H.R. 1768 — Lower Costs for Everyday Americans Act

This section deems any consumer product containing a high concentration of sodium nitrite (i.e., 10% or more by weight) to be a banned hazardous product under section 8 of the Consumer Product Safety Act (15 U.S.C. 2057), effective 90 days after enactment. The ban does not apply to (1) commercial or industrial uses not customarily produced or distributed for sale to, use by, or enjoyment of consumers or (2) products meeting the definitions of a drug, device, cosmetic, food, poultry product, meat or meat food product, or egg product under the Federal Food, Drug, and Cosmetic Act and related statutes.

This section requires the Consumer Product Safety Commission (CPSC) to promulgate, within 180 days of enactment and under notice-and-comment rulemaking, three specified ANSI/CAN/UL voluntary standards—ANSI/CAN/UL 2271 (batteries for light electric vehicles), ANSI/CAN/UL 2849 (electrical systems for eBikes), and ANSI/CAN/UL 2272 (electrical systems for personal e-mobility devices)—as final consumer product safety standards limited to consumer products under the Consumer Product Safety Act (CPSA). It further (1) deems future revisions to those standards as CPSA consumer product safety rules effective 180 days after CPSC notice unless the agency objects within 90 days; (2) treats the promulgated standards (including adopted revisions) as CPSA consumer product safety rules under 15 U.S.C. 2058; and (3) directs CPSC to report to Congress within five years on lithium-ion battery fires, explosions, and hazards in micromobility products (i.e., products such as eBikes and personal e-mobility devices), including incident sources, product details, standard compliance, and manufacturer information.

This section directs the Federal Communications Commission (FCC) to publish on its website, not later than 120 days after enactment, a list of entities holding FCC licenses issued via spectrum auctions (under 47 U.S.C. 309(j)) or under the Cable Landing Licensing Act (47 U.S.C. 34 et seq.) and Executive Order 10530 (3 U.S.C. 301 note) where a covered entity (i.e., government of a covered country such as China or Russia per 10 U.S.C. 4872(f)(2), entity organized under such country's laws, or its subsidiary) holds a reportable equity or voting interest or exerts control as determined by an appropriate national security agency. The section further requires the FCC (1) to issue rules within 18 months of enactment to identify entities holding other FCC authorizations with reportable covered entity interests and add them to the list within one year after issuing such rules; (2) to update the list at least annually; and (3) to exempt related information collections from the Paperwork Reduction Act.

This section establishes additional responsibilities for the Assistant Secretary of Commerce for Industry and Analysis, as follows: (1) promote the stability and resilience of critical supply chains and critical and emerging technologies that strengthen U.S. national security; (2) lead the Working Group established under §403 and consult covered nongovernmental representatives, industry, institutions of higher education, and state and local governments to promote resilient critical supply chains and identify, prepare for, and respond to supply chain shocks to critical industries, supply chains, and emerging technologies; (3) encourage the growth and competitiveness of U.S. production and manufacturing of emerging technologies; (4) assess the resilience, diversity, and strength of critical supply chains and critical and emerging technologies; (5) in consultation with the Secretary of State and U.S. Trade Representative, support the availability of critical goods from domestic manufacturers, domestic enterprises, and manufacturing operations in ally or key international partner nations; (6) assist the federal government in preparing for and responding to supply chain shocks to critical supply chains, including by improving flexible U.S. manufacturing capacities; (7) consistent with U.S. international obligations, encourage and incentivize reduced reliance by domestic enterprises and manufacturers on critical goods from countries described in §407(2)(B); and (8) encourage relocation of manufacturing facilities for critical goods from such countries to the United States and ally or key international partner nations to strengthen critical supply chain resilience, diversity, and strength.

This section establishes a Supply Chain Resilience Working Group, to be convened by the Assistant Secretary (of Commerce) not later than 120 days after enactment, comprising representatives from specified federal agencies including the Departments of State, Defense, Homeland Security, Transportation, Energy, Agriculture, Interior, Health and Human Services, the Office of the Director of National Intelligence, and the Small Business Administration. The section directs the Assistant Secretary, not later than 1 year after enactment, to (1) consult with the working group to assess, map, and model critical supply chains (including for critical and emerging technologies); identify gaps, vulnerabilities, and potential shocks; evaluate domestic and allied manufacturing capacity, market stability effects, and workforce needs; and identify relevant risk assessment tools; and (2) consult with state and local governments and allied nations to identify opportunities to reduce vulnerabilities, encourage stakeholder coordination, build capacity, and develop contingency plans. The section further requires the Assistant Secretary, not later than 120 days after enactment, to designate critical industries, supply chains, and goods (with public comment and updates at least every 4 years) and, not later than 1 year after enactment, to submit to relevant congressional committees a report detailing supply chain activities, data collection and analysis, and necessary tools.

This section directs the Secretary of Commerce to submit to the relevant congressional committees, not later than two years after enactment, a report identifying and assessing the Department of Commerce's offices and bureaus relevant to critical supply chain resilience and manufacturing innovation. The report must (1) identify relevant duties, responsibilities, resources, programs, and expertise; (2) assess each such office or bureau's purpose, legal authority, effectiveness, efficiency, and limitations; and (3) provide recommendations to enhance related activities, including by improving effectiveness, efficiency, and impact; coordinating across offices and bureaus; and consulting agencies with similar activities. The submission must include a strategy to implement the recommendations, as appropriate and as determined by the Secretary.

This section defines 18 terms for purposes of the title, including “critical good” (i.e., any raw, in-process, or manufactured material, article, commodity, product, or item whose absence would debilitate U.S. national or economic security and critical infrastructure or emerging technology); “critical supply chain” (i.e., a supply chain for a critical good); “critical supply chain information” (i.e., nonpublic information on sustaining, mitigating risks in, or enhancing resilience of a critical supply chain during a supply chain shock); “domestic manufacturer” (i.e., a business conducting in the U.S. the research, development, engineering, or production necessary to manufacture a critical good); “emerging technology” (e.g., artificial intelligence, quantum computing, semiconductors, robotics); and “resilient critical supply chain” (i.e., one ensuring sustainment of critical industry, including emerging technologies and access to critical goods, during a supply chain shock).

This section defines the following terms for purposes of the title: (1) “Advisory Committee” as the National Blockchain Deployment Advisory Committee established pursuant to section 503(c); (2) “blockchain technology or other distributed ledger technology” as a distributed digital database shared across a network of computers, linked using cryptography, and automatically distributed among participants; (3) “covered nongovernmental representative” as a representative specified in the second sentence of 19 U.S.C. 2155(b)(1) (i.e.g., from labor labor labor labor, excluding non-Federal government representative; (4) “Secretary” as the Secretary of Commerce; (5) “State” as each of the several States, the District of Columbia, each commonwealth, territory, or possession of the United States, and each federally recognized Indian Tribe; (6) “token” as a transferable, digital representation of information recorded on blockchain technology or other distributed ledger technology; and (7) “tokenization” as the process of creating a token.

This section designates the Secretary of Commerce as a principal advisor to the President on policy pertaining to the deployment, use, application, and competitiveness of blockchain technology or other distributed ledger technology, applications built thereon, tokens, and tokenization. It directs the Secretary to support U.S. leadership in these areas by establishing, not later than 180 days after enactment and in consultation with relevant federal agencies, the National Blockchain Deployment Advisory Committee. The committee—which terminates 7 years after establishment and includes the Secretary, federal agency representatives, and nongovernmental experts (e.g., infrastructure operators, developers, industry sectors, academia, nonprofits, cybersecurity experts, rural stakeholders, and content creators)—must (1) examine issues and risks such as decentralized identity, cybersecurity, artificial intelligence, fraud reduction, regulatory compliance, e-commerce, health care, and supply chain resiliency; (2) promote improvement, security, U.S. leadership, and national security; (3) engage the public for best practices; (4) encourage federal agency coordination and adoption; and (5) assess federal use, preparedness, and additional security measures for critical infrastructure and cyber resiliency.

This section directs the Secretary of Commerce to submit to the Senate Committee on Commerce, Science, and Transportation and the House Committee on Energy and Commerce, and to make public on the Department of Commerce website, (1) interim reports not later than two years after enactment and annually thereafter describing the Secretary's activities under this title, recommendations for legislation to strengthen U.S. competitiveness in blockchain technology, distributed ledger technology, related applications, tokens, and tokenization, and emerging risks and long-term trends in those areas; and (2) a final report not later than 18 months before the termination of the advisory committee established under section 503 containing the committee's findings, conclusions, and recommendations, which must also be submitted to the President.

