Us Congress Senate Bill SB3430 Latest Draft

                            II 
Calendar No. 265 
118THCONGRESS 
1
STSESSION S. 3430 
[Report No. 118–121] 
To amend titles XVIII and XIX of the Social Security Act to expand the 
mental health care workforce and services, reduce prescription drug costs, 
and extend certain expiring provisions under Medicare and Medicaid, 
and for other purposes. 
IN THE SENATE OF THE UNITED STATES 
DECEMBER7, 2023 
Mr. W
YDEN, from the Committee on Finance, reported the following original 
bill; which was read twice and placed on the calendar 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to expand the mental health care workforce and services, 
reduce prescription drug costs, and extend certain expir-
ing provisions under Medicare and Medicaid, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1
(a) S
HORTTITLE.—This Act may be cited as the 2
‘‘Better Mental Health Care, Lower-Cost Drugs, and Ex-3
tenders Act of 2023’’. 4
(b) T
ABLE OFCONTENTS.—The table of contents of 5
this Act is as follows: 6
Sec. 1. Short title; table of contents. 
TITLE I—EXPANDING MENTAL HEALTH CARE WORKFORCE AND 
SERVICES UNDER MEDICARE AND MEDICAID 
Sec. 101. Expanding eligibility for incentives under the Medicare health profes-
sional shortage area bonus program to practitioners furnishing 
mental health and substance use disorder services. 
Sec. 102. Improved access to mental health services under the Medicare pro-
gram. 
Sec. 103. Clarifying coverage of occupational therapy under the Medicare pro-
gram. 
Sec. 104. Medicare incentives for behavioral health integration with primary 
care. 
Sec. 105. Establishment of Medicare incident to modifier for mental health 
services furnished through telehealth. 
Sec. 106. Guidance on furnishing behavioral health services via telehealth to in-
dividuals with limited English proficiency under Medicare pro-
gram. 
Sec. 107. Ensuring timely communication regarding telehealth and interstate li-
censure requirements. 
Sec. 108. Facilitating accessibility for behavioral health services furnished 
through telehealth. 
Sec. 109. Requiring Enhanced & Accurate Lists of (REAL) Health Providers 
Act. 
Sec. 110. Guidance to States on strategies under Medicaid and CHIP to in-
crease mental health and substance use disorder care provider 
capacity. 
Sec. 111. Guidance to States on supporting mental health services and sub-
stance use disorder care for children and youth. 
Sec. 112. Recurring analysis and publication of Medicaid health care data re-
lated to mental health services. 
Sec. 113. Guidance to States on supporting mental health services or substance 
use disorder care integration with primary care in Medicaid 
and CHIP. 
Sec. 114. Medicaid State option relating to inmates with a substance use dis-
order pending disposition of charges. 
Sec. 115. Definition of Certified Community Behavioral Health Clinic Services 
under Medicaid. 
TITLE II—REDUCING PRESCRIPTION DRUG COSTS UNDER 
MEDICARE AND MEDICAID 
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Sec. 201. Assuring pharmacy access and choice for Medicare beneficiaries. 
Sec. 202. Ensuring accurate payments to pharmacies under Medicaid. 
Sec. 203. Protecting seniors from excessive cost-sharing for certain medicines. 
TITLE III—MEDICAID EXPIRING PROVISIONS 
Sec. 301. Delaying certain disproportionate share hospital payment reductions 
under the Medicaid program. 
Sec. 302. Extension of State option to provide medical assistance for certain in-
dividuals who are patients in certain institutions for mental 
diseases. 
TITLE IV—MEDICARE EXPIRING PROVISIONS AND PROVIDER 
PAYMENT CHANGES 
Sec. 401. Extension of funding for quality measure endorsement, input, and se-
lection. 
Sec. 402. Extension of funding outreach and assistance for low-income pro-
grams. 
Sec. 403. Extension of the work geographic index floor under the Medicare pro-
gram. 
Sec. 404. Extending incentive payments for participation in eligible alternative 
payment models. 
Sec. 405. Payment rates for durable medical equipment under the Medicare 
Program. 
Sec. 406. Extending the independence at home medical practice demonstration 
program under the Medicare program. 
Sec. 407. Increase in support for physicians and other professionals in adjust-
ing to Medicare payment changes. 
Sec. 408. Revised phase-in of Medicare clinical laboratory test payment 
changes. 
Sec. 409. Extension of adjustment to calculation of hospice cap amount under 
Medicare. 
TITLE V—OFFSETS 
Sec. 501. Medicaid Improvement Fund. 
Sec. 502. Medicare Improvement Fund. 
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TITLE I—EXPANDING MENTAL 1
HEALTH CARE WORKFORCE 2
AND SERVICES UNDER MEDI-3
CARE AND MEDICAID 4
SEC. 101. EXPANDING ELIGIBILITY FOR INCENTIVES 5
UNDER THE MEDICARE HEALTH PROFES-6
SIONAL SHORTAGE AREA BONUS PROGRAM 7
TO PRACTITIONERS FURNISHING MENTAL 8
HEALTH AND SUBSTANCE USE DISORDER 9
SERVICES. 10
Section 1833(m) of the Social Security Act (42 11
U.S.C. 1395l(m)) is amended— 12
(1) by striking paragraph (1) and inserting the 13
following new paragraph: 14
‘‘(1) In the case of— 15
‘‘(A) physicians’ services (other than specified 16
health services that are eligible for the additional 17
payment under subparagraph (B)) furnished in a 18
year to an individual, who is covered under the in-19
surance program established by this part and who 20
incurs expenses for such services, in an area that is 21
designated (under section 332(a)(1)(A) of the Public 22
Health Service Act) as a health professional short-23
age area as identified by the Secretary prior to the 24
beginning of such year, in addition to the amount 25
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otherwise paid under this part, there also shall be 1
paid to the physician (or to an employer or facility 2
in the cases described in clause (A) of section 3
1842(b)(6)) (on a monthly or quarterly basis) from 4
the Federal Supplementary Medical Insurance Trust 5
Fund an amount equal to 10 percent of the payment 6
amount for the service under this part; and 7
‘‘(B) specified health services (as defined in 8
paragraph (5)) furnished in a year to an individual, 9
who is covered under the insurance program estab-10
lished by this part and who incurs expenses for such 11
services, in an area that is designated (under such 12
section 332(a)(1)(A)) as a mental health profes-13
sional shortage area as identified by the Secretary 14
prior to the beginning of such year, in addition to 15
the amount otherwise paid under this part, there 16
also shall be paid to the physician or applicable 17
practitioner (as defined in paragraph (6)) (or to an 18
employer or facility in the cases described in clause 19
(A) of section 1842(b)(6)) (on a monthly or quar-20
terly basis) from such Trust Fund an amount equal 21
to 15 percent of the payment amount for the service 22
under this part.’’; 23
(2) in paragraph (2)— 24
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(A) by striking ‘‘in paragraph (1)’’ and in-1
serting ‘‘in subparagraph (A) or (B) of para-2
graph (1)’’; 3
(B) by inserting ‘‘or, in the case of speci-4
fied health services, the physician or applicable 5
practitioner’’ after ‘‘physician’’; 6
(3) in paragraph (3), by striking ‘‘in paragraph 7
(1)’’ and inserting ‘‘in subparagraph (A) or (B) of 8
paragraph (1)’’; 9
(4) in paragraph (4)— 10
(A) in subparagraph (B), by inserting ‘‘or 11
applicable practitioner’’ after ‘‘physician’’; and 12
(B) in subparagraph (C), by inserting ‘‘or 13
applicable practitioner’’ after ‘‘physician’’; and 14
(5) by adding at the end the following new 15
paragraphs: 16
‘‘(5) In this subsection, the term ‘specified health 17
services’ means services otherwise covered under this part 18
that are furnished on or after January 1, 2026, by a phy-19
sician or an applicable practitioner to an individual— 20
‘‘(A) for purposes of diagnosis, evaluation, or 21
treatment of a mental health disorder, as determined 22
by the Secretary; or 23
‘‘(B) with a substance use disorder diagnosis 24
for purposes of treatment of such disorder or co-oc-25
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curring mental health disorder, as determined by the 1
Secretary. 2
‘‘(6) In this subsection, the term ‘applicable practi-3
tioner’ means the following: 4
‘‘(A) A physician assistant, nurse practitioner, 5
or clinical nurse specialist (as defined in section 6
1861(aa)(5)). 7
‘‘(B) A clinical social worker (as defined in sec-8
tion 1861(hh)(1)). 9
‘‘(C) A clinical psychologist (as defined by the 10
Secretary for purposes of section 1861(ii)). 11
‘‘(D) A marriage and family therapist (as de-12
fined in section 1861(lll)(2)). 13
‘‘(E) A mental health counselor (as defined in 14
section 1861(lll)(4)).’’. 15
SEC. 102. IMPROVED ACCESS TO MENTAL HEALTH SERV-16
ICES UNDER THE MEDICARE PROGRAM. 17
(a) A
CCESS TOCLINICALSOCIALWORKERSERVICES 18
P
ROVIDED TORESIDENTS OFSKILLEDNURSINGFACILI-19
TIES.— 20
(1) E
XCLUSION OF CLINICAL SOCIAL WORKER 21
SERVICES FROM THE SKILLED NURSING FACILITY 22
PROSPECTIVE PAYMENT SYSTEM	.—Section 23
1888(e)(2)(A)(iii) of the Social Security Act (42 24
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U.S.C. 1395yy(e)(2)(A)(iii)) is amended by adding 1
at the end the following new subclause: 2
‘‘(VII) Clinical social worker 3
services (as defined in section 4
1861(hh)(2)).’’. 5
(2) C
ONFORMING AMENDMENT .—Section 6
1861(hh)(2) of the Social Security Act (42 U.S.C. 7
1395x(hh)(2)) is amended by striking ‘‘and other 8
than services furnished to an inpatient of a skilled 9
nursing facility which the facility is required to pro-10
vide as a requirement for participation’’. 11
(b) A
CCESS TO THECOMPLETESCOPE OFCLINICAL 12
S
OCIALWORKERSERVICES.—Section 1861(hh)(2) of the 13
Social Security Act (42 U.S.C. 1395x(hh)(2)), as amended 14
by subsection (a)(2), is amended by striking ‘‘for the diag-15
nosis and treatment of mental illnesses (other than serv-16
ices furnished to an inpatient of a hospital)’’ and inserting 17
‘‘, including services for the diagnosis and treatment of 18
mental illnesses or services for health behavior assessment 19
and intervention (identified as of January 1, 2023, by 20
HCPCS codes 96160 and 96161 (and any succeeding 21
codes)), but not including services furnished to an inpa-22
tient of a hospital,’’. 23
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(c) EFFECTIVEDATE.—The amendments made by 1
this section shall apply to items and services furnished on 2
or after January 1, 2026. 3
SEC. 103. CLARIFYING COVERAGE OF OCCUPATIONAL 4
THERAPY UNDER THE MEDICARE PROGRAM. 5
Not later than 1 year after the date of enactment 6
of this Act, the Secretary of Health and Human Services 7
shall use existing communication mechanisms to provide 8
education and outreach to stakeholders about the Medi-9
care Benefit Policy Manual with respect to occupational 10
therapy services furnished to individuals under the Medi-11
care program for the treatment of a substance use or men-12
tal health disorder diagnosis using applicable Healthcare 13
Common Procedure Coding System (HCPCS) codes. 14
SEC. 104. MEDICARE INCENTIVES FOR BEHAVIORAL 15
HEALTH INTEGRATION WITH PRIMARY CARE. 16
(a) I
NCENTIVES.— 17
(1) I
N GENERAL.—Section 1848(b) of the So-18
cial Security Act (42 U.S.C. 1395w–4(b)) is amend-19
ed by adding at the end the following new para-20
graph: 21
‘‘(13) I
NCENTIVES FOR BEHAVIORAL HEALTH 22
INTEGRATION.— 23
‘‘(A) I
N GENERAL.—For services described 24
in subparagraph (B) that are furnished during 25
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2026, 2027, or 2028, instead of the payment 1
amount that would otherwise be determined 2
under this section for such year, the payment 3
amount shall be equal to the applicable percent 4
(as defined in subparagraph (C)) of such pay-5
ment amount for such year. 6
‘‘(B) S
ERVICES DESCRIBED.—The services 7
described in this subparagraph are services 8
identified, as of January 1, 2023, by HCPCS 9
codes 99484, 99492, 99493, 99494, and G2214 10
(and any successor or similar codes as deter-11
mined appropriate by the Secretary). 12
‘‘(C) A
PPLICABLE PERCENT .—In this 13
paragraph, the term ‘applicable percent’ means, 14
with respect to a service described in subpara-15
graph (A), the following: 16
‘‘(i) For services furnished during 17
2026 , 175 percent. 18
‘‘(ii) For services furnished during 19
2027, 150 percent. 20
‘‘(iii) For services furnished during 21
2028, 125 percent.’’. 22
(2) W
AIVER OF BUDGET NEUTRALITY .—Section 23
1848(c)(2)(B)(iv) of such Act (42 U.S.C. 1395w– 24
4(c)(2)(B)(iv)) is amended— 25
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(A) in subclause (V), by striking ‘‘and’’ at 1
the end; 2
(B) in subclause (VI), by striking the pe-3
riod at the end and inserting ‘‘; and’’ and 4
(C) by adding at the end the following new 5
subclause: 6
‘‘(VII) the increase in payment 7
amounts as a result of the application 8
of subsection (b)(13) shall not be 9
taken into account in applying clause 10
(ii)(II) for 2026, 2027, or 2028.’’. 11
(b) T
ECHNICALASSISTANCE FOR THE ADOPTION OF 12
B
EHAVIORALHEALTHINTEGRATION.— 13
(1) I
N GENERAL.—Not later than January 1, 14
2025, the Secretary of Health and Human Services 15
(in this subsection referred to as the ‘‘Secretary’’) 16
shall enter into contracts or agreements with appro-17
priate entities to offer technical assistance to pri-18
mary care practices that are seeking to adopt behav-19
ioral health integration models in such practices. 20
(2) B
EHAVIORAL HEALTH INTEGRATION MOD -21
ELS.—For purposes of paragraph (1), behavioral 22
health integration models include the Collaborative 23
Care Model (with services identified as of January 24
1, 2023, by HCPCS codes 99492, 99493, 99494, 25
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and G2214 (and any successor codes)), the Primary 1
Care Behavioral Health model (with services identi-2
fied as of January 1, 2023, by HCPCS code 99484 3
(and any successor code)), and other models identi-4
fied by the Secretary. 5
(3) I
MPLEMENTATION.—Notwithstanding any 6
other provision of law, the Secretary may implement 7
the provisions of this subsection by program instruc-8
tion or otherwise. 9
(4) F
UNDING.—In addition to amounts other-10
wise available, there is appropriated to the Secretary 11
for fiscal year 2024, out of any money in the Treas-12
ury not otherwise appropriated, $5,000,000, to re-13
main available until expended, for purposes of car-14
rying out this subsection. 15
SEC. 105. ESTABLISHMENT OF MEDICARE INCIDENT TO 16
MODIFIER FOR MENTAL HEALTH SERVICES 17
FURNISHED THROUGH TELEHEALTH. 18
Section 1834(m)(7) of the Social Security Act (42 19
U.S.C. 1395m(m)(7)) is amended by adding at the end 20
the following new subparagraph: 21
‘‘(C) E
STABLISHMENT OF INCIDENT TO 22
MODIFIER FOR MENTAL HEALTH SERVICES 23
FURNISHED THROUGH TELEHEALTH .—Not 24
later than 2 years after the date of the enact-25
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ment of this subparagraph, the Secretary shall 1
establish requirements to include a code or 2
modifier, as determined appropriate by the Sec-3
retary, on claims for mental health services fur-4
nished through telehealth under this paragraph 5
that are furnished by auxiliary personnel (as 6
defined in section 410.26(a)(1) of title 42, Code 7
of Federal Regulations, or any successor regula-8
tion) and billed incident to a physician or prac-9
titioner’s professional services.’’. 10
