Falnor

IN THE SENATE OF THE UNITED STATES Ms. Reyes (for herself, with thanks to Mr. Durbin and others), introduces the following: A BILL To authorize the cancellation of removal and adjustment of status of certain individuals who are long-term United States residents and who entered the United States as children, and for other purposes. SECTION 1. SHORT TITLE. This Act may be cited as the “Dream Act of 2023”. SEC. 2. Definitions. In this Act: (1) IN GENERAL.—Except as otherwise specifically provided, any term used in this Act that is used in the immigration laws shall have the meaning given such term in the immigration laws. (2) DACA.—The term “DACA” means deferred action granted to an alien pursuant to the Deferred Action for Childhood Arrivals program announced by President Obama on June 15, 2012. (3) DISABILITY.—The term “disability” has the meaning given such term in section 3(1) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102(1)). (4) EARLY CHILDHOOD EDUCATION PROGRAM.—The term “early childhood education program” has the meaning given such term in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003). (5) ELEMENTARY SCHOOL; HIGH SCHOOL; SECONDARY SCHOOL.—The terms “elementary school”, “high school”, and “secondary school” have the meanings given such terms in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801). (6) IMMIGRATION LAWS.—The term “immigration laws” has the meaning given such term in section 101(a)(17) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(17)). (7) INSTITUTION OF HIGHER EDUCATION.—The term “institution of higher education”— (A) except as provided in subparagraph (B), has the meaning given such term in section 102 of the Higher Education Act of 1965 (20 U.S.C. 1002); and (B) does not include an institution of higher education outside of the United States. (8) PERMANENT RESIDENT STATUS ON A CONDITIONAL BASIS.—The term “permanent resident status on a conditional basis” means status as an alien lawfully admitted for permanent residence on a conditional basis under this Act. (9) POVERTY LINE.—The term “poverty line” has the meaning given such term in section 673 of the Community Services Block Grant Act (42 U.S.C. 9902). (10) SECRETARY.—Except as otherwise specifically provided, the term “Secretary” means the Secretary of Homeland Security. (11) UNIFORMED SERVICES.—The term “Uniformed Services” has the meaning given the term “uniformed services” in section 101(a) of title 10, United States Code. SEC. 3. Permanent resident status on a conditional basis for certain long-term residents who entered the United States as children. (a) Conditional basis for status.—Notwithstanding any other provision of law, an alien shall be considered, at the time of obtaining the status of an alien lawfully admitted for permanent residence under this section, to have obtained such status on a conditional basis subject to the provisions under this Act. (b) Requirements.— (1) IN GENERAL.—Notwithstanding any other provision of law, the Secretary shall cancel the removal of, and adjust to the status of an alien lawfully admitted for permanent residence on a conditional basis, an alien who is inadmissible or deportable from the United States or is in temporary protected status under section 244 of the Immigration and Nationality Act (8 U.S.C. 1254a), if— (A) the alien has been continuously physically present in the United States since the date that is 4 years before the date of the enactment of this Act; (B) the alien was younger than 18 years of age on the date on which the alien initially entered the United States; (C) subject to paragraphs (2) and (3), the alien— (i) is not inadmissible under paragraph (2), (3), (6)(E), (6)(G), (8), (10)(A), (10)(C), or (10)(D) of section 212(a) of the Immigration and Nationality Act (8 U.S.C. 1182(a)); (ii) has not ordered, incited, assisted, or otherwise participated in the persecution of any person on account of race, religion, nationality, membership in a particular social group, or political opinion; and (iii) has not been convicted of— (I) any offense under Federal or State law, other than a State offense for which an essential element is the alien’s immigration status, that is punishable by a maximum term of imprisonment of more than 1 year; or (II) 3 or more offenses under Federal or State law, other than State offenses for which an essential element is the alien’s immigration status, for which the alien was convicted on different dates for each of the 3 offenses and imprisoned for an aggregate of 90 days or more; and (D) the alien— (i) has been admitted to an institution of higher education; (ii) has earned a high school diploma or a commensurate alternative award from a public or private high school, or has obtained a general education development certificate recognized under State law or a high school equivalency diploma in the United States; or (iii) is enrolled in secondary school or in an education program assisting students in— (I) obtaining a regular high school diploma or its recognized equivalent under State law; or (II) in passing a general educational development exam, a high school equivalence diploma examination, or other similar State-authorized exam. (2) WAIVER.—With respect to any benefit under this Act, the Secretary may waive the grounds of inadmissibility under paragraph (2), (6)(E), (6)(G), or (10)(D) of section 212(a) of the Immigration and Nationality Act (8 U.S.C. 1182(a)) for humanitarian purposes or family unity or if the waiver is otherwise in the public interest. (3) TREATMENT OF EXPUNGED CONVICTIONS.—An expunged conviction shall not automatically be treated as an offense under paragraph (1). The Secretary shall evaluate expunged convictions on a case-by-case basis according to the nature and severity of the offense to determine whether, under the particular circumstances, the Secretary determines that the alien should be eligible for cancellation of removal, adjustment to permanent resident status on a conditional basis, or other adjustment of status. (4) DACA RECIPIENTS.—The Secretary shall cancel the removal of, and adjust to the status of an alien lawfully admitted for permanent residence on a conditional basis, an alien who was granted DACA unless the alien has engaged in conduct since the alien was granted DACA that would make the alien ineligible for DACA. (5) APPLICATION FEE.— (A) IN GENERAL.—The Secretary may require an alien applying for permanent resident status on a conditional basis under this section to pay a reasonable fee that is commensurate with the cost of processing the application. (B) EXEMPTION.—An applicant may be exempted from paying the fee required under subparagraph (A) if the alien— (i) (I) is younger than 18 years of age; (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line; and (III) is in foster care or otherwise lacking any parental or other familial support; (ii) is younger than 18 years of age and is homeless; (iii) (I) cannot care for himself or herself because of a serious, chronic disability; and (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line; or (iv) (I) during the 12-month period immediately preceding the date on which the alien files an application under this section, accumulated $10,000 or more in debt as a result of unreimbursed medical expenses incurred by the alien or an immediate family member of the alien; and (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line. (6) SUBMISSION OF BIOMETRIC AND BIOGRAPHIC DATA.—The Secretary may not grant an alien permanent resident status on a conditional basis under this section unless the alien submits biometric and biographic data, in accordance with procedures established by the Secretary. The Secretary shall provide an alternative procedure for aliens who are unable to provide such biometric or biographic data because of a physical impairment. (7) BACKGROUND CHECKS.— (A) REQUIREMENT FOR BACKGROUND CHECKS.—The Secretary shall utilize biometric, biographic, and other data that the Secretary determines appropriate— (i) to conduct security and law enforcement background checks of an alien seeking permanent resident status on a conditional basis under this section; and (ii) to determine whether there is any criminal, national security, or other factor that would render the alien ineligible for such status. (B) COMPLETION OF BACKGROUND CHECKS.—The security and law enforcement background checks of an alien required under subparagraph (A) shall be completed, to the satisfaction of the Secretary, before the date on which the Secretary grants such alien permanent resident status on a conditional basis under this section. (8) MEDICAL EXAMINATION.— (A) REQUIREMENT.—An alien applying for permanent resident status on a conditional basis under this section shall undergo a medical examination. (B) POLICIES AND PROCEDURES.—The Secretary, with the concurrence of the Secretary of Health and Human Services, shall prescribe policies and procedures for the nature and timing of the examination required under subparagraph (A). (9) MILITARY SELECTIVE SERVICE.—An alien applying for permanent resident status on a conditional basis under this section shall establish that the alien has registered under the Military Selective Service Act (50 U.S.C. 3801 et seq.), if the alien is subject to registration under such Act. (c) Determination of continuous presence.— (1) TERMINATION OF CONTINUOUS PERIOD.—Any period of continuous physical presence in the United States of an alien who applies for permanent resident status on a conditional basis under this section shall not terminate when the alien is served a notice to appear under section 239(a) of the Immigration and Nationality Act (8 U.S.C. 1229(a)). (2) TREATMENT OF CERTAIN BREAKS IN PRESENCE.— (A) IN GENERAL.—Except as provided in subparagraphs (B) and (C), an alien shall be considered to have failed to maintain continuous physical presence in the United States under subsection (b)(1)(A) if the alien has departed from the United States for any period exceeding 90 days or for any periods, in the aggregate, exceeding 180 days. (B) EXTENSIONS FOR EXTENUATING CIRCUMSTANCES.—The Secretary may extend the time periods described in subparagraph (A) for an alien who demonstrates that the failure to timely return to the United States was due to extenuating circumstances beyond the alien’s control, including the serious illness of the alien, or death or serious illness of a parent, grandparent, sibling, or child of the alien. (C) TRAVEL AUTHORIZED BY THE SECRETARY.—Any period of travel outside of the United States by an alien that was authorized by the Secretary may not be counted toward any period of departure from the United States under subparagraph (A). (d) Limitation on removal of certain aliens.— (1) IN GENERAL.—The Secretary or the Attorney General may not remove an alien who appears prima facie eligible for relief under this section. (2) ALIENS SUBJECT TO REMOVAL.—The Secretary shall provide a reasonable opportunity to apply for relief under this section to any alien who requests such an opportunity or who appears prima facie eligible for relief under this section if the alien is in removal proceedings, is the subject of a final removal order, or is the subject of a voluntary departure order. (3) CERTAIN ALIENS ENROLLED IN ELEMENTARY OR SECONDARY SCHOOL.— (A) STAY OF REMOVAL.—The Attorney General shall stay the removal proceedings of an alien who— (i) meets all the requirements under subparagraphs (A), (B), and (C) of subsection (b)(1), subject to paragraphs (2) and (3) of such subsection; (ii) is at least 5 years of age; and (iii) is enrolled in an elementary school, a secondary school, or an early childhood education program. (B) COMMENCEMENT OF REMOVAL PROCEEDINGS.—The Secretary may not commence removal proceedings for an alien described in subparagraph (A). (C) EMPLOYMENT.—An alien whose removal is stayed pursuant to subparagraph (A) or who may not be placed in removal proceedings pursuant to subparagraph (B) shall, upon application to the Secretary, be granted an employment authorization document. (D) LIFT OF STAY.—The Secretary or Attorney General may not lift the stay granted to an alien under subparagraph (A) unless the alien ceases to meet the requirements under such subparagraph. (e) Exemption from numerical limitations.—Nothing in this section or in any other law may be construed to apply a numerical limitation on the number of aliens who may be granted permanent resident status on a conditional basis under this Act. SEC. 4. Terms of permanent resident status on a conditional basis. (a) Period of status.—Permanent resident status on a conditional basis is— (1) valid for a period of 8 years, unless such period is extended by the Secretary; and (2) subject to termination under subsection (c). (b) Notice of requirements.—At the time an alien obtains permanent resident status on a conditional basis, the Secretary shall provide notice to the alien regarding the provisions of this Act and the requirements to have the conditional basis of such status removed. (c) Termination of status.—The Secretary may terminate the permanent resident status on a conditional basis of an alien only if the Secretary— (1) determines that the alien ceases to meet the requirements under paragraph (1)(C) of section 3(b), subject to paragraphs (2) and (3) of that section; and (2) prior to the termination, provides the alien— (A) notice of the proposed termination; and (B) the opportunity for a hearing to provide evidence that the alien meets such requirements or otherwise contest the termination. (d) Return to previous immigration status.— (1) IN GENERAL.—Except as provided in paragraph (2), an alien whose permanent resident status on a conditional basis expires under subsection (a)(1) or is terminated under subsection (c) or whose application for such status is denied shall return to the immigration status that the alien had immediately before receiving permanent resident status on a conditional basis or applying for such status, as appropriate. (2) SPECIAL RULE FOR TEMPORARY PROTECTED STATUS.—An alien whose permanent resident status on a conditional basis expires under subsection (a)(1) or is terminated under subsection (c) or whose application for such status is denied and who had temporary protected status under section 244 of the Immigration and Nationality Act (8 U.S.C. 1254a) immediately before receiving or applying for such permanent resident status on a conditional basis, as appropriate, may not return to such temporary protected status if— (A) the relevant designation under section 244(b) of the Immigration and Nationality Act (8 U.S.C. 1254a(b)) has been terminated; or (B) the Secretary determines that the reason for terminating the permanent resident status on a conditional basis renders the alien ineligible for such temporary protected status. SEC. 5. Removal of conditional basis of permanent resident status. (a) Eligibility for removal of conditional basis.— (1) IN GENERAL.—Subject to paragraph (2), the Secretary shall remove the conditional basis of an alien’s permanent resident status granted under this Act and grant the alien status as an alien lawfully admitted for permanent residence if the alien— (A) is described in paragraph (1)(C) of section 3(b), subject to paragraphs (2) and (3) of that section; (B) has not abandoned the alien’s residence in the United States; and (C) (i) has acquired a degree from an institution of higher education or has completed at least 2 years, in good standing, in a program for a bachelor’s degree or higher degree in the United States; (ii) has served in the Uniformed Services for at least 2 years and, if discharged, received an honorable discharge; or (iii) has been employed for periods totaling at least 3 years and at least 75 percent of the time that the alien has had a valid employment authorization, except that any period during which the alien is not employed while having a valid employment authorization and is enrolled in an institution of higher education, a secondary school, or an education program described in section 3(b)(1)(D)(iii), shall not count toward the time requirements under this clause. (2) HARDSHIP EXCEPTION.—The Secretary shall remove the conditional basis of an alien’s permanent resident status and grant the alien status as an alien lawfully admitted for permanent residence if the alien— (A) satisfies the requirements under subparagraphs (A) and (B) of paragraph (1); (B) demonstrates compelling circumstances for the inability to satisfy the requirements under subparagraph (C) of such paragraph; and (C) demonstrates that— (i) the alien has a disability; (ii) the alien is a full-time caregiver of a minor child; or (iii) the removal of the alien from the United States would result in extreme hardship to the alien or the alien’s spouse, parent, or child who is a national of the United States or is lawfully admitted for permanent residence. (3) CITIZENSHIP REQUIREMENT.