Public Law 108-11changedby H.R. 7148 Sec. 7034(i)
The bill says: in the matter preceding the first proviso, by striking "September 30, 2030" and inserting "September 30, 2031"; and
Bill text
Public Law 108-11changedby H.R. 7148 Sec. 7034(i)
The bill says: in the second proviso, by striking "September 30, 2030" and inserting "September 30, 2031".
Bill text
Public Law 101-167(b)(3)changedby H.R. 7148 Sec. 7034(i)
The bill says: in subsection (b)(3), by striking "and 2025" and inserting "2025, and 2026"; and
Bill text
Public Law 101-167(e)changedby H.R. 7148 Sec. 7034(i)
The bill says: in subsection (e), by striking "2025" each place it appears and inserting "2026"; and
Bill text
Public Law 101-167changedby H.R. 7148 Sec. 7034(i)
The bill says: in section 599E(b)(2) (8 U.S.C. 1255 note), by striking "2025" and inserting "2026".
Bill text
Public Law 118-159changedby H.R. 7148 Sec. 7034(k)
The bill says: in section 5101(6) (22 U.S.C. 10601(6)), by striking "International Conservation" and inserting "Natural Security and Counterterrorism"; and
Bill text
Public Law 118-159changedby H.R. 7148 Sec. 7034(k)
The bill says: in the section heading, by striking "international conservation" and inserting "natural security and counterterrorism"; and
Bill text
Public Law 118-159(a)(1)changedby H.R. 7148 Sec. 7034(k)
The bill says: in subsection (a)(1), by striking "International Conservation" and inserting "Natural Security and Counterterrorism".
Bill text
22 U.S.C. 2321h(b)(2)(A)changedby H.R. 7148 Sec. 7035(b)
The bill says: Section 514(b)(2)(A) of the Foreign Assistance Act of 1961 (22 U.S.C. 2321h(b)(2)(A)) is amended by striking "2027" and inserting "2028".
Bill text · Current law (22 U.S.C. 2321h)
22 U.S.C. 284added 33by H.R. 7148 Sec. 7070(b)
33 Twenty-first replenishment.—(a) In general.— The United States Governor of the International Development Association may contribute on behalf of the United States $3,198,552,000 to the twenty-first replenishment of the resources of the Association, subject to obtaining the necessary appropriations.(b) Authorization of appropriations.— In order to pay for the United States contribution provided for in subsection (a), there are authorized to be appropriated, without fiscal year limitation, $3,198,552,000 for payment by the Secretary of the Treasury.
The bill says: The International Development Association Act (22 U.S.C. 284 et seq.) is amended by adding at the end the following:
Bill text · Current law (22 U.S.C. 284)
22 U.S.C. 262oadded 1506by H.R. 7148 Sec. 7070(b)
1506 Multilateral development bank support for nuclear energy.— The Secretary of the Treasury shall instruct the United States Executive Director at the International Bank for Reconstruction and Development, the European Bank for Reconstruction and Development, and, as the Secretary finds appropriate, any other multilateral development bank (as defined in section 1307(g)) to use the voice, vote, and influence of the United States to advocate for—(1) the removal of prohibitions at the respective bank against financial and technical assistance for the generation, transmission, and distribution of nuclear energy, to the extent that the prohibitions apply to nuclear technologies, including small modular reactors, that meet or exceed the quality and safety standards of technologies produced by the United States or a member country of the Organisation for Economic Co-operation and Development; and(2) increased internal capacity-building at the respective bank for the purpose of assessing—(A) the potential role of nuclear energy, including small modular reactors, in the energy systems of client countries; and(B) the delivery of financial and technical assistance described in paragraph (1) to the countries.
The bill says: Title XV of the International Financial Institutions Act (22 U.S.C. 262o et seq.) is amended by adding at the end the following:
Bill text · Current law (22 U.S.C. 262o)
22 U.S.C. 285added 38by H.R. 7148 Sec. 7070(c)
38 Asian development fund thirteenth replenishment.—(a) In general.— The United States Governor of the Fund may contribute on behalf of the United States $174,440,000 to the thirteenth replenishment of the resources of the Fund, subject to obtaining the necessary appropriations.(b) Authorization of appropriations.— In order to pay for the United States contribution provided for in subsection (a), there are authorized to be appropriated, without fiscal year limitation, $174,440,000 for payment by the Secretary of the Treasury.
The bill says: The Asian Development Bank Act (22 U.S.C. 285 et seq.) is amended by adding at the end the following:
Bill text · Current law (22 U.S.C. 285)
22 U.S.C. 290iadded 1346by H.R. 7148 Sec. 7070(d)
1346 General callable capital increase.—(a) Subscription authorized.—(1) In general.— The United States Governor of the Bank may subscribe on behalf of the United States to 800,000 additional shares of the capital stock of the Bank.(2) Limitation.— Any subscription by the United States to the capital stock of the Bank shall be effective only to such extent and in such amounts as are provided in advance in appropriations Acts.(b) Authorization of appropriations.— For the increase in the United States subscription to the Bank under subsection (a), there is authorized to be appropriated, without fiscal year limitation, $7,800,000,000, for payment by the Secretary of the Treasury for callable shares of the Bank.
The bill says: The African Development Bank Act (22 U.S.C. 290i et seq.) is amended by inserting at the end the following:
Bill text · Current law (22 U.S.C. 290i)
Public Law 119-37changedby H.R. 7148 Sec. 101
The bill says: The Continuing Appropriations Act, 2026 (division A of Public Law 119–37) is amended by striking the date specified in section 106(3) and inserting "February 13, 2026".
Bill text
Public Law 117-25(b)changedby H.R. 7148 Sec. 5002
The bill says: Section 1(b) of Public Law 117–25 (135 Stat. 297; 136 Stat. 2133; 136 Stat. 5984; 139 Stat. 46) is amended in each of paragraphs (3) and (4) by striking "September 30, 2025" and inserting "September 30, 2026".
Bill text
42 U.S.C. 4016(a)changedby H.R. 7148 Sec. 5004(a)
The bill says: Section 1309(a) of the National Flood Insurance Act of 1968 (42 U.S.C. 4016(a)) is amended, in the first sentence, by striking "September 30, 2023" and inserting "September 30, 2026".
Bill text
42 U.S.C. 4026changedby H.R. 7148 Sec. 5004(b)
The bill says: Section 1319 of the National Flood Insurance Act of 1968 (42 U.S.C. 4026) is amended by striking "September 30, 2023" and inserting "September 30, 2026".
Bill text
Public Law 116-6(e)changedby H.R. 7148 Sec. 5005
The bill says: Section 225(e) of the Department of Homeland Security Appropriations Act, 2019 (division A of Public Law 116–6; 49 U.S.C. 44901 note) is amended by striking "2025" and inserting "2026".
Bill text
6 U.S.C. 1525(a)changedby H.R. 7148 Sec. 5007
The bill says: Section 227(a) of the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. 1525(a)) is amended by striking "September 30, 2025" and inserting "September 30, 2026".
Bill text · Current law (6 U.S.C. 1525)
6 U.S.C. 1510(a)changedby H.R. 7148 Sec. 5008
The bill says: Section 111(a) of the Cybersecurity Information Sharing Act of 2015 (6 U.S.C. 1510(a)) is amended by striking "September 30, 2025" and inserting "September 30, 2026".
Bill text · Current law (6 U.S.C. 1510)
6 U.S.C. 665g(s)(1)changedby H.R. 7148 Sec. 5009
The bill says: Section 2220A(s)(1) of the Homeland Security Act of 2002 (6 U.S.C. 665g(s)(1)) is amended by striking "September 30, 2025" and inserting "September 30, 2026".
Bill text · Current law (6 U.S.C. 665g)
40 U.S.C. 11301(f)(1)changedby H.R. 7148 Sec. 5010
The bill says: Section 1078(f)(1) of the National Defense Authorization Act for Fiscal Year 2018 (40 U.S.C. 11301 note) is amended by striking "On and after the date that is 2 years after the date on which the Comptroller General of the United States issues the third report required under subsection (b)(7)(B)" and inserting "After September 30, 2026".
Bill text · Current law (40 U.S.C. 11301)
18 U.S.C. 3014(a)changedby H.R. 7148 Sec. 5012
The bill says: Section 3014(a) of title 18, United States Code, is amended by striking "and ending on September 30, 2025".
Bill text · Current law (18 U.S.C. 3014)
Public Law 119-37rewrittenby H.R. 7148 Sec. 5018(a)
The bill says: Section 126 of the Continuing Appropriations Act, 2026 (division A of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026 (Public Law 119–37; 139 Stat. 502)) is amended to read as follows:
Bill text
19 U.S.C. 2466bchangedby H.R. 7148 Sec. 5019(a)
The bill says: Section 506B of the Trade Act of 1974 (19 U.S.C. 2466b) is amended by striking "September 30, 2025" and inserting "December 31, 2026".
Bill text · Current law (19 U.S.C. 2466b)
19 U.S.C. 3721(g)changedby H.R. 7148 Sec. 5019(a)
The bill says: Section 112(g) of the African Growth and Opportunity Act (19 U.S.C. 3721(g)) is amended by striking "September 30, 2025" and inserting "December 31, 2026".
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 3721(b)(3)(A)(i)changedby H.R. 7148 Sec. 5019(a)
The bill says: in clause (i), by striking "21 succeeding" and inserting "23 succeeding"; and
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 3721(b)(3)(A)(ii)(II)changedby H.R. 7148 Sec. 5019(a)
The bill says: in clause (ii)(II), by striking "September 30, 2025" and inserting "December 31, 2026".
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 3721(c)(1)changedby H.R. 7148 Sec. 5019(a)
The bill says: in the paragraph heading, by striking "September 30, 2025" and inserting "December 31, 2026";
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 3721(c)(1)(A)changedby H.R. 7148 Sec. 5019(a)
The bill says: in subparagraph (A), by striking "September 30, 2025" and inserting "December 31, 2026"; and
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 3721(c)(1)(B)(ii)changedby H.R. 7148 Sec. 5019(a)
The bill says: in subparagraph (B)(ii), by striking "September 30, 2025" and inserting "December 31, 2026".
Bill text · Current law (19 U.S.C. 3721)
19 U.S.C. 58c(j)(3)(A)changedby H.R. 7148 Sec. 5019(b)
The bill says: in subparagraph (A), by striking "September 30, 2031" and inserting "December 31, 2031"; and
Bill text · Current law (19 U.S.C. 58c)
19 U.S.C. 58c(j)(3)(B)(i)changedby H.R. 7148 Sec. 5019(b)
The bill says: in subparagraph (B)(i), by striking "September 30, 2031" and inserting "December 31, 2031".
Bill text · Current law (19 U.S.C. 58c)
Public Law 112-41changedby H.R. 7148 Sec. 5019(b)
The bill says: Section 503 of the United States-Korea Free Trade Agreement Implementation Act (Public Law 112–41;19 U.S.C. 3805 note) is amended by striking "September 30, 2031" and inserting "December 31, 2031".
Bill text
19 U.S.C. 2703a(b)(1)rewrittenby H.R. 7148 Sec. 5020(a)
The bill says: by amending subparagraph (B)(v)(I) to read as follows:
Bill text · Current law (19 U.S.C. 2703a)
19 U.S.C. 2703a(b)(1)rewrittenby H.R. 7148 Sec. 5020(a)
The bill says: by amending subparagraph (C) to read as follows:
Bill text · Current law (19 U.S.C. 2703a)
19 U.S.C. 2703a(b)(2)changedby H.R. 7148 Sec. 5020(a)
The bill says: in paragraph (2), by striking "in each of the 16 succeeding 1-year periods" each place it appears and inserting "in any of the succeeding 1-year periods"; and
Bill text · Current law (19 U.S.C. 2703a)
19 U.S.C. 2703arewrittenby H.R. 7148 Sec. 5020(a)
The bill says: by amending subsection (h) to read as follows:
Bill text · Current law (19 U.S.C. 2703a)
42 U.S.C. 1396a(kk)added (10)by H.R. 7148 Sec. 6101(a)
(10) Streamlined enrollment process for eligible out-of-state providers.—(A) In general.— The State—(i) adopts and implements a process to allow an eligible out-of-State provider to enroll under the State plan (or a waiver of such plan) to furnish items and services to, or order, prescribe, refer, or certify eligibility for items and services for, qualifying individuals without the imposition of screening or enrollment requirements by such State that exceed the minimum necessary for such State to provide payment to an eligible out-of-State provider under such State plan (or a waiver of such plan), such as the provider's name and National Provider Identifier (and such other information specified by the Secretary); and(ii) provides that an eligible out-of-State provider that enrolls as a participating provider in the State plan (or a waiver of such plan) through such process shall be so enrolled for a 5-year period, unless the provider is terminated or excluded from participation during such period.(B) Definitions.— In this paragraph:(i) Eligible out-of-state provider.— The term eligible out-of-State provider means, with respect to a State, a provider—(I) that is located in any other State;(II) that—(aa) was determined by the Secretary to have a limited risk of fraud, waste, and abuse for purposes of determining the level of screening to be conducted under section 1866(j)(2), has been so screened under such section 1866(j)(2), and is enrolled in the Medicare program under title XVIII; or(bb) was determined by the State agency administering or supervising the administration of the State plan (or a waiver of such plan) of such other State to have a limited risk of fraud, waste, and abuse for purposes of determining the level of screening to be conducted under paragraph (1) of this subsection, has been so screened under such paragraph (1), and is enrolled under such State plan (or a waiver of such plan); and(III) that has not been—(aa) excluded from participation in any Federal health care program pursuant to section 1128 or 1128A;(bb) excluded from participation in the State plan (or a waiver of such plan) pursuant to part 1002 of title 42, Code of Federal Regulations (or any successor regulation), or State law; or(cc) terminated from participating in a Federal health care program or the State plan (or a waiver of such plan) for a reason described in paragraph (8)(A).(ii) Qualifying individual.— The term qualifying individual means an individual under 21 years of age who is enrolled under the State plan (or waiver of such plan).(iii) State.— The term State means 1 of the 50 States or the District of Columbia.
The bill says: Section 1902(kk) of the Social Security Act (42 U.S.C. 1396a(kk)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(77)changedby H.R. 7148 Sec. 6101(b)
The bill says: Section 1902(a)(77) of the Social Security Act (42 U.S.C. 1396a(a)(77)) is amended by inserting "enrollment," after "screening,".
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(kk)changedby H.R. 7148 Sec. 6101(b)
The bill says: The subsection heading for section 1902(kk) of such Act (42 U.S.C. 1396a(kk)) is amended by inserting "enrollment," after "screening,".
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1397gg(e)(1)(G)changedby H.R. 7148 Sec. 6101(b)
The bill says: Section 2107(e)(1)(G) of such Act (42 U.S.C. 1397gg(e)(1)(G)) is amended by inserting "enrollment," after "screening,".
Bill text · Current law (42 U.S.C. 1397gg)
42 U.S.C. 1396a(a)(10)(A)(ii)(XV)changedby H.R. 7148 Sec. 6102(a)
The bill says: by striking ", but less than 65,"; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(10)(A)(ii)(XV)changedby H.R. 7148 Sec. 6102(a)
The bill says: by inserting ", including at least the group described in section 1905(a)(xviii)" before the semicolon at the end; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(10)(A)(ii)(XVI)changedby H.R. 7148 Sec. 6102(a)
The bill says: in subclause (XVI), by inserting "including at least the group described in section 1905(a)(xii)," after "the State may establish,".
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396d(a)(xvi)changedby H.R. 7148 Sec. 6102(a)
The bill says: in clause (xvi), by striking "or" at the end;
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(a)(xvii)changedby H.R. 7148 Sec. 6102(a)
The bill says: in clause (xvii), by adding "or" after the comma at the end; and
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(a)added (xviii)by H.R. 7148 Sec. 6102(a)
(xviii) individuals who, but for earnings in excess of the limit established under subsection (q)(2)(B), would be considered to be receiving supplemental security income, and who are at least 16 years of age,
The bill says: by adding after clause (xvii) the following new clause:
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396d(v)(1)(A)changedby H.R. 7148 Sec. 6102(a)
The bill says: Section 1905(v)(1)(A) of the Social Security Act (42 U.S.C. 1396d(v)(1)(A)) is amended by striking ", but less than 65,".
