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SEC. 30605. COST-SHARING REDUCTIONS FOR INDIVIDUALS 
RECEIVING 
UNEMPLOYMENT 
COMPENSA-
TION. 
Section 1402(f) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18071(f)) is amended— 
(1) in the header, by striking ‘‘2021’’ and in-
serting ‘‘CERTAIN YEARS’’; 
(2) in the matter preceding paragraph (1), by 
striking ‘‘2021’’ and inserting ‘‘any of years 2021 
through 2022’’; and 
(3) in paragraph (2), by striking ‘‘133 percent’’ 
and inserting ‘‘150 percent’’. 
SEC. 30606. OVERSIGHT OF PHARMACY BENEFIT MANAGER 
SERVICES. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.), as amended by sec-
tion 30604, is further amended— 
(1) in part D (42 U.S.C. 300gg–111 et seq.), 
by adding at the end the following new section: 
‘‘SEC. 2799A–12. OVERSIGHT OF PHARMACY BENEFIT MAN-
AGER SERVICES. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2023, a group health plan or health in-
surance issuer offering group health insurance coverage 
or an entity or subsidiary providing pharmacy benefits 
management services on behalf of such a plan or issuer 
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shall not enter into a contract with a drug manufacturer, 
distributor, wholesaler, subcontractor, rebate aggregator, 
or any associated third party that limits the disclosure of 
information to plan sponsors in such a manner that pre-
vents the plan or issuer, or an entity or subsidiary pro-
viding pharmacy benefits management services on behalf 
of a plan or issuer, from making the reports described in 
subsection (b). 
‘‘(b) REPORTS.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after January 1, 2023, not less frequently 
than once every 6 months, a health insurance issuer 
offering group health insurance coverage or an enti-
ty providing pharmacy benefits management services 
on behalf of a group health plan or an issuer pro-
viding group health insurance coverage shall submit 
to the plan sponsor (as defined in section 3(16)(B) 
of the Employee Retirement Income Security Act of 
1974) of such group health plan or health insurance 
coverage a report in accordance with this subsection 
and make such report available to the plan sponsor 
in a machine-readable format. Each such report 
shall include, with respect to the applicable group 
health plan or health insurance coverage— 
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‘‘(A) as applicable, information collected 
from drug manufacturers by such issuer or en-
tity on the total amount of copayment assist-
ance dollars paid, or copayment cards applied, 
that were funded by the drug manufacturer 
with respect to the participants and bene-
ficiaries in such plan or coverage; 
‘‘(B) a list of each drug covered by such 
plan, issuer, or entity providing pharmacy ben-
efit management services that was dispensed 
during the reporting period, including, with re-
spect to each such drug during the reporting 
period— 
‘‘(i) the brand name, chemical entity, 
and National Drug Code; 
‘‘(ii) the number of participants and 
beneficiaries for whom the drug was filled 
during the plan year, the total number of 
prescription fills for the drug (including 
original prescriptions and refills), and the 
total number of dosage units of the drug 
dispensed across the plan year, including 
whether the dispensing channel was by re-
tail, mail order, or specialty pharmacy; 
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‘‘(iii) the wholesale acquisition cost, 
listed as cost per days supply and cost per 
pill, or in the case of a drug in another 
form, per dose; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries on such 
drug, including participant and beneficiary 
spending through copayments, coinsurance, 
and deductibles; and 
‘‘(v) for any drug for which gross 
spending of the group health plan or 
health 
insurance 
coverage 
exceeded 
$10,000 during the reporting period— 
‘‘(I) a list of all other drugs in 
the same therapeutic category or 
class, including brand name drugs 
and biological products and generic 
drugs or biosimilar biological products 
that are in the same therapeutic cat-
egory or class as such drug; and 
‘‘(II) the rationale for preferred 
formulary placement of such drug in 
that therapeutic category or class; 
‘‘(C) a list of each therapeutic category or 
class of drugs that were dispensed under the 
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health plan or health insurance coverage during 
the reporting period, and, with respect to each 
such therapeutic category or class of drugs, 
during the reporting period— 
‘‘(i) total gross spending by the plan, 
before manufacturer rebates, fees, or other 
manufacturer remuneration; 
‘‘(ii) the number of participants and 
beneficiaries who filled a prescription for a 
drug in that category or class; 
‘‘(iii) if applicable to that category or 
class, a description of the formulary tiers 
and utilization mechanisms (such as prior 
authorization or step therapy) employed 
for drugs in that category or class; 
‘‘(iv) the total out-of-pocket spending 
by participants and beneficiaries, including 
participant 
and 
beneficiary 
spending 
through copayments, coinsurance, and 
deductibles; and 
‘‘(v) for each therapeutic category or 
class under which 3 or more drugs are in-
cluded on the formulary of such plan or 
coverage— 
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‘‘(I) the amount received, or ex-
pected to be received, from drug man-
ufacturers in rebates, fees, alternative 
discounts, or other remuneration— 
‘‘(aa) to be paid by drug 
manufacturers for claims in-
curred during the reporting pe-
riod; or 
‘‘(bb) that is related to utili-
zation of drugs, in such thera-
peutic category or class; 
‘‘(II) the total net spending, after 
deducting rebates, price concessions, 
alternative discounts or other remu-
neration from drug manufacturers, by 
the health plan or health insurance 
coverage on that category or class of 
drugs; and 
‘‘(III) the net price per course of 
treatment or single fill, such as a 30- 
day supply or 90-day supply, incurred 
by the health plan or health insurance 
coverage and its participants and 
beneficiaries, after manufacturer re-
bates, fees, and other remuneration 
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for drugs dispensed within such thera-
peutic category or class during the re-
porting period; 
‘‘(D) total gross spending on prescription 
drugs by the plan or coverage during the re-
porting period, before rebates and other manu-
facturer fees or remuneration; 
‘‘(E) total amount received, or expected to 
be received, by the health plan or health insur-
ance coverage in drug manufacturer rebates, 
fees, alternative discounts, and all other remu-
neration received from the manufacturer or any 
third party, other than the plan sponsor, re-
lated to utilization of drug or drug spending 
under that health plan or health insurance cov-
erage during the reporting period; 
‘‘(F) the total net spending on prescription 
drugs by the health plan or health insurance 
coverage during the reporting period; and 
‘‘(G) amounts paid directly or indirectly in 
rebates, fees, or any other type of remuneration 
to brokers, consultants, advisors, or any other 
individual or firm who referred the group health 
plan’s or health insurance issuer’s business to 
the pharmacy benefit manager. 
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‘‘(2) PRIVACY REQUIREMENTS.—Health insur-
ance issuers offering group health insurance cov-
erage and entities providing pharmacy benefits man-
agement services on behalf of a group health plan 
shall provide information under paragraph (1) in a 
manner consistent with the privacy, security, and 
breach notification regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996, and shall restrict 
the use and disclosure of such information according 
to such privacy regulations. 
‘‘(3) DISCLOSURE AND REDISCLOSURE.— 
‘‘(A) LIMITATION
TO
BUSINESS
ASSOCI-
ATES.—A group health plan receiving a report 
under paragraph (1) may disclose such informa-
tion only to business associates of such plan as 
defined in section 160.103 of title 45, Code of 
Federal Regulations (or successor regulations). 
‘‘(B) CLARIFICATION REGARDING PUBLIC 
DISCLOSURE
OF
INFORMATION.—Nothing in 
this section prevents a health insurance issuer 
offering group health insurance coverage or an 
entity providing pharmacy benefits management 
services on behalf of a group health plan from 
placing reasonable restrictions on the public dis-
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closure of the information contained in a report 
described in paragraph (1), except that such 
issuer or entity may not restrict disclosure of 
such report to the Department of Health and 
Human Services, the Department of Labor, or 
the Department of the Treasury. 
‘‘(C) LIMITED
FORM
OF
REPORT.—The 
Secretary shall define through rulemaking a 
limited form of the report under paragraph (1) 
required of plan sponsors who are drug manu-
facturers, drug wholesalers, or other direct par-
ticipants in the drug supply chain, in order to 
prevent anti-competitive behavior. 
‘‘(4) REPORT
TO
GAO.—A health insurance 
issuer offering group health insurance coverage or 
an entity providing pharmacy benefits management 
services on behalf of a group health plan shall sub-
mit to the Comptroller General of the United States 
each of the first 4 reports submitted to a plan spon-
sor under paragraph (1) with respect to such cov-
erage or plan, and other such reports as requested, 
in accordance with the privacy requirements under 
paragraph (2) and the disclosure and redisclosure 
standards under paragraph (3), and such other in-
formation that the Comptroller General determines 
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HR 5376 PCS
necessary to carry out the study under section 
30606(b) of An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with the Secretary of Labor and the Secretary 
of the Treasury, shall enforce this section. 
‘‘(2) FAILURE TO PROVIDE TIMELY INFORMA-
TION.—A health insurance issuer or an entity pro-
viding pharmacy benefit management services that 
violates subsection (a) or fails to provide information 
required under subsection (b), or a drug manufac-
turer that fails to provide information under sub-
section (b)(1)(A) in a timely manner, shall be sub-
ject to a civil monetary penalty in the amount of 
$10,000 for each day during which such violation 
continues or such information is not disclosed or re-
ported. 
‘‘(3) FALSE INFORMATION.—A health insurance 
issuer, entity providing pharmacy benefit manage-
ment services, or drug manufacturer that knowingly 
provides false information under this section shall be 
subject to a civil money penalty in an amount not 
to exceed $100,000 for each item of false informa-
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tion. Such civil money penalty shall be in addition to 
other penalties as may be prescribed by law. 
‘‘(4) PROCEDURE.—The provisions of section 
1128A of the Social Security Act, other than sub-
section (a) and (b) and the first sentence of sub-
section (c)(1) of such section shall apply to civil 
monetary penalties under this subsection in the 
same manner as such provisions apply to a penalty 
or proceeding under section 1128A of the Social Se-
curity Act. 
‘‘(5) WAIVERS.—The Secretary may waive pen-
alties under paragraph (2), or extend the period of 
time for compliance with a requirement of this sec-
tion, for an entity in violation of this section that 
has made a good-faith effort to comply with this sec-
tion. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit a health insurance issuer, 
group health plan, or other entity to restrict disclosure to, 
or otherwise limit the access of, the Department of Health 
and Human Services to a report described in subsection 
(b)(1) or information related to compliance with sub-
section (a) by such issuer, plan, or entity. 
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‘‘(e) DEFINITION.—In this section, the term ‘whole-
sale acquisition cost’ has the meaning given such term in 
section 1847A(c)(6)(B) of the Social Security Act.’’; and 
(2) in section 2723 (42 U.S.C. 300gg–22)— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; and 
(ii) in paragraph (2), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; 
(B) in subsection (b)— 
(i) in paragraph (1), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; 
(ii) in paragraph (2)(A), by inserting 
‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’; and 
(iii) in paragraph (2)(C)(ii), by insert-
ing ‘‘(other than subsections (a) and (b) of 
section 2799A–12)’’ after ‘‘part D’’. 
(b) GAO STUDY.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of enactment of this Act, the Comptroller 
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General of the United States shall report to Con-
gress on— 
(A) pharmacy networks of group health 
plans, health insurance issuers, and entities 
providing pharmacy benefit management serv-
ices under such group health plan or group or 
individual health insurance coverage, including 
networks that have pharmacies that are under 
common ownership (in whole or part) with 
group health plans, health insurance issuers, or 
entities providing pharmacy benefit manage-
ment services or pharmacy benefit administra-
tive services under group health plan or group 
or individual health insurance coverage; 
(B) as it relates to pharmacy networks 
that include pharmacies under common owner-
ship described in subparagraph (A)— 
(i) whether such networks are de-
signed to encourage enrollees of a plan or 
coverage to use such pharmacies over other 
network pharmacies for specific services or 
drugs, and if so, the reasons the networks 
give for encouraging use of such phar-
macies; and 
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(ii) whether such pharmacies are used 
by enrollees disproportionately more in the 
aggregate or for specific services or drugs 
compared to other network pharmacies; 
(C) whether group health plans and health 
insurance issuers offering group or individual 
health insurance coverage have options to elect 
different network pricing arrangements in the 
marketplace with entities that provide phar-
macy benefit management services, the preva-
lence of electing such different network pricing 
arrangements; 
(D) pharmacy network design parameters 
that encourage enrollees in the plan or coverage 
to fill prescriptions at mail order, specialty, or 
retail pharmacies that are wholly or partially- 
owned by that issuer or entity; and 
(E) the degree to which mail order, spe-
cialty, or retail pharmacies that dispense pre-
scription drugs to an enrollee in a group health 
plan or health insurance coverage that are 
under common ownership (in whole or part) 
with group health plans, health insurance 
issuers, or entities providing pharmacy benefit 
management services or pharmacy benefit ad-
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ministrative services under group health plan or 
group or individual health insurance coverage 
receive reimbursement that is greater than the 
median price charged to the group health plan 
or health insurance issuer when the same drug 
is dispensed to enrollees in the plan or coverage 
by other pharmacies included in the pharmacy 
network of that plan, issuer, or entity that are 
not wholly or partially owned by the health in-
surance issuer or entity providing pharmacy 
benefit management services. 
(2) REQUIREMENT.—The Comptroller General 
of the United States shall ensure that the report 
under paragraph (1) does not contain information 
that would allow a reader to identify a specific plan 
or entity providing pharmacy benefits management 
services or otherwise contain commercial or financial 
information that is privileged or confidential. 
(3) DEFINITIONS.—In this subsection, the 
terms ‘‘group health plan’’, ‘‘health insurance cov-
erage’’, and ‘‘health insurance issuer’’ have the 
meanings given such terms in section 2791 of the 
Public Health Service Act (42 U.S.C. 300gg–91). 
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SEC. 30607. FUNDING TO SUPPORT STATE APPLICATIONS 
FOR SECTION 1332 WAIVERS AND ADMINIS-
TRATION. 
Section 1332 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18052) is amended by adding 
at the end the following: 
‘‘(f) ADMINISTRATION AND PLANNING GRANTS.— 
‘‘(1) APPROPRIATION.—In addition to any other 
amounts made available, there is appropriated to the 
Secretary of Health and Human Services for fiscal 
year 2022, out of any amounts in the Treasury not 
otherwise appropriated, $50,000,000, to remain 
available until expended, for purposes of imple-
menting the grant program under paragraph (2) and 
awarding grants under such paragraph. 
‘‘(2) GRANTS.—From the amount appropriated 
under paragraph (1), the Secretary of Health and 
Human Services shall award grants to States for 
purposes of developing a new waiver application, 
preparing an application for a waiver extension or 
amendment, or implementing a State plan under 
this section. The amount of a grant awarded to a 
State under this subsection shall remain available 
until expended. 
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‘‘(3) LIMITATION.—Each grant awarded to a 
State under this subsection shall be in an amount 
not to exceed $5,000,000.’’. 
SEC. 30608. ADJUSTMENTS TO UNCOMPENSATED CARE 
POOLS AND DISPROPORTIONATE SHARE HOS-
PITAL PAYMENTS. 
(a) ADJUSTMENTS
TO
UNCOMPENSATED
CARE 
POOLS.—Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(cc) EXCLUDING EXPENDITURES FOR EXPANSION 
POPULATION FROM ASSISTANCE UNDER WAIVERS RE-
LATING TO UNCOMPENSATED CARE.—With respect to a 
State with a State plan (or waiver of such plan) that does 
not provide, with respect to a fiscal year (beginning with 
fiscal year 2023), to all individuals described in section 
1902(a)(10)(A)(i)(VIII) benchmark coverage described in 
section 1937(b)(1) or benchmark equivalent coverage de-
scribed in section 1937(b)(2), in the case of any experi-
mental, pilot, or demonstration project undertaken under 
section 1115, with respect to such State and fiscal year, 
that provides for Federal financial participation with re-
spect to expenditures for payments to providers for other-
wise uncompensated care that is furnished to low-income 
individuals, uninsured individuals, or underinsured indi-
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viduals, notwithstanding any waiver authority available 
under such section, such project shall exclude from Fed-
eral financial participation any expenditures for care that 
is furnished with respect to such fiscal year to individuals 
described in section 1902(a)(10)(A)(i)(VIII).’’. 
(b) ADJUSTMENTS TO DISPROPORTIONATE SHARE 
HOSPITAL PAYMENTS.— 
(1) IN GENERAL.—Section 1923(f) of the Social 
Security Act (42 U.S.C.1396r–4(f)) is amended— 
(A) in paragraph (3)(A), by striking 
‘‘paragraphs (6), (7), and (8)’’ and inserting 
‘‘paragraphs (6), (7), (8), and (10)’’; 
(B) in paragraph (6)(A)(vi), by inserting 
‘‘(except paragraph (10))’’ before ‘‘, any other 
provision of law’’; 
(C) in paragraph (7)(A)(i), by inserting 
‘‘without regard to paragraph (10),’’ before 
‘‘the Secretary’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(10) STATE DSH ALLOTMENTS FOR NON-EX-
PANSION
STATES
BEGINNING
WITH
FISCAL
YEAR 
2023.— 
‘‘(A) IN GENERAL.—For fiscal year 2023 
and each subsequent fiscal year— 
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‘‘(i) in the case of a State with a 
State plan (or waiver of such plan) that, 
with respect to such fiscal year, does not 
provide to all individuals described in sec-
tion 1902(a)(10)(A)(i)(VIII) benchmark 
coverage described in section 1937(b)(1) or 
benchmark equivalent coverage described 
in section 1937(b)(2), the Secretary shall 
reduce the DSH allotment to the State for 
such fiscal year in the amount equal to 
12.5 percent of the DSH allotment that 
would (after the application of paragraph 
(6), and without the application of para-
graphs (7), (8), or this paragraph) be de-
termined under this subsection for the 
State for such fiscal year; 
‘‘(ii) in the case of a State with a 
State plan (or waiver of such plan) that, 
with respect to such fiscal year, initially 
provides to all individuals described in sec-
tion 1902(a)(10)(A)(i)(VIII) benchmark 
coverage described in 1937(b)(1) or bench-
mark equivalent coverage described in sec-
tion 1937(b)(2), but during such fiscal 
year stops providing to any such individual 
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coverage described in 1937(b)(1) or 
benchmark equivalent coverage de-
scribed in section 1937(b)(2), but 
during the fiscal year establishes a 
State plan (or waiver of such plan) 
that provides, for the remainder of the 
fiscal year, all such individuals such 
benchmark or benchmark equivalent 
coverage; or 
‘‘(II) did not provide to all such 
individuals such benchmark or bench-
mark equivalent coverage during the 
fiscal year preceding such fiscal year 
described in the matter preceding sub-
clause (I), but on the first day of such 
fiscal year establishes a State plan (or 
waiver of such plan) that provides, for 
the entirety of such fiscal year, all 
such individuals such benchmark or 
benchmark equivalent coverage; 
the DSH allotment for such State for such 
fiscal year is equal to the DSH allotment 
under this subsection (without application 
of this paragraph) for the State for the en-
tirety of such fiscal year. 