— (A) IN GENERAL.—Except as provided in subparagraph (B), the conditional basis of an alien’s permanent resident status granted under this Act may not be removed unless the alien demonstrates that the alien satisfies the requirements under section 312(a) of the Immigration and Nationality Act (8 U.S.C. 1423(a)). (B) EXCEPTION.—Subparagraph (A) shall not apply to an alien who is unable to meet the requirements under such section 312(a) due to disability. (4) APPLICATION FEE.— (A) IN GENERAL.—The Secretary may require aliens applying for lawful permanent resident status under this section to pay a reasonable fee that is commensurate with the cost of processing the application. (B) EXEMPTION.—An applicant may be exempted from paying the fee required under subparagraph (A) if the alien— (i) (I) is younger than 18 years of age; (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line; and (III) is in foster care or otherwise lacking any parental or other familial support; (ii) is younger than 18 years of age and is homeless; (iii) (I) cannot care for himself or herself because of a serious, chronic disability; and (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line; or (iv) (I) during the 12-month period immediately preceding the date on which the alien files an application under this section, the alien accumulated $10,000 or more in debt as a result of unreimbursed medical expenses incurred by the alien or an immediate family member of the alien; and (II) received total income, during the 12-month period immediately preceding the date on which the alien files an application under this section, that is less than 150 percent of the poverty line. (5) SUBMISSION OF BIOMETRIC AND BIOGRAPHIC DATA.—The Secretary may not remove the conditional basis of an alien’s permanent resident status unless the alien submits biometric and biographic data, in accordance with procedures established by the Secretary. The Secretary shall provide an alternative procedure for applicants who are unable to provide such biometric data because of a physical impairment. (6) BACKGROUND CHECKS.— (A) REQUIREMENT FOR BACKGROUND CHECKS.—The Secretary shall utilize biometric, biographic, and other data that the Secretary determines appropriate— (i) to conduct security and law enforcement background checks of an alien applying for removal of the conditional basis of the alien’s permanent resident status; and (ii) to determine whether there is any criminal, national security, or other factor that would render the alien ineligible for removal of such conditional basis. (B) COMPLETION OF BACKGROUND CHECKS.—The security and law enforcement background checks of an alien required under subparagraph (A) shall be completed, to the satisfaction of the Secretary, before the date on which the Secretary removes the conditional basis of the alien’s permanent resident status. (b) Treatment for purposes of naturalization.— (1) IN GENERAL.—For purposes of title III of the Immigration and Nationality Act (8 U.S.C. 1401 et seq.), an alien granted permanent resident status on a conditional basis shall be considered to have been admitted to the United States, and be present in the United States, as an alien lawfully admitted for permanent residence. (2) LIMITATION ON APPLICATION FOR NATURALIZATION.—An alien may not apply for naturalization while the alien is in permanent resident status on a conditional basis. SEC. 6. Documentation requirements. (a) Documents establishing identity.—An alien’s application for permanent resident status on a conditional basis may include, as proof of identity— (1) a passport or national identity document from the alien’s country of origin that includes the alien’s name and the alien’s photograph or fingerprint; (2) the alien’s birth certificate and an identity card that includes the alien’s name and photograph; (3) a school identification card that includes the alien’s name and photograph, and school records showing the alien’s name and that the alien is or was enrolled at the school; (4) a Uniformed Services identification card issued by the Department of Defense; (5) any immigration or other document issued by the United States Government bearing the alien’s name and photograph; or (6) a State-issued identification card bearing the alien's name and photograph. (b) Documents establishing continuous physical presence in the United States.—To establish that an alien has been continuously physically present in the United States, as required under section 3(b)(1)(A), or to establish that an alien has not abandoned residence in the United States, as required under section 5(a)(1)(B), the alien may submit documents to the Secretary, including— (1) employment records that include the employer’s name and contact information; (2) records from any educational institution the alien has attended in the United States; (3) records of service from the Uniformed Services; (4) official records from a religious entity confirming the alien’s participation in a religious ceremony; (5) passport entries; (6) a birth certificate for a child who was born in the United States; (7) automobile license receipts or registration; (8) deeds, mortgages, or rental agreement contracts; (9) tax receipts; (10) insurance policies; (11) remittance records; (12) rent receipts or utility bills bearing the alien’s name or the name of an immediate family member of the alien, and the alien’s address; (13) copies of money order receipts for money sent in or out of the United States; (14) dated bank transactions; or (15) 2 or more sworn affidavits from individuals who are not related to the alien who have direct knowledge of the alien’s continuous physical presence in the United States, that contain— (A) the name, address, and telephone number of the affiant; and (B) the nature and duration of the relationship between the affiant and the alien. (c) Documents establishing initial entry into the United States.—To establish under section 3(b)(1)(B) that an alien was younger than 18 years of age on the date on which the alien initially entered the United States, an alien may submit documents to the Secretary, including— (1) an admission stamp on the alien’s passport; (2) records from any educational institution the alien has attended in the United States; (3) any document from the Department of Justice or the Department of Homeland Security stating the alien’s date of entry into the United States; (4) hospital or medical records showing medical treatment or hospitalization, the name of the medical facility or physician, and the date of the treatment or hospitalization; (5) rent receipts or utility bills bearing the alien’s name or the name of an immediate family member of the alien, and the alien’s address; (6) employment records that include the employer’s name and contact information; (7) official records from a religious entity confirming the alien’s participation in a religious ceremony; (8) a birth certificate for a child who was born in the United States; (9) automobile license receipts or registration; (10) deeds, mortgages, or rental agreement contracts; (11) tax receipts; (12) travel records; (13) copies of money order receipts sent in or out of the country; (14) dated bank transactions; (15) remittance records; or (16) insurance policies. (d) Documents establishing admission to an institution of higher education.—To establish that an alien has been admitted to an institution of higher education, the alien shall submit to the Secretary a document from the institution of higher education certifying that the alien— (1) has been admitted to the institution; or (2) is currently enrolled in the institution as a student. (e) Documents establishing receipt of a degree from an institution of higher education.—To establish that an alien has acquired a degree from an institution of higher education in the United States, the alien shall submit to the Secretary a diploma or other document from the institution stating that the alien has received such a degree. (f) Documents establishing receipt of high school diploma, general educational development certificate, or a recognized equivalent.—To establish that an alien has earned a high school diploma or a commensurate alternative award from a public or private high school, or has obtained a general educational development certificate recognized under State law or a high school equivalency diploma in the United States, the alien shall submit to the Secretary— (1) a high school diploma, certificate of completion, or other alternate award; (2) a high school equivalency diploma or certificate recognized under State law; or (3) evidence that the alien passed a State-authorized exam, including the general educational development exam, in the United States. (g) Documents establishing enrollment in an educational program.—To establish that an alien is enrolled in any school or education program described in section 3(b)(1)(D)(iii), 3(d)(3)(A)(iii), or 5(a)(1)(C), the alien shall submit school records from the United States school that the alien is currently attending that include— (1) the name of the school; and (2) the alien’s name, periods of attendance, and current grade or educational level. (h) Documents establishing exemption from application fees.—To establish that an alien is exempt from an application fee under section 3(b)(5)(B) or 5(a)(4)(B), the alien shall submit to the Secretary the following relevant documents: (1) DOCUMENTS TO ESTABLISH AGE.—To establish that an alien meets an age requirement, the alien shall provide proof of identity, as described in subsection (a), that establishes that the alien is younger than 18 years of age. (2) DOCUMENTS TO ESTABLISH INCOME.—To establish the alien’s income, the alien shall provide— (A) employment records that have been maintained by the Social Security Administration, the Internal Revenue Service, or any other Federal, State, or local government agency; (B) bank records; or (C) at least 2 sworn affidavits from individuals who are not related to the alien and who have direct knowledge of the alien’s work and income that contain— (i) the name, address, and telephone number of the affiant; and (ii) the nature and duration of the relationship between the affiant and the alien. (3) DOCUMENTS TO ESTABLISH FOSTER CARE, LACK OF FAMILIAL SUPPORT, HOMELESSNESS, OR SERIOUS, CHRONIC DISABILITY.—To establish that the alien was in foster care, lacks parental or familial support, is homeless, or has a serious, chronic disability, the alien shall provide at least 2 sworn affidavits from individuals who are not related to the alien and who have direct knowledge of the circumstances that contain— (A) a statement that the alien is in foster care, otherwise lacks any parental or other familiar support, is homeless, or has a serious, chronic disability, as appropriate; (B) the name, address, and telephone number of the affiant; and (C) the nature and duration of the relationship between the affiant and the alien. (4) DOCUMENTS TO ESTABLISH UNPAID MEDICAL EXPENSE.—To establish that the alien has debt as a result of unreimbursed medical expenses, the alien shall provide receipts or other documentation from a medical provider that— (A) bear the provider’s name and address; (B) bear the name of the individual receiving treatment; and (C) document that the alien has accumulated $10,000 or more in debt in the past 12 months as a result of unreimbursed medical expenses incurred by the alien or an immediate family member of the alien. (i) Documents establishing qualification for hardship exemption.—To establish that an alien satisfies one of the criteria for the hardship exemption set forth in section 5(a)(2)(C), the alien shall submit to the Secretary at least 2 sworn affidavits from individuals who are not related to the alien and who have direct knowledge of the circumstances that warrant the exemption, that contain— (1) the name, address, and telephone number of the affiant; and (2) the nature and duration of the relationship between the affiant and the alien. (j) Documents establishing service in the Uniformed Services.—To establish that an alien has served in the Uniformed Services for at least 2 years and, if discharged, received an honorable discharge, the alien shall submit to the Secretary— (1) a Department of Defense form DD–214; (2) a National Guard Report of Separation and Record of Service form 22; (3) personnel records for such service from the appropriate Uniformed Service; or (4) health records from the appropriate Uniformed Service. (k) Documents establishing employment.— (1) IN GENERAL.—An alien may satisfy the employment requirement under section 5(a)(1)(C)(iii) by submitting records that— (A) establish compliance with such employment requirement; and (B) have been maintained by the Social Security Administration, the Internal Revenue Service, or any other Federal, State, or local government agency. (2) OTHER DOCUMENTS.—An alien who is unable to submit the records described in paragraph (1) may satisfy the employment requirement by submitting at least 2 types of reliable documents that provide evidence of employment, including— (A) bank records; (B) business records; (C) employer records; (D) records of a labor union, day labor center, or organization that assists workers in employment; (E) sworn affidavits from individuals who are not related to the alien and who have direct knowledge of the alien’s work, that contain— (i) the name, address, and telephone number of the affiant; and (ii) the nature and duration of the relationship between the affiant and the alien; and (F) remittance records. (l) Authority To prohibit use of certain documents.—If the Secretary determines, after publication in the Federal Register and an opportunity for public comment, that any document or class of documents does not reliably establish identity or that permanent resident status on a conditional basis is being obtained fraudulently to an unacceptable degree, the Secretary may prohibit or restrict the use of such document or class of documents. SEC. 7. Rulemaking. (a) Initial publication.—Not later than 90 days after the date of the enactment of this Act, the Secretary shall publish regulations implementing this Act in the Federal Register. Such regulations shall allow eligible individuals to immediately apply affirmatively for the relief available under section 3 without being placed in removal proceedings. (b) Interim regulations.—Notwithstanding section 553 of title 5, United States Code, the regulations published pursuant to subsection (a) shall be effective, on an interim basis, immediately upon publication in the Federal Register, but may be subject to change and revision after public notice and opportunity for a period of public comment. (c) Final regulations.—Not later than 180 days after the date on which interim regulations are published under this section, the Secretary shall publish final regulations implementing this Act. (d) Paperwork Reduction Act.—The requirements under chapter 35 of title 44, United States Code (commonly known as the “Paperwork Reduction Act”), shall not apply to any action to implement this Act. SEC. 8. Confidentiality of information. (a) In general.—The Secretary may not disclose or use information provided in applications filed under this Act or in requests for DACA for the purpose of immigration enforcement. (b) Referrals prohibited.—The Secretary may not refer any individual who has been granted permanent resident status on a conditional basis or who was granted DACA to U.S. Immigration and Customs Enforcement, U.S. Customs and Border Protection, or any designee of either such entity. (c) Limited exception.—Notwithstanding subsections (a) and (b), information provided in an application for permanent resident status on a conditional basis or a request for DACA may be shared with Federal security and law enforcement agencies— (1) for assistance in the consideration of an application for permanent resident status on a conditional basis; (2) to identify or prevent fraudulent claims; (3) for national security purposes; or (4) for the investigation or prosecution of any felony not related to immigration status. (d) Penalty.—Any person who knowingly uses, publishes, or permits information to be examined in violation of this section shall be fined not more than $10,000. SEC. 9. Restoration of State option to determine residency for purposes of higher education benefits. (a) In general.—Section 505 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (8 U.S.C. 1623) is repealed. (b) Effective date.—The repeal under subsection (a) shall take effect as if included in the original enactment of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (division C of Public Law 104–208; 110 Stat. 3009–546).

