3588 
† HR 2617 EAS2 
nection with the process for the review 
of biosimilar biological product appli-
cations, is no less than $20,000,000, 
multiplied by the adjustment factor 
applicable to the fiscal year involved.’’; 
and 
(2) in subparagraph (C), by striking ‘‘subpara-
graph (B) in any fiscal year if the costs described in 
such subparagraph’’ and inserting ‘‘subparagraph 
(B)(i) in any fiscal year if the costs allocated as de-
scribed in subclause (I) or (II) of such subparagraph, 
as applicable,’’. 
(c) GDUFA AUTHORITY.—Section 744B of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 379j–42) is 
amended— 
(1) 
in 
subsection 
(e)(2), 
by 
striking 
‘‘744A(11)(C)’’ and inserting ‘‘744A(12)(C)’’; and 
(2) in subsection (i)(2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘available for a fiscal 
year beginning after fiscal year 2012’’ and 
inserting the following: ‘‘available— 
‘‘(I) for fiscal year 2023,’’;
3589 
† HR 2617 EAS2 
(ii) by striking ‘‘the fiscal year in-
volved.’’ and inserting ‘‘such fiscal year; 
and’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(II) for fiscal year 2024 and 
each subsequent fiscal year, to defray 
the costs of human generic drug activi-
ties (including such costs for an addi-
tional number of full-time equivalent 
positions in the Department of Health 
and Human Services to be engaged in 
such activities), only if the sum of the 
amounts allocated by the Secretary for 
such costs, excluding costs paid from 
fees collected under this section, plus 
other costs for the maintenance, ren-
ovation, and repair of facilities and 
acquisition, maintenance, and repair 
of fixtures, furniture, and other nec-
essary materials and supplies in con-
nection with human generic drug ac-
tivities, is no less than $97,000,000 
multiplied by the adjustment factor de-
3590 
† HR 2617 EAS2 
fined in section 744A(3) applicable to 
the fiscal year involved.’’; and 
(B) in subparagraph (B), by striking ‘‘for 
human generic activities’’ and inserting ‘‘as de-
scribed in subclause (I) or (II) of such subpara-
graph, as applicable,’’. 
(d) MDUFA AUTHORITY.—Section 738 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 379j), as amend-
ed by section 3309, is further amended— 
(1) in subsection (e)(2)(B)(iii), by inserting ‘‘, if 
extant,’’ after ‘‘national taxing authority’’; 
(2) in subsection (h)(2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘shall be available to 
defray’’ and inserting the following: ‘‘shall 
be available— 
‘‘(I) for fiscal year 2023, to de-
fray’’; 
(ii) by striking the period and insert-
ing ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(II) for fiscal year 2024 and 
each subsequent fiscal year, to defray 
the costs of the resources allocated for
3591 
† HR 2617 EAS2 
the process for the review of device ap-
plications (including such costs for an 
additional number of full-time equiva-
lent positions in the Department of 
Health and Human Services to be en-
gaged in such process), only if the sum 
of the amounts allocated by the Sec-
retary for such costs, excluding costs 
paid from fees collected under this sec-
tion, plus other costs for the mainte-
nance, renovation, and repair of facili-
ties and acquisition, maintenance, and 
repair of fixtures, furniture and other 
necessary materials and supplies in 
connection with the process for the re-
view of device applications, is no less 
than the amount allocated for such 
costs, excluding any such costs paid 
from fees collected under this section, 
for fiscal year 2009 multiplied by the 
adjustment factor.’’; and 
(B) in subparagraph (B)(i), in the matter 
preceding subclause (I), by striking ‘‘for the 
process for the review of device applications’’ and
3592 
† HR 2617 EAS2 
inserting ‘‘as described in subclause (I) or (II) of 
such subparagraph, as applicable’’; and 
(3) in subsection (g)(3), by striking ‘‘737(9)(C)’’ 
and inserting ‘‘737(10)(C)’’. 
(e) TECHNICAL CORRECTION.— 
(1) IN GENERAL.—Section 905(b)(2) of the FDA 
Reauthorization Act of 2017 (Public Law 115–52) is 
amended by striking ‘‘Section 738(h) of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 379j(h)) is 
amended’’ and inserting ‘‘Subsection (g) of section 
738 of the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 
379j), 
as 
so 
redesignated 
by 
section 
203(f)(2)(B)(i), is amended’’. 
(2) EFFECTIVE DATE.—The amendment made by 
paragraph (1) shall take effect as though included in 
the enactment of section 905 of the FDA Reauthoriza-
tion Act of 2017 (Public Law 115–52). 
SEC. 3626. USER FEE PROGRAM TRANSPARENCY AND AC-
COUNTABILITY. 
(a) PDUFA.— 
(1) REAUTHORIZATION; REPORTING
REQUIRE-
MENTS.—Section 736B(a) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 379h–2(a)) is amend-
ed— 
(A) in paragraph (1)—
3593 
† HR 2617 EAS2 
(i) in subparagraph (B)— 
(I) in clause (vii), by striking ‘‘; 
and’’ and inserting a semicolon; 
(II) in clause (viii), by striking 
the period and inserting ‘‘; and’’; and 
(III) by adding at the end the fol-
lowing: 
‘‘(ix) the number of investigational 
new drug applications submitted per fiscal 
year, including for each review division.’’; 
and 
(ii) by adding at the end the following 
flush text: 
‘‘Nothing in subparagraph (B) shall be construed to 
authorize the disclosure of information that is prohib-
ited from disclosure under section 301(j) of this Act 
or section 1905 of title 18, United States Code, or 
that is subject to withholding under section 552(b)(4) 
of title 5, United States Code.’’; 
(B) by adding at the end of paragraph 
(3)(B) the following: 
‘‘(v) For fiscal years 2023 and 2024, of 
the meeting requests from sponsors for 
which the Secretary has determined that a 
face-to-face meeting is appropriate, the
3594 
† HR 2617 EAS2 
number of face-to-face meetings requested by 
sponsors to be conducted in person (in such 
manner as the Secretary shall prescribe on 
the website of the Food and Drug Adminis-
tration), and the number of such in-person 
meetings granted by the Secretary, with 
both such numbers disaggregated by the rel-
evant agency center.’’; and 
(C) in paragraph (4)— 
(i) by amending subparagraph (A) to 
read as follows: 
‘‘(A) data, analysis, and discussion of the 
changes in the number of individuals hired as 
agreed upon in the letters described in section 
1001(b) of the Prescription Drug User Fee 
Amendments of 2022 and the number of remain-
ing vacancies, the number of full-time equiva-
lents funded by fees collected pursuant to section 
736, and the number of full-time equivalents 
funded by budget authority at the Food and 
Drug Administration by each division within the 
Center for Drug Evaluation and Research, the 
Center for Biologics Evaluation and Research, 
the Office of Regulatory Affairs, and the Office 
of the Commissioner;’’;
3595 
† HR 2617 EAS2 
(ii) by amending subparagraph (B) to 
read as follows: 
‘‘(B) data, analysis, and discussion of the 
changes in the fee revenue amounts and costs for 
the process for the review of human drug appli-
cations, including identifying— 
‘‘(i) drivers of such changes; and 
‘‘(ii) changes in the average total cost 
per full-time equivalent in the prescription 
drug review program;’’; 
(iii) in subparagraph (C), by striking 
the period and inserting ‘‘; and’’; and 
(iv) by adding at the end the following: 
‘‘(D) data, analysis, and discussion of the 
changes in the average full-time equivalent hours 
required to complete review of each type of 
human drug application.’’. 
(2) REAUTHORIZATION.—Section 736B(f) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379h–2(f)) is amended— 
(A) 
by 
redesignating 
paragraphs 
(4) 
through (6) as paragraphs (5) through (7), re-
spectively; 
(B) by inserting after paragraph (3) the fol-
lowing:
3596 
† HR 2617 EAS2 
‘‘(4) UPDATES TO CONGRESS.—The Secretary, in 
consultation with regulated industry, shall provide 
regular updates on negotiations on the reauthoriza-
tion of this part to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives.’’; and 
(C) in paragraph (7), as so redesignated— 
(i) in subparagraph (A)— 
(I) by striking ‘‘Before presenting 
the recommendations developed under 
paragraphs (1) through (5) to the Con-
gress, the’’ and inserting ‘‘The’’; and 
(II) by inserting ‘‘, not later than 
30 days after each such negotiation 
meeting’’ before the period at the end; 
and 
(ii) in subparagraph (B), by inserting 
‘‘, in sufficient detail,’’ after ‘‘shall summa-
rize’’. 
(b) MDUFA.— 
(1) REAUTHORIZATION; REPORTING
REQUIRE-
MENTS.—Section 738A(a)(1)(A) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 379j–1(a)(1)(A)) 
is amended—
3597 
† HR 2617 EAS2 
(A) in clause (ii)— 
(i) in subclause (II), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in subclause (III), by striking the 
period and inserting a semicolon; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(IV) the number of investiga-
tional device exemption applications 
submitted under section 520(g) per fis-
cal year, including for each review di-
vision; and 
‘‘(V) the number of expedited de-
velopment and priority review requests 
and designations under section 515B 
per fiscal year, including for each re-
view division. 
Nothing in this clause shall be construed to 
authorize the disclosure of information that 
is prohibited from disclosure under section 
301(j) of this Act or section 1905 of title 18, 
United States Code, or that is subject to 
withholding under section 552(b)(4) of title 
5, United States Code.’’; and
3598 
† HR 2617 EAS2 
(B) in clause (iv) (relating to rationale for 
MDUFA program changes)— 
(i) by amending subclause (I) to read 
as follows: 
‘‘(I) data, analysis, and discus-
sion of the changes in the number of 
individuals hired as agreed upon in 
the letters described in section 2001(b) 
of the Medical Device User Fee Amend-
ments of 2022 and the number of re-
maining vacancies, the number of full- 
time equivalents funded by fees col-
lected pursuant to section 738, and the 
number of full time equivalents funded 
by budget authority at the Food and 
Drug Administration by each division 
within the Center for Devices and Ra-
diological Health, the Center for Bio-
logics Evaluation and Research, the 
Office of Regulatory Affairs, and the 
Office of the Commissioner;’’; 
(ii) by amending subclause (II) to read 
as follows: 
‘‘(II) data, analysis, and discus-
sion of the changes in the fee revenue
3599 
† HR 2617 EAS2 
amounts and costs for the process for 
the review of device applications, in-
cluding identifying— 
‘‘(aa) drivers of such changes; 
and 
‘‘(bb) changes in the average 
total cost per full-time equivalent 
in the medical device review pro-
gram;’’; 
(iii) in subclause (III), by striking the 
period and inserting ‘‘; and’’; and 
(iv) by adding at the end the following: 
‘‘(IV) data, analysis, and discus-
sion of the changes in the average full- 
time equivalent hours required to com-
plete review of medical device applica-
tion types.’’. 
(2) REAUTHORIZATION.—Section 738A(b) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379j–1(b)) is amended— 
(A) 
by 
redesignating 
paragraphs 
(4) 
through (6) as paragraphs (5) through (7), re-
spectively; 
(B) by inserting after paragraph (3) the fol-
lowing:
3600 
† HR 2617 EAS2 
‘‘(4) UPDATES TO CONGRESS.—The Secretary, in 
consultation with regulated industry, shall provide 
regular updates on negotiations on the reauthoriza-
tion of this part to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives.’’; and 
(C) in paragraph (7), as so redesignated— 
(i) in subparagraph (A)— 
(I) by striking ‘‘Before presenting 
the recommendations developed under 
paragraphs (1) through (5) to the Con-
gress, the’’ and inserting ‘‘The’’; and 
(II) by inserting ‘‘, not later than 
30 days after each such negotiation 
meeting’’ before the period at the end; 
and 
(ii) in subparagraph (B), by inserting 
‘‘, in sufficient detail,’’ after ‘‘shall summa-
rize’’. 
(c) GDUFA.— 
(1) REAUTHORIZATION; REPORTING
REQUIRE-
MENTS.—Section 744C(a)(3) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 379j–43(a)(3)) is 
amended—
3601 
† HR 2617 EAS2 
(A) by amending subparagraph (A) to read 
as follows: 
‘‘(A) data, analysis, and discussion of the 
changes in the number of individuals hired as 
agreed upon in the letters described in section 
3001(b) of the Generic Drug User Fee Amend-
ments of 2022 and the number of remaining va-
cancies, the number of full-time equivalents fund-
ed by fees collected pursuant to section 744B, 
and the number of full time equivalents funded 
by budget authority at the Food and Drug Ad-
ministration by each division within the Center 
for Drug Evaluation and Research, the Center 
for Biologics Evaluation and Research, the Office 
of Regulatory Affairs, and the Office of the Com-
missioner;’’; 
(B) by amending subparagraph (B) to read 
as follows: 
‘‘(B) data, analysis, and discussion of the 
changes in the fee revenue amounts and costs for 
human generic drug activities, including— 
‘‘(i) 
identifying 
drivers 
of 
such 
changes; and
3602 
† HR 2617 EAS2 
‘‘(ii) changes in the total average cost 
per full-time equivalent in the generic drug 
review program;’’; 
(C) in subparagraph (C), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(D) data, analysis, and discussion of the 
changes in the average full-time equivalent hours 
required to complete review of each type of abbre-
viated new drug application.’’. 
(2) REAUTHORIZATION.—Section 744C(f) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379j–43(f)) is amended— 
(A) 
by 
redesignating 
paragraphs 
(4) 
through (6) as paragraphs (5) through (7), re-
spectively; 
(B) by inserting after paragraph (3) the fol-
lowing: 
‘‘(4) UPDATES TO CONGRESS.—The Secretary, in 
consultation with regulated industry, shall provide 
regular updates on negotiations on the reauthoriza-
tion of this part to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives.’’; and
3603 
† HR 2617 EAS2 
(C) in paragraph (7), as so redesignated— 
(i) in subparagraph (A)— 
(I) by striking ‘‘Before presenting 
the recommendations developed under 
paragraphs (1) through (5) to the Con-
gress, the’’ and inserting ‘‘The’’; and 
(II) by inserting ‘‘, not later than 
30 days after each such negotiation 
meeting’’ before the period at the end; 
and 
(ii) in subparagraph (B), by inserting 
‘‘, in sufficient detail,’’ after ‘‘shall summa-
rize’’. 
(d) BSUFA.— 
(1) REAUTHORIZATION; REPORTING
REQUIRE-
MENTS.—Section 744I(a)(4) of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 379j–53(a)(4)) is 
amended— 
(A) by amending subparagraph (A) to read 
as follows: 
‘‘(A) data, analysis, and discussion of the 
changes in the number of individuals hired as 
agreed upon in the letters described in section 
4001(b) of the Biosimilar User Fee Amendments 
of 2022 and the number of remaining vacancies,
3604 
† HR 2617 EAS2 
the number of full-time equivalents funded by 
fees collected pursuant to section 744H, and the 
number of full time equivalents funded by budget 
authority at the Food and Drug Administration 
by each division within the Center for Drug 
Evaluation and Research, the Center for Bio-
logics Evaluation and Research, the Office of 
Regulatory Affairs, and the Office of the Com-
missioner;’’; 
(B) by amending subparagraph (B) to read 
as follows: 
‘‘(B) data, analysis, and discussion of the 
changes in the fee revenue amounts and costs for 
the process for the review of biosimilar biological 
product applications, including identifying— 
‘‘(i) drivers of such changes; and 
‘‘(ii) changes in the average total cost 
per full-time equivalent in the biosimilar 
biological product review program;’’; 
(C) in subparagraph (C), by striking the 
period at the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(D) data, analysis, and discussion of the 
changes in the average full-time equivalent hours
3605 
† HR 2617 EAS2 
required to complete review of each type of bio-
similar biological product application.’’. 
(2) REAUTHORIZATION.—Section 744I(f) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379j–53(f)) is amended— 
(A) by redesignating paragraphs (2) and 
(3) as paragraphs (5) and (6), respectively; 
(B) by inserting after paragraph (1) the fol-
lowing: 
‘‘(2) PRIOR PUBLIC INPUT.—Prior to beginning 
negotiations with the regulated industry on the reau-
thorization of this part, the Secretary shall— 
‘‘(A) publish a notice in the Federal Reg-
ister requesting public input on the reauthoriza-
tion; 
‘‘(B) hold a public meeting at which the 
public may present its views on the reauthoriza-
tion; 
‘‘(C) provide a period of 30 days after the 
public meeting to obtain written comments from 
the public suggesting changes to this part; and 
‘‘(D) publish the comments on the Food and 
Drug Administration’s website. 
‘‘(3) PERIODIC
CONSULTATION.—Not less fre-
quently than once every month during negotiations
3606 
† HR 2617 EAS2 
with the regulated industry, the Secretary shall hold 
discussions with representatives of patient and con-
sumer advocacy groups to continue discussions of 
their views on the reauthorization and their sugges-
tions for changes to this part as expressed under 
paragraph (2). 
‘‘(4) UPDATES TO CONGRESS.—The Secretary, in 
consultation with regulated industry, shall provide 
regular updates on negotiations on the reauthoriza-
tion of this part to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House of 
Representatives.’’; and 
(C) by adding at the end the following: 
‘‘(7) MINUTES OF NEGOTIATION MEETINGS.— 
‘‘(A) PUBLIC AVAILABILITY.—The Secretary 
shall make publicly available, on the public 
website of the Food and Drug Administration, 
minutes of all negotiation meetings conducted 
under this subsection between the Food and Drug 
Administration and the regulated industry, not 
later than 30 days after each such negotiation 
meeting. 
‘‘(B) CONTENT.—The minutes described 
under subparagraph (A) shall summarize, in suf-
3607 
† HR 2617 EAS2 
ficient detail, any substantive proposal made by 
any party to the negotiations as well as signifi-
cant controversies or differences of opinion dur-
ing the negotiations and their resolution.’’. 
SEC. 3627. IMPROVING INFORMATION TECHNOLOGY SYS-
TEMS OF THE FOOD AND DRUG ADMINISTRA-
TION. 
(a) FDA STRATEGIC
INFORMATION
TECHNOLOGY 
PLAN.— 
(1) IN GENERAL.—Not later than September 30, 
2023, and at least every 4 years thereafter, the Sec-
retary shall develop and submit to the appropriate 
committees of Congress and post on the website of the 
Food and Drug Administration, a coordinated infor-
mation technology strategic plan to modernize the in-
formation technology systems of the Food and Drug 
Administration. Each such report shall be known as 
the ‘‘Food and Drug Administration Strategic Infor-
mation Technology Plan’’. The first such report may 
include the Data and Technology Modernization 
Strategy, as set forth in the letters described in sec-
tion 1001(b) of the FDA User Fee Reauthorization 
Act of 2022 (division F of Public Law 117–180).
3608 
† HR 2617 EAS2 
(2) CONTENT OF STRATEGIC PLAN.—The Food 
and Drug Administration Strategic Information 
Technology Plan under paragraph (1) shall include— 
(A) agency-wide strategic goals and prior-
ities for modernizing the information technology 
systems of the Food and Drug Administration to 
maximize the efficiency and effectiveness of such 
systems for enabling the Food and Drug Admin-
istration to fulfill its public health mission; 
(B) specific activities and strategies for 
achieving the goals and priorities identified 
under subparagraph (A), and specific milestones, 
metrics, and performance measures for assessing 
progress against such strategic goals and prior-
ities; 
(C) specific activities and strategies for im-
proving and streamlining internal coordination 
and communication within the Food and Drug 
Administration, including for activities and 
communications related to signals of potential 
public health concerns; 
(D) challenges and risks the Food and Drug 
Administration will face in meeting its strategic 
goals and priorities, and the activities the Food
3609 
† HR 2617 EAS2 
and Drug Administration will undertake to over-
come those challenges and mitigate those risks; 
(E) the ways in which the Food and Drug 
Administration will use the Plan to guide and 
coordinate the projects and activities of the Food 
and Drug Administration across its offices and 
centers; and 
(F) a skills inventory, needs assessment, gap 
analysis, and initiatives to address skills gaps as 
part of a strategic approach to information tech-
nology human capital planning. 
(3) EVALUATION OF PROGRESS.—Each Food and 
Drug Administration Strategic Information Tech-
nology Plan issued pursuant to this subsection, with 
the exception of the first such Food and Drug Admin-
istration Strategic Information Technology Plan, 
shall include an evaluation of— 
(A) the progress the Secretary has made, 
based on the metrics, benchmarks, and other 
milestones that measure successful development 
and implementation of information technology 
systems; and 
(B) whether actions taken in response to the 
previous Plan improved the capacity of the Food 
and Drug Administration to achieve the strategic
3610 
† HR 2617 EAS2 
goals and priorities set forth in such previous 
Plans. 
(b) GAO REPORT.— 
(1) IN GENERAL.—Not later than September 30, 
2026, the Comptroller General of the United States 
shall submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representa-
tives a report assessing the implementation of the 
Food and Drug Administration Strategic Information 
Technology Plan adopted pursuant to subsection (a). 
(2) CONTENT OF REPORT.—The report required 
under paragraph (1) shall include an assessment of— 
(A) the development and implementation of 
the Food and Drug Administration Strategic In-
formation Technology Plan, including the suffi-
ciency of the plan, progress of the Food and 
Drug Administration in meeting the results-ori-
ented goals, milestones, and performance meas-
ures identified in such plan and any gaps in 
such implementation; 
(B) the efficiency and effectiveness of the 
Food and Drug Administration’s expenditures 
on information technology systems over the pre-
ceding 10 fiscal years, including the implementa-
3611 
† HR 2617 EAS2 
tion by the Food and Drug Administration of 
the Technology Modernization Action Plan and 
Data Modernization Action Plan; 
(C) challenges posed by the information 
technology systems of the Food and Drug Admin-
istration for carrying out the Food and Drug 
Administration’s public health mission, includ-
ing on meeting user fee agreement performance 
goals, conducting inspections, responding to 
identified safety concerns, and keeping pace with 
new scientific and medical advances; and 
(D) recommendations for the Food and 
Drug Administration to address the identified 
challenges, improve its implementation of the 
Food and Drug Administration Strategic Infor-
mation Technology Plan, and to otherwise im-
prove the Food and Drug Administration’s infor-
mation technology systems. 
SEC. 3628. REPORTING ON MAILROOM AND OFFICE OF THE 
EXECUTIVE SECRETARIAT OF THE FOOD AND 
DRUG ADMINISTRATION. 
(a) REPORT.—Not later than 90 days after the date 
of enactment of this Act, the Secretary shall report to the 
Committee on Health, Education, Labor, and Pensions of
3612 
† HR 2617 EAS2 
the Senate and the Committee on Energy and Commerce 
of the House of Representatives on— 
(1) information related to policies, procedures, 
and activities of the mailroom and the Office of the 
Executive Secretariat of the Food and Drug Adminis-
tration, including— 
(A) taking receipt, tracking, managing, and 
prioritizing confidential informant complaints; 
(B) taking receipt of common carrier pack-
ages to the Food and Drug Administration; 
(C) the organizational structure and man-
agement of the mailroom; 
(D) the organizational structure and man-
agement of the Office of the Executive Secre-
tariat; 
(E) the total number of employees and con-
tractors in the mailroom including those working 
remotely and those working in person; 
(F) the total number of employees and con-
tractors in the Office of the Executive Secre-
tariat; 
(G) the number of vacant positions in the 
mailroom; 
(H) the number of vacant positions in the 
Office of the Executive Secretariat;
3613 
† HR 2617 EAS2 
(I) the average number of days for response 
to correspondence received by the Office of the 
Secretariat; 
(J) the extent to which there is a backlog of 
common carrier packages received by the mail-
room and the number of common carrier pack-
ages in any backlog; 
(K) the extent to which there is a backlog of 
correspondence in the Office of the Executive Sec-
retariat that has not been appropriately re-
sponded to by the Food and Drug Administra-
tion and the number of correspondence or com-
mon carrier packages in any backlog; 
(L) a rationale for the failure of the Office 
of the Executive Secretariat to respond to cor-
respondence in any backlog and the position of 
the decision-making official who determined not 
to respond to such correspondence; 
(M) the number of whistleblower correspond-
ence received, including within each agency cen-
ter; 
(N) the amount of resources expended for 
the mailroom, including a breakdown of budget 
authority and user fee dollars;
3614 
† HR 2617 EAS2 
(O) the amount of resources expended for 
the Office of the Executive Secretariat and cor-
respondence-related activities, including a break-
down of budget authority and user fee dollars; 
and 
(P) the performance of third-party contrac-
tors responsible for correspondence-related activi-
ties with respect to the receipt and tracking of 
correspondence, and efforts by the Food and 
Drug Administration to improve performance by 
such contractors; and 
(2) the development and implementation of new 
or revised policies and procedures of the Food and 
Drug Administration to monitor and ensure— 
(A) the effective receipt, tracking, man-
aging, and prioritization of such complaints; 
and 
(B) the effective receipt of common carrier 
packages to the Food and Drug Administration. 
