516 
tices, whether pharmacy reimburse-
ment and dispensing fees paid by 
PDP sponsors to network pharmacies 
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.’’. 
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(b) 
ESSENTIAL
RETAIL
PHARMACIES.—Section 
1860D–42 of the Social Security Act (42 U.S.C. 1395w– 
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 
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to the dispensing of covered part D drugs, in-
cluding a comparison of such trends between 
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; 
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‘‘(F) a comparison of the volume of 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 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 
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pharmacy’ means, with respect to a plan year, a re-
tail pharmacy that— 
‘‘(A) is not a pharmacy that is an affiliate 
as defined in paragraph (4); and 
‘‘(B) is located in— 
‘‘(i) a medically underserved area (as 
designated 
pursuant 
to 
section 
330(b)(3)(A) of the Public Health Service 
Act); 
‘‘(ii) a rural area in which there is no 
other retail pharmacy within 10 miles, as 
determined by the Secretary; 
‘‘(iii) a suburban area in which there 
is no other retail pharmacy within 2 miles, 
as determined by the Secretary; or 
‘‘(iv) an urban area in which there is 
no other retail pharmacy within 1 mile, as 
determined by the Secretary. 
‘‘(3) LIST
OF
ESSENTIAL
RETAIL
PHAR-
MACIES.— 
‘‘(A) PUBLICATION OF LIST OF ESSENTIAL 
RETAIL PHARMACIES.—For each plan year (be-
ginning with plan year 2028), the Secretary 
shall publish, on a publicly available internet 
website of the Centers for Medicare & Medicaid 
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Services, a list of pharmacies that meet the cri-
teria described in subparagraphs (A) and (B) of 
paragraph (2) to be considered an essential re-
tail pharmacy. 
‘‘(B) REQUIRED SUBMISSIONS FROM PDP 
SPONSORS.—For each plan year (beginning 
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, 
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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 
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.— 
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‘‘(i) ALLEGATION SUBMISSION PROC-
ESS.— 
‘‘(I) IN
GENERAL.—Not later 
than January 1, 2028, the Secretary 
shall establish a process through 
which a pharmacy may submit to the 
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. 
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524 
‘‘(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-
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, 
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525 
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-
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 
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526 
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. 
‘‘(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— 
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‘‘(aa) retaliate against a 
pharmacy for submitting any al-
legations under this clause; or 
‘‘(bb) 
coerce, 
intimidate, 
threaten, or interfere with the 
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), the Secretary may use 
authorities under sections 1857(g) 
and 1860D–12(b)(3)(E) to impose 
civil monetary penalties or other inter-
mediate sanctions. 
‘‘(II) 
APPLICATION
OF
CIVIL 
MONETARY
PENALTIES.—The provi-
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sions of section 1128A (other than 
subsections (a) and (b)) shall apply to 
a civil monetary penalty under this 
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’’; 
(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-
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529 
paragraphs (A) through (K)’’ and inserting 
‘‘subparagraphs (A) through (L)’’. 
(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, 
2028, 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.’’. 
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530 
(2) MA–PD PLANS.—Section 1857(f)(3) of the 
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 
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, 2028, 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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531 
‘‘(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 2025, to remain 
available until expended, to carry out this section. 
SEC. 227. 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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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 that is performing serv-
ices on behalf of such sponsor shall be 
deemed a ‘bona fide service fee’ (even if 
such payment does not otherwise meet the 
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533 
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-
latory and subregulatory requirements re-
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lated to direct and indirect remuneration 
for manufacturer rebates under this part, 
including 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 
General of the Department of Health and 
Human Services, as determined appro-
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535 
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 
‘‘(II) attest, subject to any re-
quirements determined appropriate by 
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536 
the Secretary, that the pharmacy ben-
efit manager has entered into a writ-
ten agreement described in subclause 
(I) with any relevant 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 
of the term under section 423.4 of 
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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-
graph, and shall make such report avail-
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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 
(bb) by each type of dispensing 
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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 providers; 
‘‘(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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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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542 
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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543 
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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546 
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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had the plan provided coverage 
for such products on the same 
formulary tier as the reference 
product. 
‘‘(dd) A written justification 
for providing more favorable cov-
erage of the reference product 
than the biosimilar biological 
product described in item (aa). 
‘‘(ee) The number of cur-
rently marketed biosimilar bio-
logical products licensed under 
section 351(k) of the Public 
Health Service Act, pursuant to 
an application that refers to such 
reference product. 
‘‘(V) Total gross spending on 
covered part D drugs by the plan, not 
net of rebates, fees, discounts, or 
other direct or indirect remuneration. 
‘‘(VI) The total amount retained 
by the pharmacy benefit manager or 
an affiliate of such pharmacy benefit 
manager in revenue related to utiliza-
tion of covered part D drugs under 
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548 
that plan, inclusive of bona fide serv-
ice fees. 
‘‘(VII) The total spending on cov-
ered part D drugs net of rebates, fees, 
discounts, or other direct and indirect 
remuneration by the plan. 
‘‘(VIII) An explanation of any 
benefit design parameters under such 
plan that encourage plan enrollees to 
fill prescriptions at pharmacies that 
are an affiliate of such pharmacy ben-
efit manager, such as mail and spe-
cialty home delivery programs, and re-
tail and mail auto-refill programs. 
‘‘(IX) The following information: 
‘‘(aa) A list of all brokers, 
consultants, advisors, and audi-
tors that receive compensation 
from the pharmacy benefit man-
ager or an affiliate of such phar-
macy benefit manager for refer-
rals, 
consulting, 
auditing, 
or 
other services offered to PDP 
sponsors related to pharmacy 
benefit management services. 
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549 
‘‘(bb) The amount of com-
pensation provided by such phar-
macy benefit manager or affiliate 
to each such broker, consultant, 
advisor, and auditor. 
‘‘(cc) The methodology for 
calculating the amount of com-
pensation provided by such phar-
macy benefit manager or affil-
iate, for each such broker, con-
sultant, advisor, and auditor. 
‘‘(X) A list of all affiliates of the 
pharmacy benefit manager. 
‘‘(XI) A summary document sub-
mitted in a standardized template de-
veloped by the Secretary that includes 
such information described in sub-
clauses (I) through (X). 
‘‘(ii) WRITTEN EXPLANATION OF CON-
TRACTS
OR
AGREEMENTS
WITH
DRUG 
MANUFACTURERS.— 
‘‘(I) IN
GENERAL.—The phar-
macy benefit manager shall, not later 
than 30 days after the finalization of 
any contract or agreement between 
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such pharmacy benefit manager or an 
affiliate of such pharmacy benefit 
manager and a drug manufacturer (or 
subsidiary, agent, or entity affiliated 
with such drug manufacturer) that 
makes rebates, discounts, payments, 
or other financial incentives related to 
one or more covered part D drugs or 
other prescription drugs, as applica-
ble, of the manufacturer directly or 
indirectly contingent upon coverage, 
formulary placement, or utilization 
management conditions on any other 
covered part D drugs or other pre-
scription drugs, as applicable, submit 
to the PDP sponsor a written expla-
nation of such contract or agreement. 
‘‘(II) REQUIREMENTS.—A writ-
ten explanation under subclause (I) 
shall— 
‘‘(aa) include the manufac-
turer subject to the contract or 
agreement, all covered part D 
drugs 
and 
other 
prescription 
drugs, as applicable, subject to 
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551 
the contract or agreement and 
the manufacturers of such drugs, 
and a high-level description of 
the terms of such contract or 
agreement and how such terms 
apply to such drugs; and 
‘‘(bb) be certified by the 
Chief Executive Officer, Chief Fi-
nancial Officer, or General Coun-
sel of such pharmacy benefit 
manager, or affiliate of such 
pharmacy benefit manager, as 
applicable, or an individual dele-
gated with the authority to sign 
on behalf of one of these officers, 
who reports directly to the offi-
cer. 
‘‘(III) DEFINITION
OF
OTHER 
PRESCRIPTION DRUGS.—For purposes 
of this clause, the term ‘other pre-
scription drugs’ means prescription 
drugs covered as supplemental bene-
fits under this part or prescription 
drugs paid outside of this part. 
‘‘(D) AUDIT RIGHTS.— 
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552 
‘‘(i) IN GENERAL.—Not less than once 
a year, at the request of the PDP sponsor, 
the pharmacy benefit manager shall allow 
for an audit of the pharmacy benefit man-
ager to ensure compliance with all terms 
and conditions under the written agree-
ment described in this paragraph and the 
accuracy of information reported under 
subparagraph (C). 
‘‘(ii) AUDITOR.—The PDP sponsor 
shall have the right to select an auditor. 
The pharmacy benefit manager shall not 
impose any limitations on the selection of 
such auditor. 
‘‘(iii) PROVISION OF INFORMATION.— 
The pharmacy benefit manager shall make 
available to such auditor all records, data, 
contracts, and other information necessary 
to confirm the accuracy of information 
provided under subparagraph (C), subject 
to reasonable restrictions on how such in-
formation must be reported to prevent re-
disclosure of such information. 
‘‘(iv) TIMING.—The pharmacy benefit 
manager must provide information under 
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553 
clause (iii) and other information, data, 
and records relevant to the audit to such 
auditor within 6 months of the initiation of 
the audit and respond to requests for addi-
tional information from such auditor with-
in 30 days after the request for additional 
information. 
‘‘(v) INFORMATION
FROM
AFFILI-
ATES.—The pharmacy benefit manager 
shall be responsible for providing to such 
auditor information required to be reported 
under subparagraph (C) or under clause 
(iii) of this subparagraph that is owned or 
held by an affiliate of such pharmacy ben-
efit manager. 
‘‘(2) ENFORCEMENT.— 
‘‘(A) IN
GENERAL.—Each PDP sponsor 
shall— 
‘‘(i) disgorge to the Secretary any 
amounts disgorged to the PDP sponsor by 
a pharmacy benefit manager under para-
graph (1)(A)(v); 
‘‘(ii) require, in a written agreement 
with any pharmacy benefit manager acting 
on behalf of such sponsor or affiliate of 
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such pharmacy benefit manager, that such 
pharmacy benefit manager or affiliate re-
imburse the PDP sponsor for any civil 
money penalty imposed on the PDP spon-
sor as a result of the failure of the phar-
macy benefit manager or affiliate to meet 
the requirements of paragraph (1) that are 
applicable to the pharmacy benefit man-
ager or affiliate under the agreement; and 
‘‘(iii) require, in a written agreement 
with any such pharmacy benefit manager 
acting on behalf of such sponsor or affil-
iate of such pharmacy benefit manager, 
that such pharmacy benefit manager or af-
filiate be subject to punitive remedies for 
breach of contract for failure to comply 
with the requirements applicable under 
paragraph (1). 
‘‘(B) REPORTING
OF
ALLEGED
VIOLA-
TIONS.—The Secretary shall make available and 
maintain a mechanism for manufacturers, PDP 
sponsors, pharmacies, and other entities that 
have contractual relationships with pharmacy 
benefit managers or affiliates of such pharmacy 
benefit managers to report, on a confidential 
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555 
basis, alleged violations of paragraph (1)(A) or 
subparagraph (C). 
‘‘(C) ANTI-RETALIATION AND ANTI-COER-
CION.—Consistent with applicable Federal or 
State law, a PDP sponsor shall not— 
‘‘(i) retaliate against an individual or 
entity for reporting an alleged violation 
under subparagraph (B); or 
‘‘(ii) coerce, intimidate, threaten, or 
interfere with the ability of an individual 
or entity to report any such alleged viola-
tions. 
‘‘(3) CERTIFICATION OF COMPLIANCE.— 
‘‘(A) IN
GENERAL.—Each PDP sponsor 
shall furnish to the Secretary (at a time and in 
a manner specified by the Secretary) an annual 
certification of compliance with this subsection, 
as well as such information as the Secretary de-
termines necessary to carry out this subsection. 
‘‘(B) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph by program instruc-
tion or otherwise. 
‘‘(4) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed as— 
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556 
‘‘(A) prohibiting flat dispensing fees or re-
imbursement or payment for ingredient costs 
(including customary, industry-standard dis-
counts directly related to drug acquisition that 
are retained by pharmacies or wholesalers) to 
entities that acquire or dispense prescription 
drugs; or 
‘‘(B) modifying regulatory requirements or 
sub-regulatory program instruction or guidance 
related to pharmacy payment, reimbursement, 
or dispensing fees. 
‘‘(5) STANDARD FORMATS.— 
‘‘(A) IN GENERAL.—Not later than June 
1, 2027, the Secretary shall specify standard, 
machine-readable formats for pharmacy benefit 
managers to submit annual reports required 
under paragraph (1)(C)(i). 
‘‘(B) IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph by program instruc-
tion or otherwise. 
‘‘(6) CONFIDENTIALITY.— 
‘‘(A) IN GENERAL.—Information disclosed 
by a pharmacy benefit manager, an affiliate of 
a pharmacy benefit manager, a PDP sponsor, 
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557 
or a pharmacy under this subsection that is not 
otherwise publicly available or available for pur-
chase shall not be disclosed by the Secretary or 
a PDP sponsor receiving the information, ex-
cept that the Secretary may disclose the infor-
mation for the following purposes: 
‘‘(i) As the Secretary determines nec-
essary to carry out this part. 
‘‘(ii) To permit the Comptroller Gen-
eral to review the information provided. 
‘‘(iii) To permit the Director of the 
Congressional Budget Office to review the 
information provided. 
‘‘(iv) To permit the Executive Direc-
tor of the Medicare Payment Advisory 
Commission to review the information pro-
vided. 
‘‘(v) To the Attorney General for the 
purposes of conducting oversight and en-
forcement under this title. 
‘‘(vi) To the Inspector General of the 
Department of Health and Human Serv-
ices in accordance with its authorities 
under the Inspector General Act of 1978 
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558 
(section 406 of title 5, United States 
Code), and other applicable statutes. 
‘‘(B) RESTRICTION ON USE OF INFORMA-
TION.—The Secretary, the Comptroller General, 
the Director of the Congressional Budget Of-
fice, and the Executive Director of the Medicare 
Payment Advisory Commission shall not report 
on or disclose information disclosed pursuant to 
subparagraph (A) to the public in a manner 
that would identify— 
‘‘(i) a specific pharmacy benefit man-
ager, affiliate, pharmacy, manufacturer, 
wholesaler, PDP sponsor, or plan; or 
‘‘(ii) contract prices, rebates, dis-
counts, or other remuneration for specific 
drugs in a manner that may allow the 
identification of specific contracting parties 
or of such specific drugs. 
‘‘(7) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) AFFILIATE.—The term ‘affiliate’ 
means, with respect to any pharmacy benefit 
manager or PDP sponsor, any entity that, di-
rectly or indirectly— 
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559 
‘‘(i) owns or is owned by, controls or 
is controlled by, or is otherwise related in 
any ownership structure to such pharmacy 
benefit manager or PDP sponsor; or 
‘‘(ii) acts as a contractor, principal, or 
agent to such pharmacy benefit manager 
or PDP sponsor, insofar as such con-
tractor, principal, or agent performs any of 
the functions described under subpara-
graph (C). 
‘‘(B) BONA FIDE SERVICE FEE.—The term 
‘bona fide service fee’ means a fee that is reflec-
tive of the fair market value (as specified by the 
Secretary, through notice and comment rule-
making) for a bona fide, itemized service actu-
ally performed on behalf of an entity, that the 
entity would otherwise perform (or contract for) 
in the absence of the service arrangement and 
that is not passed on in whole or in part to a 
client or customer, whether or not the entity 
takes title to the drug. Such fee must be a flat 
dollar amount and shall not be directly or indi-
rectly based on, or contingent upon— 
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560 
‘‘(i) drug price, such as wholesale ac-
quisition cost or drug benchmark price 
(such as average wholesale price); 
‘‘(ii) the amount of discounts, rebates, 
fees, or other direct or indirect remunera-
tion with respect to covered part D drugs 
dispensed to enrollees in a prescription 
drug plan, except as permitted pursuant to 
paragraph (1)(A)(ii); 
‘‘(iii) coverage or formulary placement 
decisions or the volume or value of any re-
ferrals or business generated between the 
parties to the arrangement; or 
‘‘(iv) any other amounts or meth-
odologies prohibited by the Secretary. 
‘‘(C) PHARMACY BENEFIT MANAGER.—The 
term ‘pharmacy benefit manager’ means any 
person or entity that, either directly or through 
an intermediary, acts as a price negotiator or 
group purchaser on behalf of a PDP sponsor or 
prescription drug plan, or manages the pre-
scription drug benefits provided by such spon-
sor or plan, including the processing and pay-
ment of claims for prescription drugs, the per-
formance of drug utilization review, the proc-
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561 
essing of drug prior authorization requests, the 
adjudication of appeals or grievances related to 
the prescription drug benefit, contracting with 
network pharmacies, controlling the cost of cov-
ered part D drugs, or the provision of related 
services. Such term includes any person or enti-
ty that carries out one or more of the activities 
described in the preceding sentence, irrespective 
of whether such person or entity calls itself a 
‘pharmacy benefit manager’.’’. 
(2) MA–PD PLANS.—Section 1857(f)(3) of the 
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 
amended by adding at the end the following new 
subparagraph: 
‘‘(F) REQUIREMENTS RELATING TO PHAR-
MACY BENEFIT MANAGERS.—For plan years be-
ginning on or after January 1, 2028, section 
1860D–12(h).’’. 
(3) NONAPPLICATION OF PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States 
Code, shall not apply to the implementation of this 
subsection. 
(4) FUNDING.— 
(A) SECRETARY.—In addition to amounts 
otherwise available, there is appropriated to the 
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562 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$113,000,000 for fiscal year 2025, to remain 
available until expended, to carry out this sub-
section. 
(B) OIG.—In addition to amounts other-
wise available, there is appropriated to the In-
spector General of the Department of Health 
and Human Services, out of any money in the 
Treasury 
not 
otherwise 
appropriated, 
$20,000,000 for fiscal year 2025, to remain 
available until expended, to carry out this sub-
section. 
(b) GAO STUDY AND REPORT ON PRICE-RELATED 
COMPENSATION ACROSS THE SUPPLY CHAIN.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study de-
scribing the use of compensation and payment struc-
tures related to a prescription drug’s price within 
the retail prescription drug supply chain in part D 
of title XVIII of the Social Security Act (42 U.S.C. 
