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‘‘(vi) Assistance with programs and 
activities, 
including 
legal 
assistance, 
deemed necessary to address arrest or con-
viction records as an employment barrier. 
‘‘(vii) 
Other 
support 
services 
as 
deemed necessary for family well-being, 
success in the project, and progress toward 
career goals. 
‘‘(C) TREATMENT OF SUPPORT FOR PUR-
POSES
OF
MEANS-TESTED
PROGRAMS.—Any 
goods or services provided to an eligible indi-
vidual participating in a project for which a 
grant is made under this section shall not be 
considered income, and shall not be taken into 
account for purposes of determining the eligi-
bility of the individual for, or amount of bene-
fits to be provided to the individual, under any 
means-tested program. 
‘‘(3) TRAINING.—The number of hours of train-
ing provided to an eligible individual under a project 
for which a grant is made under this section, for a 
recognized postsecondary credential, including an in-
dustry-recognized credential, which is awarded in 
recognition of attainment of measurable technical or 
occupational skills necessary to gain employment or 
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advance within an occupation (including a certificate 
awarded by a local workforce development board es-
tablished under section 107 of the Workforce Inno-
vation and Opportunity Act), shall be— 
‘‘(A) not less than the number of hours of 
training required for certification in that level 
of skill by the State in which the project is con-
ducted; or 
‘‘(B) if there is no such requirement, such 
number of hours of training as the Secretary 
finds is necessary to achieve that skill level. 
‘‘(4) INCOME LIMITATION.—An entity to which 
a grant is made under this section shall not use the 
grant to provide support to a person who is not an 
eligible individual. 
‘‘(5) INCLUSION OF TANF RECIPIENTS.—In the 
case of a project for which a grant is made under 
this section that is conducted in a State that has a 
program funded under part A of title IV, at least 10 
percent of the eligible individuals to whom support 
is provided under the project shall meet the income 
eligibility requirements under that State program, 
without regard to whether the individuals receive 
benefits or services directly under that State pro-
gram. 
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‘‘(6) PROHIBITION.—An entity to which a grant 
is made under this section shall not use the grant 
for purposes of entertainment, except that case man-
agement and career coaching services may include 
celebrations of specific career-based milestones such 
as completing a semester, graduation, or job place-
ment. 
‘‘(e) TECHNICAL ASSISTANCE.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
technical assistance— 
‘‘(A) to assist eligible entities in applying 
for grants under this section; 
‘‘(B) that is tailored to meet the needs of 
grantees at each stage of the administration of 
projects for which grants are made under this 
section; 
‘‘(C) that is tailored to meet the specific 
needs of Indian tribes, tribal organizations, and 
tribal colleges and universities; 
‘‘(D) that is tailored to meet the specific 
needs of the territories; 
‘‘(E) that is tailored to meet the specific 
needs of eligible entities in carrying out dem-
onstration projects for which a grant is made 
under this section; and 
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‘‘(F) to facilitate the exchange of informa-
tion among eligible entities regarding best prac-
tices and promising practices used in the 
projects. 
‘‘(2) CONTINUATION OF PEER TECHNICAL AS-
SISTANCE CONFERENCES.—The Secretary shall con-
tinue to hold peer technical assistance conferences 
for entities to which a grant is made under this sec-
tion or was made under the immediate predecessor 
of this section. 
‘‘(f) EVALUATION OF DEMONSTRATION PROJECTS.— 
‘‘(1) IN
GENERAL.—The Secretary shall, by 
grant, contract, or interagency agreement, conduct 
rigorous and well-designed evaluations of the dem-
onstration projects for which a grant is made under 
this section. 
‘‘(2) REQUIREMENT APPLICABLE TO INDIVID-
UALS WITH ARREST OR CONVICTION RECORDS DEM-
ONSTRATION.—In the case of a project of the type 
described in subsection (c)(2)(B)(i)(I), the evalua-
tion shall include identification of successful activi-
ties for creating opportunities for developing and 
sustaining, particularly with respect to low-income 
individuals with arrest or conviction records, a 
health professions workforce that has accessible 
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entry points, that meets high standards for edu-
cation, training, certification, and professional devel-
opment, and that provides increased wages and af-
fordable benefits, including health care coverage, 
that are responsive to the needs of the workforce. 
