H. R. 7148—465 
TITLE VII—LOWERING PRESCRIPTION DRUG COSTS 
Sec. 6701. Oversight of pharmacy benefit management services. 
Sec. 6702. Full rebate pass through to plan; exception for innocent plan fiduciaries. 
Sec. 6703. Increasing transparency in generic drug applications. 
TITLE I—MEDICAID 
SEC. 6101. STREAMLINED ENROLLMENT PROCESS FOR ELIGIBLE OUT- 
OF-STATE PROVIDERS UNDER MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1902(kk) of the Social Security Act 
(42 U.S.C. 1396a(kk)) is amended by adding at the end the following 
new paragraph: 
‘‘(10) STREAMLINED
ENROLLMENT
PROCESS
FOR
ELIGIBLE 
OUT-OF-STATE PROVIDERS.— 
‘‘(A) IN GENERAL.—The State— 
‘‘(i) adopts and implements a process to allow an 
eligible out-of-State provider to enroll under the State 
plan (or a waiver of such plan) to furnish items and 
services to, or order, prescribe, refer, or certify eligi-
bility for items and services for, qualifying individuals 
without the imposition of screening or enrollment 
requirements by such State that exceed the minimum 
necessary for such State to provide payment to an 
eligible out-of-State provider under such State plan 
(or a waiver of such plan), such as the provider’s name 
and National Provider Identifier (and such other 
information specified by the Secretary); and 
‘‘(ii) provides that an eligible out-of-State provider 
that enrolls as a participating provider in the State 
plan (or a waiver of such plan) through such process 
shall be so enrolled for a 5-year period, unless the 
provider is terminated or excluded from participation 
during such period. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) ELIGIBLE OUT-OF-STATE PROVIDER.—The term 
‘eligible out-of-State provider’ means, with respect to 
a State, a provider— 
‘‘(I) that is located in any other State; 
‘‘(II) that— 
‘‘(aa) was determined by the Secretary to 
have a limited risk of fraud, waste, and abuse 
for purposes of determining the level of 
screening to be conducted under section 
1866(j)(2), has been so screened under such 
section 1866(j)(2), and is enrolled in the Medi-
care program under title XVIII; or 
‘‘(bb) was determined by the State agency 
administering or supervising the administra-
tion of the State plan (or a waiver of such 
plan) of such other State to have a limited 
risk of fraud, waste, and abuse for purposes 
of determining the level of screening to be 
conducted under paragraph (1) of this sub-
section, has been so screened under such para-
graph (1), and is enrolled under such State 
plan (or a waiver of such plan); and 
‘‘(III) that has not been—
H. R. 7148—466 
‘‘(aa) excluded from participation in any 
Federal health care program pursuant to sec-
tion 1128 or 1128A; 
‘‘(bb) excluded from participation in the 
State plan (or a waiver of such plan) pursuant 
to part 1002 of title 42, Code of Federal Regu-
lations (or any successor regulation), or State 
law; or 
‘‘(cc) terminated from participating in a 
Federal health care program or the State plan 
(or a waiver of such plan) for a reason 
described in paragraph (8)(A). 
‘‘(ii) QUALIFYING INDIVIDUAL.—The term ‘qualifying 
individual’ means an individual under 21 years of age 
who is enrolled under the State plan (or waiver of 
such plan). 
‘‘(iii) STATE.—The term ‘State’ means 1 of the 50 
States or the District of Columbia.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(77) of the Social Security Act (42 U.S.C. 
1396a(a)(77)) is amended by inserting ‘‘enrollment,’’ after 
‘‘screening,’’. 
(2) The subsection heading for section 1902(kk) of such 
Act (42 U.S.C. 1396a(kk)) is amended by inserting ‘‘enrollment,’’ 
after ‘‘screening,’’. 
(3) 
Section 
2107(e)(1)(G) 
of 
such 
Act 
(42 
U.S.C. 
1397gg(e)(1)(G)) is amended by inserting ‘‘enrollment,’’ after 
‘‘screening,’’. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall take effect on the date that is 3 years after the date of 
enactment of this Act. 
SEC. 6102. REMOVING CERTAIN AGE RESTRICTIONS ON MEDICAID 
ELIGIBILITY FOR WORKING ADULTS WITH DISABILITIES. 
(a) MODIFICATION OF OPTIONAL BUY-IN GROUPS.— 
(1) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the Social 
Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is amended— 
(A) in subclause (XV)— 
(i) by striking ‘‘, but less than 65,’’; and 
(ii) by inserting ‘‘, including at least the group 
described in section 1905(a)(xviii)’’ before the semicolon 
at the end; and 
(B) in subclause (XVI), by inserting ‘‘including at least 
the group described in section 1905(a)(xii),’’ after ‘‘the State 
may establish,’’. 