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‘‘(B) CALCULATION OF DSH ALLOTMENTS 
AFTER EXPANSION PERIOD.—The DSH allot-
ment for a State for fiscal years after which a 
State provides under a State plan (or waiver of 
such plan) to all individuals described in section 
1902(a)(10)(A)(i)(VIII) benchmark coverage 
described in section 1937(b)(1) or benchmark 
equivalent 
coverage 
described 
in 
section 
1937(b)(2) and, for which the State continues 
to provide under the State plan (or waiver of 
such plan) such benchmark or benchmark 
equivalent coverage to such individuals, without 
the providing of such benchmark or benchmark 
equivalent coverage being stopped during a fis-
cal year (as described in the matter preceding 
subclause (I) of subparagraph (A)(ii)), shall be 
calculated under paragraph (3) without regard 
to this paragraph.’’. 
(2) 
TECHNICAL
AMENDMENT.—Section 
1923(f)(7)(A)(i)(II) of the Social Security Act (42 
U.S.C.1396r–4(f)(7)(A)(i)(II)) is amended by add-
ing at period at the end. 
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SEC. 30609. FURTHER INCREASE IN FMAP FOR MEDICAL AS-
SISTANCE FOR NEWLY ELIGIBLE MANDA-
TORY INDIVIDUALS. 
Section 1905(y)(1) of the Social Security Act (42 
U.S.C. 1396d(y)(1)) is amended— 
(1) in subparagraph (D), by striking at the end 
‘‘and’’; 
(2) in subparagraph (E), by striking ‘‘2020 and 
each year thereafter.’’ and inserting ‘‘2020, 2021, 
and 2022; and’’; and 
(3) by adding at the end the following new sub-
paragraphs: 
‘‘(F) 93 percent for calendar quarters in 
2023, 2024, and 2025; and 
‘‘(G) 90 percent for calendar quarters in 
2026 and each year thereafter.’’. 
Subtitle F—Medicaid 
PART 1—INVESTMENTS IN HOME AND COMMU-
NITY-BASED 
SERVICES 
AND 
LONG-TERM 
CARE QUALITY AND WORKFORCE 
SEC. 30711. HCBS IMPROVEMENT PLANNING GRANTS. 
(a) FUNDING.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise available, there is appropriated to the Sec-
retary for fiscal year 2022, out of any money in the 
Treasury not otherwise appropriated, $130,000,000, 
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to remain available until expended, for carrying out 
this section. 
(2) TECHNICAL ASSISTANCE AND GUIDANCE.— 
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 ap-
propriated, $5,000,000, to remain available until ex-
pended, for purposes of issuing guidance and pro-
viding technical assistance to States intending to 
apply for, or which are awarded, a planning grant 
under this section, and for other administrative ex-
penses related to awarding planning grants under 
this section. 
(b) AWARD AND USE OF GRANTS.— 
(1) DEADLINE FOR AWARD OF GRANTS.—From 
the amount appropriated under subsection (a)(1), 
the Secretary, not later than 12 months after the 
date of enactment of this Act, shall solicit State re-
quests for HCBS improvement planning grants and 
award such grants to all States that meet such re-
quirements as determined by the Secretary. 
(2) USE OF FUNDS.—Subject to paragraph (3), 
a State awarded a planning grant under this section 
shall use the grant to carry out planning activities 
for purposes of developing and submitting to the 
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Secretary an HCBS improvement plan for the State 
that meets the requirements of subsections (c) and 
(d). A State may use planning grant funds to sup-
port activities related to the implementation of the 
HCBS improvement plan for the State, collect and 
report information described in subsection (c), iden-
tify areas for improvement to the service delivery 
systems for home and community-based services, 
carry out activities related to evaluating payment 
rates for home and community-based services and 
identifying improvements to update the rate setting 
process, and make related infrastructure investments 
(such as case management or other information 
technology systems). 
(3) LIMITATION ON USE OF FUNDS.—None of 
the funds awarded to a State under this section may 
be used by a State as the source of the non-Federal 
share of expenditures under the State plan (or waiv-
er of such plan). 
(c) HCBS IMPROVEMENT PLAN REQUIREMENTS.— 
In order to meet the requirements of this subsection, an 
HCBS improvement plan developed using funds awarded 
to a State under this section shall include, with respect 
to the State and subject to subsection (d), the following: 
(1) EXISTING MEDICAID HCBS LANDSCAPE.— 
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(A) ELIGIBILITY AND BENEFITS.—A de-
scription of the existing standards, pathways, 
and methodologies for eligibility for home and 
community-based services pursuant to the State 
plan (or waiver of such plan), including limits 
on assets and income, the home and commu-
nity-based services available under the State 
Medicaid program and the types of settings in 
which they may be provided, and utilization 
management standards for such services. 
(B) ACCESS.— 
(i) BARRIERS.—A description of the 
barriers to accessing home and community- 
based services in the State identified by 
Medicaid eligible individuals, the families 
of such individuals, and direct care work-
ers and home care agencies, or other simi-
lar organizations. 
(ii) AVAILABILITY; UNMET NEED.—A 
summary, in accordance with guidance 
issued by the Secretary and as able to be 
practicably determined by the State, of the 
extent to which home and community- 
based services are available to all individ-
uals in the State who would be eligible for 
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such services under the State Medicaid 
program (including individuals who are on 
a waiting list for such services). 
(C) UTILIZATION.—An assessment of the 
utilization of home and community-based serv-
ices in the State (including the number of indi-
viduals receiving such services) during such pe-
riod specified by the Secretary. 
(D) SERVICE DELIVERY STRUCTURES AND 
SUPPORTS.—A description of the service deliv-
ery structures for providing home and commu-
nity-based services in the State. 
(E) WORKFORCE.—A description of the di-
rect care workforce, including estimates of the 
number of full- and part-time direct care work-
ers, the average and range of direct care worker 
wages, the benefits provided to direct care 
workers, and the turnover and vacancy rates of 
direct care worker positions. 
(F) PAYMENT RATES.— 
(i) IN GENERAL.—A description of the 
payment rates for home and community- 
based services, including, to the extent ap-
plicable, how payments for such services 
are factored into the development of man-
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aged care capitation rates, when the State 
last updated payment rates for home and 
community-based services, and an estimate 
of the portion of the payment rate that 
goes toward direct care worker compensa-
tion. 
(ii) ASSESSMENT.—An assessment of 
the relationship between payment rates for 
such services and workforce shortages, av-
erage beneficiary wait times for such serv-
ices, and provider-to-beneficiary ratios in 
the geographic region. 
(G) QUALITY.—A description of how the 
quality of home and community-based services 
is measured and monitored. 
(H) LONG-TERM SERVICES AND SUPPORTS 
PROVIDED IN INSTITUTIONAL SETTINGS.—A de-
scription of the number of individuals enrolled 
in the State Medicaid program in a year who 
receive items and services furnished by an insti-
tution for greater than 30 days in an institu-
tional setting. 
(I) HCBS SHARE OF OVERALL MEDICAID 
LTSS SPENDING.—For the most recent State 
fiscal year for which complete data is available, 
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the percentage of expenditures made by the 
State under the State Medicaid program for 
long-term services and supports that are for 
home and community-based services. 
(J) DEMOGRAPHIC DATA.—To the extent 
available and as applicable with respect to the 
information required under subparagraphs (B), 
(C), and (H), demographic data for such infor-
mation, disaggregated by age groups, primary 
disability, income brackets, gender, race, eth-
nicity, geography, primary language, and type 
of service setting. 
(2) GOALS FOR HCBS IMPROVEMENTS.—A de-
scription of how the State will do the following: 
(A) Conduct the activities required under 
subsection (jj) of section 1905 of the Social Se-
curity Act (as added under section 30712). 
(B) Reduce barriers to and disparities in 
access or utilization of home and community- 
based services in the State. 
(C) Monitor and report on access to home 
and community-based services under the State 
Medicaid program, disparities in access to such 
services, and the utilization of such services. 
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(D) Monitor and report the amount of 
State Medicaid expenditures for home and com-
munity-based services under the State Medicaid 
program as a proportion of the total amount of 
State expenditures under the State Medicaid 
program for long-term services and supports. 
(E) Monitor and report on wages, benefits, 
and vacancy and turnover rates for direct care 
workers. 
(F) Assess and monitor the sufficiency of 
payment rates under the State Medicaid pro-
gram, in a manner specified by the Secretary, 
for the specific types of home and community- 
based services available under such program for 
purposes of supporting direct care worker re-
cruitment and retention and ensuring the avail-
ability of home and community-based services. 
(G) Coordinate implementation of the 
HCBS improvement plan among the State 
Medicaid agency and State health and human 
services agencies serving individuals with dis-
abilities and the elderly. 
(d) 
DEVELOPMENT
AND
APPROVAL
REQUIRE-
MENTS.— 
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(1) DEVELOPMENT REQUIREMENTS.—In order 
to meet the requirements of this subsection, a State 
awarded a planning grant under this section shall 
develop an HCBS improvement plan for the State 
through a public notice and comment process that 
includes consultation with Medicaid eligible individ-
uals who are recipients of home and community- 
based services, family caregivers of such recipients, 
providers, health plans, direct care workers, chosen 
representatives of direct care workers, and aging, 
disability, and workforce advocates. 
(2) AUTHORITY
TO
ADJUST
CERTAIN
PLAN 
CONTENT
REQUIREMENTS.—The Secretary may 
modify the requirements for any of the information 
specified in subsection (c)(1) if a State requests a 
modification and demonstrates to the satisfaction of 
the Secretary that it is impracticable for the State 
to collect and submit the information. 
(3) SUBMISSION
AND
APPROVAL.—Not later 
than 24 months after the date on which a State is 
awarded a planning grant under this section, the 
State shall submit an HCBS improvement plan for 
approval by the Secretary, along with assurances by 
the State that the State will implement the plan in 
accordance with the requirements of the HCBS Im-
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provement Program established under subsection (jj) 
of section 1905 of the Social Security Act (42 
U.S.C. 1396d) (as added by section 30712). The 
Secretary shall approve and make publicly available 
the HCBS improvement plan for a State after the 
plan and such assurances are submitted to the Sec-
retary for approval and the Secretary determines the 
plan meets the requirements of subsection (c). A 
State may amend its HCBS improvement plan, sub-
ject to the approval of the Secretary that the plan 
as so amended meets the requirements of subsection 
(c). The Secretary may withhold or recoup funds 
provided under this section to a State, if the State 
fails to comply with the requirements of this section. 
(e) DEFINITIONS.—In the part: 
(1) DIRECT CARE WORKER.—The term ‘‘direct 
care worker’’ means, with respect to a State, any of 
the following individuals who are paid to provide di-
rectly to Medicaid eligible individuals home and com-
munity-based services available under the State 
Medicaid program: 
(A) A registered nurse, licensed practical 
nurse, nurse practitioner, or clinical nurse spe-
cialist, or a licensed nursing assistant who pro-
vides such services under the supervision of a 
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registered nurse, licensed practical nurse, nurse 
practitioner, or clinical nurse specialist. 
(B) A direct support professional. 
(C) A personal care attendant. 
(D) A home health aide. 
(E) Any other paid health care profes-
sional or worker determined to be appropriate 
by the State and approved by the Secretary. 
(2) HCBS PROGRAM IMPROVEMENT STATE.— 
The term ‘‘HCBS program improvement State’’ 
means a State that is awarded a planning grant 
under subsection (b) and has an HCBS improve-
ment plan approved by the Secretary under sub-
section (d)(3). 
(3) HEALTH PLAN.—The term ‘‘health plan’’ 
means any of the following entities that provide or 
arrange for home and community-based services for 
Medicaid eligible individuals who are enrolled with 
the entities under a contract with a State: 
(A) A medicaid managed care organiza-
tion, as defined in section 1903(m)(1)(A) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1396b(m)(1)(A)). 
(B) A prepaid inpatient health plan or pre-
paid ambulatory health plan, as defined in sec-
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tion 438.2 of title 42, Code of Federal Regula-
tions (or any successor regulation). 
(4) HOME
AND
COMMUNITY-BASED
SERV-
ICES.—The term ‘‘home and community-based serv-
ices’’ means any of the following (whether provided 
on a fee-for-service, risk, or other basis): 
(A) Home health care services authorized 
under paragraph (7) of section 1905(a) of the 
Social Security Act (42 U.S.C. 1396d(a)). 
(B) Private duty nursing services author-
ized under paragraph (8) of such section, when 
such services are provided in a Medicaid eligible 
individual’s home. 
(C) Personal care services authorized 
under paragraph (24) of such section. 
(D) PACE services authorized under para-
graph (26) of such section. 
(E) Home and community-based services 
authorized under subsections (b), (c), (i), (j), 
and (k) of section 1915 of such Act (42 U.S.C. 
1396n), authorized under a waiver under sec-
tion 1115 of such Act (42 U.S.C. 1315), or 
provided through coverage authorized under 
section 1937 of such Act (42 U.S.C. 1396u–7). 
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(F) Case management services authorized 
under section 1905(a)(19) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)(19)) and section 
1915(g) of such Act (42 U.S.C. 1396n(g)). 
(G) Rehabilitative services, including those 
related to behavioral health, described in section 
1905(a)(13) 
of 
such 
Act 
(42 
U.S.C. 
1396d(a)(13)). 
(H) Such other services specified by the 
Secretary. 
(5) INSTITUTIONAL SETTING.—The term ‘‘insti-
tutional setting’’ means— 
(A) a skilled nursing facility (as defined in 
section 1819(a) of the Social Security Act (42 
U.S.C. 1395i–3(a))); 
(B) a nursing facility (as defined in section 
1919(a) of such Act (42 U.S.C. 1396r(a))); 
(C) a long-term care hospital (as described 
in section 1886(d)(1)(B)(iv) of such Act (42 
U.S.C. 1395ww(d)(1)(B)(iv))); 
(D) a facility described in section 1905(d) 
of such Act (42 U.S.C. 1396d(d))); 
(E) an institution which is a psychiatric 
hospital (as defined in section 1861(f) of such 
Act (42 U.S.C. 1395x(f))) or that provides in-
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patient psychiatric services in a residential set-
ting specified by the Secretary; and 
(F) an institution described in section 
1905(i) of such Act (42 U.S.C. 1396d(i)). 
(6) MEDICAID
ELIGIBLE
INDIVIDUAL.—The 
term ‘‘Medicaid eligible individual’’ means an indi-
vidual who is eligible for and receiving medical as-
sistance under a State Medicaid plan or a waiver of 
such plan. Such term includes an individual who is 
on a waiting list and who would become eligible for 
medical assistance and enrolled under a State Med-
icaid plan, or waiver of such plan, upon receipt of 
home and community-based services. 
(7) STATE
MEDICAID
PROGRAM.—The term 
‘‘State Medicaid program’’ means, with respect to a 
State, the State program under title XIX of the So-
cial Security Act (42 U.S.C. 1396 through 1396w- 
6) (including any waiver or demonstration under 
such title or under section 1115 of such Act (42 
U.S.C. 1315) relating to such title). 
(8) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(9) STATE.—The term ‘‘State’’ means each of 
the 50 States, the District of Columbia, Puerto Rico, 
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the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa. 
SEC. 30712. HCBS IMPROVEMENT PROGRAM. 
(a) INCREASED FMAP FOR HCBS PROGRAM IM-
PROVEMENT STATES.—Section 1905 of the Social Secu-
rity Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ii)’’ and 
inserting ‘‘(ii), and (jj)’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(jj) ADDITIONAL SUPPORT FOR HCBS PROGRAM 
IMPROVEMENT STATES.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ADDITIONAL
SUPPORT.—Subject to 
paragraph (5), in the case of a State that is an 
HCBS program improvement State, for each 
fiscal quarter that begins on or after the first 
date on which the State is an HCBS program 
improvement State— 
‘‘(i) and for which the State meets the 
requirements described in paragraphs (2) 
and (4), notwithstanding subsection (b) or 
(ff), subject to subparagraph (B), with re-
spect to amounts expended during the 
quarter by such State for medical assist-
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ance for home and community-based serv-
ices, the Federal medical assistance per-
centage for such State and quarter (as de-
termined for the State under subsection 
(b) and, if applicable, increased under sub-
section (y), (z), (aa), or (ii), section 
6008(a) of the Families First Coronavirus 
Response Act), or section 1915(k)(2) shall 
be increased by 6 percentage points; and 
‘‘(ii) with respect to the State meeting 
the requirements described in paragraphs 
(2) and (4) and with respect to amounts 
expended during the quarter and before 
October 1, 2031, for administrative costs 
for expanding and enhancing home and 
community-based services, including for 
enhancing Medicaid data and technology 
infrastructure, modifying rate setting proc-
esses, adopting or improving training pro-
grams for direct care workers and family 
caregivers, home and community-based 
services ombudsman office activities (as re-
imbursable under section 1903(a)(7)), de-
veloping processes to identify direct care 
workers and assign such workers unique 
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identifiers (as so reimbursable), and adopt-
ing, carrying out, or enhancing programs 
that register direct care workers or connect 
beneficiaries to direct care workers, the per 
centum specified in sections 1903(a)(7) 
and 1903(a)(3) shall be increased to 80 
percent. 
In no case may the application of clause (i) re-
sult in the Federal medical assistance percent-
age determined for a State being more than 95 
percent with respect to such expenditures. In no 
case shall the application of clause (ii) result in 
a reduction to the per centum otherwise speci-
fied without application of such clause. Any in-
crease pursuant to clause (ii) shall be available 
to a State before the State meets the require-
ments of paragraphs (2) and (4). 
‘‘(B) ADDITIONAL
HCBS
IMPROVEMENT 
EFFORTS.—Subject to paragraph (5), in addi-
tion to the increase to the Federal medical as-
sistance percentage under subparagraph (A)(i) 
for amounts expended during a quarter for 
medical assistance for home and community- 
based services by an HCBS program improve-
ment State that meets the requirements of 
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paragraphs (2) and (4) for the quarter, the 
Federal medical assistance percentage for 
amounts expended by the State during the 
quarter for medical assistance for home and 
community-based services shall be further in-
creased by 2 percentage points (but not to ex-
ceed 95 percent) during the first 6 fiscal quar-
ters throughout which the State has imple-
mented and has in effect a program that meets 
the requirements of paragraph (3). 
‘‘(C) NONAPPLICATION
OF
TERRITORIAL 
FUNDING CAPS.—Any payment made to Puerto 
Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, or American Samoa for ex-
penditures that are subject to an increase in the 
Federal medical assistance percentage under 
subparagraph (A)(i) or (B), or an increase in 
an applicable Federal matching percentage 
under subparagraph (A)(ii), shall not be taken 
into account for purposes of applying payment 
limits under subsections (f) and (g) of section 
1108. 
