402 
installs or enables the installation of a heat 
pump HVAC system only if the heat pump 
HVAC system— 
‘‘(i) replaces— 
‘‘(I) a nonelectric HVAC system; 
‘‘(II) 
an 
electric 
resistance 
HVAC system; or 
‘‘(III) an air conditioning unit 
that— 
‘‘(aa) does not have a re-
versing valve; and 
‘‘(bb) has a lower seasonal 
energy-efficiency ratio than the 
heat pump HVAC system; or 
‘‘(ii) is part of new construction, as 
determined by the Secretary. 
‘‘(C) HEAT
PUMPS
FOR
WATER
HEAT-
ING.—A high-efficiency electric home rebate 
may be provided for a qualified electrification 
project that installs or enables the installation 
of a heat pump used for water heating only if 
the heat pump— 
‘‘(i) replaces— 
‘‘(I) a nonelectric heat pump 
water heater;
403 
‘‘(II) a nonelectric water heater; 
or 
‘‘(III) an electric resistance water 
heater; or 
‘‘(ii) is part of new construction, as 
determined by the Secretary. 
‘‘(D) 
ELECTRIC
STOVES, 
COOKTOPS, 
RANGES, AND OVENS.—A high-efficiency electric 
home rebate may be provided for a qualified 
electrification project described in subsection 
(d)(11)(A)(i)(III) only if the applicable electric 
stove, cooktop, range, or oven— 
‘‘(i) replaces a nonelectric stove, 
cooktop, range, or oven; or 
‘‘(ii) is part of new construction, as 
determined by the Secretary. 
‘‘(E) ELECTRIC
HEAT
PUMP
CLOTHES 
DRYERS.—A high-efficiency electric home re-
bate may be provided for a qualified electrifica-
tion 
project 
described 
in 
subsection 
(d)(11)(A)(i)(IV) only if the applicable electric 
heat pump clothes dryer— 
‘‘(i) replaces a nonelectric clothes 
dryer; or 
‘‘(ii) is part of new construction.
404 
‘‘(4) ADDITIONAL INCENTIVES FOR CONTRAC-
TORS AND QUALIFIED PROVIDERS.— 
‘‘(A) GENERAL INCENTIVE.— 
‘‘(i) IN
GENERAL.—With respect to 
each qualified electrification project de-
scribed in clause (ii), the Secretary shall 
provide a payment of $100 to the certified 
contractor company or qualified provider 
carrying out the qualified electrification 
project. 
‘‘(ii) 
QUALIFIED
ELECTRIFICATION 
PROJECT
DESCRIBED.—A qualified elec-
trification project referred to in clause (i) 
is a qualified electrification project— 
‘‘(I) that is carried out at a home 
or multifamily building; 
‘‘(II) for which a rebate is pro-
vided under this subsection; and 
‘‘(III) with respect to which the 
certified contractor company or quali-
fied provider is not eligible for a high-
er payment under any of subpara-
graphs (B) through (D). 
‘‘(B) INCENTIVE
FOR
QEPS
IN
CERTAIN 
COMMUNITIES AND HOUSEHOLDS.—
405 
‘‘(i) IN
GENERAL.—With respect to 
each qualified electrification project de-
scribed in clause (ii), the Secretary shall 
provide a payment of $200 to the certified 
contractor company or qualified provider 
carrying out the qualified electrification 
project. 
‘‘(ii) 
QUALIFIED
ELECTRIFICATION 
PROJECT
DESCRIBED.—A qualified elec-
trification project referred to in clause (i) 
is a qualified electrification project— 
‘‘(I) that is carried out at a home 
or multifamily building that— 
‘‘(aa) is located in an under-
served community or a Tribal 
community; or 
‘‘(bb) is certified, or the 
household of the homeowner of 
which is certified, as applicable, 
as low- or moderate-income; 
‘‘(II) for which a rebate is pro-
vided under this subsection; and 
‘‘(III) with respect to which the 
certified contractor company or quali-
fied provider is not eligible for a high-
406 
er payment under subparagraph (C) 
or (D). 
‘‘(C) INCENTIVE
FOR
CERTAIN
LABOR 
PRACTICES.— 
‘‘(i) IN
GENERAL.—With respect to 
each qualified electrification project de-
scribed in clause (ii), the Secretary shall 
provide a payment of $250 to the certified 
contractor company or qualified provider 
carrying out the qualified electrification 
project. 
‘‘(ii) 
QUALIFIED
ELECTRIFICATION 
PROJECT
DESCRIBED.—A qualified elec-
trification project referred to in clause (i) 
is a qualified electrification project— 
‘‘(I) that is carried out— 
‘‘(aa) at a home or multi-
family building; and 
‘‘(bb) by a certified con-
tractor company or qualified pro-
vider that allows for the use of 
collective bargaining agreements; 
‘‘(II) for which a rebate is pro-
vided under this subsection; and 
‘‘(III) with respect to which—
407 
‘‘(aa) all laborers and me-
chanics employed on the qualified 
electrification project are paid 
wages at rates not less than 
those prevailing on projects of a 
character similar in the locality; 
and 
‘‘(bb) 
the 
certified 
con-
tractor company or qualified pro-
vider is not eligible for a higher 
payment 
under 
subparagraph 
(D). 
‘‘(D) MAXIMUM INCENTIVE.— 
‘‘(i) IN
GENERAL.—With respect to 
each qualified electrification project de-
scribed in clause (ii), the Secretary shall 
provide a payment of $500 to the certified 
contractor company or qualified provider 
carrying out the qualified electrification 
project. 
‘‘(ii) 
QUALIFIED
ELECTRIFICATION 
PROJECT
DESCRIBED.—A qualified elec-
trification project referred to in clause (i) 
is a qualified electrification project— 
‘‘(I) that is carried out—
408 
‘‘(aa) at a home or multi-
family building that— 
‘‘(AA) is located in an 
underserved community or a 
Tribal community; or 
‘‘(BB) is certified, or 
the household of the home-
owner of which is certified, 
as applicable, as low- or 
moderate-income; and 
‘‘(bb) by a certified con-
tractor company or qualified pro-
vider that allows for the use of 
collective bargaining agreements; 
‘‘(II) for which a rebate is pro-
vided under this subsection; and 
‘‘(III) with respect to which all 
laborers and mechanics employed on 
the qualified electrification project are 
paid wages at rates not less than 
those prevailing on projects of a char-
acter similar in the locality. 
‘‘(E) CLARIFICATION.—An amount pro-
vided to a certified contractor company or 
qualified provider under any of subparagraphs
409 
(A) through (D) shall be in addition to the 
amount of any high-efficiency electric home re-
bate received by the certified contractor com-
pany or qualified provider. 
‘‘(5) CLAIM.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(2)(B), a homeowner, a certified contractor 
company, or a qualified provider may claim a 
separate high-efficiency electric home rebate 
under this subsection for each qualified elec-
trification project carried out at a home. 
‘‘(B) TRANSFER.—The Secretary shall es-
tablish and publish procedures pursuant to 
which a homeowner or owner of a multifamily 
building may transfer the right to claim a re-
bate under this subsection to the certified con-
tractor company or qualified provider carrying 
out 
the 
applicable 
qualified 
electrification 
project. 
‘‘(6) MULTIFAMILY BUILDINGS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the owner of a multifamily building 
may combine the amounts of high-efficiency 
electric home rebates for each dwelling unit in
410 
the multifamily building into a single rebate, 
subject to— 
‘‘(i) the condition that the applicable 
qualified electrification projects benefit 
each dwelling unit with respect to which 
the rebate is claimed; and 
‘‘(ii) any maximum per-dwelling unit 
rate established by the Secretary. 
‘‘(B) COSTS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the amount of a rebate under subpara-
graph (A) shall not exceed 50 percent of 
the total cost, including labor costs, of the 
applicable qualified electrification projects. 
‘‘(ii) LOW- 
OR
MODERATE-INCOME 
BUILDINGS.—In the case of a multifamily 
building that is certified by the Secretary 
as low- or moderate-income, the amount of 
a rebate under subparagraph (A) shall not 
exceed 100 percent of the total cost of the 
applicable qualified electrification projects. 
‘‘(C) PROCEDURES.—The Secretary shall 
establish and publish procedures— 
‘‘(i) pursuant to which the owner of a 
multifamily building may combine rebate
411 
amounts in accordance with this sub-
section; and 
‘‘(ii) for the enforcement of any limi-
tations under this subsection. 
‘‘(7) PROCESS.— 
‘‘(A) REBATE
PROCESS.—Not later than 
July 1, 2022, the Secretary shall establish a re-
bate processing system that provides immediate 
price relief for consumers who purchase and 
have installed qualified electrification projects, 
in accordance with this section. 
‘‘(B) 
QUALIFIED
ELECTRIFICATION 
PROJECT LIST.— 
‘‘(i) IN
GENERAL.—Not later than 
July 1, 2022, the Secretary shall publish a 
list of qualified electrification projects for 
which a high-efficiency electric home re-
bate may be provided under this subsection 
that includes, at a minimum, the qualified 
electrification projects described in sub-
section (d)(11)(A). 
‘‘(ii) REQUIREMENTS.—The list pub-
lished under clause (i) shall include speci-
fications for each qualified electrification 
project included on the list, including—
412 
‘‘(I) 
appropriate 
certifications 
under the Energy Star program; and 
‘‘(II) other applicable require-
ments, such as requirements relating 
to grid-interactive capability. 
‘‘(iii) UPDATES.— 
‘‘(I) IN GENERAL.—Not less fre-
quently than once every 3 years and 
subject to subclause (II), the Sec-
retary shall publish an updated list of 
qualified electrification projects for 
which a high-efficiency electric home 
rebate may be provided under this 
subsection. 
‘‘(II) LIMITATION.—An updated 
list under subclause (I) shall not allow 
for any reductions in efficiency levels 
for qualified electrification projects in-
cluded on the updated list that are 
below an efficiency level provided in a 
previously published version of the 
list. 
‘‘(c) SPECIAL PROVISIONS
FOR LOW- AND MOD-
ERATE-INCOME HOUSEHOLDS AND MULTIFAMILY BUILD-
INGS.—
413 
‘‘(1) MAXIMUM AMOUNTS.—With respect to a 
qualified electrification project carried out at a loca-
tion described in paragraph (2)— 
‘‘(A) a high-efficiency electric home rebate 
shall be equal to— 
‘‘(i) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(i), not more than $1,750; 
‘‘(ii) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(ii)— 
‘‘(I)(aa) not more than $6,000 if 
the applicable heat pump HVAC sys-
tem has a heating capacity of not less 
than 27,500 Btu per hour; or 
‘‘(bb) not more than $7,000 if 
the applicable heat pump HVAC sys-
tem meets Energy Star program cold 
climate criteria and is installed in a 
cold climate, as determined by the 
Secretary; and 
‘‘(II)(aa) not more than $3,000 if 
the applicable heat pump HVAC sys-
tem has a heating capacity of less 
than 27,500 Btu per hour; or
414 
‘‘(bb) not more than $3,500 if 
the applicable heat pump HVAC sys-
tem meets Energy Star program cold 
climate criteria and is installed in a 
cold climate, as determined by the 
Secretary; 
‘‘(iii) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(iii), not more than $840; 
‘‘(iv) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(iv), not more than $4,000; 
‘‘(v) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(v) that installs insulation and air 
sealing, not more than $1,600; and 
‘‘(vi) in the case of a qualified elec-
trification project described in subsection 
(b)(2)(A)(vi), not more than an amount 
determined by the Secretary for that quali-
fied electrification project, subject to sub-
paragraph (B); 
‘‘(B) the maximum total amount of high- 
efficiency electric home rebates that may be
415 
awarded with respect to each home of a home-
owner shall be $14,000; and 
‘‘(C) the amount of a high-efficiency elec-
tric home rebate may be used to cover not more 
than 100 percent of the costs, including labor 
costs, of the applicable qualified electrification 
project. 
‘‘(2) LOCATION
DESCRIBED.—The maximum 
amounts described in paragraph (1) shall apply to— 
‘‘(A) a home— 
‘‘(i) with respect to which the house-
hold of the homeowner is certified as low- 
or moderate-income; 
‘‘(ii) that is located in a Tribal com-
munity; or 
‘‘(iii) in the case of a home that is 
rented, with respect to which the household 
of the renter is certified as low- or mod-
erate-income; or 
‘‘(B) a multifamily building— 
‘‘(i) that— 
‘‘(I) is certified as low- or mod-
erate-income; or 
‘‘(II) is located in a Tribal com-
munity; and
416 
‘‘(ii) with respect to which more than 
more than 1⁄2 of the dwelling units in the 
multifamily building— 
‘‘(I) are occupied by households 
the annual household incomes of 
which do not exceed 80 percent of the 
median annual household income for 
the area in which the multifamily 
building is located; and 
‘‘(II) have average monthly rent-
al prices that are equal to, or less 
than, an amount that is equal to 30 
percent of the average monthly house-
hold income for the area in which the 
multifamily building is located. 
‘‘(3) REQUIREMENT.—The Secretary may pro-
vide a rebate in an amount described in paragraph 
(1) to the owner of a multifamily building or home 
(in the case of a home that is rented) that meets the 
requirements of this section if the owner agrees in 
writing to provide commensurate benefits of future 
savings to renters in the multifamily building or 
home. 
‘‘(d) DEFINITIONS.—In this section:
417 
‘‘(1) CERTIFIED CONTRACTOR.—The term ‘cer-
tified contractor’ means a contractor with a certifi-
cation reflecting training, education, or other tech-
nical expertise relating to qualified electrification 
projects for residential buildings, as identified by the 
Secretary. 
‘‘(2) CERTIFIED CONTRACTOR COMPANY.—The 
term ‘certified contractor company’ means a com-
pany— 
‘‘(A) the business of which is to provide 
services— 
‘‘(i) to residential building owners; 
and 
‘‘(ii) for which a rebate may be pro-
vided pursuant to this section; 
‘‘(B) that holds the licenses and insurance 
required by the State in which the company 
provides services; and 
‘‘(C) that employs 1 or more certified con-
tractors that perform the services for which a 
rebate may be provided under this section. 
‘‘(3) ELECTRIC LOAD OR SERVICE CENTER UP-
GRADE.—The term ‘electric load or service center 
upgrade’ means an improvement to a circuit breaker 
panel that enables the installation and use of—
418 
‘‘(A) a QEP described in any of subclauses 
(II) through (IV) of paragraph (9)(A)(i); or 
‘‘(B) a QEP described in any of subclauses 
(I) through (III) of paragraph (9)(A)(ii). 
‘‘(4) ENERGY STAR PROGRAM.—The term ‘En-
ergy Star program’ means the program established 
by section 324A of the Energy Policy and Conserva-
tion Act (42 U.S.C. 6294a). 
‘‘(5) HEAT
PUMP.—The term ‘heat pump’ 
means a heat pump used for water heating, space 
heating, or space cooling that— 
‘‘(A) relies solely on electricity for its 
source of power; and 
‘‘(B) is air-sourced, geothermal- or ground- 
sourced, or water-sourced. 
‘‘(6) HIGH-EFFICIENCY
ELECTRIC
HOME
RE-
BATE.—The term ‘high-efficiency electric home re-
bate’ means a rebate provided in accordance with 
subsection (b). 
‘‘(7) HOME.—The term ‘home’ means each of— 
‘‘(A) a building with not more than 4 
dwelling units, individual condominium units, or 
manufactured housing units, that— 
‘‘(i) is located in a State; and 
‘‘(ii)(I) is the primary residence of—
419 
‘‘(aa) the owner of that building, 
condominium unit, or manufactured 
housing unit, as applicable; or 
‘‘(bb) a renter; or 
‘‘(II) is a new-construction single-fam-
ily residential home; and 
‘‘(B) a unit of a multifamily building 
that— 
‘‘(i) is owned by an individual who is 
not the owner of the multifamily building; 
‘‘(ii) is located in a State; and 
‘‘(iii) is the primary residence of— 
‘‘(I) the owner of that unit; or 
‘‘(II) a renter. 
‘‘(8) HVAC.—The term ‘HVAC’ means heat-
ing, ventilation, and air conditioning. 
‘‘(9) LOW- OR MODERATE-INCOME.—The term 
‘low - or moderate -income’, with respect to a house-
hold, means a household— 
‘‘(A) with an annual income that is less 
than 80 percent of the annual median income 
of the area in which the household is located, 
which such annual median income of the area 
is determined according to publicly available 
data; or
421 
‘‘(IV) an electric heat pump 
clothes dryer; or 
‘‘(V) insulation, air sealing, and 
ventilation, in accordance with re-
quirements established by the Sec-
retary; or 
‘‘(ii) installs, or enables the installa-
tion and use of, in a home or multifamily 
building described in subparagraph (B)— 
‘‘(I) a solar photovoltaic system, 
including any electrical equipment, 
wiring, or other components necessary 
for the installation and use of the 
solar photovoltaic system, including a 
battery storage system; 
‘‘(II) electric vehicle charging in-
frastructure or electric vehicle support 
equipment necessary to recharge an 
electric vehicle on-site; or 
‘‘(III) electrical rewiring, power 
sharing plugs, or other installation 
tasks directly related to and necessary 
for the safe and effective functioning 
of a QEP in a home or multifamily 
building.
422 
‘‘(B) HOME
OR
MULTIFAMILY
BUILDING 
DESCRIBED.—A home or multifamily building 
referred to in subparagraph (A)(ii) is a home or 
multifamily building that is certified, or the 
household of the homeowner of which is cer-
tified, as applicable, as low- or moderate-in-
come. 
‘‘(C) EXCLUSIONS.—The terms ‘qualified 
electrification project’ and ‘QEP’ do not include 
any project with respect to which the appliance, 
system, equipment, infrastructure, component, 
or other item described in clause (i) or (ii) of 
subparagraph (A) is not certified under the En-
ergy Star program if, as of the date on which 
the project is carried out, the item is of a cat-
egory for which a certification is provided under 
that program. 
‘‘(12) QUALIFIED PROVIDER.—The term ‘quali-
fied provider’ means an electric utility, Tribal-owned 
entity or Tribally Designated Housing Entity 
(TDHE), or commercial, nonprofit, or government 
entity, including a retailer and a certified contractor 
company, that provides services for which a rebate 
may be provided pursuant to this section for 1 or
423 
more portfolios that consist of 1 or more qualified 
electrification projects. 
‘‘(13) SOLAR
PHOTOVOLTAIC
SYSTEM.—The 
term ‘solar photovoltaic system’ means a system— 
‘‘(A) placed on-site at a home or multi-
family building, or as part of the community of 
the home or multifamily building; and 
‘‘(B) that generates electricity from the 
sun specifically for the home, multifamily build-
ing, or community. 
‘‘(14) STATE.—The term ‘State’ means a State, 
the District of Columbia, or any territory or posses-
sion of the United States. 
‘‘(15) TRIBAL COMMUNITY.—The term ‘Tribal 
community’ means a Tribal tract or Tribal block 
group. 
‘‘(16) UNDERSERVED COMMUNITY.—The term 
‘underserved community’ means a community lo-
cated in a census tract that is identified by the Sec-
retary as— 
‘‘(A) a low- or moderate-income commu-
nity; or 
‘‘(B) a community of racial or ethnic mi-
nority concentration.’’. 
(b) CONFORMING AMENDMENTS.—
424 
(1) The table of contents for the Energy Policy 
Act of 2005 (Public Law 109–58; 119 Stat. 594) is 
amended by striking the item relating to section 124 
and inserting the following: 
‘‘Sec. 124. High-Efficiency Electric Home Rebate Program.’’. 
(2) Section 3201(c)(2)(A)(i) of the Energy Act 
of 2020 (42 U.S.C. 17232(c)(2)(A)(i)) is amended 
by striking ‘‘(a)’’ each place it appears. 
PART 2—BUILDING EFFICIENCY AND 
RESILIENCE 
SEC. 30421. CRITICAL FACILITY MODERNIZATION. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary for 
fiscal year 2022, out of any money in the Treasury not 
otherwise appropriated, $500,000,000, to remain available 
through September 30, 2031, to provide financial assist-
ance to States to develop and implement State programs 
described in subsection (d)(5) of section 362 of the Energy 
Policy and Conservation Act (42 U.S.C. 6322), as part 
of an approved State energy conservation plan under that 
section, to be distributed to States in accordance with the 
formula for the State Energy Program established in part 
420 of title 10, Code of Federal Regulations (as in effect 
on January 1, 2021), to carry out projects to improve the 
energy resilience of public or nonprofit buildings, including 
projects to increase the energy efficiency and grid integra-
425 
tion of public or nonprofit buildings or the renewable en-
ergy used at public or nonprofit buildings. 
(b) USE OF FUNDS.— 
(1) GUIDELINES.—Not later than 180 days 
after the date of enactment of this Act, the Sec-
retary shall issue guidelines for measures for States 
to include in any program with respect to which a 
State receives financial assistance under this section. 
(2) ADMINISTRATIVE EXPENSES.—A State re-
ceiving financial assistance under this section shall 
use not more than 10 percent for administrative 
purposes. 
(3) NO MATCHING FUNDS REQUIREMENT.—The 
Secretary may not require a State receiving financial 
assistance under this section to provide matching 
funds. 
(4) EXEMPTION.—Activities carried out using 
funds appropriated under subsection (a) shall not be 
subject to the expenditure prohibitions and limita-
tions of the State Energy Program under section 
420.18 of title 10, Code of Federal Regulations. 
(c) DEFINITIONS.—In this section: 
(1) ENERGY RESILIENCE.—The term ‘‘energy 
resilience’’ means the ability to withstand and quick-
ly recover from an energy supply disruption.
427 
(b) LATEST BUILDING ENERGY CODE.—The Sec-
retary of Energy shall use funds made available under 
subsection (a)(1) for grants to assist States, and units of 
local government that have authority to adopt building 
codes, to— 
(1) adopt— 
(A) a building energy code (or codes) for 
residential buildings that meets or exceeds the 
2021 International Energy Conservation Code, 
or achieves equivalent or greater energy sav-
ings; 
(B) a building energy code (or codes) for 
commercial buildings that meets or exceeds the 
ANSI/ASHRAE/IES Standard 90.1–2019, or 
achieves equivalent or greater energy savings; 
or 
(C) any combination of building energy 
codes described in subparagraph (A) or (B); 
and 
(2) implement a plan for the jurisdiction to 
achieve full compliance with any building energy 
code adopted under paragraph (1) in new and ren-
ovated residential or commercial buildings, as appli-
cable, which plan shall include active training and
428 
enforcement programs and measurement of the rate 
of compliance each year. 