(2) INDIVIDUALS DESCRIBED.—Section 1905(a) of the Social 
Security Act (42 U.S.C. 1396d(a)) is amended— 
(A) in clause (xvi), by striking ‘‘or’’ at the end; 
(B) in clause (xvii), by adding ‘‘or’’ after the comma 
at the end; and 
(C) by adding after clause (xvii) the following new 
clause: 
‘‘(xviii) individuals who, but for earnings in excess 
of the limit established under subsection (q)(2)(B), 
would be considered to be receiving supplemental secu-
rity income, and who are at least 16 years of age,’’.
H. R. 7148—467 
(3) DEFINITION MODIFICATION.—Section 1905(v)(1)(A) of the 
Social Security Act (42 U.S.C. 1396d(v)(1)(A)) is amended by 
striking ‘‘, but less than 65,’’. 
(b) APPLICATION TO CERTAIN STATES.—A State that, as of the 
date of enactment of this Act, provides for making medical assist-
ance available to individuals described in subclause (XV) or (XVI) 
of section 1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) shall not be regarded as failing to comply with 
the requirements of the amendments made by subsection (a) before 
January 1, 2028. 
SEC. 6103. MEDICAID STATE PLAN REQUIREMENT FOR DETERMINING 
RESIDENCY AND COVERAGE FOR MILITARY FAMILIES. 
(a) IN GENERAL.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (88), by striking ‘‘and’’ at the end; 
(B) in paragraph (89), by striking the period at the 
end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (89), the following 
new paragraph: 
‘‘(90) beginning January 1, 2030, provide, with respect to 
an active duty relocated individual (as defined in subsection 
(yy)(1))— 
‘‘(A) that, for purposes of determining eligibility for 
medical assistance under the State plan (or waiver of such 
plan), such active duty relocated individual is treated as 
a resident of the State unless such individual voluntarily 
elects not to be so treated for such purposes; 
‘‘(B) that if, at the time of relocation (as described 
in subsection (yy)(1)), such active duty relocated individual 
is on a home and community-based services waiting list 
(as defined in subsection (yy)(2)), such individual remains 
on such list until— 
‘‘(i) the State completes an assessment and renders 
a decision with respect to the eligibility of such indi-
vidual to receive the relevant home and community- 
based services at the time a slot for such services 
becomes available and, in the case such decision is 
a denial of such eligibility, such individual has 
exhausted the individual’s opportunity for a fair 
hearing; or 
‘‘(ii) such individual elects to be removed from 
such list; and 
‘‘(C) payment for medical assistance furnished under 
the State plan (or a waiver of the plan) on behalf of such 
active duty relocated individual in the military service 
relocation State (as referred to in subsection (yy)(1)(B)(i)), 
to the extent that such assistance is available in such 
military service relocation State in accordance with such 
guidance as the Secretary may issue to ensure access to 
such assistance.’’; and 
(2) by adding at the end the following new subsection: 
‘‘(yy) ACTIVE DUTY RELOCATED INDIVIDUAL; HOME AND COMMU-
NITY-BASED SERVICES WAITING LIST.—For purposes of subsection 
(a)(90) and this subsection:
H. R. 7148—468 
‘‘(1) ACTIVE DUTY RELOCATED INDIVIDUAL.—The term ‘active 
duty relocated individual’ means an individual— 
‘‘(A) who— 
‘‘(i) is enrolled under the State plan (or waiver 
of such plan); or 
‘‘(ii) with respect to an individual described in 
subparagraph (C)(ii), would be so enrolled pursuant 
to subsection (a)(10)(A)(ii)(VI) if such individual began 
receiving home and community-based services; 
‘‘(B) who— 
‘‘(i) is a member of the Armed Forces engaged 
in active duty service and is relocated to another State 
(in this subsection referred to as the ‘military service 
relocation State’) by reason of such service; 
‘‘(ii) would be described in clause (i) except that 
the individual stopped being engaged in active duty 
service (including by reason of retirement from such 
service) and the last day on which the individual was 
engaged in active duty service occurred not more than 
12 months ago; or 
‘‘(iii) is a dependent (as defined by the Secretary) 
of a member described in clause (i) or (ii) who relocates 
to the military service relocation State with such 
member; and 
‘‘(C) who— 
‘‘(i) was receiving home and community-based serv-
ices (as defined in section 9817(a)(2)(B) of the American 
Rescue Plan Act of 2021) at the time of such relocation; 
or 
‘‘(ii) if the State maintains a home and community- 
based services waiting list, was on such home and 
community-based services waiting list at the time of 
such relocation. 
‘‘(2) HOME AND COMMUNITY-BASED SERVICES WAITING LIST.— 
The term ‘home and community-based services waiting list’ 
means, in the case of a State that has a limit on the number 
of individuals who may receive home and community-based 
services under section 1115(a) or section 1915(c), a list main-
tained by such State of individuals who are requesting to 
receive such services under 1 or more such sections but for 
whom the State has not yet completed an assessment and 
rendered a decision with respect to the eligibility of such 
individuals to receive the relevant home and community-based 
services at the time a slot for such services becomes available 
due to such limit.’’. 
