239 
pharmacy or provider that dispenses 
the drug; and 
‘‘(III) is made in a manner that 
is consistent with sections 447.502, 
447.512, 447.514, and 447.518 of 
title 42, Code of Federal Regulations 
(or any successor regulation) as if 
such requirements applied directly to 
the entity or the PBM, except that 
any payment by the entity or the 
PBM for the ingredient cost of such 
drug purchased by a covered entity 
(as defined in subsection (a)(5)(B)) 
may exceed the actual acquisition cost 
(as defined in 447.502 of title 42, 
Code of Federal Regulations, or any 
successor regulation) for such drug 
if— 
‘‘(aa) such drug was subject 
to an agreement under section 
340B of the Public Health Serv-
ice Act; 
‘‘(bb) such payment for the 
ingredient cost of such drug does 
not exceed the maximum pay-
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ment that would have been made 
by the entity or the PBM for the 
ingredient cost of such drug if 
such drug had not been pur-
chased by such covered entity; 
and 
‘‘(cc) such covered entity re-
ports to the Secretary (in a form 
and manner specified by the Sec-
retary), on an annual basis and 
with respect to payments for the 
ingredient costs of such drugs so 
purchased by such covered entity 
that are in excess of the actual 
acquisition costs for such drugs, 
the aggregate amount of such ex-
cess; 
‘‘(ii) payment to the entity or the 
PBM (as applicable) for administrative 
services performed by the entity or PBM is 
limited to an administrative fee that re-
flects the fair market value (as defined by 
the Secretary) of such services; 
‘‘(iii) the entity or the PBM (as appli-
cable) makes available to the State, and 
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the Secretary upon request in a form and 
manner specified by the Secretary, all costs 
and payments related to covered outpatient 
drugs and accompanying administrative 
services (as described in clause (ii)) in-
curred, received, or made by the entity or 
the PBM, broken down (as specified by the 
Secretary), to the extent such costs and 
payments are attributable to an individual 
covered outpatient drug, by each such 
drug, including any ingredient costs, pro-
fessional dispensing fees, administrative 
fees (as described in clause (ii)), post-sale 
and post-invoice fees, discounts, or related 
adjustments such as direct and indirect re-
muneration fees, and any and all other re-
muneration, as defined by the Secretary; 
and 
‘‘(iv) any form of spread pricing 
whereby any amount charged or claimed by 
the entity or the PBM (as applicable) that 
exceeds the amount paid to the pharmacies 
or providers on behalf of the State or enti-
ty, including any post-sale or post-invoice 
fees, discounts, or related adjustments 
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such as direct and indirect remuneration 
fees or assessments, as defined by the Sec-
retary, (after allowing for an administra-
tive fee as described in clause (ii)) is not 
allowable for purposes of claiming Federal 
matching payments under this title. 
‘‘(B) PUBLICATION
OF
INFORMATION.— 
The Secretary shall publish, not less frequently 
than on an annual basis and in a manner that 
does not disclose the identity of a particular 
covered entity or organization, information re-
ceived by the Secretary pursuant to subpara-
graph (A)(i)(III)(cc) that is broken out by 
State and by each of the following categories of 
covered entity within each such State: 
‘‘(i) Covered entities described in sub-
paragraph (A) of section 340B(a)(4) of the 
Public Health Service Act. 
‘‘(ii) Covered entities described in sub-
paragraphs (B) through (K) of such sec-
tion. 
‘‘(iii) Covered entities described in 
subparagraph (L) of such section. 
‘‘(iv) Covered entities described in 
subparagraph (M) of such section. 
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‘‘(v) Covered entities described in sub-
paragraph (N) of such section. 
‘‘(vi) Covered entities described in 
subparagraph (O) of such section.’’; and 
(2) in subsection (k), as previously amended by 
this title, by adding at the end the following new 
paragraph: 
‘‘(14) PHARMACY
BENEFIT
MANAGER.—The 
term ‘pharmacy benefit manager’ means any person 
or entity that, either directly or through an inter-
mediary, acts as a price negotiator or group pur-
chaser on behalf of a State, managed care entity (as 
defined in section 1903(m)(9)(D)), or other specified 
entity (as so defined), or manages the prescription 
drug benefits provided by a State, managed care en-
tity, or other specified entity, including the proc-
essing and payment of claims for prescription drugs, 
the performance of drug utilization review, the proc-
essing of drug prior authorization requests, the man-
aging of appeals or grievances related to the pre-
scription drug benefits, contracting with pharmacies, 
controlling the cost of covered outpatient drugs, or 
the provision of services related thereto. Such term 
includes any person or entity that acts as a price ne-
gotiator (with regard to payment amounts to phar-
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macies and providers for a covered outpatient drug 
or the net cost of the drug) or group purchaser on 
behalf of a State, managed care entity, or other 
specified entity or that carries out 1 or more of the 
other activities described in the preceding sentence, 
irrespective of whether such person or entity calls 
itself a pharmacy benefit manager.’’. 