(b) ANNUAL REPORT.—Not later than the end of each 
of fiscal years 2023 and 2024, the Secretary shall issue a 
report to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives on the implemen-
tation of the new or revised policies of the Food and Drug
3615 
† HR 2617 EAS2 
Administration reported under subsection (a)(2), and since 
such implementation— 
(1) the volume of incoming common carrier 
packages to the mailroom; 
(2) the volume of incoming correspondence to the 
Office of the Executive Secretariat; 
(3) the extent to which new backlogs occur in the 
processing of common carrier packages received by the 
mailroom; 
(4) the extent to which new backlogs occur in the 
processing of correspondence received by the Office of 
the Executive Secretariat; 
(5) the length of time required to resolve each 
such backlog; 
(6) any known issues of unreasonable delays in 
correspondence being provided to the intended recipi-
ent, or in correspondence being lost, and the measures 
taken to remedy such delays or lost items; 
(7) the average number of days it takes to re-
spond to correspondence received by the Office of the 
Executive Secretariat; 
(8) the resources expended by the mailroom, in-
cluding a breakdown of budget authority and user fee 
dollars; and
3616 
† HR 2617 EAS2 
(9) the resources expended by the Office of the 
Executive Secretariat on correspondence-related ac-
tivities, including a breakdown of budget authority 
and user fee dollars. 
(c) GAO REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General of 
the United States shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of Represent-
atives a report assessing the policies and practices of the 
Division of Executive Operations of the Office of the Execu-
tive Secretariat of the Food and Drug Administration with 
respect 
to 
the 
receipt, 
tracking, 
managing, 
and 
prioritization of correspondence. 
SEC. 3629. FACILITATING THE USE OF REAL WORLD EVI-
DENCE. 
(a) GUIDANCE.—Not later than 1 year after the date 
of enactment of this Act, the Secretary shall issue or revise 
existing guidance on considerations for the use of real world 
data and real world evidence to support regulatory deci-
sion-making, as follows: 
(1) With respect to drugs, such guidance shall 
address the use of such data and evidence to support 
the approval of a drug application under section 505 
of the Federal Food, Drug, and Cosmetic Act (21
3617 
† HR 2617 EAS2 
U.S.C. 355) or a biological product application under 
section 351 of the Public Health Service Act (42 
U.S.C. 262), and to support an investigational use 
exemption submission under section 505(i) of the Fed-
eral Food, Drug, and Cosmetic Act (21 U.S.C. 355(i)) 
or section 351(a)(3) of the Public Health Service Act 
(42 U.S.C. 262(a)(3)). Such guidance shall include 
considerations for the inclusion, in such applications 
and submissions, of real world data and real world 
evidence obtained as a result of the use of drugs au-
thorized for emergency use under section 564 of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
360bbb–3), and considerations for standards and 
methodologies for collection and analysis of real world 
evidence included in such applications and submis-
sions, as appropriate. 
(2) With respect to devices, such guidance shall 
address the use of such data and evidence to support 
the approval, clearance, or classification of a device 
pursuant to an application or submission submitted 
under section 510(k), 513(f)(2), or 515 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360(k), 
360c(f)(2), 360e), to support an investigational use 
exemption submission under section 520(g) of such 
Act (21 U.S.C. 360j(g)), and to support a determina-
3618 
† HR 2617 EAS2 
tion by the Secretary for purposes of section 353 of 
the Public Health Service Act (42 U.S.C. 263a) (in-
cluding the category described under subsection (d)(3) 
of such section). Such guidance shall include consider-
ations for the inclusion, in such applications and sub-
missions, of real world data and real world evidence 
obtained as a result of the use of devices authorized 
for emergency use under section 564 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–3), 
including considerations related to a determination 
under section 353(d)(3) of the Public Health Service 
Act (42 U.S.C. 263a(d)(3)), and considerations for 
standards and methodologies for collection and anal-
ysis of real world evidence included in such applica-
tions, submissions, or determinations, as appropriate. 
(b) REPORT TO CONGRESS.—Not later than 2 years 
after the end of the public health emergency declared by the 
Secretary under section 319 of the Public Health Service 
Act (42 U.S.C. 247d) on January 31, 2020, with respect 
to COVID–19, the Secretary shall submit a report to the 
Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce 
of the House of Representatives on— 
(1) the number of applications, submissions, or 
requests submitted for clearance, approval, or author-
3619 
† HR 2617 EAS2 
ization under section 505, 510(k), 513(f)(2), or 515 of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
355, 360(k), 360c(f)(2), 360e) or section 351 of the 
Public Health Service Act (42 U.S.C. 262), for which 
an authorization under section 564 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb–3) 
was previously granted; 
(2) of the number of applications so submitted, 
the number of such applications— 
(A) for which real world evidence was sub-
mitted and used to support a regulatory deci-
sion; and 
(B) for which real world evidence was sub-
mitted and determined to be insufficient to sup-
port a regulatory decision; and 
(3) a summary explanation of why, in the case 
of applications described in paragraph (2)(B), real 
world evidence could not be used to support regu-
latory decisions. 
(c) INFORMATION DISCLOSURE.—Nothing in this sec-
tion shall be construed to authorize the disclosure of infor-
mation that is prohibited from disclosure under section 
1905 of title 18, United States Code, or subject to with-
holding under subsection (b)(4) of section 552 of title 5,
3620 
† HR 2617 EAS2 
United States Code (commonly referred to as the ‘‘Freedom 
of Information Act’’). 
SEC. 3630. FACILITATING EXCHANGE OF PRODUCT INFOR-
MATION PRIOR TO APPROVAL. 
(a) IN GENERAL.—Section 502 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 352) is amended— 
(1) in paragraph (a)— 
(A) by striking ‘‘drugs for coverage’’ and in-
serting ‘‘drugs or devices for coverage’’; and 
(B) by striking ‘‘drug’’ each place it ap-
pears and inserting ‘‘drug or device’’, respec-
tively; 
(2) in paragraphs (a)(1) and (a)(2)(B), by strik-
ing ‘‘under section 505 or under section 351 of the 
Public Health Service Act’’ and inserting ‘‘under sec-
tion 505, 510(k), 513(f)(2), or 515 of this Act or sec-
tion 351 of the Public Health Service Act’’; 
(3) in paragraph (a)(1)— 
(A) by striking ‘‘under section 505 or under 
section 351(a) of the Public Health Service Act’’ 
and inserting ‘‘under section 505, 510(k), 
513(f)(2), or 515 of this Act or section 351 of the 
Public Health Service Act’’; and 
(B) by striking ‘‘in section 505(a) or in 
subsections (a) and (k) of section 351 of the Pub-
3621 
† HR 2617 EAS2 
lic Health Service Act’’ and inserting ‘‘in section 
505, 510(k), 513(f)(2), or 515 of this Act or sec-
tion 351 of the Public Health Service Act’’; and 
(4) by adding at the end the following: 
‘‘(gg)(1) Unless its labeling bears adequate directions 
for use in accordance with paragraph (f), except that (in 
addition to drugs or devices that conform with exemptions 
pursuant to such paragraph) no drug or device shall be 
deemed to be misbranded under such paragraph through the 
provision of truthful and not misleading product informa-
tion to a payor, formulary committee, or other similar enti-
ty with knowledge and expertise in the area of health care 
economic analysis carrying out its responsibilities for the 
selection of drugs or devices for coverage or reimbursement 
if the product information relates to an investigational 
drug or device or investigational use of a drug or device 
that is approved, cleared, granted marketing authorization, 
or licensed under section 505, 510(k), 513(f)(2), or 515 of 
this Act or section 351 of the Public Health Service Act 
(as applicable), provided— 
‘‘(A) the product information includes— 
‘‘(i) a clear statement that the investiga-
tional drug or device or investigational use of a 
drug or device has not been approved, cleared, 
granted marketing authorization, or licensed
3622 
† HR 2617 EAS2 
under section 505, 510(k), 513(f)(2), or 515 of 
this Act or section 351 of the Public Health 
Service Act (as applicable) and that the safety 
and effectiveness of such drug or device for such 
use has not been established; 
‘‘(ii) information related to the stage of de-
velopment of the drug or device involved, such 
as— 
‘‘(I) the status of any study or studies 
in which the investigational drug or device 
or investigational use is being investigated; 
‘‘(II) how the study or studies relate to 
the overall plan for the development of the 
drug or device; and 
‘‘(III) whether an application, pre-
market notification, or request for classi-
fication for the investigational drug or de-
vice or investigational use has been sub-
mitted to the Secretary and when such a 
submission is planned; 
‘‘(iii) in the case of information that in-
cludes factual presentations of results from stud-
ies, which shall not be selectively presented, a de-
scription of—
3623 
† HR 2617 EAS2 
‘‘(I) all material aspects of study de-
sign, methodology, and results; and 
‘‘(II) all material limitations related to 
the study design, methodology, and results; 
‘‘(iv) where applicable, a prominent state-
ment disclosing the indication or indications for 
which the Secretary has approved, granted mar-
keting authorization, cleared, or licensed the 
product 
pursuant 
to 
section 
505, 
510(k), 
513(f)(2), or 515 of this Act or section 351 of the 
Public Health Service Act, and a copy of the 
most current required labeling; and 
‘‘(v) updated information, if previously 
communicated information becomes materially 
outdated as a result of significant changes or as 
a result of new information regarding the prod-
uct or its review status; and 
‘‘(B) the product information does not include— 
‘‘(i) information that represents that an un-
approved product— 
‘‘(I) has been approved, cleared, grant-
ed marketing authorization, or licensed 
under section 505, 510(k), 513(f)(2), or 515 
of this Act or section 351 of the Public 
Health Service Act (as applicable); or
3624 
† HR 2617 EAS2 
‘‘(II) has otherwise been determined to 
be safe or effective for the purpose or pur-
poses for which the drug or device is being 
studied; or 
‘‘(ii) information that represents that an 
unapproved use of a drug or device that has been 
so approved, granted marketing authorization, 
cleared, or licensed— 
‘‘(I) is so approved, granted marketing 
authorization, cleared, or licensed; or 
‘‘(II) that the product is safe or effec-
tive for the use or uses for which the drug 
or device is being studied. 
‘‘(2) For purposes of this paragraph, the term ‘product 
information’ includes— 
‘‘(A) information describing the drug or device 
(such as drug class, device description, and features); 
‘‘(B) information about the indication or indica-
tions being investigated; 
‘‘(C) the anticipated timeline for a possible ap-
proval, clearance, marketing authorization, or licen-
sure pursuant to section 505, 510(k), 513, or 515 of 
this Act or section 351 of the Public Health Service 
Act; 
‘‘(D) drug or device pricing information;
3625 
† HR 2617 EAS2 
‘‘(E) patient utilization projections; 
‘‘(F) product-related programs or services; and 
‘‘(G) factual presentations of results from studies 
that do not characterize or make conclusions regard-
ing safety or efficacy.’’. 
(b) GAO STUDY AND REPORT.—Beginning on the date 
that is 5 years and 6 months after the date of enactment 
of this Act, the Comptroller General of the United States 
shall conduct a study on the provision and use of informa-
tion pursuant to section 502(gg) of the Federal Food, Drug, 
and Cosmetic Act, as added by this subsection (a), between 
manufacturers of drugs and devices (as defined in section 
201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
321)) and entities described in such section 502(gg). Such 
study shall include an analysis of the following: 
(1) The types of information communicated be-
tween such manufacturers and payors. 
(2) The manner of communication between such 
manufacturers and payors. 
(3)(A) Whether such manufacturers file an ap-
plication for approval, marketing authorization, 
clearance, or licensing of a new drug or device or the 
new use of a drug or device that is the subject of com-
munication between such manufacturers and payors
3626 
† HR 2617 EAS2 
under section 502(gg) of the Federal Food, Drug, and 
Cosmetic Act, as added by subsection (a). 
(B) How frequently the Food and Drug Admin-
istration approves, grants marketing authorization, 
clears, or licenses the new drug or device or new use. 
(C) The timeframe between the initial commu-
nications permitted under section 502(gg) of the Fed-
eral Food, Drug, and Cosmetic Act, as added by sub-
section (a), regarding an investigational drug or de-
vice or investigational use, and the initial marketing 
of such drug or device. 
SEC. 3631. STREAMLINING BLOOD DONOR INPUT. 
Chapter 35 of title 44, United States Code, shall not 
apply to the collection of information to which a response 
is voluntary and that is initiated by the Secretary to solicit 
information from blood donors or potential blood donors to 
support the development of recommendations by the Sec-
retary, acting through the Commissioner of Food and 
Drugs, concerning blood donation.
3627 
† HR 2617 EAS2 
TITLE IV—MEDICARE 
PROVISIONS 
Subtitle A—Medicare Extenders 
SEC. 4101. 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), in the matter pre-
ceding clause (i), by striking ‘‘during the portion of 
fiscal year 2023 beginning on December 24, 2022, 
and ending on September 30, 2023, and in fiscal year 
2024’’ and inserting ‘‘in fiscal year 2025’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I)— 
(i) by striking ‘‘or portion of a fiscal 
year’’; and 
(ii) by striking ‘‘through 2022 and the 
portion of fiscal year 2023 beginning on 
October 1, 2022, and ending on December 
23, 2022’ ’’ and inserting ‘‘through 2024’’; 
(B) in subclause (III), by striking ‘‘through 
2022 and the portion of fiscal year 2023 begin-
ning on October 1, 2022, and ending on Decem-
3628 
† HR 2617 EAS2 
ber 23, 2022’ ’’ and inserting ‘‘through 2024’’; 
and 
(C) in subclause (IV), by striking ‘‘the por-
tion of fiscal year 2023 beginning on December 
24, 2022, and ending on September 30, 2023, 
and fiscal year 2024’’ and inserting ‘‘fiscal year 
2025’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
striking ‘‘through 2022 or during the portion of 
fiscal year 2023 beginning on October 1, 2022, 
and ending on December 23, 2022’ ’’ and insert-
ing ‘‘through 2024’’; and 
(B) in clause (ii), by striking ‘‘through 
2022 and the portion of fiscal year 2023 begin-
ning on October 1, 2022, and ending on Decem-
ber 23, 2022’ ’’ and inserting ‘‘through 2024’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
ices may implement the provisions of, including the amend-
ments made by, this section by program instruction or oth-
erwise.
3630 
† HR 2617 EAS2 
on December 23, 2022’’ and inserting ‘‘or fiscal year 
2000 through fiscal year 2024’’. 
SEC. 4103. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘January 
1, 2023’’ and inserting ‘‘January 1, 2025’’; and 
(2) in paragraph (13), by striking ‘‘January 1, 
2023’’ in each place it appears and inserting ‘‘Janu-
ary 1, 2025’’ in each such place. 
Subtitle B—Other Expiring 
Medicare Provisions 
SEC. 4111. EXTENDING INCENTIVE PAYMENTS FOR PARTICI-
PATION IN ELIGIBLE ALTERNATIVE PAYMENT 
MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Secu-
rity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A)— 
(A) by striking ‘‘2024’’ and inserting 
‘‘2025’’; and 
(B) by inserting ‘‘(or, with respect to 2025, 
3.5 percent)’’ after ‘‘5 percent’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B)—
3631 
† HR 2617 EAS2 
(i) in the header, by striking ‘‘2024’’ 
and inserting ‘‘2025’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2024’’ and inserting ‘‘2025’’; 
(B) in subparagraph (C)— 
(i) in the header, by striking ‘‘2025’’ 
and inserting ‘‘2026’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2025’’ and inserting ‘‘2026’’; 
and 
(C) in subparagraph (D), by striking ‘‘2023 
and 2024’’ and inserting ‘‘2023, 2024, and 
2025’’; and 
(3) in paragraph (4)(B), by inserting ‘‘(or, with 
respect to 2025, 3.5 percent)’’ after ‘‘5 percent’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), by striking ‘‘2024’’ and in-
serting ‘‘2025’’; and 
(2) in subclause (III), by striking ‘‘2025’’ and 
inserting ‘‘2026’’.
3632 
† HR 2617 EAS2 
SEC. 4112. EXTENSION OF SUPPORT FOR PHYSICIANS AND 
OTHER PROFESSIONALS IN ADJUSTING TO 
MEDICARE PAYMENT CHANGES. 
Section 1848 of the Social Security Act (42 U.S.C. 
1395w–4) is amended— 
(1) in subsection (c)(2)(B)(iv)(V), by striking 
‘‘2021 or 2022’’ and inserting ‘‘2021, 2022, 2023, or 
2024’’; and 
(2) in subsection (t)— 
(A) in the subsection header, by striking 
‘‘2021 
AND
2022’’ 
and 
inserting 
‘‘2021 
THROUGH 2024’’; 
(B) in paragraph (1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘during 2021 and 
2022’’ and inserting ‘‘during 2021, 2022, 
2023, and 2024’’; and 
(ii) in subparagraph (A), by striking 
at the end ‘‘and’’; 
(iii) in subparagraph (B), by striking 
at the end the period and inserting a semi-
colon; and 
(iv) by adding at the end the following 
new subparagraphs:
3633 
† HR 2617 EAS2 
‘‘(C) such services furnished on or after 
January 1, 2023, and before January 1, 2024, 
by 2.5 percent; and 
‘‘(D) such services furnished on or after 
January, 1, 2024, and before January 1, 2025, 
by 1.25 percent.’’; and 
(C) in paragraph (2)(C)— 
(i) in the subparagraph header, by 
striking ‘‘2021 AND 2022’’ and inserting ‘‘2021 
THROUGH 2024’’; 
(ii) by striking ‘‘for services furnished 
in 2021 or 2022’’ and inserting ‘‘for services 
furnished in 2021, 2022, 2023, or 2024’’; 
and 
(iii) by striking ‘‘or 2022, respectively’’ 
and inserting ‘‘, 2022, 2023, or 2024, re-
spectively’’. 
SEC. 4113. ADVANCING TELEHEALTH BEYOND COVID–19. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS AND EX-
PANDING ORIGINATING SITES
FOR TELEHEALTH SERV-
ICES.—Section 1834(m) of the Social Security Act (42 
U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii)— 
(A) by striking ‘‘With’’ and inserting ‘‘In 
the case that the emergency period described in
3634 
† HR 2617 EAS2 
section 1135(g)(1)(B) ends before December 31, 
2024, with’’; and 
(B) by striking ‘‘that are furnished during 
the 151-day period beginning on the first day 
after the end of the emergency period described 
in section 1135(g)(1)(B)’’ and inserting ‘‘that 
are furnished during the period beginning on the 
first day after the end of such emergency period 
and ending December 31, 2024’’; and 
(2) in paragraph (4)(C)(iii)— 
(A) by striking ‘‘With’’ and inserting ‘‘In 
the case that the emergency period described in 
section 1135(g)(1)(B) ends before December 31, 
2024, with’’; and 
(B) by striking ‘‘that are furnished during 
the 151-day period beginning on the first day 
after the end of the emergency period described 
in section 1135(g)(1)(B)’’ and inserting ‘‘that 
are furnished during the period beginning on the 
first day after the end of such emergency period 
and ending on December 31, 2024’’. 
(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 ‘‘and, for the 151-day period begin-
3635 
† HR 2617 EAS2 
ning on the first day after the end of the emergency period 
described in section 1135(g)(1)(B)’’ and inserting ‘‘and, in 
the case that the emergency period described in section 
1135(g)(1)(B) ends before December 31, 2024, for the period 
beginning on the first day after the end of such emergency 
period and ending on December 31, 2024’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FEDER-
ALLY 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 
‘‘during the 151-day period beginning on the first day after 
the end of such emergency period’’ and inserting ‘‘in the 
case that such emergency period ends before December 31, 
2024, during the period beginning on the first day after 
the end of such emergency period and ending on December 
31, 2024’’. 
(d) 
DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE FOR MENTAL HEALTH SERVICES FUR-
NISHED
THROUGH
TELEHEALTH
AND
TELECOMMUNI-
CATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—Section 1834(m)(7)(B)(i) of the Social Se-
curity Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amend-
ed, in the matter preceding subclause (I), by striking
3636 
† HR 2617 EAS2 
‘‘on or after the day that is the 152nd day after the 
end of the period at the end of the emergency sentence 
described in section 1135(g)(1)(B))’’ and inserting 
‘‘on or after January 1, 2025 (or, if later, the first 
day after the end of the emergency period described 
in section 1135(g)(1)(B))’’. 
(2) MENTAL
HEALTH
VISITS
FURNISHED
BY 
RURAL HEALTH CLINICS.—Section 1834(y) of the So-
cial Security Act (42 U.S.C. 1395m(y)) is amended— 
(A) in the heading, by striking ‘‘TO HOS-
PICE PATIENTS’’; and 
(B) in paragraph (2), by striking ‘‘prior to 
the day that is the 152nd day after the end of 
the emergency period described in section 
1135(g)(1)(B))’’ and inserting ‘‘prior to January 
1, 2025 (or, if later, the first day after the end 
of the emergency period described in section 
1135(g)(1)(B))’’. 
(3) MENTAL HEALTH VISITS FURNISHED BY FED-
ERALLY
QUALIFIED
HEALTH
CENTERS.—Section 
1834(o)(4) of the Social Security Act (42 U.S.C. 
1395m(o)(4) is amended— 
(A) in the heading, by striking ‘‘TO HOS-
PICE PATIENTS’’; and
3637 
† HR 2617 EAS2 
(B) in subparagraph (B), by striking ‘‘prior 
to the day that is the 152nd day after the end 
of the emergency period described in section 
1135(g)(1)(B))’’ and inserting ‘‘prior to January 
1, 2025 (or, if later, the first day after the end 
of the emergency period described in section 
1135(g)(1)(B))’’. 
(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 strik-
ing ‘‘The Secretary shall continue to provide coverage and 
payment under this part for telehealth services identified 
in paragraph (4)(F)(i) as of the date of the enactment of 
this paragraph that are furnished via an audio-only tele-
communications system during the 151-day period begin-
ning on the first day after the end of the emergency period 
described in section 1135(g)(1)(B)’’ and inserting ‘‘In the 
case that the emergency period described in section 
1135(g)(1)(B) ends before December 31, 2024, the Secretary 
shall continue to provide coverage and payment under this 
part for telehealth services identified in paragraph (4)(F)(i) 
as of the date of the enactment of this paragraph that are 
furnished via an audio-only communications system during 
the period beginning on the first day after the end of such 
emergency period and ending on December 31, 2024’’.
3638 
† HR 2617 EAS2 
(f) USE OF TELEHEALTH TO CONDUCT FACE-TO-FACE 
ENCOUNTER PRIOR TO RECERTIFICATION OF ELIGIBILITY 
FOR HOSPICE CARE DURING EMERGENCY PERIOD.—Sec-
tion 1814(a)(7)(D)(i)(II) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(D)(i)(II)) is amended by striking ‘‘and 
during the 151-day period beginning on the first day after 
the end of such emergency period’’ and inserting ‘‘and, in 
the case that such emergency period ends before December 
31, 2024, during the period beginning on the first day after 
the end of such emergency period described in such section 
1135(g)(1)(B) and ending on December 31, 2024’’. 
(g) STUDY ON TELEHEALTH AND MEDICARE PROGRAM 
INTEGRITY.— 
(1) IN GENERAL.— 
(A) STUDY.—The Secretary shall conduct a 
study using medical record review, as described 
in subparagraph (C), on program integrity re-
lated to telehealth services under part B of title 
XVIII of the Social Security Act (42 U.S.C. 
1395j et seq.). 
(B) SCOPE OF STUDY.—In conducting the 
study under subparagraph (A), the Secretary 
shall review and analyze information (to the ex-
tent that such information is available) on the 
duration of telehealth services furnished, the
3639 
† HR 2617 EAS2 
types of telehealth services furnished, and, to the 
extent feasible, the impact of the telehealth serv-
ices furnished on future utilization of health care 
services by Medicare beneficiaries, such as the 
utilization of additional telehealth services or in- 
person services, including hospitalizations and 
emergency department visits. The Secretary may 
also review and analyze information on— 
(i) any geographic differences in utili-
zation of telehealth services; 
(ii) documentation of the care and 
methods of delivery associated with tele-
health services; and 
(iii) other areas, as determined appro-
priate by the Secretary. 
