H.R. 1319 — American Rescue Plan Act of 2021

This section provides funding for FY2021 to the Department of Agriculture (USDA) to (1) purchase food and agricultural commodities; (2) purchase and distribute agricultural commodities (including fresh produce, dairy, seafood, eggs, and meat) to individuals in need; (3) provide grants and loans for small or midsized food processors or distributors, seafood processing facilities and processing vessels, farmers markets, producers, or other organizations to respond to COVID-19; and (4) provide grants, loans, and other assistance to maintain and improve food and agricultural supply chain resiliency. The section also requires USDA to use specified amounts of the funding to (1) conduct animal surveillance and monitoring related to COVID-19; and (2) reduce overtime inspection costs borne by federally inspected small and very small meat, poultry, or egg processors.

This section provides funding for, and directs USDA to establish, an emergency pilot program to provide grants to certain applicants for rural health care and other rural development needs related to COVID-19.

This section provides funding for necessary administrative expenses associated with carrying out this subtitle.

This section provides funding through FY2022 to the Office of the Inspector General of USDA for audits, investigations, and other oversight activities of projects and activities related to the COVID-19 pandemic.

This section provides funding for USDA to pay off outstanding farm loan debts of socially disadvantaged farmers and ranchers.

This section provides funding for USDA to address historical discrimination and disparities in the agriculture sector. Specifically, USDA must use specified amounts to provide outreach, mediation, training, and assistance on issues concerning food, agriculture, agricultural credit, agricultural extension, rural development, or nutrition to certain socially disadvantaged groups, including socially disadvantaged farmers, ranchers, or forest landowners; provide grants and loans to improve land access for such groups; fund one or more equity commissions to address racial equity issues within USDA and its programs; support and supplement agricultural research, education, and extension, as well as scholarships and programs that provide internships and pathways to federal employment; and provide financial assistance to socially disadvantaged farmers, ranchers, or forest landowners who are former farm loan borrowers and suffered related adverse actions or past discrimination or bias in USDA programs.

This section provides funding through FY2022 to use the Commodity Credit Corporation to make commodities available and pay associated expenses for the Food for Peace program. Subtitle B--Nutrition

This section extends through FY2021 the requirement to calculate the value of benefits under the Supplemental Nutrition Assistance Program (SNAP, formerly known as the food stamp program) by using 115% of the June 2020 value of the thrifty food plan. It also provides funding through FY2023 for the costs of state administrative expenses and administering SNAP.

This section provides additional funding through FY2026 for USDA to (1) make technological improvements to improve online purchasing in SNAP; (2) modernize electronic benefit transfer technology; (3) support the mobile technologies demonstration projects and the use of mobile technologies; and (4) provide technical assistance to educate retailers on the process and technical requirements for the online acceptance of SNAP benefits, mobile payments, and electronic benefit transfer modernization initiatives.

This section provides additional funding through FY2027 for USDA to provide grants to the Commonwealth of the Northern Mariana Islands, Puerto Rico, and American Samoa for nutrition assistance.

This section provides funding through FY2022 to USDA for the Commodity Supplemental Food Program.

This section provides authority and funding for USDA to approve state requests to increase the amount of a cash-value voucher under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) for a qualified food package to up to $35 for a four-month period during the COVID-19 public health emergency. Authority to increase the amount of a cash-value voucher shall terminate on September 30, 2021. (Cash-value vouchers are redeemable for fruits and vegetables as part of a WIC food package.)

This section provides funding for USDA to carry out outreach, innovation, and program modernization efforts to increase participation in and redemption of benefits under WIC, including through appropriate waivers and flexibilities. However, such waivers and flexibilities may not relate to the content of WIC food packages or nondiscrimination requirements.

This section directs USDA to reimburse institutions that are emergency shelters for meals and supplements provided under the Child and Adult Care Food Program during the COVID-19 public health emergency to individuals who have not attained the age of 25 and who are receiving assistance from such shelters. Under current law, emergency shelters may not receive reimbursement for meals and supplements provided to individuals who are older than age 18.

