I 
119TH CONGRESS 
1ST SESSION H. R. 5371 
Making continuing appropriations and extensions for fiscal year 2026, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 16, 2025 
Mr. COLE introduced the following bill; which was referred to the Committee 
on Appropriations, and in addition to the Committee on the Budget, for 
a period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
Making continuing appropriations and extensions for fiscal 
year 2026, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Continuing Appropria-
tions and Extensions Act, 2026’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. SHORT TITLE. 
Sec. 2. TABLE OF CONTENTS. 
Sec. 3. REFERENCES. 
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program levels under current law, under the authority and 
conditions provided in the applicable appropriations Act, 
to be continued through the date specified in section 
106(3) of this Act. 
(b) Notwithstanding section 106, obligations for man-
datory payments due on or about the first day of any 
month that begins after October 2025 but not later than 
30 days after the date specified in section 106(3) may con-
tinue to be made, and funds shall be available for such 
payments. 
SEC. 112. Amounts made available under section 101 
for civilian personnel compensation and benefits in each 
department and agency may be apportioned up to the rate 
for operations necessary to avoid furloughs within such de-
partment or agency, consistent with the applicable appro-
priations Act for fiscal year 2025, except that such author-
ity provided under this section shall not be used until after 
the department or agency has taken all necessary actions 
to reduce or defer non-personnel-related administrative ex-
penses. 
SEC. 113. Funds appropriated by this Act may be 
obligated and expended notwithstanding section 10 of 
Public Law 91–672 (22 U.S.C. 2412), section 15 of the 
State Department Basic Authorities Act of 1956 (22 
U.S.C. 2680), section 313 of the Foreign Relations Au-
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thorization Act, Fiscal Years 1994 and 1995 (22 U.S.C. 
6212), and section 504(a)(1) of the National Security Act 
of 1947 (50 U.S.C. 3094(a)(1)). 
SEC. 114. (a)(1) For each amount incorporated by 
reference in this Act that was previously designated by the 
Congress as an emergency requirement pursuant to sec-
tion 251(b)(2)(A)(i) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985, each provision of law 
designating each such amount as an emergency require-
ment pursuant to such section shall not apply. 
(2) Each amount incorporated by reference in 
this Act that was designated by the Congress as an 
emergency 
requirement 
pursuant 
to 
section 
251(b)(2)(A)(i) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985 in the following 
provisions of law are designated by the Congress as 
an emergency requirement pursuant to section 
4001(a)(1) of S. Con. Res. 14 (117th Congress), the 
concurrent resolution on the budget for fiscal year 
2022, and to legislation establishing fiscal year 2026 
budget enforcement in the House of Representatives: 
section 11206(4) of division A of Public Law 119– 
4 and 7068(b) of division F of Public Law 118–47, 
as continued in effect by section 1101 of division A 
of Public Law 119–4. 
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(b) Each amount incorporated by reference in this 
Act that was previously designated by the Congress as 
being for disaster relief pursuant to section 251(b)(2)(D) 
of the Balanced Budget and Emergency Deficit Control 
Act of 1985 is designated by the Congress as being for 
disaster relief pursuant to a concurrent resolution on the 
budget. 
(c) Each amount incorporated by reference in this 
Act that was previously designated in division B of Public 
Law 117–159, division J of Public Law 117–58, or in sec-
tion 443(b) of division G of Public Law 117–328 by the 
Congress as an emergency requirement pursuant to a con-
current resolution on the budget shall continue to be treat-
ed as an amount specified in section 103(b) of division 
A of Public Law 118–5. 
SEC. 115. (a) Rescissions or cancellations of discre-
tionary budget authority that continue pursuant to section 
101 in Treasury Appropriations Fund Symbols (TAFS)— 
(1) to which other appropriations are not pro-
vided by this Act, but for which there is a current 
applicable TAFS that does receive an appropriation 
in this Act; or 
(2) which are no-year TAFS and receive other 
appropriations in this Act, 
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may be continued instead by reducing the rate for oper-
ations otherwise provided by section 101 for such current 
applicable TAFS, as long as doing so does not impinge 
on the final funding prerogatives of the Congress. 
(b) Rescissions or cancellations described in sub-
section (a) shall continue in an amount equal to the lesser 
of— 
(1) the amount specified for rescission or can-
cellation in the applicable appropriations Act ref-
erenced in section 101 of this Act; or 
(2) the amount of balances available, as of Oc-
tober 1, 2025, from the funds specified for rescission 
or cancellation in the applicable appropriations Act 
referenced in section 101 of this Act. 
(c) No later than November 7, 2025, the Director of 
the Office of Management and Budget shall provide to the 
Committees on Appropriations of the House of Represent-
atives and the Senate a comprehensive list of the rescis-
sions or cancellations that will continue pursuant to sec-
tion 101: Provided, That the information in such com-
prehensive list shall be periodically updated to reflect any 
subsequent changes in the amount of balances available, 
as of October 1, 2025, from the funds specified for rescis-
sion or cancellation in the applicable appropriations Act 
referenced in section 101, and such updates shall be trans-
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mitted to the Committees on Appropriations of the House 
of Representatives and the Senate upon request. 
SEC. 116. Amounts made available by section 101 for 
‘‘Domestic Food Programs—Food and Nutrition Serv-
ice—Special Supplemental Nutrition Program for Women, 
Infants, and Children (WIC)’’ may be apportioned at the 
rate for operations necessary to maintain participation. 
SEC. 117. Section 260 of the Agricultural Marketing 
Act of 1946 (7 U.S.C. 1636i) and section 942 of the Live-
stock Mandatory Reporting Act of 1999 (7 U.S.C. 1635 
note; Public Law 106–78) shall be applied by substituting 
the date specified in section 106 of this Act for ‘‘Sep-
tember 30, 2025’’. 