(C) MEDICAL
RECORD
REVIEW.—In con-
ducting the study under subparagraph (A), the 
Secretary shall conduct medical record review of 
a sample of claims for telehealth services with 
dates of service during the period beginning on 
January 1, 2022, and ending on December 31, 
2024. For such claims with a date of service dur-
ing the emergency period described in section 
1135(g)(1)(B) of the Social Security Act (42 
U.S.C. 1320b–5(g)(1)(B)), the Secretary shall
3640 
† HR 2617 EAS2 
only conduct medical record review of those 
claims that have undergone standard program 
integrity review (as defined in paragraph 
(2)(B)), as determined appropriate by the Sec-
retary. 
(D) REPORTS.— 
(i) INTERIM REPORT.—Not later than 
October 1, 2024, the Secretary shall submit 
to the Committee on Finance of the Senate 
and the Committee on Energy and Com-
merce and the Committee on Ways and 
Means of the House of Representatives an 
interim report on the study conducted 
under subparagraph (A). 
(ii) FINAL
REPORT.—Not later than 
April 1, 2026, the Secretary shall submit to 
the Committee on Finance of the Senate 
and the Committee on Energy and Com-
merce and the Committee on Ways and 
Means of the House of Representatives a 
final report on the study conducted under 
subparagraph (A). 
(2) DEFINITIONS.—In this subsection:
3641 
† HR 2617 EAS2 
(A) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human Serv-
ices. 
(B) STANDARD
PROGRAM
INTEGRITY
RE-
VIEW.—The term ‘‘standard program integrity 
review’’ refers to the review of any claim that re-
quires a review of the associated medical record 
by the Secretary to determine the medical neces-
sity of the services furnished or to identify poten-
tial fraud. 
(C) 
TELEHEALTH
SERVICE.—The 
term 
‘‘telehealth service’’ has the meaning given that 
term in section 1834(m)(4)(F) of the Social Se-
curity Act (42 U.S.C. 1395(m)(4)(F)). 
(3) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for 
Medicare & Medicaid Services Program Management 
Account for fiscal year 2023, out of any amounts in 
the 
Treasury 
not 
otherwise 
appropriated, 
$10,000,000, to remain available until expended, for 
purposes of carrying out this subsection. 
(h) PROGRAM INSTRUCTION AUTHORITY.—Notwith-
standing any other provision of law, the Secretary of 
Health and Human Services may implement the provisions
3642 
† HR 2617 EAS2 
of, including amendments made by, this section through 
program instruction or otherwise. 
SEC. 4114. REVISED PHASE-IN OF MEDICARE CLINICAL LAB-
ORATORY TEST PAYMENT CHANGES. 
(a) REVISED PHASE-IN OF REDUCTIONS FROM PRI-
VATE
PAYOR
RATE
IMPLEMENTATION.—Section 
1834A(b)(3) of the Social Security Act (42 U.S.C. 1395m– 
1(b)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘through 
2025’’ and inserting ‘‘through 2026’’; and 
(2) in subparagraph (B)— 
(A) in clause (ii), by striking ‘‘and 2022’’ 
and inserting ‘‘through 2023’’; and 
(B) in clause (iii), by striking ‘‘2023 
through 2025’’ and inserting ‘‘2024 through 
2026’’. 
(b) REVISED REPORTING PERIOD FOR REPORTING OF 
PRIVATE SECTOR PAYMENT RATES FOR ESTABLISHMENT 
OF MEDICARE PAYMENT RATES.—Section 1834A(a)(1)(B) 
of the Social Security Act (42 U.S.C. 1395m–1(a)(1)(B)) 
is amended— 
(1) in clause (i), by striking ‘‘December 31, 
2022’’ and inserting ‘‘December 31, 2023’’; and 
(2) in clause (ii)—
3643 
† HR 2617 EAS2 
(A) by striking ‘‘January 1, 2023’’ and in-
serting ‘‘January 1, 2024’’; and 
(B) by striking ‘‘March 31, 2023’’ and in-
serting ‘‘March 31, 2024’’. 
Subtitle C—Medicare Mental 
Health Provisions 
SEC. 4121. COVERAGE OF MARRIAGE AND FAMILY THERA-
PIST SERVICES AND MENTAL HEALTH COUN-
SELOR SERVICES UNDER PART B OF THE 
MEDICARE PROGRAM. 
(a) COVERAGE OF SERVICES.— 
(1) IN GENERAL.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (GG), by striking 
‘‘and’’ after the semicolon at the end; 
(B) in subparagraph (HH), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(II) marriage and family therapist services (as 
defined in subsection (lll)(1)) and mental health coun-
selor services (as defined in subsection (lll)(3));’’.
3644 
† HR 2617 EAS2 
(2) DEFINITIONS.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by adding 
at the end the following new subsection: 
‘‘(lll) MARRIAGE AND FAMILY THERAPIST SERVICES; 
MARRIAGE
AND FAMILY THERAPIST; MENTAL HEALTH 
COUNSELOR SERVICES; MENTAL HEALTH COUNSELOR.— 
‘‘(1) MARRIAGE AND FAMILY THERAPIST SERV-
ICES.—The term ‘marriage and family therapist serv-
ices’ means services furnished by a marriage and 
family therapist (as defined in paragraph (2)) for the 
diagnosis and treatment of mental illnesses (other 
than services furnished to an inpatient of a hospital), 
which the marriage and family therapist is legally 
authorized to perform under State law (or the State 
regulatory mechanism provided by State law) of the 
State in which such services are furnished, as would 
otherwise be covered if furnished by a physician or as 
an incident to a physician’s professional service. 
‘‘(2) MARRIAGE AND FAMILY THERAPIST.—The 
term ‘marriage and family therapist’ means an indi-
vidual who— 
‘‘(A) possesses a master’s or doctor’s degree 
which qualifies for licensure or certification as a 
marriage and family therapist pursuant to State
3645 
† HR 2617 EAS2 
law of the State in which such individual fur-
nishes the services described in paragraph (1); 
‘‘(B) is licensed or certified as a marriage 
and family therapist by the State in which such 
individual furnishes such services; 
‘‘(C) after obtaining such degree has per-
formed at least 2 years of clinical supervised ex-
perience in marriage and family therapy; and 
‘‘(D) meets such other requirements as spec-
ified by the Secretary. 
‘‘(3) MENTAL HEALTH COUNSELOR SERVICES.— 
The term ‘mental health counselor services’ means 
services furnished by a mental health counselor (as 
defined in paragraph (4)) for the diagnosis and treat-
ment of mental illnesses (other than services furnished 
to an inpatient of a hospital), which the mental 
health counselor is legally authorized to perform 
under State law (or the State regulatory mechanism 
provided by the State law) of the State in which such 
services are furnished, as would otherwise be covered 
if furnished by a physician or as incident to a physi-
cian’s professional service. 
‘‘(4) MENTAL HEALTH COUNSELOR.—The term 
‘mental health counselor’ means an individual who—
3646 
† HR 2617 EAS2 
‘‘(A) possesses a master’s or doctor’s degree 
which qualifies for licensure or certification as a 
mental health counselor, clinical professional 
counselor, or professional counselor under the 
State law of the State in which such individual 
furnishes the services described in paragraph (3); 
‘‘(B) is licensed or certified as a mental 
health counselor, clinical professional counselor, 
or professional counselor by the State in which 
the services are furnished; 
‘‘(C) after obtaining such a degree has per-
formed at least 2 years of clinical supervised ex-
perience in mental health counseling; and 
‘‘(D) meets such other requirements as spec-
ified by the Secretary.’’. 
(3) AMOUNT OF PAYMENT.—Section 1833(a)(1) 
of the Social Security Act (42 U.S.C. 1395l(a)(1)), as 
amended by section 11101(b) of Public Law 117–169, 
is further amended— 
(A) by striking ‘‘, and (EE)’’ and inserting 
‘‘(EE)’’; and 
(B) by inserting before the semicolon at the 
end the following: ‘‘and (FF) with respect to 
marriage and family therapist services and men-
tal health counselor services under section
3647 
† HR 2617 EAS2 
1861(s)(2)(II), the amounts paid shall be 80 per-
cent of the lesser of the actual charge for the serv-
ices or 75 percent of the amount determined for 
payment of a psychologist under subparagraph 
(L)’’. 
(4) EXCLUSION OF MARRIAGE AND FAMILY THER-
APIST SERVICES AND MENTAL HEALTH COUNSELOR 
SERVICES
FROM
SKILLED
NURSING
FACILITY
PRO-
SPECTIVE
PAYMENT
SYSTEM.—Section 
1888(e)(2)(A)(ii) of the Social Security Act (42 
U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 
‘‘marriage and family therapist services (as defined 
in section 1861(lll)(1)), mental health counselor serv-
ices (as defined in section 1861(lll)(3)),’’ after ‘‘quali-
fied psychologist services,’’. 
(5) INCLUSION
OF
MARRIAGE
AND
FAMILY 
THERAPISTS AND MENTAL HEALTH COUNSELORS AS 
PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec-
tion 1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at the 
end the following new clauses: 
‘‘(vii) A marriage and family therapist (as de-
fined in section 1861(lll)(2)). 
‘‘(viii) A mental health counselor (as defined in 
section 1861(lll)(4)).’’.
3648 
† HR 2617 EAS2 
(b) COVERAGE OF CERTAIN MENTAL HEALTH SERV-
ICES PROVIDED IN CERTAIN SETTINGS.— 
(1) RURAL
HEALTH
CLINICS
AND
FEDERALLY 
QUALIFIED
HEALTH
CENTERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 
1395x(aa)(1)(B)) is amended by striking ‘‘or by a 
clinical social worker (as defined in subsection 
(hh)(1))’’ and inserting ‘‘, by a clinical social worker 
(as defined in subsection (hh)(1)), by a marriage and 
family therapist (as defined in subsection (lll)(2)), or 
by a mental health counselor (as defined in subsection 
(lll)(4))’’. 
(2) 
HOSPICE
PROGRAMS.—Section 
1861(dd)(2)(B)(i)(III) of the Social Security Act (42 
U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by insert-
ing ‘‘, marriage and family therapist, or mental 
health counselor’’ after ‘‘social worker’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to services furnished on or 
after January 1, 2024. 
SEC. 4122. ADDITIONAL RESIDENCY POSITIONS. 
(a) IN GENERAL.—Section 1886(h) of the Social Secu-
rity Act (42 U.S.C. 1395ww(h)) is amended— 
(1) in paragraph (4)(F)(i), by striking ‘‘and 
(9)’’ and inserting ‘‘(9), and (10)’’;
3649 
† HR 2617 EAS2 
(2) in paragraph (4)(H)(i), by striking ‘‘and 
(9)’’ and inserting ‘‘(9), and (10)’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(10) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS
IN
PSYCHIATRY
AND
PSYCHIATRY
SUB-
SPECIALTIES.— 
‘‘(A) ADDITIONAL RESIDENCY POSITIONS.— 
‘‘(i) IN
GENERAL.—For fiscal year 
2026, the Secretary shall, subject to the suc-
ceeding provisions of this paragraph, in-
crease the otherwise applicable resident 
limit for each qualifying hospital (as de-
fined in subparagraph (F)) that submits a 
timely application under this subparagraph 
by such number as the Secretary may ap-
prove effective beginning July 1 of the fiscal 
year of the increase. 
‘‘(ii) NUMBER
AVAILABLE
FOR
DIS-
TRIBUTION.—The aggregate number of such 
positions made available under this para-
graph shall be equal to 200. 
‘‘(iii) DISTRIBUTION FOR PSYCHIATRY 
OR
PSYCHIATRY
SUBSPECIALTY 
RESIDENCIES.—At least 100 of the positions
3650 
† HR 2617 EAS2 
made available under this paragraph shall 
be distributed for a psychiatry or psychi-
atry subspecialty residency (as defined in 
subparagraph (F)). 
‘‘(iv) TIMING.—The Secretary shall no-
tify hospitals of the number of positions dis-
tributed to the hospital under this para-
graph as a result of an increase in the oth-
erwise applicable resident limit by January 
31 of the fiscal year of the increase. Such 
increase shall be effective beginning July 1 
of such fiscal year. 
‘‘(B) DISTRIBUTION.—For purposes of pro-
viding an increase in the otherwise applicable 
resident limit under subparagraph (A), the fol-
lowing shall apply: 
‘‘(i) CONSIDERATIONS
IN
DISTRIBU-
TION.—In determining for which qualifying 
hospitals such an increase is provided under 
subparagraph (A), the Secretary shall take 
into account the demonstrated likelihood of 
the hospital filling the positions made avail-
able under this paragraph within the first 
5 training years beginning after the date
3651 
† HR 2617 EAS2 
the increase would be effective, as deter-
mined by the Secretary. 
‘‘(ii) MINIMUM
DISTRIBUTION
FOR 
CERTAIN
CATEGORIES
OF
HOSPITALS.— 
With respect to the aggregate number of 
such positions available for distribution 
under this paragraph, the Secretary shall 
distribute not less than 10 percent of such 
aggregate number to each of the following 
categories of hospitals: 
‘‘(I) Hospitals that are located in 
a rural area (as defined in section 
1886(d)(2)(D)) or are treated as being 
located in a rural area pursuant to 
section 1886(d)(8)(E). 
‘‘(II) Hospitals in which the ref-
erence resident level of the hospital (as 
specified in subparagraph (F)(iii)) is 
greater than the otherwise applicable 
resident limit. 
‘‘(III) Hospitals in States with— 
‘‘(aa) new medical schools 
that received ‘Candidate School’ 
status from the Liaison Com-
mittee on Medical Education or
3652 
† HR 2617 EAS2 
that received ‘Pre-Accreditation’ 
status from the American Osteo-
pathic Association Commission on 
Osteopathic College Accreditation 
on or after January 1, 2000, and 
that have achieved or continue to 
progress toward ‘Full Accredita-
tion’ status (as such term is de-
fined by the Liaison Committee 
on Medical Education) or toward 
‘Accreditation’ status (as such 
term is defined by the American 
Osteopathic Association Commis-
sion on Osteopathic College Ac-
creditation); or 
‘‘(bb) 
additional 
locations 
and branch campuses established 
on or after January 1, 2000, by 
medical schools with ‘Full Accred-
itation’ status (as such term is de-
fined by the Liaison Committee 
on Medical Education) or ‘Accred-
itation’ status (as such term is de-
fined by the American Osteopathic
3653 
† HR 2617 EAS2 
Association Commission on Osteo-
pathic College Accreditation). 
‘‘(IV) Hospitals that serve areas 
designated as health professional short-
age areas under section 332(a)(1)(A) of 
the Public Health Service Act, as deter-
mined by the Secretary. 
‘‘(iii) PRO
RATA
APPLICATION.—The 
Secretary shall ensure that each qualifying 
hospital that submits a timely application 
under subparagraph (A) receives at least 1 
(or a fraction of 1) of the positions made 
available under this paragraph before any 
qualifying hospital receives more than 1 of 
such positions. 
‘‘(C) REQUIREMENTS.— 
‘‘(i) LIMITATION.—A hospital may not 
receive more than 10 additional full-time 
equivalent residency positions under this 
paragraph. 
‘‘(ii) PROHIBITION
ON
DISTRIBUTION 
TO
HOSPITALS
WITHOUT
AN
INCREASE 
AGREEMENT.—No increase in the otherwise 
applicable resident limit of a hospital may 
be made under this paragraph unless such
3654 
† HR 2617 EAS2 
hospital agrees to increase the total number 
of full-time equivalent residency positions 
under the approved medical residency 
training program of such hospital by the 
number of such positions made available by 
such increase under this paragraph. 
‘‘(iii) REQUIREMENT
FOR
HOSPITALS 
TO EXPAND PROGRAMS.—If a hospital that 
receives an increase in the otherwise appli-
cable resident limit under this paragraph 
would be eligible for an adjustment to the 
otherwise applicable resident limit for par-
ticipation in a new medical residency 
training 
program 
under 
section 
413.79(e)(3) of title 42, Code of Federal 
Regulations (or any successor regulation), 
the hospital shall ensure that any positions 
made available under this paragraph are 
used to expand an existing program of the 
hospital, and not for participation in a new 
medical residency training program. 
‘‘(D) 
APPLICATION
OF
PER
RESIDENT 
AMOUNTS FOR NONPRIMARY CARE.—With respect 
to additional residency positions in a hospital 
attributable to the increase provided under this
3655 
† HR 2617 EAS2 
paragraph, the approved FTE per resident 
amounts are deemed to be equal to the hospital 
per resident amounts for nonprimary care com-
puted under paragraph (2)(D) for that hospital. 
‘‘(E) PERMITTING FACILITIES TO APPLY AG-
GREGATION RULES.—The Secretary shall permit 
hospitals receiving additional residency positions 
attributable to the increase provided under this 
paragraph to, beginning in the fifth year after 
the effective date of such increase, apply such po-
sitions to the limitation amount under para-
graph (4)(F) that may be aggregated pursuant to 
paragraph (4)(H) among members of the same 
affiliated group. 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise applica-
ble resident limit’ means, with respect to a 
hospital, the limit otherwise applicable 
under subparagraphs (F)(i) and (H) of 
paragraph (4) on the resident level for the 
hospital determined without regard to this 
paragraph but taking into account para-
graphs (7)(A), (7)(B), (8)(A), (8)(B), and 
(9)(A).
3656 
† HR 2617 EAS2 
‘‘(ii) 
PSYCHIATRY
OR
PSYCHIATRY 
SUBSPECIALTY RESIDENCY.—The term ‘psy-
chiatry or psychiatry subspecialty resi-
dency’ means a residency in psychiatry as 
accredited by the Accreditation Council for 
Graduate Medical Education for the pur-
pose of preventing, diagnosing, and treating 
mental health disorders. 
‘‘(iii) 
QUALIFYING
HOSPITAL.—The 
term ‘qualifying hospital’ means a hospital 
described in any of subclauses (I) through 
(IV) of subparagraph (B)(ii). 
‘‘(iv) REFERENCE RESIDENT LEVEL.— 
The term ‘reference resident level’ means, 
with respect to a hospital, the resident level 
for the most recent cost reporting period of 
the hospital ending on or before the date of 
enactment of this paragraph, for which a 
cost report has been settled (or, if not, sub-
mitted (subject to audit)), as determined by 
the Secretary. 
‘‘(v) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i).’’.
3657 
† HR 2617 EAS2 
(b) IME.—Section 1886(d)(5)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 
(1) in clause (v), in the third sentence, by strik-
ing ‘‘and (h)(9)’’ and inserting ‘‘(h)(9), and (h)(10)’’; 
(2) by moving clause (xii) 4 ems to the left; and 
(3) by adding at the end the following new 
clause: 
‘‘(xiii) For discharges occurring on or after July 
1, 2026, insofar as an additional payment amount 
under this subparagraph is attributable to resident 
positions distributed to a hospital under subsection 
(h)(10), the indirect teaching adjustment factor shall 
be computed in the same manner as provided under 
clause (ii) with respect to such resident positions.’’. 
(c) PROHIBITION
ON
JUDICIAL
REVIEW.—Section 
1886(h)(7)(E) of the Social Security Act (42 U.S.C. 
1395ww—4(h)(7)(E)) is amended by inserting ‘‘paragraph 
(10),’’ after ‘‘paragraph (8),’’. 
SEC. 4123. IMPROVING MOBILE CRISIS CARE IN MEDICARE. 
(a) PAYMENT FOR PSYCHOTHERAPY FOR CRISIS SERV-
ICES FURNISHED IN AN APPLICABLE SITE OF SERVICE.— 
(1) IN GENERAL.—Section 1848(b) of the Social 
Security Act (42 U.S.C. 1395w–4(b)) is amended by 
adding at the end the following new paragraph:
3658 
† HR 2617 EAS2 
‘‘(12) PAYMENT FOR PSYCHOTHERAPY FOR CRI-
SIS SERVICES FURNISHED IN AN APPLICABLE SITE OF 
SERVICE.— 
‘‘(A) IN GENERAL.—The Secretary shall es-
tablish new HCPCS codes under the fee schedule 
established under this subsection for services de-
scribed in subparagraph (B) that are furnished 
on or after January 1, 2024. 
‘‘(B) SERVICES
DESCRIBED.—The services 
described in this subparagraph are psycho-
therapy for crisis services that are a furnished in 
an applicable site of service. 
‘‘(C) AMOUNT OF PAYMENT.—For services 
described in subparagraph (B) that are fur-
nished to an individual in a year (beginning 
with 2024), in lieu of the fee schedule amount 
that would otherwise be determined under this 
subsection for such year, the fee schedule amount 
for such services for such year shall be equal to 
150 percent of the fee schedule amount for non- 
facility sites of service for such year determined 
for services identified, as of January 1, 2022, by 
HCPCS codes 90839 and 90840 (and any suc-
ceeding codes). 
‘‘(D) DEFINITIONS.—In this paragraph:
3659 
† HR 2617 EAS2 
‘‘(i) APPLICABLE SITE OF SERVICE.— 
The term ‘applicable site of service’ means 
a site of service other than a site where the 
facility rate under the fee schedule under 
this subsection applies and other than an 
office setting. 
‘‘(ii) PSYCHOTHERAPY
FOR
CRISIS 
SERVICES.—The code descriptions for serv-
ices described in subparagraph (B) shall be 
the same as the code descriptions for serv-
ices identified, as of January 1, 2022, by 
HCPCS codes 90839 and 90840 (and any 
succeeding codes), except that such new 
codes shall be limited to services furnished 
in an applicable site of service.’’. 
(2) WAIVER OF BUDGET NEUTRALITY.—Section 
1848(c)(2)(B)(iv) of such Act (42 U.S.C. 1395w– 
4(c)(2)(B)(iv)) is amended— 
(A) in subclause (IV), by striking ‘‘and’’ at 
the end; 
(B) in subclause (V), by striking the period 
at the end and inserting ‘‘; and’’ and 
(C) by adding at the end the following new 
subclause:
3660 
† HR 2617 EAS2 
‘‘(VI) subsection (b)(12) shall not 
be taken into account in applying 
clause (ii)(II) for 2024.’’. 
(b) EDUCATION AND OUTREACH.—Not later than Jan-
uary 1, 2024, the Secretary shall use existing communica-
tions mechanisms to provide education and outreach to 
stakeholders with respect to the ability of health profes-
sionals to bill for psychotherapy for crisis services under 
the Medicare physician fee schedule under section 1848 of 
the Social Security Act (42 U.S.C. 1395w–4) when such 
services are furnished in an applicable site of service to a 
Medicare beneficiary who is experiencing a mental or be-
havioral health crisis. 
(c) OPEN DOOR FORUM.—Not later than January 1, 
2024, the Secretary shall convene stakeholders and experts 
for an open door forum or other appropriate mechanism 
to discuss current Medicare program coverage and payment 
policies for services that can be furnished to provide care 
to a Medicare beneficiary who is experiencing a mental or 
behavioral health crisis. 
(d) EDUCATION AND OUTREACH ON THE USE OF PEER 
SUPPORT SPECIALISTS AND OTHER AUXILIARY PERSONNEL 
IN FURNISHING OF PSYCHOTHERAPY FOR CRISIS SERVICES 
AND BEHAVIORAL HEALTH INTEGRATION SERVICES.—Not 
later than January 1, 2024, the Secretary shall use existing
3661 
† HR 2617 EAS2 
communication mechanisms to provide education and out-
reach to providers of services, physicians, and practitioners 
with respect to the ability of auxiliary personnel, including 
peer support specialists, to participate, consistent with ap-
plicable requirements for auxiliary personnel, in the fur-
nishing of— 
(1) psychotherapy for crisis services billed under 
the Medicare physician fee schedule under section 
1848 of the Social Security Act (42 U.S.C. 1395w– 
4), as well as other services that can be furnished to 
a Medicare beneficiary experiencing a mental or be-
havioral health crisis; and 
(2) behavioral health integration services. 
(e) DEFINITIONS.—In this section: 
(1) APPLICABLE SITE OF SERVICE.—The term 
‘‘applicable site of service’’ has the meaning given 
that term in section 1848(b)(12)(D)(i) of the Social 
Security Act, as added by subsection (a). 
(2) BEHAVIORAL
HEALTH
INTEGRATION
SERV-
ICES.—The term ‘‘behavioral health integration serv-
ices’’ means services identified, as of January 1, 
2022, by HCPCS codes 99484, 99492, 99493, 99494, 
and G2214 (and any successor or similar codes as de-
termined appropriate by the Secretary).
3662 
† HR 2617 EAS2 
(3) PSYCHOTHERAPY
FOR
CRISIS
SERVICES.— 
The term ‘‘psychotherapy for crisis services’’ means 
services described in 1848(b)(12)(D)(ii) of the Social 
Security Act, as added by subsection (a). 
