4475 
(3) in subparagraph (A) of each of paragraphs 
(3) and (4), by striking ‘‘measure’’ and inserting 
‘‘measures’’; and 
(4) by adding at the end the following new para-
graph: 
‘‘(12) VALIDATION.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
apply to the measures applied under this sub-
section and the data submitted under subsection 
(e)(6) a process to validate such measures and 
data, as appropriate, which may be similar to 
the 
process 
specified 
in 
section 
1886(b)(3)(B)(viii)(XI) for validating inpatient 
hospital measures. 
‘‘(B) FUNDING.—For purposes of carrying 
out this paragraph, the Secretary shall provide 
for the transfer, from the Federal Hospital In-
surance Trust Fund established under section 
1817, of $5,000,000 to the Centers for Medicare 
& Medicaid Services Program Management Ac-
count for each of fiscal years 2023 through 2025, 
to remain available until expended.’’. 
(b) REPORT BY MEDPAC.—Not later than March 15, 
2022, the Medicare Payment Advisory Commission shall 
submit to Congress a report on establishing a prototype 
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value-based payment program under a unified prospective 
payment system for post-acute care services under the Medi-
care program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). Such report— 
(1) shall— 
(A) consider design elements such as— 
(i) measures that are important to the 
Medicare program and to beneficiaries 
under such program; 
(ii) methodologies for scoring provider 
performance and effects on payment; and 
(iii) other elements determined appro-
priate by the Commission; and 
(B) analyze the effects of implementing such 
prototype program; and 
(2) may— 
(A) discuss the possible effects, with respect 
to the Medicare program, on program spending, 
post-acute care providers, patient outcomes, and 
other effects determined appropriate by the Com-
mission; and 
(B) include recommendations with respect 
to such prototype program, as determined appro-
priate by the Commission, to Congress and the 
Secretary of Health and Human Services. 
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SEC. 112. PROVIDING THE MEDICARE PAYMENT ADVISORY 
COMMISSION AND MEDICAID AND CHIP PAY-
MENT AND ACCESS COMMISSION WITH AC-
CESS TO CERTAIN DRUG PAYMENT INFORMA-
TION, INCLUDING CERTAIN REBATE INFOR-
MATION. 
(a) ACCESS TO CERTAIN PART D PAYMENT DATA.— 
Section 1860D–15(f) of the Social Security Act (42 U.S.C. 
1395w–115(f)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by inserting at the end the following 
new subparagraph: 
‘‘(C) by the Executive Director of the Medi-
care Payment Advisory Commission for purposes 
of monitoring, making recommendations for, and 
analysis of the program under this title and by 
the Executive Director of the Medicaid and 
CHIP Payment and Access Commission for pur-
poses of monitoring, making recommendations 
for, and analysis of the Medicaid program estab-
lished under title XIX and the Children’s Health 
Insurance Program under title XXI.’’; and 
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(2) by adding at the end the following new para-
graph: 
‘‘(3) ADDITIONAL RESTRICTIONS ON DISCLOSURE 
OF INFORMATION.— 
‘‘(A) IN GENERAL.—The Executive Direc-
tors described in paragraph (2)(C) shall not dis-
close any of the following information disclosed 
to such Executive Directors or obtained by such 
Executive Directors pursuant to such paragraph, 
with respect to a prescription drug plan offered 
by a PDP sponsor or an MA–PD plan offered by 
an MA organization: 
‘‘(i) The specific amounts or the iden-
tity of the source of any rebates, discounts, 
price concessions, or other forms of direct or 
indirect remuneration under such prescrip-
tion drug plan or such MA–PD plan. 
‘‘(ii) Information submitted with the 
bid submitted under section 1860D–11(b) 
by such PDP sponsor or under section 
1854(a) by such MA organization. 
‘‘(iii) In the case of such information 
from prescription drug event records, infor-
mation in a form that would not be per-
mitted under section 423.505(m) of title 42, 
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Code of Federal Regulations, or any suc-
cessor regulation, if released by the Centers 
for Medicare & Medicaid Services. 
‘‘(B) CLARIFICATION.—The restrictions on 
disclosures described in subparagraph (A) shall 
also apply to disclosures to individual Commis-
sioners of the Medicare Payment Advisory Com-
mission or of the Medicaid and CHIP Payment 
and Access Commission.’’. 
(b) ACCESS TO CERTAIN REBATE AND PAYMENT DATA 
UNDER MEDICARE AND MEDICAID.—Section 1927(b)(3)(D) 
of the Social Security Act (42 U.S.C. 1396r–8(b)(3)(D)) is 
amended— 
(1) in the matter before clause (i), by striking 
‘‘subsection (a)(6)(A)(ii)’’ and inserting ‘‘subsection 
(a)(6)(A)’’; 
(2) in clause (v), by striking ‘‘and’’ at the end; 
(3) in clause (vi), by striking the period at the 
end and inserting ‘‘, and’’; 
(4) by inserting after clause (vi) the following 
new clause: 
‘‘(vii) to permit the Executive Director 
of the Medicare Payment Advisory Commis-
sion and the Executive Director of the Med-
icaid and CHIP Payment and Access Com-
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mission to review the information pro-
vided.’’; 
(5) in the matter at the end, by striking 
‘‘1860D–4(c)(2)(E)’’ 
and 
inserting 
‘‘1860D– 
4(c)(2)(G)’’; and 
(6) by adding at the end the following new sen-
tences: ‘‘Any information disclosed to the Executive 
Director of the Medicare Payment Advisory Commis-
sion or the Executive Director of the Medicaid and 
CHIP Payment and Access Commission pursuant to 
this subparagraph shall not be disclosed by either 
such Executive Director in a form which discloses the 
identity of a specific manufacturer or wholesaler or 
prices charged for drugs by such manufacturer or 
wholesaler. Such information also shall not be dis-
closed by either such Executive Director to individual 
Commissioners of the Medicare Payment Advisory 
Commission or of the Medicaid and CHIP Payment 
and Access Commission in a form which discloses the 
identity of a specific manufacturer or wholesaler or 
prices charged for drugs by such manufacturer or 
wholesaler.’’. 
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SEC. 113. MORATORIUM ON PAYMENT UNDER THE MEDI-
CARE PHYSICIAN FEE SCHEDULE OF THE ADD 
ON CODE FOR INHERENTLY COMPLEX EVAL-
UATION AND MANAGEMENT VISITS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services may not, prior to January 1, 2024, make 
payment under the fee schedule under section 1848 of the 
Social Security Act (42 U.S.C. 1395w–4) for services de-
scribed by Healthcare Common Procedure Coding System 
(HCPCS) code G2211 (or any successor or substantially 
similar code), as described in section II.F. of the final rule 
filed by the Secretary with the Office of the Federal Register 
for public inspection on December 2, 2020, and entitled 
‘‘Medicare Program; CY 2021 Payment Policies under the 
Physician Fee Schedule and Other Changes to Part B Pay-
ment Policies; Medicare Shared Savings Program Require-
ments; Medicaid Promoting Interoperability Program Re-
quirements for Eligible Professionals; Quality Payment 
Program; Coverage of Opioid Use Disorder Services Fur-
nished by Opioid Treatment Programs; Medicare Enroll-
ment of Opioid Treatment Programs; Electronic Pre-
scribing for Controlled Substances for a Covered Part D 
Drug; Payment for Office/Outpatient Evaluation and Man-
agement Services; Hospital IQR Program; Establish New 
Code Categories; Medicare Diabetes Prevention Program 
(MDPP) Expanded Model Emergency Policy; Coding and 
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Payment for Virtual Check-in Services Interim Final Rule 
Policy; Coding and Payment for Personal Protective Equip-
ment (PPE) Interim Final Rule Policy; Regulatory Revi-
sions in Response to the Public Health Emergency (PHE) 
for COVID-19; and Finalization of Certain Provisions from 
the March 31st , May 8th and September 2nd Interim Final 
Rules in Response to the PHE for COVID-19’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this section 
by interim final rule, program instruction, or otherwise. 
SEC. 114. TEMPORARY FREEZE OF APM PAYMENT INCEN-
TIVE THRESHOLDS. 
(a) IN GENERAL.—Section 1833(z)(2) of the Social Se-
curity Act (42 U.S.C. 1395l(z)(2)) is amended— 
(1) in subparagraph (B)— 
(A) in the heading, by striking ‘‘AND 2022’’ 
and inserting ‘‘THROUGH 2024’’; and 
(B) in the matter preceding clause (i), by 
striking ‘‘2021 and 2022’’ and inserting ‘‘each of 
2021 through 2024’’; 
(2) in subparagraph (C)— 
(A) in the heading, by striking ‘‘2023’’ and 
inserting ‘‘2025’’; and 
(B) in the matter preceding clause (i), by 
striking ‘‘2023’’ and inserting ‘‘2025’’; and 
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(3) in subparagraph (D), by adding at the end 
the following: ‘‘With respect to 2023 and 2024, the 
Secretary shall use the same percentage criteria for 
counts of patients that are used in 2022.’’. 
(b) PARTIAL QUALIFYING APM PARTICIPANT MODI-
FICATIONS.—Section 1848(q)(1)(C)(iii) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), in the matter preceding 
item (aa), by striking ‘‘2021 and 2022’’ and inserting 
‘‘each of 2021 through 2024’’; and 
(2) in subclause (III), in the matter preceding 
item (aa), by striking ‘‘2023’’ and inserting ‘‘2025’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date of the enactment of this 
Act. 
SEC. 115. PERMITTING OCCUPATIONAL THERAPISTS TO 
CONDUCT THE INITIAL ASSESSMENT VISIT 
AND COMPLETE THE COMPREHENSIVE AS-
SESSMENT WITH RESPECT TO CERTAIN REHA-
BILITATION SERVICES FOR HOME HEALTH 
AGENCIES UNDER THE MEDICARE PROGRAM. 
Not later than January 1, 2022, the Secretary of 
Health and Human Services shall revise subsections (a)(2) 
and (b)(3) of section 484.55 of title 42, Code of Federal Reg-
ulations, or a successor regulation, to permit an occupa-
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4484 
tional therapist to conduct the initial assessment visit and 
to complete the comprehensive assessment (as such terms are 
described in such subsections, respectively) for home health 
services for an individual under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) if the home health 
plan of care for such individual— 
(1) does not initially include skilled nursing 
care; 
(2) includes occupational therapy; and 
(3) includes physical therapy or speech language 
pathology. 
SEC. 116. CENTERS FOR MEDICARE & MEDICAID SERVICES 
PROVIDER OUTREACH AND REPORTING ON 
COGNITIVE ASSESSMENT AND CARE PLAN 
SERVICES. 
(a) OUTREACH.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall 
conduct outreach to physicians and appropriate non-physi-
cian 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 Medicare payment for 
cognitive assessment and care plan services furnished to in-
dividuals with cognitive impairment such as Alzheimer’s 
disease and related dementias, identified as of January 1, 
2018, by HCPCS code 99483, or any successor to such code 
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(in this section referred to as ‘‘cognitive assessment and care 
plan services’’). Such outreach shall include a comprehen-
sive, one-time education initiative to inform such physi-
cians and practitioners of the addition of such services as 
a covered benefit under the Medicare program, including 
the requirements for eligibility for such services. 
(b) REPORTS.— 
(1) HHS REPORT ON PROVIDER OUTREACH.— 
Not later than one year after the date of enactment 
of this Act, the Secretary of Health and Human Serv-
ices shall submit to the Committee on Ways and 
Means and the Committee on Energy and Commerce 
of the House of Representatives and the Committee on 
Finance of the Senate a report on the outreach con-
ducted under subsection (a). Such report shall include 
a description of the methods used for such outreach. 
(2) GAO REPORT ON UTILIZATION RATES.—Not 
later than 3 years after such date of enactment, the 
Comptroller General of the United States shall submit 
to the Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the 
Senate a report on the number of Medicare bene-
ficiaries who were furnished cognitive assessment and 
care plan services for which payment was made under 
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title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.). Such report shall include information on bar-
riers Medicare beneficiaries face to access such serv-
ices, and recommendations for such legislative and 
administrative action as the Comptroller General 
deems appropriate. 
SEC. 117. CONTINUED COVERAGE OF CERTAIN TEMPORARY 
TRANSITIONAL HOME INFUSION THERAPY 
SERVICES. 
(a) IN GENERAL.—Section 1861(iii)(3)(C) of the So-
cial Security Act (42 U.S.C. 1395x(iii)(3)(C)) is amended 
by inserting after clause (ii) the following flush sentence: 
‘‘Clause (ii) shall not apply to a self-administered 
drug or biological on a self-administered drug exclu-
sion list if such drug or biological was included as a 
transitional home infusion drug under subparagraph 
(A)(iii) of section 1834(u)(7) and was identified by a 
HCPCS code described in subparagraph (C)(ii) of 
such section.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to items and services furnished on 
or after January 1, 2021. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
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ices may implement the amendment made by subsection (a) 
by interim final rule, program instruction, or otherwise. 
SEC. 118. TRANSITIONAL COVERAGE AND RETROACTIVE 
MEDICARE PART D COVERAGE FOR CERTAIN 
LOW-INCOME BENEFICIARIES. 
Section 1860D–14 of the Social Security Act (42 
U.S.C. 1395w–114) is amended— 
(1) by redesignating subsection (e) as subsection 
(f); and 
(2) by adding after subsection (d) the following 
new subsection: 
‘‘(e) LIMITED INCOME NEWLY ELIGIBLE TRANSITION 
PROGRAM.— 
‘‘(1) IN
GENERAL.—Beginning not later than 
January 1, 2024, the Secretary shall carry out a pro-
gram to provide transitional coverage for covered part 
D drugs for LI NET eligible individuals in accord-
ance with this subsection. 
‘‘(2) LI NET ELIGIBLE INDIVIDUAL DEFINED.— 
For purposes of this subsection, the term ‘LI NET eli-
gible individual’ means a part D eligible individual 
who— 
‘‘(A) meets the requirements of clauses (ii) 
and (iii) of subsection (a)(3)(A); and 
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‘‘(B) has not yet enrolled in a prescription 
drug plan or an MA–PD plan, or, who has so 
enrolled, but with respect to whom coverage 
under such plan has not yet taken effect. 
‘‘(3) TRANSITIONAL COVERAGE.—For purposes of 
this subsection, the term ‘transitional coverage’ means 
with respect to an LI NET eligible individual— 
‘‘(A) immediate access to covered part D 
drugs at the point of sale during the period that 
begins on the first day of the month such indi-
vidual is determined to meet the requirements of 
clauses (ii) and (iii) of subsection (a)(3)(A) and 
ends on the date that coverage under a prescrip-
tion drug plan or MA–PD plan takes effect with 
respect to such individual; and 
‘‘(B) in the case of an LI NET eligible indi-
vidual who is a full-benefit dual eligible indi-
vidual (as defined in section 1935(c)(6)) or a re-
cipient of supplemental security income benefits 
under title XVI, retroactive coverage (in the form 
of reimbursement of the amounts that would 
have been paid under this part had such indi-
vidual been enrolled in a prescription drug plan 
or MA–PD plan) of covered part D drugs pur-
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chased by such individual during the period that 
begins on the date that is the later of— 
‘‘(i) the date that such individual was 
first eligible for a low-income subsidy under 
this part; or 
‘‘(ii) the date that is 36 months prior 
to the date such individual enrolls in a pre-
scription drug plan or MA–PD plan, 
and ends on the date that coverage under such 
plan takes effect. 
‘‘(4) PROGRAM ADMINISTRATION.— 
‘‘(A) POINT
OF
CONTACT.—The Secretary 
shall, as determined appropriate by the Sec-
retary, administer the program under this sub-
section through a contract with a single program 
administrator. 
‘‘(B) BENEFIT
DESIGN.—The Secretary 
shall ensure that the transitional coverage pro-
vided to LI NET eligible individuals under this 
subsection— 
‘‘(i) provides access to all covered part 
D drugs under an open formulary; 
‘‘(ii) permits all pharmacies deter-
mined by the Secretary to be in good stand-
ing to process claims under the program; 
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‘‘(iii) is consistent with such require-
ments as the Secretary considers necessary 
to improve patient safety and ensure appro-
priate dispensing of medication; and 
‘‘(iv) meets such other requirements as 
the Secretary may establish. 
‘‘(5) RELATIONSHIP TO OTHER PROVISIONS OF 
THIS TITLE; WAIVER AUTHORITY.— 
‘‘(A) IN
GENERAL.—The following provi-
sions shall not apply with respect to the program 
under this subsection: 
‘‘(i) Paragraphs (1) and (3)(B) of sec-
tion 1860D–4(a) (relating to dissemination 
of general information; availability of infor-
mation on changes in formulary through 
the internet). 
‘‘(ii) Subparagraphs (A) and (B) of 
section 1860D–4(b)(3) (relating to require-
ments on development and application of 
formularies; formulary development). 
‘‘(iii) Paragraphs (1)(C) and (2) of 
section 1860D–4(c) (relating to medication 
therapy management program). 
‘‘(B) WAIVER AUTHORITY.—The Secretary 
may waive such other requirements of title XI 
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and this title as may be necessary to carry out 
the purposes of the program established under 
this subsection. 
‘‘(6) CONTRACTING AUTHORITY.—The authority 
vested in the Secretary by this subsection may be per-
formed without regard to such provisions of law or 
regulations relating to the making, performance, 
amendment, or modification of contracts of the 
United States as the Secretary may determine to be 
inconsistent with the furtherance of the purpose of 
this title.’’. 
SEC. 119. INCREASING THE USE OF REAL-TIME BENEFIT 
TOOLS TO LOWER BENEFICIARY COSTS. 
(a) REQUIRING PRESCRIPTION DRUG PLAN SPONSORS 
AND MEDICARE ADVANTAGE ORGANIZATIONS TO INCLUDE 
REAL-TIME BENEFIT INFORMATION UNDER MEDICARE 
PART D.—Section 1860D–4 of the Social Security Act (42 
U.S.C. 1395w–104) is amended— 
(1) by redesignating subsection (m) (relating to 
program integrity transparency measures), as added 
by section 6063(c) of the Substance Use-Disorder Pre-
vention that Promotes Opioid Recovery and Treat-
ment for Patients and Communities Act (Public Law 
115–271), as subsection (n); and 
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(2) by adding at the end the following new sub-
section: 
‘‘(o) REAL-TIME BENEFIT INFORMATION.— 
‘‘(1) IN
GENERAL.—After the Secretary has 
adopted a standard under paragraph (3) for elec-
tronic real-time benefit tools, and at a time deter-
mined appropriate by the Secretary, a PDP sponsor 
of a prescription drug plan shall implement one or 
more of such tools that meet the requirements de-
scribed in paragraph (2). 
‘‘(2) REQUIREMENTS.—For purposes of para-
graph (1), the requirements described in this para-
graph, with respect to an electronic real-time benefit 
tool, are that the tool is capable of— 
‘‘(A) integrating with electronic prescribing 
and electronic health record systems of pre-
scribing health care professionals for the trans-
mission of formulary and benefit information in 
real time to such professionals; and 
‘‘(B) with respect to a covered part D drug, 
transmitting such information specific to an in-
dividual enrolled in a prescription drug plan, 
including the following: 
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‘‘(i) A list of any clinically-appro-
priate alternatives to such drug included in 
the formulary of such plan. 
‘‘(ii) Cost-sharing information and the 
negotiated price for such drug and such al-
ternatives at multiple pharmacy options, 
including the individual’s preferred phar-
macy and, as applicable, other retail phar-
macies and a mail order pharmacy. 
‘‘(iii) The formulary status of such 
drug and such alternatives and any prior 
authorization or other utilization manage-
ment requirements applicable to such drug 
and such alternatives included in the for-
mulary of such plan. 
‘‘(3) STANDARDS.—In order to be treated (for 
purposes of this subsection) as an electronic real-time 
benefit tool described in paragraph (1), such tool shall 
comply with technical standards adopted by the Sec-
retary in consultation with the National Coordinator 
for Health Information Technology through notice 
and comment rulemaking. Such technical standards 
adopted by the Secretary shall be developed by a 
standards development organization, such as the Na-
tional Council for Prescription Drug Programs, that 
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consults with stakeholders such as PDP sponsors, 
Medicare Advantage organizations, beneficiary advo-
cates, health care professionals, and health informa-
tion technology software vendors. 
‘‘(4) RULES OF CONSTRUCTION.—Nothing in this 
subsection shall be construed— 
‘‘(A) to prohibit the application of para-
graph (b)(7) of section 423.160 of title 42, Code 
of Federal Regulations, as is to be added to such 
section pursuant to the final rule published in 
the Federal Register on May 23, 2019, and titled 
‘Modernizing Part D and Medicare Advantage 
To Lower Drug Prices and Reduce Out-of-Pocket 
Expenses’ (84 Fed. Reg. 23832 through 23884); 
or 
‘‘(B) to allow a PDP sponsor to use a real- 
time benefit tool to steer an individual, without 
the consent of the individual, to a particular 
pharmacy or pharmacy type over their preferred 
pharmacy or pharmacy type nor prohibit the 
designation of an individual’s preferred phar-
macy under such tool.’’. 
(b) REQUIRING QUALIFIED ELECTRONIC HEALTH 
RECORDS TO INCLUDE REAL-TIME BENEFIT TOOLS.—Sec-
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tion 3000(13) of the Public Health Service Act (42 U.S.C. 
300jj(13)) is amended— 
(1) in subparagraph (A), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (B), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(C) includes, or is capable of including, a 
real-time benefit tool that conveys patient-spe-
cific real-time cost and coverage information 
with respect to prescription drugs that, with re-
spect to any health information technology cer-
tified for electronic prescribing, the technology 
shall be capable of incorporating the information 
described in clauses (i) through (iii) of para-
graph (2)(B) of section 1860D–4(o) of the Social 
Security Act at a time specified by the Secretary 
but not before the Secretary adopts a standard 
for such tools as described in paragraph (1) of 
such section.’’. 
