118 S3430 RS: Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023
U.S. Senate
2023-12-07
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents(a)This Act may be cited as the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023
.(b)The table of contents of this Act is as follows:Sec. 1. Short title; table of contents.TITLE I—Expanding mental health care workforce and services under Medicare and MedicaidSec. 101. Expanding eligibility for incentives under the Medicare health professional shortage area bonus program to practitioners furnishing mental health and substance use disorder services.Sec. 102. Improved access to mental health services under the Medicare program.Sec. 103. Clarifying coverage of occupational therapy under the Medicare program.Sec. 104. Medicare incentives for behavioral health integration with primary care.Sec. 105. Establishment of Medicare incident to modifier for mental health services furnished through telehealth.Sec. 106. Guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program.Sec. 107. Ensuring timely communication regarding telehealth and interstate licensure requirements.Sec. 108. Facilitating accessibility for behavioral health services furnished through telehealth.Sec. 109. Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act.Sec. 110. Guidance to States on strategies under Medicaid and CHIP to increase mental health and substance use disorder care provider capacity.Sec. 111. Guidance to States on supporting mental health services and substance use disorder care for children and youth.Sec. 112. Recurring analysis and publication of Medicaid health care data related to mental health services.Sec. 113. Guidance to States on supporting mental health services or substance use disorder care integration with primary care in Medicaid and CHIP.Sec. 114. Medicaid State option relating to inmates with a substance use disorder pending disposition of charges.Sec. 115. Definition of Certified Community Behavioral Health Clinic Services under Medicaid.TITLE II—Reducing prescription drug costs under Medicare and MedicaidSec. 201. Assuring pharmacy access and choice for Medicare beneficiaries.Sec. 202. Ensuring accurate payments to pharmacies under Medicaid.Sec. 203. Protecting seniors from excessive cost-sharing for certain medicines.TITLE III—Medicaid Expiring ProvisionsSec. 301. Delaying certain disproportionate share hospital payment reductions under the Medicaid program.Sec. 302. Extension of State option to provide medical assistance for certain individuals who are patients in certain institutions for mental diseases.TITLE IV—Medicare Expiring Provisions and Provider Payment ChangesSec. 401. Extension of funding for quality measure endorsement, input, and selection.Sec. 402. Extension of funding outreach and assistance for low-income programs.Sec. 403. Extension of the work geographic index floor under the Medicare program.Sec. 404. Extending incentive payments for participation in eligible alternative payment models.Sec. 405. Payment rates for durable medical equipment under the Medicare Program.Sec. 406. Extending the independence at home medical practice demonstration program under the Medicare program.Sec. 407. Increase in support for physicians and other professionals in adjusting to Medicare payment changes.Sec. 408. Revised phase-in of Medicare clinical laboratory test payment changes.Sec. 409. Extension of adjustment to calculation of hospice cap amount under Medicare.TITLE V—OffsetsSec. 501. Medicaid Improvement Fund.Sec. 502. Medicare Improvement Fund.<enum>I</enum><header>Expanding mental health care workforce and services under Medicare and Medicaid</header><section id="id4ef8c08d89af4000a202f70bc7e6d5dc"><enum>101.</enum><header>Expanding eligibility for incentives under the Medicare health professional shortage area bonus program to practitioners furnishing mental health and substance use disorder services</header><text display-inline="no-display-inline">Section 1833(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(m)</external-xref>) is amended—</text><paragraph id="id17BA41B543E842039847F07EEB75D472"><enum>(1)</enum><text>by striking paragraph (1) and inserting the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idA784FC57A4D2416891D58CD0E5120323"><paragraph id="id72D05DB0ED7C4F188115E9BD5AA77D58" indent="up1"><enum>(1)</enum><text>In the case of—</text><subparagraph id="id61E4F4C3D2B042A6B56993D850A22778"><enum>(A)</enum><text>physicians' services (other than specified health services that are eligible for the additional payment under subparagraph (B)) furnished in a year to an individual, who is covered under the insurance program established by this part and who incurs expenses for such services, in an area that is designated (under section 332(a)(1)(A) of the Public Health Service Act) as a health professional shortage area as identified by the Secretary prior to the beginning of such year, in addition to the amount otherwise paid under this part, there also shall be paid to the physician (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) (on a monthly or quarterly basis) from the Federal Supplementary Medical Insurance Trust Fund an amount equal to 10 percent of the payment amount for the service under this part; and</text></subparagraph><subparagraph id="id106BB112744A4E218239918872614515"><enum>(B)</enum><text>specified health services (as defined in paragraph (5)) furnished in a year to an individual, who is covered under the insurance program established by this part and who incurs expenses for such services, in an area that is designated (under such section 332(a)(1)(A)) as a mental health professional shortage area as identified by the Secretary prior to the beginning of such year, in addition to the amount otherwise paid under this part, there also shall be paid to the physician or applicable practitioner (as defined in paragraph (6)) (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) (on a monthly or quarterly basis) from such Trust Fund an amount equal to 15 percent of the payment amount for the service under this part.</text></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph><paragraph id="id429841ff63964c89b6029e4ab272ad9f"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="id6A322020FCBB48D891EA5125E35173EE"><enum>(A)</enum><text>by striking <quote>in paragraph (1)</quote> and inserting <quote>in subparagraph (A) or (B) of paragraph (1)</quote>;</text></subparagraph><subparagraph id="idD6D841B745194226A9271134C3446821"><enum>(B)</enum><text>by inserting <quote>or, in the case of specified health services, the physician or applicable practitioner</quote> after <quote>physician</quote>; </text></subparagraph></paragraph><paragraph id="id8A7DF424EA9246898A54C42B3B1C8D87"><enum>(3)</enum><text>in paragraph (3), by striking <quote>in paragraph (1)</quote> and inserting <quote>in subparagraph (A) or (B) of paragraph (1)</quote>;</text></paragraph><paragraph id="id73140A2DF6E443AC80A1E61A2788039F"><enum>(4)</enum><text>in paragraph (4)—</text><subparagraph id="idE10EC3D3CA3C46DF8784FEFEDACEBB52"><enum>(A)</enum><text>in subparagraph (B), by inserting <quote>or applicable practitioner</quote> after <quote>physician</quote>; and</text></subparagraph><subparagraph id="id8EEFEB5B32E44813A907AE92FD8AB2C0"><enum>(B)</enum><text>in subparagraph (C), by inserting <quote>or applicable practitioner</quote> after <quote>physician</quote>; and</text></subparagraph></paragraph><paragraph id="id0D51072C330846CB84097322C88003CF"><enum>(5)</enum><text>by adding at the end the following new paragraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id25CBED2E11724AADAAB523E47F466C94"><paragraph commented="no" id="id0920AB0F01F0440B82F085CEC12F203D" indent="up1"><enum>(5)</enum><text>In this subsection, the term <quote>specified health services</quote> means services otherwise covered under this part that are furnished on or after January 1, 2026, by a physician or an applicable practitioner to an individual— </text><subparagraph commented="no" id="idAA62FF38F563486B80F200EEA0C78BC6"><enum>(A)</enum><text>for purposes of diagnosis, evaluation, or treatment of a mental health disorder, as determined by the Secretary; or</text></subparagraph><subparagraph commented="no" id="id7FB16E2ED1C64A7C8E7406522E5CD0DD"><enum>(B)</enum><text>with a substance use disorder diagnosis for purposes of treatment of such disorder or co-occurring mental health disorder, as determined by the Secretary.</text></subparagraph></paragraph><paragraph commented="no" indent="up1" id="id11574004718E4FF79603C72057E2A73D"><enum>(6)</enum><text>In this subsection, the term <quote>applicable practitioner</quote> means the following:</text><subparagraph commented="no" id="idDF761800E2CC42338E1FA7AFBE131739"><enum>(A)</enum><text>A physician assistant, nurse practitioner, or clinical nurse specialist (as defined in section 1861(aa)(5)).</text></subparagraph><subparagraph commented="no" id="id12550F029B784D63A6B53053E3AE1FB8"><enum>(B)</enum><text>A clinical social worker (as defined in section 1861(hh)(1)).</text></subparagraph><subparagraph commented="no" id="idA966053E783B44D8A68FE5164AF3E62A"><enum>(C)</enum><text>A clinical psychologist (as defined by the Secretary for purposes of section 1861(ii)).</text></subparagraph><subparagraph commented="no" id="idAD89650129C94B07A8243DC581EFDB2B"><enum>(D)</enum><text>A marriage and family therapist (as defined in section 1861(lll)(2)).</text></subparagraph><subparagraph commented="no" id="idF434B42BF8F84A61B332A822A0716CF0"><enum>(E)</enum><text>A mental health counselor (as defined in section 1861(lll)(4)).</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><section id="H1677AC84CB1C422991D7FE0C8C37706C"><enum>102.</enum><header>Improved access to mental health services under the Medicare program</header><subsection id="HA8650A2F692B4B80838A248924B30229"><enum>(a)</enum><header>Access to clinical social worker services provided to residents of skilled nursing facilities</header><paragraph commented="no" id="H5F109D52364E4D09BB93A9CC43C498A6"><enum>(1)</enum><header>Exclusion of clinical social worker services from the skilled nursing facility prospective payment system</header><text>Section 1888(e)(2)(A)(iii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395yy">42 U.S.C. 1395yy(e)(2)(A)(iii)</external-xref>) is amended by adding at the end the following new subclause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id078BAC7172D040DC94F58D28FCE56F2E"><subclause commented="no" display-inline="no-display-inline" id="id3029ba72dec748ee88b66305b7240899"><enum>(VII)</enum><text>Clinical social worker services (as defined in section 1861(hh)(2)).</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="H7A70178836C2495399EB46A25C4EA291"><enum>(2)</enum><header>Conforming amendment</header><text>Section 1861(hh)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(hh)(2)</external-xref>) is amended by striking <quote>and other than services furnished to an inpatient of a skilled nursing facility which the facility is required to provide as a requirement for participation</quote>.</text></paragraph></subsection><subsection id="H6DCF0950482B4D479647CF8DE890AE71"><enum>(b)</enum><header>Access to the complete scope of clinical social worker services</header><text>Section 1861(hh)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(hh)(2)</external-xref>), as amended by subsection (a)(2), is amended by striking <quote>for the diagnosis and treatment of mental illnesses (other than services furnished to an inpatient of a hospital)</quote> and inserting <quote>, including services for the diagnosis and treatment of mental illnesses or services for health behavior assessment and intervention (identified as of January 1, 2023, by HCPCS codes 96160 and 96161 (and any succeeding codes)), but not including services furnished to an inpatient of a hospital,</quote>.</text></subsection><subsection commented="no" display-inline="no-display-inline" id="HF93AFB9A7E5D427997A1A9149807C36C"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section shall apply to items and services furnished on or after January 1, 2026.</text></subsection></section><section id="id086a6454155041d5bddbd15185fecfa1"><enum>103.</enum><header>Clarifying coverage of occupational therapy under the Medicare program</header><text display-inline="no-display-inline">Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall use existing communication mechanisms to provide education and outreach to stakeholders about the Medicare Benefit Policy Manual with respect to occupational therapy services furnished to individuals under the Medicare program for the treatment of a substance use or mental health disorder diagnosis using applicable Healthcare Common Procedure Coding System (HCPCS) codes. </text></section><section id="idb19be5318f534e27bd029c3523bfa183"><enum>104.</enum><header>Medicare incentives for behavioral health integration with primary care</header><subsection id="id8551b680e5314e00a75ee7dae121e014"><enum>(a)</enum><header>Incentives</header><paragraph id="idd2814b2a398c46ffb5c79022a2ce449f"><enum>(1)</enum><header>In general</header><text>Section 1848(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(b)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id1d3a69abaa744063bffa5ddfae81e29a"><paragraph id="id7ccaca34e8e544d09b76dc2bff1d34d5"><enum>(13)</enum><header>Incentives for behavioral health integration</header><subparagraph id="id2ef60a1ba92f474c92e81c07ce17dfe7"><enum>(A)</enum><header>In general</header><text>For services described in subparagraph (B) that are furnished during 2026, 2027, or 2028, instead of the payment amount that would otherwise be determined under this section for such year, the payment amount shall be equal to the applicable percent (as defined in subparagraph (C)) of such payment amount for such year.</text></subparagraph><subparagraph id="id4b81196385824d2aaa92594fac05aa68"><enum>(B)</enum><header>Services described</header><text>The services described in this subparagraph are services identified, as of January 1, 2023, by HCPCS codes 99484, 99492, 99493, 99494, and G2214 (and any successor or similar codes as determined appropriate by the Secretary).</text></subparagraph><subparagraph id="idc589dfafad224bc3a6c8d6e46a4750bb"><enum>(C)</enum><header>Applicable percent</header><text>In this paragraph, the term <term>applicable percent</term> means, with respect to a service described in subparagraph (A), the following:</text><clause id="idfb5eccd5ae8742bd9b6b4e7af8561bad"><enum>(i)</enum><text>For services furnished during 2026 , 175 percent.</text></clause><clause id="idfdb5066bfc3b48cea06e359bf77bc3e6"><enum>(ii)</enum><text>For services furnished during 2027, 150 percent.</text></clause><clause id="id99cfb7e19907438e9f8f899d970e735b"><enum>(iii)</enum><text>For services furnished during 2028, 125 percent.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="id853153d06ca040118dc4e3b6084b706f"><enum>(2)</enum><header>Waiver of budget neutrality</header><text>Section 1848(c)(2)(B)(iv) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(c)(2)(B)(iv)</external-xref>) is amended—</text><subparagraph id="id6fde1fe618bd4a878106909d008319fc"><enum>(A)</enum><text>in subclause (V), by striking <quote>and</quote> at the end;</text></subparagraph><subparagraph id="id39b9132bd0564c929237288da90804cc"><enum>(B)</enum><text>in subclause (VI), by striking the period at the end and inserting <quote>; and</quote> and</text></subparagraph><subparagraph id="ida34aba33ee7e435ba444f6d499be2062"><enum>(C)</enum><text>by adding at the end the following new subclause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="iddd1cfde980c0401e8c23af35afab2f3d"><subclause id="id670c8ab2e60c4026ac2747f8c81a5270"><enum>(VII)</enum><text>the increase in payment amounts as a result of the application of subsection (b)(13) shall not be taken into account in applying clause (ii)(II) for 2026, 2027, or 2028.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection><subsection id="id79bbf4a802534ea1abcb7da886205ed4"><enum>(b)</enum><header>Technical assistance for the adoption of behavioral health integration</header><paragraph id="id1346bfe548924d84b4d4e2f2ca862a78"><enum>(1)</enum><header>In general</header><text>Not later than January 1, 2025, the Secretary of Health and Human Services (in this subsection referred to as the <term>Secretary</term>) shall enter into contracts or agreements with appropriate entities to offer technical assistance to primary care practices that are seeking to adopt behavioral health integration models in such practices.</text></paragraph><paragraph id="id671fc847b1d240e2b74df882fa1acbfc"><enum>(2)</enum><header>Behavioral health integration models</header><text>For purposes of paragraph (1), behavioral health integration models include the Collaborative Care Model (with services identified as of January 1, 2023, by HCPCS codes 99492, 99493, 99494, and G2214 (and any successor codes)), the Primary Care Behavioral Health model (with services identified as of January 1, 2023, by HCPCS code 99484 (and any successor code)), and other models identified by the Secretary.</text></paragraph><paragraph id="id1ad4df4b8dff4e569b2bdc4400410b3c"><enum>(3)</enum><header>Implementation</header><text>Notwithstanding any other provision of law, the Secretary may implement the provisions of this subsection by program instruction or otherwise. </text></paragraph><paragraph id="id10466f1438e54a20a303866751f7ee1b"><enum>(4)</enum><header>Funding</header><text>In addition to amounts otherwise available, there is appropriated to the Secretary for fiscal year 2024, out of any money in the Treasury not otherwise appropriated, $5,000,000, to remain available until expended, for purposes of carrying out this subsection. </text></paragraph></subsection></section><section commented="no" id="id95eccf55882f493d95f1b191dff366ca"><enum>105.</enum><header>Establishment of Medicare incident to modifier for mental health services furnished through telehealth</header><text display-inline="no-display-inline">Section 1834(m)(7) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m">42 U.S.C. 1395m(m)(7)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id87F2AFE9D63D468AB4FCF74FF47C6345"><subparagraph commented="no" id="id89F60847C9384A878E7E9D03A794A6EE"><enum>(C)</enum><header>Establishment of incident to modifier for mental health services furnished through telehealth</header><text display-inline="yes-display-inline">Not later than 2 years after the date of the enactment of this subparagraph, the Secretary shall establish requirements to include a code or modifier, as determined appropriate by the Secretary, on claims for mental health services furnished through telehealth under this paragraph that are furnished by auxiliary personnel (as defined in section 410.26(a)(1) of title 42, Code of Federal Regulations, or any successor regulation) and billed incident to a physician or practitioner's professional services.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></section><section commented="no" id="id0621370924084d9ea53c5b23cc966c82"><enum>106.</enum><header>Guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program</header><text display-inline="no-display-inline">Not later than 1 year after the date of the enactment of this section, the Secretary of Health and Human Services shall issue and disseminate, or update and revise as applicable, guidance on the following:</text><paragraph commented="no" id="id87cc91201571487c8c4a1c212e71b534"><enum>(1)</enum><text>Best practices for providers to work with interpreters to furnish behavioral health services via video-based and audio-only telehealth, when video-based telehealth is not an option.</text></paragraph><paragraph commented="no" id="idbd51a401961c45b4b734bb99d0050e90"><enum>(2)</enum><text>Best practices on integrating the use of video platforms that enable multi-person video calls into behavioral health services furnished via telehealth.</text></paragraph><paragraph commented="no" id="idadf625cc058a401b8fc2919e5068cfef"><enum>(3)</enum><text>Best practices on teaching patients, especially those with limited English proficiency, to use video-based telehealth platforms.</text></paragraph><paragraph commented="no" id="ida9669f8045b745a2b7b8859462ed2fe9"><enum>(4)</enum><text>Best practices for providing patient materials, communications, and instructions in multiple languages, including text message appointment reminders and prescription information.</text></paragraph></section><section id="idf8ff64d4f6b4429b81fc45325eb2b612"><enum>107.</enum><header>Ensuring timely communication regarding telehealth and interstate licensure requirements</header><text display-inline="no-display-inline">The Secretary of Health and Human Services shall provide information—</text><paragraph commented="no" display-inline="no-display-inline" id="id94dfcfd0480d4c8fbb6526a89c20b0b4"><enum>(1)</enum><text display-inline="yes-display-inline">on licensure requirements for furnishing telehealth services under titles XVIII and XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>; 1396 et seq.); and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idb7b6b44b3c5c44c08dea22b7dc0f457f"><enum>(2)</enum><text display-inline="yes-display-inline">clarifying the extent to which licenses through an interstate license compact pathway can qualify as valid and full licenses for the purposes of meeting Federal licensure requirements under such titles.