[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 891 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 891
To extend expiring health provisions and improve health care delivery.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 6, 2025
Mr. Wyden (for himself and Mr. Sanders) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To extend expiring health provisions and improve health care delivery.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

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(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:

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TITLE I

-MEDICAID

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

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hospital payment adjustments under the
Medicaid program.

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TITLE II

-MEDICARE

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schedule to account for exceptional
circumstances.

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face encounter prior to recertification of
eligibility for hospice care.

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for each off-campus outpatient department
of a provider.

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TITLE III

-HUMAN SERVICES

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

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TITLE IV

-PUBLIC HEALTH EXTENDERS

Subtitle B--World Trade Center Health Program

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TITLE V

-SUPPORT ACT REAUTHORIZATION

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illness and children with serious emotional
disturbance.

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combination of buprenorphine and naloxone.
Subtitle C--Recovery

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crisis.
Subtitle D--Miscellaneous Matters

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Subtitle A--State and Local Readiness and Response

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TITLE VI

-PANDEMIC AND ALL-HAZARDS PREPAREDNESS AND RESPONSE

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and Prevention to combat public health
security threats.

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program.
Subtitle B--Federal Planning and Coordination

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Sec. 629A. Limitation related to countries of concern conducting
certain research.
Subtitle C--Addressing the Needs of All Individuals

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Sec. 649A. Epidemiology-laboratory capacity.

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TITLE VII

-PUBLIC HEALTH PROGRAMS

of Food and Drug Administration regarding
molecularly targeted cancer drugs.

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TITLE VIII

-FOOD AND DRUG ADMINISTRATION

encourage treatments for rare pediatric
diseases.

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

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TITLE IX

-LOWERING PRESCRIPTION DRUG COSTS

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TITLE X

-MISCELLANEOUS

PROVIDERS UNDER MEDICAID AND CHIP.
(a) In General.--Section 1902(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 section
1866(j)(2), has been so
screened under such section
1866(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
section 1128 or 1128A;
``(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 section 1902(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.

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BASED SERVICES UNDER MEDICAID.
(a) Increasing Transparency of HCBS Coverage Under Medicaid.--
(1) In general.--Section 1915(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.--Section 1915 of the Social
Security Act (42 U.S.C. 1396n) is amended--
(A) in subsection (i) by adding at the end the
following new paragraph:
``(8) Reporting requirement.--With respect to homemaker
services, home health aide services, personal care services,
and habilitation services 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 Section
1915(c) Waivers.--Section 1915(c) of the Social Security Act (42 U.S.C.
1396n(c)), as amended by subsection (a), is further amended--
(1) in paragraph (2)(E), by inserting ``, and the
information specified in paragraph (12)(C)(v), when
applicable'' after ``paragraph (11)''; and
(2) by adding at the end the following new paragraph:
``(12) Demonstration program to expand coverage for home or
community-based 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 Section 1915
Home and Community-Based Services Authorities.--Not later than January
1, 2027, the Secretary of Health and Human Services shall issue
guidance to the States to clarify how a State may provide, with respect
to an individual who is eligible for home and community-based services
under section 1915 of the Social Security Act (42 U.S.C. 1396n),
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).

b3bb7567d452678ee6b9469041af54745d20764b109a83a5eecfa77e89f57d8b

WORKING ADULTS WITH DISABILITIES.
(a) Modification of Optional Buy-In Groups.--
(1) In general.--Section 1902(a)(10)(A)(ii)(XV) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)(XV)) is
amended by striking ``but less than 65,''.
(2) Definition modification.--Section 1905(v)(1)(A) of the
Social Security Act (42 U.S.C. 1396d(v)(1)(A)) is amended by
striking ``, but less than 65,''.
(b) Application to Certain States.--A State that, as of the date of
enactment of this Act, provides for making medical assistance available
to individuals described in subclause (XV) or (XVI) of section
1902(a)(10)(A)(ii) of the Social Security Act (42 U.S.C.
1396a(a)(10)(A)(ii)) shall not be regarded as failing to comply with
the requirements of either such subclause (as amended by subsection
(a)(1)) or with section 1905(v)(1)(A) of the Social Security Act (42
U.S.C. 1396d(v)(1)(A)) (as amended by subsection (a)(2)) before January
1, 2027.

