Continuing Appropriations and Extensions Act, 2026

Bill: 119-hr-5371
Sponsor: full_name: Rep. Cole, Tom [R-OK-4]
Introduced: 2025-09-16
Policy area: Economics and Public Finance
Subjects: Abortion

Access Board

Accounting and auditing

Administrative law and regulatory procedures

Administrative remedies

Adoption and foster care

Advanced technology and technological innovations

Advisory bodies

Afghanistan

Africa

African Development Foundation

Aging

Agricultural conservation and pollution

Agricultural education

Agricultural equipment and machinery

Agricultural insurance

Agricultural marketing and promotion

Agricultural practices and innovations

Agricultural prices, subsidies, credit

Agricultural research

Agricultural trade

Air quality

Alabama

Alaska

Alaska Natives and Hawaiians

Alliances

Alternative and renewable resources

American Battle Monuments Commission

American Samoa

Animal and plant health

Animal protection and human-animal relationships

Appalachian Regional Commission

Appropriations

Aquatic ecology

Arab-Israeli relations

Architect of the Capitol

Arizona

Arkansas

Armed Forces Retirement Home

Arms control and nonproliferation

Army Corps of Engineers

Asia

Assault and harassment offenses

Athletes

Atmospheric science and weather

Aviation and airports

Azerbaijan

Birds

Border security and unlawful immigration

Broadcasting, cable, digital technologies

Budget process

Building construction

Burma

Business investment and capital

Buy American requirements

California

Cambodia

Canada

Cardiovascular and respiratory health

Caribbean area

Cell biology and embryology

Cemeteries and funerals

Census and government statistics

Child health

Child safety and welfare

China

Civil actions and liability

Climate change and greenhouse gases

Coal

Coast guard

Collective security

Colombia

Colorado

Commission of Fine Arts

Commission on Civil Rights

Commodities markets

Commodity Credit Corporation

Commodity Futures Trading Commission

Community life and organization

Competition and antitrust

Competitiveness, trade promotion, trade deficits

Computer security and identity theft

Computers and information technology

Conflicts and wars

Congressional officers and employees

Congressional oversight

Connecticut

Correctional facilities and imprisonment

Crime prevention

Crime victims

Crimes against children

Crimes against women

Criminal investigation, prosecution, interrogation

Criminal justice information and records

Criminal procedure and sentencing

Cuba

Cultural exchanges and relations

Currency

Customs enforcement

Dams and canals

Defense Nuclear Facilities Safety Board

Defense spending

Delta Regional Authority

Denali Commission

Department of Agriculture

Department of Commerce

Department of Defense

Department of Energy

Department of Health and Human Services

Department of Homeland Security

Department of Housing and Urban Development

Department of Justice

Department of Labor

Department of State

Department of Transportation

Department of Veterans Affairs

Department of the Interior

Department of the Treasury

Detention of persons

Digestive and metabolic diseases

Diplomacy, foreign officials, Americans abroad

Disability and paralysis

Disability assistance

Disaster relief and insurance

District of Columbia

Domestic violence and child abuse

Drug Enforcement Administration (DEA)

Drug safety, medical device, and laboratory regulation

Drug therapy

Drug trafficking and controlled substances

Drug, alcohol, tobacco use

Economic development

Education of the disadvantaged

Education programs funding

Educational technology and distance education

Egypt

Election Assistance Commission

Elections, voting, political campaign regulation

Electric power generation and transmission

Elementary and secondary education

Emergency communications systems

Emergency planning and evacuation

Employee benefits and pensions

Employee hiring

Employment and training programs

Employment discrimination and employee rights

Endangered and threatened species

Energy assistance for the poor and aged

Energy efficiency and conservation

Energy storage, supplies, demand

Environmental Protection Agency (EPA)

Environmental assessment, monitoring, research

Environmental health

Environmental regulatory procedures

Environmental technology

Equal Employment Opportunity Commission (EEOC)

Ethiopia

Europe

Evidence and witnesses

Executive Office of the President

Executive agency funding and structure

Export-Import Bank of the United States

Family planning and birth control

Family relationships

Family services

Farm Credit Administration

Farmland

Federal Bureau of Investigation (FBI)

Federal Crop Insurance Corporation

Federal Emergency Management Agency (FEMA)

Federal Energy Regulatory Commission (FERC)

Federal Maritime Commission

Federal appellate courts

Federal officials

Federal-Indian relations

Firearms and explosives

Fires

First responders and emergency personnel

Fishes

Floods and storm protection

Florida

Food and Drug Administration (FDA)

Food assistance and relief

Food industry and services

Food supply, safety, and labeling

Foreign aid and international relief

Forests, forestry, trees

Fraud offenses and financial crimes

Gaza Strip

General Services Administration

Genetics

Geography and mapping

Georgia

Georgia (Republic)

Government National Mortgage Association (Ginnie Mae)

Government buildings, facilities, and property

Government employee pay, benefits, personnel management

Government ethics and transparency, public corruption

Government information and archives

Government lending and loan guarantees

Government studies and investigations

Government trust funds

Grain

Great Lakes

Guam

HIV/AIDS

Haiti

Hate crimes

Hawaii

Hazardous wastes and toxic substances

Health care costs and insurance

Health care coverage and access

Health facilities and institutions

Health information and medical records

Health personnel

Health programs administration and funding

Health promotion and preventive care

Health technology, devices, supplies

Hereditary and development disorders

Higher education

Historic sites and heritage areas

Historical and cultural resources

Home and outpatient care

Homelessness and emergency shelter

Hong Kong

Hospital care

House of Representatives

Housing and community development funding

Housing discrimination

Housing finance and home ownership

Housing for the elderly and disabled

Housing industry and standards

Housing supply and affordability

Human rights

Human trafficking

Humanities programs funding

Hybrid, electric, and advanced technology vehicles

Idaho

Illinois

Immigration status and procedures

Immunology and vaccination

Indian claims

Indian lands and resources rights

Indian social and development programs

Infectious and parasitic diseases

Infrastructure development

Insects

Intellectual property

Intelligence activities, surveillance, classified information
Latest action: action_date: 2025-10-09
text: Fourth cloture motion on the motion to proceed to the measure presented in Senate.

Summaries:
action_date: 2025-09-16
action_desc: Introduced in House
text: <p><strong>Continuing Appropriations and Extensions Act, 2026</strong></p><p>This bill provides continuing FY2026 appropriations for federal agencies, provides additional funding for security for federal officials, and extends various expiring programs and authorities.</p><p>Specifically, the bill provides continuing FY2026 appropriations to federal agencies through the earlier of November 21, 2025, or the enactment of the applicable appropriations act. It is known as a continuing resolution (CR) and prevents a government shutdown that would otherwise occur if the FY2026 appropriations bills have not been enacted when FY2026 begins on October 1, 2025.&nbsp;</p><p>The CR funds most programs and activities at the FY2025 levels with several exceptions that provide funding flexibility and additional appropriations for various programs.</p><p>For example, the CR provides additional funding for security for Members of Congress, Supreme Court Justices, and executive branch officials. It also authorizes the District of Columbia to spend local funds at the rates included in its FY2026 local budget.</p><p>In addition, the bill extends several expiring programs and authorities, including</p><ul><li>several public health, Medicare, and Medicaid authorities and programs;</li><li>various programs and authorities related to veterans;</li><li>the U.S. Grain Standards Act;</li><li>the Department of Agriculture livestock mandatory price reporting program;</li><li>several Department of Homeland Security (DHS) programs related to cybersecurity;</li><li>authorities for DHS and the Department of Justice to take actions to mitigate a credible threat from an unmanned aircraft system;</li><li>the special assessment on nonindigent persons or entities convicted of certain offenses involving sexual abuse or human trafficking;</li><li>authorities related to the Commodity Futures Trading Commission whistleblower program; and</li><li>the Defense Production Act of 1950.</li></ul>

tv_txt: II Calendar No. 168 119th CONGRESS 1st Session H. R. 5371 IN THE SENATE OF THE UNITED STATES September 19 (legislative day, September 16), 2025 Received, read twice and ordered placed on the calendar AN ACT Making continuing appropriations and extensions for fiscal year 2026, and for other purposes.

