597 
ices consistent with Fair Hearing requirements 
and prior notice of service reductions, including 
under subpart F of part 438 of title 42, Code 
of Federal Regulations and section 438.71(d) of 
such title. 
‘‘(D) Facilitating coordination between 
State and local agencies and direct care workers 
for matters of public health, training opportuni-
ties, changes in program requirements, work-
place health and safety, or related matters. 
‘‘(E) Supporting beneficiary hiring, if se-
lected by the beneficiary, of independent pro-
viders of home and community-based services, 
including by processing applicable tax informa-
tion, collecting and processing timesheets, sub-
mitting claims and processing payments to such 
providers. 
‘‘(F) To the extent a State permits bene-
ficiaries to hire a family member or individual 
with whom they have an existing relationship to 
provide home and community-based service, 
providing support to beneficiaries who wish to 
hire a caregiver who is a family member or in-
dividual with whom they have an existing rela-
tionship, such as by facilitating enrollment of 
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such family member or individual as a provider 
of home and community-based services under 
the State plan or a waiver of such plan. 
‘‘(G) Ensuring that such programs do not 
discriminate against labor organizations or 
workers who may join or decline to join a labor 
organization. 
‘‘(4) REPORTING AND OVERSIGHT.—As condi-
tions for receipt of the increase under paragraph (1) 
to the Federal medical assistance percentage deter-
mined for a State, with respect to a fiscal year quar-
ter, the State shall meet each of the following re-
quirements: 
‘‘(A) The State designates (by a date spec-
ified by the Secretary) an HCBS ombudsman 
office that— 
‘‘(i) operates independently from the 
State Medicaid agency and managed care 
entities; 
‘‘(ii) provides direct assistance to re-
cipients of home and community-based 
services available under the State Medicaid 
program and their families; and 
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‘‘(iii) identifies and reports systemic 
problems to State officials, the public, and 
the Secretary. 
‘‘(B) Beginning with the 5th fiscal quarter 
for which the State is an HCBS program im-
provement State, and annually thereafter, the 
State reports to the Secretary on the state (as 
of the last quarter before the report) of the 
components of the home and community-based 
services landscape described in the State HCBS 
improvement plan, including with respect to— 
‘‘(i) the availability and utilization of 
home 
and 
community-based 
services, 
disaggregated (to the extent available and 
as applicable) by age groups, primary dis-
ability, income brackets, gender, race, eth-
nicity, geography, primary language, and 
type of service setting; 
‘‘(ii) wages, benefits, turnover and va-
cancy rates for the direct care workforce; 
‘‘(iii) changes in payment rates for 
home and community-based services; 
‘‘(iv) implementation of the activities 
to strengthen and expand access to home 
and community-based services and the di-
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rect care workforce that provides such 
services in accordance with the require-
ments of subparagraphs (C) and (D) of 
paragraph (2); 
‘‘(v) if applicable, implementation of 
the activities described in paragraph (3); 
‘‘(vi) State expenditures for home and 
community-based services under the State 
plan or a waiver of such plan as a propor-
tion of the total amount of State expendi-
tures under the plan or waiver of such plan 
for long-term services and supports; and 
‘‘(vii) the challenges in, and best prac-
tices for, expanding access to home and 
community-based services, reducing dis-
parities, and supporting and expanding the 
direct care workforce. 
‘‘(5) BENCHMARKS
FOR
DEMONSTRATING
IM-
PROVEMENTS.—An HCBS program improvement 
State shall cease to be eligible for an increase in the 
Federal medical assistance percentage under para-
graph (1)(A)(i) or (1)(B) or an increase in an appli-
cable Federal matching percentage under paragraph 
(1)(A)(ii) at any time or beginning with the 29th fis-
cal quarter that begins on or after the first date on 
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which a State is an HCBS program improvement 
State if the State is found to be out of compliance 
with paragraph (2)(B) or any other requirement of 
this subsection and, beginning with such 29th fiscal 
quarter, unless, not later than 90 days before the 
first day of such fiscal quarter, the State submits to 
the Secretary a report demonstrating the following 
improvements: 
‘‘(A) Increased availability (above a mar-
ginal increase) of home and community-based 
services in the State relative to such availability 
as reported in the State HCBS improvement 
plan and adjusted for demographic changes in 
the State since the submission of such plan. 
‘‘(B) Reduced disparities in the utilization 
and availability of home and community-based 
services relative to the availability and utiliza-
tion of such services by such populations as re-
ported in such plan according to age groups, 
primary disability, income brackets, gender, 
race, ethnicity, geography, primary language, 
and type of service setting (to the extent avail-
able and applicable), and adjusted for demo-
graphic changes in the State since the submis-
sion of such plan. 
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‘‘(C) Evidence that rates are sufficient to 
ensure access to items and services for individ-
uals eligible for HCBS in such State. 
‘‘(D) With respect to the percentage of ex-
penditures made by the State for long-term 
services and supports that are for home and 
community-based services, in the case of an 
HCBS program improvement State for which 
such percentage (as reported in the State 
HCBS improvement plan) was— 
‘‘(i) less than 50 percent, the State 
demonstrates that the percentage of such 
expenditures has increased to at least 50 
percent since the plan was approved; and 
‘‘(ii) at least 50 percent, the State 
demonstrates that such percentage has not 
decreased since the plan was approved. 
‘‘(6) DEFINITIONS.—In this subsection, the 
terms ‘State Medicaid plan’, ‘direct care worker’, 
‘HCBS program improvement State’, and ‘home and 
community-based services’ have the meaning given 
those terms in section 30711 of the Act titled ‘An 
Act to provide for reconciliation pursuant to title II 
of S. Con. Res. 14’.’’. 
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SEC. 30714. FUNDING FOR TECHNICAL ASSISTANCE AND 
OTHER 
ADMINISTRATIVE 
REQUIREMENTS 
RELATED TO MEDICAID HCBS. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal 
year 2022, out of any money in the Treasury not otherwise 
appropriated, $35,000,000, to remain available until ex-
pended, to carry out the following activities: 
(1) To prepare and submit to the appropriate 
committees of Congress— 
(A) not later than 4 years after the date 
of enactment of this Act, a report that in-
cludes— 
(i) a description of the HCBS im-
provement plans approved by the Secretary 
under section 30712(d); 
(ii) a description (which may be a 
narrative report with examples or other-
wise) of the landscape, at both the national 
and State levels, with respect to gaps in 
coverage of home and community-based 
services, disparities in access to, and utili-
zation of, such services, and barriers to ac-
cessing such services; and 
(iii) a description of the national land-
scape with respect to the direct care work-
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force that provides home and community- 
based services, including with respect to 
wages, benefits, and challenges to the 
availability of such workers; and 
(B) not later than 7 years after the date 
of enactment of this Act, and every 3 years 
thereafter, a report that includes— 
(i) the number of HCBS program im-
provement States; 
(ii) a summary of the progress being 
made by such States with respect to 
strengthening and expanding access to 
home and community-based services and 
the direct care workforce that provides 
such services and meeting the benchmarks 
for demonstrating improvements required 
under section 1905(jj)(5) of the Social Se-
curity Act (as added by section 30713); 
(iii) a summary of States’ perform-
ance measures as a part of the home and 
community-based 
services 
core 
quality 
measures and beneficiary and family care-
giver surveys; and 
(iv) a summary of the challenges and 
best practices reported by States in ex-
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panding access to home and community- 
based services and supporting and expand-
ing the direct care workforce that provides 
such services. 
(2) To provide HCBS program improvement 
States with technical assistance related to carrying 
out the HCBS improvement plans approved by the 
Secretary under section 30712(d) and meeting the 
requirements and benchmarks for demonstrating im-
provements required under section 1905(jj) of the 
Social Security Act (as added by section 30713), 
and to issue such guidance or regulations as nec-
essary to carry out this subtitle and the amendments 
made by this subtitle, including guidance specifying 
how States shall assess and track access to home 
and community-based services over time. 
SEC. 30715. FUNDING FOR HCBS QUALITY MEASUREMENT 
AND IMPROVEMENT. 
