119-s891

(a) Short Title.--This Act may be cited as the ``Bipartisan Health
Care Act''.

(b) Table of Contents.--The table of contents for this Act is as
follows:

TITLE I--MEDICAID

providers under Medicaid and CHIP.

based services under Medicaid.

working adults with disabilities.

coverage for military families.

under the Medicaid program.

related to deceased providers.

individuals do not remain enrolled.

screenings, referrals, and case management
services for eligible juveniles in public
institutions; State interim work plans.

labor, and delivery services.

hospital payment adjustments under the
Medicaid program.

TITLE II--MEDICARE

for certain low-volume hospitals.

(MDH) program.

alternative payment models.

schedule to account for exceptional
circumstances.

and selection.

programs.

face encounter prior to recertification of
eligibility for hospice care.

under Medicare.

with limited English proficiency.

MDPP Expanded Model.

drugs as covered part D drugs.

low-income individuals.

(REAL) Health
Providers Act.

tests.

administrable home infusion drugs.

beneficiaries.

for each off-campus outpatient department
of a provider.

TITLE III--HUMAN SERVICES

centers.
TITLE IV--PUBLIC HEALTH EXTENDERS

Subtitle A--Extensions

Service Corps, and teaching health centers
that operate GME programs.

Subtitle B--World Trade Center Health Program

TITLE V--SUPPORT ACT REAUTHORIZATION

Subtitle A--Prevention

illicit drug use and other risk factors.

alcohol spectrum disorder.

incidents.

disorders.
Subtitle B--Treatment

women.

workforce.

substance use disorder patient records.

identification, referral, and support.

illness and children with serious emotional
disturbance.

combination of buprenorphine and naloxone.
Subtitle C--Recovery

crisis.
Subtitle D--Miscellaneous Matters

prescribing practitioner.

TITLE VI--PANDEMIC AND ALL-HAZARDS PREPAREDNESS AND RESPONSE

Subtitle A--State and Local Readiness and Response

public health emergency.

and Prevention to combat public health
security threats.

detection.

program.
Subtitle B--Federal Planning and Coordination

potential.

certain research.
Subtitle C--Addressing the Needs of All Individuals

Subtitle D--Additional Reauthorizations

countermeasures.

systems.

professionals.

countermeasure development.

TITLE VII--PUBLIC HEALTH PROGRAMS

TITLE VIII--FOOD AND DRUG ADMINISTRATION

Subtitle A--Give Kids a Chance

of Food and Drug Administration regarding
molecularly targeted cancer drugs.

encourage treatments for rare pediatric
diseases.

drugs.
Subtitle B--United States-Abraham Accords Cooperation and Security

Administration.
TITLE IX--LOWERING PRESCRIPTION DRUG COSTS

fiduciaries.

TITLE X--MISCELLANEOUS

telehealth.

TITLE I--MEDICAID

PROVIDERS UNDER MEDICAID AND CHIP.

(a) In General.--

(kk) of the Social Security Act (42
U.S.C. 1396a

(kk) ) is amended by adding at the end the following new
paragraph:
``

(10) Streamlined enrollment process for eligible out-of-
state providers.--
``
(A) In general.--The State--
``
(i) adopts and implements a process to
allow an eligible out-of-State provider to
enroll under the State plan (or a waiver of
such plan) to furnish items and services to, or
order, prescribe, refer, or certify eligibility
for items and services for, qualifying
individuals without the imposition of screening
or enrollment requirements by such State that
exceed the minimum necessary for such State to
provide payment to an eligible out-of-State
provider under such State plan (or a waiver of
such plan), such as the provider's name and
National Provider Identifier (and such other
information specified by the Secretary); and
``
(ii) provides that an eligible out-of-
State provider that enrolls as a participating
provider in the State plan (or a waiver of such
plan) through such process shall be so enrolled
for a 5-year period, unless the provider is
terminated or excluded from participation
during such period.
``
(B) === Definitions. ===
-In this paragraph:
``
(i) Eligible out-of-state provider.--The
term `eligible out-of-State provider' means,
with respect to a State, a provider--
``
(I) that is located in any other
State;
``
(II) that--
``

(aa) was determined by
the Secretary to have a limited
risk of fraud, waste, and abuse
for purposes of determining the
level of screening to be
conducted under

(j)

(2) , has been so
screened under such

(j)

(2) , and is enrolled in
the Medicare program under
title XVIII; or
``

(bb) was determined by
the State agency administering
or supervising the
administration of the State
plan (or a waiver of such plan)
of such other State to have a
limited risk of fraud, waste,
and abuse for purposes of
determining the level of
screening to be conducted under
paragraph

(1) of this
subsection, has been so
screened under such paragraph

(1) , and is enrolled under such
State plan (or a waiver of such
plan); and
``
(III) that has not been--
``

(aa) excluded from
participation in any Federal
health care program pursuant to

``

(bb) excluded from
participation in the State plan
(or a waiver of such plan)
pursuant to part 1002 of title
42, Code of Federal Regulations
(or any successor regulation),
or State law; or
``
(cc) terminated from
participating in a Federal
health care program or the
State plan (or a waiver of such
plan) for a reason described in
paragraph

(8)
(A) .
``
(ii) Qualifying individual.--The term
`qualifying individual' means an individual
under 21 years of age who is enrolled under the
State plan (or waiver of such plan).
``
(iii) State.--The term `State' means 1 of
the 50 States or the District of Columbia.''.

(b) Conforming Amendments.--

(1) Section 1902

(a)

(77) of the Social Security Act (42
U.S.C. 1396a

(a)

(77) ) is amended by inserting ``enrollment,''
after ``screening,''.

(2) The subsection heading for

(kk) of such Act
(42 U.S.C. 1396a

(kk) ) is amended by inserting ``enrollment,''
after ``screening,''.

(3) Section 2107

(e)

(1)
(G) of such Act (42 U.S.C.
1397gg

(e)

(1)
(G) ) is amended by inserting ``enrollment,'' after
``screening,''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date that is 3 years after the date of enactment of this
Act.

BASED SERVICES UNDER MEDICAID.

(a) Increasing Transparency of HCBS Coverage Under Medicaid.--

(1) In general.--

(c) of the Social Security Act
(42 U.S.C. 1396n
(c) ) is amended--
(A) in paragraph

(2) --
(i) in subparagraph
(E) --
(I) by inserting ``, not less
frequently than'' before ``annually'';
and
(II) by inserting ``(including,
with respect to such information
provided on or after July 9, 2027, the
information specified in paragraph

(11) )'' before the period at the end;
and
(ii) by adding at the end the following
flush sentence:
``The Secretary shall make all information provided under
subparagraph
(E) on or after the date of the enactment of this
sentence publicly available on the website of the Centers for
Medicare & Medicaid Services.''; and
(B) by adding at the end the following new
paragraph:
``

(11) For purposes of paragraph

(2)
(E) , the information
specified in this paragraph is the following:
``
(A) In the case of a State that limits the number
of individuals who may be provided home or community-
based services under a waiver granted under this
subsection and maintains a list of individuals waiting
to enroll in such waiver, a description of how the
State maintains such list, including--
``
(i) information on whether the State
screens individuals on such list to determine
whether such individuals are eligible to
receive such services under such waiver;
``
(ii) information on whether (and, if
applicable, how often) the State periodically
re-screens individuals on such list for
eligibility;
``
(iii) the number of people on such list
of individuals waiting to enroll in such
waiver; and
``
(iv) the average amount of time that
individuals newly enrolled in such waiver
within the past 12 months were on such list of
individuals waiting to enroll in such waiver.
``
(B) With respect to homemaker services, home
health aide services, personal care services, and
habilitation services furnished under waivers under
this subsection, by each such service type--
``
(i) for individuals newly receiving such
services within the past 12 months, the average
amount of time (which may be determined using
statistically valid random sampling of such
individuals) from when such services are
initially approved for such an individual to
when such individual begins receiving such
services; and
``
(ii) the percentage of authorized hours
(which may be determined using statistically
valid random sampling of individuals authorized
to receive such services) that are provided
within the past 12 months.''.

(2) Conforming amendments.--

Security Act (42 U.S.C. 1396n) is amended--
(A) in subsection
(i) by adding at the end the
following new paragraph:
``

(8) Reporting requirement.--With respect to homemaker
services, home health aide services, personal care services,
and habilitation services provided under this subsection on or
after July 9, 2027, the State, not less frequently than
annually, shall provide to the Secretary the same information
regarding such services as the State is required to provide
under subsection
(c) (11)
(B) .'';
(B) in subsection

(j)

(2)
(E) , by inserting after the
second sentence the following: ``With respect to any
homemaker services, home health aide services, personal
care services, and habilitation services provided under
this subsection on or after July 9, 2027, the State,
not less frequently than annually, shall provide to the
Secretary the same information regarding such services
as the State is required to provide under subsection
(c) (11)
(B) .''; and
(C) in subsection

(k)

(3)
(E) --
(i) by striking ``and'' after ``the cost of
such services and supports,''; and
(ii) by inserting before the period, the
following: ``, and with respect to homemaker
services, home health aide services, personal
care services, and habilitation services
provided under this subsection on or after July
9, 2027, not less frequently than annually, the
same information regarding such services as the
State is required to provide under subsection
(c) (11)
(B) ''.

(b) Demonstration Program To Expand HCBS Coverage Under

(c) Waivers.--

(c) of the Social Security Act (42 U.S.C.
1396n
(c) ), as amended by subsection

(a) , is further amended--

(1) in paragraph

(2)
(E) , by inserting ``, and the
information specified in paragraph

(12)
(C)
(v) , when
applicable'' after ``paragraph

(11) ''; and

(2) by adding at the end the following new paragraph:
``

(12) Demonstration program to expand coverage for home or
community-based services.--
``
(A) In general.--
``
(i) Approval.--Not later than 24 months
after the date on which the planning grants
under subparagraph
(B) are awarded,
notwithstanding paragraph

(1) , the Secretary
may approve a waiver that is standalone from
any other waiver approved under this subsection
for not more than 5 States, selected in
accordance with clause
(ii) , to include as
medical assistance under the State plan of such
State, for the 3-year period beginning on the
date of such approval, payment for part or all
of the cost of home or community-based services
(other than room and board (as described in
paragraph

(1) )) approved by the Secretary which
are provided pursuant to a written plan of care
to individuals described in subparagraph
(C)
(iii) .
``
(ii) Selection criteria.--In selecting
States for purposes of clause
(i) , the
Secretary shall--
``
(I) only select States that
received a planning grant under
subparagraph
(B) ;
``
(II) only select States that meet
the requirements specified in
subparagraph
(C) and such other
requirements as the Secretary may
determine appropriate;
``
(III) select States in a manner
that ensures geographic diversity;
``
(IV) give preference to States
with a higher percentage (relative to
other States that apply to be selected
for purposes of clause
(i) ) of the
total State population residing in
rural areas (as determined by the
Secretary);
``
(V) give preference to States
that have demonstrated more progress in
rebalancing long-term services and
supports systems under this title, as
determined based on the relative share
of individuals who use home or
community-based services (as defined by
the Secretary) under this title as a
percentage of total individuals who use
long-term services and supports (as
defined by the Secretary) under this
title (in the most recent year for
which such data is available); and
``
(VI) give preference to States
that pursue a waiver under this
paragraph that incorporates the
provision of mental health services for
adults with serious mental illness,
children with serious emotional
disturbances, or individuals with
substance use disorder.
``
(B) Planning grants.--
``
(i) In general.--
``
(I) Approval.--Not later than 18
months after the date of the enactment
of this paragraph, the Secretary shall
award planning grants of not more than
$5,000,000 each to not more than 10
States for purposes of preparing to
submit a request for a waiver under
this subsection (including for costs to
implement the waiver or other
activities to expand the provision of
home or community-based services under
this section) to provide home or
community-based services to individuals
described in subparagraph
(C)
(iii) .
``
(II) Selection criteria.--In
awarding planning grants under
subclause
(I) , the Secretary shall use
the selection criteria specified in
subclauses
(III) through
(VI) of
subparagraph
(A)
(ii) .
``
(ii) Consultation.--A State that is
awarded a planning grant under clause
(i) shall, in preparing to submit a request for a
waiver described in such clause, consult with--
``
(I) individuals in need of (and
not receiving) home or community-based
services, individuals receiving home or
community-based services, and the
caregivers of such individuals;
``
(II) providers furnishing home or
community-based services; and
``
(III) such other stakeholders, as
the Secretary may specify.
``
(C) State requirements.--In addition to the
requirements specified under this subsection (except
for the requirements described in subparagraphs
(C) and
(D) of paragraph

(2) and any other requirement the
Secretary determines to be inapplicable in the context
of a waiver relation to individuals who do not require
the level of care described in paragraph

(1) ), the
requirements specified in this paragraph are, with
respect to a State, the following:
``
(i) As of the date that such State
requests a waiver under this subsection to
provide home or community-based services to
individuals described in clause
(iii) , all
other waivers (if any) granted under this
subsection to such State meet the requirements
of this subsection.
``
(ii) The State demonstrates to the
Secretary that approval of a waiver under this
subsection with respect to individuals
described in clause
(iii) will not result in a
material increase of the average amount of time
that individuals with respect to whom a
determination described in paragraph

(1) has
been made will need to wait to receive home or
community-based services under any waiver
granted under this subsection, as determined by
the Secretary.
``
(iii) The State establishes needs-based
criteria, subject to the approval of the
Secretary, to identify individuals for whom a
determination described in paragraph

(1) is not
applicable, who will be eligible for home or
community-based services under a waiver
approved under this paragraph, and specifies
the home or community-based services such
individuals so eligible will receive.
``
(iv) The State established needs-based
criteria for determining whether an individual
described in clause
(iii) requires the level of
care provided in a hospital, nursing facility,
or an intermediate care facility for
individuals with developmental disabilities
under the State plan or under any waiver of
such plan that are more stringent than the
needs-based criteria established under clause
(iii) for determining eligibility for home or
community-based services.
``
(v) The State attests that the State's
average per capita expenditure for medical
assistance under the State plan (or waiver of
such plan) provided with respect to such
individuals enrolled in a waiver under this
paragraph will not exceed the State's average
per capita expenditures for medical assistance
for individuals receiving institutional care
under the State plan (or waiver of such plan)
for the duration that the waiver under this
paragraph is in effect.
``
(vi) The State provides to the Secretary
data (in such form and manner as the Secretary
may specify) regarding the number of
individuals described in clause
(i) with
respect to a State seeking approval of a waiver
under this subsection, to whom the State will
make such services available under such waiver.
``
(vii) The State agrees to provide to the
Secretary, not less frequently than annually,
data for purposes of paragraph

(2)
(E) (in such
form and manner as the Secretary may specify)
regarding, with respect to each preceding year
in which a waiver under this subsection to
provide home and community-based services to
individuals described in clause
(iii) was in
effect--
``
(I) the cost (as such term is
defined by the Secretary) of such
services furnished to individuals
described in clause
(iii) , broken down
by type of service;
``
(II) with respect to each type of
home and community-based service
provided under the waiver, the length
of time that such individuals have
received such service;
``
(III) a comparison between the
data described in subclause
(I) and any
comparable data available with respect
to individuals with respect to whom a
determination described in paragraph

(1) has been made and with respect to
individuals receiving institutional
care under this title; and
``
(IV) the number of individuals
who have received home and community-
based services under the waiver during
the preceding year.''.
(c) Non-Application of the Paperwork Reduction Act.--Chapter 35 of
title 44, United States Code (commonly referred to as the ``Paperwork
Reduction Act of 1995''), shall not apply to the implementation of the
amendments made by subsections

(a) and

(b) .
(d) CMS Guidance to States on Interim Coverage Under

Home and Community-Based Services Authorities.--Not later than January
1, 2027, the Secretary of Health and Human Services shall issue
guidance to the States to clarify how a State may provide, with respect
to an individual who is eligible for home and community-based services
under

coverage of such services pursuant to a provisional written plan of
care, pending finalization, with respect to such individual.

(e) Funding.--

(1) In general.--There are appropriated, out of any funds
in the Treasury not otherwise obligated, $71,000,000 for fiscal
year 2025, to remain available until expended, to the Secretary
of Health and Human Services for purposes of carrying out
subsection
(d) and the amendments made by subsection

(b) .

(2) Reservation for planning grants.--Of the amount
appropriated under paragraph

(1) , the Secretary of Health and
Human Services shall reserve $50,000,000 of such amount to
award planning grants under the demonstration program
established by the amendments made by subsection

(b) .

WORKING ADULTS WITH DISABILITIES.

(a) Modification of Optional Buy-In Groups.--

(1) In general.--

(a)

(10)
(A)
(ii)
(XV) of the
Social Security Act (42 U.S.C. 1396a

(a)

(10)
(A)
(ii)
(XV) ) is
amended by striking ``but less than 65,''.

(2) Definition modification.--

(v) (1)
(A) of the
Social Security Act (42 U.S.C. 1396d
(v) (1)
(A) ) is amended by
striking ``, but less than 65,''.

(b) Application to Certain States.--A State that, as of the date of
enactment of this Act, provides for making medical assistance available
to individuals described in subclause
(XV) or
(XVI) of

(a)

(10)
(A)
(ii) of the Social Security Act (42 U.S.C.
1396a

(a)

(10)
(A)
(ii) ) shall not be regarded as failing to comply with
the requirements of either such subclause (as amended by subsection

(a)

(1) ) or with

(v) (1)
(A) of the Social Security Act (42
U.S.C. 1396d
(v) (1)
(A) ) (as amended by subsection

(a)

(2) ) before January
1, 2027.

COVERAGE FOR MILITARY FAMILIES.

(a) In General.--

1396a) is amended--

(1) in subsection

(a) --
(A) in paragraph

(86) , by striking ``and'' at the
end;
(B) in paragraph

(87) , by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph

(87) , the
following new paragraph:
``

(88) beginning January 1, 2028, provide, with respect to
an active duty relocated individual (as defined in subsection

(uu)

(1) )--
``
(A) that, for purposes of determining eligibility
for medical assistance under the State plan (or waiver
of such plan), such active duty relocated individual is
treated as a resident of the State unless such
individual voluntarily elects not to be so treated for
such purposes;
``
(B) that if, at the time of relocation (as
described in subsection

(uu)

(1) ), such active duty
relocated individual is on a home and community-based
services waiting list (as defined in subsection

(uu)

(2) ), such individual remains on such list until--
``
(i) the State completes an assessment and
renders a decision with respect to the
eligibility of such individual to receive the
relevant home and community-based services at
the time a slot for such services becomes
available and, in the case such decision is a
denial of such eligibility, such individual has
exhausted the individual's opportunity for a
fair hearing; or
``
(ii) such individual elects to be removed
from such list; and
``
(C) payment for medical assistance furnished
under the State plan (or a waiver of the plan) on
behalf of such active duty relocated individual in the
military service relocation State (as referred to in
subsection

(uu)

(1)
(B)
(i) ), to the extent that such
assistance is available in such military service
relocation State in accordance with such guidance as
the Secretary may issue to ensure access to such
assistance.''; and

(2) by adding at the end the following new subsection:
``

(uu) Active Duty Relocated Individual; Home and Community-Based
Services Waiting List.--For purposes of subsection

(a)

(88) and this
subsection:
``

(1) Active duty relocated individual.--The term `active
duty relocated individual' means an individual--
``
(A) who--
``
(i) is enrolled under the State plan (or
waiver of such plan); or
``
(ii) with respect to an individual
described in subparagraph
(C)
(ii) , would be so
enrolled pursuant to subsection

(a)

(10)
(A)
(ii)
(VI) if such individual began
receiving home and community-based services;
``
(B) who--
``
(i) is a member of the Armed Forces
engaged in active duty service and is relocated
to another State (in this subsection referred
to as the `military service relocation State')
by reason of such service;
``
(ii) would be described in clause
(i) except that the individual stopped being
engaged in active duty service (including by
reason of retirement from such service) and the
last day on which the individual was engaged in
active duty service occurred not more than 12
months ago; or
``
(iii) is a dependent (as defined by the
Secretary) of a member described in clause
(i) or
(ii) who relocates to the military service
relocation State with such member; and
``
(C) who--
``
(i) was receiving home and community-
based services (as defined in

(a)

(2)
(B) of the American Rescue Plan Act
of 2021) at the time of such relocation; or
``
(ii) if the State maintains a home and
community-based services waiting list, was on
such home and community-based services waiting
list at the time of such relocation.
``

(2) Home and community-based services waiting list.--The
term `home and community-based services waiting list' means, in
the case of a State that has a limit on the number of
individuals who may receive home and community-based services
under

(a) ,

(c) , or

(j) , a
list maintained by such State of individuals who are requesting
to receive such services under 1 or more such sections but for
whom the State has not yet completed an assessment and rendered
a decision with respect to the eligibility of such individuals
to receive the relevant home and community-based services at
the time a slot for such services becomes available due to such
limit.''.

(b) Implementation Funding.--There are appropriated, out of any
funds in the Treasury not otherwise obligated, $1,000,000 for each of
fiscal years 2025 through 2029, to remain available until expended, to
the Secretary of Health and Human Services for purposes of implementing
the amendments made by subsection

(a) .