‘‘(D) NONAPPLICATION TO CHIP EFMAP.— 
Any increase described in subparagraph (A) (or 
payment made for expenditures on medical as-
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sistance that are subject to such increase) shall 
not be taken into account in calculating the en-
hanced FMAP of a State under section 2105. 
‘‘(2) REQUIREMENTS.—Subject to the last sen-
tence of paragraph (1)(A), as conditions for receipt 
of the increase under paragraph (1) to the Federal 
medical assistance percentage determined for a 
State, with respect to a fiscal year quarter, the State 
shall meet each of the following requirements: 
‘‘(A) 
NONSUPPLANTATION.—The 
State 
uses the Federal funds attributable to the in-
crease in the Federal medical assistance per-
centage for amounts expended during a quarter 
for medical assistance for home and commu-
nity-based services under paragraph (1)(A) and 
paragraph (1)(B) (if applicable) to supplement, 
and not supplant, the level of State funds ex-
pended for home and community-based services 
for eligible individuals through programs in ef-
fect as of the date the State is awarded a plan-
ning grant under section 30711 of the Act ti-
tled ‘An Act to provide for reconciliation pursu-
ant to title II of S. Con. Res. 14’. In applying 
this subparagraph, the Secretary shall provide 
that a State shall have a 3-year period, as spec-
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ified by the Secretary, to spend any accumu-
lated unspent State funds attributable to the 
increase described in clause (i) in the Federal 
medical assistance percentage. 
‘‘(B) MAINTENANCE OF EFFORT.— 
‘‘(i) IN
GENERAL.—The State does 
not— 
‘‘(I) reduce the amount, dura-
tion, or scope of home and commu-
nity-based services available under the 
State plan (or waiver of such plan) 
relative to the home and community- 
based services available under the 
plan or a waiver of such plan as of 
the date on which the State was 
awarded a planning grant under sec-
tion 30711 of the Act titled ‘An Act 
to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’; 
‘‘(II) reduce payment rates for 
home and community-based services 
lower than such rates that were in 
place as of the date described in sub-
clause (I), including, to the extent ap-
plicable, assumed payment rates for 
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such services that are included in 
managed care capitation rates as such 
rates are being prospectively built; or 
‘‘(III) except to the extent per-
mitted under clause (ii), adopt more 
restrictive standards, methodologies, 
or procedures for determining eligi-
bility for or the scope of medical as-
sistance of home and community- 
based services, including with respect 
to cost-sharing, than the standards, 
methodologies, or procedures applica-
ble as of the date described in sub-
clause (I). 
‘‘(ii) 
CONDITIONS
FOR
FLEXI-
BILITY.—A State may make modifications 
that would otherwise violate the mainte-
nance of effort described in clause (i) if the 
State demonstrates to the satisfaction of 
the Secretary that such modifications shall 
not result in— 
‘‘(I) home and community-based 
services that are less comprehensive 
or lower in amount, duration, or 
scope; 
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‘‘(II) fewer individuals (overall 
and 
within 
particular 
eligibility 
groups) receiving home and commu-
nity-based services, the calculation of 
which may be adjusted for demo-
graphic changes since the date de-
scribed in clause (i)(I); or 
‘‘(III) 
increased 
cost-sharing 
(other than resulting from the rate of 
inflation) for home and community- 
based services. 
‘‘(C) ACCESS
TO
SERVICES.—Not later 
than an implementation date as specified by the 
Secretary (which may vary for each of the fol-
lowing clauses) after the first day of the first 
fiscal quarter for which a State receives an in-
crease to the Federal medical assistance per-
centage or other applicable Federal matching 
percentage under paragraph (1), the State does 
all of the following to improve access to serv-
ices: 
‘‘(i) Reduce access barriers and dis-
parities in access or utilization of home 
and community-based services, as de-
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scribed in the State HCBS improvement 
plan. 
‘‘(ii) Provides coverage of personal 
care services authorized under subsection 
(a)(24) for all individuals eligible for and 
enrolled in medical assistance in the State. 
‘‘(iii) Provides for navigation of home 
and community-based services through ‘no 
wrong door’ programs, provides expedited 
eligibility for home and community-based 
services, and improves home and commu-
nity-based services counseling and edu-
cation programs. 
‘‘(iv) Expands access to behavioral 
health services furnished in home and com-
munity-based settings. 
‘‘(v) Improves coordination of home 
and community-based services with em-
ployment, housing, and transportation sup-
ports. 
‘‘(vi) Provides supports to family care-
givers. 
‘‘(vii) Newly provides coverage under, 
or expands existing eligibility criteria for, 1 
or more of the eligibility categories author-
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ized under subclause (XIII), (XV), or 
(XVI) of section 1902(a)(10)(A)(ii). 
‘‘(D) WORKFORCE.— 
‘‘(i) 
IN
GENERAL.—The 
State 
strengthens and expands the direct care 
workforce that provides home and commu-
nity-based services by— 
‘‘(I) adopting processes to ensure 
that payment rates for home and com-
munity-based services are sufficient 
(as defined by the Secretary) to en-
sure that care and services are avail-
able to the extent described in the 
State HCBS improvement plan; and 
‘‘(II) 
updating 
qualification 
standards as appropriate, and devel-
oping and adopting training opportu-
nities for direct care workers and fam-
ily caregivers, at such times as the 
Secretary shall prescribe. 
‘‘(ii) PAYMENT
RATES.—In carrying 
out clause (i)(I), the State shall— 
‘‘(I) update and, as appropriate, 
increase payment rates for home and 
community-based services to support 
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recruitment and retention of the di-
rect care workforce by not later than 
2 years after approval of the HCBS 
improvement plan and, at least every 
3 years thereafter, using, through ex-
isting or other processes to determine 
provider payment, a transparent proc-
ess involving meaningful input from 
nongovernmental stakeholders; and 
‘‘(II) ensure that increases in the 
payment rates for home and commu-
nity-based services— 
‘‘(aa) at a minimum, result 
in a proportionate increase to 
payments for direct care workers 
and in a manner that is deter-
mined with input from the stake-
holders described in subclause 
(I); and 
‘‘(bb) are incorporated into 
provider payment rates for home 
and 
community-based 
services 
provided under this title by a 
health plan, under a contract and 
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paid through capitation rates 
with the State. 
‘‘(3) SELF-DIRECTED MODELS FOR THE DELIV-
ERY OF SERVICES.—As conditions for receipt of the 
increase under paragraph (1)(B) to the Federal 
medical assistance percentage determined for a 
State, with respect to a fiscal year quarter, the State 
shall establish directly, or by contract with 1 or 
more entities, including an agency with choice or a 
similar service delivery model, a program for the 
performance of all of the following functions to fa-
cilitate beneficiary use of self-directed care in the 
case the State covers home and community-based 
services under authorities that permit self-direction: 
‘‘(A) Registering qualified direct care 
workers and assisting beneficiaries in finding 
direct care workers. 
‘‘(B) Undertaking activities to recruit and 
train independent providers to enable bene-
ficiaries to direct their own care, including by 
providing or coordinating training for bene-
ficiaries on self-directed care. 
‘‘(C) Ensuring the safety of, and sup-
porting the quality of, care provided to bene-
ficiaries. 
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‘‘(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 services, 
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. 
‘‘(G) Ensuring that the program under 
this paragraph does not promote or deter the 
ability of workers to form a labor organization 
or discriminate against workers who may join 
or decline to join such an organization. 
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‘‘(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 (or a long-term care ombudsman program 
office) that— 
‘‘(i) operates independently from the 
State Medicaid agency and health plans; 
‘‘(ii) provides direct assistance to re-
cipients of home and community-based 
services available under the State Medicaid 
program and their families; and 
‘‘(iii) identifies and reports systemic 
problems to State officials, the public, and 
the Secretary. 
‘‘(B) Beginning with the last day of the 
5th fiscal quarter for which the state is an 
HCBS program improvement State, and annu-
ally thereafter, the State reports to the Sec-
retary, in a manner the Secretary shall pre-
scribe, on the progress of implementation of the 
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activities described in subparagraphs (C) and 
(D) of paragraph (2), paragraph (3) (if applica-
ble), the use of enhanced Federal funding pro-
vided under this subsection, and progress with 
respect to home and community-based services 
availability, utilization, disparities in access and 
use of services, spending on HCBS, and the 
status of 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) on or after the first date on which a State 
is an HCBS program improvement State if the 
State is found to be out of compliance with the re-
quirements of this subsection and unless, at the end 
of the 29th fiscal quarter, the State demonstrates 
the following in the annual report required in para-
graph (4) for such quarter: 
‘‘(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 
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plan and adjusted for demographic changes in 
the State since the submission of such plan. 
‘‘(B) 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’, ‘health plan’; 
and ‘home and community-based services’ have the 
meaning given those terms in section 30711(e) of 
the Act titled ‘An Act to provide for reconciliation 
pursuant to title II of S. Con. Res. 14’.’’. 
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SEC. 30713. FUNDING FOR FEDERAL ACTIVITIES RELATED 
TO MEDICAID HCBS. 
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, 
$40,000,000, to remain available until expended, to carry 
out section 30712 (including the amendments made by 
such section), including by issuing necessary guidance and 
technical assistance to States, conducting program integ-
rity and oversight efforts, and preparing and submitting 
to the Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance of the 
Senate, beginning 5 years after the date of the enactment 
of this Act and every three years thereafter, a report de-
scribing the progress of the HCBS planning and improve-
ment activities undertaken by States as applicable and as 
described in sections 30711 and 30712 (including the 
amendments made by such sections), and describing the 
impact of such activities on access to care, including with 
respect to disparities in access and utilization, and the di-
rect care workforce. 
SEC. 30714. FUNDING FOR HCBS QUALITY MEASUREMENT 
AND IMPROVEMENT. 
(a) INCREASED FEDERAL MATCHING RATE
FOR 
ADOPTION AND REPORTING OF HCBS QUALITY MEAS-
URES.— 
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(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-
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 
subsections (f) and (g) of this subsection.’’. 
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(b) HCBS QUALITY MEASURES FOR INCREASE.— 
Title XI of the Social Security Act (42 U.S.C. 1301 
through 1320e–3) 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: 
‘‘(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 or title XXI, be-
ginning with the annual State report re-
quired under subsection (c)(1) for the first 
fiscal year that begins on or after the date 
that is 2 years after the date that the Sec-
retary publishes the home and community- 
based services quality measures developed 
under subsection (b)(5)(B) the Secretary 
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shall require States to report such infor-
mation using the standardized format for 
reporting information and procedures de-
veloped under subparagraph (A) and using 
all such home and community-based qual-
ity measures developed under subsection 
(b)(5) (including any updates or changes 
to such measures).’’; and 
(B) in subsection (b)(5)— 
(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 (or, in the case of measures 
that require development and testing prior to 
availability, not later than 4 years after the 
date of enactment of this subparagraph), the 
requirements of subparagraph (A) shall apply, 
and the core measures described in subsection 
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(a) (and any updates or changes to such meas-
ures) shall include home and community-based 
services quality measures developed by the Sec-
retary. The Secretary shall ensure that such 
measures reflect the full array of home and 
community-based services, and consult with 
nongovernmental stakeholders with expertise in 
home and community-based services (including 
recipients and providers of such services).’’; 
(C) in subsection (b)(6)— 
(i) by inserting ‘‘or support services’’ 
before ‘‘that is capable of’’; 
(ii) by striking ‘‘and ambulatory 
health care settings’’ and inserting ‘‘, am-
bulatory health care, and home and com-
munity-based settings’’; and 
(iii) by inserting ‘‘and home and com-
munity-based’’ before ‘‘care system’’; and 
(D) in subsection (c)(1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘, sub-
ject to subsection (a)(4)(B)(ii),’’ before ‘‘annu-
ally report’’; and 
(2) in section 1139B— 
(A) in subsection (b)— 
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(i) in paragraph (3), by adding at the 
end the following new subparagraph: 
‘‘(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 
all of the home and community-based services 
quality measures included in the core set of 
adult health quality measures under paragraph 
(5)(D), and any updates or changes to such 
measures.’’; and 
(ii) in paragraph (5), by adding at the 
end the following new subparagraph: 
‘‘(D) HCBS QUALITY MEASURES.— 
‘‘(i) 
FUNDING.—In 
addition 
to 
amounts otherwise available, there is ap-
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propriated to the Secretary, for fiscal year 
2022, to be available until expended, out of 
any money in the Treasury not otherwise 
appropriated, $22,000,000, for carrying 
out this subparagraph. 
‘‘(ii) INCLUSION
OF
HCBS
QUALITY 
MEASURES.—Beginning with respect to 
State reports required under subsection 
(d)(1) for the first year that begins on or 
after the date that is 2 years after the date 
of enactment of this subparagraph (or, in 
the case of measures that require develop-
ment and testing prior to availability, not 
later than 4 years after the date of enact-
ment of this subparagraph) 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 qual-
ity measures developed in accordance with 
this subparagraph. 
‘‘(iii) REQUIREMENTS.— 
‘‘(I) IN
GENERAL.—In devel-
oping, reviewing and updating the 
home and community-based services 
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quality measures included in the core 
set of adult health quality measures 
maintained under this paragraph, the 
Secretary shall consult with non-
governmental stakeholders with exper-
tise in home and community-based 
services (including recipients and pro-
viders of such services) and ensure 
such measures reflect the full array of 
home and community-based services 
and recipients of such services. 
‘‘(II) 
DEFINITION.—For 
pur-
poses of this section and section 
1139A, the term ‘home and commu-
nity-based services’ has the meaning 
given such term in section 30711(e) of 
the Act titled ‘An Act to provide for 
reconciliation pursuant to title II of S. 
Con. Res. 14’.’’; 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 
that is 2 years after the Secretary publishes the 
home and community-based quality measures 
developed under subsection (b)(5)(D), all home 
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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; 
and’’. 
SEC. 30715. PERMANENT EXTENSION OF MEDICAID PRO-
TECTIONS AGAINST SPOUSAL IMPOVERISH-
MENT FOR RECIPIENTS OF HOME AND COM-
MUNITY-BASED SERVICES. 
(a) IN GENERAL.—Section 1924(h)(1)(A) of the So-
cial Security Act (42 U.S.C. 1396r–5(h)(1)(A)) is amend-
ed by striking ‘‘(at the option of the State) is described 
in section 1902(a)(10)(A)(ii)(VI)’’ and inserting the fol-
lowing: ‘‘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 reason of being determined eligible under 
section 1902(a)(10)(C) or by reason of section 1902(f) or 
otherwise on the basis of a reduction of income based on 
costs incurred for medical or other remedial care, or who 
is eligible for medical assistance for home and community- 
based attendant services and supports under section 
1915(k)’’. 
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(b) CONFORMING AMENDMENT.—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 ‘‘the date of the enactment of the 
Act titled ‘An Act to provide for reconciliation pursuant 
to title II of S. Con. Res. 14’ ’’. 
SEC. 30716. 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 2022.’’; 
(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.—In addition to 
amounts otherwise available, there is appropriated to 
the Secretary for fiscal year 2022 and for each sub-
sequent 3-year period, out of any money in the 
Treasury not otherwise appropriated, $5,000,000, to 
remain available until expended, for carrying out 
subsections (f), (g), 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. 30717. FUNDING TO IMPROVE THE ACCURACY AND RE-
LIABILITY OF CERTAIN SKILLED NURSING 
FACILITY DATA. 
Section 1888 of the Social Security Act (42 U.S.C. 
1395yy) is amended— 
(1) in subsection (h)(12)— 
(A) in subparagraph (A), by striking ‘‘and 
the data submitted under subsection (e)(6) a 
process to validate such measures and data’’ 
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and inserting ‘‘, the data submitted under sub-
section (e)(6), and, during the period beginning 
with fiscal year 2024 and ending with fiscal 
year 2031, the resident assessment data de-
scribed in section 1819(b)(3) and the direct 
care staffing information described in section 
1128I(g) a process to validate such measures, 
data, and information’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘FUNDING.—For pur-
poses’’ and inserting ‘‘FUNDING.— 
‘‘(i) FISCAL
YEARS
2023
THROUGH 
2025.—For purposes’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) ADDITIONAL
FUNDING.—There 
is appropriated to the Secretary, out of 
any monies in the Treasury not otherwise 
appropriated, $50,000,000 for fiscal year 
2022, to remain available through fiscal 
year 2031, for purposes of carrying out 
this paragraph.’’; and 
(2) in subsection (e)(6)(A)— 
(A) in the header, by striking ‘‘FOR FAIL-
URE TO REPORT’’; and 
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(B) in clause (i)— 
(i) by striking ‘‘For fiscal years begin-
ning with fiscal year 2018, in the case of 
a skilled nursing facility that does not sub-
mit’’ and inserting the following: 
‘‘(I) FAILURE TO REPORT.—For 
fiscal years beginning with fiscal year 
2018, in the case of a skilled nursing 
facility that does not submit quality 
measure data specified by the Sec-
retary and’’; and 
(ii) by adding at the end the following 
new subclause: 
‘‘(II) 
REPORTING
OF
INAC-
CURATE
INFORMATION.—For fiscal 
years during the period beginning 
with fiscal year 2026 and ending with 
fiscal year 2031, in the case of a 
skilled nursing facility that submits 
data under this paragraph, measures 
under subsection (h), resident assess-
ment 
data 
described 
in 
section 
1819(b)(3), or direct care staffing in-
formation 
described 
in 
section 
1128I(g) with respect to such fiscal 
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year that is inaccurate (as determined 
by the Secretary through the valida-
tion process described in section 
1888(h)(12) or otherwise), after de-
termining the percentage described in 
paragraph (5)(B)(i), and after appli-
cation of clauses (ii) and (iii) of para-
graph (5)(B) and of subclause (I) of 
this clause (if applicable), the Sec-
retary shall reduce such percentage 
for payment rates during such fiscal 
year by 2 percentage points.’’. 
SEC. 30718. ENSURING ACCURATE INFORMATION ON COST 
REPORTS. 
Section 1888(f) of the Social Security Act (42 U.S.C. 
1395yy(f)) is amended by adding at the end the following 
new paragraph: 
‘‘(5) AUDIT OF COST REPORTS.—There is ap-
propriated to the Secretary, out of any monies in the 
Treasury not otherwise appropriated, $250,000,000 
for fiscal year 2022, to remain available through fis-
cal year 2031, for purposes of conducting an annual 
audit (beginning with 2023 and ending with 2031) 
of cost reports submitted under this title for a rep-
resentative sample of skilled nursing facilities.’’. 
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SEC. 30719. SURVEY IMPROVEMENTS. 
Section 1819 of the Social Security Act (42 U.S.C. 
1395i–3) is amended by adding at the end the following 
new subsection: 
‘‘(l) SURVEY IMPROVEMENTS.— 
‘‘(1) IN GENERAL.—There is appropriated to 
the Secretary, out of any monies in the Treasury not 
otherwise appropriated, $325,000,000 for fiscal year 
2022, to remain available through fiscal year 2031, 
for purposes of— 
‘‘(A) conducting reviews and identifying 
plans under paragraph (2); and 
‘‘(B) providing training, tools, technical as-
sistance, and financial support in accordance 
with paragraph (3). 