</text></paragraph></section><section id="id79e60728338442bc8fc0565276a9b5a1"><enum>108.</enum><header>Facilitating accessibility for behavioral health services furnished through telehealth</header><text display-inline="no-display-inline">The Secretary of Health and Human Services shall provide regular updates to guidance to facilitate the accessibility of behavioral health services furnished through telehealth for the visually and hearing impaired.</text></section><section id="ida0e9c89fa5994d19a4977e95e9a26aea"><enum>109.</enum><header>Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act</header><subsection commented="no" display-inline="no-display-inline" id="idc95f519c931a4578ba8ada4b1dc50ea2"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text display-inline="yes-display-inline">Section 1852(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22(c)</external-xref>) is amended—</text><paragraph commented="no" id="idF75E5DBE3C3B4592AD5D4B5DEB20F944"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (1)(C)—</text><subparagraph commented="no" id="id3B532C9624844E55917BB10B15E3E30F"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>plan, and any</quote> and inserting <quote>plan, any</quote>; and</text></subparagraph><subparagraph commented="no" id="id0C383F8FB8BD4C06B51E6C89F96E6CAE"><enum>(B)</enum><text>by inserting the following before the period: <quote>, and, in the case of a network-based plan (as defined in paragraph (3)(C)), for plan year 2026 and subsequent plan years, the information described in paragraph (3)(B)</quote>; and</text></subparagraph></paragraph><paragraph commented="no" id="id0AD456C0F35C460F90AEF73C95434B68"><enum>(2)</enum><text display-inline="yes-display-inline">by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idC700DDE707304279A9121930DEBB3F9F"><paragraph commented="no" id="idF3319F762945491FA400E13B55FDEA6F"><enum>(3)</enum><header>Provider directory accuracy</header><subparagraph commented="no" id="id7D094867E0094BF6ADC79CD3FA83D287"><enum>(A)</enum><header>In general</header><text>For plan year 2026 and subsequent plan years, each MA organization offering a network-based plan (as defined in subparagraph (C)) shall, for each network-based plan offered by the organization—</text><clause id="idf19036e26dca4dd99e3cbc8ef1ecaaa7"><enum>(i)</enum><text>maintain, on a publicly available internet website, an accurate provider directory that includes the information described in subparagraph (B);</text></clause><clause commented="no" display-inline="no-display-inline" id="id67d2758574da47a0872a52871eb48e2d"><enum>(ii)</enum><text display-inline="yes-display-inline">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;</text></clause><clause commented="no" display-inline="no-display-inline" id="id36135fb66a344b22880c8e7c853a6e13"><enum>(iii)</enum><text display-inline="yes-display-inline">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;</text></clause><clause commented="no" display-inline="no-display-inline" id="idc129b027d2504135a306db2c71f46276"><enum>(iv)</enum><text display-inline="yes-display-inline">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; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id834bce6cba5b4fb2aeaeaf081927ab43"><enum>(v)</enum><text display-inline="yes-display-inline">meet such other requirements as the Secretary may specify.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idc5e5a458b7de4cd8a26020fea4209e38"><enum>(B)</enum><header>Provider directory information</header><text display-inline="yes-display-inline">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.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idff780a63633347d38900baa2f9c041a9"><enum>(C)</enum><header>Network-based plan</header><text display-inline="yes-display-inline">In this paragraph, the term <term>network-based plan</term> has the meaning given that term in subsection (d)(5)(C), except such term includes a Medicare Advantage private fee-for-service plan, as determined appropriate by the Secretary.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idf73b0bb10ad045e89a521cd9ad3d0228"><enum>(b)</enum><header>Accountability for provider directory accuracy</header><paragraph id="id73248a028bc94471b70d74a672ac1acc"><enum>(1)</enum><header>Cost Sharing for Services Furnished Based on Reliance on Incorrect Provider directory Information</header><text display-inline="yes-display-inline">Section 1852(d) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-22">42 U.S.C. 1395w–22(d)</external-xref>) is amended—</text><subparagraph commented="no" display-inline="no-display-inline" id="idd72317ca58ad4e5b87db13344a8cc32e"><enum>(A)</enum><text display-inline="yes-display-inline">in paragraph (1)(C)—</text><clause commented="no" display-inline="no-display-inline" id="id091e8c3ad4924468aa354872d69fe23c"><enum>(i)</enum><text>in clause (ii), by striking <quote>or</quote> at the end;</text></clause><clause commented="no" display-inline="no-display-inline" id="idc391d07f7464494c8f838575b7edd92e"><enum>(ii)</enum><text>in clause (iii), by striking the semicolon at the end and inserting <quote>, or</quote>; and</text></clause><clause commented="no" display-inline="no-display-inline" id="idac16281e60f84141b88e6b617ba5fa82"><enum>(iii)</enum><text>by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idE3AD04C491C74D2A96FA99B7DCCF1F59"><clause commented="no" display-inline="no-display-inline" id="id9094dd1946c349df98572cc289ef9770"><enum>(iv)</enum><text>the services are furnished by a provider that is not participating in the network of a network-based 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);</text></clause><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idc7fd2a17beee4a948e781efe0c9c33b2"><enum>(B)</enum><text display-inline="yes-display-inline">by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id06f3fe2f73554bfbbfd0c68d1af84eff"><paragraph id="idb886200c893244c39587eea5e5a0805b"><enum>(7)</enum><header>Cost sharing for services furnished based on reliance on incorrect provider directory information</header><subparagraph id="id56896316eb2c46959edd4da158805b7e"><enum>(A)</enum><header>In general</header><text>For plan year 2026 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 network-based 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 amount of cost sharing that would apply if such provider had been participating in the network of such plan.</text></subparagraph><subparagraph id="idd8aa519e993b4720bcd542d9463b625f"><enum>(B)</enum><header>Notification requirement</header><text>For plan year 2026 and subsequent plan years, each MA organization that offers a network-based plan shall—</text><clause commented="no" display-inline="no-display-inline" id="id24b99efb4446451ebb1321f25f77a400"><enum>(i)</enum><text display-inline="yes-display-inline">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; </text></clause><clause commented="no" display-inline="no-display-inline" id="id1f0d3bb286c0482ab8b53e6cba10eb95"><enum>(ii)</enum><text display-inline="yes-display-inline">include information regarding such cost-sharing protections in the provider directory of each network-based plan offered by the MA organization.; and</text></clause><clause commented="no" display-inline="no-display-inline" id="ide6b2aae493a5461a8d5ea23ad49f770e"><enum>(iii)</enum><text display-inline="yes-display-inline">notify enrollees of their cost-sharing protections under this paragraph in an explanation of benefits.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id3b286a5504434b2592378f0e0f4c6c6e"><enum>(2)</enum><header>Required provider directory accuracy analysis and reports</header><subparagraph commented="no" display-inline="no-display-inline" id="id763670fd4cff4d7699ac2c659e3f424f"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text>Section 1857(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(e)</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id12468EAC5A314168A0A459E79AFF0786"><paragraph commented="no" display-inline="no-display-inline" id="id4528e4562a1e4829a48d1d0b39bcc432"><enum>(6)</enum><header>Provider directory accuracy analysis and reports</header><subparagraph commented="no" display-inline="no-display-inline" id="id183419ef3ca24f7b881f154165330b1c"><enum>(A)</enum><header>In general</header><text>Beginning with plan years beginning on or after January 1, 2026, subject to subparagraph (C), a contract under this section with an MA organization shall require the organization, for each network-based plan (as defined in section 1852(c)(3)(C)) offered by the organization, to annually—</text><clause commented="no" display-inline="no-display-inline" id="id5457fd7e22814e7fad1c4cb7cfb84fed"><enum>(i)</enum><text display-inline="yes-display-inline">conduct an analysis estimating the accuracy of the provider directory of such plan using a sample of providers included in such provider directory (including provider specialties with high inaccuracy rates of provider directory information, such as providers specializing in mental health or substance use disorder treatment, as determined by the Secretary); and </text></clause><clause commented="no" display-inline="no-display-inline" id="id3fa55ecb22ec4b679ba4f86686b04a64"><enum>(ii)</enum><text display-inline="yes-display-inline">submit a report to the Secretary containing the results of such analysis, including an accuracy score for such provider directory (as determined using a methodology specified by the Secretary under subparagraph (B)(i)), and other information required by the Secretary.</text></clause></subparagraph><subparagraph id="id2c84f80f1fcb4073a1471e9ec341500b"><enum>(B)</enum><header>Determination of accuracy score</header><clause commented="no" display-inline="no-display-inline" id="ida3381aaad839430a89ed2ea4e05c2a7c"><enum>(i)</enum><header display-inline="yes-display-inline">In general</header><text>The Secretary shall specify methodologies for MA plans to use in estimating the accuracy of the provider directory information of such plans and determining the accuracy score for the plan's provider directory.</text></clause><clause commented="no" display-inline="no-display-inline" id="ide3e939352516497dbbb864111e9c1636"><enum>(ii)</enum><header display-inline="yes-display-inline">Considerations</header><text>In carrying out clause (i), the Secretary shall take into consideration—</text><subclause id="id06af42960a57435086eab292c35a005d"><enum>(I)</enum><text> data sources maintained by MA organizations; </text></subclause><subclause id="idace57d7d4a87446b9601bc87ea594f58"><enum>(II)</enum><text>publicly available data sets;</text></subclause><subclause id="idf9ccad5578334f4a96cd1ee13cdf79df"><enum>(III)</enum><text>the administrative burden on plans and providers; and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id46ff3e2c95a447c2ad5f8fb7d34fd73e"><enum>(IV)</enum><text>the relative importance of certain provider directory information on enrollee ability to access care.</text></subclause></clause></subparagraph><subparagraph id="id468bb8ca17f942ebb905c3003e6a7460"><enum>(C)</enum><header>Exception</header><text>The Secretary may waive the requirements of this paragraph in the case of a network-based plan with low enrollment (as defined by the Secretary).</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idb91e5aa86e7d413a8fb165461eaa1a76"><enum>(D)</enum><header>Transparency</header><text>Beginning with plan years beginning on or after January 1, 2027, 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. </text></subparagraph><subparagraph commented="no" id="id1d4a256989c44d5a9afaaec756c978b0"><enum>(E)</enum><header>Implementation</header><text>The Secretary shall implement this paragraph through notice and comment rulemaking.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph><subparagraph commented="no" id="idf8b9fdd60d6a444a919a70d0f12b5310"><enum>(B)</enum><header>Provision of information to beneficiaries</header><text>Section 1851(d)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-21">42 U.S.C. 1395w–21(d)(4)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id4FC50C1D3B7A4350A8814F44EAC12A36"><subparagraph commented="no" display-inline="no-display-inline" id="id34c62f8232234fd8bd98de1e0d7a0e13"><enum>(F)</enum><header>Provider Directory</header><text display-inline="yes-display-inline">Beginning with plan years beginning on or after January 1, 2027, the accuracy score of the plan’s provider directory (as reported under section 1857(e)(6)(A)(ii)) on the plan’s provider directory.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id6270e6c888fa4ee387f1b56423c23642"><enum>(C)</enum><header>Funding</header><text>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, $1,000,000 for fiscal year 2025, to remain available until expended, to carry out the amendments made by this paragraph.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id8ae31492d58b48248ff0e8105438344e"><enum>(3)</enum><header>GAO study and report</header><subparagraph commented="no" display-inline="no-display-inline" id="id5cc7db5a810a49a291e35d512c04978b"><enum>(A)</enum><header display-inline="yes-display-inline">Analysis</header><text>The Comptroller General of the United States (in this paragraph referred to as the <quote>Comptroller General</quote>) shall conduct 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—</text><clause id="idA808F604E31D475DA7848D409EA4996F"><enum>(i)</enum><text>the use of protections required under section 1852(d)(7) of the Social Security Act, as added by paragraph (1);</text></clause><clause id="idff7a686cc06b45fba42aa3ab6ec06d0a"><enum>(ii)</enum><text>the provider directory accuracy scores trends 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 disorder treatment;</text></clause><clause commented="no" display-inline="no-display-inline" id="ida780b639e9614e3998a0a1330f4f121f"><enum>(iii)</enum><text display-inline="yes-display-inline">provider response rates by plan verification methods; and</text></clause><clause id="id2a51b720f3a04ecdbad6e7fde2cfcfc2"><enum>(iv)</enum><text>other items determined appropriate by the Comptroller General.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id87d7291198534365985d2bb04a7f5ac7"><enum>(B)</enum><header display-inline="yes-display-inline">Report</header><text>Not later than January 15, 2031, 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. </text></subparagraph></paragraph></subsection><subsection id="id1a1d9ae9e83f49dbba2c433b7065abc6"><enum>(c)</enum><header>Guidance on maintaining accurate provider directories</header><paragraph commented="no" display-inline="no-display-inline" id="id5b6b37604c634e6494387ca96c41232e"><enum>(1)</enum><header display-inline="yes-display-inline">Stakeholder meeting</header><subparagraph commented="no" display-inline="no-display-inline" id="id11f145df289e4473a4d2b41ea44c8436"><enum>(A)</enum><header display-inline="yes-display-inline">In general</header><text>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 <term>Secretary</term>) shall hold a public stakeholder 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-21">42 U.S.C. 1395w–21 et seq.</external-xref>), including input on approaches for reducing administrative burden such as data standardization and best practices to maintain provider directory information.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="iddcf8ff0855724ecbb71b5025ff8645e2"><enum>(B)</enum><header>Participants</header><text display-inline="yes-display-inline">Participants of the meeting under subparagraph (A) shall include representatives from the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology, health care providers, companies that specialize in relevant technologies, health insurers, and patient advocates. </text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id527c7d0aaaa345dea44e297dc2455116"><enum>(2)</enum><header display-inline="yes-display-inline">Guidance to Medicare Advantage organizations</header><text display-inline="yes-display-inline">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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-21">42 U.S.C. 1395w–21 et seq.</external-xref>) 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:</text><subparagraph commented="no" display-inline="no-display-inline" id="idea50bde06ba8427b9b868e9bcf29a745"><enum>(A)</enum><text display-inline="yes-display-inline">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 .</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id1c2fb55689784a619c5bfd08275810fc"><enum>(B)</enum><text display-inline="yes-display-inline">Information on data sets and data sources with information that could be used by Medicare Advantage organizations to maintain accurate provider directories.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idd01153d807f0474a9b5c0077e343e5fb"><enum>(C)</enum><text display-inline="yes-display-inline">Approaches for utilizing data sources maintained by Medicare Advantage organizations and publicly available data sets to maintain accurate provider directories.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id4e6f6683572c46f08783009bed4074a1"><enum>(D)</enum><text display-inline="yes-display-inline">Information to be included in the provider directory 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.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idafe74ec4a2ef4392ad5a700878d1140a"><enum>(3)</enum><header>Guidance to part B providers</header><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395j">42 U.S.C. 1395j et seq.</external-xref>) on when to update the National Plan and Provider Enumeration System regarding any information changes. </text></paragraph></subsection></section><section id="idD7BD94248FCF4A198E464A3546F4C828"><enum>110.</enum><header>Guidance to States on strategies under Medicaid and CHIP to increase mental health and substance use disorder care provider capacity</header><text display-inline="no-display-inline">Not later than 12 months after the date of enactment of this Act, the Secretary of Health and Human Services shall issue guidance to States on strategies under Medicaid and the Children's Health Insurance Program (CHIP) to increase access to mental health and substance use disorder care providers that participate in Medicaid or CHIP, which may include education, training, recruitment, and retention of such providers, with a focus on improving the capacity of the mental health and substance use disorder care workforce in rural and underserved areas by increasing the number, type, and capacity of providers. Such guidance shall include, but not be limited to— </text><paragraph commented="no" display-inline="no-display-inline" id="id08cb9fe6a3db42bcbb8742d8f9162657"><enum>(1)</enum><text display-inline="yes-display-inline">best practices from States that have used Medicaid or CHIP waivers and authorities under titles XI, XIX, and XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301 et seq.</external-xref>, 1396 et seq., 1397aa et seq.) for such purposes;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idd13984fd7fe34f96a53e41487710cc76"><enum>(2)</enum><text>best practices related to expanding the availability of community-based mental health and substance use disorder services under Medicaid and CHIP, including through the participation of paraprofessionals with behavioral health expertise, and review of State practices for leveraging paraprofessionals within State scope of practice requirements as well as State supervision requirements, such as peer support specialists and clinicians with baccalaureate degrees; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id0534145880b145a5991725b7c3260421"><enum>(3)</enum><text>best practices related to financing, supporting, and expanding the education and training of providers of mental health and substance use disorder services to increase the workforce of such providers who participate in Medicaid and CHIP, including by supporting on-site training in the clinical setting and innovative public-private partnerships.</text></paragraph></section><section id="idcb3c6a51bbbc4049adcd363304f2a55c"><enum>111.