123 
that such pharmacy would charge for such 
supply of such drug dispensed to an indi-
vidual without benefits for such drug 
under any Federal health care program (as 
defined in section 1128B), a group health 
plan or group or individual health insur-
ance coverage (as such terms are defined 
in section 2791 of the Public Health Serv-
ice Act), or the program established under 
chapter 89 of title 5, United States Code. 
‘‘(ii) AVERAGE NET PRICE.—The term 
‘average net price’ means, with respect to 
a supply of a covered part D drug, a pre-
scription drug plan, and a plan year, the 
average amount paid under such plan (in-
cluding any amounts paid by an individual 
enrolled under such plan as cost sharing 
for such drug) as payment for such a sup-
ply of such drug dispensed during such 
year, less any rebates or other forms of re-
muneration received under such plan with 
respect to such drug.’’; and 
(2) in subsection (c), by adding at the end the 
following new paragraph: 
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‘‘(7) COST SHARING LIMITED TO NET PRICE.— 
The coverage is provided in accordance with sub-
section (b)(10).’’. 
(b) CONFORMING AMENDMENT TO COST-SHARING 
FOR
LOW-INCOME
INDIVIDUALS.—Section 
1860D– 
14(a)(1)(D)(iii) of the Social Security Act (42 U.S.C. 
1395w–114(a)(1)(D)(iii)) is amended by adding at the 
end the following new sentence: ‘‘For plan year 2027 and 
subsequent plan years, the copayment amount applicable 
under this clause to a supply of a covered part D drug 
dispensed to the individual may not exceed the amount 
provided under section 1860D–2(b)(10).’’. 
(c) GAO REPORT.—Not later than January 1, 2029, 
the Comptroller General of the United States shall submit 
to Congress a report containing— 
(1) an analysis of compliance with the amend-
ments made by this section; 
(2) an analysis of enforcement of such amend-
ments; 
(3) recommendations with respect to improving 
such enforcement; and 
(4) recommendations relating to improving pub-
lic disclosure, and public awareness of, the require-
ments of such amendments. 
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125 
SEC. 202. REQUIRING A SEPARATE IDENTIFICATION NUM-
BER AND AN ATTESTATION FOR EACH OFF- 
CAMPUS OUTPATIENT DEPARTMENT OF A 
PROVIDER. 
(a) IN GENERAL.—Section 1833(t) of the Social Se-
curity 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 appli-
cable payment system pursuant to paragraph 
(21)) for items and services furnished on or 
after January 1, 2026, by an off-campus out-
patient department of a provider (as defined in 
subparagraph (C)) unless— 
‘‘(i) such department has obtained, 
and such items and services are billed 
under, a standard unique health identifier 
for health care providers (as described in 
section 1173(b)) that is separate from 
such identifier for such provider; and 
‘‘(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 attestation that such 
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126 
department is compliant with the require-
ments described in section 413.65 of title 
42, Code of Federal Regulations (or a suc-
cessor regulation). 
‘‘(B) PROCESS FOR SUBMISSION AND RE-
VIEW.—Not later than 1 year after the date of 
enactment of this paragraph, the Secretary 
shall, through notice and comment rulemaking, 
establish a process for each provider with an 
off-campus outpatient department of a provider 
to submit an attestation pursuant to subpara-
graph (A)(ii), and for the Secretary to review 
each such attestation and determine, through 
site visits, remote audits, or other means (as 
determined appropriate by the Secretary), 
whether such department is compliant with the 
requirements described in such subparagraph. 
‘‘(C) OFF-CAMPUS
OUTPATIENT
DEPART-
MENT OF A PROVIDER DEFINED.—For purposes 
of this paragraph, the term ‘off-campus out-
patient department of a provider’ means a de-
partment of a provider (as defined in section 
413.65 of title 42, Code of Federal Regulations, 
or any successor regulation) that is not lo-
cated— 
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‘‘(i) on the campus (as defined in such 
section) of such provider; or 
‘‘(ii) within the distance (described in 
such definition 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— 
(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. 203. PARITY IN MEDICARE PAYMENTS FOR HOSPITAL 
OUTPATIENT DEPARTMENT SERVICES FUR-
NISHED OFF-CAMPUS. 
(a) IN GENERAL.—Section 1833(t)(16) of the Social 
Security Act (42 U.S.C. 1395l(t)(16)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(H) PARITY IN FEE SCHEDULE AMOUNT 
FOR
CERTAIN
SERVICES
FURNISHED
BY
AN 
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