[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 3430 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 265
118th CONGRESS
  1st Session
                                S. 3430

                          [Report No. 118-121]

To amend titles XVIII and XIX of the Social Security Act to expand the 
  mental health care workforce and services, reduce prescription drug 
   costs, and extend certain expiring provisions under Medicare and 
                   Medicaid, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            December 7, 2023

   Mr. Wyden, from the Committee on Finance, reported the following 
     original bill; which was read twice and placed on the calendar

_______________________________________________________________________

                                 A BILL


 
To amend titles XVIII and XIX of the Social Security Act to expand the 
  mental health care workforce and services, reduce prescription drug 
   costs, and extend certain expiring provisions under Medicare and 
                   Medicaid, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Better Mental 
Health Care, Lower-Cost Drugs, and Extenders Act of 2023''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
  TITLE I--EXPANDING MENTAL HEALTH CARE WORKFORCE AND SERVICES UNDER 
                         MEDICARE AND MEDICAID

Sec. 101. Expanding eligibility for incentives under the Medicare 
                            health professional shortage area bonus 
                            program to practitioners furnishing mental 
                            health and substance use disorder services.
Sec. 102. Improved access to mental health services under the Medicare 
                            program.
Sec. 103. Clarifying coverage of occupational therapy under the 
                            Medicare program.
Sec. 104. Medicare incentives for behavioral health integration with 
                            primary care.
Sec. 105. Establishment of Medicare incident to modifier for mental 
                            health services furnished through 
                            telehealth.
Sec. 106. Guidance on furnishing behavioral health services via 
                            telehealth to individuals with limited 
                            English proficiency under Medicare program.
Sec. 107. Ensuring timely communication regarding telehealth and 
                            interstate licensure requirements.
Sec. 108. Facilitating accessibility for behavioral health services 
                            furnished through telehealth.
Sec. 109. Requiring Enhanced & Accurate Lists of (REAL) Health 
                            Providers Act.
Sec. 110. Guidance to States on strategies under Medicaid and CHIP to 
                            increase mental health and substance use 
                            disorder care provider capacity.
Sec. 111. Guidance to States on supporting mental health services and 
                            substance use disorder care for children 
                            and youth.
Sec. 112. Recurring analysis and publication of Medicaid health care 
                            data related to mental health services.
Sec. 113. Guidance to States on supporting mental health services or 
                            substance use disorder care integration 
                            with primary care in Medicaid and CHIP.
Sec. 114. Medicaid State option relating to inmates with a substance 
                            use disorder pending disposition of 
                            charges.
Sec. 115. Definition of Certified Community Behavioral Health Clinic 
                            Services under Medicaid.
 TITLE II--REDUCING PRESCRIPTION DRUG COSTS UNDER MEDICARE AND MEDICAID

Sec. 201. Assuring pharmacy access and choice for Medicare 
                            beneficiaries.
Sec. 202. Ensuring accurate payments to pharmacies under Medicaid.
Sec. 203. Protecting seniors from excessive cost-sharing for certain 
                            medicines.
                TITLE III--MEDICAID EXPIRING PROVISIONS

Sec. 301. Delaying certain disproportionate share hospital payment 
                            reductions under the Medicaid program.
Sec. 302. Extension of State option to provide medical assistance for 
                            certain individuals who are patients in 
                            certain institutions for mental diseases.
  TITLE IV--MEDICARE EXPIRING PROVISIONS AND PROVIDER PAYMENT CHANGES

Sec. 401. Extension of funding for quality measure endorsement, input, 
                            and selection.
Sec. 402. Extension of funding outreach and assistance for low-income 
                            programs.
Sec. 403. Extension of the work geographic index floor under the 
                            Medicare program.
Sec. 404. Extending incentive payments for participation in eligible 
                            alternative payment models.
Sec. 405. Payment rates for durable medical equipment under the 
                            Medicare Program.
Sec. 406. Extending the independence at home medical practice 
                            demonstration program under the Medicare 
                            program.
Sec. 407. Increase in support for physicians and other professionals in 
                            adjusting to Medicare payment changes.
Sec. 408. Revised phase-in of Medicare clinical laboratory test payment 
                            changes.
Sec. 409. Extension of adjustment to calculation of hospice cap amount 
                            under Medicare.
                            TITLE V--OFFSETS

Sec. 501. Medicaid Improvement Fund.
Sec. 502. Medicare Improvement Fund.

  TITLE I--EXPANDING MENTAL HEALTH CARE WORKFORCE AND SERVICES UNDER 
                         MEDICARE AND MEDICAID

SEC. 101. EXPANDING ELIGIBILITY FOR INCENTIVES UNDER THE MEDICARE 
              HEALTH PROFESSIONAL SHORTAGE AREA BONUS PROGRAM TO 
              PRACTITIONERS FURNISHING MENTAL HEALTH AND SUBSTANCE USE 
              DISORDER SERVICES.

    Section 1833(m) of the Social Security Act (42 U.S.C. 1395l(m)) is 
amended--
            (1) by striking paragraph (1) and inserting the following 
        new paragraph:
    ``(1) In the case of--
            ``(A) physicians' services (other than specified health 
        services that are eligible for the additional payment under 
        subparagraph (B)) furnished in a year to an individual, who is 
        covered under the insurance program established by this part 
        and who incurs expenses for such services, in an area that is 
        designated (under section 332(a)(1)(A) of the Public Health 
        Service Act) as a health professional shortage area as 
        identified by the Secretary prior to the beginning of such 
        year, in addition to the amount otherwise paid under this part, 
        there also shall be paid to the physician (or to an employer or 
        facility in the cases described in clause (A) of section 
        1842(b)(6)) (on a monthly or quarterly basis) from the Federal 
        Supplementary Medical Insurance Trust Fund an amount equal to 
        10 percent of the payment amount for the service under this 
        part; and
            ``(B) specified health services (as defined in paragraph 
        (5)) furnished in a year to an individual, who is covered under 
        the insurance program established by this part and who incurs 
        expenses for such services, in an area that is designated 
        (under such section 332(a)(1)(A)) as a mental health 
        professional shortage area as identified by the Secretary prior 
        to the beginning of such year, in addition to the amount 
        otherwise paid under this part, there also shall be paid to the 
        physician or applicable practitioner (as defined in paragraph 
        (6)) (or to an employer or facility in the cases described in 
        clause (A) of section 1842(b)(6)) (on a monthly or quarterly 
        basis) from such Trust Fund an amount equal to 15 percent of 
        the payment amount for the service under this part.'';
            (2) in paragraph (2)--
                    (A) by striking ``in paragraph (1)'' and inserting 
                ``in subparagraph (A) or (B) of paragraph (1)'';
                    (B) by inserting ``or, in the case of specified 
                health services, the physician or applicable 
                practitioner'' after ``physician'';
            (3) in paragraph (3), by striking ``in paragraph (1)'' and 
        inserting ``in subparagraph (A) or (B) of paragraph (1)'';
            (4) in paragraph (4)--
                    (A) in subparagraph (B), by inserting ``or 
                applicable practitioner'' after ``physician''; and
                    (B) in subparagraph (C), by inserting ``or 
                applicable practitioner'' after ``physician''; and
            (5) by adding at the end the following new paragraphs:
    ``(5) In this subsection, the term `specified health services' 
means services otherwise covered under this part that are furnished on 
or after January 1, 2026, by a physician or an applicable practitioner 
to an individual--
            ``(A) for purposes of diagnosis, evaluation, or treatment 
        of a mental health disorder, as determined by the Secretary; or
            ``(B) with a substance use disorder diagnosis for purposes 
        of treatment of such disorder or co-occurring mental health 
        disorder, as determined by the Secretary.
    ``(6) In this subsection, the term `applicable practitioner' means 
the following:
            ``(A) A physician assistant, nurse practitioner, or 
        clinical nurse specialist (as defined in section 1861(aa)(5)).
            ``(B) A clinical social worker (as defined in section 
        1861(hh)(1)).
            ``(C) A clinical psychologist (as defined by the Secretary 
        for purposes of section 1861(ii)).
            ``(D) A marriage and family therapist (as defined in 
        section 1861(lll)(2)).
            ``(E) A mental health counselor (as defined in section 
        1861(lll)(4)).''.

SEC. 102. IMPROVED ACCESS TO MENTAL HEALTH SERVICES UNDER THE MEDICARE 
              PROGRAM.

    (a) Access to Clinical Social Worker Services Provided to Residents 
of Skilled Nursing Facilities.--
            (1) Exclusion of clinical social worker services from the 
        skilled nursing facility prospective payment system.--Section 
        1888(e)(2)(A)(iii) of the Social Security Act (42 U.S.C. 
        1395yy(e)(2)(A)(iii)) is amended by adding at the end the 
        following new subclause:
                                    ``(VII) Clinical social worker 
                                services (as defined in section 
                                1861(hh)(2)).''.
            (2) Conforming amendment.--Section 1861(hh)(2) of the 
        Social Security Act (42 U.S.C. 1395x(hh)(2)) is amended by 
        striking ``and other than services furnished to an inpatient of 
        a skilled nursing facility which the facility is required to 
        provide as a requirement for participation''.
    (b) Access to the Complete Scope of Clinical Social Worker 
Services.--Section 1861(hh)(2) of the Social Security Act (42 U.S.C. 
1395x(hh)(2)), as amended by subsection (a)(2), is amended by striking 
``for the diagnosis and treatment of mental illnesses (other than 
services furnished to an inpatient of a hospital)'' and inserting ``, 
including services for the diagnosis and treatment of mental illnesses 
or services for health behavior assessment and intervention (identified 
as of January 1, 2023, by HCPCS codes 96160 and 96161 (and any 
succeeding codes)), but not including services furnished to an 
inpatient of a hospital,''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2026.

SEC. 103. CLARIFYING COVERAGE OF OCCUPATIONAL THERAPY UNDER THE 
              MEDICARE PROGRAM.

    Not later than 1 year after the date of enactment of this Act, the 
Secretary of Health and Human Services shall use existing communication 
mechanisms to provide education and outreach to stakeholders about the 
Medicare Benefit Policy Manual with respect to occupational therapy 
services furnished to individuals under the Medicare program for the 
treatment of a substance use or mental health disorder diagnosis using 
applicable Healthcare Common Procedure Coding System (HCPCS) codes.

SEC. 104. MEDICARE INCENTIVES FOR BEHAVIORAL HEALTH INTEGRATION WITH 
              PRIMARY CARE.

    (a) Incentives.--
            (1) In general.--Section 1848(b) of the Social Security Act 
        (42 U.S.C. 1395w-4(b)) is amended by adding at the end the 
        following new paragraph:
            ``(13) Incentives for behavioral health integration.--
                    ``(A) In general.--For services described in 
                subparagraph (B) that are furnished during 2026, 2027, 
                or 2028, instead of the payment amount that would 
                otherwise be determined under this section for such 
                year, the payment amount shall be equal to the 
                applicable percent (as defined in subparagraph (C)) of 
                such payment amount for such year.
                    ``(B) Services described.--The services described 
                in this subparagraph are services identified, as of 
                January 1, 2023, by HCPCS codes 99484, 99492, 99493, 
                99494, and G2214 (and any successor or similar codes as 
                determined appropriate by the Secretary).
                    ``(C) Applicable percent.--In this paragraph, the 
                term `applicable percent' means, with respect to a 
                service described in subparagraph (A), the following:
                            ``(i) For services furnished during 2026 , 
                        175 percent.
                            ``(ii) For services furnished during 2027, 
                        150 percent.
                            ``(iii) For services furnished during 2028, 
                        125 percent.''.
            (2) Waiver of budget neutrality.--Section 1848(c)(2)(B)(iv) 
        of such Act (42 U.S.C. 1395w-4(c)(2)(B)(iv)) is amended--
                    (A) in subclause (V), by striking ``and'' at the 
                end;
                    (B) in subclause (VI), by striking the period at 
                the end and inserting ``; and'' and
                    (C) by adding at the end the following new 
                subclause:
                                    ``(VII) the increase in payment 
                                amounts as a result of the application 
                                of subsection (b)(13) shall not be 
                                taken into account in applying clause 
                                (ii)(II) for 2026, 2027, or 2028.''.
    (b) Technical Assistance for the Adoption of Behavioral Health 
Integration.--
            (1) In general.--Not later than January 1, 2025, the 
        Secretary of Health and Human Services (in this subsection 
        referred to as the ``Secretary'') shall enter into contracts or 
        agreements with appropriate entities to offer technical 
        assistance to primary care practices that are seeking to adopt 
        behavioral health integration models in such practices.
            (2) Behavioral health integration models.--For purposes of 
        paragraph (1), behavioral health integration models include the 
        Collaborative Care Model (with services identified as of 
        January 1, 2023, by HCPCS codes 99492, 99493, 99494, and G2214 
        (and any successor codes)), the Primary Care Behavioral Health 
        model (with services identified as of January 1, 2023, by HCPCS 
        code 99484 (and any successor code)), and other models 
        identified by the Secretary.
            (3) Implementation.--Notwithstanding any other provision of 
        law, the Secretary may implement the provisions of this 
        subsection by program instruction or otherwise.
            (4) Funding.--In addition to amounts otherwise available, 
        there is appropriated to the Secretary for fiscal year 2024, 
        out of any money in the Treasury not otherwise appropriated, 
        $5,000,000, to remain available until expended, for purposes of 
        carrying out this subsection.

SEC. 105. ESTABLISHMENT OF MEDICARE INCIDENT TO MODIFIER FOR MENTAL 
              HEALTH SERVICES FURNISHED THROUGH TELEHEALTH.

