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both Houses of Congress at least 30 days prior to any such 
action and an approval is issued by the Committees. 
SEC. 246. For funds provided to the Department of 
Veterans Affairs for each of fiscal year 2026 and 2027, sec-
tion 248 of division A of Public Law 114–223 shall apply. 
SEC. 247. (a) None of the funds appropriated or other-
wise made available by this Act may be used to conduct 
research commencing on or after July 1, 2025, that uses 
any canine, feline, or non-human primate unless the Sec-
retary of Veterans Affairs approves such research specifi-
cally and in writing pursuant to subsection (b). 
(b)(1) The Secretary of Veterans Affairs may approve 
the conduct of research commencing on or after July 1, 
2025, using canines, felines, or non-human primates if the 
Secretary certifies that— 
(A) the scientific objectives of the research can 
only be met by using such canines, felines, or non- 
human primates and cannot be met using other ani-
mal models, in vitro models, computational models, 
human clinical studies, or other research alternatives; 
(B) such scientific objectives are necessary to ad-
vance research benefiting veterans and are directly re-
lated to an illness or injury that is combat-related as 
defined by 10 U.S.C. 1413(e);
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(C) the research is consistent with the revised 
Department of Veterans Affairs canine research policy 
document dated December 15, 2017, including any 
subsequent revisions to such document; and 
(D) ethical considerations regarding minimizing 
the harm experienced by canines, felines, or non- 
human primates are included in evaluating the sci-
entific necessity of the research. 
(2) The Secretary may not delegate the authority 
under this subsection. 
(c) If the Secretary approves any new research pursu-
ant to subsection (b), not later than 30 days before the com-
mencement of such research, the Secretary shall submit to 
the Committees on Appropriations of the Senate and House 
of Representatives a report describing— 
(1) the nature of the research to be conducted 
using canines, felines, or non-human primates; 
(2) the date on which the Secretary approved the 
research; 
(3) the USDA pain category on the approved 
use; 
(4) the justification for the determination of the 
Secretary that the scientific objectives of such research 
could only be met using canines, felines, or non-
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human primates, and methods used to make such de-
termination; 
(5) the frequency and duration of such research; 
and 
(6) the protocols in place to ensure the necessity, 
safety, and efficacy of the research, and animal wel-
fare. 
(d) Not later than December 31, 2025, and biannually 
thereafter, the Secretary shall submit to such Committees 
a report describing— 
(1) any research being conducted by the Depart-
ment of Veterans Affairs using canines, felines, or 
non-human primates as of the date of the submittal 
of the report; 
(2) the circumstances under which such research 
was conducted using canines, felines, or non-human 
primates; 
(3) the justification for using canines, felines, or 
non-human primates to conduct such research; 
(4) the protocols in place to ensure the necessity, 
safety, and efficacy of such research; and 
(5) the development and adoption of alternatives 
to canines, felines, or non-human primate research. 
(e) Not later than December 31, 2025, and annually 
thereafter, the Department of Veterans Affairs must submit
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to voluntary U.S. Department of Agriculture inspections of 
canine, feline, and non-human primate research facilities. 
(f) Not later than December 31, 2025, and annually 
thereafter, the Secretary shall submit to such Committees 
a report describing— 
(1) any violations of the Animal Welfare Act, the 
Public Health Service Policy on Humane Care and 
Use of Laboratory Animals, or other Department of 
Veterans Affairs policies related to oversight of ani-
mal research found during that quarter in VA re-
search facilities; 
(2) immediate corrective actions taken; and 
(3) specific actions taken to prevent their recur-
rence. 
(g) The Department shall implement a plan under 
which the Secretary will eliminate the research conducted 
using canines, felines, or non-human primates by not later 
than September 20, 2026. 
SEC. 248. (a) The Secretary of Veterans Affairs may 
use amounts appropriated or otherwise made available in 
this title to ensure that the ratio of veterans to full-time 
employment equivalents within any program of rehabilita-
tion conducted under chapter 31 of title 38, United States 
Code, does not exceed 125 veterans to one full-time employ-
ment equivalent.
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(b) Not later than 180 days after the date of the enact-
ment of this Act, the Secretary shall submit to Congress a 
report on the programs of rehabilitation conducted under 
chapter 31 of title 38, United States Code, including— 
(1) an assessment of the veteran-to-staff ratio for 
each such program; and 
(2) recommendations for such action as the Sec-
retary considers necessary to reduce the veteran-to- 
staff ratio for each such program. 
SEC. 249. Amounts made available for the ‘‘Veterans 
Health Administration, Medical Community Care’’ account 
in this or any other Act for fiscal years 2026 and 2027 
may be used for expenses that would otherwise be payable 
from the Veterans Choice Fund established by section 802 
of the Veterans Access, Choice, and Accountability Act, as 
amended (38 U.S.C. 1701 note). 
SEC. 250. Obligations and expenditures applicable to 
the ‘‘Medical Services’’ account in fiscal years 2017 through 
2019 for aid to state homes (as authorized by section 1741 
of title 38, United States Code) shall remain in the ‘‘Med-
ical Community Care’’ account for such fiscal years. 
SEC. 251. Of the amounts made available for the De-
partment of Veterans Affairs for fiscal year 2026, in this 
or any other Act, under the ‘‘Veterans Health Administra-
tion—Medical Services’’, ‘‘Veterans Health Administra-
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tion—Medical Community Care’’, ‘‘Veterans Health Ad-
ministration—Medical Support and Compliance’’, ‘‘Vet-
erans Health Administration—Medical Facilities’’, and 
‘‘Cost 
of 
War 
Toxic 
Exposures 
Fund’’ 
accounts, 
$1,429,181,000 shall be made available for gender-specific 
care and programmatic efforts to deliver care for women 
veterans; $698,000,000 shall be made available for suicide 
prevention outreach programs; $3,500,000,000 shall be 
made available for the Caregivers program; $42,000,000 
shall be made available for the National Center for Post- 
Traumatic Stress Disorder; $80,000,000 shall be made 
available for the Neurology Centers of Excellence; 
$342,455,000 shall be made available for rural health care; 
$3,459,121,000 shall be made available for veterans’ home-
lessness programs; $6,356,000,000 shall be made available 
for telehealth for veterans; $709,573,000 shall be made 
available for opioid prevention and treatment programs; 
and, $31,997,000 shall be made available for the Intimate 
Partner Violence Assistance Program. 
SEC. 252. Of the unobligated balances available in fis-
cal year 2026 in the ‘‘Recurring Expenses Trans-
formational Fund’’ established in section 243 of division 
J of Public Law 114–113, and in addition to any funds 
otherwise made available for such purposes in this, prior, 
or subsequent fiscal years, $900,000,000 shall be available
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for constructing, altering, extending, and improving med-
ical facilities of the Veterans Health Administration, in-
cluding all supporting activities and required contin-
gencies, during the period of availability of the Fund: Pro-
vided, That prior to obligation of any of the funds provided 
in this section, the Secretary of Veterans Affairs must pro-
vide a plan for the execution of the funds appropriated in 
this section to the Committees on Appropriations of both 
Houses of Congress and such Committees issue an approval, 
or absent a response, a period of 30 days has elapsed. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 253. Of the $75,039,000,000 that became avail-
able on October 1, 2025, previously appropriated under the 
heading ‘‘Veterans Health Administration—Medical Serv-
ices’’ in the Full-Year Continuing Appropriations Act, 2025 
(division A of Public Law 119–4), $2,030,000,000 shall be 
transferred to ‘‘Veterans Health Administration—Medical 
Facilities’’. 
SEC. 254. Not later than 30 days after enactment of 
this Act, the Secretary shall submit to the Committees on 
Appropriations of both Houses of Congress an expenditure 
plan for funds made available in this Act and any available 
unobligated balances from prior Acts, including the Fiscal 
Responsibility Act of 2023 (Public Law 118–5), for the Cost 
of War Toxic Exposures Fund: Provided, That the budget
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† HR 5371 EAS 
resource categories supporting the Veterans Health Admin-
istration shall be reported by the subcategories ‘‘Medical 
Services’’, ‘‘Medical Community Care’’, ‘‘Medical Support 
and Compliance’’, and ‘‘Medical and Prosthetic Research’’: 
Provided further, That not later than 30 days after the end 
of each fiscal quarter, the Secretary shall submit a quarterly 
report on the status of the funds, including, at a minimum, 
an update on obligations by program, project or activity. 
SEC. 255. Any amounts transferred to the Secretary 
and administered by a corporation referred to in section 
7364(b) of title 38, United States Code, between October 1, 
2017 and September 30, 2018 for purposes of carrying out 
an order placed with the Department of Veterans Affairs 
pursuant to section 1535 of title 31, United States Code, 
that are available for obligation pursuant to section 
7364(b)(1) of title 38, United States Code, are to remain 
available for the liquidation of valid obligations incurred 
by such corporation during the period of performance of 
such order, provided that the Secretary of Veterans Affairs 
determines that such amounts need to remain available for 
such liquidation. 
SEC. 256. None of the funds in this or any other Act 
may be used to close Department of Veterans Affairs hos-
pitals, domiciliaries, or clinics, conduct an environmental 
assessment, or to diminish healthcare services at existing
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Veterans Health Administration medical facilities as part 
of a planned realignment of services until the Secretary 
provides to the Committees on Appropriations of both 
Houses of Congress a report including an analysis of how 
any such planned realignment of services will impact access 
to care for veterans living in rural or highly rural areas, 
including travel distances and transportation costs to access 
a Department medical facility and availability of local spe-
cialty and primary care. 
