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threat assessment, scope of the protection, and the antici-
pated cost and duration of such protection. 
(c) Not later than 15 days before extending, or 30 
days before terminating, protection for a covered indi-
vidual, the Secretary of Homeland Security shall submit 
a notification regarding the extension or termination and 
any change to the threat assessment to the congressional 
leadership and the appropriate congressional committees. 
(d) Not later than 45 days after the date of enact-
ment of this Act, and quarterly thereafter, the Secretary 
shall submit a report to the congressional leadership and 
the appropriate congressional committees, which may be 
submitted in classified form, if necessary, detailing each 
covered individual, and the scope and associated cost of 
protection. 
SEC. 532. (a) None of the funds provided to the De-
partment of Homeland Security in this or any prior Act 
may be used by an agency to submit an initial project pro-
posal to the Technology Modernization Fund (as author-
ized by section 1078 of subtitle G of title X of the National 
Defense Authorization Act for Fiscal Year 2018 (Public 
Law 115–91)) unless, concurrent with the submission of 
an initial project proposal to the Technology Moderniza-
tion Board, the head of the agency— 
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(1) notifies the Committees on Appropriations 
of the House of Representatives and the Senate of 
the proposed submission of the project proposal; 
(2) submits to the Committees on Appropria-
tions a copy of the project proposal; and 
(3) provides a detailed analysis of how the pro-
posed project funding would supplement or supplant 
funding requested as part of the Department’s most 
recent budget submission. 
(b) None of the funds provided to the Department 
of Homeland Security by the Technology Modernization 
Fund shall be available for obligation until 15 days after 
a report on such funds has been transmitted to the Com-
mittees on Appropriations of the House of Representatives 
and the Senate. 
(c) The report described in subsection (b) shall in-
clude— 
(1) the full project proposal submitted to and 
approved by the Fund’s Technology Modernization 
Board; 
(2) the finalized interagency agreement between 
the Department and the Fund including the 
project’s deliverables and repayment terms, as appli-
cable; 
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(3) a detailed analysis of how the project will 
supplement or supplant existing funding available to 
the Department for similar activities; 
(4) a plan for how the Department will repay 
the Fund, including specific planned funding 
sources, as applicable; and 
(5) other information as determined by the Sec-
retary. 
SEC. 533. Within 60 days of any budget submission 
for the Department of Homeland Security for fiscal year 
2027 that assumes revenues or proposes a reduction from 
the previous year based on user fees proposals that have 
not been enacted into law prior to the submission of the 
budget, the Secretary of Homeland Security shall provide 
the Committees on Appropriations of the House of Rep-
resentatives and the Senate specific reductions in proposed 
discretionary budget authority commensurate with the 
revenues assumed in such proposals in the event that they 
are not enacted prior to October 1, 2026. 
SEC. 534. None of the funds made available by this 
Act may be obligated or expended to implement the Arms 
Trade Treaty until the Senate approves a resolution of 
ratification for the Treaty. 
SEC. 535. No Federal funds made available to the 
Department of Homeland Security may be used to enter 
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into a procurement contract, memorandum of under-
standing, or cooperative agreement with, or make a grant 
to, or provide a loan or guarantee to, any entity identified 
under section 1260H of the William M. (Mac) Thornberry 
National Defense Authorization Act for Fiscal Year 2021 
(Public Law 116–283) or any subsidiary of such entity. 
SEC. 536. None of the funds appropriated or other-
wise made available in this or any other Act may be used 
to transfer, release, or assist in the transfer or release to 
or within the United States, its territories, or possessions 
Khalid Sheikh Mohammed or any other detainee who— 
(1) is not a United States citizen or a member 
of the Armed Forces of the United States; and 
(2) is or was held on or after June 24, 2009, 
at the United States Naval Station, Guantanamo 
Bay, Cuba, by the Department of Defense. 
SEC. 537. (a) The Secretary of Homeland Security 
shall, on a monthly basis beginning immediately after the 
date of enactment of this Act, develop estimates of the 
number of migrants anticipated to arrive at the southwest 
border of the United States. 
(b) The Secretary shall ensure that, at a minimum, 
the estimates developed pursuant to subsection (a)— 
(1) cover the current fiscal year and the fol-
lowing fiscal year; 
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(2) include a breakout by demographic, to in-
clude single adults, family units, and unaccompanied 
children; 
(3) undergo an independent validation and 
verification review; 
(4) are used to inform policy planning and 
budgeting processes within the Department of 
Homeland Security; and 
(5) are included in the budget materials sub-
mitted to Congress for each fiscal year beginning 
after the date of enactment of this Act and in sup-
port of— 
(A) the President’s annual budget request 
pursuant to section 1105 of title 31, United 
States Code; 
(B) any supplemental funding request sub-
mitted to Congress; 
(C) any reprogramming and transfer noti-
fication pursuant to section 503 of this Act; 
and 
(D) such budget materials shall include— 
(i) the most recent monthly estimates 
developed pursuant to subsection (a); 
(ii) a description and quantification of 
the estimates used to justify funding re-
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quests for Department programs related to 
border security, immigration enforcement, 
and immigration services; 
(iii) a description and quantification 
of the anticipated workload and require-
ments resulting from such estimates; and 
(iv) a confirmation as to whether the 
budget requests for impacted agencies were 
developed using the same estimates. 
(c) The Secretary shall share the monthly estimates 
developed pursuant to subsection (a) with the Secretary 
of Health and Human Services, the Attorney General, the 
Secretary of State, and the Committees on Appropriations 
of the House of Representatives and the Senate. 
(d) If the monthly estimates described in subsection 
(b) are not provided for the purposes described, the re-
programming and transfer authority provided in section 
503 of this Act shall be suspended until such time as the 
required estimates are provided to the Committees on Ap-
propriations of the House of Representatives and the Sen-
ate. 
SEC. 538. (a) The Secretary of Homeland Security 
shall, on a monthly basis beginning immediately after the 
date of enactment of this Act, develop estimates of the 
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number of individuals anticipated to be detained in and 
removed from the United States. 
(b) The Secretary shall ensure that, at a minimum, 
the estimates developed pursuant to subsection (a)— 
(1) cover the current fiscal year and the fol-
lowing fiscal year; 
(2) include a breakout by demographics, to in-
clude single adults and family units; 
(3) undergo an independent validation and 
verification review; 
(4) are used to inform policy planning and 
budgeting processes within the Department of 
Homeland Security; and 
(5) are included in the budget materials sub-
mitted to Congress for each fiscal year beginning 
after the date of enactment of this Act and in sup-
port of— 
(A) the President’s annual budget request 
pursuant to section 1105 of title 31, United 
States Code; 
(B) any supplemental funding request sub-
mitted to Congress; 
(C) any reprogramming and transfer noti-
fication pursuant to section 503 of this Act; 
and 
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(D) such budget materials shall include— 
(i) the most recent monthly estimates 
developed pursuant to subsection (a); 
(ii) a description and quantification of 
the estimates used to justify funding re-
quests for Department programs related to 
border security, immigration enforcement, 
and immigration services; 
(iii) a description and quantification 
of the anticipated workload and require-
ments resulting from such estimates; and 
(iv) a confirmation as to whether the 
budget requests for impacted agencies were 
developed using the same estimates. 
(c) The Secretary shall share the monthly estimates 
developed pursuant to subsection (a) with the Attorney 
General, the Secretary of State, and the Committees on 
Appropriations of the House of Representatives and the 
Senate. 
(d) If the monthly estimates described in subsection 
(b) are not provided for the purposes described, the re-
programming and transfer authority provided in section 
503 of this Act shall be suspended until such time as the 
required estimates are provided to the Committees on Ap-
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propriations of the House of Representatives and the Sen-
ate. 
SEC. 539. (a) Prior to the Secretary of Homeland Se-
curity requesting assistance from the Department of De-
fense for border security operations, the Secretary shall 
ensure that an alternatives analysis and cost-benefit anal-
ysis is conducted before such request is made, which shall 
include an examination of obtaining such support through 
other means. 
