911 
1396 et seq., 1397aa et seq.), including initia-
tives States have implemented under waivers 
under section 1115 of such Act (42 U.S.C. 1315), 
for such purposes. 
(B) Opportunities States can leverage to fi-
nance, support, and expand the availability of 
providers of community-based mental health and 
substance use disorder services who participate 
in Medicaid and CHIP across the continuum of 
care, including through the participation of 
paraprofessionals with behavioral health exper-
tise, such as clinicians with baccalaureate de-
grees and peer support specialists and including 
best practices especially pertinent to pediatric 
care. The guidance shall include examples of in-
novative policies states have adopted to expand 
access to behavioral health services; for example, 
by establishing more expansive and diverse be-
havioral health workforce roles such as certified 
wellness coaches. 
(C) Best practices related to financing, sup-
porting, and expanding the education and train-
ing of providers of mental health and substance 
use disorder services in order to increase the 
workforce of such providers who participate in
912 
Medicaid and CHIP across the continuum of 
care, including innovative public-private part-
nerships and including such practices that are 
especially pertinent to pediatric care. 
(2) Opportunities to promote the integration of 
mental health or substance use disorder services with 
primary care services. The guidance relating to such 
opportunities shall include the following: 
(A) An overview of State options for adopt-
ing and expanding value-based payment ar-
rangements and alternative payment models, in-
cluding accountable care organization-like mod-
els and other shared savings programs. 
(B) A description of opportunities for 
States to use and align existing authorities and 
resources to finance the integration of mental 
health or substance use disorder services with 
primary care services, including with respect to 
the use of electronic health records in mental 
health care settings and in substance use dis-
order care settings. 
(C) Strategies to support integration of 
mental health or substance use disorder services 
with primary care services through the use of
913 
non-clinical professionals and paraprofessionals, 
including peer support specialists. 
(D) Examples of specific strategies and 
models designed to support integration of mental 
health or substance use disorder services with 
primary care services for differing age groups, 
including children and youth and individuals 
over the age of 65, which may include the col-
laborative care model or primary care behavioral 
health model for behavioral health integration. 
(b) INTEGRATION OF MENTAL HEALTH OR SUBSTANCE 
USE DISORDER SERVICES WITH PRIMARY CARE SERV-
ICES.—For purposes of subsection (a)(2), the term ‘‘integra-
tion of mental health or substance use disorder services with 
primary care services’’ means any of the following: 
(1) The delivery of mental health or substance 
use disorder services in a setting that is physically lo-
cated in the same practice or building as a primary 
care setting, or when at least 1 provider of mental 
health or substance use disorder services is available 
in a primary care setting via telehealth. 
(2) The use of behavioral health integration mod-
els primarily intended for pediatric populations with 
non-severe mental health needs that are focused on 
prevention and early detection and intervention meth-
914 
ods through a multidisciplinary collaborative behav-
ioral health team approach co-managed with primary 
care, to include same-day access to family-focused 
mental health treatment services. 
(3) Having providers of mental health or sub-
stance use disorder services physically co-located in a 
primary care setting with same-day visit availability. 
(4) Implementing or maintaining enhanced care 
coordination or targeted case management which in-
cludes regular interactions between and within care 
teams. 
(5) Providing mental health or substance use dis-
order screening and follow-up assessments, interven-
tions, or services within the same practice or facility 
as a primary care or physical service setting. 
(6) The use of assertive community treatment 
that is integrated with or facilitated by a primary 
care practice. 
(7) Delivery of integrated primary care and 
mental health care or substance use disorder care in 
the home or in community-based settings for individ-
uals who are recipients of Medicaid home and com-
munity-based services.
915 
SEC. 208. FUNDING FOR IMPLEMENTATION AND OPER-
ATIONS. 
There is appropriated to the Secretary of Health and 
Human Services for fiscal year 2024, out of any funds in 
the Treasury not otherwise appropriated, to remain avail-
able until expended— 
(1) $5,000,000, for the purpose of carrying out 
section 203 and the amendments made by such sec-
tion, and sections 206, and 207; and 
(2) $10,000,000 for the recurring collection, 
analysis, and publication of health care data under 
section 1948 of the Social Security Act, as added by 
section 202. 
SEC. 209. CERTIFIED COMMUNITY BEHAVIORAL HEALTH 
CLINIC SERVICES UNDER MEDICAID. 