SEC. 257. Unobligated balances available under the 
headings ‘‘Construction, Major Projects’’ and ‘‘Construc-
tion, Minor Projects’’ may be obligated by the Secretary of 
Veterans Affairs for a facility pursuant to section 2(e)(1) 
of the Communities Helping Invest through Property and 
Improvements Needed for Veterans Act of 2016 (Public Law 
114–294; 38 U.S.C. 8103 note), as amended, to provide ad-
ditional funds or to fund an escalation clause under such 
section of such Act: Provided, That before such unobligated 
balances are obligated pursuant to this section, the Sec-
retary of Veterans Affairs shall request from the Committees 
on Appropriations of both Houses of Congress the authority 
to obligate such unobligated balances and such Committees 
issue an approval, or absent a response, a period of 30 days 
has elapsed: Provided further, That the request to obligate 
such unobligated balances must provide Congress notice
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that the entity described in section 2(a)(2) of Public Law 
114–294, as amended, has exhausted available cost contain-
ment approaches as set forth in the agreement under section 
2(c) of such Public Law. 
SEC. 258. (a) None of the funds appropriated by this 
Act or otherwise made available for fiscal year 2026 for the 
Department of Veterans Affairs may be obligated, awarded, 
or expended to procure or purchase covered information 
technology equipment in cases where the manufacturer, bid-
der, or offeror, or any subsidiary or parent entity of the 
manufacturer, bidder, or offeror, of the equipment is an en-
tity, or parent company of an entity listed on any of the 
following: 
(1) the Department of Defense’s Chinese Military 
Company List; 
(2) the Department of the Treasury’s Non-SDN 
Chinese Military Industrial Complex Companies List; 
(3) the Department of Commerce’s Denied Per-
sons List, Entity List, or Military End User List, if 
the entity is— 
(A) an agency or instrumentality of the 
People’s Republic of China; 
(B) an entity headquartered in the People’s 
Republic of China; or
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(C) directly or indirectly owned or con-
trolled by an agency, instrumentality, or entity 
described in subparagraph (A) or (B); or 
(4) the Department of Homeland Security’s 
Uyghur Forced Labor Prevention Act Entity List. 
(b) APPLICABILITY TO THIRD PARTIES.—The prohibi-
tion in subsection (a) also applies in cases in which the 
Secretary has contracted with a third party for the procure-
ment, purchase, or expenditure of funds on any of the equip-
ment and software described in such subsection. 
(c) DEFINITION.—For purposes of this section, the 
term ‘‘covered information technology equipment’’ shall 
mean the following equipment used in an office environ-
ment: 
computers, 
printers, 
or 
interoperable 
videoconferencing equipment used in or by the Department 
of Veterans Affairs directly. ‘‘Covered information tech-
nology equipment’’ shall not refer to services that use such 
equipment, including cloud services. 
SEC. 259. During the period beginning on October 1, 
2025 and ending on September 30, 2026, none of the funds 
made available by this Act may be used to administer, im-
plement, or enforce the final rule issued by the Secretary 
of Veterans Affairs relating to ‘‘Change in Rates VA Pays 
for Special Modes of Transportation’’ (88 Fed. Reg. 10032) 
and published on February 16, 2023.
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SEC. 260. None of the funds appropriated or otherwise 
made available by this Act may be used to pay award or 
incentive fees for contractors whose performance has been 
judged to be below satisfactory, behind schedule, over budget, 
or has failed to meet the basic requirements of a contract, 
unless the Agency determines that any such deviations are 
due to unforeseeable events, government-driven scope 
changes, or are not significant within the overall scope of 
the project and/or program and unless such awards or in-
centive fees are consistent with section 16.401(e)(2) of the 
Federal Acquisition Regulation. 
SEC. 261. The Department is directed to maintain 
staffing levels to facilitate the Department’s own goals, in-
cluding that benefits claims are adjudicated according to 
the 125 day goal, and that healthcare appointments and 
service are provided in the timeframes required by statute 
and regulation. 
SEC. 262. The Department is directed to provide quar-
terly briefings to the Committees on Appropriations of both 
Houses of Congress on the status of implementation of the 
provisions in Public Law 118–42 related to veterans in the 
Freely Associated States (FAS) in a way that is consistent 
with Congressional intent, including engagement with FAS 
governments, a projected timeline for veterans in the FAS
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† HR 5371 EAS 
to receive hospital care and medical services, and an esti-
mate of the cost of implementation. 
SEC. 263. None of the amounts appropriated by this 
title may be obligated or expended to cancel a contract with 
a value that exceeds $10,000,000 until the Secretary of Vet-
erans Affairs has submitted to the Committees on Appro-
priations of both Houses of Congress an advance notifica-
tion and written explanation of contingency plans to re-
place the relevant service being cancelled, including any 
necessary change in the Department’s staffing levels. 
SEC. 264. None of the funds made available by this 
Act may be used to reduce the staffing, hours of operation, 
or services of the Veterans Crisis Line or any other suicide 
prevention program of the Department of Veterans Affairs. 
TITLE III 
RELATED AGENCIES 
AMERICAN BATTLE MONUMENTS COMMISSION 
SALARIES AND EXPENSES 
For necessary expenses, not otherwise provided for, of 
the American Battle Monuments Commission, including the 
acquisition of land or interest in land in foreign countries; 
purchases and repair of uniforms for caretakers of national 
cemeteries and monuments outside of the United States and 
its territories and possessions; rent of office and garage 
space in foreign countries; purchase (one-for-one replace-
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† HR 5371 EAS 
ment basis only) and hire of passenger motor vehicles; not 
to exceed $15,000 for official reception and representation 
expenses; and insurance of official motor vehicles in foreign 
countries, when required by law of such countries, 
$110,000,000, to remain available until expended. 
FOREIGN CURRENCY FLUCTUATIONS ACCOUNT 
For necessary expenses, not otherwise provided for, of 
the American Battle Monuments Commission, such sums as 
may be necessary, to remain available until expended, for 
purposes authorized by section 2109 of title 36, United 
States Code. 
UNITED STATES COURT OF APPEALS FOR VETERANS 
CLAIMS 
SALARIES AND EXPENSES 
For necessary expenses for the operation of the United 
States Court of Appeals for Veterans Claims as authorized 
by sections 7251 through 7298 of title 38, United States 
Code, $49,000,000, of which $3,000,000 shall be available 
until September 30, 2027: Provided, That $4,256,000 shall 
be available for the purpose of providing financial assist-
ance as described and in accordance with the process and 
reporting procedures set forth under this heading in Public 
Law 102–229.
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DEPARTMENT OF DEFENSE—CIVIL 
CEMETERIAL EXPENSES, ARMY 
SALARIES AND EXPENSES 
For necessary expenses for maintenance, operation, 
and improvement of Arlington National Cemetery and Sol-
diers’ and Airmen’s Home National Cemetery, including 
the purchase or lease of passenger motor vehicles for replace-
ment on a one-for-one basis only, and not to exceed $2,000 
for 
official 
reception 
and 
representation 
expenses, 
$118,780,450, of which not to exceed $15,000,000 shall re-
main available until September 30, 2028. In addition, such 
sums as may be necessary for parking maintenance, repairs 
and replacement, to be derived from the ‘‘Lease of Depart-
ment of Defense Real Property for Defense Agencies’’ ac-
count. 
ARMED FORCES RETIREMENT HOME 
TRUST FUND 
For expenses necessary for the Armed Forces Retire-
ment Home to operate and maintain the Armed Forces Re-
tirement Home—Washington, District of Columbia, and the 
Armed Forces Retirement Home—Gulfport, Mississippi, to 
be paid from funds available in the Armed Forces Retire-
ment Home Trust Fund, $80,000,000, to remain available 
until September 30, 2027, of which $2,072,000 shall remain 
available until expended for construction and renovation of
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† HR 5371 EAS 
the physical plants at the Armed Forces Retirement 
Home—Washington, District of Columbia, and the Armed 
Forces Retirement Home—Gulfport, Mississippi: Provided, 
That of the amounts made available under this heading 
from funds available in the Armed Forces Retirement Home 
Trust Fund, $27,000,000 shall be paid from the general 
fund of the Treasury to the Trust Fund. 
ADMINISTRATIVE PROVISION 
SEC. 301. Amounts deposited into the special account 
established under 10 U.S.C. 7727 are appropriated and 
shall be available until expended to support activities at 
the Army National Military Cemeteries. 
TITLE IV 
GENERAL PROVISIONS 
SEC. 401. No part of any appropriation contained in 
this Act shall remain available for obligation beyond the 
current fiscal year unless expressly so provided herein. 
SEC. 402. None of the funds made available in this 
Act may be used for any program, project, or activity, when 
it is made known to the Federal entity or official to which 
the funds are made available that the program, project, or 
activity is not in compliance with any Federal law relating 
to risk assessment, the protection of private property rights, 
or unfunded mandates.
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SEC. 403. All departments and agencies funded under 
this Act are encouraged, within the limits of the existing 
statutory authorities and funding, to expand their use of 
‘‘E-Commerce’’ technologies and procedures in the conduct 
of their business practices and public service activities. 
SEC. 404. Unless stated otherwise, all reports and noti-
fications required by this Act shall be submitted to the Sub-
committee on Military Construction and Veterans Affairs, 
and Related Agencies of the Committee on Appropriations 
of the House of Representatives and the Subcommittee on 
Military Construction and Veterans Affairs, and Related 
Agencies of the Committee on Appropriations of the Senate. 
SEC. 405. None of the funds made available in this 
Act may be transferred to any department, agency, or in-
strumentality of the United States Government except pur-
suant to a transfer made by, or transfer authority provided 
in, this or any other appropriations Act. 