(b) Not later than 30 days after the date on which 
a request for assistance is made, the Secretary of Home-
land Security shall submit to the Committees on Appro-
priations of the House of Representatives and the Senate 
a report detailing the types of support requested, the alter-
natives analysis and cost-benefit analysis described in sub-
section (a), and the operational impact to Department of 
Homeland Security operations of any Department of De-
fense border security support requested by the Secretary. 
(c) Not later than 30 days after the date on which 
a request made for assistance is granted and quarterly 
thereafter through the duration of such assistance, the 
Secretary of Homeland Security shall submit to the Com-
mittees on Appropriations of the House of Representatives 
and the Senate, a report detailing the assistance provided 
and the operational impacts to border security operations. 
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SEC. 540. Funds made available in this Act or any 
other Act for Operations and Support may be used for 
the necessary expenses of providing an employee emer-
gency back-up care program. 
SEC. 541. (a) Not less than $5,000,000 made avail-
able in this Act shall be transferred to ‘‘U.S. Immigration 
and Customs Enforcement—Operations and Support’’ to 
support and conduct necessary operations of the Blue 
Campaign for fiscal year 2026. 
(b) Prior to the obligation of funds made available 
by subsection (a), notification shall be submitted to the 
Committees on Appropriations of the House of Represent-
atives and the Senate. 
SEC. 542. (a) If the reporting requirement set forth 
in paragraph (2) under the heading ‘‘Federal Emergency 
Management Agency—Disaster Relief Fund’’ in the De-
partment of Homeland Security Appropriations Act, 2015 
(Public Law 114–4), as applied in this fiscal year by sec-
tion 306 of this Act, is not submitted to the Committees 
on Appropriations of the House of Representatives and the 
Senate and published on the Agency’s website not later 
than the fifth business day of the applicable month, the 
amount made available for ‘‘Office of the Secretary and 
Executive Management—Operations and Support—Man-
agement and Oversight’’ shall be reduced by $100,000 for 
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each day such report is not submitted and published on 
the Agency’s website. 
(b) During any period in which the total number of 
requests for reimbursement for a covered expense for indi-
vidual assistance or public assistance related to emergency 
(42 U.S.C. 5122(1)) or major disaster (42 U.S.C. 
5122(2)) declarations under the Robert T. Stafford Dis-
aster Relief and Emergency Assistance Act (42 U.S.C. 
5121 et seq.) that the Department of Homeland Security 
has been considering under final review for greater than 
60 days exceeds 500, the amount made available for ‘‘Of-
fice of the Secretary and Executive Management—Oper-
ations and Support—Management and Oversight’’ shall be 
reduced by $100,000 for each day during such period on 
which the cumulative total of requests over 60 days in 
final review exceeds 500. 
(c) Subsection (b) shall not apply if the balance of 
funding for the Disaster Relief Fund is sufficient only for 
the purpose of obligating funds for activities determined 
to be lifesaving or life-sustaining. 
SEC. 543. Section 16005(c) of title VI of division B 
of the Coronavirus Aid, Relief, and Economic Security Act 
(Public Law 116–136) shall be applied as if the language 
read as follows: ‘‘Subsection (a) shall apply until Sep-
tember 30, 2026.’’. 
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SEC. 544. The levels for appropriations accounts 
specified for classified programs in this Act shall conform 
to the direction included in the classified annex accom-
panying this Act and shall be implemented in a manner 
consistent with section 545. 
SEC. 545. Upon a determination by the Director of 
National Intelligence that such action is necessary and in 
the national interest, the Director may, with the approval 
of the Secretary of Homeland Security and the Director 
of the Office of Management and Budget, transfer 
amounts for the National Intelligence Program consistent 
with the percentage caps specified in section 503(c): Pro-
vided, That such authority to transfer may not be used 
unless for higher priority items, based on unforeseen intel-
ligence requirements, than those for which originally ap-
propriated and in no case where the item for which funds 
are requested has been denied by the Congress: Provided 
further, That a request for any transfer of funds using 
authority provided in this section shall be made consistent 
with the requirements of section 503(d)(1). 
SEC. 546. Within seven days of the date of enactment 
of this Act, and quarterly thereafter, the Department shall 
submit to the Committees on Appropriation of the House 
of Representatives and the Senate— 
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(1) an obligation plan by program, project, or 
activity for each component receiving funds from 
Public Law 119–21; 
(2) estimated fee collections for each component 
collecting new or enhanced fees authorized by Public 
Law 119–21, delineated by collections that a compo-
nent will retain and collections that a component will 
remit to other agencies or the Treasury; and 
(3) an obligation plan by program, project, or 
activity for fee collections identified in paragraph (2) 
as being retained by a component within the Depart-
ment. 
SEC. 547. (a) None of the funds appropriated or oth-
erwise made available to the Department of Homeland Se-
curity by this Act may be used to prevent any of the fol-
lowing persons from entering, for the purpose of con-
ducting oversight, any facility operated by or for the De-
partment of Homeland Security used to detain or other-
wise house aliens, or to make any temporary modification 
at any such facility that in any way alters what is observed 
by a visiting Member of Congress or such designated em-
ployee, compared to what would be observed in the absence 
of such modification: 
(1) A Member of Congress. 
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(2) An employee of the United States House of 
Representatives or the United States Senate des-
ignated by such a Member for the purposes of this 
section. 
(b) Nothing in this section may be construed to re-
quire a Member of Congress to provide prior notice of the 
intent to enter a facility described in subsection (a) for 
the purpose of conducting oversight. 
(c) With respect to individuals described in subsection 
(a)(2), the Department of Homeland Security may require 
that a request be made at least 24 hours in advance of 
an intent to enter a facility described in subsection (a). 
SEC. 548. In addition to amounts otherwise made 
available for such purposes, there is appropriated 
$30,000,000, for an additional amount for ‘‘The Judici-
ary—Supreme Court of the United States—Salaries and 
Expenses’’, to remain available until September 30, 2028: 
Provided, That amounts made available pursuant to this 
section shall be subject to the same authorities and condi-
tions as if such amounts were provided under the heading 
‘‘The Judiciary—Supreme Court of the United States— 
Salaries and Expenses’’ in the Financial Services and 
General Government Appropriations Act, 2026. 
SEC. 549. There is appropriated $140,000,000 for an 
additional amount for ‘‘Department of Transportation- 
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Federal Aviation Administration-Operations’’ for air traf-
fic organization activities, to remain available until Sep-
tember 30, 2027: Provided, That the Administrator of the 
Federal Aviation Administration shall only use such 
amounts to provide a rate of pay increase for calendar 
year 2026 of 3.8 percent, for air traffic controllers, as de-
fined by section 2109(1)(A) of title 5, United States Code, 
and air traffic controller supervisors or managers who are 
not covered under such section, but who manage air traf-
fic: Provided further, That such adjustment shall be imple-
mented for all such employees only to the extent the Ad-
ministrator determines, in his sole discretion, that im-
provements in workforce scheduling, staffing utilization, 
or other operational efficiencies are achieved that con-
tribute to addressing workforce shortfalls and enhancing 
aviation safety: Provided further, That if the Adminis-
trator makes such determination, then such adjustment 
shall be effective the first pay period beginning after Janu-
ary 1, 2026: Provided further, That amounts provided by 
this section shall be subject to the same authorities and 
conditions as if such amounts were provided by the De-
partment of Transportation Appropriations Act, 2026. 
SEC. 550. (a) Of the total amount provided under the 
heading ‘‘Cybersecurity and Infrastructure Security Agen-
cy—Operations and Support’’, $99,750,000 shall be de-
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rived by transfer from the unobligated balances of 
amounts previously appropriated under the heading ‘‘Cy-
bersecurity and Infrastructure Security Agency—Cyberse-
curity Response and Recovery Fund’’ in division J of the 
Infrastructure Investment and Jobs Act (Public Law 117– 
58). 
(b) Amounts derived by transfer pursuant to this sec-
tion shall continue to be treated as amounts specified in 
section 103(b) of division A of Public Law 118–5. 
(RESCISSIONS OF FUNDS) 
SEC. 551. Of the funds appropriated to the Depart-
ment of Homeland Security, the following funds are here-
by rescinded from the following accounts and programs 
in the specified amounts: Provided, That no amounts may 
be rescinded from amounts that were designated by the 
Congress as an emergency requirement pursuant to a con-
current resolution on the budget or the Balanced Budget 
and Emergency Deficit Control Act of 1985: 
(1) $73,327,000 from the unobligated balances 
available in the ‘‘Management Directorate—Procure-
ment, Construction, and Improvements’’ account (70 
22/26 0406). 
