597 
(4) by adding at the end the following new 
paragraph: 
‘‘(2) SPECIAL RULE FOR PUERTO RICO RELAT-
ING TO ESTABLISHING A PAYMENT FLOOR.— 
‘‘(A) IN GENERAL.—For each fiscal quar-
ter (beginning with the first fiscal quarter be-
ginning on or after the date of the enactment 
of this paragraph), Puerto Rico’s State plan (or 
waiver of such plan) shall establish a reimburse-
ment floor, implemented through a directed 
payment arrangement plan, for physician serv-
ices that are covered under the Medicare part 
B fee schedule in the Puerto Rico locality estab-
lished under section 1848(b) that is not less 
than 70 percent of the payment that would 
apply to such services if they were furnished 
under part B of title XVIII during such fiscal 
quarter. 
‘‘(B) APPLICATION TO MANAGED CARE.— 
In determining whether Puerto Rico has estab-
lished a reimbursement floor under a directed 
payment arrangement plan that satisfies the re-
quirements of subparagraph (A) for a fiscal 
quarter occurring during fiscal year 2022 or a 
subsequent fiscal year—
598 
‘‘(i) the Secretary shall disregard pay-
ments made under sub-capitated arrange-
ments for services such as primary care 
case management; and 
‘‘(ii) if the reimbursement floor for 
physician services applicable under a man-
aged care contract satisfies the require-
ments of subparagraph (A) for a fiscal 
quarter occurring during a year in which 
the contract is entered into or renewed, 
such reimbursement floor shall be deemed 
to satisfy such requirements for each sub-
sequent fiscal quarter occurring during 
such year and for each fiscal quarter oc-
curring during the subsequent fiscal year. 
‘‘(C) FMAP REDUCTION FOR FAILURE TO 
ESTABLISH PAYMENT FLOOR.— 
‘‘(i) IN GENERAL.—In the case that 
the Secretary determines that Puerto Rico 
has failed to meet the requirement of sub-
paragraph (A) with respect to a fiscal 
quarter, the Federal medical assistance 
percentage otherwise determined under 
this subsection for Puerto Rico shall be re-
duced for such quarter by the applicable
599 
number of percentage points described in 
clause (ii). 
‘‘(ii) APPLICABLE NUMBER OF PER-
CENTAGE POINTS.—For purposes of clause 
(i), the applicable number of percentage 
points described in this clause is, with re-
spect to a fiscal quarter, the following: 
‘‘(I) In the case no reduction was 
made under this subparagraph for the 
preceding fiscal quarter, 0.5 percent-
age points. 
‘‘(II) In the case a reduction was 
made under this subparagraph for the 
preceding fiscal quarter, the number 
of percentage points of such reduction 
for such preceding fiscal quarter, plus 
0.25 percentage points, except that in 
no case may the application of this 
subclause result in a reduction of 
more than 5 percentage points.’’.
600 
PART 4—OTHER MEDICAID 
SEC. 30741. INVESTMENTS TO ENSURE CONTINUED ACCESS 
TO 
HEALTH 
CARE 
FOR 
CHILDREN 
AND 
OTHER INDIVIDUALS. 
(a) PROVIDING FOR 1 YEAR OF CONTINUOUS ELIGI-
BILITY FOR CHILDREN.— 
(1) UNDER THE MEDICAID PROGRAM.— 
(A) IN GENERAL.—Section 1902(e) of the 
Social Security Act (42 U.S.C. 1396a(e)) is 
amended— 
(i) in paragraph (12), by inserting 
‘‘before the date that is one year after the 
date of the enactment of paragraph (17)’’ 
after ‘‘subsection (a)(10)(A)’’; and 
(ii) by adding at the end following 
new paragraph: 
‘‘(17) 1 YEAR OF CONTINUOUS ELIGIBILITY FOR 
CHILDREN.—The State plan (or waiver of such 
State plan) shall provide that an individual who is 
under the age of 19 and who is determined to be eli-
gible for benefits under a State plan (or waiver of 
such plan) approved under subsection (a)(10)(A) 
shall remain eligible for such benefits until the ear-
lier of— 
‘‘(A) the end of the 12-month period begin-
ning on the date of such determination;
601 
‘‘(B) the time that such individual attains 
the age of 19; or 
‘‘(C) the date that such individual ceases 
to be a resident of such State.’’. 
(B) EFFECTIVE DATE.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the amendments made by subpara-
graph (A)(ii) shall take effect one year 
after the date of enactment of this Act. 
(ii) 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 requirement 
imposed by amendments made under sub-
paragraph (A)(ii), the plan shall not be re-
garded as failing to comply with the re-
quirements 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
602 
of this Act. For purposes 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. 
(2) UNDER THE CHILDREN’S HEALTH INSUR-
ANCE PROGRAM.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (K) 
through (T) as subparagraphs (L) through (U), 
respectively; and 
(B) by inserting after subparagraph (J) 
the following new subparagraph: 
‘‘(K) Section 1902(e)(17) (relating to 1 
year of continuous eligibility for children).’’. 
(b) REVISIONS TO TEMPORARY INCREASE OF MED-
ICAID FMAP UNDER THE FAMILIES FIRST CORONAVIRUS 
RESPONSE ACT.—Section 6008 of the Families First 
Coronavirus Response Act (42 U.S.C. 1396d note) is 
amended— 
(1) in subsection (a)— 
(A) by striking ‘‘IN GENERAL.—Subject 
to’’ and inserting ‘‘TEMPORARY INCREASE.— 
‘‘(1) IN GENERAL.—Subject to’’;
603 
(B) in the paragraph (1) inserted by sub-
paragraph (A)— 
(i) by striking ‘‘the last day of the cal-
endar quarter in which the last day of such 
emergency period occurs’’ and inserting 
‘‘September 30, 2022’’; and 
(ii) 
by 
striking 
‘‘6.2 
percentage 
points’’ and inserting ‘‘the number of per-
centage points specified in paragraph (2) 
with respect to such calendar quarter’’; 
and 
(C) by adding at the end the following new 
paragraph: 
‘‘(2) PERCENTAGE
POINTS
SPECIFIED.—For 
purposes of paragraph (1), the number of percent-
age points specified in this paragraph is— 
‘‘(A) 6.2 percentage points with respect to 
each calendar quarter occurring during the pe-
riod beginning on the first day of the emer-
gency period defined in paragraph (1)(B) of 
section 1135(g) of the Social Security Act (42 
U.S.C. 1320b-5(g)) and ending March 31, 
2022;
604 
‘‘(B) 3.0 percentage points with respect to 
the calendar quarter beginning on April 1, 
2022, and ending on June 30, 2022; and 
‘‘(C) 1.5 percentage points with respect to 
the calendar quarter beginning on July 1, 2022, 
and ending on September 30, 2022.’’; 
(2) in subsection (b)(3)— 
(A) by striking ‘‘the State fails’’ and in-
serting ‘‘subject to subsection (f), the State 
fails’’; 
(B) by striking ‘‘and ending the last day of 
the month in which the emergency period de-
scribed in subsection (a) ends’’ and inserting 
‘‘and ending on March 31, 2022,’’; and 
(C) by striking ‘‘through the end of the 
month in which such emergency period ends’’ 
and inserting ‘‘through September 30, 2022,’’; 
and 
(3) by adding at the end the following new sub-
section: 
‘‘(f) SPECIAL RULE FOR ENROLLMENTS AS OF APRIL 
1, 2022.—For calendar quarters during the period de-
scribed in subsection (a) that begin on or after April 1, 
2022, a State described in such subsection may, in accord-
ance with paragraph (3), terminate coverage for an indi-
605 
vidual who is determined to be no longer eligible for med-
ical assistance and who has been enrolled for at least 12 
consecutive months under the State plan of such State 
under title XIX of the Social Security Act (42 U.S.C. 
1396) (or waiver of such plan), and such State shall not 
be ineligible for the increase to the Federal medical assist-
ance percentage of the State described in such subsection 
on the basis that the State is in violation of the require-
ment of subsection (b)(3), if the State, with respect to 
such terminations of coverage conducted through Sep-
tember 30, 2022, for such individuals, is in compliance 
with each of the following: 
‘‘(1) The State shall conduct such eligibility re-
determinations, with respect to such an individual, 
in accordance with the provisions of section 435.916 
of title 42 of the Code of Federal Regulations (or 
any successor regulation) and the provisions of sec-
tion 1943 of the Social Security Act, as applicable. 
‘‘(2) Prior to terminating coverage for an indi-
vidual, the State shall undertake a good faith effort 
to ensure that the State has contact information (in-
cluding an up-to-date mailing address, phone num-
ber, or email address) for such individuals by coordi-
nating with Medicaid managed care organizations
606 
(where applicable), and other applicable State health 
and human services agencies. 
‘‘(3) The State may not disenroll from the 
State plan (or waiver) such an individual determined 
ineligible pursuant to such a redetermination for 
medical assistance under the State plan (or waiver) 
on the basis of returned mail unless— 
‘‘(A) there have been at least two failed at-
tempts to contact such individual through at 
least 2 modalities; and 
‘‘(B) after the second attempt, the indi-
vidual had 30 days notice, through at least 2 
modalities, before such disenrollment takes ef-
fect. 
‘‘(4) The State may not initiate eligibility rede-
terminations for more than 1/12 of individuals en-
rolled in the State plan (or waiver) with respect to 
any month during the period beginning on April 1, 
2022, and ending on September 30, 2022. 
‘‘(5) The State shall submit to the Secretary 
monthly reports during the period described in sub-
section (a) that begin on or after April 1, 2022 
which the State receives an increase pursuant to 
such subsection period on the activities of the State,
607 
including, with respect to the period for which the 
report is submitted— 
‘‘(A) the number of eligibility renewals ini-
tiated, beneficiaries renewed, and individuals 
whose eligibility was terminated; 
‘‘(B) the number of such cases in which 
eligibility for medical assistance under the State 
plan (or waiver) were so terminated due to the 
individual’s failure to return a renewal form or 
other information needed by the state to make 
an eligibility determination; 
‘‘(C) the number of such cases in which 
eligibility for medical assistance under the State 
plan (or waiver) were so terminated pursuant to 
such a redetermination due to a known change 
in circumstance; 
‘‘(D) the number of individuals whose cov-
erage was terminated pursuant to such a rede-
termination whose accounts were, during such 
period, transitioned to the Exchange, CHIP, or 
basic health program; and 
‘‘(E) with respect to eligibility redeter-
minations, the daily average volume, wait times, 
and abandonment rate (as determined by the
608 
Secretary) for each call center during such 
month.’’. 
(c) MEDICAL ASSISTANCE UNDER MEDICAID FOR IN-
MATES DURING 30-DAY PERIOD PRECEDING RELEASE.— 
(1) IN
GENERAL.—The subdivision (A) fol-
lowing paragraph (31) of section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amended 
by inserting ‘‘and, beginning on the first day of the 
first fiscal year quarter that begins two years 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’, except during the 30-day period 
preceding the date of release of an inmate of a pub-
lic institution’’ after ‘‘medical institution’’. 
(2) CONFORMING
AMENDMENTS
IN
TITLE 
XIX.—Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended— 
(A) in paragraph (74), by striking at the 
end ‘‘and’’; and 
(B) in paragraph (84)— 
(i) in subparagraph (A), by inserting 
‘‘, except, beginning on the first day of the 
first fiscal year quarter that begins two 
years after the date of the enactment of 
the Act titled ‘An Act to provide for rec-
609 
onciliation pursuant to title II of S. Con. 
Res. 14’, the State may not suspend cov-
erage during the 30-day period preceding 
the date of release of the juvenile’’ after 
‘‘during the period the juvenile is such an 
inmate’’; and 
(ii) in subparagraph (C), by striking 
‘‘upon release’’ and inserting ‘‘30 days 
prior to release’’. 
(3) CONFORMING AMENDMENT IN TITLE XXI.— 
Section 2110(b)(2) of the Social Security Act (42 
U.S.C. 1397jj(b)(2))— 
(A) in subparagraph (A), by striking at the 
end ‘‘or’’; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) except, beginning on the first day of 
the first fiscal year quarter that begins two 
years 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,’ except dur-
ing the 30-day period preceding the date of re-
610 
lease of such child from such public institu-
tion.’’. 
(d) EXTENSION OF CERTAIN PROVISIONS.— 
(1) EXPRESS LANE ELIGIBILITY OPTION.—Sec-
tion 1902(e)(13) of the Social Security Act (42 
U.S.C. 1396a(e)(13)) is amended by striking sub-
paragraph (I). 
(2) CONFORMING
AMENDMENTS
FOR
ASSUR-
ANCE OF AFFORDABILITY STANDARD FOR CHILDREN 
AND FAMILIES.—Section 1902(gg)(2) of the Social 
Security Act (42 U.S.C. 1396a(gg)(2)) is amend-
ed— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(B) by striking ‘‘through September 30’’ 
and all that follows through ‘‘ends on Sep-
tember 30, 2027’’ and inserting ‘‘(but begin-
ning on October 1, 2019,’’. 
(e) EXPANSION OF COMMUNITY MENTAL HEALTH 
SERVICES DEMONSTRATION PROGRAM.— 
(1) IN
GENERAL.—Section 223 of the Pro-
tecting Access to Medicare Act of 2014 (42 U.S.C. 
1396a note) is amended— 
(A) in subsection (c), by adding at the end 
the following new paragraph:
611 
‘‘(3) ADDITIONAL PLANNING GRANTS.—In addi-
tion to the planning grants awarded under para-
graph (1), the Secretary shall award planning grants 
to States (other than States selected to conduct 
demonstration programs under paragraph (1) or (8) 
of subsection (d)) for the purpose of developing pro-
posals to participate in time-limited demonstration 
programs described in subsection (d).’’; 
(B) in subsection (d)— 
(i) in paragraph (3), by striking 
‘‘Subject to paragraph (8)’’ and inserting 
‘‘Subject to paragraphs (8) and (9)’’; 
(ii) in paragraph (5)(C)(iii)(II), by in-
serting ‘‘or paragraph (9)’’ after ‘‘para-
graph (8)’’; 
(iii) in paragraph (7)— 
(I) in subparagraph (A), by in-
serting ‘‘through the year in which 
the last demonstration under this sec-
tion ends’’ after ‘‘annually there-
after’’; and 
(II) in subparagraph (B)— 
(aa) by striking ‘‘December 
31, 2021’’ and inserting ‘‘March 
31, 2026’’;
612 
(bb) 
by 
striking 
‘‘rec-
ommendations concerning’’ and 
all that follows through the pe-
riod and inserting ‘‘recommenda-
tions concerning whether and 
how the demonstration programs 
under this section should be 
modified.’’; and 
(cc) by adding at the end 
the 
following 
new 
sentence: 
‘‘Such recommendations shall be 
based on data collected from 
States selected to conduct dem-
onstration programs under para-
graph (1) and, to the extent 
available, data collected from 
States selected to conduct dem-
onstration programs under para-
graphs (8) and (9).’’; and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(9) FURTHER ADDITIONAL PROGRAMS.— 
‘‘(A) IN
GENERAL.—In addition to the 
States selected under paragraphs (1) and (8) 
and without regard to paragraph (4), the Sec-
613 
retary shall select any State that meets the re-
quirements described in subparagraph (B) to 
conduct a demonstration program that meets 
the requirements of this subsection for 2 years. 
‘‘(B) REQUIREMENTS.—The requirements 
described in this subparagraph with respect to 
a State are that the State— 
‘‘(i) was awarded a planning grant 
under paragraph (1) or (3) of subsection 
(c); and 
‘‘(ii) submits an application (in addi-
tion to any application that the State may 
have previously submitted under this sec-
tion) that meets the requirements of para-
graph (2)(B). 
‘‘(C) 
REQUIREMENTS
FOR
SELECTED 
STATES.—The 
requirements 
applicable 
to 
States selected under paragraph (8) pursuant 
to subparagraph (C) of such paragraph shall 
apply in the same manner to States selected 
under this paragraph.’’; 
(C) in subsection (e), by amending para-
graph (4) to read as follows: 
‘‘(4) STATE.—The term State means each of 
the 50 States, the District of Columbia, Puerto Rico,
614 
the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa.’’; and 
(D) in subsection (f)(1)— 
(i) in subparagraph (A), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in subparagraph (B), by striking 
the 
period 
and 
inserting 
‘‘, 
and 
$40,000,000 for fiscal year 2022; and’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) for purposes of updating the criteria 
under subsection (a) as needed for certified 
community behavioral health clinics and car-
rying out subsections (c)(3), (d)(7), and (d)(9) 
(including the provision of technical assistance 
to States applying for planning grants under 
subsection (c)(3) and conducting demonstration 
projects under this section), $5,000,000 for fis-
cal year 2022.’’. 
(2) EXCLUSION
OF
AMOUNTS
ATTRIBUTABLE 
TO INCREASED FMAP FROM TERRITORIAL CAPS.— 
Section 1108 of the Social Security Act (42 U.S.C. 
1308) is amended—
615 
(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsections 
(g) and (h)’’ and inserting ‘‘subsections (g), 
(h), and (i)’’; and 
(B) by adding at the end the following: 
‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO ENHANCED FMAP FOR COMMUNITY MENTAL 
HEALTH SERVICES.—Any additional amount paid to 
Puerto Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, and American Samoa for expenditures for 
medical assistance that is attributable to an enhanced 
Federal medical assistance percentage applicable to such 
expenditures under section 223(d)(5) of the Protecting 
Access to Medicare Act of 2014 shall not be taken into 
account for purposes of applying payment limits under 
subsections (f) and (g).’’. 
(f) MAKING PERMANENT A STATE OPTION TO PRO-
VIDE QUALIFYING COMMUNITY-BASED MOBILE CRISIS 
INTERVENTION SERVICES.—Section 1947 of the Social 
Security Act (42 U.S.C. 1396w–6) is amended— 
(1) in subsection (a), by striking ‘‘during the 5- 
year period’’; 
(2) in subsection (c), by striking ‘‘occurring 
during the period described in subsection (a) that a 
State’’ and inserting ‘‘in which a State provides
617 
Rescue Plan Act of 2021’’ and inserting ‘‘for the pe-
riod of the 16 fiscal year quarters that begins on 
April 1, 2021’’; and 
(2) by striking ‘‘such 8 fiscal year quarters’’ 
and inserting ‘‘such period of 16 fiscal year quar-
ters’’. 
(h) ENSURING ACCURATE PAYMENTS
TO PHAR-
MACIES UNDER MEDICAID.— 
(1) IN GENERAL.—Section 1927(f) of the Social 
Security Act (42 U.S.C. 1396r–8(f)) is amended— 
(A) by striking ‘‘and’’ after the semicolon 
at the end of paragraph (1)(A)(i) and all that 
precedes it through ‘‘(1)’’ and inserting the fol-
lowing: 
‘‘(1) DETERMINING PHARMACY ACTUAL ACQUI-
SITION COSTS.—The Secretary shall conduct a sur-
vey of retail community pharmacy drug prices in the 
50 States and the District of Columbia, to determine 
the national average drug acquisition cost, as fol-
lows: 
‘‘(A) USE
OF
VENDOR.—The Secretary 
may contract services for— 
‘‘(i) with respect to retail community 
pharmacies, the determination of retail 
survey prices of the national average drug
618 
acquisition cost for covered outpatient 
drugs based on a monthly survey of such 
pharmacies, net of all discounts and re-
bates (to the extent any information with 
respect to such discounts and rebates is 
available), the average reimbursement re-
ceived for such drugs by such pharmacies 
from all sources of payment and, to the ex-
tent available, the usual and customary 
charges to consumers for such drugs; 
and’’; 
(B) by adding at the end of paragraph (1) 
the following: 
‘‘(F) SURVEY REPORTING.—A State shall 
require that any retail community pharmacy in 
the State that receives any payment, reimburse-
ment, administrative fee, discount, or rebate re-
lated to the dispensing of covered outpatient 
drugs to individuals receiving benefits under 
this title or title XXI, regardless of whether 
such payment, fee, discount, or rebate is re-
ceived from the State or a managed care entity 
directly or from a pharmacy benefit manager or 
another entity that has a contract with the 
State or a managed care entity or other speci-
619 
fied entity (as such terms are defined in section 
1903(m)(9)(D)), shall respond to surveys of re-
tail prices conducted under this subsection with 
the specific information requested by the ven-
dor. 
‘‘(G) SURVEY INFORMATION.—Information 
on retail community actual acquisition prices 
obtained under this paragraph shall be made 
publicly available and shall include at least the 
following: 
‘‘(i) The monthly response rate of the 
survey, including a list of pharmacies not 
in compliance with subparagraph (F) and 
the identification numbers for such phar-
macies. 
‘‘(ii) The sampling frame and number 
of pharmacies sampled monthly. 
‘‘(iii) 
Characteristics 
of 
reporting 
pharmacies, including type (such as inde-
pendent or chain), geographic or regional 
location, and dispensing volume. 
‘‘(iv) Reporting of a separate national 
average drug acquisition cost for each drug 
for independent retail pharmacies and 
chain pharmacies.
620 
‘‘(v) Information on price concessions 
including on and off invoice discounts, re-
bates, and other price concessions. 
‘‘(vi) Information on average profes-
sional dispensing fees paid. 
‘‘(H) PENALTIES.— 
‘‘(i) FAILURE TO PROVIDE TIMELY IN-
FORMATION.—A retail community phar-
macy that knowingly fails to respond to a 
survey conducted under this subsection on 
a timely basis may be subject to a civil 
monetary penalty in an amount not to ex-
ceed $10,000 for each day in which such 
information has not been provided. A retail 
community pharmacy shall not be subject 
to such penalty if the pharmacy makes a 
good faith effort to provide the information 
requested by the survey on a timely basis. 
‘‘(ii) FALSE INFORMATION.—A retail 
community pharmacy that knowingly pro-
vides false information in response to a 
survey conducted under this subsection 
may be subject to a civil money penalty in 
an amount not to exceed $100,000 for 
each item of false information.’’; and
621 
(C) in paragraph (4), by inserting ‘‘, and 
$7,000,000 for fiscal year 2023 and each fiscal 
year thereafter,’’ after ‘‘2010’’. 
