Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Re-
authorizing and Extending America’s Community Health 
Act’’ or the ‘‘REACH Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—PUBLIC HEALTH EXTENDERS 
Sec. 101. Extension for community health centers, the National Health Service 
Corps, and teaching health centers that operate GME programs. 
Sec. 102. Extension for special diabetes programs. 
Sec. 103. Extension of Personal Responsibility Education Program. 
Sec. 104. Extension of sexual risk avoidance education program. 
TITLE II—MEDICARE EXTENDERS 
Sec. 201. Extension of the work geographic index floor under the Medicare pro-
gram. 
Sec. 202. Extension of funding outreach and assistance for low-income programs. 
Sec. 203. Extension of funding for quality measure endorsement, input, and selec-
tion under the Medicare program. 
Sec. 204. Extension of the Independence at Home Medical Practice Demonstra-
tion Program under the Medicare program. 
Sec. 205. Extension of appropriations and transfers to the Patient-Centered Out-
comes Research Trust Fund; extension of certain health insur-
ance fees. 
Sec. 206. Transitional coverage and retroactive Medicare part D coverage for cer-
tain low-income beneficiaries. 
Sec. 207. Health Equity and Access for Returning Troops and Servicemembers 
Act of 2019. 
Sec. 208. Exclusion of complex rehabilitative manual wheelchairs from Medicare 
competitive acquisition program; Non-application of Medicare 
fee-schedule adjustments for certain wheelchair accessories and 
cushions. 
TITLE III—MEDICAID PROVISIONS 
Sec. 301. Modification of reductions in Medicaid DSH allotments. 
Sec. 302. Public availability of hospital upper payment limit demonstrations. 
Sec. 303. Report by Comptroller General. 
Sec. 304. Sense of Congress regarding the need to develop a more permanent legis-
lative solution to provide the territories with a reliable and con-
sistent source of Federal funding under the Medicaid program. 
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TITLE IV—NO SURPRISES ACT 
Sec. 401. Short title. 
Sec. 402. Preventing surprise medical bills. 
Sec. 403. Government Accountability Office study on profit- and revenue-sharing 
in health care. 
Sec. 404. State All Payer Claims Databases. 
Sec. 405. Air ambulance cost data reporting program. 
Sec. 406. Report by Secretary of Labor. 
Sec. 407. Billing statute of limitations. 
Sec. 408. GAO report on impact of surprise billing provisions. 
Sec. 409. Report by the Secretary of Health and Human Services. 
TITLE V—TERRITORIES HEALTH CARE IMPROVEMENT ACT 
Sec. 501. Short title. 
Sec. 502. Medicaid payments for Puerto Rico and the other territories for certain 
fiscal years. 
Sec. 503. Application of certain requirements under Medicaid program to certain 
territories. 
Sec. 504. Additional program integrity requirements. 
TITLE I—PUBLIC HEALTH 
EXTENDERS 
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
THE NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) 
COMMUNITY
HEALTH
CENTERS.—Section 
10503(b)(1)(F) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(1)(F)) is amended by strik-
ing ‘‘fiscal year 2019’’ and inserting ‘‘each of fiscal years 
2019 through 2023’’. 
(b) NATIONAL HEALTH SERVICE CORPS.—Section 
10503(b)(2)(F) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(2)(F)) is amended by strik-
ing ‘‘2018 and 2019’’ and inserting ‘‘2019 through 2023’’. 
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(c) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE
MEDICAL
EDUCATION
PROGRAMS.—Section 
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)(1)) is amended by striking ‘‘2018 and 2019’’ and 
inserting ‘‘2019 through 2023’’. 
(d) APPLICATION.—Amounts appropriated for a pro-
gram pursuant to the amendments made by subsection (a), 
(b), or (c) for fiscal years 2020 through 2023 are subject 
to the requirements and limitations of the most recently en-
acted regular or full-year continuing appropriations Act or 
resolution (as of the date of obligation of current funds) ap-
plicable to the respective program. 
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 
(a) REAUTHORIZATION OF SPECIAL DIABETES PRO-
GRAMS FOR TYPE I DIABETES.—Section 330B(b)(2)(D) of 
the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(D)) 
is amended by striking ‘‘each of fiscal years 2018 and 2019’’ 
and inserting ‘‘fiscal years 2019 through 2023’’. 