‘‘(2) REVIEW.—The Secretary shall conduct re-
views, during the period specified in paragraph (1), 
of (and, as appropriate, identify plans to improve) 
the following: 
‘‘(A) The extent to which surveys con-
ducted under subsection (g) and the enforce-
ment process under subsection (h) result in in-
creased compliance with requirements under 
this section and subpart B of part 483 of title 
42, Code of Federal Regulations, with respect 
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to skilled nursing facilities (in this subsection 
referred to as ‘facilities’). 
‘‘(B) The timeliness and thoroughness of 
State agency verification of deficiency correc-
tions at facilities. 
‘‘(C) The accuracy of the identification and 
appropriateness of the scope and severity of de-
ficiencies cited at facilities. 
‘‘(D) The accuracy of the identification 
and appropriateness of the scoping and severity 
of life safety, infection control, and emergency 
preparedness deficiencies cited at facilities. 
‘‘(E) The timeliness of State agency inves-
tigations of— 
‘‘(i) complaints at facilities; 
‘‘(ii) facility-reported incidents at fa-
cilities; and 
‘‘(iii) reported allegations of abuse, 
neglect, and exploitation at facilities. 
‘‘(F) The consistency of facility reporting 
of substantiated complaints to law enforcement. 
‘‘(G) The ability of the State agency to 
sufficiently hire, train, and retain individuals 
who conduct surveys. 
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‘‘(H) Any other area related to surveys of 
facilities, or the individuals conducting such 
surveys, determined appropriate by the Sec-
retary. 
‘‘(3) SUPPORT.—Based on the review under 
paragraph (2), the Secretary shall, during the period 
specified in paragraph (1), provide training, tools, 
technical assistance, and financial support to State 
and Federal agencies that perform surveys of facili-
ties for the purpose of improving the surveys con-
ducted under subsection (g) and the enforcement 
process under subsection (h) with respect to the 
areas reviewed under paragraph (2).’’. 
SEC. 30720. NURSE STAFFING REQUIREMENTS. 
Section 1819(d) of the Social Security Act (42 U.S.C. 
1395i–3(d)) is amended— 
(1) in paragraph (4)(A), by inserting ‘‘and any 
regulations promulgated under paragraph (5)(C)’’ 
after ‘‘section 1124’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) NURSE STAFFING REQUIREMENTS.— 
‘‘(A) FUNDING.—There is appropriated to 
the Secretary, out of any monies in the Treas-
ury not otherwise appropriated, $50,000,000 
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for fiscal year 2022, to remain available 
through fiscal year 2031, for purposes of car-
rying out this paragraph. 
‘‘(B) STUDY.—Not later than 3 years after 
the date of the enactment of this paragraph, 
and not less frequently than once every 5 years 
thereafter, the Secretary shall, out of funds ap-
propriated under subparagraph (A), conduct a 
study and submit to Congress a report on the 
appropriateness of establishing minimum staff 
to resident ratios for nursing staff for skilled 
nursing facilities. Each such report shall in-
clude— 
‘‘(i) with respect to the first such re-
port, recommendations regarding appro-
priate minimum ratios of registered nurses 
(and, if practicable, licensed practical 
nurses (or licensed vocational nurses) and 
certified nursing assistants) to residents at 
such skilled nursing facilities; and 
‘‘(ii) with respect to each subsequent 
such report, recommendations regarding 
appropriate minimum ratios of registered 
nurses, licensed practical nurses (or li-
censed vocational nurses), and certified 
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nursing assistants to residents at such 
skilled nursing facilities. 
‘‘(C) PROMULGATION OF REGULATIONS.— 
‘‘(i) IN GENERAL.—Not later than 1 
year after the Secretary first submits a re-
port under subparagraph (B), the Sec-
retary shall, out of funds appropriated 
under subparagraph (A)— 
‘‘(I) specify through regulations, 
consistent with such report, appro-
priate minimum ratios (if any) of reg-
istered nurses (and, if practicable, li-
censed practical nurses (or licensed 
vocational nurses) and certified nurs-
ing assistants) to residents at skilled 
nursing facilities; and 
‘‘(II) except as provided in clause 
(ii), require such skilled nursing facili-
ties to comply with such ratios. 
‘‘(ii) EXCEPTION.— 
‘‘(I) IN
GENERAL.—In addition 
to the authority to waive the applica-
tion of clause (i)(II) under section 
1135, the Secretary may waive the 
application of such clause with respect 
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to a skilled nursing facility if the Sec-
retary finds that— 
‘‘(aa) the facility is located 
in a rural area and the supply of 
skilled nursing facility services in 
such area is not sufficient to 
meet the needs of individuals re-
siding therein; 
‘‘(bb) the Secretary provides 
notice of the waiver to the State 
long-term care ombudsman (es-
tablished 
under 
section 
307(a)(12) of the Older Ameri-
cans Act of 1965) and the pro-
tection and advocacy system in 
the State for the mentally ill; and 
‘‘(cc) the facility that is 
granted such a waiver notifies 
residents of the facility (or, 
where appropriate, the guardians 
or legal representatives of such 
residents) and members of their 
immediate families of the waiver. 
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‘‘(II) RENEWAL.—Any waiver in 
effect under this clause shall be sub-
ject to annual renewal. 
‘‘(iii) UPDATE.—Not later than 1 year 
after the submission of each subsequent re-
port under subparagraph (B), the Sec-
retary shall, out of funds appropriated 
under subparagraph (A) and consistent 
with such report, update the regulations 
described in clause (i)(I) to reflect appro-
priate minimum ratios (if any) of reg-
istered nurses, licensed practical nurses (or 
licensed vocational nurses), and certified 
nursing assistants to residents at skilled 
nursing facilities.’’. 
PART 2—EXPANDING ACCESS TO MATERNAL 
HEALTH 
SEC. 30721. EXTENDING CONTINUOUS COVERAGE FOR 
PREGNANT AND POSTPARTUM INDIVIDUALS. 
(a) MEDICAID.— 
(1) REQUIRING FULL BENEFITS FOR PREGNANT 
AND POSTPARTUM INDIVIDUALS FOR 12-MONTH PE-
RIOD POST PREGNANCY.— 
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(A) IN GENERAL.—Paragraph (5) of sec-
tion 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended— 
(i) by striking ‘‘(5) A woman who’’ 
and inserting ‘‘(5)(A) For any fiscal year 
quarter (beginning with the first fiscal 
year quarter beginning 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’) with respect 
to which subparagraph (B) does not apply, 
an individual who’’; and 
(ii) 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 the Act titled ‘An 
Act to provide for reconciliation pursuant to title II 
of S. Con. Res. 14’), any individual who, while preg-
nant, is eligible for and received medical assistance 
under the State plan or a waiver of such plan (re-
gardless of the basis for the individual’s eligibility 
for medical assistance and including during a period 
of retroactive eligibility under subsection (a)(34)), 
shall 
remain 
eligible, 
notwithstanding 
section 
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1916(c)(3) or any other limitation under this title, 
for medical assistance through the end of the month 
in which the 12-month period (beginning on the last 
day of pregnancy of the individual) ends, and such 
medical assistance shall be in accordance with 
clauses (i) and (ii) of paragraph (16)(B).’’. 
(B) CONFORMING
AMENDMENTS.—Title 
XIX of the Social Security Act (42 U.S.C. 1396 
through 1396w-6) is amended— 
(i) in section 1902(a)(10), in the mat-
ter following subparagraph (G), by striking 
‘‘(VII) the medical assistance’’ and all that 
follows through ‘‘, (VIII)’’ and inserting 
‘‘(VIII)’’; 
(ii) in section 1902(e)(6), by striking 
‘‘In the case of’’ and inserting ‘‘For any 
fiscal year quarter with respect to which 
paragraph (5)(B) does not apply, in the 
case of’’; 
(iii) in section 1902(l)(1)(A), by strik-
ing ‘‘60-day period’’ and inserting ‘‘12- 
month period (or, for any fiscal year quar-
ter with respect to which subsection 
(e)(5)(B) does not apply and for which the 
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State has not adopted the option under 
section 1902(e)(16)(A), 60-day period)’’; 
(iv) in section 1903(v)(4)— 
(I) in subparagraph (A)(i), by 
striking ‘‘the 60-day period’’ and in-
serting ‘‘the applicable period (as de-
scribed in subparagraph (D))’’; 
(II) in subparagraph (A)(ii), by 
striking the period and inserting ‘‘, 
and, in the case of such an individual 
who is or becomes pregnant, such in-
dividual (regardless of age) during 
pregnancy and during the applicable 
period (as described in subparagraph 
(D)).’’; 
(III) by adding at the end the 
following new subparagraph: 
‘‘(D) For purposes of subparagraph (A), 
the applicable period described in this subpara-
graph is— 
‘‘(i) beginning with the first fiscal 
year quarter that begins one year after the 
date of the enactment of the American 
Rescue Plan Act of 2021, for a State that 
has adopted the option under section 
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1902(e)(16)(A), the 12-month period;’’; 
and 
(IV) in the subparagraph (D) 
added by subclause (III), by adding at 
the end the following new clauses: 
‘‘(ii) beginning with the first fiscal 
year quarter beginning 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’, the 12- 
month period; and 
‘‘(iii) for any fiscal year quarter (be-
ginning with such first fiscal year quarter) 
with 
respect 
to 
which 
section 
1902(e)(5)(B) does not apply and for 
which the State has not adopted the option 
under section 1902(e)(16)(A), the 60-day 
period.’’; 
(v) in section 1905(a), in the 4th sen-
tence in the matter following paragraph 
(31), by striking ‘‘60-day period’’ and in-
serting ‘‘12-month period (or, for any fis-
cal year quarter with respect to which sec-
tion 1902(e)(5)(B) does not apply and for 
which the State has not adopted the option 
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under section 1902(e)(16)(A), 60-day pe-
riod)’’; and 
(vi) in section 1905(y), by adding at 
the end the following new paragraph: 
‘‘(3) TREATMENT FOR CERTAIN INDVIDUALS.— 
Notwithstanding paragraphs (1) and (2), section 
1902(a)(10)(A)(i)(III), 
and 
section 
1902(a)(10)(A)(i)(IV), the term ‘newly eligible’ in 
paragraph (2)(A) and the phrase ‘newly eligible indi-
viduals described in subclause (VIII) of section 
1902(a)(10)(A)(i)’ in paragraph (1) shall apply to 
individuals who but for the amendments made by 
section 30721(a) of the Act titled ‘An Act to provide 
for reconciliation pursuant to title II of S. Con. Res. 
14’ would be eligible under the State plan (or waiv-
er) 
for 
medical 
assistance 
under 
section 
1902(a)(10)(A)(i)(VIII) for the period beginning on 
the first day occurring after the end of such 60-day 
period and ending on the last day of the month in 
which the 12-month period (beginning on the last 
day of the pregnancy) ends.’’. 
(2) TRANSITION FROM STATE OPTION.— 
(A) IN GENERAL.—Section 1902(e)(16)(A) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(e)(16)(A)) is amended by striking ‘‘At 
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the option of the State’’ and inserting ‘‘For any 
fiscal year quarter with respect to which para-
graph (5)(B) does not apply, at the option of 
the State’’. 
(B) CONFORMING
AMENDMENT.—Section 
9812(b) of the American Rescue Plan Act of 
2021 (Public Law 117–2) is amended by strik-
ing ‘‘during the 5-year period’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graphs (B) and (C), the amendments made by 
this paragraph shall take effect 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 assist-
ance provided on or after such date. 
(B) EXCEPTION FOR CERTAIN AMERICAN 
RESCUE
PLAN
ACT
OF
2021
CONFORMING 
AMENDMENTS.—The amendments made by sub-
clauses (I), (II), and (III) of paragraph 
(1)(B)(iv) shall take effect on the first day of 
the first fiscal year quarter that begins one year 
after the date of the enactment of the American 
Rescue Plan Act of 2021 and shall apply with 
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respect to medical assistance provided on or 
after such date. 
(C) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
through 1396w-6) that the Secretary of Health 
and Human Services determines requires State 
legislation in order for the plan to meet any re-
quirement imposed by amendments made by 
this subsection, 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 requirement 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 en-
actment of this Act. For purposes of the pre-
vious sentence, in the case of a State that has 
a 2-year legislative session, each year of the ses-
sion shall be considered to be a separate regular 
session of the State legislature. 
(b) CHIP.— 
(1) REQUIRING FULL BENEFITS FOR PREGNANT 
AND POSTPARTUM WOMEN FOR 12-MONTH PERIOD 
POST PREGNANCY.— 
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(A) IN GENERAL.—Section 2107(e)(1)(J) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397gg(e)(1)(J)) is amended— 
(i) by striking ‘‘Paragraphs (5) and 
(16)’’ and inserting ‘‘(i) For any fiscal 
year quarter with respect to which para-
graph (5)(B) of section 1902(e) does not 
apply, paragraphs (5)(A) and (16) of such 
section’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) For any fiscal year quarter (beginning 
with the first fiscal year quarter beginning one 
year after the date of the enactment of the Act 
titled ‘An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14’), section 
1902(e)(5)(B) (requiring, notwithstanding sec-
tion 2103(e)(3)(C)(ii)(I) or any other limitation 
under this title, continuous coverage for preg-
nant and postpartum individuals, including 12 
months postpartum, of medical assistance) if 
the State provides child health assistance to 
targeted low-income children or pregnancy-re-
lated assistance to targeted low-income preg-
nant women, under the State child health plan 
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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).’’. 
(B) CONFORMING AMENDMENTS.—Section 
2112 of the Social Security Act (42 U.S.C. 
1397ll) is amended— 
(i) in subsection (d)— 
(I) in paragraph (1), by inserting 
‘‘and includes, through application of 
section 1902(e)(5)(B) pursuant to 
section 2107(e)(1)(J)(ii), continuous 
coverage for pregnant and postpartum 
individuals, 
including 
months 
postpartum’’ before the period at the 
end; and 
(II) in paragraph (2)(A), 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 
section 2107(e)(1)(J)(ii) does not 
apply and for which the State has not 
adopted the option under section 
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1902(e)(16)(A), 60-day period) ends’’; 
and 
(ii) in subsection (f)(2), by striking 
‘‘60-day period’’ and inserting ‘‘12-month 
period (or, for any fiscal year quarter (be-
ginning with the first fiscal year quarter 
beginning one year after the date of the 
enactment of the Act titled ‘An Act to pro-
vide for reconciliation pursuant to title II 
of S. Con. Res. 14’) with respect to which 
section 2107(e)(1)(J)(ii) does not apply 
and for which the State has not adopted 
the option under section 1902(e)(16)(A), 
60-day period)’’. 
(2) TRANSITION FROM STATE PLAN OPTION.— 
Section 9822(b) of the American Rescue Plan Act of 
2021 (Public Law 117–2) is amended by striking ‘‘, 
during the 5-year period’’. 
(3) EFFECTIVE DATE.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall take effect 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 assist-
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ance and pregnancy-related assistance, as appli-
cable, provided on or after such date. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State child health plan 
under title XXI of the Social Security Act (42 
U.S.C. 1397aa through 1397mm) that the Sec-
retary of Health and Human Services deter-
mines requires State legislation in order for the 
plan to meet any requirement imposed by 
amendments made under this subsection, 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 requirement 
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 pur-
poses 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. 
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SEC. 30722. STATE OPTION TO PROVIDE COORDINATED 
CARE THROUGH A MATERNAL HEALTH HOME 
FOR PREGNANT AND POSTPARTUM INDIVID-
UALS. 
Title XIX of the Social Security Act (42 U.S.C. 
1396a) is amended by inserting after section 1945A the 
following new section: 
‘‘SEC. 1945B. STATE OPTION TO PROVIDE COORDINATED 
CARE THROUGH A MATERNAL HEALTH HOME 
FOR PREGNANT AND POSTPARTUM INDIVID-
UALS. 
‘‘(a) 
IN
GENERAL.—Notwithstanding 
section 
1902(a)(1) (relating to statewideness) and section 
1902(a)(10)(B) (relating to comparability), beginning 24 
months after the date of enactment of this section, a 
State, at its option as a State plan amendment, may pro-
vide for medical assistance under this title to eligible indi-
viduals who choose to enroll in a maternal health home 
under this section and receive maternal health home serv-
ices from a designated provider, a team of health profes-
sionals operating with such a provider, or a health team. 
‘‘(b) MATERNAL HEALTH HOME QUALIFICATION 
STANDARDS.—A maternal health home under this section 
shall demonstrate to the State the ability to do the fol-
lowing: 
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‘‘(1) Develop an individualized comprehensive 
care plan for each eligible individual, working in a 
culturally and linguistically appropriate manner with 
such individual to develop and incorporate such care 
plan in a manner consistent with such individual’s 
needs and choices, including— 
‘‘(A) primary care; 
‘‘(B) inpatient care; 
‘‘(C) social support services; 
‘‘(D) local hospital emergency care; 
‘‘(E) care management and planning re-
lated to a change in an eligible individual’s eli-
gibility for medical assistance or a change in 
health insurance coverage as needed; and 
‘‘(F) behavioral health services. 
‘‘(2) Coordinate all necessary services to sup-
port prenatal, labor and delivery, and postpartum 
care for eligible individuals. 
‘‘(3) Coordinate access to specialists, behavioral 
health providers, early intervention services, and pe-
diatricians. 
‘‘(4) Collect and report information under sub-
section (d). 
‘‘(c) PAYMENTS.— 
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‘‘(1) IN GENERAL.—A State shall provide a des-
ignated provider, a team of health professionals op-
erating with such a provider, or a health team with 
payments for the provision of maternal health home 
services to each eligible individual enrolled in a ma-
ternal health home. Payments for maternal health 
home services made to a designated provider, a team 
of health professionals operating with such a pro-
vider, or a health team shall be treated as payments 
for medical assistance for purposes of section 
1903(a), except that, during the first 8 fiscal quar-
ters that the State plan amendment is in effect, the 
Federal medical assistance percentage otherwise ap-
plicable to such payments shall be increased by 15 
percentage points, not to exceed 90 percent. 
‘‘(2) METHODOLOGY.— 
‘‘(A) IN GENERAL.—The State shall speci-
fy in the State plan amendment the method-
ology the State will use for determining pay-
ment for the provision of maternal health home 
services. Such methodology for determining 
payment— 
‘‘(i) may be tiered or adjusted to re-
flect, with respect to each individual pro-
vided such services by a designated pro-
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vider, a team of health care professionals 
operating with such a provider, or a health 
team, the acuity of each individual receiv-
ing care, or the specific capabilities of the 
provider, team of health care providers, or 
health team; and 
‘‘(ii) shall be established consistent 
with section 1902(a)(30)(A). 