(a) DEFINITION OF MEDICAL ASSISTANCE.—Section 
1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended— 
(1) in subsection (a)— 
(A) in paragraph (30), by striking ‘‘; and’’ 
and inserting a semicolon; 
(B) by redesignating paragraph (31) as 
paragraph (32); and 
(C) by inserting after paragraph (30) the 
following new paragraph:
916 
‘‘(31) certified community behavioral health clin-
ic services, as defined in subsection (jj); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(jj) CERTIFIED COMMUNITY BEHAVIORAL HEALTH 
CLINIC SERVICES.— 
‘‘(1) IN GENERAL.—The term ‘certified commu-
nity behavioral health services’ means any of the fol-
lowing services when furnished to an individual as a 
patient of a certified community behavioral health 
clinic (as defined in paragraph (2)), in a manner re-
flecting person-centered care and which, if not avail-
able directly through a certified community behav-
ioral health clinic, may be provided or referred 
through formal relationships with other providers: 
‘‘(A) Crisis mental health services, includ-
ing 24-hour mobile crisis teams, emergency crisis 
intervention services, and crisis stabilization. 
‘‘(B) Screening, assessment, and diagnosis, 
including risk assessment. 
‘‘(C) Patient-centered treatment planning 
or similar processes, including risk assessment 
and crisis planning. 
‘‘(D) Outpatient mental health and sub-
stance use services.
917 
‘‘(E) Outpatient clinic primary care screen-
ing and monitoring of key health indicators and 
health risk. 
‘‘(F) Intensive case management services. 
‘‘(G) Psychiatric rehabilitation services. 
‘‘(H) Peer support and counselor services 
and family supports. 
‘‘(I) Intensive, community-based mental 
health care for members of the armed forces and 
veterans who are eligible for medical assistance, 
particularly such members and veterans located 
in rural areas, provided the care is consistent 
with minimum clinical mental health guidelines 
promulgated by the Veterans Health Administra-
tion, including clinical guidelines contained in 
the Uniform Mental Health Services Handbook 
of such Administration. 
‘‘(2) 
CERTIFIED
COMMUNITY
BEHAVIORAL 
HEALTH CLINIC.—The term ‘certified community be-
havioral health clinic’ means an organization that— 
‘‘(A) has been certified by a State as meet-
ing the criteria established by the Secretary pur-
suant to subsection (a) of section 223 of the Pro-
tecting Access to Medicare Act as of January 1, 
2024, and any subsequent updates to such cri-
918 
teria, regardless of whether the State is carrying 
out a demonstration program under this title 
under subsection (d) of such section; 
‘‘(B) is engaged in furnishing all of the 
services described in paragraph (1); and 
‘‘(C) agrees, as a condition of the certifi-
cation described in subparagraph (A), to furnish 
to the State or Secretary any data required as 
part of ongoing monitoring of the organization’s 
provision of services, including encounter data, 
clinical outcomes data, quality data, and such 
other data as the State or Secretary may re-
quire.’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to medical assistance fur-
nished on or after the date of enactment of this Act. 
SEC. 
210. 
ELIMINATING 
CERTAIN 
DISPROPORTIONATE 
SHARE HOSPITAL PAYMENT CUTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)), as amended by section 121 of sub-
title B of title I of division B of the Further Additional 
Continuing Appropriations and Other Extensions Act, 
2024 (Public Law 118–35), is amended— 
(1) in clause (i), by striking ‘‘For the period be-
ginning March 9, 2024, and ending September 30,
919 
2024, and for each of fiscal years 2025’’ and inserting 
‘‘For the period beginning January 1, 2025, and end-
ing September 30, 2025, and for each of fiscal years 
2026’’; and 
(2) in clause (ii), by striking ‘‘March 9, 2024, 
and ending September 30, 2024, and for each of fiscal 
years 2025’’ and inserting ‘‘January 1, 2025, and 
ending September 30, 2025, and for each of fiscal 
years 2026’’. 
SEC. 211. PROMOTING VALUE IN MEDICAID MANAGED CARE. 
Section 1903(m)(9)(A) of the Social Security Act (42 
U.S.C. 1396b(m)(9)(A)) is amended by striking ‘‘(and be-
fore fiscal year 2024)’’. 