1395w–101 et seq.). Such study shall summarize in-
formation from Federal agencies and industry ex-
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perts, to the extent available, with respect to the fol-
lowing: 
(A) The type, magnitude, other features 
(such as the pricing benchmarks used), and 
prevalence of compensation and payment struc-
tures related to a prescription drug’s price, 
such as calculating fee amounts as a percentage 
of a prescription drug’s price, between inter-
mediaries in the prescription drug supply chain, 
including— 
(i) pharmacy benefit managers; 
(ii) PDP sponsors offering prescrip-
tion drug plans and Medicare Advantage 
organizations offering MA–PD plans; 
(iii) drug wholesalers; 
(iv) pharmacies; 
(v) manufacturers; 
(vi) pharmacy services administrative 
organizations; 
(vii) brokers, auditors, consultants, 
and other entities that— 
(I) advise PDP sponsors offering 
prescription drug plans and Medicare 
Advantage organizations offering MA– 
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PD plans regarding pharmacy bene-
fits; or 
(II) review PDP sponsor and 
Medicare Advantage organization con-
tracts with pharmacy benefit man-
agers; and 
(viii) other service providers that con-
tract with any of the entities described in 
clauses (i) through (vii) that may use 
price-related compensation and payment 
structures, such as rebate aggregators (or 
other entities that negotiate or process 
price concessions on behalf of pharmacy 
benefit managers, plan sponsors, or phar-
macies). 
(B) The primary business models and com-
pensation structures for each category of inter-
mediary described in subparagraph (A). 
(C) Variation in price-related compensation 
structures between affiliated entities (such as 
entities with common ownership, either full or 
partial, and subsidiary relationships) and unaf-
filiated entities. 
(D) Potential conflicts of interest among 
contracting entities related to the use of pre-
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scription drug price-related compensation struc-
tures, such as the potential for fees or other 
payments set as a percentage of a prescription 
drug’s price to advantage formulary selection, 
distribution, or purchasing of prescription drugs 
with higher prices. 
(E) Notable differences, if any, in the use 
and level of price-based compensation struc-
tures over time and between different market 
segments, such as under part D of title XVIII 
of the Social Security Act (42 U.S.C. 1395w– 
101 et seq.) and the Medicaid program under 
title XIX of such Act (42 U.S.C. 1396 et seq.). 
(F) The effects of drug price-related com-
pensation structures and alternative compensa-
tion structures on Federal health care programs 
and program beneficiaries, including with re-
spect to cost-sharing, premiums, Federal out-
lays, biosimilar and generic drug adoption and 
utilization, drug shortage risks, and the poten-
tial for fees set as a percentage of a drug’s 
price to advantage the formulary selection, dis-
tribution, or purchasing of drugs with higher 
prices. 
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(G) Other issues determined to be relevant 
and appropriate by the Comptroller General. 
(2) REPORT.—Not later than 2 years after the 
date of enactment of this section, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
(c) MEDPAC REPORTS
ON AGREEMENTS WITH 
PHARMACY BENEFIT MANAGERS WITH RESPECT TO PRE-
SCRIPTION DRUG PLANS AND MA-PD PLANS.— 
(1) IN GENERAL.—The Medicare Payment Ad-
visory Commission shall submit to Congress the fol-
lowing reports: 
(A) INITIAL REPORT.—Not later than the 
first March 15 occurring after the date that is 
2 years after the date on which the Secretary 
makes the data available to the Commission, a 
report regarding agreements with pharmacy 
benefit managers with respect to prescription 
drug plans and MA–PD plans. Such report 
shall include, to the extent practicable— 
(i) a description of trends and pat-
terns, including relevant averages, totals, 
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and other figures for the types of informa-
tion submitted; 
(ii) an analysis of any differences in 
agreements and their effects on plan en-
rollee out-of-pocket spending and average 
pharmacy reimbursement, and other im-
pacts; and 
(iii) any recommendations the Com-
mission determines appropriate. 
(B) FINAL
REPORT.—Not later than 2 
years after the date on which the Commission 
submits the initial report under subparagraph 
(A), a report describing any changes with re-
spect to the information described in subpara-
graph (A) over time, together with any rec-
ommendations the Commission determines ap-
propriate. 
(2) FUNDING.—In addition to amounts other-
wise available, there is appropriated to the Medicare 
Payment Advisory Commission, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated, 
$1,000,000 for fiscal year 2025, to remain available 
until expended, to carry out this subsection. 
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568 
SEC. 228. REQUIRING A SEPARATE IDENTIFICATION NUM-
BER AND AN ATTESTATION FOR EACH OFF- 
CAMPUS OUTPATIENT DEPARTMENT OF A 
PROVIDER. 
(a) IN GENERAL.—Section 1833(t) of the Social Se-
curity Act (42 U.S.C. 1395l(t)) is amended by adding at 
the end the following new paragraph: 
‘‘(23) USE OF UNIQUE HEALTH IDENTIFIERS; 
ATTESTATION.— 
‘‘(A) IN GENERAL.—No payment may be 
made under this subsection (or under an appli-
cable payment system pursuant to paragraph 
(21)) for items and services furnished on or 
after January 1, 2026, by an off-campus out-
patient department of a provider (as defined in 
subparagraph (C)) unless— 
‘‘(i) such department has obtained, 
and such items and services are billed 
under, a standard unique health identifier 
for health care providers (as described in 
section 1173(b)) that is separate from 
such identifier for such provider; 
‘‘(ii) such provider has submitted to 
the Secretary, during the 2-year period 
ending on the date such items and services 
are so furnished, an initial provider-based 
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status attestation that such department is 
compliant with the requirements described 
in section 413.65 of title 42, Code of Fed-
eral Regulations (or a successor regula-
tion); and 
‘‘(iii) after such provider has sub-
mitted an attestation under clause (ii), 
such provider has submitted a subsequent 
attestation within the timeframe specified 
by the Secretary. 
‘‘(B) PROCESS FOR SUBMISSION AND RE-
VIEW.—Not later than 1 year after the date of 
enactment of this paragraph, the Secretary 
shall, through notice and comment rulemaking, 
establish a process for each provider with an 
off-campus outpatient department of a provider 
to submit an initial and subsequent attestation 
pursuant to clauses (ii) and (iii), respectively, of 
subparagraph (A), and for the Secretary to re-
view each such attestation and determine, 
through site visits, remote audits, or other 
means (as determined appropriate by the Sec-
retary), whether such department is compliant 
with the requirements described in such sub-
paragraph. 
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‘‘(C) OFF-CAMPUS
OUTPATIENT
DEPART-
MENT OF A PROVIDER DEFINED.—For purposes 
of this paragraph, the term ‘off-campus out-
patient department of a provider’ means a de-
partment of a provider (as defined in section 
413.65 of title 42, Code of Federal Regulations, 
or any successor regulation) that is not lo-
cated— 
‘‘(i) on the campus (as defined in such 
section) of such provider; or 
‘‘(ii) within the distance (described in 
such definition of campus) from a remote 
location of a hospital facility (as defined in 
such section).’’. 
(b) HHS OIG ANALYSIS.—Not later than January 
1, 2030, the Inspector General of the Department of 
Health and Human Services shall submit to Congress— 
(1) an analysis of the process established by the 
Secretary of Health and Human Services to conduct 
the reviews and determinations described in section 
1833(t)(23)(B) of the Social Security Act, as added 
by subsection (a) of this section; and 
(2) recommendations based on such analysis, as 
the Inspector General determines appropriate. 
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571 
SEC. 229. MEDICARE SEQUESTRATION. 
Section 251A(6) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985 (2 U.S.C. 901a(6)) is 
amended— 
(1) in subparagraph (D), by striking ‘‘such 
that,’’ and all that follows and inserting ‘‘such that 
the payment reduction shall be 2.0 percent.’’; and 
(2) by adding at the end the following: 
‘‘(F) On the date on which the President sub-
mits the budget under section 1105 of title 31, 
United States Code, for fiscal year 2033, the Presi-
dent shall order a sequestration of payments for the 
Medicare programs specified in section 256(d), effec-
tive upon issuance, such that, notwithstanding the 2 
percent limit specified in subparagraph (A) for such 
payments— 
‘‘(i) with respect to the first 2 months in 
which such order is effective for such fiscal 
year, the payment reduction shall be 2.0 per-
cent; and 
‘‘(ii) with respect to the last 10 months in 
which such order is effective for such fiscal 
year, the payment reduction shall be 0 per-
cent.’’. 
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572 
SEC. 230. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 
U.S.C. 
1395iii(b)(1)) 
is 
amended 
by 
striking 
‘‘$3,197,000,000’’ and inserting ‘‘$1,891,500,000’’. 
TITLE III—HUMAN SERVICES 
Subtitle A—Reauthorize Child Wel-
fare Services and Strengthen 
State and Tribal Child Support 
Program 
SEC. 301. SHORT TITLE. 
This subtitle may be cited as the ‘‘Supporting Amer-
ica’s Children and Families Act’’. 
PART 1—CHILD WELFARE REAUTHORIZATION 
AND MODERNIZATION 
SEC. 311. SHORT TITLE; REFERENCES. 
(a) SHORT TITLE.—This part may be cited as the 
‘‘Protecting America’s Children by Strengthening Fami-
lies Act’’. 
(b) REFERENCES.—Except as otherwise expressly 
provided, wherever in this part an amendment or repeal 
is expressed in terms of an amendment to, or repeal of, 
a section or other provision, the reference shall be consid-
ered to be made to that section or other provision of the 
Social Security Act. 
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573 
SEC. 312. REAUTHORIZATION OF CHILD WELFARE PRO-
GRAMS. 
(a) REAUTHORIZATION
OF SUBPART 1; DISCRE-
TIONARY FUNDING.—Section 425 (42 U.S.C. 625) is 
amended by striking ‘‘2017 through 2023’’ and inserting 
‘‘2025 through 2029’’. 
(b) REAUTHORIZATION OF SUBPART 2; ENHANCED 
SUPPORT.—Section 436(a) (42 U.S.C. 629f(a)) is amend-
ed by striking ‘‘each of fiscal years 2017 through 2023’’ 
and inserting ‘‘fiscal year 2025 and $420,000,000 for 
each of fiscal years 2026 through 2029’’. 
(c) REAUTHORIZATION
OF SUBPART 2; DISCRE-
TIONARY FUNDING.—Section 437(a) (42 U.S.C. 629g(a)) 
is amended by striking ‘‘2017 through 2023’’ and insert-
ing ‘‘2025 through 2029’’. 
(d) FUNDING LIMITATION.—Section 423(a)(2)(A) 
(42 U.S.C. 623(a)(2)(A)) is amended by inserting ‘‘, not 
to exceed $10,000,000’’ before the semicolon. 
SEC. 313. ENHANCEMENTS TO THE COURT IMPROVEMENT 
PROGRAM. 
(a) INCREASE IN RESERVATION OF FUNDS.—Section 
436(b)(2) (42 U.S.C. 629f(b)(2)) is amended by inserting 
‘‘for fiscal year 2025 and $40,000,000 for fiscal year 2026 
and each succeeding fiscal year’’ before ‘‘for grants’’. 
(b) EXTENSION OF STATE MATCH REQUIREMENT.— 
Section 438(d) (42 U.S.C. 629h(d)) is amended by strik-
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ing ‘‘2017 through 2023’’ and inserting ‘‘2025 through 
2029’’. 
(c) PROGRAM IMPROVEMENTS.—Section 438(a) (42 
U.S.C. 629h(a)) is amended— 
(1) in paragraph (1), by adding at the end the 
following: 
‘‘(F) that determine the appropriateness 
and best practices for use of technology to con-
duct remote hearings, subject to participant 
consent, including to ensure maximum partici-
pation of individuals involved in proceedings 
and to enable courts to maintain operations in 
times of public health or other emergencies;’’; 
(2) in paragraph (2)(C), by striking ‘‘per-
sonnel.’’ and inserting ‘‘personnel and supporting 
optimal use of remote hearing technology; and’’; and 
(3) by adding at the end the following: 
‘‘(3) to ensure continuity of needed court serv-
ices, prevent disruption of the services, and enable 
their recovery from threats such as public health cri-
ses, natural disasters or cyberattacks, including 
through— 
‘‘(A) support for technology that allows 
court proceedings to occur remotely subject to 
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participant consent, including hearings and 
legal representation; 
‘‘(B) the development of guidance and pro-
tocols for responding to the occurrences and co-
ordinating with other agencies; and 
‘‘(C) other activities carried out to ensure 
backup systems are in place.’’. 
(d) IMPLEMENTATION GUIDANCE ON SHARING BEST 
PRACTICES FOR TECHNOLOGICAL CHANGES NEEDED FOR 
REMOTE COURT PROCEEDINGS FOR FOSTER CARE OR 
ADOPTION.—Section 438 (42 U.S.C. 629h) is amended by 
adding at the end the following: 
‘‘(e) GUIDANCE.— 
‘‘(1) IN
GENERAL.—Every 5 years, the Sec-
retary shall issue implementation guidance for shar-
ing information on best practices for— 
‘‘(A) technological changes needed for 
court proceedings for foster care, guardianship, 
or adoption to be conducted remotely in a way 
that maximizes engagement and protects the 
privacy of participants; and 
‘‘(B) the manner in which the proceedings 
should be conducted. 
‘‘(2) INITIAL ISSUANCE.—The Secretary shall 
issue initial guidance required by paragraph (1) with 
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preliminary information on best practices not later 
than October 1, 2025. 
‘‘(3) ADDITIONAL
CONSULTATION.—The Sec-
retary shall consult with Indian tribes on the devel-
opment of appropriate guidelines for State court 
proceedings involving Indian children to maximize 
engagement of Indian tribes and provide appropriate 
guidelines on conducting State court proceedings 
subject to the Indian Child Welfare Act of 1978 (25 
U.S.C. 1901 et seq.).’’. 
SEC. 314. EXPANDING REGIONAL PARTNERSHIP GRANTS 
TO ADDRESS PARENTAL SUBSTANCE USE DIS-
ORDER AS CAUSE OF CHILD REMOVAL. 
(a) INCREASE IN RESERVATION OF FUNDS.—Section 
436(b)(5) (42 U.S.C. 629f(b)(5)) is amended by striking 
‘‘each of fiscal years 2017 through 2023’’ and inserting 
‘‘fiscal year 2025 and $30,000,000 for fiscal year 2026 
and each succeeding fiscal year’’. 
(b) REAUTHORIZATION.—Section 437(f) (42 U.S.C. 
629g(f)) is amended— 
(1) in paragraph (3)(A)— 
(A) by striking ‘‘In addition to amounts 
authorized to be appropriated to carry out this 
section, the’’ and inserting ‘‘The’’; and 
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577 
(B) by striking ‘‘2017 through 2023’’ and 
inserting ‘‘2025 through 2029’’; and 
(2) in paragraph (10), by striking ‘‘for each of 
fiscal years 2017 through 2023’’. 
(c) AUTHORITY TO WAIVE PLANNING PHASE.—Sec-
tion 437(f)(3)(B)(iii) (42 U.S.C. 629g(f)(3)(B)(iii)) is 
amended— 
(1) by striking all that precedes ‘‘grant award-
ed’’ and inserting the following: 
‘‘(iii) SUFFICIENT PLANNING.— 
‘‘(I) IN GENERAL.—A’’; and 
(2) by striking ‘‘may not exceed $250,000, 
and’’; and 
(3) by adding after and below the end the fol-
lowing: 
‘‘(II) 
EXCEPTION.—The 
Sec-
retary, on a case-by-case basis, may 
waive the planning phase for a part-
nership that demonstrates that the 
partnership has engaged in sufficient 
planning before submitting an appli-
cation for a grant under this sub-
section.’’. 
(d) EXPANDING AVAILABILITY OF EVIDENCE-BASED 
SERVICES.— 
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578 
(1) IN GENERAL.—Section 437(f)(1) (42 U.S.C. 
629g(f)(1)) is amended by inserting ‘‘, and expand 
the scope of the evidence-based services that may be 
approved by the clearinghouse established under sec-
tion 476(d)’’ before the period. 
(2) 
CONSIDERATIONS
FOR
AWARDING 
GRANTS.—Section 437(f)(7) (42 U.S.C. 629g(f)(7)) 
is amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (D); 
(B) by striking the period at the end of 
subparagraph (E) and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(F) have submitted information pursuant 
to paragraph (4)(F) that demonstrates the ca-
pability to participate in rigorous evaluation of 
program effectiveness.’’. 
(e) TECHNICAL ASSISTANCE ON USING REGIONAL 
PARTNERSHIP GRANT FUNDS IN COORDINATION WITH 
OTHER FEDERAL FUNDS TO BETTER SERVE FAMILIES 
AFFECTED BY A SUBSTANCE USE DISORDER.—Section 
435(d) (42 U.S.C. 629e(d)) is amended— 
(1) by striking ‘‘and’’ at the end of paragraph 
(4); 
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(2) by striking the period at the end of para-
graph (5) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(6) use grants under section 437(f) in coordi-
nation with other Federal funds to better serve fami-
lies in the child welfare system that are affected by 
a substance use disorder.’’. 
(f) 
PERFORMANCE
INDICATORS.—Section 
437(f)(8)(A) (42 U.S.C. 629g(f)(8)(A)) is amended in the 
1st sentence— 
(1) by striking ‘‘this subsection’’ the 1st place 
it appears and inserting ‘‘the Protecting America’s 
Children by Strengthening Families Act’’; 
(2) by inserting ‘‘child permanency, reunifica-
tion, re-entry into care,’’ before ‘‘parental recovery’’; 
and 
(3) by inserting ‘‘, and access to services for 
families with substance use disorder, including those 
with children who are overrepresented in foster care, 
difficult to place, or have disproportionately low per-
manency rates’’ before the period. 
(g) PERFORMANCE INDICATOR CONSULTATION RE-
QUIRED.—Section 
437(f)(8)(B) 
(42 
U.S.C. 
629g(f)(8)(B)) is amended by redesignating clause (iii) as 
clause (iv) and inserting after clause (ii) the following: 
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‘‘(iii) The Administrator of the Na-
tional Institute on Drug Abuse.’’. 
(h) REPORTS TO CONGRESS.—Section 437(f)(9)(B) 
(42 U.S.C. 629g(f)(9)(B)) is amended— 
(1) by striking ‘‘and’’ at the end of clause (ii); 
(2) by striking the period at the end of clause 
(iii) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(iv) whether any programs funded by 
the grants were submitted to the clearing-
house established under section 476(d) for 
review and the results of any such re-
view.’’. 
(i) PRIORITY FOR STATEWIDE SERVICE GROWTH.— 
Section 437(f)(7) (42 U.S.C. 629g(f)(7)), as amended by 
subsection (d)(2) of this section, is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (E); 
(2) by striking the period at the end of sub-
paragraph (F) and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(G) are a State or public agency, or out-
line a plan to increase the availability of serv-
ices funded under the grant statewide.’’. 
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(j) ADDITION OF JUVENILE COURT AS REQUIRED 
PARTNER.—Section 
437(f)(2)(A) 
(42 
U.S.C. 
629g(f)(2)(A)) is amended by adding at the end the fol-
lowing: 
‘‘(iii) The most appropriate adminis-
trative office of the juvenile court or State 
court overseeing court proceedings involv-
ing families who come to the attention of 
the court due to child abuse or neglect.’’. 
(k) ADDITIONAL
OPTIONAL
PARTNER.—Section 
437(f)(2)(C) (42 U.S.C. 629g(f)(2)(C)) is amended by re-
designating clause (ix) as clause (x) and inserting after 
clause (viii) the following: 
‘‘(ix) State or local agencies that ad-
minister Federal health care, housing, fam-
ily support, or other related programs.’’. 