SEC. 106. GUIDANCE ON FURNISHING BEHAVIORAL 11
HEALTH SERVICES VIA TELEHEALTH TO IN-12
DIVIDUALS WITH LIMITED ENGLISH PRO-13
FICIENCY UNDER MEDICARE PROGRAM. 14
Not later than 1 year after the date of the enactment 15
of this section, the Secretary of Health and Human Serv-16
ices shall issue and disseminate, or update and revise as 17
applicable, guidance on the following: 18
(1) Best practices for providers to work with in-19
terpreters to furnish behavioral health services via 20
video-based and audio-only telehealth, when video- 21
based telehealth is not an option. 22
(2) Best practices on integrating the use of 23
video platforms that enable multi-person video calls 24
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into behavioral health services furnished via tele-1
health. 2
(3) Best practices on teaching patients, espe-3
cially those with limited English proficiency, to use 4
video-based telehealth platforms. 5
(4) Best practices for providing patient mate-6
rials, communications, and instructions in multiple 7
languages, including text message appointment re-8
minders and prescription information. 9
SEC. 107. ENSURING TIMELY COMMUNICATION REGARDING 10
TELEHEALTH AND INTERSTATE LICENSURE 11
REQUIREMENTS. 12
The Secretary of Health and Human Services shall 13
provide information— 14
(1) on licensure requirements for furnishing 15
telehealth services under titles XVIII and XIX of 16
the Social Security Act (42 U.S.C. 1395 et seq.; 17
1396 et seq.); and 18
(2) clarifying the extent to which licenses 19
through an interstate license compact pathway can 20
qualify as valid and full licenses for the purposes of 21
meeting Federal licensure requirements under such 22
titles. 23
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SEC. 108. FACILITATING ACCESSIBILITY FOR BEHAVIORAL 1
HEALTH SERVICES FURNISHED THROUGH 2
TELEHEALTH. 3
The Secretary of Health and Human Services shall 4
provide regular updates to guidance to facilitate the acces-5
sibility of behavioral health services furnished through 6
telehealth for the visually and hearing impaired. 7
SEC. 109. REQUIRING ENHANCED & ACCURATE LISTS OF 8
(REAL) HEALTH PROVIDERS ACT. 9
(a) I
NGENERAL.—Section 1852(c) of the Social Se-10
curity Act (42 U.S.C. 1395w–22(c)) is amended— 11
(1) in paragraph (1)(C)— 12
(A) by striking ‘‘plan, and any’’ and insert-13
ing ‘‘plan, any’’; and 14
(B) by inserting the following before the 15
period: ‘‘, and, in the case of a network-based 16
plan (as defined in paragraph (3)(C)), for plan 17
year 2026 and subsequent plan years, the infor-18
mation described in paragraph (3)(B)’’; and 19
(2) by adding at the end the following new 20
paragraph: 21
‘‘(3) P
ROVIDER DIRECTORY ACCURACY .— 22
‘‘(A) I
N GENERAL.—For plan year 2026 23
and subsequent plan years, each MA organiza-24
tion offering a network-based plan (as defined 25
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in subparagraph (C)) shall, for each network- 1
based plan offered by the organization— 2
‘‘(i) maintain, on a publicly available 3
internet website, an accurate provider di-4
rectory that includes the information de-5
scribed in subparagraph (B); 6
‘‘(ii) not less frequently than once 7
every 90 days (or, in the case of a hospital 8
or any other facility determined appro-9
priate by the Secretary, at a lesser fre-10
quency specified by the Secretary but in no 11
case less frequently than once every 12 12
months), verify the provider directory in-13
formation of each provider listed in such 14
directory and, if applicable, update such 15
provider directory information; 16
‘‘(iii) if the organization is unable to 17
verify such information with respect to a 18
provider, include in such directory an indi-19
cation that the information of such pro-20
vider may not be up to date; 21
‘‘(iv) remove a provider from such di-22
rectory within 5 business days if the orga-23
nization determines that the provider is no 24
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longer a provider participating in the net-1
work of such plan; and 2
‘‘(v) meet such other requirements as 3
the Secretary may specify. 4
‘‘(B) P
ROVIDER DIRECTORY INFORMA -5
TION.—The information described in this sub-6
paragraph is information enrollees may need to 7
access covered benefits from a provider with 8
which such organization offering such plan has 9
an agreement for furnishing items and services 10
covered under such plan such as name, spe-11
cialty, contact information, primary office or fa-12
cility address, whether the provider is accepting 13
new patients, accommodations for people with 14
disabilities, cultural and linguistic capabilities, 15
and telehealth capabilities. 16
‘‘(C) N
ETWORK-BASED PLAN.—In this 17
paragraph, the term ‘network-based plan’ has 18
the meaning given that term in subsection 19
(d)(5)(C), except such term includes a Medicare 20
Advantage private fee-for-service plan, as deter-21
mined appropriate by the Secretary.’’. 22
(b) A
CCOUNTABILITY FOR PROVIDERDIRECTORY 23
A
CCURACY.— 24
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(1) COST SHARING FOR SERVICES FURNISHED 1
BASED ON RELIANCE ON INCORRECT PROVIDER DI -2
RECTORY INFORMATION .—Section 1852(d) of the 3
Social Security Act (42 U.S.C. 1395w–22(d)) is 4
amended— 5
(A) in paragraph (1)(C)— 6
(i) in clause (ii), by striking ‘‘or’’ at 7
the end; 8
(ii) in clause (iii), by striking the 9
semicolon at the end and inserting ‘‘, or’’; 10
and 11
(iii) by adding at the end the fol-12
lowing new clause: 13
‘‘(iv) the services are furnished by a 14
provider that is not participating in the 15
network of a network-based plan (as de-16
fined in subsection (c)(3)(C)) but is listed 17
in the provider directory of such plan on 18
the date on which the appointment is 19
made, as described in paragraph (7)(A);’’; 20
and 21
(B) by adding at the end the following new 22
paragraph: 23
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‘‘(7) COST SHARING FOR SERVICES FURNISHED 1
BASED ON RELIANCE ON INCORRECT PROVIDER DI -2
RECTORY INFORMATION .— 3
‘‘(A) I
N GENERAL.—For plan year 2026 4
and subsequent plan years, if an enrollee is fur-5
nished an item or service by a provider that is 6
not participating in the network of a network- 7
based plan (as defined in subsection (c)(3)(C)) 8
but is listed in the provider directory of such 9
plan (as required to be provided to an enrollee 10
pursuant to subsection (c)(1)(C)) on the date 11
on which the appointment is made, and if such 12
item or service would otherwise be covered 13
under such plan if furnished by a provider that 14
is participating in the network of such plan, the 15
MA organization offering such plan shall ensure 16
that the enrollee is only responsible for the 17
amount of cost sharing that would apply if such 18
provider had been participating in the network 19
of such plan. 20
‘‘(B) N
OTIFICATION REQUIREMENT .—For 21
plan year 2026 and subsequent plan years, each 22
MA organization that offers a network-based 23
plan shall— 24
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‘‘(i) notify enrollees of their cost-shar-1
ing protections under this paragraph and 2
make such notifications, to the extent 3
practicable, by not later than the first day 4
of an annual, coordinated election period 5
under section 1851(e)(3) with respect to a 6
year; 7
‘‘(ii) include information regarding 8
such cost-sharing protections in the pro-9
vider directory of each network-based plan 10
offered by the MA organization.; and 11
‘‘(iii) notify enrollees of their cost- 12
sharing protections under this paragraph 13
in an explanation of benefits.’’. 14
(2) R
EQUIRED PROVIDER DIRECTORY ACCU -15
RACY ANALYSIS AND REPORTS .— 16
(A) I
N GENERAL.—Section 1857(e) of the 17
Social Security Act (42 U.S.C. 1395w–27(e)) is 18
amended by adding at the end the following 19
new paragraph: 20
‘‘(6) P
ROVIDER DIRECTORY ACCURACY ANAL -21
YSIS AND REPORTS.— 22
‘‘(A) I
N GENERAL.—Beginning with plan 23
years beginning on or after January 1, 2026, 24
subject to subparagraph (C), a contract under 25
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this section with an MA organization shall re-1
quire the organization, for each network-based 2
plan (as defined in section 1852(c)(3)(C)) of-3
fered by the organization, to annually— 4
‘‘(i) conduct an analysis estimating 5
the accuracy of the provider directory of 6
such plan using a sample of providers in-7
cluded in such provider directory (includ-8
ing provider specialties with high inaccu-9
racy rates of provider directory informa-10
tion, such as providers specializing in men-11
tal health or substance use disorder treat-12
ment, as determined by the Secretary); and 13
‘‘(ii) submit a report to the Secretary 14
containing the results of such analysis, in-15
cluding an accuracy score for such provider 16
directory (as determined using a method-17
ology specified by the Secretary under sub-18
paragraph (B)(i)), and other information 19
required by the Secretary. 20
‘‘(B) D
ETERMINATION OF ACCURACY 21
SCORE.— 22
‘‘(i) I
N GENERAL.—The Secretary 23
shall specify methodologies for MA plans 24
to use in estimating the accuracy of the 25
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•S 3430 RS
provider directory information of such 1
plans and determining the accuracy score 2
for the plan’s provider directory. 3
‘‘(ii) C
ONSIDERATIONS.—In carrying 4
out clause (i), the Secretary shall take into 5
consideration— 6
‘‘(I) data sources maintained by 7
MA organizations; 8
‘‘(II) publicly available data sets; 9
‘‘(III) the administrative burden 10
on plans and providers; and 11
‘‘(IV) the relative importance of 12
certain provider directory information 13
on enrollee ability to access care. 14
‘‘(C) E
XCEPTION.—The Secretary may 15
waive the requirements of this paragraph in the 16
case of a network-based plan with low enroll-17
ment (as defined by the Secretary). 18
‘‘(D) T
RANSPARENCY.—Beginning with 19
plan years beginning on or after January 1, 20
2027, the Secretary shall post accuracy scores 21
(as reported under subparagraph (A)(ii)), in a 22
machine readable file, on the internet website of 23
the Centers for Medicare & Medicaid Services. 24
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‘‘(E) IMPLEMENTATION.—The Secretary 1
shall implement this paragraph through notice 2
and comment rulemaking.’’. 3
(B) P
ROVISION OF INFORMATION TO 4
BENEFICIARIES.—Section 1851(d)(4) of the So-5
cial Security Act (42 U.S.C. 1395w–21(d)(4)) 6
is amended by adding at the end the following 7
new subparagraph: 8
‘‘(F) P
ROVIDER DIRECTORY .—Beginning 9
with plan years beginning on or after January 10
1, 2027, the accuracy score of the plan’s pro-11
vider directory (as reported under section 12
1857(e)(6)(A)(ii)) on the plan’s provider direc-13
tory.’’. 14
(C) F
UNDING.—In addition to amounts 15
otherwise available, there is appropriated to the 16
Centers for Medicare & Medicaid Services Pro-17
gram Management Account, out of any money 18
in the Treasury not otherwise appropriated, 19
$1,000,000 for fiscal year 2025, to remain 20
available until expended, to carry out the 21
amendments made by this paragraph. 22
(3) GAO 
STUDY AND REPORT.— 23
(A) A
NALYSIS.—The Comptroller General 24
of the United States (in this paragraph referred 25
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•S 3430 RS
to as the ‘‘Comptroller General’’) shall conduct 1
study of the implementation of the amendments 2
made by paragraphs (1) and (2). To the extent 3
data are available and reliable, such study shall 4
include an analysis of— 5
(i) the use of protections required 6
under section 1852(d)(7) of the Social Se-7
curity Act, as added by paragraph (1); 8
(ii) the provider directory accuracy 9
scores trends under section 10
1857(e)(6)(A)(ii) of the Social Security 11
Act (as added by paragraph (2)(A)), both 12
overall and among providers specializing in 13
mental health or substance disorder treat-14
ment; 15
(iii) provider response rates by plan 16
verification methods; and 17
(iv) other items determined appro-18
priate by the Comptroller General. 19
(B) R
EPORT.—Not later than January 15, 20
2031, the Comptroller General shall submit to 21
Congress a report containing the results of the 22
study conducted under subparagraph (A), to-23
gether with recommendations for such legisla-24
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•S 3430 RS
tion and administrative action as the Comp-1
troller General determines appropriate. 2
(c) G
UIDANCE ON MAINTAININGACCURATEPRO-3
VIDERDIRECTORIES.— 4
(1) S
TAKEHOLDER MEETING .— 5
(A) I
N GENERAL.—Not later than 3 6
months after the date of enactment of this Act, 7
the Secretary of Health and Human Services 8
(referred to in this subsection as the ‘‘Sec-9
retary’’) shall hold a public stakeholder meeting 10
to receive input on approaches for maintaining 11
accurate provider directories for Medicare Ad-12
vantage plans under part C of title XVIII of the 13
Social Security Act (42 U.S.C. 1395w–21 et 14
seq.), including input on approaches for reduc-15
ing administrative burden such as data stand-16
ardization and best practices to maintain pro-17
vider directory information. 18
(B) P
ARTICIPANTS.—Participants of the 19
meeting under subparagraph (A) shall include 20
representatives from the Centers for Medicare & 21
Medicaid Services and the Office of the Na-22
tional Coordinator for Health Information 23
Technology, health care providers, companies 24
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•S 3430 RS
that specialize in relevant technologies, health 1
insurers, and patient advocates. 2
(2) G
UIDANCE TO MEDICARE ADVANTAGE OR -3
GANIZATIONS.—Not later than 12 months after the 4
date of enactment of this Act, the Secretary shall 5
issue guidance to Medicare Advantage organizations 6
offering Medicare Advantage plans under part C of 7
title XVIII of the Social Security Act (42 U.S.C. 8
1395w–21 et seq.) on maintaining accurate provider 9
directories for such plans, taking into consideration 10
input received during the stakeholder meeting under 11
paragraph (1). Such guidance may include the fol-12
lowing, as determined appropriate by the Secretary: 13
(A) Best practices for Medicare Advantage 14
organizations on how to work with providers to 15
maintain the accuracy of provider directories 16
and reduce provider and Medicare Advantage 17
organization burden with respect to maintaining 18
the accuracy of provider directories . 19
(B) Information on data sets and data 20
sources with information that could be used by 21
Medicare Advantage organizations to maintain 22
accurate provider directories. 23
(C) Approaches for utilizing data sources 24
maintained by Medicare Advantage organiza-25
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•S 3430 RS
tions and publicly available data sets to main-1
tain accurate provider directories. 2
(D) Information to be included in the pro-3
vider directory that may be useful for Medicare 4
beneficiaries to assess plan networks when se-5
lecting a plan and accessing providers partici-6
pating in plan networks during the plan year. 7
(3) G
UIDANCE TO PART B PROVIDERS .—Not 8
later than 12 months after the date of enactment of 9
this Act, the Secretary shall issue guidance to pro-10
viders of services and suppliers who furnish items or 11
services for which benefits are available under part 12
B of title XVIII of the Social Security Act (42 13
U.S.C. 1395j et seq.) on when to update the Na-14