SEC. 212. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(3)(A) of the Social Security Act (42 
U.S.C. 1396w–1(b)(3)(A)), as amended by section 122 of 
subtitle B of title I of division B of the Further Additional 
Continuing Appropriations and Other Extensions Act, 
2024 (Public Law 118–35), is further amended by striking 
‘‘$5,140,428,729’’ and inserting ‘‘$0’’. 
Subtitle C—Medicare 
SEC. 301. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended—
920 
(1) in the first sentence— 
(A) by striking ‘‘and $20,000,000’’ and in-
serting ‘‘$20,000,000’’; and 
(B) by inserting the following before the pe-
riod at the end: ‘‘, and $9,000,000 for the period 
beginning on October 1, 2023, and ending on 
December 31, 2024’’; and 
(2) in the third sentence, by striking ‘‘and 2023’’ 
and inserting ‘‘2023, and 2024 and the period begin-
ning on October 1, 2024, and ending on December 31, 
2024’’. 
SEC. 302. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note), as amended by section 3306 of 
the Patient Protection and Affordable Care Act (Public Law 
111–148), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112–240), section 1110 of the Pathway 
for SGR Reform Act of 2013 (Public Law 113–67), section 
110 of the Protecting Access to Medicare Act of 2014 (Public 
Law 113–93), section 208 of the Medicare Access and CHIP 
Reauthorization Act of 2015 (Public Law 114–10), section 
50207 of division E of the Bipartisan Budget Act of 2018
921 
(Public Law 115–123), section 1402 of division B of the 
Continuing Appropriations Act, 2020, and Health Extend-
ers Act of 2019 (Public Law 116–59), section 1402 of divi-
sion B of the Further Continuing Appropriations Act, 2020, 
and Further Health Extenders Act of 2019 (Public Law 
116–69), section 103 of division N of the Further Consoli-
dated Appropriations Act, 2020 (Public Law 116–94), sec-
tion 3803 of the CARES Act (Public Law 116–136), section 
2203 of the Continuing Appropriations Act, 2021 and 
Other Extensions Act (Public Law 116–159), section 1102 
of the Further Continuing Appropriations Act, 2021, and 
Other Extensions Act (Public Law 116–215), and section 
103 of division CC of the Consolidated Appropriations Act, 
2021 (Public Law 116–260), is amended— 
(1) in clause (xii), by striking ‘‘and’’ at the end; 
(2) in clause (xiii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) for the period beginning on Oc-
tober 1, 2023, and ending on December 31, 
2024, $18,750,000.’’. 
(b) AREA AGENCIES ON AGING.—Subsection (b)(1)(B) 
of such section 119, as so amended, is amended— 
(1) in clause (xii), by striking ‘‘and’’ at the end;
922 
(2) in clause (xiii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) for the period beginning on Oc-
tober 1, 2023, and ending on December 31, 
2024, $18,750,000.’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119, as so amended, 
is amended— 
(1) in clause (xii), by striking ‘‘and’’ at the end; 
(2) in clause (xiii), by striking the comma at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) for the period beginning on Oc-
tober 1, 2023, and ending on December 31, 
2024, $6,250,000.’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
ERAL AND STATE PROGRAMS.—Subsection (d)(2) of such 
section 119, as so amended, is amended— 
(1) in clause (xii), by striking ‘‘and’’ at the end; 
(2) in clause (xiii), by striking the period at the 
end and inserting ‘‘; and’’; and
923 
(3) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) for the period beginning on Oc-
tober 1, 2023, and ending on December 31, 
2024, $18,750,000.’’. 
SEC. 303. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR UNDER THE MEDICARE PROGRAM. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘March 
9, 2024’’ and inserting ‘‘January 1, 2025’’. 
SEC. 304. EXTENDING INCENTIVE PAYMENTS FOR PARTICI-
PATION IN ELIGIBLE ALTERNATIVE PAYMENT 
MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Secu-
rity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A)— 
(A) by striking ‘‘with 2025’’ and inserting 
‘‘with 2026’’; and 
(B) by inserting ‘‘, or, with respect to 2026, 
1.88 percent’’ after ‘‘3.5 percent’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B)— 
(i) in the heading, by striking ‘‘2025’’ 
and inserting ‘‘2026’’; and
924 
(ii) in the matter preceding clause (i), 
by striking ‘‘2025’’ and inserting ‘‘2026’’; 
(B) in subparagraph (C)— 
(i) in the heading, by striking ‘‘2026’’ 
and inserting ‘‘2027’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2026’’ and inserting ‘‘2027’’; 
and 
(C) in subparagraph (D), by striking ‘‘and 
2025’’ and inserting ‘‘2025, and 2026’’; and 
(3) in paragraph (4)(B), by inserting ‘‘, or, with 
respect to 2026, 1.88 percent’’ after ‘‘3.5 percent’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), by striking ‘‘2025’’ and in-
serting ‘‘2026’’; and 
(2) in subclause (III), by striking ‘‘2026’’ and 
inserting ‘‘2027’’. 