IN THE SENATE OF THE UNITED STATES Ms. Reyes (for herself, with thanks to Mr. Sanders and others), introduces the following: A BILL To allow Americans to earn paid sick time so that they can address their own health needs and the health needs of their families. SECTION 1. SHORT TITLE. This Act may be cited as the “Healthy Families Act”. SEC. 2. DEFINITIONS. In this Act: (1) CHILD.—The term “child” means a biological, foster, or adopted child, a stepchild, a child of a domestic partner, a legal ward, or a child of a person standing in loco parentis. (2) COMMERCE.—The terms “commerce” and “industry or activity affecting commerce” mean any activity, business, or industry in commerce or in which a labor dispute would hinder or obstruct commerce or the free flow of commerce, and include “commerce” and any “industry affecting commerce”, as defined in paragraphs (1) and (3) of section 501 of the Labor Management Relations Act, 1947 (29 U.S.C. 142 (1) and (3)). (3) DOMESTIC PARTNER.— (A) IN GENERAL.—The term “domestic partner”, with respect to an individual, means another individual with whom the individual is in a committed relationship. (B) COMMITTED RELATIONSHIP DEFINED.—The term “committed relationship” means a relationship between 2 individuals, each at least 18 years of age, in which each individual is the other individual’s sole domestic partner and both individuals share responsibility for a significant measure of each other’s common welfare. The term includes any such relationship between 2 individuals, including individuals of the same sex, that is granted legal recognition by a State or political subdivision of a State as a marriage or analogous relationship, including a civil union or domestic partnership. (4) DOMESTIC VIOLENCE.—The term “domestic violence” has the meaning given the term in section 40002(a) of the Violence Against Women Act of 1994 (34 U.S.C. 12291(a)), except that the reference in such section to the term “jurisdiction receiving grant funding” shall be deemed to mean the jurisdiction in which the victim lives or the jurisdiction in which the employer involved is located. Such term also includes “dating violence”, as that term is defined in such section. (5) EMPLOYEE.—The term “employee” means an individual who is— (A) (i) an employee, as defined in section 3(e) of the Fair Labor Standards Act of 1938 (29 U.S.C. 203(e)), who is not covered under any other provision of this paragraph, including such an employee of the Library of Congress, except that a reference in such section to an employer shall be considered to be a reference to an employer described in paragraph (6)(A)(i)(I); (ii) an employee of the Government Accountability Office; or (iii) an employee of a covered employer described in paragraph (6)(B)(i)(V) who performs work that has been traditionally performed by employees in a railroad industry craft or class recognized under the Ninth paragraph of section 2 of the Railway Labor Act (45 U.S.C. 152), including any employee who performs— (I) work with respect to the movement of trains; (II) maintenance of way work; (III) signal work; (IV) work for purposes of the inspection, maintenance, repair, or cleaning of locomotives, rail maintenance facilities, rail-related equipment, or rail cars; (V) dispatching work; (VI) work with respect to the movement of equipment within a rail yard; or (VII) rail clerical or communications work; (B) a State employee described in section 304(a) of the Government Employee Rights Act of 1991 (42 U.S.C. 2000e–16c(a)); (C) a covered employee, as defined in section 101 of the Congressional Accountability Act of 1995 (2 U.S.C. 1301), other than an applicant for employment; (D) a covered employee, as defined in section 411(c) of title 3, United States Code; or (E) a Federal officer or employee covered under subchapter V of chapter 63 of title 5, United States Code (without regard to the limitation in section 6381(1)(B) of that title). (6) EMPLOYER.— (A) IN GENERAL.—The term “employer” means a person who is— (i) (I) a covered employer who is not described in any other subclause of this clause; (II) an entity employing a State employee described in section 304(a) of the Government Employee Rights Act of 1991; (III) an employing office, as defined in section 101 of the Congressional Accountability Act of 1995; (IV) an employing office, as defined in section 411(c) of title 3, United States Code; or (V) an employing agency covered under subchapter V of chapter 63 of title 5, United States Code; and (ii) engaged in commerce (including government), or an industry or activity affecting commerce (including government). (B) COVERED EMPLOYER.— (i) IN GENERAL.—In subparagraph (A)(i)(I), the term “covered employer”— (I) means any person engaged in commerce or in any industry or activity affecting commerce who employs 15 or more employees for each working day during each of 20 or more calendar workweeks in the current or preceding year; (II) means a smaller employer, to which the special rule in paragraph (3) of section 3(a) applies; (III) means the Government Accountability Office and the Library of Congress; (IV) includes— (aa) any person who acts, directly or indirectly, in the interest of an employer covered by this clause to any of the employees of such employer; and (bb) any successor in interest of such an employer; and (V) includes any rail carrier. (ii) PUBLIC AGENCY.—For purposes of clause (i), a public agency, as defined in section 3(x) of the Fair Labor Standards Act of 1938 (29 U.S.C. 203(x)), shall be considered to be a person engaged in commerce or in an industry or activity affecting commerce. (iii) DEFINITIONS.—For purposes of this subparagraph: (I) EMPLOYEE.—The term “employee” has the meaning given such term in section 3(e) of the Fair Labor Standards Act of 1938 (29 U.S.C. 203(e)). (II) PERSON.—The term “person” has the meaning given such term in section 3(a) of the Fair Labor Standards Act of 1938 (29 U.S.C. 203(a)). (III) SMALLER EMPLOYER.—The term “smaller employer” means any person engaged in commerce or in any industry or activity affecting commerce who employs fewer than 15 employees for each working day during each of 20 or more calendar workweeks in the preceding year. (C) PREDECESSORS.—Any reference in this paragraph to an employer, including such a smaller employer, shall include a reference to any predecessor of such employer. (7) EMPLOYMENT BENEFITS.—The term “employment benefits” means all benefits provided or made available to employees by an employer, including group life insurance, health insurance, disability insurance, sick leave, annual leave, educational benefits, and pensions, regardless of whether such benefits are provided by a practice or written policy of an employer or through an “employee benefit plan”, as defined in section 3(3) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(3)). (8) HEALTH CARE PROVIDER.—The term “health care provider” means a provider who— (A) (i) is a doctor of medicine or osteopathy who is authorized to practice medicine or surgery (as appropriate) by the State in which the doctor practices; or (ii) is any other person determined by the Secretary to be capable of providing health care services; and (B) is not employed by an employer for whom the provider issues certification under this Act. (9) PAID SICK TIME.—The term “paid sick time” means an increment of compensated leave that— (A) can be earned by an employee for use during an absence from employment for any of the reasons described in paragraphs (1) through (4) of section 3(b); and (B) is compensated at a rate that is not less than the greater of— (i) the regular rate of pay of the employee; (ii) the rate specified in section 6(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(a)(1)); or (iii) the rate specified in the applicable State or local minimum wage law. (10) PARENT.—The term “parent” means a biological, foster, or adoptive parent of an employee, a stepparent of an employee, parent-in-law, parent of a domestic partner, or a legal guardian or other person who stood in loco parentis to an employee when the employee was a child. (11) RAIL CARRIER.—The term “rail carrier” has the meaning given such term in section 10102 of title 49, United States Code. (12) SECRETARY.—The term “Secretary” means the Secretary of Labor. (13) SEXUAL ASSAULT.—The term “sexual assault” has the meaning given the term in section 40002(a) of the Violence Against Women Act of 1994 (34 U.S.C. 12291(a)). (14) SPOUSE.—The term “spouse”, with respect to an employee, has the meaning given such term by the marriage laws of the State in which the marriage was celebrated. (15) STALKING.—The term “stalking” has the meaning given the term in section 40002(a) of the Violence Against Women Act of 1994 (34 U.S.C. 12291(a)). (16) STATE.—The term “State” has the meaning given the term in section 3 of the Fair Labor Standards Act of 1938 (29 U.S.C. 203). (17) UNPAID SICK TIME.—The term “unpaid sick time” means the leave earned and used in the same manner and under the same conditions and procedures as paid sick time for the purposes of this Act, except that no compensation shall be paid. (18) VICTIM SERVICES ORGANIZATION.—The term “victim services organization” means a nonprofit, nongovernmental organization that provides assistance to victims of domestic violence, sexual assault, or stalking or advocates for such victims, including a rape crisis center, an organization carrying out a domestic violence, sexual assault, or stalking prevention or treatment program, an organization operating a shelter or providing counseling services, or a legal services organization or other organization providing assistance through the legal process. SEC. 3. EARNED PAID SICK TIME. (a) Earning of paid sick time.— (1) IN GENERAL.—An employer shall provide each employee employed by the employer not less than 1 hour of earned paid sick time for every 30 hours worked, to be used as described in this section. An employer shall not be required to permit an employee to earn, under this section, more than 56 hours of paid sick time in a year, unless the employer chooses to set a higher limit. (2) EXEMPT EMPLOYEES.— (A) IN GENERAL.—Except as provided in subparagraph (B), for purposes of this section, an employee who is exempt from overtime requirements under section 13(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 213(a)(1)) shall be deemed to work 40 hours in each workweek. (B) SHORTER NORMAL WORKWEEK.—If the normal workweek of such an employee is less than 40 hours, the employee shall earn paid sick time based upon that normal workweek. (3) SPECIAL RULE FOR SMALLER EMPLOYERS.—A smaller employer, as defined in section 2(6)(B)(iii), may provide paid sick time as provided under paragraph (1) but if such smaller employer opts not to do so, the smaller employer shall provide not fewer than 56 hours of unpaid sick time to each employee per year to be used for the same purposes and under the same conditions and procedures as set out in this Act. The provision and earning of unpaid sick time shall be treated in all respects the same as the provision and earning of paid sick time under this Act. References in this Act to paid sick time shall, with respect to such smaller employers, be deemed to be references to unpaid sick time. (4) DATES FOR BEGINNING TO EARN PAID SICK TIME AND USE.—Except as provided in the second sentence of paragraph (8), employees shall begin to earn paid sick time under this section at the commencement of their employment. Except as provided in such sentence, an employee shall be entitled to use the earned paid sick time beginning on the 60th calendar day following commencement of the employee's employment. After that 60th calendar day, the employee may use the paid sick time as the time is earned. An employer may, at the discretion of the employer, loan paid sick time to an employee for use by such employee in advance of the employee earning such sick time as provided in this subsection and may permit use before the 60th day of employment. (5) CARRYOVER.— (A) IN GENERAL.—Except as provided in subparagraph (B), paid sick time earned under this section shall carry over from 1 year to the next. (B) CONSTRUCTION.—This Act shall not be construed to require an employer to permit an employee to earn more than 56 hours of earned paid sick time in a calendar year. (6) EMPLOYERS WITH EXISTING POLICIES.—Any employer with a paid leave policy who makes available an amount of paid leave that is sufficient to meet the requirements of this section and that may be used for the same purposes and under the same conditions and procedures as the purposes, conditions, and procedures described in this section shall not be required to permit an employee to earn additional paid sick time under this section. (7) CONSTRUCTION.—Nothing in this section shall be construed as requiring financial or other reimbursement to an employee from an employer upon the employee’s termination, resignation, retirement, or other separation from employment for earned paid sick time that has not been used. (8) REINSTATEMENT.—If an employee is separated from employment with an employer and is rehired, within 12 months after that separation, by the same employer, the employer shall reinstate the employee’s previously earned paid sick time. The employee shall be entitled to use the earned paid sick time and earn additional paid sick time at the recommencement of employment with the employer. (9) PROHIBITION.—An employer may not require, as a condition of providing paid sick time under this Act, that the employee involved search for or find a replacement employee to cover the hours during which the employee is using paid sick time. (b) Uses.—Paid sick time earned under subsection (a) may be used by an employee for any of the following: (1) An absence resulting from a physical or mental illness, injury, or medical condition of the employee. (2) An absence resulting from obtaining professional medical diagnosis or care, or preventive medical care, for the employee. (3) An absence for the purpose of caring for a child, a parent, a spouse, a domestic partner, or any other individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship, who— (A) has any of the conditions or needs for diagnosis or care described in paragraph (1) or (2); (B) is required to attend— (i) in the case of someone who is a child, a school meeting; or (ii) a meeting at a place where the child, parent, spouse, domestic partner, or such other individual is receiving care necessitated by a health condition or disability of the child, parent, spouse, domestic partner, or such other individual; (C) is in need of care and is typically cared for by an individual who is unable to provide care because the individual has any of conditions or needs for diagnosis or care described in paragraph (1) or (2); or (D) is otherwise in need of care. (4) An absence resulting from domestic violence, sexual assault, or stalking, if the time is to— (A) seek medical attention for the employee or the employee’s child, parent, spouse, domestic partner, or an individual related to the employee as described in paragraph (3), to recover from physical or psychological injury or disability caused by domestic violence, sexual assault, or stalking; (B) obtain or assist a child, a parent, a spouse, a domestic partner, or any other individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship in obtaining services from a victim services organization; (C) obtain or assist a child, a parent, a spouse, a domestic partner, or any other individual related by blood or affinity whose close association with the employee is the equivalent of a family relationship in obtaining psychological or other counseling; (D) seek relocation; or (E) take legal action, including preparing for or participating in any civil or criminal legal proceeding related to or resulting from domestic violence, sexual assault, or stalking. (c) Scheduling.—An employee shall make a reasonable effort to schedule a period of paid sick time under this Act in a manner that does not unduly disrupt the operations of the employer. (d) Procedures.— (1) IN GENERAL.—Paid sick time shall be provided upon the oral or written request of an employee. Such request shall— (A) include the expected duration of the period of such time; and (B) (i) in a case in which the need for such period of time is foreseeable at least 7 days in advance of such period, be provided at least 7 days in advance of such period; or (ii) otherwise, be provided as soon as practicable after the employee is aware of the need for such period. (2) CERTIFICATION IN GENERAL.— (A) PROVISION.— (i) IN GENERAL.—Subject to subparagraph (C), an employer may require that a request for paid sick time under this section for a purpose described in paragraph (1), (2), or (3) of subsection (b) be supported by a certification issued by the health care provider of the eligible employee or of an individual described in subsection (b)(3), as appropriate, if the period of such time covers more than 3 consecutive workdays. (ii) TIMELINESS.—The employee shall provide a copy of such certification to the employer in a timely manner, not later than 30 days after the first day of the period of time. The employer shall not delay the commencement of the period of time on the basis that the employer has not yet received the certification. (B) SUFFICIENT CERTIFICATION.—A certification provided under subparagraph (A) shall be sufficient if it states— (i) the date on which the period of time will be needed; (ii) the probable duration of the period of time; and (iii) (I) for purposes of paid sick time under subsection (b)(1), a statement that absence from work is medically necessary; (II) for purposes of such time under subsection (b)(2), the dates on which testing for a medical diagnosis or care is expected to be given and the duration of such testing or care; and (III) for purposes of such time under subsection (b)(3), in the case of time to care for someone who is not a child, a statement that care is needed for an individual described in such subsection, and an estimate of the amount of time that such care is needed for such individual. (C) REGULATIONS.—Regulations prescribed under section 12 shall specify the manner in which an employee who does not have health insurance shall provide a certification for purposes of this paragraph. (D) CONFIDENTIALITY AND NONDISCLOSURE.— (i) PROTECTED HEALTH INFORMATION.—Nothing in this Act shall be construed to require a health care provider to disclose information in violation of section 1177 of the Social Security Act (42 U.S.C. 1320d–6) or the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note). (ii) HEALTH INFORMATION RECORDS.—If an employer possesses health information about an employee or an employee’s child, parent, spouse, domestic partner, or an individual related to the employee as described in subsection (b)(3), such information shall— (I) be maintained on a separate form and in a separate file from other personnel information; (II) be treated as a confidential medical record; and (III) not be disclosed except to the affected employee or with the permission of the affected employee. (3) CERTIFICATION IN THE CASE OF DOMESTIC VIOLENCE, SEXUAL ASSAULT, OR STALKING.— (A) IN GENERAL.—An employer may require that a request for paid sick time under this section for a purpose described in subsection (b)(4) be supported by a form of documentation described in subparagraph (B) if the period of such time covers more than 3 consecutive workdays. (B) FORM OF DOCUMENTATION.—A form of documentation described in this subparagraph is any one of the following: (i) A police report indicating that the employee, or an individual described in subsection (b)(4)(A) with respect to the employee, was a victim of domestic violence, sexual assault, or stalking. (ii) A court order protecting or separating the employee, or such an individual with respect to the employee, from the perpetrator of an act of domestic violence, sexual assault, or stalking, or other evidence from the court or prosecuting attorney that the employee, or an individual described in subsection (b)(4)(A) with respect to the employee, has appeared in court or is scheduled to appear in court in a proceeding related to domestic violence, sexual assault, or stalking. (iii) Other documentation signed by an employee or volunteer working for a victim services organization, an attorney, a police officer, a medical professional, a social worker, an antiviolence counselor, or a member of the clergy, affirming that the employee, or an individual described in subsection (b)(4)(A) with respect to the employee, is a victim of domestic violence, sexual assault, or stalking. (C) REQUIREMENTS.