This section directs the Chair of the Federal Communications Commission (FCC) to establish a 6G Task Force within 120 days of enactment. The task force membership, appointed by the Chair, includes—to the extent practicable—representatives from the communications industry and public interest organizations or academic institutions (excluding those determined by the Chair to be "not trusted," i.e., owned by, controlled by, or subject to the influence of a foreign adversary or posing a national security threat), as well as at least one representative each from the federal government, state governments, local governments, and Tribal governments. Not later than one year after establishment (with a draft published for public comment not later than 180 days after establishment), the task force must publish a report in the Federal Register and on the FCC website—also submitting it to the House Committee on Energy and Commerce and the Senate Committee on Commerce, Science, and Transportation—covering (1) the status of industry-led standards-setting for sixth-generation (6G) wireless technology; (2) possible uses identified by such bodies; (3) limitations, including supply chain and cybersecurity issues; (4) workforce needs and training strategies for 6G and advanced wireless networks; (5) uses of emerging technologies and Open RAN networks; and (6) coordination with federal, state, local, and Tribal governments on siting, deployment, and adoption.

This section amends the Secure and Trusted Communications Networks Act of 2019 to prohibit the Federal Communications Commission (FCC) from granting a license for, or U.S. market access using, a geostationary orbit satellite system or nongeostationary orbit satellite system, or an authorization to use an individually licensed earth station (i.e., a non-blanket-licensed earth station that sends or receives signals to or from such a satellite system, including a gateway station) or blanket-licensed earth station (i.e., licensed with such a satellite system), if held or controlled by an entity that produces or provides covered communications equipment or services (i.e., equipment from national security risks such as Huawei or ZTE) or its affiliate (as defined in 47 U.S.C. 153). The prohibition applies to grants on or after enactment, and directs the FCC to issue implementing rules within one year of enactment.

This section amends Section 223 of the Communications Act of 1934 by adding a new subsection (h) that establishes criminal prohibitions, in interstate or foreign commerce, against knowingly using an interactive computer service (as defined in Section 230 of that Act) to publish certain intimate visual depictions (as defined in 15 U.S.C. 6851). (1) For authentic intimate visual depictions of adults, the prohibition applies if the depiction was obtained or created with a reasonable expectation of privacy, was not voluntarily exposed publicly or commercially, is not a matter of public concern, and publication is intended to cause or causes harm (psychological, financial, or reputational). (2) For authentic intimate visual depictions or digital forgeries (i.e., computer-generated or altered depictions indistinguishable from authentic ones) of minors (under 18 years old), the prohibition applies with intent to abuse, humiliate, harass, degrade the minor, or arouse or gratify sexual desire. Specified exceptions apply in both cases, including lawfully authorized law enforcement or intelligence activities; good-faith disclosures to law enforcement, in legal proceedings, for medical/scientific/educational purposes, to report unlawful content, or to seek support; disclosures to assist the depicted individual; and self-publication of one's own depictions.

This section requires covered platforms to establish, not later than one year after enactment, a process enabling identifiable individuals (or authorized representatives) to notify the platform of and request removal of nonconsensual intimate visual depictions (i.e., images depicting their intimate body parts or sexual acts published without consent), with removal required as soon as possible but no later than 48 hours after a valid request and conspicuous notice of the process required on the platform. It provides liability protection for good faith removals by covered platforms and treats failures to comply as unfair or deceptive acts or practices under section 18(a)(1)(B) of the Federal Trade Commission Act (15 U.S.C. 57a(a)(1)(B)), enforceable by the Federal Trade Commission notwithstanding jurisdictional limits in FTC Act sections 4, 5(a)(2), and 6 (15 U.S.C. 44, 45(a)(2), 46) to include non-profit organizations (Thus, expanding FTC enforcement to entities not organized for profit).

This section defines terms used in this title, including (1) "Commission" as the Federal Trade Commission; (2) "consent," "digital forgery," "identifiable individual," "intimate visual depiction," and "minor" as having the meanings given those terms in section 223(h) of the Communications Act of 1934 (47 U.S.C. 223(h)), as added by section 802; and (3) "covered platform" as a public-facing website, online service, online application, or mobile application that primarily functions as a forum for user-generated content (e.g., messages, videos, images, games, audio files) or regularly publishes, curates, hosts, or makes available nonconsensual intimate visual depictions, excluding broadband internet access service providers, electronic mail, and primarily preselected non-user-generated content platforms with only incidental interactive features.

This section establishes a severability clause for this title, providing that the invalidity of any provision of or amendment made by this title does not affect the remaining provisions or amendments.

This section establishes a vetting process under new subsection (m) of section 254 of the Communications Act of 1934 for applicants and recipients of new high-cost universal service fund support (i.e., covered funding) awarded on or after Commission rules are promulgated, including support via reverse auctions for broadband network deployment and service provision. (As background, the high-cost program provides universal service support to deploy telecommunications networks, including broadband, in rural, insular, and high-cost areas to ensure services reasonably comparable to those in urban areas.) Not later than 180 days after enactment, the Commission must initiate a rulemaking to require applicants to submit detailed proposals demonstrating technical, financial, and operational capabilities and a reasonable business plan, evaluated against established standards (including those from the Digital Opportunity Data Collection, WC Docket No. 19–195, or successor) and the applicant's compliance history in federal broadband programs. The rules must impose penalties for pre-authorization defaults of at least $9,000 per violation, with base forfeitures of no less than 30% of the applicant's total support unless the Commission justifies lower amounts in specific cases.

This section amends the Visit America Act to expand responsibilities of the Assistant Secretary of Commerce for Travel and Tourism regarding music tourism, as follows: (1) requires identification and promotion of domestic travel to U.S. locations and events important to music tourism; (2) revises facilitation of international business and leisure travel to emphasize large meetings and exhibitions, rural cultural and ecological destinations, sports events, and music tourism locations and events; (3) requires reports to designated Senate and House subcommittees on related activities, findings, achievements, and vulnerabilities, with the first due not later than one year after enactment and every two years thereafter; and (4) defines "music tourism" as travel to states or localities to visit music-related attractions (e.g., museums, studios, venues) or attend music festivals, concerts, live performances, or related events.

This section requires each manufacturer of a covered device (i.e., certain internet-connected devices) to disclose, clearly and conspicuously prior to purchase, whether the device contains a camera or microphone as a component.

This section establishes Federal Trade Commission (FTC) enforcement of this title—treating violations of section 1102 as unfair or deceptive acts or practices under FTC Act section 18(a)(1)(B) (15 U.S.C. 57a(a)(1)(B))—using the jurisdiction, powers, duties, penalties, privileges, and immunities of the FTC Act (15 U.S.C. 41 et seq.). It further directs the FTC to issue compliance guidance for section 1102 within 180 days of enactment (through outreach to private entities, including best practices for clear, conspicuous, age-appropriate disclosures and pictorial representations as defined in the Consumer Review Fairness Act of 2016 (15 U.S.C. 45b(a))); permits manufacturers of covered devices to petition for tailored guidance; and specifies that such guidance confers no rights, does not bind the FTC, and cannot form the basis for enforcement absent a specific violation of section 1102.

This section defines, for purposes of this title, a "covered device" as a consumer product under the Consumer Product Safety Act (15 U.S.C. 2052(a)) that is capable of connecting to the internet and includes a camera or microphone component. The definition excludes (1) telephones (including mobile phones), laptops, tablets, or any device a consumer would reasonably expect to have a microphone or camera; (2) any device specifically marketed as a camera, telecommunications device, or microphone; and (3) any device or apparatus described in sections 255, 716, and 718, and subsections (aa) and (bb) of section 303, of the Communications Act of 1934 (47 U.S.C. 255, 617, 619, 303(aa), (bb)), and related regulations.

This section establishes the effective date of this title as 180 days after the Commission issues guidance under section 1103(c), applying the title's requirements only to covered devices manufactured after that date and excluding covered devices manufactured, sold, or introduced into interstate commerce before that date.

This section defines the term SelectUSA, for purposes of this title, as the SelectUSA program of the Department of Commerce established by Executive Order 13577 (relating to the establishment of the SelectUSA Initiative).

This section states congressional findings on the critical role of semiconductors in the U.S. and global economies and national security; vulnerabilities in the semiconductor supply chain exposed by the COVID-19 pandemic and other factors; the need to onshore, reshore, or diversify fabrication, advanced packaging, and manufacturing materials and equipment; and the potential of the Department of Commerce's SelectUSA program, in coordination with other federal agencies and state organizations, to attract foreign direct investment and private funding to strengthen domestic semiconductor production.

This section directs the Executive Director of SelectUSA—not later than 180 days after the date of enactment of this Act—to solicit comments from state-level economic development organizations (1) to review (A) federal efforts to support increased foreign direct investment in semiconductor-related production, (B) barriers to such investment and ways to amplify state efforts, (C) public opportunities identified by those organizations to attract such investment, and (D) resource gaps or challenges preventing increased investment; and (2) to develop recommendations for (A) how SelectUSA can increase such investment independently or through partnerships with those organizations and (B) working with U.S. allies and partners to ensure foreign adversaries (as defined in 47 U.S.C. 1607(c)(2)) do not benefit from U.S. efforts. (SelectUSA is the Department of Commerce program that promotes and facilitates foreign direct investment in the United States.)

