364 
nual rate of the basic pay of the Under Sec-
retary) shall take effect on the first day of the 
first pay period beginning after the date of the 
enactment of this Act. 
(c) AUTHORITIES AND RESPONSIBILITIES.— 
(1) COORDINATION
OF
EXECUTIVE
BRANCH 
VIEWS ON MATTERS BEFORE THE FEDERAL COMMU-
NICATIONS COMMISSION.—Section 105(a)(1) of the 
National Telecommunications and Information Ad-
ministration Organization Act (47 U.S.C. 904(a)(1)) 
is amended— 
(A) by striking ‘‘to ensure that the con-
duct’’ and inserting the following: ‘‘to ensure 
that— 
‘‘(A) the conduct’’; 
(B) in subparagraph (A), as so designated, 
by striking the period at the end and inserting 
‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(B) the views of the executive branch on 
matters presented to the Commission are, con-
sistent with section 103(b)(2)(J)— 
‘‘(i) appropriately coordinated; and 
‘‘(ii) reflective of executive branch pol-
icy.’’. 
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(2) ASSIGNED FUNCTIONS.—Section 103(b)(2) 
of the National Telecommunications and Informa-
tion Administration Organization Act (47 U.S.C. 
902(b)(2)) is amended— 
(A) in the matter preceding subparagraph 
(A), by inserting ‘‘, some of which were’’ before 
‘‘transferred to the Secretary’’; and 
(B) in subparagraph (M), by inserting ‘‘, 
publish reports,’’ after ‘‘studies’’. 
(3) RULE OF CONSTRUCTION.—Nothing in the 
amendments made by paragraphs (1) and (2) may 
be construed to expand or contract the authority of 
the Commission. 
(d) TECHNICAL AND CONFORMING AMENDMENTS.— 
(1) PUBLIC TELECOMMUNICATIONS FINANCING 
ACT OF 1978.—Section 106(c) of the Public Tele-
communications Financing Act of 1978 (5 U.S.C. 
5316 note; Public Law 95–567) is amended by strik-
ing ‘‘The position of Deputy Assistant Secretary of 
Commerce for Communications and Information, es-
tablished in Department of Commerce Organization 
Order Numbered 10–10 (effective March 26, 
1978),’’ and inserting ‘‘The position of Deputy 
Under Secretary of Commerce for Communications 
and Information, established under section 103(a) of 
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366 
the National Telecommunications and Information 
Administration 
Organization 
Act 
(47 
U.S.C. 
902(a)),’’. 
(2) COMMUNICATIONS
ACT
OF
1934.—Section 
344(d)(2) of the Communications Act of 1934 (47 
U.S.C. 344(d)(2)) is amended by striking ‘‘Assistant 
Secretary’’ and inserting ‘‘Under Secretary’’. 
(3) HOMELAND SECURITY ACT OF 2002.—Sec-
tion 1805(d)(2) of the Homeland Security Act of 
2002 (6 U.S.C. 575(d)(2)) is amended by striking 
‘‘Assistant Secretary for Communications and Infor-
mation of the Department of Commerce’’ and insert-
ing ‘‘Under Secretary of Commerce for Communica-
tions and Information’’. 
(4) AGRICULTURE
IMPROVEMENT
ACT
OF 
2018.—Section 6212 of the Agriculture Improvement 
Act of 2018 (7 U.S.C. 950bb–6) is amended— 
(A) in subsection (d)(1), in the heading, by 
striking ‘‘ASSISTANT SECRETARY’’ and inserting 
‘‘UNDER SECRETARY’’; and 
(B) by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under 
Secretary’’. 
(5) TITLE 17, UNITED STATES CODE.—Section 
1201(a)(1)(C) of title 17, United States Code, is 
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367 
amended by striking ‘‘Assistant Secretary for Com-
munications and Information of the Department of 
Commerce’’ and inserting ‘‘Under Secretary of Com-
merce for Communications and Information’’. 
(6) UNLOCKING CONSUMER CHOICE AND WIRE-
LESS
COMPETITION
ACT.—Section 2(b) of the 
Unlocking Consumer Choice and Wireless Competi-
tion Act (17 U.S.C. 1201 note; Public Law 113– 
144) is amended by striking ‘‘Assistant Secretary 
for Communications and Information of the Depart-
ment of Commerce’’ and inserting ‘‘Under Secretary 
of Commerce for Communications and Information’’. 
(7) COMMUNICATIONS
SATELLITE
ACT
OF 
1962.—Section 625(a)(1) of the Communications 
Satellite Act of 1962 (47 U.S.C. 763d(a)(1)) is 
amended, in the matter preceding subparagraph (A), 
by striking ‘‘Assistant Secretary’’ and inserting 
‘‘Under Secretary of Commerce’’. 
(8) SPECTRUM
PIPELINE
ACT
OF
2015.—The 
Spectrum Pipeline Act of 2015 (47 U.S.C. 921 note; 
title X of Public Law 114–74) is amended— 
(A) in section 1002(1), in the heading, by 
striking ‘‘ASSISTANT SECRETARY’’ and inserting 
‘‘UNDER SECRETARY’’; and 
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368 
(B) by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under 
Secretary’’. 
(9) WARNING, ALERT, AND
RESPONSE
NET-
WORK ACT.—Section 606 of the Warning, Alert, and 
Response Network Act (47 U.S.C. 1205) is amend-
ed— 
(A) by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under 
Secretary’’; and 
(B) in subsection (b), in the first sentence, 
by striking ‘‘for7Communications’’ and insert-
ing ‘‘for Communications’’. 
(10) AMERICAN RECOVERY AND REINVESTMENT 
ACT OF 2009.—Section 6001 of the American Recov-
ery and Reinvestment Act of 2009 (47 U.S.C. 1305) 
is amended by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under Sec-
retary’’. 
(11) MIDDLE CLASS TAX RELIEF AND JOB CRE-
ATION ACT OF 2012.—Title VI of the Middle Class 
Tax Relief and Job Creation Act of 2012 (47 U.S.C. 
1401 et seq.) is amended— 
(A) in section 6001 (47 U.S.C. 1401)— 
(i) by striking paragraph (4); 
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369 
(ii) by redesignating paragraphs (5) 
through (32) as paragraphs (4) through 
(31), respectively; and 
(iii) by inserting after paragraph (31), 
as so redesignated, the following: 
‘‘(32) UNDER SECRETARY.—The term ‘Under 
Secretary’ means the Under Secretary of Commerce 
for Communications and Information.’’; and 
(B) by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under 
Secretary’’. 
(12) RAY
BAUM’S
ACT
OF
2018.—The RAY 
BAUM’S Act of 2018 (division P of Public Law 
115–141; 132 Stat. 348) is amended by striking 
‘‘Assistant Secretary’’ each place the term appears 
and inserting ‘‘Under Secretary’’. 
(13) SECURE AND TRUSTED COMMUNICATIONS 
NETWORKS ACT OF 2019.—Section 8 of the Secure 
and Trusted Communications Networks Act of 2019 
(47 U.S.C. 1607) is amended— 
(A) in subsection (c)(1), in the heading, by 
striking ‘‘ASSISTANT SECRETARY’’ and inserting 
‘‘UNDER SECRETARY’’; and 
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370 
(B) by striking ‘‘Assistant Secretary’’ each 
place the term appears and inserting ‘‘Under 
Secretary’’. 
(14) TITLE 51, UNITED STATES CODE.—Section 
50112(3) of title 51, United States Code, is amend-
ed, in the matter preceding subparagraph (A), by 
striking ‘‘Assistant Secretary’’ each place the term 
appears and inserting ‘‘Under Secretary’’. 
(15) CONSOLIDATED
APPROPRIATIONS
ACT, 
2021.—The Consolidated Appropriations Act, 2021 
(Public Law 116–260) is amended— 
(A) in title IX of division N— 
(i) in section 902(a)(2), in the head-
ing, by striking ‘‘ASSISTANT SECRETARY’’ 
and inserting ‘‘UNDER SECRETARY’’; 
(ii) in section 905— 
(I) in subsection (a)(1), in the 
heading, by striking ‘‘ASSISTANT SEC-
RETARY’’ and inserting ‘‘UNDER SEC-
RETARY’’; 
(II) in subsection (c)(3)(B), in 
the heading, by striking ‘‘ASSISTANT 
SECRETARY’’ and inserting ‘‘UNDER 
SECRETARY’’; and 
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371 
(III) in subsection (d)(2)(B), in 
the heading, by striking ‘‘ASSISTANT 
SECRETARY’’ and inserting ‘‘UNDER 
SECRETARY’’; and 
(iii) by striking ‘‘Assistant Secretary’’ 
each place the term appears and inserting 
‘‘Under Secretary’’; and 
(B) in title IX of division FF— 
(i) in section 903(g)(2), in the head-
ing, by striking ‘‘ASSISTANT SECRETARY’’ 
and inserting ‘‘UNDER SECRETARY’’; and 
(ii) by striking ‘‘Assistant Secretary’’ 
each place the term appears and inserting 
‘‘Under Secretary’’. 
(16) INFRASTRUCTURE INVESTMENT AND JOBS 
ACT.—The Infrastructure Investment and Jobs Act 
(Public Law 117–58) is amended— 
(A) in section 27003, by striking ‘‘Assist-
ant Secretary’’ each place the term appears and 
inserting ‘‘Under Secretary’’; 
(B) in division F— 
(i) in section 60102— 
(I) in subsection (a)(2)(A), by 
striking 
‘‘ASSISTANT
SECRETARY’’ 
and inserting ‘‘UNDER SECRETARY’’; 
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372 
(II) in subsection (d)(1), by 
striking 
‘‘ASSISTANT
SECRETARY’’ 
and inserting ‘‘UNDER SECRETARY’’; 
and 
(III) in subsection (h)— 
(aa) in paragraph (1)(B), by 
striking 
‘‘ASSISTANT
SEC-
RETARY’’ and inserting ‘‘UNDER 
SECRETARY’’; and 
(bb) 
in 
paragraph 
(5)(B)(iii), by striking ‘‘ASSIST-
ANT
SECRETARY’’ and inserting 
‘‘UNDER SECRETARY’’; 
(ii) in title III— 
(I) in section 60302(5), by strik-
ing ‘‘ASSISTANT SECRETARY’’ and in-
serting ‘‘UNDER SECRETARY’’; and 
(II) 
in 
section 
60305(d)(2)(B)(ii), by striking ‘‘AS-
SISTANT
SECRETARY’’ and inserting 
‘‘UNDER SECRETARY’’; 
(iii) in section 60401(a)(2), by strik-
ing ‘‘ASSISTANT SECRETARY’’ and insert-
ing ‘‘UNDER SECRETARY’’; and 
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373 
(iv) by striking ‘‘Assistant Secretary’’ 
each place the term appears and inserting 
‘‘Under Secretary’’; and 
(C) in division J, in title I, in the matter 
under the heading ‘‘distance learning, telemedi-
cine, and broadband program’’ under the head-
ing ‘‘Rural Utilities Service’’ under the heading 
‘‘RURAL DEVELOPMENT PROGRAMS’’, by 
striking ‘‘Assistant Secretary’’ and inserting 
‘‘Under Secretary’’. 
SEC. 1912. NTIA CONSOLIDATED REPORTING ACT. 
(a) ELIMINATION OF CERTAIN OUTDATED OR COM-
PLETED REPORTING REQUIREMENTS.— 
(1) 
BTOP 
QUARTERLY
REPORT.—Section 
6001(d) of the American Recovery and Reinvestment 
Act of 2009 (47 U.S.C. 1305(d)) is amended— 
(A) in paragraph (2), by striking the semi-
colon at the end and inserting ‘‘; and’’; 
(B) in paragraph (3), by striking ‘‘; and’’ 
and inserting a period; and 
(C) by striking paragraph (4). 
(2) CERTAIN REPORTS REQUIRED BY NATIONAL 
TELECOMMUNICATIONS AND INFORMATION ADMINIS-
TRATION ORGANIZATION ACT.—Sections 154, 155, 
and 156 of the National Telecommunications and 
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374 
Information Administration Organization Act are re-
pealed. 
(3) INITIAL
REPORT
REQUIRED
BY
SECTION 
9202(a)(1)(G) OF
THE
NDAA
FOR
FISCAL
YEAR 
2021.—Section 9202(a)(1)(G) of the William M. 
(Mac) Thornberry National Defense Authorization 
Act for Fiscal Year 2021 (47 U.S.C. 906(a)(1)(G)) 
is amended— 
(A) in clause (ii), by redesignating sub-
clauses (I), (II), and (III) as clauses (i), (ii), 
and (iii), respectively, and conforming the mar-
gins of such clauses accordingly; and 
(B) by striking ‘‘REPORTS TO CONGRESS’’ 
and all that follows through ‘‘For each fiscal 
year’’ and inserting ‘‘ANNUAL REPORT TO CON-
GRESS.—For each fiscal year’’. 
(4) REPORT TO PRESIDENT.—Section 105(a) of 
the National Telecommunications and Information 
Administration Organization Act (47 U.S.C. 904(a)) 
is amended— 
(A) by striking paragraph (2); and 
(B) by redesignating paragraph (3) as 
paragraph (2). 
(5) EFFECT ON AUTHORITY.—Nothing in this 
subsection or the amendments made by this sub-
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375 
section may be construed to expand or contract the 
authority of the Secretary, the Under Secretary, the 
NTIA, or the Commission. 
(6) OTHER
REPORTS.—Nothing in this sub-
section or the amendments made by this subsection 
may be construed to prohibit or otherwise prevent 
the Secretary, the Under Secretary, the NTIA, or 
the Commission from producing any additional re-
ports otherwise within the authority of the Sec-
retary, the Under Secretary, the NTIA, or the Com-
mission, respectively. 
