[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8261 Introduced in House (IH)]

<DOC>






118th CONGRESS
  2d Session
                                H. R. 8261

   To amend title XVIII of the Social Security Act to extend certain 
 flexibilities and payment adjustments under the Medicare program, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 7, 2024

Mr. Schweikert (for himself and Mr. Thompson of California) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and Commerce, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to extend certain 
 flexibilities and payment adjustments under the Medicare program, and 
                          for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preserving Telehealth, Hospital, and 
Ambulance Access Act''.

        TITLE I--PRESERVING PATIENTS' ACCESS TO CARE IN THE HOME

SEC. 101. EXTENSION OF CERTAIN TELEHEALTH FLEXIBILITIES.

    (a) Removing Geographic Requirements and Expanding Originating 
Sites for Telehealth Services.--Section 1834(m) of the Social Security 
Act (42 U.S.C. 1395m) is amended--
            (1) in paragraph (2)(B)(iii), by striking ``ending December 
        31, 2024'' and inserting ``ending December 31, 2026''; and
            (2) in paragraph (4)(C)(iii), by striking ``ending on 
        December 31, 2024'' and inserting ``ending on December 31, 
        2026''.
    (b) Expanding Practitioners Eligible to Furnish Telehealth 
Services.--Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(E)) is amended by striking ``ending on December 31, 2024'' 
and inserting ``ending on December 31, 2026''.
    (c) Extending Telehealth Services for Federally Qualified Health 
Centers and Rural Health Clinics.--Section 1834(m)(8)(A) of the Social 
Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by striking ``ending 
on December 31, 2024'' and inserting ``ending on December 31, 2026''.
    (d) Delaying the In-Person Requirements Under Medicare for Mental 
Health Services Furnished Through Telehealth and Telecommunications 
Technology.--
            (1) Delay in requirements for mental health services 
        furnished through telehealth.--Section 1834(m)(7)(B)(i) of the 
        Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended, 
        in the matter preceding subclause (I), by striking ``on or 
        after'' and all that follows through ``described in section 
        1135(g)(1)(B))'' and inserting ``on or after January 1, 2027''.
            (2) Mental health visits furnished by rural health 
        clinics.--Section 1834(y)(2) of the Social Security Act (42 
        U.S.C. 1395m(y)(2)) is amended by striking ``January 1, 2025'' 
        and all that follows through the period at the end and 
        inserting ``January 1, 2027.''.
            (3) Mental health visits furnished by federally qualified 
        health centers.--Section 1834(o)(4)(B) of the Social Security 
        Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking ``January 
        1, 2025'' and all that follows through the period at the end 
        and inserting ``January 1, 2027.''.
    (e) Allowing for the Furnishing of Audio-Only Telehealth 
Services.--Section 1834(m)(9) of the Social Security Act (42 U.S.C. 
1395m(m)(9)) is amended by striking ``ending on December 31, 2024'' and 
inserting ``ending on December 31, 2026''.
    (f) Extending Use of Telehealth To Conduct Face-to-Face Encounter 
Prior to Recertification of Eligibility for Hospice Care.--Section 
1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)) is amended--
            (1) by striking ``ending on December 31, 2024'' and 
        inserting ``ending on December 31, 2026''; and
            (2) by inserting ``, except that this subclause shall not 
        apply in the case of such an encounter with an individual 
        occurring on or after January 1, 2025, if such individual is 
        located in an area that is subject to a moratorium on the 
        enrollment of hospice programs under this title pursuant to 
        section 1866(j)(7), if such individual is receiving hospice 
        care from a provider that is subject to enhanced oversight 
        under this title pursuant to section 1866(j)(3), or if such 
        encounter is performed by a hospice physician or nurse 
        practitioner who is not enrolled under section 1866(j) and is 
        not an opt-out physician or practitioner (as defined in section 
        1802(b)(6)(D))'' before the semicolon.
    (g) Program Instruction Authority.--The Secretary of Health and 
Human Services may implement the amendments made by this section 
through program instruction or otherwise.

SEC. 102. GUIDANCE ON FURNISHING SERVICES VIA TELEHEALTH TO INDIVIDUALS 
              WITH LIMITED ENGLISH PROFICIENCY.

    (a) In General.--Not later than 1 year after the date of the 
enactment of this section, the Secretary of Health and Human Services, 
in consultation with 1 or more entities from each of the categories 
described in paragraphs (1) through (7) of subsection (b), shall issue 
and disseminate, or update and revise as applicable, guidance for the 
entities described in such subsection on the following:
            (1) Best practices on facilitating and integrating use of 
        interpreters during a telemedicine appointment.
            (2) Best practices on providing accessible instructions on 
        how to access telecommunications systems (as such term is used 
        for purposes of section 1834(m) of the Social Security Act (42 
        U.S.C. 1395m(m)) for individuals with limited English 
        proficiency.
            (3) Best practices on improving access to digital patient 
        portals for individuals with limited English proficiency.
            (4) Best practices on integrating the use of video 
        platforms that enable multi-person video calls furnished via a 
        telecommunications system for purposes of providing 
        interpretation during a telemedicine appointment for an 
        individual with limited English proficiency.
            (5) Best practices for providing patient materials, 
        communications, and instructions in multiple languages, 
        including text message appointment reminders and prescription 
        information.
    (b) Entities Described.--For purposes of subsection (a), an entity 
described in this subsection is an entity in 1 or more of the following 
categories:
            (1) Health information technology service providers, 
        including--
                    (A) electronic medical record companies;
                    (B) remote patient monitoring companies; and
                    (C) telehealth or mobile health vendors and 
                companies.
            (2) Health care providers, including--
                    (A) physicians; and
                    (B) hospitals.
            (3) Health insurers.
            (4) Language service companies.
            (5) Interpreter or translator professional associations.
            (6) Health and language services quality certification 
        organizations.
            (7) Patient and consumer advocates, including such 
        advocates that work with individuals with limited English 
        proficiency.