    Section 1834(m)(7) of the Social Security Act (42 U.S.C. 
1395m(m)(7)) is amended by adding at the end the following new 
subparagraph:
                    ``(C) Establishment of incident to modifier for 
                mental health services furnished through telehealth.--
                Not later than 2 years after the date of the enactment 
                of this subparagraph, the Secretary shall establish 
                requirements to include a code or modifier, as 
                determined appropriate by the Secretary, on claims for 
                mental health services furnished through telehealth 
                under this paragraph that are furnished by auxiliary 
                personnel (as defined in section 410.26(a)(1) of title 
                42, Code of Federal Regulations, or any successor 
                regulation) and billed incident to a physician or 
                practitioner's professional services.''.

SEC. 106. GUIDANCE ON FURNISHING BEHAVIORAL HEALTH SERVICES VIA 
              TELEHEALTH TO INDIVIDUALS WITH LIMITED ENGLISH 
              PROFICIENCY UNDER MEDICARE PROGRAM.

    Not later than 1 year after the date of the enactment of this 
section, the Secretary of Health and Human Services shall issue and 
disseminate, or update and revise as applicable, guidance on the 
following:
            (1) Best practices for providers to work with interpreters 
        to furnish behavioral health services via video-based and 
        audio-only telehealth, when video-based telehealth is not an 
        option.
            (2) Best practices on integrating the use of video 
        platforms that enable multi-person video calls into behavioral 
        health services furnished via telehealth.
            (3) Best practices on teaching patients, especially those 
        with limited English proficiency, to use video-based telehealth 
        platforms.
            (4) Best practices for providing patient materials, 
        communications, and instructions in multiple languages, 
        including text message appointment reminders and prescription 
        information.

SEC. 107. ENSURING TIMELY COMMUNICATION REGARDING TELEHEALTH AND 
              INTERSTATE LICENSURE REQUIREMENTS.

    The Secretary of Health and Human Services shall provide 
information--
            (1) on licensure requirements for furnishing telehealth 
        services under titles XVIII and XIX of the Social Security Act 
        (42 U.S.C. 1395 et seq.; 1396 et seq.); and
            (2) clarifying the extent to which licenses through an 
        interstate license compact pathway can qualify as valid and 
        full licenses for the purposes of meeting Federal licensure 
        requirements under such titles.

SEC. 108. FACILITATING ACCESSIBILITY FOR BEHAVIORAL HEALTH SERVICES 
              FURNISHED THROUGH TELEHEALTH.

    The Secretary of Health and Human Services shall provide regular 
updates to guidance to facilitate the accessibility of behavioral 
health services furnished through telehealth for the visually and 
hearing impaired.

SEC. 109. REQUIRING ENHANCED & ACCURATE LISTS OF (REAL) HEALTH 
              PROVIDERS ACT.

    (a) In General.--Section 1852(c) of the Social Security Act (42 
U.S.C. 1395w-22(c)) is amended--
            (1) in paragraph (1)(C)--
                    (A) by striking ``plan, and any'' and inserting 
                ``plan, any''; and
                    (B) by inserting the following before the period: 
                ``, and, in the case of a network-based plan (as 
                defined in paragraph (3)(C)), for plan year 2026 and 
                subsequent plan years, the information described in 
                paragraph (3)(B)''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Provider directory accuracy.--
                    ``(A) In general.--For plan year 2026 and 
                subsequent plan years, each MA organization offering a 
                network-based plan (as defined in subparagraph (C)) 
                shall, for each network-based plan offered by the 
                organization--
                            ``(i) maintain, on a publicly available 
                        internet website, an accurate provider 
                        directory that includes the information 
                        described in subparagraph (B);
                            ``(ii) not less frequently than once every 
                        90 days (or, in the case of a hospital or any 
                        other facility determined appropriate by the 
                        Secretary, at a lesser frequency specified by 
                        the Secretary but in no case less frequently 
                        than once every 12 months), verify the provider 
                        directory information of each provider listed 
                        in such directory and, if applicable, update 
                        such provider directory information;
                            ``(iii) if the organization is unable to 
                        verify such information with respect to a 
                        provider, include in such directory an 
                        indication that the information of such 
                        provider may not be up to date;
                            ``(iv) remove a provider from such 
                        directory within 5 business days if the 
                        organization determines that the provider is no 
                        longer a provider participating in the network 
                        of such plan; and
                            ``(v) meet such other requirements as the 
                        Secretary may specify.
                    ``(B) Provider directory information.--The 
                information described in this subparagraph is 
                information enrollees may need to access covered 
                benefits from a provider with which such organization 
                offering such plan has an agreement for furnishing 
                items and services covered under such plan such as 
                name, specialty, contact information, primary office or 
                facility address, whether the provider is accepting new 
                patients, accommodations for people with disabilities, 
                cultural and linguistic capabilities, and telehealth 
                capabilities.
                    ``(C) Network-based plan.--In this paragraph, the 
                term `network-based plan' has the meaning given that 
                term in subsection (d)(5)(C), except such term includes 
                a Medicare Advantage private fee-for-service plan, as 
                determined appropriate by the Secretary.''.
    (b) Accountability for Provider Directory Accuracy.--
            (1) Cost sharing for services furnished based on reliance 
        on incorrect provider directory information.--Section 1852(d) 
        of the Social Security Act (42 U.S.C. 1395w-22(d)) is amended--
                    (A) in paragraph (1)(C)--
                            (i) in clause (ii), by striking ``or'' at 
                        the end;
                            (ii) in clause (iii), by striking the 
                        semicolon at the end and inserting ``, or''; 
                        and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(iv) the services are furnished by a 
                        provider that is not participating in the 
                        network of a network-based plan (as defined in 
                        subsection (c)(3)(C)) but is listed in the 
                        provider directory of such plan on the date on 
                        which the appointment is made, as described in 
                        paragraph (7)(A);''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(7) Cost sharing for services furnished based on reliance 
        on incorrect provider directory information.--
                    ``(A) In general.--For plan year 2026 and 
                subsequent plan years, if an enrollee is furnished an 
                item or service by a provider that is not participating 
                in the network of a network-based plan (as defined in 
                subsection (c)(3)(C)) but is listed in the provider 
                directory of such plan (as required to be provided to 
                an enrollee pursuant to subsection (c)(1)(C)) on the 
                date on which the appointment is made, and if such item 
                or service would otherwise be covered under such plan 
                if furnished by a provider that is participating in the 
                network of such plan, the MA organization offering such 
                plan shall ensure that the enrollee is only responsible 
                for the amount of cost sharing that would apply if such 
                provider had been participating in the network of such 
                plan.
                    ``(B) Notification requirement.--For plan year 2026 
                and subsequent plan years, each MA organization that 
                offers a network-based plan shall--
                            ``(i) notify enrollees of their cost-
                        sharing protections under this paragraph and 
                        make such notifications, to the extent 
                        practicable, by not later than the first day of 
                        an annual, coordinated election period under 
                        section 1851(e)(3) with respect to a year;
                            ``(ii) include information regarding such 
                        cost-sharing protections in the provider 
                        directory of each network-based plan offered by 
                        the MA organization.; and
                            ``(iii) notify enrollees of their cost-
                        sharing protections under this paragraph in an 
                        explanation of benefits.''.
            (2) Required provider directory accuracy analysis and 
        reports.--
                    (A) In general.--Section 1857(e) of the Social 
                Security Act (42 U.S.C. 1395w-27(e)) is amended by 
                adding at the end the following new paragraph:
            ``(6) Provider directory accuracy analysis and reports.--
                    ``(A) In general.--Beginning with plan years 
                beginning on or after January 1, 2026, subject to 
                subparagraph (C), a contract under this section with an 
                MA organization shall require the organization, for 
                each network-based plan (as defined in section 
                1852(c)(3)(C)) offered by the organization, to 
                annually--
                            ``(i) conduct an analysis estimating the 
                        accuracy of the provider directory of such plan 
                        using a sample of providers included in such 
                        provider directory (including provider 
                        specialties with high inaccuracy rates of 
                        provider directory information, such as 
                        providers specializing in mental health or 
                        substance use disorder treatment, as determined 
                        by the Secretary); and
                            ``(ii) submit a report to the Secretary 
                        containing the results of such analysis, 
                        including an accuracy score for such provider 
                        directory (as determined using a methodology 
                        specified by the Secretary under subparagraph 
                        (B)(i)), and other information required by the 
                        Secretary.
                    ``(B) Determination of accuracy score.--
                            ``(i) In general.--The Secretary shall 
                        specify methodologies for MA plans to use in 
                        estimating the accuracy of the provider 
                        directory information of such plans and 
                        determining the accuracy score for the plan's 
                        provider directory.
                            ``(ii) Considerations.--In carrying out 
                        clause (i), the Secretary shall take into 
                        consideration--
                                    ``(I) data sources maintained by MA 
                                organizations;
                                    ``(II) publicly available data 
                                sets;
                                    ``(III) the administrative burden 
                                on plans and providers; and
                                    ``(IV) the relative importance of 
                                certain provider directory information 
                                on enrollee ability to access care.
                    ``(C) Exception.--The Secretary may waive the 
                requirements of this paragraph in the case of a 
                network-based plan with low enrollment (as defined by 
                the Secretary).
                    ``(D) Transparency.--Beginning with plan years 
                beginning on or after January 1, 2027, the Secretary 
                shall post accuracy scores (as reported under 
                subparagraph (A)(ii)), in a machine readable file, on 
                the internet website of the Centers for Medicare & 
                Medicaid Services.
                    ``(E) Implementation.--The Secretary shall 
                implement this paragraph through notice and comment 
                rulemaking.''.
                    (B) Provision of information to beneficiaries.--
                Section 1851(d)(4) of the Social Security Act (42 
                U.S.C. 1395w-21(d)(4)) is amended by adding at the end 
                the following new subparagraph:
                    ``(F) Provider directory.--Beginning with plan 
                years beginning on or after January 1, 2027, the 
                accuracy score of the plan's provider directory (as 
                reported under section 1857(e)(6)(A)(ii)) on the plan's 
                provider directory.''.
                    (C) Funding.--In addition to amounts otherwise 
                available, there is appropriated to the Centers for 
                Medicare & Medicaid Services Program Management 
                Account, out of any money in the Treasury not otherwise 
                appropriated, $1,000,000 for fiscal year 2025, to 
                remain available until expended, to carry out the 
                amendments made by this paragraph.
            (3) GAO study and report.--
                    (A) Analysis.--The Comptroller General of the 
                United States (in this paragraph referred to as the 
                ``Comptroller General'') shall conduct study of the 
                implementation of the amendments made by paragraphs (1) 
                and (2). To the extent data are available and reliable, 
                such study shall include an analysis of--
                            (i) the use of protections required under 
                        section 1852(d)(7) of the Social Security Act, 
                        as added by paragraph (1);
                            (ii) the provider directory accuracy scores 
                        trends under section 1857(e)(6)(A)(ii) of the 
                        Social Security Act (as added by paragraph 
                        (2)(A)), both overall and among providers 
                        specializing in mental health or substance 
                        disorder treatment;
                            (iii) provider response rates by plan 
                        verification methods; and
                            (iv) other items determined appropriate by 
                        the Comptroller General.
                    (B) Report.--Not later than January 15, 2031, the 
                Comptroller General shall submit to Congress a report 
                containing the results of the study conducted under 
                subparagraph (A), together with recommendations for 
                such legislation and administrative action as the 
                Comptroller General determines appropriate.
    (c) Guidance on Maintaining Accurate Provider Directories.--
            (1) Stakeholder meeting.--
                    (A) In general.--Not later than 3 months after the 
                date of enactment of this Act, the Secretary of Health 
                and Human Services (referred to in this subsection as 
                the ``Secretary'') shall hold a public stakeholder 
                meeting to receive input on approaches for maintaining 
                accurate provider directories for Medicare Advantage 
                plans under part C of title XVIII of the Social 
                Security Act (42 U.S.C. 1395w-21 et seq.), including 
                input on approaches for reducing administrative burden 
                such as data standardization and best practices to 
                maintain provider directory information.
                    (B) Participants.--Participants of the meeting 
                under subparagraph (A) shall include representatives 
                from the Centers for Medicare & Medicaid Services and 
                the Office of the National Coordinator for Health 
                Information Technology, health care providers, 
                companies that specialize in relevant technologies, 
                health insurers, and patient advocates.
            (2) Guidance to medicare advantage organizations.--Not 
        later than 12 months after the date of enactment of this Act, 
        the Secretary shall issue guidance to Medicare Advantage 
        organizations offering Medicare Advantage plans under part C of 
        title XVIII of the Social Security Act (42 U.S.C. 1395w-21 et 
        seq.) on maintaining accurate provider directories for such 
        plans, taking into consideration input received during the 
        stakeholder meeting under paragraph (1). Such guidance may 
        include the following, as determined appropriate by the 
        Secretary:
                    (A) Best practices for Medicare Advantage 
                organizations on how to work with providers to maintain 
                the accuracy of provider directories and reduce 
                provider and Medicare Advantage organization burden 
                with respect to maintaining the accuracy of provider 
                directories .
                    (B) Information on data sets and data sources with 
                information that could be used by Medicare Advantage 
                organizations to maintain accurate provider 
                directories.
                    (C) Approaches for utilizing data sources 
                maintained by Medicare Advantage organizations and 
                publicly available data sets to maintain accurate 
                provider directories.
                    (D) Information to be included in the provider 
                directory that may be useful for Medicare beneficiaries 
                to assess plan networks when selecting a plan and 
                accessing providers participating in plan networks 
                during the plan year.
            (3) Guidance to part b providers.--Not later than 12 months 
        after the date of enactment of this Act, the Secretary shall 
        issue guidance to providers of services and suppliers who 
        furnish items or services for which benefits are available 
        under part B of title XVIII of the Social Security Act (42 
        U.S.C. 1395j et seq.) on when to update the National Plan and 
        Provider Enumeration System regarding any information changes.