(c) INCLUSION OF USE OF REAL-TIME ELECTRONIC 
INFORMATION
IN
SHARED
DECISION-MAKING
UNDER 
MIPS.—Section 1848(q)(2)(B)(iii)(IV) of the Social Secu-
rity Act (42 U.S.C. 1395w–4(q)(2)(B)(iii)(IV)) is amended 
by adding at the end the following new sentences: ‘‘This sub-
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category shall include as an activity, for performance peri-
ods beginning on or after January 1, 2022, use of a real- 
time benefit tool as described in section 1860D–4(o). The 
Secretary may establish this activity as a standalone or as 
a component of another activity.’’. 
SEC. 120. BENEFICIARY ENROLLMENT SIMPLIFICATION. 
(a) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 
(1) EFFECTIVE
DATE
OF
COVERAGE.—Section 
1838(a) of the Social Security Act (42 U.S.C. 
1395q(a)) is amended— 
(A) by amending paragraph (2) to read as 
follows: 
‘‘(2)(A) in the case of an individual who enrolls 
pursuant to subsection (d) of section 1837 before the 
month in which he first satisfies paragraph (1) or (2) 
of section 1836(a), the first day of such month, 
‘‘(B) in the case of an individual who first satis-
fies such paragraph in a month beginning before Jan-
uary 2023 and who enrolls pursuant to such sub-
section (d)— 
‘‘(i) in such month in which he first satis-
fies such paragraph, the first day of the month 
following the month in which he so enrolls, 
‘‘(ii) in the month following such month in 
which he first satisfies such paragraph, the first 
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day of the second month following the month in 
which he so enrolls, or 
‘‘(iii) more than one month following such 
month in which he satisfies such paragraph, the 
first day of the third month following the month 
in which he so enrolls, 
‘‘(C) in the case of an individual who first satis-
fies such paragraph in a month beginning on or after 
January 1, 2023, and who enrolls pursuant to such 
subsection (d) in such month in which he first satis-
fies such paragraph or in any subsequent month of 
his initial enrollment period, the first day of the 
month following the month in which he so enrolls, or 
‘‘(D) in the case of an individual who enrolls 
pursuant to subsection (e) of section 1837 in a month 
beginning— 
‘‘(i) before January 1, 2023, the July 1 fol-
lowing the month in which he so enrolls; or 
‘‘(ii) on or after January 1, 2023, the first 
day of the month following the month in which 
he so enrolls; or’’; and 
(B) by amending paragraph (3) to read as 
follows: 
‘‘(3) in the case of an individual who is deemed 
to have enrolled— 
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‘‘(A) on or before the last day of the third 
month of his initial enrollment period, the first 
day of the month in which he first meets the ap-
plicable requirements of section 1836(a) or July 
1, 1973, whichever is later, or 
‘‘(B) on or after the first day of the fourth 
month of his initial enrollment period, and 
where such month begins— 
‘‘(i) before January 1, 2023, as pre-
scribed under subparagraphs (B)(i), (B)(ii), 
(B)(iii), and (D)(i) of paragraph (2), or 
‘‘(ii) on or after January 1, 2023, as 
prescribed under subparagraphs (C) and 
(D)(ii) of paragraph (2).’’. 
(2) SPECIAL ENROLLMENT PERIODS FOR EXCEP-
TIONAL CIRCUMSTANCES.— 
(A) ENROLLMENT.—Section 1837 of the So-
cial Security Act (42 U.S.C. 1395p) is amended 
by adding at the end the following new sub-
section: 
‘‘(m) Beginning January 1, 2023, the Secretary may 
establish special enrollment periods in the case of individ-
uals who satisfy paragraph (1) or (2) of section 1836(a) 
and meet such exceptional conditions as the Secretary may 
provide.’’. 
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(B) COVERAGE
PERIOD.—Section 1838 of 
the Social Security Act (42 U.S.C. 1395q) is 
amended by adding at the end the following new 
subsection: 
‘‘(g) Notwithstanding subsection (a), in the case of an 
individual who enrolls during a special enrollment period 
pursuant to section 1837(m), the coverage period shall begin 
on a date the Secretary provides in a manner consistent 
(to the extent practicable) with protecting continuity of 
health benefit coverage.’’. 
(C) 
CONFORMING
AMENDMENT.—Title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended— 
(i) in section 1818A(c)(3), by striking 
‘‘subsections (h) and (i) of section 1837’’ 
and inserting ‘‘subsections (h), (i), and (m) 
of section 1837’’; and 
(ii) in section 1839(b), in the first sen-
tence, by striking ‘‘or (l)’’ and inserting ‘‘, 
(l), or (m)’’. 
(3) TECHNICAL
CORRECTION.—Section 1839(b) 
of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended by adding at the end the following new sen-
tence: ‘‘For purposes of determining any increase 
under this subsection for individuals whose enroll-
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ment occurs on or after January 1, 2023, the second 
sentence of this subsection shall be applied by sub-
stituting ‘close of the month’ for ‘close of the enroll-
ment period’ each place it appears.’’. 
(4) REPORT.—Not later than January 1, 2023, 
the Secretary of Health and Human Services shall 
submit to the Committee on Ways and Means and 
Committee on Energy and Commerce of the House of 
Representatives and the Committee on Finance and 
Special Committee on Aging of the Senate a report on 
how to align existing Medicare enrollment periods 
under title XVIII of the Social Security Act, includ-
ing the general enrollment period under part B of 
such title and the annual, coordinated election period 
under the Medicare Advantage program under part C 
of such title and under the prescription drug program 
under part D of such title. Such report shall include 
recommendations consistent with the goals of maxi-
mizing coverage continuity and choice and easing 
beneficiary transition. 
(b) FUNDING.—Section 1808 of the Social Security Act 
(42 U.S.C. 1395b–9) is amended by adding the end the fol-
lowing new subsection: 
‘‘(e) FUNDING FOR IMPLEMENTATION OF BENEFICIARY 
ENROLLMENT SIMPLIFICATION.—For purposes of carrying 
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out the provisions of and the amendments made by section 
120 of division CC of the Consolidated Appropriations Act, 
2021, the Secretary shall provide for the transfer, from the 
Federal Hospital Insurance Trust Fund under section 1817 
and the Federal Supplementary Medical Insurance Trust 
Fund under section 1841 (in such proportion as the Sec-
retary determines appropriate), to the Centers for Medicare 
& Medicaid Services Program Management Account, of 
$2,000,000 for each of fiscal years 2021 through 2030, to 
remain available until expended.’’. 
SEC. 121. WAIVING BUDGET NEUTRALITY FOR OXYGEN 
UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1834(a)(9)(D)(ii) of the 
Social Security Act (42 U.S.C. 1395m(a)(9)(D)(ii)), with 
application of subsection (b), is amended by adding at the 
end the following new sentence: ‘‘The requirement of the pre-
ceding sentence shall not apply beginning with the second 
calendar quarter beginning on or after the date of the enact-
ment of this sentence.’’. 
(b) TECHNICAL CORRECTION.— 
(1) IN GENERAL.—Section 4552(b) of the Bal-
anced Budget Act of 1997 (Public Law 105–33) is 
amended by striking ‘‘section 1848(a)(9)’’ and insert-
ing ‘‘section 1834(a)(9)’’. 
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(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect as if included in the 
enactment of the Balanced Budget Act of 1997 (Public 
Law 105–33). 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
ices may implement the amendments made by this section 
by program instruction or otherwise. 
SEC. 122. WAIVING MEDICARE COINSURANCE FOR CERTAIN 
COLORECTAL CANCER SCREENING TESTS. 
(a) IN GENERAL.—Section 1833(a) of the Social Secu-
rity Act (42 U.S.C. 1395l(a)) is amended— 
(1) in the second sentence, by striking ‘‘section 
1834(0)’’ and inserting ‘‘section 1834(o)’’; 
(2) by moving such second sentence 2 ems to the 
left; and 
(3) by inserting the following third sentence fol-
lowing such second sentence: ‘‘For services furnished 
on or after January 1, 2022, paragraph (1)(Y) shall 
apply with respect to a colorectal cancer screening 
test regardless of the code that is billed for the estab-
lishment of a diagnosis as a result of the test, or for 
the removal of tissue or other matter or other proce-
dure that is furnished in connection with, as a result 
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of, and in the same clinical encounter as the screening 
test.’’. 
(b) SPECIAL
COINSURANCE
RULE
FOR
CERTAIN 
TESTS.—Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended— 
(1) in subsection (a)(1)(Y), by inserting ‘‘subject 
to subsection (dd),’’ before ‘‘with respect to’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(dd) SPECIAL COINSURANCE RULE
FOR CERTAIN 
COLORECTAL CANCER SCREENING TESTS.— 
‘‘(1) IN GENERAL.—In the case of a colorectal 
cancer screening test to which paragraph (1)(Y) of 
subsection (a) would not apply but for the third sen-
tence of such subsection that is furnished during a 
year beginning on or after January 1, 2022, and be-
fore January 1, 2030, the amount paid shall be equal 
to the specified percent (as defined in paragraph (2)) 
for such year of the lesser of the actual charge for the 
service or the amount determined under the fee sched-
ule that applies to such test under this part (or, in 
the case such test is a covered OPD service (as defined 
in subsection (t)(1)(B)), the amount determined under 
subsection (t)). 
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‘‘(2) SPECIFIED PERCENT DEFINED.—For pur-
poses of paragraph (1), the term ‘specified percent’ 
means— 
‘‘(A) for 2022, 80 percent; 
‘‘(B) for 2023 through 2026, 85 percent; 
and 
‘‘(C) for 2027 through 2029, 90 percent.’’. 
(c) CONFORMING AMENDMENTS.—Paragraphs (2) and 
(3) of section 1834(d) of the Social Security Act (42 U.S.C. 
1395m(d)) are each amended— 
(1) in subparagraph (C)(ii), in the matter pre-
ceding subclause (I), by striking ‘‘Notwithstanding’’ 
and inserting ‘‘Subject to section 1833(a)(1)(Y), but 
notwithstanding’’; and 
(2) in subparagraph (D), by striking ‘‘If during’’ 
and inserting ‘‘Subject to section 1833(a)(1)(Y), if 
during’’. 
SEC. 123. EXPANDING ACCESS TO MENTAL HEALTH SERV-
ICES FURNISHED THROUGH TELEHEALTH. 
(a) TREATMENT OF MENTAL HEALTH SERVICES FUR-
NISHED THROUGH TELEHEALTH.—Paragraph (7) of sec-
tion 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)) is amended— 
(1) by striking ‘‘DISORDER
SERVICES
FUR-
NISHED
THROUGH
TELEHEALTH.—The geographic’’ 
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and inserting ‘‘DISORDER
SERVICES
AND
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.— 
‘‘(A) IN GENERAL.—The geographic’’; 
(2) in subparagraph (A), as added by paragraph 
(1), by inserting ‘‘or, on or after the first day after 
the end of the emergency period described in section 
1135(g)(1)(B), subject to subparagraph (B), to an eli-
gible telehealth individual for purposes of diagnosis, 
evaluation, or treatment of a mental health disorder, 
as determined by the Secretary,’’ after ‘‘as determined 
by the Secretary,’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) REQUIREMENTS FOR MENTAL HEALTH 
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.— 
‘‘(i) IN GENERAL.—Payment may not 
be made under this paragraph for telehealth 
services furnished by a physician or practi-
tioner to an eligible telehealth individual for 
purposes of diagnosis, evaluation, or treat-
ment of a mental health disorder unless 
such physician or practitioner furnishes an 
item or service in person, without the use of 
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telehealth, for which payment is made 
under this title (or would have been made 
under this title if such individual were enti-
tled to, or enrolled for, benefits under this 
title at the time such item or service is fur-
nished)— 
‘‘(I) within the 6-month period 
prior to the first time such physician 
or practitioner furnishes such a tele-
health service to the eligible telehealth 
individual; and 
‘‘(II) during subsequent periods in 
which such physician or practitioner 
furnishes such telehealth services to the 
eligible telehealth individual, at such 
times as the Secretary determines ap-
propriate. 
‘‘(ii) CLARIFICATION.—This subpara-
graph shall not apply if payment would 
otherwise be allowed— 
‘‘(I) under this paragraph (with 
respect to telehealth services furnished 
to an eligible telehealth individual with 
a substance use disorder diagnosis for 
purposes of treatment of such disorder 
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4507 
or co-occurring mental health dis-
order); or 
‘‘(II) under this subsection with-
out application of this paragraph.’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement the provi-
sions of, or amendments made by, this section by interim 
final rule, program instruction, or otherwise. 
SEC. 124. PUBLIC-PRIVATE PARTNERSHIP FOR HEALTH 
CARE WASTE, FRAUD, AND ABUSE DETEC-
TION. 
(a) IN GENERAL.—Section 1128C(a) of the Social Se-
curity Act (42 U.S.C. 1320a–7c(a)) is amended by adding 
at the end the following new paragraph: 
‘‘(6) PUBLIC-PRIVATE PARTNERSHIP FOR WASTE, 
FRAUD, AND ABUSE DETECTION.— 
‘‘(A) IN GENERAL.—Under the program de-
scribed in paragraph (1), there is established a 
public-private partnership (in this paragraph 
referred to as the ‘partnership’) of health plans, 
Federal and State agencies, law enforcement 
agencies, health care anti-fraud organizations, 
and any other entity determined appropriate by 
the Secretary (in this paragraph referred to as 
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‘partners’) for purposes of detecting and pre-
venting health care waste, fraud, and abuse. 
‘‘(B) CONTRACT
WITH
TRUSTED
THIRD 
PARTY.—In carrying out the partnership, the 
Secretary shall enter into a contract with a 
trusted third party for purposes of carrying out 
the duties of the partnership described in sub-
paragraph (C). 
‘‘(C) DUTIES OF PARTNERSHIP.—The part-
nership shall— 
‘‘(i) provide technical and operational 
support to facilitate data sharing between 
partners in the partnership; 
‘‘(ii) analyze data so shared to identify 
fraudulent and aberrant billing patterns; 
‘‘(iii) conduct aggregate analyses of 
health care data so shared across Federal, 
State, and private health plans for purposes 
of detecting fraud, waste, and abuse 
schemes; 
‘‘(iv) identify outlier trends and poten-
tial vulnerabilities of partners in the part-
nership with respect to such schemes; 
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‘‘(v) refer specific cases of potential un-
lawful conduct to appropriate governmental 
entities; 
‘‘(vi) convene, not less than annually, 
meetings with partners in the partnership 
for purposes of providing updates on the 
partnership’s work and facilitating infor-
mation sharing between the partners; 
‘‘(vii) enter into data sharing and data 
use agreements with partners in the part-
nership in such a manner so as to ensure 
the partnership has access to data necessary 
to identify waste, fraud, and abuse while 
maintaining the confidentiality and integ-
rity of such data; 
‘‘(viii) provide partners in the partner-
ship with plan-specific, confidential feed-
back on any aberrant billing patterns or 
potential fraud identified by the partner-
ship with respect to such partner; 
‘‘(ix) establish a process by which enti-
ties described in subparagraph (A) may 
enter the partnership and requirements such 
entities must meet to enter the partnership; 
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‘‘(x) provide appropriate training, out-
reach, and education to partners based on 
the results of data analyses described in 
clauses (ii) and (iii); and 
‘‘(xi) perform such other duties as the 
Secretary determines appropriate. 
‘‘(D) SUBSTANCE
USE
DISORDER
TREAT-
MENT ANALYSIS.—Not later than 2 years after 
the date of the enactment of the Consolidated Ap-
propriations Act, 2021, the trusted third party 
with a contract in effect under subparagraph (B) 
shall perform an analysis of aberrant or fraudu-
lent billing patterns and trends with respect to 
providers and suppliers of substance use disorder 
treatments from data shared with the partner-
ship. 
‘‘(E) EXECUTIVE BOARD.— 
‘‘(i) 
EXECUTIVE
BOARD
COMPOSI-
TION.— 
‘‘(I) IN GENERAL.—There shall be 
an executive board of the partnership 
comprised of representatives of the Fed-
eral Government and representatives of 
the private sector selected by the Sec-
retary. 
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‘‘(II) 
CHAIRS.—The 
executive 
board shall be co-chaired by one Fed-
eral Government official and one rep-
resentative from the private sector. 
‘‘(ii) MEETINGS.—The executive board 
of the partnership shall meet at least once 
per year. 
‘‘(iii) EXECUTIVE
BOARD
DUTIES.— 
The duties of the executive board shall in-
clude the following: 
‘‘(I) Providing strategic direction 
for the partnership, including member-
ship criteria and a mission statement. 
‘‘(II) Communicating with the 
leadership of the Department of Health 
and Human Services and the Depart-
ment of Justice and the various private 
health sector associations. 
‘‘(F) REPORTS.—Not later than January 1, 
2023, and every 2 years thereafter, the Secretary 
shall submit to Congress and make available on 
the public website of the Centers for Medicare & 
Medicaid Services a report containing— 
‘‘(i) a review of activities conducted by 
the partnership over the 2-year period end-
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ing on the date of the submission of such re-
port, including any progress to any objec-
tives established by the partnership; 
‘‘(ii) any savings voluntarily reported 
by health plans participating in the part-
nership attributable to the partnership dur-
ing such period; 
‘‘(iii) any savings to the Federal Gov-
ernment attributable to the partnership 
during such period; 
‘‘(iv) any other outcomes attributable 
to the partnership, as determined by the 
Secretary, during such period; and 
‘‘(v) a strategic plan for the 2-year pe-
riod beginning on the day after the date of 
the submission of such report, including a 
description of any emerging fraud and 
abuse schemes, trends, or practices that the 
partnership intends to study during such 
period. 
‘‘(G) FUNDING.—The partnership shall be 
funded by amounts otherwise made available to 
the Secretary for carrying out the program de-
scribed in paragraph (1). 
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‘‘(H) TRANSITIONAL
PROVISIONS.—To the 
extent consistent with this subsection, all func-
tions, personnel, assets, liabilities, and adminis-
trative actions applicable on the date before the 
date of the enactment of this paragraph to the 
National Fraud Prevention Partnership estab-
lished on September 17, 2012, by charter of the 
Secretary shall be transferred to the partnership 
established under subparagraph (A) as of the 
date of the enactment of this paragraph. 
‘‘(I) NONAPPLICABILITY OF FACA.—The pro-
visions of the Federal Advisory Committee Act 
shall not apply to the partnership established by 
subparagraph (A). 
‘‘(J) 
IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement the partnership established by sub-
paragraph (A) by program instruction or other-
wise. 
‘‘(K) DEFINITION.—For purposes of this 
paragraph, the term ‘trusted third party’ means 
an entity that— 
‘‘(i) demonstrates the capability to 
carry out the duties of the partnership de-
scribed in subparagraph (C); 
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‘‘(ii) complies with such conflict of in-
terest standards determined appropriate by 
the Secretary; and 
‘‘(iii) meets such other requirements as 
the Secretary may prescribe.’’. 
(b) POTENTIAL EXPANSION OF PUBLIC-PRIVATE PART-
NERSHIP ANALYSES.—Not later than 2 years after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall conduct a study and submit to Con-
gress a report on the feasibility of the partnership (as de-
scribed in section 1128C(a)(6) of the Social Security Act, 
as added by subsection (a)) establishing a system to conduct 
real-time data analysis to proactively identify ongoing as 
well as emergent fraud trends for the entities participating 
in the partnership and provide such entities with real-time 
feedback on potentially fraudulent claims. Such report shall 
include the estimated cost of and any potential barriers to 
the partnership establishing such a system. 
SEC. 125. MEDICARE PAYMENT FOR RURAL EMERGENCY 
HOSPITAL SERVICES. 
(a) IN GENERAL.— 
(1) DEFINITIONS.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (e), in the last sentence of 
the matter following paragraph (9), by inserting 
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sidered a staffed emergency department if it meets the 
following requirements: 
‘‘(i) The emergency department is staffed 24 
hours a day, 7 days a week. 
‘‘(ii) A physician (as defined in section 
1861(r)(1)), nurse practitioner, clinical nurse 
specialist, or physician assistant (as those terms 
are defined in section 1861(aa)(5)) is available 
to furnish rural emergency hospital services in 
the facility 24 hours a day. 
‘‘(iii) Applicable staffing and staffing re-
sponsibilities under section 485.631 of title 42, 
Code of Federal Regulations (or any successor 
regulation). 
‘‘(2) RURAL EMERGENCY HOSPITAL.—The term ‘rural 
emergency hospital’ means a facility described in para-
graph (3) that— 
‘‘(A) is enrolled under section 1866(j), submits 
the additional information described in paragraph 
(4)(A) for purposes of such enrollment, and makes the 
detailed transition plan described in clause (i) of such 
paragraph available to the public, in a form and 
manner determined appropriate by the Secretary; 
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‘‘(B) does not provide any acute care inpatient 
services, other than those described in paragraph 
(6)(A); 
‘‘(C) has in effect a transfer agreement with a 
level I or level II trauma center; 
‘‘(D) meets— 
‘‘(i) licensure requirements as described in 
paragraph (5); 
‘‘(ii) the requirements of a staffed emer-
gency department as described in paragraph 
(1)(B); 
‘‘(iii) such staff training and certification 
requirements as the Secretary may require; 
‘‘(iv) conditions of participation applicable 
to— 
‘‘(I) critical access hospitals, with re-
spect to emergency services under section 
485.618 of title 42, Code of Federal Regula-
tions (or any successor regulation); and 
‘‘(II) hospital emergency departments 
under this title, as determined applicable by 
the Secretary; 
‘‘(v) such other requirements as the Sec-
retary finds necessary in the interest of the 
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health and safety of individuals who are fur-
nished rural emergency hospital services; and 
‘‘(vi) in the case where the rural emergency 
hospital includes a distinct part unit of the facil-
ity that is licensed as a skilled nursing facility, 
such distinct part meets the requirements appli-
cable to skilled nursing facilities under this title. 