‘‘(3) REQUIREMENT
APPLICABLE
TO
PREG-
NANCY AND CHILDBIRTH CAREER PATHWAY DEM-
ONSTRATION.—In the case of a project of the type 
described in subsection (c)(2)(B)(i)(II), the evalua-
tion shall include identification of successful activi-
ties for creating opportunities for developing and 
sustaining, particularly with respect to low-income 
individuals and other entry-level workers, a career 
pathway that has accessible entry points, that meets 
high standards for education, training, certification, 
and professional development, and that provides in-
creased wages and affordable benefits, including 
health care coverage, that are responsive to the 
needs of the birth, pregnancy, and post-partum 
workforce. 
‘‘(4) RULE OF INTERPRETATION.—Evaluations 
conducted pursuant to this subsection may include a 
randomized controlled trial, but this subsection shall 
not be interpreted to require an evaluation to include 
such a trial. 
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‘‘(g) REPORTS.— 
‘‘(1) TO THE SECRETARY.—An eligible entity 
awarded a grant to conduct a project under this sec-
tion shall submit interim reports to the Secretary on 
the activities carried out under the project, and, on 
the conclusion of the project, a final report on the 
activities. Each such report shall include data on 
participant outcomes related to earnings, employ-
ment in health professions, graduation rate, gradua-
tion timeliness, credential attainment, participant 
demographics, and other data specified by the Sec-
retary. 
‘‘(2) TO THE CONGRESS.—During each Con-
gress, the Secretary 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— 
‘‘(A) on the demographics of the partici-
pants in the projects for which a grant is made 
under this section; 
‘‘(B) on the rate of which project partici-
pants 
completed 
all 
activities 
under 
the 
projects; 
‘‘(C) on the employment credentials ac-
quired by project participants; 
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dressing health professions workforce shortages 
or in-demand jobs. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) ALLIED HEALTH PROFESSION.—The term 
‘allied health profession’ has the meaning given in 
section 799B(5) of the Public Health Service Act. 
‘‘(2) CAREER
PATHWAY.—The term ‘career 
pathway’ has the meaning given that term in section 
3(7) of the Workforce Innovation and Opportunity 
Act. 
‘‘(3) DOULA.—The term ‘doula’ means an indi-
vidual who— 
‘‘(A) is certified by an organization that 
has been established for not less than 5 years 
and that requires the completion of continuing 
education to maintain the certification, to pro-
vide non-medical advice, information, emotional 
support, and physical comfort to an individual 
during the individual’s pregnancy, childbirth, 
and post-partum period; and 
‘‘(B) maintains the certification by com-
pleting the required continuing education. 
‘‘(4) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means any of the following entities that dem-
onstrates in an application submitted under this sec-
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tion that the entity has the capacity to fully develop 
and administer the project described in the applica-
tion: 
‘‘(A) A local workforce development board 
established under section 107 of the Workforce 
Innovation and Opportunity Act. 
‘‘(B) A State or territory, a political sub-
division of a State or territory, or an agency of 
a State, territory, or such a political subdivi-
sion, including a State or local entity that ad-
ministers a State program funded under part A 
of this title. 
‘‘(C) An Indian tribe, a tribal organization, 
or a tribal college or university. 
‘‘(D) An institution of higher education (as 
defined in the Higher Education Act of 1965). 
‘‘(E) A hospital (as defined in section 
1861(e)). 
‘‘(F) A high-quality skilled nursing facility. 
‘‘(G) A Federally qualified health center 
(as defined in section 1861(aa)(4)). 
‘‘(H) A nonprofit organization described in 
section 501(c)(3) of the Internal Revenue Code 
of 1986, a labor organization, or an entity with 
shared labor-management oversight, that has a 
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demonstrated history of providing health profes-
sion training to eligible individuals. 
‘‘(I) In the case of a demonstration project 
of 
the 
type 
provided 
for 
in 
subsection 
(c)(2)(B)(i)(II) of this section, an entity recog-
nized by a State, Indian tribe, or tribal organi-
zation as qualified to train doulas or midwives, 
if midwives or doulas, as the case may be, are 
permitted to practice in the State involved. 
‘‘(J) An opioid treatment program (as de-
fined in section 1861(jjj)(2)), and other high 
quality comprehensive addiction care providers. 
‘‘(5) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual whose family income 
does not exceed 200 percent of the Federal poverty 
level. 
‘‘(6) FEDERAL
POVERTY
LEVEL.—The term 
‘Federal poverty level’ means the poverty line (as de-
fined in section 673(2) of the Omnibus Budget Rec-
onciliation Act of 1981, including any revision re-
quired by such section applicable to a family of the 
size involved). 