This section expands the Pandemic Electronic Benefit Transfer (P-EBT) program by authorizing it to be implemented during any school year in which there is a COVID-19 public health emergency designation in effect. It also allows the program to operate during the summer months. (The P-EBT program allows USDA to approve state plans to provide emergency nutrition benefits to households with children who would otherwise receive free or reduced-price school meals if their schools were not closed due to a public health emergency.) TITLE II--COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS Subtitle A--Education Matters Part 1--Department of Education

This section provides funding for various agencies within the Department of Labor to conduct worker protection activities with respect to COVID-19. Subtitle C--Human Services and Community Supports

This section provides additional funding for the Child Care and Development Block Grant program. States, territories, Indian tribes, and tribal organizations may use this funding to provide child care assistance to essential workers without regard to income eligibility requirements.

This section provides funding for grants to lead child care agencies and providers for personnel costs, facility costs, the purchase of personal protective equipment, and other costs associated with responding to the COVID-19 public health emergency.

This section provides additional funding through FY2022 to Head Start agencies based on their enrollment.

This section provides additional FY2021 funding for programs supporting adult and youth victims of family violence, domestic violence, or dating violence, including grants for community-based services.

This section provides additional FY2021 funding for child abuse or neglect prevention and treatment programs, including grants to states for community-based prevention services.

This section provides additional FY2021 funding for the Corporation for National and Community Service to operate and support national service programs. The corporation must prioritize entities disproportionately impacted by COVID-19 and take into account the diversity of the communities and participants served by such entities. Subtitle D--Public Health

This section provides additional FY2021 funding to the Centers for Disease Control and Prevention (CDC) for COVID-19 vaccination efforts. The CDC must use some of this funding to supplement certain existing grants awarded to health departments for their COVID-19 vaccination activities.

This section provides additional FY2021 funding to the CDC for activities to increase confidence in vaccines and improve vaccination rates.

This section provides additional FY2021 funding for the Department of Health and Human Services (HHS) to acquire vaccines, therapeutics, and other supplies to prevent and respond to COVID-19, the virus that causes COVID-19 and its variants, and other diseases or viruses with pandemic potential.

This section provides funding for HHS to evaluate the safety and effectiveness of COVID-19 vaccines and therapeutics and to oversee the supply chain for those products. HHS must also carry out reviews, inspections, and related activities necessary to approve medical products and devices that were delayed or cancelled for reasons related to COVID-19.

This section makes individuals who received unemployment compensation in 2021 eligible for cost-sharing subsidies for health care expenses under qualified health insurance plans. Subtitle E--Testing

This section provides additional FY2021 funding for HHS to carry out various activities to support COVID-19 testing, contact tracing, surveillance, and mitigation measures.

This section provides additional FY2021 funding for the CDC to improve its capacity and the capacity of public health laboratories to conduct genomic sequencing, analytics, and disease surveillance, including for the virus that causes COVID-19 and its variants.

This section provides additional FY2021 funding for the CDC to address COVID-19 and other infectious diseases globally.

This section provides additional FY2021 funding for the CDC to modernize and expand public health data surveillance systems, including to maintain a disease warning system to track COVID-19 and emerging biological threats. Subtitle F--Public Health Workforce

This section provides additional FY2021 funding for HHS to award grants and take other actions to expand and sustain the public health workforce, including to respond to COVID-19.

This section provides additional FY2021 funding for the Medical Reserve Corps. This is a network of volunteers, including medical providers and public health professionals, organized locally to improve community health and safety. Subtitle G--Public Health Investments

This section provides additional FY2021 funding to expand health care services and infrastructure of federally qualified health centers and similar entities that serve Native Hawaiians, including specifically for COVID-19 vaccinations and treatments.

This section provides additional FY2021 funding for the National Health Services Corps. This program provides scholarships and student loan repayment to health care providers who agree to work in areas of the United States with limited access to primary care, dental care, and mental health care.

This section provides additional FY2021 funding for the Nurse Corps. This program provides scholarships and student loan repayment to nurses who agree to work in areas of the United States with limited access to primary care and mental health care. It also provides student loan repayment for nurses who work as faculty in nursing schools.

