611 
Community Development Amendments of 1978 (12 
U.S.C. 1715z–1a) (‘‘Flex Sub loan’’). 
(b) The Secretary may only forgive or restructure 
loans under this section for properties with— 
(1) 200 or fewer assisted units; 
(2) a Flex Sub loan with an unpaid principal 
balance of $2,000,000 or less; 
(3) a score of 80 or higher on the most recent 
REAC inspection; and 
(4) a most recent management and occupancy 
review score of ‘‘above average’’ or ‘‘superior.’’ 
(c) The Secretary may set such terms and conditions 
as the Secretary determines are appropriate for forgive-
ness or restructuring under this section, including: 
(1) Different maturity dates or interest rate 
terms; 
(2) Extension of affordability use agreements; 
and 
(3) Other measures to ensure the long-term sta-
bility of operations at the property. 
(d) There is hereby appropriated $2,000,000, to re-
main available until September 30, 2029, to carry out the 
purposes of this section, in addition to amounts otherwise 
available for such purposes. 
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SEC. 240. Funds previously made available by the 
Consolidated and Further Continuing Appropriations Act, 
2013 (Public Law 113–6) for initial project rental assist-
ance contracts associated with the demonstration program 
under the heading ‘‘Housing for Persons with Disabilities’’ 
in the Consolidated and Further Continuing Appropria-
tions Act, 2012 (Public Law 112–55) that were available 
for obligation through fiscal year 2016 are to remain avail-
able through fiscal year 2031 for the liquidation of valid 
obligations incurred in fiscal years 2013 through 2016. 
SEC. 241. Amounts made available for the Office of 
Housing under the heading ‘‘Program Offices’’ in this and 
prior Acts shall also be available, without additional com-
petition, for cooperative agreements with participating ad-
ministrative entities that have been selected under section 
513(b) of the Multifamily Assisted Housing Reform and 
Affordability Act of 1997 (42 U.S.C. 1437f note) 
(MAHRAA) to provide direct support, including carrying 
out due diligence and underwriting functions for owners 
and for technical assistance activities, on conditions estab-
lished by the Secretary for small properties and owners 
converting assistance under the first component or the 
second component under the heading ‘‘Rental Assistance 
Demonstration’’ in the Department of Housing and Urban 
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613 
Development Appropriations Act, 2012 (title II of division 
C of Public Law 112–55). 
SEC. 242. The Secretary shall conduct all rulemaking 
in accordance with the policies of part 10 of title 24 of 
the Code of Federal Regulations and Executive Order 
12866, as amended, including providing for public partici-
pation and not less than 60 days for the submission of 
written comments. 
SEC. 243. For fiscal year 2026, the costs of any rent 
incentives as authorized pursuant to waivers or alternative 
requirements of the jobs-plus initiative as described under 
the heading ‘‘Self-Sufficiency Programs’’ shall not be 
charged against the competitive grant amounts made 
available under such heading: Provided, That the amount 
of any forgone increases in tenant rent payments due to 
the implementation of such rent incentives shall be 
factored into the public housing agency’s general oper-
ating fund eligibility pursuant to the formula under the 
heading ‘‘Public Housing Fund’’: Provided further, That 
the amount of any foregone increases in tenant rent pay-
ments due to the implementation of such rent incentives 
implemented on behalf of residents of a project with as-
sistance converted from public housing to project-based 
rental assistance under section 8 of the United States 
Housing Act of 1937 (42 U.S.C. 1437f) or assistance 
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614 
under section 8(o)(13) of such Act under the heading 
‘‘Rental Assistance Demonstration’’ in the Department of 
Housing and Urban Development Appropriations Act, 
2012 (title II of division C of Public Law 112–55), as 
amended (42 U.S.C. 1437f note) shall be factored into (1) 
housing assistance payments made pursuant to project- 
based subsidy contracts provided under the heading 
‘‘Project-Based Rental Assistance’’; and (2) housing as-
sistance payments made by public housing agencies pursu-
ant to project-based assistance contracts under section 
8(o)(13) of such Act, with these costs being renewed under 
the heading ‘‘Tenant-Based Rental Assistance’’. 
SEC. 244. In allocating and awarding available 
amounts provided under the heading ‘‘Homeless Assist-
ance Grants’’ in the Department of Housing and Urban 
Development Appropriations Act, 2025 (Public Law 119– 
04) and under section 231 of Public Law 116–94 for the 
continuum of care program, the Secretary shall, prior to 
awarding any amounts through a notice of funding oppor-
tunity and notwithstanding any inconsistent provisions in 
such Acts or in subtitle C of title IV of the McKinney- 
Vento Homeless Assistance Act, non-competitively renew 
for one 12-month period all projects (including youth 
homelessness demonstration projects and shelter plus care 
projects) expiring during the first quarter of calendar year 
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615 
2026 (including any projects that expired from January 
1, 2026 through the date of enactment of this Act): Pro-
vided, That if awards have not been made under a fiscal 
year 2025 notice of funding opportunity prior to April 1, 
2026, the Secretary shall also non-competitively renew all 
such projects expiring during the second quarter of cal-
endar year 2026: Provided further, That if awards have 
not been made under a fiscal year 2025 notice of funding 
opportunity prior to July 1, 2026, the Secretary shall also 
non-competitively renew all such projects expiring during 
the third and fourth quarters of calendar year 2026: Pro-
vided further, That such renewals shall be in an amount 
equal to the prior award with upward adjustments to en-
able renewal projects to operate at substantially the same 
levels, including cost-of-living adjustments for supportive 
services from the prior grant and due to changes to the 
fair market rents in the geographic area: Provided further, 
That amounts remaining after all such renewals are made 
shall be competitively awarded pursuant to a notice of 
funding opportunity: Provided further, That such renewals 
shall not render recipients ineligible for awards under any 
fiscal year 2025 and fiscal year 2026 notices of funding 
opportunity. 
This title may be cited as the ‘‘Department of Hous-
ing and Urban Development Appropriations Act, 2026’’. 
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616 
TITLE III 
RELATED AGENCIES 
ACCESS BOARD 
SALARIES AND EXPENSES 
For expenses necessary for the Access Board, as au-
thorized by section 502 of the Rehabilitation Act of 1973 
(29 U.S.C. 792), $9,955,000: Provided, That, notwith-
standing any other provision of law, there may be credited 
to this appropriation funds received for publications and 
training expenses. 
FEDERAL MARITIME COMMISSION 
SALARIES AND EXPENSES 
For necessary expenses of the Federal Maritime 
Commission as authorized by section 46107 of title 46, 
United States Code, including services as authorized by 
section 3109 of title 5, United States Code; hire of pas-
senger motor vehicles as authorized by section 1343(b) of 
title 31, United States Code; and uniforms or allowances 
therefor, as authorized by sections 5901 and 5902 of title 
5, United States Code, $40,000,000, of which $2,000,000 
shall remain available until September 30, 2027: Provided, 
That not to exceed $3,500 shall be for official reception 
and representation expenses. 
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617 
NATIONAL RAILROAD PASSENGER CORPORATION 
OFFICE OF INSPECTOR GENERAL 
SALARIES AND EXPENSES 
For necessary expenses of the Office of Inspector 
General for the National Railroad Passenger Corporation 
to carry out the provisions of the Inspector General Act 
of 1978 (5 U.S.C. Chapter 4), $29,240,000: Provided, 
That the Inspector General shall have all necessary au-
thority, in carrying out the duties specified in such Act, 
to investigate allegations of fraud, including false state-
ments to the Government under section 1001 of title 18, 
United States Code, by any person or entity that is subject 
to regulation by the National Railroad Passenger Corpora-
tion: Provided further, That the Inspector General may 
enter into contracts and other arrangements for audits, 
studies, analyses, and other services with public agencies 
and with private persons, subject to the applicable laws 
and regulations that govern the obtaining of such services 
within the National Railroad Passenger Corporation: Pro-
vided further, That the Inspector General may select, ap-
point, and employ such officers and employees as may be 
necessary for carrying out the functions, powers, and du-
ties of the Office of Inspector General, subject to the appli-
cable laws and regulations that govern such selections, ap-
pointments, and employment within the National Railroad 
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618 
Passenger Corporation: Provided further, That concurrent 
with the President’s budget request for fiscal year 2027, 
the Inspector General shall submit to the House and Sen-
ate Committees on Appropriations a budget request for 
fiscal year 2027 in similar format and substance to budget 
requests submitted by executive agencies of the Federal 
Government. 
NATIONAL TRANSPORTATION SAFETY BOARD 
SALARIES AND EXPENSES 
For necessary expenses of the National Transpor-
tation Safety Board, including hire of passenger motor ve-
hicles and aircraft; services as authorized by section 3109 
of title 5, United States Code, but at rates for individuals 
not to exceed the per diem rate equivalent to the rate for 
a GS–15; uniforms, or allowances therefor, as authorized 
by sections 5901 and 5902 of title 5, United States Code, 
$145,000,000, of which not to exceed $1,000 may be used 
for official reception and representation expenses. 
NEIGHBORHOOD REINVESTMENT CORPORATION 
PAYMENT TO THE NEIGHBORHOOD REINVESTMENT 
CORPORATION 
For payment to the Neighborhood Reinvestment Cor-
poration for use in neighborhood reinvestment activities, 
as authorized by the Neighborhood Reinvestment Corpora-
tion Act (42 U.S.C. 8101–8107), $158,000,000: Provided, 
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619 
That the Neighborhood Reinvestment Corporation shall 
notify network organizations of their full formula grant 
award by the latter of 60 days after enactment of this 
Act or March 1, 2026. 
SURFACE TRANSPORTATION BOARD 
SALARIES AND EXPENSES 
For necessary expenses of the Surface Transpor-
tation Board, including services authorized by section 
3109 of title 5, United States Code, $40,799,000: Pro-
vided, That, notwithstanding any other provision of law, 
not to exceed $1,250,000 from fees established by the Sur-
face Transportation Board shall be credited to this appro-
priation as offsetting collections and used for necessary 
and authorized expenses under this heading: Provided fur-
ther, That the amounts made available under this heading 
from the general fund shall be reduced on a dollar-for- 
dollar basis as such offsetting collections are received dur-
ing fiscal year 2026, to result in a final appropriation from 
the general fund estimated at not more than $39,549,000. 
UNITED STATES INTERAGENCY COUNCIL ON 
HOMELESSNESS 
OPERATING EXPENSES 
For necessary expenses, including payment of sala-
ries, authorized travel, hire of passenger motor vehicles, 
the rental of conference rooms, and the employment of ex-
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620 
perts and consultants under section 3109 of title 5, United 
States Code, of the United States Interagency Council on 
Homelessness (in this heading ‘‘the Council’’) in carrying 
out the functions pursuant to title II of the McKinney- 
Vento Homeless Assistance Act, as amended, $3,000,000: 
Provided, That the Council shall be staffed in accordance 
with section 11313(a)(5) of title 42, United States Code, 
and regional coordinators shall have the proven expertise 
and demonstrated experience needed to carry out the du-
ties specified in such section: Provided further, That each 
meeting of the Council shall be open to the public, and 
the Council shall post a public notification of each Council 
meeting not less than 30 days in advance of each meeting 
on its website and include the agenda for each meeting 
in such posting. 
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621 
TITLE IV 
GENERAL PROVISIONS—THIS ACT 
SEC. 401. None of the funds in this Act shall be used 
for the planning or execution of any program to pay the 
expenses of, or otherwise compensate, non-Federal parties 
intervening in regulatory or adjudicatory proceedings 
funded in this Act. 
SEC. 402. None of the funds appropriated in this Act 
shall remain available for obligation beyond the current 
fiscal year, nor may any be transferred to other appropria-
tions, unless expressly so provided herein. 
SEC. 403. The expenditure of any appropriation 
under this Act for any consulting service through a pro-
curement contract pursuant to section 3109 of title 5, 
United States Code, shall be limited to those contracts 
where such expenditures are a matter of public record and 
available for public inspection, except where otherwise pro-
vided under existing law, or under existing Executive 
Order issued pursuant to existing law. 
SEC. 404. (a) None of the funds made available in 
this Act may be obligated or expended for any employee 
training that— 
(1) does not meet identified needs for knowl-
edge, skills, and abilities bearing directly upon the 
performance of official duties; 
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622 
(2) contains elements likely to induce high lev-
els of emotional response or psychological stress in 
some participants; 
(3) does not require prior employee notification 
of the content and methods to be used in the train-
ing and written end of course evaluation; 
(4) contains any methods or content associated 
with religious or quasi-religious belief systems or 
‘‘new age’’ belief systems as defined in Equal Em-
ployment 
Opportunity 
Commission 
Notice 
N– 
915.022, dated September 2, 1988; or 
(5) is offensive to, or designed to change, par-
ticipants’ personal values or lifestyle outside the 
workplace. 
(b) Nothing in this section shall prohibit, restrict, or 
otherwise preclude an agency from conducting training 
bearing directly upon the performance of official duties. 
SEC. 405. (a) Except as otherwise provided in this 
Act or the explanatory statement described in section 4 
(in the matter preceding division A of this consolidated 
Act), none of the funds provided in this Act or provided 
by previous appropriations Acts to the agencies or entities 
funded in this Act that remain available for obligation or 
expenditure in fiscal year 2026, or provided from any ac-
counts in the Treasury derived by the collection of fees 
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623 
and available to the agencies funded by this Act, shall be 
available for obligation or expenditure through a re-
programming of funds that— 
(1) creates a new program; 
(2) eliminates a program, project, or activity; 
(3) increases funds or personnel for any pro-
gram, project, or activity for which funds have been 
denied or restricted by the Congress; 
(4) proposes to use funds directed for a specific 
activity by either the House or Senate Committees 
on Appropriations for a different purpose; 
(5) augments existing programs, projects, or ac-
tivities in excess of $5,000,000 or 10 percent, which-
ever is less; 
(6) reduces existing programs, projects, or ac-
tivities by $5,000,000 or 10 percent, whichever is 
less; or 
(7) creates, reorganizes, or restructures a 
branch, division, office, bureau, board, commission, 
agency, administration, or department different from 
the budget justifications submitted to the House and 
Senate Committees on Appropriations, the explana-
tory statement described in section 4 (in the matter 
preceding division A of this consolidated Act), or the 
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624 
relevant operating plan properly submitted by each 
agency, whichever is more detailed. 
(b) Not later than 60 days after the date of enact-
ment of this Act, each agency funded by this Act shall 
submit an operating plan to the House and Senate Com-
mittees on Appropriations to establish the baseline for ap-
plication of reprogramming and transfer authorities for 
the current fiscal year: Provided, That the operating plan 
shall include— 
(1) a table for each appropriation with a sepa-
rate column to display the prior year enacted level, 
the President’s budget request, adjustments made by 
Congress, adjustments due to enacted rescissions, if 
appropriate, and the fiscal year enacted level; 
(2) a delineation in the table for (A) each ap-
propriation and its respective prior year enacted 
level by object class and program, project, and activ-
ity as detailed in this Act, the explanatory statement 
described in section 4 (in the matter preceding divi-
sion A of this consolidated Act), or in the budget ap-
pendix for the respective appropriations, whichever 
is more detailed, (B) each item for which a dollar 
amount is specified and for all programs for which 
new budget (obligational) authority is provided, and 
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625 
(C) each discretionary grant and discretionary grant 
allocation; 
(3) an organizational chart that includes cur-
rent and estimated staffing numbers, by office, at 
the customary level of detail unless otherwise di-
rected by this Act or the explanatory statement de-
scribed in section 4 (in the matter preceding division 
A of this consolidated Act); and 
(4) an identification of items of special congres-
sional interest. 
(c) Each agency may reprogram amounts in excess 
of or contrary to the threshold limitations established in 
this section only after— 
(1) providing written notification to the House 
and Senate Committees on Appropriations no less 
than 30 days in advance of such reprogramming of 
funds; and 
(2) receiving prior written approval from the 
House and Senate Committees on Appropriations. 
SEC. 406. Except as otherwise specifically provided 
by law, not to exceed 50 percent of unobligated balances 
remaining available at the end of fiscal year 2026 from 
appropriations made available for salaries and expenses 
for fiscal year 2026 in this Act, shall remain available 
through September 30, 2027, for each such account for 
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626 
the purposes authorized: Provided, That a request shall 
be submitted to the House and Senate Committees on Ap-
propriations for approval prior to the expenditure of such 
funds: Provided further, That these requests shall be made 
in compliance with reprogramming guidelines under sec-
tion 405 of this Act. 
SEC. 407. No funds in this Act may be used to sup-
port any Federal, State, or local projects that seek to use 
the power of eminent domain, unless eminent domain is 
employed only for a public use: Provided, That for pur-
poses of this section, public use shall not be construed to 
include economic development that primarily benefits pri-
vate entities: Provided further, That any use of funds for 
mass transit, railroad, airport, seaport or highway 
projects, as well as utility projects which benefit or serve 
the general public (including energy-related, communica-
tion-related, water-related and wastewater-related infra-
structure), other structures designated for use by the gen-
eral public or which have other common-carrier or public- 
utility functions that serve the general public and are sub-
ject to regulation and oversight by the government, and 
projects for the removal of an immediate threat to public 
health and safety or brownfields as defined in the Small 
Business Liability Relief and Brownfields Revitalization 
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627 
Act (Public Law 107–118) shall be considered a public 
use for purposes of eminent domain. 
SEC. 408. None of the funds made available in this 
Act may be transferred to any department, agency, or in-
strumentality of the United States Government, except 
pursuant to a transfer made by, or transfer authority pro-
vided in, this Act or any other appropriations Act. 
SEC. 409. No funds appropriated pursuant to this 
Act may be expended by an entity unless the entity agrees 
that in expending the assistance the entity will comply 
with sections 2 through 4 of the Act of March 3, 1933 
(41 U.S.C. 8301–8305, popularly known as the ‘‘Buy 
American Act’’). 
SEC. 410. No funds appropriated or otherwise made 
available under this Act shall be made available to any 
person or entity that has been convicted of violating the 
Buy American Act (41 U.S.C. 8301–8305). 
SEC. 411. None of the funds made available in this 
Act may be used for first-class airline accommodations in 
contravention of sections 301–10.122 and 301–10.123 of 
title 41, Code of Federal Regulations. 
SEC. 412. None of the funds made available in this 
Act may be used to send or otherwise pay for the attend-
ance of more than 50 employees of a single agency or de-
partment of the United States Government, who are sta-
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628 
tioned in the United States, at any single international 
conference unless the relevant Secretary reports to the 
House and Senate Committees on Appropriations at least 
5 days in advance that such attendance is important to 
the national interest: Provided, That for purposes of this 
section the term ‘‘international conference’’ shall mean a 
conference occurring outside of the United States attended 
by representatives of the United States Government and 
of foreign governments, international organizations, or 
nongovernmental organizations. 
SEC. 413. None of the funds appropriated or other-
wise made available under this Act may be used by the 
Surface Transportation Board to charge or collect any fil-
ing fee for rate or practice complaints filed with the Board 
in an amount in excess of the amount authorized for dis-
trict court civil suit filing fees under section 1914 of title 
28, United States Code. 
SEC. 414. (a) None of the funds made available in 
this Act may be used to maintain or establish a computer 
network unless such network blocks the viewing, 
downloading, and exchanging of pornography. 
(b) Nothing in subsection (a) shall limit the use of 
funds necessary for any Federal, State, tribal, or local law 
enforcement agency or any other entity carrying out crimi-
nal investigations, prosecution, or adjudication activities. 
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629 
SEC. 415. (a) None of the funds made available in 
this Act may be used to deny an Inspector General funded 
under this Act timely access to any records, documents, 
or other materials available to the department or agency 
over which that Inspector General has responsibilities 
under the Inspector General Act of 1978 (5 U.S.C. App.), 
or to prevent or impede that Inspector General’s access 
to such records, documents, or other materials, under any 
provision of law, except a provision of law that expressly 
refers to the Inspector General and expressly limits the 
Inspector General’s right of access. 
(b) A department or agency covered by this section 
shall provide its Inspector General with access to all such 
records, documents, and other materials in a timely man-
ner. 
(c) Each Inspector General shall ensure compliance 
with statutory limitations on disclosure relevant to the in-
formation provided by the establishment over which that 
Inspector General has responsibilities under the Inspector 
General Act of 1978 (5 U.S.C. App.). 
(d) Each Inspector General covered by this section 
shall report to the Committees on Appropriations of the 
House of Representatives and the Senate within 5 cal-
endar days any failures to comply with this requirement. 
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SEC. 416. None of the funds appropriated or other-
wise made available by this Act may be used to pay award 
or incentive fees for contractors whose performance has 
been judged to be below satisfactory, behind schedule, over 
budget, or has failed to meet the basic requirements of 
a contract, unless the Agency determines that any such 
deviations are due to unforeseeable events, government- 
driven scope changes, or are not significant within the 
overall scope of the project and/or program unless such 
awards or incentive fees are consistent with 16.401(e)(2) 
of the Federal Acquisition Regulations. 
SEC. 417. No part of any appropriation contained in 
this Act shall be available to pay the salary for any person 
filling a position, other than a temporary position, for-
merly held by an employee who has left to enter the Armed 
Forces of the United States and has satisfactorily com-
pleted his or her period of active military or naval service, 
and has within 90 days after his or her release from such 
service or from hospitalization continuing after discharge 
for a period of not more than 1 year, made application 
for restoration to his or her former position and has been 
certified by the Office of Personnel Management as still 
qualified to perform the duties of his or her former posi-
tion and has not been restored thereto. 