‘‘(B) ALTERNATE MODEL OF PAYMENT.— 
The methodology for determining payment for 
provision of maternal health home services 
under this section shall not be limited to a fee- 
for-service or per-member per-month payment 
model, and may provide for alternate models of 
payment that reflect the needs of a State, sub-
ject to the approval of the Secretary. 
‘‘(3) PLANNING GRANTS.— 
‘‘(A) IN GENERAL.—Beginning 12 months 
after the date of enactment of this section, the 
Secretary may award planning grants to States 
for purposes of developing a State plan amend-
ment under this section. A planning grant 
awarded to a State under this paragraph shall 
remain available until expended. 
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‘‘(B) STATE
CONTRIBUTION.—A State 
awarded a planning grant shall contribute an 
amount equal to the State percentage deter-
mined under section 1905(b) for each fiscal 
year for which the grant is awarded. 
‘‘(C) APPROPRIATIONS.—In addition to 
amounts otherwise available, there is appro-
priated for fiscal year 2022, out of any money 
in the Treasury not otherwise appropriated, to 
remain available until expended, to carry out 
this paragraph, $5,000,000 for awarding grants 
under this section. 
‘‘(d) DATA COLLECTION AND REPORTING.— 
‘‘(1) PROVIDER REPORTING REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—In order to receive 
payments from a State under subsection (c), a 
designated provider, a team of health profes-
sionals operating with such a provider, or a 
health team shall report to the State, in accord-
ance with such requirements as the Secretary 
shall specify, the following: 
‘‘(i) With respect to each such des-
ignated provider, team of health profes-
sionals, or health team, the name, national 
provider identification number, address, 
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and specific maternal health home services 
offered to be provided to eligible individ-
uals who have selected such designated 
provider, team of health professionals, or 
health team as the maternal health home 
of such eligible individuals. 
‘‘(ii) Information on all applicable 
measures for determining the quality of 
maternal health home services provided by 
such designated provider, team of health 
professionals, or health team, including, to 
the extent applicable, the core set of child 
health quality measures published under 
section 1139A, the core set of adult health 
quality measures for Medicaid eligible 
adults published under section 1139B, and 
maternal health quality measures. 
‘‘(B) USE
OF
HEALTH
INFORMATION 
TECHNOLOGY.—A designated provider, a team 
of health professionals operating with such a 
provider, or a health team shall use, to the ex-
tent practicable, health information technology 
to provide a State with the information required 
under subparagraph (A) and to improve care 
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coordination for eligible individuals, such as 
by— 
‘‘(i) facilitating the review of person- 
centered care plans; 
‘‘(ii) monitoring service delivery and 
identifying gaps in treatment; and 
‘‘(iii) communicating with eligible in-
dividuals and with primary, behavioral 
health and specialty care providers. 
‘‘(2) STATE
REPORTING
REQUIREMENTS.—A 
State with a State plan amendment approved under 
this section shall collect and report to the Secretary, 
at such time and in such form and manner as re-
quired by the Secretary, the following information: 
‘‘(A) The number of maternal health 
homes in a State in which individuals are en-
rolled pursuant to a State plan amendment 
under this section. 
‘‘(B) The number of individuals served 
who 
selected 
a 
maternal 
health 
home, 
disaggregated by race and ethnicity, pursuant 
to a State plan amendment under this section. 
‘‘(C) Information on the quality measures 
applicable for maternal health home services, 
including, to the extent applicable, the core set 
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of child health quality measures published 
under section 1139A, and the core set of adult 
health quality measures for Medicaid eligible 
adults published under section 1139B, and ma-
ternal health quality measures. 
‘‘(D) The type of delivery systems and pay-
ment models used to provide health home serv-
ices to eligible individuals enrolled in a mater-
nal health home under a State plan amendment 
under this section. 
‘‘(E) The number and characteristics of 
designated providers, teams of health profes-
sionals, and health teams selected as maternal 
health homes pursuant to a State plan amend-
ment under this section. 
‘‘(F) Information on hospitalizations, mor-
bidity, and mortality of eligible individuals and 
their infants enrolled in a maternal health home 
in such State alongside comparable data from a 
State’s maternal mortality review committee. 
‘‘(G) A report on best practices for effec-
tive strategies in coordinating care to support 
access to comprehensive maternal health serv-
ices. 
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‘‘(H) Information reported to the State 
under paragraph (1). 
‘‘(e) STATE PLAN AMENDMENT.— 
‘‘(1) IN GENERAL.—A State plan amendment 
submitted pursuant to this section shall include— 
‘‘(A) eligibility criteria for maternal health 
homes; 
‘‘(B) services available to eligible individ-
uals through the maternal health home; 
‘‘(C) a description of providers that may 
provide care through a maternal health home, 
and that include how such State will ensure any 
provider arrangement offered includes a person- 
centered planning approach to determining nec-
essary services and supports and providing the 
appropriate care coordination to meet clinical 
and non-clinical needs of eligible individuals; 
and 
‘‘(D) reimbursement methodologies (as de-
scribed in subsection (c)(2)). 
‘‘(2) HOSPITAL NOTIFICATION.—A State with a 
State plan amendment approved under this section 
shall require each hospital that is a participating 
provider under the State plan (or a waiver of such 
plan) to establish procedures for, in the case of an 
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individual who is enrolled in a maternal health home 
pursuant to this section and seeks treatment in the 
emergency department of such hospital, notifying 
the health home of such individual of such treat-
ment. 
‘‘(3) EDUCATION
WITH
RESPECT
TO
AVAIL-
ABILITY OF MATERNAL HEALTH HOME SERVICES.— 
In order for a State plan amendment to be approved 
under this section, a State shall include in the State 
plan amendment— 
‘‘(A) a description of the State’s process 
for educating providers participating in the 
State plan (or a waiver of such plan) on the 
availability of maternal health home services, 
including the process by which such providers 
can refer individuals to a designated provider, 
team of health care professionals operating such 
a provider, or health team for the purpose of 
establishing a maternal health home through 
which such individuals may receive such serv-
ices; and 
‘‘(B) a description of the State’s process 
for educating individuals on the availability of 
such services. 
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‘‘(4) CONFIDENTIALITY.—A State with a State 
plan amendment approved under this section shall 
establish confidentiality protections to ensure, at a 
minimum, that the State does not disclose any iden-
tifying information with respect to any specific mor-
tality case (including pursuant to the reporting of 
information required under subsection (d)(2)(F)). 
‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed— 
‘‘(1) to require an eligible individual to enroll 
in, or prohibit an eligible individual from disenrolling 
at any time from, a maternal health home under this 
section; or 
‘‘(2) to require a designated provider, team of 
health professionals, or health team to act as a ma-
ternal health home and provide services in accord-
ance with this section if the designated provider, 
team of health professionals, or health team does not 
voluntarily agree to act as a maternal health home. 
‘‘(g) DEFINITIONS.—In this section: 
‘‘(1) DESIGNATED PROVIDER.—The term ‘des-
ignated provider’ means a physician, clinical practice 
or clinical group practice, rural health clinic, free-
standing birth center, community health center, ob-
stetrician gynecologist, midwife who meets at a min-
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imum the international definition of the midwife and 
global standards for midwifery education as estab-
lished by the International Confederation of Mid-
wives, or any other health care entity or provider de-
termined by the State and approved by the Sec-
retary to be qualified to act as a maternal health 
home. 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual eligible for medical 
assistance under the State plan or under a waiver of 
such plan who— 
‘‘(A) is pregnant or in the postpartum pe-
riod that begins on the last day of the preg-
nancy and ends on the last day of the month 
in which the 12-month period (beginning on the 
last day of the pregnancy of the individual) 
ends (or, if the State provides for a longer pe-
riod of postpartum coverage period under such 
plan or waiver, on the last day of such longer 
period); and 
‘‘(B) is not enrolled in a health home 
under section 1945 or 1945A. 
‘‘(3) HEALTH TEAM.—The term ‘health team’ 
has the meaning given such term for purposes of 
section 3502 of Public Law 111–148. 
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‘‘(4) MATERNAL
HEALTH
HOME.—The term 
‘maternal health home’ means a designated provider 
(including a provider that operates in coordination 
with a team of health care professionals), or a health 
team selected by a State to provide maternal health 
home services to pregnant and postpartum individ-
uals. 
‘‘(5) MATERNAL HEALTH HOME SERVICES.— 
‘‘(A) IN
GENERAL.—The term ‘maternal 
health home services’ means comprehensive and 
timely high-quality services described in sub-
paragraph (B) that are provided by a des-
ignated provider, a team of health professionals 
operating with such a provider, or a health 
team. 
‘‘(B) SERVICES DESCRIBED.—The services 
described in this subparagraph shall include— 
‘‘(i) a standardized risk assessment 
for all participants to determine needs; 
‘‘(ii) comprehensive care management; 
‘‘(iii) care coordination and health 
promotion; 
‘‘(iv) comprehensive transitional care, 
including arranging appropriate follow-up, 
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for individuals transitioning from inpatient 
care to other settings; 
‘‘(v) individual and family support (in-
cluding authorized representatives); 
‘‘(vi) making referrals to other med-
ical, community, and social support serv-
ices, if relevant; and 
‘‘(vii) the use of health information 
technology to link services and coordinate 
care, to the extent practicable. 
‘‘(6) STANDARDIZED RISK ASSESSMENT.—The 
term ‘standardized risk assessment’ means an as-
sessment to determine the needs of an eligible indi-
vidual, and shall include an assessment of medical, 
obstetric, behavioral health, and social needs per-
formed at the initial prenatal or postpartum visit. 
‘‘(7) TEAM OF HEALTH PROFESSIONALS.—The 
term ‘team of health professionals’ means a team of 
health professionals (as described in the State plan 
amendment under this section) that may— 
‘‘(A) include physicians, midwives who 
meet at a minimum the international definition 
of the midwife and global standards for mid-
wifery education as established by the Inter-
national Confederation of Midwives, nurses, 
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nurse care coordinators, nutritionists, social 
workers, doulas, behavioral health professionals, 
community health workers, translators and in-
terpreters, and other professionals determined 
to be appropriate by the State; 
‘‘(B) a health care entity or individual who 
is designated to coordinate such a team; and 
‘‘(C) provide care at a facility that is free-
standing, virtual, or based at a hospital, free-
standing birth center, community health center, 
community mental health center, rural clinic, 
clinical practice or clinical group practice, aca-
demic health center, children’s hospital, or any 
health care entity determined to be appropriate 
by the State and approved by the Secretary.’’. 
PART 3—TERRITORIES 
SEC. 30731. INCREASING MEDICAID CAP AMOUNTS AND 
THE FEDERAL MEDICAL ASSISTANCE PER-
CENTAGE FOR THE TERRITORIES. 
(a) 
CAP
AMOUNT
ADJUSTMENTS.—Section 
1108(g)(2) of the Social Security Act (42 U.S.C. 
1308(g)(2)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i)— 
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‘‘(iv) 
for 
fiscal 
year 
2022, 
$135,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000;’’; 
(3) in subparagraph (C)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
(C) by adding at the end the following: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$140,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000;’’; 
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(4) in subparagraph (D)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
(C) in clause (iii), by striking ‘‘and’’ at the 
end; and 
(D) by adding at the end the following new 
clauses: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$70,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000; and’’; 
(5) in subparagraph (E)— 
(A) in clause (i), by striking ‘‘except as 
provided in clause (ii),’’ and inserting ‘‘for each 
of fiscal years 1999 through 2019,’’; 
(B) in clause (ii), by striking ‘‘and’’ at the 
end; 
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(C) in clause (iii), by striking the period 
and inserting a semicolon; and 
(D) by adding at the end the following: 
‘‘(iv) 
for 
fiscal 
year 
2022, 
$90,000,000; and 
‘‘(v) for fiscal year 2023 and each 
subsequent year, the sum of the amount 
provided in this subsection for the pre-
ceding fiscal year, increased by the per-
centage increase described in subparagraph 
(A)(iv) for the preceding year, rounded to 
the nearest $10,000.’’; and 
(6) by striking the flush matter following sub-
paragraph (E). 
(b) FMAP ADJUSTMENTS.—Section 1905(ff) of the 
Social Security Act (42 U.S.C. 1396d(ff)) is amended— 
(1) by redesignating paragraphs (1) through 
(3) as subparagraphs (A) through (C), respectively, 
and adjusting the margins accordingly; 
(2) by striking ‘‘Notwithstanding’’ and insert-
ing the following: 
‘‘(1) IN GENERAL.—Notwithstanding’’; 
(3) in paragraph (1), as so inserted— 
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(A) in the matter preceding subparagraph 
(A), as so redesignated, by inserting ‘‘para-
graph (2) and’’ after ‘‘subject to’’; 
(B) in subparagraph (B), as so redesig-
nated— 
(i) by striking ‘‘December 3, 2021,’’ 
and inserting ‘‘September 30, 2021’’; and 
(ii) by striking ‘‘and’’ at the end; 
(C) in subparagraph (C), as so redesig-
nated, by striking ‘‘December 3, 2021,’’ and in-
serting ‘‘September 30, 2021’’; 
(D) by adding at the end the following: 
‘‘(D) for fiscal year 2022 and each subse-
quent fiscal year, the Federal medical assist-
ance percentage for the Virgin Islands, Guam, 
the Northern Mariana Islands, and American 
Samoa shall be equal to 83 percent; 
‘‘(E) for fiscal year 2022, the Federal 
medical assistance percentage for Puerto Rico 
shall be equal to 76 percent; and 
‘‘(F) for fiscal year 2023 and each subse-
quent fiscal year, the Federal medical assist-
ance percentage for Puerto Rico shall be equal 
to 83 percent.’’; and 
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(4) by adding at the end the following new 
paragraph: 
‘‘(2) SPECIAL RULE FOR PUERTO RICO RELAT-
ING TO ESTABLISHING A PAYMENT FLOOR.— 
‘‘(A) IN GENERAL.—For each fiscal quar-
ter (beginning with the first fiscal quarter be-
ginning on or after the date of the enactment 
of this paragraph), Puerto Rico’s State plan (or 
waiver of such plan) shall establish a reimburse-
ment floor, implemented through a directed 
payment arrangement plan, for physician serv-
ices that are covered under the Medicare part 
B fee schedule in the Puerto Rico locality estab-
lished under section 1848(b) that is not less 
than 70 percent of the payment that would 
apply to such services if they were furnished 
under part B of title XVIII during such fiscal 
quarter. 
‘‘(B) APPLICATION TO MANAGED CARE.— 
In determining whether Puerto Rico has estab-
lished a reimbursement floor under a directed 
payment arrangement plan that satisfies the re-
quirements of subparagraph (A) for a fiscal 
quarter occurring during fiscal year 2022 or a 
subsequent fiscal year— 
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‘‘(i) the Secretary shall disregard pay-
ments made under sub-capitated arrange-
ments for services such as primary care 
case management; and 
‘‘(ii) if the reimbursement floor for 
physician services applicable under a man-
aged care contract satisfies the require-
ments of subparagraph (A) for a fiscal 
quarter occurring during a year in which 
the contract is entered into or renewed, 
such reimbursement floor shall be deemed 
to satisfy such requirements for each sub-
sequent fiscal quarter occurring during 
such year and for each fiscal quarter oc-
curring during the subsequent fiscal year. 
‘‘(C) FMAP REDUCTION FOR FAILURE TO 
ESTABLISH PAYMENT FLOOR.— 
‘‘(i) IN GENERAL.—In the case that 
the Secretary determines that Puerto Rico 
has failed to meet the requirement of sub-
paragraph (A) with respect to a fiscal 
quarter, the Federal medical assistance 
percentage otherwise determined under 
this subsection for Puerto Rico shall be re-
duced for such quarter by the applicable 
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number of percentage points described in 
clause (ii). 
‘‘(ii) APPLICABLE NUMBER OF PER-
CENTAGE POINTS.—For purposes of clause 
(i), the applicable number of percentage 
points described in this clause is, with re-
spect to a fiscal quarter, the following: 
‘‘(I) In the case no reduction was 
made under this subparagraph for the 
preceding fiscal quarter, 0.5 percent-
age points. 
‘‘(II) In the case a reduction was 
made under this subparagraph for the 
preceding fiscal quarter, the number 
of percentage points of such reduction 
for such preceding fiscal quarter, plus 
0.25 percentage points, except that in 
no case may the application of this 
subclause result in a reduction of 
more than 5 percentage points.’’. 
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PART 4—OTHER MEDICAID 
SEC. 30741. INVESTMENTS TO ENSURE CONTINUED ACCESS 
TO 
HEALTH 
CARE 
FOR 
CHILDREN 
AND 
OTHER INDIVIDUALS. 
(a) PROVIDING FOR 1 YEAR OF CONTINUOUS ELIGI-
BILITY FOR CHILDREN.— 
(1) UNDER THE MEDICAID PROGRAM.— 
(A) IN GENERAL.—Section 1902(e) of the 
Social Security Act (42 U.S.C. 1396a(e)) is 
amended— 
(i) in paragraph (12), by inserting 
‘‘before the date that is one year after the 
date of the enactment of paragraph (17)’’ 
after ‘‘subsection (a)(10)(A)’’; and 
(ii) by adding at the end following 
new paragraph: 
‘‘(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-
gible for benefits under a State plan (or waiver of 
such plan) approved under subsection (a)(10)(A) 
shall remain eligible for such benefits until the ear-
lier of— 
‘‘(A) the end of the 12-month period begin-
ning on the date of such determination; 
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‘‘(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.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the amendments made by subpara-
graph (A)(ii) shall take effect one year 
after the date of enactment of this Act. 
(ii) EXCEPTION FOR STATE LEGISLA-
TION.—In the case of a State plan under 
title XIX of the Social Security Act (42 
U.S.C. 1396 through 1396w-6) 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 sub-
paragraph (A)(ii), the plan shall not be re-
garded 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 legislature 
that begins after the date of the enactment 
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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. 
(2) UNDER THE CHILDREN’S HEALTH INSUR-
ANCE PROGRAM.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (K) 
through (T) as subparagraphs (L) through (U), 
respectively; and 
(B) by inserting after subparagraph (J) 
the following new subparagraph: 
‘‘(K) Section 1902(e)(17) (relating to 1 
year of continuous eligibility for children).’’. 