(2) CONDITION FOR FEDERAL FINANCIAL PAR-
TICIPATION.—Section 1903(i)(10) of the Social Se-
curity Act (42 U.S.C. 1396b(i)(10)) is amended— 
(A) in subparagraph (D), by striking 
‘‘and’’ after the semicolon; 
(B) in subparagraph (E), by striking ‘‘or’’ 
after the semicolon and inserting ‘‘and’’; and 
(C) by inserting after subparagraph (E), 
the following new subparagraph: 
‘‘(F) with respect to any amount expended for 
reimbursement to a retail community pharmacy 
under this title unless the State requires the retail 
community pharmacy to respond to surveys of retail 
prices conducted under section 1927(f) in accord-
ance with paragraph (1)(F) of such section; or’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section take effect on the 1st day of the 1st 
quarter that begins on or after the date that is 18 
months after the date of enactment of this Act. 
(i) FUNDING FOR IMPLEMENTATION AND ADMINIS-
TRATION.—In addition to amounts otherwise available, 
there is appropriated to the Secretary, for fiscal year
622 
2022, to be available until expended, out of any money 
in the Treasury not otherwise appropriated, $20,000,000, 
to provide technical assistance and guidance and cover ad-
ministrative costs associated with implementing the 
amendments made by this part and part 2. 
PART 5—MAINTENANCE OF EFFORT 
SEC. 30751. ENCOURAGING CONTINUED ACCESS AFTER THE 
END OF THE PUBLIC HEALTH EMERGENCY. 
Section 6008 of the Families First Coronavirus Re-
sponse Act (42 U.S.C. 1396d note), as amended by section 
30741(b), is further amended— 
(1) by redesignating the second subsection (d) 
added by section 11 of division X of Public Law 
116–260 as subsection (e); and 
(2) by adding at the end the following new sub-
section: 
‘‘(g) ENCOURAGING CONTINUED ACCESS AFTER THE 
END OF THE PUBLIC HEALTH EMERGENCY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
if, between October 1, 2022 and December 31, 
2025, a State puts into effect for any calendar quar-
ter occurring during such period eligibility stand-
ards, methodologies, or procedures for individuals 
(except individuals described in subparagraph (D) of 
section 1902(e)(14)) who are applying for or receiv-
623 
ing medical assistance under the State plan of such 
State under title XIX of the Social Security Act (42 
U.S.C. 1396 through 1396w-6) (including any waiv-
er under such title or section 1115 of such Act (42 
U.S.C. 1315)) that are more restrictive than the eli-
gibility standards, methodologies, or procedures, re-
spectively, under the State plan (or waiver of such 
plan) that are in effect on October 1, 2021, the Fed-
eral medical assistance percentage otherwise deter-
mined under section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)) for that State shall be re-
duced by 3.1 percentage points for such calendar 
quarter. 
‘‘(2) NONAPPLICATION.—During the period de-
scribed in paragraph (1), at the option of the State, 
the condition under such paragraph may not apply 
to the State with respect to nonpregnant, non-
disabled adults who are eligible for medical assist-
ance under the State plan (or waiver such plan) 
whose income exceeds 133 percent of the poverty 
line (as defined in section 2110(c)(5)) applicable to 
a family of the size involved if, on or after December 
31, 2022, the State had certified or certifies to the 
Secretary that, with respect to the State fiscal year 
during which the certification is made, the State has
624 
a budget deficit, or with respect to the succeeding 
State fiscal year, the State is projected to have a 
budget deficit. Upon submission of such a certifi-
cation to the Secretary, the condition under para-
graph (1) shall not apply to the State with respect 
to any remaining portion of the period described in 
the preceding sentence.’’. 
Subtitle G—Children’s Health 
Insurance Program 
SEC. 30801. INVESTMENTS TO STRENGTHEN CHIP. 
(a) 
PERMANENT
EXTENSION
OF
CHILDREN’S 
HEALTH INSURANCE PROGRAM.— 
(1) IN GENERAL.—Section 2104(a)(28) of the 
Social Security Act (42 U.S.C. 1397dd(a)(28)) is 
amended to read as follows: 
‘‘(28) for fiscal year 2027 and each subsequent 
year, such sums as are necessary to fund allotments 
to States under subsection (m).’’. 
(2) ALLOTMENTS.— 
(A) IN GENERAL.—Section 2104(m) of the 
Social Security Act (42 U.S.C. 1397dd(m)) is 
amended— 
(i) in paragraph (2)(B)(i), by striking 
‘‘, 2023, and 2027’’ and inserting ‘‘and 
2023’’;
625 
(ii) in paragraph (5)— 
(I) by striking ‘‘(10), or (11)’’ 
and inserting ‘‘or (10)’’; 
(II) by striking ‘‘for a fiscal 
year’’ and inserting ‘‘for a fiscal year 
before 2027’’; and 
(III) by striking ‘‘2023, or 2027’’ 
and inserting ‘‘or 2023’’; 
(iii) in paragraph (7)— 
(I) in subparagraph (A), by strik-
ing ‘‘and ending with fiscal year 
2027,’’; and 
(II) in the flush left matter at 
the end, by striking ‘‘or fiscal year 
2026’’ and inserting ‘‘fiscal year 
2026, or a subsequent even-numbered 
fiscal year’’; 
(iv) in paragraph (9)— 
(I) by striking ‘‘(10), or (11)’’ 
and inserting ‘‘or (10)’’; and 
(II) by striking ‘‘2023, or 2027,’’ 
and inserting ‘‘or 2023’’; and 
(v) by striking paragraph (11).
626 
(B) CONFORMING
AMENDMENT.—Section 
50101(b)(2) of the Bipartisan Budget Act of 
2018 (Public Law 115–123) is repealed. 
(b) OTHER RELATED CHIP POLICIES.— 
(1) 
PEDIATRIC
QUALITY
MEASURES
PRO-
GRAM.—Section 1139A(i)(1) of the Social Security 
Act (42 U.S.C. 1320b–9a(i)(1)) is amended— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting a semicolon; 
and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(E) for fiscal year 2028, $15,000,000 for 
the purpose of carrying out this section (other 
than subsections (e), (f), and (g)); and 
‘‘(F) for each subsequent fiscal year, the 
amount appropriated under this paragraph for 
the previous fiscal year, increased by the per-
centage increase in the consumer price index for 
all urban consumers (all items; United States 
city average, as published by the Bureau of 
Labor Statistics) rounded to the nearest 
$100,000 over such previous fiscal year, for the
627 
purpose of carrying out this section (other than 
subsections (e), (f), and (g)).’’. 
(2) ASSURANCE
OF
ELIGIBILITY
STANDARDS 
FOR CHILDREN.—Section 2105(d)(3) of the Social 
Security Act (42 U.S.C. 1397ee(d)(3)) is amended— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(B) in subparagraph (A)— 
(i) in the matter preceding clause 
(i)— 
(I) by striking ‘‘During the pe-
riod that begins on the date of enact-
ment of the Patient Protection and 
Affordable Care Act and ends on Sep-
tember 30, 2027’’ and inserting ‘‘Be-
ginning on the date of the enactment 
of the Patient Protection and Afford-
able Care Act’’; 
(II) by striking ‘‘During the pe-
riod that begins on October 1, 2019, 
and ends on September 30, 2027’’ 
and inserting ‘‘Beginning on October 
1, 2019’’; and 
(III) by striking ‘‘The preceding 
sentences shall not be construed as
628 
preventing a State during any such 
periods from’’ and inserting ‘‘The pre-
ceding sentences shall not be con-
strued as preventing a State from’’; 
(ii) in clause (i), by striking the semi-
colon at the end and inserting a period; 
(iii) by striking clauses (ii) and (iii); 
and 
(iv) as amended by subclause (i)(III), 
by striking ‘‘as preventing a State from’’ 
and all that follows through ‘‘applying eli-
gibility standards’’ and inserting ‘‘as pre-
venting a State from applying eligibility 
standards’’. 
(3) 
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(A) in the paragraph heading, by striking 
‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 
inserting ‘‘AFTER FISCAL YEAR 2008’’; and 
(B) in subparagraph (A), by striking ‘‘for 
any of fiscal years 2009 through 2027’’ and in-
serting ‘‘for any fiscal year after fiscal year 
2008’’.
629 
(4) OUTREACH AND ENROLLMENT PROGRAM.— 
Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking ‘‘dur-
ing the period of fiscal years 2009 through 
2027’’ and inserting ‘‘, beginning with fis-
cal year 2009,’’; 
(ii) in paragraph (2)— 
(I) by striking ‘‘10 percent of 
such amounts’’ and inserting ‘‘10 per-
cent of such amounts for the period or 
the fiscal year for which such amounts 
are appropriated’’; and 
(II) by striking ‘‘during such pe-
riod’’ and inserting ‘‘, during such pe-
riod or such fiscal year,’’; and 
(iii) in paragraph (3), by striking 
‘‘For the period of fiscal years 2024 
through 2027, an amount equal to 10 per-
cent of such amounts’’ and inserting ‘‘Be-
ginning with fiscal year 2024, an amount 
equal to 10 percent of such amounts for 
the period or the fiscal year for which such 
amounts are appropriated’’; and
630 
(B) in subsection (g)— 
(i) by striking ‘‘2017,,’’ and inserting 
‘‘2017,’’; 
(ii) by striking ‘‘and $48,000,000’’ 
and inserting ‘‘$48,000,000’’; and 
(iii) by inserting after ‘‘through 
2027’’ the following: ‘‘, $60,000,000 for 
fiscal years 2028, 2029, and 2030, and for 
each 3 fiscal years after fiscal year 2030, 
the amount appropriated under this sub-
section for the previous fiscal year, in-
creased by the percentage increase in the 
consumer price index for all urban con-
sumers (all items; United States city aver-
age, as published by the Bureau of Labor 
Statistics) 
rounded 
to 
the 
nearest 
$100,000 over such previous fiscal year’’. 
(5) 
CHILD
ENROLLMENT
CONTINGENCY 
FUND.—Section 2104(n) of the Social Security Act 
(42 U.S.C. 1397dd(n)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
(I) by striking ‘‘2024 through 
2026’’ and inserting ‘‘beginning with 
fiscal year 2024’’; and
631 
(II) by striking ‘‘2023, and 
2027’’ and inserting ‘‘and 2023’’; and 
(ii) in subparagraph (B)— 
(I) by striking ‘‘2024 through 
2026’’ and inserting ‘‘beginning with 
fiscal year 2024’’; and 
(II) by striking ‘‘2023, and 
2027’’ and inserting ‘‘and 2023’’; and 
(B) in paragraph (3)(A)— 
(i) by striking ‘‘fiscal years 2024 
through 2026’’ and inserting ‘‘fiscal year 
2024 or any subsequent fiscal year’’; and 
(ii) by striking ‘‘2023, or 2027’’ and 
inserting ‘‘or 2023’’. 
(c) CHIP DRUG REBATES.— 
(1) IN GENERAL.—Section 2107 of the Social 
Security Act (42 U.S.C. 1397gg), as amended by 
section 30721(b)(2), is further amended— 
(A) in subsection (e)(1) by adding at the 
end the following new subparagraph: 
‘‘(V) Beginning January 1, 2024, section 
1927, in accordance with subsection (h) of this 
section, with respect to covered outpatient 
drugs (as defined in section 1927) for which 
child health assistance or pregnancy-related as-
632 
sistance (as defined in section 2112(d)(1)) is 
provided under the State child health plan, in-
cluding such drugs dispensed to individuals en-
rolled with a managed care organization that 
meets the requirements of subpart L of part 
457 of title 42, Code of Federal Regulations (or 
a successor regulation) if the organization is re-
sponsible for coverage of such drugs.’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(h) DRUG REBATES.—For purposes of subsection 
(e)(1)(V), in applying section 1927— 
‘‘(1) the Secretary shall take such actions as 
are necessary and develop or adapt such processes 
and mechanisms as are necessary, including to re-
port and collect data to bill and track rebates under 
section 1927, as applied pursuant to subsection 
(e)(1)(V) for covered outpatient drugs (as defined in 
such section 1927) for which child health assistance 
or pregnancy-related assistance (as defined in sec-
tion 2112(d)(1)) is provided under the State child 
health plan; 
‘‘(2) the requirements of such section 1927 
shall apply to any drug or biological product de-
633 
scribed in paragraph (1)(A) of section 1905(ee) that 
is— 
‘‘(A) furnished as child health assistance 
or pregnancy-related assistance under the State 
child health plan; and 
‘‘(B) a covered outpatient drug (as defined 
in section 1927(k), except that, in applying 
paragraph (2)(A) of such section to a drug de-
scribed in such paragraph (1)(A) of such sec-
tion 1905(ee), such drug shall be deemed ‘a 
prescribed drug for purposes of subsection 
(a)(12))’; and 
‘‘(3) in order for payment to be available under 
section 2105 with respect to child health assistance 
or pregnancy-related assistance for covered out-
patient drugs of a manufacturer, the manufacturer 
must have entered into and have in effect a single 
rebate agreement to— 
‘‘(A) provide rebates under section 1927 to 
a State Medicaid program under title XIX as 
well as a State program under this title; and 
‘‘(B) provide such rebates to a State pro-
gram under this title in the same form and 
manner as the manufacturer is required to pro-
vide rebates under an agreement described in
634 
section 1927(b) to a State Medicaid program 
under title XIX. 
Nothing in this subsection or subsection (e)(1)(V) 
shall be construed as limiting Federal financial par-
ticipation for prescription drugs and biological prod-
ucts that do not satisfy the definition of a covered 
outpatient drug and for which there is not a rebate 
agreement in effect.’’. 
(2) 
DRUG
REBATE
CONFORMING
AMEND-
MENT.—Section 1927(a)(1) of the Social Security 
Act (42 U.S.C. 1396r–8(a)(1)) is amended in the 
first sentence— 
(A) by striking ‘‘or under part B of title 
XVIII’’ and inserting ‘‘, under part B of title 
XVIII, or, beginning with the first full calendar 
quarter 
with 
respect 
to 
which 
section 
2107(e)(1)(V) applies, under section 2105 with 
respect to child health assistance or pregnancy- 
related assistance under title XXI’’; 
(B) by striking ‘‘a rebate agreement de-
scribed in subsection (b)’’ and inserting ‘‘a sin-
gle rebate agreement described in subsection (b) 
with respect to payment under section 1903(a) 
and, beginning January 1, 2024, title XXI,’’; 
and
635 
(C) by inserting ‘‘and including as such 
subsection (b) is applied pursuant to sub-
sections (e)(1)(V) and (h) of section 2107 with 
respect to child health assistance and preg-
nancy-related assistance under a State child 
health plan under title XXI’’ before ‘‘, and 
must meet’’. 
(3) NON-DUPLICATION
OF
REBATES
CON-
FORMING AMENDMENT.—Section 340B(a)(5)(A) of 
the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
256b(a)(5)(A)) is amended— 
(A) in clause (i), by inserting before the 
period the following: ‘‘and shall not request 
payment under title XXI of such Act for child 
health assistance or pregnancy-related assist-
ance (as defined in section 2112(d)(1) of such 
Act) under a State child health plan under title 
XXI of such Act with respect to a drug that is 
subject to an agreement under this section if 
the drug is subject to the payment of a rebate 
to the State under section 1927 of such Act, as 
applied pursuant to subsections (e)(1)(V) and 
(h) of section 2107 of such Act’’; and 
(B) in clause (ii), by inserting ‘‘, including 
as applied pursuant to subsections (e)(1)(V)
636 
and (h) of section 2107 of such Act,’’ after ‘‘the 
requirements of section 1927(a)(5)(C) of the 
Social Security Act’’. 
(4) EXCLUSION OF REBATES FROM BEST PRICE 
CONFORMING
AMENDMENT.—Section 
1927(c)(1)(C)(i) of the Social Security Act (42 
U.S.C. 1396r–8(c)(1)(C)(i)) is amended— 
(A) in subclause (V), by striking ‘‘and’’ at 
the end; 
(B) in subclause (VI), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VII) any rebates paid pursuant 
to section 2107(e)(1)(V).’’. 
(d) STATE OPTION TO EXPAND CHILDREN’S ELIGI-
BILITY FOR CHIP.— 
(1) IN GENERAL.—Section 2110(b)(1)(B)(ii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397jj(b)(1)(B)(ii)) is amended— 
(A) in subclause (II), by striking ‘‘or’’ at 
the end; 
(B) in subclause (III), by striking ‘‘and’’ 
at the end and inserting ‘‘or’’; and
637 
(C) by inserting after subclause (III) the 
following new subclause: 
‘‘(IV) at the option of the State, 
whose family income exceeds the maximum 
income level otherwise established for chil-
dren under the State child health plan as 
of the date of the enactment of this sub-
clause; and’’. 
(2) TREATMENT
OF
TERRITORIES.—Section 
2104(m)(7) of the Social Security Act (42 U.S.C. 
1397dd(m)(7)) is amended— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘the 50 States or the District 
of Columbia’’ and inserting ‘‘a State (including 
the District of Columbia and each common-
wealth and territory)’’; 
(B) in subparagraph (B)(ii), by striking 
‘‘or District’’; and 
(C) in the matter following subparagraph 
(B), by striking each place it occurs ‘‘or Dis-
trict’’ 
(3) REMOVAL OF SUNSET FOR INCREASES IN 
ALLOTMENTS.—Section 2104(m)(7)(A) of the Social 
Security Act (42 U.S.C. 1397dd(m)(7)(A)) is
638 
amended by striking ‘‘and ending with fiscal year 
2027,’’. 
(e) FUNDING FOR IMPLEMENTATION AND ADMINIS-
TRATION.—In addition to amounts otherwise available, 
there is appropriated to the Secretary, for fiscal year 
2022, to be available until expended, out of any money 
in the Treasury not otherwise appropriated, $5,000,000, 
to provide technical assistance and guidance and cover ad-
ministrative costs associated with implementing the 
amendments made by this section. 
Subtitle H—Medicare Coverage of 
Hearing Services 
SEC. 30901. PROVIDING COVERAGE FOR HEARING CARE 
UNDER THE MEDICARE PROGRAM. 
(a) PROVISION OF AUDIOLOGY SERVICES BY QUALI-
FIED AUDIOLOGISTS AND QUALIFIED HEARING AID PRO-
FESSIONALS.— 
(1) IN GENERAL.—Section 1861(ll) of the So-
cial Security Act (42 U.S.C. 1395x(ll)) is amend-
ed— 
(A) in paragraph (3)— 
(i) by inserting ‘‘(and, beginning Jan-
uary 1, 2023, such aural rehabilitation and 
treatment services)’’ after ‘‘assessment 
services’’;
639 
(ii) by inserting ‘‘, and, beginning on 
January 1, 2023, such hearing assessment 
services furnished by a qualified hearing 
aid professional,’’ after ‘‘by a qualified au-
diologist’’; and 
(iii) by striking ‘‘the audiologist’’ and 
inserting ‘‘the audiologist or qualified hear-
ing aid professional’’; and 
(B) in paragraph (4), by adding at the end 
the following new subparagraph: 
‘‘(C) The term ‘qualified hearing aid profes-
sional’ means, with respect to hearing assessment 
services described in paragraph (3), an individual 
who— 
‘‘(i) is licensed or registered as a hearing 
aid dispenser, hearing aid specialist, hearing in-
strument dispenser, or related professional by 
the State in which the individual furnishes such 
services; and 
‘‘(ii) meets such other requirements as the 
Secretary determines appropriate (including re-
quirements relating to educational certifications 
or accreditations), taking into account any addi-
tional requirements for hearing aid specialists, 
hearing aid dispensers, and hearing instrument
640 
dispensers established by Medicare Advantage 
organizations under part C, State plans (or 
waivers of such plans) under title XIX, and the 
group health plans and health insurance issuers 
(as such terms are defined in section 2791 of 
the Public Health Service Act).’’. 
(2) PAYMENT
FOR
QUALIFIED
HEARING
AID 
PROFESSIONALS.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)), as amended 
by section 139101(b), is further amended— 
(A) by striking ‘‘and’’ before ‘‘(EE)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘and (FF) with respect 
to hearing assessment services (as described in 
paragraph (3) of section 1861(ll)) furnished by 
a qualified hearing aid professional (as defined 
in paragraph (4)(C) of such section), the 
amounts paid shall be equal to 80 percent of 
the lesser of the actual charge for such services 
or 85 percent of the amount for such services 
determined under the payment basis determined 
under section 1848’’. 
(b) COVERAGE OF HEARING AIDS.— 
(1) INCLUSION
OF
HEARING
AIDS
AS
PROS-
THETIC DEVICES.—Section 1861(s)(8) of the Social
641 
Security Act (42 U.S.C. 1395x(s)(8)) is amended by 
inserting ‘‘, and including hearing aids (as described 
in section 1834(h)(7)) furnished on or after January 
1, 2023, to individuals diagnosed with moderately 
severe, severe, or profound hearing loss’’ before the 
semicolon at the end. 
(2) PAYMENT
LIMITATIONS
FOR
HEARING 
AIDS.—Section 1834(h) of the Social Security Act 
(42 U.S.C. 1395m(h)) is amended by adding at the 
end the following new paragraphs: 
‘‘(6) PAYMENT ONLY ON AN ASSIGNMENT-RE-
LATED BASIS.—Payment for hearing aids for which 
payment may be made under this part may be made 
only on an assignment-related basis. The provisions 
of section 1842(b)(18)(B) shall apply to hearing aids 
in the same manner as they apply to services fur-
nished by a practitioner described in subsection 
(b)(18)(C). 
‘‘(7) LIMITATIONS FOR HEARING AIDS.—Pay-
ment may be made under this part with respect to 
an individual, with respect to hearing aids furnished 
on or after January 1, 2023— 
‘‘(A) not more than once per ear during a 
5-year period;
642 
‘‘(B) only for types of such hearing aids 
that are determined appropriate by the Sec-
retary; and 
‘‘(C) only if furnished pursuant to a writ-
ten order of a physician, qualified audiologist 
(as defined in section 1861(ll)(4)), qualified 
hearing aid professional (as so defined), physi-
cian assistant, nurse practitioner, or clinical 
nurse specialist.’’. 