(b) IMPLEMENTATION FUNDING.—There are appropriated, out 
of any funds in the Treasury not otherwise obligated, $1,000,000 
for each of fiscal years 2026 through 2030, to remain available 
until expended, to the Secretary of Health and Human Services 
for purposes of implementing the amendments made by subsection 
(a). 
SEC. 6104. STATE STUDIES AND HHS REPORT ON COSTS OF PROVIDING 
MATERNITY, LABOR, AND DELIVERY SERVICES. 
(a) STATE STUDY.— 
(1) IN GENERAL.—Not later than 30 months after the date 
of enactment of this Act, and every 5 years thereafter, each
H. R. 7148—469 
State (as such term is defined in section 1101(a)(1) of the 
Social Security Act (42 U.S.C. 1301(a)(1)) for purposes of titles 
XIX and XXI of such Act) shall conduct a study on the costs 
of providing maternity, labor, and delivery services in applicable 
hospitals (as defined in paragraph (3)) and submit the results 
of such study to the Secretary of Health and Human Services 
(referred to in this section as the ‘‘Secretary’’) in such form 
and manner as the Secretary requires. 
(2) CONTENT
OF
STUDY.—A State study required under 
paragraph (1) shall include the following information (to the 
extent practicable and as further defined by the Secretary) 
with respect to maternity, labor, and delivery services furnished 
by applicable hospitals located in the State: 
(A) An estimate of the cost of providing maternity, 
labor, and delivery services at applicable hospitals, based 
on the expenditures a representative sample of such hos-
pitals incurred for providing such services during the 2 
most recent years for which data is available. 
(B) An estimate of the cost of providing maternity, 
labor, and delivery services at hospitals that would be 
applicable hospitals (as defined in paragraph (3)) if not 
for ceasing to provide labor and delivery services within 
the past 5 years, based on the expenditures a representa-
tive sample of such hospitals incurred for providing such 
services during the 2 most recent years for which data 
is available. 
(C) To the extent data allow, an analysis of the extent 
to which geographic location, community demographics, 
and local economic factors (as defined by the Secretary) 
affect the cost of providing maternity, labor, and delivery 
services at applicable hospitals described in subparagraphs 
(A) and (B), including the cost of services that support 
the provision of maternity, labor, and delivery services. 
(D) The amounts applicable hospitals are paid for 
maternity, labor, and delivery services, by geographic loca-
tion and hospital size, under— 
(i) parts A and B of the Medicare program; 
(ii) the State Medicaid program, including payment 
amounts for such services under fee-for-service pay-
ment arrangements and under managed care (as 
applicable); 
(iii) the State CHIP plan, including payment 
amounts for such services under fee-for-service pay-
ment arrangements and under managed care (as 
applicable); and 
(iv) private health insurance. 
(E) A comparative payment rate analysis— 
(i) comparing payment rates for maternity, labor, 
and delivery services (inclusive of all payments 
received by applicable hospitals for furnishing mater-
nity, labor, and delivery services) under the State Med-
icaid fee-for-service program to such payment rates 
for such services under Medicare (including those 
described in paragraphs (2) and (3) of section 
447.203(b) of title 42, Code of Federal Regulations), 
and, to the extent data is available, such payment 
rates for such services under Medicaid managed care
H. R. 7148—470 
and private health insurers within geographic areas 
of the State; and 
(ii) analyzing different payment methods for such 
services, such as the use of bundled payments, quality 
incentives, and low-volume adjustments. 
(F) An evaluation, using such methodology and param-
eters established by the Secretary, of whether each hospital 
located in the State that furnishes maternity, labor, and 
delivery services is expected to experience in the next 3 
years significant changes in particular expenditures or 
types of reimbursement for maternity, labor, and delivery 
services. 
(3) APPLICABLE HOSPITAL DEFINED.—For purposes of this 
subsection, the term ‘‘applicable hospital’’ means any hospital 
located in a State that meets either of the following criteria: 
(A) The hospital provides labor and delivery services 
and more than 50 percent of the hospital’s births (in the 
most recent year for which such data is available) are 
financed by the Medicaid program or CHIP. 
(B) The hospital— 
(i) is located in a rural area (as defined by the 
Federal Office of Rural Health Policy for the purpose 
of rural health grant programs administered by such 
Office); 
(ii) based on the most recent 2 years of data avail-
able (as determined by the Secretary), furnished serv-
ices for less than an average of 300 births per year; 
and 
(iii) provides labor and delivery services. 
(4) ASSISTANCE TO SMALL HOSPITALS IN COMPILING COST 
INFORMATION.—There are appropriated to the Secretary for 
fiscal year 2026, $10,000,000 for the purpose of providing grants 
and technical assistance to a hospital described in paragraph 
(3)(B) to enable such hospital to compile detailed information 
for use in the State studies required under paragraph (1), 
to remain available until expended. 