(b) REAUTHORIZATION OF SPECIAL DIABETES PRO-
GRAMS FOR INDIANS FOR DIABETES SERVICES.—Section 
330C(c)(2)(D) of the Public Health Service Act (42 U.S.C. 
254c–3(c)(2)(D)) is amended by striking ‘‘fiscal years 2018 
and 2019’’ and inserting ‘‘fiscal years 2019 through 2023’’. 
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SEC. 103. EXTENSION OF PERSONAL RESPONSIBILITY EDU-
CATION PROGRAM. 
Section 513 of the Social Security Act (42 U.S.C. 713) 
is amended— 
(1) in paragraphs (1)(A) and (4)(A) of sub-
section (a), by striking ‘‘2019’’ and inserting ‘‘2023’’ 
each place it appears; 
(2) in subsection (a)(4)(B)(i), by striking ‘‘2019’’ 
and inserting ‘‘2023’’; and 
(3) in subsection (f), by striking ‘‘2019’’ and in-
serting ‘‘2023’’. 
SEC. 104. EXTENSION OF SEXUAL RISK AVOIDANCE EDU-
CATION PROGRAM. 
Section 510 of the Social Security Act (42 U.S.C. 710) 
is amended by striking ‘‘fiscal years 2018 and 2019’’ each 
place it appears in subsections (a)(1), (a)(2)(A), (f)(1) and 
(f)(2) and inserting ‘‘fiscal years 2019 through 2023’’. 
TITLE II—MEDICARE 
EXTENDERS 
SEC. 201. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR UNDER THE MEDICARE PROGRAM. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘2020’’ 
and inserting ‘‘2023’’. 
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SEC. 202. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH INSUR-
ANCE PROGRAMS.—Subsection (a)(1)(B) of section 119 of 
the Medicare Improvements for Patients and Providers Act 
of 2008 (42 U.S.C. 1395b–3 note), as amended by section 
3306 of the Patient Protection and Affordable Care Act 
(Public Law 111–148), section 610 of the American Tax-
payer Relief Act of 2012 (Public Law 112–240), section 
1110 of the Pathway for SGR Reform Act of 2013 (Public 
Law 113–67), section 110 of the Protecting Access to Medi-
care Act of 2014 (Public Law 113–93), section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 
(Public Law 114–10), and section 50207 of the Bipartisan 
Budget Act of 2018 (Public Law 115–123), is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $15,000,000.’’. 
(b) ADDITIONAL FUNDING FOR AREA AGENCIES ON 
AGING.—Subsection (b)(1)(B) of such section 119, as so 
amended, is amended— 
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(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $15,000,000.’’. 
(c) ADDITIONAL FUNDING FOR AGING AND DISABILITY 
RESOURCE CENTERS.—Subsection (c)(1)(B) of such section 
119, as so amended, is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $5,000,000.’’. 
(d) ADDITIONAL FUNDING FOR CONTRACT WITH THE 
NATIONAL CENTER FOR BENEFITS AND OUTREACH EN-
ROLLMENT.—Subsection (d)(2) of such section 119, as so 
amended, is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
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(3) in clause (ix), by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following 
new clause: 
‘‘(x) for each of fiscal years 2020 
through 2022, of $15,000,000.’’. 
SEC. 203. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, 
INPUT, 
AND 
SELECTION 
UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1890(d)(2) of the Social Se-
curity Act (42 U.S.C. 1395aaa(d)(2)) is amended— 
(1) by striking ‘‘and $7,500,000’’ and inserting 
‘‘$7,500,000’’; and 
(2) by striking ‘‘and 2019.’’ and inserting ‘‘and 
2019, and $30,000,000 for each of fiscal years 2020 
through 2022.’’. 
(b) INPUT
FOR REMOVAL
OF MEASURES.—Section 
1890(b) of the Social Security Act (42 U.S.C. 1395aaa(b)) 
is amended by inserting after paragraph (3) the following: 
‘‘(4) REMOVAL OF MEASURES.—The entity may, 
through the multistakeholder groups convened under 
paragraph (7)(A), provide input to the Secretary on 
quality and efficiency measures described in para-
graph (7)(B) that could be considered for removal.’’. 
