[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2840 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 242
118th CONGRESS
  1st Session
                                S. 2840

To improve access to and the quality of primary health care, expand the 
               health workforce, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 19, 2023

  Mr. Sanders (for himself and Mr. Marshall) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

                            November 8, 2023

               Reported by Mr. Sanders, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
To improve access to and the quality of primary health care, expand the 
               health workforce, and for other purposes.

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

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

<DELETED>    (a) Short Title.--This Act may be cited as the 
``Bipartisan Primary Care and Health Workforce Act''.</DELETED>
<DELETED>    (b) Table of Contents.--The table of contents for this Act 
is as follows:</DELETED>

<DELETED>Sec. 1. Short title; table of contents.
<DELETED>TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL 
  HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME 
                                PROGRAMS

<DELETED>Sec. 101. Programs of payments to teaching health centers that 
                            operate graduate medical education 
                            programs.
<DELETED>Sec. 102. Community health centers.
<DELETED>Sec. 103. National Health Service Corps.
<DELETED>Sec. 104. GAO report.
<DELETED>Sec. 105. OIG report.
<DELETED>Sec. 106. Application of provisions.
        <DELETED>TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE

<DELETED>Sec. 201. Rural residency planning and development program.
<DELETED>Sec. 202. Primary care training and enhancement program.
<DELETED>Sec. 203. Telehealth technology-enabled learning program.
<DELETED>Sec. 204. Expanding the number of primary care doctors.
<DELETED>Sec. 205. Nurse education, practice, quality, and retention 
                            grants.
<DELETED>Sec. 206. Nurse faculty loan program.
<DELETED>Sec. 207. Nurse faculty demonstration program.
<DELETED>Sec. 208. Nurse corps scholarship and loan repayment program.
<DELETED>Sec. 209. Grants for primary care nurse residency training 
                            programs.
<DELETED>Sec. 210. State oral health workforce improvement grant 
                            program.
<DELETED>Sec. 211. Oral health training programs.
<DELETED>Sec. 212. Allied health professionals.
<DELETED>Sec. 213. Budgetary treatment.
      <DELETED>TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS

<DELETED>Sec. 301. Banning anticompetitive terms in facility and 
                            insurance contracts that limit access to 
                            higher quality, lower cost care.
<DELETED>Sec. 302. Honest billing requirements applicable to providers.
<DELETED>Sec. 303. Banning facility fees for certain services.
<DELETED>Sec. 304. Prevention and Public Health Fund.

<DELETED>TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL 
  HEALTH SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME 
                           PROGRAMS</DELETED>

<DELETED>SEC. 101. PROGRAMS OF PAYMENTS TO TEACHING HEALTH CENTERS THAT 
              OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.</DELETED>

<DELETED>    (a) Funding.--Section 340H(g)(1) of the Public Health 
Service Act (42 U.S.C. 256h(g)(1)) is amended--</DELETED>
        <DELETED>    (1) by striking ``such sums as may be necessary, 
        not to exceed'';</DELETED>
        <DELETED>    (2) by striking ``2017, and'' and inserting 
        ``2017,''; and</DELETED>
        <DELETED>    (3) by inserting ``and $300,000,000 for each of 
        fiscal years 2024 through 2028,'' after ``2023,''.</DELETED>
<DELETED>    (b) Per Resident Amount.--Section 340H(a)(2) of the Public 
Health Service Act (42 U.S.C. 256h(a)(2)) is amended by adding at the 
end the following: ``Beginning in fiscal year 2024, in accordance with 
paragraph (1), but notwithstanding the capped amount referenced in 
subsections (b)(2) and (d)(2), the qualified teaching health center per 
resident amount for a fiscal year shall be not less than such amount 
for the previous fiscal year.''.</DELETED>
<DELETED>    (c) Amount of Payments.--Section 340H of the Public Health 
Service Act (42 U.S.C. 256h) is amended--</DELETED>
        <DELETED>    (1) in subsection (b)(2)--</DELETED>
                <DELETED>    (A) in subparagraph (A), by striking 
                ``amount of funds appropriated under subsection (g) for 
                such payments for that fiscal year'' and inserting 
                ``total amount of funds available under subsection (g) 
                and any amounts recouped under subsection (f)''; 
                and</DELETED>
                <DELETED>    (B) in subparagraph (B), by striking 
                ``appropriated in a fiscal year under subsection (g)'' 
                and inserting ``available under subsection (g) and any 
                amounts recouped under subsection (f)''; and</DELETED>
        <DELETED>    (2) in subsection (d)(2)(B), by striking ``amount 
        appropriated for such expenses as determined in subsection 
        (g)'' and inserting ``total amount of funds available under 
        subsection (g) and any amounts recouped under subsection 
        (f)''.</DELETED>
<DELETED>    (d) Priority Payments.--Section 340H(a)(3) of Public 
Health Service Act (42 U.S.C. 256h(a)(3)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (A), by striking ``; or'' and 
        inserting a semicolon;</DELETED>
        <DELETED>    (2) in subparagraph (B), by striking the period 
        and inserting ``; or''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
                <DELETED>    ``(C) are located in a State that does not 
                already have a qualified teaching health center 
                receiving funding under this section.''.</DELETED>
<DELETED>    (e) Reporting Requirements.--Section 340H(h)(1) of the 
Public Health Service Act (42 U.S.C. 256h(h)(1)) is amended--</DELETED>
        <DELETED>    (1) by redesignating subparagraph (H) as 
        subparagraph (I); and</DELETED>
        <DELETED>    (2) by inserting after subparagraph (G) the 
        following:</DELETED>
                <DELETED>    ``(H) Of the number of residents described 
                in paragraph (4) who completed their residency 
                training, the number practicing primary care (meaning 
                any of the areas of practice listed in the definition 
                of a primary care residency program in section 749A) 5 
                years following completion of such 
                training.''.</DELETED>
<DELETED>    (f) Guidance.--The Secretary shall update guidance and 
relevant information regarding States described in subparagraph (C) of 
section 340H(a)(3) of the Public Health Service Act (42 U.S.C. 
256h(a)(3)), as amended by subsection (d), and make available model 
templates to assist health centers in such States to establish a 
teaching health center.</DELETED>

<DELETED>SEC. 102. COMMUNITY HEALTH CENTERS.</DELETED>

<DELETED>    (a) Community Health Center Fund.--Section 10503 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2) is 
amended--</DELETED>
        <DELETED>    (1) in subsection (b)(1)(F)--</DELETED>
                <DELETED>    (A) by striking ``2018 and'' and inserting 
                ``2018,''; and</DELETED>
                <DELETED>    (B) by inserting before the semicolon the 
                following: ``, and $5,800,000,000 for each of fiscal 
                years 2024 through 2026''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
<DELETED>    ``(f) Priority Use of Funds.--For fiscal years 2024 
through 2026, with respect to $1,800,000,000 of the amount appropriated 
under subsection (b)(1)(F), the Secretary shall prioritize awards to 
entities for purposes of--</DELETED>
        <DELETED>    ``(1) increasing the number of low-income patients 
        not enrolled in a group health plan or group or individual 
        health insurance coverage who are served by health centers, 
        including through Health Center Program New Access Points 
        described in section 330(e)(6) of the Public Health Service 
        Act, including school-based service sites;</DELETED>
        <DELETED>    ``(2) increasing the required primary health 
        services described in paragraph (1)(A)(i) of section 330(b) of 
        the Public Health Service Act and additional health services 
        (as defined in paragraph (2) of such section) offered by health 
        centers; and</DELETED>
        <DELETED>    ``(3) increasing patient case management, enabling 
        services, and education services, as described in clauses (iii) 
        through (v) of section 330(b)(1)(A) of the Public Health 
        Service Act.''.</DELETED>
<DELETED>    (b) Authorization of Appropriations.--Section 330(r)(1) of 
the Public Health Service Act (42 U.S.C. 254b(r)(1)) is amended--
</DELETED>
        <DELETED>    (1) in subparagraph (G), by striking ``fiscal year 
        2016, and each subsequent fiscal year'' and inserting ``each of 
        fiscal years 2016 through 2023''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
                <DELETED>    ``(H) For each of fiscal years 2024 
                through 2026, $2,200,000,000.</DELETED>
                <DELETED>    ``(I) For fiscal year 2027, and each 
                subsequent fiscal year, the amount appropriated for the 
                preceding fiscal year adjusted by the product of--
                </DELETED>
                        <DELETED>    ``(i) one plus the average 
                        percentage increase in costs incurred per 
                        patient served; and</DELETED>
                        <DELETED>    ``(ii) one plus the average 
                        percentage increase in the total number of 
                        patients served.''.</DELETED>
<DELETED>    (c) Allocation of Funds.--Section 10503 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 254b-2), as amended by 
subsection (a), is further amended by adding at the end the 
following:</DELETED>
<DELETED>    ``(g) Allocation of Funds.--For each of fiscal years 2024 
through 2026, of the amounts appropriated under subsection (b)(1)(F) 
for a fiscal year, the Secretary shall use--</DELETED>
        <DELETED>    ``(1) at least $245,000,000 for awards to support 
        health centers in each State that are receiving awards under 
        section 330 of the Public Health Service Act in extending 
        operating hours, in an amount determined pursuant to a formula 
        and eligibility criteria developed by the Secretary, for the 
        purposes of increasing access to services;</DELETED>
        <DELETED>    ``(2) at least $55,000,000 for awards under this 
        section for health centers to expand school-based services and 
        establish new school-based service sites; and</DELETED>
        <DELETED>    ``(3) such sums as may be necessary for purposes 
        of increasing the amount awarded pursuant to grants or 
        cooperative agreements under section 330 of the Public Health 
        Service Act so that each recipient of such an award receives--
        </DELETED>
                <DELETED>    ``(A) for fiscal year 2024, at least 15 
                percent more than such recipient received for fiscal 
                year 2023; and</DELETED>
                <DELETED>    ``(B) for each of fiscal years 2025 and 
                2026, the amount received in the previous year adjusted 
                by--</DELETED>
                        <DELETED>    ``(i) the percent increase in the 
                        medical component of the consumer price index 
                        for the most recent 12-month period for which 
                        applicable data is available; plus</DELETED>
                        <DELETED>    ``(ii) one percent.''.</DELETED>
<DELETED>    (d) Capital Funding.--Section 10503(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 254b-2(c)) is amended--
</DELETED>
        <DELETED>    (1) in the subsection heading, by inserting ``, 
        Capital Funding'' after ``Construction'';</DELETED>
        <DELETED>    (2) by striking ``There is'' and inserting the 
        following:</DELETED>
        <DELETED>    ``(1) Construction.--There is''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(2) Capital funding.--For the alteration, 
        renovation, construction, equipment, and other capital costs of 
        health centers that receive funding under section 330 of the 
        Public Health Service Act (42 U.S.C. 254b), in addition to 
        amounts otherwise made available for such purpose, there is 
        appropriated to the Secretary of Health and Human Services, out 
        of amounts in the Treasury not otherwise appropriated, 
        $3,000,000,000 for fiscal year 2024, to remain available until 
        September 30, 2026. In awarding amounts appropriated under this 
        paragraph, the Secretary shall prioritize awards related to 
        increasing access to dental and behavioral health 
        services.''.</DELETED>
<DELETED>    (e) Strategic Plan To Improve Health Outcomes Through 
Nutrition.--</DELETED>
        <DELETED>    (1) In general.--Not later than one year after the 
        date of enactment of this Act, the Secretary of Health and 
        Human Services, in consultation with the Secretary of 
        Agriculture, shall submit to the Committee on Health, 
        Education, Labor, and Pensions of the Senate and the Committee 
        on Energy and Commerce of the House of Representatives a 5-year 
        strategic plan to improve health outcomes through nutrition for 
        low-income or uninsured patient populations with severe, 
        complex chronic conditions and one or more diet-related 
        conditions.</DELETED>
        <DELETED>    (2) Report.--In carrying out paragraph (1), the 
        Secretary of Health and Human Services shall--</DELETED>
                <DELETED>    (A) conduct an evaluation of previous and 
                current federally-funded efforts of the Department of 
                Health and Human Services to improve patient outcomes 
                through nutrition interventions, such as medically 
                tailored meals and nutrition counseling; and</DELETED>
                <DELETED>    (B) include in the strategic report 
                recommendations for--</DELETED>
                        <DELETED>    (i) reducing the financial impact 
                        of obesity and preventable chronic conditions 
                        resulting from obesity;</DELETED>
                        <DELETED>    (ii) empowering federally-funded 
                        community health centers, rural health clinics, 
                        and other relevant federally-funded facilities 
                        to provide produce prescriptions, medically 
                        tailored groceries, and medically tailored 
                        meals;</DELETED>
                        <DELETED>    (iii) promoting long-term adoption 
                        of improved nutrition habits, including through 
                        increased culinary education and consumer 
                        nutrition aligned with the most recent Dietary 
                        Guidelines for Americans published under 
                        section 301 of the National Nutrition 
                        Monitoring and Related Research Act of 1990 (7 
                        U.S.C. 5341) and incorporating behavioral 
                        modeling or other novel methods across Federal 
                        programs;</DELETED>
                        <DELETED>    (iv) developing performance and 
                        quality metrics related to the delivery of 
                        produce prescriptions, medically tailored 
                        groceries, and medically tailored meals across 
                        relevant Federal payers to aid in reimbursement 
                        strategies;</DELETED>
                        <DELETED>    (v) developing payment models for 
                        novel obesity care therapies for the treatment 
                        of diabetes that include behavioral and 
                        nutritional and dietary services and 
                        education;</DELETED>
                        <DELETED>    (vi) improving coordination of 
                        care and integrating nutrition services and 
                        resources within federally-funded community 
                        health centers, rural health clinics, and other 
                        federally-funded primary care 
                        facilities;</DELETED>
                        <DELETED>    (vii) bolstering partnerships with 
                        State and local governments and nongovernmental 
                        organizations; and</DELETED>
                        <DELETED>    (viii) addressing geographic 
                        disparities in access to nutrition services and 
                        resources.</DELETED>
<DELETED>    (f) Required Primary Health Services.--</DELETED>
        <DELETED>    (1) In general.--Section 330 of the Public Health 
        Service Act (42 U.S.C. 254b) is amended--</DELETED>
                <DELETED>    (A) in subsection (b)(1)(A)--</DELETED>
                        <DELETED>    (i) in clause (i)--</DELETED>
                                <DELETED>    (I) in subclause (IV), by 
                                striking ``; and'' and inserting a 
                                semicolon;</DELETED>
                                <DELETED>    (II) in subclause (V), by 
                                adding ``and'' after the semicolon; 
                                and</DELETED>
                                <DELETED>    (III) by adding at the end 
                                the following:</DELETED>
                                <DELETED>    ``(VI) appropriate 
                                nutritional and dietary 
                                services;'';</DELETED>
                        <DELETED>    (ii) in clause (ii), by inserting 
                        ``and nutrition services'' after ``mental 
                        health services''; and</DELETED>
                        <DELETED>    (iii) in clause (iii), by 
                        inserting ``nutritional,'' after 
                        ``educational,''; and</DELETED>
                <DELETED>    (B) in subsection (d)(1)(A), by inserting 
                ``or one or more diet-related conditions'' before the 
                semicolon.</DELETED>
        <DELETED>    (2) Implementation of new required primary health 
        service.--Paragraph (4) of section 330(e) of the Public Health 
        Service Act (42 U.S.C. 254b(e)) is amended to read as 
        follows:</DELETED>
        <DELETED>    ``(4) Limitation.--Not more than 2 grants may be 
        made under paragraph (1)(B) for the same entity, except that 
        such limitation shall not apply for the period of 2 years 
        beginning on the date of enactment of the Bipartisan Primary 
        Care and Health Workforce Act, in any case where the only basis 
        upon which paragraph (1)(B) applies to a health center is that 
        the health center is not in noncompliance with the requirements 
        under subsection (b)(1)(A)(i)(VI) to provide appropriate 
        nutritional and dietary services.''.</DELETED>
<DELETED>    (g) Increase the Use of Provider Tools To Improve Health 
Outcomes.--Not later than one year after the date of enactment of this 
Act, the Secretary of Health and Human Services, in consultation with 
the Secretary of Agriculture, shall submit to Congress a report that 
includes--</DELETED>
        <DELETED>    (1) recommendations for States to support the 
        coordination of federally-funded nutrition programs and 
        services provided by health care professionals in community 
        health centers; and</DELETED>
        <DELETED>    (2) data on the number of individuals enrolled in 
        federally-subsidized health insurance coverage who are also 
        enrolled in or eligible for federally-subsidized nutrition and 
        food programs.</DELETED>

<DELETED>SEC. 103. NATIONAL HEALTH SERVICE CORPS.</DELETED>

<DELETED>    Section 10503(b)(2) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 254b-2(b)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (G), by striking ``; and'' and 
        inserting a semicolon;</DELETED>
        <DELETED>    (2) in subparagraph (H), by striking the period 
        and inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
                <DELETED>    ``(I) $950,000,000 for each of fiscal 
                years 2024 through 2026.''.</DELETED>

<DELETED>SEC. 104. GAO REPORT.</DELETED>

<DELETED>    (a) In General.--Not later than one year after the date of 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Health, Education, Labor, and Pensions 
of the Senate and the Committee on Energy and Commerce of the House of 
Representatives a report assessing the effectiveness of the National 
Health Service Corps (referred to in this section as the ``NHSC'') at 
attracting health care professionals to health professional shortage 
areas designated under section 332 of the Public Health Service Act (42 
U.S.C. 254e) (referred to in this section as ``HPSAs''), such as by--
</DELETED>
        <DELETED>    (1) assessing the metrics used by the Health 
        Resources and Services Administration in evaluating the 
        program;</DELETED>
        <DELETED>    (2) comparing the retention rates of NHSC 
        participants in the HPSAs where they completed their period of 
        obligated service to the retention rate of non-NHSC 
        participants in the corresponding HPSAs;</DELETED>
        <DELETED>    (3) comparing the retention rates of NHSC 
        participants in the HPSAs where they completed their period of 
        obligated service to the retention rates of NHSC participants 
        in HPSAs other than those where they completed their period of 
        obligated service;</DELETED>
        <DELETED>    (4) identifying factors that influence a NHSC 
        participant's decision to practice in a HPSA other than the 
        HPSA where they completed their period of obligated 
        service;</DELETED>
        <DELETED>    (5) identifying factors other than participation 
        in the National Health Service Corps Scholarship and Loan 
        Repayment Programs that attract health care professionals to a 
        HPSA;</DELETED>
        <DELETED>    (6) assessing the impact the NHSC has on wages for 
        health care professionals in a HPSA; and</DELETED>
        <DELETED>    (7) comparing the distribution of NHSC 
        participants across HPSAs, including a comparison of rural 
        versus non-rural HPSAs.</DELETED>
<DELETED>    (b) Definition.--In this section, the term ``NHSC 
participant'' means a National Health Service Corps member 
participating in the National Health Service Corps Scholarship or Loan 
Repayment Program under subpart III of part D of title III of the 
Public Health Service Act (42 U.S.C. 254l et seq.).</DELETED>

<DELETED>SEC. 105. OIG REPORT.</DELETED>

<DELETED>    Not later than 2 years after the date of enactment of this 
Act, the Inspector General of the Department of Health and Human 
Services shall submit to Congress a report on integrity efforts of the 
Health Resources and Services Administration with respect to programs 
carried out by the Health Resources and Services Administration. Such 
report shall include an assessment of--</DELETED>
        <DELETED>    (1) the ways in which the Administrator of the 
        Health Resources and Services Administration (referred to in 
        this section as the ``Administrator'') determines reasonable 
        efforts are continuously made to establish and maintain 
        collaborative relationships with health care 
        providers;</DELETED>
        <DELETED>    (2) the ways in which the Administrator ensures 
        quality and continuity of care for underserved areas; 
        and</DELETED>
        <DELETED>    (3) the extent to which the Administrator 
        validates the financial responsibility of and use of grant 
        funding by community health centers.</DELETED>

<DELETED>SEC. 106. APPLICATION OF PROVISIONS.</DELETED>

<DELETED>    (a) In General.--Amounts appropriated pursuant to the 
amendments made by this title shall be subject to the requirements 
contained in Public Law 117-328 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act (42 U.S.C. 
254b through 256).</DELETED>
<DELETED>    (b) Conforming Amendment.--Paragraph (4) of section 
3014(h) of title 18, United States Code, ``and section 301(d) of 
division BB of the Consolidated Appropriations Act, 2021.'' and 
inserting ``section 301(d) of division BB of the Consolidated 
Appropriations Act, 2021, and section 106(a) of the Bipartisan Primary 
Care and Health Workforce Act''.</DELETED>

   <DELETED>TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE</DELETED>

<DELETED>SEC. 201. RURAL RESIDENCY PLANNING AND DEVELOPMENT 
              PROGRAM.</DELETED>

<DELETED>    Title III of the Public Health Service Act (42 U.S.C. 241 
et seq.) is amended by inserting after section 330A-2 the 
following:</DELETED>

<DELETED>``SEC. 330A-3. RURAL RESIDENCY PLANNING AND DEVELOPMENT 
              PROGRAM AND RURAL RESIDENCY PLANNING AND DEVELOPMENT 
              TECHNICAL ASSISTANCE PROGRAM.</DELETED>