(c) ZERO ENERGY CODE.—The Secretary of Energy 
shall use funds made available under subsection (a)(2) for 
grants to assist States, and units of local government that 
have authority to adopt building codes, to— 
(1) adopt a building energy code (or codes) for 
residential and commercial buildings that meets or 
exceeds the zero energy provisions in the 2021 Inter-
national Energy Conservation Code or an equivalent 
stretch code; and 
(2) implement a plan for the jurisdiction to 
achieve full compliance with any building energy 
code adopted under paragraph (1) in new and ren-
ovated residential and commercial buildings, which 
plan shall include active training and enforcement 
programs and measurement of the rate of compli-
ance each year. 
(d) STATE MATCH.—The State cost share require-
ment under the item relating to ‘‘Department of Energy— 
Energy Conservation’’ in title II of the Department of the 
Interior and Related Agencies Appropriations Act, 1985 
(42 U.S.C. 6323a; 98 Stat. 1861) shall not apply to assist-
ance provided under this section.
429 
(e) STATE DEFINED.—In this section, the term 
‘‘State’’ has the meaning given that term in section 3 of 
the Energy Policy and Conservation Act (42 U.S.C. 
6202). 
(f) ADMINISTRATIVE COSTS.—Of the amounts made 
available under this section, the Secretary shall reserve 5 
percent for administrative costs necessary to carry out this 
section. 
PART 3—ZERO-EMISSIONS VEHICLE 
INFRASTRUCTURE 
SEC. 30431. ZERO-EMISSIONS VEHICLE INFRASTRUCTURE 
GRANTS. 
(a) APPROPRIATIONS.—In addition to amounts other-
wise available, there is appropriated to the Secretary for 
fiscal year 2022, out of any money in the Treasury not 
otherwise appropriated, to remain available through Sep-
tember 30, 2028, to be distributed to States in accordance 
with the formula for the State Energy Program estab-
lished in part 420 of title 10, Code of Federal Regulations 
(as in effect on January 1, 2021)— 
(1) $600,000,000 to carry out a program to 
provide financial assistance to States to develop and 
implement State programs described in subsection 
(d)(5) of section 362 of the Energy Policy and Con-
servation Act (42 U.S.C. 6322), as part of an ap-
430 
proved State energy conservation plan under that 
section, to carry out projects to build out publicly 
accessible level 2 electric vehicle supply equipment in 
rural communities or underserved or disadvantaged 
communities; 
(2) $200,000,000 to carry out a program to 
provide financial assistance to States to develop and 
implement State programs described in subsection 
(d)(5) of section 362 of the Energy Policy and Con-
servation Act (42 U.S.C. 6322), as part of an ap-
proved State energy conservation plan under that 
section, to carry out projects to build out publicly 
accessible networked direct current fast charge elec-
tric vehicle supply equipment in rural communities 
or underserved or disadvantaged communities; and 
(3) $200,000,000 to carry out a program to 
provide financial assistance to States to develop and 
implement State programs described in subsection 
(d)(5) of section 362 of the Energy Policy and Con-
servation Act (42 U.S.C. 6322), as part of an ap-
proved State energy conservation plan under that 
section, to carry out projects to build out hydrogen 
fueling stations in rural communities or underserved 
or disadvantaged communities. 
(b) REQUIREMENTS.—
431 
(1) MEASURES.—Not later than 180 days after 
the date of enactment of this Act, the Secretary 
shall establish requirements for measures to be in-
cluded in any program with respect to which a State 
receives financial assistance under this section. 
(2) ADMINISTRATIVE EXPENSES.—A State re-
ceiving financial assistance under this section shall 
use not more than 5 percent for administrative pur-
poses. 
(3) NO MATCHING FUNDS REQUIREMENT.—The 
Secretary may not require a State receiving financial 
assistance under this section to provide matching 
funds. 
(4) ELIGIBLE ENTITIES.—Financial assistance 
provided by a State using funds made available 
under this section shall only be available to eligible 
entities. 
(5) THIRD-PARTY CONTRACTS.—A State or eli-
gible entity may enter into a contract with a private 
third-party entity for the build out of electric vehicle 
supply equipment or hydrogen fueling stations under 
subsection (a). 
(6) USE OF PRIVATE PROPERTY.—A State or 
eligible entity may enter into an agreement for the 
use of publicly accessible private property.
432 
(7) LIMITATION.—The Secretary shall ensure 
that no entity receives a profit for access to or 
hosting of electric vehicle supply equipment or hy-
drogen fueling stations built out under a contract 
entered into under paragraph (5) or pursuant to an 
agreement entered into under paragraph (6), except 
that the Secretary shall determine an appropriate 
amount of profit that an entity may receive for the 
sale of electricity or hydrogen and the operation and 
maintenance of such electric vehicle supply equip-
ment or hydrogen fueling stations. 
(8) REALLOCATION OF FUNDS.—A State shall 
return to the Secretary any funds received under 
subsection (a) that the State does not award within 
3 years of receiving such funds, and the Secretary 
shall reallocate such funds to other States. 
(c) DEFINITIONS.—In this section: 
(1) ELECTRIC VEHICLE SUPPLY EQUIPMENT.— 
The term ‘‘electric vehicle supply equipment’’ means 
any conductors, including ungrounded, grounded, 
and equipment grounding conductors, electric vehicle 
connectors, attachment plugs, and all other fittings, 
devices, power outlets, electrical equipment, sta-
tionary energy storage systems, off-grid charging in-
stallations, or apparatuses installed specifically for
433 
the purpose of delivering energy to an electric vehicle 
or to a battery intended to be used in an electric ve-
hicle. 
(2) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a local, Tribal, or territorial government, 
a not-for-profit entity, a nonprofit entity, a metro-
politan planning organization, or an entity with 
fewer than 50 employees, as determined by the Sec-
retary. 
(3) LEVEL
ELECTRIC
VEHICLE
SUPPLY 
EQUIPMENT.—The term ‘‘level 2 electric vehicle sup-
ply equipment’’ means electric vehicle supply equip-
ment that provides an alternating current power 
source at a minimum of 208 volts. 
(4) 
NETWORKED
DIRECT
CURRENT
FAST 
CHARGE ELECTRIC VEHICLE SUPPLY EQUIPMENT.— 
The term ‘‘networked direct current fast charge elec-
tric vehicle supply equipment’’ means electric vehicle 
supply equipment that is capable of providing a di-
rect current power source at a minimum of 50 kilo-
watts and is enabled to connect to a network to fa-
cilitate at least data collection and access. 
(5) PRIVATE THIRD-PARTY ENTITY.—The term 
‘‘private third-party entity’’ means a non-govern-
mental entity, including a private business, that is
434 
able to contract with the State or an eligible entity 
to carry out projects to build out electric vehicle sup-
ply equipment or hydrogen fueling stations. 
(6) PUBLICLY ACCESSIBLE.—The term ‘‘pub-
licly accessible’’ means available to members of the 
public, including within or around— 
(A) multiunit housing structures; 
(B) workplaces; 
(C) commercial locations that are acces-
sible for a minimum of 12 hours per day at 
least 5 days a week, and capable of being mon-
itored remotely; or 
(D) other locations that are accessible for 
a minimum of 12 hours per day at least 5 days 
a week, and capable of being monitored re-
motely. 
(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Energy. 
(8) UNDERSERVED OR DISADVANTAGED COM-
MUNITY.—The term ‘‘underserved or disadvantaged 
community’’ means a community or geographic area 
that is identified by the Secretary as— 
(A) a low-income community; 
(B) a Tribal community;
435 
(C) having a disproportionately low num-
ber of electric vehicle charging stations per cap-
ita, compared to similar areas; or 
(D) disproportionately vulnerable to, or 
bearing a disproportionate burden of, any com-
bination of economic, social, environmental, or 
climate stressors. 
PART 4—DOE LOAN AND GRANT PROGRAMS 
SEC. 30441. FUNDING FOR DEPARTMENT OF ENERGY LOAN 
PROGRAMS OFFICE. 
(a) COMMITMENT AUTHORITY.—In addition to com-
mitment authority otherwise available and previously pro-
vided, the Secretary of Energy may make commitments 
to guarantee loans for eligible projects under section 1703 
of the Energy Policy Act of 2005 up to a total principal 
amount of $40,000,000,000, to remain available until Sep-
tember 30, 2026: Provided, That for amounts collected 
pursuant to section 1702(b)(2) of the Energy Policy Act 
of 2005, the source of such payment received from bor-
rowers may not be a loan or other debt obligation that 
is guaranteed by the Federal Government: Provided fur-
ther, That none of the loan guarantee authority made 
available by this section shall be available for any project 
unless the President has certified in advance in writing 
that the loan guarantee and the project comply with the
436 
provisions under this section: Provided further, That none 
of such loan guarantee authority made available by this 
section shall be available for commitments to guarantee 
loans for any projects where funds, personnel, or property 
(tangible or intangible) of any Federal agency, instrumen-
tality, personnel, or affiliated entity are expected to be 
used (directly or indirectly) through acquisitions, con-
tracts, demonstrations, exchanges, grants, incentives, 
leases, procurements, sales, other transaction authority, or 
other arrangements, to support the project or to obtain 
goods or services from the project: Provided further, That 
the previous proviso shall not be interpreted as precluding 
the use of the loan guarantee authority provided by this 
section for commitments to guarantee loans for— 
(1) projects as a result of such projects benefit-
ting from otherwise allowable Federal tax benefits; 
(2) projects as a result of such projects benefit-
ting from being located on Federal land pursuant to 
a lease or right-of-way agreement for which all con-
sideration for all uses is— 
(A) paid exclusively in cash; 
(B) deposited in the Treasury as offsetting 
receipts; and 
(C) equal to the fair market value;
437 
(3) projects as a result of such projects benefit-
ting from the Federal insurance program under sec-
tion 170 of the Atomic Energy Act of 1954 (42 
U.S.C. 2210); or 
(4) electric generation projects using trans-
mission facilities owned or operated by a Federal 
Power Marketing Administration or the Tennessee 
Valley Authority that have been authorized, ap-
proved, and financed independent of the project re-
ceiving the guarantee. 
(b) APPROPRIATION.—In addition to amounts other-
wise available and previously provided, there is appro-
priated to the Secretary of Energy for fiscal year 2022, 
out of any money in the Treasury not otherwise appro-
priated, $3,600,000,000, to remain available until Sep-
tember 30, 2026, for the costs of guarantees made under 
section 1703 of the Energy Policy Act of 2005, using the 
loan guarantee authority provided under subsection (a) of 
this section. 
(c) ADMINISTRATIVE EXPENSES.—Of the amount 
made available under subsection (b), the Secretary of En-
ergy shall reserve 3 percent for administrative expenses 
to carry out title XVII of the Energy Policy Act of 2005 
and for carrying out section 1702(h)(3) of such Act.
438 
SEC. 30442. ADVANCED TECHNOLOGY VEHICLE MANUFAC-
TURING. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $3,000,000,000, to 
remain available until September 30, 2028, for the costs 
of— 
(1) providing direct loans under section 136(d) 
of the Energy Independence and Security Act of 
2007 (42 U.S.C. 17013(d)); and 
(2) providing direct loans, in accordance with 
section 136 of such Act, for reequipping, expanding, 
or establishing a manufacturing facility in the 
United States to produce, or for engineering integra-
tion performed in the United States of— 
(A) a medium duty vehicle or a heavy duty 
vehicle; or 
(B) any of the following that emit, under 
any possible operational mode or condition, zero 
exhaust emissions of any greenhouse gas: 
(i) A train or locomotive. 
(ii) A maritime vessel. 
(iii) An aircraft. 
(iv) Hyperloop technology.
439 
(b) ADMINISTRATIVE COSTS.—The Secretary shall 
reserve $25,000,000 of amounts made available under 
subsection (a) for administrative costs of providing loans 
as described in subsection (a). 
(c) ELIMINATION OF LOAN PROGRAM CAP.—Section 
136(d)(1) of the Energy Independence and Security Act 
of 2007 (42 U.S.C. 17013(d)(1)) is amended by striking 
‘‘a total of not more than $25,000,000,000 in’’. 
SEC. 30443. DOMESTIC MANUFACTURING CONVERSION 
GRANTS. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $3,500,000,000, to 
remain available until expended, for grants relating to do-
mestic production of plug-in electric hybrid, plug-in elec-
tric drive, and hydrogen fuel cell electric vehicles, in ac-
cordance with section 712 of the Energy Policy Act of 
2005 (42 U.S.C. 16062). 
(b) ADMINISTRATIVE COSTS.—The Secretary shall 
reserve 3 percent of amounts made available under sub-
section (a) for administrative costs of making grants de-
scribed in such subsection (a) pursuant to section 712 of 
the Energy Policy Act of 2005 (42 U.S.C. 16062).
440 
SEC. 30444. ENERGY COMMUNITY REINVESTMENT FINANC-
ING. 
Title XVII of the Energy Policy Act of 2005 is 
amended by inserting after section 1705 (42 U.S.C. 
16516) the following: 
‘‘SEC. 1706. ENERGY COMMUNITY REINVESTMENT FINANC-
ING PROGRAM. 
‘‘(a) APPROPRIATION.—In addition to amounts oth-
erwise available, there is appropriated to the Secretary for 
fiscal year 2022, out of any money in the Treasury not 
otherwise appropriated, $5,000,000,000, to remain avail-
able until September 30, 2026, for the cost of providing 
financial support under this section, the gross principal 
amount of which shall not exceed $250,000,000,000. 
‘‘(b) 
ESTABLISHMENT.—Notwithstanding 
section 
1702(f) and section 1703, and not later than 180 days 
after the date of enactment of this section, the Secretary 
shall establish a program to provide financial support, in 
such form and on such terms and conditions as the Sec-
retary determines appropriate, to eligible entities for the 
purpose of making or enabling low-carbon reinvestments 
in energy communities, which such reinvestments may in-
clude— 
‘‘(1) supporting workers who are or have been 
engaged in providing, or have been affected by the 
provision of, energy-intensive goods or services by
441 
helping such workers find employment opportunities, 
including by providing training and education; 
‘‘(2) redeveloping a community that is or was 
engaged in providing, or has been affected by the 
provision of, energy-intensive goods or services; 
‘‘(3) accelerating remediation of environmental 
damage caused by the provision of energy-intensive 
goods or services; and 
‘‘(4) mitigating the effects on customers of any 
significant reduction in the carbon intensity of goods 
or services provided by the eligible entity, including 
by the cost-effective abatement of greenhouse gas 
emissions from continuing operations and the 
repowering, retooling, repurposing, redeveloping, or 
remediating of any long-lived assets, lands, or infra-
structure currently or previously used by the eligible 
entity primarily to support the provision of energy- 
intensive goods or services. 
‘‘(c) APPLICATION REQUIREMENT.—To apply for fi-
nancial support provided under this section, an eligible en-
tity shall submit to the Secretary an application at such 
time, in such manner, and containing such information as 
the Secretary may require, which such application shall 
include—
442 
‘‘(1) a detailed plan describing the activities to 
be carried out in accordance with subsection (b), in-
cluding activities for the measurement, monitoring, 
and verification of emissions of greenhouse gases; 
and 
‘‘(2) if the eligible entity is a utility subject to 
regulation by a State commission or other State reg-
ulatory authority, assurances, as determined appro-
priate by the Secretary, that such eligible entity 
shall pass through any financial benefit from the 
provision of any financial support under this section 
to its customers or energy communities. 
‘‘(d) OTHER REQUIREMENTS.— 
‘‘(1) 
FEES.—Notwithstanding 
section 
1702(h)(1), the Secretary shall charge and collect a 
fee from each eligible entity that received financial 
support provided under this section in an amount 
the Secretary determines sufficient to cover applica-
ble administrative expenses (including any costs as-
sociated with third party consultants engaged by the 
Secretary). 
‘‘(2) SPECIFIC APPROPRIATION OR CONTRIBU-
TION.—Any cost for any financial support provided 
under this section shall be paid in accordance with 
subsection (b) of section 1702 (for purposes of
443 
which any reference in such subsection to a guar-
antee shall be considered to be a reference to finan-
cial support). 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) COST.—Notwithstanding section 1701, the 
term ‘cost’ has the meaning given such term in sec-
tion 502 of the Federal Credit Reform Act of 1990 
(2 U.S.C. 661a). 
‘‘(2) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means any entity that is directly affiliated with 
the provision of energy-intensive goods or services. 
‘‘(3) ENERGY COMMUNITY.—The term ‘energy 
community’ means a community whose members are 
or were engaged in providing, or have been affected 
by the provision of, energy-intensive goods and serv-
ices. 
‘‘(4) FINANCIAL SUPPORT.—The term ‘financial 
support’ means any credit product or support the 
Secretary determines appropriate to implement this 
section, including— 
‘‘(A) a line of credit; and 
‘‘(B) a guarantee, including of a letter of 
credit for the purposes of subsection (b)(3).’’.
444 
SEC. 30445. TRIBAL ENERGY LOAN GUARANTEE PROGRAM. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $200,000,000, to re-
main available until September 30, 2028, to carry out sec-
tion 2602(c) of the Energy Policy Act of 1992 (25 U.S.C. 
3502(c)). 
(b) INCLUSIONS
IN TITLE XVII DEFINITION
OF 
GUARANTEE.—Section 1701(4)(B) of the Energy Policy 
Act of 2005 (42 U.S.C. 16511(4)(B)) is amended by strik-
ing the period at the end and inserting ‘‘and, for purposes 
of minimizing financing costs, includes a guarantee by the 
Secretary of 100 percent of the unpaid principal and inter-
est due on any obligation to the Federal Financing 
Bank.’’. 
(c) DEPARTMENT
OF ENERGY TRIBAL ENERGY 
LOAN GUARANTEE PROGRAM.— Section 2602(c) of the 
Energy Policy Act of 1992 (25 U.S.C. 3502(c)) is amend-
ed— 
(1) in paragraph (1), by striking ‘‘(as defined 
in section 502 of the Federal Credit Reform Act of 
1990 (2 U.S.C. 661a)) for an amount equal to not 
more than 90 percent of’’ and inserting ‘‘(as defined 
in section 1701 of the Energy Policy Act of 2005 
(42 U.S.C. 16511)) for’’; and
445 
(2) 
in 
paragraph 
(4), 
by 
striking 
‘‘$2,000,000,000’’ and inserting ‘‘$20,000,000,000’’. 
PART 5—ELECTRIC TRANSMISSION 
SEC. 30451. TRANSMISSION LINE AND INTERTIE INCEN-
TIVES. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, to remain available 
until September 30, 2030, $1,500,000,000 for purposes 
of providing grants under subsection (b) and for adminis-
trative expenses associated with carrying out this section, 
and $500,000,000 for the costs of providing direct loans 
under subsection (b): Provided, That the Secretary shall 
not enter into any loan agreement pursuant to this section 
that could result in disbursements after September 30, 
2031, or any grant agreement pursuant to this section 
that could result in any outlays after September 30, 2031: 
Provided further, That none of such loan authority made 
available by this section shall be available for loans for 
any projects where funds, personnel, or property (tangible 
or intangible) of any Federal agency, instrumentality, per-
sonnel, or affiliated entity are expected to be used (directly 
or indirectly) through acquisitions, contracts, demonstra-
tions, exchanges, grants, incentives, leases, procurements,
446 
sales, other transaction authority, or other arrangements 
to support the project or to obtain goods or services from 
the project: Provided further, That the previous proviso 
shall not be interpreted as precluding the use of the loan 
authority provided by this section for commitments to 
loans for: (1) projects benefitting from otherwise allowable 
Federal tax benefits; (2) projects benefitting from being 
located on Federal land pursuant to a lease or right-of- 
way agreement for which all consideration for all uses is: 
(A) paid exclusively in cash; (B) deposited in the Treasury 
as offsetting receipts; and (C) equal to the fair market 
value; (3) projects benefitting from the Federal insurance 
program under section 170 of the Atomic Energy Act of 
1954 (42 U.S.C. 2210); or (4) electric generation projects 
using transmission facilities owned or operated by a Fed-
eral Power Marketing Administration or the Tennessee 
Valley Authority that have been authorized, approved, and 
financed independent of the project receiving the guar-
antee: Provided further, That none of the loan authority 
made available by this section shall be available for any 
project unless the President has certified in advance in 
writing that the loan and the project comply with the pro-
visions under this section. 
(b) IN GENERAL.—Except as provided in subsection 
(c), the Secretary of Energy may provide grants and direct
447 
loans to eligible entities to construct new, or make up-
grades to existing, eligible transmission lines or eligible 
interties, including the related facilities thereof, if the Sec-
retary of Energy determines that such construction or up-
grade would support— 
(1) a more robust and resilient electric grid; 
and 
(2) the integration of electricity from a clean 
energy facility into the electric grid. 
(c) OTHER REQUIREMENTS.— 
(1) INTEREST RATES.—The Secretary of En-
ergy shall determine the rate of interest to charge on 
direct loans provided under subsection (b) by taking 
into consideration market yields on outstanding mar-
ketable obligations of the United States of com-
parable maturities as of the date the loan is dis-
bursed. 
(2) RECOVERY
OF
COSTS
FOR
GRANTS.—A 
grant provided under this section may not be used 
to cover the portion of costs for the construction of 
new, or for making upgrades to existing, eligible 
transmission lines or eligible interties, including the 
related facilities thereof, that are approved for recov-
ery through a Transmission Organization, regional 
planning authority, governing or ratemaking body of
448 
an electric cooperative, State commission, or another 
similar body. 
(3) NO
DUPLICATE
ASSISTANCE.—No eligible 
entity may receive both a grant and a direct loan for 
the same construction of, or upgrade to, an eligible 
transmission line or eligible intertie under this sec-
tion. 
(d) DEFINITIONS.—In this section: 
(1) CLEAN
ENERGY
FACILITY.—The term 
‘‘clean energy facility’’ means any electric generating 
unit that does not emit carbon dioxide. 
(2) DIRECT
LOAN.—The term ‘‘direct loan’’ 
means a disbursement of funds by the Government 
to a non-Federal borrower under a contract that re-
quires the repayment of such funds with or without 
interest. The term includes the purchase of, or par-
ticipation in, a loan made by another lender and fi-
nancing arrangements that defer payment for more 
than 90 days, including the sale of a government 
asset on credit terms. 
(3) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a non-Federal entity. 
