S2840-118

1. Short title; table of contents This Act may be cited as the Bipartisan Primary Care and Health Workforce Act. The table of contents for this Act is as follows:

104. GAO report Not later than one year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report assessing the effectiveness of the National Health Service Corps (referred to in this section as the NHSC) at attracting health care professionals to health professional shortage areas designated under section 332 of the Public Health Service Act (42 U.S.C. 254e) (referred to in this section as HPSAs), such as by— assessing the metrics used by the Health Resources and Services Administration in evaluating the program; comparing the retention rates of NHSC participants in the HPSAs where they completed their period of obligated service to the retention rate of non-NHSC participants in the corresponding HPSAs; comparing the retention rates of NHSC participants in the HPSAs where they completed their period of obligated service to the retention rates of NHSC participants in HPSAs other than those where they completed their period of obligated service; identifying factors that influence a NHSC participant’s decision to practice in a HPSA other than the HPSA where they completed their period of obligated service; identifying factors other than participation in the National Health Service Corps Scholarship and Loan Repayment Programs that attract health care professionals to a HPSA; assessing the impact the NHSC has on wages for health care professionals in a HPSA; and comparing the distribution of NHSC participants across HPSAs, including a comparison of rural versus non-rural HPSAs. In this section, the term NHSC participant means a National Health Service Corps member participating in the National Health Service Corps Scholarship or Loan Repayment Program under subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.).

105. OIG report Not later than 2 years after the date of enactment of this Act, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on integrity efforts of the Health Resources and Services Administration with respect to programs carried out by the Health Resources and Services Administration. Such report shall include an assessment of— the ways in which the Administrator of the Health Resources and Services Administration (referred to in this section as the Administrator) determines reasonable efforts are continuously made to establish and maintain collaborative relationships with health care providers; the ways in which the Administrator ensures quality and continuity of care for underserved areas; and the extent to which the Administrator validates the financial responsibility of and use of grant funding by community health centers.

106. Application of provisions Amounts appropriated pursuant to the amendments made by this title shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b through 256). Paragraph (4) of section 3014(h) of title 18, United States Code, and section 301(d) of division BB of the Consolidated Appropriations Act, 2021. and inserting section 301(d) of division BB of the Consolidated Appropriations Act, 2021, and section 106(a) of the Bipartisan Primary Care and Health Workforce Act.

201. Rural residency planning and development program Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by inserting after section 330A–2 the following: In this section, the term rural residency program means a physician residency program, including a rural track program, accredited by the Accreditation Council for Graduate Medical Education (or a similar body) that— trains residents in rural areas (as defined by the Secretary) for more than 50 percent of the total time of their residency; and primarily focuses on producing physicians who will practice in rural areas, as defined by the Secretary. In this subsection, the term eligible entity— means— a domestic public or private nonprofit or for-profit entity; an Indian Tribe, Tribal health program, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act); or a Native Hawaiian Health organization as defined in section 12 of the Native Hawaiian Health Care Improvement; and may include faith-based or community-based organizations, rural hospitals, rural community-based ambulatory patient care centers (including rural health clinics), health centers operated by a Native Hawaiian Health organization (defined as described in subparagraph (A)(iii)), an Indian Tribe, a Tribal health program, a Tribal organization, or an Urban Indian organization (defined as described in subparagraph (A)(ii)), graduate medical education consortiums (including institutions of higher education, such as schools of allopathic medicine, schools of osteopathic medicine, or historically Black colleges or universities (as defined by the term part B institution in section 322 of the Higher Education Act of 1965 or described in section 326(e)(1) of the Higher Education Act of 1965) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965), or other organizations as determined appropriate by the Secretary. The Secretary may award grants to eligible entities to create new rural residency programs (including adding new rural training sites to existing rural track programs). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a description of the pathway of the rural residency program as described in subparagraph (B). A pathway of a rural residency program supported under this subsection shall be for— general primary care and high-need specialty care, including family medicine, internal medicine, preventive medicine, psychiatry, or general surgery; maternal health and obstetrics, which may be obstetrics and gynecology or family medicine with enhanced obstetrical training; or any other pathway as determined appropriate by the Secretary. In this subsection, the term eligible entity means— a domestic public or private nonprofit or for-profit entity; or an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act). The Secretary may award grants to eligible entities to provide technical assistance to awardees of and potential applicants of the program described in subsection (b). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. There is authorized to be appropriated to carry out this section $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 2026, to remain available until expended. 330A–3.Rural residency planning and development program and rural residency planning and development technical assistance program(a)Definition of rural residency programIn this section, the term rural residency program means a physician residency program, including a rural track program, accredited by the Accreditation Council for Graduate Medical Education (or a similar body) that—(1)trains residents in rural areas (as defined by the Secretary) for more than 50 percent of the total time of their residency; and (2)primarily focuses on producing physicians who will practice in rural areas, as defined by the Secretary.(b)Rural residency planning and development program(1)Definition of eligible entityIn this subsection, the term eligible entity—(A)means—(i)a domestic public or private nonprofit or for-profit entity; (ii)an Indian Tribe, Tribal health program, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act); or(iii)a Native Hawaiian Health organization as defined in section 12 of the Native Hawaiian Health Care Improvement; and(B)may include faith-based or community-based organizations, rural hospitals, rural community-based ambulatory patient care centers (including rural health clinics), health centers operated by a Native Hawaiian Health organization (defined as described in subparagraph (A)(iii)), an Indian Tribe, a Tribal health program, a Tribal organization, or an Urban Indian organization (defined as described in subparagraph (A)(ii)), graduate medical education consortiums (including institutions of higher education, such as schools of allopathic medicine, schools of osteopathic medicine, or historically Black colleges or universities (as defined by the term part B institution in section 322 of the Higher Education Act of 1965 or described in section 326(e)(1) of the Higher Education Act of 1965) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965), or other organizations as determined appropriate by the Secretary. (2)Grants(A)In generalThe Secretary may award grants to eligible entities to create new rural residency programs (including adding new rural training sites to existing rural track programs).(B)FundingGrants awarded under this subsection may be fully funded at the time of the award.(C)TermThe term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary.(3)Applications(A)In generalTo be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a description of the pathway of the rural residency program as described in subparagraph (B).(B)PathwayA pathway of a rural residency program supported under this subsection shall be for—(i)general primary care and high-need specialty care, including family medicine, internal medicine, preventive medicine, psychiatry, or general surgery; (ii)maternal health and obstetrics, which may be obstetrics and gynecology or family medicine with enhanced obstetrical training; or(iii)any other pathway as determined appropriate by the Secretary.(c)Rural residency planning and development technical assistance(1)Definition of eligible entityIn this subsection, the term eligible entity means—(A)a domestic public or private nonprofit or for-profit entity; or(B)an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act).(2)Grants(A)In generalThe Secretary may award grants to eligible entities to provide technical assistance to awardees of and potential applicants of the program described in subsection (b).(B)FundingGrants awarded under this subsection may be fully funded at the time of the award.(C)TermThe term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary.(3)ApplicationsTo be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.(d)Authorization of appropriationsThere is authorized to be appropriated to carry out this section $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 2026, to remain available until expended..

301. Banning anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care Section 2799A–9 of the Public Health Service Act (42 U.S.C. 300gg–119) is amended— by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan or health insurance issuer from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to— a health maintenance organization (as defined in section 2791(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan or health insurance issuer offering group or individual health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (5) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Section 724 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m) is amended— by adding at the end the following: A group health plan or a health insurance issuer offering group health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan or health insurance issuer from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group health insurance coverage with respect to— a health maintenance organization (as defined in section 733(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan or health insurance issuer offering group health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (4) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Section 9824 of the Internal Revenue Code of 1986 is amended— by adding at the end the following: A group health plan shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans not party to the contract from paying a lower rate for items or services than the contracting plan pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan with respect to— a health maintenance organization (as defined in section 9832(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (4) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury, jointly, shall promulgate regulations to carry out section 2799A–9(b) of the Public Health Service Act, section 724(b) of the Employee Retirement Income Security Act of 1974, and section 9824(b) of the Internal Revenue Code of 1986, as added by subsection (a). Subsection (b) of section 2799A–9 of the Public Health Service Act, subsection (b) of section 724 of the Employee Retirement Income Security Act of 1974, and subsection (b) of section 9824 of the Internal Revenue Code of 1986 (as added by paragraphs (1), (2), and (3), respectively, of subsection (a)) shall apply with respect to any contract entered into on or after the date that is 18 months after the date of enactment of this Act. With respect to an applicable contract that is in effect on the date of enactment of this Act, such subsection (b) shall apply on the earlier of the date of renewal of such contract or 3 years after such date of enactment. (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan or a health insurance issuer offering group or individual health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan or health insurance issuer from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers;(B)requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for plans and issuersParagraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to—(A)a health maintenance organization (as defined in section 2791(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan or health insurance issuer offering group or individual health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)).(7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan or a health insurance issuer offering group health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan or health insurance issuer from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers;(B)requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for plans and issuersParagraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group health insurance coverage with respect to—(A)a health maintenance organization (as defined in section 733(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan or health insurance issuer offering group health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). (7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers;(B)requires the group health plan to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans not party to the contract from paying a lower rate for items or services than the contracting plan pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for certain plansParagraph (1)(A) shall not apply to a group health plan with respect to—(A)a health maintenance organization (as defined in section 9832(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)).(7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and

302. Honest billing requirements applicable to providers Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following: A group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b))) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10. Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following new item: Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: A group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following: For items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless— such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1). The term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act) that is not located— on the campus (as defined in such section 413.65(a)(2)) of such provider; or within the distance (described in such definition of campus) from a remote location of a hospital (as defined in such section 413.65(a)(2)). The Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. The Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount— in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act (or any successor regulations)), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary. Section 2799B–4(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–134(a)(1)) is amended by inserting (other than section 2799B–10) after this part. 2799A–11.Honest billing requirements applicable to plans and issuersA group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b))) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10. . 726.Honest billing requirements applicable to plans and issuersA group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. . Sec. 726. Honest billing requirements applicable to plans and issuers.. 9826.Honest billing requirements applicable to plansA group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. . Sec. 9826. Honest billing requirements applicable to plans.. 2799B–10.Honest billing requirements applicable to providers(a)Requirements relating to unique health identifiersFor items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless—(1)such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and(2)such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1).(b)Off-Campus outpatient department of a providerThe term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act) that is not located—(1)on the campus (as defined in such section 413.65(a)(2)) of such provider; or(2)within the distance (described in such definition of campus) from a remote location of a hospital (as defined in such section 413.65(a)(2)).(c)Process for reporting suspected violationsThe Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary.(d)PenaltiesThe Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount—(1)in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act (or any successor regulations)), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and(2)in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary..

2799A–11. Honest billing requirements applicable to plans and issuers A group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b))) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10.

726. Honest billing requirements applicable to plans and issuers A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act.

9826. Honest billing requirements applicable to plans A group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act.

303. Banning facility fees for certain services Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.), as amended by section 302(b), is further amended by adding at the end the following: With respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). In this section, the term applicable items and services means— evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth. 2799B–11.Banning facility fees for certain services(a)In generalWith respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). (b)Applicable items and servicesIn this section, the term applicable items and services means—(1)evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; (2)outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and(3)any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth..