1. SHORT TITLE This Act may be cited as the Continuing Appropriations and Extensions Act, 2026 . 2. TABLE OF CONTENTS The table of contents for this Act is as follows: Sec. 1. SHORT TITLE. Sec. 2. TABLE OF CONTENTS. Sec. 3. REFERENCES. Division A—CONTINUING APPROPRIATIONS ACT, 2026 Division B—MISCELLANEOUS EXTENSIONS Division C—HEALTH EXTENDERS Title I—Public Health Extenders Title II—Medicare Title III—Human Services Title IV—Medicaid Title V—Food and Drug Administration Title VI—No Surprises Act Implementation Division D—DEPARTMENT OF VETERANS AFFAIRS EXTENDERS Title I—Health Care Matters Title II—Benefits Title III—Housing Title IV—Other Matters Division E—MISCELLANEOUS 3. REFERENCES Except as expressly provided otherwise, any reference to this Act contained in any division of this Act shall be treated as referring only to the provisions of that division. A CONTINUING APPROPRIATIONS ACT, 2026 The following sums are hereby appropriated, out of any money in the Treasury not otherwise appropriated, and out of applicable corporate or other revenues, receipts, and funds, for the several departments, agencies, corporations, and other organizational units of Government for fiscal year 2026, and for other purposes, namely: 101. Such amounts as may be necessary, at a rate for operations as provided in the applicable appropriations Acts for fiscal year 2025 and under the authority and conditions provided in such Acts, for continuing projects or activities (including the costs of direct loans and loan guarantees) that are not otherwise specifically provided for in this Act, that were conducted in fiscal year 2025, and for which appropriations, funds, or other authority were made available in the Full-Year Continuing Appropriations Act, 2025 (division A of Public Law 119–4 ), except sections 1110, 1113, 1114, and 1207; the proviso in paragraph (4) of section 1602; and sections 1708 and 1808; and except section 11104 shall be applied by substituting 2020, and 2021 for and 2020 ; and except sections 774 and 778 of division B, section 540 of division C, and sections 110 and 112 of division D of Public Law 118–42 as continued in effect by section 1101 of division A of Public Law 119–4 ; and except section 7069(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . 102. (a) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used for: (1) the new production of items not funded for production in fiscal year 2025 or prior years; (2) the increase in production rates above those sustained with fiscal year 2025 funds; or (3) the initiation, resumption, or continuation of any project, activity, operation, or organization (defined as any project, subproject, activity, budget activity, program element, and subprogram within a program element, and for any investment items defined as a P–1 line item in a budget activity within an appropriation account and an R–1 line item that includes a program element and subprogram element within an appropriation account) for which appropriations, funds, or other authority were not available during fiscal year 2025. (b) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used to initiate multi-year procurements utilizing advance procurement funding for economic order quantity procurement unless specifically appropriated later. 103. Appropriations made by section 101 shall be available to the extent and in the manner that would be provided by the pertinent appropriations Act. 104. Except as otherwise provided in section 102, no appropriation or funds made available or authority granted pursuant to section 101 shall be used to initiate or resume any project or activity for which appropriations, funds, or other authority were not available during fiscal year 2025. 105. Appropriations made and authority granted pursuant to this Act shall cover all obligations or expenditures incurred for any project or activity during the period for which funds or authority for such project or activity are available under this Act. 106. Unless otherwise provided for in this Act or in the applicable appropriations Act for fiscal year 2026, appropriations and funds made available and authority granted pursuant to this Act shall be available until whichever of the following first occurs: (1) The enactment into law of an appropriation for any project or activity provided for in this Act. (2) The enactment into law of the applicable appropriations Act for fiscal year 2026 without any provision for such project or activity. (3) November 21, 2025. 107. Expenditures made pursuant to this Act shall be charged to the applicable appropriation, fund, or authorization whenever a bill in which such applicable appropriation, fund, or authorization is contained is enacted into law. 108. Appropriations made and funds made available by or authority granted pursuant to this Act may be used without regard to the time limitations for submission and approval of apportionments set forth in section 1513 of title 31, United States Code, but nothing in this Act may be construed to waive any other provision of law governing the apportionment of funds. 109. Notwithstanding any other provision of this Act, except section 106, for those programs that would otherwise have high initial rates of operation or complete distribution of appropriations at the beginning of fiscal year 2026 because of distributions of funding to States, foreign countries, grantees, or others, such high initial rates of operation or complete distribution shall not be made, and no grants shall be awarded for such programs funded by this Act that would impinge on final funding prerogatives. 110. This Act shall be implemented so that only the most limited funding action of that permitted in the Act shall be taken in order to provide for continuation of projects and activities. 111. (a) For entitlements and other mandatory payments whose budget authority was provided in an appropriations Act specified in section 101, for expenses authorized under section 324 of title 38, United States Code, and for activities under the Food and Nutrition Act of 2008, activities shall be continued at the rate to maintain program levels under current law, under the authority and conditions provided in the applicable appropriations Act, to be continued through the date specified in section 106(3) of this Act. (b) Notwithstanding section 106, obligations for mandatory payments due on or about the first day of any month that begins after October 2025 but not later than 30 days after the date specified in section 106(3) may continue to be made, and funds shall be available for such payments. 112. Amounts made available under section 101 for civilian personnel compensation and benefits in each department and agency may be apportioned up to the rate for operations necessary to avoid furloughs within such department or agency, consistent with the applicable appropriations Act for fiscal year 2025, except that such authority provided under this section shall not be used until after the department or agency has taken all necessary actions to reduce or defer non-personnel-related administrative expenses. 113. Funds appropriated by this Act may be obligated and expended notwithstanding section 10 of Public Law 91–672 ( 22 U.S.C. 2412 ), section 15 of the State Department Basic Authorities Act of 1956 ( 22 U.S.C. 2680 ), section 313 of the Foreign Relations Authorization Act, Fiscal Years 1994 and 1995 ( 22 U.S.C. 6212 ), and section 504(a)(1) of the National Security Act of 1947 ( 50 U.S.C. 3094(a)(1) ). 114. (a) (1) For each amount incorporated by reference in this Act that was previously designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985, each provision of law designating each such amount as an emergency requirement pursuant to such section shall not apply. (2) Each amount incorporated by reference in this Act that was designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 in the following provisions of law are designated by the Congress as an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives: section 11206(4) of division A of Public Law 119–4 and 7068(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . (b) Each amount incorporated by reference in this Act that was previously designated by the Congress as being for disaster relief pursuant to section 251(b)(2)(D) of the Balanced Budget and Emergency Deficit Control Act of 1985 is designated by the Congress as being for disaster relief pursuant to a concurrent resolution on the budget. (c) Each amount incorporated by reference in this Act that was previously designated in division B of Public Law 117–159 , division J of Public Law 117–58 , or in section 443(b) of division G of Public Law 117–328 by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget shall continue to be treated as an amount specified in section 103(b) of division A of Public Law 118–5 . 115. (a) Rescissions or cancellations of discretionary budget authority that continue pursuant to section 101 in Treasury Appropriations Fund Symbols (TAFS)— (1) to which other appropriations are not provided by this Act, but for which there is a current applicable TAFS that does receive an appropriation in this Act; or (2) which are no-year TAFS and receive other appropriations in this Act, may be continued instead by reducing the rate for operations otherwise provided by section 101 for such current applicable TAFS, as long as doing so does not impinge on the final funding prerogatives of the Congress. (b) Rescissions or cancellations described in subsection (a) shall continue in an amount equal to the lesser of— (1) the amount specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act; or (2) the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act. (c) No later than November 7, 2025, the Director of the Office of Management and Budget shall provide to the Committees on Appropriations of the House of Representatives and the Senate a comprehensive list of the rescissions or cancellations that will continue pursuant to section 101: Provided , That the information in such comprehensive list shall be periodically updated to reflect any subsequent changes in the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101, and such updates shall be transmitted to the Committees on Appropriations of the House of Representatives and the Senate upon request. 116. Amounts made available by section 101 for Domestic Food Programs—Food and Nutrition Service—Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be apportioned at the rate for operations necessary to maintain participation. 117. Section 260 of the Agricultural Marketing Act of 1946 ( 7 U.S.C. 1636i ) and section 942 of the Livestock Mandatory Reporting Act of 1999 ( 7 U.S.C. 1635 note; Public Law 106–78 ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 118. Section 8302(b) of the Agricultural Act of 2014 ( 16 U.S.C. 3851a(b) ) shall be applied by substituting the date specified in section 106 of this Act for October 1, 2023 . 119. (a) Amounts made available by section 101 for Department of Justice—United States Marshals Service—Salaries and Expenses may be apportioned up to the rate for operations necessary to maintain program operations. (b) In addition to amounts provided by section 101, for Department of Justice—United States Marshals Service—Salaries and Expenses , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until September 30, 2027, to carry out protective operations. 120. (a) For the closeout of all Space Shuttle contracts and associated programs, amounts that have expired but have not been cancelled in the Exploration, Space Operations, Human Space Flight, Space Flight Capabilities, and Exploration Capabilities appropriations accounts shall remain available through fiscal year 2030 for the liquidation of valid obligations incurred during the period of fiscal year 2001 through fiscal year 2013. (b) (1) Subject to paragraph (2), this section shall become effective immediately upon enactment of this Act. (2) If this Act is enacted after September 30, 2025, this section shall be applied as if it were in effect on September 30, 2025. 121. Section 3014(a) of title 18, United States Code, shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 122. Notwithstanding section 101, the first proviso in each of sections 8092 and 8096 of title VIII of division A of Public Law 118–47 shall be applied by substituting advances for reimbursements . 123. Notwithstanding sections 102 and 104, amounts made available by section 101 to the Department of Defense for Research, Development, Test and Evaluation, Air Force shall be apportioned up to the rate for operations necessary for the E–7 Wedgetail program, in an amount not to exceed $199,676,000, only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 124. Of the unobligated balance of funds available to the Department of Defense for the E–7 program under the heading Aircraft Procurement, Air Force in Public Law 119–4 , $200,000,000 is hereby transferred to and merged with amounts available for the E–7 program under the heading Research, Development, Test and Evaluation, Air Force only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 125. Section 717(a) of the Defense Production Act of 1950 ( 50 U.S.C. 4564(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 126. Notwithstanding sections 102 and 104, amounts made available by section 101 of this Act to the Department of Defense for Shipbuilding and Conversion, Navy may be apportioned up to the rate for operations necessary to fund completion of prior year shipbuilding programs for the fiscal year 2016 and fiscal year 2018 Virginia Class Submarine Programs, in an amount not to exceed $154,000,000. 127. During the period covered by this Act, section 103(f)(4)(A) of Public Law 108–361 (the Calfed Bay-Delta Authorization Act) shall be applied by substituting $32,600,000 for $30,000,000 . 128. (a) Amounts made available by section 101 in the first proviso under the heading Department of Energy—Atomic Energy Defense Activities—National Nuclear Security Administration—Weapons Activities may be apportioned up to the rate for operations necessary to maintain current operations for the safe, secure transport of nuclear weapons. (b) The Director of the Office of Management and Budget and the Secretary of Energy shall notify the Committees on Appropriations of the House of Representatives and the Senate not later than 3 days after each use of the authority provided in subsection (a). 129. Notwithstanding section 101, the matter preceding the first proviso under the heading Office of Personnel Management—Salaries and Expenses in title V of division B of Public Law 118–47 shall be applied by substituting $197,446,000 for $219,076,000 , and the second proviso under such heading in such title of such division of such Act shall be applied by substituting $214,605,000 for $192,975,000 . 130. Notwithstanding any other provision of this Act, except section 106, the District of Columbia may expend local funds made available under the heading District of Columbia—District of Columbia Funds for such programs and activities under the District of Columbia Appropriations Act, 2024 (title IV of division B of Public Law 118–47 ) at the rate set forth in the Fiscal Year 2026 Local Budget Act of 2025 (D.C. Bill No. 26–260) as modified as of the date of enactment of this Act. 131. Notwithstanding section 101, paragraph (1) under the heading Department of the Treasury—Departmental Offices—Salaries and Expenses in title I of division B of Public Law 118–47 shall be applied by substituting $1,350,000 for $350,000 : Provided, That such amounts may be obligated in the account and budget structure set forth in the fiscal year 2026 President’s Budget, submitted pursuant to section 1105(a) of title 31, United States Code, and accompanying justification materials. 132. Amounts made available by section 101 for Small Business Administration—Business Loans Program Account may be apportioned up to the rate for operations necessary to accommodate increased demand for commitments for general business loans authorized under paragraphs (1) through (35) of section 7(a) of the Small Business Act ( 15 U.S.C. 636(a) ), for commitments to guarantee trust certificates authorized by section 5(g) of the Small Business Act ( 15 U.S.C. 634(g) ), for commitments to guarantee loans under section 503 of the Small Business Investment Act of 1958 ( 15 U.S.C. 697 ), and for commitments to guarantee debentures under section 303(b) of the Small Business Investment Act of 1958 ( 15 U.S.C. 683(b) ). 133. Notwithstanding section 101, amounts are provided for Department of the Treasury—Office of Terrorism and Financial Intelligence—Salaries and Expenses at a rate for operations of $237,662,000. 134. Notwithstanding section 101, section 1605 of Public Law 119–4 shall be applied by substituting through the end of the last applicable pay period that commences on or before the date specified in section 106(3) of the Continuing Appropriations Act, 2026 for through the date specified in section 1106 of this Act . 135. Section 1(b) of Public Law 117–25 (135 Stat. 297; 136 Stat. 2133; 136 Stat. 5984; 138 Stat. 1771; 139 Stat. 46) shall be applied in each of paragraphs (3) and (4) by substituting the date specified in section 106 of this Act for September 30, 2025 . 136. In addition to amounts otherwise provided by section 101 for The Judiciary—Supreme Court of the United States—Salaries and Expenses , there is appropriated $28,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for the protection of the Supreme Court Justices, including the purchase and hire of passenger motor vehicles as authorized by 31 U.S.C. 1343 and 1344, to be expended as the Chief Justice may approve. 137. Section 210G(i) of the Homeland Security Act of 2002 ( 6 U.S.C. 124n(i) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 138. Section 225(e) of division A of Public Law 116–6 ( 49 U.S.C. 44901 note) shall be applied by substituting fiscal year 2019 through the date specified in section 106 of the Continuing Appropriations Act, 2026 for fiscal years 2019 through 2025 . 139. Amounts made available by section 101 to the Department of Homeland Security under the heading Federal Emergency Management Agency—Disaster Relief Fund may be apportioned up to the rate for operations necessary to carry out response and recovery activities under the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ). 140. Section 227(a) of the Federal Cybersecurity Enhancement Act of 2015 ( 6 U.S.C. 1525(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 141. Section 111(a) of the Cybersecurity Information Sharing Act of 2015 ( 6 U.S.C. 1510(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 142. Section 2220A(s)(1) of the Homeland Security Act of 2002 ( 6 U.S.C. 665g(s)(1) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 143. During the period covered by this Act, section 3(b)(2)(C) of the Pittman-Robertson Wildlife Restoration Act ( 16 U.S.C. 669b(b)(2)(C) ) shall be applied by substituting 2027 for 2026 . 144. During the period covered by this Act, section 1701 of title VII of division B of Public Law 117–43 , as amended, shall be applied by substituting calendar years 2021 through 2026 for 2021 or 2022 or 2023 or 2024 each place it appears. 145. Amounts made available by section 101 for Department of the Interior—Department-Wide Programs—Wildland Fire Management and Department of Agriculture—Forest Service—Wildland Fire Management may be apportioned up to the rate for operations necessary for wildfire suppression activities. 146. (a) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Services at a rate for operations of $72,265,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. (b) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Facilities at a rate for operations of $8,050,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. 147. Of the amounts made available in the third paragraph under the heading Environmental Protection Agency—State and Tribal Assistance Grants in the Disaster Relief Supplemental Appropriations Act, 2023 (division N of Public Law 117–328 ), up to $54,000,000 shall be available for technical assistance and grants under section 1442(b) of the Safe Drinking Water Act ( 42 U.S.C. 300j–1(b) ) in areas where the President declared an emergency in August of fiscal year 2022 pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ): Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and section 1(e) of H. Res. 1151 (117th Congress), as engrossed in the House of Representatives on June 8, 2022, are designated as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 148. Notwithstanding section 101, the matter under the heading Department of Health and Human Services—Administration for Children and Families—Children and Families Services Programs in title II of division D of Public Law 118–47 shall be applied by adding the following after the second proviso: Provided further , That for purposes of section 640(a)(2)(B)(v) of such Act, the base grant for each of the Federated States of Micronesia and the Republic of the Marshall Islands shall be $8,000,000, and shall be considered equal to the amount provided for base grants for such jurisdictions under such Act for the prior fiscal year: . 149. Notwithstanding any other provision of this Act, there is appropriated— (1) For payment to Ashley Paige Turner, heir of Sylvester Turner, late a Representative from the State of Texas, $174,000. (2) For payment to Ramona Grijalva, widow of Raúl M. Grijalva, late a Representative from the State of Arizona, $174,000. (3) For payment to Catherine M. Smith, widow of Gerald E. Connolly, late a Representative from the Commonwealth of Virginia, $174,000. 150. Notwithstanding any other provision of law, no adjustment shall be made under section 601(a) of the Legislative Reorganization Act of 1946 ( 2 U.S.C. 4501 ) (relating to cost of living adjustments for Members of Congress) during the period covered by this Act. 151. In addition to amounts otherwise provided by section 101, for Capitol Police—United States Capitol Police Mutual Aid Reimbursements , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for reimbursements for mutual aid and related training provided under the agreements described in section 7302 of Public Law 108–458 : Provided, That obligation of the funds made available in this section in this Act shall be subject to notification to the Chairmen and Ranking Members of the Committees on Appropriations of both Houses of Congress, the Senate Committee on Rules and Administration, and the Committee on House Administration of the amount and purpose of the expense within 15 days of obligation. 152. Notwithstanding section 101, the matter under the heading Native American Veteran Housing Loan Program Account in title II of division A of Public Law 118–42 shall be applied by adding the following new paragraph: In addition, for the cost of direct loans, $6,865,235, as authorized by subchapter V of chapter 37 of title 38, United States Code: Provided , That such costs, including the cost of modifying such loans, shall be as defined in section 502 of the Congressional Budget Act of 1974: Provided further , That funds made available under this heading are available to subsidize gross obligations for the principal amount of direct loans not to exceed $75,000,000. . 153. Section 1424(a) of the Better Utilization of Investments Leading to Development Act of 2018 ( 22 U.S.C. 9624(a) ) shall be applied by substituting the date specified in section 106 of this Act for the date that is 7 years after the date of the enactment of this Act . 154. Notwithstanding sections 101 and 106, and sections 1101, 1106, and 11201 of Public Law 119–4 , the fifth and sixth provisos under the heading Millennium Challenge Corporation in title III of division F of Public Law 118–47 shall be amended by substituting December 31, 2026 for December 31, 2024 each place it appears. 155. Notwithstanding section 106, during fiscal year 2026, the Secretary of Housing and Urban Development may use the unobligated balances of amounts made available in prior fiscal years in paragraphs (2), (3), and (8) under the heading Public and Indian Housing—Tenant-Based Rental Assistance to support additional allocations under subparagraph (D) of paragraph (1) and subparagraph (B) of paragraph (4) of such heading to prevent the termination of rental assistance for families as the result of insufficient funding in the calendar year 2025 funding cycle: Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985 are designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 156. Amounts made available by section 101 for Department of Transportation—Office of the Secretary—Payments to Air Carriers may be apportioned up to the rate for operations necessary to maintain Essential Air Service program operations. 157. Section 4144(d) of the Motor Carrier Safety Reauthorization Act of 2005 ( 49 U.S.C. 31100 note) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . This division may be cited as the Continuing Appropriations Act, 2026 . B MISCELLANEOUS EXTENSIONS 101. United States grain standards The authorities (including any limitations on the authorities) provided by each provision of the United States Grain Standards Act ( Public Law 90–487 ; 7 U.S.C. 74 et seq. ) and each provision of law amended by that Act, as in effect on September 30, 2025, shall continue, and the authorities (and any such limitations) shall be carried out, until the later of— (1) November 21, 2025; and (2) the date specified in the provision of that Act or the provision of law amended by that Act. C HEALTH EXTENDERS I Public Health Extenders 101. Extension for community health centers, National Health Service Corps, and teaching health centers that operate GME programs (a) Extension for community health centers Section 10503(b)(1) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(1) ) is amended— (1) in subparagraph (I), by striking and at the end; and (2) by adding at the end the following: (K) $606,904,110 for the period beginning on October 1, 2025, and ending on November 21, 2025; and . (b) Extension for the National Health Service Corps Section 10503(b)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(2) ) is amended— (1) in subparagraph (J), by striking and at the end; (2) in subparagraph (K), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (L) $49,150,685 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (c) Teaching health centers that operate graduate medical education programs Section 340H(g)(1) of the Public Health Service Act ( 42 U.S.C. 256h(g)(1) ) is amended— (1) in subparagraph (E), by striking and at the end; (2) in subparagraph (F), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (G) $24,931,507 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (d) Application of provisions Amounts appropriated pursuant to the amendments made by this section shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act ( 42 U.S.C. 254b et seq. ). (e) Conforming amendment Section 3014(h)(4) of title 18, United States Code, is amended by striking and section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025 and inserting section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025, and section 101(d) of title I of division C of the Continuing Appropriations and Extensions Act, 2026 . 102. Extension of special diabetes programs (a) Extension of special diabetes programs for type i diabetes Section 330B(b)(2) of the Public Health Service Act ( 42 U.S.C. 254c–2(b)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . (b) Extending funding for special diabetes programs for Indians Section 330C(c)(2) of the Public Health Service Act ( 42 U.S.C. 254c–3(c)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . 103. National health security extensions (a) Section 319(e)(8) of the Public Health Service Act ( 42 U.S.C. 247d(e)(8) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Section 319L(e)(1)(D) of the Public Health Service Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (c) Section 319L–1(b) of the Public Health Service Act (42 U.S.C. 247d–7f(b)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (d) (1) Section 2811A(g) of the Public Health Service Act (42 U.S.C. 300hh–10b(g)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (2) Section 2811B(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (3) Section 2811C(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (e) Section 2812(c)(4)(B) of the Public Health Service Act ( 42 U.S.C. 300hh–11(c)(4)(B) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . II Medicare 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), by striking in fiscal year 2026 and inserting during the portion of fiscal year 2026 beginning on November 22, 2025, 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 inserting or portion of a fiscal year after for a fiscal year ; and (ii) by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; (B) in subclause (III), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (C) in subclause (IV), by striking fiscal year 2026 and inserting the portion of fiscal year 2026 beginning on November 22, 2025, and ending on September 30, 2026, and fiscal year 2027 ; and (3) in subparagraph (D)— (A) in the matter preceding clause (i), by inserting or during the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (B) in clause (ii), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 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. 202. Extension of the Medicare-dependent hospital (MDH) program (a) In general Section 1886(d)(5)(G) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(G) ) is amended— (1) in clause (i), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in clause (ii)(II), by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 ; and (B) in clause (iv), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww note) is amended by inserting , or the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . 203. Extension of add-on payments for ambulance services Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ) is amended— (1) in paragraph (12)(A), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in paragraph (13), by striking October 1, 2025 each place it appears and inserting November 22, 2025 in each such place. 204. 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, by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in the third sentence, by striking September 30, 2025 and inserting November 21, 2025 . 205. Extension of funding outreach and assistance for low-income programs (a) State health insurance assistance programs Subsection (a)(1)(B)(xiv) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 ( 42 U.S.C. 1395b–3 note) is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (b) Area agencies on aging Subsection (b)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (c) Aging and disability resource centers Subsection (c)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $10,000,000 and inserting November 21, 2025, $10,712,329 . (d) Coordination of efforts To inform older Americans about benefits available under Federal and State programs Subsection (d)(2)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . 206. 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 October 1, 2025 and inserting November 22, 2025 . 207. Extension of certain telehealth flexibilities (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 ending September 30, 2025 and inserting ending November 21, 2025 ; and (2) in paragraph (4)(C)(iii), by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (b) Expanding practitioners eligible To furnish 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 September 30, 2025 and inserting ending on November 21, 2025 . (c) Extending telehealth services for federally qualified health centers and rural health clinics Section 1834(m)(8)(A) of the Social Security Act ( 42 U.S.C. 1395m(m)(8)(A) ) is amended by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (d) Delaying the in-Person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology (1) Delay in requirements for mental health services furnished through telehealth 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 October 1, 2025 and inserting on or after November 22, 2025 . (2) Mental health visits furnished by rural health clinics Section 1834(y)(2) of the Social Security Act ( 42 U.S.C. 1395m(y)(2) ) is amended by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 . (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 September 30, 2025 and inserting ending on November 21, 2025 . (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 by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (g) Program instruction authority The Secretary of Health and Human Services may implement the amendments made by this section through program instruction or otherwise. 208. Extending acute hospital care at home waiver authorities Section 1866G(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc–7(a)(1) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 209. Extension of temporary inclusion of authorized oral antiviral drugs as covered part D drugs Section 1860D–2(e)(1)(C) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(1)(C) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 210. Extension of funding for Medicare hospice surveys Section 3(a)(2) of the IMPACT Act of 2014 ( Public Law 113–185 ) is amended— (1) in subparagraph (A), by striking and at the end; (2) in subparagraph (B), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new subparagraph: (C) $6,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . 211. Medicare improvement fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended— (1) by striking fiscal year 2026 and inserting fiscal year 2027 ; and (2) by striking $1,804,000,000 and inserting $664,000,000 . III Human Services 301. Sexual risk avoidance education extension Section 510 of the Social Security Act ( 42 U.S.C. 710 ) is amended— (1) in subsection (a)— (A) in paragraph (1)— (i) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (ii) by striking fiscal year 2024 and inserting fiscal year 2026 ; and (B) in paragraph (2)— (i) in subparagraph (A)— (I) by striking through 2023 and inserting through 2025 ; (II) by striking fiscal year 2024 or 2025 and inserting fiscal year 2026 ; and (III) by inserting (or, with respect to the applicable period, for fiscal year 2026) after an application for the fiscal year ; and (ii) in subparagraph (B)(i), by striking 2024 or 2025 and inserting 2026 ; and (2) in subsection (f)(1) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the period at the end of the corresponding sentence for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 302. Personal responsibility education extension Section 513 of the Social Security Act ( 42 U.S.C. 713 ) is amended— (1) in subsection (a)(1)— (A) in subparagraph (A), in the matter preceding clause (i), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (B) in subparagraph (B)(i), by striking the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting fiscal years 2024 and 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; (2) in subsection (c)(3), by striking 2024 or 2025 and inserting 2026 ; and (3) in subsection (f), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 303. Extension of funding for family-to-family health information centers Section 501(c)(1)(A) of the Social Security Act ( 42 U.S.C. 701(c)(1)(A) ) is amended— (1) in clause (vii), by striking and at the end; (2) in clause (viii), by adding ; and at the end; and (3) by adding at the end the following new clause: (ix) $854,795 for the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025. . IV Medicaid 401. 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 inserting and a portion of fiscal year 2026 after 2025 ; and (2) by inserting , and the DSH allotment for Tennessee for the portion of fiscal year 2026 beginning October 1, 2025, and ending November 21, 2025, shall be $7,564,932 before the period. (b) 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)— (i) in the matter preceding subclause (I), by striking For each of fiscal years 2026 through 2028 and inserting For the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; (ii) in subclause (I), by inserting or period after the fiscal year ; and (iii) in subclause (II), by inserting or period after in the fiscal year ; and (B) in clause (ii), by striking for each of fiscal years 2026 through 2028 and inserting for the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; and (2) in paragraph (8), by striking 2027 and inserting 2028 . V Food and Drug Administration 501. Short title This title may be cited as the Over-the-Counter Monograph Drug User Fee Amendments . 502. Finding Congress finds that the fees authorized by the amendments made in this title will be dedicated to over-the-counter (OTC) monograph drug activities, as set forth in the goals identified for purposes of part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), in the letters from the Secretary of Health and Human Services to the Chairman of the Committee on Energy and Commerce of the House of Representatives and the Chairman of the Committee on Health, Education, Labor, and Pensions of the Senate, as set forth in the Congressional Record. 503. Definitions Section 744L(9)(A) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71(9)(A) ) is amended— (1) in clause (v), by striking ; or and inserting a semicolon; (2) in clause (vi)— (A) by striking addition and inserting the addition ; and (B) by striking the period and inserting ; or ; and (3) by adding at the end the following: (vii) the addition or modification of a testing procedure applicable to one or more OTC monograph drugs, provided that such additional or modified testing procedure reflects a voluntary consensus standard with respect to pharmaceutical quality that is— (I) established by a national or international standards development organization; and (II) recognized by the Secretary through a process described in guidance for industry, initially published in July 2023, or any successor guidance, publicly available on the website of the Food and Drug Administration, which addresses voluntary consensus standards for pharmaceutical quality. . 