This section provides additional FY2021 funding to establish or expand graduate medical education training programs carried out in teaching health centers.

This section provides additional FY2021 funding to entities that provide family planning services. Subtitle H--Mental Health and Substance Use Disorder

This section provides additional FY2021 funding for block grants for community mental health services and for mental health and substance use services. This funding must be expended by the end of FY2025.

This section provides additional FY2021 funding for various grants and programs to prevent and treat substance abuse. This funding must be expended by the end of FY2025.

This section provides additional FY2021 funding to the Health Resources and Services Administration (HRSA) for grants and other activities to address and prevent suicide, burnout, mental health conditions, and substance use disorders among health care professionals. HRSA must consider the needs of rural and medically underserved communities in these activities.

This section provides additional FY2021 funding for the CDC to educate health care professionals and first responders about primary prevention of mental health conditions and substance use disorders and treatments.

This section provides additional FY2021 funding for HRSA to award grants to health care providers and health care professional associations to promote mental health among those who work in the health care field.

This section provides additional FY2021 funding to the Substance Abuse and Mental Health Services Administration (SAMHSA) for grants for overdose prevention programs, syringe services programs, and other harm reduction measures.

This section provides additional FY2021 funding to SAMHSA for grants to address community behavioral health needs made worse by the COVID-19 emergency.

This section provides additional FY2021 funding for grants to prevent the long-term consequences of child trauma by providing early intervention services and treatments with a focus on high-risk or medically underserved populations that experience violence-related stress.

This section provides additional FY2021 funding for Project Aware, which promotes access to mental health services among school-aged youth and their families.

This section provides additional FY2021 funding for youth suicide prevention activities and for services for students with mental health or substance use disorders.

This section provides additional FY2021 funding for grants to support mental and behavioral health education and training programs.

This section provides additional FY2021 funding to increase access to pediatric mental health services in primary care settings.

This section provides additional FY2021 funding for certified community behavioral health clinics. These clinics provide integrated mental health and substance use disorder treatment services in communities. Subtitle I--Exchange Grant Program

This section provides funding for grants for health benefit exchanges to modernize their systems and technology. Subtitle J--Continued Assistance to Rail Workers

This section extends the Railroad Unemployment Insurance Act (RUIA) benefits-registration period through September 6, 2021, for qualified railroad employees to receive an additional RUIA benefit of $600.

This section modifies and reauthorizes the temporary increase of extended RUIA benefits to employees who received regular RUIA benefits during the period beginning July 1, 2019, and ending on June 30, 2022. However, the section does not apply to any employee with respect to a registration period beginning after September 6, 2021.

This section provides funding through September 6, 2021, to temporarily reimburse states that waive the seven-day waiting period for benefits under the RUIA.

This section provides funding for FY2021 for the Railroad Retirement Board to prevent, prepare for, and respond to COVID-19. It also provides funding for the Railroad Retirement Board Office of Inspector General for audit, investigatory, and review activities. Subtitle K--Ratepayer Protection

This section provides funding through FY2022 for the low-income home energy assistance program, with specified limitations.

This section provides funding for FY2021 to HHS to provide grants to states, Indian tribes, and other jurisdictions to assist low-income households that pay a high proportion of household income for drinking water and wastewater services by providing funds to owners or operators of public water systems or treatment works to reduce arrearages of and rates charged to such households for such services. Subtitle L--Assistance for Older Americans, Grandfamilies, and Kinship Families

This section provides additional FY2021 funding for programs that provide nutrition, health promotion, and other services for older adults and caregivers.

This section provides additional FY2021 funding for the Administration for Community Living to establish a National Technical Assistance Center on Grandfamilies and Kinship Families. The center must provide technical assistance to government agencies, nonprofits, and other community-based organizations that support grandfamilies and kinship families. The focus must be on families in which the primary caregiver is 55 years or older or the child has one or more disabilities. TITLE III--COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS Subtitle A--Defense Production Act of 1950

This section provides additional FY2021 funding to carry out activities under the Defense Production Act of 1950 to manage the supply chain for personal protective equipment, vaccines, and other products to address COVID-19 and other declared public health emergencies. That act confers on the President a broad set of authorities to influence domestic industry in order to provide essential materials and goods for the national defense. Subtitle B--Housing Provisions This subtitle provides additional FY2021 funding for rental assistance, homelessness assistance, housing counseling, and housing assistance related to the COVID-19 pandemic.