SEC. 406. None of the funds made available in this 
Act may be used for a project or program named for an 
individual serving as a Member, Delegate, or Resident Com-
missioner of the United States House of Representatives. 
SEC. 407. (a) Any agency receiving funds made avail-
able in this Act, shall, subject to subsections (b) and (c), 
post on the public Web site of that agency any report re-
quired to be submitted by the Congress in this or any other
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† HR 5371 EAS 
Act, upon the determination by the head of the agency that 
it shall serve the national interest. 
(b) Subsection (a) shall not apply to a report if— 
(1) the public posting of the report compromises 
national security; or 
(2) the report contains confidential or propri-
etary information. 
(c) The head of the agency posting such report shall 
do so only after such report has been made available to the 
requesting Committee or Committees of Congress for no less 
than 45 days. 
SEC. 408. (a) None of the funds made available in this 
Act may be used to maintain or establish a computer net-
work unless such network blocks the viewing, downloading, 
and exchanging of pornography. 
(b) Nothing in subsection (a) shall limit the use of 
funds necessary for any Federal, State, tribal, or local law 
enforcement agency or any other entity carrying out crimi-
nal investigations, prosecution, or adjudication activities. 
SEC. 409. None of the funds made available in this 
Act may be used by an agency of the executive branch to 
pay for first-class travel by an employee of the agency in 
contravention of sections 301–10.122 through 301–10.124 of 
title 41, Code of Federal Regulations.
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(A) in the custody or under the effective 
control of the Department of Defense; or 
(B) otherwise under detention at United 
States Naval Station, Guanta´namo Bay, Cuba. 
SEC. 413. None of the funds made available by this 
Act may be used by the Secretary of Veterans Affairs under 
section 5502 of title 38, United States Code, in any case 
arising out of the administration by the Secretary of laws 
and benefits under such title, to report a person who is 
deemed mentally incapacitated, mentally incompetent, or 
to be experiencing an extended loss of consciousness as a 
person who has been adjudicated as a mental defective 
under subsection (d)(4) or (g)(4) of section 922 of title 18, 
United States Code, without the order or finding of a judge, 
magistrate, or other judicial authority of competent juris-
diction that such person is a danger to himself or herself 
or others. 
SEC. 414. None of the funds appropriated by this Act 
may be used in any way, directly or indirectly, to influence 
congressional action on any legislation or appropriation 
matter pending before Congress, other than to communicate 
to Members of Congress as described in 18 U.S.C. 1913. 
SEC. 415. The Secretary of Veterans Affairs shall en-
sure that the policies and requirements described in the 
transmittal sheet of the Veterans Health Administration
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† HR 5371 EAS 
published on August 8, 2019, titled ‘‘Smoke-Free Policy for 
Employees at VA Health Care Facilities (VHA Directive 
1085.01)’’ remain in effect. 
SEC. 416. (a) Each department or agency funded in 
this or any other appropriations Act for fiscal year 2026 
shall, no later than 60 days after enactment of this Act, 
report to the Committees on Appropriations of the House 
of Representatives and the Senate on funds that are allotted 
and available for obligation as of the end of the reporting 
period and on obligations as of the end of the reporting 
period: Provided, That such report shall be delineated by: 
(1) program, project, and activity level; (2) public law mak-
ing such funds available; and (3) period of availability: 
Provided further, That such reports shall be transmitted to 
the Committees monthly thereafter, on the fifteenth of each 
such month, during the period of availability of the relevant 
funds. 
(b) The term ‘‘reporting period’’ as used in this section 
means the month that precedes the date on which the de-
partment or agency transmits the report to the Committees. 
This division may be cited as the ‘‘Military Construc-
tion, Veterans Affairs, and Related Agencies Appropria-
tions Act, 2026’’.
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† HR 5371 EAS 
DIVISION E—EXTENSION OF 
AGRICULTURAL PROGRAMS 
SEC. 5001. UNITED STATES GRAIN STANDARDS ACT EXTEN-
SION. 
(a) Sections 7(j)(5), 7A(l)(4), and 21(e) of the United 
States Grain Standards Act (7 U.S.C. 79(j)(5), 79a(l)(4), 
87j(e)) shall be applied by substituting ‘‘January 30, 2026’’ 
for ‘‘September 30, 2025’’ each place it appears. 
(b) Sections 7D and 19(a) of the United States Grain 
Standards Act (7 U.S.C. 79d, 87h(a)) shall be applied by 
substituting ‘‘2026’’ for ‘‘2025’’ each place it appears. 
SEC. 5002. EXTENSION OF AGRICULTURAL PROGRAMS. 
(a) EXTENSION.— 
(1) IN GENERAL.—Except as otherwise provided 
in this section and the amendments made by this sec-
tion, notwithstanding any other provision of law, the 
authorities (including any limitations on such au-
thorities) provided by each provision of the Agri-
culture Improvement Act of 2018 (Public Law 115– 
334; 132 Stat. 4490) and each provision of law 
amended by that Act (and for mandatory programs 
at such funding levels) as in effect (including pursu-
ant to section 4101 of division D of the American Re-
lief Act, 2025 (Public Law 118–158; 138 Stat. 1767))
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† HR 5371 EAS 
on September 30, 2025, shall continue and be carried 
out until the date specified in paragraph (2). 
(2) DATE SPECIFIED.—With respect to an au-
thority described in paragraph (1), the date specified 
in this paragraph is the later of— 
(A) September 30, 2026; 
(B) the date specified with respect to such 
authority in the Agriculture Improvement Act of 
2018 (Public Law 115–334; 132 Stat. 4490) or 
a provision of law amended by that Act (Public 
Law 115–334; 132 Stat. 4490), including any 
amendments made to such provisions by— 
(i) titles I and V of Public Law 119– 
21 (139 Stat. 80, 137); 
(ii) the Expanding Public Lands Out-
door Recreation Experiences Act (Public 
Law 118–234; 138 Stat. 2836); and 
(iii) any other provisions of law en-
acted after the Agriculture Improvement Act 
of 2018 (Public Law 115–334; 132 Stat. 
4490); and 
(C) the date in effect with respect to such 
authority pursuant to section 4101 of division D 
of the American Relief Act, 2025 (Public Law 
118–158; 138 Stat. 1767)).
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† HR 5371 EAS 
(b) DISCRETIONARY PROGRAMS.—Programs carried 
out using the authorities described in subsection (a)(1) that 
are funded by discretionary appropriations (as defined in 
section 250(c) of the Balanced Budget and Emergency Def-
icit Control Act of 1985 (2 U.S.C. 900(c))) shall be subject 
to the availability of appropriations. 
(c) COMMODITY PROGRAMS.— 
(1) DAIRY FORWARD PRICING PROGRAM.—Sec-
tion 1502(e)(2) of the Food, Conservation, and En-
ergy Act of 2008 (7 U.S.C. 8772(e)(2)) is amended by 
striking ‘‘2028’’ and inserting ‘‘2029’’. 
(2) SUSPENSION OF PERMANENT PRICE SUPPORT 
AUTHORITIES.—The provisions of law specified in— 
(A) subsections (a) and (b) of section 1602 
of the Agricultural Act of 2014 (7 U.S.C. 
9092)— 
(i) shall not be applicable to the 2026 
crops of covered commodities (as defined in 
section 1111 of that Act (7 U.S.C. 9011)), 
cotton, and sugar; and 
(ii) shall not be applicable to milk 
through December 31, 2026; and 
(B) section 1602(c) of that Act (7 U.S.C. 
9092(c)) shall not be applicable to the crops of 
wheat planted for harvest in calendar year 2026.
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† HR 5371 EAS 
(d) OTHER PROGRAMS.— 
(1) TRADE.—Section 302(h)(2) of the Bill Emer-
son Humanitarian Trust Act (7 U.S.C. 1736f– 
1(h)(2)) is amended by striking ‘‘September 30, 2025’’ 
and inserting ‘‘September 30, 2026’’. 
(2) GRAZINGLANDS
RESEARCH
LABORATORY.— 
Section 7502 of the Food, Conservation, and Energy 
Act of 2008 (Public Law 110–246; 122 Stat. 2019; 
132 Stat. 4817; 138 Stat. 1769) is amended by strik-
ing ‘‘2025’’ and inserting ‘‘2026’’. 
(3) ENERGY.—Section 9010(b) of the Farm Se-
curity and Rural Investment Act of 2002 (7 U.S.C. 
8110(b)) is amended in paragraphs (1)(A) and (2)(A) 
by striking ‘‘2025’’ each place it appears and insert-
ing ‘‘2026’’. 
(e) EXCEPTIONS.— 
(1) COMMODITIES.—Subsection (a) does not 
apply with respect to mandatory funding under sec-
tion 1614(c)(4) of the Agricultural Act of 2014 (7 
U.S.C. 9097(c)(4)). 
(2) CONSERVATION.— 
(A) MANDATORY FUNDING.—Subsection (a) 
does not apply with respect to mandatory fund-
ing under the following provisions of law:
321 
† HR 5371 EAS 
(i) Section 1240O(b)(3) of the Food Se-
curity Act of 1985 (16 U.S.C. 3839bb– 
2(b)(3)). 
(ii) Subparagraphs (A) and (B) of sec-
tion 1241(a)(1) of the Food Security Act of 
1985 (16 U.S.C. 3841(a)(1)) for fiscal years 
2025 and 2026. 
(B) LIMITATIONS.—Subsection (a) does not 
apply with respect to limitations under the fol-
lowing provisions of law: 
(i) Section 1240G of the Food Security 
Act of 1985 (16 U.S.C. 3839aa–7). 
(ii) Section 1240L(f) of the Food Secu-
rity Act of 1985 (16 U.S.C. 3839aa–24(f)). 
