Health Equity and Accountability Act of 2026

(a) Sense of congress concerning investment in lung cancer research.— It is the sense of the Congress that—

(1) lung cancer mortality reduction should be made a national public health priority; and

(2) a comprehensive mortality reduction program coordinated by the Secretary of Health and Human Services is justified and necessary to adequately address and reduce lung cancer mortality.

(b) Lung cancer mortality reduction program.—

(1) In general.— Subpart 1 of part C of title IV of the Public Health Service Act (42 U.S.C. 285 et seq.) is amended by adding at the end the following:

“417H. Lung cancer mortality reduction program.—

(a) In general.— Not later than 6 months after the date of the enactment of the Health Equity and Accountability Act of 2026, the Secretary, in consultation with the Secretary of Defense, the Secretary of Veterans Affairs, the Director of the National Institutes of Health, the Director of the Centers for Disease Control and Prevention, the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare & Medicaid Services, the Director of the National Institute on Minority Health and Health Disparities, the Administrator of the Environmental Protection Agency, and other members of the Lung Cancer Advisory Board established under section 7001(d) of the Health Equity and Accountability Act of 2026, shall implement a comprehensive program, to be known as the Lung Cancer Mortality Reduction Program, to achieve a reduction of at least 25 percent in the mortality rate of lung cancer by 2028.

(b) Requirements.— The Program shall include at least the following:

(1) With respect to the National Institutes of Health—

(A) a strategic review and prioritization by the National Cancer Institute of research grants to achieve the goal specified in subsection (a);

(B) the provision of funds to enable the Airway Biology and Disease Branch of the National Heart, Lung, and Blood Institute to expand its research programs to include predispositions to lung cancer, the interrelationship between lung cancer and other pulmonary and cardiac disease, the diagnosis and treatment of such diseases, and the investigation of rising rates of lung cancer in populations that have never smoked, such as among Asian American, Native Hawaiian, and Pacific Islander women;

(C) the provision of funds to enable the National Institute of Biomedical Imaging and Bioengineering to expedite the development of computer-assisted diagnostic, surgical, treatment, and drug-testing innovations to reduce lung cancer mortality, such as through expansion of the Institute’s Quantum Grant Program and Image-Guided Interventions program; and

(D) the provision of funds to enable the National Institute of Environmental Health Sciences to implement research programs relative to the lung cancer incidence.

(2) With respect to the Food and Drug Administration—

(A) activities under section 529B of the Federal Food, Drug, and Cosmetic Act; and

(B) activities under section 561 of the Federal Food, Drug, and Cosmetic Act to expand access to investigational drugs and devices for the diagnosis, monitoring, or treatment of lung cancer.

(3) With respect to the Centers for Disease Control and Prevention, the establishment of an early disease research and management program under section 1511.

(4) With respect to the Agency for Healthcare Research and Quality, the conduct of a biannual review of lung cancer screening, diagnostic, and treatment protocols, and the issuance of updated guidelines.

(5) The promotion (including education) of lung cancer screening within minority and rural populations and the study of the effectiveness of efforts to increase such screening.

(6) The cooperation and coordination of all minority and health disparity programs within the Department of Health and Human Services to ensure that all aspects of the Lung Cancer Mortality Reduction Program under this section adequately address the burden of lung cancer on minority and rural populations including among populations who have never smoked, such as Asian American, Native Hawaiian, and Pacific Islander women.

(7) The cooperation and coordination of all tobacco control and cessation programs within agencies of the Department of Health and Human Services to achieve the goals of the Lung Cancer Mortality Reduction Program under this section with particular emphasis on the coordination of drug and other cessation treatments with early detection protocols.”.

(2) Federal food, drug, and cosmetic act.— Subchapter B of chapter V of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et seq.) is amended by adding at the end the following:

“529B. Drugs relating to lung cancer.—

(a) In general.— The provisions of this subchapter shall apply to a drug described in subsection (b) to the same extent and in the same manner as such provisions apply to a drug for a rare disease or condition (as defined in section 526).

(b) Qualified drugs.— A drug described in this subsection is—

(1) a chemoprevention drug for precancerous conditions of the lung;

(2) a drug for targeted therapeutic treatments, including any vaccine, for lung cancer; or

(3) a drug to curtail or prevent nicotine addiction.

(c) Board.— The Board established under section 7001(d) of the Health Equity and Accountability Act of 2026 shall monitor the program implemented under this section.”.

(3) Access to unapproved therapies.— Section 561(e) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360bbb(e)) is amended by inserting before the period the following: “and shall include expanding access to drugs under section 529B, with substantial consideration being given to whether the totality of information available to the Secretary regarding the safety and effectiveness of an investigational drug, as compared to the risk of morbidity and death from the disease, indicates that a patient may obtain more benefit than risk if treated with the drug”.

(4) CDC.— Title XV of the Public Health Service Act (42 U.S.C. 300k et seq.) is amended by adding at the end the following:

“1511. Early disease research and management program.— The Secretary shall establish and implement an early disease research and management program targeted at the high incidence and mortality rates of lung cancer among minority and low-income populations.”.

(c) Department of defense and department of veterans affairs.— The Secretary of Defense and the Secretary of Veterans Affairs, each in coordination with the Secretary of Health and Human Services, shall engage—

(1) in the implementation within the Department of Defense and the Department of Veterans Affairs, as the case may be, of an early detection and disease management research program for members of the Armed Forces and veterans whose smoking history and exposure to carcinogens during service on active duty in the Armed Forces has increased their risk for lung cancer; and

(2) in the implementation of coordinated care programs for members of the Armed Forces and veterans diagnosed with lung cancer.

(d) Lung cancer advisory board.—

(1) In general.— The Secretary of Health and Human Services shall convene a Lung Cancer Advisory Board (referred to in this section as the “Board”)—

(A) to monitor the programs established under this section (and the amendments made by this section); and

(B) to provide annual reports to the Congress concerning benchmarks, expenditures, lung cancer statistics, and the public health impact of such programs.

(2) Composition.— The Board shall be composed of—

(A) the Secretary of Health and Human Services;

(B) the Secretary of Defense;

(C) the Secretary of Veterans Affairs; and

(D) 2 representatives each from the fields of clinical medicine focused on lung cancer, lung cancer research, imaging, drug development, and lung cancer advocacy, to be appointed by the Secretary of Health and Human Services.

(e) Authorization of appropriations.—

(1) In general.— To carry out this section (and the amendments made by this section), there are authorized to be appropriated $75,000,000 for fiscal year 2027 and such sums as may be necessary for each of fiscal years 2028 through 2029.

(2) Lung cancer mortality reduction program.— The amounts appropriated under paragraph (1) shall be allocated as follows:

(A) $25,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(B) of the Public Health Service Act, as added by subsection (b);

(B) $25,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(C) of the Public Health Service Act;

(C) $10,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(1)(D) of the Public Health Service Act; and

(D) $15,000,000 for fiscal year 2027, and such sums as may be necessary for each of fiscal years 2028 through 2030, for the activities described in section 417H(b)(3) of the Public Health Service Act.

(a) Prostate cancer coordination and education.—

(1) Interagency Prostate Cancer Coordination and Education Task Force.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, in cooperation with the Secretary of Defense and the Secretary of Health and Human Services, shall establish an Interagency Prostate Cancer Coordination and Education Task Force (in this section referred to as the “Prostate Cancer Task Force”).

(2) Duties.— The Prostate Cancer Task Force shall—

(A) develop a summary of advances in prostate cancer research supported or conducted by Federal agencies relevant to the diagnosis, prevention, and treatment of prostate cancer, including psychosocial impairments related to prostate cancer treatment, and compile a list of best practices that warrant broader adoption in health care programs;

(B) consider establishing, and advocating for, a guidance to enable physicians to allow screening of men who are age 74 or older, on a case-by-case basis, taking into account quality of life and family history of prostate cancer;

(C) share and coordinate information on research and health care program activities by the Federal Government, including activities related to—

(i) determining how to improve research and health care programs, including psychosocial impairments related to prostate cancer treatment;

(ii) identifying any gaps in the overall research inventory and in health care programs;

(iii) identifying opportunities to promote translation of research into practice; and

(iv) maximizing the effects of Federal Government efforts by identifying opportunities for collaboration and leveraging of resources in research and health care programs that serve individuals who are susceptible to or diagnosed with prostate cancer;

(D) develop a comprehensive interagency strategy and advise relevant Federal agencies in the solicitation of proposals for collaborative, multidisciplinary research and health care programs, including proposals to evaluate factors that may be related to the etiology of prostate cancer, that would—

(i) result in innovative approaches to study emerging scientific opportunities or eliminate knowledge gaps in research to improve the prostate cancer research portfolio of the Federal Government; and

(ii) outline key research questions, methodologies, and knowledge gaps;

(E) develop a coordinated message related to screening and treatment for prostate cancer to be reflected in educational and beneficiary materials for Federal health programs as such materials are updated; and

(F) not later than 2 years after the date of the establishment of the Prostate Cancer Task Force, submit to the expert advisory panels appointed under paragraph (4) to be reviewed and returned within 30 days, and then within 90 days submitted to Congress, recommendations—

(i) regarding any appropriate changes to research and health care programs, including recommendations to improve the research portfolio of the Department of Veterans Affairs, the Department of Defense, the National Institutes of Health, and other Federal agencies to ensure that scientifically based strategic planning is implemented in support of research and health care program priorities;

(ii) designed to ensure that the research and health care programs and activities of the Department of Veterans Affairs, the Department of Defense, the Department of Health and Human Services, and other Federal agencies are free of unnecessary duplication;

(iii) regarding public participation in decisions relating to prostate cancer research and health care programs to increase the involvement of patient advocates, community organizations, and medical associations representing a broad geographical area;

(iv) on how to best disseminate information on prostate cancer research and progress achieved by health care programs;

(v) on how to expand partnerships between public entities, including Federal agencies, and private entities to encourage collaborative, cross-cutting research and health care delivery;

(vi) assessing any cost savings and efficiencies realized through the efforts identified in, and supported through, this subsection and recommending expansion of those efforts that have proved most promising while also ensuring against any conflicts in directives in law;

(vii) identifying key priority action items from among the recommendations specified in clauses (i) through (vi); and

(viii) with respect to the level of funding needed by each agency to implement such recommendations.

(3) Members of the Prostate Cancer Task Force.— The Prostate Cancer Task Force shall be composed of representatives from such Federal agencies as the head of each such applicable agency determines necessary, so as to coordinate a uniform message relating to prostate cancer screening and treatment where appropriate, including representatives of each of the following:

(A) The Department of Veterans Affairs, including representatives of each relevant program area of the Department of Veterans Affairs.

(B) The Prostate Cancer Research Program of the Congressionally Directed Medical Research Program of the Department of Defense.

(C) The Department of Health and Human Services, including, at a minimum, representatives of each of the following:

(i) The National Institutes of Health.

(ii) National research institutes and centers, including the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the Office of Minority Health.

(iii) The Centers for Medicare & Medicaid Services.

(iv) The Food and Drug Administration.

(v) The Centers for Disease Control and Prevention.

(vi) The Agency for Healthcare Research and Quality.

(vii) The Health Resources and Services Administration.

(4) Appointing expert advisory panels.— The Prostate Cancer Task Force shall appoint expert advisory panels, as the task force determines appropriate, to provide input and concurrence from—

(A) individuals and organizations from the medical, prostate cancer patient and advocate, research, and delivery communities with expertise in prostate cancer diagnosis, treatment, and research, including practicing urologists, primary care providers, and others; and

(B) individuals with expertise in education and outreach to underserved populations affected by prostate cancer.

(5) Meetings.— The Prostate Cancer Task Force shall convene not less frequently than twice each year, or more frequently as the Secretary of Veterans Affairs determines to be appropriate.

(6) Federal Advisory Committee Act.— The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Prostate Cancer Task Force.

(7) Sunset date.— The Prostate Cancer Task Force shall terminate on September 30, 2028.

(b) Prostate cancer research.—

(1) Research coordination program.—

(A) In general.— The Secretary of Veterans Affairs, in coordination with the Secretary of Defense and the Secretary of Health and Human Services, shall establish and carry out a program to coordinate and intensify prostate cancer research.

(B) Elements.— The program established under subparagraph (A) shall—

(i) develop advances in diagnostic and prognostic methods and tests, including biomarkers and an improved prostate cancer screening blood test, including improvements or alternatives to the prostate specific antigen test and additional tests to distinguish indolent from aggressive disease;

(ii) develop a better understanding of the etiology of the disease (including an analysis of lifestyle factors proven to be involved in higher rates of prostate cancer, such as obesity and diet, and in different ethnic, racial, and socioeconomic groups, such as the African-American, Latino or Hispanic, Asian American, Native Hawaiian, Pacific Islander, and American Indian populations and men with a family history of prostate cancer) to improve prevention efforts;

(iii) expand basic research into prostate cancer, including studies of fundamental molecular and cellular mechanisms;

(iv) identify and provide clinical testing of novel agents for the prevention and treatment of prostate cancer;

(v) establish clinical registries for prostate cancer;

(vi) use the National Institute of Biomedical Imaging and Bioengineering and the National Cancer Institute for assessment of appropriate imaging modalities; and

(vii) address such other matters relating to prostate cancer research as may be identified by the Federal agencies participating in such program.

(C) Underserved minority grant program.—

(i) In general.— In carrying out the program established under subparagraph (A), the Secretary shall award grants to eligible entities—

(I) to carry out components of the research outlined in subparagraph (B);

(II) to integrate and build upon existing knowledge gained from comparative effectiveness research; and

(III) to recognize and address—

(aa) the racial and ethnic disparities in the incidence and mortality rates of prostate cancer and men with a family history of prostate cancer;

(bb) any barriers in access to care and participation in clinical trials that are specific to racial, ethnic, and other underserved minorities and men with a family history of prostate cancer;

(cc) outreach and educational efforts to raise awareness among the populations described in item (bb); and

(dd) appropriate access and utilization of imaging modalities.

(ii) Eligible entity defined.— In this subparagraph, the term eligible entity means any public, private, nonprofit, or for-profit organization that the Secretary determines would be capable to conduct medical research and other requirements under this paragraph and is otherwise eligible for research funding from the Federal Government.

(2) Prostate cancer advisory board.—

(A) In general.— There is established in the Office of the Chief Scientist of the Food and Drug Administration a Prostate Cancer Scientific Advisory Board.

(B) Duties.— The board established under subparagraph (A) shall be responsible for accelerating real-time sharing of the latest research data and accelerating movement of new medicines for the treatment of prostate cancer to patients.

(c) Telehealth and rural access pilot projects.—

(1) Establishment of pilot projects.—

(A) In general.— The Secretary of Veterans Affairs, in cooperation with the Secretary of Defense and the Secretary of Health and Human Services (referred to in this subsection collectively as the “Secretaries”) shall establish four-year telehealth pilot projects for the purpose of analyzing the clinical outcomes and cost-effectiveness associated with telehealth services in a variety of geographic areas that contain high proportions of medically underserved populations, including African Americans, Latinos or Hispanics, Asian Americans, Native Hawaiians, Pacific Islanders, American Indians, and Alaska Natives, and those in rural areas.

(B) Efficient and effective care.— Pilot projects established under subparagraph (A) shall promote efficient use of specialist care through better coordination of primary care and physician extender teams in underserved areas and more effectively employ tumor boards to better counsel patients.

(2) Eligible entities.—

(A) In general.— The Secretaries shall select eligible entities to participate in the pilot projects established under this subsection.

(B) Priority.— In selecting eligible entities to participate in the pilot projects under this subsection, the Secretaries shall give priority to entities located in medically underserved areas, particularly those that include African Americans, Asian Americans, Native Hawaiians, Pacific Islanders, Latinos and Hispanics, and facilities of the Indian Health Service, including facilities operated by the Indian Health Service, tribally operated facilities, and facilities administered by an Urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603)) pursuant to title V of that Act (25 U.S.C. 1651 et seq.), and those in rural areas.

(3) Evaluation.— The Secretaries shall, through the pilot projects established under this subsection, evaluate—

(A) the effective and economic delivery of care in diagnosing and treating prostate cancer with the use of telehealth services in medically underserved and Tribal areas including collaborative uses of health professionals and integration of the range of telehealth and other technologies;

(B) the effectiveness of improving the capacity of nonmedical providers and nonspecialized medical providers to provide health services for prostate cancer in medically underserved and Tribal areas, including the exploration of innovative medical home models with collaboration between urologists, other relevant medical specialists, including oncologists, radiologists, and primary care teams, and coordination of care through the efficient use of primary care teams and physician extenders; and

(C) the effectiveness of using telehealth services to provide prostate cancer treatment in medically underserved areas, including the use of tumor boards to facilitate better patient counseling.