UNDER THE MEDICAID PROGRAM.

(a) In General.--

(a) of the Social Security Act (42
U.S.C. 1396a

(a) ), as previously amended by this title, is amended--

(1) in paragraph

(87) , by striking ``and'' at the end;

(2) in paragraph

(88) , by striking the period at the end
and inserting ``; and''; and

(3) by inserting after paragraph

(88) the following new
paragraph:
``

(89) beginning January 1, 2026, provide for a process to
regularly obtain address information for individuals enrolled
under such plan (or a waiver of such plan) from reliable data
sources (as described in

(f)

(1)
(iii) of title
42, Code of Federal Regulations (or a successor regulation))
and act on any changes to such an address based on such
information in accordance with such section (or successor
regulation), except that this paragraph shall only apply in the
case of the 50 States and the District of Columbia.''.

(b) Application to CHIP.--

(e)

(1) of the Social Security
Act (42 U.S.C. 1397gg

(e)

(1) ) is amended--

(1) by redesignating subparagraphs
(H) through
(U) as
subparagraphs
(I) through
(V) , respectively; and

(2) by inserting after subparagraph
(G) the following new
subparagraph:
``
(H) Section 1902

(a)

(89) (relating to regularly
obtaining address information for enrollees).''.
(c) Ensuring Transmission of Address Information From Managed Care
Organizations.--

1396u-2) is amended by adding at the end the following new subsection:
``

(j) Transmission of Address Information.--Beginning January 1,
2026, each contract under a State plan with a managed care entity under

(m) shall provide that the entity transmits to the State
any address information for an individual enrolled with the entity that
is provided to such entity directly from, or verified by such entity
directly with, such individual.''.

RELATED TO DECEASED PROVIDERS.

(kk)

(1) of the Social Security Act (42 U.S.C.
1396a

(kk)

(1) ) is amended--

(1) by striking ``The State'' and inserting:
``
(A) In general.--The State''; and

(2) by adding at the end the following new subparagraph:
``
(B) Additional provider screening.--Beginning
January 1, 2027, as part of the enrollment (or
reenrollment or revalidation of enrollment) of a
provider or supplier under this title, and not less
frequently than quarterly during the period that such
provider or supplier is so enrolled, the State conducts
a check of the Death Master File (as such term is
defined in

(d) of the Bipartisan Budget Act
of 2013) to determine whether such provider or supplier
is deceased.''.

INDIVIDUALS DO NOT REMAIN ENROLLED.

previously amended by this title, is amended--

(1) in subsection

(a) --
(A) in paragraph

(88) , by striking ``; and'' and
inserting a semicolon;
(B) in paragraph

(89) , by striking the period at
the end and inserting ``; and''; and
(C) by inserting after paragraph

(89) the following
new paragraph:
``

(90) provide that the State shall comply with the
eligibility verification requirements under subsection
(vv) ,
except that this paragraph shall apply only in the case of the
50 States and the District of Columbia.''; and

(2) by adding at the end the following new subsection:
``
(vv) Verification of Certain Eligibility Criteria.--
``

(1) In general.--For purposes of subsection

(a)

(90) , the
eligibility verification requirements, beginning January 1,
2026, are as follows:
``
(A) Quarterly screening to verify enrollee
status.--The State shall, not less frequently than
quarterly, review the Death Master File (as such term
is defined in

(d) of the Bipartisan Budget
Act of 2013) to determine whether any individuals
enrolled for medical assistance under the State plan
(or waiver of such plan) are deceased.
``
(B) Disenrollment under state plan.--If the State
determines, based on information obtained from the
Death Master File, that an individual enrolled for
medical assistance under the State plan (or waiver of
such plan) is deceased, the State shall--
``
(i) treat such information as factual
information confirming the death of a
beneficiary for purposes of

(a) of title 42, Code of Federal Regulations (or
any successor regulation);
``
(ii) disenroll such individual from the
State plan (or waiver of such plan); and
``
(iii) discontinue any payments for
medical assistance under this title made on
behalf of such individual (other than payments
for any items or services furnished to such
individual prior to the death of such
individual).
``
(C) Reinstatement of coverage in the event of
error.--If a State determines that an individual was
misidentified as deceased based on information obtained
from the Death Master File, and was erroneously
disenrolled from medical assistance under the State
plan (or waiver of such plan) based on such
misidentification, the State shall immediately reenroll
such individual under the State plan (or waiver of such
plan), retroactive to the date of such disenrollment.
``

(2) Rule of construction.--Nothing under this subsection
shall be construed to preclude the ability of a State to use
other electronic data sources to timely identify potentially
deceased beneficiaries, so long as the State is also in
compliance with the requirements of this subsection (and all
other requirements under this title relating to Medicaid
eligibility determination and redetermination).''.

SCREENINGS, REFERRALS, AND CASE MANAGEMENT SERVICES FOR
ELIGIBLE JUVENILES IN PUBLIC INSTITUTIONS; STATE INTERIM
WORK PLANS.

(a) In General.--

(d) of subtitle C of title V of
division FF of the Consolidated Appropriations Act, 2023 (Public Law
117-328) is amended--

(1) by striking ``The amendments made by this section'' and
inserting the following:
``

(1) In general.--Subject to paragraph

(2) , the amendments
made by this section''; and

(2) by adding at the end the following new paragraph:
``

(2) Delay of date by which states must comply with
certain juvenile justice-related requirements.--A State shall
not be regarded as failing to comply with the requirements of

(a)

(84)
(D) or 2102
(d) (2) of the Social Security Act
(42 U.S.C. 1396a

(a)

(84)
(D) , 1397bb
(d) (2) ) before January 1,
2026.''.

(b) Clarifying Nonapplication of Requirements to Individuals in
Federal Custody.--

(1) Medicaid.--
(A) Subparagraph
(D) of

(a)

(84) of the
Social Security Act (42 U.S.C. 1396a

(a)

(84) ), as added
by

of the Consolidated Appropriations Act, 2023 (Public
Law 117-328), is amended by striking ``an individual
who is an eligible juvenile'' and inserting ``an
individual (other than an individual who is in Federal
custody, including as an inmate in a Federal prison)
who is an eligible juvenile''.
(B) Section 5122

(a) of subtitle C of title V of
division FF of the Consolidated Appropriations Act,
2023 (Public Law 117-328) is amended--
(i) by striking ``paragraph

(31) '' each
place it appears and inserting ``the last
numbered paragraph''; and
(ii) in paragraph

(1) , by striking ``an
individual who is an eligible juvenile'' and
inserting ``an individual (other than an
individual who is in Federal custody, including
as an inmate in a Federal prison) who is an
eligible juvenile''.

(2) CHIP.--
(A) Subsection
(d) (2) of

Security Act (42 U.S.C. 1397bb), as added by

Consolidated Appropriations Act, 2023 (Public Law 117-
328), is amended by striking ``a targeted low-income
child who'' and inserting ``a targeted low income child
(other than a child who is in Federal custody,
including as an inmate in a Federal prison) who''.
(B) Section 5122

(b)

(2) of subtitle C of title V of
division FF of the Consolidated Appropriations Act,
2023 (Public Law 117-328) is amended by striking ``a
child who is'' and inserting ``a child (other than a
child who is in Federal custody, including as an inmate
in a Federal prison) who is''.

(3) Effective date.--The amendments made by this subsection
shall take effect as if enacted on December 29, 2022.
(c) Interim Work Plan.--Not later than June 30, 2025, each State
(as such term is defined in

(a)

(1) of the Social Security
Act (42 U.S.C. 1301

(a)

(1) ) for purposes of titles XIX and XXI of such
Act) shall submit to the Secretary of Health and Human Services an
interim work plan, in such form and containing such information as the
Secretary may specify, describing the State's progress towards
implementing, and its plans to come into compliance with, the
requirements imposed by the amendments made by

C of title V of division FF of the Consolidated Appropriations Act,
2023 (Public Law 117-328), consistent with the guidance issued by the
Centers for Medicare & Medicaid Services in State Health Official
Letter #24-004 on July 23, 2024.

LABOR, AND DELIVERY SERVICES.

(a) State Study.--

(1) In general.--Not later than 24 months after the date of
enactment of this Act, and every 5 years thereafter, each State
(as such term is defined in

(a)

(1) of the Social
Security Act (42 U.S.C. 1301

(a)

(1) ) for purposes of titles XIX
and XXI of such Act) shall conduct a study on the costs of
providing maternity, labor, and delivery services in applicable
hospitals (as defined in paragraph

(3) ) and submit the results
of such study to the Secretary of Health and Human Services
(referred to in this section as the ``Secretary'').

(2) Content of study.--A State study required under
paragraph

(1) shall include the following information (to the
extent practicable) with respect to maternity, labor, and
delivery services furnished by applicable hospitals located in
the State:
(A) An estimate of the cost of providing maternity,
labor, and delivery services at applicable hospitals,
based on the expenditures a representative sample of
such hospitals incurred for providing such services
during the 2 most recent years for which data is
available.
(B) An estimate of the cost of providing maternity,
labor, and delivery services at applicable hospitals
that ceased providing labor and delivery services
within the past 5 years, based on the expenditures a
representative sample of such hospitals incurred for
providing such services during the 2 most recent years
for which data is available.
(C) To the extent data allows, an analysis of the
extent to which geographic location, community
demographics, and local economic factors (as defined by
the Secretary) affect the cost of providing maternity,
labor, and delivery services at applicable hospitals,
including the cost of services that support the
provision of maternity, labor, and delivery services.
(D) The amounts applicable hospitals are paid for
maternity, labor, and delivery services, by geographic
location and hospital size, under--
(i) Medicare;
(ii) the State Medicaid program, including
payment amounts for such services under fee-
for-service payment arrangements and under
managed care (as applicable);
(iii) the State CHIP plan, including
payment amounts for such services under fee-
for-service payment arrangements and under
managed care (as applicable); and
(iv) private health insurance.
(E) A comparative payment rate analysis--
(i) comparing payment rates for maternity,
labor, and delivery services (inclusive of all
payments received by applicable hospitals for
furnishing maternity, labor, and delivery
services) under the State Medicaid fee-for-
service program to such payment rates for such
services under Medicare (as described in

(b)

(3) of title 42, Code of
Federal Regulations), other Federally-funded or
State-funded programs (including, to the extent
data is available, Medicaid managed care
rates), and to the payment rates for such
services, to the extent data is available, of
private health insurers within geographic areas
of the State; and
(ii) analyzing different payment methods
for such services, such as the use of bundled
payments, quality incentives, and low-volume
adjustments.
(F) An evaluation, using such methodology and
parameters established by the Secretary, of whether
each hospital located in the State that furnishes
maternity, labor, and delivery services is expected to
experience in the next 3 years significant changes in
particular expenditures or types of reimbursement for
maternity, labor, and delivery services.

(3) Applicable hospital defined.--For purposes of this
subsection, the term ``applicable hospital'' means any hospital
located in a State that meets either of the following criteria:
(A) The hospital provides labor and delivery
services and more than 50 percent of the hospital's
births (in the most recent year for which such data is
available) are financed by the Medicaid program or
CHIP.
(B) The hospital--
(i) is located in a rural area (as defined
by the Federal Office of Rural Health Policy
for the purpose of rural health grant programs
administered by such Office);
(ii) based on the most recent 2 years of
data available (as determined by the
Secretary), furnished services for less than an
average of 300 births per year; and
(iii) provides labor and delivery services.

(4) Assistance to small hospitals in compiling cost
information.--There are appropriated to the Secretary for
fiscal year 2025, $10,000,000 for the purpose of providing
grants and technical assistance to a hospital described in
paragraph

(3)
(B) to enable such hospital to compile detailed
information for use in the State studies required under
paragraph

(1) , to remain available until expended.

(5) HHS report on state studies.--For each year in which a
State is required to conduct a study under paragraph

(1) , the
Secretary shall issue, not later than 12 months after the date
on which the State submits to the Secretary the data described
in such paragraph, a publicly available report that compiles
and details the results of such study and includes the
information described in paragraph

(2) .

(b) HHS Report on National Data Collection

(a) Extending Tennessee DSH Allotments.--

(f)

(6)
(A)
(vi) of the Social Security Act (42 U.S.C. 1396r-4

(f)

(6)
(A)
(vi) ) is
amended--

(1) in the heading, by striking ``2025'' and inserting
``2026 and for the 1st quarter of fiscal year 2027'';

(2) by striking ``fiscal year 2025'' and inserting ``fiscal
year 2026''; and

(3) by inserting ``, and the DSH allotment for Tennessee
for the 1st quarter of fiscal year 2027, shall be $13,275,000''
before the period.

(b) Eliminating and Delaying DSH Allotment Reductions.--

(f) of the Social Security Act (42 U.S.C. 1396r-4

(f) ) is amended--

(1) in paragraph

(7)
(A) --
(A) in clause
(i) , in the matter preceding
subclause
(I) , by striking ``April 1, 2025,'' and all
that follows through ``2027'' and inserting ``January
1, 2027, and ending September 30, 2027, and for fiscal
year 2028''; and
(B) in clause
(ii) , by striking ``April 1, 2025,''
and all that follows through ``2027'' and inserting
``January 1, 2027, and ending September 30, 2027, and
for fiscal year 2028''; and

(2) in paragraph

(8) , by striking ``2027'' and inserting
``2028''.

HOSPITAL PAYMENT ADJUSTMENTS UNDER THE MEDICAID PROGRAM.

(a) In General.--

(g) of the Social Security Act (42
U.S.C. 1396r-4

(g) ) is amended--

(1) in paragraph

(1) --
(A) in subparagraph
(A) --
(i) in the matter preceding clause
(i) , by
striking ``(other than a hospital described in
paragraph

(2)
(B) )'';
(ii) in clause
(i) , by inserting ``with
respect to such hospital and year'' after
``described in subparagraph
(B) ''; and
(iii) in clause
(ii) --
(I) in subclause
(I) , by striking
``and'' at the end;
(II) in subclause
(II) , by striking
the period and inserting ``; and''; and
(III) by adding at the end the
following new subclause:
``
(III) payments made under title
XVIII or by an applicable plan (as
defined in

(b)

(8)
(F) ) for
such services.''; and
(B) in subparagraph
(B) --
(i) in the matter preceding clause
(i) , by
striking ``in this clause are'' and inserting
``in this subparagraph are, with respect to a
hospital and a year,''; and
(ii) by adding at the end the following new
clause:
``
(iii) Individuals who are eligible for
medical assistance under the State plan or
under a waiver of such plan and for whom the
State plan or waiver is a payor for such
services after application of benefits under
title XVIII or under an applicable plan (as
defined in

(b)

(8)
(F) ), but only if
the hospital has in the aggregate incurred
costs exceeding payments under such State plan,
waiver, title XVIII, or applicable plan for
such services furnished to such individuals
during such year.'';

(2) by striking paragraph

(2) ;

(3) by redesignating paragraph

(3) as paragraph

(2) ; and

(4) in paragraph

(2) , as so redesignated, by striking
``Notwithstanding paragraph

(2) of this subsection (as in
effect on October 1, 2021), paragraph

(2) '' and inserting
``Paragraph

(2) ''.

(b) Effective Date.--

(1) In general.--Except as provided in paragraph

(2) , the
amendments made by this section shall apply to payment
adjustments made under

(42 U.S.C. 1396r-4) for Medicaid State plan rate years
beginning on or after the date of enactment of this Act.

(2) State option to distribute unspent dsh allotments from
prior years up to modified cap.--
(A) In general.--If, for any Medicaid State plan
rate year that begins on or after October 1, 2021, and
before the date of enactment of this Act, a State did
not spend the full amount of its Federal fiscal year
allotment under

(42 U.S.C. 1396r-4) applicable to that State plan rate
year, the State may use the unspent portion of such
allotment to increase the amount of any payment
adjustment made to a hospital for such rate year,
provided that--
(i) such payment adjustment (as so
increased) is consistent with subsection

(g) of
such section (as amended by this section); and
(ii) the total amount of all payment
adjustments for the State plan rate year (as so
increased) does not exceed the disproportionate
share hospital allotment for the State and
applicable Federal fiscal year under subsection

(f) of such section.
(B) No recoupment of payments already made to
hospitals.--A State shall not recoup any payment
adjustment made by the State to a hospital for a
Medicaid State plan rate year described in subparagraph
(A) if such payment adjustment is consistent with

(g) of such Act (42 U.S.C. 1396r-4

(g) ) as
in effect on October 1, 2021.
(C) Authority to permit retroactive modification of
state plan amendments to allow for increases.--
(i) In general.--Subject to paragraph

(2) ,
solely for the purpose of allowing a State to
increase the amount of a payment adjustment to
a hospital for a Medicaid State plan rate year
described in subparagraph
(A) pursuant to this
paragraph, a State may retroactively modify a
provision of the Medicaid State plan, a waiver
of such plan, or a State plan amendment that
relates to such rate year and the Secretary may
approve such modification.
(ii) Deadline.--A State may not submit a
request for approval of a retroactive
modification to a provision of the Medicaid
State plan, a waiver of such plan, or a State
plan amendment for a Medicaid State plan rate
year after the date by which the State is
required to submit the independent certified
audit for that State plan rate year as required
under

(j)

(2) of the Social Security
Act (42 U.S.C. 1396r-4

(j)

(2) ).
(D) Reporting.--If a State increases a payment
adjustment made to a hospital for a Medicaid State plan
rate year pursuant to this paragraph, the State shall
include information on such increased payment
adjustment as part of the next annual report submitted
by the State under

(j)

(1) of the Social
Security Act (42 U.S.C. 1396r-4

(j)

(1) ).

(a) In General.--

(f) of the Social Security Act (42
U.S.C. 1396r-8

(f) ) is amended--

(1) in paragraph

(1)
(A) --
(A) by redesignating clause
(ii) as clause
(iii) ;
and
(B) by striking ``and'' after the semicolon at the
end of clause
(i) and all that precedes it through
``

(1) '' and inserting the following:
``

(1) Determining pharmacy actual acquisition costs.--The
Secretary shall conduct a survey of retail community pharmacy
drug prices and applicable non-retail pharmacy drug prices to
determine national average drug acquisition cost benchmarks (as
such term is defined by the Secretary) as follows:
``
(A) Use of vendor.--The Secretary may contract
services for--
``
(i) with respect to retail community
pharmacies, the determination of retail survey
prices of the national average drug acquisition
cost for covered outpatient drugs that
represent a nationwide average of consumer
purchase prices for such drugs, net of all
discounts, rebates, and other price concessions
(to the extent any information with respect to
such discounts, rebates, and other price
concessions is available) based on a monthly
survey of such pharmacies;
``
(ii) with respect to applicable non-
retail pharmacies--
``
(I) the determination of survey
prices, separate from the survey prices
described in clause
(i) , of the non-
retail national average drug
acquisition cost for covered outpatient
drugs that represent a nationwide
average of consumer purchase prices for
such drugs, net of all discounts,
rebates, and other price concessions
(to the extent any information with
respect to such discounts, rebates, and
other price concessions is available)
based on a monthly survey of such
pharmacies; and
``
(II) at the discretion of the
Secretary, for each type of applicable
non-retail pharmacy, the determination
of survey prices, separate from the
survey prices described in clause
(i) or subclause
(I) of this clause, of the
national average drug acquisition cost
for such type of pharmacy for covered
outpatient drugs that represent a
nationwide average of consumer purchase
prices for such drugs, net of all
discounts, rebates, and other price
concessions (to the extent any
information with respect to such
discounts, rebates, and other price
concessions is available) based on a
monthly survey of such pharmacies;
and'';

(2) in subparagraph
(B) of paragraph

(1) , by striking
``subparagraph
(A)
(ii) '' and inserting ``subparagraph
(A)
(iii) '';

(3) in subparagraph
(D) of paragraph

(1) , by striking
clauses
(ii) and
(iii) and inserting the following:
``
(ii) The vendor must update the Secretary
no less often than monthly on the survey prices
for covered outpatient drugs.
``
(iii) The vendor must differentiate, in
collecting and reporting survey data, for all
cost information collected, whether a pharmacy
is a retail community pharmacy or an applicable
non-retail pharmacy, including whether such
pharmacy is an affiliate (as defined in
subsection

(k)

(14) ), and, in the case of an
applicable non-retail pharmacy, which type of
applicable non-retail pharmacy it is using the
relevant pharmacy type indicators included in
the guidance required by subsection
(d) (2) of

Act.'';

(4) by adding at the end of paragraph

(1) the following:
``
(F) Survey reporting.--In order to meet the
requirement of

(a)

(54) , a State shall
require that any retail community pharmacy or
applicable non-retail pharmacy in the State that
receives any payment, reimbursement, administrative
fee, discount, rebate, or other price concession
related to the dispensing of covered outpatient drugs
to individuals receiving benefits under this title,
regardless of whether such payment, reimbursement,
administrative fee, discount, rebate, or other price
concession is received from the State or a managed care
entity or other specified entity (as such terms are
defined in