(b) CONFORMING AMENDMENTS.—Section 1903(m) 
of such Act (42 U.S.C. 1396b(m)) is amended— 
(1) in paragraph (2)(A)(xiii)— 
(A) by striking ‘‘and (III)’’ and inserting 
‘‘(III)’’; 
(B) by inserting before the period at the 
end the following: ‘‘, and (IV) if the contract in-
cludes provisions making the entity responsible 
for coverage of covered outpatient drugs, the 
entity shall comply with the requirements of 
section 1927(e)(6)’’; and 
(C) by moving the margin 2 ems to the 
left; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(10) No payment shall be made under this 
title to a State with respect to expenditures incurred 
by the State for payment for services provided by an 
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other specified entity (as defined in paragraph 
(9)(D)(iii)) unless such services are provided in ac-
cordance with a contract between the State and such 
entity which satisfies the requirements of paragraph 
(2)(A)(xiii).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to contracts between States and 
managed care entities, other specified entities, or phar-
macy benefit managers that have an effective date begin-
ning on or after the date that is 18 months after the date 
of enactment of this Act. 
(d) IMPLEMENTATION.— 
(1) IN GENERAL.—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 oth-
erwise. 
(2) NONAPPLICATION OF ADMINISTRATIVE PRO-
CEDURE ACT.—Implementation of the amendments 
made by this section shall be exempt from the re-
quirements of section 553 of title 5, United States 
Code. 
(e) NONAPPLICATION OF PAPERWORK REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall 
not apply to any data collection undertaken by the Sec-
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retary of Health and Human Services under section 
1927(e) of the Social Security Act (42 U.S.C. 1396r– 
8(e)), as amended by this section. 
TITLE II—MEDICARE 
SEC. 201. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘fiscal year 2025 be-
ginning on April 1, 2025, and ending on September 
30, 2025, and in fiscal year 2026’’ and inserting 
‘‘fiscal year 2026 beginning on January 1, 2026, 
and ending on September 30, 2026, and in fiscal 
year 2027’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause 
(I)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
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(iv) by striking ‘‘March 31, 2025’’ 
and inserting ‘‘December 31, 2025’’; 
(B) in subclause (III)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘March 31, 2025’’ 
and inserting ‘‘December 31, 2025’’; and 
(C) in subclause (IV)— 
(i) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(ii) by striking ‘‘April 1, 2025’’ and 
inserting ‘‘January 1, 2026’’; 
(iii) by striking ‘‘September 30, 
2025’’ and inserting ‘‘September 30, 
2026’’; and 
(iv) by striking ‘‘fiscal year 2026’’ 
and inserting ‘‘fiscal year 2027’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
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(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘March 31, 2025’’ 
and inserting ‘‘December 31, 2025’’; and 
(B) in clause (ii)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘March 31, 2025’’ 
and inserting ‘‘December 31, 2025’’. 
(b) 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. 202. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
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(1) in clause (i), by striking ‘‘April 1, 2025’’ 
and inserting ‘‘January 1, 2026’’; and 
(2) in clause (ii)(II), by striking ‘‘April 1, 
2025’’ and inserting ‘‘January 1, 2026’’. 
(b) CONFORMING AMENDMENTS.— 
(1) IN
GENERAL.—Section 1886(b)(3)(D) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘April 1, 2025’’ and inserting ‘‘Janu-
ary 1, 2026’’; and 
(B) in clause (iv)— 
(i) by striking ‘‘fiscal year 2024’’ and 
inserting ‘‘fiscal year 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘March 31, 2025’’ 
and inserting ‘‘December 31, 2025’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended— 
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(A) by striking ‘‘through 2024’’ and insert-
ing ‘‘through 2025’’; 
(B) by striking ‘‘fiscal year 2025’’ and in-
serting ‘‘fiscal year 2026’’; 
(C) by striking ‘‘October 1, 2024’’ and in-
serting ‘‘October 1, 2025’’; and 
(D) by striking ‘‘March 31, 2025’’ and in-
serting ‘‘December 31, 2025’’. 
SEC. 203. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘April 1, 
2025’’ and inserting ‘‘January 1, 2027’’; and 
(2) in paragraph (13), by striking ‘‘April 1, 
2025’’ each place it appears and inserting ‘‘January 
1, 2027’’ in each such place. 