504. Authority to assess and use OTC monograph fees (a) Types of fees Section 744M(a)(1) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(a)(1) ) is amended— (1) in subparagraph (A)— (A) by striking on December 31 of the fiscal year or at any time during the preceding 12-month period and inserting at any time during the applicable period specified in clause (ii) for a fiscal year ; (B) by striking Each person and inserting the following: (i) Assessment of fees Each person ; and (C) by adding at the end the following: (ii) Applicable period For purposes of clause (i), the applicable period is— (I) for fiscal year 2026, the 12-month period ending on December 31, 2025; (II) for fiscal year 2027, the 9-month period ending on September 30, 2026; and (III) for fiscal year 2028 and each subsequent fiscal year, the 12-month period ending on September 30 of the preceding fiscal year. ; (2) in subparagraph (B)(i), by amending subclause (I) to read as follows: (I) has ceased all activities related to OTC monograph drugs prior to— (aa) for purposes of fiscal year 2026, January 1, 2025; (bb) for purposes of fiscal year 2027, January 1, 2026; and (cc) for purposes of fiscal year 2028 and each subsequent fiscal year, October 1 of the preceding fiscal year; and ; and (3) by amending subparagraph (D) to read as follows: (D) Due date (i) Fiscal year 2026 For fiscal year 2026, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day of June of such year; or (II) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year. (ii) Fiscal year 2027 For fiscal year 2027, the facility fees required under subparagraph (A) shall be due— (I) in a first installment representing 50 percent of such fee, on the later of— (aa) October 1, 2026; or (bb) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year; and (II) in a second installment representing the remaining 50 percent of such fee, on— (aa) February 1, 2027; or (bb) if an appropriations Act described in subclause (I)(bb) is not in effect on February 1, 2027, the first business day after enactment of such an appropriations Act. (iii) Subsequent fiscal years For fiscal year 2028 and each subsequent fiscal year, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day on or after October 1 of the fiscal year; or (II) the first business day after the date of enactment of an appropriations Act providing for the collection and obligation of fees under this section for the fiscal year. . (b) Fee revenue amounts Section 744M(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(b) ) is amended to read as follows: (b) Fee revenue amounts (1) In general For each of the fiscal years 2026 through 2030, fees under subsection (a)(1) shall be established to generate a total facility fee revenue amount equal to the sum of— (A) the annual base revenue for the fiscal year (as determined under paragraph (2)); (B) the dollar amount equal to the inflation adjustment for the fiscal year (as determined under subsection (c)(1)); (C) the dollar amount equal to the operating reserve adjustment for the fiscal year, if applicable (as determined under subsection (c)(2)); (D) additional direct cost adjustments (as determined under subsection (c)(3)); (E) an additional dollar amount equal to— (i) $2,373,000 for fiscal year 2026; (ii) $1,233,000 for fiscal year 2027; and (iii) $854,000 for fiscal year 2028; and (F) in the case of a fiscal year for which the Secretary applies the one-time facility fee workload adjustment under subsection (c)(4), the dollar amount equal to such adjustment. (2) Annual base revenue For purposes of paragraph (1), the dollar amount of the annual base revenue for a fiscal year shall be— (A) for fiscal year 2026, the dollar amount of the total revenue amount established for fiscal year 2025 under this subsection as in effect on the day before the date of enactment of the Over-the-Counter Monograph Drug User Fee Amendments , not including any adjustments made for such fiscal year 2025 under subsection (c)(2), as so in effect; and (B) for fiscal years 2027 through 2030, the dollar amount of the total revenue amount established under this subsection for the previous fiscal year, not including any adjustments made for such previous fiscal year under subsection (c)(2) or (c)(3). . (c) Adjustments; annual fee setting Section 744M(c) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(c) ) is amended— (1) in paragraph (1)— (A) in subparagraph (A), in the matter preceding clause (i)— (i) by striking subsection (b)(2)(B) and inserting subsection (b)(1)(B) ; and (ii) by striking fiscal year 2022 and each subsequent fiscal year and inserting each fiscal year ; (B) in subparagraph (B), by striking fiscal year 2022 and all that follows through the period at the end and inserting the following: a fiscal year shall be equal to the product of— (i) for fiscal year 2026— (I) the fee for fiscal year 2025 under subsection (a)(2); and (II) the inflation adjustment percentage under subparagraph (C); and (ii) for each of fiscal years 2027 through 2030— (I) the applicable fee under subsection (a)(2) for the preceding fiscal year; and (II) the inflation adjustment percentage under subparagraph (C). ; and (C) in subparagraph (C)— (i) in the matter preceding clause (i), by inserting the sum of after is equal to ; (ii) by striking clause (i); (iii) by redesignating subclauses (I) and (II) of clause (ii) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (iv) by striking (ii) for each of fiscal years 2024 and 2025, the sum of— ; and (v) in clause (ii), as so redesignated, by striking Washington-Baltimore, DC–MD–VA–WV and inserting Washington–Arlington–Alexandria–DC–VA–MD–WV ; (2) in paragraph (2)— (A) in subparagraph (A)— (i) by striking fiscal year 2021 and subsequent fiscal years and inserting each fiscal year ; (ii) by striking subsections (b)(1)(B) and (b)(2)(C) and inserting subsection (b)(1)(C) ; and (iii) by striking the number of weeks specified in subparagraph (B) and inserting 10 weeks ; (B) by striking subparagraph (B); (C) by redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively; and (D) in subparagraph (C), as so redesignated, by striking paragraph (4) establishing and inserting paragraph (5) publishing ; (3) in paragraph (3)— (A) in the matter preceding subparagraph (A), by striking subsection (b)(2)(D) and inserting subsection (b)(1)(D) ; and (B) by striking subparagraphs (A) through (E) and inserting the following: (A) $135,000 for fiscal year 2026; (B) $300,000 for fiscal year 2027; (C) $55,000 for fiscal year 2028; (D) $30,000 for fiscal year 2029; and (E) $0 for fiscal year 2030. ; and (4) by striking paragraph (4) and inserting the following: (4) One-time facility fee workload adjustment (A) In general In addition to the adjustments under paragraphs (1), (2), and (3), the Secretary may further increase the fee revenues and fees through a one-time adjustment made for fiscal year 2028, 2029, or 2030, in accordance with this paragraph. (B) Adjustment described (i) Conditions for adjustment An adjustment under this paragraph may be made for a fiscal year only if— (I) an adjustment under this paragraph had not been made for any prior fiscal year; (II) the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the period of the preceding 3 fiscal years exceeds 1,625; and (III) with respect to facilities described in subclause (II), the average number of such facilities (expressed as a percentage) that appeared on the arrears lists pursuant to subsection (e)(1)(A)(i) over the period of the preceding 3 fiscal years is less than 30 percent. (ii) Amount of adjustment An adjustment under this paragraph for a fiscal year shall equal the product of— (I) the total facility revenue amount determined under subsection (b) for the fiscal year, exclusive of the adjustment under this paragraph for such fiscal year; and (II) the excess facility percentage described in clause (iii). (iii) Excess facility percentage The excess facility percentage described in this clause is— (I) the amount by which the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the preceding 3 fiscal years exceeds 1,625; divided by (II) 1,625. (5) Annual fee setting The Secretary shall, not later than 60 days before the first day of each fiscal year— (A) establish for such fiscal year, based on the revenue amounts under subsection (b) and the adjustments provided under this subsection— (i) OTC monograph drug facility fees under subsection (a)(1); and (ii) OTC monograph order request fees under subsection (a)(2); and (B) publish such fee revenue amounts, facility fees, and OTC monograph order request fees in the Federal Register. . (d) Crediting and availability of fees Section 744M(f) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(f) ) is amended— (1) in paragraph (2)(D)— (A) in the subparagraph heading, by striking in subsequent years ; and (B) by striking (after fiscal year 2021) ; and (2) in paragraph (3), by striking 2021 through 2025 and inserting 2026 through 2030 . 505. Reauthorization; reporting requirements (a) Performance report Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) is amended— (1) in subsection (a)— (A) by striking Beginning with fiscal year 2021, and not later than 120 calendar days after the end of each fiscal year thereafter and inserting the following: (1) In general Not later than 120 calendar days after the end of each fiscal year ; (B) by striking section 3861(b) of the CARES Act and inserting section 2 of the Over-the-Counter Monograph Drug User Fee Amendments ; and (C) by adding at the end the following: (2) Additional information Beginning with fiscal year 2026, the annual report under this subsection shall include— (A) the progress of the Food and Drug Administration in achieving the goals, and future plans for meeting the goals, including— (i) the number of Tier 1 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (ii) the number of Tier 2 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iii) the number of specified safety OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iv) the number of generally recognized as safe and effective finalization OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (v) the average timeline for processing OTC monograph order requests, in the aggregate and by submission type, in the previous fiscal year; and (vi) postmarket safety activities with respect to OTC monograph drugs, including— (I) collecting, developing, and reviewing safety information on OTC monograph drugs, including adverse event reports; (II) developing and using improved analytical tools, adverse event data-collection systems, including information technology systems, to assess potential safety problems, including access to external databases; and (III) activities under section 760; (B) information regarding registration of OTC monograph drug facilities and contract manufacturing organization facilities and payment of registration fees by such facilities, including— (i) the OTC monograph drug facilities and contract manufacturing organization facilities that were first registered under section 510(c) or 510(i) in the fiscal year; and (ii) for each OTC monograph drug facility and contract manufacturing organization facility that was assessed a facility fee under section 744M(a) in the fiscal year, whether the facility paid such fee; (C) the status of implementation of evidence and testing standards under section 505G(r) for nonprescription drugs intended for topical administration, including— (i) the application of evidence or testing standards; and (ii) the number of active ingredient requests for nonprescription drugs intended for topical administration reviewed using the standards under section 505G(b); and (D) the progress of the Food and Drug Administration in allowing nonclinical testing alternatives to animal testing for the consideration of sunscreen active ingredients. (3) Confidentiality Nothing in paragraph (2) shall be construed to authorize the disclosure of information that is prohibited from disclosure under section 301(j) of this Act or section 1905 of title 18, United States Code, or that is subject to withholding under section 552(b)(4) of title 5, United States Code. ; (2) in subsection (b), by striking fiscal year 2021 and each subsequent fiscal year and inserting each fiscal year ; and (3) in subsection (d)— (A) by striking 2025 each place it appears and inserting 2030 ; and (B) by adding at the end the following: (4) Minutes of negotiation meetings (A) Public availability The Secretary shall make publicly available, on the public website of the Food and Drug Administration, robust written minutes of all negotiation meetings conducted under this subsection between the Food and Drug Administration and the regulated industry, not later than 30 days after each such negotiation meeting. (B) Content The robust written minutes described under subparagraph (A) shall contain, in detail, any substantive proposal made by any party to the negotiations as well as significant controversies or differences of opinion during the negotiations and their resolution. . (b) GAO report (1) In general Not later than September 30, 2027, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report assessing the supply chain of over-the-counter monograph drugs. (2) Contents The report required under paragraph (1) shall include an assessment of— (A) the overall stability of the supply chain of over-the-counter monograph drugs; (B) what information is collected by the Food and Drug Administration with respect to the supply chain of over-the-counter monograph drugs; (C) how the Food and Drug Administration uses information collected on the supply chain of over-the-counter monograph drugs to inform regulatory decisions; (D) how the Food and Drug Administration coordinates with other Federal agencies to monitor and mitigate disruptions to the supply chain of over-the-counter monograph drugs; and (E) the unique characteristics of the over-the-counter monograph drug marketplace and what additional authorities or information the Food and Drug Administration may need to ensure the stability of the supply chain of over-the-counter monograph drugs. 506. Treatment of active ingredients for topical administration (a) In general Section 505G of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) is amended by adding at the end the following: (r) Evidence and testing standards for active ingredients for topical administration (1) Evidence and testing standards for active ingredients for topical administration The Secretary shall— (A) in evaluating the generally recognized as safe and effective status of active ingredients used in nonprescription drugs intended for topical administration for purposes of subsection (a), utilize standards that allow for the use of real world evidence (as defined in section 505F(b)), as appropriate, as part of a comprehensive evaluation of scientific evidence to demonstrate the safety and effectiveness of such active ingredients, to supplement evidence from traditional clinical trials, provided that such standards allow the Secretary to evaluate whether the benefits of such active ingredients outweigh the risks; and (B) apply subsection (b)(6)(C) to the regulation of active ingredients used in drugs intended for topical administration. (2) Non-animal testing methods for topical active ingredients (A) In general The Secretary shall consider the types of nonclinical tests described in paragraphs (1) through (4) of the first subsection (z) of section 505 (as inserted by section 3209(a)(2) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022 (division FF of Public Law 117–328 )), or any other alternative to animal testing that the Secretary determines appropriate, in the consideration of drugs intended for topical administration under this section. (B) Guidance Not later than 1 year after the date of enactment of this subsection, the Secretary shall issue new draft guidance on how sponsors can use nonclinical testing alternatives to animal testing, as appropriate, to meet safety and efficacy standards under this section for drugs intended for topical administration. (3) Clarification Nothing in this subsection shall be construed to alter, supersede, or limit the standards for making determinations of whether a drug is generally recognized as safe and effective under section 201(p) or the standards set forth under section 505 for determining the safety and effectiveness of drugs. . (b) Sunscreen final administrative order A final administrative order on nonprescription sunscreen active ingredients issued under section 3854 of the Coronavirus Aid, Relief, and Economic Security Act ( Public Law 116–136 ; 21 U.S.C. 360fff–3 note) shall— (1) account for historical data regarding the safety of sunscreen active ingredients that have previously been accepted for marketing in the United States; (2) account for the role of broad spectrum sunscreens with a Sun Protection Factor of 15 or higher in effective skin cancer prevention; and (3) incorporate the evidence and testing standards for sunscreen active ingredients detailed in section 505G(r) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) (as added by subsection (a)). 507. Increasing the clarity and predictability of the process for developing applications for Rx-to-nonprescription switches (a) In general Section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(b) ) is amended by adding at the end the following: (7) Rx-to-nonprescription switches (A) Meetings Any person planning to submit an application for an Rx-to-nonprescription switch may submit to the Secretary a written request for a meeting, for purposes of developing a plan for such application that addresses the potential risks to public health of such switch and the evidence necessary to support such application, including the design of any necessary studies, and the format and content of the planned application. The Secretary may grant such a meeting, as appropriate, consistent with established procedures for granting meetings with, and providing written responses to, applications under this section. Each such meeting shall be documented in meeting minutes. (B) Guidance (i) In general Not later than 18 months after the date of enactment of this paragraph, the Secretary shall issue guidance to increase the clarity and predictability of the process and standards for approval of applications for nonprescription drugs under this section, including in the case of applications for an Rx-to-nonprescription switch, especially with respect to prescription drugs with well-established safety profiles for which an applicant may seek approval for nonprescription use. (ii) Contents The guidance under clause (i) shall— (I) describe how published reports in medical literature, any previous finding of safety or effectiveness for the drug under this section, the results of significant human experience with the drug, unpublished studies and other data, and other sources of information may be used to support an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch; (II) set forth procedures for sponsors to request meetings described in subparagraph (A) and document the recommendations made in such meetings; (III) describe evidentiary expectations to support approval of an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch, including how sponsors can demonstrate that consumers can appropriately self-select and use the drug and comprehend the nonprescription drug label; and (IV) provide recommendations for how mechanisms, in addition to the required Drug Facts Label, such as mobile applications and decisions aids, can be incorporated into the information submitted in support of an application for an Rx-to-nonprescription switch. (C) Plan to engage with stakeholders Not later than 1 year after the date of enactment of this paragraph, the Secretary shall develop and make publicly available on the website of the Food and Drug Administration a plan to engage stakeholders on steps and factors for application holders and other stakeholders to consider in identifying approved prescription drugs that may be promising candidates for applications for an Rx-to-nonprescription switch. (D) Definition For purposes of this paragraph, the term Rx-to-nonprescription switch means the approval of an application, or supplemental application, as applicable, submitted under this section by the holder of an approved application for a prescription drug seeking approval to market such drug as a nonprescription drug, including for— (i) a full Rx-to-nonprescription switch, under which a drug previously approved for prescription use only is— (I) approved for nonprescription use under the same conditions as applied to the drug when approved for prescription use; or (II) approved for nonprescription use subject to one or more additional conditions for nonprescription use; and (ii) a partial Rx-to-nonprescription switch, under which the drug is approved for nonprescription use only under certain conditions described in the approved labeling, while the drug otherwise remains approved for prescription use only. (E) Rule of construction Nothing in this paragraph shall be construed to— (i) supersede or modify the authority of the Secretary under section 505G with respect to the regulation of OTC monograph drugs; or (ii) authorize the disclosure by the Secretary of confidential commercial information or trade secrets. . (b) GAO Report (1) In general Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that evaluates— (A) the number of applications for an Rx-to-nonprescription switch approved during the period beginning on October 1, 2022, and ending on the date of the report; (B) the number of drugs for which an application for an Rx-to-nonprescription switch was approved during such period subject to an additional condition for nonprescription use; (C) among the drugs for which an application for a full or partial Rx-to-nonprescription switch was approved during such period, the average length of time from receipt by the Food and Drug Administration of the application to the approval of such application; (D) the number of partial Rx-to-nonprescription switch applications approved during such period, and the number of applications for such a partial switch not approved; (E) any barriers to timely and predictable review of applications for an Rx-to-nonprescription switch; (F) engagement by the Food and Drug Administration with public stakeholders, including public meetings or additional activities to support review of applications for an Rx-to-nonprescription switch; and (G) opportunities for collaboration between the Center for Drug Evaluation and Research and the Centers for Medicare & Medicaid Services for the purpose of analyzing health insurance claims data for commonly prescribed drugs that appear to be suitable for an Rx-to-nonprescription switch. (2) Definition In this subsection, the term Rx-to-nonprescription switch has the meaning given such term in paragraph (7) of section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 244(b) ), as added by subsection (a). 508. Regulation of certain nonprescription drugs that are marketed without an approved drug application (a) Development advice to sponsors or requestors Section 505G(h) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(h) ) is amended by striking sponsors or requestors and inserting sponsors, requestors, or organizations nominated by sponsors or requestors to represent their interests in a proceeding . (b) Technical correction Section 505G(b)(2)(A)(iv)(III) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(b)(2)(A)(iv)(III) ) is amended by striking requestors and inserting sponsors or requestors . 509. Sunset dates (a) Authorization Sections 744L and 744M of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 ; 379j–72) shall cease to be effective October 1, 2030. (b) Reporting requirements Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) shall cease to be effective January 31, 2031. 510. Effective date The amendments made by this title shall take effect on October 1, 2025, or the date of the enactment of this Act, whichever is later, except that fees under part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ) shall be assessed beginning October 1, 2025, regardless of the date of the enactment of this Act. 511. Savings clause Notwithstanding the amendments made by this title, part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), as in effect on the day before the date of enactment of this Act, shall continue to be in effect with respect to assessing and collecting any fee required by such part for a fiscal year prior to fiscal year 2026. VI No Surprises Act Implementation 601. Extending availability of funding for No Surprises Act implementation Section 118(a) of division BB of the Consolidated Appropriations Act, 2021 ( Public Law 116–260 ) is amended— (1) by striking otherwise appropriated, to the Secretary of Health and Human Services and inserting the following: otherwise appropriated— (1) to the Secretary of Health and Human Services ; (2) in paragraph (1), as so inserted, by striking September 30, 2025. and inserting November 21, 2025; and ; and (3) by adding at the end the following new paragraph: (2) to the Secretary of Health and Human Services, in addition to amounts otherwise appropriated under paragraph (1), $15,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . D DEPARTMENT OF VETERANS AFFAIRS EXTENDERS I Health Care Matters 101. Extension of authority for collection of copayments for hospital care and nursing home care Section 1710(f)(2)(B) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 102. Extension of requirement to provide nursing home care to certain veterans with service-connected disabilities Section 1710A(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 103. Extension of Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Section 201(j) of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 ( Public Law 116–171 ; 38 U.S.C. 1720F note) is amended by striking the date that is three years after the date on which the first grant is awarded under this section and inserting November 21, 2025 . 104. Extension of funding for expansion of Rural Access Network for Growth Enhancement Program Section 2(d) of the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 ( Public Law 117–21 ; 38 U.S.C. 1712A note) is amended by striking 2025 and inserting 2026 . II Benefits 201. Extension of requirement for quarterly briefings on administration of authorities relating to determinations regarding presumptions of service connection based on toxic exposure Section 202(b)(2) of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 ( Public Law 117–168 ) is amended by striking On a quarterly basis during the two-year period beginning on the date of the enactment of this Act, and inserting On a quarterly basis during the period beginning on the date of the enactment of this Act and ending on December 31, 2026, . 202. Extension of requirement relating to restoration of entitlement to educational assistance in cases of closure or disapproval of educational institutions Section 3699(c)(2)(C) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 203. Extension of temporary clarification of licensure requirements for contractor medical professionals to perform medical disability examinations for the Department of Veterans Affairs under pilot program for use of contract physicians for disability examinations Section 2002(a)(4) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 ( Public Law 116–315 ; 38 U.S.C. 5101 note) is amended by striking five years and inserting six years . 204. Extension of authority to maintain regional office in Republic of Philippines Section 315(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . III Housing 301. Extension of authorization of appropriations for homeless women veterans and homeless veterans with children reintegration grant program Section 2021A(f)(1) of title 38, United States Code, is amended by striking 2025 and inserting 2026 . 302. Extension of authority for treatment and rehabilitation for seriously mentally ill and homeless veterans (a) General treatment Section 2031(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Additional services at certain locations Section 2033(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 303. Extension of funding for financial assistance for supportive services for very low-income veteran families in permanent housing Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $92,000,000 shall be available until November 21, 2025, to carry out subsections (a), (b), and (c) of section 2044 of title 38, United States Code. 304. Extension of funding for grant program for homeless veterans with special needs Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $833,333 shall be available until November 21, 2025, for the purposes of the program under section 2061 of title 38, United States Code. 305. Extension of authority to provide assistance for specially adapted housing for disabled veterans residing temporarily in housing owned by a family member Section 2102A(e) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 306. Extension of authority for specially adapted housing assistive technology grant program Section 2108(g) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 307. Improvements to Partial Claim Program of the Department of Veterans Affairs (a) Clarification of relationship to other powers of Secretary Section 3720(h) of title 38, United States Code, is amended by striking of subsection (a) and all that follows through the period at the end and inserting of subsection (a) in conjunction with the purchase of a loan under section 3732(a)(2) of this title unless the Secretary determines the purchase would be made consistent with section 3732(d) of this title. . (b) Administration of Partial Claim Program Section 3737 of such title is amended— (1) in subsection (b)(2), by striking first lien guaranteed loan for such property and inserting amount of indebtedness under the guaranteed loan that the Secretary does not purchase ; and (2) in subsection (c)— (A) in paragraph (2)(B)(ii), by striking 120 days and inserting 180 days ; and (B) by amending paragraph (3) to read as follows: (3) An amount paid to the holder of a loan as a partial claim— (A) shall not alter the guaranty calculation specified by section 3703 of this title; (B) shall be included, for the purpose of a liquidation sale, in the same manner as any other advance allowed by the Secretary; and (C) shall not be claimed under the guaranty or increase the Secretary’s cost of acquisition of the property securing the defaulted loan. . (c) Requirements of loan holder Section (d)(1) of such section is amending by inserting and servicing the loan after documents . (d) Default and foreclosure Subsection (e) of such section is amended— (1) in paragraph (1)— (A) in subparagraph (A), by striking an individual who and all that follows through the period at the end and inserting the following: a borrower who defaults on a partial claim shall be liable to the Secretary for any loss suffered by the Secretary with respect to such default, and such loss may be recovered in the same manner as any other debt due the United States. The Secretary shall not restore housing loan entitlement under section 3702(b) of this title until such loss is repaid in full. ; and (B) by amending subparagraph (B) to read as follows: (B) The Secretary may charge administrative costs, fees, and interest, as appropriate, with respect to any default under a partial claim in a manner similar to the interest and administrative costs charged under section 5315 of this title. ; and (2) by amending paragraph (2) to read as follows: (2) Notwithstanding section 2410 of title 28, a nonjudicial sale of real property to satisfy a loan guaranteed under this chapter shall discharge the property from a partial claim interest held by the Secretary, provided that the holder of the guaranteed loan conducts the non-judicial sale and distributes the sale proceeds, if any, in accordance with the State or local law where such property is situated. . (e) Guidance in advance of regulations Subsection (h) of such section is amended to read as follows: (h) Guidance in advance of regulations Notwithstanding any other provision of law, the Secretary may, before prescribing regulations, issue administrative guidance with respect to the Partial Claim Program under this section and the loss mitigation options prescribed under section 3732(d) of this title, including any additional terms, conditions, and requirements the Secretary determines necessary. . 308. Government Accountability Office reports on Partial Claim Program of the Department of Veterans Affairs and other matters (a) Annual reports (1) In general Not later than one year after the date of the enactment of this Act, and every year thereafter until the Partial Claim Program terminates, the Comptroller General of the United States shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report. (2) Elements Each report required by paragraph (1) shall include, for the period covered by the report and disaggregated by quarter, the following: (A) Key data on the performance of the Partial Claim Program, including— (i) the number of partial claims filed and approved; and (ii) the redefault and foreclosure rates of loans for which a partial claim was made. (B) A comparison of the data described in subparagraph (A) with data on the performance of other loss mitigation options provided by the Department of Veterans Affairs. (C) The number of housing loans insured, guaranteed, or made by the Secretary of Veterans Affairs under chapter 37 of title 38, United States Code. (D) The number of applications for housing loan benefits under such chapter denied. (E) The number of housing loans insured, guaranteed, or made by the Secretary under such chapter refinanced under section 3710(a)(8) or 3712 of title 38, United States Code. (F) The number of veterans who owe a payment on a mortgage associated with a loan insured, guaranteed, or made by the Secretary under such chapter that is at least— (i) 60 days late; and (ii) 90 days late. (b) Assessment (1) In general Not later than one year before the Partial Claim Program terminates, the Comptroller General shall— (A) conduct an assessment of the benefits and challenges of the Partial Claim Program; and (B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Comptroller General with respect to that assessment. (2) Considerations In conducting the assessment required by paragraph (1), the Comptroller General shall consider the following: (A) The characteristics of borrowers for whom a partial claim was made compared to the characteristics of borrowers provided other loss mitigation options by the Department of Veterans Affairs. (B) The performance of loans guaranteed under chapter 37 of title 38, United States Code, following various loss mitigation actions. (C) The information the Department considered in determining whether a borrower would benefit from a partial claim compared to other loss mitigation options. (D) The costs to taxpayers of the Partial Claim Program compared to the costs of other loss mitigation options provided by the Department. (E) Any similarities and differences in the Department's administration and use of the Partial Claim Program compared to the Department's administration and use of the COVID–19 Veterans Assistance Partial Claim Payment program established under subpart F of part 36 of title 38, Code of Regulations. (F) The information the Department learned from the COVID–19 Veterans Assistance Partial Claim Payment program and the extent to which those lessons learned were applied to the Partial Claim Program. (G) The types of information the Department collected to monitor the performance and effectiveness of the Partial Claim Program and how the Department used that information to make any needed adjustments to the program. (H) How the use by the Department of partial claims compares to the use of partial claims by other Federal housing agencies, including, for each partial claim program— (i) the volume of loans for which partial claims have been made; (ii) the results for borrowers (including redefault and foreclosure rates); and (iii) the costs to taxpayers. (c) Partial Claim Program defined In this section, the term Partial Claim Program means the Partial Claim Program of the Department of Veterans Affairs carried out under section 3737 of title 38, United States Code. IV Other Matters 401. Extension of subpoena authority of Inspector General of Department of Veterans Affairs Section 312(d)(7)(A) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 402. Extension of authority for Secretary of Veterans Affairs to transport individuals to and from facilities of Department of Veterans Affairs Section 111A(a)(2) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 403. Extension of authority relating to vendee loan program Section 3733(a)(8) of title 38, United States Code, is amended— (1) in the matter preceding subparagraph (A), by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in subparagraph (C), by striking September 30, 2025 and inserting November 21, 2025 . 404. Extension of authority for transfer of real property Section 8118(a)(5) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . E MISCELLANEOUS 101. BUDGETARY EFFECTS (a) Statutory PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010. (b) Senate PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). (c) Classification of Budgetary Effects Notwithstanding Rule 3 of the Budget Scorekeeping Guidelines set forth in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217 and section 250(c)(8) of the Balanced Budget and Emergency Deficit Control Act of 1985, the budgetary effects of divisions B through D shall not be estimated— (1) for purposes of section 251 of such Act; (2) for purposes of an allocation to the Committee on Appropriations pursuant to section 302(a) of the Congressional Budget Act of 1974; and (3) for purposes of paragraph (4)(C) of section 3 of the Statutory Pay-As-You-Go Act of 2010 as being included in an appropriation Act.