This section provides FY2021 funding for the Department of the Treasury's Emergency Rental Assistance program, which was established in response to the COVID-19 pandemic. The program provides grants to states, local governments, and territories for financial assistance to households for rent, utilities, and other housing expenses. Low-income households that are at risk of homelessness and are experiencing unemployment or financial hardship are eligible. The aggregate period of assistance a household may receive under this program may not exceed 18 months.

This section provides FY2021 funding for emergency rental assistance vouchers through the Department of Housing and Urban Development (HUD) for families and individuals who are (1) experiencing homelessness; (2) at risk of homelessness; (3) fleeing, or attempting to flee, domestic violence and other dangerous situations; or (4) recently homeless.

This section provides FY2021 funding for rental assistance through USDA for individuals living in certain rural rental property.

This section provides FY2021 funding for the Neighborhood Reinvestment Corporation for grants to housing counseling intermediaries for housing counseling services, including counseling provided directly to households facing housing instability.

This section provides FY2021 funding for HUD's HOME Investment Partnerships Program. Funding is provided for tenant-based rental assistance, development and support of affordable housing, supportive housing services, and the acquisition of non-congregate shelter units. These units may remain non-congregate shelter units, be converted into permanent affordable housing, or be used as emergency shelter. Individuals qualifying for such assistance include at-risk veterans and individuals who are homeless, at risk of homelessness, or fleeing or attempting to flee domestic violence or other dangerous situations.

This section establishes and provides FY2021 funding for the Homeowner Assistance Fund, which provides assistance to mitigate the financial hardships associated with the COVID-19 pandemic. Specifically, grants are provided to states, territories, and tribes for the purpose of preventing homeowner mortgage delinquency, defaults, foreclosures, loss of utilities, and displacements of homeowners experiencing financial hardship after January 21, 2020.

This section provides FY2021 funding to USDA's Direct Home Loan and Housing Repair Loan programs for rural housing.

This section provides FY2021 funding for the Fair Housing Initiatives Program for fair housing organizations to address fair housing inquiries, complaints, investigations, outreach services, and the costs of delivering or adapting services related to the COVID-19 pandemic. Subtitle C--Small Business (SSBCI)

This section reauthorizes the State Small Business Credit Initiative and provides FY2021 funding for COVID-19 support to eligible small businesses. Specifically, the section provides this funding for states and tribal governments to support small business credit expansion programs that deliver loans or investments to eligible small businesses. The section allocates specified portions of this funding for (1) states to support businesses that are owned by socially and economically disadvantaged individuals, (2) an incentive program to boost funding for states that demonstrate robust support for those businesses, (3) support for very small businesses (e.g., those with fewer than 10 employees), and (4) tribal governments. Additionally, Treasury may provide funds to states, the Minority Business Development Agency, or other advisory firms to provide technical assistance to specified small businesses. Subtitle D--Public Transportation

This section provides funding through FY2024 to the Federal Transit Administration to provide grants to state, local, and tribal governments, and publicly owned operators of public transportation. The grants shall be used for transit agencies to prevent, prepare for, and respond to COVID-19, including for (1) reimbursement for payroll of public transportation; (2) operating costs to maintain service due to lost revenue due as a result of the COVID-19 public health emergency, including the purchase of personal protective equipment; and (3) paying the administrative leave of operations or contractor personnel due to reductions in service. This section provides funding for urbanized area formula grants; formula grants for the enhanced mobility of seniors and individuals with disabilities; formula grants for rural areas; the fixed guideway capital investment program; bus operators that partner with recipients or sub-recipients of rural area formula grants, with specified exceptions for states or territories that do not have eligible bus providers; planning of public transportation associated with the restoration of services as the COVID-19 public health emergency concludes, with specified limitations for route planning related to transitioning public transportation service to a transportation network company or other third-party contract provider; and recipients and sub-recipients of grants that, as a result of COVID-19, require additional assistance for costs related to operations, personnel, cleaning, and sanitization combating the spread of pathogens on transit systems, and debt service payments incurred to maintain operations and avoid layoffs and furloughs. TITLE IV--COMMITTEE ON HOMELAND SECURITY AND GOVERNMENTAL AFFAIRS