(2) $6,713,000 from the unobligated balances 
available in the ‘‘U.S. Customs and Border Protec-
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tion—Operations and Support’’ account (70 X 
0530). 
(3) $387,000 from the unobligated balances 
available in the ‘‘U.S. Customs and Border Protec-
tion—Automation Modernization’’ account (70 X 
0531). 
(4) $917,000 from the unobligated balances 
available in the ‘‘U.S. Customs and Border Protec-
tion—Procurement, Construction, and Improve-
ments’’ account (70 X 0532). 
(5) $6,336,000 from the unobligated balances 
available in the ‘‘U.S. Customs and Border Protec-
tion—Border Security Fencing, Infrastructure, and 
Technology’’ account (70 X 0533). 
(6) $1,413,000 from the unobligated balances 
available in the ‘‘U.S. Customs and Border Protec-
tion—Air and Marine Interdiction, Operations, 
Maintenance, and Procurement’’ account (70 X 
0544). 
(7) $172,000 from the unobligated balances 
available in the ‘‘Cybersecurity and Infrastructure 
Security Agency—Infrastructure Protection and In-
frastructure Security’’ account (70 X 0565). 
SEC. 552. The following unobligated balances made 
available to the Department of Homeland Security pursu-
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ant to section 505 of the Department of Homeland Secu-
rity Appropriations Act, 2024 (Public Law 118–47), as 
incorporated by section 1101 of the Full-Year Continuing 
Appropriations Act, 2025 (Public Law 119–4), are re-
scinded: 
(1) $2,072,147 from ‘‘Office of the Secretary 
and Executive Management—Operations and Sup-
port’’. 
(2) $5,487,177 from ‘‘Management Direc-
torate—Operations and Support’’. 
(3) $4,493,650 from ‘‘Intelligence, Analysis, 
and Situational Awareness—Operations and Sup-
port’’. 
(4) $88,190 from ‘‘Office of the Inspector Gen-
eral—Operations and Support’’. 
(5) $1,139,096 from ‘‘U.S. Customs and Bor-
der Protection—Operations and Support’’. 
(6) $19,650,000 from ‘‘Transportation Security 
Administration—Operations and Support’’. 
(7) $703,390 from ‘‘United States Secret Serv-
ice—Operations and Support’’. 
(8) $52,349,050 from ‘‘Cybersecurity and In-
frastructure Security Agency—Operations and Sup-
port’’. 
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(9) $18,525,975 from ‘‘Federal Emergency 
Management Agency—Operations and Support’’. 
(10) $120,860 from ‘‘U.S. Citizenship and Im-
migration Services—Operations and Support’’. 
(11) $178,340 from ‘‘Science and Technology 
Directorate—Operations and Support’’. 
(12) $6,937,020 from ‘‘Countering Weapons of 
Mass Destruction Office—Operations and Support’’. 
SEC. 553. Of the unobligated balances in the ‘‘De-
partment of Homeland Security Nonrecurring Expenses 
Fund’’ established in section 538 of division F of Public 
Law 117–103, $2,362,000 are hereby rescinded. 
REPEAL OF SENATE NOTIFICATION REQUIREMENTS RE-
LATING TO LEGAL PROCESS ON DISCLOSURES OF 
SENATE DATA 
SEC. 554. Section 213 of title II of division C of the 
Continuing 
Appropriations, 
Agriculture, 
Legislative 
Branch, Military Construction and Veterans Affairs, and 
Extensions Act, 2026, and the amendments made by such 
section, are hereby repealed and shall have no force or ef-
fect. 
This division may be cited as the ‘‘Department of 
Homeland Security Appropriations Act, 2026’’. 
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DIVISION I—AUTHORIZING EX-
TENDERS 
AND 
TECHNICAL 
CORRECTIONS 
SEC. 5001. UNITED STATES GRAIN STANDARDS ACT EXTEN-
SION. 
Sections 7(j)(5), 7A(l)(4), and 21(e) of the United 
States Grain Standards Act (7 U.S.C. 79(j)(5), 79a(l)(4), 
87j(e)) shall be applied by substituting ‘‘September 30, 
2026’’ for ‘‘September 30, 2025’’ each place it appears. 
SEC. 5002. COMMODITY FUTURES TRADING COMMISSION 
WHISTLEBLOWER PROGRAM. 
Section 1(b) of Public Law 117–25 (135 Stat. 297; 
136 Stat. 2133; 136 Stat. 5984; 139 Stat. 46) is amended 
in each of paragraphs (3) and (4) by striking ‘‘September 
30, 2025’’ and inserting ‘‘September 30, 2026’’. 
SEC. 5003. FOREST SERVICE PARTICIPATION IN ACES PRO-
GRAM. 
Section 8302(b) of the Agricultural Act of 2014 (16 
U.S.C. 3851a(b)) shall be applied by substituting ‘‘Octo-
ber 1, 2026’’ for ‘‘October 1, 2023’’. 
SEC. 5004. EXTENSION OF NATIONAL FLOOD INSURANCE 
PROGRAM. 
(a) FINANCING.—Section 1309(a) of the National 
Flood Insurance Act of 1968 (42 U.S.C. 4016(a)) is 
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amended, in the first sentence, by striking ‘‘September 30, 
2023’’ and inserting ‘‘September 30, 2026’’. 
(b) PROGRAM EXPIRATION.—Section 1319 of the Na-
tional Flood Insurance Act of 1968 (42 U.S.C. 4026) is 
amended by striking ‘‘September 30, 2023’’ and inserting 
‘‘September 30, 2026’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
this section shall take effect immediately upon the 
date of enactment of this Act. 
(2) ALTERNATE DATE.—If this Act is enacted 
after January 30, 2026, this section shall take effect 
as if enacted on January 30, 2026. 
SEC. 5005. EXTENSION OF REIMBURSABLE SCREENING 
SERVICES PROGRAM. 
Section 225(e) of the Department of Homeland Secu-
rity Appropriations Act, 2019 (division A of Public Law 
116–6; 49 U.S.C. 44901 note) is amended by striking 
‘‘2025’’ and inserting ‘‘2026’’. 
SEC. 5006. MOTOR CARRIER SAFETY ADVISORY COM-
MITTEE. 
Section 4144(d) of the Motor Carrier Safety Reau-
thorization Act of 2005 (49 U.S.C. 31100 note; Public 
Law 109–59) shall be applied by substituting ‘‘September 
30, 2026’’ for ‘‘September 30, 2025’’. 
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SEC. 5007. NATIONAL CYBERSECURITY PROTECTION SYS-
TEM AUTHORIZATION. 
Section 227(a) of the Federal Cybersecurity En-
hancement Act of 2015 (6 U.S.C. 1525(a)) is amended 
by striking ‘‘September 30, 2025’’ and inserting ‘‘Sep-
tember 30, 2026’’. 
SEC. 5008. CYBERSECURITY INFORMATION SHARING ACT 
OF 2015. 
Section 111(a) of the Cybersecurity Information 
Sharing Act of 2015 (6 U.S.C. 1510(a)) is amended by 
striking ‘‘September 30, 2025’’ and inserting ‘‘September 
30, 2026’’. 
SEC. 5009. STATE AND LOCAL CYBERSECURITY GRANT PRO-
GRAM. 
Section 2220A(s)(1) of the Homeland Security Act 
of 2002 (6 U.S.C. 665g(s)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘September 30, 
2026’’. 
SEC. 5010. EXTENSION OF THE TECHNOLOGY MODERNIZA-
TION FUND AND BOARD. 
Section 1078(f)(1) of the National Defense Author-
ization Act for Fiscal Year 2018 (40 U.S.C. 11301 note) 
is amended by striking ‘‘On and after the date that is 2 
years after the date on which the Comptroller General of 
the United States issues the third report required under 
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subsection (b)(7)(B)’’ and inserting ‘‘After September 30, 
2026’’. 
SEC. 5011. EXTENSION OF EXISTENCE OF PAROLE COMMIS-
SION. 