(4) ELIGIBLE
INTERTIE.—The term ‘‘eligible 
intertie’’ means—
449 
(A) any interties across the seam between 
the Western Interconnection and the Eastern 
Interconnection; 
(B) the Pacific Northwest-Pacific South-
west Intertie; 
(C) any interties between the Electric Reli-
ability Council of Texas and the Western Inter-
connection or the Eastern Interconnection; or 
(D) such other interties that the Secretary 
determines contribute to— 
(i) a more robust and resilient electric 
grid; and 
(ii) the integration of electricity from 
a clean energy facility into the electric 
grid. 
(5) ELIGIBLE TRANSMISSION LINE.—The term 
‘‘eligible transmission line’’ means an electric power 
transmission line that— 
(A) in the case of new construction under 
subsection (b), has a transmitting capacity of 
not less than 1,000 megawatts; 
(B) in the case of an upgrade made under 
subsection (b), the upgrade to which will in-
crease its transmitting capacity by not less than 
500 megawatts; and
450 
(C) is capable of transmitting electricity— 
(i) across any eligible intertie; 
(ii) from an offshore wind generating 
facility; or 
(iii) along a route, or in a corridor, 
determined by the Secretary of Energy to 
be necessary to meet interregional or na-
tional electricity transmission needs. 
(6) STATE COMMISSION; TRANSMISSION ORGA-
NIZATION.—The terms ‘‘State commission’’ and 
‘‘Transmission Organization’’ have the meanings 
given such terms in section 3 of the Federal Power 
Act (16 U.S.C. 796). 
SEC. 30452. GRANTS TO FACILITATE THE SITING OF INTER-
STATE ELECTRICITY TRANSMISSION LINES. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $800,000,000, to re-
main available until September 30, 2029, for making 
grants in accordance with this section and for administra-
tive expenses associated with carrying out this section. 
(b) USE OF FUNDS.— 
(1) IN GENERAL.—The Secretary may make a 
grant under this section to a siting authority for,
451 
with respect to a covered transmission project, any 
of the following activities: 
(A) Studies and analyses of the impacts of 
the covered transmission project. 
(B) Examination of up to 3 alternate 
siting corridors within which the covered trans-
mission project feasibly could be sited. 
(C) Hosting and facilitation of negotiations 
in settlement meetings involving the siting au-
thority, the covered transmission project appli-
cant, and opponents of the covered transmission 
project, for the purpose of identifying and ad-
dressing issues that are preventing approval of 
the application relating to the siting or permit-
ting of the covered transmission project. 
(D) Participation by the siting authority in 
regulatory proceedings or negotiations in an-
other jurisdiction, or under the auspices of a 
Transmission Organization (as defined in sec-
tion 3 of the Federal Power Act (16 U.S.C. 
796)) that is also considering the siting or per-
mitting of the covered transmission project. 
(E) Participation by the siting authority in 
regulatory proceedings at the Federal Energy 
Regulatory Commission or a State regulatory
452 
commission for determining applicable rates 
and cost allocation for the covered transmission 
project. 
(F) Other measures and actions that may 
improve the chances of, and shorten the time 
required for, approval by the siting authority of 
the application relating to the siting or permit-
ting of the covered transmission project, as the 
Secretary determines appropriate. 
(2) ECONOMIC DEVELOPMENT.—The Secretary 
may make a grant under this section to a siting au-
thority, or other State, local, or Tribal governmental 
entity, for economic development activities for com-
munities that may be affected by the construction 
and operation of a covered transmission project, pro-
vided that the Secretary shall not enter into any 
grant agreement pursuant to this section that could 
result in any outlays after September 30, 2031. 
(c) CONDITIONS.— 
(1) FINAL
DECISION
ON
APPLICATION.—In 
order to receive a grant for an activity described in 
subsection (b)(1), the Secretary shall require a siting 
authority to agree, in writing, to reach a final deci-
sion on the application relating to the siting or per-
mitting of the applicable covered transmission
453 
project not later than 2 years after the date on 
which such grant is provided, unless the Secretary 
authorizes an extension for good cause. 
(2) FEDERAL SHARE.—The Federal share of 
the cost of an activity described in subparagraph 
(D) or (E) of subsection (b)(1) shall not exceed 50 
percent. 
(3) ECONOMIC DEVELOPMENT.—The Secretary 
may only disburse grant funds for economic develop-
ment activities under subsection (b)(2)— 
(A) to a siting authority upon approval by 
the siting authority of the applicable covered 
transmission project; and 
(B) to any other State, local, or Tribal 
governmental entity upon commencement of 
construction of the applicable covered trans-
mission project in the area under the jurisdic-
tion of the entity. 
(d) RETURNING FUNDS.—If a siting authority that 
receives a grant for an activity described in subsection 
(b)(1) fails to use all grant funds within 2 years of receipt, 
the siting authority shall return to the Secretary any such 
unused funds. 
(e) DEFINITIONS.—In this section:
454 
(1) COVERED
TRANSMISSION
PROJECT.—The 
term ‘‘covered transmission project’’ means a high- 
voltage interstate or offshore electricity transmission 
line— 
(A) that is proposed to be constructed and 
to operate at a minimum of 275 kilovolts of ei-
ther alternating-current or direct-current elec-
tric energy by an entity; and 
(B) for which such entity has applied, or 
informed a siting authority of such entity’s in-
tent to apply, for regulatory approval. 
(2) SITING AUTHORITY.—The term ‘‘siting au-
thority’’ means a State, local, or Tribal govern-
mental entity with authority to make a final deter-
mination regarding the siting, permitting, or regu-
latory status of a covered transmission project that 
is proposed to be located in an area under the juris-
diction of the entity. 
(3) STATE.—The term ‘‘State’’ means a State, 
the District of Columbia, or any territory or posses-
sion of the United States. 
SEC. 30453. ORGANIZED WHOLESALE ELECTRICITY MAR-
KET TECHNICAL ASSISTANCE GRANTS. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary for
455 
fiscal year 2022, out of any money in the Treasury not 
otherwise appropriated, $40,000,000, to remain available 
until fiscal year 2031, for purposes of carrying out a pro-
gram to provide— 
(1) technical assistance and grants to States to 
evaluate forming, participating in, expanding, or im-
proving organized wholesale electricity markets; and 
(2) grants to States to procure data or tech-
nology systems related to forming, participating in, 
expanding, or improving organized wholesale elec-
tricity markets. 
(b) APPLICATIONS.—To apply for technical assist-
ance or a grant provided under this section, a State shall 
submit to the Secretary an application at such time, in 
such manner, and containing such information as the Sec-
retary may require. 
(c) DEFINITIONS.—In this section: 
(1) INDEPENDENT
SYSTEM
OPERATOR; RE-
GIONAL TRANSMISSION ORGANIZATION.—The terms 
‘‘Independent System Operator’’ and ‘‘Regional 
Transmission Organization’’ have the meanings 
given such terms in section 3 of the Federal Power 
Act (16 U.S.C. 796). 
(2) ORGANIZED WHOLESALE ELECTRICITY MAR-
KET.—The term ‘‘organized wholesale electricity
456 
market’’ means an Independent System Operator or 
a Regional Transmission Organization. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Energy. 
(4) STATE.—The term ‘‘State’’ means a State 
or the District of Columbia. 
SEC. 30454. INTERREGIONAL AND OFFSHORE WIND ELEC-
TRICITY 
TRANSMISSION 
PLANNING, 
MOD-
ELING, AND ANALYSIS. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $100,000,000, to re-
main available until September 30, 2031, to carry out this 
section. 
(b) USE OF FUNDS.—The Secretary of Energy shall 
use amounts made available under subsection (a) to— 
(1) pay expenses associated with convening rel-
evant stakeholders, including States, generation and 
transmission developers, regional transmission orga-
nizations, independent system operators, environ-
mental organizations, electric utilities, and other 
stakeholders the Secretary determines appropriate, 
to address the development of interregional elec-
457 
tricity transmission and transmission of electricity 
that is generated by offshore wind; and 
(2) conduct planning, modeling, and analysis 
regarding interregional electricity transmission and 
transmission of electricity that is generated by off-
shore wind, taking into account the local, regional, 
and national economic, reliability, resilience, secu-
rity, public policy, and environmental benefits of 
interregional electricity transmission and trans-
mission of electricity that is generated by offshore 
wind, including planning, modeling, and analysis, as 
the Secretary determines appropriate, pertaining 
to— 
(A) clean energy integration into the elec-
tric grid, including the identification of renew-
able energy zones; 
(B) the effects of changes in weather due 
to climate change on the reliability and resil-
ience of the electric grid; 
(C) cost allocation methodologies that fa-
cilitate the expansion of the bulk power system; 
(D) the benefits of coordination between 
generator interconnection processes and trans-
mission planning processes;
458 
(E) the effect of increased electrification 
on the electric grid; 
(F) power flow modeling; 
(G) the benefits of increased interconnec-
tions or interties between or among the West-
ern Interconnection, the Eastern Interconnec-
tion, the Electric Reliability Council of Texas, 
and other interconnections, as applicable; 
(H) the cooptimization of transmission and 
generation, including variable energy resources, 
energy storage, and demand-side management; 
(I) the opportunities for use of nontrans-
mission alternatives, energy storage, and grid- 
enhancing technologies; 
(J) economic development opportunities for 
communities arising from development of inter-
regional electricity transmission and trans-
mission of electricity that is generated by off-
shore wind; 
(K) evaluation of existing rights-of-way 
and the need for additional transmission cor-
ridors; and 
(L) a planned national transmission grid, 
which would include a networked transmission
459 
system to optimize the existing grid for inter-
connection of offshore wind farms. 
PART 6—ENVIRONMENTAL REVIEWS 
SEC. 30461. DEPARTMENT OF ENERGY. 
In addition to amounts otherwise available, there is 
appropriated to the Department of Energy for fiscal year 
2022, out of any money in the Treasury not otherwise ap-
propriated, $125,000,000, to remain available until Sep-
tember 30, 2031, to provide for the development of more 
efficient, accurate, and timely reviews for planning, per-
mitting, and approval processes through the hiring and 
training of personnel, the development of programmatic 
documents, the procurement of technical or scientific serv-
ices for reviews, the development of data or information 
systems, stakeholder and community engagement, the pur-
chase of new equipment for analysis, and the development 
of geographic information systems and other analysis 
tools, techniques, and guidance to improve agency trans-
parency, accountability, and public engagement. 
SEC. 30462. FEDERAL ENERGY REGULATORY COMMISSION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Federal Energy 
Regulatory Commission for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated, 
$75,000,000, to remain available until September 30,
460 
2031, to provide for the development of more efficient, ac-
curate, and timely reviews for planning, permitting, and 
approval processes through the hiring and training of per-
sonnel, the development of programmatic documents, the 
procurement of technical or scientific services for reviews, 
the development of data or information systems, stake-
holder and community engagement, the purchase of new 
equipment for analysis, and the development of geographic 
information systems and other analysis tools, techniques, 
and guidance to improve agency transparency, account-
ability, and public engagement. 
(b) FEES AND CHARGES.—Section 3401(a) of the 
Omnibus Budget Reconciliation Act of 1986 (42 U.S.C. 
7178(a)) shall not apply to the costs incurred by the Fed-
eral Energy Regulatory Commission in carrying out this 
section. 
PART 7—INDUSTRIAL 
SEC. 30471. ADVANCED INDUSTRIAL FACILITIES DEPLOY-
MENT PROGRAM. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Energy for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $4,000,000,000, to 
remain available until September 30, 2026, to carry out 
this section.
461 
(b) PROGRAM.—The Secretary shall use funds appro-
priated by subsection (a) to establish a program to provide 
financial assistance, on a competitive basis, to eligible enti-
ties to carry out projects for— 
(1) the purchase and installation, or implemen-
tation, of advanced industrial technology at an eligi-
ble facility; 
(2) retrofits, upgrades to, or operational im-
provements at an eligible facility to install or imple-
ment advanced industrial technology; or 
(3) engineering studies and other work needed 
to prepare an eligible facility for activities described 
in paragraph (1) or (2). 
(c) APPLICATION.—To be eligible to receive financial 
assistance under the program established under subsection 
(b), an eligible entity shall submit to the Secretary an ap-
plication at such time, in such manner, and containing 
such information as the Secretary may require, including 
the expected greenhouse gas emissions reductions to be 
achieved by carrying out the project. 
(d) PRIORITY.—In providing financial assistance 
under the program established under subsection (b), the 
Secretary shall give priority consideration to projects on 
the basis of, as determined by the Secretary—
462 
(1) the expected greenhouse gas emissions re-
ductions to be achieved by carrying out the project; 
(2) the extent to which the project would pro-
vide the greatest benefit for the greatest number of 
people within the area in which the eligible facility 
is located; and 
(3) whether the eligible entity participates or 
would participate in a partnership with purchasers 
of the output of the eligible facility. 
(e) COST SHARE.—The Secretary may require an eli-
gible entity to provide not more than 50 percent of the 
cost of a project carried out pursuant to this section. 
(f) ADMINISTRATIVE COSTS.—The Secretary shall re-
serve $200,000,000 of amounts made available under sub-
section (a) for administrative costs of carrying out this 
section. 
(g) DEFINITIONS.— 
(1) ADVANCED
INDUSTRIAL
TECHNOLOGY.— 
The term ‘‘advanced industrial technology’’ means 
technology or processes designed to accelerate green-
house gas emissions reduction progress to net-zero 
at an eligible facility, as determined by the Sec-
retary, including— 
(A) industrial energy efficiency tech-
nologies;
463 
(B) equipment to electrify industrial proc-
esses; 
(C) equipment to utilize low- or zero-car-
bon fuels, feedstocks, and energy sources; 
(D) low- or zero-carbon process heat sys-
tems; and 
(E) carbon capture, transport, utilization, 
and storage systems. 
(2) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means the owner or operator of an eligible facil-
ity. 
(3) ELIGIBLE FACILITY.—The term ‘‘eligible fa-
cility’’ means a domestic, non-Federal, nonpower in-
dustrial or manufacturing facility engaged in energy- 
intensive industrial processes, including production 
processes for iron, steel, steel mill products, alu-
minum, cement, concrete, glass, pulp, paper, and in-
dustrial ceramics. 
(4) FINANCIAL ASSISTANCE.—The term ‘‘finan-
cial assistance’’ means a grant, rebate, or coopera-
tive agreement. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Energy.
464 
PART 8—OTHER ENERGY MATTERS 
SEC. 30481. OVERSIGHT. 
In addition to amounts otherwise available, there is 
appropriated to the Department of Energy for fiscal year 
2022, out of any money in the Treasury not otherwise ap-
propriated, $5,000,000, to remain available until Sep-
tember 30, 2031, for oversight by the Department of En-
ergy Office of Inspector General of the Department of En-
ergy activities for which funding is appropriated in this 
subtitle. 
SEC. 30482. ENERGY INFORMATION ADMINISTRATION. 
In addition to amounts otherwise available, there is 
appropriated to the Administrator of the Energy Informa-
tion Administration for fiscal year 2022, out of any money 
in the Treasury not otherwise appropriated, $40,000,000, 
to remain available until September 30, 2031, for data 
collection, research, and analysis activities. 
Subtitle E—Affordable Health Care 
Coverage 
SEC. 30601. ENSURING AFFORDABILITY OF COVERAGE FOR 
CERTAIN LOW-INCOME POPULATIONS. 
(a) REDUCING COST SHARING UNDER QUALIFIED 
HEALTH PLANS.—Section 1402 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18071) is amended— 
(1) in subsection (b)—
465 
(A) in paragraph (2), by inserting ‘‘(or, 
with respect to plan years 2023, 2024, and 
2025, whose household income does not exceed 
400 percent of the poverty line for a family of 
the size involved)’’ before the period; and 
(B) in the matter following paragraph (2), 
by adding at the end the following new sen-
tence: ‘‘In the case of an individual who is de-
termined at any point to have a household in-
come for 2022 that does not exceed 138 percent 
of the poverty line for a family of the size in-
volved, such individual shall, for each month 
during such year, be treated as having a house-
hold income equal to 100 percent for purposes 
of applying this section.’’; and 
(2) in subsection (c)— 
(A) in paragraph (1)(A), in the matter 
preceding clause (i), by inserting ‘‘, with respect 
to eligible insureds (other than, with respect to 
plan years 2023, 2024, and 2025, specified en-
rollees (as defined in paragraph (6)(C))),’’ after 
‘‘first be achieved’’; 
(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by inserting ‘‘with re-
spect to eligible insureds (other than, with re-
466 
spect to plan years 2023, 2024, and 2025, spec-
ified enrollees)’’ after ‘‘under the plan’’; 
(C) in paragraph (3)— 
(i) in subparagraph (A), by striking 
‘‘this subsection’’ and inserting ‘‘paragraph 
(1) or (2)’’; and 
(ii) in subparagraph (B), by striking 
‘‘this section’’ and inserting ‘‘paragraphs 
(1) and (2)’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL RULE FOR SPECIFIED ENROLL-
EES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish procedures under which the issuer of 
a qualified health plan to which this section ap-
plies shall reduce cost-sharing under the plan 
with respect to months occurring during plan 
years 2023, 2024, and 2025 for enrollees who 
are specified enrollees (as defined in subpara-
graph (C)) in a manner sufficient to increase 
the plan’s share of the total allowed costs of 
benefits provided under the plan to 99 percent 
of such costs.
467 
‘‘(B) METHODS
FOR
REDUCING
COST 
SHARING.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making reductions 
under this paragraph shall notify the Sec-
retary of such reductions and the Sec-
retary shall, out of funds made available 
under clause (ii), make periodic and timely 
payments to the issuer equal to 12 percent 
of the total allowed costs of benefits pro-
vided under each such plan to specified en-
rollees during plan years 2023, 2024, and 
2025. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there are ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i). 
‘‘(C) SPECIFIED
ENROLLEE
DEFINED.— 
For purposes of this section, the term ‘specified 
enrollee’ means, with respect to a plan year, an 
eligible insured who is determined at any point 
to have a household income for such plan year 
that does not exceed 138 percent of the poverty
468 
line for a family of the size involved. Such in-
sured shall be deemed to be a specified enrollee 
for each month in such plan year.’’. 
(b) OPEN ENROLLMENTS APPLICABLE TO CERTAIN 
LOWER-INCOME POPULATIONS.—Section 1311(c) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18031(c)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) with respect to a qualified health plan 
with respect to which section 1402 applies, for 
months occurring during the period beginning 
on January 1, 2022, and ending on December 
31, 2025, enrollment periods described in sub-
paragraph (A) of paragraph (8) for individuals 
described in subparagraph (B) of such para-
graph.’’; and 
(2) by adding at the end the following new 
paragraph:
469 
‘‘(8) SPECIAL ENROLLMENT PERIOD FOR CER-
TAIN LOW-INCOME POPULATIONS.— 
‘‘(A) IN GENERAL.—The enrollment period 
described in this paragraph is, in the case of an 
individual described in subparagraph (B), the 
continuous period beginning on the first day 
that such individual is so described. 
‘‘(B) INDIVIDUAL
DESCRIBED.—For pur-
poses of subparagraph (A), an individual de-
scribed in this subparagraph is an individual— 
‘‘(i) with a household income that 
does not exceed 138 percent of the poverty 
line for a family of the size involved; and 
‘‘(ii) who is not eligible for minimum 
essential coverage (as defined in section 
5000A(f) of the Internal Revenue Code of 
1986), other than for coverage described in 
any of subparagraphs (B) through (E) of 
paragraph (1) of such section.’’. 
(c) ADDITIONAL BENEFITS FOR CERTAIN LOW-IN-
COME INDIVIDUALS FOR PLAN YEARS 2024 AND 2025.— 
Section 1301(a) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18021(a)) is amended— 
(1) in paragraph (1)—
470 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C)(iv), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) provides, with respect to a plan of-
fered in the silver level of coverage to which sec-
tion 1402 applies during plan year 2024 and 
2025, for benefits described in paragraph (5) in 
the case of an individual who has a household 
income that does not exceed 138 percent of the 
poverty line for a family of the size involved, 
and who is eligible to receive cost-sharing re-
ductions under section 1402.’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) ADDITIONAL
BENEFITS
FOR
CERTAIN 
LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2024 AND 
2025.— 
‘‘(A) IN GENERAL.— 
‘‘(i) BENEFITS.—For purposes of 
paragraph (1)(D), the benefits described in 
this paragraph to be provided by a quali-
471 
fied health plan are benefits consisting 
of— 
‘‘(I) 
non-emergency 
medical 
transportation services (as described 
in section 1902(a)(4) of the Social Se-
curity Act) for which Federal pay-
ments would have been available 
under title XIX of the Social Security 
Act had such services been furnished 
to an individual enrolled under a 
State plan (or waiver of such plan) 
under such title; and 
‘‘(II) services described in sub-
section (a)(4)(C) of section 1905 of 
such Act for which Federal payments 
would have been so available; 
which are not otherwise provided under 
such plan as part of the essential health 
benefits package described in section 
1302(a). 
‘‘(ii) CONDITION
ON
PROVISION
OF 
BENEFITS.—Benefits described in this 
paragraph shall be provided— 
‘‘(I) without any restriction on 
the choice of a qualified provider from
472 
whom an individual may receive such 
benefits; and 
‘‘(II) without any imposition of 
cost sharing. 
‘‘(B) PAYMENTS FOR ADDITIONAL BENE-
FITS.— 
‘‘(i) IN
GENERAL.—An issuer of a 
qualified health plan making payments for 
services described in subparagraph (A) fur-
nished to individuals described in para-
graph (1)(D) during plan year 2024 or 
2025 shall notify the Secretary of such 
payments and the Secretary shall, out of 
funds made available under clause (ii), 
make periodic and timely payments to the 
issuer equal to payments for such services 
so furnished. 
‘‘(ii) APPROPRIATION.—In addition to 
amounts otherwise available, there is ap-
propriated, out of any money in the Treas-
ury not otherwise appropriated, such sums 
as may be necessary to the Secretary to 
make payments under clause (i).’’. 
(d) EDUCATION AND OUTREACH ACTIVITIES.——
473 
(1) IN GENERAL.—Section 1321(c) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) OUTREACH
AND
EDUCATIONAL
ACTIVI-
TIES.— 
‘‘(A) IN GENERAL.—In the case of an Ex-
change established or operated by the Secretary 
within a State pursuant to this subsection, the 
Secretary shall carry out outreach and edu-
cational activities for purposes of informing in-
dividuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) of the Social Security 
Act who reside in States that have not ex-
pended amounts under a State plan (or waiver 
of such plan) under title XIX of such Act for 
all such individuals about qualified health plans 
offered through the Exchange, including by in-
forming such individuals of the availability of 
coverage under such plans and financial assist-
ance for coverage under such plans. Such out-
reach and educational activities shall be pro-
vided in a manner that is culturally and linguis-
tically appropriate to the needs of the popu-
lations being served by the Exchange (including
474 
hard-to-reach populations, such as racial and 
sexual minorities, limited English proficient 
populations, individuals residing in areas where 
the unemployment rates exceeds the national 
average unemployment rate, individuals in rural 
areas, veterans, and young adults). 