SEC. 110. GUIDANCE TO STATES ON STRATEGIES UNDER MEDICAID AND CHIP TO 
              INCREASE MENTAL HEALTH AND SUBSTANCE USE DISORDER CARE 
              PROVIDER CAPACITY.

    Not later than 12 months after the date of enactment of this Act, 
the Secretary of Health and Human Services shall issue guidance to 
States on strategies under Medicaid and the Children's Health Insurance 
Program (CHIP) to increase access to mental health and substance use 
disorder care providers that participate in Medicaid or CHIP, which may 
include education, training, recruitment, and retention of such 
providers, with a focus on improving the capacity of the mental health 
and substance use disorder care workforce in rural and underserved 
areas by increasing the number, type, and capacity of providers. Such 
guidance shall include, but not be limited to--
            (1) best practices from States that have used Medicaid or 
        CHIP waivers and authorities under titles XI, XIX, and XXI of 
        such Act (42 U.S.C. 1301 et seq., 1396 et seq., 1397aa et seq.) 
        for such purposes;
            (2) best practices related to expanding the availability of 
        community-based mental health and substance use disorder 
        services under Medicaid and CHIP, including through the 
        participation of paraprofessionals with behavioral health 
        expertise, and review of State practices for leveraging 
        paraprofessionals within State scope of practice requirements 
        as well as State supervision requirements, such as peer support 
        specialists and clinicians with baccalaureate degrees; and
            (3) best practices related to financing, supporting, and 
        expanding the education and training of providers of mental 
        health and substance use disorder services to increase the 
        workforce of such providers who participate in Medicaid and 
        CHIP, including by supporting on-site training in the clinical 
        setting and innovative public-private partnerships.

SEC. 111. GUIDANCE TO STATES ON SUPPORTING MENTAL HEALTH SERVICES AND 
              SUBSTANCE USE DISORDER CARE FOR CHILDREN AND YOUTH.

    (a) Guidance on Increasing the Availability and Provision of Mental 
Health Services and Substance Use Disorder Care Under Medicaid and 
CHIP.--Not later than 12 months after the date of enactment of this 
Act, the Secretary shall issue guidance to States regarding 
opportunities to improve the availability and provision of mental 
health services and substance use disorder care through Medicaid and 
CHIP for children and youth. Such guidance shall address the following:
            (1) The design and implementation of a continuum of 
        benefits for children and youth with significant mental health 
        conditions and substance use disorders covered by Medicaid and 
        CHIP, including the role of EPSDT, how EPSDT requires States to 
        make available a continuum of care across settings, and what is 
        required of States to ensure compliance with EPSDT.
            (2) Strategies to facilitate access to mental health 
        services and substance use disorder care under Medicaid and 
        CHIP that are delivered in the home or in community-based 
        settings for children and youth. Such guidance shall outline 
        strategies employed by States to expand the availability of 
        such settings and include specific interventions and financing 
        arrangements that could be replicated.
            (3) Strategies to facilitate access to mental health 
        services and substance use disorder care under Medicaid and 
        CHIP for children and youth who--
                    (A) are at risk for having a significant mental 
                health condition or substance use disorder;
                    (B) have a significant mental health condition or 
                substance use disorder; or
                    (C) have an intellectual or developmental 
                disability.
            (4) Strategies to promote screening for mental health and 
        substance use disorder needs of children and youth, including 
        children and youth provided, or at risk for needing, child 
        welfare services, in coordination with providers, managed care 
        organizations (as defined by the Secretary), prepaid inpatient 
        health plans (as defined by the Secretary), prepaid ambulatory 
        health plans (as defined by the Secretary), and schools (as 
        defined by the Secretary).
            (5) Strategies for supporting the provision of culturally 
        competent, developmentally appropriate, and trauma-informed 
        mental health services and substance use disorder care to 
        children and youth.
            (6) Strategies for providing early prevention, 
        intervention, and screening services, including for children 
        and youth at higher risk for having mental health or substance 
        use disorder needs, children and youth who do not have a mental 
        health or substance use disorder diagnosis, children and youth 
        provided, or at risk for needing, child welfare services, and 
        children at risk of first episode psychosis.
            (7) Best practices from State Medicaid and CHIP programs in 
        expanding access to mental health services and substance use 
        disorder care for children and youth, including children and 
        youth that are part of underserved communities and children and 
        youth with co-occurring intellectual disability or autism 
        spectrum disorder, and former foster youth.
            (8) Strategies to coordinate services and funding provided 
        under parts B and E of title IV of the Social Security Act (42 
        U.S.C. 621 et seq., 670 et seq.), and other funding sources at 
        the discretion of the Secretary, with services for which 
        Federal financial participation is available under Medicaid or 
        CHIP, to support improved access to comprehensive mental health 
        services and substance use disorder care for children and youth 
        provided, or at risk for needing, child welfare services.
    (b) Consultation.--The Secretary shall consult with the 
Administrator of the Centers for Medicare & Medicaid Services, the 
Assistant Secretary for the Administration for Children and Families, 
the Assistant Secretary for Mental Health and Substance Use, and the 
Director of the Office of National Drug Control Policy with respect to 
the guidance issued under subsection (a).
    (c) Definitions.--In this section:
            (1) EPSDT.--The term ``EPSDT'' means early and periodic 
        screening, diagnostic, and treatment services under Medicaid in 
        accordance with sections 1902(a)(43), 1905(a)(4)(B), and 
        1905(r) of the Social Security Act (42 U.S.C. 1396a(a)(43), 
        1396d(a)(4)(B), 1396d(r)).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (3) State.--The term ``State'' has the meaning given that 
        term in section 1101(a)(1) of the Social Security Act (42 
        U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such 
        Act.

SEC. 112. RECURRING ANALYSIS AND PUBLICATION OF MEDICAID HEALTH CARE 
              DATA RELATED TO MENTAL HEALTH SERVICES.

    (a) In General.--The Secretary, on a biennial basis, shall link, 
analyze, and publish on a publicly available website Medicaid data 
reported by States through the Transformed Medicaid Statistical 
Information System (T-MSIS) (or a successor system) relating to mental 
health services provided to individuals enrolled in Medicaid, including 
an analysis by age. Such enrollee information shall be de-identified of 
any personally identifying information, shall adhere to privacy 
standards established by the Department of Health and Human Services, 
and shall be aggregated to protect the privacy of enrollees, as 
necessary. Each publication of such analysis shall include for each 
State available data for the following measures:
            (1) The number and percentage of individuals by age 
        enrolled in the State Medicaid plan or waiver of such plan in 
        each of the major enrollment categories (as defined in a 
        letter, to be made publicly available on the website of the 
        Medicaid and CHIP Payment and Access Commission, from the 
        Medicaid and CHIP Payment and Access Commission to the 
        Secretary) who have been diagnosed with a mental health 
        condition and whether such individuals are enrolled under the 
        State Medicaid plan or waiver of such plan, including the 
        specific waiver authority under which they are enrolled, to the 
        extent available.
            (2) A list of the mental health treatment services, 
        including specifying adult and pediatric services, by each 
        major type of service, such as counseling, intensive home-based 
        services, intensive care coordination, crisis services tailored 
        to children and youth, youth peer support services, family-to-
        family support, inpatient hospitalization, and other 
        appropriate services as identified by the Secretary, for which 
        beneficiaries in each State received at least 1 service under 
        the State Medicaid plan or a waiver of such plan.
            (3) The number and percentage of individuals by age with a 
        substance use disorder diagnosis enrolled in the State Medicaid 
        plan or waiver of such plan who received services for a mental 
        health condition under such plan or waiver by each major type 
        of service specified under paragraph (2) within each major 
        setting type, such as outpatient, inpatient, residential, and 
        other home-based and community-based settings.
            (4) The number of services provided under the State 
        Medicaid plan or waiver of such plan per individual with a 
        mental health diagnosis, including by age, enrolled in such 
        plan or waiver for each major type of service specified under 
        paragraph (2).
            (5) The number and percentage of individuals by age 
        enrolled in the State Medicaid plan or waiver by major 
        enrollment category, who received mental health services 
        through--
                    (A) a Medicaid managed care entity (as defined in 
                section 1932(a)(1)(B) of the Social Security Act (42 
                U.S.C. 1396u-2(a)(1)(B))), including the number of such 
                individuals who received such assistance through a 
                prepaid inpatient health plan (as defined by the 
                Secretary) or a prepaid ambulatory health plan (as 
                defined by the Secretary);
                    (B) a fee-for-service payment model; or
                    (C) an alternative payment model, to the extent 
                available.
            (6) The number and percentage of individuals by age with a 
        mental health diagnosis who received mental health services in 
        an outpatient or home-based and community-based setting after 
        receiving services in an inpatient or residential setting and 
        the number of services received by such individuals in the 
        outpatient or home-based and community-based setting.
            (7) The number and percentage of inpatient admissions by 
        age in which services for a mental health condition were 
        provided to an individual enrolled in the State Medicaid plan 
        or a waiver of such plan that occurred within 30 days after 
        discharge from a hospital or inpatient facility in which 
        services for a mental health condition previously were provided 
        to such individual, disaggregated by type of facility, to the 
        extent such information is available.
            (8) The number of emergency department visits by an 
        individual by age enrolled in the State Medicaid plan or a 
        waiver of such plan for treatment of a mental health condition 
        within 7 days of such individual being discharged from a 
        hospital inpatient facility in which services for a mental 
        health condition were provided, or from a mental health 
        facility, an independent psychiatric wing of acute care 
        hospital, or an intermediate care facility for individuals with 
        intellectual disabilities, disaggregated by type of facility, 
        to the extent such information is available.
            (9) The number and percentage of individuals by age 
        enrolled in the State Medicaid plan or a waiver of such plan--
                    (A) who received an assessment to diagnose a mental 
                health condition; and
                    (B) the number of mental health services provided 
                to individuals described in subparagraph (A) in the 30 
                days post-assessment.
            (10) Prescription National Drug Code codes, fill dates, and 
        number of days supply of any covered outpatient drug (as 
        defined in section 1927(k)(2) of the Social Security Act (42 
        U.S.C. 1396r-8(k)(2)) to treat a mental health condition that 
        were dispensed to an individual by age enrolled in the State 
        Medicaid plan or waiver with an episode described in paragraph 
        (7) or (8) during any period that occurs after the individual's 
        discharge date defined in paragraph (7) or (8) (as applicable), 
        and before the admission date applicable under paragraph (7) or 
        the date of the emergency department visit applicable under 
        paragraph (8).
    (b) Publication.--
            (1) In general.--Not later than 18 months after the date of 
        enactment of this Act, the Secretary shall make publicly 
        available the first analysis required by subsection (a).
            (2) Use of t-msis data.--The report required under 
        paragraph (1) and updates required under paragraph (3) shall--
                    (A) use data and definitions from the Transformed 
                Medicaid Statistical Information System (``T-MSIS'') 
                (or a successor system) data set that is no more than 
                12 months old on the date that the report or update is 
                published; and
                    (B) as appropriate, include a description with 
                respect to each State of the quality and completeness 
                of the data and caveats describing the limitations of 
                the data reported to the Secretary by the State that is 
                sufficient to communicate the appropriate uses for the 
                information.
            (3) Revised publication.--Not later than 3 years after the 
        date of enactment of this Act, the Secretary shall publish a 
        revised publication of the analysis required by subsection (a) 
        that allows for a research-ready and publicly accessible 
        interface of the publication that is developed after 
        consultation with stakeholders on the usability of the data 
        contained in the publication.
    (c) Making Permanent the Requirement to Annually Update the SUD 
Data Book.--Section 1015 of the SUPPORT for Patients and Communities 
Act (Public Law 115-271) is amended--
            (1) in subsection (a)(3), by striking ``through 2024''; and
            (2) in subsection (b), by adding at the end the following 
        new paragraph:
            ``(4) Publication of data.--
                    ``(A) In general.--The Secretary shall publish in 
                the Federal Register a system of records notice that 
                modifies the system of records notice required under 
                paragraph (1) to provide that--
                            ``(i) the data specified in paragraph (2) 
                        shall be published on a publicly available 
                        website; and
                            ``(ii) such data shall be de-identified of 
                        any personally identifying information, shall 
                        adhere to privacy standards established by the 
                        Department of Health and Human Services, and 
                        shall be aggregated to protect the privacy of 
                        enrollees, as necessary.
                    ``(B) Initiation of modified data-sharing 
                activities.--Not later than January 1, 2025, the 
                Secretary shall initiate the data sharing activities 
                outlined in the notice required under paragraph (1), as 
                modified pursuant to this paragraph.''.
    (d) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) State.--The term ``State'' has the meaning given that 
        term in section 1101(a)(1) of the Social Security Act (42 
        U.S.C. 1301(a)(1)) for purposes of title XIX of such Act.

SEC. 113. GUIDANCE TO STATES ON SUPPORTING MENTAL HEALTH SERVICES OR 
              SUBSTANCE USE DISORDER CARE INTEGRATION WITH PRIMARY CARE 
              IN MEDICAID AND CHIP.