(a) IN GENERAL.—Title XI of the Social Security Act 
(42 U.S.C. 1301 et seq.) is amended— 
(1) in section 1139A— 
(A) in subsection (a)(4)(B)— 
(i) by striking ‘‘Beginning with the 
annual State report on fiscal year 2024’’ 
and inserting the following: 
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‘‘(i) IN GENERAL.—Subject to clause 
(ii), beginning with the annual State report 
on fiscal year 2024’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) 
REPORTING
HCBS
QUALITY 
MEASURES.—With respect to reporting on 
information regarding the quality of home 
and community-based services provided to 
children under title XIX, beginning with 
the annual State report for the first fiscal 
year that begins on or after the date that 
is 2 years after the date that the Secretary 
publishes the home and community-based 
services quality measures developed under 
subsection (b)(5)(B) the Secretary shall re-
quire States to report such information 
using the standardized format for report-
ing information and procedures developed 
under subparagraph (A) and using such 
home and community-based quality meas-
ures developed under subsection (b)(5) (in-
cluding any updates or changes to such 
measures).’’; and 
(B) in subsection (b)(5)— 
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(i) by striking ‘‘Beginning no later 
than January 1, 2013’’ and inserting the 
following: 
‘‘(A) IN
GENERAL.—Beginning no later 
than January 1, 2013’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) HCBS QUALITY MEASURES.—Begin-
ning with the first year that begins on the date 
that is 2 years after the date of enactment of 
this subparagraph, the core measures described 
in subsection (a) (and any updates or changes 
to such measures) shall include home and com-
munity-based services quality measures devel-
oped by the Secretary in the manner described 
in section 1139B(b)(5)(D). The Secretary may 
determine which measures are to be included in 
the core set under this section and which in the 
core set under section 1139B, based on the dif-
ferences in health care needs for the relevant 
populations.’’; and 
(2) in section 1139B— 
(A) in subsection (b)— 
(i) in paragraph (3), by adding at the 
end the following new subparagraph: 
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‘‘(C) MANDATORY
REPORTING
WITH
RE-
SPECT TO HCBS QUALITY MEASURES.—Begin-
ning with the State report required under sub-
section (d)(1) for the first year that begins on 
or after the date that is 2 years after the date 
that the Secretary publishes the home and com-
munity-based quality measures developed under 
paragraph (5)(D), the Secretary shall require 
States to report information, using the stand-
ardized format for reporting information and 
procedures developed under subparagraph (A), 
regarding the quality of home and community- 
based services for Medicaid eligible adults using 
either— 
‘‘(i) the home and community-based 
services quality measures included in the 
core set of adult health quality measures 
under subparagraph (D), and any updates 
or changes to such measures; or 
‘‘(ii) an equivalent alternative set of 
home and community-based services qual-
ity measures approved by the Secretary.’’; 
and 
(ii) in paragraph (5), by adding at the 
end the following new subparagraph: 
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‘‘(D) HCBS QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—Beginning with 
respect to State reports required under 
subsection (d)(1) for the first year that be-
gins on or after the date that is 2 years 
after the date of enactment of this sub-
paragraph, the core set of adult health 
quality measures maintained under this 
paragraph (and any updates or changes to 
such measures) shall include home and 
community-based services quality measures 
developed in accordance with this subpara-
graph. 
‘‘(ii) REQUIREMENTS.— 
‘‘(I) INTERAGENCY
COLLABORA-
TION; STAKEHOLDER INPUT.—In de-
veloping (and subsequently reviewing 
and updating) the home and commu-
nity-based services quality measures 
included in the core set of adult 
health quality measures maintained 
under this paragraph, the Secretary 
shall— 
‘‘(aa) collaborate with the 
Administrator of the Centers for 
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Medicare & Medicaid Services, 
the Administrator of the Admin-
istration for Community Living, 
the Director of the Agency for 
Healthcare Research and Qual-
ity, and the Assistant Secretary 
for Mental Health and Substance 
Use; and 
‘‘(bb) ensure that such home 
and 
community-based 
services 
quality measures are informed by 
input from stakeholders, includ-
ing recipients of home and com-
munity-based 
services, 
family 
caregivers of such recipients, pro-
viders, health plans, direct care 
workers, chosen representatives 
of direct care workers, and aging, 
disability, and workforce advo-
cates. 
‘‘(II) 
REFLECTIVE
OF
FULL 
ARRAY OF SERVICES.—Such home and 
community-based 
services 
quality 
measures shall— 
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‘‘(aa) reflect the full array 
of home and community-based 
services and recipients of such 
services; and 
‘‘(bb) include— 
‘‘(AA) 
outcomes-based 
measures; 
‘‘(BB) 
measures 
of 
availability of services; 
‘‘(CC) measures of pro-
vider capacity and avail-
ability; 
‘‘(DD) 
measures 
re-
lated 
to 
person-centered 
care; 
‘‘(EE) measures spe-
cific to self-directed care; 
‘‘(FF) measures related 
to transitions to and from 
institutional care; and 
‘‘(GG) beneficiary and 
family caregiver surveys. 
‘‘(III) 
DEMOGRAPHICS.—Such 
home and community-based services 
quality measures shall allow for the 
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collection, to the extent available, of 
data that is disaggregated by age 
groups, primary disability, income 
brackets, gender, race, ethnicity, geog-
raphy, primary language, and type of 
service setting. 
‘‘(IV) DEFINITIONS.—For pur-
poses of this section and section 
1139A, the terms ‘home and commu-
nity-based services’, ‘health plan’; and 
‘direct care worker’ have the mean-
ings given those terms in section 
30711 of the Act titled ‘An Act to 
provide for reconciliation pursuant to 
title II of S. Con. Res. 14’. 
‘‘(iii) 
FUNDING.—In 
addition 
to 
amounts otherwise available, there is ap-
propriated to the Secretary for fiscal year 
2022, out of any money in the Treasury 
not otherwise appropriated, $5,000,000, to 
remain available until expended, for car-
rying out this subparagraph.’’; and 
(B) in subsection (d)(1)(A), by striking ‘‘; 
and’’ and inserting ‘‘and, beginning with the re-
port for the first year that begins after the date 
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that is 2 years after the Secretary publishes the 
home and community-based quality measures 
developed under subsection (b)(5)(D), home 
and community-based services quality measures 
included in the core set of adult health quality 
measures maintained under subsection (b)(5) 
and any updates or changes to such measures 
or an equivalent alternative set of home and 
community-based services quality measures ap-
proved by the Secretary; and’’. 
(b) INCREASED FEDERAL MATCHING RATE
FOR 
ADOPTION AND REPORTING.— 
(1) IN GENERAL.—Section 1903(a)(3) of the 
Social Security Act (42 U.S.C. 1396b(a)(3)) is 
amended— 
(A) in subparagraph (F)(ii), by striking 
‘‘plus’’ after the semicolon and inserting ‘‘and’’; 
and 
(B) by inserting after subparagraph (F), 
the following: 
‘‘(G) 80 percent of so much of the sums 
expended during such quarter as are attrib-
utable to the reporting of information regarding 
the quality of home and community-based serv-
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ices 
in 
accordance 
with 
sections 
1139A(a)(4)(B)(ii) and 1139B(b)(3)(C); and’’. 
(2) EXEMPTION FROM TERRITORIES’ PAYMENT 
LIMITS.—Section 1108(g)(4) of the Social Security 
Act is amended by adding at the end the following 
new subparagraph: 
‘‘(C) ADDITIONAL
EXEMPTION
RELATING 
TO
HCBS
QUALITY
REPORTING.—Payments 
under section 1903(a)(3)(G) shall not be taken 
into account in applying payment limits under 
subsection (f) and this subsection.’’. 
PART 3—OTHER MEDICAID 
SEC. 30721. PERMANENT EXTENSION OF MEDICAID PRO-
TECTIONS AGAINST SPOUSAL IMPOVERISH-
MENT FOR RECIPIENTS OF HOME AND COM-
MUNITY-BASED SERVICES. 
Section 1924(h)(1)(A) of the Social Security Act (42 
U.S.C. 1396r–5(h)(1)(A)) is amended by striking ‘‘(at the 
option 
of 
the 
State) 
is 
described 
in 
section 
1902(a)(10)(A)(ii)(VI)’’ and inserting the following: ‘‘is 
eligible for medical assistance for home and community- 
based services provided under subsection (c), (d), or (i) 
of section 1915 or under a waiver approved under section 
1115, or who is eligible for such medical assistance by rea-
son 
of 
being 
determined 
eligible 
under 
section 
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1902(a)(10)(C) or by reason of section 1902(f) or other-
wise on the basis of a reduction of income based on costs 
incurred for medical or other remedial care, or who is eligi-
ble for medical assistance for home and community-based 
attendant services and supports under section 1915(k)’’. 
SEC. 30722. PERMANENT EXTENSION OF MONEY FOLLOWS 
THE PERSON REBALANCING DEMONSTRA-
TION. 
(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 subparagraph (I), by inserting 
‘‘and’’ after the semicolon; 
(B) by amending subparagraph (J) to read 
as follows: 
‘‘(J) $450,000,000 for each fiscal year 
after fiscal year 2021.’’; and 
(C) by striking subparagraph (K); 
(2) in paragraph (2), by striking ‘‘September 
30, 2023’’ and inserting ‘‘September 30 of the sub-
sequent fiscal year’’; and 
(3) by adding at the end the following new 
paragraph: 
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‘‘(3) TECHNICAL
ASSISTANCE.—Out of the 
amounts made available under paragraph (1), for 
the 3-year period beginning with fiscal year 2022 
and for each subsequent 3-year period, $5,000,000 
shall be made available for carrying out subsection 
(f) and (i).’’. 