deeb37b5604b2b17d76201b1a181c9ecbfe951b253cc0ced4a84b013587acea6

COVERAGE FOR MILITARY FAMILIES.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
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 section
9817(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 section 1115(a), section 1915(c), or section 1915(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).

a5f4e4e06e38b4460ccb0efb8ccabeab68ed59c8e13285e95974555b258915cf

UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1902(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 section 435.919(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.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(1) by redesignating subparagraphs (H) through (U) as
subparagraphs (I) through (V), 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.--Section 1932 of the Social Security Act (42 U.S.C.
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
section 1903(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.''.

d16393fff793cecd7417c079724e282720729f8cd87678e0eb5bc16f2a03a22c

RELATED TO DECEASED PROVIDERS.
Section 1902(kk)(1) of the Social Security Act (42 U.S.C.
1396a(kk)(1)) is amended--
(1) by striking ``The State'' and inserting:
``(A) In general.--The State''; and
(2) by adding at the end the following new 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 section 203(d) of the Bipartisan Budget Act
of 2013) to determine whether such provider or supplier
is deceased.''.

d691933e261e6b53e2fd53037ba0015ba9d0661a4ae7a8829af89befc715fb35

INDIVIDUALS DO NOT REMAIN ENROLLED.
Section 1902 of the Social Security Act (42 U.S.C. 1396a), as
previously amended by this title, is amended--
(1) in subsection (a)--
(A) in paragraph (88), by striking ``; and'' and
inserting a semicolon;
(B) in paragraph (89), by striking the 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 section 203(d) of the Bipartisan Budget
Act of 2013) to determine whether any individuals
enrolled for medical assistance under the State plan
(or waiver of such plan) are deceased.
``(B) Disenrollment under state plan.--If the State
determines, based on 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 section 431.213(a)
of title 42, Code of Federal Regulations (or
any successor regulation);
``(ii) disenroll such individual from the
State plan (or waiver of such plan); and
``(iii) discontinue any payments for
medical assistance under this title made on
behalf of such individual (other than 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).''.

0baa3acfa0546d4deac555ef749f6f66e528028dcc8c9105927186c4f868bdcf

SCREENINGS, REFERRALS, AND CASE MANAGEMENT SERVICES FOR
ELIGIBLE JUVENILES IN PUBLIC INSTITUTIONS; STATE INTERIM
WORK PLANS.
(a) In General.--Section 5121(d) of subtitle C of title V of
division FF of the Consolidated Appropriations Act, 2023 (Public Law
117-328) is amended--
(1) by striking ``The amendments made by this section'' and
inserting the following:
``(1) In general.--Subject to paragraph (2), the amendments
made by this section''; and
(2) by adding at the end the following new paragraph:
``(2) Delay of date by which states must comply with
certain juvenile justice-related requirements.--A State shall
not be regarded as failing to comply with the requirements of
section 1902(a)(84)(D) or 2102(d)(2) of the Social Security Act
(42 U.S.C. 1396a(a)(84)(D), 1397bb(d)(2)) before January 1,
2026.''.
(b) Clarifying Nonapplication of Requirements to Individuals in
Federal Custody.--
(1) Medicaid.--
(A) Subparagraph (D) of section 1902(a)(84) of the
Social Security Act (42 U.S.C. 1396a(a)(84)), as added
by section 5121 of subtitle C of title V of division FF
of the Consolidated Appropriations Act, 2023 (Public
Law 117-328), is amended by striking ``an 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 section 2102 of the Social
Security Act (42 U.S.C. 1397bb), as added by section
5121 of subtitle C of title V of division FF of the
Consolidated Appropriations Act, 2023 (Public Law 117-
328), is amended by striking ``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 section 1101(a)(1) of the Social Security
Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such
Act) shall submit to the Secretary of Health and Human Services an
interim work plan, in such form and 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 section 5121 of subtitle
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.