(4) Report.— Not later than one year after the completion of the pilot projects under this subsection, the Secretaries shall submit to Congress a report describing the outcomes of such pilot projects, including any cost savings and efficiencies realized, and providing recommendations, if any, for expanding the use of telehealth services.

(d) Education and awareness.—

(1) Campaign.—

(A) In general.— The Secretary of Veterans Affairs shall develop a national education campaign for prostate cancer.

(B) Elements.— The campaign developed under subparagraph (A) shall involve the use of written educational materials and public service announcements consistent with the findings of the Prostate Cancer Task Force under subsection (a) that are intended to encourage men to seek prostate cancer screening when appropriate.

(2) Racial disparities and the population of men with a family history of prostate cancer.— In developing the campaign under paragraph (1), the Secretary of Veterans Affairs shall ensure that educational materials and public service announcements used in the campaign are more readily available in communities experiencing racial disparities in the incidence and mortality rates of prostate cancer and to men of any race classification with a family history of prostate cancer.

(3) Grants.— In carrying out the campaign under this subsection, the Secretary of Veterans Affairs shall award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies.

(e) Authorization of appropriations.— There is authorized to be appropriated to carry out this section for the period of fiscal years 2027 through 2031 an amount equal to the amount of savings for the Federal Government projected to be achieved over such period by implementation of this section.

(a) Research and development of prostate cancer imaging technologies.—

(1) Expansion of research.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”), acting through the Director of the National Institutes of Health and the Administrator of the Health Resources and Services Administration, and in consultation with the Secretary of Defense, shall carry out a program to expand and intensify research to develop innovative advanced imaging technologies for prostate cancer detection, diagnosis, and treatment comparable to state-of-the-art mammography technologies.

(2) Early stage research.— In implementing the program under paragraph (1), the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall carry out a grant program to encourage the early stages of research in prostate imaging to develop and implement new ideas, proof of concepts, and pilot studies for high-risk technologic innovation in prostate cancer imaging that would have a high potential impact for improving patient care, including individualized care, quality of life, and cost-effectiveness.

(3) Large scale later stage research.— In implementing the program under paragraph (1), the Secretary, acting through the Director of the National Institutes of Health, shall utilize the National Institute of Biomedical Imaging and Bioengineering and the National Cancer Institute for advanced stages of research in prostate imaging, including technology development and clinical trials for projects determined by the Secretary to have demonstrated promising preliminary results and proof of concept.

(4) Interdisciplinary private-public partnerships.— In developing the program under paragraph (1), the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall establish interdisciplinary private-public partnerships to develop and implement research strategies for expedited innovation in imaging and image-guided treatment and to conduct such research.

(5) Racial disparities.— In developing the program under paragraph (1), the Secretary shall recognize and address—

(A) the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease; and

(B) any barriers in access to care and participation in clinical trials that are specific to racial minorities.

(6) Authorization of appropriations.—

(A) In general.— Subject to subparagraph (B), there is authorized to be appropriated to carry out this subsection, $100,000,000 for each of fiscal years 2027 through 2031.

(B) Specific allocations.— Of the amount authorized to be appropriated under subparagraph (A) for each of the fiscal years described in such subparagraph—

(i) no less than 10 percent may be used to carry out the grant program under paragraph (2); and

(ii) no more than 1 percent may be used to carry out paragraph (4).

(b) Public awareness and education campaign.—

(1) National campaign.— The Secretary shall carry out a national campaign to increase the awareness and knowledge of individuals in the United States with respect to the need for prostate cancer screening and for improved detection technologies.

(2) Requirements.— The national campaign conducted under this subsection shall include—

(A) roles for the Health Resources Services Administration, the Office of Minority Health of the Department of Health and Human Services, the Centers for Disease Control and Prevention, and the Office of Minority Health and Health Equity of the Centers for Disease Control and Prevention; and

(B) the development and distribution of written educational materials, and the development and placing of public service announcements, that are intended to encourage men to seek prostate cancer screening and to create awareness of the need for improved imaging technologies for prostate cancer screening and diagnosis, including in-vitro blood testing and imaging technologies.

(3) Racial disparities.— In developing the national campaign under paragraph (1), the Secretary shall recognize and address—

(A) the racial disparities in the incidences of prostate cancer and mortality rates with respect to such disease; and

(B) any barriers in access to care and participation in clinical trials that are specific to racial minorities.

(4) Grants.— The Secretary shall establish a program to award grants to nonprofit private entities to enable such entities to test alternative outreach and education strategies to increase the awareness and knowledge of individuals in the United States with respect to the need for prostate cancer screening and improved imaging technologies.

(5) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2027 through 2031.

(c) Improving prostate cancer screening blood tests.—

(1) In general.— The Secretary, in coordination with the Secretary of Defense, shall support research to develop an improved prostate cancer screening blood test using in-vitro detection.

(2) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection, $20,000,000 for each of fiscal years 2027 through 2031.

(d) Reporting and compliance.—

(1) Report and strategy.— Not later than 12 months after the date of the enactment of this Act, the Secretary shall submit to Congress a report that details the strategy of the Secretary for implementing the requirements of this section and the status of such efforts.

(2) Full compliance.— Not later than 36 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall submit to Congress a report that—

(A) describes the research and development and public awareness and education campaigns funded under this section;

(B) provides evidence that projects involving high-risk, high-impact technologic innovation, proof of concept, and pilot studies are prioritized;

(C) provides evidence that the Secretary recognizes and addresses any barriers in access to care and participation in clinical trials that are specific to racial minorities in the implementation of this section;

(D) contains assurances that all the other provisions of this section are fully implemented; and

(E) certifies compliance with the provisions of this section, or in the case of a Federal agency that has not complied with any of such provisions, an explanation as to such failure to comply.

(a) Plan to develop and validate a test or tests for prostate cancer.—

(1) In general.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”), acting through the Director of the National Institutes of Health, shall establish an advisory council on prostate cancer (referred to in this section as the “advisory council”) to draft a plan for the development and validation of an accurate test or tests, such as biomarkers or imaging, to detect and diagnose prostate cancer.

(2) Advisory council.—

(A) Membership.—

(i) Federal members.— The advisory council shall be composed of the following experts:

(I) A designee of the Centers for Disease Control and Prevention.

(II) A designee of the Centers for Medicare & Medicaid Services.

(III) A designee of the Office of the Director of the National Cancer Institute.

(IV) A designee of the Director of the Department of Defense Congressionally Directed Medical Research Programs.

(V) A designee of the Director of the National Institute of Biomedical Imaging and Bioengineering.

(VI) A designee of the Director of the National Institute of General Medical Sciences.

(VII) A designee of the Director of the National Institute on Minority Health and Health Disparities.

(VIII) A designee of the Director of the National Institutes of Health.

(IX) A designee of the Commissioner of Food and Drugs.

(X) A designee of the Director of the Agency for Healthcare Research and Quality.

(XI) A designee of the Director of the Telemedicine and Advanced Technology Research Center of the Department of Defense.

(ii) Non-federal members.— In addition to the members described in clause (i), the advisory council shall include 8 expert members from outside the Federal Government to be appointed by the Secretary, which shall include—

(I) 2 prostate cancer patient advocates;

(II) 2 health care providers with a range of expertise and experience in prostate cancer; and

(III) 4 leading researchers with prostate cancer-related expertise in a range of clinical disciplines.

(B) Meetings.— The advisory council shall meet quarterly and such meetings shall be open to the public.

(C) Advice.— The advisory council shall advise the Secretary, or the Secretary’s designee.

(D) Annual report.— Not later than 1 year after the date of enactment of this Act, the advisory council shall provide to the Secretary, or the Secretary’s designee, and Congress—

(i) an initial evaluation of all federally funded efforts in prostate cancer research relating to the development and validation of an accurate test or tests to detect and diagnose prostate cancer;

(ii) a plan for the development and validation of a reliable test or tests for the detection and accurate diagnosis of prostate cancer; and

(iii) a set of standards for prostate cancer screening, developed in coordination with the United States Preventive Services Task Force, to ensure that any tools for screening, detection, and diagnosis developed in accordance with the plan under clause (ii) will meet the requirements of the Task Force for recommendation as a proven preventive or diagnostic service.

(E) Termination.— The advisory council shall terminate on December 31, 2028.

(3) Funding.— Notwithstanding any other provision of law, the Secretary may make available $1,000,000, from any unobligated amounts appropriated to the National Institutes of Health, for each of fiscal years 2027 through 2031 to carry out this subsection.

(b) Coordination and intensification of prostate cancer research.—

(1) In general.— The Director of the National Institutes of Health, in consultation with the Secretary of Defense, shall coordinate and intensify research in accordance with the plan provided under subsection (a)(2)(D)(ii), with particular attention provided to leveraging existing research to develop and validate a test or tests, such as biomarkers or imaging, to detect and accurately diagnose prostate cancer in order to improve quality of life for millions of individuals in the United States, and decrease health care system costs.

(2) Funding.— Notwithstanding any other provision of law, the Secretary may make available $30,000,000, from any unobligated amounts appropriated to the National Institutes of Health, for each of fiscal years 2027 through 2031 to carry out this subsection.

(a) National prostate cancer council.—

(1) Establishment.— There is established in the Office of the Secretary of Health and Human Services (referred to in this section as the “Secretary”) the National Prostate Cancer Council on Screening, Early Detection, Assessment, and Monitoring of Prostate Cancer (referred to in this section as the “Council”).

(2) Purpose of the council.— The Council shall—

(A) develop and implement a national strategic plan for the accelerated creation, advancement, and testing of diagnostic tools to improve screening, early detection, assessment, and monitoring of prostate cancer, including—

(i) early detection of aggressive prostate cancer to save lives;

(ii) monitoring of tumor response to treatment, including recurrence and progression; and

(iii) accurate assessment and surveillance of indolent disease to reduce unnecessary biopsies and treatment;

(B) provide information and coordination of prostate cancer research and services across all Federal agencies;

(C) review diagnostic tools and their overall effectiveness at screening, detecting, assessing, and monitoring of prostate cancer;

(D) evaluate all programs in prostate cancer that are in existence on the date of enactment of this Act, including Federal budget requests and approvals and public-private partnerships;

(E) submit an annual report to the Secretary and Congress on the creation and implementation of the national strategic plan under subparagraph (A); and

(F) ensure the inclusion of men at high risk for prostate cancer, including men from minority ethnic and racial populations and men who are least likely to receive care, in clinical, research, and service efforts, with the purpose of decreasing health disparities.

(3) Membership.—

(A) Federal members.— The Council shall be led by the Secretary or the Secretary’s designee and composed of the following experts:

(i) Two representatives of the National Institutes of Health, including 1 representative of the National Institute of Biomedical Imaging and Bioengineering and 1 representative of the National Cancer Institute.

(ii) A representative of the Centers for Disease Control and Prevention.

(iii) A representative of the Centers for Medicare & Medicaid Services.

(iv) A designee of the Director of the Department of Defense Congressionally Directed Medical Research Programs.

(v) A designee of the Director of the Office of Minority Health.

(vi) A representative of the Food and Drug Administration.

(vii) A representative of the Agency for Healthcare Research and Quality.

(B) Non-federal members.— In addition to the members described in subparagraph (A), the Council shall include 14 expert members from outside the Federal Government, which shall include—

(i) 6 prostate cancer patient advocates, including—

(I) 2 patient-survivors;

(II) 2 caregivers of prostate cancer patients; and

(III) 2 representatives from national prostate cancer disease organizations that fund research or have demonstrated experience in providing assistance to patients, families, and medical professionals, including information on health care options, education, and referral; and

(ii) 8 health care stakeholders with specific expertise in prostate cancer research in the critical areas of clinical expertise, including medical oncology, radiology, radiation oncology, urology, and pathology.

(4) Meetings.— The Council shall meet quarterly and meetings shall be open to the public.

(5) Advice.— The Council shall advise the Secretary, or the Secretary’s designee.

(6) Annual report.— The Council shall submit annual reports, beginning not later than 1 year after the date of enactment of this Act, to the Secretary or the Secretary’s designee and to Congress. The annual report shall include—

(A) in the first year—

(i) an evaluation of all Federally funded efforts in prostate cancer research and gaps relating to the development and validation of diagnostic tools for prostate cancer; and

(ii) recommendations for priority actions to expand, eliminate, coordinate, or condense programs based on the performance, mission, and purpose of the programs; and

(B) annually thereafter for 5 years—

(i) an outline for the development and implementation of a national research plan for creation and validation of accurate diagnostic tools to improve prostate cancer care in accordance with paragraph (1);

(ii) roles for the National Cancer Institute, National Institute on Minority Health and Health Disparities, and the Office of Minority Health of the Department of Health and Human Services;

(iii) an analysis of the disparities in the incidence and mortality rates of prostate cancer in men at high risk of the disease, including individuals with family history, increasing age, or African-American heritage; and

(iv) a review of the progress towards the realization of the proposed strategic plan.

(7) Termination.— The Council shall terminate on December 31, 2027.

(a) Elimination of funding limitations.— Section 1108(g)(4) of the Social Security Act (42 U.S.C. 1308(g)(4)) is amended—

(1) by striking “paragraphs (1), (2), (3), and (4) of”; and

(2) by adding at the end the following: “With respect to fiscal years beginning with fiscal year 2027, payment for medical assistance for individuals who are eligible for such assistance only on the basis of section 1902(a)(10)(A)(ii)(XVIII) shall not be taken into account in applying subsection (f) (as increased in accordance with this subsection) to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa for such fiscal year.”.

(b) Application of enhanced fmap for highest state.— Section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding at the end the following: “Notwithstanding the first sentence of this subsection, with respect to medical assistance described in clause (4) of such sentence that is furnished in Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa in a fiscal year, the Federal medical assistance percentage is equal to the highest such percentage applied under such clause for such fiscal year for any of the 50 States or the District of Columbia that provides such medical assistance for any portion of such fiscal year.”.

(c) Effective date.— The amendments made by this section shall apply to payment for medical assistance for items and services furnished on or after October 1, 2026.

(a) Demonstration.—

(1) In general.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall, consistent with subsection (b), conduct demonstration projects for the purpose of developing models and evaluating methods that—

(A) improve the quality of items and services provided to target individuals in order to facilitate reduced disparities in early detection and treatment of cancer;

(B) improve clinical outcomes, satisfaction, quality of life, appropriate use of items and services covered under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), and referral patterns with respect to target individuals with cancer;

(C) eliminate disparities in the rate of preventive cancer screening measures, such as Pap smears, prostate cancer screenings, colon and colorectal cancer screenings, breast cancer screenings, and computed tomography scans, for lung cancer among target individuals;

(D) promote collaboration with community-based organizations to ensure cultural competency of health care professionals and linguistic access for target individuals with limited English proficiency; and

(E) encourage the incorporation of community health workers to increase the efficiency and appropriateness of cancer screening programs.

(2) Community health worker defined.— In this section, the term community health worker includes a community health advocate, a lay health worker, a community health representative, a peer health promoter, a community health outreach worker, and a promotore de salud, who promotes health or nutrition within the community in which the individual resides.

(3) Target individual defined.— In this section, the term target individual means an individual of a racial and ethnic minority group, as defined in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)), who is entitled to benefits under part A, and enrolled under part B, of title XVIII of the Social Security Act.

(b) Program design.—

(1) Initial design.— Not later than 1 year after the date of the enactment of this Act, the Secretary shall evaluate best practices in the private sector, community programs, and academic research of methods that reduce disparities among individuals of racial and ethnic minority groups in the prevention and treatment of cancer and shall design the demonstration projects based on such evaluation.

(2) Number and project areas.— Not later than 2 years after the date of the enactment of this Act, the Secretary shall implement at least 9 demonstration projects, including the following:

(A) Two projects, each of which shall target different ethnic subpopulations, for each racial and ethnic minority group described in clauses (i) through (vi) of section 1707(g)(1)(A) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)(A)).

(B) One project within the Pacific Islands or United States insular areas.

(C) At least 1 project in a rural area.

(D) At least 1 project in an inner-city area.

(3) Expansion of projects; implementation of demonstration project results.— The Secretary shall continue the demonstration projects and may expand the number of demonstration projects if the initial report under subsection (c) contains an evaluation that the demonstration projects—

(A) reduce expenditures under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or

(B) do not increase expenditures under such Medicare program and reduce racial and ethnic health disparities in the quality of health care services provided to target individuals and increase satisfaction of Medicare beneficiaries and health care providers.