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(c) PRIORITIZATION OF MEASURE ENDORSEMENT.— 
Section 1890(b) of the Social Security Act (42 U.S.C. 
1395aaa(b)), as amended by subsection (b), is further 
amended by adding at the end the following: 
‘‘(9) PRIORITIZATION
OF
MEASURE
ENDORSE-
MENT.—The entity— 
‘‘(A) during the period beginning on the 
date of the enactment of this paragraph and end-
ing on December 31, 2023, shall prioritize the 
endorsement of measures relating to maternal 
morbidity and mortality by the entity with a 
contract under subsection (a) in connection with 
endorsement of measures described in paragraph 
(2); and 
‘‘(B) on and after January 1, 2024, may 
prioritize the endorsement of such measures by 
such entity.’’. 
SEC. 204. EXTENSION OF THE INDEPENDENCE AT HOME 
MEDICAL PRACTICE DEMONSTRATION PRO-
GRAM UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1866E(e)(1) of the Social 
Security Act (42 U.S.C. 1395cc–5(e)(1)) is amended by 
striking ‘‘7-year’’ and inserting ‘‘10-year’’. 
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(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect as if included in the enactment 
of Public Law 111–148. 
SEC. 205. EXTENSION OF APPROPRIATIONS AND TRANS-
FERS TO THE PATIENT-CENTERED OUTCOMES 
RESEARCH TRUST FUND; EXTENSION OF CER-
TAIN HEALTH INSURANCE FEES. 
(a) IN GENERAL.— 
(1) INTERNAL REVENUE CODE.—Section 9511 of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (b)(1)(E), by striking 
‘‘2014’’ and all that follows through ‘‘2019’’ and 
inserting ‘‘2014 through 2022’’; 
(B) in subsection (d)(2)(A), by striking 
‘‘2019’’ and inserting ‘‘2022’’; and 
(C) in subsection (f), by striking ‘‘2019’’ 
and inserting ‘‘2022’’. 
(2) TITLE XI.—Section 1183(a)(2) of the Social 
Security Act (42 U.S.C. 1320e–2(a)(2)) is amended 
by striking ‘‘2014’’ and all that follows through 
‘‘2019’’ and inserting ‘‘2014 through 2022’’. 
(b) EXTENSION
OF CERTAIN HEALTH INSURANCE 
FEES.— 
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(1) HEALTH
INSURANCE
POLICIES.—Section 
4375(e) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘2019’’ and inserting ‘‘2022’’. 
(2) SELF-INSURED
HEALTH
PLANS.—Section 
4376(e) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘2019’’ and inserting ‘‘2022’’. 
SEC. 206. TRANSITIONAL COVERAGE AND RETROACTIVE 
MEDICARE PART D COVERAGE FOR CERTAIN 
LOW-INCOME BENEFICIARIES. 
Section 1860D–14 of the Social Security Act (42 
U.S.C. 1395w–114) is amended— 
(1) by redesignating subsection (e) as subsection 
(f); and 
(2) by adding after subsection (d) the following 
new subsection: 
‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSITION 
PROGRAM.— 
‘‘(1) IN
GENERAL.—Beginning not later than 
January 1, 2021, the Secretary shall carry out a pro-
gram to provide transitional coverage for covered part 
D drugs for LI NET eligible individuals in accord-
ance with this subsection. 
‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 
For purposes of this subsection, the term ‘LI NET eli-
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gible individual’ means a part D eligible individual 
who— 
‘‘(A) meets the requirements of clauses (ii) 
and (iii) of subsection (a)(3)(A); and 
‘‘(B) has not yet enrolled in a prescription 
drug plan or an MA–PD plan, or, who has so 
enrolled, but with respect to whom coverage 
under such plan has not yet taken effect. 
