(A) Section 1614(c)(4) of the Agricultural 
Act of 2014 (7 U.S.C. 9097(c)(4)). 
(B) Subparagraphs (A) and (B) of section 
1241(a)(1) of the Food Security Act of 1985 
(16 U.S.C. 3841(a)(1)). 
(e) REPORTS.— 
(1) IN GENERAL.—Subject to paragraph (2), 
any requirement under a provision of law described 
in subsection (a) to submit a report on a recurring 
basis, and the final report under which was required 
to be submitted during fiscal year 2023, shall con-
tinue, and the requirement shall be carried out, on 
the same recurring basis, until the later of the dates 
specified in paragraphs (1) and (2) of that sub-
section. 
(2) APPROPRIATIONS
REQUIRED.—If discre-
tionary appropriations (as defined in section 250(c) 
of the Balanced Budget and Emergency Deficit Con-
trol Act of 1985 (2 U.S.C. 900(c))) are required to 
carry out a reporting requirement described in para-
graph (1), the application of that paragraph to that 
reporting requirement shall be subject to the avail-
ability of appropriations. 
(f) RESCISSION.—Of the unobligated balances of 
amounts made available under section 9003(g)(1)(A) of 
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the Farm Security and Rural Investment Act of 2002 (7 
U.S.C. 8103(g)(1)(A)), $177,350,000 is rescinded. 
(g) EFFECTIVE DATE.—This section and the amend-
ments made by this section (except subsection (f) and the 
amendments made by subparagraphs (A) and (C) of sub-
section (d)(5)) shall be applied and administered as if this 
section and those amendments had been enacted on Sep-
tember 30, 2023. 
TITLE II—HEALTH AND HUMAN 
SERVICES 
Subtitle A—Public Health 
Extenders 
SEC. 201. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)) is amended by striking ‘‘and $16,635,616 for the 
period beginning on October 1, 2023, and ending on No-
vember 17, 2023’’ and inserting ‘‘$16,635,616 for the pe-
riod beginning on October 1, 2023, and ending on Novem-
ber 17, 2023, and $21,834,247 for the period beginning 
on November 18, 2023, and ending on January 19, 2024’’. 
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(b) EXTENSION
FOR COMMUNITY HEALTH CEN-
TERS.—Section 10503(b)(1)(F) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 254b–2(b)(1)(F)), as 
amended by the Continuing Appropriations Act, 2024 and 
Other Extensions Act, is further amended by striking 
‘‘and $526,027,397 for the period beginning on October 
1, 2023, and ending on November 17, 2023’’ and inserting 
‘‘$526,027,397 for the period beginning on October 1, 
2023, and ending on November 17, 2023, and 
$690,410,959 for the period beginning on November 18, 
2023, and ending on January 19, 2024’’. 
(c) EXTENSION FOR THE NATIONAL HEALTH SERV-
ICE CORPS.—Section 10503(b)(2)(I) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 254b– 
2(b)(2)(I)), as amended by the Continuing Appropriations 
Act, 2024 and Other Extensions Act, is further amended 
by striking ‘‘$40,767,123 for the period beginning on Oc-
tober 1, 2023, and ending on November 17, 2023’’ and 
inserting ‘‘$40,767,123 for the period beginning on Octo-
ber 1, 2023, and ending on November 17, 2023, and 
$53,506,849 for the period beginning on November 18, 
2023, and ending on January 19, 2024’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to the amendments made by this section 
shall be subject to the requirements contained in Public 
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Law 117–328 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act 
(42 U.S.C. 254b et seq.). 
(e) CONFORMING AMENDMENT.—Section 3014(h)(4) 
of title 18, United States Code, is amended by striking 
‘‘and section 2321(d) of the Continuing Appropriations 
Act, 2024 and Other Extensions Act’’ and inserting ‘‘sec-
tion 2321(d) of the Continuing Appropriations Act, 2024 
and Other Extensions Act, and section 201(d) of the Fur-
ther Continuing Appropriations and Other Extensions 
Act, 2024’’. 
SEC. 202. EXTENSION OF SPECIAL DIABETES PROGRAMS. 
(a) EXTENSION OF SPECIAL DIABETES PROGRAMS 
FOR TYPE I DIABETES.—Section 330B(b)(2)(E) of the 
Public Health Service Act (42 U.S.C. 254c–2(b)(2)(E)), 
as amended by the Continuing Appropriations Act, 2024 
and Other Extensions Act, is further amended by striking 
‘‘$19,726,027 for the period beginning on October 1, 
2023, and ending on November 17, 2023’’ and inserting 
‘‘$19,726,027 for the period beginning on October 1, 
2023, and ending on November 17, 2023, and 
$25,890,411 for the period beginning on November 18, 
2023, and ending on January 19, 2024’’. 