(3) RURAL DEVELOPMENT.—Subsection (a) does 
not apply with respect to mandatory funding under 
section 313B(e)(2) of the Rural Electrification Act of 
1936 (7 U.S.C. 940c–2(e)(2)). 
(4) RESEARCH.—Subsection (a) does not apply 
with respect to mandatory funding under the fol-
lowing provisions of law: 
(A) Section 1446(b)(1) of the National Agri-
cultural Research, Extension, and Teaching Pol-
icy Act of 1977 (7 U.S.C. 3222a(b)(1)).
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† HR 5371 EAS 
(B) Section 7601(g)(1)(A) of the Agricul-
tural Act of 2014 (7 U.S.C. 5939(g)(1)(A)). 
(5) ENERGY.—Subsection (a) does not apply 
with respect to mandatory funding under the fol-
lowing provisions of law: 
(A) Section 9002(k)(1) of the Farm Secu-
rity and Rural Investment Act of 2002 (7 U.S.C. 
8102(k)(1)). 
(B) Section 9003(g)(1)(A) of the Farm Se-
curity and Rural Investment Act of 2002 (7 
U.S.C. 8103(g)(1)(A)). 
(6) HORTICULTURE.—Subsection (a) does not 
apply with respect to mandatory funding under the 
following provisions of law: 
(A) Section 2123(c)(4) of the Organic Foods 
Production Act of 1990 (7 U.S.C. 6522(c)(4)). 
(B) Section 10109(c)(1) of the Agriculture 
Improvement Act of 2018 (Public Law 115–334). 
(7) MISCELLANEOUS.—Subsection (a) does not 
apply with respect to mandatory funding under sec-
tion 209(c) of the Agricultural Marketing Act of 1946 
(7 U.S.C. 1627a(c)). 
(f) REPORTS.— 
(1) IN GENERAL.—Subject to paragraph (2), any 
requirement under a provision of law described in
323 
† HR 5371 EAS 
paragraph (1) of subsection (a) to submit a report on 
a recurring basis, and the final report under which 
was required to be submitted during fiscal year 2025, 
shall continue, and the requirement shall be carried 
out, on the same recurring basis, until the later of the 
dates specified in paragraph (2) of that subsection. 
(2) 
APPROPRIATIONS
REQUIRED.—If 
discre-
tionary appropriations (as defined in section 250(c) 
of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985 (2 U.S.C. 900(c))) are required to 
carry out a reporting requirement described in para-
graph (1), the application of that paragraph to that 
reporting requirement shall be subject to the avail-
ability of appropriations. 
(g) EFFECTIVE DATE.—This section and the amend-
ments made by this section shall be applied and adminis-
tered as if this section and those amendments had been en-
acted on September 30, 2025.
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† HR 5371 EAS 
DIVISION F—HEALTH 
EXTENDERS 
TITLE I—PUBLIC HEALTH 
EXTENDERS 
SEC. 6101. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) EXTENSION
FOR
COMMUNITY
HEALTH
CEN-
TERS.—Section 10503(b)(1) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 254b–2(b)(1)) is amended— 
(1) in subparagraph (I), by striking ‘‘and’’ at 
the end; and 
(2) by adding at the end the following: 
‘‘(K) $1,423,890,411 for the period begin-
ning on October 1, 2025, and ending on January 
30, 2026; and’’. 
(b) EXTENSION FOR THE NATIONAL HEALTH SERVICE 
CORPS.—Section 10503(b)(2) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 254b–2(b)(2)) is amended— 
(1) in subparagraph (J), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (K), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following:
325 
† HR 5371 EAS 
‘‘(L) $115,315,068 for the period beginning 
on October 1, 2025, and ending on January 30, 
2026.’’. 
(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— 
(1) in subparagraph (E), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (F), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(G) $58,493,151 for the period beginning 
on October 1, 2025, and ending on January 30, 
2026.’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to the amendments made by this section 
shall be subject to the requirements contained in Public Law 
117–328 for funds for programs authorized under sections 
330 through 340 of the Public Health Service Act (42 
U.S.C. 254b et seq.). 
(e) CONFORMING AMENDMENT.—Section 3014(h)(4) of 
title 18, United States Code, is amended by striking ‘‘and 
section 2101(d) of division B of the Full-Year Continuing 
Appropriations and Extensions Act, 2025’’ and inserting
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† HR 5371 EAS 
‘‘section 2101(d) of division B of the Full-Year Continuing 
Appropriations and Extensions Act, 2025, and section 
6101(d) of the Continuing Appropriations, Agriculture, 
Legislative Branch, Military Construction and Veterans Af-
fairs, and Extensions Act, 2026’’. 
SEC. 6102. EXTENSION OF SPECIAL DIABETES PROGRAMS. 
(a) EXTENSION
OF SPECIAL DIABETES PROGRAMS 
FOR TYPE I DIABETES.—Section 330B(b)(2) of the Public 
Health Service Act (42 U.S.C. 254c–2(b)(2)) is amended— 
(1) in subparagraph (F), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (G), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(H) $53,145,205 for the period beginning 
on October 1, 2025, and ending on January 30, 
2026, to remain available until expended.’’. 
(b) EXTENDING FUNDING
FOR SPECIAL DIABETES 
PROGRAMS FOR INDIANS.—Section 330C(c)(2) of the Public 
Health Service Act (42 U.S.C. 254c–3(c)(2)) is amended— 
(1) in subparagraph (F), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (G), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following:
327 
† HR 5371 EAS 
‘‘(H) $53,145,205 for the period beginning 
on October 1, 2025, and ending on January 30, 
2026, to remain available until expended.’’. 
SEC. 6103. NATIONAL HEALTH SECURITY EXTENSIONS. 
(a) Section 319(e)(8) of the Public Health Service Act 
(42 U.S.C. 247d(e)(8)) is amended by striking ‘‘September 
30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(b) Section 319L(e)(1)(D) of the Public Health Service 
Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(c) Section 319L–1(b) of the Public Health Service Act 
(42 U.S.C. 247d–7f(b)) is amended by striking ‘‘September 
30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(d)(1) Section 2811A(g) of the Public Health Service 
Act (42 U.S.C. 300hh–10b(g)) is amended by striking ‘‘Sep-
tember 30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(2) Section 2811B(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(3) Section 2811C(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘January 30, 2026’’. 
(e) Section 2812(c)(4)(B) of the Public Health Service 
Act (42 U.S.C. 300hh–11(c)(4)(B)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘January 30, 2026’’.
328 
† HR 5371 EAS 
TITLE II—MEDICARE 
SEC. 6201. EXTENSION OF INCREASED INPATIENT HOS-
PITAL PAYMENT ADJUSTMENT FOR CERTAIN 
LOW-VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), by striking ‘‘in fiscal 
year 2026’’ and inserting ‘‘during the portion of fis-
cal year 2026 beginning on January 31, 2026, and 
ending on September 30, 2026, and in fiscal year 
2027’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I)— 
(i) by inserting ‘‘or portion of a fiscal 
year’’ after ‘‘for a fiscal year’’; and 
(ii) by inserting ‘‘and the portion of 
fiscal year 2026 beginning on October 1, 
2025, and ending on January 30, 2026’’ 
after ‘‘through 2025’’; 
(B) in subclause (III), by inserting ‘‘and 
the portion of fiscal year 2026 beginning on Oc-
tober 1, 2025, and ending on January 30, 2026’’ 
after ‘‘through 2025’’; and 
(C) in subclause (IV), by striking ‘‘fiscal 
year 2026’’ and inserting ‘‘the portion of fiscal
329 
† HR 5371 EAS 
year 2026 beginning on January 31, 2026, and 
ending on September 30, 2026, and fiscal year 
2027’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘or during the portion of fiscal year 
2026 beginning on October 1, 2025, and ending 
on January 30, 2026’’ after ‘‘through 2025’’; and 
(B) in clause (ii), by inserting ‘‘and the 
portion of fiscal year 2026 beginning on October 
1, 2025, and ending on January 30, 2026’’ after 
‘‘through 2025’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
ices may implement the amendments made by this section 
by program instruction or otherwise. 
SEC. 6202. EXTENSION OF THE MEDICARE-DEPENDENT 
HOSPITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘October 1, 2025’’ 
and inserting ‘‘January 31, 2026’’; and 
(2) in clause (ii)(II), by striking ‘‘October 1, 
2025’’ and inserting ‘‘January 31, 2026’’. 
(b) CONFORMING AMENDMENTS.—
330 
† HR 5371 EAS 
(1) IN GENERAL.—Section 1886(b)(3)(D) of the 
Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘October 1, 2025’’ and inserting ‘‘Janu-
ary 31, 2026’’; and 
(B) in clause (iv), by inserting ‘‘and the 
portion of fiscal year 2026 beginning on October 
1, 2025, and ending on January 30, 2026’’ after 
‘‘through fiscal year 2025’’. 
(2) PERMITTING
HOSPITALS
TO
DECLINE
RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by inserting ‘‘, or the por-
tion of fiscal year 2026 beginning on October 1, 2025, 
and ending on January 30, 2026’’ after ‘‘through fis-
cal year 2025’’. 
SEC. 6203. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended— 
(1) in the first sentence— 
(A) by striking ‘‘and $14,030,000’’ and in-
serting ‘‘$14,030,000’’; and
331 
† HR 5371 EAS 
(B) by inserting the following before the pe-
riod at the end: ‘‘, and $13,300,000 for fiscal 
year 2026’’; and 
(2) in the third sentence, by striking ‘‘and 2024 
and the period beginning on October 1, 2024, and 
ending on September 30, 2025,’’ and inserting ‘‘2024, 
2025, and 2026’’. 