(b) REVISIONS TO TEMPORARY INCREASE OF MED-
ICAID FMAP UNDER THE FAMILIES FIRST CORONAVIRUS 
RESPONSE ACT.—Section 6008 of the Families First 
Coronavirus Response Act (42 U.S.C. 1396d note) is 
amended— 
(1) in subsection (a)— 
(A) by striking ‘‘IN GENERAL.—Subject 
to’’ and inserting ‘‘TEMPORARY INCREASE.— 
‘‘(1) IN GENERAL.—Subject to’’; 
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(B) in the paragraph (1) inserted by sub-
paragraph (A)— 
(i) by striking ‘‘the last day of the cal-
endar quarter in which the last day of such 
emergency period occurs’’ and inserting 
‘‘September 30, 2022’’; and 
(ii) 
by 
striking 
‘‘6.2 
percentage 
points’’ and inserting ‘‘the number of per-
centage points specified in paragraph (2) 
with respect to such calendar quarter’’; 
and 
(C) by adding at the end the following new 
paragraph: 
‘‘(2) PERCENTAGE
POINTS
SPECIFIED.—For 
purposes of paragraph (1), the number of percent-
age points specified in this paragraph is— 
‘‘(A) 6.2 percentage points with respect to 
each calendar quarter occurring during the pe-
riod beginning on the first day of the emer-
gency period defined in paragraph (1)(B) of 
section 1135(g) of the Social Security Act (42 
U.S.C. 1320b-5(g)) and ending March 31, 
2022; 
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‘‘(B) 3.0 percentage points with respect to 
the calendar quarter beginning on April 1, 
2022, and ending on June 30, 2022; and 
‘‘(C) 1.5 percentage points with respect to 
the calendar quarter beginning on July 1, 2022, 
and ending on September 30, 2022.’’; 
(2) in subsection (b)(3)— 
(A) by striking ‘‘the State fails’’ and in-
serting ‘‘subject to subsection (f), the State 
fails’’; 
(B) by striking ‘‘and ending the last day of 
the month in which the emergency period de-
scribed in subsection (a) ends’’ and inserting 
‘‘and ending on March 31, 2022,’’; and 
(C) by striking ‘‘through the end of the 
month in which such emergency period ends’’ 
and inserting ‘‘through September 30, 2022,’’; 
and 
(3) by adding at the end the following new sub-
section: 
‘‘(f) SPECIAL RULE FOR ENROLLMENTS AS OF APRIL 
1, 2022.—For calendar quarters during the period de-
scribed in subsection (a) that begin on or after April 1, 
2022, a State described in such subsection may, in accord-
ance with paragraph (3), terminate coverage for an indi-
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vidual who is determined to be no longer eligible for med-
ical assistance and who has been enrolled for at least 12 
consecutive months under the State plan of such State 
under title XIX of the Social Security Act (42 U.S.C. 
1396) (or waiver of such plan), and such State shall not 
be ineligible for the increase to the Federal medical assist-
ance percentage of the State described in such subsection 
on the basis that the State is in violation of the require-
ment of subsection (b)(3), if the State, with respect to 
such terminations of coverage conducted through Sep-
tember 30, 2022, for such individuals, is in compliance 
with each of the following: 
‘‘(1) The State shall conduct such eligibility re-
determinations, with respect to such an individual, 
in accordance with the provisions of section 435.916 
of title 42 of the Code of Federal Regulations (or 
any successor regulation) and the provisions of sec-
tion 1943 of the Social Security Act, as applicable. 
‘‘(2) Prior to terminating coverage for an indi-
vidual, the State shall undertake a good faith effort 
to ensure that the State has contact information (in-
cluding an up-to-date mailing address, phone num-
ber, or email address) for such individuals by coordi-
nating with Medicaid managed care organizations 
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(where applicable), and other applicable State health 
and human services agencies. 
‘‘(3) The State may not disenroll from the 
State plan (or waiver) such an individual determined 
ineligible pursuant to such a redetermination for 
medical assistance under the State plan (or waiver) 
on the basis of returned mail unless— 
‘‘(A) there have been at least two failed at-
tempts to contact such individual through at 
least 2 modalities; and 
‘‘(B) after the second attempt, the indi-
vidual had 30 days notice, through at least 2 
modalities, before such disenrollment takes ef-
fect. 
‘‘(4) The State may not initiate eligibility rede-
terminations for more than 1/12 of individuals en-
rolled in the State plan (or waiver) with respect to 
any month during the period beginning on April 1, 
2022, and ending on September 30, 2022. 
‘‘(5) The State shall submit to the Secretary 
monthly reports during the period described in sub-
section (a) that begin on or after April 1, 2022 
which the State receives an increase pursuant to 
such subsection period on the activities of the State, 
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including, with respect to the period for which the 
report is submitted— 
‘‘(A) the number of eligibility renewals ini-
tiated, beneficiaries renewed, and individuals 
whose eligibility was terminated; 
‘‘(B) the number of such cases in which 
eligibility for medical assistance under the State 
plan (or waiver) were so terminated due to the 
individual’s failure to return a renewal form or 
other information needed by the state to make 
an eligibility determination; 
‘‘(C) the number of such cases in which 
eligibility for medical assistance under the State 
plan (or waiver) were so terminated pursuant to 
such a redetermination due to a known change 
in circumstance; 
‘‘(D) the number of individuals whose cov-
erage was terminated pursuant to such a rede-
termination whose accounts were, during such 
period, transitioned to the Exchange, CHIP, or 
basic health program; and 
‘‘(E) with respect to eligibility redeter-
minations, the daily average volume, wait times, 
and abandonment rate (as determined by the 
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Secretary) for each call center during such 
month.’’. 
(c) MEDICAL ASSISTANCE UNDER MEDICAID FOR IN-
MATES DURING 30-DAY PERIOD PRECEDING RELEASE.— 
(1) IN
GENERAL.—The subdivision (A) fol-
lowing paragraph (31) of section 1905(a) of the So-
cial 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 two years 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 an inmate of a pub-
lic institution’’ after ‘‘medical institution’’. 
(2) CONFORMING
AMENDMENTS
IN
TITLE 
XIX.—Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended— 
(A) in paragraph (74), by striking at the 
end ‘‘and’’; and 
(B) in paragraph (84)— 
(i) in subparagraph (A), by inserting 
‘‘, except, beginning on the first day of the 
first fiscal year quarter that begins two 
years after the date of the enactment of 
the Act titled ‘An Act to provide for rec-
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onciliation pursuant to title II of S. Con. 
Res. 14’, the State may not suspend cov-
erage during the 30-day period preceding 
the date of release of the juvenile’’ after 
‘‘during the period the juvenile is such an 
inmate’’; and 
(ii) in subparagraph (C), by striking 
‘‘upon release’’ and inserting ‘‘30 days 
prior to release’’. 
(3) CONFORMING AMENDMENT IN TITLE XXI.— 
Section 2110(b)(2) of the Social Security Act (42 
U.S.C. 1397jj(b)(2))— 
(A) in subparagraph (A), by striking at the 
end ‘‘or’’; 
(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) except, beginning on the first day of 
the first fiscal year quarter that begins two 
years after the date of the enactment of the Act 
titled ‘An Act to provide for reconciliation pur-
suant to title II of S. Con. Res. 14,’ except dur-
ing the 30-day period preceding the date of re-
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lease of such child from such public institu-
tion.’’. 
(d) EXTENSION OF CERTAIN PROVISIONS.— 
(1) EXPRESS LANE ELIGIBILITY OPTION.—Sec-
tion 1902(e)(13) of the Social Security Act (42 
U.S.C. 1396a(e)(13)) is amended by striking sub-
paragraph (I). 
(2) CONFORMING
AMENDMENTS
FOR
ASSUR-
ANCE OF AFFORDABILITY STANDARD FOR CHILDREN 
AND FAMILIES.—Section 1902(gg)(2) of the Social 
Security Act (42 U.S.C. 1396a(gg)(2)) is amend-
ed— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(B) by striking ‘‘through September 30’’ 
and all that follows through ‘‘ends on Sep-
tember 30, 2027’’ and inserting ‘‘(but begin-
ning on October 1, 2019,’’. 
(e) EXPANSION OF COMMUNITY MENTAL HEALTH 
SERVICES DEMONSTRATION PROGRAM.— 
(1) IN
GENERAL.—Section 223 of the Pro-
tecting Access to Medicare Act of 2014 (42 U.S.C. 
1396a note) is amended— 
(A) in subsection (c), by adding at the end 
the following new paragraph: 
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‘‘(3) ADDITIONAL PLANNING GRANTS.—In addi-
tion to the planning grants awarded under para-
graph (1), the Secretary shall award planning grants 
to States (other than States selected to conduct 
demonstration programs under paragraph (1) or (8) 
of subsection (d)) for the purpose of developing pro-
posals to participate in time-limited demonstration 
programs described in subsection (d).’’; 
(B) in subsection (d)— 
(i) in paragraph (3), by striking 
‘‘Subject to paragraph (8)’’ and inserting 
‘‘Subject to paragraphs (8) and (9)’’; 
(ii) in paragraph (5)(C)(iii)(II), by in-
serting ‘‘or paragraph (9)’’ after ‘‘para-
graph (8)’’; 
(iii) in paragraph (7)— 
(I) in subparagraph (A), by in-
serting ‘‘through the year in which 
the last demonstration under this sec-
tion ends’’ after ‘‘annually there-
after’’; and 
(II) in subparagraph (B)— 
(aa) by striking ‘‘December 
31, 2021’’ and inserting ‘‘March 
31, 2026’’; 
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(bb) 
by 
striking 
‘‘rec-
ommendations concerning’’ and 
all that follows through the pe-
riod and inserting ‘‘recommenda-
tions concerning whether and 
how the demonstration programs 
under this section should be 
modified.’’; and 
(cc) by adding at the end 
the 
following 
new 
sentence: 
‘‘Such recommendations shall be 
based on data collected from 
States selected to conduct dem-
onstration programs under para-
graph (1) and, to the extent 
available, data collected from 
States selected to conduct dem-
onstration programs under para-
graphs (8) and (9).’’; and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(9) FURTHER ADDITIONAL PROGRAMS.— 
‘‘(A) IN
GENERAL.—In addition to the 
States selected under paragraphs (1) and (8) 
and without regard to paragraph (4), the Sec-
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retary shall select any State that meets the re-
quirements described in subparagraph (B) to 
conduct a demonstration program that meets 
the requirements of this subsection for 2 years. 
‘‘(B) REQUIREMENTS.—The requirements 
described in this subparagraph with respect to 
a State are that the State— 
‘‘(i) was awarded a planning grant 
under paragraph (1) or (3) of subsection 
(c); and 
‘‘(ii) submits an application (in addi-
tion to any application that the State may 
have previously submitted under this sec-
tion) that meets the requirements of para-
graph (2)(B). 
‘‘(C) 
REQUIREMENTS
FOR
SELECTED 
STATES.—The 
requirements 
applicable 
to 
States selected under paragraph (8) pursuant 
to subparagraph (C) of such paragraph shall 
apply in the same manner to States selected 
under this paragraph.’’; 
(C) in subsection (e), by amending para-
graph (4) to read as follows: 
‘‘(4) STATE.—The term State means each of 
the 50 States, the District of Columbia, Puerto Rico, 
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the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa.’’; and 
(D) in subsection (f)(1)— 
(i) in subparagraph (A), by striking ‘‘; 
and’’ and inserting a semicolon; 
(ii) in subparagraph (B), by striking 
the 
period 
and 
inserting 
‘‘, 
and 
$40,000,000 for fiscal year 2022; and’’; 
and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) for purposes of updating the criteria 
under subsection (a) as needed for certified 
community behavioral health clinics and car-
rying out subsections (c)(3), (d)(7), and (d)(9) 
(including the provision of technical assistance 
to States applying for planning grants under 
subsection (c)(3) and conducting demonstration 
projects under this section), $5,000,000 for fis-
cal year 2022.’’. 
(2) EXCLUSION
OF
AMOUNTS
ATTRIBUTABLE 
TO INCREASED FMAP FROM TERRITORIAL CAPS.— 
Section 1108 of the Social Security Act (42 U.S.C. 
1308) is amended— 
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(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsections 
(g) and (h)’’ and inserting ‘‘subsections (g), 
(h), and (i)’’; and 
(B) by adding at the end the following: 
‘‘(i) EXCLUSION FROM CAPS OF AMOUNTS ATTRIB-
UTABLE TO ENHANCED FMAP FOR COMMUNITY MENTAL 
HEALTH SERVICES.—Any additional amount paid to 
Puerto Rico, the Virgin Islands, Guam, the Northern Mar-
iana Islands, and American Samoa for expenditures for 
medical assistance that is attributable to an enhanced 
Federal medical assistance percentage applicable to such 
expenditures under section 223(d)(5) of the Protecting 
Access to Medicare Act of 2014 shall not be taken into 
account for purposes of applying payment limits under 
subsections (f) and (g).’’. 
(f) MAKING PERMANENT A STATE OPTION TO PRO-
VIDE QUALIFYING COMMUNITY-BASED MOBILE CRISIS 
INTERVENTION SERVICES.—Section 1947 of the Social 
Security Act (42 U.S.C. 1396w–6) is amended— 
(1) in subsection (a), by striking ‘‘during the 5- 
year period’’; 
(2) in subsection (c), by striking ‘‘occurring 
during the period described in subsection (a) that a 
State’’ and inserting ‘‘in which a State provides 
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medical assistance for qualifying community-based 
mobile crisis intervention services under this section 
and’’; and 
(3) in subsection (d)(2)— 
(A) in subparagraph (A), by striking ‘‘for 
the fiscal year preceding the first fiscal quarter 
occurring during the period described in sub-
section (a)’’ and inserting ‘‘for the fiscal year 
preceding the first fiscal quarter in which the 
State provides medical assistance for qualifying 
community-based 
mobile 
crisis 
intervention 
services under this section’’; and 
(B) in subparagraph (B), by striking ‘‘oc-
curring during the period described in sub-
section (a)’’ and inserting ‘‘occurring during a 
fiscal quarter’’. 
(g) EXTENSION OF 100 PERCENT FEDERAL MED-
ICAL ASSISTANCE PERCENTAGE
FOR URBAN INDIAN 
HEALTH
ORGANIZATIONS
AND
NATIVE
HAWAIIAN 
HEALTH CARE SYSTEMS.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 
is amended— 
(1) by striking ‘‘for the 8 fiscal year quarters 
beginning with the first fiscal year quarter beginning 
after the date of the enactment of the American 
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Rescue Plan Act of 2021’’ and inserting ‘‘for the pe-
riod of the 16 fiscal year quarters that begins on 
April 1, 2021’’; and 
(2) by striking ‘‘such 8 fiscal year quarters’’ 
and inserting ‘‘such period of 16 fiscal year quar-
ters’’. 
(h) ENSURING ACCURATE PAYMENTS
TO PHAR-
MACIES UNDER MEDICAID.— 
(1) IN GENERAL.—Section 1927(f) of the Social 
Security Act (42 U.S.C. 1396r–8(f)) is amended— 
(A) by striking ‘‘and’’ after the semicolon 
at the end of paragraph (1)(A)(i) and all that 
precedes it through ‘‘(1)’’ and inserting the fol-
lowing: 
‘‘(1) DETERMINING PHARMACY ACTUAL ACQUI-
SITION COSTS.—The Secretary shall conduct a sur-
vey of retail community pharmacy drug prices in the 
50 States and the District of Columbia, to determine 
the national average drug acquisition cost, as fol-
lows: 
‘‘(A) USE
OF
VENDOR.—The Secretary 
may contract services for— 
‘‘(i) with respect to retail community 
pharmacies, the determination of retail 
survey prices of the national average drug 
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acquisition cost for covered outpatient 
drugs based on a monthly survey of such 
pharmacies, net of all discounts and re-
bates (to the extent any information with 
respect to such discounts and rebates is 
available), the average reimbursement re-
ceived for such drugs by such pharmacies 
from all sources of payment and, to the ex-
tent available, the usual and customary 
charges to consumers for such drugs; 
and’’; 
(B) by adding at the end of paragraph (1) 
the following: 
‘‘(F) SURVEY REPORTING.—A State shall 
require that any retail community pharmacy in 
the State that receives any payment, reimburse-
ment, administrative fee, discount, or rebate re-
lated to the dispensing of covered outpatient 
drugs to individuals receiving benefits under 
this title or title XXI, regardless of whether 
such payment, fee, discount, or rebate is re-
ceived from the State or a managed care entity 
directly or from a pharmacy benefit manager or 
another entity that has a contract with the 
State or a managed care entity or other speci-
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fied entity (as such terms are defined in section 
1903(m)(9)(D)), shall respond to surveys of re-
tail prices conducted under this subsection with 
the specific information requested by the ven-
dor. 
‘‘(G) SURVEY INFORMATION.—Information 
on retail community actual acquisition prices 
obtained under this paragraph shall be made 
publicly available and shall include at least the 
following: 
‘‘(i) The monthly response rate of the 
survey, including a list of pharmacies not 
in compliance with subparagraph (F) and 
the identification numbers for such phar-
macies. 
‘‘(ii) The sampling frame and number 
of pharmacies sampled monthly. 
‘‘(iii) 
Characteristics 
of 
reporting 
pharmacies, including type (such as inde-
pendent or chain), geographic or regional 
location, and dispensing volume. 
‘‘(iv) Reporting of a separate national 
average drug acquisition cost for each drug 
for independent retail pharmacies and 
chain pharmacies. 
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‘‘(v) Information on price concessions 
including on and off invoice discounts, re-
bates, and other price concessions. 
‘‘(vi) Information on average profes-
sional dispensing fees paid. 
‘‘(H) PENALTIES.— 
‘‘(i) FAILURE TO PROVIDE TIMELY IN-
FORMATION.—A retail community phar-
macy that knowingly fails to respond to a 
survey conducted under this subsection on 
a timely basis may be subject to a civil 
monetary penalty in an amount not to ex-
ceed $10,000 for each day in which such 
information has not been provided. A retail 
community pharmacy shall not be subject 
to such penalty if the pharmacy makes a 
good faith effort to provide the information 
requested by the survey on a timely basis. 
‘‘(ii) FALSE INFORMATION.—A retail 
community pharmacy that knowingly pro-
vides false information in response to a 
survey conducted under this subsection 
may be subject to a civil money penalty in 
an amount not to exceed $100,000 for 
each item of false information.’’; and 
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(C) in paragraph (4), by inserting ‘‘, and 
$7,000,000 for fiscal year 2023 and each fiscal 
year thereafter,’’ after ‘‘2010’’. 
(2) CONDITION FOR FEDERAL FINANCIAL PAR-
TICIPATION.—Section 1903(i)(10) of the Social Se-
curity Act (42 U.S.C. 1396b(i)(10)) is amended— 
(A) in subparagraph (D), by striking 
‘‘and’’ after the semicolon; 
(B) in subparagraph (E), by striking ‘‘or’’ 
after the semicolon and inserting ‘‘and’’; and 
(C) by inserting after subparagraph (E), 
the following new subparagraph: 
‘‘(F) with respect to any amount expended for 
reimbursement to a retail community pharmacy 
under this title unless the State requires the retail 
community pharmacy to respond to surveys of retail 
prices conducted under section 1927(f) in accord-
ance with paragraph (1)(F) of such section; or’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this section take effect on the 1st day of the 1st 
quarter that begins on or after the date that is 18 
months after the date of enactment of this Act. 
(i) FUNDING FOR IMPLEMENTATION AND ADMINIS-
TRATION.—In addition to amounts otherwise available, 
there is appropriated to the Secretary, for fiscal year 
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2022, to be available until expended, out of any money 
in the Treasury not otherwise appropriated, $20,000,000, 
to provide technical assistance and guidance and cover ad-
ministrative costs associated with implementing the 
amendments made by this part and part 2. 