Passed the House of Representatives September 19, 2025. Kevin F. McCumber, Clerk.

September 19 (legislative day, September 16), 2025 Received, read twice and ordered placed on the calendar

tv_txt: I 119th CONGRESS 1st Session H. R. 5371 IN THE HOUSE OF REPRESENTATIVES AN ACT Making continuing appropriations and extensions for fiscal year 2026, and for other purposes.

1. SHORT TITLE This Act may be cited as the Continuing Appropriations and Extensions Act, 2026 . 2. TABLE OF CONTENTS The table of contents for this Act is as follows: Sec. 1. SHORT TITLE. Sec. 2. TABLE OF CONTENTS. Sec. 3. REFERENCES. Division A—CONTINUING APPROPRIATIONS ACT, 2026 Division B—MISCELLANEOUS EXTENSIONS Division C—HEALTH EXTENDERS Title I—Public Health Extenders Title II—Medicare Title III—Human Services Title IV—Medicaid Title V—Food and Drug Administration Title VI—No Surprises Act Implementation Division D—DEPARTMENT OF VETERANS AFFAIRS EXTENDERS Title I—Health Care Matters Title II—Benefits Title III—Housing Title IV—Other Matters Division E—MISCELLANEOUS 3. REFERENCES Except as expressly provided otherwise, any reference to this Act contained in any division of this Act shall be treated as referring only to the provisions of that division. A CONTINUING APPROPRIATIONS ACT, 2026 The following sums are hereby appropriated, out of any money in the Treasury not otherwise appropriated, and out of applicable corporate or other revenues, receipts, and funds, for the several departments, agencies, corporations, and other organizational units of Government for fiscal year 2026, and for other purposes, namely: 101. Such amounts as may be necessary, at a rate for operations as provided in the applicable appropriations Acts for fiscal year 2025 and under the authority and conditions provided in such Acts, for continuing projects or activities (including the costs of direct loans and loan guarantees) that are not otherwise specifically provided for in this Act, that were conducted in fiscal year 2025, and for which appropriations, funds, or other authority were made available in the Full-Year Continuing Appropriations Act, 2025 (division A of Public Law 119–4 ), except sections 1110, 1113, 1114, and 1207; the proviso in paragraph (4) of section 1602; and sections 1708 and 1808; and except section 11104 shall be applied by substituting 2020, and 2021 for and 2020 ; and except sections 774 and 778 of division B, section 540 of division C, and sections 110 and 112 of division D of Public Law 118–42 as continued in effect by section 1101 of division A of Public Law 119–4 ; and except section 7069(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . 102. (a) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used for: (1) the new production of items not funded for production in fiscal year 2025 or prior years; (2) the increase in production rates above those sustained with fiscal year 2025 funds; or (3) the initiation, resumption, or continuation of any project, activity, operation, or organization (defined as any project, subproject, activity, budget activity, program element, and subprogram within a program element, and for any investment items defined as a P–1 line item in a budget activity within an appropriation account and an R–1 line item that includes a program element and subprogram element within an appropriation account) for which appropriations, funds, or other authority were not available during fiscal year 2025. (b) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used to initiate multi-year procurements utilizing advance procurement funding for economic order quantity procurement unless specifically appropriated later. 103. Appropriations made by section 101 shall be available to the extent and in the manner that would be provided by the pertinent appropriations Act. 104. Except as otherwise provided in section 102, no appropriation or funds made available or authority granted pursuant to section 101 shall be used to initiate or resume any project or activity for which appropriations, funds, or other authority were not available during fiscal year 2025. 105. Appropriations made and authority granted pursuant to this Act shall cover all obligations or expenditures incurred for any project or activity during the period for which funds or authority for such project or activity are available under this Act. 106. Unless otherwise provided for in this Act or in the applicable appropriations Act for fiscal year 2026, appropriations and funds made available and authority granted pursuant to this Act shall be available until whichever of the following first occurs: (1) The enactment into law of an appropriation for any project or activity provided for in this Act. (2) The enactment into law of the applicable appropriations Act for fiscal year 2026 without any provision for such project or activity. (3) November 21, 2025. 107. Expenditures made pursuant to this Act shall be charged to the applicable appropriation, fund, or authorization whenever a bill in which such applicable appropriation, fund, or authorization is contained is enacted into law. 108. Appropriations made and funds made available by or authority granted pursuant to this Act may be used without regard to the time limitations for submission and approval of apportionments set forth in section 1513 of title 31, United States Code, but nothing in this Act may be construed to waive any other provision of law governing the apportionment of funds. 109. Notwithstanding any other provision of this Act, except section 106, for those programs that would otherwise have high initial rates of operation or complete distribution of appropriations at the beginning of fiscal year 2026 because of distributions of funding to States, foreign countries, grantees, or others, such high initial rates of operation or complete distribution shall not be made, and no grants shall be awarded for such programs funded by this Act that would impinge on final funding prerogatives. 110. This Act shall be implemented so that only the most limited funding action of that permitted in the Act shall be taken in order to provide for continuation of projects and activities. 111. (a) For entitlements and other mandatory payments whose budget authority was provided in an appropriations Act specified in section 101, for expenses authorized under section 324 of title 38, United States Code, and for activities under the Food and Nutrition Act of 2008, activities shall be continued at the rate to maintain program levels under current law, under the authority and conditions provided in the applicable appropriations Act, to be continued through the date specified in section 106(3) of this Act. (b) Notwithstanding section 106, obligations for mandatory payments due on or about the first day of any month that begins after October 2025 but not later than 30 days after the date specified in section 106(3) may continue to be made, and funds shall be available for such payments. 112. Amounts made available under section 101 for civilian personnel compensation and benefits in each department and agency may be apportioned up to the rate for operations necessary to avoid furloughs within such department or agency, consistent with the applicable appropriations Act for fiscal year 2025, except that such authority provided under this section shall not be used until after the department or agency has taken all necessary actions to reduce or defer non-personnel-related administrative expenses. 113. Funds appropriated by this Act may be obligated and expended notwithstanding section 10 of Public Law 91–672 ( 22 U.S.C. 2412 ), section 15 of the State Department Basic Authorities Act of 1956 ( 22 U.S.C. 2680 ), section 313 of the Foreign Relations Authorization Act, Fiscal Years 1994 and 1995 ( 22 U.S.C. 6212 ), and section 504(a)(1) of the National Security Act of 1947 ( 50 U.S.C. 3094(a)(1) ). 114. (a) (1) For each amount incorporated by reference in this Act that was previously designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985, each provision of law designating each such amount as an emergency requirement pursuant to such section shall not apply. (2) Each amount incorporated by reference in this Act that was designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 in the following provisions of law are designated by the Congress as an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives: section 11206(4) of division A of Public Law 119–4 and 7068(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . (b) Each amount incorporated by reference in this Act that was previously designated by the Congress as being for disaster relief pursuant to section 251(b)(2)(D) of the Balanced Budget and Emergency Deficit Control Act of 1985 is designated by the Congress as being for disaster relief pursuant to a concurrent resolution on the budget. (c) Each amount incorporated by reference in this Act that was previously designated in division B of Public Law 117–159 , division J of Public Law 117–58 , or in section 443(b) of division G of Public Law 117–328 by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget shall continue to be treated as an amount specified in section 103(b) of division A of Public Law 118–5 . 115. (a) Rescissions or cancellations of discretionary budget authority that continue pursuant to section 101 in Treasury Appropriations Fund Symbols (TAFS)— (1) to which other appropriations are not provided by this Act, but for which there is a current applicable TAFS that does receive an appropriation in this Act; or (2) which are no-year TAFS and receive other appropriations in this Act, may be continued instead by reducing the rate for operations otherwise provided by section 101 for such current applicable TAFS, as long as doing so does not impinge on the final funding prerogatives of the Congress. (b) Rescissions or cancellations described in subsection (a) shall continue in an amount equal to the lesser of— (1) the amount specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act; or (2) the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act. (c) No later than November 7, 2025, the Director of the Office of Management and Budget shall provide to the Committees on Appropriations of the House of Representatives and the Senate a comprehensive list of the rescissions or cancellations that will continue pursuant to section 101: Provided , That the information in such comprehensive list shall be periodically updated to reflect any subsequent changes in the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101, and such updates shall be transmitted to the Committees on Appropriations of the House of Representatives and the Senate upon request. 116. Amounts made available by section 101 for Domestic Food Programs—Food and Nutrition Service—Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be apportioned at the rate for operations necessary to maintain participation. 117. Section 260 of the Agricultural Marketing Act of 1946 ( 7 U.S.C. 1636i ) and section 942 of the Livestock Mandatory Reporting Act of 1999 ( 7 U.S.C. 1635 note; Public Law 106–78 ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 118. Section 8302(b) of the Agricultural Act of 2014 ( 16 U.S.C. 3851a(b) ) shall be applied by substituting the date specified in section 106 of this Act for October 1, 2023 . 119. (a) Amounts made available by section 101 for Department of Justice—United States Marshals Service—Salaries and Expenses may be apportioned up to the rate for operations necessary to maintain program operations. (b) In addition to amounts provided by section 101, for Department of Justice—United States Marshals Service—Salaries and Expenses , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until September 30, 2027, to carry out protective operations. 120. (a) For the closeout of all Space Shuttle contracts and associated programs, amounts that have expired but have not been cancelled in the Exploration, Space Operations, Human Space Flight, Space Flight Capabilities, and Exploration Capabilities appropriations accounts shall remain available through fiscal year 2030 for the liquidation of valid obligations incurred during the period of fiscal year 2001 through fiscal year 2013. (b) (1) Subject to paragraph (2), this section shall become effective immediately upon enactment of this Act. (2) If this Act is enacted after September 30, 2025, this section shall be applied as if it were in effect on September 30, 2025. 121. Section 3014(a) of title 18, United States Code, shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 122. Notwithstanding section 101, the first proviso in each of sections 8092 and 8096 of title VIII of division A of Public Law 118–47 shall be applied by substituting advances for reimbursements . 123. Notwithstanding sections 102 and 104, amounts made available by section 101 to the Department of Defense for Research, Development, Test and Evaluation, Air Force shall be apportioned up to the rate for operations necessary for the E–7 Wedgetail program, in an amount not to exceed $199,676,000, only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 124. Of the unobligated balance of funds available to the Department of Defense for the E–7 program under the heading Aircraft Procurement, Air Force in Public Law 119–4 , $200,000,000 is hereby transferred to and merged with amounts available for the E–7 program under the heading Research, Development, Test and Evaluation, Air Force only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 125. Section 717(a) of the Defense Production Act of 1950 ( 50 U.S.C. 4564(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 126. Notwithstanding sections 102 and 104, amounts made available by section 101 of this Act to the Department of Defense for Shipbuilding and Conversion, Navy may be apportioned up to the rate for operations necessary to fund completion of prior year shipbuilding programs for the fiscal year 2016 and fiscal year 2018 Virginia Class Submarine Programs, in an amount not to exceed $154,000,000. 127. During the period covered by this Act, section 103(f)(4)(A) of Public Law 108–361 (the Calfed Bay-Delta Authorization Act) shall be applied by substituting $32,600,000 for $30,000,000 . 128. (a) Amounts made available by section 101 in the first proviso under the heading Department of Energy—Atomic Energy Defense Activities—National Nuclear Security Administration—Weapons Activities may be apportioned up to the rate for operations necessary to maintain current operations for the safe, secure transport of nuclear weapons. (b) The Director of the Office of Management and Budget and the Secretary of Energy shall notify the Committees on Appropriations of the House of Representatives and the Senate not later than 3 days after each use of the authority provided in subsection (a). 129. Notwithstanding section 101, the matter preceding the first proviso under the heading Office of Personnel Management—Salaries and Expenses in title V of division B of Public Law 118–47 shall be applied by substituting $197,446,000 for $219,076,000 , and the second proviso under such heading in such title of such division of such Act shall be applied by substituting $214,605,000 for $192,975,000 . 130. Notwithstanding any other provision of this Act, except section 106, the District of Columbia may expend local funds made available under the heading District of Columbia—District of Columbia Funds for such programs and activities under the District of Columbia Appropriations Act, 2024 (title IV of division B of Public Law 118–47 ) at the rate set forth in the Fiscal Year 2026 Local Budget Act of 2025 (D.C. Bill No. 26–260) as modified as of the date of enactment of this Act. 131. Notwithstanding section 101, paragraph (1) under the heading Department of the Treasury—Departmental Offices—Salaries and Expenses in title I of division B of Public Law 118–47 shall be applied by substituting $1,350,000 for $350,000 : Provided, That such amounts may be obligated in the account and budget structure set forth in the fiscal year 2026 President’s Budget, submitted pursuant to section 1105(a) of title 31, United States Code, and accompanying justification materials. 132. Amounts made available by section 101 for Small Business Administration—Business Loans Program Account may be apportioned up to the rate for operations necessary to accommodate increased demand for commitments for general business loans authorized under paragraphs (1) through (35) of section 7(a) of the Small Business Act ( 15 U.S.C. 636(a) ), for commitments to guarantee trust certificates authorized by section 5(g) of the Small Business Act ( 15 U.S.C. 634(g) ), for commitments to guarantee loans under section 503 of the Small Business Investment Act of 1958 ( 15 U.S.C. 697 ), and for commitments to guarantee debentures under section 303(b) of the Small Business Investment Act of 1958 ( 15 U.S.C. 683(b) ). 133. Notwithstanding section 101, amounts are provided for Department of the Treasury—Office of Terrorism and Financial Intelligence—Salaries and Expenses at a rate for operations of $237,662,000. 134. Notwithstanding section 101, section 1605 of Public Law 119–4 shall be applied by substituting through the end of the last applicable pay period that commences on or before the date specified in section 106(3) of the Continuing Appropriations Act, 2026 for through the date specified in section 1106 of this Act . 135. Section 1(b) of Public Law 117–25 (135 Stat. 297; 136 Stat. 2133; 136 Stat. 5984; 138 Stat. 1771; 139 Stat. 46) shall be applied in each of paragraphs (3) and (4) by substituting the date specified in section 106 of this Act for September 30, 2025 . 136. In addition to amounts otherwise provided by section 101 for The Judiciary—Supreme Court of the United States—Salaries and Expenses , there is appropriated $28,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for the protection of the Supreme Court Justices, including the purchase and hire of passenger motor vehicles as authorized by 31 U.S.C. 1343 and 1344, to be expended as the Chief Justice may approve. 137. Section 210G(i) of the Homeland Security Act of 2002 ( 6 U.S.C. 124n(i) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 138. Section 225(e) of division A of Public Law 116–6 ( 49 U.S.C. 44901 note) shall be applied by substituting fiscal year 2019 through the date specified in section 106 of the Continuing Appropriations Act, 2026 for fiscal years 2019 through 2025 . 139. Amounts made available by section 101 to the Department of Homeland Security under the heading Federal Emergency Management Agency—Disaster Relief Fund may be apportioned up to the rate for operations necessary to carry out response and recovery activities under the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ). 140. Section 227(a) of the Federal Cybersecurity Enhancement Act of 2015 ( 6 U.S.C. 1525(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 141. Section 111(a) of the Cybersecurity Information Sharing Act of 2015 ( 6 U.S.C. 1510(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 142. Section 2220A(s)(1) of the Homeland Security Act of 2002 ( 6 U.S.C. 665g(s)(1) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 143. During the period covered by this Act, section 3(b)(2)(C) of the Pittman-Robertson Wildlife Restoration Act ( 16 U.S.C. 669b(b)(2)(C) ) shall be applied by substituting 2027 for 2026 . 144. During the period covered by this Act, section 1701 of title VII of division B of Public Law 117–43 , as amended, shall be applied by substituting calendar years 2021 through 2026 for 2021 or 2022 or 2023 or 2024 each place it appears. 145. Amounts made available by section 101 for Department of the Interior—Department-Wide Programs—Wildland Fire Management and Department of Agriculture—Forest Service—Wildland Fire Management may be apportioned up to the rate for operations necessary for wildfire suppression activities. 146. (a) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Services at a rate for operations of $72,265,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. (b) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Facilities at a rate for operations of $8,050,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. 147. Of the amounts made available in the third paragraph under the heading Environmental Protection Agency—State and Tribal Assistance Grants in the Disaster Relief Supplemental Appropriations Act, 2023 (division N of Public Law 117–328 ), up to $54,000,000 shall be available for technical assistance and grants under section 1442(b) of the Safe Drinking Water Act ( 42 U.S.C. 300j–1(b) ) in areas where the President declared an emergency in August of fiscal year 2022 pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ): Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and section 1(e) of H. Res. 1151 (117th Congress), as engrossed in the House of Representatives on June 8, 2022, are designated as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 148. Notwithstanding section 101, the matter under the heading Department of Health and Human Services—Administration for Children and Families—Children and Families Services Programs in title II of division D of Public Law 118–47 shall be applied by adding the following after the second proviso: Provided further , That for purposes of section 640(a)(2)(B)(v) of such Act, the base grant for each of the Federated States of Micronesia and the Republic of the Marshall Islands shall be $8,000,000, and shall be considered equal to the amount provided for base grants for such jurisdictions under such Act for the prior fiscal year: . 149. Notwithstanding any other provision of this Act, there is appropriated— (1) For payment to Ashley Paige Turner, heir of Sylvester Turner, late a Representative from the State of Texas, $174,000. (2) For payment to Ramona Grijalva, widow of Raúl M. Grijalva, late a Representative from the State of Arizona, $174,000. (3) For payment to Catherine M. Smith, widow of Gerald E. Connolly, late a Representative from the Commonwealth of Virginia, $174,000. 150. Notwithstanding any other provision of law, no adjustment shall be made under section 601(a) of the Legislative Reorganization Act of 1946 ( 2 U.S.C. 4501 ) (relating to cost of living adjustments for Members of Congress) during the period covered by this Act. 151. In addition to amounts otherwise provided by section 101, for Capitol Police—United States Capitol Police Mutual Aid Reimbursements , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for reimbursements for mutual aid and related training provided under the agreements described in section 7302 of Public Law 108–458 : Provided, That obligation of the funds made available in this section in this Act shall be subject to notification to the Chairmen and Ranking Members of the Committees on Appropriations of both Houses of Congress, the Senate Committee on Rules and Administration, and the Committee on House Administration of the amount and purpose of the expense within 15 days of obligation. 152. Notwithstanding section 101, the matter under the heading Native American Veteran Housing Loan Program Account in title II of division A of Public Law 118–42 shall be applied by adding the following new paragraph: In addition, for the cost of direct loans, $6,865,235, as authorized by subchapter V of chapter 37 of title 38, United States Code: Provided , That such costs, including the cost of modifying such loans, shall be as defined in section 502 of the Congressional Budget Act of 1974: Provided further , That funds made available under this heading are available to subsidize gross obligations for the principal amount of direct loans not to exceed $75,000,000. . 153. Section 1424(a) of the Better Utilization of Investments Leading to Development Act of 2018 ( 22 U.S.C. 9624(a) ) shall be applied by substituting the date specified in section 106 of this Act for the date that is 7 years after the date of the enactment of this Act . 154. Notwithstanding sections 101 and 106, and sections 1101, 1106, and 11201 of Public Law 119–4 , the fifth and sixth provisos under the heading Millennium Challenge Corporation in title III of division F of Public Law 118–47 shall be amended by substituting December 31, 2026 for December 31, 2024 each place it appears. 155. Notwithstanding section 106, during fiscal year 2026, the Secretary of Housing and Urban Development may use the unobligated balances of amounts made available in prior fiscal years in paragraphs (2), (3), and (8) under the heading Public and Indian Housing—Tenant-Based Rental Assistance to support additional allocations under subparagraph (D) of paragraph (1) and subparagraph (B) of paragraph (4) of such heading to prevent the termination of rental assistance for families as the result of insufficient funding in the calendar year 2025 funding cycle: Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985 are designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 156. Amounts made available by section 101 for Department of Transportation—Office of the Secretary—Payments to Air Carriers may be apportioned up to the rate for operations necessary to maintain Essential Air Service program operations. 157. Section 4144(d) of the Motor Carrier Safety Reauthorization Act of 2005 ( 49 U.S.C. 31100 note) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . This division may be cited as the Continuing Appropriations Act, 2026 . B MISCELLANEOUS EXTENSIONS 101. United States grain standards The authorities (including any limitations on the authorities) provided by each provision of the United States Grain Standards Act ( Public Law 90–487 ; 7 U.S.C. 74 et seq. ) and each provision of law amended by that Act, as in effect on September 30, 2025, shall continue, and the authorities (and any such limitations) shall be carried out, until the later of— (1) November 21, 2025; and (2) the date specified in the provision of that Act or the provision of law amended by that Act. C HEALTH EXTENDERS I Public Health Extenders 101. Extension for community health centers, National Health Service Corps, and teaching health centers that operate GME programs (a) Extension for community health centers Section 10503(b)(1) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(1) ) is amended— (1) in subparagraph (I), by striking and at the end; and (2) by adding at the end the following: (K) $606,904,110 for the period beginning on October 1, 2025, and ending on November 21, 2025; and . (b) Extension for the National Health Service Corps Section 10503(b)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(2) ) is amended— (1) in subparagraph (J), by striking and at the end; (2) in subparagraph (K), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (L) $49,150,685 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (c) Teaching health centers that operate graduate medical education programs Section 340H(g)(1) of the Public Health Service Act ( 42 U.S.C. 256h(g)(1) ) is amended— (1) in subparagraph (E), by striking and at the end; (2) in subparagraph (F), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (G) $24,931,507 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (d) Application of provisions Amounts appropriated pursuant to the amendments made by this section shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act ( 42 U.S.C. 254b et seq. ). (e) Conforming amendment Section 3014(h)(4) of title 18, United States Code, is amended by striking and section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025 and inserting section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025, and section 101(d) of title I of division C of the Continuing Appropriations and Extensions Act, 2026 . 102. Extension of special diabetes programs (a) Extension of special diabetes programs for type i diabetes Section 330B(b)(2) of the Public Health Service Act ( 42 U.S.C. 254c–2(b)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . (b) Extending funding for special diabetes programs for Indians Section 330C(c)(2) of the Public Health Service Act ( 42 U.S.C. 254c–3(c)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . 103. National health security extensions (a) Section 319(e)(8) of the Public Health Service Act ( 42 U.S.C. 247d(e)(8) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Section 319L(e)(1)(D) of the Public Health Service Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (c) Section 319L–1(b) of the Public Health Service Act (42 U.S.C. 247d–7f(b)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (d) (1) Section 2811A(g) of the Public Health Service Act (42 U.S.C. 300hh–10b(g)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (2) Section 2811B(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (3) Section 2811C(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (e) Section 2812(c)(4)(B) of the Public Health Service Act ( 42 U.S.C. 300hh–11(c)(4)(B) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . II Medicare 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), by striking in fiscal year 2026 and inserting during the portion of fiscal year 2026 beginning on November 22, 2025, 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 inserting or portion of a fiscal year after for a fiscal year ; and (ii) by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; (B) in subclause (III), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (C) in subclause (IV), by striking fiscal year 2026 and inserting the portion of fiscal year 2026 beginning on November 22, 2025, and ending on September 30, 2026, and fiscal year 2027 ; and (3) in subparagraph (D)— (A) in the matter preceding clause (i), by inserting or during the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (B) in clause (ii), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 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. 202. Extension of the Medicare-dependent hospital (MDH) program (a) In general Section 1886(d)(5)(G) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(G) ) is amended— (1) in clause (i), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in clause (ii)(II), by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 ; and (B) in clause (iv), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww note) is amended by inserting , or the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . 203. Extension of add-on payments for ambulance services Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ) is amended— (1) in paragraph (12)(A), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in paragraph (13), by striking October 1, 2025 each place it appears and inserting November 22, 2025 in each such place. 204. 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, by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in the third sentence, by striking September 30, 2025 and inserting November 21, 2025 . 205. Extension of funding outreach and assistance for low-income programs (a) State health insurance assistance programs Subsection (a)(1)(B)(xiv) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 ( 42 U.S.C. 1395b–3 note) is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (b) Area agencies on aging Subsection (b)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (c) Aging and disability resource centers Subsection (c)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $10,000,000 and inserting November 21, 2025, $10,712,329 . (d) Coordination of efforts To inform older Americans about benefits available under Federal and State programs Subsection (d)(2)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . 206. 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 October 1, 2025 and inserting November 22, 2025 . 207. Extension of certain telehealth flexibilities (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 ending September 30, 2025 and inserting ending November 21, 2025 ; and (2) in paragraph (4)(C)(iii), by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (b) Expanding practitioners eligible To furnish 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 September 30, 2025 and inserting ending on November 21, 2025 . (c) Extending telehealth services for federally qualified health centers and rural health clinics Section 1834(m)(8)(A) of the Social Security Act ( 42 U.S.C. 1395m(m)(8)(A) ) is amended by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (d) Delaying the in-Person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology (1) Delay in requirements for mental health services furnished through telehealth 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 October 1, 2025 and inserting on or after November 22, 2025 . (2) Mental health visits furnished by rural health clinics Section 1834(y)(2) of the Social Security Act ( 42 U.S.C. 1395m(y)(2) ) is amended by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 . (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 September 30, 2025 and inserting ending on November 21, 2025 . (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 by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (g) Program instruction authority The Secretary of Health and Human Services may implement the amendments made by this section through program instruction or otherwise. 208. Extending acute hospital care at home waiver authorities Section 1866G(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc–7(a)(1) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 209. Extension of temporary inclusion of authorized oral antiviral drugs as covered part D drugs Section 1860D–2(e)(1)(C) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(1)(C) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 210. Extension of funding for Medicare hospice surveys Section 3(a)(2) of the IMPACT Act of 2014 ( Public Law 113–185 ) is amended— (1) in subparagraph (A), by striking and at the end; (2) in subparagraph (B), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new subparagraph: (C) $6,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . 211. Medicare improvement fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended— (1) by striking fiscal year 2026 and inserting fiscal year 2027 ; and (2) by striking $1,804,000,000 and inserting $664,000,000 . III Human Services 301. Sexual risk avoidance education extension Section 510 of the Social Security Act ( 42 U.S.C. 710 ) is amended— (1) in subsection (a)— (A) in paragraph (1)— (i) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (ii) by striking fiscal year 2024 and inserting fiscal year 2026 ; and (B) in paragraph (2)— (i) in subparagraph (A)— (I) by striking through 2023 and inserting through 2025 ; (II) by striking fiscal year 2024 or 2025 and inserting fiscal year 2026 ; and (III) by inserting (or, with respect to the applicable period, for fiscal year 2026) after an application for the fiscal year ; and (ii) in subparagraph (B)(i), by striking 2024 or 2025 and inserting 2026 ; and (2) in subsection (f)(1) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the period at the end of the corresponding sentence for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 302. Personal responsibility education extension Section 513 of the Social Security Act ( 42 U.S.C. 713 ) is amended— (1) in subsection (a)(1)— (A) in subparagraph (A), in the matter preceding clause (i), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (B) in subparagraph (B)(i), by striking the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting fiscal years 2024 and 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; (2) in subsection (c)(3), by striking 2024 or 2025 and inserting 2026 ; and (3) in subsection (f), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 303. Extension of funding for family-to-family health information centers Section 501(c)(1)(A) of the Social Security Act ( 42 U.S.C. 701(c)(1)(A) ) is amended— (1) in clause (vii), by striking and at the end; (2) in clause (viii), by adding ; and at the end; and (3) by adding at the end the following new clause: (ix) $854,795 for the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025. . IV Medicaid 401. 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 inserting and a portion of fiscal year 2026 after 2025 ; and (2) by inserting , and the DSH allotment for Tennessee for the portion of fiscal year 2026 beginning October 1, 2025, and ending November 21, 2025, shall be $7,564,932 before the period. (b) 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)— (i) in the matter preceding subclause (I), by striking For each of fiscal years 2026 through 2028 and inserting For the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; (ii) in subclause (I), by inserting or period after the fiscal year ; and (iii) in subclause (II), by inserting or period after in the fiscal year ; and (B) in clause (ii), by striking for each of fiscal years 2026 through 2028 and inserting for the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; and (2) in paragraph (8), by striking 2027 and inserting 2028 . V Food and Drug Administration 501. Short title This title may be cited as the Over-the-Counter Monograph Drug User Fee Amendments . 502. Finding Congress finds that the fees authorized by the amendments made in this title will be dedicated to over-the-counter (OTC) monograph drug activities, as set forth in the goals identified for purposes of part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), in the letters from the Secretary of Health and Human Services to the Chairman of the Committee on Energy and Commerce of the House of Representatives and the Chairman of the Committee on Health, Education, Labor, and Pensions of the Senate, as set forth in the Congressional Record. 503. Definitions Section 744L(9)(A) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71(9)(A) ) is amended— (1) in clause (v), by striking ; or and inserting a semicolon; (2) in clause (vi)— (A) by striking addition and inserting the addition ; and (B) by striking the period and inserting ; or ; and (3) by adding at the end the following: (vii) the addition or modification of a testing procedure applicable to one or more OTC monograph drugs, provided that such additional or modified testing procedure reflects a voluntary consensus standard with respect to pharmaceutical quality that is— (I) established by a national or international standards development organization; and (II) recognized by the Secretary through a process described in guidance for industry, initially published in July 2023, or any successor guidance, publicly available on the website of the Food and Drug Administration, which addresses voluntary consensus standards for pharmaceutical quality. . 