Any expiration date established by section 235(b) of 
the Sentencing Reform Act of 1984 (18 U.S.C. 3551 note; 
Public Law 98–473), as such section relates to chapter 
311 of title 18, United States Code, and the United States 
Parole Commission, shall not apply during the period be-
ginning on October 1, 2025, and ending on January 30, 
2031. 
SEC. 5012. ADDITIONAL SPECIAL ASSESSMENT. 
Section 3014(a) of title 18, United States Code, is 
amended by striking ‘‘and ending on September 30, 
2025’’. 
SEC. 5013. RURAL HEALTHCARE WORKERS. 
Section 220(c) of the Immigration and Nationality 
Technical Corrections Act of 1994 (8 U.S.C. 1182 note) 
shall be applied by substituting ‘‘September 30, 2026’’ for 
‘‘September 30, 2015’’. 
SEC. 5014. E-VERIFY. 
Section 401(b) of the Illegal Immigration Reform and 
Immigrant Responsibility Act of 1996 (8 U.S.C. 1324a 
note) shall be applied by substituting ‘‘September 30, 
2026’’ for ‘‘September 30, 2015’’. 
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SEC. 5015. NON-MINISTER RELIGIOUS WORKERS. 
Section 101(a)(27)(C)(ii) of the Immigration and 
Nationality Act (8 U.S.C. 1101(a)(27)(C)(ii)) shall be ap-
plied by substituting ‘‘September 30, 2026’’ for ‘‘Sep-
tember 30, 2015’’ each place such date appears. 
SEC. 5016. H-2B SUPPLEMENTAL VISA EXEMPTION. 
Notwithstanding the numerical limitation set forth in 
section 214(g)(1)(B) of the Immigration and Nationality 
Act (8 U.S.C. 1184(g)(1)(B)), the Secretary of Homeland 
Security, after consultation with the Secretary of Labor, 
and upon the determination that the needs of United 
States businesses cannot be satisfied during fiscal year 
2026 with United States workers who are willing, quali-
fied, and able to perform temporary nonagricultural labor, 
may increase the total number of aliens who may receive 
a visa under section 101(a)(15)(H)(ii)(b) of such Act (8 
U.S.C. 1101(a)(15)(H)(ii)(b)) in such fiscal year by not 
more than the highest number of H–2B nonimmigrants 
who participated in the H–2B returning worker program 
in any fiscal year in which returning workers were exempt 
from such numerical limitation. 
SEC. 5017. EMERGENCY AUTHORITY FOR SENTENCING 
COMMISSION. 
(a) IN GENERAL.—The United States Sentencing 
Commission (in this section, referred to as the ‘‘Commis-
sion’’) shall promulgate the guidelines or amendments pro-
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vided for under section 8605(e) of the SAFER SKIES Act 
(title LXXXVI of Public Law 119–60) as soon as possible 
after the date of enactment of such Act, and in any event 
not later than December 31, 2026, notwithstanding the 
deadline under section 994(p) of title 28, United States 
Code. 
(b) EFFECTIVE DATE.—The amendments to the 
guidelines promulgated under subsection (a) shall take ef-
fect 180 days after the date of promulgation by the Com-
mission, except to the extent that the effective date is re-
vised or the amendment is otherwise modified or dis-
approved by an Act of Congress, and shall supersede any 
amendment to the contrary contained in the amendments 
to the sentencing guidelines submitted to Congress by the 
Commission on or about May 1, 2026. 
(c) RULE OF CONSTRUCTION.—The requirements of 
this section shall supersede the timeline set forth in sec-
tion 8605(e)(1) of the SAFER SKIES Act (title LXXXVI 
of Public Law 119–60). 
SEC. 5018. BANKRUPTCY FEES. 
(a) IN GENERAL.—Section 126 of the Continuing 
Appropriations Act, 2026 (division A of the Continuing 
Appropriations, Agriculture, Legislative Branch, Military 
Construction and Veterans Affairs, and Extensions Act, 
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2026 (Public Law 119–37; 139 Stat. 502)) is amended 
to read as follows: 
‘‘SEC. 126. Notwithstanding section 106, during the 
period ending on the last day of the first calendar quarter 
of 2026, section 1930(a)(6)(B)(i) of title 28, United 
States Code, shall be applied as if ‘During the 5-year pe-
riod’ were struck.’’. 
(b) APPLICATION OF AMENDMENTS MADE BY THE 
BANKRUPTCY ADMINISTRATION IMPROVEMENT ACT OF 
2025.— 
(1) IN
GENERAL.—Section 6(b)(2)(A) of the 
Bankruptcy Administration Improvement Act of 
2025 is amended by striking ‘‘on the’’ and inserting 
‘‘on or after the’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect as though enacted 
immediately after the enactment of the Bankruptcy 
Administration Improvement Act of 2025. 
SEC. 5019. EXTENSION OF AFRICAN GROWTH AND OPPOR-
TUNITY ACT. 
(a) EXTENSION OF PREFERENTIAL TREATMENT FOR 
CERTAIN
COUNTRIES
IN
AFRICA
UNDER
AFRICAN 
GROWTH AND OPPORTUNITY ACT; RETROACTIVE APPLI-
CATION.— 
(1) EXTENSION.— 
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(A) TRADE ACT OF 1974.—Section 506B of 
the Trade Act of 1974 (19 U.S.C. 2466b) is 
amended by striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’. 
(B) AFRICAN GROWTH AND OPPORTUNITY 
ACT.— 
(i) IN GENERAL.—Section 112(g) of 
the African Growth and Opportunity Act 
(19 U.S.C. 3721(g)) is amended by strik-
ing ‘‘September 30, 2025’’ and inserting 
‘‘December 31, 2026’’. 
(ii) 
REGIONAL
APPAREL
ARTICLE 
PROGRAM.—Section 112(b)(3)(A) of the 
African Growth and Opportunity Act (19 
U.S.C. 3721(b)(3)(A)) is amended— 
(I) in clause (i), by striking ‘‘21 
succeeding’’ and inserting ‘‘23 suc-
ceeding’’; and 
(II) in clause (ii)(II), by striking 
‘‘September 30, 2025’’ and inserting 
‘‘December 31, 2026’’. 
(iii) THIRD-COUNTRY
FABRIC
PRO-
GRAM.—Section 112(c)(1) of the African 
Growth and Opportunity Act (19 U.S.C. 
3721(c)(1)) is amended— 
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(I) in the paragraph heading, by 
striking ‘‘SEPTEMBER 30, 2025’’ and 
inserting ‘‘DECEMBER 31, 2026’’; 
(II) in subparagraph (A), by 
striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’; and 
(III) in subparagraph (B)(ii), by 
striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’. 
(2) RETROACTIVE APPLICATION.— 
(A) IN
GENERAL.—Notwithstanding sec-
tion 514 of the Tariff Act of 1930 (19 U.S.C. 
1514) or any other provision of law, and subject 
to subparagraph (B), any entry of a covered ar-
ticle to which duty-free treatment or other pref-
erential treatment under section 506A of the 
Trade Act of 1974 (19 U.S.C. 2466a) or sec-
tion 112 of the African Grown and Opportunity 
Act (19 U.S.C. 3721) would have applied if the 
entry had been made on September 30, 2025, 
that was made— 
(i) after September 30, 2025, and 
(ii) before the date of the enactment 
of this Act, 
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shall be liquidated or reliquidated as though 
such entry occurred on the date of the enact-
ment of this Act. 
(B) REQUESTS.—A liquidation or reliqui-
dation may be made under subparagraph (A) 
with respect to an entry only if a request there-
for is filed with the Commissioner of U.S. Cus-
toms and Border Protection not later than 180 
days after the date of the enactment of this Act 
that contains sufficient information to enable 
such Commissioner— 
(i) to locate the entry; or 
(ii) to reconstruct the entry if it can-
not be located. 
(C) PAYMENT OF AMOUNTS OWED.—Any 
amounts owed by the United States pursuant to 
the liquidation or reliquidation of an entry of a 
covered article under subparagraph (A) shall be 
paid, without interest of any kind, not later 
than 90 days after the date of the liquidation 
or reliquidation (as the case may be). 