This section directs the Executive Director of SelectUSA—in coordination with the Federal Interagency Investment Working Group established by Executive Order 13577—to submit to the Senate Committee on Commerce, Science, and Transportation and the House Committee on Energy and Commerce, not later than two years after enactment of this Act, a report on increasing foreign direct investment in semiconductor-related manufacturing and production. The report must include (1) a review of comments SelectUSA received from state-level economic development organizations under section 1204; (2) a description of SelectUSA activities to increase such investment; and (3) an assessment of strategies SelectUSA may implement to increase such investment and secure the U.S. semiconductor supply chain, including by coordinating with other federal agencies and state-level economic development organizations.

This section prohibits the authorization of additional funds to carry out this title and directs the Executive Director of SelectUSA to use amounts otherwise available for such purposes.

This section prohibits covered entities from advertising, marketing, or offering prices for covered services—hotel rooms and other short-term rentals—in interstate commerce without clearly, conspicuously, and prominently displaying the total services price (including all government-imposed taxes, fees, and assessments) at all points of display and throughout the purchasing process. It permits less prominent display of individual price components or unrelated items; allows indemnification contracts between covered entities for shared price information; and authorizes Federal Trade Commission enforcement as an unfair or deceptive act or practice under the FTC Act (15 U.S.C. 45), with full FTC powers preserved, alongside state attorneys general (or other authorized state officials) civil enforcement actions on behalf of residents, subject to FTC notice, intervention, and coordination requirements.

This section prohibits ticket issuers, secondary market ticket issuers, and secondary market ticket exchanges from offering event tickets for sale unless, beginning 180 days after enactment, they (1) clearly and conspicuously display the total event ticket price in any advertisement, marketing, or price list; (2) clearly and conspicuously disclose the total price when first displayed to a potential purchaser and throughout the purchasing process; and (3) provide an itemized list of the base event ticket price and each event ticket fee prior to purchase completion.

This section prohibits, beginning 180 days after enactment, a ticket issuer, secondary market ticket issuer, or secondary market ticket exchange from selling, offering for sale, or advertising an event ticket that the entity does not have actual or constructive possession of. It permits such entities to sell services to obtain an event ticket on an individual's behalf if (1) the service is not marketed or listed as an event ticket, (2) a clear separation is maintained between the service and event tickets throughout the selection and purchase process, and (3) it is clearly and conspicuously disclosed prior to purchase that the service is not an event ticket and does not guarantee receipt of one.

This section requires a ticket issuer, secondary market ticket issuer, or secondary market ticket exchange offering an event ticket for resale to provide a clear and conspicuous statement—before a consumer purchases the ticket—that the issuer or exchange is engaged in the secondary sale of event tickets. The section further prohibits such entities from stating or implying affiliation with or endorsement by a venue, team, or artist (e.g., by using "official" in promotional materials) unless authorized by a partnership agreement or the venue's, team's, or artist's express written consent.

This section requires ticket issuers, secondary market ticket issuers, and secondary market ticket exchanges—effective 180 days after enactment—to provide minimum refunds for event tickets if an event is canceled or postponed (except due to causes beyond the issuer's reasonable control, such as natural disasters or civil disturbances), as follows: (1) a full refund of the total ticket price if canceled; (2) subject to availability, a replacement ticket in the same or comparable location if postponed for not more than six months and the original ticket is no longer valid; or (3) at the purchaser's option, a full refund or such a replacement ticket if postponed for more than six months and the original ticket is no longer valid. The section further requires such entities to disclose clearly and conspicuously, before completing a ticket sale, their guarantee or refund policy (including circumstances under which ticket fees are refunded) and a clear explanation of how to obtain a refund of the total ticket price.

This section directs the Federal Trade Commission (FTC), not later than six months after enactment, to submit to Congress a report on enforcement of the Better Online Ticket Sales Act of 2016 (BOTS Act; 15 U.S.C. 45c)—which prohibits using bots or other software to circumvent ticket issuers' purchasing limits or sales rules on websites. The report must include enforcement actions taken, challenges with enforcement and coordination with state attorneys general, and recommendations to improve enforcement and industry compliance.

This section provides for Federal Trade Commission (FTC) enforcement of this title by (1) treating a violation as a violation of a rule defining an unfair or deceptive act or practice under section 18(a)(1)(B) of the FTC Act (15 U.S.C. 57a(a)(1)(B)); (2) directing the FTC to enforce using the same manner, means, jurisdiction, powers, and duties as though applicable provisions of the FTC Act (15 U.S.C. 41 et seq.) were incorporated into this title; (3) subjecting violators to the penalties and entitling them to the privileges and immunities provided in the FTC Act; and (4) preserving the FTC's authority under any other provision of law. (Thus, the FTC may pursue administrative cease-and-desist orders, civil penalties up to $51,744 per violation (adjusted for inflation), and other remedies available under the FTC Act.)

This section establishes definitions for 12 terms used in this title, including "artist" (e.g., performer, musician, comedian, sports team owner); "event" (live concert, theatrical performance, sporting event, or similar in a venue exceeding 200-person capacity, open to the public, and marketed or sold in interstate commerce); "base event ticket price" (excluding event ticket fees); "event ticket fee" (mandatory charges in addition to base price, such as service or delivery fees, excluding optional products or services); "secondary market ticket issuer" (person reselling tickets to the public in the regular course of business); and "total event ticket price" (base price plus fees).

This section directs the Secretary of Commerce, in consultation with the Assistant Secretary of Commerce for Communications and Information, to conduct a study of national security risks posed by consumer routers, modems, and combination modem-router devices designed, developed, manufactured, or supplied by persons owned by, controlled by, or subject to the influence of a covered country (i.e., a country specified in 10 U.S.C. 4872(f)(2)). The Secretary must submit a report on the study to the House Committee on Energy and Commerce and the Senate Committee on Commerce, Science, and Transportation not later than one year after the date of enactment.

This section defines, for purposes of this title, the terms "Commission" (i.e., the Federal Communications Commission), "NTIA" (i.e., the National Telecommunications and Information Administration), and "Under Secretary" (i.e., the Under Secretary of Commerce for Communications and Information).

This section requires state Medicaid and Children's Health Insurance Program (CHIP) plans, effective three years after enactment, to adopt and implement a streamlined enrollment process for eligible out-of-state providers to furnish items and services to, or order, prescribe, refer, or certify eligibility for such items and services for, qualifying individuals (i.e., enrolled children under 21 years of age). Eligible out-of-state providers are those located in another state that (1) have been screened and determined to pose a limited risk of fraud, waste, and abuse in either the Medicare program or their home state's Medicaid or CHIP program and (2) have not been excluded or terminated from federal health care programs or state plans; such providers must supply only minimum necessary information (e.g., name and National Provider Identifier) and, once enrolled, receive a five-year participation period unless terminated or excluded. (Thus, the provision reduces administrative barriers for low-risk out-of-state providers serving Medicaid- and CHIP-enrolled children while maintaining program integrity safeguards.)

This section requires states operating Medicaid home and community-based services (HCBS) waivers under section 1915(c)—which enable states to provide long-term care services to elderly and disabled individuals in home or community settings as an alternative to institutions—not less frequently than annually to report specified information on waitlists (where applicable) and service delivery for homemaker, home health aide, personal care, and habilitation services, including waitlist maintenance and screening practices, waitlist size, average enrollment wait times, average time from service approval to delivery, and percentage of authorized hours provided (using statistically valid sampling); makes such information publicly available on the CMS website on or after enactment (with waitlist details and service metrics required on or after July 9, 2027); and applies the service metrics reporting requirement to HCBS provided under section 1915(i), (j), and (k) authorities on or after July 9, 2027. This section further establishes a three-year demonstration program under which the Secretary may approve standalone section 1915(c) waivers for up to five states—selected no later than 24 months after planning grant awards based on specified criteria including geographic diversity, rural population share, and progress rebalancing long-term services and supports—to cover part or all of the non-room-and-board costs of additional HCBS approved by the Secretary and provided via a plan of care to targeted individuals.

This section eliminates the upper age limit of less than 65 years old for Medicaid eligibility under the optional buy-in program for working individuals with disabilities (i.e., under SSA section 1902(a)(10)(A)(ii)(XV)) and the related definition of such individuals (i.e., under SSA section 1905(v)(1)(A)). States currently providing medical assistance to individuals described in such eligibility groups have until January 1, 2027, to conform to the revised requirements.

This section requires state Medicaid plans, beginning January 1, 2028, to treat active duty relocated individuals (i.e., active duty service members relocated to another state, certain recent retirees from active duty (within 12 months), and their dependents who were enrolled in Medicaid or on a home and community-based services (HCBS) waiting list at the time of relocation) as residents of the military service relocation state for eligibility purposes unless they elect otherwise; preserve their position on any originating-state HCBS waiting list (i.e., for services under Medicaid sections 1115(a), 1915(c), or 1915(j)) until an eligibility decision and fair hearing opportunity or voluntary removal; and cover medical assistance furnished in the relocation state to the extent available there. (Thus, the changes facilitate continuous Medicaid coverage and HCBS access for military families during PCS moves.) This section also appropriates $1 million for each of FY2025 through FY2029 to the Secretary of Health and Human Services for implementation.