SEC. 103. ESTABLISHMENT OF MODIFIER FOR RECERTIFICATIONS OF HOSPICE 
              CARE ELIGIBILITY CONDUCTED THROUGH TELEHEALTH.

    Section 1814(a)(7)(D)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(D)(i)(II)), as amended by section 101(f), is further 
amended by inserting ``, provided that, in the case of such an 
encounter occurring on or after the date that is 2 years after the date 
of the enactment of the `Preserving Telehealth, Hospital, and Ambulance 
Access Act', such physician or nurse practitioner includes in any claim 
for such encounter one or more modifiers or codes specified by the 
Secretary to indicate that such encounter was furnished through 
telehealth'' after ``as determined appropriate by the Secretary''.

SEC. 104. EXTENDING ACUTE HOSPITAL CARE AT HOME WAIVER FLEXIBILITIES.

    Section 1866G of the Social Security Act (42 U.S.C. 1395cc-7) is 
amended--
            (1) in subsection (a)(1), by striking ``2024'' and 
        inserting ``2029''; and
            (2) in subsection (b)--
                    (A) in the header, by striking ``Study and Report'' 
                and inserting ``Studies and Reports'';
                    (B) in paragraph (1)--
                            (i) in the matter preceding subparagraph 
                        (A), by striking ``The Secretary'' and 
                        inserting ``Not later than September 30, 2024, 
                        and again not later than September 30, 2028, 
                        the Secretary'';
                            (ii) in clause (vi), by striking ``and'' at 
                        the end;
                            (iii) in clause (vii), by striking the 
                        period and inserting ``; and''; and
                            (iv) by adding at the end the following new 
                        clause:
                            ``(viii) in the case of the second study 
                        conducted under this paragraph, the quality of 
                        care, outcomes, costs, quantity and intensity 
                        of services, and other relevant metrics between 
                        individuals who entered into the Acute Hospital 
                        Care at Home initiative directly from an 
                        emergency department compared with individuals 
                        who entered into the Acute Hospital Care at 
                        Home initiative directly from an existing 
                        inpatient stay in a hospital.''; and
                    (C) in paragraph (2)--
                            (i) in the header, by striking ``Report'' 
                        and inserting ``Reports''; and
                            (ii) by inserting ``and again not later 
                        than September 30, 2028,'' after ``2024,''; and
                            (iii) by striking ``on the study conducted 
                        under paragraph (1).'' and inserting the 
                        following: ``on--
                    ``(A) with respect to the first report submitted 
                under this paragraph, the first study conducted under 
                paragraph (1); and
                    ``(B) with respect to the second report submitted 
                under this paragraph, the second study conducted under 
                paragraph (1).''.

SEC. 105. REPORT ON WEARABLE MEDICAL DEVICES.

    Not later than 18 months after the date of the enactment of this 
Act, the Comptroller General of the United States shall conduct a 
technology assessment of, and submit to Congress a report on, the 
capabilities and limitations of wearable medical devices used to 
support clinical decision-making. Such report shall include a 
description of--
            (1) the potential for such devices to accurately prescribe 
        treatments;
            (2) an examination of the benefits and challenges of 
        artificial intelligence to augment such capabilities; and
            (3) policy options to enhance the benefits and mitigate 
        potential challenges of developing or using such devices.

SEC. 106. ENHANCING CERTAIN PROGRAM INTEGRITY REQUIREMENTS FOR DME 
              UNDER MEDICARE.

    (a) Durable Medical Equipment.--Section 1834(a) of the Social 
Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the 
following new paragraph:
            ``(23) Master list inclusion and claim review for certain 
        items.--
                    ``(A) Master list inclusion.--Beginning January 1, 
                2026, for purposes of the Master List described in 
                section 414.234(b) of title 42, Code of Federal 
                Regulations (or any successor regulation), an item for 
                which payment may be made under this subsection shall 
                be treated as having aberrant billing patterns (as such 
                term is used for purposes of such section) if the 
                Secretary determines that, without explanatory 
                contributing factors (such as furnishing emergent care 
                services), a substantial number of written orders for 
                such items under this subsection are from an ordering 
                physician or applicable practitioner with whom the 
                individual involved does not have a prior relationship, 
                as determined on the basis of prior payment experience.
                    ``(B) Claim review.--With respect to items 
                furnished on or after January 1, 2026 that are included 
                on the Master List pursuant to subparagraph (A), if 
                such an item is not subject to a determination of 
                coverage in advance pursuant to paragraph (15)(C), the 
                Secretary may conduct prepayment review of claims for 
                payment for such item.''.
    (b) Report on Identifying Clinical Diagnostic Laboratory Tests at 
High Risk for Fraud and Effective Mitigation Measures.--Not later than 
January 1, 2026, the Inspector General of the Department of Health and 
Human Services shall submit to Congress a report assessing fraudulent 
claims for clinical diagnostic laboratory tests for which payment may 
be made under section 1834A of the Social Security Act (42 U.S.C. 
1395m-1) and effective tools for reducing such fraudulent claims. The 
report shall include--
            (1) which, if any, clinical diagnostic laboratory tests are 
        identified as being at high risk of fraudulent claims, and an 
        analysis of the factors that contribute to such risk;
            (2) with respect to a clinical diagnostic laboratory test 
        identified under subparagraph (A) as being at high risk of 
        fraudulent claims--
                    (A) the amount payable under such section 1834A 
                with respect to such test;
                    (B) the number of such tests furnished to 
                individuals enrolled under part B of title XVIII of the 
                Social Security Act (42 U.S.C. 1395j et seq.);
                    (C) whether an order for such a test was more 
                likely to come from a provider with whom the individual 
                involved did not have a prior relationship, as 
                determined on the basis of prior payment experience; 
                and
                    (D) the frequency with which a claim for payment 
                under such section 1834A included the payment modifier 
                identified by code 59 or 91; and
            (3) suggested strategies for reducing the number of 
        fraudulent claims made with respect to tests so identified as 
        being at high risk, including--
                    (A) an analysis of whether the Centers for Medicare 
                & Medicaid Services can detect aberrant billing 
                patterns with respect to such tests in a timely manner;
                    (B) any strategies for identifying and monitoring 
                the providers who are outliers with respect to the 
                number of such tests that such providers order; and
                    (C) targeted education efforts to mitigate improper 
                billing for such tests.

