H. R. 7148—481 
Congress a report assessing fraud risks relating to clinical diag-
nostic laboratory tests for which payment may be made under 
section 1834A of the Social Security Act (42 U.S.C. 1395m–1) and 
effective tools for reducing such fraudulent claims. The report may 
include, at the Inspector General’s discretion— 
(1) which, if any, clinical diagnostic laboratory tests are 
identified as being at high risk of fraudulent claims, and an 
analysis of the factors that contribute to such risk; 
(2) with respect to a clinical diagnostic laboratory test 
identified under paragraph (1) as being at high risk of fraudu-
lent claims— 
(A) the amount payable under such section 1834A with 
respect to such test; 
(B) the number of such tests furnished to individuals 
enrolled under part B of title XVIII of the Social Security 
Act (42 U.S.C. 1395j et seq.); 
(C) whether an order for such a test was more likely 
to come from a provider with whom the individual involved 
did not have a prior relationship, as determined on the 
basis of prior payment experience; and 
(D) the frequency with which a claim for payment 
under such section 1834A included the payment modifier 
identified by code 59 or 91; and 
(3) suggested strategies for reducing the number of fraudu-
lent claims made with respect to tests so identified as being 
at high risk, including— 
(A) an analysis of whether the Centers for Medicare 
& Medicaid Services can detect aberrant billing patterns 
with respect to such tests in a timely manner; 
(B) any strategies for identifying and monitoring the 
providers who are outliers with respect to the number 
of such tests that such providers order; and 
(C) targeted education efforts to mitigate improper 
billing for such tests; and 
(4) such other information as the Inspector General deter-
mines appropriate. 
(c) FUNDING.—In addition to amounts otherwise available, there 
is appropriated to the Inspector General of the Department of 
Health and Human Services, out of any money in the Treasury 
not otherwise appropriated, $1,200,000 for fiscal year 2026, to 
remain available until expended, to carry out this section. 
SEC. 6213. GUIDANCE ON FURNISHING SERVICES VIA TELEHEALTH 
TO INDIVIDUALS WITH LIMITED ENGLISH PROFICIENCY. 
(a) IN GENERAL.—Not later than 1 year after the date of enact-
ment of this section, the Secretary of Health and Human Services, 
in consultation with 1 or more entities from each of the categories 
described in paragraphs (1) through (7) of subsection (b), shall 
issue and disseminate, or update and revise as applicable, guidance 
for the entities described in such subsection on the following: 
(1) Best practices on facilitating and integrating use of 
interpreters during a telemedicine appointment. 
(2) Best practices on providing accessible instructions on 
how to access telecommunications systems (as such term is 
used for purposes of section 1834(m) of the Social Security 
Act (42 U.S.C. 1395m(m)) for individuals with limited English 
proficiency.
H. R. 7148—482 
(3) Best practices on improving access to digital patient 
portals for individuals with limited English proficiency. 
(4) Best practices on integrating the use of video platforms 
that enable multi-person video calls furnished via a tele-
communications system for purposes of providing interpretation 
during a telemedicine appointment for an individual with lim-
ited English proficiency. 
(5) Best practices for providing patient materials, commu-
nications, and instructions in multiple languages, including 
text message appointment reminders and prescription informa-
tion. 
(b) ENTITIES DESCRIBED.—For purposes of subsection (a), an 
entity described in this subsection is an entity in 1 or more of 
the following categories: 
(1) Health information technology service providers, 
including— 
(A) electronic medical record companies; 
(B) remote patient monitoring companies; and 
(C) telehealth or mobile health vendors and companies. 
(2) Health care providers, including— 
(A) physicians; and 
(B) hospitals. 
(3) Health insurers. 
(4) Language service companies. 
(5) Interpreter or translator professional associations. 
(6) Health and language services quality certification 
organizations. 
(7) Patient and consumer advocates, including such advo-
cates that work with individuals with limited English pro-
ficiency. 
SEC. 6214. INCLUSION OF VIRTUAL DIABETES PREVENTION PROGRAM 
SUPPLIERS IN MDPP EXPANDED MODEL. 
(a) IN GENERAL.—For the period beginning on January 1, 2026, 
and ending on December 31, 2029— 
(1) an entity may participate in the MDPP by offering 
only MDPP services via distance learning or online delivery 
modalities if such entity meets the conditions for enrollment 
as an MDPP supplier; 
(2) if an entity participates in the MDPP in the manner 
described in paragraph (1), in the case of online MDPP services 
furnished by such entity to an MDPP beneficiary who was 
not located in the same State as the entity at the time such 
services were furnished, the entity shall not be prohibited from 
submitting a claim for payment for such services solely by 
reason of the location of such beneficiary at such time; and 
(3) no limit is applied on the number of times an individual 
may enroll in the MDPP. 
(b) DEFINITIONS.—In this section: 
(1) MDPP.—The term ‘‘MDPP’’ means the Medicare 
Diabetes Prevention Program (as such term is defined in section 
410.79(b) of title 42, Code of Federal Regulations). 
(2) REGULATORY TERMS.—The terms ‘‘distance learning’’, 
‘‘MDPP beneficiary’’, ‘‘MDPP services’’, ‘‘MDPP supplier’’, and 
‘‘online’’ have the meanings given such terms in section 
410.79(b) of title 42, Code of Federal Regulations.
H. R. 7148—483 
(3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(c) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary may implement this section by program instruc-
tion or otherwise. 
SEC. 6215. MEDICATION-INDUCED MOVEMENT DISORDER OUTREACH 
AND EDUCATION. 
Not later than January 1, 2028, the Secretary of Health and 
Human Services shall use existing communications mechanisms 
to provide education and outreach to physicians and appropriate 
non-physician practitioners participating under the Medicare pro-
gram under title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) with respect to periodic screening for medication-induced 
movement disorders that are associated with the treatment of 
mental health disorders in at-risk patients, as well as resources 
related to clinical guidelines and best practices for furnishing such 
screening services through telehealth. Such education and outreach 
shall include information on how to account for such screening 
services in evaluation and management code selection. The Sec-
retary shall, to the extent practicable, seek input from relevant 
stakeholders to inform such education and outreach. Such education 
and outreach may also address other relevant screening services 
furnished through telehealth, as the Secretary determines appro-
priate. 
SEC. 6216. REPORT ON WEARABLE MEDICAL DEVICES. 
Not later than 18 months after the date of the enactment 
of this Act, the Comptroller General of the United States shall 
conduct a technology assessment of, and submit to Congress a 
report on, the capabilities and limitations of wearable medical 
devices used to support clinical decision-making. Such report shall 
include a description of— 
(1) the potential for such devices to accurately prescribe 
treatments; 
(2) an examination of the benefits and challenges of artifi-
cial intelligence to augment such capabilities; and 
(3) policy options to enhance the benefits and mitigate 
potential challenges of developing or using such devices. 
SEC. 6217. EXTENSION OF TEMPORARY INCLUSION OF AUTHORIZED 
ORAL ANTIVIRAL DRUGS AS COVERED PART D DRUGS. 
Section 1860D–2(e)(1)(C) of the Social Security Act (42 U.S.C. 
1395w–102(e)(1)(C)) is amended by striking ‘‘January 30, 2026’’ 
and inserting ‘‘December 31, 2026’’. 
SEC. 6218. EXTENSION OF ADJUSTMENT TO CALCULATION OF HOSPICE 
CAP AMOUNT UNDER MEDICARE. 
Section 1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
1395f(i)(2)(B)) is amended— 
(1) in clause (ii), by striking ‘‘2033’’ and inserting ‘‘2035’’; 
and 
(2) in clause (iii), by striking ‘‘2033’’ and inserting ‘‘2035’’. 
SEC. 6219. ADJUSTMENTS TO MEDICARE PART D COST-SHARING 
REDUCTIONS FOR LOW-INCOME INDIVIDUALS. 
Section 1860D–14(a) of the Social Security Act (42 U.S.C. 
1395w–114(a)) is amended—
H. R. 7148—484 
(1) in paragraph (1)(D)(ii), by striking ‘‘that does not exceed 
$1 for’’ and all that follows through the period at the end 
and inserting ″that does not exceed— ‘‘ 
‘‘(I) for a plan year before 2028— 
‘‘(aa) for a generic drug or a preferred 
drug that is a multiple source drug (as defined 
in section 1927(k)(7)(A)(i)), $1 or, if less, the 
copayment amount applicable to an individual 
under clause (iii); and 
‘‘(bb) for any other drug, $3 or, if less, 
the copayment amount applicable to an indi-
vidual under clause (iii); and 
‘‘(II) for plan year 2028 and each subsequent 
plan year— 
‘‘(aa) for a generic drug, $0; 
‘‘(bb) for a preferred drug that is a mul-
tiple source drug (as defined in section 
1927(k)(7)(A)(i)), the dollar amount applied 
under this clause for such a drug for the pre-
ceding plan year, increased by the annual 
percentage increase in the consumer price 
index (all items; U.S. city average) as of Sep-
tember of such preceding year, or, if less, the 
copayment amount applicable to an individual 
under clause (iii); and 
‘‘(cc) for a drug not described in either 
item (aa) or (bb), the dollar amount applied 
under this clause for such a drug for the pre-
ceding plan year, increased in the manner 
specified in item (bb), or, if less, the copayment 
amount applicable to an individual under 
clause (iii). 
Any amount established under item (bb) or (cc) of 
subclause (II), that is based on an increase of $1 or 
$3, that is not a multiple of 5 cents or 10 cents, 
respectively, shall be rounded to the nearest multiple 
of 5 cents or 10 cents, respectively.’’; and 
(2) in paragraph (4)(A)(ii), by inserting ‘‘(before 2028)’’ after 
‘‘a subsequent year’’. 
SEC. 6220. REQUIRING ENHANCED AND ACCURATE LISTS OF (REAL) 
HEALTH PROVIDERS ACT. 