(l) CONFORMING AMENDMENTS.— 
(1) 
Section 
437(f)(2)(D) 
(42 
U.S.C. 
629g(f)(2)(D)) is amended— 
(A) by adding ‘‘and’’ at the end of clause 
(i); 
(B) by striking ‘‘; and’’ at the end of 
clause (ii) and inserting a period; and 
(C) by striking clause (iii). 
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(2) Section 437(f)(2) (42 U.S.C. 629g(f)(2)) is 
amended by striking subparagraph (B) and redesig-
nating subparagraphs (C) and (D) as subparagraphs 
(B) and (C), respectively 
SEC. 315. MODERNIZATION; REDUCING ADMINISTRATIVE 
BURDEN. 
(a) IN GENERAL.—Section 431 (42 U.S.C. 629a) is 
amended by adding at the end the following: 
‘‘(c) USE OF TECHNOLOGY.— 
‘‘(1) USE OF PORTAL.—The services referred to 
in subsection (a) may include the means of access to 
and use of an electronic or digital portal to facilitate 
the provision of community support to care for and 
meet specific needs of families and children. 
‘‘(2) LIMITATION.—Such a portal shall not re-
tain or share personally identifiable information 
about a beneficiary without consent or for any pur-
pose other than referral.’’. 
(b) ALLOWING SUPPORT
FOR FAMILY RESOURCE 
CENTERS.—Section 431(a) (42 U.S.C. 629a(a)) is amend-
ed— 
(1) in paragraph (2)(A), by inserting ‘‘, includ-
ing services provided by family resource centers,’’ 
before ‘‘designed’’; and 
(2) by adding at the end the following: 
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‘‘(10) FAMILY RESOURCE CENTER.— 
‘‘(A) IN GENERAL.—The term ‘family re-
source center’ means a community or school- 
based hub of support services for families 
that— 
‘‘(i) utilizes an approach that is multi- 
generational, strengths-based, and family- 
centered; 
‘‘(ii) reflects, and is responsive to, 
community needs and interests; 
‘‘(iii) provides support at no or low 
cost for participants; and 
‘‘(iv) builds communities of peer sup-
port for families, including kinship fami-
lies, to develop social connections that re-
duce isolation and stress. 
‘‘(B) SPECIAL
RULE.—For purposes of 
this subpart, an expenditure for a service pro-
vided by a family resource center may be treat-
ed as an expenditure for any 1 or more of fam-
ily support services, family preservation serv-
ices, family reunification services, or adoption 
promotion and support services as long as the 
expenditure is related to serving the children 
and families in the specified category and con-
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sistent with the overall purpose of the cat-
egory.’’. 
(c) UPDATING STATE PLAN REQUIREMENT.—Sec-
tion 422(b)(1) (42 U.S.C. 622(b)(1)) is amended to read 
as follows: 
‘‘(1) provide that a State agency will administer 
or supervise the administration of the plan under 
this subpart;’’. 
(d) ACCESS TO LEGAL REPRESENTATION.—Section 
422(b)(4) (42 U.S.C. 622(b)(4)) is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (A); 
(2) by adding ‘‘and’’ at the end of subpara-
graph (B); and 
(3) by adding at the end the following: 
‘‘(C) the steps that the State will take to 
ensure that, with respect to any judicial pro-
ceeding involving a child and in which there is 
an allegation of child abuse or neglect, includ-
ing a proceeding on dependency, adoption, 
guardianship, or termination of parental rights, 
information about available independent legal 
representation is provided to— 
‘‘(i) the child, as appropriate; and 
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‘‘(ii) any individual who is a parent or 
guardian, or has legal custody, of the 
child;’’. 
(e) SUPPORTING MENTAL HEALTH
AND WELL- 
BEING
OF
CHILDREN
IN
FOSTER
CARE.—Section 
422(b)(15)(A) (42 U.S.C. 622(b)(15) is amended— 
(1) in the matter preceding clause (i)— 
(A) by inserting ‘‘and, if applicable, the 
State agency responsible for mental health serv-
ices,’’ before ‘‘and in consultation’’; and 
(B) by inserting ‘‘mental health pro-
viders,’’ before ‘‘other experts’’; 
(2) in clause (ii), by inserting ‘‘a list of services 
provided to support the physical and’’ before ‘‘emo-
tional’’; 
(3) in clause (iv), by inserting ‘‘and mental 
health’’ before ‘‘services’’; 
(4) in clause (v), by inserting ‘‘, informed con-
sent of youth, and compliance with professional 
practice guidelines’’ before the semicolon; and 
(5) in clause (vi), by inserting ‘‘, licensed men-
tal health providers,’’ before ‘‘or other’’. 
(f) REDUCTION OF ADMINISTRATIVE BURDEN.— 
(1) IN GENERAL.—Subpart 3 of part B of title 
IV (42 U.S.C. 629m) is amended by redesignating 
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section 440 as section 443 and inserting before such 
section the following: 
‘‘SEC. 441. REDUCTION OF ADMINISTRATIVE BURDEN. 
‘‘(a) IN GENERAL.—The Secretary shall reduce the 
burden of administering this part imposed on the recipi-
ents of funds under this part, by— 
‘‘(1) reviewing and revising administrative data 
collection instruments and forms to eliminate dupli-
cation and streamline reporting requirements for the 
recipients while collecting all data required under 
this part; 
‘‘(2) in coordination with activities required 
under the Paperwork Reduction Act, conducting an 
analysis of the total number of hours reported by 
the recipients to comply with paperwork require-
ments and exploring, in consultation with the recipi-
ents, how to reduce the number of hours required 
for the compliance by at least 15 percent; 
‘‘(3) collecting input from the recipients with 
respect to fiscal and oversight requirements and 
making changes to ensure consistency with stand-
ards and guidelines for other Federal formula grant 
programs based on the input; and 
‘‘(4) respecting the sovereignty of Indian tribes 
when complying with this subsection. 
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‘‘(b) LIMITATION
ON APPLICABILITY.—Subsection 
(a) of this section shall not apply to any reporting or data 
collection otherwise required by law that would affect the 
ability of the Secretary to monitor and ensure compliance 
with State plans approved under this part or ensure that 
funds are expended consistent with this part. 
‘‘SEC. 442. PUBLIC ACCESS TO STATE PLANS. 
‘‘The Secretary shall— 
‘‘(1) create a standardized format for State 
plans required under sections 422 and 432 used to 
monitor compliance with those sections; 
‘‘(2) produce comparisons and analyses of 
trends in State plans to inform future technical as-
sistance and policy development; 
‘‘(3) make the State plans available on a public 
website; and 
‘‘(4) include on the website aggregated national 
summaries of State submissions as the Secretary 
deems appropriate.’’. 
(2) IMPLEMENTATION.—Within 2 years after 
the date of the enactment of this Act, the Secretary 
of Health and Human Services shall— 
(A) comply with section 441 of the Social 
Security Act, as added by the amendment made 
by paragraph (1); and 
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(B) notify each recipient of funds under 
part B of title IV of the Social Security Act of 
any change made by the Secretary pursuant to 
such section affecting the recipient. 
(3) REPORT.—Within 3 years after the date of 
the enactment of this Act, the Secretary of Health 
and Human Services shall submit to the Committee 
on Ways and Means of the House of Representatives 
and the Committee on Finance of the Senate a re-
port describing the efforts of the Secretary to com-
ply with section 441 of the Social Security Act, as 
added by the amendment made by paragraph (1), in-
cluding the specific actions to comply with each 
paragraph of such section. 
(g) PRIMARY
PREVENTION
PARTNERS.—Section 
435(a)(2)(B) (42 U.S.C. 429e(a)(2)(B)) is amended by in-
serting ‘‘including community-based partners with exper-
tise in preventing unnecessary child welfare system in-
volvement’’ before the semicolon. 
SEC. 316. STREAMLINING FUNDING FOR INDIAN TRIBES. 
(a) SUBPART 1.— 
(1) TRIBAL SET-ASIDE; DIRECT PAYMENTS TO 
TRIBES; EXEMPTIVE AUTHORITY.— 
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589 
(A) IN GENERAL.—Section 428 (42 U.S.C. 
628) is amended by striking subsections (a) and 
(b) and inserting the following: 
‘‘(a) RESERVATION
OF
FUNDS; DIRECT
PAY-
MENTS.—Out of any amount appropriated pursuant to 
section 425 for a fiscal year, the Secretary shall reserve 
3 percent for grants to Indian tribes and tribal organiza-
tions, which shall be paid directly to Indian tribes and 
tribal organizations with a plan approved under this sub-
part, in accordance with section 433(a).’’. 
(B) CONFORMING
AMENDMENT.—Section 
423(a) (42 U.S.C. 623(a)) is amended by strik-
ing ‘‘the sum appropriated pursuant to section 
425 for each fiscal year’’ and inserting ‘‘for 
each fiscal year, the sum appropriated pursuant 
to section 425 remaining after applying section 
428(a)’’. 
(C) 
TECHNICAL
AMENDMENT.—Section 
428(c) (42 U.S.C. 628(c)) is amended by strik-
ing ‘‘450b’’ and inserting ‘‘5304’’. 
(2) IMPROVING COMPLIANCE WITH THE INDIAN 
CHILD WELFARE ACT.— 
(A) STATE PLAN REQUIREMENT.—Section 
422(b)(9) (42 U.S.C. 622(b)(9)) is amended by 
striking ‘‘Act;’’ and inserting ‘‘Act of 1978, in-
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590 
cluding how the State will ensure timely notice 
to Indian tribes of State custody proceedings 
involving Indian children, foster care or adop-
tive placements of Indian children, and case 
recordkeeping as such matters relate to trans-
fers of jurisdiction, termination of parental 
rights, and active efforts;’’. 
(B) TECHNICAL ASSISTANCE.—Subpart 1 
of part B of title IV (42 U.S.C. 621 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 429B. EFFECTIVE IMPLEMENTATION OF THE INDIAN 
CHILD WELFARE ACT OF 1978. 
‘‘(a) IN GENERAL.—Not later than October 1, 2025, 
the Secretary, in consultation with Indian tribal organiza-
tions and States, shall develop a plan and provide tech-
nical assistance supporting effective implementation of the 
Indian Child Welfare Act of 1978, including specific meas-
ures identified in State plans as required by section 
422(b)(9) of this Act. The technical assistance plan shall 
be based on data sufficient to assess State strengths and 
areas for improvement in implementing Federal standards 
established under the Indian Child Welfare Act of 1978, 
including, at a minimum, the following: 
‘‘(1) Timely identification of Indian children 
and extended family members. 
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‘‘(2) Timely tribal notice of State child custody 
proceedings involving an Indian child. 
‘‘(3) Reports of cases in which a transfer of ju-
risdiction (as defined under the Indian Child Wel-
fare Act of 1978) was granted or was not granted, 
and reasons specified for denial in cases where 
transfer was denied. 
‘‘(4) In cases in which a State court orders a 
foster care placement of an Indian child, whether re-
quirements for active efforts to prevent the breakup 
of the Indian family, testimony of a qualified expert 
witness, and evidentiary standards were met. 
‘‘(5) Whether an Indian child was placed in a 
placement that is required to be preferred under the 
Indian Child Welfare Act of 1978, and if not, the 
reasons specified. 
‘‘(6) In cases in which a State court orders the 
termination of parental rights to an Indian child, 
whether requirements for active efforts to prevent 
the breakup of the Indian family, testimony of a 
qualified expert witness, and evidentiary standards 
were met. 
‘‘(b) INTERAGENCY COORDINATION.—On request of 
the Secretary, the Secretary of the Interior shall provide 
the Secretary with such guidance and assistance as may 
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592 
be necessary to facilitate informing States and public child 
welfare agencies on how to comply with the Indian Child 
Welfare Act of 1978, including specific measures identi-
fied in State plans as required by section 422(b)(9) of this 
Act. 
‘‘(c) BIENNIAL REPORTS TO CONGRESS.—The Sec-
retary shall biennially submit to the Committee on Ways 
and Means of the House of Representatives and the Com-
mittee on Finance of the Senate a written report on how— 
‘‘(1) the States are complying with the Indian 
Child Welfare Act of 1978 and section 422(b)(9) of 
this Act, as informed by data collected under this 
section; and 
‘‘(2) the Secretary is assisting States and In-
dian tribes to improve implementation of Federal 
standards established under the Indian Child Wel-
fare Act of 1978.’’. 
(3) REPORTING REQUIREMENTS; ADMINISTRA-
TIVE COSTS.— 
(A) IN GENERAL.—Section 428 (42 U.S.C. 
628) is amended by redesignating subsection (c) 
as subsection (d) and inserting before such sub-
section the following: 
‘‘(b) AUTHORITY TO STREAMLINE REPORTING RE-
QUIREMENTS.—The Secretary shall, in consultation with 
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the affected Indian tribes, modify any reporting require-
ment imposed by or under this part on an Indian tribe, 
tribal organization, or tribal consortium if the total of the 
amounts allotted to the Indian tribe, tribal organization, 
or tribal consortium under this part for the fiscal year is 
not more than $50,000, and in a manner that limits the 
administrative burden on any tribe to which not more than 
$50,000 is allotted under this subpart for the fiscal year. 
‘‘(c) TRIBAL AUTHORITY TO SUBSTITUTE THE FED-
ERAL NEGOTIATED INDIRECT COST RATE FOR ADMINIS-
TRATIVE
COSTS
CAP.—For 
purposes 
of 
sections 
422(b)(14) and 424(e), an Indian tribal organization may 
elect to have the weighted average of the indirect cost 
rates in effect under part 220 of title 2, Code of Federal 
Regulations with respect to the administrative costs of the 
Indian tribal organization apply in lieu of the percentage 
specified in each such section.’’. 
(B) CONFORMING AMENDMENTS.—Section 
431(a) (42 U.S.C. 629a(a)) is amended in each 
of paragraphs (5) and (6) by striking ‘‘428(c)’’ 
and inserting ‘‘428(d)’’. 
(b) SUBPART 2.— 
(1) 
TRIBAL
PLAN
EXEMPTION.—Section 
432(b)(2)(B) (42 U.S.C. 629b(b)(2)(B)) is amend-
ed— 
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(A) by striking ‘‘section 433(a)’’ the 1st 
place it appears and inserting ‘‘sections 433(a) 
and 437(c)(1) combined’’; and 
(B) by striking ‘‘section 433(a)’’ the 2nd 
place it appears and inserting ‘‘such sections’’. 
(2) APPLICATION
OF
TRIBAL
SET-ASIDE
BE-
FORE
OTHER
SET-ASIDES.—Section 436(b)(3) (42 
U.S.C. 429f(b)(3)) is amended by striking ‘‘After 
applying paragraphs (4) and (5) (but before apply-
ing paragraphs (1) or (2)), the’’ and inserting 
‘‘The’’. 
(3) INCREASE IN FUNDING FOR TRIBAL COURT 
IMPROVEMENT
PROGRAM.—Section 438(c)(3) (42 
U.S.C. 629h(c)(3)) is amended by inserting ‘‘for fis-
cal year 2025, and $2,000,000 for each of fiscal 
years 2026 through 2029,’’ before ‘‘for grants’’. 
SEC. 317. ACCELERATING ACCESS TO FAMILY FIRST PRE-
VENTION SERVICES. 
(a) IN GENERAL.—Section 435 (42 U.S.C. 629e) is 
amended by adding at the end the following: 
‘‘(f) PREVENTION SERVICES EVALUATION PARTNER-
SHIPS.— 
‘‘(1) PURPOSE.—The purpose of this subsection 
is to authorize the Secretary to make competitive 
grants to support the timely evaluation of— 
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‘‘(A) services and programs described in 
section 471(e); or 
‘‘(B) kinship navigator programs described 
in section 474(a)(7). 
‘‘(2) GRANTS.—In accordance with applications 
approved under this subsection, the Secretary may 
make grants, on a competitive basis, to eligible enti-
ties to carry out projects designed to evaluate a serv-
ice or program provided by the eligible entity, or an 
entity in partnership with the eligible entity, with re-
spect to the requirements for a promising practice, 
supported practice, or well-supported practice de-
scribed in section 471(e)(4)(C). 
‘‘(3) APPLICATIONS.— 
‘‘(A) IN GENERAL.—An eligible entity may 
apply to the Secretary for a grant under this 
subsection to carry out a project that meets the 
following requirements: 
‘‘(i) The project is designed in accord-
ance with paragraph (2). 
‘‘(ii) The project is to be carried out 
by the applicant in partnership with— 
‘‘(I) a State agency that admin-
isters, or supervises the administra-
tion of, the State plan approved under 
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part E, or an agency administering 
the plan under the supervision of the 
State agency; and 
‘‘(II) if the applicant is unable or 
unwilling to do so, at least 1 external 
evaluator to carry out the evaluation 
of the service or program provided by 
the applicant. 
‘‘(B) CONTENTS.—The application shall 
contain the following: 
‘‘(i) A description of the project, in-
cluding— 
‘‘(I) a statement explaining why 
a grant is necessary to carry out the 
project; and 
‘‘(II) the amount of grant funds 
that would be disbursed to each entity 
described in subparagraph (A)(ii) in 
partnership with the applicant. 
‘‘(ii) A certification from each entity 
described in subparagraph (A)(ii) that pro-
vides assurances that the individual or en-
tity is in partnership with the applicant 
and will fulfill the responsibilities of the 
entity specified in the description provided 
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pursuant to clause (i) of this subpara-
graph. 
‘‘(iii) A certification from the appli-
cant that provides assurances that the ap-
plicant intends to comply with subpara-
graph (A)(ii)(II), if applicable. 
‘‘(iv) At the option of the eligible enti-
ty, a certification from the applicant that 
the applicant requires an external eval-
uator secured by the Secretary pursuant to 
paragraph (5), if applicable. 
‘‘(4) PRIORITIES.—In approving applications 
under this subsection, the Secretary shall prioritize 
the following: 
‘‘(A) Addressing, with respect to the clear-
inghouse of practices described in section 
476(d)(2), deficiencies or gaps identified by the 
Secretary in consultation with— 
‘‘(i) States, political subdivisions of a 
State, and tribal communities carrying out, 
or receiving the benefits of, a service or 
program; and 
‘‘(ii) child welfare experts, including 
individuals with lived experience. 
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‘‘(B) Maximizing the number of evidence- 
based services or programs to be included in the 
clearinghouse of practices described in section 
476(d)(2). 
‘‘(C) Timely completion of evaluations and 
the production of evidence. 
‘‘(D) Supporting services or programs that 
are based on, or are adaptations to new popu-
lation settings of, a service or program with re-
liable evidence about the benefits and risks of 
the service or program. 