<DELETED>    ``(a) Definition of Rural Residency Program.--In this 
section, the term `rural residency program' means a physician residency 
program, including a rural track program, accredited by the 
Accreditation Council for Graduate Medical Education (or a similar 
body) that--</DELETED>
        <DELETED>    ``(1) trains residents in rural areas (as defined 
        by the Secretary) for more than 50 percent of the total time of 
        their residency; and</DELETED>
        <DELETED>    ``(2) primarily focuses on producing physicians 
        who will practice in rural areas, as defined by the 
        Secretary.</DELETED>
<DELETED>    ``(b) Rural Residency Planning and Development Program.--
</DELETED>
        <DELETED>    ``(1) Definition of eligible entity.--In this 
        subsection, the term `eligible entity'--</DELETED>
                <DELETED>    ``(A) means--</DELETED>
                        <DELETED>    ``(i) a domestic public or private 
                        nonprofit or for-profit entity;</DELETED>
                        <DELETED>    ``(ii) an Indian Tribe, Tribal 
                        health program, Tribal organization, or Urban 
                        Indian organization (as such terms are defined 
                        in section 4 of the Indian Health Care 
                        Improvement Act); or</DELETED>
                        <DELETED>    ``(iii) a Native Hawaiian Health 
                        organization as defined in section 12 of the 
                        Native Hawaiian Health Care Improvement; 
                        and</DELETED>
                <DELETED>    ``(B) may include faith-based or 
                community-based organizations, rural hospitals, rural 
                community-based ambulatory patient care centers 
                (including rural health clinics), health centers 
                operated by a Native Hawaiian Health organization 
                (defined as described in subparagraph (A)(iii)), an 
                Indian Tribe, a Tribal health program, a Tribal 
                organization, or an Urban Indian organization (defined 
                as described in subparagraph (A)(ii)), graduate medical 
                education consortiums (including institutions of higher 
                education, such as schools of allopathic medicine, 
                schools of osteopathic medicine, or historically Black 
                colleges or universities (as defined by the term `part 
                B institution' in section 322 of the Higher Education 
                Act of 1965 or described in section 326(e)(1) of the 
                Higher Education Act of 1965) or other minority-serving 
                institutions (as described in section 371(a) of the 
                Higher Education Act of 1965), or other organizations 
                as determined appropriate by the Secretary.</DELETED>
        <DELETED>    ``(2) Grants.--</DELETED>
                <DELETED>    ``(A) In general.--The Secretary may award 
                grants to eligible entities to create new rural 
                residency programs (including adding new rural training 
                sites to existing rural track programs).</DELETED>
                <DELETED>    ``(B) Funding.--Grants awarded under this 
                subsection may be fully funded at the time of the 
                award.</DELETED>
                <DELETED>    ``(C) Term.--The term of a grant under 
                this subsection shall be 4 years and may be extended at 
                the discretion of the Secretary.</DELETED>
        <DELETED>    ``(3) Applications.--</DELETED>
                <DELETED>    ``(A) In general.--To be eligible to 
                receive a grant under this subsection, an eligible 
                entity shall prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require, including a description of the pathway of the 
                rural residency program as described in subparagraph 
                (B).</DELETED>
                <DELETED>    ``(B) Pathway.--A pathway of a rural 
                residency program supported under this subsection shall 
                be for--</DELETED>
                        <DELETED>    ``(i) general primary care and 
                        high-need specialty care, including family 
                        medicine, internal medicine, preventive 
                        medicine, psychiatry, or general 
                        surgery;</DELETED>
                        <DELETED>    ``(ii) maternal health and 
                        obstetrics, which may be obstetrics and 
                        gynecology or family medicine with enhanced 
                        obstetrical training; or</DELETED>
                        <DELETED>    ``(iii) any other pathway as 
                        determined appropriate by the 
                        Secretary.</DELETED>
<DELETED>    ``(c) Rural Residency Planning and Development Technical 
Assistance.--</DELETED>
        <DELETED>    ``(1) Definition of eligible entity.--In this 
        subsection, the term `eligible entity' means--</DELETED>
                <DELETED>    ``(A) a domestic public or private 
                nonprofit or for-profit entity; or</DELETED>
                <DELETED>    ``(B) an Indian Tribe or Tribal 
                organization (as such terms are defined in section 4 of 
                the Indian Health Care Improvement Act).</DELETED>
        <DELETED>    ``(2) Grants.--</DELETED>
                <DELETED>    ``(A) In general.--The Secretary may award 
                grants to eligible entities to provide technical 
                assistance to awardees of and potential applicants of 
                the program described in subsection (b).</DELETED>
                <DELETED>    ``(B) Funding.--Grants awarded under this 
                subsection may be fully funded at the time of the 
                award.</DELETED>
                <DELETED>    ``(C) Term.--The term of a grant under 
                this subsection shall be 4 years and may be extended at 
                the discretion of the Secretary.</DELETED>
        <DELETED>    ``(3) Applications.--To be eligible to receive a 
        grant under this subsection, an eligible entity shall prepare 
        and submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require.</DELETED>
<DELETED>    ``(d) Authorization of Appropriations.--There is 
authorized to be appropriated to carry out this section $13,000,000 for 
fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for 
fiscal year 2026, to remain available until expended.''.</DELETED>

<DELETED>SEC. 202. PRIMARY CARE TRAINING AND ENHANCEMENT 
              PROGRAM.</DELETED>

<DELETED>    Section 747(c)(1) of the Public Health Service Act (42 
U.S.C. 293k(c)(1)) is amended--</DELETED>
        <DELETED>    (1) by striking ``$48,924,000 for each of fiscal 
        years 2021 through 2025'' and inserting ``$49,250,000 for 
        fiscal year 2024, $49,500,000 for fiscal year 2025, and 
        $50,000,000 for fiscal year 2026''; and</DELETED>
        <DELETED>    (2) by striking ``subsection (b)(1)(B)'' and 
        inserting ``subsections (b)(1)(B) and (c)''.</DELETED>

<DELETED>SEC. 203. TELEHEALTH TECHNOLOGY-ENABLED LEARNING 
              PROGRAM.</DELETED>

<DELETED>    Section 330N(k) of the Public Health Service Act (42 
U.S.C. 254c-20(k)) is amended by striking ``2026'' and inserting 
``2025, and $11,000,000 for each of fiscal years 2026 through 2028, to 
remain available until expended''.</DELETED>

<DELETED>SEC. 204. EXPANDING THE NUMBER OF PRIMARY CARE 
              DOCTORS.</DELETED>

<DELETED>    Section 747 of the Public Health Service Act (42 U.S.C. 
293k), as amended by section 202, is further amended--</DELETED>
        <DELETED>    (1) by redesignating subsection (c) as subsection 
        (d); and</DELETED>
        <DELETED>    (2) by inserting after subsection (b) the 
        following:</DELETED>
<DELETED>    ``(c) Expanding the Number of Primary Care Doctors.--
</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall award 
        grants to eligible medical schools described in paragraph (2) 
        for the purpose of graduating more physicians who will practice 
        a primary care discipline. Funds awarded under this subsection 
        may be used for costs associated with faculty, construction and 
        capital improvements, clinical support, research support, 
        student supports, and any other costs, as determined by the 
        Secretary.</DELETED>
        <DELETED>    ``(2) Eligibility.--To be eligible to receive a 
        grant under this subsection, a medical school shall--</DELETED>
                <DELETED>    ``(A) be a nonprofit school of medicine or 
                osteopathic medicine that is accredited by a nationally 
                recognized accrediting agency or association; 
                and</DELETED>
                <DELETED>    ``(B) demonstrate in the grant application 
                of the medical school--</DELETED>
                        <DELETED>    ``(i) that not less than 33 
                        percent of graduates from the medical school 
                        enter primary care and are, as of the date of 
                        the application, practicing primary care, as 
                        calculated by dividing--</DELETED>
                                <DELETED>    ``(I) the number of 
                                physicians who graduated during such 
                                time period as is specified by the 
                                Secretary who are practicing primary 
                                care; by</DELETED>
                                <DELETED>    ``(II) the total number of 
                                physicians who graduated during such 
                                time period; and</DELETED>
                        <DELETED>    ``(ii) a plan to expand the number 
                        of graduates of the medical school who are 
                        practicing primary care; and</DELETED>
                        <DELETED>    ``(iii) a commitment to use grant 
                        funds to supplement, not supplant, such 
                        school's investment in primary care medical 
                        education.</DELETED>
        <DELETED>    ``(3) Expanding the number of minority primary 
        care doctors.--Of the amounts appropriated under paragraph 
        (6)(C), the Secretary shall awards not less than 20 percent to 
        eligible medical schools described in paragraph (2) that are 
        historically Black colleges and universities (as defined by the 
        term `part B institution' in section 322 of the Higher 
        Education Act of 1965 (20 U.S.C. 1061) or described in section 
        326(e)(1) of such Act (20 U.S.C. 1063b(e)(1))) or other 
        minority-serving institutions (as described in section 371(a) 
        of the Higher Education Act of 1965 (20 U.S.C. 
        1067q(a))).</DELETED>
        <DELETED>    ``(4) Grant amounts; geographic distribution.--
        </DELETED>
                <DELETED>    ``(A) Grant amounts.--The Secretary shall 
                determine the amount of each grant awarded under this 
                subsection, which shall be based on the scope of the 
                plan submitted by the medical school under paragraph 
                (2)(B)(ii), and other appropriate factors.</DELETED>
                <DELETED>    ``(B) Geographic distribution.--In 
                awarding grants under this subsection, the Secretary 
                shall ensure, to the greatest extent practicable, that 
                such grants are equitably distributed among the 
                geographic regions of the United States.</DELETED>
        <DELETED>    ``(5) Primary care.--In this subsection, the term 
        `primary care' means health care services related to family 
        medicine, internal medicine, pediatrics, obstetrics, 
        gynecology, geriatrics, or psychiatry.</DELETED>
        <DELETED>    ``(6) Account to address the primary care 
        physician shortage.--</DELETED>
                <DELETED>    ``(A) Establishment of account.--There is 
                established in the Treasury an account, to be known as 
                the `Account to Address the Primary Care Physician 
                Shortage' (referred to in this subsection as the 
                `Account'), for purposes of carrying out this 
                subsection.</DELETED>
                <DELETED>    ``(B) Transfer of direct spending.--
                </DELETED>
                        <DELETED>    ``(i) In general.--The Secretary 
                        of the Treasury shall transfer, from the 
                        general fund of the Treasury, to the Account 
                        $300,000,000 for fiscal year 2024.</DELETED>
                        <DELETED>    ``(ii) Amounts deposited.--Any 
                        amounts transferred under clause (i) shall 
                        remain unavailable in the Account until such 
                        amounts are appropriated pursuant to 
                        subparagraph (C).</DELETED>
                <DELETED>    ``(C) Appropriations.--</DELETED>
                        <DELETED>    ``(i) Authorization of 
                        appropriations.--For the period of fiscal years 
                        2024 through 2026, there is authorized to be 
                        appropriated from the Account to the Secretary, 
                        for the purpose of carrying out the activities 
                        under this subsection, an amount not to exceed 
                        the total amount transferred to the Account 
                        under subparagraph (B)(i).</DELETED>
                        <DELETED>    ``(ii) Offsetting future 
                        appropriations.--For fiscal years 2024 through 
                        2026, for any discretionary appropriation under 
                        the heading `Account to Address the Primary 
                        Care Physician Shortage' provided to the 
                        Secretary pursuant to the authorization of 
                        appropriations under clause (i) for the purpose 
                        of carrying out this subsection, the total 
                        amount of such appropriations for the 
                        applicable fiscal year (not to exceed the total 
                        amount remaining in the Account) shall be 
                        subtracted from the estimate of discretionary 
                        budget authority and the resulting outlays for 
                        any estimate under the Congressional Budget and 
                        Impoundment Control Act of 1974 or the Balanced 
                        Budget and Emergency Deficit Control Act of 
                        1985, and the amount transferred to the Account 
                        shall be reduced by the same amount.</DELETED>
        <DELETED>    ``(7) Annual reports.--Not later than October 1 of 
        fiscal years 2025 through 2027, the Secretary shall submit to 
        the Committee on Health, Education, Labor, and Pensions and the 
        Committee on Appropriations of the Senate and the Committee on 
        Energy and Commerce and the Committee on Appropriations of the 
        House of Representatives, a report including a description of 
        any use of funds provided pursuant to the authorization of 
        appropriations under paragraph (6)(C).</DELETED>
        <DELETED>    ``(8) Limitations.--Notwithstanding any transfer 
        authority authorized by this subsection or any appropriations 
        Act, any funds made available pursuant to the authorization of 
        appropriations under paragraph (6)(C) may not be used for any 
        purpose other than the program established under paragraph 
        (1).</DELETED>
        <DELETED>    ``(9) Sunset.--Amounts remaining unappropriated in 
        the Account under this subsection shall be transferred back to 
        the general fund of the Treasury on October 1, 
        2026.''.</DELETED>

<DELETED>SEC. 205. NURSE EDUCATION, PRACTICE, QUALITY, AND RETENTION 
              GRANTS.</DELETED>

<DELETED>    (a) Reauthorization.--Section 831 of the Public Health 
Service Act (42 U.S.C. 296p) is amended by adding at the end the 
following:</DELETED>
<DELETED>    ``(g) Authorization of Appropriations.--To carry out this 
section (other than subsection (e)), in addition to amounts made 
available under section 871(a), there are authorized to be appropriated 
$59,413,000 for each of fiscal years 2024 through 2026, to remain 
available until expended.''.</DELETED>
<DELETED>    (b) Expanding Associate Degree Nursing Programs.--Section 
831 of the Public Health Service Act (42 U.S.C. 296p), as amended by 
subsection (a), is further amended--</DELETED>
        <DELETED>    (1) by redesignating subsections (e) through (g) 
        as subsections (f) through (h), respectively; and</DELETED>
        <DELETED>    (2) by inserting after subsection (d) the 
        following:</DELETED>
<DELETED>    ``(e) Supplemental Appropriations Expanding Associate 
Degree Nursing Programs.--</DELETED>
        <DELETED>    ``(1) Authorization.--The Secretary shall award 
        grants to institutions of higher education (as defined in 
        section 101 of the Higher Education Act of 1965) offering an 
        accredited registered nursing program at the associate degree 
        level for the purpose of expanding the number of students 
        enrolled in each such program.</DELETED>
        <DELETED>    ``(2) Use of funds.--A recipient of a grant under 
        this subsection shall use the grant funds to expand the number 
        of students enrolled in the recipient's accredited registered 
        nursing program, which may include increasing nurse faculty and 
        nurse faculty salaries, expanding the number of qualified 
        preceptors at clinical rotations sites, providing direct 
        support for students, supporting partnerships with health 
        facilities for clinical training, purchasing and training 
        faculty to use distance learning technologies and simulation 
        equipment, alteration, renovation, construction, equipment, and 
        other capital improvement costs, and other projects determined 
        appropriate by the Secretary.</DELETED>
        <DELETED>    ``(3) Determination of number of students and 
        application.--Each institution of higher education that offers 
        a program described in paragraph (1) that desires to receive a 
        grant under this subsection shall--</DELETED>
                <DELETED>    ``(A) provide documentation from the last 
                4 academic years, or number of academic years the 
                program has been accredited if less than 4, 
                demonstrating the average percentage of individuals who 
                graduated from the nursing degree program with an 
                associate degree within 150 percent of the expected 
                completion time designated for the program; 
                and</DELETED>
                <DELETED>    ``(B) submit an application to the 
                Secretary at such time, in such manner, and accompanied 
                by such information as the Secretary may require, 
                including the average percent of individuals determined 
                under subparagraph (A).</DELETED>
        <DELETED>    ``(4) Definition.--For purposes of this 
        subsection, the term `health facility' means an Indian health 
        service center, a Native Hawaiian health center, a Federally 
        qualified health center, a rural health clinic, a nursing home, 
        a home health agency, a hospice program, a public health 
        clinic, a State or local department of public health, a skilled 
        nursing facility, or an ambulatory surgical center.</DELETED>
        <DELETED>    ``(5) Account to address the nursing workforce 
        shortage.--</DELETED>
                <DELETED>    ``(A) Establishment of account.--There is 
                established in the Treasury an account, to be known as 
                the `Account to Address the Nursing Workforce Shortage' 
                (referred to in this subsection as the `Account'), for 
                purposes of carrying out this subsection, in addition 
                to amounts otherwise made available, including under 
                section 871(a).</DELETED>
                <DELETED>    ``(B) Transfer of direct spending.--
                </DELETED>
                        <DELETED>    ``(i) In general.--The Secretary 
                        of the Treasury shall transfer, from the 
                        general fund of the Treasury, to the Account 
                        $240,000,000 for each of fiscal years 2024 
                        through 2028.</DELETED>
                        <DELETED>    ``(ii) Amounts deposited.--Any 
                        amounts transferred under clause (i) shall 
                        remain unavailable in the Account until such 
                        amounts are appropriated pursuant to 
                        subparagraph (C).</DELETED>
                <DELETED>    ``(C) Appropriations.--</DELETED>
                        <DELETED>    ``(i) Authorization of 
                        appropriations.--For each of fiscal years 2024 
                        through 2028, there is authorized to be 
                        appropriated from the Account to the Secretary, 
                        for the purpose of carrying out the activities 
                        under this subsection, in addition to amounts 
                        otherwise made available for such purpose, an 
                        amount not to exceed the total amount 
                        transferred to the Account under subparagraph 
                        (B)(i).</DELETED>
                        <DELETED>    ``(ii) Offsetting future 
                        appropriations.--For any of fiscal years 2024 
                        through 2028, for any discretionary 
                        appropriation under the heading `Account to 
                        Address the Nursing Workforce Shortage' 
                        provided to the Secretary pursuant to the 
                        authorization of appropriations under clause 
                        (i) for an additional amount for carrying out 
                        this subsection, the total amount of such 
                        appropriations for the applicable fiscal year 
                        (not to exceed the total amount remaining in 
                        the Account) shall be subtracted from the 
                        estimate of discretionary budget authority and 
                        the resulting outlays for any estimate under 
                        the Congressional Budget and Impoundment 
                        Control Act of 1974 or the Balanced Budget and 
                        Emergency Deficit Control Act of 1985, and the 
                        amount transferred to the Account shall be 
                        reduced by the same amount.</DELETED>
        <DELETED>    ``(6) Annual reports.--Not later than October 1 of 
        fiscal years 2025 through 2029, the Secretary shall submit to 
        the Committee on Health, Education, Labor, and Pensions and the 
        Committee on Appropriations of the Senate and the Committee on 
        Energy and Commerce and the Committee on Appropriations of the 
        House of Representatives, a report including a description of 
        any use of funds provided pursuant to the authorization of 
        appropriations under paragraph (5)(C).</DELETED>
        <DELETED>    ``(7) Limitations.--Notwithstanding any transfer 
        authority authorized by this subsection or any appropriations 
        Act, any funds made available pursuant to the authorization of 
        appropriations under paragraph (5)(C) may not be used for any 
        purpose other than the program established under paragraph 
        (1).</DELETED>
        <DELETED>    ``(8) Sunset.--Amounts remaining unappropriated in 
        the Account under this subsection shall be transferred back to 
        the general fund of the Treasury on October 1, 
        2028.''.</DELETED>

<DELETED>SEC. 206. NURSE FACULTY LOAN PROGRAM.</DELETED>

<DELETED>    Section 846A of the Public Health Service Act (42 U.S.C. 
297n-1), as amended by section 207, is amended by inserting after 
subsection (b) the following:</DELETED>
<DELETED>    ``(c) Funding.--</DELETED>
        <DELETED>    ``(1) Authorization of appropriations.--</DELETED>
                <DELETED>    ``(A) In general.--To carry out this 
                section (other than subsection (d)), in addition to 
                amounts otherwise made available, including under 
                section 871(b) and paragraph (2), there are authorized 
                to be appropriated $28,500,000 for each of fiscal years 
                2024 through 2026, to remain available until 
                expended.</DELETED>
        <DELETED>    ``(2) Account to address the nurse faculty 
        workforce shortage.--</DELETED>
                <DELETED>    ``(A) Establishment of account.--There is 
                established in the Treasury an account, to be known as 
                the `Account to Address the Nurse Faculty Shortage' 
                (referred to in this paragraph as the `Account'), for 
                purposes of carrying out this section (other than 
                subsection (d)) in addition to amounts otherwise made 
                available, including under section 871(b) and paragraph 
                (1).</DELETED>
                <DELETED>    ``(B) Transfer of direct spending.--
                </DELETED>
                        <DELETED>    ``(i) In general.--The Secretary 
                        of the Treasury shall transfer, from the 
                        general fund of the Treasury, to the Account 
                        $57,000,000 for each of fiscal years 2024 
                        through 2026.</DELETED>
                        <DELETED>    ``(ii) Amounts deposited.--Any 
                        amounts transferred under clause (i) shall 
                        remain unavailable in the Account until such 
                        amounts are appropriated pursuant to 
                        subparagraph (C).</DELETED>
                <DELETED>    ``(C) Appropriations.--</DELETED>
                        <DELETED>    ``(i) Authorization of 
                        appropriations.--For each of fiscal years 2024 
                        through 2026, there is authorized to be 
                        appropriated from the Account to the Secretary, 
                        for the purpose of carrying out the activities 
                        under this section, in addition to amounts 
                        otherwise made available for such purpose, an 
                        amount not to exceed the total amount 
                        transferred to the Account under subparagraph 
                        (B)(i).</DELETED>
                        <DELETED>    ``(ii) Offsetting future 
                        appropriations.--For any of fiscal years 2024 
                        through 2026, for any discretionary 
                        appropriation under the heading `Account to 
                        Address the Nurse Faculty Shortage' provided to 
                        the Secretary pursuant to the authorization of 
                        appropriations under clause (i) for an 
                        additional amount for carrying out this 
                        section, the total amount of such 
                        appropriations for the applicable fiscal year 
                        (not to exceed the total amount remaining in 
                        the Account) shall be subtracted from the 
                        estimate of discretionary budget authority and 
                        the resulting outlays for any estimate under 
                        the Congressional Budget and Impoundment 
                        Control Act of 1974 or the Balanced Budget and 
                        Emergency Deficit Control Act of 1985, and the 
                        amount transferred to the Account shall be 
                        reduced by the same amount.</DELETED>
                <DELETED>    ``(D) Annual reports.--Not later than 
                October 1 of fiscal years 2025 through 2027, the 
                Secretary shall submit to the Committee on Health, 
                Education, Labor, and Pensions and the Committee on 
                Appropriations of the Senate and the Committee on 
                Energy and Commerce and the Committee on Appropriations 
                of the House of Representatives, a report including a 
                description of any use of funds provided pursuant to 
                the authorization of appropriations under subparagraph 
                (C).</DELETED>
                <DELETED>    ``(E) Limitations.--Notwithstanding any 
                transfer authority authorized by this paragraph or any 
                appropriations Act, any funds made available pursuant 
                to the authorization of appropriations under 
                subparagraph (C) may not be used for any purpose other 
                than the program under this section.</DELETED>
                <DELETED>    ``(F) Sunset.--Amounts remaining 
                unappropriated in the Account under this paragraph 
                shall be transferred back to the general fund of the 
                Treasury on October 1, 2026.''.</DELETED>