(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 
portion 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. 30723. EXTENDING CONTINUOUS MEDICAID COV-
ERAGE FOR PREGNANT AND POSTPARTUM 
WOMEN. 
(a) REQUIRING FULL BENEFITS
FOR PREGNANT 
AND POSTPARTUM WOMEN FOR 12-MONTH PERIOD POST 
PREGNANCY.— 
(1) IN
GENERAL.—Paragraph (5) of section 
1902(e) of the Social Security Act (42 U.S.C. 
1396a(e)) is amended— 
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(A) by striking ‘‘(5) A woman who’’ and 
inserting ‘‘(5)(A) For any fiscal year quarter 
with respect to which the amendments made by 
section 30723(a)(1)(B) of the Act titled ‘An 
Act to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ do not apply (begin-
ning with the first fiscal year quarter beginning 
one year after the date of the enactment of 
such Act), a woman who’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) For any fiscal year quarter (beginning 
with the first fiscal year quarter beginning one year 
after the date of the enactment of this subpara-
graph), any individual who, while pregnant, is eligi-
ble for and received medical assistance under the 
State plan or a waiver of such plan (regardless of 
the basis for the individual’s eligibility for medical 
assistance and including during a period of retro-
active eligibility under subsection (a)(34)), shall re-
main eligible, notwithstanding section 1916(c)(3) or 
any other limitation under this title, for medical as-
sistance through the end of the month in which the 
12-month period (beginning on the last day of preg-
nancy of the individual) ends, and such medical as-
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sistance shall be in accordance with clauses (i) and 
(ii) of paragraph (16)(B).’’. 
(2) CONFORMING AMENDMENTS.—Title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.) is 
amended— 
(A) in section 1902(a)(10), in the matter 
following subparagraph (G), by striking ‘‘(VII) 
the medical assistance’’ and all that follows 
through ‘‘, (VIII)’’ and inserting ‘‘(VIII)’’; 
(B) in section 1902(e)(6), by striking ‘‘In 
the case of’’ and inserting ‘‘For any fiscal year 
quarter with respect to which the amendments 
made by section 30723(a)(1)(B) of the Act ti-
tled ‘An Act to provide for reconciliation pursu-
ant to title II of S. Con. Res. 14’ do not apply 
(beginning with the first fiscal year quarter be-
ginning one year after the date of the enact-
ment of such Act), in the case of’’; 
(C) in section 1902(l)(1)(A), by striking 
‘‘60-day period’’ and inserting ‘‘12-month pe-
riod’’; 
(D) in section 1903(v)(4)(A)— 
(i) in clause (i), by striking ‘‘60-day 
period’’ and inserting ‘‘12-month period 
(or, for any fiscal year quarter with respect 
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to which the amendments made by section 
30723(a)(1)(B) of the Act titled ‘An Act 
to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ do not apply 
(beginning with the first fiscal year quar-
ter beginning one year after the date of the 
enactment of such Act), 60-day period)’’; 
and 
(ii) in clause (ii), by inserting ‘‘and 
including an individual to whom section 
1902(e)(5)(B) applies, in accordance with 
such section, through the end of the month 
in which the 12-month period (beginning 
on the last day of pregnancy of the indi-
vidual) ends’’ before the period at the end; 
and 
(E) in section 1905(a), in the 4th sentence 
in the matter following paragraph (31), by 
striking ‘‘60-day period’’ and inserting ‘‘12- 
month period (or, for any fiscal year quarter 
with respect to which the amendments made by 
section 30723(a)(1)(B) of the Act titled ‘An 
Act to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ do not apply (begin-
ning with the first fiscal year quarter beginning 
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one year after the date of the enactment of 
such Act), 60-day period)’’. 
(b) TRANSITION FROM STATE OPTION.—Section 
1902(e)(16)(A) of the Social Security Act (42 U.S.C. 
1396a(e)(16)(A)) is amended by striking ‘‘At the option 
of the State’’ and inserting ‘‘For any fiscal year quarter 
with respect to which the amendments made by section 
30723(a)(1)(B) of the Act titled ‘An Act to provide for 
reconciliation pursuant to title II of S. Con. Res. 14’ do 
not apply (beginning with the first fiscal year quarter be-
ginning one year after the date of the enactment of such 
Act), at the option of the State’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect on the 1st day of the 1st fiscal year quarter 
that begins one year after the date of the enactment 
of this Act and shall apply with respect to medical 
assistance provided on or after such date. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) that the 
Secretary of Health and Human Services determines 
requires State legislation in order for the plan to 
meet any requirement imposed by amendments made 
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by this section, the plan shall not be regarded as 
failing to comply with the requirements of such title 
solely on the basis of its failure to meet such a re-
quirement before the first day of the first calendar 
quarter beginning after the close of the first regular 
session of the State legislature that begins after the 
date of the enactment of this Act. For purposes of 
the previous sentence, in the case of a State that has 
a 2-year legislative session, each year of the session 
shall be considered to be a separate regular session 
of the State legislature. 
SEC. 30724. PROVIDING FOR 1 YEAR OF CONTINUOUS ELIGI-
BILITY FOR CHILDREN UNDER THE MED-
ICAID PROGRAM. 
(a) IN GENERAL.—Section 1902(e) of the Social Se-
curity Act (42 U.S.C. 1396a(e)) is amended— 
(1) in paragraph (12), by inserting ‘‘before the 
date of the enactment of paragraph (17)’’ after 
‘‘subsection (a)(10)(A)’’. 
(2) by adding at the end following new para-
graph: 
‘‘(17) 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 eli-
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gible for benefits under a State plan approved 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.’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by subsection (a)(2) shall 
apply with respect to eligibility determinations or re-
determinations made on or after the date of the en-
actment of this Act. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State plan under title XIX of the So-
cial Security Act (42 U.S.C. 1396 et seq.) that the 
Secretary of Health and Human Services determines 
requires State legislation in order for the plan to 
meet any requirement imposed by amendments made 
under subsection (a)(2), the plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
such a requirement before the first day of the first 
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calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins after the date of the enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of the session shall be considered to be a separate 
regular session of the State legislature. 
SEC. 30725. ALLOWING FOR MEDICAL ASSISTANCE UNDER 
MEDICAID FOR INMATES DURING 30-DAY PE-
RIOD PRECEDING RELEASE. 
The subdivision (A) following paragraph (31) of sec-
tion 1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended by inserting ‘‘and, beginning on the 
first day of the first fiscal year quarter that begins one 
year after the date of the enactment of the Act titled ‘An 
Act to provide for reconciliation pursuant to title II of S. 
Con. Res. 14’, except during the 30-day period preceding 
the date of release of such individual from such public in-
stitution’’ after ‘‘medical institution’’. 
SEC. 30726. EXTENSION OF CERTAIN PROVISIONS. 
(b) EXPRESS LANE ELIGIBILITY OPTION.—Section 
1902(e)(13) of the Social Security Act (42 U.S.C. 
1396a(e)(13)) is amended by striking subparagraph (I). 
(c) CONFORMING AMENDMENTS FOR ASSURANCE OF 
AFFORDABILITY STANDARD FOR CHILDREN AND FAMI-
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LIES.—Section 1902(gg)(2) of the Social Security Act (42 
U.S.C. 1396a(gg)(2)) is amended— 
(1) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(2) by striking ‘‘through September 30’’ and all 
that follows through ‘‘ends on September 30, 2027’’ 
and inserting ‘‘(but beginning on October 1, 2019,’’. 
Subtitle H—Children’s Health 
Insurance Program 
SEC. 
30801. 
PERMANENT 
EXTENSION 
OF 
CHILDREN’S 
HEALTH INSURANCE PROGRAM. 
(a) IN GENERAL.—Section 2104(a)(28) of the Social 
Security Act (42 U.S.C. 1397dd(a)(28)) is amended to 
read as follows: 
‘‘(28) for fiscal year 2027 and each subsequent 
year, such sums as are necessary to fund allotments 
to States under subsection (m).’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the So-
cial Security Act (42 U.S.C. 1397dd(m)) is amend-
ed— 
(A) in paragraph (2)(B)(i), by striking ‘‘,, 
2023, and 2027’’ and inserting ‘‘and 2023’’; 
(B) in paragraph (5)— 
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(i) by striking ‘‘(10), or (11)’’ and in-
serting ‘‘or (10)’’; 
(ii) by striking ‘‘for a fiscal year’’ and 
inserting ‘‘for a fiscal year before 2027’’; 
and 
(iii) by striking ‘‘2023, or 2027’’ and 
inserting ‘‘or 2023’’; 
(C) in paragraph (7)— 
(i) in subparagraph (A), by striking 
‘‘and ending with fiscal year 2027,’’; and 
(ii) in the flush left matter at the end, 
by striking ‘‘or fiscal year 2026’’ and in-
serting ‘‘fiscal year 2026, or a subsequent 
even-numbered fiscal year’’; 
(D) in paragraph (9)— 
(i) by striking ‘‘(10), or (11)’’ and in-
serting ‘‘or (10)’’; and 
(ii) by striking ‘‘2023, or 2027,’’ and 
inserting ‘‘or 2023’’; and 
(E) by striking paragraph (11). 