‘‘(3) FACILITY DESCRIBED.—A facility described in 
this paragraph is a facility that as of the date of the enact-
ment of this subsection— 
‘‘(A) was a critical access hospital; or 
‘‘(B) was a subsection (d) hospital (as defined in 
section 1886(d)(1)(B)) with not more than 50 beds lo-
cated in a county (or equivalent unit of local govern-
ment) in a rural area (as defined in section 
1886(d)(2)(D)), or was a subsection (d) hospital (as 
so defined) with not more than 50 beds that was 
treated as being located in a rural area pursuant to 
section 1886(d)(8)(E). 
‘‘(4) ADDITIONAL INFORMATION.— 
‘‘(A) INFORMATION.—For purposes of paragraph 
(2)(A), a facility that submits an application for en-
rollment under section 1866(j) as a rural emergency 
hospital shall submit the following information at 
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such time and in such form as the Secretary may re-
quire: 
‘‘(i) An action plan for initiating rural 
emergency hospital services (as defined in para-
graph (1)), including a detailed transition plan 
that lists the specific services that the facility 
will— 
‘‘(I) retain; 
‘‘(II) modify 
‘‘(III) add; and 
‘‘(IV) discontinue. 
‘‘(ii) A description of services that the facil-
ity intends to furnish on an outpatient basis 
pursuant to paragraph (1)(A)(ii). 
‘‘(iii) Information regarding how the facil-
ity intends to use the additional facility pay-
ment provided under section 1834(x)(2), includ-
ing a description of the services covered under 
this title that the additional facility payment 
would be supporting, such as furnishing tele-
health services and ambulance services, including 
operating the facility and maintaining the emer-
gency department to provide such services cov-
ered under this title. 
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‘‘(iv) Such other information as the Sec-
retary determines appropriate. 
‘‘(B) EFFECT
OF
ENROLLMENT.—Such enroll-
ment shall remain effective with respect to a facility 
until such time as— 
‘‘(i) the facility elects to convert back to its 
prior designation as a critical access hospital or 
a subsection (d) hospital (as defined in section 
1886(d)(1)(B)), subject to requirements applica-
ble under this title for such designation and in 
accordance with procedures established by the 
Secretary; or 
‘‘(ii) the Secretary determines the facility 
does not meet the requirements applicable to a 
rural emergency hospital under this subsection. 
‘‘(5) LICENSURE.—A facility may not operate as a 
rural emergency hospital in a State unless the facility— 
‘‘(A) is located in a State that provides for the 
licensing of such hospitals under State or applicable 
local law; and 
‘‘(B)(i) is licensed pursuant to such law; or 
‘‘(ii) is approved by the agency of such State or 
locality responsible for licensing hospitals, as meeting 
the standards established for such licensing. 
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‘‘(6) DISCRETIONARY AUTHORITY.—A rural emer-
gency hospital may— 
‘‘(A) include a unit of the facility that is a dis-
tinct part licensed as a skilled nursing facility to fur-
nish post-hospital extended care services; and 
‘‘(B) be considered a hospital with less than 50 
beds for purposes of the exception to the payment 
limit for rural health clinics under section 1833(f). 
‘‘(7) QUALITY MEASUREMENT.— 
‘‘(A) IN GENERAL.—The Secretary shall establish 
quality measurement reporting requirements for rural 
emergency hospitals, which may include the use of a 
small number of claims-based outcomes measures or 
surveys of patients with respect to their experience in 
the rural emergency hospital, in accordance with the 
succeeding provisions of this paragraph. 
‘‘(B) QUALITY
REPORTING
BY
RURAL
EMER-
GENCY HOSPITALS.— 
‘‘(i) IN
GENERAL.—With respect to each 
year beginning with 2023, (or each year begin-
ning on or after the date that is one year after 
one or more measures are first specified under 
subparagraph (C)), a rural emergency hospital 
shall submit data to the Secretary in accordance 
with clause (ii). 
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‘‘(ii) SUBMISSION OF QUALITY DATA.—With 
respect to each such year, a rural emergency hos-
pital shall submit to the Secretary data on qual-
ity measures specified under subparagraph (C). 
Such data shall be submitted in a form and 
manner, and at a time, specified by the Sec-
retary for purposes of this subparagraph. 
‘‘(C) QUALITY MEASURES.— 
‘‘(i) IN GENERAL.—Subject to clause (ii), 
any measure specified by the Secretary under 
this subparagraph must have been endorsed by 
the entity with a contract under section 1890(a). 
‘‘(ii) EXCEPTION.—In the case of a specified 
area or medical topic determined appropriate by 
the Secretary for which a feasible and practical 
measure has not been endorsed by the entity with 
a contract under section 1890(a), the Secretary 
may specify a measure that is not so endorsed as 
long as due consideration is given to measures 
that have been endorsed or adopted by a con-
sensus organization identified by the Secretary. 
‘‘(iii) CONSIDERATION OF LOW CASE VOL-
UME
WHEN
SPECIFYING
PERFORMANCE
MEAS-
URES.—The Secretary shall, in the selection of 
measures specified under this subparagraph, take 
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4523 
into consideration ways to account for rural 
emergency hospitals that lack sufficient case vol-
ume to ensure that the performance rates for 
such measures are reliable. 
‘‘(D) PUBLIC
AVAILABILITY
OF
DATA
SUB-
MITTED.—The Secretary shall establish procedures for 
making data submitted under subparagraph (B) 
available to the public regarding the performance of 
individual rural emergency hospitals. Such proce-
dures shall ensure that a rural emergency hospital 
has the opportunity to review, and submit corrections 
for, the data that is to be made public with respect 
to the rural emergency hospital prior to such data 
being made public. Such information shall be posted 
on the Internet website of the Centers for Medicare & 
Medicaid Services in an easily understandable format 
as determined appropriate by the Secretary. 
‘‘(8) CLARIFICATION REGARDING APPLICATION
OF 
PROVISIONS RELATING TO OFF-CAMPUS OUTPATIENT DE-
PARTMENT OF A PROVIDER.—Nothing in this subsection, 
section 1833(a)(10), or section 1834(x) shall affect the ap-
plication of paragraph (1)(B)(v) of section 1833(t), relating 
to applicable items and services (as defined in subpara-
graph (A) of paragraph (21) of such section) that are fur-
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4524 
nished by an off-campus outpatient department of a pro-
vider (as defined in subparagraph (B) of such paragraph). 
‘‘(9) IMPLEMENTATION.—There shall be no adminis-
trative or judicial review under section 1869, 1878, or oth-
erwise of the following: 
‘‘(A) The determination of whether a rural emer-
gency hospital meets the requirements of this sub-
section. 
‘‘(B) The establishment of requirements under 
this subsection by the Secretary, including require-
ments described in paragraphs (2)(D), (4), and (7). 
‘‘(C) The determination of payment amounts 
under section 1834(x), including the additional facil-
ity payment described in paragraph (2) of such sec-
tion.’’. 
(2) PAYMENT FOR RURAL EMERGENCY HOSPITAL 
SERVICES.— 
(A) IN GENERAL.—Section 1833(a) of the 
Social Security Act (42 U.S.C. 1395l(a)) is 
amended— 
(i) in paragraph (8), by striking 
‘‘and’’ at the end; 
(ii) in paragraph (9), by striking the 
period at the end and inserting ‘‘; and’’; 
and 
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(iii) by inserting after paragraph (9) 
the following new paragraph: 
‘‘(10) with respect to rural emergency hospital 
services furnished on or after January 1, 2023, the 
amounts determined under section 1834(x).’’. 
(B) PAYMENT
AMOUNT.—Section 1834 of 
the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following sub-
section: 
‘‘(x) PAYMENT RULES RELATING TO RURAL EMER-
GENCY HOSPITALS.— 
‘‘(1) PAYMENT
FOR
RURAL
EMERGENCY
HOS-
PITAL SERVICES.—In the case of rural emergency hos-
pital services (as defined in section 1861(kkk)(1)), 
furnished by a rural emergency hospital (as defined 
in section 1861(kkk)(2)) on or after January 1, 2023, 
the amount of payment for such services shall be 
equal to the amount of payment that would otherwise 
apply under section 1833(t) for covered OPD services 
(as defined in section 1833(t)(1)(B) (other than clause 
(ii) of such section)), increased by 5 percent to reflect 
the higher costs incurred by such hospitals, and shall 
include the application of any copayment amount de-
termined under section 1833(t)(8) as if such increase 
had not occurred. 
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4526 
‘‘(2) ADDITIONAL FACILITY PAYMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
make monthly payments to a rural emergency 
hospital in an amount that is equal to 1⁄12 of the 
annual additional facility payment specified in 
subparagraph (B). 
‘‘(B) ANNUAL
ADDITIONAL
FACILITY
PAY-
MENT AMOUNT.—The annual additional facility 
payment amount specified in this subparagraph 
is— 
‘‘(i) for 2023, a Medicare subsidy 
amount determined under subparagraph 
(C); and 
‘‘(ii) for 2024 and each subsequent 
year, the amount determined under this 
subparagraph for the preceding year, in-
creased by the hospital market basket per-
centage increase. 
‘‘(C) DETERMINATION OF MEDICARE SUB-
SIDY AMOUNT.—For purposes of subparagraph 
(B)(i), the Medicare subsidy amount determined 
under this subparagraph is an amount equal 
to— 
‘‘(i) the excess (if any) of— 
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4527 
‘‘(I) the total amount that the 
Secretary determines was paid under 
this title to all critical access hospitals 
in 2019; over 
‘‘(II) the estimated total amount 
that the Secretary determines would 
have been paid under this title to such 
hospitals in 2019 if payment were 
made for inpatient hospital, outpatient 
hospital, and skilled nursing facility 
services under the applicable prospec-
tive payment systems for such services 
during such year; divided by 
‘‘(ii) the total number of such hospitals 
in 2019. 
‘‘(D) REPORTING
ON
USE
OF
THE
ADDI-
TIONAL FACILITY PAYMENT.—A rural emergency 
hospital receiving the additional facility pay-
ment under this paragraph shall maintain de-
tailed information as specified by the Secretary 
as to how the facility has used the additional fa-
cility payments. Such information shall be made 
available to the Secretary upon request. 
‘‘(3) PAYMENT FOR AMBULANCE SERVICES.—For 
provisions relating to payment for ambulance services 
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4528 
furnished by an entity owned and operated by a rural 
emergency hospital, see section 1834(l). 
‘‘(4) PAYMENT FOR POST-HOSPITAL EXTENDED 
CARE SERVICES.—For provisions relating to payment 
for post-hospital extended care services furnished by a 
rural emergency hospital that has a unit that is a 
distinct part licensed as a skilled nursing facility, see 
section 1888(e). 
‘‘(5) SOURCE OF PAYMENTS.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), payments under this sub-
section shall be made from the Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841. 
‘‘(B) ADDITIONAL FACILITY PAYMENT AND 
POST-HOSPITAL
EXTENDED
CARE
SERVICES.— 
Payments under paragraph (2) shall be made 
from the Federal Hospital Insurance Trust Fund 
under section 1817.’’. 
(b) PROVIDER AGREEMENTS.— 
(1) AGREEMENT WITH QIO.—Section 1866(a) of 
the Social Security Act (42 U.S.C. 1395cc(a)) is 
amended— 
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4529 
(A) in paragraph (1)(F)(ii), by inserting 
‘‘rural emergency hospitals,’’ after ‘‘critical ac-
cess hospitals,’’; and 
(B) in paragraph (3)— 
(i) in subparagraph (A), by inserting 
‘‘rural emergency hospital,’’ after ‘‘critical 
access hospital,’’; 
(ii) in subparagraph (B), by inserting 
‘‘rural emergency hospital,’’ after ‘‘critical 
access hospital,’’ each place it appears; and 
(iii) in subparagraph (C)(ii)(II), by 
inserting ‘‘rural emergency hospitals,’’ after 
‘‘critical access hospitals,’’ each place it ap-
pears. 
(2) EMERGENCY
MEDICAL
TREATMENT
AND 
LABOR ACT.— 
(A) Section 1866(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1395cc(a)(1)) is amended— 
(i) in subparagraph (I)— 
(I) in the matter preceding clause 
(i), by striking ‘‘or critical access hos-
pital’’ and inserting ‘‘, critical access 
hospital, or rural emergency hospital’’; 
and 
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4530 
(II) in clause (ii), by inserting ‘‘, 
critical access hospital, or rural emer-
gency hospital’’ after ‘‘hospital’’; and 
(ii) in subparagraph (N)— 
(I) in the matter preceding clause 
(i), by striking ‘‘and critical access 
hospitals’’ and inserting ‘‘, critical ac-
cess hospitals, and rural emergency 
hospitals’’; 
(II) in clause (i), by striking ‘‘or 
critical access hospital’’ and inserting 
‘‘, critical access hospital, or rural 
emergency hospital’’; and 
(III) in clause (iv), by inserting 
‘‘, critical access hospital, or rural 
emergency hospital’’ after ‘‘hospital’’. 
(B) Section 1867(e)(5) of such Act (42 
U.S.C. 1395dd(e)(5)) is amended by inserting 
‘‘and a rural emergency hospital (as defined in 
section 1861(kkk)(2))’’ before the period. 
(c) 
TREATMENT
AS
TELEHEALTH
ORIGINATING 
SITE.—Section 1834(m)(4)(C)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding 
at the end the following new subclause: 
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4531 
‘‘(XI) A rural emergency hospital 
(as defined in section 1861(kkk)(2)).’’. 
(d) CONFORMING AMENDMENTS.— 
(1) Section 1861(u) of the Social Security Act 
(42 U.S.C. 1395x(u)) is amended by inserting ‘‘rural 
emergency hospital,’’ after ‘‘critical access hospital,’’. 
(2) Section 1864 of the Social Security Act (42 
U.S.C. 1395aa) is amended by inserting before the pe-
riod at the end of the first sentence ‘‘, or whether a 
facility is a rural emergency hospital as defined in 
section 1861(kkk)(2). 
(e) STUDIES AND REPORTS.— 
(1) STUDIES.—The Secretary of Health and 
Human Services shall conduct 3 studies to evaluate 
the impact of rural emergency hospitals on the avail-
ability of health care and health outcomes in rural 
areas (as defined in section 1886(d)(2)(D) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(2)(D))). The 
Secretary shall conduct a study— 
(A) 4 years after the date of the enactment 
of this Act; 
(B) 7 years after the date of the enactment 
of this Act; and 
(C) 10 years after the date of the enactment 
of this Act. 
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4532 
(2) REPORTS.—Not later than 6 months after 
each date that the Secretary of Health and Human 
Services is required to conduct a study under para-
graph (1), the Secretary shall submit to Congress a 
report containing the results of each such study. 
(3) FUNDING.—For purposes of carrying out this 
subsection, the Secretary of Health and Human Serv-
ices shall provide for the transfer, from the Federal 
Hospital Insurance Trust Fund under section 1817 of 
the Social Security Act (42 U.S.C. 1395i) and the 
Federal Supplementary Medical Insurance Trust 
Fund under section 1841 of such Act (42 U.S.C. 
1395t), in such proportion as the Secretary deter-
mines appropriate, to the Centers for Medicare & 
Medicaid Services Program Management Account, of 
$9,000,000. Amounts transferred under the preceding 
sentence shall remain available until expended. 
(f) MEDPAC REVIEW OF PAYMENTS TO RURAL EMER-
GENCY HOSPITALS.—Each report submitted by the Medi-
care 
Payment 
Advisory 
Commission 
under 
section 
1805(b)(1)(C) of the Social Security Act (42 U.S.C. 1395b– 
6(b)(1)(C)) (beginning with 2024), shall include a review 
of payments to rural emergency hospitals under section 
1834(x), as added by subsection (a). 
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4533 
(g) EFFECTIVE DATE.—The amendments made by this 
section shall apply to items and services furnished on or 
after January 1, 2023. 
SEC. 126. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
TIONS. 
(a) IN GENERAL.—Section 1886(h) of the Social Secu-
rity Act (42 U.S.C. 1395ww(h)) is amended— 
(1) in paragraph (4)(F)(i), by striking ‘‘para-
graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 
(8), and (9)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘para-
graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 
(8), and (9)’’; 
(3) in paragraph (7)(E), by inserting ‘‘para-
graph (9),’’ after ‘‘paragraph (8),’’; and 
(4) by adding at the end the following new para-
graph: 
‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS.— 
‘‘(A) ADDITIONAL RESIDENCY POSITIONS.— 
‘‘(i) IN
GENERAL.—For fiscal year 
2023, and for each succeeding fiscal year 
until the aggregate number of full-time 
equivalent residency positions distributed 
under this paragraph is equal to the aggre-
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4534 
gate number of such positions made avail-
able (as specified in clause (ii)(I)), the Sec-
retary shall, subject to the succeeding provi-
sions of this paragraph, increase the other-
wise applicable resident limit for each 
qualifying hospital (as defined in subpara-
graph (F)) that submits a timely applica-
tion under this subparagraph by such num-
ber as the Secretary may approve effective 
beginning July 1 of the fiscal year of the in-
crease. 
‘‘(ii) NUMBER
AVAILABLE
FOR
DIS-
TRIBUTION.— 
‘‘(I) 
TOTAL
NUMBER
AVAIL-
ABLE.—The aggregate number of such 
positions made available under this 
paragraph shall be equal to 1,000. 
‘‘(II) ANNUAL LIMIT.—The aggre-
gate number of such positions so made 
available shall not exceed 200 for a fis-
cal year. 
‘‘(iii) PROCESS FOR DISTRIBUTING PO-
SITIONS.— 
‘‘(I) ROUNDS OF APPLICATIONS.— 
The Secretary shall initiate a separate 
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4535 
round of applications for an increase 
under clause (i) for each fiscal year for 
which such an increase is to be pro-
vided. 
‘‘(II) 
TIMING.—The 
Secretary 
shall notify hospitals of the number of 
positions distributed to the hospital 
under this paragraph as a result of an 
increase in the otherwise applicable 
resident limit by January 31 of the fis-
cal year of the increase. Such increase 
shall be effective beginning July 1 of 
such fiscal year. 
‘‘(B) DISTRIBUTION.—For purposes of pro-
viding an increase in the otherwise applicable 
resident limit under subparagraph (A), the fol-
lowing shall apply: 
‘‘(i) CONSIDERATIONS
IN
DISTRIBU-
TION.—In determining for which qualifying 
hospitals such an increase is provided under 
subparagraph (A), the Secretary shall take 
into account the demonstrated likelihood of 
the hospital filling the positions made avail-
able under this paragraph within the first 
5 training years beginning after the date 
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4536 
the increase would be effective, as deter-
mined by the Secretary. 
‘‘(ii) MINIMUM
DISTRIBUTION
FOR 
CERTAIN
CATEGORIES
OF
HOSPITALS.— 
With respect to the aggregate number of 
such positions available for distribution 
under this paragraph, the Secretary shall 
distribute not less than 10 percent of such 
aggregate number to each of the following 
categories of hospitals: 
‘‘(I) Hospitals that are located in 
a rural area (as defined in section 
1886(d)(2)(D)) or are treated as being 
located in a rural area pursuant to 
section 1886(d)(8)(E). 
‘‘(II) Hospitals in which the ref-
erence resident level of the hospital (as 
specified in subparagraph (F)(iii)) is 
greater than the otherwise applicable 
resident limit. 
‘‘(III) Hospitals in States with— 
‘‘(aa) new medical schools 
that received ‘Candidate School’ 
status from the Liaison Com-
mittee on Medical Education or 
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4537 
that received ‘Pre-Accreditation’ 
status from the American Osteo-
pathic Association Commission on 
Osteopathic College Accreditation 
on or after January 1, 2000, and 
that have achieved or continue to 
progress toward ‘Full Accredita-
tion’ status (as such term is de-
fined by the Liaison Committee 
on Medical Education) or toward 
‘Accreditation’ status (as such 
term is defined by the American 
Osteopathic Association Commis-
sion on Osteopathic College Ac-
creditation); or 
‘‘(bb) 
additional 
locations 
and branch campuses established 
on or after January 1, 2000, by 
medical schools with ‘Full Accred-
itation’ status (as such term is de-
fined by the Liaison Committee 
on Medical Education) or ‘Accred-
itation’ status (as such term is de-
fined by the American Osteopathic 
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4538 
Association Commission on Osteo-
pathic College Accreditation). 
‘‘(IV) Hospitals that serve areas 
designated as health professional short-
age areas under section 332(a)(1)(A) of 
the Public Health Service Act, as deter-
mined by the Secretary. 
‘‘(C) LIMITATIONS.— 
‘‘(i) IN GENERAL.—A hospital may not 
receive more than 25 additional full-time 
equivalent residency positions under this 
paragraph. 
‘‘(ii) PROHIBITION
ON
DISTRIBUTION 
TO
HOSPITALS
WITHOUT
AN
INCREASE 
AGREEMENT.—No increase in the otherwise 
applicable resident limit of a hospital may 
be made under this paragraph unless such 
hospital agrees to increase the total number 
of full-time equivalent residency positions 
under the approved medical residency 
training program of such hospital by the 
number of such positions made available by 
such increase under this paragraph. 
‘‘(D) 
APPLICATION
OF
PER
RESIDENT 
AMOUNTS FOR PRIMARY CARE AND NONPRIMARY 
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4539 
CARE.—With respect to additional residency po-
sitions in a hospital attributable to the increase 
provided under this paragraph, the approved 
FTE per resident amounts are deemed to be 
equal to the hospital per resident amounts for 
primary care and nonprimary care computed 
under paragraph (2)(D) for that hospital. 