‘‘(7) INDIAN TRIBE; TRIBAL ORGANIZATION.— 
The terms ‘Indian tribe’ and ‘tribal organization’ 
have the meaning given the terms in section 4 of the 
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Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450b). 
‘‘(8) INSTITUTION OF HIGHER EDUCATION.— 
The term ‘institution of higher education’ has the 
meaning given the term in section 101 or 
102(a)(1)(B) of the Higher Education Act of 1965. 
‘‘(9) TERRITORY.—The term ‘territory’ means 
the Commonwealth of Puerto Rico, the United 
States Virgin Islands, Guam, the Northern Mariana 
Islands, and American Samoa. 
‘‘(10) TRIBAL COLLEGE OR UNIVERSITY.—The 
term ‘tribal college or university’ has the meaning 
given the term in section 316(b) of the Higher Edu-
cation Act of 1965. 
‘‘(i) FUNDING.— 
‘‘(1) IN GENERAL.—Out of any funds in the 
Treasury of the United States not otherwise appro-
priated, there are appropriated to the Secretary to 
carry out this section $425,000,000 for each of fis-
cal years 2021 through 2025. 
‘‘(2) ALLOCATION OF FUNDS.—Of the amount 
appropriated for a fiscal year under paragraph (1) 
of this subsection— 
‘‘(A) 75 percent shall be available for 
grants under subsection (c)(1)(A); 
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‘‘(B) 4 percent shall be reserved for grants 
under subsection (c)(1)(B); 
‘‘(C) 5 percent shall be reserved for grants 
under subsection (c)(1)(C); 
‘‘(D) 6 percent shall be available for dem-
onstration project grants under subsection 
(c)(2); 
‘‘(E) 6 percent, plus all amounts referred 
to in subparagraphs (A) through (D) of this 
paragraph that remain unused after all grant 
awards are made for the fiscal year, shall be 
available for the provision of technical assist-
ance and associated staffing; and 
‘‘(F) 4 percent shall be available for study-
ing the effects of the demonstration and non- 
demonstration projects for which a grant is 
made under this section, and for associated 
staffing, for the purpose of supporting the rig-
orous evaluation of the demonstration projects, 
and supporting the continued study of the 
short-, medium-, and long-term effects of all 
such projects, including the effectiveness of new 
or added elements of the non-demonstration 
projects. 
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‘‘(j) NONAPPLICABILITY OF PRECEDING SECTIONS 
OF THIS SUBTITLE.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the preceding sections of this subtitle 
shall not apply to a grant awarded under this sec-
tion. 
‘‘(2) EXCEPTION FOR CERTAIN LIMITATIONS ON 
USE OF GRANTS.—Section 2005(a) (other than para-
graphs (2), (3), (5), (6), and (8)) shall apply to a 
grant awarded under this section to the same extent 
and in the same manner as such section applies to 
payments to States under this subtitle.’’. 
SEC. 811. HOME VISITING TO REDUCE MATERNAL MOR-
TALITY AND MORBIDITY ACT. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Home Visiting to Reduce Maternal Mortality and Mor-
bidity Act’’. 
(b) INCREASE
IN TRIBAL SET-ASIDE PERCENT-
AGE.— 
(1) IN GENERAL.—Section 511(j)(2)(A) of the 
Social Security Act (42 U.S.C. 711(j)(2)(A)) is 
amended by striking ‘‘3’’ and inserting ‘‘6’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect on October 1, 
2020. 
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(c) INCREASE IN FUNDING.—Section 511(j)(1) of 
such Act (42 U.S.C. 711(j)(1)) is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (G); and 
(2) by striking subparagraph (H) and inserting 
the following: 
‘‘(H) $400,000,000 for each of fiscal years 
2017 through 2020; 
‘‘(I) $600,000,000 for fiscal year 2021; 
and 
‘‘(J) $800,000,000 for fiscal year 2022.’’. 
(d) USE OF ADDITIONAL FUNDS.—Section 511(c) of 
such Act (42 U.S.C. 711(c)) is amended by adding at the 
end the following: 
‘‘(6) USE OF CERTAIN FUNDS TO PROVIDE AD-
DITIONAL RESOURCES TO ADDRESS HIGH RATES OF 
MATERNAL
MORTALITY
AND
MORBIDITY, SUPPORT 
UNMET NEEDS IDENTIFIED BY THE NEEDS ASSESS-
MENT, OR INCREASE ALLOCATIONS TO STATES AND 
TERRITORIES BASED ON RELATIVE POPULATION OR 
POVERTY.—The Secretary shall ensure that any 
amounts exceeding $400,000,000 that are used for 
grants under this subsection for a fiscal year are 
used to— 
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‘‘(A) provide additional funding priority to 
States, tribes, and territories to address high 
rates of maternal mortality and morbidity; 
‘‘(B) address unmet needs identified by a 
needs assessment conducted under subsection 
(b); or 
‘‘(C) increase the amounts allocated under 
this section to States and to Puerto Rico, 
Guam, the Virgin Islands, the Northern Mar-
iana Islands, and American Samoa, based on 
the proportion of children who have not at-
tained 5 years of age and are living in pov-
erty.’’. 