(2) 
CONFORMING
AMENDMENT.—Section 
50101(b)(2) of the Bipartisan Budget Act of 2018 
(Public Law 115–123) is repealed. 
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SEC. 30802. PERMANENT EXTENSIONS OF OTHER PRO-
GRAMS AND DEMONSTRATION PROJECTS. 
(a) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i)(1) of the Social Security Act (42 U.S.C. 
1320b–9a(i)(1)) is amended— 
(1) in subparagraph (C), by striking at the end 
‘‘and’’; 
(2) in subparagraph (D), by striking the period 
at the end and insert a semicolon; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(E) for fiscal year 2028, $15,000,000 for 
the purpose of carrying out this section (other 
than subsections (e), (f), and (g)); and 
‘‘(F) for a subsequent fiscal year, the 
amount appropriated under this paragraph for 
the previous fiscal year, increased by the per-
centage increase in the consumer price index for 
all urban consumers (all items; United States 
city average) over such previous fiscal year, for 
the purpose of carrying out this section (other 
than subsections (e), (f), and (g)).’’. 
(b) ASSURANCE OF AFFORDABILITY STANDARD FOR 
CHILDREN AND FAMILIES.—Section 2105(d)(3) of the 
Social Security Act (42 U.S.C. 1397ee(d)(3)) is amend-
ed— 
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(1) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(2) in subparagraph (A)— 
(A) in the matter preceding clause (i)— 
(i) by striking ‘‘During the period 
that begins on the date of enactment of 
the Patient Protection and Affordable Care 
Act and ends on September 30, 2027’’ and 
inserting ‘‘Beginning on the date of the en-
actment of the Patient Protection and Af-
fordable Care Act’’; 
(ii) by striking ‘‘During the period 
that begins on October 1, 2019, and ends 
on September 30, 2027’’ and inserting 
‘‘Beginning on October 1, 2019’’; and 
(iii) by striking ‘‘The preceding sen-
tences shall not be construed as preventing 
a State during any such periods from’’ and 
inserting ‘‘The preceding sentences shall 
not be construed as preventing a State 
from’’; 
(B) in clause (i), by striking the semicolon 
at the end and inserting a period; 
(C) by striking clauses (ii) and (iii); and 
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(D) by striking ‘‘periods from’’ and all that 
follows through ‘‘applying eligibility standards’’ 
and inserting ‘‘periods from applying eligibility 
standards’’. 
(c) 
QUALIFYING
STATES
OPTION.—Section 
2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(1) in the paragraph heading, by striking ‘‘FOR 
FISCAL YEARS 2009 THROUGH 2027’’ and inserting 
‘‘AFTER FISCAL YEAR 2008’’; and 
(2) in subparagraph (A), by striking ‘‘for any 
of fiscal years 2009 through 2027’’ and inserting 
‘‘for any fiscal year after fiscal year 2008’’. 
(d) OUTREACH AND ENROLLMENT PROGRAM.—Sec-
tion 2113 of the Social Security Act (42 U.S.C. 1397mm) 
is amended— 
(1) in subsection (a)— 
(A) in paragraph (1), by striking ‘‘during 
the period of fiscal years 2009 through 2027’’ 
and inserting ‘‘, beginning with fiscal year 
2009,’’; 
(B) in paragraph (2)— 
(i) by striking ‘‘10 percent of such 
amounts’’ and inserting ‘‘10 percent of 
such amounts for the period or the fiscal 
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year for which such amounts are appro-
priated’’; and 
(ii) by striking ‘‘during such period’’ 
and inserting ‘‘, during such period or such 
fiscal year,’’; and 
(C) in paragraph (3), by striking ‘‘For the 
period of fiscal years 2024 through 2027, an 
amount equal to 10 percent of such amounts’’ 
and inserting ‘‘Beginning with fiscal year 2024, 
an amount equal to 10 percent of such amounts 
for the period or the fiscal year for which such 
amounts are appropriated’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘2017,,’’ and inserting 
‘‘2017,’’; 
(B) by striking ‘‘and $48,000,000’’ and in-
serting ‘‘$48,000,000’’; and 
(C) by inserting after ‘‘through 2027’’ the 
following: ‘‘, $60,000,000 for fiscal years 2028, 
2029, and 2020, for each 3 fiscal years after 
fiscal year 2030, the amount appropriated 
under this subsection for the previous fiscal 
year, increased by the percentage increase in 
the consumer price index for all urban con-
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sumers (all items; United States city average) 
over such previous fiscal year’’. 
(e) CHILD ENROLLMENT CONTINGENCY FUND.— 
Section 2104(n) of the Social Security Act (42 U.S.C. 
1397dd(n)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘and 2024 through 
2026’’ and inserting ‘‘beginning with fiscal 
year 2024’’; and 
(ii) by striking ‘‘2023, and 2027’’ and 
inserting ‘‘and 2023’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘2024 through 2026’’ 
and inserting ‘‘beginning with fiscal year 
2024’’; and 
(ii) by striking ‘‘2023, and 2027’’ and 
inserting ‘‘and 2023’’; and 
(2) in paragraph (3)(A)— 
(A) by striking ‘‘fiscal years 2024 through 
2026’’ and inserting ‘‘fiscal year 2024 or any 
subsequent fiscal year’’; and 
(B) by striking ‘‘2023, or 2027’’ and in-
serting ‘‘or 2023’’. 
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SEC. 30803. STATE OPTION TO INCREASE CHILDREN’S ELI-
GIBILITY FOR MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 2110(b)(1)(B)(ii) of the 
Social Security Act (42 U.S.C. 1397jj(b)(1)(B)(ii)) is 
amended— 
(1) in subclause (II), by striking ‘‘or’’ at the 
end; 
(2) in subclause (III), by striking ‘‘and’’ at the 
end and inserting ‘‘or’’; and 
(3) by inserting after subclause (III) the fol-
lowing new subclause: 
‘‘(IV) at the option of the State, 
whose family income exceeds the maximum 
income level otherwise established for chil-
dren under the State child health plan as 
of the date of the enactment of this sub-
clause; and’’. 
(b) 
TREATMENT
OF
TERRITORIES.—Section 
2104(m)(7) of the Social Security Act (42 U.S.C. 
1397dd(m)(7)) is amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘the 50 States or the District of Colum-
bia’’ and inserting ‘‘a State (including the District 
of Columbia and each commonwealth and terri-
tory)’’; 
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(2) in subparagraph (B)(ii), by striking ‘‘or 
District’’; and 
(3) in the matter following subparagraph (B), 
by striking each place it occurs ‘‘or District’’. 
SEC. 30804. EXTENDING CONTINUOUS CHIP COVERAGE FOR 
PREGNANT AND POSTPARTUM WOMEN. 
(a) REQUIRING FULL BENEFITS
FOR PREGNANT 
AND POSTPARTUM WOMEN FOR 12-MONTH PERIOD POST 
PREGNANCY.— 
(1) IN GENERAL.—Section 2107(e)(1)(J) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)(J)) is 
amended— 
(A) by striking ‘‘Paragraphs (5) and (16)’’ 
and inserting ‘‘(I) For any fiscal year quarter 
with respect to which the amendments made by 
section 30804(a)(1)(B) of the Act titled ‘An 
Act to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ do not apply (begin-
ning with the first fiscal year quarter beginning 
one year after the date of the enactment of 
such Act), paragraphs (5)(A) and (16)’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) For any fiscal year quarter (beginning 
with the first fiscal year quarter beginning one 
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year after the date of the enactment of this 
clause), section 1902(e)(5)(B) (requiring, not-
withstanding section 2103(e)(3)(C)(ii)(I) or any 
other limitation under this title, continuous cov-
erage for pregnant and postpartum individuals, 
including 12 months postpartum, of medical as-
sistance) if the State provides child health as-
sistance for targeted low-income children who 
are pregnant or to targeted low-income preg-
nant women, under the State child health plan 
or waiver, including coverage of all items or 
services provided to a targeted low-income child 
or targeted low-income pregnant woman (as ap-
plicable) under the State child health plan or 
waiver).’’. 