‘‘(E) PERMITTING FACILITIES TO APPLY AG-
GREGATION RULES.—The Secretary shall permit 
hospitals receiving additional residency positions 
attributable to the increase provided under this 
paragraph to, beginning in the fifth year after 
the effective date of such increase, apply such po-
sitions to the limitation amount under para-
graph (4)(F) that may be aggregated pursuant to 
paragraph (4)(H) among members of the same 
affiliated group. 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise applica-
ble resident limit’ means, with respect to a 
hospital, the limit otherwise applicable 
under subparagraphs (F)(i) and (H) of 
paragraph (4) on the resident level for the 
hospital determined without regard to this 
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paragraph but taking into account para-
graphs (7)(A), (7)(B), (8)(A), and (8)(B). 
‘‘(ii) 
QUALIFYING
HOSPITAL.—The 
term ‘qualifying hospital’ means a hospital 
described in any of subclauses (I) through 
(IV) of subparagraph (B)(ii). 
‘‘(iii) REFERENCE RESIDENT LEVEL.— 
The term ‘reference resident level’ means, 
with respect to a hospital, the resident level 
for the most recent cost reporting period of 
the hospital ending on or before the date of 
enactment of this paragraph, for which a 
cost report has been settled (or, if not, sub-
mitted (subject to audit)), as determined by 
the Secretary. 
‘‘(iv) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i).’’. 
(b) IME.—Section 1886(d)(5)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 
(1) in clause (v), in the third sentence, by strik-
ing ‘‘and (h)(8)’’ and inserting ‘‘(h)(8), and (h)(9)’’; 
(2) by redesignating clause (x), as added by sec-
tion 5505(b) of the Patient Protection and Affordable 
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Care Act (Public Law 111–148), as clause (xi) and 
moving such clause 4 ems to the left; and 
(3) by adding after clause (xi), as redesignated 
by subparagraph (A), the following new clause: 
‘‘(xii) For discharges occurring on or 
after July 1, 2023, insofar as an additional 
payment amount under this subparagraph 
is attributable to resident positions distrib-
uted to a hospital under subsection (h)(9), 
the indirect teaching adjustment factor shall 
be computed in the same manner as pro-
vided under clause (ii) with respect to such 
resident positions.’’. 
(c) PROHIBITION
ON
JUDICIAL
REVIEW.—Section 
1886(h)(7)(E) of the Social Security Act (42 U.S.C. 
1395ww–4(h)(7)(E)) is amended by inserting ‘‘paragraph 
(9),’’ after ‘‘paragraph (8),’’. 
(d) REPORTS.— 
(1) IN GENERAL.—Not later than September 30, 
2025, and again not later than September 30, 2027, 
the Comptroller General of the United States (in this 
subsection referred to as the ‘‘Comptroller General’’) 
shall conduct a study and submit to Congress a report 
on— 
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(A) the distribution of additional full-time 
equivalent resident positions under paragraph 
(9) of section 1886(h) of the Social Security Act, 
as added by subsection (a); and 
(B) rural track and rotator programs under 
such section. 
(2) CONTENTS.—Each report described in para-
graph (1) shall include— 
(A) a description of the distribution de-
scribed in paragraph (1)(A) and an analysis of 
the use of such positions so distributed, including 
a description of the effects of such distribution on 
rural track and rotator programs; 
(B) a specification, with respect to each hos-
pital that has received such a distribution, of 
whether such hospital has abided by the agree-
ment described in paragraph (9)(C)(ii) of section 
1886(h) of the Social Security Act, as added by 
subsection (a); and 
(C) to the extent practicable, a description 
of— 
(i) the type of program in which each 
such position so distributed is being used; 
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(ii) the total number of full-time equiv-
alent residency positions available in each 
such program; 
(iii) the number of instances in which 
residents filling such positions so distrib-
uted treated individuals entitled to benefits 
under part A, or enrolled under part B, of 
title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.); 
(iv) the location where each resident 
that filled a position so distributed went on 
to practice. 
SEC. 127. PROMOTING RURAL HOSPITAL GME FUNDING OP-
PORTUNITY. 
Section 1886(h)(4)(H)(iv) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(iv)) is amended— 
(1) by striking ‘‘(iv) NONRURAL HOSPITAL OP-
ERATING TRAINING PROGRAMS IN RURAL AREAS.—In 
the case of’’ and inserting the following: 
‘‘(iv) TRAINING PROGRAMS IN RURAL 
AREAS.— 
‘‘(I) COST
REPORTING
PERIODS 
BEGINNING BEFORE OCTOBER 1, 2022.— 
For cost reporting periods beginning 
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before October 1, 2022, in the case of’’; 
and 
(2) by adding at the end the following new sub-
clause: 
‘‘(II) COST
REPORTING
PERIODS 
BEGINNING ON OR AFTER OCTOBER 1, 
2022.—For cost reporting periods be-
ginning on or after October 1, 2022, in 
the case of a hospital not located in a 
rural area that established or estab-
lishes a medical residency training 
program (or rural tracks) in a rural 
area or establishes an accredited pro-
gram where greater than 50 percent of 
the program occurs in a rural area, the 
Secretary shall consistent with the 
principles of subparagraphs (F) and 
(G) and subject to paragraphs (7) and 
(8), prescribe rules for the application 
of such subparagraphs with respect to 
such a program and, in accordance 
with such rules, adjust in an appro-
priate manner the limitation under 
subparagraph (F) for such hospital 
and each such hospital located in a 
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4545 
rural area that participates in such a 
training.’’. 
SEC. 128. FIVE-YEAR EXTENSION OF THE RURAL COMMU-
NITY HOSPITAL DEMONSTRATION PROGRAM. 
(a) EXTENSION.— 
(1) IN GENERAL.—Subsection (a)(5) of section 
410A of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 
108–173; 42 U.S.C. 1395ww note), is amended by 
striking ‘‘10-year extension period’’ and inserting 
‘‘15-year extension period’’. 
(2) CONFORMING
AMENDMENTS
FOR
EXTEN-
SION.— 
(A) EXTENSION
OF
DEMONSTRATION
PE-
RIOD.—Subsection (g) of such section 410A is 
amended— 
(i) in the subsection heading, by strik-
ing ‘‘TEN-YEAR’’ and inserting ‘‘FIFTEEN- 
YEAR’’; 
(ii) in paragraph (1)— 
(I) by striking ‘‘additional 10- 
year’’ and inserting ‘‘additional 15- 
year’’; and 
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(II) by striking ‘‘10-year exten-
sion period’’ and inserting ‘‘15-year 
extension period’’; 
(iii) in paragraph (2), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; 
(iv) in paragraph (3), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; 
(v) in paragraph (4), by striking ‘‘10- 
year extension period’’ each place it appears 
and inserting ‘‘15-year extension period’’; 
(vi) in paragraph (5), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; and 
(vii) in subparagraph (A) of para-
graph (6), by striking ‘‘10-year extension 
period’’ and inserting ‘‘15-year extension 
period’’. 
(B) RULE FOR HOSPITALS THAT ARE NOT 
ORIGINAL
PARTICIPANTS
IN
THE
DEMONSTRA-
TION.—Paragraph (5) of subsection (g) of such 
section 410A is amended— 
(i) by striking ‘‘PROGRAM.—During’’ 
and inserting ‘‘PROGRAM.— 
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‘‘(A) CURES ACT
EXTENSION.—During’’; 
and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) ADDITIONAL EXTENSION.—During the 
third 5 years of the 15-year extension period, the 
Secretary shall apply the provisions of para-
graph (4) to rural community hospitals that are 
not described in paragraph (4) but are partici-
pating in the demonstration program under this 
section as of December 30, 2019, in a similar 
manner as such provisions apply to rural com-
munity hospitals described in paragraph (4).’’. 
(b) CLARIFYING TECHNICAL AMENDMENTS.—Such sec-
tion 410A, as amended by subsection (a), is further amend-
ed— 
(1) in subsection (a)(1), by inserting ‘‘of Health 
and Human Services’’ after ‘‘Secretary’’; 
(2) in subsection (f)(1)(A)(iv) by inserting ‘‘of 
the Social Security Act (42 U.S.C. 1395i–4)’’ after 
‘‘section 1820’’; and 
(3) in subsection (g)— 
(A) in the heading of paragraph (4), by 
striking ‘‘HOSPITALS IN DEMONSTRATION PRO-
GRAM ON DATE OF ENACTMENT’’ and inserting 
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‘‘HOSPITALS
PARTICIPATING
IN
THE
DEM-
ONSTRATION PROGRAM DURING THE INITIAL 5- 
YEAR PERIOD’’; and 
(B) in paragraph (6)(A), by striking ‘‘not 
later than 120 days after the date of the enact-
ment of this paragraph’’ and inserting ‘‘not later 
than April 12, 2017’’. 
SEC. 129. EXTENSION OF FRONTIER COMMUNITY HEALTH 
INTEGRATION PROJECT DEMONSTRATION. 
(a) IN GENERAL.—Subsection (f) of section 123 of the 
Medicare Improvements for Patients and Providers Act of 
2008 (42 U.S.C. 1395i–4 note) is amended— 
(1) in paragraph (1), by striking ‘‘3-year period 
beginning on October 1, 2009’’ and inserting ‘‘3-year 
period beginning on August 1, 2016 (referred to in 
this section as the ‘initial period’), and 5-year period 
beginning on July 1, 2021 (referred to in this section 
as the ‘extension period’)’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘PROJECT.—The demonstra-
tion’’ and inserting ‘‘PROJECT.— 
‘‘(A) INITIAL PERIOD.—During the initial 
period, the demonstration’’; and 
(B) by adding at the end the following new 
subparagraph: 
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‘‘(B) EXTENSION PERIOD.—During the ex-
tension period, the demonstration project under 
this section shall be considered to have begun in 
a State on the date during such period on which 
the eligible counties selected to participate in the 
demonstration project under subsection (d)(3) 
begin operations in accordance with the require-
ments under the demonstration project.’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(3) RE-ENTRY ON A ROLLING BASIS FOR EXTEN-
SION
PERIOD.—A critical access hospital partici-
pating in the demonstration project under this section 
during the extension period shall begin such partici-
pation in the cost reporting year that begins on or 
after July 1, 2021.’’. 
(b) ELIGIBLE ENTITIES.—Subsection (d)(1) of such 
section 123 is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘In this section’’ and 
inserting ‘‘Subject to subparagraph (C), in this sec-
tion’’; and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(C) EXTENSION PERIOD.—An entity shall 
only be eligible to participate in the demonstra-
tion project under this section during the exten-
sion period if the entity participated in the dem-
onstration project under this section during the 
initial period.’’. 
(c) FUNDING.—Subsection (g)(1) of such section 123 
is amended— 
(1) in subparagraph (A)— 
(A) by striking ‘‘IN GENERAL’’ and insert-
ing ‘‘INITIAL PERIOD’’; and 
(B) by inserting ‘‘with respect to the initial 
period’’ before the period at the end; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) EXTENSION
PERIOD.—The Secretary 
shall provide for the transfer of $10,000,000, in 
appropriate part from the Federal Hospital In-
surance Trust Fund established under section 
1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical 
Insurance Trust Fund established under section 
1841 of such Act (42 U.S.C. 1395t), to the Cen-
ters for Medicare & Medicaid Services for the 
purposes of carrying out its duties under the 
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4551 
demonstration project under this section with re-
spect to the extension period.’’. 
SEC. 130. IMPROVING RURAL HEALTH CLINIC PAYMENTS. 
Section 1833(f) of the Social Security Act (42 U.S.C. 
1395l(f)) is amended— 
(1) in paragraph (2)— 
(A) by inserting ‘‘(before April 1, 2021)’’ 
after ‘‘in a subsequent year’’; and 
(B) by striking ‘‘this subsection’’ and in-
serting ‘‘this paragraph’’; 
(2) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively; 
(3) in the matter preceding subparagraph (A), as 
redesignated by paragraph (2)— 
(A) by inserting ‘‘(1)’’ after ‘‘(f)’’; and 
(B) by inserting ‘‘prior to April 1, 2021’’ 
after ‘‘services provided’’; and 
(4) by adding at the end the following new para-
graphs: 
‘‘(2) In establishing limits under subsection (a) on 
payment for rural health clinic services furnished on or 
after April 1, 2021, by a rural health clinic (other than 
a rural health clinic described in paragraph (3)(B)), the 
Secretary shall establish such limit, for services provided— 
‘‘(A) in 2021, after March 31, at $100 per visit; 
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‘‘(B) in 2022, at $113 per visit; 
‘‘(C) in 2023, at $126 per visit; 
‘‘(D) in 2024, at $139 per visit; 
‘‘(E) in 2025, at $152 per visit; 
‘‘(F) in 2026, at $165 per visit; 
‘‘(G) in 2027, at $178 per visit; 
‘‘(H) in 2028, at $190 per visit; and 
‘‘(I) in a subsequent year, at the limit estab-
lished under this paragraph for the previous year in-
creased by the percentage increase in the MEI appli-
cable to primary care services furnished as of the first 
day of such subsequent year. 
‘‘(3)(A) In establishing limits under subsection (a) on 
payment for rural health clinic services furnished on or 
after April 1, 2021, by a rural health clinic described in 
subparagraph (B), the Secretary shall establish such limit, 
with respect to each such rural health clinic, for services 
provided— 
‘‘(i) in 2021, after March 31, at an amount 
equal to the greater of— 
‘‘(I) the per visit payment amount applica-
ble to such rural health clinic for rural health 
clinic services furnished in 2020, increased by 
the percentage increase in the MEI applicable to 
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4553 
primary care services furnished as of the first 
day of 2021; or 
‘‘(II) the limit described in paragraph 
(2)(A); and 
‘‘(ii) in a subsequent year, at an amount equal 
to the greater of— 
‘‘(I) the amount established under clause 
(i)(I) or this subclause for the previous year with 
respect to such rural health clinic, increased by 
the percentage increase in the MEI applicable to 
primary care services furnished as of the first 
day of such subsequent year; or 
‘‘(II) the limit established under paragraph 
(2) for such subsequent year. 
‘‘(B) A rural health clinic described in this subpara-
graph is a rural health clinic that, as of December 31, 2019, 
was— 
‘‘(i) in a hospital with less than 50 beds; and 
‘‘(ii) enrolled under section 1866(j).’’. 
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4554 
SEC. 131. MEDICARE GME TREATMENT OF HOSPITALS ES-
TABLISHING 
NEW 
MEDICAL 
RESIDENCY 
TRAINING PROGRAMS AFTER HOSTING MED-
ICAL RESIDENT ROTATORS FOR SHORT DU-
RATIONS. 
(a) REDETERMINATION OF APPROVED FTE RESIDENT 
AMOUNT.—Section 1886(h)(2)(F) of the Social Security Act 
(42 U.S.C. 1395ww(h)(2)(F)) is amended— 
(1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 
and 
(2) by adding at the end the following: 
‘‘(ii) In applying this subparagraph in the 
case of a hospital that trains residents and has 
not entered into a GME affiliation agreement (as 
defined by the Secretary for purposes of para-
graph (4)(H)(ii)), on or after the date of the en-
actment of this clause, the Secretary shall not es-
tablish an FTE resident amount until such time 
as the Secretary determines that the hospital has 
trained at least 1.0 full-time-equivalent resident 
in an approved medical residency training pro-
gram in a cost reporting period. 
‘‘(iii) In applying this subparagraph for 
cost reporting periods beginning on or after the 
date of enactment of this clause, in the case of 
a hospital that, as of such date of enactment, has 
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4555 
an approved FTE resident amount based on the 
training in an approved medical residency pro-
gram or programs of— 
‘‘(I) less than 1.0 full-time-equivalent 
resident in any cost reporting period begin-
ning before October 1, 1997, as determined 
by the Secretary; or 
‘‘(II) no more than 3.0 full-time-equiv-
alent residents in any cost reporting period 
beginning on or after October 1, 1997, and 
before the date of the enactment of this 
clause, as determined by the Secretary, 
in lieu of such FTE resident amount the Sec-
retary shall, in accordance with the methodology 
described in section 413.77(e) of title 42 of the 
Code of Federal Regulations (or any successor 
regulation), establish a new FTE resident 
amount if the hospital trains at least 1.0 full- 
time-equivalent resident (in the case of a hos-
pital described in subclause (I)) or more than 3.0 
full-time-equivalent residents (in the case of a 
hospital described in subclause (II)) in a cost re-
porting period beginning on or after such date of 
enactment and before the date that is 5 years 
after such date of enactment. 
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‘‘(iv) For purposes of carrying out this sub-
paragraph for cost reporting periods beginning 
on or after the date of the enactment of this 
clause, a hospital shall report full-time-equiva-
lent residents on its cost report for a cost report-
ing period if the hospital trains at least 1.0 full- 
time-equivalent residents in an approved med-
ical residency training program or programs in 
such period. 
‘‘(v) As appropriate, the Secretary may 
consider information from any cost reporting pe-
riod necessary to establish a new FTE resident 
amount as described in clause (iii).’’. 
(b) REDETERMINATION OF FTE RESIDENT LIMITA-
TION.—Section 1886(h)(4)(H)(i) of the Social Security Act 
(42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 
(1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 
and 
(2) by adding at the end the following: 
‘‘(II) In applying this clause in the 
case of a hospital that, on or after the date 
of the enactment of this subclause, begins 
training residents in a new approved med-
ical residency training program or pro-
grams (as defined by the Secretary), the 
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4557 
Secretary shall not determine a limitation 
applicable to the hospital under subpara-
graph (F) until such time as the Secretary 
determines that the hospital has trained at 
least 1.0 full-time-equivalent resident in 
such new approved medical residency train-
ing program or programs in a cost report-
ing period. 
‘‘(III) In applying this clause in the 
case of a hospital that, as of the date of the 
enactment of this subclause, has a limita-
tion under subparagraph (F), based on a 
cost reporting period beginning before Octo-
ber 1, 1997, of less than 1.0 full-time-equiv-
alent resident, the Secretary shall adjust the 
limitation in the manner applicable to a 
new approved medical residency training 
program if the Secretary determines the 
hospital begins training at least 1.0 full- 
time-equivalent residents in a program year 
beginning on or after such date of enact-
ment and before the date that is 5 years 
after such date of enactment. 
‘‘(IV) In applying this clause in the 
case of a hospital that, as of the date of the 
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4558 
enactment of this subclause, has a limita-
tion under subparagraph (F), based on a 
cost reporting period beginning on or after 
October 1, 1997, and before such date of en-
actment, of no more than 3.0 full-time- 
equivalent residents, the Secretary shall ad-
just the limitation in the manner applicable 
to a new approved medical residency train-
ing program if the Secretary determines the 
hospital begins training more than 3.0 full- 
time-equivalent residents in a program year 
beginning on or after such date of enact-
ment and before the date that is 5 years 
after such date of enactment. 
‘‘(V) An adjustment to the limitation 
applicable to a hospital made pursuant to 
subclause (III) or (IV) shall be made in a 
manner consistent with the methodology, as 
appropriate, in section 413.79(e) of title 42, 
Code of Federal Regulations (or any suc-
cessor regulation). As appropriate, the Sec-
retary may consider information from any 
cost reporting periods necessary to make 
such an adjustment to the limitation.’’. 
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4559 
(c) TECHNICAL
AND CONFORMING AMENDMENTS.— 
Section 1886 of the Social Security Act (42 U.S.C. 1395ww) 
is amended— 
(1) in subsection (d)(5)(B)(viii), by striking 
‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 
(2)(F)(iv) and (4)(H) of subsection (h)’’; and 
(2) in subsection (h)— 
(A) in paragraph (4)(H)(iv), by striking 
‘‘an rural area’’ and inserting ‘‘a rural area’’; 
and 
(B) in paragraph (7)(E), by striking 
‘‘under this’’ and all that follows through the pe-
riod at the end and inserting the following: 
‘‘under this paragraph, paragraph (8), clause 
(i), (ii), (iii), or (v) of paragraph (2)(F), or 
clause (i) or (vi) of paragraph (4)(H).’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply to payment under section 1886 of the 
Social Security Act (42 U.S.C. 1395ww) for cost reporting 
periods beginning on or after the date of the enactment of 
this Act. 
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4560 
SEC. 132. MEDICARE PAYMENT FOR CERTAIN FEDERALLY 
QUALIFIED HEALTH CENTER AND RURAL 
HEALTH CLINIC SERVICES FURNISHED TO 
HOSPICE PATIENTS. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m), as amended by section 125(a)(2)(B), is amended— 
(1) in subsection (o), by adding at the end the 
following new paragraph: 
‘‘(4) PAYMENT FOR ATTENDING PHYSICIAN SERV-
ICES FURNISHED BY FEDERALLY QUALIFIED HEALTH 
CENTERS TO HOSPICE PATIENTS.—In the case of serv-
ices described in section 1812(d)(2)(A)(ii) furnished 
on or after January 1, 2022, by an attending physi-
cian (as defined in section 1861(dd)(3)(B), other than 
a physician or practitioner who is employed by a hos-
pice program) who is employed by or working under 
contract with a Federally qualified health center, a 
Federally qualified health center shall be paid for 
such services under the prospective payment system 
under this subsection.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(y) PAYMENT FOR ATTENDING PHYSICIAN SERVICES 
FURNISHED BY RURAL HEALTH CLINICS TO HOSPICE PA-
TIENTS.—In the case of services described in section 
1812(d)(2)(A)(ii) furnished on or after January 1, 2022, 
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by an attending physician (as defined in section 
1861(dd)(3)(B), other than a physician or practitioner who 
is employed by a hospice program) who is employed by or 
working under contract with a rural health clinic, a rural 
health clinic shall be paid for such services under the meth-
odology for all-inclusive rates (established by the Secretary) 
under section 1833(a)(3), subject to the limits described in 
section 1833(f).’’. 
SEC. 133. DELAY TO THE IMPLEMENTATION OF THE RADI-
ATION ONCOLOGY MODEL UNDER THE MEDI-
CARE PROGRAM. 