SEC. 305. TEMPORARY PAYMENT INCREASE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE TO AC-
COUNT FOR EXCEPTIONAL CIRCUMSTANCES 
AND ATYPICAL TIMING OF ENACTMENT. 
Section 1848(t)(1) of the Social Security Act (42 
U.S.C. 1395w–4(t)(1)) is amended—
925 
(1) in subparagraph (C), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (D)— 
(A) by striking ‘‘January 1, 2025’’ and in-
serting ‘‘March 9, 2024’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) such services furnished on or after 
March 9, 2024, and before January 1, 2025, by 
2.93 percent.’’. 
SEC. 306. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘in fiscal year 2025 and 
subsequent fiscal years’’ and inserting ‘‘during the 
portion of fiscal year 2025 beginning on January 1, 
2025, and ending on September 30, 2025, and in fis-
cal year 2026 and subsequent fiscal years’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I)—
926 
(i) by inserting ‘‘or portion of a fiscal 
year’’ after ‘‘for a fiscal year’’; and 
(ii) by inserting ‘‘and the portion of 
fiscal year 2025 beginning on October 1, 
2024, and ending on December 31, 2024’’ 
after ‘‘through 2024’’; 
(B) in subclause (III), by inserting ‘‘and 
the portion of fiscal year 2025 beginning on Oc-
tober 1, 2024, and ending on December 31, 
2024’’ after ‘‘through 2024’’; and 
(C) in subclause (IV), by striking ‘‘fiscal 
year 2025’’ and inserting ‘‘the portion of fiscal 
year 2025 beginning on January 1, 2025, and 
ending on September 30, 2025, and fiscal year 
2026’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘or during the portion of fiscal year 
2025 beginning on October 1, 2024, and ending 
on December 31, 2024’’ after ‘‘through 2024’’; 
and 
(B) in clause (ii), by inserting ‘‘and the 
portion of fiscal year 2025 beginning on October 
1, 2024, and ending on December 31, 2024’’ after 
‘‘through 2024’’.
927 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
ices may implement the provisions of, including the amend-
ments made by, this section by program instruction or oth-
erwise. 
SEC. 307. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘October 1, 2024’’ 
and inserting ‘‘January 1, 2025’’; and 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2024’’ and inserting ‘‘January 1, 2025’’. 
(b) CONFORMING AMENDMENTS.— 
(1) EXTENSION
OF
TARGET
AMOUNT.—Section 
1886(b)(3)(D) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘October 1, 2024’’ and inserting ‘‘Janu-
ary 1, 2025’’; and 
(B) in clause (iv), by inserting ‘‘and the 
portion of fiscal year 2025 beginning on October 
1, 2024, and ending on December 31, 2024,’’ 
after ‘‘through fiscal year 2024’’.
928 
(2) PERMITTING
HOSPITALS
TO
DECLINE
RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by striking ‘‘or fiscal year 
2000’’ and all that follows through ‘‘the Secretary’’ 
and inserting ‘‘fiscal year 2000 through fiscal year 
2024, or the portion of fiscal year 2025 beginning on 
October 1, 2024, and ending on December 31, 2024, 
the Secretary’’. 
SEC. 308. EXTENSION OF ADJUSTMENT TO CALCULATION 
OF HOSPICE CAP AMOUNT UNDER MEDICARE. 
Section 1814(i)(2)(B) of the Social Security Act (42 
U.S.C. 1395f(i)(2)(B)) is amended— 
(1) in clause (ii), by striking ‘‘2032’’ and insert-
ing ‘‘2033’’; and 
(2) in clause (iii), by striking ‘‘2032’’ and in-
serting ‘‘2033’’. 
SEC. 309. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$2,197,795,056’’ and inserting ‘‘$0’’.
929 
Subtitle D—Human Services 
SEC. 401. EXTENSION OF TEMPORARY ASSISTANCE FOR 
NEEDY FAMILIES PROGRAM. 