(3) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)) is amended— 
(i) in the header, by inserting ‘‘AND 
HEARING AIDS’’ after ‘‘ORTHOTICS’’; 
(ii) by inserting ‘‘, or of hearing aids 
described in paragraph (2)(D) of such sec-
tion,’’ after ‘‘2011,’’; and 
(iii) in clause (i), by inserting ‘‘or 
such hearing aids’’ after ‘‘such orthotics’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C.
643 
1395w–3(a)(2)) is amended by adding at 
the end the following new subparagraph: 
‘‘(D) HEARING
AIDS.—Hearing aids de-
scribed in section 1861(s)(8) for which payment 
would 
otherwise 
be 
made 
under 
section 
1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(C) CERTAIN
HEARING
AIDS.—Those 
items and services described in paragraph 
(2)(D) if furnished by a physician or other 
practitioner (as defined by the Secretary) to the 
physician’s or practitioner’s own patients as 
part of the physician’s or practitioner’s profes-
sional service.’’. 
(4) INCLUSION
OF
QUALIFIED
AUDIOLOGISTS 
AND QUALIFIED HEARING AID PROFESSIONALS AS 
CERTAIN PRACTITIONERS TO RECEIVE PAYMENT ON 
AN
ASSIGNMENT-RELATED
BASIS.—Section 
1842(b)(18)(C) of the Social Security Act (42
644 
U.S.C. 1395u(b)(18)(C)), is amended by adding at 
the end the following new clauses: 
‘‘(vii) Beginning on January 1, 2023, 
a qualified audiologist (as defined in sec-
tion 1861(ll)(4)(B)). 
‘‘(viii) A qualified hearing aid profes-
sional 
(as 
defined 
in 
section 
1861(ll)(4)(C)).’’. 
(c) EXCLUSION MODIFICATION.—Section 1862(a)(7) 
of the Social Security Act (42 U.S.C. 1395y(a)(7)) is 
amended by inserting ‘‘(except such hearing aids or exami-
nations therefor as described in and otherwise allowed 
under section 1861(s)(8))’’ after ‘‘hearing aids or exami-
nations therefor’’. 
(d) INCLUSION
AS EXCEPTED MEDICAL TREAT-
MENT.—Section 1821(b)(5)(A) of the Social Security Act 
(42 U.S.C. 1395i–5(b)(5)(A)) is amended— 
(1) in clause (i), by striking ‘‘or’’; 
(2) in clause (ii), by striking the period and in-
serting ‘‘, or’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) consisting of audiology services 
described in subsection (ll)(3) of section 
1861, or hearing aids described in sub-
645 
section (s)(8) of such section, that are pay-
able under part B as a result of the 
amendments made by An Act to provide 
for reconciliation pursuant to title II of S. 
Con. Res. 14.’’. 
(e) RURAL
HEALTH
CLINICS
AND
FEDERALLY 
QUALIFIED HEALTH CENTERS.— 
(1) CLARIFYING
COVERAGE
OF
AUDIOLOGY 
SERVICES
AS
PHYSICIANS’ 
SERVICES.—Section 
1861(aa)(1)(A) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(A)) is amended by inserting 
‘‘(including audiology services (as defined in sub-
section (ll)(3)))’’ after ‘‘physicians’ services’’. 
(2) INCLUSION
OF
QUALIFIED
AUDIOLOGISTS 
AND QUALIFIED HEARING AID PROFESSIONALS AS 
RHC
AND
FQHC
PRACTITIONERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended by inserting 
‘‘or by a qualified audiologist or a qualified hearing 
aid professional (as such terms are defined in sub-
section (ll)),’’ after ‘‘(as defined in subsection 
(hh)(1)),’’. 
(3) TEMPORARY PAYMENT RATES FOR CERTAIN 
SERVICES UNDER THE RHC AIR AND FQHC PPS.—
646 
(A) AIR.—Section 1833 of the Social Se-
curity Act (42 U.S.C. 1395l) is amended— 
(i) in subsection (a)(3)(A), by insert-
ing ‘‘(which shall, in the case of audiology 
services (as defined in section 1861(ll)(3)), 
in lieu of any limits on reasonable charges 
otherwise applicable, be based on the rates 
payable for such services under the pay-
ment basis determined under section 1848 
until such time as the Secretary deter-
mines sufficient data has been collected to 
otherwise apply such limits (or January 1, 
2029, if no such determination has been 
made as of such date))’’ after ‘‘may pre-
scribe in regulations’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(ee) DISREGARD OF COSTS ATTRIBUTABLE TO CER-
TAIN SERVICES FROM CALCULATION OF RHC AIR.— 
Payments for rural health clinic services other than audi-
ology services (as defined in section 1861(ll)(3)) under the 
methodology for all-inclusive rates (established by the Sec-
retary) under subsection (a)(3) shall not take into account 
the costs of such services while rates for such services are
647 
based on rates payable for such services under the pay-
ment basis established under section 1848.’’. 
(B) PPS.—Section 1834(o) of the Social 
Security Act (42 U.S.C. 1395m(o)) is amended 
by adding at the end the following new para-
graph: 
‘‘(5) TEMPORARY PAYMENT RATES BASED ON 
PFS FOR CERTAIN SERVICES.—The Secretary shall, 
in establishing payment rates for audiology services 
(as defined in section 1861(ll)(3)) that are Federally 
qualified health center services under the prospective 
payment system established under this subsection, in 
lieu of the rates otherwise applicable under such sys-
tem, base such rates on rates payable for such serv-
ices under the payment basis established under sec-
tion 1848 until such time as the Secretary deter-
mines sufficient data has been collected to otherwise 
establish rates for such services under such system 
(or January 1, 2029, if no such determination has 
been made as of such date). Payments for Federally 
qualified health center services other than such audi-
ology services under such system shall not take into 
account the costs of such services while rates for 
such services are based on rates payable for such
648 
services under the payment basis established under 
section 1848.’’. 
(f) IMPLEMENTATION.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise available, there is appropriated to the Sec-
retary of Health and Human Services for fiscal year 
2022, out of any money in the Treasury not other-
wise appropriated, $370,000,000, to remain avail-
able until expended, for purposes of implementing 
the amendments made by this section during the pe-
riod beginning on January 1, 2022, and ending on 
September 30, 2031. 
(2) PROGRAM INSTRUCTION.—The Secretary of 
Health and Human Services shall implement the 
provisions of, and the amendments made by, this 
section for 2022 and 2023 by program instruction.
649 
Subtitle I—Public Health 
PART 1—HEALTH CARE INFRASTRUCTURE AND 
WORKFORCE 
SEC. 31001. FUNDING TO SUPPORT CORE PUBLIC HEALTH 
INFRASTRUCTURE FOR STATE, TERRITORIAL, 
LOCAL, AND TRIBAL HEALTH DEPARTMENTS 
AT THE CENTERS FOR DISEASE CONTROL 
AND PREVENTION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Secretary of Health 
and Human Services (in this subtitle referred to as the 
‘‘Secretary’’), acting through the Director of the Centers 
for Disease Control and Prevention (in this section re-
ferred to as the ‘‘Director’’), for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated, 
and to remain available until expended— 
(1) for the purposes of carrying out subsection 
(c)(1)(A)— 
(A) $200,000,000 in fiscal year 2022; 
(B) $300,000,000 in fiscal year 2023; and 
(C) $1,000,000,000 in each of fiscal years 
2024 through 2026; 
(2) for the purposes of carrying out subsection 
(c)(1)(B)— 
(A) $100,000,000 in fiscal year 2022;
650 
(B) $150,000,000 in fiscal year 2023; and 
(C) $500,000,000 in each of fiscal years 
2024 through 2026; and 
(3) for the purposes of carrying out subsection 
(d)— 
(A) $100,000,000 in fiscal year 2022; 
(B) $150,000,000 in fiscal year 2023; and 
(C) $500,000,000 in each of fiscal years 
2024 through 2026. 
(b) USE OF FUNDS.—Amounts made available pursu-
ant to subsection (a) shall be used to support core public 
health infrastructure activities to strengthen the public 
health system of the United States, including by awarding 
grants under this section and expanding and improving 
activities of the Centers for Disease Control and Preven-
tion under subsections (c) and (d). 
(c) GRANTS.— 
(1) AWARDS.—For the purpose of addressing 
core public health infrastructure needs, the Sec-
retary shall award— 
(A) a grant to each State or territorial 
health department, and to local health depart-
ments that serve counties with a population of 
at least 2,000,000 or cities with a population of 
at least 400,000 people; and
651 
(B) grants on a competitive basis to State, 
territorial, local, or Tribal health departments. 
(2) REQUIRED USES.— 
(A) REALLOCATION
TO
LOCAL
HEALTH 
DEPARTMENTS.—A State health department re-
ceiving funds under subparagraph (A) or (B) of 
paragraph (1) shall allocate at least 25 percent 
of such funds to local health departments, as 
applicable, within the State to support contribu-
tions of the local health departments to core 
public health infrastructure. 
(B) PROGRESS
IN
MEETING
ACCREDITA-
TION STANDARDS.—A health department receiv-
ing funds under this section that is not accred-
ited shall report to the Secretary on an annual 
basis how the department is working to meet 
accreditation standards. 
(3) FORMULA
GRANTS
TO
HEALTH
DEPART-
MENTS.—In awarding grants under paragraph (1), 
the Secretary shall award funds to each health de-
partment in accordance with a formula which con-
siders population size, the Social Vulnerability Index 
of the Centers for Disease Control and Prevention, 
and other factors as determined by the Secretary.
652 
(4) COMPETITIVE GRANTS TO STATE, TERRI-
TORIAL, LOCAL, AND
TRIBAL
HEALTH
DEPART-
MENTS.—In making grants under paragraph (1)(B), 
the Secretary shall give priority to applicants dem-
onstrating core public health infrastructure needs 
for public health agencies in the applicant’s jurisdic-
tion. 
(5) PERMITTED USES.— 
(A) IN
GENERAL.—The Secretary may 
make available a subset of the funds available 
for grants under paragraph (1) for purposes of 
awarding grants to State, territorial, local, and 
Tribal health departments for planning or to 
support public health accreditation. 
(B) USES.—Recipients of such grants may 
use the grant funds to assess core public health 
infrastructure needs and report to the Centers 
for Disease Control and Prevention on efforts 
to achieve accreditation, as applicable. 
(6) REQUIREMENTS.—To be eligible for a grant 
under this section, an entity shall— 
(A) submit an application in such form 
and containing such information as the Sec-
retary shall require;
653 
(B) demonstrate to the satisfaction of the 
Secretary that— 
(i) funds received through the grant 
will be expended only to supplement, and 
not supplant, non-Federal and Federal 
funds otherwise available to the entity for 
the purpose of addressing core public 
health infrastructure needs; and 
(ii) with respect to activities for which 
the grant is awarded, the entity will main-
tain expenditures of non-Federal amounts 
for such activities at a level not less than 
the level of such expenditures maintained 
by the entity for fiscal year 2019; and 
(C) agree to report annually to the Direc-
tor regarding the use of the grant funds. 
(d) CORE PUBLIC HEALTH INFRASTRUCTURE AND 
ACTIVITIES
FOR
THE
CDC.—The Secretary, acting 
through the Director, shall expand and improve the core 
public health infrastructure and activities of the Centers 
for Disease Control and Prevention to support activities 
necessary to address unmet, ongoing, and emerging public 
health needs, including prevention, preparation for, and 
response to public health emergencies.
654 
(e) DEFINITION.—In this section, the term ‘‘core 
public health infrastructure’’ includes— 
(1) health equity activities; 
(2) workforce capacity and competency; 
(3) all hazards public health and preparedness; 
(4) testing capacity, including test platforms, 
mobile testing units, and personnel; 
(5) health information, health information sys-
tems, and health information analysis (including 
data analytics); 
(6) epidemiology and disease surveillance; 
(7) contact tracing; 
(8) policy and communications; 
(9) financing; 
(10) community partnership development; and 
(11) relevant components of organizational ca-
pacity. 
(f) SUPPLEMENT NOT SUPPLANT.—Amounts made 
available by this section shall be used to supplement, and 
not supplant, amounts otherwise made available for the 
purposes described in this Act. 
SEC. 31002. FUNDING FOR HEALTH CENTER CAPITAL 
GRANTS. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal
655 
year 2022, out of any money in the Treasury not otherwise 
appropriated, $2,000,000,000, to remain available until 
expended, for necessary expenses for awarding grants and 
entering into cooperative agreements for capital projects 
to health centers funded under section 330 of the Public 
Health Service Act (42 U.S.C. 254b) to be awarded with-
out regard to the time limitation in subsection (e)(3) and 
subsections (e)(6)(A)(iii), (e)(6)(B)(iii), and (r)(2)(B) of 
such section 330, and for necessary expenses for awarding 
grants and cooperative agreements for capital projects to 
Federally qualified health centers, as described in section 
1861(aa)(4)(B) of the Social Security Act (42 U.S.C. 
1395x(aa)(4)(B)). The Secretary shall take such steps as 
may be necessary to expedite the awarding of such grants 
to Federally qualified health centers for capital projects. 
(b) USE OF FUNDS.—Amounts made available to a 
recipient of a grant or cooperative agreement pursuant to 
subsection (a) shall be used for— 
(1) health center facility alteration, renovation, 
remodeling, expansion, construction, and other cap-
ital improvement costs, including the costs of amor-
tizing the principal of, and paying interest on, loans 
for such purposes; and 
(2) the purchase, renovation, or maintenance of 
mobile clinics and related vehicles and equipment.
656 
SEC. 31003. FUNDING FOR TEACHING HEALTH CENTER 
GRADUATE MEDICAL EDUCATION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, and notwithstanding the limitations referred to 
in subsections (b)(2) and (d)(2) of section 340H of the 
Public Health Service Act (42 U.S.C. 256h), there is ap-
propriated to the Secretary for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated, 
$3,370,000,000, to remain available until expended, for— 
(1) the program of payments to teaching health 
centers that operate graduate medical education pro-
grams under such section; and 
(2) the award of teaching health center develop-
ment grants pursuant to section 749A of the Public 
Health Service Act (42 U.S.C. 293l–1). 
(b) EXEMPTION FROM AMOUNT AND DURATION LIM-
ITATIONS.—Subsection (b) of section 749A of the Public 
Health Service Act (42 U.S.C. 293l–1) shall not apply 
with respect to amounts awarded under such section out 
of amounts appropriated under subsection (a) or under 
section 2604 of the American Rescue Plan Act (Public 
Law 117–2). 
(c) USE OF FUNDS.—Amounts made available pursu-
ant to subsection (a) shall be used for the following activi-
ties:
657 
(1) For making payments to establish new ap-
proved graduate medical residency training pro-
grams pursuant to section 340H(a)(1)(C) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
256h(a)(1)(C)). 
(2) For making payments under section 
340H(a)(1)(A) of the Public Health Service Act (42 
U.S.C. 256h(a)(1)(A))) to qualified teaching health 
centers for maintenance of filled positions at existing 
approved graduate medical residency training pro-
grams. 
(3) For making payments under section 
340H(a)(1)(B) of the Public Health Service Act (42 
U.S.C. 256h(a)(1)(B)) for the expansion of existing 
approved graduate medical residency training pro-
grams. 
(4) For making awards under section 749A of 
the Public Health Service Act (42 U.S.C. 293l–1) to 
teaching health centers for the purpose of estab-
lishing new accredited or expanded primary care 
residency programs. 
(5) To provide an increase to the per resident 
amount described in section 340H(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256h(a)(2)).
658 
(d) PRIORITY USES OF FUNDS.—In making pay-
ments and awards under subsection (c), the Secretary 
shall, in addition to the requirements of paragraphs (3)(A) 
and (3)(B) of section 340H of the Public Health Service 
Act (42 U.S.C. 256h), make payments and awards to eligi-
ble entities in a manner that accounts for States or terri-
tories in which there is no existing qualified teaching 
health center funded by payments under such section 
340H. 
SEC. 31004. FUNDING FOR CHILDREN’S HOSPITALS THAT 
OPERATE GRADUATE MEDICAL EDUCATION 
PROGRAMS. 
In addition to amounts otherwise available, and not-
withstanding the caps on awards specified in paragraphs 
(1) and (2) of subsection (b) and (h)(1) of section 340E 
of the Public Health Service Act (42 U.S.C. 256e), there 
is appropriated to the Secretary for fiscal year 2022, out 
of any money in the Treasury not otherwise appropriated, 
$200,000,000, to remain available until expended, for car-
rying out such section 340E of the Public Health Service 
Act (42 U.S.C. 256e). 
SEC. 31005. FUNDING FOR NATIONAL HEALTH SERVICE 
CORPS. 
In addition to amounts otherwise available, there is 
appropriated to the Secretary for fiscal year 2022, out of
659 
any money in the Treasury not otherwise appropriated, 
$2,000,000,000, to remain available until expended, for 
carrying out sections 338A, 338B, and 338I of the Public 
Health Service Act (42 U.S.C. 254l, 254l–1, 254q–1). 
SEC. 31006. FUNDING FOR THE NURSE CORPS. 
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, 
$500,000,000, to remain available until expended, for car-
rying out section 846 of the Public Health Service Act 
(42 U.S.C. 297n). 
SEC. 31007. FUNDING FOR SCHOOLS OF MEDICINE IN UN-
DERSERVED AREAS. 
(a) IN GENERAL.—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, $500,000,000, to remain available until ex-
pended, for purposes of making awards to eligible entities 
for the establishment, improvement, or expansion of an 
allopathic or osteopathic school of medicine, or a branch 
campus of an allopathic or osteopathic school of medicine, 
consistent with subsection (b). 
(b) USE OF FUNDS.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall, with priority given to minority-serv-
660 
ing institutions described in section 371(a) of the Higher 
Education Act of 1965 (20 U.S.C. 1067q(a)), and taking 
into consideration equitable distribution of awards among 
the geographical regions of the United States (which shall 
include rural regions and populations as defined by the 
Secretary for the purposes of this section) and the loca-
tions of existing schools of medicine and osteopathic medi-
cine, use amounts appropriated by subsection (a) to award 
grants to eligible entities to— 
(1) recruit, enroll, and retain students, includ-
ing individuals who are from disadvantaged back-
grounds (including racial and ethnic groups under-
represented among medical students and health pro-
fessions), individuals from rural and underserved 
areas, low-income individuals, and first generation 
college students (as defined in section 402A(h)(3) of 
the Higher Education Act of 1965 (20 U.S.C. 
1070a–11(h)(3))), at a school of medicine or osteo-
pathic medicine or branch campus of a school of 
medicine or osteopathic medicine; 
(2) develop, implement, and expand curriculum 
that emphasizes care for rural and underserved pop-
ulations, including accessible and culturally appro-
priate and linguistically appropriate care and serv-
ices, at such school or branch campus;
661 
(3) plan and construct a school of medicine or 
osteopathic medicine in an area in which no other 
such school or branch campus of such a school is 
based; 
(4) plan, develop, and meet criteria for accredi-
tation for a school of medicine or osteopathic medi-
cine or branch campus of such a school; 
(5) hire faculty, including faculty from racial 
and ethnic groups who are underrepresented among 
the medical and other health professions, and other 
staff to serve at such a school or branch campus; 
(6) support educational programs at such a 
school or branch campus, including modernizing cur-
riculum; 
(7) modernize and expand infrastructure at 
such a school or branch campus; or 
(8) support other activities that the Secretary 
determines will further the establishment, improve-
ment, or expansion of a school of medicine or osteo-
pathic medicine or branch campus of a school of 
medicine or osteopathic medicine. 
(c) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means an institution of higher education as de-
662 
fined in section 101 of the Higher Education Act of 
1965 (20 U.S.C. 1001). 
(2) BRANCH CAMPUS.— 
(A) IN GENERAL.—The term ‘‘branch cam-
pus’’, with respect to a school of medicine or os-
teopathic medicine, means an additional loca-
tion of such school that is geographically apart 
and independent of the main campus, at which 
the school offers at least 50 percent of the pro-
gram leading to a degree of doctor of medicine 
or doctor of osteopathy that is offered at the 
main campus. 
(B) INDEPENDENCE
FROM
MAIN
CAM-
PUS.—For purposes of subparagraph (A), the 
location of a school described in such subpara-
graph shall be considered to be independent of 
the main campus described in such subpara-
graph if the location— 
(i) is permanent in nature; 
(ii) offers courses in educational pro-
grams leading to a degree, certificate, or 
other recognized educational credential; 
(iii) has its own faculty and adminis-
trative or supervisory organization; and
663 
(iv) has its own budgetary and hiring 
authority. 
SEC. 31008. FUNDING FOR SCHOOLS OF NURSING IN UN-
DERSERVED AREAS. 
(a) IN GENERAL.—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, $500,000,000, to remain available until ex-
pended, for purposes of making awards to schools of nurs-
ing (as defined in section 801 of the Public Health Service 
Act (42 U.S.C. 296)) to enhance and modernize nursing 
education programs and increase the number of faculty 
and students at such schools. 
(b) USE OF FUNDS.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, taking into consideration equitable dis-
tribution of awards among the geographical regions of the 
United States and the capacity of a school of nursing to 
provide care in underserved areas, shall use amounts ap-
propriated by subsection (a) to award grants for purposes 
of— 
(1) recruiting, enrolling, and retaining students 
at such school, with a priority for students from dis-
advantaged backgrounds (including racial or ethnic 
groups underrepresented in the nursing workforce),
664 
individuals from rural and underserved areas, low-in-
come individuals, and first generation college stu-
dents (as defined in section 402A(h)(3) of the High-
er Education Act of 1965 (20 U.S.C. 1070a– 
11(h)(3))); 
(2) creating, supporting, or modernizing edu-
cational programs and curricula at such school; 
(3) retaining current faculty, and hiring new 
faculty, with an emphasis on faculty from racial or 
ethnic groups that are underrepresented in the nurs-
ing workforce; 
(4) modernizing infrastructure at such school, 
including audiovisual or other equipment, personal 
protective equipment, simulation and augmented re-
ality resources, telehealth technologies, and virtual 
and physical laboratories; 
(5) partnering with a health care facility, nurse- 
managed health clinic, or community health center, 
in order to provide educational opportunities for the 
purpose of establishing or expanding clinical edu-
cation; 
(6) enhancing and expanding nursing programs 
that prepare nurse researchers and scientists; 
(7) establishing nurse-led intradisciplinary and 
interprofessional educational partnerships; or
665 
(8) other activities that the Secretary deter-
mines will further the development, improvement, 
and expansion of schools of nursing. 