Notwithstanding any provision of section 1115A of the 
Social Security Act (42 U.S.C. 1315a), the Secretary of 
Health and Human Services may not implement the radi-
ation oncology model described in the rule entitled ‘‘Medi-
care Program; Specialty Care Models To Improve Quality 
of Care and Reduce Expenditures’’ (85 Fed. Reg. 61114 et 
seq.), or any substantially similar model, pursuant to such 
section before January 1, 2022. 
SEC. 134. IMPROVING ACCESS TO SKILLED NURSING FACIL-
ITY SERVICES FOR HEMOPHILIA PATIENTS. 
(a) IN GENERAL.—Section 1888(e)(2)(A)(iii) of the 
Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is 
amended by adding at the end the following: 
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‘‘(VI) Blood clotting factors indi-
cated for the treatment of patients with 
hemophilia and other bleeding dis-
orders (identified as of July 1, 2020, 
by 
HCPCS 
codes 
J7170, 
J7175, 
J7177–J7183, J7185–J7190, J7192– 
J7195, J7198–J7203, J7205, J7207– 
J7211, and as subsequently modified 
by the Secretary) and items and serv-
ices related to the furnishing of such 
factors under section 1842(o)(5)(C), 
and any additional blood clotting fac-
tors identified by the Secretary and 
items and services related to the fur-
nishing of such factors under such sec-
tion.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to items and services furnished on 
or after October 1, 2021. 
TITLE II—MEDICAID EXTENDERS 
AND OTHER POLICIES 
SEC. 201. ELIMINATING DSH REDUCTIONS FOR FISCAL 
YEARS 2021 THROUGH 2023. 
Section 1923(f) of the Social Security Act (42 U.S.C. 
1396r–4(f)), as amended by section 1106 of the Further 
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Continuing Appropriations Act, 2021, and Other Exten-
sions Act, is amended— 
(1) in paragraph (7)(A)— 
(A) in clause (i), in the matter preceding 
subclause (I), by striking ‘‘For the period’’ and 
all that follows through ‘‘2025’’ and inserting 
‘‘For each of fiscal years 2024 through 2027,’’; 
and 
(B) in clause (ii), by striking ‘‘equal to— 
’’ and all that follows through the period at the 
end and inserting ‘‘equal to $8,000,000,000 for 
each of fiscal years 2024 through 2027’’; and 
(2) in paragraph (8), by striking ‘‘2025’’ and in-
serting ‘‘2027’’. 
SEC. 202. SUPPLEMENTAL PAYMENT REPORTING REQUIRE-
MENTS. 
Section 1903 of the Social Security Act (42 U.S.C. 
1396b) is amended by adding at the end the following new 
subsection: 
‘‘(bb) SUPPLEMENTAL
PAYMENT
REPORTING
RE-
QUIREMENTS.— 
‘‘(1) COLLECTION AND AVAILABILITY OF SUPPLE-
MENTAL PAYMENT DATA.— 
‘‘(A) IN GENERAL.—Not later than October 
1, 2021, the Secretary shall establish a system 
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for each State to submit reports, as determined 
appropriate by the Secretary, on supplemental 
payments data, as a requirement for a State 
plan or State plan amendment that would pro-
vide for a supplemental payment. 
‘‘(B) REQUIREMENTS.—Each report sub-
mitted by a State in accordance with the re-
quirement established under subparagraph (A) 
shall include the following: 
‘‘(i) An explanation of how supple-
mental payments made under the State 
plan or a State plan amendment will result 
in payments that are consistent with section 
1902(a)(30)(A), including standards with 
respect to efficiency, economy, quality of 
care, and access, along with the stated pur-
pose and intended effects of the supple-
mental payment. 
‘‘(ii) The criteria used to determine 
which providers are eligible to receive the 
supplemental payment. 
‘‘(iii) A comprehensive description of 
the methodology used to calculate the 
amount of, and distribute, the supplemental 
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payment to each eligible provider, includ-
ing— 
‘‘(I) data on the amount of the 
supplemental payment made to each 
eligible provider, if known, or, if the 
total amount is distributed using a for-
mula based on data from 1 or more fis-
cal years, data on the total amount of 
the supplemental payments for the fis-
cal year or years available to all pro-
viders eligible to receive a supple-
mental payment; 
‘‘(II) if applicable, the specific 
criteria with respect to Medicaid serv-
ice, utilization, or cost data to be used 
as the basis for calculations regarding 
the amount or distribution of the sup-
plemental payment; and 
‘‘(III) the timing of the supple-
mental payment made to each eligible 
provider. 
‘‘(iv) An assurance that the total Med-
icaid payments made to an inpatient hos-
pital provider, including the supplemental 
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payment, will not exceed upper payment 
limits. 
‘‘(v) If not already submitted, an 
upper payment limit demonstration under 
section 447.272 of title 42, Code of Federal 
Regulations (as such section is in effect as 
of the date of enactment of this subsection). 
‘‘(C) PUBLIC AVAILABILITY.—The Secretary 
shall make all reports and related data sub-
mitted under this paragraph publicly available 
on the website of the Centers for Medicare & 
Medicaid Services on a timely basis. 
‘‘(2) SUPPLEMENTAL PAYMENT DEFINED.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), in this subsection, the term ‘supple-
mental payment’ means a payment to a provider 
that is in addition to any base payment made 
to the provider under the State plan under this 
title or under demonstration authority. 
‘‘(B) DSH PAYMENTS
EXCLUDED.—Such 
term does not include a disproportionate share 
hospital payment made under section 1923.’’. 
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SEC. 203. MEDICAID SHORTFALL AND THIRD PARTY PAY-
MENTS. 
(a) IN GENERAL.—Subsection (g) of section 1923 of 
the Social Security Act (42 U.S.C. 1396r–4) is amended 
to read as follows: 
‘‘(g) LIMIT ON AMOUNT OF PAYMENT TO HOSPITAL.— 
‘‘(1) IN GENERAL.— 
‘‘(A) AMOUNT OF ADJUSTMENT SUBJECT TO 
UNCOMPENSATED
COSTS.—A payment adjust-
ment during a fiscal year shall not be considered 
to be consistent with subsection (c) with respect 
to a hospital (other than a hospital described in 
paragraph (2)(B)) if the payment adjustment ex-
ceeds an amount equal to— 
‘‘(i) the costs incurred during the year 
of furnishing hospital services by the hos-
pital to individuals described in subpara-
graph (B) minus— 
‘‘(ii) the sum of— 
‘‘(I) payments under this title 
(other than under this section) for such 
services; and 
‘‘(II) payments by uninsured pa-
tients for such services. 
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‘‘(B) INDIVIDUALS
DESCRIBED.—For pur-
poses of subparagraph (A), the individuals de-
scribed in this clause are the following: 
‘‘(i) Individuals who are eligible for 
medical assistance under the State plan or 
under a waiver of such plan and for whom 
the State plan or waiver is the primary 
payor for such services. 
‘‘(ii) Subject to subparagraph (C), in-
dividuals who have no health insurance (or 
other source of third party coverage) for 
services provided during the year, as deter-
mined by the Secretary. 
‘‘(C) EXCLUSION OF CERTAIN PAYMENTS.— 
For purposes of subparagraph (B)(ii), payments 
made to a hospital for services provided to indi-
gent patients made by a State or a unit of local 
government within a State shall not be consid-
ered to be a source of third party coverage. 
‘‘(2) APPLICATION OF LIMITS FOR CERTAIN HOS-
PITALS.— 
‘‘(A) IN GENERAL.—A payment adjustment 
during a fiscal year shall not be considered to be 
consistent with subsection (c) with respect to a 
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hospital described in subparagraph (B) if the 
payment adjustment exceeds the higher of— 
‘‘(i) the amount determined for the hos-
pital and fiscal year under paragraph 
(1)(A); and 
‘‘(ii) the amount determined for the 
hospital under paragraph (1)(A) as in effect 
on January 1, 2020. 
‘‘(B) HOSPITALS
DESCRIBED.—A hospital 
is described in this subparagraph for a fiscal 
year if, for the most recent cost reporting period, 
the hospital is in at least the 97th percentile of 
all hospitals with respect to— 
‘‘(i) the number of inpatient days for 
such period that were made up of patients 
who (for such days) were entitled to benefits 
under part A of title XVIII and were enti-
tled to supplemental security income bene-
fits under title XVI (excluding any State 
supplementary benefits paid with respect to 
such patients); or 
‘‘(ii) the percentage of total inpatient 
days that were made up of patients who 
(for such days) were described in clause 
(i).’’. 
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(b) EFFECTIVE DATE.—The amendment made by this 
section shall take effect on October 1, 2021, and shall apply 
to payment adjustments made under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4) during fiscal years 
beginning on or after such date. 
SEC. 204. EXTENSION OF MONEY FOLLOWS THE PERSON RE-
BALANCING DEMONSTRATION. 
(a) IN GENERAL.— 
(1) FUNDING.—Section 6071(h) of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(A) in paragraph (1)— 
(i) in each of subparagraphs (F) 
through (H), by striking ‘‘subject to para-
graph (3),’’; 
(ii) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(iii) in subparagraph (H), by striking 
the period and inserting a semicolon; and 
(iv) by adding at the end the following 
new subparagraphs: 
‘‘(I) for the period beginning on December 
19, 2020, and ending on September 30, 2021, the 
amount equal to the pro rata portion of an an-
nual appropriation of $450,000,000; 
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‘‘(J) $450,000,000 for fiscal year 2022; and 
‘‘(K) $450,000,000 for fiscal year 2023.’’; 
(B) in paragraph (2)— 
(i) by striking ‘‘Subject to paragraph 
(3), amounts’’ and inserting ‘‘Amounts’’; 
and 
(ii) by striking ‘‘2021’’ and inserting 
‘‘2023’’; and 
(C) by striking paragraph (3). 
(2) 
RESEARCH
AND
EVALUATION.—Section 
6071(g) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396a note) is amended— 
(A) in paragraph (2), by striking ‘‘2016’’ 
and inserting ‘‘2026’’; and 
(B) in paragraph (3), by inserting ‘‘and for 
each of fiscal years 2021 through 2023’’ after 
‘‘2016,’’. 
(b) CHANGES TO INSTITUTIONAL RESIDENCY PERIOD 
REQUIREMENT.— 
(1) IN GENERAL.—Section 6071(b)(2) of the Def-
icit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(A) in subparagraph (A)(i), by striking 
‘‘90’’ and inserting ‘‘60’’; and 
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(B) by striking the flush sentence after sub-
paragraph (B). 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall take effect on the date that is 
30 days after the date of the enactment of this Act. 
(c) UPDATES
TO
STATE
APPLICATION
REQUIRE-
MENTS.—Section 6071 of the Deficit Reduction Act of 2005 
(42 U.S.C. 1396a note) is amended— 
(1) in subsection (c)— 
(A) in paragraph (3), by striking ‘‘, which 
shall include’’ and all that follows through 
‘‘2007’’; 
(B) in paragraph (7)— 
(i) in the paragraph heading, by strik-
ing ‘‘REBALANCING’’ and inserting ‘‘EX-
PENDITURES’’; 
(ii) in subparagraph (A), by adding 
‘‘and’’ at the end; and 
(iii) in subparagraph (B)— 
(I) in clause (i), by striking 
‘‘and’’ at the end; 
(II) in clause (ii), by striking the 
period at the end and inserting a semi-
colon; and 
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(III) by adding at the end the fol-
lowing: 
‘‘(iii) include a work plan that describes for 
each Federal fiscal year that occurs during the 
proposed MFP demonstration project— 
‘‘(I) the use of grant funds for each 
proposed initiative that is designed to ac-
complish the objective described in sub-
section (a)(1), including a funding source 
for each activity that is part of each such 
proposed initiative; 
‘‘(II) an evaluation plan that identifies 
expected results for each such proposed ini-
tiative; and 
‘‘(III) a sustainability plan for compo-
nents of such proposed initiatives that are 
intended to improve transitions, which shall 
be updated with actual expenditure infor-
mation for each Federal fiscal year that oc-
curs during the MFP demonstration project; 
and 
‘‘(iv) contain assurances that grant funds 
used to accomplish the objective described in sub-
section (a)(1) shall be obligated not later than 24 
months after the date on which the funds are 
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awarded and shall be expended not later than 60 
months after the date on which the funds are 
awarded (unless the Secretary waives either such 
requirement).’’; and 
(C) in paragraph (13)— 
(i) in subparagraph (A), by striking ‘‘; 
and’’ and inserting ‘‘, and in such manner 
as will meet the reporting requirements set 
forth for the Transformed Medicaid Statis-
tical Information System (T–MSIS);’’; 
(ii) by redesignating subparagraph (B) 
as subparagraph (D); and 
(iii) by inserting after subparagraph 
(A) the following: 
‘‘(B) the State shall report on a quarterly 
basis on the use of grant funds by distinct activ-
ity, as described in the approved work plan, and 
by specific population as targeted by the State; 
‘‘(C) if the State fails to report the informa-
tion required under subparagraph (B), fails to 
report such information on a quarterly basis, or 
fails to make progress under the approved work 
plan, the State shall implement a corrective ac-
tion plan approved by the Secretary; and’’; and 
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(2) in subsection (d)(4), by adding at the end the 
following new subparagraph: 
‘‘(C) 
CORRECTIVE
ACTION
PLAN 
PROGRESS.—In the case of a State required to 
implement a corrective action plan under sub-
paragraph (C) of subsection (c)(13), the State 
must implement such plan and demonstrate 
progress in reporting information under sub-
paragraph (B) of such subsection or progress 
under the approved work plan (as applicable).’’. 
(d) FUNDING FOR QUALITY ASSURANCE AND IMPROVE-
MENT; TECHNICAL
ASSISTANCE; OVERSIGHT.—Section 
6071(f) of the Deficit Reduction Act of 2005 (42 U.S.C. 
1396a note) is amended by striking paragraph (2) and in-
serting the following: 
‘‘(2) FUNDING.—From the amounts appropriated 
under subsection (h)(1), $3,000,000 shall be available 
to the Secretary to carry out this subsection. Such 
amount shall remain available until expended.’’. 
(e) BEST PRACTICES EVALUATION.—Section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended by adding at the end the following: 
‘‘(i) BEST PRACTICES.— 
‘‘(1) 
REPORT.—The 
Secretary, 
directly 
or 
through grant or contract, shall submit a report to the 
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President and Congress not later than September 30, 
2022, that contains findings and conclusions on best 
practices from MFP demonstration projects carried 
out with grants made under this section. The report 
shall include information and analyses with respect 
to the following: 
‘‘(A) The most effective State strategies for 
transitioning beneficiaries from institutional to 
qualified community settings carried out under 
MFP demonstration projects and how such strat-
egies may vary for different types of bene-
ficiaries, such as beneficiaries who are aged, 
physically disabled, intellectually or develop-
mentally disabled, or individuals with serious 
mental illnesses, and other targeted waiver bene-
ficiary populations under section 1915(c) of the 
Social Security Act. 
‘‘(B) The most common and the most effec-
tive State uses of grant funds carried out under 
demonstration projects for transitioning bene-
ficiaries from institutional to qualified commu-
nity settings and improving health outcomes, in-
cluding differentiating funding for current ini-
tiatives that are designed for such purpose and 
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funding for proposed initiatives that are de-
signed for such purpose. 
‘‘(C) The most effective State approaches 
carried out under MFP demonstration projects 
for improving person-centered care and plan-
ning. 
‘‘(D) Identification of program, financing, 
and other flexibilities available under MFP dem-
onstration projects, that are not available under 
the traditional Medicaid program, and which di-
rectly contributed to successful transitions and 
improved health outcomes under MFP dem-
onstration projects. 
‘‘(E) State strategies and financing mecha-
nisms for effective coordination of housing fi-
nanced or supported under MFP demonstration 
projects with local housing authorities and other 
resources. 
‘‘(F) Effective State approaches for deliv-
ering Money Follows the Person transition serv-
ices through managed care entities. 
‘‘(G) Other best practices and effective tran-
sition strategies demonstrated by States with ap-
proved MFP demonstration projects, as deter-
mined by the Secretary. 
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‘‘(H) Identification and analyses of oppor-
tunities and challenges to integrating effective 
Money Follows the Person practices and State 
strategies into the traditional Medicaid program. 
‘‘(2) COLLABORATION.—In preparing the report 
required under this subsection, the Secretary shall col-
lect and incorporate information from States with 
approved MFP demonstration projects and bene-
ficiaries participating in such projects, and providers 
participating in such projects. 
‘‘(3) WAIVER OF PAPERWORK REDUCTION ACT.— 
Chapter 35 of title 44, United States Code, shall not 
apply to preparation of the report described in para-
graph (1) or collection of information described in 
paragraph (2). 
‘‘(4) FUNDING.—From the amounts appropriated 
under subsection (h)(1) for each of fiscal years 2021 
and 2022, not more than $300,000 shall be available 
to the Secretary for each such fiscal year to carry out 
this subsection.’’. 
(f) MACPAC REPORT ON QUALIFIED SETTINGS CRI-
TERIA.—Section 6071 of the Deficit Reduction Act of 2005 
(42 U.S.C. 1396a note), as amended by subsection (e), is 
further amended by adding at the end the following: 
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‘‘(j) MACPAC REPORT.—Prior to the final implemen-
tation date established by the Secretary for the criteria es-
tablished for home and community-based settings in section 
441.301(c)(4) of title 42, Code of Federal Regulations, as 
part of final implementation of the Home and Community 
Based Services (HCBS) Final Rule published on January 
16, 2014 (79 Fed. Reg. 2947) (referred to in this subsection 
as the ‘HCBS final rule’), the Medicaid and CHIP Pay-
ment and Access Commission (MACPAC) shall submit to 
Congress a report that— 
‘‘(1) identifies the types of home and commu-
nity-based settings and associated services that are 
available to eligible individuals in both the MFP 
demonstration program and sites in compliance with 
the HCBS final rule; and 
‘‘(2) if determined appropriate by the Commis-
sion, recommends policies to align the criteria for a 
qualified residence under subsection (b)(6) (as in ef-
fect on October 1, 2017) with the criteria in the 
HCBS final rule.’’. 
(g) APPLICATION TO CURRENT PROJECTS.—Not later 
than 1 year after the date of the enactment of this Act, the 
Secretary shall update the terms and conditions of any ap-
proved MFP demonstration project under section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
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in effect on the date of the enactment of this Act to ensure 
that such terms and conditions are the same as are required 
for any new State applicant for such project under the 
amendments made by this section. 
SEC. 205. EXTENSION OF SPOUSAL IMPOVERISHMENT PRO-
TECTIONS. 
(a) IN GENERAL.—Section 2404 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 1396r-5 note) is 
amended by striking ‘‘December 18, 2020’’ and inserting 
‘‘September 30, 2023’’. 
(b) RULE
OF CONSTRUCTION.—Nothing in section 
2404 of Public Law 111-148 (42 U.S.C. 1396r-5 note) or 
section 1902(a)(17) or 1924 of the Social Security Act (42 
U.S.C. 1396a(a)(17), 1396r-5) shall be construed as prohib-
iting a State from— 
(1) applying an income or resource disregard 
under a methodology authorized under section 
1902(r)(2) of such Act (42 U.S.C. 1396a(r)(2))— 
(A) to the income or resources of an indi-
vidual 
described 
in 
section 
1902(a)(10)(A)(ii)(VI) of such Act (42 U.S.C. 
1396a(a)(10)(A)(ii)(VI)) (including a disregard 
of the income or resources of such individual’s 
spouse); or 
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(B) on the basis of an individual’s need for 
home and community-based services authorized 
under subsection (c), (d), (i), or (k) of section 
1915 of such Act (42 U.S.C. 1396n) or under sec-
tion 1115 of such Act (42 U.S.C. 1315); or 
(2) disregarding an individual’s spousal income 
and assets under a plan amendment to provide med-
ical assistance for home and community-based serv-
ices for individuals by reason of being determined eli-
gible under section 1902(a)(10)(C) of such Act (42 
U.S.C. 1396a(a)(10)(C)) or by reason of section 
1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise 
on the basis of a reduction of income based on costs 
incurred for medical or other remedial care under 
which the State disregarded the income and assets of 
the individual’s spouse in determining the initial and 
ongoing financial eligibility of an individual for such 
services in place of the spousal impoverishment provi-
sions applied under section 1924 of such Act (42 
U.S.C. 1396r-5). 
SEC. 206. EXTENSION OF COMMUNITY MENTAL HEALTH 
SERVICES DEMONSTRATION PROGRAM. 
Section 223(d) of the Protecting Access to Medicare Act 
of 2014 (42 U.S.C. 1396a note), as amended by section 1104 
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of the Further Continuing Appropriations Act, 2021, and 
Other Extensions Act, is amended— 
(1) in paragraph (3), by striking ‘‘under this 
subsection’’ and all that follows through the period 
and inserting ‘‘that meet the requirements of this sub-
section through September 30, 2023.’’; 
(2) in paragraph (5)(C)(iii)(I), by striking 
‘‘during the 8 fiscal quarter period (or any portion 
of the period) that begins on January 1, 2020’’ and 
inserting ‘‘through September 30, 2023’’; 
(3) in paragraph (5)(C)(iii)(II), by inserting be-
fore the period at the end ‘‘or through September 30, 
2023, whichever is longer’’; 
(4) in paragraph (8)(A), by striking ‘‘to partici-
pate’’ and all that follows through the period and in-
serting ‘‘to conduct demonstration programs that meet 
the requirements of this subsection for 2 years or 
through September 30, 2023, whichever is longer.’’. 
SEC. 207. CLARIFYING AUTHORITY OF STATE MEDICAID 
FRAUD AND ABUSE CONTROL UNITS TO IN-
VESTIGATE AND PROSECUTE CASES OF MED-
ICAID PATIENT ABUSE AND NEGLECT IN ANY 
SETTING. 