‘‘(5) 
AVAILABILITY
OF
EXTERNAL
EVAL-
UATORS.— 
‘‘(A) IN GENERAL.—Before accepting ap-
plications under this subsection, the Secretary 
shall make reasonable efforts to identify at least 
1 entity to serve as an external evaluator for 
any eligible entity that includes a certification 
under paragraph (3)(B)(iv) with an application 
under this subsection. 
‘‘(B) NO EFFECT ON CONSIDERATION OF 
APPLICATION.—The Secretary may not consider 
whether an eligible entity is in partnership with 
an external evaluator described in paragraph 
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(A) in approving an application under this sub-
section submitted by the eligible entity. 
‘‘(6) REPORTS.— 
‘‘(A) BY
GRANT
RECIPIENTS.—Within 1 
year after receiving a grant under this sub-
section, and every year thereafter for the next 
5 years, the grant recipient shall submit to the 
Secretary a written report on— 
‘‘(i) the use of grant funds; 
‘‘(ii) whether the program or service 
evaluated by the project meets a require-
ment specified in section 471(e)(4)(C), in-
cluding information about— 
‘‘(I) how the program or service 
is being carried out in accordance 
with standards specified in the re-
quirement; 
‘‘(II) any outcomes of the pro-
gram or service; and 
‘‘(III) any outcome with respect 
to which the service or program com-
pares favorably to a comparison prac-
tice; and 
‘‘(iii) whether the Secretary has in-
cluded the program or service in an update 
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to the clearinghouse of practices described 
in section 476(d)(2). 
‘‘(B) BY THE SECRETARY.—The Secretary 
shall submit to the Committee on Ways and 
Means of the House of Representatives and to 
the Committee on Finance of the Senate an an-
nual written report on— 
‘‘(i) the grants awarded under this 
subsection; 
‘‘(ii) the programs funded by the 
grants; 
‘‘(iii) any technical assistance pro-
vided by the Secretary in carrying out this 
subsection, including with respect to the 
efforts to secure external evaluators pursu-
ant to paragraph (5); and 
‘‘(iv) any efforts by the Secretary to 
support program evaluation and review 
pursuant to section 471(e) and inclusion of 
programs in the pre-approved list of serv-
ices and programs described in section 
471(e)(4)(D) or the clearinghouse of prac-
tices described in section 476(d)(2). 
‘‘(7) FUNDING.— 
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601 
‘‘(A) LIMITATIONS.—Of the amounts avail-
able to carry out this subsection, the Secretary 
may use not more than 5 percent to provide 
technical assistance. 
‘‘(B) CARRYOVER.—Amounts made avail-
able to carry out this subsection shall remain 
available until expended. 
‘‘(8) DEFINITIONS.—In this subsection: 
‘‘(A) ELIGIBLE ENTITY.—The term ‘eligi-
ble entity’ means any of the following providing 
a service or program or, in the sole determina-
tion of the Secretary, able to provide a service 
or program if awarded a grant under this sub-
section: 
‘‘(i) A State, a political subdivision of 
a State, or an agency or department of a 
State or political subdivision of a State. 
‘‘(ii) An entity described in subpara-
graph (A) or (B) of section 426(a)(1). 
‘‘(iii) An Indian tribe or tribal organi-
zation. 
‘‘(B) EXTERNAL EVALUATOR.—The term 
‘external evaluator’ means an entity with the 
ability and willingness to evaluate a service or 
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602 
program pursuant to paragraph (2) that is not 
provided by the entity. 
‘‘(C) SERVICE
OR
PROGRAM.—The term 
‘service or program’— 
‘‘(i) means a service or program de-
scribed in section 471(e); and 
‘‘(ii) includes a kinship navigator pro-
gram described in section 474(a)(7).’’. 
(b) FUNDING.—Section 437(b) (42 U.S.C. 629g(b)) 
is amended by adding at the end the following: 
‘‘(5) 
PREVENTIVE
SERVICES
EVALUATION 
PARTNERSHIPS.—The 
Secretary 
shall 
reserve 
$5,000,000 for grants under section 435(f) for each 
of fiscal years 2026 through 2029.’’. 
SEC. 318. STRENGTHENING SUPPORT FOR YOUTH AGING 
OUT OF FOSTER CARE. 
(a) CASEWORKER VISITS.—Section 422(b)(17) (42 
U.S.C. 622(b)(17)) is amended by inserting ‘‘, and include 
a description of how the State may offer virtual case-
worker visits to youth in care who have attained the age 
of 18 years and provided informed consent for virtual vis-
its’’ before the semicolon. 
(b) YOUTH AND FAMILY ENGAGEMENT IN CHILD 
WELFARE PROGRAM PLANNING.—Section 432(b)(1) (42 
U.S.C. 629b(b)(1)) is amended to read as follows: 
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‘‘(1) IN
GENERAL.—The Secretary shall ap-
prove a plan that meets the requirements of sub-
section (a) only if— 
‘‘(A) the plan was developed jointly by the 
Secretary and the State, and the State, in de-
veloping the plan, consulted with— 
‘‘(i) appropriate public and nonprofit 
private agencies; 
‘‘(ii) community-based organizations 
involved in providing services for children 
and families in the areas of family preser-
vation, family support, family reunifica-
tion, foster care, kinship, and adoption 
promotion and support; 
‘‘(iii) parents with child welfare expe-
rience, foster parents, adoptive parents, 
and kinship caregivers; and 
‘‘(iv) children, youth, and young 
adults with experience in the child welfare 
system, including State boards and coun-
cils comprised of youth with lived experi-
ence who represent the diversity of chil-
dren in the State to whom the plan would 
apply; and 
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‘‘(B) the State has made publicly acces-
sible on a website of the State agency a report 
that outlines how the State has implemented 
the suggestions of the children and youth re-
ferred to in subparagraph (A)(iv).’’. 
SEC. 319. RECOGNIZING THE IMPORTANCE OF RELATIVE 
AND KINSHIP CAREGIVERS. 
(a) IN
GENERAL.—Section 431(a) (42 U.S.C. 
629a(a)), as amended by section 316(b)(2) of this part, 
is amended— 
(1) in paragraph (1)— 
(A) in the matter preceding subparagraph 
(A)— 
(i) by striking ‘‘children’’ and insert-
ing ‘‘children, youth,’’; and 
(ii) by striking ‘‘adoptive and ex-
tended’’ and inserting ‘‘kinship and adop-
tive’’; 
(B) in subparagraph (D), by striking ‘‘par-
ents and other caregivers (including foster par-
ents)’’ and inserting ‘‘parents, kinship care-
givers, and foster parents’’; 
(C) by striking ‘‘and’’ at the end of sub-
paragraph (E); 
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(D) by striking the period at the end of 
subparagraph (F) and inserting ‘‘ ; and’’; and 
(E) by adding at the end the following: 
‘‘(G)(i) peer-to-peer mentoring and support 
programs with demonstrated experience fos-
tering constructive relationships between chil-
dren and families and mentors with relevant 
lived experience or interactions with the child 
welfare system; and 
‘‘(ii) for purposes of this subpart, an ex-
penditure for a service described in clause (i) 
may be treated as an expenditure for any 1 or 
more of family support services, family preser-
vation services, family reunification services, or 
adoption promotion and support services, as 
long as the expenditure is related to serving the 
children and families in the specified category 
and consistent with the overall purpose of the 
category.’’; 
(2) in paragraph (2)(B)— 
(A) in clause (i), by striking ‘‘children’’ 
and inserting ‘‘children, youth,’’; and 
(B) in clause (ii), by striking ‘‘extended’’ 
and inserting ‘‘kinship’’; 
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(3) in paragraph (7)(A), by inserting ‘‘with kin-
ship caregivers or’’ before ‘‘in a foster family home’’; 
and 
(4) by adding at the end the following: 
‘‘(11) YOUTH.—The term ‘youth’ means an in-
dividual who has not attained 26 years of age.’’. 
(b) KINSHIP NAVIGATORS.— 
(1) IN GENERAL.—Section 427 (42 U.S.C. 627) 
is amended— 
(A) in the section heading, by striking 
‘‘FAMILY CONNECTION GRANTS’’ and insert-
ing ‘‘KINSHIP NAVIGATORS’’; 
(B) in subsection (a)— 
(i) in the matter preceding paragraph 
(1), by striking ‘‘helping’’ and inserting 
‘‘administering programs to help’’; 
(ii) by striking ‘‘of—’’ and all that 
follows through ‘‘a kinship’’ and inserting 
‘‘of a kinship’’; 
(iii) in paragraph (1)(C)— 
(I) by striking ‘‘and’’ at the end 
of clause (iii); 
(II) by adding ‘‘and’’ at the end 
of clause (iv); and 
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(III) by adding at the end the 
following: 
‘‘(v) connections to individualized as-
sistance, as needed;’’; 
(iv) 
by 
striking 
paragraphs 
(2) 
through (4); 
(v) by redesignating subparagraphs 
(A) through (G) of paragraph (1) as para-
graphs (1) through (7), respectively; 
(vi) 
by 
redesignating 
clauses 
(i) 
through (iv) and clause (v) (as added by 
clause (iii)(III) of this subparagraph) as 
subparagraphs (A) through (E), respec-
tively; 
(vii) by moving each provision so re-
designated 2 ems to the left; and 
(viii) by striking ‘‘caregiving;’’ and in-
serting ‘‘caregiving.’’; 
(C) in subsection (b)— 
(i) in paragraph (1), by striking ‘‘1 or 
more of’’; 
(ii) by redesignating paragraphs (3) 
and (4) as paragraphs (4) and (5), respec-
tively, and inserting after paragraph (2) 
the following: 
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‘‘(3) a description of how the entity will directly 
fund, or provide data to the Secretary for, an eval-
uation which will publish and submit information to 
the clearinghouse described in section 476(d)(2) and 
which is designed to meet the requirements of sec-
tion 471(e)(4)(C), or a description of how the funds 
will be used to help the State transition to a pro-
gram for which the State will seek reimbursement 
under section 474(a)(7);’’; 
(iii) in paragraph (4) (as so redesig-
nated), by striking ‘‘and’’ at the end; 
(iv) in paragraph (5) (as so redesig-
nated), by striking the period and inserting 
‘‘; and’’; and 
(v) by adding at the end the following: 
‘‘(6) if the entity is a State, local or tribal child 
welfare agency— 
‘‘(A) documentation of support from a rel-
evant community-based organization with expe-
rience serving kinship families when applicable; 
or 
‘‘(B) a description of how the organization 
plans to coordinate its services and activities 
with those offered by the relevant community- 
based organizations.’’; 
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(D) by striking subsection (d) and insert-
ing the following: 
‘‘(d) FEDERAL SHARE.—An entity to which a grant 
is made under this section may use the grant to pay not 
more than 75 percent of the cost of the activities to be 
carried out by the entity pursuant to this section.’’; 
(E) in subsection (g)— 
(i) by striking all that precedes ‘‘2 
percent’’ and inserting the following: 
‘‘(g) RESERVATION OF FUNDS FOR TECHNICAL AS-
SISTANCE.—The Secretary may reserve’’; and 
(ii) by striking ‘‘subsection (h)’’ the 
2nd place it appears and inserting ‘‘section 
437(b)(6)’’; and 
(F) by striking subsection (h). 
(2) 
RESERVATION
OF
DISCRETIONARY 
FUNDS.—Section 437(b) (42 U.S.C. 629g(b)), as 
amended by section 318(b) of this part, is amended 
by adding at the end the following: 
‘‘(6) KINSHIP
NAVIGATORS.—The Secretary 
shall reserve $10,000,000 for grants under section 
427 for each of fiscal years 2026 through 2029.’’. 
(3) 
CONFORMING
AMENDMENT.—Section 
474(a)(7) (42 U.S.C. 674(a)(7)) is amended by 
striking ‘‘427(a)(1)’’ and inserting ‘‘427(a)’’. 
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SEC. 320. AVOIDING NEGLECT BY ADDRESSING POVERTY. 
(a) FAMILY
PRESERVATION
SERVICES.—Section 
431(a)(1) (42 U.S.C. 629a(a)(1)), as amended by section 
320(a)(1) of this part, is amended— 
(1) in subparagraph (F), by striking ‘‘and’’ 
after the semicolon; 
(2) in subparagraph (G), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(H)(i) services providing nonrecurring 
short term benefits (including supports related 
to housing instability, utilities, transportation, 
and food assistance, among other basic needs) 
that address immediate needs related to a spe-
cific crisis, situation, or event affecting the abil-
ity of a child to remain in a home established 
for the child that is not intended to meet an on-
going need; and 
‘‘(ii) for purposes of this subpart, an ex-
penditure for a service described in clause (i) 
may be treated as an expenditure for any 1 or 
more of family support services, family preser-
vation services, family reunification services, or 
adoption promotion and support services as 
long as the expenditure is related to serving the 
children and families in the specified category 
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and consistent with the overall purpose of the 
category.’’. 
(b) STATE PLAN REQUIREMENTS.—Section 432(a) 
(42 U.S.C. 629b(a)) is amended— 
(1) in paragraph (9), by striking ‘‘and’’ after 
the semicolon; 
(2) in paragraph (10), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(11) provides a description of policies in place, 
including training for employees, to address child 
welfare reports and investigations of neglect con-
cerning the living arrangements or subsistence needs 
of a child with the goal to prevent the separation of 
a child from a parent of the child solely due to pov-
erty, to ensure access to services described in section 
431(a)(1)(H).’’. 
SEC. 321. STRENGTHENING SUPPORT FOR CASEWORKERS. 
(a) REAUTHORIZATION OF, AND INCREASE IN FUND-
ING
FOR, CASEWORKER VISITS.—Section 436(b)(4)(A) 
(42 U.S.C. 629f(b)(4)(A)) is amended by striking ‘‘each 
of fiscal years 2017 through 2023’’ and inserting ‘‘fiscal 
year 2025 and $26,000,000 for fiscal year 2026 and each 
succeeding fiscal year’’. 
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(b) MINIMUM GRANT AMOUNT.—Section 433(e) (42 
U.S.C. 629c(e)) is amended by striking paragraphs (1) 
and (2) and inserting the following: 
‘‘(1) BASE ALLOTMENT.—From the amount re-
served pursuant to section 436(b)(4)(A) for any fis-
cal year, the Secretary shall first allot to each State 
(other than an Indian tribe) that has provided to the 
Secretary such documentation as may be necessary 
to verify that the jurisdiction has complied with sec-
tion 436(b)(4)(B)(ii) during the fiscal year, a base 
allotment of $100,000, and shall then allot to each 
of those States an amount determined in paragraph 
(2) or (3) of this subsection, as applicable. 
‘‘(2) TERRITORIES.—From the amount reserved 
pursuant to section 436(b)(4)(A) for any fiscal year 
that remains after applying paragraph (1) of this 
subsection for the fiscal year, the Secretary shall 
allot to each jurisdiction specified in subsection (b) 
of this section to which a base allotment is made 
under such paragraph (1) an amount determined in 
the same manner as the allotment to each of such 
jurisdictions is determined under section 423 (with-
out regard to the initial allotment of $70,000 to 
each State). 
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‘‘(3) OTHER
STATES.—From the amount re-
served pursuant to section 436(b)(4)(A) for any fis-
cal year that remains after applying paragraphs (1) 
and (2) of this subsection for the fiscal year, the 
Secretary shall allot to each State (other than an In-
dian tribe) not specified in subsection (b) of this sec-
tion to which a base allotment was made under 
paragraph (1) of this subsection an amount equal to 
such remaining amount multiplied by the supple-
mental nutrition assistance program benefits per-
centage of the State (as defined in subsection (c)(2) 
of this section) for the fiscal year, except that in ap-
plying subsection (c)(2)(A) of this section, ‘sub-
section (e)(3)’ shall be substituted for ‘such para-
graph (1)’.’’. 
(c) REQUIREMENT
TO USE FUNDS
TO IMPROVE 
QUALITY OF CASEWORKER VISITS WITH FOSTER CHIL-
DREN.—Section 
436(b)(4)(B)(i) 
(42 
U.S.C. 
629f(b)(4)(B)(i)) is amended to read as follows: 
‘‘(i) IN GENERAL.—A State to which 
an amount is paid from amounts reserved 
under subparagraph (A) shall use the 
amount to improve the quality of monthly 
caseworker visits with children who are in 
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foster care under the responsibility of the 
State, with an emphasis on— 
‘‘(I) reducing caseload ratios and 
the administrative burden on case-
workers, to improve caseworker deci-
sion making on the safety, perma-
nency, and well-being of foster chil-
dren and on activities designed to in-
crease retention, recruitment, and 
training of caseworkers; 
‘‘(II) 
implementing 
technology 
solutions to streamline caseworker du-
ties and modernize systems, ensuring 
improved efficiency and effectiveness 
in child welfare services; 
‘‘(III) improving caseworker safe-
ty; 
‘‘(IV) mental health resources to 
support caseworker well-being, includ-
ing peer-to-peer support programs; 
and 
‘‘(V) 
recruitment 
campaigns 
aimed at attracting qualified case-
worker candidates.’’. 
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(d) ELIMINATION OF COST-SHARE PENALTY TIED TO 
MONTHLY
CASEWORKER
VISIT
STANDARD.—Section 
424(f) (42 U.S.C. 624(f)) is amended— 
(1) by striking ‘‘(1)(A)’’; and 
(2) by striking paragraphs (1)(B) and (2). 
SEC. 322. DEMONSTRATION PROJECTS FOR IMPROVING RE-
LATIONSHIPS 
BETWEEN 
INCARCERATED 
PARENTS AND CHILDREN IN FOSTER CARE. 
(a) IN GENERAL.—Section 439 (42 U.S.C. 629i) is 
amended to read as follows: 
‘‘SEC. 439. STATE PARTNERSHIP PLANNING AND DEM-
ONSTRATION GRANTS TO SUPPORT MEAN-
INGFUL RELATIONSHIPS BETWEEN FOSTER 
CHILDREN AND THE INCARCERATED PAR-
ENTS OF THE CHILDREN. 
‘‘(a) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may make 
demonstration grants to eligible State partnerships 
to develop, implement, and provide support for pro-
grams that enable and sustain meaningful relation-
ships between covered foster children and the incar-
cerated parents of the children. 
‘‘(2) PAYMENT OF ANNUAL INSTALLMENTS.— 
The Secretary shall pay each demonstration grant in 
5 annual installments. 
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‘‘(3) 1-YEAR
PLANNING
GRANTS.—The Sec-
retary may make a planning grant to a recipient of 
a demonstration grant, to be paid to the recipient 1 
year before payment of the 1st annual installment of 
the demonstration grant and in an amount not 
greater than any installment of the demonstration 
grant, if— 
‘‘(A) the recipient includes a request for a 
planning grant in the application under sub-
section (c); and 
‘‘(B) the Secretary determines that a plan-
ning grant would assist the recipient and im-
prove the effectiveness of the demonstration 
grant. 
‘‘(b) ELIGIBLE STATE PARTNERSHIP DEFINED.— 
‘‘(1) IN GENERAL.—In this section, the term 
‘eligible State partnership’ means an agreement en-
tered into by, at a minimum, the following: 
‘‘(A) The State child welfare agency re-
sponsible for the administration of the State 
plans under this part. 
