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‘‘(ii) CONTENTS.—The guidance under 
clause (i) shall— 
‘‘(I) describe how published re-
ports in medical literature, any pre-
vious finding of safety or effectiveness 
for the drug under this section, the re-
sults of significant human experience 
with the drug, unpublished studies and 
other data, and other sources of infor-
mation may be used to support an ap-
plication for a nonprescription drug, 
including in the context of an applica-
tion 
for 
an 
Rx-to-nonprescription 
switch; 
‘‘(II) set forth procedures for 
sponsors to request meetings described 
in subparagraph (A) and document the 
recommendations made in such meet-
ings; 
‘‘(III) describe evidentiary expec-
tations to support approval of an ap-
plication for a nonprescription drug, 
including in the context of an applica-
tion 
for 
an 
Rx-to-nonprescription 
switch, including how sponsors can
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demonstrate that consumers can appro-
priately self-select and use the drug 
and comprehend the nonprescription 
drug label; and 
‘‘(IV) provide recommendations 
for how mechanisms, in addition to the 
required Drug Facts Label, such as 
mobile applications and decisions aids, 
can be incorporated into the informa-
tion submitted in support of an appli-
cation for an Rx-to-nonprescription 
switch. 
‘‘(C) PLAN
TO
ENGAGE
WITH
STAKE-
HOLDERS.—Not later than 1 year after the date 
of enactment of this paragraph, the Secretary 
shall develop and make publicly available on the 
website of the Food and Drug Administration a 
plan to engage stakeholders on steps and factors 
for application holders and other stakeholders to 
consider in identifying approved prescription 
drugs that may be promising candidates for ap-
plications for an Rx-to-nonprescription switch. 
‘‘(D) DEFINITION.—For purposes of this 
paragraph, 
the 
term 
‘Rx-to-nonprescription 
switch’ means the approval of an application, or
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supplemental application, as applicable, sub-
mitted under this section by the holder of an ap-
proved application for a prescription drug seek-
ing approval to market such drug as a non-
prescription drug, including for— 
‘‘(i) 
a 
full 
Rx-to-nonprescription 
switch, under which a drug previously ap-
proved for prescription use only is— 
‘‘(I) approved for nonprescription 
use under the same conditions as ap-
plied to the drug when approved for 
prescription use; or 
‘‘(II) approved for nonprescrip-
tion use subject to one or more addi-
tional conditions for nonprescription 
use; and 
‘‘(ii) a partial Rx-to-nonprescription 
switch, under which the drug is approved 
for nonprescription use only under certain 
conditions described in the approved label-
ing, while the drug otherwise remains ap-
proved for prescription use only. 
‘‘(E) RULE OF CONSTRUCTION.—Nothing in 
this paragraph shall be construed to—
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‘‘(i) supersede or modify the authority 
of the Secretary under section 505G with re-
spect to the regulation of OTC monograph 
drugs; or 
‘‘(ii) authorize the disclosure by the 
Secretary of confidential commercial infor-
mation or trade secrets.’’. 
(b) GAO REPORT.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to the Com-
mittee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Com-
merce of the House of Representatives a report that 
evaluates— 
(A) the number of applications for an Rx- 
to-nonprescription switch approved during the 
period beginning on October 1, 2022, and ending 
on the date of the report; 
(B) the number of drugs for which an ap-
plication for an Rx-to-nonprescription switch 
was approved during such period subject to an 
additional condition for nonprescription use; 
(C) among the drugs for which an applica-
tion for a full or partial Rx-to-nonprescription
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switch was approved during such period, the av-
erage length of time from receipt by the Food 
and Drug Administration of the application to 
the approval of such application; 
(D) the number of partial Rx-to-non-
prescription switch applications approved dur-
ing such period, and the number of applications 
for such a partial switch not approved; 
(E) any barriers to timely and predictable 
review of applications for an Rx-to-nonprescrip-
tion switch; 
(F) engagement by the Food and Drug Ad-
ministration with public stakeholders, including 
public meetings or additional activities to sup-
port review of applications for an Rx-to-non-
prescription switch; and 
(G) opportunities for collaboration between 
the Center for Drug Evaluation and Research 
and the Centers for Medicare & Medicaid Serv-
ices for the purpose of analyzing health insur-
ance claims data for commonly prescribed drugs 
that appear to be suitable for an Rx-to-non-
prescription switch. 