(m) (9)
(D) ) directly or from a
pharmacy benefit manager or another entity that has a
contract with the State or a managed care entity or
other specified entity (as so defined), shall respond
to surveys conducted under this paragraph.
``
(G) Survey information.--Information on national
drug acquisition prices obtained under this paragraph
shall be made publicly available in a form and manner
to be determined by the Secretary and shall include at
least the following:
``
(i) The monthly response rate to the
survey including a list of pharmacies not in
compliance with subparagraph
(F) .
``
(ii) The sampling methodology and number
of pharmacies sampled monthly.
``
(iii) Information on price concessions to
pharmacies, including discounts, rebates, and
other price concessions, to the extent that
such information may be publicly released and
has been collected by the Secretary as part of
the survey.
``
(H) Penalties.--
``
(i) In general.--Subject to clauses
(ii) ,
(iii) , and
(iv) , the Secretary shall enforce
the provisions of this paragraph with respect
to a pharmacy through the establishment of
civil money penalties applicable to a retail
community pharmacy or an applicable non-retail
pharmacy.
``
(ii) Basis for penalties.--The Secretary
shall impose a civil money penalty established
under this subparagraph on a retail community
pharmacy or applicable non-retail pharmacy if--
``
(I) the retail pharmacy or
applicable non-retail pharmacy refuses
or otherwise fails to respond to a
request for information about prices in
connection with a survey under this
subsection;
``
(II) knowingly provides false
information in response to such a
survey; or
``
(III) otherwise fails to comply
with the requirements established under
this paragraph.
``
(iii) Parameters for penalties.--
``
(I) In general.--A civil money
penalty established under this
subparagraph may be assessed with
respect to each violation, and with
respect to each non-compliant retail
community pharmacy (including a
pharmacy that is part of a chain) or
non-compliant applicable non-retail
pharmacy (including a pharmacy that is
part of a chain), in an amount not to
exceed $100,000 for each such
violation.
``
(II) Considerations.--In
determining the amount of a civil money
penalty imposed under this
subparagraph, the Secretary may
consider the size, business structure,
and type of pharmacy involved, as well
as the type of violation and other
relevant factors, as determined
appropriate by the Secretary.
``
(iv) Rule of application.--The provisions
of

(a) and

(b) ) shall apply to a civil money penalty
under this subparagraph in the same manner as
such provisions apply to a civil money penalty
or proceeding under

(a) .
``
(I) Limitation on use of applicable non-retail
pharmacy pricing information.--No State shall use
pricing information reported by applicable non-retail
pharmacies under subparagraph
(A)
(ii) to develop or
inform payment methodologies for retail community
pharmacies.'';

(5) in paragraph

(2) --
(A) in subparagraph
(A) , by inserting ``, including
payment rates and methodologies for determining
ingredient cost reimbursement under managed care
entities or other specified entities (as such terms are
defined in

(m) (9)
(D) ),'' after ``under this
title''; and
(B) in subparagraph
(B) , by inserting ``and the
basis for such dispensing fees'' before the semicolon;

(6) by redesignating paragraph

(4) as paragraph

(5) ;

(7) by inserting after paragraph

(3) the following new
paragraph:
``

(4) Oversight.--
``
(A) In general.--The Inspector General of the
Department of Health and Human Services shall conduct
periodic studies of the survey data reported under this
subsection, as appropriate, including with respect to
substantial variations in acquisition costs or other
applicable costs, as well as with respect to how
internal transfer prices and related party transactions
may influence the costs reported by pharmacies that are
affiliates (as defined in subsection

(k)

(14) ) or are
owned by, controlled by, or related under a common
ownership structure with a wholesaler, distributor, or
other entity that acquires covered outpatient drugs
relative to costs reported by pharmacies not affiliated
with such entities. The Inspector General shall provide
periodic updates to Congress on the results of such
studies, as appropriate, in a manner that does not
disclose trade secrets or other proprietary
information.
``
(B) Appropriation.--There is appropriated to the
Inspector General of the Department of Health and Human
Services, out of any money in the Treasury not
otherwise appropriated, $5,000,000 for fiscal year
2025, to remain available until expended, to carry out
this paragraph.''; and

(8) in paragraph

(5) , as so redesignated--
(A) by inserting ``, and $9,000,000 for fiscal year
2025 and each fiscal year thereafter,'' after ``2010'';
and
(B) by inserting ``Funds appropriated under this
paragraph for fiscal year 2025 and any subsequent
fiscal year shall remain available until expended.''
after the period.

(b)

(k) of the Social Security Act (42
U.S.C. 1396r-8

(k) ) is amended--

(1) in the matter preceding paragraph

(1) , by striking ``In
the section'' and inserting ``In this section''; and

(2) by adding at the end the following new paragraphs:
``

(12) Applicable non-retail pharmacy.--The term
`applicable non-retail pharmacy' means a pharmacy that is
licensed as a pharmacy by the State and that is not a retail
community pharmacy, including a pharmacy that dispenses
prescription medications to patients primarily through mail and
specialty pharmacies. Such term does not include nursing home
pharmacies, long-term care facility pharmacies, hospital
pharmacies, clinics, charitable or not-for-profit pharmacies,
government pharmacies, or low dispensing pharmacies (as defined
by the Secretary).
``

(13) Affiliate.--The term `affiliate' means any entity
that is owned by, controlled by, or related under a common
ownership structure with a pharmacy benefit manager or a
managed care entity or other specified entity (as such terms
are defined in

(m) (9)
(D) ).''.
(c) Effective Date.--

(1) In general.--Subject to paragraph

(2) , the amendments
made by this section shall take effect on the first day of the
first quarter that begins on or after the date that is 6 months
after the date of enactment of this Act.

(2) Delayed application to applicable non-retail
pharmacies.--The pharmacy survey requirements established by
the amendments to

(f) of the Social Security Act
(42 U.S.C. 1396r-8

(f) ) made by this section shall apply to
retail community pharmacies beginning on the effective date
described in paragraph

(1) , but shall not apply to applicable
non-retail pharmacies until the first day of the first quarter
that begins on or after the date that is 18 months after the
date of enactment of this Act.
(d) Identification of Applicable Non-Retail Pharmacies.--

(1) In general.--Not later than January 1, 2026, the
Secretary of Health and Human Services shall, in consultation
with stakeholders as appropriate, publish guidance specifying
pharmacies that meet the definition of applicable non-retail
pharmacies (as such term is defined in subsection

(k)

(12) of

added by subsection

(b) ), and that will be subject to the
survey requirements under subsection

(f)

(1) of such section, as
amended by subsection

(a) .

(2) Inclusion of pharmacy type indicators.--The guidance
published under paragraph

(1) shall include pharmacy type
indicators to distinguish between different types of applicable
non-retail pharmacies, such as pharmacies that dispense
prescriptions primarily through the mail and pharmacies that
dispense prescriptions that require special handling or
distribution. An applicable non-retail pharmacy may be
identified through multiple pharmacy type indicators.

(e) Implementation.--

(1) In general.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services may implement
the amendments made by this section by program instruction or
otherwise.

(2) Nonapplication of administrative procedure act.--
Implementation of the amendments made by this section shall be
exempt from the requirements of

States Code.

(f) Nonapplication of Paperwork Reduction Act.--Chapter 35 of title
44, United States Code, shall not apply to any data collection
undertaken by the Secretary of Health and Human Services under

(f) of the Social Security Act (42 U.S.C. 1396r-8

(f) ), as amended
by this section.

(a) In General.--

1396r-8) is amended--

(1) in subsection

(e) , by adding at the end the following
new paragraph:
``

(6) Transparent prescription drug pass-through pricing
required.--
``
(A) In general.--A contract between the State and
a pharmacy benefit manager (referred to in this
paragraph as a `PBM'), or a contract between the State
and a managed care entity or other specified entity (as
such terms are defined in

(m) (9)
(D) and
collectively referred to in this paragraph as the
`entity') that includes provisions making the entity
responsible for coverage of covered outpatient drugs
dispensed to individuals enrolled with the entity,
shall require that payment for such drugs and related
administrative services (as applicable), including
payments made by a PBM on behalf of the State or
entity, is based on a transparent prescription drug
pass-through pricing model under which--
``
(i) any payment made by the entity or the
PBM (as applicable) for such a drug--
``
(I) is limited to--
``

(aa) ingredient cost; and
``

(bb) a professional
dispensing fee that is not less
than the professional
dispensing fee that the State
would pay if the State were
making the payment directly in
accordance with the State plan;
``
(II) is passed through in its
entirety (except as reduced under
Federal or State laws and regulations
in response to instances of waste,
fraud, or abuse) by the entity or PBM
to the pharmacy or provider that
dispenses the drug; and
``
(III) is made in a manner that is
consistent with sections 447.502,
447.512, 447.514, and 447.518 of title
42, Code of Federal Regulations (or any
successor regulation) as if such
requirements applied directly to the
entity or the PBM, except that any
payment by the entity or the PBM for
the ingredient cost of such drug
purchased by a covered entity (as
defined in subsection

(a)

(5)
(B) ) may
exceed the actual acquisition cost (as
defined in 447.502 of title 42, Code of
Federal Regulations, or any successor
regulation) for such drug if--
``

(aa) such drug was
subject to an agreement under

Health Service Act;
``

(bb) such payment for the
ingredient cost of such drug
does not exceed the maximum
payment that would have been
made by the entity or the PBM
for the ingredient cost of such
drug if such drug had not been
purchased by such covered
entity; and
``
(cc) such covered entity
reports to the Secretary (in a
form and manner specified by
the Secretary), on an annual
basis and with respect to
payments for the ingredient
costs of such drugs so
purchased by such covered
entity that are in excess of
the actual acquisition costs
for such drugs, the aggregate
amount of such excess;
``
(ii) payment to the entity or the PBM (as
applicable) for administrative services
performed by the entity or PBM is limited to an
administrative fee that reflects the fair
market value (as defined by the Secretary) of
such services;
``
(iii) the entity or the PBM (as
applicable) makes available to the State, and
the Secretary upon request in a form and manner
specified by the Secretary, all costs and
payments related to covered outpatient drugs
and accompanying administrative services (as
described in clause
(ii) ) incurred, received,
or made by the entity or the PBM, broken down
(as specified by the Secretary), to the extent
such costs and payments are attributable to an
individual covered outpatient drug, by each
such drug, including any ingredient costs,
professional dispensing fees, administrative
fees (as described in clause
(ii) ), post-sale
and post-invoice fees, discounts, or related
adjustments such as direct and indirect
remuneration fees, and any and all other
remuneration, as defined by the Secretary; and
``
(iv) any form of spread pricing whereby
any amount charged or claimed by the entity or
the PBM (as applicable) that exceeds the amount
paid to the pharmacies or providers on behalf
of the State or entity, including any post-sale
or post-invoice fees, discounts, or related
adjustments such as direct and indirect
remuneration fees or assessments, as defined by
the Secretary, (after allowing for an
administrative fee as described in clause
(ii) )
is not allowable for purposes of claiming
Federal matching payments under this title.
``
(B) Publication of information.--The Secretary
shall publish, not less frequently than on an annual
basis and in a manner that does not disclose the
identity of a particular covered entity or
organization, information received by the Secretary
pursuant to subparagraph
(A)
(iii)
(III) that is broken
out by State and by each of the following categories of
covered entity within each such State:
``
(i) Covered entities described in
subparagraph
(A) of

(a)

(4) of the
Public Health Service Act.
``
(ii) Covered entities described in
subparagraphs
(B) through
(K) of such section.
``
(iii) Covered entities described in
subparagraph
(L) of such section.
``
(iv) Covered entities described in
subparagraph
(M) of such section.
``
(v) Covered entities described in
subparagraph
(N) of such section.
``
(vi) Covered entities described in
subparagraph
(O) of such section.''; and

(2) in subsection

(k) , as previously amended by this title,
by adding at the end the following new paragraph:
``

(14) Pharmacy benefit manager.--The term `pharmacy
benefit manager' means any person or entity that, either
directly or through an intermediary, acts as a price negotiator
or group purchaser on behalf of a State, managed care entity
(as defined in

(m) (9)
(D) ), or other specified
entity (as so defined), or manages the prescription drug
benefits provided by a State, managed care entity, or other
specified entity, including the processing and payment of
claims for prescription drugs, the performance of drug
utilization review, the processing of drug prior authorization
requests, the managing of appeals or grievances related to the
prescription drug benefits, contracting with pharmacies,
controlling the cost of covered outpatient drugs, or the
provision of services related thereto. Such term includes any
person or entity that acts as a price negotiator (with regard
to payment amounts to pharmacies and providers for a covered
outpatient drug or the net cost of the drug) or group purchaser
on behalf of a State, managed care entity, or other specified
entity or that carries out 1 or more of the other activities
described in the preceding sentence, irrespective of whether
such person or entity calls itself a pharmacy benefit
manager.''.

(b) Conforming Amendments.--

(m) of such Act (42 U.S.C.
1396b
(m) ) is amended--

(1) in paragraph

(2)
(A)
(xiii) --
(A) by striking ``and
(III) '' and inserting
``
(III) '';
(B) by inserting before the period at the end the
following: ``, and
(IV) if the contract includes
provisions making the entity responsible for coverage
of covered outpatient drugs, the entity shall comply
with the requirements of

(e)

(6) ''; and
(C) by moving the margin 2 ems to the left; and

(2) by adding at the end the following new paragraph:
``

(10) No payment shall be made under this title to a State
with respect to expenditures incurred by the State for payment
for services provided by an other specified entity (as defined
in paragraph

(9)
(D)
(iii) ) unless such services are provided in
accordance with a contract between the State and such entity
which satisfies the requirements of paragraph

(2)
(A)
(xiii) .''.
(c) Effective Date.--The amendments made by this section shall
apply to contracts between States and managed care entities, other
specified entities, or pharmacy benefit managers that have an effective
date beginning on or after the date that is 18 months after the date of
enactment of this Act.
(d) Implementation.--

(1) In general.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services may implement
the amendments made by this section by program instruction or
otherwise.

(2) Nonapplication of administrative procedure act.--
Implementation of the amendments made by this section shall be
exempt from the requirements of

States Code.

(e) Nonapplication of Paperwork Reduction Act.--Chapter 35 of title
44, United States Code, shall not apply to any data collection
undertaken by the Secretary of Health and Human Services under

(e) of the Social Security Act (42 U.S.C. 1396r-8

(e) ), as amended
by this section.

TITLE II--MEDICARE

FOR CERTAIN LOW-VOLUME HOSPITALS.

(a) In General.--

(d) (12) of the Social Security Act (42
U.S.C. 1395ww
(d) (12) ) is amended--

(1) in subparagraph
(B) , in the matter preceding clause
(i) , by striking ``fiscal year 2025 beginning on April 1, 2025,
and ending on September 30, 2025, and in fiscal year 2026'' and
inserting ``fiscal year 2026 beginning on January 1, 2026, and
ending on September 30, 2026, and in fiscal year 2027'';

(2) in subparagraph
(C)
(i) --
(A) in the matter preceding subclause
(I) , by
striking ``through 2024 and the portion of fiscal year
2025 beginning on October 1, 2024, and ending on March
31, 2025'' and inserting ``through 2025 and the portion
of fiscal year 2026 beginning on October 1, 2025, and
ending on December 31, 2025'';
(B) in subclause
(III) , by striking ``through 2024
and the portion of fiscal year 2025 beginning on
October 1, 2024, and ending on March 31, 2025'' and
inserting ``through 2025 and the portion of fiscal year
2026 beginning on October 1, 2025, and ending on
December 31, 2025''; and
(C) in subclause
(IV) , by striking ``fiscal year
2025 beginning on April 1, 2025, and ending on
September 30, 2025, and fiscal year 2026'' and
inserting ``fiscal year 2026 beginning on January 1,
2026, and ending on September 30, 2026, and fiscal year
2027''; and

(3) in subparagraph
(D) --
(A) in the matter preceding clause
(i) , by striking
``through 2024 or during the portion of fiscal year
2025 beginning on October 1, 2024, and ending on March
31, 2025'' and inserting ``through 2025 or during the
portion of fiscal year 2026 beginning on October 1,
2025, and ending on December 31, 2025''; and
(B) in clause
(ii) , by striking ``through 2024 and
the portion of fiscal year 2025 beginning on October 1,
2024, and ending on March 31, 2025'' and inserting
``through 2025 and the portion of fiscal year 2026
beginning on October 1, 2025, and ending on December
31, 2025''.

(b) Implementation.--Notwithstanding any other provision of law,
the Secretary of Health and Human Services may implement the amendments
made by this section by program instruction or otherwise.

(MDH) PROGRAM.

(a) In General.--

(d) (5)
(G) of the Social Security Act
(42 U.S.C. 1395ww
(d) (5)
(G) ) is amended--

(1) in clause
(i) , by striking ``April 1, 2025'' and
inserting ``January 1, 2026''; and

(2) in clause
(ii)
(II) , by striking ``April 1, 2025'' and
inserting ``January 1, 2026''.

(b) Conforming Amendments.--

(1) In general.--

(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
``April 1, 2025'' and inserting ``January 1, 2026'';
and
(B) in clause
(iv) , by striking ``through fiscal
year 2024 and the portion of fiscal year 2025 beginning
on October 1, 2024, and ending on March 31, 2025'' and
inserting ``through fiscal year 2025 and the portion of
fiscal year 2026 beginning on October 1, 2025, and
ending on December 31, 2025''.

(2) Permitting hospitals to decline reclassification.--

(e)

(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note) is amended by striking ``through
fiscal year 2024, or the portion of fiscal year 2025 beginning
on October 1, 2024, and ending on March 31, 2025'' and
inserting ``through fiscal year 2025, or the portion of fiscal
year 2026 beginning on October 1, 2025, and ending on December
31, 2025''.

(l) of the Social Security Act (42 U.S.C. 1395m
(l) ) is
amended--

(1) in paragraph

(12)
(A) , by striking ``April 1, 2025'' and
inserting ``January 1, 2027''; and

(2) in paragraph

(13) , by striking ``April 1, 2025'' each
place it appears and inserting ``January 1, 2027'' in each such
place.

ALTERNATIVE PAYMENT MODELS.

(a) In General.--

(z) of the Social Security Act (42
U.S.C. 1395l

(z) ) is amended--

(1) in paragraph

(1)
(A) --
(A) by striking ``with 2026'' and inserting ``with
2027''; and
(B) by inserting ``, or, with respect to 2027, 3.53
percent'' after ``1.88 percent'';

(2) in paragraph

(2) --
(A) in subparagraph
(B) --
(i) in the heading, by striking ``2026''
and inserting ``2027''; and
(ii) in the matter preceding clause
(i) , by
striking ``2026'' and inserting ``2027'';
(B) in subparagraph
(C) --
(i) in the heading, by striking ``2027''
and inserting ``2028''; and
(ii) in the matter preceding clause
(i) , by
striking ``2027'' and inserting ``2028''; and
(C) in subparagraph
(D) , by striking ``and 2026''
and inserting ``2026, and 2027''; and

(3) in paragraph

(4)
(B) , by inserting ``or, with respect to
2027, 3.53 percent'' after ``1.88 percent''.

(b) Conforming Amendments.--

(q)

(1)
(C)
(iii) of the
Social Security Act (42 U.S.C. 1395w-4

(q)

(1)
(C)
(iii) ) is amended--

(1) in subclause
(II) , by striking ``2026'' and inserting
``2027''; and

(2) in subclause
(III) , by striking ``2027'' and inserting
``2028''.

SCHEDULE TO ACCOUNT FOR EXCEPTIONAL CIRCUMSTANCES.

(a) In General.--

(t)

(1) of the Social Security Act (42
U.S.C. 1395w-4

(t)

(1) ) is amended--

(1) in subparagraph
(D) , by striking ``and'' at the end;

(2) in subparagraph
(E) , by striking the period at the end
and inserting ``; and''; and

(3) by adding at the end the following new subparagraph:
``
(F) such services furnished on or after March 15,
2025, and before January 1, 2026, by 3.5375 percent.''.

(b) Conforming Amendment.--

(c) (2)
(B)
(iv)
(V) is amended
by striking ``or 2024'' and inserting ``2024, or 2025''.

AND SELECTION.

(d) (2) of the Social Security Act (42 U.S.C.
1395aaa
(d) (2) ) is amended--

(1) in the first sentence--
(A) by striking ``$11,030,000'' and inserting
``$14,000,000''; and
(B) by striking ``March 31, 2025'' and inserting
``December 31, 2025''; and

(2) in the third sentence, by striking ``March 31, 2025''
and inserting ``December 31, 2025''.

PROGRAMS.

(a) State Health Insurance Assistance Programs.--Subsection

(a)

(1)
(B) of

Providers Act of 2008 (42 U.S.C. 1395b-3 note) is amended--

(1) in clause
(xiii) , by striking ``and'' at the end;

(2) in clause
(xiv) , by striking the period and inserting
``; and''; and

(3) by inserting after clause
(xiv) the following new
clause:
``
(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.

