499 
practicable, by not later than the first day 
of an annual, coordinated election period 
under section 1851(e)(3) with respect to a 
year; 
‘‘(ii) include information regarding 
such cost-sharing protections in the pro-
vider directory of each specified MA plan 
offered by the MA organization.; and 
‘‘(iii) notify enrollees of their cost- 
sharing protections under this paragraph 
in an explanation of benefits.’’. 
(2) REQUIRED
PROVIDER
DIRECTORY
ACCU-
RACY ANALYSIS AND REPORTS.— 
(A) IN GENERAL.—Section 1857(e) of the 
Social Security Act (42 U.S.C. 1395w–27(e)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) PROVIDER
DIRECTORY
ACCURACY
ANAL-
YSIS AND REPORTS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2027, 
subject to subparagraph (C), a contract under 
this section with an MA organization shall re-
quire the organization, for each specified MA 
plan (as defined in section 1852(c)(3)(C)) of-
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fered by the organization to annually do the fol-
lowing: 
‘‘(i) Conduct an analysis estimating 
the accuracy of the provider directory in-
formation of such plan using a random 
sample of providers included in such pro-
vider directory as follows: 
‘‘(I) Such a random sample shall 
include a random sample of each spe-
cialty of providers with a high inaccu-
racy rate of provider directory infor-
mation relative to other specialties of 
providers, as determined by the Sec-
retary. 
‘‘(II) For purposes of subclause 
(I), one type of specialty may be pro-
viders specializing in mental health or 
substance use disorder treatment. 
‘‘(ii) Submit to the Secretary a report 
containing the results of the analysis con-
ducted under clause (i), including an accu-
racy score for such provider directory in-
formation (as determined using a plan 
verification method specified by the Sec-
retary under subparagraph (B)(i)). 
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501 
‘‘(B) 
DETERMINATION
OF
ACCURACY 
SCORE.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall specify plan verification methods, 
such as using telephonic verification or 
other approaches using data sources main-
tained by an MA organization or using 
publicly available data sets, that MA orga-
nizations may use for estimating accuracy 
scores of the provider directory information 
of specified MA plans offered by such or-
ganizations. 
‘‘(ii) 
ACCURACY
SCORE
METHOD-
OLOGY.—With respect to each such meth-
od specified by the Secretary as described 
in clause (i), the Secretary shall specify a 
methodology for MA organizations to use 
in estimating such accuracy scores. Each 
such methodology shall take into account 
the administrative burden on plans and 
providers and the relative importance of 
certain provider directory information on 
enrollee ability to access care. 
‘‘(C) EXCEPTION.—The Secretary may 
waive the requirements of this paragraph in the 
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502 
case of a specified MA plan with low enrollment 
(as defined by the Secretary). 
‘‘(D) 
TRANSPARENCY.—Beginning 
with 
plan years beginning on or after January 1, 
2028, the Secretary shall post accuracy scores 
(as reported under subparagraph (A)(ii)), in a 
machine readable file, on the internet website of 
the Centers for Medicare & Medicaid Services.’’. 
(B) PROVISION
OF
INFORMATION
TO 
BENEFICIARIES.—Section 1851(d)(4) of the So-
cial Security Act (42 U.S.C. 1395w–21(d)(4)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(F) PROVIDER
DIRECTORY.—Beginning 
with plan years beginning on or after January 
1, 2028, the accuracy score of the plan’s pro-
vider directory (as reported under section 
1857(e)(6)(A)(ii)) listed prominently on the 
plan’s provider directory.’’. 
(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated to the 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$4,000,000 for fiscal year 2025, to remain 
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503 
available until expended, to carry out the 
amendments made by this paragraph. 
(3) GAO STUDY AND REPORT.— 
(A) ANALYSIS.—The Comptroller General 
of the United States (in this paragraph referred 
to as the ‘‘Comptroller General’’) shall conduct 
a study of the implementation of the amend-
ments made by paragraphs (1) and (2). To the 
extent data are available and reliable, such 
study shall include an analysis of— 
(i) the use of cost-sharing protections 
required under section 1852(d)(7)(A) of 
the Social Security Act, as added by para-
graph (1); 
(ii) the trends in provider directory in-
formation accuracy scores under section 
1857(e)(6)(A)(ii) of the Social Security 
Act (as added by paragraph (2)(A)), both 
overall and among providers specializing in 
mental health or substance use disorder 
treatment; 
(iii) provider response rates by plan 
verification methods; 
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504 
(iv) administrative costs to providers 
and Medicare Advantage organizations; 
and 
(v) other items determined appro-
priate by the Comptroller General. 