    (a) Analysis Regarding Care Integration.--Not later than 18 months 
after the date of enactment of this Act, the Secretary shall conduct an 
analysis of Medicaid and CHIP regarding clinical outcomes among 
different models of integration of mental health services or substance 
use disorder care within the primary care setting. Such analysis 
shall--
            (1) consider different models for how mental health 
        services or substance use disorder care is delivered and 
        integrated within the primary care setting, including when 
        providers operating in an integrated model are physically 
        located in the same practice or building, when at least 1 
        provider in an integrated care model is available via 
        telehealth, and when primary care, mental health, or substance 
        use disorder care providers seek education and consultation 
        from other providers through electronic modalities; and
            (2) evaluate--
                    (A) the use of different payment methodologies, 
                such as bundled payments and value-based payment 
                arrangements; and
                    (B) the use and quality of services to coordinate 
                care, including but not limited to case management, 
                care coordination, enhanced care coordination, and 
                enhanced care management, for mental health services 
                and for substance use disorder care.
    (b) Guidance.--Not later than 12 months after the Secretary 
completes the analysis required under subsection (a), the Secretary 
shall issue guidance to States on supporting integration of mental 
health services or substance use disorder care with primary care under 
Medicaid and CHIP. Such guidance shall be informed by the analysis 
required under subsection (a) and, at minimum, shall do the following:
            (1) Provide an overview of State options for adopting and 
        expanding value-based payment arrangements and alternative 
        payment models, including accountable care organizations and 
        other shared savings programs, that integrate mental health 
        services or substance use disorder care with primary care.
            (2) Describe opportunities for States to use and align 
        existing authorities and resources to finance integration of 
        mental health services or substance use disorder care with 
        primary care, including with respect to the use of electronic 
        health records in mental health care settings and in substance 
        use disorder care settings.
            (3) Describe strategies to support integration of mental 
        health services or substance use disorder care with primary 
        care through the use of non-clinical professionals and 
        paraprofessionals, including trained peer support specialists.
            (4) Provide examples of specific strategies and models 
        designed to support integration of mental health services or 
        substance use disorder care with primary care for differing age 
        groups, including children and youth, and individuals over the 
        age of 65.
            (5) Describe options for assessing the clinical outcomes of 
        differing models and strategies for integration of mental 
        health services or substance use disorder care with primary 
        care.
    (c) Integration of Mental Health Services or Substance Use Disorder 
Care With Primary Care.--For purposes of subsections (a) and (b), 
integration of mental health services or substance use disorder care 
with primary care may include (and shall not be limited to, including 
when furnished via telehealth, when appropriate)--
            (1) adherence to the collaborative care model or primary 
        care behavioral health model for behavioral health integration;
            (2) use of behavioral health integration models primarily 
        intended for pediatric populations with non-severe mental 
        health needs that are focused on prevention and early detection 
        and intervention methods through a multidisciplinary 
        collaborative behavioral health team approach co-managed with 
        primary care, to include same-day access to family-focused 
        mental health treatment services;
            (3) having mental health providers or substance use 
        disorder providers physically co-located in a primary care 
        setting with same-day visit availability;
            (4) implementing or maintaining enhanced care coordination 
        or targeted case management which includes regular interactions 
        between and within care teams;
            (5) providing mental health or substance use disorder 
        screening and follow-up assessments, interventions, or services 
        within the same practice or facility as a primary care or 
        physical service setting;
            (6) the use of assertive community treatment that is 
        integrated with or facilitated by a primary care practice; and
            (7) delivery of integrated primary care and mental health 
        services or substance use disorder care in the home or in 
        community-based settings for individuals who choose and are 
        able to receive care in such settings, as authorized under 
        subsections (b), (c), (i), (j), and (k) of section 1915 of the 
        Social Security Act (42 U.S.C. 1396n), under a waiver under 
        section 1115 of such Act (42 U.S.C. 1315), or under section 
        1937, 1945, or 1945A of such Act (42 U.S.C. 1396u-7, 1396w-4, 
        1396w-4a).
    (d) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) State.--The term ``State'' has the meaning given that 
        term in section 1101(a)(1) of the Social Security Act (42 
        U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such 
        Act.

SEC. 114. MEDICAID STATE OPTION RELATING TO INMATES WITH A SUBSTANCE 
              USE DISORDER PENDING DISPOSITION OF CHARGES.

    (a) State Option.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in the subdivision (A) following the last 
                numbered paragraph of subsection (a), by inserting 
                ``subject to subsection (jj),'' before ``any such 
                payments''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jj) State Option to Provide Medical Assistance to Certain 
Inmates With a Substance Use Disorder Pending Disposition of Charges.--
            ``(1) In general.--Subject to paragraph (2), a State may 
        elect to provide, and, notwithstanding the subdivision (A) 
        following the last numbered paragraph of subsection (a), 
        receive Federal financial participation for, medical assistance 
        for an individual who--
                    ``(A) is an inmate of a public institution (as 
                defined in section 1902(nn)(3)) pending disposition of 
                charges; and
                    ``(B) has been diagnosed with a substance use 
                disorder.
            ``(2) Limitation; conditions.--
                    ``(A) Limitation.--A State may only receive Federal 
                financial participation for medical assistance provided 
                to an individual described in paragraph (1) during the 
                7-day period that begins on the first day that the 
                individual is an inmate of a public institution.
                    ``(B) Conditions.--A State may only receive Federal 
                financial participation for medical assistance provided 
                to an individual described in paragraph (1) if--
                            ``(i) the State has elected to not 
                        terminate eligibility for medical assistance 
                        under the State plan for individuals on the 
                        basis that they are inmates of public 
                        institutions (but may suspend coverage during 
                        the period an individual is such an inmate); 
                        and
                            ``(ii) the diagnosis that the covered 
                        individual has a substance use disorder is made 
                        while the individual is an inmate of the public 
                        institution by a licensed medical professional 
                        using a standardized screening and assessment 
                        model approved by the Secretary.''.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect on January 1, 2026.
    (b) Technical Correction and Conforming Amendments.--
            (1) Technical correction.--Section 5122(a)(1) of the 
        Consolidated Appropriations Act, 2023 (Public Law 117-328) is 
        amended by striking ``after'' and all that follows through the 
        period at the end and inserting ``after `or in the case of an 
        eligible juvenile described in section 1902(a)(84)(D) with 
        respect to the screenings, diagnostic services, referrals, and 
        targeted case management services required under such 
        section'.''.
            (2) Other conforming amendments.--
                    (A) Section 1902(nn)(3) of the Social Security Act 
                (42 U.S.C. 1396a(nn)(3)), is amended by striking 
                ``following'' and all that follows through ``section 
                1905(a)'' and inserting ``following the last numbered 
                paragraph of section 1905(a)''.
                    (B) The fifth sentence of section 1905(a) of the 
                Social Security Act (42 U.S.C. 1396d(a)) is amended by 
                striking ``paragraph (30)'' and inserting ``the last 
                numbered paragraph''.

SEC. 115. DEFINITION OF CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC 
              SERVICES UNDER MEDICAID.

    (a) Definition of Medical Assistance.--Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (30), by striking ``; and'' and 
                inserting a semicolon;
                    (B) by redesignating paragraph (31) as paragraph 
                (32); and
                    (C) by inserting after paragraph (30) the following 
                new paragraph:
            ``(31) certified community behavioral health clinic 
        services, as defined in subsection (jj); and''; and
            (2) by adding at the end the following new subsection:
    ``(jj) Certified Community Behavioral Health Clinic Services.--
            ``(1) In general.--The term `certified community behavioral 
        health services' means any of the following when furnished to 
        an individual as a patient of a certified community behavioral 
        health clinic (as defined in paragraph (2)), in a manner 
        reflecting person-centered care and which, if not available 
        directly through a certified community behavioral health 
        clinic, may be provided or referred through formal 
        relationships with other providers:
                    ``(A) Crisis mental health services, including 24-
                hour mobile crisis teams, emergency crisis intervention 
                services, and crisis stabilization.
                    ``(B) Screening, assessment, and diagnosis, 
                including risk assessment.
                    ``(C) Patient-centered treatment planning or 
                similar processes, including risk assessment and crisis 
                planning.
                    ``(D) Outpatient mental health and substance use 
                services.
                    ``(E) Outpatient clinic primary care screening and 
                monitoring of key health indicators and health risk.
                    ``(F) Intensive case management.
                    ``(G) Psychiatric rehabilitation services.
                    ``(H) Peer support and counselor services and 
                family supports.
                    ``(I) Intensive, community-based mental health care 
                for members of the armed forces and veterans, 
                particularly those members and veterans located in 
                rural areas, provided the care is consistent with 
                minimum clinical mental health guidelines promulgated 
                by the Veterans Health Administration, including 
                clinical guidelines contained in the Uniform Mental 
                Health Services Handbook of such Administration.
            ``(2) Certified community behavioral health clinic.--The 
        term `certified community behavioral health clinic' means an 
        organization that--
                    ``(A) is engaged in furnishing to patients all of 
                the services described in paragraph (1);
                    ``(B) is legally authorized to furnish such 
                services under State law;
                    ``(C) agrees, as a condition of the certification 
                described in subparagraph (D), to furnish to the State 
                or Secretary any data required as part of ongoing 
                monitoring of the organization's provision of services, 
                including encounter data, clinical outcomes data, 
                quality data, and such other data as the State or 
                Secretary may require; and
                    ``(D) has been certified by a State as meeting the 
                criteria established by the Secretary pursuant to 
                subsection (a) of section 223 of the Protecting Access 
                to Medicare Act as of January 1, 2024, and any 
                subsequent updates to such criteria, regardless of 
                whether the State is carrying out a demonstration 
                program under this title under subsection (d) of such 
                section.''.
    (b) Effective Date.--The amendments made by this section shall 
apply with respect to medical assistance furnished on or after January 
1, 2024.

 TITLE II--REDUCING PRESCRIPTION DRUG COSTS UNDER MEDICARE AND MEDICAID

SEC. 201. ASSURING PHARMACY ACCESS AND CHOICE FOR MEDICARE 
              BENEFICIARIES.

    (a) In General.--Section 1860D-4(b)(1) of the Social Security Act 
(42 U.S.C. 1395w-104(b)(1)) is amended by striking subparagraph (A) and 
inserting the following:
                    ``(A) In general.--
                            ``(i) Participation of any willing 
                        pharmacy.--A PDP sponsor offering a 
                        prescription drug plan shall permit any 
                        pharmacy that meets the standard contract terms 
                        and conditions under such plan to participate 
                        as a network pharmacy of such plan.
                            ``(ii) Contract terms and conditions.--
                                    ``(I) In general.--For plan years 
                                beginning on or after January 1, 2028, 
                                in accordance with clause (i), contract 
                                terms and conditions offered by such 
                                PDP sponsor shall be reasonable and 
                                relevant according to standards 
                                established by the Secretary under 
                                subclause (II).
                                    ``(II) Standards.--Not later than 
                                the first Monday in April of 2027, the 
                                Secretary shall establish standards for 
                                reasonable and relevant contract terms 
                                and conditions for purposes of this 
                                clause.
                                    ``(III) Request for information.--
                                Not later than January 1, 2025, for 
                                purposes of establishing the standards 
                                under subclause (II), the Secretary 
                                shall issue a request for information 
                                to seek input on trends in prescription 
                                drug plan and network pharmacy contract 
                                terms and conditions, current 
                                prescription drug plan and network 
                                pharmacy contracting practices, whether 
                                pharmacy reimbursement and dispensing 
                                fees under this part cover pharmacy 
                                ingredient and operational costs, areas 
                                in current regulations or program 
                                guidance related to contracting between 
                                prescription drug plans and network 
                                pharmacies requiring clarification or 
                                additional specificity, factors for 
                                consideration in determining the 
                                reasonableness and relevance of 
                                contract terms and conditions between 
                                prescription drug plans and network 
                                pharmacies, and other issues determined 
                                appropriate by the Secretary.''.
    (b) Treatment of Essential Retail Pharmacies.--Section 1860D-
4(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w-104(b)(1)(C)) is 
amended by adding at the end the following new clause:
                            ``(v) Essential retail pharmacies.--
                                    ``(I) In general.--For plan years 
                                beginning on or after January 1, 2028, 
                                a PDP sponsor of a prescription drug 
                                plan that has preferred pharmacies in 
                                its network shall contract with, as 
                                preferred pharmacies in such plan's 
                                network, at least--
                                            ``(aa) 80 percent of 
                                        essential retail pharmacies (as 
                                        defined in subclause (III)) in 
                                        such plan's service area that 
                                        are independent community 
                                        pharmacies (as defined in 
                                        subclause (V)(bb)); and
                                            ``(bb) 50 percent of 
                                        essential retail pharmacies in 
                                        such plan's service area not 
                                        described in item (aa).
                                    ``(II) Total reimbursement for 
                                essential retail pharmacies that are 
                                independent community pharmacies.--For 
                                plan years beginning on or after 
                                January 1, 2028, total reimbursement 
                                (as defined in subclause (V)(dd)) paid 
                                by a PDP sponsor to an essential retail 
                                pharmacy that is an independent 
                                community pharmacy for a covered part D 
                                drug shall not be lower than--
                                            ``(aa) in the case where 
                                        National Average Drug 
                                        Acquisition Cost information 
                                        for such drug for retail 
                                        community pharmacies or 
                                        applicable non-retail community 
                                        pharmacies has been available 
                                        under section 1927(f) for at 
                                        least one full plan year--

                                                    ``(AA) if such 
                                                information is 
                                                available for such drug 
                                                for retail community 
                                                pharmacies, the average 
                                                National Average Drug 
                                                Acquisition Cost for 
                                                such drug for retail 
                                                community pharmacies 
                                                for the most recent 
                                                plan year for which 
                                                such information is 
                                                available;

                                                    ``(BB) in the case 
                                                where such information 
                                                for retail community 
                                                pharmacies is not 
                                                available, the average 
                                                National Average Drug 
                                                Acquisition Cost for 
                                                such drug for 
                                                applicable non-retail 
                                                pharmacies for the most 
                                                recent plan year for 
                                                which such information 
                                                is available;

                                            ``(bb) in the case where 
                                        National Average Drug 
                                        Acquisition Cost information 
                                        for such drug under section 
                                        1927(f) is not available for 
                                        retail community pharmacies or 
                                        applicable non-retail 
                                        pharmacies, the wholesale 
                                        acquisition cost (as defined in 
                                        section 1847A(c)(6)(B)) for 
                                        such drug; and
                                            ``(cc) in the case where 
                                        National Average Drug 
                                        Acquisition Cost information 
                                        under section 1927(f) is 
                                        available for such drug and 
                                        ending on the date such survey 
                                        information has been available 
                                        for such drug but has not been 
                                        available for a full plan 
                                        year--

                                                    ``(AA) the most 
                                                recent National Average 
                                                Drug Acquisition Cost 
                                                for such drug for 
                                                retail community 
                                                pharmacies, if 
                                                available; or

                                                    ``(BB) if the 
                                                information specified 
                                                in subitem (AA) is not 
                                                available, the most 
                                                recent National Average 
                                                Drug Acquisition Cost 
                                                for such drug for 
                                                applicable non-retail 
                                                pharmacies.