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631 
SEC. 418. (a) None of the funds made available by 
this Act may be used to approve a new foreign air carrier 
permit under sections 41301 through 41305 of title 49, 
United States Code, or exemption application under sec-
tion 40109 of that title of an air carrier already holding 
an air operators certificate issued by a country that is 
party to the U.S.-E.U.-Iceland-Norway Air Transport 
Agreement where such approval would contravene United 
States law or Article 17 bis of the U.S.-E.U.-Iceland-Nor-
way Air Transport Agreement. 
(b) Nothing in this section shall prohibit, restrict or 
otherwise preclude the Secretary of Transportation from 
granting a foreign air carrier permit or an exemption to 
such an air carrier where such authorization is consistent 
with the U.S.-E.U.-Iceland-Norway Air Transport Agree-
ment and United States law. 
SEC. 419. None of the funds made available by this 
Act may be used in contravention of existing Federal law 
regarding non-citizen eligibility and ineligibility for occu-
pancy in federally assisted housing or for participation in 
and assistance under Federal housing programs, including 
section 214 of the Housing and Community Development 
Act of 1980 (42 U.S.C. 1436a) and title IV of the Per-
sonal Responsibility and Work Opportunity Reconciliation 
Act of 1996 (8 U.S.C. 1601 et seq.). 
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SEC. 420. (a) No part of any appropriation contained 
in this Act or title VIII of division J of Public Law 117– 
58 shall be used, other than for normal and recognized 
executive-legislative relationships, for publicity or propa-
ganda purposes, and for the preparation, distribution, or 
use of any kit, pamphlet, booklet, publication, radio, tele-
vision, or film presentation designed to support or defeat 
legislation pending before the Congress, except in presen-
tation to the Congress itself. 
(b) No part of any appropriation contained in this 
Act or in title VIII of division J of Public Law 117–58 
shall be used to pay the salary or expenses of any grant 
or contract recipient, or agent acting for such recipient, 
related to any activity designed to influence the enactment 
of legislation or appropriations proposed or pending before 
the Congress, other than for normal and recognized execu-
tive-legislative relationships. 
(c) Amounts repurposed pursuant to subsections (a) 
and (b) shall continue to be treated as amounts specified 
in section 103(b) of division A of Public Law 118–5. 
SEC. 421. (a) In the table of projects in the explana-
tory statement referenced in section 417 of the Transpor-
tation, Housing and Urban Development, and Related 
Agencies Appropriations Act, 2022 (division L of Public 
Law 117–103)— 
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(1) the item relating to ‘‘Kansas Rail Safety 
Improvement Project’’ is deemed to be amended by 
striking recipient ‘‘Pittsburg Port Authority (KS)’’ 
and inserting ‘‘Kansas Department of Transpor-
tation’’; 
(2) the item relating to ‘‘The Barkers Creek In-
dustrial Park Power Expansion’’ is deemed to be 
amended by striking ‘‘The Barkers Creek Industrial 
Park Power Expansion’’ and inserting ‘‘Barkers 
Creek Industrial Park Access Bridge, Phase II’’; 
(3) the item relating to ‘‘Acquisition of new 
commercial space’’ is deemed to be amended by 
striking project ‘‘Acquisition of new commercial 
space’’ and inserting ‘‘Renovation of commercial 
space’’; 
(4) the item relating to ‘‘Electric school bus 
and associated electric vehicle (EV) charging infra-
structure’’ is deemed to be amended by striking re-
cipient ‘‘Falls Church City Public Schools’’ and in-
serting ‘‘City of Falls Church’’; 
(5) the item relating to ‘‘North Commons Re-
gional Vision’’ is deemed to be amended by striking 
recipient ‘‘Minneapolis Park and Recreation Board’’ 
and inserting ‘‘City of Minneapolis’’; 
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(6) the item relating to ‘‘Orangewood Parkette’’ 
is deemed to be amended by striking project ‘‘Or-
angewood Parkette’’ and inserting ‘‘Orangewood 
Complete Streets’’; 
(7) the item relating to ‘‘Replacing Five Ele-
vators in a Public Housing Development’’ is deemed 
to be amended by striking project ‘‘Replacing Five 
Elevators in a Public Housing Development’’ and in-
serting ‘‘Replacing Elevators in a Public Housing 
Development’’; 
(8) the item relating to ‘‘Long Branch Stream 
Valley Park Pedestrian Bridge Replacements and 
ADA Improvements’’ is deemed to be amended by 
striking recipient ‘‘Montgomery County Govern-
ment’’ and inserting ‘‘Maryland National Capital 
Park and Planning Commission’’; 
(9) the item relating to ‘‘Washington Gorge Ac-
tion Programs—Goldendale Childcare and Early 
Learning Center’’ is deemed to be amended by strik-
ing ‘‘Goldendale’’; 
(10) the item relating to ‘‘Habitat for Human-
ity’s Veterans Blitz Build’’ is deemed to be amended 
by striking recipient ‘‘Habitat for Humanity San 
Bernardino Area, Inc.’’ and inserting ‘‘Neighborhood 
Partnership Housing Services, Inc. (NPHS)’’; 
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635 
(11) the item relating to ‘‘Allen University Res-
toration of Historic Waverly-Good Samaritan Hos-
pital’’ is deemed to be amended by striking ‘‘Allen 
University Restoration of Historic Waverly-Good Sa-
maritan Hospital’’ and inserting ‘‘Facility Up-
grades’’; 
(12) the item relating to ‘‘The MEWS at Spen-
cer Road, Affordable Housing and Mixed Use Devel-
opment’’ is deemed to be amended by striking ‘‘The 
MEWS at Spencer Road,’’; and 
(13) The item relating to ‘‘ARISE housing for 
young adults transitioning out of foster care’’ is 
deemed to be amended by striking ‘‘ARISE housing 
for young adults transitioning out of foster care’’ 
and inserting ‘‘Construction of Housing in the City 
of Greenville.’’ 
(b) In the table of projects entitled ‘‘Community 
Project Funding/Congressionally Directed Spending’’ in 
the explanatory statement for division L of the Consoli-
dated Appropriations Act, 2023 (Public Law 117–328) de-
scribed in section 4 in the matter preceding division A of 
such Act— 
(1) the item relating to ‘‘Lower Shore Clinic 
Co-Occurring Disorder Treatment Facility Housing’’ 
is deemed to be amended by: 
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(A) striking ‘‘Lower Shore Clinic Co-Oc-
curring Disorder Treatment Facility Housing’’ 
and inserting ‘‘HealthPort Co-Occurring Dis-
order Treatment Facility’’; and 
(B) striking recipient ‘‘Lower Shore Clinic 
Inc.’’ and inserting ‘‘HealthPort, Inc.’’; 
(2) the item relating to ‘‘Metra Zero Emission 
Locomotive Commuter Rail Pilot’’ is deemed to be 
amended by striking ‘‘Locomotive’’; 
(3) the item relating to ‘‘Acquisition of Prop-
erty for the Revitalization of Cliftondale Square 
Business District’’ is deemed to be amended by 
striking ‘‘Acquisition of Property for the’’; 
(4) the item relating to ‘‘Supportive Living, 
Community Day Services, and Housing Site Project 
for Adults with Intellectual and Developmental Dis-
abilities’’ is deemed to be amended by striking 
project ‘‘Supportive Living, Community Day Serv-
ices, and Housing Site Project for Adults with Intel-
lectual and Developmental Disabilities’’ and insert-
ing ‘‘Community Day Services and Housing Expan-
sion for Adults with Intellectual and Developmental 
Disabilities’’; 
(5) the item relating to ‘‘Public Library Addi-
tion’’ is deemed to be amended by striking project 
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‘‘Public Library Addition’’ and inserting ‘‘Public Li-
brary Renovations’’; 
(6) the item relating to ‘‘Renovation of Snelling 
Motel to Affordable Housing for Veterans’’ is 
deemed to be amended by striking project ‘‘Renova-
tion of Snelling Motel to Affordable Housing for 
Veterans’’ and inserting ‘‘Acquisition for Affordable 
Housing for Veterans’’; 
(7) the item relating to ‘‘El Centro de la Raza- 
Pattison’s West Community Campus Property Ac-
quisition’’ is deemed to be amended by striking 
project ‘‘El Centro de la Raza-Pattison’s West Com-
munity Campus Property Acquisition’’ and inserting 
‘‘Pattison’s West Community Campus’’; 
(8) the item relating to ‘‘Riverbrook Regional 
YMCA’’ is deemed to be amended by striking recipi-
ent ‘‘Riverbrook Regional Young Men’s Christian 
Association, Inc.’’ and inserting ‘‘City of Norwalk’’; 
(9) the item relating to ‘‘The SE1 Rehab’’ is 
deemed to be amended by striking recipient ‘‘The 
Skid Row Housing Trust’’ and inserting ‘‘PATH 
Ventures’’ and striking project ‘‘The SE1 Rehab’’ 
and inserting ‘‘Skid Row Permanent Supportive 
Housing Rehabilitation’’; 
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638 
(10) the item relating to ‘‘Community Aging & 
Retirement Services, Inc.’’ is deemed to be amended 
by striking recipient ‘‘Community Aging & Retire-
ment Services, Inc.’’ and inserting ‘‘Pasco County,’’ 
and striking project ‘‘CARES One Stop Senior Cen-
ter Acquisition and Construction’’ and inserting 
‘‘Senior Center Acquisition and Construction’’; 
(11) the item relating to ‘‘Western Flyer Coast 
Guard Pier Repair and Classroom Design’’ is 
deemed to be amended by striking project ‘‘Western 
Flyer Coast Guard Pier Repair and Classroom De-
sign’’ and inserting ‘‘Western Flyer Pier and Class-
room Repair’’; 
(12) the item relating to ‘‘NYCHA ADA Acces-
sibility and Security Lighting Project’’ is deemed to 
be amended by striking project ‘‘NYCHA ADA Ac-
cessibility and Security Lighting Project’’ and in-
serting 
‘‘Installation 
of 
Exterior 
Lighting 
at 
Borinquen Plaza II’’; 
(13) the item relating to ‘‘Ausonia Apartments 
Modernization’’ is deemed to be amended by striking 
recipient ‘‘Ausonia Apartments’’ and inserting ‘‘Bos-
ton Housing Authority’’; 
(14) the item relating to ‘‘Helping Up Mission 
Permanent Housing on East Baltimore Street’’ is 
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639 
deemed to be amended by striking ‘‘Helping Up Mis-
sion Permanent Housing on East Baltimore Street’’ 
and inserting ‘‘Greenspace Development in Balti-
more’’; 
(15) the item relating to ‘‘The Choir School of 
Delaware’s New Building at 8th and West Street in 
Wilmington’s Historic Quaker Hill District’’ is 
deemed to be amended by striking ‘‘at 8th and West 
Street in Wilmington’s Historic Quaker Hill Dis-
trict’’ and inserting ‘‘in Wilmington’’; 
(16) the item relating to ‘‘WTA 2011 Fixed 
Route Diesel to Electric Replacement Project, Bel-
lingham’’ is deemed to be amended by striking 
‘‘WTA 2011 Fixed Route Diesel to Electric Replace-
ment Project, Bellingham’’ and inserting ‘‘Acquisi-
tion of Hybrid-Electric Buses’’; and 
(17) the item relating to ‘‘Media and Arts Col-
laborative Building Renovation’’ is deemed to be 
amended by striking ‘‘Renovation’’. 
(c) In the table of projects entitled ‘‘Community 
Project Funding/Congressionally Directed Spending’’ in 
the explanatory statement for division F of the Consoli-
dated Appropriations Act, 2024 (Public Law 118–42) de-
scribed in section 4 in the matter preceding division A of 
such Act— 
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(1) the item relating to ‘‘Hardwoods Permanent 
Supportive Housing’’ is deemed to be amended by 
striking ‘‘Hardwoods’’; 
(2) the item relating to ‘‘Cle Elum—First 
Street Downtown Revitalization’’ is deemed to be 
amended by striking ‘‘First Street’’; 
(3) the item relating to ‘‘Center for Community 
Programs in Livermore Falls and Jay’’ is deemed to 
be amended by striking recipient ‘‘United Way of 
the Tri-Valley Area’’ and inserting ‘‘Town of Jay’’; 
(4) the item relating to ‘‘Pawtucket Library, 
Sayles Building Re-Pointing’’ is deemed to be 
amended by striking project ‘‘Pawtucket Library, 
Sayles Building Re-Pointing’’ and inserting ‘‘Paw-
tucket Library, Sayles Building Renovation’’; 
(5) the item relating to ‘‘Germany Road Reloca-
tion Project’’ is deemed to be amended by striking 
project ‘‘Germany Road Relocation Project’’ and in-
serting ‘‘Sewer Improvements’’; 
(6) the item relating to ‘‘Community Center 
Expansion and Land Acquisition’’ is deemed to be 
amended by striking ‘‘Expansion and Land Acquisi-
tion’’ and inserting ‘‘Planning and Design’’; 
(7) the item relating to ‘‘Laconia, NH Hill 
Street Pedestrian Bridge Replacement’’ is deemed to 
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641 
be amended by striking ‘‘Hill Street’’ and inserting 
‘‘Mill Street’’; 
(8) the item relating to ‘‘Sunnyside Community 
Reinvestment as Cultura & Traditions: Tucson, AZ’’ 
is deemed to be amended by striking recipient ‘‘Sun-
nyside Foundation’’ and inserting ‘‘Sunnyside Uni-
fied School District’’; 
(9) the item relating to ‘‘Craighead Technology 
Park and Public Safety Center’’ is deemed to be 
amended by striking recipient ‘‘City Water and 
Light of Jonesboro’’ and inserting ‘‘City of 
Jonesboro’’; 
(10) the item relating to ‘‘Capital Repairs of 4 
Affordable Housing properties, City of Seattle, King 
County, WA’’ is deemed to be amended by striking 
‘‘4’’ and inserting ‘‘3’’; 
(11) the item relating to ‘‘Middletown Plaza El-
evator Replacement’’ is deemed to be amended by 
striking ‘‘Middletown Plaza Elevator Replacement’’ 
and inserting ‘‘Security Upgrades at NYCHA’s 
Soundview Houses’’; 
(12) the item relating to ‘‘Morris Affordable 
Housing Infrastructure’’ is deemed to be amended 
by striking recipient ‘‘Morris Affordable Housing In-
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frastructure’’ and inserting ‘‘Morris Housing Au-
thority’’; 
(13) the item relating to ‘‘Rehabilitation of His-
toric Alumni House as Skills-based Workforce Devel-
opment Community Center’’ is deemed to be amend-
ed by striking ‘‘Historic Alumni House as’’ and in-
serting ‘‘a building for a’’; 
(14) the item relating to ‘‘Mt. Airy/German-
town Streetscape Improvement and Reconnection’’ is 
deemed to be amended by striking recipient ‘‘Mt. 
Airy Business Improvement District’’ and inserting 
‘‘City of Philadelphia’’; 
(15) the item relating to ‘‘YMCA of Greater 
Pittsburgh’’ is deemed to be amended by striking 
‘‘YMCA of Greater Pittsburgh’’ and inserting ‘‘Alle-
gheny YMCA Renovation’’; 
(16) the item relating to ‘‘Corn Maiden Early 
Learning Center’’ is deemed to be amended by strik-
ing recipient ‘‘Corn Maiden Early Learning Center’’ 
and inserting ‘‘Indian Pueblo Cultural Center’’; 
(17) the item relating to ‘‘10th Street Realign-
ment Project Overpass Project’’ is deemed to be 
amended by striking recipient ‘‘City of Richmond’’ 
and inserting ‘‘Fort Bend County’’; and 
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643 
(18) the item relating to ‘‘S. Roosevelt Road 
Share Use Path’’ is deemed to be amended by strik-
ing ‘‘S. Roosevelt Road’’. 
(d) Each amendment made by subsection (a) shall be 
considered and treated as a continuation of an existing 
obligation of funds and not as a new obligation of funds. 
(e) Amounts made available under the heading ‘‘De-
partment of Transportation—Consolidated Rail Infra-
structure and Safety Improvements’’ for the item relating 
to ‘‘Midway Crossing’’ in the table of projects entitled 
‘‘Community Project Funding/Congressionally Directed 
Spending’’ in the explanatory statement for division L of 
the Consolidated Appropriations Act, 2023 (Public Law 
117–328) described in section 4 in the matter preceding 
division A of such Act shall be transferred to ‘‘Department 
of Transportation—Transit Infrastructure Grants’’ and 
shall be available under the heading to which transferred 
for its original purpose. 
(1) The item relating to ‘‘Midway Crossing’’ is 
deemed to be amended by striking account ‘‘Consoli-
dated Rail Infrastructure and Safety Improvements’’ 
and inserting ‘‘Transit Infrastructure Grants’’ in the 
table of projects entitled ‘‘Community Project Fund-
ing/Congressionally Directed Spending’’ in the ex-
planatory statement for division L of the Consoli-
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644 
dated Appropriations Act, 2023 (Public Law 117– 
328) described in section 4 in the matter preceding 
division A of such Act. 
SEC. 422. The Department of Transportation and the 
Department of Housing and Urban Development shall 
provide the House and Senate Committees on Appropria-
tions: 
(1) quarterly reports on the status of all funds, 
including the start of year unobligated and uncom-
mitted balances, and the total obligations and recap-
tures for the fiscal year, by program, project, and 
activity; 
(2) semiannual reports on staffing levels, 
hirings, and separations (including through the de-
ferred resignation program and any other voluntary 
retirement programs), consistent with direction pro-
vided in this Act or the explanatory statement de-
scribed in section 4 (in the matter preceding division 
A of this consolidated Act); and 
(3) additional, updated budget or financial tech-
nical assistance, upon request. 
SEC. 423. Each Department and agency funded in 
this Act shall maintain on its publicly accessible website: 
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(1) notices of funding opportunities (including 
any amendments) for all competitive grant programs 
issued in the most recent 10 years; 
(2) grant awards for the most recent 10 years; 
and 
(3) programmatic notices, guidance, and grant 
agreement templates for any grant program with 
disbursement activity within the previous 5 fiscal 
years. 
SEC. 424. No later than 30 days after the date of 
enactment of this Act, and annually thereafter, the De-
partments and agencies funded under this Act shall sub-
mit a report to the House and Senate Committees on Ap-
propriations on current staffing levels for all political and 
Presidential appointees in such Departments and agencies 
and categorized by which office within such Departments 
and agencies such employee is funded from, the office in 
which such employee carries out their daily work, such em-
ployee’s title, and such employee’s pay grade or the equiv-
alent level based on the GS-scale. 
SEC. 425. The assistance made available under para-
graph (5)(B) under the heading ‘‘Public and Indian Hous-
ing—Tenant-Based Rental Assistance’’ in title II of this 
Act shall be known and designated as ‘‘The Melania 
Trump Foster Youth to Independence Initiative’’. 
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646 
SEC. 426. (a) In the table titled ‘‘Community Project 
Funding/Congressionally Directed Spending’’ in the ex-
planatory statement for division A of the Commerce, Jus-
tice, Science; Energy and Water Development; and Inte-
rior and Environment Appropriations Act, 2026 described 
in section 4 in the matter preceding division A of such 
Act— 
(1) the contents in the ‘‘Senate’’ sub column of 
the ‘‘Requestor(s)’’ column are deemed to be amend-
ed by inserting ‘‘Kaine, Warner’’ for the project 
identified as the ‘‘Center of Excellence in Environ-
mental Forecasting’’ for the recipient ‘‘Virginia In-
stitute of Marine Science’’; 
(2) the contents in the ‘‘Recipient’’ column are 
deemed to be amended by— 
(A) inserting ‘‘Research Foundation of 
the’’ before ‘‘City University of New York on 
behalf of Medgar Evers College’’ for the project 
identified as ‘‘Advancing Scientific Research 
Capabilities’’; 
(B) inserting ‘‘Research Foundation of 
the’’ before ‘‘State University of New York on 
behalf of the University at Buffalo’’ for the 
project identified as ‘‘Center of Excellence for 
Cross-Border Supply Chains’’; 
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(C) striking ‘‘Game Department/Great Bay 
National Estuarine Research’’ and inserting 
‘‘New Hampshire Fish and Game Department/ 
Great Bay National Estuarine Research Re-
serve’’ for the project identified as ‘‘Great Bay 
National Estuarine Research Reserve: Research 
Facility’’; 
(D) striking ‘‘of Albany’’ and inserting ‘‘at 
Albany’’ for the project identified as ‘‘UAlbany 
CNSE 200mm Wafer Cleanroom Equipment 
Upgrade’’; and 
(E) striking ‘‘Penn’’ and inserting ‘‘Pen-
nington’’ for the project identified as ‘‘Jail 
Tech Upgrades’’; and 
(3) the contents in the ‘‘Project’’ column are 
deemed to be amended by inserting— 
(A) ‘‘Chip Design Hub: Advanced Chip 
Design, Testing and’’ before ‘‘Fabrication Lab-
oratory Equipment for Preparing the Semicon-
ductor Workforce’’ for recipient ‘‘Florida Atlan-
tic University’’; 
(B) ‘‘University of Texas at Dallas Com-
parative Effectiveness of’’ before ‘‘North Texas 
Workforce Development Programs for Semi-
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conductors’’ for recipient ‘‘The University of 
Texas at Dallas’’; 
(C) ‘‘D’Youville University School of Phar-
macy Sterile’’ before ‘‘Compounding and Non- 
Sterile Hazardous Compounding Lab’’ for re-
cipient ‘‘D’Youville University’’; 
(D) ‘‘Building the Workforce of the Future 
Generation By’’ before ‘‘Empowering Under-
served Students with Technology-based STEM 
Education’’ for recipient ‘‘Research Foundation 
of CUNY’’; 
(E) ‘‘Additive Construction and Manufac-
turing Equipment for’’ before ‘‘Affordable and 
Resilient Housing Research and Workforce De-
velopment’’ for recipient ‘‘Rowan University’’; 
and 
(F) ‘‘Interdisciplinary Engineering & Com-
puting initiative to’’ before ‘‘Advance Semicon-
ductor Industry and National Security Project’’ 
for recipient ‘‘Florida International University’’. 