<DELETED>SEC. 207. NURSE FACULTY DEMONSTRATION PROGRAM.</DELETED>

<DELETED>    Section 846A of the Public Health Service Act (42 U.S.C. 
297n-1) is amended--</DELETED>
        <DELETED>    (1) by amending subsection (a) to read as 
        follows:</DELETED>
<DELETED>    ``(a) In General.--To increase the number of qualified 
nursing faculty, the Secretary may--</DELETED>
        <DELETED>    ``(1) enter into an agreement with any accredited 
        school of nursing for the establishment and operation of a 
        student loan fund in accordance with subsection (b); 
        and</DELETED>
        <DELETED>    ``(2) award nurse faculty grants in accordance 
        with subsection (d).'';</DELETED>
        <DELETED>    (2) in subsection (b)--</DELETED>
                <DELETED>    (A) by redesignating subparagraphs (A) 
                through (D) of paragraph (2) as clauses (i) through 
                (iv), respectively, and adjusting the margins 
                accordingly;</DELETED>
                <DELETED>    (B) by redesignating paragraphs (1) 
                through (5) as subparagraphs (A) through (E), 
                respectively, and adjusting the margins 
                accordingly;</DELETED>
                <DELETED>    (C) in subparagraph (C), as so 
                redesignated, by striking ``subsection (c)'' and 
                inserting ``paragraph (2)''; and</DELETED>
                <DELETED>    (D) by striking ``(b) Agreements--Each 
                agreement entered into under subsection (a) shall--'' 
                and inserting the following:</DELETED>
<DELETED>    ``(b) School of Nursing Student Loan Fund.--</DELETED>
        <DELETED>    ``(1) In general.--Each agreement entered into 
        under subsection (a)(1) shall--'';</DELETED>
        <DELETED>    (3) in subsection (c)--</DELETED>
                <DELETED>    (A) by striking ``subsection (a)'' each 
                place it appears and inserting ``subsection 
                (a)(1)'';</DELETED>
                <DELETED>    (B) in paragraph (3), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and adjusting the margins 
                accordingly;</DELETED>
                <DELETED>    (C) in paragraph (6), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and adjusting the margins 
                accordingly;</DELETED>
                <DELETED>    (D) by redesignating paragraphs (1) 
                through (6) as subparagraphs (A) through (F), 
                respectively, and adjusting the margins accordingly; 
                and</DELETED>
                <DELETED>    (E) in subparagraph (F)(ii), as so 
                redesignated, by striking ``subsection (e)'' and 
                inserting ``paragraph (4)'';</DELETED>
        <DELETED>    (4) in subsection (e), by striking ``subsection 
        (c)(6)(B)'' and inserting ``paragraph (2)(F)(ii)'';</DELETED>
        <DELETED>    (5) by redesignating subsections (c) through (e) 
        (before application of the amendment made by section 206) as 
        paragraphs (2) through (4), respectively, and adjusting the 
        margins accordingly; and</DELETED>
        <DELETED>    (6) by adding after subsection (c), as added by 
        section 206, the following:</DELETED>
<DELETED>    ``(d) Nurse Faculty Demonstration Program.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall establish 
        and carry out a demonstration program described in subsection 
        (a)(2) under which eligible schools of nursing receive a grant 
        for purposes of supplementing the salaries of eligible nursing 
        faculty members to enhance recruitment and retention of nursing 
        faculty members.</DELETED>
        <DELETED>    ``(2) Eligible entities.--To be eligible to 
        receive a grant under this subsection, an entity shall--
        </DELETED>
                <DELETED>    ``(A) be an accredited school of nursing; 
                and</DELETED>
                <DELETED>    ``(B) submit an application to the 
                Secretary, at such time, in such manner, and containing 
                such information as the Secretary may require, 
                including--</DELETED>
                        <DELETED>    ``(i)(I) to the extent such 
                        information is available to the school of 
                        nursing, the salary history of nursing faculty 
                        at such school who previously were nurses in 
                        clinical practice, for the most recent 3-year 
                        period ending on the date of application, 
                        adjusted for inflation as appropriate and 
                        broken down by credentials, experience, and 
                        levels of education of such nurses; 
                        or</DELETED>
                        <DELETED>    ``(II) if the information 
                        described in subclause (I) is not available, 
                        information on the average local salary of 
                        nurses in clinical practice, adjusted for 
                        inflation as appropriate and broken down by 
                        credentials, experience, and levels of 
                        education of the individual nurses, in 
                        accordance with such requirements as the 
                        Secretary may specify;</DELETED>
                        <DELETED>    ``(ii) an attestation of the 
                        average nursing faculty salary at the school of 
                        nursing during the most recent 3-year period 
                        prior to the date of application, adjusted for 
                        inflation, as appropriate, broken down by 
                        credentials, experience, and levels of 
                        education of such faculty members;</DELETED>
                        <DELETED>    ``(iii) the number of nursing 
                        faculty member vacancies at the entity at the 
                        time of application, and the entity's 
                        projection of such vacancies over the ensuing 
                        5-year period; and</DELETED>
                        <DELETED>    ``(iv) a description of the 
                        entity's plans to identify funding sources to 
                        sustainably continue, after the 2-year grant 
                        period, the salary available to the eligible 
                        nursing faculty member pursuant to the program 
                        under this subsection during such grant program 
                        and to retain eligible nursing faculty members 
                        after the end of the grant period.</DELETED>
        <DELETED>    ``(3) Awards.--A grant awarded under this 
        subsection, with respect to supporting eligible nursing faculty 
        members, shall--</DELETED>
                <DELETED>    ``(A) be awarded to the school of nursing 
                to supplement the salaries of eligible faculty members 
                at the school of nursing, annually, for up to a 2-year 
                period, in an amount equal to, for each eligible 
                nursing faculty member at the eligible entity during 
                the grant period, the difference between--</DELETED>
                        <DELETED>    ``(i) the average salary of nurses 
                        in clinical practice submitted under subclause 
                        (I) or (II) of paragraph (2)(B)(i); 
                        and</DELETED>
                        <DELETED>    ``(ii) the greater of--</DELETED>
                                <DELETED>    ``(I) the salary for the 
                                eligible nursing faculty member at the 
                                school of nursing; or</DELETED>
                                <DELETED>    ``(II) the average nursing 
                                faculty salary submitted under 
                                paragraph (2)(B)(ii) for faculty 
                                members with the same or similar 
                                credentials and level of 
                                education;</DELETED>
                <DELETED>    ``(B) notwithstanding section 803(a), be 
                used in its entirety to supplement the eligible faculty 
                member's salary; and</DELETED>
                <DELETED>    ``(C) be conditioned upon the school of 
                nursing maintaining, for each year in which the award 
                is made as described in subparagraph (A), a salary for 
                such faculty member at a level that is not less than 
                the greater of the amount under subclause (I) or (II) 
                of subparagraph (A)(ii).</DELETED>
        <DELETED>    ``(4) Priority.--In awarding grants under this 
        subsection, the Secretary shall ensure the equitable geographic 
        distribution of awards, and shall give priority to applications 
        from schools of nursing that demonstrate--</DELETED>
                <DELETED>    ``(A) the greatest need for such grant, 
                which may be based upon the financial circumstances of 
                the school of nursing, eligible nurse faculty members, 
                the planned number of students to be trained or 
                admitted off a wait list;</DELETED>
                <DELETED>    ``(B) training or partnerships to serve 
                vulnerable patient populations, such as through the 
                location or activity of a school in a health 
                professional shortage area (as defined in section 
                332);</DELETED>
                <DELETED>    ``(C) recruitment and retention of faculty 
                from underrepresented populations; or</DELETED>
                <DELETED>    ``(D) other particular need for such 
                grant, including public institutions of higher 
                education that offer 4-year degrees but at which the 
                predominant degree awarded is an associate 
                degree.</DELETED>
        <DELETED>    ``(5) Rule of construction.--Nothing in this 
        subsection precludes a school of nursing or an eligible nursing 
        faculty member receiving an award under this section from 
        obtaining or receiving any other form of Federal support or 
        funding.</DELETED>
        <DELETED>    ``(6) Report.--Not later than 3 years after the 
        date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, the Secretary shall submit to the Committee on 
        Finance and the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Ways and Means and 
        the Committee on Energy and Commerce of the House of 
        Representatives, a report that evaluates the program 
        established under this subsection, including--</DELETED>
                <DELETED>    ``(A) the impact of such program on 
                recruitment and retention rates of nursing faculty, as 
                available, and specifically for each faculty member 
                participating in the program; and</DELETED>
                <DELETED>    ``(B) recommendations and considerations 
                for Congress on continuing the program under this 
                subsection.</DELETED>
        <DELETED>    ``(7) Definitions.--In this subsection:</DELETED>
                <DELETED>    ``(A) Eligible nursing faculty member.--
                The term `eligible nursing faculty member' means a 
                nursing faculty member who--</DELETED>
                        <DELETED>    ``(i) was hired by a school of 
                        nursing within the 2-year period preceding the 
                        submission of an application under paragraph 
                        (2), or a prospective nursing faculty 
                        member;</DELETED>
                        <DELETED>    ``(ii) is currently employed at 
                        the school of nursing and who demonstrates the 
                        need for such support;</DELETED>
                        <DELETED>    ``(iii) previously worked as a 
                        nurse in clinical practice or as a nurse 
                        faculty member at another school of nursing; 
                        or</DELETED>
                        <DELETED>    ``(iv) may work on a part-time 
                        basis as a nursing faculty member, for whom 
                        such award amounts described in paragraph (3) 
                        shall be prorated relative to the amount of 
                        time participating in part-time 
                        teaching.</DELETED>
                <DELETED>    ``(B) Inflation.--The term `inflation' 
                means the Consumer Price Index for all urban consumers 
                (all items; U.S. city average).</DELETED>
        <DELETED>    ``(8) Authorization of appropriations.--To carry 
        out this subsection, in addition to amounts otherwise 
        available, including under section 871(b), there is authorized 
        to be appropriated $15,000,000 for each of fiscal years 2024 
        and 2025.''.</DELETED>

<DELETED>SEC. 208. NURSE CORPS SCHOLARSHIP AND LOAN REPAYMENT 
              PROGRAM.</DELETED>

<DELETED>    Section 846 of the Public Health Service Act (42 U.S.C. 
297n) is amended by adding at the end the following:</DELETED>
<DELETED>    ``(j) Authorization of Appropriations.--To carry out this 
section, in addition to amounts otherwise made available, including 
under section 871(b), there are authorized to be appropriated 
$93,600,000 for fiscal year 2024, $94,600,000 for fiscal year 2025, and 
$95,600,000 for fiscal year 2026, to remain available until 
expended.''.</DELETED>

<DELETED>SEC. 209. GRANTS FOR PRIMARY CARE NURSE RESIDENCY TRAINING 
              PROGRAMS.</DELETED>

<DELETED>    Section 5316 of the Patient Protection and Affordable Care 
Act (42 U.S.C. 296j-1) is amended--</DELETED>
        <DELETED>    (1) in the section heading, by striking 
        ``demonstration'';</DELETED>
        <DELETED>    (2) in subsection (a), by striking 
        ``demonstration'';</DELETED>
        <DELETED>    (3) in subsection (d)--</DELETED>
                <DELETED>    (A) in paragraph (1)(B), by striking 
                ``and'' at the end;</DELETED>
                <DELETED>    (B) by redesignating paragraph (2) as 
                paragraph (3); and</DELETED>
                <DELETED>    (C) by inserting after paragraph (1) the 
                following:</DELETED>
        <DELETED>    ``(2)(A) in the case of an entity that does not 
        have an established residency program for nurse practitioners 
        at the time of the application, demonstrate plans to establish 
        a new residency program for nurse practitioners; or</DELETED>
        <DELETED>    ``(B) in the case of an entity that has an 
        established residency program for nurse practitioners at the 
        time of the application, demonstrate plans to use the grant 
        under this section to offer not fewer than 4 additional 
        residency positions for new nurse practitioners to participate 
        in such program; and''; and</DELETED>
        <DELETED>    (4) in subsection (i), by striking ``such sums as 
        may be necessary for each of fiscal years 2011 through 2014'' 
        and inserting ``$30,000,000 for each of fiscal years 2024 
        through 2026''.</DELETED>

<DELETED>SEC. 210. STATE ORAL HEALTH WORKFORCE IMPROVEMENT GRANT 
              PROGRAM.</DELETED>

<DELETED>    Subsection (f) of section 340G of the Public Health 
Service Act (42 U.S.C. 256g) is amended by striking ``$13,903,000 for 
each of fiscal years 2019 through 2023'' and inserting ``$15,200,000 
for fiscal year 2024, $15,500,000 for fiscal year 2025, and $15,800,000 
for fiscal year 2026, to remain available until expended''.</DELETED>

<DELETED>SEC. 211. ORAL HEALTH TRAINING PROGRAMS.</DELETED>

<DELETED>    Subsection (f) of section 748 of the Public Health Service 
Act (42 U.S.C. 293k-2) is amended to read as follows:</DELETED>
<DELETED>    ``(f) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(1) In general.--To carry out this section, 
        there is authorized to be appropriated $28,500,000 for fiscal 
        year 2026, to remain available until expended.</DELETED>
        <DELETED>    ``(2) Geographic distribution.--In awarding grants 
        under this section, the Secretary shall ensure, to the greatest 
        extent practicable, that such grants are equitably distributed 
        among the geographical regions of the United 
        States.''.</DELETED>

<DELETED>SEC. 212. ALLIED HEALTH PROFESSIONALS.</DELETED>

<DELETED>    (a) Supporting Dual or Concurrent Enrollment in the Allied 
Health Projects Program.--Section 755(b)(1) of the Public Health 
Service Act (42 U.S.C. 294e(b)(1)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (B), by striking ``to 
        individuals who have baccalaureate degrees in health-related 
        sciences'';</DELETED>
        <DELETED>    (2) in the flush text at the end of subparagraph 
        (I), by striking ``; and'' and inserting a semicolon;</DELETED>
        <DELETED>    (3) in subparagraph (J), by striking the period 
        and inserting ``; and''; and</DELETED>
        <DELETED>    (4) by adding at the end the following:</DELETED>
                <DELETED>    ``(K) those that establish or support a 
                dual or concurrent enrollment program (as defined in 
                section 8101 of the Elementary and Secondary Education 
                Act of 1965) if the dual or concurrent enrollment 
                program--</DELETED>
                        <DELETED>    ``(i) provides outreach on allied 
                        health careers requiring an industry-recognized 
                        credential, a certificate, or an associate 
                        degree, to all high schools served by the local 
                        educational agency that is a partner in the 
                        partnership offering the dual or concurrent 
                        enrollment program;</DELETED>
                        <DELETED>    ``(ii) provides information to 
                        high school students about the training 
                        requirements and expected salary of allied 
                        health professions; and</DELETED>
                        <DELETED>    ``(iii) provides academic and 
                        financial aid counseling to students who 
                        participate in the dual or concurrent 
                        enrollment program.''.</DELETED>
<DELETED>    (b) Supporting Dual or Concurrent Enrollment in the Health 
Careers Opportunity Program.--Section 739(a)(2) of the Public Health 
Service Act (42 U.S.C. 293c(a)(2)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (H), by striking ``and'' after 
        the semicolon;</DELETED>
        <DELETED>    (2) in subparagraph (I), by striking the period at 
        the end and inserting ``; and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
                <DELETED>    ``(J) providing academic and financial aid 
                counseling to support participation in a dual or 
                concurrent enrollment program (as defined in section 
                8101 of the Elementary and Secondary Education Act of 
                1965) that leads to an industry-recognized credential, 
                a certificate, or an associate degree in the health 
                professions or academic credits that can be 
                transferred, as indicated through an articulation 
                agreement between 2 or more community colleges or 
                universities, to obtain an industry-recognized 
                credential, a certificate, or a degree in the health 
                professions.''.</DELETED>
<DELETED>    (c) Health Care Workforce Innovation Program.--Section 
755(b) of the Public Health Service Act (42 U.S.C. 294e(b)) is amended 
by adding at the end the following:</DELETED>
        <DELETED>    ``(5)(A) Supporting and developing new innovative, 
        community-driven approaches for the education and training of 
        allied health professionals, including those described in 
        subparagraph (F)(i), with an emphasis on expanding the supply 
        of such professionals located in, and meeting the needs of, 
        underserved communities and rural areas. Grants under this 
        paragraph shall be awarded through a new program (referred to 
        as the `Health Care Workforce Innovation Program' or in this 
        paragraph as the `Program').</DELETED>
        <DELETED>    ``(B) To be eligible to receive a grant under the 
        Program an entity shall--</DELETED>
                <DELETED>    ``(i) be a Federally qualified health 
                center (as defined in section 1905(l)(2)(B) of the 
                Social Security Act), a State-level association or 
                other consortium that represents and is comprised of 
                Federally qualified health centers, or a certified 
                rural health clinic that meets the requirements of 
                section 334; and</DELETED>
                <DELETED>    ``(ii) submit to the Secretary an 
                application that, at a minimum, contains--</DELETED>
                        <DELETED>    ``(I) a description of how all 
                        trainees will be trained in accredited training 
                        programs either directly or through 
                        partnerships with public or nonprofit private 
                        entities;</DELETED>
                        <DELETED>    ``(II) a description of the 
                        community-driven health care workforce 
                        innovation model to be carried out under the 
                        grant, including the specific professions to be 
                        funded;</DELETED>
                        <DELETED>    ``(III) the geographic service 
                        area that will be served, including 
                        quantitative data, if available, showing that 
                        such particular area faces a shortage of health 
                        professionals and lacks access to health 
                        care;</DELETED>
                        <DELETED>    ``(IV) a description of the 
                        benefits provided to each health care 
                        professional trained under the proposed model 
                        during the education and training 
                        phase;</DELETED>
                        <DELETED>    ``(V) a description of the 
                        experience that the applicant has in the 
                        recruitment, retention, and promotion of the 
                        well-being of workers and volunteers;</DELETED>
                        <DELETED>    ``(VI) a description of how the 
                        funding awarded under the Program will 
                        supplement rather than supplant existing 
                        funding;</DELETED>
                        <DELETED>    ``(VII) a description of the 
                        scalability and replicability of the community-
                        driven approach to be funded under the 
                        Program;</DELETED>
                        <DELETED>    ``(VIII) a description of the 
                        infrastructure, outreach and communication plan 
                        and other program support costs required to 
                        operationalize the proposed model; 
                        and</DELETED>
                        <DELETED>    ``(IX) any other information, as 
                        the Secretary determines appropriate.</DELETED>
        <DELETED>    ``(C)(i) An entity shall use amounts received 
        under a grant awarded under the Program to carry out the 
        innovative, community-driven model described in the application 
        under subparagraph (B). Such amounts may be used for launching 
        new or expanding existing innovative health care professional 
        partnerships, including the following specific uses:</DELETED>
                <DELETED>    ``(I) Establishing or expanding a 
                partnership between an eligible entity and 1 or more 
                high schools, accredited public or nonprofit private 
                vocational-technical schools, accredited public or 
                nonprofit private 2-year colleges, area health 
                education centers, and entities with clinical settings 
                for the provision of education and training 
                opportunities not available at the grantee's 
                facilities.</DELETED>
                <DELETED>    ``(II) Providing education and training 
                programs to improve allied health professionals' 
                readiness in settings that serve underserved 
                communities and rural areas; encouraging students from 
                underserved and disadvantaged backgrounds and former 
                patients to consider careers in health care, and better 
                reflecting and meeting community needs; providing 
                education and training programs for individuals to work 
                in patient-centered, team-based, community-driven 
                health care models that include integration with other 
                clinical practitioners and training in cultural and 
                linguistic competence; providing pre-apprenticeship and 
                apprenticeship programs for health care technical, 
                support, and entry-level occupations, particularly for 
                those enrolled in dual or concurrent enrollment 
                programs; building a preceptorship training-to-practice 
                model for medical, behavioral health, oral health, and 
                public health disciplines in an integrated, community-
                driven setting; providing and expanding internships, 
                career ladders, and development opportunities for 
                health care professionals, including new and existing 
                staff; or investing in training equipment, supplies, 
                and limited renovations or retrofitting of training 
                space needed for grantees to carry out their particular 
                model.</DELETED>
        <DELETED>    ``(ii) Amounts received under a grant awarded 
        under the Program shall not be used to support construction 
        costs or to supplant funding from existing programs that 
        support the applicant's health workforce.</DELETED>
        <DELETED>    ``(iii) Models funded under the Program shall be 
        for a duration of at least 3 years.</DELETED>
        <DELETED>    ``(D) In awarding grants under the Program, the 
        Secretary may give priority to applicants that will use grant 
        funds to support workforce innovation models that increase the 
        number of individuals from underserved and disadvantaged 
        backgrounds working in such health care professions, improve 
        access to health care (including medical, behavioral health and 
        oral health) in underserved communities, or demonstrate that 
        the model can be replicated in other underserved communities in 
        a cost-efficient and effective manner to achieve the purposes 
        of the Program.</DELETED>
        <DELETED>    ``(E) An entity that receives a grant under the 
        Program shall provide periodic reports to the Secretary 
        detailing the findings and outcomes of the innovative, 
        community-driven model carried out under the grant. Such 
        reports shall contain information in a manner and at such times 
        as determined appropriate by the Secretary.</DELETED>
        <DELETED>    ``(F) In this paragraph:</DELETED>
                <DELETED>    ``(i) The term `allied health care 
                professional' includes individuals who provide clinical 
                support services, including medical assistants, dental 
                assistants, dental hygienists, pharmacy technicians, 
                physical therapists and health care interpreters; 
                individuals providing non-clinical support, such as 
                billing and coding professionals and health information 
                technology professionals; dieticians; medical 
                technologists; emergency medical technicians; community 
                health workers; public health personnel; and peer 
                support workers.</DELETED>
                <DELETED>    ``(ii) The term `rural area' has the 
                meaning given such term by the Administrator of the 
                Health Resources and Services Administration.</DELETED>
                <DELETED>    ``(iii) The term `underserved communities' 
                means areas, population groups, and facilities 
                designated as health professional shortage areas under 
                section 332, medically underserved areas as defined 
                under section 330I(a)), or medically underserved 
                populations as defined under section 
                330(b)(3).</DELETED>
        <DELETED>    ``(G)(i) There are authorized to be appropriated 
        $100,000,000 for each of fiscal years 2024 through 2026, to 
        carry out this section, to remain available until 
        expended.</DELETED>
        <DELETED>    ``(ii) A grant provided under the Program shall 
        not exceed $2,500,000 for a grant period.''.</DELETED>