0869aeb64d9bf7aa1106d519ea7928d2caeed61c296a22a430564a721db49ea4

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 section 1101(a)(1) of the Social
Security Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX
and XXI of such Act) shall conduct a study on the costs of
providing maternity, labor, and delivery services in applicable
hospitals (as defined in 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
section 447.203(b)(3) of title 42, Code of
Federal Regulations), other Federally-funded or
State-funded programs (including, to the extent
data is available, Medicaid managed care
rates), and to the payment rates for such
services, to the extent data is 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 Findings.--Not later
than 3 years after the date of enactment of this Act, the Secretary
shall submit to Congress, and make publicly available, a report
analyzing the first studies conducted by States under subsection
(a)(1), including recommendations for improving data collection on the
cost of providing maternity, labor, and delivery services.
(c) Implementation Funding.--In addition to the amount appropriated
under subsection (a)(4), there are appropriated, out of any funds in
the Treasury not otherwise obligated, $3,000,000 for fiscal year 2025,
to remain available until expended, to the Secretary of Health and
Human Services for purposes of implementing this section.

43e5a77dd349acf33b2167de66554accc095202ed2c4559c324c1b1ec944548a

(a) Extending Tennessee DSH Allotments.--Section 1923(f)(6)(A)(vi)
of the Social Security Act (42 U.S.C. 1396r-4(f)(6)(A)(vi)) is
amended--
(1) in the heading, by striking ``2025'' and 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.--Section
1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is amended--
(1) in paragraph (7)(A)--
(A) in clause (i), in the matter preceding
subclause (I), by striking ``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''.

7cf1ab7836296c1e5f7f26c8b079c4e9b8fb2ab9a41075aec70f0bcfda2b9e74

HOSPITAL PAYMENT ADJUSTMENTS UNDER THE MEDICAID PROGRAM.
(a) In General.--Section 1923(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 section 1862(b)(8)(F)) for
such services.''; and
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by
striking ``in this clause are'' and 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 section 1862(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 section 1923 of the Social Security Act
(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 section 1923 of the Social Security Act
(42 U.S.C. 1396r-4) applicable to that State plan rate
year, the State may use the unspent portion of such
allotment to increase the amount of any payment
adjustment made to a hospital for such rate year,
provided that--
(i) such payment adjustment (as so
increased) is consistent with subsection (g) of
such section (as amended by this 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
section 1923(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 section 1923(j)(2) of the Social Security
Act (42 U.S.C. 1396r-4(j)(2)).
(D) Reporting.--If a State increases a payment
adjustment made to a hospital for a Medicaid State plan
rate year pursuant to this paragraph, the State shall
include information on such increased payment
adjustment as part of the next annual report submitted
by the State under section 1923(j)(1) of the Social
Security Act (42 U.S.C. 1396r-4(j)(1)).

509c0b5c76df9881cefde1d907290bb152960ca6ac5d0420cf56a4ad40b779e7

(a) In General.--Section 1927(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
section 112 of the Bipartisan Health Care
Act.'';
(4) by adding at the end of paragraph (1) the following:
``(F) Survey reporting.--In order to meet the
requirement of section 1902(a)(54), a State shall
require that any retail community pharmacy 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 section 1903(m)(9)(D)) directly or from a
pharmacy benefit manager or another entity that has a
contract with the State or a managed care 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 section 1128A (other than subsections (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 section 1128A(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 section 1903(m)(9)(D)),'' after ``under this
title''; and
(B) in subparagraph (B), by inserting ``and the
basis for such dispensing fees'' before the semicolon;
(6) by redesignating paragraph (4) as 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) Definitions.--Section 1927(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 section 1903(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 section 1927(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
section 1927 of the Social Security Act (42 U.S.C. 1396r-8), as
added by subsection (b)), and that will be subject to the
survey requirements under subsection (f)(1) of such section, as
amended by subsection (a).
(2) Inclusion of pharmacy type 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 section 553 of title 5, United
States Code.
(f) Nonapplication of Paperwork Reduction Act.--Chapter 35 of title
44, United States Code, shall not apply to any data collection
undertaken by the Secretary of Health and Human Services under section
1927(f) of the Social Security Act (42 U.S.C. 1396r-8(f)), as amended
by this section.