SEC. 118. Section 8302(b) of the Agricultural Act of 
2014 (16 U.S.C. 3851a(b)) shall be applied by sub-
stituting the date specified in section 106 of this Act for 
‘‘October 1, 2023’’. 
SEC. 119. (a) Amounts made available by section 101 
for ‘‘Department of Justice—United States Marshals 
Service—Salaries and Expenses’’ may be apportioned up 
to the rate for operations necessary to maintain program 
operations. 
(b) In addition to amounts provided by section 101, 
for ‘‘Department of Justice—United States Marshals 
Service—Salaries and Expenses’’, there is appropriated 
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$30,000,000, for an additional amount for fiscal year 
2026, to remain available until September 30, 2027, to 
carry out protective operations. 
SEC. 120. (a) For the closeout of all Space Shuttle 
contracts and associated programs, amounts that have ex-
pired but have not been cancelled in the Exploration, 
Space Operations, Human Space Flight, Space Flight Ca-
pabilities, and Exploration Capabilities appropriations ac-
counts shall remain available through fiscal year 2030 for 
the liquidation of valid obligations incurred during the pe-
riod of fiscal year 2001 through fiscal year 2013. 
(b)(1) Subject to paragraph (2), this section shall be-
come effective immediately upon enactment of this Act. 
(2) If this Act is enacted after September 30, 
2025, this section shall be applied as if it were in 
effect on September 30, 2025. 
SEC. 121. Section 3014(a) of title 18, United States 
Code, shall be applied by substituting the date specified 
in section 106 of this Act for ‘‘September 30, 2025’’. 
SEC. 122. Notwithstanding section 101, the first pro-
viso in each of sections 8092 and 8096 of title VIII of 
division A of Public Law 118–47 shall be applied by sub-
stituting ‘‘advances’’ for ‘‘reimbursements’’. 
SEC. 123. Notwithstanding sections 102 and 104, 
amounts made available by section 101 to the Department 
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necessary to fund completion of prior year shipbuilding 
programs for the fiscal year 2016 and fiscal year 2018 
Virginia Class Submarine Programs, in an amount not to 
exceed $154,000,000. 
SEC. 127. During the period covered by this Act, sec-
tion 103(f)(4)(A) of Public Law 108–361 (the Calfed Bay- 
Delta Authorization Act) shall be applied by substituting 
‘‘$32,600,000’’ for ‘‘$30,000,000’’. 
SEC. 128. (a) Amounts made available by section 101 
in the first proviso under the heading ‘‘Department of En-
ergy—Atomic Energy Defense Activities—National Nu-
clear Security Administration—Weapons Activities’’ may 
be apportioned up to the rate for operations necessary to 
maintain current operations for the safe, secure transport 
of nuclear weapons. 
(b) The Director of the Office of Management and 
Budget and the Secretary of Energy shall notify the Com-
mittees on Appropriations of the House of Representatives 
and the Senate not later than 3 days after each use of 
the authority provided in subsection (a). 
SEC. 129. Notwithstanding section 101, the matter 
preceding the first proviso under the heading ‘‘Office of 
Personnel Management—Salaries and Expenses’’ in title 
V of division B of Public Law 118–47 shall be applied 
by substituting ‘‘$197,446,000’’ for ‘‘$219,076,000’’, and 
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the second proviso under such heading in such title of such 
division of such Act shall be applied by substituting 
‘‘$214,605,000’’ for ‘‘$192,975,000’’. 
SEC. 130. Notwithstanding any other provision of 
this Act, except section 106, the District of Columbia may 
expend local funds made available under the heading ‘‘Dis-
trict of Columbia—District of Columbia Funds’’ for such 
programs and activities under the District of Columbia 
Appropriations Act, 2024 (title IV of division B of Public 
Law 118–47) at the rate set forth in the Fiscal Year 2026 
Local Budget Act of 2025 (D.C. Bill No. 26–260) as 
modified as of the date of enactment of this Act. 
SEC. 131. Notwithstanding section 101, paragraph 
(1) under the heading ‘‘Department of the Treasury—De-
partmental Offices—Salaries and Expenses’’ in title I of 
division B of Public Law 118–47 shall be applied by sub-
stituting ‘‘$1,350,000’’ for ‘‘$350,000’’: Provided, That 
such amounts may be obligated in the account and budget 
structure set forth in the fiscal year 2026 President’s 
Budget, submitted pursuant to section 1105(a) of title 31, 
United States Code, and accompanying justification mate-
rials. 
SEC. 132. Amounts made available by section 101 for 
‘‘Small Business Administration—Business Loans Pro-
gram Account’’ may be apportioned up to the rate for op-
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erations necessary to accommodate increased demand for 
commitments for general business loans authorized under 
paragraphs (1) through (35) of section 7(a) of the Small 
Business Act (15 U.S.C. 636(a)), for commitments to 
guarantee trust certificates authorized by section 5(g) of 
the Small Business Act (15 U.S.C. 634(g)), for commit-
ments to guarantee loans under section 503 of the Small 
Business Investment Act of 1958 (15 U.S.C. 697), and 
for commitments to guarantee debentures under section 
303(b) of the Small Business Investment Act of 1958 (15 
U.S.C. 683(b)). 
SEC. 133. Notwithstanding section 101, amounts are 
provided for ‘‘Department of the Treasury—Office of Ter-
rorism and Financial Intelligence—Salaries and Ex-
penses’’ at a rate for operations of $237,662,000. 