     TITLE II--SUSTAINING ACCESS TO HOSPITAL AND EMERGENCY SERVICES

SEC. 201. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT 
              FOR CERTAIN LOW-VOLUME HOSPITALS.

    (a) In General.--Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12)) is amended--
            (1) in subparagraph (B), by striking ``during the portion 
        of fiscal year 2025 beginning on January 1, 2025, and ending on 
        September 30, 2025, and'';
            (2) in subparagraph (C)(i)--
                    (A) in the matter preceding subclause (I)--
                            (i) by striking ``or portion of a fiscal 
                        year''; and
                            (ii) by striking ``2024 and the portion of 
                        fiscal year 2025 beginning on October 1, 2024, 
                        and ending on December 31, 2024'' and inserting 
                        ``2025'';
                    (B) in subclause (III), by striking ``2024 and the 
                portion of fiscal year 2025 beginning on October 1, 
                2024, and ending on December 31, 2024'' and inserting 
                ``2025''; and
                    (C) in subclause (IV), by striking ``the portion of 
                fiscal year 2025 beginning on January 1, 2025, and 
                ending on September 30, 2025, and''; and
            (3) in subparagraph (D)--
                    (A) in the matter preceding clause (i), by striking 
                ``2024 or during the portion of fiscal year 2025 
                beginning on October 1, 2024, and ending on December 
                31, 2024'' and inserting ``2025''; and
                    (B) in clause (ii), by striking `` 2024 and the 
                portion of fiscal year 2025 beginning on October 1, 
                2024, and ending on December 31, 2024'' and inserting 
                ``2025''.
    (b) Implementation.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services may implement the provisions 
of, including the amendments made by, this section by program 
instruction or otherwise.

SEC. 202. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL PROGRAM.

    (a) In General.--Section 1886(d)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
            (1) in clause (i), by striking ``January 1, 2025'' and 
        inserting ``October 1, 2025''; and
            (2) in clause (ii)(II), by striking ``January 1, 2025'' and 
        inserting ``October 1, 2025''.
    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
        amended--
                    (A) in the matter preceding clause (i), by striking 
                ``January 1, 2025'' and inserting ``October 1, 2025''; 
                and
                    (B) in clause (iv), by striking ``2024 and the 
                portion of fiscal year 2025 beginning on October 1, 
                2024, and ending on December 31, 2024'' and inserting 
                ``2025''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``2024, or 
        the portion of fiscal year 2025 beginning on October 1, 2024, 
        and ending on December 31, 2024'' and inserting ``2025''.

SEC. 203. EXTENSION OF ADD-ON PAYMENTS FOR AMBULANCE SERVICES.

    (a) In General.--Section 1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) is amended--
            (1) in paragraph (12)(A), by striking ``January 1, 2025'' 
        and inserting ``October 1, 2025''; and
            (2) in paragraph (13), by striking ``January 1, 2025'' in 
        each place it appears and inserting ``October 1, 2025'' in each 
        such place.
    (b) Program Instruction Authority.--Notwithstanding any other 
provision of law, the Secretary of Health and Human Services may 
implement the provisions of, including amendments made by, this section 
through program instruction or otherwise.

                           TITLE III--OFFSETS

SEC. 301. REVISING PHASE-IN OF MEDICARE CLINICAL LABORATORY TEST 
              PAYMENT CHANGES.

    (a) Revised Phase-In of Reductions From Private Payor Rate 
Implementation.--Section 1834A(b)(3) of the Social Security Act (42 
U.S.C. 1395m-1(b)(3)) is amended--
            (1) in subparagraph (A), by striking ``2027'' and inserting 
        ``2028''; and
            (2) in subparagraph (B)--
                    (A) in clause (ii), by striking ``2024'' and 
                inserting ``2025''; and
                    (B) in clause (iii), by striking ``2025 through 
                2027'' and inserting ``2026 through 2028''.
    (b) Revised Reporting Period for Reporting of Private Sector 
Payment Rates for Establishment of Medicare Payment Rates.--Section 
1834A(a)(1)(B) of the Social Security Act (42 U.S.C. 1395m-1(a)(1)(B)) 
is amended--
            (1) in clause (i), by striking ``2024'' and inserting 
        ``2025''; and
            (2) in clause (ii), by striking ``2025'' each place it 
        appears and inserting ``2026''.
    (c) Implementation.--The Secretary of Health and Human Services may 
implement the amendments made by this section by program instruction or 
otherwise.

SEC. 302. ARRANGEMENTS WITH PHARMACY BENEFIT MANAGERS WITH RESPECT TO 
              PRESCRIPTION DRUG PLANS AND MA-PD PLANS.