(b) CONSOLIDATED ANNUAL REPORT.— 
(1) IN GENERAL.—In the first quarter of each 
calendar year, the Under Secretary shall publish on 
the website of the NTIA and submit to the Com-
mittee on Energy and Commerce of the House of 
Representatives and the Committee on Commerce, 
Science, and Transportation of the Senate a report 
that contains the reports described in paragraph (2) 
for the fiscal year ending most recently before the 
beginning of such quarter. 
(2) REPORTS
DESCRIBED.—The reports de-
scribed in this paragraph are the following: 
(A) 
The 
report 
required 
by 
section 
903(c)(2)(C) of division FF of the Consolidated 
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376 
Appropriations 
Act, 
2021 
(47 
U.S.C. 
1307(c)(2)(C)). 
(B) If amounts in the Public Wireless Sup-
ply Chain Innovation Fund established by sec-
tion 9202(a)(1)(A)(i) of the William M. (Mac) 
Thornberry National Defense Authorization Act 
for 
Fiscal 
Year 
2021 
(47 
U.S.C. 
906(a)(1)(A)(i)) were available for the fiscal 
year described in paragraph (1) of this sub-
section, 
the 
report 
required 
by 
section 
9202(a)(1)(G) 
of 
such 
Act 
(47 
U.S.C. 
906(a)(1)(G)). 
(C) If the Under Secretary awarded grants 
under section 60304(d)(1) of the Infrastructure 
Investment 
and 
Jobs 
Act 
(47 
U.S.C. 
1723(d)(1)) in the fiscal year described in para-
graph (1) of this subsection, the report required 
by section 60306(a)(1)(A) of such Act (47 
U.S.C. 1725(a)(1)(A)). 
(3) TIMING OF UNDERLYING REPORTING RE-
QUIREMENTS.— 
(A) REPORT
OF
OFFICE
OF
INTERNET 
CONNECTIVITY
AND
GROWTH.—Section 
903(c)(2)(C) of division FF of the Consolidated 
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377 
Appropriations 
Act, 
2021 
(47 
U.S.C. 
1307(c)(2)(C)) is amended— 
(i) in the matter preceding clause 
(i)— 
(I) by striking ‘‘Not later than 1 
year after the date of the enactment 
of this Act, and every year there-
after,’’ and inserting ‘‘In the first 
quarter of each calendar year,’’; and 
(II) by inserting ‘‘, for the fiscal 
year ending most recently before the 
beginning of such quarter,’’ after ‘‘a 
report’’; and 
(ii) in clause (i), by striking ‘‘for the 
previous year’’. 
(B) REPORT ON DIGITAL EQUITY GRANT 
PROGRAMS.—Section 60306(a)(1) of the Infra-
structure Investment and Jobs Act (47 U.S.C. 
1725(a)(1)) is amended— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘Not later than 1 
year’’ and all that follows through ‘‘shall— 
’’ and inserting the following: ‘‘For the 
first fiscal year in which the Under Sec-
retary 
awards 
grants 
under 
section 
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378 
60304(d)(1), and each fiscal year there-
after in which the Under Secretary awards 
grants under such section, the Under Sec-
retary shall—’’; and 
(ii) in subparagraph (A)— 
(I) by inserting ‘‘in the first 
quarter of the first calendar year that 
begins after the end of such fiscal 
year,’’ before ‘‘submit’’; and 
(II) by striking ‘‘, for the year 
covered by the report’’. 
(4) SATISFACTION OF UNDERLYING REPORTING 
REQUIREMENTS.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the publication and submis-
sion of a report as required by paragraph (1) 
in the first quarter of a calendar year shall be 
treated as satisfying any requirement to publish 
or otherwise make publicly available or to sub-
mit to Congress or to a committee of Congress 
a report described in paragraph (2) for the fis-
cal year ending most recently before the begin-
ning of such quarter. 
(B) 
CERTAIN
SUBMISSION
REQUIRE-
MENTS.—At the time when the Under Secretary 
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379 
submits a report required by paragraph (1) to 
the committees described in such paragraph, 
the Under Secretary shall submit any portion of 
such report that relates to a report described in 
paragraph (2)(C) to each committee of Con-
gress not described in paragraph (1) to which 
such report would (without regard to subpara-
graph (A) of this paragraph) be required to be 
submitted. 
(5) APPLICABILITY.—Paragraph (1), and the 
amendments made by paragraph (3), shall apply be-
ginning on January 1 of the first calendar year that 
begins after the date of the enactment of this Act. 
(c) EXTENSION OF CERTAIN AUDIT AND REPORTING 
REQUIREMENTS.—Section 902(c)(4)(A) of division N of 
the Consolidated Appropriations Act, 2021 (47 U.S.C. 
1306(c)(4)(A)) is amended by striking ‘‘fiscal years 2021 
and 2022’’ and inserting ‘‘fiscal years 2021, 2022, 2023, 
and 2024’’. 
(d) DEFINITION.—In this section, the term ‘‘Sec-
retary’’ means the Secretary of Commerce. 
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380 
Subtitle B—Office of Spectrum 
Management 
SEC. 1921. OFFICE OF SPECTRUM MANAGEMENT. 
Part A of the National Telecommunications and In-
formation Administration Organization Act (47 U.S.C. 
901 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 106. OFFICE OF SPECTRUM MANAGEMENT. 
‘‘(a) ESTABLISHMENT.—There is established within 
the NTIA an Office of Spectrum Management (in this sec-
tion referred to as the ‘Office’). 
‘‘(b) HEAD OF OFFICE.— 
‘‘(1) IN
GENERAL.—The head of the Office 
shall be an Associate Administrator for Spectrum 
Management (in this section referred to as the ‘As-
sociate Administrator’). 
‘‘(2) REQUIREMENT
TO
REPORT.—The Asso-
ciate Administrator shall report to the Under Sec-
retary (or a designee of the Under Secretary). 
‘‘(c) DUTIES.—The Associate Administrator shall, at 
the direction of the Under Secretary— 
‘‘(1) carry out responsibilities under section 
103(b)(2)(A) (relating to frequency assignments for 
radio stations belonging to and operated by the 
United States), make frequency allocations for fre-
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381 
quencies that will be used by such stations, and de-
velop and maintain techniques, databases, measure-
ments, files, and procedures necessary for such allo-
cations; 
‘‘(2) carry out responsibilities under section 
103(b)(2)(K) (relating to establishing policies con-
cerning spectrum assignments and use by radio sta-
tions belonging to and operated by the United 
States) and provide Federal agencies with guidance 
to ensure that the conduct of telecommunications ac-
tivities by such agencies is consistent with such poli-
cies; 
‘‘(3) represent the interests of Federal agencies 
in the process through which the Commission and 
the NTIA jointly determine the National Table of 
Frequency Allocations, and coordinate with the 
Commission in the development of a comprehensive 
long-range plan for improved management of all 
electromagnetic spectrum resources; 
‘‘(4) appoint the chairpersons of and provide 
secretariat functions for the Interdepartmental 
Radio Advisory Committee and the Interagency 
Spectrum Advisory Council; 
‘‘(5) carry out responsibilities under section 
103(b)(2)(B) (relating to authorizing a foreign gov-
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385 
policy meetings and the activities related to prepara-
tion for such meetings; 
‘‘(7) in coordination with the Secretary of 
State, coordinate with Federal agencies and private 
organizations engaged in activities involving inter-
national telecommunications and information policy 
matters and maintain cognizance of the activities of 
United States signatories with respect to related 
treaties, agreements, and other instruments; 
‘‘(8) provide advice and assistance related to 
international telecommunications and information 
policy to other Federal agencies charged with re-
sponsibility 
for 
international 
negotiations, 
to 
strengthen the position and serve the best interests 
of the United States in the conduct of negotiations 
with foreign nations; 
‘‘(9) provide advice and assistance to the Under 
Secretary with respect to evaluating the inter-
national impact of matters pending before the Com-
mission, other Federal agencies, and Congress; 
‘‘(10) carry out, at the request of the Secretary, 
the responsibilities of the Secretary under the Com-
munications Satellite Act of 1962 (47 U.S.C. 701 et 
seq.) and other Federal laws related to international 
telecommunications and information policy; and 
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386 
‘‘(11) carry out any other duties of the NTIA 
with respect to international telecommunications and 
information policy that the Under Secretary may 
designate.’’. 
DIVISION E—HEALTH 
SEC. 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This division may be cited as the 
‘‘Health Improvements, Extenders, and Reauthorizations 
Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this division is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICAID 
Sec. 101. Streamlined enrollment process for eligible out-of-state providers 
under Medicaid and CHIP. 
Sec. 102. Making certain adjustments to coverage of home or community-based 
services under Medicaid. 
Sec. 103. Removing certain age restrictions on Medicaid eligibility for working 
adults with disabilities. 
Sec. 104. Medicaid State plan requirement for determining residency and cov-
erage for military families. 
Sec. 105. Ensuring the reliability of address information provided under the 
Medicaid program. 
Sec. 106. Codifying certain Medicaid provider screening requirements related to 
deceased providers. 
Sec. 107. Modifying certain State requirements for ensuring deceased individ-
uals do not remain enrolled. 
Sec. 108. One-year delay of Medicaid and CHIP requirements for health 
screenings, referrals, and case management services for eligible 
juveniles in public institutions; State interim work plans. 
Sec. 109. State studies and HHS report on costs of providing maternity, labor, 
and delivery services. 
Sec. 110. Modifying certain disproportionate share hospital allotments. 
Sec. 111. Modifying certain limitations on disproportionate share hospital pay-
ment adjustments under the Medicaid program. 
Sec. 112. Ensuring accurate payments to pharmacies under Medicaid. 
Sec. 113. Preventing the use of abusive spread pricing in Medicaid. 
TITLE II—MEDICARE 
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Sec. 201. Extension of increased inpatient hospital payment adjustment for cer-
tain low-volume hospitals. 
Sec. 202. Extension of the Medicare-dependent hospital (MDH) program. 
Sec. 203. Extension of add-on payments for ambulance services. 
Sec. 204. Extending incentive payments for participation in eligible alternative 
payment models. 
Sec. 205. Temporary payment increase under the Medicare physician fee sched-
ule to account for exceptional circumstances. 
Sec. 206. Extension of funding for quality measure endorsement, input, and se-
lection. 
Sec. 207. Extension of funding outreach and assistance for low-income pro-
grams. 
Sec. 208. Extension of the work geographic index floor. 
Sec. 209. Extension of certain telehealth flexibilities. 
Sec. 210. Requiring modifier for use of telehealth to conduct face-to-face en-
counter prior to recertification of eligibility for hospice care. 
Sec. 211. Extending acute hospital care at home waiver flexibilities. 
Sec. 212. Enhancing certain program integrity requirements for DME under 
Medicare. 
Sec. 213. Guidance on furnishing services via telehealth to individuals with lim-
ited English proficiency. 
Sec. 214. In-home cardiopulmonary rehabilitation flexibilities. 
Sec. 215. Inclusion of virtual diabetes prevention program suppliers in MDPP 
Expanded Model. 
Sec. 216. Medication-induced movement disorder outreach and education. 
Sec. 217. Report on wearable medical devices. 
Sec. 218. Extension of temporary inclusion of authorized oral antiviral drugs as 
covered part D drugs. 
Sec. 219. Extension of adjustment to calculation of hospice cap amount. 
Sec. 220. Multiyear contracting authority for MedPAC and MACPAC. 
Sec. 221. Contracting parity for MedPAC and MACPAC. 
Sec. 222. Adjustments to Medicare part D cost-sharing reductions for low-in-
come individuals. 
Sec. 223. Requiring Enhanced and Accurate Lists of (REAL) Health Providers 
Act. 
Sec. 224. Medicare coverage of multi-cancer early detection screening tests. 
Sec. 225. Medicare coverage of external infusion pumps and non-self-admin-
istrable home infusion drugs. 
Sec. 226. Assuring pharmacy access and choice for Medicare beneficiaries. 
Sec. 227. Modernizing and Ensuring PBM Accountability. 
Sec. 228. Requiring a separate identification number and an attestation for 
each off-campus outpatient department of a provider. 
Sec. 229. Medicare sequestration. 
Sec. 230. Medicare improvement fund. 
TITLE III—HUMAN SERVICES 
Subtitle A—Reauthorize Child Welfare Services and Strengthen State and 
Tribal Child Support Program 
Sec. 301. Short title. 
PART 1—CHILD WELFARE REAUTHORIZATION AND MODERNIZATION 
Sec. 311. Short title; references. 
Sec. 312. Reauthorization of child welfare programs. 
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Sec. 313. Enhancements to the court improvement program. 
Sec. 314. Expanding regional partnership grants to address parental substance 
use disorder as cause of child removal. 
Sec. 315. Modernization; reducing administrative burden. 
Sec. 316. Streamlining funding for Indian tribes. 
Sec. 317. Accelerating access to Family First prevention services. 
Sec. 318. Strengthening support for youth aging out of foster care. 
Sec. 319. Recognizing the importance of relative and kinship caregivers. 
Sec. 320. Avoiding neglect by addressing poverty. 
Sec. 321. Strengthening support for caseworkers. 
Sec. 322. Demonstration projects for improving relationships between incarcer-
ated parents and children in foster care. 
Sec. 323. Guidance to States on improving data collection and reporting for 
youth in residential treatment programs. 
Sec. 324. Streamlining research, training, and technical assistance funding. 
Sec. 325. Report on post adoption and subsidized guardianship services. 
Sec. 326. Effective date. 
PART 2—STRENGTHENING STATE AND TRIBAL CHILD SUPPORT 
Sec. 331. Short title. 
Sec. 332. Improving the effectiveness of tribal child support enforcement agen-
cies. 
Subtitle B—Other Matters 
Sec. 341. Sexual risk avoidance education extension. 
Sec. 342. Personal responsibility education extension. 
Sec. 343. Extension of funding for family-to-family health information centers. 
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 pro-
grams. 
Sec. 402. Extension of special diabetes programs. 
Subtitle B—World Trade Center Health Program 
Sec. 411. 9/11 responder and survivor health funding corrections. 