(a) IN GENERAL.—Section 1903(q)(4)(A)(ii) of the So-
cial Security Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is amended 
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by inserting after ‘‘patients residing in board and care fa-
cilities’’ the following: ‘‘and of patients (who are receiving 
medical assistance under the State plan under this title (or 
waiver of such plan)) in a noninstitutional or other set-
ting’’. 
(b) AVAILABILITY OF FUNDING.—Section 1903(a)(6) of 
the Social Security Act (42 U.S.C. 1396b(a)(6)) is amend-
ed, in the matter following subparagraph (B), by striking 
‘‘(as found necessary by the Secretary for the elimination 
of fraud in the provision and administration of medical 
assistance provided under the State plan (or waiver of such 
plan))’’. 
SEC. 208. MEDICAID COVERAGE FOR CITIZENS OF FREELY 
ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
to eligibility for benefits for the designated Fed-
eral program defined in paragraph (3)(C) (relat-
ing to the Medicaid program), paragraph (1) 
shall not apply to any individual who lawfully 
resides in 1 of the 50 States or the District of 
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Columbia in accordance with the Compacts of 
Free Association between the Government of the 
United States and the Governments of the Fed-
erated States of Micronesia, the Republic of the 
Marshall Islands, and the Republic of Palau and 
shall not apply, at the option of the Governor of 
Puerto Rico, the Virgin Islands, Guam, the 
Northern Mariana Islands, or American Samoa 
as communicated to the Secretary of Health and 
Human Services in writing, to any individual 
who lawfully resides in the respective territory in 
accordance with such Compacts.’’. 
(b) EXCEPTION TO 5–YEAR LIMITED ELIGIBILITY.— 
Section 403(b) of such Act (8 U.S.C. 1613(b)) is amended 
by adding at the end the following new paragraph: 
‘‘(3) EXCEPTION FOR CITIZENS OF FREELY ASSO-
CIATED STATES.—An individual described in section 
402(b)(2)(G), but only with respect to the designated 
Federal program defined in section 402(b)(3)(C).’’. 
(c) DEFINITION
OF
QUALIFIED
ALIEN.—Section 
431(b) of such Act (8 U.S.C. 1641(b)) is amended— 
(1) in paragraph (6), by striking ‘‘; or’’ at the 
end and inserting a comma; 
(2) in paragraph (7), by striking the period at 
the end and inserting ‘‘, or’’; and 
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(3) by adding at the end the following new para-
graph: 
‘‘(8) an individual who lawfully resides in the 
United States in accordance with a Compact of Free 
Association referred to in section 402(b)(2)(G), but 
only with respect to the designated Federal program 
defined in section 402(b)(3)(C) (relating to the Med-
icaid program).’’. 
(d) CONFORMING AMENDMENTS.—Section 1108 of the 
Social Security Act (42 U.S.C. 1308) is amended— 
(1) in subsection (f), in the matter preceding 
paragraph (1), by striking ‘‘subsection (g) and section 
1935(e)(1)(B)’’ and inserting ‘‘subsections (g) and (h) 
and section 1935(e)(1)(B)’’; and 
(2) by adding at the end the following: 
‘‘(h) EXCLUSION OF MEDICAL ASSISTANCE EXPENDI-
TURES FOR CITIZENS OF FREELY ASSOCIATED STATES.— 
Expenditures for medical assistance provided to an indi-
vidual described in section 431(b)(8) of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1641(b)(8)) shall not be taken into account 
for purposes of applying payment limits under subsections 
(f) and (g).’’. 
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(e) EFFECTIVE DATE.—The amendments made by this 
section shall apply to benefits for items and services fur-
nished on or after the date of the enactment of this Act. 
SEC. 209. MEDICAID COVERAGE OF CERTAIN MEDICAL 
TRANSPORTATION. 
(a) CONTINUING REQUIREMENT OF MEDICAID COV-
ERAGE OF NECESSARY TRANSPORTATION.— 
(1) REQUIREMENT.—Section 1902(a)(4) of the 
Social Security Act (42 U.S.C. 1396a(a)(4)) is 
amended— 
(A) by striking ‘‘and including provision 
for utilization’’ and inserting ‘‘including provi-
sion for utilization’’; and 
(B) by inserting after ‘‘supervision of ad-
ministration of the plan’’ the following: ‘‘, and, 
subject to section 1903(i), including a specifica-
tion that the single State agency described in 
paragraph (5) will ensure necessary transpor-
tation for beneficiaries under the State plan to 
and from providers and a description of the 
methods that such agency will use to ensure such 
transportation’’. 
(2) APPLICATION WITH RESPECT TO BENCHMARK 
BENEFIT
PACKAGES
AND
BENCHMARK
EQUIVALENT 
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4587 
COVERAGE.—Section 1937(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1396u–7(a)(1)) is amended— 
(A) in subparagraph (A), by striking ‘‘sub-
section (E)’’ and inserting ‘‘subparagraphs (E) 
and (F)’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) NECESSARY
TRANSPORTATION.—Not-
withstanding the preceding provisions of this 
paragraph, a State may not provide medical as-
sistance through the enrollment of an individual 
with benchmark coverage or benchmark equiva-
lent coverage described in subparagraph (A)(i) 
unless, subject to section 1903(i)(9) and in ac-
cordance with section 1902(a)(4), the benchmark 
benefit package or benchmark equivalent coverage 
(or the State)— 
‘‘(i) ensures necessary transportation 
for individuals enrolled under such package 
or coverage to and from providers; and 
‘‘(ii) provides a description of the 
methods that will be used to ensure such 
transportation.’’. 
(3) LIMITATION
ON
FEDERAL
FINANCIAL
PAR-
TICIPATION.—Section 1903(i) of the Social Security 
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Act (42 U.S.C. 1396b(i)) is amended by inserting 
after paragraph (8) the following new paragraph: 
‘‘(9) with respect to any amount expended for 
non-emergency transportation authorized under sec-
tion 1902(a)(4), unless the State plan provides for the 
methods and procedures required under section 
1902(a)(30)(A); or’’. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on the date of the 
enactment of this Act and shall apply to transpor-
tation furnished on or after such date. 
(b) MEDICAID PROGRAM INTEGRITY MEASURES RE-
LATED TO COVERAGE OF NONEMERGENCY MEDICAL TRANS-
PORTATION.— 
(1) GAO STUDY.—Not later than two years after 
the date of the enactment of this Act, the Comptroller 
General of the United States shall conduct a study, 
and submit to Congress, a report on coverage under 
the Medicaid program under title XIX of the Social 
Security Act of nonemergency transportation to serv-
ices. Such study shall take into account the 2009 re-
port of the Office of the Inspector General of the De-
partment of Health and Human Services, titled 
‘‘Fraud and Abuse Safeguards for State Medicaid 
Nonemergency 
Medical 
Transportation 
Services’’ 
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(OEI–06–07–00320). Such report shall include the 
following: 
(A) An examination of the 50 States and 
the District of Columbia to identify safeguards to 
prevent and detect fraud and abuse with respect 
to coverage under the Medicaid program of non-
emergency transportation to covered services. 
(B) An examination of transportation bro-
kers to identify the range of safeguards against 
such fraud and abuse to prevent improper pay-
ments for such transportation. 
(C) Identification of the numbers, types, 
and outcomes of instances of fraud and abuse, 
with respect to coverage under the Medicaid pro-
gram of such transportation, that State Medicaid 
Fraud Control Units have investigated in recent 
years. 
(D) Identification of commonalities or 
trends in program integrity, with respect to such 
coverage, to inform risk management strategies 
of States and the Centers for Medicare & Med-
icaid Services. 
(2) STAKEHOLDER MEETINGS.— 
(A) IN
GENERAL.—Not later than 18 
months after the date of the enactment of this 
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Act, the Secretary of Health and Human Serv-
ices, through the Centers for Medicare & Med-
icaid Services, shall convene a series of meetings 
to obtain input from appropriate stakeholders to 
facilitate discussion and shared learning about 
the leading practices for improving Medicaid 
program integrity, with respect to coverage of 
nonemergency transportation to medically nec-
essary services. 
(B) TOPICS.—The meetings convened under 
subparagraph (A) shall— 
(i) focus on ongoing challenges to Med-
icaid program integrity as well as leading 
practices to address such challenges; and 
(ii) address specific challenges raised 
by stakeholders involved in coverage under 
the Medicaid program of nonemergency 
transportation to covered services, including 
unique considerations for specific groups of 
Medicaid beneficiaries meriting particular 
attention, such as American Indians and 
tribal land issues or accommodations for in-
dividuals with disabilities. 
(C) 
STAKEHOLDERS.—Stakeholders 
de-
scribed in subparagraph (A) shall include indi-
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4591 
viduals from State Medicaid programs, brokers 
for nonemergency transportation to medically 
necessary services that meet the criteria described 
in section 1902(a)(70)(B) of the Social Security 
Act (42 U.S.C. 1396a(a)(70)(B)), providers (in-
cluding 
transportation 
network 
companies), 
Medicaid patient advocates, and such other indi-
viduals specified by the Secretary. 
(3) GUIDANCE
REVIEW.—Not later than 24 
months after the date of the enactment of this Act, the 
Secretary of Health and Human Services, through the 
Centers for Medicare & Medicaid Services, shall assess 
guidance issued to States by the Centers for Medicare 
& Medicaid Services relating to Federal requirements 
for nonemergency transportation to medically nec-
essary services under the Medicaid program under 
title XIX of the Social Security Act and update such 
guidance as necessary to ensure States have appro-
priate and current guidance in designing and admin-
istering coverage under the Medicaid program of non-
emergency transportation to medically necessary serv-
ices. 
(4) NEMT
TRANSPORTATION
PROVIDER
AND 
DRIVER REQUIREMENTS.— 
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4592 
(A) STATE
PLAN
REQUIREMENT.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended— 
(i) by striking ‘‘and’’ at the end of 
paragraph (85); 
(ii) by striking the period at the end of 
paragraph (86) and inserting ‘‘; and’’; and 
(iii) by inserting after paragraph (86) 
the following new paragraph: 
‘‘(87) provide for a mechanism, which may in-
clude attestation, that ensures that, with respect to 
any provider (including a transportation network 
company) or individual driver of nonemergency 
transportation to medically necessary services receiv-
ing payments under such plan (but excluding any 
public transit authority), at a minimum— 
‘‘(A) each such provider and individual 
driver is not excluded from participation in any 
Federal health care program (as defined in sec-
tion 1128B(f)) and is not listed on the exclusion 
list of the Inspector General of the Department 
of Health and Human Services; 
‘‘(B) each such individual driver has a 
valid driver’s license; 
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4593 
‘‘(C) each such provider has in place a 
process to address any violation of a State drug 
law; and 
‘‘(D) each such provider has in place a 
process to disclose to the State Medicaid program 
the driving history, including any traffic viola-
tions, of each such individual driver employed by 
such provider, including any traffic violations.’’. 
(B) EFFECTIVE DATE.— 
(i) IN GENERAL.—Except as provided 
in clause (ii), the amendments made by 
subparagraph (A) shall take effect on the 
date of the enactment of this Act and shall 
apply to services furnished on or after the 
date that is one year after the date of the 
enactment of this Act. 
(ii) EXCEPTION.—In the case of a 
State plan under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.), or 
waiver of such plan, that the Secretary of 
Health and Human Services determines re-
quires State legislation in order for the re-
spective plan to meet any requirement im-
posed by amendments made by this section, 
the respective plan shall not be regarded as 
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4594 
failing to comply with the requirements of 
such title solely on the basis of its failure to 
meet such an additional requirement before 
the first day of the first calendar quarter be-
ginning after the close of the first regular 
session of the State legislature that begins 
after the date of the enactment of this Act. 
For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative 
session, each year of the session shall be con-
sidered to be a separate regular session of 
the State legislature. 
(5) ANALYSIS OF T–MSIS DATA.—Not later than 
one year after the date of the enactment of this Act, 
the Secretary of Health and Human Services, through 
the Centers for Medicare & Medicaid Services, shall 
analyze, and submit to Congress a report on, the na-
tion-wide data set under the Transformed Medicaid 
Statistical Information System to identify rec-
ommendations relating to coverage under the Med-
icaid program under title XIX of the Social Security 
Act of nonemergency transportation to medically nec-
essary services. 
(c) CONSULTATION RELATING
TO NONEMERGENCY 
MEDICAL TRANSPORTATION.—In the case of a State that 
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4595 
exercises the option described in section 1902(a)(70) of the 
Social Security Act (42 U.S.C. 1396a(a)(7)), in estab-
lishing a non-emergency medical transportation brokerage 
program under such section, a State Medicaid agency may 
consult relevant stakeholders, including stakeholders rep-
resenting patients, medical providers, Medicaid managed 
care organizations, brokers for non-emergency medical 
transportation, and transportation providers (including 
public transportation providers). 
SEC. 210. PROMOTING ACCESS TO LIFE-SAVING THERAPIES 
FOR MEDICAID ENROLLEES BY ENSURING 
COVERAGE OF ROUTINE PATIENT COSTS FOR 
ITEMS AND SERVICES FURNISHED IN CON-
NECTION WITH PARTICIPATION IN QUALI-
FYING CLINICAL TRIALS. 
(a) IN GENERAL.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (a)— 
(A) in paragraph (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (30) as 
paragraph (31); and 
(C) by inserting after paragraph (29) the 
following new paragraph: 
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4596 
‘‘(30) subject to subsection (gg), routine patient 
costs for items and services furnished in connection 
with participation in a qualifying clinical trial (as 
defined in such subsection); and’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(gg)(1) ROUTINE PATIENT COSTS.—For purposes of 
subsection (a)(30), with respect to a State and an indi-
vidual enrolled under the State plan (or a waiver of such 
plan) who participates in a qualifying clinical trial, rou-
tine patient costs— 
‘‘(A) include any item or service provided to the 
individual under the qualifying clinical trial, includ-
ing— 
‘‘(i) any item or service provided to prevent, 
diagnose, monitor, or treat complications result-
ing from such participation, to the extent that 
the provision of such an item or service to the in-
dividual outside the course of such participation 
would otherwise be covered under the State plan 
or waiver; and 
‘‘(ii) any item or service required solely for 
the provision of the investigational item or serv-
ice that is the subject of such trial, including the 
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4597 
administration of such investigational item or 
service; and 
‘‘(B) does not include— 
‘‘(i) an item or service that is the investiga-
tional item or service that is— 
‘‘(I) the subject of the qualifying clin-
ical trial; and 
‘‘(II) not otherwise covered outside of 
the clinical trial under the State plan or 
waiver; or 
‘‘(ii) an item or service that is— 
‘‘(I) provided to the individual solely 
to satisfy data collection and analysis needs 
for the qualifying clinical trial and is not 
used in the direct clinical management of 
the individual; and 
‘‘(II) not otherwise covered under the 
State plan or waiver. 
‘‘(2) QUALIFYING CLINICAL TRIAL DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this sub-
section and subsection (a)(30), the term ‘qualifying 
clinical trial’ means a clinical trial (in any clinical 
phase of development) that is conducted in relation to 
the prevention, detection, or treatment of any serious 
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4598 
or life-threatening disease or condition and is de-
scribed in any of the following clauses: 
‘‘(i) The study or investigation is approved, 
conducted, or supported (which may include 
funding through in-kind contributions) by one or 
more of the following: 
‘‘(I) The National Institutes of Health. 
‘‘(II) The Centers for Disease Control 
and Prevention. 
‘‘(III) The Agency for Healthcare Re-
search and Quality. 
‘‘(IV) The Centers for Medicare & Med-
icaid Services. 
‘‘(V) A cooperative group or center of 
any of the entities described in subclauses 
(I) through (IV) or the Department of De-
fense or the Department of Veterans Affairs. 
‘‘(VI) A qualified non-governmental re-
search entity identified in the guidelines 
issued by the National Institutes of Health 
for center support grants. 
‘‘(VII) Any of the following if the con-
ditions described in subparagraph (B) are 
met: 
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4599 
‘‘(aa) The Department of Veterans 
Affairs. 
‘‘(bb) The Department of Defense. 
‘‘(cc) The Department of Energy. 
‘‘(ii) The clinical trial is conducted pursu-
ant to an investigational new drug exemption 
under section 505(i) of the Federal Food, Drug, 
and Cosmetic Act or an exemption for a biologi-
cal product undergoing investigation under sec-
tion 351(a)(3) of the Public Health Service Act. 
‘‘(iii) The clinical trial is a drug trial that 
is exempt from being required to have an exemp-
tion described in clause (ii). 
‘‘(B) CONDITIONS.—For purposes of subpara-
graph (A)(i)(VII), the conditions described in this 
subparagraph, with respect to a clinical trial ap-
proved or funded by an entity described in such sub-
paragraph (A)(i)(VII), are that the clinical trial has 
been reviewed and approved through a system of peer 
review that the Secretary determines— 
‘‘(i) to be comparable to the system of peer 
review of studies and investigations used by the 
National Institutes of Health; and 
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‘‘(ii) assures unbiased review of the highest 
scientific standards by qualified individuals 
with no interest in the outcome of the review. 
‘‘(3) COVERAGE DETERMINATION REQUIREMENTS.—A 
determination with respect to coverage under subsection 
(a)(30) for an individual participating in a qualifying 
clinical trial— 
‘‘(A) shall be expedited and completed within 72 
hours; 
‘‘(B) shall be made without limitation on the ge-
ographic location or network affiliation of the health 
care provider treating such individual or the prin-
cipal investigator of the qualifying clinical trial; 
‘‘(C) shall be based on attestation regarding the 
appropriateness of the qualifying clinical trial by the 
health care provider and principal investigator de-
scribed in subparagraph (B), which shall be made 
using a streamlined, uniform form developed for State 
use by the Secretary and that includes the option to 
reference information regarding the qualifying clin-
ical trial that is publicly available on a website 
maintained 
by 
the 
Secretary, 
such 
as 
clinicaltrials.gov (or a successor website); and 
‘‘(D) shall not require submission of the protocols 
of the qualifying clinical trial, or any other docu-
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4601 
mentation that may be proprietary or determined by 
the Secretary to be burdensome to provide.’’. 
(b) REQUIRING MANDATORY COVERAGE UNDER STATE 
PLAN.—Section 1902(a)(10)(A) of such Act is amended, in 
the matter preceding clause (i), by striking ‘‘and (29)’’ and 
inserting ‘‘(29), and (30)’’. 
(c) INCLUSION IN BENCHMARK COVERAGE.—Section 
1937(b)(5) of such Act is amended by inserting before the 
period at the end the following: ‘‘, and beginning January 
1, 2022, coverage of routine patient costs for items and serv-
ices furnished in connection with participation in a quali-
fying clinical trial (as defined in section 1905(gg))’’. 
(d) EXEMPTION OF ADDITIONAL EXPENDITURES FROM 
PAYMENT LIMITS FOR TERRITORIES.—Section 1108(g)(4) 
of the Social Security Act (42 U.S.C. 1308(g)(4)) is amend-
ed— 
(1) by striking ‘‘With respect to’’ and inserting 
the following: 
‘‘(A) IN GENERAL.—With respect to’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) ADDITIONAL
EXEMPTION.—Payments 
under section 1903 for medical assistance con-
sisting of routine patient costs (as defined in sec-
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4602 
tion 1905(gg)(1)) shall not be taken into account 
in applying subsection (f).’’. 
(e) EFFECTIVE DATE.— 
(1) IN
GENERAL.—The amendments made by 
this section shall apply with respect to items and 
services furnished on or after January 1, 2022. 
(2) EXCEPTION
FOR
STATE
LEGISLATION.—In 
the case of a State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.), or waiver of 
such plan, that the Secretary of Health and Human 
Services determines requires State legislation in order 
for the respective plan to meet any requirement im-
posed by amendments made by this section, the re-
spective plan shall not be regarded as failing to com-
ply with the requirements of such title solely on the 
basis of its failure to meet such an additional require-
ment before the first day of the first calendar quarter 
beginning after the close of the first regular session of 
the State legislature that begins after the date of the 
enactment of this Act. For purposes of the previous 
sentence, in the case of a State that has a 2-year leg-
islative session, each year of the session shall be con-
sidered to be a separate regular session of the State 
legislature. 
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4603 
TITLE III—HUMAN SERVICES 
SEC. 301. EXTENSION OF TANF, CHILD CARE ENTITLEMENT 
TO STATES, AND RELATED PROGRAMS. 
Activities authorized by part A of title IV and section 
1108(b) of the Social Security Act shall continue through 
September 30, 2021, in the manner authorized for fiscal 
year 2020, 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 pur-
pose. Grants and payments may be made pursuant to this 
authority on a quarterly basis through the 4th quarter of 
fiscal year 2021 at the level provided for such activities for 
the corresponding quarter of fiscal year 2020. 
SEC. 302. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 713) 
is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in subparagraph (A)— 
(I) in the matter preceding clause 
(i), by striking ‘‘2020 and for the pe-
riod beginning October 1, 2020, and 
ending December 18, 2020’’ and insert-
ing ‘‘2023’’; and 
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4604 
(II) in clause (i), by striking ‘‘or 
period’’; 
(ii) in subparagraph (B)(i), by strik-
ing the 2nd sentence; 
(iii) in subparagraph (C)(i)— 
(I) by striking ‘‘or the period de-
scribed in subparagraph (A)’’; and 
(II) by striking ‘‘or period’’; 
(B) in paragraph (3)— 
(i) by striking ‘‘or the period described 
in paragraph (1)(A)’’; and 
(ii) by striking ‘‘or period’’; and 
(C) in paragraph (4)— 
(i) by striking ‘‘2020 and for the pe-
riod described in paragraph (1)(A)’’ and 
inserting ‘‘2023’’; 
(ii) by striking ‘‘2020 and for the pe-
riod so described’’ and inserting ‘‘2023’’; 
and 
(iii) by striking ‘‘or the period so de-
scribed’’; 
(2) in subsection (c)— 
(A) in each of paragraphs (1) and (2), by 
striking ‘‘Subject to paragraph (3), from’’ and 
inserting ‘‘From’’; and 
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(B) by striking paragraph (3); and 
(3) in subsection (f), by striking ‘‘2020, and for 
the period beginning on October 1, 2020, and ending 
on December 18, 2020, the amount equal to the pro 
rata portion of the amount appropriated for such pe-
riod for fiscal year 2020’’ and inserting ‘‘2023’’. 