‘‘(3) TRANSITIONAL COVERAGE.—For purposes of 
this subsection, the term ‘transitional coverage’ 
means, with respect to an LI NET eligible indi-
vidual— 
‘‘(A) immediate access to covered part D 
drugs at the point of sale during the period that 
begins on the first day of the month such indi-
vidual is determined to meet the requirements of 
clauses (ii) and (iii) of subsection (a)(3)(A) and 
ends on the date that coverage under a prescrip-
tion drug plan or MA–PD plan takes effect with 
respect to such individual; and 
‘‘(B) in the case of an LI NET eligible indi-
vidual who is a full-benefit dual eligible indi-
vidual (as defined in section 1935(c)(6)) or a re-
cipient of supplemental security income benefits 
under title XVI, retroactive coverage (in the form 
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of reimbursement of the amounts that would 
have been paid under this part had such indi-
vidual been enrolled in a prescription drug plan 
or MA–PD plan) of covered part D drugs pur-
chased by such individual during the period that 
begins on the date that is the later of— 
‘‘(i) the date that such individual was 
first eligible for a low-income subsidy under 
this part; or 
‘‘(ii) the date that is 36 months prior 
to the date such individual enrolls in a pre-
scription drug plan or MA–PD plan, 
and ends on the date that coverage under such 
plan takes effect. 
‘‘(4) PROGRAM ADMINISTRATION.— 
‘‘(A) SINGLE POINT OF CONTACT.—The Sec-
retary shall, to the extent feasible, administer the 
program under this subsection through a con-
tract with a single program administrator. 
‘‘(B) BENEFIT
DESIGN.—The Secretary 
shall ensure that the transitional coverage pro-
vided to LI NET eligible individuals under this 
subsection— 
‘‘(i) provides access to all covered part 
D drugs under an open formulary; 
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‘‘(ii) permits all pharmacies deter-
mined by the Secretary to be in good stand-
ing to process claims under the program; 
‘‘(iii) is consistent with such require-
ments as the Secretary considers necessary 
to improve patient safety and ensure appro-
priate dispensing of medication; and 
‘‘(iv) meets such other requirements as 
the Secretary may establish. 
‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF 
THIS TITLE; WAIVER AUTHORITY.— 
‘‘(A) IN
GENERAL.—The following provi-
sions shall not apply with respect to the program 
under this subsection: 
‘‘(i) Paragraphs (1) and (3)(B) of sec-
tion 1860D–4(a) (relating to dissemination 
of general information; availability of infor-
mation on changes in formulary through 
the internet). 
‘‘(ii) Subparagraphs (A) and (B) of 
section 1860D–4(b)(3) (relating to require-
ments on development and application of 
formularies; formulary development). 
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‘‘(iii) Paragraphs (1)(C) and (2) of 
section 1860D–4(c) (relating to medication 
therapy management program). 
‘‘(B) WAIVER AUTHORITY.—The Secretary 
may waive such other requirements of titles XI 
and this title as may be necessary to carry out 
the purposes of the program established under 
this subsection.’’. 
SEC. 207. HEALTH EQUITY AND ACCESS FOR RETURNING 
TROOPS AND SERVICEMEMBERS ACT OF 2019. 
(a) MODIFICATION OF REQUIREMENT FOR CERTAIN 
FORMER MEMBERS OF THE ARMED FORCES TO ENROLL 
IN MEDICARE PART B TO BE ELIGIBLE FOR TRICARE 
FOR LIFE.— 
(1) TRICARE ELIGIBILITY.— 
(A) IN GENERAL.—Subsection (d) of section 
1086 of title 10, United States Code, is amended 
by adding at the end the following new para-
graph: 
‘‘(6)(A) The requirement in paragraph (2)(A) to enroll 
in the supplementary medical insurance program under 
part B of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) shall not apply to a person described in sub-
paragraph (B) during any month in which such person is 
not entitled to a benefit described in subparagraph (A) of 
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section 226(b)(2) of the Social Security Act (42 U.S.C. 
426(b)(2)) if such person has received the counseling and 
information under subparagraph (C). 
‘‘(B) A person described in this subparagraph is a per-
son— 
‘‘(i) who is under 65 years of age; 
‘‘(ii) who is entitled to hospital insurance bene-
fits under part A of title XVIII of the Social Security 
Act pursuant to subparagraph (A) or (C) of section 
226(b)(2) of such Act (42 U.S.C. 426(b)(2)); 
‘‘(iii) whose entitlement to a benefit described in 
subparagraph (A) of such section has terminated due 
to performance of substantial gainful activity; and 
‘‘(iv) who is retired under chapter 61 of this 
title. 