TITLE V—SUPPORT ACT REAUTHORIZATION 
Sec. 501. Short title. 
Subtitle A—Prevention 
Sec. 511. Prenatal and postnatal health. 
Sec. 512. Monitoring and education regarding infections associated with illicit 
drug use and other risk factors. 
Sec. 513. Preventing overdoses of controlled substances. 
Sec. 514. Support for individuals and families impacted by fetal alcohol spec-
trum disorder. 
Sec. 515. Promoting state choice in PDMP systems. 
Sec. 516. First responder training program. 
Sec. 517. Donald J. Cohen National Child Traumatic Stress Initiative. 
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Sec. 518. Protecting suicide prevention lifeline from cybersecurity incidents. 
Sec. 519. Bruce’s law. 
Sec. 520. Guidance on at-home drug disposal systems. 
Sec. 521. Assessment of opioid drugs and actions. 
Sec. 522. Grant program for State and Tribal response to opioid use disorders. 
Subtitle B—Treatment 
Sec. 531. Residential treatment program for pregnant and postpartum women. 
Sec. 532. Improving access to addiction medicine providers. 
Sec. 533. Mental and behavioral health education and training grants. 
Sec. 534. Loan repayment program for substance use disorder treatment work-
force. 
Sec. 535. Development and dissemination of model training programs for sub-
stance use disorder patient records. 
Sec. 536. Task force on best practices for trauma-informed identification, refer-
ral, and support. 
Sec. 537. Grants to enhance access to substance use disorder treatment. 
Sec. 538. State guidance related to individuals with serious mental illness and 
children with serious emotional disturbance. 
Sec. 539. Reviewing the scheduling of approved products containing a combina-
tion of buprenorphine and naloxone. 
Subtitle C—Recovery 
Sec. 541. Building communities of recovery. 
Sec. 542. Peer support technical assistance center. 
Sec. 543. Comprehensive opioid recovery centers. 
Sec. 544. Youth prevention and recovery. 
Sec. 545. CAREER Act. 
Sec. 546. Addressing economic and workforce impacts of the opioid crisis. 
Subtitle D—Miscellaneous Matters 
Sec. 551. Delivery of a controlled substance by a pharmacy to a prescribing 
practitioner. 
Sec. 552. Technical correction on controlled substances dispensing. 
Sec. 553. Required training for prescribers of controlled substances. 
Sec. 554. Extension of temporary order for fentanyl-related substances. 
TITLE VI—PANDEMIC AND ALL-HAZARDS PREPAREDNESS AND 
RESPONSE 
Sec. 601. Short title. 
Subtitle A—State and Local Readiness and Response 
Sec. 611. Temporary reassignment of State and local personnel during a public 
health emergency. 
Sec. 612. Public Health Emergency Preparedness program. 
Sec. 613. Hospital Preparedness Program. 
Sec. 614. Facilities and capacities of the Centers for Disease Control and Pre-
vention to combat public health security threats. 
Sec. 615. Pilot program to support State medical stockpiles. 
Sec. 616. Enhancing domestic wastewater surveillance for pathogen detection. 
Sec. 617. Reauthorization of Mosquito Abatement for Safety and Health pro-
gram. 
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Subtitle B—Federal Planning and Coordination 
Sec. 621. All-Hazards Emergency Preparedness and Response. 
Sec. 622. National Health Security Strategy. 
Sec. 623. Improving development and distribution of diagnostic tests. 
Sec. 624. Combating antimicrobial resistance. 
Sec. 625. Strategic National Stockpile and material threats. 
Sec. 626. Medical countermeasures for viral threats with pandemic potential. 
Sec. 627. Public Health Emergency Medical Countermeasures Enterprise. 
Sec. 628. Fellowship and training programs. 
Sec. 629. Regional biocontainment research laboratories. 
Sec. 629A. Limitation related to countries of concern conducting certain re-
search. 
Subtitle C—Addressing the Needs of All Individuals 
Sec. 631. Improving access to certain programs. 
Sec. 632. Supporting at-risk individuals during emergency responses. 
Sec. 633. National advisory committees. 
Sec. 634. National Academies study on prizes. 
Subtitle D—Additional Reauthorizations 
Sec. 641. Medical countermeasure priority review voucher. 
Sec. 642. Epidemic Intelligence Service. 
Sec. 643. Monitoring and distribution of certain medical countermeasures. 
Sec. 644. Regional health care emergency preparedness and response systems. 
Sec. 645. Emergency system for advance registration of volunteer health pro-
fessionals. 
Sec. 646. Ensuring collaboration and coordination in medical countermeasure 
development. 
Sec. 647. Military and civilian partnership for trauma readiness. 
Sec. 648. National Disaster Medical System. 
Sec. 649. Volunteer Medical Reserve Corps. 
Sec. 649A. Epidemiology-laboratory capacity. 
TITLE VII—PUBLIC HEALTH PROGRAMS 
Sec. 701. Action for dental health. 
Sec. 702. PREEMIE. 
Sec. 703. Preventing maternal deaths. 
Sec. 704. Sickle cell disease prevention and treatment. 
Sec. 705. Traumatic brain injuries. 
Sec. 706. Lifespan respite care. 
Sec. 707. Dr. Lorna Breen health care provider protection. 
Sec. 708. Gabriella Miller kids first research. 
Sec. 709. SCREENS for Cancer. 
Sec. 710. DeOndra Dixon INCLUDE Project. 
Sec. 711. IMPROVE Initiative. 
Sec. 712. Organ Procurement and Transplantation Network. 
Sec. 713. Honor Our Living Donors. 
Sec. 714. Program for pediatric studies of drugs. 
TITLE VIII—FOOD AND DRUG ADMINISTRATION 
Subtitle A—Give Kids a Chance 
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Sec. 801. Research into pediatric uses of drugs; additional authorities of Food 
and Drug Administration regarding molecularly targeted can-
cer drugs. 
Sec. 802. Ensuring completion of pediatric study requirements. 
Sec. 803. FDA report on PREA enforcement. 
Sec. 804. Extension of authority to issue priority review vouchers to encourage 
treatments for rare pediatric diseases. 
Sec. 805. Limitations on exclusive approval or licensure of orphan drugs. 
Subtitle B—United States-Abraham Accords Cooperation and Security 
Sec. 811. Establishment of Abraham Accords Office within Food and Drug Ad-
ministration. 
TITLE IX—LOWERING PRESCRIPTION DRUG COSTS 
Sec. 901. Oversight of pharmacy benefit management services. 
Sec. 902. Full rebate pass through to plan; exception for innocent plan fidu-
ciaries. 
Sec. 903. Increasing transparency in generic drug applications. 
Sec. 904. Title 35 amendments. 
TITLE X—MISCELLANEOUS 
Sec. 1001. Two-year extension of safe harbor for absence of deductible for tele-
health. 
Sec. 1002. Eligibility for FEHBP enrollment for Members of Congress. 
TITLE I—MEDICAID 
SEC. 101. STREAMLINED ENROLLMENT PROCESS FOR ELI-
GIBLE 
OUT-OF-STATE 
PROVIDERS 
UNDER 
MEDICAID AND CHIP. 
(a) IN GENERAL.—Section 1902(kk) of the Social Se-
curity Act (42 U.S.C. 1396a(kk)) is amended by adding 
at the end the following new paragraph: 
‘‘(10) STREAMLINED
ENROLLMENT
PROCESS 
FOR ELIGIBLE OUT-OF-STATE PROVIDERS.— 
‘‘(A) IN GENERAL.—The State— 
‘‘(i) adopts and implements a process 
to allow an eligible out-of-State provider to 
enroll under the State plan (or a waiver of 
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392 
such plan) to furnish items and services to, 
or order, prescribe, refer, or certify eligi-
bility for items and services for, qualifying 
individuals without the imposition of 
screening or enrollment requirements by 
such State that exceed the minimum nec-
essary for such State to provide payment 
to an eligible out-of-State provider under 
such State plan (or a waiver of such plan), 
such as the provider’s name and National 
Provider Identifier (and such other infor-
mation specified by the Secretary); and 
‘‘(ii) provides that an eligible out-of- 
State provider that enrolls as a partici-
pating provider in the State plan (or a 
waiver of such plan) through such process 
shall be so enrolled for a 5-year period, un-
less the provider is terminated or excluded 
from participation during such period. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) ELIGIBLE
OUT-OF-STATE
PRO-
VIDER.—The term ‘eligible out-of-State 
provider’ means, with respect to a State, a 
provider— 
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393 
‘‘(I) that is located in any other 
State; 
‘‘(II) that— 
‘‘(aa) was determined by the 
Secretary to have a limited risk 
of fraud, waste, and abuse for 
purposes of determining the level 
of screening to be conducted 
under section 1866(j)(2), has 
been so screened under such sec-
tion 1866(j)(2), and is enrolled in 
the Medicare program under title 
XVIII; or 
‘‘(bb) was determined by the 
State agency administering or su-
pervising the administration of 
the State plan (or a waiver of 
such plan) of such other State to 
have a limited risk of fraud, 
waste, and abuse for purposes of 
determining the level of screening 
to be conducted under paragraph 
(1) of this subsection, has been 
so screened under such para-
graph (1), and is enrolled under 
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394 
such State plan (or a waiver of 
such plan); and 
‘‘(III) that has not been— 
‘‘(aa) excluded from partici-
pation in any Federal health care 
program 
pursuant 
to 
section 
1128 or 1128A; 
‘‘(bb) excluded from partici-
pation in the State plan (or a 
waiver of such plan) pursuant to 
part 1002 of title 42, Code of 
Federal Regulations (or any suc-
cessor regulation), or State law; 
or 
‘‘(cc) terminated from par-
ticipating in a Federal health 
care program or the State plan 
(or a waiver of such plan) for a 
reason described in paragraph 
(8)(A). 
‘‘(ii) QUALIFYING
INDIVIDUAL.—The 
term ‘qualifying individual’ means an indi-
vidual under 21 years of age who is en-
rolled under the State plan (or waiver of 
such plan). 
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395 
‘‘(iii) 
STATE.—The 
term 
‘State’ 
means 1 of the 50 States or the District 
of Columbia.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902(a)(77) of the Social Security 
Act (42 U.S.C. 1396a(a)(77)) is amended by insert-
ing ‘‘enrollment,’’ after ‘‘screening,’’. 
(2) 
The 
subsection 
heading 
for 
section 
1902(kk) of such Act (42 U.S.C. 1396a(kk)) is 
amended by inserting ‘‘enrollment,’’ after ‘‘screen-
ing,’’. 
(3) Section 2107(e)(1)(G) of such Act (42 
U.S.C. 1397gg(e)(1)(G)) is amended by inserting 
‘‘enrollment,’’ after ‘‘screening,’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date that is 3 years 
after the date of enactment of this Act. 
SEC. 102. MAKING CERTAIN ADJUSTMENTS TO COVERAGE 
OF HOME OR COMMUNITY-BASED SERVICES 
UNDER MEDICAID. 
(a) INCREASING TRANSPARENCY
OF HCBS COV-
ERAGE UNDER MEDICAID.— 
(1) IN GENERAL.—Section 1915(c) of the So-
cial Security Act (42 U.S.C. 1396n(c)) is amend-
ed— 
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(A) in paragraph (2)— 
(i) in subparagraph (E)— 
(I) by inserting ‘‘, not less fre-
quently than’’ before ‘‘annually’’; and 
(II) by inserting ‘‘(including, 
with respect to such information pro-
vided on or after July 9, 2027, the in-
formation 
specified 
in 
paragraph 
(11))’’ before the period at the end; 
and 
(ii) by adding at the end the following 
flush sentence: 
‘‘The Secretary shall make all information provided 
under subparagraph (E) on or after the date of the 
enactment of this sentence publicly available on the 
website of the Centers for Medicare & Medicaid 
Services.’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(11) For purposes of paragraph (2)(E), the 
information specified in this paragraph is the fol-
lowing: 
‘‘(A) In the case of a State that limits the 
number of individuals who may be provided 
home or community-based services under a 
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waiver granted under this subsection and main-
tains a list of individuals waiting to enroll in 
such waiver, a description of how the State 
maintains such list, including— 
‘‘(i) information on whether the State 
screens individuals on such list to deter-
mine whether such individuals are eligible 
to receive such services under such waiver; 
‘‘(ii) information on whether (and, if 
applicable, how often) the State periodi-
cally re-screens individuals on such list for 
eligibility; 
‘‘(iii) the number of people on such 
list of individuals waiting to enroll in such 
waiver; and 
‘‘(iv) the average amount of time that 
individuals newly enrolled in such waiver 
within the past 12 months were on such 
list of individuals waiting to enroll in such 
waiver. 
‘‘(B) With respect to homemaker services, 
home health aide services, personal care serv-
ices, and habilitation services furnished under 
waivers under this subsection, by each such 
service type— 
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398 
‘‘(i) for individuals newly receiving 
such services within the past 12 months, 
the average amount of time (which may be 
determined using statistically valid random 
sampling of such individuals) from when 
such services are initially approved for 
such an individual to when such individual 
begins receiving such services; and 
‘‘(ii) the percentage of authorized 
hours (which may be determined using sta-
tistically valid random sampling of individ-
uals authorized to receive such services) 
that are provided within the past 12 
months.’’. 