SEC. 303. SEXUAL RISK AVOIDANCE EDUCATION EXTEN-
SION. 
Section 510 of the Social Security Act (42 U.S.C. 710) 
is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A)— 
(I) by striking ‘‘2020 and for the 
period beginning October 1, 2020, and 
ending December 18, 2020’’ and insert-
ing ‘‘2023’’; and 
(II) by striking ‘‘(or, with respect 
to such period, for fiscal year 2021)’’; 
and 
(ii) in subparagraph (A), by striking 
‘‘or period’’ each place it appears; 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
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(I) by striking ‘‘2020 and for the 
period beginning October 1, 2020, and 
ending December 18, 2020’’ and insert-
ing ‘‘2023’’; and 
(II) by striking ‘‘(or, with respect 
to such period, for fiscal year 2021)’’; 
and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘(or, with respect to the period de-
scribed in subparagraph (A), for fiscal year 
2021)’’; and 
(2) in subsection (f)— 
(A) in paragraph (1), by striking ‘‘2020, 
and for the period beginning on October 1, 2020, 
and ending on December 18, 2020, the amount 
equal to the pro rata portion of the amount ap-
propriated for such period for fiscal year 2020’’ 
and inserting ‘‘2023’’; and 
(B) in paragraph (2), by striking ‘‘2020, 
and for the period described in paragraph (1),’’ 
and inserting ‘‘2023,’’. 
SEC. 304. EXTENSION OF SUPPORT FOR CURRENT HEALTH 
PROFESSIONS OPPORTUNITY GRANTS. 
Out of any money in the Treasury of the United States 
not otherwise appropriated, there are hereby appropriated 
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to the Secretary of Health and Human Services $3,600,000, 
which shall be available— 
(1) through the end of fiscal year 2021 for nec-
essary administrative expenses to carry out grants 
made under section 2008(a) of the Social Security Act 
before the date of the enactment of this Act; and 
(2) through the end of fiscal year 2022 for re-
search, evaluation, and reporting under such section, 
and for necessary administrative expenses to carry 
out these activities. 
SEC. 305. EXTENSION OF MARYLEE ALLEN PROMOTING 
SAFE AND STABLE FAMILIES PROGRAM AND 
STATE COURT SUPPORT. 
(a) EXTENSIONS.—Section 436 of the Social Security 
Act (42 U.S.C. 629f) is amended in each of subsections (a), 
(b)(4)(A), (b)(5), and (f)(10) by striking ‘‘2021’’ and insert-
ing ‘‘2022’’. 
(b) PROGRAM CHANGES.—Section 438 of such Act (42 
U.S.C. 629h) is amended— 
(1) in subsection (a)— 
(A) in paragraph (2)— 
(i) in subparagraph (A), by inserting 
‘‘in a timely and complete manner’’ before 
‘‘, as set forth’’; and 
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(ii) in subparagraph (C), by striking 
the semicolon and inserting ‘‘, including by 
training judges, attorneys, and other legal 
personnel.’’; and 
(B) by striking paragraphs (3) and (4); 
(2) in subsection (b)— 
(A) by striking paragraph (2); 
(B) by striking all that precedes ‘‘be eligible 
to receive’’ and inserting the following: 
‘‘(b) APPLICATIONS.—In order to’’; and 
(C) in the matter preceding paragraph 
(2)— 
(i) by moving the matter 2 ems to the 
left; 
(ii) in subparagraph (A)— 
(I) by striking ‘‘(A) in the case of 
a grant for the purpose described in 
subsection (a)(3),’’ and inserting ‘‘(1)’’; 
and 
(II) by inserting ‘‘use not less 
than 30 percent of grant funds to’’ be-
fore ‘‘collaborate’’; 
(iii) in subparagraph (B), by striking 
‘‘(B) in the case of a grant for the purpose 
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described in subsection (a)(4),’’ and insert-
ing ‘‘(2)’’; and 
(iv) in subparagraph (C), by striking 
‘‘(C) in the case of a grant for the purpose 
described in subsection (a),’’ and inserting 
‘‘(3)’’; 
(3) by striking subsection (c) and inserting the 
following: 
‘‘(c) AMOUNT OF GRANT.— 
‘‘(1) IN GENERAL.—From the amounts reserved 
under sections 436(b)(2) and 437(b)(2) for a fiscal 
year, each highest State court that has an application 
approved under this section for the fiscal year shall 
be entitled to payment of an amount equal to the sum 
of— 
‘‘(A) $255,000; and 
‘‘(B) the amount described in paragraph (2) 
with respect to the court and the fiscal year. 
‘‘(2) AMOUNT
DESCRIBED.—The amount de-
scribed in this paragraph with respect to a court and 
a fiscal year is the amount that bears the same ratio 
to the total of the amounts reserved under sections 
436(b)(2) and 437(b)(2) for grants under this section 
for the fiscal year (after applying paragraphs (1)(A) 
and (3) of this subsection) as the number of individ-
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4610 
uals in the State in which the court is located who 
have not attained 21 years of age bears to the total 
number of such individuals in all States with a high-
est State court that has an approved application 
under this section for the fiscal year. 
‘‘(3) INDIAN
TRIBES.—From the amounts re-
served under section 436(b)(2) for a fiscal year, the 
Secretary shall, before applying paragraph (1) of this 
subsection, allocate $1,000,000 for grants to be award-
ed on a competitive basis among the highest courts of 
Indian tribes or tribal consortia that— 
‘‘(A) are operating a program under part 
E, in accordance with section 479B; 
‘‘(B) are seeking to operate a program 
under part E and have received an implementa-
tion grant under section 476; or 
‘‘(C) have a court responsible for pro-
ceedings related to foster care or adoption.’’; and 
(4) in subsection (d), by striking ‘‘2017 through 
2021’’ and inserting ‘‘2018 through 2022’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on October 1, 2021. 
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4611 
TITLE IV—HEALTH OFFSETS 
SEC. 401. REQUIRING CERTAIN MANUFACTURERS TO RE-
PORT DRUG PRICING INFORMATION WITH RE-
SPECT TO DRUGS UNDER THE MEDICARE 
PROGRAM. 
(a) IN GENERAL.—Section 1847A of the Social Secu-
rity Act (42 U.S.C. 1395w–3a) is amended— 
(1) in subsection (b)— 
(A) in paragraph (2)(A), by inserting ‘‘or 
subsection (f)(2), as applicable’’ before the period 
at the end; 
(B) in paragraph (3), in the matter pre-
ceding subparagraph (A), by inserting ‘‘or sub-
section (f)(2), as applicable,’’ before ‘‘determined 
by’’; and 
(C) in paragraph (6)(A), in the matter pre-
ceding clause (i), by inserting ‘‘or subsection 
(f)(2), as applicable,’’ before ‘‘determined by’’; 
and 
(2) in subsection (f)— 
(A) by striking ‘‘For requirements’’ and in-
serting the following: 
‘‘(1) IN GENERAL.—For requirements’’; and 
(B) by adding at the end the following new 
paragraph: 
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4612 
‘‘(2) MANUFACTURERS
WITHOUT
A
REBATE 
AGREEMENT UNDER TITLE XIX.— 
‘‘(A) IN GENERAL.—If the manufacturer of 
a drug or biological described in subparagraph 
(C), (E), or (G) of section 1842(o)(1) or in sec-
tion 1881(b)(14)(B) that is payable under this 
part has not entered into and does not have in 
effect a rebate agreement described in subsection 
(b) of section 1927, for calendar quarters begin-
ning on January 1, 2022, such manufacturer 
shall report to the Secretary the information de-
scribed in subsection (b)(3)(A)(iii) of such sec-
tion 1927 with respect to such drug or biological 
in a time and manner specified by the Secretary. 
For purposes of applying this paragraph, a drug 
or biological described in the previous sentence 
includes items, services, supplies, and products 
that are payable under this part as a drug or bi-
ological. 
‘‘(B) AUDIT.—Information reported under 
subparagraph (A) is subject to audit by the In-
spector General of the Department of Health and 
Human Services. 
‘‘(C) VERIFICATION.—The Secretary may 
survey wholesalers and manufacturers that di-
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4613 
rectly distribute drugs or biologicals described in 
subparagraph (A), when necessary, to verify 
manufacturer prices and manufacturer’s average 
sales prices (including wholesale acquisition cost) 
if required to make payment reported under sub-
paragraph (A). The Secretary may impose a 
civil monetary penalty in an amount not to ex-
ceed $100,000 on a wholesaler, manufacturer, or 
direct seller, if the wholesaler, manufacturer, or 
direct seller of such a drug or biological refuses 
a request for information about charges or prices 
by the Secretary in connection with a survey 
under this subparagraph or knowingly provides 
false information. The provisions of section 
1128A (other than subsections (a) (with respect 
to amounts of penalties or additional assess-
ments) and (b)) shall apply to a civil money 
penalty under this subparagraph in the same 
manner as such provisions apply to a penalty or 
proceeding under section 1128A(a). 
‘‘(D) CONFIDENTIALITY.—Notwithstanding 
any other provision of law, information disclosed 
by manufacturers or wholesalers under this 
paragraph (other than the wholesale acquisition 
cost for purposes of carrying out this section) is 
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4614 
confidential and shall not be disclosed by the 
Secretary in a form which discloses the identity 
of a specific manufacturer or wholesaler or prices 
charged for drugs or biologicals by such manu-
facturer or wholesaler, except— 
‘‘(i) as the Secretary determines to be 
necessary to carry out this section (includ-
ing the determination and implementation 
of the payment amount), or to carry out 
section 1847B; 
‘‘(ii) to permit the Comptroller General 
of the United States to review the informa-
tion provided; 
‘‘(iii) to permit the Director of the 
Congressional Budget Office to review the 
information provided; 
‘‘(iv) to permit the Medicare Payment 
Advisory Commission to review the infor-
mation provided; and 
‘‘(v) to permit the Medicaid and CHIP 
Payment and Access Commission to review 
the information provided.’’. 
(b) ENFORCEMENT.—Section 1847A of such Act (42 
U.S.C. 1395w–3a) is further amended— 
(1) in subsection (d)(4)— 
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4615 
(A) in subparagraph (A), by striking ‘‘IN 
GENERAL’’ and inserting ‘‘MISREPRESENTA-
TION’’; 
(B) in subparagraph (B), by striking ‘‘sub-
paragraph (B)’’ and inserting ‘‘subparagraph 
(A), (B), or (C)’’; 
(C) by redesignating subparagraph (B) as 
subparagraph (E); and 
(D) by inserting after subparagraph (A) the 
following new subparagraphs: 
‘‘(B) FAILURE TO PROVIDE TIMELY INFOR-
MATION.—If the Secretary determines that a 
manufacturer described in subsection (f)(2) has 
failed to report on information described in sec-
tion 1927(b)(3)(A)(iii) with respect to a drug or 
biological in accordance with such subsection, the 
Secretary shall apply a civil money penalty in 
an amount of $10,000 for each day the manufac-
turer has failed to report such information and 
such amount shall be paid to the Treasury. 
‘‘(C) FALSE INFORMATION.—Any manufac-
turer required to submit information under sub-
section (f)(2) that knowingly provides false infor-
mation is subject to a civil money penalty in an 
amount not to exceed $100,000 for each item of 
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4616 
false information. Such civil money penalties are 
in addition to other penalties as may be pre-
scribed by law. 
‘‘(D) INCREASING
OVERSIGHT
AND
EN-
FORCEMENT.—For calendar quarters beginning 
on 
or 
after 
January 
1, 
2022, 
section 
1927(b)(3)(C)(iv) shall be applied as if— 
‘‘(i) each reference to ‘under this sub-
paragraph and subsection (c)(4)(B)(ii)(III)’ 
were a reference to ‘under this subpara-
graph, subsection (c)(4)(B)(ii)(III), and 
subparagraphs (A), (B), and (C) of section 
1847A(d)(4)’; and 
‘‘(ii) the reference to ‘activities related 
to the oversight and enforcement of this sec-
tion and agreements under this section’ 
were a reference to ‘activities related to the 
oversight and enforcement of this section 
and under subsection (f)(2) of section 1847A 
and subparagraphs (A), (B), and (C) of sec-
tion 1847A(d)(4) and, if applicable, agree-
ments under this section’.’’; and 
(2) in subsection (c)(6)(A), by striking the period 
at the end and inserting ‘‘, except that, for purposes 
of subsection (f)(2), the Secretary may, if the Sec-
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4617 
retary determines appropriate, exclude repackagers of 
a drug or biological from such term.’’. 
(c) MANUFACTURERS WITH A REBATE AGREEMENT.— 
(1) IN GENERAL.—Section 1927(b)(3)(A) of the 
Social Security Act (42 U.S.C. 1396r-8(b)(3)(A)) is 
amended by adding at the end the following new sen-
tence: ‘‘For purposes of applying clause (iii), for cal-
endar quarters beginning on or after January 1, 
2022, a drug or biological described in the flush mat-
ter following such clause includes items, services, sup-
plies, and products that are payable under part B of 
title XVIII as a drug or biological.’’. 
(2) 
TECHNICAL
AMENDMENT.—Section 
1927(b)(3)(A)(iii) of the Social Security Act (42 
U.S.C. 1396r-8(b)(3)(A)(iii)) is amended by striking 
‘‘section 1881(b)(13)(A)(ii)’’ and inserting ‘‘section 
1881(b)(14)(B)’’. 
(d) REPORT.—Not later than January 1, 2023, the In-
spector General of the Department of Health and Human 
Services shall assess and submit to Congress a report on 
the accuracy of average sales price information submitted 
by manufacturers under section 1847A of the Social Secu-
rity Act (42 U.S.C. 1395w–3a), including the extent to 
which manufacturers provide false information, misclassify 
drug products, or misreport information. Such report shall 
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4618 
include any recommendations on how to improve the accu-
racy of such information. 
SEC. 402. EXTENDED MONTHS OF COVERAGE OF IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANS-
PLANT PATIENTS AND OTHER RENAL DIALY-
SIS PROVISIONS. 
(a) 
MEDICARE
ENTITLEMENT
TO
IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI-
ENTS.— 
(1) IN GENERAL.—Section 226A(b)(2) of the So-
cial Security Act (42 U.S.C. 426–1(b)(2)) is amended 
by inserting ‘‘(except for eligibility for enrollment 
under part B solely for purposes of coverage of im-
munosuppressive 
drugs 
described 
in 
section 
1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth month’’. 
(2) INDIVIDUALS ELIGIBLE ONLY FOR COVERAGE 
OF IMMUNOSUPPRESSIVE DRUGS.— 
(A) IN GENERAL.—Section 1836 of the So-
cial Security Act (42 U.S.C. 1395o) is amend-
ed— 
(i) by striking ‘‘Every’’ and inserting 
‘‘(a) IN GENERAL.—Every’’; and 
(ii) by adding at the end the following 
new subsection: 
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4619 
‘‘(b) 
INDIVIDUALS
ELIGIBLE
FOR
IMMUNO-
SUPPRESSIVE DRUG COVERAGE.— 
‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2), every individual whose entitlement to 
insurance benefits under part A ends (whether before, 
on, or after January 1, 2023) by reason of section 
226A(b)(2) is eligible to enroll or to be deemed to have 
enrolled in the medical insurance program established 
by this part solely for purposes of coverage of im-
munosuppressive drugs in accordance with section 
1837(n). 
‘‘(2) EXCEPTION IF OTHER COVERAGE IS AVAIL-
ABLE.— 
‘‘(A) IN
GENERAL.—An individual de-
scribed in paragraph (1) shall not be eligible for 
enrollment in the program for purposes of cov-
erage described in such paragraph with respect 
to any period in which the individual, as deter-
mined in accordance with subparagraph (B)— 
‘‘(i) is enrolled in a group health plan 
or group or individual health insurance 
coverage, as such terms are defined in sec-
tion 2791 of the Public Health Service Act; 
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‘‘(ii) is enrolled for coverage under the 
TRICARE for Life program under section 
1086(d) of title 10, United States Code; 
‘‘(iii) is enrolled under a State plan 
(or waiver of such plan) under title XIX 
and is eligible to receive benefits for im-
munosuppressive drugs described in this 
subsection under such plan (or such waiv-
er); 
‘‘(iv) is enrolled under a State child 
health plan (or waiver of such plan) under 
title XXI and is eligible to receive benefits 
for such drugs under such plan (or such 
waiver); or 
‘‘(v)(I) is enrolled in the patient enroll-
ment system of the Department of Veterans 
Affairs established and operated under sec-
tion 1705 of title 38, United States Code; 
‘‘(II) is not required to enroll under 
section 1705 of such title to receive im-
munosuppressive drugs described in this 
subsection; or 
‘‘(III) is otherwise eligible under a pro-
vision of title 38, United States Code, other 
than section 1710 of such title to receive im-
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4621 
munosuppressive drugs described in this 
subsection. 
‘‘(B) ELIGIBILITY DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
coordination with the Commissioner of So-
cial Security, shall establish a process for 
determining whether an individual de-
scribed in paragraph (1) who is to be en-
rolled or deemed to be enrolled in the med-
ical insurance program described in such 
paragraph meets the requirements for such 
enrollment under this subsection, including 
the requirement that the individual not be 
enrolled in other coverage as described in 
subparagraph (A). 
‘‘(ii) ATTESTATION REGARDING OTHER 
COVERAGE.—The process established under 
clause (i) shall include, at a minimum, a 
requirement that— 
‘‘(I) the individual provide to the 
Commissioner an attestation that the 
individual is not enrolled and does not 
expect to enroll in such other coverage; 
and 
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4622 
‘‘(II) the individual notify the 
Commissioner within 60 days of en-
rollment in such other coverage.’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Sections 1837, 1838, 
and 1839 of the Social Security Act (42 
U.S.C. 1395p, 42 U.S.C. 1395q, 42 U.S.C. 
1395r) are each amended by striking 
‘‘1836’’ and inserting ‘‘1836(a)’’ each place 
it appears. 
(ii) ADDITIONAL
AMENDMENT.—Sec-
tion 1837(j)(1) of such Act (42 U.S.C. 
1395p(j)(1)) 
is 
amended 
by 
striking 
‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 
(b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Section 
1837 of the Social Security Act (42 U.S.C. 1395p), as 
amended by section 120, is amended by adding at the end 
the following new subsection: 
‘‘(n)(1) Any individual who is eligible for coverage of 
immunosuppressive drugs under section 1836(b) may enroll 
or be deemed to have enrolled only in such manner and 
form as may be prescribed by regulations, and only during 
an enrollment period described in this subsection. 
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‘‘(2) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) prior to January 1, 
2023, may enroll beginning on October 1, 2022, or the day 
on which the individual first satisfies section 1836(b), 
whichever is later. 
‘‘(3) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) on or after January 
1, 2023, shall be deemed to have enrolled in the medical 
insurance program established by this part for purposes of 
coverage of immunosuppressive drugs. 
‘‘(4) The Secretary shall establish a process under 
which an individual described in paragraph (1) whose other 
coverage described in section 1836(b)(2)(A), or coverage 
under this part (including the medical insurance program 
established under this part for purposes of coverage of im-
munosuppressive drugs), is terminated voluntarily or invol-
untary may enroll or reenroll, if applicable, in the medical 
insurance program established under this part for purposes 
of coverage of immunosuppressive drugs.’’. 
(c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELIGI-
BLE FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
(1) IN GENERAL.—Section 1838 of the Social Se-
curity Act (42 U.S.C. 1395q), as amended by section 
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120, is further amended by adding at the end the fol-
lowing new subsection: 
‘‘(h) In the case of an individual described in section 
1836(b)(1), the following rules shall apply: 
‘‘(1) In the case of such an individual who is 
deemed to have enrolled in part B for coverage of im-
munosuppressive drugs under section 1837(n)(3), such 
individual’s coverage period shall begin on the first 
day of the month in which the individual first satis-
fies section 1836(b). 
‘‘(2) In the case of such an individual who en-
rolls (or reenrolls, if applicable) in part B for cov-
erage of immunosuppressive drugs under paragraph 
(2) or (4) of section 1837(n), such individual’s cov-
erage period shall begin on January 1, 2023, or the 
month following the month in which the individual so 
enrolls (or reenrolls), whichever is later. 
‘‘(3) The provisions of subsections (b) and (d) 
shall apply with respect to an individual described in 
paragraph (1) or (2). 
‘‘(4) In addition to the reasons for termination 
under subsection (b), the coverage period of an indi-
vidual described in paragraph (1) or (2) shall end 
when the individual becomes entitled to benefits under 
this title under subsection (a) or (b) of section 226, 
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4625 
or under section 226A, or is no longer eligible for such 
coverage as a result of the application of section 
1836(b)(2). 
‘‘(5) The Secretary may conduct public edu-
cation activities to raise awareness of the availability 
of more comprehensive, individual health insurance 
coverage (as defined in section 2791 of the Public 
Health Service Act) for individuals eligible under sec-
tion 1836(b) to enroll or to be deemed enrolled in the 
medical insurance program established under this 
part for purposes of coverage of immunosuppressive 
drugs.’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1838(b) of the Social Security Act (42 U.S.C. 
1395q(b)) is amended, in the matter following para-
graph (2), by inserting ‘‘or section 1837(n)(3)’’ after 
‘‘section 1837(f)’’ each place it appears. 