</enum><header>Guidance to States on supporting mental health services and substance use disorder care for children and youth</header><subsection id="id40a37124f7264e6aab5d116d3bbaf30a"><enum>(a)</enum><header>Guidance on increasing the availability and provision of mental health services and substance use disorder care under Medicaid and CHIP</header><text>Not later than 12 months after the date of enactment of this Act, the Secretary shall issue guidance to States regarding opportunities to improve the availability and provision of mental health services and substance use disorder care through Medicaid and CHIP for children and youth. Such guidance shall address the following: </text><paragraph id="id7dc1722d1f7d492c8878b0235f088b6a"><enum>(1)</enum><text>The design and implementation of a continuum of benefits for children and youth with significant mental health conditions and substance use disorders covered by Medicaid and CHIP, including the role of EPSDT, how EPSDT requires States to make available a continuum of care across settings, and what is required of States to ensure compliance with EPSDT. </text></paragraph><paragraph id="id600eb94c665649b591ec4d729dcd028f"><enum>(2)</enum><text>Strategies to facilitate access to mental health services and substance use disorder care under Medicaid and CHIP that are delivered in the home or in community-based settings for children and youth. Such guidance shall outline strategies employed by States to expand the availability of such settings and include specific interventions and financing arrangements that could be replicated. </text></paragraph><paragraph id="ida4261adad7e942d0b3dd20a26db9f6b2"><enum>(3)</enum><text>Strategies to facilitate access to mental health services and substance use disorder care under Medicaid and CHIP for children and youth who—</text><subparagraph id="id4a442432adcd483a89291211a9fdc980"><enum>(A)</enum><text>are at risk for having a significant mental health condition or substance use disorder;</text></subparagraph><subparagraph id="id0b988bac1c4e4f559cd225bbfb5552e1"><enum>(B)</enum><text>have a significant mental health condition or substance use disorder; or</text></subparagraph><subparagraph id="id25067f86ce834a87ba5d5e00d2db0ad5"><enum>(C)</enum><text>have an intellectual or developmental disability.</text></subparagraph></paragraph><paragraph id="idd697a04f1c0d44d5a75f6e932daab659"><enum>(4)</enum><text>Strategies to promote screening for mental health and substance use disorder needs of children and youth, including children and youth provided, or at risk for needing, child welfare services, in coordination with providers, managed care organizations (as defined by the Secretary), prepaid inpatient health plans (as defined by the Secretary), prepaid ambulatory health plans (as defined by the Secretary), and schools (as defined by the Secretary).</text></paragraph><paragraph id="id468fc1ec3d3348adb19f0031487c989b"><enum>(5)</enum><text>Strategies for supporting the provision of culturally competent, developmentally appropriate, and trauma-informed mental health services and substance use disorder care to children and youth.</text></paragraph><paragraph id="id52f9d3ad61e9428a8d156bccceb80335"><enum>(6)</enum><text>Strategies for providing early prevention, intervention, and screening services, including for children and youth at higher risk for having mental health or substance use disorder needs, children and youth who do not have a mental health or substance use disorder diagnosis, children and youth provided, or at risk for needing, child welfare services, and children at risk of first episode psychosis.</text></paragraph><paragraph id="id8d8d3b8ce9ce481ca791d14e7a279b2f"><enum>(7)</enum><text>Best practices from State Medicaid and CHIP programs in expanding access to mental health services and substance use disorder care for children and youth, including children and youth that are part of underserved communities and children and youth with co-occurring intellectual disability or autism spectrum disorder, and former foster youth.</text></paragraph><paragraph id="id3cdb26f93417411995f1b93249d24c40"><enum>(8)</enum><text>Strategies to coordinate services and funding provided under parts B and E of title IV of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/621">42 U.S.C. 621 et seq.</external-xref>, 670 et seq.), and other funding sources at the discretion of the Secretary, with services for which Federal financial participation is available under Medicaid or CHIP, to support improved access to comprehensive mental health services and substance use disorder care for children and youth provided, or at risk for needing, child welfare services. </text></paragraph></subsection><subsection id="id05CEA729B96C490093F29C3CFF922DFC"><enum>(b)</enum><header>Consultation</header><text>The Secretary shall consult with the Administrator of the Centers for Medicare & Medicaid Services, the Assistant Secretary for the Administration for Children and Families, the Assistant Secretary for Mental Health and Substance Use, and the Director of the Office of National Drug Control Policy with respect to the guidance issued under subsection (a). </text></subsection><subsection id="id1A41398D7B5E46A0A76EE0464B55B8A2"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph commented="no" display-inline="no-display-inline" id="ida35a1ff285074b61ba5bc2301cd64a21"><enum>(1)</enum><header>EPSDT</header><text>The term <term>EPSDT</term> means early and periodic screening, diagnostic, and treatment services under Medicaid in accordance with sections 1902(a)(43), 1905(a)(4)(B), and 1905(r) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(43)</external-xref>, 1396d(a)(4)(B), 1396d(r)). </text></paragraph><paragraph id="idB06C8C0ADA4043F9840E7C7AAF80C07F"><enum>(2)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id46B0418EBAB244C4825303EB8C0AA9C4"><enum>(3)</enum><header>State</header><text>The term <term>State</term> has the meaning given that term in section 1101(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301(a)(1)</external-xref>) for purposes of titles XIX and XXI of such Act. </text></paragraph></subsection></section><section id="id4E94F869FBB240CBB1AA6B8B387E4303"><enum>112.</enum><header>Recurring analysis and publication of Medicaid health care data related to mental health services</header><subsection id="id3ED71696ED1445CA8C9DD1866A84609E"><enum>(a)</enum><header>In general</header><text>The Secretary, on a biennial basis, shall link, analyze, and publish on a publicly available website Medicaid data reported by States through the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system) relating to mental health services provided to individuals enrolled in Medicaid, including an analysis by age. Such enrollee information shall be de-identified of any personally identifying information, shall adhere to privacy standards established by the Department of Health and Human Services, and shall be aggregated to protect the privacy of enrollees, as necessary. Each publication of such analysis shall include for each State available data for the following measures: </text><paragraph id="id79f6d54a647e4cee9a21b49cae42183c"><enum>(1)</enum><text>The number and percentage of individuals by age enrolled in the State Medicaid plan or waiver of such plan in each of the major enrollment categories (as defined in a letter, to be made publicly available on the website of the Medicaid and CHIP Payment and Access Commission, from the Medicaid and CHIP Payment and Access Commission to the Secretary) who have been diagnosed with a mental health condition and whether such individuals are enrolled under the State Medicaid plan or waiver of such plan, including the specific waiver authority under which they are enrolled, to the extent available.</text></paragraph><paragraph id="ide20a50f55a9642178ecadc8620c272a5"><enum>(2)</enum><text>A list of the mental health treatment services, including specifying adult and pediatric services, by each major type of service, such as counseling, intensive home-based services, intensive care coordination, crisis services tailored to children and youth, youth peer support services, family-to-family support, inpatient hospitalization, and other appropriate services as identified by the Secretary, for which beneficiaries in each State received at least 1 service under the State Medicaid plan or a waiver of such plan. </text></paragraph><paragraph id="idb41b3879acb64ef0bea43a78d2a2de65"><enum>(3)</enum><text>The number and percentage of individuals by age with a substance use disorder diagnosis enrolled in the State Medicaid plan or waiver of such plan who received services for a mental health condition under such plan or waiver by each major type of service specified under paragraph (2) within each major setting type, such as outpatient, inpatient, residential, and other home-based and community-based settings.</text></paragraph><paragraph id="id7a495d55127241e487c2282e4f8928a1"><enum>(4)</enum><text>The number of services provided under the State Medicaid plan or waiver of such plan per individual with a mental health diagnosis, including by age, enrolled in such plan or waiver for each major type of service specified under paragraph (2).</text></paragraph><paragraph id="id7933c96740d74514b6d921f0c6fa1cd2"><enum>(5)</enum><text>The number and percentage of individuals by age enrolled in the State Medicaid plan or waiver by major enrollment category, who received mental health services through—</text><subparagraph id="id3359bccceca54c70b94c23958d8c403c"><enum>(A)</enum><text>a Medicaid managed care entity (as defined in section 1932(a)(1)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-2">42 U.S.C. 1396u–2(a)(1)(B)</external-xref>)), including the number of such individuals who received such assistance through a prepaid inpatient health plan (as defined by the Secretary) or a prepaid ambulatory health plan (as defined by the Secretary);</text></subparagraph><subparagraph id="id28d774fc1de94b5ba19de7829919f6ad"><enum>(B)</enum><text>a fee-for-service payment model; or</text></subparagraph><subparagraph id="ida61067b631fd477288d9131fdfad071d"><enum>(C)</enum><text>an alternative payment model, to the extent available.</text></subparagraph></paragraph><paragraph id="id1c672a3d05d348e9930028e2d846e7df"><enum>(6)</enum><text>The number and percentage of individuals by age with a mental health diagnosis who received mental health services in an outpatient or home-based and community-based setting after receiving services in an inpatient or residential setting and the number of services received by such individuals in the outpatient or home-based and community-based setting.</text></paragraph><paragraph id="idce3f850a1bbc4598907d54fbc3250188"><enum>(7)</enum><text>The number and percentage of inpatient admissions by age in which services for a mental health condition were provided to an individual enrolled in the State Medicaid plan or a waiver of such plan that occurred within 30 days after discharge from a hospital or inpatient facility in which services for a mental health condition previously were provided to such individual, disaggregated by type of facility, to the extent such information is available. </text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id04d8d79824594e15ba62f638eb76ef13"><enum>(8)</enum><text>The number of emergency department visits by an individual by age enrolled in the State Medicaid plan or a waiver of such plan for treatment of a mental health condition within 7 days of such individual being discharged from a hospital inpatient facility in which services for a mental health condition were provided, or from a mental health facility, an independent psychiatric wing of acute care hospital, or an intermediate care facility for individuals with intellectual disabilities, disaggregated by type of facility, to the extent such information is available. </text></paragraph><paragraph id="id5157e04b1e3c48feab67c52e28d63f67"><enum>(9)</enum><text>The number and percentage of individuals by age enrolled in the State Medicaid plan or a waiver of such plan—</text><subparagraph commented="no" display-inline="no-display-inline" id="id5f50b5068a6c43d0b121f3f05639b8a2"><enum>(A)</enum><text display-inline="yes-display-inline">who received an assessment to diagnose a mental health condition; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id6f5ef280ddc34e9082e1efe477c453fe"><enum>(B)</enum><text display-inline="yes-display-inline">the number of mental health services provided to individuals described in subparagraph (A) in the 30 days post-assessment. </text></subparagraph></paragraph><paragraph id="id8d02e3b3dfb1452bb4af50aeed892ecb"><enum>(10)</enum><text>Prescription National Drug Code codes, fill dates, and number of days supply of any covered outpatient drug (as defined in section 1927(k)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r-8(k)(2)</external-xref>) to treat a mental health condition that were dispensed to an individual by age enrolled in the State Medicaid plan or waiver with an episode described in paragraph (7) or (8) during any period that occurs after the individual’s discharge date defined in paragraph (7) or (8) (as applicable), and before the admission date applicable under paragraph (7) or the date of the emergency department visit applicable under paragraph (8). </text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id43b9e06ba44445d0b218e51fba3eb4cb"><enum>(b)</enum><header>Publication</header><paragraph commented="no" display-inline="no-display-inline" id="ided954e8ea28e459ba222454a55aebd67"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Not later than 18 months after the date of enactment of this Act, the Secretary shall make publicly available the first analysis required by subsection (a). </text></paragraph><paragraph id="id9de6046892174725ae9eba31b19bbec1"><enum>(2)</enum><header>Use of T–MSIS data</header><text>The report required under paragraph (1) and updates required under paragraph (3) shall—</text><subparagraph commented="no" display-inline="no-display-inline" id="id523a90c46a304a3aaa13160e16d2303d"><enum>(A)</enum><text display-inline="yes-display-inline">use data and definitions from the Transformed Medicaid Statistical Information System (<quote>T–MSIS</quote>) (or a successor system) data set that is no more than 12 months old on the date that the report or update is published; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id7a5f220678bd4578a0f4dd68fab5e3bc"><enum>(B)</enum><text display-inline="yes-display-inline">as appropriate, include a description with respect to each State of the quality and completeness of the data and caveats describing the limitations of the data reported to the Secretary by the State that is sufficient to communicate the appropriate uses for the information. </text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9a48354e6a8c44709ba35e7e51ee0699"><enum>(3)</enum><header>Revised publication</header><text display-inline="yes-display-inline">Not later than 3 years after the date of enactment of this Act, the Secretary shall publish a revised publication of the analysis required by subsection (a) that allows for a research-ready and publicly accessible interface of the publication that is developed after consultation with stakeholders on the usability of the data contained in the publication.</text></paragraph></subsection><subsection commented="no" id="idCA8E9D2E604A420F8C234B84C68414F0"><enum>(c)</enum><header>Making permanent the requirement to annually update the SUD data book</header><text>Section 1015 of the SUPPORT for Patients and Communities Act (<external-xref legal-doc="public-law" parsable-cite="pl/115/271">Public Law 115–271</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="id10c5ddf44b024b89bc99bf6d2f0faa42"><enum>(1)</enum><text display-inline="yes-display-inline">in subsection (a)(3), by striking <quote>through 2024</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5f140d7d8e4b48998042f6f3d6032bd8"><enum>(2)</enum><text>in subsection (b), by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id5E19CFFAE6E44F22982DB995B6762960"><paragraph commented="no" display-inline="no-display-inline" id="id0e1ae0fb958c4e1ea8be1e796c92fc7d"><enum>(4)</enum><header>Publication of data</header><subparagraph commented="no" display-inline="no-display-inline" id="id5098384eeeb9440c8de9e3ac581d77cc"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall publish in the Federal Register a system of records notice that modifies the system of records notice required under paragraph (1) to provide that—</text><clause commented="no" display-inline="no-display-inline" id="idf7dac8998fb3450ba0e6d9a1faed3ef8"><enum>(i)</enum><text display-inline="yes-display-inline">the data specified in paragraph (2) shall be published on a publicly available website; and</text></clause><clause commented="no" display-inline="no-display-inline" id="id36a33a57b4fa45c38bcd9f23f9c98bff"><enum>(ii)</enum><text display-inline="yes-display-inline">such data shall be de-identified of any personally identifying information, shall adhere to privacy standards established by the Department of Health and Human Services, and shall be aggregated to protect the privacy of enrollees, as necessary.</text></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id53b5b1095026415cab182c78a3e8814a"><enum>(B)</enum><header>Initiation of modified data-sharing activities</header><text display-inline="yes-display-inline">Not later than January 1, 2025, the Secretary shall initiate the data sharing activities outlined in the notice required under paragraph (1), as modified pursuant to this paragraph.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idBA3332DC019649D893EB98725E58E4E6"><enum>(d)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="id4B9BF2719A2C4734AC6EBA05635F4BE3"><enum>(1)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph><paragraph id="id570919F8A8F84CF6A6603F5B99C6DBA5" commented="no" display-inline="no-display-inline"><enum>(2)</enum><header>State</header><text display-inline="yes-display-inline">The term <term>State</term> has the meaning given that term in section 1101(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301(a)(1)</external-xref>) for purposes of title XIX of such Act.</text></paragraph></subsection></section><section id="id5776259D1F184D329D4F01CA5E19B13A"><enum>113.</enum><header>Guidance to States on supporting mental health services or substance use disorder care integration with primary care in Medicaid and CHIP</header><subsection id="idAB96E02C131B4654825B77E48A2F6ABB"><enum>(a)</enum><header>Analysis regarding care integration</header><text display-inline="yes-display-inline">Not later than 18 months after the date of enactment of this Act, the Secretary shall conduct an analysis of Medicaid and CHIP regarding clinical outcomes among different models of integration of mental health services or substance use disorder care within the primary care setting. Such analysis shall—</text><paragraph id="id843a170e6f034192982bd6f3a851d397"><enum>(1)</enum><text>consider different models for how mental health services or substance use disorder care is delivered and integrated within the primary care setting, including when providers operating in an integrated model are physically located in the same practice or building, when at least 1 provider in an integrated care model is available via telehealth, and when primary care, mental health, or substance use disorder care providers seek education and consultation from other providers through electronic modalities; and </text></paragraph><paragraph id="id853520cdd5dc4296adfeff52149bd754"><enum>(2)</enum><text>evaluate—</text><subparagraph id="idc22cfe979ffa45d2adddbdf91d40d060"><enum>(A)</enum><text>the use of different payment methodologies, such as bundled payments and value-based payment arrangements; and</text></subparagraph><subparagraph id="iddfe13664ee434ca9a27506072d4b2094"><enum>(B)</enum><text>the use and quality of services to coordinate care, including but not limited to case management, care coordination, enhanced care coordination, and enhanced care management, for mental health services and for substance use disorder care.</text></subparagraph></paragraph></subsection><subsection id="idF0BCF5EC106B4DC8B653AD61926457C3"><enum>(b)</enum><header>Guidance</header><text>Not later than 12 months after the Secretary completes the analysis required under subsection (a), the Secretary shall issue guidance to States on supporting integration of mental health services or substance use disorder care with primary care under Medicaid and CHIP. Such guidance shall be informed by the analysis required under subsection (a) and, at minimum, shall do the following:</text><paragraph id="id9c37b62b931c4b64a2bfc325815f7492"><enum>(1)</enum><text>Provide an overview of State options for adopting and expanding value-based payment arrangements and alternative payment models, including accountable care organizations and other shared savings programs, that integrate mental health services or substance use disorder care with primary care.</text></paragraph><paragraph id="idd7415aaa493f4b1aab01dd62e06ec35d"><enum>(2)</enum><text>Describe opportunities for States to use and align existing authorities and resources to finance integration of mental health services or substance use disorder care with primary care, including with respect to the use of electronic health records in mental health care settings and in substance use disorder care settings.</text></paragraph><paragraph id="id5ae363c5741646b6a9f943499c31f7ae"><enum>(3)</enum><text>Describe strategies to support integration of mental health services or substance use disorder care with primary care through the use of non-clinical professionals and paraprofessionals, including trained peer support specialists.