‘‘(C) The Secretary of Defense shall coordinate with 
the Secretary of Health and Human Services and the Com-
missioner of Social Security to notify persons described in 
subparagraph (B) of, and provide information and coun-
seling regarding, the effects of not enrolling in the supple-
mentary medical insurance program under part B of title 
XVIII of the Social Security Act (42 U.S.C. 1395j et seq.), 
as described in subparagraph (A).’’. 
(B) CONFORMING AMENDMENT.—Paragraph 
(2)(A) of such subsection is amended by striking 
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‘‘is enrolled’’ and inserting ‘‘except as provided 
by paragraph (6), is enrolled’’. 
(C) IDENTIFICATION OF PERSONS.—Section 
1110a of such title is amended by adding at the 
end the following new subsection: 
‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN-
ROLL IN MEDICARE PART B.—In carrying out subsection 
(a), the Secretary of Defense shall coordinate with the Sec-
retary of Health and Human Services and the Commis-
sioner of Social Security to— 
‘‘(1) identify persons described in subparagraph 
(B) of section 1086(d)(6) of this title; and 
‘‘(2) provide information and counseling pursu-
ant to subparagraph (C) of such section.’’. 
(2) NON-APPLICATION
OF
MEDICARE
PART
B 
LATE ENROLLMENT PENALTY.—Section 1839(b) of the 
Social Security Act (42 U.S.C. 1395r(b)) is amended, 
in the second sentence, by inserting ‘‘or months for 
which the individual can demonstrate that the indi-
vidual is an individual described in paragraph 
(6)(B) of section 1086(d) of title 10, United States 
Code, who is enrolled in the TRICARE program pur-
suant to such section’’ after ‘‘an individual described 
in section 1837(k)(3)’’. 
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(3) REPORT.—Not later than October 1, 2024, 
the Secretary of Defense, the Secretary of Health and 
Human Services, and the Commissioner of Social Se-
curity shall jointly submit to the Committees on 
Armed Services of the House of Representatives and 
the Senate, the Committee on Ways and Means and 
the Committee on Energy and Commerce of the House 
of Representatives, and the Committee on Finance of 
the Senate a report on the implementation of section 
1086(d)(6) of title 10, United States Code, as added 
by paragraph (1). Such report shall include, with re-
spect to the period covered by the report— 
(A) the number of individuals enrolled in 
TRICARE for Life who are not enrolled in the 
supplementary 
medical 
insurance 
program 
under part B of title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395j et seq.) by reason of 
such section 1086(d)(6); and 
(B) the number of individuals who— 
(i) are retired from the Armed Forces 
under chapter 61 of title 10, United States 
Code; 
(ii) are entitled to hospital insurance 
benefits under part A of title XVIII of the 
Social Security Act pursuant to receiving 
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benefits for 24 months as described in sub-
paragraph (A) or (C) of section 226(b)(2) of 
such Act (42 U.S.C. 426(b)(2)); and 
(iii) because of such entitlement, are no 
longer enrolled in TRICARE Standard, 
TRICARE Prime, TRICARE Extra, or 
TRICARE Select under chapter 55 of title 
10, United States Code. 
(4) DEPOSIT OF SAVINGS INTO MEDICARE IM-
PROVEMENT FUND.—Section 1898(b)(1) of the Social 
Security Act (42 U.S.C. 1395iii(b)(1)) is amended by 
striking ‘‘during and after fiscal year 2021, $0’’ and 
inserting ‘‘during and after fiscal year 2024, 
$5,000,000’’. 
(5) APPLICATION.—The amendments made by 
paragraphs (1) and (2) shall apply with respect to a 
person who, on or after October 1, 2023, is a person 
described in section 1086(d)(6)(B) of title 10, United 
States Code, as added by paragraph (1). 
(b) COVERAGE OF CERTAIN DNA SPECIMEN PROVE-
NANCE ASSAY TESTS UNDER MEDICARE.— 
(1) BENEFIT.— 
(A) COVERAGE.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended— 
(i) in subsection (s)(2)— 
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(ii) in subparagraph (P), by striking 
the semicolon at the end and inserting ‘‘, 
and’’; and 
(iii) by adding at the end the following 
new subparagraph: 
‘‘(Q) in the case of a prostate cancer DNA Speci-
men Provenance Assay test (DSPA test) (as defined 
in section 1861(kkk)), unless such test is furnished on 
or after January 1, 2021, and before January 1, 
2026, and such test is ordered by the physician who 
furnished the prostate cancer biopsy that obtained the 
specimen tested;’’. 