SEC. 812. ADDITION OF NEW MEASURES BASED ON ACCESS 
TO BIOSIMILAR BIOLOGICAL PRODUCTS TO 
THE 5-STAR RATING SYSTEM UNDER MEDI-
CARE ADVANTAGE. 
(a) IN GENERAL.—Section 1853(o)(4) of the Social 
Security Act (42 U.S.C. 1395w–23(o)(4)) is amended by 
adding at the end the following new subparagraph: 
‘‘(E) ADDITION OF NEW MEASURES BASED 
ON ACCESS TO BIOSIMILAR BIOLOGICAL PROD-
UCTS.— 
‘‘(i) IN
GENERAL.—For 2021 and 
subsequent years, the Secretary shall add a 
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new set of measures to the 5-star rating 
system based on access to biosimilar bio-
logical products covered under part B and, 
in the case of MA–PD plans, such prod-
ucts that are covered part D drugs. Such 
measures shall assess the impact a plan’s 
benefit structure may have on enrollees’ 
utilization of or ability to access biosimilar 
biological products, including in compari-
son to the reference biological product, and 
shall include measures, as applicable, with 
respect to the following: 
‘‘(I) 
COVERAGE.—Assessing 
whether a biosimilar biological prod-
uct is on the plan formulary in lieu of 
or in addition to the reference biologi-
cal product. 
‘‘(II) 
PREFERENCING.—Assess-
ing tier placement or cost-sharing for 
a biosimilar biological product relative 
to the reference biological product. 
‘‘(III) 
UTILIZATION
MANAGE-
MENT TOOLS.—Assessing whether and 
how utilization management tools are 
used with respect to a biosimilar bio-
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logical product relative to the ref-
erence biological product. 
‘‘(IV) 
UTILIZATION.—Assessing 
the percentage of enrollees prescribed 
the biosimilar biological product when 
the reference biological product is also 
available. 
‘‘(ii) DEFINITIONS.—In this subpara-
graph, the terms ‘biosimilar biological 
product’ and ‘reference biological product’ 
have the meaning given those terms in sec-
tion 1847A(c)(6). 
‘‘(iii) PROTECTING
PATIENT
INTER-
ESTS.—In developing such measures, the 
Secretary shall ensure that each measure 
developed 
to 
address 
coverage, 
preferencing, or utilization management is 
constructed such that patients retain equal 
access to appropriate therapeutic options 
without undue administrative burden.’’. 
(b) CLARIFICATION REGARDING APPLICATION
TO 
PRESCRIPTION DRUG PLANS.—To the extent the Sec-
retary of Health and Human Services applies the 5-star 
rating system under section 1853(o)(4) of the Social Secu-
rity Act (42 U.S.C. 1395w–23(o)(4)), or a similar system, 
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to prescription drug plans under part D of title XVIII of 
such Act, the provisions of subparagraph (E) of such sec-
tion, as added by subsection (a) of this section, shall apply 
under the system with respect to such plans in the same 
manner as such provisions apply to the 5-star rating sys-
tem under such section 1853(o)(4). 
SEC. 813. SENSE OF CONGRESS REGARDING THE IMPACT 
OF 
THE 
HIGH 
COST 
OF 
PRESCRIPTION 
DRUGS ON COMMUNITIES OF COLOR AND 
PERSONS LIVING IN RURAL OR SPARSELY 
POPULATED AREAS OF THE UNITED STATES. 