SEC. 6204. EXTENDING ACUTE HOSPITAL CARE AT HOME 
WAIVER AUTHORITIES. 
Section 1866G(a)(1) of the Social Security Act (42 
U.S.C. 1395cc–7(a)(1)) is amended by striking ‘‘September 
30, 2025’’ and inserting ‘‘January 30, 2026’’. 
SEC. 6205. EXTENSION OF FUNDING FOR MEDICARE HOS-
PICE SURVEYS. 
Section 3(a)(2) of the IMPACT Act of 2014 (Public 
Law 113–185) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) $2,000,000 for the period beginning on 
October 1, 2025, and ending on January 30, 
2026.’’.
332 
† HR 5371 EAS 
SEC. 6206. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘October 
1, 2025’’ and inserting ‘‘January 31, 2026’’; and 
(2) in paragraph (13), by striking ‘‘October 1, 
2025’’ each place it appears and inserting ‘‘January 
31, 2026’’ in each such place. 
SEC. 6207. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘October 
1, 2025’’ and inserting ‘‘January 31, 2026’’. 
SEC. 6208. EXTENSION OF CERTAIN TELEHEALTH FLEXI-
BILITIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS AND EX-
PANDING ORIGINATING SITES
FOR TELEHEALTH SERV-
ICES.—Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘ending 
September 30, 2025’’ and inserting ‘‘ending January 
30, 2026’’; and 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on September 30, 2025’’ and inserting ‘‘ending on 
January 30, 2026’’.
333 
† HR 5371 EAS 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) of 
the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) is 
amended by striking ‘‘ending on September 30, 2025’’ and 
inserting ‘‘ending on January 30, 2026’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FEDER-
ALLY QUALIFIED HEALTH CENTERS AND RURAL HEALTH 
CLINICS.—Section 1834(m)(8)(A) of the Social Security 
Act (42 U.S.C. 1395m(m)(8)(A)) is amended by striking 
‘‘ending on September 30, 2025’’ and inserting ‘‘ending on 
January 30, 2026’’. 
(d) DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE FOR MENTAL HEALTH SERVICES FUR-
NISHED
THROUGH
TELEHEALTH
AND
TELECOMMUNI-
CATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—Section 1834(m)(7)(B)(i) of the Social Se-
curity Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amend-
ed, in the matter preceding subclause (I), by striking 
‘‘on or after October 1, 2025’’ and inserting ‘‘on or 
after January 31, 2026’’. 
(2) MENTAL
HEALTH
VISITS
FURNISHED
BY 
RURAL HEALTH CLINICS.—Section 1834(y)(2) of the 
Social Security Act (42 U.S.C. 1395m(y)(2)) is
334 
† HR 5371 EAS 
amended by striking ‘‘October 1, 2025’’ and inserting 
‘‘January 31, 2026’’. 
(3) MENTAL HEALTH VISITS FURNISHED BY FED-
ERALLY
QUALIFIED
HEALTH
CENTERS.—Section 
1834(o)(4)(B) of the Social Security Act (42 U.S.C. 
1395m(o)(4)(B)) is amended by striking ‘‘October 1, 
2025’’ and inserting ‘‘January 31, 2026’’. 
(e) ALLOWING FOR THE FURNISHING OF AUDIO-ONLY 
TELEHEALTH SERVICES.—Section 1834(m)(9) of the Social 
Security Act (42 U.S.C. 1395m(m)(9)) is amended by strik-
ing ‘‘ending on September 30, 2025’’ and inserting ‘‘ending 
on January 30, 2026’’. 
(f) EXTENDING USE OF TELEHEALTH TO CONDUCT 
FACE-TO-FACE ENCOUNTER PRIOR TO RECERTIFICATION 
OF
ELIGIBILITY
FOR
HOSPICE
CARE.—Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended by striking ‘‘ending on 
September 30, 2025’’ and inserting ‘‘ending on January 30, 
2026’’. 
(g) PROGRAM INSTRUCTION AUTHORITY.—The Sec-
retary of Health and Human Services may implement the 
amendments made by this section through program instruc-
tion or otherwise.
335 
† HR 5371 EAS 
SEC. 6209. REVISING PHASE-IN OF MEDICARE CLINICAL 
LABORATORY TEST PAYMENT CHANGES. 
(a) REVISED PHASE-IN OF REDUCTIONS FROM PRI-
VATE
PAYOR
RATE
IMPLEMENTATION.—Section 
1834A(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395m–1(b)(3)(B)) is amended— 
(1) in clause (ii), by inserting ‘‘and for the pe-
riod beginning on January 1, 2026, and ending on 
January 30, 2026’’ after ‘‘2025’’; and 
(2) in clause (iii), by striking ‘‘for each of 2026 
through 2028’’ and inserting ‘‘for the period begin-
ning on January 31, 2026, and ending on December 
31, 2026, and for each of 2027 and 2028’’. 
(b) REVISED REPORTING PERIOD FOR REPORTING OF 
PRIVATE SECTOR PAYMENT RATES FOR ESTABLISHMENT 
OF MEDICARE PAYMENT RATES.—Section 1834A(a)(1)(B) 
of the Social Security Act (42 U.S.C. 1395m–1(a)(1)(B)) 
is amended— 
(1) in clause (i), by striking ‘‘December 31, 
2025’’ and inserting ‘‘January 31, 2026’’; and 
(2) in clause (ii), by striking ‘‘January 1, 2026, 
and ending March 31, 2026’’ and inserting ‘‘Feb-
ruary 1, 2026, and ending April 30, 2026’’.
336 
† HR 5371 EAS 
SEC. 6210. EXTENSION OF FUNDING OUTREACH AND AS-
SISTANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note) is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the end; 
(2) in clause (xiv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Octo-
ber 1, 2025, and ending on January 30, 
2026, $5,013,699.’’. 
(b) AREA AGENCIES ON AGING.—Subsection (b)(1)(B) 
of such section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the end; 
(2) in clause (xiv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Octo-
ber 1, 2025, and ending on January 30, 
2026, $5,013,699.’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119 is amended—
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† HR 5371 EAS 
(1) in clause (xiii), by striking ‘‘and’’ at the end; 
(2) in clause (xiv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Octo-
ber 1, 2025, and ending on January 30, 
2026, $1,671,233.’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
ERAL AND STATE PROGRAMS.—Subsection (d)(2) of such 
section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the end; 
(2) in clause (xiv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on October 1, 
2025, and ending on January 30, 2026, 
$5,013,699.’’.
339 
† HR 5371 EAS 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘2023, for the period be-
ginning on October 1, 2023, and ending on 
November 17, 2023, for the period beginning 
on November 18, 2023, and ending on Jan-
uary 19, 2024, for the period beginning on 
January 20, 2024, and ending on March 8, 
2024, for the period beginning on March 9, 
2024, and ending on September 30, 2024, 
and for fiscal year 2025’’ and inserting 
‘‘2025, and for the period beginning on Oc-
tober 1, 2025, and ending on January 30, 
2026’’; and 
(ii) by striking ‘‘fiscal year 2024’’ and 
inserting ‘‘fiscal year 2026’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘through 2023’’ 
and inserting ‘‘through 2025’’; 
(II) by striking ‘‘fiscal year 2024 
or 2025’’ and inserting ‘‘fiscal year 
2026’’; and 
(III) by inserting ‘‘(or, with re-
spect to the applicable period, for fiscal
340 
† HR 5371 EAS 
year 2026)’’ after ‘‘an application for 
the fiscal year’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘2024 or 2025’’ and inserting ‘‘2026’’; 
and 
(2) in subsection (f)(1) by striking ‘‘2023, for the 
period beginning on October 1, 2023, and ending on 
November 17, 2023, an amount equal to the pro rata 
portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the period 
beginning on November 18, 2023, and ending on Jan-
uary 19, 2024, an amount equal to the pro rata por-
tion of the amount appropriated for the corresponding 
period for fiscal year 2023, for the period beginning 
on January 20, 2024, and ending on March 8, 2024, 
an amount equal to the pro rata portion of the 
amount appropriated for the period at the end of the 
corresponding sentence for fiscal year 2023, for the 
period beginning on March 9, 2024, and ending on 
September 30, 2024, an amount equal to the pro rata 
portion of the amount appropriated for the cor-
responding period for fiscal year 2023, and for for fis-
cal year 2025, an amount equal to the amount appro-
priated for fiscal year 2024’’ and inserting ‘‘2025, 
and for the period beginning on October 1, 2025, and
341 
† HR 5371 EAS 
ending on January 30, 2026, an amount equal to the 
pro rata portion of the amount appropriated for the 
corresponding period for fiscal year 2025’’. 