This section requires state Medicaid plans, beginning January 1, 2026, to establish a process for regularly obtaining address information for enrollees from reliable data sources (as described in 42 CFR 435.919(f)(1)(iii) or successor regulation) and acting on any address changes in accordance with such regulation (applicable only to the 50 states and the District of Columbia). It applies this requirement to state CHIP plans. The section further requires Medicaid managed care contracts to provide, beginning January 1, 2026, for managed care entities to transmit to the state any enrollee address information provided directly from or verified directly with the enrollee.

This section requires states, beginning January 1, 2027, to check the Death Master File (i.e., Social Security Administration database of deceased persons) upon Medicaid provider or supplier enrollment, reenrollment, or revalidation—and not less frequently than quarterly thereafter—to determine if such provider or supplier is deceased. (Thus, states must deactivate deceased providers to prevent improper payments under Medicaid.)

This section requires state Medicaid plans to comply with new eligibility verification requirements under subsection (vv), beginning January 1, 2026, and applicable only to the 50 states and the District of Columbia. Those requirements are (1) quarterly screening of the Death Master File to identify deceased individuals enrolled under the state plan (or waiver); (2) prompt disenrollment of such individuals, treating Death Master File data as factual confirmation of death and discontinuing payments for medical assistance on their behalf (except for services furnished prior to death); and (3) immediate reenrollment, retroactive to the date of disenrollment, for any individual erroneously identified as deceased. (Thus, states may supplement Death Master File screening with other electronic data sources to identify deceased enrollees.)

This section (1) delays state compliance with Medicaid and CHIP requirements for arranging health screenings, referrals, and follow-up case management services for eligible juveniles (i.e., Medicaid- or CHIP-eligible individuals under age 26 in pre-adjudication juvenile justice custody) in public institutions until January 1, 2026; (2) excludes individuals in federal custody (including federal prison inmates) from those Medicaid and CHIP requirements, effective as if enacted on December 29, 2022; and (3) requires each state to submit to the Secretary of Health and Human Services by June 30, 2025, an interim work plan describing progress toward implementing those requirements, consistent with CMS guidance issued July 23, 2024.

This section directs each state—as defined in section 1101(a)(1) of the Social Security Act for Medicaid (title XIX) and CHIP (title XXI) purposes—to conduct a study on the costs of providing maternity, labor, and delivery services in applicable hospitals, not later than 24 months after enactment and every five years thereafter, and to submit the results to the Secretary of Health and Human Services (HHS). Applicable hospitals are those where more than 50% of births (in the most recent year for which data are available) are financed by Medicaid or CHIP, or rural hospitals (as defined by the Federal Office of Rural Health Policy) averaging fewer than 300 births per year over the most recent two years that provide labor and delivery services. State studies must include, to the extent practicable: (1) cost estimates for such services at a representative sample of applicable hospitals and those that ceased providing labor and delivery services within the past five years, based on the two most recent years of data; (2) analysis of how geographic location, community demographics, and local economic factors affect those costs; (3) payment amounts for such services under Medicare, state Medicaid and CHIP (fee-for-service and managed care), and private insurance, by geographic location and hospital size; (4) comparative payment rate analysis relative to Medicare, other programs, and private insurers, including alternative payment methods; and (5) evaluation of expected changes in expenditures or reimbursements over the next three years. This section appropriates $10 million for FY2025 to HHS for grants and technical assistance to low-volume rural hospitals to compile study data, to remain available until expended; requires HHS to issue a public report compiling each state's study results within 12 months of submission; and requires an additional HHS report to Congress, due not later than three years after enactment, analyzing the first round of state studies with data collection recommendations. It further appropriates $3 million for FY2025 to HHS for implementation, to remain available until expended.

This section modifies Medicaid disproportionate share hospital (DSH) allotments, which provide federal funds to states for extra payments to hospitals serving high shares of low-income or Medicaid patients. Specifically, it (1) extends Tennessee's DSH allotment to fiscal year (FY) 2026 and the first quarter of FY2027 at $13,275,000 (previously through FY2025); and (2) delays statutory DSH allotment reductions under SSA sec. 1923(f)(7)(A) to the period from January 1, 2027, through September 30, 2027, and FY2028 (from April 1, 2025, through 2027) and under paragraph (8) to 2028 (from 2027).

This section revises limitations on Medicaid disproportionate share hospital (DSH) payment adjustments under section 1923(g) of the Social Security Act to more broadly apply the uncompensated care cost cap to all DSH-eligible hospitals (eliminating prior exceptions for certain public hospitals under former paragraph (2)(B)); expand the third-party payments that offset such costs to include Medicare payments and payments by applicable plans (as defined in SSA section 1862(b)(8)(F)); and include costs for Medicaid-eligible individuals for whom the state plan is payor of last resort after such third-party benefits, provided the hospital's aggregate costs exceed payments for services to those individuals in the applicable year. (As background, DSH payments provide additional federal matching funds to hospitals serving disproportionate shares of low-income and Medicaid patients, capped at uncompensated care costs net of payments for services to Medicaid and uninsured patients.) The amendments apply to state plan rate years beginning on or after the date of enactment. For rate years beginning on or after October 1, 2021, and before enactment, a state may elect to use unspent DSH allotments to increase payments consistent with the revised limitations (without exceeding the state's annual allotment), must not recoup prior payments made under prior rules, may seek Secretary approval for retroactive state plan amendments (by the independent audit deadline under SSA section 1923(j)(2)), and must report such increases in its next annual DSH report under SSA section 1923(j)(1).

This section revises Medicaid requirements for surveying national average drug acquisition costs (i.e., benchmarks used by states to reimburse pharmacies for covered outpatient drugs) to include both retail community pharmacies and applicable non-retail pharmacies (with separate monthly vendor-conducted surveys net of discounts, rebates, and price concessions, and optional surveys by non-retail pharmacy type). It further (1) requires monthly vendor updates to the Secretary with data differentiated by pharmacy type (including affiliates); (2) directs states to require all pharmacies receiving Medicaid-related payments, reimbursements, or concessions to respond to surveys; (3) mandates public release of survey details such as response rates, non-compliant pharmacies, sampling methodology, and price concessions; and (4) authorizes civil money penalties up to $100 per violation per pharmacy (including chains) for non-response, false information, or other non-compliance.

This section amends the Medicaid drug rebate requirements (SSA §1927) to require states' contracts with pharmacy benefit managers (PBMs) or managed care entities and other specified entities responsible for covered outpatient drugs to use a transparent prescription drug pass-through pricing model. Under the model, payments for such drugs are limited to ingredient cost plus a professional dispensing fee (not less than the fee the state would pay directly under its plan), passed through in full to dispensing pharmacies or providers (except for waste, fraud, or abuse reductions) and consistent with specified Medicaid payment regulations (42 C.F.R. §§447.502, 447.512, 447.514, 447.518); PBM or entity administrative fees are capped at fair market value; all related costs and payments must be disclosed to the state and HHS; and spread pricing—where the PBM or entity charges the state more than it pays pharmacies (after admin fees)—is unallowable for federal matching payments. (Thus, this prevents PBMs from retaining differences between what states pay them and what they reimburse pharmacies for Medicaid managed care enrollees' drugs.) It provides a limited exception for 340B drug payments exceeding actual acquisition cost (requiring annual covered entity reporting to HHS, with HHS publishing aggregate excess amounts by state and 340B entity category without identifying entities) and defines PBM as an entity acting as prescription drug price negotiator, group purchaser, or benefit manager for states or such entities.

This section extends the increased payment adjustment for low-volume hospitals under Medicare's inpatient prospective payment system (IPPS)—which provides qualifying hospitals (those with fewer than 800 Medicare discharges located 25 road miles or more from the nearest subsection (d) hospital) a 25% increase in their base operating payments—to fiscal year 2026 (beginning January 1, 2026, and ending September 30, 2026, from fiscal year 2025 beginning April 1, 2025, and ending September 30, 2025) and fiscal year 2027 (from fiscal year 2026). It also revises related eligibility determination periods in subpar. (C)(i) and (D) to use hospital cost report and discharge data through 2025 (from 2024), for fiscal year 2026 (from fiscal year 2025), and for the period October 1, 2025, through December 31, 2025 (from October 1, 2024, through March 31, 2025).

This section extends the Medicare-dependent hospital (MDH) program—which provides additional payments under Medicare's inpatient hospital prospective payment system (IPPS) to small rural hospitals (fewer than 100 beds) with Medicare inpatient days comprising at least 60% of total inpatient days—to January 1, 2026 (from April 1, 2025). It makes conforming amendments to (1) the IPPS standardized amount update schedule for MDHs by shifting fiscal year references to FY2025 and FY2026 (from FY2024 and FY2025) and dates to October 1, 2025, and December 31, 2025 (from October 1, 2024, and March 31, 2025); and (2) the period through which certain hospitals may elect to decline reclassification from FY2025 to FY2026 with corresponding date changes to October 1, 2025, and December 31, 2025 (from October 1, 2024, and March 31, 2025).