(b) EXTENDING FUNDING FOR SPECIAL DIABETES 
PROGRAMS FOR INDIANS.—Section 330C(c)(2)(E) of the 
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Public Health Service Act (42 U.S.C. 254c–3(c)(2)(E)), 
as amended by the Continuing Appropriations Act, 2024 
and Other Extensions Act, is further amended by striking 
‘‘$19,726,027 for the period beginning on October 1, 
2023, and ending on November 17, 2023’’ and inserting 
‘‘$19,726,027 for the period beginning on October 1, 
2023, and ending on November 17, 2023, and 
$25,890,411 for the period beginning on November 18, 
2023, and ending on January 19, 2024’’. 
SEC. 203. NATIONAL HEALTH SECURITY EXTENSIONS. 
(a) Section 319(e)(8) of the Public Health Service 
Act (42 U.S.C. 247d(e)(8)) is amended by striking ‘‘No-
vember 17, 2023’’ and inserting ‘‘January 19, 2024’’. 
(b) Section 319L(e)(1)(D) of the Public Health Serv-
ice Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by strik-
ing ‘‘the date that is 17 years after the date of enactment 
of the Pandemic and All-Hazards Preparedness Act’’ and 
inserting ‘‘January 19, 2024’’. 
(c) Section 319L–1(b) of the Public Health Service 
Act (42 U.S.C. 247d–7f(b)) is amended by striking ‘‘at 
the end of the 17-year period that begins on the date of 
enactment of this Act’’ and inserting ‘‘January 19, 2024’’. 
(d)(1) Section 2811A(g) of the Public Health Service 
Act (42 U.S.C. 300hh–10b(g)) is amended by striking 
‘‘November 17, 2023’’ and inserting ‘‘January 19, 2024’’. 
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(2) Section 2811B(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking 
‘‘November 17, 2023’’ and inserting ‘‘January 19, 2024’’. 
(3) Section 2811C(g)(1) of the Public Health Service 
Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking 
‘‘November 17, 2023’’ and inserting ‘‘January 19, 2024’’. 
(e) Section 2812(c)(4)(B) of the Public Health Serv-
ice Act (42 U.S.C. 300hh–11(c)(4)(B)) is amended by 
striking ‘‘November 17, 2023’’ and inserting ‘‘January 19, 
2024’’. 
Subtitle B—Medicaid 
SEC. 301. DELAYING CERTAIN DISPROPORTIONATE SHARE 
PAYMENT CUTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), by striking ‘‘November 18, 
2023’’ and inserting ‘‘January 19, 2024’’; and 
(2) in clause (ii), by striking ‘‘November 18, 
2023’’ and inserting ‘‘January 19, 2024’’. 
SEC. 302. MEDICAID IMPROVEMENT FUND REDUCTION. 
Section 1941(b)(3)(A) of the Social Security Act (42 
U.S.C. 1396w–1(b)(3)(A)), as amended by the Continuing 
Appropriations Act, 2024 and Other Extensions Act, is 
further amended by striking ‘‘$6,357,117,810’’ and insert-
ing ‘‘5,796,117,810’’. 
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Subtitle C—Human Services 
SEC. 401. EXTENSION OF CHILD AND FAMILY SERVICES 
PROGRAMS. 
Activities authorized by part B of title IV of the So-
cial Security Act shall continue through January 19, 
2024, in the manner authorized for fiscal year 2023, 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. 
SEC. 402. SEXUAL RISK AVOIDANCE EDUCATION EXTEN-
SION. 
Section 510 of the Social Security Act (42 U.S.C. 
710), as amended by the Continuing Appropriations Act, 
2024 and Other Extensions Act, is further amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘and for the period be-
ginning on October 1, 2023, and ending on 
November 17, 2023’’ and inserting ‘‘, for 
the period beginning on October 1, 2023, 
and ending on November 17, 2023, and for 
the period beginning on November 18, 
2023, and ending on January 19, 2024’’; 
and 
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(ii) by striking ‘‘with respect to such 
period’’ and inserting ‘‘with respect to the 
applicable period’’; 
(B) in paragraphs (2)(A), by striking ‘‘for 
the period’’ and inserting ‘‘for the applicable 
period’’; and 
(C) in paragraphs (2)(B), by striking ‘‘for 
the period’’ and inserting ‘‘for the applicable 
period’’; and 
(2) in subsection (f)— 
(A) in paragraph (1), by striking ‘‘and for 
the period beginning on October 1, 2023, and 
ending on November 17, 2023, an amount 
equal to the pro rata portion of the amount ap-
propriated for the corresponding period for fis-
cal year 2023’’ and inserting ‘‘for the period be-
ginning on October 1, 2023, and ending on No-
vember 17, 2023, an amount equal to the pro 
rata portion of the amount appropriated for the 
corresponding period for fiscal year 2023, and 
for the period beginning on November 18, 
2023, and ending on January 19, 2024, an 
amount equal to the pro rata portion of the 
amount appropriated for the corresponding pe-
riod for fiscal year 2023’’; and 
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(B) in paragraph (2), by striking ‘‘for the 
period’’ and inserting ‘‘for the applicable pe-
riod’’. 