SEC. 6302. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 713) 
is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘2023, for the pe-
riod beginning on October 1, 2023, and ending 
on November 17, 2023, for the period beginning 
on November 18, 2023, and ending on January 
19, 2024, for the period beginning on January 
20, 2024, and ending on March 8, 2024, for the 
period beginning on March 9, 2024, and ending 
on September 30, 2024, and for fiscal year 2025’’ 
and inserting ‘‘2025, and for the period begin-
ning on October 1, 2025, and ending on January 
30, 2026’’; and 
(B) in subparagraph (B)(i), by striking 
‘‘the period beginning on October 1, 2023, and 
ending on November 17, 2023, for the period be-
ginning on November 18, 2023, and ending on 
January 19, 2024, for the period beginning on
342 
† HR 5371 EAS 
January 20, 2024, and ending on March 8, 
2024, for the period beginning on March 9, 2024, 
and ending on September 30, 2024, and for fis-
cal year 2025’’ and inserting ‘‘fiscal years 2024 
and 2025, and for the period beginning on Octo-
ber 1, 2025, and ending on January 30, 2026’’; 
(2) in subsection (c)(3), by striking ‘‘2024 or 
2025’’ and inserting ‘‘2026’’; and 
(3) in subsection (f), by striking ‘‘2023, for the 
period beginning on October 1, 2023, and ending on 
November 17, 2023, an amount equal to the pro rata 
portion of the amount appropriated for the cor-
responding period for fiscal year 2023, for the period 
beginning on November 18, 2023, and ending on Jan-
uary 19, 2024, an amount equal to the pro rata por-
tion of the amount appropriated for the corresponding 
period for fiscal year 2023, for the period beginning 
on January 20, 2024, and ending on March 8, 2024, 
an amount equal to the pro rata portion of the 
amount appropriated for the corresponding period for 
fiscal year 2023, for the period beginning on March 
9, 2024, and ending on September 30, 2024, an 
amount equal to the pro rata portion of the amount 
appropriated for the corresponding period for fiscal 
year 2023, and for fiscal year 2025, an amount equal
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to the amount appropriated for fiscal year 2024 for 
fiscal year 2024’’ and inserting ‘‘2025, and for the pe-
riod beginning on October 1, 2025, and ending on 
January 30, 2026, an amount equal to the pro rata 
portion of the amount appropriated for the cor-
responding period for fiscal year 2025’’. 
SEC. 6303. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY 
HEALTH INFORMATION CENTERS. 
Section 501(c)(1)(A) of the Social Security Act (42 
U.S.C. 701(c)(1)(A)) is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by adding ‘‘; and’’ at the 
end; and 
(3) by adding at the end the following new 
clause: 
‘‘(ix) for the period beginning on October 1, 
2025, and ending on January 30, 2026, an amount 
equal to the pro rata portion of the amount appro-
priated for fiscal year 2025.’’. 
TITLE IV—MEDICAID 
SEC. 
6401. 
MODIFYING 
CERTAIN 
DISPROPORTIONATE 
SHARE HOSPITAL ALLOTMENTS. 
(a) EXTENDING TENNESSEE DSH ALLOTMENTS.— 
Section 1923(f)(6)(A)(vi) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)(A)(vi)) is amended—
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† HR 5371 EAS 
(1) in the heading, by inserting ‘‘AND A PORTION 
OF FISCAL YEAR 2026’’ after ‘‘2025’’; and 
(2) by inserting ‘‘, and the DSH allotment for 
Tennessee for the portion of fiscal year 2026 begin-
ning October 1, 2025, and ending January 30, 2026, 
shall be $17,748,493, which may be claimed as fiscal 
year 2026 uncompensated care costs’’ before the pe-
riod. 
(b) DELAYING DSH ALLOTMENT REDUCTIONS.—Sec-
tion 1923(f) of the Social Security Act (42 U.S.C. 1396r– 
4(f)) is amended— 
(1) in paragraph (7)(A)— 
(A) in clause (i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘For each of fiscal years 
2026 through 2028’’ and inserting ‘‘For the 
period beginning January 31, 2026, and 
ending September 30, 2026, and for each of 
fiscal years 2027 and 2028’’; 
(ii) in subclause (I), by inserting ‘‘or 
period’’ after ‘‘the fiscal year’’; and 
(iii) in subclause (II), by inserting ‘‘or 
period’’ after ‘‘in the fiscal year’’; and 
(B) in clause (ii), by striking ‘‘for each of 
fiscal years 2026 through 2028’’ and inserting
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‘‘for the period beginning January 31, 2026, and 
ending September 30, 2026, and for each of fiscal 
years 2027 and 2028’’; and 
(2) in paragraph (8), by striking ‘‘2027’’ and in-
serting ‘‘2028’’. 
TITLE V—FOOD AND DRUG 
ADMINISTRATION 
SEC. 6501. SHORT TITLE. 
This title may be cited as the ‘‘Over-the-Counter Mono-
graph Drug User Fee Amendments’’. 
SEC. 6502. FINDING. 
Congress finds that the fees authorized by the amend-
ments made in this title will be dedicated to over-the- 
counter (OTC) monograph drug activities, as set forth in 
the goals identified for purposes of part 10 of subchapter 
C of chapter VII of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 379j–71 et seq.), in the letters from the Sec-
retary of Health and Human Services to the Chairman of 
the Committee on Energy and Commerce of the House of 
Representatives and the Chairman of the Committee on 
Health, Education, Labor, and Pensions of the Senate, as 
set forth in the Congressional Record. 
SEC. 6503. DEFINITIONS. 
Section 744L(9)(A) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 379j–71(9)(A)) is amended—
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(1) in clause (v), by striking ‘‘; or’’ and inserting 
a semicolon; 
(2) in clause (vi)— 
(A) by striking ‘‘addition’’ and inserting 
‘‘the addition’’; and 
(B) by striking the period and inserting ‘‘; 
or’’; and 
(3) by adding at the end the following: 
‘‘(vii) the addition or modification of a test-
ing procedure applicable to one or more OTC 
monograph drugs, provided that such additional 
or modified testing procedure reflects a voluntary 
consensus standard with respect to pharma-
ceutical quality that is— 
‘‘(I) established by a national or inter-
national standards development organiza-
tion; and 
‘‘(II) recognized by the Secretary 
through a process described in guidance for 
industry, initially published in July 2023, 
or any successor guidance, publicly avail-
able on the website of the Food and Drug 
Administration, which addresses voluntary 
consensus standards for pharmaceutical 
quality.’’.
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SEC. 6504. AUTHORITY TO ASSESS AND USE OTC MONO-
GRAPH FEES. 
(a) TYPES OF FEES.—Section 744M(a)(1) of the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
72(a)(1)) is amended— 
(1) in subparagraph (A)— 
(A) by striking ‘‘on December 31 of the fis-
cal year or at any time during the preceding 12- 
month period’’ and inserting ‘‘at any time dur-
ing the applicable period specified in clause (ii) 
for a fiscal year’’; 
(B) by striking ‘‘Each person’’ and insert-
ing the following: 
‘‘(i) ASSESSMENT
OF
FEES.—Each 
person’’; and 
(C) by adding at the end the following: 
‘‘(ii) APPLICABLE PERIOD.—For pur-
poses of clause (i), the applicable period 
is— 
‘‘(I) for fiscal year 2026, the 12- 
month period ending on December 31, 
2025; 
‘‘(II) for fiscal year 2027, the 9- 
month period ending on September 30, 
2026; and
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‘‘(III) for fiscal year 2028 and 
each subsequent fiscal year, the 12- 
month period ending on September 30 
of the preceding fiscal year.’’; 
(2) in subparagraph (B)(i), by amending sub-
clause (I) to read as follows: 
‘‘(I) has ceased all activities re-
lated to OTC monograph drugs prior 
to— 
‘‘(aa) for purposes of fiscal 
year 2026, January 1, 2025; 
‘‘(bb) for purposes of fiscal 
year 2027, January 1, 2026; and 
‘‘(cc) for purposes of fiscal 
year 2028 and each subsequent 
fiscal year, October 1 of the pre-
ceding fiscal year; and’’; and 
(3) by amending subparagraph (D) to read as 
follows: 
‘‘(D) DUE DATE.— 
‘‘(i) FISCAL
YEAR
2026.—For fiscal 
year 2026, the facility fees required under 
subparagraph (A) shall be due on the later 
of—
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† HR 5371 EAS 
‘‘(I) the first business day of June 
of such year; or 
‘‘(II) the first business day after 
the enactment of an appropriations 
Act providing for the collection and ob-
ligation of fees under this section for 
such year. 
‘‘(ii) FISCAL
YEAR
2027.—For fiscal 
year 2027, the facility fees required under 
subparagraph (A) shall be due— 
‘‘(I) in a first installment rep-
resenting 50 percent of such fee, on the 
later of— 
‘‘(aa) October 1, 2026; or 
‘‘(bb) the first business day 
after the enactment of an appro-
priations Act providing for the 
collection and obligation of fees 
under this section for such year; 
and 
‘‘(II) in a second installment rep-
resenting the remaining 50 percent of 
such fee, on— 
‘‘(aa) February 1, 2027; or
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‘‘(bb) if an appropriations 
Act described in subclause (I)(bb) 
is not in effect on February 1, 
2027, the first business day after 
enactment of such an appropria-
tions Act. 
‘‘(iii) SUBSEQUENT
FISCAL
YEARS.— 
For fiscal year 2028 and each subsequent 
fiscal year, the facility fees required under 
subparagraph (A) shall be due on the later 
of— 
‘‘(I) the first business day on or 
after October 1 of the fiscal year; or 
‘‘(II) the first business day after 
the date of enactment of an appropria-
tions Act providing for the collection 
and obligation of fees under this sec-
tion for the fiscal year.’’. 
(b) FEE REVENUE AMOUNTS.—Section 744M(b) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
72(b)) is amended to read as follows: 
‘‘(b) FEE REVENUE AMOUNTS.— 
‘‘(1) IN GENERAL.—For each of the fiscal years 
2026 through 2030, fees under subsection (a)(1) shall
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† HR 5371 EAS 
be established to generate a total facility fee revenue 
amount equal to the sum of— 
‘‘(A) the annual base revenue for the fiscal 
year (as determined under paragraph (2)); 
‘‘(B) the dollar amount equal to the infla-
tion adjustment for the fiscal year (as deter-
mined under subsection (c)(1)); 
‘‘(C) the dollar amount equal to the oper-
ating reserve adjustment for the fiscal year, if 
applicable (as determined under subsection 
(c)(2)); 
‘‘(D) additional direct cost adjustments (as 
determined under subsection (c)(3)); 
‘‘(E) an additional dollar amount equal 
to— 
‘‘(i) $2,373,000 for fiscal year 2026; 
‘‘(ii) $1,233,000 for fiscal year 2027; 
and 
‘‘(iii) $854,000 for fiscal year 2028; 
and 
‘‘(F) in the case of a fiscal year for which 
the Secretary applies the one-time facility fee 
workload adjustment under subsection (c)(4), the 
dollar amount equal to such adjustment.