SEC. 31009. FUNDING FOR PALLIATIVE CARE AND HOSPICE 
EDUCATION AND TRAINING. 
(a) IN GENERAL.—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, $25,000,000, to remain available until ex-
pended, to support the establishment or operation of pro-
grams that— 
(1) support training of health professionals in 
palliative and hospice care (including through 
traineeships or fellowships); and 
(2) foster patient and family engagement, inte-
gration of palliative and hospice care with primary 
care and other appropriate specialties, and collabora-
tion with community partners to address gaps in 
health care for individuals in need of palliative or 
hospice care. 
(b) USE OF FUNDS.—The Secretary shall, giving pri-
ority to applicants proposing to carry out programs or ac-
tivities that demonstrate coordination with other Federal 
or State programs and are expected to substantially ben-
efit rural populations, medically underserved populations,
666 
medically underserved communities, Indian Tribes or 
Tribal organizations, or Urban Indian organizations, use 
amounts appropriated by subsection (a) to carry out a pro-
gram to award grants or contracts to entities defined in 
paragraph (1), (3), or (4) of section 799B of the Public 
Health Service Act (42 U.S.C. 295p) or section 801(2) 
of such Act (42 U.S.C. 296) for purposes of carrying out 
the following activities: 
(1) Clinical training on providing integrated 
palliative and hospice care and primary care delivery 
services. 
(2) Interprofessional or interdisciplinary train-
ing to practitioners from multiple disciplines and 
specialties, including training on the provision of 
care to individuals with palliative or hospice care 
needs. 
(3) Establishing or maintaining training-related 
community-based programs for individuals with pal-
liative or hospice care needs and caregivers to im-
prove quality of life, and where appropriate, health 
outcomes for individuals who have palliative or hos-
pice care needs.
667 
SEC. 31010. FUNDING FOR PALLIATIVE MEDICINE PHYSI-
CIAN TRAINING. 
(a) IN GENERAL.—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, $20,000,000, to remain available until ex-
pended, to carry out a program to award grants and con-
tracts to accredited schools of medicine, schools of osteo-
pathic medicine, teaching hospitals, and graduate medical 
education programs for the purpose of providing support 
for projects that fund the training of physicians or special-
ists who plan to teach or practice palliative medicine. 
(b) USE OF FUNDS.—Amounts made available to an 
awardee pursuant to subsection (a) shall be used to— 
(1) provide training in interprofessional or 
interdisciplinary 
team-based 
palliative 
medicine 
through a variety of service rotations, such as rota-
tions with respect to consultation services or acute 
and chronic care services, and rotations in other 
health care settings, including extended care facili-
ties, ambulatory care and comprehensive evaluation 
units, hospices, home care, and community care pro-
grams; 
(2) develop specific performance-based meas-
ures to evaluate the competency of trainees; and
668 
(3) provide training in interprofessional or 
interdisciplinary, team-based palliative medicine. 
(c) GRADUATE MEDICAL EDUCATION PROGRAM DE-
FINED.—In this section, the term ‘‘graduate medical edu-
cation program’’ means a program sponsored by an ac-
credited school of medicine, an accredited school of osteo-
pathic medicine, a hospital, or a public or private institu-
tion that— 
(1) offers postgraduate medical training in the 
specialties and subspecialties of medicine; and 
(2) has been accredited by— 
(A) the Accreditation Council for Graduate 
Medical Education; or 
(B) the American Osteopathic Association 
through its Committee on Postdoctoral Train-
ing (or a successor committee). 
SEC. 31011. FUNDING FOR PALLIATIVE CARE AND HOSPICE 
ACADEMIC CAREER AWARDS. 
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, 
$20,000,000, to remain available until expended, to estab-
lish a program, consistent with section 753(b) of the Pub-
lic Health Service Act (42 U.S.C. 294c(b)), including 
paragraphs (5)(A) and (5)(B) of such section 753(b) con-
669 
cerning the amount and duration of awards, respectively, 
except that such program shall be to provide awards to 
accredited schools of medicine, osteopathic medicine, nurs-
ing, social work, psychology, allied health, dentistry, or 
chaplaincy applying on behalf of board-certified or board- 
eligible individuals in hospice and palliative medicine that 
have an early-career junior (non-tenured) faculty appoint-
ment at an accredited school of medicine, or osteopathic 
medicine, nursing, social work, psychology, allied health, 
dentistry, or chaplaincy, to promote the academic career 
development of individuals as hospice and palliative care 
specialists. 
SEC. 31012. FUNDING FOR HOSPICE AND PALLIATIVE NURS-
ING. 
(a) IN GENERAL.—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, $20,000,000, to remain available until ex-
pended, to establish a program to award grants and con-
tracts to accredited schools of nursing, health care facili-
ties, programs leading to certification as a certified nurse 
assistant, partnerships of such schools and facilities, or 
partnerships of such programs and facilities to develop 
and implement, in coordination with other hospice and 
palliative care programs administered by the Department
670 
of Health and Human Services, programs and initiatives 
to train and educate individuals in providing interprofes-
sional, interdisciplinary, team-based palliative care in 
health-related educational, hospital, hospice, home, or 
long-term care settings. 
(b) USE OF FUNDS.—Amounts made available to an 
awardee pursuant to subsection (a) shall be used to— 
(1) provide training to individuals who will pro-
vide palliative care in health-related educational, 
hospital, home, hospice, or long-term care settings; 
(2) develop and disseminate curricula relating 
to palliative care in health-related educational, hos-
pital, home, hospice, or long-term care settings; 
(3) train faculty members in palliative care in 
health-related educational, hospital, home, hospice, 
or long-term care settings; and 
(4) provide continuing education to individuals 
who provide palliative care in health-related edu-
cational, home, hospice, or long-term care settings. 
SEC. 31013. FUNDING FOR DISSEMINATION OF PALLIATIVE 
CARE INFORMATION. 
(a) IN GENERAL.—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
671 
appropriated, $5,000,000, to remain available until ex-
pended, for the purpose described in subsection (b). 
(b) USE OF FUNDS.—The Secretary, after consulta-
tion with appropriate medical and other health profes-
sional societies and palliative care and hospice stake-
holders, shall use amounts appropriated by subsection (a) 
to award grants or contracts to public and nonprofit pri-
vate entities to disseminate information to inform pa-
tients, families, caregivers, direct care workers, and health 
professionals about the benefits of palliative care through-
out the continuum of care for patients with serious or life- 
threatening illness. Such awareness campaign shall in-
clude— 
(1) information, resources, communication, and 
education materials about palliative care for patients 
and families facing serious or life-threatening ill-
nesses; 
(2) information regarding hospice and palliative 
care services, including information on how such 
services may— 
(A) incorporate age-friendly, patient-cen-
tered, and family-centered support throughout 
the continuum of care for serious and life- 
threatening illness; 
(B) anticipate, prevent, and treat pain;
672 
(C) optimize quality of life; and 
(D) facilitate and support the goals and 
values of patients and families; 
(3) materials that explain the role of profes-
sionals trained in hospice and palliative care in pro-
viding team-based care for patients and families 
throughout the continuum of care for serious or life- 
threatening illness; and 
(4) materials for specific populations, including 
patients with serious or life-threatening illness who 
are among medically underserved populations (as de-
fined in section 330(b)(3) of the Public Health Serv-
ice Act (42 U.S.C. 254b(b)(3)) and families of such 
patients or health professionals serving medically un-
derserved populations. 
PART 2—PANDEMIC PREPAREDNESS 
SEC. 31021. FUNDING FOR LABORATORY ACTIVITIES AT 
THE CENTERS FOR DISEASE CONTROL AND 
PREVENTION. 
(a) IN GENERAL.—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, $1,400,000,000 to remain available until ex-
pended, for purposes of carrying out activities consistent 
with subsection (b).
673 
(b) USE OF FUNDS.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall use amounts made available pursuant to 
subsection (a) for the following activities: 
(1) Supporting renovation, improvement, expan-
sion, and modernization of State and local public 
health laboratory infrastructure (as the term ‘‘lab-
oratory’’ is defined in section 353 of the Public 
Health Service Act (42 U.S.C. 263a)), including— 
(A) the improvement and enhancement of 
testing and response capacity; 
(B) improvements and expansion of the 
Laboratory Response Network for rapid out-
break detection; 
(C) the improvement and expansion of 
genomic 
sequencing 
capabilities 
to 
detect 
emerging diseases and variant strains; and 
(D) the improvement and expansion of bio-
safety and biosecurity capacity. 
(2) Enhancing the capacity of the laboratories 
of the Centers for Disease Control and Prevention 
as described in subparagraphs (A) through (D) of 
paragraph (1). 
(3) Enhancing the ability of the Centers for 
Disease Control and Prevention to monitor and exer-
674 
cise oversight over the biosafety and biosecurity of 
State and local public health laboratories. 
SEC. 31022. FUNDING FOR PUBLIC HEALTH AND PRE-
PAREDNESS RESEARCH, DEVELOPMENT, AND 
COUNTERMEASURE CAPACITY. 
(a) IN GENERAL.—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, $1,300,000,000, to carry out activities to 
prepare for, and respond to, public health emergencies de-
clared under section 319 of the Public Health Service Act 
(42 U.S.C. 247d), as described in subsection (b), to re-
main available until expended. 
(b) USE OF FUNDS.—The Secretary, acting through 
the Assistant Secretary for Preparedness and Response, 
shall use amounts made available pursuant to subsection 
(a)— 
(1) to support surge capacity, including through 
construction, expansion, or modernization of facili-
ties, to respond to a public health emergency, and 
for development, procurement, and domestic manu-
facture of drugs, active pharmaceutical ingredients, 
vaccines and other biological products, diagnostic 
technologies and products, medical devices (including 
personal protective equipment), vials, syringes, nee-
675 
dles, and other components or supplies for the Stra-
tegic National Stockpile under section 319F–2 of 
the Public Health Service Act (42 U.S.C. 247d–6b); 
(2) to support expanded vaccine production ca-
pacity and capabilities, including by developing or 
acquiring new technology and expanding manufac-
turing capacity through construction, expansion, or 
modernization of facilities; 
(3) to support activities to mitigate supply 
chain risks and enhance supply chain elasticity and 
resilience for critical drugs, active pharmaceutical in-
gredients, and supplies (including essential medi-
cines, medical countermeasures, and supplies in 
shortage or at risk of shortage), drug and vaccine 
raw materials, and other supplies, as the Secretary 
determines appropriate, including construction, ex-
pansion, or modernization of facilities, adoption of 
advanced manufacturing processes, and other activi-
ties to support domestic manufacturing of such sup-
plies; 
(4) to support activities conducted by the Bio-
medical Advanced Research and Development Au-
thority for advanced research, standards develop-
ment, and domestic manufacturing capacity for 
drugs, including essential medicines, diagnostics,
676 
vaccines, therapeutics, and personal protective equip-
ment; and 
(5) to support increased biosafety and biosecu-
rity in research on infectious diseases, including by 
modernization or improvement of facilities. 
SEC. 31023. FUNDING FOR INFRASTRUCTURE MODERNIZA-
TION AND INNOVATION AT THE FOOD AND 
DRUG ADMINISTRATION. 
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, 
to remain available until expended, with respect to improv-
ing and modernizing infrastructure at the Food and Drug 
Administration and enhancing food and medical product 
safety— 
(1) $150,000,000 for improving technological 
infrastructure, including through developing inte-
grated systems and improving the interoperability of 
information technology systems; and 
(2) $150,000,000 for modernizing laboratory 
infrastructure of, or used by, the Food and Drug 
Administration, including modernization of facilities 
related to, and supporting, such laboratory infra-
structure, including through planning for, and the 
construction, repair, improvement, extension, alter-
677 
ation, demolition, and purchase of, fixed equipment 
or facilities. 
PART 3—MATERNAL MORTALITY 
SEC. 31031. FUNDING FOR LOCAL ENTITIES ADDRESSING 
SOCIAL 
DETERMINANTS 
OF 
MATERNAL 
HEALTH. 
(a) IN GENERAL.—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, $100,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to community-based organizations, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, Native Hawaiian organizations, or other nonprofit 
organizations working with a community-based organiza-
tion, or consortia of any such entities, operating in areas 
with high rates of adverse maternal health outcomes or 
with significant racial or ethnic disparities in maternal 
health outcomes. 
(b) USE OF FUNDING.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Addressing social determinants of health, 
including social determinants of maternal health, for 
pregnant and postpartum individuals and elimi-
678 
nating racial and ethnic disparities in maternal 
health outcomes by— 
(A) hiring, training, or retaining staff; 
(B) developing or distributing culturally 
and linguistically appropriate resources for so-
cial services programs; 
(C) offering programs and resources to ad-
dress social determinants of health; 
(D) conducting demonstration projects to 
address social determinants of health; 
(E) establishing a culturally and linguis-
tically appropriate resource center that provides 
multiple social services programs in a single lo-
cation; and 
(F) 
consulting 
with 
pregnant 
and 
postpartum individuals to conduct an assess-
ment of the activities conducted under this sec-
tion. 
(2) Promoting evidence-based health literacy 
and pregnancy, childbirth, and parenting education 
for pregnant and postpartum individuals, and indi-
viduals seeking to become pregnant. 
(3) Providing support from perinatal health 
workers, including clinical and community-based
679 
staff members that provide direct care and support 
services to pregnant and postpartum individuals. 
(4) Providing culturally congruent, linguistically 
appropriate, 
and 
trauma-informed 
training 
to 
perinatal health workers, including clinical and com-
munity-based staff members that provide direct care 
and support services to pregnant and postpartum in-
dividuals. 
(c) TECHNICAL ASSISTANCE.—Using amounts made 
available under subsection (a), the Secretary shall— 
(1) conduct outreach to eligible entities to apply 
for grants or contracts under subsection (a); and 
(2) provide technical assistance, including 
through a grant or contract, to eligible entities re-
ceiving funding pursuant to subsection (a). 
SEC. 31032. FUNDING FOR THE OFFICE OF MINORITY 
HEALTH. 
(a) IN GENERAL.—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, $75,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to community-based organizations operating in 
areas with high rates of adverse maternal health outcomes
680 
or with significant racial or ethnic disparities in maternal 
health outcomes. 
(b) USE OF FUNDS.—The Secretary, acting through 
the Deputy Assistant Secretary for Minority Health, shall 
use amounts made available under subsection (a) to award 
grants for the following activities: 
(1) Addressing social determinants of health, 
including social determinants of maternal health, for 
pregnant and postpartum individuals and elimi-
nating racial and ethnic disparities in maternal 
health outcomes by— 
(A) hiring, training, or retaining staff; 
(B) developing or distributing culturally 
and linguistically appropriate resources for so-
cial services programs; 
(C) offering programs and resources to ad-
dress social determinants of health; 
(D) conducting demonstration projects to 
address social determinants of health; 
(E) establishing a culturally and linguis-
tically appropriate resource center that provides 
multiple social services programs in a single lo-
cation; and 
(F) 
consulting 
with 
pregnant 
and 
postpartum individuals to conduct an assess-
681 
ment of the activities conducted under this sec-
tion. 
(2) Promoting evidence-based health literacy 
and pregnancy, childbirth, and parenting education 
for pregnant and postpartum individuals, and indi-
viduals seeking to become pregnant. 
(3) Providing support from perinatal health 
workers, including clinical and community-based 
staff members that provide direct care and support 
services to pregnant and postpartum individuals. 
(4) Providing culturally congruent, linguistically 
appropriate, 
and 
trauma-informed 
training 
to 
perinatal health workers, including clinical and com-
munity-based staff members that provide direct care 
and support services to pregnant and postpartum in-
dividuals. 
(c) TECHNICAL ASSISTANCE.—Using amounts made 
available under subsection (a), the Secretary shall— 
(1) conduct outreach to eligible entities to apply 
for grants or contracts under subsection (a); and 
(2) provide technical assistance, including 
through a grant or contract, to eligible entities re-
ceiving funding pursuant to subsection (a).
682 
SEC. 31033. FUNDING TO GROW AND DIVERSIFY THE NURS-
ING 
WORKFORCE 
IN 
MATERNAL 
AND 
PERINATAL HEALTH. 
(a) IN GENERAL.—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, $170,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to accredited schools of nursing for the purpose 
of growing and diversifying the perinatal nursing work-
force, including through improving the capacity and sup-
ply of health care providers. 
(b) USES OF FUNDS.— 
(1) AWARDEES.—Prioritizing students and reg-
istered nurses who plan to practice or currently 
practice in an underserved area, amounts made 
available to awardees by subsection (a) shall, con-
sistent with section 846 of the Public Health Service 
Act (42 U.S.C. 297n), be used for the following ac-
tivities: 
(A) Providing scholarships to students, in-
cluding those from racial and ethnic groups 
underrepresented in the health professions, 
seeking to become nurse practitioners whose 
education includes a focus on maternal and 
perinatal health.
683 
(B) Providing scholarships to students 
seeking to become clinical nurse specialists 
whose education includes a focus on maternal 
and perinatal health. 
(C) Providing scholarships to students 
seeking to become certified nurse midwives. 
(D) Providing scholarships to registered 
nurses seeking certification as an obstetrics and 
gynecology registered nurse. 
(2) SECRETARY.—The Secretary shall use 
amounts made available pursuant to subsection (a) 
for the following activities: 
(A) Developing and implementing strate-
gies to recruit and retain a diverse pool of stu-
dents seeking to enter careers focused on ma-
ternal and perinatal health. 
(B) Developing partnerships with practice 
settings in an underserved area for the clinical 
placements of students at the schools receiving 
such grants. 
(C) Developing curriculum for students 
seeking to enter careers focused on maternal 
and perinatal health that includes training pro-
grams on bias, racism, discrimination, providing
684 
culturally competent care, or trauma-informed 
care. 
SEC. 
31034. 
FUNDING 
FOR 
PERINATAL 
QUALITY 
COLLABORATIVES. 
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, 
$50,000,000, to remain available until expended, for car-
rying out a program to establish or support perinatal qual-
ity collaboratives to improve perinatal care and perinatal 
health outcomes for pregnant and postpartum individuals 
and their infants. 
SEC. 31035. FUNDING TO GROW AND DIVERSIFY THE DOULA 
WORKFORCE. 
(a) IN GENERAL.—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, $50,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to health professions schools, academic health 
centers, State or local governments, territories, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, Native Hawaiian organizations, or other appropriate 
public or private nonprofit entities (or consortia of any 
such entities, including entities promoting multidisci-
685 
plinary approaches), to establish or expand programs to 
grow and diversify the doula workforce, including through 
improving the capacity and supply of health care pro-
viders. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Establishing programs that provide edu-
cation and training to individuals seeking appro-
priate training or certification as doulas. 
(2) Expanding the capacity of existing pro-
grams described in paragraph (1), for the purpose of 
increasing the number of students enrolled in such 
programs, including by awarding scholarships for 
students who agree to work in underserved commu-
nities after receiving such education and training. 
(3) Developing and implementing strategies to 
recruit and retain students from underserved com-
munities, particularly from demographic groups ex-
periencing high rates of maternal mortality and se-
vere maternal morbidity, including racial and ethnic 
minority groups, into programs described in para-
graphs (1) and (2).
686 
SEC. 31036. FUNDING TO GROW AND DIVERSIFY THE MA-
TERNAL MENTAL HEALTH AND SUBSTANCE 
USE DISORDER TREATMENT WORKFORCE. 
(a) IN GENERAL.—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, $75,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to health professions schools, academic health 
centers, State or local governments, territories, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, Native Hawaiian organizations, or other appropriate 
public or private nonprofit entities (or consortia of any 
such entities, including entities promoting multidisci-
plinary approaches), to establish or expand programs to 
grow and diversify the maternal mental health and sub-
stance use disorder treatment workforce, including 
through improving the capacity and supply of health care 
providers. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Establishing programs that provide edu-
cation and training to individuals seeking appro-
priate licensing or certification as mental health or 
substance use disorder treatment providers who plan
687 
to specialize in maternal mental health conditions or 
substance use disorders. 
(2) Expanding the capacity of existing pro-
grams described in paragraph (1), for the purposes 
of increasing the number of students enrolled in 
such programs, including by awarding scholarships 
for students. 
(3) Developing and implementing strategies to 
recruit and retain students from underserved com-
munities into programs described in paragraphs (1) 
and (2). 
SEC. 31037. FUNDING FOR MATERNAL MENTAL HEALTH EQ-
UITY GRANT PROGRAMS. 
(a) IN GENERAL.—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, $100,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to community-based organizations, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, Native Hawaiian organizations, health care pro-
viders, accredited medical schools, accredited schools of 
nursing, teaching hospitals, accredited midwifery pro-
grams, physician assistant education programs, residency 
or fellowship programs, or other nonprofit organizations,
688 
schools, or programs determined appropriate by the Sec-
retary, or consortia of any such entities, to address mater-
nal mental health conditions and substance use disorders 
with respect to pregnant, lactating, and postpartum indi-
viduals in areas with high rates of adverse maternal health 
outcomes or with significant racial or ethnic disparities in 
maternal health outcomes. 
(b) USE OF FUNDS.—Amounts made available pursu-
ant to subsection (a), prioritizing community-based orga-
nizations, shall be for the following activities: 
(1) Establishing or expanding maternity care 
programs to improve— 
(A) the integration of mental health and 
substance use disorder treatment services into 
primary care settings where pregnant individ-
uals regularly receive health care services; and 
(B) the coordination between such primary 
care settings and mental health and substance 
use disorder professionals who treat maternal 
mental health conditions and substance use dis-
orders. 