It is the sense of the Congress that— 
(1) the United States has the highest drug 
prices in the world and for millions of Americans the 
cost of prescription drugs is increasing as a barrier 
to proper disease treatment, especially for commu-
nities of color and for persons living in rural or 
sparsely populated areas of the nation; 
(2) the Patient Protection and Affordable Care 
Act (Public Law 111–148) substantially reduced the 
number of uninsured Americans, but over 28 million 
Americans remain without insurance and approxi-
mately 55 percent of uninsured Americans under the 
age of 65 are persons of color; 
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(3) without health insurance, paying retail 
prices for medications is invariably burdensome or 
financially impossible; 
(4) the median net worth of Caucasian house-
holds in 2016 was 9.7 times higher than African- 
American households and 8.3 times higher than His-
panic households, which contributes to disparities in 
negative health consequences, including for example 
the underuse of insulin among insured adults with 
diabetes; and 
(5) due to the high cost of prescription drugs 
to communities of color and for persons living in 
rural or sparsely populated areas of the nation, this 
Act should positively impact such communities and 
persons (and the Secretaries of Health and Human 
Services, Labor, and Treasury should monitor such 
impact). 
SEC. 
814. 
REGULATIONS 
REQUIRING 
DIRECT-TO-CON-
SUMER ADVERTISEMENTS FOR PRESCRIP-
TION DRUGS AND BIOLOGICAL PRODUCTS TO 
INCLUDE TRUTHFUL AND NOT MISLEADING 
PRICING INFORMATION. 
(a) IN GENERAL.—Not later than the date that is 
one year after the date of the enactment of the Elijah E. 
Cummings Lower Drug Costs Now Act, the Secretary of 
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Health and Human Services, acting through the Adminis-
trator of the Centers for Medicare & Medicaid Services 
(referred to in this section as the ‘‘Administrator’’), shall 
promulgate final regulations requiring each direct-to-con-
sumer advertisement on television (including broadcast, 
cable, streaming, and satellite television) for a prescription 
drug or biological product for which payment is available 
under title XVIII or XIX of the Social Security Act to 
include a textual statement, which shall be truthful and 
not misleading, indicating the list price, as determined on 
the first day of the quarter during which the advertise-
ment is being aired or otherwise broadcast, for a typical 
30-day regimen or typical course of treatment (whichever 
is most appropriate). 
(b) DETERMINATIONS.—In promulgating final regu-
lations under subsection (a), the Administrator shall de-
termine— 
(1) whether such regulations should apply with 
respect to additional forms of advertising; 
(2) the manner and format of textual state-
ments described in such subsection; 
(3) appropriate enforcement mechanisms; and 
(4) whether such textual statements should in-
clude any other price information, as appropriate. 
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SEC. 815. IMPROVING TRANSPARENCY AND PREVENTING 
THE USE OF ABUSIVE SPREAD PRICING AND 
RELATED PRACTICES IN MEDICAID. 
(a) PASS-THROUGH PRICING REQUIRED.— 
(1) IN GENERAL.—Section 1927(e) of the So-
cial Security Act (42 U.S.C. 1396r–8(e)) is amended 
by adding at the end the following: 
‘‘(6) PASS-THROUGH
PRICING
REQUIRED.—A 
contract between the State and a pharmacy benefit 
manager (referred to in this paragraph as a ‘PBM’), 
or a contract between the State and a managed care 
entity or other specified entity (as such terms are 
defined in section 1903(m)(9)(D)) that includes pro-
visions making the entity responsible for coverage of 
covered outpatient drugs dispensed to individuals en-
rolled with the entity, shall require that payment for 
such drugs and related administrative services (as 
applicable), including payments made by a PBM on 
behalf of the State or entity, is based on a pass- 
through pricing model under which— 
‘‘(A) any payment made by the entity or 
the PBM (as applicable) for such a drug— 
‘‘(i) is limited to— 
‘‘(I) ingredient cost; and 
‘‘(II) a professional dispensing 
fee that is not less than the profes-
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sional dispensing fee that the State 
plan or waiver would pay if the plan 
or waiver was making the payment di-
rectly; 
‘‘(ii) is passed through in its entirety 
by the entity or PBM to the pharmacy 
that dispenses the drug; and 
‘‘(iii) is made in a manner that is con-
sistent with section 1902(a)(30)(A) and 
sections 447.512, 447.514, and 447.518 of 
title 42, Code of Federal Regulations (or 
any successor regulation) as if such re-
quirements applied directly to the entity or 
the PBM; 
‘‘(B) payment to the entity or the PBM 
(as applicable) for administrative services per-
formed by the entity or PBM is limited to a 
reasonable administrative fee that covers the 
reasonable cost of providing such services; 
‘‘(C) the entity or the PBM (as applicable) 
shall make available to the State, and the Sec-
retary upon request, all costs and payments re-
lated to covered outpatient drugs and accom-
panying administrative services incurred, re-
ceived, or made by the entity or the PBM, in-
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cluding ingredient costs, professional dispensing 
fees, administrative fees, post-sale and post-in- 
voice fees. Discounts, or related adjustments 
such as direct and indirect remuneration fees, 
and any and all remuneration; and 
‘‘(D) any form of spread pricing whereby 
any amount charged or claimed by the entity or 
the PBM (as applicable) that is in excess of the 
amount paid to the pharmacies on behalf of the 
entity, including any post-sale or post-invoice 
fees, discounts, or related adjustments such as 
direct and indirect remuneration fees or assess-
ments (after allowing for a reasonable adminis-
trative fee as described in subparagraph (B)), is 
not allowable for purposes of claiming Federal 
matching payments under this title.’’. 