—The requirements of paragraph (2) shall apply to certifications under this paragraph, except that— (i) subparagraph (B)(iii) of such paragraph shall not apply; (ii) the certification shall state the reason that the leave is required with the facts to be disclosed limited to the minimum necessary to establish a need for the employee to be absent from work, and the employee shall not be required to explain the details of the domestic violence, sexual assault, or stalking involved; and (iii) with respect to confidentiality under subparagraph (D) of such paragraph, any information provided to the employer under this paragraph shall be confidential, except to the extent that any disclosure of such information is— (I) requested or consented to in writing by the employee; or (II) otherwise required by applicable Federal or State law. (D) SPECIFICATION OF DOCUMENTATION.—An employer may not specify which of the forms of documentation described in clause (i), (ii), or (iii) of subparagraph (B) is required to be provided in order to satisfy the requirement under subparagraph (A). SEC. 4. NOTICE REQUIREMENT. (a) In general.—Each employer shall notify each employee and include in any employee handbook, information— (1) describing paid sick time available to employees under this Act; (2) pertaining to the filing of an action under this Act; (3) on the details of the notice requirement for a foreseeable period of time under section 3(d)(1)(B)(i); and (4) that describes— (A) the protections that an employee has in exercising rights under this Act; and (B) how the employee can contact the Secretary (or other appropriate authority as described in section 6) if any of the rights are violated. (b) Posting of notice.—Each employer shall post and keep posted a notice, to be prepared or approved in accordance with procedures specified in regulations prescribed under section 12, setting forth excerpts from, or summaries of, the pertinent provisions of this Act including the information described in paragraphs (1) through (4) of subsection (a). (c) Location.—The notice described under subsection (b) shall be posted— (1) in conspicuous places on the premises of the employer, where notices to employees (including applicants) are customarily posted; and (2) in employee handbooks. (d) Violation; penalty.—Any employer who willfully violates subsection (b) shall be subject to a civil fine in an amount not to exceed $100 for each separate offense. SEC. 5. PROHIBITED ACTS. (a) Interference with rights.— (1) EXERCISE OF RIGHTS.—It shall be unlawful for any employer to interfere with, restrain, or deny the exercise of, or the attempt to exercise, any right provided under this Act, including— (A) discharging or discriminating against (including retaliating against) any individual, including a job applicant, for exercising, or attempting to exercise, any right provided under this Act; (B) using the taking of paid sick time or unpaid sick time under this Act as a negative factor in an employment action, such as hiring, promotion, reducing hours or number of shifts, or a disciplinary action; or (C) counting the paid sick time or unpaid sick time under a no-fault attendance policy or any other absence-control policy. (2) DISCRIMINATION.—It shall be unlawful for any employer to discharge or in any other manner discriminate against (including retaliating against) any individual, including a job applicant, for opposing any practice made unlawful by this Act. (b) Interference with proceedings or inquiries.—It shall be unlawful for any person to discharge or in any other manner discriminate against (including retaliating against) any individual, including a job applicant, because such individual— (1) has filed an action, or has instituted or caused to be instituted any proceeding, under or related to this Act; (2) has given, or is about to give, any information in connection with any inquiry or proceeding relating to any right provided under this Act; or (3) has testified, or is about to testify, in any inquiry or proceeding relating to any right provided under this Act. (c) Construction.—Nothing in this section shall be construed to state or imply that the scope of the activities prohibited by section 105 of the Family and Medical Leave Act of 1993 (29 U.S.C. 2615) is less than the scope of the activities prohibited by this section. SEC. 6. ENFORCEMENT AUTHORITY. (a) In general.— (1) DEFINITION.—In this subsection— (A) the term “employee” means an employee described in subparagraph (A) or (B) of section 2(5); and (B) the term “employer” means an employer described in subclause (I) or (II) of section 2(6)(A)(i). (2) INVESTIGATIVE AUTHORITY.— (A) IN GENERAL.—To ensure compliance with the provisions of this Act, or any regulation or order issued under this Act, the Secretary shall have, subject to subparagraph (C), the investigative authority provided under section 11(a) of the Fair Labor Standards Act of 1938 (29 U.S.C. 211(a)), with respect to employers, employees, and other individuals affected by an employer. (B) OBLIGATION TO KEEP AND PRESERVE RECORDS.—An employer shall make, keep, and preserve records pertaining to compliance with this Act in accordance with section 11(c) of the Fair Labor Standards Act of 1938 (29 U.S.C. 211(c)) and in accordance with regulations prescribed by the Secretary. (C) REQUIRED SUBMISSIONS GENERALLY LIMITED TO AN ANNUAL BASIS.—The Secretary shall not require, under the authority of this paragraph, an employer to submit to the Secretary any books or records more than once during any 12-month period, unless the Secretary has reasonable cause to believe there may exist a violation of this Act or any regulation or order issued pursuant to this Act, or is investigating a charge pursuant to paragraph (4). (D) SUBPOENA AUTHORITY.—For the purposes of any investigation provided for in this paragraph, the Secretary shall have the subpoena authority provided for under section 9 of the Fair Labor Standards Act of 1938 (29 U.S.C. 209). (3) CIVIL ACTION BY EMPLOYEES OR INDIVIDUALS.— (A) RIGHT OF ACTION.—An action to recover the damages or equitable relief prescribed in subparagraph (B) may be maintained against any employer in any Federal or State court of competent jurisdiction by an employee or individual or a representative for and on behalf of— (i) the employee or individual; or (ii) the employee or individual and others similarly situated. (B) LIABILITY.—Any employer who violates section 5 (including a violation relating to rights provided under section 3) shall be liable to any employee or individual affected— (i) for damages equal to— (I) the amount of— (aa) any wages, salary, employment benefits, or other compensation denied or lost by reason of the violation; or (bb) in a case in which wages, salary, employment benefits, or other compensation have not been denied or lost, any actual monetary losses sustained as a direct result of the violation up to a sum equal to 56 hours of wages or salary for the employee or individual; (II) the interest on the amount described in subclause (I) calculated at the prevailing rate; and (III) an additional amount as liquidated damages; and (ii) for such equitable relief as may be appropriate, including employment, reinstatement, and promotion. (C) FEES AND COSTS.—The court in an action under this paragraph shall, in addition to any judgment awarded to the plaintiff, allow a reasonable attorney’s fee, reasonable expert witness fees, and other costs of the action to be paid by the defendant. (4) ACTION BY THE SECRETARY.— (A) ADMINISTRATIVE ACTION.—The Secretary shall receive, investigate, and attempt to resolve complaints of violations of section 5 (including a violation relating to rights provided under section 3) in the same manner that the Secretary receives, investigates, and attempts to resolve complaints of violations of sections 6 and 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 206 and 207). (B) CIVIL ACTION.—The Secretary may bring an action in any court of competent jurisdiction to recover the damages described in paragraph (3)(B)(i). (C) SUMS RECOVERED.—Any sums recovered by the Secretary pursuant to subparagraph (B) shall be held in a special deposit account and shall be paid, on order of the Secretary, directly to each employee or individual affected. Any such sums not paid to an employee or individual affected because of inability to do so within a period of 3 years shall be deposited into the Treasury of the United States as miscellaneous receipts. (5) LIMITATION.— (A) IN GENERAL.—Except as provided in subparagraph (B), an action may be brought under paragraph (3), (4), or (6) not later than 2 years after the date of the last event constituting the alleged violation for which the action is brought. (B) WILLFUL VIOLATION.—In the case of an action brought for a willful violation of section 5 (including a willful violation relating to rights provided under section 3), such action may be brought not later than 3 years after of the last event constituting the alleged violation for which such action is brought. (C) COMMENCEMENT.—In determining when an action is commenced under paragraph (3), (4), or (6) for the purposes of this paragraph, it shall be considered to be commenced on the date when the complaint is filed. (6) ACTION FOR INJUNCTION BY SECRETARY.—The district courts of the United States shall have jurisdiction, for cause shown, in an action brought by the Secretary— (A) to restrain violations of section 5 (including a violation relating to rights provided under section 3), including the restraint of any withholding of payment of wages, salary, employment benefits, or other compensation, plus interest, found by the court to be due to employees or individuals eligible under this Act; or (B) to award such other equitable relief as may be appropriate, including employment, reinstatement, and promotion. (7) SOLICITOR OF LABOR.—The Solicitor of Labor may appear for and represent the Secretary on any litigation brought under paragraph (4) or (6). (8) GOVERNMENT ACCOUNTABILITY OFFICE AND LIBRARY OF CONGRESS.—Notwithstanding any other provision of this subsection, in the case of the Government Accountability Office and the Library of Congress, the authority of the Secretary of Labor under this subsection shall be exercised respectively by the Comptroller General of the United States and the Librarian of Congress. (b) Employees covered by Congressional Accountability Act of 1995.—The powers, remedies, and procedures provided in the Congressional Accountability Act of 1995 (2 U.S.C. 1301 et seq.) to the Board (as defined in section 101 of that Act (2 U.S.C. 1301)), or any person, alleging a violation of section 202(a)(1) of that Act (2 U.S.C. 1312(a)(1)) shall be the powers, remedies, and procedures this Act provides to that Board, or any person, alleging an unlawful employment practice in violation of this Act against an employee described in section 2(5)(C). (c) Employees covered by chapter 5 of title 3, United States Code.—The powers, remedies, and procedures provided in chapter 5 of title 3, United States Code, to the President, the Merit Systems Protection Board, or any person, alleging a violation of section 412(a)(1) of that title, shall be the powers, remedies, and procedures this Act provides to the President, that Board, or any person, respectively, alleging an unlawful employment practice in violation of this Act against an employee described in section 2(5)(D). (d) Employees covered by chapter 63 of title 5, United States Code.—The powers, remedies, and procedures provided in title 5, United States Code, to an employing agency, provided in chapter 12 of that title to the Merit Systems Protection Board, or provided in that title to any person, alleging a violation of chapter 63 of that title, shall be the powers, remedies, and procedures this Act provides to that agency, that Board, or any person, respectively, alleging an unlawful employment practice in violation of this Act against an employee described in section 2(5)(E). (e) Remedies for State employees.— (1) WAIVER OF SOVEREIGN IMMUNITY.—A State’s receipt or use of Federal financial assistance for any program or activity of a State shall constitute a waiver of sovereign immunity, under the 11th Amendment to the Constitution or otherwise, to a suit brought by an employee of that program or activity under this Act for equitable, legal, or other relief authorized under this Act. (2) OFFICIAL CAPACITY.—An official of a State may be sued in the official capacity of the official by any employee who has complied with the procedures under subsection (a)(3), for injunctive relief that is authorized under this Act. In such a suit the court may award to the prevailing party those costs authorized by section 722 of the Revised Statutes (42 U.S.C. 1988). (3) APPLICABILITY.—With respect to a particular program or activity, paragraph (1) applies to conduct occurring on or after the day, after the date of enactment of this Act, on which a State first receives or uses Federal financial assistance for that program or activity. (4) DEFINITION OF PROGRAM OR ACTIVITY.—In this subsection, the term “program or activity” has the meaning given the term in section 606 of the Civil Rights Act of 1964 (42 U.S.C. 2000d–4a). SEC. 7. EDUCATION AND OUTREACH. (a) In general.—The Secretary may conduct a public awareness campaign to educate and inform the public of the requirements for paid sick time required by this Act. (b) Authorization of appropriations.—There is authorized to be appropriated to the Secretary such sums as may be necessary to carry out such campaign. SEC. 8. COLLECTION OF DATA ON PAID SICK TIME AND FURTHER STUDY. (a) Compilation of information.—The Commissioner of Labor Statistics of the Department of Labor shall annually compile and report to the Comptroller General of the United States information on— (1) the amount of paid and unpaid sick time available to employees by occupation and type of employment establishment; and (2) an estimate of the average sick time used by employees according to occupation and the type of employment establishment. (b) GAO study.— (1) IN GENERAL.—Not later than 5 years after the date of enactment of this Act, the Comptroller General of the United States shall conduct a study to evaluate the implementation of this Act. Such study shall include an estimation of employees’ access to paid sick time, employees’ awareness of their rights under this Act, and employers’ experiences complying with this Act. Such study shall take into account access, awareness and experiences of employees by race, ethnicity, gender, and occupation. (2) REPORT.—Upon completion of the study required by paragraph (1), the Comptroller General of the United States shall prepare and submit a report to the appropriate committees of Congress concerning the results of the study and the information compiled pursuant to subsection (a). (c) Report on rail carrier enforcement.—Not later than 3 years after the date of enactment of this Act, the Secretary shall submit a report to Congress on any action by the Secretary under section 6(a) with respect to employers described in section 2(6)(B)(i)(V) providing paid sick time to employees described in section 2(5)(A)(iii). SEC. 9. EFFECT ON OTHER LAWS. (a) Federal and State antidiscrimination laws.—Nothing in this Act shall be construed to modify or affect any Federal or State law prohibiting discrimination on the basis of race, religion, color, national origin, sex, age, disability, sexual orientation, gender identity, marital status, familial status, or any other protected status. (b) State and local laws.—Nothing in this Act shall be construed to supersede (including preempting) any provision of any State or local law that provides greater paid sick time or leave rights (including greater amounts of paid sick time or leave or greater coverage of those eligible for paid sick time or leave) than the rights established under this Act. SEC. 10. EFFECT ON EXISTING EMPLOYMENT BENEFIT. (a) More protective.—Nothing in this Act shall be construed to diminish the obligation of an employer to comply with any contract, collective bargaining agreement, or any employment benefit program or plan that provides greater paid sick leave or other leave rights to employees or individuals than the rights established under this Act. (b) Less protective.—The rights established for employees under this Act shall not be diminished by any contract, collective bargaining agreement, or any employment benefit program or plan. SEC. 11. ENCOURAGEMENT OF MORE GENEROUS LEAVE POLICIES. Nothing in this Act shall be construed to discourage employers from adopting or retaining leave policies more generous than policies that comply with the requirements of this Act. SEC. 12. REGULATIONS. (a) In general.— (1) AUTHORITY.—Except as provided in paragraph (2), not later than 180 days after the date of enactment of this Act, the Secretary shall prescribe such regulations as are necessary to carry out this Act with respect to employees described in subparagraph (A) or (B) of section 2(5) and other individuals affected by employers described in subclause (I) or (II) of section 2(6)(A)(i). (2) GOVERNMENT ACCOUNTABILITY OFFICE; LIBRARY OF CONGRESS.—The Comptroller General of the United States and the Librarian of Congress shall prescribe the regulations with respect to employees of the Government Accountability Office and the Library of Congress, respectively, and other individuals affected by the Comptroller General of the United States and the Librarian of Congress, respectively. (b) Employees covered by Congressional Accountability Act of 1995.— (1) AUTHORITY.—Not later than 90 days after the Secretary prescribes regulations under subsection (a), the Board of Directors of the Office of Compliance shall prescribe (in accordance with section 304 of the Congressional Accountability Act of 1995 (2 U.S.C. 1384)) such regulations as are necessary to carry out this Act with respect to employees described in section 2(5)(C) and other individuals affected by employers described in section 2(6)(A)(i)(III). (2) AGENCY REGULATIONS.—The regulations prescribed under paragraph (1) shall be the same as substantive regulations promulgated by the Secretary to carry out this Act except insofar as the Board may determine, for good cause shown and stated together with the regulations prescribed under paragraph (1), that a modification of such regulations would be more effective for the implementation of the rights and protections involved under this section. (c) Employees covered by chapter 5 of title 3, United States Code.— (1) AUTHORITY.—Not later than 90 days after the Secretary prescribes regulations under subsection (a), the President (or the designee of the President) shall prescribe such regulations as are necessary to carry out this Act with respect to employees described in section 2(5)(D) and other individuals affected by employers described in section 2(6)(A)(i)(IV). (2) AGENCY REGULATIONS.—The regulations prescribed under paragraph (1) shall be the same as substantive regulations promulgated by the Secretary to carry out this Act except insofar as the President (or designee) may determine, for good cause shown and stated together with the regulations prescribed under paragraph (1), that a modification of such regulations would be more effective for the implementation of the rights and protections involved under this section. (d) Employees covered by chapter 63 of title 5, United States Code.— (1) AUTHORITY.—Not later than 90 days after the Secretary prescribes regulations under subsection (a), the Director of the Office of Personnel Management shall prescribe such regulations as are necessary to carry out this Act with respect to employees described in section 2(5)(E) and other individuals affected by employers described in section 2(6)(A)(i)(V). (2) AGENCY REGULATIONS.—The regulations prescribed under paragraph (1) shall be the same as substantive regulations promulgated by the Secretary to carry out this Act except insofar as the Director may determine, for good cause shown and stated together with the regulations prescribed under paragraph (1), that a modification of such regulations would be more effective for the implementation of the rights and protections involved under this section. SEC. 13. EFFECTIVE DATES. (a) Effective date.—This Act shall take effect 6 months after the date of issuance of regulations under section 12(a)(1). (b) Collective bargaining agreements.—In the case of a collective bargaining agreement in effect on the effective date prescribed by subsection (a), this Act shall take effect on the earlier of— (1) the date of the termination of such agreement; (2) the date of any amendment, made on or after such effective date, to such agreement; or (3) the date that occurs 18 months after the date of issuance of regulations under section 12(a)(1).