tional Plan and Provider Enumeration System re-15
garding any information changes. 16
SEC. 110. GUIDANCE TO STATES ON STRATEGIES UNDER 17
MEDICAID AND CHIP TO INCREASE MENTAL 18
HEALTH AND SUBSTANCE USE DISORDER 19
CARE PROVIDER CAPACITY. 20
Not later than 12 months after the date of enactment 21
of this Act, the Secretary of Health and Human Services 22
shall issue guidance to States on strategies under Med-23
icaid and the Children’s Health Insurance Program 24
(CHIP) to increase access to mental health and substance 25
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•S 3430 RS
use disorder care providers that participate in Medicaid 1
or CHIP, which may include education, training, recruit-2
ment, and retention of such providers, with a focus on im-3
proving the capacity of the mental health and substance 4
use disorder care workforce in rural and underserved areas 5
by increasing the number, type, and capacity of providers. 6
Such guidance shall include, but not be limited to— 7
(1) best practices from States that have used 8
Medicaid or CHIP waivers and authorities under ti-9
tles XI, XIX, and XXI of such Act (42 U.S.C. 1301 10
et seq., 1396 et seq., 1397aa et seq.) for such pur-11
poses; 12
(2) best practices related to expanding the 13
availability of community-based mental health and 14
substance use disorder services under Medicaid and 15
CHIP, including through the participation of para-16
professionals with behavioral health expertise, and 17
review of State practices for leveraging paraprofes-18
sionals within State scope of practice requirements 19
as well as State supervision requirements, such as 20
peer support specialists and clinicians with bacca-21
laureate degrees; and 22
(3) best practices related to financing, sup-23
porting, and expanding the education and training of 24
providers of mental health and substance use dis-25
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•S 3430 RS
order services to increase the workforce of such pro-1
viders who participate in Medicaid and CHIP, in-2
cluding by supporting on-site training in the clinical 3
setting and innovative public-private partnerships. 4
SEC. 111. GUIDANCE TO STATES ON SUPPORTING MENTAL 5
HEALTH SERVICES AND SUBSTANCE USE DIS-6
ORDER CARE FOR CHILDREN AND YOUTH. 7
(a) G
UIDANCE ONINCREASING THE AVAILABILITY 8
ANDPROVISION OFMENTALHEALTHSERVICES AND 9
S
UBSTANCEUSEDISORDERCAREUNDERMEDICAID AND 10
CHIP.—Not later than 12 months after the date of enact-11
ment of this Act, the Secretary shall issue guidance to 12
States regarding opportunities to improve the availability 13
and provision of mental health services and substance use 14
disorder care through Medicaid and CHIP for children 15
and youth. Such guidance shall address the following: 16
(1) The design and implementation of a con-17
tinuum of benefits for children and youth with sig-18
nificant mental health conditions and substance use 19
disorders covered by Medicaid and CHIP, including 20
the role of EPSDT, how EPSDT requires States to 21
make available a continuum of care across settings, 22
and what is required of States to ensure compliance 23
with EPSDT. 24
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(2) Strategies to facilitate access to mental 1
health services and substance use disorder care 2
under Medicaid and CHIP that are delivered in the 3
home or in community-based settings for children 4
and youth. Such guidance shall outline strategies 5
employed by States to expand the availability of 6
such settings and include specific interventions and 7
financing arrangements that could be replicated. 8
(3) Strategies to facilitate access to mental 9
health services and substance use disorder care 10
under Medicaid and CHIP for children and youth 11
who— 12
(A) are at risk for having a significant 13
mental health condition or substance use dis-14
order; 15
(B) have a significant mental health condi-16
tion or substance use disorder; or 17
(C) have an intellectual or developmental 18
disability. 19
(4) Strategies to promote screening for mental 20
health and substance use disorder needs of children 21
and youth, including children and youth provided, or 22
at risk for needing, child welfare services, in coordi-23
nation with providers, managed care organizations 24
(as defined by the Secretary), prepaid inpatient 25
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•S 3430 RS
health plans (as defined by the Secretary), prepaid 1
ambulatory health plans (as defined by the Sec-2
retary), and schools (as defined by the Secretary). 3
(5) Strategies for supporting the provision of 4
culturally competent, developmentally appropriate, 5
and trauma-informed mental health services and 6
substance use disorder care to children and youth. 7
(6) Strategies for providing early prevention, 8
intervention, and screening services, including for 9
children and youth at higher risk for having mental 10
health or substance use disorder needs, children and 11
youth who do not have a mental health or substance 12
use disorder diagnosis, children and youth provided, 13
or at risk for needing, child welfare services, and 14
children at risk of first episode psychosis. 15
(7) Best practices from State Medicaid and 16
CHIP programs in expanding access to mental 17
health services and substance use disorder care for 18
children and youth, including children and youth 19
that are part of underserved communities and chil-20
dren and youth with co-occurring intellectual dis-21
ability or autism spectrum disorder, and former fos-22
ter youth. 23
(8) Strategies to coordinate services and fund-24
ing provided under parts B and E of title IV of the 25
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•S 3430 RS
Social Security Act (42 U.S.C. 621 et seq., 670 et 1
seq.), and other funding sources at the discretion of 2
the Secretary, with services for which Federal finan-3
cial participation is available under Medicaid or 4
CHIP, to support improved access to comprehensive 5
mental health services and substance use disorder 6
care for children and youth provided, or at risk for 7
needing, child welfare services. 8
(b) C
ONSULTATION.—The Secretary shall consult 9
with the Administrator of the Centers for Medicare & 10
Medicaid Services, the Assistant Secretary for the Admin-11
istration for Children and Families, the Assistant Sec-12
retary for Mental Health and Substance Use, and the Di-13
rector of the Office of National Drug Control Policy with 14
respect to the guidance issued under subsection (a). 15
(c) D
EFINITIONS.—In this section: 16
(1) EPSDT.—The term ‘‘EPSDT’’ means early 17
and periodic screening, diagnostic, and treatment 18
services under Medicaid in accordance with sections 19
1902(a)(43), 1905(a)(4)(B), and 1905(r) of the So-20
cial Security Act (42 U.S.C. 1396a(a)(43), 21
1396d(a)(4)(B), 1396d(r)). 22
(2) S
ECRETARY.—The term ‘‘Secretary’’ means 23
the Secretary of Health and Human Services. 24
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•S 3430 RS
(3) STATE.—The term ‘‘State’’ has the mean-1
ing given that term in section 1101(a)(1) of the So-2
cial Security Act (42 U.S.C. 1301(a)(1)) for pur-3
poses of titles XIX and XXI of such Act. 4
SEC. 112. RECURRING ANALYSIS AND PUBLICATION OF 5
MEDICAID HEALTH CARE DATA RELATED TO 6
MENTAL HEALTH SERVICES. 7
(a) I
NGENERAL.—The Secretary, on a biennial 8
basis, shall link, analyze, and publish on a publicly avail-9
able website Medicaid data reported by States through the 10
Transformed Medicaid Statistical Information System (T– 11
MSIS) (or a successor system) relating to mental health 12
services provided to individuals enrolled in Medicaid, in-13
cluding an analysis by age. Such enrollee information shall 14
be de-identified of any personally identifying information, 15
shall adhere to privacy standards established by the De-16
partment of Health and Human Services, and shall be ag-17
gregated to protect the privacy of enrollees, as necessary. 18
Each publication of such analysis shall include for each 19
State available data for the following measures: 20
(1) The number and percentage of individuals 21
by age enrolled in the State Medicaid plan or waiver 22
of such plan in each of the major enrollment cat-23
egories (as defined in a letter, to be made publicly 24
available on the website of the Medicaid and CHIP 25
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•S 3430 RS
Payment and Access Commission, from the Medicaid 1
and CHIP Payment and Access Commission to the 2
Secretary) who have been diagnosed with a mental 3
health condition and whether such individuals are 4
enrolled under the State Medicaid plan or waiver of 5
such plan, including the specific waiver authority 6
under which they are enrolled, to the extent avail-7
able. 8
(2) A list of the mental health treatment serv-9
ices, including specifying adult and pediatric serv-10
ices, by each major type of service, such as coun-11
seling, intensive home-based services, intensive care 12
coordination, crisis services tailored to children and 13
youth, youth peer support services, family-to-family 14
support, inpatient hospitalization, and other appro-15
priate services as identified by the Secretary, for 16
which beneficiaries in each State received at least 1 17
service under the State Medicaid plan or a waiver of 18
such plan. 19
(3) The number and percentage of individuals 20
by age with a substance use disorder diagnosis en-21
rolled in the State Medicaid plan or waiver of such 22
plan who received services for a mental health condi-23
tion under such plan or waiver by each major type 24
of service specified under paragraph (2) within each 25
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•S 3430 RS
major setting type, such as outpatient, inpatient, 1
residential, and other home-based and community- 2
based settings. 3
(4) The number of services provided under the 4
State Medicaid plan or waiver of such plan per indi-5
vidual with a mental health diagnosis, including by 6
age, enrolled in such plan or waiver for each major 7
type of service specified under paragraph (2). 8
(5) The number and percentage of individuals 9
by age enrolled in the State Medicaid plan or waiver 10
by major enrollment category, who received mental 11
health services through— 12
(A) a Medicaid managed care entity (as 13
defined in section 1932(a)(1)(B) of the Social 14
Security Act (42 U.S.C. 1396u–2(a)(1)(B))), 15
including the number of such individuals who 16
received such assistance through a prepaid in-17
patient health plan (as defined by the Sec-18
retary) or a prepaid ambulatory health plan (as 19
defined by the Secretary); 20
(B) a fee-for-service payment model; or 21
(C) an alternative payment model, to the 22
extent available. 23
(6) The number and percentage of individuals 24
by age with a mental health diagnosis who received 25
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mental health services in an outpatient or home- 1
based and community-based setting after receiving 2
services in an inpatient or residential setting and the 3
number of services received by such individuals in 4
the outpatient or home-based and community-based 5
setting. 6
(7) The number and percentage of inpatient ad-7
missions by age in which services for a mental 8
health condition were provided to an individual en-9
rolled in the State Medicaid plan or a waiver of such 10
plan that occurred within 30 days after discharge 11
from a hospital or inpatient facility in which services 12
for a mental health condition previously were pro-13
vided to such individual, disaggregated by type of fa-14
cility, to the extent such information is available. 15
(8) The number of emergency department visits 16
by an individual by age enrolled in the State Med-17
icaid plan or a waiver of such plan for treatment of 18
a mental health condition within 7 days of such indi-19
vidual being discharged from a hospital inpatient fa-20
cility in which services for a mental health condition 21
were provided, or from a mental health facility, an 22
independent psychiatric wing of acute care hospital, 23
or an intermediate care facility for individuals with 24
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•S 3430 RS
intellectual disabilities, disaggregated by type of fa-1
cility, to the extent such information is available. 2
(9) The number and percentage of individuals 3
by age enrolled in the State Medicaid plan or a waiv-4
er of such plan— 5
(A) who received an assessment to diag-6
nose a mental health condition; and 7
(B) the number of mental health services 8
provided to individuals described in subpara-9
graph (A) in the 30 days post-assessment. 10
(10) Prescription National Drug Code codes, 11
fill dates, and number of days supply of any covered 12
outpatient drug (as defined in section 1927(k)(2) of 13
the Social Security Act (42 U.S.C. 1396r-8(k)(2)) to 14
treat a mental health condition that were dispensed 15
to an individual by age enrolled in the State Med-16
icaid plan or waiver with an episode described in 17
paragraph (7) or (8) during any period that occurs 18
after the individual’s discharge date defined in para-19
graph (7) or (8) (as applicable), and before the ad-20
mission date applicable under paragraph (7) or the 21
date of the emergency department visit applicable 22
under paragraph (8). 23
(b) P
UBLICATION.— 24
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•S 3430 RS
(1) IN GENERAL.—Not later than 18 months 1
after the date of enactment of this Act, the Sec-2
retary shall make publicly available the first analysis 3
required by subsection (a). 4
(2) U
SE OF T–MSIS DATA.—The report required 5
under paragraph (1) and updates required under 6
paragraph (3) shall— 7
(A) use data and definitions from the 8
Transformed Medicaid Statistical Information 9
System (‘‘T–MSIS’’) (or a successor system) 10
data set that is no more than 12 months old on 11
the date that the report or update is published; 12
and 13
(B) as appropriate, include a description 14
with respect to each State of the quality and 15
completeness of the data and caveats describing 16
the limitations of the data reported to the Sec-17
retary by the State that is sufficient to commu-18
nicate the appropriate uses for the information. 19
(3) R
EVISED PUBLICATION.—Not later than 3 20
years after the date of enactment of this Act, the 21
Secretary shall publish a revised publication of the 22
analysis required by subsection (a) that allows for a 23
research-ready and publicly accessible interface of 24
the publication that is developed after consultation 25
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•S 3430 RS
with stakeholders on the usability of the data con-1
tained in the publication. 2
(c) M
AKINGPERMANENT THE REQUIREMENT TOAN-3
NUALLYUPDATE THESUD DATABOOK.—Section 1015 4
of the SUPPORT for Patients and Communities Act 5
(Public Law 115–271) is amended— 6
(1) in subsection (a)(3), by striking ‘‘through 7
2024’’; and 8
(2) in subsection (b), by adding at the end the 9
following new paragraph: 10
‘‘(4) P
UBLICATION OF DATA.— 11
‘‘(A) I
N GENERAL.—The Secretary shall 12
publish in the Federal Register a system of 13
records notice that modifies the system of 14
records notice required under paragraph (1) to 15
provide that— 16
‘‘(i) the data specified in paragraph 17
(2) shall be published on a publicly avail-18
able website; and 19
‘‘(ii) such data shall be de-identified 20
of any personally identifying information, 21