(4) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 4124. ENSURING ADEQUATE COVERAGE OF OUT-
PATIENT MENTAL HEALTH SERVICES UNDER 
THE MEDICARE PROGRAM. 
(a) MODIFICATION OF DEFINITION OF PARTIAL HOS-
PITALIZATION SERVICES.—Section 1861(ff)(1) of the Social 
Security Act (42 U.S.C. 1395x(ff)(1)) is amended by insert-
ing ‘‘for an individual determined (not less frequently than 
monthly) by a physician to have a need for such services 
for a minimum of 20 hours per week’’ after ‘‘prescribed by 
a physician’’. 
(b) COVERAGE
OF INTENSIVE OUTPATIENT SERV-
ICES.— 
(1) SCOPE OF BENEFITS.— 
(A) COMMUNITY
MENTAL
HEALTH
CEN-
TERS.—Section 1832(a)(2)(J) of the Social Secu-
rity Act (42 U.S.C. 1395k(a)(2)(J)) is amended 
by inserting ‘‘and intensive outpatient services’’ 
after ‘‘partial hospitalization services’’.
3663 
† HR 2617 EAS2 
(B) 
INCIDENT-TO
SERVICES.—Section 
1861(s)(2)(B) is amended by inserting ‘‘or inten-
sive outpatient services’’ after ‘‘partial hos-
pitalization services’’. 
(2) DEFINITION.—Section 1861(ff) of the Social 
Security Act (42 U.S.C. 1395x(ff)) is amended— 
(A) in the header, by inserting ‘‘; Intensive 
Outpatient Services’’ after ‘‘Partial Hospitaliza-
tion Services’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(4) The term ‘intensive outpatient services’ has the 
meaning given the term ‘partial hospitalization services’ in 
paragraph (1), except that— 
‘‘(A) section 1835(a)(2)(F)(i) shall not apply; 
‘‘(B) the reference in such paragraph to an indi-
vidual ‘determined (not less frequently than monthly) 
by a physician to have a need for such services for a 
minimum of 20 hours per week’ shall be treated as a 
reference to an individual ‘determined (not less fre-
quently than once every other month) by a physician 
to have a need for such services for a minimum of 9 
hours per week’; and 
‘‘(C) the reference to ‘a community mental health 
center (as defined in subparagraph (B))’ in para-
3664 
† HR 2617 EAS2 
graph (3) shall be treated as a reference to ‘a commu-
nity mental health center (as defined in subpara-
graph (B)), a Federally qualified health center, or a 
rural health clinic’.’’. 
(3) EXCLUSION FROM CALCULATION OF CERTAIN 
TREATMENT COSTS.—Section 1833(c)(2) of the Social 
Security Act (42 U.S.C. 1395l(c)(2)) is amended by 
inserting ‘‘or intensive outpatient services’’ after 
‘‘partial hospitalization services’’. 
(4) CONFORMING AMENDMENTS.— 
(A) INTENSIVE
OUTPATIENT
SERVICES.— 
Section 1861(aa) of the Social Security Act (42 
U.S.C. 1395x(aa)) is amended— 
(i) in paragraph (1)— 
(I) in subparagraph (B), by strik-
ing ‘‘and’’ at the end; 
(II) in subparagraph (C), by add-
ing ‘‘and’’ at the end; and 
(III) by inserting after subpara-
graph (C) the following new subpara-
graph: 
‘‘(D) intensive outpatient services (as defined in 
section 1861(ff)(4)),’’; and 
(ii) in paragraph (3), by striking 
‘‘through (C)’’ and inserting ‘‘through (D)’’.
3665 
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(B) 
PROVIDER
OF
SERVICES.—Section 
1866(e)(2) of the Social Security Act (42 U.S.C. 
1395cc(e)(2)) is amended by inserting ‘‘, or in-
tensive outpatient services (as described in sec-
tion 1861(ff)(4))’’ after ‘‘partial hospitalization 
services (as described in section 1861(ff)(1))’’. 
(c) SPECIAL
PAYMENT
RULE
FOR
FQHCS
AND 
RHCS.—Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended— 
(1) in subsection (o), by adding at the end the 
following new paragraph: 
‘‘(5) SPECIAL
PAYMENT
RULE
FOR
INTENSIVE 
OUTPATIENT SERVICES.— 
‘‘(A) IN GENERAL.—In the case of intensive 
outpatient services furnished by a Federally 
qualified health center, the payment amount for 
such services shall be equal to the amount that 
would have been paid under this title for such 
services had such services been covered OPD serv-
ices furnished by a hospital. 
‘‘(B) EXCLUSION.—Costs associated with 
intensive outpatient services shall not be used to 
determine the amount of payment for Federally 
qualified health center services under the pro-
3666 
† HR 2617 EAS2 
spective payment system under this subsection.’’; 
and 
(2) in subsection (y)— 
(A) in the header, by striking ‘‘TO HOSPICE 
PATIENTS’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(3) SPECIAL
PAYMENT
RULE
FOR
INTENSIVE 
OUTPATIENT SERVICES.— 
‘‘(A) IN GENERAL.—In the case of intensive 
outpatient services furnished by a rural health 
clinic, the payment amount for such services 
shall be equal to the amount that would have 
been paid under this title for such services had 
such services been covered OPD services fur-
nished by a hospital. 
‘‘(B) EXCLUSION.—Costs associated with 
intensive outpatient services shall not be used to 
determine the amount of payment for rural 
health clinic services under the methodology for 
all-inclusive rates (established by the Secretary) 
under section 1833(a)(3).’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to items and services fur-
nished on or after January 1, 2024.
3667 
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SEC. 4125. IMPROVEMENTS TO MEDICARE PROSPECTIVE 
PAYMENT SYSTEM FOR PSYCHIATRIC HOS-
PITALS AND PSYCHIATRIC UNITS. 
(a) IMPROVEMENTS THROUGH ADDITIONAL CLAIMS 
DATA.—Section 1886(s) of the Social Security Act (42 
U.S.C. 1395ww(s)) is amended by adding at the end the 
following new paragraph: 
‘‘(5) ADDITIONAL DATA AND INFORMATION.— 
‘‘(A) IN GENERAL.—The Secretary shall col-
lect data and information as the Secretary deter-
mines appropriate to revise payments under the 
system described in paragraph (1) for psy-
chiatric hospitals and psychiatric units pursu-
ant to subparagraph (D) and for other purposes 
as determined appropriate by the Secretary. The 
Secretary shall begin to collect such data by not 
later than October 1, 2023. 
‘‘(B) DATA AND INFORMATION.—The data 
and information to be collected under subpara-
graph (A) may include— 
‘‘(i) charges, including those related to 
ancillary services; 
‘‘(ii) the required intensity of behav-
ioral monitoring, such as cognitive deficit, 
suicide ideations, violent behavior, and need 
for physical restraint; and
3668 
† HR 2617 EAS2 
‘‘(iii) interventions, such as detoxifica-
tion services for substance abuse, dependence 
on respirator, total parenteral nutritional 
support, dependence on renal dialysis, and 
burn care. 
‘‘(C) METHOD OF COLLECTION.—The Sec-
retary may collect the additional data and infor-
mation under subparagraph (A) on cost reports, 
on claims, or otherwise. 
‘‘(D) REVISIONS TO PAYMENT RATES.— 
‘‘(i) IN
GENERAL.—Notwithstanding 
the preceding paragraphs of this subsection 
or section 124 of the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement 
Act of 1999, for rate year 2025 (and for 
any subsequent rate year, if determined ap-
propriate by the Secretary), the Secretary 
shall, by regulation, implement revisions to 
the methodology for determining the pay-
ment rates under the system described in 
paragraph (1) for psychiatric hospitals and 
psychiatric units, as the Secretary deter-
mines to be appropriate. Such revisions 
may be based on a review of data and in-
3669 
† HR 2617 EAS2 
formation collected under subparagraph 
(A). 
‘‘(ii) REVIEW.—The Secretary may 
make revisions to the diagnosis-related 
group classifications, in accordance with 
subsection (d)(4)(C), to reflect nursing and 
staff resource use and costs involved in fur-
nishing services at such hospitals and units, 
including considerations for patient com-
plexity and prior admission to an inpatient 
psychiatric facility, which may be based on 
review of data and information collected 
under subparagraph (A), as the Secretary 
determines to be appropriate. 
‘‘(iii) 
BUDGET
NEUTRALITY.—Revi-
sions in payment implemented pursuant to 
clause (i) for a rate year shall result in the 
same estimated amount of aggregate ex-
penditures under this title for psychiatric 
hospitals and psychiatric units furnished in 
the rate year as would have been made 
under this title for such care in such rate 
year if such revisions had not been imple-
mented.’’.
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† HR 2617 EAS2 
(b) IMPROVEMENTS THROUGH STANDARDIZED PA-
TIENT ASSESSMENT DATA.—Section 1886(s) of the Social 
Security Act (42 U.S.C. 1395ww(s)), as amended by sub-
section (a), is further amended— 
(1) in paragraph (4)— 
(A) in subparagraph (A)(i), by striking 
‘‘subparagraph (C)’’ and inserting ‘‘subpara-
graphs (C) and (E)’’; 
(B) by redesignating subparagraph (E) as 
subparagraph (F); 
(C) by inserting after subparagraph (D) the 
following new subparagraph: 
‘‘(E) STANDARDIZED PATIENT ASSESSMENT 
DATA.— 
‘‘(i) IN GENERAL.—For rate year 2028 
and each subsequent rate year, in addition 
to such data on the quality measures de-
scribed in subparagraph (C), each psy-
chiatric hospital and psychiatric unit shall 
submit to the Secretary, through the use of 
a standardized assessment instrument im-
plemented under clause (iii), the standard-
ized patient assessment data described in 
clause (ii). Such data shall be submitted 
with respect to admission and discharge of
3671 
† HR 2617 EAS2 
an individual (and may be submitted more 
frequently as the Secretary determines ap-
propriate). 
‘‘(ii) STANDARDIZED PATIENT ASSESS-
MENT DATA DESCRIBED.—For purposes of 
clause (i), the standardized patient assess-
ment data described in this clause, with re-
spect to a psychiatric hospital or psy-
chiatric unit, is data with respect to the fol-
lowing categories: 
‘‘(I) Functional status, such as 
mobility and self-care at admission to 
a psychiatric hospital or unit and be-
fore discharge from a psychiatric hos-
pital or unit. 
‘‘(II) Cognitive function, such as 
ability to express ideas and to under-
stand, and mental status, such as de-
pression and dementia. 
‘‘(III) 
Special 
services, 
treat-
ments, and interventions for psy-
chiatric conditions. 
‘‘(IV) Medical conditions and co- 
morbidities, such as diabetes, conges-
tive heart failure, and pressure ulcers.
3672 
† HR 2617 EAS2 
‘‘(V) Impairments, such as incon-
tinence and an impaired ability to 
hear, see, or swallow. 
‘‘(VI) Other categories as deter-
mined appropriate by the Secretary. 
‘‘(iii) STANDARDIZED ASSESSMENT IN-
STRUMENT.— 
‘‘(I) IN GENERAL.—For purposes 
of clause (i), the Secretary shall imple-
ment a standardized assessment instru-
ment that provides for the submission 
of standardized patient assessment 
data under this title with respect to 
psychiatric hospitals and psychiatric 
units which enables comparison of such 
assessment data across all such hos-
pitals and units to which such data 
are applicable. 
‘‘(II) FUNDING.—The Secretary 
shall provide for the transfer, from the 
Federal 
Hospital 
Insurance 
Trust 
Fund under section 1817 to the Centers 
for Medicare & Medicaid Services Pro-
gram 
Management 
Account, 
of
3673 
† HR 2617 EAS2 
$10,000,000 for purposes of carrying 
out subclause (I).’’; and 
(D) in subparagraph (F), as redesignated 
by subparagraph (B) of this paragraph, by strik-
ing ‘‘subparagraph (C)’’ and inserting ‘‘subpara-
graphs (C) and (F)’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(6) ADDITIONAL
CONSIDERATIONS
FOR
DIAG-
NOSIS-RELATED GROUP CLASSIFICATIONS.— 
‘‘(A) IN
GENERAL.—Notwithstanding the 
preceding paragraphs of this subsection (other 
than paragraph (5)) or section 124 of the Medi-
care, Medicaid, and SCHIP Balanced Budget 
Refinement Act of 1999, beginning not later than 
rate year 2031, in addition to any revisions pur-
suant to paragraph (5), the Secretary shall, by 
regulation, implement revisions to the method-
ology for determining the payment rates under 
the system described in paragraph (1) for psy-
chiatric hospitals and psychiatric units, as the 
Secretary determines to be appropriate, to take 
into account the patient assessment data de-
scribed in paragraph (4)(E)(ii).
3674 
† HR 2617 EAS2 
‘‘(B) BUDGET
NEUTRALITY.—Revisions in 
payment implemented pursuant to subparagraph 
(A) for a rate year shall result in the same esti-
mated amount of aggregate expenditures under 
this title for psychiatric hospitals and psy-
chiatric units furnished in the rate year as 
would have been made under this title for such 
care in such rate year if such revisions had not 
been implemented.’’. 
(c) IMPROVEMENTS THROUGH INCLUSION
OF PA-
TIENTS’ PERSPECTIVE ON CARE QUALITY MEASURE.—Sec-
tion 1886(s)(4) of the Social Security Act (42 U.S.C. 
1395ww(s)(4)) is amended— 
(1) in subparagraph (D), by adding at the end 
the following new clause: 
‘‘(iv) 
PATIENTS’ 
PERSPECTIVE
ON 
CARE.—Not later than for rate year 2031, 
the quality measures specified under this 
subparagraph shall include a quality meas-
ure of patients’ perspective on care.’’; and 
(2) in subparagraph (E), by inserting ‘‘, includ-
ing the quality measure of patients’ perspective on 
care described in subparagraph (D)(iv),’’ after ‘‘shall 
report quality measures’’.
3675 
† HR 2617 EAS2 
SEC. 4126. EXCEPTION FOR PHYSICIAN WELLNESS PRO-
GRAMS. 
(a) IN GENERAL.—Section 1877(e) of the Social Secu-
rity Act (42 U.S.C. 1395nn(e)) is amended by adding at 
the end the following: 
‘‘(9) PHYSICIAN WELLNESS PROGRAMS.—A bona 
fide mental health or behavioral health improvement 
or maintenance program offered to a physician by an 
entity, if— 
‘‘(A) such program— 
‘‘(i) consists of counseling, mental 
health services, a suicide prevention pro-
gram, or a substance use disorder preven-
tion and treatment program; 
‘‘(ii) is made available to a physician 
for the primary purpose of preventing sui-
cide, improving mental health and resil-
iency, or providing training in appropriate 
strategies to promote the mental health and 
resiliency of such physician; 
‘‘(iii) is set out in a written policy, 
approved in advance of the operation of the 
program by the governing body of the entity 
providing such program (and which shall be 
updated accordingly in advance to substan-
3676 
† HR 2617 EAS2 
tial changes to the operation of such pro-
gram), that includes— 
‘‘(I) a description of the content 
and duration of the program; 
‘‘(II) a description of the evi-
dence-based support for the design of 
the program; 
‘‘(III) the estimated cost of the 
program; 
‘‘(IV) the personnel (including the 
qualifications of such personnel) con-
ducting the program; and 
‘‘(V) the method by which such en-
tity will evaluate the use and success of 
the program; 
‘‘(iv) is offered by an entity described 
in subparagraph (B) with a formal medical 
staff to all physicians who practice in the 
geographic area served by such entity, in-
cluding physicians who hold bona fide ap-
pointments to the medical staff of such enti-
ty or otherwise have clinical privileges at 
such entity; 
‘‘(v) is offered to all such physicians on 
the same terms and conditions and without
3677 
† HR 2617 EAS2 
regard to the volume or value of referrals or 
other business generated by a physician for 
such entity; 
‘‘(vi) is evidence-based and conducted 
by a qualified health professional; and 
‘‘(vii) meets such other requirements 
the Secretary may impose by regulation as 
needed to protect against program or pa-
tient abuse; 
‘‘(B) such entity is— 
‘‘(i) a hospital; 
‘‘(ii) an ambulatory surgical center; 
‘‘(iii) a community health center; 
‘‘(iv) a rural emergency hospital; 
‘‘(v) a rural health clinic; 
‘‘(vi) a skilled nursing facility; or 
‘‘(vii) a similar entity, as determined 
by the Secretary; and 
‘‘(C) neither the provision of such program, 
nor the value of such program, are contingent 
upon the number or value of referrals made by 
a physician to such entity or the amount or 
value of other business generated by such physi-
cian for the entity.’’.
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† HR 2617 EAS2 
(b) EXCEPTION UNDER THE ANTI-KICKBACK STAT-
UTE.—Section 1128B(b)(3) of the Social Security Act (42 
U.S.C. 1320a–7b(b)(3)) is amended— 
(1) in subparagraph (J), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (K), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(L) a bona fide mental health or behavioral 
health improvement or maintenance program, if— 
‘‘(i) such program— 
‘‘(I) consists of counseling, mental 
health services, a suicide prevention pro-
gram, or a substance use disorder preven-
tion and treatment program; 
‘‘(II) is made available to a physician 
or other clinician for the primary purpose 
of preventing suicide, improving mental 
health and resiliency, or providing training 
in appropriate strategies to promote the 
mental health and resiliency of such physi-
cian or other clinician; 
‘‘(III) is set out in a written policy, 
approved in advance of the operation of the 
program by the governing body of the entity
3679 
† HR 2617 EAS2 
providing such program (and which shall be 
updated accordingly in advance to substan-
tial changes to the operation of such pro-
gram), that includes— 
‘‘(aa) a description of the content 
and duration of the program; 
‘‘(bb) a description of the evi-
dence-based support for the design of 
the program; 
‘‘(cc) the estimated cost of the pro-
gram; 
‘‘(dd) the personnel (including the 
qualifications of such personnel) imple-
menting the program; and 
‘‘(ee) the method by which such 
entity will evaluate the use and success 
of the program; 
‘‘(IV) is offered by an entity described 
in clause (ii) with a formal medical staff to 
all physicians and other clinicians who 
practice in the geographic area served by 
such entity, including physicians who hold 
bona fide appointments to the medical staff 
of such entity or otherwise have clinical 
privileges at such entity;
3680 
† HR 2617 EAS2 
‘‘(V) is offered to all such physicians 
and clinicians on the same terms and con-
ditions and without regard to the volume or 
value of referrals or other business generated 
by a physician or clinician for such entity; 
‘‘(VI) is evidence-based and conducted 
by a qualified health professional; and 
‘‘(VII) meets such other requirements 
the Secretary may impose by regulation as 
needed to protect against program or pa-
tient abuse; 
‘‘(ii) such entity is— 
‘‘(I) a hospital; 
‘‘(II) an ambulatory surgical center; 
‘‘(III) a community health center; 
‘‘(IV) a rural emergency hospital; 
‘‘(V) a skilled nursing facility; or 
‘‘(VI) any similar entity, as deter-
mined by the Secretary; and 
‘‘(iii) neither the provision of such program, 
nor the value of such program, are contingent 
upon the number or value of referrals made by 
a physician or other clinician to such entity or 
the amount or value of other business generated 
by such physician for the entity.’’.
3681 
† HR 2617 EAS2 
SEC. 4127. CONSIDERATION OF SAFE HARBOR UNDER THE 
ANTI-KICKBACK STATUTE FOR CERTAIN CON-
TINGENCY MANAGEMENT INTERVENTIONS. 
Section 1128D(a) of the Social Security Act (42 U.S.C. 
1320a–7d(a)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(3) CONSIDERATION OF SAFE HARBOR FOR CER-
TAIN CONTINGENCY MANAGEMENT INTERVENTIONS.— 
‘‘(A) IN GENERAL.—Not later than one year 
after the date of the enactment of this paragraph, 
the Inspector General shall conduct a review on 
whether to establish a safe harbor described in 
paragraph (1)(A)(ii) for evidence-based contin-
gency management incentives and the param-
eters for such a safe harbor. In conducting the re-
view under the previous sentence, the Inspector 
General shall consider the extent to which pro-
viding such a safe harbor for evidence-based con-
tingency management incentives may result in 
any of the factors described in paragraph (2). 
‘‘(B) REPORT.—Not later than two years 
after the date of the enactment of this paragraph, 
the Secretary and the Inspector General shall 
submit to Congress recommendations, including 
based on the review conducted under subpara-
graph (A), for improving access to evidence-based
3682 
† HR 2617 EAS2 
contingency management interventions while en-
suring quality of care, ensuring fidelity to evi-
dence-based practices, and including strong pro-
gram integrity safeguards that prevent increased 
waste, fraud, and abuse and prevent medically 
unnecessary or inappropriate items or services 
reimbursed in whole or in part by a Federal 
health care program.’’. 
SEC. 4128. PROVIDER OUTREACH AND REPORTING ON CER-
TAIN 
BEHAVIORAL 
HEALTH 
INTEGRATION 
SERVICES. 
(a) OUTREACH.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall 
conduct outreach to physicians and appropriate non-physi-
cian practitioners participating under the Medicare pro-
gram under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) with respect to behavioral health inte-
gration services described by any of HCPCS codes 99492 
through 99494 or 99484 (or any successor code). Such out-
reach shall include a comprehensive, one-time education 
initiative to inform such physicians and practitioners of 
the inclusion of such services as a covered benefit under the 
Medicare program, including describing the requirements 
to bill for such codes and the requirements for beneficiary 
eligibility for such services.
3683 
† HR 2617 EAS2 
(b) REPORTS TO CONGRESS.— 
(1) PROVIDER
OUTREACH.—Not later than 1 
year after the date of the completion of the education 
initiative described in subsection (a), the Secretary 
shall submit to the Committee on Ways and Means 
and the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Fi-
nance of the Senate a report on the outreach con-
ducted under such subsection. Such report shall in-
clude a description of the methods used for such out-
reach. 
(2) UTILIZATION
RATES.—Not later than 18 
months after the date of the completion of the edu-
cation initiative described in subsection (a), and two 
years thereafter, the Secretary shall submit to the 
Committee on Ways and Means and the Committee 
on Energy and Commerce of the House of Representa-
tives and the Committee on Finance of the Senate a 
report on the number of Medicare beneficiaries (in-
cluding those beneficiaries accessing services in rural 
and underserved areas) who, during the preceding 
year, were furnished services described in subsection 
(a) for which payment was made under title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.).
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† HR 2617 EAS2 
SEC. 4129. OUTREACH AND REPORTING ON OPIOID USE DIS-
ORDER TREATMENT SERVICES FURNISHED 
BY OPIOID TREATMENT PROGRAMS. 
(a) OUTREACH.— 
(1) PROVIDER
OUTREACH.—The Secretary of 
Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall conduct outreach to phy-
sicians and appropriate non-physician practitioners 
participating under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et 
seq.) with respect to opioid use disorder treatment 
services furnished by an opioid treatment program 
(as defined in section 1861(jjj) of the Social Security 
Act (42 U.S.C. 1395x(jjj))). Such outreach shall in-
clude a comprehensive, one-time education initiative 
to inform such physicians and practitioners of the in-
clusion of such services as a covered benefit under the 
Medicare program, including describing the require-
ments for billing and the requirements for beneficiary 
eligibility for such services. 
(2) BENEFICIARY
OUTREACH.—The Secretary 
shall conduct outreach to Medicare beneficiaries with 
respect to opioid use disorder treatment services fur-
nished by an opioid treatment program (as defined in 
section 1861(jjj) of the Social Security Act (42 U.S.C. 
1395x(jjj))), including a comprehensive, one-time edu-
3685 
† HR 2617 EAS2 
cation initiative informing such beneficiaries about 
the eligibility requirements to receive such services. 
(b) REPORTS TO CONGRESS.— 
(1) OUTREACH.—Not later than 1 year after the 
date of the completion of the education initiatives de-
scribed in subsection (a), the Secretary shall submit 
to the Committee on Ways and Means and the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of the 
Senate a report on the outreach conducted under such 
subsection. Such report shall include a description of 
the methods used for such outreach. 
(2) UTILIZATION
RATES.—Not later than 18 
months after the date of the completion of the edu-
cation initiatives described in subsection (a), and two 
years thereafter, the Secretary shall submit to the 
Committee on Ways and Means and the Committee 
on Energy and Commerce of the House of Representa-
tives and the Committee on Finance of the Senate a 
report on the number of Medicare beneficiaries who, 
during the preceding year, were furnished opioid use 
disorder treatment services by an opioid treatment 
program (as defined in section 1861(jjj) of the Social 
Security Act (42 U.S.C. 1395x(jjj))) for which pay-
3686 
† HR 2617 EAS2 
ment was made under title XVIII of such Act (42 
U.S.C. 1395 et seq.). 