IN THE SENATE OF THE UNITED STATES Ms. Reyes (for herself, with thanks to Mr. Warnock, Mr. Sanders, Mr. Casey, Ms. Gilibrand, Mr. Booker, and others), introduces the following: A BILL To enhance the equitability and accessibility of healthcare to deliver less-costly, higher-quality care in the United States. SECTION 1. SHORT TITLE. This Act may be cited as the "Healthcare Equity and Accessibility for Less Act (HEAL Act)". TITLE I -- BRIDGE TO MEDICAID SECTION 101. ENSURING AFFORDABILITY OF COVERAGE FOR CERTAIN LOW-INCOME POPULATIONS. (a) Reducing cost sharing under qualified health plans.—Section 1402 of the Patient Protection and Affordable Care Act (42 U.S.C. 18071) is amended— (1) in subsection (b)— (A) in paragraph (2), by inserting “(or, with respect to plan years 2026, 2027, and 2028, whose household income does not exceed 400 percent of the poverty line for a family of the size involved)” before the period; and (B) in the matter following paragraph (2), by adding at the end the following new sentence: “In the case of an individual who is determined at any point to have a household income for 2025 that does not exceed 138 percent of the poverty line for a family of the size involved, such individual shall, for each month during such year, be treated as having a household income equal to 100 percent for purposes of applying this section.”; and (2) in subsection (c)— (A) in paragraph (1)(A), in the matter preceding clause (i), by inserting “, with respect to eligible insureds (other than, with respect to plan years 2026, 2027, and 2028, specified enrollees (as defined in paragraph (6)(C))),” after “first be achieved”; (B) in paragraph (2), in the matter preceding subparagraph (A), by inserting “with respect to eligible insureds (other than, with respect to plan years 2026, 2027, and 2028, specified enrollees)” after “under the plan”; (C) in paragraph (3)— (i) in subparagraph (A), by striking “this subsection” and inserting “paragraph (1) or (2)”; and (ii) in subparagraph (B), by striking “this section” and inserting “paragraphs (1) and (2)”; and (D) by adding at the end the following new paragraph: “(6) SPECIAL RULE FOR SPECIFIED ENROLLEES.— “(A) IN GENERAL.—The Secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall reduce cost-sharing under the plan with respect to months occurring during plan years 2026, 2027, and 2028 for enrollees who are specified enrollees (as defined in subparagraph (C)) in a manner sufficient to increase the plan’s share of the total allowed costs of benefits provided under the plan to 99 percent of such costs. “(B) METHODS FOR REDUCING COST SHARING.— “(i) IN GENERAL.—An issuer of a qualified health plan making reductions under this paragraph shall notify the Secretary of such reductions and the Secretary shall, out of funds made available under clause (ii), make periodic and timely payments to the issuer equal to 12 percent of the total allowed costs of benefits provided under each such plan to specified enrollees during plan years 2026, 2027, and 2028. “(ii) APPROPRIATION.—In addition to amounts otherwise available, there are appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary to the Secretary to make payments under clause (i). “(C) SPECIFIED ENROLLEE DEFINED.—For purposes of this section, the term ‘specified enrollee’ means, with respect to a plan year, an eligible insured who is determined at any point to have a household income for such plan year that does not exceed 138 percent of the poverty line for a family of the size involved. Such insured shall be deemed to be a specified enrollee for each month in such plan year.”. (b) Open enrollments applicable to certain lower-Income populations.—Section 1311(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(c)) is amended— (1) in paragraph (6)— (A) in subparagraph (C), by striking at the end “and”; (B) in subparagraph (D), by striking the period at the end and inserting “; and”; and (C) by adding at the end the following new subparagraph: “(E) with respect to a qualified health plan with respect to which section 1402 applies, for months occurring during the period beginning on January 1, 2025, and ending on December 31, 2028, enrollment periods described in subparagraph (A) of paragraph (8) for individuals described in subparagraph (B) of such paragraph.”; and (2) by adding at the end the following new paragraph: “(8) SPECIAL ENROLLMENT PERIOD FOR CERTAIN LOW-INCOME POPULATIONS.— “(A) IN GENERAL.—The enrollment period described in this paragraph is, in the case of an individual described in subparagraph (B), the continuous period beginning on the first day that such individual is so described. “(B) INDIVIDUAL DESCRIBED.—For purposes of subparagraph (A), an individual described in this subparagraph is an individual— “(i) with a household income that does not exceed 138 percent of the poverty line for a family of the size involved; and “(ii) who is not eligible for minimum essential coverage (as defined in section 5000A(f) of the Internal Revenue Code of 1986), other than for coverage described in any of subparagraphs (B) through (E) of paragraph (1) of such section.”. (c) Additional benefits for certain low-Income individuals for plan years 2027 and 2028.—Section 1301(a) of the Patient Protection and Affordable Care Act (42 U.S.C. 18021(a)) is amended— (1) in paragraph (1)— (A) in subparagraph (B), by striking “and” at the end; (B) in subparagraph (C)(iv), by striking the period and inserting “; and”; and (C) by adding at the end the following new subparagraph: “(D) provides, with respect to a plan offered in the silver level of coverage to which section 1402 applies during plan year 2027 and 2028, for benefits described in paragraph (5) in the case of an individual who has a household income that does not exceed 138 percent of the poverty line for a family of the size involved, and who is eligible to receive cost-sharing reductions under section 1402.”; and (2) by adding at the end the following new paragraph: “(5) ADDITIONAL BENEFITS FOR CERTAIN LOW-INCOME INDIVIDUALS FOR PLAN YEAR 2027 AND 2028.— “(A) IN GENERAL.— “(i) BENEFITS.—For purposes of paragraph (1)(D), the benefits described in this paragraph to be provided by a qualified health plan are benefits consisting of— “(I) non-emergency medical transportation services (as described in section 1902(a)(4) of the Social Security Act) for which Federal payments would have been available under title XIX of the Social Security Act had such services been furnished to an individual enrolled under a State plan (or waiver of such plan) under such title; and “(II) services described in subsection (a)(4)(C) of section 1905 of such Act for which Federal payments would have been so available; which are not otherwise provided under such plan as part of the essential health benefits package described in section 1302(a). “(ii) CONDITION ON PROVISION OF BENEFITS.—Benefits described in this paragraph shall be provided— “(I) without any restriction on the choice of a qualified provider from whom an individual may receive such benefits; and “(II) without any imposition of cost sharing. “(B) PAYMENTS FOR ADDITIONAL BENEFITS.— “(i) IN GENERAL.—An issuer of a qualified health plan making payments for services described in subparagraph (A) furnished to individuals described in paragraph (1)(D) during plan year 2027 or 2028 shall notify the Secretary of such payments and the Secretary shall, out of funds made available under clause (ii), make periodic and timely payments to the issuer equal to payments for such services so furnished. “(ii) APPROPRIATION.—In addition to amounts otherwise available, there is appropriated, out of any money in the Treasury not otherwise appropriated, such sums as may be necessary to the Secretary to make payments under clause (i).”. (d) Education and outreach activities.— (1) IN GENERAL.—Section 1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) is amended by adding at the end the following new paragraph: “(3) OUTREACH AND EDUCATIONAL ACTIVITIES.— “(A) IN GENERAL.—In the case of an Exchange established or operated by the Secretary within a State pursuant to this subsection, the Secretary shall carry out outreach and educational activities for purposes of informing individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act who reside in States that have not expended amounts under a State plan (or waiver of such plan) under title XIX of such Act for all such individuals about qualified health plans offered through the Exchange, including by informing such individuals of the availability of coverage under such plans and financial assistance for coverage under such plans. Such outreach and educational activities shall be provided in a manner that is culturally and linguistically appropriate to the needs of the populations being served by the Exchange (including hard-to-reach populations, such as racial and sexual minorities, limited English proficient populations, individuals residing in areas where the unemployment rates exceeds the national average unemployment rate, individuals in rural areas, veterans, and young adults). “(B) LIMITATION ON USE OF FUNDS.—Funds appropriated under this paragraph shall not be used to promote any health insurance coverage other than qualified health plans. “(C) FUNDING.—In addition to amounts otherwise available, there is appropriated, out of any money in the Treasury not otherwise appropriated, to remain available until expended, $105,000,000 for fiscal year 2025 to carry out this paragraph, of which— “(i) $15,000,000 shall be used to carry out this paragraph in fiscal year 2025; and “(ii) $30,000,000 shall be used to carry out this paragraph for each of fiscal years 2026 through 2028.”. (2) NAVIGATOR PROGRAM.—Section 1311(i) of the Patient Protection and Affordable Care Act (42 U.S.C. 18031(i)) is amended— (A) in paragraph (1)— (i) by striking “An Exchange” and inserting the following: “(A) IN GENERAL.—An Exchange”; and (ii) by adding at the end the following: “(B) GRANTS FOR ELIGIBLE ENTITIES WITH RESPECT TO CERTAIN STATES.—The Secretary shall establish a program to award grants to entities described in paragraph (2) to carry out the duties described in paragraph (3) in one or more States that do not provide under the State plan under title XIX of the Social Security Act (or a waiver of such plan) benchmark coverage described in section 1937(b)(1) of such Act or benchmark equivalent coverage described in section 1937(b)(2) of such Act to all individuals described in section 1902(a)(10)(A)(i)(VIII) of such Act.”; and (B) in paragraph (6)— (i) by striking “Grants under” and inserting the following: “(A) STATE EXCHANGES.—Except as provided in subparagraph (B), grants under”; and (ii) by adding at the end the following new subparagraph: “(B) FEDERAL EXCHANGES; GRANTS TO ELIGIBLE ENTITIES WITH RESPECT TO CERTAIN STATES.—For purposes of carrying out this subsection, with respect to an Exchange established and operated by the Secretary within a State pursuant to section 1321(c) and with respect to grants under paragraph (1)(B), the Secretary shall obligate not less than $10,000,000 out of amounts collected through the user fees on participating health insurance issuers pursuant to section 156.50 of title 45, Code of Federal Regulations (or any successor regulations) for fiscal year 2026, and not less than $20,000,000 for each of fiscal years 2027 and 2028. Such amount so obligated for a fiscal year shall remain available until expended.”. (e) Funding.—In addition to amounts otherwise available, there is appropriated to the Secretary of Health and Human Services for fiscal year 2025, out of any money in the Treasury not otherwise appropriated, $65,000,000, to remain available until expended, for purposes of carrying out the provisions of, and the amendments made by, this section. SECTION 102. TEMPORARY EXPANSION OF HEALTH INSURANCE PREMIUM TAX CREDITS FOR CERTAIN LOW-INCOME POPULATIONS. (a) In general.—Section 36B of the Internal Revenue Code of 1986 is amended by redesignating subsection (h) as subsection (i) and by inserting after subsection (g) the following new subsection: “(h) Certain temporary rules beginning in 2026.—With respect to any taxable year beginning after December 31, 2025, and before January 1, 2029— “(1) ELIGIBILITY FOR CREDIT NOT LIMITED BASED ON INCOME.—Subsection (c)(1)(A) shall be applied without regard to ‘equals or exceeds 100 percent but’. “(2) CREDIT ALLOWED TO CERTAIN LOW-INCOME EMPLOYEES OFFERED EMPLOYER-PROVIDED COVERAGE.—In the case of an individual whose household income does not exceed 138 percent of the poverty line for a family of the size involved, clause (i) of subsection (c)(2)(C) shall be applied (including in the case of any individual described in the last sentence of such clause) without regard to subclause (II) thereof. “(3) CREDIT ALLOWED TO CERTAIN LOW-INCOME EMPLOYEES OFFERED QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENTS.—A qualified small employer health reimbursement arrangement shall not be treated as constituting affordable coverage for an employee (or any spouse or dependent of such employee) for any months of a taxable year if the employee’s household income for such taxable year does not exceed 138 percent of the poverty line for a family of the size involved. “(4) LIMITATIONS ON RECAPTURE.— “(A) IN GENERAL.—In the case of a taxpayer whose household income is less than 200 percent of the poverty line for the size of the family involved for the taxable year, the amount of the increase under subsection (f)(2)(A) shall in no event exceed $300 (one-half of such amount in the case of a taxpayer whose tax is determined under section 1(c) for the taxable year). “(B) LIMITATION ON INCREASE FOR CERTAIN NON-FILERS.—In the case of any taxpayer who would not be required to file a return of tax for the taxable year but for any requirement to reconcile advance credit payments under subsection (f), if an Exchange established under title I of the Patient Protection and Affordable Care Act has determined that— “(i) such taxpayer is eligible for advance payments under section 1412 of such Act for any portion of such taxable year, and “(ii) such taxpayer’s household income for such taxable year is projected not to exceed 138 percent of the poverty line for a family of the size involved, subsection (f)(2)(A) shall not apply to such taxpayer for such taxable year and such taxpayer shall not be required to file such return of tax. “(C) INFORMATION PROVIDED BY EXCHANGE.—The information required to be provided by an Exchange to the Secretary and to the taxpayer under subsection (f)(3) shall include such information as is necessary to determine whether such Exchange has made the determinations described in clauses (i) and (ii) of subparagraph (B) with respect to such taxpayer.”. (b) Employer shared responsibility provision not applicable with respect to certain low-Income taxpayers receiving premium assistance.—Section 4980H(c)(3) of the Internal Revenue Code of 1986 is amended to read as follows: “(3) APPLICABLE PREMIUM TAX CREDIT AND COST-SHARING REDUCTION.— “(A) IN GENERAL.—The term ‘applicable premium tax credit and cost-sharing reduction’ means— “(i) any premium tax credit allowed under section 36B, “(ii) any cost-sharing reduction under section 1402 of the Patient Protection and Affordable Care Act, and “(iii) any advance payment of such credit or reduction under section 1412 of such Act. “(B) EXCEPTION WITH RESPECT TO CERTAIN LOW-INCOME TAXPAYERS.—Such term shall not include any premium tax credit, cost-sharing reduction, or advance payment otherwise described in subparagraph (A) if such credit, reduction, or payment is allowed or paid for a taxable year of an employee (beginning after December 31, 2025, and before January 1, 2029) with respect to which— “(i) an Exchange established under title I of the Patient Protection and Affordable Care Act has determined that such employee’s household income for such taxable year is projected to not exceed 138 percent of the poverty line for a family of the size involved, or “(ii) such employee’s household income for such taxable year does not exceed 138 percent of the poverty line for a family of the size involved.”. (c) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2025. SECTION 103. FURTHER INCREASE IN FMAP FOR MEDICAL ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS. Section 1905(y)(1) of the Social Security Act (42 U.S.C. 1396d(y)(1)) is amended— (1) in subparagraph (D), by striking at the end “and”; (2) in subparagraph (E), by striking “2020 and each year thereafter.” and inserting “2020, 2021, 2022, 2023, 2024, and 2025;”; and (3) by adding at the end the following new subparagraphs: “(F) 93 percent for calendar quarters in 2026, 2027, and 2028; and “(G) 90 percent for calendar quarters in 2029 and each year thereafter.”. SECTION 104. EXTENDING MEDICAID ELIGIBILITY TO ALL PREGNANT WOMEN. (a) In general.—Section 1905(n)(1) of the Social Security Act (42 U.S.C. 1396d(n)(1)) is amended to read as follows: “(1) a woman who is pregnant and through the end of the month in which the 365-day period (beginning on the last day of her pregnancy) ends; and”. (b) Conforming amendments.—Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended— (1) in section 1902— (A) in subsection (a)(10)(C)— (i) in clause (ii), by striking “must make available medical assistance—” and all that follows through “individual described in subparagraph (A);” and inserting “must make available medical assistance to individuals under the age of 18 who (but for income and resources) would be eligible for medical assistance as an individual described in subparagraph (A)(i);”; and (ii) in clause (iii)— (I) by striking “must include (I) with respect to” and inserting “must include, with respect to”; and (II) by striking “, and (II)” and all that follows through “delivery services”; (B) in subsection (e), by striking paragraph (6); (C) in subsection (l)(1)(A), by inserting “before January 1, 2022,” before “women during pregnancy”; and (D) in subsection (ii)(1)(A), by inserting “that was in effect as of January 1, 2022” after “pregnant women”; (2) in section 1920(b)(1)(A), by striking “that the family income” and all that follows through “income level of eligibility” and inserting “that the woman is eligible for medical assistance”; and (3) in section 1937(a)(2)(B), by amending clause (i) to read as follows: “(i) QUALIFIED PREGNANT WOMEN.—The individual is a qualified pregnant woman (as defined in section 1905(n)(1)).”. SECTION 105. EXTENDING CONTINUOUS MEDICAID AND CHIP COVERAGE FOR PREGNANT AND POSTPARTUM WOMEN. (a) Extending continuous Medicaid and CHIP coverage for pregnant and postpartum women.