shall adhere to privacy standards estab-22
lished by the Department of Health and 23
Human Services, and shall be aggregated 24
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•S 3430 RS
to protect the privacy of enrollees, as nec-1
essary. 2
‘‘(B) I
NITIATION OF MODIFIED DATA - 3
SHARING ACTIVITIES.—Not later than January 4
1, 2025, the Secretary shall initiate the data 5
sharing activities outlined in the notice required 6
under paragraph (1), as modified pursuant to 7
this paragraph.’’. 8
(d) D
EFINITIONS.—In this section: 9
(1) S
ECRETARY.—The term ‘‘Secretary’’ means 10
the Secretary of Health and Human Services. 11
(2) S
TATE.—The term ‘‘State’’ has the mean-12
ing given that term in section 1101(a)(1) of the So-13
cial Security Act (42 U.S.C. 1301(a)(1)) for pur-14
poses of title XIX of such Act. 15
SEC. 113. GUIDANCE TO STATES ON SUPPORTING MENTAL 16
HEALTH SERVICES OR SUBSTANCE USE DIS-17
ORDER CARE INTEGRATION WITH PRIMARY 18
CARE IN MEDICAID AND CHIP. 19
(a) A
NALYSISREGARDINGCAREINTEGRATION.— 20
Not later than 18 months after the date of enactment of 21
this Act, the Secretary shall conduct an analysis of Med-22
icaid and CHIP regarding clinical outcomes among dif-23
ferent models of integration of mental health services or 24
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•S 3430 RS
substance use disorder care within the primary care set-1
ting. Such analysis shall— 2
(1) consider different models for how mental 3
health services or substance use disorder care is de-4
livered and integrated within the primary care set-5
ting, including when providers operating in an inte-6
grated model are physically located in the same 7
practice or building, when at least 1 provider in an 8
integrated care model is available via telehealth, and 9
when primary care, mental health, or substance use 10
disorder care providers seek education and consulta-11
tion from other providers through electronic modali-12
ties; and 13
(2) evaluate— 14
(A) the use of different payment meth-15
odologies, such as bundled payments and value- 16
based payment arrangements; and 17
(B) the use and quality of services to co-18
ordinate care, including but not limited to case 19
management, care coordination, enhanced care 20
coordination, and enhanced care management, 21
for mental health services and for substance use 22
disorder care. 23
(b) G
UIDANCE.—Not later than 12 months after the 24
Secretary completes the analysis required under sub-25
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•S 3430 RS
section (a), the Secretary shall issue guidance to States 1
on supporting integration of mental health services or sub-2
stance use disorder care with primary care under Medicaid 3
and CHIP. Such guidance shall be informed by the anal-4
ysis required under subsection (a) and, at minimum, shall 5
do the following: 6
(1) Provide an overview of State options for 7
adopting and expanding value-based payment ar-8
rangements and alternative payment models, includ-9
ing accountable care organizations and other shared 10
savings programs, that integrate mental health serv-11
ices or substance use disorder care with primary 12
care. 13
(2) Describe opportunities for States to use and 14
align existing authorities and resources to finance 15
integration of mental health services or substance 16
use disorder care with primary care, including with 17
respect to the use of electronic health records in 18
mental health care settings and in substance use dis-19
order care settings. 20
(3) Describe strategies to support integration of 21
mental health services or substance use disorder care 22
with primary care through the use of non-clinical 23
professionals and paraprofessionals, including 24
trained peer support specialists. 25
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•S 3430 RS
(4) Provide examples of specific strategies and 1
models designed to support integration of mental 2
health services or substance use disorder care with 3
primary care for differing age groups, including chil-4
dren and youth, and individuals over the age of 65. 5
(5) Describe options for assessing the clinical 6
outcomes of differing models and strategies for inte-7
gration of mental health services or substance use 8
disorder care with primary care. 9
(c) I
NTEGRATION OFMENTALHEALTHSERVICES OR 10
S
UBSTANCE USEDISORDERCAREWITHPRIMARY 11
C
ARE.—For purposes of subsections (a) and (b), integra-12
tion of mental health services or substance use disorder 13
care with primary care may include (and shall not be lim-14
ited to, including when furnished via telehealth, when ap-15
propriate)— 16
(1) adherence to the collaborative care model or 17
primary care behavioral health model for behavioral 18
health integration; 19
(2) use of behavioral health integration models 20
primarily intended for pediatric populations with 21
non-severe mental health needs that are focused on 22
prevention and early detection and intervention 23
methods through a multidisciplinary collaborative be-24
havioral health team approach co-managed with pri-25
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•S 3430 RS
mary care, to include same-day access to family-fo-1
cused mental health treatment services; 2
(3) having mental health providers or substance 3
use disorder providers physically co-located in a pri-4
mary care setting with same-day visit availability; 5
(4) implementing or maintaining enhanced care 6
coordination or targeted case management which in-7
cludes regular interactions between and within care 8
teams; 9
(5) providing mental health or substance use 10
disorder screening and follow-up assessments, inter-11
ventions, or services within the same practice or fa-12
cility as a primary care or physical service setting; 13
(6) the use of assertive community treatment 14
that is integrated with or facilitated by a primary 15
care practice; and 16
(7) delivery of integrated primary care and 17
mental health services or substance use disorder care 18
in the home or in community-based settings for indi-19
viduals who choose and are able to receive care in 20
such settings, as authorized under subsections (b), 21
(c), (i), (j), and (k) of section 1915 of the Social Se-22
curity Act (42 U.S.C. 1396n), under a waiver under 23
section 1115 of such Act (42 U.S.C. 1315), or under 24
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•S 3430 RS
section 1937, 1945, or 1945A of such Act (42 1
U.S.C. 1396u–7, 1396w–4, 1396w–4a). 2
(d) D
EFINITIONS.—In this section: 3
(1) S
ECRETARY.—The term ‘‘Secretary’’ means 4
the Secretary of Health and Human Services. 5
(2) S
TATE.—The term ‘‘State’’ has the mean-6
ing given that term in section 1101(a)(1) of the So-7
cial Security Act (42 U.S.C. 1301(a)(1)) for pur-8
poses of titles XIX and XXI of such Act. 9
SEC. 114. MEDICAID STATE OPTION RELATING TO INMATES 10
WITH A SUBSTANCE USE DISORDER PENDING 11
DISPOSITION OF CHARGES. 12
(a) S
TATEOPTION.— 13
(1) I
N GENERAL.—Section 1905 of the Social 14
Security Act (42 U.S.C. 1396d) is amended— 15
(A) in the subdivision (A) following the 16
last numbered paragraph of subsection (a), by 17
inserting ‘‘subject to subsection (jj),’’ before 18
‘‘any such payments’’; and 19
(B) by adding at the end the following new 20
subsection: 21
‘‘(jj) S
TATEOPTION TOPROVIDEMEDICALASSIST-22
ANCE TOCERTAININMATESWITH ASUBSTANCEUSE 23
D
ISORDERPENDINGDISPOSITION OFCHARGES.— 24
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•S 3430 RS
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 1
State may elect to provide, and, notwithstanding the 2
subdivision (A) following the last numbered para-3
graph of subsection (a), receive Federal financial 4
participation for, medical assistance for an indi-5
vidual who— 6
‘‘(A) is an inmate of a public institution 7
(as defined in section 1902(nn)(3)) pending dis-8
position of charges; and 9
‘‘(B) has been diagnosed with a substance 10
use disorder. 11
‘‘(2) L
IMITATION; CONDITIONS.— 12
‘‘(A) L
IMITATION.—A State may only re-13
ceive Federal financial participation for medical 14
assistance provided to an individual described in 15
paragraph (1) during the 7-day period that be-16
gins on the first day that the individual is an 17
inmate of a public institution. 18
‘‘(B) C
ONDITIONS.—A State may only re-19
ceive Federal financial participation for medical 20
assistance provided to an individual described in 21
paragraph (1) if— 22
‘‘(i) the State has elected to not ter-23
minate eligibility for medical assistance 24
under the State plan for individuals on the 25
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•S 3430 RS
basis that they are inmates of public insti-1
tutions (but may suspend coverage during 2
the period an individual is such an in-3
mate); and 4
‘‘(ii) the diagnosis that the covered in-5
dividual has a substance use disorder is 6
made while the individual is an inmate of 7
the public institution by a licensed medical 8
professional using a standardized screening 9
and assessment model approved by the 10
Secretary.’’. 11
(2) E
FFECTIVE DATE.—The amendments made 12
by this subsection shall take effect on January 1, 13
2026. 14
(b) T
ECHNICALCORRECTION AND CONFORMING 15
A
MENDMENTS.— 16
(1) T
ECHNICAL CORRECTION .—Section 17
5122(a)(1) of the Consolidated Appropriations Act, 18
2023 (Public Law 117–328) is amended by striking 19
‘‘after’’ and all that follows through the period at 20
the end and inserting ‘‘after ‘or in the case of an eli-21
gible juvenile described in section 1902(a)(84)(D) 22
with respect to the screenings, diagnostic services, 23
referrals, and targeted case management services re-24
quired under such section’.’’. 25
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•S 3430 RS
(2) OTHER CONFORMING AMENDMENTS .— 1
(A) Section 1902(nn)(3) of the Social Se-2
curity Act (42 U.S.C. 1396a(nn)(3)), is amend-3
ed by striking ‘‘following’’ and all that follows 4
through ‘‘section 1905(a)’’ and inserting ‘‘fol-5
lowing the last numbered paragraph of section 6
1905(a)’’. 7
(B) The fifth sentence of section 1905(a) 8
of the Social Security Act (42 U.S.C. 1396d(a)) 9
is amended by striking ‘‘paragraph (30)’’ and 10
inserting ‘‘the last numbered paragraph’’. 11
SEC. 115. DEFINITION OF CERTIFIED COMMUNITY BEHAV-12
IORAL HEALTH CLINIC SERVICES UNDER 13
MEDICAID. 14
(a) D
EFINITION OFMEDICALASSISTANCE.—Section 15
1905 of the Social Security Act (42 U.S.C. 1396d) is 16
amended— 17
(1) in subsection (a)— 18
(A) in paragraph (30), by striking ‘‘; and’’ 19
and inserting a semicolon; 20
(B) by redesignating paragraph (31) as 21
paragraph (32); and 22
(C) by inserting after paragraph (30) the 23
following new paragraph: 24
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•S 3430 RS
‘‘(31) certified community behavioral health 1
clinic services, as defined in subsection (jj); and’’; 2
and 3
(2) by adding at the end the following new sub-4
section: 5
‘‘(jj) C
ERTIFIEDCOMMUNITYBEHAVIORALHEALTH 6
C
LINICSERVICES.— 7
‘‘(1) I
N GENERAL.—The term ‘certified commu-8
nity behavioral health services’ means any of the fol-9
lowing when furnished to an individual as a patient 10
of a certified community behavioral health clinic (as 11
defined in paragraph (2)), in a manner reflecting 12
person-centered care and which, if not available di-13
rectly through a certified community behavioral 14
health clinic, may be provided or referred through 15
formal relationships with other providers: 16
‘‘(A) Crisis mental health services, includ-17
ing 24-hour mobile crisis teams, emergency cri-18
sis intervention services, and crisis stabilization. 19
‘‘(B) Screening, assessment, and diagnosis, 20
including risk assessment. 21
‘‘(C) Patient-centered treatment planning 22
or similar processes, including risk assessment 23
and crisis planning. 24
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•S 3430 RS
‘‘(D) Outpatient mental health and sub-1
stance use services. 2
‘‘(E) Outpatient clinic primary care screen-3
ing and monitoring of key health indicators and 4
health risk. 5
‘‘(F) Intensive case management. 6
‘‘(G) Psychiatric rehabilitation services. 7
‘‘(H) Peer support and counselor services 8
and family supports. 9
‘‘(I) Intensive, community-based mental 10
health care for members of the armed forces 11
and veterans, particularly those members and 12
veterans located in rural areas, provided the 13
care is consistent with minimum clinical mental 14
health guidelines promulgated by the Veterans 15
Health Administration, including clinical guide-16
lines contained in the Uniform Mental Health 17
Services Handbook of such Administration. 18
‘‘(2) C
ERTIFIED COMMUNITY BEHAVIORAL 19
HEALTH CLINIC.—The term ‘certified community be-20
havioral health clinic’ means an organization that— 21
‘‘(A) is engaged in furnishing to patients 22
all of the services described in paragraph (1); 23
‘‘(B) is legally authorized to furnish such 24
services under State law; 25
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•S 3430 RS
‘‘(C) agrees, as a condition of the certifi-1
cation described in subparagraph (D), to fur-2
nish to the State or Secretary any data re-3
quired as part of ongoing monitoring of the or-4
ganization’s provision of services, including en-5
counter data, clinical outcomes data, quality 6
data, and such other data as the State or Sec-7
retary may require; and 8
‘‘(D) has been certified by a State as meet-9
ing the criteria established by the Secretary 10
pursuant to subsection (a) of section 223 of the 11
Protecting Access to Medicare Act as of Janu-12
ary 1, 2024, and any subsequent updates to 13
such criteria, regardless of whether the State is 14
carrying out a demonstration program under 15
this title under subsection (d) of such section.’’. 16
(b) E
FFECTIVEDATE.—The amendments made by 17
this section shall apply with respect to medical assistance 18
furnished on or after January 1, 2024. 19
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•S 3430 RS
TITLE II—REDUCING PRESCRIP-1
TION DRUG COSTS UNDER 2
MEDICARE AND MEDICAID 3
SEC. 201. ASSURING PHARMACY ACCESS AND CHOICE FOR 4
MEDICARE BENEFICIARIES. 5
(a) I
NGENERAL.—Section 1860D–4(b)(1) of the So-6
cial Security Act (42 U.S.C. 1395w–104(b)(1)) is amend-7
ed by striking subparagraph (A) and inserting the fol-8
lowing: 9
‘‘(A) I
N GENERAL.— 10
‘‘(i) P
ARTICIPATION OF ANY WILLING 11
PHARMACY.—A PDP sponsor offering a 12
prescription drug plan shall permit any 13
pharmacy that meets the standard contract 14
terms and conditions under such plan to 15
participate as a network pharmacy of such 16
plan. 17
‘‘(ii) C
ONTRACT TERMS AND CONDI -18
TIONS.— 19
‘‘(I) I
N GENERAL.—For plan 20
years beginning on or after January 21
1, 2028, in accordance with clause (i), 22
contract terms and conditions offered 23
by such PDP sponsor shall be reason-24
able and relevant according to stand-25
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•S 3430 RS
ards established by the Secretary 1
under subclause (II). 2
‘‘(II) S
TANDARDS.—Not later 3
than the first Monday in April of 4
2027, the Secretary shall establish 5
standards for reasonable and relevant 6
contract terms and conditions for pur-7
poses of this clause. 8
‘‘(III) R
EQUEST FOR INFORMA -9
TION.—Not later than January 1, 10
2025, for purposes of establishing the 11
standards under subclause (II), the 12
Secretary shall issue a request for in-13
formation to seek input on trends in 14
prescription drug plan and network 15
pharmacy contract terms and condi-16