</text></paragraph><paragraph id="id829da22ee7384dbda9eed10a9ef0e74d"><enum>(4)</enum><text>Provide examples of specific strategies and models designed to support integration of mental health services or substance use disorder care with primary care for differing age groups, including children and youth, and individuals over the age of 65.</text></paragraph><paragraph id="id0213eaefc1374ed98c9402d8e96296af"><enum>(5)</enum><text>Describe options for assessing the clinical outcomes of differing models and strategies for integration of mental health services or substance use disorder care with primary care. </text></paragraph></subsection><subsection id="id02cf97aaec464014b4271a8ba66a3d62"><enum>(c)</enum><header>Integration of mental health services or substance use disorder care with primary care</header><text>For purposes of subsections (a) and (b), integration of mental health services or substance use disorder care with primary care may include (and shall not be limited to, including when furnished via telehealth, when appropriate)—</text><paragraph id="id25dc65153fcd458cb48776e7c9bbbcdc"><enum>(1)</enum><text>adherence to the collaborative care model or primary care behavioral health model for behavioral health integration;</text></paragraph><paragraph id="id0957f848db004d11968b9b794b6b4921"><enum>(2)</enum><text>use of behavioral health integration models primarily intended for pediatric populations with non-severe mental health needs that are focused on prevention and early detection and intervention methods through a multidisciplinary collaborative behavioral health team approach co-managed with primary care, to include same-day access to family-focused mental health treatment services;</text></paragraph><paragraph id="idb0e15ee6a1b54ae6a30e39c27bfd2ee1"><enum>(3)</enum><text>having mental health providers or substance use disorder providers physically co-located in a primary care setting with same-day visit availability;</text></paragraph><paragraph id="id8f5afb75238e4ab19ff44868a40f755c"><enum>(4)</enum><text>implementing or maintaining enhanced care coordination or targeted case management which includes regular interactions between and within care teams;</text></paragraph><paragraph id="iddf9dd95fec5d4c85b6b5e7025a571455"><enum>(5)</enum><text>providing mental health or substance use disorder screening and follow-up assessments, interventions, or services within the same practice or facility as a primary care or physical service setting;</text></paragraph><paragraph id="iddde389ddf26148458e26d359756ac446"><enum>(6)</enum><text>the use of assertive community treatment that is integrated with or facilitated by a primary care practice; and </text></paragraph><paragraph id="idbfdb8e1285424de28e9efd16e215bc4a"><enum>(7)</enum><text>delivery of integrated primary care and mental health services or substance use disorder care in the home or in community-based settings for individuals who choose and are able to receive care in such settings, as authorized under subsections (b), (c), (i), (j), and (k) of section 1915 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n</external-xref>), under a waiver under section 1115 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1315">42 U.S.C. 1315</external-xref>), or under section 1937, 1945, or 1945A of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-7">42 U.S.C. 1396u–7</external-xref>, 1396w–4, 1396w–4a). </text></paragraph></subsection><subsection id="id1FD1A4FFC51443EAA9F87E53CA759B36"><enum>(d)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section:</text><paragraph id="id6C5B3C3AAA164AFBBC757E81F294330F"><enum>(1)</enum><header>Secretary</header><text>The term <term>Secretary</term> means the Secretary of Health and Human Services.</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id323D58A9776B4058BFB74B4ACC87F8E1"><enum>(2)</enum><header>State</header><text>The term <term>State</term> has the meaning given that term in section 1101(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1301">42 U.S.C. 1301(a)(1)</external-xref>) for purposes of titles XIX and XXI of such Act. </text></paragraph></subsection></section><section id="idFB4A63AD9A33424198329B803820D06E"><enum>114.</enum><header>Medicaid State option relating to inmates with a substance use disorder pending disposition of charges</header><subsection commented="no" display-inline="no-display-inline" id="id242be973066d40b1a9fe06d41f004f82"><enum>(a)</enum><header display-inline="yes-display-inline">State option</header><paragraph commented="no" display-inline="no-display-inline" id="ida85a1b3766a444b990fd10ca515c59af"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended—</text><subparagraph commented="no" display-inline="no-display-inline" id="idf79b18464db54152bf99049770a580a4"><enum>(A)</enum><text display-inline="yes-display-inline">in the subdivision (A) following the last numbered paragraph of subsection (a), by inserting <quote>subject to subsection (jj),</quote> before <quote>any such payments</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="ide3f745d767a34fcabdafb70c8dca053d"><enum>(B)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" id="id03CF070878844BAEB9A16FD0FA91F1C7" act-name=""><subsection id="id1F8B4E85C8C343B2A909A838F422D1EE"><enum>(jj)</enum><header>State option to provide medical assistance to certain inmates with a substance use disorder pending disposition of charges</header><paragraph commented="no" display-inline="no-display-inline" id="id94c684cc8acd4411aedea41a5bc29fb5"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Subject to paragraph (2), a State may elect to provide, and, notwithstanding the subdivision (A) following the last numbered paragraph of subsection (a), receive Federal financial participation for, medical assistance for an individual who— </text><subparagraph commented="no" display-inline="no-display-inline" id="id4e62e955b54343948f66ec3f45cb3003"><enum>(A)</enum><text display-inline="yes-display-inline">is an inmate of a public institution (as defined in section 1902(nn)(3)) pending disposition of charges; and </text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id852099f1f2e94a1ab903a8cbdf5a3a38"><enum>(B)</enum><text display-inline="yes-display-inline">has been diagnosed with a substance use disorder.</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id58d146f9df8d4131bfebdb35ca46f431"><enum>(2)</enum><header>Limitation; conditions</header><subparagraph commented="no" display-inline="no-display-inline" id="id1523a1f3b39e42b984f8d8d4a5a3e7e3"><enum>(A)</enum><header>Limitation</header><text display-inline="yes-display-inline">A State may only receive Federal financial participation for medical assistance provided to an individual described in paragraph (1) during the 7-day period that begins on the first day that the individual is an inmate of a public institution. </text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idbf2d5a1e47e84adc881b979e9697234a"><enum>(B)</enum><header>Conditions</header><text display-inline="yes-display-inline">A State may only receive Federal financial participation for medical assistance provided to an individual described in paragraph (1) if—</text><clause commented="no" display-inline="no-display-inline" id="id1d6db2290f004680bf6d614424c540b1"><enum>(i)</enum><text display-inline="yes-display-inline">the State has elected to not terminate eligibility for medical assistance under the State plan for individuals on the basis that they are inmates of public institutions (but may suspend coverage during the period an individual is such an inmate); and</text></clause><clause commented="no" display-inline="no-display-inline" id="id98d80b1a45284bd2bbb4f7cb298dc7e6"><enum>(ii)</enum><text display-inline="yes-display-inline">the diagnosis that the covered individual has a substance use disorder is made while the individual is an inmate of the public institution by a licensed medical professional using a standardized screening and assessment model approved by the Secretary.</text></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="HB3486BD639C54B8CB1A008861F220025"><enum>(2)</enum><header>Effective date</header><text>The amendments made by this subsection shall take effect on January 1, 2026. </text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idE763CB47F6A0414D8475F5208FA40021"><enum>(b)</enum><header>Technical correction and conforming amendments</header><paragraph commented="no" display-inline="no-display-inline" id="id3e4180c2828644b5a7c47cbb542841a5"><enum>(1)</enum><header>Technical correction</header><text display-inline="yes-display-inline">Section 5122(a)(1) of the Consolidated Appropriations Act, 2023 (<external-xref legal-doc="public-law" parsable-cite="pl/117/328">Public Law 117–328</external-xref>) is amended by striking <quote>after</quote> and all that follows through the period at the end and inserting <quote>after <quote>or in the case of an eligible juvenile described in section 1902(a)(84)(D) with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section</quote>.</quote>. </text></paragraph><paragraph id="id80626856d10943ec968b7f652a2eb5b4"><enum>(2)</enum><header>Other conforming amendments</header><subparagraph id="id3e3b29ed33614d9bb1eb0b554e17cce9"><enum>(A)</enum><text>Section 1902(nn)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(nn)(3)</external-xref>), is amended by striking <quote>following</quote> and all that follows through <quote>section 1905(a)</quote> and inserting <quote>following the last numbered paragraph of section 1905(a)</quote>.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id913c6a3afc8d47dc94c290d48d18e9a7"><enum>(B)</enum><text>The fifth sentence of section 1905(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(a)</external-xref>) is amended by striking <quote>paragraph (30)</quote> and inserting <quote>the last numbered paragraph</quote>. </text></subparagraph></paragraph></subsection></section><section id="idf6925f84b2a94dcc959690746580d388"><enum>115.</enum><header>Definition of Certified Community Behavioral Health Clinic Services under Medicaid</header><subsection commented="no" display-inline="no-display-inline" id="ida4a69e8a35954359a4bd7531b653f1c0"><enum>(a)</enum><header display-inline="yes-display-inline">Definition of medical assistance</header><text display-inline="yes-display-inline">Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended—</text><paragraph id="ida1570435ff6c41dcb3a4ae0452f2ba48"><enum>(1)</enum><text>in subsection (a)—</text><subparagraph id="idb11af456f54744c7882e4081111214b4"><enum>(A)</enum><text>in paragraph (30), by striking <quote>; and</quote> and inserting a semicolon;</text></subparagraph><subparagraph id="id789f335cf2fc4f12bd45cf95c39a8e63"><enum>(B)</enum><text>by redesignating paragraph (31) as paragraph (32); and</text></subparagraph><subparagraph id="id45fffdd089534fa1b4bcf7d1891633ea"><enum>(C)</enum><text>by inserting after paragraph (30) the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idb6c3b5129ba143c9ad711a125f29ea54"><paragraph id="idd5d8066aa68f439684b64ed7253ca168"><enum>(31)</enum><text>certified community behavioral health clinic services, as defined in subsection (jj); and</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id0f0d0ba70986449f88e089ebefda6456"><enum>(2)</enum><text>by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id2922BE208D71494AB3BA9D825A8778B5"><subsection commented="no" display-inline="no-display-inline" id="id231f406f469f4e62b30c649bcf7296d6"><enum>(jj)</enum><header>Certified community behavioral health clinic services</header><paragraph id="id61c0114a66e84eb3b153a2360c34b43e"><enum>(1)</enum><header>In general</header><text>The term <term>certified community behavioral health services</term> means any of the following when furnished to an individual as a patient of a certified community behavioral health clinic (as defined in paragraph (2)), in a manner reflecting person-centered care and which, if not available directly through a certified community behavioral health clinic, may be provided or referred through formal relationships with other providers:</text><subparagraph id="id9bc8f06b2f314195bea190dace3d7ee3"><enum>(A)</enum><text>Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.</text></subparagraph><subparagraph id="idd815a780f81c48b68eb289b938f54ab2"><enum>(B)</enum><text>Screening, assessment, and diagnosis, including risk assessment.</text></subparagraph><subparagraph id="id43b812b472574571b2c2fcaa2f5fcb0c"><enum>(C)</enum><text>Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.</text></subparagraph><subparagraph id="id352e9b2a8f2b4d1992bd46e984087744"><enum>(D)</enum><text>Outpatient mental health and substance use services.</text></subparagraph><subparagraph id="id9a5f1c96579043dab62c583098b832df"><enum>(E)</enum><text>Outpatient clinic primary care screening and monitoring of key health indicators and health risk.</text></subparagraph><subparagraph id="id7f600eb25de8432c874e2bda3862055a"><enum>(F)</enum><text>Intensive case management.</text></subparagraph><subparagraph id="id025b8a09731e44758d5e036fe2b9f7fc"><enum>(G)</enum><text>Psychiatric rehabilitation services.</text></subparagraph><subparagraph id="ide1f25f7d19224224a74611556907c82b"><enum>(H)</enum><text>Peer support and counselor services and family supports.</text></subparagraph><subparagraph id="iddb14f2703d144fde8e6232298194272d"><enum>(I)</enum><text>Intensive, community-based mental health care for members of the armed forces and veterans, particularly those members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.</text></subparagraph></paragraph><paragraph id="id6ecf0749eb8f4725aff599aadff0a56e"><enum>(2)</enum><header>Certified community behavioral health clinic</header><text>The term <term>certified community behavioral health clinic</term> means an organization that—</text><subparagraph id="id301515ef842a4eecb7b3871c09ba1f6d"><enum>(A)</enum><text>is engaged in furnishing to patients all of the services described in paragraph (1);</text></subparagraph><subparagraph id="ide9920e39ff3f414f97b6df2a92afc901"><enum>(B)</enum><text>is legally authorized to furnish such services under State law;</text></subparagraph><subparagraph id="idf00bcaafde9442a6ae3337e210d3722e"><enum>(C)</enum><text>agrees, as a condition of the certification described in subparagraph (D), to furnish to the State or Secretary any data required as part of ongoing monitoring of the organization’s provision of services, including encounter data, clinical outcomes data, quality data, and such other data as the State or Secretary may require; and </text></subparagraph><subparagraph id="id4aad9f6b487d4a1f8f83b7ba15785f4d"><enum>(D)</enum><text>has been certified by a State as meeting the criteria established by the Secretary pursuant to subsection (a) of section 223 of the Protecting Access to Medicare Act as of January 1, 2024, and any subsequent updates to such criteria, regardless of whether the State is carrying out a demonstration program under this title under subsection (d) of such section.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="idcd348eb540e0473590c38ed5f8d60bb2" commented="no" display-inline="no-display-inline"><enum>(b)</enum><header>Effective date</header><text>The amendments made by this section shall apply with respect to medical assistance furnished on or after January 1, 2024. </text></subsection></section><enum>II</enum><header>Reducing prescription drug costs under Medicare and Medicaid</header><section id="id8d6dc248587e43a5be07b6d128aa39ab"><enum>201.</enum><header>Assuring pharmacy access and choice for Medicare beneficiaries</header><subsection commented="no" display-inline="no-display-inline" id="id1a57b1c9b9d94cfcbffd36df86d2d303"><enum>(a)</enum><header display-inline="yes-display-inline">In general</header><text>Section 1860D–4(b)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(b)(1)</external-xref>) is amended by striking subparagraph (A) and inserting the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id8CE4A65AE13946928410000CD4965A24"><subparagraph id="id938a638c2ce341d2a88c5923df15c6a9"><enum>(A)</enum><header>In general</header><clause id="id5610ec3606b84c13a20896e1101cd9fe"><enum>(i)</enum><header>Participation of any willing pharmacy</header><text>A PDP sponsor offering a prescription drug plan shall permit any pharmacy that meets the standard contract terms and conditions under such plan to participate as a network pharmacy of such plan.</text></clause><clause id="iddd734fc8f0d64cfb8be9d0bad3f0f5da"><enum>(ii)</enum><header>Contract terms and conditions</header><subclause commented="no" display-inline="no-display-inline" id="idf8af1a0806f94b76bb92a17ee0e6d968"><enum>(I)</enum><header display-inline="yes-display-inline">In general</header><text>For plan years beginning on or after January 1, 2028, in accordance with clause (i), contract terms and conditions offered by such PDP sponsor shall be reasonable and relevant according to standards established by the Secretary under subclause (II). </text></subclause><subclause commented="no" display-inline="no-display-inline" id="id6ad9845d1b09409d8f4f7b54a3be4839"><enum>(II)</enum><header>Standards</header><text display-inline="yes-display-inline">Not later than the first Monday in April of 2027, the Secretary shall establish standards for reasonable and relevant contract terms and conditions for purposes of this clause.</text></subclause><subclause commented="no" id="id1b9415f1262e4eb68d97dd368a335b34"><enum>(III)</enum><header>Request for information</header><text>Not later than January 1, 2025, for purposes of establishing the standards under subclause (II), the Secretary shall issue a request for information to seek input on trends in prescription drug plan and network pharmacy contract terms and conditions, current prescription drug plan and network pharmacy contracting practices, whether pharmacy reimbursement and dispensing fees under this part cover pharmacy ingredient and operational costs, areas in current regulations or program guidance related to contracting between prescription drug plans and network pharmacies requiring clarification or additional specificity, factors for consideration in determining the reasonableness and relevance of contract terms and conditions between prescription drug plans and network pharmacies, and other issues determined appropriate by the Secretary.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id61ac79191540437a9c5718666ffc35eb"><enum>(b)</enum><header>Treatment of essential retail pharmacies</header><text>Section 1860D–4(b)(1)(C) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(b)(1)(C)</external-xref>) is amended by adding at the end the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id8dcfe971f0a84a8492dd6275560112a3"><clause id="id869d8ba7856e4bfa8681c85b473538aa"><enum>(v)</enum><header>Essential retail pharmacies</header><subclause id="idda3776cdef084483a4dcf06384d1dcc1"><enum>(I)</enum><header>In general</header><text>For plan years beginning on or after January 1, 2028, a PDP sponsor of a prescription drug plan that has preferred pharmacies in its network shall contract with, as preferred pharmacies in such plan’s network, at least—</text><item id="idd2b03f633c5a4b559251f7f2b9c60d12"><enum>(aa)</enum><text>80 percent of essential retail pharmacies (as defined in subclause (III)) in such plan’s service area that are independent community pharmacies (as defined in subclause (V)(bb)); and</text></item><item id="id7f49126460c2482980b1bd0d2e287fdc"><enum>(bb)</enum><text>50 percent of essential retail pharmacies in such plan’s service area not described in item (aa).