(2) Establishing or expanding programs that 
improve maternal mental health and substance use 
disorder treatment from the preconception through 
the postpartum periods, with a focus on individuals
689 
from racial and ethnic minority groups with high 
rates of maternal mortality and morbidity. 
(3) Establishing or expanding programs to pre-
vent suicide or self-harm among pregnant, lactating, 
and postpartum individuals. 
(4) Establishing or expanding programs to pro-
vide education and training to maternity care pro-
viders, with respect to identifying potential warning 
signs for maternal mental health conditions or sub-
stance use disorders in pregnant, lactating, and 
postpartum individuals, with a focus on individuals 
from racial and ethnic minority groups and offering 
referrals to mental health substance use disorder 
treatment professionals. 
(5) Raising awareness of, and addressing stig-
ma associated with, maternal mental health condi-
tions and substance use disorders, with a focus on 
pregnant, lactating, and postpartum individuals 
from racial and ethnic minority groups. 
(6) Carrying out other evidence-based or evi-
dence-informed programs to address maternal men-
tal health conditions and substance use disorders for 
pregnant and postpartum individuals from racial 
and ethnic minority groups.
690 
SEC. 31038. FUNDING FOR EDUCATION AND TRAINING AT 
HEALTH PROFESSIONS SCHOOLS TO IDEN-
TIFY AND ADDRESS HEALTH RISKS ASSOCI-
ATED WITH CLIMATE CHANGE. 
(a) IN GENERAL.—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, $85,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to accredited medical schools, accredited schools 
of nursing, teaching hospitals, accredited midwifery pro-
grams, physician assistant education programs, residency 
or fellowship programs, or other schools or programs de-
termined appropriate by the Secretary, or consortia of any 
such entities, to support the development and integration 
of education and training programs for identifying and ad-
dressing health risks associated with climate change for 
pregnant, lactating, and postpartum individuals. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for developing, integrating, 
and implementing curriculum and continuing education 
that focuses on the following: 
(1) Identifying health risks associated with cli-
mate 
change 
for 
pregnant, 
lactating, 
and 
postpartum individuals and individuals with the in-
tent to become pregnant.
691 
(2) How health risks associated with climate 
change affect pregnant, lactating, and postpartum 
individuals and individuals with the intent to become 
pregnant. 
(3) Racial and ethnic disparities in exposure to, 
and the effects of, health risks associated with cli-
mate 
change 
for 
pregnant, 
lactating, 
and 
postpartum individuals and individuals with the in-
tent to become pregnant. 
(4) Patient counseling and mitigation strategies 
relating to health risks associated with climate 
change for pregnant, lactating, and postpartum indi-
viduals. 
(5) Relevant services and support for pregnant, 
lactating, and postpartum individuals relating to 
health risks associated with climate change and 
strategies for ensuring such individuals have access 
to such services and support. 
(6) Implicit and explicit bias, racism, and dis-
crimination in providing care to pregnant, lactating, 
and postpartum individuals and individuals with the 
intent to become pregnant.
692 
SEC. 31039. FUNDING FOR MINORITY-SERVING INSTITU-
TIONS TO STUDY MATERNAL MORTALITY, SE-
VERE MATERNAL MORBIDITY, AND ADVERSE 
MATERNAL HEALTH OUTCOMES. 
(a) IN GENERAL.—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, $50,000,000, to remain available until ex-
pended for carrying out a program to award grants or con-
tracts to minority-serving institutions described in section 
371 of the Higher Education Act of 1965 (20 U.S.C. 
1067q) to study maternal mortality, severe maternal mor-
bidity, and maternal health outcomes. 
(b) USE OF FUNDS.—Amounts made available to an 
awardee under subsection (a) shall be used for the purpose 
specified in such subsection, including the following activi-
ties: 
(1) Developing and implementing systematic 
processes of listening to the stories of pregnant and 
postpartum individuals from racial and ethnic mi-
nority groups, and perinatal health workers sup-
porting such individuals, to fully understand the 
causes of, and inform potential solutions to, the ma-
ternal mortality and severe maternal morbidity crisis 
within their respective communities.
693 
(2) Assessing the potential causes of relatively 
low rates of maternal mortality among Hispanic in-
dividuals and foreign-born Black women. 
(3) Assessing differences in rates of adverse 
maternal health outcomes among subgroups identi-
fying as Hispanic. 
(4) Conducting research on maternal morbidity 
and mortality, with a focus on health disparities. 
(c) TECHNICAL ASSISTANCE.—Using amounts made 
available by subsection (a), the Secretary shall conduct 
outreach to minority-serving institutions (as described in 
section 371 of the Higher Education Act of 1965 (20 
U.S.C. 1067q))— 
(1) to inform and raise awareness of the avail-
ability funding through a grant or contract awarded 
pursuant to this section; 
(2) to provide technical assistance, including 
through a grant or contract, on the application proc-
ess for grants or contracts awarded pursuant to sub-
section (a); and 
(3) to promote capacity building to eligible enti-
ties for grant applications pursuant to subsection 
(a).
694 
SEC. 31040. FUNDING FOR IDENTIFICATION OF MATERNITY 
CARE 
HEALTH 
PROFESSIONAL 
TARGET 
AREAS. 
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, 
$25,000,000, to remain available until expended, for car-
rying out section 332(k) of the Public Health Service Act 
(42 U.S.C. 254e(k)). 
SEC. 31041. FUNDING FOR MATERNAL MORTALITY REVIEW 
COMMITTEES TO PROMOTE REPRESENTA-
TIVE COMMUNITY ENGAGEMENT. 
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, 
$50,000,000, to remain available until expended, for car-
rying out section 317K(d) of the Public Health Service 
Act (42 U.S.C. 247b–12(d)) to promote community en-
gagement in maternal mortality review committees to in-
crease the diversity of a committee’s membership with re-
spect to race and ethnicity, location, and professional 
background.
695 
SEC. 
31042. 
FUNDING 
FOR 
THE 
SURVEILLANCE 
FOR 
EMERGING THREATS TO MOTHERS AND BA-
BIES. 
(a) IN GENERAL.—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, $100,000,000, to remain available until ex-
pended, for carrying out section 317C of the Public Health 
Service Act (42 U.S.C. 247b–4) with respect to conducting 
surveillance for emerging threats to mothers and babies. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Expanding the Surveillance for Emerging 
Threats to Mothers and Babies activities of the Cen-
ters for Disease Control and Prevention. 
(2) Working with public health, clinical, and 
community-based organizations to provide timely, 
continually updated, evidence-based guidance to fam-
ilies and health care providers on ways to reduce 
risk to pregnant and postpartum individuals and 
their newborns and tailor interventions to improve 
their long-term health. 
(3) Partnering with more State, Tribal, terri-
torial, and local public health programs in the collec-
tion and analysis of clinical data on the impact of 
COVID–19 on pregnant and postpartum patients
696 
and their newborns, particularly among patients 
from racial and ethnic minority groups. 
(4) Establishing regionally based centers of ex-
cellence to offer medical, public health, and other 
knowledge (in coordination with State and Tribal 
public health authorities) to ensure that commu-
nities, especially communities with large populations 
of individuals from racial and ethnic minority 
groups, can help pregnant and postpartum individ-
uals and newborns get the care and support they 
need. 
SEC. 31043. FUNDING FOR ENHANCING REVIEWS AND SUR-
VEILLANCE TO ELIMINATE MATERNAL MOR-
TALITY PROGRAM. 
(a) IN GENERAL.—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, $30,000,000, to remain available until ex-
pended, for carrying out the Enhancing Reviews and Sur-
veillance to Eliminate Maternal Mortality program estab-
lished under section 317K of the Public Health Service 
Act (42 U.S.C. 247b–12). 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities:
697 
(1) Expanding the Enhancing Reviews and Sur-
veillance to Eliminate Maternal Mortality program 
(commonly known as the ‘‘ERASE MM program’’) 
of the Centers for Disease Control and Prevention. 
(2) Expanding partnerships with States, terri-
tories, Indian Tribes, and Tribal organizations to 
support Maternal Mortality Review Committees. 
(3) Providing technical assistance to existing 
maternal mortality review committees. 
SEC. 31044. FUNDING FOR THE PREGNANCY RISK ASSESS-
MENT MONITORING SYSTEM. 
(a) IN GENERAL.—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, $15,000,000, to remain available until ex-
pended, for carrying out section 317K of the Public 
Health Service Act (42 U.S.C. 247b–12) with respect to 
the Pregnancy Risk Assessment Monitoring System. 
(b) USE OF FUNDS.—Amounts made available by 
subsection (a) shall be used for the following activities: 
(1) Supporting COVID–19 supplements to the 
Pregnancy Risk Assessment Monitoring System 
questionnaire. 
(2) Conducting a rapid assessment of COVID– 
19 awareness, impact on care and experiences, and
698 
use of preventive measures among pregnant, labor-
ing and birthing, and postpartum individuals. 
(3) Supporting the transition of the question-
naire described in paragraph (1) to an electronic 
platform and expanding the distribution of the ques-
tionnaire to a larger population, with a special focus 
on reaching underrepresented communities. 
SEC. 31045. FUNDING FOR THE NATIONAL INSTITUTE OF 
CHILD HEALTH AND HUMAN DEVELOPMENT. 
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, 
$15,000,000, to remain available until expended, con-
sistent with the child health and human development ac-
tivities of the Eunice Kennedy Shriver National Institute 
of Child Health and Human Development described in sec-
tion 448 of the Public Health Service Act (42 U.S.C. 
285g), to conduct or support research for interventions to 
mitigate the effects of COVID–19 on pregnant, lactating, 
and postpartum individuals, with a particular focus on in-
dividuals from racial and ethnic minority groups.
699 
SEC. 31046. FUNDING FOR EXPANDING THE USE OF TECH-
NOLOGY-ENABLED COLLABORATIVE LEARN-
ING AND CAPACITY BUILDING MODELS FOR 
PREGNANT AND POSTPARTUM INDIVIDUALS. 
(a) IN GENERAL.—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, $30,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to community-based organizations, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, health care providers, accredited medical schools, 
accredited schools of nursing, teaching hospitals, accred-
ited midwifery programs, physician assistant education 
programs, residency or fellowship programs, or other 
schools or programs determined appropriate by the Sec-
retary, or consortia of any such entities, that are operating 
in underserved areas with high rates of adverse maternal 
health outcomes or significant racial and ethnic disparities 
in maternal health outcomes, to evaluate, develop, and ex-
pand the use of technology-enabled collaborative learning 
and capacity building models (as defined in section 330N 
of the Public Health Service Act (42 U.S.C. 254c–20)). 
(b) USE OF FUNDS.—
700 
(1) AWARDEES.—A recipient of a grant or con-
tract awarded pursuant to subsection (a) shall use 
such amounts to— 
(A) train maternal health care providers, 
students, staff of community-based organiza-
tions, and other entities described in subsection 
(a) through the use and expansion of tech-
nology-enabled collaborative learning and capac-
ity building models, including hardware and 
software that— 
(i) enables distance learning and tech-
nical support; and 
(ii) supports the secure exchange of 
electronic health information; and 
(B) conduct evaluations on the use of tech-
nology-enabled collaborative learning and capac-
ity building models to improve maternal health 
outcomes. 
(2) SECRETARY.—The Secretary shall use 
amounts made available pursuant to subsection (a) 
to provide technical assistance to recipients of grants 
awarded pursuant to subsection (a) on the develop-
ment, use, and sustainability of technology-enabled 
collaborative learning and capacity building models
701 
to expand access to maternal health services pro-
vided by such entities. 
SEC. 31047. FUNDING FOR PROMOTING EQUITY IN MATER-
NAL HEALTH OUTCOMES THROUGH DIGITAL 
TOOLS. 
(a) IN GENERAL.—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, $30,000,000, to remain available until ex-
pended, for carrying out a program to award grants or 
contracts to community-based organizations, Indian 
Tribes and Tribal organizations, Urban Indian organiza-
tions, health care providers, accredited medical schools, 
accredited schools of nursing, teaching hospitals, accred-
ited midwifery programs, physician assistant education 
programs, residency or fellowship programs, or other 
schools or programs determined appropriate by the Sec-
retary, or consortia of any such entities, that are operating 
in underserved areas with high rates of adverse maternal 
health outcomes or significant racial and ethnic disparities 
in maternal health outcomes to reduce racial and ethnic 
disparities in maternal health outcomes by increasing ac-
cess to digital tools related to maternal health care. 
(b) USE OF FUNDS.—Amounts made available to an 
awardee pursuant to subsection (a) shall be used for the
702 
purpose specified in such subsection, including for increas-
ing access to telehealth technologies (as defined in section 
330I of the Public Health Service Act (42 U.S.C. 254c– 
14)) and digital tools that could improve maternal health 
outcomes, such as wearable technologies, patient portals, 
telehealth services, and web-based and mobile phone appli-
cations, digital health services, secure text messaging, on-
line provider communities, mobile clinical decision support 
services, and clinical tools to increase diagnostic accuracy. 
(c) TECHNICAL ASSISTANCE.—Using amounts made 
available under subsection (a), the Secretary shall provide 
technical assistance, including through a grant or con-
tract, to eligible entities receiving funding pursuant to 
subsection (a) on the development, use, evaluation, and 
post-grant sustainability of digital tools designed to pro-
mote equity and reduce disparities in maternal health out-
comes. 
SEC. 31048. FUNDING FOR ANTIDISCRIMINATION AND BIAS 
TRAINING. 
(a) IN GENERAL.—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, $50,000,000, to remain available until ex-
pended, for the purpose described in subsection (b).
703 
(b) USE OF FUNDS.—The Secretary shall, with a 
focus on maternal health providers, use amounts appro-
priated under subsection (a) to carry out a program to 
award competitive grants or contracts to national non-
profit organizations focused on improving health equity, 
accredited schools of medicine or nursing, and other health 
professional training programs to develop, disseminate, re-
view, research, and evaluate training for health profes-
sionals and all staff who interact with patients to reduce 
discrimination and bias in the provision of health care, 
with a focus on maternal health care. 
PART 4—OTHER PUBLIC HEALTH INVESTMENTS 
SEC. 31051. FUNDING FOR MENTAL HEALTH AND SUB-
STANCE USE DISORDER PROFESSIONALS. 
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, 
$50,000,000, to remain available until expended, for pur-
poses of carrying out section 597 of the Public Health 
Service Act (42 U.S.C. 290ll). 
SEC. 31052. FUNDING TO SUPPORT PEER RECOVERY SPE-
CIALISTS. 
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,
704 
$25,000,000, to remain available until expended, to carry 
out section 509 of the Public Health Service Act (42 
U.S.C. 290bb–2) with respect to strengthening recovery 
community organizations and their statewide network of 
recovery stakeholders. 
SEC. 31053. FUNDING FOR PROJECT AWARE. 
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, 
$15,000,000, to remain available until expended, for car-
rying out section 520A of the Public Health Service Act 
(42 U.S.C. 290bb–32) with respect to advancing wellness 
and resiliency in education. 
SEC. 31054. FUNDING FOR THE NATIONAL SUICIDE PRE-
VENTION LIFELINE. 
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, 
$75,000,000, to remain available until expended, for ad-
vancing infrastructure for the National Suicide Prevention 
Lifeline program under section 520E–3 of the Public 
Health Service Act (42 U.S.C. 290bb–36c) in order to ex-
pand existing capabilities for response in a manner that 
avoids duplicating existing capabilities for text-based crisis 
support.
705 
SEC. 31055. FUNDING FOR COMMUNITY VIOLENCE AND 
TRAUMA INTERVENTIONS. 
(a) IN GENERAL.—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 $2,500,000,000, to remain available until ex-
pended, for the purposes described in subsection (b): 
(b) USE
OF
FUNDING.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, and in consultation with the Assistant 
Secretary for Mental Health and Substance Use, the Ad-
ministrator of the Health Resources and Services Admin-
istration, the Deputy Assistant Secretary for Minority 
Health, and the Assistant Secretary for the Administra-
tion for Children and Families, shall use amounts appro-
priated by subsection (a) to support public health-based 
interventions to reduce community violence and trauma, 
taking into consideration the needs of communities with 
high rates of, and prevalence of risk factors associated 
with, violence-related injuries and deaths, by— 
(1) awarding competitive grants or contracts to 
local governmental entities, States, territories, In-
dian Tribes and Tribal organizations, Urban Indian 
organizations, hospitals and community health cen-
ters, nonprofit community-based organizations, cul-
turally specific organizations, victim services pro-
706 
viders, or other entities as determined by the Sec-
retary (or consortia of such entities) to support evi-
dence-informed, culturally competent, and develop-
mentally appropriate strategies to reduce community 
violence, including outreach and conflict mediation, 
hospital-based violence intervention, violence inter-
ruption, and services for victims and individuals and 
communities at risk for experiencing violence, such 
as trauma-informed mental health care and coun-
seling, social-emotional learning and school-based 
mental health services, workforce development serv-
ices, and other services that prevent or mitigate the 
impact of trauma, build appropriate skills, or pro-
mote resilience; and 
(2) supporting training, technical assistance, re-
search, evaluation, public health surveillance sys-
tems, data collection, and coordination among rel-
evant stakeholders, to facilitate support for strate-
gies to reduce community violence and ensure safe 
and healthy communities. 
(c) SUPPLEMENT NOT SUPPLANT.—Amounts appro-
priated under this section shall be used to supplement and 
not supplant any Federal, State, or local funding other-
wise made available for the purposes described in this sec-
tion.
707 
(d) EXPENDITURE REQUIREMENT.—All expenditures 
made pursuant to subsection (a) shall be made on or be-
fore September 30, 2031. 
SEC. 31056. FUNDING FOR THE NATIONAL CHILD TRAU-
MATIC STRESS NETWORK. 
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, 
$5,000,000, to remain available until expended, for car-
rying out section 582 of the Public Health Service Act 
(42 U.S.C. 290hh–1) with respect to addressing the prob-
lem of high-risk or medically underserved persons who ex-
perience violence-related stress. 
SEC. 31057. FUNDING FOR HIV HEALTH CARE SERVICES 
PROGRAMS. 
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, 
$75,000,000, to remain available until expended, for nec-
essary expenses for modifications to existing contracts, 
and supplements to existing grants and cooperative agree-
ments under sections 2601, 2611, 2651, 2671, and 
2692(a) of the Public Health Service Act (42 U.S. Code 
300ff–11, 300ff–21, 300ff–51, 300ff–71, 300ff–111).
709 
appropriated, $75,000,000, to remain available until ex-
pended, for the purposes described in subsection (b). 
(b) USE OF FUNDS.—The Secretary, acting through 
the Director of the National Institutes of Health, shall use 
amounts made available under subsection (a) to— 
(1) maintain and expand programs to increase 
research capacity at minority-serving institutions (as 
described in section 371 of the Higher Education 
Act of 1965 (20 U.S.C. 1067q)), including by sup-
porting the Path to Excellence and Innovation pro-
gram of the National Institutes of Health; 
(2) support centers of excellence under sections 
464z–4 and 736 of the Public Health Service Act 
(42 U.S.C. 285t–1, 293); 
(3) support efforts to diversify the national sci-
entific workforce and expand recruitment and reten-
tion of individuals who are— 
(A) underrepresented in the biomedical, 
clinical, behavioral, and social sciences; and 
(B) from disadvantaged backgrounds; and 
(4) support and expand the activities of the Sci-
entific Workforce Diversity Office of the National 
Institutes of Health.
710 
SEC. 31061. FUNDING FOR RESEARCH RELATED TO DEVEL-
OPMENTAL DELAYS. 
(a) IN GENERAL.—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, $10,000,000, to remain available until ex-
pended, for the purpose described in subsection (b). 
(b) USE OF FUNDS.—The Secretary, acting through 
the Director of the National Institutes of Health, shall use 
amounts appropriated by subsection (a) to conduct or sup-
port research related to developmental delays, including 
speech and language delays in infants and toddlers, char-
acterizing speech and language development and outcomes 
in infants and toddlers through early adolescence. Such 
research shall include studies, including longitudinal stud-
ies, conducted or supported by the National Institute on 
Deafness and Other Communication Disorders, the Eu-
nice Kennedy Shriver National Institute of Child Health 
and Human Development, and other relevant institutes 
and centers of the National Institutes of Health. 
(c) SUPPLEMENT, NOT SUPPLANT.—Amounts made 
available to carry out this section shall be used to supple-
ment and not supplant other Federal, State, and local 
public funds expended to conduct or support research re-
lated to developmental delays, including speech and lan-
guage delays, in infants, toddlers, and children.
711 
SEC. 31062. SUPPLEMENTAL FUNDING FOR THE WORLD 
TRADE CENTER HEALTH PROGRAM. 
(a) IN GENERAL.—Title XXXIII of the Public 
Health Service Act is amended by adding at the end the 
following: 
‘‘SEC. 3352. SUPPLEMENTAL FUND. 
‘‘(a) IN GENERAL.—There is established a fund to 
be known as the World Trade Center Health Program 
Supplemental Fund (referred to in this section as the 
‘Supplemental Fund’), consisting of amounts deposited 
into the Supplemental Fund under subsection (b). 
‘‘(b) AMOUNT.—Out of any money in the Treasury 
not otherwise appropriated, there is appropriated for fiscal 
year 2022, $2,860,000,000, for deposit into the Supple-
mental Fund, which amounts shall remain available 
through fiscal year 2031. 
‘‘(c) USE OF FUNDS.—Amounts deposited into the 
Supplemental Fund under subsection (b) shall be avail-
able, without further appropriation and without regard to 
any spending limitation under section 3351(c), to the 
WTC Program Administrator as needed at the discretion 
of such Administrator for carrying out any provision in 
this title, including sections 3303 and 3341(c). 
‘‘(d) RETURN OF FUNDS.—Any amounts that remain 
in the Supplemental Fund on September 30, 2031, shall 
be deposited into the Treasury as miscellaneous receipts.’’.
712 
(b) CONFORMING AMENDMENTS.—Title XXXIII of 
the Public Health Service Act is amended— 
(1) in section 3311(a)(4)(B)(i)(II) (42 U.S.C. 