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‘‘(2) ANNUAL BASE REVENUE.—For purposes of 
paragraph (1), the dollar amount of the annual base 
revenue for a fiscal year shall be— 
‘‘(A) for fiscal year 2026, the dollar amount 
of the total revenue amount established for fiscal 
year 2025 under this subsection as in effect on 
the day before the date of enactment of the Over- 
the-Counter Monograph Drug User Fee Amend-
ments, not including any adjustments made for 
such fiscal year 2025 under subsection (c)(2), as 
so in effect; and 
‘‘(B) for fiscal years 2027 through 2030, the 
dollar amount of the total revenue amount estab-
lished under this subsection for the previous fis-
cal year, not including any adjustments made 
for such previous fiscal year under subsection 
(c)(2) or (c)(3).’’. 
(c) ADJUSTMENTS; ANNUAL FEE SETTING.—Section 
744M(c) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 379j–72(c)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A), in the matter pre-
ceding clause (i)— 
(i) by striking ‘‘subsection (b)(2)(B)’’ 
and inserting ‘‘subsection (b)(1)(B)’’; and
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(ii) by striking ‘‘fiscal year 2022 and 
each subsequent fiscal year’’ and inserting 
‘‘each fiscal year’’; 
(B) in subparagraph (B), by striking ‘‘fis-
cal year 2022’’ and all that follows through the 
period at the end and inserting the following: ‘‘a 
fiscal year shall be equal to the product of— 
‘‘(i) for fiscal year 2026— 
‘‘(I) the fee for fiscal year 2025 
under subsection (a)(2); and 
‘‘(II) the inflation adjustment per-
centage under subparagraph (C); and 
‘‘(ii) for each of fiscal years 2027 
through 2030— 
‘‘(I) the applicable fee under sub-
section (a)(2) for the preceding fiscal 
year; and 
‘‘(II) the inflation adjustment per-
centage under subparagraph (C).’’; and 
(C) in subparagraph (C)— 
(i) in the matter preceding clause (i), 
by inserting ‘‘the sum of’’ after ‘‘is equal 
to’’; 
(ii) by striking clause (i);
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† HR 5371 EAS 
(iii) by redesignating subclauses (I) 
and (II) of clause (ii) as clauses (i) and 
(ii), respectively, and adjusting the margins 
accordingly; 
(iv) by striking ‘‘(ii) for each of fiscal 
years 2024 and 2025, the sum of—’’; and 
(v) in clause (ii), as so redesignated, 
by striking ‘‘Washington-Baltimore, DC– 
MD–VA–WV’’ and inserting ‘‘Washington– 
Arlington–Alexandria–DC–VA–MD–WV’’; 
(2) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) by striking ‘‘fiscal year 2021 and 
subsequent fiscal years’’ and inserting ‘‘each 
fiscal year’’; 
(ii) by striking ‘‘subsections (b)(1)(B) 
and (b)(2)(C)’’ and inserting ‘‘subsection 
(b)(1)(C)’’; and 
(iii) by striking ‘‘the number of weeks 
specified in subparagraph (B)’’ and insert-
ing ‘‘10 weeks’’; 
(B) by striking subparagraph (B); 
(C) by redesignating subparagraphs (C) 
and (D) as subparagraphs (B) and (C), respec-
tively; and
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† HR 5371 EAS 
(D) in subparagraph (C), as so redesig-
nated, by striking ‘‘paragraph (4) establishing’’ 
and inserting ‘‘paragraph (5) publishing’’; 
(3) in paragraph (3)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘subsection (b)(2)(D)’’ and in-
serting ‘‘subsection (b)(1)(D)’’; and 
(B) by striking subparagraphs (A) through 
(E) and inserting the following: 
‘‘(A) $135,000 for fiscal year 2026; 
‘‘(B) $300,000 for fiscal year 2027; 
‘‘(C) $55,000 for fiscal year 2028; 
‘‘(D) $30,000 for fiscal year 2029; and 
‘‘(E) $0 for fiscal year 2030.’’; and 
(4) by striking paragraph (4) and inserting the 
following: 
‘‘(4) ONE-TIME
FACILITY
FEE
WORKLOAD
AD-
JUSTMENT.— 
‘‘(A) IN GENERAL.—In addition to the ad-
justments under paragraphs (1), (2), and (3), the 
Secretary may further increase the fee revenues 
and fees through a one-time adjustment made for 
fiscal year 2028, 2029, or 2030, in accordance 
with this paragraph. 
‘‘(B) ADJUSTMENT DESCRIBED.—
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‘‘(i) CONDITIONS FOR ADJUSTMENT.— 
An adjustment under this paragraph may 
be made for a fiscal year only if— 
‘‘(I) an adjustment under this 
paragraph had not been made for any 
prior fiscal year; 
‘‘(II) the average number of OTC 
monograph drug facilities subject to a 
facility fee under subsection (a)(1) over 
the period of the preceding 3 fiscal 
years exceeds 1,625; and 
‘‘(III) with respect to facilities de-
scribed in subclause (II), the average 
number of such facilities (expressed as 
a percentage) that appeared on the ar-
rears lists pursuant to subsection 
(e)(1)(A)(i) over the period of the pre-
ceding 3 fiscal years is less than 30 
percent. 
‘‘(ii) AMOUNT
OF
ADJUSTMENT.—An 
adjustment under this paragraph for a fis-
cal year shall equal the product of— 
‘‘(I) the total facility revenue 
amount determined under subsection 
(b) for the fiscal year, exclusive of the
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† HR 5371 EAS 
adjustment under this paragraph for 
such fiscal year; and 
‘‘(II) the excess facility percentage 
described in clause (iii). 
‘‘(iii) 
EXCESS
FACILITY
PERCENT-
AGE.—The excess facility percentage de-
scribed in this clause is— 
‘‘(I) the amount by which the av-
erage number of OTC monograph drug 
facilities subject to a facility fee under 
subsection (a)(1) over the preceding 3 
fiscal years exceeds 1,625; divided by 
‘‘(II) 1,625. 
‘‘(5) ANNUAL
FEE
SETTING.—The Secretary 
shall, not later than 60 days before the first day of 
each fiscal year— 
‘‘(A) establish for such fiscal year, based on 
the revenue amounts under subsection (b) and 
the adjustments provided under this subsection— 
‘‘(i) OTC monograph drug facility fees 
under subsection (a)(1); and 
‘‘(ii) OTC monograph order request 
fees under subsection (a)(2); and
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† HR 5371 EAS 
‘‘(B) publish such fee revenue amounts, fa-
cility fees, and OTC monograph order request 
fees in the Federal Register.’’. 
(d) CREDITING AND AVAILABILITY OF FEES.—Section 
744M(f) of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 379j–72(f)) is amended— 
(1) in paragraph (2)(D)— 
(A) in the subparagraph heading, by strik-
ing ‘‘IN SUBSEQUENT YEARS’’; and 
(B) by striking ‘‘(after fiscal year 2021)’’; 
and 
(2) in paragraph (3), by striking ‘‘2021 through 
2025’’ and inserting ‘‘2026 through 2030’’. 
SEC. 
6505. 
REAUTHORIZATION; 
REPORTING 
REQUIRE-
MENTS. 
(a) PERFORMANCE REPORT.—Section 744N of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
73) is amended— 
(1) in subsection (a)— 
(A) by striking ‘‘Beginning with fiscal year 
2021, and not later than 120 calendar days after 
the end of each fiscal year thereafter’’ and insert-
ing the following: 
‘‘(1) IN GENERAL.—Not later than 120 calendar 
days after the end of each fiscal year’’;
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† HR 5371 EAS 
(B) by striking ‘‘section 3861(b) of the 
CARES Act’’ and inserting ‘‘section 6502 of the 
Over-the-Counter Monograph Drug User Fee 
Amendments’’; and 
(C) by adding at the end the following: 
‘‘(2) 
ADDITIONAL
INFORMATION.—Beginning 
with fiscal year 2026, the annual report under this 
subsection shall include— 
‘‘(A) the progress of the Food and Drug Ad-
ministration in achieving the goals, and future 
plans for meeting the goals, including— 
‘‘(i) the number of Tier 1 OTC mono-
graph order requests for which a proposed 
order was issued, and the number of such 
requests for which a final order was issued, 
in the previous fiscal year; 
‘‘(ii) the number of Tier 2 OTC mono-
graph order requests for which a proposed 
order was issued, and the number of such 
requests for which a final order was issued, 
in the previous fiscal year; 
‘‘(iii) the number of specified safety 
OTC monograph order requests for which a 
proposed order was issued, and the number
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† HR 5371 EAS 
of such requests for which a final order was 
issued, in the previous fiscal year; 
‘‘(iv) the number of generally recog-
nized as safe and effective finalization OTC 
monograph order requests for which a pro-
posed order was issued, and the number of 
such requests for which a final order was 
issued, in the previous fiscal year; 
‘‘(v) the average timeline for processing 
OTC monograph order requests, in the ag-
gregate and by submission type, in the pre-
vious fiscal year; and 
‘‘(vi) postmarket safety activities with 
respect to OTC monograph drugs, includ-
ing— 
‘‘(I) collecting, developing, and re-
viewing safety information on OTC 
monograph drugs, including adverse 
event reports; 
‘‘(II) developing and using im-
proved analytical tools, adverse event 
data-collection systems, including in-
formation technology systems, to assess 
potential safety problems, including 
access to external databases; and
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‘‘(III) activities under section 
760; 
‘‘(B) information regarding registration of 
OTC monograph drug facilities and contract 
manufacturing organization facilities and pay-
ment of registration fees by such facilities, in-
cluding— 
‘‘(i) the OTC monograph drug facilities 
and contract manufacturing organization 
facilities that were first registered under 
section 510(c) or 510(i) in the fiscal year; 
and 
‘‘(ii) for each OTC monograph drug fa-
cility and contract manufacturing organi-
zation facility that was assessed a facility 
fee under section 744M(a) in the fiscal year, 
whether the facility paid such fee; 
‘‘(C) the status of implementation of evi-
dence and testing standards under section 
505G(r) for nonprescription drugs intended for 
topical administration, including— 
‘‘(i) the application of evidence or test-
ing standards; and 
‘‘(ii) the number of active ingredient 
requests for nonprescription drugs intended
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for topical administration reviewed using 
the standards under section 505G(b); and 
‘‘(D) the progress of the Food and Drug Ad-
ministration in allowing nonclinical testing al-
ternatives to animal testing for the consideration 
of sunscreen active ingredients. 