(D) DEFINITIONS.—In this paragraph: 
(i) COVERED
ARTICLE.—The term 
‘‘covered article’’ means an article from a 
country that is designated by the President 
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as a beneficiary sub-Saharan African coun-
try under section 104 of the African 
Growth and Opportunity Act (19 U.S.C. 
3703) as of the day before the date of the 
enactment of this Act. 
(ii) ENTRY.—The term ‘‘entry’’ in-
cludes a withdrawal from warehouse for 
consumption. 
(b) EXTENSION OF CUSTOMS USER FEES.— 
(1) IN GENERAL.—Section 13031(j)(3) of the 
Consolidated Omnibus Budget Reconciliation Act of 
1985 (19 U.S.C. 58c(j)(3)) is amended— 
(A) in subparagraph (A), by striking ‘‘Sep-
tember 30, 2031’’ and inserting ‘‘December 31, 
2031’’; and 
(B) in subparagraph (B)(i), by striking 
‘‘September 30, 2031’’ and inserting ‘‘Decem-
ber 31, 2031’’. 
(2) RATE
FOR
MERCHANDISE
PROCESSING 
FEES.—Section 503 of the United States-Korea 
Free Trade Agreement Implementation Act (Public 
Law 112–41;19 U.S.C. 3805 note) is amended by 
striking ‘‘September 30, 2031’’ and inserting ‘‘De-
cember 31, 2031’’. 
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SEC. 5020. EXTENSION OF HAITI ECONOMIC LIFT PRO-
GRAM. 
(a) EXTENSION
OF SPECIAL RULES
FOR HAITI 
UNDER CARIBBEAN BASIN ECONOMIC RECOVERY ACT.— 
Section 213A of the Caribbean Basin Economic Recovery 
Act (19 U.S.C. 2703a) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1)— 
(i) 
by 
amending 
subparagraph 
(B)(v)(I) to read as follows: 
‘‘(I) 
APPLICABLE
PERCENT-
AGE.—The term ‘applicable percent-
age’ means 60 percent or more on and 
after December 20, 2017.’’; and 
(ii) by amending subparagraph (C) to 
read as follows: 
‘‘(C) QUANTITATIVE
LIMITATIONS.—The 
preferential treatment described in subpara-
graph (A) shall be extended, during each period 
after the initial applicable 1-year period, to not 
more than 1.25 percent of the aggregate square 
meter equivalents of all apparel articles im-
ported into the United States in the most re-
cent 12-month period for which data are avail-
able.’’; and 
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(B) in paragraph (2), by striking ‘‘in each 
of the 16 succeeding 1-year periods’’ each place 
it appears and inserting ‘‘in any of the suc-
ceeding 1-year periods’’; and 
(2) by amending subsection (h) to read as fol-
lows: 
‘‘(h) TERMINATION.—The duty-free treatment pro-
vided under this section shall remain in effect until De-
cember 31, 2026.’’. 
(b) RESTORATION OF ELIGIBILITY OF CERTAIN AR-
TICLES FOR PREFERENTIAL TREATMENT.— 
(1) IN GENERAL.—The President shall proclaim 
such modifications to the Harmonized Tariff Sched-
ule of the United States as may be necessary to re-
store the eligibility of articles described in paragraph 
(2) for preferential treatment under section 213A of 
the Caribbean Basin Economic Recovery Act (19 
U.S.C. 2703a). 
(2) ARTICLES
DESCRIBED.—An article de-
scribed in this paragraph is an article that— 
(A) was eligible for preferential treatment 
under section 213A of the Caribbean Basin 
Economic Recovery Act (19 U.S.C. 2703a) on 
December 20, 2006; and 
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(B) became ineligible for such treatment 
after that date and before the date of the enact-
ment of this Act as a result of revisions to the 
Harmonized Tariff Schedule. 
(3) EFFECTIVE DATE OF PROCLAMATION.—A 
proclamation under paragraph (1) shall take effect 
not earlier than 2 business days after the President 
submits to the Committee on Finance of the Senate 
and the Committee on Ways and Means of the 
House of Representatives a report on the proclama-
tion and the reasons for the modifications to the 
Harmonized Tariff Schedule under the proclamation. 
(c) RETROACTIVE APPLICATION.— 
(1) IN GENERAL.—Notwithstanding section 514 
of the Tariff Act of 1930 (19 U.S.C. 1514) or any 
other provision of law, and subject to paragraph (2), 
any entry of a covered article to which duty-free 
treatment or other preferential treatment under the 
Caribbean Basin Economic Recovery Act (19 U.S.C. 
2701 et seq.) would have applied if the entry had 
been made before September 30, 2025, that was 
made— 
(A) on or after September 30, 2025, and 
(B) before the date of the enactment of 
this Act, 
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shall be liquidated or reliquidated as though such 
entry occurred on the date of the enactment of this 
Act. 
(2) REQUESTS.—A liquidation or reliquidation 
may be made under paragraph (1) with respect to 
an entry only if a request therefor is filed with the 
Commissioner of U.S. Customs and Border Protec-
tion not later than 180 days after the date of the 
enactment of this Act that contains sufficient infor-
mation to enable such Commissioner— 
(A) to locate the entry; or 
(B) to reconstruct the entry if it cannot be 
located. 
(3) 
PAYMENT
OF
AMOUNTS
OWED.—Any 
amounts owed by the United States pursuant to the 
liquidation or reliquidation of an entry of a covered 
article under paragraph (1) shall be paid, without 
interest of any kind, not later than 90 days after the 
date of the liquidation or reliquidation (as the case 
may be). 
(4) DEFINITIONS.—In this subsection: 
(A) COVERED ARTICLE.—The term ‘‘cov-
ered article’’ means an article from Haiti. 
(B) ENTRY.—The term ‘‘entry’’ includes a 
withdrawal from warehouse for consumption. 
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SEC. 5021. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this division and each succeeding division 
shall not be entered on either PAYGO scorecard main-
tained 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 and each succeeding division shall 
not be entered on any PAYGO scorecard maintained for 
purposes of section 4106 of H. Con. Res. 71 (115th Con-
gress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 105–217 and section 250(c)(8) of the Balanced 
Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this division and each succeeding divi-
sion shall not be estimated— 
(1) for purposes of section 251 of such Act; 
(2) for purposes of an allocation to the Com-
mittee on Appropriations pursuant to section 302(a) 
of the Congressional Budget Act of 1974; and 
(3) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
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DIVISION J—HEALTH CARE 
EXTENDERS 
SEC. 6001. TABLE OF CONTENTS. 
The table of contents of this division is as follows: 
DIVISION J—HEALTH CARE EXTENDERS 
Sec. 6001. Table of contents. 
TITLE I—MEDICAID 
Sec. 6101. Streamlined enrollment process for eligible out-of-State providers 
under Medicaid and CHIP. 
Sec. 6102. Removing certain age restrictions on Medicaid eligibility for working 
adults with disabilities. 
Sec. 6103. Medicaid State plan requirement for determining residency and cov-
erage for military families. 
Sec. 6104. State studies and HHS report on costs of providing maternity, 
labor, and delivery services. 
Sec. 6105. Modifying certain disproportionate share hospital allotments. 
Sec. 6106. Modifying certain limitations on disproportionate share hospital pay-
ment adjustments under the Medicaid program. 
TITLE II—MEDICARE 
Sec. 6201. Extension of increased inpatient hospital payment adjustment for 
certain low-volume hospitals. 
Sec. 6202. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 6203. Extension of add-on payments for ambulance services. 
Sec. 6204. Extending incentive payments for participation in eligible alternative 
payment models. 
Sec. 6205. Extension of funding for quality measure endorsement, input, and 
selection. 
Sec. 6206. Extension of funding outreach and assistance for low-income pro-
grams. 
Sec. 6207. Extension of funding for Medicare hospice surveys. 
Sec. 6208. Extension of the work geographic index floor. 
Sec. 6209. Extension of certain telehealth flexibilities. 
Sec. 6210. Extending acute hospital care at home waiver flexibilities. 
Sec. 6211. In-home cardiopulmonary rehabilitation flexibility. 
Sec. 6212. Enhancing certain program integrity requirements for DME under 
Medicare. 
Sec. 6213. Guidance on furnishing services via telehealth to individuals with 
limited English proficiency. 