(2) CONFORMING AMENDMENTS.—Section 2112 
of the Social Security Act (42 U.S.C. 1397ll) is 
amended— 
(A) in subsection (d)— 
(i) in paragraph (1), by inserting 
‘‘and includes, through application of sec-
tion 1902(e)(5)(B) pursuant to section 
2107(e)(1)(J)(ii), continuous coverage for 
pregnant and postpartum individuals, in-
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cluding 12 months postpartum of assist-
ance’’ before the period at the end; and 
(ii) in paragraph (2), by striking ‘‘60- 
day period’’ and all that follows through 
‘‘ends’’ and inserting ‘‘12-month period 
(or, for any fiscal year quarter with respect 
to which the amendments made by section 
30804(a)(1)(B) of the Act titled ‘An Act 
to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ do not apply 
(beginning with the first fiscal year quar-
ter beginning one year after the date of the 
enactment of such Act), 60-day period) 
(beginning on the last day of her preg-
nancy) ends’’; and 
(B) in subsection (f)(2), by striking ‘‘60- 
day period’’ and inserting ‘‘12-month period 
(or, for any fiscal year quarter with respect to 
which the amendments made by section 
30804(a)(1)(B) of the Act titled ‘An Act to 
provide for reconciliation pursuant to title II of 
S. Con. Res. 14’ do not apply (beginning with 
the first fiscal year quarter beginning one year 
after the date of the enactment of such Act), 
60-day period)’’. 
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(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect on the 1st day of the 1st fiscal year quarter 
that begins one year after the date of the enactment 
of this Act and shall apply with respect to child 
health assistance and pregnancy-related assistance, 
as applicable, provided on or after such date. 
(2) EXCEPTION FOR STATE LEGISLATION.—In 
the case of a State child health plan under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.) that the Secretary of Health and Human Serv-
ices determines requires State legislation in order for 
the plan to meet any requirement imposed by 
amendments made under this section, the plan shall 
not be regarded as failing to comply with the re-
quirements of such title solely on the basis of its 
failure to meet such a requirement before the first 
day of the first calendar quarter beginning after the 
close of the first regular session of the State legisla-
ture that begins after the date of the enactment of 
this Act. For purposes of the previous sentence, in 
the case of a State that has a 2-year legislative ses-
sion, each year of the session shall be considered to 
be a separate regular session of the State legislature. 
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SEC. 30805. PROVIDING FOR 1 YEAR OF CONTINUOUS ELIGI-
BILITY FOR CHILDREN UNDER THE CHIL-
DREN’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), re-
spectively; and 
(2) by inserting after subparagraph (J) the fol-
lowing new subparagraph: 
‘‘(K) Section 1902(e)(17) (relating to 1 
year of continuous eligibility for children).’’. 
Subtitle I—Medicare Coverage of 
Dental, 
Hearing, 
and 
Vision 
Services 
SEC. 30901. PROVIDING COVERAGE FOR DENTAL AND ORAL 
HEALTH CARE UNDER THE MEDICARE PRO-
GRAM. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)) is amended— 
(1) in subparagraph (GG), by striking ‘‘and’’ 
after the semicolon at the end; 
(2) in subparagraph (HH), by striking the pe-
riod at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
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‘‘(II) dental and oral health services (as defined 
in subsection (lll));’’. 
(b) DENTAL
AND ORAL HEALTH SERVICES DE-
FINED.—Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(lll) DENTAL AND ORAL HEALTH SERVICES.— 
‘‘(1) IN GENERAL.—The term ‘dental and oral 
health services’ means items and services (other 
than such items and services for which payment may 
be made under part A as inpatient hospital services) 
that are furnished during 2028 or a subsequent 
year, for which coverage was not provided under 
part B as of the date of the enactment of this sub-
section, and that are— 
‘‘(A) the preventive and screening services 
described in paragraph (2) furnished by a doc-
tor of dental surgery or of dental medicine (as 
described in subsection (r)(2)) or an oral health 
professional (as defined in paragraph (4)); or 
‘‘(B) the basic treatments specified for 
such year by the Secretary pursuant to para-
graph (3)(A) and the major treatments speci-
fied for such year by the Secretary pursuant to 
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paragraph (3)(B) furnished by such a doctor or 
such a professional. 
‘‘(2) PREVENTIVE
AND
SCREENING
SERV-
ICES.—The preventive and screening services de-
scribed in this paragraph are the following: 
‘‘(A) Oral exams. 
‘‘(B) Dental cleanings. 
‘‘(C) Dental x-rays performed in the office 
of a doctor or professional described in para-
graph (1)(A). 
‘‘(D) Fluoride treatments. 
‘‘(3) BASIC
AND
MAJOR
TREATMENTS.—For 
2028 and each subsequent year, the Secretary shall 
specify— 
‘‘(A) basic treatments (which may include 
basic tooth restorations, basic periodontal serv-
ices, tooth extractions, and oral disease man-
agement services); and 
‘‘(B) major treatments (which may include 
major tooth restorations, major periodontal 
services, bridges, crowns, and root canals); 
that shall be included as dental and oral health serv-
ices for such year. 
‘‘(4) ORAL HEALTH PROFESSIONAL.—The term 
‘oral health professional’ means, with respect to den-
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tal and oral health services, a health professional 
(other than a doctor of dental surgery or of dental 
medicine (as described in subsection (r)(2))) who is 
licensed to furnish such services, acting within the 
scope of such license, by the State in which such 
services are furnished.’’. 
(c) PAYMENT; COINSURANCE; AND LIMITATIONS.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)), as 
amended by section 30511(b), is further amended— 
(A) in subparagraph (N), by inserting 
‘‘and dental and oral health services (as defined 
in 
section 
1861(lll))’’ 
after 
‘‘section 
1861(hhh)(1))’’; 
(B) by striking ‘‘and’’ before ‘‘(EE)’’; and 
(C) by inserting before the semicolon at 
the end the following: ‘‘and (FF) with respect 
to dental and oral health services (as defined in 
section 1861(lll)), the amount paid shall be the 
payment 
amount 
specified 
under 
section 
1834(z)’’. 
(2) PAYMENT AND LIMITS SPECIFIED.—Section 
1834 of the Social Security Act (42 U.S.C. 1395m) 
is amended by adding at the end the following new 
subsection: 
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‘‘(z) PAYMENT AND LIMITS FOR DENTAL AND ORAL 
HEALTH SERVICES.— 
‘‘(1) IN
GENERAL.—The payment amount 
under this part for dental and oral health services 
(as defined in section 1861(lll)) shall be, subject to 
paragraph (3), the applicable percent (specified in 
paragraph (2)) of the lesser of— 
‘‘(A) the actual charge for the service; or 
‘‘(B) the amount determined under the 
payment basis determined under section 1848 
for the service, or, in lieu of such amount, if de-
termined appropriate by the Secretary, an 
amount specified by the Secretary for such 
service under a fee schedule determined appro-
priate by the Secretary, taking into account fee 
schedules for such services— 
‘‘(i) under the TRICARE program 
under chapter 55 of title 10 of the United 
States Code; 
‘‘(ii) under the health insurance pro-
gram under chapter 89 of title 5 of such 
Code; 
‘‘(iii) under State plans (or waivers of 
such plans) under title XIX; 
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‘‘(iv) under Medicare Advantage plans 
under part C; 
‘‘(v) established by the Secretary of 
Veterans Affairs; and 
‘‘(vi) established by other health care 
payers. 
‘‘(2) APPLICABLE PERCENT.—For purposes of 
paragraph (1), the applicable percent specified in 
this paragraph is, with respect to dental and oral 
health services (as defined in section 1861(lll)) fur-
nished in a year— 
‘‘(A) that are preventive and screening 
services described in paragraph (2) or basic 
treatments specified for such year pursuant to 
paragraph (3)(A) of such section, 80 percent; 
and 
‘‘(B) that are major treatments specified 
for such year pursuant to paragraph (3)(B) of 
such section— 
‘‘(i) in the case such services are fur-
nished during 2028, 10 percent; 
‘‘(ii) in the case such services are fur-
nished during 2029 or a subsequent year 
before 2032, the applicable percent speci-
fied under this subparagraph for the pre-
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vious year, increased by 10 percentage 
points; and 
‘‘(iii) in the case such services are fur-
nished during 2032 or a subsequent year, 
50 percent. 
‘‘(3) LIMITATIONS.—With respect to dental and 
oral health services that are— 
‘‘(A) preventive and screening oral exams, 
payment may be made under this part for not 
more than two such exams during a 12-month 
period; 
‘‘(B) dental cleanings, payment may be 
made under this part for not more than two 
such cleanings during a 12-month period; and 
‘‘(C) not described in subparagraph (A) or 
(B), payment may be made under this part only 
at such frequencies and under such cir-
cumstances determined appropriate by the Sec-
retary. 
‘‘(4) USE OF BUNDLED PAYMENTS.—The Sec-
retary may make payment for dentures and associ-
ated professional services, and for any other dental 
and oral health services, as bundled payments as the 
Secretary determines appropriate. 