(5) HHS REPORT
ON
STATE
STUDIES.—For each year in 
which a State is required to conduct a study under paragraph 
(1), the Secretary shall issue, not later than 18 months after 
the date on which the State submits to the Secretary the 
data described in such paragraph, a publicly available report 
that compiles and details the results of such study and includes 
the information described in paragraph (2). 
(b) HHS REPORT ON NATIONAL DATA COLLECTION FINDINGS.— 
Not later than 3 years and 6 months after the date of enactment 
of this Act, the Secretary shall submit to Congress, and make 
publicly available, a report analyzing the first studies conducted 
by States under subsection (a)(1), including recommendations for 
improving data collection on the cost of providing maternity, labor, 
and delivery services. 
(c) IMPLEMENTATION FUNDING.—In addition to the amount 
appropriated under subsection (a)(4), there are appropriated, out 
of any funds in the Treasury not otherwise obligated, $3,000,000 
for fiscal year 2026, to remain available until expended, to the 
Secretary of Health and Human Services for purposes of imple-
menting this section.
H. R. 7148—471 
SEC. 6105. MODIFYING CERTAIN DISPROPORTIONATE SHARE HOS-
PITAL ALLOTMENTS. 
(a) 
EXTENDING
TENNESSEE
DSH 
ALLOTMENTS.—Section 
1923(f)(6)(A)(vi) of the Social Security Act (42 U.S.C. 1396r– 
4(f)(6)(A)(vi)) is amended— 
(1) in the heading, by striking ‘‘2025 AND A PORTION OF 
FISCAL YEAR 2026’’ and inserting ‘‘2027’’; and 
(2) by inserting ‘‘, and the DSH allotment for Tennessee 
for the portion of fiscal year 2026 beginning on January 31, 
2026, and ending September 30, 2026, shall be $35,351,507, 
which may be claimed as fiscal year 2026 uncompensated care 
costs, and the DSH allotment for Tennessee for fiscal year 
2027, shall be $53,100,000’’ before the period. 
(b) ELIMINATING CERTAIN DSH ALLOTMENT REDUCTIONS.—Sec-
tion 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r– 
4(f)(7)(A)) is amended— 
(1) in clause (i)— 
(A) in the matter preceding subclause (I), by striking 
‘‘the period beginning January 31, 2026, and ending Sep-
tember 30, 2026, and for each of fiscal years 2027 and 
2028’’ and inserting ‘‘fiscal year 2028’’; 
(B) in subclause (I), by striking ‘‘or period’’; and 
(C) in subclause (II), by striking ‘‘or period’’ each place 
it appears; and 
(2) in clause (ii), by striking ‘‘the period beginning January 
31, 2026, and ending September 30, 2026, and for each of 
fiscal years 2027 and 2028’’ and inserting ‘‘fiscal year 2028’’. 
SEC. 6106. MODIFYING CERTAIN LIMITATIONS ON DISPROPORTIONATE 
SHARE HOSPITAL PAYMENT ADJUSTMENTS UNDER THE 
MEDICAID PROGRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Security Act 
(42 U.S.C. 1396r–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) in the matter preceding clause (i), by striking 
‘‘(other than a hospital described in paragraph (2)(B))’’; 
(ii) in clause (i), by inserting ‘‘with respect to such 
hospital and year’’ after ‘‘described in subparagraph 
(B)’’; and 
(iii) in clause (ii)— 
(I) in subclause (I), by striking ‘‘and’’ at the 
end; 
(II) in subclause (II), by striking the period 
and inserting ‘‘; and’’; and 
(III) by adding at the end the following new 
subclause: 
‘‘(III) payments made under title XVIII or by 
an 
applicable 
plan 
(as 
defined 
in 
section 
1862(b)(8)(F)) for such services.’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), by striking 
‘‘in this clause are’’ and inserting ‘‘in this subparagraph 
are, with respect to a hospital and a year,’’; and 
(ii) by adding at the end the following new clause: 
‘‘(iii) Individuals who are eligible for medical 
assistance under the State plan or under a waiver
H. R. 7148—472 
of such plan and for whom the State plan or waiver 
is a payor for such services after application of benefits 
under title XVIII or under an applicable plan (as 
defined in section 1862(b)(8)(F)), but only if the hospital 
has in the aggregate incurred costs exceeding payments 
under such State plan, waiver, title XVIII, or applicable 
plan for such services furnished to such individuals 
during such year.’’; 
(2) by striking paragraph (2); 
(3) by redesignating paragraph (3) as paragraph (2); and 
(4) in paragraph (2), as so redesignated, by striking ‘‘Not-
withstanding paragraph (2) of this subsection (as in effect on 
October 1, 2021), paragraph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in paragraph (2), the 
amendments made by this section shall apply to payment 
adjustments made under section 1923 of the Social Security 
Act (42 U.S.C. 1396r–4) for Medicaid State plan rate years 
beginning on or after the date of enactment of this Act. 