Bill text · Current law (42 U.S.C. 1396d)
42 U.S.C. 1396a(a)(88)changedby H.R. 7148 Sec. 6103(a)
The bill says: in paragraph (88), by striking "and" at the end;
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)(89)changedby H.R. 7148 Sec. 6103(a)
The bill says: in paragraph (89), by striking the period at the end and inserting "; and"; and
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396a(a)added (90)by H.R. 7148 Sec. 6103(a)
(90) beginning January 1, 2030, provide, with respect to an active duty relocated individual (as defined in subsection (yy)(1))—(A) that, for purposes of determining eligibility for medical assistance under the State plan (or waiver of such plan), such active duty relocated individual is treated as a resident of the State unless such individual voluntarily elects not to be so treated for such purposes;(B) that if, at the time of relocation (as described in subsection (yy)(1)), such active duty relocated individual is on a home and community-based services waiting list (as defined in subsection (yy)(2)), such individual remains on such list until—(i) the State completes an assessment and renders a decision with respect to the eligibility of such individual to receive the relevant home and community-based services at the time a slot for such services becomes available and, in the case such decision is a denial of such eligibility, such individual has exhausted the individual’s opportunity for a fair hearing; or(ii) such individual elects to be removed from such list; and(C) payment for medical assistance furnished under the State plan (or a waiver of the plan) on behalf of such active duty relocated individual in the military service relocation State (as referred to in subsection (yy)(1)(B)(i)), to the extent that such assistance is available in such military service relocation State in accordance with such guidance as the Secretary may issue to ensure access to such assistance.
The bill says: by inserting after paragraph (89), the following new paragraph:
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396aadded (yy)by H.R. 7148 Sec. 6103(a)
(yy) Active duty relocated individual; home and community-based services waiting list.— For purposes of subsection (a)(90) and this subsection:(1) Active duty relocated individual.— The term active duty relocated individual means an individual—(A) who—(i) is enrolled under the State plan (or waiver of such plan); or(ii) with respect to an individual described in subparagraph (C)(ii), would be so enrolled pursuant to subsection (a)(10)(A)(ii)(VI) if such individual began receiving home and community-based services;(B) who—(i) is a member of the Armed Forces engaged in active duty service and is relocated to another State (in this subsection referred to as the "military service relocation State") by reason of such service;(ii) would be described in clause (i) except that the individual stopped being engaged in active duty service (including by reason of retirement from such service) and the last day on which the individual was engaged in active duty service occurred not more than 12 months ago; or(iii) is a dependent (as defined by the Secretary) of a member described in clause (i) or (ii) who relocates to the military service relocation State with such member; and(C) who—(i) was receiving home and community-based services (as defined in section 9817(a)(2)(B) of the American Rescue Plan Act of 2021) at the time of such relocation; or(ii) if the State maintains a home and community-based services waiting list, was on such home and community-based services waiting list at the time of such relocation.(2) Home and community-based services waiting list.— The term home and community-based services waiting list means, in the case of a State that has a limit on the number of individuals who may receive home and community-based services under section 1115(a) or section 1915(c), a list maintained by such State of individuals who are requesting to receive such services under 1 or more such sections but for whom the State has not yet completed an assessment and rendered a decision with respect to the eligibility of such individuals to receive the relevant home and community-based services at the time a slot for such services becomes available due to such limit.
The bill says: by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1396a)
42 U.S.C. 1396r-4(f)(6)(A)(vi)changedby H.R. 7148 Sec. 6105(a)
The bill says: in the heading, by striking "2025 and a portion of fiscal year 2026" and inserting "2027"; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(f)(6)(A)(vi)changedby H.R. 7148 Sec. 6105(a)
The bill says: by inserting ", and the DSH allotment for Tennessee for the portion of fiscal year 2026 beginning on January 31, 2026, and ending September 30, 2026, shall be $35,351,507, which may be claimed as fiscal year 2026 uncompensated care costs, and the DSH allotment for Tennessee for fiscal year 2027, shall be $53,100,000" before the period.
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(f)(7)(A)(i)changedby H.R. 7148 Sec. 6105(b)
The bill says: in the matter preceding subclause (I), by striking "the period beginning January 31, 2026, and ending September 30, 2026, and for each of fiscal years 2027 and 2028" and inserting "fiscal year 2028";
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(f)(7)(A)(i)(I)changedby H.R. 7148 Sec. 6105(b)
The bill says: in subclause (I), by striking "or period"; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(f)(7)(A)(i)(II)changedby H.R. 7148 Sec. 6105(b)
The bill says: in subclause (II), by striking "or period" each place it appears; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(f)(7)(A)(ii)changedby H.R. 7148 Sec. 6105(b)
The bill says: in clause (ii), by striking "the period beginning January 31, 2026, and ending September 30, 2026, and for each of fiscal years 2027 and 2028 " and inserting "fiscal year 2028".
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(A)changedby H.R. 7148 Sec. 6106(a)
The bill says: in the matter preceding clause (i), by striking "(other than a hospital described in paragraph (2)(B))";
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(A)(i)changedby H.R. 7148 Sec. 6106(a)
The bill says: in clause (i), by inserting "with respect to such hospital and year" after "described in subparagraph (B)"; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(A)(ii)(I)changedby H.R. 7148 Sec. 6106(a)
The bill says: in subclause (I), by striking "and" at the end;
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(A)(ii)(II)changedby H.R. 7148 Sec. 6106(a)
The bill says: in subclause (II), by striking the period and inserting "; and"; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(A)(ii)added (III)by H.R. 7148 Sec. 6106(a)
(III) payments made under title XVIII or by an applicable plan (as defined in section 1862(b)(8)(F)) for such services.
The bill says: by adding at the end the following new subclause:
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(B)changedby H.R. 7148 Sec. 6106(a)
The bill says: in the matter preceding clause (i), by striking "in this clause are" and inserting "in this subparagraph are, with respect to a hospital and a year,"; and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(1)(B)added (iii)by H.R. 7148 Sec. 6106(a)
(iii) Individuals who are eligible for medical assistance under the State plan or under a waiver of such plan and for whom the State plan or waiver is a payor for such services after application of benefits under title XVIII or under an applicable plan (as defined in section 1862(b)(8)(F)), but only if the hospital has in the aggregate incurred costs exceeding payments under such State plan, waiver, title XVIII, or applicable plan for such services furnished to such individuals during such year.
The bill says: by adding at the end the following new clause:
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)removedby H.R. 7148 Sec. 6106(a)
The bill says: by striking paragraph (2);
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)renumberedby H.R. 7148 Sec. 6106(a)
The bill says: by redesignating paragraph (3) as paragraph (2); and
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1396r-4(g)(2)changedby H.R. 7148 Sec. 6106(a)
The bill says: in paragraph (2), as so redesignated, by striking "Notwithstanding paragraph (2) of this subsection (as in effect on October 1, 2021), paragraph (2)" and inserting "Paragraph (2)".
Bill text · Current law (42 U.S.C. 1396r-4)
42 U.S.C. 1395ww(d)(12)(B)changedby H.R. 7148 Sec. 6201(a)
The bill says: in subparagraph (B), by striking "during the portion of fiscal year 2026 beginning on January 31, 2026, and ending on September 30, 2026, and in fiscal year 2027" and inserting "during the portion of fiscal year 2027 beginning on January 1, 2027, and ending on September 30, 2027, and in fiscal year 2028";
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(12)(C)(i)changedby H.R. 7148 Sec. 6201(a)
The bill says: in the matter preceding subclause (I), by striking "through 2025 and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through 2026 and the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026";
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(12)(C)(i)(III)changedby H.R. 7148 Sec. 6201(a)
The bill says: in subclause (III), by striking "through 2025 and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through 2026 and the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026"; and
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(12)(C)(i)(IV)changedby H.R. 7148 Sec. 6201(a)
The bill says: in subclause (IV), by striking "the portion of fiscal year 2026 beginning on January 31, 2026, and ending on September 30, 2026, and fiscal year 2027" and inserting "the portion of fiscal year 2027 beginning on January 1, 2027, and ending on September 30, 2027, and fiscal year 2028"; and
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(12)(D)changedby H.R. 7148 Sec. 6201(a)
The bill says: in the matter preceding clause (i), by striking "through 2025 or during the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through 2026 or during the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026"; and
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(12)(D)(ii)changedby H.R. 7148 Sec. 6201(a)
The bill says: in clause (ii), by striking "through 2025 and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through 2026 and the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026".
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(5)(G)(i)changedby H.R. 7148 Sec. 6202(a)
The bill says: in clause (i), by striking "January 31, 2026" and inserting "January 1, 2027"; and
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(d)(5)(G)(ii)(II)changedby H.R. 7148 Sec. 6202(a)
The bill says: in clause (ii)(II), by striking "January 31, 2026" and inserting "January 1, 2027".
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(b)(3)(D)changedby H.R. 7148 Sec. 6202(b)
The bill says: in the matter preceding clause (i), by striking "January 31, 2026" and inserting "January 1, 2027"; and
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(b)(3)(D)(iv)changedby H.R. 7148 Sec. 6202(b)
The bill says: in clause (iv), by striking "through fiscal year 2025 and the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through fiscal year 2026 and the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026".
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395ww(e)(2)changedby H.R. 7148 Sec. 6202(b)
The bill says: Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww note) is amended by striking "through fiscal year 2025, or the portion of fiscal year 2026 beginning on October 1, 2025, and ending on January 30, 2026" and inserting "through fiscal year 2026, or the portion of fiscal year 2027 beginning on October 1, 2026, and ending on December 31, 2026".
Bill text · Current law (42 U.S.C. 1395ww)
42 U.S.C. 1395m(l)(12)(A)changedby H.R. 7148 Sec. 6203(1)
The bill says: in paragraph (12)(A), by striking "January 31, 2026" and inserting "January 1, 2028"; and
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(l)(13)changedby H.R. 7148 Sec. 6203(2)
The bill says: in paragraph (13), by striking "January 31, 2026" each place it appears and inserting "January 1, 2028" in each such place.
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395l(z)(1)(A)changedby H.R. 7148 Sec. 6204(a)
The bill says: by inserting ", and during 2028," after "with 2026"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(1)(A)changedby H.R. 7148 Sec. 6204(a)
The bill says: by inserting ", or, with respect to 2028, 3.1 percent" after "1.88 percent";
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(2)(B)changedby H.R. 7148 Sec. 6204(a)
The bill says: in the heading, by inserting "and 2028" after "2026"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(2)(B)changedby H.R. 7148 Sec. 6204(a)
The bill says: in the matter preceding clause (i), by inserting "and 2028" after "2026";
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(2)(C)changedby H.R. 7148 Sec. 6204(a)
The bill says: in the heading, by striking "Beginning in 2027" and inserting "2027 and 2029 and subsequent years"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(2)(C)changedby H.R. 7148 Sec. 6204(a)
The bill says: in the matter preceding clause (i), by inserting "and 2029" after "2027"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(2)(D)changedby H.R. 7148 Sec. 6204(a)
The bill says: in subparagraph (D), by striking "and 2026" and inserting "2026, and 2028"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(z)(4)(B)changedby H.R. 7148 Sec. 6204(a)
The bill says: in paragraph (4)(B), by inserting ", or, with respect to 2028, 3.1 percent" after "1.88 percent".
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395w-4(q)(1)(C)(iii)(II)changedby H.R. 7148 Sec. 6204(b)
The bill says: in subclause (II), by inserting "and 2028" after "2026"; and
Bill text · Current law (42 U.S.C. 1395w-4)
42 U.S.C. 1395w-4(q)(1)(C)(iii)(III)changedby H.R. 7148 Sec. 6204(b)
The bill says: in subclause (III), by inserting "and 2029" after "2027".
Bill text · Current law (42 U.S.C. 1395w-4)
42 U.S.C. 1395aaa(d)(2)changedby H.R. 7148 Sec. 6205(1)
The bill says: by striking "and $13,300,000" and inserting "$13,300,000"; and
Bill text · Current law (42 U.S.C. 1395aaa)
42 U.S.C. 1395aaa(d)(2)addedby H.R. 7148 Sec. 6205(1)
The bill says: by inserting the following before the period at the end: ", and $15,100,000 for fiscal year 2027"; and
Bill text · Current law (42 U.S.C. 1395aaa)
42 U.S.C. 1395aaa(d)(2)changedby H.R. 7148 Sec. 6205(2)
The bill says: in the third sentence, by striking "and 2026" and inserting "2026, and 2027".
Bill text · Current law (42 U.S.C. 1395aaa)
42 U.S.C. 1395b-3(xiv)changedby H.R. 7148 Sec. 6206(a)
The bill says: in clause (xiv), by striking "and" at the end;
Bill text · Current law (42 U.S.C. 1395b-3)
42 U.S.C. 1395b-3(xv)changedby H.R. 7148 Sec. 6206(a)
The bill says: in clause (xv), by striking the period at the end and inserting "; and"; and
Bill text · Current law (42 U.S.C. 1395b-3)
42 U.S.C. 1395b-3added (xvi)by H.R. 7148 Sec. 6206(a)
(xvi) for the period beginning on January 31, 2026, and ending on December 31, 2027, $30,000,000.
The bill says: by inserting after clause (xv) the following new clause:
Bill text · Current law (42 U.S.C. 1395b-3)
Public Law 113-185(a)(2)(B)changedby H.R. 7148 Sec. 6207(1)
The bill says: in subparagraph (B), by striking "and" at the end;
Bill text
Public Law 113-185(a)(2)(C)changedby H.R. 7148 Sec. 6207(2)
The bill says: in subparagraph (C), by striking the period at the end and inserting "; and"; and
Bill text
Public Law 113-185(a)(2)added (D)by H.R. 7148 Sec. 6207(3)
(D) $4,400,000 for the period beginning on January 31, 2026, and ending on December 31, 2026, to remain available until expended.
The bill says: by adding at the end the following new subparagraph:
Bill text
42 U.S.C. 1395w-4(e)(1)(E)changedby H.R. 7148 Sec. 6208
The bill says: Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking "January 31, 2026" and inserting "January 1, 2027".
Bill text · Current law (42 U.S.C. 1395w-4)
42 U.S.C. 1395m(m)(2)(B)(iii)changedby H.R. 7148 Sec. 6209(a)
The bill says: in paragraph (2)(B)(iii), by striking "ending January 30, 2026" and inserting "ending December 31, 2027"; and
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(4)(C)(iii)changedby H.R. 7148 Sec. 6209(a)
The bill says: in paragraph (4)(C)(iii), by striking "ending on January 30, 2026" and inserting "ending on December 31, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(4)(E)changedby H.R. 7148 Sec. 6209(b)
The bill says: Section 1834(m)(4)(E) of the Social Security Act (42 U.S.C. 1395m(m)(4)(E)) is amended by striking "ending on January 30, 2026" and inserting "ending on December 31, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(8)(A)changedby H.R. 7148 Sec. 6209(c)
The bill says: Section 1834(m)(8)(A) of the Social Security Act (42 U.S.C. 1395m(m)(8)(A)) is amended by striking "ending on January 30, 2026" and inserting "ending on December 31, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(7)(B)(i)changedby H.R. 7148 Sec. 6209(d)
The bill says: Section 1834(m)(7)(B)(i) of the Social Security Act (42 U.S.C. 1395m(m)(7)(B)(i)) is amended, in the matter preceding subclause (I), by striking "on or after January 31, 2026" and inserting "on or after January 1, 2028".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(y)(2)changedby H.R. 7148 Sec. 6209(d)
The bill says: Section 1834(y)(2) of the Social Security Act (42 U.S.C. 1395m(y)(2)) is amended by striking "January 31, 2026" and inserting "January 1, 2028".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(o)(4)(B)changedby H.R. 7148 Sec. 6209(d)
The bill says: Section 1834(o)(4)(B) of the Social Security Act (42 U.S.C. 1395m(o)(4)(B)) is amended by striking "January 31, 2026" and inserting "January 1, 2028".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(m)(9)changedby H.R. 7148 Sec. 6209(e)
The bill says: Section 1834(m)(9) of the Social Security Act (42 U.S.C. 1395m(m)(9)) is amended by striking "ending on January 30, 2026" and inserting "ending on December 31, 2027".