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‘‘(5) LIMITATION ON JUDICIAL REVIEW.—There 
shall be no administrative or judicial review under 
section 1869 or otherwise of— 
‘‘(A) 
the 
determination 
of 
payment 
amounts under this subsection for dental and 
oral health services and under subsection (h)(6) 
or subsection (z)(4) for dentures; 
‘‘(B) the determination of what services 
are basic and major services under subpara-
graphs (A) and (B) of section 1861(lll)(3); or 
‘‘(C) the determination of the frequency 
and circumstance limitations for dental and oral 
health services under paragraph (3)(C).’’. 
(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
(1) IN
GENERAL.—Section 1848(j)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(II),’’ before ‘‘(3)’’. 
(2) 
EXCLUSION
FROM
MIPS.—Section 
1848(q)(1)(C)(ii) of the Social Security Act (42 
U.S.C. 1395w–4(q)(1)(C)(ii)) is amended— 
(A) in subclause (II), by striking ‘‘or’’ at 
the end; 
(B) in subclause (III), by striking the pe-
riod at the end and inserting ‘‘; or’’; and 
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(C) by adding at the end the following new 
subclause: 
‘‘(IV) with respect to 2028 and 
each subsequent year, is a doctor of 
dental surgery or of dental medicine 
(as described in section 1861(r)(2)) or 
is an oral health professional (as de-
fined in section 1861(lll)(4)).’’. 
(3) INCLUSION
OF
ORAL
HEALTH
PROFES-
SIONALS
AS
CERTAIN
PRACTITIONERS.—Section 
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 clause: 
‘‘(vii) With respect to 2028 and each subse-
quent year, an oral health professional (as defined in 
section 1861(lll)(4)).’’. 
(e) DENTURES.— 
(1) IN
GENERAL.—Section 1861(s)(8) of the 
Social Security Act (42 U.S.C. 1395x(s)(8)) is 
amended— 
(A) by striking ‘‘(other than dental)’’; and 
(B) by inserting ‘‘and excluding dental, ex-
cept for a full or partial set of dentures (as de-
scribed in section 1834(h)(6)) furnished on or 
after January 1, 2028’’ after ‘‘colostomy care’’. 
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(2) SPECIAL PAYMENT RULES.— 
(A) LIMITATIONS.—Section 1834(h) of the 
Social Security Act (42 U.S.C. 1395m(h)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) SPECIAL
PAYMENT
RULE
FOR
DEN-
TURES.—Payment may be made under this part 
with respect to an individual for dentures— 
‘‘(A) not more than once during any 5-year 
period (except in the case that a doctor de-
scribed in section 1861(lll)(1)(A) determines 
such dentures do not fit the individual); and 
‘‘(B) only to the extent that such dentures 
are furnished pursuant to a written order of 
such a doctor or professional.’’. 
(B) APPLICATION OF COMPETITIVE ACQUI-
SITION.— 
(i) 
IN
GENERAL.—Section 
1834(h)(1)(H) of the Social Security Act 
(42 U.S.C. 1395m(h)(1)(H)) is amended— 
(I) in the subparagraph heading, 
by inserting ‘‘, 
DENTURES’’ after 
‘‘ORTHOTICS’’; 
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(II) by inserting ‘‘, of dentures 
described in paragraph (2)(D) of such 
section,’’ after ‘‘2011,’’; and 
(III) in clause (i), by inserting ‘‘, 
such dentures’’ after ‘‘orthotics’’. 
(ii) CONFORMING AMENDMENT.—Sec-
tion 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 sub-
paragraph: 
‘‘(D) DENTURES.—Dentures described in 
section 1861(s)(8) for which payment would 
otherwise be made under section 1834(h).’’. 
(iii) EXEMPTION OF CERTAIN ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(C) CERTAIN
DENTURES.—Those items 
and services described in paragraph (2)(D) if 
furnished by a physician or other practitioner 
(as defined by the Secretary) to the physician’s 
or practitioner’s own patients as part of the 
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physician’s or practitioner’s professional serv-
ice.’’. 
(f) EXCLUSION MODIFICATIONS.—Section 1862(a) of 
the Social Security Act (42 U.S.C. 1395y(a)) is amend-
ed— 
(1) in paragraph (1)— 
(A) in subparagraph (O), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of dental and oral health serv-
ices (as defined in section 1861(lll)) that are preven-
tive and screening services described in paragraph 
(2) of such section, which are furnished more fre-
quently than provided under section 1834(z)(3) or 
under circumstances other than circumstances deter-
mined appropriate under subparagraph (C) of such 
section;’’; and 
(2) in paragraph (12), by inserting before the 
semicolon at the end the following: ‘‘and except that 
payment may be made under part B for dental and 
oral health services that are covered under section 
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1861(s)(2)(II) and for dentures under section 
1861(s)(8)’’. 
(g) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—Paragraphs (1) and (4) of 
section 1839(a) of the Social Security Act (42 
U.S.C. 1395r(a)) are amended by adding at the end 
of each such paragraphs the following: ‘‘In applying 
this paragraph there shall not be taken into account 
benefits and administrative costs attributable to the 
amendments made by section 30901 (other than 
subsection (g)) of the Act titled ‘An Act to provide 
for reconciliation pursuant to title II of S. Con. Res. 
14’ and the Government contribution under section 
1844(a)(5)’’. 
(2) PAYMENT.—Section 1844(a) of such Act 
(42 U.S.C. 1395w(a)) is amended— 
(A) in paragraph (4), by striking the pe-
riod at the end and inserting ‘‘; plus’’; 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) a Government contribution equal to the 
amount that is estimated to be payable for benefits 
and related administrative costs incurred that are 
attributable to the amendments made by section 
30901 (other than subsection (g)) of the Act titled 
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‘An Act to provide for reconciliation pursuant to 
title II of S. Con. Res. 14’ .’’; and 
(C) in the flush matter at the end, by 
striking ‘‘paragraph (4)’’ and inserting ‘‘para-
graphs (4) and (5)’’. 
(h) IMPLEMENTATION.— 
(1) FUNDING.— 
(A) IN GENERAL.—In addition to amounts 
otherwise available, the Secretary of Health and 
Human Services (in this subsection referred to 
as the ‘‘Secretary’’) shall provide for the trans-
fer from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of 
the Social Security Act (42 U.S.C. 1395t) to 
the Centers for Medicare & Medicaid Services 
Program Management Account of— 
(i) $20,000,000 for each of fiscal 
years 2022 through 2028 for purposes of 
implementing the amendments made by 
this section; and 
(ii) such sums as determined appro-
priate by the Secretary for each subse-
quent fiscal year for purposes of admin-
istering the provisions of such amend-
ments. 
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(B) AVAILABILITY AND ADDITIONAL USE 
OF
FUNDS.—Funds transferred pursuant to 
subparagraph (A) shall remain available until 
expended and may be used, in addition to the 
purpose specified in subparagraph (A)(i), to im-
plement the amendments made by sections 
30902 and 30903. 
(2) ADMINISTRATION.—The Secretary may im-
plement, by program instruction or otherwise, any of 
the provisions of, or amendments made by, this sec-
tion. 
(3) PAPERWORK REDUCTION ACT.—Chapter 35 
of title 44, United States Code, shall not apply to 
the provisions of, or the amendments made by, this 
section. 
SEC. 30902. PROVIDING COVERAGE FOR HEARING CARE 
UNDER THE MEDICARE PROGRAM. 
(a) PROVISION
OF AURAL REHABILITATION
AND 
TREATMENT SERVICES BY QUALIFIED AUDIOLOGISTS.— 
Section 1861(ll)(3) of the Social Security Act (42 U.S.C. 
1395x(ll)(3)) is amended by inserting ‘‘(and, beginning 
October 1, 2023, such aural rehabilitation and treatment 
services)’’ after ‘‘assessment services’’. 
(b) COVERAGE OF HEARING AIDS.— 
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(1) INCLUSION
OF
HEARING
AIDS
AS
PROS-
THETIC DEVICES.—Section 1861(s)(8) of the Social 
Security Act (42 U.S.C. 1395x(s)(8)) is amended by 
inserting ‘‘, and including hearing aids (as described 
in section 1834(h)(7)) furnished on or after October 
1, 2023, to individuals diagnosed with profound or 
severe hearing loss’’ before the semicolon at the end. 
(2) PAYMENT
LIMITATIONS
FOR
HEARING 
AIDS.—Section 1834(h) of the Social Security Act 
(42 U.S.C. 1395m(h)), as amended by section 
30901(e)(2)(A), is further amended by adding at the 
end the following new paragraph: 
‘‘(7) LIMITATIONS FOR HEARING AIDS.— 
‘‘(A) IN
GENERAL.—Payment may be 
made under this part with respect to an indi-
vidual, with respect to hearing aids furnished 
on or after October 1, 2023— 
‘‘(i) not more than once during a 5- 
year period; 
‘‘(ii) only for types of such hearing 
aids that are not over-the-counter hearing 
aids (as defined in section 520(q)(1) of the 
Federal Food, Drug, and Cosmetic Act) 
and that are determined appropriate by 
the Secretary; and 
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‘‘(iii) only if furnished pursuant to a 
written order of a physician or qualified 
audiologist 
(as 
defined 
in 
section 
1861(ll)(4)(B)). 