tions, current prescription drug plan 17
and network pharmacy contracting 18
practices, whether pharmacy reim-19
bursement and dispensing fees under 20
this part cover pharmacy ingredient 21
and operational costs, areas in current 22
regulations or program guidance re-23
lated to contracting between prescrip-24
tion drug plans and network phar-25
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•S 3430 RS
macies requiring clarification or addi-1
tional specificity, factors for consider-2
ation in determining the reasonable-3
ness and relevance of contract terms 4
and conditions between prescription 5
drug plans and network pharmacies, 6
and other issues determined appro-7
priate by the Secretary.’’. 8
(b) T
REATMENT OF ESSENTIALRETAILPHAR-9
MACIES.—Section 1860D–4(b)(1)(C) of the Social Secu-10
rity Act (42 U.S.C. 1395w–104(b)(1)(C)) is amended by 11
adding at the end the following new clause: 12
‘‘(v) E
SSENTIAL RETAIL PHAR -13
MACIES.— 14
‘‘(I) I
N GENERAL.—For plan 15
years beginning on or after January 16
1, 2028, a PDP sponsor of a prescrip-17
tion drug plan that has preferred 18
pharmacies in its network shall con-19
tract with, as preferred pharmacies in 20
such plan’s network, at least— 21
‘‘(aa) 80 percent of essential 22
retail pharmacies (as defined in 23
subclause (III)) in such plan’s 24
service area that are independent 25
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•S 3430 RS
community pharmacies (as de-1
fined in subclause (V)(bb)); and 2
‘‘(bb) 50 percent of essential 3
retail pharmacies in such plan’s 4
service area not described in item 5
(aa). 6
‘‘(II) T
OTAL REIMBURSEMENT 7
FOR ESSENTIAL RETAIL PHARMACIES 8
THAT ARE INDEPENDENT COMMUNITY 9
PHARMACIES.—For plan years begin-10
ning on or after January 1, 2028, 11
total reimbursement (as defined in 12
subclause (V)(dd)) paid by a PDP 13
sponsor to an essential retail phar-14
macy that is an independent commu-15
nity pharmacy for a covered part D 16
drug shall not be lower than— 17
‘‘(aa) in the case where Na-18
tional Average Drug Acquisition 19
Cost information for such drug 20
for retail community pharmacies 21
or applicable non-retail commu-22
nity pharmacies has been avail-23
able under section 1927(f) for at 24
least one full plan year— 25
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•S 3430 RS
‘‘(AA) if such informa-1
tion is available for such 2
drug for retail community 3
pharmacies, the average Na-4
tional Average Drug Acqui-5
sition Cost for such drug for 6
retail community pharmacies 7
for the most recent plan 8
year for which such informa-9
tion is available; 10
‘‘(BB) in the case 11
where such information for 12
retail community pharmacies 13
is not available, the average 14
National Average Drug Ac-15
quisition Cost for such drug 16
for applicable non-retail 17
pharmacies for the most re-18
cent plan year for which 19
such information is avail-20
able; 21
‘‘(bb) in the case where Na-22
tional Average Drug Acquisition 23
Cost information for such drug 24
under section 1927(f) is not 25
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•S 3430 RS
available for retail community 1
pharmacies or applicable non-re-2
tail pharmacies, the wholesale ac-3
quisition cost (as defined in sec-4
tion 1847A(c)(6)(B)) for such 5
drug; and 6
‘‘(cc) in the case where Na-7
tional Average Drug Acquisition 8
Cost information under section 9
1927(f) is available for such drug 10
and ending on the date such sur-11
vey information has been avail-12
able for such drug but has not 13
been available for a full plan 14
year— 15
‘‘(AA) the most recent 16
National Average Drug Ac-17
quisition Cost for such drug 18
for retail community phar-19
macies, if available; or 20
‘‘(BB) if the informa-21
tion specified in subitem 22
(AA) is not available, the 23
most recent National Aver-24
age Drug Acquisition Cost 25
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•S 3430 RS
for such drug for applicable 1
non-retail pharmacies. 2
‘‘(III) D
EFINITION OF ESSEN -3
TIAL RETAIL PHARMACY .—In this 4
clause, the term ‘essential retail phar-5
macy’ means, with respect to a plan 6
year, a retail pharmacy that— 7
‘‘(aa) is not an affiliate of a 8
pharmacy benefit manager or 9
PDP sponsor; 10
‘‘(bb) is located in a medi-11
cally underserved area (as des-12
ignated pursuant to section 13
330(b)(3)(A) of the Public 14
Health Service Act); and 15
‘‘(cc) is designated as an es-16
sential retail pharmacy by the 17
Secretary for such plan year 18
under subclause (IV). 19
‘‘(IV) D
ESIGNATION OF ESSEN -20
TIAL RETAIL PHARMACIES .— 21
‘‘(aa) I
N GENERAL.—For 22
each plan year (beginning with 23
plan year 2028), the Secretary 24
shall designate pharmacies that 25
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•S 3430 RS
meet the requirements specified 1
in items (aa) and (bb) of sub-2
clause (III) as essential retail 3
pharmacies, in accordance with 4
this subclause. 5
‘‘(bb) R
EQUIRED SUBMIS -6
SIONS FROM PDP SPONSORS .— 7
For each plan year beginning 8
with plan year 2028, each PDP 9
sponsor offering a prescription 10
drug plan shall submit to the 11
Secretary, for the purposes of de-12
termining retail pharmacies that 13
do not meet the requirement 14
specified in item (aa) of sub-15
clause (III), a list of any retail 16
pharmacy that is an affiliate of 17
such sponsor, subject to time, 18
manner, and form requirements 19
established by the Secretary. 20
‘‘(cc) P
UBLICATION.—Not 21
later than one month prior to the 22
start of each plan year (begin-23
ning with plan year 2028), the 24
Secretary shall list, on a publicly 25
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•S 3430 RS
available website of the Centers 1
for Medicare & Medicaid Serv-2
ices, all pharmacies designated as 3
essential retail pharmacies for 4
such plan year. 5
‘‘(dd) R
EVOCATION OF DES-6
IGNATION.—In the case where, 7
during a plan year, the Secretary 8
determines that a pharmacy no 9
longer meets the requirements 10
for designation as an essential re-11
tail pharmacy, the Secretary may 12
revoke such designation for such 13
pharmacy, as determined appro-14
priate by the Secretary. 15
‘‘(V) O
THER DEFINITIONS .—In 16
this clause: 17
‘‘(aa) A
FFILIATE.—The 18
term ‘affiliate’ means any entity 19
that is owned by, controlled by, 20
or related under a common own-21
ership structure with a pharmacy 22
benefit manager or PDP sponsor 23
or that acts as a contractor or 24
agent to such pharmacy benefit 25
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•S 3430 RS
manager or PDP sponsor, if such 1
contractor or agent performs any 2
of the functions described in item 3
(cc). 4
‘‘(bb) I
NDEPENDENT COM -5
MUNITY PHARMACY .—The term 6
‘independent community phar-7
macy’ means a retail pharmacy, 8
including a pharmacy that is as-9
sociated with a franchise or a 10
pharmacy services administrative 11
organization, that has fewer than 12
4 locations and is not affiliated 13
with any person or entity other 14
than its owners. 15
‘‘(cc) P
HARMACY BENEFIT 16
MANAGER.—The term ‘pharmacy 17
benefit manager’ means any per-18
son or entity that, either directly 19
or through an intermediary, acts 20
as a price negotiator or group 21
purchaser on behalf of a PDP 22
sponsor or prescription drug 23
plan, or manages the prescription 24
drug benefits provided by such 25
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•S 3430 RS
sponsor or plan, including the 1
processing and payment of claims 2
for prescription drugs, the per-3
formance of drug utilization re-4
view, the processing of drug prior 5
authorization requests, the adju-6
dication of appeals or grievances 7
related to the prescription drug 8
benefit, contracting with network 9
pharmacies, controlling the cost 10
of covered part D drugs, or the 11
provision of related services. 12
Such term includes any person or 13
entity that carries out one or 14
more of the activities described in 15
the preceding sentence, irrespec-16
tive of whether such person or 17
entity identifies itself as a ‘phar-18
macy benefit manager’. 19
‘‘(dd) T
OTAL REIMBURSE -20
MENT.—The term ‘total reim-21
bursement’ means, with respect 22
to a covered part D drug, the ne-23
gotiated price (as defined in sec-24
tion 1860D–2(d)(1)(B)) plus any 25
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•S 3430 RS
incentive payments paid by the 1
PDP sponsor to such essential 2
retail pharmacy that is an inde-3
pendent community pharmacy 4
net of any fees, pharmacy price 5
concessions, discounts, or any 6
other forms of remuneration paid 7
by such pharmacy and furnished 8
by such PDP sponsor under sec-9
tion 1860D–2(f)(4).’’. 10
(c) E
NFORCEMENT.— 11
(1) I
N GENERAL.—Section 1860D–4(b)(1) of 12
the Social Security Act (42 U.S.C. 1395w– 13
104(b)(1)) is amended by adding at the end the fol-14
lowing new subparagraph: 15
‘‘(F) E
NFORCEMENT OF STANDARDS FOR 16
REASONABLE AND RELEVANT CONTRACT TERMS 17
AND CONDITIONS AND ESSENTIAL RETAIL 18
PHARMACY PROTECTIONS .— 19
‘‘(i) A
LLEGATION SUBMISSION PROC -20
ESS.— 21
‘‘(I) I
N GENERAL.—Not later 22
than January 1, 2028, the Secretary 23
shall establish a process through 24
which a pharmacy may submit an al-25
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•S 3430 RS
legation of a violation by a PDP spon-1
sor offering a prescription drug plan 2
of— 3
‘‘(aa) the standards for rea-4
sonable and relevant contract 5
terms and conditions under sub-6
paragraph (A)(ii); or 7
‘‘(bb) the requirements for 8
total reimbursement for essential 9
retail pharmacies that are inde-10
pendent community pharmacies 11
under subparagraph (C)(v)(II). 12
‘‘(II) F
REQUENCY OF SUBMIS -13
SION.— 14
‘‘(aa) V
IOLATIONS OF REA-15
SONABLE AND RELEVANT CON -16
TRACT TERMS AND CONDI -17
TIONS.— 18
‘‘(AA) I
N GENERAL.— 19
Except as provided in 20
subitem (BB), the allegation 21
submission process under 22
this clause shall allow phar-23
macies to submit any allega-24
tions of violations described 25
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•S 3430 RS
in item (aa) of subclause (I) 1
not more frequently than 2
once per plan year per con-3
tract between a pharmacy 4
and a PDP sponsor. 5
‘‘(BB) A
LLEGATIONS 6
RELATING TO CONTRACT 7
CHANGES.—In the case 8
where a contract is amended 9
or otherwise updated fol-10
lowing the submission of al-11
legations by a pharmacy 12
with respect to such contract 13
and plan year, the allegation 14
submission process under 15
this clause shall allow such 16
pharmacy to submit an addi-17
tional allegation related to 18
those changes with respect 19
to such contract and plan 20
year. 21
‘‘(CC) S
UBMISSIONS.— 22
Submissions of any allega-23
tions under this item shall 24
be separate from any sub-25
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•S 3430 RS
missions under item (bb) 1
and may include multiple al-2
legations of such violations. 3
‘‘(bb) V
IOLATIONS OF ES -4
SENTIAL RETAIL PHARMACY PRO -5
TECTIONS.— 6
‘‘(AA) I
N GENERAL.— 7
The allegation submission 8
process under this clause 9
shall allow essential retail 10
pharmacies that are inde-11
pendent community phar-12
macies to submit any allega-13
tions of violations described 14
in item (bb) of subclause (I) 15
once per calendar quarter. 16
‘‘(BB) S
UBMISSIONS.— 17
Submissions of any allega-18
tions under this item shall 19
be separate from any sub-20
missions under item (aa) 21
and may include multiple al-22
legations of such violations. 23
‘‘(III) A
CCESS TO RELEVANT 24
DOCUMENTS AND MATERIALS .—A 25
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•S 3430 RS
PDP sponsor subject to an allegation 1
under this clause— 2
‘‘(aa) shall provide docu-3
ments or materials, as specified 4
by the Secretary, including con-5
tract offers made by such spon-6
sor to such pharmacy or cor-7
respondence related to such of-8
fers, to the Secretary at a time 9
and in a form and manner speci-10
fied by the Secretary; and 11
‘‘(bb) shall not prohibit or 12
otherwise limit the ability of a 13
pharmacy to submit such docu-14
ments or materials to the Sec-15
retary for the purpose of submit-16
ting an allegation or providing 17
evidence for such an allegation 18
under this clause. 19
‘‘(IV) S
TANDARDIZED TEM -20
PLATE.—The Secretary shall establish 21
separate standardized templates for 22
pharmacies to use for the submission 23
of allegations described in items (aa) 24
and (bb) of subclause (I). Each such 25
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•S 3430 RS
template shall require that the sub-1
mission include a certification by the 2
pharmacy that the information in-3
cluded is accurate, complete, and true 4
to the best of the knowledge, informa-5
tion, and belief of such pharmacy. 6
‘‘(V) P
REVENTING FRIVOLOUS 7
ALLEGATIONS.—In the case where the 8
Secretary determines that a pharmacy 9
has submitted frivolous allegations 10
under this clause on a routine basis, 11
the Secretary may temporarily pro-12
hibit such pharmacy from using the 13
allegation submission process under 14
this clause, as determined appropriate 15
by the Secretary. 16
‘‘(VI) E
XEMPTION FROM FREE -17
DOM OF INFORMATION ACT .—Allega-18
tions submitted under this clause shall 19
be exempt from disclosure under sec-20
tion 552 of title 5, United States 21
Code. 22
‘‘(ii) I
NVESTIGATION.—The Secretary 23
shall investigate, as determined appro-24
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•S 3430 RS
priate by the Secretary, allegations sub-1
mitted pursuant to clause (i). 2
‘‘(iii) E
NFORCEMENT.— 3
‘‘(I) R
EASONABLE AND REL -4
EVANT CONTRACT TERMS AND CONDI -5
TIONS.—In the case where the Sec-6
retary determines that a PDP sponsor 7
offering a prescription drug plan has 8
violated the standards for reasonable 9
and relevant contract terms and con-10
ditions under subparagraph (A)(ii), 11
the Secretary shall use existing au-12
thorities under sections 1857(g) and 13
1860D–12(b)(3)(E) to impose civil 14
monetary penalties or take other en-15
forcement actions. 16
‘‘(II) E
SSENTIAL RETAIL PHAR -17
MACY PROTECTIONS .—In the case 18
where the Secretary determines that a 19
PDP sponsor offering a prescription 20
drug plan has violated the require-21
ments for total reimbursement for es-22
sential retail pharmacies that are 23
independent community pharmacies 24
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•S 3430 RS
under subparagraph (C)(v)(II), the 1
Secretary shall— 2
‘‘(aa) if the amount of total 3
reimbursement paid by the spon-4
sor to an essential retail phar-5
macy that is an independent 6
community pharmacy for a cov-7
ered part D drug was less than 8
the amount of total reimburse-9
ment required to be paid to the 10
pharmacy under subparagraph 11
(C)(v)(II) for such drug, require 12
the PDP sponsor to pay to the 13
pharmacy an amount equal to 14
the difference between such 15
amounts; and 16
‘‘(bb) use existing authori-17
ties under section 1857(g) and 18
1860D–12(b)(3)(E) to impose 19
civil monetary penalties or take 20
other enforcement actions. 21
‘‘(III) A
PPLICATION OF CIVIL 22
MONETARY PENALTIES .—The provi-23
sions of section 1128A (other than 24
subsections (a) and (b)) shall apply to 25
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•S 3430 RS
a civil monetary penalty under this 1
clause in the same manner as such 2
provisions apply to a penalty or pro-3
ceeding under section 1128A(a). 4
‘‘(iv) D
EFINITIONS.—In this subpara-5
graph, the terms ‘essential retail phar-6
macy’, ‘independent community pharmacy’, 7
and ‘total reimbursement’ have the mean-8