<DELETED>SEC. 213. BUDGETARY TREATMENT.</DELETED>

<DELETED>    (a) Statutory Paygo Scorecards.--The budgetary effects of 
section 302 (including the amendments made by such section), up to 
$1,671,000,000, shall not be entered on either PAYGO scorecard 
maintained pursuant to section 4(d) of the Statutory Pay As-You-Go Act 
of 2010 (2 U.S.C. 933(d)).</DELETED>
<DELETED>    (b) Senate Paygo Scorecards.--The budgetary effects of 
section 302 (including the amendments made by such section), up to 
$1,671,000,000, shall not be entered on any PAYGO scorecard maintained 
for purposes of section 4106 of H. Con. Res. 71 (115th 
Congress).</DELETED>
<DELETED>    (c) Reservation of Savings.--None of the funds in the 
Account to Address the Primary Care Physician Shortage (established 
under section 747(c)(6) of the Public Health Service Act, as amended by 
section 204), the Account to Address the Nursing Workforce Shortage 
(established under section 831(e)(5) of the Public Health Service Act, 
as amended by section 205), or the Account to Address the Nurse Faculty 
Shortage (established under section 846A(c)(2) of the Public Health 
Service Act, as amended by section 206) shall be made available except 
to the extent provided in advance in appropriations Acts, and 
legislation or an Act that rescinds or reduces amounts in such accounts 
shall not be estimated as a reduction in direct spending under the 
Congressional Budget and Impoundment Control Act of 1974 or the 
Balanced Budget and Emergency Deficit Control Act of 1985.</DELETED>

 <DELETED>TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS</DELETED>

<DELETED>SEC. 301. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND 
              INSURANCE CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, 
              LOWER COST CARE.</DELETED>

<DELETED>    (a) In General.--</DELETED>
        <DELETED>    (1) Public health service act.--Section 2799A-9 of 
        the Public Health Service Act (42 U.S.C. 300gg-119) is 
        amended--</DELETED>
                <DELETED>    (A) by adding at the end the 
                following:</DELETED>
<DELETED>    ``(b) Protecting Health Plans Network Design 
Flexibility.--</DELETED>
        <DELETED>    ``(1) In general.--A group health plan or a health 
        insurance issuer offering group or individual health insurance 
        coverage shall not enter into an agreement with a provider, 
        network or association of providers, or other service provider 
        offering access to a network of service providers if such 
        agreement, directly or indirectly--</DELETED>
                <DELETED>    ``(A) restricts the group health plan or 
                health insurance issuer from--</DELETED>
                        <DELETED>    ``(i) directing or steering 
                        enrollees to other health care providers; 
                        or</DELETED>
                        <DELETED>    ``(ii) offering incentives to 
                        encourage enrollees to utilize specific health 
                        care providers;</DELETED>
                <DELETED>    ``(B) requires the group health plan or 
                health insurance issuer to enter into any additional 
                contract with an affiliate of the provider as a 
                condition of entering into a contract with such 
                provider;</DELETED>
                <DELETED>    ``(C) requires the group health plan or 
                health insurance issuer to agree to payment rates or 
                other terms for any affiliate not party to the contract 
                of the provider involved; or</DELETED>
                <DELETED>    ``(D) restricts other group health plans 
                or health insurance issuers not party to the contract 
                from paying a lower rate for items or services than the 
                contracting plan or issuer pays for such items or 
                services.</DELETED>
        <DELETED>    ``(2) Additional requirement for self-insured 
        plans.--A self-insured group health plan shall not enter into 
        an agreement with a provider, network or association of 
        providers, third-party administrator, or other service provider 
        offering access to a network of providers if such agreement 
        directly or indirectly requires the group health plan to 
        certify, attest, or otherwise confirm in writing that the group 
        health plan is bound by restrictive contracting terms between 
        the service provider and a third-party administrator that the 
        group health plan is not party to, without a disclosure that 
        such terms exist.</DELETED>
        <DELETED>    ``(3) Exception for plans and issuers.--Paragraph 
        (1)(A) shall not apply to a group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage with respect to--</DELETED>
                <DELETED>    ``(A) a health maintenance organization 
                (as defined in section 2791(b)(3)), if such health 
                maintenance organization operates primarily through 
                exclusive contracts with multi-specialty physician 
                groups, nor to any arrangement between such a health 
                maintenance organization and its affiliates; 
                or</DELETED>
                <DELETED>    ``(B) a value-based network arrangement, 
                such as an exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.</DELETED>
        <DELETED>    ``(4) Attestation.--A group health plan or health 
        insurance issuer offering group or individual health insurance 
        coverage shall annually submit to, as applicable, the 
        applicable authority described in section 2723 or the Secretary 
        of Labor or the Secretary of the Treasury, an attestation that 
        such plan or issuer is in compliance with the requirements of 
        this subsection.</DELETED>
        <DELETED>    ``(5) Rule of construction.--Nothing in this 
        subsection shall be construed to limit network design or cost 
        or quality initiatives by a group health plan or health 
        insurance issuer, including accountable care organizations, 
        exclusive provider organizations, networks that tier providers 
        by cost or quality or steer enrollees to centers of excellence, 
        or other pay-for-performance programs.</DELETED>
        <DELETED>    ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).</DELETED>
        <DELETED>    ``(7) Grandfathering.--An applicable State 
        authority may make a determination that the prohibitions under 
        paragraph (1) (with respect to conditions that would direct or 
        steer to, or offer incentives to encourage enrollees to use, 
        other health care providers) will not apply in the State with 
        respect to any specified agreement that is executed before the 
        date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence an applicable 
        State authority may determine whether renewal of the contract, 
        within the applicable 10-year period, is allowed.''; 
        and</DELETED>
                <DELETED>    (B) by redesignating paragraph (5) of 
                subsection (a) as subsection (c), adjusting the margin 
                of such subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).</DELETED>
        <DELETED>    (2) Employee retirement income security act of 
        1974.--Section 724 of the Employee Retirement Income Security 
        Act of 1974 (29 U.S.C. 1185m) is amended--</DELETED>
                <DELETED>    (A) by adding at the end the 
                following:</DELETED>
<DELETED>    ``(b) Protecting Health Plans Network Design 
Flexibility.--</DELETED>
        <DELETED>    ``(1) In general.--A group health plan or a health 
        insurance issuer offering group health insurance coverage shall 
        not enter into an agreement with a provider, network or 
        association of providers, or other service provider offering 
        access to a network of service providers if such agreement, 
        directly or indirectly--</DELETED>
                <DELETED>    ``(A) restricts the group health plan or 
                health insurance issuer from--</DELETED>
                        <DELETED>    ``(i) directing or steering 
                        enrollees to other health care providers; 
                        or</DELETED>
                        <DELETED>    ``(ii) offering incentives to 
                        encourage enrollees to utilize specific health 
                        care providers;</DELETED>
                <DELETED>    ``(B) requires the group health plan or 
                health insurance issuer to enter into any additional 
                contract with an affiliate of the provider as a 
                condition of entering into a contract with such 
                provider;</DELETED>
                <DELETED>    ``(C) requires the group health plan or 
                health insurance issuer to agree to payment rates or 
                other terms for any affiliate not party to the contract 
                of the provider involved; or</DELETED>
                <DELETED>    ``(D) restricts other group health plans 
                or health insurance issuers not party to the contract 
                from paying a lower rate for items or services than the 
                contracting plan or issuer pays for such items or 
                services.</DELETED>
        <DELETED>    ``(2) Additional requirement for self-insured 
        plans.--A self-insured group health plan shall not enter into 
        an agreement with a provider, network or association of 
        providers, third-party administrator, or other service provider 
        offering access to a network of providers if such agreement 
        directly or indirectly requires the group health plan to 
        certify, attest, or otherwise confirm in writing that the group 
        health plan is bound by restrictive contracting terms between 
        the service provider and a third-party administrator that the 
        group health plan is not party to, without a disclosure that 
        such terms exist.</DELETED>
        <DELETED>    ``(3) Exception for plans and issuers.--Paragraph 
        (1)(A) shall not apply to a group health plan or health 
        insurance issuer offering group health insurance coverage with 
        respect to--</DELETED>
                <DELETED>    ``(A) a health maintenance organization 
                (as defined in section 733(b)(3)), if such health 
                maintenance organization operates primarily through 
                exclusive contracts with multi-specialty physician 
                groups, nor to any arrangement between such a health 
                maintenance organization and its affiliates; 
                or</DELETED>
                <DELETED>    ``(B) a value-based network arrangement, 
                such as an exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.</DELETED>
        <DELETED>    ``(4) Attestation.--A group health plan or health 
        insurance issuer offering group health insurance coverage shall 
        annually submit to, as applicable, the applicable authority 
        described in section 2723 of the Public Health Service Act or 
        the Secretary of Labor or the Secretary of the Treasury, an 
        attestation that such plan or issuer is in compliance with the 
        requirements of this subsection.</DELETED>
        <DELETED>    ``(5) Rule of construction.--Nothing in this 
        subsection shall be construed to limit network design or cost 
        or quality initiatives by a group health plan or health 
        insurance issuer, including accountable care organizations, 
        exclusive provider organizations, networks that tier providers 
        by cost or quality or steer enrollees to centers of excellence, 
        or other pay-for-performance programs.</DELETED>
        <DELETED>    ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).</DELETED>
        <DELETED>    ``(7) Grandfathering.--An applicable State 
        authority may make a determination that the prohibitions under 
        paragraph (1) (with respect to conditions that would direct or 
        steer to, or offer incentives to encourage enrollees to use, 
        other health care providers) will not apply in the State with 
        respect to any specified agreement that is executed before the 
        date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence an applicable 
        State authority may determine whether renewal of the contract, 
        within the applicable 10-year period, is allowed.''; 
        and</DELETED>
                <DELETED>    (B) by redesignating paragraph (4) of 
                subsection (a) as subsection (c), adjusting the margin 
                of such subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).</DELETED>
        <DELETED>    (3) Internal revenue code of 1986.--Section 9824 
        of the Internal Revenue Code of 1986 is amended--</DELETED>
                <DELETED>    (A) by adding at the end the 
                following:</DELETED>
<DELETED>    ``(b) Protecting Health Plans Network Design 
Flexibility.--</DELETED>
        <DELETED>    ``(1) In general.--A group health plan shall not 
        enter into an agreement with a provider, network or association 
        of providers, or other service provider offering access to a 
        network of service providers if such agreement, directly or 
        indirectly--</DELETED>
                <DELETED>    ``(A) restricts the group health plan 
                from--</DELETED>
                        <DELETED>    ``(i) directing or steering 
                        enrollees to other health care providers; 
                        or</DELETED>
                        <DELETED>    ``(ii) offering incentives to 
                        encourage enrollees to utilize specific health 
                        care providers;</DELETED>
                <DELETED>    ``(B) requires the group health plan to 
                enter into any additional contract with an affiliate of 
                the provider as a condition of entering into a contract 
                with such provider;</DELETED>
                <DELETED>    ``(C) requires the group health plan to 
                agree to payment rates or other terms for any affiliate 
                not party to the contract of the provider involved; 
                or</DELETED>
                <DELETED>    ``(D) restricts other group health plans 
                not party to the contract from paying a lower rate for 
                items or services than the contracting plan pays for 
                such items or services.</DELETED>
        <DELETED>    ``(2) Additional requirement for self-insured 
        plans.--A self-insured group health plan shall not enter into 
        an agreement with a provider, network or association of 
        providers, third-party administrator, or other service provider 
        offering access to a network of providers if such agreement 
        directly or indirectly requires the group health plan to 
        certify, attest, or otherwise confirm in writing that the group 
        health plan is bound by restrictive contracting terms between 
        the service provider and a third-party administrator that the 
        group health plan is not party to, without a disclosure that 
        such terms exist.</DELETED>
        <DELETED>    ``(3) Exception for certain plans.--Paragraph 
        (1)(A) shall not apply to a group health plan with respect to--
        </DELETED>
                <DELETED>    ``(A) a health maintenance organization 
                (as defined in section 9832(b)(3)), if such health 
                maintenance organization operates primarily through 
                exclusive contracts with multi-specialty physician 
                groups, nor to any arrangement between such a health 
                maintenance organization and its affiliates; 
                or</DELETED>
                <DELETED>    ``(B) a value-based network arrangement, 
                such as an exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.</DELETED>
        <DELETED>    ``(4) Attestation.--A group health plan shall 
        annually submit to, as applicable, the applicable authority 
        described in section 2723 of the Public Health Service Act or 
        the Secretary of Labor or the Secretary of the Treasury, an 
        attestation that such plan is in compliance with the 
        requirements of this subsection.</DELETED>
        <DELETED>    ``(5) Rule of construction.--Nothing in this 
        subsection shall be construed to limit network design or cost 
        or quality initiatives by a group health plan, including 
        accountable care organizations, exclusive provider 
        organizations, networks that tier providers by cost or quality 
        or steer enrollees to centers of excellence, or other pay-for-
        performance programs.</DELETED>
        <DELETED>    ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).</DELETED>
        <DELETED>    ``(7) Grandfathering.--An applicable State 
        authority may make a determination that the prohibitions under 
        paragraph (1) (with respect to conditions that would direct or 
        steer to, or offer incentives to encourage enrollees to use, 
        other health care providers) will not apply in the State with 
        respect to any specified agreement that is executed before the 
        date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence an applicable 
        State authority may determine whether renewal of the contract, 
        within the applicable 10-year period, is allowed.''; 
        and</DELETED>
                <DELETED>    (B) by redesignating paragraph (4) of 
                subsection (a) as subsection (c), adjusting the margin 
                of such subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).</DELETED>
<DELETED>    (b) Regulations.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human Services, the 
Secretary of Labor, and the Secretary of the Treasury, jointly, shall 
promulgate regulations to carry out section 2799A-9(b) of the Public 
Health Service Act, section 724(b) of the Employee Retirement Income 
Security Act of 1974, and section 9824(b) of the Internal Revenue Code 
of 1986, as added by subsection (a).</DELETED>
<DELETED>    (c) Effective Date.--Subsection (b) of section 2799A-9 of 
the Public Health Service Act, subsection (b) of section 724 of the 
Employee Retirement Income Security Act of 1974, and subsection (b) of 
section 9824 of the Internal Revenue Code of 1986 (as added by 
paragraphs (1), (2), and (3), respectively, of subsection (a)) shall 
apply with respect to any contract entered into on or after the date 
that is 18 months after the date of enactment of this Act. With respect 
to an applicable contract that is in effect on the date of enactment of 
this Act, such subsection (b) shall apply on the earlier of the date of 
renewal of such contract or 3 years after such date of 
enactment.</DELETED>

<DELETED>SEC. 302. HONEST BILLING REQUIREMENTS APPLICABLE TO 
              PROVIDERS.</DELETED>

<DELETED>    (a) Group Health Plan and Health Insurance Issuer 
Requirements.--</DELETED>
        <DELETED>    (1) Public health service act.--Part D of title 
        XXVII of the Public Health Service Act (42 U.S.C. 300gg-111 et 
        seq.) is amended by adding at the end the following:</DELETED>

<DELETED>``SEC. 2799A-11. HONEST BILLING REQUIREMENTS APPLICABLE TO 
              PLANS AND ISSUERS.</DELETED>

<DELETED>    ``A group health plan or health insurance issuer offering 
group or individual health insurance coverage may not pay a claim for 
items and services furnished on or after January 1, 2026, to an 
individual at an off-campus outpatient department of a provider (as 
defined in section 2799B-10(b))) submitted by a health care provider or 
facility unless such claim submitted by such provider or facility 
includes a separate unique health identifier for the department where 
items and services were furnished, in accordance with section 2799B-
10.''.</DELETED>
        <DELETED>    (2) Employee retirement income security act of 
        1974.--</DELETED>
                <DELETED>    (A) In general.--Subpart B of part 7 of 
                subtitle B of title I of the Employee Retirement Income 
                Security Act of 1974 (29 U.S.C. 1185 et seq.) is 
                amended by adding at the end the following:</DELETED>

<DELETED>``SEC. 726. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS 
              AND ISSUERS.</DELETED>

<DELETED>    ``A group health plan or health insurance issuer offering 
group health insurance coverage may not pay a claim for items and 
services furnished on or after January 1, 2026, to an individual at an 
off-campus outpatient department of a provider (as defined in section 
2799B-10(b)) of the Public Health Service Act) submitted by a health 
care provider or facility unless such claim submitted by such provider 
or facility includes a separate unique health identifier for the 
department where items and services were furnished, in accordance with 
section 2799B-10 of such Act.''.</DELETED>
                <DELETED>    (B) Clerical amendment.--The table of 
                contents in section 1 of the Employee Retirement Income 
                Security Act of 1974 (29 U.S.C. 1001 et seq.) is 
                amended by inserting after the item relating to section 
                725 the following new item:</DELETED>

<DELETED>``Sec. 726. Honest billing requirements applicable to plans 
                            and issuers.''.
        <DELETED>    (3) Internal revenue code of 1986.--</DELETED>
                <DELETED>    (A) In general.--Subchapter B of chapter 
                100 of the Internal Revenue Code of 1986 is amended by 
                adding at the end the following:</DELETED>

<DELETED>``SEC. 9826. HONEST BILLING REQUIREMENTS APPLICABLE TO 
              PLANS.</DELETED>

<DELETED>    ``A group health plan may not pay a claim for items and 
services furnished on or after January 1, 2026, to an individual at an 
off-campus outpatient department of a provider (as defined in section 
2799B-10(b)) of the Public Health Service Act) submitted by a health 
care provider or facility unless such claim submitted by such provider 
or facility includes a separate unique health identifier for the 
department where items and services were furnished, in accordance with 
section 2799B-10 of such Act.''.</DELETED>
                <DELETED>    (B) Clerical amendment.--The table of 
                sections for subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following new item:</DELETED>

<DELETED>``Sec. 9826. Honest billing requirements applicable to 
                            plans.''.
<DELETED>    (b) Requiring a Separate Identification Number and an 
Attestation for Each Off-Campus Outpatient Department of a Provider.--
</DELETED>
        <DELETED>    (1) In general.--Part E of title XXVII of the 
        Public Health Service Act (42 U.S.C. 300gg-131 et seq.) is 
        amended by adding at the end the following:</DELETED>