(a) IN GENERAL.—Section 1852(c) of the Social Security Act 
(42 U.S.C. 1395w–22(c)) is amended— 
(1) in paragraph (1)(C)— 
(A) by striking ‘‘plan, and any’’ and inserting ‘‘plan, 
any’’; and 
(B) by inserting the following before the period: ‘‘, 
and, in the case of a specified MA plan (as defined in 
paragraph (3)(C)), for plan year 2028 and subsequent plan 
years, the information described in paragraph (3)(B)’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(3) PROVIDER DIRECTORY ACCURACY.— 
‘‘(A) IN GENERAL.—For plan year 2028 and subsequent 
plan years, each MA organization offering a specified MA 
plan (as defined in subparagraph (C)) shall, for each such 
plan offered by the organization—
H. R. 7148—485 
‘‘(i) maintain, on a publicly available internet 
website, an accurate provider directory that includes 
the information described in subparagraph (B); 
‘‘(ii) not less frequently than once every 90 days 
(or, in the case of a hospital or any other facility 
determined appropriate by the Secretary, at a lesser 
frequency specified by the Secretary but in no case 
less frequently than once every 12 months), verify the 
provider directory information of each provider listed 
in such directory and, if applicable, update such 
information; 
‘‘(iii) if the organization is unable to verify such 
information with respect to a provider, include in such 
directory an indication that the information of such 
provider may not be up to date; and 
‘‘(iv) remove a provider from such directory within 
5 business days if the organization determines that 
the provider is no longer a provider participating in 
the network of such plan. 
‘‘(B) PROVIDER DIRECTORY INFORMATION.—The informa-
tion described in this subparagraph is information enrollees 
may need to access covered benefits from a provider with 
which such organization offering such plan has an agree-
ment for furnishing items and services covered under such 
plan, such as name, specialty, contact information, primary 
office or facility addresses where items or services are 
furnished, whether the provider is accepting new patients, 
accommodations for people with disabilities, cultural and 
linguistic capabilities, and telehealth capabilities. 
‘‘(C) SPECIFIED MA PLAN.—In this paragraph, the term 
‘specified MA plan’ means— 
‘‘(i) a network-based plan (as defined in subsection 
(d)(5)(C)); or 
‘‘(ii) a Medicare Advantage private fee-for-service 
plan (as defined in section 1859(b)(2)) that meets the 
access standards under subsection (d)(4), in whole or 
in part, through entering into contracts or agreements 
as provided for under subparagraph (B) of such sub-
section.’’. 
(b) ACCOUNTABILITY
FOR PROVIDER DIRECTORY ACCURACY.— 
(1) COST SHARING FOR SERVICES FURNISHED BASED ON RELI-
ANCE ON INCORRECT PROVIDER DIRECTORY INFORMATION.—Sec-
tion 1852(d) of the Social Security Act (42 U.S.C. 1395w–22(d)) 
is amended— 
(A) in paragraph (1)(C)— 
(i) in clause (ii), by striking ‘‘or’’ at the end; 
(ii) in clause (iii), by striking the semicolon at 
the end and inserting ‘‘, or’’; and 
(iii) by adding at the end the following new clause: 
‘‘(iv) for plan year 2028 and subsequent plan years, 
in the case of a specified MA plan (as defined in 
subsection (c)(3)(C)), the services were furnished by 
a provider that was not participating in the network 
of such plan but was listed in the provider directory 
of such plan on the date on which the appointment 
was made, as described in paragraph (7)(A);’’; and 
(B) by adding at the end the following new paragraph:
H. R. 7148—486 
‘‘(7) COST SHARING FOR SERVICES FURNISHED BASED ON RELI-
ANCE ON INCORRECT PROVIDER DIRECTORY INFORMATION.— 
‘‘(A) IN GENERAL.—For plan year 2028 and subsequent 
plan years, if an enrollee in a specified MA plan (as defined 
in subsection (c)(3)(C)) is furnished an item or service by 
a provider that is not participating in the network of such 
plan but is listed in the provider directory of such plan 
(as required to be provided to an enrollee pursuant to 
subsection (c)(1)(C)) on the date on which the appointment 
is made, and if such item or service would otherwise be 
covered under such plan if furnished by a provider that 
is participating in the network of such plan, the MA 
organization offering such plan shall ensure that the 
enrollee is only responsible for the lesser of— 
‘‘(i) the amount of cost sharing that would apply 
if such provider had been participating in the network 
of such plan; or 
‘‘(ii) the amount of cost sharing that would other-
wise apply (without regard to this subparagraph). 
‘‘(B) NOTIFICATION REQUIREMENT.—For plan year 2028 
and subsequent plan years, each MA organization that 
offers a specified MA plan shall— 
‘‘(i) notify enrollees of their cost-sharing protections 
under this paragraph and make such notifications, to 
the extent practicable, by not later than the first day 
of an annual, coordinated election period under section 
1851(e)(3) with respect to a year; 
‘‘(ii) include information regarding such cost- 
sharing protections in the provider directory of each 
specified MA plan offered by the MA organization.; 
and 
‘‘(iii) notify enrollees of their cost-sharing protec-
tions under this paragraph in the first explanation 
of benefits issued in a plan year.’’. 
(2) REQUIRED PROVIDER DIRECTORY ACCURACY ANALYSIS AND 
REPORTS.— 
(A) IN GENERAL.—Section 1857(e) of the Social Security 
Act (42 U.S.C. 1395w–27(e)) is amended by adding at the 
end the following new paragraph: 
‘‘(6) 
PROVIDER
DIRECTORY
ACCURACY
ANALYSIS
AND 
REPORTS.— 
‘‘(A) IN GENERAL.—Beginning with plan years begin-
ning on or after January 1, 2028, subject to subparagraph 
(C), a contract under this section with an MA organization 
shall require the organization, for each specified MA plan 
(as defined in section 1852(c)(3)(C)) offered by the organiza-
tion, to annually do the following: 
‘‘(i) Conduct an analysis estimating the accuracy 
of the provider directory information of such plan using 
a random sample of providers included in such provider 
directory as follows: 
‘‘(I) Such a random sample shall include a 
random sample of each specialty of providers with 
a high inaccuracy rate of provider directory 
information relative to other specialties of pro-
viders, as determined by the Secretary.
H. R. 7148—487 
‘‘(II) For purposes of subclause (I), one type 
of specialty may be providers specializing in 
mental health or substance use disorder treatment. 
‘‘(ii) Submit to the Secretary a report containing 
the results of the analysis conducted under clause (i), 
including an accuracy score for such provider directory 
information (as determined using a plan verification 
method specified by the Secretary under subparagraph 
(B)(i)). 
‘‘(B) DETERMINATION OF ACCURACY SCORE.— 
‘‘(i) IN GENERAL.—The Secretary shall specify plan 
verification 
methods, 
such 
as 
using 
telephonic 
verification or other approaches using data sources 
maintained by an MA organization or using publicly 
available data sets, that MA organizations may use 
for estimating accuracy scores of the provider directory 
information of specified MA plans offered by such 
organizations. 
‘‘(ii) 
ACCURACY
SCORE
METHODOLOGY.—With 
respect to each such method specified by the Secretary 
as described in clause (i), the Secretary shall specify 
a methodology for MA organizations to use in esti-
mating such accuracy scores. Each such methodology 
shall take into account the administrative burden on 
plans and providers and the relative importance of 
certain provider directory information on enrollee 
ability to access care. 
‘‘(C) EXCEPTION.—The Secretary may waive the 
requirements of this paragraph in the case of a specified 
MA plan with low enrollment (as defined by the Secretary). 
‘‘(D) TRANSPARENCY.—Beginning with plan years begin-
ning on or after January 1, 2029, the Secretary shall post 
accuracy scores (as reported under subparagraph (A)(ii)), 
in a machine readable file, on an internet website main-
tained by the Centers for Medicare & Medicaid Services.’’. 
(B) PROVISION OF INFORMATION TO BENEFICIARIES.— 
Section 1851(d)(4) of the Social Security Act (42 U.S.C. 
1395w–21(d)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) PROVIDER DIRECTORY.—Beginning with plan years 
beginning on or after January 1, 2029, in the case of 
a specified MA plan (as defined in section 1852(c)(3)(C)), 
the accuracy score of the plan’s provider directory (as 
reported under section 1857(e)(6)(A)(ii)) listed prominently 
on the plan’s provider directory.’’. 
(C) FUNDING.—In addition to amounts otherwise avail-
able, there is appropriated to the Centers for Medicare 
& Medicaid Services Program Management Account, out 
of any money in the Treasury not otherwise appropriated, 
$4,000,000 for fiscal year 2026, to remain available until 
expended, to carry out the amendments made by this para-
graph. 
(3) GAO STUDY AND REPORT.— 
(A) ANALYSIS.—The Comptroller General of the United 
States (in this paragraph referred to as the ‘‘Comptroller 
General’’) shall conduct a study of the implementation of 
the amendments made by paragraphs (1) and (2). To the
H. R. 7148—488 
extent data are available and reliable, such study shall 
include an analysis of— 
(i) the use of cost-sharing protections required 
under section 1852(d)(7)(A) of the Social Security Act, 
as added by paragraph (1); 
(ii) the trends in provider directory information 
accuracy scores submitted to the Secretary of Health 
and Human Services under section 1857(e)(6)(A)(ii) of 
the Social Security Act (as added by paragraph (2)(A)), 
both overall and among providers specializing in 
mental health or substance use disorder treatment; 
(iii) provider response rates by plan verification 
methods; 
(iv) administrative costs to providers and Medicare 
Advantage organizations; and 
(v) other items determined appropriate by the 
Comptroller General. 
(B) REPORT.—Not later than January 15, 2033, the 
Comptroller General shall submit to Congress a report 
containing the results of the study conducted under 
subparagraph (A), together with recommendations for such 
legislation and administrative action as the Comptroller 
General determines appropriate. 
(c) GUIDANCE
ON MAINTAINING ACCURATE PROVIDER DIREC-
TORIES.— 
(1) STAKEHOLDER MEETING.— 
(A) IN GENERAL.—Not later than 6 months after the 
date of enactment of this Act, the Secretary of Health 
and Human Services (referred to in this subsection as 
the ‘‘Secretary’’) shall hold a public meeting to receive 
input on approaches for maintaining accurate provider 
directories for Medicare Advantage plans under part C 
of title XVIII of the Social Security Act (42 U.S.C. 1395w– 
21 et seq.), including input on approaches for reducing 
administrative burden, such as data standardization, and 
best practices to maintain accurate provider directory 
information. 