(c) Report to congress.—

(1) In general.— Not later than 2 years after the date the Secretary implements the initial demonstration projects under this section, and biannually thereafter, the Secretary shall submit to Congress a report regarding the demonstration projects.

(2) Content of report.— Each report under paragraph (1) shall include the following:

(A) A description of the demonstration projects.

(B) An evaluation of—

(i) the cost-effectiveness of the demonstration projects;

(ii) the quality of the health care services provided to target individuals under the demonstration projects; and

(iii) beneficiary and health care provider satisfaction under the demonstration projects.

(C) Any other information regarding the demonstration projects that the Secretary determines to be appropriate.

(d) Waiver authority.— The Secretary shall waive compliance with the requirements of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to such extent and for such period as the Secretary determines is necessary to conduct the demonstration projects under this section.

(a) Development of measures of disparities in quality of cancer care.—

(1) Development of measures.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”) shall enter into an agreement with an entity that specializes in developing quality measures for cancer care under which the entity shall develop a uniform set of measures to evaluate disparities in the quality of cancer care and annually update such set of measures.

(2) Measures to be included.— Such set of measures shall include, with respect to the treatment of cancer, measures of patient outcomes, the process for delivering medical care related to such treatment, patient counseling and engagement in decision making, patient experience of care, resource use, and practice capabilities, such as care coordination.

(b) Establishment of reporting process.—

(1) In general.— The Secretary shall establish a reporting process that requires, and provides for, a method for health care providers specified under paragraph (2) to submit to the Secretary and make public data on the performance of such providers during each reporting period through use of the measures developed pursuant to subsection (a). Such data shall be submitted in a form and manner and at a time specified by the Secretary.

(2) Specification of providers to report on measures.— The Secretary shall specify the classes of Medicare providers of services and suppliers, including hospitals, cancer centers, physicians, primary care providers, and specialty providers, that will be required under such process to publicly report on the measures specified under subsection (a).

(3) Assessment of changes.— Under such reporting process, the Secretary shall establish a format that assesses changes in both the absolute and relative disparities in cancer care over time. These measures shall be presented in an easily comprehensible format, such as those presented in the final publications relating to Healthy People 2010 or the National Healthcare Disparities Report.

(4) Initial implementation.— The Secretary shall implement the reporting process under this subsection for reporting periods beginning not later than 6 months after the date that measures are first established under subsection (a).

Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended—

(1) by striking section 317N (42 U.S.C. 247b–15); and

(2) by adding after part W the following:

“(a) In general.— The Secretary shall conduct a biennial assessment of the Secretary’s plan for the prevention, control, and medical management of, and education and research relating to, hepatitis B and hepatitis C, for the purposes of—

(1) incorporating into such plan new knowledge or observations relating to hepatitis B and hepatitis C (such as knowledge and observations that may be derived from clinical, laboratory, and epidemiological research and disease detection, prevention, and surveillance outcomes);

(2) addressing gaps in the coverage or effectiveness of the plan; and

(3) evaluating and, if appropriate, updating recommendations, guidelines, or educational materials of the Centers for Disease Control and Prevention or the National Institutes of Health for health care providers or the public on viral hepatitis in order to be consistent with the plan.

(b) Publication of notice of assessments.— Not later than October 1 of the first even-numbered year beginning after the date of the enactment of this part, and October 1 of each even-numbered year thereafter, the Secretary shall publish in the Federal Register a notice of the results of the assessments conducted under subsection (a). Such notice shall include—

(1) a description of any revisions to the plan referred to in subsection (a) as a result of the assessment;

(2) an explanation of the basis for any such revisions, including the ways in which such revisions can reasonably be expected to further promote the original goals and objectives of the plan; and

(3) in the case of a determination by the Secretary that the plan does not need revision, an explanation of the basis for such determination.

(a) Education and awareness programs.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Assistant Secretary for Mental Health and Substance Use, and in accordance with the plan referred to in section 399PP(a), shall implement programs to increase awareness and enhance knowledge and understanding of hepatitis B and hepatitis C. Such programs shall include—

(1) the conduct of culturally and linguistically appropriate health education in primary and secondary schools, college campuses, public awareness campaigns, and community outreach activities (especially to the ethnic communities with high rates of chronic hepatitis B and chronic hepatitis C and other high-risk groups) to promote public awareness and knowledge about—

(A) the value of hepatitis A and hepatitis B immunization, including the importance of universal birth dose hepatitis B vaccination and universal childhood and adult hepatitis B vaccination;

(B) risk factors, transmission, and prevention of hepatitis B and hepatitis C;

(C) the value of screening for the early detection of hepatitis B and hepatitis C; and

(D) options available for the treatment of chronic hepatitis B and chronic hepatitis C;

(2) the promotion of immunization programs that increase awareness and access to hepatitis A and hepatitis B vaccines for susceptible adults and children;

(3) the training of health care professionals regarding the importance of vaccinating individuals regarding the importance of hepatitis B screening in individuals infected with hepatitis C and the importance of vaccinating individuals who are at risk for hepatitis C infection against hepatitis A and hepatitis B;

(4) the training of health care professionals regarding the importance of vaccinating individuals chronically infected with hepatitis B and individuals who are at risk for chronic hepatitis B infection against the hepatitis A virus;

(5) the training of health care professionals and health educators to make them aware of the high rates of chronic hepatitis B and chronic hepatitis C in certain adult ethnic populations, and the importance of prevention, detection, and medical management of hepatitis B and hepatitis C and of liver cancer screening;

(6) the development and distribution of health education curricula (including information relating to the special needs of individuals infected with or at risk of hepatitis B and hepatitis C, such as the importance of prevention and early intervention, regular monitoring, the recognition of psychosocial needs, appropriate treatment, and liver cancer screening) for individuals providing hepatitis B and hepatitis C counseling; and

(7) support for the implementation of the curricula described in paragraph (6) by State and local public health agencies.

(b) Immunization, prevention, and control programs.—

(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the integration of activities described in paragraph (3) into existing clinical and public health programs at State, local, territorial, and Tribal levels (including community health clinics, programs for the prevention and treatment of HIV/AIDS, sexually transmitted infections, and substance use disorder, and programs for individuals in correctional settings).

(2) Coordination of development of federal screening guidelines.—

(A) References.— For purposes of this subsection, the term CDC Director means the Director of the Centers for Disease Control and Prevention, and the term AHRQ Director means the Director of the Agency for Healthcare Research and Quality.

(B) Agency for healthcare research and quality.— Due to the rapidly evolving standard of care associated with diagnosing and treating viral hepatitis infection, the AHRQ Director shall convene the Preventive Services Task Force under section 915(a) to review its recommendation for screening for HBV and HCV infection every 3 years.

(3) Activities.—

(A) Voluntary testing programs.—

(i) In general.— The Secretary shall establish a mechanism by which to support and promote the development of State, local, territorial, and Tribal voluntary hepatitis B and hepatitis C testing programs to screen the high-prevalence populations to aid in the early identification of chronically infected individuals.

(ii) Confidentiality of the test results.— The Secretary shall prohibit the use of the results of a hepatitis B or hepatitis C test conducted by a testing program developed or supported under this subparagraph for any of the following:

(I) Issues relating to health insurance.

(II) To screen or determine suitability for employment.

(III) To discharge a person from employment with issues relating to immigration status.

(B) Counseling regarding viral hepatitis.— The Secretary shall support State, local, territorial, and Tribal programs in a wide variety of settings, including those providing primary and specialty health care services in nonprofit private and public sectors, to—

(i) provide individuals with ongoing risk factors for hepatitis B and hepatitis C infection with client-centered education and counseling which concentrates on—

(I) promoting testing of individuals that have been exposed to their blood, family members, and their sexual partners; and

(II) changing behaviors that place individuals at risk for infection;

(ii) provide individuals chronically infected with hepatitis B or hepatitis C with education, health information, and counseling to reduce their risk of—

(I) dying from end-stage liver disease and liver cancer; and

(II) transmitting viral hepatitis to others; and

(iii) provide people chronically infected with hepatitis B or hepatitis C who are pregnant or of childbearing age with culturally and linguistically appropriate health information, such as how to prevent hepatitis B perinatal infection, and to alleviate fears associated with pregnancy or raising a family.

(C) Immunization.— The Secretary shall support State, local, territorial, and Tribal efforts to expand the current vaccination programs to protect every child in the Nation and all susceptible adults, particularly those infected with hepatitis C and high-prevalence ethnic populations and other high-risk groups, from the risks of acute and chronic hepatitis B infection by—

(i) ensuring continued funding for hepatitis B vaccination for all children 18 years of age or younger through the Vaccines for Children program;

(ii) ensuring that the recommendations of the American Academy of Pediatrics and American College of Physicians are followed regarding hepatitis B vaccination for infants, children, and adults;

(iii) requiring proof of hepatitis B vaccination for entry into public or private daycare, preschool, elementary school, secondary school, and institutions of higher education for those not infected with hepatitis B;

(iv) expanding the availability of hepatitis B vaccination for all adults to protect them from becoming acutely or chronically infected, including ethnic and other populations with high prevalence rates of chronic hepatitis B infection;

(v) expanding the availability of hepatitis B vaccination for all adults, particularly those of reproductive age, to protect them from the risk of hepatitis B infection;

(vi) ensuring the vaccination of individuals infected, or at risk for infection, with hepatitis C against hepatitis A, hepatitis B, and other infectious diseases, as appropriate, for which such individuals may be at increased risk; and

(vii) ensuring the vaccination of individuals infected, or at risk for infection, with hepatitis B against hepatitis A virus and other infectious diseases, as appropriate, for which such individuals may be at increased risk.

(D) Medical referral.— The Secretary shall support State, local, territorial, and Tribal programs that support—

(i) referral of persons chronically infected with hepatitis B or hepatitis C—

(I) for medical evaluation to determine the appropriateness for antiviral treatment to reduce the risk of progression to cirrhosis and liver cancer; and

(II) for ongoing medical management including regular monitoring of liver function and screening for liver cancer; and

(ii) referral of persons infected with acute or chronic hepatitis B infection or acute or chronic hepatitis C infection for drug and alcohol abuse treatment where appropriate.

(4) Increased support for adult viral hepatitis prevention coordinators.— The Secretary, acting through the CDC Director, shall provide increased support to adult viral hepatitis prevention coordinators in State, local, territorial, and Tribal health departments in order to enhance the additional management, networking, and technical expertise needed to ensure successful integration of hepatitis B and hepatitis C prevention and control activities into existing public health programs.

(c) Epidemiological surveillance.—

(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall support the establishment and maintenance of a national chronic and acute hepatitis B and hepatitis C surveillance program, in order to identify—

(A) trends in the incidence of acute and chronic hepatitis B and acute and chronic hepatitis C;

(B) trends in the prevalence of acute and chronic hepatitis B and acute and chronic hepatitis C infection among groups that may be disproportionately affected; and

(C) trends in liver cancer and end-stage liver disease incidence and deaths, caused by chronic hepatitis B and chronic hepatitis C in the high-risk ethnic populations.

(2) Seroprevalence and liver cancer studies.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall prepare a report outlining the population-based seroprevalence studies currently underway, future planned studies, the criteria involved in determining which seroprevalence studies to conduct, defer, or suspend, and the scope of those studies, the economic and clinical impact of hepatitis B and hepatitis C, and the impact of chronic hepatitis B and chronic hepatitis C infections on the quality of life. Not later than one year after the date of the enactment of this part, the Secretary shall submit the report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives.

(3) Confidentiality.— The Secretary shall not disclose any individually identifiable information identified under paragraph (1) or derived through studies under paragraph (2).

(d) Research.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, the Director of the National Cancer Institute, and the Director of the National Institutes of Health, shall—

(1) conduct epidemiologic and community-based research to develop, implement, and evaluate best practices for hepatitis B and hepatitis C prevention especially in the ethnic populations with high rates of chronic hepatitis B and chronic hepatitis C and other high-risk groups;

(2) conduct research on hepatitis B and hepatitis C natural history, pathophysiology, improved treatments and prevention (such as the hepatitis C vaccine), and noninvasive tests that help to predict the risk of progression to liver cirrhosis and liver cancer;

(3) conduct research that will lead to better noninvasive or blood tests to screen for liver cancer, and more effective treatments of liver cancer caused by chronic hepatitis B and chronic hepatitis C; and

(4) conduct research comparing the effectiveness of screening, diagnostic, management, and treatment approaches for chronic hepatitis B, chronic hepatitis C, and liver cancer in the affected communities.

(e) Underserved and disproportionately affected populations.— In carrying out this section, the Secretary shall provide expanded support for individuals with limited access to health education, testing, and health care services and groups that may be disproportionately affected by hepatitis B and hepatitis C.

(f) Evaluation of program.— The Secretary shall develop benchmarks for evaluating the effectiveness of the programs and activities conducted under this section and make determinations as to whether such benchmarks have been achieved.

(a) In general.— The Secretary may award grants to, or enter into contracts or cooperative agreements with, States, political subdivisions of States, territories, Indian Tribes, or nonprofit entities that have special expertise relating to hepatitis B, hepatitis C, or both, to carry out activities under this part.

(b) Application.— To be eligible for a grant, contract, or cooperative agreement under subsection (a), an entity shall prepare and submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.”.

There are authorized to be appropriated to carry out this part $90,000,000 for fiscal year 2027, $110,000,000 for fiscal year 2028, $130,000,000 for fiscal year 2029, and $150,000,000 for fiscal year 2030.

Subpart I of part D of title III of the Public Health Service Act (42 U.S.C. 254b et seq.) is amended by adding at the end the following:

“330Q. Liver cancer and disease prevention, awareness, and patient tracking grants.—

(a) Prevention initiative grant program.—

(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants and enter into cooperative agreements with entities for the purpose of expanding and supporting—

(A) prevention activities (including providing screenings, vaccinations, or other preventative interventions) for conditions known to increase an individual’s risk of developing a major liver disease, such as liver cancer, hepatitis B, hepatitis C, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and cirrhosis of the liver;

(B) activities relating to detection and provision of guidance for individuals at high risk for contracting liver cancer and other liver diseases; and

(C) viral hepatitis surveillance to provide for timely and accurate information regarding progress to eliminate viral hepatitis.

(2) Report.— An entity that receives a grant or cooperative agreement under paragraph (1) shall submit to the Secretary, at a time specified by the Secretary, a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in promoting prevention and treatment of liver cancer and other liver diseases.

(3) Authorization of appropriations.— For purposes of carrying out this subsection, there is authorized to be appropriated $90,000,000 for each of fiscal years 2027 through 2031.

(b) Awareness initiative grant program.—

(1) In general.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants to eligible entities for the purpose of raising awareness for liver cancer and other liver diseases, which may include the production, dissemination, and distribution of informational materials targeted towards communities and populations with a higher risk for developing liver cancer and other liver diseases.

(2) Eligible entities.— To be eligible to receive a grant under paragraph (1), an entity shall 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 how the entity, in disseminating information on liver cancer and other liver diseases pursuant to paragraph (1), will—

(A) with respect to any community or population, consult with members of such community or population and provide such information in a manner that is culturally and linguistically appropriate for such community or population;

(B) highlight the range of preventative measures and treatments available for liver cancer and other liver diseases;

(C) integrate information on available hepatitis B and hepatitis C testing programs into any liver cancer presentations carried out by the entity; and

(D) address communities and populations with a higher risk for contracting liver cancer and other liver diseases.

(3) Preference.— In awarding grants under paragraph (1), the Secretary shall give preference to entities that—

(A) work with a Federally qualified health center;

(B) are community-based organizations; or

(C) serve communities and populations with a higher risk for contracting liver cancer and other liver diseases.

(4) Report.— An entity that receives a grant under paragraph (1) shall submit to the Secretary, at a time specified by the Secretary, a report describing each activity carried out pursuant to such paragraph and evaluating the effectiveness of such activity in raising awareness for liver cancer and other liver diseases.

(5) Authorization of appropriations.— For purposes of carrying out this subsection, there is authorized to be appropriated $10,000,000 for each of fiscal years 2027 through 2031.”.

(a) National acquired bone marrow failure disease registry.— Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is amended by inserting after section 317W, as added by section 1009, the following:

“317X. National Acquired Bone Marrow Failure Disease Registry.—

(a) Establishment of registry.—

(1) In general.— Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall—

(A) develop a system to collect data on acquired bone marrow failure diseases; and

(B) establish and maintain a national and publicly available registry, to be known as the National Acquired Bone Marrow Failure Disease Registry, in accordance with paragraph (3).