SEC. 4130. GAO STUDY AND REPORT COMPARING COV-
ERAGE OF MENTAL HEALTH AND SUBSTANCE 
USE DISORDER BENEFITS AND NON-MENTAL 
HEALTH AND SUBSTANCE USE DISORDER 
BENEFITS. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study that 
compares the mental health and substance use dis-
order benefits offered by Medicare Advantage plans 
(including specialized MA plans for special needs in-
dividuals, as defined in section 1859(b)(6) of the So-
cial Security Act (42 U.S.C. 1395w–28(b)(6)) under 
part C of title XVIII of such Act with— 
(A) benefits (other than mental health and 
substance use disorder benefits) offered by such 
Medicare Advantage plans; and 
(B) the mental health and substance use 
disorder benefits under the original Medicare fee- 
for-service program under parts A and B of such 
title XVIII.
3687 
† HR 2617 EAS2 
(2) ANALYSIS.—To the extent data is available 
and reliable, the study under paragraph (1) shall in-
clude an analysis of— 
(A) out-of-pocket expenses for in-network 
care; 
(B) the use of prior authorization and other 
utilization management tools; 
(C) the mental health and substance use dis-
order benefits offered; and 
(D) other items determined appropriate by 
the Comptroller General. 
(3) PLAN AND SERVICE SPECIFIC.—To the extent 
practicable, the study under paragraph (1) shall ex-
amine differences by type of Medicare Advantage plan 
and type of item or service. 
(4) BOTH REQUIRED AND SUPPLEMENTAL BENE-
FITS.—For purposes of the study under paragraph 
(1), benefits offered by Medicare Advantage plans (in-
cluding specialized MA plans for special needs indi-
viduals) under part C of title XVIII of the Social Se-
curity Act shall include both and differentiate be-
tween— 
(A) benefits under the original Medicare fee- 
for-service program, as described in section
3688 
† HR 2617 EAS2 
1852(a)(1)(B) of such Act (42 U.S.C. 1395w– 
22(a)(1)(B)); and 
(B) supplemental health care benefits, as de-
scribed in section 1852(a)(3)(A) of such Act (42 
U.S.C. 1395w–22(a)(3)(A)). 
(b) REPORT.—Not later than 30 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report on the study conducted under 
subsection (a). 
Subtitle D—Other Medicare 
Provisions 
SEC. 4131. TEMPORARY INCLUSION OF AUTHORIZED ORAL 
ANTIVIRAL DRUGS AS COVERED PART D 
DRUG. 
Section 1860D–2(e)(1) of the Social Security Act (42 
U.S.C. 1395w–102(e)(1)) is amended— 
(1) in subparagraph (A), by striking at the end 
‘‘or’’; 
(2) in subparagraph (B), by striking the comma 
at the end and inserting ‘‘; or’’; and 
(3) by inserting after subparagraph (B) the fol-
lowing new subparagraph: 
‘‘(C) for the period beginning on the date of 
the enactment of this subparagraph and ending 
on December 31, 2024, an oral antiviral drug
3689 
† HR 2617 EAS2 
that may be dispensed only upon a prescription 
and is authorized under section 564 of the Fed-
eral Food, Drug, and Cosmetic Act, on the basis 
of the declaration published in the Federal Reg-
ister by the Secretary of Health and Human 
Services on April 1, 2020 (85 Fed. Reg. 18250 
et seq.),’’. 
SEC. 4132. RESTORATION OF CBO ACCESS TO CERTAIN 
PART D PAYMENT DATA. 
Section 1860D–15(f)(2) of the Social Security Act (42 
U.S.C. 1395w–115(f)(2)) is amended— 
(1) in subparagraph (B), by striking at the end 
‘‘and’’; 
(2) in subparagraph (C), by striking at the end 
the period and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(D) by the Director of the Congressional 
Budget Office for the purposes of analysis of pro-
grams authorized under the Social Security Act, 
as applicable, and the fulfilment of such Direc-
tor’s duties under the Congressional Budget and 
Impoundment Control Act of 1974.’’.
3690 
† HR 2617 EAS2 
SEC. 
4133. 
MEDICARE 
COVERAGE 
OF 
CERTAIN 
LYMPHEDEMA 
COMPRESSION 
TREATMENT 
ITEMS. 
(a) COVERAGE.— 
(1) IN GENERAL.—Section 1861 of the Social Se-
curity Act (42 U.S.C. 1395x), as amended by section 
4121(a), is amended— 
(A) in subsection (s)(2)— 
(i) in subparagraph (HH), by striking 
‘‘and’’ after the semicolon at the end; 
(ii) in subparagraph (II), by striking 
the period at the end and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the following 
new subparagraph: 
‘‘(JJ) lymphedema compression treatment items 
(as defined in subsection (mmm));’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(mmm) LYMPHEDEMA COMPRESSION TREATMENT 
ITEMS.—The term ‘lymphedema compression treatment 
items’ means standard and custom fitted gradient compres-
sion garments and other items determined by the Secretary 
that are—
3691 
† HR 2617 EAS2 
‘‘(1) furnished on or after January 1, 2024, to 
an individual with a diagnosis of lymphedema for the 
treatment of such condition; 
‘‘(2) primarily and customarily used to serve a 
medical 
purpose 
and 
for 
the 
treatment 
of 
lymphedema, as determined by the Secretary; and 
‘‘(3) prescribed by a physician (or a physician 
assistant, nurse practitioner, or a clinical nurse spe-
cialist (as those terms are defined in section 
1861(aa)(5)) to the extent authorized under State 
law).’’. 
(2) PAYMENT.— 
(A) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) , as 
amended by section 4121(a), is amended— 
(i) by striking ‘‘and’’ before ‘‘(FF)’’; 
and 
(ii) by inserting before the semicolon at 
the end the following: ‘‘, and (GG) with re-
spect to lymphedema compression treatment 
items (as defined in section 1861(mmm)), 
the amount paid shall be equal to 80 per-
cent of the lesser of the actual charge or the 
amount determined under the payment 
basis determined under section 1834(z)’’.
3692 
† HR 2617 EAS2 
(B) PAYMENT
BASIS
AND
LIMITATIONS.— 
Section 1834 of the Social Security Act (42 
U.S.C. 1395m) is amended by adding at the end 
the following new subsection: 
‘‘(z) PAYMENT
FOR
LYMPHEDEMA
COMPRESSION 
TREATMENT ITEMS.— 
‘‘(1) IN GENERAL.—The Secretary shall deter-
mine an appropriate payment basis for lymphedema 
compression treatment items (as defined in section 
1861(mmm)). In making such a determination, the 
Secretary may take into account payment rates for 
such items under State plans (or waivers of such 
plans) under title XIX, the Veterans Health Adminis-
tration, and group health plans and health insurance 
coverage (as such terms are defined in section 2791 
of the Public Health Service Act), and such other in-
formation as the Secretary determines appropriate. 
‘‘(2) FREQUENCY
LIMITATION.—No payment 
may be made under this part for lymphedema com-
pression treatment items furnished other than at such 
frequency as the Secretary may establish. 
‘‘(3) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.—In the case of lymphedema compression treat-
ment items that are included in a competitive acqui-
3693 
† HR 2617 EAS2 
sition program in a competitive acquisition area 
under section 1847(a)— 
‘‘(A) the payment basis under this sub-
section for such items furnished in such area 
shall be the payment basis determined under 
such competitive acquisition program; and 
‘‘(B) the Secretary may use information on 
the payment determined under such competitive 
acquisition programs to adjust the payment 
amount otherwise determined under this sub-
section for an area that is not a competitive ac-
quisition area under section 1847, and in the 
case of such adjustment, paragraphs (8) and (9) 
of section 1842(b) shall not be applied.’’. 
(3) 
CONFORMING
AMENDMENT.—Section 
1847(a)(2) of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)) is amended by adding at the end the 
following new subparagraph: 
‘‘(D) LYMPHEDEMA
COMPRESSION
TREAT-
MENT ITEMS.—Lymphedema compression treat-
ment items (as defined in section 1861(mmm)) 
for which payment would otherwise be made 
under section 1834(z).’’.
3694 
† HR 2617 EAS2 
(b) INCLUSION IN REQUIREMENTS FOR SUPPLIERS OF 
MEDICAL EQUIPMENT AND SUPPLIES.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended— 
(1) in subsection (a)(20)(D), by adding at the 
end the following new clause: 
‘‘(iv) Lymphedema compression treat-
ment 
items 
(as 
defined 
in 
section 
1861(mmm)).’’. 
(2) in subsection (j)(5)— 
(A) by redesignating subparagraphs (E) 
and (F) as subparagraphs (F) and (G), respec-
tively; and 
(B) by inserting after subparagraph (D) the 
following new subparagraph: 
‘‘(E) lymphedema compression treatment 
items (as defined in section 1861(mmm));’’. 
SEC. 4134. PERMANENT IN-HOME BENEFIT FOR IVIG SERV-
ICES. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)(Z) by inserting ‘‘, and 
items and services furnished on or after January 1, 
2024, related to the administration of intravenous 
immune globulin,’’ after ‘‘globulin’’; and
3695 
† HR 2617 EAS2 
(2) in subsection (zz), by inserting ‘‘furnished be-
fore January 1, 2024,’’ after ‘‘but not including items 
or services’’. 
(b) PAYMENT.—Section 1842(o) of the Social Security 
Act (42 U.S.C. 1395u(o)) is amended by adding at the end 
the following new paragraph: 
‘‘(8) In the case of intravenous immune globulin 
described in section 1861(s)(2)(Z) that are furnished 
on or after January 1, 2024, to an individual by a 
supplier in the patient’s home, the Secretary shall 
provide for a separate bundled payment to the sup-
plier for all items and services related to the adminis-
tration of such intravenous immune globulin to such 
individual in the patient’s home during a calendar 
day in an amount that the Secretary determines to 
be appropriate, which may be based on the payment 
established pursuant to subsection (d) of section 101 
of the Medicare IVIG Access and Strengthening Medi-
care and Repaying Taxpayers Act of 2012. For pur-
poses of the preceding sentence, such separate bundled 
payment shall not apply in the case of an individual 
receiving home health services under section 1895.’’. 
(c) CLARIFICATION WITH RESPECT TO PAYMENT FOR 
THE IN-HOME ADMINISTRATION OF IVIG ITEMS AND SERV-
3696 
† HR 2617 EAS2 
ICES.—Section 1834(j)(5) of the Social Security Act (42 
U.S.C. 1395m(j)(5)) is amended— 
(1) by redesignating subparagraphs (E) and (F) 
as subparagraphs (F) and (G), respectively; and 
(2) by inserting after subparagraph (D) the fol-
lowing new subparagraph: 
‘‘(E) items and services related to the ad-
ministration of intravenous immune globulin 
furnished on or after January 1, 2024, as de-
scribed in section 1861(zz);’’. 
(d) COINSURANCE.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1), as amended by section 
4121(a) and section 4133(a), is amended— 
(1) by striking ‘‘and’’ before ‘‘(GG)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (HH) with respect to items and 
services related to the administration of intravenous 
immune globulin furnished on or after January 1, 
2024, as described in section 1861(zz), the amounts 
paid shall be the lesser of the 80 percent of the actual 
charge or the payment amount established under sec-
tion 1842(o)(8)’’. 
(e) ADDITIONAL FUNDING FOR MEDICARE IVIG DEM-
ONSTRATION PROJECT.—
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† HR 2617 EAS2 
(1) FUNDING.—There is authorized to be appro-
priated, and there is hereby appropriated, out of any 
monies in the Treasury not otherwise appropriated, 
$4,300,000 for purposes of paying for items and serv-
ices furnished under the demonstration project estab-
lished by the Medicare IVIG Access and Strength-
ening Medicare and Repaying Taxpayers Act of 2012 
(42 U.S.C. 1395l note). 
(2) 
SUPPLEMENT, 
NOT
SUPPLANT.—Any 
amounts appropriated pursuant to this subsection 
shall be in addition to any other amounts otherwise 
appropriated pursuant to any other provision of law. 
SEC. 4135. ACCESS TO NON-OPIOID TREATMENTS FOR PAIN 
RELIEF. 
(a) IN GENERAL.—Section 1833(t) of the Social Secu-
rity Act (42 U.S.C. 1395l(t)) is amended— 
(1) in paragraph (2)(E), by inserting ‘‘and tem-
porary additional payments for non-opioid treat-
ments for pain relief under paragraph (16)(G),’’ after 
‘‘payments under paragraph (6)’’; and 
(2) in paragraph (16), by adding at the end the 
following new subparagraph: 
‘‘(G) TEMPORARY
ADDITIONAL
PAYMENTS 
FOR
NON-OPIOID
TREATMENTS
FOR
PAIN
RE-
LIEF.—
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† HR 2617 EAS2 
‘‘(i) IN
GENERAL.—Notwithstanding 
any other provision of this subsection, with 
respect to a non-opioid treatment for pain 
relief (as defined in clause (iv)) furnished 
on or after January 1, 2025, and before 
January 1, 2028, the Secretary shall not 
package payment for such non-opioid treat-
ment for pain relief into a payment for a 
covered OPD service (or group of services), 
and shall make an additional payment as 
specified in clause (ii) for such non-opioid 
treatment for pain relief. 
‘‘(ii) AMOUNT
OF
PAYMENT.—Subject 
to the limitation under clause (iii), the 
amount of the payment specified in this 
clause is, with respect to a non-opioid treat-
ment for pain relief that is— 
‘‘(I) a drug or biological product, 
the amount of payment for such drug 
or biological determined under section 
1847A that exceeds the portion of the 
otherwise applicable Medicare OPD fee 
schedule that the Secretary determines 
is associated with the drug or biologi-
cal; or
3699 
† HR 2617 EAS2 
‘‘(II) 
a 
medical 
device, 
the 
amount of the hospital’s charges for the 
device, adjusted to cost, that exceeds the 
portion of the otherwise applicable 
Medicare OPD fee schedule that the 
Secretary determines is associated with 
the device. 
‘‘(iii) 
LIMITATION.—The 
additional 
payment amount specified in clause (ii) 
shall not exceed the estimated average of 18 
percent of the OPD fee schedule amount for 
the OPD service (or group of services) with 
which the non-opioid treatment for pain re-
lief is furnished, as determined by the Sec-
retary. 
‘‘(iv) 
DEFINITION
OF
NON-OPIOID 
TREATMENT
FOR
PAIN
RELIEF.—In this 
subparagraph, the term ‘non-opioid treat-
ment for pain relief’ means a drug, biologi-
cal product, or medical device that— 
‘‘(I) in the case of a drug or bio-
logical product, has a label indication 
approved by the Food and Drug Ad-
ministration to reduce postoperative 
pain, or produce postsurgical or re-
3700 
† HR 2617 EAS2 
gional analgesia, without acting upon 
the body’s opioid receptors; 
‘‘(II) in case of a medical device, 
is used to deliver a therapy to reduce 
postoperative pain, or produce post-
surgical or regional analgesia, and 
has— 
‘‘(aa) an application under 
section 515 of the Federal Food, 
Drug, and Cosmetic Act that has 
been approved with respect to the 
device, been cleared for market 
under section 510(k) of such Act, 
or is exempt from the require-
ments of section 510(k) of such 
Act pursuant to subsection (l) or 
(m) or section 510 of such Act or 
section 520(g) of such Act; and 
‘‘(bb) demonstrated the abil-
ity to replace, reduce, or avoid 
intraoperative 
or 
postoperative 
opioid use or the quantity of 
opioids prescribed in a clinical 
trial or through data published in 
a peer-reviewed journal;
3701 
† HR 2617 EAS2 
‘‘(III) does not receive transi-
tional pass-through payment under 
paragraph (6); and 
‘‘(IV) has payment that is pack-
aged into a payment for a covered 
OPD service (or group of services).’’. 
(b) AMBULATORY SURGICAL CENTER PAYMENT SYS-
TEM.—Section 1833(i) of the Social Security Act (42 
U.S.C. 1395l(i)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(10) TEMPORARY ADDITIONAL PAYMENTS FOR 
NON-OPIOID TREATMENTS FOR PAIN RELIEF.— 
‘‘(A) IN GENERAL.—In the case of surgical 
services furnished on or after January 1, 2025, 
and before January 1, 2028, the payment system 
described in paragraph (2)(D)(i) shall provide, 
in a budget-neutral manner, for an additional 
payment for a non-opioid treatment for pain re-
lief (as defined in clause (iv) of subsection 
(t)(16)(G)) furnished as part of such services in 
the amount specified in clause (ii) of such sub-
section, subject to the limitation under clause 
(iii) of such subsection. 
‘‘(B) TRANSITION.—A drug or biological 
that meets the requirements of section 416.174 of
3702 
† HR 2617 EAS2 
title 42, Code of Federal Regulations (or any 
successor regulation) and is a non-opioid treat-
ment for pain relief (as defined in clause (iv) of 
subsection (t)(16)(G)) shall receive additional 
payment in the amount specified in clause (ii) 
of such subsection, subject to the limitation under 
clause (iii) of such subsection.’’. 
(c) EVALUATION OF COVERAGE AND PAYMENT FOR 
NON-OPIOID THERAPIES AND THERAPEUTIC SERVICES FOR 
PAIN MANAGEMENT.— 
(1) REPORT TO CONGRESS.—Not later than Jan-
uary 1, 2028, the Secretary of Health and Human 
Services (in this subsection referred to as the ‘‘Sec-
retary’’) shall submit to Congress a report— 
(A) identifying limitations, gaps, barriers 
to access, or deficits in Medicare coverage or re-
imbursement for restorative therapies, behavioral 
approaches, and complementary and integrative 
health services that are identified in the Pain 
Management Best Practices Inter-Agency Task 
Force Report and that have demonstrated the 
ability to replace or reduce opioid consumption; 
(B) recommending actions to address the 
limitations, gaps, barriers to access, or deficits 
identified under subparagraph (A) to improve
3703 
† HR 2617 EAS2 
Medicare coverage and reimbursement for such 
therapies, approaches, and services; and 
(C) comparing, for the 12-month period fol-
lowing the first 6 months in which additional 
payment for non-opioid treatments for pain re-
lief (as defined in clause (iv) of section 
1833(t)(16)(G) of the Social Security Act, as 
added by subsection (a)) is made under such sec-
tion 1833(t)(16)(G)— 
(i) with respect to Medicare bene-
ficiaries who received a non-opioid treat-
ment for pain relief (as so defined) as part 
of a covered OPD service, the quantity of 
opioids administered, dispensed, and pre-
scribed for the same covered OPD service, 
including postoperative management; and 
(ii) with respect to Medicare bene-
ficiaries who did not receive a non-opioid 
treatment for pain relief (as so defined) as 
part of the same covered OPD service in 
clause (i)), the quantity of opioids adminis-
tered, dispensed, and prescribed for the 
same covered OPD service, including post-
operative management.
3704 
† HR 2617 EAS2 
(2) REPORTING
STANDARD
AND
PUBLIC
CON-
SULTATION.—In developing the report described in 
paragraph (1), the Secretary shall compare results 
from nationally represented samples of beneficiaries 
and consult with relevant stakeholders as determined 
appropriate by the Secretary. 
(3) EXCLUSIVE TREATMENT.—Any drug, biologi-
cal product, or medical device that is a non-opioid 
treatment for pain relief (as defined in section 
1833(t)(16)(G)(iv) of the Social Security Act, as 
added by subsection (a)) shall not be considered a 
therapeutic service for purposes of the report under 
paragraph (1). 
SEC. 4136. TECHNICAL AMENDMENTS TO MEDICARE SEPA-
RATE PAYMENT FOR DISPOSABLE NEGATIVE 
PRESSURE WOUND THERAPY DEVICES. 
(a) IN GENERAL.—Section 1834(s) of the Social Secu-
rity Act (42 U.S.C. 1395m(s)) is amended— 
(1) by amending paragraph (3) to read as fol-
lows: 
‘‘(3) PAYMENT.— 
‘‘(A) IN GENERAL.—The separate payment 
amount established under this paragraph for an 
applicable disposable device for a year shall be 
equal to—
3705 
† HR 2617 EAS2 
‘‘(i) for a year before 2024, the amount 
of the payment that would be made under 
section 1833(t) (relating to payment for 
covered OPD services) for the year for the 
Level I Healthcare Common Procedure Cod-
ing System (HCPCS) code for which the de-
scription for a professional service includes 
the furnishing of such device; 
‘‘(ii) for 2024, the supply price used to 
determine the relative value for the service 
under the fee schedule under section 1848 
(as of January 1, 2022) for the applicable 
disposable device, updated by the specified 
adjustment described in subparagraph (B) 
for such year; and 
‘‘(iii) for 2025 and each subsequent 
year, the payment amount established under 
this paragraph for such device for the pre-
vious year, updated by the specified adjust-
ment described in subparagraph (B) for 
such year. 
‘‘(B) SPECIFIED ADJUSTMENT.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), the specified adjustment
3706 
† HR 2617 EAS2 
described in this subparagraph for a year is 
equal to— 
‘‘(I) the percentage increase in the 
consumer price index for all urban 
consumers (United States city average) 
for the 12-month period ending in 
June of the previous year; minus 
‘‘(II) the productivity adjustment 
described 
in 
section 
1886(b)(3)(B)(xi)(II) for such year. 
‘‘(ii) CLARIFICATION ON APPLICATION 
OF THE PRODUCTIVITY ADJUSTMENT.—The 
application of clause (i)(II) may result in 
a specified adjustment of less than 0.0 for a 
year, and may result in the separate pay-
ment amount under this subsection for an 
applicable device for a year being less than 
such separate payment amount for such de-
vice for the preceding year. 
‘‘(C) EXCLUSION OF NURSING AND THERAPY 
SERVICES FROM SEPARATE PAYMENT.—With re-
spect to applicable devices furnished on or after 
January 1, 2024, the separate payment amount 
determined under this paragraph shall not in-
clude payment for nursing or therapy services
3707 
† HR 2617 EAS2 
described in section 1861(m). Payment for such 
nursing or therapy services shall be made under 
the prospective payment system established under 
section 1895 and shall not be separately 
billable.’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(4) IMPLEMENTATION.—As part of submitting 
claims for the separate payment established under 
this subsection, beginning with 2024, the Secretary 
shall accept and process claims submitted using the 
type of bill that is most commonly used by home 
health agencies to bill services under a home health 
plan of care.’’. 
SEC. 4137. EXTENSION OF CERTAIN HOME HEALTH RURAL 
ADD-ON PAYMENTS. 
Subsection (b)(1)(B) of section 421 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173; 117 Stat. 2283; 42 U.S.C. 
1395fff note), as amended by section 5201(b) of the Deficit 
Reduction Act of 2005 (Public Law 109–171; 120 Stat. 46), 
section 3131(c) of the Patient Protection and Affordable 
Care Act (Public Law 111–148; 124 Stat. 428), section 210 
of the Medicare Access and CHIP Reauthorization Act of 
2015 (Public Law 114–10; 129 Stat. 151), and section
3708 
† HR 2617 EAS2 
50208 of the Bipartisan Budget Act of 2018 (Public Law 
115–123; 132 Stat. 187) is amended— 
(1) in clause (iii), by striking ‘‘and’’ at the end; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(v) in the case of episodes and visits 
ending during 2023, by 1 percent; and’’. 
SEC. 4138. REMEDYING ELECTION REVOCATIONS RELATING 
TO ADMINISTRATION OF COVID–19 VACCINES. 
(a) IN GENERAL.—Section 1821(b)(5)(A) of the Social 
Security Act (42 U.S.C. 1395i–5(b)(5)(A)) is amended— 
(1) in clause (i), by striking ‘‘or’’ or at the end; 
(2) in clause (ii), by striking the period at the 
end and inserting ‘‘, or’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) effective beginning on the date of 
the enactment of this clause, that is a 
COVID–19 vaccine and its administration 
described in section 1861(s)(10)(A).’’. 
(b) SPECIAL RULES FOR COVID–19 VACCINES RELAT-
ING
TO
REVOCATION
OF
ELECTION.—Notwithstanding 
paragraphs (3) and (4) of section 1821(b) of the Social Se-
curity Act (42 U.S.C. 1395i–5(b)), in the case of an indi-
3709 
† HR 2617 EAS2 
vidual with a revocation of an election under such section 
prior to the date of enactment of this Act by reason of re-
ceiving a COVID–19 vaccine and its administration de-
scribed in section 1861(s)(10)(A) of such Act (42 U.S.C. 