PART 5—MAINTENANCE OF EFFORT 
SEC. 30751. ENCOURAGING CONTINUED ACCESS AFTER THE 
END OF THE PUBLIC HEALTH EMERGENCY. 
Section 6008 of the Families First Coronavirus Re-
sponse Act (42 U.S.C. 1396d note), as amended by section 
30741(b), is further amended— 
(1) by redesignating the second subsection (d) 
added by section 11 of division X of Public Law 
116–260 as subsection (e); and 
(2) by adding at the end the following new sub-
section: 
‘‘(g) ENCOURAGING CONTINUED ACCESS AFTER THE 
END OF THE PUBLIC HEALTH EMERGENCY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
if, between October 1, 2022 and December 31, 
2025, a State puts into effect for any calendar quar-
ter occurring during such period eligibility stand-
ards, methodologies, or procedures for individuals 
(except individuals described in subparagraph (D) of 
section 1902(e)(14)) who are applying for or receiv-
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ing medical assistance under the State plan of such 
State under title XIX of the Social Security Act (42 
U.S.C. 1396 through 1396w-6) (including any waiv-
er under such title or section 1115 of such Act (42 
U.S.C. 1315)) that are more restrictive than the eli-
gibility standards, methodologies, or procedures, re-
spectively, under the State plan (or waiver of such 
plan) that are in effect on October 1, 2021, the Fed-
eral medical assistance percentage otherwise deter-
mined under section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)) for that State shall be re-
duced by 3.1 percentage points for such calendar 
quarter. 
‘‘(2) NONAPPLICATION.—During the period de-
scribed in paragraph (1), at the option of the State, 
the condition under such paragraph may not apply 
to the State with respect to nonpregnant, non-
disabled adults who are eligible for medical assist-
ance under the State plan (or waiver such plan) 
whose income exceeds 133 percent of the poverty 
line (as defined in section 2110(c)(5)) applicable to 
a family of the size involved if, on or after December 
31, 2022, the State had certified or certifies to the 
Secretary that, with respect to the State fiscal year 
during which the certification is made, the State has 
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a budget deficit, or with respect to the succeeding 
State fiscal year, the State is projected to have a 
budget deficit. Upon submission of such a certifi-
cation to the Secretary, the condition under para-
graph (1) shall not apply to the State with respect 
to any remaining portion of the period described in 
the preceding sentence.’’. 
Subtitle G—Children’s Health 
Insurance Program 
SEC. 30801. INVESTMENTS TO STRENGTHEN CHIP. 
(a) 
PERMANENT
EXTENSION
OF
CHILDREN’S 
HEALTH INSURANCE PROGRAM.— 
(1) 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).’’. 
(2) ALLOTMENTS.— 
(A) IN GENERAL.—Section 2104(m) of the 
Social Security Act (42 U.S.C. 1397dd(m)) is 
amended— 
(i) in paragraph (2)(B)(i), by striking 
‘‘, 2023, and 2027’’ and inserting ‘‘and 
2023’’; 
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(ii) in paragraph (5)— 
(I) by striking ‘‘(10), or (11)’’ 
and inserting ‘‘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’’; 
(iii) in paragraph (7)— 
(I) in subparagraph (A), by strik-
ing ‘‘and ending with fiscal year 
2027,’’; and 
(II) in the flush left matter at 
the end, by striking ‘‘or fiscal year 
2026’’ and inserting ‘‘fiscal year 
2026, or a subsequent even-numbered 
fiscal year’’; 
(iv) in paragraph (9)— 
(I) by striking ‘‘(10), or (11)’’ 
and inserting ‘‘or (10)’’; and 
(II) by striking ‘‘2023, or 2027,’’ 
and inserting ‘‘or 2023’’; and 
(v) by striking paragraph (11). 
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(B) CONFORMING
AMENDMENT.—Section 
50101(b)(2) of the Bipartisan Budget Act of 
2018 (Public Law 115–123) is repealed. 
(b) OTHER RELATED CHIP POLICIES.— 
(1) 
PEDIATRIC
QUALITY
MEASURES
PRO-
GRAM.—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 a semicolon; 
and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(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 each 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, as published by the Bureau of 
Labor Statistics) rounded to the nearest 
$100,000 over such previous fiscal year, for the 
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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 
Security Act (42 U.S.C. 1397ee(d)(3)) is amended— 
(A) in the paragraph heading, by striking 
‘‘THROUGH SEPTEMBER 30, 2027’’; and 
(B) in subparagraph (A)— 
(i) in the matter preceding clause 
(i)— 
(I) by striking ‘‘During the pe-
riod that begins on the date of enact-
ment of the Patient Protection and 
Affordable Care Act and ends on Sep-
tember 30, 2027’’ and inserting ‘‘Be-
ginning on the date of the enactment 
of the Patient Protection and Afford-
able Care Act’’; 
(II) by striking ‘‘During the pe-
riod 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 
sentences shall not be construed as 
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preventing a State during any such 
periods from’’ and inserting ‘‘The pre-
ceding sentences shall not be con-
strued as preventing a State from’’; 
(ii) in clause (i), by striking the semi-
colon at the end and inserting a period; 
(iii) by striking clauses (ii) and (iii); 
and 
(iv) as amended by subclause (i)(III), 
by striking ‘‘as preventing a State from’’ 
and all that follows through ‘‘applying eli-
gibility standards’’ and inserting ‘‘as pre-
venting a State from applying eligibility 
standards’’. 
(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 
‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and 
inserting ‘‘AFTER FISCAL YEAR 2008’’; and 
(B) in subparagraph (A), by striking ‘‘for 
any of fiscal years 2009 through 2027’’ and in-
serting ‘‘for any fiscal year after fiscal year 
2008’’. 
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(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 ‘‘dur-
ing the period of fiscal years 2009 through 
2027’’ and inserting ‘‘, beginning with fis-
cal year 2009,’’; 
(ii) in paragraph (2)— 
(I) by striking ‘‘10 percent of 
such amounts’’ and inserting ‘‘10 per-
cent of such amounts for the period or 
the fiscal year for which such amounts 
are appropriated’’; and 
(II) by striking ‘‘during such pe-
riod’’ and inserting ‘‘, during such pe-
riod or such fiscal year,’’; and 
(iii) in paragraph (3), by striking 
‘‘For the period of fiscal years 2024 
through 2027, an amount equal to 10 per-
cent of such amounts’’ and inserting ‘‘Be-
ginning 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 
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(B) in subsection (g)— 
(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: ‘‘, $60,000,000 for 
fiscal years 2028, 2029, and 2030, and for 
each 3 fiscal years after fiscal year 2030, 
the amount appropriated under this sub-
section for the previous fiscal year, in-
creased by the percentage increase in the 
consumer price index for all urban con-
sumers (all items; United States city aver-
age, as published by the Bureau of Labor 
Statistics) 
rounded 
to 
the 
nearest 
$100,000 over such previous fiscal year’’. 
(5) 
CHILD
ENROLLMENT
CONTINGENCY 
FUND.—Section 2104(n) of the Social Security Act 
(42 U.S.C. 1397dd(n)) is amended— 
(A) in paragraph (2)— 
(i) in subparagraph (A)(ii)— 
(I) by striking ‘‘2024 through 
2026’’ and inserting ‘‘beginning with 
fiscal year 2024’’; and 
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(II) by striking ‘‘2023, and 
2027’’ and inserting ‘‘and 2023’’; and 
(ii) 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 
(B) in paragraph (3)(A)— 
(i) by striking ‘‘fiscal years 2024 
through 2026’’ and inserting ‘‘fiscal year 
2024 or any subsequent fiscal year’’; and 
(ii) by striking ‘‘2023, or 2027’’ and 
inserting ‘‘or 2023’’. 
(c) CHIP DRUG REBATES.— 
(1) IN GENERAL.—Section 2107 of the Social 
Security Act (42 U.S.C. 1397gg), as amended by 
section 30721(b)(2), is further amended— 
(A) in subsection (e)(1) by adding at the 
end the following new subparagraph: 
‘‘(V) Beginning January 1, 2024, section 
1927, in accordance with subsection (h) of this 
section, with respect to covered outpatient 
drugs (as defined in section 1927) for which 
child health assistance or pregnancy-related as-
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sistance (as defined in section 2112(d)(1)) is 
provided under the State child health plan, in-
cluding such drugs dispensed to individuals en-
rolled with a managed care organization that 
meets the requirements of subpart L of part 
457 of title 42, Code of Federal Regulations (or 
a successor regulation) if the organization is re-
sponsible for coverage of such drugs.’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(h) DRUG REBATES.—For purposes of subsection 
(e)(1)(V), in applying section 1927— 
‘‘(1) the Secretary shall take such actions as 
are necessary and develop or adapt such processes 
and mechanisms as are necessary, including to re-
port and collect data to bill and track rebates under 
section 1927, as applied pursuant to subsection 
(e)(1)(V) for covered outpatient drugs (as defined in 
such section 1927) for which child health assistance 
or pregnancy-related assistance (as defined in sec-
tion 2112(d)(1)) is provided under the State child 
health plan; 
‘‘(2) the requirements of such section 1927 
shall apply to any drug or biological product de-
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scribed in paragraph (1)(A) of section 1905(ee) that 
is— 
‘‘(A) furnished as child health assistance 
or pregnancy-related assistance under the State 
child health plan; and 
‘‘(B) a covered outpatient drug (as defined 
in section 1927(k), except that, in applying 
paragraph (2)(A) of such section to a drug de-
scribed in such paragraph (1)(A) of such sec-
tion 1905(ee), such drug shall be deemed ‘a 
prescribed drug for purposes of subsection 
(a)(12))’; and 
‘‘(3) in order for payment to be available under 
section 2105 with respect to child health assistance 
or pregnancy-related assistance for covered out-
patient drugs of a manufacturer, the manufacturer 
must have entered into and have in effect a single 
rebate agreement to— 
‘‘(A) provide rebates under section 1927 to 
a State Medicaid program under title XIX as 
well as a State program under this title; and 
‘‘(B) provide such rebates to a State pro-
gram under this title in the same form and 
manner as the manufacturer is required to pro-
vide rebates under an agreement described in 
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section 1927(b) to a State Medicaid program 
under title XIX. 
Nothing in this subsection or subsection (e)(1)(V) 
shall be construed as limiting Federal financial par-
ticipation for prescription drugs and biological prod-
ucts that do not satisfy the definition of a covered 
outpatient drug and for which there is not a rebate 
agreement in effect.’’. 
(2) 
DRUG
REBATE
CONFORMING
AMEND-
MENT.—Section 1927(a)(1) of the Social Security 
Act (42 U.S.C. 1396r–8(a)(1)) is amended in the 
first sentence— 
(A) by striking ‘‘or under part B of title 
XVIII’’ and inserting ‘‘, under part B of title 
XVIII, or, beginning with the first full calendar 
quarter 
with 
respect 
to 
which 
section 
2107(e)(1)(V) applies, under section 2105 with 
respect to child health assistance or pregnancy- 
related assistance under title XXI’’; 
(B) by striking ‘‘a rebate agreement de-
scribed in subsection (b)’’ and inserting ‘‘a sin-
gle rebate agreement described in subsection (b) 
with respect to payment under section 1903(a) 
and, beginning January 1, 2024, title XXI,’’; 
and 
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(C) by inserting ‘‘and including as such 
subsection (b) is applied pursuant to sub-
sections (e)(1)(V) and (h) of section 2107 with 
respect to child health assistance and preg-
nancy-related assistance under a State child 
health plan under title XXI’’ before ‘‘, and 
must meet’’. 
(3) NON-DUPLICATION
OF
REBATES
CON-
FORMING AMENDMENT.—Section 340B(a)(5)(A) of 
the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
256b(a)(5)(A)) is amended— 
(A) in clause (i), by inserting before the 
period the following: ‘‘and shall not request 
payment under title XXI of such Act for child 
health assistance or pregnancy-related assist-
ance (as defined in section 2112(d)(1) of such 
Act) under a State child health plan under title 
XXI of such Act with respect to a drug that is 
subject to an agreement under this section if 
the drug is subject to the payment of a rebate 
to the State under section 1927 of such Act, as 
applied pursuant to subsections (e)(1)(V) and 
(h) of section 2107 of such Act’’; and 
(B) in clause (ii), by inserting ‘‘, including 
as applied pursuant to subsections (e)(1)(V) 
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and (h) of section 2107 of such Act,’’ after ‘‘the 
requirements of section 1927(a)(5)(C) of the 
Social Security Act’’. 
(4) EXCLUSION OF REBATES FROM BEST PRICE 
CONFORMING
AMENDMENT.—Section 
1927(c)(1)(C)(i) of the Social Security Act (42 
U.S.C. 1396r–8(c)(1)(C)(i)) is amended— 
(A) in subclause (V), by striking ‘‘and’’ at 
the end; 
(B) in subclause (VI), by striking the pe-
riod and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subclause: 
‘‘(VII) any rebates paid pursuant 
to section 2107(e)(1)(V).’’. 
(d) STATE OPTION TO EXPAND CHILDREN’S ELIGI-
BILITY FOR CHIP.— 
(1) IN GENERAL.—Section 2110(b)(1)(B)(ii) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397jj(b)(1)(B)(ii)) is amended— 
(A) in subclause (II), by striking ‘‘or’’ at 
the end; 
(B) in subclause (III), by striking ‘‘and’’ 
at the end and inserting ‘‘or’’; and 
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(C) by inserting after subclause (III) the 
following 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’’. 
(2) TREATMENT
OF
TERRITORIES.—Section 
2104(m)(7) of the Social Security Act (42 U.S.C. 
1397dd(m)(7)) is amended— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘the 50 States or the District 
of Columbia’’ and inserting ‘‘a State (including 
the District of Columbia and each common-
wealth and territory)’’; 
(B) in subparagraph (B)(ii), by striking 
‘‘or District’’; and 
(C) in the matter following subparagraph 
(B), by striking each place it occurs ‘‘or Dis-
trict’’ 
(3) REMOVAL OF SUNSET FOR INCREASES IN 
ALLOTMENTS.—Section 2104(m)(7)(A) of the Social 
Security Act (42 U.S.C. 1397dd(m)(7)(A)) is 
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amended by striking ‘‘and ending with fiscal year 
2027,’’. 
(e) FUNDING FOR IMPLEMENTATION AND ADMINIS-
TRATION.—In addition to amounts otherwise available, 
there is appropriated to the Secretary, for fiscal year 
2022, to be available until expended, out of any money 
in the Treasury not otherwise appropriated, $5,000,000, 
to provide technical assistance and guidance and cover ad-
ministrative costs associated with implementing the 
amendments made by this section. 
Subtitle H—Medicare Coverage of 
Hearing Services 
SEC. 30901. PROVIDING COVERAGE FOR HEARING CARE 
UNDER THE MEDICARE PROGRAM. 
(a) PROVISION OF AUDIOLOGY SERVICES BY QUALI-
FIED AUDIOLOGISTS AND QUALIFIED HEARING AID PRO-
FESSIONALS.— 
(1) IN GENERAL.—Section 1861(ll) of the So-
cial Security Act (42 U.S.C. 1395x(ll)) is amend-
ed— 
(A) in paragraph (3)— 
(i) by inserting ‘‘(and, beginning Jan-
uary 1, 2023, such aural rehabilitation and 
treatment services)’’ after ‘‘assessment 
services’’; 
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(ii) by inserting ‘‘, and, beginning on 
January 1, 2023, such hearing assessment 
services furnished by a qualified hearing 
aid professional,’’ after ‘‘by a qualified au-
diologist’’; and 
(iii) by striking ‘‘the audiologist’’ and 
inserting ‘‘the audiologist or qualified hear-
ing aid professional’’; and 
(B) in paragraph (4), by adding at the end 
the following new subparagraph: 
‘‘(C) The term ‘qualified hearing aid profes-
sional’ means, with respect to hearing assessment 
services described in paragraph (3), an individual 
who— 
‘‘(i) is licensed or registered as a hearing 
aid dispenser, hearing aid specialist, hearing in-
strument dispenser, or related professional by 
the State in which the individual furnishes such 
services; and 
‘‘(ii) meets such other requirements as the 
Secretary determines appropriate (including re-
quirements relating to educational certifications 
or accreditations), taking into account any addi-
tional requirements for hearing aid specialists, 
hearing aid dispensers, and hearing instrument 
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dispensers established by Medicare Advantage 
organizations under part C, State plans (or 
waivers of such plans) under title XIX, and the 
group health plans and health insurance issuers 
(as such terms are defined in section 2791 of 
the Public Health Service Act).’’. 
(2) PAYMENT
FOR
QUALIFIED
HEARING
AID 
PROFESSIONALS.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)), as amended 
by section 139101(b), is further amended— 
(A) by striking ‘‘and’’ before ‘‘(EE)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘and (FF) with respect 
to hearing assessment services (as described in 
paragraph (3) of section 1861(ll)) furnished by 
a qualified hearing aid professional (as defined 
in paragraph (4)(C) of such section), the 
amounts paid shall be equal to 80 percent of 
the lesser of the actual charge for such services 
or 85 percent of the amount for such services 
determined under the payment basis determined 
under section 1848’’. 
(b) COVERAGE OF HEARING AIDS.— 
(1) INCLUSION
OF
HEARING
AIDS
AS
PROS-
THETIC DEVICES.—Section 1861(s)(8) of the Social 
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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 January 
1, 2023, to individuals diagnosed with moderately 
severe, severe, or profound 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)) is amended by adding at the 
end the following new paragraphs: 
‘‘(6) PAYMENT ONLY ON AN ASSIGNMENT-RE-
LATED BASIS.—Payment for hearing aids for which 
payment may be made under this part may be made 
only on an assignment-related basis. The provisions 
of section 1842(b)(18)(B) shall apply to hearing aids 
in the same manner as they apply to services fur-
nished by a practitioner described in subsection 
(b)(18)(C). 
‘‘(7) LIMITATIONS FOR HEARING AIDS.—Pay-
ment may be made under this part with respect to 
an individual, with respect to hearing aids furnished 
on or after January 1, 2023— 
‘‘(A) not more than once per ear during a 
5-year period; 
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‘‘(B) only for types of such hearing aids 
that are determined appropriate by the Sec-
retary; and 
‘‘(C) only if furnished pursuant to a writ-
ten order of a physician, qualified audiologist 
(as defined in section 1861(ll)(4)), qualified 
hearing aid professional (as so defined), physi-
cian assistant, nurse practitioner, or clinical 
nurse specialist.’’. 
(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)) is amended— 
(i) in the header, by inserting ‘‘AND 
HEARING AIDS’’ after ‘‘ORTHOTICS’’; 
(ii) by inserting ‘‘, or of hearing aids 
described in paragraph (2)(D) of such sec-
tion,’’ after ‘‘2011,’’; and 
(iii) in clause (i), by inserting ‘‘or 
such hearing aids’’ after ‘‘such orthotics’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN GENERAL.—Section 1847(a)(2) 
of the Social Security Act (42 U.S.C. 