(2) CONFORMING AMENDMENTS.—Section 1915 
of the Social Security Act (42 U.S.C. 1396n) is 
amended— 
(A) in subsection (i) by adding at the end 
the following new paragraph: 
‘‘(8) REPORTING REQUIREMENT.—With respect 
to homemaker services, home health aide services, 
personal care services, and habilitation services pro-
vided under this subsection on or after July 9, 2027, 
the State, not less frequently than annually, shall 
provide to the Secretary the same information re-
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399 
garding such services as the State is required to pro-
vide under subsection (c)(11)(B).’’; 
(B) in subsection (j)(2)(E), by inserting 
after the second sentence the following: ‘‘With 
respect to any homemaker services, home health 
aide services, personal care services, and habili-
tation services provided under this subsection 
on or after July 9, 2027, the State, not less fre-
quently than annually, shall provide to the Sec-
retary the same information regarding such 
services as the State is required to provide 
under subsection (c)(11)(B).’’; and 
(C) in subsection (k)(3)(E)— 
(i) by striking ‘‘and’’ after ‘‘the cost 
of such services and supports,’’; and 
(ii) by inserting before the period, the 
following: ‘‘, and with respect to home-
maker services, home health aide services, 
personal care services, and habilitation 
services provided under this subsection on 
or after July 9, 2027, not less frequently 
than annually, the same information re-
garding such services as the State is re-
quired 
to 
provide 
under 
subsection 
(c)(11)(B)’’. 
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400 
(b) DEMONSTRATION PROGRAM TO EXPAND HCBS 
COVERAGE UNDER SECTION 1915(C) WAIVERS.—Section 
1915(c) of the Social Security Act (42 U.S.C. 1396n(c)), 
as amended by subsection (a), is further amended— 
(1) in paragraph (2)(E), by inserting ‘‘, and the 
information specified in paragraph (12)(C)(v), when 
applicable’’ after ‘‘paragraph (11)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(12) DEMONSTRATION PROGRAM TO EXPAND 
COVERAGE FOR HOME OR COMMUNITY-BASED SERV-
ICES.— 
‘‘(A) IN GENERAL.— 
‘‘(i) APPROVAL.—Not later than 24 
months after the date on which the plan-
ning grants under subparagraph (B) are 
awarded, notwithstanding paragraph (1), 
the Secretary may approve a waiver that is 
standalone from any other waiver approved 
under this subsection for not more than 5 
States, selected in accordance with clause 
(ii), to include as medical assistance under 
the State plan of such State, for the 3-year 
period beginning on the date of such ap-
proval, payment for part or all of the cost 
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401 
of home or community-based services 
(other than room and board (as described 
in paragraph (1))) approved by the Sec-
retary which are provided pursuant to a 
written plan of care to individuals de-
scribed in subparagraph (C)(iii). 
‘‘(ii) SELECTION
CRITERIA.—In se-
lecting States for purposes of clause (i), 
the Secretary shall— 
‘‘(I) only select States that re-
ceived a planning grant under sub-
paragraph (B); 
‘‘(II) only select States that meet 
the requirements specified in subpara-
graph (C) and such other require-
ments as the Secretary may determine 
appropriate; 
‘‘(III) select States in a manner 
that ensures geographic diversity; 
‘‘(IV) give preference to States 
with a higher percentage (relative to 
other States that apply to be selected 
for purposes of clause (i)) of the total 
State population residing in rural 
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402 
areas (as determined by the Sec-
retary); 
‘‘(V) give preference to States 
that have demonstrated more progress 
in rebalancing long-term services and 
supports systems under this title, as 
determined based on the relative share 
of individuals who use home or com-
munity-based services (as defined by 
the Secretary) under this title as a 
percentage of total individuals who 
use long-term services and supports 
(as defined by the Secretary) under 
this title (in the most recent year for 
which such data is available); and 
‘‘(VI) give preference to States 
that pursue a waiver under this para-
graph that incorporates the provision 
of mental health services for adults 
with serious mental illness, children 
with serious emotional disturbances, 
or individuals with substance use dis-
order. 
‘‘(B) PLANNING GRANTS.— 
‘‘(i) IN GENERAL.— 
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403 
‘‘(I) APPROVAL.—Not later than 
18 months after the date of the enact-
ment of this paragraph, the Secretary 
shall award planning grants of not 
more than $5,000,000 each to not 
more than 10 States for purposes of 
preparing to submit a request for a 
waiver under this subsection (includ-
ing for costs to implement the waiver 
or other activities to expand the provi-
sion of home or community-based 
services under this section) to provide 
home or community-based services to 
individuals described in subparagraph 
(C)(iii). 
‘‘(II) SELECTION
CRITERIA.—In 
awarding planning grants under sub-
clause (I), the Secretary shall use the 
selection criteria specified in sub-
clauses (III) through (VI) of subpara-
graph (A)(ii). 
‘‘(ii) CONSULTATION.—A State that is 
awarded a planning grant under clause (i) 
shall, in preparing to submit a request for 
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a waiver described in such clause, consult 
with— 
‘‘(I) individuals in need of (and 
not receiving) home or community- 
based services, individuals receiving 
home or community-based services, 
and the caregivers of such individuals; 
‘‘(II) providers furnishing home 
or community-based services; and 
‘‘(III) such other stakeholders, as 
the Secretary may specify. 
‘‘(C) STATE REQUIREMENTS.—In addition 
to the requirements specified under this sub-
section (except for the requirements described 
in subparagraphs (C) and (D) of paragraph (2) 
and any other requirement the Secretary deter-
mines to be inapplicable in the context of a 
waiver relation to individuals who do not re-
quire the level of care described in paragraph 
(1)), the requirements specified in this para-
graph are, with respect to a State, the fol-
lowing: 
‘‘(i) As of the date that such State re-
quests a waiver under this subsection to 
provide home or community-based services 
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to individuals described in clause (iii), all 
other waivers (if any) granted under this 
subsection to such State meet the require-
ments of this subsection. 
‘‘(ii) The State demonstrates to the 
Secretary that approval of a waiver under 
this subsection with respect to individuals 
described in clause (iii) will not result in a 
material increase of the average amount of 
time that individuals with respect to whom 
a determination described in paragraph (1) 
has been made will need to wait to receive 
home or community-based services under 
any waiver granted under this subsection, 
as determined by the Secretary. 
‘‘(iii) The State establishes needs- 
based criteria, subject to the approval of 
the Secretary, to identify individuals for 
whom a determination described in para-
graph (1) is not applicable, who will be eli-
gible for home or community-based serv-
ices under a waiver approved under this 
paragraph, and specifies the home or com-
munity-based services such individuals so 
eligible will receive. 
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‘‘(iv) The State established needs- 
based criteria for determining whether an 
individual described in clause (iii) requires 
the level of care provided in a hospital, 
nursing facility, or an intermediate care fa-
cility for individuals with developmental 
disabilities under the State plan or under 
any waiver of such plan that are more 
stringent than the needs-based criteria es-
tablished under clause (iii) for determining 
eligibility for home or community-based 
services. 
‘‘(v) The State attests that the State’s 
average per capita expenditure for medical 
assistance under the State plan (or waiver 
of such plan) provided with respect to such 
individuals enrolled in a waiver under this 
paragraph will not exceed the State’s aver-
age per capita expenditures for medical as-
sistance for individuals receiving institu-
tional care under the State plan (or waiver 
of such plan) for the duration that the 
waiver under this paragraph is in effect. 
‘‘(vi) The State provides to the Sec-
retary data (in such form and manner as 
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407 
the Secretary may specify) regarding the 
number of individuals described in clause 
(i) with respect to a State seeking approval 
of a waiver under this subsection, to whom 
the State will make such services available 
under such waiver. 
‘‘(vii) The State agrees to provide to 
the Secretary, not less frequently than an-
nually, data for purposes of paragraph 
(2)(E) (in such form and manner as the 
Secretary may specify) regarding, with re-
spect to each preceding year in which a 
waiver under this subsection to provide 
home and community-based services to in-
dividuals described in clause (iii) was in ef-
fect— 
‘‘(I) the cost (as such term is de-
fined by the Secretary) of such serv-
ices furnished to individuals described 
in clause (iii), broken down by type of 
service; 
‘‘(II) with respect to each type of 
home and community-based service 
provided under the waiver, the length 
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of time that such individuals have re-
ceived such service; 
‘‘(III) a comparison between the 
data described in subclause (I) and 
any comparable data available with 
respect to individuals with respect to 
whom a determination described in 
paragraph (1) has been made and 
with respect to individuals receiving 
institutional care under this title; and 
‘‘(IV) the number of individuals 
who have received home and commu-
nity-based services under the waiver 
during the preceding year.’’. 
(c) NON-APPLICATION OF THE PAPERWORK REDUC-
TION ACT.—Chapter 35 of title 44, United States Code 
(commonly referred to as the ‘‘Paperwork Reduction Act 
of 1995’’), shall not apply to the implementation of the 
amendments made by subsections (a) and (b). 
(d) CMS GUIDANCE TO STATES ON INTERIM COV-
ERAGE UNDER SECTION 1915 HOME AND COMMUNITY- 
BASED SERVICES AUTHORITIES.—Not later than January 
1, 2027, the Secretary of Health and Human Services 
shall issue guidance to the States to clarify how a State 
may provide, with respect to an individual who is eligible 
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for home and community-based services under section 
1915 of the Social Security Act (42 U.S.C. 1396n), cov-
erage of such services pursuant to a provisional written 
plan of care, pending finalization, with respect to such in-
dividual. 
(e) FUNDING.— 
(1) IN GENERAL.—There are appropriated, out 
of any funds in the Treasury not otherwise obli-
gated, $71,000,000 for fiscal year 2025, to remain 
available until expended, to the Secretary of Health 
and Human Services for purposes of carrying out 
subsection (d) and the amendments made by sub-
section (b). 
(2) RESERVATION FOR PLANNING GRANTS.—Of 
the amount appropriated under paragraph (1), the 
Secretary of Health and Human Services shall re-
serve $50,000,000 of such amount to award plan-
ning grants under the demonstration program estab-
lished by the amendments made by subsection (b). 
SEC. 103. REMOVING CERTAIN AGE RESTRICTIONS ON MED-
ICAID ELIGIBILITY FOR WORKING ADULTS 
WITH DISABILITIES. 
(a) MODIFICATION OF OPTIONAL BUY-IN GROUPS.— 
(1) 
IN
GENERAL.—Section 
1902(a)(10)(A)(ii)(XV) of the Social Security Act 
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410 
(42 U.S.C. 1396a(a)(10)(A)(ii)(XV)) is amended by 
striking ‘‘but less than 65,’’. 
(2) 
DEFINITION
MODIFICATION.—Section 
1905(v)(1)(A) of the Social Security Act (42 U.S.C. 
1396d(v)(1)(A)) is amended by striking ‘‘, but less 
than 65,’’. 
(b) APPLICATION
TO CERTAIN STATES.—A State 
that, as of the date of enactment of this Act, provides for 
making medical assistance available to individuals de-
scribed 
in 
subclause 
(XV) 
or 
(XVI) 
of 
section 
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) shall not be regarded as failing to 
comply with the requirements of either such subclause (as 
amended 
by 
subsection 
(a)(1)) 
or 
with 
section 
1905(v)(1)(A) of the Social Security Act (42 U.S.C. 
1396d(v)(1)(A)) (as amended by subsection (a)(2)) before 
January 1, 2027. 
SEC. 104. MEDICAID STATE PLAN REQUIREMENT FOR DE-
TERMINING RESIDENCY AND COVERAGE FOR 
MILITARY FAMILIES. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)— 
(A) in paragraph (86), by striking ‘‘and’’ 
at the end; 
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(B) in paragraph (87), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (87), the 
following new paragraph: 
‘‘(88) beginning January 1, 2028, provide, with 
respect to an active duty relocated individual (as de-
fined in subsection (uu)(1))— 
‘‘(A) that, for purposes of determining eli-
gibility for medical assistance under the State 
plan (or waiver of such plan), such active duty 
relocated individual is treated as a resident of 
the State unless such individual voluntarily 
elects not to be so treated for such purposes; 
‘‘(B) that if, at the time of relocation (as 
described in subsection (uu)(1)), such active 
duty relocated individual is on a home and com-
munity-based services waiting list (as defined in 
subsection (uu)(2)), such individual remains on 
such list until— 
‘‘(i) the State completes an assess-
ment and renders a decision with respect 
to the eligibility of such individual to re-
ceive the relevant home and community- 
based services at the time a slot for such 
services becomes available and, in the case 
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such decision is a denial of such eligibility, 
such individual has exhausted the individ-
ual’s opportunity for a fair hearing; or 
‘‘(ii) such individual elects to be re-
moved from such list; and 
‘‘(C) payment for medical assistance fur-
nished under the State plan (or a waiver of the 
plan) on behalf of such active duty relocated in-
dividual in the military service relocation State 
(as referred to in subsection (uu)(1)(B)(i)), to 
the extent that such assistance is available in 
such military service relocation State in accord-
ance with such guidance as the Secretary may 
issue to ensure access to such assistance.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(uu) ACTIVE DUTY RELOCATED INDIVIDUAL; HOME 
AND COMMUNITY-BASED SERVICES WAITING LIST.—For 
purposes of subsection (a)(88) and this subsection: 
‘‘(1) ACTIVE DUTY RELOCATED INDIVIDUAL.— 
The term ‘active duty relocated individual’ means an 
individual— 
‘‘(A) who— 
‘‘(i) is enrolled under the State plan 
(or waiver of such plan); or 
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‘‘(ii) with respect to an individual de-
scribed in subparagraph (C)(ii), would be 
so 
enrolled 
pursuant 
to 
subsection 
(a)(10)(A)(ii)(VI) if such individual began 
receiving home and community-based serv-
ices; 
‘‘(B) who— 
‘‘(i) is a member of the Armed Forces 
engaged in active duty service and is relo-
cated to another State (in this subsection 
referred to as the ‘military service reloca-
tion State’) by reason of such service; 
‘‘(ii) would be described in clause (i) 
except that the individual stopped being 
engaged in active duty service (including 
by reason of retirement from such service) 
and the last day on which the individual 
was engaged in active duty service oc-
curred not more than 12 months ago; or 
‘‘(iii) is a dependent (as defined by 
the Secretary) of a member described in 
clause (i) or (ii) who relocates to the mili-
tary service relocation State with such 
member; and 
‘‘(C) who— 
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‘‘(i) was receiving home and commu-
nity-based services (as defined in section 
9817(a)(2)(B) of the American Rescue 
Plan Act of 2021) at the time of such relo-
cation; or 
‘‘(ii) if the State maintains a home 
and community-based services waiting list, 
was on such home and community-based 
services waiting list at the time of such re-
location. 