                                    ``(III) Definition of essential 
                                retail pharmacy.--In this clause, the 
                                term `essential retail pharmacy' means, 
                                with respect to a plan year, a retail 
                                pharmacy that--
                                            ``(aa) is not an affiliate 
                                        of a pharmacy benefit manager 
                                        or PDP sponsor;
                                            ``(bb) is located in a 
                                        medically underserved area (as 
                                        designated pursuant to section 
                                        330(b)(3)(A) of the Public 
                                        Health Service Act); and
                                            ``(cc) is designated as an 
                                        essential retail pharmacy by 
                                        the Secretary for such plan 
                                        year under subclause (IV).
                                    ``(IV) Designation of essential 
                                retail pharmacies.--
                                            ``(aa) In general.--For 
                                        each plan year (beginning with 
                                        plan year 2028), the Secretary 
                                        shall designate pharmacies that 
                                        meet the requirements specified 
                                        in items (aa) and (bb) of 
                                        subclause (III) as essential 
                                        retail pharmacies, in 
                                        accordance with this subclause.
                                            ``(bb) Required submissions 
                                        from pdp sponsors.--For each 
                                        plan year beginning with plan 
                                        year 2028, each PDP sponsor 
                                        offering a prescription drug 
                                        plan shall submit to the 
                                        Secretary, for the purposes of 
                                        determining retail pharmacies 
                                        that do not meet the 
                                        requirement specified in item 
                                        (aa) of subclause (III), a list 
                                        of any retail pharmacy that is 
                                        an affiliate of such sponsor, 
                                        subject to time, manner, and 
                                        form requirements established 
                                        by the Secretary.
                                            ``(cc) Publication.--Not 
                                        later than one month prior to 
                                        the start of each plan year 
                                        (beginning with plan year 
                                        2028), the Secretary shall 
                                        list, on a publicly available 
                                        website of the Centers for 
                                        Medicare & Medicaid Services, 
                                        all pharmacies designated as 
                                        essential retail pharmacies for 
                                        such plan year.
                                            ``(dd) Revocation of 
                                        designation.--In the case 
                                        where, during a plan year, the 
                                        Secretary determines that a 
                                        pharmacy no longer meets the 
                                        requirements for designation as 
                                        an essential retail pharmacy, 
                                        the Secretary may revoke such 
                                        designation for such pharmacy, 
                                        as determined appropriate by 
                                        the Secretary.
                                    ``(V) Other definitions.--In this 
                                clause:
                                            ``(aa) Affiliate.--The term 
                                        `affiliate' means any entity 
                                        that is owned by, controlled 
                                        by, or related under a common 
                                        ownership structure with a 
                                        pharmacy benefit manager or PDP 
                                        sponsor or that acts as a 
                                        contractor or agent to such 
                                        pharmacy benefit manager or PDP 
                                        sponsor, if such contractor or 
                                        agent performs any of the 
                                        functions described in item 
                                        (cc).
                                            ``(bb) Independent 
                                        community pharmacy.--The term 
                                        `independent community 
                                        pharmacy' means a retail 
                                        pharmacy, including a pharmacy 
                                        that is associated with a 
                                        franchise or a pharmacy 
                                        services administrative 
                                        organization, that has fewer 
                                        than 4 locations and is not 
                                        affiliated with any person or 
                                        entity other than its owners.
                                            ``(cc) Pharmacy benefit 
                                        manager.--The term `pharmacy 
                                        benefit manager' means any 
                                        person or entity that, either 
                                        directly or through an 
                                        intermediary, acts as a price 
                                        negotiator or group purchaser 
                                        on behalf of a PDP sponsor or 
                                        prescription drug plan, or 
                                        manages the prescription drug 
                                        benefits provided by such 
                                        sponsor or plan, including the 
                                        processing and payment of 
                                        claims for prescription drugs, 
                                        the performance of drug 
                                        utilization review, the 
                                        processing of drug prior 
                                        authorization requests, the 
                                        adjudication of appeals or 
                                        grievances related to the 
                                        prescription drug benefit, 
                                        contracting with network 
                                        pharmacies, controlling the 
                                        cost of covered part D drugs, 
                                        or the provision of related 
                                        services. Such term includes 
                                        any person or entity that 
                                        carries out one or more of the 
                                        activities described in the 
                                        preceding sentence, 
                                        irrespective of whether such 
                                        person or entity identifies 
                                        itself as a `pharmacy benefit 
                                        manager'.
                                            ``(dd) Total 
                                        reimbursement.--The term `total 
                                        reimbursement' means, with 
                                        respect to a covered part D 
                                        drug, the negotiated price (as 
                                        defined in section 1860D-
                                        2(d)(1)(B)) plus any incentive 
                                        payments paid by the PDP 
                                        sponsor to such essential 
                                        retail pharmacy that is an 
                                        independent community pharmacy 
                                        net of any fees, pharmacy price 
                                        concessions, discounts, or any 
                                        other forms of remuneration 
                                        paid by such pharmacy and 
                                        furnished by such PDP sponsor 
                                        under section 1860D-2(f)(4).''.
    (c) Enforcement.--
            (1) In general.--Section 1860D-4(b)(1) of the Social 
        Security Act (42 U.S.C. 1395w-104(b)(1)) is amended by adding 
        at the end the following new subparagraph:
                    ``(F) Enforcement of standards for reasonable and 
                relevant contract terms and conditions and essential 
                retail pharmacy protections.--
                            ``(i) Allegation submission process.--
                                    ``(I) In general.--Not later than 
                                January 1, 2028, the Secretary shall 
                                establish a process through which a 
                                pharmacy may submit an allegation of a 
                                violation by a PDP sponsor offering a 
                                prescription drug plan of--
                                            ``(aa) the standards for 
                                        reasonable and relevant 
                                        contract terms and conditions 
                                        under subparagraph (A)(ii); or
                                            ``(bb) the requirements for 
                                        total reimbursement for 
                                        essential retail pharmacies 
                                        that are independent community 
                                        pharmacies under subparagraph 
                                        (C)(v)(II).
                                    ``(II) Frequency of submission.--
                                            ``(aa) Violations of 
                                        reasonable and relevant 
                                        contract terms and 
                                        conditions.--

                                                    ``(AA) In 
                                                general.--Except as 
                                                provided in subitem 
                                                (BB), the allegation 
                                                submission process 
                                                under this clause shall 
                                                allow pharmacies to 
                                                submit any allegations 
                                                of violations described 
                                                in item (aa) of 
                                                subclause (I) not more 
                                                frequently than once 
                                                per plan year per 
                                                contract between a 
                                                pharmacy and a PDP 
                                                sponsor.

                                                    ``(BB) Allegations 
                                                relating to contract 
                                                changes.--In the case 
                                                where a contract is 
                                                amended or otherwise 
                                                updated following the 
                                                submission of 
                                                allegations by a 
                                                pharmacy with respect 
                                                to such contract and 
                                                plan year, the 
                                                allegation submission 
                                                process under this 
                                                clause shall allow such 
                                                pharmacy to submit an 
                                                additional allegation 
                                                related to those 
                                                changes with respect to 
                                                such contract and plan 
                                                year.

                                                    ``(CC) 
                                                Submissions.--Submission
                                                s of any allegations 
                                                under this item shall 
                                                be separate from any 
                                                submissions under item 
                                                (bb) and may include 
                                                multiple allegations of 
                                                such violations.

                                            ``(bb) Violations of 
                                        essential retail pharmacy 
                                        protections.--

                                                    ``(AA) In 
                                                general.--The 
                                                allegation submission 
                                                process under this 
                                                clause shall allow 
                                                essential retail 
                                                pharmacies that are 
                                                independent community 
                                                pharmacies to submit 
                                                any allegations of 
                                                violations described in 
                                                item (bb) of subclause 
                                                (I) once per calendar 
                                                quarter.

                                                    ``(BB) 
                                                Submissions.--Submission
                                                s of any allegations 
                                                under this item shall 
                                                be separate from any 
                                                submissions under item 
                                                (aa) and may include 
                                                multiple allegations of 
                                                such violations.

                                    ``(III) Access to relevant 
                                documents and materials.--A PDP sponsor 
                                subject to an allegation under this 
                                clause--
                                            ``(aa) shall provide 
                                        documents or materials, as 
                                        specified by the Secretary, 
                                        including contract offers made 
                                        by such sponsor to such 
                                        pharmacy or correspondence 
                                        related to such offers, to the 
                                        Secretary at a time and in a 
                                        form and manner specified by 
                                        the Secretary; and
                                            ``(bb) shall not prohibit 
                                        or otherwise limit the ability 
                                        of a pharmacy to submit such 
                                        documents or materials to the 
                                        Secretary for the purpose of 
                                        submitting an allegation or 
                                        providing evidence for such an 
                                        allegation under this clause.
                                    ``(IV) Standardized template.--The 
                                Secretary shall establish separate 
                                standardized templates for pharmacies 
                                to use for the submission of 
                                allegations described in items (aa) and 
                                (bb) of subclause (I). Each such 
                                template shall require that the 
                                submission include a certification by 
                                the pharmacy that the information 
                                included is accurate, complete, and 
                                true to the best of the knowledge, 
                                information, and belief of such 
                                pharmacy.
                                    ``(V) Preventing frivolous 
                                allegations.--In the case where the 
                                Secretary determines that a pharmacy 
                                has submitted frivolous allegations 
                                under this clause on a routine basis, 
                                the Secretary may temporarily prohibit 
                                such pharmacy from using the allegation 
                                submission process under this clause, 
                                as determined appropriate by the 
                                Secretary.
                                    ``(VI) Exemption from freedom of 
                                information act.--Allegations submitted 
                                under this clause shall be exempt from 
                                disclosure under section 552 of title 
                                5, United States Code.
                            ``(ii) Investigation.--The Secretary shall 
                        investigate, as determined appropriate by the 
                        Secretary, allegations submitted pursuant to 
                        clause (i).
                            ``(iii) Enforcement.--
                                    ``(I) Reasonable and relevant 
                                contract terms and conditions.--In the 
                                case where the Secretary determines 
                                that a PDP sponsor offering a 
                                prescription drug plan has violated the 
                                standards for reasonable and relevant 
                                contract terms and conditions under 
                                subparagraph (A)(ii), the Secretary 
                                shall use existing authorities under 
                                sections 1857(g) and 1860D-12(b)(3)(E) 
                                to impose civil monetary penalties or 
                                take other enforcement actions.
                                    ``(II) Essential retail pharmacy 
                                protections.--In the case where the 
                                Secretary determines that a PDP sponsor 
                                offering a prescription drug plan has 
                                violated the requirements for total 
                                reimbursement for essential retail 
                                pharmacies that are independent 
                                community pharmacies under subparagraph 
                                (C)(v)(II), the Secretary shall--
                                            ``(aa) if the amount of 
                                        total reimbursement paid by the 
                                        sponsor to an essential retail 
                                        pharmacy that is an independent 
                                        community pharmacy for a 
                                        covered part D drug was less 
                                        than the amount of total 
                                        reimbursement required to be 
                                        paid to the pharmacy under 
                                        subparagraph (C)(v)(II) for 
                                        such drug, require the PDP 
                                        sponsor to pay to the pharmacy 
                                        an amount equal to the 
                                        difference between such 
                                        amounts; and
                                            ``(bb) use existing 
                                        authorities under section 
                                        1857(g) and 1860D-12(b)(3)(E) 
                                        to impose civil monetary 
                                        penalties or take other 
                                        enforcement actions.
                                    ``(III) Application of civil 
                                monetary penalties.--The provisions of 
                                section 1128A (other than subsections 
                                (a) and (b)) shall apply to a civil 
                                monetary penalty under this clause in 
                                the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A(a).
                            ``(iv) Definitions.--In this subparagraph, 
                        the terms `essential retail pharmacy', 
                        `independent community pharmacy', and `total 
                        reimbursement' have the meaning given those 
                        terms in subparagraph (C)(v).''.
            (2) Conforming amendment.--Section 1857(g)(1) of the Social 
        Security Act (42 U.S.C. 1395w-27(g)(1)) is amended--
                    (A) in subparagraph (J), by striking ``or'' after 
                the semicolon;
                    (B) by redesignating subparagraph (K) as 
                subparagraph (L);
                    (C) by inserting after subparagraph (J), the 
                following new subparagraph:
                    ``(K) fails to comply with--
                            ``(i) the standards for reasonable and 
                        relevant contract terms and conditions under 
                        subparagraph (A)(ii) of section 1860D-4(b)(1); 
                        or
                            ``(ii) the requirements for total 
                        reimbursement for essential retail pharmacies 
                        that are independent community pharmacies under 
                        subparagraph (C)(v)(II) of such section; or'';
                    (D) in subparagraph (L), as redesignated by 
                subparagraph (B), by striking ``through (J)'' and 
                inserting ``through (K)''; and
                    (E) in the flush matter following subparagraph (L), 
                as so redesignated, by striking ``subparagraphs (A) 
                through (K)'' and inserting ``subparagraphs (A) through 
                (L)''.
    (d) Accountability of Pharmacy Benefit Managers for Violations of 
Reasonable and Relevant Contract Terms and Conditions and Essential 
Retail Pharmacy Protections.--
            (1) In general.--Section 1860D-12(b) of the Social Security 
        Act (42 U.S.C. 1395w-112) is amended by adding at the end the 
        following new paragraph:
            ``(9) Accountability of pharmacy benefit managers for 
        violations of reasonable and relevant contract terms and 
        conditions and essential retail pharmacy protections.--For plan 
        years beginning on or after January 1, 2028, each contract 
        entered into with a PDP sponsor under this part with respect to 
        a prescription drug plan offered by such sponsor shall provide 
        that any pharmacy benefit manager acting on behalf of such 
        sponsor has a written agreement with the PDP sponsor under 
        which the pharmacy benefit manager agrees to reimburse the PDP 
        sponsor for any amounts paid by such sponsor under subclause 
        (I) or (II) of section 1860D-4(b)(1)(F)(iii) as a result of a 
        violation described in such subclause (I) or (II) if such 
        violation is related to a responsibility delegated to the 
        pharmacy benefit manager by such PDP sponsor.''.
            (2) Ma-pd plans.--Section 1857(f)(3) of the Social Security 
        Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end 
        the following new subparagraph:
                    ``(F) Accountability of pharmacy benefit managers 
                for violations of reasonable and relevant contract 
                terms and conditions and essential retail pharmacy 
                protections.--For plan years beginning on or after 
                January 1, 2028, section 1860D-12(b)(9).''.
    (e) Section 1860D-42 of the Social Security Act (42 U.S.C. 1395w-
152) is amended by adding at the end the following new subsection:
    ``(e) Briefing and Reporting Requirements Related to Pharmacy Price 
Concessions Under This Part.--
            ``(1) Briefing requirements.--The Secretary shall provide 
        periodic briefings to the Committee on Finance of the Senate, 
        the Committee on Ways and Means of the House of 
        Representatives, and the Committee on Energy and Commerce of 
        the House of Representatives, beginning not later than 90 days 
        after the date of enactment of this subsection, on 
        implementation, oversight, data collection, and enforcement 
        activities related to the administration of the `Pharmacy Price 
        Concessions to Drug Prices at the Point of Sale' provisions 
        codified under sections 423.100 and 423.2305 of title 42, Code 
        of Federal Regulations (or any successor regulations), as 
        published in the Federal Register on May 9, 2022, in the final 
        rule entitled `Medicare Program; Contract Year 2023 Policy and 
        Technical Changes to the Medicare Advantage and Medicare 
        Prescription Drug Benefit Programs; Policy and Regulatory 
        Revisions in Response to the COVID-19 Public Health Emergency; 
        Additional Policy and Regulatory Revisions in Response to the 
        COVID-19 Public Health Emergency'.
            ``(2) Reporting requirements.--Beginning not later than 90 
        days after the date of enactment of this subsection, and at 
        least once every plan year beginning thereafter (through plan 
        year 2027), the Secretary shall develop and submit to Congress 
        reports on the activities specified in paragraph (1).
            ``(3) Contents for briefings and reports.--The briefings 
        required under paragraph (1) and reports required under 
        paragraph (2) shall include information on--
                    ``(A) implementation, oversight, data collection, 
                and enforcement activities related to contract terms 
                and conditions among PDP sponsors, MA organizations, 
                and pharmacies for the purpose of establishing or 
                maintaining pharmacy network participation or preferred 
                pharmacy network participation;
                    ``(B) patterns and trends in such terms and 
                conditions, to the extent applicable;
                    ``(C) implementation, oversight, and enforcement 
                activities and developments related to assuring 
                pharmacy access under section 1860D-4(b)(1), along with 
                applicable regulations and program instruction or 
                guidance;
                    ``(D) plans, strategies, initiatives, or 
                programmatic changes undertaken by the Secretary to 
                prevent, mitigate, or otherwise address stakeholder 
                feedback and concerns related to convenient pharmacy 
                access for beneficiaries under this part; and
                    ``(E) other issues determined appropriate by the 
                Secretary.''.
    (f) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Centers for Medicare & Medicaid Services Program 
Management Account, out of any money in the Treasury not otherwise 
appropriated, $250,000,000 for fiscal year 2024, to remain available 
until expended, to carry out the amendment made by this section.