    (a) In General.--
            (1) Prescription drug plans.--Section 1860D-12 of the 
        Social Security Act (42 U.S.C. 1395w-112) is amended by adding 
        at the end the following new subsection:
    ``(h) Requirements Relating to Pharmacy Benefit Managers.--For plan 
years beginning on or after January 1, 2027:
            ``(1) Agreements with pharmacy benefit managers.--Each 
        contract entered into with a PDP sponsor under this part with 
        respect to a prescription drug plan offered by such sponsor 
        shall provide that any pharmacy benefit manager acting on 
        behalf of such sponsor has a written agreement with the PDP 
        sponsor under which the pharmacy benefit manager, and any 
        affiliates of such pharmacy benefit manager, as applicable, 
        agree to meet the following requirements:
                    ``(A) No income other than bona fide service 
                fees.--
                            ``(i) In general.--The pharmacy benefit 
                        manager and any affiliate of such pharmacy 
                        benefit manager shall not derive any 
                        remuneration with respect to any services 
                        provided on behalf of any entity or individual, 
                        in connection with the utilization of covered 
                        part D drugs, from any such entity or 
                        individual other than bona fide service fees, 
                        subject to clauses (ii) and (iii).
                            ``(ii) Incentive payments.--For the 
                        purposes of this subsection, an incentive 
                        payment paid by a PDP sponsor to a pharmacy 
                        benefit manager that is performing services on 
                        behalf of such sponsor shall be deemed a `bona 
                        fide service fee'(even if such payment does not 
                        otherwise meet the definition of such term 
                        under paragraph (7)(B)) if such payment is a 
                        flat dollar amount, is consistent with fair 
                        market value (as specified by the Secretary), 
                        is related to services actually performed by 
                        the pharmacy benefit manager or affiliate of 
                        such pharmacy benefit manager, on behalf of the 
                        entity making such payment, in connection with 
                        the utilization of covered part D drugs, and 
                        meets additional requirements, if any, as 
                        determined appropriate by the Secretary.
                            ``(iii) Clarification on rebates and 
                        discounts used to lower costs for covered part 
                        d drugs.--Rebates, discounts, and other price 
                        concessions received by a pharmacy benefit 
                        manager or an affiliate of a pharmacy benefit 
                        manager from manufacturers, even if such price 
                        concessions are calculated as a percentage of a 
                        drug's price, shall not be considered a 
                        violation of the requirements of clause (i) if 
                        they are fully passed through to a PDP sponsor 
                        and are compliant with all regulatory and 
                        subregulatory requirements related to direct 
                        and indirect remuneration for manufacturer 
                        rebates under this part, including in cases 
                        where a PDP sponsor is acting as a pharmacy 
                        benefit manager on behalf of a prescription 
                        drug plan offered by such PDP sponsor.
                            ``(iv) Evaluation of remuneration 
                        arrangements.--Components of subsets of 
                        remuneration arrangements (such as fees or 
                        other forms of compensation paid to or retained 
                        by the pharmacy benefit manager or affiliate of 
                        such pharmacy benefit manager), as determined 
                        appropriate by the Secretary, between pharmacy 
                        benefit managers or affiliates of such pharmacy 
                        benefit managers, as applicable, and other 
                        entities involved in the dispensing or 
                        utilization of covered part D drugs (including 
                        PDP sponsors, manufacturers, pharmacies, and 
                        other entities as determined appropriate by the 
                        Secretary) shall be subject to review by the 
                        Secretary, in consultation with the Office of 
                        the Inspector General of the Department of 
                        Health and Human Services, as determined 
                        appropriate by the Secretary. The Secretary, in 
                        consultation with the Office of the Inspector 
                        General, shall review whether remuneration 
                        under such arrangements is consistent with fair 
                        market value (as specified by the Secretary) 
                        through reviews and assessments of such 
                        remuneration, as determined appropriate.
                            ``(v) Disgorgement.--The pharmacy benefit 
                        manager shall disgorge any remuneration paid to 
                        such pharmacy benefit manager or an affiliate 
                        of such pharmacy benefit manager in violation 
                        of this subparagraph to the PDP sponsor.
                            ``(vi) Additional requirements.--The 
                        pharmacy benefit manager shall--
                                    ``(I) enter into a written 
                                agreement with any affiliate of such 
                                pharmacy benefit manager, under which 
                                the affiliate shall identify and 
                                disgorge any remuneration described in 
                                clause (v) to the pharmacy benefit 
                                manager; and
                                    ``(II) attest, subject to any 
                                requirements determined appropriate by 
                                the Secretary, that the pharmacy 
                                benefit manager has entered into a 
                                written agreement described in 
                                subclause (I) with any relevant 
                                affiliate of the pharmacy benefit 
                                manager.
                    ``(B) Transparency regarding guarantees and cost 
                performance evaluations.--The pharmacy benefit manager 
                shall--
                            ``(i) define, interpret, and apply, in a 
                        fully transparent and consistent manner for 
                        purposes of calculating or otherwise evaluating 
                        pharmacy benefit manager performance against 
                        pricing guarantees or similar cost performance 
                        measurements related to rebates, discounts, 
                        price concessions, or net costs, terms such 
                        as--
                                    ``(I) `generic drug', in a manner 
                                consistent with the definition of the 
                                term under section 423.4 of title 42, 
                                Code of Federal Regulations, or a 
                                successor regulation;
                                    ``(II) `brand name drug', in a 
                                manner consistent with the definition 
                                of the term under section 423.4 of 
                                title 42, Code of Federal Regulations, 
                                or a successor regulation;
                                    ``(III) `specialty drug';
                                    ``(IV) `rebate'; and
                                    ``(V) `discount';
                            ``(ii) identify any drugs, claims, or price 
                        concessions excluded from any pricing guarantee 
                        or other cost performance calculation or 
                        evaluation in a clear and consistent manner; 
                        and
                            ``(iii) where a pricing guarantee or other 
                        cost performance measure is based on a pricing 
                        benchmark other than the wholesale acquisition 
                        cost (as defined in section 1847A(c)(6)(B)) of 
                        a drug, calculate and provide a wholesale 
                        acquisition cost-based equivalent to the 
                        pricing guarantee or other cost performance 
                        measure in the written agreement.
                    ``(C) Provision of information.--
                            ``(i) In general.--Not later than July 1 of 
                        each year, beginning in 2027, the pharmacy 
                        benefit manager shall submit to the PDP 
                        sponsor, and to the Secretary, a report, in 
                        accordance with this subparagraph, and shall 
                        make such report available to such sponsor at 
                        no cost to such sponsor in a format specified 
                        by the Secretary under paragraph (5). Each such 
                        report shall include, with respect to such PDP 
                        sponsor and each plan offered by such sponsor, 
                        the following information with respect to the 
                        previous plan year:
                                    ``(I) A list of all drugs covered 