(b) Area Agencies on Aging.--Subsection

(b)

(1)
(B) of such

(1) in clause
(xiii) , by striking ``and'' at the end;

(2) in clause
(xiv) , by striking the period and inserting
``; and''; and

(3) by inserting after clause
(xiv) the following new
clause:
``
(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.
(c) Aging and Disability Resource Centers.--Subsection
(c) (1)
(B) of
such

(1) in clause
(xiii) , by striking ``and'' at the end;

(2) in clause
(xiv) , by striking the period and inserting
``; and''; and

(3) by inserting after clause
(xiv) the following new
clause:
``
(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$7,750,000.''.
(d) Coordination of Efforts To Inform Older Americans About
Benefits Available Under Federal and State Programs.--Subsection
(d) (2) of such

(1) in clause
(xiii) , by striking ``and'' at the end;

(2) in clause
(xiv) , by striking the period and inserting
``; and''; and

(3) by inserting after clause
(xiv) the following new
clause:
``
(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.

(e)

(1)
(E) of the Social Security Act (42 U.S.C. 1395w-
4

(e)

(1)
(E) ) is amended by striking ``April 1, 2025'' and inserting
``January 1, 2026''.

(a) Removing Geographic Requirements and Expanding Originating
Sites for Telehealth Services.--

(m) of the Social Security
Act (42 U.S.C. 1395m
(m) ) is amended--

(1) in paragraph

(2)
(B)
(iii) , by striking ``ending March
31, 2025'' and inserting ``ending December 31, 2026''; and

(2) in paragraph

(4)
(C)
(iii) , by striking ``ending on March
31, 2025'' and inserting ``ending on December 31, 2026''.

(b) Expanding Practitioners Eligible To Furnish Telehealth
Services.--

(m) (4)
(E) of the Social Security Act (42 U.S.C.
1395m
(m) (4)
(E) ) is amended by striking ``ending on March 31, 2025'' and
inserting ``ending on December 31, 2026''.
(c) Extending Telehealth Services for Federally Qualified Health
Centers and Rural Health Clinics.--

(m) (8) of the Social
Security Act (42 U.S.C. 1395m
(m) (8) ) is amended--

(1) in subparagraph
(A) , by striking ``ending on March 31,
2025'' and inserting ``ending on December 31, 2026'';

(2) in subparagraph
(B) --
(A) in the subparagraph heading, by inserting
``before april 1, 2025'' after ``rule'';
(B) in clause
(i) , by striking ``during the periods
for which subparagraph
(A) applies'' and inserting
``before April 1, 2025''; and
(C) in clause
(ii) , by inserting ``furnished to an
eligible telehealth individual before April 1, 2025''
after ``telehealth services''; and

(3) by adding at the end the following new subparagraph:
``
(C) Payment rule for portion of 2025 and 2026.--
``
(i) In general.--A telehealth service
furnished to an eligible telehealth individual
by a Federally qualified health center or rural
health clinic on or after April 1, 2025, and
before January 1, 2027, shall be paid as a
Federally qualified health center service or
rural health clinic service (as applicable)
under the prospective payment system
established under

(o) or the
methodology for all-inclusive rates established
under

(a)

(3) , respectively.
``
(ii) Treatment of costs.--Costs
associated with the furnishing of telehealth
services by a Federally qualified health center
or rural health clinic on or after April 1,
2025, and before January 1, 2027, shall be
considered allowable costs for purposes of the
prospective payment system established under

(o) and the methodology for all-
inclusive rates established under

(a)

(3) , as applicable.
``
(iii) Requiring modifiers.--Not later
than July 1, 2025, the Secretary shall
establish requirements to include 1 or more
codes or modifiers, as determined appropriate
by the Secretary, in the case of claims for
telehealth services furnished to an eligible
telehealth individual by a Federally qualified
health center or rural health clinic.''.
(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.--

(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 ``April 1,
2025'' and inserting ``January 1, 2027''.

(2) Mental health visits furnished by rural health
clinics.--

(y)

(2) of the Social Security Act (42
U.S.C. 1395m

(y)

(2) ) is amended by striking ``April 1, 2025''
and inserting ``January 1, 2027''.

(3) Mental health visits furnished by federally qualified
health centers.--

(o)

(4)
(B) of the Social Security
Act (42 U.S.C. 1395m

(o)

(4)
(B) ) is amended by striking ``April
1, 2025'' and inserting ``January 1, 2027''.

(e) Allowing for the Furnishing of Audio-Only Telehealth
Services.--

(m) (9) of the Social Security Act (42 U.S.C.
1395m
(m) (9) ) is amended by striking ``ending on March 31, 2025'' and
inserting ``ending on December 31, 2026''.

(f) Extending Use of Telehealth To Conduct Face-to-Face Encounter
Prior to Recertification of Eligibility for Hospice Care.--

(a)

(7)
(D)
(i)
(II) of the Social Security Act (42 U.S.C.
1395f

(a)

(7)
(D)
(i)
(II) ) is amended--

(1) by striking ``ending on March 31, 2025'' and inserting
``ending on December 31, 2026''; and

(2) by inserting ``, except that this subclause shall not
apply in the case of such an encounter with an individual
occurring on or after April 1, 2025, if such individual is
located in an area that is subject to a moratorium on the
enrollment of hospice programs under this title pursuant to

(j)

(7) , if such individual is receiving hospice
care from a provider that is subject to enhanced oversight
under this title pursuant to

(j)

(3) , or if such
encounter is performed by a hospice physician or nurse
practitioner who is not enrolled under

(j) and is
not an opt-out physician or practitioner (as defined in

(b)

(6)
(D) )'' before the semicolon.

(g) Requiring Modifiers for Telehealth Services in Certain
Instances.--

(m) of the Social Security Act (42 U.S.C.
1395m
(m) ) is amended by adding at the end the following new paragraph:
``

(10) Required use of modifiers in certain instances.--Not
later than January 1, 2026, the Secretary shall establish
requirements to include 1 or more codes or modifiers, as
determined appropriate by the Secretary, in the case of--
``
(A) claims for telehealth services under this
subsection that are furnished through a telehealth
virtual platform--
``
(i) by a physician or practitioner that
contracts with an entity that owns such virtual
platform; or
``
(ii) for which a physician or
practitioner has a payment arrangement with an
entity for use of such virtual platform; and
``
(B) claims for telehealth services under this
subsection that are furnished incident to a physician's
or practitioner's professional service.''.

(h) Program Instruction Authority.--The Secretary of Health and
Human Services may implement the amendments made by this section
through program instruction or otherwise.

FACE ENCOUNTER PRIOR TO RECERTIFICATION OF ELIGIBILITY
FOR HOSPICE CARE.

(a)

(7)
(D)
(i)
(II) of the Social Security Act (42 U.S.C.
1395f

(a)

(7)
(D)
(i)
(II) ), as amended by

(f) , is further
amended by inserting ``, but only if, in the case of such an encounter
occurring on or after January 1, 2026, any hospice claim includes 1 or
more modifiers or codes (as specified by the Secretary) to indicate
that such encounter was conducted via telehealth'' after ``as
determined appropriate by the Secretary''.

amended--

(1) in the section heading, by inserting ``the thomas r.
carper, tim scott, brad r. wenstrup, d.p.m., and earl
blumenauer'' after ``extension of'';

(2) in subsection

(a) --
(A) in paragraph

(1) --
(i) by striking ``March 31, 2025'' and
inserting ``December 31, 2029''; and
(ii) by striking ``in the Acute Hospital
Care at Home initiative of the Secretary'' and
inserting ``in the Thomas R. Carper, Tim Scott,
Brad R. Wenstrup, D.P.M., and Earl Blumenauer
Acute Hospital Care at Home initiative of the
Secretary (in this section referred to as the
`Acute Hospital Care at Home initiative')'';
(B) in paragraph

(2) , by striking ``of the
Secretary''; and
(C) in paragraph

(3)
(E) , by adding at the end the
following new flush sentence:
``The Secretary may require that such data and
information be submitted through a hospital's cost
report, through such survey instruments as the
Secretary may develop, through medical record
information, or through such other means as the
Secretary determines appropriate.'';

(3) in subsection

(b) --
(A) in the subsection heading, by striking
``Study'' and inserting ``Initial Study'';
(B) in paragraph

(1)
(A) , by striking ``of the
Secretary''; and
(C) in paragraph

(3) , by inserting ``or subsection
(c) '' before the period at the end;

(4) by redesignating subsections
(c) and
(d) as subsections
(d) and

(e) , respectively; and

(5) by inserting after subsection

(b) the following new
subsection:
``
(c) Subsequent Study and Report.--
``

(1) In general.--Not later than September 30, 2028, the
Secretary shall conduct a study to--
``
(A) analyze, to the extent practicable, the
criteria established by hospitals under the Acute
Hospital Care at Home initiative to determine which
individuals may be furnished services under such
initiative; and
``
(B) analyze and compare (both within and between
hospitals participating in the initiative, and relative
to comparable hospitals that do not participate in the
initiative, for relevant parameters such as diagnosis-
related groups)--
``
(i) quality of care furnished to
individuals with similar conditions and
characteristics in the inpatient setting and
through the Acute Hospital Care at Home
initiative, including health outcomes, hospital
readmission rates (including readmissions both
within and beyond 30 days post-discharge),
hospital mortality rates, length of stay,
infection rates, composition of care team
(including the types of labor used, such as
contracted labor), the ratio of nursing staff,
transfers from the hospital to the home,
transfers from the home to the hospital
(including the timing, frequency, and causes of
such transfers), transfers and discharges to
post-acute care settings (including the timing,
frequency, and causes of such transfers and
discharges), and patient and caregiver
experience of care;
``
(ii) clinical conditions treated and
diagnosis-related groups of discharges from
inpatient settings relative to discharges from
the Acute Hospital Care at Home initiative;
``
(iii) costs incurred by the hospital for
furnishing care in inpatient settings relative
to costs incurred by the hospital for
furnishing care through the Acute Hospital Care
at Home initiative, including costs relating to
staffing, equipment, food, prescriptions, and
other services, as determined by the Secretary;
``
(iv) the quantity, mix, and intensity of
services (such as in-person visits and virtual
contacts with patients and the intensity of
such services) furnished in inpatient settings
relative to the Acute Hospital Care at Home
initiative, and, to the extent practicable, the
nature and extent of family or caregiver
involvement;
``
(v) socioeconomic information on
individuals treated in comparable inpatient
settings relative to the initiative, including
racial and ethnic data, income, housing,
geographic proximity to the brick-and-mortar
facility and whether such individuals are
dually eligible for benefits under this title
and title XIX; and
``
(vi) the quality of care, outcomes,
costs, quantity and intensity of services, and
other relevant metrics between individuals who
entered into the Acute Hospital Care at Home
initiative directly from an emergency
department compared with individuals who
entered into the Acute Hospital Care at Home
initiative directly from an existing inpatient
stay in a hospital.
``

(2) Selection bias.--In conducting the study under
paragraph

(1) , the Secretary shall, to the extent practicable,
analyze and compare individuals who participate and do not
participate in the initiative controlling for selection bias or
other factors that may impact the reliability of data.
``

(3) Report.--Not later than September 30, 2028, the
Secretary of Health and Human Services shall post on a website
of the Centers for Medicare & Medicaid Services a report on the
study conducted under paragraph

(1) .
``

(4) Funding.--In addition to amounts otherwise available,
there is appropriated to the Centers for Medicare & Medicaid
Services Program Management Account for fiscal year 2026, out
of any amounts in the Treasury not otherwise appropriated,
$6,000,000, respectively, to remain available until expended,
for purposes of carrying out this section.''.

UNDER MEDICARE.

(a) Durable Medical Equipment.--

(1) In general.--

(a) of the Social Security Act
(42 U.S.C. 1395m

(a) ) is amended by adding at the end the
following new paragraph:
``

(23) Master list inclusion and claim review for certain
items.--
``
(A) Master list inclusion.--Beginning January 1,
2028, for purposes of the Master List described in

(b) of title 42, Code of Federal
Regulations (or any successor regulation), an item for
which payment may be made under this subsection shall
be treated as having aberrant billing patterns (as such
term is used for purposes of such section) if the
Secretary determines that, without explanatory
contributing factors (such as furnishing emergent care
services), a substantial number of claims for such
items under this subsection are for such items ordered
by a physician or practitioner who has not previously
(during a period of not less than 24 months, as
established by the Secretary) furnished to the
individual involved any item or service for which
payment may be made under this title.
``
(B) Claim review.--With respect to items
furnished on or after January 1, 2028, that are
included on the Master List pursuant to subparagraph
(A) , if such an item is not subject to a determination
of coverage in advance pursuant to paragraph

(15)
(C) ,
the Secretary may conduct prepayment review of claims
for payment for such item.''.

(2) Conforming amendment for prosthetic devices, orthotics,
and prosthetics.--

(h)

(3) of the Social Security Act
(42 U.S.C. 1395m

(h)

(3) ) is amended by inserting ``, and
paragraph

(23) of subsection

(a) shall apply to prosthetic
devices, orthotics, and prosthetics in the same manner as such
provision applies to items for which payment may be made under
such subsection'' before the period at the end.

(b) Report on Identifying Clinical Diagnostic Laboratory Tests at
High Risk for Fraud and Effective Mitigation Measures.--Not later than
January 1, 2026, the Inspector General of the Department of Health and
Human Services shall submit to Congress a report assessing fraud risks
relating to claims for clinical diagnostic laboratory tests for which
payment may be made under

U.S.C. 1395m-1) and effective tools for reducing such fraudulent
claims. The report may include information regarding--

(1) which, if any, clinical diagnostic laboratory tests are
identified as being at high risk of fraudulent claims, and an
analysis of the factors that contribute to such risk;

(2) with respect to a clinical diagnostic laboratory test
identified under paragraph

(1) as being at high risk of
fraudulent claims--
(A) the amount payable under such

with respect to such test;
(B) the number of such tests furnished to
individuals enrolled under part B of title XVIII of the
Social Security Act (42 U.S.C. 1395j et seq.);
(C) whether an order for such a test was more
likely to come from a provider with whom the individual
involved did not have a prior relationship, as
determined on the basis of prior payment experience;
and
(D) the frequency with which a claim for payment
under such

identified by code 59 or 91; and

(3) suggested strategies for reducing the number of
fraudulent claims made with respect to tests so identified as
being at high risk, including--
(A) an analysis of whether the Centers for Medicare
& Medicaid Services can detect aberrant billing
patterns with respect to such tests in a timely manner;
(B) any strategies for identifying and monitoring
the providers who are outliers with respect to the
number of such tests that such providers order; and
(C) targeted education efforts to mitigate improper
billing for such tests; and

(4) such other information as the Inspector General
determines appropriate.

WITH LIMITED ENGLISH PROFICIENCY.

(a) In General.--Not later than 1 year after the date of the
enactment of this section, the Secretary of Health and Human Services,
in consultation with 1 or more entities from each of the categories
described in paragraphs

(1) through

(7) of subsection

(b) , shall issue
and disseminate, or update and revise as applicable, guidance for the
entities described in such subsection on the following:

(1) Best practices on facilitating and integrating use of
interpreters during a telemedicine appointment.

(2) Best practices on providing accessible instructions on
how to access telecommunications systems (as such term is used
for purposes of

(m) of the Social Security Act (42
U.S.C. 1395m
(m) ) for individuals with limited English
proficiency.

(3) Best practices on improving access to digital patient
portals for individuals with limited English proficiency.

(4) Best practices on integrating the use of video
platforms that enable multi-person video calls furnished via a
telecommunications system for purposes of providing
interpretation during a telemedicine appointment for an
individual with limited English proficiency.

(5) Best practices for providing patient materials,
communications, and instructions in multiple languages,
including text message appointment reminders and prescription
information.

(b) Entities Described.--For purposes of subsection

(a) , an entity
described in this subsection is an entity in 1 or more of the following
categories:

(1) Health information technology service providers,
including--
(A) electronic medical record companies;
(B) remote patient monitoring companies; and
(C) telehealth or mobile health vendors and
companies.

(2) Health care providers, including--
(A) physicians; and
(B) hospitals.

(3) Health insurers.

(4) Language service companies.

(5) Interpreter or translator professional associations.

(6) Health and language services quality certification
organizations.

(7) Patient and consumer advocates, including such
advocates that work with individuals with limited English
proficiency.

(a) In General.--

(eee)

(2) of the Social Security Act
(42 U.S.C. 1395x

(eee)

(2) ) is amended--

(1) in subparagraph
(A)
(ii) , by inserting ``(including,
with respect to items and services furnished through audio and
video real-time communications technology (excluding audio-
only) on or after April 1, 2025, and before January 1, 2027, in
the home of an individual who is an outpatient of the
hospital)'' after ``outpatient basis''; and

(2) in subparagraph
(B) , by inserting ``(including, with
respect to items and services furnished through audio and video
real-time communications technology on or after April 1, 2025,
and before January 1, 2027, the virtual presence of such
physician, physician assistant, nurse practitioner, or clinical
nurse specialist)'' after ``under the program''.

(b) Program Instruction Authority.--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.

MDPP EXPANDED MODEL.

(a) In General.--Not later than January 1, 2026, the Secretary
shall revise the regulations under parts 410 and 424 of title 42, Code
of Federal Regulations, to provide that, for the period beginning
January 1, 2026, and ending December 31, 2030--

(1) an entity may participate in the MDPP by offering only
online MDPP services via synchronous or asynchronous technology
or telecommunications if such entity meets the conditions for
enrollment as an MDPP supplier (as specified in

(b) of title 42, Code of Federal Regulations (or a
successor regulation));

(2) if an entity participates in the MDPP in the manner
described in paragraph

(1) --
(A) the administrative location of such entity
shall be the address of the entity on file under the
Diabetes Prevention Recognition Program; and
(B) in the case of online MDPP services furnished
by such entity to an MDPP beneficiary who was not
located in the same State as the entity at the time
such services were furnished, the entity shall not be
prohibited from submitting a claim for payment for such
services solely by reason of the location of such
beneficiary at such time; and

(3) no limit is applied on the number of times an
individual may enroll in the MDPP.

(b)

Security Act (42 U.S.C. 1315a), as described in the final rule
published in the Federal Register entitled ``Medicare and
Medicaid Programs; CY 2024 Payment Policies Under the Physician
Fee Schedule and Other Changes to Part B Payment and Coverage
Policies; Medicare Shared Savings Program Requirements;
Medicare Advantage; Medicare and Medicaid Provider and Supplier
Enrollment Policies; and Basic Health Program'' (88 Fed. Reg.
78818 (November 16, 2023)) (or a successor regulation).

(2) Regulatory terms.--The terms ``Diabetes Prevention
Recognition Program'', ``full CDC DPRP recognition'', ``MDPP
beneficiary'', ``MDPP services'', and ``MDPP supplier'' have
the meanings given each such term in

(b) of title
42, Code of Federal Regulations.

(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.

Not later than January 1, 2026, the Secretary shall use existing
communications mechanisms to provide education and outreach to
physicians and appropriate non-physician practitioners participating
under the Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) with respect to periodic screening for
medication-induced movement disorders that are associated with the
treatment of mental health disorders in at-risk patients, as well as
resources related to clinical guidelines and best practices for
furnishing such screening services through telehealth. Such education
and outreach shall include information on how to account for such
screening services in evaluation and management code selection. The
Secretary shall, to the extent practicable, seek input from relevant
stakeholders to inform such education and outreach. Such education and
outreach may also address other relevant screening services furnished
through telehealth, as the Secretary determines appropriate.

Not later than 18 months after the date of the enactment of this
Act, the Comptroller General of the United States shall conduct a
technology assessment of, and submit to Congress a report on, the
capabilities and limitations of wearable medical devices used to
support clinical decision-making. Such report shall include a
description of--

(1) the potential for such devices to accurately prescribe
treatments;

(2) an examination of the benefits and challenges of
artificial intelligence to augment such capabilities; and

(3) policy options to enhance the benefits and mitigate
potential challenges of developing or using such devices.

DRUGS AS COVERED PART D DRUGS.

(e)

(1)
(C) of the Social Security Act (42 U.S.C.
1395w-102

(e)

(1)
(C) ) is amended by striking ``March 31, 2025'' and
inserting ``December 31, 2025''.

(i) (2)
(B) of the Social Security Act (42 U.S.C.
1395f
(i) (2)
(B) ) is amended--

(1) in clause
(ii) , by striking ``2033'' and inserting
``2034''; and

(2) in clause
(iii) , by striking ``2033'' and inserting
``2034''.

at the end the following new subsections:
``
(i) The Medicare Payment Advisory Commission.--The Medicare
Payment Advisory Commission may use available funds to enter into
contracts for the procurement of severable services for a period that
begins in one fiscal year and ends in the next fiscal year and may
enter into multiyear contracts for the acquisition of property and
services to the same extent as executive agencies under the authority
of sections 3902 and 3903 of this title.
``

(j) The Medicaid and CHIP Payment and Access Commission.--The
Medicaid and CHIP Payment and Access Commission may use available funds
to enter into contracts for the procurement of severable services for a
period that begins in one fiscal year and ends in the next fiscal year
and may enter into multiyear contracts for the acquisition of property
and services to the same extent as executive agencies under the
authority of sections 3902 and 3903 of this title.''.