(B) REPORT.—Not later than January 15, 
2032, the Comptroller General shall submit to 
Congress a report containing the results of the 
study conducted under subparagraph (A), to-
gether with recommendations for such legisla-
tion and administrative action as the Comp-
troller General determines appropriate. 
(c) GUIDANCE
ON MAINTAINING ACCURATE PRO-
VIDER DIRECTORIES.— 
(1) STAKEHOLDER MEETING.— 
(A) IN
GENERAL.—Not later than 3 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
(referred to in this subsection as the ‘‘Sec-
retary’’) shall hold a public meeting to receive 
input on approaches for maintaining accurate 
provider directories for Medicare Advantage 
plans under part C of title XVIII of the Social 
Security Act (42 U.S.C. 1395w–21 et seq.), in-
cluding input on approaches for reducing ad-
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505 
ministrative burden, such as data standardiza-
tion, and best practices to maintain accurate 
provider directory information. 
(B) PARTICIPANTS.—Participants of the 
meeting under subparagraph (A) shall include 
representatives from the Centers for Medicare & 
Medicaid Services and the Assistant Secretary 
for Technology Policy and Office of the Na-
tional Coordinator for Health Information 
Technology. Such meeting shall be open to the 
public. To the extent practicable, the Secretary 
shall include health care providers, companies 
that specialize in relevant technologies, health 
insurers, and patient advocates. 
(2) GUIDANCE TO MEDICARE ADVANTAGE OR-
GANIZATIONS.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall 
issue guidance to Medicare Advantage organizations 
offering Medicare Advantage plans under part C of 
title XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) on maintaining accurate provider 
directories for such plans, taking into consideration 
input received during the stakeholder meeting under 
paragraph (1). Such guidance may include the fol-
lowing, as determined appropriate by the Secretary: 
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506 
(A) Best practices for Medicare Advantage 
organizations on how to work with providers to 
maintain the accuracy of provider directories 
and reduce provider and Medicare Advantage 
organization burden with respect to maintaining 
the accuracy of provider directories. 
(B) Information on data sets and data 
sources with information that could be used by 
Medicare Advantage organizations to maintain 
accurate provider directories. 
(C) Approaches for utilizing data sources 
maintained by Medicare Advantage organiza-
tions and publicly available data sets to main-
tain accurate provider directories. 
(D) Information to be included in provider 
directories that may be useful for Medicare 
beneficiaries to assess plan networks when se-
lecting a plan and accessing providers partici-
pating in plan networks during the plan year. 
(3) GUIDANCE
TO
PART
B
PROVIDERS.—Not 
later than 12 months after the date of enactment of 
this Act, the Secretary shall issue guidance to pro-
viders of services and suppliers who furnish items or 
services for which benefits are available under part 
B of title XVIII of the Social Security Act (42 
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507 
U.S.C. 1395j et seq.) on when to update the Na-
tional Plan and Provider Enumeration System for 
information changes. 
SEC. 224. MEDICARE COVERAGE OF MULTI-CANCER EARLY 
DETECTION SCREENING TESTS. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking the semicolon at the end of 
subparagraph (JJ) and inserting ‘‘; and’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) multi-cancer early detection screen-
ing tests (as defined in subsection (nnn));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nnn) MULTI-CANCER EARLY DETECTION SCREEN-
ING TESTS.— 
‘‘(1) IN
GENERAL.—The term ‘multi-cancer 
early detection screening test’ means a test fur-
nished to an individual for the concurrent detection 
of multiple cancer types across multiple organ sites 
on or after January 1, 2029, that— 
‘‘(A) is cleared under section 510(k), clas-
sified under section 513(f)(2), or approved 
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under section 515 of the Federal Food, Drug, 
and Cosmetic Act; 
‘‘(B) is— 
‘‘(i) a genomic sequencing blood or 
blood product test that includes the anal-
ysis of cell-free nucleic acids; or 
‘‘(ii) a test based on samples of bio-
logical material that provide results com-
parable to those obtained with a test de-
scribed in clause (i), as determined by the 
Secretary; and 
‘‘(C) the Secretary determines is— 
‘‘(i) reasonable and necessary for the 
prevention or early detection of an illness 
or disability; and 
‘‘(ii) appropriate for individuals enti-
tled to benefits under part A or enrolled 
under part B. 