ac5bbcc67f7b4b673326bdcfdfc186f9f6a085e6e09530c6011cd42b84db6e93

(a) In General.--Section 1927 of the Social Security Act (42 U.S.C.
1396r-8) is amended--
(1) in subsection (e), by adding at the end the following
new paragraph:
``(6) Transparent prescription drug pass-through pricing
required.--
``(A) In general.--A contract between the State and
a pharmacy benefit manager (referred to in this
paragraph as a `PBM'), or a contract between the State
and a managed care entity or other specified entity (as
such terms are defined in section 1903(m)(9)(D) 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
section 340B of the Public
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 section 340B(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 section 1903(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.--Section 1903(m) of such Act (42 U.S.C.
1396b(m)) is amended--
(1) in paragraph (2)(A)(xiii)--
(A) by striking ``and (III)'' and inserting
``(III)'';
(B) by inserting before the period at the end the
following: ``, and (IV) if the contract includes
provisions making the entity responsible for coverage
of covered outpatient drugs, the entity shall comply
with the requirements of section 1927(e)(6)''; and
(C) by moving the margin 2 ems to the left; and
(2) by adding at the end the following new paragraph:
``(10) No payment shall be made under this title to a State
with respect to expenditures incurred by the State for payment
for services provided by an 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 section 553 of title 5, United
States Code.
(e) Nonapplication of Paperwork Reduction Act.--Chapter 35 of title
44, United States Code, shall not apply to any data collection
undertaken by the Secretary of Health and Human Services under section
1927(e) of the Social Security Act (42 U.S.C. 1396r-8(e)), as amended
by this section.

63a9c809cf53138d7de66c37b67f914f46b6ca993a7ea426b315da0129b52d2e

FOR CERTAIN LOW-VOLUME HOSPITALS.
(a) In General.--Section 1886(d)(12) of the Social Security Act (42
U.S.C. 1395ww(d)(12)) is amended--
(1) in subparagraph (B), in the matter 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.

8a674ea6d3b0029ff9d293baf86163ba3c8878d07b1852220d48ecdc6391635a

(a) In General.--Section 1886(d)(5)(G) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``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.--Section 1886(b)(3)(D) of the Social
Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended--
(A) in the matter preceding clause (i), by striking
``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.--
Section 13501(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''.

661cfc1d654ea76cd55decf820642cf221f742d78649506c99d2874f10810e55

Section 1834(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.

afc45ab97cc6ed51ece91d490895f1e932770857ba8b7c4a1bc7652f9dc3c9a4

ALTERNATIVE PAYMENT MODELS.
(a) In General.--Section 1833(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.--Section 1848(q)(1)(C)(iii) of the
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii)) is amended--
(1) in subclause (II), by striking ``2026'' and inserting
``2027''; and
(2) in subclause (III), by striking ``2027'' and inserting
``2028''.

7c38da00d1ebb030059ae529dba07cd71c314f2f25d395103a7a3daa89506f0d

SCHEDULE TO ACCOUNT FOR EXCEPTIONAL CIRCUMSTANCES.
(a) In General.--Section 1848(t)(1) of the Social Security Act (42
U.S.C. 1395w-4(t)(1)) is amended--
(1) in subparagraph (D), by striking ``and'' at the end;
(2) in subparagraph (E), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(F) such services furnished on or after March 15,
2025, and before January 1, 2026, by 3.5375 percent.''.
(b) Conforming Amendment.--Section 1848(c)(2)(B)(iv)(V) is amended
by striking ``or 2024'' and inserting ``2024, or 2025''.

