H. R. 2471—752 
‘‘SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEM-
ONSTRATION. 
‘‘(a) IN GENERAL.—The Secretary shall award grants to accred-
ited schools of allopathic medicine, osteopathic medicine, and 
nursing, and other appropriate health professional training pro-
grams, to establish a training demonstration program to support— 
‘‘(1) training for physicians, medical residents, fellows, 
nurse practitioners, physician assistants, nurses, certified nurse 
midwives, relevant home visiting workforce professionals and 
paraprofessionals, or other professionals who meet relevant 
State training and licensing requirements, as applicable, to 
reduce preventable maternal mortality and severe maternal 
morbidity by improving prenatal care, labor care, birthing, and 
postpartum care in rural community-based settings; and 
‘‘(2) developing recommendations for such training pro-
grams. 
‘‘(b) APPLICATION.—To be eligible to receive a grant under sub-
section (a), an entity shall submit to the Secretary an application 
at such time, in such manner, and containing such information 
as the Secretary may require. 
‘‘(c) ACTIVITIES.— 
‘‘(1) TRAINING
FOR
HEALTH
CARE
PROFESSIONALS.— A 
recipient of a grant under subsection (a)— 
‘‘(A) shall use the grant funds to plan, develop, and 
operate a training program to provide prenatal care, labor 
care, birthing, and postpartum care in rural areas; and 
‘‘(B) may use the grant funds to provide additional 
support for the administration of the program or to meet 
the costs of projects to establish, maintain, or improve 
faculty development, or departments, divisions, or other 
units necessary to implement such training. 
‘‘(2) TRAINING PROGRAM REQUIREMENTS.—The recipient of 
a grant under subsection (a) shall ensure that training pro-
grams carried out under the grant are evidence-based and 
address improving prenatal care, labor care, birthing, and 
postpartum care in rural areas, and such programs may include 
training on topics such as— 
‘‘(A) maternal mental health, including perinatal 
depression and anxiety; 
‘‘(B) substance use disorders; 
‘‘(C) social determinants of health that affect individ-
uals living in rural areas; and 
‘‘(D) improving the provision of prenatal care, labor 
care, birthing, and postpartum care for racial and ethnic 
minority populations, including with respect to perceptions 
and biases that may affect the approach to, and provision 
of, care. 
‘‘(d) EVALUATION AND REPORT.— 
‘‘(1) EVALUATION.— 
‘‘(A) IN GENERAL.—The Secretary shall evaluate the 
outcomes of the demonstration program under this section. 
‘‘(B) DATA SUBMISSION.—Recipients of a grant under 
subsection (a) shall submit to the Secretary performance 
metrics and other related data in order to evaluate the 
program for the report described in paragraph (2). 
‘‘(2) REPORT TO CONGRESS.—Not later than January 1, 2026, 
the Secretary shall submit to Congress a report that includes—
H. R. 2471—753 
‘‘(A) an analysis of the effects of the demonstration 
program under this section on the quality, quantity, and 
distribution of maternal health care services, including pre-
natal care, labor care, birthing, and postpartum care serv-
ices, and the demographics of the recipients of those serv-
ices; 
‘‘(B) an analysis of maternal and infant health out-
comes (including quality of care, morbidity, and mortality) 
before and after implementation of the program in the 
communities served by entities participating in the dem-
onstration; and 
‘‘(C) recommendations on whether the demonstration 
program should be continued. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section $5,000,000 for each 
of fiscal years 2023 through 2027.’’. 
Subtitle E—Fentanyl Scheduling Extension 
SEC. 151. EXTENSION OF TEMPORARY ORDER FOR FENTANYL- 
RELATED SUBSTANCES. 
Effective as if included in the enactment of the Temporary 
Reauthorization and Study of the Emergency Scheduling of 
Fentanyl Analogues Act (Public Law 116–114), section 2 of such 
Act is amended by striking ‘‘March 15, 2022’’ and inserting 
‘‘December 31, 2022’’. 
Subtitle F—Drug-Free Communities 
SEC. 161. WAIVER OF FEDERAL FUND LIMITATION FOR THE DRUG- 
FREE COMMUNITIES SUPPORT PROGRAM. 
(a) IN GENERAL.—Subject to subsection (b), if the Administrator 
of the Drug-Free Communities Support Program determines that, 
as a result of the public health emergency declared pursuant to 
section 319 of the Public Health Service Act (42 U.S.C. 247d) 
with respect to COVID–19, an eligible coalition is unable to raise 
the amount of non-Federal funds, including in-kind contributions, 
agreed to be raised by the coalition for fiscal year 2020, 2021, 
or 2022 under an agreement entered into with the Administrator 
pursuant to paragraph (1)(A) or (3) of section 1032(b) of the Anti- 
Drug Abuse Act of 1988 (21 U.S.C. 1532(b)), the Administrator 
may, notwithstanding such paragraphs, provide to the eligible coali-
tion the grant or renewal grant, as applicable, for that fiscal year 
only in an amount— 
(1) with respect to an initial grant or renewal grant 
described under paragraph (1)(A) or (3)(A) of such section, 
that exceeds the amount of non-Federal funds raised by the 
eligible coalition, including in-kind contributions, for that fiscal 
year; 
(2) with respect to a renewal grant described under para-
graph (3)(D)(i) of such section, that exceeds 125 percent of 
the amount of non-Federal funds raised by the eligible coalition, 
including in-kind contributions, for that fiscal year; and 
(3) with respect to a renewal grant described under para-
graph (3)(D)(ii) of such section, that exceeds 150 percent of
H. R. 2471—754 
the amount of non-Federal funds raised by the eligible coalition, 
including in-kind contributions, for that fiscal year. 