2799B–11. Banning facility fees for certain services With respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). In this section, the term applicable items and services means— evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth.

1. Short title; table of contents This Act may be cited as the Bipartisan Primary Care and Health Workforce Act. The table of contents for this Act is as follows:

102. Community health centers Section 10503 of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2) is amended— in subsection (b)(1)(F)— by striking 2018 and and inserting 2018,; and by inserting before the semicolon the following: , and $5,800,000,000 for each of fiscal years 2024 through 2026; and by adding at the end the following: For fiscal years 2024 through 2026, with respect to $1,800,000,000 of the amount appropriated under subsection (b)(1)(F), the Secretary shall prioritize awards to entities for purposes of— increasing the number of low-income patients not enrolled in a group health plan or group or individual health insurance coverage who are served by health centers, including through Health Center Program New Access Points described in section 330(e)(6) of the Public Health Service Act, including school-based service sites; increasing the required primary health services described in paragraph (1)(A)(i) of section 330(b) of the Public Health Service Act and additional health services (as defined in paragraph (2) of such section) offered by health centers; and increasing patient case management, enabling services, and education services, as described in clauses (iii) through (v) of section 330(b)(1)(A) of the Public Health Service Act. Section 330(r)(1) of the Public Health Service Act (42 U.S.C. 254b(r)(1)) is amended— in subparagraph (G), by striking fiscal year 2016, and each subsequent fiscal year and inserting each of fiscal years 2016 through 2023; and by adding at the end the following: For each of fiscal years 2024 through 2026, $2,200,000,000. For fiscal year 2027, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of— one plus the average percentage increase in costs incurred per patient served; and one plus the average percentage increase in the total number of patients served. Section 10503 of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2), as amended by subsection (a), is further amended by adding at the end the following: For each of fiscal years 2024 through 2026, of the amounts appropriated under subsection (b)(1)(F) for a fiscal year, the Secretary shall use— at least $245,000,000 for awards to support health centers in each State that are receiving awards under section 330 of the Public Health Service Act in extending operating hours, in an amount determined pursuant to a formula and eligibility criteria developed by the Secretary, for the purposes of increasing access to services; at least $55,000,000 for awards under this section for health centers to expand school-based services and establish new school-based service sites; and such sums as may be necessary for purposes of increasing the amount awarded pursuant to grants or cooperative agreements under section 330 of the Public Health Service Act so that each recipient of such an award receives— for fiscal year 2024, at least 15 percent more than such recipient received for fiscal year 2023; and for each of fiscal years 2025 and 2026, the amount received in the previous year adjusted by— the percent increase in the medical component of the consumer price index for the most recent 12-month period for which applicable data is available; plus one percent. Section 10503(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(c)) is amended— in the subsection heading, by inserting ; Capital funding after Construction; by striking There is and inserting the following: There is by adding at the end the following: For the alteration, renovation, construction, equipment, and other capital costs of health centers that receive funding under section 330 of the Public Health Service Act (42 U.S.C. 254b), in addition to amounts otherwise made available for such purpose, there is appropriated to the Secretary of Health and Human Services, out of amounts in the Treasury not otherwise appropriated, $3,000,000,000 for fiscal year 2024, to remain available until September 30, 2026. In awarding amounts appropriated under this paragraph, the Secretary shall prioritize awards related to increasing access to dental and behavioral health services. Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Secretary of Agriculture, shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a 5-year strategic plan to improve health outcomes through nutrition for low-income or uninsured patient populations with severe, complex chronic conditions and one or more diet-related conditions. In carrying out paragraph (1), the Secretary of Health and Human Services shall— conduct an evaluation of previous and current federally funded efforts of the Department of Health and Human Services to improve patient outcomes through nutrition interventions, such as medically tailored meals and nutrition counseling; and include in the strategic report recommendations for— reducing the financial impact of obesity and preventable chronic conditions resulting from obesity; empowering federally funded community health centers, rural health clinics, and other relevant federally funded facilities to provide produce prescriptions, medically-tailored groceries, and medically-tailored meals; promoting long-term adoption of improved nutrition habits, including through increased culinary education and consumer nutrition aligned with the most recent Dietary Guidelines for Americans published under section 301 of the National Nutrition Monitoring and Related Research Act of 1990 (7 U.S.C. 5341) and incorporating behavioral modeling or other novel methods across Federal programs; developing performance and quality metrics related to the delivery of produce prescriptions, medically tailored groceries, and medically-tailored meals across relevant Federal payers to aid in reimbursement strategies; developing payment models for novel obesity care therapies for the treatment of diabetes that include behavioral and nutritional and dietary services and education; improving coordination of care and integrating nutrition services and resources within federally funded community health centers, rural health clinics, and other federally funded primary care facilities; bolstering partnerships with State and local governments and nongovernmental organizations; and addressing geographic disparities in access to nutrition services and resources. Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended— in subsection (b)(1)(A)— in clause (i)— in subclause (IV), by striking ; and and inserting a semicolon; and by adding at the end the following: appropriate nutritional and dietary services; and appropriate behavioral and mental health and substance use disorder services; in clause (ii)— by striking substance use disorder and mental health services and inserting behavioral and mental health and substance use disorder services and nutrition services; and by inserting , including such referrals to certified community behavioral health clinics before the semicolon; and in clause (iii), by inserting nutritional, after educational,; in subsection (b)(2)— by striking subparagraph (A); and by redesignating subparagraphs (B) through (D) as subparagraphs (A) through (C), respectively; and in subsection (d)(1)(A), by inserting or one or more diet-related conditions before the semicolon. Paragraph (4) of section 330(e) of the Public Health Service Act (42 U.S.C. 254b(e)) is amended to read as follows: Not more than 2 grants may be made under paragraph (1)(B) for the same entity, except that such limitation shall not apply for the period of 2 years beginning on the date of enactment of the Bipartisan Primary Care and Health Workforce Act, in any case where the only basis upon which paragraph (1)(B) applies to a health center is that the health center is not in noncompliance with the requirements under subclauses (VI) and (VII) of subsection (b)(1)(A)(i) to provide appropriate nutritional disorder providers, including for health centers, certified community behavioral health centers, and other community care settings. Not later than one year after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Secretary of Agriculture, shall submit to Congress a report that includes— recommendations for States on how to support the coordination of federally funded nutrition programs and services provided by health care professionals in community health centers; and data on the number of individuals enrolled in federally subsidized health insurance coverage who are also enrolled in or eligible for federally subsidized nutrition and food programs. (f)Priority use of fundsFor fiscal years 2024 through 2026, with respect to $1,800,000,000 of the amount appropriated under subsection (b)(1)(F), the Secretary shall prioritize awards to entities for purposes of—(1)increasing the number of low-income patients not enrolled in a group health plan or group or individual health insurance coverage who are served by health centers, including through Health Center Program New Access Points described in section 330(e)(6) of the Public Health Service Act, including school-based service sites;(2)increasing the required primary health services described in paragraph (1)(A)(i) of section 330(b) of the Public Health Service Act and additional health services (as defined in paragraph (2) of such section) offered by health centers; and(3)increasing patient case management, enabling services, and education services, as described in clauses (iii) through (v) of section 330(b)(1)(A) of the Public Health Service Act.. (H)For each of fiscal years 2024 through 2026, $2,200,000,000.(I)For fiscal year 2027, and each subsequent fiscal year, the amount appropriated for the preceding fiscal year adjusted by the product of—(i)one plus the average percentage increase in costs incurred per patient served; and(ii)one plus the average percentage increase in the total number of patients served.. (g)Allocation of fundsFor each of fiscal years 2024 through 2026, of the amounts appropriated under subsection (b)(1)(F) for a fiscal year, the Secretary shall use—(1)at least $245,000,000 for awards to support health centers in each State that are receiving awards under section 330 of the Public Health Service Act in extending operating hours, in an amount determined pursuant to a formula and eligibility criteria developed by the Secretary, for the purposes of increasing access to services;(2)at least $55,000,000 for awards under this section for health centers to expand school-based services and establish new school-based service sites; and(3)such sums as may be necessary for purposes of increasing the amount awarded pursuant to grants or cooperative agreements under section 330 of the Public Health Service Act so that each recipient of such an award receives— (A)for fiscal year 2024, at least 15 percent more than such recipient received for fiscal year 2023; and(B)for each of fiscal years 2025 and 2026, the amount received in the previous year adjusted by—(i)the percent increase in the medical component of the consumer price index for the most recent 12-month period for which applicable data is available; plus(ii)one percent.. (1)ConstructionThere is; and (2)Capital fundingFor the alteration, renovation, construction, equipment, and other capital costs of health centers that receive funding under section 330 of the Public Health Service Act (42 U.S.C. 254b), in addition to amounts otherwise made available for such purpose, there is appropriated to the Secretary of Health and Human Services, out of amounts in the Treasury not otherwise appropriated, $3,000,000,000 for fiscal year 2024, to remain available until September 30, 2026. In awarding amounts appropriated under this paragraph, the Secretary shall prioritize awards related to increasing access to dental and behavioral health services.. (VI)appropriate nutritional and dietary services; and(VII)appropriate behavioral and mental health and substance use disorder services;; (4)LimitationNot more than 2 grants may be made under paragraph (1)(B) for the same entity, except that such limitation shall not apply for the period of 2 years beginning on the date of enactment of the Bipartisan Primary Care and Health Workforce Act, in any case where the only basis upon which paragraph (1)(B) applies to a health center is that the health center is not in noncompliance with the requirements under subclauses (VI) and (VII) of subsection (b)(1)(A)(i) to provide appropriate nutritional disorder providers, including for health centers, certified community behavioral health centers, and other community care settings..

103. National Health Service Corps Section 10503(b)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(2)) is amended— in subparagraph (G), by striking ; and and inserting a semicolon; in subparagraph (H), by striking the period and inserting ; and; and by adding at the end the following: $950,000,000 for each of fiscal years 2024 through 2026. (I)$950,000,000 for each of fiscal years 2024 through 2026..

104. GAO report Not later than one year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives a report assessing the effectiveness of the National Health Service Corps (referred to in this section as the NHSC) in attracting health care professionals to health professional shortage areas designated under section 332 of the Public Health Service Act (42 U.S.C. 254e) (referred to in this section as HPSAs), such as by— assessing the metrics used by the Health Resources and Services Administration in evaluating the program; comparing the retention rates of NHSC participants in the HPSAs where they completed their period of obligated service to the retention rates of non-NHSC participants in the corresponding HPSAs; comparing the retention rates of NHSC participants in the HPSAs where they completed their period of obligated service to the retention rates of NHSC participants in HPSAs other than those where they completed their period of obligated service; identifying factors that influence an NHSC participant’s decision to practice in an HPSA other than the HPSA where they completed their period of obligated service; identifying factors other than participation in the National Health Service Corps Scholarship and Loan Repayment Programs that attract health care professionals to practice in a HPSA; assessing the impact the NHSC has on wages for health care professionals in an HPSA; and comparing the distribution of NHSC participants across HPSAs, including a comparison of rural versus non-rural HPSAs. In this section, the term NHSC participant means a National Health Service Corps member participating in the National Health Service Corps Scholarship or Loan Repayment Program under subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.).

