and community-based services for individuals by reason of being determined eligible under section 1902(a)(10)(C) of such Act (42 U.S.C. 1396a(a)(10)(C)) or by reason of section 1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise on the basis of a reduction of income based on costs incurred for medical or other remedial care under which the State disregarded the income and assets of the individual’s spouse in determining the initial and ongoing financial eligibility of an individual for such services in place of the spousal impoverishment provisions applied under section 1924 of such Act (42 U.S.C. 1396r–5).
Subtitle C—Human Services and Other Health Programs
Sec. 301. extension of demonstration projects to address health professions workforce needs.
Activities authorized by section 2008 of the Social Security Act shall continue through May 22, 2020, in the manner authorized for fiscal year 2019, and out of any money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary for such purpose. Grants and payments may be made pursuant to this authority through the date so specified at the pro rata portion of the total amount authorized for such activities in fiscal year 2019.
Sec. 302. extension of the temporary assistance for needy families program and related programs.
Activities authorized by part A of title IV and section 1108(b) of the Social Security Act shall continue through May 22, 2020, in the manner authorized for fiscal year 2019, and out of any money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary for such purpose.
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Subtitle F—Miscellaneous Provisions
sec. 602. Addressing expiration of child welfare demonstration projects and supporting family first implementation.
(a) Short Title.—This section may be cited as the “Family First Transition Act”.
(1) Temporary suspension of requirement that at least 50 percent of a state’s reimbursement for prevention and family services and programs be for programs and services that meet the well-supported practice requirement.—With respect to quarters in fiscal years 2020 and 2021, section 474(a)(6)(A) of the Social Security Act (42 U.S.C. 674(a)(6)(A)) shall be applied without regard to clause (ii) of such section.
(2) Supported practices temporarily treated as well-supported practices.—With respect to quarters in fiscal years 2022 and 2023, practices that meet the criteria specified for supported practices in section 471(e)(4)(C) of the Social Security Act (42 U.S.C. 671(e)(4)(C)) shall be considered well-supported practices for purposes of section 474(a)(6)(A)(ii) of such Act (42 U.S.C. 674(a)(6)(A)(ii)).
(c) Enhances Funding for Transition Activities.—
(1) Transition funding.—
(A) Appropriation.—Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Secretary of Health and Human Services (in this section referred to as the “Secretary”) to carry out this subsection $500,000,000 for fiscal year 2020, which shall remain available through fiscal year 2021.
(B) Distribution of funds.—
(i) In general.—The Secretary shall allot the amount appropriated by subparagraph (A) of this paragraph in accordance with section 423 of the Social Security Act (42 U.S.C. 623), and shall pay each State to which an allotment is so made, the total amount so allotted, subject to clause (ii) of this subparagraph.
(ii) Reservation of funds for indian tribes and tribal organizations.—Before applying clause (i) of this subparagraph, the Secretary shall reserve 3 percent of the amount appropriated by subparagraph (A) of this paragraph for allotment to the Indian tribes and tribal organizations with a plan approved under subpart 1 of part B of title IV of the Social Security Act, based on each tribe or tribal organization’s share of the total tribal child population among all such tribes and tribal organizations.
(2) Funding certainty for states with expiring demonstration projects.—
(A) In general.—Out of any money in the Treasury of the United States not otherwise appropriated, there are appropriated to the Secretary, for payment to each State that was operating a demonstration project approved under section 1130 of the Social Security Act on September 30, 2019, for each fiscal year specified in subparagraph (B) of this paragraph, an amount equal to the amount (if any) by which—
(i) (I) the applicable percentage for the fiscal year so specified of the maximum capped allocation due to the State or sub-State jurisdiction for fiscal year 2019 for foster care maintenance, administration, or training costs, under the demonstration project, as specified in section 4.3 of the State waiver terms and conditions document capped allocation payment table in effect on August 31, 2019; or
(II) if the terms and conditions do not specify a maximum amount payable for fiscal year 2019 for the State or sub-State jurisdiction (due to the use of a comparison jurisdiction to ensure cost neutrality), the final cost neutrality limit for the State or sub-State jurisdiction for fiscal year 2018, as most recently reported by the State or sub-State jurisdiction as of September 30, 2019, for foster care maintenance, administration, or training costs under the demonstration project that were included in the waiver; exceeds
(III) the total amount payable to the State or sub- State jurisdiction under part E of title IV of such Act for the fiscal year so specified for foster care expenditures (whether payable under paragraph (1) or (3) of section 474(a) of such Act) that were maintenance, administration, or training costs of the demonstration project taken into account by the Secretary in determining the total amount referred to in clause (i) of this subparagraph.