‘‘(B) LIMITATION ON JUDICIAL REVIEW.— 
There shall be no administrative or judicial re-
view under section 1869 or otherwise of— 
‘‘(i) the determination of the types of 
hearing aids paid for under subparagraph 
(A)(ii); or 
‘‘(ii) the determination of fee schedule 
rates for hearing aids described in this 
paragraph.’’. 
(3) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)), 
as 
amended 
by 
section 
30901(e)(2)(B)(i), is further amended— 
(i) in the header, by inserting ‘‘, 
HEARING AIDS’’ after ‘‘DENTURES’’; 
(ii) by inserting ‘‘, of hearing aids de-
scribed in paragraph (2)(E) of such sec-
tion,’’ after ‘‘paragraph (2)(D) of such sec-
tion’’; and 
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653 
(iii) in clause (i), by inserting ‘‘, such 
hearing aids’’ after ‘‘such dentures’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)), as amended by section 
30901(e)(2)(B)(ii), is further amended by 
adding at the end the following new sub-
paragraph: 
‘‘(E) HEARING
AIDS.—Hearing aids de-
scribed in section 1861(s)(8) for which payment 
would 
otherwise 
be 
made 
under 
section 
1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)), as amended 
by section 30901(e)(2)(B)(iii), is further 
amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) CERTAIN
HEARING
AIDS.—Those 
items and services described in paragraph 
(2)(E) if furnished by a physician or other 
practitioner (as defined by the Secretary) to the 
physician’s or practitioner’s own patients as 
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654 
part of the physician’s or practitioner’s profes-
sional service.’’. 
(4) INCLUSION OF AUDIOLOGISTS AS CERTAIN 
PRACTITIONERS TO RECEIVE PAYMENT ON AN AS-
SIGNMENT-RELATED
BASIS.—Section 
1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)), as amended by section 
30901(d)(4), is further amended by adding at the 
end the following new clause: 
‘‘(viii) Beginning October 1, 2023, a 
qualified audiologist (as defined in section 
1861(ll)(4)(B)).’’. 
(c) EXCLUSION MODIFICATION.—Section 1862(a)(7) 
of the Social Security Act (42 U.S.C. 1395y(a)(7)) is 
amended by inserting ‘‘(except such hearing aids or exami-
nations therefor as described in and otherwise allowed 
under section 1861(s)(8))’’ after ‘‘hearing aids or exami-
nations therefor’’. 
(d) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—The last sentence of section 
1839(a)(1) of the Social Security Act (42 U.S.C. 
1395r(a)(1)), as added by section 30901(g)(1), is 
amended by striking ‘‘section 30901 (other than 
subsection (g))’’ and inserting ‘‘sections 30901 
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655 
(other than subsection (g)), 30902 (other than sub-
section (d))’’. 
(2) 
PAYMENT.—Paragraph 
(4) 
of 
section 
1844(a) of such Act (42 U.S.C. 1395w(a)), as added 
by section 30901(g)(2), is amended by striking ‘‘sec-
tion 30901 (other than subsection (g))’’ and insert-
ing ‘‘sections 30901 (other than subsection (g)), 
30902 (other than subsection (d))’’. 
(e) IMPLEMENTATION.— 
(1) FUNDING.— 
(A) IN GENERAL.—In addition to amounts 
otherwise available, the Secretary of Health and 
Human Services (in this subsection referred to 
as the ‘‘Secretary’’) shall provide for the trans-
fer from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of 
the Social Security Act (42 U.S.C. 1395t) to 
the Centers for Medicare & Medicaid Services 
Program Management Account of— 
(i) $20,000,000 for each of fiscal 
years 2022 through 2023 for purposes of 
implementing the amendments made by 
this section; and 
(ii) such sums as determined appro-
priate by the Secretary for each subse-
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656 
quent fiscal year for purposes of admin-
istering the provisions of such amend-
ments. 
(B) AVAILABILITY AND ADDITIONAL USE 
OF
FUNDS.—Funds transferred pursuant to 
subparagraph (A) shall remain available until 
expended and may be used, in addition to the 
purpose specified in subparagraph (A)(i), to im-
plement the amendments made by sections 
30901 and 30903. 
(2) ADMINISTRATION.—The Secretary may im-
plement, by program instruction or otherwise, any of 
the provisions of, or amendments made by, this sec-
tion. 
(3) PAPERWORK REDUCTION ACT.—Chapter 35 
of title 44, United States Code, shall not apply to 
the provisions of, or the amendments made by, this 
section. 
SEC. 30903. PROVIDING COVERAGE FOR VISION CARE 
UNDER THE MEDICARE PROGRAM. 
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section 
30901(a), is further amended— 
(1) in subparagraph (HH), by striking ‘‘and’’ 
after the semicolon at the end; 
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(2) in subparagraph (II), by striking the period 
at the end and adding ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(JJ) vision services (as defined in subsection 
(mmm));’’. 
(b) VISION SERVICES DEFINED.—Section 1861 of 
the Social Security Act (42 U.S.C. 1395x), as amended 
by section 30901(b), is further amended by adding at the 
end the following new subsection: 
‘‘(mmm) VISION SERVICES.—The term ‘vision serv-
ices’ means— 
‘‘(1) routine eye examinations to determine the 
refractive state of the eyes, including procedures per-
formed during the course of such examination; and 
‘‘(2) contact lens fitting services; 
furnished on or after October 1, 2022, by or under the 
direct supervision of an ophthalmologist or optometrist 
who is legally authorized to furnish such examinations, 
procedures, or fitting services (as applicable) under State 
law (or the State regulatory mechanism provided by State 
law) of the State in which the examinations, procedures, 
or fitting services are furnished.’’. 
(c) PAYMENT LIMITATIONS.—Section 1834 of the 
Social Security Act (42 U.S.C. 1395m), as amended by 
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section 30901(c)(2), is further amended by adding at the 
end the following new subsection: 
‘‘(aa) LIMITATION FOR VISION SERVICES.—With re-
spect to vision services (as defined in section 1861(mmm)) 
and an individual, payment may be made under this part 
for only 1 routine eye examination described in paragraph 
(1) of such section and 1 contact lens fitting service de-
scribed in paragraph (2) of such section during a 2-year 
period.’’. 
(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.— 
Section 1848(j)(3) of the Social Security Act (42 U.S.C. 
1395w–4(j)(3)), as amended by section 30901(d)(1), is 
further amended by inserting ‘‘(2)(JJ),’’ before ‘‘(3)’’. 
(e) COVERAGE OF CONVENTIONAL EYEGLASSES AND 
CONTACT LENSES.— 
(1) IN
GENERAL.—Section 1861(s)(8) of the 
Social Security Act (42 U.S.C. 1395x(s)(8)), as 
amended by section 30902(b)(1), is further amended 
by striking ‘‘, and including one pair of conventional 
eyeglasses or contact lenses furnished subsequent to 
each cataract surgery with insertion of an intra-
ocular lens’’ and inserting ‘‘, including one pair of 
conventional eyeglasses or contact lenses furnished 
subsequent to each cataract surgery with insertion 
of an intraocular lens, if furnished before October 1, 
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659 
2022, and including conventional eyeglasses or con-
tact lenses (as described in section 1834(h)(8)), 
whether or not furnished subsequent to such a sur-
gery, if furnished on or after October 1, 2022’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1842(b)(11)(A) of the Social Security Act (42 
U.S.C. 1395u(b)(11)(A)) is amended by inserting 
‘‘furnished prior to October 1, 2022,’’ after ‘‘relating 
to them,’’. 
(f) SPECIAL PAYMENT RULES FOR EYEGLASSES AND 
CONTACT LENSES.— 
(1) LIMITATIONS.—Section 1834(h) of the So-
cial Security Act (42 U.S.C. 1395m(h)), as amended 
by section 30901(e)(2)(A) and section 30902(b)(2), 
is further amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) PAYMENT LIMITATIONS FOR EYEGLASSES 
AND CONTACT LENSES.— 
‘‘(A) IN GENERAL.—With respect to eye-
glasses and contact lenses furnished to an indi-
vidual on or after October 1, 2022, subject to 
subparagraph (B), payment may be made under 
this part only— 
‘‘(i) during a 2-year period, for either 
1 pair of eyeglasses (including lenses and 
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660 
frames) or not more than a 2-year supply 
of contact lenses; 
‘‘(ii) with respect to amounts attrib-
utable to the lenses and frames of such a 
pair of eyeglasses or amounts attributable 
to such a 2-year supply of contact lenses, 
in an amount not greater than— 
‘‘(I) for a pair of eyeglasses fur-
nished in, or a 2-year supply of con-
tact lenses beginning in, 2022— 
‘‘(aa) $85 for the lenses of 
such pair of eyeglasses and $85 
for the frames of such pair of 
eyeglasses; or 
‘‘(bb) $85 for such 2-year 
supply of contact lenses; and 
‘‘(II) for the lenses and frames of 
a pair of eyeglasses furnished in, or a 
2-year supply of contact lenses begin-
ning in, a subsequent year, the dollar 
amounts specified under this subpara-
graph for the previous year, increased 
by the percentage change in the con-
sumer price index for all urban con-
sumers (United States city average) 
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661 
for the 12-month period ending with 
June of the previous year; 
‘‘(iii) if furnished pursuant to a writ-
ten order of an ophthalmologist or optom-
etrist described in subsection (mmm); and 
‘‘(iv) if during the 2-year period de-
scribed in clause (i), the individual did not 
already receive (as described in subpara-
graph (B)) one pair of conventional eye-
glasses or contact lenses subsequent to a 
cataract surgery with insertion of an intra-
ocular lens furnished during such period. 