(2) DEFINITION.—In this subsection, the term 
‘‘Rx-to-nonprescription switch’’ has the meaning
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given such term in paragraph (7) of section 505(b) of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
244(b)), as added by subsection (a). 
SEC. 6508. REGULATION OF CERTAIN NONPRESCRIPTION 
DRUGS THAT ARE MARKETED WITHOUT AN 
APPROVED DRUG APPLICATION. 
(a) DEVELOPMENT ADVICE TO SPONSORS OR REQUES-
TORS.—Section 505G(h) of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 355h(h)) is amended by striking 
‘‘sponsors or requestors’’ and inserting ‘‘sponsors, reques-
tors, or organizations nominated by sponsors or requestors 
to represent their interests in a proceeding’’. 
(b) 
TECHNICAL
CORRECTION.—Section 
505G(b)(2)(A)(iv)(III) of the Federal Food, Drug, and Cos-
metic Act (21 U.S.C. 355h(b)(2)(A)(iv)(III)) is amended by 
striking ‘‘requestors’’ and inserting ‘‘sponsors or reques-
tors’’. 
SEC. 6509. SUNSET DATES. 
(a) AUTHORIZATION.—Sections 744L and 744M of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
71; 379j–72) shall cease to be effective October 1, 2030. 
(b) REPORTING REQUIREMENTS.—Section 744N of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379j– 
73) shall cease to be effective January 31, 2031.
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SEC. 6510. EFFECTIVE DATE. 
The amendments made by this title shall take effect 
on October 1, 2025, or the date of the enactment of this 
Act, whichever is later, except that fees under part 10 of 
subchapter C of chapter VII of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 379j–71 et seq.) shall be assessed 
beginning October 1, 2025, regardless of the date of the en-
actment of this Act. 
SEC. 6511. SAVINGS CLAUSE. 
Notwithstanding the amendments made by this title, 
part 10 of subchapter C of chapter VII of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 379j–71 et seq.), as in 
effect on the day before the date of enactment of this Act, 
shall continue to be in effect with respect to assessing and 
collecting any fee required by such part for a fiscal year 
prior to fiscal year 2026. 
TITLE VI—NO SURPRISES ACT 
IMPLEMENTATION 
SEC. 6601. EXTENDING AVAILABILITY OF FUNDING FOR NO 
SURPRISES ACT IMPLEMENTATION. 
Section 118(a) of division BB of the Consolidated Ap-
propriations Act, 2021 (Public Law 116–260) is amend-
ed— 
(1) by striking ‘‘otherwise appropriated, to the 
Secretary of Health and Human Services’’ and in-
serting the following: ‘‘otherwise appropriated—
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‘‘(1) to the Secretary of Health and Human 
Services’’; 
(2) in paragraph (1), as so inserted, by striking 
‘‘September 30, 2025.’’ and inserting ‘‘January 30, 
2026; and’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(2) to the Secretary of Health and Human 
Services, in addition to amounts otherwise appro-
priated under paragraph (1), $14,000,000 for the pe-
riod beginning on October 1, 2025, and ending on 
January 30, 2026.’’. 
DIVISION G—DEPARTMENT OF 
VETERANS AFFAIRS EXTENDERS 
TITLE I—HEALTH CARE 
MATTERS 
SEC. 7101. EXTENSION OF AUTHORITY FOR COLLECTION OF 
COPAYMENTS 
FOR 
HOSPITAL 
CARE 
AND 
NURSING HOME CARE. 
Section 1710(f)(2)(B) of title 38, United States Code, 
is amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’.
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SEC. 7102. EXTENSION OF REQUIREMENT TO PROVIDE 
NURSING HOME CARE TO CERTAIN VETERANS 
WITH SERVICE-CONNECTED DISABILITIES. 
Section 1710A(d) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7103. EXTENSION OF STAFF SERGEANT PARKER GOR-
DON FOX SUICIDE PREVENTION GRANT PRO-
GRAM. 
Section 201(j) of the Commander John Scott Hannon 
Veterans Mental Health Care Improvement Act of 2019 
(Public Law 116–171; 38 U.S.C. 1720F note) is amended 
by striking ‘‘the date that is three years after the date on 
which the first grant is awarded under this section’’ and 
inserting ‘‘September 30, 2026’’. 