(2) Recommendations of advisory committee.— In carrying out this subsection, the Secretary shall take into consideration the recommendations of the Advisory Committee on Acquired Bone Marrow Failure Diseases established under subsection (b).

(3) Purposes of registry.— The National Acquired Bone Marrow Failure Disease Registry shall—

(A) identify the incidence and prevalence of acquired bone marrow failure diseases in the United States;

(B) be used to collect and store data on acquired bone marrow failure diseases, including data concerning—

(i) the age, race or ethnicity, general geographic location, sex, and family history of individuals who are diagnosed with acquired bone marrow failure diseases, and any other characteristics of such individuals determined appropriate by the Secretary;

(ii) the genetic and environmental factors that may be associated with developing acquired bone marrow failure diseases;

(iii) treatment approaches for dealing with acquired bone marrow failure diseases;

(iv) outcomes for individuals treated for acquired bone marrow failure diseases, including outcomes for recipients of stem cell therapeutic products as contained in the database established pursuant to section 379A; and

(v) any other factors pertaining to acquired bone marrow failure diseases determined appropriate by the Secretary; and

(C) be made available—

(i) to the general public; and

(ii) to researchers to facilitate further research into the causes of, and treatments for, acquired bone marrow failure diseases in accordance with standard practices of the Centers for Disease Control and Prevention.

(b) Advisory committee.—

(1) Establishment.— Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall establish an advisory committee, to be known as the Advisory Committee on Acquired Bone Marrow Failure Diseases.

(2) Members.— The members of the Advisory Committee on Acquired Bone Marrow Failure Diseases shall be appointed by the Secretary, acting through the Director of the Centers for Disease Control and Prevention, and shall include at least one representative from each of the following:

(A) A national patient advocacy organization with experience advocating on behalf of patients suffering from acquired bone marrow failure diseases.

(B) The National Institutes of Health, including at least one representative from each of—

(i) the National Cancer Institute;

(ii) the National Heart, Lung, and Blood Institute; and

(iii) the Office of Rare Diseases.

(C) The Centers for Disease Control and Prevention.

(D) Clinicians with experience in—

(i) diagnosing or treating acquired bone marrow failure diseases; or

(ii) medical data registries.

(E) Epidemiologists who have experience with data registries.

(F) Publicly or privately funded researchers who have experience researching acquired bone marrow failure diseases.

(G) The entity operating the C.W. Bill Young Cell Transplantation Program established pursuant to section 379 and the entity operating the C.W. Bill Young Cell Transplantation Program Outcomes Database.

(3) Responsibilities.— The Advisory Committee on Acquired Bone Marrow Failure Diseases shall provide recommendations to the Secretary on the establishment and maintenance of the National Acquired Bone Marrow Failure Disease Registry, including recommendations on the collection, maintenance, and dissemination of data.

(4) Public availability.— The Secretary shall make the recommendations of the Advisory Committee on Acquired Bone Marrow Failure Disease publicly available.

(c) Grants.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, may award grants to, and enter into contracts and cooperative agreements with, public or private nonprofit entities for the management of, as well as the collection, analysis, and reporting of data to be included in, the National Acquired Bone Marrow Failure Disease Registry.

(d) Definition.— In this section, the term acquired bone marrow failure disease means—

(1) myelodysplastic syndromes;

(2) aplastic anemia;

(3) paroxysmal nocturnal hemoglobinuria;

(4) pure red cell aplasia;

(5) acute myeloid leukemia that has progressed from myelodysplastic syndromes; or

(6) large granular lymphocytic leukemia.

(e) Authorization of appropriations.— There is authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2027 through 2031.”.

(b) Pilot studies through the agency for toxic substances and disease registry.—

(1) Pilot studies.— The Secretary of Health and Human Services, acting through the Director of the Agency for Toxic Substances and Disease Registry, shall conduct pilot studies to determine which environmental factors, including exposure to toxins, may cause acquired bone marrow failure diseases.

(2) Collaboration with the radiation injury treatment network.— In carrying out the directives of this section, the Secretary of Health and Human Services may collaborate with the Radiation Injury Treatment Network of the C.W. Bill Young Cell Transplantation Program established pursuant to section 379 of the Public Health Service Act (42 U.S.C. 274k) to—

(A) augment data for the pilot studies authorized by this section;

(B) access technical assistance that may be provided by the Radiation Injury Treatment Network; or

(C) perform joint research projects.

(3) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $1,000,000 for each of fiscal years 2027 through 2031.

(c) Minority-Focused programs on acquired bone marrow failure diseases.— Title XVII of the Public Health Service Act (42 U.S.C. 300u et seq.) is amended by inserting after section 1707A the following:

“1707B. Minority-focused programs on acquired bone marrow failure disease.—

(a) Information and referral services.—

(1) In general.— Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall establish and coordinate outreach and informational programs targeted to minority populations affected by acquired bone marrow failure diseases.

(2) Program requirements.— Minority-focused outreach and informational programs authorized by this section at the National Minority Health Resource Center supported under section 1707(b)(8) (including by means of the Center’s website, through appropriate locations such as the Center’s knowledge center, and through appropriate programs such as the Center’s resource persons network) and through minority health consultants located at each Department of Health and Human Services regional office—

(A) shall make information about treatment options and clinical trials for acquired bone marrow failure diseases publicly available; and

(B) shall provide referral services for treatment options and clinical trials.

(b) Hispanic and asian-American and pacific islander outreach.—

(1) In general.— The Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall undertake a coordinated outreach effort to connect Hispanic, Asian-American, and Pacific Islander communities with comprehensive services focused on treatment of, and information about, acquired bone marrow failure diseases.

(2) Collaboration.— In carrying out this subsection, the Secretary may collaborate with public health agencies, nonprofit organizations, community groups, and online entities to disseminate information about treatment options and clinical trials for acquired bone marrow failure diseases.

(c) Grants and cooperative agreements.—

(1) In general.— Not later than 6 months after the date of the enactment of this section, the Secretary, acting through the Deputy Assistant Secretary for Minority Health, shall award grants to, or enter into cooperative agreements with, entities to perform research on acquired bone marrow failure diseases.

(2) Requirement.— Grants and cooperative agreements authorized by this subsection shall be awarded or entered into on a competitive, peer-reviewed basis.

(3) Scope of research.— Research funded under this subsection shall examine factors affecting the incidence of acquired bone marrow failure diseases in minority populations.

(d) Definition.— In this section, the term acquired bone marrow failure disease has the meaning given to such term in section 317X(d).

(e) Authorization of appropriations.— There is authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2027 through 2031.”.

(d) Diagnosis and quality of care for acquired bone marrow failure diseases.—

(1) Grants.— The Secretary of Health and Human Services, acting through the Director of the Agency for Healthcare Research and Quality, shall award grants to entities to improve diagnostic practices and quality of care with respect to patients with acquired bone marrow failure diseases.

(2) Authorization of appropriations.— There is authorized to be appropriated to carry out this subsection $2,000,000 for each of fiscal years 2027 through 2031.

(e) Definition.— In this section, the term acquired bone marrow failure disease has the meaning given such term in section 317X(d) of the Public Health Service Act, as added by subsection (a).

(a) In general.— The Secretary of Health and Human Services (in this section referred to as the “Secretary”), acting through the Director of the Agency for Healthcare Research and Quality, shall convene a series of meetings to develop guidelines for disease screening for minority patient populations that have a higher than average risk for many chronic diseases and cancers.

(b) Participants.— In convening meetings under subsection (a), the Secretary shall ensure that meeting participants include representatives of—

(1) professional societies and associations;

(2) minority health organizations;

(3) health care researchers and providers, including those with expertise in minority health;

(4) Federal health agencies, including the Office of Minority Health, the National Institute on Minority Health and Health Disparities, and the National Institutes of Health; and

(5) other experts as the Secretary determines appropriate.

(c) Diseases.— Screening guidelines for minority populations shall be developed as appropriate under subsection (a) for—

(1) hypertension;

(2) hypercholesterolemia;

(3) diabetes;

(4) cardiovascular disease;

(5) cancers, including breast, prostate, colon, cervical, and lung cancer;

(6) other pulmonary problems including sleep apnea;

(7) asthma;

(8) kidney diseases;

(9) eye diseases and disorders, including glaucoma;

(10) HIV/AIDS and sexually transmitted infections;

(11) uterine fibroids;

(12) autoimmune diseases, including lupus;

(13) mental health conditions;

(14) dental health conditions and oral diseases, including oral cancer;

(15) environmental and related health illnesses and conditions;

(16) sickle cell disease and sickle cell trait;

(17) violence and injury prevention and control;

(18) genetic and related conditions;

(19) heart disease and stroke;

(20) tuberculosis;

(21) chronic obstructive pulmonary disease;

(22) musculoskeletal diseases, arthritis, and obesity; and

(23) other diseases determined appropriate by the Secretary.

(d) Dissemination.— Not later than 2 years after the date of enactment of this Act, the Secretary shall publish and disseminate to health care provider organizations the guidelines developed under subsection (a).

(e) Authorization of appropriations.— There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2027 through 2031.

Section 1509 of the Public Health Service Act (42 U.S.C. 300n–4a) is amended—

(1) in subsection (a)—

(A) by striking the heading and inserting “In general”; and

(B) in the matter preceding paragraph (1), by striking “may make grants” and all that follows through “purpose” and inserting the following: “may make grants to such States for the purpose”; and

(2) in subsection (d)(1), by striking “there are authorized” and all that follows through the period and inserting “there are authorized to be appropriated $23,000,000 for fiscal year 2027, $25,300,000 for fiscal year 2028, $27,800,000 for fiscal year 2029, $30,800,000 for fiscal year 2030, and $34,000,000 for fiscal year 2031.”.

Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 5201(c)(3), is amended by adding at the end the following:

“399V–10. Report on cardiovascular care for women and minorities.— Not later than September 30, 2027, and annually thereafter, the Secretary shall prepare and submit to Congress a report on the quality of and access to care for women and minorities with heart disease, stroke, and other cardiovascular diseases. The report shall contain recommendations for eliminating disparities in, and improving the treatment of, heart disease, stroke, and other cardiovascular diseases in women, racial and ethnic minorities, those for whom English is not their primary language, and individuals with disabilities.”.

(a) In general.— Not later than September 30, 2027, the Comptroller General of the United States shall prepare and submit a report to Congress that contains the results of an investigation of—

(1) the structural and systemic factors that perpetuate disparities in access to screenings, care, and treatment of cardiovascular disease; and

(2) how care navigation, including community-based health workers, can improve cardiovascular disease management and improve health outcomes.

(b) Contents.— The report shall—

(1) identify the challenges and barriers facing health care providers and patients, which contribute to postponed, delayed, or suboptimal treatments for cardiovascular disease;

(2) examine efforts by Federal agencies and Federal programs to improve screening and management of patients with cardiovascular disease;

(3) identify and examine existing quality measures from the Centers for Medicare & Medicaid Services related to cholesterol management and whether these measures encourage providers and health systems to—

(A) perform appropriate and timely low-density-lipoprotein cholesterol (LDL-C) testing on patients at risk of a cardiovascular event; and

(B) better manage patients’ elevated LDL-C levels in concordance with clinical guidelines prescribing directives to ensure patients are progressing towards guideline-recommended LDL-C levels;

(4) identify actions the Federal Government could take to promote collaboration with community-based organizations to ensure improvement in clinical outcomes for patients with cardiovascular disease, including by building on recommendations from the National Academy of Medicine and the Centers for Disease Control to include community health workers to improve health care delivery for underserved and high-risk communities; and

(5) assess whether racial and ethnic minority groups, as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300g–6(g)), have higher prior authorization rejection rates of prescription drugs to treat or prevent cardiovascular disease by health insurance providers and, if so, identify the resulting impacts on cardiovascular disease medication adherence, morbidity, and mortality, as well as resulting postponed, delayed, or suboptimal treatment prescribing for cardiovascular disease among racial and ethnic minorities.

(a) Requiring medicaid coverage of counseling and pharmacotherapy for cessation of tobacco use and temporary enhanced FMAP for coverage of tobacco cessation services.— Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5201(b)(2)(A)(i), is amended—

(1) in subsection (a)(4), by striking “(D)” and all that follows through “subsection (bb))” and inserting the following: “(D) counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in subsection (bb))”;

(2) in subsection (b), by inserting “(bb)(2),” after “(aa),”; and

(3) by striking subsection (bb) and inserting the following:

“(bb) Counseling and pharmacotherapy for cessation of tobacco use.—

(1) In general.— For purposes of this title, the term counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that is furnished—

(A) by or under the supervision of a physician; or

(B) by any other health care professional who—

(i) is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and

(ii) is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose, which is recommended in the guideline entitled, “Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline” published by the Public Health Service in May 2008 (or any subsequent modification of such guideline) or is recommended for the cessation of tobacco use by the United States Preventive Services Task Force or any additional intervention approved by the Food and Drug Administration as safe and effective in helping smokers quit.

(2) Temporary enhanced fmap for coverage of tobacco cessation services.— Notwithstanding subsection (b), for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending 5 years after the date of enactment of this paragraph, the Federal medical assistance percentage with respect to amounts expended by a State for medical assistance for counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in paragraph (1)) shall be equal to 90 percent.”.

(b) No cost sharing.—

(1) In general.— Subsections (a)(2) and (b)(2) of section 1916 of the Social Security Act (42 U.S.C. 1396o), as amended by section 2007(d)(4), are each amended—

(A) in subparagraph (B), by striking “, and counseling” and all that follows through “section 1905(bb)(2)(A)”;

(B) in subparagraph (J), by striking “or” after the comma;

(C) in subparagraph (K), by striking “; and” and inserting “, or”; and

(D) by adding at the end the following new subparagraph:

“(L) counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 1905(bb); and”.

(2) Application to alternative cost sharing.— Section 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 1396o–1(b)(3)(B)) is amended—

(A) in clause (iii), by striking “, and counseling and pharmacotherapy for cessation of tobacco use by pregnant women (as defined in section 1905(bb))”; and

(B) by adding at the end the following new clause:

“(xv) Counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State plan (as defined in section 1905(bb)) and covered outpatient drugs (as defined in subsection (k)(2) of section 1927 and including nonprescription drugs described in subsection (d)(2) of such section) that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 1905(bb).”.

(c) Exception from optional restriction under medicaid prescription drug coverage.— Section 1927(d)(2)(F) of the Social Security Act (42 U.S.C. 1396r–8(d)(2)(F)) is amended to read as follows:

“(F) Nonprescription drugs, except, when recommended in accordance with the guideline referred to in section 1905(bb), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation.”.

(d) State monitoring and promoting of comprehensive tobacco cessation services under medicaid.— Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 5201(c)(2)(B), is amended—

(1) in paragraph (90)(C), by striking “and” at the end;

(2) in paragraph (91), by striking the period at the end and inserting “; and”; and

(3) by inserting after paragraph (91) the following new paragraph:

“(92) provide that the State will monitor and promote the use of comprehensive tobacco cessation services under the State plan (including conducting an outreach campaign to increase awareness of the benefits of using such services) among—

(A) individuals entitled to medical assistance under the State plan who use tobacco products; and

(B) clinicians and others who provide services to individuals entitled to medical assistance under the State plan.”.

(e) Federal reimbursement for outreach campaign.— Section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is amended—

(1) in paragraph (6)(B), by striking “plus” at the end;

(2) in paragraph (7), by striking the period at the end and inserting “; plus”; and

(3) by inserting after paragraph (7) the following new paragraph:

“(8) with respect to the development, implementation, and evaluation of an outreach campaign to—

(A) increase awareness of comprehensive tobacco cessation services covered in the State plan among—

(i) individuals who are likely to be eligible for medical assistance under the State plan; and

(ii) clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State plan; and

(B) increase awareness of the benefits of using comprehensive tobacco cessation services covered in the State plan among—

(i) individuals who are likely to be eligible for medical assistance under the State plan; and

(ii) clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State plan about the benefits of using comprehensive tobacco cessation services, for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending on the date that is 5 years after the date of enactment of this paragraph, an amount equal to 90 percent of the sums expended during each quarter which are attributable to such development, implementation, and evaluation, and for calendar quarters succeeding such period, an amount equal to Federal medical assistance percentage determined under section 1905(b) of the sums expended during each quarter which are so attributable.”.