Activities authorized by part A of title IV (other than 
under section 403(c) or 418) and section 1108(b) of the So-
cial Security Act shall continue through September 30, 
2024, in the manner authorized for fiscal year 2023, and 
out of any money in the Treasury of the United States not 
otherwise appropriated, there are hereby appropriated such 
sums as may be necessary for such purpose. 
SEC. 402. EXTENSION OF CHILD AND FAMILY SERVICES 
PROGRAMS. 
Activities authorized by part B of title IV of the Social 
Security Act shall continue through December 31, 2024, in 
the manner authorized for fiscal year 2023, and out of any 
money in the Treasury of the United States not otherwise 
appropriated, there are hereby appropriated such sums as 
may be necessary for such purpose. 
SEC. 403. SEXUAL RISK AVOIDANCE EDUCATION EXTEN-
SION. 
Section 510 of the Social Security Act (42 U.S.C. 710), 
as amended by section 142 of subtitle D of title I of division 
B of the Further Additional Continuing Appropriations 
and Other Extensions Act, 2024 (Public Law 118–35), is 
further amended—
930 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘and’’ after ‘‘January 
19, 2024,’’; 
(ii) by inserting ‘‘for the period begin-
ning on March 9, 2024, and ending on Sep-
tember 30, 2024, and for the period begin-
ning on October 1, 2024, and ending on De-
cember 31, 2024,’’ after ‘‘March 8, 2024,’’; 
and 
(iii) by inserting ‘‘or 2025’’ after ‘‘for 
fiscal year 2024’’; and 
(B) in paragraph (2), by inserting ‘‘or 
2025’’ after ‘‘with respect to fiscal year 2024’’ 
each place it appears; and 
(2) in subsection (f)(1)— 
(A) by striking ‘‘and’’ before ‘‘for the period 
beginning on January 20, 2024,’’; and 
(B) by striking the period at the end and 
inserting ‘‘, for the period beginning on March 
9, 2024, and ending on September 30, 2024, an 
amount equal to the pro rata portion of the 
amount appropriated for the corresponding pe-
riod for fiscal year 2023, and for the period be-
ginning on October 1, 2024, and ending on De-
931 
cember 31, 2024, an amount equal to the pro 
rata portion of the amount appropriated for the 
corresponding period for fiscal year 2024.’’. 
SEC. 404. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 713), 
as amended by section 143 of subtitle D of title I of division 
B of the Further Additional Continuing Appropriations 
and Other Extensions Act, 2024 (Public Law 118–35), is 
further amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), in the matter pre-
ceding clause (i)— 
(i) by striking ‘‘and’’ after ‘‘January 
19, 2024,’’; and 
(ii) by inserting ‘‘for the period begin-
ning on March 9, 2024, and ending on Sep-
tember 30, 2024, and for the period begin-
ning on October 1, 2024, and ending on De-
cember 31, 2024,’’ after ‘‘March 8, 2024,’’; 
and 
(B) in subparagraph (B)(i)— 
(i) by striking ‘‘and’’ after ‘‘January 
19, 2024,’’; and
932 
(ii) by striking the period at the end 
and inserting ‘‘, for the period beginning on 
March 9, 2024, and ending on September 
30, 2024, and for the period beginning on 
October 1, 2024, and ending on December 
31, 2024.’’; 
(2) in subsection (c)(3), by inserting ‘‘or 2025’’ 
after ‘‘fiscal year 2024’’; and 
(3) in subsection (f)— 
(A) by striking ‘‘and’’ before ‘‘for the period 
beginning on January 20, 2024,’’; and 
(B) by striking ‘‘fiscal year 2023.’’ and in-
serting ‘‘fiscal year 2023, for the period begin-
ning on March 9, 2024, and ending on Sep-
tember 30, 2024, an amount equal to the pro 
rata portion of the amount appropriated for the 
corresponding period for fiscal year 2023, and 
for the period beginning on October 1, 2024, and 
ending on December 31, 2024, an amount equal 
to the pro rata portion of the amount appro-
priated for the corresponding period for fiscal 
year 2024.’’.
933 
SEC. 405. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY 
HEALTH INFORMATION CENTERS. 