</text></item></subclause><subclause id="idEA0644C65FCF4D1B92A41D7AC890FE0B"><enum>(II)</enum><header>Total reimbursement for essential retail pharmacies that are independent community pharmacies</header><text>For plan years beginning on or after January 1, 2028, total reimbursement (as defined in subclause (V)(dd)) paid by a PDP sponsor to an essential retail pharmacy that is an independent community pharmacy for a covered part D drug shall not be lower than—</text><item id="id3efaeebd1a1249dc8d24fa6c97e0d145"><enum>(aa)</enum><text>in the case where National Average Drug Acquisition Cost information for such drug for retail community pharmacies or applicable non-retail community pharmacies has been available under section 1927(f) for at least one full plan year— </text><subitem commented="no" display-inline="no-display-inline" id="idc32a16345c16463da625f127733a37c7"><enum>(AA)</enum><text display-inline="yes-display-inline">if such information is available for such drug for retail community pharmacies, the average National Average Drug Acquisition Cost for such drug for retail community pharmacies for the most recent plan year for which such information is available;</text></subitem><subitem commented="no" display-inline="no-display-inline" id="id475d4b79cd6341fd945f93b6172391ad"><enum>(BB)</enum><text display-inline="yes-display-inline">in the case where such information for retail community pharmacies is not available, the average National Average Drug Acquisition Cost for such drug for applicable non-retail pharmacies for the most recent plan year for which such information is available; </text></subitem></item><item commented="no" display-inline="no-display-inline" id="ida86c1c453d0e46b8bcc7d4df8e55a9d9"><enum>(bb)</enum><text>in the case where National Average Drug Acquisition Cost information for such drug under section 1927(f) is not available for retail community pharmacies or applicable non-retail pharmacies, the wholesale acquisition cost (as defined in section 1847A(c)(6)(B)) for such drug; and</text></item><item commented="no" display-inline="no-display-inline" id="id11904c6695544fde8b0c7e3a90a36cfa"><enum>(cc)</enum><text display-inline="yes-display-inline">in the case where National Average Drug Acquisition Cost information under section 1927(f) is available for such drug and ending on the date such survey information has been available for such drug but has not been available for a full plan year—</text><subitem id="idbb6644534b904d57916a118d4a7a49e7"><enum>(AA)</enum><text>the most recent National Average Drug Acquisition Cost for such drug for retail community pharmacies, if available; or</text></subitem><subitem id="idc3d2adc144c44a20948faa0a13b8c834"><enum>(BB)</enum><text>if the information specified in subitem (AA) is not available, the most recent National Average Drug Acquisition Cost for such drug for applicable non-retail pharmacies. </text></subitem></item></subclause><subclause commented="no" id="ide99d447823ff40f191a155d81848749b"><enum>(III)</enum><header>Definition of essential retail pharmacy</header><text>In this clause, the term <term>essential retail pharmacy</term> means, with respect to a plan year, a retail pharmacy that—</text><item commented="no" display-inline="no-display-inline" id="idd51e273a63034bb0a3655b0ce8d4bc71"><enum>(aa)</enum><text>is not an affiliate of a pharmacy benefit manager or PDP sponsor;</text></item><item commented="no" display-inline="no-display-inline" id="id578e956f5ab3465ba2efdb7a588da6ac"><enum>(bb)</enum><text>is located in a medically underserved area (as designated pursuant to section 330(b)(3)(A) of the Public Health Service Act); and</text></item><item commented="no" display-inline="no-display-inline" id="id108bc856441c4f768971fce66b7f9980"><enum>(cc)</enum><text display-inline="yes-display-inline">is designated as an essential retail pharmacy by the Secretary for such plan year under subclause (IV).</text></item></subclause><subclause commented="no" display-inline="no-display-inline" id="idd8993db151f34022b892ae354c2066b3"><enum>(IV)</enum><header>Designation of essential retail pharmacies</header><item id="id72d60ed2785e4a6bad3a8d24f19cba82"><enum>(aa)</enum><header>In general</header><text>For each plan year (beginning with plan year 2028), the Secretary shall designate pharmacies that meet the requirements specified in items (aa) and (bb) of subclause (III) as essential retail pharmacies, in accordance with this subclause.</text></item><item commented="no" display-inline="no-display-inline" id="id654e17f1b6744b3cb11bda409d46748c"><enum>(bb)</enum><header>Required submissions from PDP sponsors</header><text>For each plan year beginning with plan year 2028, each PDP sponsor offering a prescription drug plan shall submit to the Secretary, for the purposes of determining retail pharmacies that do not meet the requirement specified in item (aa) of subclause (III), a list of any retail pharmacy that is an affiliate of such sponsor, subject to time, manner, and form requirements established by the Secretary.</text></item><item id="id18b3866cf7a54d48adead575e6502952"><enum>(cc)</enum><header>Publication</header><text>Not later than one month prior to the start of each plan year (beginning with plan year 2028), the Secretary shall list, on a publicly available website of the Centers for Medicare & Medicaid Services, all pharmacies designated as essential retail pharmacies for such plan year.</text></item><item id="id07cc6be9b7d3406393c7450e35514352"><enum>(dd)</enum><header>Revocation of designation</header><text>In the case where, during a plan year, the Secretary determines that a pharmacy no longer meets the requirements for designation as an essential retail pharmacy, the Secretary may revoke such designation for such pharmacy, as determined appropriate by the Secretary.</text></item></subclause><subclause commented="no" display-inline="no-display-inline" id="idc20ff280bf164cecbc328874970d98d8"><enum>(V)</enum><header>Other definitions</header><text display-inline="yes-display-inline">In this clause:</text><item id="idd3a3c16ef7b949f7a26b5a90f6040377"><enum>(aa)</enum><header>Affiliate</header><text>The term <term>affiliate</term> means any entity that is owned by, controlled by, or related under a common ownership structure with a pharmacy benefit manager or PDP sponsor or that acts as a contractor or agent to such pharmacy benefit manager or PDP sponsor, if such contractor or agent performs any of the functions described in item (cc).</text></item><item id="id507cba460ff5408f82df9a11f79d8b0b"><enum>(bb)</enum><header>Independent community pharmacy</header><text>The term <term>independent community pharmacy</term> means a retail pharmacy, including a pharmacy that is associated with a franchise or a pharmacy services administrative organization, that has fewer than 4 locations and is not affiliated with any person or entity other than its owners. </text></item><item id="ide97971e7fcc045198070ee95ddfb3e7c"><enum>(cc)</enum><header>Pharmacy benefit manager</header><text>The term <term>pharmacy benefit manager</term> means any person or entity that, either directly or through an intermediary, acts as a price negotiator or group purchaser on behalf of a PDP sponsor or prescription drug plan, or manages the prescription drug benefits provided by such sponsor or plan, including the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to the prescription drug benefit, contracting with network pharmacies, controlling the cost of covered part D drugs, or the provision of related services. Such term includes any person or entity that carries out one or more of the activities described in the preceding sentence, irrespective of whether such person or entity identifies itself as a <quote>pharmacy benefit manager</quote>.</text></item><item commented="no" display-inline="no-display-inline" id="id841ff1c5493145e99b437d7fed645cdd"><enum>(dd)</enum><header>Total reimbursement</header><text>The term <term>total reimbursement</term> means, with respect to a covered part D drug, the negotiated price (as defined in section 1860D–2(d)(1)(B)) plus any incentive payments paid by the PDP sponsor to such essential retail pharmacy that is an independent community pharmacy net of any fees, pharmacy price concessions, discounts, or any other forms of remuneration paid by such pharmacy and furnished by such PDP sponsor under section 1860D–2(f)(4).</text></item></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id348195a47d2d44088425a2a5c0ed7b8a"><enum>(c)</enum><header>Enforcement</header><paragraph commented="no" display-inline="no-display-inline" id="id9eb33771f2d64b858402ad3e33e0ec96"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text>Section 1860D–4(b)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-104">42 U.S.C. 1395w–104(b)(1)</external-xref>) is amended by adding at the end the following new subparagraph: </text><quoted-block style="OLC" display-inline="no-display-inline" id="idE13D2F7D1F874FBF87501DA21171CD79"><subparagraph id="iddfee2f039c024a7a9e6d10c1e52b6c81"><enum>(F)</enum><header>Enforcement of standards for reasonable and relevant contract terms and conditions and essential retail pharmacy protections</header><clause id="idd372ec11175a4f7ba651e8da60b763c2"><enum>(i)</enum><header>Allegation submission process</header><subclause commented="no" display-inline="no-display-inline" id="id05a11a0deb4d49c0a2affba265af989f"><enum>(I)</enum><header display-inline="yes-display-inline">In general</header><text>Not later than January 1, 2028, the Secretary shall establish a process through which a pharmacy may submit an allegation of a violation by a PDP sponsor offering a prescription drug plan of—</text><item commented="no" display-inline="no-display-inline" id="id6152e19269c54bce9595459a7ee97b86"><enum>(aa)</enum><text display-inline="yes-display-inline">the standards for reasonable and relevant contract terms and conditions under subparagraph (A)(ii); or</text></item><item commented="no" display-inline="no-display-inline" id="idd7d45dab91d040e5b0c5dd7b1554c587"><enum>(bb)</enum><text display-inline="yes-display-inline">the requirements for total reimbursement for essential retail pharmacies that are independent community pharmacies under subparagraph (C)(v)(II).</text></item></subclause><subclause id="id3287bdab5de9468c958619ac52545a05"><enum>(II)</enum><header>Frequency of submission</header><item commented="no" display-inline="no-display-inline" id="id09bed76f28d34ef6ab17097d1ebcc2ca"><enum>(aa)</enum><header display-inline="yes-display-inline">Violations of reasonable and relevant contract terms and conditions</header><subitem commented="no" display-inline="no-display-inline" id="idd1ee50ea11644c10b4491edafc29f317"><enum>(AA)</enum><header display-inline="yes-display-inline">In general</header><text>Except as provided in subitem (BB), the allegation submission process under this clause shall allow pharmacies to submit any allegations of violations described in item (aa) of subclause (I) not more frequently than once per plan year per contract between a pharmacy and a PDP sponsor.</text></subitem><subitem commented="no" display-inline="no-display-inline" id="id580b7f378203453f92d1b616553f9e55"><enum>(BB)</enum><header>Allegations relating to contract changes</header><text display-inline="yes-display-inline">In the case where a contract is amended or otherwise updated following the submission of allegations by a pharmacy with respect to such contract and plan year, the allegation submission process under this clause shall allow such pharmacy to submit an additional allegation related to those changes with respect to such contract and plan year.</text></subitem><subitem commented="no" display-inline="no-display-inline" id="id3d0cb6d83f81484684bda3b633e1323c"><enum>(CC)</enum><header>Submissions</header><text display-inline="yes-display-inline">Submissions of any allegations under this item shall be separate from any submissions under item (bb) and may include multiple allegations of such violations.</text></subitem></item><item id="ide181c0d78d044c1a82a2f4ef0e5a735b"><enum>(bb)</enum><header>Violations of essential retail pharmacy protections</header><subitem commented="no" display-inline="no-display-inline" id="ida8f28935b1944c6592f42e23fdd25afa"><enum>(AA)</enum><header display-inline="yes-display-inline">In general</header><text>The allegation submission process under this clause shall allow essential retail pharmacies that are independent community pharmacies to submit any allegations of violations described in item (bb) of subclause (I) once per calendar quarter.</text></subitem><subitem commented="no" display-inline="no-display-inline" id="idb1f50cb18cfa4e20b74ccff70e91a711"><enum>(BB)</enum><header>Submissions</header><text display-inline="yes-display-inline">Submissions of any allegations under this item shall be separate from any submissions under item (aa) and may include multiple allegations of such violations.</text></subitem></item></subclause><subclause id="id851bd5910de44acdab587a97e46eba2d"><enum>(III)</enum><header>Access to relevant documents and materials</header><text>A PDP sponsor subject to an allegation under this clause—</text><item commented="no" display-inline="no-display-inline" id="idd53cfc52c8cd4ab997e3eb21fc6ae4b2"><enum>(aa)</enum><text display-inline="yes-display-inline">shall provide documents or materials, as specified by the Secretary, including contract offers made by such sponsor to such pharmacy or correspondence related to such offers, to the Secretary at a time and in a form and manner specified by the Secretary; and</text></item><item commented="no" display-inline="no-display-inline" id="id3966671ac3034d15b00a0372d900edb5"><enum>(bb)</enum><text display-inline="yes-display-inline">shall not prohibit or otherwise limit the ability of a pharmacy to submit such documents or materials to the Secretary for the purpose of submitting an allegation or providing evidence for such an allegation under this clause.</text></item></subclause><subclause id="ida479225ecf94408e97e6807dab07f940"><enum>(IV)</enum><header>Standardized template</header><text>The Secretary shall establish separate standardized templates for pharmacies to use for the submission of allegations described in items (aa) and (bb) of subclause (I). Each such template shall require that the submission include a certification by the pharmacy that the information included is accurate, complete, and true to the best of the knowledge, information, and belief of such pharmacy. </text></subclause><subclause commented="no" display-inline="no-display-inline" id="id7a33a613a7294b5ebfd698b20e6daf80"><enum>(V)</enum><header>Preventing frivolous allegations</header><text display-inline="yes-display-inline">In the case where the Secretary determines that a pharmacy has submitted frivolous allegations under this clause on a routine basis, the Secretary may temporarily prohibit such pharmacy from using the allegation submission process under this clause, as determined appropriate by the Secretary.</text></subclause><subclause id="idadb4c8f12add47dbb379ec6e7513e6ad"><enum>(VI)</enum><header>Exemption from Freedom of Information Act</header><text>Allegations submitted under this clause shall be exempt from disclosure under section 552 of title 5, United States Code.</text></subclause></clause><clause id="ida59034ddbf964ee8a286fb830b1409b1"><enum>(ii)</enum><header>Investigation</header><text>The Secretary shall investigate, as determined appropriate by the Secretary, allegations submitted pursuant to clause (i). </text></clause><clause id="idbd8cefe222fe498d9536e0bd8a36a67e"><enum>(iii)</enum><header>Enforcement</header><subclause id="id28e96f22c30d445ea672417de9fcc535"><enum>(I)</enum><header>Reasonable and relevant contract terms and conditions</header><text>In the case where the Secretary determines that a PDP sponsor offering a prescription drug plan has violated the standards for reasonable and relevant contract terms and conditions under subparagraph (A)(ii), the Secretary shall use existing authorities under sections 1857(g) and 1860D–12(b)(3)(E) to impose civil monetary penalties or take other enforcement actions.</text></subclause><subclause id="id36003d9f619a4f9a99f35f45efa1d0a6"><enum>(II)</enum><header>Essential retail pharmacy protections</header><text>In the case where the Secretary determines that a PDP sponsor offering a prescription drug plan has violated the requirements for total reimbursement for essential retail pharmacies that are independent community pharmacies under subparagraph (C)(v)(II), the Secretary shall—</text><item commented="no" display-inline="no-display-inline" id="idb43a85fb78a24eadbfc2819b11726993"><enum>(aa)</enum><text display-inline="yes-display-inline">if the amount of total reimbursement paid by the sponsor to an essential retail pharmacy that is an independent community pharmacy for a covered part D drug was less than the amount of total reimbursement required to be paid to the pharmacy under subparagraph (C)(v)(II) for such drug, require the PDP sponsor to pay to the pharmacy an amount equal to the difference between such amounts; and</text></item><item commented="no" display-inline="no-display-inline" id="idd161ae18d9c34c7686abbe71a05454f2"><enum>(bb)</enum><text display-inline="yes-display-inline">use existing authorities under section 1857(g) and 1860D–12(b)(3)(E) to impose civil monetary penalties or take other enforcement actions.</text></item></subclause><subclause id="ide961292cda064af3b0c814454f367e84"><enum>(III)</enum><header>Application of civil monetary penalties</header><text>The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil monetary penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).</text></subclause></clause><clause commented="no" display-inline="no-display-inline" id="id0b79e60884ee4e1b9d58b66516e4edf2"><enum>(iv)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this subparagraph, the terms <term>essential retail pharmacy</term>, <term>independent community pharmacy</term>, and <term>total reimbursement</term> have the meaning given those terms in subparagraph (C)(v).</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7d3b2be5f05248cc9f3e685afd0c58fa"><enum>(2)</enum><header>Conforming amendment</header><text>Section 1857(g)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(g)(1)</external-xref>) is amended—</text><subparagraph id="id8eef43fb64ee4a7389a161456caf6d7b"><enum>(A)</enum><text>in subparagraph (J), by striking <quote>or</quote> after the semicolon;</text></subparagraph><subparagraph id="id82f98598062f46559f18646856d10241"><enum>(B)</enum><text>by redesignating subparagraph (K) as subparagraph (L);</text></subparagraph><subparagraph id="idbdd3e123fec1455090b2c7e04966ddd8"><enum>(C)</enum><text>by inserting after subparagraph (J), the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idd067cb975d7d482c8c19f4b82eeb13ee"><subparagraph id="idd193680b5dca4167b59d1738ff14fe92"><enum>(K)</enum><text>fails to comply with—</text><clause commented="no" display-inline="no-display-inline" id="id399f97401e6e40c9b6f84e84126929a9"><enum>(i)</enum><text display-inline="yes-display-inline">the standards for reasonable and relevant contract terms and conditions under subparagraph (A)(ii) of section 1860D–4(b)(1); or</text></clause><clause commented="no" display-inline="no-display-inline" id="id2dcc635193b94a6d82b53439952af72f"><enum>(ii)</enum><text display-inline="yes-display-inline">the requirements for total reimbursement for essential retail pharmacies that are independent community pharmacies under subparagraph (C)(v)(II) of such section; or</text></clause></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph><subparagraph id="iddc08bc0032394d56adb1ce1b2cc81908"><enum>(D)</enum><text>in subparagraph (L), as redesignated by subparagraph (B), by striking <quote>through (J)</quote> and inserting <quote>through (K)</quote>; and</text></subparagraph><subparagraph id="id50c3774cde2e441c83dc1fc0a77fd61a"><enum>(E)</enum><text>in the flush matter following subparagraph (L), as so redesignated, by striking <quote>subparagraphs (A) through (K)</quote> and inserting <quote>subparagraphs (A) through (L)</quote>. </text></subparagraph></paragraph></subsection><subsection commented="no" id="idaddcc68ef4394931ab040bd0135a4365"><enum>(d)</enum><header>Accountability of pharmacy benefit managers for violations of reasonable and relevant contract terms and conditions and essential retail pharmacy protections</header><paragraph commented="no" display-inline="no-display-inline" id="idc93ea1cef1f8444cbbaac7be116c6682"><enum>(1)</enum><header display-inline="yes-display-inline">In general</header><text>Section 1860D–12(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-112">42 U.S.C. 1395w–112</external-xref>) is amended by adding at the end the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id6E21B29BAD1440E4ACB5FAF698D89233"><paragraph id="id577ef4f0d7f54a8aa086473143590f1b"><enum>(9)</enum><header>Accountability of pharmacy benefit managers for violations of reasonable and relevant contract terms and conditions and essential retail pharmacy protections</header><text>For plan years beginning on or after January 1, 2028, each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that any pharmacy benefit manager acting on behalf of such sponsor has a written agreement with the PDP sponsor under which the pharmacy benefit manager agrees to reimburse the PDP sponsor for any amounts paid by such sponsor under subclause (I) or (II) of section 1860D–4(b)(1)(F)(iii) as a result of a violation described in such subclause (I) or (II) if such violation is related to a responsibility delegated to the pharmacy benefit manager by such PDP sponsor.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph id="ida643d9af4b0a4d088e863eb06baeea67"><enum>(2)</enum><header>Ma–pd plans</header><text>Section 1857(f)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-27">42 U.S.C. 1395w–27(f)(3)</external-xref>) is amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id249852d9a93c4917b2fb7f0b3d2c9aeb"><subparagraph id="idd6d055b9ddc64ec58b6472e4bca39bdb"><enum>(F)</enum><header>Accountability of pharmacy benefit managers for violations of reasonable and relevant contract terms and conditions and essential retail pharmacy protections</header><text>For plan years beginning on or after January 1, 2028, section 1860D–12(b)(9).