ing given those terms in subparagraph 9
(C)(v).’’. 10
(2) C
ONFORMING AMENDMENT .—Section 11
1857(g)(1) of the Social Security Act (42 U.S.C. 12
1395w–27(g)(1)) is amended— 13
(A) in subparagraph (J), by striking ‘‘or’’ 14
after the semicolon; 15
(B) by redesignating subparagraph (K) as 16
subparagraph (L); 17
(C) by inserting after subparagraph (J), 18
the following new subparagraph: 19
‘‘(K) fails to comply with— 20
‘‘(i) the standards for reasonable and 21
relevant contract terms and conditions 22
under subparagraph (A)(ii) of section 23
1860D–4(b)(1); or 24
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•S 3430 RS
‘‘(ii) the requirements for total reim-1
bursement for essential retail pharmacies 2
that are independent community phar-3
macies under subparagraph (C)(v)(II) of 4
such section; or’’; 5
(D) in subparagraph (L), as redesignated 6
by subparagraph (B), by striking ‘‘through (J)’’ 7
and inserting ‘‘through (K)’’; and 8
(E) in the flush matter following subpara-9
graph (L), as so redesignated, by striking ‘‘sub-10
paragraphs (A) through (K)’’ and inserting 11
‘‘subparagraphs (A) through (L)’’. 12
(d) A
CCOUNTABILITY OF PHARMACYBENEFITMAN-13
AGERS FORVIOLATIONS OFREASONABLE ANDRELEVANT 14
C
ONTRACTTERMS ANDCONDITIONS ANDESSENTIALRE-15
TAILPHARMACYPROTECTIONS.— 16
(1) I
N GENERAL.—Section 1860D–12(b) of the 17
Social Security Act (42 U.S.C. 1395w–112) is 18
amended by adding at the end the following new 19
paragraph: 20
‘‘(9) A
CCOUNTABILITY OF PHARMACY BENEFIT 21
MANAGERS FOR VIOLATIONS OF REASONABLE AND 22
RELEVANT CONTRACT TERMS AND CONDITIONS AND 23
ESSENTIAL RETAIL PHARMACY PROTECTIONS .—For 24
plan years beginning on or after January 1, 2028, 25
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•S 3430 RS
each contract entered into with a PDP sponsor 1
under this part with respect to a prescription drug 2
plan offered by such sponsor shall provide that any 3
pharmacy benefit manager acting on behalf of such 4
sponsor has a written agreement with the PDP 5
sponsor under which the pharmacy benefit manager 6
agrees to reimburse the PDP sponsor for any 7
amounts paid by such sponsor under subclause (I) 8
or (II) of section 1860D–4(b)(1)(F)(iii) as a result 9
of a violation described in such subclause (I) or (II) 10
if such violation is related to a responsibility dele-11
gated to the pharmacy benefit manager by such 12
PDP sponsor.’’. 13
(2) M
A–PD PLANS.—Section 1857(f)(3) of the 14
Social Security Act (42 U.S.C. 1395w–27(f)(3)) is 15
amended by adding at the end the following new 16
subparagraph: 17
‘‘(F) A
CCOUNTABILITY OF PHARMACY 18
BENEFIT MANAGERS FOR VIOLATIONS OF REA -19
SONABLE AND RELEVANT CONTRACT TERMS 20
AND CONDITIONS AND ESSENTIAL RETAIL 21
PHARMACY PROTECTIONS .—For plan years be-22
ginning on or after January 1, 2028, section 23
1860D–12(b)(9).’’. 24
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•S 3430 RS
(e) Section 1860D–42 of the Social Security Act (42 1
U.S.C. 1395w–152) is amended by adding at the end the 2
following new subsection: 3
‘‘(e) B
RIEFING ANDREPORTINGREQUIREMENTSRE-4
LATED TOPHARMACYPRICECONCESSIONSUNDERTHIS 5
P
ART.— 6
‘‘(1) B
RIEFING REQUIREMENTS .—The Sec-7
retary shall provide periodic briefings to the Com-8
mittee on Finance of the Senate, the Committee on 9
Ways and Means of the House of Representatives, 10
and the Committee on Energy and Commerce of the 11
House of Representatives, beginning not later than 12
90 days after the date of enactment of this sub-13
section, on implementation, oversight, data collec-14
tion, and enforcement activities related to the ad-15
ministration of the ‘Pharmacy Price Concessions to 16
Drug Prices at the Point of Sale’ provisions codified 17
under sections 423.100 and 423.2305 of title 42, 18
Code of Federal Regulations (or any successor regu-19
lations), as published in the Federal Register on 20
May 9, 2022, in the final rule entitled ‘Medicare 21
Program; Contract Year 2023 Policy and Technical 22
Changes to the Medicare Advantage and Medicare 23
Prescription Drug Benefit Programs; Policy and 24
Regulatory Revisions in Response to the COVID–19 25
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•S 3430 RS
Public Health Emergency; Additional Policy and 1
Regulatory Revisions in Response to the COVID–19 2
Public Health Emergency’. 3
‘‘(2) R
EPORTING REQUIREMENTS .—Beginning 4
not later than 90 days after the date of enactment 5
of this subsection, and at least once every plan year 6
beginning thereafter (through plan year 2027), the 7
Secretary shall develop and submit to Congress re-8
ports on the activities specified in paragraph (1). 9
‘‘(3) C
ONTENTS FOR BRIEFINGS AND RE -10
PORTS.—The briefings required under paragraph (1) 11
and reports required under paragraph (2) shall in-12
clude information on— 13
‘‘(A) implementation, oversight, data col-14
lection, and enforcement activities related to 15
contract terms and conditions among PDP 16
sponsors, MA organizations, and pharmacies for 17
the purpose of establishing or maintaining 18
pharmacy network participation or preferred 19
pharmacy network participation; 20
‘‘(B) patterns and trends in such terms 21
and conditions, to the extent applicable; 22
‘‘(C) implementation, oversight, and en-23
forcement activities and developments related to 24
assuring pharmacy access under section 25
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1860D–4(b)(1), along with applicable regula-1
tions and program instruction or guidance; 2
‘‘(D) plans, strategies, initiatives, or pro-3
grammatic changes undertaken by the Sec-4
retary to prevent, mitigate, or otherwise address 5
stakeholder feedback and concerns related to 6
convenient pharmacy access for beneficiaries 7
under this part; and 8
‘‘(E) other issues determined appropriate 9
by the Secretary.’’. 10
(f) F
UNDING.—In addition to amounts otherwise 11
available, there is appropriated to the Centers for Medi-12
care & Medicaid Services Program Management Account, 13
out of any money in the Treasury not otherwise appro-14
priated, $250,000,000 for fiscal year 2024, to remain 15
available until expended, to carry out the amendment 16
made by this section. 17
SEC. 202. ENSURING ACCURATE PAYMENTS TO PHAR-18
MACIES UNDER MEDICAID. 19
(a) I
NGENERAL.—Section 1927(f) of the Social Se-20
curity Act (42 U.S.C. 1396r–8(f)) is amended— 21
(1) in paragraph (1)(A)— 22
(A) by redesignating clause (ii) as clause 23
(iii); and 24
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•S 3430 RS
(B) by striking ‘‘and’’ after the semicolon 1
at the end of clause (i) and all that precedes it 2
through ‘‘(1)’’ and inserting the following: 3
‘‘(1) D
ETERMINING PHARMACY ACTUAL ACQUI -4
SITION COSTS.—The Secretary shall conduct a sur-5
vey of retail community pharmacy drug prices and 6
applicable non-retail pharmacy drug prices to deter-7
mine national average drug acquisition cost bench-8
marks as follows: 9
‘‘(A) U
SE OF VENDOR .—The Secretary 10
may contract services for— 11
‘‘(i) with respect to retail community 12
pharmacies, the determination of retail 13
survey prices of the national average drug 14
acquisition cost for covered outpatient 15
drugs that represent a nationwide average 16
of consumer purchase prices for such 17
drugs, net of all discounts and rebates (to 18
the extent any information with respect to 19
such discounts and rebates is available) 20
based on a monthly survey of such phar-21
macies; 22
‘‘(ii) with respect to applicable non-re-23
tail pharmacies— 24
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‘‘(I) the determination of survey 1
prices, separate from the survey prices 2
described in clause (i), of the non-re-3
tail national average drug acquisition 4
cost for covered outpatient drugs that 5
represent a nationwide average of con-6
sumer purchase prices for such drugs, 7
net of all discounts and rebates (to 8
the extent any information with re-9
spect to such discounts and rebates is 10
available) based on a monthly survey 11
of such pharmacies; and 12
‘‘(II) at the discretion of the Sec-13
retary, for each type of applicable 14
non-retail pharmacy (as identified 15
pursuant to the type indicators estab-16
lished by the Secretary under sub-17
section (k)(12)(B)(ii)), the determina-18
tion of survey prices, separate from 19
the survey prices described in clause 20
(i) or subclause (I) of this clause, of 21
the national average drug acquisition 22
cost for such type of pharmacy for 23
covered outpatient drugs that rep-24
resent a nationwide average of con-25
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•S 3430 RS
sumer purchase prices for such drugs, 1
net of all discounts and rebates (to 2
the extent any information with re-3
spect to such discounts and rebates is 4
available) based on a monthly survey 5
of such pharmacies; and’’; 6
(2) in subparagraph (D) of paragraph (1), by 7
striking clauses (ii) and (iii) and inserting the fol-8
lowing: 9
‘‘(ii) The vendor must update the Sec-10
retary no less often than monthly on the 11
survey prices for covered outpatient drugs. 12
‘‘(iii) The vendor must differentiate, 13
in collecting and reporting survey data, the 14
relevant pharmacy type indicator for all 15
cost information collected, including wheth-16
er a pharmacy is owned by, operated by, or 17
otherwise affiliated with a pharmacy ben-18
efit manager and whether a pharmacy is a 19
retail community pharmacy or an applica-20
ble non-retail pharmacy, and, in the case 21
of an applicable non-retail pharmacy, 22
which type of applicable non-retail phar-23
macy (as identified pursuant to the type 24
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•S 3430 RS
indicators established by the Secretary 1
under subsection (k)(12)(B)(ii)) it is.’’; 2
(3) by adding at the end of paragraph (1) the 3
following: 4
‘‘(F) S
URVEY REPORTING .—In order to 5
meet the requirement of section 1902(a)(54), a 6
State shall require that any retail community 7
pharmacy or applicable non-retail pharmacy in 8
the State that receives any payment, reimburse-9
ment, administrative fee, discount, or rebate re-10
lated to the dispensing of covered outpatient 11
drugs to individuals receiving benefits under 12
this title, regardless of whether such payment, 13
reimbursement, administrative fee, discount, or 14
rebate is received from the State or a managed 15
care entity or other specified entity (as such 16
terms are defined in section 1903(m)(9)(D)) di-17
rectly or from a pharmacy benefit manager or 18
another entity that has a contract with the 19
State or a managed care entity or other speci-20
fied entity (as so defined), shall respond to sur-21
veys conducted under this paragraph. 22
‘‘(G) S
URVEY INFORMATION .—Information 23
on national drug acquisition prices obtained 24
under this paragraph shall be made publicly 25
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•S 3430 RS
available and shall include at least the fol-1
lowing: 2
‘‘(i) The monthly response rate to the 3
survey including a list of pharmacies not in 4
compliance with subparagraph (F). 5
‘‘(ii) The sampling frame and number 6
of pharmacies sampled monthly. 7
‘‘(iii) Information on price concessions 8
to the pharmacy, including discounts, re-9
bates, and other price concessions, to the 10
extent that such information may be pub-11
licly released and has been collected by the 12
Secretary as part of the survey. 13
‘‘(H) P
ENALTIES.—The Secretary, in con-14
sultation with the Office of the Inspector Gen-15
eral of the Department of Health and Human 16
Services, shall enforce the provisions of this 17
paragraph with respect to a pharmacy through 18
the establishment of appropriate civil monetary 19
penalties, which may be assessed with respect 20
to each violation or survey non-response, and 21
with respect to each non-compliant pharmacy 22
(including a pharmacy that is part of a chain), 23
until compliance with this paragraph has been 24
completed. The provisions of section 1128A 25
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•S 3430 RS
(other than subsections (a) and (b)) shall apply 1
to a civil money penalty under the preceding 2
sentence in the same manner as such provisions 3
apply to a civil money penalty or proceeding 4
under section 1128A(a). 5
‘‘(I) L
IMITATION ON USE OF APPLICABLE 6
NON-RETAIL PHARMACY PRICING INFORMA -7
TION.—No State shall use pricing information 8
reported by applicable non-retail pharmacies 9
under paragraph (1)(A)(ii) to develop or inform 10
reimbursement rates for retail community phar-11
macies.’’; 12
(4) in paragraph (2)— 13
(A) in subparagraph (A), by inserting ‘‘, 14
including payment rates under managed care 15
entities or other specified entities (as such 16
terms are defined in section 1903(m)(9)(D)),’’ 17
after ‘‘under this title’’; and 18
(B) in subparagraph (B), by inserting 19
‘‘and the basis for such dispensing fees’’ before 20
the semicolon; 21
(5) by redesignating paragraph (4) as para-22
graph (5); 23
(6) by inserting after paragraph (3) the fol-24
lowing new paragraph: 25
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•S 3430 RS
‘‘(4) OVERSIGHT.— 1
‘‘(A) I
N GENERAL.—The Inspector General 2
of the Department of Health and Human Serv-3
ices shall conduct periodic studies of the survey 4
data reported under this subsection, as appro-5
priate, including with respect to substantial 6
variations in acquisition costs or other applica-7
ble costs, as well as with respect to how internal 8
transfer prices and related party transactions 9
may influence the costs reported by pharmacies 10
affiliated with pharmacy benefit managers, 11
wholesalers, distributors, and other entities that 12
acquire covered outpatient drugs relative to 13
costs reported by pharmacies not affiliated with 14
such entities. The Inspector General shall pro-15
vide periodic updates to Congress on the results 16
of such studies, as appropriate, in a manner 17
that does not disclose trade secrets or other 18
proprietary information. 19
‘‘(B) A
PPROPRIATION.—There is appro-20
priated to the Inspector General of the Depart-21
ment of Health and Human Services, out of 22
any money in the Treasury not otherwise ap-23
propriated, $5,000,000 for fiscal year 2024, to 24
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•S 3430 RS
remain available until expended, to carry out 1
this paragraph.’’; and 2
(7) in paragraph (5), as so redesignated, by in-3
serting ‘‘, and $9,000,000 for fiscal year 2024 and 4
each fiscal year thereafter,’’ after ‘‘2010’’. 5
(b) D
EFINITIONS.—Section 1927(k) of the Social Se-6
curity Act (42 U.S.C. 1396r–8(k)) is amended by adding 7
the following— 8
‘‘(12) A
PPLICABLE NON-RETAIL PHARMACY.— 9
‘‘(A) I
N GENERAL.—The term ‘applicable 10
non-retail pharmacy’ means a pharmacy that is 11
licensed as a pharmacy by the State and that 12
is not a retail community pharmacy, including 13
a pharmacy that dispenses prescription medica-14
tions to patients primarily through mail and 15
specialty pharmacies. Such term does not in-16
clude nursing home pharmacies, long-term care 17
facility pharmacies, hospital pharmacies, clinics, 18
charitable or not-for-profit pharmacies, govern-19
ment pharmacies, or low dispensing pharmacies 20
(as defined by the Secretary). 21
‘‘(B) I
DENTIFICATION OF APPLICABLE 22
NON-RETAIL PHARMACIES.— 23
‘‘(i) I
N GENERAL.—For purposes of 24
subsection (f), the Secretary shall, not 25
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•S 3430 RS
later than January 1, 2025, in consulta-1