‘‘(2) NCD PROCESS.—In making determina-
tions under paragraph (1)(C) regarding the coverage 
of a new test, the Secretary shall use the process for 
making national coverage determinations (as defined 
in section 1869(f)(1)(B)) under this title.’’. 
(b) PAYMENT AND STANDARDS FOR MULTI-CANCER 
EARLY DETECTION SCREENING TESTS.— 
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509 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
‘‘(aa) PAYMENT AND STANDARDS FOR MULTI-CAN-
CER EARLY DETECTION SCREENING TESTS.— 
‘‘(1) 
PAYMENT
AMOUNT.—The 
payment 
amount for a multi-cancer early detection screening 
test (as defined in section 1861(nnn)) is— 
‘‘(A) with respect to such a test furnished 
before January 1, 2031, equal to the payment 
amount in effect on the date of the enactment 
of this subsection for a multi-target stool 
screening DNA test covered pursuant to section 
1861(pp)(1)(D); and 
‘‘(B) with respect to such a test furnished 
on or after January 1, 2031, equal to the lesser 
of— 
‘‘(i) the amount described in subpara-
graph (A); or 
‘‘(ii) the payment amount determined 
for such test under section 1834A. 
‘‘(2) LIMITATIONS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this part for a multi-cancer early 
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detection screening test furnished during a year 
to an individual if— 
‘‘(i) such individual— 
‘‘(I) is under 50 years of age; or 
‘‘(II) as of January 1 of such 
year, has attained the age specified in 
subparagraph (B) for such year; or 
‘‘(ii) such a test was furnished to the 
individual during the previous 11 months. 
‘‘(B) AGE
SPECIFIED.—For purposes of 
subparagraph (A)(i)(II), the age specified in 
this subparagraph is— 
‘‘(i) for 2029, 65 years of age; and 
‘‘(ii) for a succeeding year, the age 
specified in this subparagraph for the pre-
ceding year, increased by 1 year. 
‘‘(C) STANDARDS
FOLLOWING
USPSTF 
RATING OF A OR B.—In the case of a multi-can-
cer early detection screening test that is rec-
ommended with a grade of A or B by the 
United States Preventive Services Task Force, 
beginning on the date on which coverage for 
such test is provided pursuant to section 
1861(ddd)(1), the preceding provisions of this 
paragraph shall not apply.’’. 
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(2) CONFORMING AMENDMENTS.— 
(A) Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended— 
(i) in subsection (a)— 
(I) in paragraph (1)(D)(i)(I), by 
striking ‘‘section 1834(d)(1)’’ and in-
serting ‘‘subsection (d)(1) or (aa) of 
section 1834’’; and 
(II) in paragraph (2)(D)(i)(I), by 
striking ‘‘section 1834(d)(1)’’ and in-
serting ‘‘subsection (d)(1) or (aa) of 
section 1834’’; and 
(ii) in subsection (h)(1)(A), by strik-
ing ‘‘section 1834(d)(1)’’ and inserting 
‘‘subsections (d)(1) and (aa) of section 
1834’’. 
(B) Section 1862(a)(1)(A) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)(A)) is 
amended— 
(i) by striking ‘‘or additional preven-
tive services’’ and inserting ‘‘, additional 
preventive services’’; and 
(ii) by inserting ‘‘, or multi-cancer 
early detection screening tests (as defined 
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512 
in section 1861(nnn))’’ after ‘‘(as de-
scribed in section 1861(ddd)(1))’’. 