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="id6361fe1c310146e384bbc44e1ce22a4f"><enum>(e)</enum><text>Section 1860D–42 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-152">42 U.S.C. 1395w–152</external-xref>) is amended by adding at the end the following new subsection:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id35a27363c80342bc9b20a3c4f945ec59"><subsection id="id202c474febd546e4b26244befa961c14"><enum>(e)</enum><header>Briefing and reporting requirements related to pharmacy price concessions under this part</header><paragraph id="id8e64ea7a48184a83a898e4f507bb2d4e"><enum>(1)</enum><header>Briefing requirements</header><text>The Secretary shall provide periodic briefings to the Committee on Finance of the Senate, the Committee on Ways and Means of the House of Representatives, and the Committee on Energy and Commerce of the House of Representatives, beginning not later than 90 days after the date of enactment of this subsection, on implementation, oversight, data collection, and enforcement activities related to the administration of the <quote>Pharmacy Price Concessions to Drug Prices at the Point of Sale</quote> provisions codified under sections 423.100 and 423.2305 of title 42, Code of Federal Regulations (or any successor regulations), as published in the Federal Register on May 9, 2022, in the final rule entitled <quote>Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency; Additional Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency</quote>.</text></paragraph><paragraph id="id27686cf39eac4531a95a2cf2561e76e6"><enum>(2)</enum><header>Reporting requirements</header><text>Beginning not later than 90 days after the date of enactment of this subsection, and at least once every plan year beginning thereafter (through plan year 2027), the Secretary shall develop and submit to Congress reports on the activities specified in paragraph (1).</text></paragraph><paragraph id="id2cfb5b005fad4455bb5d4391d20c3868"><enum>(3)</enum><header>Contents for briefings and reports</header><text>The briefings required under paragraph (1) and reports required under paragraph (2) shall include information on—</text><subparagraph id="id1bd64f2a90324c87a59399c3ff2c2d7a"><enum>(A)</enum><text>implementation, oversight, data collection, and enforcement activities related to contract terms and conditions among PDP sponsors, MA organizations, and pharmacies for the purpose of establishing or maintaining pharmacy network participation or preferred pharmacy network participation;</text></subparagraph><subparagraph id="id322080bafb604a6a866b95bfafdfab21"><enum>(B)</enum><text>patterns and trends in such terms and conditions, to the extent applicable;</text></subparagraph><subparagraph id="id77259a4638114d45a12d25e23c24b18e"><enum>(C)</enum><text>implementation, oversight, and enforcement activities and developments related to assuring pharmacy access under section 1860D–4(b)(1), along with applicable regulations and program instruction or guidance;</text></subparagraph><subparagraph id="id2c6ba15c248a4f36951d7ad85ee98328"><enum>(D)</enum><text>plans, strategies, initiatives, or programmatic changes undertaken by the Secretary to prevent, mitigate, or otherwise address stakeholder feedback and concerns related to convenient pharmacy access for beneficiaries under this part; and</text></subparagraph><subparagraph id="id9a88b0a56c104d2482d35964af902d6c"><enum>(E)</enum><text>other issues determined appropriate by the Secretary.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection id="id41ba5a7854af4b4482602410cf1de16c"><enum>(f)</enum><header>Funding</header><text>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, $250,000,000 for fiscal year 2024, to remain available until expended, to carry out the amendment made by this section.</text></subsection></section><section section-type="subsequent-section" id="H79E4515B510D4E85A22C5E1BC1814D05"><enum>202.</enum><header>Ensuring accurate payments to pharmacies under Medicaid</header><subsection id="HD4B52036C4E54F0F98997D55A33FDB4B"><enum>(a)</enum><header>In general</header><text>Section 1927(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(f)</external-xref>) is amended—</text><paragraph id="HBDE45AED1E704BFA9F135EC318E5A32A"><enum>(1)</enum><text>in paragraph (1)(A)—</text><subparagraph commented="no" display-inline="no-display-inline" id="id9b9a5c76ec254c348063f3ea1c23f15f"><enum>(A)</enum><text display-inline="yes-display-inline">by redesignating clause (ii) as clause (iii); and</text></subparagraph><subparagraph id="id3edd2b5ffb184235a0446d05341b7a68"><enum>(B)</enum><text display-inline="yes-display-inline">by striking <quote>and</quote> after the semicolon at the end of clause (i) and all that precedes it through <quote>(1)</quote> and inserting the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H46955B6F36854182BCA697251E9E6CE7"><paragraph id="HCF5F19355E39493E9502217485EF4ADB"><enum>(1)</enum><header>Determining pharmacy actual acquisition costs</header><text>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 follows:</text><subparagraph commented="no" display-inline="no-display-inline" id="HA92E4E3C98704BB1A8DA9F8A9F5E053D"><enum>(A)</enum><header display-inline="yes-display-inline">Use of vendor</header><text display-inline="yes-display-inline">The Secretary may contract services for—</text><clause commented="no" display-inline="no-display-inline" id="H453A617DDF3248D3909E5D358372CFAA"><enum>(i)</enum><text>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 and rebates (to the extent any information with respect to such discounts and rebates is available) based on a monthly survey of such pharmacies;</text></clause><clause commented="no" display-inline="no-display-inline" id="id35fb884ae4ae45569812b78eb31f3ccf"><enum>(ii)</enum><text>with respect to applicable non-retail pharmacies— </text><subclause commented="no" display-inline="no-display-inline" id="ide6568be23d1f4e8f8bcfc09f74fe77e5"><enum>(I)</enum><text display-inline="yes-display-inline">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 and rebates (to the extent any information with respect to such discounts and rebates is available) based on a monthly survey of such pharmacies; and</text></subclause><subclause commented="no" display-inline="no-display-inline" id="id1eb1e8d88c05408cbca02ed0a265c8bd"><enum>(II)</enum><text display-inline="yes-display-inline">at the discretion of the Secretary, for each type of applicable non-retail pharmacy (as identified pursuant to the type indicators established by the Secretary under subsection (k)(12)(B)(ii)), 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 and rebates (to the extent any information with respect to such discounts and rebates is available) based on a monthly survey of such pharmacies; and</text></subclause></clause></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="H72F18B57F6E849338D5D0615DB07ACA2"><enum>(2)</enum><text>in subparagraph (D) of paragraph (1), by striking clauses (ii) and (iii) and inserting the following: </text><quoted-block style="OLC" display-inline="no-display-inline" id="id7e9d1c5fb67a45fd9b4217110db541bb"><clause id="id6ee933953427434bae734f8f30bfc00f"><enum>(ii)</enum><text>The vendor must update the Secretary no less often than monthly on the survey prices for covered outpatient drugs.</text></clause><clause id="id09cca79eaf974ae0a49fb372ae7a2a3a"><enum>(iii)</enum><text>The vendor must differentiate, in collecting and reporting survey data, the relevant pharmacy type indicator for all cost information collected, including whether a pharmacy is owned by, operated by, or otherwise affiliated with a pharmacy benefit manager and whether a pharmacy is a retail community pharmacy or an applicable non-retail pharmacy, and, in the case of an applicable non-retail pharmacy, which type of applicable non-retail pharmacy (as identified pursuant to the type indicators established by the Secretary under subsection (k)(12)(B)(ii)) it is.</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></paragraph><paragraph commented="no" display-inline="no-display-inline" id="ideefa6d9eef6c4ea2a4fb88dc2283bdf4"><enum>(3)</enum><text display-inline="yes-display-inline">by adding at the end of paragraph (1) the following:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H4A3FC189E5C34A2D9FE13B0DD62A25C3"><subparagraph id="HAC2D72251CA4460284A3EFCC29E6520C"><enum>(F)</enum><header>Survey reporting</header><text display-inline="yes-display-inline">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, or rebate related to the dispensing of covered outpatient drugs to individuals receiving benefits under this title, regardless of whether such payment, reimbursement, administrative fee, discount, or rebate 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. </text></subparagraph><subparagraph id="HF56AAE8C731C437E94B3CFC622BC8060"><enum>(G)</enum><header>Survey information</header><text>Information on national drug acquisition prices obtained under this paragraph shall be made publicly available and shall include at least the following:</text><clause id="H7F1FB364612B4BE1BD54AA97DD82C620"><enum>(i)</enum><text>The monthly response rate to the survey including a list of pharmacies not in compliance with subparagraph (F).</text></clause><clause id="H1113FC12BB1944DF96D542A4C93142F1"><enum>(ii)</enum><text>The sampling frame and number of pharmacies sampled monthly.</text></clause><clause id="H90924956A48B4512B812DEB437B3A439"><enum>(iii)</enum><text>Information on price concessions to the pharmacy, 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.</text></clause></subparagraph><subparagraph id="id6abfd4a16fdb4470a83ca51faf2834e5"><enum>(H)</enum><header>Penalties</header><text>The Secretary, in consultation with the Office of the Inspector General of the Department of Health and Human Services, shall enforce the provisions of this paragraph with respect to a pharmacy through the establishment of appropriate civil monetary penalties, which may be assessed with respect to each violation or survey non-response, and with respect to each non-compliant pharmacy (including a pharmacy that is part of a chain), until compliance with this paragraph has been completed. The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the preceding sentence in the same manner as such provisions apply to a civil money penalty or proceeding under section 1128A(a). </text></subparagraph><subparagraph id="idf38db5d7e6cf4661a5caae6d4147baf4"><enum>(I)</enum><header>Limitation on use of applicable non-retail pharmacy pricing information</header><text>No State shall use pricing information reported by applicable non-retail pharmacies under paragraph (1)(A)(ii) to develop or inform reimbursement rates for retail community pharmacies.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph><paragraph id="HD76BBACECADD46CB9E5C67D0BBEA6AF6"><enum>(4)</enum><text>in paragraph (2)—</text><subparagraph id="H3ED64373C9284423A876B1310740B0C8"><enum>(A)</enum><text>in subparagraph (A), by inserting <quote>, including payment rates under managed care entities or other specified entities (as such terms are defined in section 1903(m)(9)(D)),</quote> after <quote>under this title</quote>; and</text></subparagraph><subparagraph id="HA1C2DCE0AF3344C2AAEB7285F24D54BB"><enum>(B)</enum><text>in subparagraph (B), by inserting <quote>and the basis for such dispensing fees</quote> before the semicolon; </text></subparagraph></paragraph><paragraph id="H27589E7053B947EAA2EBD51B9FBE3D9F"><enum>(5)</enum><text>by redesignating paragraph (4) as paragraph (5);</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1da23ec43a1140dc9b2be5bd5bdc0e8d"><enum>(6)</enum><text display-inline="yes-display-inline">by inserting after paragraph (3) the following new paragraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id3F29E1A39DBA45F4B5E0BA3ABB16C1A1"><paragraph id="id727055e61b0049a4b8709617f0099bea"><enum>(4)</enum><header>Oversight</header><subparagraph commented="no" display-inline="no-display-inline" id="id02d554b0e2af4db2b38eaf135f4b7f71"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">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 affiliated with pharmacy benefit managers, wholesalers, distributors, and other entities that acquire 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.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idbad9972bcce94ece805703e0c13ff368"><enum>(B)</enum><header>Appropriation</header><text display-inline="yes-display-inline">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 2024, to remain available until expended, to carry out this paragraph.</text></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id7b4b3db4e0e746ee94186e10e86294ef"><enum>(7)</enum><text display-inline="yes-display-inline">in paragraph (5), as so redesignated, by inserting <quote>, and $9,000,000 for fiscal year 2024 and each fiscal year thereafter,</quote> after <quote>2010</quote>.</text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="ide6705ad67f4e4286884e900116a3f36b"><enum>(b)</enum><header>Definitions</header><text display-inline="yes-display-inline">Section 1927(k) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-8">42 U.S.C. 1396r–8(k)</external-xref>) is amended by adding the following—</text><quoted-block style="OLC" display-inline="no-display-inline" id="id4e2bc827158747b5918ee09dfc64bc6b"><paragraph id="id2fe150c6a6c74859846c69d1925614ce"><enum>(12)</enum><header>Applicable non-retail pharmacy</header><subparagraph commented="no" display-inline="no-display-inline" id="idd9f66d34b7e84928b5e4f9c55df23164"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>applicable non-retail pharmacy</term> 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).</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id30689fc5921d43efb0b68777b6329f0d"><enum>(B)</enum><header>Identification of applicable non-retail pharmacies</header><clause commented="no" display-inline="no-display-inline" id="id05fcfd6e280c4f65bc70a82416932df6"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">For purposes of subsection (f), the Secretary shall, not later than January 1, 2025, in consultation with stakeholders as appropriate, issue guidance specifying pharmacies that meet the definition of applicable non-retail pharmacies and that will be subject to the survey requirements under subsection (f)(1).</text></clause><clause id="ide63d4aee0b654d10ab72f4bb9827e570"><enum>(ii)</enum><header>Inclusion of pharmacy type indicators</header><text>The guidance promulgated under clause (i) 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.</text></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id5190D0AA36A34E5CA329D153DAF86678"><enum>(13)</enum><header display-inline="yes-display-inline">Pharmacy benefit manager</header><text display-inline="yes-display-inline">The term <term>pharmacy benefit manager</term> 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 or other specified entity (as such terms are defined in section 1903(m)(9)(D)), or manages the prescription drug benefits provided by such 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 carries out 1 or more of the activities described in the preceding sentence, irrespective of whether such person or entity calls itself a <quote>pharmacy benefit manager</quote>.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection><subsection commented="no" display-inline="no-display-inline" id="HA07DCB9E9EC84EAD9F630AA40381FB72"><enum>(c)</enum><header>Effective date</header><text>The amendments made by this section take effect on 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. </text></subsection></section><section id="id5158016ff36c48f5ad81f3a536e67e7f"><enum>203.</enum><header>Protecting seniors from excessive cost-sharing for certain medicines</header><text display-inline="no-display-inline">Section 1860D–2 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-102">42 U.S.C. 1395w–102</external-xref>) is amended—</text><paragraph id="id3b1d4bbce39f4a94a0a83a79129a3ced"><enum>(1)</enum><text>in subsection (b)—</text><subparagraph id="id616ee07d0973441aac4f725c50e6f6e0"><enum>(A)</enum><text>in paragraph (2)(A), in the matter preceding clause (i), by striking <quote>and (9)</quote> and inserting <quote>, (9), (10), and (11)</quote>; and</text></subparagraph><subparagraph id="idb1a88ceec2b2445888eb07478d7fea41"><enum>(B)</enum><text>by adding at the end the following new paragraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id06030169033B4524AEF147B7C302402F"><paragraph id="id8fcda81ea115498abe2607a6d71fa804"><enum>(10)</enum><header>Tying cost-sharing to net price for certain medications</header><subparagraph id="id5f61ca78d4e34fb698ded45388986a8a"><enum>(A)</enum><header>In general</header><text>For plan years beginning on or after January 1, 2028, for costs above the annual deductible specified in paragraph (1) and below the annual out-of-pocket threshold specified in paragraph (4), any coinsurance amount for a discount-eligible drug that is included on the plan's formulary and subject to coinsurance rather than a copayment shall be calculated based on the net price of such discount-eligible drug.</text></subparagraph><subparagraph id="id9125EEACF620417E8015B639ABCC656B"><enum>(B)</enum><header>Reporting to the Secretary</header><text>For plan years beginning on or after January 1, 2028, a PDP sponsor of a prescription drug plan and an MA organization offering an MA–PD plan shall annually submit to the Secretary, in a form and manner determined appropriate by the Secretary—</text><clause commented="no" display-inline="no-display-inline" id="id8e2aefec192e4d4581c550841b7a9cd9"><enum>(i)</enum><text display-inline="yes-display-inline">approximate price concessions and net prices for each discount-eligible drug; and </text></clause><clause commented="no" display-inline="no-display-inline" id="id0af2388fa75f4dde9eaef631ed9afded"><enum>(ii)</enum><text display-inline="yes-display-inline">a written explanation of the methodology used to calculate such approximate price concessions and net prices. </text></clause></subparagraph><subparagraph id="ide68e730c715741078d3c6b6e07cb9b40"><enum>(C)</enum><header>Requirements for approximate price concessions</header><clause commented="no" display-inline="no-display-inline" id="idf59a0d97971441eda5a5dac7a36b97ea"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">Approximate price concessions submitted under subparagraph (B) shall comply with—</text><subclause commented="no" display-inline="no-display-inline" id="id1fb24af9b4284fcc9d405f1006ab09bf"><enum>(I)</enum><text display-inline="yes-display-inline">the drug-specific threshold under clause (ii) for the applicable plan year; and </text></subclause><subclause commented="no" display-inline="no-display-inline" id="id12404533ee494a5fae11fa6235c03a56"><enum>(II)</enum><text display-inline="yes-display-inline">the aggregate threshold under clause (iii) for the applicable plan year.</text></subclause></clause><clause id="id01ca5c7eb76e423eb01f4f2df2dcd94b"><enum>(ii)</enum><header>Thresholds</header><subclause commented="no" display-inline="no-display-inline" id="iddef6716b651648068599dec52f50b5c0"><enum>(I)</enum><header>Plan years 2028 through 2032</header><text display-inline="yes-display-inline">For plan years 2028 through 2032—</text><item commented="no" display-inline="no-display-inline" id="id430a084bcccf42aa9504b3f6a0709b18"><enum>(aa)</enum><text display-inline="yes-display-inline">the drug-specific threshold is 20 percent; and </text></item><item commented="no" display-inline="no-display-inline" id="id73442a218813456abde0e944f4fb32ad"><enum>(bb)</enum><text display-inline="yes-display-inline">the aggregate threshold is 15 percent. </text></item></subclause><subclause commented="no" display-inline="no-display-inline" id="id0f93705ecfc345dcaa2595d0784cc4b3"><enum>(II)</enum><header>Subsequent plan years</header><item commented="no" display-inline="no-display-inline" id="id61eaa289b0a443b592242021e6b87587"><enum>(aa)</enum><header>In general</header><text display-inline="yes-display-inline">For plan years beginning with 2033, the Secretary may, as determined appropriate by the Secretary, adjust the drug-specific and aggregate thresholds under this clause. </text></item><item commented="no" display-inline="no-display-inline" id="id7e9c87b51cd541c39cb123e787462161"><enum>(bb)</enum><header>Considerations</header><text display-inline="yes-display-inline">In making any such adjustments, the Secretary may consider historical variations in expected and actual manufacturer price concessions for covered part D drugs, factors that may result in manufacturer price concession uncertainty or variation in a given plan year, PDP sponsor and MA organization behavioral responses, effects of precise manufacturer price concession disclosures, beneficiary out-of-pocket costs, expenditures under this part, and other factors determined appropriate by the Secretary. </text></item><item id="id502d5128e4674e7aad48bb2b3db0b640"><enum>(cc)</enum><header>Requirements</header><text>In making any such adjustments, the Secretary shall ensure that the aggregate threshold for an applicable plan year is lower than the drug-specific threshold for such applicable plan year. </text></item><item commented="no" display-inline="no-display-inline" id="id5b3c56fb9d9a4c648a43476ce9d38521"><enum>(dd)</enum><header>Publication</header><text>The Secretary shall publish any adjustments to the drug-specific and aggregate thresholds under this clause no later than the first Monday of April of the year before the start of the plan year for which such adjusted thresholds are applicable. </text></item></subclause></clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id096903d59cad4938bcecc18c3930479d"><enum>(D)</enum><header>Publication of discount-eligible drugs</header><text display-inline="yes-display-inline">Not later than 15 months before the start of each plan year (beginning with plan year 2028), the Secretary shall publish on a publicly available website a list of the discount-eligible drugs that apply with respect to such plan year (as determined by the Secretary under subparagraph (F)(iv)).