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395f(a)(7)(D)(i)(II)changedby H.R. 7148 Sec. 6209(f)
The bill says: by striking "ending on January 30, 2026" and inserting "ending on December 31, 2027"; and
Bill text · Current law (42 U.S.C. 1395f)
42 U.S.C. 1395f(a)(7)(D)(i)(II)changedby H.R. 7148 Sec. 6209(f)
The bill says: by inserting ", except that this subclause shall not apply in the case of such an encounter with an individual occurring on or after January 31, 2026, if such individual is located in an area that is subject to a moratorium on the enrollment of hospice programs under this title pursuant to section 1866(j)(7), if such individual is receiving hospice care from a provider that is subject to enhanced oversight under this title pursuant to section 1866(j)(3), or if such encounter is performed by a hospice physician or nurse practitioner who is not enrolled under section 1866(j) and is not an opt-out physician or practitioner (as defined in section 1802(b)(6)(D))" before the semicolon.
Bill text · Current law (42 U.S.C. 1395f)
42 U.S.C. 1395m(m)added (10)by H.R. 7148 Sec. 6209(g)
(10) Required use of modifiers in certain instances.— Not later than January 1, 2027, the Secretary shall establish requirements to include one or more codes or modifiers, as determined appropriate by the Secretary, in the case of—(A) claims for telehealth services under this subsection that are furnished through a telehealth virtual platform—(i) by a physician or practitioner that contracts with an entity that owns such virtual platform; or(ii) for which a physician or practitioner has a payment arrangement with an entity for use of such virtual platform; and(B) claims for telehealth services under this subsection that are furnished incident to a physician’s or practitioner’s professional service.
The bill says: Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395cc-7(a)(1)changedby H.R. 7148 Sec. 6210(a)
The bill says: Section 1866G(a)(1) of the Social Security Act (42 U.S.C. 1395cc–7(a)(1)) is amended by striking "January 30, 2026" and inserting "September 30, 2030".
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7(a)(3)(E)(ii)changedby H.R. 7148 Sec. 6210(b)
The bill says: in clause (ii), by striking "the study described in subsection (b)" and inserting "the studies described in subsections (b) and (c)"; and
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7(a)(3)(E)addedby H.R. 7148 Sec. 6210(b)
The bill says: by adding at the end the following new flush sentence:
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7(b)changedby H.R. 7148 Sec. 6210(b)
The bill says: in the subsection heading, by striking "Study" and inserting "Initial study"; and
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7(b)(3)changedby H.R. 7148 Sec. 6210(b)
The bill says: in paragraph (3), by striking “subsection” and inserting "section";
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7renumberedby H.R. 7148 Sec. 6210(b)
The bill says: by redesignating subsections (c) and (d) as subsections (d) and (e), respectively;
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7added (c)by H.R. 7148 Sec. 6210(b)
(c) Subsequent study and report.—(1) In general.— Not later than September 30, 2029, the Secretary shall conduct a study to—(A) analyze, to the extent practicable, the criteria established by hospitals under the Acute Hospital Care at Home initiative to determine which individuals may be furnished services under such initiative; and(B) analyze and compare (both within and between hospitals participating in the initiative, and relative to comparable hospitals that do not participate in the initiative, for relevant parameters such as diagnosis-related groups)—(i) quality of care furnished to individuals with similar conditions and characteristics in the inpatient setting and through the Acute Hospital Care at Home initiative, including health outcomes, hospital readmission rates (including readmissions both within and beyond 30 days post-discharge), hospital mortality rates, length of stay, infection rates, composition of care team (including the types of labor used, such as contracted labor), the ratio of nursing staff, transfers from the hospital to the home, transfers from the home to the hospital (including the timing, frequency, and causes of such transfers), transfers and discharges to post-acute care settings (including the timing, frequency, and causes of such transfers and discharges), and patient and caregiver experience of care;(ii) clinical conditions treated and diagnosis-related groups of discharges from inpatient settings relative to discharges from the Acute Hospital Care at Home initiative;(iii) costs incurred by the hospital for furnishing care in inpatient settings relative to costs incurred by the hospital for furnishing care through the Acute Hospital Care at Home initiative, including costs relating to staffing, equipment, food, prescriptions, and other services, as determined by the Secretary;(iv) the quantity, mix, and intensity of services (such as in-person visits and virtual contacts with patients and the intensity of such services) furnished in inpatient settings relative to the Acute Hospital Care at Home initiative, and, to the extent practicable, the nature and extent of family or caregiver involvement;(v) socioeconomic information on individuals treated in comparable inpatient settings relative to the initiative, including racial and ethnic data, income, housing, geographic proximity to the brick-and-mortar facility and whether such individuals are dually eligible for benefits under this title and title XIX; and(vi) the quality of care, outcomes, costs, quantity and intensity of services, and other relevant metrics between individuals who entered into the Acute Hospital Care at Home initiative directly from an emergency department compared with individuals who entered into the Acute Hospital Care at Home initiative directly from an existing inpatient stay in a hospital.(2) Selection bias.— In conducting the study under paragraph (1), the Secretary shall, to the extent practicable, analyze and compare individuals who participate and do not participate in the initiative controlling for selection bias or other factors that may impact the reliability of data.(3) Report.— Not later than September 30, 2029, the Secretary of Health and Human Services shall—(A) submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the study conducted under paragraph (1); and(B) make such report publicly available on a website of the Centers for Medicare & Medicaid Services.(4) Funding.— In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $2,500,000, to remain available until expended, for purposes of carrying out this section.
The bill says: by inserting after subsection (b) the following new subsection:
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395cc-7(e)changedby H.R. 7148 Sec. 6210(b)
The bill says: in subsection (e), as redesignated by paragraph (3), by striking "and (b)(1)" and inserting ", (b)(1), and (c)(1)".
Bill text · Current law (42 U.S.C. 1395cc-7)
42 U.S.C. 1395x(eee)(2)(A)(ii)changedby H.R. 7148 Sec. 6211(a)
The bill says: Section 1861(eee)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395x(eee)(2)(A)(ii)) is amended by inserting "(including, with respect to items and services furnished through audio and video real-time communications technology (excluding audio-only) on or after January 31, 2026, and before January 1, 2028, in the home of an individual who is an outpatient of the hospital)" after "outpatient basis".
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395m(a)added (23)by H.R. 7148 Sec. 6212(a)
(23) Master List inclusion and claim review for certain items.—(A) Master List inclusion.— Beginning January 1, 2029, for purposes of the Master List described in section 414.234(b) of title 42, Code of Federal Regulations (or any successor regulation), in determining which items have aberrant billing patterns (as such term is used for purposes of such section), the Secretary shall also treat an item for which payment may be made under this subsection as having such an aberrant billing pattern if the Secretary determines that, without explanatory contributing factors (such as furnishing emergent care services), a substantial number of claims for such items under this subsection are for such items ordered by a physician or practitioner who has not previously (during a period of not less than 24 months, as established by the Secretary) furnished to the individual involved any item or service for which payment may be made under this title.(B) Claim review.— With respect to items furnished on or after January 1, 2029, that are included on the Master List pursuant to subparagraph (A), if such an item is not subject to a determination of coverage in advance pursuant to paragraph (15)(C), the Secretary may conduct prepayment review of claims for payment for such item.
The bill says: Section 1834(a) of the Social Security Act (42 U.S.C. 1395m(a)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395m(h)(3)changedby H.R. 7148 Sec. 6212(a)
The bill says: Section 1834(h)(3) of the Social Security Act (42 U.S.C. 1395m(h)(3)) is amended by inserting ", and paragraph (23) of subsection (a) shall apply to prosthetic devices, orthotics, and prosthetics in the same manner as such provision applies to items for which payment may be made under such subsection" before the period at the end.
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395w-102(e)(1)(C)changedby H.R. 7148 Sec. 6217
The bill says: Section 1860D–2(e)(1)(C) of the Social Security Act (42 U.S.C. 1395w–102(e)(1)(C)) is amended by striking "January 30, 2026" and inserting "December 31, 2026".
Bill text · Current law (42 U.S.C. 1395w-102)
42 U.S.C. 1395f(i)(2)(B)(ii)changedby H.R. 7148 Sec. 6218(1)
The bill says: in clause (ii), by striking "2033" and inserting "2035"; and
Bill text · Current law (42 U.S.C. 1395f)
42 U.S.C. 1395f(i)(2)(B)(iii)changedby H.R. 7148 Sec. 6218(2)
The bill says: in clause (iii), by striking "2033" and inserting "2035".
Bill text · Current law (42 U.S.C. 1395f)
42 U.S.C. 1395w-114(a)(1)(D)(ii)changedby H.R. 7148 Sec. 6219(1)
(I) for a plan year before 2028—(aa) for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and(bb) for any other drug, $3 or, if less, the copayment amount applicable to an individual under clause (iii); and(II) for plan year 2028 and each subsequent plan year—(aa) for a generic drug, $0;(bb) for a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), the dollar amount applied under this clause for such a drug for the preceding plan year, increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such preceding year, or, if less, the copayment amount applicable to an individual under clause (iii); and(cc) for a drug not described in either item (aa) or (bb), the dollar amount applied under this clause for such a drug for the preceding plan year, increased in the manner specified in item (bb), or, if less, the copayment amount applicable to an individual under clause (iii).
The bill says: in paragraph (1)(D)(ii), by striking "that does not exceed $1 for" and all that follows through the period at the end and inserting "that does not exceed—
Bill text · Current law (42 U.S.C. 1395w-114)
42 U.S.C. 1395w-114(a)(4)(A)(ii)changedby H.R. 7148 Sec. 6219(2)
The bill says: in paragraph (4)(A)(ii), by inserting "(before 2028)" after "a subsequent year".
Bill text · Current law (42 U.S.C. 1395w-114)
42 U.S.C. 1395w-22(c)(1)(C)changedby H.R. 7148 Sec. 6220(a)
The bill says: by striking "plan, and any" and inserting "plan, any"; and
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(c)(1)(C)addedby H.R. 7148 Sec. 6220(a)
The bill says: by inserting the following before the period: ", and, in the case of a specified MA plan (as defined in paragraph (3)(C)), for plan year 2028 and subsequent plan years, the information described in paragraph (3)(B)"; and
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(c)added (3)by H.R. 7148 Sec. 6220(a)
(3) Provider directory accuracy.—(A) In general.— For plan year 2028 and subsequent plan years, each MA organization offering a specified MA plan (as defined in subparagraph (C)) shall, for each such plan offered by the organization—(i) maintain, on a publicly available internet website, an accurate provider directory that includes the information described in subparagraph (B);(ii) not less frequently than once every 90 days (or, in the case of a hospital or any other facility determined appropriate by the Secretary, at a lesser frequency specified by the Secretary but in no case less frequently than once every 12 months), verify the provider directory information of each provider listed in such directory and, if applicable, update such information;(iii) if the organization is unable to verify such information with respect to a provider, include in such directory an indication that the information of such provider may not be up to date; and(iv) remove a provider from such directory within 5 business days if the organization determines that the provider is no longer a provider participating in the network of such plan.(B) Provider directory information.— The information described in this subparagraph is information enrollees may need to access covered benefits from a provider with which such organization offering such plan has an agreement for furnishing items and services covered under such plan, such as name, specialty, contact information, primary office or facility addresses where items or services are furnished, whether the provider is accepting new patients, accommodations for people with disabilities, cultural and linguistic capabilities, and telehealth capabilities.(C) Specified MA plan.— In this paragraph, the term specified MA plan means—(i) a network-based plan (as defined in subsection (d)(5)(C)); or(ii) a Medicare Advantage private fee-for-service plan (as defined in section 1859(b)(2)) that meets the access standards under subsection (d)(4), in whole or in part, through entering into contracts or agreements as provided for under subparagraph (B) of such subsection.
The bill says: by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(d)(1)(C)(ii)changedby H.R. 7148 Sec. 6220(b)
The bill says: in clause (ii), by striking "or" at the end;
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(d)(1)(C)(iii)changedby H.R. 7148 Sec. 6220(b)
The bill says: in clause (iii), by striking the semicolon at the end and inserting ", or"; and
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(d)(1)(C)added (iv)by H.R. 7148 Sec. 6220(b)
(iv) for plan year 2028 and subsequent plan years, in the case of a specified MA plan (as defined in subsection (c)(3)(C)), the services were furnished by a provider that was not participating in the network of such plan but was listed in the provider directory of such plan on the date on which the appointment was made, as described in paragraph (7)(A);
The bill says: by adding at the end the following new clause:
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-22(d)added (7)by H.R. 7148 Sec. 6220(b)
(7) Cost sharing for services furnished based on reliance on incorrect provider directory information.—(A) In general.— For plan year 2028 and subsequent plan years, if an enrollee in a specified MA plan (as defined in subsection (c)(3)(C)) is furnished an item or service by a provider that is not participating in the network of such plan but is listed in the provider directory of such plan (as required to be provided to an enrollee pursuant to subsection (c)(1)(C)) on the date on which the appointment is made, and if such item or service would otherwise be covered under such plan if furnished by a provider that is participating in the network of such plan, the MA organization offering such plan shall ensure that the enrollee is only responsible for the lesser of—(i) the amount of cost sharing that would apply if such provider had been participating in the network of such plan; or(ii) the amount of cost sharing that would otherwise apply (without regard to this subparagraph).(B) Notification requirement.— For plan year 2028 and subsequent plan years, each MA organization that offers a specified MA plan shall—(i) notify enrollees of their cost-sharing protections under this paragraph and make such notifications, to the extent practicable, by not later than the first day of an annual, coordinated election period under section 1851(e)(3) with respect to a year;(ii) include information regarding such cost-sharing protections in the provider directory of each specified MA plan offered by the MA organization.; and(iii) notify enrollees of their cost-sharing protections under this paragraph in the first explanation of benefits issued in a plan year.
The bill says: by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395w-22)
42 U.S.C. 1395w-27(e)added (6)by H.R. 7148 Sec. 6220(b)
(6) Provider directory accuracy analysis and reports.—(A) In general.— Beginning with plan years beginning on or after January 1, 2028, subject to subparagraph (C), a contract under this section with an MA organization shall require the organization, for each specified MA plan (as defined in section 1852(c)(3)(C)) offered by the organization, to annually do the following:(i) Conduct an analysis estimating the accuracy of the provider directory information of such plan using a random sample of providers included in such provider directory as follows:(I) Such a random sample shall include a random sample of each specialty of providers with a high inaccuracy rate of provider directory information relative to other specialties of providers, as determined by the Secretary.(II) For purposes of subclause (I), one type of specialty may be providers specializing in mental health or substance use disorder treatment.(ii) Submit to the Secretary a report containing the results of the analysis conducted under clause (i), including an accuracy score for such provider directory information (as determined using a plan verification method specified by the Secretary under subparagraph (B)(i)).(B) Determination of accuracy score.—(i) In general.— The Secretary shall specify plan verification methods, such as using telephonic verification or other approaches using data sources maintained by an MA organization or using publicly available data sets, that MA organizations may use for estimating accuracy scores of the provider directory information of specified MA plans offered by such organizations.(ii) Accuracy score methodology.— With respect to each such method specified by the Secretary as described in clause (i), the Secretary shall specify a methodology for MA organizations to use in estimating such accuracy scores. Each such methodology shall take into account the administrative burden on plans and providers and the relative importance of certain provider directory information on enrollee ability to access care.(C) Exception.— The Secretary may waive the requirements of this paragraph in the case of a specified MA plan with low enrollment (as defined by the Secretary).(D) Transparency.— Beginning with plan years beginning on or after January 1, 2029, the Secretary shall post accuracy scores (as reported under subparagraph (A)(ii)), in a machine readable file, on an internet website maintained by the Centers for Medicare & Medicaid Services.
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-21(d)(4)added (F)by H.R. 7148 Sec. 6220(b)
(F) Provider Directory.— Beginning with plan years beginning on or after January 1, 2029, in the case of a specified MA plan (as defined in section 1852(c)(3)(C)), the accuracy score of the plan’s provider directory (as reported under section 1857(e)(6)(A)(ii)) listed prominently on the plan’s provider directory.