(B) PARTICIPANTS.—Participants of the meeting under 
subparagraph (A) shall include representatives from the 
Centers for Medicare & Medicaid Services and the Assist-
ant Secretary for Technology Policy and Office of the 
National Coordinator for Health Information Technology. 
Such meeting shall be open to the public. To the extent 
practicable, the Secretary shall include health care pro-
viders, companies that specialize in relevant technologies, 
health insurers, and patient advocates. 
(2) GUIDANCE TO MEDICARE ADVANTAGE ORGANIZATIONS.— 
Not later than 18 months after the date of enactment of this 
Act, the Secretary shall issue guidance to Medicare Advantage 
organizations offering Medicare Advantage plans under part 
C of title XVIII of the Social Security Act (42 U.S.C. 1395w– 
21 et seq.) on maintaining accurate provider directories for 
such plans, taking into consideration input received during 
the stakeholder meeting under paragraph (1). Such guidance 
may include the following, as determined appropriate by the 
Secretary:
H. R. 7148—489 
(A) Best practices for Medicare Advantage organiza-
tions on how to work with providers to maintain the 
accuracy of provider directories and reduce provider and 
Medicare Advantage organization burden with respect to 
maintaining the accuracy of provider directories. 
(B) Information on data sets and data sources with 
information that could be used by Medicare Advantage 
organizations to maintain accurate provider directories. 
(C) Approaches for utilizing data sources maintained 
by Medicare Advantage organizations and publicly avail-
able data sets to maintain accurate provider directories. 
(D) Information that may be useful to include in pro-
vider directories for Medicare beneficiaries to use in 
assessing plan networks when selecting a plan and 
accessing providers participating in plan networks during 
the plan year. 
(3) GUIDANCE TO PART B PROVIDERS.—Not later than 12 
months after the date of enactment of this Act, the Secretary 
shall issue guidance to providers of services and suppliers who 
furnish items or services for which benefits are available under 
part B of title XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.) on when to update the National Plan and Provider 
Enumeration System (or a successor system) for information 
changes. 
SEC. 6221. MEDICARE COVERAGE OF MULTI-CANCER EARLY DETEC-
TION SCREENING TESTS. 
(a) COVERAGE.—Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking the semicolon at the end of subpara-
graph (JJ) and inserting ‘‘; and’’; and 
(B) by adding at the end the following new subpara-
graph: 
‘‘(KK) multi-cancer early detection screening tests (as 
defined in subsection (nnn));’’; and 
(2) by adding at the end the following new subsection: 
‘‘(nnn) MULTI-CANCER EARLY DETECTION SCREENING TESTS.— 
‘‘(1) IN GENERAL.—The term ‘multi-cancer early detection 
screening test’ means a test furnished to an individual for 
the concurrent detection of multiple cancer types across mul-
tiple organ sites on or after January 1, 2029, that— 
‘‘(A) is cleared under section 510(k), classified under 
section 513(f)(2), or approved under section 515 of the 
Federal Food, Drug, and Cosmetic Act; 
‘‘(B) is— 
‘‘(i) a genomic sequencing blood or blood product 
test that includes the analysis of cell-free nucleic acids; 
or 
‘‘(ii) a test based on samples of biological material 
that provide results comparable to those obtained with 
a test described in clause (i), as determined by the 
Secretary; and 
‘‘(C) the Secretary determines is— 
‘‘(i) reasonable and necessary for the prevention 
or early detection of an illness or disability; and
H. R. 7148—490 
‘‘(ii) appropriate for individuals entitled to benefits 
under part A or enrolled under part B. 
‘‘(2) NCD PROCESS.—In making determinations under para-
graph (1)(C) regarding the coverage of a new test, the Secretary 
shall use the process for making national coverage determina-
tions (as defined in section 1869(f)(1)(B)) under this title.’’. 
(b) PAYMENT AND STANDARDS FOR MULTI-CANCER EARLY DETEC-
TION SCREENING TESTS.— 
(1) IN GENERAL.—Section 1834 of the Social Security Act 
(42 U.S.C. 1395m) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(aa) PAYMENT
AND STANDARDS
FOR MULTI-CANCER EARLY 
DETECTION SCREENING TESTS.— 
‘‘(1) PAYMENT AMOUNT.—The payment amount for a multi- 
cancer early detection screening test (as defined in section 
1861(nnn)) is— 
‘‘(A) with respect to such a test furnished before 
January 1, 2031, equal to the payment amount in effect 
on the date of the enactment of this subsection for a multi- 
target stool screening DNA test covered pursuant to section 
1861(pp)(1)(D); and 
‘‘(B) with respect to such a test furnished on or after 
January 1, 2031, equal to the lesser of— 
‘‘(i) the amount described in subparagraph (A); 
or 
‘‘(ii) the payment amount determined for such test 
under section 1834A. 
‘‘(2) LIMITATIONS.— 
‘‘(A) IN GENERAL.—No payment may be made under 
this part for a multi-cancer early detection screening test 
furnished during a year to an individual if— 
‘‘(i) such individual— 
‘‘(I) is under 50 years of age; or 
‘‘(II) as of January 1 of such year, has attained 
the age specified in subparagraph (B) for such 
year; or 
‘‘(ii) such a test was furnished to the individual 
during the previous 11 months. 
‘‘(B) AGE
SPECIFIED.—For purposes of subparagraph 
(A)(i)(II), the age specified in this subparagraph is— 
‘‘(i) for 2029, 65 years of age; and 
‘‘(ii) for a succeeding year, the age specified in 
this subparagraph for the preceding year, increased 
by 1 year. 
‘‘(C) STANDARDS FOLLOWING USPSTF RATING OF A OR 
B.—In the case of a multi-cancer early detection screening 
test that is recommended with a grade of A or B by the 
United States Preventive Services Task Force, beginning 
on the date on which coverage for such test is provided 
pursuant to section 1861(ddd)(1), the preceding provisions 
of this paragraph shall not apply.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended— 
(i) in subsection (a)—
H. R. 7148—491 
(I) in paragraph (1)(D)(i)(I), by striking ‘‘sec-
tion 1834(d)(1)’’ and inserting ‘‘subsection (d)(1) 
or (aa) of section 1834’’; and 
(II) in paragraph (2)(D)(i)(I), by striking ‘‘sec-
tion 1834(d)(1)’’ and inserting ‘‘subsection (d)(1) 
or (aa) of section 1834’’; and 
(ii) in subsection (h)(1)(A), by striking ‘‘section 
1834(d)(1)’’ and inserting ‘‘subsections (d)(1) and (aa) 
of section 1834’’. 
(B) Section 1862(a)(1)(A) of the Social Security Act 
(42 U.S.C. 1395y(a)(1)(A)) is amended— 
(i) by striking ‘‘or additional preventive services’’ 
and inserting ‘‘, additional preventive services’’; and 
(ii) by inserting ‘‘, or multi-cancer early detection 
screening tests (as defined in section 1861(nnn))’’ after 
‘‘(as described in section 1861(ddd)(1))’’. 
(c) RULE
OF CONSTRUCTION RELATING
TO OTHER CANCER 
SCREENING TESTS.—Nothing in this section, including the amend-
ments made by this section, shall be construed— 
(1) in the case of an individual who undergoes a multi- 
cancer early detection screening test, to affect coverage under 
part B of title XVIII of the Social Security Act for other cancer 
screening tests covered under such title, such as screening 
tests for breast, cervical, colorectal, lung, or prostate cancer; 
or 
(2) in the case of an individual who undergoes another 
cancer screening test, to affect coverage under such part for 
a multi-cancer early detection screening test or the use of 
such a test as a diagnostic or confirmatory test for a result 
of the other cancer screening test. 
(d) FUNDING.—In addition to amounts otherwise available, 
there is appropriated to the Centers for Medicare & Medicaid Serv-
ices Program Management Account, out of any money in the 
Treasury not otherwise appropriated, $2,000,000 for fiscal year 
2026, to remain available until expended, to carry out this section. 
SEC. 6222. MEDICARE COVERAGE OF EXTERNAL INFUSION PUMPS AND 
NON-SELF-ADMINISTRABLE HOME INFUSION DRUGS. 
(a) IN GENERAL.—Section 1861(n) of the Social Security Act 
(42 U.S.C. 1395x(n)) is amended by adding at the end the following 
new sentence: ‘‘Beginning with the first calendar quarter beginning 
on or after the date that is 1 year after the date of the enactment 
of this sentence, an external infusion pump and associated home 
infusion drug (as defined in subsection (iii)(3)(C)) or other associated 
supplies that do not meet the appropriate for use in the home 
requirement applied to the definition of durable medical equipment 
under section 414.202 of title 42, Code of Federal Regulations 
(or any successor to such regulation) shall be treated as meeting 
such requirement if each of the following criteria is satisfied: 
‘‘(1) The prescribing information approved by the Food and 
Drug Administration for the home infusion drug associated 
with the pump instructs that the drug should be administered 
by or under the supervision of a health care professional. 
‘‘(2) A qualified home infusion therapy supplier (as defined 
in subsection (iii)(3)(D)) administers or supervises the adminis-
tration of the drug or biological in a safe and effective manner 
in the patient’s home (as defined in subsection (iii)(3)(B)).
H. R. 7148—492 
‘‘(3) The prescribing information described in paragraph 
(1) instructs that the drug should be infused at least 12 times 
per year— 
‘‘(A) intravenously or subcutaneously; or 
‘‘(B) at infusion rates that the Secretary determines 
would require the use of an external infusion pump.’’. 
(b) COST SHARING NOTIFICATION.—The Secretary of Health and 
Human Services shall ensure that patients are notified of the cost 
sharing for electing home infusion therapy compared to other 
applicable settings of care for the furnishing of infusion drugs 
under the Medicare program. 