(f) No prior authorization for tobacco cessation drugs under medicaid.— Section 1927(d) of the Social Security Act (42 U.S.C. 1396r–8(d)) is amended—

(1) in paragraph (1)(A), by striking “A State” and inserting “Subject to paragraph (8), a State”; and

(2) by adding at the end the following new paragraph:

“(8) No prior authorization programs for tobacco cessation drugs.— A State plan may not require, as a condition of coverage or payment for a covered outpatient drug, the approval of an agent to promote smoking cessation (including agents approved by the Food and Drug Administration) or tobacco cessation.”.

(g) Exclusion of enhanced payments from territorial caps.— Notwithstanding any other provision of law, for purposes of section 1108 of the Social Security Act (42 U.S.C. 1308), with respect to any additional amount paid to a territory as a result of the application of section 1905(bb)(2) of the Social Security Act (42 U.S.C. 1396d(bb)(2))—

(1) the limitation on payments to territories under subsections (f) and (g) of such section 1108 shall not apply to such additional amounts; and

(2) such additional amounts shall be disregarded in applying such subsections.

(h) Requiring CHIP coverage of counseling and pharmacotherapy for cessation of tobacco use.—

(1) In general.— Section 2103(c)(2) of the Social Security Act (42 U.S.C. 1397cc(c)(2)) is amended by adding at the end the following new subparagraph:

“(D) Counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State child health plan.”.

(2) Counseling and pharmacotherapy for cessation of tobacco use defined.— Section 2110(c) of the Social Security Act (42 U.S.C. 1397jj(c)) is amended by adding at the end the following new paragraph:

“(10) Counseling and pharmacotherapy for cessation of tobacco use.— The term counseling and pharmacotherapy for cessation of tobacco use means diagnostic, therapy, and counseling services and pharmacotherapy (including the coverage of prescription and nonprescription tobacco cessation agents approved by the Food and Drug Administration) for the cessation of tobacco use by individuals who use tobacco products or who are being treated for tobacco use that are furnished—

(A) by or under the supervision of a physician; or

(B) by any other health care professional who—

(i) is legally authorized to furnish such services under State law (or the State regulatory mechanism provided by State law) of the State in which the services are furnished; and

(ii) is authorized to receive payment for other services under this title or is designated by the Secretary for this purpose, which is recommended in the guideline entitled, “Treating Tobacco Use and Dependence: 2008 Update: A Clinical Practice Guideline” published by the Public Health Service in May 2008 (or any subsequent modification of such guideline) or is recommended for the cessation of tobacco use by the United States Preventive Services Task Force or any additional intervention approved by the Food and Drug Administration as safe and effective in helping smokers quit.”.

(i) No cost sharing.— Section 2103(e) of the Social Security Act (42 U.S.C. 1397cc(e)) is amended by adding at the end the following new paragraph:

“(5) No cost sharing on benefits for counseling and pharmacotherapy for cessation of tobacco use.— The State child health plan may not impose deductibles, coinsurance, or other cost sharing with respect to benefits for counseling and pharmacotherapy for cessation of tobacco use (as defined in section 2110(c)(10)) and prescription drugs that are covered under a State child health plan that are prescribed for purposes of promoting tobacco cessation in accordance with the guideline specified in section 2110(c)(10)(B).”.

(j) Exception from optional restriction under CHIP prescription drug coverage.— Section 2103 of the Social Security Act (42 U.S.C. 1397cc) is amended by adding at the end the following new subsection:

“(g) Exception from optional restriction under CHIP prescription drug coverage.— The State child health plan may exclude or otherwise restrict nonprescription drugs, except, in the case of—

(1) pregnant women when recommended in accordance with the guideline specified in section 2110(c)(10)(B), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation; and

(2) individuals who are eligible under the State child health plan when recommended in accordance with the Guideline referred to in section 2110(c)(10)(B), agents approved by the Food and Drug Administration under the over-the-counter monograph process for purposes of promoting tobacco cessation.”.

(k) State monitoring and promoting of comprehensive tobacco cessation services under CHIP.— Section 2102 of the Social Security Act (42 U.S.C. 1397bb) is amended by adding at the end the following new subsection:

“(e) State monitoring and promoting of comprehensive tobacco cessation services under CHIP.— A State child health plan shall include a description of the procedures to be used by the State to monitor and promote the use of comprehensive tobacco cessation services under the State plan (including conducting an outreach campaign to increase awareness of the benefits of using such services) among—

(1) individuals entitled to medical assistance under the State child health plan who use tobacco products; and

(2) clinicians and others who provide services to individuals entitled to medical assistance under the State child health plan.”.

(l) Federal reimbursement for CHIP coverage and outreach campaign.—

(1) In general.— Section 2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) is amended by adding at the end the following new paragraph:

“(5) Federal reimbursement for CHIP coverage of comprehensive tobacco cessation services and outreach campaign.— In addition to the payments made under paragraph (1) for calendar quarters occurring during the period beginning on the date of the enactment of this paragraph and ending 5 years after such date, the Secretary shall pay—

(A) an amount equal to 90 percent of the sums expended during each quarter which are attributable to the cost of furnishing counseling and pharmacotherapy for cessation of tobacco use by individuals who are eligible under the State child health plan (net of any payments made to the State under paragraph (1) with respect to such counseling and pharmacotherapy); plus

(B) an amount equal to 90 percent of the sums expended during each quarter which are attributable to the development, implementation, and evaluation of an outreach campaign to—

(i) increase awareness of comprehensive tobacco cessation services covered in the State child health plan among—

(I) individuals who are likely to be eligible for medical assistance under the State child health plan; and

(II) clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State child health plan; and

(ii) increase awareness of the benefits of using comprehensive tobacco cessation services covered in the State child health plan among—

(I) individuals who are likely to be eligible for medical assistance under the State child health plan; and

(II) clinicians and others who provide services to individuals who are likely to be eligible for medical assistance under the State child health plan about the benefits of using comprehensive tobacco cessation services.”.

(2) Adjustment of CHIP allotments.— Section 2104(m) of the Social Security Act (42 U.S.C. 1397dd(m)) is amended—

(A) in paragraph (2)(B), by striking “and (12)” and inserting “(12), and (13)”; and

(B) by adding at the end the following new paragraph:

“(13) Adjusting allotments to account for federal payments for chip coverage of comprehensive tobacco cessation services and outreach campaign.— If a State (including the District of Columbia and each commonwealth and territory) receives a payment for a fiscal year under section 2105(a)(5), the allotment determined for the State for such fiscal year shall be increased by the amount of such payment.”.

(m) No prior authorization for tobacco cessation drugs under CHIP.— Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as amended by subsection (h), is further amended—

(1) in subsection (c)(2)(A), by inserting “(in accordance with subsection (h))” after “Coverage of prescription drugs”; and

(2) by adding at the end the following new subsection:

“(h) No prior authorization programs for tobacco cessation drugs.— A State child health plan may not require, as a condition of coverage or payment for prescription drugs, the approval of an agent to promote smoking cessation (including agents approved by the Food and Drug Administration) or tobacco cessation.”.

(n) Comprehensive coverage of tobacco cessation coverage in private health insurance.— Section 2713 of the Public Health Service Act (42 U.S.C. 300gg–13) is amended by adding at the end the following:

“(d) No prior authorization.— A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not impose any prior authorization requirement for tobacco cessation counseling and pharmacotherapy that has in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force.”.

(o) Rule of construction.— None of the amendments made by this section shall be construed to limit coverage of any counseling or pharmacotherapy for individuals under 18 years of age.

(p) Effective date.— The amendments made by this section shall take effect on the first day of the first fiscal year that begins on or after the date of enactment of this Act.

(a) In general.— The Secretary of Health and Human Services shall expand and intensify the conduct and support of the research activities of the National Institutes of Health and the National Institute of Dental and Craniofacial Research to improve the oral health of the population through the prevention and management of oral diseases and conditions.

(b) Included research activities.— Research activities under subsection (a) shall include—

(1) comparative effectiveness research and clinical disease management research addressing early childhood cancer and oral cancer; and

(2) awarding of grants and contracts to support the training and development of health services researchers, comparative effectiveness researchers, and clinical researchers whose research improves the oral health of the population.

(a) Development and dissemination of an evidence-Based strategies guide.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”), acting through the Director of the Centers for Disease Control and Prevention, not later than 2 years after the date of enactment of this Act, shall—

(1) develop a guide on evidence-based strategies for State, territorial, and local health departments to use to build and maintain effective obesity prevention and reduction programs, and, in consultation with stakeholders that have expertise in Tribal health, a guide on such evidence-based strategies with respect to Indian Tribes and Tribal organizations for such Indian Tribes and Tribal organizations to use for such purpose, both of which guides shall—

(A) describe an integrated program structure for implementing interventions proven to be effective in preventing and reducing the incidence of obesity; and

(B) recommend—

(i) optimal resources, including staffing and infrastructure, for promoting nutrition and obesity prevention and reduction; and

(ii) strategies for effective obesity prevention programs for State and local health departments, Indian Tribes, and Tribal organizations, including strategies related to—

(I) the application of evidence-based and evidence-informed practices to prevent and reduce obesity rates;

(II) the development, implementation, and evaluation of obesity prevention and reduction strategies for specific communities and populations;

(III) demonstrated knowledge of obesity prevention practices that reduce associated preventable diseases, health conditions, death, and health care costs;

(IV) best practices for the coordination of efforts to prevent and reduce obesity and related chronic diseases;

(V) addressing the underlying risk factors and social determinants of health that impact obesity rates; and

(VI) interdisciplinary coordination between relevant public health officials specializing in fields such as nutrition, physical activity, epidemiology, communications, and policy implementation, and collaboration between public health officials and community-based organizations; and

(2) disseminate the guides and current research, evidence-based practices, tools, and educational materials related to obesity prevention, consistent with the guides, to State and local health departments, Indian Tribes, and Tribal organizations.

(b) Technical assistance.— The Secretary, acting through the Director of the Centers for Disease Control and Prevention, shall provide technical assistance to State and local health departments, Indian Tribes, and Tribal organizations to support such health departments in implementing the guides developed under subsection (a)(1).

(c) Indian tribes; tribal organizations.— In this section, the terms Indian Tribe and Tribal organization have the meanings given the terms in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304).

(a) Research with respect to uterine fibroids.—

(1) Research.— The Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall expand, intensify, and coordinate programs for the conduct and support of research with respect to uterine fibroids.

(2) Administration and coordination.— The Secretary shall carry out the conduct and support of research pursuant to paragraph (1), in coordination with the appropriate institutes, offices, and centers of the National Institutes of Health and any other relevant Federal agency, as determined by the Director of the National Institutes of Health.

(3) Authorization of appropriations.— For the purpose of carrying out this subsection, there are authorized to be appropriated $30,000,000 for each of fiscal years 2027 through 2031.

(b) Research with respect to medicaid coverage of uterine fibroids treatment.—

(1) Research.— The Secretary (or the Secretary’s designee) shall establish a research database, or expand an existing research database, to collect data on services furnished to individuals diagnosed with uterine fibroids under a State plan (or a waiver of such a plan) under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) or under a State child health plan (or a waiver of such a plan) under the Children’s Health Insurance Program under title XXI of such Act (42 U.S.C. 1397aa et seq.) for the treatment of such fibroids for purposes of assessing the frequency at which such individuals are furnished such services.

(2) Report.—

(A) In general.— Not later than 2 years after the date of enactment of this Act, the Secretary shall submit to Congress a report on the amount of Federal and State expenditures with respect to services furnished for the treatment of uterine fibroids under State plans (or waivers of such plans) under the Medicaid program under such title XIX and State child health plans (or waivers of such plans) under the Children’s Health Insurance Program under such title XXI.

(B) Coordination.— The Secretary shall coordinate the development and submission of the report required under paragraph (1) with any other relevant Federal agency, as determined by the Secretary.

(c) Education and dissemination of information with respect to uterine fibroids.—

(1) Uterine fibroids public education program.— The Secretary shall develop and disseminate to the public information regarding uterine fibroids, including information on—

(A) the awareness, incidence, and prevalence of uterine fibroids among individuals, including all minority individuals;

(B) the elevated risk for minority individuals to develop uterine fibroids; and

(C) the availability, as medically appropriate, of the range of treatment options for symptomatic uterine fibroids, including non-hysterectomy treatments and procedures.

(2) Dissemination of information.— The Secretary may disseminate information under paragraph (1) directly or through arrangements with intra-agency initiatives, nonprofit organizations, consumer groups, institutions of higher education (as defined in section 101 of the Higher Education Act of 1965 (20 U.S.C. 1001)), or Federal, State, or local public private partnerships.

(3) Authorization of appropriations.— For the purpose of carrying out this subsection, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.

(d) Information to health care providers with respect to uterine fibroids.—

(1) Dissemination of information.— The Secretary shall, in consultation and in accordance with guidelines from relevant medical societies, work with health care-related specialty societies and health systems to promote evidence-based care for individuals with fibroids. Such efforts shall include minority individuals who have an elevated risk to develop uterine fibroids and the range of available options for the treatment of symptomatic uterine fibroids, including non-hysterectomy drugs and devices approved under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.).

(2) Authorization of appropriations.— For the purpose of carrying out this subsection, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2031.

(e) Definition.— In this section, the term minority individuals means individuals who are members of a racial and ethnic minority group, as defined in section 1707(g) of the Public Health Service Act (42 U.S.C. 300u–6(g)).

It is the policy of the United States to achieve an AIDS-free generation, and to—

(1) expand access to lifesaving antiretroviral therapy for people living with HIV and immediately link people to continuous and coordinated high-quality care when they learn they are living with HIV;

(2) expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches, including routine HIV screening, and universal access to HIV prevention tools, including preexposure prophylaxis, in communities disproportionately impacted by HIV, particularly communities of color;

(3) ensure laws, policies, and regulations do not impede access to prevention, treatment, and care for people living with HIV or disproportionately impacted by HIV;

(4) accelerate research for more efficacious HIV prevention and treatments, tools, a cure, and a vaccine; and

(5) respect the human rights and dignity of persons living with HIV.

Section 2623 of the Public Health Service Act (42 U.S.C. 300ff–31b) is amended by adding at the end the following:

“(c) Additional funding for AIDS drug assistance program treatments.— In addition to amounts otherwise authorized to be appropriated for carrying out this subpart, there are authorized to be appropriated such sums as may be necessary to carry out sections 2612(b)(3)(B) and 2616 for each of fiscal years 2027 through 2030.”.

(a) Grants.— The Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall make grants to States to support integration of public health surveillance systems into all electronic health records in order to allow rapid communications between the clinical setting and health departments, by means that include—

(1) providing technical assistance and policy guidance to State and local health departments, clinical providers, and other agencies serving individuals with HIV to improve the interoperability of data systems relevant to monitoring HIV care and supportive services;

(2) capturing longitudinal data pertaining to the initiation and ongoing prescription or dispensing of antiretroviral therapy for individuals diagnosed with HIV (such as through pharmacy-based reporting);

(3) obtaining information—

(A) on a voluntary basis, on sexual orientation and gender identity; and

(B) on sources of coverage (or the lack of coverage) for medical treatment (including coverage through the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.), the program under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the “Ryan White HIV/AIDS Program”), other public funding, private insurance, and health maintenance organizations); and

(4) obtaining and using current geographic markers of residence (such as current address, ZIP Code, partial ZIP Code, and census block).

(b) Privacy and security safeguards.— In carrying out this section, the Secretary of Health and Human Services shall ensure that appropriate privacy and security safeguards are met to prevent unauthorized disclosure of protected health information and compliance with the HIPAA privacy and security law (as defined in section 3009 of the Public Health Service Act (42 U.S.C. 300jj–19)) and other relevant laws and regulations.

(c) Prohibition against improper use of data.— No grant under this section may be used to allow or facilitate the collection or use of surveillance or clinical data or records—

(1) for punitive measures of any kind, civil or criminal, against the subject of such data or records; or

(2) for imposing any requirement or restriction with respect to an individual without the individual’s written consent.

(d) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2030.

(a) Strategies.— The Secretary of Health and Human Services, in collaboration with the Director of the Centers for Disease Control and Prevention, the Assistant Secretary for Mental Health and Substance Use, the Director of the Office of AIDS Research, the Administrator of the Health Resources and Services Administration, and the Administrator of the Centers for Medicare & Medicaid Services, shall—

(1) identify evidence-based strategies most effective at addressing the multifaceted issues that impede disease status awareness with respect to HIV/AIDS and linkage to, and retention in, appropriate care, taking into consideration health care systems issues, clinic and provider issues, and individual psychosocial, environmental, and other contextual factors;

(2) support the wide-scale implementation of the evidence-based strategies identified pursuant to paragraph (1), including through incorporating such strategies into health care coverage supported by the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), the program under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the “Ryan White HIV/AIDS Program”), and health plans purchased through an Exchange established under title I of the Patient Protection and Affordable Care Act (Public Law 111–148); and

(3) not later than 1 year after the date of the enactment of this Act, submit a report to the Congress on the status of activities under paragraphs (1) and (2).