(B) Applicable percentage defined.—In this subparagraph, the term ‘‘applicable percentage’’ means—
(i) 90 percent, in the case of fiscal year 2020; or
(ii) 75 percent, in the case of fiscal year 2021.
(C) Special rule.—The calculation under subparagraph (A) with respect to a State shall be made without regard to—
(i) any change approved after August 31, 2019, in the capped allocation or the terms and conditions referred to in clause (i) of subparagraph (A) with respect to the State; or
(ii) any change made after such date to the financial form submitted by the State that is used in determining the capped allocation.
(D) Distribution of funds.—Each State that receives funds under this paragraph shall distribute the funds to jurisdictions in the State that were operating demonstration projects under section 1130 of the Social Security Act in a manner consistent with each sub-State jurisdiction’s proportionate loss as compared with fiscal year 2019.
(E) Reconciliation process.—Each State seeking a payment under this paragraph shall report expenditures pursuant to part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.) in a manner determined by the Secretary and the Secretary shall account for any revisions to spending for fiscal years 2020 and 2021 after the end of the respective fiscal year that are reported by the State agency administering the State plan approved under such part, and received by the Department of Health and Human Services, within 2 years after the last day of the fiscal quarter in which the expenditure was made.
(F) Availability of funds.—The amounts made available for payments to States under this paragraph for a fiscal year shall remain available through the end of the third succeeding fiscal year.
(3) Use of funds.—
(A) In general.—In addition to the purposes specified in part B of title IV of the Social Security Act (42 U.S.C. 671 et seq.), a State may use funds provided under this subsection for activities previously funded under a demonstration project under section 1130 of such Act (42 U.S.C. 1320a–9) to reduce any adverse fiscal impacts as jurisdictions transition funding sources for the projects, and for activities directly associated with the implementation of title VII of division E of Public Law 115–123 (also known as the Family First Prevention Services Act).
(B) Limitation.—None of the funds provided under this subsection may be used to match Federal funds under any program.
(d) Reporting on Enhanced funding for Transition Activities.—
(1) In general.—Each State to which funds are paid under subsection (c) of this section shall submit to the Secretary, in a manner specified by the Secretary, a written report on—
(A) how the grant is used to implement each part of title VII of division E of Public Law 115–123 (also known as the Family First Prevention Services Act), with a separate statement with respect to each such part;
(B) all programs, services, and operational costs to which the grant is put;
(C) the characteristics of the families and children served by use of the grant; and
(D) (i) the use by the State of amounts provided for each fiscal year to continue activities previously funded under a waiver provided under section 1130 of the Social Security Act (42 U.S.C. 1320a–9); and
(i) (I) the plan of the State to transition the activities so that needed activities can be provided under the State plan approved under part E of title IV of the Social Security Act (42 U.S.C. 670 et seq.); or
(II) if expenditures for the activities would not be eligible for payment under the State plan approved under such part E—
(aa) the reason therefor; and
(bb) the funding sources the State plans to use to cover the costs of needed activities.
(2) Applicability of other laws.—For purposes of subpart 2 of part B of title IV of the Social Security Act (42 U.S.C. 629 et seq.), each report required by paragraph (1) of this subsection shall be considered to be required by section 432(a)(8) of such Act (42 U.S.C. 629b(a)(8)), and shall contain such additional information as the Secretary may require.
(e) Definition of State.—In this section, the term “State” has the meaning given the term in section 431(a)(4) of the Social Security Act (42 U.S.C. 629a(a)(4)).
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[Internal References.—Footnotes for SSAct §1834A(a)(1) refers to Div. N, §105. SSAct §1847(a)(2)(A) refers to §106. SSAct §1902(a)(61) and (j) refer to §202. SSAct §1902(a)(17) refers to §204. SSAct §2008 refers to §301. SSAct §1108(b) refers to §302. SSAct §474(a)(6)(A) refers to §602. SSAct §1130 refers to §602.]
 Effective as if enacted as part of the Bipartisan Budget Act of 2018 (P.L. 115–123), February 9, 2018.