(b) The table titled ‘‘Department of Commerce Allo-
cation of National Institute of Standards and Technology 
Funds: CHIPS Act Fiscal Year 2026’’ in the explanatory 
statement for division A of the Commerce, Justice, 
Science; Energy and Water Development; and Interior and 
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Environment Appropriations Act, 2026 described in sec-
tion 4 in the matter preceding division A of such Act is 
deemed to be amended by striking ‘‘(1,000,000)’’ and in-
serting ‘‘(100,000)’’ for the ‘‘Administrative Expenses’’ 
project and activity. 
(c) In the table titled ‘‘Interior and Environment In-
corporation of Community Project Funding/Congression-
ally Directed Spending Items’’ in the explanatory state-
ment for division C of the Commerce, Justice, Science; 
Energy and Water Development; and Interior and Envi-
ronment Appropriations Act, 2026 described in section 4 
in the matter preceding division A of such Act, the con-
tents in the ‘‘Project Recipient and Name’’ column for the 
‘‘STAG—Other (CDS)’’ account are deemed to be amend-
ed by striking ‘‘COR Healthy Communities for Waste Im-
provement System’’ and inserting ‘‘Oregon Metro for 
Waste Improvement System’’. 
(d) The Department of the Interior, Environment, 
and Related Agencies Appropriations Act, 2026, is amend-
ed— 
(1) in the matter preceding the first proviso 
under the heading ‘‘National Park Service—Oper-
ation of the National Park System’’ by striking 
‘‘$2,877,195,000’’ and inserting ‘‘$2,901,195,000’’, 
striking 
‘‘$148,285,000’’ 
and 
inserting 
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‘‘$157,165,000’’, and striking ‘‘$157,950,000’’ and 
inserting ‘‘$173,070,000’’; and 
(2) in the matter preceding the first proviso 
under the heading ‘‘National Park Service—Historic 
Preservation Fund’’, by striking ‘‘$205,059,000’’ 
and inserting ‘‘$181,059,000’’. 
This division may be cited as the ‘‘Transportation, 
Housing and Urban Development, and Related Agencies 
Appropriations Act, 2026’’. 
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DIVISION E—AUTHORIZING EX-
TENDERS 
AND 
TECHNICAL 
CORRECTIONS 
SEC. 5001. UNITED STATES GRAIN STANDARDS ACT EXTEN-
SION. 
Sections 7(j)(5), 7A(l)(4), and 21(e) of the United 
States Grain Standards Act (7 U.S.C. 79(j)(5), 79a(l)(4), 
87j(e)) shall be applied by substituting ‘‘September 30, 
2026’’ for ‘‘September 30, 2025’’ each place it appears. 
SEC. 5002. COMMODITY FUTURES TRADING COMMISSION 
WHISTLEBLOWER PROGRAM. 
Section 1(b) of Public Law 117–25 (135 Stat. 297; 
136 Stat. 2133; 136 Stat. 5984; 139 Stat. 46) is amended 
in each of paragraphs (3) and (4) by striking ‘‘September 
30, 2025’’ and inserting ‘‘September 30, 2026’’. 
SEC. 5003. FOREST SERVICE PARTICIPATION IN ACES PRO-
GRAM. 
Section 8302(b) of the Agricultural Act of 2014 (16 
U.S.C. 3851a(b)) shall be applied by substituting ‘‘Octo-
ber 1, 2026’’ for ‘‘October 1, 2023’’. 
SEC. 5004. EXTENSION OF NATIONAL FLOOD INSURANCE 
PROGRAM. 
(a) FINANCING.—Section 1309(a) of the National 
Flood Insurance Act of 1968 (42 U.S.C. 4016(a)) is 
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amended, in the first sentence, by striking ‘‘September 30, 
2023’’ and inserting ‘‘September 30, 2026’’. 
(b) PROGRAM EXPIRATION.—Section 1319 of the Na-
tional Flood Insurance Act of 1968 (42 U.S.C. 4026) is 
amended by striking ‘‘September 30, 2023’’ and inserting 
‘‘September 30, 2026’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
this section shall take effect immediately upon the 
date of enactment of this Act. 
(2) ALTERNATE DATE.—If this Act is enacted 
after January 30, 2026, this section shall take effect 
as if enacted on January 30, 2026. 
SEC. 5005. EXTENSION OF REIMBURSABLE SCREENING 
SERVICES PROGRAM. 
Section 225(e) of the Department of Homeland Secu-
rity Appropriations Act, 2019 (division A of Public Law 
116–6; 49 U.S.C. 44901 note) is amended by striking 
‘‘2025’’ and inserting ‘‘2026’’. 
SEC. 5006. MOTOR CARRIER SAFETY ADVISORY COM-
MITTEE. 
Section 4144(d) of the Motor Carrier Safety Reau-
thorization Act of 2005 (49 U.S.C. 31100 note; Public 
Law 109–59) shall be applied by substituting ‘‘September 
30, 2026’’ for ‘‘September 30, 2025’’. 
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SEC. 5007. NATIONAL CYBERSECURITY PROTECTION SYS-
TEM AUTHORIZATION. 
Section 227(a) of the Federal Cybersecurity En-
hancement Act of 2015 (6 U.S.C. 1525(a)) is amended 
by striking ‘‘September 30, 2025’’ and inserting ‘‘Sep-
tember 30, 2026’’. 
SEC. 5008. CYBERSECURITY INFORMATION SHARING ACT 
OF 2015. 
Section 111(a) of the Cybersecurity Information 
Sharing Act of 2015 (6 U.S.C. 1510(a)) is amended by 
striking ‘‘September 30, 2025’’ and inserting ‘‘September 
30, 2026’’. 
SEC. 5009. STATE AND LOCAL CYBERSECURITY GRANT PRO-
GRAM. 
Section 2220A(s)(1) of the Homeland Security Act 
of 2002 (6 U.S.C. 665g(s)(1)) is amended by striking 
‘‘September 30, 2025’’ and inserting ‘‘September 30, 
2026’’. 
SEC. 5010. EXTENSION OF THE TECHNOLOGY MODERNIZA-
TION FUND AND BOARD. 
Section 1078(f)(1) of the National Defense Author-
ization Act for Fiscal Year 2018 (40 U.S.C. 11301 note) 
is amended by striking ‘‘On and after the date that is 2 
years after the date on which the Comptroller General of 
the United States issues the third report required under 
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subsection (b)(7)(B)’’ and inserting ‘‘After September 30, 
2026’’. 
SEC. 5011. EXTENSION OF EXISTENCE OF PAROLE COMMIS-
SION. 
Any expiration date established by section 235(b) of 
the Sentencing Reform Act of 1984 (18 U.S.C. 3551 note; 
Public Law 98–473), as such section relates to chapter 
311 of title 18, United States Code, and the United States 
Parole Commission, shall not apply during the period be-
ginning on October 1, 2025, and ending on January 30, 
2031. 
SEC. 5012. ADDITIONAL SPECIAL ASSESSMENT. 
Section 3014(a) of title 18, United States Code, is 
amended by striking ‘‘and ending on September 30, 
2025’’. 
SEC. 5013. RURAL HEALTHCARE WORKERS. 
Section 220(c) of the Immigration and Nationality 
Technical Corrections Act of 1994 (8 U.S.C. 1182 note) 
shall be applied by substituting ‘‘September 30, 2026’’ for 
‘‘September 30, 2015’’. 
SEC. 5014. E-VERIFY. 
Section 401(b) of the Illegal Immigration Reform and 
Immigrant Responsibility Act of 1996 (8 U.S.C. 1324a 
note) shall be applied by substituting ‘‘September 30, 
2026’’ for ‘‘September 30, 2015’’. 
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SEC. 5015. NON-MINISTER RELIGIOUS WORKERS. 
Section 101(a)(27)(C)(ii) of the Immigration and 
Nationality Act (8 U.S.C. 1101(a)(27)(C)(ii)) shall be ap-
plied by substituting ‘‘September 30, 2026’’ for ‘‘Sep-
tember 30, 2015’’ each place such date appears. 
SEC. 5016. H-2B SUPPLEMENTAL VISA EXEMPTION. 
Notwithstanding the numerical limitation set forth in 
section 214(g)(1)(B) of the Immigration and Nationality 
Act (8 U.S.C. 1184(g)(1)(B)), the Secretary of Homeland 
Security, after consultation with the Secretary of Labor, 
and upon the determination that the needs of United 
States businesses cannot be satisfied during fiscal year 
2026 with United States workers who are willing, quali-
fied, and able to perform temporary nonagricultural labor, 
may increase the total number of aliens who may receive 
a visa under section 101(a)(15)(H)(ii)(b) of such Act (8 
U.S.C. 1101(a)(15)(H)(ii)(b)) in such fiscal year by not 
more than the highest number of H–2B nonimmigrants 
who participated in the H–2B returning worker program 
in any fiscal year in which returning workers were exempt 
from such numerical limitation. 
SEC. 5017. EMERGENCY AUTHORITY FOR SENTENCING 
COMMISSION. 
(a) IN GENERAL.—The United States Sentencing 
Commission (in this section, referred to as the ‘‘Commis-
sion’’) shall promulgate the guidelines or amendments pro-
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vided for under section 8605(e) of the SAFER SKIES Act 
(title LXXXVI of Public Law 119–60) as soon as possible 
after the date of enactment of such Act, and in any event 
not later than December 31, 2026, notwithstanding the 
deadline under section 994(p) of title 28, United States 
Code. 
(b) EFFECTIVE DATE.—The amendments to the 
guidelines promulgated under subsection (a) shall take ef-
fect 180 days after the date of promulgation by the Com-
mission, except to the extent that the effective date is re-
vised or the amendment is otherwise modified or dis-
approved by an Act of Congress, and shall supersede any 
amendment to the contrary contained in the amendments 
to the sentencing guidelines submitted to Congress by the 
Commission on or about May 1, 2026. 
(c) RULE OF CONSTRUCTION.—The requirements of 
this section shall supersede the timeline set forth in sec-
tion 8605(e)(1) of the SAFER SKIES Act (title LXXXVI 
of Public Law 119–60). 
SEC. 5018. BANKRUPTCY FEES. 
(a) IN GENERAL.—Section 126 of the Continuing 
Appropriations Act, 2026 (division A of the Continuing 
Appropriations, Agriculture, Legislative Branch, Military 
Construction and Veterans Affairs, and Extensions Act, 
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2026 (Public Law 119–37; 139 Stat. 502)) is amended 
to read as follows: 
‘‘SEC. 126. Notwithstanding section 106, during the 
period ending on the last day of the first calendar quarter 
of 2026, section 1930(a)(6)(B)(i) of title 28, United 
States Code, shall be applied as if ‘during the 5-year pe-
riod’ were struck.’’. 
(b) APPLICATION OF AMENDMENTS MADE BY THE 
BANKRUPTCY ADMINISTRATION IMPROVEMENT ACT OF 
2025.— 
(1) IN
GENERAL.—Section 6(b)(2)(A) of the 
Bankruptcy Administration Improvement Act of 
2025 is amended by striking ‘‘on the’’ and inserting 
‘‘on or after the’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect as though enacted 
immediately after the enactment of the Bankruptcy 
Administration Improvement Act of 2025. 
SEC. 5019. EXTENSION OF AFRICAN GROWTH AND OPPOR-
TUNITY ACT. 
(a) EXTENSION OF PREFERENTIAL TREATMENT FOR 
CERTAIN
COUNTRIES
IN
AFRICA
UNDER
AFRICAN 
GROWTH AND OPPORTUNITY ACT; RETROACTIVE APPLI-
CATION.— 
(1) EXTENSION.— 
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(A) TRADE ACT OF 1974.—Section 506B of 
the Trade Act of 1974 (19 U.S.C. 2466b) is 
amended by striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’. 
(B) AFRICAN GROWTH AND OPPORTUNITY 
ACT.— 
(i) IN GENERAL.—Section 112(g) of 
the African Growth and Opportunity Act 
(19 U.S.C. 3721(g)) is amended by strik-
ing ‘‘September 30, 2025’’ and inserting 
‘‘December 31, 2026’’. 
(ii) 
REGIONAL
APPAREL
ARTICLE 
PROGRAM.—Section 112(b)(3)(A) of the 
African Growth and Opportunity Act (19 
U.S.C. 3721(b)(3)(A)) is amended— 
(I) in clause (i), by striking ‘‘21 
succeeding’’ and inserting ‘‘23 suc-
ceeding’’; and 
(II) in clause (ii)(II), by striking 
‘‘September 30, 2025’’ and inserting 
‘‘December 31, 2026’’. 
(iii) THIRD-COUNTRY
FABRIC
PRO-
GRAM.—Section 112(c)(1) of the African 
Growth and Opportunity Act (19 U.S.C. 
3721(c)(1)) is amended— 
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(I) in the paragraph heading, by 
striking ‘‘SEPTEMBER 30, 2025’’ and 
inserting ‘‘DECEMBER 31, 2026’’; 
(II) in subparagraph (A), by 
striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’; and 
(III) in subparagraph (B)(ii), by 
striking ‘‘September 30, 2025’’ and 
inserting ‘‘December 31, 2026’’. 
(2) RETROACTIVE APPLICATION.— 
(A) IN
GENERAL.—Notwithstanding sec-
tion 514 of the Tariff Act of 1930 (19 U.S.C. 
1514), section 112 of the African Growth and 
Opportunity Act (19 U.S.C. 3721), or any other 
provision of law, and subject to subparagraph 
(B), any entry of a covered article to which 
duty-free treatment or other preferential treat-
ment under section 506A of the Trade Act of 
1974 (19 U.S.C. 2466a) would have applied if 
the entry had been made on September 30, 
2025, that was made— 
(i) after September 30, 2025, and 
(ii) before the date of the enactment 
of this Act, 
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shall be liquidated or reliquidated as though 
such entry occurred on the date of the enact-
ment of this Act. 
(B) REQUESTS.—A liquidation or reliqui-
dation may be made under subparagraph (A) 
with respect to an entry only if a request there-
for is filed with the Commissioner of U.S. Cus-
toms and Border Protection not later than 180 
days after the date of the enactment of this Act 
that contains sufficient information to enable 
such Commissioner— 
(i) to locate the entry; or 
(ii) to reconstruct the entry if it can-
not be located. 
(C) PAYMENT OF AMOUNTS OWED.—Any 
amounts owed by the United States pursuant to 
the liquidation or reliquidation of an entry of a 
covered article under subparagraph (A) shall be 
paid, without interest of any kind, not later 
than 90 days after the date of the liquidation 
or reliquidation (as the case may be). 
(D) DEFINITIONS.—In this paragraph: 
(i) COVERED
ARTICLE.—The term 
‘‘covered article’’ means an article from a 
country that is designated by the President 
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661 
as a beneficiary sub-Saharan African coun-
try under section 104 of the African 
Growth and Opportunity Act (19 U.S.C. 
3703) as of the day before the date of the 
enactment of this Act. 
(ii) ENTRY.—The term ‘‘entry’’ in-
cludes a withdrawal from warehouse for 
consumption. 
(b) EXTENSION OF CUSTOMS USER FEES.— 
(1) IN GENERAL.—Section 13031(j)(3) of the 
Consolidated Omnibus Budget Reconciliation Act of 
1985 (19 U.S.C. 58c(j)(3)) is amended— 
(A) in subparagraph (A), by striking ‘‘Sep-
tember 30, 2031’’ and inserting ‘‘December 31, 
2031’’; and 
(B) in subparagraph (B)(i), by striking 
‘‘September 30, 2031’’ and inserting ‘‘Decem-
ber 31, 2031’’. 
(2) RATE
FOR
MERCHANDISE
PROCESSING 
FEES.—Section 503 of the United States-Korea 
Free Trade Agreement Implementation Act (Public 
Law 112–41;19 U.S.C. 3805 note) is amended by 
striking ‘‘September 30, 2031’’ and inserting ‘‘De-
cember 31, 2031’’. 
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662 
SEC. 5020. EXTENSION OF HAITI ECONOMIC LIFT PRO-
GRAM. 
(a) EXTENSION
OF SPECIAL RULES
FOR HAITI 
UNDER CARIBBEAN BASIN ECONOMIC RECOVERY ACT.— 
Section 213A of the Caribbean Basin Economic Recovery 
Act (19 U.S.C. 2703a) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1)— 
(i) 
by 
amending 
subparagraph 
(B)(v)(I) to read as follows: 
‘‘(I) 
APPLICABLE
PERCENT-
AGE.—The term ‘applicable percent-
age’ means 60 percent or more on and 
after December 20, 2017.’’; and 
(ii) by amending subparagraph (C) to 
read as follows: 
‘‘(C) QUANTITATIVE
LIMITATIONS.—The 
preferential treatment described in subpara-
graph (A) shall be extended, during each period 
after the initial applicable 1-year period, to not 
more than 1.25 percent of the aggregate square 
meter equivalents of all apparel articles im-
ported into the United States in the most re-
cent 12-month period for which data are avail-
able.’’; and 
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(B) in paragraph (2), by striking ‘‘in each 
of the 16 succeeding 1-year periods’’ each place 
it appears and inserting ‘‘in any of the suc-
ceeding 1-year periods’’; and 
(2) by amending subsection (h) to read as fol-
lows: 
‘‘(h) TERMINATION.—The duty-free treatment pro-
vided under this section shall remain in effect until De-
cember 31, 2026.’’. 
(b) RESTORATION OF ELIGIBILITY OF CERTAIN AR-
TICLES FOR PREFERENTIAL TREATMENT.— 
(1) IN GENERAL.—The President shall proclaim 
such modifications to the Harmonized Tariff Sched-
ule of the United States as may be necessary to re-
store the eligibility of articles described in paragraph 
(2) for preferential treatment under section 213A of 
the Caribbean Basin Economic Recovery Act (19 
U.S.C. 2703a). 
(2) ARTICLES
DESCRIBED.—An article de-
scribed in this paragraph is an article that— 
(A) was eligible for preferential treatment 
under section 213A of the Caribbean Basin 
Economic Recovery Act (19 U.S.C. 2703a) on 
December 20, 2006; and 
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(B) became ineligible for such treatment 
after that date and before the date of the enact-
ment of this Act as a result of revisions to the 
Harmonized Tariff Schedule. 
(3) EFFECTIVE DATE OF PROCLAMATION.—A 
proclamation under paragraph (1) shall take effect 
not earlier than 2 business days after the President 
submits to the Committee on Finance of the Senate 
and the Committee on Ways and Means of the 
House of Representatives a report on the proclama-
tion and the reasons for the modifications to the 
Harmonized Tariff Schedule under the proclamation. 
(c) RETROACTIVE APPLICATION.— 
(1) IN GENERAL.—Notwithstanding section 514 
of the Tariff Act of 1930 (19 U.S.C. 1514) or any 
other provision of law, and subject to paragraph (2), 
any entry of a covered article to which duty-free 
treatment or other preferential treatment under the 
Caribbean Basin Economic Recovery Act (19 U.S.C. 
2701 et seq.) would have applied if the entry had 
been made before September 30, 2025, that was 
made— 
(A) on or after September 30, 2025, and 
(B) before the date of the enactment of 
this Act, 
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shall be liquidated or reliquidated as though such 
entry occurred on the date of the enactment of this 
Act. 
(2) REQUESTS.—A liquidation or reliquidation 
may be made under paragraph (1) with respect to 
an entry only if a request therefor is filed with the 
Commissioner of U.S. Customs and Border Protec-
tion not later than 180 days after the date of the 
enactment of this Act that contains sufficient infor-
mation to enable such Commissioner— 
(A) to locate the entry; or 
(B) to reconstruct the entry if it cannot be 
located. 
(3) 
PAYMENT
OF
AMOUNTS
OWED.—Any 
amounts owed by the United States pursuant to the 
liquidation or reliquidation of an entry of a covered 
article under paragraph (1) shall be paid, without 
interest of any kind, not later than 90 days after the 
date of the liquidation or reliquidation (as the case 
may be). 
(4) DEFINITIONS.—In this subsection: 
(A) COVERED ARTICLE.—The term ‘‘cov-
ered article’’ means an article from Haiti. 
(B) ENTRY.—The term ‘‘entry’’ includes a 
withdrawal from warehouse for consumption. 