This section provides funding through FY2024 to the National Railroad Passenger Corporation (Amtrak) for grants to prevent, prepare for, and respond to COVID-19. For example, Amtrak shall use specified amounts to (1) restore the frequency of rail service on long-distance and rehire employees furloughed on or after October 1, 2020, as a result of COVID-19; (2) offset amounts required to be paid by states for state-supported routes; (3) repay or prepay debt, including for loans from the Department of Transportation (DOT); and (4) provide project management oversight.

This section provides funding through FY2024 for assistance to airport sponsors to prevent, prepare for, and respond to COVID-19, including for costs related to operations, personnel, cleaning, sanitization, janitorial services, combating the spread of pathogens at the airport, and debt service payments.

This section establishes in the Federal Aviation Administration (FAA) the Emergency FAA Employee Leave Fund for the use of paid leave by an FAA employee who is unable to work due to COVID-19.

This section establishes in the Transportation Security Administration (TSA) the Emergency TSA Employee Leave Fund for the use of paid leave by a TSA employee who is unable to work due to COVID-19. Subtitle B--Aviation Manufacturing Jobs Protection

This section directs DOT to establish a payroll support program and enter into agreements with employers that meet specified criteria to provide public contributions to supplement compensation of an eligible employee group. Eligible employee group means the portion of an employer's U.S. workforce that (1) does not exceed 25% of the employer's total U.S. workforce as of April 1, 2020; (2) contains only employees with a total compensation level of $200,000 or less per year; and (3) is engaged in aviation manufacturing activities and services, or maintenance, repair, and overhaul activities and services. Subtitle C--Airlines

This section directs DOT to provide financial assistance to certain air carriers and contractors for the continuation of payment of employee wages, salaries, and benefits. Subtitle D--Consumer Protection and Commerce Oversight

This section provides additional FY2021 funding for the Consumer Product Safety Commission to conduct surveillance at ports of entry, and other monitoring activities, to identify products with risks associated with COVID-19.

This section provides funding for the Federal Communications Commission to reimburse schools and libraries for the purchase of computer and internet connectivity equipment during the COVID-19 public health emergency.

This section provides additional FY2021 funding for the Office of the Inspector General of Commerce to respond to COVID-19.

This section provides additional FY2021 funding for the Federal Trade Commission to address complaints and respond to unfair or deceptive practices related to COVID-19. Subtitle E--Science and Technology

This section provides additional FY2021 funding for the National Institute of Standards and Technology to support research, development, and testing related to COVID-19.

This section provides additional FY2021 funding for National Science Foundation to provide research grants, scholarships, cooperative agreements, and other activities to respond to COVID-19. Subtitle F--Corporation for Public Broadcasting

This section provides additional FY2021 funding for the Corporation for Public Broadcasting to respond to COVID-19, including by providing grants to public broadcast stations. TITLE VIII--COMMITTEE ON VETERANS' AFFAIRS

This section provides additional FY2021 funding for entities receiving grants for early childhood home visitation programs. The funds must be used to facilitate virtual visits, provide hazard pay to staff, train home visitors, or provide other supports to families participating in such programs. Subtitle C--Emergency Assistance to Children and Families

This section provides additional FY2021 funding to states, territories, and Indian tribes to supplement Temporary Assistance for Needy Families block grants. These funds must be allocated according to a specified formula and used for only nonrecurrent short-term benefits, such as cash benefits for families experiencing hardship resulting from the COVID-19 pandemic. Subtitle D--Elder Justice and Support Guarantee

This section provides additional funding for elder justice programs, including adult protective services that report and investigate abuse of older adults and adults with disabilities. Subtitle E--Support to Skilled Nursing Facilities in Response to COVID-19

This section provides additional funding for quality improvement organizations under Medicare to support COVID-19 infection control and vaccination uptake at skilled nursing facilities.