<DELETED>``SEC. 2799B-10. HONEST BILLING REQUIREMENTS APPLICABLE TO 
              PROVIDERS.</DELETED>

<DELETED>    ``(a) Requirements Relating to Unique Health 
Identifiers.--For items and services furnished, on or after January 1, 
2026, at an off-campus outpatient department of a provider to a 
participant, beneficiary, or enrollee with benefits under a group 
health plan or group or individual health insurance coverage offered by 
a health insurance issuer, a health care provider or facility may not 
submit a claim to the group health plan or health insurance issuer, 
bill the participant, beneficiary, or enrollee, or hold liable the 
participant, beneficiary, or enrollee, unless--</DELETED>
        <DELETED>    ``(1) such provider or facility obtains a separate 
        unique health identifier established for such department 
        pursuant to section 1173(b) of the Social Security Act; 
        and</DELETED>
        <DELETED>    ``(2) such items and services are billed using the 
        separate unique health identifier established for such 
        department pursuant to paragraph (1).</DELETED>
<DELETED>    ``(b) Off-Campus Outpatient Department of a Provider.--The 
term `off-campus outpatient department of a provider' means a 
department of a provider (as defined in section 413.65(a)(2) of title 
42 of the Code of Federal Regulations, as in effect on the date of the 
enactment of the Bipartisan Primary Care and Health Workforce Act) that 
is not located--</DELETED>
        <DELETED>    ``(1) on the campus (as defined in such section 
        413.65(a)(2)) of such provider; or</DELETED>
        <DELETED>    ``(2) within the distance (described in such 
        definition of campus) from a remote location of a hospital (as 
        defined in such section 413.65(a)(2)).</DELETED>
<DELETED>    ``(c) Process for Reporting Suspected Violations.--The 
Secretary shall establish a process under which a suspected violation 
of this section may be reported to such Secretary.</DELETED>
<DELETED>    ``(d) Penalties.--The Secretary may assess a civil 
monetary penalty against a hospital for a violation under this section 
in an amount--</DELETED>
        <DELETED>    ``(1) in the case of a hospital with not more than 
        30 beds (as determined under section 180.90(c)(2)(ii)(D) of 
        title 45, Code of Federal Regulations, as in effect on the date 
        of the enactment of the Bipartisan Primary Care and Health 
        Workforce Act (or any successor regulations)), not to exceed 
        $300 per day that the violation is ongoing, as determined by 
        the Secretary; and</DELETED>
        <DELETED>    ``(2) in the case of a hospital with more than 30 
        beds (as so determined), not to exceed $5,500 per day that the 
        violation is ongoing, as determined by the 
        Secretary.''.</DELETED>
        <DELETED>    (2) Conforming amendment.--Section 2799B-4(a)(1) 
        of the Public Health Service Act (42 U.S.C. 300gg-134(a)(1)) is 
        amended by inserting ``(other than section 2799B-10)'' after 
        ``this part''.</DELETED>

<DELETED>SEC. 303. BANNING FACILITY FEES FOR CERTAIN 
              SERVICES.</DELETED>

<DELETED>    Part E of title XXVII of the Public Health Service Act (42 
U.S.C. 300gg-131 et seq.), as amended by section 302(b), is further 
amended by adding at the end the following:</DELETED>

<DELETED>``SEC. 2799B-11. BANNING FACILITY FEES FOR CERTAIN 
              SERVICES.</DELETED>

<DELETED>    ``(a) In General.--With respect to applicable items and 
services furnished to an individual on or after January 1, 2026, a 
health care provider or facility may not charge a facility fee 
(regardless of how the fee is labeled) to a group health plan, a health 
insurance issuer offering group or individual health insurance 
coverage, a participant, beneficiary, or enrollee in such a plan or 
coverage, or an individual patient who is not covered by a group health 
plan, health insurance coverage, or a Federal health care program (as 
defined in section 1128(f) of the Social Security Act).</DELETED>
<DELETED>    ``(b) Applicable Items and Services.--In this section, the 
term `applicable items and services' means--</DELETED>
        <DELETED>    ``(1) evaluation and management services described 
        in section 1833(cc)(1)(B)(i) of the Social Security 
        Act;</DELETED>
        <DELETED>    ``(2) outpatient behavioral health services (not 
        including partial hospitalizations, intensive outpatient 
        program services, and other services not typically provided in 
        an office setting (as the Secretary may determine)); 
        and</DELETED>
        <DELETED>    ``(3) any items and services (including the items 
        and services described in paragraphs (1) and (2)) furnished via 
        telehealth.''.</DELETED>

<DELETED>SEC. 304. PREVENTION AND PUBLIC HEALTH FUND.</DELETED>

<DELETED>    Section 4002(b) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 300u-11(b)) is amended by striking paragraphs (8) 
through (10) and inserting the following:</DELETED>
        <DELETED>    ``(8) for each of fiscal years 2026 and 2027, 
        $1,425,000,000;</DELETED>
        <DELETED>    ``(9) for each of fiscal years 2028 and 2029, 
        $1,495,000,000;</DELETED>
        <DELETED>    ``(10) for fiscal year 2030, $1,680,000,000; 
        and</DELETED>
        <DELETED>    ``(11) for fiscal year 2031 and each fiscal year 
        thereafter, $2,000,000,000.''.</DELETED>

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Bipartisan Primary 
Care and Health Workforce Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.

 TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
  SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS

Sec. 101. Programs of payments to teaching health centers that operate 
                            graduate medical education programs.
Sec. 102. Community health centers.
Sec. 103. National Health Service Corps.
Sec. 104. GAO report.
Sec. 105. OIG report.
Sec. 106. Application of provisions.

             TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE

Sec. 201. Rural residency planning and development program.
Sec. 202. Primary care training and enhancement program.
Sec. 203. Telehealth technology-enabled learning program.
Sec. 204. Nurse education, practice, quality, and retention grants and 
                            contracts.
Sec. 205. Nurse faculty loan program.
Sec. 206. Nurse faculty demonstration program.
Sec. 207. Nurse corps scholarship and loan repayment program.
Sec. 208. Grants for primary care nurse residency training programs.
Sec. 209. State oral health workforce improvement grant program.
Sec. 210. Oral health training programs.
Sec. 211. Allied health professionals.
Sec. 212. Review of and report on programs supporting the nursing 
                            workforce.
Sec. 213. Report on impacts to community health centers.

           TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS

Sec. 301. Banning anticompetitive terms in facility and insurance 
                            contracts that limit access to higher 
                            quality, lower cost care.
Sec. 302. Honest billing requirements applicable to providers.
Sec. 303. Banning facility fees for certain services.
Sec. 304. Prevention and Public Health Fund.
Sec. 305. Price transparency requirements.
Sec. 306. Publication of list of hospitals.

 TITLE I--EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
  SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS

SEC. 101. PROGRAMS OF PAYMENTS TO TEACHING HEALTH CENTERS THAT OPERATE 
              GRADUATE MEDICAL EDUCATION PROGRAMS.

    (a) Funding.--Section 340H(g)(1) of the Public Health Service Act 
(42 U.S.C. 256h(g)(1)) is amended--
            (1) by striking ``such sums as may be necessary, not to 
        exceed'';
            (2) by striking ``2017, and'' and inserting ``2017,''; and
            (3) by inserting ``and $300,000,000 for each of fiscal 
        years 2024 through 2028,'' after ``2023,''.
    (b) Per Resident Amount.--Section 340H(a)(2) of the Public Health 
Service Act (42 U.S.C. 256h(a)(2)) is amended by adding at the end the 
following: ``Beginning in fiscal year 2024, in accordance with 
paragraph (1), but notwithstanding the capped amount referenced in 
subsections (b)(2) and (d)(2), the qualified teaching health center per 
resident amount for a fiscal year shall be not less than $10,000 more 
than the qualified teaching health center per resident amount for the 
prior fiscal year.''.
    (c) Amount of Payments.--Section 340H of the Public Health Service 
Act (42 U.S.C. 256h) is amended--
            (1) in subsection (b)(2)--
                    (A) in subparagraph (A), by striking ``amount of 
                funds appropriated under subsection (g) for such 
                payments for that fiscal year'' and inserting ``total 
                amount of funds available under subsection (g) and any 
                amounts recouped under subsection (f)''; and
                    (B) in subparagraph (B), by striking ``appropriated 
                in a fiscal year under subsection (g)'' and inserting 
                ``available under subsection (g) and any amounts 
                recouped under subsection (f)''; and
            (2) in subsection (d)(2)(B), by striking ``amount 
        appropriated for such expenses as determined in subsection 
        (g)'' and inserting ``total amount of funds available under 
        subsection (g) and any amounts recouped under subsection (f)''.
    (d) Priority Payments.--Section 340H(a)(3) of Public Health Service 
Act (42 U.S.C. 256h(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``; or'' and inserting 
        a semicolon;
            (2) in subparagraph (B), by striking the period and 
        inserting ``; or''; and
            (3) by adding at the end the following:
                    ``(C) are located in a State that does not already 
                have a qualified teaching health center receiving 
                funding under this section.''.
    (e) Reporting Requirements.--Section 340H(h)(1) of the Public 
Health Service Act (42 U.S.C. 256h(h)(1)) is amended--
            (1) by redesignating subparagraph (H) as subparagraph (I); 
        and
            (2) by inserting after subparagraph (G) the following:
                    ``(H) Of the number of residents described in 
                paragraph (4) who completed their residency training, 
                the number practicing primary care (meaning any of the 
                areas of practice listed in the definition of a primary 
                care residency program in section 749A) 5 years 
                following completion of such training.''.
    (f) Guidance.--The Secretary shall update guidance and relevant 
information regarding States described in subparagraph (C) of section 
340H(a)(3) of the Public Health Service Act (42 U.S.C. 256h(a)(3)), as 
amended by subsection (d), and make available model templates to assist 
health centers in such States in establishing a teaching health center.

SEC. 102. COMMUNITY HEALTH CENTERS.

    (a) Community Health Center Fund.--Section 10503 of the Patient 
Protection and Affordable Care Act (42 U.S.C. 254b-2) is amended--
            (1) in subsection (b)(1)(F)--
                    (A) by striking ``2018 and'' and inserting 
                ``2018,''; and
                    (B) by inserting before the semicolon the 
                following: ``, and $5,800,000,000 for each of fiscal 
                years 2024 through 2026''; and
            (2) by adding at the end the following:
    ``(f) Priority Use of Funds.--For fiscal years 2024 through 2026, 
with respect to $1,800,000,000 of the amount appropriated under 
subsection (b)(1)(F), the Secretary shall prioritize awards to entities 
for purposes of--
            ``(1) increasing the number of low-income patients not 
        enrolled in a group health plan or group or individual health 
        insurance coverage who are served by health centers, including 
        through Health Center Program New Access Points described in 
        section 330(e)(6) of the Public Health Service Act, including 
        school-based service sites;
            ``(2) increasing the required primary health services 
        described in paragraph (1)(A)(i) of section 330(b) of the 
        Public Health Service Act and additional health services (as 
        defined in paragraph (2) of such section) offered by health 
        centers; and
            ``(3) increasing patient case management, enabling 
        services, and education services, as described in clauses (iii) 
        through (v) of section 330(b)(1)(A) of the Public Health 
        Service Act.''.
    (b) Authorization of Appropriations.--Section 330(r)(1) of the 
Public Health Service Act (42 U.S.C. 254b(r)(1)) is amended--
            (1) in subparagraph (G), by striking ``fiscal year 2016, 
        and each subsequent fiscal year'' and inserting ``each of 
        fiscal years 2016 through 2023''; and
            (2) by adding at the end the following:
                    ``(H) For each of fiscal years 2024 through 2026, 
                $2,200,000,000.
                    ``(I) For fiscal year 2027, and each subsequent 
                fiscal year, the amount appropriated for the preceding 
                fiscal year adjusted by the product of--
                            ``(i) one plus the average percentage 
                        increase in costs incurred per patient served; 
                        and
                            ``(ii) one plus the average percentage 
                        increase in the total number of patients 
                        served.''.
    (c) Allocation of Funds.--Section 10503 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 254b-2), as amended by subsection 
(a), is further amended by adding at the end the following:
    ``(g) Allocation of Funds.--For each of fiscal years 2024 through 
2026, of the amounts appropriated under subsection (b)(1)(F) for a 
fiscal year, the Secretary shall use--
            ``(1) at least $245,000,000 for awards to support health 
        centers in each State that are receiving awards under section 
        330 of the Public Health Service Act in extending operating 
        hours, in an amount determined pursuant to a formula and 
        eligibility criteria developed by the Secretary, for the 
        purposes of increasing access to services;
            ``(2) at least $55,000,000 for awards under this section 
        for health centers to expand school-based services and 
        establish new school-based service sites; and
            ``(3) such sums as may be necessary for purposes of 
        increasing the amount awarded pursuant to grants or cooperative 
        agreements under section 330 of the Public Health Service Act 
        so that each recipient of such an award receives--
                    ``(A) for fiscal year 2024, at least 15 percent 
                more than such recipient received for fiscal year 2023; 
                and
                    ``(B) for each of fiscal years 2025 and 2026, the 
                amount received in the previous year adjusted by--
                            ``(i) the percent increase in the medical 
                        component of the consumer price index for the 
                        most recent 12-month period for which 
                        applicable data is available; plus
                            ``(ii) one percent.''.
    (d) Capital Funding.--Section 10503(c) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 254b-2(c)) is amended--
            (1) in the subsection heading, by inserting ``; Capital 
        Funding'' after ``Construction'';
            (2) by striking ``There is'' and inserting the following:
            ``(1) Construction.--There is''; and
            (3) by adding at the end the following:
            ``(2) Capital funding.--For the alteration, renovation, 
        construction, equipment, and other capital costs of health 
        centers that receive funding under section 330 of the Public 
        Health Service Act (42 U.S.C. 254b), in addition to amounts 
        otherwise made available for such purpose, there is 
        appropriated to the Secretary of Health and Human Services, out 
        of amounts in the Treasury not otherwise appropriated, 
        $3,000,000,000 for fiscal year 2024, to remain available until 
        September 30, 2026. In awarding amounts appropriated under this 
        paragraph, the Secretary shall prioritize awards related to 
        increasing access to dental and behavioral health services.''.
    (e) Strategic Plan To Improve Health Outcomes Through Nutrition.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services, in consultation with the Secretary of Agriculture, 
        shall submit to the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives a 5-year strategic plan to 
        improve health outcomes through nutrition for low-income or 
        uninsured patient populations with severe, complex chronic 
        conditions and one or more diet-related conditions.
            (2) Report.--In carrying out paragraph (1), the Secretary 
        of Health and Human Services shall--
                    (A) conduct an evaluation of previous and current 
                federally funded efforts of the Department of Health 
                and Human Services to improve patient outcomes through 
                nutrition interventions, such as medically tailored 
                meals and nutrition counseling; and
                    (B) include in the strategic report recommendations 
                for--
                            (i) reducing the financial impact of 
                        obesity and preventable chronic conditions 
                        resulting from obesity;
                            (ii) empowering federally funded community 
                        health centers, rural health clinics, and other 
                        relevant federally funded facilities to provide 
                        produce prescriptions, medically-tailored 
                        groceries, and medically-tailored meals;
                            (iii) promoting long-term adoption of 
                        improved nutrition habits, including through 
                        increased culinary education and consumer 
                        nutrition aligned with the most recent Dietary 
                        Guidelines for Americans published under 
                        section 301 of the National Nutrition 
                        Monitoring and Related Research Act of 1990 (7 
                        U.S.C. 5341) and incorporating behavioral 
                        modeling or other novel methods across Federal 
                        programs;
                            (iv) developing performance and quality 
                        metrics related to the delivery of produce 
                        prescriptions, medically tailored groceries, 
                        and medically-tailored meals across relevant 
                        Federal payers to aid in reimbursement 
                        strategies;
                            (v) developing payment models for novel 
                        obesity care therapies for the treatment of 
                        diabetes that include behavioral and 
                        nutritional and dietary services and education;
                            (vi) improving coordination of care and 
                        integrating nutrition services and resources 
                        within federally funded community health 
                        centers, rural health clinics, and other 
                        federally funded primary care facilities;
                            (vii) bolstering partnerships with State 
                        and local governments and nongovernmental 
                        organizations; and
                            (viii) addressing geographic disparities in 
                        access to nutrition services and resources.
    (f) Required Primary Health Services.--
            (1) In general.--Section 330 of the Public Health Service 
        Act (42 U.S.C. 254b) is amended--
                    (A) in subsection (b)(1)(A)--
                            (i) in clause (i)--
                                    (I) in subclause (IV), by striking 
                                ``; and'' and inserting a semicolon; 
                                and
                                    (II) by adding at the end the 
                                following:
                                    ``(VI) appropriate nutritional and 
                                dietary services; and
                                    ``(VII) appropriate behavioral and 
                                mental health and substance use 
                                disorder services;'';
                            (ii) in clause (ii)--
                                    (I) by striking ``substance use 
                                disorder and mental health services'' 
                                and inserting ``behavioral and mental 
                                health and substance use disorder 
                                services and nutrition services''; and
                                    (II) by inserting ``, including 
                                such referrals to certified community 
                                behavioral health clinics'' before the 
                                semicolon; and
                            (iii) in clause (iii), by inserting 
                        ``nutritional,'' after ``educational,'';
                    (B) in subsection (b)(2)--
                            (i) by striking subparagraph (A); and
                            (ii) by redesignating subparagraphs (B) 
                        through (D) as subparagraphs (A) through (C), 
                        respectively; and
                    (C) in subsection (d)(1)(A), by inserting ``or one 
                or more diet-related conditions'' before the semicolon.
            (2) Implementation of new required primary health 
        service.--Paragraph (4) of section 330(e) of the Public Health 
        Service Act (42 U.S.C. 254b(e)) is amended to read as follows:
            ``(4) Limitation.--Not more than 2 grants may be made under 
        paragraph (1)(B) for the same entity, except that such 
        limitation shall not apply for the period of 2 years beginning 
        on the date of enactment of the Bipartisan Primary Care and 
        Health Workforce Act, in any case where the only basis upon 
        which paragraph (1)(B) applies to a health center is that the 
        health center is not in noncompliance with the requirements 
        under subclauses (VI) and (VII) of subsection (b)(1)(A)(i) to 
        provide appropriate nutritional disorder providers, including 
        for health centers, certified community behavioral health 
        centers, and other community care settings.''.
    (g) Increase the Use of Provider Tools To Improve Health 
Outcomes.--Not later than one year after the date of enactment of this 
Act, the Secretary of Health and Human Services, in consultation with 
the Secretary of Agriculture, shall submit to Congress a report that 
includes--
            (1) recommendations for States on how to support the 
        coordination of federally funded nutrition programs and 
        services provided by health care professionals in community 
        health centers; and
            (2) data on the number of individuals enrolled in federally 
        subsidized health insurance coverage who are also enrolled in 
        or eligible for federally subsidized nutrition and food 
        programs.

SEC. 103. NATIONAL HEALTH SERVICE CORPS.

    Section 10503(b)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 254b-2(b)(2)) is amended--
            (1) in subparagraph (G), by striking ``; and'' and 
        inserting a semicolon;
            (2) in subparagraph (H), by striking the period and 
        inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(I) $950,000,000 for each of fiscal years 2024 
                through 2026.''.

SEC. 104. GAO REPORT.

    (a) In General.--Not later than one year after the date of 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Health, Education, Labor, and Pensions 
of the Senate and the Committee on Energy and Commerce of the House of 
Representatives a report assessing the effectiveness of the National 
Health Service Corps (referred to in this section as the ``NHSC'') in 
attracting health care professionals to health professional shortage 
areas designated under section 332 of the Public Health Service Act (42 
U.S.C. 254e) (referred to in this section as ``HPSAs''), such as by--
            (1) assessing the metrics used by the Health Resources and 
        Services Administration in evaluating the program;
            (2) comparing the retention rates of NHSC participants in 
        the HPSAs where they completed their period of obligated 
        service to the retention rates of non-NHSC participants in the 
        corresponding HPSAs;
            (3) comparing the retention rates of NHSC participants in 
        the HPSAs where they completed their period of obligated 
        service to the retention rates of NHSC participants in HPSAs 
        other than those where they completed their period of obligated 
        service;
            (4) identifying factors that influence an NHSC 
        participant's decision to practice in an HPSA other than the 
        HPSA where they completed their period of obligated service;
            (5) identifying factors other than participation in the 
        National Health Service Corps Scholarship and Loan Repayment 
        Programs that attract health care professionals to practice in 
        a HPSA;
            (6) assessing the impact the NHSC has on wages for health 
        care professionals in an HPSA; and
            (7) comparing the distribution of NHSC participants across 
        HPSAs, including a comparison of rural versus non-rural HPSAs.
    (b) Definition.--In this section, the term ``NHSC participant'' 
means a National Health Service Corps member participating in the 
National Health Service Corps Scholarship or Loan Repayment Program 
under subpart III of part D of title III of the Public Health Service 
Act (42 U.S.C. 254l et seq.).

SEC. 105. OIG REPORT.

    Not later than 2 years after the date of enactment of this Act, the 
Inspector General of the Department of Health and Human Services shall 
submit to Congress a report on integrity efforts of the Health 
Resources and Services Administration with respect to programs carried 
out by the Health Resources and Services Administration. Such report 
shall include an assessment of--
            (1) the ways in which the Administrator of the Health 
        Resources and Services Administration (referred to in this 
        section as the ``Administrator'') determines reasonable efforts 
        are continuously made to establish and maintain collaborative 
        relationships with health care providers;
            (2) the ways in which the Administrator ensures quality and 
        continuity of care for underserved areas; and
            (3) the extent to which the Administrator validates the 
        financial responsibility of and use of grant funding by 
        community health centers.