‘‘(B) EXCEPTION.—With respect to a 2- 
year period described in subparagraph (A)(i), in 
the case of an individual who receives cataract 
surgery with insertion of an intraocular lens, 
notwithstanding subparagraph (A), payment 
may be made under this part for one pair of 
conventional eyeglasses or contact lenses fur-
nished subsequent to such cataract surgery dur-
ing such period. 
‘‘(C) LIMITATION ON JUDICIAL REVIEW.— 
There shall be no administrative or judicial re-
view under section 1869 or otherwise of— 
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662 
‘‘(i) the determination of the types of 
eyeglasses and contact lenses covered 
under this paragraph; or 
‘‘(ii) the determination of fee schedule 
rates under this subsection for eyeglasses 
and contact lenses.’’. 
(2) APPLICATION
OF
COMPETITIVE
ACQUISI-
TION.— 
(A) IN GENERAL.—Section 1834(h)(1)(H) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395m(h)(1)(H)), 
as 
amended 
by 
section 
30901(e)(2)(B)(i) and section 30902(b)(3)(A), 
is further amended— 
(i) in the header by inserting ‘‘, EYE-
GLASSES, AND
CONTACT
LENSES’’ after 
‘‘HEARING AIDS’’; 
(ii) by inserting ‘‘and of eyeglasses 
and contact lenses described in paragraph 
(2)(F) of such section,’’ after ‘‘paragraph 
(2)(E) of such section,’’; and 
(iii) in clause (i), by inserting ‘‘, or 
such eyeglasses and contact lenses’’ after 
‘‘such hearing aids’’. 
(B) CONFORMING AMENDMENT.— 
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663 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
1395w–3(a)(2)), as amended by section 
30901(e)(2)(B)(ii) 
and 
section 
30902(b)(3)(B)(i), is further amended by 
adding at the end the following new sub-
paragraph: 
‘‘(F) 
EYEGLASSES
AND
CONTACT 
LENSES.—Eyeglasses and contact lenses de-
scribed in section 1861(s)(8) for which payment 
would 
otherwise 
be 
made 
under 
section 
1834(h).’’. 
(ii) EXEMPTION
OF
CERTAIN
ITEMS 
FROM
COMPETITIVE
ACQUISITION.—Sec-
tion 1847(a)(7) of the Social Security Act 
(42 U.S.C. 1395w–3(a)(7)), as amended 
by section 30901(e)(2)(B)(iii) and section 
30902(b)(3)(B)(ii), is further amended by 
adding at the end the following new sub-
paragraph: 
‘‘(E) CERTAIN EYEGLASSES AND CONTACT 
LENSES.—Those items and services described in 
paragraph (2)(F) if furnished by a physician or 
other practitioner (as defined by the Secretary) 
to the physician’s or practitioner’s own patients 
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as part of the physician’s or practitioner’s pro-
fessional service.’’. 
(g) EXCLUSION MODIFICATIONS.—Section 1862(a) 
of the Social Security Act (42 U.S.C. 1395y(a)), as 
amended by section 30901(f), is further amended— 
(1) in paragraph (1)— 
(A) in subparagraph (P), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (Q), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(R) in the case of vision services (as defined 
in section 1861(mmm)) that are routine eye exami-
nations and contact lens fitting services (as de-
scribed in paragraph (1) or (2), respectively, of such 
section), which are furnished more frequently than 
once during a 2-year period;’’; and 
(2) in paragraph (7)— 
(A) by inserting ‘‘(other than such an ex-
amination that is a vision service that is cov-
ered under section 1861(s)(2)(JJ))’’ after ‘‘eye 
examinations’’; and 
(B) by inserting ‘‘(other than such a proce-
dure that is a vision service that is covered 
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under section 1861(s)(2)(JJ))’’ after ‘‘refractive 
state of the eyes’’. 
(h) CERTAIN NON-APPLICATION.— 
(1) IN GENERAL.—The last sentence of section 
1839(a)(1) of the Social Security Act (42 U.S.C. 
1395r(a)(1)), as added by section 30901(g)(1) and 
amended by section 30902(d)(1), is further amended 
by inserting ‘‘, and 30903 (other than subsection 
(h))’’ after ‘‘30902 (other than subsection (d))’’. 
(2) 
PAYMENT.—Paragraph 
(4) 
of 
section 
1844(a) of such Act (42 U.S.C. 1395w(a)), as added 
by section 30901(g)(2) and amended by section 
30902(d)(2), is further amended by inserting ‘‘, and 
30903 (other than subsection (h))’’ after ‘‘30902 
(other than subsection (d))’’. 
(i) IMPLEMENTATION.— 
(1) FUNDING.— 
(A) IN GENERAL.—In addition to amounts 
otherwise available, the Secretary of Health and 
Human Services (in this subsection referred to 
as the ‘‘Secretary’’) shall provide for the trans-
fer from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of 
the Social Security Act (42 U.S.C. 1395t) to 
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666 
the Centers for Medicare & Medicaid Services 
Program Management Account of— 
(i) $20,000,000 for each of fiscal 
years 2022 and 2023 for purposes of im-
plementing the amendments made by this 
section; and 
(ii) such sums as determined appro-
priate by the Secretary for each subse-
quent fiscal year for purposes of admin-
istering the provisions of such amend-
ments. 
(B) AVAILABILITY AND ADDITIONAL USE 
OF
FUNDS.—Funds transferred pursuant to 
subparagraph (A) shall remain available until 
expended and may be used, in addition to the 
purpose specified in subparagraph (A)(i), to im-
plement the amendments made by sections 
30901 and 30902. 
(2) ADMINISTRATION.—The Secretary may im-
plement, by program instruction or otherwise, any of 
the provisions of, or amendments made by, this sec-
tion. 
(3) PAPERWORK REDUCTION ACT.—Chapter 35 
of title 44, United States Code, shall not apply to 
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(2) INTERMEDIARY; MICROLOAN.—The terms 
‘‘intermediary’’ and ‘‘microloan’’ have the meanings 
given those terms, respectively, in section 7(m)(11) 
of the Small Business Act (15 U.S.C. 636(m)(11)). 
(3) PARTICIPATING LENDER.—The term ‘‘par-
ticipating lender’’ means a participating lender de-
scribed under section 7(a) of the Small Business Act 
(15 U.S.C. 636(a)). 
(4) PILOT
PROGRAM.—The term ‘‘pilot pro-
gram’’ means the pilot program established under 
subsection (b). 
(5) RESOURCE PARTNER.—The term ‘‘resource 
partner’’ means— 
(A) a small business development center 
(defined in section 3 of the Small Business Act 
(15 U.S.C. 632)); 
(B) a women’s business center (described 
under section 29 of such Act (15 U.S.C. 656)); 
(C) a chapter of the Service Corps of Re-
tired Executives (established under section 
8(b)(1)(B) 
of 
such 
Act 
((15 
U.S.C. 
637(b)(1)(B))); and 
(D) a Veteran Business Outreach Center 
(described under section 32 of such Act (15 
U.S.C. 657b)). 
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(C) for any project activities related to the 
acquisition of zero-emission buses or related in-
frastructure, as if funds for such activities were 
awarded under section 5339(c) of such title; 
(D) for any activities related to research 
that supports efforts to reduce barriers to the 
deployment of zero-emission transit vehicles in 
disadvantaged communities or neighborhoods 
and rural areas, including barriers related to 
the cost of such vehicles, as if funds for such 
activities were provided under section 5312 of 
such title; or 
(E) for any activities related to the train-
ing and development of the transit workforce 
that provides service to disadvantaged commu-
nities or neighborhoods and rural areas, includ-
ing the creation of new employment opportuni-
ties in the transit industry for workers from 
such communities, neighborhoods or areas, as if 
funds for such activities were provided under 
section 5314 of such title; 
(3) not be subject to any restriction on the total 
amount of funds available for implementation or exe-
cution of programs authorized under section 5307, 
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