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-21)
42 U.S.C. 1395x(s)(2)changedby H.R. 7148 Sec. 6221(a)
The bill says: by striking the semicolon at the end of subparagraph (JJ) and inserting "; and"; and
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395x(s)(2)added (KK)by H.R. 7148 Sec. 6221(a)
(KK) multi-cancer early detection screening tests (as defined in subsection (nnn));
The bill says: by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395xadded (nnn)by H.R. 7148 Sec. 6221(a)
(nnn) Multi-cancer early detection screening tests.—(1) In general.— The term multi-cancer early detection screening test means a test furnished to an individual for the concurrent detection of multiple cancer types across multiple organ sites on or after January 1, 2029, that—(A) is cleared under section 510(k), classified under section 513(f)(2), or approved under section 515 of the Federal Food, Drug, and Cosmetic Act;(B) is—(i) a genomic sequencing blood or blood product test that includes the analysis of cell-free nucleic acids; or(ii) a test based on samples of biological material that provide results comparable to those obtained with a test described in clause (i), as determined by the Secretary; and(C) the Secretary determines is—(i) reasonable and necessary for the prevention or early detection of an illness or disability; and(ii) appropriate for individuals entitled to benefits under part A or enrolled under part B.(2) NCD process.— In making determinations under paragraph (1)(C) regarding the coverage of a new test, the Secretary shall use the process for making national coverage determinations (as defined in section 1869(f)(1)(B)) under this title.
The bill says: by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395madded (aa)by H.R. 7148 Sec. 6221(b)
(aa) Payment and standards for multi-cancer early detection screening tests.—(1) Payment amount.— The payment amount for a multi-cancer early detection screening test (as defined in section 1861(nnn)) is—(A) with respect to such a test furnished before January 1, 2031, equal to the payment amount in effect on the date of the enactment of this subsection for a multi-target stool screening DNA test covered pursuant to section 1861(pp)(1)(D); and(B) with respect to such a test furnished on or after January 1, 2031, equal to the lesser of—(i) the amount described in subparagraph (A); or(ii) the payment amount determined for such test under section 1834A.(2) Limitations.—(A) In general.— No payment may be made under this part for a multi-cancer early detection screening test furnished during a year to an individual if—(i) such individual—(I) is under 50 years of age; or(II) as of January 1 of such year, has attained the age specified in subparagraph (B) for such year; or(ii) such a test was furnished to the individual during the previous 11 months.(B) Age specified.— For purposes of subparagraph (A)(i)(II), the age specified in this subparagraph is—(i) for 2029, 65 years of age; and(ii) for a succeeding year, the age specified in this subparagraph for the preceding year, increased by 1 year.(C) Standards following USPSTF rating of A or B.— In the case of a multi-cancer early detection screening test that is recommended with a grade of A or B by the United States Preventive Services Task Force, beginning on the date on which coverage for such test is provided pursuant to section 1861(ddd)(1), the preceding provisions of this paragraph shall not apply.
The bill says: Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395m)
42 U.S.C. 1395l(a)(1)(D)(i)(I)changedby H.R. 7148 Sec. 6221(b)
The bill says: in paragraph (1)(D)(i)(I), by striking "section 1834(d)(1)" and inserting "subsection (d)(1) or (aa) of section 1834"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(a)(2)(D)(i)(I)changedby H.R. 7148 Sec. 6221(b)
The bill says: in paragraph (2)(D)(i)(I), by striking "section 1834(d)(1)" and inserting "subsection (d)(1) or (aa) of section 1834"; and
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395l(h)(1)(A)changedby H.R. 7148 Sec. 6221(b)
The bill says: in subsection (h)(1)(A), by striking "section 1834(d)(1)" and inserting "subsections (d)(1) and (aa) of section 1834".
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395y(a)(1)(A)changedby H.R. 7148 Sec. 6221(b)
The bill says: by striking "or additional preventive services" and inserting ", additional preventive services"; and
Bill text · Current law (42 U.S.C. 1395y)
42 U.S.C. 1395y(a)(1)(A)changedby H.R. 7148 Sec. 6221(b)
The bill says: by inserting ", or multi-cancer early detection screening tests (as defined in section 1861(nnn))" after "(as described in section 1861(ddd)(1))".
Bill text · Current law (42 U.S.C. 1395y)
42 U.S.C. 1395x(n)added (1)by H.R. 7148 Sec. 6222(a)
(1) The prescribing information approved by the Food and Drug Administration for the home infusion drug associated with the pump instructs that the drug should be administered by or under the supervision of a health care professional.(2) A qualified home infusion therapy supplier (as defined in subsection (iii)(3)(D)) administers or supervises the administration of the drug or biological in a safe and effective manner in the patient’s home (as defined in subsection (iii)(3)(B)).(3) The prescribing information described in paragraph (1) instructs that the drug should be infused at least 12 times per year—(A) intravenously or subcutaneously; or(B) at infusion rates that the Secretary determines would require the use of an external infusion pump.
The bill says: Section 1861(n) of the Social Security Act (42 U.S.C. 1395x(n)) is amended by adding at the end the following new sentence: “Beginning with the first calendar quarter beginning on or after the date that is 1 year after the date of the enactment of this sentence, an external infusion pump and associated home infusion drug (as defined in subsection (iii)(3)(C)) or other associated supplies that do not meet the appropriate for use in the home requirement applied to the definition of durable medical equipment under section 414.202 of title 42, Code of Federal Regulations (or any successor to such regulation) shall be treated as meeting such requirement if each of the following criteria is satisfied:
Bill text · Current law (42 U.S.C. 1395x)
42 U.S.C. 1395w-104(b)(1)changedby H.R. 7148 Sec. 6223(a)
(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.— Notwithstanding any other provision of law, for plan years beginning on or after January 1, 2029, 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 2028, 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 April 1, 2027, 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 paid by PDP sponsors to network pharmacies sufficiently cover the ingredient and operational costs of such pharmacies, the use and application of pharmacy quality measures by PDP sponsors for network pharmacies, PDP sponsor restrictions or limitations on the dispensing of covered part D drugs by network pharmacies (or any subsets of such pharmacies), PDP sponsor auditing practices for network pharmacies, 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 as determined appropriate by the Secretary.
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-104)
42 U.S.C. 1395w-152added (e)by H.R. 7148 Sec. 6223(b)
(e) Essential retail pharmacies.—(1) In general.— With respect to plan years beginning on or after January 1, 2028, the Secretary shall publish reports, at least once every 2 years until 2034, and periodically thereafter, that provide information, to the extent feasible, on—(A) trends in ingredient cost reimbursement, dispensing fees, incentive payments and other fees paid by PDP sponsors offering prescription drug plans and MA organizations offering MA–PD plans under this part to essential retail pharmacies (as defined in paragraph (2)) with respect to the dispensing of covered part D drugs, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;(B) trends in amounts paid to PDP sponsors offering prescription drug plans and MA organizations offering MA–PD plans under this part by essential retail pharmacies with respect to the dispensing of covered part D drugs, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;(C) trends in essential retail pharmacy participation in pharmacy networks and preferred pharmacy networks for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part, including a comparison of such trends between essential retail pharmacies and pharmacies that are not essential retail pharmacies;(D) trends in the number of essential retail pharmacies, including variation in such trends by geographic region or other factors;(E) a comparison of cost-sharing for covered part D drugs dispensed by essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part and cost-sharing for covered part D drugs dispensed by other network pharmacies for such plans located in similar geographic areas that are not essential retail pharmacies;(F) a comparison of the volume of covered part D drugs dispensed by essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors and MA–PD plans offered by MA organizations under this part and such volume of dispensing by network pharmacies for such plans located in similar geographic areas that are not essential retail pharmacies, including information on any patterns or trends in such comparison specific to certain types of covered part D drugs, such as generic drugs or drugs specified as specialty drugs by a PDP sponsor under a prescription drug plan or an MA organization under an MA–PD plan; and(G) a comparison of the information described in subparagraphs (A) through (F) between essential retail pharmacies that are network pharmacies for prescription drug plans offered by PDP sponsors under this part and essential retail pharmacies that are network pharmacies for MA–PD plans offered by MA organizations under this part.(2) Definition of essential retail pharmacy.— In this subsection, the term essential retail pharmacy means, with respect to a plan year, a retail pharmacy that—(A) is not a pharmacy that is an affiliate as defined in paragraph (4); and(B) is located in—(i) a rural area in which there is no other retail pharmacy within 10 miles, as determined by the Secretary;(ii) a suburban area in which there is no other retail pharmacy within 2 miles, as determined by the Secretary; or(iii) an urban area in which there is no other retail pharmacy within 1 mile, as determined by the Secretary.(3) List of essential retail pharmacies.—(A) Publication of list of essential retail pharmacies.— For each plan year (beginning with plan year 2028), the Secretary shall publish, on a publicly available internet website of the Centers for Medicare & Medicaid Services, a list of retail pharmacies that meet the criteria described in subparagraphs (A) and (B) of paragraph (2) to be considered an essential retail pharmacy.(B) Required submissions from pdp sponsors.— For each plan year (beginning with plan year 2028), each PDP sponsor offering a prescription drug plan and each MA organization offering an MA–PD plan shall submit to the Secretary, for the purposes of determining retail pharmacies that meet the criterion specified in subparagraph (A) of paragraph (2), a list of retail pharmacies that are affiliates of such sponsor or organization, or are affiliates of a pharmacy benefit manager acting on behalf of such sponsor or organization, at a time, and in a form and manner, specified by the Secretary.(C) Reporting by pdp sponsors and ma organizations.— For each plan year beginning with plan year 2027, each PDP sponsor offering a prescription drug plan and each MA organization offering an MA–PD plan under this part shall submit to the Secretary information on incentive payments and other fees paid by such sponsor or organization to pharmacies, insofar as any such payments or fees are not otherwise reported, at a time, and in a form and manner, specified by the Secretary.(D) Implementation.— Notwithstanding any other provision of law, the Secretary may implement this paragraph by program instruction or otherwise.(E) Nonapplication of paperwork reduction Act.— Chapter 35 of title 44, United States Code, shall not apply to the implementation of this paragraph.(4) Definition of affiliate; pharmacy benefit manager.— In this subsection, the terms affiliate and pharmacy benefit manager have the meaning given those terms in section 1860D–12(h)(7).
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-152)
42 U.S.C. 1395w-104(b)(1)added (F)by H.R. 7148 Sec. 6223(c)
(F) Enforcement of standards for reasonable and relevant contract terms and conditions.—(i) Allegation submission process.—(I) In general.— Not later than January 1, 2029, the Secretary shall establish a process through which a pharmacy may submit to the Secretary an allegation of a violation by a PDP sponsor offering a prescription drug plan of the standards for reasonable and relevant contract terms and conditions under subparagraph (A)(ii), or of subclause (VIII) of this clause.(II) Frequency of submission.—(aa) In general.— Except as provided in item (bb), the allegation submission process under this clause shall allow pharmacies to submit any allegations of violations described in subclause (I) not more frequently than once per plan year per contract between a pharmacy and a PDP sponsor.(bb) Allegations relating to contract modifications.— In the case where a contract between a pharmacy and a PDP sponsor is modified 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 modifications with respect to such contract and plan year.(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 a standardized template for pharmacies to use for the submission of allegations described in subclause (I). 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.(VII) Rule of construction.— Nothing in this clause shall be construed as limiting the ability of a pharmacy to pursue other legal actions or remedies, consistent with applicable Federal or State law, with respect to a potential violation of a requirement described in this subparagraph.(VIII) Anti-retaliation and anti-coercion.— Consistent with applicable Federal or State law, a PDP sponsor shall not—(aa) retaliate against a pharmacy for submitting any allegations under this clause; or(bb) coerce, intimidate, threaten, or interfere with the ability of a pharmacy to submit any such allegations.(ii) Investigation.— The Secretary shall investigate, as determined appropriate by the Secretary, allegations submitted pursuant to clause (i).(iii) Enforcement.—(I) In general.— 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) or the provisions of clause (i)(VIII) of this subparagraph, the Secretary may use authorities under sections 1857(g) and 1860D–12(b)(3)(E) to impose civil monetary penalties or other intermediate sanctions.(II) 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).
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-104)
42 U.S.C. 1395w-27(g)(1)(J)changedby H.R. 7148 Sec. 6223(c)
The bill says: in subparagraph (J), by striking "or" after the semicolon;
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-27(g)(1)renumberedby H.R. 7148 Sec. 6223(c)
The bill says: by redesignating subparagraph (K) as subparagraph (L);
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-27(g)(1)added (K)by H.R. 7148 Sec. 6223(c)
(K) fails to comply with the standards for reasonable and relevant contract terms and conditions under subparagraph (A)(ii) of section 1860D–4(b)(1) or violates the provisions of subparagraph (F)(i)(VIII) of such section; or
The bill says: by inserting after subparagraph (J), the following new subparagraph:
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-27(g)(1)(L)changedby H.R. 7148 Sec. 6223(c)
The bill says: in subparagraph (L), as redesignated by subparagraph (B), by striking "through (J)" and inserting "through (K)"; and
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-27(g)(1)changedby H.R. 7148 Sec. 6223(c)
The bill says: in the flush matter following subparagraph (L), as so redesignated, by striking "subparagraphs (A) through (K)" and inserting "subparagraphs (A) through (L)".
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-112added (9)by H.R. 7148 Sec. 6223(d)
(9) Accountability of pharmacy benefit managers for violations of reasonable and relevant contract terms and conditions.— For plan years beginning on or after January 1, 2029, 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 section 1860D–4(b)(1)(F)(iii)(I) to the Secretary as a result of a violation described in such section if such violation is related to a responsibility delegated to the pharmacy benefit manager by such PDP sponsor.
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-112)
42 U.S.C. 1395w-27(f)(3)added (F)by H.R. 7148 Sec. 6223(d)
(F) Accountability of pharmacy benefit managers for violations of reasonable and relevant contract terms.— For plan years beginning on or after January 1, 2029, section 1860D–12(b)(9).
The bill says: 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:
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395w-152added (f)by H.R. 7148 Sec. 6223(e)
(f) Biennial report on enforcement and oversight of pharmacy access requirements.—(1) In general.— Not later than 2 years after the date of enactment of this subsection, and at least once every 2 years thereafter, the Secretary shall publish a report on enforcement and oversight actions and activities undertaken by the Secretary with respect to the requirements under section 1860D–4(b)(1).(2) Limitation.— A report under paragraph (1) shall not disclose—(A) identifiable information about individuals or entities unless such information is otherwise publicly available; or(B) trade secrets with respect to any entities.