SEC. 106. APPLICATION OF PROVISIONS.

    (a) In General.--Amounts appropriated pursuant to the amendments 
made by this title shall be subject to the requirements contained in 
Public Law 117-328 for funds for programs authorized under sections 330 
through 340 of the Public Health Service Act (42 U.S.C. 254b through 
256).
    (b) Conforming Amendment.--Paragraph (4) of section 3014(h) of 
title 18, United States Code, is amended by striking ``and section 
301(d) of division BB of the Consolidated Appropriations Act, 2021.'' 
and inserting ``section 301(d) of division BB of the Consolidated 
Appropriations Act, 2021, and section 106(a) of the Bipartisan Primary 
Care and Health Workforce Act''.

             TITLE II--SUPPORTING THE HEALTH CARE WORKFORCE

SEC. 201. RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by inserting after section 330A-2 the following:

``SEC. 330A-3. RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM AND 
              RURAL RESIDENCY PLANNING AND DEVELOPMENT TECHNICAL 
              ASSISTANCE PROGRAM.

    ``(a) Definition of Rural Residency Program.--In this section, the 
term `rural residency program' means a physician residency program, 
including a rural track program, accredited by the Accreditation 
Council for Graduate Medical Education (or a similar body) that--
            ``(1) trains residents in rural areas (as defined by the 
        Secretary) for more than 50 percent of the total time of their 
        residency; and
            ``(2) primarily focuses on producing physicians who will 
        practice in rural areas, as defined by the Secretary.
    ``(b) Rural Residency Planning and Development Program.--
            ``(1) Definition of eligible entity.--In this subsection, 
        the term `eligible entity'--
                    ``(A) means--
                            ``(i) a domestic public or private 
                        nonprofit or for-profit entity;
                            ``(ii) an Indian Tribe, Tribal health 
                        program, Tribal organization, or Urban Indian 
                        organization (as such terms are defined in 
                        section 4 of the Indian Health Care Improvement 
                        Act); or
                            ``(iii) a Native Hawaiian Health 
                        organization as defined in section 12 of the 
                        Native Hawaiian Health Care Improvement Act; 
                        and
                    ``(B) may include faith-based or community-based 
                organizations, rural hospitals, rural community-based 
                ambulatory patient care centers (including rural health 
                clinics), health centers operated by a Native Hawaiian 
                Health organization (defined as described in 
                subparagraph (A)(iii)), an Indian Tribe, a Tribal 
                health program, a Tribal organization, or an Urban 
                Indian organization (defined as described in 
                subparagraph (A)(ii)), graduate medical education 
                consortiums (including institutions of higher 
                education, such as schools of allopathic medicine, 
                schools of osteopathic medicine, or historically Black 
                colleges or universities (as defined by the term `part 
                B institution' in section 322 of the Higher Education 
                Act of 1965 or described in section 326(e)(1) of the 
                Higher Education Act of 1965) or other minority-serving 
                institutions (as described in section 371(a) of the 
                Higher Education Act of 1965)), or other organizations 
                as determined appropriate by the Secretary.
            ``(2) Grants.--
                    ``(A) In general.--The Secretary may award grants 
                to eligible entities to create new rural residency 
                programs (including adding new rural training sites to 
                existing rural track programs).
                    ``(B) Funding.--Grants awarded under this 
                subsection may be fully funded at the time of the 
                award.
                    ``(C) Term.--The term of a grant under this 
                subsection shall be 4 years and may be extended at the 
                discretion of the Secretary.
            ``(3) Applications.--
                    ``(A) In general.--To be eligible to receive a 
                grant under this subsection, an eligible entity shall 
                prepare and submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require, including a 
                description of the pathway of the rural residency 
                program as described in subparagraph (B).
                    ``(B) Pathway.--A pathway of a rural residency 
                program supported under this subsection shall be for--
                            ``(i) general primary care and high-need 
                        specialty care, including family medicine, 
                        internal medicine, preventive medicine, 
                        psychiatry, or general surgery;
                            ``(ii) maternal health and obstetrics, 
                        which may be obstetrics and gynecology or 
                        family medicine with enhanced obstetrical 
                        training; or
                            ``(iii) any other pathway as determined 
                        appropriate by the Secretary.
    ``(c) Rural Residency Planning and Development Technical 
Assistance.--
            ``(1) Definition of eligible entity.--In this subsection, 
        the term `eligible entity' means--
                    ``(A) a domestic public or private nonprofit or 
                for-profit entity; or
                    ``(B) an Indian Tribe or Tribal organization (as 
                such terms are defined in section 4 of the Indian 
                Health Care Improvement Act).
            ``(2) Grants.--
                    ``(A) In general.--The Secretary may award grants 
                to eligible entities to provide technical assistance to 
                awardees of and potential applicants of the program 
                described in subsection (b).
                    ``(B) Funding.--Grants awarded under this 
                subsection may be fully funded at the time of the 
                award.
                    ``(C) Term.--The term of a grant under this 
                subsection shall be 4 years and may be extended at the 
                discretion of the Secretary.
            ``(3) Applications.--To be eligible to receive a grant 
        under this subsection, an eligible entity shall prepare and 
        submit to the Secretary an application at such time, in such 
        manner, and containing such information as the Secretary may 
        require.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $13,000,000 for fiscal year 
2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 
2026, to remain available until expended.''.

SEC. 202. PRIMARY CARE TRAINING AND ENHANCEMENT PROGRAM.

    Section 747(c)(1) of the Public Health Service Act (42 U.S.C. 
293k(c)(1)) is amended by striking ``$48,924,000 for each of fiscal 
years 2021 through 2025'' and inserting ``$49,250,000 for fiscal year 
2024, $49,500,000 for fiscal year 2025, and $50,000,000 for fiscal year 
2026''.

SEC. 203. TELEHEALTH TECHNOLOGY-ENABLED LEARNING PROGRAM.

    Section 330N(k) of the Public Health Service Act (42 U.S.C. 254c-
20(k)) is amended by striking ``2026'' and inserting ``2025, and 
$11,000,000 for each of fiscal years 2026 through 2028, to remain 
available until expended''.

SEC. 204. NURSE EDUCATION, PRACTICE, QUALITY, AND RETENTION GRANTS AND 
              CONTRACTS.

    Section 831 of the Public Health Service Act (42 U.S.C. 296p) is 
amended by adding at the end the following:
    ``(g) Pilot Program.--
            ``(1) In general.--The Secretary shall establish a 2-year 
        pilot program under which the Secretary may award grants to, 
        and enter into contracts with, schools of nursing offering 
        associate degrees that otherwise meet the criteria for 
        receiving a grant or contract under this section, for the 
        purpose of promoting career advancement for individuals, 
        including licensed practical nurses, licensed vocational 
        nurses, certified nurse assistants, home health aides, and 
        other health professionals, such as health aides or community 
        health practitioners certified under the Community Health Aide 
        Program of the Indian Health Service under section 119 of the 
        Indian Health Care Improvement Act, by supporting such 
        individuals in becoming registered nurses with associate 
        degrees.
            ``(2) Criteria; requirements.--With respect to grants and 
        contracts awarded under this subsection, the Secretary shall 
        use the same criteria (except as otherwise provided in 
        paragraph (1)) as apply to other grants and contracts awarded 
        under this section, and entities receiving such grants or 
        contracts shall be subject to the same requirements (except as 
        otherwise provided in paragraph (1)) as apply to other grant 
        and contract recipients under this section.
            ``(3) Authorization of appropriations.--To carry out this 
        subsection, there are authorized to be appropriated such sums 
        as may be necessary for the period of fiscal years 2024 and 
        2025.''.

SEC. 205. NURSE FACULTY LOAN PROGRAM.

    Section 846A of the Public Health Service Act (42 U.S.C. 297n-1), 
as amended by section 206, is amended by inserting after subsection (b) 
the following:
    ``(c) Authorization of Appropriations.--To carry out this section 
(other than subsection (d)), in addition to amounts otherwise made 
available, including under section 871(b), there are authorized to be 
appropriated $28,500,000 for each of fiscal years 2024 through 2026, to 
remain available until expended.''.

SEC. 206. NURSE FACULTY DEMONSTRATION PROGRAM.

    Section 846A of the Public Health Service Act (42 U.S.C. 297n-1) is 
amended--
            (1) by amending subsection (a) to read as follows:
    ``(a) In General.--To increase the number of qualified nursing 
faculty, the Secretary may--
            ``(1) enter into an agreement with any accredited school of 
        nursing for the establishment and operation of a student loan 
        fund in accordance with subsection (b); and
            ``(2) award nurse faculty grants in accordance with 
        subsection (d).'';
            (2) in subsection (b)--
                    (A) by redesignating subparagraphs (A) through (D) 
                of paragraph (2) as clauses (i) through (iv), 
                respectively, and adjusting the margins accordingly;
                    (B) by redesignating paragraphs (1) through (5) as 
                subparagraphs (A) through (E), respectively, and 
                adjusting the margins accordingly;
                    (C) in subparagraph (C), as so redesignated, by 
                striking ``subsection (c)'' and inserting ``paragraph 
                (2)''; and
                    (D) by striking ``(b) Agreements--Each agreement 
                entered into under subsection (a) shall--'' and 
                inserting the following:
    ``(b) School of Nursing Student Loan Fund.--
            ``(1) In general.--Each agreement entered into under 
        subsection (a)(1) shall--'';
            (3) in subsection (c)--
                    (A) by striking ``subsection (a)'' each place it 
                appears and inserting ``subsection (a)(1)'';
                    (B) in paragraph (3), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and adjusting the margins accordingly;
                    (C) in paragraph (6), by redesignating 
                subparagraphs (A) and (B) as clauses (i) and (ii), 
                respectively, and adjusting the margins accordingly;
                    (D) by redesignating paragraphs (1) through (6) as 
                subparagraphs (A) through (F), respectively, and 
                adjusting the margins accordingly; and
                    (E) in subparagraph (F)(ii), as so redesignated, by 
                striking ``subsection (e)'' and inserting ``paragraph 
                (4)'';
            (4) in subsection (e), by striking ``subsection (c)(6)(B)'' 
        and inserting ``paragraph (2)(F)(ii)'';
            (5) by redesignating subsections (c) through (e) (before 
        application of the amendment made by section 206) as paragraphs 
        (2) through (4), respectively, and adjusting the margins 
        accordingly; and
            (6) by adding after subsection (c), as added by section 
        205, the following:
    ``(d) Nurse Faculty Demonstration Program.--
            ``(1) In general.--The Secretary shall establish and carry 
        out a demonstration program described in subsection (a)(2) 
        under which eligible schools of nursing receive a grant for 
        purposes of supplementing the salaries of eligible nursing 
        faculty members to enhance recruitment and retention of nursing 
        faculty members.
            ``(2) Eligible entities.--To be eligible to receive a grant 
        under this subsection, an entity shall--
                    ``(A) be an accredited school of nursing; and
                    ``(B) submit an application to the Secretary, at 
                such time, in such manner, and containing such 
                information as the Secretary may require, including--
                            ``(i)(I) to the extent such information is 
                        available to the school of nursing, the salary 
                        history of nursing faculty at such school who 
                        previously were nurses in clinical practice, 
                        for the most recent 3-year period ending on the 
                        date of application, adjusted for inflation as 
                        appropriate and broken down by credentials, 
                        experience, and levels of education of such 
                        nurses; or
                            ``(II) if the information described in 
                        subclause (I) is not available, information on 
                        the average local salary of nurses in clinical 
                        practice, adjusted for inflation as appropriate 
                        and broken down by credentials, experience, and 
                        levels of education of the individual nurses, 
                        in accordance with such requirements as the 
                        Secretary may specify;
                            ``(ii) an attestation of the average 
                        nursing faculty salary at the school of nursing 
                        during the most recent 3-year period prior to 
                        the date of application, adjusted for 
                        inflation, as appropriate, broken down by 
                        credentials, experience, and levels of 
                        education of such faculty members;
                            ``(iii) the number of nursing faculty 
                        member vacancies at the entity at the time of 
                        application, and the entity's projection of 
                        such vacancies over the ensuing 5-year period; 
                        and
                            ``(iv) a description of the entity's plans 
                        to identify funding sources to sustainably 
                        continue, after the 2-year grant period, the 
                        salary available to the eligible nursing 
                        faculty member pursuant to the program under 
                        this subsection during such grant program and 
                        to retain eligible nursing faculty members 
                        after the end of the grant period.
            ``(3) Awards.--A grant awarded under this subsection, with 
        respect to supporting eligible nursing faculty members, shall--
                    ``(A) be awarded to the school of nursing to 
                supplement the salaries of eligible faculty members at 
                the school of nursing, annually, for up to a 2-year 
                period, in an amount equal to, for each eligible 
                nursing faculty member at the eligible entity during 
                the grant period, the difference between--
                            ``(i) the average salary of nurses in 
                        clinical practice, as submitted under subclause 
                        (I) or (II) of paragraph (2)(B)(i); and
                            ``(ii) the greater of--
                                    ``(I) the salary for the eligible 
                                nursing faculty member at the school of 
                                nursing; or
                                    ``(II) the average nursing faculty 
                                salary submitted under paragraph 
                                (2)(B)(ii) for faculty members with the 
                                same or similar credentials and level 
                                of education;
                    ``(B) notwithstanding section 803(a), be used in 
                its entirety to supplement the eligible faculty 
                member's salary; and
                    ``(C) be conditioned upon the school of nursing 
                maintaining, for each year in which the award is made 
                as described in subparagraph (A), a salary for such 
                faculty member at a level that is not less than the 
                greater of the amount under subclause (I) or (II) of 
                subparagraph (A)(ii).
            ``(4) Priority.--In awarding grants under this subsection, 
        the Secretary shall ensure the equitable geographic 
        distribution of awards, and shall give priority to applications 
        from schools of nursing that demonstrate--
                    ``(A) the greatest need for such grant, which may 
                be based upon the financial circumstances of the school 
                of nursing, the number of eligible nurse faculty 
                members, and the planned number of students to be 
                trained or admitted off a wait list;
                    ``(B) training or partnerships to serve vulnerable 
                patient populations, such as through the location or 
                activity of a school in a health professional shortage 
                area (as defined in section 332);
                    ``(C) recruitment and retention of faculty from 
                underrepresented populations; or
                    ``(D) other particular need for such grant, 
                including public institutions of higher education that 
                offer 4-year degrees but at which the predominant 
                degree awarded is an associate degree.
            ``(5) Rule of construction.--Nothing in this subsection 
        precludes a school of nursing or an eligible nursing faculty 
        member receiving an award under this section from obtaining or 
        receiving any other form of Federal support or funding.
            ``(6) Report.--Not later than 3 years after the date of 
        enactment of the Bipartisan Primary Care and Health Workforce 
        Act, the Secretary shall submit to the Committee on Finance and 
        the Committee on Health, Education, Labor, and Pensions of the 
        Senate and the Committee on Ways and Means and the Committee on 
        Energy and Commerce of the House of Representatives, a report 
        that evaluates the program established under this subsection, 
        including--
                    ``(A) the impact of such program on recruitment and 
                retention rates of nursing faculty, as available, and 
                specifically for each faculty member participating in 
                the program; and
                    ``(B) recommendations and considerations for 
                Congress on continuing the program under this 
                subsection.
            ``(7) Definitions.--In this subsection:
                    ``(A) Eligible nursing faculty member.--The term 
                `eligible nursing faculty member' means a nursing 
                faculty member who--
                            ``(i) was hired by a school of nursing 
                        within the 2-year period preceding the 
                        submission of an application under paragraph 
                        (2), or a prospective nursing faculty member;
                            ``(ii) is currently employed at the school 
                        of nursing and who demonstrates the need for 
                        such support;
                            ``(iii) previously worked as a nurse in 
                        clinical practice or as a nurse faculty member 
                        at another school of nursing; or
                            ``(iv) may work on a part-time basis as a 
                        nursing faculty member, for whom such award 
                        amounts described in paragraph (3) shall be 
                        prorated relative to the amount of time 
                        participating in part-time teaching.
                    ``(B) Inflation.--The term `inflation' means the 
                Consumer Price Index for all urban consumers (all 
                items; U.S. city average).
            ``(8) Authorization of appropriations.--To carry out this 
        subsection, in addition to amounts otherwise available, 
        including under section 871(b), there is authorized to be 
        appropriated $15,000,000 for each of fiscal years 2024 and 
        2025.''.

SEC. 207. NURSE CORPS SCHOLARSHIP AND LOAN REPAYMENT PROGRAM.

    Section 846 of the Public Health Service Act (42 U.S.C. 297n) is 
amended by adding at the end the following:
    ``(j) Authorization of Appropriations.--To carry out this section, 
in addition to amounts otherwise made available, including under 
section 871(b), there are authorized to be appropriated $93,600,000 for 
fiscal year 2024, $94,600,000 for fiscal year 2025, and $95,600,000 for 
fiscal year 2026, to remain available until expended.''.

SEC. 208. GRANTS FOR PRIMARY CARE NURSE RESIDENCY TRAINING PROGRAMS.

    Section 5316 of the Patient Protection and Affordable Care Act (42 
U.S.C. 296j-1) is amended--
            (1) in the section heading, by striking ``demonstration'';
            (2) in subsection (a), by striking ``demonstration'';
            (3) in subsection (d)--
                    (A) in paragraph (1)(B), by striking ``and'' at the 
                end;
                    (B) by redesignating paragraph (2) as paragraph 
                (3); and
                    (C) by inserting after paragraph (1) the following:
            ``(2)(A) in the case of an entity that does not have an 
        established residency program for nurse practitioners at the 
        time of the application, demonstrate plans to establish a new 
        residency program for nurse practitioners; or
            ``(B) in the case of an entity that has an established 
        residency program for nurse practitioners at the time of the 
        application, demonstrate plans to use the grant under this 
        section to offer not fewer than 4 additional residency 
        positions for new nurse practitioners to participate in such 
        program; and''; and
            (4) in subsection (i), by striking ``such sums as may be 
        necessary for each of fiscal years 2011 through 2014'' and 
        inserting ``$30,000,000 for each of fiscal years 2024 through 
        2026''.

SEC. 209. STATE ORAL HEALTH WORKFORCE IMPROVEMENT GRANT PROGRAM.

    Subsection (f) of section 340G of the Public Health Service Act (42 
U.S.C. 256g) is amended by striking ``$13,903,000 for each of fiscal 
years 2019 through 2023'' and inserting ``$15,200,000 for fiscal year 
2024, $15,500,000 for fiscal year 2025, and $15,800,000 for fiscal year 
2026, to remain available until expended''.

SEC. 210. ORAL HEALTH TRAINING PROGRAMS.

    Subsection (f) of section 748 of the Public Health Service Act (42 
U.S.C. 293k-2) is amended to read as follows:
    ``(f) Authorization of Appropriations.--
            ``(1) In general.--To carry out this section, there is 
        authorized to be appropriated $28,500,000 for fiscal year 2026, 
        to remain available until expended.
            ``(2) Geographic distribution.--In awarding grants under 
        this section, the Secretary shall ensure, to the greatest 
        extent practicable, that such grants are equitably distributed 
        among the geographical regions of the United States.''.

SEC. 211. ALLIED HEALTH PROFESSIONALS.