SEC. 134. Notwithstanding section 101, section 1605 
of Public Law 119–4 shall be applied by substituting 
‘‘through the end of the last applicable pay period that 
commences on or before the date specified in section 
106(3) of the Continuing Appropriations Act, 2026’’ for 
‘‘through the date specified in section 1106 of this Act’’. 
SEC. 135. Section 1(b) of Public Law 117–25 (135 
Stat. 297; 136 Stat. 2133; 136 Stat. 5984; 138 Stat. 
1771; 139 Stat. 46) shall be applied in each of paragraphs 
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(3) and (4) by substituting the date specified in section 
106 of this Act for ‘‘September 30, 2025’’. 
SEC. 136. In addition to amounts otherwise provided 
by section 101 for ‘‘The Judiciary—Supreme Court of the 
United States—Salaries and Expenses’’, there is appro-
priated $28,000,000, for an additional amount for fiscal 
year 2026, to remain available until expended, for the pro-
tection of the Supreme Court Justices, including the pur-
chase and hire of passenger motor vehicles as authorized 
by 31 U.S.C. 1343 and 1344, to be expended as the Chief 
Justice may approve. 
SEC. 137. Section 210G(i) of the Homeland Security 
Act of 2002 (6 U.S.C. 124n(i)) shall be applied by sub-
stituting the date specified in section 106 of this Act for 
‘‘September 30, 2025’’. 
SEC. 138. Section 225(e) of division A of Public Law 
116–6 (49 U.S.C. 44901 note) shall be applied by sub-
stituting ‘‘fiscal year 2019 through the date specified in 
section 106 of the Continuing Appropriations Act, 2026’’ 
for ‘‘fiscal years 2019 through 2025’’. 
SEC. 139. Amounts made available by section 101 to 
the Department of Homeland Security under the heading 
‘‘Federal Emergency Management Agency—Disaster Re-
lief Fund’’ may be apportioned up to the rate for oper-
ations necessary to carry out response and recovery activi-
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ties under the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act (42 U.S.C. 5121 et seq.). 
SEC. 140. Section 227(a) of the Federal Cybersecu-
rity Enhancement Act of 2015 (6 U.S.C. 1525(a)) shall 
be applied by substituting the date specified in section 106 
of this Act for ‘‘September 30, 2025’’. 
SEC. 141. Section 111(a) of the Cybersecurity Infor-
mation Sharing Act of 2015 (6 U.S.C. 1510(a)) shall be 
applied by substituting the date specified in section 106 
of this Act for ‘‘September 30, 2025’’. 
SEC. 142. Section 2220A(s)(1) of the Homeland Se-
curity Act of 2002 (6 U.S.C. 665g(s)(1)) shall be applied 
by substituting the date specified in section 106 of this 
Act for ‘‘September 30, 2025’’. 
SEC. 143. During the period covered by this Act, sec-
tion 3(b)(2)(C) of the Pittman-Robertson Wildlife Res-
toration Act (16 U.S.C. 669b(b)(2)(C)) shall be applied 
by substituting ‘‘2027’’ for ‘‘2026’’. 
SEC. 144. During the period covered by this Act, sec-
tion 1701 of title VII of division B of Public Law 117– 
43, as amended, shall be applied by substituting ‘‘calendar 
years 2021 through 2026’’ for ‘‘2021 or 2022 or 2023 
or 2024’’ each place it appears. 
SEC. 145. Amounts made available by section 101 for 
‘‘Department of the Interior—Department-Wide Pro-
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grams—Wildland Fire Management’’ and ‘‘Department of 
Agriculture—Forest Service—Wildland Fire Manage-
ment’’ may be apportioned up to the rate for operations 
necessary for wildfire suppression activities. 
SEC. 146. (a) In addition to amounts otherwise pro-
vided by section 101, amounts are provided for ‘‘Depart-
ment of Health and Human Services—Indian Health 
Service—Indian Health Services’’ at a rate for operations 
of $72,265,000, for an additional amount for costs of 
staffing and operating facilities that were opened, ren-
ovated, or expanded in fiscal years 2025 and 2026, and 
such amounts may be apportioned up to the rate for oper-
ations necessary to staff and operate such facilities. 
(b) In addition to amounts otherwise provided by sec-
tion 101, amounts are provided for ‘‘Department of 
Health and Human Services—Indian Health Service—In-
dian Health Facilities’’ at a rate for operations of 
$8,050,000, for an additional amount for costs of staffing 
and operating facilities that were opened, renovated, or ex-
panded in fiscal years 2025 and 2026, and such amounts 
may be apportioned up to the rate for operations necessary 
to staff and operate such facilities. 
SEC. 147. Of the amounts made available in the third 
paragraph under the heading ‘‘Environmental Protection 
Agency—State and Tribal Assistance Grants’’ in the Dis-
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Police Mutual Aid Reimbursements’’, there is appro-
priated $30,000,000, for an additional amount for fiscal 
year 2026, to remain available until expended, for reim-
bursements for mutual aid and related training provided 
under the agreements described in section 7302 of Public 
Law 108–458: Provided,That obligation of the funds made 
available in this section in this Act shall be subject to noti-
fication to the Chairmen and Ranking Members of the 
Committees on Appropriations of both Houses of Con-
gress, the Senate Committee on Rules and Administration, 
and the Committee on House Administration of the 
amount and purpose of the expense within 15 days of obli-
gation. 