The bill says: Section 1860D–42 of the Social Security Act (42 U.S.C. 1395w–152), as amended by subsection (b), is amended by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395w-152)
42 U.S.C. 1395w-112added (h)by H.R. 7148 Sec. 6224(a)
(h) Requirements relating to pharmacy benefit managers.— For plan years beginning on or after January 1, 2028:(1) Agreements with pharmacy benefit managers.— Each contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that any pharmacy benefit manager acting on behalf of such sponsor has a written agreement with the PDP sponsor under which the pharmacy benefit manager, and any affiliates of such pharmacy benefit manager, as applicable, agree to meet the following requirements:(A) No income other than bona fide service fees.—(i) In general.— The pharmacy benefit manager and any affiliate of such pharmacy benefit manager shall not derive any remuneration with respect to any services provided on behalf of any entity or individual, in connection with the utilization of covered part D drugs, from any such entity or individual other than bona fide service fees, subject to clauses (ii) and (iii).(ii) Incentive payments.— For the purposes of this subsection, an incentive payment (as determined by the Secretary) paid by a PDP sponsor to a pharmacy benefit manager or an affiliate of a pharmacy benefit manager that is performing services on behalf of such sponsor shall be deemed a "bona fide service fee" (even if such payment does not otherwise meet the definition of such term under paragraph (7)(B)) if such payment is a flat dollar amount, is consistent with fair market value (as specified by the Secretary), is related to services actually performed by the pharmacy benefit manager or affiliate of such pharmacy benefit manager, on behalf of the PDP sponsor making such payment, in connection with the utilization of covered part D drugs, and meets additional requirements, if any, as determined appropriate by the Secretary.(iii) Clarification on rebates and discounts used to lower costs for covered part d drugs.— Rebates, discounts, and other price concessions received by a pharmacy benefit manager or an affiliate of a pharmacy benefit manager from manufacturers, even if such price concessions are calculated as a percentage of a drug’s price, shall not be considered a violation of the requirements of clause (i) if they are fully passed through to a PDP sponsor and are compliant with all regulatory and subregulatory requirements related to direct and indirect remuneration for manufacturer rebates, discounts, and other price concessions under this part, including in cases where a PDP sponsor is acting as a pharmacy benefit manager on behalf of a prescription drug plan offered by such PDP sponsor.(iv) Evaluation of remuneration arrangements.— Components of subsets of remuneration arrangements (such as fees or other forms of compensation paid to or retained by the pharmacy benefit manager or affiliate of such pharmacy benefit manager), as determined appropriate by the Secretary, between pharmacy benefit managers or affiliates of such pharmacy benefit managers, as applicable, and other entities involved in the dispensing or utilization of covered part D drugs (including PDP sponsors, manufacturers, pharmacies, and other entities as determined appropriate by the Secretary) shall be subject to review by the Secretary, in consultation with the Office of the Inspector General of the Department of Health and Human Services, as determined appropriate by the Secretary. The Secretary, in consultation with the Office of the Inspector General, shall review whether remuneration under such arrangements is consistent with fair market value (as specified by the Secretary) through reviews and assessments of such remuneration, as determined appropriate.(v) Disgorgement.— The pharmacy benefit manager shall disgorge any remuneration paid to such pharmacy benefit manager or an affiliate of such pharmacy benefit manager in violation of this subparagraph to the PDP sponsor.(vi) Additional requirements.— The pharmacy benefit manager shall—(I) enter into a written agreement with any affiliate of such pharmacy benefit manager, under which the affiliate shall identify and disgorge any remuneration described in clause (v) to the pharmacy benefit manager; and(II) attest, subject to any requirements determined appropriate by the Secretary, that the pharmacy benefit manager has entered into a written agreement described in subclause (I) with any affiliate of the pharmacy benefit manager.(B) Transparency regarding guarantees and cost performance evaluations.— The pharmacy benefit manager shall—(i) define, interpret, and apply, in a fully transparent and consistent manner for purposes of calculating or otherwise evaluating pharmacy benefit manager performance against pricing guarantees or similar cost performance measurements related to rebates, discounts, price concessions, or net costs, terms such as—(I) generic drug, in a manner consistent with the definition of the term under section 423.4 of title 42, Code of Federal Regulations, or a successor regulation;(II) brand name drug, in a manner consistent with the definition of the term under section 423.4 of title 42, Code of Federal Regulations, or a successor regulation;(III) specialty drug;(IV) rebate; and(V) discount;(ii) identify any drugs, claims, or price concessions excluded from any pricing guarantee or other cost performance measure in a clear and consistent manner; and(iii) where a pricing guarantee or other cost performance measure is based on a pricing benchmark other than the wholesale acquisition cost (as defined in section 1847A(c)(6)(B)) of a drug, calculate and provide a wholesale acquisition cost-based equivalent to the pricing guarantee or other cost performance measure.(C) Provision of information.—(i) In general.— Not later than July 1 of each year, beginning in 2028, the pharmacy benefit manager shall submit to the PDP sponsor, and to the Secretary, a report, in accordance with this subparagraph, and shall make such report available to such sponsor at no cost to s
The bill says: Section 1860D–12 of the Social Security Act (42 U.S.C. 1395w–112) is amended by adding at the end the following new subsection:
Bill text · Current law (42 U.S.C. 1395w-112)
42 U.S.C. 1395w-27(f)(3)added (G)by H.R. 7148 Sec. 6224(a)
(G) Requirements relating to pharmacy benefit managers.— For plan years beginning on or after January 1, 2028, section 1860D–12(h).
The bill says: Section 1857(f)(3) of the Social Security Act (42 U.S.C. 1395w–27(f)(3)), as amended by section 6223(d)(2), is amended by adding at the end the following new subparagraph:
Bill text · Current law (42 U.S.C. 1395w-27)
42 U.S.C. 1395l(t)added (23)by H.R. 7148 Sec. 6225(a)
(23) Use of unique health identifiers; attestation.—(A) In general.— No payment may be made under this subsection (or under an applicable payment system pursuant to paragraph (21)) for items and services furnished on or after January 1, 2028, by an off-campus outpatient department of a provider (as defined in subparagraph (C)) unless—(i) such department has obtained, and such items and services are billed under, a National Provider Identifier that is separate from such identifier for such provider;(ii) such provider has submitted to the Secretary, during the 2-year period ending on the date such items and services are so furnished, an initial provider-based status attestation that such department is compliant with the requirements described in section 413.65 of title 42, Code of Federal Regulations (or a successor regulation), which, until the Secretary establishes the process described in subparagraph (B), may include an attestation submitted in accordance with paragraph (b)(3) of such section (as in effect on the date of enactment of this paragraph); and(iii) after such provider has submitted an attestation under clause (ii), such provider has submitted a subsequent attestation within the timeframe specified by the Secretary.(B) Process for submission and review.—(i) In general.— The Secretary shall, through notice and comment rulemaking, establish a process for each provider with an off-campus outpatient department of a provider to submit an initial and subsequent attestation pursuant to clauses (ii) and (iii), respectively, of subparagraph (A), and for the Secretary to review each such attestation and determine, through site visits, remote audits, or other means (as determined appropriate by the Secretary), whether such department is compliant with the requirements described in such subparagraph.(ii) Funding.— In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $20,000,000, to remain available until expended, for purposes of carrying out this subparagraph.(C) Off-campus outpatient department of a provider defined.— For purposes of this paragraph, the term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65 of title 42, Code of Federal Regulations, or any successor regulation) that is not located—(i) on the campus (as defined in such section) of such provider; or(ii) within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).
The bill says: Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph:
Bill text · Current law (42 U.S.C. 1395l)
42 U.S.C. 1395m-1(b)(3)(A)changedby H.R. 7148 Sec. 6226(a)
The bill says: in subparagraph (A), by striking "2028" and inserting "2029"; and
Bill text · Current law (42 U.S.C. 1395m-1)
42 U.S.C. 1395m-1(b)(3)(B)(ii)changedby H.R. 7148 Sec. 6226(a)
The bill says: in clause (ii), by striking "2025 and for the period beginning on January 1, 2026, and ending on January 30, 2026" and inserting "2026"; and
Bill text · Current law (42 U.S.C. 1395m-1)
42 U.S.C. 1395m-1(b)(3)(B)(iii)changedby H.R. 7148 Sec. 6226(a)
The bill says: in clause (iii), by striking "the period beginning on January 31, 2026, and ending on December 31, 2026, and for each of 2027 and 2028" and inserting "each of 2027 through 2029".
Bill text · Current law (42 U.S.C. 1395m-1)
42 U.S.C. 1395m-1(a)(4)(B)changedby H.R. 7148 Sec. 6226(b)
The bill says: Section 1834A(a)(4)(B) of the Social Security Act (42 U.S.C. 1395m–1(a)(4)(B)) is amended by striking "2019" each place it appears and inserting "2025" in each such place.
Bill text · Current law (42 U.S.C. 1395m-1)
42 U.S.C. 1395m-1(a)(1)(B)(i)changedby H.R. 7148 Sec. 6226(c)
The bill says: in clause (i), by striking "January 31" and inserting "April 30"; and
Bill text · Current law (42 U.S.C. 1395m-1)
42 U.S.C. 1395m-1(a)(1)(B)(ii)changedby H.R. 7148 Sec. 6226(c)
The bill says: in clause (ii), by striking "February 1, 2026, and ending April 30, 2026" and inserting "May 1, 2026, and ending July 31, 2026".
Bill text · Current law (42 U.S.C. 1395m-1)
2 U.S.C. 901a(6)(D)changedby H.R. 7148 Sec. 6227(1)
The bill says: in subparagraph (D), by striking "such that," and all that follows and inserting "such that the payment reduction shall be 2.0 percent for such fiscal year."; and
Bill text · Current law (2 U.S.C. 901a)
2 U.S.C. 901a(6)added (F)by H.R. 7148 Sec. 6227(2)
(F) On the date on which the President submits the budget under section 1105 of title 31, United States Code, for fiscal year 2033, the President shall order a sequestration of payments for the Medicare programs specified in section 256(d), effective upon issuance, such that, notwithstanding the 2 percent limit specified in subparagraph (A) for such payments—(i) with respect to the first 5 months in which such order is effective for such fiscal year, the payment reduction shall be 2.0 percent; and(ii) with respect to the last 7 months in which such order is effective for such fiscal year, the payment reduction shall be 0 percent.
The bill says: by adding at the end the following:
Bill text · Current law (2 U.S.C. 901a)
42 U.S.C. 1395iii(b)(1)changedby H.R. 7148 Sec. 6228
The bill says: Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking "$1,403,000,000" and inserting "$2,062,000,000".
Bill text · Current law (42 U.S.C. 1395iii)
42 U.S.C. 710(a)(1)changedby H.R. 7148 Sec. 6301(1)
The bill says: by striking "2025, and for the period beginning on October 1, 2025, and ending on January 30, 2026" and inserting "2026, and for the period beginning on October 1, 2026, and ending on December 31, 2026"; and
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 710(a)(1)changedby H.R. 7148 Sec. 6301(1)
The bill says: by striking "fiscal year 2026" and inserting "fiscal year 2027"; and
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 710(a)(2)(A)changedby H.R. 7148 Sec. 6301(1)
The bill says: by striking "through 2025" and inserting "through 2026"; and
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 710(a)(2)(A)changedby H.R. 7148 Sec. 6301(1)
The bill says: by striking "fiscal year 2026" each place it appears and inserting "fiscal year 2027"; and
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 710(a)(2)(B)(i)changedby H.R. 7148 Sec. 6301(1)
The bill says: in subparagraph (B)(i), by striking "2026" and inserting "2027"; and
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 710(f)(1)changedby H.R. 7148 Sec. 6301(2)
The bill says: in subsection (f)(1) by striking "2025, and for the period beginning on October 1, 2025, and ending on January 30, 2026, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025" and inserting "2026, and for the period beginning on October 1, 2026, and ending on December 31, 2026, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2026".
Bill text · Current law (42 U.S.C. 710)
42 U.S.C. 713(a)(1)(A)changedby H.R. 7148 Sec. 6302(1)
The bill says: in subparagraph (A), in the matter preceding clause (i), by striking "2025, and for the period beginning on October 1, 2025, and ending on January 30, 2026" and inserting "2026, and for the period beginning on October 1, 2026, and ending on December 31, 2026"; and
Bill text
42 U.S.C. 713(a)(1)(B)(i)changedby H.R. 7148 Sec. 6302(1)
The bill says: in subparagraph (B)(i), by striking "fiscal years 2024 and 2025, and for the period beginning on October 1, 2025, and ending on January 30, 2026" and inserting "fiscal years 2025 and 2026, and for the period beginning on October 1, 2026, and ending on December 31, 2026";
Bill text
42 U.S.C. 713(c)(3)changedby H.R. 7148 Sec. 6302(2)
The bill says: in subsection (c)(3), by striking "2026" and inserting "2027"; and
Bill text
42 U.S.C. 713(f)changedby H.R. 7148 Sec. 6302(3)
The bill says: in subsection (f), by striking "2025, and for the period beginning on October 1, 2025, and ending on January 30, 2026, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2025" and inserting "2026, and for the period beginning on October 1, 2026, and ending on December 31, 2026, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2026".
Bill text
42 U.S.C. 701(c)(1)(A)(viii)changedby H.R. 7148 Sec. 6303(1)
The bill says: in clause (viii), by striking "for fiscal year 2025" and inserting "for each of fiscal years 2025 and 2026"; and
Bill text · Current law (42 U.S.C. 701)
42 U.S.C. 701(c)(1)(A)(ix)changedby H.R. 7148 Sec. 6303(2)
The bill says: in clause (ix), by striking "October 1, 2025, and ending on January 30, 2026, an amount equal to the pro rata portion of the amount appropriated for fiscal year 2025" and inserting "October 1, 2026, and ending on December 31, 2026, an amount equal to the pro rata portion of the amount appropriated for fiscal year 2026".
Bill text · Current law (42 U.S.C. 701)
42 U.S.C. 254b-2(b)(1)changedby H.R. 7148 Sec. 6401(a)
(H) $4,236,712,328 for fiscal year 2024;(I) $4,295,287,671 for fiscal year 2025;(J) $4,600,000,000 for fiscal year 2026; and(K) $1,159,452,055 for the period beginning on October 1, 2026, and ending on December 31, 2026; and
The bill says: Section 10503(b)(1) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(1)) is amended by striking subparagraphs (H), (I), (J), and (K) and inserting the following:
Bill text · Current law (42 U.S.C. 254b-2)
42 U.S.C. 254b-2(b)(2)changedby H.R. 7148 Sec. 6401(b)
(I) $341,208,605 for fiscal year 2024;(J) $349,736,600 for fiscal year 2025;(K) $350,000,000 for fiscal year 2026; and(L) $88,219,178 for the period beginning on October 1, 2026, and ending on December 31, 2026.
The bill says: Section 10503(b)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(2)) is amended by striking subparagraphs (I), (J), (K), and (L) and inserting the following:
Bill text · Current law (42 U.S.C. 254b-2)
42 U.S.C. 256h(g)(1)changedby H.R. 7148 Sec. 6401(c)
(D) $168,915,878 for fiscal year 2024;(E) $181,563,574 for fiscal year 2025;(F) $225,000,000 for fiscal year 2026;(G) $250,000,000 for fiscal year 2027;(H) $275,000,000 for fiscal year 2028; and(I) $300,000,000 for fiscal year 2029.
The bill says: Section 340H(g)(1) of the Public Health Service Act (42 U.S.C. 256h(g)(1)) is amended by striking subparagraphs (D), (E), (F), and (G) and inserting the following:
Bill text · Current law (42 U.S.C. 256h)
18 U.S.C. 3014(h)(4)changedby H.R. 7148 Sec. 6401(e)
The bill says: Section 3014(h)(4) of title 18, United States Code, is amended by striking "and section 6101(d) of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026" and inserting "section 6101(d) of the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, 2026, and section 6401(d) of the Consolidated Appropriations Act, 2026".
Bill text · Current law (18 U.S.C. 3014)
42 U.S.C. 254c-2(b)(2)changedby H.R. 7148 Sec. 6402(a)
(E) $155,619,196 for fiscal year 2024, to remain available until expended;(F) $159,228,188 for fiscal year 2025, to remain available until expended;(G) $200,000,000 for fiscal year 2026, to remain available until expended; and(H) $50,410,959 for the period beginning on October 1, 2026, and ending on December 31, 2026, to remain available until expended.
The bill says: Section 330B(b)(2) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)) is amended by striking subparagraphs (E), (F), (G), and (H) and inserting the following:
Bill text
42 U.S.C. 254c-3(c)(2)changedby H.R. 7148 Sec. 6402(b)
(E) $155,619,196 for fiscal year 2024, to remain available until expended;(F) $159,228,188 for fiscal year 2025, to remain available until expended;(G) $200,000,000 for fiscal year 2026, to remain available until expended; and(H) $50,410,959 for the period beginning on October 1, 2026, and ending on December 31, 2026, to remain available until expended.
The bill says: Section 330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)) is amended by striking subparagraphs (E), (F), (G), and (H) and inserting the following:
Bill text
42 U.S.C. 247d(e)(8)changedby H.R. 7148 Sec. 6403(a)
The bill says: Section 319(e)(8) of the Public Health Service Act (42 U.S.C. 247d(e)(8)) is amended by striking "January 30, 2026" and inserting "December 31, 2026".
Bill text
42 U.S.C. 300hh-11(c)(4)(B)changedby H.R. 7148 Sec. 6403(g)
The bill says: Section 2812(c)(4)(B) of the Public Health Service Act (42 U.S.C. 300hh–11(c)(4)(B)) is amended by striking "January 30, 2026" and inserting "December 31, 2026".