tion with stakeholders as appropriate, issue 2
guidance specifying pharmacies that meet 3
the definition of applicable non-retail phar-4
macies and that will be subject to the sur-5
vey requirements under subsection (f)(1). 6
‘‘(ii) I
NCLUSION OF PHARMACY TYPE 7
INDICATORS.—The guidance promulgated 8
under clause (i) shall include pharmacy 9
type indicators to distinguish between dif-10
ferent types of applicable non-retail phar-11
macies, such as pharmacies that dispense 12
prescriptions primarily through the mail 13
and pharmacies that dispense prescriptions 14
that require special handling or distribu-15
tion. An applicable non-retail pharmacy 16
may be identified through multiple phar-17
macy type indicators. 18
‘‘(13) P
HARMACY BENEFIT MANAGER .—The 19
term ‘pharmacy benefit manager’ means any person 20
or entity that, either directly or through an inter-21
mediary, acts as a price negotiator or group pur-22
chaser on behalf of a State, managed care entity or 23
other specified entity (as such terms are defined in 24
section 1903(m)(9)(D)), or manages the prescription 25
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•S 3430 RS
drug benefits provided by such State, managed care 1
entity, or other specified entity, including the proc-2
essing and payment of claims for prescription drugs, 3
the performance of drug utilization review, the proc-4
essing of drug prior authorization requests, the man-5
aging of appeals or grievances related to the pre-6
scription drug benefits, contracting with pharmacies, 7
controlling the cost of covered outpatient drugs, or 8
the provision of services related thereto. Such term 9
includes any person or entity that carries out 1 or 10
more of the activities described in the preceding sen-11
tence, irrespective of whether such person or entity 12
calls itself a ‘pharmacy benefit manager’.’’. 13
(c) E
FFECTIVEDATE.—The amendments made by 14
this section take effect on the first day of the first quarter 15
that begins on or after the date that is 18 months after 16
the date of enactment of this Act. 17
SEC. 203. PROTECTING SENIORS FROM EXCESSIVE COST- 18
SHARING FOR CERTAIN MEDICINES. 19
Section 1860D–2 of the Social Security Act (42 20
U.S.C. 1395w–102) is amended— 21
(1) in subsection (b)— 22
(A) in paragraph (2)(A), in the matter 23
preceding clause (i), by striking ‘‘and (9)’’ and 24
inserting ‘‘, (9), (10), and (11)’’; and 25
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•S 3430 RS
(B) by adding at the end the following new 1
paragraphs: 2
‘‘(10) T
YING COST-SHARING TO NET PRICE FOR 3
CERTAIN MEDICATIONS.— 4
‘‘(A) I
N GENERAL.—For plan years begin-5
ning on or after January 1, 2028, for costs 6
above the annual deductible specified in para-7
graph (1) and below the annual out-of-pocket 8
threshold specified in paragraph (4), any coin-9
surance amount for a discount-eligible drug 10
that is included on the plan’s formulary and 11
subject to coinsurance rather than a copayment 12
shall be calculated based on the net price of 13
such discount-eligible drug. 14
‘‘(B) R
EPORTING TO THE SECRETARY .— 15
For plan years beginning on or after January 16
1, 2028, a PDP sponsor of a prescription drug 17
plan and an MA organization offering an MA– 18
PD plan shall annually submit to the Secretary, 19
in a form and manner determined appropriate 20
by the Secretary— 21
‘‘(i) approximate price concessions 22
and net prices for each discount-eligible 23
drug; and 24
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‘‘(ii) a written explanation of the 1
methodology used to calculate such approx-2
imate price concessions and net prices. 3
‘‘(C) R
EQUIREMENTS FOR APPROXIMATE 4
PRICE CONCESSIONS.— 5
‘‘(i) I
N GENERAL.—Approximate price 6
concessions submitted under subparagraph 7
(B) shall comply with— 8
‘‘(I) the drug-specific threshold 9
under clause (ii) for the applicable 10
plan year; and 11
‘‘(II) the aggregate threshold 12
under clause (iii) for the applicable 13
plan year. 14
‘‘(ii) T
HRESHOLDS.— 15
‘‘(I) P
LAN YEARS 2028 THROUGH 16
2032.—For plan years 2028 through 17
2032— 18
‘‘(aa) the drug-specific 19
threshold is 20 percent; and 20
‘‘(bb) the aggregate thresh-21
old is 15 percent. 22
‘‘(II) S
UBSEQUENT PLAN 23
YEARS.— 24
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•S 3430 RS
‘‘(aa) IN GENERAL.—For 1
plan years beginning with 2033, 2
the Secretary may, as determined 3
appropriate by the Secretary, ad-4
just the drug-specific and aggre-5
gate thresholds under this clause. 6
‘‘(bb) C
ONSIDERATIONS.—In 7
making any such adjustments, 8
the Secretary may consider his-9
torical variations in expected and 10
actual manufacturer price conces-11
sions for covered part D drugs, 12
factors that may result in manu-13
facturer price concession uncer-14
tainty or variation in a given 15
plan year, PDP sponsor and MA 16
organization behavioral re-17
sponses, effects of precise manu-18
facturer price concession disclo-19
sures, beneficiary out-of-pocket 20
costs, expenditures under this 21
part, and other factors deter-22
mined appropriate by the Sec-23
retary. 24
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•S 3430 RS
‘‘(cc) REQUIREMENTS.—In 1
making any such adjustments, 2
the Secretary shall ensure that 3
the aggregate threshold for an 4
applicable plan year is lower than 5
the drug-specific threshold for 6
such applicable plan year. 7
‘‘(dd) P
UBLICATION.—The 8
Secretary shall publish any ad-9
justments to the drug-specific 10
and aggregate thresholds under 11
this clause no later than the first 12
Monday of April of the year be-13
fore the start of the plan year for 14
which such adjusted thresholds 15
are applicable. 16
‘‘(D) P
UBLICATION OF DISCOUNT -ELIGI-17
BLE DRUGS.—Not later than 15 months before 18
the start of each plan year (beginning with plan 19
year 2028), the Secretary shall publish on a 20
publicly available website a list of the discount- 21
eligible drugs that apply with respect to such 22
plan year (as determined by the Secretary 23
under subparagraph (F)(iv)). 24
‘‘(E) E
NFORCEMENT.— 25
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•S 3430 RS
‘‘(i) MONITORING COMPLIANCE .—The 1
Secretary, in consultation with the Office 2
of the Inspector General, shall conduct 3
periodic audits of prescription drug plans 4
and MA–PD plans to monitor compliance 5
with the requirements under this para-6
graph. All information reported by a PDP 7
sponsor or MA organization under this 8
paragraph may be subject to audit by the 9
Secretary and the Office of the Inspector 10
General. 11
‘‘(ii) P
ENALTIES.— 12
‘‘(I) I
N GENERAL.—A PDP spon-13
sor or an MA organization that vio-14
lates the requirements under this 15
paragraph may be subject to civil 16
monetary penalties, consistent with 17
sections 1857(g) and 1860D– 18
12(b)(3)(E), as determined appro-19
priate by the Secretary. 20
‘‘(II) A
PPLICATION.—The provi-21
sions of section 1128A (other than 22
subsections (a) and (b)) shall apply to 23
a civil monetary penalty under this 24
clause in the same manner as such 25
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•S 3430 RS
provisions apply to a penalty or pro-1
ceeding under section 1128A(a). 2
‘‘(F) D
EFINITIONS.—In this paragraph: 3
‘‘(i) A
CTUAL PRICE CONCESSIONS .— 4
The term ‘actual price concessions’ means, 5
with respect to a covered part D drug, the 6
amount of manufacturer price concessions 7
that the PDP sponsor or MA organization 8
reports for such drug in the Detailed DIR 9
Report (or successor report) for the appli-10
cable plan year. 11
‘‘(ii) A
GGREGATE THRESHOLD .—The 12
term ‘aggregate threshold’ means the max-13
imum percentage by which the total ap-14
proximate price concessions for all dis-15
count-eligible drugs may vary from the 16
total actual manufacturer price concessions 17
for all such discount-eligible drugs as re-18
ported in the Detailed DIR Report (or suc-19
cessor report) for the applicable plan year. 20
‘‘(iii) A
PPROXIMATE PRICE CONCES -21
SIONS.—The term ‘approximate price con-22
cessions’ means, with respect to a covered 23
part D drug, the amount of price conces-24
sions from manufacturers that the PDP 25
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•S 3430 RS
sponsor or MA organization estimates it 1
will receive with respect to an applicable 2
plan year, subject to the thresholds estab-3
lished under subparagraph (C)(ii), and re-4
flected in the net price. 5
‘‘(iv) D
ISCOUNT-ELIGIBLE DRUG.— 6
‘‘(I) I
N GENERAL.—The term 7
‘discount-eligible drug’ means a cov-8
ered part D drug (other than a cov-9
ered part D drug described in para-10
graph (8) or (9))— 11
‘‘(aa) that is in an applica-12
ble category or class described in 13
subclause (II); and 14
‘‘(bb) for which the aggre-15
gate manufacturer price conces-16
sions received by PDP sponsors 17
and MA organizations (or phar-18
macy benefit managers acting on 19
behalf of such sponsors or orga-20
nizations) for such drug are 21
equal to or exceed 50 percent of 22
aggregate gross covered prescrip-23
tion drug costs for such drug in 24
the most recent plan year for 25
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•S 3430 RS
which data is available, as deter-1
mined by the Secretary based on 2
previous submissions of Detailed 3
DIR Reports (or successor re-4
ports) or other relevant reporting 5
from PDP sponsors or MA orga-6
nizations. 7
‘‘(II) A
PPLICABLE CATEGORY OR 8
CLASS.—The applicable categories and 9
classes described in this subclause are 10
the following, as specified by the 11
United States Pharmacopeia: 12
‘‘(aa) Anti-inflammatories 13
(Inhaled Corticosteroids). 14
‘‘(bb) Bronchodilators, Anti-15
cholinergic. 16
‘‘(cc) Bronchodilators, 17
Sympathomimetic. 18
‘‘(dd) Respiratory tract 19
agents. 20
‘‘(ee) Anticoagulants. 21
‘‘(ff) Cardiovascular agents. 22
‘‘(v) D
RUG-SPECIFIC THRESHOLD .— 23
The term ‘drug-specific threshold’ means 24
the maximum percentage by which approx-25
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•S 3430 RS
imate price concessions with respect to a 1
discount-eligible drug may vary from the 2
actual manufacturer price concessions for 3
such drug, as reported in the Detailed DIR 4
Report (or successor report) for the appli-5
cable plan year. 6
‘‘(vi) N
ET PRICE.—The term ‘net 7
price’ means, with respect to a covered 8
part D drug, the negotiated price of such 9
drug, net of all approximate price conces-10
sions (estimated on an average per-unit 11
basis, as needed) not already reflected in 12
the negotiated price for the applicable plan 13
year. 14
‘‘(vii) M
ANUFACTURER PRICE CON -15
CESSIONS.—The term ‘manufacturer price 16
concessions’ means, with respect to a cov-17
ered part D drug, rebates that the PDP 18
sponsor or MA organization receives from 19
manufacturers. 20
‘‘(G) N
ONAPPLICATION OF PAPERWORK 21
REDUCTION ACT .—Chapter 35 of title 44, 22
United States Code, shall not apply to any data 23
collection undertaken by the Secretary under 24
this paragraph. 25
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•S 3430 RS
‘‘(11) LIMITING COST-SHARING TO NET 1
PRICE.— 2
‘‘(A) I
N GENERAL.—For plan years begin-3
ning on or after January 1, 2028, the cost- 4
sharing (for costs above the annual deductible 5
specified in paragraph (1)) for a covered part D 6
drug (other than a covered part D drug de-7
scribed in paragraph (8) or (9)) shall not ex-8
ceed the negotiated price for such covered part 9
D drug net of all price concessions (as defined 10
in paragraph (10)(F)(v)), as reported in the 11
Detailed DIR Report (or successor report) for 12
the applicable plan year. 13
‘‘(B) E
NFORCEMENT.— 14
‘‘(i) M
ONITORING COMPLIANCE .—The 15
Secretary shall monitor compliance with 16
the requirements under subparagraph (A) 17
on an ongoing basis, including through 18
periodic audits. 19
‘‘(ii) R
ETROACTIVE PENALTIES .— 20
‘‘(I) I
N GENERAL.—A PDP spon-21
sor or an MA organization that vio-22
lates the requirements under subpara-23
graph (A) may be subject to civil 24
monetary penalties, consistent with 25
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•S 3430 RS
sections 1857(g) and 1860D– 1
12(b)(3)(E), as determined appro-2
priate by the Secretary. The Secretary 3
may impose such penalties retro-4
actively upon review of the Detailed 5
DIR Report (or any successor report) 6
with respect to a given plan year. 7
‘‘(II) A
PPLICATION.—The provi-8
sions of section 1128A (other than 9
subsections (a) and (b)) shall apply to 10
a civil monetary penalty under this 11
clause in the same manner as such 12
provisions apply to a penalty or pro-13
ceeding under section 1128A(a). 14
‘‘(12) GAO 
STUDY AND REPORT ON IMPLEMEN -15
TATION AND EFFECTS OF COST -SHARING RELIEF 16
PROVISIONS.— 17
‘‘(A) S
TUDY.—The Comptroller General of 18
the United States (in this paragraph referred to 19
as the ‘Comptroller General’) shall conduct a 20
study on certain effects of the implementation 21
of the requirements specified under the provi-22
sions of paragraphs (10) and (11). 23
‘‘(B) R
EPORT.—Once the data and infor-24
mation needed to conduct the study described 25
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•S 3430 RS
in subparagraph (A) has become available and 1
the Comptroller General has had sufficient op-2
portunity to review and analyze such data and 3
information, the Comptroller General shall de-4
velop and publish a report on the findings of 5
such study, including with respect to the fol-6
lowing: 7
‘‘(i) Effects on enrollee cost-sharing, 8
utilization and adherence, formulary cov-9
erage and placement, and utilization man-10
agement with respect to affected covered 11
part D drugs (discount-eligible drugs and 12
covered part D drugs for which, prior to 13
implementation of such provisions, cost- 14
sharing exceeded net price for some bene-15
ficiaries). 16
‘‘(ii) Changes to pharmacy reimburse-17
ment methodologies and levels, if any, with 18
respect to discount-eligible drugs. 19
‘‘(iii) Changes in manufacturer rebat-20
ing levels (relative to gross costs) for dis-21
count-eligible drugs. 22
‘‘(iv) Other behavioral responses by 23
PDP sponsors, enrollees, manufacturers, 24
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•S 3430 RS
pharmacies, or other entities related to the 1
implementation of such provisions. 2
‘‘(v) Effects of such provisions on en-3
rollee premiums and Federal outlays. 4
‘‘(vi) Other issues determined appro-5
priate by the Comptroller General. 6
‘‘(C) S
UBSEQUENT REPORTS .—The Comp-7
troller General may, as determined appropriate, 8
conduct subsequent studies and produce subse-9
quent reports with respect to the ongoing imple-10
mentation and effects of the provisions of para-11
graphs (10) and (11).’’; and 12
(2) in subsection (c), by adding at the end the 13
following new paragraphs: 14
‘‘(7) T
YING COST-SHARING TO NET PRICE FOR 15
CERTAIN DRUGS.—The coverage is provided in ac-16
cordance with subsection (b)(10). 17
‘‘(8) L
IMITING COST-SHARING TO NET PRICE.— 18
The coverage is provided in accordance with sub-19
section (b)(11).’’. 20
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•S 3430 RS
TITLE III—MEDICAID EXPIRING 1
PROVISIONS 2
SEC. 301. DELAYING CERTAIN DISPROPORTIONATE SHARE 3
HOSPITAL PAYMENT REDUCTIONS UNDER 4
THE MEDICAID PROGRAM. 5
Section 1923(f)(7)(A) of the Social Security Act (42 6
U.S.C. 1396r–4(f)(7)(A)), as amended by section 2341 of 7
title III of division B of the Continuing Appropriations 8
Act, 2024 and Other Extensions Act (Public Law 118– 9
15), is further amended— 10