SEC. 6223. ASSURING PHARMACY ACCESS AND CHOICE FOR MEDICARE 
BENEFICIARIES. 
(a) IN GENERAL.—Section 1860D–4(b)(1) of the Social Security 
Act (42 U.S.C. 1395w–104(b)(1)) is amended by striking subpara-
graph (A) and inserting the following: 
‘‘(A) IN GENERAL.— 
‘‘(i) PARTICIPATION OF ANY WILLING PHARMACY.— 
A PDP sponsor offering a prescription drug plan shall 
permit any pharmacy that meets the standard contract 
terms and conditions under such plan to participate 
as a network pharmacy of such plan. 
‘‘(ii) CONTRACT TERMS AND CONDITIONS.— 
‘‘(I) IN GENERAL.—Notwithstanding any other 
provision of law, for plan years beginning on or 
after January 1, 2029, in accordance with clause 
(i), contract terms and conditions offered by such 
PDP sponsor shall be reasonable and relevant 
according to standards established by the Sec-
retary under subclause (II). 
‘‘(II) STANDARDS.—Not later than the first 
Monday in April of 2028, the Secretary shall estab-
lish standards for reasonable and relevant contract 
terms and conditions for purposes of this clause. 
‘‘(III) REQUEST FOR INFORMATION.—Not later 
than April 1, 2027, for purposes of establishing 
the standards under subclause (II), the Secretary 
shall issue a request for information to seek input 
on trends in prescription drug plan and network 
pharmacy contract terms and conditions, current 
prescription drug plan and network pharmacy con-
tracting practices, whether pharmacy reimburse-
ment and dispensing fees paid by PDP sponsors 
to network pharmacies sufficiently cover the ingre-
dient and operational costs of such pharmacies, 
the use and application of pharmacy quality meas-
ures by PDP sponsors for network pharmacies, 
PDP sponsor restrictions or limitations on the dis-
pensing of covered part D drugs by network phar-
macies (or any subsets of such pharmacies), PDP 
sponsor auditing practices for network pharmacies, 
areas in current regulations or program guidance 
related to contracting between prescription drug
H. R. 7148—493 
plans and network pharmacies requiring clarifica-
tion or additional specificity, factors for consider-
ation in determining the reasonableness and rel-
evance of contract terms and conditions between 
prescription drug plans and network pharmacies, 
and other issues as determined appropriate by the 
Secretary.’’. 
(b) ESSENTIAL RETAIL PHARMACIES.—Section 1860D–42 of the 
Social Security Act (42 U.S.C. 1395w–152) is amended by adding 
at the end the following new subsection: 
‘‘(e) ESSENTIAL RETAIL PHARMACIES.— 
‘‘(1) IN GENERAL.—With respect to plan years beginning 
on or after January 1, 2028, the Secretary shall publish reports, 
at least once every 2 years until 2034, and periodically there-
after, that provide information, to the extent feasible, on— 
‘‘(A) trends in ingredient cost reimbursement, dis-
pensing fees, incentive payments and other fees paid by 
PDP sponsors offering prescription drug plans and MA 
organizations offering MA–PD plans under this part to 
essential retail pharmacies (as defined in paragraph (2)) 
with respect to the dispensing of covered part D drugs, 
including a comparison of such trends between essential 
retail pharmacies and pharmacies that are not essential 
retail pharmacies; 
‘‘(B) trends in amounts paid to PDP sponsors offering 
prescription drug plans and MA organizations offering MA– 
PD plans under this part by essential retail pharmacies 
with respect to the dispensing of covered part D drugs, 
including a comparison of such trends between essential 
retail pharmacies and pharmacies that are not essential 
retail pharmacies; 
‘‘(C) trends in essential retail pharmacy participation 
in pharmacy networks and preferred pharmacy networks 
for prescription drug plans offered by PDP sponsors and 
MA–PD plans offered by MA organizations under this part, 
including a comparison of such trends between essential 
retail pharmacies and pharmacies that are not essential 
retail pharmacies; 
‘‘(D) trends in the number of essential retail phar-
macies, including variation in such trends by geographic 
region or other factors; 
‘‘(E) a comparison of cost-sharing for covered part D 
drugs dispensed by essential retail pharmacies that are 
network pharmacies for prescription drug plans offered 
by PDP sponsors and MA–PD plans offered by MA 
organizations under this part and cost-sharing for covered 
part D drugs dispensed by other network pharmacies for 
such plans located in similar geographic areas that are 
not essential retail pharmacies; 
‘‘(F) a comparison of the volume of covered part D 
drugs dispensed by essential retail pharmacies that are 
network pharmacies for prescription drug plans offered 
by PDP sponsors and MA–PD plans offered by MA 
organizations under this part and such volume of dis-
pensing by network pharmacies for such plans located in 
similar geographic areas that are not essential retail phar-
macies, including information on any patterns or trends
H. R. 7148—494 
in such comparison specific to certain types of covered 
part D drugs, such as generic drugs or drugs specified 
as specialty drugs by a PDP sponsor under a prescription 
drug plan or an MA organization under an MA–PD plan; 
and 
‘‘(G) a comparison of the information described in sub-
paragraphs (A) through (F) between essential retail phar-
macies that are network pharmacies for prescription drug 
plans offered by PDP sponsors under this part and essential 
retail pharmacies that are network pharmacies for MA– 
PD plans offered by MA organizations under this part. 
‘‘(2) DEFINITION OF ESSENTIAL RETAIL PHARMACY.—In this 
subsection, the term ‘essential retail pharmacy’ means, with 
respect to a plan year, a retail pharmacy that— 
‘‘(A) is not a pharmacy that is an affiliate as defined 
in paragraph (4); and 
‘‘(B) is located in— 
‘‘(i) a rural area in which there is no other retail 
pharmacy within 10 miles, as determined by the Sec-
retary; 
‘‘(ii) a suburban area in which there is no other 
retail pharmacy within 2 miles, as determined by the 
Secretary; or 
‘‘(iii) an urban area in which there is no other 
retail pharmacy within 1 mile, as determined by the 
Secretary. 
‘‘(3) LIST OF ESSENTIAL RETAIL PHARMACIES.— 
‘‘(A) PUBLICATION OF LIST OF ESSENTIAL RETAIL PHAR-
MACIES.—For each plan year (beginning with plan year 
2028), the Secretary shall publish, on a publicly available 
internet website of the Centers for Medicare & Medicaid 
Services, a list of retail pharmacies that meet the criteria 
described in subparagraphs (A) and (B) of paragraph (2) 
to be considered an essential retail pharmacy. 
‘‘(B) REQUIRED SUBMISSIONS FROM PDP SPONSORS.—For 
each plan year (beginning with plan year 2028), each PDP 
sponsor offering a prescription drug plan and each MA 
organization offering an MA–PD plan shall submit to the 
Secretary, for the purposes of determining retail phar-
macies that meet the criterion specified in subparagraph 
(A) of paragraph (2), a list of retail pharmacies that are 
affiliates of such sponsor or organization, or are affiliates 
of a pharmacy benefit manager acting on behalf of such 
sponsor or organization, at a time, and in a form and 
manner, specified by the Secretary. 
‘‘(C) REPORTING BY PDP SPONSORS AND MA ORGANIZA-
TIONS.—For each plan year beginning with plan year 2027, 
each PDP sponsor offering a prescription drug plan and 
each MA organization offering an MA–PD plan under this 
part shall submit to the Secretary information on incentive 
payments and other fees paid by such sponsor or organiza-
tion to pharmacies, insofar as any such payments or fees 
are not otherwise reported, at a time, and in a form and 
manner, specified by the Secretary. 
‘‘(D) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this para-
graph by program instruction or otherwise.
H. R. 7148—495 
‘‘(E) NONAPPLICATION OF PAPERWORK REDUCTION ACT.— 
Chapter 35 of title 44, United States Code, shall not apply 
to the implementation of this paragraph. 
‘‘(4) DEFINITION
OF
AFFILIATE; PHARMACY
BENEFIT
MAN-
AGER.—In this subsection, the terms ‘affiliate’ and ‘pharmacy 
benefit manager’ have the meaning given those terms in section 
1860D–12(h)(7).’’. 
(c) ENFORCEMENT.— 
(1) IN GENERAL.—Section 1860D–4(b)(1) of the Social Secu-
rity Act (42 U.S.C. 1395w–104(b)(1)) is amended by adding 
at the end the following new subparagraph: 
‘‘(F) ENFORCEMENT
OF
STANDARDS
FOR
REASONABLE 
AND RELEVANT CONTRACT TERMS AND CONDITIONS.— 
‘‘(i) ALLEGATION SUBMISSION PROCESS.— 
‘‘(I) IN GENERAL.—Not later than January 1, 
2029, the Secretary shall establish a process 
through which a pharmacy may submit to the 
Secretary an allegation of a violation by a PDP 
sponsor offering a prescription drug plan of the 
standards for reasonable and relevant contract 
terms and conditions under subparagraph (A)(ii), 
or of subclause (VIII) of this clause. 
‘‘(II) FREQUENCY OF SUBMISSION.— 
‘‘(aa) IN GENERAL.—Except as provided in 
item (bb), the allegation submission process 
under this clause shall allow pharmacies to 
submit any allegations of violations described 
in subclause (I) not more frequently than once 
per plan year per contract between a phar-
macy and a PDP sponsor. 
‘‘(bb) ALLEGATIONS RELATING TO CONTRACT 
MODIFICATIONS.—In the case where a contract 
between a pharmacy and a PDP sponsor is 
modified following the submission of allega-
tions by a pharmacy with respect to such con-
tract and plan year, the allegation submission 
process under this clause shall allow such 
pharmacy to submit an additional allegation 
related to those modifications with respect to 
such contract and plan year. 
‘‘(III) ACCESS TO RELEVANT DOCUMENTS AND 
MATERIALS.—A PDP sponsor subject to an allega-
tion under this clause— 
‘‘(aa) shall provide documents or mate-
rials, as specified by the Secretary, including 
contract offers made by such sponsor to such 
pharmacy or correspondence related to such 
offers, to the Secretary at a time, and in a 
form and manner, specified by the Secretary; 
and 
‘‘(bb) shall not prohibit or otherwise limit 
the ability of a pharmacy to submit such docu-
ments or materials to the Secretary for the 
purpose of submitting an allegation or pro-
viding evidence for such an allegation under 
this clause.