‘‘(B) The State agency responsible for 
adult corrections. 
‘‘(2) ADDITIONAL PARTNERS.—For purposes of 
this section, an eligible State partnership may in-
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clude any entity with experience in serving incarcer-
ated parents and their children. 
‘‘(3) PARTNERSHIPS ENTERED INTO BY INDIAN 
TRIBES
OR
TRIBAL
CONSORTIA.—Notwithstanding 
paragraph (1), if an Indian tribe or tribal consor-
tium enters into a partnership pursuant to this sec-
tion that does not consist solely of tribal child wel-
fare agencies (or a consortium of the agencies), the 
partnership shall be considered an eligible State 
partnership for purposes of this section. 
‘‘(c) APPLICATION
REQUIREMENTS.—An eligible 
State partnership seeking a demonstration grant under 
this section to carry out a program described in subsection 
(a)(1) shall submit an application to the Secretary at such 
time, in such manner, and containing such information as 
the Secretary may require. The application shall include 
the following: 
‘‘(1) A summary of the program, including how 
the program will support a meaningful relationship 
between a covered foster child and an incarcerated 
parent of the child. 
‘‘(2) A description of the activities to be carried 
out by the program, which must include all of the 
activities described in subsection (d) that are in the 
best interest of the covered foster child. 
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‘‘(3) A framework for identifying— 
‘‘(A) each covered foster child eligible for 
services under the program, including, to the 
extent practicable, coordination of data between 
relevant State child welfare agencies and court 
systems; and 
‘‘(B) the roles and responsibilities of the 
entities in the partnership. 
‘‘(4) Documentation that the applicant is an eli-
gible State partnership. 
‘‘(5) Assurances that the applicant will partici-
pate fully in the evaluation described in subsection 
(f)(2) and shall maintain records for the program, 
including demographic information disaggregated by 
relevant characteristics with respect to covered foster 
children and incarcerated parents who participate in 
the program. 
‘‘(d) PROGRAM ACTIVITIES.—To the extent that the 
activities are in the best interest of the covered foster 
child, the activities referred to in subsection (c)(2) shall 
include the following: 
‘‘(1) REVISION
OF
POLICIES.—Through con-
sultation with incarcerated parents and their fami-
lies, grantees shall promote organizational policies of 
participating child welfare entities and collaborating 
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correctional facilities to promote meaningful rela-
tionships through regular and developmentally ap-
propriate communication and visitation between cov-
ered foster children and the incarcerated parents, in-
cluding, when appropriate, the following: 
‘‘(A) For child welfare entities— 
‘‘(i) inclusion of parents in case plan-
ning and decision making for children; 
‘‘(ii) regular sharing of information 
and responses to requests for information 
between caseworkers and incarcerated par-
ents with respect to the case information 
of a child, any changes to a case, perma-
nency plans, requirements to maintain pa-
rental rights, and any efforts to terminate 
parental rights; 
‘‘(iii) appropriate opportunities for in-
carcerated parents to demonstrate their re-
lationship with a covered foster child given 
their incarceration, including training and 
courses required for a service plan; and 
‘‘(iv) the enhanced visitation described 
in paragraph (2). 
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‘‘(B) For correctional facilities, fostering 
visitation and communication that is develop-
mentally appropriate in terms of— 
‘‘(i) the nature of communication and 
visitation, including— 
‘‘(I) the ability to physically 
touch parents; 
‘‘(II) engaging with parents in lo-
cations that are appropriate for the 
age and development of the child; 
‘‘(III) exchanging items that are 
appropriate to the age and develop-
ment of the child, include expectations 
that are appropriate for the age and 
development of the child related to be-
havior, attire, and wait times; and 
‘‘(IV) allowing appropriate adults 
to bring children if legal guardians 
are not available to promote regular 
contact; 
‘‘(ii) reasonable inclusion of all chil-
dren of the parent; 
‘‘(iii) communication and visitation at 
times when the children are available; 
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‘‘(iv) security procedures to comfort 
children and be minimally invasive; and 
‘‘(v) promoting parent-child relation-
ships regardless of the sentence imposed 
on the parent. 
‘‘(2) ENHANCED VISITATION.— 
‘‘(A) Grantees shall facilitate weekly com-
munication and, for at least 9 days each year, 
in-person visitation between a covered foster 
child and any incarcerated parent of the child. 
‘‘(B) Electronic visitation (such as live 
video visits, phone calls, and recorded books) 
may be used but shall not be the sole method 
to promote a meaningful relationship for pur-
poses of the grant. 
‘‘(C) Enhanced visitation programs shall— 
‘‘(i) integrate best practices for visita-
tion programs with incarcerated parents 
and their children; 
‘‘(ii) adopt developmentally appro-
priate visitation policies and procedures 
such as those described in paragraph 
(1)(B); 
‘‘(iii) reduce or eliminate the cost of 
developmentally appropriate communica-
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tion and visitation for the covered foster 
child, which may include the purchase of 
communication technology, covering trans-
portation, insurance, and lodging costs, 
costs related to providing appropriate visi-
tation spaces and activities, and other rel-
evant costs; 
‘‘(iv) to the extent practicable, inte-
grate appropriate parenting education to 
help prepare and process visits; and 
‘‘(v) avoid restricting visitation and 
communication as a punishment for the in-
carcerated parents. 
‘‘(3) TRAINING.—Grantees shall incorporate on-
going training for child welfare workers, correctional 
facility staff, and other program providers to under-
stand the importance of promoting meaningful rela-
tionships between children and incarcerated parents. 
‘‘(4) CASE MANAGEMENT.—Grantees shall pro-
vide case management services for the incarcerated 
parents of a covered foster child to promote the rela-
tionship, access to services, and coordination with 
the caseworkers of the covered foster child to 
strengthen the relationship. 
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‘‘(5) LEGAL ASSISTANCE.—Grantees shall facili-
tate access to necessary legal services and may use 
grant funds for services that are not reimbursable 
under other Federal programs. 
‘‘(e) FEDERAL SHARE.—The Federal share of the 
cost of any activity carried out using a grant made under 
this section shall be not greater than 75 percent. 
‘‘(f) TECHNICAL ASSISTANCE, EVALUATIONS, AND 
REPORTS.— 
‘‘(1) TECHNICAL ASSISTANCE.—The Secretary 
shall provide technical assistance with respect to 
grants under this section, including by— 
‘‘(A) assisting grantees in understanding 
best practices in promoting meaningful relation-
ships between incarcerated parents and their 
children as well as consulting with appropriate 
stakeholders when developing their programs; 
‘‘(B) assisting grantees with establishing 
and analyzing implementation and performance 
indicators; and 
‘‘(C) conducting an annual technical assist-
ance and training meeting and an annual grant-
ee meeting so that grantees can learn from the 
experiences of other grantees. 
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‘‘(2) EVALUATIONS.—The Secretary shall con-
duct an evaluation of program outcomes, including 
with respect to parent and child well-being, parent- 
child interactions, parental involvement, awareness 
of child development and parenting practices, place-
ment stability, and termination of parental rights 
with respect to covered foster children and incarcer-
ated parents, to measure program effectiveness, as 
determined by the Secretary, and identify opportuni-
ties for improved program practices and implemen-
tation. 
‘‘(3) REPORTS TO THE CONGRESS.— 
‘‘(A) INITIAL REPORT.—Not later than 3 
years after the date of the enactment of this 
section, the Secretary shall submit to the Com-
mittee on Ways and Means of the House of 
Representatives and the Committee on Finance 
of the Senate a report that includes— 
‘‘(i) the number of applications for 
grants under this section; 
‘‘(ii) the number of grants awarded, 
and the amounts for each grant; and 
‘‘(iii) information on the grants, in-
cluding— 
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‘‘(I) interim results of the evalua-
tion described in paragraph (2); 
‘‘(II) disaggregated data on cov-
ered foster children and incarcerated 
parents; 
‘‘(III) information on the com-
position of eligible State partnerships; 
‘‘(IV) best practices for facili-
tating meaningful relationships be-
tween covered foster children and in-
carcerated parents; and 
‘‘(V) barriers to implementation 
or expansion of programs funded 
under this section. 
‘‘(B) FINAL REPORT.—Not later than 6 
years after the date of the enactment of this 
section, the Secretary shall submit to the Com-
mittee on Ways and Means of the House of 
Representatives and the Committee on Finance 
of the Senate a report that includes— 
‘‘(i) the final results of the evaluation 
described in paragraph (2); and 
‘‘(ii) recommendations for refinements 
to grant requirements to improve program 
outcomes. 
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‘‘(g) AUTHORITY OF SECRETARY WITH RESPECT TO 
INDIAN TRIBES AND TRIBAL ORGANIZATIONS.— 
‘‘(1) WAIVER OR MODIFICATION OF REQUIRE-
MENTS.—In making a grant to an Indian tribe or 
tribal organization under this section, the Secretary 
may waive the matching requirement of subsection 
(e) or modify an application requirement imposed by 
or under subsection (c) if the Secretary determines 
that the waiver or modification is appropriate to the 
needs, culture, and circumstances of the Indian tribe 
or tribal organization. 
‘‘(2) EVALUATION.—The Secretary shall use 
tribally relevant data in carrying out the evaluation 
under subsection (f)(2) with respect to an Indian 
tribe or tribal organization. 
‘‘(h) LIMITATIONS ON AUTHORIZATION OF APPRO-
PRIATIONS.—There is authorized to be appropriated to the 
Secretary not more than $35,000,000 for each of fiscal 
years 2026 through 2029 to carry out this section. 
‘‘(i) DEFINITION OF COVERED FOSTER CHILD.—In 
this section, the term ‘covered foster child’ means a child 
that— 
‘‘(1) is in foster care; and 
‘‘(2) has at least 1 parent incarcerated in a 
Federal, State, or local correctional facility.’’. 
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(b) CONFORMING AMENDMENTS.— 
(1) 
Section 
431(a)(2)(B)(vii) 
(42 
U.S.C. 
629a(a)(2)(B)(vii)) is amended by striking ‘‘(as de-
fined in section 439(b)(2))’’. 
(2) Section 431(a) (42 U.S.C. 629a(a)), as 
amended by sections 316(b)(2) and 320(a)(4) of this 
part, is amended by adding at the end the following: 
‘‘(12) MENTORING.—The term ‘mentoring’ 
means a structured, managed program in which chil-
dren are appropriately matched with screened and 
trained adult volunteers for one on-one relationships, 
involving meetings and activities on a regular basis, 
intended to meet, in part, the child’s need for in-
volvement with a caring and supportive adult who 
provides a positive role model.’’. 
SEC. 323. GUIDANCE TO STATES ON IMPROVING DATA COL-
LECTION AND REPORTING FOR YOUTH IN 
RESIDENTIAL TREATMENT PROGRAMS. 
Within 2 years after the date of the enactment of this 
Act, the Secretary of Health and Human Services, in con-
sultation with the Department of Education, the Adminis-
tration for Children and Families, the Centers for Medi-
care and Medicaid Services, the Administration for Com-
munity Living, the Department of Justice, and other rel-
evant policy experts, as determined by the Secretary, shall 
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issue and disseminate, or update and revise, as applicable, 
guidance to State agencies in administering State plans 
approved under parts B and E of title IV of the Social 
Security Act on the following: 
(1) Best practices for Federal and State agen-
cies to collect data and share information related to 
the well-being of youth residing in residential treat-
ment facilities, including those facilities operating in 
multiple States or serving out-of-state youth. 
(2) Best practices on improving State collection 
and sharing of data related to incidences of mal-
treatment of youth residing in residential treatment 
facilities, including with respect to meeting the re-
quirement of section 471(a)(9)(A) of such Act for 
such youth in foster care. 
(3) Best practices on improving oversight of 
youth residential programs receiving Federal fund-
ing, and research-based strategies for risk assess-
ment related to the health, safety, and well-being of 
youth in the facilities. 
SEC. 324. STREAMLINING RESEARCH, TRAINING, AND 
TECHNICAL ASSISTANCE FUNDING. 
(a) REPURPOSING DISCRETIONARY RESEARCH SET- 
ASIDE.—Section 435(c) (42 U.S.C. 629e(c)) is amended 
to read as follows: 
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‘‘(c) EVALUATION, RESEARCH, AND TECHNICAL AS-
SISTANCE WITH RESPECT TO TARGETED PROGRAM RE-
SOURCES.—Of the amount reserved under section 
437(b)(1) for a fiscal year, the Secretary shall use not less 
than— 
‘‘(1) $1,000,000 for technical assistance to 
grantees under section 437(f) and to support design 
of local site evaluations with the goal of publishing 
and submitting evaluation findings to the clearing-
house established under section 476(d), or to award 
grants to allow current or former grantees under 
section 437(f) to analyze, publish, and submit to the 
clearinghouse data collected during past grants; and 
‘‘(2) $1,000,000 for technical assistance re-
quired under section 429B of this Act to support ef-
fective implementation of the Indian Child Welfare 
Act of 1978 and to support development of associ-
ated State plan measures described pursuant to sec-
tion 422(b)(9) of this Act.’’. 
(b) ELIMINATION OF RESEARCH SET-ASIDE FROM 
MANDATORY FUNDS.— 
(1) IN GENERAL.—Section 436(b) (42 U.S.C. 
629f(b)), as amended by the preceding provisions of 
this Act, is amended by striking paragraph (1) and 
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redesignating paragraphs (2) through (5) as para-
graphs (1) through (4), respectively. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 433(a) (42 U.S.C. 629c(a)) is 
amended by striking ‘‘436(b)(3)’’ and inserting 
‘‘436(b)(2)’’. 
(B) Section 433(e) (42 U.S.C. 629c(e)), as 
amended by section 322(b) of this part, is 
amended by striking ‘‘436(b)(4)(A)’’ and insert-
ing ‘‘436(b)(3)(A)’’ each place it appears. 
(C) Section 434(a)(2)(A) (42 U.S.C. 
629d(a)(2)(A)) 
is 
amended 
by 
striking 
‘‘436(b)(4)(B)’’ and inserting ‘‘436(b)(3)(B)’’. 
(D) 
Section 
437(b)(1) 
(42 
U.S.C. 
629g(b)(1)) is amended by striking ‘‘436(b)(1)’’ 
and inserting ‘‘435’’. 
(E) 
Section 
437(f)(3) 
(42 
U.S.C. 
629g(f)(3)) is amended by striking ‘‘436(b)(5)’’ 
and inserting ‘‘436(b)(4)’’. 
(F) Section 438(c) (42 U.S.C. 629g(c)) is 
amended in each of paragraphs (1) through (3) 
is amended by striking ‘‘436(b)(2)’’ and insert-
ing ‘‘436(b)(1)’’. 
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631 
SEC. 325. REPORT ON POST ADOPTION AND SUBSIDIZED 
GUARDIANSHIP SERVICES. 
(a) IN GENERAL.—Within 2 years after the date of 
the enactment of this Act, the Secretary of Health and 
Human Services shall prepare and submit to the Com-
mittee on Ways and Means of the House of Representa-
tives and the Committee on Finance of the Senate a report 
on children who enter into foster care under the super-
vision of a State administering a plan approved under part 
B or E of title IV of the Social Security Act after finaliza-
tion of an adoption or legal guardianship. 
(b) INFORMATION.—The Secretary shall include in 
the report information, to the extent available through the 
Adoption and Foster Care Analysis and Reporting System 
and other data sources, regarding the incidence of adop-
tion disruption and dissolution affecting children described 
in subsection (a) and factors associated with such cir-
cumstances, including— 
(1) whether affected individuals received pre- or 
post-legal adoption services; and 
(2) other relevant information, such as the age 
of the child involved. 
(c) POST-ADOPTION
SERVICES
AND
GUARDIAN-
SHIP.—The Secretary shall include in the report— 
(1) a summary of post-adoption services and 
guardianship in each State that are available to fam-
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ilies that adopted children from foster care and the 
extent to which the services are evidence-based or 
evidence-informed. 
(2) a summary of funding and funding sources 
for the services in each State, including set-asides 
under the Promoting Safe and Stable Families pro-
gram. 
SEC. 326. EFFECTIVE DATE. 
(a) IN GENERAL.—The amendments made by this 
part shall take effect on October 1, 2025, and shall apply 
to payments under part B of title IV of the Social Security 
Act for calendar quarters beginning on or after such date. 
(b) DELAY PERMITTED IF STATE LEGISLATION RE-
QUIRED.—If the Secretary of Health and Human Services 
determines that State legislation (other than legislation 
appropriating funds) is required in order for a State plan 
developed pursuant to part B of title IV of the Social Se-
curity Act to meet the additional requirements imposed 
by the amendments made by this part, the plan shall not 
be regarded as failing to meet any of the additional re-
quirements before the 1st day of the 1st calendar quarter 
beginning after the first regular session of the State legis-
lature that begins after the date of the enactment of this 
Act. For purposes of the preceding sentence, if the State 
has a 2-year legislative session, each year of the session 
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is deemed to be a separate regular session of the State 
legislature. 
(c) APPLICATION TO PROGRAMS OPERATED BY IN-
DIAN TRIBAL ORGANIZATIONS.—In the case of an Indian 
tribe, tribal organization, or tribal consortium that the 
Secretary of Health and Human Services determines re-
quires time to take action necessary to comply with the 
additional requirements imposed by the amendments made 
by this part (whether the tribe, organization, or tribal con-
sortium has a plan under section 479B of the Social Secu-
rity Act or a cooperative agreement or contract entered 
into with a State), the Secretary shall provide the tribe, 
organization, or tribal consortium with such additional 
time as the Secretary determines is necessary for the tribe, 
organization, or tribal consortium to take the action to 
comply with the additional requirements before being re-
garded as failing to comply with the requirements. 
PART 2—STRENGTHENING STATE AND TRIBAL 
CHILD SUPPORT 
SEC. 331. SHORT TITLE. 
This part may be cited as the ‘‘Strengthening State 
and Tribal Child Support Enforcement Act’’. 
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634 
SEC. 332. IMPROVING THE EFFECTIVENESS OF TRIBAL 
CHILD SUPPORT ENFORCEMENT AGENCIES. 
(a) IMPROVING
THE COLLECTION
OF PAST-DUE 
CHILD SUPPORT THROUGH STATE AND TRIBAL PARITY 
IN THE ALLOWABLE USE OF TAX INFORMATION.— 
(1) AMENDMENT
TO
THE
SOCIAL
SECURITY 
ACT.—Section 464 of the Social Security Act (42 
U.S.C. 664) is amended by adding at the end the 
following: 
‘‘(d) APPLICABILITY TO INDIAN TRIBES AND TRIBAL 
ORGANIZATIONS
RECEIVING
A
GRANT
UNDER
THIS 
PART.—This section, except for the requirement to dis-
tribute amounts in accordance with section 457, shall 
apply to an Indian tribe or tribal organization receiving 
a grant under section 455(f) in the same manner in which 
this section applies to a State with a plan approved under 
this part.’’. 