Section 501(c)(1)(A) of the Social Security Act (42 
U.S.C. 701(c)(1)(A)) is amended— 
(1) in clause (vi), by striking ‘‘and’’ after the 
semicolon; 
(2) in clause (vii), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (vii), the following 
new clause: 
‘‘(viii) $1,500,000 for the portion of fiscal year 
2025 before January 1, 2025.’’. 
TITLE II—AMENDING COMPACTS 
OF FREE ASSOCIATION 
SEC. 201. SHORT TITLE. 
This title may be cited as the ‘‘Compact of Free Asso-
ciation Amendments Act of 2024’’. 
SEC. 202. FINDINGS. 
Congress finds the following: 
(1) The United States (in accordance with the 
Trusteeship Agreement for the Trust Territory of the 
Pacific Islands, the United Nations Charter, and the 
objectives of the international trusteeship system of 
the United Nations) fulfilled its obligations to pro-
mote the development of the people of the Trust Terri-
tory toward self-government or independence, as ap-
934 
propriate, to the particular circumstances of the 
Trust Territory and the people of the Trust Territory 
and the freely expressed wishes of the people con-
cerned. 
(2) The United States, the Federated States of 
Micronesia, and the Republic of the Marshall Islands 
entered into the Compact of Free Association set forth 
in section 201 of the Compact of Free Association Act 
of 1985 (48 U.S.C. 1901 note; Public Law 99–239) 
and the United States and the Republic of Palau en-
tered into the Compact of Free Association set forth 
in section 201 of Public Law 99–658 (48 U.S.C. 1931 
note) to create and maintain a close and mutually 
beneficial relationship. 
(3) The ‘‘Compact of Free Association, as 
amended, between the Government of the United 
States of America and the Government of the Fed-
erated States of Micronesia’’, the ‘‘Compact of Free 
Association, as amended, between the Government of 
the United States of America and the Government of 
the Republic of the Marshall Islands’’, and related 
agreements were signed by the Government of the 
United States and the Governments of the Federated 
States of Micronesia and the Republic of the Marshall 
Islands and approved, as applicable, by section 201
935 
of the Compact of Free Association Amendments Act 
of 2003 (48 U.S.C. 1921 note; Public Law 108–188). 
(4) The ‘‘Agreement between the Government of 
the United States of America and the Government of 
the Republic of Palau Following the Compact of Free 
Association Section 432 Review’’, was signed by the 
Government of the United States and the Government 
of the Republic of Palau on September 3, 2010, and 
amended on September 19, 2018. 
(5) On May 22, 2023, the United States signed 
the ‘‘Agreement between the Government of the United 
States of America and the Government of the Repub-
lic of Palau Resulting From the 2023 Compact of 
Free Association Section 432 Review’’. 
(6) On May 23, 2023, the United States signed 
3 agreements related to the U.S.-FSM Compact of 
Free Association, including an Agreement to Amend 
the Compact, as amended, a new fiscal procedures 
agreement, and a new trust fund agreement and on 
September 28, 2023, the United States signed a Fed-
eral Programs and Services agreement related to the 
U.S.-FSM Compact of Free Association. 
(7) On October 16, 2023, the United States 
signed 3 agreements relating to the U.S.-RMI Com-
pact of Free Association, including an Agreement to
936 
Amend the Compact, as amended, a new fiscal proce-
dures agreement, and a new trust fund agreement. 
SEC. 203. DEFINITIONS. 
In this title: 
(1) 1986 COMPACT.—The term ‘‘1986 Compact’’ 
means the Compact of Free Association between the 
Government of the United States and the Govern-
ments of the Marshall Islands and the Federated 
States of Micronesia set forth in section 201 of the 
Compact of Free Association Act of 1985 (48 U.S.C. 
1901 note; Public Law 99–239). 
(2) 2003 AMENDED
U.S.-FSM
COMPACT.—The 
term ‘‘2003 Amended U.S.-FSM Compact’’ means the 
Compact of Free Association amending the 1986 
Compact entitled the ‘‘Compact of Free Association, 
as amended, between the Government of the United 
States of America and the Government of the Fed-
erated States of Micronesia’’ set forth in section 
201(a) of the Compact of Free Association Amend-
ments Act of 2003 (48 U.S.C. 1921 note; Public Law 
108–188). 