‘‘(B) LIMITATION ON USE OF FUNDS.—No 
funds appropriated under this paragraph shall 
be used for expenditures for promoting non- 
ACA compliant health insurance coverage. 
‘‘(C) NON-ACA COMPLIANT HEALTH INSUR-
ANCE
COVERAGE.—For purposes of subpara-
graph (B): 
‘‘(i) The term ‘non-ACA compliant 
health insurance coverage’ means health 
insurance coverage, or a group health plan, 
that is not a qualified health plan. 
‘‘(ii) Such term includes the following: 
‘‘(I) An association health plan. 
‘‘(II) Short-term limited duration 
insurance. 
‘‘(D) FUNDING.—In addition to amounts 
otherwise available, there is appropriated, out of 
any money in the Treasury not otherwise ap-
propriated, to remain available until expended,
475 
$105,000,000 for fiscal year 2022 to carry out 
this paragraph, of which— 
‘‘(i) $15,000,000 shall be used to 
carry out this paragraph in fiscal year 
2022; and 
‘‘(ii) $30,000,000 shall be used to 
carry out this paragraph for each of fiscal 
years 2023 through 2025.’’. 
(2) NAVIGATOR PROGRAM.—Section 1311(i)(6) 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(i)(6)) is amended— 
(A) 
by 
striking 
‘‘FUNDING.—Grants 
under’’ and inserting ‘‘FUNDING.— 
‘‘(A) STATE EXCHANGES.—Grants under’’; 
and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) FEDERAL
EXCHANGES.—For pur-
poses of carrying out this subsection, with re-
spect to an Exchange established and operated 
by the Secretary within a State pursuant to sec-
tion 1321(c), the Secretary shall obligate not 
less than $10,000,000 out of amounts collected 
through the user fees on participating health in-
surance issuers pursuant to section 156.50 of
476 
title 45, Code of Federal Regulations (or any 
successor regulations) for fiscal year 2022, and 
not less than $20,000,000 for each of fiscal 
years 2023, 2024, and 2025. Such amount so 
obligated for a fiscal year shall remain available 
until expended.’’. 
(e) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Secretary of Health 
and Human Services for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated, 
$65,000,000, to remain available until expended, for pur-
poses of carrying out the provisions of, and the amend-
ments made by, this section, section 30602, and section 
30603. 
SEC. 30602. ESTABLISHING A HEALTH INSURANCE AFFORD-
ABILITY FUND. 
(a) IN GENERAL.—Subtitle D of title I of the Patient 
Protection and Affordable Care Act is amended by insert-
ing after section 1343 (42 U.S.C. 18063) the following 
new part: 
‘‘PART 6—IMPROVE HEALTH INSURANCE 
AFFORDABILITY FUND 
‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM. 
‘‘There is hereby established the ‘Improve Health In-
surance Affordability Fund’ to be administered by the Sec-
477 
retary of Health and Human Services, acting through the 
Administrator of the Centers for Medicare & Medicaid 
Services (in this section referred to as the ‘Adminis-
trator’), to provide funding, in accordance with this part, 
to the 50 States and the District of Columbia (each re-
ferred to in this section as a ‘State’) beginning on January 
1, 2023, for the purposes described in section 1352. 
‘‘SEC. 1352. USE OF FUNDS. 
‘‘(a) IN GENERAL.—A State shall use the funds allo-
cated to the State under this part for one of the following 
purposes: 
‘‘(1) To provide reinsurance payments to health 
insurance issuers with respect to individuals enrolled 
under individual health insurance coverage (other 
than through a plan described in subsection (b)) of-
fered by such issuers. 
‘‘(2) To provide assistance (other than through 
payments described in paragraph (1)) to reduce out- 
of-pocket costs, such as copayments, coinsurance, 
premiums, and deductibles, of individuals enrolled 
under qualified health plans offered on the indi-
vidual market through an Exchange and of individ-
uals enrolled under standard health plans offered 
through a basic health program established under 
section 1331.
478 
‘‘(b) EXCLUSION
OF CERTAIN GRANDFATHERED 
PLANS, 
TRANSITIONAL
PLANS, 
STUDENT
HEALTH 
PLANS, AND EXCEPTED BENEFITS.—For purposes of 
subsection (a), a plan described in this subsection is the 
following: 
‘‘(1) A grandfathered health plan (as defined in 
section 1251). 
‘‘(2) A plan (commonly referred to as a ‘transi-
tional plan’) continued under the letter issued by the 
Centers for Medicare & Medicaid Services on No-
vember 14, 2013, to the State Insurance Commis-
sioners outlining a transitional policy for coverage in 
the individual and small group markets to which sec-
tion 1251 does not apply, and under the extension 
of the transitional policy for such coverage set forth 
in the Insurance Standards Bulletin Series guidance 
issued by the Centers for Medicare & Medicaid Serv-
ices on March 5, 2014, February 29, 2016, Feb-
ruary 13, 2017, April 9, 2018, March 25, 2019, 
January 31, 2020, and January 19, 2021, or under 
any subsequent extensions thereof. 
‘‘(3) Student health insurance coverage (as de-
fined in section 147.145 of title 45, Code of Federal 
Regulations, or any successor regulation).
479 
‘‘(4) Excepted benefits (as defined in section 
2791(c) of the Public Health Service Act). 
‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
SAFEGUARD. 
‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLOCA-
TIONS.— 
‘‘(1) IN GENERAL.—Subject to subsection (b), 
to be eligible for an allocation of funds under this 
part for a year (beginning with 2023), a State shall 
submit to the Administrator an application at such 
time (but, in the case of allocations for 2023, not 
later than 120 days after the date of the enactment 
of this part and, in the case of allocations for a sub-
sequent year, not later than January 1 of the pre-
vious year) and in such form and manner as speci-
fied by the Administrator containing— 
‘‘(A) a description of how the funds will be 
used; and 
‘‘(B) such other information as the Admin-
istrator may require. 
‘‘(2) AUTOMATIC APPROVAL.—An application so 
submitted is approved (as outlined in the terms of 
the plan) unless the Administrator notifies the State 
submitting the application, not later than 90 days 
after the date of the submission of such application,
480 
that the application has been denied for not being in 
compliance with any requirement of this part and of 
the reason for such denial. 
‘‘(3) SUBSEQUENT
YEAR
APPLICATION
AP-
PROVAL.—If an application of a State is approved 
for a purpose described in section 1352 for a year, 
such application shall be treated as approved for 
such purpose for each of subsequent year through 
2025. 
‘‘(4) OVERSIGHT AUTHORITY AND AUTHORITY 
TO REVOKE APPROVAL.— 
‘‘(A) OVERSIGHT.—The Secretary may 
conduct periodic reviews of the use of funds 
provided to a State under this section, with re-
spect to a purpose described in section 1352, to 
ensure the State uses such funds for such pur-
pose and otherwise complies with the require-
ments of this section. 
‘‘(B) REVOCATION
OF
APPROVAL.—The 
approval of an application of a State, with re-
spect to a purpose described in section 1352, 
may be revoked if the State fails to use funds 
provided to the State under this section for 
such purpose or otherwise fails to comply with 
the requirements of this section.
481 
‘‘(b) DEFAULT FEDERAL SAFEGUARD
FOR 2023, 
2024, AND 2025 FOR CERTAIN STATES.— 
‘‘(1) IN GENERAL.—For 2023, 2024, and 2025, 
in the case of a State described in paragraph (5), 
with respect to such year, the State shall not be eli-
gible to submit an application under subsection (a), 
and the Administrator, in consultation with the ap-
plicable State authority, shall from the amount cal-
culated under paragraph (3) for such year, carry out 
the purpose described in paragraph (2) in such State 
for such year. 
‘‘(2) SPECIFIED USE.—The amount described 
in paragraph (3), with respect to a State described 
in paragraph (5) for 2023, 2024, or 2025, shall be 
used to carry out the purpose described in section 
1352(a)(1) in such State for such year, as applica-
ble, by providing reinsurance payments to health in-
surance issuers with respect to attachment range 
claims (as defined in section 1354(b)(2), using the 
dollar amounts specified in subparagraph (B) of 
such section for such year) in an amount equal to, 
subject to paragraph (4), the percentage (specified 
for such year by the Secretary under such subpara-
graph) of the amount of such claims.
482 
‘‘(3) AMOUNT
DESCRIBED.—The amount de-
scribed in this paragraph, with respect to 2023, 
2024, or 2025, is the amount equal to the total sum 
of amounts that the Secretary would otherwise esti-
mate under section 1354(b)(2)(A)(i) for such year 
for each State described in paragraph (5) for such 
year, as applicable, if each such State were not so 
described for such year. 
‘‘(4) ADJUSTMENT.—For purposes of this sub-
section, the Secretary may apply a percentage under 
paragraph (3) with respect to a year that is less 
than the percentage otherwise specified in section 
1354(b)(2)(B) for such year, if the cost of paying 
the total eligible attachment range claims for States 
described in paragraph (5) for such year at such 
percentage otherwise specified would exceed the 
amount calculated under paragraph (3) for such 
year. 
‘‘(5) STATE DESCRIBED.—A State described in 
this paragraph, with respect to years 2023, 2024, 
and 2025, is a State that, as of January 1 of 2022, 
2023, or 2024, respectively, was not expending 
amounts under the State plan (or waiver of such 
plan) for all individuals described in section 
1902(a)(10)(A)(i)(VIII) during such year.
483 
‘‘SEC. 1354. ALLOCATIONS. 
‘‘(a) APPROPRIATION.—In addition to amounts oth-
erwise available, there is appropriated, out of any money 
in 
the 
Treasury 
not 
otherwise 
appropriated, 
$10,000,000,000 for 2023 and each subsequent year 
through 2025 to provide allocations for States under sub-
section (b) and payments under section 1353(b). 
‘‘(b) ALLOCATIONS.— 
‘‘(1) PAYMENT.— 
‘‘(A) IN GENERAL.—From amounts appro-
priated under subsection (a) for a year, the 
Secretary shall, with respect to a State not de-
scribed in section 1353(b) for such year and 
not later than the date specified under subpara-
graph (B) for such year, allocate for such State 
the amount determined for such State and year 
under paragraph (2). 
‘‘(B) SPECIFIED DATE.—For purposes of 
subparagraph (A), the date specified in this 
subparagraph is— 
‘‘(i) for 2023, the date that is 90 days 
after the date of the enactment of this 
part; and 
‘‘(ii) for 2024 or 2025, January 1 of 
the previous year.
484 
‘‘(C) 
NOTIFICATIONS
OF
ALLOCATION 
AMOUNTS.—For 2024 and 2025, the Secretary 
shall notify each State of the amount deter-
mined for such State under paragraph (2) for 
such year by not later than January 1 of the 
previous year. 
‘‘(2) 
ALLOCATION
AMOUNT
DETERMINA-
TIONS.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the amount determined under this 
paragraph for a year for a State described in 
paragraph (1)(A) for such year is the amount 
equal to— 
‘‘(i) the amount that the Secretary es-
timates would be expended under this part 
for such year on attachment range claims 
of individuals residing in such State if such 
State used such funds only for the purpose 
described in paragraph (1) of section 
1352(a) at the dollar amounts and per-
centage specified under subparagraph (B) 
for such year; minus 
‘‘(ii) the amount, if any, by which the 
Secretary determines—
485 
‘‘(I) the estimated amount of 
premium tax credits under section 
36B of the Internal Revenue Code of 
1986 that would be attributable to in-
dividuals residing in such State for 
such year without application of this 
part; exceeds 
‘‘(II) the estimated amount of 
premium tax credits under section 
36B of the Internal Revenue Code of 
1986 that would be attributable to in-
dividuals residing in such State for 
such year if section 1353(b) applied 
for such year and applied with respect 
to such State for such year. 
For purposes of the previous sentence and sec-
tion 1353(b)(3), the term ‘attachment range 
claims’ means, with respect to an individual, the 
claims for such individual that exceed a dollar 
amount specified by the Secretary for a year, 
but do not exceed a ceiling dollar amount speci-
fied by the Secretary for such year, under sub-
paragraph (B). 
‘‘(B) SPECIFICATIONS.—For purposes of 
subparagraph (A) and section 1353(b)(3), the
486 
Secretary shall determine the dollar amounts 
and the percentage to be specified under this 
subparagraph for a year in a manner to ensure 
that the total amount of expenditures under 
this part for such year is estimated to equal the 
total amount appropriated for such year under 
subsection (a) if such expenditures were used 
solely for the purpose described in paragraph 
(1) of section 1352(a) for attachment range 
claims at the dollar amounts and percentage so 
specified for such year. 
‘‘(3) AVAILABILITY.—Funds allocated to a 
State under this subsection for a year shall remain 
available through the end of the subsequent year.’’. 
(b) BASIC HEALTH PROGRAM FUNDING ADJUST-
MENTS.—Section 1331 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18051) is amended— 
(1) in subsection (a), by adding at the end the 
following new paragraph: 
‘‘(3) PROVISION OF INFORMATION ON QUALI-
FIED HEALTH PLAN PREMIUMS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2023, the program 
described in paragraph (1) shall provide that a 
State may not establish a basic health program
487 
unless such State furnishes to the Secretary, 
with respect to each qualified health plan of-
fered in such State during a year that receives 
any reinsurance payment from funds made 
available under part 6 for such year, the ad-
justed premium amount (as defined in subpara-
graph (B)) for each such plan and year. 
‘‘(B) ADJUSTED
PREMIUM
AMOUNT
DE-
FINED.—For purposes of subparagraph (A), the 
term ‘adjusted premium amount’ means, with 
respect to a qualified health plan and a year, 
the monthly premium for such plan and year 
that would have applied had such plan not re-
ceived any payments described in subparagraph 
(A) for such year.’’; and 
(2) in subsection (d)(3)(A)(ii), by adding at the 
end the following new sentence: ‘‘In making such de-
termination, the Secretary shall calculate the value 
of such premium tax credits that would have been 
provided to such individuals enrolled through a basic 
health program established by a State during a year 
using the adjusted premium amounts (as defined in 
subsection (a)(3)(B)) for qualified health plans of-
fered in such State during such year.’’.
488 
(c) IMPLEMENTATION AUTHORITY.—The Secretary 
of Health and Human Services may implement the provi-
sions of, and the amendments made by, this section by 
subregulatory guidance or otherwise. 
SEC. 30603. FUNDING FOR THE PROVISION OF HEALTH IN-
SURANCE CONSUMER INFORMATION. 
Section 2793(e) of the Public Health Service Act (42 
U.S.C. 300gg–93(e)) is amended by adding at the end the 
following new paragraph: 
‘‘(3) FUNDING
FOR
2022
THROUGH
2025.—In 
addition to amounts otherwise available, there is ap-
propriated, out of any money in the Treasury not 
otherwise appropriated, $100,000,000 for 2022, to 
remain 
available 
until 
expended, 
of 
which 
$25,000,000 shall be used for each of 2022 through 
2025 to carry out this section.’’. 
SEC. 30604. REQUIREMENTS WITH RESPECT TO COST-SHAR-
ING FOR INSULIN PRODUCTS. 
(a) IN GENERAL.—Part D of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–111 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 2799A–11. REQUIREMENTS WITH RESPECT TO COST- 
SHARING FOR CERTAIN INSULIN PRODUCTS. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2023, a group health plan or health in-
489 
surance issuer offering group or individual health insur-
ance coverage shall provide coverage of selected insulin 
products, and with respect to such products, shall not— 
‘‘(1) apply any deductible; or 
‘‘(2) impose any cost-sharing in excess of the 
lesser of, per 30-day supply— 
‘‘(A) $35; or 
‘‘(B) the amount equal to 25 percent of 
the negotiated price of the selected insulin prod-
uct net of all price concessions received by or on 
behalf of the plan or coverage, including price 
concessions received by or on behalf of third- 
party entities providing services to the plan or 
coverage, such as pharmacy benefit manage-
ment services. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) SELECTED INSULIN PRODUCTS.—The term 
‘selected insulin products’ means at least one of each 
dosage form (such as vial, pump, or inhaler dosage 
forms) of each different type (such as rapid-acting, 
short-acting, intermediate-acting, long-acting, ultra 
long-acting, and premixed) of insulin (as defined 
below), when available, as selected by the group 
health plan or health insurance issuer.
490 
‘‘(2) INSULIN
DEFINED.—The term ‘insulin’ 
means insulin that is licensed under subsection (a) 
or (k) of section 351 and continues to be marketed 
under such section, including any insulin product 
that has been deemed to be licensed under section 
351(a) pursuant to section 7002(e)(4) of the Bio-
logics Price Competition and Innovation Act of 2009 
and continues to be marketed pursuant to such li-
censure. 
‘‘(c) OUT-OF-NETWORK
PROVIDERS.—Nothing in 
this section requires a plan or issuer that has a network 
of providers to provide benefits for selected insulin prod-
ucts described in this section that are delivered by an out- 
of-network provider, or precludes a plan or issuer that has 
a network of providers from imposing higher cost-sharing 
than the levels specified in subsection (a) for selected insu-
lin products described in this section that are delivered 
by an out-of-network provider. 
‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 
not be construed to require coverage of, or prevent a group 
health plan or health insurance coverage from imposing 
cost-sharing other than the levels specified in subsection 
(a) on, insulin products that are not selected insulin prod-
ucts, to the extent that such coverage is not otherwise re-
491 
quired and such cost-sharing is otherwise permitted under 
Federal and applicable State law. 
‘‘(e) APPLICATION
OF
COST-SHARING
TOWARDS 
DEDUCTIBLES
AND OUT-OF-POCKET MAXIMUMS.—Any 
cost-sharing payments made pursuant to subsection (a)(2) 
shall be counted toward any deductible or out-of-pocket 
maximum that applies under the plan or coverage.’’. 
(b) NO EFFECT ON OTHER COST-SHARING.—Section 
1302(d)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(d)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(D) SPECIAL RULE RELATING TO INSU-
LIN COVERAGE.—The exemption of coverage of 
selected insulin products (as defined in section 
2799A–11(b) of the Public Health Service Act) 
from the application of any deductible pursuant 
to section 2799A–11(a)(1) of such Act, section 
726(a)(1) of the Employee Retirement Income 
Security Act of 1974, or section 9826(a)(1) of 
the Internal Revenue Code of 1986 shall not be 
considered when determining the actuarial value 
of a qualified health plan under this sub-
section.’’. 
(c) COVERAGE
OF CERTAIN INSULIN PRODUCTS 
UNDER CATASTROPHIC PLANS.—Section 1302(e) of the
492 
Patient Protection and Affordable Care Act (42 U.S.C. 
18022(e)) is amended by adding at the end the following: 
‘‘(4) COVERAGE
OF
CERTAIN
INSULIN
PROD-
UCTS.— 
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1)(B)(i), a health plan described in 
paragraph (1) shall provide coverage of selected 
insulin products, in accordance with section 
2799A–11 of the Public Health Service Act, for 
a plan year before an enrolled individual has in-
curred cost-sharing expenses in an amount 
equal to the annual limitation in effect under 
subsection (c)(1) for the plan year. 
‘‘(B) TERMINOLOGY.—For purposes of 
subparagraph (A)— 
‘‘(i) the term ‘selected insulin prod-
ucts’ has the meaning given such term in 
section 2799A–11(b) of the Public Health 
Service Act; and 
‘‘(ii) the requirements of section 
2799A–11 of such Act shall be applied by 
deeming each reference in such section to 
‘individual health insurance coverage’ to be 
a reference to a plan described in para-
graph (1).’’.
493 
SEC. 30605. COST-SHARING REDUCTIONS FOR INDIVIDUALS 
RECEIVING 
UNEMPLOYMENT 
COMPENSA-
TION. 
Section 1402(f) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071(f)) is amended— 
(1) in the header, by striking ‘‘2021’’ and in-
serting ‘‘CERTAIN YEARS’’; 
(2) in the matter preceding paragraph (1), by 
striking ‘‘2021’’ and inserting ‘‘any of years 2021 
through 2022’’; and 
(3) in paragraph (2), by striking ‘‘133 percent’’ 
and inserting ‘‘150 percent’’. 
SEC. 30606. OVERSIGHT OF PHARMACY BENEFIT MANAGER 
SERVICES. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.), as amended by sec-
tion 30604, is further amended— 
(1) in part D (42 U.S.C. 300gg–111 et seq.), 
by adding at the end the following new section: 
‘‘SEC. 2799A–12. OVERSIGHT OF PHARMACY BENEFIT MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2023, a group health plan or health in-
surance issuer offering group health insurance coverage 
or an entity or subsidiary providing pharmacy benefits 
management services on behalf of such a plan or issuer
494 
shall not enter into a contract with a drug manufacturer, 
distributor, wholesaler, subcontractor, rebate aggregator, 
or any associated third party that limits the disclosure of 
information to plan sponsors in such a manner that pre-
vents the plan or issuer, or an entity or subsidiary pro-
viding pharmacy benefits management services on behalf 
of a plan or issuer, from making the reports described in 
subsection (b). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2023, not less frequently 
than once every 6 months, a health insurance issuer 
offering group health insurance coverage or an enti-
ty providing pharmacy benefits management services 
on behalf of a group health plan or an issuer pro-
viding group health insurance coverage shall submit 
to the plan sponsor (as defined in section 3(16)(B) 
of the Employee Retirement Income Security Act of 
1974) of such group health plan or health insurance 
coverage a report in accordance with this subsection 
and make such report available to the plan sponsor 
in a machine-readable format. Each such report 
shall include, with respect to the applicable group 
health plan or health insurance coverage—
496 
‘‘(iii) the wholesale acquisition cost, 
listed as cost per days supply and cost per 
pill, or in the case of a drug in another 
form, per dose; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; and 
‘‘(v) for any drug for which gross 
spending of the group health plan or 
health 
insurance 
coverage 
exceeded 
$10,000 during the reporting period— 
‘‘(I) a list of all other drugs in 
the same therapeutic category or 
class, including brand name drugs 
and biological products and generic 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
‘‘(II) the rationale for preferred 
formulary placement of such drug in 
that therapeutic category or class; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the
497 
health plan or health insurance coverage during 
the reporting period, and, with respect to each 
such therapeutic category or class of drugs, 
during the reporting period— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who filled a prescription for a 
drug in that category or class; 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization mechanisms (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
‘‘(v) for each therapeutic category or 
class under which 3 or more drugs are in-
cluded on the formulary of such plan or 
coverage—
498 
‘‘(I) the amount received, or ex-
pected to be received, from drug man-
ufacturers in rebates, fees, alternative 
discounts, or other remuneration— 
‘‘(aa) to be paid by drug 
manufacturers for claims in-
curred during the reporting pe-
riod; or 
‘‘(bb) that is related to utili-
zation of drugs, in such thera-
peutic category or class; 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
alternative discounts or other remu-
neration from drug manufacturers, by 
the health plan or health insurance 
coverage on that category or class of 
drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
day supply or 90-day supply, incurred 
by the health plan or health insurance 
coverage and its participants and 
beneficiaries, after manufacturer re-
bates, fees, and other remuneration
499 
for drugs dispensed within such thera-
peutic category or class during the re-
porting period; 
‘‘(D) total gross spending on prescription 
drugs by the plan or coverage during the re-
porting period, before rebates and other manu-
facturer fees or remuneration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan or health insur-
ance coverage in drug manufacturer rebates, 
fees, alternative discounts, and all other remu-
neration received from the manufacturer or any 
third party, other than the plan sponsor, re-
lated to utilization of drug or drug spending 
under that health plan or health insurance cov-
erage during the reporting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan or health insurance 
coverage during the reporting period; and 
‘‘(G) amounts paid directly or indirectly in 
rebates, fees, or any other type of remuneration 
to brokers, consultants, advisors, or any other 
individual or firm who referred the group health 
plan’s or health insurance issuer’s business to 
the pharmacy benefit manager.