    (a) Supporting Dual or Concurrent Enrollment in the Allied Health 
Projects Program.--Section 755(b)(1) of the Public Health Service Act 
(42 U.S.C. 294e(b)(1)) is amended--
            (1) in subparagraph (B), by striking ``to individuals who 
        have baccalaureate degrees in health-related sciences'';
            (2) in the flush text at the end of subparagraph (I), by 
        striking ``; and'' and inserting a semicolon;
            (3) in subparagraph (J), by striking the period and 
        inserting ``; and''; and
            (4) by adding at the end the following:
                    ``(K) those that establish or support a dual or 
                concurrent enrollment program (as defined in section 
                8101 of the Elementary and Secondary Education Act of 
                1965) if the dual or concurrent enrollment program--
                            ``(i) provides outreach on allied health 
                        careers requiring an industry-recognized 
                        credential, a certificate, or an associate 
                        degree, to all high schools served by the local 
                        educational agency that is a partner in the 
                        partnership offering the dual or concurrent 
                        enrollment program;
                            ``(ii) provides information to high school 
                        students about the training requirements and 
                        expected salary of allied health professionals; 
                        and
                            ``(iii) provides academic and financial aid 
                        counseling to students who participate in the 
                        dual or concurrent enrollment program.''.
    (b) Supporting Dual or Concurrent Enrollment in the Health Careers 
Opportunity Program.--Section 739(a)(2) of the Public Health Service 
Act (42 U.S.C. 293c(a)(2)) is amended--
            (1) in subparagraph (H), by striking ``and'' after the 
        semicolon;
            (2) in subparagraph (I), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(J) providing academic and financial aid 
                counseling to support participation in a dual or 
                concurrent enrollment program (as defined in section 
                8101 of the Elementary and Secondary Education Act of 
                1965) that leads to an industry-recognized credential, 
                a certificate, or an associate degree in the health 
                professions or academic credits that can be 
                transferred, as indicated through an articulation 
                agreement between 2 or more community colleges or 
                universities, to obtain an industry-recognized 
                credential, a certificate, or a degree in the health 
                professions.''.
    (c) Health Care Workforce Innovation Program.--Section 755(b) of 
the Public Health Service Act (42 U.S.C. 294e(b)) is amended by adding 
at the end the following:
            ``(5)(A) Supporting and developing new innovative, 
        community-driven approaches for the education and training of 
        allied health professionals, including those described in 
        subparagraph (F)(i), with an emphasis on expanding the supply 
        of such professionals located in, and meeting the needs of, 
        underserved communities and rural areas. Grants under this 
        paragraph shall be awarded through a new program (referred to 
        as the `Health Care Workforce Innovation Program' or in this 
        paragraph as the `Program').
            ``(B) To be eligible to receive a grant under the Program 
        an entity shall--
                    ``(i) be a Federally qualified health center (as 
                defined in section 1905(l)(2)(B) of the Social Security 
                Act), a State-level association or other consortium 
                that represents and is comprised of Federally qualified 
                health centers, or a certified rural health clinic that 
                meets the requirements of section 334; and
                    ``(ii) submit to the Secretary an application that, 
                at a minimum, contains--
                            ``(I) a description of how all trainees 
                        will be trained in accredited training programs 
                        either directly or through partnerships with 
                        public or nonprofit private entities;
                            ``(II) a description of the community-
                        driven health care workforce innovation model 
                        to be carried out under the grant, including 
                        the specific professions to be funded;
                            ``(III) the geographic service area that 
                        will be served, including quantitative data, if 
                        available, showing that such particular area 
                        faces a shortage of health professionals and 
                        lacks access to health care;
                            ``(IV) a description of the benefits 
                        provided to each health care professional 
                        trained under the proposed model during the 
                        education and training phase;
                            ``(V) a description of the experience that 
                        the applicant has in the recruitment, 
                        retention, and promotion of the well-being of 
                        workers and volunteers;
                            ``(VI) a description of how the funding 
                        awarded under the Program will supplement 
                        rather than supplant existing funding;
                            ``(VII) a description of the scalability 
                        and replicability of the community-driven 
                        approach to be funded under the Program;
                            ``(VIII) a description of the 
                        infrastructure, outreach and communication 
                        plan, and other program support costs required 
                        to operationalize the proposed model; and
                            ``(IX) any other information, as the 
                        Secretary determines appropriate.
            ``(C)(i) An entity shall use amounts received under a grant 
        awarded under the Program to carry out the innovative, 
        community-driven model described in the application under 
        subparagraph (B). Such amounts may be used for launching new, 
        or expanding existing, innovative health care professional 
        partnerships, including the following specific uses:
                    ``(I) Establishing or expanding a partnership 
                between an eligible entity and 1 or more high schools, 
                accredited public or nonprofit private vocational-
                technical schools, accredited public or nonprofit 
                private 2-year colleges, area health education centers, 
                and entities with clinical settings for the provision 
                of education and training opportunities not available 
                at the grantee's facilities.
                    ``(II) Providing education and training programs to 
                improve allied health professionals' readiness in 
                settings that serve underserved communities and rural 
                areas; encouraging students from underserved and 
                disadvantaged backgrounds and former patients to 
                consider careers in health care, and better reflecting 
                and meeting community needs; providing education and 
                training programs for individuals to work in patient-
                centered, team-based, community-driven health care 
                models that include integration with other clinical 
                practitioners and training in cultural and linguistic 
                competence; providing pre-apprenticeship and 
                apprenticeship programs for health care technical, 
                support, and entry-level occupations, particularly for 
                those enrolled in dual or concurrent enrollment 
                programs; building a preceptorship training-to-practice 
                model for medical, behavioral health, oral health, and 
                public health disciplines in an integrated, community-
                driven setting; providing and expanding internships, 
                career ladders, and development opportunities for 
                health care professionals, including new and existing 
                staff; or investing in training equipment, supplies, 
                and limited renovations or retrofitting of training 
                space needed for grantees to carry out their particular 
                model.
            ``(ii) Amounts received under a grant awarded under the 
        Program shall not be used to support construction costs or to 
        supplant funding from existing programs that support the 
        applicant's health workforce.
            ``(iii) Funding of models under the Program shall be for a 
        duration of at least 3 years.
            ``(D) In awarding grants under the Program, the Secretary 
        may give priority to applicants that will use grant funds to 
        support workforce innovation models that increase the number of 
        individuals from underserved and disadvantaged backgrounds 
        working in such health care professions, improve access to 
        health care (including medical, behavioral health and oral 
        health) in underserved communities, or demonstrate that the 
        model can be replicated in other underserved communities in a 
        cost-efficient and effective manner to achieve the purposes of 
        the Program.
            ``(E) An entity that receives a grant under the Program 
        shall provide periodic reports to the Secretary detailing the 
        findings and outcomes of the innovative, community-driven model 
        carried out under the grant. Such reports shall contain 
        information in a manner and at such times as determined 
        appropriate by the Secretary.
            ``(F) In this paragraph:
                    ``(i) The term `allied health care professional' 
                includes individuals who provide clinical support 
                services, including medical assistants, dental 
                assistants, dental hygienists, pharmacy technicians, 
                physical therapists, and health care interpreters; 
                individuals providing non-clinical support, such as 
                billing and coding professionals and health information 
                technology professionals; dieticians; medical 
                technologists; emergency medical technicians; community 
                health workers; public health personnel; and peer 
                support workers.
                    ``(ii) The term `rural area' has the meaning given 
                such term by the Administrator of the Health Resources 
                and Services Administration.
                    ``(iii) The term `underserved communities' means 
                areas, population groups, and facilities designated as 
                health professional shortage areas under section 332, 
                medically underserved areas as defined under section 
                330I(a), or medically underserved populations as 
                defined under section 330(b)(3).
            ``(G)(i) There are authorized to be appropriated 
        $100,000,000 for each of fiscal years 2024 through 2026, to 
        carry out this section, to remain available until expended.
            ``(ii) A grant provided under the Program shall not exceed 
        $2,500,000 for a grant period.''.

SEC. 212. REVIEW OF AND REPORT ON PROGRAMS SUPPORTING THE NURSING 
              WORKFORCE.

    The Secretary of Health and Human Services and the Secretary of 
Labor, jointly, shall--
            (1) conduct a review of all grant programs carried out by 
        the Department of Health and Human Services or by the 
        Department of Labor that support the nurse workforce; and
            (2) not later than 1 year after the date of enactment of 
        this Act, submit to Congress a report on the review under 
        paragraph (1) that includes recommendations for changes to such 
        grant programs to improve upon the goals of--
                    (A) increasing nurse faculty, particularly in 
                underserved areas;
                    (B) providing pathways for nurses who have more 
                than 10 years of clinical experience to become faculty 
                at schools of nursing; and
                    (C) encouraging and increasing the nursing pipeline 
                through pathways for licensed practical nurses to 
                become registered nurses.

SEC. 213. REPORT ON IMPACTS TO COMMUNITY HEALTH CENTERS.

    Not later than 5 years after the date of enactment of this Act, the 
Secretary of Health and Human Services, acting through the Assistant 
Secretary for Planning and Evaluation, shall submit to Congress a 
report on the impacts of this title, including the amendments made by 
this title, on community health centers. Such report shall consider--
            (1) current and projected savings or cost impact on the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX 
        of such Act (42 U.S.C. 1396 et seq.), and the Children's Health 
        Insurance Program under title XXI of such Act (42 U.S.C. 1397aa 
        et seq.);
            (2) current and projected changes in access to health care, 
        health outcomes, health literacy, and access to social care 
        services;
            (3) current and projected changes in wait and travel times 
        to access primary care services; and
            (4) contributions to the economies of the communities 
        served by community health centers, including employment 
        opportunities.

           TITLE III--REDUCING HEALTH CARE COSTS FOR PATIENTS

SEC. 301. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE 
              CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST 
              CARE.

    (a) In General.--
            (1) Public health service act.--Section 2799A-9 of the 
        Public Health Service Act (42 U.S.C. 300gg-119) is amended--
                    (A) by adding at the end the following:
    ``(b) Protecting Health Plans Network Design Flexibility.--
            ``(1) In general.--A group health plan or a health 
        insurance issuer offering group or individual health insurance 
        coverage shall not enter into an agreement with a provider, 
        network or association of providers, or other service provider 
        offering access to a network of service providers if such 
        agreement, directly or indirectly--
                    ``(A) restricts the group health plan or health 
                insurance issuer from--
                            ``(i) directing or steering enrollees to 
                        other health care providers; or
                            ``(ii) offering incentives to encourage 
                        enrollees to utilize specific health care 
                        providers;
                    ``(B) requires the group health plan or health 
                insurance issuer to enter into any additional contract 
                with an affiliate of the provider as a condition of 
                entering into a contract with such provider;
                    ``(C) requires the group health plan or health 
                insurance issuer to agree to payment rates or other 
                terms for any affiliate not party to the contract of 
                the provider involved; or
                    ``(D) restricts other group health plans or health 
                insurance issuers not party to the contract from paying 
                a lower rate for items or services than the contracting 
                plan or issuer pays for such items or services.
            ``(2) Additional requirement for self-insured plans.--A 
        self-insured group health plan shall not enter into an 
        agreement with a provider, network or association of providers, 
        third-party administrator, or other service provider offering 
        access to a network of providers if such agreement directly or 
        indirectly requires the group health plan to certify, attest, 
        or otherwise confirm in writing that the group health plan is 
        bound by restrictive contracting terms between the service 
        provider and a third-party administrator that the group health 
        plan is not party to, without a disclosure that such terms 
        exist.
            ``(3) Exception for plans and issuers.--Paragraph (1)(A) 
        shall not apply to a group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        with respect to--
                    ``(A) a health maintenance organization (as defined 
                in section 2791(b)(3)), if such health maintenance 
                organization operates primarily through exclusive 
                contracts with multi-specialty physician groups, nor to 
                any arrangement between such a health maintenance 
                organization and its affiliates; or
                    ``(B) a value-based network arrangement, such as an 
                exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.
            ``(4) Attestation.--A group health plan or health insurance 
        issuer offering group or individual health insurance coverage 
        shall annually submit to, as applicable, the applicable 
        authority described in section 2723 or the Secretary of Labor 
        or the Secretary of the Treasury, an attestation that such plan 
        or issuer is in compliance with the requirements of this 
        subsection.
            ``(5) Rule of construction.--Nothing in this subsection 
        shall be construed to limit network design or cost or quality 
        initiatives by a group health plan or health insurance issuer, 
        including accountable care organizations, exclusive provider 
        organizations, networks that tier providers by cost or quality 
        or steer enrollees to centers of excellence, or other pay-for-
        performance programs.
            ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).
            ``(7) Grandfathering.--An applicable State authority may 
        make a determination that the prohibitions under paragraph (1) 
        (with respect to conditions that would direct or steer 
        enrollees to, or offer incentives to encourage enrollees to 
        use, other health care providers) will not apply in the State 
        with respect to any specified agreement that is executed before 
        the date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence, an 
        applicable State authority may determine whether renewal of the 
        contract, within the applicable 10-year period, is allowed.''; 
        and
                    (B) by redesignating paragraph (5) of subsection 
                (a) as subsection (c), adjusting the margin of such 
                subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).
            (2) Employee retirement income security act of 1974.--
        Section 724 of the Employee Retirement Income Security Act of 
        1974 (29 U.S.C. 1185m) is amended--
                    (A) by adding at the end the following:
    ``(b) Protecting Health Plans Network Design Flexibility.--
            ``(1) In general.--A group health plan or a health 
        insurance issuer offering group health insurance coverage shall 
        not enter into an agreement with a provider, network or 
        association of providers, or other service provider offering 
        access to a network of service providers if such agreement, 
        directly or indirectly--
                    ``(A) restricts the group health plan or health 
                insurance issuer from--
                            ``(i) directing or steering enrollees to 
                        other health care providers; or
                            ``(ii) offering incentives to encourage 
                        enrollees to utilize specific health care 
                        providers;
                    ``(B) requires the group health plan or health 
                insurance issuer to enter into any additional contract 
                with an affiliate of the provider as a condition of 
                entering into a contract with such provider;
                    ``(C) requires the group health plan or health 
                insurance issuer to agree to payment rates or other 
                terms for any affiliate not party to the contract of 
                the provider involved; or
                    ``(D) restricts other group health plans or health 
                insurance issuers not party to the contract from paying 
                a lower rate for items or services than the contracting 
                plan or issuer pays for such items or services.
            ``(2) Additional requirement for self-insured plans.--A 
        self-insured group health plan shall not enter into an 
        agreement with a provider, network or association of providers, 
        third-party administrator, or other service provider offering 
        access to a network of providers if such agreement directly or 
        indirectly requires the group health plan to certify, attest, 
        or otherwise confirm in writing that the group health plan is 
        bound by restrictive contracting terms between the service 
        provider and a third-party administrator that the group health 
        plan is not party to, without a disclosure that such terms 
        exist.
            ``(3) Exception for plans and issuers.--Paragraph (1)(A) 
        shall not apply to a group health plan or health insurance 
        issuer offering group health insurance coverage with respect 
        to--
                    ``(A) a health maintenance organization (as defined 
                in section 733(b)(3)), if such health maintenance 
                organization operates primarily through exclusive 
                contracts with multi-specialty physician groups, nor to 
                any arrangement between such a health maintenance 
                organization and its affiliates; or
                    ``(B) a value-based network arrangement, such as an 
                exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.
            ``(4) Attestation.--A group health plan or health insurance 
        issuer offering group health insurance coverage shall annually 
        submit to, as applicable, the applicable authority described in 
        section 2723 of the Public Health Service Act or the Secretary 
        of Labor or the Secretary of the Treasury, an attestation that 
        such plan or issuer is in compliance with the requirements of 
        this subsection.
            ``(5) Rule of construction.--Nothing in this subsection 
        shall be construed to limit network design or cost or quality 
        initiatives by a group health plan or health insurance issuer, 
        including accountable care organizations, exclusive provider 
        organizations, networks that tier providers by cost or quality 
        or steer enrollees to centers of excellence, or other pay-for-
        performance programs.
            ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).
            ``(7) Grandfathering.--An applicable State authority may 
        make a determination that the prohibitions under paragraph (1) 
        (with respect to conditions that would direct or steer 
        enrollees to, or offer incentives to encourage enrollees to 
        use, other health care providers) will not apply in the State 
        with respect to any specified agreement that is executed before 
        the date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence, an 
        applicable State authority may determine whether renewal of the 
        contract, within the applicable 10-year period, is allowed.''; 
        and
                    (B) by redesignating paragraph (4) of subsection 
                (a) as subsection (c), adjusting the margin of such 
                subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).
            (3) Internal revenue code of 1986.--Section 9824 of the 
        Internal Revenue Code of 1986 is amended--
                    (A) by adding at the end the following:
    ``(b) Protecting Health Plans Network Design Flexibility.--
            ``(1) In general.--A group health plan shall not enter into 
        an agreement with a provider, network or association of 
        providers, or other service provider offering access to a 
        network of service providers if such agreement, directly or 
        indirectly--
                    ``(A) restricts the group health plan from--
                            ``(i) directing or steering enrollees to 
                        other health care providers; or
                            ``(ii) offering incentives to encourage 
                        enrollees to utilize specific health care 
                        providers;
                    ``(B) requires the group health plan to enter into 
                any additional contract with an affiliate of the 
                provider as a condition of entering into a contract 
                with such provider;
                    ``(C) requires the group health plan to agree to 
                payment rates or other terms for any affiliate not 
                party to the contract of the provider involved; or
                    ``(D) restricts other group health plans not party 
                to the contract from paying a lower rate for items or 
                services than the contracting plan pays for such items 
                or services.
            ``(2) Additional requirement for self-insured plans.--A 
        self-insured group health plan shall not enter into an 
        agreement with a provider, network or association of providers, 
        third-party administrator, or other service provider offering 
        access to a network of providers if such agreement directly or 
        indirectly requires the group health plan to certify, attest, 
        or otherwise confirm in writing that the group health plan is 
        bound by restrictive contracting terms between the service 
        provider and a third-party administrator that the group health 
        plan is not party to, without a disclosure that such terms 
        exist.
            ``(3) Exception for certain plans.--Paragraph (1)(A) shall 
        not apply to a group health plan with respect to--
                    ``(A) a health maintenance organization (as defined 
                in section 9832(b)(3)), if such health maintenance 
                organization operates primarily through exclusive 
                contracts with multi-specialty physician groups, nor to 
                any arrangement between such a health maintenance 
                organization and its affiliates; or
                    ``(B) a value-based network arrangement, such as an 
                exclusive provider network, accountable care 
                organization, center of excellence, a provider 
                sponsored health insurance issuer that operates 
                primarily through aligned multi-specialty physician 
                group practices or integrated health systems, or such 
                other similar network arrangements as determined by the 
                Secretary through rulemaking.
            ``(4) Attestation.--A group health plan shall annually 
        submit to, as applicable, the applicable authority described in 
        section 2723 of the Public Health Service Act or the Secretary 
        of Labor or the Secretary of the Treasury, an attestation that 
        such plan is in compliance with the requirements of this 
        subsection.
            ``(5) Rule of construction.--Nothing in this subsection 
        shall be construed to limit network design or cost or quality 
        initiatives by a group health plan, including accountable care 
        organizations, exclusive provider organizations, networks that 
        tier providers by cost or quality or steer enrollees to centers 
        of excellence, or other pay-for-performance programs.
            ``(6) Compliance with respect to antitrust laws.--
        Compliance with this subsection does not constitute compliance 
        with the antitrust laws, as defined in subsection (a) of the 
        first section of the Clayton Act (15 U.S.C. 12(a)).
            ``(7) Grandfathering.--An applicable State authority may 
        make a determination that the prohibitions under paragraph (1) 
        (with respect to conditions that would direct or steer 
        enrollees to, or offer incentives to encourage enrollees to 
        use, other health care providers) will not apply in the State 
        with respect to any specified agreement that is executed before 
        the date of enactment of the Bipartisan Primary Care and Health 
        Workforce Act, for a maximum length of nonapplicability of up 
        to 10 years from the date of execution of the contract if the 
        applicable State authority determines that the contract is 
        unlikely to significantly lessen competition. With respect to a 
        specified agreement for which an applicable State authority has 
        made a determination under the preceding sentence, an 
        applicable State authority may determine whether renewal of the 
        contract, within the applicable 10-year period, is allowed.''; 
        and
                    (B) by redesignating paragraph (4) of subsection 
                (a) as subsection (c), adjusting the margin of such 
                subsection accordingly, and transferring such 
                subsection (c) to appear after subsection (b), as added 
                by subparagraph (A).
    (b) Regulations.--Not later than 1 year after the date of enactment 
of this Act, the Secretary of Health and Human Services, the Secretary 
of Labor, and the Secretary of the Treasury, jointly, shall promulgate 
regulations to carry out section 2799A-9(b) of the Public Health 
Service Act, section 724(b) of the Employee Retirement Income Security 
Act of 1974, and section 9824(b) of the Internal Revenue Code of 1986, 
as added by subsection (a).
    (c) Effective Date.--Subsection (b) of section 2799A-9 of the 
Public Health Service Act, subsection (b) of section 724 of the 
Employee Retirement Income Security Act of 1974, and subsection (b) of 
section 9824 of the Internal Revenue Code of 1986 (as added by 
paragraphs (1), (2), and (3), respectively, of subsection (a)) shall 
apply with respect to any contract entered into on or after the date 
that is 18 months after the date of enactment of this Act. With respect 
to an applicable contract that is in effect on the date of enactment of 
this Act, such subsection (b) shall apply on the earlier of the date of 
renewal of such contract or 3 years after such date of enactment.

SEC. 302. HONEST BILLING REQUIREMENTS APPLICABLE TO PROVIDERS.

    (a) Group Health Plan and Health Insurance Issuer Requirements.--
            (1) Public health service act.--Part D of title XXVII of 
        the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is 
        amended by adding at the end the following:

``SEC. 2799A-11. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS AND 
              ISSUERS.

    ``A group health plan or health insurance issuer offering group or 
individual health insurance coverage may not pay a claim for items and 
services furnished on or after January 1, 2026, to an individual at an 
off-campus outpatient department of a provider (as defined in section 
2799B-10(b)) submitted by a health care provider or facility unless 
such claim submitted by such provider or facility includes a separate 
unique health identifier for the department where items and services 
were furnished, in accordance with section 2799B-10.''.
            (2) Employee retirement income security act of 1974.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1185 et seq.) is amended by 
                adding at the end the following:

``SEC. 726. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS AND 
              ISSUERS.

    ``A group health plan or health insurance issuer offering group 
health insurance coverage may not pay a claim for items and services 
furnished on or after January 1, 2026, to an individual at an off-
campus outpatient department of a provider (as defined in section 
2799B-10(b) of the Public Health Service Act) submitted by a health 
care provider or facility unless such claim submitted by such provider 
or facility includes a separate unique health identifier for the 
department where items and services were furnished, in accordance with 
section 2799B-10 of such Act.''.
                    (B) Clerical amendment.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974 (29 U.S.C. 1001 et seq.) is amended by 
                inserting after the item relating to section 725 the 
                following new item:

``Sec. 726. Honest billing requirements applicable to plans and 
                            issuers.''.
            (3) Internal revenue code of 1986.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended by adding at 
                the end the following:

``SEC. 9826. HONEST BILLING REQUIREMENTS APPLICABLE TO PLANS.