(c) RULE OF CONSTRUCTION RELATING TO OTHER 
CANCER SCREENING TESTS.—Nothing in this section, in-
cluding the amendments made by this section, shall be 
construed— 
(1) in the case of an individual who undergoes 
a multi-cancer early detection screening test, to af-
fect coverage under part B of title XVIII of the So-
cial Security Act for other cancer screening tests 
covered under such title, such as screening tests for 
breast, cervical, colorectal, lung, or prostate cancer; 
or 
(2) in the case of an individual who undergoes 
another cancer screening test, to affect coverage 
under such part for a multi-cancer early detection 
screening test or the use of such a test as a diag-
nostic or confirmatory test for a result of the other 
cancer screening test. 
SEC. 225. MEDICARE COVERAGE OF EXTERNAL INFUSION 
PUMPS 
AND 
NON-SELF-ADMINISTRABLE 
HOME INFUSION DRUGS. 
(a) IN GENERAL.—Section 1861(n) of the Social Se-
curity Act (42 U.S.C. 1395x(n)) is amended by adding 
at the end the following new sentence: ‘‘Beginning with 
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the first calendar quarter beginning on or after the date 
that is 1 year after the date of the enactment of this sen-
tence, an external infusion pump and associated home in-
fusion drug (as defined in subsection (iii)(3)(C)) or other 
associated supplies that do not meet the appropriate for 
use in the home requirement applied to the definition of 
durable medical equipment under section 414.202 of title 
42, Code of Federal Regulations (or any successor to such 
regulation) shall be treated as meeting such requirement 
if each of the following criteria is satisfied: 
‘‘(1) The prescribing information approved by 
the Food and Drug Administration for the home in-
fusion drug associated with the pump instructs that 
the drug should be administered by or under the su-
pervision of a health care professional. 
‘‘(2) A qualified home infusion therapy supplier 
(as defined in subsection (iii)(3)(D)) administers or 
supervises the administration of the drug or biologi-
cal in a safe and effective manner in the patient’s 
home (as defined in subsection (iii)(3)(B)). 
‘‘(3) The prescribing information described in 
paragraph (1) instructs that the drug should be in-
fused at least 12 times per year— 
‘‘(A) intravenously or subcutaneously; or 
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514 
‘‘(B) at infusion rates that the Secretary 
determines would require the use of an external 
infusion pump.’’. 
(b) COST SHARING NOTIFICATION.—The Secretary 
of Health and Human Services shall ensure that patients 
are notified of the cost sharing for electing home infusion 
therapy compared to other applicable settings of care for 
the furnishing of infusion drugs under the Medicare pro-
gram. 
SEC. 226. ASSURING PHARMACY ACCESS AND CHOICE FOR 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Section 1860D–4(b)(1) of the So-
cial Security Act (42 U.S.C. 1395w–104(b)(1)) is amend-
ed by striking subparagraph (A) and inserting the fol-
lowing: 
‘‘(A) IN GENERAL.— 
‘‘(i) PARTICIPATION OF ANY WILLING 
PHARMACY.—A PDP sponsor offering a 
prescription drug plan shall permit any 
pharmacy that meets the standard contract 
terms and conditions under such plan to 
participate as a network pharmacy of such 
plan. 
‘‘(ii) CONTRACT TERMS AND CONDI-
TIONS.— 
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515 
‘‘(I) 
IN
GENERAL.—Notwith-
standing any other provision of law, 
for plan years beginning on or after 
January 1, 2028, in accordance with 
clause (i), contract terms and condi-
tions offered by such PDP sponsor 
shall be reasonable and relevant ac-
cording to standards established by 
the Secretary under subclause (II). 
‘‘(II) 
STANDARDS.—Not 
later 
than the first Monday in April of 
2027, the Secretary shall establish 
standards for reasonable and relevant 
contract terms and conditions for pur-
poses of this clause. 
‘‘(III) REQUEST
FOR
INFORMA-
TION.—Not later than April 1, 2026, 
for purposes of establishing the stand-
ards under subclause (II), the Sec-
retary shall issue a request for infor-
mation to seek input on trends in pre-
scription drug plan and network phar-
macy contract terms and conditions, 
current prescription drug plan and 
network pharmacy contracting prac-
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