(d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE FOR 
COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
(1) IN GENERAL.—Section 1839 of the Social Se-
curity Act (42 U.S.C. 1395r), as amended by section 
120, is further amended— 
(A) in subsection (b), by adding at the end 
the following new sentence: ‘‘No increase in the 
premium shall be effected for individuals who 
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are enrolled pursuant to section 1836(b) for cov-
erage only of immunosuppressive drugs.’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(j) DETERMINATION OF PREMIUM FOR INDIVIDUALS 
ONLY ELIGIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE 
DRUGS.—The Secretary shall, during September of each 
year (beginning with 2022), determine and promulgate a 
monthly premium rate for the succeeding calendar year for 
individuals enrolled only for the purpose of coverage of im-
munosuppressive drugs under section 1836(b). Such pre-
mium shall be equal to 15 percent of the monthly actuarial 
rate for enrollees age 65 and over (as would be determined 
in accordance with subsection (a)(1) if the reference to ‘one- 
half’ in such subsection were a reference to ‘100 percent’) 
for that succeeding calendar year. The monthly premium 
of each individual enrolled for coverage of immuno-
suppressive drugs under section 1836(b) for each month 
shall be the amount promulgated in this subsection. In the 
case of such individual not otherwise enrolled under this 
part, such premium shall be in lieu of any other monthly 
premium applicable under this section. Such amount shall 
be adjusted in accordance with subsections (c), (f), and (i), 
but shall not be adjusted under subsection (b).’’. 
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(2) SPECIAL RULE FOR APPLICATION OF HOLD 
HARMLESS PROVISIONS TO TRANSITIONING INDIVID-
UALS.—Section 1839(f) of the Social Security Act (42 
U.S.C. 1395r(f)) is amended by adding at the end the 
following new sentence: ‘‘Any increase in the pre-
mium for an individual who was enrolled under sec-
tion 1836(b) attributable to such individual otherwise 
enrolling under this part shall not be taken into ac-
count in applying this subsection.’’. 
(3) SPECIAL RULE FOR APPLICATION OF PRE-
MIUM
SUBSIDY
REDUCTION
PROVISIONS.—Section 
1839(i)(3)(A)(ii)(II) of the Social Security Act (42 
U.S.C. 1395r(i)(3)(A)(ii)(II)) is amended by insert-
ing ‘‘(or, with respect to an individual enrolled under 
section 1836(b) and not otherwise enrolled under this 
part, 0 times the amount of such increase)’’ after ‘‘in 
the year’’. 
(e) GOVERNMENT CONTRIBUTION.—Section 1844(a) of 
the Social Security Act (42 U.S.C. 1395w(a)) is amended— 
(1) in paragraph (3), by striking the period at 
the end and inserting ‘‘; plus’’; 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) a Government contribution equal to the esti-
mated aggregate reduction in premiums payable 
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under part B that results from establishing the pre-
mium at 15 percent of the actuarial rate (as would 
be determined in accordance with section 1839(a)(1) 
if the reference to ‘one-half’ in such section were a ref-
erence to ‘100 percent’) under section 1839(j) instead 
of 25 percent of such rate (as so determined) for indi-
viduals enrolled only for the purpose of coverage of 
immunosuppressive drugs under section 1836(b).’’; 
and 
(3) by adding the following sentence at the end 
of the flush matter following paragraph (4), as added 
by paragraph (2) of this subsection: 
‘‘The Government contribution under paragraph (4) 
shall be treated as premiums payable and deposited 
for purposes of subparagraphs (A) and (B) of para-
graph (1).’’. 
(f) ENSURING COVERAGE UNDER THE MEDICARE SAV-
INGS PROGRAM.— 
(1) IN GENERAL.—Section 1905(p)(1)(A) of the 
Social Security Act (42 U.S.C. 1396d(p)(1)(A)) is 
amended by inserting ‘‘or who is enrolled under part 
B for the purpose of coverage of immunosuppressive 
drugs under section 1836(b)’’ after ‘‘under section 
1818A)’’. 
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4629 
(2) 
CONFORMING
AMENDMENTS.—Section 
1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(E)) is amended in each of clauses (iii) 
and (iv) by inserting ‘‘(including such individuals 
enrolled under section 1836(b))’’ after ‘‘section 
1905(p)(1)’’. 
(g) PART D.—Section 1860D–1(a)(3)(A) of the Social 
Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is amended 
by inserting ‘‘(but not including an individual enrolled 
solely for coverage of immunosuppressive drugs under sec-
tion 1836(b))’’ before the period at the end. 
(h) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
implementation of coverage of immunosuppressive 
drugs for kidney transplant patients under the Medi-
care program pursuant to the provisions of, and 
amendments made by, this section. 
(2) REPORT.—Not later than January 1, 2025, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
together with recommendations as the Comptroller 
General determines appropriate. 
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4630 
SEC. 403. PERMITTING DIRECT PAYMENT TO PHYSICIAN AS-
SISTANTS UNDER MEDICARE. 
Section 1842(b)(6)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(6)(C)) is amended, in the matter preceding 
clause (i), by inserting ‘‘for such services furnished before 
January 1, 2022,’’ after ‘‘1861(s)(2)(K),’’. 
SEC. 404. ADJUSTING 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 ‘‘2025’’ and insert-
ing ‘‘2030’’; and 
(2) in clause (iii), by striking ‘‘2025’’ and in-
serting ‘‘2030’’. 
SEC. 405. SPECIAL RULE FOR DETERMINATION OF ASP IN 
CASES OF CERTAIN NONCOVERED SELF-AD-
MINISTERED DRUG PRODUCTS. 
Section 1847A of the Social Security Act (42 U.S.C. 
1395w–3a) is amended by redesignating subsection (g) as 
subsection (h) and by inserting after subsection (f) the fol-
lowing: 
‘‘(g) PAYMENT ADJUSTMENT FOR CERTAIN DRUGS FOR 
WHICH THERE IS A SELF-ADMINISTERED NDC.— 
‘‘(1) OIG STUDIES.—The Inspector General of 
the Department of Health and Human Services shall 
conduct periodic studies to identify National Drug 
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Codes for drug or biological products that are self-ad-
ministered for which payment may not be made 
under this part because such products are not covered 
pursuant to section 1861(s)(2) and which the Inspec-
tor General determines (based on the same or similar 
methodologies to the methodologies used in the final 
recommendation followup report of the Inspector Gen-
eral described in paragraph (3) or in the November 
2017 final report of the Inspector General entitled 
‘Excluding Noncovered Versions When Setting Pay-
ment for Two Part B Drugs Would Have Resulted in 
Lower Drug Costs for Medicare and its Beneficiaries’) 
should be excluded from the determination of the pay-
ment amount under this section. 
‘‘(2) PAYMENT
ADJUSTMENT.—If the Inspector 
General identifies a National Drug Code for a drug 
or biological product under paragraph (1), the In-
spector General shall inform the Secretary (at such 
times as the Secretary may specify to carry out this 
paragraph) and the Secretary shall, to the extent the 
Secretary deems appropriate, apply as the amount of 
payment under this section for the applicable billing 
and payment code the lesser of— 
‘‘(A) the amount of payment that would be 
determined under this section for such billing 
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and payment code if such National Drug Code 
for such product so identified under paragraph 
(1) were excluded from such determination; or 
‘‘(B) the amount of payment otherwise de-
termined under this section for such billing and 
payment code without application of this sub-
section. 
‘‘(3) APPLICATION
TO
CERTAIN
IDENTIFIED 
PRODUCTS.—In the case of a National Drug Code for 
a drug or biological product that is self-administered 
for which payment is not made under this part be-
cause such product is not covered pursuant to section 
1861(s)(2) that was identified by the Inspector Gen-
eral of the Department of Health and Human Serv-
ices in the final recommendation followup report of 
the Inspector General published July 2020, entitled 
Loophole in Drug Payment Rule Continues To Cost 
Medicare and Beneficiaries Hundreds of Millions of 
Dollars, beginning July 1, 2021, the amount of pay-
ment under this section for the applicable billing and 
payment code shall be the lesser of— 
‘‘(A) the amount of payment that would be 
determined under this section for such billing 
and payment code if such National Drug Code 
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for such drug or biological products so identified 
were excluded from such determination; or 
‘‘(B) the amount of payment otherwise de-
termined under this section for such billing and 
payment code without application of this sub-
section.’’. 
SEC. 406. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(3)(A) of the Social Security Act (42 
U.S.C 1396w–1(b)(3)(A)), as amended by section 1303 of 
the Further Continuing Appropriations Act, 2021, and 
Other Extensions Act, is amended by striking ‘‘ 
$3,464,000,000’’ and inserting ‘‘ $0’’. 
SEC. 407. ESTABLISHING HOSPICE PROGRAM SURVEY AND 
ENFORCEMENT PROCEDURES UNDER THE 
MEDICARE PROGRAM. 
(a) SURVEY AND ENFORCEMENT PROCEDURES.— 
(1) IN GENERAL.—Part A of title XVIII of the 
Social Security Act (42 U.S.C. 1395c et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE-
MENT PROCEDURES. 
‘‘(a) SURVEYS.— 
‘‘(1) FREQUENCY.—Any entity that is certified 
as a hospice program (as defined in section 
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1861(dd)(2)) shall be subject to a standard survey by 
an appropriate State or local survey agency, or an 
approved accreditation agency, as determined by the 
Secretary, not less frequently than once every 36 
months. 
‘‘(2) PUBLIC
TRANSPARENCY
OF
SURVEY
AND 
CERTIFICATION INFORMATION.— 
‘‘(A) SUBMISSION OF INFORMATION TO THE 
SECRETARY.— 
‘‘(i) IN GENERAL.—Each State or local 
survey agency, and each national accredita-
tion body with respect to which the Sec-
retary has made a finding under section 
1865(a) respecting the accreditation of a 
hospice program by such body, shall submit, 
in a form and manner, and at a time, spec-
ified by the Secretary for purposes of this 
paragraph, information respecting any sur-
vey or certification made with respect to a 
hospice program by such survey agency or 
body, as applicable. Such information shall 
include any inspection report made by such 
survey agency or body with respect to such 
survey or certification, any enforcement ac-
tions taken as a result of such survey or cer-
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4635 
tification, and any other information deter-
mined appropriate by the Secretary. 
‘‘(ii) REQUIRED INCLUSION OF SPECI-
FIED
FORM.—With respect to a survey 
under this subsection carried out by a na-
tional accreditation body described in 
clause (i) on or after October 1, 2021, infor-
mation described in such clause shall in-
clude Form CMS-2567 (or a successor 
form), along with such additional informa-
tion determined appropriate by such body. 
‘‘(B) PUBLIC
DISCLOSURE
OF
INFORMA-
TION.—Beginning not later than October 1, 
2022, the Secretary shall publish the information 
submitted under subparagraph (A) on the public 
website of the Centers for Medicare & Medicaid 
Services in a manner that is prominent, easily 
accessible, readily understandable, and search-
able. The Secretary shall provide for the timely 
update of such information so published. 
‘‘(3) CONSISTENCY
OF
SURVEYS.—Each State 
and the Secretary shall implement programs to meas-
ure and reduce inconsistency in the application of 
survey results among surveyors. 
‘‘(4) SURVEY TEAMS.— 
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‘‘(A) IN GENERAL.—In the case of a survey 
conducted under this subsection on or after Octo-
ber 1, 2021, by more than 1 individual, such 
survey shall be conducted by a multidisciplinary 
team of professionals (including a registered pro-
fessional nurse). 
‘‘(B) PROHIBITION
OF
CONFLICTS
OF
IN-
TEREST.—Beginning October 1, 2021, a State 
may not use as a member of a survey team 
under this subsection an individual who is serv-
ing (or has served within the previous 2 years) 
as a member of the staff of, or as a consultant 
to, the program surveyed respecting compliance 
with the requirements of section 1861(dd) or who 
has a personal or familial financial interest in 
the program being surveyed. 
‘‘(C) TRAINING.—The Secretary shall pro-
vide, not later than October 1, 2021, for the com-
prehensive training of State and Federal sur-
veyors, and any surveyor employed by a na-
tional accreditation body described in paragraph 
(2)(A)(i), in the conduct of surveys under this 
subsection, including training with respect to the 
review of written plans for providing hospice 
care (as described in section 1814(a)(7)(B)). No 
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individual shall serve as a member of a survey 
team with respect to a survey conducted on or 
after such date unless the individual has success-
fully completed a training and testing program 
in survey and certification techniques that has 
been approved by the Secretary. 
‘‘(5) FUNDING.—The Secretary shall provide for 
the transfer, from the Federal Hospital Insurance 
Trust Fund under section 1817 to the Centers for 
Medicare & Medicaid Services Program Management 
Account, of $10,000,000 for each fiscal year (begin-
ning with fiscal year 2022) for purposes of carrying 
out this subsection and subsection (b). Sums so trans-
ferred shall remain available until expended. Any 
transfer pursuant to this paragraph shall be in addi-
tion to any transfer pursuant to section 3(a)(2) of the 
Improving Medicare Post-Acute Care Transformation 
Act of 2014. 
‘‘(b) SPECIAL FOCUS PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall conduct 
a special focus program for enforcement of require-
ments for hospice programs that the Secretary has 
identified as having substantially failed to meet ap-
plicable requirements of this Act. 
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4638 
‘‘(2) PERIODIC
SURVEYS.—Under such special 
focus program, the Secretary shall conduct surveys of 
each hospice program in the special focus program 
not less than once every 6 months. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP-
ARDY.—If the Secretary determines on the basis of a 
standard survey or otherwise that a hospice program 
that is certified for participation under this title is 
no longer in compliance with the requirements speci-
fied in section 1861(dd) and determines that the defi-
ciencies involved immediately jeopardize the health 
and safety of the individuals to whom the program 
furnishes items and services, the Secretary shall take 
immediate action to ensure the removal of the jeop-
ardy and correction of the deficiencies or terminate 
the certification of the program, and may provide, in 
addition, for 1 or more of the other remedies described 
in paragraph (5)(B). 
‘‘(2) SITUATIONS
NOT
INVOLVING
IMMEDIATE 
JEOPARDY.—If the Secretary determines on the basis 
of a standard survey or otherwise that a hospice pro-
gram that is certified for participation under this 
title is no longer in compliance with the requirements 
specified in section 1861(dd) and determines that the 
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4639 
deficiencies involved do not immediately jeopardize 
the health and safety of the individuals to whom the 
program furnishes items and services, the Secretary 
may (for a period not to exceed 6 months) impose 
remedies developed pursuant to paragraph (5)(A), in 
lieu of terminating the certification of the program. 
If, after such a period of remedies, the program is 
still no longer in compliance with such requirements, 
the Secretary shall terminate the certification of the 
program. 
‘‘(3) 
PENALTY
FOR
PREVIOUS
NONCOMPLI-
ANCE.—If the Secretary determines that a hospice 
program that is certified for participation under this 
title is in compliance with the requirements specified 
in section 1861(dd) but, as of a previous period, did 
not meet such requirements, the Secretary may pro-
vide for a civil money penalty under paragraph 
(5)(B)(i) for the days in which the Secretary finds 
that the program was not in compliance with such re-
quirements. 
‘‘(4) OPTION TO CONTINUE PAYMENTS FOR NON-
COMPLIANT HOSPICE PROGRAMS.—The Secretary may 
continue payments under this title with respect to a 
hospice program not in compliance with the require-
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4640 
ments specified in section 1861(dd) over a period of 
not longer than 6 months, if— 
‘‘(A) the State or local survey agency finds 
that it is more appropriate to take alternative 
action to assure compliance of the program with 
such requirements than to terminate the certifi-
cation of the program; 
‘‘(B) the program has submitted a plan and 
timetable for corrective action to the Secretary 
for approval and the Secretary approves the 
plan of corrective action; and 
‘‘(C) the program agrees to repay to the 
Federal Government payments received under 
this title during such period if the corrective ac-
tion is not taken in accordance with the ap-
proved plan and timetable. 
The Secretary shall establish guidelines for approval 
of corrective actions requested by hospice programs 
under this paragraph. 
‘‘(5) REMEDIES.— 
‘‘(A) DEVELOPMENT.— 
‘‘(i) IN GENERAL.—Not later than Oc-
tober 1, 2022, the Secretary shall develop 
and implement— 
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4641 
‘‘(I) a range of remedies to apply 
to hospice programs under the condi-
tions described in paragraphs (1) 
through (4); and 
‘‘(II) appropriate procedures for 
appealing determinations relating to 
the imposition of such remedies. 
Remedies developed pursuant to the pre-
ceding sentence shall include the remedies 
specified in subparagraph (B). 
‘‘(ii) CONDITIONS
OF
IMPOSITION
OF 
REMEDIES.—Not later than October 1, 
2022, the Secretary shall develop and imple-
ment specific procedures with respect to the 
conditions under which each of the remedies 
developed under clause (i) is to be applied, 
including the amount of any fines and the 
severity of each of these remedies. Such pro-
cedures shall be designed so as to minimize 
the time between identification of defi-
ciencies and imposition of these remedies 
and shall provide for the imposition of in-
crementally more severe fines for repeated 
or uncorrected deficiencies. 
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4642 
‘‘(B) SPECIFIED REMEDIES.—The remedies 
specified in this subparagraph are the following: 
‘‘(i) Civil money penalties in an 
amount not to exceed $10,000 for each day 
of noncompliance by a hospice program 
with the requirements specified in section 
1861(dd). 
‘‘(ii) Suspension of all or part of the 
payments to which a hospice program 
would otherwise be entitled under this title 
with respect to items and services furnished 
by a hospice program on or after the date 
on which the Secretary determines that 
remedies should be imposed pursuant to 
paragraphs (1) and (2). 
‘‘(iii) The appointment of temporary 
management to oversee the operation of the 
hospice program and to protect and assure 
the health and safety of the individuals 
under the care of the program while im-
provements are made in order to bring the 
program into compliance with all such re-
quirements. 
‘‘(C) PROCEDURES.— 
‘‘(i) CIVIL MONEY PENALTIES.— 
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4643 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the provisions of section 
1128A (other than subsections (a) and 
(b)) shall apply to a civil money pen-
alty under this subsection in the same 
manner as such provisions apply to a 
penalty or proceeding under section 
1128A(a). 
‘‘(II) RETENTION
OF
AMOUNTS 
FOR
HOSPICE
PROGRAM
IMPROVE-
MENTS.—The Secretary may provide 
that any portion of civil money pen-
alties collected under this subsection 
may be used to support activities that 
benefit individuals receiving hospice 
care, including education and training 
programs to ensure hospice program 
compliance with the requirements of 
section 1861(dd). 
‘‘(ii) SUSPENSION
OF
PAYMENT.—A 
finding to suspend payment under subpara-
graph (B)(ii) shall terminate when the Sec-
retary finds that the program is in substan-
tial compliance with all requirements of sec-
tion 1861(dd). 
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4644 
‘‘(iii) TEMPORARY MANAGEMENT.—The 
temporary management under subpara-
graph (B)(iii) shall not be terminated until 
the Secretary has determined that the pro-
gram has the management capability to en-
sure continued compliance with all the re-
quirements referred to in such subpara-
graph. 
‘‘(D) 
RELATIONSHIP
TO
OTHER
REM-
EDIES.—The remedies developed under subpara-
graph (A) are in addition to sanctions otherwise 
available under State or Federal law and shall 
not be construed as limiting other remedies, in-
cluding any remedy available to an individual 
at common law.’’. 
(2) AVAILABILITY OF HOSPICE ACCREDITATION 
SURVEYS.—Section 1865(b) of the Social Security Act 
(42 U.S.C. 1395bb(b)) is amended by inserting ‘‘or, 
beginning on the date of the enactment of the Consoli-
dated Appropriations Act, 2021, a hospice program’’ 
after ‘‘home health agency’’. 
(3) STATE PROVISION OF HOSPICE PROGRAM IN-
FORMATION.— 
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(A) IN GENERAL.—Section 1864(a) of the 
Social Security Act (42 U.S.C. 1395aa(a)) is 
amended in the sixth sentence— 
(i) by inserting ‘‘and hospice pro-
grams’’ after ‘‘information on home health 
agencies’’; 
(ii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘the home health agency’’; 
(iii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘with respect to the agency’’; 
and 
(iv) by inserting ‘‘and hospice pro-
grams’’ after ‘‘with respect to home health 
agencies’’. 
(B) EFFECTIVE
DATE.—The amendments 
made by subparagraph (A) shall apply with re-
spect to agreements entered into on or after, or 
in effect as of, the date that is 1 year after the 
date of the enactment of this Act. 
(4) CONFORMING AMENDMENTS.— 
(A) DEFINITION OF A HOSPICE PROGRAM.— 
Section 1861(dd)(4) of the Social Security Act 
(42 U.S.C. 1395x(dd)(4)) is amended by striking 
subparagraph (C). 
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(B) CONTINUATION OF FUNDING.—Section 
3(a)(2) of the Improving Medicare Post-Acute 
Care Transformation Act of 2014 is amended by 
inserting ‘‘and section 1822(a)(1) of such Act,’’ 
after ‘‘as added by paragraph (1),’’. 
(b) INCREASING PAYMENT REDUCTIONS FOR FAILURE 
TO MEET QUALITY DATA REPORTING REQUIREMENTS.— 
Section 1814(i)(5)(A)(i) of the Social Security Act (42 
U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting ‘‘(or, for 
fiscal year 2024 and each subsequent fiscal year, 4 percent-
age points)’’ before the period. 
(c) REPORT.—Not later than 36 months after the date 
of the enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report containing 
an analysis of the effects of the amendments made by sub-
section (a), including the frequency of application of rem-
edies specified in section 1822(c)(5)(B) of the Social Secu-
rity Act (as added by such subsection), on access to, and 
quality of, care furnished by hospice programs under part 
A of title XVIII of the Social Security Act (42 U.S.C. 1395c 
et seq.). 
SEC. 408. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 1395iii(b)(1)) is amended by striking ‘‘ $0’’ and in-
serting ‘‘ $165,000,000’’. 
VerDate Sep 11 2014 
22:37 Dec 23, 2020
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