(2) CONFORMING
AMENDMENT.—Clause (xiii) 
of section 1903(m)(2)(A) of such Act (42 U.S.C. 
1396b(m)(2)(A)) is amended— 
(A) by striking ‘‘and (III)’’ and inserting 
‘‘(III)’’; and 
(B) by inserting before the period at the 
end the following: ‘‘, and (IV) pharmacy benefit 
management services provided by the entity, or 
provided by a pharmacy benefit manager on be-
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half of the entity under a contract or other ar-
rangement between the entity and the phar-
macy benefit manager, shall comply with the re-
quirements of section 1927(e)(6)’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection apply to contracts between States 
and managed care entities, other specified entities, 
or pharmacy benefits managers that are entered into 
or renewed on or after the date that is 18 months 
after the date of enactment of this Act. 
(b) SURVEY OF RETAIL PRICES.— 
(1) IN GENERAL.—Section 1927(f) of the Social 
Security Act (42 U.S.C. 1396r–8(f)) is amended— 
(A) by striking ‘‘and’’ after the semicolon 
at the end of paragraph (1)(A)(i) and all that 
precedes it through ‘‘(1)’’ and inserting the fol-
lowing: 
‘‘(1) SURVEY
OF
RETAIL
PRICES.—The Sec-
retary shall conduct a survey of retail community 
drug prices, to include at least the national average 
drug acquisition cost, as follows: 
‘‘(A) USE
OF
VENDOR.—The Secretary 
may contract services for— 
‘‘(i) with respect to retail community 
pharmacies, the determination on a month-
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ly basis of retail survey prices of the na-
tional average drug acquisition cost for 
covered outpatient drugs for such phar-
macies, net of all discounts and rebates (to 
the extent any information with respect to 
such discounts and rebates is available), 
the average reimbursement received for 
such drugs by such pharmacies from all 
sources of payment, including third par-
ties, and, to the extent available, the usual 
and customary charges to consumers for 
such drugs; and’’; 
(B) by adding at the end of paragraph (1) 
the following: 
‘‘(F) SURVEY
REPORTING.—In order to 
meet the requirement of section 1902(a)(54), a 
State shall require that any retail community 
pharmacy in the State that receives any pay-
ment, administrative fee, discount, or rebate re-
lated to the dispensing of covered outpatient 
drugs to individuals receiving benefits under 
this title, regardless of whether such payment, 
fee, discount, or rebate is received from the 
State or a managed care entity directly or from 
a pharmacy benefit manager or another entity 
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that has a contract with the State or a man-
aged care entity, shall respond to surveys of re-
tail prices conducted under this subsection. 
‘‘(G) SURVEY INFORMATION.—Information 
on retail community prices obtained under this 
paragraph shall be made publicly available and 
shall include at least the following: 
‘‘(i) The monthly response rate of the 
survey including a list of pharmacies not in 
compliance with subparagraph (F). 
‘‘(ii) The sampling frame and number 
of pharmacies sampled monthly. 
‘‘(iii) 
Characteristics 
of 
reporting 
pharmacies, including type (such as inde-
pendent or chain), geographic or regional 
location, and dispensing volume. 
‘‘(iv) Reporting of a separate national 
average drug acquisition cost for each drug 
for independent retail pharmacies and 
chain operated pharmacies. 
‘‘(v) Information on price concessions 
including on and off invoice discounts, re-
bates, and other price concessions. 
‘‘(vi) Information on average profes-
sional dispensing fees paid. 
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‘‘(H) PENALTIES.— 
‘‘(i) FAILURE TO PROVIDE TIMELY IN-
FORMATION.—A retail community phar-
macy that fails to respond to a survey con-
ducted under this subsection on a timely 
basis may be subject to a civil monetary 
penalty in the amount of $10,000 for each 
day in which such information has not 
been provided. 