                                by the plan that were dispensed 
                                including, with respect to each such 
                                drug--
                                            ``(aa) the brand name, 
                                        generic or non-proprietary 
                                        name, and National Drug Code;
                                            ``(bb) the number of plan 
                                        enrollees for whom the drug was 
                                        dispensed, the total number of 
                                        prescription claims for the 
                                        drug (including original 
                                        prescriptions and refills, 
                                        counted as separate claims), 
                                        and the total number of dosage 
                                        units of the drug dispensed;
                                            ``(cc) the number of 
                                        prescription claims described 
                                        in item (bb) by each type of 
                                        dispensing channel through 
                                        which the drug was dispensed, 
                                        including retail, mail order, 
                                        specialty pharmacy, long term 
                                        care pharmacy, home infusion 
                                        pharmacy, or other types of 
                                        pharmacies or providers;
                                            ``(dd) the average 
                                        wholesale acquisition cost, 
                                        listed as cost per day's 
                                        supply, cost per dosage unit, 
                                        and cost per typical course of 
                                        treatment (as applicable);
                                            ``(ee) the average 
                                        wholesale price for the drug, 
                                        listed as cost per day's 
                                        supply, cost per dosage unit, 
                                        and cost per typical course of 
                                        treatment (as applicable);
                                            ``(ff) the total out-of-
                                        pocket spending by plan 
                                        enrollees on such drug after 
                                        application of any benefits 
                                        under the plan, including plan 
                                        enrollee spending through 
                                        copayments, coinsurance, and 
                                        deductibles;
                                            ``(gg) total rebates paid 
                                        by the manufacturer on the drug 
                                        as reported under the Detailed 
                                        DIR Report (or any successor 
                                        report) submitted by such 
                                        sponsor to the Centers for 
                                        Medicare & Medicaid Services;
                                            ``(hh) all other direct or 
                                        indirect remuneration on the 
                                        drug as reported under the 
                                        Detailed DIR Report (or any 
                                        successor report) submitted by 
                                        such sponsor to the Centers for 
                                        Medicare & Medicaid Services;
                                            ``(ii) the average pharmacy 
                                        reimbursement amount paid by 
                                        the plan for the drug in the 
                                        aggregate and disaggregated by 
                                        dispensing channel identified 
                                        in item (cc);
                                            ``(jj) the average National 
                                        Average Drug Acquisition Cost 
                                        (NADAC); and
                                            ``(kk) total manufacturer-
                                        derived revenue, inclusive of 
                                        bona fide service fees, 
                                        attributable to the drug and 
                                        retained by the pharmacy 
                                        benefit manager and any 
                                        affiliate of such pharmacy 
                                        benefit manager.
                                    ``(II) In the case of a pharmacy 
                                benefit manager that has an affiliate 
                                that is a retail, mail order, or 
                                specialty pharmacy, with respect to 
                                drugs covered by such plan that were 
                                dispensed, the following information:
                                            ``(aa) The percentage of 
                                        total prescriptions that were 
                                        dispensed by pharmacies that 
                                        are an affiliate of the 
                                        pharmacy benefit manager for 
                                        each drug.
                                            ``(bb) The interquartile 
                                        range of the total combined 
                                        costs paid by the plan and plan 
                                        enrollees, per dosage unit, per 
                                        course of treatment, per 30-day 
                                        supply, and per 90-day supply 
                                        for each drug dispensed by 
                                        pharmacies that are not an 
                                        affiliate of the pharmacy 
                                        benefit manager and that are 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(cc) The interquartile 
                                        range of the total combined 
                                        costs paid by the plan and plan 
                                        enrollees, per dosage unit, per 
                                        course of treatment, per 30-day 
                                        supply, and per 90-day supply 
                                        for each drug dispensed by 
                                        pharmacies that are an 
                                        affiliate of the pharmacy 
                                        benefit manager and that are 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(dd) The lowest total 
                                        combined cost paid by the plan 
                                        and plan enrollees, per dosage 
                                        unit, per course of treatment, 
                                        per 30-day supply, and per 90-
                                        day supply, for each drug that 
                                        is available from any pharmacy 
                                        included in the pharmacy 
                                        network of such plan.
                                            ``(ee) The difference 
                                        between the average acquisition 
                                        cost of the affiliate, such as 
                                        a pharmacy or other entity that 
                                        acquires prescription drugs, 
                                        that initially acquires the 
                                        drug and the amount reported 
                                        under subclause (I)(jj) for 
                                        each drug.
                                            ``(ff) A list inclusive of 
                                        the brand name, generic or non-
                                        proprietary name, and National 
                                        Drug Code of covered part D 
                                        drugs subject to an agreement 
                                        with a covered entity under 
                                        section 340B of the Public 
                                        Health Service Act for which 
                                        the pharmacy benefit manager or 
                                        an affiliate of the pharmacy 
                                        benefit manager had a contract 
                                        or other arrangement with such 
                                        a covered entity in the service 
                                        area of such plan.
                                    ``(III) Where a drug approved under 
                                section 505(c) of the Federal Food, 
                                Drug, and Cosmetic Act (referred to in 
                                this subclause as the `listed drug') is 
                                covered by the plan, the following 
                                information:
                                            ``(aa) A list of currently 
                                        marketed generic drugs approved 
                                        under section 505(j) of the 
                                        Federal Food, Drug, and 
                                        Cosmetic Act pursuant to an 