H. R. 7148—496 
‘‘(IV) STANDARDIZED
TEMPLATE.—The Sec-
retary shall establish a standardized template for 
pharmacies to use for the submission of allegations 
described in subclause (I). Such template shall 
require that the submission include a certification 
by the pharmacy that the information included 
is accurate, complete, and true to the best of the 
knowledge, information, and belief of such phar-
macy. 
‘‘(V) PREVENTING
FRIVOLOUS
ALLEGATIONS.— 
In the case where the Secretary determines that 
a pharmacy has submitted frivolous allegations 
under this clause on a routine basis, the Secretary 
may temporarily prohibit such pharmacy from 
using the allegation submission process under this 
clause, as determined appropriate by the Sec-
retary. 
‘‘(VI) EXEMPTION FROM FREEDOM OF INFORMA-
TION ACT.—Allegations submitted under this clause 
shall be exempt from disclosure under section 552 
of title 5, United States Code. 
‘‘(VII) RULE
OF
CONSTRUCTION.—Nothing in 
this clause shall be construed as limiting the 
ability of a pharmacy to pursue other legal actions 
or remedies, consistent with applicable Federal or 
State law, with respect to a potential violation 
of a requirement described in this subparagraph. 
‘‘(VIII) 
ANTI-RETALIATION
AND
ANTI-COER-
CION.—Consistent with applicable Federal or State 
law, a PDP sponsor shall not— 
‘‘(aa) retaliate against a pharmacy for 
submitting any allegations under this clause; 
or 
‘‘(bb) coerce, intimidate, threaten, or inter-
fere with the ability of a pharmacy to submit 
any such allegations. 
‘‘(ii) INVESTIGATION.—The Secretary shall inves-
tigate, as determined appropriate by the Secretary, 
allegations submitted pursuant to clause (i). 
‘‘(iii) ENFORCEMENT.— 
‘‘(I) IN GENERAL.—In the case where the Sec-
retary determines that a PDP sponsor offering a 
prescription drug plan has violated the standards 
for reasonable and relevant contract terms and 
conditions under subparagraph (A)(ii) or the provi-
sions of clause (i)(VIII) of this subparagraph, the 
Secretary may use authorities under sections 
1857(g) and 1860D–12(b)(3)(E) to impose civil 
monetary penalties or other intermediate sanc-
tions. 
‘‘(II) APPLICATION
OF
CIVIL
MONETARY
PEN-
ALTIES.—The provisions of section 1128A (other 
than subsections (a) and (b)) shall apply to a civil 
monetary penalty under this clause in the same 
manner as such provisions apply to a penalty or 
proceeding under section 1128A(a).’’.
H. R. 7148—497 
(2) CONFORMING
AMENDMENT.—Section 1857(g)(1) of the 
Social Security Act (42 U.S.C. 1395w–27(g)(1)) is amended— 
(A) in subparagraph (J), by striking ‘‘or’’ after the 
semicolon; 
(B) by redesignating subparagraph (K) as subpara-
graph (L); 
(C) by inserting after subparagraph (J), the following 
new subparagraph: 
‘‘(K) fails to comply with the standards for reasonable 
and relevant contract terms and conditions under subpara-
graph (A)(ii) of section 1860D–4(b)(1) or violates the provi-
sions of subparagraph (F)(i)(VIII) of such section; or’’; 
(D) in subparagraph (L), as redesignated by subpara-
graph (B), by striking ‘‘through (J)’’ and inserting ‘‘through 
(K)’’; and 
(E) in the flush matter following subparagraph (L), 
as so redesignated, by striking ‘‘subparagraphs (A) through 
(K)’’ and inserting ‘‘subparagraphs (A) through (L)’’. 
(d) ACCOUNTABILITY OF PHARMACY BENEFIT MANAGERS FOR VIO-
LATIONS
OF REASONABLE
AND RELEVANT CONTRACT TERMS
AND 
CONDITIONS.— 
(1) IN GENERAL.—Section 1860D–12(b) of the Social Secu-
rity Act (42 U.S.C. 1395w–112) is amended by adding at the 
end the following new paragraph: 
‘‘(9) ACCOUNTABILITY OF PHARMACY BENEFIT MANAGERS FOR 
VIOLATIONS OF REASONABLE AND RELEVANT CONTRACT TERMS 
AND CONDITIONS.—For plan years beginning on or after January 
1, 2029, each contract entered into with a PDP sponsor under 
this part with respect to a prescription drug plan offered by 
such sponsor shall provide that any pharmacy benefit manager 
acting on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy benefit man-
ager agrees to reimburse the PDP sponsor for any amounts 
paid by such sponsor under section 1860D–4(b)(1)(F)(iii)(I) to 
the Secretary as a result of a violation described in such section 
if such violation is related to a responsibility delegated to 
the pharmacy benefit manager by such PDP sponsor.’’. 
(2) MA–PD PLANS.—Section 1857(f)(3) of the Social Security 
Act (42 U.S.C. 1395w–27(f)(3)) is amended by adding at the 
end the following new subparagraph: 
‘‘(F) ACCOUNTABILITY OF PHARMACY BENEFIT MANAGERS 
FOR VIOLATIONS OF REASONABLE AND RELEVANT CONTRACT 
TERMS.—For plan years beginning on or after January 1, 
2029, section 1860D–12(b)(9).’’. 
(e) BIENNIAL REPORT
ON ENFORCEMENT
AND OVERSIGHT
OF 
PHARMACY ACCESS REQUIREMENTS.—Section 1860D–42 of the Social 
Security Act (42 U.S.C. 1395w–152), as amended by subsection 
(b), is amended by adding at the end the following new subsection: 
‘‘(f) BIENNIAL REPORT ON ENFORCEMENT AND OVERSIGHT OF 
PHARMACY ACCESS REQUIREMENTS.— 
‘‘(1) IN GENERAL.—Not later than 2 years after the date 
of enactment of this subsection, and at least once every 2 
years thereafter, the Secretary shall publish a report on enforce-
ment and oversight actions and activities undertaken by the 
Secretary with respect to the requirements under section 
1860D–4(b)(1).
H. R. 7148—498 
‘‘(2) LIMITATION.—A report under paragraph (1) shall not 
disclose— 
‘‘(A) identifiable information about individuals or enti-
ties unless such information is otherwise publicly available; 
or 
‘‘(B) trade secrets with respect to any entities.’’. 
(f) FUNDING.—In addition to amounts otherwise available, there 
is appropriated to the Centers for Medicare & Medicaid Services 
Program Management Account, out of any money in the Treasury 
not otherwise appropriated, $188,000,000 for fiscal year 2026, to 
remain available until expended, to carry out this section. 
SEC. 6224. MODERNIZING AND ENSURING PBM ACCOUNTABILITY. 
(a) IN GENERAL.— 
(1) PRESCRIPTION DRUG PLANS.—Section 1860D–12 of the 
Social Security Act (42 U.S.C. 1395w–112) is amended by 
adding at the end the following new subsection: 
‘‘(h) REQUIREMENTS RELATING
TO PHARMACY BENEFIT MAN-
AGERS.—For plan years beginning on or after January 1, 2028: 
‘‘(1) AGREEMENTS WITH PHARMACY BENEFIT MANAGERS.— 
Each contract entered into with a PDP sponsor under this 
part with respect to a prescription drug plan offered by such 
sponsor shall provide that any pharmacy benefit manager 
acting on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy benefit man-
ager, and any affiliates of such pharmacy benefit manager, 
as applicable, agree to meet the following requirements: 
‘‘(A) NO
INCOME
OTHER
THAN
BONA
FIDE
SERVICE 
FEES.— 
‘‘(i) IN GENERAL.—The pharmacy benefit manager 
and any affiliate of such pharmacy benefit manager 
shall not derive any remuneration with respect to any 
services provided on behalf of any entity or individual, 
in connection with the utilization of covered part D 
drugs, from any such entity or individual other than 
bona fide service fees, subject to clauses (ii) and (iii). 
‘‘(ii) INCENTIVE
PAYMENTS.—For the purposes of 
this subsection, an incentive payment (as determined 
by the Secretary) paid by a PDP sponsor to a pharmacy 
benefit manager or an affiliate of a pharmacy benefit 
manager that is performing services on behalf of such 
sponsor shall be deemed a ‘bona fide service fee’ (even 
if such payment does not otherwise meet the definition 
of such term under paragraph (7)(B)) if such payment 
is a flat dollar amount, is consistent with fair market 
value (as specified by the Secretary), is related to serv-
ices actually performed by the pharmacy benefit man-
ager or affiliate of such pharmacy benefit manager, 
on behalf of the PDP sponsor making such payment, 
in connection with the utilization of covered part D 
drugs, and meets additional requirements, if any, as 
determined appropriate by the Secretary. 
‘‘(iii) CLARIFICATION ON REBATES AND DISCOUNTS 
USED TO LOWER COSTS FOR COVERED PART D DRUGS.— 
Rebates, 
discounts, 
and 
other 
price 
concessions 
received by a pharmacy benefit manager or an affiliate 
of a pharmacy benefit manager from manufacturers,
H. R. 7148—499 
even if such price concessions are calculated as a 
percentage of a drug’s price, shall not be considered 
a violation of the requirements of clause (i) if they 
are fully passed through to a PDP sponsor and are 
compliant with all regulatory and subregulatory 
requirements related to direct and indirect remunera-
tion for manufacturer rebates, discounts, and other 
price concessions under this part, including in cases 
where a PDP sponsor is acting as a pharmacy benefit 
manager on behalf of a prescription drug plan offered 
by such PDP sponsor. 