‘‘(3) CONFIDENTIALITY.—Nothing in paragraph 
(2) shall be construed to authorize the disclosure of in-
formation that is prohibited from disclosure under 
section 301(j) of this Act or section 1905 of title 18, 
United States Code, or that is subject to withholding 
under section 552(b)(4) of title 5, United States 
Code.’’; 
(2) in subsection (b), by striking ‘‘fiscal year 
2021 and each subsequent fiscal year’’ and inserting 
‘‘each fiscal year’’; and 
(3) in subsection (d)— 
(A) by striking ‘‘2025’’ each place it ap-
pears and inserting ‘‘2030’’; and 
(B) by adding at the end the following: 
‘‘(4) MINUTES OF NEGOTIATION MEETINGS.— 
‘‘(A) PUBLIC AVAILABILITY.—The Secretary 
shall make publicly available, on the public 
website of the Food and Drug Administration, 
robust written minutes of all negotiation meet-
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ings conducted under this subsection between the 
Food and Drug Administration and the regu-
lated industry, not later than 30 days after each 
such negotiation meeting. 
‘‘(B) CONTENT.—The robust written min-
utes described under subparagraph (A) shall con-
tain, in detail, any substantive proposal made 
by any party to the negotiations as well as sig-
nificant controversies or differences of opinion 
during the negotiations and their resolution.’’. 
(b) GAO REPORT.— 
(1) IN GENERAL.—Not later than September 30, 
2027, the Comptroller General of the United States 
shall submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representa-
tives a report assessing the supply chain of over-the- 
counter monograph drugs. 
(2) CONTENTS.—The report required under 
paragraph (1) shall include an assessment of— 
(A) the overall stability of the supply chain 
of over-the-counter monograph drugs; 
(B) what information is collected by the 
Food and Drug Administration with respect to
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the supply chain of over-the-counter monograph 
drugs; 
(C) how the Food and Drug Administration 
uses information collected on the supply chain of 
over-the-counter monograph drugs to inform reg-
ulatory decisions; 
(D) how the Food and Drug Administration 
coordinates with other Federal agencies to mon-
itor and mitigate disruptions to the supply 
chain of over-the-counter monograph drugs; and 
(E) the unique characteristics of the over- 
the-counter monograph drug marketplace and 
what additional authorities or information the 
Food and Drug Administration may need to en-
sure the stability of the supply chain of over-the- 
counter monograph drugs. 
SEC. 6506. TREATMENT OF ACTIVE INGREDIENTS FOR TOP-
ICAL ADMINISTRATION. 
(a) IN GENERAL.—Section 505G of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 355h) is amended by 
adding at the end the following: 
‘‘(r) EVIDENCE AND TESTING STANDARDS FOR ACTIVE 
INGREDIENTS FOR TOPICAL ADMINISTRATION.—
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† HR 5371 EAS 
‘‘(1) EVIDENCE AND TESTING STANDARDS FOR 
ACTIVE
INGREDIENTS
FOR
TOPICAL
ADMINISTRA-
TION.—The Secretary shall— 
‘‘(A) in evaluating the generally recognized 
as safe and effective status of active ingredients 
used in nonprescription drugs intended for top-
ical administration for purposes of subsection 
(a), utilize standards that allow for the use of 
real world evidence (as defined in section 
505F(b)), as appropriate, as part of a com-
prehensive evaluation of scientific evidence to 
demonstrate the safety and effectiveness of such 
active ingredients, to supplement evidence from 
traditional clinical trials, provided that such 
standards allow the Secretary to evaluate wheth-
er the benefits of such active ingredients outweigh 
the risks; and 
‘‘(B) apply subsection (b)(6)(C) to the regu-
lation of active ingredients used in drugs in-
tended for topical administration. 
‘‘(2) NON-ANIMAL TESTING METHODS FOR TOP-
ICAL ACTIVE INGREDIENTS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
consider the types of nonclinical tests described 
in paragraphs (1) through (4) of the first sub-
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section (z) of section 505 (as inserted by section 
3209(a)(2) of the Health Extenders, Improving 
Access to Medicare, Medicaid, and CHIP, and 
Strengthening Public Health Act of 2022 (divi-
sion FF of Public Law 117–328)), or any other 
alternative to animal testing that the Secretary 
determines appropriate, in the consideration of 
drugs intended for topical administration under 
this section. 
‘‘(B) GUIDANCE.—Not later than 1 year 
after the date of enactment of this subsection, the 
Secretary shall issue new draft guidance on how 
sponsors can use nonclinical testing alternatives 
to animal testing, as appropriate, to meet safety 
and efficacy standards under this section for 
drugs intended for topical administration. 
‘‘(3) CLARIFICATION.—Nothing in this subsection 
shall be construed to alter, supersede, or limit the 
standards for making determinations of whether a 
drug is generally recognized as safe and effective 
under section 201(p) or the standards set forth under 
section 505 for determining the safety and effective-
ness of drugs.’’. 
(b) SUNSCREEN FINAL ADMINISTRATIVE ORDER.—A 
final administrative order on nonprescription sunscreen ac-
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tive ingredients issued under section 3854 of the 
Coronavirus Aid, Relief, and Economic Security Act (Pub-
lic Law 116–136; 21 U.S.C. 360fff–3 note) shall— 
(1) account for historical data regarding the 
safety of sunscreen active ingredients that have pre-
viously been accepted for marketing in the United 
States; 
(2) account for the role of broad spectrum sun-
screens with a Sun Protection Factor of 15 or higher 
in effective skin cancer prevention; and 
(3) incorporate the evidence and testing stand-
ards for sunscreen active ingredients detailed in sec-
tion 505G(r) of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 355h) (as added by subsection (a)). 
SEC. 6507. INCREASING THE CLARITY AND PREDICTABILITY 
OF THE PROCESS FOR DEVELOPING APPLICA-
TIONS 
FOR 
RX-TO-NONPRESCRIPTION 
SWITCHES. 
(a) IN GENERAL.—Section 505(b) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 355(b)) is amended by 
adding at the end the following: 
‘‘(7) RX-TO-NONPRESCRIPTION SWITCHES.— 
‘‘(A) MEETINGS.—Any person planning to 
submit an application for an Rx-to-nonprescrip-
tion switch may submit to the Secretary a writ-
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ten request for a meeting, for purposes of devel-
oping a plan for such application that addresses 
the potential risks to public health of such switch 
and the evidence necessary to support such ap-
plication, including the design of any necessary 
studies, and the format and content of the 
planned application. The Secretary may grant 
such a meeting, as appropriate, consistent with 
established procedures for granting meetings 
with, and providing written responses to, appli-
cations under this section. Each such meeting 
shall be documented in meeting minutes. 
‘‘(B) GUIDANCE.— 
‘‘(i) IN GENERAL.—Not later than 18 
months after the date of enactment of this 
paragraph, the Secretary shall issue guid-
ance to increase the clarity and predict-
ability of the process and standards for ap-
proval of applications for nonprescription 
drugs under this section, including in the 
case of applications for an Rx-to-non-
prescription switch, especially with respect 
to prescription drugs with well-established 
safety profiles for which an applicant may 
seek approval for nonprescription use.
381 
† HR 5371 EAS 
SEC. 7305. EXTENSION OF AUTHORITY TO PROVIDE ASSIST-
ANCE FOR SPECIALLY ADAPTED HOUSING 
FOR DISABLED VETERANS RESIDING TEMPO-
RARILY IN HOUSING OWNED BY A FAMILY 
MEMBER. 
Section 2102A(e) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7306. EXTENSION OF AUTHORITY FOR SPECIALLY 
ADAPTED HOUSING ASSISTIVE TECHNOLOGY 
GRANT PROGRAM. 
Section 2108(g) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7307. IMPROVEMENTS TO PARTIAL CLAIM PROGRAM 
OF THE DEPARTMENT OF VETERANS AF-
FAIRS. 
(a) CLARIFICATION
OF RELATIONSHIP
TO OTHER 
POWERS
OF SECRETARY.—Section 3720(h) of title 38, 
United States Code, is amended by striking ‘‘of subsection 
(a)’’ and all that follows through the period at the end and 
inserting ‘‘of subsection (a) in conjunction with the pur-
chase of a loan under section 3732(a)(2) of this title unless 
the Secretary determines the purchase would be made con-
sistent with section 3732(d) of this title.’’.