105. OIG report Not later than 2 years after the date of enactment of this Act, the Inspector General of the Department of Health and Human Services shall submit to Congress a report on integrity efforts of the Health Resources and Services Administration with respect to programs carried out by the Health Resources and Services Administration. Such report shall include an assessment of— the ways in which the Administrator of the Health Resources and Services Administration (referred to in this section as the Administrator) determines reasonable efforts are continuously made to establish and maintain collaborative relationships with health care providers; the ways in which the Administrator ensures quality and continuity of care for underserved areas; and the extent to which the Administrator validates the financial responsibility of and use of grant funding by community health centers.

106. Application of provisions Amounts appropriated pursuant to the amendments made by this title shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b through 256). Paragraph (4) of section 3014(h) of title 18, United States Code, is amended by striking and section 301(d) of division BB of the Consolidated Appropriations Act, 2021. and inserting section 301(d) of division BB of the Consolidated Appropriations Act, 2021, and section 106(a) of the Bipartisan Primary Care and Health Workforce Act.

201. Rural residency planning and development program Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by inserting after section 330A–2 the following: In this section, the term rural residency program means a physician residency program, including a rural track program, accredited by the Accreditation Council for Graduate Medical Education (or a similar body) that— trains residents in rural areas (as defined by the Secretary) for more than 50 percent of the total time of their residency; and primarily focuses on producing physicians who will practice in rural areas, as defined by the Secretary. In this subsection, the term eligible entity— means— a domestic public or private nonprofit or for-profit entity; an Indian Tribe, Tribal health program, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act); or a Native Hawaiian Health organization as defined in section 12 of the Native Hawaiian Health Care Improvement Act; and may include faith-based or community-based organizations, rural hospitals, rural community-based ambulatory patient care centers (including rural health clinics), health centers operated by a Native Hawaiian Health organization (defined as described in subparagraph (A)(iii)), an Indian Tribe, a Tribal health program, a Tribal organization, or an Urban Indian organization (defined as described in subparagraph (A)(ii)), graduate medical education consortiums (including institutions of higher education, such as schools of allopathic medicine, schools of osteopathic medicine, or historically Black colleges or universities (as defined by the term part B institution in section 322 of the Higher Education Act of 1965 or described in section 326(e)(1) of the Higher Education Act of 1965) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965)), or other organizations as determined appropriate by the Secretary. The Secretary may award grants to eligible entities to create new rural residency programs (including adding new rural training sites to existing rural track programs). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a description of the pathway of the rural residency program as described in subparagraph (B). A pathway of a rural residency program supported under this subsection shall be for— general primary care and high-need specialty care, including family medicine, internal medicine, preventive medicine, psychiatry, or general surgery; maternal health and obstetrics, which may be obstetrics and gynecology or family medicine with enhanced obstetrical training; or any other pathway as determined appropriate by the Secretary. In this subsection, the term eligible entity means— a domestic public or private nonprofit or for-profit entity; or an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act). The Secretary may award grants to eligible entities to provide technical assistance to awardees of and potential applicants of the program described in subsection (b). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. There is authorized to be appropriated to carry out this section $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 2026, to remain available until expended. 330A–3.Rural residency planning and development program and rural residency planning and development technical assistance program(a)Definition of rural residency programIn this section, the term rural residency program means a physician residency program, including a rural track program, accredited by the Accreditation Council for Graduate Medical Education (or a similar body) that—(1)trains residents in rural areas (as defined by the Secretary) for more than 50 percent of the total time of their residency; and (2)primarily focuses on producing physicians who will practice in rural areas, as defined by the Secretary.(b)Rural residency planning and development program(1)Definition of eligible entityIn this subsection, the term eligible entity—(A)means—(i)a domestic public or private nonprofit or for-profit entity; (ii)an Indian Tribe, Tribal health program, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act); or(iii)a Native Hawaiian Health organization as defined in section 12 of the Native Hawaiian Health Care Improvement Act; and(B)may include faith-based or community-based organizations, rural hospitals, rural community-based ambulatory patient care centers (including rural health clinics), health centers operated by a Native Hawaiian Health organization (defined as described in subparagraph (A)(iii)), an Indian Tribe, a Tribal health program, a Tribal organization, or an Urban Indian organization (defined as described in subparagraph (A)(ii)), graduate medical education consortiums (including institutions of higher education, such as schools of allopathic medicine, schools of osteopathic medicine, or historically Black colleges or universities (as defined by the term part B institution in section 322 of the Higher Education Act of 1965 or described in section 326(e)(1) of the Higher Education Act of 1965) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965)), or other organizations as determined appropriate by the Secretary. (2)Grants(A)In generalThe Secretary may award grants to eligible entities to create new rural residency programs (including adding new rural training sites to existing rural track programs).(B)FundingGrants awarded under this subsection may be fully funded at the time of the award.(C)TermThe term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary.(3)Applications(A)In generalTo be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a description of the pathway of the rural residency program as described in subparagraph (B).(B)PathwayA pathway of a rural residency program supported under this subsection shall be for—(i)general primary care and high-need specialty care, including family medicine, internal medicine, preventive medicine, psychiatry, or general surgery; (ii)maternal health and obstetrics, which may be obstetrics and gynecology or family medicine with enhanced obstetrical training; or(iii)any other pathway as determined appropriate by the Secretary.(c)Rural residency planning and development technical assistance(1)Definition of eligible entityIn this subsection, the term eligible entity means—(A)a domestic public or private nonprofit or for-profit entity; or(B)an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act).(2)Grants(A)In generalThe Secretary may award grants to eligible entities to provide technical assistance to awardees of and potential applicants of the program described in subsection (b).(B)FundingGrants awarded under this subsection may be fully funded at the time of the award.(C)TermThe term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary.(3)ApplicationsTo be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.(d)Authorization of appropriationsThere is authorized to be appropriated to carry out this section $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 2026, to remain available until expended..

330A–3. Rural residency planning and development program and rural residency planning and development technical assistance program In this section, the term rural residency program means a physician residency program, including a rural track program, accredited by the Accreditation Council for Graduate Medical Education (or a similar body) that— trains residents in rural areas (as defined by the Secretary) for more than 50 percent of the total time of their residency; and primarily focuses on producing physicians who will practice in rural areas, as defined by the Secretary. In this subsection, the term eligible entity— means— a domestic public or private nonprofit or for-profit entity; an Indian Tribe, Tribal health program, Tribal organization, or Urban Indian organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act); or a Native Hawaiian Health organization as defined in section 12 of the Native Hawaiian Health Care Improvement Act; and may include faith-based or community-based organizations, rural hospitals, rural community-based ambulatory patient care centers (including rural health clinics), health centers operated by a Native Hawaiian Health organization (defined as described in subparagraph (A)(iii)), an Indian Tribe, a Tribal health program, a Tribal organization, or an Urban Indian organization (defined as described in subparagraph (A)(ii)), graduate medical education consortiums (including institutions of higher education, such as schools of allopathic medicine, schools of osteopathic medicine, or historically Black colleges or universities (as defined by the term part B institution in section 322 of the Higher Education Act of 1965 or described in section 326(e)(1) of the Higher Education Act of 1965) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965)), or other organizations as determined appropriate by the Secretary. The Secretary may award grants to eligible entities to create new rural residency programs (including adding new rural training sites to existing rural track programs). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including a description of the pathway of the rural residency program as described in subparagraph (B). A pathway of a rural residency program supported under this subsection shall be for— general primary care and high-need specialty care, including family medicine, internal medicine, preventive medicine, psychiatry, or general surgery; maternal health and obstetrics, which may be obstetrics and gynecology or family medicine with enhanced obstetrical training; or any other pathway as determined appropriate by the Secretary. In this subsection, the term eligible entity means— a domestic public or private nonprofit or for-profit entity; or an Indian Tribe or Tribal organization (as such terms are defined in section 4 of the Indian Health Care Improvement Act). The Secretary may award grants to eligible entities to provide technical assistance to awardees of and potential applicants of the program described in subsection (b). Grants awarded under this subsection may be fully funded at the time of the award. The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. To be eligible to receive a grant under this subsection, an eligible entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require. There is authorized to be appropriated to carry out this section $13,000,000 for fiscal year 2024, $13,500,00 for fiscal year 2025, and $14,000,000 for fiscal year 2026, to remain available until expended.

202. Primary care training and enhancement program Section 747(c)(1) of the Public Health Service Act (42 U.S.C. 293k(c)(1)) is amended by striking $48,924,000 for each of fiscal years 2021 through 2025 and inserting $49,250,000 for fiscal year 2024, $49,500,000 for fiscal year 2025, and $50,000,000 for fiscal year 2026.

203. Telehealth technology-enabled learning program Section 330N(k) of the Public Health Service Act (42 U.S.C. 254c–20(k)) is amended by striking 2026 and inserting 2025, and $11,000,000 for each of fiscal years 2026 through 2028, to remain available until expended.

204. Nurse education, practice, quality, and retention grants and contracts Section 831 of the Public Health Service Act (42 U.S.C. 296p) is amended by adding at the end the following: The Secretary shall establish a 2-year pilot program under which the Secretary may award grants to, and enter into contracts with, schools of nursing offering associate degrees that otherwise meet the criteria for receiving a grant or contract under this section, for the purpose of promoting career advancement for individuals, including licensed practical nurses, licensed vocational nurses, certified nurse assistants, home health aides, and other health professionals, such as health aides or community health practitioners certified under the Community Health Aide Program of the Indian Health Service under section 119 of the Indian Health Care Improvement Act, by supporting such individuals in becoming registered nurses with associate degrees. With respect to grants and contracts awarded under this subsection, the Secretary shall use the same criteria (except as otherwise provided in paragraph (1)) as apply to other grants and contracts awarded under this section, and entities receiving such grants or contracts shall be subject to the same requirements (except as otherwise provided in paragraph (1)) as apply to other grant and contract recipients under this section. To carry out this subsection, there are authorized to be appropriated such sums as may be necessary for the period of fiscal years 2024 and 2025. (g)Pilot program(1)In generalThe Secretary shall establish a 2-year pilot program under which the Secretary may award grants to, and enter into contracts with, schools of nursing offering associate degrees that otherwise meet the criteria for receiving a grant or contract under this section, for the purpose of promoting career advancement for individuals, including licensed practical nurses, licensed vocational nurses, certified nurse assistants, home health aides, and other health professionals, such as health aides or community health practitioners certified under the Community Health Aide Program of the Indian Health Service under section 119 of the Indian Health Care Improvement Act, by supporting such individuals in becoming registered nurses with associate degrees.(2)Criteria; requirementsWith respect to grants and contracts awarded under this subsection, the Secretary shall use the same criteria (except as otherwise provided in paragraph (1)) as apply to other grants and contracts awarded under this section, and entities receiving such grants or contracts shall be subject to the same requirements (except as otherwise provided in paragraph (1)) as apply to other grant and contract recipients under this section.(3)Authorization of appropriationsTo carry out this subsection, there are authorized to be appropriated such sums as may be necessary for the period of fiscal years 2024 and 2025..