‘‘(2) HOME AND COMMUNITY-BASED SERVICES 
WAITING LIST.—The term ‘home and community- 
based services waiting list’ means, in the case of a 
State that has a limit on the number of individuals 
who may receive home and community-based services 
under section 1115(a), section 1915(c), or section 
1915(j), a list maintained by such State of individ-
uals who are requesting to receive such services 
under 1 or more such sections but for whom the 
State has not yet completed an assessment and ren-
dered a decision with respect to the eligibility of 
such individuals to receive the relevant home and 
community-based services at the time a slot for such 
services becomes available due to such limit.’’. 
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415 
(b) IMPLEMENTATION FUNDING.—There are appro-
priated, out of any funds in the Treasury not otherwise 
obligated, $1,000,000 for each of fiscal years 2025 
through 2029, to remain available until expended, to the 
Secretary of Health and Human Services for purposes of 
implementing the amendments made by subsection (a). 
SEC. 105. ENSURING THE RELIABILITY OF ADDRESS INFOR-
MATION PROVIDED UNDER THE MEDICAID 
PROGRAM. 
(a) IN GENERAL.—Section 1902(a) of the Social Se-
curity Act (42 U.S.C. 1396a(a)), as previously amended 
by this title, is amended— 
(1) in paragraph (87), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (88), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by inserting after paragraph (88) the fol-
lowing new paragraph: 
‘‘(89) beginning January 1, 2026, provide for a 
process to regularly obtain address information for 
individuals enrolled under such plan (or a waiver of 
such plan) from reliable data sources (as described 
in section 435.919(f)(1)(iii) of title 42, Code of Fed-
eral Regulations (or a successor regulation)) and act 
on any changes to such an address based on such in-
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416 
formation in accordance with such section (or suc-
cessor regulation), except that this paragraph shall 
only apply in the case of the 50 States and the Dis-
trict of Columbia.’’. 
(b) APPLICATION TO CHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(1) 
by 
redesignating 
subparagraphs 
(H) 
through (U) as subparagraphs (I) through (V), re-
spectively; and 
(2) by inserting after subparagraph (G) the fol-
lowing new subparagraph: 
‘‘(H) Section 1902(a)(89) (relating to reg-
ularly obtaining address information for enroll-
ees).’’. 
(c) ENSURING TRANSMISSION OF ADDRESS INFOR-
MATION FROM MANAGED CARE ORGANIZATIONS.—Sec-
tion 1932 of the Social Security Act (42 U.S.C. 1396u– 
2) is amended by adding at the end the following new sub-
section: 
‘‘(j) TRANSMISSION OF ADDRESS INFORMATION.— 
Beginning January 1, 2026, each contract under a State 
plan with a managed care entity under section 1903(m) 
shall provide that the entity transmits to the State any 
address information for an individual enrolled with the en-
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tity that is provided to such entity directly from, or 
verified by such entity directly with, such individual.’’. 
SEC. 
106. 
CODIFYING 
CERTAIN 
MEDICAID 
PROVIDER 
SCREENING REQUIREMENTS RELATED TO 
DECEASED PROVIDERS. 
Section 1902(kk)(1) of the Social Security Act (42 
U.S.C. 1396a(kk)(1)) is amended— 
(1) by striking ‘‘The State’’ and inserting: 
‘‘(A) IN GENERAL.—The State’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(B) ADDITIONAL
PROVIDER
SCREEN-
ING.—Beginning January 1, 2027, as part of 
the enrollment (or reenrollment or revalidation 
of enrollment) of a provider or supplier under 
this title, and not less frequently than quarterly 
during the period that such provider or supplier 
is so enrolled, the State conducts a check of the 
Death Master File (as such term is defined in 
section 203(d) of the Bipartisan Budget Act of 
2013) to determine whether such provider or 
supplier is deceased.’’. 
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418 
SEC. 107. MODIFYING CERTAIN STATE REQUIREMENTS FOR 
ENSURING DECEASED INDIVIDUALS DO NOT 
REMAIN ENROLLED. 
Section 1902 of the Social Security Act (42 U.S.C. 
1396a), as previously amended by this title, is amended— 
(1) in subsection (a)— 
(A) in paragraph (88), by striking ‘‘; and’’ 
and inserting a semicolon; 
(B) in paragraph (89), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (89) the 
following new paragraph: 
‘‘(90) provide that the State shall comply with 
the eligibility verification requirements under sub-
section (vv), except that this paragraph shall apply 
only in the case of the 50 States and the District 
of Columbia.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(vv) VERIFICATION OF CERTAIN ELIGIBILITY CRI-
TERIA.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(90), the eligibility verification requirements, be-
ginning January 1, 2026, are as follows: 
‘‘(A) QUARTERLY SCREENING TO VERIFY 
ENROLLEE STATUS.—The State shall, not less 
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frequently than quarterly, review the Death 
Master File (as such term is defined in section 
203(d) of the Bipartisan Budget Act of 2013) 
to determine whether any individuals enrolled 
for medical assistance under the State plan (or 
waiver of such plan) are deceased. 
‘‘(B) 
DISENROLLMENT
UNDER
STATE 
PLAN.—If the State determines, based on infor-
mation obtained from the Death Master File, 
that an individual enrolled for medical assist-
ance under the State plan (or waiver of such 
plan) is deceased, the State shall— 
‘‘(i) treat such information as factual 
information confirming the death of a ben-
eficiary for purposes of section 431.213(a) 
of title 42, Code of Federal Regulations (or 
any successor regulation); 
‘‘(ii) disenroll such individual from the 
State plan (or waiver of such plan); and 
‘‘(iii) discontinue any payments for 
medical assistance under this title made on 
behalf of such individual (other than pay-
ments for any items or services furnished 
to such individual prior to the death of 
such individual). 
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420 
‘‘(C) REINSTATEMENT
OF
COVERAGE
IN 
THE EVENT OF ERROR.—If a State determines 
that an individual was misidentified as deceased 
based on information obtained from the Death 
Master File, and was erroneously disenrolled 
from medical assistance under the State plan 
(or waiver of such plan) based on such 
misidentification, the State shall immediately 
reenroll such individual under the State plan 
(or waiver of such plan), retroactive to the date 
of such disenrollment. 
‘‘(2) RULE OF CONSTRUCTION.—Nothing under 
this subsection shall be construed to preclude the 
ability of a State to use other electronic data sources 
to timely identify potentially deceased beneficiaries, 
so long as the State is also in compliance with the 
requirements of this subsection (and all other re-
quirements under this title relating to Medicaid eli-
gibility determination and redetermination).’’. 
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421 
SEC. 108. ONE-YEAR DELAY OF MEDICAID AND CHIP RE-
QUIREMENTS FOR HEALTH SCREENINGS, RE-
FERRALS, AND CASE MANAGEMENT SERV-
ICES FOR ELIGIBLE JUVENILES IN PUBLIC 
INSTITUTIONS; STATE INTERIM WORK PLANS. 
(a) IN GENERAL.—Section 5121(d) of subtitle C of 
title V of division FF of the Consolidated Appropriations 
Act, 2023 (Public Law 117–328) is amended— 
(1) by striking ‘‘The amendments made by this 
section’’ and inserting the following: 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(2) DELAY OF DATE BY WHICH STATES MUST 
COMPLY
WITH
CERTAIN
JUVENILE
JUSTICE-RE-
LATED REQUIREMENTS.—A State shall not be re-
garded as failing to comply with the requirements of 
section 1902(a)(84)(D) or 2102(d)(2) of the Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(84)(D), 
1397bb(d)(2)) before January 1, 2026.’’. 
(b) CLARIFYING NONAPPLICATION
OF REQUIRE-
MENTS TO INDIVIDUALS IN FEDERAL CUSTODY.— 
(1) MEDICAID.— 
(A) 
Subparagraph 
(D) 
of 
section 
1902(a)(84) of the Social Security Act (42 
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422 
U.S.C. 1396a(a)(84)), as added by section 5121 
of subtitle C of title V of division FF of the 
Consolidated Appropriations Act, 2023 (Public 
Law 117–328), is amended by striking ‘‘an in-
dividual who is an eligible juvenile’’ and insert-
ing ‘‘an individual (other than an individual 
who is in Federal custody, including as an in-
mate in a Federal prison) who is an eligible ju-
venile’’. 
(B) Section 5122(a) of subtitle C of title 
V of division FF of the Consolidated Appropria-
tions Act, 2023 (Public Law 117–328) is 
amended— 
(i) by striking ‘‘paragraph (31)’’ each 
place it appears and inserting ‘‘the last 
numbered paragraph’’; and 
(ii) in paragraph (1), by striking ‘‘an 
individual who is an eligible juvenile’’ and 
inserting ‘‘an individual (other than an in-
dividual who is in Federal custody, includ-
ing as an inmate in a Federal prison) who 
is an eligible juvenile’’. 
(2) CHIP.— 
(A) Subsection (d)(2) of section 2102 of 
the Social Security Act (42 U.S.C. 1397bb), as 
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423 
added by section 5121 of subtitle C of title V 
of division FF of the Consolidated Appropria-
tions Act, 2023 (Public Law 117–328), is 
amended by striking ‘‘a targeted low-income 
child who’’ and inserting ‘‘a targeted low in-
come child (other than a child who is in Federal 
custody, including as an inmate in a Federal 
prison) who’’. 
(B) Section 5122(b)(2) of subtitle C of 
title V of division FF of the Consolidated Ap-
propriations Act, 2023 (Public Law 117–328) 
is amended by striking ‘‘a child who is’’ and in-
serting ‘‘a child (other than a child who is in 
Federal custody, including as an inmate in a 
Federal prison) who is’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect as if enacted on 
December 29, 2022. 
(c) INTERIM WORK PLAN.—Not later than June 30, 
2025, each State (as such term is defined in section 
1101(a)(1) of the Social Security Act (42 U.S.C. 
1301(a)(1)) for purposes of titles XIX and XXI of such 
Act) shall submit to the Secretary of Health and Human 
Services an interim work plan, in such form and con-
taining such information as the Secretary may specify, de-
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424 
scribing the State’s progress towards implementing, and 
its plans to come into compliance with, the requirements 
imposed by the amendments made by section 5121 of sub-
title C of title V of division FF of the Consolidated Appro-
priations Act, 2023 (Public Law 117–328), consistent 
with the guidance issued by the Centers for Medicare & 
Medicaid Services in State Health Official Letter #24– 
004 on July 23, 2024. 
SEC. 109. STATE STUDIES AND HHS REPORT ON COSTS OF 
PROVIDING MATERNITY, LABOR, AND DELIV-
ERY SERVICES. 
(a) STATE STUDY.— 
(1) IN GENERAL.—Not later than 24 months 
after the date of enactment of this Act, and every 
5 years thereafter, each State (as such term is de-
fined in section 1101(a)(1) of the Social Security 
Act (42 U.S.C. 1301(a)(1)) for purposes of titles 
XIX and XXI of such Act) shall conduct a study on 
the costs of providing maternity, labor, and delivery 
services in applicable hospitals (as defined in para-
graph (3)) and submit the results of such study to 
the Secretary of Health and Human Services (re-
ferred to in this section as the ‘‘Secretary’’). 
(2) CONTENT OF STUDY.—A State study re-
quired under paragraph (1) shall include the fol-
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lowing information (to the extent practicable) with 
respect to maternity, labor, and delivery services fur-
nished by applicable hospitals located in the State: 
(A) An estimate of the cost of providing 
maternity, labor, and delivery services at appli-
cable hospitals, based on the expenditures a 
representative sample of such hospitals incurred 
for providing such services during the 2 most 
recent years for which data is available. 
(B) An estimate of the cost of providing 
maternity, labor, and delivery services at appli-
cable hospitals that ceased providing labor and 
delivery services within the past 5 years, based 
on the expenditures a representative sample of 
such hospitals incurred for providing such serv-
ices during the 2 most recent years for which 
data is available. 
(C) To the extent data allows, an analysis 
of the extent to which geographic location, com-
munity demographics, and local economic fac-
tors (as defined by the Secretary) affect the 
cost of providing maternity, labor, and delivery 
services at applicable hospitals, including the 
cost of services that support the provision of 
maternity, labor, and delivery services. 
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(D) The amounts applicable hospitals are 
paid for maternity, labor, and delivery services, 
by geographic location and hospital size, 
under— 
(i) Medicare; 
(ii) the State Medicaid program, in-
cluding payment amounts for such services 
under fee-for-service payment arrange-
ments and under managed care (as appli-
cable); 
(iii) the State CHIP plan, including 
payment amounts for such services under 
fee-for-service payment arrangements and 
under managed care (as applicable); and 
(iv) private health insurance. 
(E) A comparative payment rate anal-
ysis— 
(i) comparing payment rates for ma-
ternity, labor, and delivery services (inclu-
sive of all payments received by applicable 
hospitals for furnishing maternity, labor, 
and delivery services) under the State 
Medicaid fee-for-service program to such 
payment rates for such services under 
Medicare 
(as 
described 
in 
section 
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447.203(b)(3) of title 42, Code of Federal 
Regulations), other Federally-funded or 
State-funded programs (including, to the 
extent data is available, Medicaid managed 
care rates), and to the payment rates for 
such services, to the extent data is avail-
able, of private health insurers within geo-
graphic areas of the State; and 
(ii) analyzing different payment meth-
ods for such services, such as the use of 
bundled payments, quality incentives, and 
low-volume adjustments. 
(F) An evaluation, using such methodology 
and parameters established by the Secretary, of 
whether each hospital located in the State that 
furnishes maternity, labor, and delivery services 
is expected to experience in the next 3 years 
significant changes in particular expenditures 
or types of reimbursement for maternity, labor, 
and delivery services. 