‘‘(ii) FALSE INFORMATION.—A retail 
community pharmacy that knowingly pro-
vides false information in response to a 
survey conducted under this subsection 
may be subject to a civil money penalty in 
an amount not to exceed $100,000 for 
each item of false information. 
‘‘(iii) OTHER
PENALTIES.—Any civil 
money penalties imposed under this sub-
paragraph shall be in addition to other 
penalties as may be prescribed by law. The 
provisions of section 1128A (other than 
subsections (a) and (b)) shall apply to a 
civil money penalty under this subpara-
graph in the same manner as such provi-
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sions apply to a penalty or proceedings 
under section 1128A(a). 
‘‘(I) 
REPORT
ON
SPECIALTY
PHAR-
MACIES.— 
‘‘(i) IN GENERAL.—Not later than 1 
year after the effective date of this sub-
paragraph, the Secretary shall submit a re-
port to Congress examining specialty drug 
coverage and reimbursement under this 
title. 
‘‘(ii) CONTENT OF REPORT.—Such re-
port shall include a description of how 
State Medicaid programs define specialty 
drugs, how much State Medicaid programs 
pay for specialty drugs, how States and 
managed care plans determine payment for 
specialty drugs, the settings in which spe-
cialty drugs are dispensed (such as retail 
community pharmacies or specialty phar-
macies), whether acquisition costs for spe-
cialty drugs are captured in the national 
average drug acquisition cost survey, and 
recommendations as to whether specialty 
pharmacies should be included in the sur-
vey of retail prices to ensure national aver-
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age drug acquisition costs capture drugs 
sold at specialty pharmacies and how such 
specialty pharmacies should be defined.’’; 
(C) in paragraph (2)— 
(i) in subparagraph (A), by inserting 
‘‘, including payments rates under Med-
icaid managed care plans,’’ after ‘‘under 
this title’’; and 
(ii) in subparagraph (B), by inserting 
‘‘and the basis for such dispensing fees’’ 
before the semicolon; and 
(D) in paragraph (4), by inserting ‘‘, and 
$5,000,000 for fiscal year 2020 and each fiscal 
year thereafter,’’ after ‘‘2010’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection take effect on the 1st day of the 
1st quarter that begins on or after the date that is 
18 months after the date of enactment of this Act. 
(c) MANUFACTURER REPORTING
OF WHOLESALE 
ACQUISITION COST.—Section 1927(b)(3) of such Act (42 
U.S.C. 1396r–8(b)(3)) is amended— 
(1) in subparagraph (A)(i)— 
(A) in subclause (I), by striking ‘‘and’’ 
after the semicolon; 
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(B) in subclause (II), by adding ‘‘and’’ 
after the semicolon; 
(C) by moving the left margins of sub-
clause (I) and (II) 2 ems to the right; and 
(D) by adding at the end the following: 
‘‘(III) in the case of rebate peri-
ods that begin on or after the date of 
enactment of this subclause, on the 
wholesale acquisition cost (as defined 
in section 1847A(c)(6)(B)) for cov-
ered outpatient drugs for the rebate 
period under the agreement (including 
for all such drugs that are sold under 
a new drug application approved 
under section 505(c) of the Federal 
Food, Drug, and Cosmetic Act);’’; and 
(2) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
inserting ‘‘and clause (vii) of this subpara-
graph’’ after ‘‘1847A’’; 
(B) in clause (v), by striking ‘‘and’’ after 
the comma; 
(C) in clause (vi), by striking the period 
and inserting ‘‘, and’’; and 
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(D) by inserting after clause (vi) the fol-
lowing: 
‘‘(vii) to the Secretary to disclose 
(through a website accessible to the public) 
the most recently reported wholesale acqui-
sition 
cost 
(as 
defined 
in 
section 
1847A(c)(6)(B)) for each covered out-
patient drug (including for all such drugs 
that are sold under a new drug application 
approved under section 505(c) of the Fed-
eral Food, Drug, and Cosmetic Act), as re-
ported under subparagraph (A)(i)(III).’’. 
SEC. 816. GRADUATE MEDICAL EDUCATION IMPROVE-
MENTS IN RURAL AND UNDERSERVED COM-
MUNITIES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 399V–7. GRADUATE MEDICAL EDUCATION IMPROVE-
MENTS IN RURAL AND UNDERSERVED COM-
MUNITIES. 