(2) STATE OPTION TO DISTRIBUTE UNSPENT DSH ALLOTMENTS 
FROM PRIOR YEARS UP TO MODIFIED CAP.— 
(A) IN GENERAL.—If, for any Medicaid State plan rate 
year that begins on or after October 1, 2022, and before 
the date of enactment of this Act, a State did not spend 
the full amount of its Federal fiscal year allotment under 
section 1923 of the Social Security Act (42 U.S.C. 1396r– 
4) applicable to that State plan rate year, the State may 
use the unspent portion of such allotment to increase the 
amount of any payment adjustment made to a hospital 
for such rate year, provided that— 
(i) such payment adjustment (as so increased) is 
consistent with subsection (g) of such section (as 
amended by this section); and 
(ii) the total amount of all payment adjustments 
for the State plan rate year (as so increased) does 
not exceed the disproportionate share hospital allot-
ment for the State and applicable Federal fiscal year 
under subsection (f) of such section. 
(B) NO RECOUPMENT OF PAYMENTS ALREADY MADE TO 
HOSPITALS.—A State shall not recoup any payment adjust-
ment made by the State to a hospital for a Medicaid State 
plan rate year described in subparagraph (A) if such pay-
ment adjustment is consistent with section 1923(g) of such 
Act (42 U.S.C. 1396r–4(g)) as in effect on October 1, 2021. 
(C) AUTHORITY TO PERMIT RETROACTIVE MODIFICATION 
OF STATE PLAN AMENDMENTS TO ALLOW FOR INCREASES.— 
(i) IN GENERAL.—Subject to clause (ii), solely for 
the purpose of allowing a State to increase the amount 
of a payment adjustment to a hospital for a Medicaid 
State plan rate year described in subparagraph (A) 
pursuant to this paragraph, a State may retroactively 
modify a provision of the Medicaid State plan, a waiver 
of such plan, or a State plan amendment that relates 
to such rate year and the Secretary may approve such 
modification. 
(ii) DEADLINE.—A State may not submit a request 
for approval of a retroactive modification to a provision
H. R. 7148—473 
of the Medicaid State plan, a waiver of such plan, 
or a State plan amendment for a Medicaid State plan 
rate year after the date by which the State is required 
to submit the independent certified audit for such State 
plan rate year as required under section 1923(j)(2) 
of the Social Security Act (42 U.S.C. 1396r–4(j)(2)). 
(D) REPORTING.—If a State increases a payment adjust-
ment made to a hospital for a Medicaid State plan rate 
year pursuant to this paragraph, the State shall include 
information in such form and manner as the Secretary 
shall specify on such increased payment adjustment as 
part of the annual report submitted by the State under 
section 1923(j)(1) of the Social Security Act (42 U.S.C. 
1396r–4(j)(1)) for such State plan rate year or, if necessary, 
as determined by the Secretary, in an amendment to such 
annual report. 
TITLE II—MEDICARE 
SEC. 6201. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT 
ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social Security 
Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), by striking ‘‘during the portion 
of fiscal year 2026 beginning on January 31, 2026, and ending 
on September 30, 2026, and in fiscal year 2027’’ and inserting 
‘‘during the portion of fiscal year 2027 beginning on January 
1, 2027, and ending on September 30, 2027, and in fiscal 
year 2028’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I), by striking 
‘‘through 2025 and the portion of fiscal year 2026 beginning 
on October 1, 2025, and ending on January 30, 2026’’ 
and inserting ‘‘through 2026 and the portion of fiscal year 
2027 beginning on October 1, 2026, and ending on 
December 31, 2026’’; 
(B) in subclause (III), by striking ‘‘through 2025 and 
the portion of fiscal year 2026 beginning on October 1, 
2025, and ending on January 30, 2026’’ and inserting 
‘‘through 2026 and the portion of fiscal year 2027 beginning 
on October 1, 2026, and ending on December 31, 2026’’; 
and 
(C) in subclause (IV), by striking ‘‘the portion of fiscal 
year 2026 beginning on January 31, 2026, and ending 
on September 30, 2026, and fiscal year 2027’’ and inserting 
‘‘the portion of fiscal year 2027 beginning on January 1, 
2027, and ending on September 30, 2027, and fiscal year 
2028’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by striking 
‘‘through 2025 or during the portion of fiscal year 2026 
beginning on October 1, 2025, and ending on January 30, 
2026’’ and inserting ‘‘through 2026 or during the portion 
of fiscal year 2027 beginning on October 1, 2026, and 
ending on December 31, 2026’’; and
H. R. 7148—474 
(B) in clause (ii), by striking ‘‘through 2025 and the 
portion of fiscal year 2026 beginning on October 1, 2025, 
and ending on January 30, 2026’’ and inserting ‘‘through 
2026 and the portion of fiscal year 2027 beginning on 
October 1, 2026, and ending on December 31, 2026’’. 