SEC. 202. ENSURING ACCURATE PAYMENTS TO PHARMACIES UNDER MEDICAID.

    (a) In General.--Section 1927(f) of the Social Security Act (42 
U.S.C. 1396r-8(f)) is amended--
            (1) in paragraph (1)(A)--
                    (A) by redesignating clause (ii) as clause (iii); 
                and
                    (B) by striking ``and'' after the semicolon at the 
                end of clause (i) and all that precedes it through 
                ``(1)'' and inserting the following:
            ``(1) Determining pharmacy actual acquisition costs.--The 
        Secretary shall conduct a survey of retail community pharmacy 
        drug prices and applicable non-retail pharmacy drug prices to 
        determine national average drug acquisition cost benchmarks as 
        follows:
                    ``(A) Use of vendor.--The Secretary may contract 
                services for--
                            ``(i) with respect to retail community 
                        pharmacies, the determination of retail survey 
                        prices of the national average drug acquisition 
                        cost for covered outpatient drugs that 
                        represent a nationwide average of consumer 
                        purchase prices for such drugs, net of all 
                        discounts and rebates (to the extent any 
                        information with respect to such discounts and 
                        rebates is available) based on a monthly survey 
                        of such pharmacies;
                            ``(ii) with respect to applicable non-
                        retail pharmacies--
                                    ``(I) the determination of survey 
                                prices, separate from the survey prices 
                                described in clause (i), of the non-
                                retail national average drug 
                                acquisition cost for covered outpatient 
                                drugs that represent a nationwide 
                                average of consumer purchase prices for 
                                such drugs, net of all discounts and 
                                rebates (to the extent any information 
                                with respect to such discounts and 
                                rebates is available) based on a 
                                monthly survey of such pharmacies; and
                                    ``(II) at the discretion of the 
                                Secretary, for each type of applicable 
                                non-retail pharmacy (as identified 
                                pursuant to the type indicators 
                                established by the Secretary under 
                                subsection (k)(12)(B)(ii)), the 
                                determination of survey prices, 
                                separate from the survey prices 
                                described in clause (i) or subclause 
                                (I) of this clause, of the national 
                                average drug acquisition cost for such 
                                type of pharmacy for covered outpatient 
                                drugs that represent a nationwide 
                                average of consumer purchase prices for 
                                such drugs, net of all discounts and 
                                rebates (to the extent any information 
                                with respect to such discounts and 
                                rebates is available) based on a 
                                monthly survey of such pharmacies; 
                                and'';
            (2) in subparagraph (D) of paragraph (1), by striking 
        clauses (ii) and (iii) and inserting the following:
                            ``(ii) The vendor must update the Secretary 
                        no less often than monthly on the survey prices 
                        for covered outpatient drugs.
                            ``(iii) The vendor must differentiate, in 
                        collecting and reporting survey data, the 
                        relevant pharmacy type indicator for all cost 
                        information collected, including whether a 
                        pharmacy is owned by, operated by, or otherwise 
                        affiliated with a pharmacy benefit manager and 
                        whether a pharmacy is a retail community 
                        pharmacy or an applicable non-retail pharmacy, 
                        and, in the case of an applicable non-retail 
                        pharmacy, which type of applicable non-retail 
                        pharmacy (as identified pursuant to the type 
                        indicators established by the Secretary under 
                        subsection (k)(12)(B)(ii)) it is.'';
            (3) by adding at the end of paragraph (1) the following:
                    ``(F) Survey reporting.--In order to meet the 
                requirement of section 1902(a)(54), a State shall 
                require that any retail community pharmacy or 
                applicable non-retail pharmacy in the State that 
                receives any payment, reimbursement, administrative 
                fee, discount, or rebate related to the dispensing of 
                covered outpatient drugs to individuals receiving 
                benefits under this title, regardless of whether such 
                payment, reimbursement, administrative fee, discount, 
                or rebate is received from the State or a managed care 
                entity or other specified entity (as such terms are 
                defined in section 1903(m)(9)(D)) directly or from a 
                pharmacy benefit manager or another entity that has a 
                contract with the State or a managed care entity or 
                other specified entity (as so defined), shall respond 
                to surveys conducted under this paragraph.
                    ``(G) Survey information.--Information on national 
                drug acquisition prices obtained under this paragraph 
                shall be made publicly available and shall include at 
                least the following:
                            ``(i) The monthly response rate to the 
                        survey including a list of pharmacies not in 
                        compliance with subparagraph (F).
                            ``(ii) The sampling frame and number of 
                        pharmacies sampled monthly.
                            ``(iii) Information on price concessions to 
                        the pharmacy, including discounts, rebates, and 
                        other price concessions, to the extent that 
                        such information may be publicly released and 
                        has been collected by the Secretary as part of 
                        the survey.
                    ``(H) Penalties.--The Secretary, in consultation 
                with the Office of the Inspector General of the 
                Department of Health and Human Services, shall enforce 
                the provisions of this paragraph with respect to a 
                pharmacy through the establishment of appropriate civil 
                monetary penalties, which may be assessed with respect 
                to each violation or survey non-response, and with 
                respect to each non-compliant pharmacy (including a 
                pharmacy that is part of a chain), until compliance 
                with this paragraph has been completed. The provisions 
                of section 1128A (other than subsections (a) and (b)) 
                shall apply to a civil money penalty under the 
                preceding sentence in the same manner as such 
                provisions apply to a civil money penalty or proceeding 
                under section 1128A(a).
                    ``(I) Limitation on use of applicable non-retail 
                pharmacy pricing information.--No State shall use 
                pricing information reported by applicable non-retail 
                pharmacies under paragraph (1)(A)(ii) to develop or 
                inform reimbursement rates for retail community 
                pharmacies.'';
            (4) in paragraph (2)--
                    (A) in subparagraph (A), by inserting ``, including 
                payment rates under managed care entities or other 
                specified entities (as such terms are defined in 
                section 1903(m)(9)(D)),'' after ``under this title''; 
                and
                    (B) in subparagraph (B), by inserting ``and the 
                basis for such dispensing fees'' before the semicolon;
            (5) by redesignating paragraph (4) as paragraph (5);
            (6) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) Oversight.--
                    ``(A) In general.--The Inspector General of the 
                Department of Health and Human Services shall conduct 
                periodic studies of the survey data reported under this 
                subsection, as appropriate, including with respect to 
                substantial variations in acquisition costs or other 
                applicable costs, as well as with respect to how 
                internal transfer prices and related party transactions 
                may influence the costs reported by pharmacies 
                affiliated with pharmacy benefit managers, wholesalers, 
                distributors, and other entities that acquire covered 
                outpatient drugs relative to costs reported by 
                pharmacies not affiliated with such entities. The 
                Inspector General shall provide periodic updates to 
                Congress on the results of such studies, as 
                appropriate, in a manner that does not disclose trade 
                secrets or other proprietary information.
                    ``(B) Appropriation.--There is appropriated to the 
                Inspector General of the Department of Health and Human 
                Services, out of any money in the Treasury not 
                otherwise appropriated, $5,000,000 for fiscal year 
                2024, to remain available until expended, to carry out 
                this paragraph.''; and
            (7) in paragraph (5), as so redesignated, by inserting ``, 
        and $9,000,000 for fiscal year 2024 and each fiscal year 
        thereafter,'' after ``2010''.
    (b) Definitions.--Section 1927(k) of the Social Security Act (42 
U.S.C. 1396r-8(k)) is amended by adding the following--
            ``(12) Applicable non-retail pharmacy.--
                    ``(A) In general.--The term `applicable non-retail 
                pharmacy' means a pharmacy that is licensed as a 
                pharmacy by the State and that is not a retail 
                community pharmacy, including a pharmacy that dispenses 
                prescription medications to patients primarily through 
                mail and specialty pharmacies. Such term does not 
                include nursing home pharmacies, long-term care 
                facility pharmacies, hospital pharmacies, clinics, 
                charitable or not-for-profit pharmacies, government 
                pharmacies, or low dispensing pharmacies (as defined by 
                the Secretary).
                    ``(B) Identification of applicable non-retail 
                pharmacies.--
                            ``(i) In general.--For purposes of 
                        subsection (f), the Secretary shall, not later 
                        than January 1, 2025, in consultation with 
                        stakeholders as appropriate, issue guidance 
                        specifying pharmacies that meet the definition 
                        of applicable non-retail pharmacies and that 
                        will be subject to the survey requirements 
                        under subsection (f)(1).
                            ``(ii) Inclusion of pharmacy type 
                        indicators.--The guidance promulgated under 
                        clause (i) shall include pharmacy type 
                        indicators to distinguish between different 
                        types of applicable non-retail pharmacies, such 
                        as pharmacies that dispense prescriptions 
                        primarily through the mail and pharmacies that 
                        dispense prescriptions that require special 
                        handling or distribution. An applicable non-
                        retail pharmacy may be identified through 
                        multiple pharmacy type indicators.
            ``(13) Pharmacy benefit manager.--The term `pharmacy 
        benefit manager' means any person or entity that, either 
        directly or through an intermediary, acts as a price negotiator 
        or group purchaser on behalf of a State, managed care entity or 
        other specified entity (as such terms are defined in section 
        1903(m)(9)(D)), or manages the prescription drug benefits 
        provided by such State, managed care entity, or other specified 
        entity, including the processing and payment of claims for 
        prescription drugs, the performance of drug utilization review, 
        the processing of drug prior authorization requests, the 
        managing of appeals or grievances related to the prescription 
        drug benefits, contracting with pharmacies, controlling the 
        cost of covered outpatient drugs, or the provision of services 
        related thereto. Such term includes any person or entity that 
        carries out 1 or more of the activities described in the 
        preceding sentence, irrespective of whether such person or 
        entity calls itself a `pharmacy benefit manager'.''.
    (c) Effective Date.--The amendments made by this section take 
effect on the first day of the first quarter that begins on or after 
the date that is 18 months after the date of enactment of this Act.