504. Authority to assess and use OTC monograph fees (a) Types of fees Section 744M(a)(1) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(a)(1) ) is amended— (1) in subparagraph (A)— (A) by striking on December 31 of the fiscal year or at any time during the preceding 12-month period and inserting at any time during the applicable period specified in clause (ii) for a fiscal year ; (B) by striking Each person and inserting the following: (i) Assessment of fees Each person ; and (C) by adding at the end the following: (ii) Applicable period For purposes of clause (i), the applicable period is— (I) for fiscal year 2026, the 12-month period ending on December 31, 2025; (II) for fiscal year 2027, the 9-month period ending on September 30, 2026; and (III) for fiscal year 2028 and each subsequent fiscal year, the 12-month period ending on September 30 of the preceding fiscal year. ; (2) in subparagraph (B)(i), by amending subclause (I) to read as follows: (I) has ceased all activities related to OTC monograph drugs prior to— (aa) for purposes of fiscal year 2026, January 1, 2025; (bb) for purposes of fiscal year 2027, January 1, 2026; and (cc) for purposes of fiscal year 2028 and each subsequent fiscal year, October 1 of the preceding fiscal year; and ; and (3) by amending subparagraph (D) to read as follows: (D) Due date (i) Fiscal year 2026 For fiscal year 2026, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day of June of such year; or (II) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year. (ii) Fiscal year 2027 For fiscal year 2027, the facility fees required under subparagraph (A) shall be due— (I) in a first installment representing 50 percent of such fee, on the later of— (aa) October 1, 2026; or (bb) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year; and (II) in a second installment representing the remaining 50 percent of such fee, on— (aa) February 1, 2027; or (bb) if an appropriations Act described in subclause (I)(bb) is not in effect on February 1, 2027, the first business day after enactment of such an appropriations Act. (iii) Subsequent fiscal years For fiscal year 2028 and each subsequent fiscal year, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day on or after October 1 of the fiscal year; or (II) the first business day after the date of enactment of an appropriations Act providing for the collection and obligation of fees under this section for the fiscal year. . (b) Fee revenue amounts Section 744M(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(b) ) is amended to read as follows: (b) Fee revenue amounts (1) In general For each of the fiscal years 2026 through 2030, fees under subsection (a)(1) shall be established to generate a total facility fee revenue amount equal to the sum of— (A) the annual base revenue for the fiscal year (as determined under paragraph (2)); (B) the dollar amount equal to the inflation adjustment for the fiscal year (as determined under subsection (c)(1)); (C) the dollar amount equal to the operating reserve adjustment for the fiscal year, if applicable (as determined under subsection (c)(2)); (D) additional direct cost adjustments (as determined under subsection (c)(3)); (E) an additional dollar amount equal to— (i) $2,373,000 for fiscal year 2026; (ii) $1,233,000 for fiscal year 2027; and (iii) $854,000 for fiscal year 2028; and (F) in the case of a fiscal year for which the Secretary applies the one-time facility fee workload adjustment under subsection (c)(4), the dollar amount equal to such adjustment. (2) Annual base revenue For purposes of paragraph (1), the dollar amount of the annual base revenue for a fiscal year shall be— (A) for fiscal year 2026, the dollar amount of the total revenue amount established for fiscal year 2025 under this subsection as in effect on the day before the date of enactment of the Over-the-Counter Monograph Drug User Fee Amendments , not including any adjustments made for such fiscal year 2025 under subsection (c)(2), as so in effect; and (B) for fiscal years 2027 through 2030, the dollar amount of the total revenue amount established under this subsection for the previous fiscal year, not including any adjustments made for such previous fiscal year under subsection (c)(2) or (c)(3). . (c) Adjustments; annual fee setting Section 744M(c) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(c) ) is amended— (1) in paragraph (1)— (A) in subparagraph (A), in the matter preceding clause (i)— (i) by striking subsection (b)(2)(B) and inserting subsection (b)(1)(B) ; and (ii) by striking fiscal year 2022 and each subsequent fiscal year and inserting each fiscal year ; (B) in subparagraph (B), by striking fiscal year 2022 and all that follows through the period at the end and inserting the following: a fiscal year shall be equal to the product of— (i) for fiscal year 2026— (I) the fee for fiscal year 2025 under subsection (a)(2); and (II) the inflation adjustment percentage under subparagraph (C); and (ii) for each of fiscal years 2027 through 2030— (I) the applicable fee under subsection (a)(2) for the preceding fiscal year; and (II) the inflation adjustment percentage under subparagraph (C). ; and (C) in subparagraph (C)— (i) in the matter preceding clause (i), by inserting the sum of after is equal to ; (ii) by striking clause (i); (iii) by redesignating subclauses (I) and (II) of clause (ii) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (iv) by striking (ii) for each of fiscal years 2024 and 2025, the sum of— ; and (v) in clause (ii), as so redesignated, by striking Washington-Baltimore, DC–MD–VA–WV and inserting Washington–Arlington–Alexandria–DC–VA–MD–WV ; (2) in paragraph (2)— (A) in subparagraph (A)— (i) by striking fiscal year 2021 and subsequent fiscal years and inserting each fiscal year ; (ii) by striking subsections (b)(1)(B) and (b)(2)(C) and inserting subsection (b)(1)(C) ; and (iii) by striking the number of weeks specified in subparagraph (B) and inserting 10 weeks ; (B) by striking subparagraph (B); (C) by redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively; and (D) in subparagraph (C), as so redesignated, by striking paragraph (4) establishing and inserting paragraph (5) publishing ; (3) in paragraph (3)— (A) in the matter preceding subparagraph (A), by striking subsection (b)(2)(D) and inserting subsection (b)(1)(D) ; and (B) by striking subparagraphs (A) through (E) and inserting the following: (A) $135,000 for fiscal year 2026; (B) $300,000 for fiscal year 2027; (C) $55,000 for fiscal year 2028; (D) $30,000 for fiscal year 2029; and (E) $0 for fiscal year 2030. ; and (4) by striking paragraph (4) and inserting the following: (4) One-time facility fee workload adjustment (A) In general In addition to the adjustments under paragraphs (1), (2), and (3), the Secretary may further increase the fee revenues and fees through a one-time adjustment made for fiscal year 2028, 2029, or 2030, in accordance with this paragraph. (B) Adjustment described (i) Conditions for adjustment An adjustment under this paragraph may be made for a fiscal year only if— (I) an adjustment under this paragraph had not been made for any prior fiscal year; (II) the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the period of the preceding 3 fiscal years exceeds 1,625; and (III) with respect to facilities described in subclause (II), the average number of such facilities (expressed as a percentage) that appeared on the arrears lists pursuant to subsection (e)(1)(A)(i) over the period of the preceding 3 fiscal years is less than 30 percent. (ii) Amount of adjustment An adjustment under this paragraph for a fiscal year shall equal the product of— (I) the total facility revenue amount determined under subsection (b) for the fiscal year, exclusive of the adjustment under this paragraph for such fiscal year; and (II) the excess facility percentage described in clause (iii). (iii) Excess facility percentage The excess facility percentage described in this clause is— (I) the amount by which the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the preceding 3 fiscal years exceeds 1,625; divided by (II) 1,625. (5) Annual fee setting The Secretary shall, not later than 60 days before the first day of each fiscal year— (A) establish for such fiscal year, based on the revenue amounts under subsection (b) and the adjustments provided under this subsection— (i) OTC monograph drug facility fees under subsection (a)(1); and (ii) OTC monograph order request fees under subsection (a)(2); and (B) publish such fee revenue amounts, facility fees, and OTC monograph order request fees in the Federal Register. . (d) Crediting and availability of fees Section 744M(f) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(f) ) is amended— (1) in paragraph (2)(D)— (A) in the subparagraph heading, by striking in subsequent years ; and (B) by striking (after fiscal year 2021) ; and (2) in paragraph (3), by striking 2021 through 2025 and inserting 2026 through 2030 . 505. Reauthorization; reporting requirements (a) Performance report Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) is amended— (1) in subsection (a)— (A) by striking Beginning with fiscal year 2021, and not later than 120 calendar days after the end of each fiscal year thereafter and inserting the following: (1) In general Not later than 120 calendar days after the end of each fiscal year ; (B) by striking section 3861(b) of the CARES Act and inserting section 2 of the Over-the-Counter Monograph Drug User Fee Amendments ; and (C) by adding at the end the following: (2) Additional information Beginning with fiscal year 2026, the annual report under this subsection shall include— (A) the progress of the Food and Drug Administration in achieving the goals, and future plans for meeting the goals, including— (i) the number of Tier 1 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (ii) the number of Tier 2 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iii) the number of specified safety OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iv) the number of generally recognized as safe and effective finalization OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (v) the average timeline for processing OTC monograph order requests, in the aggregate and by submission type, in the previous fiscal year; and (vi) postmarket safety activities with respect to OTC monograph drugs, including— (I) collecting, developing, and reviewing safety information on OTC monograph drugs, including adverse event reports; (II) developing and using improved analytical tools, adverse event data-collection systems, including information technology systems, to assess potential safety problems, including access to external databases; and (III) activities under section 760; (B) information regarding registration of OTC monograph drug facilities and contract manufacturing organization facilities and payment of registration fees by such facilities, including— (i) the OTC monograph drug facilities and contract manufacturing organization facilities that were first registered under section 510(c) or 510(i) in the fiscal year; and (ii) for each OTC monograph drug facility and contract manufacturing organization facility that was assessed a facility fee under section 744M(a) in the fiscal year, whether the facility paid such fee; (C) the status of implementation of evidence and testing standards under section 505G(r) for nonprescription drugs intended for topical administration, including— (i) the application of evidence or testing standards; and (ii) the number of active ingredient requests for nonprescription drugs intended for topical administration reviewed using the standards under section 505G(b); and (D) the progress of the Food and Drug Administration in allowing nonclinical testing alternatives to animal testing for the consideration of sunscreen active ingredients. (3) Confidentiality Nothing in paragraph (2) shall be construed to authorize the disclosure of information that is prohibited from disclosure under section 301(j) of this Act or section 1905 of title 18, United States Code, or that is subject to withholding under section 552(b)(4) of title 5, United States Code. ; (2) in subsection (b), by striking fiscal year 2021 and each subsequent fiscal year and inserting each fiscal year ; and (3) in subsection (d)— (A) by striking 2025 each place it appears and inserting 2030 ; and (B) by adding at the end the following: (4) Minutes of negotiation meetings (A) Public availability The Secretary shall make publicly available, on the public website of the Food and Drug Administration, robust written minutes of all negotiation meetings conducted under this subsection between the Food and Drug Administration and the regulated industry, not later than 30 days after each such negotiation meeting. (B) Content The robust written minutes described under subparagraph (A) shall contain, in detail, any substantive proposal made by any party to the negotiations as well as significant controversies or differences of opinion during the negotiations and their resolution. . (b) GAO report (1) In general Not later than September 30, 2027, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report assessing the supply chain of over-the-counter monograph drugs. (2) Contents The report required under paragraph (1) shall include an assessment of— (A) the overall stability of the supply chain of over-the-counter monograph drugs; (B) what information is collected by the Food and Drug Administration with respect to the supply chain of over-the-counter monograph drugs; (C) how the Food and Drug Administration uses information collected on the supply chain of over-the-counter monograph drugs to inform regulatory decisions; (D) how the Food and Drug Administration coordinates with other Federal agencies to monitor and mitigate disruptions to the supply chain of over-the-counter monograph drugs; and (E) the unique characteristics of the over-the-counter monograph drug marketplace and what additional authorities or information the Food and Drug Administration may need to ensure the stability of the supply chain of over-the-counter monograph drugs. 506. Treatment of active ingredients for topical administration (a) In general Section 505G of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) is amended by adding at the end the following: (r) Evidence and testing standards for active ingredients for topical administration (1) Evidence and testing standards for active ingredients for topical administration The Secretary shall— (A) in evaluating the generally recognized as safe and effective status of active ingredients used in nonprescription drugs intended for topical administration for purposes of subsection (a), utilize standards that allow for the use of real world evidence (as defined in section 505F(b)), as appropriate, as part of a comprehensive evaluation of scientific evidence to demonstrate the safety and effectiveness of such active ingredients, to supplement evidence from traditional clinical trials, provided that such standards allow the Secretary to evaluate whether the benefits of such active ingredients outweigh the risks; and (B) apply subsection (b)(6)(C) to the regulation of active ingredients used in drugs intended for topical administration. (2) Non-animal testing methods for topical active ingredients (A) In general The Secretary shall consider the types of nonclinical tests described in paragraphs (1) through (4) of the first subsection (z) of section 505 (as inserted by section 3209(a)(2) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022 (division FF of Public Law 117–328 )), or any other alternative to animal testing that the Secretary determines appropriate, in the consideration of drugs intended for topical administration under this section. (B) Guidance Not later than 1 year after the date of enactment of this subsection, the Secretary shall issue new draft guidance on how sponsors can use nonclinical testing alternatives to animal testing, as appropriate, to meet safety and efficacy standards under this section for drugs intended for topical administration. (3) Clarification Nothing in this subsection shall be construed to alter, supersede, or limit the standards for making determinations of whether a drug is generally recognized as safe and effective under section 201(p) or the standards set forth under section 505 for determining the safety and effectiveness of drugs. . (b) Sunscreen final administrative order A final administrative order on nonprescription sunscreen active ingredients issued under section 3854 of the Coronavirus Aid, Relief, and Economic Security Act ( Public Law 116–136 ; 21 U.S.C. 360fff–3 note) shall— (1) account for historical data regarding the safety of sunscreen active ingredients that have previously been accepted for marketing in the United States; (2) account for the role of broad spectrum sunscreens with a Sun Protection Factor of 15 or higher in effective skin cancer prevention; and (3) incorporate the evidence and testing standards for sunscreen active ingredients detailed in section 505G(r) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) (as added by subsection (a)). 507. Increasing the clarity and predictability of the process for developing applications for Rx-to-nonprescription switches (a) In general Section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(b) ) is amended by adding at the end the following: (7) Rx-to-nonprescription switches (A) Meetings Any person planning to submit an application for an Rx-to-nonprescription switch may submit to the Secretary a written request for a meeting, for purposes of developing a plan for such application that addresses the potential risks to public health of such switch and the evidence necessary to support such application, including the design of any necessary studies, and the format and content of the planned application. The Secretary may grant such a meeting, as appropriate, consistent with established procedures for granting meetings with, and providing written responses to, applications under this section. Each such meeting shall be documented in meeting minutes. (B) Guidance (i) In general Not later than 18 months after the date of enactment of this paragraph, the Secretary shall issue guidance to increase the clarity and predictability of the process and standards for approval of applications for nonprescription drugs under this section, including in the case of applications for an Rx-to-nonprescription switch, especially with respect to prescription drugs with well-established safety profiles for which an applicant may seek approval for nonprescription use. (ii) Contents The guidance under clause (i) shall— (I) describe how published reports in medical literature, any previous finding of safety or effectiveness for the drug under this section, the results of significant human experience with the drug, unpublished studies and other data, and other sources of information may be used to support an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch; (II) set forth procedures for sponsors to request meetings described in subparagraph (A) and document the recommendations made in such meetings; (III) describe evidentiary expectations to support approval of an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch, including how sponsors can demonstrate that consumers can appropriately self-select and use the drug and comprehend the nonprescription drug label; and (IV) provide recommendations for how mechanisms, in addition to the required Drug Facts Label, such as mobile applications and decisions aids, can be incorporated into the information submitted in support of an application for an Rx-to-nonprescription switch. (C) Plan to engage with stakeholders Not later than 1 year after the date of enactment of this paragraph, the Secretary shall develop and make publicly available on the website of the Food and Drug Administration a plan to engage stakeholders on steps and factors for application holders and other stakeholders to consider in identifying approved prescription drugs that may be promising candidates for applications for an Rx-to-nonprescription switch. (D) Definition For purposes of this paragraph, the term Rx-to-nonprescription switch means the approval of an application, or supplemental application, as applicable, submitted under this section by the holder of an approved application for a prescription drug seeking approval to market such drug as a nonprescription drug, including for— (i) a full Rx-to-nonprescription switch, under which a drug previously approved for prescription use only is— (I) approved for nonprescription use under the same conditions as applied to the drug when approved for prescription use; or (II) approved for nonprescription use subject to one or more additional conditions for nonprescription use; and (ii) a partial Rx-to-nonprescription switch, under which the drug is approved for nonprescription use only under certain conditions described in the approved labeling, while the drug otherwise remains approved for prescription use only. (E) Rule of construction Nothing in this paragraph shall be construed to— (i) supersede or modify the authority of the Secretary under section 505G with respect to the regulation of OTC monograph drugs; or (ii) authorize the disclosure by the Secretary of confidential commercial information or trade secrets. . (b) GAO Report (1) In general Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that evaluates— (A) the number of applications for an Rx-to-nonprescription switch approved during the period beginning on October 1, 2022, and ending on the date of the report; (B) the number of drugs for which an application for an Rx-to-nonprescription switch was approved during such period subject to an additional condition for nonprescription use; (C) among the drugs for which an application for a full or partial Rx-to-nonprescription switch was approved during such period, the average length of time from receipt by the Food and Drug Administration of the application to the approval of such application; (D) the number of partial Rx-to-nonprescription switch applications approved during such period, and the number of applications for such a partial switch not approved; (E) any barriers to timely and predictable review of applications for an Rx-to-nonprescription switch; (F) engagement by the Food and Drug Administration with public stakeholders, including public meetings or additional activities to support review of applications for an Rx-to-nonprescription switch; and (G) opportunities for collaboration between the Center for Drug Evaluation and Research and the Centers for Medicare & Medicaid Services for the purpose of analyzing health insurance claims data for commonly prescribed drugs that appear to be suitable for an Rx-to-nonprescription switch. (2) Definition In this subsection, the term Rx-to-nonprescription switch has the meaning given such term in paragraph (7) of section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 244(b) ), as added by subsection (a). 508. Regulation of certain nonprescription drugs that are marketed without an approved drug application (a) Development advice to sponsors or requestors Section 505G(h) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(h) ) is amended by striking sponsors or requestors and inserting sponsors, requestors, or organizations nominated by sponsors or requestors to represent their interests in a proceeding . (b) Technical correction Section 505G(b)(2)(A)(iv)(III) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(b)(2)(A)(iv)(III) ) is amended by striking requestors and inserting sponsors or requestors . 509. Sunset dates (a) Authorization Sections 744L and 744M of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 ; 379j–72) shall cease to be effective October 1, 2030. (b) Reporting requirements Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) shall cease to be effective January 31, 2031. 510. Effective date The amendments made by this title shall take effect on October 1, 2025, or the date of the enactment of this Act, whichever is later, except that fees under part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ) shall be assessed beginning October 1, 2025, regardless of the date of the enactment of this Act. 511. Savings clause Notwithstanding the amendments made by this title, part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), as in effect on the day before the date of enactment of this Act, shall continue to be in effect with respect to assessing and collecting any fee required by such part for a fiscal year prior to fiscal year 2026. VI No Surprises Act Implementation 601. Extending availability of funding for No Surprises Act implementation Section 118(a) of division BB of the Consolidated Appropriations Act, 2021 ( Public Law 116–260 ) is amended— (1) by striking otherwise appropriated, to the Secretary of Health and Human Services and inserting the following: otherwise appropriated— (1) to the Secretary of Health and Human Services ; (2) in paragraph (1), as so inserted, by striking September 30, 2025. and inserting November 21, 2025; and ; and (3) by adding at the end the following new paragraph: (2) to the Secretary of Health and Human Services, in addition to amounts otherwise appropriated under paragraph (1), $15,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . D DEPARTMENT OF VETERANS AFFAIRS EXTENDERS I Health Care Matters 101. Extension of authority for collection of copayments for hospital care and nursing home care Section 1710(f)(2)(B) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 102. Extension of requirement to provide nursing home care to certain veterans with service-connected disabilities Section 1710A(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 103. Extension of Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Section 201(j) of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 ( Public Law 116–171 ; 38 U.S.C. 1720F note) is amended by striking the date that is three years after the date on which the first grant is awarded under this section and inserting November 21, 2025 . 104. Extension of funding for expansion of Rural Access Network for Growth Enhancement Program Section 2(d) of the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 ( Public Law 117–21 ; 38 U.S.C. 1712A note) is amended by striking 2025 and inserting 2026 . II Benefits 201. Extension of requirement for quarterly briefings on administration of authorities relating to determinations regarding presumptions of service connection based on toxic exposure Section 202(b)(2) of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 ( Public Law 117–168 ) is amended by striking On a quarterly basis during the two-year period beginning on the date of the enactment of this Act, and inserting On a quarterly basis during the period beginning on the date of the enactment of this Act and ending on December 31, 2026, . 202. Extension of requirement relating to restoration of entitlement to educational assistance in cases of closure or disapproval of educational institutions Section 3699(c)(2)(C) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 203. Extension of temporary clarification of licensure requirements for contractor medical professionals to perform medical disability examinations for the Department of Veterans Affairs under pilot program for use of contract physicians for disability examinations Section 2002(a)(4) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 ( Public Law 116–315 ; 38 U.S.C. 5101 note) is amended by striking five years and inserting six years . 204. Extension of authority to maintain regional office in Republic of Philippines Section 315(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . III Housing 301. Extension of authorization of appropriations for homeless women veterans and homeless veterans with children reintegration grant program Section 2021A(f)(1) of title 38, United States Code, is amended by striking 2025 and inserting 2026 . 302. Extension of authority for treatment and rehabilitation for seriously mentally ill and homeless veterans (a) General treatment Section 2031(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Additional services at certain locations Section 2033(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 303. Extension of funding for financial assistance for supportive services for very low-income veteran families in permanent housing Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $92,000,000 shall be available until November 21, 2025, to carry out subsections (a), (b), and (c) of section 2044 of title 38, United States Code. 304. Extension of funding for grant program for homeless veterans with special needs Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $833,333 shall be available until November 21, 2025, for the purposes of the program under section 2061 of title 38, United States Code. 305. Extension of authority to provide assistance for specially adapted housing for disabled veterans residing temporarily in housing owned by a family member Section 2102A(e) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 306. Extension of authority for specially adapted housing assistive technology grant program Section 2108(g) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 307. Improvements to Partial Claim Program of the Department of Veterans Affairs (a) Clarification of relationship to other powers of Secretary Section 3720(h) of title 38, United States Code, is amended by striking of subsection (a) and all that follows through the period at the end and inserting of subsection (a) in conjunction with the purchase of a loan under section 3732(a)(2) of this title unless the Secretary determines the purchase would be made consistent with section 3732(d) of this title. . (b) Administration of Partial Claim Program Section 3737 of such title is amended— (1) in subsection (b)(2), by striking first lien guaranteed loan for such property and inserting amount of indebtedness under the guaranteed loan that the Secretary does not purchase ; and (2) in subsection (c)— (A) in paragraph (2)(B)(ii), by striking 120 days and inserting 180 days ; and (B) by amending paragraph (3) to read as follows: (3) An amount paid to the holder of a loan as a partial claim— (A) shall not alter the guaranty calculation specified by section 3703 of this title; (B) shall be included, for the purpose of a liquidation sale, in the same manner as any other advance allowed by the Secretary; and (C) shall not be claimed under the guaranty or increase the Secretary’s cost of acquisition of the property securing the defaulted loan. . (c) Requirements of loan holder Section (d)(1) of such section is amending by inserting and servicing the loan after documents . (d) Default and foreclosure Subsection (e) of such section is amended— (1) in paragraph (1)— (A) in subparagraph (A), by striking an individual who and all that follows through the period at the end and inserting the following: a borrower who defaults on a partial claim shall be liable to the Secretary for any loss suffered by the Secretary with respect to such default, and such loss may be recovered in the same manner as any other debt due the United States. The Secretary shall not restore housing loan entitlement under section 3702(b) of this title until such loss is repaid in full. ; and (B) by amending subparagraph (B) to read as follows: (B) The Secretary may charge administrative costs, fees, and interest, as appropriate, with respect to any default under a partial claim in a manner similar to the interest and administrative costs charged under section 5315 of this title. ; and (2) by amending paragraph (2) to read as follows: (2) Notwithstanding section 2410 of title 28, a nonjudicial sale of real property to satisfy a loan guaranteed under this chapter shall discharge the property from a partial claim interest held by the Secretary, provided that the holder of the guaranteed loan conducts the non-judicial sale and distributes the sale proceeds, if any, in accordance with the State or local law where such property is situated. . (e) Guidance in advance of regulations Subsection (h) of such section is amended to read as follows: (h) Guidance in advance of regulations Notwithstanding any other provision of law, the Secretary may, before prescribing regulations, issue administrative guidance with respect to the Partial Claim Program under this section and the loss mitigation options prescribed under section 3732(d) of this title, including any additional terms, conditions, and requirements the Secretary determines necessary. . 308. Government Accountability Office reports on Partial Claim Program of the Department of Veterans Affairs and other matters (a) Annual reports (1) In general Not later than one year after the date of the enactment of this Act, and every year thereafter until the Partial Claim Program terminates, the Comptroller General of the United States shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report. (2) Elements Each report required by paragraph (1) shall include, for the period covered by the report and disaggregated by quarter, the following: (A) Key data on the performance of the Partial Claim Program, including— (i) the number of partial claims filed and approved; and (ii) the redefault and foreclosure rates of loans for which a partial claim was made. (B) A comparison of the data described in subparagraph (A) with data on the performance of other loss mitigation options provided by the Department of Veterans Affairs. (C) The number of housing loans insured, guaranteed, or made by the Secretary of Veterans Affairs under chapter 37 of title 38, United States Code. (D) The number of applications for housing loan benefits under such chapter denied. (E) The number of housing loans insured, guaranteed, or made by the Secretary under such chapter refinanced under section 3710(a)(8) or 3712 of title 38, United States Code. (F) The number of veterans who owe a payment on a mortgage associated with a loan insured, guaranteed, or made by the Secretary under such chapter that is at least— (i) 60 days late; and (ii) 90 days late. (b) Assessment (1) In general Not later than one year before the Partial Claim Program terminates, the Comptroller General shall— (A) conduct an assessment of the benefits and challenges of the Partial Claim Program; and (B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Comptroller General with respect to that assessment. (2) Considerations In conducting the assessment required by paragraph (1), the Comptroller General shall consider the following: (A) The characteristics of borrowers for whom a partial claim was made compared to the characteristics of borrowers provided other loss mitigation options by the Department of Veterans Affairs. (B) The performance of loans guaranteed under chapter 37 of title 38, United States Code, following various loss mitigation actions. (C) The information the Department considered in determining whether a borrower would benefit from a partial claim compared to other loss mitigation options. (D) The costs to taxpayers of the Partial Claim Program compared to the costs of other loss mitigation options provided by the Department. (E) Any similarities and differences in the Department's administration and use of the Partial Claim Program compared to the Department's administration and use of the COVID–19 Veterans Assistance Partial Claim Payment program established under subpart F of part 36 of title 38, Code of Regulations. (F) The information the Department learned from the COVID–19 Veterans Assistance Partial Claim Payment program and the extent to which those lessons learned were applied to the Partial Claim Program. (G) The types of information the Department collected to monitor the performance and effectiveness of the Partial Claim Program and how the Department used that information to make any needed adjustments to the program. (H) How the use by the Department of partial claims compares to the use of partial claims by other Federal housing agencies, including, for each partial claim program— (i) the volume of loans for which partial claims have been made; (ii) the results for borrowers (including redefault and foreclosure rates); and (iii) the costs to taxpayers. (c) Partial Claim Program defined In this section, the term Partial Claim Program means the Partial Claim Program of the Department of Veterans Affairs carried out under section 3737 of title 38, United States Code. IV Other Matters 401. Extension of subpoena authority of Inspector General of Department of Veterans Affairs Section 312(d)(7)(A) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 402. Extension of authority for Secretary of Veterans Affairs to transport individuals to and from facilities of Department of Veterans Affairs Section 111A(a)(2) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 403. Extension of authority relating to vendee loan program Section 3733(a)(8) of title 38, United States Code, is amended— (1) in the matter preceding subparagraph (A), by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in subparagraph (C), by striking September 30, 2025 and inserting November 21, 2025 . 404. Extension of authority for transfer of real property Section 8118(a)(5) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . E MISCELLANEOUS 101. BUDGETARY EFFECTS (a) Statutory PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010. (b) Senate PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). (c) Classification of Budgetary Effects Notwithstanding Rule 3 of the Budget Scorekeeping Guidelines set forth in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217 and section 250(c)(8) of the Balanced Budget and Emergency Deficit Control Act of 1985, the budgetary effects of divisions B through D shall not be estimated— (1) for purposes of section 251 of such Act; (2) for purposes of an allocation to the Committee on Appropriations pursuant to section 302(a) of the Congressional Budget Act of 1974; and (3) for purposes of paragraph (4)(C) of section 3 of the Statutory Pay-As-You-Go Act of 2010 as being included in an appropriation Act.

