; and (B) is necessary to carry out a demonstration project under this subsection. (5) Demonstration project sites The Secretary shall ensure that the 5 demonstration projects funded under this subsection are conducted at a variety of sites representing the diversity of rural communities in the United States. (6) Duration Each demonstration project under this subsection shall be for a period of 4 years. (7) Independent evaluation The Secretary shall enter into an arrangement with an entity that has experience working directly with rural health systems for the conduct of an independent evaluation of the program carried out under this subsection. (8) Report Not later than 1 year after the conclusion of all of the demonstration projects funded under this subsection, the Secretary shall submit a report to the Congress on the results of such projects. The report shall include— (A) an evaluation of patient access to care, patient outcomes, and an analysis of the cost effectiveness of each such project; and (B) recommendations on Federal legislation, regulations, or administrative policies to enhance rural health quality and outcomes. (c) Appropriation (1) In general Out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary to carry out this section $30,000,000 for the period of fiscal years 2019 through 2023. (2) Availability (A) In general Funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2023. (B) Report For purposes of carrying out subsection (b)(8), funds appropriated under paragraph (1) shall remain available for expenditure through fiscal year 2024. (3) Reservation Of the amount appropriated under paragraph (1), the Secretary shall reserve— (A) $5,000,000 to carry out subsection (a); and (B) $25,000,000 to carry out subsection (b), of which— (i) 2 percent shall be for the provision of technical assistance to grant recipients