</text></subparagraph><subparagraph id="id3b2c437d83f7456b838451cb805c13bf"><enum>(E)</enum><header>Enforcement</header><clause id="id9b94dfe2ac664cae855bf9cc36a7de70"><enum>(i)</enum><header>Monitoring compliance</header><text>The Secretary, in consultation with the Office of the Inspector General, shall conduct periodic audits of prescription drug plans and MA–PD plans to monitor compliance with the requirements under this paragraph. All information reported by a PDP sponsor or MA organization under this paragraph may be subject to audit by the Secretary and the Office of the Inspector General.</text></clause><clause id="idd54b09bd6d464bb688b7f3869b1490ac"><enum>(ii)</enum><header>Penalties</header><subclause id="ida61cb2a670ef41b185eb02e501e934fb"><enum>(I)</enum><header>In general</header><text>A PDP sponsor or an MA organization that violates the requirements under this paragraph may be subject to civil monetary penalties, consistent with sections 1857(g) and 1860D–12(b)(3)(E), as determined appropriate by the Secretary. </text></subclause><subclause id="id4cac10f24275428dba959cdc3eb60220"><enum>(II)</enum><header>Application</header><text>The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil monetary penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).</text></subclause></clause></subparagraph><subparagraph id="id5a4927e42ce84e7aa04189e060fe83e3"><enum>(F)</enum><header>Definitions</header><text>In this paragraph:</text><clause id="id6b5c9c7322984398b232b21f32c280db"><enum>(i)</enum><header>Actual price concessions</header><text>The term <term>actual price concessions</term> means, with respect to a covered part D drug, the amount of manufacturer price concessions that the PDP sponsor or MA organization reports for such drug in the Detailed DIR Report (or successor report) for the applicable plan year. </text></clause><clause id="id4143684a548540b6a6cd8825ea7625ed"><enum>(ii)</enum><header>Aggregate threshold</header><text>The term <term>aggregate threshold</term> means the maximum percentage by which the total approximate price concessions for all discount-eligible drugs may vary from the total actual manufacturer price concessions for all such discount-eligible drugs as reported in the Detailed DIR Report (or successor report) for the applicable plan year. </text></clause><clause id="id699d8c015292454182821ca5481630d9"><enum>(iii)</enum><header>Approximate price concessions</header><text>The term <term>approximate price concessions</term> means, with respect to a covered part D drug, the amount of price concessions from manufacturers that the PDP sponsor or MA organization estimates it will receive with respect to an applicable plan year, subject to the thresholds established under subparagraph (C)(ii), and reflected in the net price.</text></clause><clause id="id2af22cfacb214ceca2ff2c0107fa00a0"><enum>(iv)</enum><header>Discount-eligible drug</header><subclause commented="no" display-inline="no-display-inline" id="id071fe450ee14466fa92fb78d7d5fba57"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">The term <term>discount-eligible drug</term> means a covered part D drug (other than a covered part D drug described in paragraph (8) or (9))—</text><item commented="no" display-inline="no-display-inline" id="idb7e6e9d070b645dab5c6bef30e74c034"><enum>(aa)</enum><text>that is in an applicable category or class described in subclause (II); and</text></item><item commented="no" display-inline="no-display-inline" id="id90528743a16f4c60a3c2ba889f88556e"><enum>(bb)</enum><text display-inline="yes-display-inline">for which the aggregate manufacturer price concessions received by PDP sponsors and MA organizations (or pharmacy benefit managers acting on behalf of such sponsors or organizations) for such drug are equal to or exceed 50 percent of aggregate gross covered prescription drug costs for such drug in the most recent plan year for which data is available, as determined by the Secretary based on previous submissions of Detailed DIR Reports (or successor reports) or other relevant reporting from PDP sponsors or MA organizations.</text></item></subclause><subclause commented="no" display-inline="no-display-inline" id="id964433cf53474cdda3881138b499e45c"><enum>(II)</enum><header>Applicable category or class</header><text>The applicable categories and classes described in this subclause are the following, as specified by the United States Pharmacopeia:</text><item id="ide06ff1b051cb4243ab8f143afd6a476f"><enum>(aa)</enum><text>Anti-inflammatories (Inhaled Corticosteroids). </text></item><item commented="no" display-inline="no-display-inline" id="idd761194b87f34e6a97783aec6f2b9602"><enum>(bb)</enum><text display-inline="yes-display-inline">Bronchodilators, Anticholinergic. </text></item><item commented="no" display-inline="no-display-inline" id="id88d438464ff2469593d6280134ef09e4"><enum>(cc)</enum><text display-inline="yes-display-inline">Bronchodilators, Sympathomimetic. </text></item><item commented="no" display-inline="no-display-inline" id="idf92aa0ac86d84deaac732a45980cc86c"><enum>(dd)</enum><text display-inline="yes-display-inline">Respiratory tract agents. </text></item><item commented="no" display-inline="no-display-inline" id="idb493dd9772ea47a49f16141633854d58"><enum>(ee)</enum><text display-inline="yes-display-inline">Anticoagulants. </text></item><item commented="no" display-inline="no-display-inline" id="ide85fcf9b1c994ac4af2d02cf085c4f6d"><enum>(ff)</enum><text display-inline="yes-display-inline">Cardiovascular agents. </text></item></subclause></clause><clause id="idf8582bb9398340178e4ca8b41d596abd"><enum>(v)</enum><header>Drug-specific threshold</header><text>The term <term>drug-specific threshold</term> means the maximum percentage by which approximate price concessions with respect to a discount-eligible drug may vary from the actual manufacturer price concessions for such drug, as reported in the Detailed DIR Report (or successor report) for the applicable plan year. </text></clause><clause id="idc930734f02bf4fb3bb3c9afb4f41ce4a"><enum>(vi)</enum><header>Net price</header><text>The term <term>net price</term> means, with respect to a covered part D drug, the negotiated price of such drug, net of all approximate price concessions (estimated on an average per-unit basis, as needed) not already reflected in the negotiated price for the applicable plan year.</text></clause><clause id="ida90b246300004887bde2f6170801d67a"><enum>(vii)</enum><header>Manufacturer price concessions</header><text>The term <term>manufacturer price concessions</term> means, with respect to a covered part D drug, rebates that the PDP sponsor or MA organization receives from manufacturers.</text></clause></subparagraph><subparagraph id="id9f1eda8d94ef4884ba21a7b081813394"><enum>(G)</enum><header>Nonapplication of Paperwork Reduction Act</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code, shall not apply to any data collection undertaken by the Secretary under this paragraph. </text></subparagraph></paragraph><paragraph id="idcca3bab8b841465087d696a88a513f38"><enum>(11)</enum><header>Limiting cost-sharing to net price</header><subparagraph commented="no" display-inline="no-display-inline" id="id246a740a41ce4f3093438dc6fcfd282c"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">For plan years beginning on or after January 1, 2028, the cost-sharing (for costs above the annual deductible specified in paragraph (1)) for a covered part D drug (other than a covered part D drug described in paragraph (8) or (9)) shall not exceed the negotiated price for such covered part D drug net of all price concessions (as defined in paragraph (10)(F)(v)), as reported in the Detailed DIR Report (or successor report) for the applicable plan year.</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2c41819ca0894f53ac6763820d9c60ce"><enum>(B)</enum><header>Enforcement</header><clause id="id29631155F88E4D10ADFB360F7312B45C"><enum>(i)</enum><header>Monitoring compliance</header><text>The Secretary shall monitor compliance with the requirements under subparagraph (A) on an ongoing basis, including through periodic audits.</text></clause><clause id="idF1C1DED583A84F3880352E67E48FDE31"><enum>(ii)</enum><header>Retroactive penalties</header><subclause id="id87DD1F17DC164DA4B5D5F1BBC5B302CF"><enum>(I)</enum><header>In general</header><text>A PDP sponsor or an MA organization that violates the requirements under subparagraph (A) may be subject to civil monetary penalties, consistent with sections 1857(g) and 1860D–12(b)(3)(E), as determined appropriate by the Secretary. The Secretary may impose such penalties retroactively upon review of the Detailed DIR Report (or any successor report) with respect to a given plan year. </text></subclause><subclause id="idF08A5B95A15747A588A56E251C242136"><enum>(II)</enum><header>Application</header><text>The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil monetary penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).</text></subclause></clause></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id1cfda462d24d40fc84724e6bab384179"><enum>(12)</enum><header>GAO study and report on implementation and effects of cost-sharing relief provisions</header><subparagraph commented="no" id="idc5695572be7c4c97b608355d78b3703d"><enum>(A)</enum><header>Study</header><text>The Comptroller General of the United States (in this paragraph referred to as the <quote>Comptroller General</quote>) shall conduct a study on certain effects of the implementation of the requirements specified under the provisions of paragraphs (10) and (11).</text></subparagraph><subparagraph commented="no" id="id6538ee7d2b6242c2bc356f1108af26d3"><enum>(B)</enum><header>Report</header><text>Once the data and information needed to conduct the study described in subparagraph (A) has become available and the Comptroller General has had sufficient opportunity to review and analyze such data and information, the Comptroller General shall develop and publish a report on the findings of such study, including with respect to the following:</text><clause commented="no" id="ida14d4f62055e4ae781f3834677ddd8bd"><enum>(i)</enum><text>Effects on enrollee cost-sharing, utilization and adherence, formulary coverage and placement, and utilization management with respect to affected covered part D drugs (discount-eligible drugs and covered part D drugs for which, prior to implementation of such provisions, cost-sharing exceeded net price for some beneficiaries).</text></clause><clause commented="no" id="idcd117e06e0504eaaae81c35d7d303ed0"><enum>(ii)</enum><text>Changes to pharmacy reimbursement methodologies and levels, if any, with respect to discount-eligible drugs.</text></clause><clause commented="no" id="id954923380f8e4a368ab490fa733cb62a"><enum>(iii)</enum><text>Changes in manufacturer rebating levels (relative to gross costs) for discount-eligible drugs.</text></clause><clause commented="no" id="id1c05dfb02924465981fe666c574e315f"><enum>(iv)</enum><text>Other behavioral responses by PDP sponsors, enrollees, manufacturers, pharmacies, or other entities related to the implementation of such provisions.</text></clause><clause commented="no" id="idcab64e49cd7446ab82e12fb49161b725"><enum>(v)</enum><text>Effects of such provisions on enrollee premiums and Federal outlays.</text></clause><clause commented="no" id="id7091e55f255840a39986f9df7ed58aec"><enum>(vi)</enum><text>Other issues determined appropriate by the Comptroller General. </text></clause></subparagraph><subparagraph commented="no" id="ide4c991f747d04ed88c7a3cf750a48dcf"><enum>(C)</enum><header>Subsequent reports</header><text>The Comptroller General may, as determined appropriate, conduct subsequent studies and produce subsequent reports with respect to the ongoing implementation and effects of the provisions of paragraphs (10) and (11).</text></subparagraph></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="id5fb164ec4cc44edeafd9d89d579b297a"><enum>(2)</enum><text>in subsection (c), by adding at the end the following new paragraphs:</text><quoted-block style="OLC" display-inline="no-display-inline" id="idce9f1d549c464dafad6dcf7d82f4fe7b"><paragraph id="ide34685634be94a51983d655029d9c3e1"><enum>(7)</enum><header>Tying cost-sharing to net price for certain drugs</header><text>The coverage is provided in accordance with subsection (b)(10).</text></paragraph><paragraph id="id7b48b8c546f94750899a12ec85106a34"><enum>(8)</enum><header>Limiting cost-sharing to net price</header><text>The coverage is provided in accordance with subsection (b)(11).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section><enum>III</enum><header>Medicaid Expiring Provisions</header><section id="H620AAB38018249B9ACAE5A40F39B052F"><enum>301.</enum><header>Delaying certain disproportionate share hospital payment reductions under the Medicaid program</header><text display-inline="no-display-inline">Section 1923(f)(7)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4(f)(7)(A)</external-xref>), as amended by section 2341 of title III of division B of the Continuing Appropriations Act, 2024 and Other Extensions Act (<external-xref legal-doc="public-law" parsable-cite="pl/118/15">Public Law 118–15</external-xref>), is further amended—</text><paragraph id="H6DF1A6E3D40A44DCAE77D9A66F0AD93E"><enum>(1)</enum><text>in clause (i)— </text><subparagraph commented="no" display-inline="no-display-inline" id="id45259f842736451192c4c9ad933ab581"><enum>(A)</enum><text display-inline="yes-display-inline">in the matter preceding subclause (I), by striking <quote>For the period beginning</quote> and all that follows through <quote>2027</quote> and inserting <quote>For each of fiscal years 2026 and 2027</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id2538c0b5f40548409a681b81247368ea"><enum>(B)</enum><text display-inline="yes-display-inline">in subclauses (I) and (II), by striking <quote>or period</quote> each place it appears; and</text></subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id02765e501e84442faef140aca041b9f0"><enum>(2)</enum><text>in clause (ii), by striking <quote>for the period beginning</quote> and all that follows through <quote>2027</quote> and inserting <quote>for each of fiscal years 2026 and 2027</quote>.</text></paragraph></section><section display-inline="no-display-inline" id="H30662AECD0C344BD98FA820E62B367B9"><enum>302.</enum><header>Extension of State option to provide medical assistance for certain individuals who are patients in certain institutions for mental diseases</header><subsection id="H11C08D6932C5483D96B9F48AF7E395C6"><enum>(a)</enum><header>Making permanent State Plan Amendment Option To Provide Medical Assistance for Certain Individuals Who Are Patients in Certain Institutions for Mental Diseases</header><text display-inline="yes-display-inline">Section 1915(l)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(l)(1)</external-xref>) is amended by striking <quote>With respect to calendar quarters beginning during the period beginning October 1, 2019, and ending September 30, 2023,</quote> and inserting <quote>With respect to calendar quarters beginning on or after October 1, 2019,</quote>.</text></subsection><subsection id="H5A78C74FDC7642638784DE5FA5729643"><enum>(b)</enum><header>Maintenance of effort revision</header><text>Section 1915(l)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(l)(3)</external-xref>) is amended—</text><paragraph id="H4D8C160FB8474E05927B906D4642A1FB"><enum>(1)</enum><text>in subparagraph (A)—</text><subparagraph id="H11D9152A4556434BBB68D9FEB3F78B59"><enum>(A)</enum><text>in the matter preceding clause (i), by striking <quote>other than under this title</quote>; and </text></subparagraph><subparagraph id="H73B00CEBCE8C4EF583FC6BB9EBDE7398"><enum>(B)</enum><text>in clause (i), by striking <quote>or, if higher,</quote> and all that follows through <quote>in accordance with this subsection</quote>; and</text></subparagraph></paragraph><paragraph id="H93877AD5305F4658A9EEB86A9AD8D6DF"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H114A63CEFBF347D1B1D88C1338F9BDDB"><subparagraph id="HBA149EE547E744E682EB59DE3DAE09E7"><enum>(D)</enum><header>Application of maintenance of effort requirements to certain States</header><text display-inline="yes-display-inline">In the case of a State with a State plan amendment in effect as of September 30, 2023, for the 1-year period beginning on the date of enactment of this subparagraph, the provisions of subparagraph (A) shall be applied as if the amendments to that subparagraph made by the <short-title>Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023</short-title> had never been made.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="HE210288690C94F448C58909B522375FD"><enum>(c)</enum><header>Additional requirements</header><paragraph id="H050882839E684CE3B6EECB13F4A578EC"><enum>(1)</enum><header>In general</header><text>Section 1915(l)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(l)(4)</external-xref>) is amended—</text><subparagraph id="HB50497D73C524696A74830FDDA7905FB"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>through (D)</quote> and inserting <quote>through (F)</quote>;</text></subparagraph><subparagraph id="H8DFD4501736C49B8B481479330757390"><enum>(B)</enum><text>in subparagraph (D), by adding at and below clause (ii)(II), the following flush sentence:</text><quoted-block style="OLC" display-inline="no-display-inline" id="id5D4049ED357545A3896C820CD84878EB"><quoted-block-continuation-text quoted-block-continuation-text-level="subparagraph">With respect to calendar quarters beginning on or after October 1, 2025, the State shall have in place evidence-based, substance use disorder-specific individual placement criteria and utilization management approaches to ensure placement of an eligible individual in an appropriate level of care and, prior to the approval of a State plan amendment for which approval is sought on or after such date, shall notify the Secretary of how the State will ensure that the requirements of clauses (i) and (ii) will be met.</quoted-block-continuation-text><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph><subparagraph id="H08FA5236BC4D41CCBA8E3B8D7562977C"><enum>(C)</enum><text>by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H4F211BE8948143B8992ACCD66ED5F78F"><subparagraph id="HC5459FF3490E4087B89EB21A7720B341"><enum>(E)</enum><header>Review process</header><text display-inline="yes-display-inline">With respect to calendar quarters beginning on or after October 1, 2025, the State shall have in place a process to review the compliance of eligible institutions for mental diseases with nationally recognized, evidence-based, substance use disorder-specific program standards specified by the State.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph><paragraph id="H320DD7654B79490B9E94550DA6746581"><enum>(2)</enum><header>One-time assessment</header><text display-inline="yes-display-inline">Section 1915(l)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(l)(4)</external-xref>), as amended by paragraph (1), is further amended by adding at the end the following new subparagraph:</text><quoted-block style="OLC" display-inline="no-display-inline" id="H53CD3F9CEBA34947A7133CB94AD2C0BA"><subparagraph id="H0F15EAD750664D3282FBCAB559237600"><enum>(F)</enum><header>Assessment</header><clause id="H85A9C70693BF41C78EAFB47F7DBA49EA"><enum>(i)</enum><header>In general</header><text>The State shall, not later than 12 months after the approval of a State plan amendment described in this subsection (or, in the case such State has such an amendment approved as of September 30, 2023, not later than 12 months after the date of enactment of this subparagraph), commence an assessment of—</text><subclause id="H8540E543C6B64289856F757864610C55"><enum>(I)</enum><text>the availability for individuals enrolled under a State plan under this title (or waiver of such plan) of treatment in—</text><item commented="no" display-inline="no-display-inline" id="id469c72b2683b486fb08da6780736daaf"><enum>(aa)</enum><text display-inline="yes-display-inline">each level of care described in clause (i) of subparagraph (C); and</text></item><item commented="no" display-inline="no-display-inline" id="idefc2e0f23c75497fbb2026bc4509289e"><enum>(bb)</enum><text display-inline="yes-display-inline">each level of care described in clause (ii) of subparagraph (C) at which the State provides medical assistance; and</text></item></subclause><subclause id="H16A4E7ABDC964D18986FE2123A0DF256"><enum>(II)</enum><text>the availability of medication-assisted treatment and medically supervised withdrawal management services for such individuals.