Passed the House of Representatives September 19, 2025. Kevin F. McCumber, Clerk.

tv_txt: I 119th CONGRESS 1st Session H. R. 5371 IN THE HOUSE OF REPRESENTATIVES September 16, 2025 Mr. Cole introduced the following bill; which was referred to the Committee on Appropriations , and in addition to the Committee on the Budget , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL Making continuing appropriations and extensions for fiscal year 2026, and for other purposes.

1. SHORT TITLE This Act may be cited as the Continuing Appropriations and Extensions Act, 2026 . 2. TABLE OF CONTENTS The table of contents for this Act is as follows: Sec. 1. SHORT TITLE. Sec. 2. TABLE OF CONTENTS. Sec. 3. REFERENCES. Division A—CONTINUING APPROPRIATIONS ACT, 2026 Division B—MISCELLANEOUS EXTENSIONS Division C—HEALTH EXTENDERS Title I—Public Health Extenders Title II—Medicare Title III—Human Services Title IV—Medicaid Title V—Food and Drug Administration Title VI—No Surprises Act Implementation Division D—DEPARTMENT OF VETERANS AFFAIRS EXTENDERS Title I—Health Care Matters Title II—Benefits Title III—Housing Title IV—Other Matters Division E—MISCELLANEOUS 3. REFERENCES Except as expressly provided otherwise, any reference to this Act contained in any division of this Act shall be treated as referring only to the provisions of that division. A CONTINUING APPROPRIATIONS ACT, 2026 The following sums are hereby appropriated, out of any money in the Treasury not otherwise appropriated, and out of applicable corporate or other revenues, receipts, and funds, for the several departments, agencies, corporations, and other organizational units of Government for fiscal year 2026, and for other purposes, namely: 101. Such amounts as may be necessary, at a rate for operations as provided in the applicable appropriations Acts for fiscal year 2025 and under the authority and conditions provided in such Acts, for continuing projects or activities (including the costs of direct loans and loan guarantees) that are not otherwise specifically provided for in this Act, that were conducted in fiscal year 2025, and for which appropriations, funds, or other authority were made available in the Full-Year Continuing Appropriations Act, 2025 (division A of Public Law 119–4 ), except sections 1110, 1113, 1114, and 1207; the proviso in paragraph (4) of section 1602; and sections 1708 and 1808; and except section 11104 shall be applied by substituting 2020, and 2021 for and 2020 ; and except sections 774 and 778 of division B, section 540 of division C, and sections 110 and 112 of division D of Public Law 118–42 as continued in effect by section 1101 of division A of Public Law 119–4 ; and except section 7069(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . 102. (a) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used for: (1) the new production of items not funded for production in fiscal year 2025 or prior years; (2) the increase in production rates above those sustained with fiscal year 2025 funds; or (3) the initiation, resumption, or continuation of any project, activity, operation, or organization (defined as any project, subproject, activity, budget activity, program element, and subprogram within a program element, and for any investment items defined as a P–1 line item in a budget activity within an appropriation account and an R–1 line item that includes a program element and subprogram element within an appropriation account) for which appropriations, funds, or other authority were not available during fiscal year 2025. (b) No appropriation or funds made available or authority granted pursuant to section 101 for the Department of Defense shall be used to initiate multi-year procurements utilizing advance procurement funding for economic order quantity procurement unless specifically appropriated later. 103. Appropriations made by section 101 shall be available to the extent and in the manner that would be provided by the pertinent appropriations Act. 104. Except as otherwise provided in section 102, no appropriation or funds made available or authority granted pursuant to section 101 shall be used to initiate or resume any project or activity for which appropriations, funds, or other authority were not available during fiscal year 2025. 105. Appropriations made and authority granted pursuant to this Act shall cover all obligations or expenditures incurred for any project or activity during the period for which funds or authority for such project or activity are available under this Act. 106. Unless otherwise provided for in this Act or in the applicable appropriations Act for fiscal year 2026, appropriations and funds made available and authority granted pursuant to this Act shall be available until whichever of the following first occurs: (1) The enactment into law of an appropriation for any project or activity provided for in this Act. (2) The enactment into law of the applicable appropriations Act for fiscal year 2026 without any provision for such project or activity. (3) November 21, 2025. 107. Expenditures made pursuant to this Act shall be charged to the applicable appropriation, fund, or authorization whenever a bill in which such applicable appropriation, fund, or authorization is contained is enacted into law. 108. Appropriations made and funds made available by or authority granted pursuant to this Act may be used without regard to the time limitations for submission and approval of apportionments set forth in section 1513 of title 31, United States Code, but nothing in this Act may be construed to waive any other provision of law governing the apportionment of funds. 109. Notwithstanding any other provision of this Act, except section 106, for those programs that would otherwise have high initial rates of operation or complete distribution of appropriations at the beginning of fiscal year 2026 because of distributions of funding to States, foreign countries, grantees, or others, such high initial rates of operation or complete distribution shall not be made, and no grants shall be awarded for such programs funded by this Act that would impinge on final funding prerogatives. 110. This Act shall be implemented so that only the most limited funding action of that permitted in the Act shall be taken in order to provide for continuation of projects and activities. 111. (a) For entitlements and other mandatory payments whose budget authority was provided in an appropriations Act specified in section 101, for expenses authorized under section 324 of title 38, United States Code, and for activities under the Food and Nutrition Act of 2008, activities shall be continued at the rate to maintain program levels under current law, under the authority and conditions provided in the applicable appropriations Act, to be continued through the date specified in section 106(3) of this Act. (b) Notwithstanding section 106, obligations for mandatory payments due on or about the first day of any month that begins after October 2025 but not later than 30 days after the date specified in section 106(3) may continue to be made, and funds shall be available for such payments. 112. Amounts made available under section 101 for civilian personnel compensation and benefits in each department and agency may be apportioned up to the rate for operations necessary to avoid furloughs within such department or agency, consistent with the applicable appropriations Act for fiscal year 2025, except that such authority provided under this section shall not be used until after the department or agency has taken all necessary actions to reduce or defer non-personnel-related administrative expenses. 113. Funds appropriated by this Act may be obligated and expended notwithstanding section 10 of Public Law 91–672 ( 22 U.S.C. 2412 ), section 15 of the State Department Basic Authorities Act of 1956 ( 22 U.S.C. 2680 ), section 313 of the Foreign Relations Authorization Act, Fiscal Years 1994 and 1995 ( 22 U.S.C. 6212 ), and section 504(a)(1) of the National Security Act of 1947 ( 50 U.S.C. 3094(a)(1) ). 114. (a) (1) For each amount incorporated by reference in this Act that was previously designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985, each provision of law designating each such amount as an emergency requirement pursuant to such section shall not apply. (2) Each amount incorporated by reference in this Act that was designated by the Congress as an emergency requirement pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit Control Act of 1985 in the following provisions of law are designated by the Congress as an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives: section 11206(4) of division A of Public Law 119–4 and 7068(b) of division F of Public Law 118–47 , as continued in effect by section 1101 of division A of Public Law 119–4 . (b) Each amount incorporated by reference in this Act that was previously designated by the Congress as being for disaster relief pursuant to section 251(b)(2)(D) of the Balanced Budget and Emergency Deficit Control Act of 1985 is designated by the Congress as being for disaster relief pursuant to a concurrent resolution on the budget. (c) Each amount incorporated by reference in this Act that was previously designated in division B of Public Law 117–159 , division J of Public Law 117–58 , or in section 443(b) of division G of Public Law 117–328 by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget shall continue to be treated as an amount specified in section 103(b) of division A of Public Law 118–5 . 115. (a) Rescissions or cancellations of discretionary budget authority that continue pursuant to section 101 in Treasury Appropriations Fund Symbols (TAFS)— (1) to which other appropriations are not provided by this Act, but for which there is a current applicable TAFS that does receive an appropriation in this Act; or (2) which are no-year TAFS and receive other appropriations in this Act, may be continued instead by reducing the rate for operations otherwise provided by section 101 for such current applicable TAFS, as long as doing so does not impinge on the final funding prerogatives of the Congress. (b) Rescissions or cancellations described in subsection (a) shall continue in an amount equal to the lesser of— (1) the amount specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act; or (2) the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101 of this Act. (c) No later than November 7, 2025, the Director of the Office of Management and Budget shall provide to the Committees on Appropriations of the House of Representatives and the Senate a comprehensive list of the rescissions or cancellations that will continue pursuant to section 101: Provided , That the information in such comprehensive list shall be periodically updated to reflect any subsequent changes in the amount of balances available, as of October 1, 2025, from the funds specified for rescission or cancellation in the applicable appropriations Act referenced in section 101, and such updates shall be transmitted to the Committees on Appropriations of the House of Representatives and the Senate upon request. 116. Amounts made available by section 101 for Domestic Food Programs—Food and Nutrition Service—Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may be apportioned at the rate for operations necessary to maintain participation. 117. Section 260 of the Agricultural Marketing Act of 1946 ( 7 U.S.C. 1636i ) and section 942 of the Livestock Mandatory Reporting Act of 1999 ( 7 U.S.C. 1635 note; Public Law 106–78 ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 118. Section 8302(b) of the Agricultural Act of 2014 ( 16 U.S.C. 3851a(b) ) shall be applied by substituting the date specified in section 106 of this Act for October 1, 2023 . 119. (a) Amounts made available by section 101 for Department of Justice—United States Marshals Service—Salaries and Expenses may be apportioned up to the rate for operations necessary to maintain program operations. (b) In addition to amounts provided by section 101, for Department of Justice—United States Marshals Service—Salaries and Expenses , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until September 30, 2027, to carry out protective operations. 120. (a) For the closeout of all Space Shuttle contracts and associated programs, amounts that have expired but have not been cancelled in the Exploration, Space Operations, Human Space Flight, Space Flight Capabilities, and Exploration Capabilities appropriations accounts shall remain available through fiscal year 2030 for the liquidation of valid obligations incurred during the period of fiscal year 2001 through fiscal year 2013. (b) (1) Subject to paragraph (2), this section shall become effective immediately upon enactment of this Act. (2) If this Act is enacted after September 30, 2025, this section shall be applied as if it were in effect on September 30, 2025. 121. Section 3014(a) of title 18, United States Code, shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 122. Notwithstanding section 101, the first proviso in each of sections 8092 and 8096 of title VIII of division A of Public Law 118–47 shall be applied by substituting advances for reimbursements . 123. Notwithstanding sections 102 and 104, amounts made available by section 101 to the Department of Defense for Research, Development, Test and Evaluation, Air Force shall be apportioned up to the rate for operations necessary for the E–7 Wedgetail program, in an amount not to exceed $199,676,000, only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 124. Of the unobligated balance of funds available to the Department of Defense for the E–7 program under the heading Aircraft Procurement, Air Force in Public Law 119–4 , $200,000,000 is hereby transferred to and merged with amounts available for the E–7 program under the heading Research, Development, Test and Evaluation, Air Force only for the purpose of continued rapid prototyping activities to maintain program schedule and transition to production for the E–7 Wedgetail program. 125. Section 717(a) of the Defense Production Act of 1950 ( 50 U.S.C. 4564(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 126. Notwithstanding sections 102 and 104, amounts made available by section 101 of this Act to the Department of Defense for Shipbuilding and Conversion, Navy may be apportioned up to the rate for operations necessary to fund completion of prior year shipbuilding programs for the fiscal year 2016 and fiscal year 2018 Virginia Class Submarine Programs, in an amount not to exceed $154,000,000. 127. During the period covered by this Act, section 103(f)(4)(A) of Public Law 108–361 (the Calfed Bay-Delta Authorization Act) shall be applied by substituting $32,600,000 for $30,000,000 . 128. (a) Amounts made available by section 101 in the first proviso under the heading Department of Energy—Atomic Energy Defense Activities—National Nuclear Security Administration—Weapons Activities may be apportioned up to the rate for operations necessary to maintain current operations for the safe, secure transport of nuclear weapons. (b) The Director of the Office of Management and Budget and the Secretary of Energy shall notify the Committees on Appropriations of the House of Representatives and the Senate not later than 3 days after each use of the authority provided in subsection (a). 129. Notwithstanding section 101, the matter preceding the first proviso under the heading Office of Personnel Management—Salaries and Expenses in title V of division B of Public Law 118–47 shall be applied by substituting $197,446,000 for $219,076,000 , and the second proviso under such heading in such title of such division of such Act shall be applied by substituting $214,605,000 for $192,975,000 . 130. Notwithstanding any other provision of this Act, except section 106, the District of Columbia may expend local funds made available under the heading District of Columbia—District of Columbia Funds for such programs and activities under the District of Columbia Appropriations Act, 2024 (title IV of division B of Public Law 118–47 ) at the rate set forth in the Fiscal Year 2026 Local Budget Act of 2025 (D.C. Bill No. 26–260) as modified as of the date of enactment of this Act. 131. Notwithstanding section 101, paragraph (1) under the heading Department of the Treasury—Departmental Offices—Salaries and Expenses in title I of division B of Public Law 118–47 shall be applied by substituting $1,350,000 for $350,000 : Provided, That such amounts may be obligated in the account and budget structure set forth in the fiscal year 2026 President’s Budget, submitted pursuant to section 1105(a) of title 31, United States Code, and accompanying justification materials. 132. Amounts made available by section 101 for Small Business Administration—Business Loans Program Account may be apportioned up to the rate for operations necessary to accommodate increased demand for commitments for general business loans authorized under paragraphs (1) through (35) of section 7(a) of the Small Business Act ( 15 U.S.C. 636(a) ), for commitments to guarantee trust certificates authorized by section 5(g) of the Small Business Act ( 15 U.S.C. 634(g) ), for commitments to guarantee loans under section 503 of the Small Business Investment Act of 1958 ( 15 U.S.C. 697 ), and for commitments to guarantee debentures under section 303(b) of the Small Business Investment Act of 1958 ( 15 U.S.C. 683(b) ). 133. Notwithstanding section 101, amounts are provided for Department of the Treasury—Office of Terrorism and Financial Intelligence—Salaries and Expenses at a rate for operations of $237,662,000. 134. Notwithstanding section 101, section 1605 of Public Law 119–4 shall be applied by substituting through the end of the last applicable pay period that commences on or before the date specified in section 106(3) of the Continuing Appropriations Act, 2026 for through the date specified in section 1106 of this Act . 135. Section 1(b) of Public Law 117–25 (135 Stat. 297; 136 Stat. 2133; 136 Stat. 5984; 138 Stat. 1771; 139 Stat. 46) shall be applied in each of paragraphs (3) and (4) by substituting the date specified in section 106 of this Act for September 30, 2025 . 136. In addition to amounts otherwise provided by section 101 for The Judiciary—Supreme Court of the United States—Salaries and Expenses , there is appropriated $28,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for the protection of the Supreme Court Justices, including the purchase and hire of passenger motor vehicles as authorized by 31 U.S.C. 1343 and 1344, to be expended as the Chief Justice may approve. 137. Section 210G(i) of the Homeland Security Act of 2002 ( 6 U.S.C. 124n(i) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 138. Section 225(e) of division A of Public Law 116–6 ( 49 U.S.C. 44901 note) shall be applied by substituting fiscal year 2019 through the date specified in section 106 of the Continuing Appropriations Act, 2026 for fiscal years 2019 through 2025 . 139. Amounts made available by section 101 to the Department of Homeland Security under the heading Federal Emergency Management Agency—Disaster Relief Fund may be apportioned up to the rate for operations necessary to carry out response and recovery activities under the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ). 140. Section 227(a) of the Federal Cybersecurity Enhancement Act of 2015 ( 6 U.S.C. 1525(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 141. Section 111(a) of the Cybersecurity Information Sharing Act of 2015 ( 6 U.S.C. 1510(a) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 142. Section 2220A(s)(1) of the Homeland Security Act of 2002 ( 6 U.S.C. 665g(s)(1) ) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . 143. During the period covered by this Act, section 3(b)(2)(C) of the Pittman-Robertson Wildlife Restoration Act ( 16 U.S.C. 669b(b)(2)(C) ) shall be applied by substituting 2027 for 2026 . 144. During the period covered by this Act, section 1701 of title VII of division B of Public Law 117–43 , as amended, shall be applied by substituting calendar years 2021 through 2026 for 2021 or 2022 or 2023 or 2024 each place it appears. 145. Amounts made available by section 101 for Department of the Interior—Department-Wide Programs—Wildland Fire Management and Department of Agriculture—Forest Service—Wildland Fire Management may be apportioned up to the rate for operations necessary for wildfire suppression activities. 146. (a) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Services at a rate for operations of $72,265,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. (b) In addition to amounts otherwise provided by section 101, amounts are provided for Department of Health and Human Services—Indian Health Service—Indian Health Facilities at a rate for operations of $8,050,000, for an additional amount for costs of staffing and operating facilities that were opened, renovated, or expanded in fiscal years 2025 and 2026, and such amounts may be apportioned up to the rate for operations necessary to staff and operate such facilities. 147. Of the amounts made available in the third paragraph under the heading Environmental Protection Agency—State and Tribal Assistance Grants in the Disaster Relief Supplemental Appropriations Act, 2023 (division N of Public Law 117–328 ), up to $54,000,000 shall be available for technical assistance and grants under section 1442(b) of the Safe Drinking Water Act ( 42 U.S.C. 300j–1(b) ) in areas where the President declared an emergency in August of fiscal year 2022 pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act ( 42 U.S.C. 5121 et seq. ): Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and section 1(e) of H. Res. 1151 (117th Congress), as engrossed in the House of Representatives on June 8, 2022, are designated as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 148. Notwithstanding section 101, the matter under the heading Department of Health and Human Services—Administration for Children and Families—Children and Families Services Programs in title II of division D of Public Law 118–47 shall be applied by adding the following after the second proviso: Provided further , That for purposes of section 640(a)(2)(B)(v) of such Act, the base grant for each of the Federated States of Micronesia and the Republic of the Marshall Islands shall be $8,000,000, and shall be considered equal to the amount provided for base grants for such jurisdictions under such Act for the prior fiscal year: . 149. Notwithstanding any other provision of this Act, there is appropriated— (1) For payment to Ashley Paige Turner, heir of Sylvester Turner, late a Representative from the State of Texas, $174,000. (2) For payment to Ramona Grijalva, widow of Raúl M. Grijalva, late a Representative from the State of Arizona, $174,000. (3) For payment to Catherine M. Smith, widow of Gerald E. Connolly, late a Representative from the Commonwealth of Virginia, $174,000. 150. Notwithstanding any other provision of law, no adjustment shall be made under section 601(a) of the Legislative Reorganization Act of 1946 ( 2 U.S.C. 4501 ) (relating to cost of living adjustments for Members of Congress) during the period covered by this Act. 151. In addition to amounts otherwise provided by section 101, for Capitol Police—United States Capitol Police Mutual Aid Reimbursements , there is appropriated $30,000,000, for an additional amount for fiscal year 2026, to remain available until expended, for reimbursements for mutual aid and related training provided under the agreements described in section 7302 of Public Law 108–458 : Provided, That obligation of the funds made available in this section in this Act shall be subject to notification to the Chairmen and Ranking Members of the Committees on Appropriations of both Houses of Congress, the Senate Committee on Rules and Administration, and the Committee on House Administration of the amount and purpose of the expense within 15 days of obligation. 152. Notwithstanding section 101, the matter under the heading Native American Veteran Housing Loan Program Account in title II of division A of Public Law 118–42 shall be applied by adding the following new paragraph: In addition, for the cost of direct loans, $6,865,235, as authorized by subchapter V of chapter 37 of title 38, United States Code: Provided , That such costs, including the cost of modifying such loans, shall be as defined in section 502 of the Congressional Budget Act of 1974: Provided further , That funds made available under this heading are available to subsidize gross obligations for the principal amount of direct loans not to exceed $75,000,000. . 153. Section 1424(a) of the Better Utilization of Investments Leading to Development Act of 2018 ( 22 U.S.C. 9624(a) ) shall be applied by substituting the date specified in section 106 of this Act for the date that is 7 years after the date of the enactment of this Act . 154. Notwithstanding sections 101 and 106, and sections 1101, 1106, and 11201 of Public Law 119–4 , the fifth and sixth provisos under the heading Millennium Challenge Corporation in title III of division F of Public Law 118–47 shall be amended by substituting December 31, 2026 for December 31, 2024 each place it appears. 155. Notwithstanding section 106, during fiscal year 2026, the Secretary of Housing and Urban Development may use the unobligated balances of amounts made available in prior fiscal years in paragraphs (2), (3), and (8) under the heading Public and Indian Housing—Tenant-Based Rental Assistance to support additional allocations under subparagraph (D) of paragraph (1) and subparagraph (B) of paragraph (4) of such heading to prevent the termination of rental assistance for families as the result of insufficient funding in the calendar year 2025 funding cycle: Provided, That amounts repurposed pursuant to this section that were previously designated by the Congress as an emergency requirement pursuant to a concurrent resolution on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985 are designated by the Congress as being for an emergency requirement pursuant to section 4001(a)(1) of S. Con. Res. 14 (117th Congress), the concurrent resolution on the budget for fiscal year 2022, and to legislation establishing fiscal year 2026 budget enforcement in the House of Representatives. 156. Amounts made available by section 101 for Department of Transportation—Office of the Secretary—Payments to Air Carriers may be apportioned up to the rate for operations necessary to maintain Essential Air Service program operations. 