(b) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services may implement 
the amendments made by this section by program instruction or 
otherwise. 
SEC. 6202. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL 
(MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘January 31, 2026’’ and 
inserting ‘‘January 1, 2027’’; and 
(2) in clause (ii)(II), by striking ‘‘January 31, 2026’’ and 
inserting ‘‘January 1, 2027’’. 
(b) CONFORMING AMENDMENTS.— 
(1) IN GENERAL.—Section 1886(b)(3)(D) of the Social Secu-
rity Act (42 U.S.C. 1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by striking 
‘‘January 31, 2026’’ and inserting ‘‘January 1, 2027’’; and 
(B) in clause (iv), by striking ‘‘through fiscal year 2025 
and the portion of fiscal year 2026 beginning on October 
1, 2025, and ending on January 30, 2026’’ and inserting 
‘‘through fiscal year 2026 and the portion of fiscal year 
2027 beginning on October 1, 2026, and ending on 
December 31, 2026’’. 
(2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION.— 
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act 
of 1993 (42 U.S.C. 1395ww note) is amended by striking 
‘‘through fiscal year 2025, or the portion of fiscal year 2026 
beginning on October 1, 2025, and ending on January 30, 
2026’’ and inserting ‘‘through fiscal year 2026, or the portion 
of fiscal year 2027 beginning on October 1, 2026, and ending 
on December 31, 2026’’. 
SEC. 6203. EXTENSION OF ADD-ON PAYMENTS FOR AMBULANCE SERV-
ICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) 
is amended— 
(1) in paragraph (12)(A), by striking ‘‘January 31, 2026’’ 
and inserting ‘‘January 1, 2028’’; and 
(2) in paragraph (13), by striking ‘‘January 31, 2026’’ each 
place it appears and inserting ‘‘January 1, 2028’’ in each such 
place. 
SEC. 6204. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPATION IN 
ELIGIBLE ALTERNATIVE PAYMENT MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Security Act 
(42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A)— 
(A) by inserting ‘‘, and during 2028,’’ after ‘‘with 2026’’; 
and 
(B) by inserting ‘‘, or, with respect to 2028, 3.1 percent’’ 
after ‘‘1.88 percent’’; 
(2) in paragraph (2)—
H. R. 7148—477 
‘‘on or after January 31, 2026’’ and inserting ‘‘on or after 
January 1, 2028’’. 
(2) MENTAL HEALTH VISITS FURNISHED BY RURAL HEALTH 
CLINICS.—Section 1834(y)(2) of the Social Security Act (42 
U.S.C. 1395m(y)(2)) is amended by striking ‘‘January 31, 2026’’ 
and inserting ‘‘January 1, 2028’’. 
(3) MENTAL HEALTH VISITS FURNISHED BY FEDERALLY QUALI-
FIED
HEALTH
CENTERS.—Section 1834(o)(4)(B) of the Social 
Security Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking 
‘‘January 31, 2026’’ and inserting ‘‘January 1, 2028’’. 
(e) ALLOWING FOR THE FURNISHING OF AUDIO-ONLY TELEHEALTH 
SERVICES.—Section 1834(m)(9) of the Social Security Act (42 U.S.C. 
1395m(m)(9)) is amended by striking ‘‘ending on January 30, 2026’’ 
and inserting ‘‘ending on December 31, 2027’’. 
(f) EXTENDING USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE 
ENCOUNTER PRIOR TO RECERTIFICATION OF ELIGIBILITY FOR HOSPICE 
CARE.— 
(1) IN GENERAL.—Section 1814(a)(7)(D)(i)(II) of the Social 
Security Act (42 U.S.C. 1395f(a)(7)(D)(i)(II)) is amended— 
(A) by striking ‘‘ending on January 30, 2026’’ and 
inserting ‘‘ending on December 31, 2027’’; and 
(B) by inserting ‘‘, except that this subclause shall 
not apply in the case of such an encounter with an indi-
vidual occurring on or after January 31, 2026, if such 
individual is located in an area that is subject to a morato-
rium on the enrollment of hospice programs under this 
title pursuant to section 1866(j)(7), if such individual is 
receiving hospice care from a provider that is subject to 
enhanced oversight under this title pursuant to section 
1866(j)(3), or if such encounter is performed by a hospice 
physician or nurse practitioner who is not enrolled under 
section 1866(j) and is not an opt-out physician or practi-
tioner (as defined in section 1802(b)(6)(D))’’ before the semi-
colon. 