                                        application that references 
                                        such listed drug that are not 
                                        covered by the plan, are 
                                        covered on the same formulary 
                                        tier or a formulary tier 
                                        typically associated with 
                                        higher cost-sharing than the 
                                        listed drug, or are subject to 
                                        utilization management that the 
                                        listed drug is not subject to.
                                            ``(bb) The estimated 
                                        average beneficiary cost-
                                        sharing under the plan for a 
                                        30-day supply of the listed 
                                        drug.
                                            ``(cc) Where a generic drug 
                                        listed under item (aa) is on a 
                                        formulary tier typically 
                                        associated with higher cost-
                                        sharing than the listed drug, 
                                        the estimated average cost-
                                        sharing that a beneficiary 
                                        would have paid for a 30-day 
                                        supply of each of the generic 
                                        drugs described in item (aa), 
                                        had the plan provided coverage 
                                        for such drugs on the same 
                                        formulary tier as the listed 
                                        drug.
                                            ``(dd) A written 
                                        justification for providing 
                                        more favorable coverage of the 
                                        listed drug than the generic 
                                        drugs described in item (aa).
                                            ``(ee) The number of 
                                        currently marketed generic 
                                        drugs approved under section 
                                        505(j) of the Federal Food, 
                                        Drug, and Cosmetic Act pursuant 
                                        to an application that 
                                        references such listed drug.
                                    ``(IV) Where a reference product 
                                (as defined in section 351(i) of the 
                                Public Health Service Act) is covered 
                                by the plan, the following information:
                                            ``(aa) A list of currently 
                                        marketed biosimilar biological 
                                        products licensed under section 
                                        351(k) of the Public Health 
                                        Service Act pursuant to an 
                                        application that refers to such 
                                        reference product that are not 
                                        covered by the plan, are 
                                        covered on the same formulary 
                                        tier or a formulary tier 
                                        typically associated with 
                                        higher cost-sharing than the 
                                        reference product, or are 
                                        subject to utilization 
                                        management that the reference 
                                        product is not subject to.
                                            ``(bb) The estimated 
                                        average beneficiary cost-
                                        sharing under the plan for a 
                                        30-day supply of the reference 
                                        product.
                                            ``(cc) Where a biosimilar 
                                        biological product listed under 
                                        item (aa) is on a formulary 
                                        tier typically associated with 
                                        higher cost-sharing than the 
                                        listed drug, the estimated 
                                        average cost-sharing that a 
                                        beneficiary would have paid for 
                                        a 30-day supply of each of the 
                                        biosimilar biological products 
                                        described in item (aa), had the 
                                        plan provided coverage for such 
                                        products on the same formulary 
                                        tier as the reference product.
                                            ``(dd) A written 
                                        justification for providing 
                                        more favorable coverage of the 
                                        reference product than the 
                                        biosimilar biological product 
                                        described in item (aa).
                                            ``(ee) The number of 
                                        currently marketed biosimilar 
                                        biological products licensed 
                                        under section 351(k) of the 
                                        Public Health Service Act, 
                                        pursuant to an application that 
                                        refers to such reference 
                                        product.
                                    ``(V) Total gross spending on 
                                covered part D drugs by the plan, not 
                                net of rebates, fees, discounts, or 
                                other direct or indirect remuneration.
                                    ``(VI) The total amount retained by 
                                the pharmacy benefit manager or an 
                                affiliate of such pharmacy benefit 
                                manager in revenue related to 
                                utilization of covered part D drugs 
                                under that plan, inclusive of bona fide 
                                service fees.
                                    ``(VII) The total spending on 
                                covered part D drugs net of rebates, 
                                fees, discounts, or other direct and 
                                indirect remuneration by the plan.
                                    ``(VIII) An explanation of any 
                                benefit design parameters under such 
                                plan that encourage plan enrollees to 
                                fill prescriptions at pharmacies that 
                                are an affiliate of such pharmacy 
                                benefit manager, such as mail and 
                                specialty home delivery programs, and 
                                retail and mail auto-refill programs.
                                    ``(IX) The following information:
                                            ``(aa) A list of all 
                                        brokers, consultants, advisors, 
                                        and auditors that receive 
                                        compensation from the pharmacy 
                                        benefit manager or an affiliate 
                                        of such pharmacy benefit 
                                        manager for referrals, 
                                        consulting, auditing, or other 
                                        services offered to PDP 
                                        sponsors related to pharmacy 
                                        benefit management services.
                                            ``(bb) The amount of 
                                        compensation provided by such 
                                        pharmacy benefit manager or 
                                        affiliate to each such broker, 
                                        consultant, advisor, and 
                                        auditor.
                                            ``(cc) The methodology for 
                                        calculating the amount of 
                                        compensation provided by such 
                                        pharmacy benefit manager or 
                                        affiliate, for each such 
                                        broker, consultant, advisor, 
                                        and auditor.
                                    ``(X) A list of all affiliates of 
                                the pharmacy benefit manager.
                                    ``(XI) A summary document submitted 
                                in a standardized template developed by 
                                the Secretary that includes such 
                                information described in subclauses (I) 
                                through (X).
                            ``(ii) Written explanation of contracts or 
                        agreements with drug manufacturers.--