SEC. 204. EXTENDING INCENTIVE PAYMENTS FOR PARTICI-
PATION IN ELIGIBLE ALTERNATIVE PAYMENT 
MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Se-
curity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A)— 
(A) by striking ‘‘with 2026’’ and inserting 
‘‘with 2027’’; and 
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(B) by inserting ‘‘, or, with respect to 
2027, 3.53 percent’’ after ‘‘1.88 percent’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B)— 
(i) in the heading, by striking ‘‘2026’’ 
and inserting ‘‘2027’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2026’’ and inserting ‘‘2027’’; 
(B) in subparagraph (C)— 
(i) in the heading, by striking ‘‘2027’’ 
and inserting ‘‘2028’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2027’’ and inserting ‘‘2028’’; 
and 
(C) in subparagraph (D), by striking ‘‘and 
2026’’ and inserting ‘‘2026, and 2027’’; and 
(3) in paragraph (4)(B), by inserting ‘‘or, with 
respect to 2027, 3.53 percent’’ after ‘‘1.88 percent’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), by striking ‘‘2026’’ and 
inserting ‘‘2027’’; and 
(2) in subclause (III), by striking ‘‘2027’’ and 
inserting ‘‘2028’’. 
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252 
SEC. 205. TEMPORARY PAYMENT INCREASE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE TO AC-
COUNT FOR EXCEPTIONAL CIRCUMSTANCES. 
(a) IN GENERAL.—Section 1848(t)(1) of the Social 
Security Act (42 U.S.C. 1395w–4(t)(1)) is amended— 
(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(F) such services furnished on or after 
January 1, 2025, and before January 1, 2026, 
by 2.5 percent.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1848(c)(2)(B)(iv)(V) is amended by striking ‘‘or 2024’’ 
and inserting ‘‘2024, or 2025’’. 
SEC. 206. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended— 
(1) in the first sentence— 
(A) by striking ‘‘$11,030,000’’ and insert-
ing ‘‘$20,030,000’’; and 
(B) by striking ‘‘March 31’’ and inserting 
‘‘December 31’’; and 
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253 
(2) in the third sentence, by striking ‘‘March 
31’’ and inserting ‘‘December 31’’. 
SEC. 207. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note) is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on 
April 1, 2025, and ending on December 
31, 2026, $30,000,000.’’. 
(b) 
AREA
AGENCIES
ON
AGING.—Subsection 
(b)(1)(B) of such section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
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254 
‘‘(xv) for the period beginning on 
April 1, 2025, and ending on December 
31, 2026, $30,000,000.’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on 
April 1, 2025, and ending on December 
31, 2026, $10,000,000.’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
ERAL AND STATE PROGRAMS.—Subsection (d)(2) of such 
section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
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‘‘(xv) for the period beginning on 
April 1, 2025, and ending on December 
31, 2026, $30,000,000.’’. 
SEC. 208. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘April 
1, 2025’’ and inserting ‘‘January 1, 2026’’. 
SEC. 209. EXTENSION OF CERTAIN TELEHEALTH FLEXIBILI-
TIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS
AND 
EXPANDING
ORIGINATING
SITES
FOR
TELEHEALTH 
SERVICES.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘end-
ing March 31, 2025’’ and inserting ‘‘ending Decem-
ber 31, 2026’’; and 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on March 31, 2025’’ and inserting ‘‘ending on De-
cember 31, 2026’’. 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) 
is amended by striking ‘‘ending on March 31, 2025’’ and 
inserting ‘‘ending on December 31, 2026’’. 
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(c) EXTENDING TELEHEALTH SERVICES FOR FED-
ERALLY
QUALIFIED
HEALTH
CENTERS
AND
RURAL 
HEALTH CLINICS.—Section 1834(m)(8) of the Social Se-
curity Act (42 U.S.C. 1395m(m)(8)) is amended— 
(1) in subparagraph (A), by striking ‘‘ending on 
March 31, 2025’’ and inserting ‘‘ending on Decem-
ber 31, 2026’’; 
(2) in subparagraph (B)— 
(A) in the subparagraph heading, by in-
serting ‘‘BEFORE 2025’’ after ‘‘RULE’’; 
(B) in clause (i), by striking ‘‘during the 
periods for which subparagraph (A) applies’’ 
and inserting ‘‘before January 1, 2025’’; and 
(C) in clause (ii), by inserting ‘‘furnished 
to an eligible telehealth individual before Janu-
ary 1, 2025’’ after ‘‘telehealth services’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) PAYMENT
RULE
FOR
2025
AND 
2026.— 
‘‘(i) IN GENERAL.—A telehealth serv-
ice furnished to an eligible telehealth indi-
vidual by a Federally qualified health cen-
ter or rural health clinic on or after Janu-
ary 1, 2025, and before January 1, 2027, 
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