157. Section 4144(d) of the Motor Carrier Safety Reauthorization Act of 2005 ( 49 U.S.C. 31100 note) shall be applied by substituting the date specified in section 106 of this Act for September 30, 2025 . This division may be cited as the Continuing Appropriations Act, 2026 . B MISCELLANEOUS EXTENSIONS 101. United States grain standards The authorities (including any limitations on the authorities) provided by each provision of the United States Grain Standards Act ( Public Law 90–487 ; 7 U.S.C. 74 et seq. ) and each provision of law amended by that Act, as in effect on September 30, 2025, shall continue, and the authorities (and any such limitations) shall be carried out, until the later of— (1) November 21, 2025; and (2) the date specified in the provision of that Act or the provision of law amended by that Act. C HEALTH EXTENDERS I Public Health Extenders 101. Extension for community health centers, National Health Service Corps, and teaching health centers that operate GME programs (a) Extension for community health centers Section 10503(b)(1) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(1) ) is amended— (1) in subparagraph (I), by striking and at the end; and (2) by adding at the end the following: (K) $606,904,110 for the period beginning on October 1, 2025, and ending on November 21, 2025; and . (b) Extension for the National Health Service Corps Section 10503(b)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(2) ) is amended— (1) in subparagraph (J), by striking and at the end; (2) in subparagraph (K), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (L) $49,150,685 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (c) Teaching health centers that operate graduate medical education programs Section 340H(g)(1) of the Public Health Service Act ( 42 U.S.C. 256h(g)(1) ) is amended— (1) in subparagraph (E), by striking and at the end; (2) in subparagraph (F), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (G) $24,931,507 for the period beginning on October 1, 2025, and ending on November 21, 2025. . (d) Application of provisions Amounts appropriated pursuant to the amendments made by this section shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act ( 42 U.S.C. 254b et seq. ). (e) Conforming amendment Section 3014(h)(4) of title 18, United States Code, is amended by striking and section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025 and inserting section 2101(d) of division B of the Full-Year Continuing Appropriations and Extensions Act, 2025, and section 101(d) of title I of division C of the Continuing Appropriations and Extensions Act, 2026 . 102. Extension of special diabetes programs (a) Extension of special diabetes programs for type i diabetes Section 330B(b)(2) of the Public Health Service Act ( 42 U.S.C. 254c–2(b)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . (b) Extending funding for special diabetes programs for Indians Section 330C(c)(2) of the Public Health Service Act ( 42 U.S.C. 254c–3(c)(2) ) is amended— (1) in subparagraph (F), by striking and at the end; (2) in subparagraph (G), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following: (H) $22,652,055 for the period beginning on October 1, 2025, and ending on November 21, 2025, to remain available until expended. . 103. National health security extensions (a) Section 319(e)(8) of the Public Health Service Act ( 42 U.S.C. 247d(e)(8) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Section 319L(e)(1)(D) of the Public Health Service Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (c) Section 319L–1(b) of the Public Health Service Act (42 U.S.C. 247d–7f(b)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (d) (1) Section 2811A(g) of the Public Health Service Act (42 U.S.C. 300hh–10b(g)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (2) Section 2811B(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (3) Section 2811C(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking September 30, 2025 and inserting November 21, 2025 . (e) Section 2812(c)(4)(B) of the Public Health Service Act ( 42 U.S.C. 300hh–11(c)(4)(B) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . II Medicare 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), by striking in fiscal year 2026 and inserting during the portion of fiscal year 2026 beginning on November 22, 2025, 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 inserting or portion of a fiscal year after for a fiscal year ; and (ii) by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; (B) in subclause (III), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (C) in subclause (IV), by striking fiscal year 2026 and inserting the portion of fiscal year 2026 beginning on November 22, 2025, and ending on September 30, 2026, and fiscal year 2027 ; and (3) in subparagraph (D)— (A) in the matter preceding clause (i), by inserting or during the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 2025 ; and (B) in clause (ii), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through 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. 202. Extension of the Medicare-dependent hospital (MDH) program (a) In general Section 1886(d)(5)(G) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(G) ) is amended— (1) in clause (i), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in clause (ii)(II), by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 ; and (B) in clause (iv), by inserting and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww note) is amended by inserting , or the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025 after through fiscal year 2025 . 203. Extension of add-on payments for ambulance services Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ) is amended— (1) in paragraph (12)(A), by striking October 1, 2025 and inserting November 22, 2025 ; and (2) in paragraph (13), by striking October 1, 2025 each place it appears and inserting November 22, 2025 in each such place. 204. 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, by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in the third sentence, by striking September 30, 2025 and inserting November 21, 2025 . 205. Extension of funding outreach and assistance for low-income programs (a) State health insurance assistance programs Subsection (a)(1)(B)(xiv) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 ( 42 U.S.C. 1395b–3 note) is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (b) Area agencies on aging Subsection (b)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . (c) Aging and disability resource centers Subsection (c)(1)(B)(xiv) of such section 119 is amended by striking September 30, 2025, $10,000,000 and inserting November 21, 2025, $10,712,329 . (d) Coordination of efforts To inform older Americans about benefits available under Federal and State programs Subsection (d)(2)(xiv) of such section 119 is amended by striking September 30, 2025, $30,000,000 and inserting November 21, 2025, $32,136,986 . 206. 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 October 1, 2025 and inserting November 22, 2025 . 207. Extension of certain telehealth flexibilities (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 ending September 30, 2025 and inserting ending November 21, 2025 ; and (2) in paragraph (4)(C)(iii), by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (b) Expanding practitioners eligible To furnish 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 September 30, 2025 and inserting ending on November 21, 2025 . (c) Extending telehealth services for federally qualified health centers and rural health clinics Section 1834(m)(8)(A) of the Social Security Act ( 42 U.S.C. 1395m(m)(8)(A) ) is amended by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (d) Delaying the in-Person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology (1) Delay in requirements for mental health services furnished through telehealth 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 October 1, 2025 and inserting on or after November 22, 2025 . (2) Mental health visits furnished by rural health clinics Section 1834(y)(2) of the Social Security Act ( 42 U.S.C. 1395m(y)(2) ) is amended by striking October 1, 2025 and inserting November 22, 2025 . (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 October 1, 2025 and inserting November 22, 2025 . (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 September 30, 2025 and inserting ending on November 21, 2025 . (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 by striking ending on September 30, 2025 and inserting ending on November 21, 2025 . (g) Program instruction authority The Secretary of Health and Human Services may implement the amendments made by this section through program instruction or otherwise. 208. Extending acute hospital care at home waiver authorities Section 1866G(a)(1) of the Social Security Act ( 42 U.S.C. 1395cc–7(a)(1) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 209. Extension of temporary inclusion of authorized oral antiviral drugs as covered part D drugs Section 1860D–2(e)(1)(C) of the Social Security Act ( 42 U.S.C. 1395w–102(e)(1)(C) ) is amended by striking September 30, 2025 and inserting November 21, 2025 . 210. Extension of funding for Medicare hospice surveys Section 3(a)(2) of the IMPACT Act of 2014 ( Public Law 113–185 ) is amended— (1) in subparagraph (A), by striking and at the end; (2) in subparagraph (B), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new subparagraph: (C) $6,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . 211. Medicare improvement fund Section 1898(b)(1) of the Social Security Act ( 42 U.S.C. 1395iii(b)(1) ) is amended— (1) by striking fiscal year 2026 and inserting fiscal year 2027 ; and (2) by striking $1,804,000,000 and inserting $664,000,000 . III Human Services 301. Sexual risk avoidance education extension Section 510 of the Social Security Act ( 42 U.S.C. 710 ) is amended— (1) in subsection (a)— (A) in paragraph (1)— (i) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (ii) by striking fiscal year 2024 and inserting fiscal year 2026 ; and (B) in paragraph (2)— (i) in subparagraph (A)— (I) by striking through 2023 and inserting through 2025 ; (II) by striking fiscal year 2024 or 2025 and inserting fiscal year 2026 ; and (III) by inserting (or, with respect to the applicable period, for fiscal year 2026) after an application for the fiscal year ; and (ii) in subparagraph (B)(i), by striking 2024 or 2025 and inserting 2026 ; and (2) in subsection (f)(1) by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the period at the end of the corresponding sentence for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 302. Personal responsibility education extension Section 513 of the Social Security Act ( 42 U.S.C. 713 ) is amended— (1) in subsection (a)(1)— (A) in subparagraph (A), in the matter preceding clause (i), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; and (B) in subparagraph (B)(i), by striking the period beginning on October 1, 2023, and ending on November 17, 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, for the period beginning on January 20, 2024, and ending on March 8, 2024, for the period beginning on March 9, 2024, and ending on September 30, 2024, and for fiscal year 2025 and inserting fiscal years 2024 and 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025 ; (2) in subsection (c)(3), by striking 2024 or 2025 and inserting 2026 ; and (3) in subsection (f), by striking 2023, for the period beginning on October 1, 2023, and ending on November 17, 2023, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on November 18, 2023, and ending on January 19, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on January 20, 2024, and ending on March 8, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for fiscal year 2025, an amount equal to the amount appropriated for fiscal year 2024 for fiscal year 2024 and inserting 2025, and for the period beginning on October 1, 2025, and ending on November 21, 2025, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025 . 303. Extension of funding for family-to-family health information centers Section 501(c)(1)(A) of the Social Security Act ( 42 U.S.C. 701(c)(1)(A) ) is amended— (1) in clause (vii), by striking and at the end; (2) in clause (viii), by adding ; and at the end; and (3) by adding at the end the following new clause: (ix) $854,795 for the portion of fiscal year 2026 beginning on October 1, 2025, and ending on November 21, 2025. . IV Medicaid 401. 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 inserting and a portion of fiscal year 2026 after 2025 ; and (2) by inserting , and the DSH allotment for Tennessee for the portion of fiscal year 2026 beginning October 1, 2025, and ending November 21, 2025, shall be $7,564,932 before the period. (b) 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)— (i) in the matter preceding subclause (I), by striking For each of fiscal years 2026 through 2028 and inserting For the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; (ii) in subclause (I), by inserting or period after the fiscal year ; and (iii) in subclause (II), by inserting or period after in the fiscal year ; and (B) in clause (ii), by striking for each of fiscal years 2026 through 2028 and inserting for the period beginning November 22, 2025, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 ; and (2) in paragraph (8), by striking 2027 and inserting 2028 . V Food and Drug Administration 501. Short title This title may be cited as the Over-the-Counter Monograph Drug User Fee Amendments . 502. Finding Congress finds that the fees authorized by the amendments made in this title will be dedicated to over-the-counter (OTC) monograph drug activities, as set forth in the goals identified for purposes of part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), in the letters from the Secretary of Health and Human Services to the Chairman of the Committee on Energy and Commerce of the House of Representatives and the Chairman of the Committee on Health, Education, Labor, and Pensions of the Senate, as set forth in the Congressional Record. 503. Definitions Section 744L(9)(A) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71(9)(A) ) is amended— (1) in clause (v), by striking ; or and inserting a semicolon; (2) in clause (vi)— (A) by striking addition and inserting the addition ; and (B) by striking the period and inserting ; or ; and (3) by adding at the end the following: (vii) the addition or modification of a testing procedure applicable to one or more OTC monograph drugs, provided that such additional or modified testing procedure reflects a voluntary consensus standard with respect to pharmaceutical quality that is— (I) established by a national or international standards development organization; and (II) recognized by the Secretary through a process described in guidance for industry, initially published in July 2023, or any successor guidance, publicly available on the website of the Food and Drug Administration, which addresses voluntary consensus standards for pharmaceutical quality. . 504. Authority to assess and use OTC monograph fees (a) Types of fees Section 744M(a)(1) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(a)(1) ) is amended— (1) in subparagraph (A)— (A) by striking on December 31 of the fiscal year or at any time during the preceding 12-month period and inserting at any time during the applicable period specified in clause (ii) for a fiscal year ; (B) by striking Each person and inserting the following: (i) Assessment of fees Each person ; and (C) by adding at the end the following: (ii) Applicable period For purposes of clause (i), the applicable period is— (I) for fiscal year 2026, the 12-month period ending on December 31, 2025; (II) for fiscal year 2027, the 9-month period ending on September 30, 2026; and (III) for fiscal year 2028 and each subsequent fiscal year, the 12-month period ending on September 30 of the preceding fiscal year. ; (2) in subparagraph (B)(i), by amending subclause (I) to read as follows: (I) has ceased all activities related to OTC monograph drugs prior to— (aa) for purposes of fiscal year 2026, January 1, 2025; (bb) for purposes of fiscal year 2027, January 1, 2026; and (cc) for purposes of fiscal year 2028 and each subsequent fiscal year, October 1 of the preceding fiscal year; and ; and (3) by amending subparagraph (D) to read as follows: (D) Due date (i) Fiscal year 2026 For fiscal year 2026, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day of June of such year; or (II) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year. (ii) Fiscal year 2027 For fiscal year 2027, the facility fees required under subparagraph (A) shall be due— (I) in a first installment representing 50 percent of such fee, on the later of— (aa) October 1, 2026; or (bb) the first business day after the enactment of an appropriations Act providing for the collection and obligation of fees under this section for such year; and (II) in a second installment representing the remaining 50 percent of such fee, on— (aa) February 1, 2027; or (bb) if an appropriations Act described in subclause (I)(bb) is not in effect on February 1, 2027, the first business day after enactment of such an appropriations Act. (iii) Subsequent fiscal years For fiscal year 2028 and each subsequent fiscal year, the facility fees required under subparagraph (A) shall be due on the later of— (I) the first business day on or after October 1 of the fiscal year; or (II) the first business day after the date of enactment of an appropriations Act providing for the collection and obligation of fees under this section for the fiscal year. . (b) Fee revenue amounts Section 744M(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(b) ) is amended to read as follows: (b) Fee revenue amounts (1) In general For each of the fiscal years 2026 through 2030, fees under subsection (a)(1) shall be established to generate a total facility fee revenue amount equal to the sum of— (A) the annual base revenue for the fiscal year (as determined under paragraph (2)); (B) the dollar amount equal to the inflation adjustment for the fiscal year (as determined under subsection (c)(1)); (C) the dollar amount equal to the operating reserve adjustment for the fiscal year, if applicable (as determined under subsection (c)(2)); (D) additional direct cost adjustments (as determined under subsection (c)(3)); (E) an additional dollar amount equal to— (i) $2,373,000 for fiscal year 2026; (ii) $1,233,000 for fiscal year 2027; and (iii) $854,000 for fiscal year 2028; and (F) in the case of a fiscal year for which the Secretary applies the one-time facility fee workload adjustment under subsection (c)(4), the dollar amount equal to such adjustment. (2) Annual base revenue For purposes of paragraph (1), the dollar amount of the annual base revenue for a fiscal year shall be— (A) for fiscal year 2026, the dollar amount of the total revenue amount established for fiscal year 2025 under this subsection as in effect on the day before the date of enactment of the Over-the-Counter Monograph Drug User Fee Amendments , not including any adjustments made for such fiscal year 2025 under subsection (c)(2), as so in effect; and (B) for fiscal years 2027 through 2030, the dollar amount of the total revenue amount established under this subsection for the previous fiscal year, not including any adjustments made for such previous fiscal year under subsection (c)(2) or (c)(3). . (c) Adjustments; annual fee setting Section 744M(c) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(c) ) is amended— (1) in paragraph (1)— (A) in subparagraph (A), in the matter preceding clause (i)— (i) by striking subsection (b)(2)(B) and inserting subsection (b)(1)(B) ; and (ii) by striking fiscal year 2022 and each subsequent fiscal year and inserting each fiscal year ; (B) in subparagraph (B), by striking fiscal year 2022 and all that follows through the period at the end and inserting the following: a fiscal year shall be equal to the product of— (i) for fiscal year 2026— (I) the fee for fiscal year 2025 under subsection (a)(2); and (II) the inflation adjustment percentage under subparagraph (C); and (ii) for each of fiscal years 2027 through 2030— (I) the applicable fee under subsection (a)(2) for the preceding fiscal year; and (II) the inflation adjustment percentage under subparagraph (C). ; and (C) in subparagraph (C)— (i) in the matter preceding clause (i), by inserting the sum of after is equal to ; (ii) by striking clause (i); (iii) by redesignating subclauses (I) and (II) of clause (ii) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (iv) by striking (ii) for each of fiscal years 2024 and 2025, the sum of— ; and (v) in clause (ii), as so redesignated, by striking Washington-Baltimore, DC–MD–VA–WV and inserting Washington–Arlington–Alexandria–DC–VA–MD–WV ; (2) in paragraph (2)— (A) in subparagraph (A)— (i) by striking fiscal year 2021 and subsequent fiscal years and inserting each fiscal year ; (ii) by striking subsections (b)(1)(B) and (b)(2)(C) and inserting subsection (b)(1)(C) ; and (iii) by striking the number of weeks specified in subparagraph (B) and inserting 10 weeks ; (B) by striking subparagraph (B); (C) by redesignating subparagraphs (C) and (D) as subparagraphs (B) and (C), respectively; and (D) in subparagraph (C), as so redesignated, by striking paragraph (4) establishing and inserting paragraph (5) publishing ; (3) in paragraph (3)— (A) in the matter preceding subparagraph (A), by striking subsection (b)(2)(D) and inserting subsection (b)(1)(D) ; and (B) by striking subparagraphs (A) through (E) and inserting the following: (A) $135,000 for fiscal year 2026; (B) $300,000 for fiscal year 2027; (C) $55,000 for fiscal year 2028; (D) $30,000 for fiscal year 2029; and (E) $0 for fiscal year 2030. ; and (4) by striking paragraph (4) and inserting the following: (4) One-time facility fee workload adjustment (A) In general In addition to the adjustments under paragraphs (1), (2), and (3), the Secretary may further increase the fee revenues and fees through a one-time adjustment made for fiscal year 2028, 2029, or 2030, in accordance with this paragraph. (B) Adjustment described (i) Conditions for adjustment An adjustment under this paragraph may be made for a fiscal year only if— (I) an adjustment under this paragraph had not been made for any prior fiscal year; (II) the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the period of the preceding 3 fiscal years exceeds 1,625; and (III) with respect to facilities described in subclause (II), the average number of such facilities (expressed as a percentage) that appeared on the arrears lists pursuant to subsection (e)(1)(A)(i) over the period of the preceding 3 fiscal years is less than 30 percent. (ii) Amount of adjustment An adjustment under this paragraph for a fiscal year shall equal the product of— (I) the total facility revenue amount determined under subsection (b) for the fiscal year, exclusive of the adjustment under this paragraph for such fiscal year; and (II) the excess facility percentage described in clause (iii). (iii) Excess facility percentage The excess facility percentage described in this clause is— (I) the amount by which the average number of OTC monograph drug facilities subject to a facility fee under subsection (a)(1) over the preceding 3 fiscal years exceeds 1,625; divided by (II) 1,625. (5) Annual fee setting The Secretary shall, not later than 60 days before the first day of each fiscal year— (A) establish for such fiscal year, based on the revenue amounts under subsection (b) and the adjustments provided under this subsection— (i) OTC monograph drug facility fees under subsection (a)(1); and (ii) OTC monograph order request fees under subsection (a)(2); and (B) publish such fee revenue amounts, facility fees, and OTC monograph order request fees in the Federal Register. . (d) Crediting and availability of fees Section 744M(f) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–72(f) ) is amended— (1) in paragraph (2)(D)— (A) in the subparagraph heading, by striking in subsequent years ; and (B) by striking (after fiscal year 2021) ; and (2) in paragraph (3), by striking 2021 through 2025 and inserting 2026 through 2030 . 505. Reauthorization; reporting requirements (a) Performance report Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) is amended— (1) in subsection (a)— (A) by striking Beginning with fiscal year 2021, and not later than 120 calendar days after the end of each fiscal year thereafter and inserting the following: (1) In general Not later than 120 calendar days after the end of each fiscal year ; (B) by striking section 3861(b) of the CARES Act and inserting section 2 of the Over-the-Counter Monograph Drug User Fee Amendments ; and (C) by adding at the end the following: (2) Additional information Beginning with fiscal year 2026, the annual report under this subsection shall include— (A) the progress of the Food and Drug Administration in achieving the goals, and future plans for meeting the goals, including— (i) the number of Tier 1 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (ii) the number of Tier 2 OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iii) the number of specified safety OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (iv) the number of generally recognized as safe and effective finalization OTC monograph order requests for which a proposed order was issued, and the number of such requests for which a final order was issued, in the previous fiscal year; (v) the average timeline for processing OTC monograph order requests, in the aggregate and by submission type, in the previous fiscal year; and (vi) postmarket safety activities with respect to OTC monograph drugs, including— (I) collecting, developing, and reviewing safety information on OTC monograph drugs, including adverse event reports; (II) developing and using improved analytical tools, adverse event data-collection systems, including information technology systems, to assess potential safety problems, including access to external databases; and (III) activities under section 760; (B) information regarding registration of OTC monograph drug facilities and contract manufacturing organization facilities and payment of registration fees by such facilities, including— (i) the OTC monograph drug facilities and contract manufacturing organization facilities that were first registered under section 510(c) or 510(i) in the fiscal year; and (ii) for each OTC monograph drug facility and contract manufacturing organization facility that was assessed a facility fee under section 744M(a) in the fiscal year, whether the facility paid such fee; (C) the status of implementation of evidence and testing standards under section 505G(r) for nonprescription drugs intended for topical administration, including— (i) the application of evidence or testing standards; and (ii) the number of active ingredient requests for nonprescription drugs intended for topical administration reviewed using the standards under section 505G(b); and (D) the progress of the Food and Drug Administration in allowing nonclinical testing alternatives to animal testing for the consideration of sunscreen active ingredients. (3) Confidentiality Nothing in paragraph (2) shall be construed to authorize the disclosure of information that is prohibited from disclosure under section 301(j) of this Act or section 1905 of title 18, United States Code, or that is subject to withholding under section 552(b)(4) of title 5, United States Code. ; (2) in subsection (b), by striking fiscal year 2021 and each subsequent fiscal year and inserting each fiscal year ; and (3) in subsection (d)— (A) by striking 2025 each place it appears and inserting 2030 ; and (B) by adding at the end the following: (4) Minutes of negotiation meetings (A) Public availability The Secretary shall make publicly available, on the public website of the Food and Drug Administration, robust written minutes of all negotiation meetings conducted under this subsection between the Food and Drug Administration and the regulated industry, not later than 30 days after each such negotiation meeting. (B) Content The robust written minutes described under subparagraph (A) shall contain, in detail, any substantive proposal made by any party to the negotiations as well as significant controversies or differences of opinion during the negotiations and their resolution. . (b) GAO report (1) In general Not later than September 30, 2027, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report assessing the supply chain of over-the-counter monograph drugs. (2) Contents The report required under paragraph (1) shall include an assessment of— (A) the overall stability of the supply chain of over-the-counter monograph drugs; (B) what information is collected by the Food and Drug Administration with respect to the supply chain of over-the-counter monograph drugs; (C) how the Food and Drug Administration uses information collected on the supply chain of over-the-counter monograph drugs to inform regulatory decisions; (D) how the Food and Drug Administration coordinates with other Federal agencies to monitor and mitigate disruptions to the supply chain of over-the-counter monograph drugs; and (E) the unique characteristics of the over-the-counter monograph drug marketplace and what additional authorities or information the Food and Drug Administration may need to ensure the stability of the supply chain of over-the-counter monograph drugs. 