1395x(s)(10)(A)), the following rules shall apply: 
(1) Beginning on such date of enactment, such 
individual may make an election under such section, 
which shall take effect immediately upon its execu-
tion, if such individual would be eligible to make such 
an election if they had not received such COVID–19 
vaccine and its administration. 
(2) Such revoked election shall not be taken into 
account for purposes of determining the effective date 
for an election described in subparagraph (A) or (B) 
of such paragraph (4). 
SEC. 4139. PAYMENT RATES FOR DURABLE MEDICAL EQUIP-
MENT UNDER THE MEDICARE PROGRAM. 
(a) AREAS OTHER THAN RURAL AND NONCONTIGUOUS 
AREAS.—The 
Secretary 
shall 
implement 
section 
414.210(g)(9)(v) of title 42, Code of Federal Regulations (or 
any successor regulation), to apply the transition rule de-
scribed in the first sentence of such section to all applicable 
items and services furnished in areas other than rural or 
noncontiguous areas (as such terms are defined for purposes 
of such section) through the remainder of the duration of
3710 
† HR 2617 EAS2 
the emergency period described in section 1135(g)(1)(B) of 
the Social Security Act (42 U.S.C. 1320b–5(g)(1)(B)) or 
December 31, 2023, whichever is later. 
(b) ALL AREAS.—The Secretary shall not implement 
section 414.210(g)(9)(vi) of title 42, Code of Federal Regula-
tions (or any successor regulation) until the date imme-
diately following the last day of the emergency period de-
scribed in section 1135(g)(1)(B) of the Social Security Act 
(42 U.S.C. 1320b–5(g)(1)(B)), or January 1, 2024, which-
ever is later. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement the provi-
sions of this section by program instruction or otherwise. 
SEC. 4140. EXTENDING ACUTE HOSPITAL CARE AT HOME 
WAIVERS AND FLEXIBILITIES. 
Title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.) is amended by inserting after section 1866F the fol-
lowing new section: 
‘‘SEC. 1866G. EXTENSION OF ACUTE HOSPITAL CARE AT 
HOME INITIATIVE. 
‘‘(a) IN GENERAL.— 
‘‘(1) EXTENSION.—With respect to inpatient hos-
pital admissions occurring during the period begin-
ning on the first day after the end of the emergency 
period described in section 1135(g)(1)(B) and ending
3711 
† HR 2617 EAS2 
on December, 31, 2024, the Secretary of Health and 
Human Services shall grant waivers and flexibilities 
(as described in paragraph (2)) to an individual hos-
pital that submits a request for such waivers and 
flexibilities and meets specified criteria (as described 
in paragraph (3)) in order to participate in the 
Acute Hospital Care at Home initiative of the Sec-
retary. 
‘‘(2) ACUTE HOSPITAL CARE AT HOME WAIVERS 
AND FLEXIBILITIES.—For the purposes of paragraph 
(1), the waivers and flexibilities described in this 
paragraph are the following waivers and flexibilities 
that were made available to individual hospitals 
under the Acute Hospital Care at Home initiative of 
the Secretary during the emergency period described 
in section 1135(g)(1)(B): 
‘‘(A) Subject to paragraph (3)(D), waiver of 
the requirements to provide 24-hour nursing 
services on premises and for the immediate 
availability of a registered nurse under section 
482.23(b) of title 42, Code of Federal Regulations 
(or any successor regulation), and the waivers of 
the physical environment and Life Safety Code 
requirements under section 482.41 of title 42,
3712 
† HR 2617 EAS2 
Code of Federal Regulations (or any successor 
regulation). 
‘‘(B) Flexibility to allow a hospital to fur-
nish inpatient services, including routine serv-
ices, outside the hospital under arrangements, as 
described in Medicare Program: Hospital Out-
patient Prospective Payment and Ambulatory 
Surgical Center Payment Systems and Quality 
Reporting Programs; Organ Acquisition; Rural 
Emergency Hospitals: Payment Policies, Condi-
tions of Participation, Provider Enrollment, 
Physician Self-Referral; New Service Category 
for Hospital Outpatient Department Prior Au-
thorization Process; Overall Hospital Quality 
Star Rating; COVID–19 (87 Fed. Reg. 71748 et 
seq.). 
‘‘(C) Waiver of the telehealth requirements 
under clause (i) of section 1834(m)(4)(C), as 
amended by section 4113(a) of the Health Ex-
tenders, Improving Access to Medicare, Medicaid, 
and CHIP, and Strengthening Public Health Act 
of 2022, such that the originating sites described 
in clause (ii) of such section shall include the 
home or temporary residence of the individual.
3713 
† HR 2617 EAS2 
‘‘(D) Other waivers and flexibilities that, as 
of the date of enactment of this section, were in 
place for such initiative during such emergency 
period. 
‘‘(3) SPECIFIED
CRITERIA.—For purposes of 
paragraph (1), the specified criteria for granting such 
waivers and flexibilities to individual hospitals are: 
‘‘(A) The hospital shall indicate to the Sec-
retary the criteria it would use to ensure that 
hospital services be furnished only to an indi-
vidual who requires an inpatient level of care, 
and shall require that a physician document in 
the medical record of each such individual that 
the individual meets such criteria. 
‘‘(B) The hospital and any other entities 
providing services under arrangements with the 
hospital shall ensure that the standard of care to 
treat an individual at home is the same as the 
standard of care to treat such individual as an 
inpatient of the hospital. 
‘‘(C) The hospital shall ensure that an indi-
vidual is only eligible for services under para-
graph (1) if the individual is a hospital inpa-
tient or is a patient of the hospital’s emergency 
department for whom the hospital determines
3716 
† HR 2617 EAS2 
‘‘(iii) costs incurred by furnishing care 
in the inpatient setting and through the 
Acute Hospital Care at Home initiative; 
‘‘(iv) the quantity, mix and intensity 
of such services (such as in-person visits 
and virtual contacts with patients) fur-
nished in the Acute Hospital Care at Home 
initiative and furnished in the inpatient 
setting; and 
‘‘(v) socioeconomic information on 
beneficiaries treated under the initiative, 
including racial and ethnic data, income, 
and whether such beneficiaries are dually 
eligible for benefits under this title and title 
XIX. 
‘‘(2) REPORT.—Not later than September 30, 
2024, the Secretary of Health and Human Services 
shall post on a website of the Centers for Medicare & 
Medicaid Services a report on the study conducted 
under paragraph (1). 
‘‘(3) 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 2023, out of any 
amounts in the Treasury not otherwise appropriated,
3717 
† HR 2617 EAS2 
$5,000,000, to remain available until expended, for 
purposes of carrying out this subsection. 
‘‘(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this section 
by program instruction or otherwise. 
‘‘(d) PUBLICLY AVAILABLE INFORMATION.—The Sec-
retary shall, as feasible, make the information collected 
under subsections (a)(3)(E) and (b)(1) available on the 
Medicare.gov internet website (or a successor website).’’. 
SEC. 4141. EXTENSION OF PASS-THROUGH STATUS UNDER 
THE MEDICARE PROGRAM FOR CERTAIN DE-
VICES IMPACTED BY COVID–19. 
(a) IN GENERAL.—Section 1833(t)(6) of the Social Se-
curity Act (42 U.S.C. 1395l(t)(6)) is amended— 
(1) in subparagraph (B)(iii), in the matter pre-
ceding subclause (I), by striking ‘‘A category’’ and in-
serting ‘‘Subject to subparagraph (K), a category’’; 
and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(K) PASS-THROUGH EXTENSION FOR CER-
TAIN DEVICES.— 
‘‘(i) IN GENERAL.—In the case of a de-
vice whose period of pass-through status 
under this paragraph will end on December
3718 
† HR 2617 EAS2 
31, 2022, such pass-through status shall be 
extended for a 1–year period beginning on 
January 1, 2023. 
‘‘(ii) NO ADJUSTMENT FOR PACKAGED 
COSTS.—For purposes of the 1–year period 
described in clause (i), the Secretary shall 
not remove the packaged costs of such device 
(as determined by the Secretary) from the 
payment amount under this subsection for a 
covered OPD service (or group of services) 
with which it is packaged. 
‘‘(iii) NO APPLICATION OF AGGREGATE 
LIMIT OR BUDGET NEUTRALITY.—Notwith-
standing any other provision of this sub-
section, this subparagraph shall not be 
taken into account— 
‘‘(I) in applying the limit on an-
nual aggregate adjustments under sub-
paragraph (E) for 2023; or 
‘‘(II) in making any budget neu-
trality adjustments under this sub-
section for 2023.’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human Serv-
3719 
† HR 2617 EAS2 
ice may implement the amendments made by subsection (a) 
by program instruction or otherwise. 
SEC. 
4142. 
INCREASING 
TRANSPARENCY 
FOR 
HOME 
HEALTH PAYMENTS UNDER THE MEDICARE 
PROGRAM. 
(a) TRANSPARENCY.—In notice and comment rule-
making used to implement section 1895(b)(3)(D) of the So-
cial Security Act (42 U.S.C. 1395fff(b)(3)(D), the Secretary 
of Health and Human Services (referred to in this section 
as the ‘‘Secretary’’) shall, on the date of the notice of pro-
posed rulemaking, make available through the internet 
website of the Centers for Medicare & Medicaid Services the 
following: 
(1) Electronic data files showing the Centers for 
Medicare & Medicaid Services simulation of 60-day 
episodes under the home health prospective payment 
system in effect prior to the Patient Driven 
Groupings Model using data from 30-day periods 
paid under such Model, if such data are used in de-
termining payment adjustments under clauses (ii) or 
(iii) of such section 1895(b)(3)(D). 
(2) To the extent practicable, a description of ac-
tual behavior changes, as described in clause (i) of 
such 
section 
1895(b)(3)(D), 
including 
behavior 
changes as a result of the implementation of sections
3720 
† HR 2617 EAS2 
1895(b)(2)(B) and 1895(b)(4)(B) of the Social Secu-
rity 
Act 
(42 
U.S.C. 
1395fff(b)(2)(B) 
and 
1395(b)(4)(B)) that occurred in calendar years 2020 
through 2026. 
(b) ENGAGEMENT WITH STAKEHOLDERS.— 
(1) IN GENERAL.—Not later than 90 days after 
the date of enactment of this section, the Secretary 
shall use an open door forum, a town hall meeting, 
a web-based forum, or other appropriate mechanism 
to receive input from home health stakeholders and 
interested parties on Medicare home health payment 
rate development, including the items described in 
paragraphs (1) and (2) of subsection (a) with respect 
to the home health prospective payment system rate 
for calendar year 2023. 
(2) REQUIREMENT.—At least 30 days before the 
forum, meeting, or other mechanism referred to in 
paragraph (1), the Secretary shall make available 
through the internet website of the Centers for Medi-
care & Medicaid Services the items described in para-
graphs (1) and (2) of subsection (a) with respect to 
the home health prospective payment system rate for 
calendar year 2023 as finalized in the final rule enti-
tled ‘‘Medicare Program; Calendar Year 2023 Home 
Health Prospective Payment System Rate Update;
3721 
† HR 2617 EAS2 
Home Health Quality Reporting Program Require-
ments; Home Health Value-Based Purchasing Ex-
panded Model Requirements; and Home Infusion 
Therapy Services Requirements’’ published in the 
Federal Register on November 4, 2022 (87 Fed. Reg. 
66790). 
(c) CONSTRUCTION.—Nothing in this section shall be 
construed to require any change in the methodology used 
by the Secretary to implement such section 1895(b)(3)(D), 
to restrict the Secretary’s discretion in establishing the 
methodology to implement such section, or to suggest that 
the Secretary’s promulgation of the methodology imple-
menting such Calendar Year 2023 home health final rule 
was inadequate under Chapter 5 of title 5, United States 
Code (commonly known as the ‘‘Administrative Procedures 
Act’’) or any other provision of law. 
SEC. 4143. WAIVER OF CAP ON ANNUAL PAYMENTS FOR 
NURSING AND ALLIED HEALTH EDUCATION 
PAYMENTS. 
(a) IN GENERAL.—Section 1886(l)(2)(B) of the Social 
Security Act (42 U.S.C. 1395ww(l)(2)(B)) is amended— 
(1) by striking ‘‘PAYMENTS.—Such ratio’’ and 
inserting ‘‘PAYMENTS.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), such ratio’’; and
3722 
† HR 2617 EAS2 
(2) by adding at the end the following new 
clause: 
‘‘(ii) EXCEPTION TO ANNUAL LIMITA-
TION FOR EACH OF 2010 THROUGH 2019.— 
For each of 2010 through 2019, the limita-
tion under clause (i) on the total amount of 
additional payments for nursing and allied 
health education to be distributed to hos-
pitals under this subsection for portions of 
cost reporting periods occurring in the year 
shall not apply to such payments made in 
such year to those hospitals that, as of the 
date of the enactment of this clause, are op-
erating a school of nursing, a school of al-
lied health, or a school of nursing and allied 
health.’’. 
(b) NO AFFECT ON PAYMENTS FOR DIRECT GRADUATE 
MEDICAL EDUCATION.—Section 1886(h)(3)(D)(iii) of the 
Social Security Act (42 U.S.C. 1395ww(h)(3)(D)(iii)) is 
amended by adding at the end the following sentence: ‘‘In 
applying the preceding sentence for each of 2010 through 
2019, the Secretary shall not take into account any increase 
in the total amount of such additional payment amounts 
for such nursing and allied health education for portions 
of cost reporting periods occurring in the year pursuant
3723 
† HR 2617 EAS2 
to the application of paragraph (2)(B)(ii) of such sub-
section.’’. 
(c) RETROACTIVE APPLICATION.—The amendments 
made by this section shall apply to payments made for por-
tions of cost reporting periods occurring in 2010 through 
2019. 
(d) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medicare 
& Medicaid Services Program Management Account for fis-
cal year 2023, out of any amounts in the Treasury not oth-
erwise appropriated, $3,000,000, to remain available until 
expended, for purposes of carrying out the amendments 
made by this section. 
Subtitle E—Health Care Tax 
Provisions 
SEC. 4151. EXTENSION OF SAFE HARBOR FOR ABSENCE OF 
DEDUCTIBLE FOR TELEHEALTH. 
(a) IN GENERAL.—Section 223(c)(2)(E) of the Inter-
nal Revenue Code of 1986 is amended by striking ‘‘In the 
case of plan years’’ and all that follows through ‘‘a plan’’ 
and inserting ‘‘In the case of— 
‘‘(i) months beginning after March 31, 
2022, and before January 1, 2023, and
3724 
† HR 2617 EAS2 
‘‘(ii) plan years beginning on or before 
December 31, 2021, or after December 31, 
2022, and before January 1, 2025, 
a plan’’. 
(b) CERTAIN
COVERAGE
DISREGARDED.—Section 
223(c)(1)(B)(ii) of the Internal Revenue Code of 1986 is 
amended by striking ‘‘(in the case of plan years beginning 
on or before December 31, 2021, or in the case of months 
beginning after March 31, 2022, and before January 1, 
2023)’’ and inserting ‘‘(in the case of months or plan years 
to which paragraph (2)(E) applies)’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to plan years beginning after December 
31, 2022. 
Subtitle F—Offsets 
SEC. 4161. REDUCTION OF MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$7,278,000,000’’ and inserting ‘‘$180,000,000’’. 
SEC. 4162. EXTENSION OF ADJUSTMENT TO CALCULATION 
OF HOSPICE CAP AMOUNT UNDER MEDICARE. 
Section 1814(i)(2)(B) of the Social Security Act (42 
U.S.C. 1395f(i)(2)(B)) is amended— 
(1) in clause (ii), by striking ‘‘2031’’ and insert-
ing ‘‘2032’’; and
3725 
† HR 2617 EAS2 
(2) in clause (iii), by striking ‘‘2031’’ and in-
serting ‘‘2032’’. 
SEC. 4163. MEDICARE DIRECT SPENDING REDUCTIONS. 
Section 251A(6) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985 (2 U.S.C. 901a(6)) is 
amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i)— 
(A) by striking ‘‘On the dates OMB issues 
its sequestration preview reports’’ and inserting 
‘‘On the date on which the President submits the 
budget under section 1105 of title 31, United 
States Code,’’; and 
(B) by striking ‘‘pursuant to section 
254(c),’’; 
(2) in subparagraph (C), by moving the margin 
2 ems to the left; 
(3) by striking subparagraphs (D) and (E); and 
(4) by adding at the end the following: 
‘‘(D) On the date on which the President submits 
the budget under section 1105 of title 31, United 
States Code, for fiscal year 2032, the President shall 
order a sequestration of payments for the Medicare 
programs specified in section 256(d), effective upon 
issuance, such that, notwithstanding the 2 percent
3726 
† HR 2617 EAS2 
limit specified in subparagraph (A) for such pay-
ments— 
‘‘(i) with respect to the first 6 months in 
which such order is effective for such fiscal year, 
the payment reduction shall be 2.0 percent; and 
‘‘(ii) with respect to the second 6 months in 
which such order is effective for such fiscal year, 
the payment reduction shall be 0 percent.’’. 
TITLE V—MEDICAID AND CHIP 
PROVISIONS 
Subtitle A—Territories 
SEC. 5101. MEDICAID ADJUSTMENTS FOR THE TERRI-
TORIES. 
(a) REVISING ALLOTMENTS FOR PUERTO RICO.—Sec-
tion 1108(g) of the Social Security Act (42 U.S.C. 1308(g)) 
is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) in clause (i)— 
(I) by striking ‘‘clause (ii)’’ and 
inserting ‘‘clause (ii) or (iii)’’; and 
(II) by striking ‘‘and’’ at the end; 
(ii) in clause (ii), by striking the semi-
colon and inserting ‘‘; and’’; and
3727 
† HR 2617 EAS2 
(iii) by adding at the end the following 
new clause: 
‘‘(iii) for fiscal year 2023 and each 
subsequent fiscal year, the amount specified 
in paragraph (11) for such fiscal year;’’; 
and 
(B) in the matter following subparagraph 
(E), by striking ‘‘each fiscal year after fiscal 
year 2021’’ and inserting ‘‘fiscal year 2022 (and, 
in the case of a territory other than Puerto Rico, 
for each subsequent fiscal year)’’; and 
(2) by adding at the end the following new para-
graphs: 
‘‘(11) ALLOTMENT AMOUNTS FOR PUERTO RICO 
FOR
FISCAL
YEAR
2023
AND
SUBSEQUENT
FISCAL 
YEARS.—For purposes of paragraph (2)(A)(iii), sub-
ject to paragraphs (12) and (13), the amounts speci-
fied in this paragraph are the following: 
‘‘(A) For fiscal year 2023, $3,275,000,000. 
‘‘(B) For fiscal year 2024, $3,325,000,000. 
‘‘(C) For fiscal year 2025, $3,475,000,000. 
‘‘(D) For fiscal year 2026, $3,645,000,000. 
‘‘(E) For fiscal year 2027, $3,825,000,000. 
‘‘(F) For fiscal year 2028, the sum of the 
amount that would have been provided under
3728 
† HR 2617 EAS2 
this subsection for Puerto Rico for such fiscal 
year in accordance with clause (i) of paragraph 
(2)(A) (without regard to clause (iii) of such 
paragraph) had the amount provided under this 
subsection for Puerto Rico for each of fiscal years 
2020 through 2027 been equal to the following: 
‘‘(i) For fiscal year 2020, the sum of 
the amount provided under this subsection 
for Puerto Rico for fiscal year 2019, in-
creased by the percentage increase in the 
medical care component of the Consumer 
Price Index for all urban consumers (as 
published by the Bureau of Labor Statis-
tics) for the 12-month period ending in 
March preceding the beginning of the fiscal 
year, rounded to the nearest $100,000. 
‘‘(ii) For each of fiscal years 2021 
through 2027, the sum of the amount pro-
vided under this subparagraph for the pre-
ceding fiscal year, increased in accordance 
with the percentage increase described in 
clause (i), rounded to the nearest $100,000. 
‘‘(G) For fiscal year 2029 and each subse-
quent fiscal year, the sum of the amount speci-
fied in this paragraph for the preceding fiscal
3729 
† HR 2617 EAS2 
year, increased by the percentage increase in the 
medical care component of the Consumer Price 
Index for all urban consumers (as published by 
the Bureau of Labor Statistics) for the 12-month 
period ending in March preceding the beginning 
of the fiscal year, rounded to the nearest 
$100,000. 
In determining the amount specified under subpara-
graph (F) for fiscal year 2028 or under subparagraph 
(G) for fiscal year 2029 or a subsequent fiscal year, 
the Secretary may in no way take into account the 
amount that was provided under this subsection for 
Puerto Rico for fiscal year 2022 that was based on 
the Centers for Medicare & Medicaid Services’ inter-
pretation of the flush language following paragraph 
(2)(E) (as described in the letters sent by the Centers 
for Medicare & Medicaid Services to the Director of 
the Medicaid Program for Puerto Rico dated Sep-
tember 24, 2021, and November 18, 2021, respec-
tively). 
‘‘(12) 
ADDITIONAL
INCREASE
FOR
PUERTO 
RICO.— 
‘‘(A) IN GENERAL.—For fiscal year 2023 
and each subsequent fiscal year through fiscal 
year 2027, the amount specified in paragraph
3730 
† HR 2617 EAS2 
(11) for the fiscal year shall be equal to the 
amount specified for such fiscal year under such 
paragraph increased by $300,000,000 if the Sec-
retary certifies that, with respect to such fiscal 
year, Puerto Rico’s State plan under title XIX 
(or waiver of such plan) establishes a reimburse-
ment floor, implemented through a directed pay-
ment arrangement plan, for physician services 
that are covered under the Medicare part B fee 
schedule in the Puerto Rico locality established 
under section 1848(b) that is not less than 75 
percent of the payment that would apply to such 
services if they were furnished under part B of 
title XVIII during such fiscal year. 
‘‘(B) APPLICATION TO MANAGED CARE.—In 
certifying whether Puerto Rico has established a 
reimbursement floor under a directed payment 
arrangement plan that satisfies the requirements 
of subparagraph (A)— 
‘‘(i) for fiscal year 2023, the Secretary 
shall apply such requirements to payments 
for physician services under a managed 
care contract entered into or renewed after 
the date of enactment of this paragraph and 
disregard payments for physician services
3731 
† HR 2617 EAS2 
under any managed care contract that was 
entered into prior to such date; and 
‘‘(ii) for each subsequent fiscal year 
through fiscal year 2027— 
‘‘(I) the Secretary shall disregard 
payments made under subcapitated ar-
rangements for services such as pri-
mary care case management; and 
‘‘(II) if the reimbursement floor 
for physician services applicable under 
a managed care contract satisfies the 
requirements of subparagraph (A) for 
the fiscal year in which the contract is 
entered into or renewed, such reim-
bursement floor shall be deemed to sat-
isfy such requirements for the subse-
quent fiscal year. 
‘‘(C) NONAPPLICATION OF INCREASE IN DE-
TERMINING ALLOTMENTS FOR SUBSEQUENT FIS-
CAL YEARS.—An increase under this paragraph 
for a fiscal year may not be taken into account 
in calculating the amount specified under para-
graph (11) for the succeeding fiscal year. 
‘‘(13) FURTHER INCREASE FOR PUERTO RICO.—
3732 
† HR 2617 EAS2 
‘‘(A) IN GENERAL.—For each of fiscal years 
2023 through 2027, the amount specified in 
paragraph (11) for the fiscal year shall be equal 
to the amount specified for such fiscal year 
under such paragraph (increased, if applicable, 
in accordance with paragraph (12)) and further 
increased— 
‘‘(i) in the case of each of fiscal years 
2023 through 2025, by $75,000,000 if the 
Secretary determines that Puerto Rico fully 
satisfies the requirements described in para-
graph (7)(A)(i) for such fiscal year; and 
‘‘(ii) in the case of each of fiscal years 
2026 and 2027, by $75,000,000 if the Sec-
retary determines that Puerto Rico fully 
satisfies the requirements described in— 
‘‘(I) paragraph (7)(A)(i) for such 
fiscal year; and 
‘‘(II) paragraph (7)(A)(v) for 
such fiscal year. 
‘‘(B) NONAPPLICATION OF INCREASE IN DE-
TERMINING ALLOTMENTS FOR SUBSEQUENT FIS-
CAL YEARS.—An increase under this paragraph 
for a fiscal year may not be taken into account
3733 
† HR 2617 EAS2 
in calculating the amount specified under para-
graph (11) for the succeeding fiscal year.’’. 