(3) 2003 AMENDED
U.S.-RMI
COMPACT.—The 
term ‘‘2003 Amended U.S.-RMI Compact’’ means the 
Compact of Free Association amending the 1986 
Compact entitled ‘‘Compact of Free Association, as
937 
amended, between the Government of the United 
States of America and the Government of the Repub-
lic of the Marshall Islands’’ set forth in section 201(b) 
of the Compact of Free Association Amendments Act 
of 2003 (48 U.S.C. 1921 note; Public Law 108–188). 
(4) 2023 AGREEMENT TO AMEND THE U.S.-FSM 
COMPACT.—The term ‘‘2023 Agreement to Amend the 
U.S.-FSM Compact’’ means the Agreement between 
the Government of the United States of America and 
the Government of the Federated States of Micronesia 
to Amend the Compact of Free Association, as 
Amended, done at Palikir May 23, 2023. 
(5) 2023 AGREEMENT TO AMEND THE U.S.-RMI 
COMPACT.—The term ‘‘2023 Agreement to Amend the 
U.S.-RMI Compact’’ means the Agreement between 
the Government of the United States of America and 
the Government of the Republic of the Marshall Is-
lands to Amend the Compact of Free Association, as 
Amended, done at Honolulu October 16, 2023. 
(6) 2023 AMENDED
U.S.-FSM
COMPACT.—The 
term ‘‘2023 Amended U.S.-FSM Compact’’ means the 
2003 Amended U.S.-FSM Compact, as amended by 
the 2023 Agreement to Amend the U.S.-FSM Com-
pact.
938 
(7) 2023 AMENDED
U.S.-RMI
COMPACT.—The 
term ‘‘2023 Amended U.S.-RMI Compact’’ means the 
2003 Amended U.S.-RMI Compact, as amended by 
the 2023 Agreement to Amend the U.S.-RMI Com-
pact. 
(8) 2023 U.S.-FSM
FEDERAL
PROGRAMS
AND 
SERVICES AGREEMENT.—The term ‘‘2023 U.S.-FSM 
Federal Programs and Services Agreement’’ means the 
2023 Federal Programs and Services Agreement be-
tween the Government of the United States of Amer-
ica and the Government of the Federated States of 
Micronesia, done at Washington September 28, 2023. 
(9) 2023 U.S.-FSM FISCAL PROCEDURES AGREE-
MENT.—The term ‘‘2023 U.S.-FSM Fiscal Procedures 
Agreement’’ means the Agreement Concerning Proce-
dures for the Implementation of United States Eco-
nomic Assistance provided in the 2023 Amended 
U.S.-FSM Compact between the Government of the 
United States of America and the Government of the 
Federated States of Micronesia, done at Palikir May 
23, 2023. 
(10) 2023 U.S.-FSM TRUST FUND AGREEMENT.— 
The term ‘‘2023 U.S.-FSM Trust Fund Agreement’’ 
means the Agreement between the Government of the 
United States of America and the Government of the
939 
Federated States of Micronesia Regarding the Com-
pact Trust Fund, done at Palikir May 23, 2023. 
(11) 2023 U.S.-PALAU COMPACT REVIEW AGREE-
MENT.—The term ‘‘2023 U.S.-Palau Compact Review 
Agreement’’ means the Agreement between the Govern-
ment of the United States of America and the Govern-
ment of the Republic of Palau Resulting From the 
2023 Compact of Free Association Section 432 Re-
view, done at Port Moresby May 22, 2023. 
(12) 2023 U.S.-RMI FISCAL PROCEDURES AGREE-
MENT.—The term ‘‘2023 U.S.-RMI Fiscal Procedures 
Agreement’’ means the Agreement Concerning Proce-
dures for the Implementation of United States Eco-
nomic Assistance Provided in the 2023 Amended 
Compact Between the Government of the United 
States of America and the Government of the Repub-
lic of the Marshall Islands, done at Honolulu October 
16, 2023. 
(13) 2023 U.S.-RMI TRUST FUND AGREEMENT.— 
The term ‘‘2023 U.S.-RMI Trust Fund Agreement’’ 
means the Agreement between the Government of the 
United States of America and the Government of the 
Republic of the Marshall Islands Regarding the Com-
pact Trust Fund, done at Honolulu October 16, 2023.
940 
(14) 
APPROPRIATE
COMMITTEES
OF
CON-
GRESS.—The term ‘‘appropriate committees of Con-
gress’’ means— 
(A) the Committee on Energy and Natural 
Resources of the Senate; 
(B) the Committee on Foreign Relations of 
the Senate; 
(C) the Committee on Natural Resources of 
the House of Representatives; and 
(D) the Committee on Foreign Affairs of the 
House of Representatives. 