(b) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) Sense of congress.— It is the sense of Congress that AIDS research has led to scientific advancements that have—

(1) saved the lives of millions of people living with HIV;

(2) prevented millions of individuals from receiving new diagnoses of HIV; and

(3) had broad benefits that extend far beyond helping people at risk for, or living with, HIV.

(b) In general.— The Secretary of Health and Human Services, acting through the Director of the National Institutes of Health, shall expand, intensify, and coordinate operational and translational research and other activities of the National Institutes of Health regarding methods—

(1) to increase adoption of evidence-based adherence strategies within HIV care and treatment programs;

(2) to increase HIV testing and case detection rates;

(3) to reduce HIV-related health disparities;

(4) to ensure that research to improve adherence to HIV care and treatment programs address the unique concerns of women;

(5) to integrate HIV prevention and care services with mental health and substance use prevention and treatment delivery systems;

(6) to increase knowledge on the implementation of preexposure prophylaxis (referred to in this section as “PrEP”), including with respect to—

(A) who can benefit most from PrEP;

(B) how to provide PrEP safely and efficiently;

(C) how to integrate PrEP with other essential prevention methods such as condoms; and

(D) how to ensure high levels of adherence; and

(7) to increase knowledge of “undetectable and untransmittable”, when a person living with HIV who is on antiretroviral therapy and is durably virally suppressed (defined as having a consistent viral load of less than 200 copies/ml) cannot sexually transmit HIV.

(c) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) In general.— For the purpose of reducing new HIV diagnoses in racial and ethnic minority communities, the Secretary of Health and Human Services, acting through the Deputy Assistant Secretary for Minority Health, may make grants to public health agencies and faith-based organizations to conduct—

(1) outreach activities related to HIV prevention and testing activities;

(2) HIV prevention activities;

(3) HIV testing activities; and

(4) public health education campaigns on accessing HIV prevention medication.

(b) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) Expanded funding.— The Secretary of Health and Human Services, in collaboration with the Deputy Assistant Secretary for Minority Health, the Director of the Centers for Disease Control and Prevention, the Administrator of the Health Resources and Services Administration, and the Assistant Secretary for Mental Health and Substance Use, shall provide funds and carry out activities to expand the Minority AIDS Initiative.

(b) Use of funds.— The additional funds made available under this section may be used, through the Minority AIDS Initiative, to support the following activities:

(1) Providing technical assistance and infrastructure support to reduce HIV/AIDS in minority populations.

(2) Increasing minority populations’ access to HIV prevention and care services.

(3) Building strong community programs and partnerships to address HIV prevention and the health care needs of specific racial and ethnic minority populations.

(c) Priority interventions.— Within the racial and ethnic minority populations referred to in subsection (b), priority in conducting intervention services shall be given to—

(1) men who have sex with men;

(2) youth;

(3) persons who engage in intravenous drug abuse;

(4) women;

(5) homeless individuals;

(6) individuals incarcerated or in the penal system;

(7) transgender individuals; and

(8) nonbinary individuals.

(d) Authorization of appropriations.— For carrying out this section, there are authorized to be appropriated $610,000,000 for fiscal year 2027 and such sums as may be necessary for each of fiscal years 2028 through 2031.

(a) In general.— The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall expand, intensify, and coordinate workforce initiatives of the Health Resources and Services Administration to increase the capacity of the health workforce focusing primarily on HIV to meet the demand for culturally competent care, and may award grants for any of the following:

(1) Development of curricula for training primary care providers in HIV/AIDS prevention and care, including routine HIV testing.

(2) Support to expand access to culturally and linguistically accessible benefits counselors, trained peer navigators, and mental and behavioral health professionals with expertise in HIV.

(3) Training health care professionals to provide care to individuals living with HIV.

(4) Development by grant recipients under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.; commonly referred to as the “Ryan White HIV/AIDS Program”) and other persons, of policies for providing culturally relevant and sensitive treatment to individuals living with HIV, with particular emphasis on treatment to racial and ethnic minorities, men who have sex with men, and women, young people, and children living with HIV.

(5) Development and implementation of programs to increase the use of telehealth to respond to HIV-specific health care needs in rural and minority communities, with particular emphasis given to medically underserved communities and insular areas.

(6) Evaluating interdisciplinary medical provider care team models that promote high-quality care, with particular emphasis on care to racial and ethnic minorities.

(7) Training health care professionals to make them aware of the high rates of chronic hepatitis B and chronic hepatitis C in adult racial and ethnic minority populations, and the importance of prevention, detection, and medical management of hepatitis B and hepatitis C and of liver cancer screening.

(8) Development of curricula for training primary care providers that HIV and tuberculosis are significant mutual comorbidities, and that a patient who tests positive for one disease should be offered and encouraged to receive testing for the other.

(b) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) In general.— The Secretary may enter into an agreement with any physician, nurse practitioner, or physician assistant under which—

(1) the physician, nurse practitioner, or physician assistant agrees to serve as a medical provider for a period of not less than 2 years—

(A) at a Ryan White-funded or title X-funded facility with a critical shortage of doctors (as determined by the Secretary); or

(B) in an area with a high incidence of HIV/AIDS; and

(2) the Secretary agrees to make payments in accordance with subsection (b) on the professional education loans of the physician, nurse practitioner, or physician assistant.

(b) Manner of payments.— The payments described in subsection (a) shall be made by the Secretary as follows:

(1) Upon completion by the physician, nurse practitioner, or physician assistant for whom the payments are to be made of the first year of the service specified in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal of and the interest on the individual’s professional education loans.

(2) Upon completion by the physician, nurse practitioner, or physician assistant of the second year of such service, the Secretary shall pay another 30 percent of the principal of and the interest on such loans.

(3) Upon completion by that individual of a third year of such service, the Secretary shall pay another 25 percent of the principal of and the interest on such loans.

(c) Applicability of certain provisions.— Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) shall, except as inconsistent with this section, apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps loan repayment program.

(d) Reports.— Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall prepare and submit to Congress a report describing the program carried out under this section, including statements regarding the following:

(1) The number of physicians, nurse practitioners, and physician assistants enrolled in the program.

(2) The number and amount of loan repayments provided through the program.

(3) The placement location of loan repayment recipients at facilities described in subsection (a)(1).

(4) The default rate on such loans and actions required.

(5) The amount of outstanding default funds with respect to such loans.

(6) To the extent that it can be determined, the reason for the default on such a loan.

(7) The demographics of individuals participating in the program.

(8) An evaluation of the overall costs and benefits of the program.

(e) Definitions.— In this section:

(1) HIV/AIDS.— The term HIV/AIDS means human immunodeficiency virus and acquired immune deficiency syndrome.

(2) Nurse practitioner.— The term nurse practitioner means a registered nurse who has completed an accredited graduate degree program in advanced nurse practice and has successfully passed a national certification exam.

(3) Physician.— The term physician means a graduate of a school of medicine who has completed postgraduate training in general or pediatric medicine.

(4) Physician assistant.— The term physician assistant means a medical provider who completed an accredited physician assistant training program and successfully passed the Physician Assistant National Certifying Examination.

(5) Professional education loan.— The term professional education loan—

(A) means a loan that is incurred for the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) at a school of medicine, school of nursing, or physician assistant training program; and

(B) includes only the portion of the loan that is outstanding on the date the physician, nurse practitioner, or physician assistant involved begins the service specified in the agreement under subsection (a).

(6) Ryan white-funded.— The term Ryan White-funded means, with respect to a facility, receiving funds under title XXVI of the Public Health Service Act (42 U.S.C. 300ff–11 et seq.).

(7) Secretary.— The term Secretary means the Secretary of Health and Human Services.

(8) School of medicine.— The term school of medicine has the meaning given to that term in section 799B of the Public Health Service Act (42 U.S.C. 295p).

(9) Title x-funded.— The term title X-funded means, with respect to a facility, receiving funds under title X of the Public Health Service Act (42 U.S.C. 300 et seq.).

(f) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) In general.— The Secretary may enter into an agreement with any dentist under which—

(1) the dentist agrees to serve as a dentist for a period of not less than 2 years at a facility with a critical shortage of dentists (as determined by the Secretary) in an area with a high incidence of HIV/AIDS; and

(2) the Secretary agrees to make payments in accordance with subsection (b) on the dental education loans of the dentist.

(b) Manner of payments.— The payments described in subsection (a) shall be made by the Secretary as follows:

(1) Upon completion by the dentist for whom the payments are to be made of the first year of the service specified in the agreement entered into with the Secretary under subsection (a), the Secretary shall pay 30 percent of the principal of and the interest on the dental education loans of the dentist.

(2) Upon completion by the dentist of the second year of such service, the Secretary shall pay another 30 percent of the principal of and the interest on such loans.

(3) Upon completion by that individual of a third year of such service, the Secretary shall pay another 25 percent of the principal of and the interest on such loans.

(c) Applicability of certain provisions.— Subpart III of part D of title III of the Public Health Service Act (42 U.S.C. 254l et seq.) shall, except as inconsistent with this section, apply to the program carried out under this section in the same manner and to the same extent as such provisions apply to the National Health Service Corps Loan Repayment Program.

(d) Reports.— Not later than 18 months after the date of the enactment of this Act, and annually thereafter, the Secretary shall prepare and submit to the Congress a report describing the program carried out under this section, including statements regarding the following:

(1) The number of dentists enrolled in the program.

(2) The number and amount of loan repayments provided through the program.

(3) The placement location of loan repayment recipients at facilities described in subsection (a)(1).

(4) The default rate on such loans and actions required.

(5) The amount of outstanding default funds with respect to such loans.

(6) To the extent that it can be determined, the reason for the default on such a loan.

(7) The demographics of individuals participating in the program.

(8) An evaluation of the overall costs and benefits of the program.

(e) Definitions.— In this section:

(1) Dental education loan.— The term dental education loan—

(A) means a loan that is incurred for the cost of attendance (including tuition, other reasonable educational expenses, and reasonable living costs) at a school of dentistry; and

(B) includes only the portion of the loan that is outstanding on the date the dentist involved begins the service specified in the agreement under subsection (a).

(2) Dentist.— The term dentist means a graduate of a school of dentistry who has completed postgraduate training in general or pediatric dentistry.

(3) HIV/AIDS.— The term HIV/AIDS means human immunodeficiency virus and acquired immune deficiency syndrome.

(4) School of dentistry.— The term school of dentistry has the meaning given to that term in section 799B of the Public Health Service Act (42 U.S.C. 295p).

(5) Secretary.— The term Secretary means the Secretary of Health and Human Services.

(f) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2030.

(a) Sense of congress.— It is the sense of Congress that providing sterile syringes and sterilized equipment to injecting drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.

(b) In general.— The Secretary of Health and Human Services may provide grants and technical assistance for the purpose of reducing the rate of HIV infections among injecting drug users through a comprehensive package of services for such users, including the provision of sterile syringes, education and outreach, access to infectious disease testing, overdose prevention, and treatment for drug dependence.

(c) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for fiscal years 2027 through 2030.

(a) In general.— The Secretary of Health and Human Services shall submit to Congress and the President an annual report on the impact of HIV/AIDS for racial and ethnic minority communities, women, and youth aged 24 and younger.

(b) Contents.— The report under subsection (a) shall include information on the—

(1) progress that has been made in reducing the impact of HIV/AIDS in such communities;

(2) opportunities that exist to make additional progress in reducing the impact of HIV/AIDS in such communities;

(3) challenges that may impede such additional progress; and

(4) Federal funding necessary to achieve substantial reductions in HIV/AIDS in racial and ethnic minority communities.

(a) National observance days.— It is the sense of Congress that national observance days highlighting the impact of HIV on communities of color include the following:

(1) National Black HIV/AIDS Awareness Day.

(2) National Latino AIDS Awareness Day.

(3) National Asian and Pacific Islander HIV/AIDS Awareness Day.

(4) National Native American HIV/AIDS Awareness Day.

(5) National Youth HIV/AIDS Awareness Day.

(b) Call to action.— It is the sense of Congress that the President should call on members of communities of color—

(1) to become involved at the local community level in HIV testing, policy, and advocacy;

(2) to become aware, engaged, and empowered on the HIV epidemic within their communities; and

(3) to urge members of their communities to reduce risk factors, practice safe sex and other preventive measures, be tested for HIV, and seek care when appropriate.

(a) Sense of congress regarding laws or regulations directed at people living with HIV.— It is the sense of Congress that Federal and State laws, policies, and regulations regarding people living with HIV—

(1) should not place unique or additional burdens on such individuals solely as a result of their HIV status; and

(2) should instead demonstrate a public health-oriented, evidence-based, medically accurate, and contemporary understanding of—

(A) the multiple factors that lead to HIV transmission;

(B) the relative risk of demonstrated HIV transmission routes;

(C) the current health implications of living with HIV;

(D) the associated benefits of treatment and support services for people living with HIV; and

(E) the impact of punitive HIV-specific laws, policies, regulations, and judicial precedents and decisions on public health, on people living with or affected by HIV, and on their families and communities.

(b) Review of federal and state laws.—

(1) Review of federal and state laws.—

(A) In general.— Not later than 90 days after the date of the enactment of this Act, the Attorney General, the Secretary of Health and Human Services, and the Secretary of Defense acting jointly (in this section referred to as the “designated officials”) shall initiate a national review of Federal and State laws, including the Uniform Code of Military Justice (referred to in this section as the “UCMJ”), policies, regulations, and judicial precedents and decisions regarding criminal and related civil commitment cases involving people living with HIV/AIDS.

(B) Consultation.— In carrying out the review under subparagraph (A), the designated officials shall seek to include diverse participation from, and consultation with, each of the following:

(i) Each State.

(ii) State attorneys general (or their representatives).

(iii) State public health officials (or their representatives).

(iv) State judicial and court system officers, including judges, district attorneys, prosecutors, defense attorneys, law enforcement, and correctional officers.

(v) Members of the United States Armed Forces, including members of other Federal services subject to the UCMJ.

(vi) People living with HIV/AIDS, particularly those who have been subject to HIV-related prosecution or who are from minority communities whose members have been disproportionately subject to HIV-specific arrests and prosecution.

(vii) Legal advocacy and HIV/AIDS service organizations that work with people living with HIV/AIDS.

(viii) Nongovernmental health organizations that work on behalf of people living with HIV/AIDS, including syringe services programs, LGBTQ-focused health organizations, and organizations who serve people who engage in sex work.

(ix) Trade organizations or associations representing persons or entities described in clauses (i) through (vii).

(C) Relation to other reviews.— In carrying out the review under subparagraph (A), the designated officials may utilize other existing reviews of criminal and related civil commitment cases involving people living with HIV, including any such review conducted by any Federal or State agency or any public health, legal advocacy, or trade organization or association if the designated officials determines that such reviews were conducted in accordance with the principles set forth in subsection (a).

(2) Report.— Not later than 180 days after initiating the review required under paragraph (1), the Attorney General shall transmit to the Congress and make publicly available a report containing the results of the review, which includes the following:

(A) For each State and for the UCMJ, a summary of the relevant laws, policies, regulations, and judicial precedents and decisions regarding criminal cases involving people living with HIV, including the following:

(i) A determination of whether such laws, policies, regulations, and judicial precedents and decisions place any unique or additional burdens upon people living with HIV.

(ii) A determination of whether such laws, policies, regulations, and judicial precedents and decisions demonstrate a public health-oriented, evidence-based, medically accurate, and contemporary understanding of—

(I) the multiple factors that lead to HIV transmission;

(II) the relative risk of HIV transmission routes, including that a person that has an undetectable viral load cannot transmit HIV;

(III) the current health implications of living with HIV, including data disaggregated by race and ethnicity;

(IV) the current status of providing protection to people who engage in survival sex work against whom condom possession has been used as evidence of intent to commit a crime;

(V) States that have the classification of mandatory sex offenders;

(VI) the associated benefits of treatment and support services for people living with HIV; and

(VII) the impact of punitive HIV-specific laws and policies on public health, on people living with or affected by HIV, and on their families and communities, including people who are in abusive, dependent, violent, or nonconsensual relationships and are unable to both negotiate the use of condoms and status disclosure.