— (1) MEDICAID.—Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended— (A) in section 1902(e)— (i) in paragraph (5), by striking “60-day period” and inserting “365-day period”; and (ii) in paragraph (16), by striking “At the option of the State” and inserting “Before January 1, 2022, at the option of the State”; (B) in section 1902(l)(1)(A), by striking “60-day period” and inserting “365-day period”; (C) in section 1903(v)(4)(A)(i), by striking “60-day period” and inserting “365-day period”; and (D) in section 1905(a), in the 4th sentence in the matter following paragraph (30)— (i) by striking “60-day period” and inserting “365-day period”; and (ii) by striking “subdivision (B) following paragraph (30)” and inserting “subdivision (B) following paragraph (32)”. (2) CHIP.—Section 2112 of the Social Security Act (42 U.S.C. 1397ll) is amended by striking “60-day period” each place it appears and inserting “365-day period”. (3) CONFORMING AMENDMENT.—Section 1938(b)(2)(C) of the Social Security Act (42 U.S.C. 1396u–8(b)(2)(C)) is amended by striking “previous 60 days” and inserting “previous 365 days”. (b) Requiring full benefits for pregnant and postpartum women.— (1) MEDICAID.— (A) IN GENERAL.—Paragraph (5) of section 1902(e) of the Social Security Act (24 U.S.C. 1396a(e)) is amended to read as follows: “(5) Any woman who is eligible for medical assistance under the State plan or a waiver of such plan and who is, or who while so eligible becomes, pregnant, shall continue to be eligible under the plan or waiver for medical assistance through the end of the month in which the 365-day period (beginning on the last day of her pregnancy) ends, regardless of the basis for the woman's eligibility for medical assistance, including if the woman's eligibility for medical assistance is on the basis of being pregnant.”. (B) CONFORMING AMENDMENT.—Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in the matter following subparagraph (G) by striking “(VII) the medical assistance” and all that follows through “complicate pregnancy,”. (2) CHIP.—Section 2107(e)(1)(J) of the Social Security Act (42 U.S.C. 1397gg(e)(1)(J)) is amended— (A) by inserting “, before January 1, 2022,” before “(16) of section 1902(e)”; and (B) by striking “(relating to” and all that follows through the period and inserting “(relating to the provision of medical assistance to pregnant women during pregnancy and the 365-day postpartum period under title XIX).” SECTION 106. MEDICAID COVERAGE OF SERVICES PROVIDED BY DOULAS, MIDWIVES, AND LACTATION CONSULTANTS. (a) In general.—Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (a)— (A) in paragraph (30), by striking “and” at the end; (B) by redesignating paragraph (31) as paragraph (32); and (C) by inserting after paragraph (30) the following new paragraph: “(31) services, including— “(A) prenatal, delivery, postpartum, and lactation consulting services, provided by doulas, midwives, and lactation consultants (as those terms are defined in subsection (jj)) to the extent authorized under State law; and “(B) services included in the components of postpartum care identified by the American College of Obstetricians and Gynecologists in Committee Opinion Number 736 published in May of 2018 (or any successor opinion or publication); and”; and (2) by adding at the end the following new subsection: “(jj) Doulas and midwives defined.—For purposes of subsection (a)(31): “(1) DOULAS DEFINED.—The term ‘doula’ means an individual who— “(A) is certified by an organization, which has been established for not less than 5 years and which requires the completion of continuing education to maintain such certification, to provide non-medical advice, information, emotional support, and physical comfort to an individual during such individual’s pregnancy, childbirth, and postpartum period; and “(B) maintains such certification by completing such required continuing education. “(2) MIDWIVES DEFINED.— “(A) IN GENERAL.—The term ‘midwife’ means a certified midwife, certified professional midwife, and Tribal-recognized midwife. “(B) CERTIFIED MIDWIFE.—For purposes of subparagraph (A), the term ‘certified midwife’ means an individual who is certified by the American Midwifery Certification Board to practice midwifery. “(C) CERTIFIED PROFESSIONAL MIDWIFE.—For purposes of subparagraph (A), the term ‘certified professional midwife’ means an individual who— “(i) is certified by the North American Registry of Midwives to practice midwifery for normal, low-risk pregnancies and childbirths; “(ii) completes— “(I) a midwifery education program accredited by the Midwifery Education and Accreditation Council or any other entity recognized by the Department of Education; or “(II) the requirements to obtain a Midwifery Bridge Certificate from the North American Registry of Midwives; and “(iii) maintains the certification described in clause (i) by completing any required continuing education for such certification. “(D) TRIBAL-RECOGNIZED MIDWIFE.—For purposes of subparagraph (A), the term ‘Tribal-recognized midwife’ means an individual who is recognized by an Indian tribe (as defined in section 4 of the Indian Health Care Improvement Act) to practice midwifery for such tribe. “(3) LACTATION CONSULTANT DEFINED.—The term ‘lactation consultant’ means an individual who is a specialist who— “(A) is trained to— “(i) focus on the needs and concerns of a breastfeeding mother and baby; and “(ii) prevent, recognize, and solve breastfeeding difficulties; “(B) is certified by an organization, which has been established for not less than 5 years and which requires the completion of continuing education to maintain such certification, to provide lactation consulting services; and “(C) maintains such certification by completing such required continuing education.”. (b) Requiring mandatory coverage under State plan.—Section 1902(a)(10)(A) of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)) is amended, in the matter preceding clause (i), by striking “and (30)” and inserting “(30), and (31)”. SECTION 107. FURTHER INCREASE IN FMAP FOR MEDICAL ASSISTANCE FOR NEWLY ELIGIBLE MANDATORY INDIVIDUALS. Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 4, is further amended— (1) in subsection (b), by striking “and (ii)” and inserting “(ii), and (kk)”; and (2) by adding at the end the following: “(kk) Increased FMAP for additional expenditures for medical assistance to pregnant and postpartum women.—For calendar quarters beginning on or after January 1, 2022, notwithstanding subsection (b), the Federal medical assistance percentage for a State, with respect to the additional amounts expended by such State for medical assistance under the State plan under this title or a waiver of such plan that are attributable to requirements imposed by the amendments made by the Improving Coverage and Care for Mothers Act (as determined by the Secretary), shall be equal to 100 percent.”. TITLE II - REDUCING CARE COSTS FOR PATIENTS SECTION 201. CAP ON PRESCRIPTION DRUG COST-SHARING. (a) Qualified health plans.—Section 1302(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(c)) is amended— (1) in paragraph (3)(A)(i), by inserting “, including cost-sharing with respect to prescription drugs covered by the plan” after “charges”; and (2) by adding at the end the following: “(5) PRESCRIPTION DRUG COST-SHARING.— “(A) 2026.—For plan years beginning in 2026, the cost-sharing incurred under a health plan with respect to prescription drugs covered by the plan shall not exceed $2,000 per year for each enrolled individual, or $4,000 per year for each family. “(B) 2027 AND LATER.— “(i) IN GENERAL.—In the case of any plan year beginning in a calendar year after 2026, the limitation under this paragraph shall be equal to the applicable dollar amount under subparagraph (A) for plan years beginning in 2026, increased by an amount equal to the product of that amount and the medical care component of the consumer price index for all urban consumers (as published by the Bureau of Labor Statistics) for that year. “(ii) ADJUSTMENT TO AMOUNT.—If the amount of any increase under clause (i) is not a multiple of $5, such increase shall be rounded to the next lowest multiple of $5.”. (b) Group health plans.—Section 2707(b) of the Public Health Service Act (42 U.S.C. 300gg–6(b)) is amended— (1) by striking “annual”; and (2) by striking “paragraph (1) of section 1302(c)” and inserting “paragraphs (1) and (5) of section 1302(c) of the Patient Protection and Affordable Care Act”. (c) Effective date.—The amendments made by subsections (a) and (b) shall take effect with respect to plans beginning after December 31, 2025. SECTION 202. BANNING ANTICOMPETITIVE TERMS IN FACILITY AND INSURANCE CONTRACTS THAT LIMIT ACCESS TO HIGHER QUALITY, LOWER COST CARE. (a) In general.— (1) PUBLIC HEALTH SERVICE ACT.—Section 2799A–9 of the Public Health Service Act (42 U.S.C. 300gg–119) is amended— (A) by adding at the end the following: “(b) Protecting Health Plans Network Design Flexibility.— “(1) IN GENERAL.—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— “(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 PLANS.—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. “(3) EXCEPTION FOR PLANS AND ISSUERS.—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) 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) ATTESTATION.—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. “(5) RULE OF CONSTRUCTION.—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. “(6) COMPLIANCE WITH RESPECT TO ANTITRUST LAWS.—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)). “(7) GRANDFATHERING.—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.”; and (B) 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). (2) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.—Section 724 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185m) is amended— (A) by adding at the end the following: “(b) Protecting Health Plans Network Design Flexibility.— “(1) IN GENERAL.—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— “(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 PLANS.—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. “(3) EXCEPTION FOR PLANS AND ISSUERS.—Paragraph (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) ATTESTATION.—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. “(5) RULE OF CONSTRUCTION.—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. “(6) COMPLIANCE WITH RESPECT TO ANTITRUST LAWS.—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)). “(7) GRANDFATHERING.—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.”; and (B) 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). (3) INTERNAL REVENUE CODE OF 1986.—Section 9824 of the Internal Revenue Code of 1986 is amended— (A) by adding at the end the following: “(b) Protecting Health Plans Network Design Flexibility.— “(1) IN GENERAL.—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— “(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 PLANS.—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. “(3) EXCEPTION FOR CERTAIN PLANS.—Paragraph (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) ATTESTATION.—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. “(5) RULE OF CONSTRUCTION.—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. “(6) COMPLIANCE WITH RESPECT TO ANTITRUST LAWS.—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)). “(7) GRANDFATHERING.—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.”; and (B) 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). (b) Regulations.—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). (c) Effective date.—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. SECTION 203. HONEST BILLING REQUIREMENTS APPLICABLE TO PROVIDERS. (a) Group health plan and health insurance issuer requirements.— (1) PUBLIC HEALTH SERVICE ACT.—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: “SEC. 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.”. (2) EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974.— (A) IN GENERAL.—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: “SEC. 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.”. (B) CLERICAL AMENDMENT.—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: “Sec. 726. Honest billing requirements applicable to plans and issuers.”. (3) INTERNAL REVENUE CODE OF 1986.— (A) IN GENERAL.—Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following: “SEC. 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.”. (B) CLERICAL AMENDMENT.—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: “Sec. 9826. Honest billing requirements applicable to plans.”. (b) Requiring a separate identification number and an attestation for each off-Campus outpatient department of a provider.— (1) IN GENERAL.—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: “SEC. 2799B–10. Honest billing requirements applicable to providers. “(a) Requirements relating to unique health identifiers.—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— “(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 provider.—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— “(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 violations.—The Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary. “(d) Penalties.—The 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.”. (2) CONFORMING AMENDMENT.—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”. SECTION 204. 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: “SEC. 2799B–11. Banning facility fees for certain services. “(a) In general.—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). “(b) Applicable items and services.—In 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.”. SECTION 205. HEALTH EQUITY INNOVATION GRANT PROGRAM. Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following: “SEC. 399V–8. Health Equity Innovation Grant Program. “(a) In general.—The Secretary, acting through the Deputy Assistant Secretary for Minority Health (in this section referred to as the ‘Secretary’), may award grants to eligible entities to expand access to culturally and linguistically appropriate care, encourage innovation, and address persistent health inequities and chronic disease challenges, including by— “(1) paying the costs of necessary medical services, health screenings, tests, and other preventive services; “(2) expanding access to care, such as by— “(A) expanding access to health care and public health services; “(B) expanding the diversity of types of health workers; “(C) expanding the availability of culturally and linguistically appropriate services; and “(D) addressing other social determinants of health and barriers to receiving timely and quality care; “(3) supporting— “(A) community health navigators; “(B) community health workers (also known as ‘promotores de salud’); “(C) peer support specialists; “(D) community health representatives; and “(E) other health care professionals, including those who work with faith- or community-based organizations as trusted messengers with lived experiences to support access and connection to care; “(4) expanding the capacity of the eligible entity; and “(5) carrying out other programs that address social determinants of health. “(b) Eligible entities.—To be eligible for a grant under this section, an entity shall be a faith- or community-based organization that— “(1) has demonstrated an ability to address chronic health disparities and health conditions in communities disproportionately affected by such disparities and conditions; and “(2) is located in a medically underserved community or a designated health professional shortage area. “(c) Community-Based organization defined.—In this section, the term ‘community-based organization’ has the meaning given the term in section 8101 of the Elementary and Secondary Education Act of 1965. “(d) Authorization of appropriations.— “(1) IN GENERAL.—There is authorized to be appropriated to carry out this section— “(A) $50,000,000 for fiscal year 2024; “(B) $55,000,000 for fiscal year 2025; “(C) $60,000,000 for fiscal year 2026; “(D) $65,000,000 for fiscal year 2027; and “(E) $70,000,000 for fiscal year 2028. “(2) ADMINISTRATIVE COSTS.—Of the funds appropriated to carry out this section, not more than 5 percent may be used by the Secretary for the administrative costs of carrying out this section.”. TITLE III - EXTENSION OF PRIMARY HEALTH CARE PROGRAMS SECTION 301. Programs of payments to teaching health centers that operate graduate medical education programs. (a) Funding.—Section 340H(g)(1) of the Public Health Service Act (42 U.S.C. 256h(g)(1)) is amended— (1) by striking “such sums as may be necessary, not to exceed”; (2) by striking “2017, and” and inserting “2017,”; and (3) by inserting “and $300,000,000 for each of fiscal years 2024 through 2028,” after “2023,”. (b) Per resident amount.—Section 340H(a)(2) of the Public Health Service Act (42 U.S.C. 256h(a)(2)) is amended by adding at the end the following: “Beginning in fiscal year 2024, in accordance with paragraph (1), but notwithstanding the capped amount referenced in subsections (b)(2) and (d)(2), the qualified teaching health center per resident amount for a fiscal year shall be not less than such amount for the previous fiscal year.”. (c) Amount of payments.—Section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended— (1) in subsection (b)(2)— (A) in subparagraph (A), by striking “amount of funds appropriated under subsection (g) for such payments for that fiscal year” and inserting “total amount of funds available under subsection (g) and any amounts recouped under subsection (f)”; and (B) in subparagraph (B), by striking “appropriated in a fiscal year under subsection (g)” and inserting “available under subsection (g) and any amounts recouped under subsection (f)”; and (2) in subsection (d)(2)(B), by striking “amount appropriated for such expenses as determined in subsection (g)” and inserting “total amount of funds available under subsection (g) and any amounts recouped under subsection (f)”. (d) Priority payments.—Section 340H(a)(3) of Public Health Service Act (42 U.S.C. 256h(a)(3)) is amended— (1) in subparagraph (A), by striking “; or” and inserting a semicolon; (2) in subparagraph (B), by striking the period and inserting “; or”; and (3) by adding at the end the following: “(C) are located in a State that does not already have a qualified teaching health center receiving funding under this section.”. (e) Reporting requirements.