In fiscal year 2025 and thereafter, for all contracts for goods and
services to which the Medicare and Payment Advisory Commission or the
Medicaid and CHIP Payment and Access Commission is a party, the
following Federal Acquisition Regulation

(FAR) clauses will apply: FAR
52.232-39 and FAR 52.233-4 (or a successor clause).

LOW-INCOME INDIVIDUALS.

(a) of the Social Security Act (42 U.S.C. 1395w-
114

(a) ) is amended--

(1) in paragraph

(1)
(D)
(ii) , by striking ``that does not
exceed $1 for'' and all that follows through the period at the
end and inserting ``that does not exceed--
``
(I) for a plan year before 2027--
``

(aa) for a generic drug
or a preferred drug that is a
multiple source drug (as
defined in

(k)

(7)
(A)
(i) ), $1 or, if
less, the copayment amount
applicable to an individual
under clause
(iii) ; and
``

(bb) for any other drug,
$3 or, if less, the copayment
amount applicable to an
individual under clause
(iii) ;
and
``
(II) for plan year 2027 and each
subsequent plan year--
``

(aa) for a generic drug,
$0;
``

(bb) for a preferred drug
that is a multiple source drug
(as defined in

(k)

(7)
(A)
(i) ), the dollar
amount applied under this
clause for such a drug for the
preceding plan year, increased
by the annual percentage
increase in the consumer price
index (all items; U.S. city
average) as of September of
such preceding year, or, if
less, the copayment amount
applicable to an individual
under clause
(iii) ; and
``
(cc) for a drug not
described in either item

(aa) or

(bb) , the dollar amount
applied under this clause for
such a drug for the preceding
plan year, increased in the
manner specified in item

(bb) ,
or, if less, the copayment
amount applicable to an
individual under clause
(iii) .
Any amount established under item

(bb) or
(cc) of subclause
(II) , that is based on an increase
of $1 or $3, that is not a multiple of 5 cents
or 10 cents, respectively, shall be rounded to
the nearest multiple of 5 cents or 10 cents,
respectively.''; and

(2) in paragraph

(4)
(A)
(ii) , by inserting ``(before 2027)''
after ``a subsequent year''.

(REAL) HEALTH
PROVIDERS ACT.

(a) In General.--

(c) of the Social Security Act (42
U.S.C. 1395w-22
(c) ) is amended--

(1) in paragraph

(1)
(C) --
(A) by striking ``plan, and any'' and inserting
``plan, any''; and
(B) by inserting the following before the period at
the end: ``, and, in the case of a specified MA plan
(as defined in paragraph

(3)
(C) ), for plan year 2027
and subsequent plan years, the information described in
paragraph

(3)
(B) ''; and

(2) by adding at the end the following new paragraph:
``

(3) Provider directory accuracy.--
``
(A) In general.--For plan year 2027 and
subsequent plan years, each MA organization offering a
specified MA plan (as defined in subparagraph
(C) )
shall, for each such plan offered by the organization--
``
(i) maintain, on a publicly available
internet website, an accurate provider
directory that includes the information
described in subparagraph
(B) ;
``
(ii) not less frequently than once every
90 days (or, in the case of a hospital or any
other facility determined appropriate by the
Secretary, at a lesser frequency specified by
the Secretary but in no case less frequently
than once every 12 months), verify the provider
directory information of each provider listed
in such directory and, if applicable, update
such provider directory information;
``
(iii) if the organization is unable to
verify such information with respect to a
provider, include in such directory an
indication that the information of such
provider may not be up-to-date; and
``
(iv) remove a provider from such
directory within 5 business days if the
organization determines that the provider is no
longer a provider participating in the network
of such plan.
``
(B) Provider directory information.--The
information described in this subparagraph is
information enrollees may need to access covered
benefits from a provider with which such organization
offering such plan has an agreement for furnishing
items and services covered under such plan such as
name, specialty, contact information, primary office or
facility address, whether the provider is accepting new
patients, accommodations for people with disabilities,
cultural and linguistic capabilities, and telehealth
capabilities.
``
(C) Specified ma plan.--In this paragraph, the
term `specified MA plan' means--
``
(i) a network-based plan (as defined in
subsection
(d) (5)
(C) ); or
``
(ii) a Medicare Advantage private fee-
for-service plan (as defined in

(b)

(2) ) that meets the access standards
under subsection
(d) (4) , in whole or in part,
through entering into contracts or agreements
as provided for under subparagraph
(B) of such
subsection.''.

(b) Accountability for Provider Directory Accuracy.--

(1) Cost sharing for services furnished based on reliance
on incorrect provider directory information.--

(d) of the Social Security Act (42 U.S.C. 1395w-22
(d) ) is amended--
(A) in paragraph

(1)
(C) --
(i) in clause
(ii) , by striking ``or'' at
the end;
(ii) in clause
(iii) , by striking the
semicolon at the end and inserting ``, or'';
and
(iii) by adding at the end the following
new clause:
``
(iv) the services are furnished by a
provider that is not participating in the
network of a specified MA plan (as defined in
subsection
(c) (3)
(C) ) but is listed in the
provider directory of such plan on the date on
which the appointment is made, as described in
paragraph

(7)
(A) ;''; and
(B) by adding at the end the following new
paragraph:
``

(7) Cost sharing for services furnished based on reliance
on incorrect provider directory information.--
``
(A) In general.--For plan year 2027 and
subsequent plan years, if an enrollee is furnished an
item or service by a provider that is not participating
in the network of a specified MA plan (as defined in
subsection
(c) (3)
(C) ) but is listed in the provider
directory of such plan (as required to be provided to
an enrollee pursuant to subsection
(c) (1)
(C) ) on the
date on which the appointment is made, and if such item
or service would otherwise be covered under such plan
if furnished by a provider that is participating in the
network of such plan, the MA organization offering such
plan shall ensure that the enrollee is only responsible
for the lesser of--
``
(i) the amount of cost sharing that would
apply if such provider had been participating
in the network of such plan; or
``
(ii) the amount of cost sharing that
would otherwise apply (without regard to this
subparagraph).
``
(B) Notification requirement.--For plan year 2027
and subsequent plan years, each MA organization that
offers a specified MA plan shall--
``
(i) notify enrollees of their cost-
sharing protections under this paragraph and
make such notifications, to the extent
practicable, by not later than the first day of
an annual, coordinated election period under

(e)

(3) with respect to a year;
``
(ii) include information regarding such
cost-sharing protections in the provider
directory of each specified MA plan offered by
the MA organization.; and
``
(iii) notify enrollees of their cost-
sharing protections under this paragraph in an
explanation of benefits.''.

(2) Required provider directory accuracy analysis and
reports.--
(A) In general.--

(e) of the Social
Security Act (42 U.S.C. 1395w-27

(e) ) is amended by
adding at the end the following new paragraph:
``

(6) Provider directory accuracy analysis and reports.--
``
(A) In general.--Beginning with plan years
beginning on or after January 1, 2027, subject to
subparagraph
(C) , a contract under this section with an
MA organization shall require the organization, for
each specified MA plan (as defined in

(c) (3)
(C) ) offered by the organization to annually
do the following:
``
(i) Conduct an analysis estimating the
accuracy of the provider directory information
of such plan using a random sample of providers
included in such provider directory as follows:
``
(I) Such a random sample shall
include a random sample of each
specialty of providers with a high
inaccuracy rate of provider directory
information relative to other
specialties of providers, as determined
by the Secretary.
``
(II) For purposes of subclause
(I) , one type of specialty may be
providers specializing in mental health
or substance use disorder treatment.
``
(ii) Submit to the Secretary a report
containing the results of the analysis
conducted under clause
(i) , including an
accuracy score for such provider directory
information (as determined using a plan
verification method specified by the Secretary
under subparagraph
(B)
(i) ).
``
(B) Determination of accuracy score.--
``
(i) In general.--The Secretary shall
specify plan verification methods, such as
using telephonic verification or other
approaches using data sources maintained by an
MA organization or using publicly available
data sets, that MA organizations may use for
estimating accuracy scores of the provider
directory information of specified MA plans
offered by such organizations.
``
(ii) Accuracy score methodology.--With
respect to each such method specified by the
Secretary as described in clause
(i) , the
Secretary shall specify a methodology for MA
organizations to use in estimating such
accuracy scores. Each such methodology shall
take into account the administrative burden on
plans and providers and the relative importance
of certain provider directory information on
enrollee ability to access care.
``
(C) Exception.--The Secretary may waive the
requirements of this paragraph in the case of a
specified MA plan with low enrollment (as defined by
the Secretary).
``
(D) Transparency.--Beginning with plan years
beginning on or after January 1, 2028, the Secretary
shall post accuracy scores (as reported under
subparagraph
(A)
(ii) ), in a machine readable file, on
the internet website of the Centers for Medicare &
Medicaid Services.''.
(B) Provision of information to beneficiaries.--

(d) (4) of the Social Security Act (42
U.S.C. 1395w-21
(d) (4) ) is amended by adding at the end
the following new subparagraph:
``
(F) Provider directory.--Beginning with plan
years beginning on or after January 1, 2028, the
accuracy score of the plan's provider directory (as
reported under

(e)

(6)
(A)
(ii) ) listed
prominently on the plan's provider directory.''.
(C) Funding.--In addition to amounts otherwise
available, there is appropriated to the Centers for
Medicare & Medicaid Services Program Management
Account, out of any money in the Treasury not otherwise
appropriated, $4,000,000 for fiscal year 2025, to
remain available until expended, to carry out the
amendments made by this paragraph.

(3) GAO study and report.--
(A) Analysis.--The Comptroller General of the
United States (in this paragraph referred to as the
``Comptroller General'') shall conduct a study of the
implementation of the amendments made by paragraphs

(1) and

(2) . To the extent data are available and reliable,
such study shall include an analysis of--
(i) the use of cost-sharing protections
required under

(d) (7)
(A) of the
Social Security Act, as added by paragraph

(1) ;
(ii) the trends in provider directory
information accuracy scores under

(e)

(6)
(A)
(ii) of the Social Security Act
(as added by paragraph

(2)
(A) ), both overall
and among providers specializing in mental
health or substance use disorder treatment;
(iii) provider response rates by plan
verification methods;
(iv) administrative costs to providers and
Medicare Advantage organizations; and
(v) other items determined appropriate by
the Comptroller General.
(B) Report.--Not later than January 15, 2032, the
Comptroller General shall submit to Congress a report
containing the results of the study conducted under
subparagraph
(A) , together with recommendations for
such legislation and administrative action as the
Comptroller General determines appropriate.
(c) Guidance on Maintaining Accurate Provider Directories.--

(1) Stakeholder meeting.--
(A) In general.--Not later than 3 months after the
date of enactment of this Act, the Secretary of Health
and Human Services (referred to in this subsection as
the ``Secretary'') shall hold a public meeting to
receive input on approaches for maintaining accurate
provider directories for Medicare Advantage plans under
part C of title XVIII of the Social Security Act (42
U.S.C. 1395w-21 et seq.), including input on approaches
for reducing administrative burden, such as data
standardization, and best practices to maintain
accurate provider directory information.
(B) Participants.--Participants of the meeting
under subparagraph
(A) shall include representatives
from the Centers for Medicare & Medicaid Services and
the Assistant Secretary for Technology Policy and
Office of the National Coordinator for Health
Information Technology. Such meeting shall be open to
the public. To the extent practicable, the Secretary
shall include health care providers, companies that
specialize in relevant technologies, health insurers,
and patient advocates.

(2) Guidance to medicare advantage organizations.--Not
later than 12 months after the date of enactment of this Act,
the Secretary shall issue guidance to Medicare Advantage
organizations offering Medicare Advantage plans under part C of
title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et
seq.) on maintaining accurate provider directories for such
plans, taking into consideration input received during the
stakeholder meeting under paragraph

(1) . Such guidance may
include the following, as determined appropriate by the
Secretary:
(A) Best practices for Medicare Advantage
organizations on how to work with providers to maintain
the accuracy of provider directories and reduce
provider and Medicare Advantage organization burden
with respect to maintaining the accuracy of provider
directories.
(B) Information on data sets and data sources with
information that could be used by Medicare Advantage
organizations to maintain accurate provider
directories.
(C) Approaches for utilizing data sources
maintained by Medicare Advantage organizations and
publicly available data sets to maintain accurate
provider directories.
(D) Information to be included in provider
directories that may be useful for Medicare
beneficiaries to assess plan networks when selecting a
plan and accessing providers participating in plan
networks during the plan year.

(3) Guidance to part b providers.--Not later than 12 months
after the date of enactment of this Act, the Secretary shall
issue guidance to providers of services and suppliers who
furnish items or services for which benefits are available
under part B of title XVIII of the Social Security Act (42
U.S.C. 1395j et seq.) on when to update the National Plan and
Provider Enumeration System for information changes.

TESTS.

(a) Coverage.--

1395x) is amended--

(1) in subsection

(s)

(2) --
(A) by striking the semicolon at the end of
subparagraph

(JJ) and inserting ``; and''; and
(B) by adding at the end the following new
subparagraph:
``

(KK) multi-cancer early detection screening tests
(as defined in subsection

(nnn) );''; and

(2) by adding at the end the following new subsection:
``

(nnn) Multi-Cancer Early Detection Screening Tests.--
``

(1) In general.--The term `multi-cancer early detection
screening test' means a test furnished to an individual for the
concurrent detection of multiple cancer types across multiple
organ sites on or after January 1, 2029, that--
``
(A) is cleared under

(k) , classified
under

(f)

(2) , or approved under

of the Federal Food, Drug, and Cosmetic Act;
``
(B) is--
``
(i) a genomic sequencing blood or blood
product test that includes the analysis of
cell-free nucleic acids; or
``
(ii) a test based on samples of
biological material that provide results
comparable to those obtained with a test
described in clause
(i) , as determined by the
Secretary; and
``
(C) the Secretary determines is--
``
(i) reasonable and necessary for the
prevention or early detection of an illness or
disability; and
``
(ii) appropriate for individuals entitled
to benefits under part A or enrolled under part
B.
``

(2) NCD process.--In making determinations under
paragraph

(1)
(C) regarding the coverage of a new test, the
Secretary shall use the process for making national coverage
determinations (as defined in

(f)

(1)
(B) ) under this
title.''.

(b) Payment and Standards for Multi-Cancer Early Detection
Screening Tests.--

(1) In general.--

(42 U.S.C. 1395m) is amended by adding at the end the following
new subsection:
``

(aa) Payment and Standards for Multi-Cancer Early Detection
Screening Tests.--
``

(1) Payment amount.--The payment amount for a multi-
cancer early detection screening test (as defined in

(nnn) ) is--
``
(A) with respect to such a test furnished before
January 1, 2031, equal to the payment amount in effect
on the date of the enactment of this subsection for a
multi-target stool screening DNA test covered pursuant
to

(pp)

(1)
(D) ; and
``
(B) with respect to such a test furnished on or
after January 1, 2031, equal to the lesser of--
``
(i) the amount described in subparagraph
(A) ; or
``
(ii) the payment amount determined for
such test under

``

(2) Limitations.--
``
(A) In general.--No payment may be made under
this part for a multi-cancer early detection screening
test furnished during a year to an individual if--
``
(i) such individual--
``
(I) is under 50 years of age; or
``
(II) as of January 1 of such
year, has attained the age specified in
subparagraph
(B) for such year; or
``
(ii) such a test was furnished to the
individual during the previous 11 months.
``
(B) Age specified.--For purposes of subparagraph
(A)
(i)
(II) , the age specified in this subparagraph is--
``
(i) for 2029, 65 years of age; and
``
(ii) for a succeeding year, the age
specified in this subparagraph for the
preceding year, increased by 1 year.
``
(C) Standards following uspstf rating of a or
b.--In the case of a multi-cancer early detection
screening test that is recommended with a grade of A or
B by the United States Preventive Services Task Force,
beginning on the date on which coverage for such test
is provided pursuant to

(ddd) (1) , the
preceding provisions of this paragraph shall not
apply.''.

(2) Conforming amendments.--
(A) Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended--
(i) in subsection

(a) --
(I) in paragraph

(1)
(D)
(i)
(I) , by
striking ``

(d) (1) '' and
inserting ``subsection
(d) (1) or

(aa) of

(II) in paragraph

(2)
(D)
(i)
(I) , by
striking ``

(d) (1) '' and
inserting ``subsection
(d) (1) or

(aa) of

(ii) in subsection

(h)

(1)
(A) , by striking
``

(d) (1) '' and inserting
``subsections
(d) (1) and

(aa) of

(B) Section 1862

(a)

(1)
(A) of the Social Security
Act (42 U.S.C. 1395y

(a)

(1)
(A) ) is amended--
(i) by striking ``or additional preventive
services'' and inserting ``, additional
preventive services''; and
(ii) by inserting ``, or multi-cancer early
detection screening tests (as defined in

(nnn) )'' after ``(as described in

(ddd) (1) )''.
(c) Rule of Construction Relating to Other Cancer Screening
Tests.--Nothing in this section, including the amendments made by this
section, shall be construed--

(1) in the case of an individual who undergoes a multi-
cancer early detection screening test, to affect coverage under
part B of title XVIII of the Social Security Act for other
cancer screening tests covered under such title, such as
screening tests for breast, cervical, colorectal, lung, or
prostate cancer; or

(2) in the case of an individual who undergoes another
cancer screening test, to affect coverage under such part for a
multi-cancer early detection screening test or the use of such
a test as a diagnostic or confirmatory test for a result of the
other cancer screening test.

ADMINISTRABLE HOME INFUSION DRUGS.

(a) In General.--

(n) of the Social Security Act (42
U.S.C. 1395x

(n) ) is amended by adding at the end the following new
sentence: ``Beginning with the first calendar quarter beginning on or
after the date that is 1 year after the date of the enactment of this
sentence, an external infusion pump and associated home infusion drug
(as defined in subsection
(iii) (3)
(C) ) or other associated supplies
that do not meet the appropriate for use in the home requirement
applied to the definition of durable medical equipment under

such regulation) shall be treated as meeting such requirement if each
of the following criteria is satisfied:
``

(1) The prescribing information approved by the Food and
Drug Administration for the home infusion drug associated with
the pump instructs that the drug should be administered by or
under the supervision of a health care professional.
``

(2) A qualified home infusion therapy supplier (as
defined in subsection
(iii) (3)
(D) ) administers or supervises
the administration of the drug or biological in a safe and
effective manner in the patient's home (as defined in
subsection
(iii) (3)
(B) ).
``

(3) The prescribing information described in paragraph

(1) instructs that the drug should be infused at least 12 times
per year--
``
(A) intravenously or subcutaneously; or
``
(B) at infusion rates that the Secretary
determines would require the use of an external
infusion pump.''.

(b) Cost Sharing Notification.--The Secretary of Health and Human
Services shall ensure that patients are notified of the cost sharing
for electing home infusion therapy compared to other applicable
settings of care for the furnishing of infusion drugs under the
Medicare program.

BENEFICIARIES.

(a) In General.--

(b)

(1) of the Social Security Act
(42 U.S.C. 1395w-104

(b)

(1) ) is amended by striking subparagraph
(A) and
inserting the following:
``
(A) In general.--
``
(i) Participation of any willing
pharmacy.--A PDP sponsor offering a
prescription drug plan shall permit any
pharmacy that meets the standard contract terms
and conditions under such plan to participate
as a network pharmacy of such plan.
``
(ii) Contract terms and conditions.--
``
(I) In general.--Notwithstanding
any other provision of law, for plan
years beginning on or after January 1,
2028, in accordance with clause
(i) ,
contract terms and conditions offered
by such PDP sponsor shall be reasonable
and relevant according to standards
established by the Secretary under
subclause
(II) .
``
(II) Standards.--Not later than
the first Monday in April of 2027, the
Secretary shall establish standards for
reasonable and relevant contract terms
and conditions for purposes of this
clause.
``
(III) Request for information.--
Not later than April 1, 2026, for
purposes of establishing the standards
under subclause
(II) , the Secretary
shall issue a request for information
to seek input on trends in prescription
drug plan and network pharmacy contract
terms and conditions, current
prescription drug plan and network
pharmacy contracting practices, whether
pharmacy reimbursement and dispensing
fees paid by PDP sponsors to network
pharmacies sufficiently cover the
ingredient and operational costs of
such pharmacies, the use and
application of pharmacy quality
measures by PDP sponsors for network
pharmacies, PDP sponsor restrictions or
limitations on the dispensing of
covered part D drugs by network
pharmacies (or any subsets of such
pharmacies), PDP sponsor auditing
practices for network pharmacies, areas
in current regulations or program
guidance related to contracting between
prescription drug plans and network
pharmacies requiring clarification or
additional specificity, factors for
consideration in determining the
reasonableness and relevance of
contract terms and conditions between
prescription drug plans and network
pharmacies, and other issues as
determined appropriate by the
Secretary.''.