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1395w–3(a)(2)) is amended by adding at 
the end the following new subparagraph: 
‘‘(D) 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)) is amended by 
adding at the end the following new sub-
paragraph: 
‘‘(C) CERTAIN
HEARING
AIDS.—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 physician’s or practitioner’s profes-
sional service.’’. 
(4) INCLUSION
OF
QUALIFIED
AUDIOLOGISTS 
AND QUALIFIED HEARING AID PROFESSIONALS AS 
CERTAIN PRACTITIONERS TO RECEIVE PAYMENT ON 
AN
ASSIGNMENT-RELATED
BASIS.—Section 
1842(b)(18)(C) of the Social Security Act (42 
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U.S.C. 1395u(b)(18)(C)), is amended by adding at 
the end the following new clauses: 
‘‘(vii) Beginning on January 1, 2023, 
a qualified audiologist (as defined in sec-
tion 1861(ll)(4)(B)). 
‘‘(viii) A qualified hearing aid profes-
sional 
(as 
defined 
in 
section 
1861(ll)(4)(C)).’’. 
(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) INCLUSION
AS EXCEPTED MEDICAL TREAT-
MENT.—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’’; 
(2) in clause (ii), by striking the period and in-
serting ‘‘, or’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) consisting of audiology services 
described in subsection (ll)(3) of section 
1861, or hearing aids described in sub-
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section (s)(8) of such section, that are pay-
able under part B as a result of the 
amendments made by An Act to provide 
for reconciliation pursuant to title II of S. 
Con. Res. 14.’’. 
(e) RURAL
HEALTH
CLINICS
AND
FEDERALLY 
QUALIFIED HEALTH CENTERS.— 
(1) CLARIFYING
COVERAGE
OF
AUDIOLOGY 
SERVICES
AS
PHYSICIANS’ 
SERVICES.—Section 
1861(aa)(1)(A) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(A)) is amended by inserting 
‘‘(including audiology services (as defined in sub-
section (ll)(3)))’’ after ‘‘physicians’ services’’. 
(2) INCLUSION
OF
QUALIFIED
AUDIOLOGISTS 
AND QUALIFIED HEARING AID PROFESSIONALS AS 
RHC
AND
FQHC
PRACTITIONERS.—Section 
1861(aa)(1)(B) of the Social Security Act (42 
U.S.C. 1395x(aa)(1)(B)) is amended by inserting 
‘‘or by a qualified audiologist or a qualified hearing 
aid professional (as such terms are defined in sub-
section (ll)),’’ after ‘‘(as defined in subsection 
(hh)(1)),’’. 
(3) TEMPORARY PAYMENT RATES FOR CERTAIN 
SERVICES UNDER THE RHC AIR AND FQHC PPS.— 
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(A) AIR.—Section 1833 of the Social Se-
curity Act (42 U.S.C. 1395l) is amended— 
(i) in subsection (a)(3)(A), by insert-
ing ‘‘(which shall, in the case of audiology 
services (as defined in section 1861(ll)(3)), 
in lieu of any limits on reasonable charges 
otherwise applicable, be based on the rates 
payable for such services under the pay-
ment basis determined under section 1848 
until such time as the Secretary deter-
mines sufficient data has been collected to 
otherwise apply such limits (or January 1, 
2029, if no such determination has been 
made as of such date))’’ after ‘‘may pre-
scribe in regulations’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(ee) DISREGARD OF COSTS ATTRIBUTABLE TO CER-
TAIN SERVICES FROM CALCULATION OF RHC AIR.— 
Payments for rural health clinic services other than audi-
ology services (as defined in section 1861(ll)(3)) under the 
methodology for all-inclusive rates (established by the Sec-
retary) under subsection (a)(3) shall not take into account 
the costs of such services while rates for such services are 
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based on rates payable for such services under the pay-
ment basis established under section 1848.’’. 
(B) PPS.—Section 1834(o) of the Social 
Security Act (42 U.S.C. 1395m(o)) is amended 
by adding at the end the following new para-
graph: 
‘‘(5) TEMPORARY PAYMENT RATES BASED ON 
PFS FOR CERTAIN SERVICES.—The Secretary shall, 
in establishing payment rates for audiology services 
(as defined in section 1861(ll)(3)) that are Federally 
qualified health center services under the prospective 
payment system established under this subsection, in 
lieu of the rates otherwise applicable under such sys-
tem, base such rates on rates payable for such serv-
ices under the payment basis established under sec-
tion 1848 until such time as the Secretary deter-
mines sufficient data has been collected to otherwise 
establish rates for such services under such system 
(or January 1, 2029, if no such determination has 
been made as of such date). Payments for Federally 
qualified health center services other than such audi-
ology services under such system shall not take into 
account the costs of such services while rates for 
such services are based on rates payable for such 
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services under the payment basis established under 
section 1848.’’. 
(f) IMPLEMENTATION.— 
(1) IN GENERAL.—In addition to amounts oth-
erwise available, there is appropriated to the Sec-
retary of Health and Human Services for fiscal year 
2022, out of any money in the Treasury not other-
wise appropriated, $370,000,000, to remain avail-
able until expended, for purposes of implementing 
the amendments made by this section during the pe-
riod beginning on January 1, 2022, and ending on 
September 30, 2031. 
(2) PROGRAM INSTRUCTION.—The Secretary of 
Health and Human Services shall implement the 
provisions of, and the amendments made by, this 
section for 2022 and 2023 by program instruction. 
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Subtitle I—Public Health 
PART 1—HEALTH CARE INFRASTRUCTURE AND 
WORKFORCE 
SEC. 31001. FUNDING TO SUPPORT CORE PUBLIC HEALTH 
INFRASTRUCTURE FOR STATE, TERRITORIAL, 
LOCAL, AND TRIBAL HEALTH DEPARTMENTS 
AT THE CENTERS FOR DISEASE CONTROL 
AND PREVENTION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Secretary of Health 
and Human Services (in this subtitle referred to as the 
‘‘Secretary’’), acting through the Director of the Centers 
for Disease Control and Prevention (in this section re-
ferred to as the ‘‘Director’’), for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated, 
and to remain available until expended— 
(1) for the purposes of carrying out subsection 
(c)(1)(A)— 
(A) $200,000,000 in fiscal year 2022; 
(B) $300,000,000 in fiscal year 2023; and 
(C) $1,000,000,000 in each of fiscal years 
2024 through 2026; 
(2) for the purposes of carrying out subsection 
(c)(1)(B)— 
(A) $100,000,000 in fiscal year 2022; 
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(B) $150,000,000 in fiscal year 2023; and 
(C) $500,000,000 in each of fiscal years 
2024 through 2026; and 
(3) for the purposes of carrying out subsection 
(d)— 
(A) $100,000,000 in fiscal year 2022; 
(B) $150,000,000 in fiscal year 2023; and 
(C) $500,000,000 in each of fiscal years 
2024 through 2026. 
(b) USE OF FUNDS.—Amounts made available pursu-
ant to subsection (a) shall be used to support core public 
health infrastructure activities to strengthen the public 
health system of the United States, including by awarding 
grants under this section and expanding and improving 
activities of the Centers for Disease Control and Preven-
tion under subsections (c) and (d). 
(c) GRANTS.— 
(1) AWARDS.—For the purpose of addressing 
core public health infrastructure needs, the Sec-
retary shall award— 
(A) a grant to each State or territorial 
health department, and to local health depart-
ments that serve counties with a population of 
at least 2,000,000 or cities with a population of 
at least 400,000 people; and 
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(B) grants on a competitive basis to State, 
territorial, local, or Tribal health departments. 
(2) REQUIRED USES.— 
(A) REALLOCATION
TO
LOCAL
HEALTH 
DEPARTMENTS.—A State health department re-
ceiving funds under subparagraph (A) or (B) of 
paragraph (1) shall allocate at least 25 percent 
of such funds to local health departments, as 
applicable, within the State to support contribu-
tions of the local health departments to core 
public health infrastructure. 
(B) PROGRESS
IN
MEETING
ACCREDITA-
TION STANDARDS.—A health department receiv-
ing funds under this section that is not accred-
ited shall report to the Secretary on an annual 
basis how the department is working to meet 
accreditation standards. 
(3) FORMULA
GRANTS
TO
HEALTH
DEPART-
MENTS.—In awarding grants under paragraph (1), 
the Secretary shall award funds to each health de-
partment in accordance with a formula which con-
siders population size, the Social Vulnerability Index 
of the Centers for Disease Control and Prevention, 
and other factors as determined by the Secretary. 
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(4) COMPETITIVE GRANTS TO STATE, TERRI-
TORIAL, LOCAL, AND
TRIBAL
HEALTH
DEPART-
MENTS.—In making grants under paragraph (1)(B), 
the Secretary shall give priority to applicants dem-
onstrating core public health infrastructure needs 
for public health agencies in the applicant’s jurisdic-
tion. 
(5) PERMITTED USES.— 
(A) IN
GENERAL.—The Secretary may 
make available a subset of the funds available 
for grants under paragraph (1) for purposes of 
awarding grants to State, territorial, local, and 
Tribal health departments for planning or to 
support public health accreditation. 
(B) USES.—Recipients of such grants may 
use the grant funds to assess core public health 
infrastructure needs and report to the Centers 
for Disease Control and Prevention on efforts 
to achieve accreditation, as applicable. 
(6) REQUIREMENTS.—To be eligible for a grant 
under this section, an entity shall— 
(A) submit an application in such form 
and containing such information as the Sec-
retary shall require; 
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(B) demonstrate to the satisfaction of the 
Secretary that— 
(i) funds received through the grant 
will be expended only to supplement, and 
not supplant, non-Federal and Federal 
funds otherwise available to the entity for 
the purpose of addressing core public 
health infrastructure needs; and 
(ii) with respect to activities for which 
the grant is awarded, the entity will main-
tain expenditures of non-Federal amounts 
for such activities at a level not less than 
the level of such expenditures maintained 
by the entity for fiscal year 2019; and 
(C) agree to report annually to the Direc-
tor regarding the use of the grant funds. 
(d) CORE PUBLIC HEALTH INFRASTRUCTURE AND 
ACTIVITIES
FOR
THE
CDC.—The Secretary, acting 
through the Director, shall expand and improve the core 
public health infrastructure and activities of the Centers 
for Disease Control and Prevention to support activities 
necessary to address unmet, ongoing, and emerging public 
health needs, including prevention, preparation for, and 
response to public health emergencies. 
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(e) DEFINITION.—In this section, the term ‘‘core 
public health infrastructure’’ includes— 
(1) health equity activities; 
(2) workforce capacity and competency; 
(3) all hazards public health and preparedness; 
(4) testing capacity, including test platforms, 
mobile testing units, and personnel; 
(5) health information, health information sys-
tems, and health information analysis (including 
data analytics); 
(6) epidemiology and disease surveillance; 
(7) contact tracing; 
(8) policy and communications; 
(9) financing; 
(10) community partnership development; and 
(11) relevant components of organizational ca-
pacity. 
(f) SUPPLEMENT NOT SUPPLANT.—Amounts made 
available by this section shall be used to supplement, and 
not supplant, amounts otherwise made available for the 
purposes described in this Act. 
SEC. 31002. FUNDING FOR HEALTH CENTER CAPITAL 
GRANTS. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal 
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year 2022, out of any money in the Treasury not otherwise 
appropriated, $2,000,000,000, to remain available until 
expended, for necessary expenses for awarding grants and 
entering into cooperative agreements for capital projects 
to health centers funded under section 330 of the Public 
Health Service Act (42 U.S.C. 254b) to be awarded with-
out regard to the time limitation in subsection (e)(3) and 
subsections (e)(6)(A)(iii), (e)(6)(B)(iii), and (r)(2)(B) of 
such section 330, and for necessary expenses for awarding 
grants and cooperative agreements for capital projects to 
Federally qualified health centers, as described in section 
1861(aa)(4)(B) of the Social Security Act (42 U.S.C. 
1395x(aa)(4)(B)). The Secretary shall take such steps as 
may be necessary to expedite the awarding of such grants 
to Federally qualified health centers for capital projects. 
(b) USE OF FUNDS.—Amounts made available to a 
recipient of a grant or cooperative agreement pursuant to 
subsection (a) shall be used for— 
(1) health center facility alteration, renovation, 
remodeling, expansion, construction, and other cap-
ital improvement costs, including the costs of amor-
tizing the principal of, and paying interest on, loans 
for such purposes; and 
(2) the purchase, renovation, or maintenance of 
mobile clinics and related vehicles and equipment. 
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SEC. 31003. FUNDING FOR TEACHING HEALTH CENTER 
GRADUATE MEDICAL EDUCATION. 
(a) IN GENERAL.—In addition to amounts otherwise 
available, and notwithstanding the limitations referred to 
in subsections (b)(2) and (d)(2) of section 340H of the 
Public Health Service Act (42 U.S.C. 256h), there is ap-
propriated to the Secretary for fiscal year 2022, out of 
any money in the Treasury not otherwise appropriated, 
$3,370,000,000, to remain available until expended, for— 
(1) the program of payments to teaching health 
centers that operate graduate medical education pro-
grams under such section; and 
(2) the award of teaching health center develop-
ment grants pursuant to section 749A of the Public 
Health Service Act (42 U.S.C. 293l–1). 
(b) EXEMPTION FROM AMOUNT AND DURATION LIM-
ITATIONS.—Subsection (b) of section 749A of the Public 
Health Service Act (42 U.S.C. 293l–1) shall not apply 
with respect to amounts awarded under such section out 
of amounts appropriated under subsection (a) or under 
section 2604 of the American Rescue Plan Act (Public 
Law 117–2). 
(c) USE OF FUNDS.—Amounts made available pursu-
ant to subsection (a) shall be used for the following activi-
ties: 
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(1) For making payments to establish new ap-
proved graduate medical residency training pro-
grams pursuant to section 340H(a)(1)(C) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
256h(a)(1)(C)). 
(2) For making payments under section 
340H(a)(1)(A) of the Public Health Service Act (42 
U.S.C. 256h(a)(1)(A))) to qualified teaching health 
centers for maintenance of filled positions at existing 
approved graduate medical residency training pro-
grams. 
(3) For making payments under section 
340H(a)(1)(B) of the Public Health Service Act (42 
U.S.C. 256h(a)(1)(B)) for the expansion of existing 
approved graduate medical residency training pro-
grams. 
(4) For making awards under section 749A of 
the Public Health Service Act (42 U.S.C. 293l–1) to 
teaching health centers for the purpose of estab-
lishing new accredited or expanded primary care 
residency programs. 
(5) To provide an increase to the per resident 
amount described in section 340H(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256h(a)(2)). 
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(d) PRIORITY USES OF FUNDS.—In making pay-
ments and awards under subsection (c), the Secretary 
shall, in addition to the requirements of paragraphs (3)(A) 
and (3)(B) of section 340H of the Public Health Service 
Act (42 U.S.C. 256h), make payments and awards to eligi-
ble entities in a manner that accounts for States or terri-
tories in which there is no existing qualified teaching 
health center funded by payments under such section 
340H. 
SEC. 31004. FUNDING FOR CHILDREN’S HOSPITALS THAT 
OPERATE GRADUATE MEDICAL EDUCATION 
PROGRAMS. 
In addition to amounts otherwise available, and not-
withstanding the caps on awards specified in paragraphs 
(1) and (2) of subsection (b) and (h)(1) of section 340E 
of the Public Health Service Act (42 U.S.C. 256e), there 
is appropriated to the Secretary for fiscal year 2022, out 
of any money in the Treasury not otherwise appropriated, 
$200,000,000, to remain available until expended, for car-
rying out such section 340E of the Public Health Service 
Act (42 U.S.C. 256e). 
SEC. 31005. FUNDING FOR NATIONAL HEALTH SERVICE 
CORPS. 
In addition to amounts otherwise available, there is 
appropriated to the Secretary for fiscal year 2022, out of 
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any money in the Treasury not otherwise appropriated, 
$2,000,000,000, to remain available until expended, for 
carrying out sections 338A, 338B, and 338I of the Public 
Health Service Act (42 U.S.C. 254l, 254l–1, 254q–1). 
SEC. 31006. FUNDING FOR THE NURSE CORPS. 
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, 
$500,000,000, to remain available until expended, for car-
rying out section 846 of the Public Health Service Act 
(42 U.S.C. 297n). 
SEC. 31007. FUNDING FOR SCHOOLS OF MEDICINE IN UN-
DERSERVED AREAS. 
(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, $500,000,000, to remain available until ex-
pended, for purposes of making awards to eligible entities 
for the establishment, improvement, or expansion of an 
allopathic or osteopathic school of medicine, or a branch 
campus of an allopathic or osteopathic school of medicine, 
consistent with subsection (b). 
(b) USE OF FUNDS.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall, with priority given to minority-serv-
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ing institutions described in section 371(a) of the Higher 
Education Act of 1965 (20 U.S.C. 1067q(a)), and taking 
into consideration equitable distribution of awards among 
the geographical regions of the United States (which shall 
include rural regions and populations as defined by the 
Secretary for the purposes of this section) and the loca-
tions of existing schools of medicine and osteopathic medi-
cine, use amounts appropriated by subsection (a) to award 
grants to eligible entities to— 
(1) recruit, enroll, and retain students, includ-
ing individuals who are from disadvantaged back-
grounds (including racial and ethnic groups under-
represented among medical students and health pro-
fessions), individuals from rural and underserved 
areas, low-income individuals, and first generation 
college students (as defined in section 402A(h)(3) of 
the Higher Education Act of 1965 (20 U.S.C. 
1070a–11(h)(3))), at a school of medicine or osteo-
pathic medicine or branch campus of a school of 
medicine or osteopathic medicine; 
(2) develop, implement, and expand curriculum 
that emphasizes care for rural and underserved pop-
ulations, including accessible and culturally appro-
priate and linguistically appropriate care and serv-
ices, at such school or branch campus; 
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(3) plan and construct a school of medicine or 
osteopathic medicine in an area in which no other 
such school or branch campus of such a school is 
based; 
(4) plan, develop, and meet criteria for accredi-
tation for a school of medicine or osteopathic medi-
cine or branch campus of such a school; 
(5) hire faculty, including faculty from racial 
and ethnic groups who are underrepresented among 
the medical and other health professions, and other 
staff to serve at such a school or branch campus; 
(6) support educational programs at such a 
school or branch campus, including modernizing cur-
riculum; 
(7) modernize and expand infrastructure at 
such a school or branch campus; or 
(8) support other activities that the Secretary 
determines will further the establishment, improve-
ment, or expansion of a school of medicine or osteo-
pathic medicine or branch campus of a school of 
medicine or osteopathic medicine. 
(c) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means an institution of higher education as de-
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