205. Nurse faculty loan program Section 846A of the Public Health Service Act (42 U.S.C. 297n–1), as amended by section 206, is amended by inserting after subsection (b) the following: To carry out this section (other than subsection (d)), in addition to amounts otherwise made available, including under section 871(b), there are authorized to be appropriated $28,500,000 for each of fiscal years 2024 through 2026, to remain available until expended. (c)Authorization of appropriationsTo carry out this section (other than subsection (d)), in addition to amounts otherwise made available, including under section 871(b), there are authorized to be appropriated $28,500,000 for each of fiscal years 2024 through 2026, to remain available until expended..

206. Nurse faculty demonstration program Section 846A of the Public Health Service Act (42 U.S.C. 297n–1) is amended— by amending subsection (a) to read as follows: To increase the number of qualified nursing faculty, the Secretary may— enter into an agreement with any accredited school of nursing for the establishment and operation of a student loan fund in accordance with subsection (b); and award nurse faculty grants in accordance with subsection (d). in subsection (b)— by redesignating subparagraphs (A) through (D) of paragraph (2) as clauses (i) through (iv), respectively, and adjusting the margins accordingly; by redesignating paragraphs (1) through (5) as subparagraphs (A) through (E), respectively, and adjusting the margins accordingly; in subparagraph (C), as so redesignated, by striking subsection (c) and inserting paragraph (2); and by striking (b) Agreements—Each agreement entered into under subsection (a) shall— and inserting the following: Each agreement entered into under subsection (a)(1) shall— in subsection (c)— by striking subsection (a) each place it appears and inserting subsection (a)(1); in paragraph (3), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; in paragraph (6), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; by redesignating paragraphs (1) through (6) as subparagraphs (A) through (F), respectively, and adjusting the margins accordingly; and in subparagraph (F)(ii), as so redesignated, by striking subsection (e) and inserting paragraph (4); in subsection (e), by striking subsection (c)(6)(B) and inserting paragraph (2)(F)(ii); by redesignating subsections (c) through (e) (before application of the amendment made by section 206) as paragraphs (2) through (4), respectively, and adjusting the margins accordingly; and by adding after subsection (c), as added by section 205, the following: The Secretary shall establish and carry out a demonstration program described in subsection (a)(2) under which eligible schools of nursing receive a grant for purposes of supplementing the salaries of eligible nursing faculty members to enhance recruitment and retention of nursing faculty members. To be eligible to receive a grant under this subsection, an entity shall— be an accredited school of nursing; and submit an application to the Secretary, at such time, in such manner, and containing such information as the Secretary may require, including— to the extent such information is available to the school of nursing, the salary history of nursing faculty at such school who previously were nurses in clinical practice, for the most recent 3-year period ending on the date of application, adjusted for inflation as appropriate and broken down by credentials, experience, and levels of education of such nurses; or if the information described in subclause (I) is not available, information on the average local salary of nurses in clinical practice, adjusted for inflation as appropriate and broken down by credentials, experience, and levels of education of the individual nurses, in accordance with such requirements as the Secretary may specify; an attestation of the average nursing faculty salary at the school of nursing during the most recent 3-year period prior to the date of application, adjusted for inflation, as appropriate, broken down by credentials, experience, and levels of education of such faculty members; the number of nursing faculty member vacancies at the entity at the time of application, and the entity’s projection of such vacancies over the ensuing 5-year period; and a description of the entity’s plans to identify funding sources to sustainably continue, after the 2-year grant period, the salary available to the eligible nursing faculty member pursuant to the program under this subsection during such grant program and to retain eligible nursing faculty members after the end of the grant period. A grant awarded under this subsection, with respect to supporting eligible nursing faculty members, shall— be awarded to the school of nursing to supplement the salaries of eligible faculty members at the school of nursing, annually, for up to a 2-year period, in an amount equal to, for each eligible nursing faculty member at the eligible entity during the grant period, the difference between— the average salary of nurses in clinical practice, as submitted under subclause (I) or (II) of paragraph (2)(B)(i); and the greater of— the salary for the eligible nursing faculty member at the school of nursing; or the average nursing faculty salary submitted under paragraph (2)(B)(ii) for faculty members with the same or similar credentials and level of education; notwithstanding section 803(a), be used in its entirety to supplement the eligible faculty member’s salary; and be conditioned upon the school of nursing maintaining, for each year in which the award is made as described in subparagraph (A), a salary for such faculty member at a level that is not less than the greater of the amount under subclause (I) or (II) of subparagraph (A)(ii). In awarding grants under this subsection, the Secretary shall ensure the equitable geographic distribution of awards, and shall give priority to applications from schools of nursing that demonstrate— the greatest need for such grant, which may be based upon the financial circumstances of the school of nursing, the number of eligible nurse faculty members, and the planned number of students to be trained or admitted off a wait list; training or partnerships to serve vulnerable patient populations, such as through the location or activity of a school in a health professional shortage area (as defined in section 332); recruitment and retention of faculty from underrepresented populations; or other particular need for such grant, including public institutions of higher education that offer 4-year degrees but at which the predominant degree awarded is an associate degree. Nothing in this subsection precludes a school of nursing or an eligible nursing faculty member receiving an award under this section from obtaining or receiving any other form of Federal support or funding. Not later than 3 years after the date of enactment of the Bipartisan Primary Care and Health Workforce Act, the Secretary shall submit to the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, a report that evaluates the program established under this subsection, including— the impact of such program on recruitment and retention rates of nursing faculty, as available, and specifically for each faculty member participating in the program; and recommendations and considerations for Congress on continuing the program under this subsection. In this subsection: The term eligible nursing faculty member means a nursing faculty member who— was hired by a school of nursing within the 2-year period preceding the submission of an application under paragraph (2), or a prospective nursing faculty member; is currently employed at the school of nursing and who demonstrates the need for such support; previously worked as a nurse in clinical practice or as a nurse faculty member at another school of nursing; or may work on a part-time basis as a nursing faculty member, for whom such award amounts described in paragraph (3) shall be prorated relative to the amount of time participating in part-time teaching. The term inflation means the Consumer Price Index for all urban consumers (all items; U.S. city average). To carry out this subsection, in addition to amounts otherwise available, including under section 871(b), there is authorized to be appropriated $15,000,000 for each of fiscal years 2024 and 2025. (a)In generalTo increase the number of qualified nursing faculty, the Secretary may—(1)enter into an agreement with any accredited school of nursing for the establishment and operation of a student loan fund in accordance with subsection (b); and(2)award nurse faculty grants in accordance with subsection (d).; (b)School of nursing student loan fund(1)In generalEach agreement entered into under subsection (a)(1) shall—; (d)Nurse faculty demonstration program(1)In generalThe Secretary shall establish and carry out a demonstration program described in subsection (a)(2) under which eligible schools of nursing receive a grant for purposes of supplementing the salaries of eligible nursing faculty members to enhance recruitment and retention of nursing faculty members.(2)Eligible entitiesTo be eligible to receive a grant under this subsection, an entity shall—(A)be an accredited school of nursing; and(B)submit an application to the Secretary, at such time, in such manner, and containing such information as the Secretary may require, including—(i)(I)to the extent such information is available to the school of nursing, the salary history of nursing faculty at such school who previously were nurses in clinical practice, for the most recent 3-year period ending on the date of application, adjusted for inflation as appropriate and broken down by credentials, experience, and levels of education of such nurses; or(II)if the information described in subclause (I) is not available, information on the average local salary of nurses in clinical practice, adjusted for inflation as appropriate and broken down by credentials, experience, and levels of education of the individual nurses, in accordance with such requirements as the Secretary may specify;(ii)an attestation of the average nursing faculty salary at the school of nursing during the most recent 3-year period prior to the date of application, adjusted for inflation, as appropriate, broken down by credentials, experience, and levels of education of such faculty members;(iii)the number of nursing faculty member vacancies at the entity at the time of application, and the entity’s projection of such vacancies over the ensuing 5-year period; and(iv)a description of the entity’s plans to identify funding sources to sustainably continue, after the 2-year grant period, the salary available to the eligible nursing faculty member pursuant to the program under this subsection during such grant program and to retain eligible nursing faculty members after the end of the grant period.(3)AwardsA grant awarded under this subsection, with respect to supporting eligible nursing faculty members, shall—(A)be awarded to the school of nursing to supplement the salaries of eligible faculty members at the school of nursing, annually, for up to a 2-year period, in an amount equal to, for each eligible nursing faculty member at the eligible entity during the grant period, the difference between—(i)the average salary of nurses in clinical practice, as submitted under subclause (I) or (II) of paragraph (2)(B)(i); and(ii)the greater of—(I)the salary for the eligible nursing faculty member at the school of nursing; or(II)the average nursing faculty salary submitted under paragraph (2)(B)(ii) for faculty members with the same or similar credentials and level of education;(B)notwithstanding section 803(a), be used in its entirety to supplement the eligible faculty member’s salary; and(C)be conditioned upon the school of nursing maintaining, for each year in which the award is made as described in subparagraph (A), a salary for such faculty member at a level that is not less than the greater of the amount under subclause (I) or (II) of subparagraph (A)(ii).(4)PriorityIn awarding grants under this subsection, the Secretary shall ensure the equitable geographic distribution of awards, and shall give priority to applications from schools of nursing that demonstrate—(A)the greatest need for such grant, which may be based upon the financial circumstances of the school of nursing, the number of eligible nurse faculty members, and the planned number of students to be trained or admitted off a wait list;(B)training or partnerships to serve vulnerable patient populations, such as through the location or activity of a school in a health professional shortage area (as defined in section 332);(C)recruitment and retention of faculty from underrepresented populations; or(D)other particular need for such grant, including public institutions of higher education that offer 4-year degrees but at which the predominant degree awarded is an associate degree.(5)Rule of constructionNothing in this subsection precludes a school of nursing or an eligible nursing faculty member receiving an award under this section from obtaining or receiving any other form of Federal support or funding.(6)ReportNot later than 3 years after the date of enactment of the Bipartisan Primary Care and Health Workforce Act, the Secretary shall submit to the Committee on Finance and the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, a report that evaluates the program established under this subsection, including—(A)the impact of such program on recruitment and retention rates of nursing faculty, as available, and specifically for each faculty member participating in the program; and(B)recommendations and considerations for Congress on continuing the program under this subsection.(7)DefinitionsIn this subsection:(A)Eligible nursing faculty memberThe term eligible nursing faculty member means a nursing faculty member who—(i)was hired by a school of nursing within the 2-year period preceding the submission of an application under paragraph (2), or a prospective nursing faculty member;(ii)is currently employed at the school of nursing and who demonstrates the need for such support;(iii)previously worked as a nurse in clinical practice or as a nurse faculty member at another school of nursing; or(iv)may work on a part-time basis as a nursing faculty member, for whom such award amounts described in paragraph (3) shall be prorated relative to the amount of time participating in part-time teaching.(B)InflationThe term inflation means the Consumer Price Index for all urban consumers (all items; U.S. city average).(8)Authorization of appropriationsTo carry out this subsection, in addition to amounts otherwise available, including under section 871(b), there is authorized to be appropriated $15,000,000 for each of fiscal years 2024 and 2025..