(b) LIMITATION.—The Administrator may not provide a grant 
or renewal grant to an eligible coalition in an amount exceeding 
the amount of funds initially agreed to be provided by the Adminis-
trator under the applicable agreement. 
TITLE II—MEDICAID 
SEC. 201. CERTAIN MEDICAID EXTENSIONS FOR TERRITORIES. 
(a) EXTENDING INCREASED FMAP.—Section 1905(ff) of the Social 
Security Act (42 U.S.C. 1396d(ff)) is amended— 
(1) in paragraph (2), by inserting ‘‘and for the period begin-
ning January 1, 2022, and ending December 13, 2022’’ after 
‘‘and ending December 3, 2021,’’ and 
(2) in paragraph (3), by striking ‘‘March 11, 2022’’ and 
inserting ‘‘December 13, 2022’’. 
(b) EXTENDING ADDITIONAL INCREASE FOR PUERTO RICO.—Sec-
tion 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) is 
amended by adding at the end the following new paragraph: 
‘‘(10) ADDITIONAL INCREASE FOR PUERTO RICO FOR FISCAL 
YEAR 2022.— 
‘‘(A) IN
GENERAL.—Notwithstanding the preceding 
provisions of this subsection, the total amount certified 
for Puerto Rico for fiscal year 2022 under this subsection 
shall be increased by $200,000,000 if the Secretary certifies 
that, with respect to such fiscal year, Puerto Rico’s State 
plan under title XIX (or a waiver of such plan) establishes 
a reimbursement floor, implemented through a directed 
payment arrangement plan, for physician services that are 
covered under the Medicare part B fee schedule in the 
Puerto Rico locality established under section 1848(b) that 
is not less than 70 percent of the payment that would 
apply to such services if they were furnished under part 
B of title XVIII during such fiscal year. 
‘‘(B) APPLICATION
TO
MANAGED
CARE.—In certifying 
whether Puerto Rico has established a reimbursement floor 
under a directed payment arrangement plan that satisfies 
the requirements of subparagraph (A) for fiscal year 2022, 
the Secretary shall— 
‘‘(i) disregard payments made under sub-capitated 
arrangements for services such as primary care case 
management; and 
‘‘(ii) if the reimbursement floor for physician serv-
ices applicable under a managed care contract satisfies 
the requirements of subparagraph (A) for the fiscal 
year in which the contract is entered into or renewed, 
such reimbursement floor shall be deemed to satisfy 
such requirements for the subsequent fiscal year.’’. 
(c) PUERTO RICO REPORT ON PROCUREMENT PROCESSES AND 
STANDARDS USED FOR CONTRACTING UNDER THE MEDICAID PRO-
GRAM.— 
(1) REPORT REQUIRED.—Not later than December 1, 2022, 
the agency responsible for administering Puerto Rico’s Medicaid 
program under title XIX of the Social Security Act (42 U.S.C.
H. R. 2471—755 
1396 et seq.) shall submit to Congress a report on the procure-
ment processes and standards used for selecting contracts under 
Puerto Rico’s Medicaid program. 
(2) INFORMATION IN REPORT.—The report required under 
paragraph (1) shall include the following: 
(A) A detailed description of the procurement processes 
and standards used for selecting contracts under Puerto 
Rico’s Medicaid program under title XIX of the Social Secu-
rity Act (42 U.S.C. 1396 et seq.), for contracts in effect 
as of the date of the enactment of this subsection. 
(B) The number of contracts, and a description of such 
contracts, for an amount greater than $150,000 as of the 
date of the enactment of this subsection. 
(C) Differences between the procurement processes and 
standards for selecting contracts in place as of the date 
of the enactment of this subsection, and the Federal 
procurement standards (as described in sections 75.327, 
75.328, and 75.329 of title 45, Code of Federal Regulations) 
as of such date. 
SEC. 202. INCREASING STATE FLEXIBILITY WITH RESPECT TO THIRD 
PARTY LIABILITY. 
(a) IN GENERAL.—Section 1902(a)(25)(I) of the Social Security 
Act (42 U.S.C. 1396a(a)(25)(I)) is amended— 
(1) by amending clause (ii) to read as follows: 
‘‘(ii)(I) accept the State’s right of recovery and the 
assignment to the State of any right of an individual 
or other entity to payment from the party for an item 
or service for which payment has been made under 
the State plan (or under a waiver of such plan); and 
‘‘(II) in the case of a responsible third party (other 
than the original medicare fee-for-service program 
under parts A and B of title XVIII, a Medicare Advan-
tage plan offered by a Medicare Advantage organiza-
tion under part C of such title, a reasonable cost 
reimbursement plan under section 1876, a health care 
prepayment plan under section 1833, or a prescription 
drug plan offered by a PDP sponsor under part D 
of such title) that requires prior authorization for an 
item or service furnished to an individual eligible to 
receive medical assistance under this title, accept 
authorization provided by the State that the item or 
service is covered under the State plan (or waiver 
of such plan) for such individual, as if such authoriza-
tion were the prior authorization made by the third 
party for such item or service;’’; 
(2) in clause (iii)— 
(A) by striking ‘‘respond to any inquiry’’ and inserting 
‘‘not later than 60 days after receiving any inquiry’’; and 
(B) by striking ‘‘; and’’ at the end and inserting ‘‘, 
respond to such inquiry; and’’; and 
(3) in clause (iv)— 
(A) by striking ‘‘or a failure’’ and inserting ‘‘a failure’’; 
and 
(B) by inserting after ‘‘the basis of the claim’’ the 
following: ‘‘, or in the case of a responsible third party 
(other than the original medicare fee-for-service program