(2) 
REQUIRING
USE
OF
MODIFIER.—Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)), as amended by paragraph (1), is further 
amended by inserting ‘‘, but only if, in the case of such an 
encounter occurring on or after January 1, 2027, any hospice 
claim includes 1 or more modifiers or codes (as specified by 
the Secretary) to indicate that such encounter was conducted 
via telehealth’’ after ‘‘as determined appropriate by the Sec-
retary’’. 
(g) REQUIRING MODIFIERS FOR TELEHEALTH SERVICES IN CER-
TAIN INSTANCES.—Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended by adding at the end the following 
new paragraph: 
‘‘(10) REQUIRED USE OF MODIFIERS IN CERTAIN INSTANCES.— 
Not later than January 1, 2027, the Secretary shall establish 
requirements to include one or more codes or modifiers, as 
determined appropriate by the Secretary, in the case of— 
‘‘(A) claims for telehealth services under this subsection 
that are furnished through a telehealth virtual platform— 
‘‘(i) by a physician or practitioner that contracts 
with an entity that owns such virtual platform; or
H. R. 7148—478 
‘‘(ii) for which a physician or practitioner has a 
payment arrangement with an entity for use of such 
virtual platform; and 
‘‘(B) claims for telehealth services under this subsection 
that are furnished incident to a physician’s or practitioner’s 
professional service.’’. 
(h) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services may implement 
the amendments made by this section by program instruction or 
otherwise. 
SEC. 6210. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER 
FLEXIBILITIES. 
(a) IN GENERAL.—Section 1866G(a)(1) of the Social Security 
Act (42 U.S.C. 1395cc–7(a)(1)) is amended by striking ‘‘January 
30, 2026’’ and inserting ‘‘September 30, 2030’’. 
(b) REQUIRING ADDITIONAL STUDY AND REPORT.—Section 1866G 
of the Social Security Act (42 U.S.C. 1395cc–7) is amended— 
(1) in subsection (a)(3)(E)— 
(A) in clause (ii), by striking ‘‘the study described in 
subsection (b)’’ and inserting ‘‘the studies described in sub-
sections (b) and (c)’’; and 
(B) by adding at the end the following new flush sen-
tence: 
‘‘The Secretary may require that such data and information 
be submitted through a hospital’s cost report, through such 
survey instruments as the Secretary may develop, through 
medical record information, or through such other means 
as the Secretary determines appropriate.’’; 
(2) in subsection (b)— 
(A) in the subsection heading, by striking ‘‘STUDY’’ 
and inserting ‘‘INITIAL STUDY’’; and 
(B) in paragraph (3), by striking ‘‘subsection’’ and 
inserting ‘‘section’’; 
(3) by redesignating subsections (c) and (d) as subsections 
(d) and (e), respectively; 
(4) by inserting after subsection (b) the following new sub-
section: 
‘‘(c) SUBSEQUENT STUDY AND REPORT.— 
‘‘(1) IN GENERAL.—Not later than September 30, 2029, the 
Secretary shall conduct a study to— 
‘‘(A) analyze, to the extent practicable, the criteria 
established by hospitals under the Acute Hospital Care 
at Home initiative to determine which individuals may 
be furnished services under such initiative; and 
‘‘(B) analyze and compare (both within and between 
hospitals participating in the initiative, and relative to 
comparable hospitals that do not participate in the initia-
tive, for relevant parameters such as diagnosis-related 
groups)— 
‘‘(i) quality of care furnished to individuals with 
similar conditions and characteristics in the inpatient 
setting and through the Acute Hospital Care at Home 
initiative, including health outcomes, hospital readmis-
sion rates (including readmissions both within and 
beyond 30 days post-discharge), hospital mortality 
rates, length of stay, infection rates, composition of
H. R. 7148—479 
care team (including the types of labor used, such 
as contracted labor), the ratio of nursing staff, transfers 
from the hospital to the home, transfers from the home 
to the hospital (including the timing, frequency, and 
causes of such transfers), transfers and discharges to 
post-acute care settings (including the timing, fre-
quency, and causes of such transfers and discharges), 
and patient and caregiver experience of care; 
‘‘(ii) clinical conditions treated and diagnosis- 
related groups of discharges from inpatient settings 
relative to discharges from the Acute Hospital Care 
at Home initiative; 
‘‘(iii) costs incurred by the hospital for furnishing 
care in inpatient settings relative to costs incurred 
by the hospital for furnishing care through the Acute 
Hospital Care at Home initiative, including costs 
relating to staffing, equipment, food, prescriptions, and 
other services, as determined by the Secretary; 
‘‘(iv) the quantity, mix, and intensity of services 
(such as in-person visits and virtual contacts with 
patients and the intensity of such services) furnished 
in inpatient settings relative to the Acute Hospital 
Care at Home initiative, and, to the extent practicable, 
the nature and extent of family or caregiver involve-
ment; 
‘‘(v) socioeconomic information on individuals 
treated in comparable inpatient settings relative to 
the initiative, including racial and ethnic data, income, 
housing, geographic proximity to the brick-and-mortar 
facility and whether such individuals are dually eligible 
for benefits under this title and title XIX; and 
‘‘(vi) the quality of care, outcomes, costs, quantity 
and intensity of services, and other relevant metrics 
between individuals who entered into the Acute Hos-
pital Care at Home initiative directly from an emer-
gency department compared with individuals who 
entered into the Acute Hospital Care at Home initiative 
directly from an existing inpatient stay in a hospital. 