300mm–21(a)(4)(B)(i)(II)), by striking ‘‘section 
3351’’ and inserting ‘‘sections 3351 and 3352’’; 
(2) in section 3321(a)(3)(B)(i)(II) (42 U.S.C. 
300mm–31(a)(3)(B)(i)(II)), by striking ‘‘section 
3351’’ and inserting ‘‘sections 3351 and 3352’’; 
(3) in section 3331 (42 U.S.C. 300mm–41)— 
(A) in subsection (a), by inserting ‘‘and 
the World Trade Center Health Program Sup-
plemental Fund’’ before the period at the end; 
and 
(B) in subsection (d)— 
(i) in paragraph (1)(B), by inserting 
‘‘(excluding 
any 
expenditures 
from 
amounts in the World Trade Center 
Health Program Supplemental Fund under 
section 3352)’’ before the period at the 
end; and 
(ii) in paragraph (2), in the flush text 
following subparagraph (C), by inserting 
‘‘(excluding 
any 
expenditures 
from 
amounts in the World Trade Center 
Health Program Supplemental Fund under
713 
section 3352)’’ before the period at the 
end; and 
(4) in section 3351(b) (42 U.S.C. 300mm– 
61(b))— 
(A) in paragraph (2), by inserting ‘‘or as 
available from the World Trade Center Health 
Program Supplemental Fund under section 
3352’’ before the period at the end; and 
(B) in paragraph (3), by inserting ‘‘or as 
available from the World Trade Center Health 
Program Supplemental Fund under section 
3352’’ before the period at the end. 
PART 5—NATIVE HAWAIIAN PROVISIONS 
SEC. 31071. NATIVE HAWAIIAN HEALTH CARE SYSTEMS. 
(a) IN GENERAL.—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, $50,000,000, to remain available until Sep-
tember 30, 2031, for the Secretary, not later than 180 
days after the date of enactment of this Act, to award 
grants to, or enter into contracts with, Papa Ola Lokahi 
to support services described in section 6(c) of the Native 
Hawaiian Health Care Improvement Act (42 U.S.C. 
11705(c)) in accordance with this section.
714 
(b) USE OF FUNDS.—Amounts made available to an 
awardee pursuant to subsection (a) shall be used for— 
(1) the purchase, construction, alteration, ren-
ovation, or equipping of health facilities; 
(2) maintenance and improvement projects; 
(3) information technology, telehealth infra-
structure, electric health records systems, and med-
ical equipment; and 
(4) awarding grants to, or entering into con-
tracts with, Native Hawaiian health care systems 
(directly, or through subgrants or subcontracts) to 
support services described in section 6(c) of the Na-
tive Hawaiian Health Care Improvement Act (42 
U.S.C. 11705(c)), on the condition that such grants 
or contracts may only be used for the purposes and 
uses described in paragraphs (1) through (3). 
(c) WAIVER
OF
CERTAIN
RESTRICTIONS.—Sub-
sections (e) and (f)(4) of section 6 of the Native Hawaiian 
Health Care Improvement Act (42 U.S.C. 11705(e), 
11705(f)(4)) shall not apply to grants (or subgrants) 
made using amounts made available under subsection (a). 
(d) DEFINITIONS.—In this section: 
(1) NATIVE
HAWAIIAN
HEALTH
CARE
SYS-
TEM.—The term ‘‘Native Hawaiian health care sys-
tem’’ has the meaning given the term in section 12
719 
including ensuring the cybersecurity of Next Genera-
tion 9–1–1; and 
(3) training of personnel related to Next Gen-
eration 9–1–1. 
(c) CLAWBACK.—The Assistant Secretary shall re-
cover some or all of the grant funds made available to 
an eligible entity under this section if— 
(1) the eligible entity uses the funds for any 
other purpose than those set forth in subsection (b); 
(2) the eligible entity fails to establish a fund-
ing mechanism for Next Generation 9–1–1 sufficient 
to cover operations, maintenance, and upgrade costs 
within 3 years of the establishment of the grant pro-
gram; 
(3) the eligible entity engages in the diversion 
of any 9–1–1 fee or charge imposed by the eligible 
entity; or 
(4) the eligible entity uses funds to purchase, 
rent, lease, or otherwise obtain covered communica-
tions equipment or services (as defined in section 9 
of the Secure and Trusted Communications Net-
works Act of 2019 (47 U.S.C. 1608)).
720 
SEC. 31102. ESTABLISHMENT OF NEXT GENERATION 9–1–1 
CYBERSECURITY CENTER. 
In addition to amounts otherwise available, there is 
appropriated to the National Telecommunications and In-
formation Administration for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated, 
$9,000,000, to remain available until September 30, 2030, 
for the establishment of a Next Generation 9–1–1 Cyber-
security Center to coordinate with State, local, and re-
gional governments on the sharing of cybersecurity infor-
mation about, the analysis of cybersecurity threats to, and 
strategies to detect and prevent cybersecurity intrusions 
relating to, Next Generation 9–1–1. 
SEC. 31103. PUBLIC SAFETY NEXT GENERATION 9–1–1 ADVI-
SORY BOARD. 
In addition to amounts otherwise available, there is 
appropriated to the National Telecommunications and In-
formation Administration for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated, 
$1,000,000, to remain available until September 30, 2030, 
to establish a 16-member Public Safety Next Generation 
9–1–1 Advisory Board, consisting of public safety officials 
and 9–1–1 professionals from diverse backgrounds and 
with the necessary technical expertise, to provide rec-
ommendations to the Assistant Secretary with respect to 
carrying out the duties and responsibilities of the Assist-
721 
ant Secretary related to Next Generation 9–1–1, including 
with respect to the grant program established under sec-
tion 31101. 
SEC. 31104. DEFINITIONS. 
In this subtitle: 
(1) 9–1–1 FEE OR CHARGE.—The term ‘‘9–1– 
1 fee or charge’’ has the meaning given the term in 
section 6(f)(3)(D) of the Wireless Communications 
and Public Safety Act of 1999 (47 U.S.C. 615a– 
1(f)(3)(D)). 
(2) ASSISTANT SECRETARY.—The term ‘‘Assist-
ant Secretary’’ means the Assistant Secretary of 
Commerce for Communications and Information. 
(3) COMMONLY
ACCEPTED
STANDARDS.—The 
term ‘‘commonly accepted standards’’ means the 
technical standards followed by the communications 
industry for network, device, and Internet Protocol 
connectivity that— 
(A) ensure interoperability by enabling 
emergency communications centers to receive, 
process, and analyze all types of 9–1–1 requests 
for emergency assistance (including multimedia 
and data) and share such requests with other 
emergency communications centers and emer-
gency response providers without the need for
722 
proprietary interfaces and regardless of juris-
diction, equipment, device, software, service 
provider, or any other factor; and 
(B) are developed and approved by a 
standards development organization that is ac-
credited by a United States or international 
standards body through a process— 
(i) that is consensus-based and open 
for participation, provides conflict resolu-
tion, and invites comment; and 
(ii) through which standards are made 
publicly available once approved. 
(4) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a State or a Tribal organization that 
has— 
(A) named a single point of contact to co-
ordinate the implementation of Next Generation 
9–1–1; and 
(B) developed and submitted a plan for the 
coordination and implementation of Next Gen-
eration 9–1–1 consistent with any requirements 
of the Assistant Secretary. 
(5) NEXT
GENERATION
9–1–1.—The term 
‘‘Next Generation 9–1–1’’ means an interoperable, 
secure, Internet Protocol-based system that—
723 
(A) employs commonly accepted standards; 
(B) enables emergency communications 
centers to receive, process, and analyze all types 
of 9–1–1 requests for emergency assistance; 
(C) acquires and integrates additional in-
formation useful to handling 9–1–1 requests for 
emergency assistance; 
(D) supports sharing information related 
to 9–1–1 requests for emergency assistance 
among emergency communications centers and 
emergency response providers without the need 
for proprietary interfaces and regardless of ju-
risdiction, equipment, device, software, service 
provider, or any other factor; and 
(E) ensures reliability by enabling ongoing 
operation, including through the use of geo-di-
verse device and network agnostic elements that 
provide more than 1 physical route between end 
points with no common points where a single 
failure at that point would cause the operation 
of Next Generation 9–1–1 to fail. 
(6) STATE.—The term ‘‘State’’ means any 
State of the United States, the District of Columbia, 
Puerto Rico, American Samoa, Guam, the United 
States Virgin Islands, the Northern Mariana Is-
724 
lands, and any other territory or possession of the 
United States. 
Subtitle K—Other Matters Related 
to Connectivity 
SEC. 31201. OUTREACH. 
In addition to amounts otherwise available, there is 
appropriated to the Federal Communications Commission 
for fiscal year 2022, out of any money in the Treasury 
not otherwise appropriated, $100,000,000, to remain 
available until September 30, 2031, to conduct outreach 
and provide education to the public regarding the 
broadband and communications affordability programs of 
the Federal Communications Commission to raise aware-
ness about the programs and help consumers access the 
programs. 
SEC. 31202. FUTURE OF TELECOMMUNICATIONS COUNCIL. 
In addition to amounts otherwise available, there is 
appropriated to the Secretary of Commerce for fiscal year 
2022, out of any money in the Treasury not otherwise ap-
propriated, $7,000,000, to remain available until Sep-
tember 30, 2031, to establish a council of 14 members 
in coordination with the Committee on Commerce, 
Science, and Transportation of the Senate, the Committee 
on Energy and Commerce of the House of Representa-
tives, the Deputy Secretary of Commerce, the Assistant
725 
Secretary of Commerce for Communications and Informa-
tion, the Under Secretary of Commerce for Standards and 
Technology, the Chair of the Federal Communications 
Commission, the Director of the National Science Founda-
tion, the Majority Leader of the Senate, and the Speaker 
of the House of Representatives, to be known as the ‘‘Fu-
ture of Telecommunications Council’’, to advise Congress 
on the development and adoption of 6G and other ad-
vanced wireless communications technologies, including 
ensuring equity in access to those technologies for commu-
nities of color and rural communities. 
SEC. 31203. AFFORDABILITY. 
(a) DEFINITIONS.—In this section: 
(1) BROADBAND; BROADBAND
SERVICE.—The 
term ‘‘broadband’’ or ‘‘broadband service’’ has the 
meaning given the term ‘‘broadband internet access 
service’’ in section 8.1 of title 47, Code of Federal 
Regulations, or any successor regulation. 
(2) COVERED BROADBAND SERVICE.—The term 
‘‘covered broadband service’’ means broadband serv-
ice being delivered through a broadband network 
that can easily scale speeds over time to— 
(A) meet the evolving connectivity needs of 
households and businesses; and
726 
(B) support the deployment of 5G, suc-
cessor wireless technologies, and other advanced 
services. 
(3) 
COVERED
PUBLIC-PRIVATE
PARTNER-
SHIP.—The term ‘‘covered public-private partner-
ship’’ means a partnership between— 
(A) a State, 1 or more political subdivi-
sions of a State, a utility (including a utility co-
operative), a public utility district, a nonprofit 
organization, a regional planning council, or an 
economic development authority; and 
(B) a provider of covered broadband serv-
ice. 
(4) STATE.—The term ‘‘State’’ means any 
State of the United States, the District of Columbia, 
Puerto Rico, American Samoa, Guam, the United 
States Virgin Islands, the Northern Mariana Is-
lands, and any other territory or possession of the 
United States. 
(b) FUNDING.— 
(1) PILOT PROJECTS.—In addition to amounts 
otherwise available, there is appropriated to the Na-
tional Telecommunications and Information Admin-
istration for fiscal year 2022, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated,
727 
$280,000,000, to remain available until September 
30, 2031, for grants to covered public-private part-
nerships for pilot projects to increase access to af-
fordable covered broadband service in urban commu-
nities, including communities of color and for low- 
and middle-income consumers, through long-term so-
lutions for such affordability. 
(2) ADMINISTRATION.—In addition to amounts 
otherwise available, there is appropriated to the Na-
tional Telecommunications and Information Admin-
istration for fiscal year 2022, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated, 
$15,000,000, to remain available until September 
30, 2031, to administer this section. 
(3) ADVISORY
COMMITTEE.—In addition to 
amounts otherwise available, there is appropriated to 
the National Telecommunications and Information 
Administration for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated, 
$5,000,000, to remain available until September 30, 
2031, to establish an advisory committee of 12 
members consisting of experts on broadband afford-
ability from diverse backgrounds, to be known as the 
‘‘Affordable Urban and Suburban Broadband Advi-
sory Committee’’, to advise the National Tele-
728 
communications and Information Administration, 
the Federal Communications Commission, and Con-
gress on ways to make broadband more affordable 
for urban and suburban broadband subscribers, in-
cluding for communities of color and low- and mid-
dle-income consumers, through long-term solutions 
for such affordability. 
SEC. 31204. ACCESS TO DEVICES. 
(a) DEFINITIONS.—In this section: 
(1) ASSISTANT SECRETARY.—The term ‘‘Assist-
ant Secretary’’ means the Assistant Secretary of 
Commerce for Communications and Information. 
(2) CONNECTED
DEVICE.—The term ‘‘con-
nected device’’ means any of the following devices 
that meets minimum standards established by the 
Assistant Secretary: 
(A) A WiFi-enabled desktop computer. 
(B) A WiFi-enabled laptop computer. 
(C) A WiFi-enabled tablet computer. 
(D) Any similar WiFi-enabled device (ex-
cept for a telephone or smartphone). 
(3) CONNECTED
DEVICE
DISTRIBUTION
PRO-
GRAM.—The term ‘‘connected device distribution 
program’’ means a program approved by the Assist-
729 
ant Secretary that makes available connected devices 
for free or at a low cost to an eligible household. 
(4) ELIGIBLE HOUSEHOLD.—The term ‘‘eligible 
household’’ means a household in which— 
(A) at least one member of the household 
meets the qualifications for the Lifeline pro-
gram of the Federal Communications Commis-
sion, except that a household shall be deemed to 
meet the income component of those qualifica-
tions if the household’s income is at or below 
200 percent of the Federal Poverty Guidelines 
for a household of that size; 
(B) at least one member of the household 
has applied for and been approved to receive 
benefits under the free and reduced price lunch 
program or the school breakfast program; 
(C) at least one member of the household 
has received a Federal Pell Grant in the current 
award year, if such award is verifiable through 
the National Verifier or National Lifeline Ac-
countability Database or a connected device dis-
tribution program verifies eligibility; or 
(D) at least one member of the household 
receives assistance through the special supple-
730 
mental nutritional program for women, infants, 
and children. 
(b) CONNECTED DEVICE GRANT PROGRAM.— 
(1) APPROPRIATIONS.— 
(A) IN GENERAL.—In addition to amounts 
otherwise available, there is appropriated to the 
Assistant Secretary for fiscal year 2022, out of 
any money in the Treasury not otherwise ap-
propriated, $475,000,000, to remain available 
until September 30, 2031, for the awarding of 
grants to connected device distribution pro-
grams in accordance with this section. 
(B) ADMINISTRATION.—In addition to 
amounts otherwise available, there is appro-
priated to the Assistant Secretary for fiscal 
year 2022, out of any money in the Treasury 
not otherwise appropriated, $20,000,000, to re-
main available until September 30, 2031, to ad-
minister this section, including providing tech-
nical assistance to a connected device distribu-
tion program. 
(C) OUTREACH.—In addition to amounts 
otherwise available, there is appropriated to the 
Assistant Secretary for fiscal year 2022, out of 
any money in the Treasury not otherwise ap-
731 
propriated, $5,000,000, to remain available 
until September 30, 2031, to conduct outreach 
related to the availability of grants under this 
section. 
(2) USE OF FUNDS.— 
(A) IN GENERAL.—A connected device dis-
tribution program shall use grant funds re-
ceived under this section for— 
(i) the reasonable purchase or refur-
bishment cost of connected devices for dis-
tribution to eligible households consistent 
with this section; and 
(ii) 
the 
reasonable 
administrative 
costs associated with the distribution of 
connected devices described in clause (i). 
(B) LIMITATION.—A connected device dis-
tribution program may use grant funds received 
under this section to provide not more than— 
(i) 1 connected device to an eligible 
household that includes not more than 2 
members over the age of 6; or 
(ii) 2 connected devices to an eligible 
household that includes not fewer than 3 
members over the age of 6.
732 
(3) CLAWBACK.—If a connected device distribu-
tion program is found to have used grant funds 
awarded under this section in a manner not per-
mitted under this section or is found to have other-
wise violated a requirement under this section, the 
Assistant Secretary shall recover from the program 
some or all of the grant funds awarded to the pro-
gram. 
Subtitle L—Distance Learning 
SEC. 31301. ADDITIONAL SUPPORT FOR DISTANCE LEARN-
ING. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Emergency 
Connectivity Fund established under subsection (c)(1) of 
section 7402 of the American Rescue Plan Act of 2021 
(Public Law 117–2) for fiscal year 2022, out of any money 
in 
the 
Treasury 
not 
otherwise 
appropriated, 
$300,000,000, to remain available until September 30, 
2030, to provide support under the covered regulations 
promulgated under subsection (a) of that section, except 
that that amount shall be used to provide support under 
the covered regulations for costs incurred after the date 
of enactment of this Act but before June 30, 2030, regard-
less of whether those costs are incurred during a COVID–
733 
19 emergency period (as defined in subsection (d) of that 
section). 
(b) LIMITATION.—None of the funds appropriated 
under subsection (a) may be used to purchase, rent, lease, 
or otherwise obtain any covered communications equip-
ment or service (as defined in section 9 of the Secure and 
Trusted Communications Networks Act of 2019 (47 
U.S.C. 1608)). 
Subtitle M—Manufacturing Supply 
Chain and Tourism 
SEC. 31401. MANUFACTURING SUPPLY CHAIN RESILIENCE. 
In addition to amounts otherwise available, there is 
appropriated for fiscal year 2022, out of any money in 
the Treasury not otherwise appropriated, $5,000,000,000, 
to remain available until September 30, 2026, to the Of-
fice of the Secretary of Commerce, to support the resil-
ience of manufacturing supply chains affecting interstate 
commerce and related administrative costs, by— 
(1) mapping and monitoring manufacturing 
supply chains; 
(2) facilitating and supporting the establish-
ment of voluntary standards, guidelines, and best 
practices relevant to the resilience of manufacturing 
supply chains;
734 
(3) identifying, accelerating, promoting, dem-
onstrating, and deploying technological advances for 
manufacturing supply chains; and 
(4) providing grants, loans, and loan guarantees 
to maintain and improve manufacturing supply 
chain resiliency. 
SEC. 
31402. 
DESTINATION 
MARKETING 
ORGANIZATION 
GRANT PROGRAM TO PROMOTE SAFE DOMES-
TIC TRAVEL. 
(a) GRANTS FOR DOMESTIC MARKETING ORGANIZA-
TIONS.—In addition to amounts otherwise available, there 
is appropriated for fiscal year 2022, out of any money in 
the Treasury not otherwise appropriated, $47,500,000, to 
remain available until September 30, 2024, to the Sec-
retary of Commerce to award grants to destination mar-
keting organizations, including public or public-private en-
tities that perform the functions of a destination mar-
keting organization as determined by the Secretary, to 
conduct marketing activities to promote domestic travel 
within the United States, including with respect to current 
travel requirements and safe travel practices, with pref-
erence to destination marketing organizations promoting 
a town, city, State, or region where the civilian labor force 
in the accommodation, leisure, and hospitality sector has 
suffered, and continues to suffer, significant job losses as
735 
a result of the COVID–19 pandemic, as determined by 
the Secretary. 
(b) 
ADMINISTRATIVE
COSTS.—In 
addition 
to 
amounts otherwise available, there is appropriated for fis-
cal year 2022, out of any money in the Treasury not other-
wise appropriated, $1,500,000, to remain available until 
September 30, 2027, to the Secretary of Commerce for 
administrative costs associated with providing grants 
under subsection (a). 
(c) DATA ON DOMESTIC TRAVEL AND TOURISM.— 
In addition to amounts otherwise available, there is appro-
priated for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $1,000,000, to re-
main available until September 30, 2027, to the Secretary 
of Commerce to collect data on domestic travel and tour-
ism in the United States, including the impact of the 
COVID–19 pandemic on domestic travel and tourism. 
Subtitle N—FTC Privacy 
Enforcement 
SEC. 31501. FEDERAL TRADE COMMISSION FUNDING FOR A 
PRIVACY BUREAU AND RELATED EXPENSES. 
In addition to amounts otherwise available, there is 
appropriated for fiscal year 2022, out of any money in 
the Treasury not otherwise appropriated, $500,000,000, 
to remain available until September 30, 2029, to the Fed-
736 
eral Trade Commission to create and operate a bureau, 
including by hiring and retaining technologists, user expe-
rience designers, and other experts as the Commission 
considers appropriate, to accomplish its work related to 
unfair or deceptive acts or practices relating to privacy, 
data security, identity theft, data abuses, and related mat-
ters. 
SEC. 31502. FEDERAL TRADE COMMISSION. 
Section 5(m)(1)(A) of the Federal Trade Commission 
Act (15 U.S.C. 45(m)(1)(A)) is amended— 
(1) by inserting ‘‘this Act’s prohibition of unfair 
or deceptive acts or practices or’’ after ‘‘violates’’ the 
first place it appears; and 
(2) by inserting ‘‘a violation of this Act or’’ 
after ‘‘unfair or deceptive and’’. 
Subtitle O—Department of 
Commerce Inspector General 
SEC. 31601. FUNDING FOR THE OFFICE OF INSPECTOR GEN-
ERAL OF THE DEPARTMENT OF COMMERCE. 
In addition to amounts otherwise available, there is 
appropriated for fiscal year 2022, out of any money in 
the Treasury not otherwise appropriated, $5,000,000, to 
remain available until September 30, 2030, to the Office 
of Inspector General of the Department of Commerce for
737 
oversight of activities supported with funds appropriated 
to the Department of Commerce in this Act. 