500 
‘‘(2) PRIVACY REQUIREMENTS.—Health insur-
ance issuers offering group health insurance cov-
erage and entities providing pharmacy benefits man-
agement services on behalf of a group health plan 
shall provide information under paragraph (1) in a 
manner consistent with the privacy, security, and 
breach notification regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, and shall restrict 
the use and disclosure of such information according 
to such privacy regulations. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
this section prevents a health insurance issuer 
offering group health insurance coverage or an 
entity providing pharmacy benefits management 
services on behalf of a group health plan from 
placing reasonable restrictions on the public dis-
501 
closure of the information contained in a report 
described in paragraph (1), except that such 
issuer or entity may not restrict disclosure of 
such report to the Department of Health and 
Human Services, the Department of Labor, or 
the Department of the Treasury. 
‘‘(C) LIMITED
FORM
OF
REPORT.—The 
Secretary shall define through rulemaking a 
limited form of the report under paragraph (1) 
required of plan sponsors who are drug manu-
facturers, drug wholesalers, or other direct par-
ticipants in the drug supply chain, in order to 
prevent anti-competitive behavior. 
‘‘(4) REPORT
TO
GAO.—A health insurance 
issuer offering group health insurance coverage or 
an entity providing pharmacy benefits management 
services on behalf of a group health plan shall sub-
mit to the Comptroller General of the United States 
each of the first 4 reports submitted to a plan spon-
sor under paragraph (1) with respect to such cov-
erage or plan, and other such reports as requested, 
in accordance with the privacy requirements under 
paragraph (2) and the disclosure and redisclosure 
standards under paragraph (3), and such other in-
formation that the Comptroller General determines
502 
necessary to carry out the study under section 
30606(b) of An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
‘‘(2) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—A health insurance issuer or an entity pro-
viding pharmacy benefit management services that 
violates subsection (a) or fails to provide information 
required under subsection (b), or a drug manufac-
turer that fails to provide information under sub-
section (b)(1)(A) in a timely manner, shall be sub-
ject to a civil monetary penalty in the amount of 
$10,000 for each day during which such violation 
continues or such information is not disclosed or re-
ported. 
‘‘(3) FALSE INFORMATION.—A health insurance 
issuer, entity providing pharmacy benefit manage-
ment services, or drug manufacturer that knowingly 
provides false information under this section shall be 
subject to a civil money penalty in an amount not 
to exceed $100,000 for each item of false informa-
503 
tion. Such civil money penalty shall be in addition to 
other penalties as may be prescribed by law. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of sub-
section (c)(1) of such section shall apply to civil 
monetary penalties under this subsection in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A of the Social Se-
curity Act. 
‘‘(5) WAIVERS.—The Secretary may waive pen-
alties under paragraph (2), or extend the period of 
time for compliance with a requirement of this sec-
tion, for an entity in violation of this section that 
has made a good-faith effort to comply with this sec-
tion. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit a health insurance issuer, 
group health plan, or other entity to restrict disclosure to, 
or otherwise limit the access of, the Department of Health 
and Human Services to a report described in subsection 
(b)(1) or information related to compliance with sub-
section (a) by such issuer, plan, or entity.
504 
‘‘(e) DEFINITION.—In this section, the term ‘whole-
sale acquisition cost’ has the meaning given such term in 
section 1847A(c)(6)(B) of the Social Security Act.’’; and 
(2) in section 2723 (42 U.S.C. 300gg–22)— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; 
(B) in subsection (b)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; 
(ii) in paragraph (2)(A), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; and 
(iii) in paragraph (2)(C)(ii), by insert-
ing ‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’. 
(b) GAO STUDY.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of enactment of this Act, the Comptroller
505 
General of the United States shall report to Con-
gress on— 
(A) pharmacy networks of group health 
plans, health insurance issuers, and entities 
providing pharmacy benefit management serv-
ices under such group health plan or group or 
individual health insurance coverage, including 
networks that have pharmacies that are under 
common ownership (in whole or part) with 
group health plans, health insurance issuers, or 
entities providing pharmacy benefit manage-
ment services or pharmacy benefit administra-
tive services under group health plan or group 
or individual health insurance coverage; 
(B) as it relates to pharmacy networks 
that include pharmacies under common owner-
ship described in subparagraph (A)— 
(i) whether such networks are de-
signed to encourage enrollees of a plan or 
coverage to use such pharmacies over other 
network pharmacies for specific services or 
drugs, and if so, the reasons the networks 
give for encouraging use of such phar-
macies; and
506 
(ii) whether such pharmacies are used 
by enrollees disproportionately more in the 
aggregate or for specific services or drugs 
compared to other network pharmacies; 
(C) whether group health plans and health 
insurance issuers offering group or individual 
health insurance coverage have options to elect 
different network pricing arrangements in the 
marketplace with entities that provide phar-
macy benefit management services, the preva-
lence of electing such different network pricing 
arrangements; 
(D) pharmacy network design parameters 
that encourage enrollees in the plan or coverage 
to fill prescriptions at mail order, specialty, or 
retail pharmacies that are wholly or partially- 
owned by that issuer or entity; and 
(E) the degree to which mail order, spe-
cialty, or retail pharmacies that dispense pre-
scription drugs to an enrollee in a group health 
plan or health insurance coverage that are 
under common ownership (in whole or part) 
with group health plans, health insurance 
issuers, or entities providing pharmacy benefit 
management services or pharmacy benefit ad-
507 
ministrative services under group health plan or 
group or individual health insurance coverage 
receive reimbursement that is greater than the 
median price charged to the group health plan 
or health insurance issuer when the same drug 
is dispensed to enrollees in the plan or coverage 
by other pharmacies included in the pharmacy 
network of that plan, issuer, or entity that are 
not wholly or partially owned by the health in-
surance issuer or entity providing pharmacy 
benefit management services. 
(2) REQUIREMENT.—The Comptroller General 
of the United States shall ensure that the report 
under paragraph (1) does not contain information 
that would allow a reader to identify a specific plan 
or entity providing pharmacy benefits management 
services or otherwise contain commercial or financial 
information that is privileged or confidential. 
(3) DEFINITIONS.—In this subsection, the 
terms ‘‘group health plan’’, ‘‘health insurance cov-
erage’’, and ‘‘health insurance issuer’’ have the 
meanings given such terms in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg–91).
508 
SEC. 30607. FUNDING TO SUPPORT STATE APPLICATIONS 
FOR SECTION 1332 WAIVERS AND ADMINIS-
TRATION. 
Section 1332 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18052) is amended by adding 
at the end the following: 
‘‘(f) ADMINISTRATION AND PLANNING GRANTS.— 
‘‘(1) APPROPRIATION.—In addition to any other 
amounts made available, there is appropriated to the 
Secretary of Health and Human Services for fiscal 
year 2022, out of any amounts in the Treasury not 
otherwise appropriated, $50,000,000, to remain 
available until expended, for purposes of imple-
menting the grant program under paragraph (2) and 
awarding grants under such paragraph. 
‘‘(2) GRANTS.—From the amount appropriated 
under paragraph (1), the Secretary of Health and 
Human Services shall award grants to States for 
purposes of developing a new waiver application, 
preparing an application for a waiver extension or 
amendment, or implementing a State plan under 
this section. The amount of a grant awarded to a 
State under this subsection shall remain available 
until expended.
509 
‘‘(3) LIMITATION.—Each grant awarded to a 
State under this subsection shall be in an amount 
not to exceed $5,000,000.’’. 
SEC. 30608. ADJUSTMENTS TO UNCOMPENSATED CARE 
POOLS AND DISPROPORTIONATE SHARE HOS-
PITAL PAYMENTS. 
(a) ADJUSTMENTS
TO
UNCOMPENSATED
CARE 
POOLS.—Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(cc) EXCLUDING EXPENDITURES FOR EXPANSION 
POPULATION FROM ASSISTANCE UNDER WAIVERS RE-
LATING TO UNCOMPENSATED CARE.—With respect to a 
State with a State plan (or waiver of such plan) that does 
not provide, with respect to a fiscal year (beginning with 
fiscal year 2023), to all individuals described in section 
1902(a)(10)(A)(i)(VIII) benchmark coverage described in 
section 1937(b)(1) or benchmark equivalent coverage de-
scribed in section 1937(b)(2), in the case of any experi-
mental, pilot, or demonstration project undertaken under 
section 1115, with respect to such State and fiscal year, 
that provides for Federal financial participation with re-
spect to expenditures for payments to providers for other-
wise uncompensated care that is furnished to low-income 
individuals, uninsured individuals, or underinsured indi-
510 
viduals, notwithstanding any waiver authority available 
under such section, such project shall exclude from Fed-
eral financial participation any expenditures for care that 
is furnished with respect to such fiscal year to individuals 
described in section 1902(a)(10)(A)(i)(VIII).’’. 
(b) ADJUSTMENTS TO DISPROPORTIONATE SHARE 
HOSPITAL PAYMENTS.— 
(1) IN GENERAL.—Section 1923(f) of the Social 
Security Act (42 U.S.C.1396r–4(f)) is amended— 
(A) in paragraph (3)(A), by striking 
‘‘paragraphs (6), (7), and (8)’’ and inserting 
‘‘paragraphs (6), (7), (8), and (10)’’; 
(B) in paragraph (6)(A)(vi), by inserting 
‘‘(except paragraph (10))’’ before ‘‘, any other 
provision of law’’; 
(C) in paragraph (7)(A)(i), by inserting 
‘‘without regard to paragraph (10),’’ before 
‘‘the Secretary’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(10) STATE DSH ALLOTMENTS FOR NON-EX-
PANSION
STATES
BEGINNING
WITH
FISCAL
YEAR 
2023.— 
‘‘(A) IN GENERAL.—For fiscal year 2023 
and each subsequent fiscal year—
511 
‘‘(i) in the case of a State with a 
State plan (or waiver of such plan) that, 
with respect to such fiscal year, does not 
provide to all individuals described in sec-
tion 1902(a)(10)(A)(i)(VIII) benchmark 
coverage described in section 1937(b)(1) or 
benchmark equivalent coverage described 
in section 1937(b)(2), the Secretary shall 
reduce the DSH allotment to the State for 
such fiscal year in the amount equal to 
12.5 percent of the DSH allotment that 
would (after the application of paragraph 
(6), and without the application of para-
graphs (7), (8), or this paragraph) be de-
termined under this subsection for the 
State for such fiscal year; 
‘‘(ii) in the case of a State with a 
State plan (or waiver of such plan) that, 
with respect to such fiscal year, initially 
provides to all individuals described in sec-
tion 1902(a)(10)(A)(i)(VIII) benchmark 
coverage described in 1937(b)(1) or bench-
mark equivalent coverage described in sec-
tion 1937(b)(2), but during such fiscal 
year stops providing to any such individual
512 
such benchmark or benchmark equivalent 
coverage, the Secretary shall reduce the 
DSH allotment to the State for such fiscal 
year in the amount equal to the product 
of— 
‘‘(I) 12.5 percent of the DSH al-
lotment that would (after the applica-
tion of paragraph (6), and without the 
application of paragraphs (7), (8), or 
this paragraph) be determined under 
this subsection for the State for such 
fiscal year; and 
‘‘(II) expressed as a percentage, 
the number of days of such fiscal year 
during which such State plan (or 
waiver of such plan), with respect to 
such fiscal year, did not provide to 
such individuals such benchmark or 
benchmark equivalent coverage; or 
‘‘(iii) in the case of a State with a 
State plan (or waiver of such plan) that, 
with respect to such fiscal year, either— 
‘‘(I) initially does not provide to 
all individuals described in section 
1902(a)(10)(A)(i)(VIII) 
benchmark
513 
coverage described in 1937(b)(1) or 
benchmark equivalent coverage de-
scribed in section 1937(b)(2), but 
during the fiscal year establishes a 
State plan (or waiver of such plan) 
that provides, for the remainder of the 
fiscal year, all such individuals such 
benchmark or benchmark equivalent 
coverage; or 
‘‘(II) did not provide to all such 
individuals such benchmark or bench-
mark equivalent coverage during the 
fiscal year preceding such fiscal year 
described in the matter preceding sub-
clause (I), but on the first day of such 
fiscal year establishes a State plan (or 
waiver of such plan) that provides, for 
the entirety of such fiscal year, all 
such individuals such benchmark or 
benchmark equivalent coverage; 
the DSH allotment for such State for such 
fiscal year is equal to the DSH allotment 
under this subsection (without application 
of this paragraph) for the State for the en-
tirety of such fiscal year.
514 
‘‘(B) CALCULATION OF DSH ALLOTMENTS 
AFTER EXPANSION PERIOD.—The DSH allot-
ment for a State for fiscal years after which a 
State provides under a State plan (or waiver of 
such plan) to all individuals described in section 
1902(a)(10)(A)(i)(VIII) benchmark coverage 
described in section 1937(b)(1) or benchmark 
equivalent 
coverage 
described 
in 
section 
1937(b)(2) and, for which the State continues 
to provide under the State plan (or waiver of 
such plan) such benchmark or benchmark 
equivalent coverage to such individuals, without 
the providing of such benchmark or benchmark 
equivalent coverage being stopped during a fis-
cal year (as described in the matter preceding 
subclause (I) of subparagraph (A)(ii)), shall be 
calculated under paragraph (3) without regard 
to this paragraph.’’. 
(2) 
TECHNICAL
AMENDMENT.—Section 
1923(f)(7)(A)(i)(II) of the Social Security Act (42 
U.S.C.1396r–4(f)(7)(A)(i)(II)) is amended by add-
ing at period at the end.
515 
SEC. 30609. FURTHER INCREASE IN FMAP FOR MEDICAL AS-
SISTANCE FOR NEWLY ELIGIBLE MANDA-
TORY INDIVIDUALS. 
Section 1905(y)(1) of the Social Security Act (42 
U.S.C. 1396d(y)(1)) is amended— 
(1) in subparagraph (D), by striking at the end 
‘‘and’’; 
(2) in subparagraph (E), by striking ‘‘2020 and 
each year thereafter.’’ and inserting ‘‘2020, 2021, 
and 2022; and’’; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(F) 93 percent for calendar quarters in 
2023, 2024, and 2025; and 
‘‘(G) 90 percent for calendar quarters in 
2026 and each year thereafter.’’. 
Subtitle F—Medicaid 
PART 1—INVESTMENTS IN HOME AND COMMU-
NITY-BASED 
SERVICES 
AND 
LONG-TERM 
CARE QUALITY AND WORKFORCE 
SEC. 30711. HCBS IMPROVEMENT PLANNING GRANTS. 
(a) FUNDING.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise available, there is appropriated to the Sec-
retary for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $130,000,000,
516 
to remain available until expended, for carrying out 
this section. 
(2) TECHNICAL ASSISTANCE AND GUIDANCE.— 
In addition to amounts otherwise available, there is 
appropriated to the Secretary for fiscal year 2022, 
out of any money in the Treasury not otherwise ap-
propriated, $5,000,000, to remain available until ex-
pended, for purposes of issuing guidance and pro-
viding technical assistance to States intending to 
apply for, or which are awarded, a planning grant 
under this section, and for other administrative ex-
penses related to awarding planning grants under 
this section. 
(b) AWARD AND USE OF GRANTS.— 
(1) DEADLINE FOR AWARD OF GRANTS.—From 
the amount appropriated under subsection (a)(1), 
the Secretary, not later than 12 months after the 
date of enactment of this Act, shall solicit State re-
quests for HCBS improvement planning grants and 
award such grants to all States that meet such re-
quirements as determined by the Secretary. 
(2) USE OF FUNDS.—Subject to paragraph (3), 
a State awarded a planning grant under this section 
shall use the grant to carry out planning activities 
for purposes of developing and submitting to the
517 
Secretary an HCBS improvement plan for the State 
that meets the requirements of subsections (c) and 
(d). A State may use planning grant funds to sup-
port activities related to the implementation of the 
HCBS improvement plan for the State, collect and 
report information described in subsection (c), iden-
tify areas for improvement to the service delivery 
systems for home and community-based services, 
carry out activities related to evaluating payment 
rates for home and community-based services and 
identifying improvements to update the rate setting 
process, and make related infrastructure investments 
(such as case management or other information 
technology systems). 
(3) LIMITATION ON USE OF FUNDS.—None of 
the funds awarded to a State under this section may 
be used by a State as the source of the non-Federal 
share of expenditures under the State plan (or waiv-
er of such plan). 
(c) HCBS IMPROVEMENT PLAN REQUIREMENTS.— 
In order to meet the requirements of this subsection, an 
HCBS improvement plan developed using funds awarded 
to a State under this section shall include, with respect 
to the State and subject to subsection (d), the following: 
(1) EXISTING MEDICAID HCBS LANDSCAPE.—
518 
(A) ELIGIBILITY AND BENEFITS.—A de-
scription of the existing standards, pathways, 
and methodologies for eligibility for home and 
community-based services pursuant to the State 
plan (or waiver of such plan), including limits 
on assets and income, the home and commu-
nity-based services available under the State 
Medicaid program and the types of settings in 
which they may be provided, and utilization 
management standards for such services. 
(B) ACCESS.— 
(i) BARRIERS.—A description of the 
barriers to accessing home and community- 
based services in the State identified by 
Medicaid eligible individuals, the families 
of such individuals, and direct care work-
ers and home care agencies, or other simi-
lar organizations. 
(ii) AVAILABILITY; UNMET NEED.—A 
summary, in accordance with guidance 
issued by the Secretary and as able to be 
practicably determined by the State, of the 
extent to which home and community- 
based services are available to all individ-
uals in the State who would be eligible for
519 
such services under the State Medicaid 
program (including individuals who are on 
a waiting list for such services). 
(C) UTILIZATION.—An assessment of the 
utilization of home and community-based serv-
ices in the State (including the number of indi-
viduals receiving such services) during such pe-
riod specified by the Secretary. 
(D) SERVICE DELIVERY STRUCTURES AND 
SUPPORTS.—A description of the service deliv-
ery structures for providing home and commu-
nity-based services in the State. 
(E) WORKFORCE.—A description of the di-
rect care workforce, including estimates of the 
number of full- and part-time direct care work-
ers, the average and range of direct care worker 
wages, the benefits provided to direct care 
workers, and the turnover and vacancy rates of 
direct care worker positions. 
(F) PAYMENT RATES.— 
(i) IN GENERAL.—A description of the 
payment rates for home and community- 
based services, including, to the extent ap-
plicable, how payments for such services 
are factored into the development of man-
520 
aged care capitation rates, when the State 
last updated payment rates for home and 
community-based services, and an estimate 
of the portion of the payment rate that 
goes toward direct care worker compensa-
tion. 
(ii) ASSESSMENT.—An assessment of 
the relationship between payment rates for 
such services and workforce shortages, av-
erage beneficiary wait times for such serv-
ices, and provider-to-beneficiary ratios in 
the geographic region. 
(G) QUALITY.—A description of how the 
quality of home and community-based services 
is measured and monitored. 
(H) LONG-TERM SERVICES AND SUPPORTS 
PROVIDED IN INSTITUTIONAL SETTINGS.—A de-
scription of the number of individuals enrolled 
in the State Medicaid program in a year who 
receive items and services furnished by an insti-
tution for greater than 30 days in an institu-
tional setting. 
(I) HCBS SHARE OF OVERALL MEDICAID 
LTSS SPENDING.—For the most recent State 
fiscal year for which complete data is available,
521 
the percentage of expenditures made by the 
State under the State Medicaid program for 
long-term services and supports that are for 
home and community-based services. 
(J) DEMOGRAPHIC DATA.—To the extent 
available and as applicable with respect to the 
information required under subparagraphs (B), 
(C), and (H), demographic data for such infor-
mation, disaggregated by age groups, primary 
disability, income brackets, gender, race, eth-
nicity, geography, primary language, and type 
of service setting. 
(2) GOALS FOR HCBS IMPROVEMENTS.—A de-
scription of how the State will do the following: 
(A) Conduct the activities required under 
subsection (jj) of section 1905 of the Social Se-
curity Act (as added under section 30712). 
(B) Reduce barriers to and disparities in 
access or utilization of home and community- 
based services in the State. 
(C) Monitor and report on access to home 
and community-based services under the State 
Medicaid program, disparities in access to such 
services, and the utilization of such services.
522 
(D) Monitor and report the amount of 
State Medicaid expenditures for home and com-
munity-based services under the State Medicaid 
program as a proportion of the total amount of 
State expenditures under the State Medicaid 
program for long-term services and supports. 
(E) Monitor and report on wages, benefits, 
and vacancy and turnover rates for direct care 
workers. 
(F) Assess and monitor the sufficiency of 
payment rates under the State Medicaid pro-
gram, in a manner specified by the Secretary, 
for the specific types of home and community- 
based services available under such program for 
purposes of supporting direct care worker re-
cruitment and retention and ensuring the avail-
ability of home and community-based services. 
(G) Coordinate implementation of the 
HCBS improvement plan among the State 
Medicaid agency and State health and human 
services agencies serving individuals with dis-
abilities and the elderly. 