‘‘(2) SELECTION BIAS.—In conducting the study under para-
graph (1), the Secretary shall, to the extent practicable, analyze 
and compare individuals who participate and do not participate 
in the initiative controlling for selection bias or other factors 
that may impact the reliability of data. 
‘‘(3) REPORT.—Not later than September 30, 2029, the Sec-
retary of Health and Human Services shall— 
‘‘(A) submit to the Committee on Ways and Means 
of the House of Representatives and the Committee on 
Finance of the Senate a report on the study conducted 
under paragraph (1); and 
‘‘(B) make such report publicly available on a website 
of the Centers for Medicare & Medicaid Services. 
‘‘(4) FUNDING.—In addition to amounts otherwise available, 
there is appropriated to the Centers for Medicare & Medicaid 
Services Program Management Account for fiscal year 2026, 
out of any amounts in the Treasury not otherwise appropriated, 
$2,500,000, to remain available until expended, for purposes 
of carrying out this section.’’; and
H. R. 7148—480 
(5) in subsection (e), as redesignated by paragraph (3), 
by striking ‘‘and (b)(1)’’ and inserting ‘‘, (b)(1), and (c)(1)’’. 
SEC. 6211. IN-HOME CARDIOPULMONARY REHABILITATION FLEXI-
BILITY. 
(a) IN GENERAL.—Section 1861(eee)(2)(A)(ii) of the Social Secu-
rity Act (42 U.S.C. 1395x(eee)(2)(A)(ii)) is amended by inserting 
‘‘(including, with respect to items and services furnished through 
audio and video real-time communications technology (excluding 
audio-only) on or after January 31, 2026, and before January 1, 
2028, in the home of an individual who is an outpatient of the 
hospital)’’ after ‘‘outpatient basis’’. 
(b) IMPLEMENTATION.—Notwithstanding any other provision of 
law, the Secretary of Health and Human Services may implement 
the amendment made by subsection (a) by program instruction 
or otherwise. 
SEC. 6212. ENHANCING CERTAIN PROGRAM INTEGRITY REQUIRE-
MENTS FOR DME UNDER MEDICARE. 
(a) DURABLE MEDICAL EQUIPMENT.— 
(1) IN GENERAL.—Section 1834(a) of the Social Security 
Act (42 U.S.C. 1395m(a)) is amended by adding at the end 
the following new paragraph: 
‘‘(23) MASTER LIST INCLUSION AND CLAIM REVIEW FOR CER-
TAIN ITEMS.— 
‘‘(A) MASTER LIST INCLUSION.—Beginning January 1, 
2029, for purposes of the Master List described in section 
414.234(b) of title 42, Code of Federal Regulations (or any 
successor regulation), in determining which items have 
aberrant billing patterns (as such term is used for purposes 
of such section), the Secretary shall also treat an item 
for which payment may be made under this subsection 
as having such an aberrant billing pattern if the Secretary 
determines that, without explanatory contributing factors 
(such as furnishing emergent care services), a substantial 
number of claims for such items under this subsection 
are for such items ordered by a physician or practitioner 
who has not previously (during a period of not less than 
24 months, as established by the Secretary) furnished to 
the individual involved any item or service for which pay-
ment may be made under this title. 
‘‘(B) CLAIM REVIEW.—With respect to items furnished 
on or after January 1, 2029, that are included on the 
Master List pursuant to subparagraph (A), if such an item 
is not subject to a determination of coverage in advance 
pursuant to paragraph (15)(C), the Secretary may conduct 
prepayment review of claims for payment for such item.’’. 
(2) CONFORMING
AMENDMENT
FOR
PROSTHETIC
DEVICES, 
ORTHOTICS, AND PROSTHETICS.—Section 1834(h)(3) of the Social 
Security Act (42 U.S.C. 1395m(h)(3)) is amended by inserting 
‘‘, and paragraph (23) of subsection (a) shall apply to prosthetic 
devices, orthotics, and prosthetics in the same manner as such 
provision applies to items for which payment may be made 
under such subsection’’ before the period at the end. 
(b) REPORT ON IDENTIFYING CLINICAL DIAGNOSTIC LABORATORY 
TESTS AT HIGH RISK FOR FRAUD AND EFFECTIVE MITIGATION MEAS-
URES.—Not later than January 1, 2028, the Inspector General of 
the Department of Health and Human Services shall submit to