(b) Essential Retail Pharmacies.--

Security Act (42 U.S.C. 1395w-152) is amended by adding at the end the
following new subsection:
``

(e) Essential Retail Pharmacies.--
``

(1) In general.--With respect to plan years beginning on
or after January 1, 2028, the Secretary shall publish reports,
at least once every 2 years until 2034, and periodically
thereafter, that provide information, to the extent feasible,
on--
``
(A) trends in ingredient cost reimbursement,
dispensing fees, incentive payments and other fees paid
by PDP sponsors offering prescription drug plans and MA
organizations offering MA-PD plans under this part to
essential retail pharmacies (as defined in paragraph

(2) ) with respect to the dispensing of covered part D
drugs, including a comparison of such trends between
essential retail pharmacies and pharmacies that are not
essential retail pharmacies;
``
(B) trends in amounts paid to PDP sponsors
offering prescription drug plans and MA organizations
offering MA-PD plans under this part by essential
retail pharmacies with respect to the dispensing of
covered part D drugs, including a comparison of such
trends between essential retail pharmacies and
pharmacies that are not essential retail pharmacies;
``
(C) trends in essential retail pharmacy
participation in pharmacy networks and preferred
pharmacy networks for prescription drug plans offered
by PDP sponsors and MA-PD plans offered by MA
organizations under this part, including a comparison
of such trends between essential retail pharmacies and
pharmacies that are not essential retail pharmacies;
``
(D) trends in the number of essential retail
pharmacies, including variation in such trends by
geographic region or other factors;
``
(E) a comparison of cost-sharing for covered part
D drugs dispensed by essential retail pharmacies that
are network pharmacies for prescription drug plans
offered by PDP sponsors and MA-PD plans offered by MA
organizations under this part and cost-sharing for
covered part D drugs dispensed by other network
pharmacies for such plans located in similar geographic
areas that are not essential retail pharmacies;
``
(F) a comparison of the volume of covered part D
drugs dispensed by essential retail pharmacies that are
network pharmacies for prescription drug plans offered
by PDP sponsors and MA-PD plans offered by MA
organizations under this part and such volume of
dispensing by network pharmacies for such plans located
in similar geographic areas that are not essential
retail pharmacies, including information on any
patterns or trends in such comparison specific to
certain types of covered part D drugs, such as generic
drugs or drugs specified as specialty drugs by a PDP
sponsor under a prescription drug plan or an MA
organization under an MA-PD plan; and
``
(G) a comparison of the information described in
subparagraphs
(A) through
(F) between essential retail
pharmacies that are network pharmacies for prescription
drug plans offered by PDP sponsors under this part and
essential retail pharmacies that are network pharmacies
for MA-PD plans offered by MA organizations under this
part.
``

(2) Definition of essential retail pharmacy.--In this
subsection, the term `essential retail pharmacy' means, with
respect to a plan year, a retail pharmacy that--
``
(A) is not a pharmacy that is an affiliate as
defined in paragraph

(4) ; and
``
(B) is located in--
``
(i) a medically underserved area (as
designated pursuant to

(b)

(3)
(A) of
the Public Health Service Act);
``
(ii) a rural area in which there is no
other retail pharmacy within 10 miles, as
determined by the Secretary;
``
(iii) a suburban area in which there is
no other retail pharmacy within 2 miles, as
determined by the Secretary; or
``
(iv) an urban area in which there is no
other retail pharmacy within 1 mile, as
determined by the Secretary.
``

(3) List of essential retail pharmacies.--
``
(A) Publication of list of essential retail
pharmacies.--For each plan year (beginning with plan
year 2028), the Secretary shall publish, on a publicly
available internet website of the Centers for Medicare
& Medicaid Services, a list of pharmacies that meet the
criteria described in subparagraphs
(A) and
(B) of
paragraph

(2) to be considered an essential retail
pharmacy.
``
(B) Required submissions from pdp sponsors.--For
each plan year (beginning with plan year 2028), each
PDP sponsor offering a prescription drug plan and each
MA organization offering an MA-PD plan shall submit to
the Secretary, for the purposes of determining retail
pharmacies that meet the criterion specified in
subparagraph
(A) of paragraph

(2) , a list of retail
pharmacies that are affiliates of such sponsor or
organization, or are affiliates of a pharmacy benefit
manager acting on behalf of such sponsor or
organization, at a time, and in a form and manner,
specified by the Secretary.
``
(C) Reporting by pdp sponsors and ma
organizations.--For each plan year beginning with plan
year 2027, each PDP sponsor offering a prescription
drug plan and each MA organization offering an MA-PD
plan under this part shall submit to the Secretary
information on incentive payments and other fees paid
by such sponsor or organization to pharmacies, insofar
as any such payments or fees are not otherwise
reported, at a time, and in a form and manner,
specified by the Secretary.
``
(D) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph by program instruction or otherwise.
``
(E) Nonapplication of paperwork reduction act.--
Chapter 35 of title 44, United States Code, shall not
apply to the implementation of this paragraph.
``

(4) Definition of affiliate; pharmacy benefit manager.--
In this subsection, the terms `affiliate' and `pharmacy benefit
manager' have the meaning given those terms in

12

(h)

(7) .''.
(c) Enforcement.--

(1) In general.--

(b)

(1) of the Social
Security Act (42 U.S.C. 1395w-104

(b)

(1) ) is amended by adding
at the end the following new subparagraph:
``
(F) Enforcement of standards for reasonable and
relevant contract terms and conditions.--
``
(i) Allegation submission process.--
``
(I) In general.--Not later than
January 1, 2028, the Secretary shall
establish a process through which a
pharmacy may submit to the Secretary an
allegation of a violation by a PDP
sponsor offering a prescription drug
plan of the standards for reasonable
and relevant contract terms and
conditions under subparagraph
(A)
(ii) ,
or of subclause
(VIII) of this clause.
``
(II) Frequency of submission.--
``

(aa) In general.--Except
as provided in item

(bb) , the
allegation submission process
under this clause shall allow
pharmacies to submit any
allegations of violations
described in subclause
(I) not
more frequently than once per
plan year per contract between
a pharmacy and a PDP sponsor.
``

(bb) Allegations relating
to contract modifications.--In
the case where a contract
between a pharmacy and a PDP
sponsor is modified following
the submission of allegations
by a pharmacy with respect to
such contract and plan year,
the allegation submission
process under this clause shall
allow such pharmacy to submit
an additional allegation
related to those modifications
with respect to such contract
and plan year.
``
(III) Access to relevant
documents and materials.--A PDP sponsor
subject to an allegation under this
clause--
``

(aa) shall provide
documents or materials, as
specified by the Secretary,
including contract offers made
by such sponsor to such
pharmacy or correspondence
related to such offers, to the
Secretary at a time, and in a
form and manner, specified by
the Secretary; and
``

(bb) shall not prohibit
or otherwise limit the ability
of a pharmacy to submit such
documents or materials to the
Secretary for the purpose of
submitting an allegation or
providing evidence for such an
allegation under this clause.
``
(IV) Standardized template.--The
Secretary shall establish a
standardized template for pharmacies to
use for the submission of allegations
described in subclause
(I) . Such
template shall require that the
submission include a certification by
the pharmacy that the information
included is accurate, complete, and
true to the best of the knowledge,
information, and belief of such
pharmacy.
``
(V) Preventing frivolous
allegations.--In the case where the
Secretary determines that a pharmacy
has submitted frivolous allegations
under this clause on a routine basis,
the Secretary may temporarily prohibit
such pharmacy from using the allegation
submission process under this clause,
as determined appropriate by the
Secretary.
``
(VI) Exemption from freedom of
information act.--Allegations submitted
under this clause shall be exempt from
disclosure under

5, United States Code.
``
(VII) Rule of construction.--
Nothing in this clause shall be
construed as limiting the ability of a
pharmacy to pursue other legal actions
or remedies, consistent with applicable
Federal or State law, with respect to a
potential violation of a requirement
described in this subparagraph.
``
(VIII) Anti-retaliation and anti-
coercion.--Consistent with applicable
Federal or State law, a PDP sponsor
shall not--
``

(aa) retaliate against a
pharmacy for submitting any
allegations under this clause;
or
``

(bb) coerce, intimidate,
threaten, or interfere with the
ability of a pharmacy to submit
any such allegations.
``
(ii) Investigation.--The Secretary shall
investigate, as determined appropriate by the
Secretary, allegations submitted pursuant to
clause
(i) .
``
(iii) Enforcement.--
``
(I) In general.--In the case
where the Secretary determines that a
PDP sponsor offering a prescription
drug plan has violated the standards
for reasonable and relevant contract
terms and conditions under subparagraph
(A)
(ii) , the Secretary may use
authorities under sections 1857

(g) and
1860D-12

(b)

(3)
(E) to impose civil
monetary penalties or other
intermediate sanctions.
``
(II) Application of civil
monetary penalties.--The provisions of

(a) and

(b) ) shall apply to a civil
monetary penalty under this clause in
the same manner as such provisions
apply to a penalty or proceeding under

(a) .''.

(2) Conforming amendment.--

(g)

(1) of the Social
Security Act (42 U.S.C. 1395w-27

(g)

(1) ) is amended--
(A) in subparagraph
(J) , by striking ``or'' after
the semicolon;
(B) by redesignating subparagraph
(K) as
subparagraph
(L) ;
(C) by inserting after subparagraph
(J) , the
following new subparagraph:
``
(K) fails to comply with the standards for
reasonable and relevant contract terms and conditions
under subparagraph
(A)
(ii) of

(b)

(1) ;
or'';
(D) in subparagraph
(L) , as redesignated by
subparagraph
(B) , by striking ``through
(J) '' and
inserting ``through
(K) ''; and
(E) in the flush matter following subparagraph
(L) ,
as so redesignated, by striking ``subparagraphs
(A) through
(K) '' and inserting ``subparagraphs
(A) through
(L) ''.
(d) Accountability of Pharmacy Benefit Managers for Violations of
Reasonable and Relevant Contract Terms and Conditions.--

(1) In general.--

(b) of the Social Security
Act (42 U.S.C. 1395w-112) is amended by adding at the end the
following new paragraph:
``

(9) Accountability of pharmacy benefit managers for
violations of reasonable and relevant contract terms and
conditions.--For plan years beginning on or after January 1,
2028, each contract entered into with a PDP sponsor under this
part with respect to a prescription drug plan offered by such
sponsor shall provide that any pharmacy benefit manager acting
on behalf of such sponsor has a written agreement with the PDP
sponsor under which the pharmacy benefit manager agrees to
reimburse the PDP sponsor for any amounts paid by such sponsor
under

(b)

(1)
(F)
(iii)
(I) to the Secretary as a
result of a violation described in such section if such
violation is related to a responsibility delegated to the
pharmacy benefit manager by such PDP sponsor.''.

(2) MA-PD plans.--

(f)

(3) of the Social Security
Act (42 U.S.C. 1395w-27

(f)

(3) ) is amended by adding at the end
the following new subparagraph:
``
(F) Accountability of pharmacy benefit managers
for violations of reasonable and relevant contract
terms.--For plan years beginning on or after January 1,
2028,

(b)

(9) .''.

(e) Biennial Report on Enforcement and Oversight of Pharmacy Access
Requirements.--

1395w-152), as amended by subsection

(b) , is amended by adding at the
end the following new subsection:
``

(f) Biennial Report on Enforcement and Oversight of Pharmacy
Access Requirements.--
``

(1) In general.--Not later than 2 years after the date of
enactment of this subsection, and at least once every 2 years
thereafter, the Secretary shall publish a report on enforcement
and oversight actions and activities undertaken by the
Secretary with respect to the requirements under

4

(b)

(1) .
``

(2) Limitation.--A report under paragraph

(1) shall not
disclose--
``
(A) identifiable information about individuals or
entities unless such information is otherwise publicly
available; or
``
(B) trade secrets with respect to any
entities.''.

(f) Funding.--In addition to amounts otherwise available, there is
appropriated to the Centers for Medicare & Medicaid Services Program
Management Account, out of any money in the Treasury not otherwise
appropriated, $188,000,000 for fiscal year 2025, to remain available
until expended, to carry out this section.

(a) In General.--

(1) Prescription drug plans.--

Social Security Act (42 U.S.C. 1395w-112) is amended by adding
at the end the following new subsection:
``

(h) Requirements Relating to Pharmacy Benefit Managers.--For plan
years beginning on or after January 1, 2028:
``

(1) Agreements with pharmacy benefit managers.--Each
contract entered into with a PDP sponsor under this part with
respect to a prescription drug plan offered by such sponsor
shall provide that any pharmacy benefit manager acting on
behalf of such sponsor has a written agreement with the PDP
sponsor under which the pharmacy benefit manager, and any
affiliates of such pharmacy benefit manager, as applicable,
agree to meet the following requirements:
``
(A) No income other than bona fide service
fees.--
``
(i) In general.--The pharmacy benefit
manager and any affiliate of such pharmacy
benefit manager shall not derive any
remuneration with respect to any services
provided on behalf of any entity or individual,
in connection with the utilization of covered
part D drugs, from any such entity or
individual other than bona fide service fees,
subject to clauses
(ii) and
(iii) .
``
(ii) Incentive payments.--For the
purposes of this subsection, an incentive
payment (as determined by the Secretary) paid
by a PDP sponsor to a pharmacy benefit manager
that is performing services on behalf of such
sponsor shall be deemed a `bona fide service
fee' (even if such payment does not otherwise
meet the definition of such term under
paragraph

(7)
(B) ) if such payment is a flat
dollar amount, is consistent with fair market
value (as specified by the Secretary), is
related to services actually performed by the
pharmacy benefit manager or affiliate of such
pharmacy benefit manager, on behalf of the PDP
sponsor making such payment, in connection with
the utilization of covered part D drugs, and
meets additional requirements, if any, as
determined appropriate by the Secretary.
``
(iii) Clarification on rebates and
discounts used to lower costs for covered part
d drugs.--Rebates, discounts, and other price
concessions received by a pharmacy benefit
manager or an affiliate of a pharmacy benefit
manager from manufacturers, even if such price
concessions are calculated as a percentage of a
drug's price, shall not be considered a
violation of the requirements of clause
(i) if
they are fully passed through to a PDP sponsor
and are compliant with all regulatory and
subregulatory requirements related to direct
and indirect remuneration for manufacturer
rebates under this part, including in cases
where a PDP sponsor is acting as a pharmacy
benefit manager on behalf of a prescription
drug plan offered by such PDP sponsor.
``
(iv) Evaluation of remuneration
arrangements.--Components of subsets of
remuneration arrangements (such as fees or
other forms of compensation paid to or retained
by the pharmacy benefit manager or affiliate of
such pharmacy benefit manager), as determined
appropriate by the Secretary, between pharmacy
benefit managers or affiliates of such pharmacy
benefit managers, as applicable, and other
entities involved in the dispensing or
utilization of covered part D drugs (including
PDP sponsors, manufacturers, pharmacies, and
other entities as determined appropriate by the
Secretary) shall be subject to review by the
Secretary, in consultation with the Office of
the Inspector General of the Department of
Health and Human Services, as determined
appropriate by the Secretary. The Secretary, in
consultation with the Office of the Inspector
General, shall review whether remuneration
under such arrangements is consistent with fair
market value (as specified by the Secretary)
through reviews and assessments of such
remuneration, as determined appropriate.
``
(v) Disgorgement.--The pharmacy benefit
manager shall disgorge any remuneration paid to
such pharmacy benefit manager or an affiliate
of such pharmacy benefit manager in violation
of this subparagraph to the PDP sponsor.
``
(vi) Additional requirements.--The
pharmacy benefit manager shall--
``
(I) enter into a written
agreement with any affiliate of such
pharmacy benefit manager, under which
the affiliate shall identify and
disgorge any remuneration described in
clause
(v) to the pharmacy benefit
manager; and
``
(II) attest, subject to any
requirements determined appropriate by
the Secretary, that the pharmacy
benefit manager has entered into a
written agreement described in
subclause
(I) with any relevant
affiliate of the pharmacy benefit
manager.
``
(B) Transparency regarding guarantees and cost
performance evaluations.--The pharmacy benefit manager
shall--
``
(i) define, interpret, and apply, in a
fully transparent and consistent manner for
purposes of calculating or otherwise evaluating
pharmacy benefit manager performance against
pricing guarantees or similar cost performance
measurements related to rebates, discounts,
price concessions, or net costs, terms such
as--
``
(I) `generic drug', in a manner
consistent with the definition of the
term under

Code of Federal Regulations, or a
successor regulation;
``
(II) `brand name drug', in a
manner consistent with the definition
of the term under

title 42, Code of Federal Regulations,
or a successor regulation;
``
(III) `specialty drug';
``
(IV) `rebate'; and
``
(V) `discount';
``
(ii) identify any drugs, claims, or price
concessions excluded from any pricing guarantee
or other cost performance measure in a clear
and consistent manner; and
``
(iii) where a pricing guarantee or other
cost performance measure is based on a pricing
benchmark other than the wholesale acquisition
cost (as defined in

(c) (6)
(B) ) of
a drug, calculate and provide a wholesale
acquisition cost-based equivalent to the
pricing guarantee or other cost performance
measure.
``
(C) Provision of information.--
``
(i) In general.--Not later than July 1 of
each year, beginning in 2028, the pharmacy
benefit manager shall submit to the PDP
sponsor, and to the Secretary, a report, in
accordance with this subparagraph, and shall
make such report available to such sponsor at
no cost to such sponsor in a format specified
by the Secretary under paragraph

(5) . Each such
report shall include, with respect to such PDP
sponsor and each plan offered by such sponsor,
the following information with respect to the
previous plan year:
``
(I) A list of all drugs covered
by the plan that were dispensed
including, with respect to each such
drug--
``

(aa) the brand name,
generic or non-proprietary
name, and National Drug Code;
``

(bb) the number of plan
enrollees for whom the drug was
dispensed, the total number of
prescription claims for the
drug (including original
prescriptions and refills,
counted as separate claims),
and the total number of dosage
units of the drug dispensed;
``
(cc) the number of
prescription claims described
in item

(bb) by each type of
dispensing channel through
which the drug was dispensed,
including retail, mail order,
specialty pharmacy, long term
care pharmacy, home infusion
pharmacy, or other types of
pharmacies or providers;
``
(dd) the average
wholesale acquisition cost,
listed as cost per day's
supply, cost per dosage unit,
and cost per typical course of
treatment (as applicable);
``

(ee) the average
wholesale price for the drug,
listed as price per day's
supply, price per dosage unit,
and price per typical course of
treatment (as applicable);
``

(ff) the total out-of-
pocket spending by plan
enrollees on such drug after
application of any benefits
under the plan, including plan
enrollee spending through
copayments, coinsurance, and
deductibles;
``

(gg) total rebates paid
by the manufacturer on the drug
as reported under the Detailed
DIR Report (or any successor
report) submitted by such
sponsor to the Centers for
Medicare & Medicaid Services;
``

(hh) all other direct or
indirect remuneration on the
drug as reported under the
Detailed DIR Report (or any
successor report) submitted by
such sponsor to the Centers for
Medicare & Medicaid Services;
``
(ii) the average pharmacy
reimbursement amount paid by
the plan for the drug in the
aggregate and disaggregated by
dispensing channel identified
in item
(cc) ;
``

(jj) the average National
Average Drug Acquisition Cost

(NADAC) ; and
``

(kk) total manufacturer-
derived revenue, inclusive of
bona fide service fees,
attributable to the drug and
retained by the pharmacy
benefit manager and any
affiliate of such pharmacy
benefit manager.
``
(II) In the case of a pharmacy
benefit manager that has an affiliate
that is a retail, mail order, or
specialty pharmacy, with respect to
drugs covered by such plan that were
dispensed, the following information:
``

(aa) The percentage of
total prescriptions that were
dispensed by pharmacies that
are an affiliate of the
pharmacy benefit manager for
each drug.
``

(bb) The interquartile
range of the total combined
costs paid by the plan and plan
enrollees, per dosage unit, per
course of treatment, per 30-day
supply, and per 90-day supply
for each drug dispensed by
pharmacies that are not an
affiliate of the pharmacy
benefit manager and that are
included in the pharmacy
network of such plan.
``
(cc) The interquartile
range of the total combined
costs paid by the plan and plan
enrollees, per dosage unit, per
course of treatment, per 30-day
supply, and per 90-day supply
for each drug dispensed by
pharmacies that are an
affiliate of the pharmacy
benefit manager and that are
included in the pharmacy
network of such plan.
``
(dd) The lowest total
combined cost paid by the plan
and plan enrollees, per dosage
unit, per course of treatment,
per 30-day supply, and per 90-
day supply, for each drug that
is available from any pharmacy
included in the pharmacy
network of such plan.
``

(ee) The difference
between the average acquisition
cost of the affiliate, such as
a pharmacy or other entity that
acquires prescription drugs,
that initially acquires the
drug and the amount reported
under subclause
(I) (jj) for
each drug.
``

(ff) A list inclusive of
the brand name, generic or non-
proprietary name, and National
Drug Code of covered part D
drugs subject to an agreement
with a covered entity under