    ``A group health plan may not pay a claim for items and services 
furnished on or after January 1, 2026, to an individual at an off-
campus outpatient department of a provider (as defined in section 
2799B-10(b) of the Public Health Service Act) submitted by a health 
care provider or facility unless such claim submitted by such provider 
or facility includes a separate unique health identifier for the 
department where items and services were furnished, in accordance with 
section 2799B-10 of such Act.''.
                    (B) Clerical amendment.--The table of sections for 
                subchapter B of chapter 100 of the Internal Revenue 
                Code of 1986 is amended by adding at the end the 
                following new item:

``Sec. 9826. Honest billing requirements applicable to plans.''.
    (b) Requiring a Separate Identification Number and an Attestation 
for Each Off-Campus Outpatient Department of a Provider.--
            (1) In general.--Part E of title XXVII of the Public Health 
        Service Act (42 U.S.C. 300gg-131 et seq.) is amended by adding 
        at the end the following:

``SEC. 2799B-10. HONEST BILLING REQUIREMENTS APPLICABLE TO PROVIDERS.

    ``(a) Requirements Relating to Unique Health Identifiers.--For 
items and services furnished, on or after January 1, 2026, at an off-
campus outpatient department of a provider to a participant, 
beneficiary, or enrollee with benefits under a group health plan or 
group or individual health insurance coverage offered by a health 
insurance issuer, a health care provider or facility may not submit a 
claim to the group health plan or health insurance issuer, bill the 
participant, beneficiary, or enrollee, or hold liable the participant, 
beneficiary, or enrollee, unless--
            ``(1) such provider or facility obtains a separate unique 
        health identifier established for such department pursuant to 
        section 1173(b) of the Social Security Act; and
            ``(2) such items and services are billed using the separate 
        unique health identifier established for such department 
        pursuant to paragraph (1).
    ``(b) Off-Campus Outpatient Department of a Provider.--The term 
`off-campus outpatient department of a provider' means a department of 
a provider (as defined in section 413.65(a)(2) of title 42 of the Code 
of Federal Regulations, as in effect on the date of the enactment of 
the Bipartisan Primary Care and Health Workforce Act) that is not 
located--
            ``(1) on the campus (as defined in such section 
        413.65(a)(2)) of such provider; or
            ``(2) within the distance described in such definition of 
        campus from a remote location of a hospital (as defined in such 
        section 413.65(a)(2)).
    ``(c) Process for Reporting Suspected Violations.--The Secretary 
shall establish a process under which a suspected violation of this 
section may be reported to such Secretary.
    ``(d) Penalties.--The Secretary may assess a civil monetary penalty 
against a hospital for a violation under this section in an amount--
            ``(1) in the case of a hospital with not more than 30 beds 
        (as determined under section 180.90(c)(2)(ii)(D) of title 45, 
        Code of Federal Regulations, as in effect on the date of the 
        enactment of the Bipartisan Primary Care and Health Workforce 
        Act (or any successor regulations), not to exceed $300 per day 
        that the violation is ongoing, as determined by the Secretary; 
        and
            ``(2) in the case of a hospital with more than 30 beds (as 
        so determined), not to exceed $5,500 per day that the violation 
        is ongoing, as determined by the Secretary.''.
            (2) Conforming amendment.--Section 2799B-4(a)(1) of the 
        Public Health Service Act (42 U.S.C. 300gg-134(a)(1)) is 
        amended by inserting ``(other than section 2799B-10)'' after 
        ``this part''.

SEC. 303. BANNING FACILITY FEES FOR CERTAIN SERVICES.

    Part E of title XXVII of the Public Health Service Act (42 U.S.C. 
300gg-131 et seq.), as amended by section 302(b), is further amended by 
adding at the end the following:

``SEC. 2799B-11. BANNING FACILITY FEES FOR CERTAIN SERVICES.

    ``(a) In General.--With respect to applicable items and services 
furnished to an individual on or after January 1, 2026, a health care 
provider or facility may not charge a facility fee (regardless of how 
the fee is labeled) to a group health plan, a health insurance issuer 
offering group or individual health insurance coverage, a participant, 
beneficiary, or enrollee in such a plan or coverage, or an individual 
patient who is not covered by a group health plan, health insurance 
coverage, or a Federal health care program (as defined in section 
1128(f) of the Social Security Act).
    ``(b) Applicable Items and Services.--In this section, the term 
`applicable items and services' means--
            ``(1) evaluation and management services described in 
        section 1833(cc)(1)(B)(i) of the Social Security Act;
            ``(2) outpatient behavioral health services (not including 
        partial hospitalizations, intensive outpatient program 
        services, and other services not typically provided in an 
        office setting (as the Secretary may determine)); and
            ``(3) any items and services (including the items and 
        services described in paragraphs (1) and (2)) furnished via 
        telehealth.''.

SEC. 304. PREVENTION AND PUBLIC HEALTH FUND.

    Section 4002(b) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 300u-11(b)) is amended by striking paragraphs (8) through 
(10) and inserting the following:
            ``(8) for each of fiscal years 2026 and 2027, 
        $1,425,000,000;
            ``(9) for each of fiscal years 2028 and 2029, 
        $1,495,000,000;
            ``(10) for fiscal year 2030, $1,680,000,000; and
            ``(11) for fiscal year 2031 and each fiscal year 
        thereafter, $2,000,000,000.''.

SEC. 305. PRICE TRANSPARENCY REQUIREMENTS.

    (a) Hospitals.--Section 2718(e) of the Public Health Service Act 
(42 U.S.C. 300gg-18(e)) is amended--
            (1) by striking ``Each hospital'' and inserting the 
        following:
            ``(1) In general.--Each hospital'';
            (2) by inserting ``, in plain language without subscription 
        and free of charge, in a consumer-friendly, machine-readable 
        format,'' after ``a list''; and
            (3) by adding at the end the following: ``Each hospital 
        shall include in its list of standard charges, along with such 
        additional information as the Secretary may require with 
        respect to such charges for purposes of promoting public 
        awareness of hospital pricing in advance of receiving a 
        hospital item or service, as applicable, the following:
                    ``(A) A description of each item or service 
                provided by the hospital.
                    ``(B) The gross charge.
                    ``(C) Any payer-specific negotiated charge clearly 
                associated with the name of the third-party payer and 
                plan.
                    ``(D) The de-identified minimum negotiated charge.
                    ``(E) The de-identified maximum negotiated charge.
                    ``(F) The discounted cash price.
                    ``(G) Any code used by the hospital for purposes of 
                accounting or billing, including Current Procedural 
                Terminology (CPT) code, the Healthcare Common Procedure 
                Coding System (HCPCS) code, the Diagnosis Related Group 
                (DRG), the National Drug Code (NDC), or other common 
                payer identifier.
            ``(2) Delivery methods and use.--
                    ``(A) In general.--Each hospital shall make public 
                the standard charges described in paragraph (1) for as 
                many of the 70 Centers for Medicaid & Medicare 
                Services-specified shoppable services that are provided 
                by the hospital, and as many additional hospital-
                selected shoppable services as may be necessary for a 
                combined total of at least 300 shoppable services, 
                including the rate at which a hospital provides and 
                bills for that shoppable service. If a hospital does 
                not provide 300 shoppable services in accordance with 
                the previous sentence, the hospital shall make public 
                the information specified under paragraph (1) for as 
                many shoppable services as it provides.
                    ``(B) Determination by cms.--A hospital shall be 
                deemed by the Centers for Medicare & Medicaid Services 
                to meet the requirements of subparagraph (A) if the 
                hospital maintains an internet-based price estimator 
                tool that meets the following requirements:
                            ``(i) The tool provides estimates for as 
                        many of the 70 specified shoppable services 
                        that are provided by the hospital, and as many 
                        additional hospital-selected shoppable services 
                        as may be necessary for a combined total of at 
                        least 300 shoppable services.
                            ``(ii) The tool allows health care 
                        consumers to, at the time they use the tool, 
                        obtain an estimate of the amount they will be 
                        obligated to pay the hospital for the shoppable 
                        service.
                            ``(iii) The tool is prominently displayed 
                        on the hospital's website and easily accessible 
                        to the public, without subscription, fee, or 
                        having to submit personal identifying 
                        information (PII), and searchable by service 
                        description, billing code, and payer.
            ``(3) Definitions.--Notwithstanding any other provision of 
        law, for the purpose of paragraphs (1) and (2):
                    ``(A) De-identified maximum negotiated charge.--The 
                term `de-identified maximum negotiated charge' means 
                the highest charge that a hospital has negotiated with 
                all third-party payers for an item or service.
                    ``(B) De-identified minimum negotiated charge.--The 
                term `de-identified minimum negotiated charge' means 
                the lowest charge that a hospital has negotiated with 
                all third-party payers for an item or service.
                    ``(C) Discounted cash price.--The term `discounted 
                cash price' means the charge that applies to an 
                individual who pays cash, or cash equivalent, for a 
                hospital item or service. Hospitals that do not offer 
                self-pay discounts may display the hospital's 
                undiscounted gross charges as found in the hospital 
                chargemaster.
                    ``(D) Gross charge.--The term `gross charge' means 
                the charge for an individual item or service that is 
                reflected on a hospital's chargemaster, absent any 
                discounts.
                    ``(E) Payer-specific negotiated charge.--The term 
                `payer-specific negotiated charge' means the charge 
                that a hospital has negotiated with a third-party payer 
                for an item or service.
                    ``(F) Shoppable service.--The term `shoppable 
                service' means a service that can be scheduled by a 
                health care consumer in advance.
                    ``(G) Standard charges.--The term `standard 
                charges' means the regular rate established by the 
                hospital for an item or service, including both 
                individual items and services and service packages, 
                provided to a specific group of paying patients, 
                including the gross charge, the payer-specific 
                negotiated charge, the discounted cash price, the de-
                identified minimum negotiated charge, the de-identified 
                maximum negotiated charge, and other rates determined 
                by the Secretary.
                    ``(H) Third-party payer.--The term `third-party 
                payer' means an entity that is, by statute, contract, 
                or agreement, legally responsible for payment of a 
                claim for a health care item or service.
            ``(4) Enforcement.--In addition to any other enforcement 
        actions or penalties that may apply under subsection (b)(3) or 
        another provision of law, a hospital that fails to provide the 
        information required by this subsection and has not completed a 
        corrective action plan to comply with the requirements of such 
        subsection shall be subject to a civil monetary penalty of an 
        amount not to exceed $300 per day that the violation is ongoing 
        as determined by the Secretary. Such penalty shall be imposed 
        and collected in the same manner as civil money penalties under 
        subsection (a) of section 1128A of the Social Security Act are 
        imposed and collected.''.
    (b) Transparency in Coverage.--Section 1311(e)(3) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended--
            (1) in subparagraph (A)--
                    (A) by redesignating clause (ix) as clause (xii); 
                and
                    (B) by inserting after clause (viii) the following:
                            ``(ix) In-network provider rates for 
                        covered items and services.
                            ``(x) Out-of-network allowed amounts and 
                        billed charges for covered items and services.
                            ``(xi) Negotiated rates and historical net 
                        prices for covered prescription drugs.'';
            (2) in subparagraph (B)--
                    (A) in the heading, by striking ``use'' and 
                inserting ``delivery methods and use'';
                    (B) by inserting ``and subparagraph (C)'' after 
                ``subparagraph (A)'';
                    (C) by inserting ``, as applicable'' after 
                ``English proficiency''; and
                    (D) by inserting after the second sentence, the 
                following: ``The Secretary shall establish standards 
                for the methods and formats for disclosing information 
                to individuals. At a minimum, these standards shall 
                include the following:
                            ``(i) An internet-based self-service tool 
                        to provide information to an individual in 
                        plain language, without subscription and free 
                        of charge, in a machine-readable format, 
                        through a self-service tool on an internet 
                        website that provides real-time responses based 
                        on cost-sharing information that is accurate at 
                        the time of the request that allows, at a 
                        minimum, users to--
                                    ``(I) search for cost-sharing 
                                information for a covered item or 
                                service provided by a specific in-
                                network provider or by all in-network 
                                providers;
                                    ``(II) search for an out-of-network 
                                allowed amount, percentage of billed 
                                charges, or other rate that provides a 
                                reasonably accurate estimate of the 
                                amount an insurer will pay for a 
                                covered item or service provided by 
                                out-of-network providers; and
                                    ``(III) refine and reorder search 
                                results based on geographic proximity 
                                of in-network providers, and the amount 
                                of the individual's cost-sharing 
                                liability for the covered item or 
                                service, to the extent the search for 
                                cost-sharing information for covered 
                                items or services returns multiple 
                                results.
                            ``(ii) In paper form at the request of the 
                        individual that includes no fewer than 20 
                        providers per request with respect to which 
                        cost-sharing information for covered items and 
                        services is provided, and discloses the 
                        applicable provider, per-request limit to the 
                        individual, mailed to the individual not later 
                        than 2 business days after receiving an 
                        individual's request.'';
            (3) in subparagraph (C)--
                    (A) in the first sentence--
                            (i) by striking ``The Exchange'' and 
                        inserting the following:
                            ``(i) In general.--The Exchange'';
                            (ii) by inserting ``or out-of-network 
                        provider'' after ``item or service by a 
                        participating provider''; and
                            (iii) by striking the period and inserting 
                        the following: ``the following information:
                            ``(i) An estimate of an individual's cost-
                        sharing liability for a requested covered item 
                        or service furnished by a provider, which shall 
                        reflect any cost-sharing reductions the 
                        individual would receive.
                            ``(ii) A description of the accumulated 
                        amounts.
                            ``(iii) The in-network rate, including 
                        negotiated rates and underlying fee schedule 
                        rates.
                            ``(iv) The out-of-network allowed amount or 
                        any other rate that provides a more accurate 
                        estimate of an amount an issuer will pay, 
                        including the percent reimbursed by insurers to 
                        out-of-network providers, for the requested 
                        covered item or service furnished by an out-of-
                        network provider.
                            ``(v) A list of the items and services 
                        included in bundled payment arrangements for 
                        which cost-sharing information is being 
                        disclosed.
                            ``(vi) A notification that coverage of a 
                        specific item or service is subject to a 
                        prerequisite, if applicable.
                            ``(vii) A notice that includes the 
                        following information:
                                    ``(I) A statement that out-of-
                                network providers may bill individuals 
                                for the difference, including the 
                                balance billing, between a provider's 
                                billed charges and the sum of the 
                                amount collected from the insurer in 
                                the form of a copayment or coinsurance 
                                amount and the cost-sharing 
                                information.
                                    ``(II) A statement that the actual 
                                charges for an individual's covered 
                                item or service may be different from 
                                an estimate of cost-sharing liability 
                                depending on the actual items or 
                                services the individual receives at the 
                                point of care.
                                    ``(III) A statement that the 
                                estimate of cost-sharing liability for 
                                a covered item or service is not a 
                                guarantee that benefits will be 
                                provided for that item or service.
                                    ``(IV) A statement disclosing 
                                whether the plan counts copayment 
                                assistance and other third-party 
                                payments in the calculation of the 
                                individual's deductible and out-of-
                                pocket maximum.
                                    ``(V) For items and services that 
                                are recommended preventive services 
                                under section 2713 of the Public Health 
                                Service Act, a statement that an in-
                                network item or service may not be 
                                subject to cost-sharing if it is billed 
                                as a preventive service and the insurer 
                                cannot determine whether the request is 
                                for a preventive or non-preventive item 
                                or service.
                                    ``(VI) Any additional information, 
                                including other disclaimers, that the 
                                insurer determines is appropriate, 
                                provided the additional information 
                                does not conflict with the information 
                                required to be provided by this 
                                subsection.'';
                    (B) by striking the second sentence; and
                    (C) by adding at the end the following:
                            ``(ii) Definitions.--Notwithstanding any 
                        other provision of law, for the purpose of 
                        subparagraphs (A), (B), and (C):
                                    ``(I) Accumulated amounts.--The 
                                term `accumulated amounts' means the 
                                amount of financial responsibility an 
                                individual has incurred at the time a 
                                request for cost-sharing information is 
                                made, with respect to a deductible or 
                                out-of-pocket limit, including any 
                                expense that counts toward a deductible 
                                or out-of-pocket limit, but excluding 
                                any expense that does not count toward 
                                a deductible or out-of-pocket limit. To 
                                the extent an insurer imposes a 
                                cumulative treatment limitation on a 
                                particular covered item or service 
                                independent of individual medical 
                                necessity determinations, the amount 
                                that has accrued toward the limit on 
                                the item or service.
                                    ``(II) Historical net price.--The 
                                term `historical net price' means the 
                                retrospective average amount an insurer 
                                paid for a prescription drug, inclusive 
                                of any reasonably allocated rebates, 
                                discounts, chargebacks, fees, and any 
                                additional price concessions received 
                                by the insurer with respect to the 
                                prescription drug. The allocation shall 
                                be determined by dollar value for non-
                                product specific and product-specific 
                                rebates, discounts, chargebacks, fees, 
                                and other price concessions to the 
                                extent that the total amount of any 
                                such price concession is known to the 
                                insurer at the time of publication of 
                                the historical net price.
                                    ``(III) Negotiated rate.--The term 
                                `negotiated rate' means the amount a 
                                plan or issuer has contractually agreed 
                                to pay for a covered item or service, 
                                whether directly or indirectly through 
                                a third-party administrator or pharmacy 
                                benefit manager, to an in-network 
                                provider, including an in-network 
                                pharmacy or other prescription drug 
                                dispenser, for covered items or 
                                services.
                                    ``(IV) Out-of-network allowed 
                                amount.--The term `out-of-network 
                                allowed amount' means the maximum 
                                amount an insurer will pay for a 
                                covered item or service furnished by an 
                                out-of-network provider.
                                    ``(V) Out-of-network limit.--The 
                                term `out-of-network limit' means the 
                                maximum amount that an individual is 
                                required to pay during a coverage 
                                period for his or her share of the 
                                costs of covered items and services 
                                under his or her plan or coverage, 
                                including for self-only and other than 
                                self-only coverage, as applicable.
                                    ``(VI) Underlying fee schedule 
                                rate.--The term `underlying fee 
                                schedule rate' means the rate for an 
                                item or service that a plan or issuer 
                                uses to determine a participant's, 
                                beneficiary's, or enrollee's cost-
                                sharing liability with respect to a 
                                particular provider or providers, when 
                                the rate is different from the 
                                negotiated rate.'';
            (4) in subparagraph (D), by striking ``subparagraph (A)'' 
        and inserting ``subparagraphs (A), (B), and (C)''; and
            (5) by adding at the end the following:
                    ``(E) Application of paragraph.--In addition to 
                qualified health plans (and plans seeking certification 
                as qualified health plans), this paragraph (as amended 
                by the Bipartisan Primary Care and Health Workforce 
                Act) shall apply to group health plans (including self-
                insured and fully insured plans) and health insurance 
                coverage (as such terms are defined in section 2791 of 
                the Public Health Service Act).''.

SEC. 306. PUBLICATION OF LIST OF HOSPITALS.

    (a) List of Hospitals.--Beginning not later than 90 days after the 
date of enactment of this Act, the Secretary of Health and Human 
Services (referred to in this section as the ``Secretary'') shall 
establish and maintain a publicly available list, on the website of the 
Centers for Medicare & Medicaid Services, of each hospital that--
            (1) is not in compliance with the hospital price 
        transparency rule implementing section 2718(e) of the Public 
        Health Service Act (42 U.S.C. 300gg-18(e)), and that, with 
        respect to such noncompliance--
                    (A) has been issued a civil monetary penalty;
                    (B) has received a warning notice; or
                    (C) has received a request for a corrective action 
                plan; or
            (2) has received any written communication from the 
        Secretary regarding potential noncompliance with such hospital 
        price transparency rule.
    (b) FOIA Requests.--Any penalty, notice, request, or other 
communication described in subsection (a) shall be subject to public 
disclosure, in full and without redaction, under section 552 of title 
5, United States Code, notwithstanding any exemptions or exclusions 
otherwise available under such section 552.
    (c) Report to Congress.--Not later than 1 year after the date of 
enactment of this Act and each year thereafter, the Secretary shall 
submit to Congress, and make publicly available, a report that contains 
information regarding complaints of alleged violations of law with 
respect to, and enforcement activities by the Secretary under, the 
hospital price transparency rule implementing section 2718(e) of the 
Public Health Service Act (42 U.S.C. 300gg-18(e)). Such report shall be 
made available to the public on the website of the Centers for Medicare 
& Medicaid Services.
    (d) GAO Report.--Not later than 1 year after the date of enactment 
of this Act, the Comptroller General of the United States shall submit 
to the Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Ways and Means and the Committee on Energy 
and Commerce of the House of Representatives a report on compliance and 
enforcement of the hospital price transparency rule implementing 
section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg-
18(e)). The report shall include recommendations related to--
            (1) improving price transparency for patients, employers, 
        and the public;
            (2) the revocation or suspension of tax-exempt status under 
        section 501(c)(3) of the Internal Revenue Code of 1986 for 
        noncompliant hospitals; and
            (3) increased civil monetary penalty amounts to ensure 
        compliance.
    (e) Rulemaking.--Not later than 180 days after the report described 
in subsection (d) is published, the Secretary, in consultation with the 
Secretary of the Treasury, shall issue a proposed rule based on the 
recommendations of the Comptroller General of the United States under 
subsection (d), including the recommendations described in paragraphs 
(2) and (3) of such subsection.
                                                       Calendar No. 242

118th CONGRESS

  1st Session

                                S. 2840

_______________________________________________________________________

                                 A BILL

To improve access to and the quality of primary health care, expand the 
               health workforce, and for other purposes.

_______________________________________________________________________

                            November 8, 2023

                       Reported with an amendment