Sec. 6214. Inclusion of virtual diabetes prevention program suppliers in MDPP 
Expanded Model. 
Sec. 6215. Medication-induced movement disorder outreach and education. 
Sec. 6216. Report on wearable medical devices. 
Sec. 6217. Extension of temporary inclusion of authorized oral antiviral drugs 
as covered part D drugs. 
Sec. 6218. Extension of adjustment to calculation of hospice cap amount under 
Medicare. 
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Sec. 6219. Adjustments to Medicare part D cost-sharing reductions for low-in-
come individuals. 
Sec. 6220. Requiring Enhanced and Accurate Lists of (REAL) Health Pro-
viders Act. 
Sec. 6221. Medicare coverage of multi-cancer early detection screening tests. 
Sec. 6222. Medicare coverage of external infusion pumps and non-self-admin-
istrable home infusion drugs. 
Sec. 6223. Assuring pharmacy access and choice for medicare beneficiaries. 
Sec. 6224. Modernizing and ensuring PBM accountability. 
Sec. 6225. Requiring a separate identification number and an attestation for 
each off-campus outpatient department of a provider. 
Sec. 6226. Revising phase-in of medicare clinical laboratory test payment 
changes. 
Sec. 6227. Medicare sequestration. 
Sec. 6228. Medicare Improvement Fund. 
TITLE III—HUMAN SERVICES 
Sec. 6301. Sexual risk avoidance education extension. 
Sec. 6302. Personal responsibility education extension. 
Sec. 6303. Extension of funding for family-to-family health information centers. 
Sec. 6304. Extension of the Temporary Assistance for Needy Families Pro-
gram. 
TITLE IV—PUBLIC HEALTH AND OTHER EXTENDERS 
Subtitle A—Extensions 
Sec. 6401. Extension for community health centers, National Health Service 
Corps, and teaching health centers that operate GME pro-
grams. 
Sec. 6402. Extension of special diabetes programs. 
Sec. 6403. Extension of national health security programs. 
Sec. 6404. No Surprises Act implementation. 
Subtitle B—World Trade Center Health Program 
Sec. 6411. 9/11 responder and survivor health funding corrections. 
TITLE V—PUBLIC HEALTH PROGRAMS 
Sec. 6501. Preventing maternal deaths. 
Sec. 6502. Organ Procurement and Transplantation Network. 
Sec. 6503. Honor our living donors. 
Sec. 6504. Program for pediatric studies of drugs. 
Sec. 6505. Sickle cell disease prevention and treatment. 
Sec. 6506. Lifespan respite care. 
Sec. 6507. PREEMIE. 
Sec. 6508. Dr. Lorna Breen health care provider protection. 
TITLE VI—FOOD AND DRUG ADMINISTRATION 
Subtitle A—Mikaela Naylon Give Kids a Chance Act 
Sec. 6601. Research into pediatric uses of drugs; additional authorities of Food 
and Drug Administration regarding molecularly targeted can-
cer drugs. 
Sec. 6602. Ensuring completion of pediatric study requirements. 
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Sec. 6603. FDA report on PREA enforcement. 
Sec. 6604. Extension of authority to issue priority review vouchers to encourage 
treatments for rare pediatric diseases. 
Sec. 6605. Limitations on exclusive approval or licensure of orphan drugs. 
Subtitle B—United States-Abraham Accords Cooperation and Security 
Sec. 6611. Establishment of Abraham Accords Office within Food and Drug 
Administration. 
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 fidu-
ciaries. 
Sec. 6703. Increasing transparency in generic drug applications. 
TITLE I—MEDICAID 
SEC. 6101. STREAMLINED ENROLLMENT PROCESS FOR ELI-
GIBLE 
OUT-OF-STATE 
PROVIDERS 
UNDER 
MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1902(kk) of the Social Se-
curity 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 
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such State that exceed the minimum nec-
essary 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 infor-
mation specified by the Secretary); and 
‘‘(ii) provides that an eligible out-of- 
State provider that enrolls as a partici-
pating provider in the State plan (or a 
waiver of such plan) through such process 
shall be so enrolled for a 5-year period, un-
less the provider is terminated or excluded 
from participation during such period. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) ELIGIBLE
OUT-OF-STATE
PRO-
VIDER.—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 
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purposes of determining the level 
of screening to be conducted 
under section 1866(j)(2), has 
been so screened under such sec-
tion 1866(j)(2), and is enrolled in 
the Medicare program under title 
XVIII; or 
‘‘(bb) was determined by the 
State agency administering or su-
pervising the administration 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 subsection, 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— 
‘‘(aa) excluded from partici-
pation in any Federal health care 
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1905(a)(xviii)’’ before the semicolon at the 
end; and 
(B) in subclause (XVI), by inserting ‘‘in-
cluding 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 fol-
lowing new clause: 
‘‘(xviii) individuals who, but for earn-
ings in excess of the limit established 
under subsection (q)(2)(B), would be con-
sidered to be receiving supplemental secu-
rity income, and who are at least 16 years 
of age,’’. 
(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,’’. 
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(b) APPLICATION
TO CERTAIN STATES.—A State 
that, as of the date of enactment of this Act, provides for 
making medical assistance available to individuals de-
scribed 
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 DE-
TERMINING RESIDENCY AND COVERAGE FOR 
MILITARY FAMILIES. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity 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 pe-
riod 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 de-
fined in subsection (yy)(1))— 
‘‘(A) that, for purposes of determining eli-
gibility for medical assistance under the State 
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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 com-
munity-based services waiting list (as defined in 
subsection (yy)(2)), such individual remains on 
such list until— 
‘‘(i) the State completes an assess-
ment and renders a decision with respect 
to the eligibility of such individual to re-
ceive 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 individ-
ual’s opportunity for a fair hearing; or 
‘‘(ii) such individual elects to be re-
moved from such list; and 
‘‘(C) payment for medical assistance fur-
nished under the State plan (or a waiver of the 
plan) on behalf of such active duty relocated in-
dividual in the military service relocation State 
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(as referred to in subsection (yy)(1)(B)(i)), to 
the extent that such assistance is available in 
such military service relocation State in accord-
ance with such guidance as the Secretary may 
issue to ensure access to such assistance.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(yy) ACTIVE DUTY RELOCATED INDIVIDUAL; HOME 
AND COMMUNITY-BASED SERVICES WAITING LIST.—For 
purposes of subsection (a)(90) and this subsection: 
‘‘(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 de-
scribed 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 serv-
ices; 
‘‘(B) who— 
‘‘(i) is a member of the Armed Forces 
engaged in active duty service and is relo-
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cated to another State (in this subsection 
referred to as the ‘military service reloca-
tion 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 oc-
curred 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 mili-
tary service relocation State with such 
member; and 
‘‘(C) who— 
‘‘(i) was receiving home and commu-
nity-based services (as defined in section 
9817(a)(2)(B) of the American Rescue 
Plan Act of 2021) at the time of such relo-
cation; or 
‘‘(ii) if the State maintains a home 
and community-based services waiting list, 
was on such home and community-based 
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services waiting list at the time of such re-
location. 
‘‘(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 
maintained by such State of individuals who are re-
questing 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 appro-
priated, 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). 
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SEC. 6104. STATE STUDIES AND HHS REPORT ON COSTS OF 
PROVIDING MATERNITY, LABOR, AND DELIV-
ERY 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 State (as such term is de-
fined 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 para-
graph (3)) and submit the results of such study to 
the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’) in such 
form and manner as the Secretary requires. 
(2) CONTENT OF STUDY.—A State study re-
quired under paragraph (1) shall include the fol-
lowing 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 appli-
cable hospitals, based on the expenditures a 
representative sample of such hospitals incurred 
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available, such payment rates for such 
services under Medicaid managed care and 
private health insurers within geographic 
areas of the State; and 
(ii) analyzing different payment meth-
ods for such services, such as the use of 
bundled payments, quality incentives, and 
low-volume adjustments. 
(F) An evaluation, using such methodology 
and parameters 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 deliv-
ery 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. 
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(B) The hospital— 
(i) is located in a rural area (as de-
fined 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 available (as determined by the 
Secretary), furnished services for less than 
an average of 300 births per year; and 
(iii) provides labor and delivery serv-
ices. 