(1) in clause (i)— 11
(A) in the matter preceding subclause (I), 12
by striking ‘‘For the period beginning’’ and all 13
that follows through ‘‘2027’’ and inserting ‘‘For 14
each of fiscal years 2026 and 2027’’; and 15
(B) in subclauses (I) and (II), by striking 16
‘‘or period’’ each place it appears; and 17
(2) in clause (ii), by striking ‘‘for the period be-18
ginning’’ and all that follows through ‘‘2027’’ and 19
inserting ‘‘for each of fiscal years 2026 and 2027’’. 20
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•S 3430 RS
SEC. 302. EXTENSION OF STATE OPTION TO PROVIDE MED-1
ICAL ASSISTANCE FOR CERTAIN INDIVID-2
UALS WHO ARE PATIENTS IN CERTAIN INSTI-3
TUTIONS FOR MENTAL DISEASES. 4
(a) M
AKINGPERMANENTSTATEPLANAMENDMENT 5
O
PTIONTOPROVIDEMEDICALASSISTANCE FORCER-6
TAININDIVIDUALSWHOAREPATIENTS INCERTAININ-7
STITUTIONS FORMENTALDISEASES.—Section 1915(l)(1) 8
of the Social Security Act (42 U.S.C. 1396n(l)(1)) is 9
amended by striking ‘‘With respect to calendar quarters 10
beginning during the period beginning October 1, 2019, 11
and ending September 30, 2023,’’ and inserting ‘‘With re-12
spect to calendar quarters beginning on or after October 13
1, 2019,’’. 14
(b) M
AINTENANCE OF EFFORTREVISION.—Section 15
1915(l)(3) of the Social Security Act (42 U.S.C. 16
1396n(l)(3)) is amended— 17
(1) in subparagraph (A)— 18
(A) in the matter preceding clause (i), by 19
striking ‘‘other than under this title’’; and 20
(B) in clause (i), by striking ‘‘or, if high-21
er,’’ and all that follows through ‘‘in accordance 22
with this subsection’’; and 23
(2) by adding at the end the following new sub-24
paragraph: 25
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•S 3430 RS
‘‘(D) APPLICATION OF MAINTENANCE OF 1
EFFORT REQUIREMENTS TO CERTAIN 2
STATES.—In the case of a State with a State 3
plan amendment in effect as of September 30, 4
2023, for the 1-year period beginning on the 5
date of enactment of this subparagraph, the 6
provisions of subparagraph (A) shall be applied 7
as if the amendments to that subparagraph 8
made by the Better Mental Health Care, 9
Lower-Cost Drugs, and Extenders Act of 2023 10
had never been made.’’. 11
(c) A
DDITIONALREQUIREMENTS.— 12
(1) I
N GENERAL.—Section 1915(l)(4) of the 13
Social Security Act (42 U.S.C. 1396n(l)(4)) is 14
amended— 15
(A) in subparagraph (A), by striking 16
‘‘through (D)’’ and inserting ‘‘through (F)’’; 17
(B) in subparagraph (D), by adding at and 18
below clause (ii)(II), the following flush sen-19
tence: 20
‘‘With respect to calendar quarters beginning 21
on or after October 1, 2025, the State shall 22
have in place evidence-based, substance use dis-23
order-specific individual placement criteria and 24
utilization management approaches to ensure 25
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•S 3430 RS
placement of an eligible individual in an appro-1
priate level of care and, prior to the approval of 2
a State plan amendment for which approval is 3
sought on or after such date, shall notify the 4
Secretary of how the State will ensure that the 5
requirements of clauses (i) and (ii) will be 6
met.’’; and 7
(C) by adding at the end the following new 8
subparagraph: 9
‘‘(E) R
EVIEW PROCESS.—With respect to 10
calendar quarters beginning on or after October 11
1, 2025, the State shall have in place a process 12
to review the compliance of eligible institutions 13
for mental diseases with nationally recognized, 14
evidence-based, substance use disorder-specific 15
program standards specified by the State.’’. 16
(2) O
NE-TIME ASSESSMENT .—Section 17
1915(l)(4) of the Social Security Act (42 U.S.C. 18
1396n(l)(4)), as amended by paragraph (1), is fur-19
ther amended by adding at the end the following 20
new subparagraph: 21
‘‘(F) A
SSESSMENT.— 22
‘‘(i) I
N GENERAL.—The State shall, 23
not later than 12 months after the ap-24
proval of a State plan amendment de-25
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•S 3430 RS
scribed in this subsection (or, in the case 1
such State has such an amendment ap-2
proved as of September 30, 2023, not later 3
than 12 months after the date of enact-4
ment of this subparagraph), commence an 5
assessment of— 6
‘‘(I) the availability for individ-7
uals enrolled under a State plan under 8
this title (or waiver of such plan) of 9
treatment in— 10
‘‘(aa) each level of care de-11
scribed in clause (i) of subpara-12
graph (C); and 13
‘‘(bb) each level of care de-14
scribed in clause (ii) of subpara-15
graph (C) at which the State pro-16
vides medical assistance; and 17
‘‘(II) the availability of medica-18
tion-assisted treatment and medically 19
supervised withdrawal management 20
services for such individuals. 21
‘‘(ii) R
EQUIRED COMPLETION .—The 22
State shall complete the assessment de-23
scribed in clause (i) not later than 12 24
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•S 3430 RS
months after the date the State com-1
mences such assessment.’’. 2
(3) C
LARIFICATION OF LEVELS OF CARE .—Sec-3
tion 1915(l)(7)(A) of the Social Security Act (42 4
U.S.C. 1396n(l)(7)(A)) is amended by inserting ‘‘(or 5
any successor publication)’’ before the period. 6
TITLE IV—MEDICARE EXPIRING 7
PROVISIONS AND PROVIDER 8
PAYMENT CHANGES 9
SEC. 401. EXTENSION OF FUNDING FOR QUALITY MEASURE 10
ENDORSEMENT, INPUT, AND SELECTION. 11
Section 1890(d)(2) of the Social Security Act (42 12
U.S.C. 1395aaa(d)(2)) is amended— 13
(1) in the first sentence— 14
(A) by striking ‘‘and $20,000,000’’ and in-15
serting ‘‘$20,000,000’’; and 16
(B) by inserting the following before the 17
period at the end: ‘‘, and $20,000,000 for fiscal 18
year 2024’’; and 19
(2) in the third sentence, by striking ‘‘and 20
2023’’ and inserting ‘‘2023, and 2024’’. 21
SEC. 402. EXTENSION OF FUNDING OUTREACH AND ASSIST-22
ANCE FOR LOW-INCOME PROGRAMS. 23
(a) S
TATEHEALTHINSURANCEASSISTANCEPRO-24
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medi-25
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•S 3430 RS
care Improvements for Patients and Providers Act of 2008 1
(42 U.S.C. 1395b–3 note), as amended by section 3306 2
of the Patient Protection and Affordable Care Act (Public 3
Law 111–148), section 610 of the American Taxpayer Re-4
lief Act of 2012 (Public Law 112–240), section 1110 of 5
the Pathway for SGR Reform Act of 2013 (Public Law 6
113–67), section 110 of the Protecting Access to Medicare 7
Act of 2014 (Public Law 113–93), section 208 of the 8
Medicare Access and CHIP Reauthorization Act of 2015 9
(Public Law 114–10), section 50207 of division E of the 10
Bipartisan Budget Act of 2018 (Public Law 115–123), 11
section 1402 of division B of the Continuing Appropria-12
tions Act, 2020, and Health Extenders Act of 2019 (Pub-13
lic Law 116–59), section 1402 of division B of the Further 14
Continuing Appropriations Act, 2020, and Further Health 15
Extenders Act of 2019 (Public Law 116–69), section 103 16
of division N of the Further Consolidated Appropriations 17
Act, 2020 (Public Law 116–94), section 3803 of the 18
CARES Act (Public Law 116–136), section 2203 of the 19
Continuing Appropriations Act, 2021 and Other Exten-20
sions Act (Public Law 116–159), section 1102 of the Fur-21
ther Continuing Appropriations Act, 2021, and Other Ex-22
tensions Act (Public Law 116–215), and section 103 of 23
division CC of the Consolidated Appropriations Act, 2021 24
(Public Law 116–260), is amended— 25
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•S 3430 RS
(1) in the matter preceding clause (i), by strik-1
ing ‘‘Centers for Medicare & Medicaid Services Pro-2
gram Management Account’’ and inserting ‘‘Admin-3
istration for Community Living’’; 4
(2) in clause (xii), by striking ‘‘and’’ at the end; 5
(3) in clause (xiii), by striking the period at the 6
end and inserting ‘‘; and’’; and 7
(4) by inserting after clause (xiii) the following 8
new clause: 9
‘‘(xiv) for fiscal year 2024, 10
$15,000,000.’’. 11
(b) A
REAAGENCIES ON AGING.—Subsection 12
(b)(1)(B) of such section 119, as so amended, is amend-13
ed— 14
(1) in clause (xii), by striking ‘‘and’’ at the end; 15
(2) in clause (xiii), by striking the period at the 16
end and inserting ‘‘; and’’; and 17
(3) by inserting after clause (xiii) the following 18
new clause: 19
‘‘(xiv) for fiscal year 2024, 20
$15,000,000.’’. 21
(c) A
GING ANDDISABILITYRESOURCECENTERS.— 22
Subsection (c)(1)(B) of such section 119, as so amended, 23
is amended— 24
(1) in clause (xii), by striking ‘‘and’’ at the end; 25
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•S 3430 RS
(2) in clause (xiii), by striking the comma at 1
the end and inserting ‘‘; and’’; and 2
(3) by inserting after clause (xiii) the following 3
new clause: 4
‘‘(xiv) for fiscal year 2024, 5
$5,000,000.’’. 6
(d) C
OORDINATION OFEFFORTS TOINFORMOLDER 7
A
MERICANSABOUTBENEFITSAVAILABLEUNDERFED-8
ERAL ANDSTATEPROGRAMS.—Subsection (d)(2) of such 9
section 119, as so amended, is amended— 10
(1) in clause (xii), by striking ‘‘and’’ at the end; 11
(2) in clause (xiii), by striking the period at the 12
end and inserting ‘‘; and’’; and 13
(3) by inserting after clause (xiii) the following 14
new clause: 15
‘‘(xiv) for fiscal year 2024, 16
$15,000,000.’’. 17
SEC. 403. EXTENSION OF THE WORK GEOGRAPHIC INDEX 18
FLOOR UNDER THE MEDICARE PROGRAM. 19
Section 1848(e)(1)(E) of the Social Security Act (42 20
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-21
ary 1, 2024’’ and inserting ‘‘January 1, 2025’’. 22
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•S 3430 RS
SEC. 404. EXTENDING INCENTIVE PAYMENTS FOR PARTICI-1
PATION IN ELIGIBLE ALTERNATIVE PAYMENT 2
MODELS. 3
(a) I
NGENERAL.—Section 1833(z) of the Social Se-4
curity Act (42 U.S.C. 1395l(z)) is amended— 5
(1) in paragraph (1)(A)— 6
(A) by striking ‘‘with 2025’’ and inserting 7
‘‘with 2026’’; and 8
(B) by inserting ‘‘, or, with respect to 9
2026, 1.75 percent’’ after ‘‘3.5 percent’’. 10
(2) in paragraph (2)— 11
(A) in subparagraph (B)— 12
(i) in the header, by striking ‘‘
2025’’ 13
and inserting ‘‘
2026’’; and 14
(ii) in the matter preceding clause (i), 15
by striking ‘‘2025’’ and inserting ‘‘2026’’; 16
(B) in subparagraph (C)— 17
(i) in the header, by striking ‘‘
2026’’ 18
and inserting ‘‘
2027’’; and 19
(ii) in the matter preceding clause (i), 20
by striking ‘‘2026’’ and inserting ‘‘2027’’; 21
and 22
(C) in subparagraph (D), by striking ‘‘and 23
2025’’ and inserting ‘‘2025, and 2026’’; and 24
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•S 3430 RS
(3) in paragraph (4)(B), by inserting ‘‘, or, 1
with respect to 2026, 1.75 percent’’ after ‘‘3.5 per-2
cent’’. 3
(b) C
ONFORMING AMENDMENTS.—Section 4
1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 5
1395w–4(q)(1)(C)(iii)) is amended— 6
(1) in subclause (II), by striking ‘‘2025’’ and 7
inserting ‘‘2026’’; and 8
(2) in subclause (III), by striking ‘‘2026’’ and 9
inserting ‘‘2027’’. 10
SEC. 405. PAYMENT RATES FOR DURABLE MEDICAL EQUIP-11
MENT UNDER THE MEDICARE PROGRAM. 12
(a) A
REASOTHERTHANRURAL ANDNONCONTIG-13
UOUSAREAS.—The Secretary shall implement section 14
414.210(g)(9)(v) of title 42, Code of Federal Regulations 15
(or any successor regulation), to apply the transition rule 16
described in the first sentence of such section to all appli-17
cable items and services furnished in areas other than 18
rural or noncontiguous areas (as such terms are defined 19
for purposes of such section) through December 31, 2024. 20
(b) A
LLAREAS.—The Secretary shall not implement 21
section 414.210(g)(9)(vi) of title 42, Code of Federal Reg-22
ulations (or any successor regulation) until January 1, 23
2025. 24
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•S 3430 RS
(c) IMPLEMENTATION.—Notwithstanding any other 1
provision of law, the Secretary may implement the provi-2
sions of this section by program instruction or otherwise. 3
SEC. 406. EXTENDING THE INDEPENDENCE AT HOME MED-4
ICAL PRACTICE DEMONSTRATION PROGRAM 5
UNDER THE MEDICARE PROGRAM. 6
(a) I
NGENERAL.—Section 1866E of the Social Secu-7
rity Act (42 U.S.C. 1395cc–5) is amended— 8
(1) in subsection (e)— 9
(A) in paragraph (1), by striking ‘‘10- 10
year’’ and inserting ‘‘12-year’’; and 11
(B) in paragraph (5)— 12
(i) in the second sentence, by striking 13
‘‘tenth’’ and inserting ‘‘twelfth’’; and 14
(ii) in the third sentence, by striking 15
‘‘tenth’’ and inserting ‘‘twelfth’’; and 16
(2) in subsection (h), by striking ‘‘and 17
$9,000,000 for fiscal year 2021’’ and inserting ‘‘, 18
$9,000,000 for fiscal year 2021, and $3,000,000 for 19
fiscal year 2024’’. 20
(b) E
FFECTIVEDATE.—The amendments made by 21
subsection (a) shall take effect as if included in the enact-22
ment of Public Law 111–148. 23
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•S 3430 RS
SEC. 407. INCREASE IN SUPPORT FOR PHYSICIANS AND 1
OTHER PROFESSIONALS IN ADJUSTING TO 2
MEDICARE PAYMENT CHANGES. 3
Section 1848(t)(1)(D) of the Social Security Act (42 4
U.S.C. 1395w–4(t)(1)(D)) is amended by striking ‘‘1.25 5
percent’’ and inserting ‘‘2.5 percent’’. 6
SEC. 408. REVISED PHASE-IN OF MEDICARE CLINICAL LAB-7
ORATORY TEST PAYMENT CHANGES. 8
(a) R
EVISEDPHASE-IN OFREDUCTIONSFROMPRI-9
VATE PAYOR RATE IMPLEMENTATION.—Section 10
1834A(b)(3) of the Social Security Act (42 U.S.C. 11
1395m–1(b)(3)) is amended— 12
(1) in subparagraph (A), by striking ‘‘through 13
2026’’ and inserting ‘‘through 2027’’; and 14
(2) in subparagraph (B)— 15
(A) in clause (ii), by striking ‘‘through 16
2023’’ and inserting ‘‘through 2024’’; and 17
(B) in clause (iii), by striking ‘‘2024 18
through 2026’’ and inserting ‘‘2025 through 19
2027’’. 20
(b) R
EVISEDREPORTINGPERIOD FORREPORTING 21
OFPRIVATESECTORPAYMENTRATES FORESTABLISH-22
MENT OF MEDICARE PAYMENT RATES.—Section 23
1834A(a)(1)(B) of the Social Security Act (42 U.S.C. 24
1395m–1(a)(1)(B)) is amended— 25
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•S 3430 RS
(1) in clause (i), by striking ‘‘December 31, 1
2023’’ and inserting ‘‘December 31, 2024’’; and 2
(2) in clause (ii)— 3
(A) by striking ‘‘January 1, 2024’’ and in-4
serting ‘‘January 1, 2025’’; and 5
(B) by striking ‘‘March 31, 2024’’ and in-6
serting ‘‘March 31, 2025’’. 7
SEC. 409. EXTENSION OF ADJUSTMENT TO CALCULATION 8
OF HOSPICE CAP AMOUNT UNDER MEDI-9
CARE. 10
Section 1814(i)(2)(B) of the Social Security Act (42 11
U.S.C. 1395f(i)(2)(B)) is amended— 12
(1) in clause (ii), by striking ‘‘2032’’ and in-13
serting ‘‘2033’’; and 14
(2) in clause (iii), by striking ‘‘2032’’ and in-15
serting ‘‘2033’’. 16
TITLE V—OFFSETS 17
SEC. 501. MEDICAID IMPROVEMENT FUND. 18
Section 1941(b)(3)(A) of the Social Security Act (42 19
U.S.C. 1396w–1(b)(3)(A)), as amended by section 2342 20
of the Continuing Appropriations Act, 2024 and Other 21
Extensions Act (Public Law 118–15), is amended by strik-22
ing ‘‘$6,357,117,810’’ and inserting ‘‘$561,000,000’’. 23
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SEC. 502. MEDICARE IMPROVEMENT FUND. 1
Section 1898(b)(1) of the Social Security Act (42 2
U.S.C. 1395iii(b)(1)) is amended by striking 3
‘‘$180,000,000’’ and inserting ‘‘756,000,000’’. 4
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265 
118
TH
CONGRESS 
1
ST
S
ESSION
 
S. 3430 
[Report No. 118–121] 
A BILL 
To amend titles XVIII and XIX of the Social Secu-
rity Act to expand the mental health care work-
force and services, reduce prescription drug 
costs, and extend certain expiring provisions 
under Medicare and Medicaid, and for other pur-
poses. 
D
ECEMBER
7, 2023 
Read twice and placed on the calendar 
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