SEC. 152. Notwithstanding section 101, the matter 
under the heading ‘‘Native American Veteran Housing 
Loan Program Account’’ in title II of division A of Public 
Law 118–42 shall be applied by adding the following new 
paragraph:In addition, for the cost of direct loans, 
$6,865,235, as authorized by subchapter V of chapter 37 
of title 38, United States Code: Provided, That such costs, 
including the cost of modifying such loans, shall be as de-
fined in section 502 of the Congressional Budget Act of 
1974: Provided further, That funds made available under 
this heading are available to subsidize gross obligations 
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for the principal amount of direct loans not to exceed 
$75,000,000.’’. 
SEC. 153. Section 1424(a) of the Better Utilization 
of Investments Leading to Development Act of 2018 (22 
U.S.C. 9624(a)) shall be applied by substituting the date 
specified in section 106 of this Act for ‘‘the date that is 
7 years after the date of the enactment of this Act’’. 
SEC. 154. Notwithstanding sections 101 and 106, 
and sections 1101, 1106, and 11201 of Public Law 119– 
4, the fifth and sixth provisos under the heading ‘‘Millen-
nium Challenge Corporation’’ in title III of division F of 
Public Law 118–47 shall be amended by substituting ‘‘De-
cember 31, 2026’’ for ‘‘December 31, 2024’’ each place 
it appears. 
SEC. 155. Notwithstanding section 106, during fiscal 
year 2026, the Secretary of Housing and Urban Develop-
ment may use the unobligated balances of amounts made 
available in prior fiscal years in paragraphs (2), (3), and 
(8) under the heading ‘‘Public and Indian Housing—Ten-
ant-Based Rental Assistance’’ to support additional alloca-
tions under subparagraph (D) of paragraph (1) and sub-
paragraph (B) of paragraph (4) of such heading to pre-
vent the termination of rental assistance for families as 
the result of insufficient funding in the calendar year 2025 
funding cycle: Provided,That amounts repurposed pursu-
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ant to this section that were previously designated by the 
Congress as an emergency requirement pursuant to a con-
current resolution on the budget or the Balanced Budget 
and Emergency Deficit Control Act of 1985 are des-
ignated by the Congress as being for an emergency re-
quirement pursuant to section 4001(a)(1) of S. Con. Res. 
14 (117th Congress), the concurrent resolution on the 
budget for fiscal year 2022, and to legislation establishing 
fiscal year 2026 budget enforcement in the House of Rep-
resentatives. 
SEC. 156. Amounts made available by section 101 for 
‘‘Department of Transportation—Office of the Sec-
retary—Payments to Air Carriers’’ may be apportioned up 
to the rate for operations necessary to maintain Essential 
Air Service program operations. 
SEC. 157. Section 4144(d) of the Motor Carrier Safe-
ty Reauthorization Act of 2005 (49 U.S.C. 31100 note) 
shall be applied by substituting the date specified in sec-
tion 106 of this Act for ‘‘September 30, 2025’’. 
This division may be cited as the ‘‘Continuing Appro-
priations Act, 2026’’. 
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DIVISION B—MISCELLANEOUS 
EXTENSIONS 
SEC. 101. UNITED STATES GRAIN STANDARDS. 
The authorities (including any limitations on the au-
thorities) provided by each provision of the United States 
Grain Standards Act (Public Law 90–487; 7 U.S.C. 74 
et seq.) and each provision of law amended by that Act, 
as in effect on September 30, 2025, shall continue, and 
the authorities (and any such limitations) shall be carried 
out, until the later of— 
(1) November 21, 2025; and 
(2) the date specified in the provision of that 
Act or the provision of law amended by that Act. 
DIVISION C—HEALTH 
EXTENDERS 
TITLE I—PUBLIC HEALTH 
EXTENDERS 
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) EXTENSION
FOR COMMUNITY HEALTH CEN-
TERS.—Section 10503(b)(1) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 254b–2(b)(1)) is amend-
ed— 
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(1) in subparagraph (I), by striking ‘‘and’’ at 
the end; and 
(2) by adding at the end the following: 
‘‘(K) $606,904,110 for the period begin-
ning on October 1, 2025, and ending on No-
vember 21, 2025; and’’. 
(b) EXTENSION FOR THE NATIONAL HEALTH SERV-
ICE CORPS.—Section 10503(b)(2) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 254b–2(b)(2)) 
is amended— 
(1) in subparagraph (J), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (K), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(L) $49,150,685 for the period beginning 
on October 1, 2025, and ending on November 
21, 2025.’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)(1)) is amended— 
(1) in subparagraph (E), by striking ‘‘and’’ at 
the end; 
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(2) in subparagraph (F), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(G) $24,931,507 for the period beginning 
on October 1, 2025, and ending on November 
21, 2025.’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to the amendments made by this section 
shall be subject to the requirements contained in Public 
Law 117–328 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act 
(42 U.S.C. 254b et seq.). 
(e) CONFORMING AMENDMENT.—Section 3014(h)(4) 
of title 18, United States Code, is amended by striking 
‘‘and section 2101(d) of division B of the Full-Year Con-
tinuing Appropriations and Extensions Act, 2025’’ and in-
serting ‘‘section 2101(d) of division B of the Full-Year 
Continuing Appropriations and Extensions Act, 2025, and 
section 101(d) of title I of division C of the Continuing 
Appropriations and Extensions Act, 2026’’. 
SEC. 102. EXTENSION OF SPECIAL DIABETES PROGRAMS. 
(a) EXTENSION OF SPECIAL DIABETES PROGRAMS 
FOR TYPE I DIABETES.—Section 330B(b)(2) of the Pub-
lic Health Service Act (42 U.S.C. 254c–2(b)(2)) is amend-
ed— 
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(b) Section 319L(e)(1)(D) of the Public Health Serv-
ice Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by strik-
ing ‘‘September 30, 2025’’ and inserting ‘‘November 21, 
2025’’. 