Bill text
Public Law 116-260(a)(1)changedby H.R. 7148 Sec. 6404(1)
The bill says: in paragraph (1), by striking "January 30, 2026" and inserting "December 31, 2026"; and
Bill text
Public Law 116-260(a)(2)changedby H.R. 7148 Sec. 6404(2)
The bill says: by striking "$14,000,000" and inserting "$42,100,000"; and
Bill text
Public Law 116-260(a)(2)changedby H.R. 7148 Sec. 6404(2)
The bill says: by striking "January 30, 2026" and inserting "December 31, 2026".
Bill text
42 U.S.C. 300mm-61(a)(2)(A)(x)changedby H.R. 7148 Sec. 6411(a)
The bill says: in clause (x), by striking "; and" and inserting a semicolon;
Bill text
42 U.S.C. 300mm-61(a)(2)(A)renumberedby H.R. 7148 Sec. 6411(a)
The bill says: by redesignating clause (xi) as clause (xii); and
Bill text
42 U.S.C. 300mm-61(a)(2)(A)added (xi)by H.R. 7148 Sec. 6411(a)
(xi) for each of fiscal years 2026 through 2040—(I) the amount determined under this subparagraph for the previous fiscal year multiplied by 1.07; multiplied by(II) the ratio of—(aa) the total number of individuals enrolled in the WTC Program on July 1 of such previous fiscal year; to(bb) the total number of individuals so enrolled on July 1 of the fiscal year prior to such previous fiscal year; and
The bill says: by inserting after clause (x), the following:
Bill text
42 U.S.C. 300mmchangedby H.R. 7148 Sec. 6411(c)
The bill says: in section 3352(d) (42 U.S.C. 300mm–62(d)), by striking "Any amounts" and inserting "Any unobligated amounts";
Bill text
42 U.S.C. 300mmchangedby H.R. 7148 Sec. 6411(c)
The bill says: in section 3353(d) (42 U.S.C. 300mm–63(d)), by striking "Any amounts" and inserting "Any unobligated amounts"; and
Bill text
42 U.S.C. 300mmchangedby H.R. 7148 Sec. 6411(c)
The bill says: in section 3354(d) (42 U.S.C. 300mm–64(d)), by striking "Any amounts" and inserting "Any unobligated amounts".
Bill text
42 U.S.C. 247b-12(d)(1)(A)changedby H.R. 7148 Sec. 6501(a)
The bill says: in paragraph (1)(A), by inserting "(including obstetricians and gynecologists)" after "clinical specialties"; and
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 247b-12(d)(3)(A)(i)(I)changedby H.R. 7148 Sec. 6501(a)
The bill says: in subclause (I), by striking "as applicable" and inserting "if available"; and
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 247b-12(d)(3)(A)(i)(III)changedby H.R. 7148 Sec. 6501(a)
The bill says: in subclause (III), by striking ", as appropriate" and inserting "and coordinating with individuals responsible for certifying deaths to improve the collection and quality of death record reports, including by amending errors and missing or incomplete information to cause-of-death information on a death certificate, as appropriate".
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 247b-12renumberedby H.R. 7148 Sec. 6501(b)
The bill says: by redesignating subsections (e) and (f) as subsections (f) and (g), respectively; and
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 247b-12added (e)by H.R. 7148 Sec. 6501(b)
(e) Best practices relating to the prevention of maternal mortality.—(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall, in consultation with the Administrator of the Health Resources and Services Administration, identify and disseminate to health care providers, relevant professional societies, and perinatal quality collaboratives, best practices related to preventing maternal morbidity and mortality, taking into consideration any relevant findings from other Federal maternal health programs.(2) Frequency.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall disseminate the best practices referred to in paragraph (1) not less than once per fiscal year.
The bill says: by inserting after subsection (d) the following:
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 247b-12(g)changedby H.R. 7148 Sec. 6501(c)
The bill says: Subsection (g) of section 317K of the Public Health Service Act (42 U.S.C. 247b–12), as redesignated by subsection (b)(1), is amended by striking "$58,000,000 for each of fiscal years 2019 through 2023" and inserting "$100,000,000 for each of fiscal years 2026 through 2030".
Bill text · Current law (42 U.S.C. 247b-12)
42 U.S.C. 274(b)(2)(A)(i)changedby H.R. 7148 Sec. 6502(1)
The bill says: in clause (i), by striking ", and" and inserting "; and"; and
Bill text
42 U.S.C. 274(b)(2)(A)(ii)changedby H.R. 7148 Sec. 6502(1)
The bill says: in clause (ii), by striking the comma at the end and inserting a semicolon;
Bill text
42 U.S.C. 274(b)(2)(C)changedby H.R. 7148 Sec. 6502(1)
The bill says: in subparagraph (C), by striking "twenty-four-hour telephone service" and inserting "24-hour telephone or information technology service";
Bill text
42 U.S.C. 274(b)(2)changedby H.R. 7148 Sec. 6502(1)
The bill says: in each of subparagraphs (B) through (M), by striking the comma at the end and inserting a semicolon;
Bill text
42 U.S.C. 274(b)(2)(N)changedby H.R. 7148 Sec. 6502(1)
The bill says: in subparagraph (N), by striking "transportation, and" and inserting "transportation;";
Bill text
42 U.S.C. 274(b)(2)(O)changedby H.R. 7148 Sec. 6502(1)
The bill says: in subparagraph (O), by striking the period and inserting a semicolon; and
Bill text
42 U.S.C. 274(b)(2)added (P)by H.R. 7148 Sec. 6502(1)
(P) encourage the integration of electronic health records systems through application programming interfaces (or successor technologies) among hospitals, organ procurement organizations, and transplant centers, including the use of automated electronic hospital referrals and the grant of remote, electronic access to hospital electronic health records of potential donors by organ procurement organizations, in a manner that complies with the privacy regulations promulgated under the Health Insurance Portability and Accountability Act of 1996, at part 160 of title 45, Code of Federal Regulations, and subparts A, C, and E of part 164 of such title (or any successor regulations); and(Q) consider establishing a dashboard to display the number of transplants performed, the types of transplants performed, the number and types of organs that entered the Organ Procurement and Transplantation Network system and failed to be transplanted, and other appropriate statistics, which should be updated more frequently than annually.
The bill says: by adding at the end the following:
Bill text
42 U.S.C. 274added (d)by H.R. 7148 Sec. 6502(2)
(d) Registration fees.—(1) In general.— The Secretary may collect registration fees from any member of the Organ Procurement and Transplantation Network for each transplant candidate such member places on the list described in subsection (b)(2)(A)(i). Such registration fees shall be collected and distributed only to support the operation of the Organ Procurement and Transplantation Network. Such registration fees are authorized to remain available until expended.(2) Collection.— The Secretary may collect the registration fees under paragraph (1) directly or through awards made under subsection (b)(1)(A).(3) Distribution.— Any amounts collected under this subsection shall—(A) be credited to the currently applicable appropriation, account, or fund of the Department of Health and Human Services as discretionary offsetting collections; and(B) be available, only to the extent and in the amounts provided in advance in appropriations Acts, to distribute such fees among awardees described in subsection (b)(1)(A).(4) Transparency.— The Secretary shall—(A) promptly post on the website of the Organ Procurement and Transplantation Network—(i) the amount of registration fees collected under this subsection from each member of the Organ Procurement and Transplantation Network; and(ii) a list of activities such fees are used to support; and(B) update the information posted pursuant to subparagraph (A), as applicable for each calendar quarter for which fees are collected under paragraph (1).(5) GAO review.— Not later than 2 years after the date of enactment of this subsection, the Comptroller General of the United States shall, to the extent data are available—(A) conduct a review concerning the activities under this subsection; and(B) submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives, a report on such review, including related recommendations, as applicable.(6) Sunset.— The authority to collect registration fees under paragraph (1) shall expire on the date that is 3 years after the date of enactment of the Consolidated Appropriations Act, 2026.
The bill says: by adding at the end the following:
Bill text
42 U.S.C. 274frenumberedby H.R. 7148 Sec. 6503(a)
The bill says: by redesignating subsections (c) through (f) as subsections (d) through (g), respectively;
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274fadded (c)by H.R. 7148 Sec. 6503(a)
(c) No consideration of income of organ recipient.— The recipient of a grant under this section, in providing reimbursement to a donating individual through such grant, shall not give any consideration to the income of the organ recipient.
The bill says: by inserting after subsection (b) the following:
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274f(f)(1)changedby H.R. 7148 Sec. 6503(a)
The bill says: in paragraph (1), by striking "subsection (c)(1)" and inserting "subsection (d)(1)"; and
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274f(f)(2)changedby H.R. 7148 Sec. 6503(a)
The bill says: in paragraph (2), by striking "subsection (c)(2)" and inserting "subsection (d)(2)".
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274f(e)(1)changedby H.R. 7148 Sec. 6503(b)
The bill says: in paragraph (1), by adding "or" at the end;
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274f(e)(2)changedby H.R. 7148 Sec. 6503(b)
The bill says: in paragraph (2), by striking "; or" and inserting a period; and
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274f(e)removedby H.R. 7148 Sec. 6503(b)
The bill says: by striking paragraph (3).
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 274fadded (h)by H.R. 7148 Sec. 6503(c)
(h) Annual report.— Not later than December 31 of each year, beginning in fiscal year 2027, the Secretary shall—(1) prepare, submit to the Congress, and make public a report on whether grants under this section provided adequate funding during the preceding fiscal year to reimburse all donating individuals participating in the grant program under this section for all qualifying expenses; and(2) include in each such report—(A) the estimated number of all donating individuals participating in the grant program under this section who did not receive reimbursement for all qualifying expenses during the preceding fiscal year; and(B) the total amount of funding that is estimated to be necessary to fully reimburse all donating individuals participating in the grant program under this section for all qualifying expenses.
The bill says: Section 377 of the Public Health Service Act (42 U.S.C. 274f), as amended by subsections (a) and (b), is amended by adding at the end the following:
Bill text · Current law (42 U.S.C. 274f)
42 U.S.C. 284m(d)(1)changedby H.R. 7148 Sec. 6504
The bill says: Section 409I(d)(1) of the Public Health Service Act (42 U.S.C. 284m(d)(1)) is amended by striking "section," and all that follows through the period at the end and inserting "section, $25,000,000 for each of fiscal years 2026 through 2028.".
Bill text
42 U.S.C. 300b-5(b)(1)(A)(iii)changedby H.R. 7148 Sec. 6505(a)
The bill says: in paragraph (1)(A)(iii), by striking "prevention and treatment of sickle cell disease" and inserting "treatment of sickle cell disease and the prevention and treatment of complications of sickle cell disease";
Bill text
42 U.S.C. 300b-5(b)(2)(D)changedby H.R. 7148 Sec. 6505(a)
The bill says: in paragraph (2)(D), by striking "prevention and treatment of sickle cell disease" and inserting "treatment of sickle cell disease and the prevention and treatment of complications of sickle cell disease";
Bill text
42 U.S.C. 300b-5(b)(3)(A)changedby H.R. 7148 Sec. 6505(a)
The bill says: in subparagraph (A), by striking "enter into a contract with" and inserting "make a grant to, or enter into a contract or cooperative agreement with,"; and
Bill text
42 U.S.C. 300b-5(b)(3)(B)changedby H.R. 7148 Sec. 6505(a)
The bill says: in subparagraph (B), in each of clauses (ii) and (iii), by striking "prevention and treatment of sickle cell disease" and inserting "treatment of sickle cell disease and the prevention and treatment of complications of sickle cell disease"; and
Bill text
42 U.S.C. 300b-5(b)(6)changedby H.R. 7148 Sec. 6505(a)
The bill says: in paragraph (6), by striking "$4,455,000 for each of fiscal years 2019 through 2023" and inserting "$8,205,000 for each of fiscal years 2026 through 2030".
Bill text
42 U.S.C. 300ii(5)changedby H.R. 7148 Sec. 6506(a)
The bill says: Section 2901(5) of the Public Health Service Act (42 U.S.C. 300ii(5)) is amended by striking "unpaid adult" and inserting "unpaid individual".
Bill text
42 U.S.C. 300ii-4changedby H.R. 7148 Sec. 6506(b)
The bill says: Section 2905 of the Public Health Service Act (42 U.S.C. 300ii–4) is amended by striking "fiscal years 2020 through fiscal year 2024" and inserting "fiscal years 2026 through 2030".
Bill text
Public Law 115-328changedby H.R. 7148 Sec. 6507(a)
The bill says: Effective as if included in the enactment of the PREEMIE Reauthorization Act of 2018 (Public Law 115–328), section 2 of such Act is amended, in the matter preceding paragraph (1), by striking "Section 2" and inserting "Section 3".
Bill text
Public Law 115-328(a)changedby H.R. 7148 Sec. 6507(b)
The bill says: Section 5(a) of the PREEMIE Reauthorization Act of 2018 (Public Law 115–328) is amended by striking "The Secretary of Health and Human Services, in collaboration with other departments, as appropriate, may establish" and inserting "Not later than 18 months after the date of the enactment of the Consolidated Appropriations Act, 2026, the Secretary of Health and Human Services, in collaboration with other departments, as appropriate, shall establish".
Bill text
Public Law 117-105changedby H.R. 7148 Sec. 6508(a)
The bill says: Section 2 of the Dr. Lorna Breen Health Care Provider Protection Act (Public Law 117–105) is amended by striking "2 years" and inserting "5 years".
Bill text
Public Law 117-105(b)changedby H.R. 7148 Sec. 6508(b)
The bill says: in subsection (b), by inserting "and annually thereafter," after "of this Act,"; and
Bill text
Public Law 117-105(c)changedby H.R. 7148 Sec. 6508(b)
The bill says: in subsection (c), by striking "2022 through 2024" and inserting "2026 through 2030".
Bill text
42 U.S.C. 294trenumberedby H.R. 7148 Sec. 6508(c)
The bill says: by redesignating such section 764 as section 764A;
Bill text · Current law (42 U.S.C. 294t)
42 U.S.C. 294t(a)(3)changedby H.R. 7148 Sec. 6508(c)
The bill says: by striking "to eligible entities in" and inserting “to eligible entities that—
Bill text · Current law (42 U.S.C. 294t)
42 U.S.C. 294t(a)(3)changedby H.R. 7148 Sec. 6508(c)
The bill says: by striking the period and inserting "; or"; and
Bill text · Current law (42 U.S.C. 294t)
42 U.S.C. 294t(a)(3)added (B)by H.R. 7148 Sec. 6508(c)
(B) have a focus on the reduction of administrative burden on health care workers.
The bill says: by adding at the end the following:
Bill text · Current law (42 U.S.C. 294t)
42 U.S.C. 294t(c)changedby H.R. 7148 Sec. 6508(c)
The bill says: in subsection (c), by inserting "not less than" after "period of"; and
Bill text · Current law (42 U.S.C. 294t)
42 U.S.C. 294t(f)changedby H.R. 7148 Sec. 6508(c)
The bill says: in subsection (f), by striking "2022 through 2024" and inserting "2026 through 2030".