207. Nurse corps scholarship and loan repayment program Section 846 of the Public Health Service Act (42 U.S.C. 297n) is amended by adding at the end the following: To carry out this section, in addition to amounts otherwise made available, including under section 871(b), there are authorized to be appropriated $93,600,000 for fiscal year 2024, $94,600,000 for fiscal year 2025, and $95,600,000 for fiscal year 2026, to remain available until expended. (j)Authorization of appropriationsTo carry out this section, in addition to amounts otherwise made available, including under section 871(b), there are authorized to be appropriated $93,600,000 for fiscal year 2024, $94,600,000 for fiscal year 2025, and $95,600,000 for fiscal year 2026, to remain available until expended..

208. Grants for primary care nurse residency training programs Section 5316 of the Patient Protection and Affordable Care Act (42 U.S.C. 296j–1) is amended— in the section heading, by striking Demonstration; in subsection (a), by striking demonstration; in subsection (d)— in paragraph (1)(B), by striking and at the end; by redesignating paragraph (2) as paragraph (3); and by inserting after paragraph (1) the following: in the case of an entity that does not have an established residency program for nurse practitioners at the time of the application, demonstrate plans to establish a new residency program for nurse practitioners; or in the case of an entity that has an established residency program for nurse practitioners at the time of the application, demonstrate plans to use the grant under this section to offer not fewer than 4 additional residency positions for new nurse practitioners to participate in such program; and in subsection (i), by striking such sums as may be necessary for each of fiscal years 2011 through 2014 and inserting $30,000,000 for each of fiscal years 2024 through 2026. (2)(A)in the case of an entity that does not have an established residency program for nurse practitioners at the time of the application, demonstrate plans to establish a new residency program for nurse practitioners; or(B)in the case of an entity that has an established residency program for nurse practitioners at the time of the application, demonstrate plans to use the grant under this section to offer not fewer than 4 additional residency positions for new nurse practitioners to participate in such program; and; and

209. State oral health workforce improvement grant program Subsection (f) of section 340G of the Public Health Service Act (42 U.S.C. 256g) is amended by striking $13,903,000 for each of fiscal years 2019 through 2023 and inserting $15,200,000 for fiscal year 2024, $15,500,000 for fiscal year 2025, and $15,800,000 for fiscal year 2026, to remain available until expended.

210. Oral health training programs Subsection (f) of section 748 of the Public Health Service Act (42 U.S.C. 293k–2) is amended to read as follows: To carry out this section, there is authorized to be appropriated $28,500,000 for fiscal year 2026, to remain available until expended. In awarding grants under this section, the Secretary shall ensure, to the greatest extent practicable, that such grants are equitably distributed among the geographical regions of the United States. (f)Authorization of appropriations(1)In generalTo carry out this section, there is authorized to be appropriated $28,500,000 for fiscal year 2026, to remain available until expended.(2)Geographic distributionIn awarding grants under this section, the Secretary shall ensure, to the greatest extent practicable, that such grants are equitably distributed among the geographical regions of the United States..

211. Allied health professionals Section 755(b)(1) of the Public Health Service Act (42 U.S.C. 294e(b)(1)) is amended— in subparagraph (B), by striking to individuals who have baccalaureate degrees in health-related sciences; in the flush text at the end of subparagraph (I), by striking ; and and inserting a semicolon; in subparagraph (J), by striking the period and inserting ; and; and by adding at the end the following: those that establish or support a dual or concurrent enrollment program (as defined in section 8101 of the Elementary and Secondary Education Act of 1965) if the dual or concurrent enrollment program— provides outreach on allied health careers requiring an industry-recognized credential, a certificate, or an associate degree, to all high schools served by the local educational agency that is a partner in the partnership offering the dual or concurrent enrollment program; provides information to high school students about the training requirements and expected salary of allied health professionals; and provides academic and financial aid counseling to students who participate in the dual or concurrent enrollment program. Section 739(a)(2) of the Public Health Service Act (42 U.S.C. 293c(a)(2)) is amended— in subparagraph (H), by striking and after the semicolon; in subparagraph (I), by striking the period at the end and inserting ; and; and by adding at the end the following: providing academic and financial aid counseling to support participation in a dual or concurrent enrollment program (as defined in section 8101 of the Elementary and Secondary Education Act of 1965) that leads to an industry-recognized credential, a certificate, or an associate degree in the health professions or academic credits that can be transferred, as indicated through an articulation agreement between 2 or more community colleges or universities, to obtain an industry-recognized credential, a certificate, or a degree in the health professions. Section 755(b) of the Public Health Service Act (42 U.S.C. 294e(b)) is amended by adding at the end the following: Supporting and developing new innovative, community-driven approaches for the education and training of allied health professionals, including those described in subparagraph (F)(i), with an emphasis on expanding the supply of such professionals located in, and meeting the needs of, underserved communities and rural areas. Grants under this paragraph shall be awarded through a new program (referred to as the Health Care Workforce Innovation Program or in this paragraph as the Program). To be eligible to receive a grant under the Program an entity shall— be a Federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act), a State-level association or other consortium that represents and is comprised of Federally qualified health centers, or a certified rural health clinic that meets the requirements of section 334; and submit to the Secretary an application that, at a minimum, contains— a description of how all trainees will be trained in accredited training programs either directly or through partnerships with public or nonprofit private entities; a description of the community-driven health care workforce innovation model to be carried out under the grant, including the specific professions to be funded; the geographic service area that will be served, including quantitative data, if available, showing that such particular area faces a shortage of health professionals and lacks access to health care; a description of the benefits provided to each health care professional trained under the proposed model during the education and training phase; a description of the experience that the applicant has in the recruitment, retention, and promotion of the well-being of workers and volunteers; a description of how the funding awarded under the Program will supplement rather than supplant existing funding; a description of the scalability and replicability of the community-driven approach to be funded under the Program; a description of the infrastructure, outreach and communication plan, and other program support costs required to operationalize the proposed model; and any other information, as the Secretary determines appropriate. An entity shall use amounts received under a grant awarded under the Program to carry out the innovative, community-driven model described in the application under subparagraph (B). Such amounts may be used for launching new, or expanding existing, innovative health care professional partnerships, including the following specific uses: Establishing or expanding a partnership between an eligible entity and 1 or more high schools, accredited public or nonprofit private vocational-technical schools, accredited public or nonprofit private 2-year colleges, area health education centers, and entities with clinical settings for the provision of education and training opportunities not available at the grantee’s facilities. Providing education and training programs to improve allied health professionals’ readiness in settings that serve underserved communities and rural areas; encouraging students from underserved and disadvantaged backgrounds and former patients to consider careers in health care, and better reflecting and meeting community needs; providing education and training programs for individuals to work in patient-centered, team-based, community-driven health care models that include integration with other clinical practitioners and training in cultural and linguistic competence; providing pre-apprenticeship and apprenticeship programs for health care technical, support, and entry-level occupations, particularly for those enrolled in dual or concurrent enrollment programs; building a preceptorship training-to-practice model for medical, behavioral health, oral health, and public health disciplines in an integrated, community-driven setting; providing and expanding internships, career ladders, and development opportunities for health care professionals, including new and existing staff; or investing in training equipment, supplies, and limited renovations or retrofitting of training space needed for grantees to carry out their particular model. Amounts received under a grant awarded under the Program shall not be used to support construction costs or to supplant funding from existing programs that support the applicant’s health workforce. Funding of models under the Program shall be for a duration of at least 3 years. In awarding grants under the Program, the Secretary may give priority to applicants that will use grant funds to support workforce innovation models that increase the number of individuals from underserved and disadvantaged backgrounds working in such health care professions, improve access to health care (including medical, behavioral health and oral health) in underserved communities, or demonstrate that the model can be replicated in other underserved communities in a cost-efficient and effective manner to achieve the purposes of the Program. An entity that receives a grant under the Program shall provide periodic reports to the Secretary detailing the findings and outcomes of the innovative, community-driven model carried out under the grant. Such reports shall contain information in a manner and at such times as determined appropriate by the Secretary. In this paragraph: The term allied health care professional includes individuals who provide clinical support services, including medical assistants, dental assistants, dental hygienists, pharmacy technicians, physical therapists, and health care interpreters; individuals providing non-clinical support, such as billing and coding professionals and health information technology professionals; dieticians; medical technologists; emergency medical technicians; community health workers; public health personnel; and peer support workers. The term rural area has the meaning given such term by the Administrator of the Health Resources and Services Administration. The term underserved communities means areas, population groups, and facilities designated as health professional shortage areas under section 332, medically underserved areas as defined under section 330I(a), or medically underserved populations as defined under section 330(b)(3). There are authorized to be appropriated $100,000,000 for each of fiscal years 2024 through 2026, to carry out this section, to remain available until expended. A grant provided under the Program shall not exceed $2,500,000 for a grant period. (K)those that establish or support a dual or concurrent enrollment program (as defined in section 8101 of the Elementary and Secondary Education Act of 1965) if the dual or concurrent enrollment program—(i)provides outreach on allied health careers requiring an industry-recognized credential, a certificate, or an associate degree, to all high schools served by the local educational agency that is a partner in the partnership offering the dual or concurrent enrollment program; (ii)provides information to high school students about the training requirements and expected salary of allied health professionals; and(iii)provides academic and financial aid counseling to students who participate in the dual or concurrent enrollment program.. (J)providing academic and financial aid counseling to support participation in a dual or concurrent enrollment program (as defined in section 8101 of the Elementary and Secondary Education Act of 1965) that leads to an industry-recognized credential, a certificate, or an associate degree in the health professions or academic credits that can be transferred, as indicated through an articulation agreement between 2 or more community colleges or universities, to obtain an industry-recognized credential, a certificate, or a degree in the health professions.. (5)(A)Supporting and developing new innovative, community-driven approaches for the education and training of allied health professionals, including those described in subparagraph (F)(i), with an emphasis on expanding the supply of such professionals located in, and meeting the needs of, underserved communities and rural areas. Grants under this paragraph shall be awarded through a new program (referred to as the Health Care Workforce Innovation Program or in this paragraph as the Program).(B)To be eligible to receive a grant under the Program an entity shall—(i)be a Federally qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act), a State-level association or other consortium that represents and is comprised of Federally qualified health centers, or a certified rural health clinic that meets the requirements of section 334; and(ii)submit to the Secretary an application that, at a minimum, contains—(I)a description of how all trainees will be trained in accredited training programs either directly or through partnerships with public or nonprofit private entities; (II)a description of the community-driven health care workforce innovation model to be carried out under the grant, including the specific professions to be funded;(III)the geographic service area that will be served, including quantitative data, if available, showing that such particular area faces a shortage of health professionals and lacks access to health care;(IV)a description of the benefits provided to each health care professional trained under the proposed model during the education and training phase;(V)a description of the experience that the applicant has in the recruitment, retention, and promotion of the well-being of workers and volunteers;(VI)a description of how the funding awarded under the Program will supplement rather than supplant existing funding;(VII)a description of the scalability and replicability of the community-driven approach to be funded under the Program;(VIII)a description of the infrastructure, outreach and communication plan, and other program support costs required to operationalize the proposed model; and(IX)any other information, as the Secretary determines appropriate.(C)(i)An entity shall use amounts received under a grant awarded under the Program to carry out the innovative, community-driven model described in the application under subparagraph (B). Such amounts may be used for launching new, or expanding existing, innovative health care professional partnerships, including the following specific uses:(I)Establishing or expanding a partnership between an eligible entity and 1 or more high schools, accredited public or nonprofit private vocational-technical schools, accredited public or nonprofit private 2-year colleges, area health education centers, and entities with clinical settings for the provision of education and training opportunities not available at the grantee’s facilities.(II)Providing education and training programs to improve allied health professionals’ readiness in settings that serve underserved communities and rural areas; encouraging students from underserved and disadvantaged backgrounds and former patients to consider careers in health care, and better reflecting and meeting community needs; providing education and training programs for individuals to work in patient-centered, team-based, community-driven health care models that include integration with other clinical practitioners and training in cultural and linguistic competence; providing pre-apprenticeship and apprenticeship programs for health care technical, support, and entry-level occupations, particularly for those enrolled in dual or concurrent enrollment programs; building a preceptorship training-to-practice model for medical, behavioral health, oral health, and public health disciplines in an integrated, community-driven setting; providing and expanding internships, career ladders, and development opportunities for health care professionals, including new and existing staff; or investing in training equipment, supplies, and limited renovations or retrofitting of training space needed for grantees to carry out their particular model.(ii)Amounts received under a grant awarded under the Program shall not be used to support construction costs or to supplant funding from existing programs that support the applicant’s health workforce.(iii)Funding of models under the Program shall be for a duration of at least 3 years.(D)In awarding grants under the Program, the Secretary may give priority to applicants that will use grant funds to support workforce innovation models that increase the number of individuals from underserved and disadvantaged backgrounds working in such health care professions, improve access to health care (including medical, behavioral health and oral health) in underserved communities, or demonstrate that the model can be replicated in other underserved communities in a cost-efficient and effective manner to achieve the purposes of the Program.(E)An entity that receives a grant under the Program shall provide periodic reports to the Secretary detailing the findings and outcomes of the innovative, community-driven model carried out under the grant. Such reports shall contain information in a manner and at such times as determined appropriate by the Secretary.(F)In this paragraph:(i)The term allied health care professional includes individuals who provide clinical support services, including medical assistants, dental assistants, dental hygienists, pharmacy technicians, physical therapists, and health care interpreters; individuals providing non-clinical support, such as billing and coding professionals and health information technology professionals; dieticians; medical technologists; emergency medical technicians; community health workers; public health personnel; and peer support workers.(ii)The term rural area has the meaning given such term by the Administrator of the Health Resources and Services Administration.(iii)The term underserved communities means areas, population groups, and facilities designated as health professional shortage areas under section 332, medically underserved areas as defined under section 330I(a), or medically underserved populations as defined under section 330(b)(3).(G)(i)There are authorized to be appropriated $100,000,000 for each of fiscal years 2024 through 2026, to carry out this section, to remain available until expended.(ii)A grant provided under the Program shall not exceed $2,500,000 for a grant period..