4c4ce625eeba18dbb2b51bb5fba3473bf422988451a72d18c0e2fd2167ffc127

AND SELECTION.
Section 1890(d)(2) of the Social Security Act (42 U.S.C.
1395aaa(d)(2)) is amended--
(1) in the first sentence--
(A) by striking ``$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''.

8cde76b3d2d546d24434763344a31d19dd53ed182acdf4a2f5368bfdb6a99fc9

PROGRAMS.
(a) State Health Insurance Assistance Programs.--Subsection
(a)(1)(B) of section 119 of the Medicare Improvements for Patients and
Providers Act of 2008 (42 U.S.C. 1395b-3 note) is amended--
(1) in clause (xiii), by striking ``and'' at the end;
(2) in clause (xiv), by striking the period and inserting
``; and''; and
(3) by inserting after clause (xiv) the following new
clause:
``(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.
(b) Area Agencies on Aging.--Subsection (b)(1)(B) of such section
119 is amended--
(1) in clause (xiii), by striking ``and'' at the end;
(2) in clause (xiv), by striking the period and inserting
``; and''; and
(3) by inserting after clause (xiv) the following new
clause:
``(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.
(c) Aging and Disability Resource Centers.--Subsection (c)(1)(B) of
such section 119 is amended--
(1) in clause (xiii), by striking ``and'' at the end;
(2) in clause (xiv), by striking the period and inserting
``; and''; and
(3) by inserting after clause (xiv) the following new
clause:
``(xv) for the period beginning on 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 section 119 is amended--
(1) in clause (xiii), by striking ``and'' at the end;
(2) in clause (xiv), by striking the period and inserting
``; and''; and
(3) by inserting after clause (xiv) the following new
clause:
``(xv) for the period beginning on April 1,
2025, and ending on December 31, 2026,
$26,250,000.''.

d41280244057530e6ab5030ee0b1300cd2c5edf104a93a8badbf2eaccf0ded22

Section 1848(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''.

5eaa25d4e8f9e4386c59cc849d4b8a355350b0c1bb1b5d456080db4439037314

(a) Removing Geographic Requirements and Expanding Originating
Sites for Telehealth Services.--Section 1834(m) of the Social Security
Act (42 U.S.C. 1395m(m)) is amended--
(1) in paragraph (2)(B)(iii), by striking ``ending 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.--Section 1834(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.--Section 1834(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 section 1834(o) or the
methodology for all-inclusive rates established
under section 1833(a)(3), respectively.
``(ii) Treatment of costs.--Costs
associated with the furnishing of telehealth
services by a Federally qualified health center
or rural health clinic on or after April 1,
2025, and before January 1, 2027, shall be
considered allowable costs for purposes of the
prospective payment system established under
section 1834(o) and the methodology for all-
inclusive rates established under section
1833(a)(3), as applicable.
``(iii) Requiring modifiers.--Not later
than July 1, 2025, the Secretary shall
establish requirements to include 1 or more
codes or modifiers, as determined 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.--Section 1834(m)(7)(B)(i) of the
Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended,
in the matter preceding subclause (I), by striking ``April 1,
2025'' and inserting ``January 1, 2027''.
(2) Mental health visits furnished by rural health
clinics.--Section 1834(y)(2) of the Social Security Act (42
U.S.C. 1395m(y)(2)) is amended by striking ``April 1, 2025''
and inserting ``January 1, 2027''.
(3) Mental health visits furnished by federally qualified
health centers.--Section 1834(o)(4)(B) of the Social Security
Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking ``April
1, 2025'' and inserting ``January 1, 2027''.
(e) Allowing for the Furnishing of Audio-Only Telehealth
Services.--Section 1834(m)(9) of the Social Security Act (42 U.S.C.
1395m(m)(9)) is amended by striking ``ending on 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.--Section
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C.
1395f(a)(7)(D)(i)(II)) is amended--
(1) by striking ``ending on 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
section 1866(j)(7), if such individual is receiving hospice
care from a provider that is subject to enhanced oversight
under this title pursuant to section 1866(j)(3), or if such
encounter is performed by a hospice physician or nurse
practitioner who is not enrolled under section 1866(j) and is
not an opt-out physician or practitioner (as defined in section
1802(b)(6)(D))'' before the semicolon.
(g) Requiring Modifiers for Telehealth Services in Certain
Instances.--Section 1834(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.