SEC. 7104. EXTENSION OF FUNDING FOR EXPANSION OF 
RURAL ACCESS NETWORK FOR GROWTH EN-
HANCEMENT PROGRAM. 
Section 2(d) of the Sgt. Ketchum Rural Veterans Men-
tal Health Act of 2021 (Public Law 117–21; 38 U.S.C. 
1712A note) is amended by striking ‘‘2025’’ and inserting 
‘‘2026’’.
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TITLE II—BENEFITS 
SEC. 7201. EXTENSION OF REQUIREMENT FOR QUARTERLY 
BRIEFINGS 
ON 
ADMINISTRATION 
OF 
AU-
THORITIES RELATING TO DETERMINATIONS 
REGARDING 
PRESUMPTIONS 
OF 
SERVICE 
CONNECTION BASED ON TOXIC EXPOSURE. 
Section 202(b)(2) of the Sergeant First Class Heath 
Robinson Honoring our Promise to Address Comprehensive 
Toxics Act of 2022 (Public Law 117–168) is amended by 
striking ‘‘On a quarterly basis during the two-year period 
beginning on the date of the enactment of this Act,’’ and 
inserting ‘‘On a quarterly basis during the period begin-
ning on the date of the enactment of this Act and ending 
on December 31, 2026,’’. 
SEC. 7202. EXTENSION OF REQUIREMENT RELATING TO 
RESTORATION OF ENTITLEMENT TO EDU-
CATIONAL ASSISTANCE IN CASES OF CLO-
SURE OR DISAPPROVAL OF EDUCATIONAL IN-
STITUTIONS. 
Section 3699(c)(2)(C) of title 38, United States Code, 
is amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’.
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SEC. 7203. EXTENSION OF TEMPORARY CLARIFICATION OF 
LICENSURE 
REQUIREMENTS 
FOR 
CON-
TRACTOR MEDICAL PROFESSIONALS TO PER-
FORM MEDICAL DISABILITY EXAMINATIONS 
FOR THE DEPARTMENT OF VETERANS AF-
FAIRS UNDER PILOT PROGRAM FOR USE OF 
CONTRACT PHYSICIANS FOR DISABILITY EX-
AMINATIONS. 
Section 2002(a)(4) of the Johnny Isakson and David 
P. Roe, M.D. Veterans Health Care and Benefits Improve-
ment Act of 2020 (Public Law 116–315; 38 U.S.C. 5101 
note) is amended by striking ‘‘five years’’ and inserting ‘‘six 
years’’. 
SEC. 7204. EXTENSION OF AUTHORITY TO MAINTAIN RE-
GIONAL 
OFFICE 
IN 
REPUBLIC 
OF 
PHIL-
IPPINES. 
Section 315(b) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
TITLE III—HOUSING 
SEC. 7301. EXTENSION OF AUTHORIZATION OF APPROPRIA-
TIONS FOR HOMELESS WOMEN VETERANS 
AND HOMELESS VETERANS WITH CHILDREN 
REINTEGRATION GRANT PROGRAM. 
Section 2021A(f)(1) of title 38, United States Code, is 
amended by striking ‘‘2025’’ and inserting ‘‘2026’’.
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SEC. 7302. EXTENSION OF AUTHORITY FOR TREATMENT 
AND REHABILITATION FOR SERIOUSLY MEN-
TALLY ILL AND HOMELESS VETERANS. 
(a) GENERAL TREATMENT.—Section 2031(b) of title 
38, United States Code, is amended by striking ‘‘September 
30, 2025’’ and inserting ‘‘September 30, 2026’’. 
(b) ADDITIONAL SERVICES AT CERTAIN LOCATIONS.— 
Section 2033(d) of title 38, United States Code, is amended 
by striking ‘‘September 30, 2025’’ and inserting ‘‘September 
30, 2026’’. 
SEC. 7303. EXTENSION OF FUNDING FOR FINANCIAL AS-
SISTANCE FOR SUPPORTIVE SERVICES FOR 
VERY LOW-INCOME VETERAN FAMILIES IN 
PERMANENT HOUSING. 
Section 2044(e) of title 38, United States Code, is 
amended by adding at the end the following new paragraph: 
‘‘(9) $660,000,000 for fiscal year 2026.’’. 