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SEC. 5021. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this division and each succeeding division 
shall not be entered on either PAYGO scorecard main-
tained pursuant to section 4(d) of the Statutory Pay-As- 
You-Go Act of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this division and each succeeding division shall 
not be entered on any PAYGO scorecard maintained for 
purposes of section 4106 of H. Con. Res. 71 (115th Con-
gress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 105–217 and section 250(c)(8) of the Balanced 
Budget and Emergency Deficit Control Act of 1985, the 
budgetary effects of this division and each succeeding divi-
sion shall not be estimated— 
(1) for purposes of section 251 of such Act; 
(2) for purposes of an allocation to the Com-
mittee on Appropriations pursuant to section 302(a) 
of the Congressional Budget Act of 1974; and 
(3) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
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DIVISION F—HEALTH CARE 
EXTENDERS 
SEC. 6001. TABLE OF CONTENTS. 
The table of contents of this division is as follows: 
DIVISION F—HEALTH CARE EXTENDERS 
Sec. 6001. Table of contents. 
TITLE I—MEDICAID 
Sec. 6101. Streamlined enrollment process for eligible out-of-State providers 
under Medicaid and CHIP. 
Sec. 6102. Removing certain age restrictions on Medicaid eligibility for working 
adults with disabilities. 
Sec. 6103. Medicaid State plan requirement for determining residency and cov-
erage for military families. 
Sec. 6104. State studies and HHS report on costs of providing maternity, 
labor, and delivery services. 
Sec. 6105. Modifying certain disproportionate share hospital allotments. 
Sec. 6106. Modifying certain limitations on disproportionate share hospital pay-
ment adjustments under the Medicaid program. 
TITLE II—MEDICARE 
Sec. 6201. Extension of increased inpatient hospital payment adjustment for 
certain low-volume hospitals. 
Sec. 6202. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 6203. Extension of add-on payments for ambulance services. 
Sec. 6204. Extending incentive payments for participation in eligible alternative 
payment models. 
Sec. 6205. Extension of funding for quality measure endorsement, input, and 
selection. 
Sec. 6206. Extension of funding outreach and assistance for low-income pro-
grams. 
Sec. 6207. Extension of funding for Medicare hospice surveys. 
Sec. 6208. Extension of the work geographic index floor. 
Sec. 6209. Extension of certain telehealth flexibilities. 
Sec. 6210. Extending acute hospital care at home waiver flexibilities. 
Sec. 6211. In-home cardiopulmonary rehabilitation flexibility. 
Sec. 6212. Enhancing certain program integrity requirements for DME under 
Medicare. 
Sec. 6213. Guidance on furnishing services via telehealth to individuals with 
limited English proficiency. 
Sec. 6214. Inclusion of virtual diabetes prevention program suppliers in MDPP 
Expanded Model. 
Sec. 6215. Medication-induced movement disorder outreach and education. 
Sec. 6216. Report on wearable medical devices. 
Sec. 6217. Extension of temporary inclusion of authorized oral antiviral drugs 
as covered part D drugs. 
Sec. 6218. Extension of adjustment to calculation of hospice cap amount under 
Medicare. 
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Sec. 6219. Adjustments to Medicare part D cost-sharing reductions for low-in-
come individuals. 
Sec. 6220. Requiring Enhanced and Accurate Lists of (REAL) Health Pro-
viders Act. 
Sec. 6221. Medicare coverage of multi-cancer early detection screening tests. 
Sec. 6222. Medicare coverage of external infusion pumps and non-self-admin-
istrable home infusion drugs. 
Sec. 6223. Assuring pharmacy access and choice for medicare beneficiaries. 
Sec. 6224. Modernizing and ensuring PBM accountability. 
Sec. 6225. Requiring a separate identification number and an attestation for 
each off-campus outpatient department of a provider. 
Sec. 6226. Revising phase-in of medicare clinical laboratory test payment 
changes. 
Sec. 6227. Medicare sequestration. 
Sec. 6228. Medicare Improvement Fund. 
TITLE III—HUMAN SERVICES 
Sec. 6301. Sexual risk avoidance education extension. 
Sec. 6302. Personal responsibility education extension. 
Sec. 6303. Extension of funding for family-to-family health information centers. 
Sec. 6304. Extension of the Temporary Assistance for Needy Families Pro-
gram. 
TITLE IV—PUBLIC HEALTH AND OTHER EXTENDERS 
Subtitle A—Extensions 
Sec. 6401. Extension for community health centers, National Health Service 
Corps, and teaching health centers that operate GME pro-
grams. 
Sec. 6402. Extension of special diabetes programs. 
Sec. 6403. Extension of national health security programs. 
Sec. 6404. No Surprises Act implementation. 
Subtitle B—World Trade Center Health Program 
Sec. 6411. 9/11 responder and survivor health funding corrections. 
TITLE V—PUBLIC HEALTH PROGRAMS 
Sec. 6501. Preventing maternal deaths. 
Sec. 6502. Organ Procurement and Transplantation Network. 
Sec. 6503. Honor our living donors. 
Sec. 6504. Program for pediatric studies of drugs. 
Sec. 6505. Sickle cell disease prevention and treatment. 
Sec. 6506. Lifespan respite care. 
Sec. 6507. PREEMIE. 
Sec. 6508. Dr. Lorna Breen health care provider protection. 
TITLE VI—FOOD AND DRUG ADMINISTRATION 
Subtitle A—Mikaela Naylon Give Kids a Chance Act 
Sec. 6601. Research into pediatric uses of drugs; additional authorities of Food 
and Drug Administration regarding molecularly targeted can-
cer drugs. 
Sec. 6602. Ensuring completion of pediatric study requirements. 
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Sec. 6603. FDA report on PREA enforcement. 
Sec. 6604. Extension of authority to issue priority review vouchers to encourage 
treatments for rare pediatric diseases. 
Sec. 6605. Limitations on exclusive approval or licensure of orphan drugs. 
Subtitle B—United States-Abraham Accords Cooperation and Security 
Sec. 6611. Establishment of Abraham Accords Office within Food and Drug 
Administration. 
TITLE VII—LOWERING PRESCRIPTION DRUG COSTS 
Sec. 6701. Oversight of pharmacy benefit management services. 
Sec. 6702. Full rebate pass through to plan; exception for innocent plan fidu-
ciaries. 
Sec. 6703. Increasing transparency in generic drug applications. 
TITLE I—MEDICAID 
SEC. 6101. STREAMLINED ENROLLMENT PROCESS FOR ELI-
GIBLE 
OUT-OF-STATE 
PROVIDERS 
UNDER 
MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1902(kk) of the Social Se-
curity Act (42 U.S.C. 1396a(kk)) is amended by adding 
at the end the following new paragraph: 
‘‘(10) STREAMLINED
ENROLLMENT
PROCESS 
FOR ELIGIBLE OUT-OF-STATE PROVIDERS.— 
‘‘(A) IN GENERAL.—The State— 
‘‘(i) adopts and implements a process 
to allow an eligible out-of-State provider to 
enroll under the State plan (or a waiver of 
such plan) to furnish items and services to, 
or order, prescribe, refer, or certify eligi-
bility for items and services for, qualifying 
individuals without the imposition of 
screening or enrollment requirements by 
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670 
such State that exceed the minimum nec-
essary for such State to provide payment 
to an eligible out-of-State provider under 
such State plan (or a waiver of such plan), 
such as the provider’s name and National 
Provider Identifier (and such other infor-
mation specified by the Secretary); and 
‘‘(ii) provides that an eligible out-of- 
State provider that enrolls as a partici-
pating provider in the State plan (or a 
waiver of such plan) through such process 
shall be so enrolled for a 5-year period, un-
less the provider is terminated or excluded 
from participation during such period. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) ELIGIBLE
OUT-OF-STATE
PRO-
VIDER.—The term ‘eligible out-of-State 
provider’ means, with respect to a State, a 
provider— 
‘‘(I) that is located in any other 
State; 
‘‘(II) that— 
‘‘(aa) was determined by the 
Secretary to have a limited risk 
of fraud, waste, and abuse for 
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671 
purposes of determining the level 
of screening to be conducted 
under section 1866(j)(2), has 
been so screened under such sec-
tion 1866(j)(2), and is enrolled in 
the Medicare program under title 
XVIII; or 
‘‘(bb) was determined by the 
State agency administering or su-
pervising the administration of 
the State plan (or a waiver of 
such plan) of such other State to 
have a limited risk of fraud, 
waste, and abuse for purposes of 
determining the level of screening 
to be conducted under paragraph 
(1) of this subsection, has been 
so screened under such para-
graph (1), and is enrolled under 
such State plan (or a waiver of 
such plan); and 
‘‘(III) that has not been— 
‘‘(aa) excluded from partici-
pation in any Federal health care 
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672 
program 
pursuant 
to 
section 
1128 or 1128A; 
‘‘(bb) excluded from partici-
pation in the State plan (or a 
waiver of such plan) pursuant to 
part 1002 of title 42, Code of 
Federal Regulations (or any suc-
cessor regulation), or State law; 
or 
‘‘(cc) terminated from par-
ticipating in a Federal health 
care program or the State plan 
(or a waiver of such plan) for a 
reason described in paragraph 
(8)(A). 
‘‘(ii) QUALIFYING
INDIVIDUAL.—The 
term ‘qualifying individual’ means an indi-
vidual under 21 years of age who is en-
rolled under the State plan (or waiver of 
such plan). 
‘‘(iii) 
STATE.—The 
term 
‘State’ 
means 1 of the 50 States or the District 
of Columbia.’’. 
(b) CONFORMING AMENDMENTS.— 
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673 
(1) Section 1902(a)(77) of the Social Security 
Act (42 U.S.C. 1396a(a)(77)) is amended by insert-
ing ‘‘enrollment,’’ after ‘‘screening,’’. 
(2) 
The 
subsection 
heading 
for 
section 
1902(kk) of such Act (42 U.S.C. 1396a(kk)) is 
amended by inserting ‘‘enrollment,’’ after ‘‘screen-
ing,’’. 
(3) Section 2107(e)(1)(G) of such Act (42 
U.S.C. 1397gg(e)(1)(G)) is amended by inserting 
‘‘enrollment,’’ after ‘‘screening,’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 3 years 
after the date of enactment of this Act. 
SEC. 6102. REMOVING CERTAIN AGE RESTRICTIONS ON 
MEDICAID 
ELIGIBILITY 
FOR 
WORKING 
ADULTS WITH DISABILITIES. 
(a) MODIFICATION OF OPTIONAL BUY-IN GROUPS.— 
(1) IN
GENERAL.—Section 1902(a)(10)(A)(ii) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(10)(A)(ii)) is amended— 
(A) in subclause (XV)— 
(i) by striking ‘‘, but less than 65,’’; 
and 
(ii) by inserting ‘‘, including at least 
the 
group 
described 
in 
section 
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674 
1905(a)(xviii)’’ before the semicolon at the 
end; and 
(B) in subclause (XVI), by inserting ‘‘in-
cluding at least the group described in section 
1905(a)(xii),’’ after ‘‘the State may establish,’’. 
(2) INDIVIDUALS DESCRIBED.—Section 1905(a) 
of the Social Security Act (42 U.S.C. 1396d(a)) is 
amended— 
(A) in clause (xvi), by striking ‘‘or’’ at the 
end; 
(B) in clause (xvii), by adding ‘‘or’’ after 
the comma at the end; and 
(C) by adding after clause (xvii) the fol-
lowing new clause: 
‘‘(xviii) individuals who, but for earn-
ings in excess of the limit established 
under subsection (q)(2)(B), would be con-
sidered to be receiving supplemental secu-
rity income, and who are at least 16 years 
of age,’’. 
(3) 
DEFINITION
MODIFICATION.—Section 
1905(v)(1)(A) of the Social Security Act (42 U.S.C. 
1396d(v)(1)(A)) is amended by striking ‘‘, but less 
than 65,’’. 
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675 
(b) APPLICATION
TO CERTAIN STATES.—A State 
that, as of the date of enactment of this Act, provides for 
making medical assistance available to individuals de-
scribed 
in 
subclause 
(XV) 
or 
(XVI) 
of 
section 
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) shall not be regarded as failing to 
comply with the requirements of the amendments made 
by subsection (a) before January 1, 2028. 
SEC. 6103. MEDICAID STATE PLAN REQUIREMENT FOR DE-
TERMINING RESIDENCY AND COVERAGE FOR 
MILITARY FAMILIES. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (88), by striking ‘‘and’’ 
at the end; 
(B) in paragraph (89), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (89), the 
following new paragraph: 
‘‘(90) beginning January 1, 2030, provide, with 
respect to an active duty relocated individual (as de-
fined in subsection (yy)(1))— 
‘‘(A) that, for purposes of determining eli-
gibility for medical assistance under the State 
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676 
plan (or waiver of such plan), such active duty 
relocated individual is treated as a resident of 
the State unless such individual voluntarily 
elects not to be so treated for such purposes; 
‘‘(B) that if, at the time of relocation (as 
described in subsection (yy)(1)), such active 
duty relocated individual is on a home and com-
munity-based services waiting list (as defined in 
subsection (yy)(2)), such individual remains on 
such list until— 
‘‘(i) the State completes an assess-
ment and renders a decision with respect 
to the eligibility of such individual to re-
ceive the relevant home and community- 
based services at the time a slot for such 
services becomes available and, in the case 
such decision is a denial of such eligibility, 
such individual has exhausted the individ-
ual’s opportunity for a fair hearing; or 
‘‘(ii) such individual elects to be re-
moved from such list; and 
‘‘(C) payment for medical assistance fur-
nished under the State plan (or a waiver of the 
plan) on behalf of such active duty relocated in-
dividual in the military service relocation State 
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677 
(as referred to in subsection (yy)(1)(B)(i)), to 
the extent that such assistance is available in 
such military service relocation State in accord-
ance with such guidance as the Secretary may 
issue to ensure access to such assistance.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(yy) ACTIVE DUTY RELOCATED INDIVIDUAL; HOME 
AND COMMUNITY-BASED SERVICES WAITING LIST.—For 
purposes of subsection (a)(90) and this subsection: 
‘‘(1) ACTIVE DUTY RELOCATED INDIVIDUAL.— 
The term ‘active duty relocated individual’ means an 
individual— 
‘‘(A) who— 
‘‘(i) is enrolled under the State plan 
(or waiver of such plan); or 
‘‘(ii) with respect to an individual de-
scribed in subparagraph (C)(ii), would be 
so 
enrolled 
pursuant 
to 
subsection 
(a)(10)(A)(ii)(VI) if such individual began 
receiving home and community-based serv-
ices; 
‘‘(B) who— 
‘‘(i) is a member of the Armed Forces 
engaged in active duty service and is relo-
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678 
cated to another State (in this subsection 
referred to as the ‘military service reloca-
tion State’) by reason of such service; 
‘‘(ii) would be described in clause (i) 
except that the individual stopped being 
engaged in active duty service (including 
by reason of retirement from such service) 
and the last day on which the individual 
was engaged in active duty service oc-
curred not more than 12 months ago; or 
‘‘(iii) is a dependent (as defined by 
the Secretary) of a member described in 
clause (i) or (ii) who relocates to the mili-
tary service relocation State with such 
member; and 
‘‘(C) who— 
‘‘(i) was receiving home and commu-
nity-based services (as defined in section 
9817(a)(2)(B) of the American Rescue 
Plan Act of 2021) at the time of such relo-
cation; or 
‘‘(ii) if the State maintains a home 
and community-based services waiting list, 
was on such home and community-based 
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679 
services waiting list at the time of such re-
location. 
‘‘(2) HOME AND COMMUNITY-BASED SERVICES 
WAITING LIST.—The term ‘home and community- 
based services waiting list’ means, in the case of a 
State that has a limit on the number of individuals 
who may receive home and community-based services 
under section 1115(a) or section 1915(c), a list 
maintained by such State of individuals who are re-
questing to receive such services under 1 or more 
such sections but for whom the State has not yet 
completed an assessment and rendered a decision 
with respect to the eligibility of such individuals to 
receive the relevant home and community-based 
services at the time a slot for such services becomes 
available due to such limit.’’. 
(b) IMPLEMENTATION FUNDING.—There are appro-
priated, out of any funds in the Treasury not otherwise 
obligated, $1,000,000 for each of fiscal years 2026 
through 2030, to remain available until expended, to the 
Secretary of Health and Human Services for purposes of 
implementing the amendments made by subsection (a). 
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680 
SEC. 6104. STATE STUDIES AND HHS REPORT ON COSTS OF 
PROVIDING MATERNITY, LABOR, AND DELIV-
ERY SERVICES. 
(a) STATE STUDY.— 
(1) IN GENERAL.—Not later than 30 months 
after the date of enactment of this Act, and every 
5 years thereafter, each State (as such term is de-
fined in section 1101(a)(1) of the Social Security 
Act (42 U.S.C. 1301(a)(1)) for purposes of titles 
XIX and XXI of such Act) shall conduct a study on 
the costs of providing maternity, labor, and delivery 
services in applicable hospitals (as defined in para-
graph (3)) and submit the results of such study to 
the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’) in such 
form and manner as the Secretary requires. 
(2) CONTENT OF STUDY.—A State study re-
quired under paragraph (1) shall include the fol-
lowing information (to the extent practicable and as 
further defined by the Secretary) with respect to 
maternity, labor, and delivery services furnished by 
applicable hospitals located in the State: 
(A) An estimate of the cost of providing 
maternity, labor, and delivery services at appli-
cable hospitals, based on the expenditures a 
representative sample of such hospitals incurred 
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681 
for providing such services during the 2 most 
recent years for which data is available. 
(B) An estimate of the cost of providing 
maternity, labor, and delivery services at hos-
pitals that would be applicable hospitals (as de-
fined in paragraph (3)) if not for ceasing to 
provide labor and delivery services within the 
past 5 years, based on the expenditures a rep-
resentative sample of such hospitals incurred 
for providing such services during the 2 most 
recent years for which data is available. 
(C) To the extent data allow, an analysis 
of the extent to which geographic location, com-
munity demographics, and local economic fac-
tors (as defined by the Secretary) affect the 
cost of providing maternity, labor, and delivery 
services at applicable hospitals described in sub-
paragraphs (A) and (B), including the cost of 
services that support the provision of maternity, 
labor, and delivery services. 
(D) The amounts applicable hospitals are 
paid for maternity, labor, and delivery services, 
by geographic location and hospital size, 
under— 
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682 
(i) parts A and B of the Medicare 
program; 
(ii) the State Medicaid program, in-
cluding payment amounts for such services 
under fee-for-service payment arrange-
ments and under managed care (as appli-
cable); 
(iii) the State CHIP plan, including 
payment amounts for such services under 
fee-for-service payment arrangements and 
under managed care (as applicable); and 
(iv) private health insurance. 
(E) A comparative payment rate anal-
ysis— 
(i) comparing payment rates for ma-
ternity, labor, and delivery services (inclu-
sive of all payments received by applicable 
hospitals for furnishing maternity, labor, 
and delivery services) under the State 
Medicaid fee-for-service program to such 
payment rates for such services under 
Medicare (including those described in 
paragraphs 
(2) 
and 
(3) 
of 
section 
447.203(b) of title 42, Code of Federal 
Regulations), and, to the extent data is 
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683 
available, such payment rates for such 
services under Medicaid managed care and 
private health insurers within geographic 
areas of the State; and 
(ii) analyzing different payment meth-
ods for such services, such as the use of 
bundled payments, quality incentives, and 
low-volume adjustments. 
(F) An evaluation, using such methodology 
and parameters established by the Secretary, of 
whether each hospital located in the State that 
furnishes maternity, labor, and delivery services 
is expected to experience in the next 3 years 
significant changes in particular expenditures 
or types of reimbursement for maternity, labor, 
and delivery services. 
(3) APPLICABLE
HOSPITAL
DEFINED.—For 
purposes of this subsection, the term ‘‘applicable 
hospital’’ means any hospital located in a State that 
meets either of the following criteria: 
(A) The hospital provides labor and deliv-
ery services and more than 50 percent of the 
hospital’s births (in the most recent year for 
which such data is available) are financed by 
the Medicaid program or CHIP. 
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684 
(B) The hospital— 
(i) is located in a rural area (as de-
fined by the Federal Office of Rural 
Health Policy for the purpose of rural 
health grant programs administered by 
such Office); 
(ii) based on the most recent 2 years 
of data available (as determined by the 
Secretary), furnished services for less than 
an average of 300 births per year; and 
(iii) provides labor and delivery serv-
ices. 
(4) ASSISTANCE TO SMALL HOSPITALS IN COM-
PILING
COST
INFORMATION.—There are appro-
priated to the Secretary for fiscal year 2026, 
$10,000,000 for the purpose of providing grants and 
technical assistance to a hospital described in para-
graph (3)(B) to enable such hospital to compile de-
tailed information for use in the State studies re-
quired under paragraph (1), to remain available 
until expended. 
(5) HHS REPORT
ON
STATE
STUDIES.—For 
each year in which a State is required to conduct a 
study under paragraph (1), the Secretary shall issue, 
not later than 18 months after the date on which 
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685 
the State submits to the Secretary the data de-
scribed in such paragraph, a publicly available re-
port that compiles and details the results of such 
study and includes the information described in 
paragraph (2). 
(b) HHS REPORT ON NATIONAL DATA COLLECTION 
FINDINGS.—Not later than 3 years and 6 months after 
the date of enactment of this Act, the Secretary shall sub-
mit to Congress, and make publicly available, a report 
analyzing the first studies conducted by States under sub-
section (a)(1), including recommendations for improving 
data collection on the cost of providing maternity, labor, 
and delivery services. 