(c) Section 319L–1(b) of the Public Health Service 
Act (42 U.S.C. 247d–7f(b)) is amended by striking ‘‘Sep-
tember 30, 2025’’ and inserting ‘‘November 21, 2025’’. 
(d)(1) Section 2811A(g) of the Public Health Service 
Act (42 U.S.C. 300hh–10b(g)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘November 21, 
2025’’. 
(2) Section 2811B(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘November 21, 
2025’’. 
(3) Section 2811C(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘November 21, 
2025’’. 
(e) Section 2812(c)(4)(B) of the Public Health Serv-
ice Act (42 U.S.C. 300hh–11(c)(4)(B)) is amended by 
striking ‘‘September 30, 2025’’ and inserting ‘‘November 
21, 2025’’. 
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TITLE II—MEDICARE 
SEC. 201. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), by striking ‘‘in fiscal 
year 2026’’ and inserting ‘‘during the portion of fis-
cal year 2026 beginning on November 22, 2025, and 
ending on September 30, 2026, and in fiscal year 
2027’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause 
(I)— 
(i) by inserting ‘‘or portion of a fiscal 
year’’ after ‘‘for a fiscal year’’; and 
(ii) by inserting ‘‘and the portion of 
fiscal year 2026 beginning on October 1, 
2025, and ending on November 21, 2025’’ 
after ‘‘through 2025’’; 
(B) in subclause (III), by inserting ‘‘and 
the portion of fiscal year 2026 beginning on Oc-
tober 1, 2025, and ending on November 21, 
2025’’ after ‘‘through 2025’’; and 
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(C) in subclause (IV), by striking ‘‘fiscal 
year 2026’’ and inserting ‘‘the portion of fiscal 
year 2026 beginning on November 22, 2025, 
and ending on September 30, 2026, and fiscal 
year 2027’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘or during the portion of fiscal year 
2026 beginning on October 1, 2025, and ending 
on November 21, 2025’’ after ‘‘through 2025’’; 
and 
(B) in clause (ii), by inserting ‘‘and the 
portion of fiscal year 2026 beginning on Octo-
ber 1, 2025, and ending on November 21, 
2025’’ after ‘‘through 2025’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
SEC. 202. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
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(1) in clause (i), by striking ‘‘October 1, 2025’’ 
and inserting ‘‘November 22, 2025’’; and 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2025’’ and inserting ‘‘November 22, 2025’’. 
(b) CONFORMING AMENDMENTS.— 
(1) IN
GENERAL.—Section 1886(b)(3)(D) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘October 1, 2025’’ and inserting ‘‘No-
vember 22, 2025’’; and 
(B) in clause (iv), by inserting ‘‘and the 
portion of fiscal year 2026 beginning on Octo-
ber 1, 2025, and ending on November 21, 
2025’’ after ‘‘through fiscal year 2025’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by inserting ‘‘, or the por-
tion of fiscal year 2026 beginning on October 1, 
2025, and ending on November 21, 2025’’ after 
‘‘through fiscal year 2025’’. 
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SEC. 203. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘October 
1, 2025’’ and inserting ‘‘November 22, 2025’’; and 
(2) in paragraph (13), by striking ‘‘October 1, 
2025’’ each place it appears and inserting ‘‘Novem-
ber 22, 2025’’ in each such place. 
SEC. 204. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended— 
(1) in the first sentence, by striking ‘‘Sep-
tember 30, 2025’’ and inserting ‘‘November 21, 
2025’’; and 
(2) in the third sentence, by striking ‘‘Sep-
tember 30, 2025’’ and inserting ‘‘November 21, 
2025’’. 
SEC. 205. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B)(xiv) of section 119 of the 
Medicare Improvements for Patients and Providers Act of 
2008 (42 U.S.C. 1395b–3 note) is amended by striking 
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‘‘September 30, 2025, $30,000,000’’ and inserting ‘‘No-
vember 21, 2025, $32,136,986’’. 
(b) 
AREA
AGENCIES
ON
AGING.—Subsection 
(b)(1)(B)(xiv) of such section 119 is amended by striking 
‘‘September 30, 2025, $30,000,000’’ and inserting ‘‘No-
vember 21, 2025, $32,136,986’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B)(xiv) of such section 119 is amended 
by striking ‘‘September 30, 2025, $10,000,000’’ and in-
serting ‘‘November 21, 2025, $10,712,329’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
ERAL AND STATE PROGRAMS.—Subsection (d)(2)(xiv) of 
such section 119 is amended by striking ‘‘September 30, 
2025, $30,000,000’’ and inserting ‘‘November 21, 2025, 
$32,136,986’’. 
SEC. 206. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Octo-
ber 1, 2025’’ and inserting ‘‘November 22, 2025’’. 
SEC. 207. EXTENSION OF CERTAIN TELEHEALTH FLEXIBILI-
TIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS
AND 
EXPANDING
ORIGINATING
SITES
FOR
TELEHEALTH 
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SERVICES.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘end-
ing September 30, 2025’’ and inserting ‘‘ending No-
vember 21, 2025’’; and 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on September 30, 2025’’ and inserting ‘‘ending on 
November 21, 2025’’. 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) 
is amended by striking ‘‘ending on September 30, 2025’’ 
and inserting ‘‘ending on November 21, 2025’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FED-
ERALLY
QUALIFIED
HEALTH
CENTERS
AND
RURAL 
HEALTH CLINICS.—Section 1834(m)(8)(A) of the Social 
Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by 
striking ‘‘ending on September 30, 2025’’ and inserting 
‘‘ending on November 21, 2025’’. 