212. Review of and report on programs supporting the nursing workforce The Secretary of Health and Human Services and the Secretary of Labor, jointly, shall— conduct a review of all grant programs carried out by the Department of Health and Human Services or by the Department of Labor that support the nurse workforce; and not later than 1 year after the date of enactment of this Act, submit to Congress a report on the review under paragraph (1) that includes recommendations for changes to such grant programs to improve upon the goals of— increasing nurse faculty, particularly in underserved areas; providing pathways for nurses who have more than 10 years of clinical experience to become faculty at schools of nursing; and encouraging and increasing the nursing pipeline through pathways for licensed practical nurses to become registered nurses.

213. Report on impacts to community health centers Not later than 5 years after the date of enactment of this Act, the Secretary of Health and Human Services, acting through the Assistant Secretary for Planning and Evaluation, shall submit to Congress a report on the impacts of this title, including the amendments made by this title, on community health centers. Such report shall consider— current and projected savings or cost impact on the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.); current and projected changes in access to health care, health outcomes, health literacy, and access to social care services; current and projected changes in wait and travel times to access primary care services; and contributions to the economies of the communities served by community health centers, including employment opportunities.

301. Banning anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care Section 2799A–9 of the Public Health Service Act (42 U.S.C. 300gg–119) is amended— by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan or health insurance issuer from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to— a health maintenance organization (as defined in section 2791(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan or health insurance issuer offering group or individual health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (5) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Section 724 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m) is amended— by adding at the end the following: A group health plan or a health insurance issuer offering group health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan or health insurance issuer from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group health insurance coverage with respect to— a health maintenance organization (as defined in section 733(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan or health insurance issuer offering group health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (4) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Section 9824 of the Internal Revenue Code of 1986 is amended— by adding at the end the following: A group health plan shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly— restricts the group health plan from— directing or steering enrollees to other health care providers; or offering incentives to encourage enrollees to utilize specific health care providers; requires the group health plan to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider; requires the group health plan to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or restricts other group health plans not party to the contract from paying a lower rate for items or services than the contracting plan pays for such items or services. A self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist. Paragraph (1)(A) shall not apply to a group health plan with respect to— a health maintenance organization (as defined in section 9832(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking. A group health plan shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan is in compliance with the requirements of this subsection. Nothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs. Compliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). An applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed. by redesignating paragraph (4) of subsection (a) as subsection (c), adjusting the margin of such subsection accordingly, and transferring such subsection (c) to appear after subsection (b), as added by subparagraph (A). Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury, jointly, shall promulgate regulations to carry out section 2799A–9(b) of the Public Health Service Act, section 724(b) of the Employee Retirement Income Security Act of 1974, and section 9824(b) of the Internal Revenue Code of 1986, as added by subsection (a). Subsection (b) of section 2799A–9 of the Public Health Service Act, subsection (b) of section 724 of the Employee Retirement Income Security Act of 1974, and subsection (b) of section 9824 of the Internal Revenue Code of 1986 (as added by paragraphs (1), (2), and (3), respectively, of subsection (a)) shall apply with respect to any contract entered into on or after the date that is 18 months after the date of enactment of this Act. With respect to an applicable contract that is in effect on the date of enactment of this Act, such subsection (b) shall apply on the earlier of the date of renewal of such contract or 3 years after such date of enactment. (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan or a health insurance issuer offering group or individual health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan or health insurance issuer from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers; (B)requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for plans and issuersParagraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to—(A)a health maintenance organization (as defined in section 2791(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan or health insurance issuer offering group or individual health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)).(7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan or a health insurance issuer offering group health insurance coverage shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan or health insurance issuer from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers;(B)requires the group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan or health insurance issuer to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans or health insurance issuers not party to the contract from paying a lower rate for items or services than the contracting plan or issuer pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for plans and issuersParagraph (1)(A) shall not apply to a group health plan or health insurance issuer offering group health insurance coverage with respect to—(A)a health maintenance organization (as defined in section 733(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan or health insurance issuer offering group health insurance coverage shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan or issuer is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan or health insurance issuer, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)). (7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and (b)Protecting Health Plans Network Design Flexibility(1)In generalA group health plan shall not enter into an agreement with a provider, network or association of providers, or other service provider offering access to a network of service providers if such agreement, directly or indirectly—(A)restricts the group health plan from—(i)directing or steering enrollees to other health care providers; or(ii)offering incentives to encourage enrollees to utilize specific health care providers;(B)requires the group health plan to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract with such provider;(C)requires the group health plan to agree to payment rates or other terms for any affiliate not party to the contract of the provider involved; or(D)restricts other group health plans not party to the contract from paying a lower rate for items or services than the contracting plan pays for such items or services.(2)Additional requirement for self-insured plansA self-insured group health plan shall not enter into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers if such agreement directly or indirectly requires the group health plan to certify, attest, or otherwise confirm in writing that the group health plan is bound by restrictive contracting terms between the service provider and a third-party administrator that the group health plan is not party to, without a disclosure that such terms exist.(3)Exception for certain plansParagraph (1)(A) shall not apply to a group health plan with respect to—(A)a health maintenance organization (as defined in section 9832(b)(3)), if such health maintenance organization operates primarily through exclusive contracts with multi-specialty physician groups, nor to any arrangement between such a health maintenance organization and its affiliates; or(B)a value-based network arrangement, such as an exclusive provider network, accountable care organization, center of excellence, a provider sponsored health insurance issuer that operates primarily through aligned multi-specialty physician group practices or integrated health systems, or such other similar network arrangements as determined by the Secretary through rulemaking.(4)AttestationA group health plan shall annually submit to, as applicable, the applicable authority described in section 2723 of the Public Health Service Act or the Secretary of Labor or the Secretary of the Treasury, an attestation that such plan is in compliance with the requirements of this subsection.(5)Rule of constructionNothing in this subsection shall be construed to limit network design or cost or quality initiatives by a group health plan, including accountable care organizations, exclusive provider organizations, networks that tier providers by cost or quality or steer enrollees to centers of excellence, or other pay-for-performance programs.(6)Compliance with respect to antitrust lawsCompliance with this subsection does not constitute compliance with the antitrust laws, as defined in subsection (a) of the first section of the Clayton Act (15 U.S.C. 12(a)).(7)GrandfatheringAn applicable State authority may make a determination that the prohibitions under paragraph (1) (with respect to conditions that would direct or steer enrollees to, or offer incentives to encourage enrollees to use, other health care providers) will not apply in the State with respect to any specified agreement that is executed before the date of enactment of the Bipartisan Primary Care and Health Workforce Act, for a maximum length of nonapplicability of up to 10 years from the date of execution of the contract if the applicable State authority determines that the contract is unlikely to significantly lessen competition. With respect to a specified agreement for which an applicable State authority has made a determination under the preceding sentence, an applicable State authority may determine whether renewal of the contract, within the applicable 10-year period, is allowed.; and

302. Honest billing requirements applicable to providers Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–111 et seq.) is amended by adding at the end the following: A group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10. Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.) is amended by inserting after the item relating to section 725 the following new item: Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: A group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.) is amended by adding at the end the following: For items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless— such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1). The term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act) that is not located— on the campus (as defined in such section 413.65(a)(2)) of such provider; or within the distance described in such definition of campus from a remote location of a hospital (as defined in such section 413.65(a)(2)). The Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. The Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount— in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act (or any successor regulations), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary. Section 2799B–4(a)(1) of the Public Health Service Act (42 U.S.C. 300gg–134(a)(1)) is amended by inserting (other than section 2799B–10) after this part. 2799A–11.Honest billing requirements applicable to plans and issuersA group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10. . 726.Honest billing requirements applicable to plans and issuersA group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. . Sec. 726. Honest billing requirements applicable to plans and issuers.. 9826.Honest billing requirements applicable to plansA group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act. . Sec. 9826. Honest billing requirements applicable to plans.. 2799B–10.Honest billing requirements applicable to providers(a)Requirements relating to unique health identifiersFor items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless—(1)such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and(2)such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1).(b)Off-Campus outpatient department of a providerThe term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act) that is not located—(1)on the campus (as defined in such section 413.65(a)(2)) of such provider; or(2)within the distance described in such definition of campus from a remote location of a hospital (as defined in such section 413.65(a)(2)).(c)Process for reporting suspected violationsThe Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary.(d)PenaltiesThe Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount—(1)in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act (or any successor regulations), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and(2)in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary..