SEC. 7304. EXTENSION OF FUNDING FOR GRANT PROGRAM 
FOR HOMELESS VETERANS WITH SPECIAL 
NEEDS. 
Section 2061(d)(1) of title 38, United States Code, is 
amended by striking ‘‘2025’’ and inserting ‘‘2026’’.
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under this chapter shall discharge the property from a par-
tial claim interest held by the Secretary, provided that the 
holder of the guaranteed loan conducts the non-judicial sale 
and distributes the sale proceeds, if any, in accordance with 
the State or local law where such property is situated.’’. 
(e) GUIDANCE IN ADVANCE OF REGULATIONS.—Sub-
section (h) of such section is amended to read as follows: 
‘‘(h) GUIDANCE IN ADVANCE OF REGULATIONS.—Not-
withstanding any other provision of law, the Secretary 
may, before prescribing regulations, issue administrative 
guidance with respect to the Partial Claim Program under 
this section and the loss mitigation options prescribed under 
section 3732(d) of this title, including any additional 
terms, conditions, and requirements the Secretary deter-
mines necessary.’’. 
SEC. 7308. GOVERNMENT ACCOUNTABILITY OFFICE RE-
PORTS ON PARTIAL CLAIM PROGRAM OF THE 
DEPARTMENT OF VETERANS AFFAIRS AND 
OTHER MATTERS. 
(a) ANNUAL REPORTS.— 
(1) IN GENERAL.—Not later than one year after 
the date of the enactment of this Act, and every year 
thereafter until the Partial Claim Program termi-
nates, the Comptroller General of the United States 
shall submit to the Committee on Veterans’ Affairs of
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the Senate and the Committee on Veterans’ Affairs of 
the House of Representatives a report. 
(2) ELEMENTS.—Each report required by para-
graph (1) shall include, for the period covered by the 
report and disaggregated by quarter, the following: 
(A) Key data on the performance of the 
Partial Claim Program, including— 
(i) the number of partial claims filed 
and approved; and 
(ii) the redefault and foreclosure rates 
of loans for which a partial claim was 
made. 
(B) A comparison of the data described in 
subparagraph (A) with data on the performance 
of other loss mitigation options provided by the 
Department of Veterans Affairs. 
(C) The number of housing loans insured, 
guaranteed, or made by the Secretary of Veterans 
Affairs under chapter 37 of title 38, United 
States Code. 
(D) The number of applications for housing 
loan benefits under such chapter denied. 
(E) The number of housing loans insured, 
guaranteed, or made by the Secretary under such
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chapter refinanced under section 3710(a)(8) or 
3712 of title 38, United States Code. 
(F) The number of veterans who owe a pay-
ment on a mortgage associated with a loan in-
sured, guaranteed, or made by the Secretary 
under such chapter that is at least— 
(i) 60 days late; and 
(ii) 90 days late. 
(b) ASSESSMENT.— 
(1) IN GENERAL.—Not later than one year before 
the Partial Claim Program terminates, the Comp-
troller General shall— 
(A) conduct an assessment of the benefits 
and challenges of the Partial Claim Program; 
and 
(B) submit to the Committee on Veterans’ 
Affairs of the Senate and the Committee on Vet-
erans’ Affairs of the House of Representatives a 
report on the findings of the Comptroller General 
with respect to that assessment. 
(2) CONSIDERATIONS.—In conducting the assess-
ment required by paragraph (1), the Comptroller 
General shall consider the following: 
(A) The characteristics of borrowers for 
whom a partial claim was made compared to the
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characteristics of borrowers provided other loss 
mitigation options by the Department of Vet-
erans Affairs. 
(B) The performance of loans guaranteed 
under chapter 37 of title 38, United States Code, 
following various loss mitigation actions. 
(C) The information the Department con-
sidered in determining whether a borrower would 
benefit from a partial claim compared to other 
loss mitigation options. 
(D) The costs to taxpayers of the Partial 
Claim Program compared to the costs of other 
loss mitigation options provided by the Depart-
ment. 
(E) Any similarities and differences in the 
Department’s administration and use of the Par-
tial Claim Program compared to the Depart-
ment’s administration and use of the COVID–19 
Veterans Assistance Partial Claim Payment pro-
gram established under subpart F of part 36 of 
title 38, Code of Regulations. 
