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SEC. 1403. EXTENSION OF TERMINATION DATE OF PATIENT-CENTERED 
OUTCOMES RESEARCH TRUST FUND. 
Section 9511(f) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘September 30’’ and inserting ‘‘November 21’’. 
TITLE V—HUMAN SERVICES 
EXTENDERS 
SEC. 1501. EXTENSION OF DEMONSTRATION PROJECTS TO ADDRESS 
HEALTH PROFESSIONS WORKFORCE NEEDS. 
Activities authorized by section 2008 of the Social Security 
Act shall continue through November 21, 2019, in the manner 
authorized for fiscal year 2019, and out of any money in the 
Treasury of the United States not otherwise appropriated, there 
are hereby appropriated such sums as may be necessary for such 
purpose. Grants and payments may be made pursuant to this 
authority through the date so specified at the pro rata portion 
of the total amount authorized for such activities in fiscal year 
2019. 
SEC. 1502. EXTENSION OF THE TEMPORARY ASSISTANCE FOR NEEDY 
FAMILIES PROGRAM AND RELATED PROGRAMS. 
Activities authorized by part A of title IV and section 1108(b) 
of the Social Security Act shall continue through November 21, 
2019, in the manner authorized for fiscal year 2019, and out of 
any money in the Treasury of the United States not otherwise 
appropriated, there are hereby appropriated such sums as may 
be necessary for such purpose. 
TITLE VI—MISCELLANEOUS POLICIES 
SEC. 1601. ALASKA NATIVE REGIONAL HEALTH ENTITIES. 
Section 424(a) of the Consolidated Appropriations Act, 2014 
(Public Law 113–76), as amended by section 428 of the Consolidated 
Appropriations Act, 2018 (Public Law 115–141), shall be applied 
by substituting ‘‘November 21, 2019’’ for ‘‘October 1, 2019’’. 
SEC. 1602. INCREASING NUMERICAL LIMITATIONS OF THE WORLD 
TRADE CENTER HEALTH PROGRAM. 
(a) WORLD TRADE CENTER RESPONDERS.—Section 3311(a)(4)(A) 
of the Public Health Service Act (42 U.S.C. 300mm–21(a)(4)(A)) 
is amended by striking ‘‘25,000’’ and inserting ‘‘75,000’’. 
(b) WORLD TRADE CENTER SURVIVORS.—Section 3321(a)(3)(A) 
of the Public Health Service Act (42 U.S.C. 300mm–31(a)(3)(A)) 
is amended by striking ‘‘25,000’’ and inserting ‘‘75,000’’. 
(c) RULE
OF CONSTRUCTION REGARDING ANNUAL FUNDING 
LIMITATIONS.—Nothing in this section, or the amendments made 
by this section, shall alter the annual limitations on amounts appro-
priated to the World Trade Center Health Program Fund under 
section 3351(a)(2) of the Public Health Service Act (42 U.S.C. 
300mm–61(a)(2)).
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SEC. 1603. EXCLUDING AUTHORIZED GENERIC DRUGS FROM CALCULA-
TION OF AVERAGE MANUFACTURER PRICE FOR PUR-
POSES OF THE MEDICAID DRUG REBATE PROGRAM; 
EXCLUDING MANUFACTURERS FROM DEFINITION OF 
WHOLESALER. 
(a) IN GENERAL.—Subparagraph (C) of section 1927(k)(1) of 
the Social Security Act (42 U.S.C. 1396r–8(k)(1)) is amended— 
(1) in the subparagraph heading, by striking ‘‘INCLUSION’’ 
and inserting ‘‘EXCLUSION’’; 
(2) by striking ‘‘a new drug application’’ and inserting ‘‘the 
manufacturer’s new drug application’’; and 
(3) by striking ‘‘inclusive’’ and inserting ‘‘exclusive’’. 
(b) EXCLUDING MANUFACTURERS FROM DEFINITION OF WHOLE-
SALER.—Section 1927(k)(11) of the Social Security Act (42 U.S.C. 
1396r–8(k)(11)) is amended— 
(1) by striking ‘‘manufacturers,’’; and 
(2) by striking ‘‘manufacturer’s and’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on the first day of the first fiscal quarter that 
begins after the date of enactment of this Act. 
SEC. 1604. MEDICAID IMPROVEMENT FUND. 
Section 1941(b) of the Social Security Act (42 U.S.C. 1396w– 
1(b)), as amended by section 2 of Public Law 116–29, is amended— 
(1) in paragraph (1), by striking ‘‘$1,000,000’’ and inserting 
‘‘$0’’; and 
(2) in paragraph (3)— 
(A) by striking ‘‘2023’’ each place it appears and 
inserting ‘‘2025’’; and 
(B) in subparagraph (A), by striking ‘‘$0’’ and inserting 
‘‘$2,387,000,000’’. 
TITLE VII—BUDGETARY EFFECTS 
SEC. 1701. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budgetary effects 
of this division shall not be entered on either PAYGO scorecard 
maintained pursuant to section 4(d) of the Statutory Pay-As-You- 
Go Act of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary effects of this 
division shall not be entered on any PAYGO scorecard maintained 
for purposes of section 4106 of H. Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION OF BUDGETARY EFFECTS.—Notwithstanding 
Rule 3 of the Budget Scorekeeping Guidelines set forth in the 
joint explanatory statement of the committee of conference accom-
panying Conference Report 105–217 and section 250(c)(8) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this division shall not be estimated— 
(1) for purposes of section 251 of such Act; and
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(2) for purposes of paragraph (4)(C) of section 3 of the 
Statutory Pay-As-You-Go Act of 2010 as being included in an 
appropriation Act. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.