This section extends temporary add-on payments under the Medicare ambulance fee schedule for ground ambulance services furnished in rural areas and super-rural areas through January 1, 2027 (from April 1, 2025).

This section extends incentive payments to eligible Medicare Part B professionals participating in eligible alternative payment models through 2027 (from 2026), specifies a 3.53 percent payment rate for 2027 (in addition to the prior 1.88 percent rate), and makes conforming changes by shifting specified dates in the program's payment structure and MIPS exemptions to 2027 and 2028 (from 2026 and 2027). (As background, these payments—originally 5 percent through 2024 and thereafter declining—encourage clinician participation in alternative payment models that tie Medicare payments to care quality and outcomes rather than service volume.)

This section provides a temporary 2.5 percent increase in payments under the Medicare physician fee schedule for services furnished on or after January 1, 2025, and before January 1, 2026. It also makes a conforming amendment to extend through 2025 (from 2024) an exception in the budget neutrality adjustment for relative value units.

This section increases funding for the contract with a consensus-based entity (e.g., National Quality Forum)—which endorses standardized health care performance measures used in Medicare and other programs—to $20,030,000 (from $11,030,000) and extends the funding period through December 31 (from March 31) in two provisions.

This section extends funding for Medicare beneficiary outreach and assistance programs for low-income individuals (i.e., State Health Insurance Assistance Programs (SHIP), which counsel beneficiaries on plan options and low-income subsidies; Area Agencies on Aging; Aging and Disability Resource Centers; and related coordination activities) by providing, for the period beginning April 1, 2025, and ending December 31, 2026, (1) $30 million for SHIP; (2) $30 million for Area Agencies on Aging; (3) $10 million for Aging and Disability Resource Centers; and (4) $30 million for coordination efforts to inform older Americans about federal and state benefits.

This section extends multiple Medicare telehealth flexibilities under section 1834(m) of the Social Security Act (i.e., temporary waivers of geographic restrictions, originating site limits, and eligible practitioner requirements) through December 31, 2026 (from March 31, 2025). This section further (1) extends eligibility of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) as distant sites through December 31, 2026 (from March 31, 2025), and for telehealth services furnished by FQHCs or RHCs on or after January 1, 2025, and before January 1, 2027, provides payment as FQHC or RHC services under their respective prospective payment systems or all-inclusive rates (with associated costs treated as allowable); (2) delays in-person requirements for mental health telehealth services, including those furnished by RHCs and FQHCs, until January 1, 2027 (from April 1, 2025); (3) extends coverage of audio-only telehealth through December 31, 2026 (from March 31, 2025); and (4) extends use of telehealth for the face-to-face encounter prior to hospice eligibility recertification through December 31, 2026 (from March 31, 2025), except for encounters on or after January 1, 2025, involving individuals in moratorium areas, providers under enhanced oversight, or non-enrolled/opt-out physicians or nurse practitioners. This section requires the Secretary of Health and Human Services, not later than (1) July 1, 2025, to establish modifiers for FQHC and RHC telehealth claims and (2) January 1, 2026, to establish modifiers for claims involving telehealth virtual platforms with certain payment arrangements or furnished incident to a physician's service; and authorizes implementation through program instruction.

This section requires that any Medicare claim for hospice care include one or more modifiers or codes (as specified by the Secretary of Health and Human Services) to indicate a telehealth face-to-face encounter prior to recertification of eligibility, for encounters occurring on or after January 1, 2026. (Thus, telehealth may be used for such encounters only if properly indicated on the claim.)

This section extends the Acute Hospital Care at Home initiative waiver flexibilities through December 31, 2029 (from March 31, 2025), renames it the Thomas R. Carper, Tim Scott, Brad R. Wenstrup, D.P.M., and Earl Blumenauer Acute Hospital Care at Home initiative, and makes conforming and technical changes. (The initiative, launched by CMS during the COVID-19 public health emergency, allows participating hospitals to provide acute-level care in patients' homes under Medicare Part A while waiving certain conditions of participation, site-neutral payment requirements, and three-day inpatient stay rules for skilled nursing facility care.) The section also (1) revises subsection (b) as the "initial study" on the initiative; (2) authorizes the Secretary to require data submissions through hospital cost reports, surveys, medical records, or other means; (3) requires a subsequent study by September 30, 2028, analyzing patient selection criteria, quality metrics (e.g., readmissions, mortality, length of stay, infection rates), costs, service intensity, demographics, and selection bias by comparing initiative participants to non-participants and inpatient care; and (4) directs the Secretary to post a report on the study on the CMS website by September 30, 2028. Additionally, this section appropriates $6 million to the CMS Program Management Account for FY2025, to remain available until expended, for purposes of the section.

This section establishes enhanced Medicare program integrity requirements for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Specifically, it (1) requires, beginning January 1, 2028, that DMEPOS items with a substantial number of claims ordered by a physician or practitioner lacking a prior 24-month service history with the beneficiary be included on the DMEPOS Prior Authorization Master List (42 CFR 414.234(b)) as exhibiting aberrant billing patterns (absent explanatory factors such as emergent care), and (2) authorizes prepayment claim review for such listed items furnished on or after January 1, 2028, if not subject to advance coverage determinations under current law (para. (15)(C)); these requirements also apply to prosthetics, orthotics, and prosthetics. Separately, this section directs the HHS Inspector General to submit to Congress, by January 1, 2026, a report assessing fraud risks for clinical diagnostic laboratory tests under Medicare Part B (SSA sec. 1834A), including identification of high-risk tests, billing patterns (e.g., from providers without prior beneficiary relationships or using certain payment modifiers), aberrant provider ordering, and recommended mitigation strategies such as improved detection, outlier monitoring, and targeted education.

This section directs the Secretary of Health and Human Services (HHS), not later than one year after enactment and in consultation with entities such as health information technology providers (e.g., electronic medical record companies, remote patient monitoring companies, and telehealth vendors), health care providers (e.g., physicians and hospitals), health insurers, language service companies, interpreter associations, health and language services certification organizations, and patient advocates, to issue or update guidance on best practices for telehealth services (as defined in Medicare at 42 U.S.C. 1395m(m)) for individuals with limited English proficiency. The guidance addresses (1) facilitating interpreter use during telemedicine appointments, (2) providing accessible instructions for telecommunications systems, (3) improving access to digital patient portals, (4) integrating multi-person video platforms for interpretation, and (5) providing multilingual patient materials, communications, and instructions (e.g., text message reminders and prescription information).

This section expands the definitions of cardiac rehabilitation program and pulmonary rehabilitation program under Medicare Part B to temporarily allow, for items and services furnished on or after April 1, 2025, and before January 1, 2027—(1) delivery through audio and video real-time communications technology (excluding audio-only) in the home of a hospital outpatient; and (2) virtual presence of a physician, physician assistant, nurse practitioner, or clinical nurse specialist through audio and video real-time communications technology. (As background, these programs provide supervised exercise training, education, and risk-factor modification to Medicare beneficiaries with qualifying cardiac or pulmonary conditions.) The section also authorizes the Secretary of Health and Human Services to implement these changes by program instruction or otherwise, notwithstanding any other provision of law.

This section revises Medicare regulations to expand the Medicare Diabetes Prevention Program (MDPP)—a Center for Medicare and Medicaid Innovation model furnishing intensive lifestyle coaching to at-risk beneficiaries to prevent or delay type 2 diabetes—by authorizing virtual suppliers from January 1, 2026, through December 31, 2030. Specifically, it (1) permits entities meeting MDPP supplier enrollment conditions to participate solely by furnishing online MDPP services via synchronous or asynchronous technology or telecommunications; (2) for such entities, sets the administrative location as the address on file under the Diabetes Prevention Recognition Program and removes prohibitions on claims for interstate online services; and (3) eliminates limits on the number of times a beneficiary may enroll in MDPP.

This section directs the Secretary of Health and Human Services, not later than January 1, 2026, to provide education and outreach—using existing communications mechanisms—to physicians and non-physician practitioners participating in the Medicare program on periodic screening for medication-induced movement disorders associated with mental health disorder treatments in at-risk patients, including clinical guidelines and best practices for telehealth delivery and evaluation and management code selection. The Secretary must, to the extent practicable, seek input from relevant stakeholders and may address other relevant telehealth screening services.

This section directs the Comptroller General of the United States to conduct a technology assessment of, and submit a report to Congress not later than 18 months after enactment on, the capabilities and limitations of wearable medical devices used to support clinical decision-making. The report must describe (1) the potential of such devices to accurately prescribe treatments, (2) the benefits and challenges of artificial intelligence to augment such capabilities, and (3) policy options to enhance benefits and mitigate challenges of developing or using such devices.