2799A–11. Honest billing requirements applicable to plans and issuers A group health plan or health insurance issuer offering group or individual health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b)) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10.

726. Honest billing requirements applicable to plans and issuers A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act.

9826. Honest billing requirements applicable to plans A group health plan may not pay a claim for items and services furnished on or after January 1, 2026, to an individual at an off-campus outpatient department of a provider (as defined in section 2799B–10(b) of the Public Health Service Act) submitted by a health care provider or facility unless such claim submitted by such provider or facility includes a separate unique health identifier for the department where items and services were furnished, in accordance with section 2799B–10 of such Act.

2799B–10. Honest billing requirements applicable to providers For items and services furnished, on or after January 1, 2026, at an off-campus outpatient department of a provider to a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer, a health care provider or facility may not submit a claim to the group health plan or health insurance issuer, bill the participant, beneficiary, or enrollee, or hold liable the participant, beneficiary, or enrollee, unless— such provider or facility obtains a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act; and such items and services are billed using the separate unique health identifier established for such department pursuant to paragraph (1). The term off-campus outpatient department of a provider means a department of a provider (as defined in section 413.65(a)(2) of title 42 of the Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act) that is not located— on the campus (as defined in such section 413.65(a)(2)) of such provider; or within the distance described in such definition of campus from a remote location of a hospital (as defined in such section 413.65(a)(2)). The Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. The Secretary may assess a civil monetary penalty against a hospital for a violation under this section in an amount— in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of the Bipartisan Primary Care and Health Workforce Act (or any successor regulations), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per day that the violation is ongoing, as determined by the Secretary.

303. Banning facility fees for certain services Part E of title XXVII of the Public Health Service Act (42 U.S.C. 300gg–131 et seq.), as amended by section 302(b), is further amended by adding at the end the following: With respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). In this section, the term applicable items and services means— evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth. 2799B–11.Banning facility fees for certain services(a)In generalWith respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). (b)Applicable items and servicesIn this section, the term applicable items and services means—(1)evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; (2)outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and(3)any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth..

2799B–11. Banning facility fees for certain services With respect to applicable items and services furnished to an individual on or after January 1, 2026, a health care provider or facility may not charge a facility fee (regardless of how the fee is labeled) to a group health plan, a health insurance issuer offering group or individual health insurance coverage, a participant, beneficiary, or enrollee in such a plan or coverage, or an individual patient who is not covered by a group health plan, health insurance coverage, or a Federal health care program (as defined in section 1128(f) of the Social Security Act). In this section, the term applicable items and services means— evaluation and management services described in section 1833(cc)(1)(B)(i) of the Social Security Act; outpatient behavioral health services (not including partial hospitalizations, intensive outpatient program services, and other services not typically provided in an office setting (as the Secretary may determine)); and any items and services (including the items and services described in paragraphs (1) and (2)) furnished via telehealth.

304. Prevention and Public Health Fund Section 4002(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11(b)) is amended by striking paragraphs (8) through (10) and inserting the following: for each of fiscal years 2026 and 2027, $1,425,000,000; for each of fiscal years 2028 and 2029, $1,495,000,000; for fiscal year 2030, $1,680,000,000; and for fiscal year 2031 and each fiscal year thereafter, $2,000,000,000. (8)for each of fiscal years 2026 and 2027, $1,425,000,000;(9)for each of fiscal years 2028 and 2029, $1,495,000,000;(10)for fiscal year 2030, $1,680,000,000; and(11)for fiscal year 2031 and each fiscal year thereafter, $2,000,000,000..