(2) PAYMENT AMOUNT AND RELATED REQUIRE-
MENTS.—Section 1834 of the Social Security Act (42 
U.S.C. 1395m) is amended by adding at the end the 
following new subsection: 
‘‘(x) PROSTATE CANCER DNA SPECIMEN PROVENANCE 
ASSAY TESTS.— 
‘‘(1) PAYMENT FOR COVERED TESTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the payment amount for a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(kkk)) 
shall be $200. Such payment shall be payment 
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for all of the specimens obtained from the biopsy 
furnished to an individual that are tested. 
‘‘(B) LIMITATION.—Payment for a DSPA 
test under subparagraph (A) may only be made 
on an assignment-related basis. 
‘‘(C) PROHIBITION
ON
SEPARATE
PAY-
MENT.—No separate payment shall be made for 
obtaining DNA that was separately taken from 
an individual at the time of a biopsy described 
in subparagraph (A). 
‘‘(2) HCPCS CODE
AND
MODIFIER
ASSIGN-
MENT.— 
‘‘(A) IN GENERAL.—The Secretary shall as-
sign one or more HCPCS codes to a prostate 
cancer DNA Specimen Provenance Assay test 
and may use a modifier to facilitate making 
payment under this section for such test. 
‘‘(B) IDENTIFICATION
OF
DNA
MATCH
ON 
CLAIM.—The Secretary shall require an indica-
tion on a claim for a prostate cancer DNA Spec-
imen Provenance Assay test of whether the DNA 
of the prostate biopsy specimens match the DNA 
of the individual diagnosed with prostate cancer. 
Such indication may be made through use of a 
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HCPCS code, a modifier, or other means, as de-
termined appropriate by the Secretary. 
‘‘(3) DNA MATCH REVIEW.— 
‘‘(A) IN GENERAL.—The Secretary shall re-
view at least three years of claims under part B 
for prostate cancer DNA Specimen Provenance 
Assay tests to identify whether the DNA of the 
prostate biopsy specimens match the DNA of the 
individuals diagnosed with prostate cancer. 
‘‘(B) POSTING ON INTERNET WEBSITE.—Not 
later than July 1, 2023, the Secretary shall post 
on the internet website of the Centers for Medi-
care & Medicaid Services the findings of the re-
view conducted under subparagraph (A).’’. 
(3) COST-SHARING.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and (CC)’’ and inserting 
‘‘(CC)’’; and 
(B) by inserting before the semicolon at the 
end the following: ‘‘, and (DD) with respect to 
a prostate cancer DNA Specimen Provenance 
Assay test (DSPA test) (as defined in section 
1861(kkk)), the amount paid shall be an amount 
equal to 80 percent of the lesser of the actual 
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charge for the test or the amount specified under 
section 1834(x)’’. 
SEC. 208. EXCLUSION OF COMPLEX REHABILITATIVE MAN-
UAL WHEELCHAIRS FROM MEDICARE COM-
PETITIVE ACQUISITION PROGRAM; NON-AP-
PLICATION OF MEDICARE FEE-SCHEDULE AD-
JUSTMENTS FOR CERTAIN WHEELCHAIR AC-
CESSORIES AND CUSHIONS. 
(a) EXCLUSION OF COMPLEX REHABILITATIVE MAN-
UAL WHEELCHAIRS FROM COMPETITIVE ACQUISITION PRO-
GRAM.—Section 1847(a)(2)(A) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(2)(A)) is amended— 
(1) by inserting ‘‘, complex rehabilitative man-
ual wheelchairs (as determined by the Secretary), and 
certain manual wheelchairs (identified, as of October 
1, 2018, by HCPCS codes E1235, E1236, E1237, 
E1238, and K0008 or any successor to such codes)’’ 
after ‘‘group 3 or higher’’; and 
(2) by striking ‘‘such wheelchairs’’ and inserting 
‘‘such complex rehabilitative power wheelchairs, com-
plex rehabilitative manual wheelchairs, and certain 
manual wheelchairs’’. 