(b) EXTENSION
OF
INCREASED
FMAPS.—Section 
1905(ff) of the Social Security Act (42 U.S.C. 1396d(ff)) 
is amended— 
(1) in the header, by striking ‘‘TEMPORARY’’; 
(2) in paragraph (2)— 
(A) 
by 
striking 
‘‘subject 
to 
section 
1108(g)(7)(C),’’; and 
(B) by striking ‘‘December 23, 2022’’ and 
inserting ‘‘September 30, 2027,’’; and 
(3) in paragraph (3), by striking ‘‘for the period 
beginning December 21, 2019, and ending December 
23, 2022’’ and inserting ‘‘beginning December 21, 
2019’’. 
(c) APPLICATION OF ASSET VERIFICATION PROGRAM 
REQUIREMENTS TO PUERTO RICO.—Section 1940 of the 
Social Security Act (42 U.S.C. 1396w) is amended— 
(1) in subsection (a)— 
(A) in paragraph (3)(A), by adding at the 
end the following new clause: 
‘‘(iii) IMPLEMENTATION
IN
PUERTO 
RICO.—The Secretary shall require Puerto 
Rico to implement an asset verification pro-
3734 
† HR 2617 EAS2 
gram under this subsection by January 1, 
2026.’’; and 
(B) in paragraph (4)— 
(i) in the paragraph heading, by strik-
ing ‘‘EXEMPTION OF TERRITORIES’’ and in-
serting ‘‘EXEMPTION
OF
CERTAIN
TERRI-
TORIES’’; and 
(ii) by striking ‘‘and the District of 
Columbia’’ and inserting ‘‘, the District of 
Columbia, and Puerto Rico’’; and 
(2) in subsection (k)— 
(A) in paragraph (1)— 
(i) by redesignating subparagraphs (A) 
through (D) as clauses (i) through (iv), re-
spectively, and adjusting the margins ac-
cordingly; 
(ii) in the matter preceding clause (i), 
as so redesignated— 
(I) by striking ‘‘beginning on or 
after January 1, 2021’’; and 
(II) by striking ‘‘for a non-com-
pliant State shall be reduced—’’ and 
inserting the following: ‘‘for—
3735 
† HR 2617 EAS2 
‘‘(A) a non-compliant State that is one of 
the 50 States or the District of Columbia shall 
be reduced—’’; 
(iii) in clause (iv), as so redesignated, 
by striking the period at the end and insert-
ing ‘‘; and’’; and 
(iv) by adding at the end the following 
new subparagraph: 
‘‘(B) a non-compliant State that is Puerto 
Rico shall be reduced— 
‘‘(i) for calendar quarters in fiscal 
year 2026 beginning on or after January 1, 
2026, by 0.12 percentage points; 
‘‘(ii) for calendar quarters in fiscal 
year 2027, by 0.25 percentage points; 
‘‘(iii) for calendar quarters in fiscal 
year 2028, by 0.35 percentage points; and 
‘‘(iv) for calendar quarters in fiscal 
year 2029 and each fiscal year thereafter, 
by 0.5 percentage points.’’; and 
(B) in paragraph (2)(A), by striking ‘‘or 
the District of Columbia’’ and inserting ‘‘, the 
District of Columbia, or Puerto Rico’’.
3736 
† HR 2617 EAS2 
(d) EXTENSION OF REPORTING REQUIREMENT.—Sec-
tion 1108(g)(9) of the Social Security Act (42 U.S.C. 
1308(g)(9)) is amended— 
(1) in subparagraph (A), by inserting ‘‘and for 
fiscal year 2023 and each subsequent fiscal year (or, 
in the case of Puerto Rico, and for fiscal year 2023 
and each subsequent fiscal year before fiscal year 
2028)’’ after ‘‘fiscal year 2021)’’; and 
(2) in subparagraph (B)(i), by inserting ‘‘or by 
reason of the amendments made by section 5101 of the 
Health Extenders, Improving Access to Medicare, 
Medicaid, and CHIP, and Strengthening Public 
Health Act of 2022’’ before the period at the end. 
(e) PUERTO RICO PROGRAM INTEGRITY.—Section 
1108(g)(7)(A) of the Social Security Act (42 U.S.C. 
1308(g)(7)(A)) is amended— 
(1) in clause (iii), in the header, by inserting 
‘‘REPORTING’’ after ‘‘REFORM’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(v) CONTRACTING AND PROCUREMENT 
OVERSIGHT LEAD REQUIREMENT.— 
‘‘(I) IN GENERAL.—Not later than 
6 months after the date of the enact-
ment of this clause, the agency respon-
3737 
† HR 2617 EAS2 
sible for the administration of Puerto 
Rico’s Medicaid program under title 
XIX shall designate an officer (other 
than the director of such agency) to 
serve as the Contracting and Procure-
ment Oversight Lead to carry out the 
duties specified in subclause (II). 
‘‘(II) DUTIES.—Not later than 60 
days after the end of each fiscal quar-
ter (beginning with the first fiscal 
quarter beginning on or after the date 
that is 1 year after the date of the en-
actment of this clause), the officer des-
ignated pursuant to subclause (I) shall, 
with respect to each contract described 
in clause (iii) with an annual value 
exceeding $150,000 entered into during 
such quarter, certify to the Secretary 
either— 
‘‘(aa) that such contract has 
met the procurement standards 
identified under any of sections 
75.327, 75.328, and 75.329 of title 
45, Code of Federal Regulations 
(or successor regulations); or
3738 
† HR 2617 EAS2 
‘‘(bb) that extenuating cir-
cumstances (including a lack of 
multiple entities competing for 
such contract) prevented the com-
pliance of such contract with such 
standards. 
‘‘(III) PUBLICATION.—The officer 
designated pursuant to subclause (I) 
shall make public each certification 
containing extenuating circumstances 
described in subclause (II)(bb) not 
later than 30 days after such certifi-
cation is made, including a description 
of, and justification of, such extenu-
ating circumstances. 
‘‘(IV) REVIEW OF COMPLIANCE.— 
Not later than 2 years after the date of 
the enactment of this clause, the In-
spector General of the Department of 
Health and Human Services shall sub-
mit to Congress a report on the compli-
ance of Puerto Rico with the provisions 
of this clause.’’. 
(f) MEDICAID DATA SYSTEMS IMPROVEMENT PAY-
MENTS.—Section 1108 of the Social Security Act (42
3739 
† HR 2617 EAS2 
U.S.C. 1308) is amended by adding at the end the following 
new subsection: 
‘‘(i) DATA SYSTEMS IMPROVEMENT PAYMENTS.— 
‘‘(1) IN GENERAL.—Subject to paragraphs (2) 
and (3), the Secretary shall pay to each eligible terri-
tory an amount equal to 100 percent of the qualifying 
data system improvement expenditures incurred by 
such territory on or after October 1, 2023. 
‘‘(2) TREATMENT AS MEDICAID PAYMENTS.— 
‘‘(A) IN
GENERAL.—Payments to eligible 
territories made under this paragraph shall be 
considered to have been made under, and are 
subject to the requirements of, section 1903. 
‘‘(B) NONDUPLICATION.—No payment shall 
be made under title XIX (other than as provided 
under paragraph (1)), title XXI, or any other 
provision of law with respect to an expenditure 
for which payment is made under such para-
graph. 
‘‘(3) ALLOTMENTS.—The Secretary shall specify 
an allotment for each eligible territory for payments 
made under paragraph (1) in a manner such that— 
‘‘(A) the total amount of payments made 
under such paragraph for all eligible territories 
does not exceed $20,000,000; and
3740 
† HR 2617 EAS2 
‘‘(B) each eligible territory receives an equi-
table allotment of such payments. 
‘‘(4) NO EFFECT ON TERRITORIAL CAPS.—A pay-
ment to an eligible territory under this subsection 
shall not be taken into account for purposes of apply-
ing the payment limits under subsections (f) and (g). 
‘‘(5) DEFINITIONS.—In this subsection: 
‘‘(A) ELIGIBLE TERRITORY.—The term ‘eli-
gible territory’ means American Samoa, Guam, 
the Northern Mariana Islands, and the Virgin 
Islands. 
‘‘(B) QUALIFYING DATA SYSTEM IMPROVE-
MENT EXPENDITURE.—The term ‘qualifying data 
system improvement expenditure’ means an ex-
penditure by an eligible territory to improve, up-
date, or enhance a data system that is used by 
the territory to carry out an administrative ac-
tivity for which Federal financial participation 
is available under section 1903(a).’’. 
(g) STRATEGIC PLAN AND EVALUATION.— 
(1) IN GENERAL.—Each territory described in 
paragraph (2) shall— 
(A) not later than September 30, 2023, sub-
mit to the Secretary of Health and Human Serv-
ices a 4-year strategic plan that outlines the ter-
3741 
† HR 2617 EAS2 
ritory’s goals relating to workforce development, 
financing, systems implementation and oper-
ation, and program integrity with respect to the 
territory’s Medicaid program under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.); 
and 
(B) not later than September 30, 2027, sub-
mit to the Secretary of Health and Human Serv-
ices an analysis of the extent to which the terri-
tory has achieved, or is making progress toward 
achieving, the goals described in such strategic 
plan, and any policy changes relating to such 
goals that were adopted by the territory after the 
submission of the plan. 
(2) TERRITORIES
DESCRIBED.—The territories 
described in this paragraph are American Samoa, 
Guam, the Northern Mariana Islands, and the Virgin 
Islands. 
Subtitle B—Medicaid and CHIP 
Coverage 
SEC. 5111. FUNDING EXTENSION OF THE CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAM 
AND 
RE-
LATED PROVISIONS. 
(a) IN GENERAL.—Section 2104(a) of the Social Secu-
rity Act (42 U.S.C. 1397dd(a)) is amended—
3742 
† HR 2617 EAS2 
(1) in paragraph (27), by striking ‘‘through 
2026’’ and inserting ‘‘through 2028’’; and 
(2) in paragraph (28)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘for fiscal year 2027’’ and in-
serting ‘‘for fiscal year 2029’’; 
(B) in subparagraph (A), by striking ‘‘be-
ginning on October 1, 2026, and ending on 
March 31, 2027’’ and inserting ‘‘beginning on 
October 1, 2028, and ending on March 31, 
2029’’; and 
(C) in subparagraph (B), by striking ‘‘be-
ginning on April 1, 2027, and ending on Sep-
tember 30, 2027’’ and inserting ‘‘beginning on 
April 1, 2029, and ending on September 30, 
2029’’. 
(b) CHIP ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the Social 
Security Act (42 U.S.C. 1397dd(m)) is amended— 
(A) in paragraph (2)(B)(i), by striking ‘‘, 
2023, and 2027’’ and inserting ‘‘2023, and 
2029’’; 
(B) in paragraph (5), by striking ‘‘or 2027’’ 
and inserting ‘‘or 2029’’; 
(C) in paragraph (7)—
3743 
† HR 2617 EAS2 
(i) in subparagraph (A), by striking 
‘‘fiscal year 2027,’’ and inserting ‘‘fiscal 
year 2029’’; and 
(ii) in the flush left matter at the end, 
by striking ‘‘or fiscal year 2026.’’ and in-
serting ‘‘fiscal year 2026, or fiscal year 
2028.’’; 
(D) in paragraph (9), by striking ‘‘or 
2027’’ and inserting ‘‘or 2029’’; and 
(E) in paragraph (11)— 
(i) in the paragraph header, by strik-
ing ‘‘FISCAL YEAR 2027’’ and inserting ‘‘FIS-
CAL YEAR 2029’’; and 
(ii) in subparagraph (C)— 
(I) by striking ‘‘fiscal year 2026’’ 
each place it appears and inserting 
‘‘fiscal year 2028’’; and 
(II) by striking ‘‘fiscal year 2027’’ 
and inserting ‘‘fiscal year 2029’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
50101(b)(2) of the Bipartisan Budget Act of 2018 
(Public Law 115–123) is amended— 
(A) in the paragraph header, by striking 
‘‘FISCAL YEAR 2027’’ and inserting ‘‘FISCAL YEAR 
2029’’;
3744 
† HR 2617 EAS2 
(B) by striking ‘‘fiscal year 2027’’ each 
place it appears and inserting ‘‘fiscal year 
2029’’; and 
(C) by striking ‘‘beginning on October 1, 
2026, and ending on March 31, 2027’’ and in-
serting ‘‘beginning on October 1, 2028, and end-
ing on March 31, 2029’’. 
(c) OTHER RELATED CHIP POLICIES.— 
(1) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i)(1) of the Social Security Act (42 
U.S.C. 1320b–9a(i)(1)) is amended— 
(A) in subparagraph (C), by striking at the 
end ‘‘and’’; 
(B) in subparagraph (D), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(E) for each of fiscal years 2028 and 2029, 
$15,000,000 for the purpose of carrying out this 
section (other than subsections (e), (f), and 
(g)).’’. 
(2) ASSURANCE OF ELIGIBILITY STANDARDS FOR 
CHILDREN.—Section 2105(d)(3) of the Social Secu-
rity Act (42 U.S.C. 1397ee(d)(3)) is amended—
3745 
† HR 2617 EAS2 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2029’’; and 
(B) in subparagraph (A) by striking ‘‘Sep-
tember 30, 2027’’ each place it appears and in-
serting ‘‘September 30, 2029’’. 
(3) 
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(A) in the paragraph heading, by striking 
‘‘THROUGH 2027’’ and inserting ‘‘THROUGH 2029’’; 
and 
(B) in subparagraph (A), by striking 
‘‘through 2027’’ and inserting ‘‘through 2029’’. 
(4) OUTREACH AND ENROLLMENT PROGRAM.— 
Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), by striking 
‘‘through 2027’’ and inserting ‘‘through 
2029’’; and 
(ii) in paragraph (3), by striking 
‘‘through 2027’’ and inserting ‘‘through 
2029’’; and 
(B) in subsection (g)—
3746 
† HR 2617 EAS2 
(i) by striking ‘‘2017,,’’ and inserting 
‘‘2017,’’; 
(ii) by striking ‘‘and $48,000,000’’ and 
inserting ‘‘$48,000,000’’; and 
(iii) by inserting after ‘‘through 2027’’ 
the following: ‘‘, and $40,000,000 for the pe-
riod of fiscal years 2028 and 2029’’. 
(5) CHILD ENROLLMENT CONTINGENCY FUND.— 
Section 2104(n) of the Social Security Act (42 U.S.C. 
1397dd(n)) is amended— 
(A) by striking ‘‘2024 through 2026’’ each 
place it appears and inserting ‘‘2024 through 
2028’’; and 
(B) by striking ‘‘2023, and 2027’’ each 
place it appears and inserting ‘‘2023, and 
2029’’. 
(d) EXTENSION OF CERTAIN PROVISIONS.— 
(1) EXPRESS LANE ELIGIBILITY OPTION.—Sec-
tion 1902(e)(13)(I) of the Social Security Act (42 
U.S.C. 1396a(e)(13)(I)) is amended by striking 
‘‘2027’’ and inserting ‘‘2029’’. 
(2) CONFORMING AMENDMENTS FOR ASSURANCE 
OF
AFFORDABILITY
STANDARD
FOR
CHILDREN
AND 
FAMILIES.—Section 1902(gg)(2) of the Social Secu-
rity Act (42 U.S.C. 1396a(gg)(2)) is amended—
3747 
† HR 2617 EAS2 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2029’’; and 
(B) by striking ‘‘2027’’ each place it ap-
pears and inserting ‘‘2029,’’. 
SEC. 
5112. 
CONTINUOUS 
ELIGIBILITY 
FOR 
CHILDREN 
UNDER MEDICAID AND CHIP. 
(a) UNDER
THE
MEDICAID
PROGRAM.—Section 
1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is 
amended by striking paragraph (12) and inserting the fol-
lowing new paragraph: 
‘‘(12) 1 YEAR OF CONTINUOUS ELIGIBILITY FOR 
CHILDREN.—The State plan (or waiver of such State 
plan) shall provide that an individual who is under 
the age of 19 and who is determined to be eligible for 
benefits under a State plan (or waiver of such plan) 
approved under this title under subsection (a)(10)(A) 
shall remain eligible for such benefits until the earlier 
of— 
‘‘(A) the end of the 12-month period begin-
ning on the date of such determination; 
‘‘(B) the time that such individual attains 
the age of 19; or 
‘‘(C) the date that such individual ceases to 
be a resident of such State.’’.
3748 
† HR 2617 EAS2 
(b) UNDER
THE CHILDREN’S HEALTH INSURANCE 
PROGRAM.—Section 2107(e)(1) of the Social Security Act 
(42 U.S.C. 1397gg(e)(1)) is amended— 
(1) by redesignating subparagraphs (K) through 
(T) as subparagraphs (L) through (U), respectively; 
and 
(2) by inserting after subparagraph (J) the fol-
lowing new subparagraph: 
‘‘(K) Section 1902(e)(12) (relating to 1 year 
of continuous eligibility for children), except that 
a targeted low-income child enrolled under the 
State child health plan or waiver may be trans-
ferred to the Medicaid program under title XIX 
for the remaining duration of the 12-month con-
tinuous eligibility period, if the child becomes el-
igible for full benefits under title XIX during 
such period.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the first day of the first fiscal 
quarter that begins on or after the date that is 1 year after 
the date of enactment of this Act. 
SEC. 5113. MODIFICATIONS TO POSTPARTUM COVERAGE 
UNDER MEDICAID AND CHIP. 
Effective as if included in the enactment of sections 
9812 and 9822 of the American Rescue Plan Act of 2021
3749 
† HR 2617 EAS2 
(Public Law 117–2), subsection (b) of each such section is 
amended by striking ‘‘during the 5-year period’’. 
SEC. 5114. EXTENSION OF MONEY FOLLOWS THE PERSON 
REBALANCING DEMONSTRATION. 
(a) IN GENERAL.—Subsection (h) of section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended— 
(1) in paragraph (1)— 
(A) in each of subparagraphs (F), (H), and 
(J), by striking ‘‘and’’ after the semicolon; 
(B) in subparagraph (K), by striking the 
period and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(L) $450,000,000 for each of fiscal years 
2024 through 2027.’’; 
(2) in paragraph (2), by striking ‘‘September 30, 
2023’’ and inserting ‘‘September 30 of the subsequent 
fiscal year’’; and 
(3) by adding at the end the following new para-
graph: 
‘‘(3) TECHNICAL
ASSISTANCE.—In addition to 
amounts otherwise available, there is appropriated to 
the Secretary, out of any money in the Treasury not 
otherwise appropriated for fiscal 2023 and for each 
subsequent 3-year period through fiscal year 2029,
3750 
† HR 2617 EAS2 
$5,000,000, to remain available until expended, for 
carrying out subsections (f) and (g).’’. 
(b) 
REDISTRIBUTION
OF
UNEXPENDED
GRANT 
AWARDS.—Subsection (e)(2) of section 6071 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is amended 
by adding at the end the following new sentence: ‘‘Any por-
tion of a State grant award for a fiscal year under this 
section that is unexpended by the State at the end of the 
fourth succeeding fiscal year shall be rescinded by the Sec-
retary and added to the appropriation for the fifth suc-
ceeding fiscal year.’’. 
SEC. 
5115. 
EXTENSION 
OF 
MEDICAID 
PROTECTIONS 
AGAINST SPOUSAL IMPOVERISHMENT FOR 
RECIPIENTS 
OF 
HOME 
AND 
COMMUNITY- 
BASED SERVICES. 
Section 2404 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 1396r–5 note) is amended by striking 
‘‘September 30, 2023’’ and inserting ‘‘September 30, 2027’’.
3751 
† HR 2617 EAS2 
Subtitle C—Medicaid and CHIP 
Mental Health 
SEC. 5121. MEDICAID AND CHIP REQUIREMENTS FOR 
HEALTH SCREENINGS, REFERRALS, AND CASE 
MANAGEMENT SERVICES FOR ELIGIBLE JU-
VENILES IN PUBLIC INSTITUTIONS. 
(a) MEDICAID STATE PLAN REQUIREMENT.—Section 
1902 of the Social Security Act (42 U.S.C. 1396a) is 
amended— 
(1) in subsection (a)(84)— 
(A) in subparagraph (A), by inserting ‘‘, 
subject to subparagraph (D),’’ after ‘‘but’’; 
(B) in subparagraph (B), by striking ‘‘and’’ 
at the end; 
(C) in subparagraph (C), by adding ‘‘and’’ 
at the end; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(D) in the case of an individual who is an 
eligible juvenile described in subsection (nn)(2) 
and is within 30 days of the date on which such 
eligible juvenile is scheduled to be released from 
a public institution following adjudication, the 
State shall have in place a plan, and in accord-
ance with such plan, provide for—
3752 
† HR 2617 EAS2 
‘‘(i) in the 30 days prior to the release 
of such eligible juvenile from such public in-
stitution (or not later than one week, or as 
soon as practicable, after release from the 
public institution), and in coordination 
with such institution, any screening or di-
agnostic service which meets reasonable 
standards of medical and dental practice, 
as determined by the State, or as indicated 
as medically necessary, in accordance with 
paragraphs (1)(A) and (5) of section 
1905(r), including a behavioral health 
screening or diagnostic service; and 
‘‘(ii) in the 30 days prior to the release 
of such eligible juvenile from such public in-
stitution, and for at least 30 days following 
the release of such eligible juvenile from 
such institution, targeted case management 
services, including referrals for such eligible 
juvenile to the appropriate care and services 
available in the geographic region of the 
home or residence of such eligible juvenile 
(where feasible) under the State plan (or 
waiver of such plan);’’; and
3753 
† HR 2617 EAS2 
(2) in subsection (nn)(3), by striking ‘‘(30)’’ and 
inserting ‘‘(31)’’. 
(b) AUTHORIZATION OF FEDERAL FINANCIAL PARTICI-
PATION.—The subdivision (A) of section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) following paragraph 
(31) of such section is amended by inserting ‘‘, or in the 
case 
of 
an 
eligible 
juvenile 
described 
in 
section 
1902(a)(84)(D) with respect to the screenings, diagnostic 
services, referrals, and targeted case management services 
required under such section’’ after ‘‘(except as a patient in 
a medical institution’’. 
(c) CHIP CONFORMING AMENDMENTS.— 
(1) Section 2102 of the Social Security Act (42 
U.S.C. 1397bb) is amended by adding at the end the 
following new subsection: 
‘‘(d) TREATMENT OF CHILDREN WHO ARE INMATES 
OF A PUBLIC INSTITUTION.— 
‘‘(1) IN GENERAL.—The State child health plan 
shall provide that— 
‘‘(A) the State shall not terminate eligibility 
for child health assistance under the State child 
health plan for a targeted low-income child be-
cause the child is an inmate of a public institu-
tion, but may suspend coverage during the pe-
riod the child is such an inmate;
3754 
† HR 2617 EAS2 
‘‘(B) in the case of a targeted low-income 
child who was determined eligible for child 
health assistance under the State child health 
plan (or waiver of such plan) immediately before 
becoming an inmate of a public institution, the 
State shall, prior to the child’s release from such 
public institution, conduct a redetermination of 
eligibility for such child with respect to such 
child health assistance (without requiring a new 
application from the child) and, if the State de-
termines pursuant to such redetermination that 
the child continues to meet the eligibility require-
ments for such child health assistance, the State 
shall restore coverage for such child health assist-
ance to such child upon the child’s release from 
such public institution; and 
‘‘(C) in the case of a targeted low-income 
child who is determined eligible for child health 
assistance while an inmate of a public institu-
tion (subject to the exception to the exclusion of 
children who are inmates of a public institution 
described in section 2110(b)(7)), the State shall 
process any application for child health assist-
ance submitted by, or on behalf of, the child such 
that the State makes a determination of eligi-
3755 
† HR 2617 EAS2 
bility for the child with respect to child health 
assistance upon release of the child from the pub-
lic institution. 
‘‘(2) REQUIRED COVERAGE OF SCREENINGS, DI-
AGNOSTIC SERVICES, REFERRALS, AND CASE MANAGE-
MENT FOR CERTAIN INMATES PRE-RELEASE.—A State 
child health plan shall provide that, in the case of a 
targeted low-income child who is within 30 days of 
the date on which such child is scheduled to be re-
leased from a public institution following adjudica-
tion, the State shall have in place a plan for pro-
viding, and shall provide in accordance with such 
plan, screenings, diagnostic services, referrals, and 
case management services otherwise covered under the 
State child health plan (or waiver of such plan) in 
the 
same 
manner 
as 
described 
in 
section 
1902(a)(84)(D).’’. 