TITLE IV—COMMITTEE ON 
FINANCIAL SERVICES 
Subtitle 
A—Creating 
and 
Pre-
serving 
Affordable, 
Equitable 
and Accessible Housing for the 
21st Century 
SEC. 40001. PUBLIC HOUSING INVESTMENTS. 
(a) APPROPRIATION.—In addition to amounts other-
wise made available, there is appropriated to the Secretary 
of Housing and Urban Development (in this section re-
ferred to as the ‘‘Secretary’’) for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated— 
(1) $10,000,000,000, to remain available until 
September 30, 2031, for the Capital Fund under 
section 9(d) of the United States Housing Act of 
1937 (42 U.S.C. 1437g(d)) pursuant to the same 
formula as in fiscal year 2021, to be made available 
within 60 days of the date of the enactment of this 
Act; 
(2) $53,000,000,000, to remain available until 
September 30, 2026, for eligible activities under sec-
tion 9(d)(1) of the United States Housing Act of 
1937 (42 U.S.C. 1437g(d)(1)) for priority invest-
738 
ments as determined by the Secretary to repair, re-
place, or construct properties assisted under such 
section 9; 
(3) $1,200,000,000, to remain available until 
September 30, 2026, for competitive grants under 
section 24 of the United States Housing Act of 1937 
(42 U.S.C. 1437v) (in this section referred to as 
‘‘section 24’’), under the terms and conditions in 
subsection (b), for transformation, rehabilitation, 
and replacement housing needs of public and as-
sisted housing, and to transform neighborhoods of 
poverty into functioning, sustainable mixed-income 
neighborhoods; 
(4) $750,000,000, to remain available until 
September 30, 2031, for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the Public Housing Capital Fund 
and the section 24 grant program generally, includ-
ing information technology, financial reporting, re-
search and evaluation, other cross-program costs in 
support of programs administered by the Secretary 
in this title, and other costs; and 
(5) $50,000,000, to remain available until Sep-
tember 30, 2031, to make new awards or increase 
prior awards to existing technical assistance pro-
739 
viders to provide an increase in capacity building 
and technical assistance available to entities eligible 
for funding for activities or projects consistent with 
this section. 
(b) TERMS
AND CONDITIONS
FOR SECTION 24 
GRANTS.—Grants awarded under subsection (a)(3) shall 
be subject to terms and conditions determined by the Sec-
retary, which shall include the following: 
(1) USE.—Grant funds may be used for resi-
dent and community services, community develop-
ment and revitalization, and affordable housing 
needs in the community. 
(2) APPLICANTS.—Eligible recipients of grants 
shall include lead applicants and joint applicants, as 
follows: 
(A) LEAD APPLICANTS.—A lead applicant 
shall be a local government, a public housing 
agency, or an owner of an assisted housing 
property. 
(B) JOINT APPLICANTS.—A nonprofit or-
ganization or a for-profit developer may apply 
jointly as a joint applicant with such public en-
tities specified in subparagraph (A). A local 
government must be a joint applicant with an
740 
owner of an assisted housing property specified 
in subparagraph (A). 
(3) PERIOD
OF
AFFORDABILITY.—Grantees 
shall commit to a period of affordability determined 
by the Secretary of not fewer than 20 years, but the 
Secretary may specify a period of affordability that 
is fewer than 20 years with respect to homeowner-
ship units developed with section 24 grants. 
(4) ENVIRONMENTAL
REVIEW.—For purposes 
of environmental review, a grantee shall be treated 
as a public housing agency under section 26 of the 
United States Housing Act of 1937 (42 U.S.C. 
1437x). 
(5) LOW-INCOME
AND
AFFORDABLE
HOUS-
ING.—Amounts made available under this section 
shall be used for low-income housing (as such term 
is defined under section 3(b) of the United States 
Housing Act of 1937 (42 U.S.C. 1437a(b))), HUD- 
assisted housing, and affordable housing, which shall 
be housing for which the owner of the project shall 
record an affordability use restriction approved by 
the Secretary for households earning up to 120 per-
cent of the area median income and is subject to the 
period of affordability under paragraph (3) of this 
subsection.
741 
(c) OTHER
TERMS
AND
CONDITIONS.—Grants 
awarded under this section shall be subject to the fol-
lowing terms and conditions: 
(1) LIMITATION.—Amounts provided pursuant 
to this section may not be used for operating costs 
or rental assistance. 
(2) DEVELOPMENT OF NEW UNITS.—Paragraph 
(3) of section 9(g) of the United States Housing Act 
of 1937 (42 U.S.C. 1437g(g)(3)) shall not apply to 
new funds made available under this section. 
(3) HEALTH
AND
SAFETY.—Amounts made 
available under this section shall be used to address 
health, safety, and environmental hazards, including 
lead, fire, carbon monoxide, mold, asbestos, radon, 
pest infestation, and other hazards as defined by the 
Secretary. 
(4) ENERGY EFFICIENCY AND RESILIENCE.— 
Amounts made available under this section shall ad-
vance improvements to energy and water efficiency 
or climate and disaster resilience in housing assisted 
under this section. 
(5) RECAPTURE.—If the Secretary recaptures 
funding allocated by formula from a public housing 
agency under subsection (a)(1), such recaptured 
amounts shall be added to the amounts available
742 
under subsection (a)(2), and shall be obligated by 
the Secretary prior to the expiration of such funds. 
(6) SUPPLEMENTATION OF FUNDS.—The Sec-
retary shall ensure that amounts provided pursuant 
to this section shall serve to supplement and not 
supplant other amounts generated by a recipient of 
such amounts or amounts provided by other Federal, 
State, or local sources. 
(7) WAIVERS
AND
ALTERNATIVE
REQUIRE-
MENTS.—The Secretary may waive or specify alter-
native requirements for subsections (d)(1), (d)(2), 
(e), and (j) of section 9 of the United States Hous-
ing Act of 1937 (42 U.S.C. 1437g) and associated 
regulations in connection with the use of amounts 
made available under this section other than require-
ments related to tenant rights and protections, fair 
housing, nondiscrimination, labor standards, and the 
environment, upon a finding that the waiver or alter-
native requirement is necessary to facilitate the use 
of amounts made available under this section. 
(d) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations or notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
743 
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40002. INVESTMENTS IN AFFORDABLE AND ACCES-
SIBLE HOUSING PRODUCTION. 
(a) APPROPRIATION.—In addition to amounts other-
wise made available, there is appropriated to the Secretary 
of Housing and Urban Development (in this section re-
ferred to as the ‘‘Secretary’’) for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated— 
(1) $9,925,000,000, to remain available until 
September 30, 2026, for activities and assistance for 
the HOME Investment Partnerships Program (in 
this section referred to as the ‘‘HOME program’’), 
as authorized under sections 241 through 242, 244 
through 253, 255 through 256, and 281 through 
290 of the Cranston-Gonzalez National Affordable 
Housing Act (42 U.S.C. 12741-12742, 42 U.S.C. 
12744–12753, 42 U.S.C. 12755–12756, 42 U.S.C. 
12831–12840) (in this section referred to as 
‘‘NAHA’’), subject to the terms and conditions para-
graph (1)(A) of subsection (b); 
(2) $14,925,000,000, to remain available until 
September 30, 2026, for activities and assistance for 
the HOME Investment Partnerships Program, as 
authorized under sections 241 through 242, 244
744 
through 253, 255 through 256, and 281 through 
290 of the Cranston-Gonzalez National Affordable 
Housing Act (42 U.S.C. 12741–12742, 42 U.S.C. 
12744–12753, 42 U.S.C. 12755–12756, 42 U.S.C. 
12831–12840), subject to the terms and conditions 
in paragraphs (1)(B) and (2) of subsection (b); 
(3) $50,000,000, to remain available until Sep-
tember 30, 2031, to make new awards or increase 
prior awards to existing technical assistance pro-
viders to provide an increase in capacity building 
and technical assistance available to any grantees 
implementing activities or projects consistent with 
this section; and 
(4) $100,000,000, to remain available until 
September 30, 2031, for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the HOME and Housing Trust 
Fund programs generally, including information 
technology, financial reporting, research and evalua-
tions, and other cross-program costs in support of 
programs administered by the Secretary in this title, 
and other costs. 
(b) TERMS AND CONDITIONS.— 
(1) FORMULAS.—
745 
(A) The Secretary shall allocate amounts 
made available under subsection (a)(1) pursu-
ant to section 217 of NAHA (42 U.S.C. 12747) 
to grantees that received allocations pursuant 
to that same formula in fiscal year 2021 and 
shall make such allocations within 60 days of 
the enactment of this Act. 
(B) The Secretary shall allocate amounts 
made available under subsection (a)(2) pursu-
ant to the formula specified in section 
1338(c)(3) of the Federal Housing Enterprises 
Financial Safety and Soundness Act of 1992 
(12 U.S.C. 4568(c)(3)) to grantees that re-
ceived Housing Trust Fund allocations pursu-
ant to that same formula in fiscal year 2021 
and shall make such allocations within 60 days 
of the date of the enactment of this Act. 
(2) ELIGIBLE ACTIVITIES.—Other than as pro-
vided in paragraph (5) of this subsection, funds 
made available under subsection (a)(2) may only be 
used for eligible activities described in subpara-
graphs (A) through (B)(i) of section 1338(c)(7) of 
the Federal Housing Enterprises Financial Safety 
and Soundness Act of 1992 (12 U.S.C. 4568(c)(7)), 
except that not more than 10 percent of funds made
746 
available may be used for activities under such sub-
paragraph (B)(i). 
(3) FUNDING
RESTRICTIONS.—The commit-
ment requirements in section 218(g) (42 U.S.C. 
12748(g)) of NAHA, the matching requirements in 
section 220 (42 U.S.C. 12750) of NAHA, and the 
set-aside for housing developed, sponsored, or owned 
by community housing development organizations re-
quired in section 231 of NAHA (42 U.S.C. 12771) 
shall not apply for amounts made available under 
this section. 
(4) REALLOCATION.—For funds provided under 
paragraphs (1) and (2) of subsection (a), the Sec-
retary may recapture certain amounts remaining 
available to a grantee under this section or amounts 
declined by a grantee, and reallocate such amounts 
to other grantees under that paragraph to ensure 
fund expenditure, geographic diversity, and avail-
ability of funding to communities within the State 
from which the funds have been recaptured. 
(5) ADMINISTRATION.— Notwithstanding sub-
sections (c) and (d)(1) of section 212 of NAHA (42 
U.S.C. 12742), grantees may use not more than 15 
percent of their allocations under this section for ad-
ministrative and planning costs.
747 
(c) WAIVERS.—The Secretary may waive or specify 
alternative requirements for any provision of the Cran-
ston-Gonzalez National Affordable Housing Act specified 
in subsection (a)(1) or (a)(2) or regulation for the admin-
istration of the amounts made available under this section 
other than requirements related to tenant rights and pro-
tections, fair housing, nondiscrimination, labor standards, 
and the environment, upon a finding that the waiver or 
alternative requirement is necessary to facilitate the use 
of amounts made available under this section. 
(d) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40003. HOUSING INVESTMENT FUND. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated for fiscal year 2022, 
out of any money in the Treasury not otherwise appro-
priated, to remain available until September 30, 2026— 
(1) $740,000,000 to the Department of the 
Treasury to establish the Housing Investment Fund 
established by this section within the Community 
Development Financial Institutions Fund (in this
748 
section referred to as the ‘‘CDFI Fund’’) to make 
grants to increase investment in the development, 
preservation, rehabilitation, financing, or purchase 
of affordable housing primarily for low-, very-low, 
and extremely low-income families who are renters, 
and for homeowners with incomes up to 120 percent 
of the area median income, and for economic devel-
opment and community facilities related to such 
housing and to further fair housing; and 
(2) $10,000,000 for the costs to the CDFI 
Fund of administering and overseeing the implemen-
tation of this section, including information tech-
nology, financial reporting, research and evaluations, 
and other costs. 
(b) ELIGIBLE GRANTEES.—A grant under this sec-
tion may be made, pursuant to such requirements as the 
CDFI Fund shall establish, only to— 
(1) a CDFI Fund certified community develop-
ment financial institution, as such term is defined in 
section 103 of the Riegle Community Development 
and Regulatory Improvement Act of 1994 (12 
U.S.C. 4702); 
(2) a nonprofit organization having as one of its 
principal purposes the creation, development, or
749 
preservation of affordable housing, including a sub-
sidiary of a public housing authority; or 
(3) a consortium comprised of certified commu-
nity development financial institutions, eligible non-
profit housing organizations, or a combination of 
both. 
(c) ELIGIBLE
USES.—Eligible uses for grant 
amounts awarded from the Housing Investment Fund 
pursuant to this section shall— 
(1) be reasonably expected to result in eligible 
affordable housing activities that support or sustain 
affordable housing funded by a grant under this sec-
tion and capital from other public and private 
sources; and 
(2) include activities— 
(A) to provide loan loss reserves; 
(B) to capitalize an acquisition fund to ac-
quire residential, industrial, or commercial 
property and land for the purpose of the preser-
vation, development, or rehabilitation of afford-
able housing, including to support the creation, 
preservation, or rehabilitation of resident-owned 
manufactured housing communities; 
(C) to capitalize an affordable housing 
fund, for development, preservation, rehabilita-
750 
tion, or financing of affordable housing and eco-
nomic development activities, including commu-
nity facilities, if part of a mixed-use project, or 
activities described in this paragraph related to 
transit-oriented development, which may also be 
designated as a focus of such a fund; 
(D) to capitalize an affordable housing 
mortgage fund, to facilitate the origination of 
mortgages to buyers that may experience sig-
nificant barriers to accessing affordable mort-
gage credit, including mortgages having low 
original principal obligations; 
(E) for risk-sharing loans; 
(F) to provide loan guarantees; and 
(G) to fund rental housing operations. 
(d) IMPLEMENTATION.—The CDFI Fund shall have 
the authority to issue such regulations, notice, or other 
guidance, forms, instructions, and publications to carry 
out the programs, projects, or activities authorized under 
this section to ensure that such programs, projects, or ac-
tivities are completed in a timely and effective manner. 
SEC. 40004. SECTION 811 SUPPORTIVE HOUSING FOR PEO-
PLE WITH DISABILITIES. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of
751 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $450,000,000 for capital advances, includ-
ing amendments to capital advance contracts, for 
supportive housing for persons with disabilities, as 
authorized by section 811(b)(2) of the Cranston- 
Gonzalez National Affordable Housing Act (42 
U.S.C. 8013(b)(2)) (in this section referred to as the 
‘‘Act’’), and subject to subsections (a) through 
(h)(4), (h)(6) through (i)(1)(C), and (i)(2) through 
(m) of such section 811 (42 U.S.C. 8013(a)-42 
U.S.C. 8013(h)(4), 42 U.S.C. 8013(h)(6)-42 U.S.C. 
8013(i)(1)(C), 42 U.S.C. 8013(i)(2)-42 U.S.C. 
8013(m)), and for project rental assistance for sup-
portive housing for persons with disabilities under 
section 811(d)(2) of the Act and for project assist-
ance contracts pursuant to section 202(h) of the 
Housing Act of 1959 (Public Law 86–372; 73 Stat. 
667), for project rental assistance to State housing 
finance agencies and other appropriate entities as 
authorized under section 811(b)(3) of the Act, for 
State housing finance agencies; 
(2) $7,500,000 for providing technical assist-
ance to support State-level efforts to integrate hous-
752 
ing assistance and voluntary supportive services for 
residents of housing receiving such assistance, which 
funding may also be used to provide technical assist-
ance to applicants and potential applicants to under-
stand program requirements and develop effective 
applications, and the Secretary may use amounts 
made available under this paragraph to increase 
prior awards to existing technical assistance pro-
viders to provide an immediate increase in capacity 
building and technical assistance; and 
(3) $42,500,000 for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the Supportive Housing for Per-
sons with Disabilities program generally, including 
information technology, financial reporting, research 
and evaluations, other cross-program costs in sup-
port of programs administered by the Secretary in 
this title, and other costs. 
Amounts appropriated by this section shall remain avail-
able until September 30, 2031. 
(b) LIMITATIONS ON COSTS.—When awarding grants 
under paragraph (1) of subsection (a), the Secretary shall 
establish and assess reasonable development cost limita-
tions by market area for various types and sizes of sup-
portive housing for persons with disabilities. The Sec-
753 
retary shall not count owner or sponsor contributions of 
other funding or assistance against the overall cost of a 
project. 
(c) OCCUPANCY STANDARDS.—The owner or sponsor 
of housing assisted with funds provided under this section 
may, with the approval of the Secretary, limit occupancy 
with the housing to persons with disabilities who can ben-
efit from the supportive services offered in connection with 
the housing. 
(d) WAIVERS.—The Secretary may waive or specify 
alternative requirements for subsection (c) or (bb) of sec-
tion 8 of the United States Housing Act of 1937 (42 
U.S.C. 1437f (c), 1437f(bb)) upon a finding that the waiv-
er or alternative requirement is necessary to facilitate the 
use of amounts made available under this section. 
(e) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40005. SECTION 202 SUPPORTIVE HOUSING FOR THE 
ELDERLY PROGRAM. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of
754 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $450,000,000 for the Supportive Housing 
for the Elderly Program authorized under section 
202 of the Housing Act of 1959, and subject to sub-
sections (a) through (g), (h)(2) through (h)(5), and 
(i) through (m) of such section 202 (12 U.S.C. 
1701q(a)-12 
U.S.C. 
1701q(g), 
U.S.C. 
1701q(h)(2)-12 U.S.C. 1701q(h)(5), 12 U.S.C. 
1701q(i)-12 U.S.C. 1701q(m)) (in this section re-
ferred to as the ‘‘Act’’), which shall be used— 
(A) for capital advance awards in accord-
ance with section 202(c)(1) of the Act to recipi-
ents that are eligible under the Act; 
(B) for new section 8 project-based rental 
assistance contracts under section 8(b) of the 
United States Housing Act of 1937 Act (42 
U.S.C. 1437f(b)), subject to subsection (c) of 
this section, with the Secretary setting the 
terms of such project-based rental assistance 
contracts, including the duration and provisions 
regarding rent setting and rent adjustment, to 
support the capital advance projects funded 
under this section; and
755 
(C) for service coordinators; 
(2) $7,500,000, to provide technical assistance 
to support State-level efforts to improve the design 
and delivery of voluntary supportive services for resi-
dents of any housing assisted under the Act and 
other housing supporting low-income older adults, in 
order to support residents to age-in-place and avoid 
institutional care, as well as to assist applicants and 
potential applicants with project-specific design, and 
the Secretary may use amounts made available 
under this paragraph to increase prior awards to ex-
isting technical assistance providers to provide an 
immediate increase in capacity building and tech-
nical assistance; and 
(3) $42,500,000 for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the Supportive Housing for the 
Elderly program generally, including information 
technology, financial reporting, research and evalua-
tion, other cross-program costs in support of pro-
grams administered by the Secretary in this title, 
and other costs. 
Amounts appropriated by this section shall remain avail-
able until September 30, 2031.
756 
(b) LIMITATION ON COSTS.—When awarding grants 
under paragraph (1) of subsection (a), the Secretary shall 
establish and assess reasonable development cost limita-
tions by market area for various types and sizes of sup-
portive housing for the elderly. The Secretary shall not 
count owner or sponsor contributions of other funding or 
assistance against the overall cost of a project. 
(c) WAIVERS.—The Secretary may waive or specify 
alternative requirements for any provision of subsection 
(c) or (bb) of section 8 of the United States Housing Act 
of 1937 (42 U.S.C. 1437f (c), 1437f(bb)) upon a finding 
that the waiver or alternative requirement is necessary to 
facilitate the use of amounts made available under this 
section. 
(d) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40006. IMPROVING ENERGY EFFICIENCY OR WATER 
EFFICIENCY OR CLIMATE RESILIENCE OF AF-
FORDABLE HOUSING. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of
757 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $1,770,000,000, to remain available until 
September 30, 2028, for the cost of providing direct 
loans, including the costs of modifying such loans, 
and for grants, as provided for and subject to terms 
and conditions in subsection (b), including to sub-
sidize gross obligations for the principal amount of 
direct loans, not to exceed $4,000,000,000, to fund 
projects that improve the energy or water efficiency, 
indoor air quality and sustainability improvements, 
implement low-emission technologies, materials, or 
processes, including zero-emission electricity genera-
tion, energy storage, or building electrification, elec-
tric car charging station installations, or address cli-
mate resilience of multifamily properties; 
(2) $25,000,000, to remain available until Sep-
tember 30, 2030, for the costs to the Secretary of 
administering and overseeing the implementation of 
this section, including information technology, finan-
cial reporting, research and evaluation, other cross- 
program costs in support of programs administered 
by the Secretary in this title, and other costs;
758 
(3) $120,000,000, to remain available until 
September 30, 2029, for expenses of contracts ad-
ministered by the Secretary, including to carry out 
property climate risk, energy, or water assessments, 
due diligence, and underwriting functions for such 
grant and direct loan program; and 
(4) $85,000,000, to remain available until Sep-
tember 
30, 
2028, 
for 
energy 
and 
water 
benchmarking of properties eligible to receive grants 
or loans under this section, regardless of whether 
they actually received such grants, along with associ-
ated data analysis and evaluation at the property 
and portfolio level, including the development of in-
formation technology systems necessary for the col-
lection, evaluation, and analysis of such data. 
(b) LOAN AND GRANT TERMS AND CONDITIONS.— 
Amounts made available under this section shall be for 
direct loans, grants, and direct loans that can be converted 
to grants to eligible recipients that agree to an extended 
period of affordability for the property. 
(c) DEFINITIONS.—As used in this section— 
(1) the term ‘‘eligible recipient’’ means any 
owner or sponsor of an eligible property; and 
(2) the term ‘‘eligible property’’ means a prop-
erty receiving project-based assistance pursuant to—
759 
(A) section 202 of the Housing Act of 
1959 (12 U.S.C. 1701q); 
(B) section 811 of the Cranston-Gonzalez 
National Affordable Housing Act (42 U.S.C. 