(c) IMPLEMENTATION FUNDING.—In addition to the 
amount appropriated under subsection (a)(4), there are 
appropriated, out of any funds in the Treasury not other-
wise obligated, $3,000,000 for fiscal year 2026, to remain 
available until expended, to the Secretary of Health and 
Human Services for purposes of implementing this sec-
tion. 
SEC. 
6105. 
MODIFYING 
CERTAIN 
DISPROPORTIONATE 
SHARE HOSPITAL ALLOTMENTS. 
(a) EXTENDING TENNESSEE DSH ALLOTMENTS.— 
Section 1923(f)(6)(A)(vi) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 
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686 
(1) in the heading, by striking ‘‘2025 AND A 
PORTION
OF
FISCAL
YEAR
2026’’ and inserting 
‘‘2027’’; and 
(2) by inserting ‘‘, and the DSH allotment for 
Tennessee for the portion of fiscal year 2026 begin-
ning on January 31, 2026, and ending September 
30, 2026, shall be $35,351,507, which may be 
claimed as fiscal year 2026 uncompensated care 
costs, and the DSH allotment for Tennessee for fis-
cal year 2027, shall be $53,100,000’’ before the pe-
riod. 
(b) ELIMINATING CERTAIN DSH ALLOTMENT RE-
DUCTIONS.—Section 1923(f)(7)(A) of the Social Security 
Act (42 U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘the period beginning January 31, 
2026, and ending September 30, 2026, and for 
each of fiscal years 2027 and 2028’’ and insert-
ing ‘‘fiscal year 2028’’; 
(B) in subclause (I), by striking ‘‘or pe-
riod’’; and 
(C) in subclause (II), by striking ‘‘or pe-
riod’’ each place it appears; and 
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687 
(2) in clause (ii), by striking ‘‘the period begin-
ning January 31, 2026, and ending September 30, 
2026, and for each of fiscal years 2027 and 2028’’ 
and inserting ‘‘fiscal year 2028’’. 
SEC. 6106. MODIFYING CERTAIN LIMITATIONS ON DIS-
PROPORTIONATE 
SHARE 
HOSPITAL 
PAY-
MENT ADJUSTMENTS UNDER THE MEDICAID 
PROGRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Se-
curity Act (42 U.S.C. 1396r–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) in the matter preceding clause (i), 
by striking ‘‘(other than a hospital de-
scribed in paragraph (2)(B))’’; 
(ii) in clause (i), by inserting ‘‘with 
respect to such hospital and year’’ after 
‘‘described in subparagraph (B)’’; and 
(iii) in clause (ii)— 
(I) in subclause (I), by striking 
‘‘and’’ at the end; 
(II) in subclause (II), by striking 
the period and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following new subclause: 
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688 
‘‘(III) payments made under title 
XVIII or by an applicable plan (as de-
fined in section 1862(b)(8)(F)) for 
such services.’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), 
by striking ‘‘in this clause are’’ and insert-
ing ‘‘in this subparagraph are, with respect 
to a hospital and a year,’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) Individuals who are eligible for 
medical assistance under the State plan or 
under a waiver of such plan and for whom 
the State plan or waiver is a payor for 
such services after application of benefits 
under title XVIII or under an applicable 
plan (as defined in section 1862(b)(8)(F)), 
but only if the hospital has in the aggre-
gate incurred costs exceeding payments 
under such State plan, waiver, title XVIII, 
or applicable plan for such services fur-
nished to such individuals during such 
year.’’; 
(2) by striking paragraph (2); 
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689 
(3) by redesignating paragraph (3) as para-
graph (2); and 
(4) in paragraph (2), as so redesignated, by 
striking ‘‘Notwithstanding paragraph (2) of this 
subsection (as in effect on October 1, 2021), para-
graph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to payment adjustments made under sec-
tion 1923 of the Social Security Act (42 U.S.C. 
1396r–4) for Medicaid State plan rate years begin-
ning on or after the date of enactment of this Act. 
(2) STATE OPTION TO DISTRIBUTE UNSPENT 
DSH ALLOTMENTS FROM PRIOR YEARS UP TO MODI-
FIED CAP.— 
(A) IN
GENERAL.—If, for any Medicaid 
State plan rate year that begins on or after Oc-
tober 1, 2022, and before the date of enactment 
of this Act, a State did not spend the full 
amount of its Federal fiscal year allotment 
under section 1923 of the Social Security Act 
(42 U.S.C. 1396r–4) applicable to that State 
plan rate year, the State may use the unspent 
portion of such allotment to increase the 
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690 
amount of any payment adjustment made to a 
hospital for such rate year, provided that— 
(i) such payment adjustment (as so 
increased) is consistent with subsection (g) 
of such section (as amended by this sec-
tion); and 
(ii) the total amount of all payment 
adjustments for the State plan rate year 
(as so increased) does not exceed the dis-
proportionate share hospital allotment for 
the State and applicable Federal fiscal 
year under subsection (f) of such section. 
(B) NO RECOUPMENT OF PAYMENTS AL-
READY MADE TO HOSPITALS.—A State shall not 
recoup any payment adjustment made by the 
State to a hospital for a Medicaid State plan 
rate year described in subparagraph (A) if such 
payment adjustment is consistent with section 
1923(g) of such Act (42 U.S.C. 1396r–4(g)) as 
in effect on October 1, 2021. 
(C) AUTHORITY TO PERMIT RETROACTIVE 
MODIFICATION OF STATE PLAN AMENDMENTS 
TO ALLOW FOR INCREASES.— 
(i) IN
GENERAL.—Subject to clause 
(ii), solely for the purpose of allowing a 
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691 
State to increase the amount of a payment 
adjustment to a hospital for a Medicaid 
State plan rate year described in subpara-
graph (A) pursuant to this paragraph, a 
State may retroactively modify a provision 
of the Medicaid State plan, a waiver of 
such plan, or a State plan amendment that 
relates to such rate year and the Secretary 
may approve such modification. 
(ii) DEADLINE.—A State may not 
submit a request for approval of a retro-
active modification to a provision of the 
Medicaid State plan, a waiver of such plan, 
or a State plan amendment for a Medicaid 
State plan rate year after the date by 
which the State is required to submit the 
independent certified audit for such State 
plan rate year as required under section 
1923(j)(2) of the Social Security Act (42 
U.S.C. 1396r–4(j)(2)). 
(D) REPORTING.—If a State increases a 
payment adjustment made to a hospital for a 
Medicaid State plan rate year pursuant to this 
paragraph, the State shall include information 
in such form and manner as the Secretary shall 
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692 
specify on such increased payment adjustment 
as part of the annual report submitted by the 
State under section 1923(j)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–4(j)(1)) for such 
State plan rate year or, if necessary, as deter-
mined by the Secretary, in an amendment to 
such annual report. 
TITLE II—MEDICARE 
SEC. 6201. EXTENSION OF INCREASED INPATIENT HOS-
PITAL PAYMENT ADJUSTMENT FOR CERTAIN 
LOW-VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), by striking ‘‘during 
the portion of fiscal year 2026 beginning on January 
31, 2026, and ending on September 30, 2026, and 
in fiscal year 2027’’ and inserting ‘‘during the por-
tion of fiscal year 2027 beginning on January 1, 
2027, and ending on September 30, 2027, and in 
fiscal year 2028’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘through 2025 and the portion of 
fiscal year 2026 beginning on October 1, 2025, 
and ending on January 30, 2026’’ and inserting 
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693 
‘‘through 2026 and the portion of fiscal year 
2027 beginning on October 1, 2026, and ending 
on December 31, 2026’’; 
(B) 
in 
subclause 
(III), 
by 
striking 
‘‘through 2025 and the portion of fiscal year 
2026 beginning on October 1, 2025, and ending 
on January 30, 2026’’ and inserting ‘‘through 
2026 and the portion of fiscal year 2027 begin-
ning on October 1, 2026, and ending on De-
cember 31, 2026’’; and 
(C) in subclause (IV), by striking ‘‘the por-
tion of fiscal year 2026 beginning on January 
31, 2026, and ending on September 30, 2026, 
and fiscal year 2027’’ and inserting ‘‘the por-
tion of fiscal year 2027 beginning on January 
1, 2027, and ending on September 30, 2027, 
and fiscal year 2028’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
striking ‘‘through 2025 or during the portion of 
fiscal year 2026 beginning on October 1, 2025, 
and ending on January 30, 2026’’ and inserting 
‘‘through 2026 or during the portion of fiscal 
year 2027 beginning on October 1, 2026, and 
ending on December 31, 2026’’; and 
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694 
(B) in clause (ii), by striking ‘‘through 
2025 and the portion of fiscal year 2026 begin-
ning on October 1, 2025, and ending on Janu-
ary 30, 2026’’ and inserting ‘‘through 2026 and 
the portion of fiscal year 2027 beginning on Oc-
tober 1, 2026, and ending on December 31, 
2026’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
SEC. 6202. EXTENSION OF THE MEDICARE-DEPENDENT 
HOSPITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
(1) in clause (i), by striking ‘‘January 31, 
2026’’ and inserting ‘‘January 1, 2027’’; and 
(2) in clause (ii)(II), by striking ‘‘January 31, 
2026’’ and inserting ‘‘January 1, 2027’’. 
(b) CONFORMING AMENDMENTS.— 
(1) IN
GENERAL.—Section 1886(b)(3)(D) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(D)) is amended— 
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695 
(A) in the matter preceding clause (i), by 
striking ‘‘January 31, 2026’’ and inserting 
‘‘January 1, 2027’’; and 
(B) in clause (iv), by striking ‘‘through fis-
cal year 2025 and the portion of fiscal year 
2026 beginning on October 1, 2025, and ending 
on January 30, 2026’’ and inserting ‘‘through 
fiscal year 2026 and the portion of fiscal year 
2027 beginning on October 1, 2026, and ending 
on December 31, 2026’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by striking ‘‘through fis-
cal year 2025, or the portion of fiscal year 2026 be-
ginning on October 1, 2025, and ending on January 
30, 2026’’ and inserting ‘‘through fiscal year 2026, 
or the portion of fiscal year 2027 beginning on Octo-
ber 1, 2026, and ending on December 31, 2026’’. 
SEC. 6203. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘January 
31, 2026’’ and inserting ‘‘January 1, 2028’’; and 
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697 
(ii) in the matter preceding clause (i), 
by inserting ‘‘and 2029’’ after ‘‘2027’’; 
and 
(C) in subparagraph (D), by striking ‘‘and 
2026’’ and inserting ‘‘2026, and 2028’’; and 
(3) in paragraph (4)(B), by inserting ‘‘, or, 
with respect to 2028, 3.1 percent’’ after ‘‘1.88 per-
cent’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), by inserting ‘‘and 2028’’ 
after ‘‘2026’’; and 
(2) in subclause (III), by inserting ‘‘and 2029’’ 
after ‘‘2027’’. 
SEC. 6205. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended— 
(1) in the first sentence— 
(A) by striking ‘‘and $13,300,000’’ and in-
serting ‘‘$13,300,000’’; and 
(B) by inserting the following before the 
period at the end: ‘‘, and $15,100,000 for fiscal 
year 2027’’; and 
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698 
(2) in the third sentence, by striking ‘‘and 
2026’’ and inserting ‘‘2026, and 2027’’. 
SEC. 6206. EXTENSION OF FUNDING OUTREACH AND AS-
SISTANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note) is amended— 
(1) in clause (xiv), by striking ‘‘and’’ at the 
end; 
(2) in clause (xv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xv) the following 
new clause: 
‘‘(xvi) for the period beginning on 
January 31, 2026, and ending on Decem-
ber 31, 2027, $30,000,000.’’. 
(b) 
AREA
AGENCIES
ON
AGING.—Subsection 
(b)(1)(B) of such section 119 is amended— 
(1) in clause (xiv), by striking ‘‘and’’ at the 
end; 
(2) in clause (xv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xv) the following 
new clause: 
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699 
‘‘(xvi) for the period beginning on 
January 31, 2026, and ending on Decem-
ber 31, 2027, $30,000,000.’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119 is amended— 
(1) in clause (xiv), by striking ‘‘and’’ at the 
end; 
(2) in clause (xv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xv) the following 
new clause: 
‘‘(xvi) for the period beginning on 
January 31, 2026, and ending on Decem-
ber 31, 2027, $10,000,000.’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
ERAL AND STATE PROGRAMS.—Subsection (d)(2) of such 
section 119 is amended— 
(1) in clause (xiv), by striking ‘‘and’’ at the 
end; 
(2) in clause (xv), by striking the period at the 
end and inserting ‘‘; and’’; and 
(3) by inserting after clause (xv) the following 
new clause: 
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700 
‘‘(xvi) for the period beginning on January 
31, 2026, and ending on December 31, 2027, 
$30,000,000.’’. 
SEC. 6207. EXTENSION OF FUNDING FOR MEDICARE HOS-
PICE SURVEYS. 
Section 3(a)(2) of the IMPACT Act of 2014 (Public 
Law 113–185), as amended by section 6205 of division 
F of the Continuing Appropriations, Agriculture, Legisla-
tive Branch, Military Construction and Veterans Affairs, 
and Extensions Act, 2026 (Public Law 119–37), is 
amended— 
(1) in subparagraph (B), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (C), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(D) $4,400,000 for the period beginning 
on January 31, 2026, and ending on December 
31, 2026, to remain available until expended.’’. 
SEC. 6208. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 31, 2026’’ and inserting ‘‘January 1, 2027’’. 
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701 
SEC. 6209. EXTENSION OF CERTAIN TELEHEALTH FLEXI-
BILITIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS
AND 
EXPANDING
ORIGINATING
SITES
FOR
TELEHEALTH 
SERVICES.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘end-
ing January 30, 2026’’ and inserting ‘‘ending De-
cember 31, 2027’’; and 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on January 30, 2026’’ and inserting ‘‘ending on De-
cember 31, 2027’’. 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) 
is amended by striking ‘‘ending on January 30, 2026’’ and 
inserting ‘‘ending on December 31, 2027’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FED-
ERALLY
QUALIFIED
HEALTH
CENTERS
AND
RURAL 
HEALTH CLINICS.—Section 1834(m)(8)(A) of the Social 
Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by 
striking ‘‘ending on January 30, 2026’’ and inserting 
‘‘ending on December 31, 2027’’. 
(d) DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE
FOR MENTAL HEALTH SERVICES 
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702 
FURNISHED
THROUGH
TELEHEALTH
AND
TELE-
COMMUNICATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—Section 1834(m)(7)(B)(i) of the Social 
Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
amended, in the matter preceding subclause (I), by 
striking ‘‘on or after January 31, 2026’’ and insert-
ing ‘‘on or after January 1, 2028’’. 
(2) MENTAL
HEALTH
VISITS
FURNISHED
BY 
RURAL HEALTH CLINICS.—Section 1834(y)(2) of the 
Social Security Act (42 U.S.C. 1395m(y)(2)) is 
amended by striking ‘‘January 31, 2026’’ and in-
serting ‘‘January 1, 2028’’. 
(3) MENTAL
HEALTH
VISITS
FURNISHED
BY 
FEDERALLY QUALIFIED HEALTH CENTERS.—Section 
1834(o)(4)(B) of the Social Security Act (42 U.S.C. 
1395m(o)(4)(B)) is amended by striking ‘‘January 
31, 2026’’ and inserting ‘‘January 1, 2028’’. 
(e) ALLOWING FOR THE FURNISHING OF AUDIO- 
ONLY TELEHEALTH SERVICES.—Section 1834(m)(9) of 
the Social Security Act (42 U.S.C. 1395m(m)(9)) is 
amended by striking ‘‘ending on January 30, 2026’’ and 
inserting ‘‘ending on December 31, 2027’’. 
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703 
(f) EXTENDING USE OF TELEHEALTH TO CONDUCT 
FACE-TO-FACE ENCOUNTER PRIOR TO RECERTIFICATION 
OF ELIGIBILITY FOR HOSPICE CARE.— 
(1) IN GENERAL.—Section 1814(a)(7)(D)(i)(II) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended— 
(A) by striking ‘‘ending on January 30, 
2026’’ and inserting ‘‘ending on December 31, 
2027’’; and 
(B) by inserting ‘‘, except that this sub-
clause shall not apply in the case of such an en-
counter with an individual occurring on or after 
January 31, 2026, if such individual is located 
in an area that is subject to a moratorium on 
the enrollment of hospice programs under this 
title pursuant to section 1866(j)(7), if such in-
dividual is receiving hospice care from a pro-
vider that is subject to enhanced oversight 
under this title pursuant to section 1866(j)(3), 
or if such encounter is performed by a hospice 
physician or nurse practitioner who is not en-
rolled under section 1866(j) and is not an opt- 
out physician or practitioner (as defined in sec-
tion 1802(b)(6)(D))’’ before the semicolon. 
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704 
(2) REQUIRING
USE
OF
MODIFIER.—Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(D)(i)(II)), as amended by para-
graph (1), is further amended by inserting ‘‘, but 
only if, in the case of such an encounter occurring 
on or after January 1, 2027, any hospice claim in-
cludes 1 or more modifiers or codes (as specified by 
the Secretary) to indicate that such encounter was 
conducted via telehealth’’ after ‘‘as determined ap-
propriate by the Secretary’’. 
(g) REQUIRING MODIFIERS FOR TELEHEALTH SERV-
ICES IN CERTAIN INSTANCES.—Section 1834(m) of the 
Social Security Act (42 U.S.C. 1395m(m)) is amended by 
adding at the end the following new paragraph: 
‘‘(10) REQUIRED USE OF MODIFIERS IN CER-
TAIN INSTANCES.—Not later than January 1, 2027, 
the Secretary shall establish requirements to include 
one or more codes or modifiers, as determined ap-
propriate by the Secretary, in the case of— 
‘‘(A) claims for telehealth services under 
this subsection that are furnished through a 
telehealth virtual platform— 
‘‘(i) by a physician or practitioner 
that contracts with an entity that owns 
such virtual platform; or 
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705 
‘‘(ii) for which a physician or practi-
tioner has a payment arrangement with an 
entity for use of such virtual platform; and 
‘‘(B) claims for telehealth services under 
this subsection that are furnished incident to a 
physician’s or practitioner’s professional serv-
ice.’’. 
(h) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
SEC. 6210. EXTENDING ACUTE HOSPITAL CARE AT HOME 
WAIVER FLEXIBILITIES. 
(a) IN GENERAL.—Section 1866G(a)(1) of the Social 
Security Act (42 U.S.C. 1395cc–7(a)(1)) is amended by 
striking ‘‘January 30, 2026’’ and inserting ‘‘September 
30, 2030’’. 
(b) REQUIRING ADDITIONAL STUDY AND REPORT.— 
Section 1866G of the Social Security Act (42 U.S.C. 
1395cc–7) is amended— 
(1) in subsection (a)(3)(E)— 
(A) in clause (ii), by striking ‘‘the study 
described in subsection (b)’’ and inserting ‘‘the 
studies described in subsections (b) and (c)’’; 
and 
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706 
(B) by adding at the end the following new 
flush sentence: 
‘‘The Secretary may require that such data and 
information be submitted through a hospital’s 
cost report, through such survey instruments as 
the Secretary may develop, through medical 
record information, or through such other 
means as the Secretary determines appro-
priate.’’; 
(2) in subsection (b)— 
(A) in the subsection heading, by striking 
‘‘STUDY’’ and inserting ‘‘INITIAL STUDY’’; and 
(B) in paragraph (3), by striking ‘‘sub-
section’’ and inserting ‘‘section’’; 
(3) by redesignating subsections (c) and (d) as 
subsections (d) and (e), respectively; 
(4) by inserting after subsection (b) the fol-
lowing new subsection: 
‘‘(c) SUBSEQUENT STUDY AND REPORT.— 
‘‘(1) IN GENERAL.—Not later than September 
30, 2029, the Secretary shall conduct a study to— 
‘‘(A) analyze, to the extent practicable, the 
criteria established by hospitals under the Acute 
Hospital Care at Home initiative to determine 
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707 
which individuals may be furnished services 
under such initiative; and 
‘‘(B) analyze and compare (both within 
and between hospitals participating in the ini-
tiative, and relative to comparable hospitals 
that do not participate in the initiative, for rel-
evant parameters such as diagnosis-related 
groups)— 
‘‘(i) quality of care furnished to indi-
viduals with similar conditions and charac-
teristics in the inpatient setting and 
through the Acute Hospital Care at Home 
initiative, including health outcomes, hos-
pital readmission rates (including readmis-
sions both within and beyond 30 days post- 
discharge), hospital mortality rates, length 
of stay, infection rates, composition of care 
team (including the types of labor used, 
such as contracted labor), the ratio of 
nursing staff, transfers from the hospital 
to the home, transfers from the home to 
the hospital (including the timing, fre-
quency, and causes of such transfers), 
transfers and discharges to post-acute care 
settings (including the timing, frequency, 
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708 
and causes of such transfers and dis-
charges), and patient and caregiver experi-
ence of care; 
‘‘(ii) clinical conditions treated and di-
agnosis-related groups of discharges from 
inpatient settings relative to discharges 
from the Acute Hospital Care at Home ini-
tiative; 
‘‘(iii) costs incurred by the hospital 
for furnishing care in inpatient settings 
relative to costs incurred by the hospital 
for furnishing care through the Acute Hos-
pital Care at Home initiative, including 
costs relating to staffing, equipment, food, 
prescriptions, and other services, as deter-
mined by the Secretary; 
‘‘(iv) the quantity, mix, and intensity 
of services (such as in-person visits and 
virtual contacts with patients and the in-
tensity of such services) furnished in inpa-
tient settings relative to the Acute Hospital 
Care at Home initiative, and, to the extent 
practicable, the nature and extent of family 
or caregiver involvement; 
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709 
‘‘(v) socioeconomic information on in-
dividuals treated in comparable inpatient 
settings relative to the initiative, including 
racial and ethnic data, income, housing, 
geographic proximity to the brick-and-mor-
tar facility and whether such individuals 
are dually eligible for benefits under this 
title and title XIX; and 
‘‘(vi) the quality of care, outcomes, 
costs, quantity and intensity of services, 
and other relevant metrics between individ-
uals who entered into the Acute Hospital 
Care at Home initiative directly from an 
emergency department compared with indi-
viduals who entered into the Acute Hos-
pital Care at Home initiative directly from 
an existing inpatient stay in a hospital. 