SEC. 403. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 
713), as amended by the Continuing Appropriations Act, 
2024 and Other Extensions Act, is further amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in subparagraph (A), by striking 
‘‘and for the period beginning on October 
1, 2023, and ending on November 17, 
2023,’’ and inserting ‘‘, for the period be-
ginning on October 1, 2023, and ending on 
November 17, 2023, and for the period be-
ginning on November 18, 2023, and end-
ing on January 19, 2024,’’; and 
(ii) in subparagraph (B)(i), by insert-
ing after ‘‘November 17, 2023’’ the fol-
lowing: ‘‘, and for the period beginning on 
November 18, 2023, and ending on Janu-
ary 19, 2024’’; 
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(iii) in subparagraph (C)(i), by strik-
ing ‘‘for a fiscal year or the period’’ and 
inserting ‘‘for a fiscal year or period’’; and 
(B) in paragraph (3), by striking ‘‘for a 
fiscal year or the period’’ and inserting ‘‘for a 
fiscal year or period’’; and 
(C) in paragraph (4)(A)— 
(i) by striking ‘‘for the period’’ each 
place it appears and inserting ‘‘for each 
period’’; and 
(ii) by striking ‘‘for a fiscal year or 
the period’’ and inserting ‘‘for a fiscal year 
or period’’; 
(D) in paragraph (4)(B)(i), by striking 
‘‘the period described in paragraph (1)(A)’’ and 
inserting ‘‘each period described in paragraph 
(1)(A)’’; 
(2) in subsection (c), by striking ‘‘for the period 
described in subsection (a)(1)(A)’’ and inserting ‘‘for 
a period described in subsection (a)(1)(A) for fiscal 
year 2024’’; and 
(3) in subsection (f)(1), by striking ‘‘2023, and 
for the period beginning on October 1, 2023, and 
ending on November 17, 2023, an amount equal to 
the pro rata portion of the amount appropriated for 
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the corresponding period for fiscal year 2023’’ and 
inserting ‘‘2023, for the period beginning on October 
1, 2023, and ending on November 17, 2023, an 
amount equal to the pro rata portion of the amount 
appropriated for the corresponding period for fiscal 
year 2023, and for the period beginning on Novem-
ber 18, 2023, and ending on January 19, 2024, an 
amount equal to the pro rata portion of the amount 
appropriated for the corresponding period for fiscal 
year 2023’’. 
Subtitle D—Medicare 
SEC. 501. EXTENDING FLOOR FOR WORK GEOGRAPHIC 
INDEX. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 1, 2024’’ and inserting ‘‘January 19, 2024’’. 
SEC. 502. REVISING PHASE-IN OF MEDICARE CLINICAL LAB-
ORATORY TEST PAYMENT CHANGES. 
(a) REVISED PHASE-IN OF REDUCTIONS FROM PRI-
VATE
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 ‘‘2026’’ 
and inserting ‘‘2027’’; and 
(2) in subparagraph (B)— 
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(A) in clause (ii), by striking ‘‘2023’’ and 
inserting ‘‘2024’’; and 
(B) in clause (iii), by striking ‘‘2024 
through 2026’’ and inserting ‘‘2025 through 
2027’’. 
(b) REVISED REPORTING PERIOD FOR REPORTING 
OF PRIVATE SECTOR PAYMENT RATES FOR ESTABLISH-
MENT
OF
MEDICARE
PAYMENT
RATES.—Section 
1834A(a)(1)(B) of the Social Security Act (42 U.S.C. 
1395m–1(a)(1)(B)) is amended— 
(1) in clause (i), by striking ‘‘2023’’ and insert-
ing ‘‘2024’’; and 
(2) in clause (ii), by striking ‘‘2024’’ each place 
it appears and inserting ‘‘2025’’. 
SEC. 503. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$180,000,000’’ and inserting ‘‘$466,795,056’’. 
TITLE III—BUDGETARY EFFECTS 
SEC. 601. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this division shall not be entered on either 
PAYGO scorecard maintained pursuant to section 4(d) of 
the Statutory Pay-As-You-Go Act of 2010. 
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(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this division shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 105–217 and section 250(c)(8) of the Balanced 
Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this division shall not be estimated— 
(1) for purposes of section 251 of such Act; 
(2) for purposes of an allocation to the Com-
mittee on Appropriations pursuant to section 302(a) 
of the Congressional Budget Act of 1974; and 
(3) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
Æ 
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