Bill text · Current law (42 U.S.C. 294t)
21 U.S.C. 355c(a)(3)renumberedby H.R. 7148 Sec. 6601(a)
The bill says: by redesignating subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively; and
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(a)(3)changedby H.R. 7148 Sec. 6601(a)
(A) In general.— For purposes of paragraph (1)(B), the investigation described in this paragraph is a molecularly targeted pediatric cancer investigation of—(i) the drug or biological product for which the application referred to in such paragraph is submitted; or(ii) such drug or biological product used in combination with—(I) an active ingredient of a drug or biological product—(aa) for which an approved application under section 505(j) under this Act or under section 351(k) of the Public Health Service Act is in effect; and(bb) that is determined by the Secretary, after consultation with the applicant, to be part of the standard of care for treating a pediatric cancer; or(II) an active ingredient of a drug or biological product—(aa) for which an approved application under section 505(b) of this Act or section 351(a) of the Public Health Service Act to treat an adult cancer is in effect and is held by the same person submitting the application under paragraph (1)(B); and(bb) that is directed at a molecular target that the Secretary determines to be substantially relevant to the growth or progression of a pediatric cancer.(B) Additional requirements.—(i) Design of investigation.— A molecularly targeted pediatric cancer investigation referred to in subparagraph (A) shall be designed to yield clinically meaningful pediatric study data that is gathered using appropriate formulations for each age group for which the study is required, regarding dosing, safety, and preliminary efficacy to inform potential pediatric labeling.(ii) Limitation.— An investigation described in subparagraph (A)(ii) may be required only if the drug or biological product for which the application referred to in paragraph (1)(B) contains either—(I) a single new active ingredient; or(II) more than one active ingredient, if an application for the combination of active ingredients has not previously been approved but each active ingredient is in a drug product that has been previously approved to treat an adult cancer.(iii) Results of already-completed preclinical studies of application drug.— With respect to an investigation required pursuant to paragraph (1)(B), the Secretary may require the results of any completed preclinical studies relevant to the initial pediatric study plan be submitted to the Secretary at the same time that the initial pediatric study plan required under subsection (e)(1) is submitted.(iv) Rule of construction regarding inactive ingredients.— With respect to a combination of active ingredients referred to in subparagraph (A)(ii), such subparagraph shall not be construed as addressing the use of inactive ingredients with such combination.
The bill says: by striking subparagraph (A) and inserting the following:
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(e)(1)addedby H.R. 7148 Sec. 6601(a)
The bill says: Section 505B(e)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355c(e)(1)) is amended by adding at the end the following: "The Secretary shall determine whether subparagraph (A) or (B) of subsection (a)(1) applies with respect to an application before the date on which the applicant is required to submit the initial pediatric study plan under paragraph (2)(A).".
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(a)(1)added (C)by H.R. 7148 Sec. 6601(a)
(C) Rule of construction.— No application that is subject to the requirements of subparagraph (B) shall be subject to the requirements of subparagraph (A), and no application (or supplement to an application) that is subject to the requirements of subparagraph (A) shall be subject to the requirements of subparagraph (B).
The bill says: Section 505B(a)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355c(a)(1)) is amended by adding at the end the following:
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(a)(3)(C)changedby H.R. 7148 Sec. 6601(a)
The bill says: in paragraph (3)(C), as redesignated by paragraph (1)(A) of this subsection, by striking "investigations described in this paragraph" and inserting "investigations referred to in subparagraph (A)"; and
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(a)(3)(D)changedby H.R. 7148 Sec. 6601(a)
The bill says: in paragraph (3)(D), as redesignated by paragraph (1)(A) of this subsection, by striking "the assessments under paragraph (2)(B)" and inserting "the assessments required under paragraph (1)(A)".
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(d)(1)changedby H.R. 7148 Sec. 6602(a)
The bill says: in paragraph (1), by striking "Beginning 270" and inserting "Noncompliance letter.—Beginning 270";
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(d)(2)changedby H.R. 7148 Sec. 6602(a)
The bill says: by striking "The drug or" and inserting "Effect of noncompliance.—The drug or"; and
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(d)(2)changedby H.R. 7148 Sec. 6602(a)
The bill says: by striking "(except that the drug or biological product shall not be subject to action under section 303)" and inserting "(except that the drug or biological product shall be subject to action under section 303 only if such person demonstrated a lack of due diligence in satisfying the applicable requirement)"; and
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 355c(d)added (3)by H.R. 7148 Sec. 6602(a)
(3) Limitation.— The Secretary shall not issue enforcement actions under section 303 for failures under this subsection in the case of a drug or biological product that is no longer marketed.
The bill says: by adding at the end the following:
Bill text · Current law (21 U.S.C. 355c)
21 U.S.C. 333(f)(4)(A)changedby H.R. 7148 Sec. 6602(c)
The bill says: Section 303(f)(4)(A) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 333(f)(4)(A)) is amended by striking "or 505–1" and inserting "505–1, or 505B".
Bill text · Current law (21 U.S.C. 333)
21 U.S.C. 355c-1(b)(11)changedby H.R. 7148 Sec. 6603(1)
The bill says: in paragraph (11), by striking the semicolon at the end and inserting ", including an evaluation of compliance with deadlines provided for in deferrals and deferral extensions;";
Bill text · Current law (21 U.S.C. 355c-1)
21 U.S.C. 355c-1(b)(15)changedby H.R. 7148 Sec. 6603(2)
The bill says: in paragraph (15), by striking "and" at the end;
Bill text · Current law (21 U.S.C. 355c-1)
21 U.S.C. 355c-1(b)(16)changedby H.R. 7148 Sec. 6603(3)
The bill says: in paragraph (16), by striking the period at the end and inserting "; and"; and
Bill text · Current law (21 U.S.C. 355c-1)
21 U.S.C. 355c-1(b)added (17)by H.R. 7148 Sec. 6603(4)
(17) a listing of penalties, settlements, or payments under section 303 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353) for failure to comply with requirements under such section 505B, including, for each penalty, settlement, or payment, the name of the drug, the sponsor thereof, and the amount of the penalty, settlement, or payment imposed.
The bill says: by adding at the end the following:
Bill text · Current law (21 U.S.C. 355c-1)
21 U.S.C. 360ff(b)changedby H.R. 7148 Sec. 6604(a)
The bill says: Paragraph (5) of section 529(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360ff(b)) is amended by striking "December 20, 2024, unless" and all that follows through the period at the end and inserting "September 30, 2029.".
Bill text · Current law (21 U.S.C. 360ff)
21 U.S.C. 360ff(c)(4)changedby H.R. 7148 Sec. 6604(b)
The bill says: Section 529(c)(4) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360ff(c)(4)) is amended by striking subparagraph (A) and inserting the following:
Bill text · Current law (21 U.S.C. 360ff)
21 U.S.C. 360cc(a)changedby H.R. 7148 Sec. 6605(a)
The bill says: in subsection (a), in the matter following paragraph (2), by striking "same disease or condition" and inserting "same approved use or indication within such rare disease or condition";
Bill text · Current law (21 U.S.C. 360cc)
21 U.S.C. 360cc(b)changedby H.R. 7148 Sec. 6605(a)
The bill says: in the matter preceding paragraph (1), by striking "same rare disease or condition" and inserting "same approved use or indication for which such 7-year period applies to such already approved or licensed drug"; and
Bill text · Current law (21 U.S.C. 360cc)
21 U.S.C. 360cc(b)(1)changedby H.R. 7148 Sec. 6605(a)
The bill says: in paragraph (1), by inserting ", relating to the approved use or indication," after "the needs";
Bill text · Current law (21 U.S.C. 360cc)
21 U.S.C. 360cc(c)(1)changedby H.R. 7148 Sec. 6605(a)
The bill says: in subsection (c)(1), by striking "same rare disease or condition as the already approved drug" and inserting "same use or indication for which the already approved or licensed drug was approved or licensed"; and
Bill text · Current law (21 U.S.C. 360cc)
21 U.S.C. 360ccadded (f)by H.R. 7148 Sec. 6605(a)
(f) Approved use or indication defined.— In this section, the term approved use or indication means the use or indication approved under section 505 of this Act or licensed under section 351 of the Public Health Service Act for a drug designated under section 526 for a rare disease or condition.
The bill says: by adding at the end the following:
Bill text · Current law (21 U.S.C. 360cc)
21 U.S.C. 391added 1015by H.R. 7148 Sec. 6611(a)
1015 Abraham Accords Office.—(a) In general.— The Secretary, acting through the Commissioner of Food and Drugs, shall establish within the Food and Drug Administration an office, to be known as the Abraham Accords Office, to be headed by a director.(b) Office.— Not later than 2 years after the date of enactment of this section, the Secretary shall—(1) in consultation with the governments of Abraham Accords countries, as well as appropriate United States Government diplomatic and security personnel—(A) select the location of the Abraham Accords Office in an Abraham Accords country; and(B) establish such office; and(2) assign to such office such personnel of the Food and Drug Administration as the Secretary determines necessary to carry out the functions of such office.(c) Duties.— The Secretary, acting through the Director of the Abraham Accords Office, shall—(1) after the Abraham Accords Office is established—(A) as part of the Food and Drug Administration’s work to strengthen the international oversight of regulated commodities, provide technical assistance to regulatory partners in Abraham Accords countries on strengthening regulatory oversight and converging regulatory requirements for the oversight of regulated products, including good manufacturing practices and other issues relevant to manufacturing medical products that are regulated by the Food and Drug Administration; and(B) facilitate interactions between the Food and Drug Administration and interested parties in Abraham Accords countries, including by sharing relevant information regarding United States regulatory pathways with such parties, and facilitate feedback on the research, development, and manufacturing of products regulated in accordance with this Act; and(2) carry out other functions and activities as the Secretary determines to be necessary to carry out this section.(d) Abraham Accords country defined.— In this section, the term Abraham Accords country means a country identified by the Department of State as having signed the Abraham Accords Declaration.(e) National security.— Nothing in this section shall be construed to require any action inconsistent with a national security recommendation provided by the Federal Government.
The bill says: Chapter X of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 391 et seq.) is amended by adding at the end the following:
Bill text · Current law (21 U.S.C. 391)
42 U.S.C. 300ggadded 2799A–11by H.R. 7148 Sec. 6701(a)
2799A–11. Oversight of entities that provide pharmacy benefit management services.—(a) In general.— For plan years beginning on or after the date that is 30 months after the date of enactment of this section (referred to in this subsection and subsection (b) as the "effective date"), a group health plan or a health insurance issuer offering group health insurance coverage, or an entity providing pharmacy benefit management services on behalf of such a plan or issuer, shall not enter into a contract, including an extension or renewal of a contract, entered into on or after the effective date, with an applicable entity unless such applicable entity agrees to—(1) not limit or delay the disclosure of information to the group health plan (including such a plan offered through a health insurance issuer) in such a manner that prevents an entity providing pharmacy benefit management services on behalf of a group health plan or health insurance issuer offering group health insurance coverage from making the reports described in subsection (b); and(2) provide the entity providing pharmacy benefit management services on behalf of a group health plan or health insurance issuer relevant information necessary to make the reports described in subsection (b).(b) Reports.—(1) In general.— For plan years beginning on or after the effective date, in the case of any contract between a group health plan or a health insurance issuer offering group health insurance coverage offered in connection with such a plan and an entity providing pharmacy benefit management services on behalf of such plan or issuer, including an extension or renewal of such a contract, entered into on or after the effective date, the entity providing pharmacy benefit management services on behalf of such a group health plan or health insurance issuer, not less frequently than every 6 months (or, at the request of a group health plan, not less frequently than quarterly, and under the same conditions, terms, and cost of the semiannual report under this subsection), shall submit to the group health plan a report in accordance with this section. Each such report shall be made available to such group health plan in plain language, in a machine-readable format, and as the Secretary may determine, other formats. Each such report shall include the information described in paragraph (2).(2) Information described.— For purposes of paragraph (1), the information described in this paragraph is, with respect to drugs covered by a group health plan or group health insurance coverage offered by a health insurance issuer in connection with a group health plan during each reporting period—(A) in the case of a group health plan that is offered by a specified large employer or that is a specified large plan, and is not offered as health insurance coverage, or in the case of health insurance coverage for which the election under paragraph (3) is made for the applicable reporting period—(i) a list of drugs for which a claim was filed and, with respect to each such drug on such list—(I) the contracted compensation paid by the group health plan or health insurance issuer for each covered drug (identified by the National Drug Code) to the entity providing pharmacy benefit management services or other applicable entity on behalf of the group health plan or health insurance issuer;(II) the contracted compensation paid to the pharmacy, by any entity providing pharmacy benefit management services or other applicable entity on behalf of the group health plan or health insurance issuer, for each covered drug (identified by the National Drug Code);(III) for each such claim, the difference between the amount paid under subclause (I) and the amount paid under subclause (II);(IV) the proprietary name, established name or proper name, and the National Drug Code;(V) for each claim for the drug (including original prescriptions and refills) and for each dosage unit of the drug for which a claim was filed, the type of dispensing channel used to furnish the drug, including retail, mail order, or specialty pharmacy;(VI) with respect to each drug dispensed, for each type of dispensing channel (including retail, mail order, or specialty pharmacy)—(aa) whether such drug is a brand name drug or a generic drug, and—(AA) in the case of a brand name drug, the wholesale acquisition cost, listed as cost per days supply and cost per dosage unit, on the date such drug was dispensed; and(BB) in the case of a generic drug, the average wholesale price, listed as cost per days supply and cost per dosage unit, on the date such drug was dispensed; and(bb) the total number of—(AA) prescription claims (including original prescriptions and refills);(BB) participants and beneficiaries for whom a claim for such drug was filed through the applicable dispensing channel;(CC) dosage units and dosage units per fill of such drug; and(DD) days supply of such drug per fill;(VII) the net price per course of treatment or single fill, such as a 30-day supply or 90-day supply to the plan or coverage after rebates, fees, alternative discounts, or other remuneration received from applicable entities;(VIII) the total amount of out-of-pocket spending by participants and beneficiaries on such drug, including spending through copayments, coinsurance, and deductibles, but not including any amounts spent by participants and beneficiaries on drugs not covered under the plan or coverage, or for which no claim is submitted under the plan or coverage;(IX) the total net spending on the drug;(X) the total amount received, or expected to be received, by the plan or issuer from any applicable entity in rebates, fees, alternative discounts, or other remuneration;(XI) the total amount received, or expected to be received, by the entity providing pharmacy benefit management services, from applicable entities, in rebates, fees, alternative discounts, or other remuneration from such entities—(aa) for cl
The bill says: in part D (42 U.S.C. 300gg–111 et seq.), by adding at the end the following new section:
Bill text
42 U.S.C. 300gg(a)(1)changedby H.R. 7148 Sec. 6701(a)
The bill says: in paragraph (1), by inserting "(other than section 2799A–11)" after "part D"; and
Bill text
42 U.S.C. 300gg(a)(2)changedby H.R. 7148 Sec. 6701(a)
The bill says: in paragraph (2), by inserting "(other than section 2799A–11)" after "part D"; and
Bill text
42 U.S.C. 300gg(b)(1)changedby H.R. 7148 Sec. 6701(a)
The bill says: in paragraph (1), by inserting "(other than section 2799A–11)" after "part D";
Bill text
42 U.S.C. 300gg(b)(2)(A)changedby H.R. 7148 Sec. 6701(a)
The bill says: in paragraph (2)(A), by inserting "(other than section 2799A–11)" after "part D"; and
Bill text
42 U.S.C. 300gg(b)(2)(C)(ii)changedby H.R. 7148 Sec. 6701(a)
The bill says: in paragraph (2)(C)(ii), by inserting "(other than section 2799A–11)" after "part D".