Health Service Act for which
the pharmacy benefit manager or
an affiliate of the pharmacy
benefit manager had a contract
or other arrangement with such
a covered entity in the service
area of such plan.
``
(III) Where a drug approved under

(c) of the Federal Food,
Drug, and Cosmetic Act (referred to in
this subclause as the `listed drug') is
covered by the plan, the following
information:
``

(aa) A list of currently
marketed generic drugs approved
under

(j) of the
Federal Food, Drug, and
Cosmetic Act pursuant to an
application that references
such listed drug that are not
covered by the plan, are
covered on the same formulary
tier or a formulary tier
typically associated with
higher cost-sharing than the
listed drug, or are subject to
utilization management that the
listed drug is not subject to.
``

(bb) The estimated
average beneficiary cost-
sharing under the plan for a
30-day supply of the listed
drug.
``
(cc) Where a generic drug
listed under item

(aa) is on a
formulary tier typically
associated with higher cost-
sharing than the listed drug,
the estimated average cost-
sharing that a beneficiary
would have paid for a 30-day
supply of each of the generic
drugs described in item

(aa) ,
had the plan provided coverage
for such drugs on the same
formulary tier as the listed
drug.
``
(dd) A written
justification for providing
more favorable coverage of the
listed drug than the generic
drugs described in item

(aa) .
``

(ee) The number of
currently marketed generic
drugs approved under

(j) of the Federal Food,
Drug, and Cosmetic Act pursuant
to an application that
references such listed drug.
``
(IV) Where a reference product
(as defined in

(i) of the
Public Health Service Act) is covered
by the plan, the following information:
``

(aa) A list of currently
marketed biosimilar biological
products licensed under

(k) of the Public Health
Service Act pursuant to an
application that refers to such
reference product that are not
covered by the plan, are
covered on the same formulary
tier or a formulary tier
typically associated with
higher cost-sharing than the
reference product, or are
subject to utilization
management that the reference
product is not subject to.
``

(bb) The estimated
average beneficiary cost-
sharing under the plan for a
30-day supply of the reference
product.
``
(cc) Where a biosimilar
biological product listed under
item

(aa) is on a formulary
tier typically associated with
higher cost-sharing than the
reference product, the
estimated average cost-sharing
that a beneficiary would have
paid for a 30-day supply of
each of the biosimilar
biological products described
in item

(aa) , had the plan
provided coverage for such
products on the same formulary
tier as the reference product.
``
(dd) A written
justification for providing
more favorable coverage of the
reference product than the
biosimilar biological product
described in item

(aa) .
``

(ee) The number of
currently marketed biosimilar
biological products licensed
under

(k) of the
Public Health Service Act,
pursuant to an application that
refers to such reference
product.
``
(V) Total gross spending on
covered part D drugs by the plan, not
net of rebates, fees, discounts, or
other direct or indirect remuneration.
``
(VI) The total amount retained by
the pharmacy benefit manager or an
affiliate of such pharmacy benefit
manager in revenue related to
utilization of covered part D drugs
under that plan, inclusive of bona fide
service fees.
``
(VII) The total spending on
covered part D drugs net of rebates,
fees, discounts, or other direct and
indirect remuneration by the plan.
``
(VIII) An explanation of any
benefit design parameters under such
plan that encourage plan enrollees to
fill prescriptions at pharmacies that
are an affiliate of such pharmacy
benefit manager, such as mail and
specialty home delivery programs, and
retail and mail auto-refill programs.
``
(IX) The following information:
``

(aa) A list of all
brokers, consultants, advisors,
and auditors that receive
compensation from the pharmacy
benefit manager or an affiliate
of such pharmacy benefit
manager for referrals,
consulting, auditing, or other
services offered to PDP
sponsors related to pharmacy
benefit management services.
``

(bb) The amount of
compensation provided by such
pharmacy benefit manager or
affiliate to each such broker,
consultant, advisor, and
auditor.
``
(cc) The methodology for
calculating the amount of
compensation provided by such
pharmacy benefit manager or
affiliate, for each such
broker, consultant, advisor,
and auditor.
``
(X) A list of all affiliates of
the pharmacy benefit manager.
``
(XI) A summary document submitted
in a standardized template developed by
the Secretary that includes such
information described in subclauses
(I) through
(X) .
``
(ii) Written explanation of contracts or
agreements with drug manufacturers.--
``
(I) In general.--The pharmacy
benefit manager shall, not later than
30 days after the finalization of any
contract or agreement between such
pharmacy benefit manager or an
affiliate of such pharmacy benefit
manager and a drug manufacturer (or
subsidiary, agent, or entity affiliated
with such drug manufacturer) that makes
rebates, discounts, payments, or other
financial incentives related to one or
more covered part D drugs or other
prescription drugs, as applicable, of
the manufacturer directly or indirectly
contingent upon coverage, formulary
placement, or utilization management
conditions on any other covered part D
drugs or other prescription drugs, as
applicable, submit to the PDP sponsor a
written explanation of such contract or
agreement.
``
(II) Requirements.--A written
explanation under subclause
(I) shall--
``

(aa) include the
manufacturer subject to the
contract or agreement, all
covered part D drugs and other
prescription drugs, as
applicable, subject to the
contract or agreement and the
manufacturers of such drugs,
and a high-level description of
the terms of such contract or
agreement and how such terms
apply to such drugs; and
``

(bb) be certified by the
Chief Executive Officer, Chief
Financial Officer, or General
Counsel of such pharmacy
benefit manager, or affiliate
of such pharmacy benefit
manager, as applicable, or an
individual delegated with the
authority to sign on behalf of
one of these officers, who
reports directly to the
officer.
``
(III) Definition of other
prescription drugs.--For purposes of
this clause, the term `other
prescription drugs' means prescription
drugs covered as supplemental benefits
under this part or prescription drugs
paid outside of this part.
``
(D) Audit rights.--
``
(i) In general.--Not less than once a
year, at the request of the PDP sponsor, the
pharmacy benefit manager shall allow for an
audit of the pharmacy benefit manager to ensure
compliance with all terms and conditions under
the written agreement described in this
paragraph and the accuracy of information
reported under subparagraph
(C) .
``
(ii) Auditor.--The PDP sponsor shall have
the right to select an auditor. The pharmacy
benefit manager shall not impose any
limitations on the selection of such auditor.
``
(iii) Provision of information.--The
pharmacy benefit manager shall make available
to such auditor all records, data, contracts,
and other information necessary to confirm the
accuracy of information provided under
subparagraph
(C) , subject to reasonable
restrictions on how such information must be
reported to prevent redisclosure of such
information.
``
(iv) Timing.--The pharmacy benefit
manager must provide information under clause
(iii) and other information, data, and records
relevant to the audit to such auditor within 6
months of the initiation of the audit and
respond to requests for additional information
from such auditor within 30 days after the
request for additional information.
``
(v) Information from affiliates.--The
pharmacy benefit manager shall be responsible
for providing to such auditor information
required to be reported under subparagraph
(C) or under clause
(iii) of this subparagraph that
is owned or held by an affiliate of such
pharmacy benefit manager.
``

(2) Enforcement.--
``
(A) In general.--Each PDP sponsor shall--
``
(i) disgorge to the Secretary any amounts
disgorged to the PDP sponsor by a pharmacy
benefit manager under paragraph

(1)
(A)
(v) ;
``
(ii) require, in a written agreement with
any pharmacy benefit manager acting on behalf
of such sponsor or affiliate of such pharmacy
benefit manager, that such pharmacy benefit
manager or affiliate reimburse the PDP sponsor
for any civil money penalty imposed on the PDP
sponsor as a result of the failure of the
pharmacy benefit manager or affiliate to meet
the requirements of paragraph

(1) that are
applicable to the pharmacy benefit manager or
affiliate under the agreement; and
``
(iii) require, in a written agreement
with any such pharmacy benefit manager acting
on behalf of such sponsor or affiliate of such
pharmacy benefit manager, that such pharmacy
benefit manager or affiliate be subject to
punitive remedies for breach of contract for
failure to comply with the requirements
applicable under paragraph

(1) .
``
(B) Reporting of alleged violations.--The
Secretary shall make available and maintain a mechanism
for manufacturers, PDP sponsors, pharmacies, and other
entities that have contractual relationships with
pharmacy benefit managers or affiliates of such
pharmacy benefit managers to report, on a confidential
basis, alleged violations of paragraph

(1)
(A) or
subparagraph
(C) .
``
(C) Anti-retaliation and anti-coercion.--
Consistent with applicable Federal or State law, a PDP
sponsor shall not--
``
(i) retaliate against an individual or
entity for reporting an alleged violation under
subparagraph
(B) ; or
``
(ii) coerce, intimidate, threaten, or
interfere with the ability of an individual or
entity to report any such alleged violations.
``

(3) Certification of compliance.--
``
(A) In general.--Each PDP sponsor shall furnish
to the Secretary (at a time and in a manner specified
by the Secretary) an annual certification of compliance
with this subsection, as well as such information as
the Secretary determines necessary to carry out this
subsection.
``
(B) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph by program instruction or otherwise.
``

(4) Rule of construction.--Nothing in this subsection
shall be construed as--
``
(A) prohibiting flat dispensing fees or
reimbursement or payment for ingredient costs
(including customary, industry-standard discounts
directly related to drug acquisition that are retained
by pharmacies or wholesalers) to entities that acquire
or dispense prescription drugs; or
``
(B) modifying regulatory requirements or sub-
regulatory program instruction or guidance related to
pharmacy payment, reimbursement, or dispensing fees.
``

(5) Standard formats.--
``
(A) In general.--Not later than June 1, 2027, the
Secretary shall specify standard, machine-readable
formats for pharmacy benefit managers to submit annual
reports required under paragraph

(1)
(C)
(i) .
``
(B) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph by program instruction or otherwise.
``

(6) Confidentiality.--
``
(A) In general.--Information disclosed by a
pharmacy benefit manager, an affiliate of a pharmacy
benefit manager, a PDP sponsor, or a pharmacy under
this subsection that is not otherwise publicly
available or available for purchase shall not be
disclosed by the Secretary or a PDP sponsor receiving
the information, except that the Secretary may disclose
the information for the following purposes:
``
(i) As the Secretary determines necessary
to carry out this part.
``
(ii) To permit the Comptroller General to
review the information provided.
``
(iii) To permit the Director of the
Congressional Budget Office to review the
information provided.
``
(iv) To permit the Executive Director of
the Medicare Payment Advisory Commission to
review the information provided.
``
(v) To the Attorney General for the
purposes of conducting oversight and
enforcement under this title.
``
(vi) To the Inspector General of the
Department of Health and Human Services in
accordance with its authorities under the
Inspector General Act of 1978 (

title 5, United States Code), and other
applicable statutes.
``
(B) Restriction on use of information.--The
Secretary, the Comptroller General, the Director of the
Congressional Budget Office, and the Executive Director
of the Medicare Payment Advisory Commission shall not
report on or disclose information disclosed pursuant to
subparagraph
(A) to the public in a manner that would
identify--
``
(i) a specific pharmacy benefit manager,
affiliate, pharmacy, manufacturer, wholesaler,
PDP sponsor, or plan; or
``
(ii) contract prices, rebates, discounts,
or other remuneration for specific drugs in a
manner that may allow the identification of
specific contracting parties or of such
specific drugs.
``

(7) === Definitions. ===
-For purposes of this subsection:
``
(A) Affiliate.--The term `affiliate' means, with
respect to any pharmacy benefit manager or PDP sponsor,
any entity that, directly or indirectly--
``
(i) owns or is owned by, controls or is
controlled by, or is otherwise related in any
ownership structure to such pharmacy benefit
manager or PDP sponsor; or
``
(ii) acts as a contractor, principal, or
agent to such pharmacy benefit manager or PDP
sponsor, insofar as such contractor, principal,
or agent performs any of the functions
described under subparagraph
(C) .
``
(B) Bona fide service fee.--The term `bona fide
service fee' means a fee that is reflective of the fair
market value (as specified by the Secretary, through
notice and comment rulemaking) for a bona fide,
itemized service actually performed on behalf of an
entity, that the entity would otherwise perform (or
contract for) in the absence of the service arrangement
and that is not passed on in whole or in part to a
client or customer, whether or not the entity takes
title to the drug. Such fee must be a flat dollar
amount and shall not be directly or indirectly based
on, or contingent upon--
``
(i) drug price, such as wholesale
acquisition cost or drug benchmark price (such
as average wholesale price);
``
(ii) the amount of discounts, rebates,
fees, or other direct or indirect remuneration
with respect to covered part D drugs dispensed
to enrollees in a prescription drug plan,
except as permitted pursuant to paragraph

(1)
(A)
(ii) ;
``
(iii) coverage or formulary placement
decisions or the volume or value of any
referrals or business generated between the
parties to the arrangement; or
``
(iv) any other amounts or methodologies
prohibited by the Secretary.
``
(C) Pharmacy benefit manager.--The term `pharmacy
benefit manager' means any person or entity that,
either directly or through an intermediary, acts as a
price negotiator or group purchaser on behalf of a PDP
sponsor or prescription drug plan, or manages the
prescription drug benefits provided by such sponsor or
plan, including the processing and payment of claims
for prescription drugs, the performance of drug
utilization review, the processing of drug prior
authorization requests, the adjudication of appeals or
grievances related to the prescription drug benefit,
contracting with network pharmacies, controlling the
cost of covered part D drugs, or the provision of
related services. Such term includes any person or
entity that carries out one or more of the activities
described in the preceding sentence, irrespective of
whether such person or entity calls itself a `pharmacy
benefit manager'.''.

(2) MA-PD plans.--

(f)

(3) of the Social Security
Act (42 U.S.C. 1395w-27

(f)

(3) ), as amended by

(d) (2) , is amended by adding at the end the following new
subparagraph:
``
(G) Requirements relating to pharmacy benefit
managers.--For plan years beginning on or after January
1, 2028,

(h) .''.

(3) Nonapplication of paperwork reduction act.--Chapter 35
of title 44, United States Code, shall not apply to the
implementation of this subsection.

(4) Funding.--
(A) Secretary.--In addition to amounts otherwise
available, there is appropriated to the Centers for
Medicare & Medicaid Services Program Management
Account, out of any money in the Treasury not otherwise
appropriated, $113,000,000 for fiscal year 2025, to
remain available until expended, to carry out this
subsection.
(B) OIG.--In addition to amounts otherwise
available, there is appropriated to the Inspector
General of the Department of Health and Human Services,
out of any money in the Treasury not otherwise
appropriated, $20,000,000 for fiscal year 2025, to
remain available until expended, to carry out this
subsection.

(b) GAO Study and Report on Price-Related Compensation Across the
Supply Chain.--

(1) Study.--The Comptroller General of the United States
(in this subsection referred to as the ``Comptroller General'')
shall conduct a study describing the use of compensation and
payment structures related to a prescription drug's price
within the retail prescription drug supply chain in part D of
title XVIII of the Social Security Act (42 U.S.C. 1395w-101 et
seq.). Such study shall summarize information from Federal
agencies and industry experts, to the extent available, with
respect to the following:
(A) The type, magnitude, other features (such as
the pricing benchmarks used), and prevalence of
compensation and payment structures related to a
prescription drug's price, such as calculating fee
amounts as a percentage of a prescription drug's price,
between intermediaries in the prescription drug supply
chain, including--
(i) pharmacy benefit managers;
(ii) PDP sponsors offering prescription
drug plans and Medicare Advantage organizations
offering MA-PD plans;
(iii) drug wholesalers;
(iv) pharmacies;
(v) manufacturers;
(vi) pharmacy services administrative
organizations;
(vii) brokers, auditors, consultants, and
other entities that--
(I) advise PDP sponsors offering
prescription drug plans and Medicare
Advantage organizations offering MA-PD
plans regarding pharmacy benefits; or
(II) review PDP sponsor and
Medicare Advantage organization
contracts with pharmacy benefit
managers; and
(viii) other service providers that
contract with any of the entities described in
clauses
(i) through
(vii) that may use price-
related compensation and payment structures,
such as rebate aggregators (or other entities
that negotiate or process price concessions on
behalf of pharmacy benefit managers, plan
sponsors, or pharmacies).
(B) The primary business models and compensation
structures for each category of intermediary described
in subparagraph
(A) .
(C) Variation in price-related compensation
structures between affiliated entities (such as
entities with common ownership, either full or partial,
and subsidiary relationships) and unaffiliated
entities.
(D) Potential conflicts of interest among
contracting entities related to the use of prescription
drug price-related compensation structures, such as the
potential for fees or other payments set as a
percentage of a prescription drug's price to advantage
formulary selection, distribution, or purchasing of
prescription drugs with higher prices.
(E) Notable differences, if any, in the use and
level of price-based compensation structures over time
and between different market segments, such as under
part D of title XVIII of the Social Security Act (42
U.S.C. 1395w-101 et seq.) and the Medicaid program
under title XIX of such Act (42 U.S.C. 1396 et seq.).
(F) The effects of drug price-related compensation
structures and alternative compensation structures on
Federal health care programs and program beneficiaries,
including with respect to cost-sharing, premiums,
Federal outlays, biosimilar and generic drug adoption
and utilization, drug shortage risks, and the potential
for fees set as a percentage of a drug's price to
advantage the formulary selection, distribution, or
purchasing of drugs with higher prices.
(G) Other issues determined to be relevant and
appropriate by the Comptroller General.

(2) Report.--Not later than 2 years after the date of
enactment of this section, the Comptroller General shall submit
to Congress a report containing the results of the study
conducted under paragraph

(1) , together with recommendations
for such legislation and administrative action as the
Comptroller General determines appropriate.
(c) MedPAC Reports on Agreements With Pharmacy Benefit Managers
With Respect to Prescription Drug Plans and MA-PD Plans.--

(1) In general.--The Medicare Payment Advisory Commission
shall submit to Congress the following reports:
(A) Initial report.--Not later than the first March
15 occurring after the date that is 2 years after the
date on which the Secretary makes the data available to
the Commission, a report regarding agreements with
pharmacy benefit managers with respect to prescription
drug plans and MA-PD plans. Such report shall include,
to the extent practicable--
(i) a description of trends and patterns,
including relevant averages, totals, and other
figures for the types of information submitted;
(ii) an analysis of any differences in
agreements and their effects on plan enrollee
out-of-pocket spending and average pharmacy
reimbursement, and other impacts; and
(iii) any recommendations the Commission
determines appropriate.
(B) Final report.--Not later than 2 years after the
date on which the Commission submits the initial report
under subparagraph
(A) , a report describing any changes
with respect to the information described in
subparagraph
(A) over time, together with any
recommendations the Commission determines appropriate.

(2) Funding.--In addition to amounts otherwise available,
there is appropriated to the Medicare Payment Advisory
Commission, out of any money in the Treasury not otherwise
appropriated, $1,000,000 for fiscal year 2025, to remain
available until expended, to carry out this subsection.

FOR EACH OFF-CAMPUS OUTPATIENT DEPARTMENT OF A PROVIDER.

(a) In General.--

(t) of the Social Security Act (42
U.S.C. 1395l

(t) ) is amended by adding at the end the following new
paragraph:
``

(23) Use of unique health identifiers; attestation.--
``
(A) In general.--No payment may be made under
this subsection (or under an applicable payment system
pursuant to paragraph

(21) ) for items and services
furnished on or after January 1, 2026, by an off-campus
outpatient department of a provider (as defined in
subparagraph
(C) ) unless--
``
(i) such department has obtained, and
such items and services are billed under, a
standard unique health identifier for health
care providers (as described in

(b) ) that is separate from such identifier
for such provider;
``
(ii) such provider has submitted to the
Secretary, during the 2-year period ending on
the date such items and services are so
furnished, an initial provider-based status
attestation that such department is compliant
with the requirements described in

(or a successor regulation); and
``
(iii) after such provider has submitted
an attestation under clause
(ii) , such provider
has submitted a subsequent attestation within
the timeframe specified by the Secretary.
``
(B) Process for submission and review.--Not later
than 1 year after the date of enactment of this
paragraph, the Secretary shall, through notice and
comment rulemaking, establish a process for each
provider with an off-campus outpatient department of a
provider to submit an initial and subsequent
attestation pursuant to clauses
(ii) and
(iii) ,
respectively, of subparagraph
(A) , and for the
Secretary to review each such attestation and
determine, through site visits, remote audits, or other
means (as determined appropriate by the Secretary),
whether such department is compliant with the
requirements described in such subparagraph.
``
(C) Off-campus outpatient department of a
provider defined.--For purposes of this paragraph, the
term `off-campus outpatient department of a provider'
means a department of a provider (as defined in

successor regulation) that is not located--
``
(i) on the campus (as defined in such
section) of such provider; or
``
(ii) within the distance (described in
such definition of campus) from a remote
location of a hospital facility (as defined in
such section).''.

(b) HHS OIG Analysis.--Not later than January 1, 2030, the
Inspector General of the Department of Health and Human Services shall
submit to Congress--

(1) an analysis of the process established by the Secretary
of Health and Human Services to conduct the reviews and
determinations described in

(t)

(23)
(B) of the
Social Security Act, as added by subsection

(a) of this
section; and

(2) recommendations based on such analysis, as the
Inspector General determines appropriate.