—Section 340H(h)(1) of the Public Health Service Act (42 U.S.C. 256h(h)(1)) is amended— (1) by redesignating subparagraph (H) as subparagraph (I); and (2) by inserting after subparagraph (G) the following: “(H) Of the number of residents described in paragraph (4) who completed their residency training, the number practicing primary care (meaning any of the areas of practice listed in the definition of a primary care residency program in section 749A) 5 years following completion of such training.”. (f) Guidance.—The Secretary shall update guidance and relevant information regarding States described in subparagraph (C) of section 340H(a)(3) of the Public Health Service Act (42 U.S.C. 256h(a)(3)), as amended by subsection (d), and make available model templates to assist health centers in such States to establish a teaching health center. SECTION 302. COMMUNITY HEALTH CENTERS. (a) Community health center fund.—Section 10503 of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2) is amended— (1) in subsection (b)(1)(F)— (A) by striking “2018 and” and inserting “2018,”; and (B) by inserting before the semicolon the following: “, and $5,800,000,000 for each of fiscal years 2024 through 2026”; and (2) by adding at the end the following: “(f) Priority use of funds.—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— “(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.”. (b) Authorization of appropriations.—Section 330(r)(1) of the Public Health Service Act (42 U.S.C. 254b(r)(1)) is amended— (1) in subparagraph (G), by striking “fiscal year 2016, and each subsequent fiscal year” and inserting “each of fiscal years 2016 through 2023”; and (2) by adding at the end the following: “(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.”. (c) Allocation of funds.—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: “(g) Allocation of funds.—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— “(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.”. (d) Capital funding.—Section 10503(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(c)) is amended— (1) in the subsection heading, by inserting “, Capital funding” after “Construction”; (2) by striking “There is” and inserting the following: “(1) CONSTRUCTION.—There is”; and (3) by adding at the end the following: “(2) CAPITAL FUNDING.—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.”. (e) Strategic plan To improve health outcomes through nutrition.— (1) IN GENERAL.—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. (2) REPORT.—In carrying out paragraph (1), the Secretary of Health and Human Services shall— (A) 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 (B) include in the strategic report recommendations for— (i) reducing the financial impact of obesity and preventable chronic conditions resulting from obesity; (ii) 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; (iii) 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; (iv) 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; (v) developing payment models for novel obesity care therapies for the treatment of diabetes that include behavioral and nutritional and dietary services and education; (vi) 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; (vii) bolstering partnerships with State and local governments and nongovernmental organizations; and (viii) addressing geographic disparities in access to nutrition services and resources. (f) Required primary health services.— (1) IN GENERAL.—Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended— (A) in subsection (b)(1)(A)— (i) in clause (i)— (I) in subclause (IV), by striking “; and” and inserting a semicolon; (II) in subclause (V), by adding “and” after the semicolon; and (III) by adding at the end the following: “(VI) appropriate nutritional and dietary services;”; (ii) in clause (ii), by inserting “and nutrition services” after “mental health services”; and (iii) in clause (iii), by inserting “nutritional,” after “educational,”; and (B) in subsection (d)(1)(A), by inserting “or one or more diet-related conditions” before the semicolon. (2) IMPLEMENTATION OF NEW REQUIRED PRIMARY HEALTH SERVICE.—Paragraph (4) of section 330(e) of the Public Health Service Act (42 U.S.C. 254b(e)) is amended to read as follows: “(4) LIMITATION.—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 subsection (b)(1)(A)(i)(VI) to provide appropriate nutritional and dietary services.”. (g) Increase the use of provider tools To improve health outcomes.—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— (1) recommendations for States to support the coordination of federally-funded nutrition programs and services provided by health care professionals in community health centers; and (2) 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. SECTION 303. 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— (1) in subparagraph (G), by striking “; and” and inserting a semicolon; (2) in subparagraph (H), by striking the period and inserting “; and”; and (3) by adding at the end the following: “(I) $950,000,000 for each of fiscal years 2024 through 2026.”. SECTION 304. GAO REPORT. (a) In general.—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— (1) assessing the metrics used by the Health Resources and Services Administration in evaluating the program; (2) 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; (3) 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; (4) 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; (5) identifying factors other than participation in the National Health Service Corps Scholarship and Loan Repayment Programs that attract health care professionals to a HPSA; (6) assessing the impact the NHSC has on wages for health care professionals in a HPSA; and (7) comparing the distribution of NHSC participants across HPSAs, including a comparison of rural versus non-rural HPSAs. (b) Definition.—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.). SECTION 305. 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— (1) 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; (2) the ways in which the Administrator ensures quality and continuity of care for underserved areas; and (3) the extent to which the Administrator validates the financial responsibility of and use of grant funding by community health centers. SECTION 306. APPLICATION OF PROVISIONS. (a) In general.—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). (b) Conforming amendment.—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”. SECTION 307. HEALTH EQUITY FOR PEOPLE WITH DISABILITIES. (a) In general.—Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended— (1) in subsection (a)(1)— (A) in the matter preceding subparagraph (A), by inserting “including people with disabilities within these populations;” after “public housing,”; and (B) in subparagraph (A), by inserting “including accessible healthcare services” before the semicolon; (2) in subsection (b)— (A) in paragraph (1)(A)— (i) in clause (i), in the matter preceding subclause (I), by inserting “, including accessible healthcare services” after “health services”; (ii) in clause (iv), by inserting “, including people with disabilities,” after “enable individuals”; and (iii) in clause (v), by inserting “, including people with disabilities,” after “health center”; and (B) by adding at the end the following: “(4) DISABILITY.—The term ‘disability’ has the meaning given such term in the Americans with Disabilities Act of 1990.”; (3) in subsection (c)(1)— (A) in the matter preceding subparagraph (A)— (i) by inserting “, including people with disabilities within these medically underserved populations” before the first period; and (ii) by inserting “accessible” after “lease of”; and (B) in subparagraph (E), by inserting “non-profit health and wellness agencies,” after “local hospitals,”; (4) in subsection (d)— (A) in paragraph (1)(A), by inserting “or with disabilities” before the semicolon; and (B) in paragraph (3), by inserting “or for addressing barriers to care affecting people with disabilities in their communities” before the period; (5) in subsection (e)(6)(A)(ii), insert “, or will serve a significant population of people with disabilities” after “other applicants”; (6) in subsection (f)(1)(B), by inserting “, including people with disabilities,” after “women and children”; (7) in subsection (g)(1)(A), by inserting “, including people with disabilities” before the semicolon; (8) in subsection (h)(1), by striking “and veterans at risk of homelessness” and inserting “veterans at risk of homelessness, and people with disabilities who are homeless or at risk of homelessness”; (9) in subsection (i)(1), by inserting “, inclusive of people with disabilities in these communities” before the period; and (10) in subsection (j)(4)— (A) in subparagraph (A), by striking “and” at the end; (B) in subparagraph (B), by striking the period and inserting “; or”; and (C) by adding at the end the following: “(C) provide communication devices, aids, or services to meet disability accessibility requirements.”. (b) Rule of construction.—Nothing in the amendments made by subsection (a) shall be construed to modify the manner in which funding is provided to targeted populations on the date of enactment of this Act or to otherwise shift the focus of programming for such populations. Such amendments are intended to ensure that members of targeted populations with disabilities are included in such programming, have access to care, and are served under programs under section 330 of the Public Health Service Act (as amended by this section). TITLE IV - SUPPORTING THE HEALTH CARE WORKFORCE SECTION 401. 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: “SEC. 330A–3. Rural residency planning and development program and rural residency planning and development technical assistance program. “(a) Definition of rural residency 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— “(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 ENTITY.—In 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 GENERAL.—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). “(B) FUNDING.—Grants awarded under this subsection may be fully funded at the time of the award. “(C) TERM.—The 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 GENERAL.—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). “(B) PATHWAY.—A 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 ENTITY.—In 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 GENERAL.—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). “(B) FUNDING.—Grants awarded under this subsection may be fully funded at the time of the award. “(C) TERM.—The term of a grant under this subsection shall be 4 years and may be extended at the discretion of the Secretary. “(3) APPLICATIONS.—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. “(d) Authorization of appropriations.—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.”. SECTION 402. 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— (1) 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”; and (2) by striking “subsection (b)(1)(B)” and inserting “subsections (b)(1)(B) and (c)”. SECTION 403. 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”. SECTION 404. EXPANDING THE NUMBER OF PRIMARY CARE DOCTORS. Section 747 of the Public Health Service Act (42 U.S.C. 293k), as amended by section 202, is further amended— (1) by redesignating subsection (c) as subsection (d); and (2) by inserting after subsection (b) the following: “(c) Expanding the number of primary care doctors.— “(1) IN GENERAL.—The Secretary shall award grants to eligible medical schools described in paragraph (2) for the purpose of graduating more physicians who will practice a primary care discipline. Funds awarded under this subsection may be used for costs associated with faculty, construction and capital improvements, clinical support, research support, student supports, and any other costs, as determined by the Secretary. “(2) ELIGIBILITY.—To be eligible to receive a grant under this subsection, a medical school shall— “(A) be a nonprofit school of medicine or osteopathic medicine that is accredited by a nationally recognized accrediting agency or association; and “(B) demonstrate in the grant application of the medical school— “(i) that not less than 33 percent of graduates from the medical school enter primary care and are, as of the date of the application, practicing primary care, as calculated by dividing— “(I) the number of physicians who graduated during such time period as is specified by the Secretary who are practicing primary care; by “(II) the total number of physicians who graduated during such time period; and “(ii) a plan to expand the number of graduates of the medical school who are practicing primary care; and “(iii) a commitment to use grant funds to supplement, not supplant, such school’s investment in primary care medical education. “(3) EXPANDING THE NUMBER OF MINORITY PRIMARY CARE DOCTORS.—Of the amounts appropriated under paragraph (6)(C), the Secretary shall awards not less than 20 percent to eligible medical schools described in paragraph (2) that are historically Black colleges and universities (as defined by the term ‘part B institution’ in section 322 of the Higher Education Act of 1965 (20 U.S.C. 1061) or described in section 326(e)(1) of such Act (20 U.S.C. 1063b(e)(1))) or other minority-serving institutions (as described in section 371(a) of the Higher Education Act of 1965 (20 U.S.C. 1067q(a))). “(4) GRANT AMOUNTS; GEOGRAPHIC DISTRIBUTION.— “(A) GRANT AMOUNTS.—The Secretary shall determine the amount of each grant awarded under this subsection, which shall be based on the scope of the plan submitted by the medical school under paragraph (2)(B)(ii), and other appropriate factors. “(B) GEOGRAPHIC DISTRIBUTION.—In awarding grants under this subsection, the Secretary shall ensure, to the greatest extent practicable, that such grants are equitably distributed among the geographic regions of the United States. “(5) PRIMARY CARE.—In this subsection, the term ‘primary care’ means health care services related to family medicine, internal medicine, pediatrics, obstetrics, gynecology, geriatrics, or psychiatry. “(6) ACCOUNT TO ADDRESS THE PRIMARY CARE PHYSICIAN SHORTAGE.— “(A) ESTABLISHMENT OF ACCOUNT.—There is established in the Treasury an account, to be known as the ‘Account to Address the Primary Care Physician Shortage’ (referred to in this subsection as the ‘Account’), for purposes of carrying out this subsection. “(B) TRANSFER OF DIRECT SPENDING.— “(i) IN GENERAL.—The Secretary of the Treasury shall transfer, from the general fund of the Treasury, to the Account $300,000,000 for fiscal year 2024. “(ii) AMOUNTS DEPOSITED.—Any amounts transferred under clause (i) shall remain unavailable in the Account until such amounts are appropriated pursuant to subparagraph (C). “(C) APPROPRIATIONS.— “(i) AUTHORIZATION OF APPROPRIATIONS.—For the period of fiscal years 2024 through 2026, there is authorized to be appropriated from the Account to the Secretary, for the purpose of carrying out the activities under this subsection, an amount not to exceed the total amount transferred to the Account under subparagraph (B)(i). “(ii) OFFSETTING FUTURE APPROPRIATIONS.—For fiscal years 2024 through 2026, for any discretionary appropriation under the heading ‘Account to Address the Primary Care Physician Shortage’ provided to the Secretary pursuant to the authorization of appropriations under clause (i) for the purpose of carrying out this subsection, the total amount of such appropriations for the applicable fiscal year (not to exceed the total amount remaining in the Account) shall be subtracted from the estimate of discretionary budget authority and the resulting outlays for any estimate under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985, and the amount transferred to the Account shall be reduced by the same amount. “(7) ANNUAL REPORTS.—Not later than October 1 of fiscal years 2025 through 2027, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives, a report including a description of any use of funds provided pursuant to the authorization of appropriations under paragraph (6)(C). “(8) LIMITATIONS.—Notwithstanding any transfer authority authorized by this subsection or any appropriations Act, any funds made available pursuant to the authorization of appropriations under paragraph (6)(C) may not be used for any purpose other than the program established under paragraph (1). “(9) SUNSET.—Amounts remaining unappropriated in the Account under this subsection shall be transferred back to the general fund of the Treasury on October 1, 2026.”. SECTION 405. NURSE EDUCATION, PRACTICE, QUALITY, AND RETENTION GRANTS. (a) Reauthorization.—Section 831 of the Public Health Service Act (42 U.S.C. 296p) is amended by adding at the end the following: “(g) Authorization of appropriations.—To carry out this section (other than subsection (e)), in addition to amounts made available under section 871(a), there are authorized to be appropriated $59,413,000 for each of fiscal years 2024 through 2026, to remain available until expended.”. (b) Expanding associate degree nursing programs.—Section 831 of the Public Health Service Act (42 U.S.C. 296p), as amended by subsection (a), is further amended— (1) by redesignating subsections (e) through (g) as subsections (f) through (h), respectively; and (2) by inserting after subsection (d) the following: “(e) Supplemental appropriations expanding associate degree nursing programs.— “(1) AUTHORIZATION.—The Secretary shall award grants to institutions of higher education (as defined in section 101 of the Higher Education Act of 1965) offering an accredited registered nursing program at the associate degree level for the purpose of expanding the number of students enrolled in each such program. “(2) USE OF FUNDS.—A recipient of a grant under this subsection shall use the grant funds to expand the number of students enrolled in the recipient's accredited registered nursing program, which may include increasing nurse faculty and nurse faculty salaries, expanding the number of qualified preceptors at clinical rotations sites, providing direct support for students, supporting partnerships with health facilities for clinical training, purchasing and training faculty to use distance learning technologies and simulation equipment, alteration, renovation, construction, equipment, and other capital improvement costs, and other projects determined appropriate by the Secretary. “(3) DETERMINATION OF NUMBER OF STUDENTS AND APPLICATION.