(15) FREELY
ASSOCIATED
STATES.—The term 
‘‘Freely Associated States’’ means— 
(A) the Federated States of Micronesia; 
(B) the Republic of the Marshall Islands; 
and 
(C) the Republic of Palau. 
(16) SUBSIDIARY AGREEMENT.—The term ‘‘sub-
sidiary agreement’’ means any of the following: 
(A) The 2023 U.S.-FSM Federal Programs 
and Services Agreement. 
(B) The 2023 U.S.-FSM Fiscal Procedures 
Agreement. 
(C) The 2023 U.S.-FSM Trust Fund Agree-
ment.
941 
(D) The 2023 U.S.-RMI Fiscal Procedures 
Agreement. 
(E) The 2023 U.S.-RMI Trust Fund Agree-
ment. 
(F) Any Federal Programs and Services 
Agreement in force between the United States 
and the Republic of the Marshall Islands. 
(G) Any Federal Programs and Services 
Agreement in force between the United States 
and the Republic of Palau. 
(H) Any other agreement that the United 
States may from time-to-time enter into with the 
Government of the Federated States of Micro-
nesia, the Government of the Republic of Palau, 
or the Government of the Republic of the Mar-
shall Islands, in accordance with— 
(i) the 2023 Amended U.S.-FSM Com-
pact; 
(ii) the 2023 U.S.-Palau Compact Re-
view Agreement; or 
(iii) the 2023 Amended U.S.-RMI 
Compact. 
(17) U.S.-PALAU
COMPACT.—The term ‘‘U.S.- 
Palau Compact’’ means the Compact of Free Associa-
tion between the United States and the Government
942 
of Palau set forth in section 201 of Public Law 99– 
658 (48 U.S.C. 1931 note). 
SEC. 204. APPROVAL OF 2023 AGREEMENT TO AMEND THE 
U.S.-FSM 
COMPACT, 
2023 
AGREEMENT 
TO 
AMEND THE U.S.-RMI COMPACT, 2023 U.S.- 
PALAU COMPACT REVIEW AGREEMENT, AND 
SUBSIDIARY AGREEMENTS. 
(a) FEDERATED STATES OF MICRONESIA.— 
(1) APPROVAL.—The 2023 Agreement to Amend 
the U.S.-FSM Compact and the 2023 U.S.-FSM 
Trust Fund Agreement, as submitted to Congress on 
June 15, 2023, are approved and incorporated by ref-
erence. 
(2) CONSENT OF CONGRESS.—Congress consents 
to— 
(A) the 2023 U.S.-FSM Fiscal Procedures 
Agreement, as submitted to Congress on June 15, 
2023; and 
(B) the 2023 U.S.-FSM Federal Programs 
and Services Agreement. 
(3) 
AUTHORITY
OF
PRESIDENT.—Notwith-
standing section 101(f) of the Compact of Free Asso-
ciation Amendments Act of 2003 (48 U.S.C. 1921(f)), 
the President is authorized to bring into force and
965 
(B) if the report is not submitted by the ap-
plicable deadline, written notice that the report 
has not been timely submitted. 
(f) FOUR ATOLL HEALTH CARE PROGRAM.—Congress 
reaffirms that— 
(1) section 103(j)(1) of the Compact of Free Asso-
ciation Act of 1985 (48 U.S.C. 1903(j)(1)) and section 
103(h)(1) of the Compact of Free Association Amend-
ments Act of 2003 (48 U.S.C. 1921b(h)(1)) provided 
that services ‘‘provided by the United States Public 
Health Service or any other United States agency 
pursuant to section 1(a) of Article II of the Agreement 
for the Implementation of Section 177 of the Compact 
(hereafter in this subsection referred to as the ‘Section 
177 Agreement’) shall be only for services to the peo-
ple of the Atolls of Bikini, Enewetak, Rongelap, and 
Utrik who were affected by the consequences of the 
United States nuclear testing program, pursuant to 
the program described in Public Law 95–134 and 
Public Law 96–205 and their descendants (and any 
other persons identified as having been so affected if 
such identification occurs in the manner described in 
such public laws). Nothing in this subsection shall be 
construed as prejudicial to the views or policies of the 
Government of the Marshall Islands as to the persons