(iii) An analysis of the public health and legal implications of such laws, policies, regulations, and judicial precedents and decisions, including an analysis of the consequences of having a similar penal scheme applied to comparable situations involving other communicable diseases.

(iv) An analysis of the proportionality of punishments imposed under HIV-specific laws, policies, regulations, and judicial precedents, taking into consideration penalties attached to violation of State laws against similar degrees of endangerment or harm, such as driving while intoxicated or transmission of other communicable diseases, or more serious harms, such as vehicular manslaughter offenses.

(B) An analysis of common elements shared between State laws, policies, regulations, and judicial precedents.

(C) A set of best practice recommendations directed to State governments, including State attorneys general, public health officials, and judicial officers, in order to ensure that laws, policies, regulations, and judicial precedents regarding people living with HIV are in accordance with the principles set forth in subsection (a).

(D) Recommendations for adjustments to the UCMJ, including discontinuing the use of a service member’s HIV diagnosis as the basis for prosecution, enhanced penalties, or discharge from military service, in order to ensure that laws, policies, regulations, and judicial precedents regarding people living with HIV are in accordance with the principles set forth in subsection (a). Such recommendations should include any necessary and appropriate changes to “Orders to Follow Preventative Medicine Requirements”.

(3) Guidance.— Not later than 90 days after the date of the release of the report required by paragraph (2), the Attorney General and the Secretary of Health and Human Services shall jointly develop and publicly release updated guidance for States based on the set of best practice recommendations required under paragraph (2)(C) in order to assist States dealing with criminal and related civil commitment cases regarding people living with HIV.

(4) Monitoring and evaluation system.— Not later than 60 days after the date of the release of the guidance required under paragraph (3), the Attorney General and the Secretary of Health and Human Services shall jointly establish an integrated monitoring and evaluation system that includes, where appropriate, objective and quantifiable performance goals and indicators to measure progress toward statewide implementation in each State of the best practice recommendations required under paragraph (2)(C).

(5) Modernization of federal laws, policies, and regulations.— Not later than 90 days after the date of the release of the report required under paragraph (2), the designated officials shall develop and transmit to the President and the Congress, and make publicly available, such proposals as may be necessary to implement adjustments to Federal laws, policies, or regulations, including the UCMJ, based on the recommendations required under paragraph (2)(D), either through Executive order or through changes to statutory law.

(c) Rule of construction.— Nothing in this section shall be construed to discourage the prosecution of individuals who intentionally transmit or attempt to transmit HIV to another individual.

(d) No additional appropriations authorized.— This section shall not be construed to increase the amount of appropriations that are authorized to be appropriated for any fiscal year.

(a) Sense of congress regarding distribution of sexual barrier protection devices in state prison systems.— It is the sense of Congress that States shall allow for the legal distribution of sexual barrier protection devices in State correctional facilities to reduce the prevalence and spread of STIs in those facilities.

(b) Authority To allow community organizations To provide STI counseling, STI prevention education, and sexual barrier protection devices in federal correctional facilities.—

(1) Directive to attorney general.— Not later than 30 days after the date of enactment of this Act, the Attorney General shall direct the Director of the Bureau of Prisons to allow community organizations to, in accordance with all relevant Federal laws and regulations that govern visitation in Federal correctional facilities—

(A) distribute sexual barrier protection devices in Federal correctional facilities; and

(B) engage in STI counseling and STI prevention education in Federal correctional facilities.

(2) Information requirement.— Any community organization permitted to distribute sexual barrier protection devices under paragraph (1) shall ensure that the individuals to whom the devices are distributed are informed about the proper use and disposal of sexual barrier protection devices in accordance with established public health practices. Any community organization conducting STI counseling or STI prevention education under paragraph (1) shall offer comprehensive sexuality education.

(3) Possession of device protected.— A Federal correctional facility may not, because of the possession or use of a sexual barrier protection device—

(A) take adverse action against an incarcerated individual; or

(B) consider possession or use as evidence of prohibited activity for the purpose of any Federal correctional facility administrative proceeding.

(4) Implementation.— The Attorney General and the Director of the Bureau of Prisons shall implement this section according to established public health practices in a manner that protects the health, safety, and privacy of incarcerated individuals and of correctional facility staff.

(c) Survey of and report on correctional facility programs aimed at reducing the spread of STIs.—

(1) Survey.— Not later than 180 days after the date of enactment of this Act, and annually thereafter for 5 years, the Attorney General, after consulting with the Secretary of Health and Human Services, State officials, and community organizations, shall, to the maximum extent practicable, conduct a survey of all Federal and State correctional facilities, to determine the following:

(A) Counseling, treatment, and supportive services.— Whether the correctional facility—

(i) requires incarcerated individuals to participate in counseling, treatment, and supportive services relating to STIs; or

(ii) offers such programs to incarcerated individuals.

(B) Access to sexual barrier protection devices.— Whether incarcerated individuals can—

(i) possess sexual barrier protection devices;

(ii) purchase sexual barrier protection devices;

(iii) purchase sexual barrier protection devices at a reduced cost; or

(iv) obtain sexual barrier protection devices without cost.

(C) Incidence of sexual violence.— The incidence of sexual violence and assault committed by incarcerated individuals and by correctional facility staff.

(D) Prevention education offered.— The type of prevention education, information, or training offered to incarcerated individuals and correctional facility staff regarding sexual violence and the spread of STIs, including whether such education, information, or training—

(i) constitutes comprehensive sexuality education;

(ii) is compulsory for new incarcerated individuals and for new correctional facility staff; and

(iii) is offered on an ongoing basis.

(E) STI testing.— Whether the correctional facility tests incarcerated individuals for STIs or gives them the option to undergo such testing—

(i) at intake;

(ii) on a regular basis; and

(iii) prior to release.

(F) STI test results.— The number of incarcerated individuals who are tested for STIs and the outcome of such tests at each correctional facility, disaggregated to include results for—

(i) the type of STI tested for;

(ii) the race and ethnicity of an individual tested;

(iii) the age of an individual tested; and

(iv) the gender of the individual tested.

(G) Prerelease referral policy.— Whether incarcerated individuals are informed prior to release about STI-related services or other health services in their communities, including free and low-cost counseling and treatment options.

(H) Prerelease referrals made.— The number of referrals to community-based organizations or public health facilities offering STI-related or other health services provided to incarcerated individuals prior to release, and the type of counseling or treatment for which the referral was made.

(I) Reinstatement of medicaid benefits.— Whether—

(i) the correctional facility assists incarcerated individuals that were enrolled in the State Medicaid program prior to their incarceration in reinstating their enrollment upon release; and

(ii) such individuals receive referrals as described in subparagraph (G) to entities that accept the State Medicaid program, including, if applicable—

(I) the number of such individuals, including those diagnosed with HIV, that have been reinstated;

(II) a list of obstacles to reinstating enrollment or to making determinations of eligibility for reinstatement, if any; and

(III) the number of individuals denied enrollment.

(J) Other actions taken.— Whether the correctional facility has taken any other action, in conjunction with community organizations or otherwise, to reduce the prevalence and spread of STIs in that facility.

(2) Privacy.— In conducting the survey under paragraph (1), the Attorney General shall not request or retain the identity of any individual who has sought or been offered counseling, treatment, testing, or prevention education information regarding an STI (including information about sexual barrier protection devices), or who has tested positive for an STI.

(3) Report.—

(A) In general.— The Attorney General shall transmit to Congress and make publicly available the results of the survey required under paragraph (1), both for the United States as a whole and disaggregated as to each State and each correctional facility.

(B) Deadlines.— To the maximum extent possible, the Attorney General shall—

(i) issue the first report under subparagraph (A) not later than 1 year after the date of enactment of this Act; and

(ii) issue reports under subparagraph (A) annually thereafter for 5 years.

(d) Strategy.—

(1) Directive to attorney general.— The Attorney General, in consultation with the Secretary of Health and Human Services, State officials, and community organizations, shall develop and implement a 5-year strategy to reduce the prevalence and spread of STIs in Federal and State correctional facilities. To the maximum extent possible, the strategy shall be developed, transmitted to Congress, and made publicly available not later than 180 days after the transmission of the first report required under subsection (c)(3).

(2) Contents of strategy.— The strategy developed under paragraph (1) shall include the following:

(A) Prevention education.— A plan for improving prevention education, information, and training offered to incarcerated individuals and correctional facility staff, including information and training on sexual violence and the spread of STIs, and comprehensive sexuality education.

(B) Sexual barrier protection device access.— A plan for expanding access to sexual barrier protection devices in correctional facilities.

(C) Sexual violence reduction.— A plan for reducing the incidence of sexual violence among incarcerated individuals and correctional facility staff.

(D) Counseling and supportive services.— A plan for expanding access to counseling and supportive services related to STIs in correctional facilities.

(E) Testing.— A plan for testing incarcerated individuals for STIs during intake, during regular health exams, and prior to release that—

(i) is conducted in accordance with guidelines established by the Centers for Disease Control and Prevention;

(ii) includes pretest counseling;

(iii) requires that incarcerated individuals are notified of their option to decline testing at any time;

(iv) requires that incarcerated individuals are confidentially notified of their test results in a timely manner; and

(v) ensures that incarcerated individuals testing positive for STIs receive post-test counseling, care, treatment, and supportive services.

(F) Treatment.— A plan for ensuring that correctional facilities have the necessary medicine and equipment to treat and monitor STIs and for ensuring that incarcerated individuals living with or testing positive for STIs receive and have access to care and treatment services.

(G) Strategies for demographic groups.— A plan for developing and implementing culturally appropriate, sensitive, and specific strategies to reduce the spread of STIs among demographic groups heavily impacted by STIs.

(H) Linkages with communities and facilities.— A plan for establishing and strengthening linkages to local community and health facilities that—

(i) provide counseling, testing, care, and treatment services;

(ii) may receive individuals recently released from incarceration who are living with STIs; and

(iii) accept payment through the State Medicaid program.

(I) Enrollment in state medicaid programs.— Plans to ensure that—

(i) incarcerated individuals who were enrolled in their State Medicaid program prior to incarceration in a correctional facility are automatically reenrolled in such program upon their release; and

(ii) incarcerated individuals who were not enrolled in their State Medicaid program prior to incarceration, and who are diagnosed with HIV while incarcerated in a correctional facility, are automatically enrolled in such program upon their release.

(J) Other plans.— Any other plans developed by the Attorney General for reducing the spread of STIs or improving the quality of health care in correctional facilities.

(K) Monitoring system.— A monitoring system that establishes performance goals related to reducing the prevalence and spread of STIs in correctional facilities and which, where feasible, expresses such goals in quantifiable form.

(L) Monitoring system performance indicators.— Performance indicators that measure or assess the achievement of the performance goals described in subparagraph (K).

(M) Cost estimate.— A detailed estimate of the funding necessary to implement the strategy at the Federal and State levels for all 5 years, including the amount of funds required by community organizations to implement the parts of the strategy in which they take part.

(3) Report.— Not later than 1 year after the date of the enactment of this Act, and annually thereafter, the Attorney General shall transmit to Congress and make publicly available an annual progress report regarding the implementation and effectiveness of the strategy described in paragraph (1). The progress report shall include an evaluation of the implementation of the strategy using the monitoring system and performance indicators provided for in subparagraphs (K) and (L) of paragraph (2).

(e) Authorization of appropriations.—

(1) In general.— There are authorized to be appropriated such sums as may be necessary to carry out this section for each of fiscal years 2027 through 2031.

(2) Availability of funds.— Amounts made available under paragraph (1) are authorized to remain available until expended.

(f) Definitions.— In this section:

(1) Community organization.— The term community organization means a public health care facility or a nonprofit organization that provides health- or STI-related services according to established public health standards.

(2) Comprehensive sexuality education.— The term comprehensive sexuality education means sexuality education—

(A) that includes information about abstinence and about the proper use and disposal of sexual barrier protection devices; and

(B) that is—

(i) evidence based;

(ii) medically accurate;

(iii) age and developmentally appropriate;

(iv) gender and identity sensitive;

(v) culturally and linguistically appropriate; and

(vi) structured to promote critical thinking, self-esteem, respect for others, and the development of healthy attitudes and relationships.

(3) Correctional facility.— The term correctional facility means any prison, penitentiary, adult detention facility, juvenile detention facility, jail, or other facility to which individuals may be sent after conviction of a crime or act of juvenile delinquency within the United States.

(4) Incarcerated individual.— The term incarcerated individual means any individual who is serving a sentence in a correctional facility after conviction of a crime.

(5) Sexual barrier protection device.— The term sexual barrier protection device means any physical device approved, cleared, or otherwise authorized by the Food and Drug Administration that has not been tampered with and which reduces the probability of STI transmission or infection between sexual partners, including female condoms, male condoms, and dental dams.

(6) Sexually transmitted infection.— The term sexually transmitted infection or “STI” means any disease or infection that is commonly transmitted through sexual activity, including HIV, gonorrhea, chlamydia, syphilis, genital herpes, viral hepatitis, and human papillomavirus.

(7) State.— The term State includes the District of Columbia, American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the United States Virgin Islands.

(8) State medicaid program.— The term State Medicaid program means the State plan (or a waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(a) In general.— Section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is amended by adding at the end the following:

“(17) Enrollment of ex-offenders.—

(A) Automatic enrollment or reinstatement.—

(i) In general.— The State plan shall provide for the automatic enrollment or reinstatement of enrollment of an eligible individual—

(I) if such individual is scheduled to be released from a public institution due to the completion of sentence, not less than 30 days prior to the scheduled date of the release; and

(II) if such individual is to be released from a public institution on parole or on probation, as soon as possible after the date on which the determination to release such individual was made, and before the date such individual is released.

(ii) Exception.— If a State makes a determination that an individual is not eligible to be enrolled under the State plan—

(I) on or before the date by which the individual would be enrolled under clause (i), such clause shall not apply to such individual; or

(II) after such date, the State may terminate the enrollment of such individual.

(B) Relationship of enrollment to payment for services.—

(i) In general.— Subject to subparagraph (A)(ii), an eligible individual who is enrolled, or whose enrollment is reinstated, under subparagraph (A) shall be eligible for all services for which medical assistance is provided under the State plan after the date that the eligible individual is released from the public institution.

(ii) Relationship to payment prohibition for inmates.— No provision of this paragraph may be construed to permit payment for care or services for which payment is excluded under subparagraph (A) following the last numbered paragraph of section 1905(a).

(C) Treatment of continuous eligibility.—

(i) Suspension for inmates.— Any period of continuous eligibility under this title shall be suspended on the date an individual enrolled under this title becomes an inmate of a public institution (except as a patient of a medical institution).

(ii) Determination of remaining period.— Notwithstanding any changes to State law related to continuous eligibility during the time that an individual is an inmate of a public institution (except as a patient of a medical institution), subject to clause (iii), with respect to an eligible individual who was subject to a suspension under clause (i), on the date that such individual is released from a public institution the suspension of continuous eligibility under such clause shall be lifted for a period that is equal to the time remaining in the period of continuous eligibility for such individual on the date that such period was suspended under such clause.

(iii) Exception.— If a State makes a determination that an individual is not eligible to be enrolled under the State plan—

(I) on or before the date that the suspension of continuous eligibility is lifted under clause (ii), such clause shall not apply to such individual; or

(II) after such date, the State may terminate the enrollment of such individual.

(D) Automatic enrollment or reinstatement of enrollment defined.— For purposes of this paragraph, the term automatic enrollment or reinstatement of enrollment means that the State determines eligibility for medical assistance under the State plan without a program application from, or on behalf of, the eligible individual, but an individual can only be automatically enrolled in the State Medicaid plan if the individual affirmatively consents to being enrolled through affirmation in writing, by telephone, orally, through electronic signature, or through any other means specified by the Secretary.

(E) Eligible individual defined.— For purposes of this paragraph, the term eligible individual means an individual who is an inmate of a public institution (except as a patient in a medical institution)—

(i) who was enrolled under the State plan for medical assistance immediately before becoming an inmate of such an institution; or

(ii) who is diagnosed with human immunodeficiency virus.”.

(b) Supplemental funding for state implementation of automatic reinstatement of medicaid benefits.—

(1) In general.— Subject to paragraph (3), with respect to a State, for each of the first 4 calendar quarters in which the State plan meets the requirements of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as added by subsection (a)), the Federal matching payments (including payments based on the Federal medical assistance percentage) made to such State under section 1903 of the Social Security Act (42 U.S.C. 1396b) for the State expenditures described in paragraph (2) shall be increased by 5 percentage points.