(b) NON-APPLICATION OF MEDICARE FEE SCHEDULE 
ADJUSTMENTS FOR WHEELCHAIR ACCESSORIES AND SEAT 
AND BACK CUSHIONS WHEN FURNISHED IN CONNECTION 
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WITH
COMPLEX
REHABILITATIVE
MANUAL
WHEEL-
CHAIRS.— 
(1) IN
GENERAL.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services shall not, during the period beginning on 
January 1, 2020, and ending on December 31, 2020, 
use information on the payment determined under the 
competitive acquisition programs under section 1847 
of the Social Security Act (42 U.S.C. 1395w–3) to ad-
just the payment amount that would otherwise be rec-
ognized under section 1834(a)(1)(B)(ii) of such Act 
(42 U.S.C. 1395m(a)(1)(B)(ii)) for wheelchair acces-
sories (including seating systems) and seat and back 
cushions when furnished in connection with complex 
rehabilitative manual wheelchairs (as determined by 
the Secretary), and certain manual wheelchairs (iden-
tified, as of October 1, 2018, by HCPCS codes E1235, 
E1236, E1237, E1238, and K0008 or any successor 
to such codes). 
(2) 
IMPLEMENTATION.—Notwithstanding 
any 
other provision of law, the Secretary may implement 
this subsection by program instruction or otherwise. 
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TITLE III—MEDICAID 
PROVISIONS 
SEC. 301. MODIFICATION OF REDUCTIONS IN MEDICAID 
DSH ALLOTMENTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘2020’’ and inserting ‘‘2022’’; 
and 
(2) in clause (ii)— 
(A) in subclause (I), by striking ‘‘2020’’ 
and inserting ‘‘2022’’; and 
(B) in subclause (II), by striking ‘‘for each 
of fiscal years 2021 through 2025’’ and inserting 
‘‘for each of fiscal years 2023 through 2025’’. 
SEC. 302. PUBLIC AVAILABILITY OF HOSPITAL UPPER PAY-
MENT LIMIT DEMONSTRATIONS. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
‘‘(bb) PUBLIC AVAILABILITY
OF HOSPITAL UPPER 
PAYMENT LIMIT DEMONSTRATIONS.—The Secretary shall 
make publicly available upper payment limit demonstra-
tions for hospital services that a State submits with respect 
to a fiscal year of the State (beginning with State fiscal 
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year 2022) to the Administrator of the Centers for Medicare 
& Medicaid Services.’’. 
SEC. 303. REPORT BY COMPTROLLER GENERAL. 
Not later than the date that is 21 months after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall identify and report to Congress 
policy considerations for legislative action with respect to 
establishing an equitable formula for determining dis-
proportionate share hospital allotments for States under 
section 1923 of the Social Security Act (42 U.S.C. 1396r– 
4) that takes into account the following factors: 
(1) The level of uncompensated care costs of hos-
pitals in a State. 
(2) Expenditures of a State with respect to hos-
pitals, including payment adjustments made under 
such section 1923 to disproportionate share hospitals 
(as defined under the State plan under title XIX of 
such Act (42 U.S.C. 1396 et seq.) pursuant to sub-
section (a)(1)(A) of such section 1923), upper pay-
ment limit supplemental payments, and other related 
payments that hospitals may receive from the State. 
(3) State policy decisions that may affect the 
level of uncompensated care costs of hospitals in a 
State. 
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SEC. 304. SENSE OF CONGRESS REGARDING THE NEED TO 
DEVELOP A MORE PERMANENT LEGISLATIVE 
SOLUTION TO PROVIDE THE TERRITORIES 
WITH A RELIABLE AND CONSISTENT SOURCE 
OF FEDERAL FUNDING UNDER THE MEDICAID 
PROGRAM. 