This section extends through 2034 (from 2033) the adjustment to the calculation of the Medicare hospice aggregate cap amount (i.e., the limit on total payments to a hospice program for all beneficiaries served in an accounting year) in two clauses of law.

This section establishes multiyear contracting authority for the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) by adding new subsections (i) and (j) to 41 U.S.C. §3904. Specifically, both commissions may use available funds to enter into (1) contracts for severable services spanning two fiscal years and (2) multiyear contracts for property and services, to the same extent as executive agencies under 41 U.S.C. §§3902 and 3903. (MedPAC advises Congress on Medicare payment and access issues; MACPAC performs a similar role for Medicaid and the Children's Health Insurance Program (CHIP).)

This section requires the Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) to apply Federal Acquisition Regulation (FAR) clauses 52.232-39 and 52.233-4 (or successors) to all contracts for goods and services beginning in FY2025. (Thus, these clauses prohibit charging the government for unauthorized commitments and specify U.S. law as governing breach-of-contract claims.)

This section revises maximum copayments under the Medicare Part D low-income subsidy program (i.e., Extra Help) for applicable covered Part D drugs. For plan years before 2027, it retains caps of $1 (or less, if the plan copayment amount under subclause (iii) is lower) for generic drugs or preferred multiple-source drugs (as defined in SSA section 1927(k)(7)(A)(i)) and $3 (or less) for other drugs; for 2027 and subsequent years, it sets the cap at $0 for generic drugs, indexes the cap for preferred multiple-source drugs annually from the prior year's amount by the CPI for all urban consumers (U.S. city average) as of September of the prior year (rounded to the nearest multiple of 5 cents if based on $1, or less if the plan copayment is lower), and similarly indexes the cap for other drugs (rounded to the nearest multiple of 10 cents if based on $3, or less if the plan copayment is lower). This section also limits the application of paragraph (4)(A)(ii)—describing a reduction in copayments for subsequent years—to years before 2027.

This section requires Medicare Advantage (MA) organizations offering specified MA plans—defined as network-based plans (i.e., HMOs, local PPOs, or regional PPOs) or private fee-for-service plans meeting access standards through provider contracts—beginning with plan year 2027 to (1) maintain an accurate, publicly available online provider directory including provider name, specialty, contact information, office address, new patient status, disability accommodations, cultural and linguistic capabilities, and telehealth capabilities; (2) verify listed provider information at least every 90 days (or annually for hospitals and certain facilities), indicate unverifiable information as potentially outdated, and remove non-participating providers within five business days; (3) provide this directory information to enrollees; and (4) annually analyze directory accuracy using a random sample of providers, with emphasis on high-inaccuracy specialties as determined by the Secretary of Health and Human Services, and report results. This section further establishes enrollee protections beginning plan year 2027, under which, for services from a provider listed in a specified MA plan's directory but not in its network, the enrollee pays the lesser of in-network cost-sharing or otherwise applicable cost-sharing (Thus, protecting enrollees from higher out-of-network costs due to inaccurate directories). MA organizations must notify enrollees of these protections annually before the coordinated election period, in provider directories, and in explanations of benefits.

This section provides Medicare Part B coverage for multi-cancer early detection screening tests (MCEDs)—FDA-approved genomic sequencing blood or comparable tests for concurrent detection of multiple cancers—furnished on or after January 1, 2029, if determined reasonable and necessary via the national coverage determination process (as added to SSA sections 1861(s)(2)(KK) and (nnn)). The section establishes payment under SSA section 1834(aa) equal to the payment rate for the multi-target stool DNA screening test before January 1, 2031, and thereafter the lesser of that rate or the clinical laboratory fee schedule amount under section 1834A; limits coverage to individuals ages 50 through 65 in 2029 (increasing the upper age limit by 1 year annually thereafter) who have not received such a test in the prior 11 months; and exempts tests recommended with an A or B grade by the U.S. Preventive Services Task Force from these limits once covered under SSA section 1861(ddd)(1). The section makes conforming amendments to update payment references in SSA section 1833(a) and (h)(1)(A) and add MCEDs to the reasonable and necessary exclusion exception in SSA section 1862(a)(1)(A); and clarifies that MCED coverage does not affect Medicare coverage of other cancer screenings (e.g., for breast, cervical, colorectal, lung, or prostate cancer).

This section amends the Medicare definition of durable medical equipment (DME) in section 1861(n) to deem certain external infusion pumps, associated home infusion drugs (as defined in section 1861(iii)(3)(C)), and related supplies as meeting the "appropriate for use in the home" requirement of 42 CFR 414.202 (or successor regulation), notwithstanding prior ineligibility due to the need for professional administration, beginning with the first calendar quarter one year after enactment if (1) FDA-approved prescribing information for the drug requires administration by or under the supervision of a health care professional, (2) a qualified home infusion therapy supplier (as defined in section 1861(iii)(3)(D)) administers or supervises delivery in the patient's home (as defined in section 1861(iii)(3)(B)), and (3) prescribing information requires infusion at least 12 times per year intravenously or subcutaneously, or at rates the Secretary determines necessitate an external infusion pump. (As background, Medicare covers DME only if suitable for safe, effective non-professional use in a home setting; this provision expands coverage for professionally supervised home infusion therapy.) This section also directs the Secretary of HHS to notify patients of Medicare cost-sharing differences for home infusion therapy versus other care settings for infusion drugs.

This section revises Medicare Part D prescription drug plan (PDP) network pharmacy participation requirements to require PDP sponsors to permit participation by any willing pharmacy meeting standard contract terms and conditions, which for plan years beginning on or after January 1, 2028, must be reasonable and relevant per standards established by the Secretary of Health and Human Services no later than the first Monday in April 2027 (following a request for information issued by April 1, 2026, on contracting practices and related issues). The section also requires the Secretary to publish reports at least every two years through 2034 (and periodically thereafter) on trends in payments to, participation by, and other metrics for essential retail pharmacies—defined as non-affiliated retail pharmacies in medically underserved areas or areas lacking another retail pharmacy within 10 miles (rural), 2 miles (suburban), or 1 mile (urban)—compared to other pharmacies and between PDPs and Medicare Advantage prescription drug (MA-PD) plans.

This section establishes requirements for pharmacy benefit manager (PBM) agreements in contracts between Medicare Part D prescription drug plan (PDP) sponsors and PBMs, for plan years beginning on or after January 1, 2028. Such agreements must provide that PBMs and their affiliates (1) derive no remuneration for covered Part D drugs other than bona fide service fees (with exceptions for certain incentive payments deemed bona fide by the Secretary if flat-dollar, at fair market value, and service-related; and for manufacturer rebates, discounts, or price concessions if fully passed through to the PDP sponsor and compliant with direct and indirect remuneration rules), subject to Secretary review of remuneration arrangements for fair market value (in consultation with the HHS Office of Inspector General) and disgorgement of improper amounts to the PDP sponsor; (2) apply pricing guarantees and cost performance measures transparently by consistently defining terms such as "generic drug," "brand name drug," "specialty drug," "rebate," and "discount" (per specified regulations where applicable), clearly identifying exclusions, and providing wholesale acquisition cost equivalents for non-wholesale acquisition cost-based measures; and (3) submit annual reports to the PDP sponsor and Secretary by July 1 (beginning in 2028) on specified information.

This section prohibits Medicare payment under the hospital outpatient prospective payment system (OPPS) for items and services furnished on or after January 1, 2026, by an off-campus outpatient department of a provider unless (1) the department bills using a separate unique health identifier from the provider, (2) the provider submitted an initial attestation of compliance with provider-based status requirements (42 CFR 413.65) during the two-year period ending on the service date, and (3) the provider submitted a subsequent attestation within the Secretary's specified timeframe. (As background, off-campus outpatient departments are hospital facilities not located on the main campus or within specified distances from it that may qualify as provider-based under 42 CFR 413.65 to receive higher OPPS payments rather than physician fee schedule rates; thus, these requirements enhance oversight of such billing.) It further directs the Secretary of Health and Human Services, through notice-and-comment rulemaking by one year after enactment, to establish a process for attestation submission and review (including site visits or audits); and requires the HHS Office of Inspector General to analyze that process and submit recommendations to Congress by January 1, 2030.

This section amends Medicare sequestration provisions under section 251A(6) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901a) by (1) revising subparagraph (D) to specify a payment reduction of 2.0 percent; and (2) adding subparagraph (F) to require the President, upon submitting the FY2033 budget, to order sequestration for Medicare programs specified in section 256(d) (i.e., primarily Parts B and certain Part D payments) such that the reduction is 2.0 percent for the first two months the order is effective in FY2033 and 0 percent for the last 10 months. (As background, Medicare sequestration reduces payments to Medicare providers by 2 percent annually for deficit reduction under the Budget Control Act of 2011. Thus, this effectively terminates the reduction after two months in FY2033.)