(4) ASSISTANCE TO SMALL HOSPITALS IN COM-
PILING
COST
INFORMATION.—There are appro-
priated to the Secretary for fiscal year 2026, 
$10,000,000 for the purpose of providing grants and 
technical assistance to a hospital described in para-
graph (3)(B) to enable such hospital to compile de-
tailed information for use in the State studies re-
quired 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 
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the State submits to the Secretary the data de-
scribed in such paragraph, a publicly available re-
port 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 sub-
mit to Congress, and make publicly available, a report 
analyzing the first studies conducted by States under sub-
section (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 other-
wise obligated, $3,000,000 for fiscal year 2026, to remain 
available until expended, to the Secretary of Health and 
Human Services for purposes of implementing this sec-
tion. 
SEC. 
6105. 
MODIFYING 
CERTAIN 
DISPROPORTIONATE 
SHARE HOSPITAL 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— 
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(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 begin-
ning 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 fis-
cal year 2027, shall be $53,100,000’’ before the pe-
riod. 
(b) ELIMINATING CERTAIN DSH ALLOTMENT RE-
DUCTIONS.—Section 1923(f)(7)(A) of the Social Security 
Act (42 U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘the period beginning January 31, 
2026, and ending September 30, 2026, and for 
each of fiscal years 2027 and 2028’’ and insert-
ing ‘‘fiscal year 2028’’; 
(B) in subclause (I), by striking ‘‘or pe-
riod’’; and 
(C) in subclause (II), by striking ‘‘or pe-
riod’’ each place it appears; and 
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(2) in clause (ii), by striking ‘‘the period begin-
ning 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 DIS-
PROPORTIONATE 
SHARE 
HOSPITAL 
PAY-
MENT ADJUSTMENTS UNDER THE MEDICAID 
PROGRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Se-
curity 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 de-
scribed 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: 
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‘‘(III) payments made under title 
XVIII or by an applicable plan (as de-
fined 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 insert-
ing ‘‘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 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 aggre-
gate incurred costs exceeding payments 
under such State plan, waiver, title XVIII, 
or applicable plan for such services fur-
nished to such individuals during such 
year.’’; 
(2) by striking paragraph (2); 
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(3) by redesignating paragraph (3) as para-
graph (2); and 
(4) in paragraph (2), as so redesignated, by 
striking ‘‘Notwithstanding paragraph (2) of this 
subsection (as in effect on October 1, 2021), para-
graph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to payment adjustments made under sec-
tion 1923 of the Social Security Act (42 U.S.C. 
1396r–4) for Medicaid State plan rate years begin-
ning on or after the date of enactment of this Act. 
(2) STATE OPTION TO DISTRIBUTE UNSPENT 
DSH ALLOTMENTS FROM PRIOR YEARS UP TO MODI-
FIED CAP.— 
(A) IN
GENERAL.—If, for any Medicaid 
State plan rate year that begins on or after Oc-
tober 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 
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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 sec-
tion); and 
(ii) the total amount of all payment 
adjustments for the State plan rate year 
(as so increased) does not exceed the dis-
proportionate share hospital allotment for 
the State and applicable Federal fiscal 
year under subsection (f) of such section. 
(B) NO RECOUPMENT OF PAYMENTS AL-
READY MADE TO HOSPITALS.—A State shall not 
recoup any payment adjustment made by the 
State to a hospital for a Medicaid State plan 
rate year described in subparagraph (A) if such 
payment 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 
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State to increase the amount of a payment 
adjustment to a hospital for a Medicaid 
State plan rate year described in subpara-
graph (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 retro-
active modification to a provision 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 adjustment 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 
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specify on such increased payment adjustment 
as part of the annual report submitted by the 
State under section 1923(j)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–4(j)(1)) for such 
State plan rate year or, if necessary, as deter-
mined by the Secretary, in an amendment to 
such annual report. 
TITLE II—MEDICARE 
SEC. 6201. EXTENSION OF INCREASED INPATIENT HOS-
PITAL 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 por-
tion 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 
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‘‘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 begin-
ning on October 1, 2026, and ending on De-
cember 31, 2026’’; and 
(C) in subclause (IV), by striking ‘‘the por-
tion of fiscal year 2026 beginning on January 
31, 2026, and ending on September 30, 2026, 
and fiscal year 2027’’ and inserting ‘‘the por-
tion 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 
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(B) in clause (ii), by striking ‘‘through 
2025 and the portion of fiscal year 2026 begin-
ning on October 1, 2025, and ending on Janu-
ary 30, 2026’’ and inserting ‘‘through 2026 and 
the portion of fiscal year 2027 beginning on Oc-
tober 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 So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
(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 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(D)) is amended— 
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‘‘(xvi) for the period beginning on January 
31, 2026, and ending on December 31, 2027, 
$30,000,000.’’. 
SEC. 6207. EXTENSION OF FUNDING FOR MEDICARE HOS-
PICE SURVEYS. 
Section 3(a)(2) of the IMPACT Act of 2014 (Public 
Law 113–185), as amended by section 6205 of division 
F of the Continuing Appropriations, Agriculture, Legisla-
tive Branch, Military Construction and Veterans Affairs, 
and Extensions Act, 2026 (Public Law 119–37), is 
amended— 
(1) in subparagraph (B), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (C), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(D) $4,400,000 for the period beginning 
on January 31, 2026, and ending on December 
31, 2026, to remain available until expended.’’. 
SEC. 6208. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 31, 2026’’ and inserting ‘‘January 1, 2027’’. 
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SEC. 6209. EXTENSION OF CERTAIN TELEHEALTH FLEXI-
BILITIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS
AND 
EXPANDING
ORIGINATING
SITES
FOR
TELEHEALTH 
SERVICES.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘end-
ing January 30, 2026’’ and inserting ‘‘ending De-
cember 31, 2027’’; and 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on January 30, 2026’’ and inserting ‘‘ending on De-
cember 31, 2027’’. 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) 
is amended by striking ‘‘ending on January 30, 2026’’ and 
inserting ‘‘ending on December 31, 2027’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FED-
ERALLY
QUALIFIED
HEALTH
CENTERS
AND
RURAL 
HEALTH CLINICS.—Section 1834(m)(8)(A) of the Social 
Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by 
striking ‘‘ending on January 30, 2026’’ and inserting 
‘‘ending on December 31, 2027’’. 
(d) DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE
FOR MENTAL HEALTH SERVICES 
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FURNISHED
THROUGH
TELEHEALTH
AND
TELE-
COMMUNICATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—Section 1834(m)(7)(B)(i) of the Social 
Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
amended, in the matter preceding subclause (I), by 
striking ‘‘on or after January 31, 2026’’ and insert-
ing ‘‘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 in-
serting ‘‘January 1, 2028’’. 
(3) MENTAL
HEALTH
VISITS
FURNISHED
BY 
FEDERALLY QUALIFIED 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’’. 
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(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 sub-
clause shall not apply in the case of such an en-
counter with an individual occurring on or after 
January 31, 2026, if such individual is located 
in an area that is subject to a moratorium on 
the enrollment of hospice programs under this 
title pursuant to section 1866(j)(7), if such in-
dividual is receiving hospice care from a pro-
vider 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 en-
rolled under section 1866(j) and is not an opt- 
out physician or practitioner (as defined in sec-
tion 1802(b)(6)(D))’’ before the semicolon. 
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(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 para-
graph (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 in-
cludes 1 or more modifiers or codes (as specified by 
the Secretary) to indicate that such encounter was 
conducted via telehealth’’ after ‘‘as determined ap-
propriate by the Secretary’’. 
(g) REQUIRING MODIFIERS FOR TELEHEALTH SERV-
ICES IN CERTAIN 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 CER-
TAIN INSTANCES.—Not later than January 1, 2027, 
the Secretary shall establish requirements to include 
one or more codes or modifiers, as determined ap-
propriate 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 
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‘‘(ii) for which a physician or practi-
tioner 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 serv-
ice.’’. 