(F) 
The 
information 
the 
Department 
learned from the COVID–19 Veterans Assistance 
Partial Claim Payment program and the extent
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† HR 5371 EAS 
to which those lessons learned were applied to the 
Partial Claim Program. 
(G) The types of information the Depart-
ment collected to monitor the performance and 
effectiveness of the Partial Claim Program and 
how the Department used that information to 
make any needed adjustments to the program. 
(H) How the use by the Department of par-
tial claims compares to the use of partial claims 
by other Federal housing agencies, including, for 
each partial claim program— 
(i) the volume of loans for which par-
tial claims have been made; 
(ii) the results for borrowers (including 
redefault and foreclosure rates); and 
(iii) the costs to taxpayers. 
(c) PARTIAL CLAIM PROGRAM DEFINED.—In this sec-
tion, the term ‘‘Partial Claim Program’’ means the Partial 
Claim Program of the Department of Veterans Affairs car-
ried out under section 3737 of title 38, United States Code.
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TITLE IV—OTHER MATTERS 
SEC. 7401. EXTENSION OF SUBPOENA AUTHORITY OF IN-
SPECTOR GENERAL OF DEPARTMENT OF VET-
ERANS AFFAIRS. 
Section 312(d)(7)(A) of title 38, United States Code, 
is amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7402. EXTENSION OF REQUIREMENT FOR ANNUAL RE-
PORT ON USE OF AUTHORITY TO PROVIDE 
EQUITABLE RELIEF. 
Section 503(c) of title 38, United States Code, is 
amended by striking ‘‘December 31, 2025’’ and inserting 
‘‘December 31, 2026’’. 
SEC. 7403. EXTENSION OF AUTHORITY FOR SECRETARY OF 
VETERANS AFFAIRS TO TRANSPORT INDIVID-
UALS TO AND FROM FACILITIES OF DEPART-
MENT OF VETERANS AFFAIRS. 
Section 111A(a)(2) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7404. EXTENSION OF AUTHORITY RELATING TO VEND-
EE LOAN PROGRAM. 
Section 3733(a)(8) of title 38, United States Code, is 
amended—
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† HR 5371 EAS 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’; and 
(2) in subparagraph (C), by striking ‘‘September 
30, 2025’’ and inserting ‘‘September 30, 2026’’. 
SEC. 7405. EXTENSION OF AUTHORITY FOR TRANSFER OF 
REAL PROPERTY. 
Section 8118(a)(5) of title 38, United States Code, is 
amended by striking ‘‘September 30, 2025’’ and inserting 
‘‘September 30, 2026’’. 
SEC. 7406. RETROACTIVE EFFECTIVE DATE. 
The amendments made by this division, except for the 
amendments made by section 7307, shall take effect as if 
enacted on September 30, 2025. 
DIVISION H—MISCELLANEOUS 
SEC. 8001. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this division and divisions E through G shall 
not be entered on either PAYGO scorecard maintained pur-
suant to section 4(d) of the Statutory Pay-As-You-Go Act 
of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary ef-
fects of this division and divisions E through G shall not 
be entered on any PAYGO scorecard maintained for pur-
poses of section 4106 of H. Con. Res. 71 (115th Congress).
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† HR 5371 EAS 
(c) CLASSIFICATION OF BUDGETARY EFFECTS.—Not-
withstanding Rule 3 of the Budget Scorekeeping Guidelines 
set forth in the joint explanatory statement of the committee 
of conference accompanying Conference Report 105–217 
and section 250(c)(8) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985, the budgetary effects of 
this division and divisions E through G shall not be esti-
mated— 
(1) for purposes of section 251 of such Act; 
(2) for purposes of an allocation to the Com-
mittee on Appropriations pursuant to section 302(a) 
of the Congressional Budget Act of 1974; and 
(3) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
(d) BALANCES ON THE PAYGO SCORECARDS.—Effec-
tive on the date of the adjournment of the first session of 
the 119th Congress, and for the purposes of the annual re-
port issued pursuant to section 5 of the Statutory Pay-As- 
You-Go Act of 2010 (2 U.S.C. 934) after such adjournment 
and for determining whether a sequestration order is nec-
essary under such section, the balances on the PAYGO score-
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cards established pursuant to paragraphs (4) and (5) of sec-
tion 4(d) of such Act shall be zero. 
Attest: 
Secretary.