(d) DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE
FOR MENTAL HEALTH SERVICES 
FURNISHED
THROUGH
TELEHEALTH
AND
TELE-
COMMUNICATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
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ing on January 19, 2024, for the period 
beginning on January 20, 2024, and end-
ing on March 8, 2024, for the period be-
ginning on March 9, 2024, and ending on 
September 30, 2024, and for fiscal year 
2025’’ and inserting ‘‘2025, and for the 
period beginning on October 1, 2025, and 
ending on November 21, 2025’’; and 
(ii) by striking ‘‘fiscal year 2024’’ and 
inserting ‘‘fiscal year 2026’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘through 2023’’ 
and inserting ‘‘through 2025’’; 
(II) by striking ‘‘fiscal year 2024 
or 2025’’ and inserting ‘‘fiscal year 
2026’’; and 
(III) by inserting ‘‘(or, with re-
spect to the applicable period, for fis-
cal year 2026)’’ after ‘‘an application 
for the fiscal year’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘2024 or 2025’’ and inserting ‘‘2026’’; 
and 
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(2) in subsection (f)(1) by striking ‘‘2023, for 
the period beginning on October 1, 2023, and ending 
on November 17, 2023, an amount equal to the pro 
rata portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the pe-
riod beginning on November 18, 2023, and ending 
on January 19, 2024, an amount equal to the pro 
rata portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the pe-
riod beginning on January 20, 2024, and ending on 
March 8, 2024, an amount equal to the pro rata 
portion of the amount appropriated for the period at 
the end of the corresponding sentence for fiscal year 
2023, for the period beginning on March 9, 2024, 
and ending on September 30, 2024, an amount 
equal to the pro rata portion of the amount appro-
priated for the corresponding period for fiscal year 
2023, and for fiscal year 2025, an amount equal to 
the amount appropriated for fiscal year 2024’’ and 
inserting ‘‘2025, and for the period beginning on Oc-
tober 1, 2025, and ending on November 21, 2025, 
an amount equal to the pro rata portion of the 
amount appropriated for the corresponding period 
for fiscal year 2025’’. 
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SEC. 302. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 
713) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), in the matter 
preceding clause (i), by striking ‘‘2023, for the 
period beginning on October 1, 2023, and end-
ing on November 17, 2023, for the period be-
ginning on November 18, 2023, and ending on 
January 19, 2024, for the period beginning on 
January 20, 2024, and ending on March 8, 
2024, for the period beginning on March 9, 
2024, and ending on September 30, 2024, and 
for fiscal year 2025’’ and inserting ‘‘2025, and 
for the period beginning on October 1, 2025, 
and ending on November 21, 2025’’; and 
(B) in subparagraph (B)(i), by striking 
‘‘the period beginning on October 1, 2023, and 
ending on November 17, 2023, for the period 
beginning on November 18, 2023, and ending 
on January 19, 2024, for the period beginning 
on January 20, 2024, and ending on March 8, 
2024, for the period beginning on March 9, 
2024, and ending on September 30, 2024, and 
for fiscal year 2025’’ and inserting ‘‘fiscal years 
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2024 and 2025, and for the period beginning 
on October 1, 2025, and ending on November 
21, 2025’’; 
(2) in subsection (c)(3), by striking ‘‘2024 or 
2025’’ and inserting ‘‘2026’’; and 
(3) in subsection (f), by striking ‘‘2023, for the 
period beginning on October 1, 2023, and ending on 
November 17, 2023, an amount equal to the pro 
rata portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the pe-
riod beginning on November 18, 2023, and ending 
on January 19, 2024, an amount equal to the pro 
rata portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the pe-
riod beginning on January 20, 2024, and ending on 
March 8, 2024, an amount equal to the pro rata 
portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the pe-
riod beginning on March 9, 2024, and ending on 
September 30, 2024, an amount equal to the pro 
rata portion of the amount appropriated for the cor-
responding period for fiscal year 2023, and for fiscal 
year 2025, an amount equal to the amount appro-
priated for fiscal year 2024 for fiscal year 2024’’ 
and inserting ‘‘2025, and for the period beginning 
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on October 1, 2025, and ending on November 21, 
2025, an amount equal to the pro rata portion of 
the amount appropriated for the corresponding pe-
riod for fiscal year 2025’’. 
SEC. 303. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY 
HEALTH INFORMATION CENTERS. 
Section 501(c)(1)(A) of the Social Security Act (42 
U.S.C. 701(c)(1)(A)) is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by adding ‘‘; and’’ at the 
end; and 
(3) by adding at the end the following new 
clause: 
‘‘(ix) $854,795 for the portion of fiscal year 
2026 beginning on October 1, 2025, and ending on 
November 21, 2025.’’. 
TITLE IV—MEDICAID 
SEC. 401. MODIFYING CERTAIN DISPROPORTIONATE SHARE 
HOSPITAL ALLOTMENTS. 
(a) EXTENDING TENNESSEE DSH ALLOTMENTS.— 
Section 1923(f)(6)(A)(vi) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 
(1) in the heading, by inserting ‘‘AND A POR-
TION OF FISCAL YEAR 2026’’ after ‘‘2025’’; and 
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(2) in paragraph (8), by striking ‘‘2027’’ and 
inserting ‘‘2028’’. 
TITLE V—FOOD AND DRUG 
ADMINISTRATION 
SEC. 501. SHORT TITLE. 
This title may be cited as the ‘‘Over-the-Counter 
Monograph Drug User Fee Amendments’’. 
SEC. 502. FINDING. 