‘‘(2) SELECTION
BIAS.—In conducting the 
study under paragraph (1), the Secretary shall, to 
the extent practicable, analyze and compare individ-
uals who participate and do not participate in the 
initiative controlling for selection bias or other fac-
tors that may impact the reliability of data. 
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710 
‘‘(3) REPORT.—Not later than September 30, 
2029, the Secretary of Health and Human Services 
shall— 
‘‘(A) submit to the Committee on Ways 
and Means of the House of Representatives and 
the Committee on Finance of the Senate a re-
port on the study conducted under paragraph 
(1); and 
‘‘(B) make such report publicly available 
on a website of the Centers for Medicare & 
Medicaid Services. 
‘‘(4) FUNDING.—In addition to amounts other-
wise available, there is appropriated to the Centers 
for Medicare & Medicaid Services Program Manage-
ment Account for fiscal year 2026, out of any 
amounts in the Treasury not otherwise appropriated, 
$2,500,000, to remain available until expended, for 
purposes of carrying out this section.’’; and 
(5) in subsection (e), as redesignated by para-
graph (3), by striking ‘‘and (b)(1)’’ and inserting ‘‘, 
(b)(1), and (c)(1)’’. 
SEC. 6211. IN-HOME CARDIOPULMONARY REHABILITATION 
FLEXIBILITY. 
(a) IN GENERAL.—Section 1861(eee)(2)(A)(ii) of the 
Social Security Act (42 U.S.C. 1395x(eee)(2)(A)(ii)) is 
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711 
amended by inserting ‘‘(including, with respect to items 
and services furnished through audio and video real-time 
communications technology (excluding audio-only) on or 
after January 31, 2026, and before January 1, 2028, in 
the home of an individual who is an outpatient of the hos-
pital)’’ after ‘‘outpatient basis’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendment made by sub-
section (a) by program instruction or otherwise. 
SEC. 6212. ENHANCING CERTAIN PROGRAM INTEGRITY RE-
QUIREMENTS FOR DME UNDER MEDICARE. 
(a) DURABLE MEDICAL EQUIPMENT.— 
(1) IN GENERAL.—Section 1834(a) of the So-
cial Security Act (42 U.S.C. 1395m(a)) is amended 
by adding at the end the following new paragraph: 
‘‘(23) MASTER LIST INCLUSION AND CLAIM RE-
VIEW FOR CERTAIN ITEMS.— 
‘‘(A) MASTER
LIST
INCLUSION.—Begin-
ning January 1, 2029, for purposes of the Mas-
ter List described in section 414.234(b) of title 
42, Code of Federal Regulations (or any suc-
cessor regulation), in determining which items 
have aberrant billing patterns (as such term is 
used for purposes of such section), the Sec-
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712 
retary shall also treat an item for which pay-
ment may be made under this subsection as 
having such an aberrant billing pattern if the 
Secretary determines that, without explanatory 
contributing factors (such as furnishing emer-
gent care services), a substantial number of 
claims for such items under this subsection are 
for such items ordered by a physician or practi-
tioner who has not previously (during a period 
of not less than 24 months, as established by 
the Secretary) furnished to the individual in-
volved any item or service for which payment 
may be made under this title. 
‘‘(B) CLAIM
REVIEW.—With respect to 
items furnished on or after January 1, 2029, 
that are included on the Master List pursuant 
to subparagraph (A), if such an item is not sub-
ject to a determination of coverage in advance 
pursuant to paragraph (15)(C), the Secretary 
may conduct prepayment review of claims for 
payment for such item.’’. 
(2) CONFORMING
AMENDMENT
FOR
PROS-
THETIC DEVICES, ORTHOTICS, AND PROSTHETICS.— 
Section 1834(h)(3) of the Social Security Act (42 
U.S.C. 1395m(h)(3)) is amended by inserting ‘‘, and 
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713 
paragraph (23) of subsection (a) shall apply to pros-
thetic devices, orthotics, and prosthetics in the same 
manner as such provision applies to items for which 
payment may be made under such subsection’’ be-
fore the period at the end. 
(b) REPORT ON IDENTIFYING CLINICAL DIAGNOSTIC 
LABORATORY TESTS AT HIGH RISK FOR FRAUD AND EF-
FECTIVE MITIGATION MEASURES.—Not later than Janu-
ary 1, 2028, the Inspector General of the Department of 
Health and Human Services shall submit to Congress a 
report assessing fraud risks relating to clinical diagnostic 
laboratory tests for which payment may be made under 
section 1834A of the Social Security Act (42 U.S.C. 
1395m–1) and effective tools for reducing such fraudulent 
claims. The report may include, at the Inspector General’s 
discretion— 
(1) which, if any, clinical diagnostic laboratory 
tests are identified as being at high risk of fraudu-
lent claims, and an analysis of the factors that con-
tribute to such risk; 
(2) with respect to a clinical diagnostic labora-
tory test identified under paragraph (1) as being at 
high risk of fraudulent claims— 
(A) the amount payable under such section 
1834A with respect to such test; 
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714 
(B) the number of such tests furnished to 
individuals enrolled under part B of title XVIII 
of the Social Security Act (42 U.S.C. 1395j et 
seq.); 
(C) whether an order for such a test was 
more likely to come from a provider with whom 
the individual involved did not have a prior re-
lationship, as determined on the basis of prior 
payment experience; and 
(D) the frequency with which a claim for 
payment under such section 1834A included the 
payment modifier identified by code 59 or 91; 
and 
(3) suggested strategies for reducing the num-
ber of fraudulent claims made with respect to tests 
so identified as being at high risk, including— 
(A) an analysis of whether the Centers for 
Medicare & Medicaid Services can detect aber-
rant billing patterns with respect to such tests 
in a timely manner; 
(B) any strategies for identifying and mon-
itoring the providers who are outliers with re-
spect to the number of such tests that such pro-
viders order; and 
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715 
(C) targeted education efforts to mitigate 
improper billing for such tests; and 
(4) such other information as the Inspector 
General determines appropriate. 
(c) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Inspector General 
of the Department of Health and Human Services, out 
of any money in the Treasury not otherwise appropriated, 
$1,200,000 for fiscal year 2026, to remain available until 
expended, to carry out this section. 
SEC. 6213. GUIDANCE ON FURNISHING SERVICES VIA TELE-
HEALTH TO INDIVIDUALS WITH LIMITED 
ENGLISH PROFICIENCY. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, the Secretary of Health 
and Human Services, in consultation with 1 or more enti-
ties from each of the categories described in paragraphs 
(1) through (7) of subsection (b), shall issue and dissemi-
nate, or update and revise as applicable, guidance for the 
entities described in such subsection on the following: 
(1) Best practices on facilitating and inte-
grating use of interpreters during a telemedicine ap-
pointment. 
(2) Best practices on providing accessible in-
structions on how to access telecommunications sys-
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716 
tems (as such term is used for purposes of section 
1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)) for individuals with limited English pro-
ficiency. 
(3) Best practices on improving access to dig-
ital patient portals for individuals with limited 
English proficiency. 
(4) Best practices on integrating the use of 
video platforms that enable multi-person video calls 
furnished via a telecommunications system for pur-
poses of providing interpretation during a telemedi-
cine appointment for an individual with limited 
English proficiency. 
(5) Best practices for providing patient mate-
rials, communications, and instructions in multiple 
languages, including text message appointment re-
minders and prescription information. 
(b) ENTITIES DESCRIBED.—For purposes of sub-
section (a), an entity described in this subsection is an 
entity in 1 or more of the following categories: 
(1) Health information technology service pro-
viders, including— 
(A) electronic medical record companies; 
(B) remote patient monitoring companies; 
and 
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717 
(C) telehealth or mobile health vendors and 
companies. 
(2) Health care providers, including— 
(A) physicians; and 
(B) hospitals. 
(3) Health insurers. 
(4) Language service companies. 
(5) Interpreter or translator professional asso-
ciations. 
(6) Health and language services quality certifi-
cation organizations. 
(7) Patient and consumer advocates, including 
such advocates that work with individuals with lim-
ited English proficiency. 
SEC. 6214. INCLUSION OF VIRTUAL DIABETES PREVENTION 
PROGRAM SUPPLIERS IN MDPP EXPANDED 
MODEL. 
(a) IN GENERAL.—For the period beginning on Jan-
uary 1, 2026, and ending on December 31, 2029— 
(1) an entity may participate in the MDPP by 
offering only MDPP services via distance learning or 
online delivery modalities if such entity meets the 
conditions for enrollment as an MDPP supplier; 
(2) if an entity participates in the MDPP in the 
manner described in paragraph (1), in the case of 
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718 
online MDPP services furnished by such entity to an 
MDPP beneficiary who was not located in the same 
State as the entity at the time such services were 
furnished, the entity shall not be prohibited from 
submitting a claim for payment for such services 
solely by reason of the location of such beneficiary 
at such time; and 
(3) no limit is applied on the number of times 
an individual may enroll in the MDPP. 
(b) DEFINITIONS.—In this section: 
(1) MDPP.—The term ‘‘MDPP’’ means the 
Medicare Diabetes Prevention Program (as such 
term is defined in section 410.79(b) of title 42, Code 
of Federal Regulations). 
(2) REGULATORY TERMS.—The terms ‘‘distance 
learning’’, ‘‘MDPP beneficiary’’, ‘‘MDPP services’’, 
‘‘MDPP supplier’’, and ‘‘online’’ have the meanings 
given such terms in section 410.79(b) of title 42, 
Code of Federal Regulations. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(c) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary may implement this section 
by program instruction or otherwise. 
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719 
SEC. 6215. MEDICATION-INDUCED MOVEMENT DISORDER 
OUTREACH AND EDUCATION. 
Not later than January 1, 2028, the Secretary of 
Health and Human Services shall use existing communica-
tions mechanisms to provide education and outreach to 
physicians and appropriate non-physician practitioners 
participating under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
with respect to periodic screening for medication-induced 
movement disorders that are associated with the treat-
ment of mental health disorders in at-risk patients, as well 
as resources related to clinical guidelines and best prac-
tices for furnishing such screening services through tele-
health. Such education and outreach shall include infor-
mation on how to account for such screening services in 
evaluation and management code selection. The Secretary 
shall, to the extent practicable, seek input from relevant 
stakeholders to inform such education and outreach. Such 
education and outreach may also address other relevant 
screening services furnished through telehealth, as the 
Secretary determines appropriate. 
SEC. 6216. REPORT ON WEARABLE MEDICAL DEVICES. 
Not later than 18 months after the date of the enact-
ment of this Act, the Comptroller General of the United 
States shall conduct a technology assessment of, and sub-
mit to Congress a report on, the capabilities and limita-
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720 
tions of wearable medical devices used to support clinical 
decision-making. Such report shall include a description 
of— 
(1) the potential for such devices to accurately 
prescribe treatments; 
(2) an examination of the benefits and chal-
lenges of artificial intelligence to augment such ca-
pabilities; and 
(3) policy options to enhance the benefits and 
mitigate potential challenges of developing or using 
such devices. 
SEC. 6217. EXTENSION OF TEMPORARY INCLUSION OF AU-
THORIZED ORAL ANTIVIRAL DRUGS AS COV-
ERED PART D DRUGS. 
Section 1860D–2(e)(1)(C) of the Social Security Act 
(42 U.S.C. 1395w–102(e)(1)(C)) is amended by striking 
‘‘January 30, 2026’’ and inserting ‘‘December 31, 2026’’. 
SEC. 6218. EXTENSION OF ADJUSTMENT TO CALCULATION 
OF HOSPICE CAP AMOUNT UNDER MEDI-
CARE. 
Section 1814(i)(2)(B) of the Social Security Act (42 
U.S.C. 1395f(i)(2)(B)) is amended— 
(1) in clause (ii), by striking ‘‘2033’’ and in-
serting ‘‘2035’’; and 
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721 
(2) in clause (iii), by striking ‘‘2033’’ and in-
serting ‘‘2035’’. 
SEC. 6219. ADJUSTMENTS TO MEDICARE PART D COST- 
SHARING REDUCTIONS FOR LOW-INCOME IN-
DIVIDUALS. 
Section 1860D–14(a) of the Social Security Act (42 
U.S.C. 1395w–114(a)) is amended— 
(1) in paragraph (1)(D)(ii), by striking ‘‘that 
does not exceed $1 for’’ and all that follows through 
the period at the end and inserting ″that does not 
exceed— ‘‘ 
‘‘(I) for a plan year before 
2028— 
‘‘(aa) for a generic drug or a 
preferred drug that is a multiple 
source drug (as defined in section 
1927(k)(7)(A)(i)), $1 or, if less, 
the copayment amount applicable 
to an individual under clause 
(iii); and 
‘‘(bb) for any other drug, $3 
or, if less, the copayment amount 
applicable to an individual under 
clause (iii); and 
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722 
‘‘(II) for plan year 2028 and 
each subsequent plan year— 
‘‘(aa) for a generic drug, $0; 
‘‘(bb) for a preferred drug 
that is a multiple source drug (as 
defined 
in 
section 
1927(k)(7)(A)(i)), 
the 
dollar 
amount applied under this clause 
for such a drug for the preceding 
plan year, increased by the an-
nual percentage increase in the 
consumer price index (all items; 
U.S. city average) as of Sep-
tember of such preceding year, 
or, if less, the copayment amount 
applicable to an individual under 
clause (iii); and 
‘‘(cc) for a drug not de-
scribed in either item (aa) or 
(bb), the dollar amount applied 
under this clause for such a drug 
for the preceding plan year, in-
creased in the manner specified 
in item (bb), or, if less, the co-
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723 
payment amount applicable to an 
individual under clause (iii). 
Any amount established under item (bb) or 
(cc) of subclause (II), that is based on an 
increase of $1 or $3, that is not a multiple 
of 5 cents or 10 cents, respectively, shall 
be rounded to the nearest multiple of 5 
cents or 10 cents, respectively.’’; and 
(2) in paragraph (4)(A)(ii), by inserting ‘‘(be-
fore 2028)’’ after ‘‘a subsequent year’’. 
SEC. 6220. REQUIRING ENHANCED AND ACCURATE LISTS 
OF (REAL) HEALTH PROVIDERS ACT. 
(a) IN GENERAL.—Section 1852(c) of the Social Se-
curity Act (42 U.S.C. 1395w–22(c)) is amended— 
(1) in paragraph (1)(C)— 
(A) by striking ‘‘plan, and any’’ and insert-
ing ‘‘plan, any’’; and 
(B) by inserting the following before the 
period: ‘‘, and, in the case of a specified MA 
plan (as defined in paragraph (3)(C)), for plan 
year 2028 and subsequent plan years, the infor-
mation described in paragraph (3)(B)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) PROVIDER DIRECTORY ACCURACY.— 
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724 
‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, each MA organiza-
tion offering a specified MA plan (as defined in 
subparagraph (C)) shall, for each such plan of-
fered by the organization— 
‘‘(i) maintain, on a publicly available 
internet website, an accurate provider di-
rectory that includes the information de-
scribed in subparagraph (B); 
‘‘(ii) not less frequently than once 
every 90 days (or, in the case of a hospital 
or any other facility determined appro-
priate by the Secretary, at a lesser fre-
quency specified by the Secretary but in no 
case less frequently than once every 12 
months), verify the provider directory in-
formation of each provider listed in such 
directory and, if applicable, update such 
information; 
‘‘(iii) if the organization is unable to 
verify such information with respect to a 
provider, include in such directory an indi-
cation that the information of such pro-
vider may not be up to date; and 
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725 
‘‘(iv) remove a provider from such di-
rectory within 5 business days if the orga-
nization determines that the provider is no 
longer a provider participating in the net-
work of such plan. 
‘‘(B) PROVIDER
DIRECTORY
INFORMA-
TION.—The information described in this sub-
paragraph is information enrollees may need to 
access covered benefits from a provider with 
which such organization offering such plan has 
an agreement for furnishing items and services 
covered under such plan, such as name, spe-
cialty, contact information, primary office or fa-
cility addresses where items or services are fur-
nished, whether the provider is accepting new 
patients, accommodations for people with dis-
abilities, cultural and linguistic capabilities, and 
telehealth capabilities. 
‘‘(C) SPECIFIED MA PLAN.—In this para-
graph, the term ‘specified MA plan’ means— 
‘‘(i) a network-based plan (as defined 
in subsection (d)(5)(C)); or 
‘‘(ii) a Medicare Advantage private 
fee-for-service plan (as defined in section 
1859(b)(2)) that meets the access stand-
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726 
ards under subsection (d)(4), in whole or 
in part, through entering into contracts or 
agreements as provided for under subpara-
graph (B) of such subsection.’’. 
(b) ACCOUNTABILITY
FOR PROVIDER DIRECTORY 
ACCURACY.— 
(1) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY
INFORMATION.—Section 1852(d) of the 
Social Security Act (42 U.S.C. 1395w–22(d)) is 
amended— 
(A) in paragraph (1)(C)— 
(i) in clause (ii), by striking ‘‘or’’ at 
the end; 
(ii) in clause (iii), by striking the 
semicolon at the end and inserting ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iv) for plan year 2028 and subse-
quent plan years, in the case of a specified 
MA 
plan 
(as 
defined 
in 
subsection 
(c)(3)(C)), the services were furnished by a 
provider that was not participating in the 
network of such plan but was listed in the 
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727 
provider directory of such plan on the date 
on which the appointment was made, as 
described in paragraph (7)(A);’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(7) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY INFORMATION.— 
‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, if an enrollee in a 
specified MA plan (as defined in subsection 
(c)(3)(C)) is furnished an item or service by a 
provider that is not participating in the network 
of such plan but is listed in the provider direc-
tory of such plan (as required to be provided to 
an enrollee pursuant to subsection (c)(1)(C)) on 
the date on which the appointment is made, 
and if such item or service would otherwise be 
covered under such plan if furnished by a pro-
vider that is participating in the network of 
such plan, the MA organization offering such 
plan shall ensure that the enrollee is only re-
sponsible for the lesser of— 
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‘‘(i) the amount of cost sharing that 
would apply if such provider had been par-
ticipating in the network of such plan; or 
‘‘(ii) the amount of cost sharing that 
would otherwise apply (without regard to 
this subparagraph). 
‘‘(B) NOTIFICATION REQUIREMENT.—For 
plan year 2028 and subsequent plan years, each 
MA organization that offers a specified MA 
plan shall— 
‘‘(i) notify enrollees of their cost-shar-
ing protections under this paragraph and 
make such notifications, to the extent 
practicable, by not later than the first day 
of an annual, coordinated election period 
under section 1851(e)(3) with respect to a 
year; 
‘‘(ii) include information regarding 
such cost-sharing protections in the pro-
vider directory of each specified MA plan 
offered by the MA organization.; and 
‘‘(iii) notify enrollees of their cost- 
sharing protections under this paragraph 
in the first explanation of benefits issued 
in a plan year.’’. 
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(2) REQUIRED
PROVIDER
DIRECTORY
ACCU-
RACY ANALYSIS AND REPORTS.— 
(A) IN GENERAL.—Section 1857(e) of the 
Social Security Act (42 U.S.C. 1395w–27(e)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) PROVIDER
DIRECTORY
ACCURACY
ANAL-
YSIS AND REPORTS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2028, 
subject to subparagraph (C), a contract under 
this section with an MA organization shall re-
quire the organization, for each specified MA 
plan (as defined in section 1852(c)(3)(C)) of-
fered by the organization, to annually do the 
following: 
‘‘(i) Conduct an analysis estimating 
the accuracy of the provider directory in-
formation of such plan using a random 
sample of providers included in such pro-
vider directory as follows: 
‘‘(I) Such a random sample shall 
include a random sample of each spe-
cialty of providers with a high inaccu-
racy rate of provider directory infor-
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730 
mation relative to other specialties of 
providers, as determined by the Sec-
retary. 
‘‘(II) For purposes of subclause 
(I), one type of specialty may be pro-
viders specializing in mental health or 
substance use disorder treatment. 
‘‘(ii) Submit to the Secretary a report 
containing the results of the analysis con-
ducted under clause (i), including an accu-
racy score for such provider directory in-
formation (as determined using a plan 
verification method specified by the Sec-
retary under subparagraph (B)(i)). 
‘‘(B) 
DETERMINATION
OF
ACCURACY 
SCORE.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall specify plan verification methods, 
such as using telephonic verification or 
other approaches using data sources main-
tained by an MA organization or using 
publicly available data sets, that MA orga-
nizations may use for estimating accuracy 
scores of the provider directory information 
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731 
of specified MA plans offered by such or-
ganizations. 