(3) APPLICABLE
HOSPITAL
DEFINED.—For 
purposes of this subsection, the term ‘‘applicable 
hospital’’ means any hospital located in a State that 
meets either of the following criteria: 
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(A) The hospital provides labor and deliv-
ery services and more than 50 percent of the 
hospital’s births (in the most recent year for 
which such data is available) are financed by 
the Medicaid program or CHIP. 
(B) The hospital— 
(i) is located in a rural area (as de-
fined by the Federal Office of Rural 
Health Policy for the purpose of rural 
health grant programs administered by 
such Office); 
(ii) based on the most recent 2 years 
of data available (as determined by the 
Secretary), furnished services for less than 
an average of 300 births per year; and 
(iii) provides labor and delivery serv-
ices. 
(4) ASSISTANCE TO SMALL HOSPITALS IN COM-
PILING
COST
INFORMATION.—There are appro-
priated to the Secretary for fiscal year 2025, 
$10,000,000 for the purpose of providing grants and 
technical assistance to a hospital described in para-
graph (3)(B) to enable such hospital to compile de-
tailed information for use in the State studies re-
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quired under paragraph (1), to remain available 
until expended. 
(5) HHS REPORT
ON
STATE
STUDIES.—For 
each year in which a State is required to conduct a 
study under paragraph (1), the Secretary shall issue, 
not later than 12 months after the date on which 
the State submits to the Secretary the data de-
scribed in such paragraph, a publicly available re-
port that compiles and details the results of such 
study and includes the information described in 
paragraph (2). 
(b) HHS REPORT ON NATIONAL DATA COLLECTION 
FINDINGS.—Not later than 3 years after the date of en-
actment of this Act, the Secretary shall submit to Con-
gress, and make publicly available, a report analyzing the 
first studies conducted by States under subsection (a)(1), 
including recommendations for improving data collection 
on the cost of providing maternity, labor, and delivery 
services. 
(c) IMPLEMENTATION FUNDING.—In addition to the 
amount appropriated under subsection (a)(4), there are 
appropriated, out of any funds in the Treasury not other-
wise obligated, $3,000,000 for fiscal year 2025, to remain 
available until expended, to the Secretary of Health and 
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Human Services for purposes of implementing this sec-
tion. 
SEC. 110. MODIFYING CERTAIN DISPROPORTIONATE SHARE 
HOSPITAL ALLOTMENTS. 
(a) EXTENDING TENNESSEE DSH ALLOTMENTS.— 
Section 1923(f)(6)(A)(vi) of the Social Security Act (42 
U.S.C. 1396r–4(f)(6)(A)(vi)) is amended— 
(1) in the heading, by striking ‘‘2025’’ and in-
serting ‘‘2026 AND FOR THE 1ST QUARTER OF FISCAL 
YEAR 2027’’; 
(2) by striking ‘‘fiscal year 2025’’ and inserting 
‘‘fiscal year 2026’’; and 
(3) by inserting ‘‘, and the DSH allotment for 
Tennessee for the 1st quarter of fiscal year 2027, 
shall be $13,275,000’’ before the period. 
(b) ELIMINATING AND DELAYING DSH ALLOTMENT 
REDUCTIONS.—Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
(1) in paragraph (7)(A)— 
(A) in clause (i), in the matter preceding 
subclause (I), by striking ‘‘January 1, 2025,’’ 
and all that follows through ‘‘2027’’ and insert-
ing ‘‘January 1, 2027, and ending September 
30, 2027, and for fiscal year 2028’’; and 
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(B) in clause (ii), by striking ‘‘January 1, 
2025,’’ and all that follows through ‘‘2027’’ and 
inserting ‘‘January 1, 2027, and ending Sep-
tember 30, 2027, and for fiscal year 2028’’; 
and 
(2) in paragraph (8), by striking ‘‘2027’’ and 
inserting ‘‘2028’’. 
SEC. 111. MODIFYING CERTAIN LIMITATIONS ON DIS-
PROPORTIONATE 
SHARE 
HOSPITAL 
PAY-
MENT ADJUSTMENTS UNDER THE MEDICAID 
PROGRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Se-
curity Act (42 U.S.C. 1396r–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) in the matter preceding clause (i), 
by striking ‘‘(other than a hospital de-
scribed in paragraph (2)(B))’’; 
(ii) in clause (i), by inserting ‘‘with 
respect to such hospital and year’’ after 
‘‘described in subparagraph (B)’’; and 
(iii) in clause (ii)— 
(I) in subclause (I), by striking 
‘‘and’’ at the end; 
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(II) in subclause (II), by striking 
the period and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following new subclause: 
‘‘(III) payments made under title 
XVIII or by an applicable plan (as de-
fined in section 1862(b)(8)(F)) for 
such services.’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), 
by striking ‘‘in this clause are’’ and insert-
ing ‘‘in this subparagraph are, with respect 
to a hospital and a year,’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) Individuals who are eligible for 
medical assistance under the State plan or 
under a waiver of such plan and for whom 
the State plan or waiver is a payor for 
such services after application of benefits 
under title XVIII or under an applicable 
plan (as defined in section 1862(b)(8)(F)), 
but only if the hospital has in the aggre-
gate incurred costs exceeding payments 
under such State plan, waiver, title XVIII, 
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or applicable plan for such services fur-
nished to such individuals during such 
year.’’; 
(2) by striking paragraph (2); 
(3) by redesignating paragraph (3) as para-
graph (2); and 
(4) in paragraph (2), as so redesignated, by 
striking ‘‘Notwithstanding paragraph (2) of this 
subsection (as in effect on October 1, 2021), para-
graph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
shall apply to payment adjustments made under sec-
tion 1923 of the Social Security Act (42 U.S.C. 
1396r–4) for Medicaid State plan rate years begin-
ning on or after the date of enactment of this Act. 
(2) STATE OPTION TO DISTRIBUTE UNSPENT 
DSH ALLOTMENTS FROM PRIOR YEARS UP TO MODI-
FIED CAP.— 
(A) IN
GENERAL.—If, for any Medicaid 
State plan rate year that begins on or after Oc-
tober 1, 2021, and before the date of enactment 
of this Act, a State did not spend the full 
amount of its Federal fiscal year allotment 
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under section 1923 of the Social Security Act 
(42 U.S.C. 1396r–4) applicable to that State 
plan rate year, the State may use the unspent 
portion of such allotment to increase the 
amount of any payment adjustment made to a 
hospital for such rate year, provided that— 
(i) such payment adjustment (as so 
increased) is consistent with subsection (g) 
of such section (as amended by this sec-
tion); and 
(ii) the total amount of all payment 
adjustments for the State plan rate year 
(as so increased) does not exceed the dis-
proportionate share hospital allotment for 
the State and applicable Federal fiscal 
year under subsection (f) of such section. 
(B) NO RECOUPMENT OF PAYMENTS AL-
READY MADE TO HOSPITALS.—A State shall not 
recoup any payment adjustment made by the 
State to a hospital for a Medicaid State plan 
rate year described in subparagraph (A) if such 
payment adjustment is consistent with section 
1923(g) of such Act (42 U.S.C. 1396r–4(g)) as 
in effect on October 1, 2021. 
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(C) AUTHORITY TO PERMIT RETROACTIVE 
MODIFICATION OF STATE PLAN AMENDMENTS 
TO ALLOW FOR INCREASES.— 
(i) IN
GENERAL.—Subject to para-
graph (2), solely for the purpose of allow-
ing a State to increase the amount of a 
payment adjustment to a hospital for a 
Medicaid State plan rate year described in 
subparagraph (A) pursuant to this para-
graph, a State may retroactively modify a 
provision of the Medicaid State plan, a 
waiver of such plan, or a State plan 
amendment that relates to such rate year 
and the Secretary may approve such modi-
fication. 
(ii) DEADLINE.—A State may not 
submit a request for approval of a retro-
active modification to a provision of the 
Medicaid State plan, a waiver of such plan, 
or a State plan amendment for a Medicaid 
State plan rate year after the date by 
which the State is required to submit the 
independent certified audit for that State 
plan rate year as required under section 
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436 
1923(j)(2) of the Social Security Act (42 
U.S.C. 1396r–4(j)(2)). 
(D) REPORTING.—If a State increases a 
payment adjustment made to a hospital for a 
Medicaid State plan rate year pursuant to this 
paragraph, the State shall include information 
on such increased payment adjustment as part 
of the next annual report submitted by the 
State under section 1923(j)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–4(j)(1)). 
SEC. 112. ENSURING ACCURATE PAYMENTS TO PHAR-
MACIES UNDER MEDICAID. 
(a) IN GENERAL.—Section 1927(f) of the Social Se-
curity Act (42 U.S.C. 1396r–8(f)) is amended— 
(1) in paragraph (1)(A)— 
(A) by redesignating clause (ii) as clause 
(iii); and 
(B) by striking ‘‘and’’ after the semicolon 
at the end of clause (i) and all that precedes it 
through ‘‘(1)’’ and inserting the following: 
‘‘(1) DETERMINING PHARMACY ACTUAL ACQUI-
SITION COSTS.—The Secretary shall conduct a sur-
vey of retail community pharmacy drug prices and 
applicable non-retail pharmacy drug prices to deter-
mine national average drug acquisition cost bench-
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437 
marks (as such term is defined by the Secretary) as 
follows: 
‘‘(A) USE
OF
VENDOR.—The Secretary 
may contract services for— 
‘‘(i) with respect to retail community 
pharmacies, the determination of retail 
survey prices of the national average drug 
acquisition cost for covered outpatient 
drugs that represent a nationwide average 
of consumer purchase prices for such 
drugs, net of all discounts, rebates, and 
other price concessions (to the extent any 
information with respect to such discounts, 
rebates, and other price concessions is 
available) based on a monthly survey of 
such pharmacies; 
‘‘(ii) with respect to applicable non-re-
tail pharmacies— 
‘‘(I) the determination of survey 
prices, separate from the survey prices 
described in clause (i), of the non-re-
tail national average drug acquisition 
cost for covered outpatient drugs that 
represent a nationwide average of con-
sumer purchase prices for such drugs, 
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net of all discounts, rebates, and other 
price concessions (to the extent any 
information with respect to such dis-
counts, rebates, and other price con-
cessions is available) based on a 
monthly survey of such pharmacies; 
and 
‘‘(II) at the discretion of the Sec-
retary, for each type of applicable 
non-retail pharmacy, the determina-
tion of survey prices, separate from 
the survey prices described in clause 
(i) or subclause (I) of this clause, of 
the national average drug acquisition 
cost for such type of pharmacy for 
covered outpatient drugs that rep-
resent a nationwide average of con-
sumer purchase prices for such drugs, 
net of all discounts, rebates, and other 
price concessions (to the extent any 
information with respect to such dis-
counts, rebates, and other price con-
cessions is available) based on a 
monthly survey of such pharmacies; 
and’’; 
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(2) in subparagraph (B) of paragraph (1), by 
striking ‘‘subparagraph (A)(ii)’’ and inserting ‘‘sub-
paragraph (A)(iii)’’; 
(3) in subparagraph (D) of paragraph (1), by 
striking clauses (ii) and (iii) and inserting the fol-
lowing: 
‘‘(ii) The vendor must update the Sec-
retary no less often than monthly on the 
survey prices for covered outpatient drugs. 
‘‘(iii) The vendor must differentiate, 
in collecting and reporting survey data, for 
all cost information collected, whether a 
pharmacy is a retail community pharmacy 
or an applicable non-retail pharmacy, in-
cluding whether such pharmacy is an affil-
iate (as defined in subsection (k)(14)), 
and, in the case of an applicable non-retail 
pharmacy, which type of applicable non-re-
tail pharmacy it is using the relevant phar-
macy type indicators included in the guid-
ance required by subsection (d)(2) of sec-
tion 112 of the Health Improvements, Ex-
tenders, and Reauthorizations Act.’’; 
(4) by adding at the end of paragraph (1) the 
following: 
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440 
‘‘(F) SURVEY
REPORTING.—In order to 
meet the requirement of section 1902(a)(54), a 
State shall require that any retail community 
pharmacy or applicable non-retail pharmacy in 
the State that receives any payment, reimburse-
ment, administrative fee, discount, rebate, or 
other price concession related to the dispensing 
of covered outpatient drugs to individuals re-
ceiving benefits under this title, regardless of 
whether such payment, reimbursement, admin-
istrative fee, discount, rebate, or other price 
concession is received from the State or a man-
aged care entity or other specified entity (as 
such 
terms 
are 
defined 
in 
section 
1903(m)(9)(D)) directly or from a pharmacy 
benefit manager or another entity that has a 
contract with the State or a managed care enti-
ty or other specified entity (as so defined), shall 
respond to surveys conducted under this para-
graph. 
‘‘(G) SURVEY INFORMATION.—Information 
on national drug acquisition prices obtained 
under this paragraph shall be made publicly 
available in a form and manner to be deter-
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441 
mined by the Secretary and shall include at 
least the following: 
‘‘(i) The monthly response rate to the 
survey including a list of pharmacies not in 
compliance with subparagraph (F). 
‘‘(ii) The sampling methodology and 
number of pharmacies sampled monthly. 
‘‘(iii) Information on price concessions 
to pharmacies, including discounts, re-
bates, and other price concessions, to the 
extent that such information may be pub-
licly released and has been collected by the 
Secretary as part of the survey. 
‘‘(H) PENALTIES.— 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii), (iii), and (iv), the Secretary shall en-
force the provisions of this paragraph with 
respect to a pharmacy through the estab-
lishment of civil money penalties applicable 
to a retail community pharmacy or an ap-
plicable non-retail pharmacy. 
‘‘(ii) BASIS
FOR
PENALTIES.—The 
Secretary shall impose a civil money pen-
alty established under this subparagraph 
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442 
on a retail community pharmacy or appli-
cable non-retail pharmacy if— 
‘‘(I) the retail pharmacy or appli-
cable non-retail pharmacy refuses or 
otherwise fails to respond to a request 
for information about prices in con-
nection with a survey under this sub-
section; 
‘‘(II) knowingly provides false in-
formation in response to such a sur-
vey; or 
‘‘(III) otherwise fails to comply 
with the requirements established 
under this paragraph. 