SEC. 203. PROTECTING SENIORS FROM EXCESSIVE COST-SHARING FOR CERTAIN 
              MEDICINES.

    Section 1860D-2 of the Social Security Act (42 U.S.C. 1395w-102) is 
amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)(A), in the matter preceding 
                clause (i), by striking ``and (9)'' and inserting ``, 
                (9), (10), and (11)''; and
                    (B) by adding at the end the following new 
                paragraphs:
            ``(10) Tying cost-sharing to net price for certain 
        medications.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2028, for costs above the annual 
                deductible specified in paragraph (1) and below the 
                annual out-of-pocket threshold specified in paragraph 
                (4), any coinsurance amount for a discount-eligible 
                drug that is included on the plan's formulary and 
                subject to coinsurance rather than a copayment shall be 
                calculated based on the net price of such discount-
                eligible drug.
                    ``(B) Reporting to the secretary.--For plan years 
                beginning on or after January 1, 2028, a PDP sponsor of 
                a prescription drug plan and an MA organization 
                offering an MA-PD plan shall annually submit to the 
                Secretary, in a form and manner determined appropriate 
                by the Secretary--
                            ``(i) approximate price concessions and net 
                        prices for each discount-eligible drug; and
                            ``(ii) a written explanation of the 
                        methodology used to calculate such approximate 
                        price concessions and net prices.
                    ``(C) Requirements for approximate price 
                concessions.--
                            ``(i) In general.--Approximate price 
                        concessions submitted under subparagraph (B) 
                        shall comply with--
                                    ``(I) the drug-specific threshold 
                                under clause (ii) for the applicable 
                                plan year; and
                                    ``(II) the aggregate threshold 
                                under clause (iii) for the applicable 
                                plan year.
                            ``(ii) Thresholds.--
                                    ``(I) Plan years 2028 through 
                                2032.--For plan years 2028 through 
                                2032--
                                            ``(aa) the drug-specific 
                                        threshold is 20 percent; and
                                            ``(bb) the aggregate 
                                        threshold is 15 percent.
                                    ``(II) Subsequent plan years.--
                                            ``(aa) In general.--For 
                                        plan years beginning with 2033, 
                                        the Secretary may, as 
                                        determined appropriate by the 
                                        Secretary, adjust the drug-
                                        specific and aggregate 
                                        thresholds under this clause.
                                            ``(bb) Considerations.--In 
                                        making any such adjustments, 
                                        the Secretary may consider 
                                        historical variations in 
                                        expected and actual 
                                        manufacturer price concessions 
                                        for covered part D drugs, 
                                        factors that may result in 
                                        manufacturer price concession 
                                        uncertainty or variation in a 
                                        given plan year, PDP sponsor 
                                        and MA organization behavioral 
                                        responses, effects of precise 
                                        manufacturer price concession 
                                        disclosures, beneficiary out-
                                        of-pocket costs, expenditures 
                                        under this part, and other 
                                        factors determined appropriate 
                                        by the Secretary.
                                            ``(cc) Requirements.--In 
                                        making any such adjustments, 
                                        the Secretary shall ensure that 
                                        the aggregate threshold for an 
                                        applicable plan year is lower 
                                        than the drug-specific 
                                        threshold for such applicable 
                                        plan year.
                                            ``(dd) Publication.--The 
                                        Secretary shall publish any 
                                        adjustments to the drug-
                                        specific and aggregate 
                                        thresholds under this clause no 
                                        later than the first Monday of 
                                        April of the year before the 
                                        start of the plan year for 
                                        which such adjusted thresholds 
                                        are applicable.
                    ``(D) Publication of discount-eligible drugs.--Not 
                later than 15 months before the start of each plan year 
                (beginning with plan year 2028), the Secretary shall 
                publish on a publicly available website a list of the 
                discount-eligible drugs that apply with respect to such 
                plan year (as determined by the Secretary under 
                subparagraph (F)(iv)).
                    ``(E) Enforcement.--
                            ``(i) Monitoring compliance.--The 
                        Secretary, in consultation with the Office of 
                        the Inspector General, shall conduct periodic 
                        audits of prescription drug plans and MA-PD 
                        plans to monitor compliance with the 
                        requirements under this paragraph. All 
                        information reported by a PDP sponsor or MA 
                        organization under this paragraph may be 
                        subject to audit by the Secretary and the 
                        Office of the Inspector General.
                            ``(ii) Penalties.--
                                    ``(I) In general.--A PDP sponsor or 
                                an MA organization that violates the 
                                requirements under this paragraph may 
                                be subject to civil monetary penalties, 
                                consistent with sections 1857(g) and 
                                1860D-12(b)(3)(E), as determined 
                                appropriate by the Secretary.
                                    ``(II) Application.--The provisions 
                                of section 1128A (other than 
                                subsections (a) and (b)) shall apply to 
                                a civil monetary penalty under this 
                                clause in the same manner as such 
                                provisions apply to a penalty or 
                                proceeding under section 1128A(a).
                    ``(F) Definitions.--In this paragraph:
                            ``(i) Actual price concessions.--The term 
                        `actual price concessions' means, with respect 
                        to a covered part D drug, the amount of 
                        manufacturer price concessions that the PDP 
                        sponsor or MA organization reports for such 
                        drug in the Detailed DIR Report (or successor 
                        report) for the applicable plan year.
                            ``(ii) Aggregate threshold.--The term 
                        `aggregate threshold' means the maximum 
                        percentage by which the total approximate price 
                        concessions for all discount-eligible drugs may 
                        vary from the total actual manufacturer price 
                        concessions for all such discount-eligible 
                        drugs as reported in the Detailed DIR Report 
                        (or successor report) for the applicable plan 
                        year.
                            ``(iii) Approximate price concessions.--The 
                        term `approximate price concessions' means, 
                        with respect to a covered part D drug, the 
                        amount of price concessions from manufacturers 
                        that the PDP sponsor or MA organization 
                        estimates it will receive with respect to an 
                        applicable plan year, subject to the thresholds 
                        established under subparagraph (C)(ii), and 
                        reflected in the net price.
                            ``(iv) Discount-eligible drug.--
                                    ``(I) In general.--The term 
                                `discount-eligible drug' means a 
                                covered part D drug (other than a 
                                covered part D drug described in 
                                paragraph (8) or (9))--
                                            ``(aa) that is in an 
                                        applicable category or class 
                                        described in subclause (II); 
                                        and
                                            ``(bb) for which the 
                                        aggregate manufacturer price 
                                        concessions received by PDP 
                                        sponsors and MA organizations 
                                        (or pharmacy benefit managers 
                                        acting on behalf of such 
                                        sponsors or organizations) for 
                                        such drug are equal to or 
                                        exceed 50 percent of aggregate 
                                        gross covered prescription drug 
                                        costs for such drug in the most 
                                        recent plan year for which data 
                                        is available, as determined by 
                                        the Secretary based on previous 
                                        submissions of Detailed DIR 
                                        Reports (or successor reports) 
                                        or other relevant reporting 
                                        from PDP sponsors or MA 
                                        organizations.
                                    ``(II) Applicable category or 
                                class.--The applicable categories and 
                                classes described in this subclause are 
                                the following, as specified by the 
                                United States Pharmacopeia:
                                            ``(aa) Anti-inflammatories 
                                        (Inhaled Corticosteroids).
                                            ``(bb) Bronchodilators, 
                                        Anticholinergic.
                                            ``(cc) Bronchodilators, 
                                        Sympathomimetic.
                                            ``(dd) Respiratory tract 
                                        agents.
                                            ``(ee) Anticoagulants.
                                            ``(ff) Cardiovascular 
                                        agents.
                            ``(v) Drug-specific threshold.--The term 
                        `drug-specific threshold' means the maximum 
                        percentage by which approximate price 
                        concessions with respect to a discount-eligible 
                        drug may vary from the actual manufacturer 
                        price concessions for such drug, as reported in 
                        the Detailed DIR Report (or successor report) 
                        for the applicable plan year.
                            ``(vi) Net price.--The term `net price' 
                        means, with respect to a covered part D drug, 
                        the negotiated price of such drug, net of all 
                        approximate price concessions (estimated on an 
                        average per-unit basis, as needed) not already 
                        reflected in the negotiated price for the 
                        applicable plan year.
                            ``(vii) Manufacturer price concessions.--
                        The term `manufacturer price concessions' 
                        means, with respect to a covered part D drug, 
                        rebates that the PDP sponsor or MA organization 
                        receives from manufacturers.
                    ``(G) Nonapplication of paperwork reduction act.--
                Chapter 35 of title 44, United States Code, shall not 
                apply to any data collection undertaken by the 
                Secretary under this paragraph.
            ``(11) Limiting cost-sharing to net price.--
                    ``(A) In general.--For plan years beginning on or 
                after January 1, 2028, the cost-sharing (for costs 
                above the annual deductible specified in paragraph (1)) 
                for a covered part D drug (other than a covered part D 
                drug described in paragraph (8) or (9)) shall not 
                exceed the negotiated price for such covered part D 
                drug net of all price concessions (as defined in 
                paragraph (10)(F)(v)), as reported in the Detailed DIR 
                Report (or successor report) for the applicable plan 
                year.
                    ``(B) Enforcement.--
                            ``(i) Monitoring compliance.--The Secretary 
                        shall monitor compliance with the requirements 
                        under subparagraph (A) on an ongoing basis, 
                        including through periodic audits.
                            ``(ii) Retroactive penalties.--
                                    ``(I) In general.--A PDP sponsor or 
                                an MA organization that violates the 
                                requirements under subparagraph (A) may 
                                be subject to civil monetary penalties, 
                                consistent with sections 1857(g) and 
                                1860D-12(b)(3)(E), as determined 
                                appropriate by the Secretary. The 
                                Secretary may impose such penalties 
                                retroactively upon review of the 
                                Detailed DIR Report (or any successor 
                                report) with respect to a given plan 
                                year.
                                    ``(II) Application.--The provisions 
                                of section 1128A (other than 
                                subsections (a) and (b)) shall apply to 
                                a civil monetary penalty under this 
                                clause in the same manner as such 
                                provisions apply to a penalty or 
                                proceeding under section 1128A(a).
            ``(12) GAO study and report on implementation and effects 
        of cost-sharing relief provisions.--
                    ``(A) Study.--The Comptroller General of the United 
                States (in this paragraph referred to as the 
                `Comptroller General') shall conduct a study on certain 
                effects of the implementation of the requirements 
                specified under the provisions of paragraphs (10) and 
                (11).
                    ``(B) Report.--Once the data and information needed 
                to conduct the study described in subparagraph (A) has 
                become available and the Comptroller General has had 
                sufficient opportunity to review and analyze such data 
                and information, the Comptroller General shall develop 
                and publish a report on the findings of such study, 
                including with respect to the following:
                            ``(i) Effects on enrollee cost-sharing, 
                        utilization and adherence, formulary coverage 
                        and placement, and utilization management with 
                        respect to affected covered part D drugs 
                        (discount-eligible drugs and covered part D 
                        drugs for which, prior to implementation of 
                        such provisions, cost-sharing exceeded net 
                        price for some beneficiaries).
                            ``(ii) Changes to pharmacy reimbursement 
                        methodologies and levels, if any, with respect 
                        to discount-eligible drugs.
                            ``(iii) Changes in manufacturer rebating 
                        levels (relative to gross costs) for discount-
                        eligible drugs.
                            ``(iv) Other behavioral responses by PDP 
                        sponsors, enrollees, manufacturers, pharmacies, 
                        or other entities related to the implementation 
                        of such provisions.
                            ``(v) Effects of such provisions on 
                        enrollee premiums and Federal outlays.
                            ``(vi) Other issues determined appropriate 
                        by the Comptroller General.
                    ``(C) Subsequent reports.--The Comptroller General 
                may, as determined appropriate, conduct subsequent 
                studies and produce subsequent reports with respect to 
                the ongoing implementation and effects of the 
                provisions of paragraphs (10) and (11).''; and
            (2) in subsection (c), by adding at the end the following 
        new paragraphs:
            ``(7) Tying cost-sharing to net price for certain drugs.--
        The coverage is provided in accordance with subsection (b)(10).
            ``(8) Limiting cost-sharing to net price.--The coverage is 
        provided in accordance with subsection (b)(11).''.

                TITLE III--MEDICAID EXPIRING PROVISIONS

SEC. 301. DELAYING CERTAIN DISPROPORTIONATE SHARE HOSPITAL PAYMENT 
              REDUCTIONS UNDER THE MEDICAID PROGRAM.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)), as amended by section 2341 of title III of division B of 
the Continuing Appropriations Act, 2024 and Other Extensions Act 
(Public Law 118-15), is further amended--
            (1) in clause (i)--
                    (A) in the matter preceding subclause (I), by 
                striking ``For the period beginning'' and all that 
                follows through ``2027'' and inserting ``For each of 
                fiscal years 2026 and 2027''; and
                    (B) in subclauses (I) and (II), by striking ``or 
                period'' each place it appears; and
            (2) in clause (ii), by striking ``for the period 
        beginning'' and all that follows through ``2027'' and inserting 
        ``for each of fiscal years 2026 and 2027''.

SEC. 302. EXTENSION OF STATE OPTION TO PROVIDE MEDICAL ASSISTANCE FOR 
              CERTAIN INDIVIDUALS WHO ARE PATIENTS IN CERTAIN 
              INSTITUTIONS FOR MENTAL DISEASES.