(d) 
DEVELOPMENT
AND
APPROVAL
REQUIRE-
MENTS.—
523 
(1) DEVELOPMENT REQUIREMENTS.—In order 
to meet the requirements of this subsection, a State 
awarded a planning grant under this section shall 
develop an HCBS improvement plan for the State 
through a public notice and comment process that 
includes consultation with Medicaid eligible individ-
uals who are recipients of home and community- 
based services, family caregivers of such recipients, 
providers, health plans, direct care workers, chosen 
representatives of direct care workers, and aging, 
disability, and workforce advocates. 
(2) AUTHORITY
TO
ADJUST
CERTAIN
PLAN 
CONTENT
REQUIREMENTS.—The Secretary may 
modify the requirements for any of the information 
specified in subsection (c)(1) if a State requests a 
modification and demonstrates to the satisfaction of 
the Secretary that it is impracticable for the State 
to collect and submit the information. 
(3) SUBMISSION
AND
APPROVAL.—Not later 
than 24 months after the date on which a State is 
awarded a planning grant under this section, the 
State shall submit an HCBS improvement plan for 
approval by the Secretary, along with assurances by 
the State that the State will implement the plan in 
accordance with the requirements of the HCBS Im-
524 
provement Program established under subsection (jj) 
of section 1905 of the Social Security Act (42 
U.S.C. 1396d) (as added by section 30712). The 
Secretary shall approve and make publicly available 
the HCBS improvement plan for a State after the 
plan and such assurances are submitted to the Sec-
retary for approval and the Secretary determines the 
plan meets the requirements of subsection (c). A 
State may amend its HCBS improvement plan, sub-
ject to the approval of the Secretary that the plan 
as so amended meets the requirements of subsection 
(c). The Secretary may withhold or recoup funds 
provided under this section to a State, if the State 
fails to comply with the requirements of this section. 
(e) DEFINITIONS.—In the part: 
(1) DIRECT CARE WORKER.—The term ‘‘direct 
care worker’’ means, with respect to a State, any of 
the following individuals who are paid to provide di-
rectly to Medicaid eligible individuals home and com-
munity-based services available under the State 
Medicaid program: 
(A) A registered nurse, licensed practical 
nurse, nurse practitioner, or clinical nurse spe-
cialist, or a licensed nursing assistant who pro-
vides such services under the supervision of a
525 
registered nurse, licensed practical nurse, nurse 
practitioner, or clinical nurse specialist. 
(B) A direct support professional. 
(C) A personal care attendant. 
(D) A home health aide. 
(E) Any other paid health care profes-
sional or worker determined to be appropriate 
by the State and approved by the Secretary. 
(2) HCBS PROGRAM IMPROVEMENT STATE.— 
The term ‘‘HCBS program improvement State’’ 
means a State that is awarded a planning grant 
under subsection (b) and has an HCBS improve-
ment plan approved by the Secretary under sub-
section (d)(3). 
(3) HEALTH PLAN.—The term ‘‘health plan’’ 
means any of the following entities that provide or 
arrange for home and community-based services for 
Medicaid eligible individuals who are enrolled with 
the entities under a contract with a State: 
(A) A medicaid managed care organiza-
tion, as defined in section 1903(m)(1)(A) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(1)(A)). 
(B) A prepaid inpatient health plan or pre-
paid ambulatory health plan, as defined in sec-
526 
tion 438.2 of title 42, Code of Federal Regula-
tions (or any successor regulation). 
(4) HOME
AND
COMMUNITY-BASED
SERV-
ICES.—The term ‘‘home and community-based serv-
ices’’ means any of the following (whether provided 
on a fee-for-service, risk, or other basis): 
(A) Home health care services authorized 
under paragraph (7) of section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)). 
(B) Private duty nursing services author-
ized under paragraph (8) of such section, when 
such services are provided in a Medicaid eligible 
individual’s home. 
(C) Personal care services authorized 
under paragraph (24) of such section. 
(D) PACE services authorized under para-
graph (26) of such section. 
(E) Home and community-based services 
authorized under subsections (b), (c), (i), (j), 
and (k) of section 1915 of such Act (42 U.S.C. 
1396n), authorized under a waiver under sec-
tion 1115 of such Act (42 U.S.C. 1315), or 
provided through coverage authorized under 
section 1937 of such Act (42 U.S.C. 1396u–7).
527 
(F) Case management services authorized 
under section 1905(a)(19) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)(19)) and section 
1915(g) of such Act (42 U.S.C. 1396n(g)). 
(G) Rehabilitative services, including those 
related to behavioral health, described in section 
1905(a)(13) 
of 
such 
Act 
(42 
U.S.C. 
1396d(a)(13)). 
(H) Such other services specified by the 
Secretary. 
(5) INSTITUTIONAL SETTING.—The term ‘‘insti-
tutional setting’’ means— 
(A) a skilled nursing facility (as defined in 
section 1819(a) of the Social Security Act (42 
U.S.C. 1395i–3(a))); 
(B) a nursing facility (as defined in section 
1919(a) of such Act (42 U.S.C. 1396r(a))); 
(C) a long-term care hospital (as described 
in section 1886(d)(1)(B)(iv) of such Act (42 
U.S.C. 1395ww(d)(1)(B)(iv))); 
(D) a facility described in section 1905(d) 
of such Act (42 U.S.C. 1396d(d))); 
(E) an institution which is a psychiatric 
hospital (as defined in section 1861(f) of such 
Act (42 U.S.C. 1395x(f))) or that provides in-
528 
patient psychiatric services in a residential set-
ting specified by the Secretary; and 
(F) an institution described in section 
1905(i) of such Act (42 U.S.C. 1396d(i)). 
(6) MEDICAID
ELIGIBLE
INDIVIDUAL.—The 
term ‘‘Medicaid eligible individual’’ means an indi-
vidual who is eligible for and receiving medical as-
sistance under a State Medicaid plan or a waiver of 
such plan. Such term includes an individual who is 
on a waiting list and who would become eligible for 
medical assistance and enrolled under a State Med-
icaid plan, or waiver of such plan, upon receipt of 
home and community-based services. 
(7) STATE
MEDICAID
PROGRAM.—The term 
‘‘State Medicaid program’’ means, with respect to a 
State, the State program under title XIX of the So-
cial Security Act (42 U.S.C. 1396 through 1396w- 
6) (including any waiver or demonstration under 
such title or under section 1115 of such Act (42 
U.S.C. 1315) relating to such title). 
(8) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(9) STATE.—The term ‘‘State’’ means each of 
the 50 States, the District of Columbia, Puerto Rico,
529 
the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa. 
SEC. 30712. HCBS IMPROVEMENT PROGRAM. 
(a) INCREASED FMAP FOR HCBS PROGRAM IM-
PROVEMENT STATES.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ii)’’ and 
inserting ‘‘(ii), and (jj)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(jj) ADDITIONAL SUPPORT FOR HCBS PROGRAM 
IMPROVEMENT STATES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ADDITIONAL
SUPPORT.—Subject to 
paragraph (5), in the case of a State that is an 
HCBS program improvement State, for each 
fiscal quarter that begins on or after the first 
date on which the State is an HCBS program 
improvement State— 
‘‘(i) and for which the State meets the 
requirements described in paragraphs (2) 
and (4), notwithstanding subsection (b) or 
(ff), subject to subparagraph (B), with re-
spect to amounts expended during the 
quarter by such State for medical assist-
530 
ance for home and community-based serv-
ices, the Federal medical assistance per-
centage for such State and quarter (as de-
termined for the State under subsection 
(b) and, if applicable, increased under sub-
section (y), (z), (aa), or (ii), section 
6008(a) of the Families First Coronavirus 
Response Act), or section 1915(k)(2) shall 
be increased by 6 percentage points; and 
‘‘(ii) with respect to the State meeting 
the requirements described in paragraphs 
(2) and (4) and with respect to amounts 
expended during the quarter and before 
October 1, 2031, for administrative costs 
for expanding and enhancing home and 
community-based services, including for 
enhancing Medicaid data and technology 
infrastructure, modifying rate setting proc-
esses, adopting or improving training pro-
grams for direct care workers and family 
caregivers, home and community-based 
services ombudsman office activities (as re-
imbursable under section 1903(a)(7)), de-
veloping processes to identify direct care 
workers and assign such workers unique
531 
identifiers (as so reimbursable), and adopt-
ing, carrying out, or enhancing programs 
that register direct care workers or connect 
beneficiaries to direct care workers, the per 
centum specified in sections 1903(a)(7) 
and 1903(a)(3) shall be increased to 80 
percent. 
In no case may the application of clause (i) re-
sult in the Federal medical assistance percent-
age determined for a State being more than 95 
percent with respect to such expenditures. In no 
case shall the application of clause (ii) result in 
a reduction to the per centum otherwise speci-
fied without application of such clause. Any in-
crease pursuant to clause (ii) shall be available 
to a State before the State meets the require-
ments of paragraphs (2) and (4). 
‘‘(B) ADDITIONAL
HCBS
IMPROVEMENT 
EFFORTS.—Subject to paragraph (5), in addi-
tion to the increase to the Federal medical as-
sistance percentage under subparagraph (A)(i) 
for amounts expended during a quarter for 
medical assistance for home and community- 
based services by an HCBS program improve-
ment State that meets the requirements of
532 
paragraphs (2) and (4) for the quarter, the 
Federal medical assistance percentage for 
amounts expended by the State during the 
quarter for medical assistance for home and 
community-based services shall be further in-
creased by 2 percentage points (but not to ex-
ceed 95 percent) during the first 6 fiscal quar-
ters throughout which the State has imple-
mented and has in effect a program that meets 
the requirements of paragraph (3). 
‘‘(C) NONAPPLICATION
OF
TERRITORIAL 
FUNDING CAPS.—Any payment made to Puerto 
Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, or American Samoa for ex-
penditures that are subject to an increase in the 
Federal medical assistance percentage under 
subparagraph (A)(i) or (B), or an increase in 
an applicable Federal matching percentage 
under subparagraph (A)(ii), shall not be taken 
into account for purposes of applying payment 
limits under subsections (f) and (g) of section 
1108. 
‘‘(D) NONAPPLICATION TO CHIP EFMAP.— 
Any increase described in subparagraph (A) (or 
payment made for expenditures on medical as-
533 
sistance that are subject to such increase) shall 
not be taken into account in calculating the en-
hanced FMAP of a State under section 2105. 
‘‘(2) REQUIREMENTS.—Subject to the last sen-
tence of paragraph (1)(A), as conditions for receipt 
of the increase under paragraph (1) to the Federal 
medical assistance percentage determined for a 
State, with respect to a fiscal year quarter, the State 
shall meet each of the following requirements: 
‘‘(A) 
NONSUPPLANTATION.—The 
State 
uses the Federal funds attributable to the in-
crease in the Federal medical assistance per-
centage for amounts expended during a quarter 
for medical assistance for home and commu-
nity-based services under paragraph (1)(A) and 
paragraph (1)(B) (if applicable) to supplement, 
and not supplant, the level of State funds ex-
pended for home and community-based services 
for eligible individuals through programs in ef-
fect as of the date the State is awarded a plan-
ning grant under section 30711 of the Act ti-
tled ‘An Act to provide for reconciliation pursu-
ant to title II of S. Con. Res. 14’. In applying 
this subparagraph, the Secretary shall provide 
that a State shall have a 3-year period, as spec-
534 
ified by the Secretary, to spend any accumu-
lated unspent State funds attributable to the 
increase described in clause (i) in the Federal 
medical assistance percentage. 
‘‘(B) MAINTENANCE OF EFFORT.— 
‘‘(i) IN
GENERAL.—The State does 
not— 
‘‘(I) reduce the amount, dura-
tion, or scope of home and commu-
nity-based services available under the 
State plan (or waiver of such plan) 
relative to the home and community- 
based services available under the 
plan or a waiver of such plan as of 
the date on which the State was 
awarded a planning grant under sec-
tion 30711 of the Act titled ‘An Act 
to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’; 
‘‘(II) reduce payment rates for 
home and community-based services 
lower than such rates that were in 
place as of the date described in sub-
clause (I), including, to the extent ap-
plicable, assumed payment rates for
535 
such services that are included in 
managed care capitation rates as such 
rates are being prospectively built; or 
‘‘(III) except to the extent per-
mitted under clause (ii), adopt more 
restrictive standards, methodologies, 
or procedures for determining eligi-
bility for or the scope of medical as-
sistance of home and community- 
based services, including with respect 
to cost-sharing, than the standards, 
methodologies, or procedures applica-
ble as of the date described in sub-
clause (I). 
‘‘(ii) 
CONDITIONS
FOR
FLEXI-
BILITY.—A State may make modifications 
that would otherwise violate the mainte-
nance of effort described in clause (i) if the 
State demonstrates to the satisfaction of 
the Secretary that such modifications shall 
not result in— 
‘‘(I) home and community-based 
services that are less comprehensive 
or lower in amount, duration, or 
scope;
536 
‘‘(II) fewer individuals (overall 
and 
within 
particular 
eligibility 
groups) receiving home and commu-
nity-based services, the calculation of 
which may be adjusted for demo-
graphic changes since the date de-
scribed in clause (i)(I); or 
‘‘(III) 
increased 
cost-sharing 
(other than resulting from the rate of 
inflation) for home and community- 
based services. 
‘‘(C) ACCESS
TO
SERVICES.—Not later 
than an implementation date as specified by the 
Secretary (which may vary for each of the fol-
lowing clauses) after the first day of the first 
fiscal quarter for which a State receives an in-
crease to the Federal medical assistance per-
centage or other applicable Federal matching 
percentage under paragraph (1), the State does 
all of the following to improve access to serv-
ices: 
‘‘(i) Reduce access barriers and dis-
parities in access or utilization of home 
and community-based services, as de-
537 
scribed in the State HCBS improvement 
plan. 
‘‘(ii) Provides coverage of personal 
care services authorized under subsection 
(a)(24) for all individuals eligible for and 
enrolled in medical assistance in the State. 
‘‘(iii) Provides for navigation of home 
and community-based services through ‘no 
wrong door’ programs, provides expedited 
eligibility for home and community-based 
services, and improves home and commu-
nity-based services counseling and edu-
cation programs. 
‘‘(iv) Expands access to behavioral 
health services furnished in home and com-
munity-based settings. 
‘‘(v) Improves coordination of home 
and community-based services with em-
ployment, housing, and transportation sup-
ports. 
‘‘(vi) Provides supports to family care-
givers. 
‘‘(vii) Newly provides coverage under, 
or expands existing eligibility criteria for, 1 
or more of the eligibility categories author-
538 
ized under subclause (XIII), (XV), or 
(XVI) of section 1902(a)(10)(A)(ii). 
‘‘(D) WORKFORCE.— 
‘‘(i) 
IN
GENERAL.—The 
State 
strengthens and expands the direct care 
workforce that provides home and commu-
nity-based services by— 
‘‘(I) adopting processes to ensure 
that payment rates for home and com-
munity-based services are sufficient 
(as defined by the Secretary) to en-
sure that care and services are avail-
able to the extent described in the 
State HCBS improvement plan; and 
‘‘(II) 
updating 
qualification 
standards as appropriate, and devel-
oping and adopting training opportu-
nities for direct care workers and fam-
ily caregivers, at such times as the 
Secretary shall prescribe. 
‘‘(ii) PAYMENT
RATES.—In carrying 
out clause (i)(I), the State shall— 
‘‘(I) update and, as appropriate, 
increase payment rates for home and 
community-based services to support
539 
recruitment and retention of the di-
rect care workforce by not later than 
2 years after approval of the HCBS 
improvement plan and, at least every 
3 years thereafter, using, through ex-
isting or other processes to determine 
provider payment, a transparent proc-
ess involving meaningful input from 
nongovernmental stakeholders; and 
‘‘(II) ensure that increases in the 
payment rates for home and commu-
nity-based services— 
‘‘(aa) at a minimum, result 
in a proportionate increase to 
payments for direct care workers 
and in a manner that is deter-
mined with input from the stake-
holders described in subclause 
(I); and 
‘‘(bb) are incorporated into 
provider payment rates for home 
and 
community-based 
services 
provided under this title by a 
health plan, under a contract and
540 
paid through capitation rates 
with the State. 
‘‘(3) SELF-DIRECTED MODELS FOR THE DELIV-
ERY OF SERVICES.—As conditions for receipt of the 
increase under paragraph (1)(B) to the Federal 
medical assistance percentage determined for a 
State, with respect to a fiscal year quarter, the State 
shall establish directly, or by contract with 1 or 
more entities, including an agency with choice or a 
similar service delivery model, a program for the 
performance of all of the following functions to fa-
cilitate beneficiary use of self-directed care in the 
case the State covers home and community-based 
services under authorities that permit self-direction: 
‘‘(A) Registering qualified direct care 
workers and assisting beneficiaries in finding 
direct care workers. 
‘‘(B) Undertaking activities to recruit and 
train independent providers to enable bene-
ficiaries to direct their own care, including by 
providing or coordinating training for bene-
ficiaries on self-directed care. 
‘‘(C) Ensuring the safety of, and sup-
porting the quality of, care provided to bene-
ficiaries.
541 
‘‘(D) Facilitating coordination between 
State and local agencies and direct care workers 
for matters of public health, training opportuni-
ties, changes in program requirements, work-
place health and safety, or related matters. 
‘‘(E) Supporting beneficiary hiring, if se-
lected by the beneficiary, of independent pro-
viders of home and community-based services, 
including by processing applicable tax informa-
tion, collecting and processing timesheets, sub-
mitting claims and processing payments to such 
providers. 
‘‘(F) To the extent a State permits bene-
ficiaries to hire a family member or individual 
with whom they have an existing relationship to 
provide home and community-based services, 
providing support to beneficiaries who wish to 
hire a caregiver who is a family member or in-
dividual with whom they have an existing rela-
tionship. 
‘‘(G) Ensuring that the program under 
this paragraph does not promote or deter the 
ability of workers to form a labor organization 
or discriminate against workers who may join 
or decline to join such an organization.
542 
‘‘(4) REPORTING AND OVERSIGHT.—As condi-
tions for receipt of the increase under paragraph (1) 
to the Federal medical assistance percentage deter-
mined for a State, with respect to a fiscal year quar-
ter, the State shall meet each of the following re-
quirements: 
‘‘(A) The State designates (by a date spec-
ified by the Secretary) an HCBS ombudsman 
office (or a long-term care ombudsman program 
office) that— 
‘‘(i) operates independently from the 
State Medicaid agency and health plans; 
‘‘(ii) provides direct assistance to re-
cipients of home and community-based 
services available under the State Medicaid 
program and their families; and 
‘‘(iii) identifies and reports systemic 
problems to State officials, the public, and 
the Secretary. 
‘‘(B) Beginning with the last day of the 
5th fiscal quarter for which the state is an 
HCBS program improvement State, and annu-
ally thereafter, the State reports to the Sec-
retary, in a manner the Secretary shall pre-
scribe, on the progress of implementation of the
543 
activities described in subparagraphs (C) and 
(D) of paragraph (2), paragraph (3) (if applica-
ble), the use of enhanced Federal funding pro-
vided under this subsection, and progress with 
respect to home and community-based services 
availability, utilization, disparities in access and 
use of services, spending on HCBS, and the 
status of the direct care workforce. 
‘‘(5) BENCHMARKS
FOR
DEMONSTRATING
IM-
PROVEMENTS.—An HCBS program improvement 
State shall cease to be eligible for an increase in the 
Federal medical assistance percentage under para-
graph (1)(A)(i) or (1)(B) or an increase in an appli-
cable Federal matching percentage under paragraph 
(1)(A)(ii) on or after the first date on which a State 
is an HCBS program improvement State if the 
State is found to be out of compliance with the re-
quirements of this subsection and unless, at the end 
of the 29th fiscal quarter, the State demonstrates 
the following in the annual report required in para-
graph (4) for such quarter: 
‘‘(A) Increased availability (above a mar-
ginal increase) of home and community-based 
services in the State relative to such availability 
as reported in the State HCBS improvement
544 
plan and adjusted for demographic changes in 
the State since the submission of such plan. 
‘‘(B) With respect to the percentage of ex-
penditures made by the State for long-term 
services and supports that are for home and 
community-based services, in the case of an 
HCBS program improvement State for which 
such percentage (as reported in the State 
HCBS improvement plan) was— 
‘‘(i) less than 50 percent, the State 
demonstrates that the percentage of such 
expenditures has increased to at least 50 
percent since the plan was approved; and 
‘‘(ii) at least 50 percent, the State 
demonstrates that such percentage has not 
decreased since the plan was approved. 
‘‘(6) DEFINITIONS.—In this subsection, the 
terms ‘State Medicaid plan’, ‘direct care worker’, 
‘HCBS program improvement State’, ‘health plan’; 
and ‘home and community-based services’ have the 
meaning given those terms in section 30711(e) of 
the Act titled ‘An Act to provide for reconciliation 
pursuant to title II of S. Con. Res. 14’.’’.
545 
SEC. 30713. FUNDING FOR FEDERAL ACTIVITIES RELATED 
TO MEDICAID HCBS. 
In addition to amounts otherwise available, there is 
appropriated to the Secretary for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated, 
$40,000,000, to remain available until expended, to carry 
out section 30712 (including the amendments made by 
such section), including by issuing necessary guidance and 
technical assistance to States, conducting program integ-
rity and oversight efforts, and preparing and submitting 
to the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance of the 
Senate, beginning 5 years after the date of the enactment 
of this Act and every three years thereafter, a report de-
scribing the progress of the HCBS planning and improve-
ment activities undertaken by States as applicable and as 
described in sections 30711 and 30712 (including the 
amendments made by such sections), and describing the 
impact of such activities on access to care, including with 
respect to disparities in access and utilization, and the di-
rect care workforce. 
SEC. 30714. FUNDING FOR HCBS QUALITY MEASUREMENT 
AND IMPROVEMENT. 
(a) INCREASED FEDERAL MATCHING RATE
FOR 
ADOPTION AND REPORTING OF HCBS QUALITY MEAS-
URES.—
546 
(1) IN GENERAL.—Section 1903(a)(3) of the 
Social Security Act (42 U.S.C. 1396b(a)(3)) is 
amended— 
(A) in subparagraph (F)(ii), by striking 
‘‘plus’’ after the semicolon and inserting ‘‘and’’; 
and 
(B) by inserting after subparagraph (F), 
the following: 
‘‘(G) 80 percent of so much of the sums 
expended during such quarter as are attrib-
utable to the reporting of information regarding 
the quality of home and community-based serv-
ices 
in 
accordance 
with 
sections 
1139A(a)(4)(B)(ii) and 1139B(b)(3)(C); and’’. 