Congress finds that the fees authorized by the 
amendments made in this title will be dedicated to over- 
the-counter (OTC) monograph drug activities, as set forth 
in the goals identified for purposes of part 10 of sub-
chapter C of chapter VII of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 379j–71 et seq.), in the letters 
from the Secretary of Health and Human Services to the 
Chairman of the Committee on Energy and Commerce of 
the House of Representatives and the Chairman of the 
Committee on Health, Education, Labor, and Pensions of 
the Senate, as set forth in the Congressional Record. 
SEC. 503. DEFINITIONS. 
Section 744L(9)(A) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 379j–71(9)(A)) is amended— 
(1) in clause (v), by striking ‘‘; or’’ and insert-
ing a semicolon; 
(2) in clause (vi)— 
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(A) by striking ‘‘addition’’ and inserting 
‘‘the addition’’; and 
(B) by striking the period and inserting ‘‘; 
or’’; and 
(3) by adding at the end the following: 
‘‘(vii) the addition or modification of a 
testing procedure applicable to one or more 
OTC monograph drugs, provided that such ad-
ditional or modified testing procedure reflects a 
voluntary consensus standard with respect to 
pharmaceutical quality that is— 
‘‘(I) established by a national or inter-
national standards development organiza-
tion; and 
‘‘(II) recognized by the Secretary 
through a process described in guidance 
for industry, initially published in July 
2023, or any successor guidance, publicly 
available on the website of the Food and 
Drug Administration, which addresses vol-
untary consensus standards for pharma-
ceutical quality.’’. 
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SEC. 504. AUTHORITY TO ASSESS AND USE OTC MONO-
GRAPH FEES. 
(a) TYPES OF FEES.—Section 744M(a)(1) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
72(a)(1)) is amended— 
(1) in subparagraph (A)— 
(A) by striking ‘‘on December 31 of the 
fiscal year or at any time during the preceding 
12-month period’’ and inserting ‘‘at any time 
during the applicable period specified in clause 
(ii) for a fiscal year’’; 
(B) by striking ‘‘Each person’’ and insert-
ing the following: 
‘‘(i) ASSESSMENT
OF
FEES.—Each 
person’’; and 
(C) by adding at the end the following: 
‘‘(ii) APPLICABLE PERIOD.—For pur-
poses of clause (i), the applicable period 
is— 
‘‘(I) for fiscal year 2026, the 12- 
month period ending on December 31, 
2025; 
‘‘(II) for fiscal year 2027, the 9- 
month period ending on September 
30, 2026; and 
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‘‘(III) for fiscal year 2028 and 
each subsequent fiscal year, the 12- 
month period ending on September 30 
of the preceding fiscal year.’’; 
(2) in subparagraph (B)(i), by amending sub-
clause (I) to read as follows: 
‘‘(I) has ceased all activities re-
lated to OTC monograph drugs prior 
to— 
‘‘(aa) for purposes of fiscal 
year 2026, January 1, 2025; 
‘‘(bb) for purposes of fiscal 
year 2027, January 1, 2026; and 
‘‘(cc) for purposes of fiscal 
year 2028 and each subsequent 
fiscal year, October 1 of the pre-
ceding fiscal year; and’’; and 
(3) by amending subparagraph (D) to read as 
follows: 
‘‘(D) DUE DATE.— 
‘‘(i) FISCAL
YEAR
2026.—For fiscal 
year 2026, the facility fees required under 
subparagraph (A) shall be due on the later 
of— 
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‘‘(I) the first business day of 
June of such year; or 
‘‘(II) the first business day after 
the enactment of an appropriations 
Act providing for the collection and 
obligation of fees under this section 
for such year. 
‘‘(ii) FISCAL
YEAR
2027.—For fiscal 
year 2027, the facility fees required under 
subparagraph (A) shall be due— 
‘‘(I) in a first installment rep-
resenting 50 percent of such fee, on 
the later of— 
‘‘(aa) October 1, 2026; or 
‘‘(bb) the first business day 
after the enactment of an appro-
priations Act providing for the 
collection and obligation of fees 
under this section for such year; 
and 
‘‘(II) in a second installment rep-
resenting the remaining 50 percent of 
such fee, on— 
‘‘(aa) February 1, 2027; or 
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‘‘(bb) if an appropriations 
Act 
described 
in 
subclause 
(I)(bb) is not in effect on Feb-
ruary 1, 2027, the first business 
day after enactment of such an 
appropriations Act. 
‘‘(iii) SUBSEQUENT FISCAL YEARS.— 
For fiscal year 2028 and each subsequent 
fiscal year, the facility fees required under 
subparagraph (A) shall be due on the later 
of— 
‘‘(I) the first business day on or 
after October 1 of the fiscal year; or 
‘‘(II) the first business day after 
the date of enactment of an appro-
priations Act providing for the collec-
tion and obligation of fees under this 
section for the fiscal year.’’. 
(b) FEE REVENUE AMOUNTS.—Section 744M(b) of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379j–72(b)) is amended to read as follows: 
‘‘(b) FEE REVENUE AMOUNTS.— 
‘‘(1) IN GENERAL.—For each of the fiscal years 
2026 through 2030, fees under subsection (a)(1) 
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‘‘(2) ANNUAL BASE REVENUE.—For purposes 
of paragraph (1), the dollar amount of the annual 
base revenue for a fiscal year shall be— 
‘‘(A) for fiscal year 2026, the dollar 
amount of the total revenue amount established 
for fiscal year 2025 under this subsection as in 
effect on the day before the date of enactment 
of the Over-the-Counter Monograph Drug User 
Fee Amendments, not including any adjust-
ments made for such fiscal year 2025 under 
subsection (c)(2), as so in effect; and 
‘‘(B) for fiscal years 2027 through 2030, 
the dollar amount of the total revenue amount 
established under this subsection for the pre-
vious fiscal year, not including any adjustments 
made for such previous fiscal year under sub-
section (c)(2) or (c)(3).’’. 