‘‘(a) RURAL AND UNDERSERVED COMMUNITY GME 
GRANT PROGRAM.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services (in this section referred to as the ‘Sec-
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retary’), acting through the Administrator of the Health 
Resources and Services Administration, shall establish a 
rural and underserved community graduate medical edu-
cation grant program under which the Secretary shall 
award grants to specified hospitals (as defined in sub-
section (b)) that have not established an approved medical 
residency training program (as defined for purposes of 
section 1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h))) in order to encourage such hospitals to es-
tablish such a program, or to establish an affiliation with 
a hospital that has established such a program in order 
to host residents under such program. 
‘‘(b) USE OF FUNDS.—Grants awarded under sub-
section (a) may be used by a specified hospital for any 
initial costs associated with establishing such a program 
or such an affiliation, including costs associated with fac-
ulty development, administration, infrastructure, supplies, 
and legal and consultant services. 
‘‘(c) SPECIFIED HOSPITAL DEFINED.—For purposes 
of subsection (a), the term ‘specified hospital’ means a 
hospital or critical access hospital (as such terms are de-
fined in section 1861 of the Social Security Act (42 U.S.C. 
1395x)) that— 
‘‘(1) is— 
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‘‘(A) located in a rural area (as defined in 
section 1886(d)(2)(D) of such Act (42 U.S.C. 
1395ww(d)(2)(D))); or 
‘‘(B) treated as being located in a rural 
area pursuant to section 1886(d)(8)(E) of such 
Act (42 U.S.C. 1395ww(d)(8)(E)); and 
‘‘(2) is located in a medically underserved area 
(as defined in section 330I(a) of the Public Health 
Service Act (42 U.S.C. 254c–14(a))). 
‘‘(d) CRITICAL
ACCESS
HOSPITAL
GRANT
PRO-
GRAM.—Not later than 1 year after the date of the enact-
ment of this Act, the Secretary, acting through the Admin-
istrator of the Health Resources and Services Administra-
tion, shall establish a grant program under which the Sec-
retary awards grants to critical access hospitals (as de-
fined in section 1861 of the Social Security Act (42 U.S.C. 
1395x)) that do not have in effect an affiliation with a 
hospital with an approved medical residency training pro-
gram to host residents of such program in order to assist 
such critical access hospitals in setting up such affiliations 
in order to host such residents. 
‘‘(e) LIMITATION ON GRANT AMOUNTS.—No hospital 
may receive an aggregate amount of grants under this sec-
tion in excess of $250,000. 
‘‘(f) REPORTS.— 
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‘‘(1) HHS.—Not later than 5 years after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services shall submit to the 
Committee on Energy and Commerce of the House 
of Representatives and the Committee on Health, 
Education, Labor, and Pensions of the Senate a re-
port on graduate medical residency training pro-
grams of hospitals that received a grant under sub-
section (a) or (d). Such report shall include the fol-
lowing: 
‘‘(A) The number of hospitals that applied 
for a grant under this section. 
‘‘(B) The number of hospitals that were 
awarded such a grant. 
‘‘(C) The number of residency positions 
created by hospitals receiving such a grant. 
‘‘(D) An estimate of the number of such 
positions such hospitals will create after the 
date of the submission of such report. 
‘‘(E) A description of any challenges faced 
by hospitals in applying for such a grant or 
using funds awarded under such a grant. 
‘‘(2) GAO.—Not later than 10 years after the 
date of the enactment of this Act, the Comptroller 
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General of the United States shall submit to Con-
gress a report containing an analysis of— 
‘‘(A) the number of residents who trained 
at a hospital or critical access hospital that re-
ceived a grant under subsection (a) or (d); and 
‘‘(B) whether such residents continued to 
practice medicine in a rural area (as defined in 
section 1886(d)(2)(D) of the Social Security 
Act (42 U.S.C. 1395ww(d)(2)(D))) or in a 
medically underserved area (as defined in sec-
tion 330I(a) of the Public Health Service Act 
(42 U.S.C. 254c–14(a))) after completing such 
training. 
‘‘(g) FUNDING.—There are authorized to be appro-
priated such sums as are necessary for purposes of making 
grants under this section for each of fiscal years 2020 
through 2029.’’. 
Passed the House of Representatives December 12, 
2019. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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Calendar No. 521 
116TH CONGRESS 
2D SESSION 
H. R. 3 
AN ACT 
To establish a fair price negotiation program, pro-
tect the Medicare program from excessive price 
increases, and establish an out-of-pocket max-
imum for Medicare part D enrollees, and for 
other purposes. 
SEPTEMBER 8, 2020 
Read the second time and placed on the calendar 
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