(2) EXEMPTION FROM TERRITORIES’ PAYMENT 
LIMITS.—Section 1108(g)(4) of the Social Security 
Act is amended by adding at the end the following 
new subparagraph: 
‘‘(C) ADDITIONAL
EXEMPTION
RELATING 
TO
HCBS
QUALITY
REPORTING.—Payments 
under section 1903(a)(3)(G) shall not be taken 
into account in applying payment limits under 
subsections (f) and (g) of this subsection.’’.
547 
(b) HCBS QUALITY MEASURES FOR INCREASE.— 
Title XI of the Social Security Act (42 U.S.C. 1301 
through 1320e–3) is amended— 
(1) in section 1139A— 
(A) in subsection (a)(4)(B)— 
(i) by striking ‘‘Beginning with the 
annual State report on fiscal year 2024’’ 
and inserting the following: 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), beginning with the annual State report 
on fiscal year 2024’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) 
REPORTING
HCBS
QUALITY 
MEASURES.—With respect to reporting on 
information regarding the quality of home 
and community-based services provided to 
children under title XIX or title XXI, be-
ginning with the annual State report re-
quired under subsection (c)(1) for the first 
fiscal year that begins on or after the date 
that is 2 years after the date that the Sec-
retary publishes the home and community- 
based services quality measures developed 
under subsection (b)(5)(B) the Secretary
548 
shall require States to report such infor-
mation using the standardized format for 
reporting information and procedures de-
veloped under subparagraph (A) and using 
all such home and community-based qual-
ity measures developed under subsection 
(b)(5) (including any updates or changes 
to such measures).’’; and 
(B) in subsection (b)(5)— 
(i) by striking ‘‘Beginning no later 
than January 1, 2013’’ and inserting the 
following: 
‘‘(A) IN
GENERAL.—Beginning no later 
than January 1, 2013’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) HCBS QUALITY MEASURES.—Begin-
ning with the first year that begins on the date 
that is 2 years after the date of enactment of 
this subparagraph (or, in the case of measures 
that require development and testing prior to 
availability, not later than 4 years after the 
date of enactment of this subparagraph), the 
requirements of subparagraph (A) shall apply, 
and the core measures described in subsection
549 
(a) (and any updates or changes to such meas-
ures) shall include home and community-based 
services quality measures developed by the Sec-
retary. The Secretary shall ensure that such 
measures reflect the full array of home and 
community-based services, and consult with 
nongovernmental stakeholders with expertise in 
home and community-based services (including 
recipients and providers of such services).’’; 
(C) in subsection (b)(6)— 
(i) by inserting ‘‘or support services’’ 
before ‘‘that is capable of’’; 
(ii) by striking ‘‘and ambulatory 
health care settings’’ and inserting ‘‘, am-
bulatory health care, and home and com-
munity-based settings’’; and 
(iii) by inserting ‘‘and home and com-
munity-based’’ before ‘‘care system’’; and 
(D) in subsection (c)(1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘, sub-
ject to subsection (a)(4)(B)(ii),’’ before ‘‘annu-
ally report’’; and 
(2) in section 1139B— 
(A) in subsection (b)—
550 
(i) in paragraph (3), by adding at the 
end the following new subparagraph: 
‘‘(C) MANDATORY
REPORTING
WITH
RE-
SPECT TO HCBS QUALITY MEASURES.—Begin-
ning with the State report required under sub-
section (d)(1) for the first year that begins on 
or after the date that is 2 years after the date 
that the Secretary publishes the home and com-
munity-based quality measures developed under 
paragraph (5)(D), the Secretary shall require 
States to report information, using the stand-
ardized format for reporting information and 
procedures developed under subparagraph (A), 
regarding the quality of home and community- 
based services for Medicaid eligible adults using 
all of the home and community-based services 
quality measures included in the core set of 
adult health quality measures under paragraph 
(5)(D), and any updates or changes to such 
measures.’’; and 
(ii) in paragraph (5), by adding at the 
end the following new subparagraph: 
‘‘(D) HCBS QUALITY MEASURES.— 
‘‘(i) 
FUNDING.—In 
addition 
to 
amounts otherwise available, there is ap-
551 
propriated to the Secretary, for fiscal year 
2022, to be available until expended, out of 
any money in the Treasury not otherwise 
appropriated, $22,000,000, for carrying 
out this subparagraph. 
‘‘(ii) INCLUSION
OF
HCBS
QUALITY 
MEASURES.—Beginning with respect to 
State reports required under subsection 
(d)(1) for the first year that begins on or 
after the date that is 2 years after the date 
of enactment of this subparagraph (or, in 
the case of measures that require develop-
ment and testing prior to availability, not 
later than 4 years after the date of enact-
ment of this subparagraph) the core set of 
adult health quality measures maintained 
under this paragraph (and any updates or 
changes to such measures) shall include 
home and community-based services qual-
ity measures developed in accordance with 
this subparagraph. 
‘‘(iii) REQUIREMENTS.— 
‘‘(I) IN
GENERAL.—In devel-
oping, reviewing and updating the 
home and community-based services
552 
quality measures included in the core 
set of adult health quality measures 
maintained under this paragraph, the 
Secretary shall consult with non-
governmental stakeholders with exper-
tise in home and community-based 
services (including recipients and pro-
viders of such services) and ensure 
such measures reflect the full array of 
home and community-based services 
and recipients of such services. 
‘‘(II) 
DEFINITION.—For 
pur-
poses of this section and section 
1139A, the term ‘home and commu-
nity-based services’ has the meaning 
given such term in section 30711(e) of 
the Act titled ‘An Act to provide for 
reconciliation pursuant to title II of S. 
Con. Res. 14’.’’; and 
(B) in subsection (d)(1)(A), by striking ‘‘; 
and’’ and inserting ‘‘and, beginning with the re-
port for the first year that begins after the date 
that is 2 years after the Secretary publishes the 
home and community-based quality measures 
developed under subsection (b)(5)(D), all home
553 
and community-based services quality measures 
included in the core set of adult health quality 
measures maintained under subsection (b)(5) 
and any updates or changes to such measures; 
and’’. 
SEC. 30715. PERMANENT EXTENSION OF MEDICAID PRO-
TECTIONS AGAINST SPOUSAL IMPOVERISH-
MENT FOR RECIPIENTS OF HOME AND COM-
MUNITY-BASED SERVICES. 
(a) IN GENERAL.—Section 1924(h)(1)(A) of the So-
cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend-
ed by striking ‘‘(at the option of the State) is described 
in section 1902(a)(10)(A)(ii)(VI)’’ and inserting the fol-
lowing: ‘‘is eligible for medical assistance for home and 
community-based services provided under subsection (c), 
(d), or (i) of section 1915 or under a waiver approved 
under section 1115, or who is eligible for such medical 
assistance by reason of being determined eligible under 
section 1902(a)(10)(C) or by reason of section 1902(f) or 
otherwise on the basis of a reduction of income based on 
costs incurred for medical or other remedial care, or who 
is eligible for medical assistance for home and community- 
based attendant services and supports under section 
1915(k)’’.
554 
(b) CONFORMING AMENDMENT.—Section 2404 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
1396r–5 note) is amended by striking ‘‘September 30, 
2023’’ and inserting ‘‘the date of the enactment of the 
Act titled ‘An Act to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’ ’’. 
SEC. 30716. PERMANENT EXTENSION OF MONEY FOLLOWS 
THE PERSON REBALANCING DEMONSTRA-
TION. 
(a) IN GENERAL.—Subsection (h) of section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (I), by inserting 
‘‘and’’ after the semicolon; 
(B) by amending subparagraph (J) to read 
as follows: 
‘‘(J) $450,000,000 for each fiscal year 
after fiscal year 2022.’’; 
(C) by striking subparagraph (K); 
(2) in paragraph (2), by striking ‘‘September 
30, 2023’’ and inserting ‘‘September 30 of the sub-
sequent fiscal year’’; and 
(3) by adding at the end the following new 
paragraph:
555 
‘‘(3) TECHNICAL ASSISTANCE.—In addition to 
amounts otherwise available, there is appropriated to 
the Secretary for fiscal year 2022 and for each sub-
sequent 3-year period, out of any money in the 
Treasury not otherwise appropriated, $5,000,000, to 
remain available until expended, for carrying out 
subsections (f), (g), and (i).’’. 
(b) REDISTRIBUTION
OF
UNEXPENDED
GRANT 
AWARDS.—Subsection (e)(2) of section 6071 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended 
by adding at the end the following new sentence: ‘‘Any 
portion of a State grant award for a fiscal year under this 
section that is unexpended by the State at the end of the 
fourth succeeding fiscal year shall be rescinded by the Sec-
retary and added to the appropriation for the fifth suc-
ceeding fiscal year.’’. 
SEC. 30717. FUNDING TO IMPROVE THE ACCURACY AND RE-
LIABILITY OF CERTAIN SKILLED NURSING 
FACILITY DATA. 
Section 1888 of the Social Security Act (42 U.S.C. 
1395yy) is amended— 
(1) in subsection (h)(12)— 
(A) in subparagraph (A), by striking ‘‘and 
the data submitted under subsection (e)(6) a 
process to validate such measures and data’’
556 
and inserting ‘‘, the data submitted under sub-
section (e)(6), and, during the period beginning 
with fiscal year 2024 and ending with fiscal 
year 2031, the resident assessment data de-
scribed in section 1819(b)(3) and the direct 
care staffing information described in section 
1128I(g) a process to validate such measures, 
data, and information’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘FUNDING.—For pur-
poses’’ and inserting ‘‘FUNDING.— 
‘‘(i) FISCAL
YEARS
2023
THROUGH 
2025.—For purposes’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) ADDITIONAL
FUNDING.—There 
is appropriated to the Secretary, out of 
any monies in the Treasury not otherwise 
appropriated, $50,000,000 for fiscal year 
2022, to remain available through fiscal 
year 2031, for purposes of carrying out 
this paragraph.’’; and 
(2) in subsection (e)(6)(A)— 
(A) in the header, by striking ‘‘FOR FAIL-
URE TO REPORT’’; and
557 
(B) in clause (i)— 
(i) by striking ‘‘For fiscal years begin-
ning with fiscal year 2018, in the case of 
a skilled nursing facility that does not sub-
mit’’ and inserting the following: 
‘‘(I) FAILURE TO REPORT.—For 
fiscal years beginning with fiscal year 
2018, in the case of a skilled nursing 
facility that does not submit quality 
measure data specified by the Sec-
retary and’’; and 
(ii) by adding at the end the following 
new subclause: 
‘‘(II) 
REPORTING
OF
INAC-
CURATE
INFORMATION.—For fiscal 
years during the period beginning 
with fiscal year 2026 and ending with 
fiscal year 2031, in the case of a 
skilled nursing facility that submits 
data under this paragraph, measures 
under subsection (h), resident assess-
ment 
data 
described 
in 
section 
1819(b)(3), or direct care staffing in-
formation 
described 
in 
section 
1128I(g) with respect to such fiscal
558 
year that is inaccurate (as determined 
by the Secretary through the valida-
tion process described in section 
1888(h)(12) or otherwise), after de-
termining the percentage described in 
paragraph (5)(B)(i), and after appli-
cation of clauses (ii) and (iii) of para-
graph (5)(B) and of subclause (I) of 
this clause (if applicable), the Sec-
retary shall reduce such percentage 
for payment rates during such fiscal 
year by 2 percentage points.’’. 
SEC. 30718. ENSURING ACCURATE INFORMATION ON COST 
REPORTS. 
Section 1888(f) of the Social Security Act (42 U.S.C. 
1395yy(f)) is amended by adding at the end the following 
new paragraph: 
‘‘(5) AUDIT OF COST REPORTS.—There is ap-
propriated to the Secretary, out of any monies in the 
Treasury not otherwise appropriated, $250,000,000 
for fiscal year 2022, to remain available through fis-
cal year 2031, for purposes of conducting an annual 
audit (beginning with 2023 and ending with 2031) 
of cost reports submitted under this title for a rep-
resentative sample of skilled nursing facilities.’’.
559 
SEC. 30719. SURVEY IMPROVEMENTS. 
Section 1819 of the Social Security Act (42 U.S.C. 
1395i–3) is amended by adding at the end the following 
new subsection: 
‘‘(l) SURVEY IMPROVEMENTS.— 
‘‘(1) IN GENERAL.—There is appropriated to 
the Secretary, out of any monies in the Treasury not 
otherwise appropriated, $325,000,000 for fiscal year 
2022, to remain available through fiscal year 2031, 
for purposes of— 
‘‘(A) conducting reviews and identifying 
plans under paragraph (2); and 
‘‘(B) providing training, tools, technical as-
sistance, and financial support in accordance 
with paragraph (3). 
‘‘(2) REVIEW.—The Secretary shall conduct re-
views, during the period specified in paragraph (1), 
of (and, as appropriate, identify plans to improve) 
the following: 
‘‘(A) The extent to which surveys con-
ducted under subsection (g) and the enforce-
ment process under subsection (h) result in in-
creased compliance with requirements under 
this section and subpart B of part 483 of title 
42, Code of Federal Regulations, with respect
560 
to skilled nursing facilities (in this subsection 
referred to as ‘facilities’). 
‘‘(B) The timeliness and thoroughness of 
State agency verification of deficiency correc-
tions at facilities. 
‘‘(C) The accuracy of the identification and 
appropriateness of the scope and severity of de-
ficiencies cited at facilities. 
‘‘(D) The accuracy of the identification 
and appropriateness of the scoping and severity 
of life safety, infection control, and emergency 
preparedness deficiencies cited at facilities. 
‘‘(E) The timeliness of State agency inves-
tigations of— 
‘‘(i) complaints at facilities; 
‘‘(ii) facility-reported incidents at fa-
cilities; and 
‘‘(iii) reported allegations of abuse, 
neglect, and exploitation at facilities. 
‘‘(F) The consistency of facility reporting 
of substantiated complaints to law enforcement. 
‘‘(G) The ability of the State agency to 
sufficiently hire, train, and retain individuals 
who conduct surveys.
561 
‘‘(H) Any other area related to surveys of 
facilities, or the individuals conducting such 
surveys, determined appropriate by the Sec-
retary. 
‘‘(3) SUPPORT.—Based on the review under 
paragraph (2), the Secretary shall, during the period 
specified in paragraph (1), provide training, tools, 
technical assistance, and financial support to State 
and Federal agencies that perform surveys of facili-
ties for the purpose of improving the surveys con-
ducted under subsection (g) and the enforcement 
process under subsection (h) with respect to the 
areas reviewed under paragraph (2).’’. 
SEC. 30720. NURSE STAFFING REQUIREMENTS. 
Section 1819(d) of the Social Security Act (42 U.S.C. 
1395i–3(d)) is amended— 
(1) in paragraph (4)(A), by inserting ‘‘and any 
regulations promulgated under paragraph (5)(C)’’ 
after ‘‘section 1124’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) NURSE STAFFING REQUIREMENTS.— 
‘‘(A) FUNDING.—There is appropriated to 
the Secretary, out of any monies in the Treas-
ury not otherwise appropriated, $50,000,000
562 
for fiscal year 2022, to remain available 
through fiscal year 2031, for purposes of car-
rying out this paragraph. 
‘‘(B) STUDY.—Not later than 3 years after 
the date of the enactment of this paragraph, 
and not less frequently than once every 5 years 
thereafter, the Secretary shall, out of funds ap-
propriated under subparagraph (A), conduct a 
study and submit to Congress a report on the 
appropriateness of establishing minimum staff 
to resident ratios for nursing staff for skilled 
nursing facilities. Each such report shall in-
clude— 
‘‘(i) with respect to the first such re-
port, recommendations regarding appro-
priate minimum ratios of registered nurses 
(and, if practicable, licensed practical 
nurses (or licensed vocational nurses) and 
certified nursing assistants) to residents at 
such skilled nursing facilities; and 
‘‘(ii) with respect to each subsequent 
such report, recommendations regarding 
appropriate minimum ratios of registered 
nurses, licensed practical nurses (or li-
censed vocational nurses), and certified
563 
nursing assistants to residents at such 
skilled nursing facilities. 
‘‘(C) PROMULGATION OF REGULATIONS.— 
‘‘(i) IN GENERAL.—Not later than 1 
year after the Secretary first submits a re-
port under subparagraph (B), the Sec-
retary shall, out of funds appropriated 
under subparagraph (A)— 
‘‘(I) specify through regulations, 
consistent with such report, appro-
priate minimum ratios (if any) of reg-
istered nurses (and, if practicable, li-
censed practical nurses (or licensed 
vocational nurses) and certified nurs-
ing assistants) to residents at skilled 
nursing facilities; and 
‘‘(II) except as provided in clause 
(ii), require such skilled nursing facili-
ties to comply with such ratios. 
‘‘(ii) EXCEPTION.— 
‘‘(I) IN
GENERAL.—In addition 
to the authority to waive the applica-
tion of clause (i)(II) under section 
1135, the Secretary may waive the 
application of such clause with respect
564 
to a skilled nursing facility if the Sec-
retary finds that— 
‘‘(aa) the facility is located 
in a rural area and the supply of 
skilled nursing facility services in 
such area is not sufficient to 
meet the needs of individuals re-
siding therein; 
‘‘(bb) the Secretary provides 
notice of the waiver to the State 
long-term care ombudsman (es-
tablished 
under 
section 
307(a)(12) of the Older Ameri-
cans Act of 1965) and the pro-
tection and advocacy system in 
the State for the mentally ill; and 
‘‘(cc) the facility that is 
granted such a waiver notifies 
residents of the facility (or, 
where appropriate, the guardians 
or legal representatives of such 
residents) and members of their 
immediate families of the waiver.
565 
‘‘(II) RENEWAL.—Any waiver in 
effect under this clause shall be sub-
ject to annual renewal. 
‘‘(iii) UPDATE.—Not later than 1 year 
after the submission of each subsequent re-
port under subparagraph (B), the Sec-
retary shall, out of funds appropriated 
under subparagraph (A) and consistent 
with such report, update the regulations 
described in clause (i)(I) to reflect appro-
priate minimum ratios (if any) of reg-
istered nurses, licensed practical nurses (or 
licensed vocational nurses), and certified 
nursing assistants to residents at skilled 
nursing facilities.’’. 
PART 2—EXPANDING ACCESS TO MATERNAL 
HEALTH 
SEC. 30721. EXTENDING CONTINUOUS COVERAGE FOR 
PREGNANT AND POSTPARTUM INDIVIDUALS. 
(a) MEDICAID.— 
(1) REQUIRING FULL BENEFITS FOR PREGNANT 
AND POSTPARTUM INDIVIDUALS FOR 12-MONTH PE-
RIOD POST PREGNANCY.—
566 
(A) IN GENERAL.—Paragraph (5) of sec-
tion 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended— 
(i) by striking ‘‘(5) A woman who’’ 
and inserting ‘‘(5)(A) For any fiscal year 
quarter (beginning with the first fiscal 
year quarter beginning one year after the 
date of the enactment of the Act titled ‘An 
Act to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’) with respect 
to which subparagraph (B) does not apply, 
an individual who’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) For any fiscal year quarter (beginning 
with the first fiscal year quarter beginning one year 
after the date of the enactment of the Act titled ‘An 
Act to provide for reconciliation pursuant to title II 
of S. Con. Res. 14’), any individual who, while preg-
nant, is eligible for and received medical assistance 
under the State plan or a waiver of such plan (re-
gardless of the basis for the individual’s eligibility 
for medical assistance and including during a period 
of retroactive eligibility under subsection (a)(34)), 
shall 
remain 
eligible, 
notwithstanding 
section
567 
1916(c)(3) or any other limitation under this title, 
for medical assistance through the end of the month 
in which the 12-month period (beginning on the last 
day of pregnancy of the individual) ends, and such 
medical assistance shall be in accordance with 
clauses (i) and (ii) of paragraph (16)(B).’’. 
(B) CONFORMING
AMENDMENTS.—Title 
XIX of the Social Security Act (42 U.S.C. 1396 
through 1396w-6) is amended— 
(i) in section 1902(a)(10), in the mat-
ter following subparagraph (G), by striking 
‘‘(VII) the medical assistance’’ and all that 
follows through ‘‘, (VIII)’’ and inserting 
‘‘(VIII)’’; 
(ii) in section 1902(e)(6), by striking 
‘‘In the case of’’ and inserting ‘‘For any 
fiscal year quarter with respect to which 
paragraph (5)(B) does not apply, in the 
case of’’; 
(iii) in section 1902(l)(1)(A), by strik-
ing ‘‘60-day period’’ and inserting ‘‘12- 
month period (or, for any fiscal year quar-
ter with respect to which subsection 
(e)(5)(B) does not apply and for which the
568 
State has not adopted the option under 
section 1902(e)(16)(A), 60-day period)’’; 
(iv) in section 1903(v)(4)— 
(I) in subparagraph (A)(i), by 
striking ‘‘the 60-day period’’ and in-
serting ‘‘the applicable period (as de-
scribed in subparagraph (D))’’; 
(II) in subparagraph (A)(ii), by 
striking the period and inserting ‘‘, 
and, in the case of such an individual 
who is or becomes pregnant, such in-
dividual (regardless of age) during 
pregnancy and during the applicable 
period (as described in subparagraph 
(D)).’’; 
(III) by adding at the end the 
following new subparagraph: 
‘‘(D) For purposes of subparagraph (A), 
the applicable period described in this subpara-
graph is— 
‘‘(i) beginning with the first fiscal 
year quarter that begins one year after the 
date of the enactment of the American 
Rescue Plan Act of 2021, for a State that 
has adopted the option under section
569 
1902(e)(16)(A), the 12-month period;’’; 
and 
(IV) in the subparagraph (D) 
added by subclause (III), by adding at 
the end the following new clauses: 
‘‘(ii) beginning with the first fiscal 
year quarter beginning one year after the 
date of the enactment of the Act titled ‘An 
Act to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’, the 12- 
month period; and 
‘‘(iii) for any fiscal year quarter (be-
ginning with such first fiscal year quarter) 
with 
respect 
to 
which 
section 
1902(e)(5)(B) does not apply and for 
which the State has not adopted the option 
under section 1902(e)(16)(A), the 60-day 
period.’’; 
(v) in section 1905(a), in the 4th sen-
tence in the matter following paragraph 
(31), by striking ‘‘60-day period’’ and in-
serting ‘‘12-month period (or, for any fis-
cal year quarter with respect to which sec-
tion 1902(e)(5)(B) does not apply and for 
which the State has not adopted the option
570 
under section 1902(e)(16)(A), 60-day pe-
riod)’’; and 
(vi) in section 1905(y), by adding at 
the end the following new paragraph: 
‘‘(3) TREATMENT FOR CERTAIN INDVIDUALS.— 
Notwithstanding paragraphs (1) and (2), section 
1902(a)(10)(A)(i)(III), 
and 
section 
1902(a)(10)(A)(i)(IV), the term ‘newly eligible’ in 
paragraph (2)(A) and the phrase ‘newly eligible indi-
viduals described in subclause (VIII) of section 
1902(a)(10)(A)(i)’ in paragraph (1) shall apply to 
individuals who but for the amendments made by 
section 30721(a) of the Act titled ‘An Act to provide 
for reconciliation pursuant to title II of S. Con. Res. 