(c) ADJUSTMENTS; ANNUAL FEE SETTING.—Section 
744M(c) of the Federal Food, Drug, and Cosmetic Act 
(21 U.S.C. 379j–72(c)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), in the matter 
preceding clause (i)— 
(i) by striking ‘‘subsection (b)(2)(B)’’ 
and inserting ‘‘subsection (b)(1)(B)’’; and 
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(ii) by striking ‘‘fiscal year 2022 and 
each subsequent fiscal year’’ and inserting 
‘‘each fiscal year’’; 
(B) in subparagraph (B), by striking ‘‘fis-
cal year 2022’’ and all that follows through the 
period at the end and inserting the following: 
‘‘a fiscal year shall be equal to the product of— 
‘‘(i) for fiscal year 2026— 
‘‘(I) the fee for fiscal year 2025 
under subsection (a)(2); and 
‘‘(II) the inflation adjustment 
percentage under subparagraph (C); 
and 
‘‘(ii) for each of fiscal years 2027 
through 2030— 
‘‘(I) the applicable fee under sub-
section (a)(2) for the preceding fiscal 
year; and 
‘‘(II) the inflation adjustment 
percentage under subparagraph (C).’’; 
and 
(C) in subparagraph (C)— 
(i) in the matter preceding clause (i), 
by inserting ‘‘the sum of’’ after ‘‘is equal 
to’’; 
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(ii) by striking clause (i); 
(iii) by redesignating subclauses (I) 
and (II) of clause (ii) as clauses (i) and 
(ii), respectively, and adjusting the mar-
gins accordingly; 
(iv) by striking ‘‘(ii) for each of fiscal 
years 2024 and 2025, the sum of—’’; and 
(v) in clause (ii), as so redesignated, 
by striking ‘‘Washington-Baltimore, DC– 
MD–VA–WV’’ and inserting ‘‘Washington– 
Arlington–Alexandria–DC–VA–MD–WV’’; 
(2) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘fiscal year 2021 and 
subsequent fiscal years’’ and inserting 
‘‘each fiscal year’’; 
(ii) by striking ‘‘subsections (b)(1)(B) 
and (b)(2)(C)’’ and inserting ‘‘subsection 
(b)(1)(C)’’; and 
(iii) by striking ‘‘the number of weeks 
specified in subparagraph (B)’’ and insert-
ing ‘‘10 weeks’’; 
(B) by striking subparagraph (B); 
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(C) by redesignating subparagraphs (C) 
and (D) as subparagraphs (B) and (C), respec-
tively; and 
(D) in subparagraph (C), as so redesig-
nated, by striking ‘‘paragraph (4) establishing’’ 
and inserting ‘‘paragraph (5) publishing’’; 
(3) in paragraph (3)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘subsection (b)(2)(D)’’ and in-
serting ‘‘subsection (b)(1)(D)’’; and 
(B) by striking subparagraphs (A) through 
(E) and inserting the following: 
‘‘(A) $135,000 for fiscal year 2026; 
‘‘(B) $300,000 for fiscal year 2027; 
‘‘(C) $55,000 for fiscal year 2028; 
‘‘(D) $30,000 for fiscal year 2029; and 
‘‘(E) $0 for fiscal year 2030.’’; and 
(4) by striking paragraph (4) and inserting the 
following: 
‘‘(4) ONE-TIME FACILITY FEE WORKLOAD AD-
JUSTMENT.— 
‘‘(A) IN GENERAL.—In addition to the ad-
justments under paragraphs (1), (2), and (3), 
the Secretary may further increase the fee reve-
nues and fees through a one-time adjustment 
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made for fiscal year 2028, 2029, or 2030, in 
accordance with this paragraph. 
‘‘(B) ADJUSTMENT DESCRIBED.— 
‘‘(i) 
CONDITIONS
FOR
ADJUST-
MENT.—An adjustment under this para-
graph may be made for a fiscal year only 
if— 
‘‘(I) an adjustment under this 
paragraph had not been made for any 
prior fiscal year; 
‘‘(II) the average number of OTC 
monograph drug facilities subject to a 
facility fee under subsection (a)(1) 
over the period of the preceding 3 fis-
cal years exceeds 1,625; and 
‘‘(III) with respect to facilities 
described in subclause (II), the aver-
age number of such facilities (ex-
pressed as a percentage) that ap-
peared on the arrears lists pursuant 
to subsection (e)(1)(A)(i) over the pe-
riod of the preceding 3 fiscal years is 
less than 30 percent. 
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‘‘(ii) AMOUNT OF ADJUSTMENT.—An 
adjustment under this paragraph for a fis-
cal year shall equal the product of— 
‘‘(I) the total facility revenue 
amount determined under subsection 
(b) for the fiscal year, exclusive of the 
adjustment under this paragraph for 
such fiscal year; and 
‘‘(II) the excess facility percent-
age described in clause (iii). 
‘‘(iii) EXCESS
FACILITY
PERCENT-
AGE.—The excess facility percentage de-
scribed in this clause is— 
‘‘(I) the amount by which the av-
erage number of OTC monograph 
drug facilities subject to a facility fee 
under subsection (a)(1) over the pre-
ceding 3 fiscal years exceeds 1,625; 
divided by 
‘‘(II) 1,625. 
‘‘(5) ANNUAL
FEE
SETTING.—The Secretary 
shall, not later than 60 days before the first day of 
each fiscal year— 
‘‘(A) establish for such fiscal year, based 
on the revenue amounts under subsection (b) 
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