305. Price transparency requirements Section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)) is amended— by striking Each hospital and inserting the following: Each hospital by inserting , in plain language without subscription and free of charge, in a consumer-friendly, machine-readable format, after a list; and by adding at the end the following: “Each hospital shall include in its list of standard charges, along with such additional information as the Secretary may require with respect to such charges for purposes of promoting public awareness of hospital pricing in advance of receiving a hospital item or service, as applicable, the following: A description of each item or service provided by the hospital. The gross charge. Any payer-specific negotiated charge clearly associated with the name of the third-party payer and plan. The de-identified minimum negotiated charge. The de-identified maximum negotiated charge. The discounted cash price. Any code used by the hospital for purposes of accounting or billing, including Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG), the National Drug Code (NDC), or other common payer identifier. Each hospital shall make public the standard charges described in paragraph (1) for as many of the 70 Centers for Medicaid & Medicare Services-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as may be necessary for a combined total of at least 300 shoppable services, including the rate at which a hospital provides and bills for that shoppable service. If a hospital does not provide 300 shoppable services in accordance with the previous sentence, the hospital shall make public the information specified under paragraph (1) for as many shoppable services as it provides. A hospital shall be deemed by the Centers for Medicare & Medicaid Services to meet the requirements of subparagraph (A) if the hospital maintains an internet-based price estimator tool that meets the following requirements: The tool provides estimates for as many of the 70 specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as may be necessary for a combined total of at least 300 shoppable services. The tool allows health care consumers to, at the time they use the tool, obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service. The tool is prominently displayed on the hospital’s website and easily accessible to the public, without subscription, fee, or having to submit personal identifying information (PII), and searchable by service description, billing code, and payer. Notwithstanding any other provision of law, for the purpose of paragraphs (1) and (2): The term de-identified maximum negotiated charge means the highest charge that a hospital has negotiated with all third-party payers for an item or service. The term de-identified minimum negotiated charge means the lowest charge that a hospital has negotiated with all third-party payers for an item or service. The term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for a hospital item or service. Hospitals that do not offer self-pay discounts may display the hospital’s undiscounted gross charges as found in the hospital chargemaster. The term gross charge means the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts. The term payer-specific negotiated charge means the charge that a hospital has negotiated with a third-party payer for an item or service. The term shoppable service means a service that can be scheduled by a health care consumer in advance. The term standard charges means the regular rate established by the hospital for an item or service, including both individual items and services and service packages, provided to a specific group of paying patients, including the gross charge, the payer-specific negotiated charge, the discounted cash price, the de-identified minimum negotiated charge, the de-identified maximum negotiated charge, and other rates determined by the Secretary. The term third-party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. In addition to any other enforcement actions or penalties that may apply under subsection (b)(3) or another provision of law, a hospital that fails to provide the information required by this subsection and has not completed a corrective action plan to comply with the requirements of such subsection shall be subject to a civil monetary penalty of an amount not to exceed $300 per day that the violation is ongoing as determined by the Secretary. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A of the Social Security Act are imposed and collected. Section 1311(e)(3) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(e)(3)) is amended— in subparagraph (A)— by redesignating clause (ix) as clause (xii); and by inserting after clause (viii) the following: In-network provider rates for covered items and services. Out-of-network allowed amounts and billed charges for covered items and services. Negotiated rates and historical net prices for covered prescription drugs. in subparagraph (B)— in the heading, by striking use and inserting delivery methods and use; by inserting and subparagraph (C) after subparagraph (A); by inserting , as applicable after English proficiency; and by inserting after the second sentence, the following: “The Secretary shall establish standards for the methods and formats for disclosing information to individuals. At a minimum, these standards shall include the following: An internet-based self-service tool to provide information to an individual in plain language, without subscription and free of charge, in a machine-readable format, through a self-service tool on an internet website that provides real-time responses based on cost-sharing information that is accurate at the time of the request that allows, at a minimum, users to— search for cost-sharing information for a covered item or service provided by a specific in-network provider or by all in-network providers; search for an out-of-network allowed amount, percentage of billed charges, or other rate that provides a reasonably accurate estimate of the amount an insurer will pay for a covered item or service provided by out-of-network providers; and refine and reorder search results based on geographic proximity of in-network providers, and the amount of the individual’s cost-sharing liability for the covered item or service, to the extent the search for cost-sharing information for covered items or services returns multiple results. In paper form at the request of the individual that includes no fewer than 20 providers per request with respect to which cost-sharing information for covered items and services is provided, and discloses the applicable provider, per-request limit to the individual, mailed to the individual not later than 2 business days after receiving an individual’s request. in subparagraph (C)— in the first sentence— by striking The Exchange and inserting the following: The Exchange by inserting or out-of-network provider after item or service by a participating provider; and by striking the period and inserting the following: “the following information: An estimate of an individual’s cost-sharing liability for a requested covered item or service furnished by a provider, which shall reflect any cost-sharing reductions the individual would receive. A description of the accumulated amounts. The in-network rate, including negotiated rates and underlying fee schedule rates. The out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount an issuer will pay, including the percent reimbursed by insurers to out-of-network providers, for the requested covered item or service furnished by an out-of-network provider. A list of the items and services included in bundled payment arrangements for which cost-sharing information is being disclosed. A notification that coverage of a specific item or service is subject to a prerequisite, if applicable. A notice that includes the following information: A statement that out-of-network providers may bill individuals for the difference, including the balance billing, between a provider’s billed charges and the sum of the amount collected from the insurer in the form of a copayment or coinsurance amount and the cost-sharing information. A statement that the actual charges for an individual's covered item or service may be different from an estimate of cost-sharing liability depending on the actual items or services the individual receives at the point of care. A statement that the estimate of cost-sharing liability for a covered item or service is not a guarantee that benefits will be provided for that item or service. A statement disclosing whether the plan counts copayment assistance and other third-party payments in the calculation of the individual’s deductible and out-of-pocket maximum. For items and services that are recommended preventive services under section 2713 of the Public Health Service Act, a statement that an in-network item or service may not be subject to cost-sharing if it is billed as a preventive service and the insurer cannot determine whether the request is for a preventive or non-preventive item or service. Any additional information, including other disclaimers, that the insurer determines is appropriate, provided the additional information does not conflict with the information required to be provided by this subsection. by striking the second sentence; and by adding at the end the following: Notwithstanding any other provision of law, for the purpose of subparagraphs (A), (B), and (C): The term accumulated amounts means the amount of financial responsibility an individual has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit, including any expense that counts toward a deductible or out-of-pocket limit, but excluding any expense that does not count toward a deductible or out-of-pocket limit. To the extent an insurer imposes a cumulative treatment limitation on a particular covered item or service independent of individual medical necessity determinations, the amount that has accrued toward the limit on the item or service. The term historical net price means the retrospective average amount an insurer paid for a prescription drug, inclusive of any reasonably allocated rebates, discounts, chargebacks, fees, and any additional price concessions received by the insurer with respect to the prescription drug. The allocation shall be determined by dollar value for non-product specific and product-specific rebates, discounts, chargebacks, fees, and other price concessions to the extent that the total amount of any such price concession is known to the insurer at the time of publication of the historical net price. The term negotiated rate means the amount a plan or issuer has contractually agreed to pay for a covered item or service, whether directly or indirectly through a third-party administrator or pharmacy benefit manager, to an in-network provider, including an in-network pharmacy or other prescription drug dispenser, for covered items or services. The term out-of-network allowed amount means the maximum amount an insurer will pay for a covered item or service furnished by an out-of-network provider. The term out-of-network limit means the maximum amount that an individual is required to pay during a coverage period for his or her share of the costs of covered items and services under his or her plan or coverage, including for self-only and other than self-only coverage, as applicable. The term underlying fee schedule rate means the rate for an item or service that a plan or issuer uses to determine a participant’s, beneficiary’s, or enrollee’s cost-sharing liability with respect to a particular provider or providers, when the rate is different from the negotiated rate. in subparagraph (D), by striking subparagraph (A) and inserting subparagraphs (A), (B), and (C); and by adding at the end the following: In addition to qualified health plans (and plans seeking certification as qualified health plans), this paragraph (as amended by the Bipartisan Primary Care and Health Workforce Act) shall apply to group health plans (including self-insured and fully insured plans) and health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act). (1)In generalEach hospital; (A)A description of each item or service provided by the hospital.(B)The gross charge.(C)Any payer-specific negotiated charge clearly associated with the name of the third-party payer and plan.(D)The de-identified minimum negotiated charge.(E)The de-identified maximum negotiated charge.(F)The discounted cash price.(G)Any code used by the hospital for purposes of accounting or billing, including Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG), the National Drug Code (NDC), or other common payer identifier.(2)Delivery methods and use(A)In generalEach hospital shall make public the standard charges described in paragraph (1) for as many of the 70 Centers for Medicaid & Medicare Services-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as may be necessary for a combined total of at least 300 shoppable services, including the rate at which a hospital provides and bills for that shoppable service. If a hospital does not provide 300 shoppable services in accordance with the previous sentence, the hospital shall make public the information specified under paragraph (1) for as many shoppable services as it provides. (B)Determination by CMSA hospital shall be deemed by the Centers for Medicare & Medicaid Services to meet the requirements of subparagraph (A) if the hospital maintains an internet-based price estimator tool that meets the following requirements:(i)The tool provides estimates for as many of the 70 specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as may be necessary for a combined total of at least 300 shoppable services.(ii)The tool allows health care consumers to, at the time they use the tool, obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service.(iii)The tool is prominently displayed on the hospital’s website and easily accessible to the public, without subscription, fee, or having to submit personal identifying information (PII), and searchable by service description, billing code, and payer.(3)DefinitionsNotwithstanding any other provision of law, for the purpose of paragraphs (1) and (2):(A)De-identified maximum negotiated chargeThe term de-identified maximum negotiated charge means the highest charge that a hospital has negotiated with all third-party payers for an item or service.(B)De-identified minimum negotiated chargeThe term de-identified minimum negotiated charge means the lowest charge that a hospital has negotiated with all third-party payers for an item or service.(C)Discounted cash priceThe term discounted cash price means the charge that applies to an individual who pays cash, or cash equivalent, for a hospital item or service. Hospitals that do not offer self-pay discounts may display the hospital’s undiscounted gross charges as found in the hospital chargemaster.(D)Gross chargeThe term gross charge means the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts.(E)Payer-specific negotiated chargeThe term payer-specific negotiated charge means the charge that a hospital has negotiated with a third-party payer for an item or service.(F)Shoppable serviceThe term shoppable service means a service that can be scheduled by a health care consumer in advance.(G)Standard chargesThe term standard charges means the regular rate established by the hospital for an item or service, including both individual items and services and service packages, provided to a specific group of paying patients, including the gross charge, the payer-specific negotiated charge, the discounted cash price, the de-identified minimum negotiated charge, the de-identified maximum negotiated charge, and other rates determined by the Secretary. (H)Third-party payerThe term third-party payer means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.(4)EnforcementIn addition to any other enforcement actions or penalties that may apply under subsection (b)(3) or another provision of law, a hospital that fails to provide the information required by this subsection and has not completed a corrective action plan to comply with the requirements of such subsection shall be subject to a civil monetary penalty of an amount not to exceed $300 per day that the violation is ongoing as determined by the Secretary. Such penalty shall be imposed and collected in the same manner as civil money penalties under subsection (a) of section 1128A of the Social Security Act are imposed and collected.. (ix)In-network provider rates for covered items and services.(x)Out-of-network allowed amounts and billed charges for covered items and services.(xi)Negotiated rates and historical net prices for covered prescription drugs.; (i)An internet-based self-service tool to provide information to an individual in plain language, without subscription and free of charge, in a machine-readable format, through a self-service tool on an internet website that provides real-time responses based on cost-sharing information that is accurate at the time of the request that allows, at a minimum, users to—(I)search for cost-sharing information for a covered item or service provided by a specific in-network provider or by all in-network providers;(II)search for an out-of-network allowed amount, percentage of billed charges, or other rate that provides a reasonably accurate estimate of the amount an insurer will pay for a covered item or service provided by out-of-network providers; and(III)refine and reorder search results based on geographic proximity of in-network providers, and the amount of the individual’s cost-sharing liability for the covered item or service, to the extent the search for cost-sharing information for covered items or services returns multiple results.(ii)In paper form at the request of the individual that includes no fewer than 20 providers per request with respect to which cost-sharing information for covered items and services is provided, and discloses the applicable provider, per-request limit to the individual, mailed to the individual not later than 2 business days after receiving an individual’s request.; (i)In generalThe Exchange; (i)An estimate of an individual’s cost-sharing liability for a requested covered item or service furnished by a provider, which shall reflect any cost-sharing reductions the individual would receive.(ii)A description of the accumulated amounts.(iii)The in-network rate, including negotiated rates and underlying fee schedule rates.(iv)The out-of-network allowed amount or any other rate that provides a more accurate estimate of an amount an issuer will pay, including the percent reimbursed by insurers to out-of-network providers, for the requested covered item or service furnished by an out-of-network provider.(v)A list of the items and services included in bundled payment arrangements for which cost-sharing information is being disclosed.(vi)A notification that coverage of a specific item or service is subject to a prerequisite, if applicable.(vii)A notice that includes the following information:(I)A statement that out-of-network providers may bill individuals for the difference, including the balance billing, between a provider’s billed charges and the sum of the amount collected from the insurer in the form of a copayment or coinsurance amount and the cost-sharing information.(II)A statement that the actual charges for an individual's covered item or service may be different from an estimate of cost-sharing liability depending on the actual items or services the individual receives at the point of care.(III)A statement that the estimate of cost-sharing liability for a covered item or service is not a guarantee that benefits will be provided for that item or service.(IV)A statement disclosing whether the plan counts copayment assistance and other third-party payments in the calculation of the individual’s deductible and out-of-pocket maximum.(V)For items and services that are recommended preventive services under section 2713 of the Public Health Service Act, a statement that an in-network item or service may not be subject to cost-sharing if it is billed as a preventive service and the insurer cannot determine whether the request is for a preventive or non-preventive item or service.(VI)Any additional information, including other disclaimers, that the insurer determines is appropriate, provided the additional information does not conflict with the information required to be provided by this subsection.; (ii)DefinitionsNotwithstanding any other provision of law, for the purpose of subparagraphs (A), (B), and (C):(I)Accumulated amountsThe term accumulated amounts means the amount of financial responsibility an individual has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit, including any expense that counts toward a deductible or out-of-pocket limit, but excluding any expense that does not count toward a deductible or out-of-pocket limit. To the extent an insurer imposes a cumulative treatment limitation on a particular covered item or service independent of individual medical necessity determinations, the amount that has accrued toward the limit on the item or service.(II)Historical net priceThe term historical net price means the retrospective average amount an insurer paid for a prescription drug, inclusive of any reasonably allocated rebates, discounts, chargebacks, fees, and any additional price concessions received by the insurer with respect to the prescription drug. The allocation shall be determined by dollar value for non-product specific and product-specific rebates, discounts, chargebacks, fees, and other price concessions to the extent that the total amount of any such price concession is known to the insurer at the time of publication of the historical net price. (III)Negotiated rateThe term negotiated rate means the amount a plan or issuer has contractually agreed to pay for a covered item or service, whether directly or indirectly through a third-party administrator or pharmacy benefit manager, to an in-network provider, including an in-network pharmacy or other prescription drug dispenser, for covered items or services.(IV)Out-of-network allowed amountThe term out-of-network allowed amount means the maximum amount an insurer will pay for a covered item or service furnished by an out-of-network provider.(V)Out-of-network limitThe term out-of-network limit means the maximum amount that an individual is required to pay during a coverage period for his or her share of the costs of covered items and services under his or her plan or coverage, including for self-only and other than self-only coverage, as applicable. (VI)Underlying fee schedule rateThe term underlying fee schedule rate means the rate for an item or service that a plan or issuer uses to determine a participant’s, beneficiary’s, or enrollee’s cost-sharing liability with respect to a particular provider or providers, when the rate is different from the negotiated rate.; (E)Application of paragraphIn addition to qualified health plans (and plans seeking certification as qualified health plans), this paragraph (as amended by the Bipartisan Primary Care and Health Workforce Act) shall apply to group health plans (including self-insured and fully insured plans) and health insurance coverage (as such terms are defined in section 2791 of the Public Health Service Act)..

306. Publication of list of hospitals Beginning not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary) shall establish and maintain a publicly available list, on the website of the Centers for Medicare & Medicaid Services, of each hospital that— is not in compliance with the hospital price transparency rule implementing section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)), and that, with respect to such noncompliance— has been issued a civil monetary penalty; has received a warning notice; or has received a request for a corrective action plan; or has received any written communication from the Secretary regarding potential noncompliance with such hospital price transparency rule. Any penalty, notice, request, or other communication described in subsection (a) shall be subject to public disclosure, in full and without redaction, under section 552 of title 5, United States Code, notwithstanding any exemptions or exclusions otherwise available under such section 552. Not later than 1 year after the date of enactment of this Act and each year thereafter, the Secretary shall submit to Congress, and make publicly available, a report that contains information regarding complaints of alleged violations of law with respect to, and enforcement activities by the Secretary under, the hospital price transparency rule implementing section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)). Such report shall be made available to the public on the website of the Centers for Medicare & Medicaid Services. Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report on compliance and enforcement of the hospital price transparency rule implementing section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg–18(e)). The report shall include recommendations related to— improving price transparency for patients, employers, and the public; the revocation or suspension of tax-exempt status under section 501(c)(3) of the Internal Revenue Code of 1986 for noncompliant hospitals; and increased civil monetary penalty amounts to ensure compliance. Not later than 180 days after the report described in subsection (d) is published, the Secretary, in consultation with the Secretary of the Treasury, shall issue a proposed rule based on the recommendations of the Comptroller General of the United States under subsection (d), including the recommendations described in paragraphs (2) and (3) of such subsection.