This section extends allotments to states (or other entities via competitive grants if a state does not apply) under the sexual risk avoidance education program—i.e., grants for education exclusively on sexual risk avoidance, allocated by the number of low-income children—through September 30, 2025 (from March 31, 2025) and for the additional period of October 1 through December 31, 2025 (previously ending March 31, 2025), and updates related state application references to include FY2026 (from FY2024 or 2025). It makes conforming changes to appropriations availability under subsection (f)(1), including a pro rata share for October 1 through December 31, 2025, based on the FY2025 appropriation.

This section extends state allotments under the Personal Responsibility Education Program—grants to states for youth education on avoiding unintended pregnancy and sexually transmitted infections, including abstinence and partner reduction—through September 30, 2025 (from March 31, 2025), and provides additional allotments for the period beginning October 1, 2025, and ending December 31, 2025. It further (1) applies the $250,000 minimum allotment exception to these extended periods; (2) extends the reallotment provision in subsection (c)(3) to include FY2026 (from FY2024 or 2025); and (3) appropriates pro rata funding for the new October-December 2025 period based on FY2025 appropriations.

This section increases funding for family-to-family health information centers—which provide information, training, and support to families of children and youth with special health care needs under the Maternal and Child Health Services Block Grant—to $7.5 million (from $3 million) for the period beginning October 1, 2024, and ending December 31, 2025 (from the portion of FY2025 before April 1, 2025).

This section increases and extends the authorization of appropriations for grants to states to develop and implement programs addressing dental workforce needs in designated dental health professional shortage areas—including dentist loan repayment, recruitment, practice expansion, and new facilities—to $15 million for each of fiscal years 2025 through 2029 (from $13,903,000 for fiscal years 2019 through 2023), with funds to remain available until expended.

This section reauthorizes appropriations for research on preterm labor and delivery and the care, treatment, and outcomes of preterm and low birthweight infants under the Prematurity Research Expansion and Education for Mothers who deliver Infants Early Act (PREEMIE Act) through FY2029 (from FY2023); makes a technical correction to the PREEMIE Reauthorization Act of 2018 (Public Law 115-328) to reference "Section 3" instead of "Section 2"; requires the Secretary of Health and Human Services, in collaboration with other departments as appropriate, to establish an interagency preterm birth working group not later than 18 months after enactment (previously optional); and directs the Secretary to contract with the National Academies of Sciences, Engineering, and Medicine for a consensus study on preterm births—including financial costs, risk factors, detection opportunities, research strategies, best practices, and precision medicine approaches—with a report due to specified congressional committees and the Secretary not later than 24 months after enactment.

This section revises requirements for state maternal mortality review committees (MMRCs) under section 317K of the Public Health Service Act (PHS Act); requires the Centers for Disease Control and Prevention (CDC), in consultation with the Health Resources and Services Administration (HRSA), to disseminate best practices for preventing maternal mortality and morbidity annually to hospitals, state professional society groups, and perinatal quality collaboratives; and increases authorized funding to $100 million for each of FY2025 through FY2029 (from $58 million for FY2019 through FY2023). (MMRCs review pregnancy-associated deaths to identify causes and prevention strategies.) Specifically, the section requires MMRCs to include obstetricians and gynecologists among clinical experts; changes the review of live birth and fetal death records from "as applicable" to "if available"; and expands MMRC duties to coordinate with death certifiers to improve death record collection and quality, including amending cause-of-death information on death certificates as appropriate.

This section amends the sickle cell disease prevention and treatment program (42 U.S.C. 300b-5(b))—which supports grants to comprehensive sickle cell centers and other entities for disease treatment, counseling, and related services—by (1) revising authorized activities in multiple paragraphs to cover treatment of sickle cell disease and prevention and treatment of its complications (previously, prevention and treatment of sickle cell disease); (2) authorizing grants, in addition to contracts, for certain demonstration projects; (3) increasing annual funding to $8,205,000 for FY2025 through FY2029 (from $4,455,000 for FY2019 through FY2023); and (4) expressing the sense of Congress that further research is needed on heritable blood disorders, including sickle cell disease, to better understand causes and develop cures.

This section amends the Public Health Service Act to expand the prevention of traumatic brain injury program (Section 393B), including by adding prevalence data collection; requiring surveillance of higher-risk populations (e.g., due to occupational or circumstantial factors), causes, and risk factors; extending related activities through 2030 (from 2020); and involving other federal agencies. This section renames the national traumatic brain injury surveillance and registries program as the Bill Pascrell, Jr., national program (Section 393C); requires data collection on higher-risk populations, causes, risk factors, occupation-related injuries, and short- and long-term outcomes; eliminates prior state matching requirements; promotes evidence-based concussion practices; and directs public availability of aggregated data on the CDC website, including tailored prevention strategies. (As background, these CDC programs monitor TBI incidence—a leading cause of disability and death, affecting over 2.8 million U.S. cases annually—to inform prevention and support services for survivors.) This section reauthorizes appropriations for TBI prevention, surveillance, and other activities through FY2029 (from FY2024) (Section 394A). This section revises the state grant program for TBI projects (Section 1252) by prioritizing outreach to higher-risk populations and including Tribal entities; requiring state and American Indian consortium maintenance of effort for nonfederal spending (with up to 50% matching waivers); and defining "traumatic brain injury" as an acquired brain injury from external or internal trauma (excluding congenital, degenerative, or birth-related causes, subject to revision after consultation). (Thus, grants support improved care systems, including protection and advocacy services, for TBI survivors.)

This section makes two changes to the Lifespan Respite Care program, which provides grants to states for respite care services (i.e., temporary relief) to family caregivers of children or adults with special needs: (1) revises the definition of family caregiver to include unpaid individuals (from unpaid adults); and (2) extends authorization of appropriations through FY2029 (from FY2024).

This section revises programs under the Dr. Lorna Breen Health Care Provider Protection Act (Public Law 117-105) to promote mental health and resiliency among health care professionals as follows: (1) extends the deadline for dissemination of best practices from 2 years to 5 years after enactment; (2) for the education and awareness initiative, requires the Secretary to issue guidance and annually thereafter (previously, only upon enactment) and extends the authorization period to 2025 through 2029 (from 2022 through 2024); and (3) for grants under section 764 of the Public Health Service Act (42 U.S.C. 294t, redesignated as section 764A), which support new or enhanced evidence-based programs—including awareness, suicide prevention, peer support, and mental health services—with priority previously limited to entities in health professional shortage areas or rural areas, expands priority to also include entities focused on reducing administrative burdens on health care workers, revises grant terms to not less than 3 years (from 3 years), and extends the authorization period to 2025 through 2029 (from 2022 through 2024).

This section revises the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides grants to states for breast and cervical cancer screening and diagnostic services to low-income, uninsured women. Specifically, it (1) revises authorized grant activities under section 1501(a) by streamlining follow-up services requirements, adding "prevention" to detection and control purposes, requiring states to ensure rather than monitor public information efforts, and inserting new purposes to enhance support activities (e.g., patient navigation and evidence-based screening strategies), reduce disparities in targeted populations, and improve access while reducing barriers; (2) under section 1503(a), replaces requirements that states expend at least 60% of grants on core screening services (i.e., mammography and Pap tests) and no more than 40% on other activities, provide all services by the end of the second fiscal year of funding, and use specified examination procedures with a single requirement to provide appropriate screening and diagnostic services consistent with relevant evidence-based recommendations (thus allowing flexibility to adopt updated clinical guidelines on screening frequency and eligibility); strikes paragraphs specifying examination procedures and spending caps; and eliminates demonstration waiver authority for up to five states under former subsections 1501(d) and 1503(d); (3) revises HHS reporting requirements under section 1508(b) to every five years beginning two years after enactment (from annually beginning one year after 2007), covering the preceding two fiscal years for the first report and preceding five fiscal years thereafter (from preceding fiscal year), and updates the Senate authorizing committee name; (4) authorizes $235,500,000 for each of fiscal years 2025 through 2029 under section 1510(a); and (5) requires a GAO study, due by September 30, 2027, estimating eligible individuals, summarizing trends in those served, and assessing barriers to screenings.

This section establishes the DeOndra Dixon INCLUDE Project (i.e., INvestigation of Co-occurring conditions across the Lifespan to Understand Down syndromE Project) within the National Institutes of Health (NIH) to conduct research, training, and investigation related to Down syndrome (i.e., trisomy 21). The program requires (1) high-risk, high-reward research on trisomy 21 effects on human development and health; (2) lifespan research including cohort studies on co-occurring conditions and new interventions; (3) expanded clinical trials inclusive of or targeted to participants with Down syndrome; (4) research on biological mechanisms of anomalies, dysfunction, and stunted growth; (5) research to improve diagnosis and treatment of co-occurring conditions, including biomarkers; (6) research on causes and treatment of co-occurring conditions such as Alzheimer’s disease, related dementias, and autoimmunity; and (7) research, training, and investigation to improve quality of life for individuals with Down syndrome and their families. It further directs NIH to coordinate Down syndrome-related activities across institutes and centers (including through priority-setting reviews), prioritize nonduplicative research, and consult stakeholders such as patient advocates. The NIH Director must submit biennial reports to specified congressional committees cataloging such research, including the involved institutes or centers, whether conducted directly or collaboratively, and any resulting real-world evidence for clinical research and medical care.