    (a) Making Permanent State Plan Amendment Option To Provide Medical 
Assistance for Certain Individuals Who Are Patients in Certain 
Institutions for Mental Diseases.--Section 1915(l)(1) of the Social 
Security Act (42 U.S.C. 1396n(l)(1)) is amended by striking ``With 
respect to calendar quarters beginning during the period beginning 
October 1, 2019, and ending September 30, 2023,'' and inserting ``With 
respect to calendar quarters beginning on or after October 1, 2019,''.
    (b) Maintenance of Effort Revision.--Section 1915(l)(3) of the 
Social Security Act (42 U.S.C. 1396n(l)(3)) is amended--
            (1) in subparagraph (A)--
                    (A) in the matter preceding clause (i), by striking 
                ``other than under this title''; and
                    (B) in clause (i), by striking ``or, if higher,'' 
                and all that follows through ``in accordance with this 
                subsection''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Application of maintenance of effort 
                requirements to certain states.--In the case of a State 
                with a State plan amendment in effect as of September 
                30, 2023, for the 1-year period beginning on the date 
                of enactment of this subparagraph, the provisions of 
                subparagraph (A) shall be applied as if the amendments 
                to that subparagraph made by the Better Mental Health 
                Care, Lower-Cost Drugs, and Extenders Act of 2023 had 
                never been made.''.
    (c) Additional Requirements.--
            (1) In general.--Section 1915(l)(4) of the Social Security 
        Act (42 U.S.C. 1396n(l)(4)) is amended--
                    (A) in subparagraph (A), by striking ``through 
                (D)'' and inserting ``through (F)'';
                    (B) in subparagraph (D), by adding at and below 
                clause (ii)(II), the following flush sentence:
                ``With respect to calendar quarters beginning on or 
                after October 1, 2025, the State shall have in place 
                evidence-based, substance use disorder-specific 
                individual placement criteria and utilization 
                management approaches to ensure placement of an 
                eligible individual in an appropriate level of care 
                and, prior to the approval of a State plan amendment 
                for which approval is sought on or after such date, 
                shall notify the Secretary of how the State will ensure 
                that the requirements of clauses (i) and (ii) will be 
                met.''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(E) Review process.--With respect to calendar 
                quarters beginning on or after October 1, 2025, the 
                State shall have in place a process to review the 
                compliance of eligible institutions for mental diseases 
                with nationally recognized, evidence-based, substance 
                use disorder-specific program standards specified by 
                the State.''.
            (2) One-time assessment.--Section 1915(l)(4) of the Social 
        Security Act (42 U.S.C. 1396n(l)(4)), as amended by paragraph 
        (1), is further amended by adding at the end the following new 
        subparagraph:
                    ``(F) Assessment.--
                            ``(i) In general.--The State shall, not 
                        later than 12 months after the approval of a 
                        State plan amendment described in this 
                        subsection (or, in the case such State has such 
                        an amendment approved as of September 30, 2023, 
                        not later than 12 months after the date of 
                        enactment of this subparagraph), commence an 
                        assessment of--
                                    ``(I) the availability for 
                                individuals enrolled under a State plan 
                                under this title (or waiver of such 
                                plan) of treatment in--
                                            ``(aa) each level of care 
                                        described in clause (i) of 
                                        subparagraph (C); and
                                            ``(bb) each level of care 
                                        described in clause (ii) of 
                                        subparagraph (C) at which the 
                                        State provides medical 
                                        assistance; and
                                    ``(II) the availability of 
                                medication-assisted treatment and 
                                medically supervised withdrawal 
                                management services for such 
                                individuals.
                            ``(ii) Required completion.--The State 
                        shall complete the assessment described in 
                        clause (i) not later than 12 months after the 
                        date the State commences such assessment.''.
            (3) Clarification of levels of care.--Section 1915(l)(7)(A) 
        of the Social Security Act (42 U.S.C. 1396n(l)(7)(A)) is 
        amended by inserting ``(or any successor publication)'' before 
        the period.

  TITLE IV--MEDICARE EXPIRING PROVISIONS AND PROVIDER PAYMENT CHANGES

SEC. 401. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, 
              AND SELECTION.

    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended--
            (1) in the first sentence--
                    (A) by striking ``and $20,000,000'' and inserting 
                ``$20,000,000''; and
                    (B) by inserting the following before the period at 
                the end: ``, and $20,000,000 for fiscal year 2024''; 
                and
            (2) in the third sentence, by striking ``and 2023'' and 
        inserting ``2023, and 2024''.

SEC. 402. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME 
              PROGRAMS.

    (a) State Health Insurance Assistance Programs.--Subsection 
(a)(1)(B) of section 119 of the Medicare Improvements for Patients and 
Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended by section 
3306 of the Patient Protection and Affordable Care Act (Public Law 111-
148), section 610 of the American Taxpayer Relief Act of 2012 (Public 
Law 112-240), section 1110 of the Pathway for SGR Reform Act of 2013 
(Public Law 113-67), section 110 of the Protecting Access to Medicare 
Act of 2014 (Public Law 113-93), section 208 of the Medicare Access and 
CHIP Reauthorization Act of 2015 (Public Law 114-10), section 50207 of 
division E of the Bipartisan Budget Act of 2018 (Public Law 115-123), 
section 1402 of division B of the Continuing Appropriations Act, 2020, 
and Health Extenders Act of 2019 (Public Law 116-59), section 1402 of 
division B of the Further Continuing Appropriations Act, 2020, and 
Further Health Extenders Act of 2019 (Public Law 116-69), section 103 
of division N of the Further Consolidated Appropriations Act, 2020 
(Public Law 116-94), section 3803 of the CARES Act (Public Law 116-
136), section 2203 of the Continuing Appropriations Act, 2021 and Other 
Extensions Act (Public Law 116-159), section 1102 of the Further 
Continuing Appropriations Act, 2021, and Other Extensions Act (Public 
Law 116-215), and section 103 of division CC of the Consolidated 
Appropriations Act, 2021 (Public Law 116-260), is amended--
            (1) in the matter preceding clause (i), by striking 
        ``Centers for Medicare & Medicaid Services Program Management 
        Account'' and inserting ``Administration for Community 
        Living'';
            (2) in clause (xii), by striking ``and'' at the end;
            (3) in clause (xiii), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (xiii) the following new 
        clause:
                            ``(xiv) for fiscal year 2024, 
                        $15,000,000.''.
    (b) Area Agencies on Aging.--Subsection (b)(1)(B) of such section 
119, as so amended, is amended--
            (1) in clause (xii), by striking ``and'' at the end;
            (2) in clause (xiii), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after clause (xiii) the following new 
        clause:
                            ``(xiv) for fiscal year 2024, 
                        $15,000,000.''.
    (c) Aging and Disability Resource Centers.--Subsection (c)(1)(B) of 
such section 119, as so amended, is amended--
            (1) in clause (xii), by striking ``and'' at the end;
            (2) in clause (xiii), by striking the comma at the end and 
        inserting ``; and''; and
            (3) by inserting after clause (xiii) the following new 
        clause:
                            ``(xiv) for fiscal year 2024, 
                        $5,000,000.''.
    (d) Coordination of Efforts to Inform Older Americans About 
Benefits Available Under Federal and State Programs.--Subsection (d)(2) 
of such section 119, as so amended, is amended--
            (1) in clause (xii), by striking ``and'' at the end;
            (2) in clause (xiii), by striking the period at the end and 
        inserting ``; and''; and
            (3) by inserting after clause (xiii) the following new 
        clause:
                            ``(xiv) for fiscal year 2024, 
                        $15,000,000.''.

SEC. 403. EXTENSION OF THE WORK GEOGRAPHIC INDEX FLOOR UNDER THE 
              MEDICARE PROGRAM.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 1, 2024'' and inserting 
``January 1, 2025''.

SEC. 404. EXTENDING INCENTIVE PAYMENTS FOR PARTICIPATION IN ELIGIBLE 
              ALTERNATIVE PAYMENT MODELS.

    (a) In General.--Section 1833(z) of the Social Security Act (42 
U.S.C. 1395l(z)) is amended--
            (1) in paragraph (1)(A)--
                    (A) by striking ``with 2025'' and inserting ``with 
                2026''; and
                    (B) by inserting ``, or, with respect to 2026, 1.75 
                percent'' after ``3.5 percent''.
            (2) in paragraph (2)--
                    (A) in subparagraph (B)--
                            (i) in the header, by striking ``2025'' and 
                        inserting ``2026''; and
                            (ii) in the matter preceding clause (i), by 
                        striking ``2025'' and inserting ``2026'';
                    (B) in subparagraph (C)--
                            (i) in the header, by striking ``2026'' and 
                        inserting ``2027''; and
                            (ii) in the matter preceding clause (i), by 
                        striking ``2026'' and inserting ``2027''; and
                    (C) in subparagraph (D), by striking ``and 2025'' 
                and inserting ``2025, and 2026''; and
            (3) in paragraph (4)(B), by inserting ``, or, with respect 
        to 2026, 1.75 percent'' after ``3.5 percent''.
    (b) Conforming Amendments.--Section 1848(q)(1)(C)(iii) of the 
Social Security Act (42 U.S.C. 1395w-4(q)(1)(C)(iii)) is amended--
            (1) in subclause (II), by striking ``2025'' and inserting 
        ``2026''; and
            (2) in subclause (III), by striking ``2026'' and inserting 
        ``2027''.

SEC. 405. PAYMENT RATES FOR DURABLE MEDICAL EQUIPMENT UNDER THE 
              MEDICARE PROGRAM.

    (a) Areas Other Than Rural and Noncontiguous Areas.--The Secretary 
shall implement section 414.210(g)(9)(v) of title 42, Code of Federal 
Regulations (or any successor regulation), to apply the transition rule 
described in the first sentence of such section to all applicable items 
and services furnished in areas other than rural or noncontiguous areas 
(as such terms are defined for purposes of such section) through 
December 31, 2024.
    (b) All Areas.--The Secretary shall not implement section 
414.210(g)(9)(vi) of title 42, Code of Federal Regulations (or any 
successor regulation) until January 1, 2025.
    (c) Implementation.--Notwithstanding any other provision of law, 
the Secretary may implement the provisions of this section by program 
instruction or otherwise.

SEC. 406. EXTENDING THE INDEPENDENCE AT HOME MEDICAL PRACTICE 
              DEMONSTRATION PROGRAM UNDER THE MEDICARE PROGRAM.

    (a) In General.--Section 1866E of the Social Security Act (42 
U.S.C. 1395cc-5) is amended--
            (1) in subsection (e)--
                    (A) in paragraph (1), by striking ``10-year'' and 
                inserting ``12-year''; and
                    (B) in paragraph (5)--
                            (i) in the second sentence, by striking 
                        ``tenth'' and inserting ``twelfth''; and
                            (ii) in the third sentence, by striking 
                        ``tenth'' and inserting ``twelfth''; and
            (2) in subsection (h), by striking ``and $9,000,000 for 
        fiscal year 2021'' and inserting ``, $9,000,000 for fiscal year 
        2021, and $3,000,000 for fiscal year 2024''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect as if included in the enactment of Public Law 111-148.

SEC. 407. INCREASE IN SUPPORT FOR PHYSICIANS AND OTHER PROFESSIONALS IN 
              ADJUSTING TO MEDICARE PAYMENT CHANGES.

    Section 1848(t)(1)(D) of the Social Security Act (42 U.S.C. 1395w-
4(t)(1)(D)) is amended by striking ``1.25 percent'' and inserting ``2.5 
percent''.

SEC. 408. REVISED PHASE-IN OF MEDICARE CLINICAL LABORATORY TEST PAYMENT 
              CHANGES.

    (a) Revised Phase-in of Reductions From Private Payor Rate 
Implementation.--Section 1834A(b)(3) of the Social Security Act (42 
U.S.C. 1395m-1(b)(3)) is amended--
            (1) in subparagraph (A), by striking ``through 2026'' and 
        inserting ``through 2027''; and
            (2) in subparagraph (B)--
                    (A) in clause (ii), by striking ``through 2023'' 
                and inserting ``through 2024''; and
                    (B) in clause (iii), by striking ``2024 through 
                2026'' and inserting ``2025 through 2027''.
    (b) Revised Reporting Period for Reporting of Private Sector 
Payment Rates for Establishment of Medicare Payment Rates.--Section 
1834A(a)(1)(B) of the Social Security Act (42 U.S.C. 1395m-1(a)(1)(B)) 
is amended--
            (1) in clause (i), by striking ``December 31, 2023'' and 
        inserting ``December 31, 2024''; and
            (2) in clause (ii)--
                    (A) by striking ``January 1, 2024'' and inserting 
                ``January 1, 2025''; and
                    (B) by striking ``March 31, 2024'' and inserting 
                ``March 31, 2025''.

SEC. 409. EXTENSION OF ADJUSTMENT TO CALCULATION OF HOSPICE CAP AMOUNT 
              UNDER MEDICARE.

    Section 1814(i)(2)(B) of the Social Security Act (42 U.S.C. 
1395f(i)(2)(B)) is amended--
            (1) in clause (ii), by striking ``2032'' and inserting 
        ``2033''; and
            (2) in clause (iii), by striking ``2032'' and inserting 
        ``2033''.

                            TITLE V--OFFSETS

SEC. 501. MEDICAID IMPROVEMENT FUND.

    Section 1941(b)(3)(A) of the Social Security Act (42 U.S.C. 1396w-
1(b)(3)(A)), as amended by section 2342 of the Continuing 
Appropriations Act, 2024 and Other Extensions Act (Public Law 118-15), 
is amended by striking ``$6,357,117,810'' and inserting 
``$561,000,000''.

SEC. 502. MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``$180,000,000'' and inserting 
``756,000,000''.
                                                       Calendar No. 265

118th CONGRESS

  1st Session

                                S. 3430

                          [Report No. 118-121]

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                                 A BILL

To amend titles XVIII and XIX of the Social Security Act to expand the 
  mental health care workforce and services, reduce prescription drug 
   costs, and extend certain expiring provisions under Medicare and 
                   Medicaid, and for other purposes.

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                            December 7, 2023

                 Read twice and placed on the calendar