‘‘(ii) 
ACCURACY
SCORE
METHOD-
OLOGY.—With respect to each such meth-
od specified by the Secretary as described 
in clause (i), the Secretary shall specify a 
methodology for MA organizations to use 
in estimating such accuracy scores. Each 
such methodology shall take into account 
the administrative burden on plans and 
providers and the relative importance of 
certain provider directory information on 
enrollee ability to access care. 
‘‘(C) EXCEPTION.—The Secretary may 
waive the requirements of this paragraph in the 
case of a specified MA plan with low enrollment 
(as defined by the Secretary). 
‘‘(D) 
TRANSPARENCY.—Beginning 
with 
plan years beginning on or after January 1, 
2029, the Secretary shall post accuracy scores 
(as reported under subparagraph (A)(ii)), in a 
machine readable file, on an internet website 
maintained by the Centers for Medicare & Med-
icaid Services.’’. 
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(B) PROVISION
OF
INFORMATION
TO 
BENEFICIARIES.—Section 1851(d)(4) of the So-
cial Security Act (42 U.S.C. 1395w–21(d)(4)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(F) PROVIDER
DIRECTORY.—Beginning 
with plan years beginning on or after January 
1, 2029, in the case of a specified MA plan (as 
defined in section 1852(c)(3)(C)), the accuracy 
score of the plan’s provider directory (as re-
ported under section 1857(e)(6)(A)(ii)) listed 
prominently on the plan’s provider directory.’’. 
(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated to the 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$4,000,000 for fiscal year 2026, to remain 
available until expended, to carry out the 
amendments made by this paragraph. 
(3) GAO STUDY AND REPORT.— 
(A) ANALYSIS.—The Comptroller General 
of the United States (in this paragraph referred 
to as the ‘‘Comptroller General’’) shall conduct 
a study of the implementation of the amend-
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733 
ments made by paragraphs (1) and (2). To the 
extent data are available and reliable, such 
study shall include an analysis of— 
(i) the use of cost-sharing protections 
required under section 1852(d)(7)(A) of 
the Social Security Act, as added by para-
graph (1); 
(ii) the trends in provider directory in-
formation accuracy scores submitted to the 
Secretary of Health and Human Services 
under section 1857(e)(6)(A)(ii) of the So-
cial Security Act (as added by paragraph 
(2)(A)), both overall and among providers 
specializing in mental health or substance 
use disorder treatment; 
(iii) provider response rates by plan 
verification methods; 
(iv) administrative costs to providers 
and Medicare Advantage organizations; 
and 
(v) other items determined appro-
priate by the Comptroller General. 
(B) REPORT.—Not later than January 15, 
2033, the Comptroller General shall submit to 
Congress a report containing the results of the 
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734 
study conducted under subparagraph (A), to-
gether with recommendations for such legisla-
tion and administrative action as the Comp-
troller General determines appropriate. 
(c) GUIDANCE
ON MAINTAINING ACCURATE PRO-
VIDER DIRECTORIES.— 
(1) STAKEHOLDER MEETING.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
(referred to in this subsection as the ‘‘Sec-
retary’’) shall hold a public meeting to receive 
input on approaches for maintaining accurate 
provider directories for Medicare Advantage 
plans under part C of title XVIII of the Social 
Security Act (42 U.S.C. 1395w–21 et seq.), in-
cluding input on approaches for reducing ad-
ministrative burden, such as data standardiza-
tion, and best practices to maintain accurate 
provider directory information. 
(B) PARTICIPANTS.—Participants of the 
meeting under subparagraph (A) shall include 
representatives from the Centers for Medicare & 
Medicaid Services and the Assistant Secretary 
for Technology Policy and Office of the Na-
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735 
tional Coordinator for Health Information 
Technology. Such meeting shall be open to the 
public. To the extent practicable, the Secretary 
shall include health care providers, companies 
that specialize in relevant technologies, health 
insurers, and patient advocates. 
(2) GUIDANCE TO MEDICARE ADVANTAGE OR-
GANIZATIONS.—Not later than 18 months after the 
date of enactment of this Act, the Secretary shall 
issue guidance to Medicare Advantage organizations 
offering Medicare Advantage plans under part C of 
title XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) on maintaining accurate provider 
directories for such plans, taking into consideration 
input received during the stakeholder meeting under 
paragraph (1). Such guidance may include the fol-
lowing, as determined appropriate by the Secretary: 
(A) Best practices for Medicare Advantage 
organizations on how to work with providers to 
maintain the accuracy of provider directories 
and reduce provider and Medicare Advantage 
organization burden with respect to maintaining 
the accuracy of provider directories. 
(B) Information on data sets and data 
sources with information that could be used by 
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736 
Medicare Advantage organizations to maintain 
accurate provider directories. 
(C) Approaches for utilizing data sources 
maintained by Medicare Advantage organiza-
tions and publicly available data sets to main-
tain accurate provider directories. 
(D) Information that may be useful to in-
clude in provider directories for Medicare bene-
ficiaries to use in assessing plan networks when 
selecting a plan and accessing providers partici-
pating in plan networks during the plan year. 
(3) GUIDANCE
TO
PART
B
PROVIDERS.—Not 
later than 12 months after the date of enactment of 
this Act, the Secretary shall issue guidance to pro-
viders of services and suppliers who furnish items or 
services for which benefits are available under part 
B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) on when to update the Na-
tional Plan and Provider Enumeration System (or a 
successor system) for information changes. 
SEC. 6221. MEDICARE COVERAGE OF MULTI-CANCER EARLY 
DETECTION SCREENING TESTS. 
(a) COVERAGE.—Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
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737 
(A) by striking the semicolon at the end of 
subparagraph (JJ) and inserting ‘‘; and’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(KK) multi-cancer early detection screening 
tests (as defined in subsection (nnn));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(nnn) MULTI-CANCER EARLY DETECTION SCREEN-
ING TESTS.— 
‘‘(1) IN
GENERAL.—The term ‘multi-cancer 
early detection screening test’ means a test fur-
nished to an individual for the concurrent detection 
of multiple cancer types across multiple organ sites 
on or after January 1, 2029, that— 
‘‘(A) is cleared under section 510(k), clas-
sified under section 513(f)(2), or approved 
under section 515 of the Federal Food, Drug, 
and Cosmetic Act; 
‘‘(B) is— 
‘‘(i) a genomic sequencing blood or 
blood product test that includes the anal-
ysis of cell-free nucleic acids; or 
‘‘(ii) a test based on samples of bio-
logical material that provide results com-
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738 
parable to those obtained with a test de-
scribed in clause (i), as determined by the 
Secretary; and 
‘‘(C) the Secretary determines is— 
‘‘(i) reasonable and necessary for the 
prevention or early detection of an illness 
or disability; and 
‘‘(ii) appropriate for individuals enti-
tled to benefits under part A or enrolled 
under part B. 
‘‘(2) NCD PROCESS.—In making determina-
tions under paragraph (1)(C) regarding the coverage 
of a new test, the Secretary shall use the process for 
making national coverage determinations (as defined 
in section 1869(f)(1)(B)) under this title.’’. 
(b) PAYMENT AND STANDARDS FOR MULTI-CANCER 
EARLY DETECTION SCREENING TESTS.— 
(1) IN GENERAL.—Section 1834 of the Social 
Security Act (42 U.S.C. 1395m) is amended by add-
ing at the end the following new subsection: 
‘‘(aa) PAYMENT AND STANDARDS FOR MULTI-CAN-
CER EARLY DETECTION SCREENING TESTS.— 
‘‘(1) 
PAYMENT
AMOUNT.—The 
payment 
amount for a multi-cancer early detection screening 
test (as defined in section 1861(nnn)) is— 
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739 
‘‘(A) with respect to such a test furnished 
before January 1, 2031, equal to the payment 
amount in effect on the date of the enactment 
of this subsection for a multi-target stool 
screening DNA test covered pursuant to section 
1861(pp)(1)(D); and 
‘‘(B) with respect to such a test furnished 
on or after January 1, 2031, equal to the lesser 
of— 
‘‘(i) the amount described in subpara-
graph (A); or 
‘‘(ii) the payment amount determined 
for such test under section 1834A. 
‘‘(2) LIMITATIONS.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this part for a multi-cancer early 
detection screening test furnished during a year 
to an individual if— 
‘‘(i) such individual— 
‘‘(I) is under 50 years of age; or 
‘‘(II) as of January 1 of such 
year, has attained the age specified in 
subparagraph (B) for such year; or 
‘‘(ii) such a test was furnished to the 
individual during the previous 11 months. 
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740 
‘‘(B) AGE
SPECIFIED.—For purposes of 
subparagraph (A)(i)(II), the age specified in 
this subparagraph is— 
‘‘(i) for 2029, 65 years of age; and 
‘‘(ii) for a succeeding year, the age 
specified in this subparagraph for the pre-
ceding year, increased by 1 year. 
‘‘(C) STANDARDS
FOLLOWING
USPSTF 
RATING OF A OR B.—In the case of a multi-can-
cer early detection screening test that is rec-
ommended with a grade of A or B by the 
United States Preventive Services Task Force, 
beginning on the date on which coverage for 
such test is provided pursuant to section 
1861(ddd)(1), the preceding provisions of this 
paragraph shall not apply.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 1833 of the Social Security 
Act (42 U.S.C. 1395l) is amended— 
(i) in subsection (a)— 
(I) in paragraph (1)(D)(i)(I), by 
striking ‘‘section 1834(d)(1)’’ and in-
serting ‘‘subsection (d)(1) or (aa) of 
section 1834’’; and 
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741 
(II) in paragraph (2)(D)(i)(I), by 
striking ‘‘section 1834(d)(1)’’ and in-
serting ‘‘subsection (d)(1) or (aa) of 
section 1834’’; and 
(ii) in subsection (h)(1)(A), by strik-
ing ‘‘section 1834(d)(1)’’ and inserting 
‘‘subsections (d)(1) and (aa) of section 
1834’’. 
(B) Section 1862(a)(1)(A) of the Social 
Security Act (42 U.S.C. 1395y(a)(1)(A)) is 
amended— 
(i) by striking ‘‘or additional preven-
tive services’’ and inserting ‘‘, additional 
preventive services’’; and 
(ii) by inserting ‘‘, or multi-cancer 
early detection screening tests (as defined 
in section 1861(nnn))’’ after ‘‘(as de-
scribed in section 1861(ddd)(1))’’. 
(c) RULE OF CONSTRUCTION RELATING TO OTHER 
CANCER SCREENING TESTS.—Nothing in this section, in-
cluding the amendments made by this section, shall be 
construed— 
(1) in the case of an individual who undergoes 
a multi-cancer early detection screening test, to af-
fect coverage under part B of title XVIII of the So-
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742 
cial Security Act for other cancer screening tests 
covered under such title, such as screening tests for 
breast, cervical, colorectal, lung, or prostate cancer; 
or 
(2) in the case of an individual who undergoes 
another cancer screening test, to affect coverage 
under such part for a multi-cancer early detection 
screening test or the use of such a test as a diag-
nostic or confirmatory test for a result of the other 
cancer screening test. 
(d) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $2,000,000 for fiscal year 2026, to remain avail-
able until expended, to carry out this section. 
SEC. 6222. MEDICARE COVERAGE OF EXTERNAL INFUSION 
PUMPS 
AND 
NON-SELF-ADMINISTRABLE 
HOME INFUSION DRUGS. 
(a) IN GENERAL.—Section 1861(n) of the Social Se-
curity Act (42 U.S.C. 1395x(n)) is amended by adding 
at the end the following new sentence: ‘‘Beginning with 
the first calendar quarter beginning on or after the date 
that is 1 year after the date of the enactment of this sen-
tence, an external infusion pump and associated home in-
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743 
fusion drug (as defined in subsection (iii)(3)(C)) or other 
associated supplies that do not meet the appropriate for 
use in the home requirement applied to the definition of 
durable medical equipment under section 414.202 of title 
42, Code of Federal Regulations (or any successor to such 
regulation) shall be treated as meeting such requirement 
if each of the following criteria is satisfied: 
‘‘(1) The prescribing information approved by 
the Food and Drug Administration for the home in-
fusion drug associated with the pump instructs that 
the drug should be administered by or under the su-
pervision of a health care professional. 
‘‘(2) A qualified home infusion therapy supplier 
(as defined in subsection (iii)(3)(D)) administers or 
supervises the administration of the drug or biologi-
cal in a safe and effective manner in the patient’s 
home (as defined in subsection (iii)(3)(B)). 
‘‘(3) The prescribing information described in 
paragraph (1) instructs that the drug should be in-
fused at least 12 times per year— 
‘‘(A) intravenously or subcutaneously; or 
‘‘(B) at infusion rates that the Secretary 
determines would require the use of an external 
infusion pump.’’. 
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744 
(b) COST SHARING NOTIFICATION.—The Secretary 
of Health and Human Services shall ensure that patients 
are notified of the cost sharing for electing home infusion 
therapy compared to other applicable settings of care for 
the furnishing of infusion drugs under the Medicare pro-
gram. 
SEC. 6223. ASSURING PHARMACY ACCESS AND CHOICE FOR 
MEDICARE BENEFICIARIES. 
(a) IN GENERAL.—Section 1860D–4(b)(1) of the So-
cial Security Act (42 U.S.C. 1395w–104(b)(1)) is amend-
ed by striking subparagraph (A) and inserting the fol-
lowing: 
‘‘(A) IN GENERAL.— 
‘‘(i) PARTICIPATION OF ANY WILLING 
PHARMACY.—A PDP sponsor offering a 
prescription drug plan shall permit any 
pharmacy that meets the standard contract 
terms and conditions under such plan to 
participate as a network pharmacy of such 
plan. 
‘‘(ii) CONTRACT TERMS AND CONDI-
TIONS.— 
‘‘(I) 
IN
GENERAL.—Notwith-
standing any other provision of law, 
for plan years beginning on or after 
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745 
January 1, 2029, in accordance with 
clause (i), contract terms and condi-
tions offered by such PDP sponsor 
shall be reasonable and relevant ac-
cording to standards established by 
the Secretary under subclause (II). 
‘‘(II) 
STANDARDS.—Not 
later 
than the first Monday in April of 
2028, the Secretary shall establish 
standards for reasonable and relevant 
contract terms and conditions for pur-
poses of this clause. 
‘‘(III) REQUEST
FOR
INFORMA-
TION.—Not later than April 1, 2027, 
for purposes of establishing the stand-
ards under subclause (II), the Sec-
retary shall issue a request for infor-
mation to seek input on trends in pre-
scription drug plan and network phar-
macy contract terms and conditions, 
current prescription drug plan and 
network pharmacy contracting prac-
tices, whether pharmacy reimburse-
ment and dispensing fees paid by 
PDP sponsors to network pharmacies 
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746 
sufficiently cover the ingredient and 
operational costs of such pharmacies, 
the use and application of pharmacy 
quality measures by PDP sponsors for 
network pharmacies, PDP sponsor re-
strictions or limitations on the dis-
pensing of covered part D drugs by 
network pharmacies (or any subsets of 
such pharmacies), PDP sponsor au-
diting practices for network phar-
macies, areas in current regulations or 
program guidance related to con-
tracting between prescription drug 
plans and network pharmacies requir-
ing clarification or additional speci-
ficity, factors for consideration in de-
termining the reasonableness and rel-
evance of contract terms and condi-
tions between prescription drug plans 
and network pharmacies, and other 
issues as determined appropriate by 
the Secretary.’’. 
(b) 
ESSENTIAL
RETAIL
PHARMACIES.—Section 
1860D–42 of the Social Security Act (42 U.S.C. 1395w– 
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747 
152) is amended by adding at the end the following new 
subsection: 
‘‘(e) ESSENTIAL RETAIL PHARMACIES.— 
‘‘(1) IN GENERAL.—With respect to plan years 
beginning on or after January 1, 2028, the Sec-
retary shall publish reports, at least once every 2 
years until 2034, and periodically thereafter, that 
provide information, to the extent feasible, on— 
‘‘(A) trends in ingredient cost reimburse-
ment, dispensing fees, incentive payments and 
other fees paid by PDP sponsors offering pre-
scription drug plans and MA organizations of-
fering MA–PD plans under this part to essen-
tial retail pharmacies (as defined in paragraph 
(2)) with respect to the dispensing of covered 
part D drugs, including a comparison of such 
trends between essential retail pharmacies and 
pharmacies that are not essential retail phar-
macies; 
‘‘(B) trends in amounts paid to PDP spon-
sors offering prescription drug plans and MA 
organizations offering MA–PD plans under this 
part by essential retail pharmacies with respect 
to the dispensing of covered part D drugs, in-
cluding a comparison of such trends between 
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748 
essential retail pharmacies and pharmacies that 
are not essential retail pharmacies; 
‘‘(C) trends in essential retail pharmacy 
participation in pharmacy networks and pre-
ferred pharmacy networks for prescription drug 
plans offered by PDP sponsors and MA–PD 
plans offered by MA organizations under this 
part, including a comparison of such trends be-
tween essential retail pharmacies and phar-
macies that are not essential retail pharmacies; 
‘‘(D) trends in the number of essential re-
tail pharmacies, including variation in such 
trends by geographic region or other factors; 
‘‘(E) a comparison of cost-sharing for cov-
ered part D drugs dispensed by essential retail 
pharmacies that are network pharmacies for 
prescription drug plans offered by PDP spon-
sors and MA–PD plans offered by MA organi-
zations under this part and cost-sharing for 
covered part D drugs dispensed by other net-
work pharmacies for such plans located in simi-
lar geographic areas that are not essential retail 
pharmacies; 
‘‘(F) a comparison of the volume of cov-
ered part D drugs dispensed by essential retail 
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749 
pharmacies that are network pharmacies for 
prescription drug plans offered by PDP spon-
sors and MA–PD plans offered by MA organi-
zations under this part and such volume of dis-
pensing by network pharmacies for such plans 
located in similar geographic areas that are not 
essential retail pharmacies, including informa-
tion on any patterns or trends in such compari-
son specific to certain types of covered part D 
drugs, such as generic drugs or drugs specified 
as specialty drugs by a PDP sponsor under a 
prescription drug plan or an MA organization 
under an MA–PD plan; and 
‘‘(G) a comparison of the information de-
scribed in subparagraphs (A) through (F) be-
tween essential retail pharmacies that are net-
work pharmacies for prescription drug plans of-
fered by PDP sponsors under this part and es-
sential retail pharmacies that are network phar-
macies for MA–PD plans offered by MA organi-
zations under this part. 
‘‘(2) DEFINITION OF ESSENTIAL RETAIL PHAR-
MACY.—In this subsection, the term ‘essential retail 
pharmacy’ means, with respect to a plan year, a re-
tail pharmacy that— 
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with plan year 2028), each PDP sponsor offer-
ing a prescription drug plan and each MA orga-
nization offering an MA–PD plan shall submit 
to the Secretary, for the purposes of deter-
mining retail pharmacies that meet the criterion 
specified in subparagraph (A) of paragraph (2), 
a list of retail pharmacies that are affiliates of 
such sponsor or organization, or are affiliates of 
a pharmacy benefit manager acting on behalf of 
such sponsor or organization, at a time, and in 
a form and manner, specified by the Secretary. 
‘‘(C) REPORTING BY PDP SPONSORS AND 
MA ORGANIZATIONS.—For each plan year be-
ginning with plan year 2027, each PDP sponsor 
offering a prescription drug plan and each MA 
organization offering an MA–PD plan under 
this part shall submit to the Secretary informa-
tion on incentive payments and other fees paid 
by such sponsor or organization to pharmacies, 
insofar as any such payments or fees are not 
otherwise reported, at a time, and in a form 
and manner, specified by the Secretary. 
‘‘(D) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
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752 
implement this paragraph by program instruc-
tion or otherwise. 
‘‘(E) NONAPPLICATION
OF
PAPERWORK 
REDUCTION
ACT.—Chapter 35 of title 44, 
United States Code, shall not apply to the im-
plementation of this paragraph. 
‘‘(4) DEFINITION
OF
AFFILIATE; PHARMACY 
BENEFIT MANAGER.—In this subsection, the terms 
‘affiliate’ and ‘pharmacy benefit manager’ have the 
meaning given those terms in section 1860D– 
12(h)(7).’’. 
(c) ENFORCEMENT.— 
(1) IN
GENERAL.—Section 1860D–4(b)(1) of 
the Social Security Act (42 U.S.C. 1395w– 
104(b)(1)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) ENFORCEMENT OF STANDARDS FOR 
REASONABLE AND RELEVANT CONTRACT TERMS 
AND CONDITIONS.— 
‘‘(i) ALLEGATION SUBMISSION PROC-
ESS.— 
‘‘(I) IN
GENERAL.—Not later 
than January 1, 2029, the Secretary 
shall establish a process through 
which a pharmacy may submit to the 
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Secretary an allegation of a violation 
by a PDP sponsor offering a prescrip-
tion drug plan of the standards for 
reasonable 
and 
relevant 
contract 
terms and conditions under subpara-
graph (A)(ii), or of subclause (VIII) 
of this clause. 
‘‘(II) FREQUENCY
OF
SUBMIS-
SION.— 
‘‘(aa) IN GENERAL.—Except 
as provided in item (bb), the alle-
gation submission process under 
this clause shall allow pharmacies 
to submit any allegations of vio-
lations described in subclause (I) 
not more frequently than once 
per plan year per contract be-
tween a pharmacy and a PDP 
sponsor. 