14’ would be eligible under the State plan (or waiv-
er) 
for 
medical 
assistance 
under 
section 
1902(a)(10)(A)(i)(VIII) for the period beginning on 
the first day occurring after the end of such 60-day 
period and ending on the last day of the month in 
which the 12-month period (beginning on the last 
day of the pregnancy) ends.’’. 
(2) TRANSITION FROM STATE OPTION.— 
(A) IN GENERAL.—Section 1902(e)(16)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(e)(16)(A)) is amended by striking ‘‘At
571 
the option of the State’’ and inserting ‘‘For any 
fiscal year quarter with respect to which para-
graph (5)(B) does not apply, at the option of 
the State’’. 
(B) CONFORMING
AMENDMENT.—Section 
9812(b) of the American Rescue Plan Act of 
2021 (Public Law 117–2) is amended by strik-
ing ‘‘during the 5-year period’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), the amendments made by 
this paragraph shall take effect on the 1st day 
of the 1st fiscal year quarter that begins one 
year after the date of the enactment of this Act 
and shall apply with respect to medical assist-
ance provided on or after such date. 
(B) EXCEPTION FOR CERTAIN AMERICAN 
RESCUE
PLAN
ACT
OF
2021
CONFORMING 
AMENDMENTS.—The amendments made by sub-
clauses (I), (II), and (III) of paragraph 
(1)(B)(iv) shall take effect on the first day of 
the first fiscal year quarter that begins one year 
after the date of the enactment of the American 
Rescue Plan Act of 2021 and shall apply with
572 
respect to medical assistance provided on or 
after such date. 
(C) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
through 1396w-6) that the Secretary of Health 
and Human Services determines requires State 
legislation in order for the plan to meet any re-
quirement imposed by amendments made by 
this subsection, the plan shall not be regarded 
as failing to comply with the requirements of 
such title solely on the basis of its failure to 
meet such a requirement before the first day of 
the first calendar quarter beginning after the 
close of the first regular session of the State 
legislature that begins after the date of the en-
actment of this Act. For purposes of the pre-
vious sentence, in the case of a State that has 
a 2-year legislative session, each year of the ses-
sion shall be considered to be a separate regular 
session of the State legislature. 
(b) CHIP.— 
(1) REQUIRING FULL BENEFITS FOR PREGNANT 
AND POSTPARTUM WOMEN FOR 12-MONTH PERIOD 
POST PREGNANCY.—
573 
(A) IN GENERAL.—Section 2107(e)(1)(J) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397gg(e)(1)(J)) is amended— 
(i) by striking ‘‘Paragraphs (5) and 
(16)’’ and inserting ‘‘(i) For any fiscal 
year quarter with respect to which para-
graph (5)(B) of section 1902(e) does not 
apply, paragraphs (5)(A) and (16) of such 
section’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) For any fiscal year quarter (beginning 
with the first fiscal year quarter beginning one 
year after the date of the enactment of the Act 
titled ‘An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14’), section 
1902(e)(5)(B) (requiring, notwithstanding sec-
tion 2103(e)(3)(C)(ii)(I) or any other limitation 
under this title, continuous coverage for preg-
nant and postpartum individuals, including 12 
months postpartum, of medical assistance) if 
the State provides child health assistance to 
targeted low-income children or pregnancy-re-
lated assistance to targeted low-income preg-
nant women, under the State child health plan
574 
or waiver, including coverage of all items or 
services provided to a targeted low-income child 
or targeted low-income pregnant woman (as ap-
plicable) under the State child health plan or 
waiver).’’. 
(B) CONFORMING AMENDMENTS.—Section 
2112 of the Social Security Act (42 U.S.C. 
1397ll) is amended— 
(i) in subsection (d)— 
(I) in paragraph (1), by inserting 
‘‘and includes, through application of 
section 1902(e)(5)(B) pursuant to 
section 2107(e)(1)(J)(ii), continuous 
coverage for pregnant and postpartum 
individuals, 
including 
months 
postpartum’’ before the period at the 
end; and 
(II) in paragraph (2)(A), by 
striking ‘‘60-day period’’ and all that 
follows through ‘‘ends’’ and inserting 
‘‘12-month period (or, for any fiscal 
year quarter with respect to which 
section 2107(e)(1)(J)(ii) does not 
apply and for which the State has not 
adopted the option under section
575 
1902(e)(16)(A), 60-day period) ends’’; 
and 
(ii) in subsection (f)(2), by striking 
‘‘60-day period’’ and inserting ‘‘12-month 
period (or, for any fiscal year quarter (be-
ginning with the first fiscal year quarter 
beginning one year after the date of the 
enactment of the Act titled ‘An Act to pro-
vide for reconciliation pursuant to title II 
of S. Con. Res. 14’) with respect to which 
section 2107(e)(1)(J)(ii) does not apply 
and for which the State has not adopted 
the option under section 1902(e)(16)(A), 
60-day period)’’. 
(2) TRANSITION FROM STATE PLAN OPTION.— 
Section 9822(b) of the American Rescue Plan Act of 
2021 (Public Law 117–2) is amended by striking ‘‘, 
during the 5-year period’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall take effect on the 1st day of the 
1st fiscal year quarter that begins one year 
after the date of the enactment of this Act and 
shall apply with respect to child health assist-
576 
ance and pregnancy-related assistance, as appli-
cable, provided on or after such date. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State child health plan 
under title XXI of the Social Security Act (42 
U.S.C. 1397aa through 1397mm) that the Sec-
retary of Health and Human Services deter-
mines requires State legislation in order for the 
plan to meet any requirement imposed by 
amendments made under this subsection, the 
plan shall not be regarded as failing to comply 
with the requirements of such title solely on the 
basis of its failure to meet such a requirement 
before the first day of the first calendar quarter 
beginning after the close of the first regular 
session of the State legislature that begins after 
the date of the enactment of this Act. For pur-
poses of the previous sentence, in the case of a 
State that has a 2-year legislative session, each 
year of the session shall be considered to be a 
separate regular session of the State legislature.
577 
SEC. 30722. STATE OPTION TO PROVIDE COORDINATED 
CARE THROUGH A MATERNAL HEALTH HOME 
FOR PREGNANT AND POSTPARTUM INDIVID-
UALS. 
Title XIX of the Social Security Act (42 U.S.C. 
1396a) is amended by inserting after section 1945A the 
following new section: 
‘‘SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED 
CARE THROUGH A MATERNAL HEALTH HOME 
FOR PREGNANT AND POSTPARTUM INDIVID-
UALS. 
‘‘(a) 
IN
GENERAL.—Notwithstanding 
section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability), beginning 24 
months after the date of enactment of this section, a 
State, at its option as a State plan amendment, may pro-
vide for medical assistance under this title to eligible indi-
viduals who choose to enroll in a maternal health home 
under this section and receive maternal health home serv-
ices from a designated provider, a team of health profes-
sionals operating with such a provider, or a health team. 
‘‘(b) MATERNAL HEALTH HOME QUALIFICATION 
STANDARDS.—A maternal health home under this section 
shall demonstrate to the State the ability to do the fol-
lowing:
578 
‘‘(1) Develop an individualized comprehensive 
care plan for each eligible individual, working in a 
culturally and linguistically appropriate manner with 
such individual to develop and incorporate such care 
plan in a manner consistent with such individual’s 
needs and choices, including— 
‘‘(A) primary care; 
‘‘(B) inpatient care; 
‘‘(C) social support services; 
‘‘(D) local hospital emergency care; 
‘‘(E) care management and planning re-
lated to a change in an eligible individual’s eli-
gibility for medical assistance or a change in 
health insurance coverage as needed; and 
‘‘(F) behavioral health services. 
‘‘(2) Coordinate all necessary services to sup-
port prenatal, labor and delivery, and postpartum 
care for eligible individuals. 
‘‘(3) Coordinate access to specialists, behavioral 
health providers, early intervention services, and pe-
diatricians. 
‘‘(4) Collect and report information under sub-
section (d). 
‘‘(c) PAYMENTS.—
579 
‘‘(1) IN GENERAL.—A State shall provide a des-
ignated provider, a team of health professionals op-
erating with such a provider, or a health team with 
payments for the provision of maternal health home 
services to each eligible individual enrolled in a ma-
ternal health home. Payments for maternal health 
home services made to a designated provider, a team 
of health professionals operating with such a pro-
vider, or a health team shall be treated as payments 
for medical assistance for purposes of section 
1903(a), except that, during the first 8 fiscal quar-
ters that the State plan amendment is in effect, the 
Federal medical assistance percentage otherwise ap-
plicable to such payments shall be increased by 15 
percentage points, not to exceed 90 percent. 
‘‘(2) METHODOLOGY.— 
‘‘(A) IN GENERAL.—The State shall speci-
fy in the State plan amendment the method-
ology the State will use for determining pay-
ment for the provision of maternal health home 
services. Such methodology for determining 
payment— 
‘‘(i) may be tiered or adjusted to re-
flect, with respect to each individual pro-
vided such services by a designated pro-
580 
vider, a team of health care professionals 
operating with such a provider, or a health 
team, the acuity of each individual receiv-
ing care, or the specific capabilities of the 
provider, team of health care providers, or 
health team; and 
‘‘(ii) shall be established consistent 
with section 1902(a)(30)(A). 
‘‘(B) ALTERNATE MODEL OF PAYMENT.— 
The methodology for determining payment for 
provision of maternal health home services 
under this section shall not be limited to a fee- 
for-service or per-member per-month payment 
model, and may provide for alternate models of 
payment that reflect the needs of a State, sub-
ject to the approval of the Secretary. 
‘‘(3) PLANNING GRANTS.— 
‘‘(A) IN GENERAL.—Beginning 12 months 
after the date of enactment of this section, the 
Secretary may award planning grants to States 
for purposes of developing a State plan amend-
ment under this section. A planning grant 
awarded to a State under this paragraph shall 
remain available until expended.
581 
‘‘(B) STATE
CONTRIBUTION.—A State 
awarded a planning grant shall contribute an 
amount equal to the State percentage deter-
mined under section 1905(b) for each fiscal 
year for which the grant is awarded. 
‘‘(C) APPROPRIATIONS.—In addition to 
amounts otherwise available, there is appro-
priated for fiscal year 2022, out of any money 
in the Treasury not otherwise appropriated, to 
remain available until expended, to carry out 
this paragraph, $5,000,000 for awarding grants 
under this section. 
‘‘(d) DATA COLLECTION AND REPORTING.— 
‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—In order to receive 
payments from a State under subsection (c), a 
designated provider, a team of health profes-
sionals operating with such a provider, or a 
health team shall report to the State, in accord-
ance with such requirements as the Secretary 
shall specify, the following: 
‘‘(i) With respect to each such des-
ignated provider, team of health profes-
sionals, or health team, the name, national 
provider identification number, address,
582 
and specific maternal health home services 
offered to be provided to eligible individ-
uals who have selected such designated 
provider, team of health professionals, or 
health team as the maternal health home 
of such eligible individuals. 
‘‘(ii) Information on all applicable 
measures for determining the quality of 
maternal health home services provided by 
such designated provider, team of health 
professionals, or health team, including, to 
the extent applicable, the core set of child 
health quality measures published under 
section 1139A, the core set of adult health 
quality measures for Medicaid eligible 
adults published under section 1139B, and 
maternal health quality measures. 
‘‘(B) USE
OF
HEALTH
INFORMATION 
TECHNOLOGY.—A designated provider, a team 
of health professionals operating with such a 
provider, or a health team shall use, to the ex-
tent practicable, health information technology 
to provide a State with the information required 
under subparagraph (A) and to improve care
583 
coordination for eligible individuals, such as 
by— 
‘‘(i) facilitating the review of person- 
centered care plans; 
‘‘(ii) monitoring service delivery and 
identifying gaps in treatment; and 
‘‘(iii) communicating with eligible in-
dividuals and with primary, behavioral 
health and specialty care providers. 
‘‘(2) STATE
REPORTING
REQUIREMENTS.—A 
State with a State plan amendment approved under 
this section shall collect and report to the Secretary, 
at such time and in such form and manner as re-
quired by the Secretary, the following information: 
‘‘(A) The number of maternal health 
homes in a State in which individuals are en-
rolled pursuant to a State plan amendment 
under this section. 
‘‘(B) The number of individuals served 
who 
selected 
a 
maternal 
health 
home, 
disaggregated by race and ethnicity, pursuant 
to a State plan amendment under this section. 
‘‘(C) Information on the quality measures 
applicable for maternal health home services, 
including, to the extent applicable, the core set
585 
‘‘(H) Information reported to the State 
under paragraph (1). 
‘‘(e) STATE PLAN AMENDMENT.— 
‘‘(1) IN GENERAL.—A State plan amendment 
submitted pursuant to this section shall include— 
‘‘(A) eligibility criteria for maternal health 
homes; 
‘‘(B) services available to eligible individ-
uals through the maternal health home; 
‘‘(C) a description of providers that may 
provide care through a maternal health home, 
and that include how such State will ensure any 
provider arrangement offered includes a person- 
centered planning approach to determining nec-
essary services and supports and providing the 
appropriate care coordination to meet clinical 
and non-clinical needs of eligible individuals; 
and 
‘‘(D) reimbursement methodologies (as de-
scribed in subsection (c)(2)). 
‘‘(2) HOSPITAL NOTIFICATION.—A State with a 
State plan amendment approved under this section 
shall require each hospital that is a participating 
provider under the State plan (or a waiver of such 
plan) to establish procedures for, in the case of an
586 
individual who is enrolled in a maternal health home 
pursuant to this section and seeks treatment in the 
emergency department of such hospital, notifying 
the health home of such individual of such treat-
ment. 
‘‘(3) EDUCATION
WITH
RESPECT
TO
AVAIL-
ABILITY OF MATERNAL HEALTH HOME SERVICES.— 
In order for a State plan amendment to be approved 
under this section, a State shall include in the State 
plan amendment— 
‘‘(A) a description of the State’s process 
for educating providers participating in the 
State plan (or a waiver of such plan) on the 
availability of maternal health home services, 
including the process by which such providers 
can refer individuals to a designated provider, 
team of health care professionals operating such 
a provider, or health team for the purpose of 
establishing a maternal health home through 
which such individuals may receive such serv-
ices; and 
‘‘(B) a description of the State’s process 
for educating individuals on the availability of 
such services.
587 
‘‘(4) CONFIDENTIALITY.—A State with a State 
plan amendment approved under this section shall 
establish confidentiality protections to ensure, at a 
minimum, that the State does not disclose any iden-
tifying information with respect to any specific mor-
tality case (including pursuant to the reporting of 
information required under subsection (d)(2)(F)). 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed— 
‘‘(1) to require an eligible individual to enroll 
in, or prohibit an eligible individual from disenrolling 
at any time from, a maternal health home under this 
section; or 
‘‘(2) to require a designated provider, team of 
health professionals, or health team to act as a ma-
ternal health home and provide services in accord-
ance with this section if the designated provider, 
team of health professionals, or health team does not 
voluntarily agree to act as a maternal health home. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DESIGNATED PROVIDER.—The term ‘des-
ignated provider’ means a physician, clinical practice 
or clinical group practice, rural health clinic, free-
standing birth center, community health center, ob-
stetrician gynecologist, midwife who meets at a min-
588 
imum the international definition of the midwife and 
global standards for midwifery education as estab-
lished by the International Confederation of Mid-
wives, or any other health care entity or provider de-
termined by the State and approved by the Sec-
retary to be qualified to act as a maternal health 
home. 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual eligible for medical 
assistance under the State plan or under a waiver of 
such plan who— 
‘‘(A) is pregnant or in the postpartum pe-
riod that begins on the last day of the preg-
nancy and ends on the last day of the month 
in which the 12-month period (beginning on the 
last day of the pregnancy of the individual) 
ends (or, if the State provides for a longer pe-
riod of postpartum coverage period under such 
plan or waiver, on the last day of such longer 
period); and 
‘‘(B) is not enrolled in a health home 
under section 1945 or 1945A. 
‘‘(3) HEALTH TEAM.—The term ‘health team’ 
has the meaning given such term for purposes of 
section 3502 of Public Law 111–148.
589 
‘‘(4) MATERNAL
HEALTH
HOME.—The term 
‘maternal health home’ means a designated provider 
(including a provider that operates in coordination 
with a team of health care professionals), or a health 
team selected by a State to provide maternal health 
home services to pregnant and postpartum individ-
uals. 
‘‘(5) MATERNAL HEALTH HOME SERVICES.— 
‘‘(A) IN
GENERAL.—The term ‘maternal 
health home services’ means comprehensive and 
timely high-quality services described in sub-
paragraph (B) that are provided by a des-
ignated provider, a team of health professionals 
operating with such a provider, or a health 
team. 
‘‘(B) SERVICES DESCRIBED.—The services 
described in this subparagraph shall include— 
‘‘(i) a standardized risk assessment 
for all participants to determine needs; 
‘‘(ii) comprehensive care management; 
‘‘(iii) care coordination and health 
promotion; 
‘‘(iv) comprehensive transitional care, 
including arranging appropriate follow-up,
590 
for individuals transitioning from inpatient 
care to other settings; 
‘‘(v) individual and family support (in-
cluding authorized representatives); 
‘‘(vi) making referrals to other med-
ical, community, and social support serv-
ices, if relevant; and 
‘‘(vii) the use of health information 
technology to link services and coordinate 
care, to the extent practicable. 
‘‘(6) STANDARDIZED RISK ASSESSMENT.—The 
term ‘standardized risk assessment’ means an as-
sessment to determine the needs of an eligible indi-
vidual, and shall include an assessment of medical, 
obstetric, behavioral health, and social needs per-
formed at the initial prenatal or postpartum visit. 
‘‘(7) TEAM OF HEALTH PROFESSIONALS.—The 
term ‘team of health professionals’ means a team of 
health professionals (as described in the State plan 
amendment under this section) that may— 
‘‘(A) include physicians, midwives who 
meet at a minimum the international definition 
of the midwife and global standards for mid-
wifery education as established by the Inter-
national Confederation of Midwives, nurses,
591 
nurse care coordinators, nutritionists, social 
workers, doulas, behavioral health professionals, 
community health workers, translators and in-
terpreters, and other professionals determined 
to be appropriate by the State; 
‘‘(B) a health care entity or individual who 
is designated to coordinate such a team; and 
‘‘(C) provide care at a facility that is free-
standing, virtual, or based at a hospital, free-
standing birth center, community health center, 
community mental health center, rural clinic, 
clinical practice or clinical group practice, aca-
demic health center, children’s hospital, or any 
health care entity determined to be appropriate 
by the State and approved by the Secretary.’’. 
PART 3—TERRITORIES 
SEC. 30731. INCREASING MEDICAID CAP AMOUNTS AND 
THE FEDERAL MEDICAL ASSISTANCE PER-
CENTAGE FOR THE TERRITORIES. 
(a) 
CAP
AMOUNT
ADJUSTMENTS.—Section 
1108(g)(2) of the Social Security Act (42 U.S.C. 
1308(g)(2)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)—
592 
(i) by striking ‘‘except as provided in 
clause (ii)’’ and inserting ‘‘for each of fis-
cal years 1999 through 2019’’; and 
(ii) by striking ‘‘and’’ at the end; and 
(B) by adding at the end the following new 
clauses: 
‘‘(iii) 
for 
fiscal 
year 
2022, 
$3,600,000,000; and 
‘‘(iv) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase, if any, in Medicaid 
spending under title XIX during the pre-
ceding year (as determined based on the 
most recent National Health Expenditure 
data with respect to such year), rounded to 
the nearest $100,000;’’; 
(2) in subparagraph (B)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
(C) by adding at the end the following:
593 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$135,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000;’’; 
(3) in subparagraph (C)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
(C) by adding at the end the following: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$140,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000;’’;
594 
(4) in subparagraph (D)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
(C) in clause (iii), by striking ‘‘and’’ at the 
end; and 
(D) by adding at the end the following new 
clauses: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$70,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000; and’’; 
(5) in subparagraph (E)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end;
595 
(C) in clause (iii), by striking the period 
and inserting a semicolon; and 
(D) by adding at the end the following: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$90,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000.’’; and 
(6) by striking the flush matter following sub-
paragraph (E). 
(b) FMAP ADJUSTMENTS.—Section 1905(ff) of the 
Social Security Act (42 U.S.C. 1396d(ff)) is amended— 
(1) by redesignating paragraphs (1) through 
(3) as subparagraphs (A) through (C), respectively, 
and adjusting the margins accordingly; 
(2) by striking ‘‘Notwithstanding’’ and insert-
ing the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(3) in paragraph (1), as so inserted—
596 
(A) in the matter preceding subparagraph 
(A), as so redesignated, by inserting ‘‘para-
graph (2) and’’ after ‘‘subject to’’; 
(B) in subparagraph (B), as so redesig-
nated— 
(i) by striking ‘‘December 3, 2021,’’ 
and inserting ‘‘September 30, 2021’’; and 
(ii) by striking ‘‘and’’ at the end; 
(C) in subparagraph (C), as so redesig-
nated, by striking ‘‘December 3, 2021,’’ and in-
serting ‘‘September 30, 2021’’; 
(D) by adding at the end the following: 
‘‘(D) for fiscal year 2022 and each subse-
quent fiscal year, the Federal medical assist-
ance percentage for the Virgin Islands, Guam, 
the Northern Mariana Islands, and American 
Samoa shall be equal to 83 percent; 
‘‘(E) for fiscal year 2022, the Federal 
medical assistance percentage for Puerto Rico 
shall be equal to 76 percent; and 
‘‘(F) for fiscal year 2023 and each subse-
quent fiscal year, the Federal medical assist-
ance percentage for Puerto Rico shall be equal 
to 83 percent.’’; and