(6) of the Balanced Budget and Emergency Deficit
Control Act of 1985 (2 U.S.C. 901a

(6) ) is amended--

(1) in subparagraph
(D) , by striking ``such that,'' and all
that follows and inserting ``such that the payment reduction
shall be 2.0 percent.''; and

(2) by adding at the end the following:
``
(F) On the date on which the President submits the budget
under

year 2033, the President shall order a sequestration of
payments for the Medicare programs specified in

(d) ,
effective upon issuance, such that, notwithstanding the 2
percent limit specified in subparagraph
(A) for such payments--
``
(i) with respect to the first 2 months in which
such order is effective for such fiscal year, the
payment reduction shall be 2.0 percent; and
``
(ii) with respect to the last 10 months in which
such order is effective for such fiscal year, the
payment reduction shall be 0 percent.''.

(b)

(1) of the Social Security Act (42 U.S.C.
1395iii

(b)

(1) ) is amended by striking ``$1,251,000,000'' and inserting
``$1,938,000,000''.

TITLE III--HUMAN SERVICES

(1) in subsection

(a) --
(A) in paragraph

(1) --
(i) by striking ``and for the period'' and
inserting ``for the period'';
(ii) by inserting ``for the period
beginning on April 1, 2025, and ending on
September 30, 2025, and for the period
beginning on October 1, 2025, and ending on
December 31, 2025,'' before ``allot to each
State''; and
(iii) by striking ``for fiscal year 2024 or
2025'' and inserting ``for fiscal year 2024,
2025, or 2026''; and
(B) in paragraph

(2) , by striking ``or 2025'' each
place it appears and inserting ``, 2025, or 2026''; and

(2) in subsection

(f)

(1) , by striking ``and for the period
beginning on October 1, 2024, and ending on March 31, 2025, an
amount equal to the pro rata portion of the amount appropriated
for the corresponding period for fiscal year 2024'' and
inserting ``for the period beginning on October 1, 2024, and
ending on March 31, 2025, and for the period beginning on April
1, 2025, and ending on September 30, 2025, an amount equal to
the pro rata portion of the amount appropriated for the
corresponding period for fiscal year 2024, and for the period
beginning on October 1, 2025, and ending on December 31, 2025,
an amount equal to the pro rata portion of the amount
appropriated for the corresponding period for fiscal year
2025''

(1) in subsection

(a)

(1) --
(A) in subparagraph
(A) , in the matter preceding
clause
(i) --
(i) by striking ``and for the period'' and
inserting ``for the period''; and
(ii) by inserting ``for the period
beginning on April 1, 2025, and ending on
September 30, 2025, and for the period
beginning on October 1, 2025, and ending on
December 31, 2025,'' before ``the Secretary
shall allot''; and
(B) in subparagraph
(B)
(i) --
(i) by striking ``and for the period'' and
inserting ``for the period''; and
(ii) by inserting ``, for the period
beginning on April 1, 2025, and ending on
September 30, 2025, and for the period
beginning on October 1, 2025, and ending on
December 31, 2025'' before the period;

(2) in subsection
(c) (3) , by striking ``fiscal year 2024 or
2025'' and inserting ``fiscal year 2024, 2025, or 2026''; and

(3) in subsection

(f) , by striking ``and for the period
beginning on October 1, 2024, and ending on March 31, 2025, an
amount equal to the pro rata portion of the amount appropriated
for the corresponding period for fiscal year 2024'' and
inserting ``for the period beginning on October 1, 2024, and
ending on March 31, 2025, and for the period beginning on April
1, 2025, and ending on September 30, 2025, an amount equal to
the pro rata portion of the amount appropriated for the
corresponding period for fiscal year 2024, and for the period
beginning on October 1, 2025, and ending on December 31, 2025,
an amount equal to the pro rata portion of the amount
appropriated for the corresponding period for fiscal year
2025''.

CENTERS.

(c) (1)
(A)
(viii) of the Social Security Act (42 U.S.C.
701
(c) (1)
(A)
(viii) ) is amended--

(1) by striking ``$3,000,000'' and inserting
``$7,500,000''; and

(2) by striking ``for the portion of fiscal year 2025
before April 1, 2025'' and inserting ``for the period beginning
on October 1, 2024, and ending on December 31, 2025''.

TITLE IV--PUBLIC HEALTH EXTENDERS

Subtitle A--Extensions

SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE
GME PROGRAMS.

(a) Extension for Community Health Centers.--

(b)

(1) of
the Patient Protection and Affordable Care Act (42 U.S.C. 254b-2

(b)

(1) )
is amended--

(1) in subparagraph
(H) , by striking ``and'' at the end;

(2) in subparagraph
(I) , by striking the period and
inserting ``, and $2,315,342,466 for the period beginning on
April 1, 2025, and ending on September 30, 2025; and''; and

(3) by adding at the end the following:
``
(J) $4,600,000,000 for fiscal year 2026; and''.

(b) Extension for the National Health Service Corps.--

(b)

(2) of the Patient Protection and Affordable Care Act (42
U.S.C. 254b-2

(b)

(2) ) is amended--

(1) in subparagraph
(I) , by striking ``and'' at the end;

(2) in subparagraph
(J) , by striking the period and
inserting ``, and $176,712,329 for the period beginning on
April 1, 2025, and ending on September 30, 2025; and''; and

(3) by adding at the end the following:
``
(J) $350,000,000 for fiscal year 2026.''.
(c) Teaching Health Centers That Operate Graduate Medical Education
Programs.--

(g)

(1) of the Public Health Service Act (42
U.S.C. 256h

(g)

(1) ) is amended--

(1) in subparagraph
(D) , by striking ``; and'' and
inserting a semicolon;

(2) in subparagraph
(E) , by striking the period and
inserting a semicolon; and

(3) by adding at the end the following: ``
``
(F) $112,849,315 for the period beginning on
January 1, 2025, and ending on September 30, 2025;
``
(G) $225,000,000 for fiscal year 2026;
``
(H) $250,000,000 for fiscal year 2027;
``
(I) $275,000,000 for fiscal year 2028; and
``
(J) $300,000,000 for fiscal year 2029.''.
(d) Application of Provisions.--Amounts appropriated pursuant to
the amendments made by this section shall be subject to the
requirements contained in Public Law 118-47 for funds for programs
authorized under sections 330 through 340 of the Public Health Service
Act (42 U.S.C. 254b et seq.).

(e) Conforming Amendments.--

(h)

(4) of title 18, United
States Code, is amended by striking ``and

(d) of the Health
Extensions and Other Matters Act, 2025'' and inserting ``

(d) of the Health Extensions and Other Matters Act, 2025, and

(d) of the Bipartisan Health Care Act''.

(a) Extension of Special Diabetes Programs for Type I Diabetes.--

(b)

(2) of the Public Health Service Act (42 U.S.C. 254c-
2

(b)

(2) ) 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 $110,327,296 for the period beginning on
April 1, 2025, and ending on September 30, 2025; and''; and

(3) by adding at the end the following:
``
(G) $200,000,000 for fiscal year 2026, to remain
available until expended.''.

(b) Extending Funding for Special Diabetes Programs for Indians.--

(c) (2) of the Public Health Service Act (42 U.S.C. 254c-
3
(c) (2) ) 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 $110,327,296 for the period beginning on
April 1, 2025, and ending on September 30, 2025; and''; and

(3) by adding at the end the following:
``
(G) $200,000,000 for fiscal year 2026, to remain
available until expended.''.

Subtitle B--World Trade Center Health Program

(a) In General.--

(a)

(2)
(A) of the Public Health Service
Act (42 U.S.C. 300mm-61

(a)

(2)
(A) ) is amended--

(1) in clause
(x) , by striking ``; and'' and inserting a
semicolon;

(2) by redesignating clause
(xi) as clause
(xii) ; and

(3) by inserting after clause
(x) , the following:
``
(xi) for each of fiscal years 2026
through 2040--
``
(I) the amount determined under
this subparagraph for the previous
fiscal year multiplied by 1.05;
multiplied by
``
(II) the ratio of--
``

(aa) the total number of
individuals enrolled in the WTC
Program on July 1 of such
previous fiscal year; to
``

(bb) the total number of
individuals so enrolled on July
1 of the fiscal year prior to
such previous fiscal year;
and''.

(b) Report to Congress.--

(1) In general.--Not later than 3 years after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the ``Secretary'')
shall conduct an assessment of anticipated budget authority and
outlays of the World Trade Center Health Program (referred to
in this subsection as the ``Program'') through the duration of
the Program and submit a report summarizing such assessment
to--
(A) the Speaker and minority leader of the House of
Representatives;
(B) the majority and minority leaders of the
Senate;
(C) the Committee on Health, Education, Labor, and
Pensions and the Committee on the Budget of the Senate;
and
(D) the Committee on Energy and Commerce and the
Committee on the Budget of the House of
Representatives.

(2) Inclusions.--The report required under paragraph

(1) shall include--
(A) a projection of Program budgetary needs on a
per-fiscal year basis through fiscal year 2090;
(B) a review of Program modeling for each of fiscal
years 2017 through the fiscal year prior to the fiscal
year in which the report is issued to assess how
anticipated budgetary needs compared to actual
expenditures;
(C) an assessment of the projected budget authority
and expenditures of the Program through fiscal year
2090 by comparing--
(i) such projected authority and
expenditures resulting from application of

(a)

(2)
(A) of the Public Health
Service Act (42 U.S.C. 300mm-61

(a)

(2)
(A) ), as
amended by subsection

(a) ; and
(ii) such projected authority and
expenditures that would result if such section
were amended so that the formula under clause
(xi) of such section, as amended by subsection

(a) , were to be extended through fiscal year
2090; and
(D) any recommendations of the Secretary to make
changes to the formula under such

(a)

(2)
(A) , as so amended, to fully offset
anticipated Program expenditures through fiscal year
2090.
(c) Technical Amendments.--Title XXXIII of the Public Health
Service Act (42 U.S.C. 300mm et seq.) is amended--

(1) in

(d) (42 U.S.C. 300mm-62
(d) ), by striking
``Any amounts'' and inserting ``Any unobligated amounts'';

(2) in

(d) (42 U.S.C. 300mm-63
(d) ), by striking
``Any amounts'' and inserting ``Any unobligated amounts''; and

(3) in

(d) (42 U.S.C. 300mm-64
(d) ), by striking
``Any amounts'' and inserting ``Any unobligated amounts''.

TITLE V--SUPPORT ACT REAUTHORIZATION

This title may be cited as the ``SUPPORT for Patients and
Communities Reauthorization Act of 2025''.

Subtitle A--Prevention

(d) of the Public Health Service Act (42 U.S.C. 247b-
13
(d) ) is amended by striking ``such sums as may be necessary for each
of the fiscal years 2019 through 2023'' and inserting ``$4,250,000 for
each of fiscal years 2025 through 2029''.

ILLICIT DRUG USE AND OTHER RISK FACTORS.

(d) of the Public Health Service Act (42 U.S.C. 247b-
15
(d) ) is amended by striking ``fiscal years 2019 through 2023'' and
inserting ``fiscal years 2025 through 2029''.

(a) In General.--

U.S.C. 280b-1) is amended--

(1) in subsection

(a)

(2) --
(A) in subparagraph
(C) , by inserting ``and
associated risks'' before the period at the end; and
(B) in subparagraph
(D) , by striking ``opioids''
and inserting ``substances causing overdose''; and

(2) in subsection

(b)

(2) --
(A) in subparagraph
(B) , by inserting ``, and
associated risk factors,'' after ``such overdoses'';
(B) in subparagraph
(C) , by striking ``coding'' and
inserting ``monitoring and identifying'';
(C) in subparagraph
(E) --
(i) by inserting a comma after ``public
health laboratories''; and
(ii) by inserting ``and other emerging
substances related'' after ``analogues''; and
(D) in subparagraph
(F) , by inserting ``and
associated risk factors'' after ``overdoses''.

(b) Additional Grants.--

(a)

(3) of the Public Health
Service Act (42 U.S.C. 280b-1

(a)

(3) ) is amended--

(1) in the matter preceding subparagraph
(A) , by striking
``and Indian Tribes--'' and inserting ``and Indian Tribes for
the following purposes:'';

(2) by amending subparagraph
(A) to read as follows:
``
(A) To carry out innovative projects for grantees
to detect, identify, and rapidly respond to controlled
substance misuse, abuse, and overdoses, and associated
risk factors, including changes in patterns of such
controlled substance use. Such projects may include the
use of innovative, evidence-based strategies for
detecting such patterns, such as wastewater
surveillance, if proven to support actionable
prevention strategies, in a manner consistent with
applicable Federal and State privacy laws.''; and

(3) in subparagraph
(B) , by striking ``for any'' and
inserting ``For any''.
(c) Authorization of Appropriations.--

(e) of the Public
Health Service Act (42 U.S.C. 280b-1

(e) ) is amended by striking
``$496,000,000 for each of fiscal years 2019 through 2023'' and
inserting ``$505,579,000 for each of fiscal years 2025 through 2029''.

ALCOHOL SPECTRUM DISORDER.

(a) In General.--Part O of title III of the Public Health Service
Act (42 U.S.C. 280f et seq.) is amended to read as follows:

``PART O--FETAL ALCOHOL SYNDROME PREVENTION AND SERVICES PROGRAM

``

AND SERVICES DELIVERY PROGRAM.

``

(a) In General.--The Secretary shall establish or continue
activities to support a comprehensive fetal alcohol spectrum disorders
(referred to in this section as `FASD') education, prevention,
identification, intervention, and services delivery program, which may
include--
``

(1) an education and public awareness program to support,
conduct, and evaluate the effectiveness of--
``
(A) educational programs targeting health
professions schools, social and other supportive
services, educators and counselors and other service
providers in all phases of childhood development, and
other relevant service providers, concerning the
prevention, identification, and provision of services
for infants, children, adolescents and adults with
FASD;
``
(B) strategies to educate school-age children,
including pregnant and high-risk youth, concerning
FASD;
``
(C) public and community awareness programs
concerning FASD; and
``
(D) strategies to coordinate information and
services across affected community agencies, including
agencies providing social services such as foster care,
adoption, and social work, agencies providing health
services, and agencies involved in education,
vocational training and civil and criminal justice;
``

(2) supporting and conducting research on FASD, as
appropriate, including to--
``
(A) develop appropriate medical diagnostic
methods for identifying FASD; and
``
(B) develop effective culturally and
linguistically appropriate evidence-based or evidence-
informed interventions and appropriate supports for
preventing prenatal alcohol exposure, which may co-
occur with exposure to other substances;
``

(3) building State and Tribal capacity for the
identification, treatment, and support of individuals with FASD
and their families, which may include--
``
(A) utilizing and adapting existing Federal,
State, or Tribal programs to include FASD
identification and FASD-informed support;
``
(B) developing and expanding screening and
diagnostic capacity for FASD;
``
(C) developing, implementing, and evaluating
targeted FASD-informed intervention programs for FASD;
``
(D) providing training with respect to FASD for
professionals across relevant sectors; and
``
(E) disseminating information about FASD and
support services to affected individuals and their
families; and
``

(4) an applied research program concerning intervention
and prevention to support and conduct service demonstration
projects, clinical studies and other research models providing
advocacy, educational and vocational training, counseling,
medical and mental health, and other supportive services, as
well as models that integrate and coordinate such services,
that are aimed at the unique challenges facing individuals with
Fetal Alcohol Syndrome or Fetal Alcohol Effect and their
families.
``

(b) Grants and Technical Assistance.--
``

(1) In general.--The Secretary may award grants,
cooperative agreements and contracts and provide technical
assistance to eligible entities to carry out subsection

(a) .
``

(2) Eligible entities.--To be eligible to receive a
grant, or enter into a cooperative agreement or contract, under
this section, an entity shall--
``
(A) be a State, Indian Tribe or Tribal
organization, local government, scientific or academic
institution, or nonprofit organization; and
``
(B) prepare and submit to the Secretary an
application at such time, in such manner, and
containing such information as the Secretary may
require, including a description of the activities that
the entity intends to carry out using amounts received
under this section.
``

(3) Additional application contents.--The Secretary may
require that an eligible entity include in the application
submitted under paragraph

(2)
(B) --
``
(A) a designation of an individual to serve as a
FASD State or Tribal coordinator of activities such
eligible entity proposes to carry out through a grant,
cooperative agreement, or contract under this section;
and
``
(B) a description of an advisory committee the
entity will establish to provide guidance for the
entity on developing and implementing a statewide or
Tribal strategic plan to prevent FASD and provide for
the identification, treatment, and support of
individuals with FASD and their families.
``
(c) Definition of FASD-Informed.--For purposes of this section,
the term `FASD-informed', with respect to support or an intervention
program, means that such support or intervention program uses
culturally and linguistically informed evidence-based or practice-based
interventions and appropriate resources to support an improved quality
of life for an individual with FASD and the family of such individual.

``

SPECTRUM DISORDERS.

``

(a) In General.--The Secretary shall award grants, contracts, or
cooperative agreements, as the Secretary determines appropriate, to
public or nonprofit private entities with demonstrated expertise in the
field of fetal alcohol spectrum disorders (referred to in this section
as `FASD'). Such awards shall be for the purposes of building local,
Tribal, State, and nationwide capacities to prevent the occurrence of
FASD by carrying out the programs described in subsection

(b) .
``

(b) Programs.--An entity receiving an award under subsection

(a) may use such award for the following purposes:
``

(1) Developing and supporting public education and
outreach activities to raise public awareness of the risks
associated with alcohol consumption during pregnancy.
``

(2) Acting as a clearinghouse for evidence-based
resources on FASD prevention, identification, and culturally
and linguistically appropriate best practices to help inform
systems of care for individuals with FASD across their
lifespan.
``

(3) Increasing awareness and understanding of
efficacious, evidence-based screening tools and culturally and
linguistically appropriate evidence-based intervention services
and best practices, which may include improving the capacity
for State, Tribal, and local affiliates.
``

(4) Providing technical assistance to recipients of
grants, cooperative agreements, or contracts under

``
(c) Application.--To be eligible for a grant, contract, or
cooperative agreement under this section, an entity shall submit to the
Secretary an application at such time, in such manner, and containing
such information as the Secretary may require.
``
(d) Subcontracting.--A public or private nonprofit entity may
carry out the following activities required under this section through
contracts or cooperative agreements with other public and private
nonprofit entities with demonstrated expertise in FASD:
``

(1) Resource development and dissemination.
``

(2) Intervention services.
``

(3) Training and technical assistance.

``

``There are authorized to be appropriated to carry out this part
$12,500,000 for each of fiscal years 2025 through 2029.''.

(b) Report.--Not later than 4 years after the date of enactment of
this Act, and every year thereafter, the Secretary of Health and Human
Services shall prepare and submit to the Committee on Health,
Education, Labor, and Pensions of the Senate and the Committee on
Energy and Commerce of the House of Representatives a report
containing--

(1) a review of the activities carried out pursuant to
sections 399H and 399I of the Public Health Service Act, as
amended, to advance public education and awareness of fetal
alcohol spectrum disorders (referred to in this section as
``FASD'');

(2) a description of--
(A) the activities carried out pursuant to such
sections 399H and 399I to identify, prevent, and treat
FASD; and
(B) methods used to evaluate the outcomes of such
activities; and

(3) an assessment of activities carried out pursuant to
such sections 399H and 399I to support individuals with FASD.

(h) of the Public Health Service Act (42 U.S.C. 280g-
3

(h) ) is amended by adding at the end the following:
``

(5) Promoting state choice.--Nothing in this section
shall be construed to authorize the Secretary to require States
to use a specific vendor or a specific interoperability
connection other than to align with nationally recognized,
consensus-based open standards, such as in accordance with
sections 3001 and 3004.''.

amended--

(1) in subsection

(a) , by striking ``tribes and tribal''
and inserting ``Tribes and Tribal'';

(2) in subsections

(a) ,
(c) , and
(d) --
(A) by striking ``approved or cleared'' each place
it appears and inserting ``approved, cleared, or
otherwise legally marketed''; and
(B) by striking ``opioid'' each place it appears;

(3) in subsection

(f) --
(A) by striking ``approved or cleared'' each place
it appears and inserting ``approved, cleared, or
otherwise legally marketed'';
(B) in paragraph

(1) , by striking ``opioid'';
(C) in paragraph

(2) --
(i) by striking ``opioid and heroin'' and
inserting ``opioid, heroin, and other drug'';
and
(ii) by striking ``opioid overdose'' and
inserting ``overdose''; and
(D) in paragraph

(3) , by striking ``opioid and
heroin''; and

(4) in subsection

(h) , by striking ``$36,000,000 for each
of fiscal years 2019 through 2023'' and inserting ``$56,000,000
for each of fiscal years 2025 through 2029''.

(a) Technical Amendment.--The second part G of title V of the
Public Health Service Act (42 U.S.C. 290kk et seq.), as added by

554), is amended--

(1) by redesignating such part as part J; and

(2) by redesignating sections 581 through 584 as sections
596 through 596C, respectively.

(b) In General.--