(2) AMENDMENTS TO THE INTERNAL REVENUE 
CODE.— 
(A) Section 6103(a)(2) of the Internal 
Revenue Code of 1986 is amended by striking 
‘‘any local child support enforcement agency’’ 
and inserting ‘‘any tribal or local child support 
enforcement agency’’. 
(B) Section 6103(a)(3) of such Code is 
amended by inserting ‘‘, (8)’’ after ‘‘(6)’’. 
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(C) Section 6103(l) of such Code is 
amended— 
(i) in paragraph (6)— 
(I) by striking ‘‘or local’’ in sub-
paragraph (A) and inserting ‘‘tribal, 
or local’’; 
(II) by striking ‘‘AND LOCAL’’ in 
the heading thereof and inserting 
‘‘TRIBAL, AND LOCAL’’; 
(III) by striking ‘‘The following’’ 
in subparagraph (B) and inserting 
‘‘The’’; 
(IV) by striking the colon and all 
that follows in subparagraph (B) and 
inserting a period; and 
(V) by adding at the end the fol-
lowing: 
‘‘(D) STATE, TRIBAL, OR
LOCAL
CHILD 
SUPPORT
ENFORCEMENT
AGENCY.—For pur-
poses of this paragraph, the following shall be 
treated as a State, tribal, or local child support 
enforcement agency: 
‘‘(i) Any agency of a State or political 
subdivision thereof operating pursuant to a 
plan described in section 454 of the Social 
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Security Act which has been approved by 
the Secretary of Health and Human Serv-
ices under part D of title IV of such Act. 
‘‘(ii) Any child support enforcement 
agency of an Indian tribe or tribal organi-
zation receiving a grant under section 
455(f) of the Social Security Act.’’; 
(ii) in paragraph (8)— 
(I) in subparagraph (A), by strik-
ing ‘‘or State or local’’ and inserting 
‘‘, State, tribal, or local’’; 
(II) in subparagraph (B), by 
striking ‘‘enforced pursuant to a plan 
described’’ 
and 
all 
that 
follows 
through ‘‘of such Act’’ and inserting 
‘‘enforced pursuant to the provisions 
of part D of title IV of the Social Se-
curity Act’’; 
(III) by adding at the end of sub-
paragraph (B) the following: ‘‘The in-
formation disclosed to any child sup-
port enforcement agency under sub-
paragraph (A) with respect to any in-
dividual with respect to whom child 
support obligations are sought to be 
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established or enforced may be dis-
closed by such agency to any agent of 
such agency which is under contract 
with such agency for purposes of, and 
to the extent necessary in, estab-
lishing and collecting child support 
obligations from, and locating, individ-
uals owing such obligations.’’; 
(IV) by striking subparagraph 
(C) and inserting the following: 
‘‘(C) STATE, TRIBAL, OR
LOCAL
CHILD 
SUPPORT
ENFORCEMENT
AGENCY.—For pur-
poses of this paragraph, the term ‘State, tribal, 
or local child support enforcement agency’ has 
the same meaning as when used in paragraph 
(6)(D).’’; and 
(V) by striking ‘‘AND LOCAL’’ in 
the heading thereof and inserting 
‘‘TRIBAL, AND LOCAL’’; and 
(iii) in paragraph (10)(B), by adding 
at the end the following new clause: 
‘‘(iii) The information disclosed to any 
child support enforcement agency under 
subparagraph (A) with respect to any indi-
vidual with respect to whom child support 
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obligations are sought to be established or 
enforced may be disclosed by such agency 
to any agent of such agency which is under 
contract with such agency for purposes of, 
and to the extent necessary in, establishing 
and collecting child support obligations 
from, and locating, individuals owing such 
obligations.’’. 
(D) Section 6103(p)(4) of such Code is 
amended— 
(i) by striking ‘‘subsection (l)(10), 
(13)(A), (13)(B), (13)(C), (13)(D)(i), (16), 
(18), (19), or (20), or any entity’’ in the 
matter preceding subparagraph (A) and in-
serting 
‘‘subsection 
(l)(6), 
(8), 
(10), 
(13)(A), (13)(B), (13)(C), (13)(D)(i), (16), 
(18), (19), or (20), or any Indian tribe or 
tribal organization receiving a grant under 
section 455(f) of the Social Security Act, 
or any entity’’; 
(ii) by striking ‘‘subsection (l)(10)’’ in 
subparagraph (F)(i) and inserting ‘‘sub-
section (l)(6), (8), (10)’’; 
(iii) by striking ‘‘subsection (l)(10), 
(13)(A), (13)(B), (13)(C), (13)(D)(i), (16), 
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(18), (19), or (20) or any entity’’ each 
place it appears in the matter following 
subparagraph (F)(iii) and inserting ‘‘sub-
section (l)(6), (8), (10), (13)(A), (13)(B), 
(13)(C), (13)(D)(i), (16), (18), (19), or 
(20), or any Indian tribe or tribal organi-
zation receiving a grant under section 
455(f) of the Social Security Act, or any 
entity’’; and 
(iv) by inserting ‘‘, (8)’’ after ‘‘para-
graph (6)(A)’’ in the matter following sub-
paragraph (F)(iii). 
(E) Section 6103(p)(9) of such Code is 
amended by striking ‘‘or local’’ and inserting 
‘‘tribal, or local’’. 
(F) Section 6402(c) of such Code is 
amended by adding at the end the following: 
‘‘For purposes of this subsection, any reference 
to a State shall include a reference to any In-
dian tribe or tribal organization receiving a 
grant under section 455(f) of the Social Secu-
rity Act.’’. 
(b) 
REIMBURSEMENT
FOR
REPORTS.—Section 
453(g) of the Social Security Act (42 U.S.C. 653(g)) is 
amended— 
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(1) in the subsection heading, by striking 
‘‘STATE’’; and 
(2) by striking ‘‘and State’’ and inserting ‘‘, 
State, and tribal’’. 
(c) TECHNICAL AMENDMENTS.—Paragraphs (7) and 
(33) of section 454 of the Social Security Act (42 U.S.C. 
654) are each amended by striking ‘‘450b’’ and inserting 
‘‘5304’’. 
Subtitle B—Other Matters 
SEC. 341. SEXUAL RISK AVOIDANCE EDUCATION EXTEN-
SION. 
Section 510 of the Social Security Act (42 U.S.C. 
710) is amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) by striking ‘‘and for the period’’ 
and inserting ‘‘for the period’’; 
(ii) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘September 30, 2025’’; 
(iii) by inserting ‘‘and for the period 
beginning on October 1, 2025, and ending 
on December 31, 2025,’’ before ‘‘allot to 
each State’’; and 
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(iv) by striking ‘‘for fiscal year 2024 
or 2025’’ and inserting ‘‘for fiscal year 
2024, 2025, or 2026’’; and 
(B) in paragraph (2), by striking ‘‘or 
2025’’ each place it appears and inserting ‘‘, 
2025, or 2026’’; and 
(2) in subsection (f)(1)— 
(A) by striking ‘‘and for the period’’ and 
inserting ‘‘for the period’’; 
(B) by striking ‘‘December 31, 2024’’ and 
inserting ‘‘September 30, 2025’’; and 
(C) by inserting ‘‘, and for the period be-
ginning on October 1, 2025, and ending on De-
cember 31, 2025, an amount equal to the pro 
rata portion of the amount appropriated for the 
corresponding period for fiscal year 2025’’ after 
‘‘corresponding period for fiscal year 2024’’. 
SEC. 342. PERSONAL RESPONSIBILITY EDUCATION EXTEN-
SION. 
Section 513 of the Social Security Act (42 U.S.C. 
713) is amended— 
(1) in subsection (a)(1)— 
(A) in subparagraph (A), in the matter 
preceding clause (i)— 
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(i) by striking ‘‘and for the period’’ 
and inserting ‘‘for the period’’; 
(ii) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘September 30, 2025’’; and 
(iii) by inserting ‘‘and for the period 
beginning on October 1, 2025, and ending 
on December 31, 2025,’’ before ‘‘the Sec-
retary shall allot’’; and 
(B) in subparagraph (B)(i)— 
(i) by striking ‘‘and for the period’’ 
and inserting ‘‘for the period’’; 
(ii) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘September 30, 2025’’; and 
(iii) by inserting ‘‘, and for the period 
beginning on October 1, 2025, and ending 
on December 31, 2025’’ before the period; 
(2) in subsection (c)(3), by striking ‘‘fiscal year 
2024 or 2025’’ and inserting ‘‘fiscal year 2024, 
2025, or 2026’’; and 
(3) in subsection (f)— 
(A) by striking ‘‘and for the period’’ and 
inserting ‘‘for the period’’; 
(B) by striking ‘‘December 31, 2024’’ and 
inserting ‘‘September 30, 2025’’; and 
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(C) by inserting ‘‘, and for the period be-
ginning on October 1, 2025, and ending on De-
cember 31, 2025, an amount equal to the pro 
rata portion of the amount appropriated for the 
corresponding period for fiscal year 2025’’ after 
‘‘corresponding period for fiscal year 2024’’. 
SEC. 343. EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY 
HEALTH INFORMATION CENTERS. 
Section 501(c)(1)(A)(viii) of the Social Security Act 
(42 U.S.C. 701(c)(1)(A)(viii)) is amended— 
(1) by striking ‘‘$1,500,000’’ and inserting 
‘‘$7,500,000’’; and 
(2) by striking ‘‘for the portion of fiscal year 
2025 before January 1, 2025’’ and inserting ‘‘for 
the period beginning on October 1, 2024, and ending 
on December 31, 2025’’. 
TITLE IV—PUBLIC HEALTH 
EXTENDERS 
Subtitle A—Extensions 
SEC. 401. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) EXTENSION
FOR COMMUNITY HEALTH CEN-
TERS.—Section 10503(b)(1) of the Patient Protection and 
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Affordable Care Act (42 U.S.C. 254b–2(b)(1)) is amend-
ed— 
(1) in subparagraph (E), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (F), by striking ‘‘, 
$4,000,000,000 for each of fiscal years 2019 
through 2023’’ and all that follows through ‘‘and 
ending on December 31, 2024; and’’ and inserting 
a semicolon; and 
(3) by adding at the end the following: 
‘‘(G) $4,000,000,000 for each of fiscal 
years 2019 through 2023; 
‘‘(H) $526,027,397 for the period begin-
ning on October 1, 2023, and ending on No-
vember 17, 2023, $690,410,959 for the period 
beginning on November 18, 2023, and ending 
on January 19, 2024, $536,986,301 for the pe-
riod beginning on January 20, 2024, and end-
ing on March 8, 2024, and $3,592,328,767 for 
the period beginning on October 1, 2023, and 
ending on December 31, 2024; 
‘‘(I) $3,365,753,425 for the period begin-
ning on January 1, 2025, and ending on Sep-
tember 30, 2025; and 
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‘‘(J) $4,600,000,000 for fiscal year 2026; 
and’’. 
(b) EXTENSION FOR THE NATIONAL HEALTH SERV-
ICE CORPS.—Section 10503(b)(2) of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 254b–2(b)(2)) 
is amended— 
(1) in subparagraph (H), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (I), by striking the period 
at the end and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(J) $261,780,822 for the period begin-
ning on January 1, 2025, and ending on Sep-
tember 30, 2025; and 
‘‘(K) $350,000,000 for fiscal year 2026.’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)(1)) is amended— 
(1) by striking ‘‘not to exceed $230,000,000’’ 
and all that follows through ‘‘and ending on Decem-
ber 31, 2024,’’; and 
(2) by striking the period at the end and insert-
ing the following: ‘‘, not to exceed— 
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shall be subject to the requirements contained in Public 
Law 117–328 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act 
(42 U.S.C. 254b et seq.). 
(e) CONFORMING AMENDMENTS.—Section 3014(h) 
of title 18, United States Code, is amended— 
(1) in paragraph (1), by striking ‘‘under sub-
paragraphs (E) and (F) of section 10503(b)(1) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 254b–2(b)(1))’’ and inserting ‘‘under section 
10503(b)(1) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 254b–2(b)(1)) for fiscal 
year 2015 and each subsequent fiscal year (or period 
thereof)’’; and 
(2) in paragraph (4), by striking ‘‘and section 
101(d) of the Consolidated Appropriations Act, 
2024’’ and inserting ‘‘section 101(d) of the Consoli-
dated Appropriations Act, 2024, and section 401 of 
the Health Improvements, Extenders, and Reauthor-
izations Act’’. 
SEC. 402. EXTENSION OF SPECIAL DIABETES PROGRAMS. 
(a) EXTENSION OF SPECIAL DIABETES PROGRAMS 
FOR TYPE I DIABETES.—Section 330B(b)(2) of the Pub-
lic Health Service Act (42 U.S.C. 254c–2(b)(2)) is amend-
ed— 
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(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
at the end and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(F) $149,589,041 for the period begin-
ning on January 1, 2025, and ending on Sep-
tember 30, 2025, to remain available until ex-
pended; and 
‘‘(G) $200,000,000 for fiscal year 2026, to 
remain available until expended.’’. 
(b) EXTENDING FUNDING FOR SPECIAL DIABETES 
PROGRAMS
FOR INDIANS.—Section 330C(c)(2) of the 
Public Health Service Act (42 U.S.C. 254c–3(c)(2)) is 
amended— 
(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
at the end and inserting a semicolon; and 
(3) by adding at the end the following: 
‘‘(F) $149,589,041 for the period begin-
ning on January 1, 2025, and ending on Sep-
tember 30, 2025, to remain available until ex-
pended; and 
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‘‘(G) $200,000,000 for fiscal year 2026, to 
remain available until expended.’’. 
Subtitle B—World Trade Center 
Health Program 
SEC. 411. 9/11 RESPONDER AND SURVIVOR HEALTH FUND-
ING CORRECTIONS. 
(a) IN GENERAL.—Section 3351(a)(2)(A) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
300mm– 
61(a)(2)(A)) is amended— 
(1) in clause (x), by striking ‘‘; and’’ and insert-
ing a semicolon; 
(2) by redesignating clause (xi) as clause (xii); 
and 
(3) by inserting after clause (x), the following: 
‘‘(xi) for each of fiscal years 2026 
through 2040— 
‘‘(I) 
the 
amount 
determined 
under this subparagraph for the pre-
vious fiscal year multiplied by 1.05; 
multiplied by 
‘‘(II) the ratio of— 
‘‘(aa) the total number of 
individuals enrolled in the WTC 
Program on July 1 of such pre-
vious fiscal year; to 
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‘‘(bb) the total number of 
individuals so enrolled on July 1 
of the fiscal year prior to such 
previous fiscal year; and’’. 
(b) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 3 years after 
the date of enactment of this Act, the Secretary of 
Health and Human Services (referred to in this sub-
section as the ‘‘Secretary’’) shall conduct an assess-
ment of anticipated budget authority and outlays of 
the World Trade Center Health Program (referred 
to in this subsection as the ‘‘Program’’) through the 
duration of the Program and submit a report sum-
marizing such assessment to— 
(A) the Speaker and minority leader of the 
House of Representatives; 
(B) the majority and minority leaders of 
the Senate; 
(C) the Committee on Health, Education, 
Labor, and Pensions and Committee on the 
Budget of the Senate; and 
(D) the Committee on Energy and Com-
merce and the Committee on the Budget of the 
House of Representatives. 
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(2) INCLUSIONS.—The report required under 
paragraph (1) shall include— 
(A) a projection of Program budgetary 
needs on a per-fiscal year basis through fiscal 
year 2090; 
(B) a review of Program modeling for each 
of fiscal years 2017 through the fiscal year 
prior to the fiscal year in which the report is 
issued to assess how anticipated budgetary 
needs compared to actual expenditures; 
(C) an assessment of the projected budget 
authority and expenditures of the Program 
through fiscal year 2090 by comparing— 
(i) such projected authority and ex-
penditures resulting from application of 
section 3351(a)(2)(A) of the Public Health 
Service 
Act 
(42 
U.S.C. 
300mm– 
61(a)(2)(A)), as amended by subsection 
(a); and 
(ii) such projected authority and ex-
penditures that would result if such section 
were amended so that the formula under 
clause (xi) of such section, as amended by 
subsection (a), were to be extended 
through fiscal year 2090; and 
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(D) any recommendations of the Secretary 
to make changes to the formula under such sec-
tion 3351(a)(2)(A), as so amended, to fully off-
set anticipated Program expenditures through 
fiscal year 2090. 
(c) TECHNICAL AMENDMENTS.—Title XXXIII of the 
Public Health Service Act (42 U.S.C. 300mm et seq.) is 
amended— 
(1) in section 3352(d) (42 U.S.C. 300mm– 
62(d)), by striking ‘‘Any amounts’’ and inserting 
‘‘Any unobligated amounts’’; 
(2) in section 3353(d) (42 U.S.C. 300mm– 
63(d)), by striking ‘‘Any amounts’’ and inserting 
‘‘Any unobligated amounts’’; and 
(3) in section 3354(d) (42 U.S.C. 300mm– 
64(d)), by striking ‘‘Any amounts’’ and inserting 
‘‘Any unobligated amounts’’. 
TITLE V—SUPPORT ACT 
REAUTHORIZATION 
SEC. 501. SHORT TITLE. 
This title may be cited as the ‘‘SUPPORT for Pa-
tients and Communities Reauthorization Act of 2024’’. 
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Subtitle A—Prevention 
SEC. 511. PRENATAL AND POSTNATAL HEALTH. 
Section 317L(d) of the Public Health Service Act (42 
U.S.C. 247b–13(d)) is amended by striking ‘‘such sums 
as may be necessary for each of the fiscal years 2019 
through 2023’’ and inserting ‘‘$4,250,000 for each of fis-
cal years 2025 through 2029’’. 
SEC. 512. MONITORING AND EDUCATION REGARDING IN-
FECTIONS ASSOCIATED WITH ILLICIT DRUG 
USE AND OTHER RISK FACTORS. 
Section 317N(d) of the Public Health Service Act (42 
U.S.C. 247b–15(d)) is amended by striking ‘‘fiscal years 
2019 through 2023’’ and inserting ‘‘fiscal years 2025 
through 2029’’. 
SEC. 513. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
(a) IN GENERAL.—Section 392A of the Public 
Health Service Act (42 U.S.C. 280b–1) is amended— 
(1) in subsection (a)(2)— 
(A) in subparagraph (C), by inserting ‘‘and 
associated risks’’ before the period at the end; 
and 
(B) in subparagraph (D), by striking 
‘‘opioids’’ and inserting ‘‘substances causing 
overdose’’; and 
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(2) in subsection (b)(2)— 
(A) in subparagraph (B), by inserting ‘‘, 
and associated risk factors,’’ after ‘‘such 
overdoses’’; 
(B) in subparagraph (C), by striking ‘‘cod-
ing’’ and inserting ‘‘monitoring and identi-
fying’’; 
(C) in subparagraph (E)— 
(i) by inserting a comma after ‘‘public 
health laboratories’’; and 
(ii) by inserting ‘‘and other emerging 
substances related’’ after ‘‘analogues’’; and 
(D) in subparagraph (F), by inserting 
‘‘and associated risk factors’’ after ‘‘overdoses’’. 