It is the sense of Congress that— 
(1) the territories of American Samoa, the Com-
monwealth of the Northern Mariana Islands, Guam, 
Puerto Rico, and the United States Virgin Islands are 
currently subject to Federal funding caps for their 
Medicaid programs; 
(2) as a result of these Federal funding caps, 
which have not been adjusted over time, the territories 
continue to struggle in managing their Medicaid pro-
grams, including planning for their respective finan-
cial obligations and managing health care services for 
low-income adults, children, pregnant women, elderly 
adults, and persons with disabilities; 
(3) to address this disparate funding treatment 
and to provide the territories with some measure of 
relief, Congress has had to enact legislation six times 
in the last 15 years, including multiple temporary in-
creases in the Federal funding caps, higher Federal 
medical assistance percentage rates, and billions of 
dollars in supplemental block grants; 
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(4) the supplemental funding provided to the ter-
ritories under title V with respect to their Medicaid 
programs continues Congress’ commitment to ensur-
ing the sustainability of these critically important 
programs and the people these programs serve; and 
(5) a more permanent legislative solution must 
be developed in order to provide the territories with 
a reliable and consistent source of Federal funding 
under their Medicaid programs so that the territories 
can continue to meet the health care needs of vulner-
able populations. 
TITLE IV—NO SURPRISES ACT 
SEC. 401. SHORT TITLE. 
This title may be cited as the ‘‘No Surprises Act’’. 
SEC. 402. PREVENTING SURPRISE MEDICAL BILLS. 
(a) COVERAGE OF EMERGENCY SERVICES.—Section 
2719A(b) of the Public Health Service Act (42 U.S.C. 
300gg–19a(b)) is amended— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A)— 
(i) by striking ‘‘a group health plan, or 
a health insurance issuer offering group or 
individual health insurance issuer,’’ and in-
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serting ‘‘a health plan (as defined in sub-
section (e)(2)(A))’’; 
(ii) by inserting ‘‘or, for plan year 
2021 or a subsequent plan year, with re-
spect to emergency services in an inde-
pendent freestanding emergency department 
(as defined in paragraph (3)(D))’’ after 
‘‘emergency department of a hospital’’; 
(iii) by striking ‘‘the plan or issuer’’ 
and inserting ‘‘the plan’’; and 
(iv) by striking ‘‘paragraph (2)(B)’’ 
and inserting ‘‘paragraph (3)(C)’’; 
(B) in subparagraph (B), by inserting ‘‘or 
a participating emergency facility, as applica-
ble,’’ after ‘‘participating provider’’; and 
(C) in subparagraph (C)— 
(i) in the matter preceding clause (i), 
by inserting ‘‘by a nonparticipating pro-
vider or a nonparticipating emergency fa-
cility’’ after ‘‘enrollee’’; 
(ii) by striking clause (i); 
(iii) by striking ‘‘(ii)(I) such services’’ 
and inserting ‘‘(i) such services’’; 
(iv) by striking ‘‘where the provider of 
services does not have a contractual rela-
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tionship with the plan for the providing of 
services’’; 
(v) by striking ‘‘emergency department 
services received from providers who do have 
such a contractual relationship with the 
plan; and’’ and inserting ‘‘emergency serv-
ices received from participating providers 
and participating emergency facilities with 
respect to such plan;’’; 
(vi) by striking ‘‘(II) if such services’’ 
and all that follows through ‘‘were provided 
in-network;’’ and inserting the following: 
‘‘(ii) the cost-sharing requirement (ex-
pressed as a copayment amount or coinsur-
ance rate) is not greater than the require-
ment that would apply if such services were 
provided by a participating provider or a 
participating emergency facility;’’; and 
(vii) by adding at the end the following 
new clauses: 
‘‘(iii) such requirement is calculated as 
if the total amount that would have been 
charged for such services by such partici-
pating provider or participating emergency 
facility were equal to— 
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‘‘(I) in the case of such services 
furnished in a State described in para-
graph (3)(H)(ii), the median con-
tracted rate (as defined in paragraph 
(3)(E)(i)) for such services; and 
‘‘(II) in the case of such services 
furnished in a State described in para-
graph (3)(H)(i), the lesser of— 
‘‘(aa) the amount determined 
by such State for such services in 
accordance with the method de-
scribed in such paragraph; and 
‘‘(bb) the median contracted 
rate (as so defined) for such serv-
ices; 
‘‘(iv) the health plan pays to such pro-
vider or facility, respectively, the amount by 
which the recognized amount (as defined in 
paragraph (3)(H)) for such services exceeds 
the cost-sharing amount for such services 
(as determined in accordance with clauses 
(ii) and (iii)); and 
‘‘(v) any cost-sharing payments made 
by the participant, beneficiary, or enrollee 
with respect to such emergency services so 
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