</text></subclause></clause><clause id="H2172AB6089604A3DA2F4FC02A20B5B43"><enum>(ii)</enum><header>Required completion</header><text>The State shall complete the assessment described in clause (i) not later than 12 months after the date the State commences such assessment.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7734119066564F43B6F1138F245AA152"><enum>(3)</enum><header>Clarification of levels of care</header><text display-inline="yes-display-inline">Section 1915(l)(7)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396n">42 U.S.C. 1396n(l)(7)(A)</external-xref>) is amended by inserting <quote>(or any successor publication)</quote> before the period. </text></paragraph></subsection></section><enum>IV</enum><header>Medicare Expiring Provisions and Provider Payment Changes</header><section id="idf2feceb4d5cb455bb3d590b1e7b04b87"><enum>401.</enum><header>Extension of funding for quality measure endorsement, input, and selection</header><text display-inline="no-display-inline">Section 1890(d)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395aaa">42 U.S.C. 1395aaa(d)(2)</external-xref>) is amended—</text><paragraph id="idf38d2f9364ba4b30be7e6d39f598910e"><enum>(1)</enum><text>in the first sentence—</text><subparagraph id="id99ff28a7c2df438e9a3fbcf15e07f01f"><enum>(A)</enum><text>by striking <quote>and $20,000,000</quote> and inserting <quote>$20,000,000</quote>; and</text></subparagraph><subparagraph id="id42dafcfc49e74f308d0b6fc7f75c770e"><enum>(B)</enum><text>by inserting the following before the period at the end: <quote>, and $20,000,000 for fiscal year 2024</quote>; and</text></subparagraph></paragraph><paragraph id="id3af5f8508c5744809532c5f7b07013c2"><enum>(2)</enum><text>in the third sentence, by striking <quote>and 2023</quote> and inserting <quote>2023, and 2024</quote>. </text></paragraph></section><section id="H4E6C1A6D36CC4B0DABA180F7648289D6"><enum>402.</enum><header>Extension of funding outreach and assistance for low-income programs</header><subsection id="H533AB852B3F84E05A7BD771DEDA6D248"><enum>(a)</enum><header>State health insurance assistance programs</header><text display-inline="yes-display-inline">Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395b-3">42 U.S.C. 1395b–3</external-xref> note), as amended by section 3306 of the Patient Protection and Affordable Care Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>), section 610 of the American Taxpayer Relief Act of 2012 (<external-xref legal-doc="public-law" parsable-cite="pl/112/240">Public Law 112–240</external-xref>), section 1110 of the Pathway for SGR Reform Act of 2013 (<external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), section 110 of the Protecting Access to Medicare Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/93">Public Law 113–93</external-xref>), section 208 of the Medicare Access and CHIP Reauthorization Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/10">Public Law 114–10</external-xref>), section 50207 of division E of the Bipartisan Budget Act of 2018 (<external-xref legal-doc="public-law" parsable-cite="pl/115/123">Public Law 115–123</external-xref>), section 1402 of division B of the Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (<external-xref legal-doc="public-law" parsable-cite="pl/116/59">Public Law 116–59</external-xref>), section 1402 of division B of the Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 (<external-xref legal-doc="public-law" parsable-cite="pl/116/69">Public Law 116–69</external-xref>), section 103 of division N of the Further Consolidated Appropriations Act, 2020 (<external-xref legal-doc="public-law" parsable-cite="pl/116/94">Public Law 116–94</external-xref>), section 3803 of the CARES Act (<external-xref legal-doc="public-law" parsable-cite="pl/116/136">Public Law 116–136</external-xref>), section 2203 of the Continuing Appropriations Act, 2021 and Other Extensions Act (<external-xref legal-doc="public-law" parsable-cite="pl/116/159">Public Law 116–159</external-xref>), section 1102 of the Further Continuing Appropriations Act, 2021, and Other Extensions Act (<external-xref legal-doc="public-law" parsable-cite="pl/116/215">Public Law 116–215</external-xref>), and section 103 of division CC of the Consolidated Appropriations Act, 2021 (<external-xref legal-doc="public-law" parsable-cite="pl/116/260">Public Law 116–260</external-xref>), is amended—</text><paragraph id="H642E31E9440E431FA1009F7D24DB4779"><enum>(1)</enum><text>in the matter preceding clause (i), by striking <quote>Centers for Medicare & Medicaid Services Program Management Account</quote> and inserting <quote>Administration for Community Living</quote>;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id9e3c6a7a511941e1ad190cab5b6800f1"><enum>(2)</enum><text display-inline="yes-display-inline">in clause (xii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="H17C2A4F7F4C6415680F5CF2D39F68058"><enum>(3)</enum><text>in clause (xiii), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idc8e67415bc094eb78e4eb50ab5e81d97"><enum>(4)</enum><text display-inline="yes-display-inline">by inserting after clause (xiii) the following new clause:</text><quoted-block style="OLC" display-inline="no-display-inline" id="HD0A2A09D107B45AAA3EC5F5CFC6BDCBC"><clause id="H8A054ADF12EC45C997B6DC5179FC4C60"><enum>(xiv)</enum><text display-inline="yes-display-inline">for fiscal year 2024, $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H1A7ED5BE7B3A4EFF826984E76DDA4178"><enum>(b)</enum><header>Area agencies on aging</header><text display-inline="yes-display-inline">Subsection (b)(1)(B) of such section 119, as so amended, is amended—</text><paragraph id="H391BDD42B5A142E09B3ADAE02A51C901"><enum>(1)</enum><text>in clause (xii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph id="HCE2D38EF5021405AA6AA48DE1BA42359"><enum>(2)</enum><text>in clause (xiii), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6f834315f2534b689cc3bc7641c2a227"><enum>(3)</enum><text display-inline="yes-display-inline">by inserting after clause (xiii) the following new clause: </text><quoted-block style="OLC" display-inline="no-display-inline" id="HF3ACBAA71E354A1AA323FE22A250AD23"><clause id="H64D5E7F36122480E8610F058B478ECCA"><enum>(xiv)</enum><text display-inline="yes-display-inline">for fiscal year 2024, $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection id="H3832E1C283844CE7A06BF6614326E545"><enum>(c)</enum><header>Aging and disability resource centers</header><text display-inline="yes-display-inline">Subsection (c)(1)(B) of such section 119, as so amended, is amended—</text><paragraph id="HA0638630E48E4F15805A7810AED0481A"><enum>(1)</enum><text>in clause (xii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idcaf6d3d0dfa1403a8723c0623148d4cc"><enum>(2)</enum><text display-inline="yes-display-inline">in clause (xiii), by striking the comma at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph id="H54B9938867714A688959353B5AF97608"><enum>(3)</enum><text>by inserting after clause (xiii) the following new clause: </text><quoted-block style="OLC" display-inline="no-display-inline" id="H532455809B7749E5A12CE2C96A464155"><clause id="HBCABE190DAE546E18EDEB4C5DB299F2A"><enum>(xiv)</enum><text display-inline="yes-display-inline">for fiscal year 2024, $5,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection><subsection commented="no" id="HA74F10B623564817A53FDA7A4964EFBA"><enum>(d)</enum><header>Coordination of efforts to inform older americans about benefits available under Federal and State programs</header><text display-inline="yes-display-inline">Subsection (d)(2) of such section 119, as so amended, is amended—</text><paragraph commented="no" id="HC66CA82D97A2421D9B19BB8D81BBC6E8"><enum>(1)</enum><text>in clause (xii), by striking <quote>and</quote> at the end;</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id036238e297f84c76bc4df5eb681aebab"><enum>(2)</enum><text display-inline="yes-display-inline">in clause (xiii), by striking the period at the end and inserting <quote>; and</quote>; and</text></paragraph><paragraph commented="no" id="HC4A4267F1E9F4EE1AC44A24AB18D71A2"><enum>(3)</enum><text>by inserting after clause (xiii) the following new clause: </text><quoted-block style="OLC" display-inline="no-display-inline" id="H5B4798951C0A4FB28860BC0C2C69042D"><clause id="H25943A3EC85A4CCDBECAEA38601B9E87"><enum>(xiv)</enum><text display-inline="yes-display-inline">for fiscal year 2024, $15,000,000.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section><section id="HE6B84F13B3FC48329F06FBCD06E34B25"><enum>403.</enum><header>Extension of the work geographic index floor under the Medicare program</header><text display-inline="no-display-inline">Section 1848(e)(1)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(e)(1)(E)</external-xref>) is amended by striking <quote>January 1, 2024</quote> and inserting <quote>January 1, 2025</quote>.</text></section><section section-type="subsequent-section" id="HF18EDCDA0A814C558BC402F2E4C6BE0B"><enum>404.</enum><header>Extending incentive payments for participation in eligible alternative payment models</header><subsection id="HBD9A1D9D12B04271BA425FF42AB88BE4"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1833(z) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l(z)</external-xref>) is amended—</text><paragraph id="HE902B46585914C489216C24E59F12895"><enum>(1)</enum><text>in paragraph (1)(A)—</text><subparagraph id="H8B0B069092F24B4A9D4BDD764F7C1DDA"><enum>(A)</enum><text>by striking <quote>with 2025</quote> and inserting <quote>with 2026</quote>; and</text></subparagraph><subparagraph id="HC7033410BF804145B6F3CF5B66572FEA"><enum>(B)</enum><text>by inserting <quote>, or, with respect to 2026, 1.75 percent</quote> after <quote>3.5 percent</quote>.</text></subparagraph></paragraph><paragraph id="HE633D8B6F90A496C914E9C6C1D096674"><enum>(2)</enum><text>in paragraph (2)—</text><subparagraph id="H4229852EAAC648718F7E9496533EEC3E"><enum>(A)</enum><text>in subparagraph (B)—</text><clause id="H457756D633DE41488EC4FCA1BA6483F0"><enum>(i)</enum><text>in the header, by striking <quote><header-in-text level="subparagraph" style="OLC">2025</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">2026</header-in-text></quote>; and</text></clause><clause id="HC027435F01ED4299AC4146A63A2D31CD"><enum>(ii)</enum><text>in the matter preceding clause (i), by striking <quote>2025</quote> and inserting <quote>2026</quote>;</text></clause></subparagraph><subparagraph id="HE0A226BB35014EB0BA8EBF649548FB6C"><enum>(B)</enum><text>in subparagraph (C)—</text><clause id="H93FF1B1374874D5AB9449D5BB00D58E2"><enum>(i)</enum><text>in the header, by striking <quote><header-in-text level="subparagraph" style="OLC">2026</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">2027</header-in-text></quote>; and</text></clause><clause id="H7CB7873C322542F6A8ACFDFE06772441"><enum>(ii)</enum><text>in the matter preceding clause (i), by striking <quote>2026</quote> and inserting <quote>2027</quote>; and</text></clause></subparagraph><subparagraph id="H7C9B369335754B06B6B9929586029F63"><enum>(C)</enum><text>in subparagraph (D), by striking <quote>and 2025</quote> and inserting <quote>2025, and 2026</quote>; and</text></subparagraph></paragraph><paragraph id="H5F6B1B6A30A649FB9C41035ABD4A78F3"><enum>(3)</enum><text>in paragraph (4)(B), by inserting <quote>, or, with respect to 2026, 1.75 percent</quote> after <quote>3.5 percent</quote>.</text></paragraph></subsection><subsection id="H5824E4722D424A2184C2F847D2A68704"><enum>(b)</enum><header>Conforming amendments</header><text>Section 1848(q)(1)(C)(iii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(q)(1)(C)(iii)</external-xref>) is amended—</text><paragraph id="H06A8E21198D844D7AF30D6ACAFFC9AC0"><enum>(1)</enum><text>in subclause (II), by striking <quote>2025</quote> and inserting <quote>2026</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HF0C1F22489C74BE5B57193AB241FAC62"><enum>(2)</enum><text>in subclause (III), by striking <quote>2026</quote> and inserting <quote>2027</quote>. </text></paragraph></subsection></section><section id="H6097865396F74E5CAA875A2FFEA6A43E"><enum>405.</enum><header>Payment rates for durable medical equipment under the Medicare Program</header><subsection id="H1437D85DE1D84CB6B3826794FBF8D0F4"><enum>(a)</enum><header>Areas other than rural and noncontiguous areas</header><text>The Secretary shall implement section 414.210(g)(9)(v) of title 42, Code of Federal Regulations (or any successor regulation), to apply the transition rule described in the first sentence of such section to all applicable items and services furnished in areas other than rural or noncontiguous areas (as such terms are defined for purposes of such section) through December 31, 2024. </text></subsection><subsection id="H72F42344F9364DE4B993516D38AD116A"><enum>(b)</enum><header>All areas</header><text>The Secretary shall not implement section 414.210(g)(9)(vi) of title 42, Code of Federal Regulations (or any successor regulation) until January 1, 2025. </text></subsection><subsection commented="no" display-inline="no-display-inline" id="H6FA15900F8DA45559074BF7F86C0C246"><enum>(c)</enum><header>Implementation</header><text>Notwithstanding any other provision of law, the Secretary may implement the provisions of this section by program instruction or otherwise. </text></subsection></section><section id="HAABD29DEDFDD420686823828CDEAEE0B"><enum>406.</enum><header>Extending the independence at home medical practice demonstration program under the Medicare program</header><subsection id="HBC6D75CA3200409E9AE00F14ACF72EAC"><enum>(a)</enum><header>In general</header><text>Section 1866E of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc-5">42 U.S.C. 1395cc–5</external-xref>) is amended—</text><paragraph id="H271BD90FE29A4482A1D85E23FD9030C4"><enum>(1)</enum><text>in subsection (e)—</text><subparagraph id="H33B969A67E0E45EBA344D3F567D62A46"><enum>(A)</enum><text>in paragraph (1), by striking <quote>10-year</quote> and inserting <quote>12-year</quote>; and</text></subparagraph><subparagraph commented="no" id="H8C868040A7D44C7ABB1664A9BB880B45"><enum>(B)</enum><text>in paragraph (5)—</text><clause commented="no" id="HE0B849D3CB80446D96E28154A1467CE8"><enum>(i)</enum><text>in the second sentence, by striking <quote>tenth</quote> and inserting <quote>twelfth</quote>; and</text></clause><clause commented="no" id="H08D69D2D2430471A86F8B17259C8D092"><enum>(ii)</enum><text>in the third sentence, by striking <quote>tenth</quote> and inserting <quote>twelfth</quote>; and</text></clause></subparagraph></paragraph><paragraph id="HAE68AD6D1B204A458CF754312BE7BE3E"><enum>(2)</enum><text>in subsection (h), by striking <quote>and $9,000,000 for fiscal year 2021</quote> and inserting <quote>, $9,000,000 for fiscal year 2021, and $3,000,000 for fiscal year 2024</quote>. </text></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="HAD43333CDCD44EF0AE3FB20634072CE5"><enum>(b)</enum><header>Effective date</header><text>The amendments made by subsection (a) shall take effect as if included in the enactment of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>. </text></subsection></section><section commented="no" display-inline="no-display-inline" section-type="subsequent-section" id="id83BBD7FE4CF3491192B8CB3DC3562C9E"><enum>407.</enum><header display-inline="yes-display-inline">Increase in support for physicians and other professionals in adjusting to Medicare payment changes</header><text display-inline="no-display-inline">Section 1848(t)(1)(D) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395w-4">42 U.S.C. 1395w–4(t)(1)(D)</external-xref>) is amended by striking <quote>1.25 percent</quote> and inserting <quote>2.5 percent</quote>. </text></section><section commented="no" display-inline="no-display-inline" section-type="subsequent-section" id="HC39D9586DD534559AE16CC4B772C096A"><enum>408.</enum><header display-inline="yes-display-inline">Revised phase-in of Medicare clinical laboratory test payment changes</header><subsection commented="no" display-inline="no-display-inline" id="HC7932CAFE442405E816C1A17C450CD30"><enum>(a)</enum><header display-inline="yes-display-inline">Revised phase-in of reductions from private payor rate implementation</header><text display-inline="yes-display-inline">Section 1834A(b)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m-1">42 U.S.C. 1395m–1(b)(3)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="HC677CE5359D94003A18293A9AD46DEAC"><enum>(1)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking <quote>through 2026</quote> and inserting <quote>through 2027</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H5FC22DEFCE1F4FB2A574D3C2AC91F245"><enum>(2)</enum><text display-inline="yes-display-inline">in subparagraph (B)—</text><subparagraph commented="no" display-inline="no-display-inline" id="H3C55F343821942769344281BA5B37680"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (ii), by striking <quote>through 2023</quote> and inserting <quote>through 2024</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HDE4F2F4BE72647BE9220B8950965BC6D"><enum>(B)</enum><text display-inline="yes-display-inline">in clause (iii), by striking <quote>2024 through 2026</quote> and inserting <quote>2025 through 2027</quote>.</text></subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H135BFC424F974487AAD277F8E51B6C2D"><enum>(b)</enum><header display-inline="yes-display-inline">Revised Reporting Period for Reporting of Private Sector Payment Rates for Establishment of Medicare Payment Rates</header><text display-inline="yes-display-inline">Section 1834A(a)(1)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395m-1">42 U.S.C. 1395m–1(a)(1)(B)</external-xref>) is amended—</text><paragraph commented="no" display-inline="no-display-inline" id="HBE9BC24B416647BA9F9118757DC4E320"><enum>(1)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>December 31, 2023</quote> and inserting <quote>December 31, 2024</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H0A70CBF0712246FF8C4B0DE4827FFC1E"><enum>(2)</enum><text display-inline="yes-display-inline">in clause (ii)—</text><subparagraph commented="no" display-inline="no-display-inline" id="H68F28EBA2D424FE6AA76174A2BF577E8"><enum>(A)</enum><text display-inline="yes-display-inline">by striking <quote>January 1, 2024</quote> and inserting <quote>January 1, 2025</quote>; and</text></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H9316CBB6155F417494BBD0A643585364"><enum>(B)</enum><text display-inline="yes-display-inline">by striking <quote>March 31, 2024</quote> and inserting <quote>March 31, 2025</quote>. </text></subparagraph></paragraph></subsection></section><section section-type="subsequent-section" id="H59887DE7290A48D599A3FECB8B070A33"><enum>409.</enum><header>Extension of adjustment to calculation of hospice cap amount under Medicare</header><text display-inline="no-display-inline">Section 1814(i)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395f">42 U.S.C. 1395f(i)(2)(B)</external-xref>) is amended—</text><paragraph id="H6152E9887309447482EF0D47480C6BFE"><enum>(1)</enum><text>in clause (ii), by striking <quote>2032</quote> and inserting <quote>2033</quote>; and</text></paragraph><paragraph commented="no" display-inline="no-display-inline" id="H20DDBEBE620049978AC2A51BC982D046"><enum>(2)</enum><text>in clause (iii), by striking <quote>2032</quote> and inserting <quote>2033</quote>. </text></paragraph></section><enum>V</enum><header>Offsets</header><section commented="no" display-inline="no-display-inline" id="H90845081E8B2427CA911395F3DCC5154"><enum>501.</enum><header>Medicaid Improvement Fund</header><text display-inline="no-display-inline">Section 1941(b)(3)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396w-1">42 U.S.C. 1396w–1(b)(3)(A)</external-xref>), as amended by section 2342 of the Continuing Appropriations Act, 2024 and Other Extensions Act (<external-xref legal-doc="public-law" parsable-cite="pl/118/15">Public Law 118–15</external-xref>), is amended by striking <quote>$6,357,117,810</quote> and inserting <quote>$561,000,000</quote>. </text></section><section id="idb30978ba778d4b69b3f30d16484879a5"><enum>502.</enum><header>Medicare Improvement Fund</header><text display-inline="no-display-inline">Section 1898(b)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395iii">42 U.S.C. 1395iii(b)(1)</external-xref>) is amended by striking <quote>$180,000,000</quote> and inserting <quote>756,000,000</quote>.</text></section>December 7, 2023Read twice and placed on the calendar