‘‘(iv) EVALUATION
OF
REMUNERATION
ARRANGE-
MENTS.—Components of subsets of remuneration 
arrangements (such as fees or other forms of compensa-
tion paid to or retained by the pharmacy benefit man-
ager or affiliate of such pharmacy benefit manager), 
as determined appropriate by the Secretary, between 
pharmacy benefit managers or affiliates of such phar-
macy benefit managers, as applicable, and other enti-
ties involved in the dispensing or utilization of covered 
part D drugs (including PDP sponsors, manufacturers, 
pharmacies, and other entities as determined appro-
priate by the Secretary) shall be subject to review 
by the Secretary, in consultation with the Office of 
the Inspector General of the Department of Health 
and Human Services, as determined appropriate by 
the Secretary. The Secretary, in consultation with the 
Office of the Inspector General, shall review whether 
remuneration under such arrangements is consistent 
with fair market value (as specified by the Secretary) 
through reviews and assessments of such remunera-
tion, as determined appropriate. 
‘‘(v) DISGORGEMENT.—The pharmacy benefit man-
ager shall disgorge any remuneration paid to such 
pharmacy benefit manager or an affiliate of such phar-
macy benefit manager in violation of this subparagraph 
to the PDP sponsor. 
‘‘(vi) ADDITIONAL REQUIREMENTS.—The pharmacy 
benefit manager shall— 
‘‘(I) enter into a written agreement with any 
affiliate of such pharmacy benefit manager, under 
which the affiliate shall identify and disgorge any 
remuneration described in clause (v) to the phar-
macy benefit manager; and 
‘‘(II) attest, subject to any requirements deter-
mined appropriate by the Secretary, that the phar-
macy benefit manager has entered into a written 
agreement described in subclause (I) with any affil-
iate of the pharmacy benefit manager. 
‘‘(B) TRANSPARENCY REGARDING GUARANTEES AND COST 
PERFORMANCE EVALUATIONS.—The pharmacy benefit man-
ager shall— 
‘‘(i) define, interpret, and apply, in a fully trans-
parent and consistent manner for purposes of calcu-
lating or otherwise evaluating pharmacy benefit man-
ager performance against pricing guarantees or similar
H. R. 7148—500 
cost performance measurements related to rebates, dis-
counts, price concessions, or net costs, terms such as— 
‘‘(I) ‘generic drug’, in a manner consistent with 
the definition of the term under section 423.4 of 
title 42, Code of Federal Regulations, or a suc-
cessor regulation; 
‘‘(II) ‘brand name drug’, in a manner consistent 
with the definition of the term under section 423.4 
of title 42, Code of Federal Regulations, or a suc-
cessor regulation; 
‘‘(III) ‘specialty drug’; 
‘‘(IV) ‘rebate’; and 
‘‘(V) ‘discount’; 
‘‘(ii) identify any drugs, claims, or price concessions 
excluded from any pricing guarantee or other cost 
performance measure in a clear and consistent manner; 
and 
‘‘(iii) where a pricing guarantee or other cost 
performance measure is based on a pricing benchmark 
other than the wholesale acquisition cost (as defined 
in section 1847A(c)(6)(B)) of a drug, calculate and pro-
vide a wholesale acquisition cost-based equivalent to 
the pricing guarantee or other cost performance 
measure. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) IN GENERAL.—Not later than July 1 of each 
year, beginning in 2028, the pharmacy benefit manager 
shall submit to the PDP sponsor, and to the Secretary, 
a report, in accordance with this subparagraph, and 
shall make such report available to such sponsor at 
no cost to such sponsor in a format specified by the 
Secretary under paragraph (5). Each such report shall 
include, with respect to such PDP sponsor and each 
plan offered by such sponsor, the following information 
with respect to the previous plan year: 
‘‘(I) A list of all drugs covered by the plan 
that were dispensed including, with respect to each 
such drug— 
‘‘(aa) the brand name, generic or non- 
proprietary name, and National Drug Code; 
‘‘(bb) the number of plan enrollees for 
whom the drug was dispensed, the total 
number of prescription claims for the drug 
(including original prescriptions and refills, 
counted as separate claims), and the total 
number of dosage units of the drug dispensed; 
‘‘(cc) the number of prescription claims 
described in item (bb) by each type of dis-
pensing channel through which the drug was 
dispensed, including retail, mail order, spe-
cialty pharmacy, long term care pharmacy, 
home infusion pharmacy, or other types of 
pharmacies or dispensers; 
‘‘(dd) the average wholesale acquisition 
cost, listed as cost per day’s supply, cost per 
dosage unit, and cost per typical course of 
treatment (as applicable);
H. R. 7148—506 
‘‘(B) REPORTING
OF
ALLEGED
VIOLATIONS.—The Sec-
retary shall make available and maintain a mechanism 
for manufacturers, PDP sponsors, pharmacies, and other 
entities that have contractual relationships with pharmacy 
benefit managers or affiliates of such pharmacy benefit 
managers to report, on a confidential basis, alleged viola-
tions of paragraph (1)(A) or subparagraph (C). 
‘‘(C) 
ANTI-RETALIATION
AND
ANTI-COERCION.—Con-
sistent with applicable Federal or State law, a PDP sponsor 
shall not— 
‘‘(i) retaliate against an individual or entity for 
reporting an alleged violation under subparagraph (B); 
or 
‘‘(ii) coerce, intimidate, threaten, or interfere with 
the ability of an individual or entity to report any 
such alleged violations. 
‘‘(3) CERTIFICATION OF COMPLIANCE.— 
‘‘(A) IN
GENERAL.—Each PDP sponsor shall furnish 
to the Secretary (at a time and in a manner specified 
by the Secretary) an annual certification of compliance 
with this subsection, as well as such information as the 
Secretary determines necessary to carry out this subsection. 
‘‘(B) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this para-
graph by program instruction or otherwise. 
‘‘(4) RULE OF CONSTRUCTION.—Nothing in this subsection 
shall be construed as— 
‘‘(A) prohibiting flat dispensing fees or reimbursement 
or payment for ingredient costs (including customary, 
industry-standard discounts directly related to drug 
acquisition that are retained by pharmacies or wholesalers) 
to entities that acquire or dispense prescription drugs; or 
‘‘(B) modifying regulatory requirements or sub-regu-
latory program instruction or guidance related to pharmacy 
payment, reimbursement, or dispensing fees. 
‘‘(5) STANDARD FORMATS.— 
‘‘(A) IN GENERAL.—Not later than June 1, 2027, the 
Secretary shall specify standard, machine-readable formats 
for pharmacy benefit managers to submit annual reports 
required under paragraph (1)(C)(i). 
‘‘(B) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this para-
graph by program instruction or otherwise. 
‘‘(6) CONFIDENTIALITY.— 
‘‘(A) IN GENERAL.—Information disclosed by a phar-
macy benefit manager, an affiliate of a pharmacy benefit 
manager, a PDP sponsor, or a pharmacy under this sub-
section that is not otherwise publicly available or available 
for purchase shall not be disclosed by the Secretary or 
a PDP sponsor receiving the information, except that the 
Secretary may disclose the information for the following 
purposes: 
‘‘(i) As the Secretary determines necessary to carry 
out this part. 
‘‘(ii) To permit the Comptroller General to review 
the information provided.
H. R. 7148—507 
‘‘(iii) To permit the Director of the Congressional 
Budget Office to review the information provided. 
‘‘(iv) To permit the Executive Director of the Medi-
care Payment Advisory Commission to review the 
information provided. 
‘‘(v) To the Attorney General for the purposes of 
conducting oversight and enforcement under this title. 
‘‘(vi) To the Inspector General of the Department 
of Health and Human Services in accordance with 
its authorities under the Inspector General Act of 1978 
(section 406 of title 5, United States Code), and other 
applicable statutes. 
‘‘(B) RESTRICTION ON USE OF INFORMATION.—The Sec-
retary, the Comptroller General, the Director of the 
Congressional Budget Office, and the Executive Director 
of the Medicare Payment Advisory Commission shall not 
report on or disclose information disclosed pursuant to 
subparagraph (A) to the public in a manner that would 
identify— 
‘‘(i) a specific pharmacy benefit manager, affiliate, 
pharmacy, manufacturer, wholesaler, PDP sponsor, or 
plan; or 
‘‘(ii) contract prices, rebates, discounts, or other 
remuneration for specific drugs in a manner that may 
allow the identification of specific contracting parties 
or of such specific drugs. 
‘‘(7) DEFINITIONS.—For purposes of this subsection: 
‘‘(A) AFFILIATE.—The term ‘affiliate’ means, with 
respect to any pharmacy benefit manager or PDP sponsor, 
any entity that, directly or indirectly— 
‘‘(i) owns or is owned by, controls or is controlled 
by, or is otherwise related in any ownership structure 
to such pharmacy benefit manager or PDP sponsor; 
or 
‘‘(ii) acts as a contractor, principal, or agent to 
such pharmacy benefit manager or PDP sponsor, 
insofar as such contractor, principal, or agent performs 
any of the functions described under subparagraph 
(C). 
‘‘(B) BONA
FIDE
SERVICE
FEE.—The term ‘bona fide 
service fee’ means a fee that is reflective of the fair market 
value (as specified by the Secretary, through notice and 
comment rulemaking) for a bona fide, itemized service actu-
ally performed on behalf of an entity, that the entity would 
otherwise perform (or contract for) in the absence of the 
service arrangement and that is not passed on in whole 
or in part to a client or customer, whether or not the 
entity takes title to the drug. Such fee must be a flat 
dollar amount and shall not be directly or indirectly based 
on, or contingent upon— 
‘‘(i) drug price, such as wholesale acquisition cost 
or drug benchmark price (such as average wholesale 
price); 
‘‘(ii) the amount of discounts, rebates, fees, or other 
direct or indirect remuneration with respect to covered 
part D drugs dispensed to enrollees in a prescription
H. R. 7148—508 
drug plan, except as permitted pursuant to paragraph 
(1)(A)(ii); 
‘‘(iii) coverage or formulary placement decisions 
or the volume or value of any referrals or business 
generated between the parties to the arrangement; 
or 
‘‘(iv) any other amounts or methodologies prohib-
ited by the Secretary. 