(b) ADDITIONAL GRANTS.—Section 392A(a)(3) of 
the Public Health Service Act (42 U.S.C. 280b–1(a)(3)) 
is amended— 
(1) in the matter preceding subparagraph (A), 
by striking ‘‘and Indian Tribes—’’ and inserting 
‘‘and Indian Tribes for the following purposes:’’; 
(2) by amending subparagraph (A) to read as 
follows: 
‘‘(A) To carry out innovative projects for 
grantees to detect, identify, and rapidly respond 
to controlled substance misuse, abuse, and 
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overdoses, and associated risk factors, including 
changes in patterns of such controlled sub-
stance use. Such projects may include the use 
of innovative, evidence-based strategies for de-
tecting such patterns, such as wastewater sur-
veillance, if proven to support actionable pre-
vention strategies, in a manner consistent with 
applicable Federal and State privacy laws.’’; 
and 
(3) in subparagraph (B), by striking ‘‘for any’’ 
and inserting ‘‘For any’’. 
(c) AUTHORIZATION OF APPROPRIATIONS.—Section 
392A(e) of the Public Health Service Act (42 U.S.C. 
280b–1(e)) is amended by striking ‘‘$496,000,000 for 
each of fiscal years 2019 through 2023’’ and inserting 
‘‘$505,579,000 for each of fiscal years 2025 through 
2029’’. 
SEC. 514. SUPPORT FOR INDIVIDUALS AND FAMILIES IM-
PACTED BY FETAL ALCOHOL SPECTRUM DIS-
ORDER. 
(a) IN GENERAL.—Part O of title III of the Public 
Health Service Act (42 U.S.C. 280f et seq.) is amended 
to read as follows: 
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‘‘PART O—FETAL ALCOHOL SYNDROME 
PREVENTION AND SERVICES PROGRAM 
‘‘SEC. 399H. FETAL ALCOHOL SPECTRUM DISORDERS PRE-
VENTION, INTERVENTION, AND SERVICES DE-
LIVERY PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary shall establish or 
continue activities to support a comprehensive fetal alcohol 
spectrum disorders (referred to in this section as ‘FASD’) 
education, prevention, identification, intervention, and 
services delivery program, which may include— 
‘‘(1) an education and public awareness pro-
gram to support, conduct, and evaluate the effective-
ness of— 
‘‘(A) 
educational 
programs 
targeting 
health professions schools, social and other sup-
portive services, educators and counselors and 
other service providers in all phases of child-
hood development, and other relevant service 
providers, concerning the prevention, identifica-
tion, and provision of services for infants, chil-
dren, adolescents and adults with FASD; 
‘‘(B) strategies to educate school-age chil-
dren, including pregnant and high-risk youth, 
concerning FASD; 
‘‘(C) public and community awareness pro-
grams concerning FASD; and 
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‘‘(D) strategies to coordinate information 
and services across affected community agen-
cies, including agencies providing social services 
such as foster care, adoption, and social work, 
agencies providing health services, and agencies 
involved in education, vocational training and 
civil and criminal justice; 
‘‘(2) supporting and conducting research on 
FASD, as appropriate, including to— 
‘‘(A) develop appropriate medical diag-
nostic methods for identifying FASD; and 
‘‘(B) develop effective culturally and lin-
guistically appropriate evidence-based or evi-
dence-informed interventions and appropriate 
supports for preventing prenatal alcohol expo-
sure, which may co-occur with exposure to other 
substances; 
‘‘(3) building State and Tribal capacity for the 
identification, treatment, and support of individuals 
with FASD and their families, which may include— 
‘‘(A) utilizing and adapting existing Fed-
eral, State, or Tribal programs to include 
FASD identification and FASD-informed sup-
port; 
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‘‘(B) developing and expanding screening 
and diagnostic capacity for FASD; 
‘‘(C) developing, implementing, and evalu-
ating targeted FASD-informed intervention 
programs for FASD; 
‘‘(D) providing training with respect to 
FASD for professionals across relevant sectors; 
and 
‘‘(E) 
disseminating 
information 
about 
FASD and support services to affected individ-
uals and their families; and 
‘‘(4) an applied research program concerning 
intervention and prevention to support and conduct 
service demonstration projects, clinical studies and 
other research models providing advocacy, edu-
cational and vocational training, counseling, medical 
and mental health, and other supportive services, as 
well as models that integrate and coordinate such 
services, that are aimed at the unique challenges fac-
ing individuals with Fetal Alcohol Syndrome or 
Fetal Alcohol Effect and their families. 
‘‘(b) GRANTS AND TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary may award 
grants, cooperative agreements and contracts and 
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provide technical assistance to eligible entities to 
carry out subsection (a). 
‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re-
ceive a grant, or enter into a cooperative agreement 
or contract, under this section, an entity shall— 
‘‘(A) be a State, Indian Tribe or Tribal or-
ganization, local government, scientific or aca-
demic institution, or nonprofit organization; 
and 
‘‘(B) prepare and submit to the Secretary 
an application at such time, in such manner, 
and containing such information as the Sec-
retary may require, including a description of 
the activities that the entity intends to carry 
out using amounts received under this section. 
‘‘(3) ADDITIONAL
APPLICATION
CONTENTS.— 
The Secretary may require that an eligible entity in-
clude in the application submitted under paragraph 
(2)(B)— 
‘‘(A) a designation of an individual to 
serve as a FASD State or Tribal coordinator of 
activities such eligible entity proposes to carry 
out through a grant, cooperative agreement, or 
contract under this section; and 
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‘‘(B) a description of an advisory com-
mittee the entity will establish to provide guid-
ance for the entity on developing and imple-
menting a statewide or Tribal strategic plan to 
prevent FASD and provide for the identifica-
tion, treatment, and support of individuals with 
FASD and their families. 
‘‘(c) DEFINITION OF FASD-INFORMED.—For pur-
poses of this section, the term ‘FASD-informed’, with re-
spect to support or an intervention program, means that 
such support or intervention program uses culturally and 
linguistically informed evidence-based or practice-based 
interventions and appropriate resources to support an im-
proved quality of life for an individual with FASD and 
the family of such individual. 
‘‘SEC. 399I. STRENGTHENING CAPACITY AND EDUCATION 
FOR 
FETAL 
ALCOHOL 
SPECTRUM 
DIS-
ORDERS. 
‘‘(a) IN
GENERAL.—The Secretary shall award 
grants, contracts, or cooperative agreements, as the Sec-
retary determines appropriate, to public or nonprofit pri-
vate entities with demonstrated expertise in the field of 
fetal alcohol spectrum disorders (referred to in this section 
as ‘FASD’). Such awards shall be for the purposes of 
building local, Tribal, State, and nationwide capacities to 
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prevent the occurrence of FASD by carrying out the pro-
grams described in subsection (b). 
‘‘(b) PROGRAMS.—An entity receiving an award 
under subsection (a) may use such award for the following 
purposes: 
‘‘(1) Developing and supporting public edu-
cation and outreach activities to raise public aware-
ness of the risks associated with alcohol consumption 
during pregnancy. 
‘‘(2) Acting as a clearinghouse for evidence- 
based resources on FASD prevention, identification, 
and culturally and linguistically appropriate best 
practices to help inform systems of care for individ-
uals with FASD across their lifespan. 
‘‘(3) Increasing awareness and understanding 
of efficacious, evidence-based screening tools and 
culturally and linguistically appropriate evidence- 
based intervention services and best practices, which 
may include improving the capacity for State, Trib-
al, and local affiliates. 
‘‘(4) Providing technical assistance to recipients 
of grants, cooperative agreements, or contracts 
under section 399H, as appropriate. 
‘‘(c) APPLICATION.—To be eligible for a grant, con-
tract, or cooperative agreement under this section, an enti-
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ty shall submit to the Secretary an application at such 
time, in such manner, and containing such information as 
the Secretary may require. 
‘‘(d) SUBCONTRACTING.—A public or private non-
profit entity may carry out the following activities required 
under this section through contracts or cooperative agree-
ments with other public and private nonprofit entities with 
demonstrated expertise in FASD: 
‘‘(1) Resource development and dissemination. 
‘‘(2) Intervention services. 
‘‘(3) Training and technical assistance. 
‘‘SEC. 399J. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated to carry out 
this part $12,500,000 for each of fiscal years 2025 
through 2029.’’. 
(b) REPORT.—Not later than 4 years after the date 
of enactment of this Act, and every year thereafter, the 
Secretary of Health and Human Services shall prepare 
and submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives 
a report containing— 
(1) a review of the activities carried out pursu-
ant to sections 399H and 399I of the Public Health 
Service Act, as amended, to advance public edu-
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cation and awareness of fetal alcohol spectrum dis-
orders (referred to in this section as ‘‘FASD’’); 
(2) a description of— 
(A) the activities carried out pursuant to 
such sections 399H and 399I to identify, pre-
vent, and treat FASD; and 
(B) methods used to evaluate the outcomes 
of such activities; and 
(3) an assessment of activities carried out pur-
suant to such sections 399H and 399I to support in-
dividuals with FASD. 
SEC. 515. PROMOTING STATE CHOICE IN PDMP SYSTEMS. 
Section 399O(h) of the Public Health Service Act (42 
U.S.C. 280g–3(h)) is amended by adding at the end the 
following: 
‘‘(5) PROMOTING STATE CHOICE.—Nothing in 
this section shall be construed to authorize the Sec-
retary to require States to use a specific vendor or 
a specific interoperability connection other than to 
align with nationally recognized, consensus-based 
open standards, such as in accordance with sections 
3001 and 3004.’’. 
SEC. 516. FIRST RESPONDER TRAINING PROGRAM. 
Section 546 of the Public Health Service Act (42 
U.S.C. 290ee–1) is amended— 
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(1) in subsection (a), by striking ‘‘tribes and 
tribal’’ and inserting ‘‘Tribes and Tribal’’; 
(2) in subsections (a), (c), and (d)— 
(A) by striking ‘‘approved or cleared’’ each 
place it appears and inserting ‘‘approved, 
cleared, or otherwise legally marketed’’; and 
(B) by striking ‘‘opioid’’ each place it ap-
pears; 
(3) in subsection (f)— 
(A) by striking ‘‘approved or cleared’’ each 
place it appears and inserting ‘‘approved, 
cleared, or otherwise legally marketed’’; 
(B) in paragraph (1), by striking ‘‘opioid’’; 
(C) in paragraph (2)— 
(i) by striking ‘‘opioid and heroin’’ 
and inserting ‘‘opioid, heroin, and other 
drug’’; and 
(ii) by striking ‘‘opioid overdose’’ and 
inserting ‘‘overdose’’; and 
(D) in paragraph (3), by striking ‘‘opioid 
and heroin’’; and 
(4) in subsection (h), by striking ‘‘$36,000,000 
for each of fiscal years 2019 through 2023’’ and in-
serting ‘‘$56,000,000 for each of fiscal years 2025 
through 2029’’. 
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SEC. 517. DONALD J. COHEN NATIONAL CHILD TRAUMATIC 
STRESS INITIATIVE. 
(a) TECHNICAL AMENDMENT.—The second part G of 
title V of the Public Health Service Act (42 U.S.C. 290kk 
et seq.), as added by section 144 of the Community Re-
newal Tax Relief Act (Public Law 106–554), is amend-
ed— 
(1) by redesignating such part as part J; and 
(2) by redesignating sections 581 through 584 
as sections 596 through 596C, respectively. 
(b) IN GENERAL.—Section 582 of the Public Health 
Service Act (42 U.S.C. 290hh–1) is amended— 
(1) in the section heading, by striking ‘‘VIO-
LENCE RELATED STRESS’’ and inserting ‘‘TRAU-
MATIC EVENTS’’; 
(2) in subsection (a)— 
(A) in the matter preceding paragraph (1), 
by striking ‘‘tribes and tribal’’ and inserting 
‘‘Tribes and Tribal’’; and 
(B) in paragraph (2), by inserting ‘‘and 
dissemination’’ after ‘‘the development’’; 
(3) in subsection (b), by inserting ‘‘and dissemi-
nation’’ after ‘‘the development’’; 
(4) in subsection (d)— 
(A) by striking ‘‘The NCTSI’’ and insert-
ing the following: 
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‘‘(1) COORDINATING
CENTER.—The NCTSI’’; 
and 
(B) by adding at the end the following: 
‘‘(2) NCTSI GRANTEES.—In carrying out sub-
section (a)(2), NCTSI grantees shall develop 
trainings and other resources, as applicable and ap-
propriate, to support implementation of the evi-
dence-based practices developed and disseminated 
under such subsection.’’; 
(5) in subsection (e)— 
(A) by redesignating paragraphs (1) and 
(2) as subparagraphs (A) and (B), respectively, 
and adjusting the margins accordingly; 
(B) in subparagraph (A), as so redesig-
nated, by inserting ‘‘and implementation’’ after 
‘‘the dissemination’’; 
(C) by striking ‘‘The NCTSI’’ and insert-
ing the following: 
‘‘(1) COORDINATING
CENTER.—The NCTSI’’; 
and 
(D) by adding at the end the following: 
‘‘(2) NCTSI GRANTEES.—NCTSI grantees shall, 
as appropriate, collaborate with other such grantees, 
the NCTSI coordinating center, and the Secretary in 
carrying out subsections (a)(2) and (d)(2).’’; 
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(6) by amending subsection (h) to read as fol-
lows: 
‘‘(h) APPLICATION AND EVALUATION.—To be eligible 
to receive a grant, contract, or cooperative agreement 
under subsection (a), a public or nonprofit private entity 
or an Indian Tribe or Tribal organization shall submit to 
the Secretary an application at such time, in such manner, 
and containing such information and assurances as the 
Secretary may require, including— 
‘‘(1) a plan for the evaluation of the activities 
funded under the grant, contract, or agreement, in-
cluding both process and outcomes evaluation, and 
the submission of an evaluation at the end of the 
project period; and 
‘‘(2) a description of how such entity, Indian 
Tribe, or Tribal organization will support efforts led 
by the Secretary or the NCTSI coordinating center, 
as applicable, to evaluate activities carried out under 
this section.’’; and 
(7) by amending subsection (j) to read as fol-
lows: 
‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section— 
‘‘(1) $93,887,000 for fiscal year 2025; 
‘‘(2) $95,000,000 for fiscal year 2026; 
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‘‘(3) $97,000,000 for fiscal year 2027; 
‘‘(4) $100,000,000 for fiscal year 2028; and 
‘‘(5) $100,000,000 for fiscal year 2029.’’. 
SEC. 518. PROTECTING SUICIDE PREVENTION LIFELINE 
FROM CYBERSECURITY INCIDENTS. 
(a) NATIONAL SUICIDE PREVENTION LIFELINE PRO-
GRAM.—Section 520E–3(b) of the Public Health Service 
Act (42 U.S.C. 290bb–36c(b)) is amended— 
(1) in paragraph (4), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (5), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(6) taking such steps as may be necessary to 
ensure the suicide prevention hotline is protected 
from cybersecurity incidents and eliminates known 
cybersecurity vulnerabilities.’’. 
(b) REPORTING.—Section 520E–3 of the Public 
Health Service Act (42 U.S.C. 290bb–36c) is amended— 
(1) by redesignating subsection (f) as sub-
section (g); and 
(2) by inserting after subsection (e) the fol-
lowing: 
‘‘(f) CYBERSECURITY REPORTING.— 
‘‘(1) NOTIFICATION.— 
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‘‘(A) IN
GENERAL.—The program’s net-
work administrator receiving Federal funding 
pursuant to subsection (a) shall report to the 
Assistant Secretary, in a manner that protects 
personal privacy, consistent with applicable 
Federal and State privacy laws— 
‘‘(i) 
any 
identified 
cybersecurity 
vulnerabilities to the program within a rea-
sonable amount of time after identification 
of such a vulnerability; and 
‘‘(ii) any identified cybersecurity inci-
dents to the program within a reasonable 
amount of time after identification of such 
incident. 
‘‘(B) LOCAL AND REGIONAL CRISIS CEN-
TERS.—Local and regional crisis centers par-
ticipating in the program shall report to the 
program’s network administrator identified 
under subparagraph (A), in a manner that pro-
tects personal privacy, consistent with applica-
ble Federal and State privacy laws— 
‘‘(i) 
any 
identified 
cybersecurity 
vulnerabilities to the program within a rea-
sonable amount of time after identification 
of such vulnerability; and 
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‘‘(ii) any identified cybersecurity inci-
dents to the program within a reasonable 
amount of time after identification of such 
incident. 
‘‘(2) NOTIFICATION.—If the program’s network 
administrator receiving funding pursuant to sub-
section (a) discovers, or is informed by a local or re-
gional crisis center pursuant to paragraph (1)(B) of, 
a cybersecurity vulnerability or incident, within a 
reasonable amount of time after such discovery or 
receipt of information, such entity shall report the 
vulnerability or incident to the Assistant Secretary. 
‘‘(3) CLARIFICATION.— 
‘‘(A) OVERSIGHT.— 
‘‘(i) LOCAL
AND
REGIONAL
CRISIS 
CENTERS.—Except as provided in clause 
(ii), local and regional crisis centers par-
ticipating in the program shall oversee all 
technology each center employs in the pro-
vision of services as a participant in the 
program. 
‘‘(ii) NETWORK
ADMINISTRATOR.— 
The program’s network administrator re-
ceiving Federal funding pursuant to sub-
section (a) shall oversee the technology 
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each crisis center employs in the provision 
of services as a participant in the program 
if such oversight responsibilities are estab-
lished in the applicable network participa-
tion agreement. 
‘‘(B) SUPPLEMENT, NOT SUPPLANT.—The 
cybersecurity incident reporting requirements 
under this subsection shall supplement, and not 
supplant, cybersecurity incident reporting re-
quirements under other provisions of applicable 
Federal law that are in effect on the date of the 
enactment of the SUPPORT for Patients and 
Communities Reauthorization Act of 2024.’’. 
(c) STUDY.—Not later than 180 days after the date 
of the enactment of this Act, the Comptroller General of 
the United States shall— 
(1) conduct and complete a study that evaluates 
cybersecurity risks and vulnerabilities associated 
with the 9–8–8 National Suicide Prevention Lifeline; 
and 
(2) submit a report on the findings of such 
study to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Com-
mittee on Energy and Commerce of the House of 
Representatives. 
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SEC. 519. BRUCE’S LAW. 