65999a1cd0c0e487f6fa8e24de891e733d3517c57907351b8f9f0116739384ce

FACE ENCOUNTER PRIOR TO RECERTIFICATION OF ELIGIBILITY
FOR HOSPICE CARE.
Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C.
1395f(a)(7)(D)(i)(II)), as amended by section 209(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''.

7f5fd13db2637343f17d7abac10aa562d6d75509d93b4af0521fb80e3666fc47

Section 1866G of the Social Security Act (42 U.S.C. 1395cc-7) is
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.''.

ec4889ff465f6d0ec94a76d69c3cf8263a6bd8da96dfb4206d433979ba3c48c5

UNDER MEDICARE.
(a) Durable Medical Equipment.--
(1) In general.--Section 1834(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
section 414.234(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.--Section 1834(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 section 1834A of the Social Security Act (42
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 section 1834A
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 section 1834A included the payment modifier
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.

f33b3b05dcd2c02ddabc1e0906ed6fb44cba034e647b8b1f8f398ad56bdd6d25

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 section 1834(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.

cc50595841b35e89b425d88736ee532215e1f40fe436eaea77fa527af5387ec6

(a) In General.--Section 1861(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.

c186424a0935ebecad2559481425fb233b47d3f6bd7b4c30cb69c0b5d44430ae

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 section
424.205(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) Definitions.--In this section:
(1) MDPP.--The term ``MDPP'' means the Medicare Diabetes
Prevention Program conducted under section 1115A of the Social
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 section 410.79(b) of title
42, Code of Federal Regulations.
(3) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.

1645a0760d6e39ed378e24516e8129863103a45e947d2265e916f5a069118ed6

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.

931db3cdb95180007239770df8a65a10d09e6820fd94df179f6e2edf5c282a8d

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.

6bd8a0bad3561efcc8596d9dcc4e2bfda36210f43be862bb8605592cc4db49c0

DRUGS AS COVERED PART D DRUGS.
Section 1860D-2(e)(1)(C) of the Social Security Act (42 U.S.C.
1395w-102(e)(1)(C)) is amended by striking ``March 31, 2025'' and
inserting ``December 31, 2025''.

cedb27c82e9098ef982a12563823bb9eb477fa6a766c783b10463198c034761e

Section 1814(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''.

001b553010e7d80d40b742a1e1211a7fddadf1933bd91034d3e6df6abee7e9c0

Section 3904 of title 41, United States Code, is amended by adding
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.''.

cdc62f26fdaee67d1f221232931d18725a56cf850f84731b994b4861b3614290

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).

d60979854e4d696e5483ae665003c2dfd5a6976a75dc34a182043fe843d177f8

LOW-INCOME INDIVIDUALS.
Section 1860D-14(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 section
1927(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 section
1927(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''.

619b7a060b4e6a5292e1ddabd42530e01ff7ea833d4bb84d4e242087005e6409

PROVIDERS ACT.
(a) In General.--Section 1852(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 section
1859(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.--Section 1852(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
section 1851(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.--Section 1857(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 section
1852(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.--
Section 1851(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 section 1857(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 section 1852(d)(7)(A) of the
Social Security Act, as added by paragraph (1);
(ii) the trends in provider directory
information accuracy scores under section
1857(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.

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Bipartisan Health Care Act — S. 891

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