‘‘(iii) 
PARAMETERS
FOR
PEN-
ALTIES.— 
‘‘(I) IN GENERAL.—A civil money 
penalty established under this sub-
paragraph may be assessed with re-
spect to each violation, and with re-
spect to each non-compliant retail 
community pharmacy (including a 
pharmacy that is part of a chain) or 
non-compliant 
applicable 
non-retail 
pharmacy (including a pharmacy that 
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443 
is part of a chain), in an amount not 
to exceed $100,000 for each such vio-
lation. 
‘‘(II) CONSIDERATIONS.—In de-
termining the amount of a civil money 
penalty imposed under this subpara-
graph, the Secretary may consider the 
size, business structure, and type of 
pharmacy involved, as well as the type 
of violation and other relevant factors, 
as determined appropriate by the Sec-
retary. 
‘‘(iv) RULE
OF
APPLICATION.—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-
sions apply to a civil money penalty or pro-
ceeding under section 1128A(a). 
‘‘(I) LIMITATION ON USE OF APPLICABLE 
NON-RETAIL
PHARMACY
PRICING
INFORMA-
TION.—No State shall use pricing information 
reported by applicable non-retail pharmacies 
under subparagraph (A)(ii) to develop or inform 
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444 
payment methodologies for retail community 
pharmacies.’’; 
(5) in paragraph (2)— 
(A) in subparagraph (A), by inserting ‘‘, 
including payment rates and methodologies for 
determining 
ingredient 
cost 
reimbursement 
under managed care entities or other specified 
entities (as such terms are defined in section 
1903(m)(9)(D)),’’ after ‘‘under this title’’; and 
(B) in subparagraph (B), by inserting 
‘‘and the basis for such dispensing fees’’ before 
the semicolon; 
(6) by redesignating paragraph (4) as para-
graph (5); 
(7) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) OVERSIGHT.— 
‘‘(A) IN GENERAL.—The Inspector General 
of the Department of Health and Human Serv-
ices shall conduct periodic studies of the survey 
data reported under this subsection, as appro-
priate, including with respect to substantial 
variations in acquisition costs or other applica-
ble costs, as well as with respect to how internal 
transfer prices and related party transactions 
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445 
may influence the costs reported by pharmacies 
that are affiliates (as defined in subsection 
(k)(14)) or are owned by, controlled by, or re-
lated under a common ownership structure with 
a wholesaler, distributor, or other entity that 
acquires covered outpatient drugs relative to 
costs reported by pharmacies not affiliated with 
such entities. The Inspector General shall pro-
vide periodic updates to Congress on the results 
of such studies, as appropriate, in a manner 
that does not disclose trade secrets or other 
proprietary information. 
‘‘(B) APPROPRIATION.—There is appro-
priated to the Inspector General of the Depart-
ment of Health and Human Services, out of 
any money in the Treasury not otherwise ap-
propriated, $5,000,000 for fiscal year 2025, to 
remain available until expended, to carry out 
this paragraph.’’; and 
(8) in paragraph (5), as so redesignated— 
(A) by inserting ‘‘, and $9,000,000 for fis-
cal year 2025 and each fiscal year thereafter,’’ 
after ‘‘2010’’; and 
(B) by inserting ‘‘Funds appropriated 
under this paragraph for fiscal year 2025 and 
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446 
any subsequent fiscal year shall remain avail-
able until expended.’’ after the period. 
(b) DEFINITIONS.—Section 1927(k) of the Social Se-
curity Act (42 U.S.C. 1396r–8(k)) is amended— 
(1) in the matter preceding paragraph (1), by 
striking ‘‘In the section’’ and inserting ‘‘In this sec-
tion’’; and 
(2) by adding at the end the following new 
paragraphs: 
‘‘(12) APPLICABLE NON-RETAIL PHARMACY.— 
The term ‘applicable non-retail pharmacy’ means a 
pharmacy that is licensed as a pharmacy by the 
State and that is not a retail community pharmacy, 
including a pharmacy that dispenses prescription 
medications to patients primarily through mail and 
specialty pharmacies. Such term does not include 
nursing home pharmacies, long-term care facility 
pharmacies, hospital pharmacies, clinics, charitable 
or not-for-profit pharmacies, government phar-
macies, or low dispensing pharmacies (as defined by 
the Secretary). 
‘‘(13) AFFILIATE.—The term ‘affiliate’ means 
any entity that is owned by, controlled by, or related 
under a common ownership structure with a phar-
macy benefit manager or a managed care entity or 
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447 
other specified entity (as such terms are defined in 
section 1903(m)(9)(D)).’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Subject to paragraph (2), 
the amendments made by this section shall take ef-
fect on the first day of the first quarter that begins 
on or after the date that is 6 months after the date 
of enactment of this Act. 
(2) DELAYED
APPLICATION
TO
APPLICABLE 
NON-RETAIL
PHARMACIES.—The pharmacy survey 
requirements established by the amendments to sec-
tion 1927(f) of the Social Security Act (42 U.S.C. 
1396r–8(f)) made by this section shall apply to re-
tail community pharmacies beginning on the effec-
tive date described in paragraph (1), but shall not 
apply to applicable non-retail pharmacies until the 
first day of the first quarter that begins on or after 
the date that is 18 months after the date of enact-
ment of this Act. 
(d) IDENTIFICATION OF APPLICABLE NON-RETAIL 
PHARMACIES.— 
(1) IN GENERAL.—Not later than January 1, 
2026, the Secretary of Health and Human Services 
shall, in consultation with stakeholders as appro-
priate, publish guidance specifying pharmacies that 
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448 
meet the definition of applicable non-retail phar-
macies (as such term is defined in subsection 
(k)(12) of section 1927 of the Social Security Act 
(42 U.S.C. 1396r–8), as added by subsection (b)), 
and that will be subject to the survey requirements 
under subsection (f)(1) of such section, as amended 
by subsection (a). 
(2) INCLUSION
OF
PHARMACY
TYPE
INDICA-
TORS.—The guidance published under paragraph (1) 
shall include pharmacy type indicators to distinguish 
between different types of applicable non-retail phar-
macies, such as pharmacies that dispense prescrip-
tions primarily through the mail and pharmacies 
that dispense prescriptions that require special han-
dling or distribution. An applicable non-retail phar-
macy may be identified through multiple pharmacy 
type indicators. 
(e) IMPLEMENTATION.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary of Health and 
Human Services may implement the amendments 
made by this section by program instruction or oth-
erwise. 
(2) NONAPPLICATION OF ADMINISTRATIVE PRO-
CEDURE ACT.—Implementation of the amendments 
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449 
made by this section shall be exempt from the re-
quirements of section 553 of title 5, United States 
Code. 
(f) NONAPPLICATION OF PAPERWORK REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall 
not apply to any data collection undertaken by the Sec-
retary of Health and Human Services under section 
1927(f) of the Social Security Act (42 U.S.C. 1396r–8(f)), 
as amended by this section. 
SEC. 113. PREVENTING THE USE OF ABUSIVE SPREAD PRIC-
ING IN MEDICAID. 
(a) IN GENERAL.—Section 1927 of the Social Secu-
rity Act (42 U.S.C. 1396r–8) is amended— 
(1) in subsection (e), by adding at the end the 
following new paragraph: 
‘‘(6) TRANSPARENT PRESCRIPTION DRUG PASS- 
THROUGH PRICING REQUIRED.— 
‘‘(A) IN
GENERAL.—A contract between 
the State and a pharmacy benefit manager (re-
ferred 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) and col-
lectively referred to in this paragraph as the 
‘entity’) that includes provisions making the en-
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450 
tity responsible for coverage of covered out-
patient drugs dispensed to individuals enrolled 
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 transparent prescription drug pass- 
through pricing model under which— 
‘‘(i) any payment made by the entity 
or the PBM (as applicable) for such a 
drug— 
‘‘(I) is limited to— 
‘‘(aa) ingredient cost; and 
‘‘(bb) a professional dis-
pensing fee that is not less than 
the professional dispensing fee 
that the State would pay if the 
State were making the payment 
directly in accordance with the 
State plan; 
‘‘(II) is passed through in its en-
tirety (except as reduced under Fed-
eral or State laws and regulations in 
response to instances of waste, fraud, 
or abuse) by the entity or PBM to the 
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451 
pharmacy or provider that dispenses 
the drug; and 
‘‘(III) is made in a manner that 
is consistent with sections 447.502, 
447.512, 447.514, and 447.518 of 
title 42, Code of Federal Regulations 
(or any successor regulation) as if 
such requirements applied directly to 
the entity or the PBM, except that 
any payment by the entity or the 
PBM for the ingredient cost of such 
drug purchased by a covered entity 
(as defined in subsection (a)(5)(B)) 
may exceed the actual acquisition cost 
(as defined in 447.502 of title 42, 
Code of Federal Regulations, or any 
successor regulation) for such drug 
if— 
‘‘(aa) such drug was subject 
to an agreement under section 
340B of the Public Health Serv-
ice Act; 
‘‘(bb) such payment for the 
ingredient cost of such drug does 
not exceed the maximum pay-
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453 
the Secretary upon request in a form and 
manner specified by the Secretary, all costs 
and payments related to covered outpatient 
drugs and accompanying administrative 
services (as described in clause (ii)) in-
curred, received, or made by the entity or 
the PBM, broken down (as specified by the 
Secretary), to the extent such costs and 
payments are attributable to an individual 
covered outpatient drug, by each such 
drug, including any ingredient costs, pro-
fessional dispensing fees, administrative 
fees (as described in clause (ii)), post-sale 
and post-invoice fees, discounts, or related 
adjustments such as direct and indirect re-
muneration fees, and any and all other re-
muneration, as defined by the Secretary; 
and 
‘‘(iv) any form of spread pricing 
whereby any amount charged or claimed by 
the entity or the PBM (as applicable) that 
exceeds the amount paid to the pharmacies 
or providers on behalf of the State or enti-
ty, including any post-sale or post-invoice 
fees, discounts, or related adjustments 
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454 
such as direct and indirect remuneration 
fees or assessments, as defined by the Sec-
retary, (after allowing for an administra-
tive fee as described in clause (ii)) is not 
allowable for purposes of claiming Federal 
matching payments under this title. 
‘‘(B) PUBLICATION
OF
INFORMATION.— 
The Secretary shall publish, not less frequently 
than on an annual basis and in a manner that 
does not disclose the identity of a particular 
covered entity or organization, information re-
ceived by the Secretary pursuant to subpara-
graph (A)(iii)(III) that is broken out by State 
and by each of the following categories of cov-
ered entity within each such State: 
‘‘(i) Covered entities described in sub-
paragraph (A) of section 340B(a)(4) of the 
Public Health Service Act. 
‘‘(ii) Covered entities described in sub-
paragraphs (B) through (K) of such sec-
tion. 
‘‘(iii) Covered entities described in 
subparagraph (L) of such section. 
‘‘(iv) Covered entities described in 
subparagraph (M) of such section. 
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455 
‘‘(v) Covered entities described in sub-
paragraph (N) of such section. 
‘‘(vi) Covered entities described in 
subparagraph (O) of such section.’’; and 
(2) in subsection (k), as previously amended by 
this title, by adding at the end the following new 
paragraph: 
‘‘(14) PHARMACY
BENEFIT
MANAGER.—The 
term ‘pharmacy benefit manager’ means any person 
or entity that, either directly or through an inter-
mediary, acts as a price negotiator or group pur-
chaser on behalf of a State, managed care entity (as 
defined in section 1903(m)(9)(D)), or other specified 
entity (as so defined), or manages the prescription 
drug benefits provided by a State, managed care en-
tity, or other specified entity, including the proc-
essing and payment of claims for prescription drugs, 
the performance of drug utilization review, the proc-
essing of drug prior authorization requests, the man-
aging of appeals or grievances related to the pre-
scription drug benefits, contracting with pharmacies, 
controlling the cost of covered outpatient drugs, or 
the provision of services related thereto. Such term 
includes any person or entity that acts as a price ne-
gotiator (with regard to payment amounts to phar-
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456 
macies and providers for a covered outpatient drug 
or the net cost of the drug) or group purchaser on 
behalf of a State, managed care entity, or other 
specified entity or that carries out 1 or more of the 
other activities described in the preceding sentence, 
irrespective of whether such person or entity calls 
itself a pharmacy benefit manager.’’. 
(b) CONFORMING AMENDMENTS.—Section 1903(m) 
of such Act (42 U.S.C. 1396b(m)) is amended— 
(1) in paragraph (2)(A)(xiii)— 
(A) by striking ‘‘and (III)’’ and inserting 
‘‘(III)’’; 
(B) by inserting before the period at the 
end the following: ‘‘, and (IV) if the contract in-
cludes provisions making the entity responsible 
for coverage of covered outpatient drugs, the 
entity shall comply with the requirements of 
section 1927(e)(6)’’; and 
(C) by moving the margin 2 ems to the 
left; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(10) No payment shall be made under this 
title to a State with respect to expenditures incurred 
by the State for payment for services provided by an 
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457 
other specified entity (as defined in paragraph 
(9)(D)(iii)) unless such services are provided in ac-
cordance with a contract between the State and such 
entity which satisfies the requirements of paragraph 
(2)(A)(xiii).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to contracts between States and 
managed care entities, other specified entities, or phar-
macy benefit managers that have an effective date begin-
ning on or after the date that is 18 months after the date 
of enactment of this Act. 
(d) IMPLEMENTATION.— 
(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary of Health and 
Human Services may implement the amendments 
made by this section by program instruction or oth-
erwise. 
(2) NONAPPLICATION OF ADMINISTRATIVE PRO-
CEDURE ACT.—Implementation of the amendments 
made by this section shall be exempt from the re-
quirements of section 553 of title 5, United States 
Code. 