‘‘(C) PHARMACY BENEFIT MANAGER.—The term ‘phar-
macy benefit manager’ means any person or entity that, 
either directly or through an intermediary, acts as a price 
negotiator or group purchaser on behalf of a PDP sponsor 
or prescription drug plan, or manages the prescription drug 
benefits provided by such sponsor or plan, including the 
processing and payment of claims for prescription drugs, 
the performance of drug utilization review, the processing 
of drug prior authorization requests, the adjudication of 
appeals or grievances related to the prescription drug ben-
efit, contracting with network pharmacies, controlling the 
cost of covered part D drugs, or the provision of related 
services. Such term includes any person or entity that 
carries out one or more of the activities described in the 
preceding sentence, irrespective of whether such person 
or entity calls itself a ‘pharmacy benefit manager’.’’. 
(2) MA–PD PLANS.—Section 1857(f)(3) of the Social Security 
Act (42 U.S.C. 1395w–27(f)(3)), as amended by section 
6223(d)(2), is amended by adding at the end the following 
new subparagraph: 
‘‘(G) REQUIREMENTS RELATING TO PHARMACY BENEFIT 
MANAGERS.—For plan years beginning on or after January 
1, 2028, section 1860D–12(h).’’. 
(3) NONAPPLICATION
OF
PAPERWORK
REDUCTION
ACT.— 
Chapter 35 of title 44, United States Code, shall not apply 
to the implementation of this subsection. 
(4) FUNDING.— 
(A) SECRETARY.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medicare 
& Medicaid Services Program Management Account, out 
of any money in the Treasury not otherwise appropriated, 
$113,000,000 for fiscal year 2026, to remain available until 
expended, to carry out this subsection. 
(B) OIG.—In addition to amounts otherwise available, 
there is appropriated to the Inspector General of the 
Department of Health and Human Services, out of any 
money in the Treasury not otherwise appropriated, 
$20,000,000 for fiscal year 2026, to remain available until 
expended, to carry out this subsection. 
(b) GAO STUDY AND REPORT ON PRICE-RELATED COMPENSATION 
ACROSS THE SUPPLY CHAIN.— 
(1) STUDY.—The Comptroller General of the United States 
(in this subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study describing the use of compensation and 
payment structures related to a prescription drug’s price within 
the retail prescription drug supply chain in part D of title 
XVIII of the Social Security Act (42 U.S.C. 1395w–101 et seq.). 
Such study shall summarize information from Federal agencies
H. R. 7148—509 
and industry experts, to the extent available, with respect 
to the following: 
(A) The type, magnitude, other features (such as the 
pricing benchmarks used), and prevalence of compensation 
and payment structures related to a prescription drug’s 
price, such as calculating fee amounts as a percentage 
of a prescription drug’s price, between intermediaries in 
the prescription drug supply chain, including— 
(i) pharmacy benefit managers; 
(ii) PDP sponsors offering prescription drug plans 
and Medicare Advantage organizations offering MA– 
PD plans; 
(iii) drug wholesalers; 
(iv) pharmacies; 
(v) manufacturers; 
(vi) pharmacy services administrative organiza-
tions; 
(vii) brokers, auditors, consultants, and other enti-
ties that— 
(I) advise PDP sponsors offering prescription 
drug plans and Medicare Advantage organizations 
offering MA–PD plans regarding pharmacy bene-
fits; or 
(II) review PDP sponsor and Medicare Advan-
tage organization contracts with pharmacy benefit 
managers; and 
(viii) other service providers that contract with 
any of the entities described in clauses (i) through 
(vii) that may use price-related compensation and pay-
ment structures, such as rebate aggregators (or other 
entities that negotiate or process price concessions on 
behalf of pharmacy benefit managers, plan sponsors, 
or pharmacies). 
(B) The primary business models and compensation 
structures for each category of intermediary described in 
subparagraph (A). 
(C) Variation in price-related compensation structures 
between affiliated entities (such as entities with common 
ownership, either full or partial, and subsidiary relation-
ships) and unaffiliated entities. 
(D) Potential conflicts of interest among contracting 
entities related to the use of prescription drug price-related 
compensation structures, such as the potential for fees 
or other payments set as a percentage of a prescription 
drug’s price to advantage formulary selection, distribution, 
or purchasing of prescription drugs with higher prices. 
(E) Notable differences, if any, in the use and level 
of price-based compensation structures over time and 
between different market segments, such as under part 
D of title XVIII of the Social Security Act (42 U.S.C. 1395w– 
101 et seq.) and the Medicaid program under title XIX 
of such Act (42 U.S.C. 1396 et seq.). 
(F) The effects of drug price-related compensation 
structures and alternative compensation structures on Fed-
eral health care programs and program beneficiaries, 
including with respect to cost-sharing, premiums, Federal
H. R. 7148—510 
outlays, biosimilar and generic drug adoption and utiliza-
tion, drug shortage risks, and the potential for fees set 
as a percentage of a drug’s price to advantage the formulary 
selection, distribution, or purchasing of drugs with higher 
prices. 
(G) Other issues determined to be relevant and appro-
priate by the Comptroller General. 
(2) REPORT.—Not later than 2 years after the date of enact-
ment of this section, the Comptroller General shall submit 
to Congress a report containing the results of the study con-
ducted under paragraph (1), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
(c) MEDPAC REPORTS ON AGREEMENTS WITH PHARMACY BENEFIT 
MANAGERS WITH RESPECT TO PRESCRIPTION DRUG PLANS AND MA- 
PD PLANS.— 
(1) IN GENERAL.—The Medicare Payment Advisory Commis-
sion shall submit to Congress the following reports: 
(A) INITIAL REPORT.—Not later than the first March 
15 occurring after the date that is 2 years after the date 
on which the Secretary makes the data available to the 
Commission, a report regarding agreements with pharmacy 
benefit managers with respect to prescription drug plans 
and MA–PD plans. Such report shall include, to the extent 
practicable— 
(i) a description of trends and patterns, including 
relevant averages, totals, and other figures for the 
types of information submitted; 
(ii) an analysis of any differences in agreements 
and their effects on plan enrollee out-of-pocket 
spending and average pharmacy reimbursement, and 
other impacts; and 
(iii) any recommendations the Commission deter-
mines appropriate. 
(B) FINAL REPORT.—Not later than 2 years after the 
date on which the Commission submits the initial report 
under subparagraph (A), a report describing any changes 
with respect to the information described in subparagraph 
(A) over time, together with any recommendations the 
Commission determines appropriate. 
(2) FUNDING.—In addition to amounts otherwise available, 
there is appropriated to the Medicare Payment Advisory 
Commission, out of any money in the Treasury not otherwise 
appropriated, $1,000,000 for fiscal year 2026, to remain avail-
able until expended, to carry out this subsection. 
SEC. 6225. REQUIRING A SEPARATE IDENTIFICATION NUMBER AND 
AN ATTESTATION FOR EACH OFF-CAMPUS OUTPATIENT 
DEPARTMENT OF A PROVIDER. 
(a) IN GENERAL.—Section 1833(t) of the Social Security Act 
(42 U.S.C. 1395l(t)) is amended by adding at the end the following 
new paragraph: 
‘‘(23) USE OF UNIQUE HEALTH IDENTIFIERS; ATTESTATION.— 
‘‘(A) IN GENERAL.—No payment may be made under 
this subsection (or under an applicable payment system
H. R. 7148—511 
pursuant to paragraph (21)) for items and services fur-
nished on or after January 1, 2028, by an off-campus out-
patient department of a provider (as defined in subpara-
graph (C)) unless— 
‘‘(i) such department has obtained, and such items 
and services are billed under, a National Provider 
Identifier that is separate from such identifier for such 
provider; 
‘‘(ii) such provider has submitted to the Secretary, 
during the 2-year period ending on the date such items 
and services are so furnished, an initial provider-based 
status attestation that such department is compliant 
with the requirements described in section 413.65 of 
title 42, Code of Federal Regulations (or a successor 
regulation), which, until the Secretary establishes the 
process described in subparagraph (B), may include 
an attestation submitted in accordance with paragraph 
(b)(3) of such section (as in effect on the date of enact-
ment of this paragraph); and 
‘‘(iii) after such provider has submitted an attesta-
tion under clause (ii), such provider has submitted 
a subsequent attestation within the timeframe speci-
fied by the Secretary. 
‘‘(B) PROCESS FOR SUBMISSION AND REVIEW.— 
‘‘(i) IN
GENERAL.—The Secretary shall, through 
notice and comment rulemaking, establish a process 
for each provider with an off-campus outpatient depart-
ment of a provider to submit an initial and subsequent 
attestation pursuant to clauses (ii) and (iii), respec-
tively, of subparagraph (A), and for the Secretary to 
review each such attestation and determine, through 
site visits, remote audits, or other means (as deter-
mined appropriate by the Secretary), whether such 
department is compliant with the requirements 
described in such subparagraph. 
‘‘(ii) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for 
Medicare & Medicaid Services Program Management 
Account for fiscal year 2026, out of any amounts in 
the Treasury not otherwise appropriated, $20,000,000, 
to remain available until expended, for purposes of 
carrying out this subparagraph. 
‘‘(C) OFF-CAMPUS OUTPATIENT DEPARTMENT OF A PRO-
VIDER DEFINED.—For purposes of this paragraph, the term 
‘off-campus outpatient department of a provider’ means 
a department of a provider (as defined in section 413.65 
of title 42, Code of Federal Regulations, or any successor 
regulation) that is not located— 
‘‘(i) on the campus (as defined in such section) 
of such provider; or 
‘‘(ii) within the distance (described in such defini-
tion of campus) from a remote location of a hospital 
facility (as defined in such section).’’. 
(b) HHS OIG ANALYSIS.—Not later than January 1, 2030, the 
Inspector General of the Department of Health and Human Services 
shall submit to Congress—
H. R. 7148—512 
(1) an analysis of the process established by the Secretary 
of Health and Human Services to conduct the reviews and 
determinations described in section 1833(t)(23)(B) of the Social 
Security Act, as added by subsection (a) of this section; and 
(2) recommendations based on such analysis, as the 
Inspector General determines appropriate. 