This section provides additional funding to deploy teams to support skilled nursing facilities with cases of COVID-19 among residents or staff during, and for one year after, the COVID-19 public health emergency. Subtitle F--Preserving Health Benefits for Workers

This section provides health insurance premium assistance for individuals who become eligible for, and elect to enroll in, the COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage program. Specifically, the premiums for such individuals are treated as paid through September 30, 2021. The section also extends the election period for eligible individuals who have not elected COBRA coverage and for individuals who elected COBRA coverage but discontinued the coverage. Subject to specified requirements for eligible individuals changing or enrolling in other health plans under this program, such assistance is not available once an individual becomes eligible for any other group health plan. Assistance eligible individuals must notify their group health plan when they become eligible for coverage under another plan, subject to monetary penalties. Additionally, the section requires employers to provide eligible individuals specified written notice about the premium assistance program, including, among other information, available health plan enrollment options and the date that such assistance expires. Further, Treasury must reimburse employers, group health plans, and insurance issuers through a payroll tax credit or refund for unpaid premiums that were treated as paid under the program. Premium assistance is not considered income for federal income tax purposes. Subtitle G--Promoting Economic Security PART 1--2021 RECOVERY REBATES TO INDIVIDUALS

This section permits multiemployer pension plans to elect to retain their funding zone status from the previous year for either (1) the first plan year beginning during the period from March 1, 2020, through February 28, 2021; or (2) the next succeeding plan year, as designated by the plan sponsor. Further, if such a plan is in endangered or critical status for the plan year preceding the designated plan year, the plan is not required to update its funding improvement or rehabilitation plans or schedules until the plan year following such designated year. If an election has been made under this section, but the plan has been certified as in critical status for the designated plan year, the plan is treated as in critical status for the purpose of specified tax liability and contribution requirements.

This section permits a multiemployer pension plan to extend by five years the funding improvement or rehabilitation period if the plan is designated as in endangered or critical status for a plan year beginning in 2020 or 2021.

This section modifies the minimum funding standards for multiemployer pension plans to account for investment losses and other losses related to the COVID-19 pandemic. The section permits two years of experience losses to be amortized over 30 years instead of 15 years. This section does not apply to plans receiving special financial assistance.

This section expands the authority of, and provides funding for, the Pension Benefit Guaranty Corporation (PBGC) to provide special financial assistance to eligible multiemployer pension plans that are in various declining or critical statuses. The PBGC must issue application requirements for such assistance and may require, subject to certain limitations, reasonable conditions on plans receiving assistance. Plans approved for special financial assistance must be paid the amount sufficient for the plan to pay the full benefits due through the plan year ending in 2051. Plans receiving special assistance are deemed to be in critical status and must follow certain requirements such as reinstating any benefits that have been suspended. This section also increases the PBGC insurance premium for multiemployer pension plans.

This section revises the amortization rules for single employer pension plans. The section reduces shortfall amortization bases and the required shortfall amortization installments for specified plan years to zero. It also extends the shortfall amortization period from 7 years to 15 years.

This section extends and modifies the pension funding stabilization percentages for single employer pension plans. The percentages are used to determine the applicable interest rates for valuing single employer plan liabilities that affect a plan's minimum funding requirements. It also sets a floor of 5% on the average segment rate for any 25-year period.

This section expands the eligibility for special funding rules for pension plans operated by certain community newspapers.

This section expands the limitation on the tax deductibility of certain employees' annual compensation that is above $1 million to include an employer's five highest paid employees beginning in 2027.

This section provides permanent funding for the Child Care Entitlement to States and specifically makes this funding available to U.S. territories. Subtitle J--Medicaid

This section requires state Medicaid programs to cover vaccines, testing, and treatments for COVID-19 without cost-sharing until one year after the end of the public health emergency. The section applies a 100% federal matching rate, also known as the Federal Medical Assistance Percentage (FMAP), to COVID-19 vaccines during this period. States may also cover COVID-19 vaccines and treatments, in addition to testing, for uninsured individuals. The section also specifically includes drugs that are used to treat or prevent COVID-19 in the Medicaid Drug Rebate Program.