—Each institution of higher education that offers a program described in paragraph (1) that desires to receive a grant under this subsection shall— “(A) provide documentation from the last 4 academic years, or number of academic years the program has been accredited if less than 4, demonstrating the average percentage of individuals who graduated from the nursing degree program with an associate degree within 150 percent of the expected completion time designated for the program; and “(B) submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require, including the average percent of individuals determined under subparagraph (A). “(4) DEFINITION.—For purposes of this subsection, the term ‘health facility’ means an Indian health service center, a Native Hawaiian health center, a Federally qualified health center, a rural health clinic, a nursing home, a home health agency, a hospice program, a public health clinic, a State or local department of public health, a skilled nursing facility, or an ambulatory surgical center. “(5) ACCOUNT TO ADDRESS THE NURSING WORKFORCE SHORTAGE.— “(A) ESTABLISHMENT OF ACCOUNT.—There is established in the Treasury an account, to be known as the ‘Account to Address the Nursing Workforce Shortage’ (referred to in this subsection as the ‘Account’), for purposes of carrying out this subsection, in addition to amounts otherwise made available, including under section 871(a). “(B) TRANSFER OF DIRECT SPENDING.— “(i) IN GENERAL.—The Secretary of the Treasury shall transfer, from the general fund of the Treasury, to the Account $240,000,000 for each of fiscal years 2024 through 2028. “(ii) AMOUNTS DEPOSITED.—Any amounts transferred under clause (i) shall remain unavailable in the Account until such amounts are appropriated pursuant to subparagraph (C). “(C) APPROPRIATIONS.— “(i) AUTHORIZATION OF APPROPRIATIONS.—For each of fiscal years 2024 through 2028, there is authorized to be appropriated from the Account to the Secretary, for the purpose of carrying out the activities under this subsection, in addition to amounts otherwise made available for such purpose, an amount not to exceed the total amount transferred to the Account under subparagraph (B)(i). “(ii) OFFSETTING FUTURE APPROPRIATIONS.—For any of fiscal years 2024 through 2028, for any discretionary appropriation under the heading ‘Account to Address the Nursing Workforce Shortage’ provided to the Secretary pursuant to the authorization of appropriations under clause (i) for an additional amount for carrying out this subsection, the total amount of such appropriations for the applicable fiscal year (not to exceed the total amount remaining in the Account) shall be subtracted from the estimate of discretionary budget authority and the resulting outlays for any estimate under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985, and the amount transferred to the Account shall be reduced by the same amount. “(6) ANNUAL REPORTS.—Not later than October 1 of fiscal years 2025 through 2029, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives, a report including a description of any use of funds provided pursuant to the authorization of appropriations under paragraph (5)(C). “(7) LIMITATIONS.—Notwithstanding any transfer authority authorized by this subsection or any appropriations Act, any funds made available pursuant to the authorization of appropriations under paragraph (5)(C) may not be used for any purpose other than the program established under paragraph (1). “(8) SUNSET.—Amounts remaining unappropriated in the Account under this subsection shall be transferred back to the general fund of the Treasury on October 1, 2028.”. SECTION 406. NURSE FACULTY LOAN PROGRAM. Section 846A of the Public Health Service Act (42 U.S.C. 297n–1), as amended by section 207, is amended by inserting after subsection (b) the following: “(c) Funding.— “(1) AUTHORIZATION OF APPROPRIATIONS.— “(A) IN GENERAL.—To carry out this section (other than subsection (d)), in addition to amounts otherwise made available, including under section 871(b) and paragraph (2), there are authorized to be appropriated $28,500,000 for each of fiscal years 2024 through 2026, to remain available until expended. “(2) ACCOUNT TO ADDRESS THE NURSE FACULTY WORKFORCE SHORTAGE.— “(A) ESTABLISHMENT OF ACCOUNT.—There is established in the Treasury an account, to be known as the ‘Account to Address the Nurse Faculty Shortage’ (referred to in this paragraph as the ‘Account’), for purposes of carrying out this section (other than subsection (d)) in addition to amounts otherwise made available, including under section 871(b) and paragraph (1). “(B) TRANSFER OF DIRECT SPENDING.— “(i) IN GENERAL.—The Secretary of the Treasury shall transfer, from the general fund of the Treasury, to the Account $57,000,000 for each of fiscal years 2024 through 2026. “(ii) AMOUNTS DEPOSITED.—Any amounts transferred under clause (i) shall remain unavailable in the Account until such amounts are appropriated pursuant to subparagraph (C). “(C) APPROPRIATIONS.— “(i) AUTHORIZATION OF APPROPRIATIONS.—For each of fiscal years 2024 through 2026, there is authorized to be appropriated from the Account to the Secretary, for the purpose of carrying out the activities under this section, in addition to amounts otherwise made available for such purpose, an amount not to exceed the total amount transferred to the Account under subparagraph (B)(i). “(ii) OFFSETTING FUTURE APPROPRIATIONS.—For any of fiscal years 2024 through 2026, for any discretionary appropriation under the heading ‘Account to Address the Nurse Faculty Shortage’ provided to the Secretary pursuant to the authorization of appropriations under clause (i) for an additional amount for carrying out this section, the total amount of such appropriations for the applicable fiscal year (not to exceed the total amount remaining in the Account) shall be subtracted from the estimate of discretionary budget authority and the resulting outlays for any estimate under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985, and the amount transferred to the Account shall be reduced by the same amount. “(D) ANNUAL REPORTS.—Not later than October 1 of fiscal years 2025 through 2027, the Secretary shall submit to the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate and the Committee on Energy and Commerce and the Committee on Appropriations of the House of Representatives, a report including a description of any use of funds provided pursuant to the authorization of appropriations under subparagraph (C). “(E) LIMITATIONS.—Notwithstanding any transfer authority authorized by this paragraph or any appropriations Act, any funds made available pursuant to the authorization of appropriations under subparagraph (C) may not be used for any purpose other than the program under this section. “(F) SUNSET.—Amounts remaining unappropriated in the Account under this paragraph shall be transferred back to the general fund of the Treasury on October 1, 2026.”. SECTION 407. NURSE FACULTY DEMONSTRATION PROGRAM. Section 846A of the Public Health Service Act (42 U.S.C. 297n–1) is amended— (1) by amending subsection (a) to read as follows: “(a) In general.—To 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).”; (2) in subsection (b)— (A) by redesignating subparagraphs (A) through (D) of paragraph (2) as clauses (i) through (iv), respectively, and adjusting the margins accordingly; (B) by redesignating paragraphs (1) through (5) as subparagraphs (A) through (E), respectively, and adjusting the margins accordingly; (C) in subparagraph (C), as so redesignated, by striking “subsection (c)” and inserting “paragraph (2)”; and (D) by striking “(b) Agreements—Each agreement entered into under subsection (a) shall—” and inserting the following: “(b) School of nursing student loan fund.— “(1) IN GENERAL.—Each agreement entered into under subsection (a)(1) shall—”; (3) in subsection (c)— (A) by striking “subsection (a)” each place it appears and inserting “subsection (a)(1)”; (B) in paragraph (3), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (C) in paragraph (6), by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (D) by redesignating paragraphs (1) through (6) as subparagraphs (A) through (F), respectively, and adjusting the margins accordingly; and (E) in subparagraph (F)(ii), as so redesignated, by striking “subsection (e)” and inserting “paragraph (4)”; (4) in subsection (e), by striking “subsection (c)(6)(B)” and inserting “paragraph (2)(F)(ii)”; (5) 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 (6) by adding after subsection (c), as added by section 206, the following: “(d) Nurse faculty demonstration program.— “(1) IN GENERAL.—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. “(2) ELIGIBLE ENTITIES.—To 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) AWARDS.—A 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 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) PRIORITY.—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— “(A) the greatest need for such grant, which may be based upon the financial circumstances of the school of nursing, eligible nurse faculty members, 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 CONSTRUCTION.—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. “(6) REPORT.—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— “(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) DEFINITIONS.—In this subsection: “(A) ELIGIBLE NURSING FACULTY MEMBER.—The 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) INFLATION.—The term ‘inflation’ means the Consumer Price Index for all urban consumers (all items; U.S. city average). “(8) AUTHORIZATION OF APPROPRIATIONS.—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.”. SECTION 408. 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: “(j) Authorization of appropriations.—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.”. SECTION 409. GRANTS FOR PRIMARY CARE NURSE PRESIDENCY TRAINING PROGRAMS. Section 5316 of the Patient Protection and Affordable Care Act (42 U.S.C. 296j–1) is amended— (1) in the section heading, by striking “Demonstration”; (2) in subsection (a), by striking “demonstration”; (3) in subsection (d)— (A) in paragraph (1)(B), by striking “and” at the end; (B) by redesignating paragraph (2) as paragraph (3); and (C) by inserting after paragraph (1) the following: “(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 (4) 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”. SECTION 410. STATE ORAL HEALTH WORKFORCE IMPROVEMENT 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”. SECTION 411. 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: “(f) Authorization of appropriations.— “(1) IN GENERAL.—To carry out this section, there is authorized to be appropriated $28,500,000 for fiscal year 2026, to remain available until expended. “(2) GEOGRAPHIC DISTRIBUTION.—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.”. SECTION 412. ALLIED HEALTH PROFESSIONALS. (a) Supporting dual or concurrent enrollment in the allied health projects program.—Section 755(b)(1) of the Public Health Service Act (42 U.S.C. 294e(b)(1)) is amended— (1) in subparagraph (B), by striking “to individuals who have baccalaureate degrees in health-related sciences”; (2) in the flush text at the end of subparagraph (I), by striking “; and” and inserting a semicolon; (3) in subparagraph (J), by striking the period and inserting “; and”; and (4) by adding at the end the following: “(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 professions; and “(iii) provides academic and financial aid counseling to students who participate in the dual or concurrent enrollment program.”. (b) Supporting dual or concurrent enrollment in the health careers opportunity program.—Section 739(a)(2) of the Public Health Service Act (42 U.S.C. 293c(a)(2)) is amended— (1) in subparagraph (H), by striking “and” after the semicolon; (2) in subparagraph (I), by striking the period at the end and inserting “; and”; and (3) by adding at the end the following: “(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.”. (c) Health care workforce innovation program.—Section 755(b) of the Public Health Service Act (42 U.S.C. 294e(b)) is amended by adding at the end the following: “(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) Models funded 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.”.

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Name: Isabel Reyes Seat: Nevada (Class I) Party: Democrat Avatar: Eva Longoria Major Caucus: New Democrats/Third Way Special Talent: Party Boss Gender: Female (10) Age: 47 (5) Sexuality: Straight, unmarried, no children (5) Race/Ancestry: Hispanic/Latino (10) Religion: Roman Catholic (0) Education: B.S. in Political Science & Government, UCLA (0) J.D. Stanford University (5) Socioeconomic History: Child of Immigrants (15) Career History: Well-Known Lawyer (20) Started own firm Reyes & Associates (5) Awards & Extras: Wrote a NYTimes Best-Seller titled "Bridging the Divide: Building a More Inclusive America" (10) Political History: U.S. Senator from Nevada (2017-Present) (5) Chair of Senate Subcommittee on Housing, Transportation, and Community Development (3) Chair of Senate Subcommittee on Senate Subcommittee on Primary Health & Retirement Security (3) Voting History: 115th Congress (2017-2019) Voted NAY on Economic Growth, Regulatory Relief, and Consumer Protection Act 116th Congress (2019-2021) Voted AYE on United States–Mexico–Canada Agreement (USMCA) Family History: Father: Miguel Reyes – A hardworking small business owner in the construction industry, Miguel immigrated to the U.S. from Jalisco, Mexico, seeking better opportunities for his family. Known for his dedication to both his work and his family, he instilled a strong work ethic in Isabel and her siblings. Mother: Maria Elena Reyes (née Hernández) – A caring and compassionate nurse, Maria Elena also emigrated from Guadalajara, Mexico. She played an active role in the local community, volunteering at church and helping underserved families access healthcare. Her nurturing presence shaped Isabel’s passion for helping others. Older Brother: Javier Reyes – At 50 years old, Javier is a police captain in Las Vegas. He followed a different path than Isabel, choosing to serve and protect his community through law enforcement. His grounded perspective and strong sense of duty often serve as a counterbalance to Isabel’s more idealistic worldview. Younger Sister: Elena Reyes – At 42, Elena works as a teacher for disadvantaged students in the Clark County School District. Deeply passionate about education and social justice, she shares Isabel’s commitment to making a difference but works at the grassroots level. The sisters often collaborate on initiatives to improve local education systems and opportunities for low-income families. Biography: Early Life and Education Born and raised in the working-class neighborhoods of Las Vegas, Nevada, Isabel Reyes grew up in a bilingual, tight-knit Mexican-American household. Her parents were both first-generation immigrants from Mexico, with her mother working as a nurse and her father as a small business owner in the local construction industry. Raised with strong Catholic values and a deep sense of community, Isabel learned early the importance of hard work, perseverance, and empathy. Reyes excelled academically and earned a scholarship to attend Stanford University, where she pursued a degree in Political Science before obtaining her Juris Doctor (J.D.) from Stanford Law School. During her time in college, she became deeply involved in advocacy for immigrant rights and affordable education, leading various campus organizations focused on social justice. Legal and Business Career After graduating from law school, Isabel returned to Las Vegas to practice law, focusing on civil rights cases and representing underserved communities in the state of Nevada. Her work soon gained her a reputation as a fierce advocate for justice, especially on behalf of immigrants and working-class families. At 35, Isabel made a bold move by founding her own law firm, Reyes & Associates, specializing in civil litigation and corporate law. Her firm became one of the leading minority-owned legal firms in Nevada, and she often took on pro-bono cases involving housing discrimination and workers’ rights. This entrepreneurial leap not only built her reputation as a community leader but also gave her valuable experience managing a successful business. Political Career In 2016, encouraged by local activists and community leaders, Isabel Reyes entered the political arena by running for U.S. Senate from Nevada. Her campaign focused on creating pragmatic solutions for affordable healthcare, raising the minimum wage, and comprehensive immigration reform. Positioned as a bridge between the progressive and moderate wings of the Democratic Party, Isabel advocated for progressive social policies while supporting center-left economic and foreign policies. Her campaign slogan, "Fighting for the American Dream," resonated with both urban and rural voters, particularly among Nevada's growing Hispanic population. She won the election narrowly, becoming one of the youngest women and one of the first Hispanic women to represent Nevada in the Senate. As a senator, Isabel has worked to build bipartisan coalitions on issues like education reform, criminal justice reform, and climate change policy, while consistently defending reproductive rights and expanding access to healthcare. Her ability to navigate the increasingly polarized political environment earned her recognition as a "rising star" in the Democratic Party. She serves on several key committees, including Judiciary and Health, Education, Labor, and Pensions (HELP). After being reelected in 2022, Isabel was named chair of two Senate subcommittees. In 2021, Senator Reyes published her first book, "Bridging the Divide: Building a More Inclusive America," which outlined her vision for pragmatic, forward-thinking solutions to the country's most pressing issues. The book became a bestseller and has been praised for its balanced approach to policy, blending progressive ideals with centrist pragmatism. Her policy platform is grounded in promoting equality and social justice through practical, evidence-based solutions that address the needs of everyday Americans. She consistently champions issues like criminal justice reform, economic mobility, and climate action, while carefully promoting fiscal responsibility and pragmatic diplomacy abroad. Personal Life Isabel is unmarried and has no children, a personal choice she attributes to her career focus and desire for independence. She maintains close ties to her family and frequently returns to Las Vegas to visit her parents and engage with her constituents. Outside of politics, she is an avid reader, enjoys hiking in Nevada’s stunning Red Rock Canyon, and is passionate about mentoring young women interested in public service.