(2) Section 2110(b) of the Social Security Act 
(42 U.S.C. 1397jj(b)) is amended— 
(A) in paragraph (2)(A), by inserting ‘‘ex-
cept as provided in paragraph (7),’’ before ‘‘a 
child who is an inmate of a public institution’’; 
and 
(B) by adding at the end the following new 
paragraph:
3756 
† HR 2617 EAS2 
‘‘(7) EXCEPTION TO EXCLUSION OF CHILDREN 
WHO ARE INMATES OF A PUBLIC INSTITUTION.—In 
the case of a child who is an inmate of a public insti-
tution, during the 30 days prior to the release of the 
child from such institution the child shall not be con-
sidered to be described in paragraph (2)(A) with re-
spect to the screenings, diagnostic services, referrals, 
and case management services otherwise covered 
under the State child health plan (or waiver of such 
plan) that the State is required to provide under sec-
tion 2102(d)(2).’’. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall apply beginning on the first day of the first 
calendar quarter that begins on or after the date that is 
24 months after the date of enactment of this Act. 
SEC. 5122. REMOVAL OF LIMITATIONS ON FEDERAL FINAN-
CIAL PARTICIPATION FOR INMATES WHO ARE 
ELIGIBLE JUVENILES PENDING DISPOSITION 
OF CHARGES. 
(a) MEDICAID.— 
(1) IN GENERAL.—The subdivision (A) of section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) following paragraph (31) of such section, 
as amended by section 5121(b), is further amended by 
inserting ‘‘, or, at the option of the State, for an indi-
3757 
† HR 2617 EAS2 
vidual who is an eligible juvenile (as defined in sec-
tion 1902(nn)(2)), while such individual is an inmate 
of a public institution (as defined in section 
1902(nn)(3)) pending disposition of charges’’ after 
‘‘or in the case of an eligible juvenile described in sec-
tion 1902(a)(84)(D) with respect to the screenings, di-
agnostic services, referrals, and case management re-
quired under such section’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1902(a)(84)(A) of the Social Security Act (42 U.S.C. 
1396a(a)(84)(A)) is amended by inserting ‘‘(or in the 
case of a State electing the option described in the 
subdivision (A) following paragraph (31) of section 
1905(a), during such period beginning after the dis-
position of charges with respect to such individual)’’ 
after ‘‘is such an inmate’’. 
(b) CHIP.—Section 2110(b)(7) of the Social Security 
Act (42 U.S.C. 13977jj(b)(7)), as added by section 
5121(c)(2)(B), is amended— 
(1) in the heading, by striking ‘‘EXCEPTION’’ 
and inserting ‘‘EXCEPTIONS’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘At the option of the State, a child who is an 
inmate of a public institution shall not be considered 
to be described in paragraph (2)(A) during the period
3758 
† HR 2617 EAS2 
that the child is an inmate of such institution pend-
ing disposition of charges.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the first day of the first calendar 
quarter that begins after the date that is 24 months after 
the date of enactment of this Act and shall apply to items 
and services furnished for periods beginning on or after 
such date. 
SEC. 5123. REQUIRING ACCURATE, UPDATED, AND SEARCH-
ABLE PROVIDER DIRECTORIES. 
(a) APPLICATION
TO
MANAGED
CARE.—Section 
1932(a)(5) of the Social Security Act (42 U.S.C. 1396u– 
2(a)(5)) is amended— 
(1) in subparagraph (B)(i), by inserting ‘‘, in-
cluding as required by subparagraph (E)’’ before the 
period at the end; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) PROVIDER DIRECTORIES.— 
‘‘(i) IN GENERAL.—Each managed care 
organization, prepaid inpatient health plan 
(as defined by the Secretary), prepaid am-
bulatory health plan (as defined by the Sec-
retary), and, when appropriate, primary 
care case management entity (as defined by
3759 
† HR 2617 EAS2 
the Secretary) with a contract with a State 
to enroll individuals who are eligible for 
medical assistance under the State plan 
under this title or under a waiver of such 
plan, shall publish (and update on at least 
a quarterly basis or more frequently as re-
quired by the Secretary) on a public 
website, a searchable directory of network 
providers, which shall include physicians, 
hospitals, pharmacies, providers of mental 
health services, providers of substance use 
disorder services, providers of long term 
services and supports as appropriate, and 
such other providers as required by the Sec-
retary, and that includes with respect to 
each such provider— 
‘‘(I) the name of the provider; 
‘‘(II) the specialty of the provider; 
‘‘(III) the address at which the 
provider provides services; 
‘‘(IV) the telephone number of the 
provider; and 
‘‘(V) information regarding— 
‘‘(aa) the provider’s cultural 
and linguistic capabilities, in-
3760 
† HR 2617 EAS2 
cluding 
languages 
(including 
American Sign Language) offered 
by the provider or by a skilled 
medical interpreter who provides 
interpretation services at the pro-
vider’s office; 
‘‘(bb) whether the provider is 
accepting as new patients, indi-
viduals who receive medical as-
sistance under this title; 
‘‘(cc) whether the provider’s 
office or facility has accommoda-
tions for individuals with phys-
ical disabilities, including offices, 
exam rooms, and equipment; 
‘‘(dd) the Internet website of 
such provider, if applicable; and 
‘‘(ee) whether the provider of-
fers covered services via telehealth; 
and 
‘‘(VI) other relevant information, 
as required by the Secretary. 
‘‘(ii) NETWORK PROVIDER DEFINED.— 
In this subparagraph, the term ‘network 
provider’ includes any provider, group of
3761 
† HR 2617 EAS2 
providers, or entity that has a network pro-
vider agreement with a managed care orga-
nization, a prepaid inpatient health plan 
(as defined by the Secretary), a prepaid 
ambulatory health plan (as defined by the 
Secretary), or a primary care case manage-
ment entity (as defined by the Secretary) or 
a subcontractor of any such entity or plan, 
and receives payment under this title di-
rectly or indirectly to order, refer, or render 
covered services as a result of the State’s 
contract with the entity or plan. For pur-
poses of this subparagraph, a network pro-
vider shall not be considered to be a subcon-
tractor by virtue of the network provider 
agreement.’’. 
(b) CONFORMING AMENDMENTS TO STATE PLAN RE-
QUIREMENTS.—Section 1902(a) of the Social Security Act 
(42 U.S.C. 1396a) is amended— 
(1) by striking paragraph (83) and inserting the 
following: 
‘‘(83) provide that in the case of a State plan (or 
waiver of the plan) that provides medical assistance 
on a fee-for-service basis or through a primary care 
case-management 
system 
described 
in 
section
3762 
† HR 2617 EAS2 
1915(b)(1), the State shall publish (and update on at 
least a quarterly basis or more frequently as required 
by the Secretary) on the public website of the State 
agency administering the State plan, a searchable di-
rectory of the providers described in subsection (mm) 
that, in addition to such other requirements as the 
Secretary may specify, such as making paper direc-
tories available to enrollees, includes with respect to 
each such provider— 
‘‘(A) the name of the provider; 
‘‘(B) the specialty of the provider; 
‘‘(C) the address at which the provider pro-
vides services; 
‘‘(D) the telephone number of the provider; 
‘‘(E) information regarding— 
‘‘(i) the provider’s cultural and lin-
guistic capabilities, including languages 
(including American Sign Language) of-
fered by the provider or by a skilled medical 
interpreter 
who 
provides 
interpretation 
services at the provider’s office; 
‘‘(ii) whether the provider is accepting 
as new patients individuals who receive 
medical assistance under this title;
3763 
† HR 2617 EAS2 
‘‘(iii) whether the provider’s office or 
facility has accommodations for individuals 
with physical disabilities, including offices, 
exam rooms, and equipment; 
‘‘(iv) the Internet website of such pro-
vider, if applicable; and 
‘‘(v) whether the provider offers covered 
services via telehealth; and 
‘‘(F) other relevant information as required 
by the Secretary;’’; and 
(2) by striking subsection (mm) and inserting 
the following: 
‘‘(mm) DIRECTORY PROVIDER DESCRIBED.— 
‘‘(1) IN GENERAL.—A provider described in this 
subsection, at a minimum, includes physicians, hos-
pitals, pharmacies, providers of mental health serv-
ices, providers of substance use disorder services, pro-
viders of long term services and supports as appro-
priate, and such other providers as required by the 
Secretary, and— 
‘‘(A) in the case of a provider or a provider 
type for which the State agency, as a condition 
of receiving payment for items and services fur-
nished by the provider to individuals eligible to 
receive medical assistance under the State plan
3764 
† HR 2617 EAS2 
(or a waiver of the plan), requires the enrollment 
of the provider with the State agency, includes a 
provider that— 
‘‘(i) is enrolled with the agency as of 
the date on which the directory is published 
or updated (as applicable) under subsection 
(a)(83); and 
‘‘(ii) received payment under the State 
plan in the 12-month period preceding such 
date; and 
‘‘(B) in the case of a provider or a provider 
type for which the State agency does not require 
such enrollment, includes a provider that re-
ceived payment under the State plan (or a waiv-
er of the plan) in the 12-month period preceding 
the date on which the directory is published or 
updated (as applicable) under subsection (a)(83). 
‘‘(2) STATE OPTION TO INCLUDE OTHER PARTICI-
PATING PROVIDERS.—At State option, a provider de-
scribed in this subsection may include any provider 
who furnishes services and is participating under the 
State plan under this title or under a waiver of such 
plan.’’. 
(c) GENERAL
APPLICATION
TO
CHIP.—Section 
2107(e)(1)(G) of the Social Security Act (42 U.S.C.
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† HR 2617 EAS2 
1397gg(e)(1)(G)) is amended by inserting ‘‘and subsection 
(a)(83) of section 1902 (relating to searchable directories 
of the providers described in subsection (mm) of such sec-
tion)’’ before the period. 
(d) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on July 1, 2025. 
SEC. 5124. SUPPORTING ACCESS TO A CONTINUUM OF CRI-
SIS RESPONSE SERVICES UNDER MEDICAID 
AND CHIP. 
(a) GUIDANCE.—Not later than July 1, 2025, the Sec-
retary, in coordination with the Administrator of the Cen-
ters for Medicare & Medicaid Services and the Assistant 
Secretary for Mental Health and Substance Use, shall issue 
guidance to States regarding Medicaid and CHIP that in-
cludes the following: 
(1) Provides, in consultation with health care 
providers and stakeholders with expertise in mental 
health and substance use disorder crisis response serv-
ices, recommendations for an effective continuum of 
crisis response services that— 
(A) includes crisis call centers, including 
988 crisis services hotlines, mobile crisis teams, 
crisis response services delivered in home, com-
munity, residential facility, and hospital set-
tings, and coordination with follow-on mental
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† HR 2617 EAS2 
health and substance use disorder services, such 
as intensive outpatient and partial hospitaliza-
tion programs, as well as connections to social 
services and supports; 
(B) promotes access to appropriate and 
timely mental health and substance use disorder 
crisis response services in the least restrictive set-
ting appropriate to an individual’s needs; and 
(C) promotes culturally competent, trauma- 
informed care, and crisis de-escalation. 
(2) Outlines the Federal authorities through 
which States may finance and enhance under Med-
icaid and CHIP the availability of crisis response 
services across each stage of the continuum of crisis 
response services. 
(3) Addresses how States under Medicaid and 
CHIP may support the ongoing implementation of 
crisis call centers, including 988 crisis services hot-
lines, and how Medicaid administrative funding, in-
cluding enhanced matching, and the Medicaid Infor-
mation Technology Architecture 3.0 framework, may 
be used to establish or enhance regional or statewide 
crisis call centers, including 988 crisis services hot-
lines, that coordinate in real time.
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† HR 2617 EAS2 
(4) Identifies how States under Medicaid and 
CHIP may support access to crisis response services 
that are responsive to the needs of children, youth, 
and families, including through CHIP health services 
initiatives, behavioral disorder-specific crisis re-
sponse, trained peer support services, and establishing 
or enhancing crisis call centers that are youth-focused. 
(5) Identifies policies and practices to meet the 
need for crisis response services with respect to dif-
fering patient populations, including urban, rural, 
and frontier communities, differing age groups, cul-
tural and linguistic minorities, individuals with co- 
occurring mental health and substance use disorder 
conditions, and individuals with disabilities. 
(6) Identifies policies and practices to promote 
evidence-based suicide risk screenings and assess-
ments. 
(7) Identifies strategies to facilitate timely provi-
sion of crisis response services, including how States 
can enable access to crisis response services without 
requiring a diagnosis, the use of presumptive eligi-
bility at different stages of the continuum of crisis re-
sponse services, the use of telehealth to deliver crisis 
response services, strategies to make crisis response 
services available 24/7 in medically underserved re-
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† HR 2617 EAS2 
gions, and best practices used by States and health 
providers for maximizing capacity to deliver crisis re-
sponse services, such as identifying and repurposing 
available beds, space, and staff for crisis response 
services. 
(8) Describes best practices for coordinating 
Medicaid and CHIP funding with other payors and 
sources of Federal funding for mental health and sub-
stance use disorder crisis response services, and best 
practices for Medicaid and CHIP financing when the 
continuum of crisis response services serves individ-
uals regardless of payor. 
(9) Describes best practices for establishing effec-
tive connections with follow-on mental health and 
substance use disorder services, as well as with social 
services and supports. 
(10) Describes best practices for coordinating 
and financing a continuum of crisis response services 
through Medicaid managed care organizations, pre-
paid inpatient health plans, prepaid ambulatory 
health plans, and fee-for-service delivery systems, in-
cluding when States carve-out from delivery through 
Medicaid managed care organizations, prepaid inpa-
tient health plans, prepaid ambulatory health plans,
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† HR 2617 EAS2 
or fee-for-service systems, mental health or substance 
use disorder benefits or a subset of such services. 
(11) Identifies strategies and best practices for 
measuring and monitoring utilization of, and out-
comes related to, crisis response services. 
(b) TECHNICAL ASSISTANCE CENTER.— 
(1) IN GENERAL.—Not later than July 1, 2025, 
the Secretary, in coordination with the Administrator 
of the Centers for Medicare & Medicaid Services and 
the Assistant Secretary for Mental Health and Sub-
stance Use, shall establish a technical assistance cen-
ter to help States under Medicaid and CHIP design, 
implement, or enhance a continuum of crisis response 
services for children, youth, and adults. Such tech-
nical assistance shall, at least in part, provide sup-
port to States in— 
(A) leveraging the Federal authorities 
through which Medicaid and CHIP may finance 
mental health and substance use disorder crisis 
response services; 
(B) coordinating Medicaid and CHIP funds 
with other sources of Federal funding for mental 
health and substance use disorder crisis response 
services; and
3770 
† HR 2617 EAS2 
(C) after the guidance described in sub-
section (a) is issued, adopting the best practices 
and strategies identified in such guidance. 
(2) COMPENDIUM
OF
BEST
PRACTICES.—The 
Secretary shall develop and maintain a publicly 
available compendium of best practices for the suc-
cessful operation under Medicaid and CHIP of a con-
tinuum of crisis response services. The Secretary an-
nually shall review the information available through 
the compendium and shall update such information 
when appropriate. 
(c) FUNDING.—There is appropriated to the Secretary, 
out of any funds in the Treasury not otherwise appro-
priated, to remain available until expended for purposes 
of carrying out subsections (a) and (b), $8,000,000. 
(d) DEFINITIONS.—In this section: 
(1) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(2) STATE.—The term ‘‘State’’ means each of the 
50 States, the District of Columbia, Puerto Rico, the 
United States Virgin Islands, Guam, American 
Samoa, and the Commonwealth of the Northern Mar-
iana Islands.
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Subtitle 
D—Transitioning 
From 
Medicaid FMAP Increase Re-
quirements 
SEC. 5131. TRANSITIONING FROM MEDICAID FMAP IN-
CREASE REQUIREMENTS. 
(a) IN GENERAL.—Section 6008 of the Families First 
Coronavirus Response Act (42 U.S.C. 1396d note) is 
amended— 
(1) in subsection (a)— 
(A) by striking ‘‘Subject to subsection (b)’’ 
and inserting the following: 
‘‘(1) TEMPORARY FMAP INCREASE.—Subject to 
subsections (b) and (f)’’; 
(B) by striking ‘‘the last day of the calendar 
quarter in which the last day of such emergency 
period occurs’’ and inserting ‘‘December 31, 
2023’’; 
(C) by striking ‘‘6.2 percentage points’’ and 
inserting ‘‘the applicable number of percentage 
points for the quarter (as determined in para-
graph (2))’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(2) APPLICABLE
NUMBER
OF
PERCENTAGE 
POINTS.—For purposes of paragraph (1), the applica-
3772 
† HR 2617 EAS2 
ble number of percentage points for a calendar quar-
ter is the following: 
‘‘(A) For each calendar quarter that occurs 
during the portion of the period described in 
paragraph (1) that ends on March 31, 2023, 6.2 
percentage points. 
‘‘(B) For the calendar quarter that begins 
on April 1, 2023, and ends on June 30, 2023, 
5 percentage points. 
‘‘(C) For the calendar quarter that begins 
on July 1, 2023, and ends on September 30, 
2023, 2.5 percentage points. 
‘‘(D) For the calendar quarter that begins 
on October 1, 2023, and ends on December 31, 
2023, 1.5 percentage points.’’; 
(2) in subsection (b)— 
(A) in the matter preceding paragraph (1), 
by striking ‘‘subsection (a)’’ and inserting ‘‘sub-
section (a)(1)’’; 
(B) in paragraph (2), by striking ‘‘, with 
respect to an individual enrolled under such 
plan (or waiver),’’; and 
(C) in paragraph (3)—
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† HR 2617 EAS2 
(i) by striking ‘‘as of the date of enact-
ment of this section’’ and inserting ‘‘as of 
March 18, 2020,’’; 
(ii) by striking ‘‘such date of enact-
ment’’ and inserting ‘‘March 18, 2020,’’; 
(iii) by striking ‘‘the last day of the 
month in which the emergency period de-
scribed in subsection (a) ends’’ and insert-
ing ‘‘March 31, 2023,’’; and 
(iv) by striking ‘‘the end of the month 
in which such emergency period ends’’ and 
inserting ‘‘March 31, 2023,’’; 
(3) by redesignating the subsection (d) added by 
section 11 of division X of the Consolidated Appro-
priations Act, 2021 (Public Law 116–260) as sub-
section (e); and 
(4) by adding at the end the following new sub-
sections: 
‘‘(f) ELIGIBILITY REDETERMINATIONS DURING TRAN-
SITION PERIOD.— 
‘‘(1) IN GENERAL.— For each calendar quarter 
occurring during the portion of the period described 
in subsection (a)(1) that begins on April 1, 2023, and 
ends on December 31, 2023 (such portion to be re-
ferred to in this subsection as the ‘transition period’),
3774 
† HR 2617 EAS2 
if a State described in such subsection satisfies the 
conditions of subsection (b) and paragraph (2) of this 
subsection, the State shall receive the increase to the 
Federal medical assistance percentage of the State ap-
plicable under subsection (a). Nothing in this sub-
section shall be construed as prohibiting a State, fol-
lowing the expiration of the condition described in 
paragraph (3) of subsection (b), from initiating re-
newals, post-enrollment verifications, and redeter-
minations over a 12-month period for all individuals 
who are enrolled in such plan (or waiver) as of April 
1, 2023. 
‘‘(2) CONDITIONS FOR FMAP INCREASE DURING 
TRANSITION PERIOD.—The conditions of this para-
graph with respect to a State and the transition pe-
riod are the following: 
‘‘(A) COMPLIANCE
WITH
FEDERAL
RE-
QUIREMENTS.—The State conducts eligibility re-
determinations under title XIX of the Social Se-
curity Act in accordance with all Federal re-
quirements applicable to such redeterminations, 
including renewal strategies authorized under 
section 1902(e)(14)(A) of the Social Security Act 
(42 U.S.C. 1396a(e)(14)(A)) or other alternative
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† HR 2617 EAS2 
processes and procedures approved by the Sec-
retary of Health and Human Services. 
‘‘(B) MAINTENANCE
OF
UP-TO-DATE
CON-
TACT INFORMATION.—The State, using the Na-
tional Change of Address Database Maintained 
by the United States Postal Service, State health 
and human services agencies, or other reliable 
sources of contact information, attempts to en-
sure that it has up-to-date contact information 
(including a mailing address, phone number, 
and email address) for each individual for whom 
the State conducts an eligibility redetermination. 
‘‘(C) REQUIREMENT TO ATTEMPT TO CON-
TACT
BENEFICIARIES
PRIOR
TO 
DISENROLLMENT.—The State does not disenroll 
from the State plan or waiver any individual 
who is determined ineligible for medical assist-
ance under the State plan or waiver pursuant to 
such a redetermination on the basis of returned 
mail unless the State first undertakes a good 
faith effort to contact the individual using more 
than one modality. 
‘‘(g) APPLICABLE QUARTERS.—A State that ceases to 
meet the requirements of subsection (b) or (f) (as applicable) 
shall not qualify for the increase described in subsection (a)
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† HR 2617 EAS2 
in the Federal medical assistance percentage for such State 
for the calendar quarter in which the State ceases to meet 
such requirements.’’. 
(b) REPORTING AND ENFORCEMENT AND CORRECTIVE 
ACTION.—Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(tt) REQUIREMENTS RELATING TO TRANSITION FROM 
FAMILIES FIRST CORONAVIRUS RESPONSE ACT FMAP IN-
CREASE REQUIREMENTS; ENFORCEMENT AND CORRECTIVE 
ACTION.— 
‘‘(1) REPORTING
REQUIREMENTS.—For each 
month occurring during the period that begins on 
April 1, 2023, and ends on June 30, 2024, each State 
shall submit to the Secretary, on a timely basis, a re-
port, that the Secretary shall make publicly available, 
on the activities of the State relating to eligibility re-
determinations conducted during such period, and 
which include, with respect to the month for which the 
report is submitted, the following information: 
‘‘(A) The number of eligibility renewals ini-
tiated, beneficiaries renewed on a total and ex 
parte basis, and individuals whose coverage for 
medical assistance, child health assistance, or 
pregnancy-related assistance was terminated.
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† HR 2617 EAS2 
‘‘(B) The number of individuals whose cov-
erage for medical assistance, child health assist-
ance, or pregnancy-related assistance was so ter-
minated for procedural reasons. 
‘‘(C) Where applicable, the number of indi-
viduals who were enrolled in a State child health 
plan or waiver in the form described in para-
graph (1) of section 2101(a). 
‘‘(D) Unless the Administrator of the Cen-
ters for Medicare & Medicaid Services reports 
such information on behalf of the State: 
‘‘(i) In a State with a Federal or State 
American Health Benefit Exchange estab-
lished under title I of the Patient Protection 
and Affordable Care Act in which the sys-
tems used to determine eligibility for assist-
ance under this title or title XXI are not in-
tegrated with the systems used to determine 
eligibility for coverage under a qualified 
health plan with advance payment under 
section 1412(a) of the Patient Protection 
and Affordable Care Act of any premium 
tax credit allowed under section 36B of the 
Internal Revenue Code of 1986—
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† HR 2617 EAS2 
‘‘(I) the number of individuals 
whose accounts were received via secure 
electronic transfer by the Federal or 
State American Health Benefit Ex-
change, or a basic health program es-
tablished under section 1331 of the Pa-
tient Protection and Affordable Care 
Act; 
‘‘(II) the number of individuals 
identified in subclause (I) who were 
determined eligible for a qualified 
health plan, as defined in section 
1301(a)(1) of the Patient Protection 
and Affordable Care Act, or (if appli-
cable) the basic health program estab-
lished under section 1331 of such Act; 
and 
‘‘(III) the number of individuals 
identified in subclause (II) who made 
a qualified health plan selection or 
were enrolled in a basic health pro-
gram plan (if applicable). 
‘‘(ii) In a State with a State American 
Health Benefit Exchange established under 
title I of the Patient Protection and Afford-
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† HR 2617 EAS2 
able Care Act in which the systems used to 
determine eligibility for assistance under 
this title or title XXI are integrated with 
the systems used to determine eligibility for 
coverage under a qualified health plan with 
advance payment under section 1412(a) of 
the Patient Protection and Affordable Care 
Act of any premium tax credit allowed 
under section 36B of the Internal Revenue 
Code of 1986— 
‘‘(I) the number of individuals 
who were determined eligible for a 
qualified health plan, as defined in sec-
tion 1301(a)(1) of the Patient Protec-
tion and Affordable Care Act, or (if 
applicable) the basic health program 
established under section 1331 of such 
Act; and 
‘‘(II) the number of individuals 
identified in subclause (I) who made a 
qualified health plan selection or were 
enrolled in a basic health program 
plan (if applicable). 
‘‘(E) The total call center volume, average 
wait times, and average abandonment rate (as