(a) YOUTH PREVENTION AND RECOVERY.—Section 
7102(c) of the SUPPORT for Patients and Communities 
Act (42 U.S.C. 290bb–7a(c)) is amended— 
(1) in paragraph (3)(A)(i), by inserting ‘‘, 
which may include strategies to increase education 
and awareness of the potency and dangers of syn-
thetic opioids (including drugs contaminated with 
fentanyl) and, as appropriate, other emerging drug 
use or misuse issues’’ before the semicolon; and 
(2) in paragraph (4)(A), by inserting ‘‘and 
strategies to increase education and awareness of 
the potency and dangers of synthetic opioids (includ-
ing drugs contaminated with fentanyl) and, as ap-
propriate, emerging drug use or misuse issues’’ be-
fore the semicolon. 
(b) INTERDEPARTMENTAL SUBSTANCE USE DIS-
ORDERS COORDINATING COMMITTEE.—Section 7022 of 
the SUPPORT for Patients and Communities Act (42 
U.S.C. 290aa note) is amended— 
(1) by striking subsection (g) and inserting the 
following: 
‘‘(g) WORKING GROUPS.— 
‘‘(1) IN GENERAL.—The Committee may estab-
lish working groups for purposes of carrying out the 
duties described in subsection (e). Any such working 
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group shall be composed of members of the Com-
mittee (or the designees of such members) and may 
hold such meetings as are necessary to carry out the 
duties delegated to the working group. 
‘‘(2) 
ADDITIONAL
FEDERAL
INTERAGENCY 
WORK GROUP ON FENTANYL CONTAMINATION OF IL-
LEGAL DRUGS.— 
‘‘(A) ESTABLISHMENT.—The Secretary, 
acting through the Committee, shall establish a 
Federal Interagency Work Group on Fentanyl 
Contamination of Illegal Drugs (referred to in 
this paragraph as the ‘Work Group’) consisting 
of representatives from relevant Federal depart-
ments and agencies on the Committee. 
‘‘(B) CONSULTATION.—The Work Group 
shall consult with relevant stakeholders and 
subject matter experts, including— 
‘‘(i) State, Tribal, and local subject 
matter experts in reducing, preventing, and 
responding to drug overdose caused by 
fentanyl contamination of illicit drugs; and 
‘‘(ii) family members of both adults 
and youth who have overdosed by fentanyl 
contaminated illicit drugs. 
‘‘(C) DUTIES.—The Work Group shall— 
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‘‘(i) examine Federal efforts to reduce 
and prevent drug overdose by fentanyl-con-
taminated illicit drugs; 
‘‘(ii) identify strategies to improve 
State, Tribal, and local responses to over-
dose by fentanyl-contaminated illicit drugs; 
‘‘(iii) coordinate with the Secretary, as 
appropriate, in carrying out activities to 
raise public awareness of synthetic opioids 
and other emerging drug use and misuse 
issues; 
‘‘(iv) make recommendations to Con-
gress for improving Federal programs, in-
cluding with respect to the coordination of 
efforts across such programs; and 
‘‘(v) make recommendations for edu-
cating youth on the potency and dangers of 
drugs contaminated by fentanyl. 
‘‘(D) ANNUAL REPORT TO SECRETARY.— 
The Work Group shall annually prepare and 
submit to the Secretary, the Committee on 
Health, Education, Labor, and Pensions of the 
Senate, and the Committee on Energy and 
Commerce and the Committee on Education 
and the Workforce of the House of Representa-
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tives, a report on the activities carried out by 
the Work Group under subparagraph (C), in-
cluding recommendations to reduce and prevent 
drug overdose by fentanyl contamination of ille-
gal drugs, in all populations, and specifically 
among youth at risk for substance misuse.’’; 
and 
(2) by striking subsection (i) and inserting the 
following: 
‘‘(i) SUNSET.—The Committee shall 
terminate on September 30, 2029.’’. 
SEC. 520. GUIDANCE ON AT-HOME DRUG DISPOSAL SYS-
TEMS. 
(a) IN GENERAL.—Not later than one year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services, in consultation with the Administrator 
of the Drug Enforcement Administration, shall publish 
guidance to facilitate the use of at-home safe disposal sys-
tems for applicable drugs. 
(b) CONTENTS.—The guidance under subsection (a) 
shall include— 
(1) recommended standards for effective at- 
home drug disposal systems to meet applicable re-
quirements enforced by the Food and Drug Adminis-
tration; 
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(2) recommended information to include as in-
structions for use to disseminate with at-home drug 
disposal systems; 
(3) best practices and educational tools to sup-
port the use of an at-home drug disposal system, as 
appropriate; and 
(4) recommended use of licensed health pro-
viders for the dissemination of education, instruc-
tion, and at-home drug disposal systems, as appro-
priate. 
SEC. 521. ASSESSMENT OF OPIOID DRUGS AND ACTIONS. 
(a) IN GENERAL.—Not later than one year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall publish on the website of the Food and 
Drug Administration (referred to in this section as the 
‘‘FDA’’) a report that outlines a plan for assessing opioid 
analgesic drugs that are approved under section 505 of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
355) that addresses the public health effects of such opioid 
analgesic drugs as part of the benefit-risk assessment and 
the activities of the FDA that relate to facilitating the de-
velopment of nonaddictive medical products intended to 
treat pain or addiction. Such report shall include— 
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(1) an update on the actions taken by the FDA 
to consider the effectiveness, safety, benefit-risk pro-
file, and use of approved opioid analgesic drugs; 
(2) a timeline for an assessment of the potential 
need, as appropriate, for labeling changes, revised or 
additional postmarketing requirements, enforcement 
actions, or withdrawals for opioid analgesic drugs; 
(3) an overview of the steps that the FDA has 
taken to support the development and approval of 
nonaddictive medical products intended to treat pain 
or addiction, and actions planned to further support 
the development and approval of such products; and 
(4) an overview of the consideration by the 
FDA of clinical trial methodologies for analgesic 
drugs, including the enriched enrollment randomized 
withdrawal methodology, and the benefits and draw-
backs associated with different trial methodologies 
for such drugs, incorporating any public input re-
ceived under subsection (b). 
(b) PUBLIC INPUT.—In carrying out subsection (a), 
the Secretary shall provide an opportunity for public input 
concerning the regulation by the FDA of opioid analgesic 
drugs, including scientific evidence that relates to condi-
tions of use, safety, or benefit-risk assessment (including 
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consideration of the public health effects) of such opioid 
analgesic drugs. 
SEC. 522. GRANT PROGRAM FOR STATE AND TRIBAL RE-
SPONSE TO OPIOID USE DISORDERS. 
The activities carried out pursuant to section 
1003(b)(4)(A) of the 21st Century Cures Act (42 U.S.C. 
290ee–3a(b)(4)(A)) may include facilitating access to 
products used to prevent overdose deaths by detecting the 
presence of one or more substances, such as fentanyl and 
xylazine test strips, to the extent the purchase and posses-
sion of such products is consistent with Federal and State 
law. 
Subtitle B—Treatment 
SEC. 531. RESIDENTIAL TREATMENT PROGRAM FOR PREG-
NANT AND POSTPARTUM WOMEN. 
Section 508 of the Public Health Service Act (42 
U.S.C. 290bb–1) is amended— 
(1) in subsection (d)(11)(C), by striking ‘‘pro-
viding health services’’ and inserting ‘‘providing 
health care services’’; 
(2) in subsection (g)— 
(A) by inserting ‘‘a plan describing’’ after 
‘‘will provide’’; and 
(B) by adding at the end the following: 
‘‘Such plan may include a description of how 
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such applicant will target outreach to women 
disproportionately impacted by maternal sub-
stance use disorder.’’; and 
(3) in subsection (s), by striking ‘‘$29,931,000 
for each of fiscal years 2019 through 2023’’ and in-
serting ‘‘$38,931,000 for each of fiscal years 2025 
through 2029’’. 
SEC. 532. IMPROVING ACCESS TO ADDICTION MEDICINE 
PROVIDERS. 
Section 597 of the Public Health Service Act (42 
U.S.C. 290ll) is amended— 
(1) in subsection (a)(1), by inserting ‘‘diag-
nosis,’’ after ‘‘related to’’; and 
(2) in subsection (b), by inserting ‘‘addiction 
medicine,’’ after ‘‘psychiatry,’’. 
SEC. 533. MENTAL AND BEHAVIORAL HEALTH EDUCATION 
AND TRAINING GRANTS. 
Section 756(f) of the Public Health Service Act (42 
U.S.C. 294e–1(f)) is amended by striking ‘‘fiscal years 
2023 through 2027’’ and inserting ‘‘fiscal years 2025 
through 2029’’. 
SEC. 534. LOAN REPAYMENT PROGRAM FOR SUBSTANCE 
USE DISORDER TREATMENT WORKFORCE. 
Section 781(j) of the Public Health Service Act (42 
U.S.C. 295h(j)) is amended by striking ‘‘$25,000,000 for 
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each of fiscal years 2019 through 2023’’ and inserting 
‘‘$40,000,000 for each of fiscal years 2025 through 
2029’’. 
SEC. 535. DEVELOPMENT AND DISSEMINATION OF MODEL 
TRAINING PROGRAMS FOR SUBSTANCE USE 
DISORDER PATIENT RECORDS. 
Section 7053 of the SUPPORT for Patients and 
Communities Act (42 U.S.C. 290dd–2 note) is amended 
by striking subsection (e). 
SEC. 536. TASK FORCE ON BEST PRACTICES FOR TRAUMA- 
INFORMED IDENTIFICATION, REFERRAL, AND 
SUPPORT. 
Section 7132 of the SUPPORT for Patients and 
Communities Act (Public Law 115–271; 132 Stat. 4046) 
is amended— 
(1) in subsection (b)(1)— 
(A) by redesignating subparagraph (CC) as 
subparagraph (DD); and 
(B) by inserting after subparagraph (BB) 
the following: 
‘‘(CC) The Administration for Community 
Living.’’; 
(2) in subsection (d)(1), in the matter pre-
ceding subparagraph (A), by inserting ‘‘, develop-
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mental disability service providers’’ before ‘‘, individ-
uals who are’’; and 
(3) in subsection (i), by striking ‘‘2023’’ and in-
serting ‘‘2029’’. 
SEC. 537. GRANTS TO ENHANCE ACCESS TO SUBSTANCE 
USE DISORDER TREATMENT. 
Section 3203 of the SUPPORT for Patients and 
Communities Act (21 U.S.C. 823 note) is amended— 
(1) by striking subsection (b); and 
(2) by striking ‘‘(a) IN GENERAL.—The Sec-
retary’’ and inserting the following: ‘‘The Sec-
retary’’. 
SEC. 538. STATE GUIDANCE RELATED TO INDIVIDUALS 
WITH SERIOUS MENTAL ILLNESS AND CHIL-
DREN WITH SERIOUS EMOTIONAL DISTURB-
ANCE. 
(a) REVIEW OF USE OF CERTAIN FUNDING.—Not 
later than 1 year after the date of enactment of this Act, 
the Secretary of Health and Human Services (referred to 
in this section as the ‘‘Secretary’’), acting through the As-
sistant Secretary for Mental Health and Substance Use, 
shall conduct a review of State use of funds made available 
under the Community Mental Health Services Block 
Grant program under subpart I of part B of title XIX 
of the Public Health Service Act (42 U.S.C. 300x et seq.) 
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(referred to in this section as the ‘‘block grant program’’) 
for first episode psychosis activities. Such review shall con-
sider the following: 
(1) How States use funds for evidence-based 
treatments and services according to the standard of 
care for individuals with early serious mental illness 
and children with a serious emotional disturbance. 
(2) The percentages of the State funding under 
the block grant program expended on early serious 
mental illness and first episode psychosis, and the 
number of individuals served under such funds. 
(b) REPORT AND GUIDANCE.— 
(1) REPORT.—Not later than 180 days after 
the completion of the review under subsection (a), 
the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions and the 
Committee on Appropriations of the Senate and the 
Committee on Energy and Commerce and the Com-
mittee on Appropriations of the House of Represent-
atives a report describing— 
(A) the findings of the review under sub-
section (a); and 
(B) any recommendations for changes to 
the block grant program that would facilitate 
improved outcomes for individuals with serious 
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mental illness and children with serious emo-
tional disturbance. 
(2) GUIDANCE.—Not later than 1 year after 
the date on which the report is submitted under 
paragraph (1), the Secretary shall update the guid-
ance provided to States under the block grant pro-
gram on coordinated specialty care and other evi-
dence-based mental health care services for individ-
uals with serious mental illness and children with a 
serious emotional disturbance, based on the findings 
and recommendations of such report. 
SEC. 539. REVIEWING THE SCHEDULING OF APPROVED 
PRODUCTS CONTAINING A COMBINATION OF 
BUPRENORPHINE AND NALOXONE. 
(a) SECRETARY OF HHS.—The Secretary of Health 
and Human Services shall, consistent with the require-
ments and procedures set forth in sections 201 and 202 
of the Controlled Substances Act (21 U.S.C. 811, 812)— 
(1) review the relevant data pertaining to the 
scheduling of products containing a combination of 
buprenorphine and naloxone that have been ap-
proved under section 505 of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 355); and 
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(2) if appropriate, request that the Attorney 
General initiate rulemaking proceedings to revise the 
schedules accordingly with respect to such products. 
(b) ATTORNEY GENERAL.—The Attorney General 
shall review any request made by the Secretary of Health 
and Human Services under subsection (a)(2) and deter-
mine whether to initiate proceedings to revise the sched-
ules in accordance with the criteria set forth in sections 
201 and 202 of the Controlled Substances Act (21 U.S.C. 
811, 812). 
Subtitle C—Recovery 
SEC. 541. BUILDING COMMUNITIES OF RECOVERY. 
Section 547(f) of the Public Health Service Act (42 
U.S.C. 290ee–2(f)) is amended by striking ‘‘$5,000,000 
for each of fiscal years 2019 through 2023’’ and inserting 
‘‘$16,000,000 for each of fiscal years 2025 through 
2029’’. 
SEC. 542. PEER SUPPORT TECHNICAL ASSISTANCE CEN-
TER. 
Section 547A of the Public Health Service Act (42 
U.S.C. 290ee–2a) is amended— 
(1) in subsection (b)(4), by striking ‘‘building; 
and’’ and inserting the following: ‘‘building, such 
as— 
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‘‘(A) professional development of peer sup-
port specialists; and 
‘‘(B) making recovery support services 
available in nonclinical settings; and’’; 
(2) by redesignating subsections (d) and (e) as 
subsections (e) and (f), respectively; 
(3) by inserting after subsection (c) the fol-
lowing: 
‘‘(d) REGIONAL CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary may estab-
lish one regional technical assistance center (referred 
to in this subsection as the ‘Regional Center’), with 
existing resources, to assist the Center in carrying 
out activities described in subsection (b) within the 
geographic region of such Regional Center in a man-
ner that is tailored to the needs of such region. 
‘‘(2) EVALUATION.—Not later than 4 years 
after the date of enactment of the SUPPORT for 
Patients and Communities Reauthorization Act of 
2024, the Secretary shall evaluate the activities of 
the Regional Center and submit to the Committee 
on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Com-
merce of the House of Representatives a report on 
the findings of such evaluation, including— 
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‘‘(A) a description of the distinct roles and 
responsibilities of the Regional Center and the 
Center; 
‘‘(B) available information relating to the 
outcomes of the Regional Center under this 
subsection, such as any impact on the oper-
ations and efficiency of the Center relating to 
requests for technical assistance and support 
within the region of such Regional Center; 
‘‘(C) a description of any gaps or areas of 
duplication relating to the activities of the Re-
gional Center and the Center within such re-
gion; and 
‘‘(D) recommendations relating to the 
modification, expansion, or termination of the 
Regional Center under this subsection. 
‘‘(3) TERMINATION.—This subsection shall ter-
minate on September 30, 2029.’’; and 
(4) in subsection (f), as so redesignated, by 
striking ‘‘$1,000,000 for each of fiscal years 2019 
through 2023’’ and inserting ‘‘$2,000,000 for each 
of fiscal years 2025 through 2029’’. 
SEC. 543. COMPREHENSIVE OPIOID RECOVERY CENTERS. 
Section 552 of the Public Health Service Act (42 
U.S.C. 290ee–7) is amended— 
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(1) in subsection (d)(2)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘and in such manner’’ and in-
serting ‘‘, in such manner, and containing such 
information and assurances, including relevant 
documentation,’’; and 
(B) in subparagraph (A), by striking ‘‘is 
capable of coordinating with other entities to 
carry out’’ and inserting ‘‘has the demonstrated 
capability to carry out, through referral or con-
tractual arrangements’’; 
(2) in subsection (h)— 
(A) 
by 
redesignating 
paragraphs 
(1) 
through (4) as subparagraphs (A) through (D), 
respectively, and adjusting the margins accord-
ingly; 
(B) by striking ‘‘With respect to’’ and in-
serting the following: 
‘‘(1) IN GENERAL.—With respect to’’; and 
(C) by adding at the end the following: 
‘‘(2) ADDITIONAL REPORTING FOR CERTAIN EL-
IGIBLE ENTITIES.—An entity carrying out activities 
described in subsection (g) through referral or con-
tractual arrangements shall include in the submis-
sions required under paragraph (1) information re-
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lated to the status of such referrals or contractual 
arrangements, including an assessment of whether 
such referrals or contractual arrangements are sup-
porting the ability of such entity to carry out such 
activities.’’; and 
(3) in subsection (j), by striking ‘‘2019 through 
2023’’ and inserting ‘‘2025 through 2029’’. 
SEC. 544. YOUTH PREVENTION AND RECOVERY. 
Section 7102(c) of the SUPPORT for Patients and 
Communities Act (42 U.S.C. 290bb–7a(c)) (as amended 
by section 110(a)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) in clause (i)— 
(I) by inserting ‘‘, or a consor-
tium of local educational agencies,’’ 
after ‘‘a local educational agency’’; 
and 
(II) by striking ‘‘high schools’’ 
and inserting ‘‘secondary schools’’; 
and 
(ii) in clause (vi), by striking ‘‘tribe, 
or tribal’’ and inserting ‘‘Tribe, or Tribal’’; 
(B) by amending subparagraph (E) to read 
as follows: 
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‘‘(E) INDIAN
TRIBE; TRIBAL
ORGANIZA-
TION.—The terms ‘Indian Tribe’ and ‘Tribal 
organization’ have the meanings given such 
terms in section 4 of the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 5304).’’; 
(C) by redesignating subparagraph (K) as 
subparagraph (L); and 
(D) by inserting after subparagraph (J) 
the following: 
‘‘(K) SECONDARY
SCHOOL.—The term 
‘secondary school’ has the meaning given such 
term in section 8101 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 
7801).’’; 
(2) in paragraph (3)(A), in the matter pre-
ceding clause (i)— 
(A) by striking ‘‘and abuse’’; and 
(B) by inserting ‘‘at increased risk for sub-
stance misuse’’ after ‘‘specific populations’’; 
(3) in paragraph (4)— 
(A) in the matter preceding subparagraph 
(A), by striking ‘‘Indian tribes’’ and inserting 
‘‘Indian Tribes’’; 
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