                                    ``(I) In general.--The pharmacy 
                                benefit manager shall, not later than 
                                30 days after the finalization of any 
                                contract or agreement between such 
                                pharmacy benefit manager or an 
                                affiliate of such pharmacy benefit 
                                manager and a drug manufacturer (or 
                                subsidiary, agent, or entity affiliated 
                                with such drug manufacturer) that makes 
                                rebates, discounts, payments, or other 
                                financial incentives related to one or 
                                more covered part D drugs or other 
                                prescription drugs, as applicable, of 
                                the manufacturer directly or indirectly 
                                contingent upon coverage, formulary 
                                placement, or utilization management 
                                conditions on any other covered part D 
                                drugs or other prescription drugs, as 
                                applicable, submit to the PDP sponsor a 
                                written explanation of such contract or 
                                agreement.
                                    ``(II) Requirements.--A written 
                                explanation under subclause (I) shall--
                                            ``(aa) include the 
                                        manufacturer subject to the 
                                        contract or agreement, all 
                                        covered part D drugs and other 
                                        prescription drugs, as 
                                        applicable, subject to the 
                                        contract or agreement and the 
                                        manufacturers of such drugs, 
                                        and a high-level description of 
                                        the terms of such contract or 
                                        agreement and how such terms 
                                        apply to such drugs; and
                                            ``(bb) be certified by the 
                                        Chief Executive Officer, Chief 
                                        Financial Officer, or General 
                                        Counsel of such pharmacy 
                                        benefit manager, or affiliate 
                                        of such pharmacy benefit 
                                        manager, as applicable, or an 
                                        individual delegated with the 
                                        authority to sign on behalf of 
                                        one of these officers, who 
                                        reports directly to the 
                                        officer.
                                    ``(III) Definition of other 
                                prescription drugs.--For purposes of 
                                this clause, the term `other 
                                prescription drugs' means prescription 
                                drugs covered as supplemental benefits 
                                under this part or prescription drugs 
                                paid outside of this part.
                    ``(D) Audit rights.--
                            ``(i) In general.--Not less than once a 
                        year, at the request of the PDP sponsor, the 
                        pharmacy benefit manager shall allow for an 
                        audit of the pharmacy benefit manager to ensure 
                        compliance with all terms and conditions under 
                        the written agreement and the accuracy of 
                        information reported under subparagraph (C).
                            ``(ii) Auditor.--The PDP sponsor shall have 
                        the right to select an auditor. The pharmacy 
                        benefit manager shall not impose any 
                        limitations on the selection of such auditor.
                            ``(iii) Provision of information.--The 
                        pharmacy benefit manager shall make available 
                        to such auditor all records, data, contracts, 
                        and other information necessary to confirm the 
                        accuracy of information provided under 
                        subparagraph (C), subject to reasonable 
                        restrictions on how such information must be 
                        reported to prevent redisclosure of such 
                        information.
                            ``(iv) Timing.--The pharmacy benefit 
                        manager must provide information under clause 
                        (iii) and other information, data, and records 
                        relevant to the audit to such auditor within 6 
                        months of the initiation of the audit and 
                        respond to requests for additional information 
                        from such auditor within 30 days after the 
                        request for additional information.
                            ``(v) Information from affiliates.--The 
                        pharmacy benefit manager shall be responsible 
                        for providing to such auditor information 
                        required to be reported under subparagraph (C) 
                        that is owned or held by an affiliate of such 
                        pharmacy benefit manager.
            ``(2) Enforcement.--
                    ``(A) In general.--Each PDP sponsor shall--
                            ``(i) disgorge to the Secretary any amounts 
                        disgorged to the PDP sponsor by a pharmacy 
                        benefit manager under paragraph (1)(A)(v);
                            ``(ii) require, in a written agreement with 
                        any pharmacy benefit manager acting on behalf 
                        of such sponsor or affiliate of such pharmacy 
                        benefit manager, that such pharmacy benefit 
                        manager or affiliate reimburse the PDP sponsor 
                        for any civil money penalty imposed on the PDP 
                        sponsor as a result of the failure of the 
                        pharmacy benefit manager or affiliate to meet 
                        the requirements of paragraph (1) that are 
                        applicable to the pharmacy benefit manager or 
                        affiliate under the agreement; and
                            ``(iii) require, in a written agreement 
                        with any such pharmacy benefit manager acting 
                        on behalf of such sponsor or affiliate of such 
                        pharmacy benefit manager, that such pharmacy 
                        benefit manager or affiliate be subject to 
                        punitive remedies for breach of contract for 
                        failure to comply with the requirements 
                        applicable under paragraph (1).
                    ``(B) Reporting of alleged violations.--The 
                Secretary shall make available and maintain a mechanism 
                for manufacturers, PDP sponsors, pharmacies, and other 
                entities that have contractual relationships with 
                pharmacy benefit managers or affiliates of such 
                pharmacy benefit managers to report, on a confidential 
                basis, alleged violations of paragraph (1)(A) or 
                subparagraph (C).
                    ``(C) Anti-retaliation and anti-coercion.--
                Consistent with applicable Federal or State law, a PDP 
                sponsor shall not--
                            ``(i) retaliate against an individual or 
                        entity for reporting an alleged violation under 
                        subparagraph (B); or
                            ``(ii) coerce, intimidate, threaten, or 
                        interfere with the ability of an individual or 
                        entity to report any such alleged violations.
            ``(3) Certification of compliance.--
                    ``(A) In general.--Each PDP sponsor shall furnish 
                to the Secretary (in a time and manner specified by the 
                Secretary) an annual certification of compliance with 
                this subsection, as well as such information as the 
                Secretary determines necessary to carry out this 
                subsection.
                    ``(B) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed as prohibiting payments related to 
        reimbursement for ingredient costs to any entity that acquires 
        prescription drugs, such as a pharmacy or wholesaler.
            ``(5) Standard formats.--
                    ``(A) In general.--Not later than June 1, 2026, the 
                Secretary shall specify standard, machine-readable 
                formats for pharmacy benefit managers to submit annual 
                reports required under paragraph (1)(C)(i).
                    ``(B) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.
            ``(6) Confidentiality.--
                    ``(A) In general.--Information disclosed by a 
                pharmacy benefit manager, an affiliate of a pharmacy 
                benefit manager, a PDP sponsor, or a pharmacy under 
                this subsection that is not otherwise publicly 
                available or available for purchase shall not be 
                disclosed by the Secretary or a PDP sponsor receiving 
                the information, except that the Secretary may disclose 
                the information for the following purposes:
                            ``(i) As the Secretary determines necessary 
                        to carry out this part.
                            ``(ii) To permit the Comptroller General to 
                        review the information provided.
                            ``(iii) To permit the Director of the 
                        Congressional Budget Office to review the 
                        information provided.
                            ``(iv) To permit the Executive Director of 
                        the Medicare Payment Advisory Commission to 
                        review the information provided.
                            ``(v) To the Attorney General for the 
                        purposes of conducting oversight and 
                        enforcement under this title.
                            ``(vi) To the Inspector General of the 
                        Department of Health and Human Services in 
                        accordance with its authorities under the 
                        Inspector General Act of 1978 (section 406 of 
                        title 5, United States Code), and other 
                        applicable statutes.
                    ``(B) Restriction on use of information.--The 
                Secretary, the Comptroller General, the Director of the 
                Congressional Budget Office, and the Executive Director 
                of the Medicare Payment Advisory Commission shall not 
                report on or disclose information disclosed pursuant to 
                subparagraph (A) to the public in a manner that would 
                identify--
                            ``(i) a specific pharmacy benefit manager, 
                        affiliate, pharmacy, manufacturer, wholesaler, 
                        PDP sponsor, or plan; or
                            ``(ii) contract prices, rebates, discounts, 
                        or other remuneration for specific drugs in a 
                        manner that may allow the identification of 
                        specific contracting parties or of such 
                        specific drugs.
            ``(7) Definitions.--For purposes of this subsection:
                    ``(A) Affiliate.--The term `affiliate' means 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, insofar as such contractor or agent 
                performs any of the functions described under 
                subparagraph (C).
                    ``(B) Bona fide service fee.--The term `bona fide 
                service fee' means a fee that is reflective of the fair 
                market value (as specified by the Secretary) for a bona 
                fide, itemized service actually performed on behalf of 
                an entity, that the entity would otherwise perform (or 
                contract for) in the absence of the service arrangement 
                and that is not passed on in whole or in part to a 
                client or customer, whether or not the entity takes 
                title to the drug. Such fee must be a flat dollar 
                amount and shall not be directly or indirectly based 
                on, or contingent upon--
                            ``(i) drug price, such as wholesale 
                        acquisition cost or drug benchmark price (such 
                        as average wholesale price);
                            ``(ii) the amount of discounts, rebates, 
                        fees, or other direct or indirect remuneration 
                        with respect to covered part D drugs dispensed 
                        to enrollees in a prescription drug plan, 
                        except as permitted pursuant to paragraph 
                        (1)(A)(ii);
                            ``(iii) coverage or formulary placement 
                        decisions or the volume or value of any 
                        referrals or business generated between the 
                        parties to the arrangement; or
                            ``(iv) any other amounts or methodologies 
                        prohibited by the Secretary.
                    ``(C) Pharmacy benefit manager.--The term `pharmacy 
                benefit manager' means any person or entity that, 
                either directly or through an intermediary, acts as a 
                price negotiator or group purchaser on behalf of a PDP 
                sponsor or prescription drug plan, or manages the 
                prescription drug benefits provided by such sponsor or 
                plan, including the processing and payment of claims 
                for prescription drugs, the performance of drug 
                utilization review, the processing of drug prior 
                authorization requests, the adjudication of appeals or 
                grievances related to the prescription drug benefit, 
                contracting with network pharmacies, controlling the 
                cost of covered part D drugs, or the provision of 
                related services. Such term includes any person or 
                entity that carries out one or more of the activities 
                described in the preceding sentence, irrespective of 
                whether such person or entity calls itself a `pharmacy 
                benefit manager'.''.
            (2) MA-PD plans.--Section 1857(f)(3) of the Social Security 
        Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end 
        the following new subparagraph:
                    ``(F) Requirements relating to pharmacy benefit 
                managers.--For plan years beginning on or after January 
                1, 2027, section 1860D-12(h).''.
            (3) Nonapplication of paperwork reduction act.--Chapter 35 
        of title 44, United States Code, shall not apply to the 
        implementation of this subsection.
            (4) Funding.--
                    (A) Secretary.--In addition to amounts otherwise 
                available, there is appropriated to the Centers for 
                Medicare & Medicaid Services Program Management 
                Account, out of any money in the Treasury not otherwise 
                appropriated, $113,000,000 for fiscal year 2025, to 
                remain available until expended, to carry out this 
                subsection.
                    (B) OIG.--In addition to amounts otherwise 
                available, there is appropriated to the Inspector 
                General of the Department of Health and Human Services, 
                out of any money in the Treasury not otherwise 
                appropriated, $20,000,000 for fiscal year 2025, to 
                remain available until expended, to carry out this 
                subsection.
    (b) GAO Study and Report on Certain Reporting Requirements.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on Federal and State reporting 
        requirements for health plans and pharmacy benefit managers 
        related to the transparency of prescription drug costs and 
        prices. Such study shall include an analysis of the following:
                    (A) Federal statutory and regulatory reporting 
                requirements for health plans and pharmacy benefit 
                managers related to prescription drug costs and prices.
                    (B) Selected States' statutory and regulatory 
                reporting requirements for health plans and pharmacy 
                benefit managers related to prescription drug costs and 
                prices.
                    (C) The extent to which the statutory and 
                regulatory reporting requirements identified in 
                subparagraphs (A) and (B) overlap and conflict.
                    (D) The resources required by health plans and 
                pharmacy benefit managers to comply with the reporting 
                requirements described in subparagraphs (A) and (B).
                    (E) Other items determined appropriate by the 
                Comptroller General.
            (2) Report.--Not later than 2 years after the date on which 
        information is first required to be reported under section 
        1860D-12(h)(1)(C) of the Social Security Act, as added by 
        subsection (a)(1), the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for 
        legislation and administrative actions that would streamline 
        and reduce the burden associated with the reporting 
        requirements for health plans and pharmacy benefit managers 
        described in paragraph (1).
    (c) MedPAC Reports on Agreements With Pharmacy Benefit Managers 
With Respect to Prescription Drug Plans and MA-PD Plans.--The Medicare 
Payment Advisory Commission shall submit to Congress the following 
reports:
            (1) Not later than March 31, 2028, a report regarding 
        agreements with pharmacy benefit managers with respect to 
        prescription drug plans and MA-PD plans. Such report shall 
        include--
                    (A) a description of trends and patterns, including 
                relevant averages, totals, and other figures for each 
                of the types of information submitted;
                    (B) an analysis of any differences in agreements 
                and their effects on plan enrollee out-of-pocket 
                spending and average pharmacy reimbursement, and any 
                other impacts; and
                    (C) any recommendations the Commission determines 
                appropriate.
            (2) Not later than March 31, 2030, a report describing any 
        changes with respect to the information described in paragraph 
        (1) over time, together with any recommendations the Commission 
        determines appropriate.

SEC. 303. EXTENDING THE ADJUSTMENT TO THE CALCULATION OF HOSPICE CAP 
              AMOUNTS UNDER THE MEDICARE PROGRAM.

    Section 1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
1395f(i)(2)(B)) is amended--
            (1) in clause (ii), by striking ``2033'' and inserting 
        ``2034''; and
            (2) in clause (iii), by striking ``2033'' and inserting 
        ``2034''.
                                 <all>