This section establishes the Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone Initiative (IMPROVE Initiative) under the Director of the National Institutes of Health (NIH). The Initiative advances research to reduce preventable maternal mortality and severe maternal morbidity (SMM), address related health disparities (including in medically underserved populations), and improve health for pregnant and postpartum women; employs an integrated approach to study biological, behavioral, and other factors affecting these outcomes and build an evidence base for specific U.S. regions; and targets disparities through community-based interventions for disproportionately affected women and identification of risk factors and biological mechanisms for leading causes. Authority under this section expires on September 30, 2029.

This section amends Organ Procurement and Transplantation Network (OPTN) requirements—operated by a contractor under HHS oversight to manage the national organ waiting list, matching system, and equitable allocation—by (1) expanding the 24-hour service in subsection (b)(2)(C) for matching organs with waitlisted individuals to include information technology (from telephone service only); (2) adding subsection (b)(2)(P) to encourage integration of electronic health records via application programming interfaces (or successors) among hospitals, organ procurement organizations, and transplant centers, including automated referrals and remote electronic access to potential donors' records in compliance with HIPAA privacy regulations; and (3) adding subsection (b)(2)(Q) to consider establishing a dashboard displaying transplants performed, types of transplants and organs entering the OPTN that failed to transplant, and related statistics updated more frequently than annually. The section further adds subsection (d) authorizing the Secretary to collect registration fees from OPTN members (i.e., transplant centers) for each transplant candidate placed on the national waiting list, with fees available until expended as discretionary offsetting collections (per appropriations) solely to support OPTN operations; collected directly or via awards; requiring quarterly public posting of amounts collected per member and supported activities; directing a GAO review within two years after enactment with a report to specified congressional committees; and sunsetting the fee authority three years after enactment.

This section amends the grant program authorizing the Secretary to reimburse travel, subsistence, and incidental nonmedical expenses incurred by living organ donors (42 U.S.C. 274f) by (1) prohibiting grant recipients from considering the income of the organ recipient when providing reimbursements to donors; (2) removing the restriction against using grant funds for expenses to the extent paid or expected to be paid by the organ recipient (thus, permitting duplication of such payments); and (3) requiring the Secretary to submit to Congress and make public an annual report, not later than December 31 of each year beginning in FY2026, on whether grants adequately funded all qualifying expenses in the preceding fiscal year—including estimates of unreimbursed donors and total funding needed for full reimbursement.

This section authorizes appropriations of $25,000,000 for each of fiscal years 2025 through 2027 for the National Institutes of Health program for pediatric studies of drugs. The program requires NIH, in consultation with the Food and Drug Administration, to develop and update every three years a priority list of needs in pediatric therapeutics (including gaps in developmental pharmacology, pediatric diseases or conditions requiring further study of drugs or biological products, and research infrastructure) and to award grants or contracts for related pediatric clinical trials and research.

This section adds a new section 2799A–11 to Part D of Title XXVII of the Public Health Service Act to establish oversight of pharmacy benefit management (PBM) services for group health plans and health insurance issuers offering group health insurance coverage. For plan years beginning on or after 30 months after enactment (the effective date), such plans, issuers, or PBMs acting on their behalf may not enter into, extend, or renew contracts with applicable entities (i.e., pharmacies or other third parties) unless the entities agree (1) not to limit or delay information disclosure to the plan in ways that prevent PBM reporting and (2) to provide information needed for such reports. For contracts entered, extended, or renewed on or after the effective date, PBMs must submit reports to the group health plan semiannually (or quarterly upon plan request, under the same terms and at the same cost as semiannual reports), in plain language and machine-readable format. The reports must disclose, for covered drugs during each reporting period and identified by National Drug Code, for specified large employer plans or those electing such reporting: (1) contracted compensation paid to the PBM and to pharmacies; (2) per-claim differences between such payments; (3) drug names; (4) dispensing channel (i.e., retail, mail order, specialty pharmacy), with claims volume, participants and beneficiaries served, dosage units, and days supply; (5) for each channel and drug type (brand name with wholesale acquisition cost or generic with average wholesale price, listed per days supply and dosage unit); (6) net price per course of treatment or single fill after rebates and other remuneration; (7) participant and beneficiary out-of-pocket spending (copays, coinsurance, deductibles); (8) total net spending; and (9) total rebates, fees, discounts, or other remuneration received or expected from applicable entities. (Thus, the requirements promote transparency into PBM pricing, payments, and rebates for employer-sponsored group health plans, which cover medical benefits under ERISA welfare plans.)

This section amends the Employee Retirement Income Security Act of 1974 (ERISA) prohibited transaction exemption for reasonable service contracts (29 U.S.C. 1108(b)(2)) by (1) inserting a new subclause in subparagraph (B)(viii) to exempt responsible plan fiduciaries from ERISA sections 406(a)(1)(C) and (D) prohibitions on certain failures by covered service providers to remit required amounts, if the fiduciary reasonably believed remittances occurred, makes a written request for compliance, and notifies the Secretary within 90 days of noncompliance; and (2) adding subparagraph (C) to require that, for plan years beginning on or after 30 months after enactment, contracts for pharmacy benefit management (PBM) services provided to group health plans (through health insurance issuers, third-party administrators, or other entities) remit 100% of rebates, fees, alternative discounts, and related remuneration from drug manufacturers or others to the plan or issuer quarterly within 90 days (or sooner for underpayments), with full disclosure, annual audit rights by the plan fiduciary, procedures set by the Secretary, 45-day quarterly remittance by rebate aggregators to PBMs, and availability of rebate contracts for audit.

This section amends section 505(j)(3) of the Federal Food, Drug, and Cosmetic Act to require the Secretary of Health and Human Services (HHS), upon request by a person submitting or intending to submit an abbreviated new drug application (ANDA) for a generic drug with the same inactive ingredient concentrations as the reference listed drug (or where in vitro testing suffices for bioequivalence), to disclose whether the generic is qualitatively (Q1) and quantitatively (Q2) the same as the reference listed drug. If not the same, HHS must identify differing ingredients and quantitative deviations; if the same, HHS generally may not rescind that determination post-ANDA submission absent a safety/effectiveness withdrawal of the prior reference formulation or a documented error (with notice provided). Such disclosures are authorized by law, including under 18 U.S.C. 1905 (trade secrets), without otherwise affecting trade secret status. Separately, (1) this section directs HHS to issue draft guidance within one year of enactment on sameness determinations (including pH adjusters), with at least 60 days for comment and final guidance within one year thereafter; and (2) the new requirements apply upon enactment regardless of guidance finalization. (Thus, the provision promotes generic drug development by clarifying inactive ingredient matching, which affects ANDA approval pathways relying on in vitro bioequivalence demonstrations.)

This section amends the patent infringement safe harbor in 35 U.S.C. §271(e) relating to biological products approved under the Biologics Price Competition and Innovation Act (BPCIA). (As background, the BPCIA establishes an abbreviated approval pathway for biosimilar and interchangeable biological products under section 351(k) of the Public Health Service Act [42 U.S.C. §262(k)] and requires a "patent dance" process under section 351(l) [42 U.S.C. §262(l)] in which reference product sponsors identify patents for potential assertion against biosimilar applicants.) Specifically, the section (1) expands the scope of infringement under §271(e)(2)(C) for certain biosimilar submissions to encompass any patent claiming the biological product, a method of using the product, or a method or product used to manufacture the product; and (2) adds §271(e)(7), limiting a reference product sponsor to asserting not more than 20 qualifying patents against a §351(k) biosimilar applicant, not more than 10 of which may have issued after the date specified in §351(l)(7)(A) [42 U.S.C. §262(l)(7)(A)]; requires such patents to claim the biosimilar product (or a use thereof) or a manufacturing method/product, appear on the §351(l) patent lists, and either have a filing date more than four years after reference product approval or claim a manufacturing process not used by the sponsor; authorizes courts to increase the limit without undue delay if in the interest of justice or for good cause (e.g., biosimilar applicant's failure to provide required information under §351(k)(2)(A), material product/process changes, specified patent issuance delays, or other court-determined reasons); conditions the limit's applicability on the biosimilar applicant's completion of specified §351(l) actions; and excludes method-of-use patents for therapy, diagnosis, or prophylaxis. The amendments apply to §351(k) applications submitted on or after the date of enactment.

This section extends the safe harbor permitting high-deductible health plans (HDHPs) eligible for Health Savings Accounts (HSAs) to provide telehealth services without a deductible to plan years beginning before January 1, 2027 (from January 1, 2025). (As background, HDHPs generally must impose minimum deductibles on most medical expenses to qualify for HSAs, but this safe harbor exception supports telehealth access without disqualifying HSA eligibility.)