Bill text
29 U.S.C. 1021added 726by H.R. 7148 Sec. 6701(b)
726 Oversight of entities that provide pharmacy benefit management services.—(a) In general.— For plan years beginning on or after the date that is 30 months after the date of enactment of this section (referred to in this subsection and subsection (b) as the "effective date"), a group health plan or a health insurance issuer offering group health insurance coverage, or an entity providing pharmacy benefit management services on behalf of such a plan or issuer, shall not enter into a contract, including an extension or renewal of a contract, entered into on or after the effective date, with an applicable entity unless such applicable entity agrees to—(1) not limit or delay the disclosure of information to the group health plan (including such a plan offered through a health insurance issuer) in such a manner that prevents an entity providing pharmacy benefit management services on behalf of a group health plan or health insurance issuer offering group health insurance coverage from making the reports described in subsection (b); and(2) provide the entity providing pharmacy benefit management services on behalf of a group health plan or health insurance issuer relevant information necessary to make the reports described in subsection (b).(b) Reports.—(1) In general.— For plan years beginning on or after the effective date, in the case of any contract between a group health plan or a health insurance issuer offering group health insurance coverage offered in connection with such a plan and an entity providing pharmacy benefit management services on behalf of such plan or issuer, including an extension or renewal of such a contract, entered into on or after the effective date, the entity providing pharmacy benefit management services on behalf of such a group health plan or health insurance issuer, not less frequently than every 6 months (or, at the request of a group health plan, not less frequently than quarterly, and under the same conditions, terms, and cost of the semiannual report under this subsection), shall submit to the group health plan a report in accordance with this section. Each such report shall be made available to such group health plan in plain language, in a machine-readable format, and as the Secretary may determine, other formats. Each such report shall include the information described in paragraph (2).(2) Information described.— For purposes of paragraph (1), the information described in this paragraph is, with respect to drugs covered by a group health plan or group health insurance coverage offered by a health insurance issuer in connection with a group health plan during each reporting period—(A) in the case of a group health plan that is offered by a specified large employer or that is a specified large plan, and is not offered as health insurance coverage, or in the case of health insurance coverage for which the election under paragraph (3) is made for the applicable reporting period—(i) a list of drugs for which a claim was filed and, with respect to each such drug on such list—(I) the contracted compensation paid by the group health plan or health insurance issuer for each covered drug (identified by the National Drug Code) to the entity providing pharmacy benefit management services or other applicable entity on behalf of the group health plan or health insurance issuer;(II) the contracted compensation paid to the pharmacy, by any entity providing pharmacy benefit management services or other applicable entity on behalf of the group health plan or health insurance issuer, for each covered drug (identified by the National Drug Code);(III) for each such claim, the difference between the amount paid under subclause (I) and the amount paid under subclause (II);(IV) the proprietary name, established name or proper name, and the National Drug Code;(V) for each claim for the drug (including original prescriptions and refills) and for each dosage unit of the drug for which a claim was filed, the type of dispensing channel used to furnish the drug, including retail, mail order, or specialty pharmacy;(VI) with respect to each drug dispensed, for each type of dispensing channel (including retail, mail order, or specialty pharmacy)—(aa) whether such drug is a brand name drug or a generic drug, and—(AA) in the case of a brand name drug, the wholesale acquisition cost, listed as cost per days supply and cost per dosage unit, on the date such drug was dispensed; and(BB) in the case of a generic drug, the average wholesale price, listed as cost per days supply and cost per dosage unit, on the date such drug was dispensed; and(bb) the total number of—(AA) prescription claims (including original prescriptions and refills);(BB) participants and beneficiaries for whom a claim for such drug was filed through the applicable dispensing channel;(CC) dosage units and dosage units per fill of such drug; and(DD) days supply of such drug per fill;(VII) the net price per course of treatment or single fill, such as a 30-day supply or 90-day supply to the plan or coverage after rebates, fees, alternative discounts, or other remuneration received from applicable entities;(VIII) the total amount of out-of-pocket spending by participants and beneficiaries on such drug, including spending through copayments, coinsurance, and deductibles, but not including any amounts spent by participants and beneficiaries on drugs not covered under the plan or coverage, or for which no claim is submitted under the plan or coverage;(IX) the total net spending on the drug;(X) the total amount received, or expected to be received, by the plan or issuer from any applicable entity in rebates, fees, alternative discounts, or other remuneration;(XI) the total amount received, or expected to be received, by the entity providing pharmacy benefit management services, from applicable entities, in rebates, fees, alternative discounts, or other remuneration from such entities—(aa) for claims i
The bill says: in subpart B of part 7 (29 U.S.C. 1185 et seq.), by adding at the end the following:
Bill text · Current law (29 U.S.C. 1021)
29 U.S.C. 1021(a)(6)changedby H.R. 7148 Sec. 6701(b)
The bill says: in subsection (a)(6), by striking "or (9)" and inserting "(9), or (13)";
Bill text · Current law (29 U.S.C. 1021)
29 U.S.C. 1021(b)(3)changedby H.R. 7148 Sec. 6701(b)
The bill says: in subsection (b)(3), by striking "under subsection (c)(9)" and inserting "under paragraphs (9) and (13) of subsection (c)"; and
Bill text · Current law (29 U.S.C. 1021)
29 U.S.C. 1021(c)added (13)by H.R. 7148 Sec. 6701(b)
(13) Secretarial enforcement authority relating to oversight of pharmacy benefit management services.—(A) Failure to provide information.— The Secretary may impose a penalty against a plan administrator of a group health plan, a health insurance issuer offering group health insurance coverage, or an entity providing pharmacy benefit management services on behalf of such a plan or issuer, or an applicable entity (as defined in section 726(e)) that violates section 726(a); an entity providing pharmacy benefit management services on behalf of such a plan or issuer that fails to provide the information required under section 726(b); or any person who causes a group health plan to fail to provide the information required under section 726(c), in the amount of $10,000 for each day during which such violation continues or such information is not disclosed or reported.(B) False information.— The Secretary may impose a penalty against a plan administrator of a group health plan, a health insurance issuer offering group health insurance coverage, an entity providing pharmacy benefit management services, or an applicable entity (as defined in section 726(e)) that knowingly provides false information under section 726, in an amount not to exceed $100,000 for each item of false information. Such penalty shall be in addition to other penalties as may be prescribed by law.(C) Waivers.— The Secretary may waive penalties under subparagraph (A), or extend the period of time for compliance with a requirement of this section, for an entity in violation of section 726 that has made a good-faith effort to comply with the requirements of section 726.
The bill says: in subsection (c), by adding at the end the following:
Bill text · Current law (29 U.S.C. 1021)
29 U.S.C. 1021changedby H.R. 7148 Sec. 6701(b)
The bill says: in section 732(a) (29 U.S.C. 1191a(a)), by striking "section 711" and inserting "sections 711 and 726".
Bill text · Current law (29 U.S.C. 1021)
29 U.S.C. 1001addedby H.R. 7148 Sec. 6701(b)
The bill says: The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following new item:
Bill text · Current law (29 U.S.C. 1001)
26 U.S.C. 9831(a)(2)changedby H.R. 7148 Sec. 6701(c)
The bill says: Section 9831(a)(2) of the Internal Revenue Code of 1986 is amended by inserting "other than with respect to section 9826," before "any group health plan".
Bill text · Current law (26 U.S.C. 9831)
26 U.S.C. 4980Dadded (g)by H.R. 7148 Sec. 6701(c)
(g) Application to requirements imposed on certain entities providing pharmacy benefit management services.— In the case of any requirement under section 9826 that applies with respect to an entity providing pharmacy benefit management services on behalf of a group health plan, any reference in this section to such group health plan (and the reference in subsection (e)(1) to the employer) shall be treated as including a reference to such entity.
The bill says: Section 4980D of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection:
Bill text · Current law (26 U.S.C. 4980D)
29 U.S.C. 1108(b)(2)(B)(viii)renumberedby H.R. 7148 Sec. 6702(a)
The bill says: by redesignating subclauses (II) through (IV) as subclauses (III) through (V), respectively;
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(viii)(I)changedby H.R. 7148 Sec. 6702(a)
The bill says: by striking "subclause (II)" and inserting "subclause (III)"; and
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(viii)(I)changedby H.R. 7148 Sec. 6702(a)
The bill says: by striking "subclauses (II) and (III)" and inserting "subclauses (III) and (IV)"; and
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(viii)added (II)by H.R. 7148 Sec. 6702(a)
(II) Pursuant to subsection (a), subparagraphs (C) and (D) of section 406(a)(1) shall not apply to a responsible plan fiduciary, notwithstanding any failure to remit required amounts under subparagraph (C)(i), if the following conditions are met:(aa) The responsible plan fiduciary did not know that the covered service provider failed or would fail to make required remittances and reasonably believed that the covered service provider remitted such required amounts.(bb) The responsible plan fiduciary, upon discovering that the covered service provider failed to remit the required amounts, requests in writing that the covered service provider remit such amounts.(cc) If the covered service provider fails to comply with a written request described in subclause (III) within 90 days of the request, the responsible plan fiduciary notifies the Secretary of the covered service provider’s failure, in accordance with subclauses (III) and (IV).
The bill says: by inserting after subclause (I) the following:
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)added (C)by H.R. 7148 Sec. 6702(a)
(C)(i)(I) For plan years beginning on or after the date that is 30 months after the date of enactment of this subparagraph (referred to in this clause as the "effective date"), no contract or arrangement or renewal or extension of a contract or arrangement, entered into on or after the effective date, for services between a covered plan and a covered service provider (or between a sponsor of a covered plan and a covered service provider), through a health insurance issuer offering group health insurance coverage, a third-party administrator, an entity providing pharmacy benefit management services, or other entity, for pharmacy benefit management services, is reasonable within the meaning of this paragraph unless such entity providing pharmacy benefit management services—(aa) remits 100 percent of rebates, fees, alternative discounts, and other remuneration received from any applicable entity that are related to utilization of drugs or drug spending under such health plan or health insurance coverage, to the group health plan or, in the case of a health insurance issuer offering group health insurance coverage in connection with a group health plan, to the health insurance issuer offering group health insurance coverage on behalf of the plan; and(bb) does not enter into any contract for pharmacy benefit management services on behalf of such a plan or coverage, with an applicable entity unless 100 percent of rebates, fees, alternative discounts, and other remuneration received under such contract that are related to the utilization of drugs or drug spending under such group health plan or health insurance coverage are remitted to the group health plan or, in the case of a health insurance issuer offering group health insurance coverage in connection with a group health plan, to the health insurance issuer on behalf of the plan by the entity providing pharmacy benefit management services.(II) Nothing in subclause (I) shall be construed to affect the term of a contract or arrangement, as in effect on the effective date (as described in such subclause), except that such subclause shall apply to any renewal or extension of such a contract or arrangement entered into on or after such effective date, as so described.(ii) With respect to such rebates, fees, alternative discounts, and other remuneration—(I) the rebates, fees, alternative discounts, and other remuneration under clause (i)(I) shall be—(aa) remitted—(AA) on a quarterly basis, to the group health plan or, in the case of a health insurance issuer offering group health insurance coverage in connection with a group health plan, to the group health insurance issuer on behalf of the plan, not later than 90 days after the end of each quarter; or(BB) in the case of an underpayment in a remittance for a prior quarter, as soon as practicable, but not later than 90 days after notice of the underpayment is first given;(bb) fully disclosed and enumerated to the group health plan or health insurance issuer; and(cc) returned to the covered service provider for pharmacy benefit management services on behalf of the group health plan if any audit by a plan sponsor, issuer or a third party designated by a plan sponsor, indicates that the amounts received are in excess of correct amounts after such amounts have been paid to the group health plan, in the amount of such excess;(II) the Secretary may issue regulations governing—(aa) procedures for the remittance of rebates, fees, alternative discounts, and other remuneration under subclause (I)(aa);(bb) any audit pursuant to this subparagraph; and(cc) the timing, manner, and content of the disclosure of rebates, fees, alternative discounts, and other remuneration under subclause (I)(bb) as well as any other information the Secretary determines necessary for the responsible plan fiduciary to consider the reasonableness of the contract or arrangement (provided that such information does not include personally identifiable health information or protected health information subject to established individual privacy and nondiscrimination requirements under law); and(III) the records of such rebates, fees, alternative discounts, other remuneration, and disclosures, shall be available for audit by the plan (or the plan sponsor, issuer, or a third party designated by a plan sponsor on behalf of the plan), not less than once per plan year.(iii) To ensure that an entity providing pharmacy benefit management services is able to meet the requirements of clause (ii)(I), a rebate aggregator (or other purchasing entity designed to aggregate rebates) and an applicable group purchasing organization shall remit such rebates to the entity providing pharmacy benefit management services not later than 45 days after the end of each quarter.(iv) A third-party administrator of a group health plan, a health insurance issuer offering group health insurance coverage, or a covered service provider for pharmacy benefit management services under such health plan or health insurance coverage shall make rebate contracts with rebate aggregators or drug manufacturers available for audit by such plan, subject to reasonable restrictions (as determined by the Secretary) on confidentiality to prevent re-disclosure of such contracts or use of such information in audits for purposes unrelated to this section.(v) Audits carried out under clauses (ii)(III) and (iv) shall be performed by an auditor selected by the responsible plan fiduciary. Payment for such auditors shall not be made, whether directly or indirectly, by the entity providing pharmacy benefit management services.(vi) Nothing in this subparagraph shall be construed to—(I) prohibit reasonable payments to entities offering pharmacy benefit management services for bona fide services using a fee structure not described in this subparagraph, provided that such fees are transparent and quantifiable to group health plans and health insurance issuers;(II) require a thi
The bill says: by adding at the end the following:
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(i)changedby H.R. 7148 Sec. 6702(c)
The bill says: by striking "requirements of this clause" and inserting "requirements of this subparagraph"; and
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(i)addedby H.R. 7148 Sec. 6702(c)
The bill says: by adding at the end the following: "For purposes of applying section 406(a)(1)(C) with respect to a transaction described under this subparagraph or subparagraph (C), a contract or arrangement for services between a covered plan and an entity providing services to the plan, including a health insurance issuer providing health insurance coverage in connection with the covered plan, in which such entity contracts, in connection with such plan, with a service provider for pharmacy benefit management services, shall be considered an indirect furnishing of goods, services, or facilities between the covered plan and the service provider for pharmacy benefit management services acting as the party in interest.".
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)added (x)by H.R. 7148 Sec. 6702(c)
(x) A service provider for pharmacy benefit management services that is considered to indirectly furnish goods, services, or facilities to a covered plan, as described in clause (i)(I), is entitled to relief with respect to a violation of this section provided the conditions for receiving such relief are satisfied.
The bill says: Section 408(b)(2)(B) (29 U.S.C. 1108(b)(2)(B)) of such Act is amended by adding at the end the following:
Bill text · Current law (29 U.S.C. 1108)
29 U.S.C. 1108(b)(2)(B)(iii)changedby H.R. 7148 Sec. 6702(c)
The bill says: Section 408(b)(2)(B)(iii) of such Act (29 U.S.C. 1108(b)(2)(B)(iii)) is amended, in the matter preceding subclause (I), by inserting "(in accordance with regulations issued by the Secretary addressing time, manner, and content of such disclosures)", after "following".
Bill text · Current law (29 U.S.C. 1108)
21 U.S.C. 355(j)(3)added (H)by H.R. 7148 Sec. 6703(a)
(H)(i) Upon request (in controlled correspondence or an analogous process) by a person that has submitted or intends to submit an abbreviated application under this subsection for a drug that is required by regulation to contain one or more of the same inactive ingredients in the same concentrations as the listed drug referred to, or for which the Secretary determines there is a scientific justification for an approach that is in vitro, in whole or in part, to be used to demonstrate bioequivalence for a drug if such a drug contains one or more of the same inactive ingredients in the same concentrations as the listed drug referred to, the Secretary shall inform the person whether such drug is qualitatively and quantitatively the same as the listed drug. The Secretary may also provide such information to such a person on the Secretary’s own initiative during the review of an abbreviated application under this subsection for such drug.(ii) Notwithstanding section 301(j), if the Secretary determines that such drug is not qualitatively or quantitatively the same as the listed drug, the Secretary shall identify and disclose to the person—(I) the ingredient or ingredients that cause such drug not to be qualitatively or quantitatively the same as the listed drug; and(II) for any ingredient for which there is an identified quantitative deviation, the amount of such deviation.(iii) If the Secretary determines that such drug is qualitatively and quantitatively the same as the listed drug, the Secretary shall not change or rescind such determination after the submission of an abbreviated application for such drug under this subsection unless—(I) the formulation of the listed drug has been changed and the Secretary has determined that the prior listed drug formulation was withdrawn for reasons of safety or effectiveness; or(II) the Secretary makes a written determination that the prior determination must be changed because an error has been identified.(iv) If the Secretary makes a written determination described in clause (iii)(II), the Secretary shall provide notice and a copy of the written determination to the person making the request under clause (i).(v) The disclosures authorized under clauses (i) and (ii) are disclosures authorized by law, including for purposes of section 1905 of title 18, United States Code. This subparagraph shall not otherwise be construed to authorize the disclosure of nonpublic qualitative or quantitative information about the ingredients in a listed drug, or to affect the status, if any, of such information as trade secret or confidential commercial information for purposes of section 301(j) of this Act, section 552 of title 5, United States Code, or section 1905 of title 18, United States Code.
The bill says: Section 505(j)(3) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(j)(3)) is amended by adding at the end the following:
Bill text · Current law (21 U.S.C. 355)