SEC. 6226. REVISING PHASE-IN OF MEDICARE CLINICAL LABORATORY 
TEST PAYMENT CHANGES. 
(a) REVISED PHASE-IN OF REDUCTIONS FROM PRIVATE PAYOR 
RATE IMPLEMENTATION.—Section 1834A(b)(3) of the Social Security 
Act (42 U.S.C. 1395m–1(b)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘2028’’ and inserting 
‘‘2029’’; and 
(2) in subparagraph (B)— 
(A) in clause (ii), by striking ‘‘2025 and for the period 
beginning on January 1, 2026, and ending on January 
30, 2026’’ and inserting ‘‘2026’’; and 
(B) in clause (iii), by striking ‘‘the period beginning 
on January 31, 2026, and ending on December 31, 2026, 
and for each of 2027 and 2028’’ and inserting ‘‘each of 
2027 through 2029’’. 
(b) REVISED DATA COLLECTION PERIOD FOR REPORTING OF PRI-
VATE SECTOR PAYMENT RATES FOR ESTABLISHMENT OF MEDICARE 
PAYMENT RATES.—Section 1834A(a)(4)(B) of the Social Security Act 
(42 U.S.C. 1395m–1(a)(4)(B)) is amended by striking ‘‘2019’’ each 
place it appears and inserting ‘‘2025’’ in each such place. 
(c) REVISED REPORTING PERIOD FOR REPORTING OF PRIVATE 
SECTOR PAYMENT RATES FOR ESTABLISHMENT OF MEDICARE PAY-
MENT 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 ‘‘January 31’’ and inserting 
‘‘April 30’’; and 
(2) in clause (ii), by striking ‘‘February 1, 2026, and ending 
April 30, 2026’’ and inserting ‘‘May 1, 2026, and ending July 
31, 2026’’. 
(d) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services may implement 
the amendments made by this section by program instruction or 
otherwise. 
SEC. 6227. MEDICARE SEQUESTRATION. 
Section 251A(6) of the Balanced Budget and Emergency Deficit 
Control Act of 1985 (2 U.S.C. 901a(6)) is amended— 
(1) in subparagraph (D), by striking ‘‘such that,’’ and all 
that follows and inserting ‘‘such that the payment reduction 
shall be 2.0 percent for such fiscal year.’’; and 
(2) by adding at the end the following: 
‘‘(F) On the date on which the President submits the budget 
under section 1105 of title 31, United States Code, for fiscal 
year 2033, the President shall order a sequestration of pay-
ments for the Medicare programs specified in section 256(d), 
effective upon issuance, such that, notwithstanding the 2 per-
cent limit specified in subparagraph (A) for such payments— 
‘‘(i) with respect to the first 5 months in which such 
order is effective for such fiscal year, the payment reduction 
shall be 2.0 percent; and
H. R. 7148—513 
‘‘(ii) with respect to the last 7 months in which such 
order is effective for such fiscal year, the payment reduction 
shall be 0 percent.’’. 
SEC. 6228. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ‘‘$1,403,000,000’’ and inserting 
‘‘$2,062,000,000’’. 
TITLE III—HUMAN SERVICES 
SEC. 6301. SEXUAL RISK AVOIDANCE EDUCATION EXTENSION. 
Section 510 of the Social Security Act (42 U.S.C. 710) is 
amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘2025, and for the period beginning 
on October 1, 2025, and ending on January 30, 2026’’ 
and inserting ‘‘2026, and for the period beginning on 
October 1, 2026, and ending on December 31, 2026’’; 
and 
(ii) by striking ‘‘fiscal year 2026’’ and inserting 
‘‘fiscal year 2027’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by striking ‘‘through 2025’’ and inserting 
‘‘through 2026’’; and 
(II) by striking ‘‘fiscal year 2026’’ each place 
it appears and inserting ‘‘fiscal year 2027’’; and 
(ii) in subparagraph (B)(i), by striking ‘‘2026’’ and 
inserting ‘‘2027’’; and 
(2) in subsection (f)(1) by striking ‘‘2025, and 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 
appropriated for the corresponding period for fiscal year 2025’’ 
and inserting ‘‘2026, and for the period beginning on October 
1, 2026, and ending on December 31, 2026, an amount equal 
to the pro rata portion of the amount appropriated for the 
corresponding period for fiscal year 2026’’. 
SEC. 6302. PERSONAL RESPONSIBILITY EDUCATION EXTENSION. 
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 preceding clause 
(i), by striking ‘‘2025, and for the period beginning on 
October 1, 2025, and ending on January 30, 2026’’ and 
inserting ‘‘2026, and for the period beginning on October 
1, 2026, and ending on December 31, 2026’’; and 
(B) in subparagraph (B)(i), by striking ‘‘fiscal years 
2024 and 2025, and for the period beginning on October 
1, 2025, and ending on January 30, 2026’’ and inserting 
‘‘fiscal years 2025 and 2026, and for the period beginning 
on October 1, 2026, and ending on December 31, 2026’’; 
(2) in subsection (c)(3), by striking ‘‘2026’’ and inserting 
‘‘2027’’; and
H. R. 7148—514 
(3) in subsection (f), by striking ‘‘2025, and 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 
appropriated for the corresponding period for fiscal year 2025’’ 
and inserting ‘‘2026, and for the period beginning on October 
1, 2026, and ending on December 31, 2026, an amount equal 
to the pro rata portion of the amount appropriated for the 
corresponding period for fiscal year 2026’’. 
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 (viii), by striking ‘‘for fiscal year 2025’’ and 
inserting ‘‘for each of fiscal years 2025 and 2026’’; and 
(2) in clause (ix), by striking ‘‘October 1, 2025, and ending 
on January 30, 2026, an amount equal to the pro rata portion 
of the amount appropriated for fiscal year 2025’’ and inserting 
‘‘October 1, 2026, and ending on December 31, 2026, an amount 
equal to the pro rata portion of the amount appropriated for 
fiscal year 2026’’. 
SEC. 6304. EXTENSION OF THE TEMPORARY ASSISTANCE FOR NEEDY 
FAMILIES PROGRAM. 
Activities authorized by part A of title IV of the Social Security 
Act (other than under section 403(c) or 418 of such Act) and section 
1108(b) of the Social Security Act shall continue through December 
31, 2026, in the manner authorized for fiscal year 2025, and out 
of any money in the Treasury of the United States not otherwise 
appropriated, there are hereby appropriated such sums as may 
be necessary for such purpose. 
TITLE IV—PUBLIC HEALTH AND OTHER 
EXTENDERS 
Subtitle A—Extensions 
SEC. 6401. EXTENSION FOR COMMUNITY HEALTH CENTERS, NATIONAL 
HEALTH SERVICE CORPS, AND TEACHING HEALTH CEN-
TERS THAT OPERATE GME PROGRAMS. 
(a) EXTENSION
FOR COMMUNITY HEALTH CENTERS.—Section 
10503(b)(1) of the Patient Protection and Affordable Care Act (42 
U.S.C. 254b–2(b)(1)) is amended by striking subparagraphs (H), 
(I), (J), and (K) and inserting the following: 
‘‘(H) $4,236,712,328 for fiscal year 2024; 
‘‘(I) $4,295,287,671 for fiscal year 2025; 
‘‘(J) $4,600,000,000 for fiscal year 2026; and 
‘‘(K) $1,159,452,055 for the period beginning on October 
1, 2026, and ending on December 31, 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 by striking subparagraphs 
(I), (J), (K), and (L) and inserting the following: 
‘‘(I) $341,208,605 for fiscal year 2024; 
‘‘(J) $349,736,600 for fiscal year 2025; 
‘‘(K) $350,000,000 for fiscal year 2026; and
H. R. 7148—515 
‘‘(L) $88,219,178 for the period beginning on October 
1, 2026, and ending on December 31, 2026.’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE GRADUATE MED-
ICAL EDUCATION PROGRAMS.—Section 340H(g)(1) of the Public 
Health Service Act (42 U.S.C. 256h(g)(1)) is amended by striking 
subparagraphs (D), (E), (F), and (G) and inserting the following: 
‘‘ 
‘‘(D) $168,915,878 for fiscal year 2024; 
‘‘(E) $181,563,574 for fiscal year 2025; 
‘‘(F) $225,000,000 for fiscal year 2026; 
‘‘(G) $250,000,000 for fiscal year 2027; 
‘‘(H) $275,000,000 for fiscal year 2028; and 
‘‘(I) $300,000,000 for fiscal year 2029.’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appropriated pursu-
ant to the amendments made by this section shall be subject to 
the requirements contained in Public Law 118–47 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 AMENDMENTS.—Section 3014(h)(4) of title 18, 
United States Code, is amended by striking ‘‘and section 6101(d) 
of the Continuing Appropriations, Agriculture, Legislative Branch, 
Military Construction and Veterans Affairs, and Extensions Act, 
2026’’ and inserting ‘‘section 6101(d) of the Continuing Appropria-
tions, Agriculture, Legislative Branch, Military Construction and 
Veterans Affairs, and Extensions Act, 2026, and section 6401(d) 
of the Consolidated Appropriations Act, 2026’’. 
SEC. 6402. 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 by striking subparagraphs (E), 
(F), (G), and (H) and inserting the following: 
‘‘(E) $155,619,196 for fiscal year 2024, to remain avail-
able until expended; 
‘‘(F) $159,228,188 for fiscal year 2025, to remain avail-
able until expended; 
‘‘(G) $200,000,000 for fiscal year 2026, to remain avail-
able until expended; and 
‘‘(H) $50,410,959 for the period beginning on October 
1, 2026, and ending on December 31, 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 by striking subparagraphs (E), 
(F), (G), and (H) and inserting the following: 
‘‘(E) $155,619,196 for fiscal year 2024, to remain avail-
able until expended; 
‘‘(F) $159,228,188 for fiscal year 2025, to remain avail-
able until expended; 
‘‘(G) $200,000,000 for fiscal year 2026, to remain avail-
able until expended; and 
‘‘(H) $50,410,959 for the period beginning on October 
1, 2026, and ending on December 31, 2026, to remain 
available until expended.’’.