8013); or 
(C) section 8(b) of the United States 
Housing Act of 1937 (42 U.S.C. 1437f(b)) 
(d) WAIVER.—The Secretary may waive or specify al-
ternative requirements for any provision of subsection (c) 
or (bb) of section 8 of the United States Housing Act of 
1937 (42 U.S.C. 1437f(c), 1437f(bb)) upon a finding that 
the waiver or alternative requirement is necessary to facili-
tate the use of amounts made available under this section. 
(e) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 
40007. 
REVITALIZATION 
OF 
DISTRESSED 
MULTI-
FAMILY PROPERTIES. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Housing and Urban Development (in this section referred
760 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $1,550,000,000 for providing direct loans, 
which may be forgivable, to owners of distressed 
properties for the purpose of making necessary phys-
ical improvements, including to subsidize gross obli-
gations for the principal amount of direct loans not 
to exceed $6,000,000,000, subject to the terms and 
conditions in subsection (b); and 
(2) $50,000,000 for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the Office of Housing programs 
generally, including information technology, financial 
reporting, research and evaluations, other cross-pro-
gram costs in support of programs administered by 
the Secretary in this title, and other costs. 
Amounts appropriated by this section shall remain avail-
able until September 30, 2029. 
(b) LOAN TERMS AND CONDITIONS.— 
(1) ELIGIBILITY.—Owners or sponsors of multi-
family housing projects who meet each of the fol-
lowing requirements shall be eligible for loan assist-
ance under this section: 
(A) The multifamily housing project, in-
cluding any project from which assistance has
761 
been approved to be transferred has deficiencies 
that cause the project to be at risk of physical 
obsolescence or economic non-viability. 
(B) The actual rents received by the owner 
or sponsor of the distressed property would not 
adequately sustain the debt needed to make 
necessary physical improvements. 
(C) The owner or sponsor meets any such 
additional eligibility criteria as the Secretary 
determines to be appropriate, considering fac-
tors that contributed to the project’s defi-
ciencies. 
(2) USE OF LOAN FUNDS.—Each recipient of 
loan assistance under this section may only use such 
loan assistance to make necessary physical improve-
ments. 
(3) LOAN AVAILABILITY.—The Secretary shall 
only provide loan assistance to an owner or sponsor 
of a multifamily housing project when such assist-
ance, considered with other financial resources avail-
able to the owner or sponsor, is needed to make the 
necessary physical improvements. 
(4) INTEREST
RATES
AND
LENGTH.—Loans 
provided under this section shall bear interest at 1 
percent, and at origination shall have a repayment
762 
period coterminous with the affordability period es-
tablished under paragraph (6), with the frequency 
and amount of repayments to be determined by re-
quirements established by the Secretary. 
(5) LOAN MODIFICATIONS OR FORGIVENESS.— 
With respect to loans provided under this section, 
the Secretary may take any of the following actions 
if the Secretary determines that doing so will pre-
serve affordability of the project: 
(A) Waive any due on sale or due on refi-
nancing restriction. 
(B) Consent to the terms of new debt to 
which the loans may be subordinate, even if 
such new debt would impact the repayment of 
the loans. 
(C) Extend the term of the loan. 
(D) Forgive the loan in whole or in part. 
(6) EXTENDED AFFORDABILITY PERIOD.—Each 
recipient of loan assistance under this section shall 
agree to an extended affordability period for the 
project that is subject to the loan by extending any 
existing affordable housing use agreements for an 
additional 30 years or, if the project is not currently 
subject to a use agreement establishing affordability
763 
requirements, by establishing a use agreement for 
30 years. 
(7) MATCHING CONTRIBUTION.—Each recipient 
of loan assistance under this section shall secure at 
least 20 percent of the total cost needed to make the 
necessary physical improvements from non-Federal 
sources, except in cases where the Secretary deter-
mines that a lack of financial resources qualifies a 
loan recipient for— 
(A) a reduced contribution below 20 per-
cent; or 
(B) an exemption to the matching con-
tribution requirement. 
(8) ADDITIONAL LOAN CONDITIONS.—The Sec-
retary may establish additional conditions for loan 
eligibility provided under this section as the Sec-
retary determines to be appropriate. 
(9) PROPERTIES
INSURED
BY
THE
SEC-
RETARY.—In the case of any property with respect 
to which assistance is provided under this section 
that has a mortgage insured by the Secretary, the 
Secretary may use funds available under this section 
as necessary to pay for the costs of modifying such 
loan. 
(c) DEFINITIONS.—As used in this section—
764 
(1) the term ‘‘multifamily housing project’’ 
means a project consisting of five or more dwelling 
units assisted or approved to receive a transfer of 
assistance, insured, or with a loan held by the Sec-
retary or a State or State agency in part or in whole 
pursuant to— 
(A) section 8 of the United States Housing 
Act of 1937 (42 U.S.C. 1437f), not including 
subsection (o)(13) of such section; 
(B) section 202 of the Housing Act of 
1959 (12 U.S.C. 1701q), as amended by section 
801 of the Cranston-Gonzalez National Afford-
able Housing Act; 
(C) section 202 of the Housing Act of 
1959 (former 12 U.S.C. 1701q), as such section 
existed before the enactment of the Cranston- 
Gonzalez National Affordable Housing Act; 
(D) section 811 of the Cranston-Gonzalez 
National Affordable Housing Act (42 U.S.C. 
8013); or 
(E) section 236 of the National Housing 
Act (12 U.S.C. 1715z-1); and 
(2) the term ‘‘necessary physical improve-
ments’’ means new construction or capital improve-
ments to an existing multifamily housing project
765 
that the Secretary determines are necessary to ad-
dress the deficiencies or that rise to such a level that 
delaying physical improvements to the project would 
be detrimental to the longevity of the project as suit-
able housing for occupancy. 
(d) WAIVER.—The Secretary may waive or specify al-
ternative requirements for any provision of subsection (c) 
or (bb) of section 8 of the United States Housing Act of 
1937 (42 U.S.C. 1437f(c), 1437f(bb)) upon a finding that 
the waiver or alternative requirement is necessary to facili-
tate the use of amounts made available under this section. 
(e) IMPLEMENTATION.—The Secretary shall have the 
authority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40008. INVESTMENTS IN RURAL RENTAL HOUSING. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Rural Housing 
Service of the Department of Agriculture for fiscal year 
2022, out of any money in the Treasury not otherwise ap-
propriated— 
(1) $1,800,000,000, to remain available until 
September 30, 2029, for the Administrator of the
766 
Rural Housing Service for making loans and grants 
for new construction, improvements to energy and 
water efficiency or climate resilience, the removal of 
health and safety hazards, and the preservation and 
revitalization of housing for other purposes described 
under section 514 of the Housing Act of 1949 (42 
U.S.C. 1484), subsections (a)(1) through (a)(2), 
(b)(1) through (b)(3), (b)(5) through (aa)(2)(A), 
and (aa)(4) of section 515 of such Act (42 U.S.C. 
1485(a)(1)-42 
U.S.C. 
1485(a)(2), 
U.S.C. 
1485(b)(1)-(b)(3), 42 U.S.C. 1485(b)(5)-42 U.S.C. 
1485(aa)(2)(A), 42 U.S.C. 1485(aa)(4)), and 516 of 
such act (42 U.S.C. 1486), subject to the terms and 
conditions in subsection (b); 
(2) $100,000,000, to remain available until 
September 30, 2029, to provide continued assistance 
pursuant to section 3203 of the American Rescue 
Plan Act of 2021; and 
(3) $100,000,000, to remain available until 
September 30, 2030, for the costs to the Rural 
Housing Service of the Department of Agriculture of 
administering and overseeing the implementation of 
this section, including information technology, finan-
cial reporting, research and evaluations, other cross-
767 
program costs in support of programs administered 
by the Secretary in this title, and other costs. 
(b) PRESERVATION
AND REVITALIZATION TERMS 
AND CONDITIONS.— 
(1) LOANS AND GRANTS AND OTHER ASSIST-
ANCE.—The Administrator of the Rural Housing 
Service of the Department of Agriculture shall pro-
vide direct loans and grants, including the cost of 
modifying loans, to restructure existing Department 
of Agriculture multi-family housing loans expressly 
for the purposes of ensuring the project has suffi-
cient resources to preserve the project for the pur-
pose of providing safe and affordable housing for 
low-income residents and farm laborers, including— 
(A) reducing or eliminating interest; 
(B) deferring loan payments; 
(C) subordinating, reducing, or re-amor-
tizing loan debt; and 
(D) providing other financial assistance, 
including advances, payments, and incentives 
(including the ability of owners to obtain rea-
sonable returns on investment) required by the 
Secretary, including such assistance to non- 
profit entities and public housing authorities.
768 
(2) RESTRICTIVE USE AGREEMENT.—The Ad-
ministrator of the Rural Housing Service of the De-
partment of Agriculture shall as part of the preser-
vation and revitalization agreement obtain a restric-
tive use agreement consistent with the terms of the 
restructuring. 
(c) IMPLEMENTATION.—The Administrator of the 
Rural Housing Service of the Department of Agriculture 
shall have authority to issue such regulations, notices, or 
other guidance, forms, instructions, and publications to 
carry out the programs, projects, or activities authorized 
under this section to ensure that such programs, projects, 
or activities are completed in a timely and effective man-
ner. 
SEC. 40009. HOUSING VOUCHERS. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $15,000,000,000, to remain available until 
September 30, 2029, for— 
(A) incremental tenant-based rental assist-
ance for extremely low-income families under
769 
section 8(o) of the United States Housing Act 
of 1937 (42 U.S.C. 1437f(o)); 
(B) renewals of such tenant-based rental 
assistance; and 
(C) fees for the costs of administering ten-
ant-based rental assistance and other expenses 
related to the utilization of voucher assistance 
under subparagraph (A), which may include the 
cost of facilitating the use of voucher assistance 
provided under paragraph (5); 
(2) $7,100,000,000, to remain available until 
September 30, 2029, for— 
(A) incremental tenant-based rental assist-
ance under section 8(o) of the United States 
Housing Act of 1937 (42 U.S.C. 1437f(o)) for 
households experiencing or at risk of homeless-
ness, survivors of domestic violence, dating vio-
lence, sexual assault, and stalking, and sur-
vivors of trafficking; 
(B) renewals of such tenant-based rental 
assistance; and 
(C) fees for the costs of administering ten-
ant-based rental assistance and other expenses 
related to the utilization of voucher assistance 
under subparagraph (A), which may include the
770 
cost of facilitating the use of voucher assistance 
provided under paragraph (5); 
(3) $1,000,000,000, to remain available until 
September 30, 2031, for— 
(A) tenant protection vouchers for reloca-
tion and replacement of public housing units 
demolished or disposed as part of a public hous-
ing preservation or project-based replacement 
transaction using funds made available under 
this title; 
(B) renewals of such tenant-based rental 
assistance; and 
(C) fees for the costs of administering ten-
ant-based rental assistance and other expenses 
related to the utilization of voucher assistance 
under subparagraph (A), which may include the 
cost of facilitating the use of voucher assistance 
provided under paragraph (5); 
(4) $300,000,000, to remain available until 
September 30, 2031, for competitive grants, subject 
to terms and conditions determined by the Sec-
retary, to public housing agencies for mobility-re-
lated services for voucher families, including families 
with children, and service coordination;
771 
(5) $230,000,000, to remain available until 
September 30, 2031, for eligible expenses to facili-
tate the use of voucher assistance under this section 
and for other voucher assistance under section 8(o) 
of the United States Housing Act of 1937, as deter-
mined by the Secretary, in addition to amounts oth-
erwise available for such expenses, including prop-
erty owner outreach and retention activities such as 
incentive payments, security deposit payments and 
loss reserves, landlord liaisons, and other uses of 
funds designed primarily— 
(A) to recruit owners of dwelling units, 
particularly dwelling units in census tracts with 
a poverty rate of less than 20 percent, to enter 
into housing assistance payment contracts; and 
(B) to encourage owners that enter into 
housing assistance payment contracts as de-
scribed in subparagraph (A) to continue to 
lease their dwelling units to tenants assisted 
under section 8(o) of the United States Hous-
ing Act of 1937; 
(6) $300,000,000, to remain available until 
September 30, 2031, for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the Housing Choice Voucher pro-
772 
gram generally, including information technology, fi-
nancial reporting, research and evaluations, other 
cross-program costs in support of programs adminis-
tered by the Secretary in this title, and other costs; 
and 
(7) $70,000,000, to remain available until Sep-
tember 30, 2031, for making new awards or increas-
ing prior awards to existing technical assistance pro-
viders to provide an increase in capacity building 
and technical assistance available to public housing 
agencies. 
(b) TERMS AND CONDITIONS.— 
(1) ALLOCATION.—The Secretary shall allocate 
initial incremental assistance provided for rental as-
sistance under subsection (a)(1) and (2) in each fis-
cal year commencing in 2022 and ending in 2026 in 
accordance with a formula or formulas that include 
measures of severe housing need among extremely 
low-income renters and public housing agency capac-
ity, and ensures geographic diversity among public 
housing agencies administering the Housing Choice 
Voucher program. 
(2) ELECTION TO ADMINISTER.—The Secretary 
shall establish a procedure for public housing agen-
773 
cies to accept or decline the incremental vouchers 
made available under this section. 
(3) FAILURE TO USE VOUCHERS PROMPTLY.— 
If a public housing agency fails to lease the author-
ized vouchers it has received under this subsection 
on behalf of eligible families within a reasonable pe-
riod of time, the Secretary may offset the agency’s 
voucher renewal allocations and may revoke and re-
distribute any unleased vouchers and associated 
funds, which may include administrative fees and 
amounts allocated under subsections (a)(3) and 
(a)(4), to other public housing agencies. 
(4) LIMITATION OF USE OF FUNDS.— Public 
housing agencies may use funds received under this 
section only for the activities listed in subsection (a) 
for which the funds were provided to such agency. 
(5) CAP
ON
PROJECT-BASED
VOUCHERS
FOR 
VULNERABLE
POPULATIONS.—Upon request by a 
public housing agency, the Secretary may designate 
a number of the public housing agency’s vouchers al-
located under this section as excepted units that do 
not count against the percentage limitation on the 
number of authorized units a public housing agency 
may project-base under section 8(o)(13)(B) of the 
United States Housing Act of 1937, in accordance
774 
with the conditions established by the Secretary. 
This paragraph may not be construed to waive, 
limit, or specify alternative requirements, or permit 
such waivers, limitations, or alternative require-
ments, related to fair housing and nondiscrimina-
tion, including the requirement to provide housing 
and services to individuals with disabilities in inte-
grated settings. 
(6) HOMELESS WAIVER AUTHORITY.— In ad-
ministering the voucher assistance targeted for 
households experiencing or at risk of homelessness, 
survivors of domestic violence, dating violence sexual 
assault, and stalking, and survivors of trafficking 
under subsection (a)(2), the Secretary may, upon a 
finding that a waiver or alternative requirement is 
necessary to facilitate the use of such assistance, 
waive or specify alternative requirements for— 
(A) section 8(o)(6)(A) of the United States 
Housing 
Act 
of 
1937 
(42 
U.S.C. 
1437f(o)(6)(A)) and regulatory provisions re-
lated to the administration of waiting lists and 
local preferences; 
(B) section 214(d)(2) of the Housing and 
Community Development Act of 1980 (42 
U.S.C. 1436a(d)(2)), section 576(a), (b), and
775 
(c) of the Quality Housing and Work Responsi-
bility Act of 1998 (42 U.S.C. 13661(a), (b),and 
(c)), and regulatory provisions related to the 
verification of eligibility, eligibility require-
ments, and the admissions process; 
(C) section 8(o)((7)(A) of the United 
States Housing Act of 1937 (42 U.S.C. 
1437f(o)(7)(A)) and regulatory provisions re-
lated to the initial lease term; 
(D) section 8(r)(B)(i) of the United States 
Housing 
Act 
of 
1937 
(42 
U.S.C. 
1437f(r)(B)(i)) and regulatory provisions re-
lated to portability moves by non-resident appli-
cants; and 
(E) regulatory provisions related to the es-
tablishment of payment standards. 
(c) IMPLEMENTATION.—The Secretary shall have au-
thority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner. 
SEC. 40010. PROJECT-BASED RENTAL ASSISTANCE. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of
776 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $880,000,000 for the project-based rental 
assistance program, as authorized under section 8(b) 
of the United States Housing Act of 1937 (42 
U.S.C. 1437f(b)), (in this section referred to as the 
‘‘Act’’), subject to the terms and conditions of sub-
section (b) of this section; 
(2) $20,000,000 for providing technical assist-
ance to recipients of or applicants for project-based 
rental assistance or to States allocating the project- 
based rental assistance; and 
(3) $100,000,000 for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and the section 8 project-based rental 
assistance program generally, including information 
technology, financial reporting, research and evalua-
tions, other cross-program costs in support of pro-
grams administered by the Secretary in this title, 
and other costs. 
Amounts appropriated by this section shall remain avail-
able until September 30, 2031. 
(b) TERMS AND CONDITIONS.—
777 
(1) AUTHORITY.—Notwithstanding section 8(a) 
the Act (42 U.S.C. 1437f(a)), the Secretary may use 
amounts made available under this section to pro-
vide assistance payments with respect to newly con-
structed housing, existing housing, or substantially 
rehabilitated non-housing structures for use as new 
multifamily housing in accordance with this section 
and the provisions of section 8 of the Act. In addi-
tion, the Secretary may use amounts made available 
under this section for performance-based contract 
administrators for section 8 project-based assistance, 
for carrying out this section and section 8 of the 
Act. 
(2) PROJECT-BASED
RENTAL
ASSISTANCE.— 
The Secretary may make assistance payments using 
amounts made available under this section pursuant 
to contracts with owners or prospective owners who 
agree to construct housing, to substantially rehabili-
tate existing housing, to substantially rehabilitate 
non-housing structures for use as new multifamily 
housing, or to attach the assistance to newly con-
structed housing in which some or all of the units 
shall be available for occupancy by very low-income 
families in accordance with the provisions of section 
8 of the Act. In awarding contracts pursuant to this
778 
section, the Secretary shall give priority to owners or 
prospective owners of multifamily housing projects 
located or to be located in areas of high opportunity, 
as defined by the Secretary, in areas experiencing 
economic growth or rising housing prices to prevent 
displacement or secure affordable housing for low-in-
come households, or that serve people at risk of 
homelessness or that integrate additional units that 
are accessible for persons with mobility impairments 
and persons with hearing or visual impairments be-
yond those required by applicable Federal accessi-
bility standards. 
(3) ALLOCATION.—The Secretary shall make 
awards with amounts made available under this sec-
tion using the following mechanisms, alone or in 
combination: 
(A) A competitive process, which the Sec-
retary may carry out in multiple rounds of com-
petition, each of which may have its own selec-
tion, performance, and reporting criteria as es-
tablished by the Secretary. 
(B) Selecting proposals submitted through 
FHA loan applications that meet specified cri-
teria.
779 
(C) Delegating to States the awarding of 
contracts, including related determinations such 
as the maximum monthly rent, subject to the 
requirements of section 8 of the Act, as deter-
mined by the Secretary. 
(4) CONTRACT
TERM, RENT
SETTING, AND 
RENT ADJUSTMENTS.—The Secretary may set the 
terms of the contract, including the duration and 
provisions regarding rent setting and rent adjust-
ments. 
(c) WAIVERS.—The Secretary may waive or specify 
alternative requirements for any provision of subsection 
(c) or (bb) of section 8 of the United States Housing Act 
of 1937 (42 U.S.C. 1437f(c), 1437f(bb)) upon a finding 
that the waiver or alternative requirement is necessary to 
facilitate the use of amounts made available under this 
section. 
(d) IMPLEMENTATION.—The Secretary shall have the 
authority to issue such regulations, notices, or other guid-
ance, forms, instructions, and publications to carry out the 
programs, projects, or activities authorized under this sec-
tion to ensure that such programs, projects, or activities 
are completed in a timely and effective manner.
780 
SEC. 40011. INVESTMENTS IN NATIVE AMERICAN COMMU-
NITIES. 
(a) APPROPRIATION.—In addition to amounts other-
wise available, there is appropriated to the Secretary of 
Housing and Urban Development (in this section referred 
to as the ‘‘Secretary’’) for fiscal year 2022, out of any 
money in the Treasury not otherwise appropriated— 
(1) $277,500,000 for formula grants for eligible 
affordable housing activities described in section 202 
of the Native American Housing Assistance and 
Self-Determination Act of 1996 (in this section re-
ferred to as ‘‘NAHASDA’’) (25 U.S.C. 4132), which 
shall be distributed according to the most recent fis-
cal year funding formula for the Indian Housing 
Block Grant; 
(2) $200,000,000 for— 
(A) affordable housing activities authorized 
under section 810(a) of NAHASDA (25 U.S.C. 
4229); 
(B) community-wide infrastructure and in-
frastructure improvement projects carried out 
on Hawaiian Home Lands pursuant to section 
810(b)(5) 
of 
NAHASDA 
(25 
U.S.C. 
4229(b)(5)); and 
(C) rental assistance to Native Hawaiians 
(as defined in section 801 of NAHASDA (25
781 
U.S.C. 4221)) on and off Hawaiian Home 
Lands; 
(3) $277,500,000 for competitive grants for eli-
gible affordable housing activities described in sec-
tion 202 of NAHASDA (25 U.S.C. 4132); 
(4) $200,000,000 for— 
(A) competitive single-purpose Indian com-
munity development block grants for Indian 
tribes; and 
(B) imminent threat Indian community de-
velopment block grants, including for long-term 
environmental threats and relocation, for Indian 
tribes, or a tribal organization, governmental 
entity, or nonprofit organization designated by 
the Indian tribe to apply for a grant on its be-
half; 
(5) $25,000,000 for the costs to the Secretary 
of administering and overseeing the implementation 
of this section and Indian and Native Hawaiian pro-
grams administered by the Secretary, including in-
formation technology, financial reporting, research 
and evaluations, other cross-program costs in sup-
port of programs administered by the Secretary in 
this title, and other costs; and