506. Treatment of active ingredients for topical administration (a) In general Section 505G of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) is amended by adding at the end the following: (r) Evidence and testing standards for active ingredients for topical administration (1) Evidence and testing standards for active ingredients for topical administration The Secretary shall— (A) in evaluating the generally recognized as safe and effective status of active ingredients used in nonprescription drugs intended for topical administration for purposes of subsection (a), utilize standards that allow for the use of real world evidence (as defined in section 505F(b)), as appropriate, as part of a comprehensive evaluation of scientific evidence to demonstrate the safety and effectiveness of such active ingredients, to supplement evidence from traditional clinical trials, provided that such standards allow the Secretary to evaluate whether the benefits of such active ingredients outweigh the risks; and (B) apply subsection (b)(6)(C) to the regulation of active ingredients used in drugs intended for topical administration. (2) Non-animal testing methods for topical active ingredients (A) In general The Secretary shall consider the types of nonclinical tests described in paragraphs (1) through (4) of the first subsection (z) of section 505 (as inserted by section 3209(a)(2) of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022 (division FF of Public Law 117–328 )), or any other alternative to animal testing that the Secretary determines appropriate, in the consideration of drugs intended for topical administration under this section. (B) Guidance Not later than 1 year after the date of enactment of this subsection, the Secretary shall issue new draft guidance on how sponsors can use nonclinical testing alternatives to animal testing, as appropriate, to meet safety and efficacy standards under this section for drugs intended for topical administration. (3) Clarification Nothing in this subsection shall be construed to alter, supersede, or limit the standards for making determinations of whether a drug is generally recognized as safe and effective under section 201(p) or the standards set forth under section 505 for determining the safety and effectiveness of drugs. . (b) Sunscreen final administrative order A final administrative order on nonprescription sunscreen active ingredients issued under section 3854 of the Coronavirus Aid, Relief, and Economic Security Act ( Public Law 116–136 ; 21 U.S.C. 360fff–3 note) shall— (1) account for historical data regarding the safety of sunscreen active ingredients that have previously been accepted for marketing in the United States; (2) account for the role of broad spectrum sunscreens with a Sun Protection Factor of 15 or higher in effective skin cancer prevention; and (3) incorporate the evidence and testing standards for sunscreen active ingredients detailed in section 505G(r) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h ) (as added by subsection (a)). 507. Increasing the clarity and predictability of the process for developing applications for Rx-to-nonprescription switches (a) In general Section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355(b) ) is amended by adding at the end the following: (7) Rx-to-nonprescription switches (A) Meetings Any person planning to submit an application for an Rx-to-nonprescription switch may submit to the Secretary a written request for a meeting, for purposes of developing a plan for such application that addresses the potential risks to public health of such switch and the evidence necessary to support such application, including the design of any necessary studies, and the format and content of the planned application. The Secretary may grant such a meeting, as appropriate, consistent with established procedures for granting meetings with, and providing written responses to, applications under this section. Each such meeting shall be documented in meeting minutes. (B) Guidance (i) In general Not later than 18 months after the date of enactment of this paragraph, the Secretary shall issue guidance to increase the clarity and predictability of the process and standards for approval of applications for nonprescription drugs under this section, including in the case of applications for an Rx-to-nonprescription switch, especially with respect to prescription drugs with well-established safety profiles for which an applicant may seek approval for nonprescription use. (ii) Contents The guidance under clause (i) shall— (I) describe how published reports in medical literature, any previous finding of safety or effectiveness for the drug under this section, the results of significant human experience with the drug, unpublished studies and other data, and other sources of information may be used to support an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch; (II) set forth procedures for sponsors to request meetings described in subparagraph (A) and document the recommendations made in such meetings; (III) describe evidentiary expectations to support approval of an application for a nonprescription drug, including in the context of an application for an Rx-to-nonprescription switch, including how sponsors can demonstrate that consumers can appropriately self-select and use the drug and comprehend the nonprescription drug label; and (IV) provide recommendations for how mechanisms, in addition to the required Drug Facts Label, such as mobile applications and decisions aids, can be incorporated into the information submitted in support of an application for an Rx-to-nonprescription switch. (C) Plan to engage with stakeholders Not later than 1 year after the date of enactment of this paragraph, the Secretary shall develop and make publicly available on the website of the Food and Drug Administration a plan to engage stakeholders on steps and factors for application holders and other stakeholders to consider in identifying approved prescription drugs that may be promising candidates for applications for an Rx-to-nonprescription switch. (D) Definition For purposes of this paragraph, the term Rx-to-nonprescription switch means the approval of an application, or supplemental application, as applicable, submitted under this section by the holder of an approved application for a prescription drug seeking approval to market such drug as a nonprescription drug, including for— (i) a full Rx-to-nonprescription switch, under which a drug previously approved for prescription use only is— (I) approved for nonprescription use under the same conditions as applied to the drug when approved for prescription use; or (II) approved for nonprescription use subject to one or more additional conditions for nonprescription use; and (ii) a partial Rx-to-nonprescription switch, under which the drug is approved for nonprescription use only under certain conditions described in the approved labeling, while the drug otherwise remains approved for prescription use only. (E) Rule of construction Nothing in this paragraph shall be construed to— (i) supersede or modify the authority of the Secretary under section 505G with respect to the regulation of OTC monograph drugs; or (ii) authorize the disclosure by the Secretary of confidential commercial information or trade secrets. . (b) GAO Report (1) In general Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report that evaluates— (A) the number of applications for an Rx-to-nonprescription switch approved during the period beginning on October 1, 2022, and ending on the date of the report; (B) the number of drugs for which an application for an Rx-to-nonprescription switch was approved during such period subject to an additional condition for nonprescription use; (C) among the drugs for which an application for a full or partial Rx-to-nonprescription switch was approved during such period, the average length of time from receipt by the Food and Drug Administration of the application to the approval of such application; (D) the number of partial Rx-to-nonprescription switch applications approved during such period, and the number of applications for such a partial switch not approved; (E) any barriers to timely and predictable review of applications for an Rx-to-nonprescription switch; (F) engagement by the Food and Drug Administration with public stakeholders, including public meetings or additional activities to support review of applications for an Rx-to-nonprescription switch; and (G) opportunities for collaboration between the Center for Drug Evaluation and Research and the Centers for Medicare & Medicaid Services for the purpose of analyzing health insurance claims data for commonly prescribed drugs that appear to be suitable for an Rx-to-nonprescription switch. (2) Definition In this subsection, the term Rx-to-nonprescription switch has the meaning given such term in paragraph (7) of section 505(b) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 244(b) ), as added by subsection (a). 508. Regulation of certain nonprescription drugs that are marketed without an approved drug application (a) Development advice to sponsors or requestors Section 505G(h) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(h) ) is amended by striking sponsors or requestors and inserting sponsors, requestors, or organizations nominated by sponsors or requestors to represent their interests in a proceeding . (b) Technical correction Section 505G(b)(2)(A)(iv)(III) of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 355h(b)(2)(A)(iv)(III) ) is amended by striking requestors and inserting sponsors or requestors . 509. Sunset dates (a) Authorization Sections 744L and 744M of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 ; 379j–72) shall cease to be effective October 1, 2030. (b) Reporting requirements Section 744N of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–73 ) shall cease to be effective January 31, 2031. 510. Effective date The amendments made by this title shall take effect on October 1, 2025, or the date of the enactment of this Act, whichever is later, except that fees under part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ) shall be assessed beginning October 1, 2025, regardless of the date of the enactment of this Act. 511. Savings clause Notwithstanding the amendments made by this title, part 10 of subchapter C of chapter VII of the Federal Food, Drug, and Cosmetic Act ( 21 U.S.C. 379j–71 et seq. ), as in effect on the day before the date of enactment of this Act, shall continue to be in effect with respect to assessing and collecting any fee required by such part for a fiscal year prior to fiscal year 2026. VI No Surprises Act Implementation 601. Extending availability of funding for No Surprises Act implementation Section 118(a) of division BB of the Consolidated Appropriations Act, 2021 ( Public Law 116–260 ) is amended— (1) by striking otherwise appropriated, to the Secretary of Health and Human Services and inserting the following: otherwise appropriated— (1) to the Secretary of Health and Human Services ; (2) in paragraph (1), as so inserted, by striking September 30, 2025. and inserting November 21, 2025; and ; and (3) by adding at the end the following new paragraph: (2) to the Secretary of Health and Human Services, in addition to amounts otherwise appropriated under paragraph (1), $15,000,000 for the period beginning on October 1, 2025, and ending on November 21, 2025. . D DEPARTMENT OF VETERANS AFFAIRS EXTENDERS I Health Care Matters 101. Extension of authority for collection of copayments for hospital care and nursing home care Section 1710(f)(2)(B) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 102. Extension of requirement to provide nursing home care to certain veterans with service-connected disabilities Section 1710A(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 103. Extension of Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Section 201(j) of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 ( Public Law 116–171 ; 38 U.S.C. 1720F note) is amended by striking the date that is three years after the date on which the first grant is awarded under this section and inserting November 21, 2025 . 104. Extension of funding for expansion of Rural Access Network for Growth Enhancement Program Section 2(d) of the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 ( Public Law 117–21 ; 38 U.S.C. 1712A note) is amended by striking 2025 and inserting 2026 . II Benefits 201. Extension of requirement for quarterly briefings on administration of authorities relating to determinations regarding presumptions of service connection based on toxic exposure Section 202(b)(2) of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 ( Public Law 117–168 ) is amended by striking On a quarterly basis during the two-year period beginning on the date of the enactment of this Act, and inserting On a quarterly basis during the period beginning on the date of the enactment of this Act and ending on December 31, 2026, . 202. Extension of requirement relating to restoration of entitlement to educational assistance in cases of closure or disapproval of educational institutions Section 3699(c)(2)(C) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 203. Extension of temporary clarification of licensure requirements for contractor medical professionals to perform medical disability examinations for the Department of Veterans Affairs under pilot program for use of contract physicians for disability examinations Section 2002(a)(4) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 ( Public Law 116–315 ; 38 U.S.C. 5101 note) is amended by striking five years and inserting six years . 204. Extension of authority to maintain regional office in Republic of Philippines Section 315(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . III Housing 301. Extension of authorization of appropriations for homeless women veterans and homeless veterans with children reintegration grant program Section 2021A(f)(1) of title 38, United States Code, is amended by striking 2025 and inserting 2026 . 302. Extension of authority for treatment and rehabilitation for seriously mentally ill and homeless veterans (a) General treatment Section 2031(b) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . (b) Additional services at certain locations Section 2033(d) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 303. Extension of funding for financial assistance for supportive services for very low-income veteran families in permanent housing Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $92,000,000 shall be available until November 21, 2025, to carry out subsections (a), (b), and (c) of section 2044 of title 38, United States Code. 304. Extension of funding for grant program for homeless veterans with special needs Of the amounts appropriated to the Department of Veterans Affairs for fiscal year 2026 for Medical Services , $833,333 shall be available until November 21, 2025, for the purposes of the program under section 2061 of title 38, United States Code. 305. Extension of authority to provide assistance for specially adapted housing for disabled veterans residing temporarily in housing owned by a family member Section 2102A(e) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 306. Extension of authority for specially adapted housing assistive technology grant program Section 2108(g) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 307. Improvements to Partial Claim Program of the Department of Veterans Affairs (a) Clarification of relationship to other powers of Secretary Section 3720(h) of title 38, United States Code, is amended by striking of subsection (a) and all that follows through the period at the end and inserting of subsection (a) in conjunction with the purchase of a loan under section 3732(a)(2) of this title unless the Secretary determines the purchase would be made consistent with section 3732(d) of this title. . (b) Administration of Partial Claim Program Section 3737 of such title is amended— (1) in subsection (b)(2), by striking first lien guaranteed loan for such property and inserting amount of indebtedness under the guaranteed loan that the Secretary does not purchase ; and (2) in subsection (c)— (A) in paragraph (2)(B)(ii), by striking 120 days and inserting 180 days ; and (B) by amending paragraph (3) to read as follows: (3) An amount paid to the holder of a loan as a partial claim— (A) shall not alter the guaranty calculation specified by section 3703 of this title; (B) shall be included, for the purpose of a liquidation sale, in the same manner as any other advance allowed by the Secretary; and (C) shall not be claimed under the guaranty or increase the Secretary’s cost of acquisition of the property securing the defaulted loan. . (c) Requirements of loan holder Section (d)(1) of such section is amending by inserting and servicing the loan after documents . (d) Default and foreclosure Subsection (e) of such section is amended— (1) in paragraph (1)— (A) in subparagraph (A), by striking an individual who and all that follows through the period at the end and inserting the following: a borrower who defaults on a partial claim shall be liable to the Secretary for any loss suffered by the Secretary with respect to such default, and such loss may be recovered in the same manner as any other debt due the United States. The Secretary shall not restore housing loan entitlement under section 3702(b) of this title until such loss is repaid in full. ; and (B) by amending subparagraph (B) to read as follows: (B) The Secretary may charge administrative costs, fees, and interest, as appropriate, with respect to any default under a partial claim in a manner similar to the interest and administrative costs charged under section 5315 of this title. ; and (2) by amending paragraph (2) to read as follows: (2) Notwithstanding section 2410 of title 28, a nonjudicial sale of real property to satisfy a loan guaranteed under this chapter shall discharge the property from a partial claim interest held by the Secretary, provided that the holder of the guaranteed loan conducts the non-judicial sale and distributes the sale proceeds, if any, in accordance with the State or local law where such property is situated. . (e) Guidance in advance of regulations Subsection (h) of such section is amended to read as follows: (h) Guidance in advance of regulations Notwithstanding any other provision of law, the Secretary may, before prescribing regulations, issue administrative guidance with respect to the Partial Claim Program under this section and the loss mitigation options prescribed under section 3732(d) of this title, including any additional terms, conditions, and requirements the Secretary determines necessary. . 308. Government Accountability Office reports on Partial Claim Program of the Department of Veterans Affairs and other matters (a) Annual reports (1) In general Not later than one year after the date of the enactment of this Act, and every year thereafter until the Partial Claim Program terminates, the Comptroller General of the United States shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report. (2) Elements Each report required by paragraph (1) shall include, for the period covered by the report and disaggregated by quarter, the following: (A) Key data on the performance of the Partial Claim Program, including— (i) the number of partial claims filed and approved; and (ii) the redefault and foreclosure rates of loans for which a partial claim was made. (B) A comparison of the data described in subparagraph (A) with data on the performance of other loss mitigation options provided by the Department of Veterans Affairs. (C) The number of housing loans insured, guaranteed, or made by the Secretary of Veterans Affairs under chapter 37 of title 38, United States Code. (D) The number of applications for housing loan benefits under such chapter denied. (E) The number of housing loans insured, guaranteed, or made by the Secretary under such chapter refinanced under section 3710(a)(8) or 3712 of title 38, United States Code. (F) The number of veterans who owe a payment on a mortgage associated with a loan insured, guaranteed, or made by the Secretary under such chapter that is at least— (i) 60 days late; and (ii) 90 days late. (b) Assessment (1) In general Not later than one year before the Partial Claim Program terminates, the Comptroller General shall— (A) conduct an assessment of the benefits and challenges of the Partial Claim Program; and (B) submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Comptroller General with respect to that assessment. (2) Considerations In conducting the assessment required by paragraph (1), the Comptroller General shall consider the following: (A) The characteristics of borrowers for whom a partial claim was made compared to the characteristics of borrowers provided other loss mitigation options by the Department of Veterans Affairs. (B) The performance of loans guaranteed under chapter 37 of title 38, United States Code, following various loss mitigation actions. (C) The information the Department considered in determining whether a borrower would benefit from a partial claim compared to other loss mitigation options. (D) The costs to taxpayers of the Partial Claim Program compared to the costs of other loss mitigation options provided by the Department. (E) Any similarities and differences in the Department's administration and use of the Partial Claim Program compared to the Department's administration and use of the COVID–19 Veterans Assistance Partial Claim Payment program established under subpart F of part 36 of title 38, Code of Regulations. (F) The information the Department learned from the COVID–19 Veterans Assistance Partial Claim Payment program and the extent to which those lessons learned were applied to the Partial Claim Program. (G) The types of information the Department collected to monitor the performance and effectiveness of the Partial Claim Program and how the Department used that information to make any needed adjustments to the program. (H) How the use by the Department of partial claims compares to the use of partial claims by other Federal housing agencies, including, for each partial claim program— (i) the volume of loans for which partial claims have been made; (ii) the results for borrowers (including redefault and foreclosure rates); and (iii) the costs to taxpayers. (c) Partial Claim Program defined In this section, the term Partial Claim Program means the Partial Claim Program of the Department of Veterans Affairs carried out under section 3737 of title 38, United States Code. IV Other Matters 401. Extension of subpoena authority of Inspector General of Department of Veterans Affairs Section 312(d)(7)(A) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 402. Extension of authority for Secretary of Veterans Affairs to transport individuals to and from facilities of Department of Veterans Affairs Section 111A(a)(2) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . 403. Extension of authority relating to vendee loan program Section 3733(a)(8) of title 38, United States Code, is amended— (1) in the matter preceding subparagraph (A), by striking September 30, 2025 and inserting November 21, 2025 ; and (2) in subparagraph (C), by striking September 30, 2025 and inserting November 21, 2025 . 404. Extension of authority for transfer of real property Section 8118(a)(5) of title 38, United States Code, is amended by striking September 30, 2025 and inserting November 21, 2025 . E MISCELLANEOUS 101. BUDGETARY EFFECTS (a) Statutory PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010. (b) Senate PAYGO Scorecards The budgetary effects of divisions B through D shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). (c) Classification of Budgetary Effects Notwithstanding Rule 3 of the Budget Scorekeeping Guidelines set forth in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217 and section 250(c)(8) of the Balanced Budget and Emergency Deficit Control Act of 1985, the budgetary effects of divisions B through D shall not be estimated— (1) for purposes of section 251 of such Act; (2) for purposes of an allocation to the Committee on Appropriations pursuant to section 302(a) of the Congressional Budget Act of 1974; and (3) for purposes of paragraph (4)(C) of section 3 of the Statutory Pay-As-You-Go Act of 2010 as being included in an appropriation Act.