(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 subsections (b) and (c)’’; 
and 
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(B) by adding at the end the following new 
flush sentence: 
‘‘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 appro-
priate.’’; 
(2) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘STUDY’’ and inserting ‘‘INITIAL STUDY’’; and 
(B) in paragraph (3), by striking ‘‘sub-
section’’ and inserting ‘‘section’’; 
(3) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; 
(4) by inserting after subsection (b) the fol-
lowing new subsection: 
‘‘(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 
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which individuals may be furnished services 
under such initiative; and 
‘‘(B) analyze and compare (both within 
and between hospitals participating in the ini-
tiative, and relative to comparable hospitals 
that do not participate in the initiative, for rel-
evant parameters such as diagnosis-related 
groups)— 
‘‘(i) quality of care furnished to indi-
viduals with similar conditions and charac-
teristics in the inpatient setting and 
through the Acute Hospital Care at Home 
initiative, including health outcomes, hos-
pital readmission rates (including readmis-
sions both within and beyond 30 days post- 
discharge), hospital mortality rates, length 
of stay, infection rates, composition of 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, fre-
quency, and causes of such transfers), 
transfers and discharges to post-acute care 
settings (including the timing, frequency, 
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and causes of such transfers and dis-
charges), and patient and caregiver experi-
ence of care; 
‘‘(ii) clinical conditions treated and di-
agnosis-related groups of discharges from 
inpatient settings relative to discharges 
from the Acute Hospital Care at Home ini-
tiative; 
‘‘(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 Hos-
pital Care at Home initiative, including 
costs relating to staffing, equipment, food, 
prescriptions, and other services, as deter-
mined by the Secretary; 
‘‘(iv) the quantity, mix, and intensity 
of services (such as in-person visits and 
virtual contacts with patients and the in-
tensity of such services) furnished in inpa-
tient settings relative to the Acute Hospital 
Care at Home initiative, and, to the extent 
practicable, the nature and extent of family 
or caregiver involvement; 
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‘‘(v) socioeconomic information on in-
dividuals treated in comparable inpatient 
settings relative to the initiative, including 
racial and ethnic data, income, housing, 
geographic proximity to the brick-and-mor-
tar 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 individ-
uals who entered into the Acute Hospital 
Care at Home initiative directly from an 
emergency department compared with indi-
viduals who entered into the Acute Hos-
pital Care at Home initiative directly from 
an existing inpatient stay in a hospital. 
‘‘(2) SELECTION
BIAS.—In conducting the 
study under paragraph (1), the Secretary shall, to 
the extent practicable, analyze and compare individ-
uals who participate and do not participate in the 
initiative controlling for selection bias or other fac-
tors that may impact the reliability of data. 
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‘‘(3) REPORT.—Not later than September 30, 
2029, the Secretary 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 re-
port 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 other-
wise available, there is appropriated to the Centers 
for Medicare & Medicaid Services Program Manage-
ment 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 
(5) in subsection (e), as redesignated by para-
graph (3), by striking ‘‘and (b)(1)’’ and inserting ‘‘, 
(b)(1), and (c)(1)’’. 
SEC. 6211. IN-HOME CARDIOPULMONARY REHABILITATION 
FLEXIBILITY. 
(a) IN GENERAL.—Section 1861(eee)(2)(A)(ii) of the 
Social Security Act (42 U.S.C. 1395x(eee)(2)(A)(ii)) is 
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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 hos-
pital)’’ after ‘‘outpatient basis’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendment made by sub-
section (a) by program instruction or otherwise. 
SEC. 6212. ENHANCING CERTAIN PROGRAM INTEGRITY RE-
QUIREMENTS FOR DME UNDER MEDICARE. 
(a) DURABLE MEDICAL EQUIPMENT.— 
(1) IN GENERAL.—Section 1834(a) of the So-
cial 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 RE-
VIEW FOR CERTAIN ITEMS.— 
‘‘(A) MASTER
LIST
INCLUSION.—Begin-
ning January 1, 2029, for purposes of the Mas-
ter List described in section 414.234(b) of title 
42, Code of Federal Regulations (or any suc-
cessor regulation), in determining which items 
have aberrant billing patterns (as such term is 
used for purposes of such section), the Sec-
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retary shall also treat an item for which pay-
ment 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 emer-
gent care services), a substantial number of 
claims for such items under this subsection are 
for such items ordered by a physician or practi-
tioner who has not previously (during a period 
of not less than 24 months, as established by 
the Secretary) furnished to the individual in-
volved any item or service for which payment 
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 sub-
ject 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
PROS-
THETIC 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 
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paragraph (23) of subsection (a) shall apply to pros-
thetic devices, orthotics, and prosthetics in the same 
manner as such provision applies to items for which 
payment may be made under such subsection’’ be-
fore the period at the end. 
(b) REPORT ON IDENTIFYING CLINICAL DIAGNOSTIC 
LABORATORY TESTS AT HIGH RISK FOR FRAUD AND EF-
FECTIVE MITIGATION MEASURES.—Not later than Janu-
ary 1, 2028, the Inspector General of the Department of 
Health and Human Services shall submit to Congress a 
report assessing fraud risks relating to clinical diagnostic 
laboratory tests for which payment may be made under 
section 1834A of the Social Security Act (42 U.S.C. 
1395m–1) and effective tools for reducing such fraudulent 
claims. The report may include, at the Inspector General’s 
discretion— 
(1) which, if any, clinical diagnostic laboratory 
tests are identified as being at high risk of fraudu-
lent claims, and an analysis of the factors that con-
tribute to such risk; 
(2) with respect to a clinical diagnostic labora-
tory test identified under paragraph (1) as being at 
high risk of fraudulent claims— 
(A) the amount payable under such section 
1834A with respect to such test; 
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(B) the number of such tests furnished to 
individuals enrolled under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et 
seq.); 
(C) whether an order for such a test was 
more likely to come from a provider with whom 
the individual involved did not have a prior re-
lationship, as determined on the basis of prior 
payment experience; and 
(D) the frequency with which a claim for 
payment under such section 1834A included the 
payment modifier identified by code 59 or 91; 
and 
(3) suggested strategies for reducing the num-
ber of fraudulent claims made with respect to tests 
so identified as being at high risk, including— 
(A) an analysis of whether the Centers for 
Medicare & Medicaid Services can detect aber-
rant billing patterns with respect to such tests 
in a timely manner; 
(B) any strategies for identifying and mon-
itoring the providers who are outliers with re-
spect to the number of such tests that such pro-
viders order; and 
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(C) targeted education efforts to mitigate 
improper billing for such tests; and 
(4) such other information as the Inspector 
General determines appropriate. 
(c) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Inspector General 
of the Department of Health and Human Services, out 
of any money in the Treasury not otherwise appropriated, 
$1,200,000 for fiscal year 2026, to remain available until 
expended, to carry out this section. 
SEC. 6213. GUIDANCE ON FURNISHING SERVICES VIA TELE-
HEALTH TO INDIVIDUALS WITH LIMITED 
ENGLISH PROFICIENCY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, the Secretary of Health 
and Human Services, in consultation with 1 or more enti-
ties from each of the categories described in paragraphs 
(1) through (7) of subsection (b), shall issue and dissemi-
nate, or update and revise as applicable, guidance for the 
entities described in such subsection on the following: 
(1) Best practices on facilitating and inte-
grating use of interpreters during a telemedicine ap-
pointment. 
(2) Best practices on providing accessible in-
structions on how to access telecommunications sys-
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tems (as such term is used for purposes of section 
1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)) for individuals with limited English pro-
ficiency. 
(3) Best practices on improving access to dig-
ital patient portals for individuals with limited 
English proficiency. 
(4) Best practices on integrating the use of 
video platforms that enable multi-person video calls 
furnished via a telecommunications system for pur-
poses of providing interpretation during a telemedi-
cine appointment for an individual with limited 
English proficiency. 
(5) Best practices for providing patient mate-
rials, communications, and instructions in multiple 
languages, including text message appointment re-
minders and prescription information. 
(b) ENTITIES DESCRIBED.—For purposes of sub-
section (a), an entity described in this subsection is an 
entity in 1 or more of the following categories: 
(1) Health information technology service pro-
viders, including— 
(A) electronic medical record companies; 
(B) remote patient monitoring companies; 
and 
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22:21 Jan 26, 2026
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H7148
kjohnson on DSK7ZCZBW3PROD with $$_JOB