‘‘(bb) ALLEGATIONS RELAT-
ING
TO
CONTRACT
MODIFICA-
TIONS.—In the case where a con-
tract between a pharmacy and a 
PDP sponsor is modified fol-
lowing the submission of allega-
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tions by a pharmacy with respect 
to such contract and plan year, 
the allegation submission process 
under this clause shall allow such 
pharmacy to submit an additional 
allegation related to those modi-
fications with respect to such 
contract and plan year. 
‘‘(III) ACCESS
TO
RELEVANT 
DOCUMENTS
AND
MATERIALS.—A 
PDP sponsor subject to an allegation 
under this clause— 
‘‘(aa) shall provide docu-
ments or materials, as specified 
by the Secretary, including con-
tract offers made by such spon-
sor to such pharmacy or cor-
respondence related to such of-
fers, to the Secretary at a time, 
and in a form and manner, speci-
fied by the Secretary; and 
‘‘(bb) shall not prohibit or 
otherwise limit the ability of a 
pharmacy to submit such docu-
ments or materials to the Sec-
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755 
retary for the purpose of submit-
ting an allegation or providing 
evidence for such an allegation 
under this clause. 
‘‘(IV) 
STANDARDIZED
TEM-
PLATE.—The Secretary shall establish 
a standardized template for phar-
macies to use for the submission of al-
legations described in subclause (I). 
Such template shall require that the 
submission include a certification by 
the pharmacy that the information in-
cluded is accurate, complete, and true 
to the best of the knowledge, informa-
tion, and belief of such pharmacy. 
‘‘(V) PREVENTING
FRIVOLOUS 
ALLEGATIONS.—In the case where the 
Secretary determines that a pharmacy 
has submitted frivolous allegations 
under this clause on a routine basis, 
the Secretary may temporarily pro-
hibit such pharmacy from using the 
allegation submission process under 
this clause, as determined appropriate 
by the Secretary. 
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756 
‘‘(VI) EXEMPTION
FROM
FREE-
DOM OF INFORMATION ACT.—Allega-
tions submitted under this clause shall 
be exempt from disclosure under sec-
tion 552 of title 5, United States 
Code. 
‘‘(VII) 
RULE
OF
CONSTRUC-
TION.—Nothing in this clause shall be 
construed as limiting the ability of a 
pharmacy to pursue other legal ac-
tions or remedies, consistent with ap-
plicable Federal or State law, with re-
spect to a potential violation of a re-
quirement described in this subpara-
graph. 
‘‘(VIII) ANTI-RETALIATION
AND 
ANTI-COERCION.—Consistent with ap-
plicable Federal or State law, a PDP 
sponsor shall not— 
‘‘(aa) retaliate against a 
pharmacy for submitting any al-
legations under this clause; or 
‘‘(bb) 
coerce, 
intimidate, 
threaten, or interfere with the 
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ability of a pharmacy to submit 
any such allegations. 
‘‘(ii) INVESTIGATION.—The Secretary 
shall investigate, as determined appro-
priate by the Secretary, allegations sub-
mitted pursuant to clause (i). 
‘‘(iii) ENFORCEMENT.— 
‘‘(I) IN GENERAL.—In the case 
where the Secretary determines that a 
PDP sponsor offering a prescription 
drug plan has violated the standards 
for reasonable and relevant contract 
terms and conditions under subpara-
graph (A)(ii) or the provisions of 
clause (i)(VIII) of this subparagraph, 
the Secretary may use authorities 
under sections 1857(g) and 1860D– 
12(b)(3)(E) to impose civil monetary 
penalties or other intermediate sanc-
tions. 
‘‘(II) 
APPLICATION
OF
CIVIL 
MONETARY
PENALTIES.—The provi-
sions of section 1128A (other than 
subsections (a) and (b)) shall apply to 
a civil monetary penalty under this 
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758 
clause in the same manner as such 
provisions apply to a penalty or pro-
ceeding under section 1128A(a).’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1857(g)(1) of the Social Security Act (42 U.S.C. 
1395w–27(g)(1)) is amended— 
(A) in subparagraph (J), by striking ‘‘or’’ 
after the semicolon; 
(B) by redesignating subparagraph (K) as 
subparagraph (L); 
(C) by inserting after subparagraph (J), 
the following new subparagraph: 
‘‘(K) fails to comply with the standards for 
reasonable and relevant contract terms and con-
ditions under subparagraph (A)(ii) of section 
1860D–4(b)(1) or violates the provisions of 
subparagraph (F)(i)(VIII) of such section; or’’; 
(D) in subparagraph (L), as redesignated 
by subparagraph (B), by striking ‘‘through (J)’’ 
and inserting ‘‘through (K)’’; and 
(E) in the flush matter following subpara-
graph (L), as so redesignated, by striking ‘‘sub-
paragraphs (A) through (K)’’ and inserting 
‘‘subparagraphs (A) through (L)’’. 
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759 
(d) ACCOUNTABILITY OF PHARMACY BENEFIT MAN-
AGERS FOR VIOLATIONS OF REASONABLE AND RELEVANT 
CONTRACT TERMS AND CONDITIONS.— 
(1) IN GENERAL.—Section 1860D–12(b) of the 
Social Security Act (42 U.S.C. 1395w–112) is 
amended by adding at the end the following new 
paragraph: 
‘‘(9) ACCOUNTABILITY OF PHARMACY BENEFIT 
MANAGERS FOR VIOLATIONS OF REASONABLE AND 
RELEVANT
CONTRACT
TERMS
AND
CONDITIONS.— 
For plan years beginning on or after January 1, 
2029, each contract entered into with a PDP spon-
sor under this part with respect to a prescription 
drug plan offered by such sponsor shall provide that 
any pharmacy benefit manager acting on behalf of 
such sponsor has a written agreement with the PDP 
sponsor under which the pharmacy benefit manager 
agrees to reimburse the PDP sponsor for any 
amounts paid by such sponsor under section 1860D– 
4(b)(1)(F)(iii)(I) to the Secretary as a result of a 
violation described in such section if such violation 
is related to a responsibility delegated to the phar-
macy benefit manager by such PDP sponsor.’’. 
(2) MA–PD PLANS.—Section 1857(f)(3) of the 
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 
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760 
amended by adding at the end the following new 
subparagraph: 
‘‘(F) 
ACCOUNTABILITY
OF
PHARMACY 
BENEFIT MANAGERS FOR VIOLATIONS OF REA-
SONABLE AND RELEVANT CONTRACT TERMS.— 
For plan years beginning on or after January 
1, 2029, section 1860D–12(b)(9).’’. 
(e) BIENNIAL
REPORT
ON
ENFORCEMENT
AND 
OVERSIGHT OF PHARMACY ACCESS REQUIREMENTS.— 
Section 1860D–42 of the Social Security Act (42 U.S.C. 
1395w–152), as amended by subsection (b), is amended 
by adding at the end the following new subsection: 
‘‘(f) BIENNIAL REPORT
ON ENFORCEMENT
AND 
OVERSIGHT OF PHARMACY ACCESS REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—Not later than 2 years 
after the date of enactment of this subsection, and 
at least once every 2 years thereafter, the Secretary 
shall publish a report on enforcement and oversight 
actions and activities undertaken by the Secretary 
with respect to the requirements under section 
1860D–4(b)(1). 
‘‘(2) LIMITATION.—A report under paragraph 
(1) shall not disclose— 
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761 
‘‘(A) identifiable information about individ-
uals or entities unless such information is oth-
erwise publicly available; or 
‘‘(B) trade secrets with respect to any enti-
ties.’’. 
(f) FUNDING.—In addition to amounts otherwise 
available, there is appropriated to the Centers for Medi-
care & Medicaid Services Program Management Account, 
out of any money in the Treasury not otherwise appro-
priated, $188,000,000 for fiscal year 2026, to remain 
available until expended, to carry out this section. 
SEC. 6224. MODERNIZING AND ENSURING PBM ACCOUNT-
ABILITY. 
(a) IN GENERAL.— 
(1) 
PRESCRIPTION
DRUG
PLANS.—Section 
1860D–12 of the Social Security Act (42 U.S.C. 
1395w–112) is amended by adding at the end the 
following new subsection: 
‘‘(h) REQUIREMENTS RELATING TO PHARMACY BEN-
EFIT MANAGERS.—For plan years beginning on or after 
January 1, 2028: 
‘‘(1) AGREEMENTS WITH PHARMACY BENEFIT 
MANAGERS.—Each contract entered into with a 
PDP sponsor under this part with respect to a pre-
scription drug plan offered by such sponsor shall 
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762 
provide that any pharmacy benefit manager acting 
on behalf of such sponsor has a written agreement 
with the PDP sponsor under which the pharmacy 
benefit manager, and any affiliates of such phar-
macy benefit manager, as applicable, agree to meet 
the following requirements: 
‘‘(A) NO INCOME OTHER THAN BONA FIDE 
SERVICE FEES.— 
‘‘(i) IN
GENERAL.—The pharmacy 
benefit manager and any affiliate of such 
pharmacy benefit manager shall not derive 
any remuneration with respect to any serv-
ices provided on behalf of any entity or in-
dividual, in connection with the utilization 
of covered part D drugs, from any such en-
tity or individual other than bona fide serv-
ice fees, subject to clauses (ii) and (iii). 
‘‘(ii) INCENTIVE PAYMENTS.—For the 
purposes of this subsection, an incentive 
payment (as determined by the Secretary) 
paid by a PDP sponsor to a pharmacy 
benefit manager or an affiliate of a phar-
macy benefit manager that is performing 
services on behalf of such sponsor shall be 
deemed a ‘bona fide service fee’ (even if 
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such payment does not otherwise meet the 
definition of such term under paragraph 
(7)(B)) if such payment is a flat dollar 
amount, is consistent with fair market 
value (as specified by the Secretary), is re-
lated to services actually performed by the 
pharmacy benefit manager or affiliate of 
such pharmacy benefit manager, on behalf 
of the PDP sponsor making such payment, 
in connection with the utilization of cov-
ered part D drugs, and meets additional 
requirements, if any, as determined appro-
priate by the Secretary. 
‘‘(iii) CLARIFICATION
ON
REBATES 
AND DISCOUNTS USED TO LOWER COSTS 
FOR COVERED PART D DRUGS.—Rebates, 
discounts, and other price concessions re-
ceived by a pharmacy benefit manager or 
an affiliate of a pharmacy benefit manager 
from manufacturers, even if such price 
concessions are calculated as a percentage 
of a drug’s price, shall not be considered a 
violation of the requirements of clause (i) 
if they are fully passed through to a PDP 
sponsor and are compliant with all regu-
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764 
latory and subregulatory requirements re-
lated to direct and indirect remuneration 
for manufacturer rebates, discounts, and 
other price concessions under this part, in-
cluding in cases where a PDP sponsor is 
acting as a pharmacy benefit manager on 
behalf of a prescription drug plan offered 
by such PDP sponsor. 
‘‘(iv) EVALUATION OF REMUNERATION 
ARRANGEMENTS.—Components of subsets 
of remuneration arrangements (such as 
fees or other forms of compensation paid 
to or retained by the pharmacy benefit 
manager or affiliate of such pharmacy ben-
efit manager), as determined appropriate 
by the Secretary, between pharmacy ben-
efit managers or affiliates of such phar-
macy benefit managers, as applicable, and 
other entities involved in the dispensing or 
utilization of covered part D drugs (includ-
ing PDP sponsors, manufacturers, phar-
macies, and other entities as determined 
appropriate by the Secretary) shall be sub-
ject to review by the Secretary, in con-
sultation with the Office of the Inspector 
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765 
General of the Department of Health and 
Human Services, as determined appro-
priate by the Secretary. The Secretary, in 
consultation with the Office of the Inspec-
tor General, shall review whether remu-
neration under such arrangements is con-
sistent with fair market value (as specified 
by the Secretary) through reviews and as-
sessments of such remuneration, as deter-
mined appropriate. 
‘‘(v) DISGORGEMENT.—The pharmacy 
benefit manager shall disgorge any remu-
neration paid to such pharmacy benefit 
manager or an affiliate of such pharmacy 
benefit manager in violation of this sub-
paragraph to the PDP sponsor. 
‘‘(vi) ADDITIONAL REQUIREMENTS.— 
The pharmacy benefit manager shall— 
‘‘(I) enter into a written agree-
ment with any affiliate of such phar-
macy benefit manager, under which 
the affiliate shall identify and disgorge 
any remuneration described in clause 
(v) to the pharmacy benefit manager; 
and 
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‘‘(II) attest, subject to any re-
quirements determined appropriate by 
the Secretary, that the pharmacy ben-
efit manager has entered into a writ-
ten agreement described in subclause 
(I) with any affiliate of the pharmacy 
benefit manager. 
‘‘(B) TRANSPARENCY REGARDING GUARAN-
TEES
AND
COST
PERFORMANCE
EVALUA-
TIONS.—The pharmacy benefit manager shall— 
‘‘(i) define, interpret, and apply, in a 
fully transparent and consistent manner 
for purposes of calculating or otherwise 
evaluating pharmacy benefit manager per-
formance against pricing guarantees or 
similar cost performance measurements re-
lated to rebates, discounts, price conces-
sions, or net costs, terms such as— 
‘‘(I) ‘generic drug’, in a manner 
consistent with the definition of the 
term under section 423.4 of title 42, 
Code of Federal Regulations, or a suc-
cessor regulation; 
‘‘(II) ‘brand name drug’, in a 
manner consistent with the definition 
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767 
of the term under section 423.4 of 
title 42, Code of Federal Regulations, 
or a successor regulation; 
‘‘(III) ‘specialty drug’; 
‘‘(IV) ‘rebate’; and 
‘‘(V) ‘discount’; 
‘‘(ii) identify any drugs, claims, or 
price concessions excluded from any pric-
ing guarantee or other cost performance 
measure in a clear and consistent manner; 
and 
‘‘(iii) where a pricing guarantee or 
other cost performance measure is based 
on a pricing benchmark other than the 
wholesale acquisition cost (as defined in 
section 1847A(c)(6)(B)) of a drug, cal-
culate and provide a wholesale acquisition 
cost-based equivalent to the pricing guar-
antee or other cost performance measure. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) IN
GENERAL.—Not later than 
July 1 of each year, beginning in 2028, the 
pharmacy benefit manager shall submit to 
the PDP sponsor, and to the Secretary, a 
report, in accordance with this subpara-
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graph, and shall make such report avail-
able to such sponsor at no cost to such 
sponsor in a format specified by the Sec-
retary under paragraph (5). Each such re-
port shall include, with respect to such 
PDP sponsor and each plan offered by 
such sponsor, the following information 
with respect to the previous plan year: 
‘‘(I) A list of all drugs covered by 
the plan that were dispensed includ-
ing, with respect to each such drug— 
‘‘(aa) the brand name, ge-
neric or non-proprietary name, 
and National Drug Code; 
‘‘(bb) the number of plan 
enrollees for whom the drug was 
dispensed, the total number of 
prescription claims for the drug 
(including original prescriptions 
and refills, counted as separate 
claims), and the total number of 
dosage units of the drug dis-
pensed; 
‘‘(cc) the number of pre-
scription claims described in item 
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(bb) by each type of dispensing 
channel through which the drug 
was dispensed, including retail, 
mail order, specialty pharmacy, 
long term care pharmacy, home 
infusion pharmacy, or other types 
of pharmacies or dispensers; 
‘‘(dd) the average wholesale 
acquisition cost, listed as cost per 
day’s supply, cost per dosage 
unit, and cost per typical course 
of treatment (as applicable); 
‘‘(ee) the average wholesale 
price for the drug, listed as price 
per day’s supply, price per dos-
age unit, and price per typical 
course of treatment (as applica-
ble); 
‘‘(ff) the total out-of-pocket 
spending by plan enrollees on 
such drug after application of 
any benefits under the plan, in-
cluding plan enrollee spending 
through copayments, coinsurance, 
and deductibles; 
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‘‘(gg) total rebates paid by 
the manufacturer on the drug as 
reported under the Detailed DIR 
Report (or any successor report) 
submitted by such sponsor to the 
Centers for Medicare & Medicaid 
Services; 
‘‘(hh) all other direct or in-
direct remuneration on the drug 
as reported under the Detailed 
DIR Report (or any successor re-
port) submitted by such sponsor 
to the Centers for Medicare & 
Medicaid Services; 
‘‘(ii) the average pharmacy 
reimbursement amount paid by 
the plan for the drug in the ag-
gregate and disaggregated by dis-
pensing channel identified in item 
(cc); 
‘‘(jj) the average National 
Average Drug Acquisition Cost 
(NADAC); and 
‘‘(kk) total manufacturer-de-
rived revenue, inclusive of bona 
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771 
fide service fees, attributable to 
the drug and retained by the 
pharmacy benefit manager and 
any affiliate of such pharmacy 
benefit manager. 
‘‘(II) In the case of a pharmacy 
benefit manager that has an affiliate 
that is a retail, mail order, or spe-
cialty pharmacy, with respect to drugs 
covered by such plan that were dis-
pensed, the following information: 
‘‘(aa) The percentage of 
total prescriptions that were dis-
pensed by pharmacies that are an 
affiliate of the pharmacy benefit 
manager for each drug. 
‘‘(bb) 
The 
interquartile 
range of the total combined costs 
paid by the plan and plan enroll-
ees, per dosage unit, per course 
of treatment, per 30-day supply, 
and per 90-day supply for each 
drug dispensed by pharmacies 
that are not an affiliate of the 
pharmacy benefit manager and 
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772 
that are included in the phar-
macy network of such plan. 
‘‘(cc) 
The 
interquartile 
range of the total combined costs 
paid by the plan and plan enroll-
ees, per dosage unit, per course 
of treatment, per 30-day supply, 
and per 90-day supply for each 
drug dispensed by pharmacies 
that are an affiliate of the phar-
macy benefit manager and that 
are included in the pharmacy 
network of such plan. 
‘‘(dd) The lowest total com-
bined cost paid by the plan and 
plan enrollees, per dosage unit, 
per course of treatment, per 30- 
day supply, and per 90-day sup-
ply, for each drug that is avail-
able from any pharmacy included 
in the pharmacy network of such 
plan. 
‘‘(ee) The difference between 
the average acquisition cost of 
the affiliate, such as a pharmacy 
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773 
or other entity that acquires pre-
scription drugs, that initially ac-
quires the drug and the amount 
reported under subclause (I)(jj) 
for each drug. 
‘‘(ff) A list inclusive of the 
brand name, generic or non-pro-
prietary 
name, 
and 
National 
Drug Code of covered part D 
drugs subject to an agreement 
with a covered entity under sec-
tion 340B of the Public Health 
Service Act for which the phar-
macy benefit manager or an affil-
iate of the pharmacy benefit 
manager had a contract or other 
arrangement with such a covered 
entity in the service area of such 
plan. 
‘‘(III) Where a drug approved 
under section 505(c) of the Federal 
Food, Drug, and Cosmetic Act (re-
ferred to in this subclause as the ‘list-
ed drug’) is covered by the plan, the 
following information: 
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‘‘(aa) A list of currently 
marketed generic drugs approved 
under section 505(j) of the Fed-
eral Food, Drug, and Cosmetic 
Act pursuant to an application 
that references such listed drug 
that are not covered by the plan, 
are covered on the same for-
mulary tier or a formulary tier 
typically associated with higher 
cost-sharing than the listed drug, 
or are subject to utilization man-
agement that the listed drug is 
not subject to. 
‘‘(bb) The estimated average 
beneficiary 
cost-sharing 
under 
the plan for a 30-day supply of 
the listed drug. 
‘‘(cc) Where a generic drug 
listed under item (aa) is on a for-
mulary tier typically associated 
with higher cost-sharing than the 
listed drug, the estimated aver-
age cost-sharing that a bene-
ficiary would have paid for a 30- 
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day supply of each of the generic 
drugs described in item (aa), had 
the plan provided coverage for 
such drugs on the same for-
mulary tier as the listed drug. 
‘‘(dd) A written justification 
for providing more favorable cov-
erage of the listed drug than the 
generic drugs described in item 
(aa). 
‘‘(ee) The number of cur-
rently marketed generic drugs 
approved under section 505(j) of 
the Federal Food, Drug, and 
Cosmetic Act pursuant to an ap-
plication that references such 
listed drug. 
‘‘(IV) Where a reference product 
(as defined in section 351(i) of the 
Public Health Service Act) is covered 
by the plan, the following information: 
‘‘(aa) A list of currently 
marketed 
biosimilar 
biological 
products licensed under section 
351(k) of the Public Health 
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Service Act pursuant to an appli-
cation that refers to such ref-
erence product that are not cov-
ered by the plan, are covered on 
the same formulary tier or a for-
mulary tier typically associated 
with higher cost-sharing than the 
reference product, or are subject 
to utilization management that 
the reference product is not sub-
ject to. 
‘‘(bb) The estimated average 
beneficiary 
cost-sharing 
under 
the plan for a 30-day supply of 
the reference product. 
‘‘(cc) Where a biosimilar bi-
ological product listed under item 
(aa) is on a formulary tier typi-
cally associated with higher cost- 
sharing than the reference prod-
uct, the estimated average cost- 
sharing that a beneficiary would 
have paid for a 30-day supply of 
each of the biosimilar biological 
products described in item (aa), 
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