This section temporarily allows states to provide one year of postpartum coverage under Medicaid. Current law requires 60 days of postpartum coverage.

This section temporarily allows state Medicaid programs to cover certain community-based mobile crisis intervention services for individuals experiencing a mental health or substance-use disorder crisis outside of a facility setting.

This section temporarily increases the FMAP for states that elect to participate in Medicaid expansion (pursuant to the Patient Protection and Affordable Care Act) if they have not already done so.

This section temporarily applies a 100% FMAP to services provided through Urban Indian Organizations, Native Hawaiian Health Centers, and other specified entities.

This section terminates certain limitations regarding drug rebates under the Medicaid Drug Rebate Program. Currently, the maximum rebate that drug manufacturers must pay for single-source and innovator multiple-source drugs is 100% of the average manufacturer price of the drug. The section specifies that this limitation only applies to rebate periods that begin before January 1, 2024.

This section temporarily increases the FMAP for home- and community-based services. In order to receive the increase, states must implement activities that enhance, expand, or strengthen such services under their Medicaid programs.

This section provides funding for COVID-19 strike teams that can be deployed to Medicaid nursing facilities during, and for one year after, the public health emergency to help with clinical care, infection control, or staffing.

This section requires the Centers for Medicare & Medicaid Services (CMS) to recalculate Medicaid disproportionate share hospital (DSH) allotments for states so as to ensure that certain FMAP increases do not affect the total payments states can make during the COVID-19 public health emergency. (DSHs are hospitals that receive additional payment under Medicaid for treating a large share of low-income patients.) Subtitle K--Children's Health Insurance Program

This section requires Children's Health Insurance Program (CHIP) coverage of COVID-19 vaccines, testing, and treatments without cost-sharing until one year after the end of the public health emergency. The section applies a 100% enhanced FMAP to COVID-19 vaccines during this period.

This section temporarily allows states to provide one year of postpartum coverage under CHIP. Specifically, states that choose to provide one year of postpartum coverage under Medicaid (as authorized under this bill) must also extend the coverage period under CHIP. Subtitle L--Medicare

This section establishes an area wage adjustment floor for Medicare hospital payments in all-urban states (i.e., states that have no rural areas or rural hospitals) and excludes such adjustments from certain budget neutrality rules. The CMS must determine the floor using a specified methodology.

This section allows for Medicare payment of ground ambulance services that did not result in the actual transport of an individual to a permitted facility, if the lack of transport was due to community-wide COVID-19 protocols for emergency medical services during the public health emergency.

This section provides funding for the Office of the Inspector General of HHS to oversee the agency's COVID-19 activities. Subtitle M--Coronavirus State and Local Fiscal Recovery Funds

This section provides funding to states, territories, and tribal governments to mitigate the fiscal effects stemming from the COVID-19 public health emergency. A state, territory, or tribal government shall use the funds to cover costs incurred by December 31, 2024, to respond to the COVID-19 emergency or its negative economic impacts, including assistance to households, small businesses, and nonprofits or aid to impacted industries such as tourism, travel, and hospitality; provide premium pay to essential workers or provide grants to employers of essential workers during the COVID-19 emergency; provide government services to the extent of the reduction in revenue of such state, territory, or tribal government due to the COVID-19 emergency; or make necessary investments in water, sewer, or broadband infrastructure. The section prohibits (1) the use of funds to reduce or delay the imposition of a tax or tax increase, or (2) deposit of the funds into a pension fund. The section provides funding for payments to states, territories, and tribal governments to carry out critical capital projects directly enabling work, education, and health monitoring, including remote options, in response to the COVID-19 emergency. The section makes provides funding for tribal governments and certain local governments for FY2022-FY2023, to be allocated by Treasury, taking into account economic conditions.

This section provides funding for payments to Medicare, Medicaid, and CHIP health care providers in rural areas for health care expenses and lost revenues that are attributable to COVID-19.

This section extends the authority to collect certain customs user fees through FY2030.