(e) NONAPPLICATION OF PAPERWORK REDUCTION 
ACT.—Chapter 35 of title 44, United States Code, shall 
not apply to any data collection undertaken by the Sec-
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458 
retary of Health and Human Services under section 
1927(e) of the Social Security Act (42 U.S.C. 1396r– 
8(e)), as amended by this section. 
TITLE II—MEDICARE 
SEC. 201. EXTENSION OF INCREASED INPATIENT HOSPITAL 
PAYMENT ADJUSTMENT FOR CERTAIN LOW- 
VOLUME HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(12) of the Social 
Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘fiscal year 2025 be-
ginning on January 1, 2025, and ending on Sep-
tember 30, 2025, and in fiscal year 2026’’ and in-
serting ‘‘fiscal year 2026 beginning on January 1, 
2026, and ending on September 30, 2026, and in 
fiscal year 2027’’; 
(2) in subparagraph (C)(i)— 
(A) in the matter preceding subclause 
(I)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
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459 
(iv) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘December 31, 2025’’; 
(B) in subclause (III)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘December 31, 2025’’; and 
(C) in subclause (IV)— 
(i) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(ii) by striking ‘‘January 1, 2025’’ 
and inserting ‘‘January 1, 2026’’; 
(iii) by striking ‘‘September 30, 
2025’’ and inserting ‘‘September 30, 
2026’’; and 
(iv) by striking ‘‘fiscal year 2026’’ 
and inserting ‘‘fiscal year 2027’’; and 
(3) in subparagraph (D)— 
(A) in the matter preceding clause (i)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
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460 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘December 31, 2025’’; and 
(B) in clause (ii)— 
(i) by striking ‘‘through 2024’’ and 
inserting ‘‘through 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘December 31, 2025’’. 
(b) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by this 
section by program instruction or otherwise. 
SEC. 202. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) IN GENERAL.—Section 1886(d)(5)(G) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend-
ed— 
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461 
(1) in clause (i), by striking ‘‘January 1, 2025’’ 
and inserting ‘‘January 1, 2026’’; and 
(2) in clause (ii)(II), by striking ‘‘January 1, 
2025’’ and inserting ‘‘January 1, 2026’’. 
(b) CONFORMING AMENDMENTS.— 
(1) IN
GENERAL.—Section 1886(b)(3)(D) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(b)(3)(D)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘January 1, 2025’’ and inserting ‘‘Jan-
uary 1, 2026’’; and 
(B) in clause (iv)— 
(i) by striking ‘‘fiscal year 2024’’ and 
inserting ‘‘fiscal year 2025’’; 
(ii) by striking ‘‘fiscal year 2025’’ and 
inserting ‘‘fiscal year 2026’’; 
(iii) by striking ‘‘October 1, 2024’’ 
and inserting ‘‘October 1, 2025’’; and 
(iv) by striking ‘‘December 31, 2024’’ 
and inserting ‘‘December 31, 2025’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended— 
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462 
(A) by striking ‘‘through 2024’’ and insert-
ing ‘‘through 2025’’; 
(B) by striking ‘‘fiscal year 2025’’ and in-
serting ‘‘fiscal year 2026’’; 
(C) by striking ‘‘October 1, 2024’’ and in-
serting ‘‘October 1, 2025’’; and 
(D) by striking ‘‘December 31, 2024’’ and 
inserting ‘‘December 31, 2025’’. 
SEC. 203. EXTENSION OF ADD-ON PAYMENTS FOR AMBU-
LANCE SERVICES. 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)) is amended— 
(1) in paragraph (12)(A), by striking ‘‘January 
1, 2025’’ and inserting ‘‘January 1, 2027’’; and 
(2) in paragraph (13), by striking ‘‘January 1, 
2025’’ each place it appears and inserting ‘‘January 
1, 2027’’ in each such place. 
SEC. 204. EXTENDING INCENTIVE PAYMENTS FOR PARTICI-
PATION IN ELIGIBLE ALTERNATIVE PAYMENT 
MODELS. 
(a) IN GENERAL.—Section 1833(z) of the Social Se-
curity Act (42 U.S.C. 1395l(z)) is amended— 
(1) in paragraph (1)(A)— 
(A) by striking ‘‘with 2026’’ and inserting 
‘‘with 2027’’; and 
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463 
(B) by inserting ‘‘, or, with respect to 
2027, 3.53 percent’’ after ‘‘1.88 percent’’; 
(2) in paragraph (2)— 
(A) in subparagraph (B)— 
(i) in the heading, by striking ‘‘2026’’ 
and inserting ‘‘2027’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2026’’ and inserting ‘‘2027’’; 
(B) in subparagraph (C)— 
(i) in the heading, by striking ‘‘2027’’ 
and inserting ‘‘2028’’; and 
(ii) in the matter preceding clause (i), 
by striking ‘‘2027’’ and inserting ‘‘2028’’; 
and 
(C) in subparagraph (D), by striking ‘‘and 
2026’’ and inserting ‘‘2026, and 2027’’; and 
(3) in paragraph (4)(B), by inserting ‘‘or, with 
respect to 2027, 3.53 percent’’ after ‘‘1.88 percent’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 
1395w–4(q)(1)(C)(iii)) is amended— 
(1) in subclause (II), by striking ‘‘2026’’ and 
inserting ‘‘2027’’; and 
(2) in subclause (III), by striking ‘‘2027’’ and 
inserting ‘‘2028’’. 
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464 
SEC. 205. TEMPORARY PAYMENT INCREASE UNDER THE 
MEDICARE PHYSICIAN FEE SCHEDULE TO AC-
COUNT FOR EXCEPTIONAL CIRCUMSTANCES. 
(a) IN GENERAL.—Section 1848(t)(1) of the Social 
Security Act (42 U.S.C. 1395w– 4(t)(1)) 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 ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(F) such services furnished on or after 
January 1, 2025, and before January 1, 2026, 
by 2.5 percent.’’. 
(b) 
CONFORMING
AMENDMENT.—Section 
1848(c)(2)(B)(iv)(V) is amended by striking ‘‘or 2024’’ 
and inserting ‘‘2024, or 2025’’. 
SEC. 206. EXTENSION OF FUNDING FOR QUALITY MEASURE 
ENDORSEMENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 
U.S.C. 1395aaa(d)(2)) is amended— 
(1) in the first sentence— 
(A) by striking ‘‘and $9,000,000’’ and in-
serting ‘‘$9,000,000’’; and 
(B) by inserting ‘‘, and $5,000,000 for the 
period beginning on January 1, 2025, and end-
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465 
ing on December 31, 2025’’ after ‘‘December 
31, 2024’’; and 
(2) in the third sentence— 
(A) by striking ‘‘and the period’’ and in-
serting ‘‘, the period’’; 
(B) by inserting ‘‘and the period beginning 
on January 1, 2025, and ending on December 
31, 2025,’’ after ‘‘December 31, 2024,’’; and 
(C) by inserting ‘‘or period’’ after ‘‘pre-
ceding fiscal year’’. 
SEC. 207. EXTENSION OF FUNDING OUTREACH AND ASSIST-
ANCE FOR LOW-INCOME PROGRAMS. 
(a) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note) is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Jan-
uary 1, 2025, and ending on December 31, 
2026, $30,000,000.’’. 
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466 
(b) 
AREA
AGENCIES
ON
AGING.—Subsection 
(b)(1)(B) of such section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Jan-
uary 1, 2025, and ending on December 31, 
2026, $30,000,000.’’. 
(c) AGING AND DISABILITY RESOURCE CENTERS.— 
Subsection (c)(1)(B) of such section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Jan-
uary 1, 2025, and ending on December 31, 
2026, $10,000,000.’’. 
(d) COORDINATION OF EFFORTS TO INFORM OLDER 
AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED-
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467 
ERAL AND STATE PROGRAMS.—Subsection (d)(2) of such 
section 119 is amended— 
(1) in clause (xiii), by striking ‘‘and’’ at the 
end; 
(2) in clause (xiv), by striking the period and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (xiv) the following 
new clause: 
‘‘(xv) for the period beginning on Jan-
uary 1, 2025, and ending on December 31, 
2026, $30,000,000.’’. 
SEC. 208. EXTENSION OF THE WORK GEOGRAPHIC INDEX 
FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 1, 2025’’ and inserting ‘‘January 1, 2026’’. 
SEC. 209. EXTENSION OF CERTAIN TELEHEALTH FLEXIBILI-
TIES. 
(a) REMOVING GEOGRAPHIC REQUIREMENTS
AND 
EXPANDING
ORIGINATING
SITES
FOR
TELEHEALTH 
SERVICES.—Section 1834(m) of the Social Security Act 
(42 U.S.C. 1395m(m)) is amended— 
(1) in paragraph (2)(B)(iii), by striking ‘‘end-
ing December 31, 2024’’ and inserting ‘‘ending De-
cember 31, 2026’’; and 
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468 
(2) in paragraph (4)(C)(iii), by striking ‘‘ending 
on December 31, 2024’’ and inserting ‘‘ending on 
December 31, 2026’’. 
(b) EXPANDING PRACTITIONERS ELIGIBLE TO FUR-
NISH TELEHEALTH SERVICES.—Section 1834(m)(4)(E) 
of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) 
is amended by striking ‘‘ending on December 31, 2024’’ 
and inserting ‘‘ending on December 31, 2026’’. 
(c) EXTENDING TELEHEALTH SERVICES FOR FED-
ERALLY
QUALIFIED
HEALTH
CENTERS
AND
RURAL 
HEALTH CLINICS.—Section 1834(m)(8) of the Social Se-
curity Act (42 U.S.C. 1395m(m)(8)) is amended— 
(1) in subparagraph (A), by striking ‘‘ending on 
December 31, 2024’’ and inserting ‘‘ending on De-
cember 31, 2026’’; 
(2) in subparagraph (B)— 
(A) in the subparagraph heading, by in-
serting ‘‘BEFORE 2025’’ after ‘‘RULE’’; 
(B) in clause (i), by striking ‘‘during the 
periods for which subparagraph (A) applies’’ 
and inserting ‘‘before January 1, 2025’’; and 
(C) in clause (ii), by inserting ‘‘furnished 
to an eligible telehealth individual before Janu-
ary 1, 2025’’ after ‘‘telehealth services’’; and 
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469 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(C) PAYMENT
RULE
FOR
2025
AND 
2026.— 
‘‘(i) IN GENERAL.—A telehealth serv-
ice furnished to an eligible telehealth indi-
vidual by a Federally qualified health cen-
ter or rural health clinic on or after Janu-
ary 1, 2025, and before January 1, 2027, 
shall be paid as a Federally qualified 
health center service or rural health clinic 
service (as applicable) under the prospec-
tive payment system established under sec-
tion 1834(o) or the methodology for all-in-
clusive rates established under section 
1833(a)(3), respectively. 
‘‘(ii) TREATMENT
OF
COSTS.—Costs 
associated with the furnishing of telehealth 
services by a Federally qualified health 
center or rural health clinic on or after 
January 1, 2025, and before January 1, 
2027, shall be considered allowable costs 
for purposes of the prospective payment 
system established under section 1834(o) 
and the methodology for all-inclusive rates 
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470 
established under section 1833(a)(3), as 
applicable. 
‘‘(iii) REQUIRING
MODIFIERS.—Not 
later than July 1, 2025, the Secretary 
shall establish requirements to include 1 or 
more codes or modifiers, as determined ap-
propriate by the Secretary, in the case of 
claims for telehealth services furnished to 
an eligible telehealth individual by a Feder-
ally qualified health center or rural health 
clinic.’’. 
(d) DELAYING
THE
IN-PERSON
REQUIREMENTS 
UNDER MEDICARE
FOR MENTAL HEALTH SERVICES 
FURNISHED
THROUGH
TELEHEALTH
AND
TELE-
COMMUNICATIONS TECHNOLOGY.— 
(1) DELAY
IN
REQUIREMENTS
FOR
MENTAL 
HEALTH
SERVICES
FURNISHED
THROUGH
TELE-
HEALTH.—Section 1834(m)(7)(B)(i) of the Social 
Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is 
amended, in the matter preceding subclause (I), by 
striking ‘‘on or after’’ and all that follows through 
‘‘described in section 1135(g)(1)(B))’’ and inserting 
‘‘on or after January 1, 2027’’. 
(2) MENTAL
HEALTH
VISITS
FURNISHED
BY 
RURAL HEALTH CLINICS.—Section 1834(y)(2) of the 
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471 
Social Security Act (42 U.S.C. 1395m(y)(2)) is 
amended by striking ‘‘January 1, 2025’’ and all that 
follows through the period at the end and inserting 
‘‘January 1, 2027.’’. 
(3) MENTAL
HEALTH
VISITS
FURNISHED
BY 
FEDERALLY QUALIFIED HEALTH CENTERS.—Section 
1834(o)(4)(B) of the Social Security Act (42 U.S.C. 
1395m(o)(4)(B)) is amended by striking ‘‘January 
1, 2025’’ and all that follows through the period at 
the end and inserting ‘‘January 1, 2027.’’. 
(e) ALLOWING FOR THE FURNISHING OF AUDIO- 
ONLY TELEHEALTH SERVICES.—Section 1834(m)(9) of 
the Social Security Act (42 U.S.C. 1395m(m)(9)) is 
amended by striking ‘‘ending on December 31, 2024’’ and 
inserting ‘‘ending on December 31, 2026’’. 
(f) EXTENDING USE OF TELEHEALTH TO CONDUCT 
FACE-TO-FACE ENCOUNTER PRIOR TO RECERTIFICATION 
OF
ELIGIBILITY
FOR
HOSPICE
CARE.—Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended— 
(1) by striking ‘‘ending on December 31, 2024’’ 
and inserting ‘‘ending on December 31, 2026’’; and 
(2) by inserting ‘‘, except that this subclause 
shall not apply in the case of such an encounter with 
an individual occurring on or after January 1, 2025, 
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