(2) Expenditures.— The expenditures described in this paragraph are the following:

(A) Expenditures for which payment is available under section 1903 of the Social Security Act (42 U.S.C. 1396b) and which are attributable to strengthening the State’s enrollment and administrative resources for the purpose of improving processes for enrolling (or reinstating the enrollment of) eligible individuals (as such term is defined in subparagraph (E) of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) (as amended by subsection (a))).

(B) Expenditures for medical assistance (as such term is defined in section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a))) provided to such eligible individuals.

(3) Requirements; limitation.—

(A) Report.— A State is not eligible for an increase in its Federal matching payments under paragraph (1) unless the State agrees to submit to the Secretary of Health and Human Services, and make publicly available, a report that contains the information required under paragraph (4) by the end of the 1-year period during which the State receives increased Federal matching payments in accordance with that paragraph.

(B) Maintenance of eligibility.—

(i) In general.— Subject to clause (ii), a State is not eligible for an increase in its Federal matching payments under paragraph (1) if eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or waiver of such a plan, are more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan or waiver as in effect on the date of enactment of this Act.

(ii) State reinstatement of eligibility permitted.— A State that has restricted eligibility standards, methodologies, or procedures under its State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), or a waiver of such plan, after the date of enactment of this Act, is no longer ineligible under clause (i) beginning with the first calendar quarter in which the State has reinstated eligibility standards, methodologies, or procedures that are no more restrictive than the eligibility standards, methodologies, or procedures, respectively, under such plan (or waiver) as in effect on such date.

(C) Limitation of matching payments to 100 percent.— In no case shall an increase in Federal matching payments under paragraph (1) result in Federal matching payments that exceed 100 percent of State expenditures.

(4) Required report information.— The information that is required in the report under paragraph (3)(A) shall include—

(A) the results of an evaluation of the impact of the implementation of the requirements of paragraph (17) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) on improving the State’s processes for enrolling individuals who are released from public institutions under the State Medicaid plan;

(B) the number of individuals who were automatically enrolled (or whose enrollment was reinstated) under such paragraph during the 1-year period during which the State received increased payments under this subsection; and

(C) any other information that is required by the Secretary of Health and Human Services.

(c) Effective date.—

(1) In general.— Except as provided in paragraph (2), the amendments made by subsection (a) shall take effect 180 days after the date of the enactment of this Act.

(2) Rule for changes requiring state legislation.— In the case of a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

(a) HIV policy.— The Director of the Bureau of Prisons (referred to in this section as the “Director”) shall develop a comprehensive policy to provide HIV testing, treatment, and prevention for inmates within the correctional setting and upon reentry.

(b) Purpose.— The purposes of the policy required to be developed under subsection (a) shall be as follows:

(1) To stop the spread of HIV among inmates.

(2) To protect guards and other personnel at correctional facilities from HIV infection.

(3) To provide comprehensive medical treatment to inmates who are living with HIV.

(4) To promote HIV awareness and prevention among inmates.

(5) To encourage inmates to take personal responsibility for their health.

(6) To reduce the risk that inmates will transmit HIV to other persons in the community following their release from a correctional facility.

(c) Consultation.— The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of the policy required under subsection (a).

(d) Time limit.— Not later than 1 year after the date of enactment of this Act, the Director shall draft appropriate regulations to implement the policy required to be developed under subsection (a).

(e) Requirements for policy.— The policy required to be developed under subsection (a) shall provide for the following:

(1) Testing and counseling upon intake.—

(A) Health care personnel shall provide routine HIV testing to all inmates as a part of a comprehensive medical examination immediately following admission to a facility. Health care personnel need not provide routine HIV testing to an inmate who is transferred to a facility from another facility if the inmate’s medical records are transferred with the inmate and indicate that the inmate has been tested previously.

(B) With respect to all inmates admitted to a facility prior to the effective date of the policy—

(i) health care personnel shall provide routine HIV testing by not later than 180 days after such effective date; and

(ii) HIV testing described in clause (i) may be performed in conjunction with other health services provided to these inmates by health care personnel.

(C) All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).

(2) Pre-test and post-test counseling.— Health care personnel shall provide confidential pre-test and post-test counseling to all inmates who are tested for HIV. Counseling may be included with other general health counseling provided to inmates by health care personnel.

(3) HIV prevention education.—

(A) Health care personnel shall improve HIV awareness through frequent educational programs for all inmates. HIV educational programs may be provided by community-based organizations, local health departments, and inmate peer educators.

(B) HIV educational materials shall be made available to all inmates at orientation, at health care clinics, at regular educational programs, and prior to release. Both written and audiovisual materials shall be made available to all inmates.

(C)

(i) The HIV educational programs and materials under this paragraph shall include information on—

(I) modes of transmission, including transmission through tattooing, sexual contact, and intravenous drug use;

(II) prevention methods;

(III) treatment; and

(IV) disease progression.

(ii) The programs and materials shall be culturally sensitive, written or designed for low-literacy levels, available in a variety of languages, and present scientifically accurate information in a clear and understandable manner.

(4) HIV testing upon request.—

(A) Health care personnel shall allow inmates to obtain HIV tests upon request once per year or whenever an inmate has a reason to believe the inmate may have been exposed to HIV. Health care personnel shall, both orally and in writing, inform inmates, during orientation and periodically throughout incarceration, of their right to obtain HIV tests.

(B) Health care personnel shall encourage inmates to request HIV tests if the inmate is sexually active, has been raped, uses intravenous drugs, receives a tattoo, or if the inmate is concerned that the inmate may have been exposed to HIV.

(C) An inmate’s request for an HIV test shall not be considered an indication that the inmate has put themselves at risk of infection or committed a violation of the rules of the correctional facility.

(5) HIV testing of pregnant woman.—

(A) Health care personnel shall provide routine HIV testing to all inmates who become pregnant.

(B) All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).

(6) Comprehensive treatment.—

(A) Health care personnel shall provide all inmates who test positive for HIV—

(i) timely, comprehensive medical treatment;

(ii) confidential counseling on managing their medical condition and preventing its transmission to other persons; and

(iii) voluntary partner notification services.

(B) Health care provided under this paragraph shall be consistent with Department of Health and Human Services guidelines and standard medical practice. Health care personnel shall discuss treatment options, the importance of adherence to antiretroviral therapy, and the side effects of medications with inmates receiving treatment.

(C) Health care personnel and pharmacy personnel shall ensure that the facility formulary contains all Food and Drug Administration-approved medications necessary to provide comprehensive treatment for inmates living with HIV, and that the facility maintains adequate supplies of such medications to meet inmates’ medical needs. Health care personnel and pharmacy personnel shall also develop and implement automatic renewal systems for these medications to prevent interruptions in care.

(D) Correctional staff, health care personnel, and pharmacy personnel shall develop and implement distribution procedures to ensure timely and confidential access to medications.

(7) Protection of confidentiality.—

(A) Health care personnel shall develop and implement procedures to ensure the confidentiality of inmate tests, diagnoses, and treatment. Health care personnel and correctional staff shall receive regular training on the implementation of these procedures. Penalties for violations of inmate confidentiality by health care personnel or correctional staff shall be specified and strictly enforced.

(B) HIV testing, counseling, and treatment shall be provided in a confidential setting where other routine health services are provided and in a manner that allows the inmate to request and obtain these services as routine medical services.

(8) Testing, counseling, and referral prior to reentry.—

(A) Health care personnel shall provide routine HIV testing to all inmates not earlier than 90 days prior to their release and reentry into the community. Inmates who are already known to be infected need not be tested again. This requirement may be waived if an inmate’s release occurs without sufficient notice to the Director to allow health care personnel to perform a routine HIV test and notify the inmate of the results.

(B) All HIV tests under this paragraph shall comply with the opt-out provision under paragraph (9).

(C) With respect to all inmates who test positive for HIV and all inmates who already are known to have HIV, health care personnel shall provide—

(i) confidential prerelease counseling on managing their medical condition in the community, accessing appropriate treatment and services in the community, and preventing the transmission of their condition to family members and other persons in the community;

(ii) referrals to appropriate health care providers and social service agencies in the community that meet the inmate’s individual needs, including voluntary partner notification services and prevention counseling services for people living with HIV; and

(iii) a 30-day supply of any medically necessary medications the inmate is currently receiving.

(9) Opt-out provision.— Inmates shall have the right to refuse routine HIV testing. Inmates shall be informed both orally and in writing of this right. Oral and written disclosure of this right may be included with other general health information and counseling provided to inmates by health care personnel. If an inmate refuses a routine test for HIV, health care personnel shall make a note of the inmate’s refusal in the inmate’s confidential medical records. However, the inmate’s refusal shall not be considered a violation of the rules of the correctional facility or result in disciplinary action.

(10) Exclusion of tests performed under section 4014(b) from the definition of routine HIV testing.— HIV testing of an inmate under section 4014(b) of title 18, United States Code, is not routine HIV testing for the purposes of the opt-out provision under paragraph (9). Health care personnel shall document the reason for testing under section 4014(b) of title 18, United States Code, in the inmate’s confidential medical records.

(11) Timely notification of test results.— Health care personnel shall provide timely notification to inmates of the results of HIV tests.

(f) Changes in existing law.—

(1) Screening in general.— Section 4014(a) of title 18, United States Code, is amended—

(A) by striking “for a period of 6 months or more”;

(B) by striking “, as appropriate,”; and

(C) by striking “if such individual is determined to be at risk for infection with such virus in accordance with the guidelines issued by the Bureau of Prisons relating to infectious disease management.” and inserting “unless the individual declines. The Attorney General shall also cause such individual to be so tested before release from that incarceration unless the individual declines.”.

(2) Inadmissibility of HIV test results in civil and criminal proceedings.— Section 4014(d) of title 18, United States Code, is amended by inserting “or under section 7417 of the Health Equity and Accountability Act of 2026” after “under this section”.

(3) Screening as part of routine screening.— Section 4014(e) of title 18, United States Code, is amended by adding at the end the following: “Such rules shall also provide that the initial test under this section be performed as part of the routine health screening conducted at intake.”.

(g) Reporting requirements.—

(1) Report on hepatitis, liver, and other diseases.— Not later than 1 year after the date of enactment of this Act, the Director shall submit to Congress a report on the policies and procedures of the Bureau of Prisons to provide testing, treatment, and prevention education programs for hepatitis, liver failure, and other liver-related diseases transmitted through sexual activity, intravenous drug use, or other means. The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of this report.

(2) Annual reports.—

(A) Generally.— Not later than 2 years after the date of enactment of this Act, and annually thereafter, the Director submit to Congress a report on the incidence among inmates of diseases transmitted through sexual activity and intravenous drug use.

(B) Matters pertaining to various diseases.— Each report under subparagraph (A) shall discuss—

(i) the incidence among inmates of HIV, hepatitis, and other diseases transmitted through sexual activity and intravenous drug use; and

(ii) updates on the testing, treatment, and prevention education programs for these diseases conducted by the Bureau of Prisons.

(C) Matters pertaining to hiv only.— Each report under subparagraph (A) shall also include—

(i) the number of inmates who tested positive for HIV upon intake;

(ii) the number of inmates who tested positive for HIV prior to reentry;

(iii) the number of inmates who were not tested for HIV prior to reentry because they were released without sufficient notice;

(iv) the number of inmates who opted out of taking an HIV test;

(v) the number of inmates who were tested under section 4014(b) of title 18, United States Code; and

(vi) the number of inmates under treatment for HIV.

(D) Consultation.— The Director shall consult with appropriate officials of the Department of Health and Human Services, the Office of National Drug Control Policy, the Office of National AIDS Policy, and the Centers for Disease Control and Prevention regarding the development of each report under subparagraph (A).

Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) is amended by inserting after section 241 (42 U.S.C. 238j) the following:

“241A. Transfer of funds for implementation of National HIV/AIDS Strategy.—

(a) Transfer authorization.— Of the discretionary appropriations made available to the Department of Health and Human Services for any fiscal year for programs and activities that, as determined by the Secretary, pertain to HIV, the Secretary may transfer up to 1 percent of such appropriations to the Office of the Assistant Secretary for Health for implementation of the Ending the HIV Epidemic: A Plan for America.

(b) Congressional notification.— Not less than 30 days before making any transfer under this section, the Secretary shall give notice of the transfer to the Congress.

(c) Definitions.— In this section, the term Ending the HIV Epidemic: A Plan for America means the initiative of the Department of Health and Human Services that seeks to reduce the number of new HIV infections in the United States by 75 percent by 2027, and then by at least 90 percent by 2032, for an estimated 250,000 total HIV infections averted.”.

(a) Coverage of HIV testing and prevention services.—

(1) Private insurance.—

(A) In general.— Section 2713(a) of the Public Health Service Act (42 U.S.C. 300gg–13(a)) is amended to read as follows:

“(a) Coverage of preventive health services.—

(1) In general.— A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum, provide coverage for and shall not impose any cost sharing requirements for—

(A) evidence-based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force;

(B) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;

(C) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration;

(D) with respect to women, such additional preventive care and screenings not described in subparagraph (A) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this subparagraph;

(E) any prescription drug approved by the Food and Drug Administration for the prevention of HIV (other than a drug subject to preauthorization requirements consistent with section 2729A), administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation; and”.

(B) Prohibition on preauthorization requirements.—

(i) PHSA.— 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:

“2799A–12. Prohibition on preauthorization requirements with respect to certain services.— A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.”.

(ii) ERISA.—

(I) 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:

“727. Prohibition on preauthorization requirements with respect to certain services.— A group health plan or a health insurance issuer offering group health insurance coverage shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan or issuer may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan or issuer provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.”.

(II) Clerical amendment.— The table of contents in section 1 of such Act is amended by inserting after the item relating to section 726 the following new item:

(iii) IRC.—

(I) In general.— Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following:

“9827. Prohibition on preauthorization requirements with respect to certain services.— A group health plan shall not impose any preauthorization requirements with respect to coverage of the services described in section 2713(a)(1)(E), except that a plan may impose preauthorization requirements with respect to coverage of a particular drug approved under section 505(c) of the Federal Food, Drug, and Cosmetic Act or section 351(a) of this Act if such plan provides coverage without any preauthorization requirements for a drug that is therapeutically equivalent.”.

(C) 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:

(2) Coverage under federal employees health benefits program.— Section 8904 of title 5, United States Code, is amended by adding at the end the following:

“(c) Any health benefits plan offered under this chapter shall include benefits for, and may not impose any cost sharing requirements for, any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.”.

(3) Medicaid.—

(A) In general.— Section 1905 of the Social Security Act (42 U.S.C. 1396d), as amended by section 5201(b)(2)(A)(i) and 5406(f), is amended—

(i) in subsection (a)(4)—

(I) by striking “; and (G)” and inserting “; (G)”; and

(II) by striking the semicolon at the end and inserting “; and (H) HIV prevention services;”; and

(ii) by adding at the end the following new subsection:

“(rr) HIV prevention services.— For purposes of subsection (a)(4)(H), the term HIV prevention services means prescription drugs for the prevention of HIV acquisition, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.”.

(B) No cost-sharing.— Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended—

(i) in section 1916, by inserting “HIV prevention services described in section 1905(a)(4)(H),” after “section 1905(a)(4)(C),” each place it appears; and

(ii) in section 1916A(b)(3)(B), as amended by section 7305, by adding at the end the following new clause:

“(xvi) HIV prevention services described in section 1905(a)(4)(H).”.

(C) Inclusion in benchmark coverage.— Section 1937(b)(7) of the Social Security Act (42 U.S.C. 1396u–7(b)(7)) is amended—

(i) in the paragraph header, by inserting “and HIV prevention services” after “supplies”; and

(ii) by striking “includes for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section” and inserting “includes medical assistance for HIV prevention services described in section 1905(a)(4)(H), and includes, for any individual described in section 1905(a)(4)(C), medical assistance for family planning services and supplies in accordance with such section”.

(4) CHIP.—

(A) In general.— Section 2103 of the Social Security Act (42 U.S.C. 1397cc), as amended by section 2007(d)(5), is amended—

(i) in subsection (a), by striking “through (13)” and inserting “through (14)”; and

(ii) in subsection (c), by adding at the end the following new paragraph:

“(14) HIV prevention services.— Regardless of the type of coverage elected by a State under subsection (a), the child health assistance provided for a targeted low-income child, and, in the case of a State that elects to provide pregnancy-related assistance pursuant to section 2112, the pregnancy-related assistance provided for a targeted low-income pregnant woman (as such terms are defined for purposes of such section), shall include coverage of HIV prevention services (as defined in section 1905(rr)).”.

(B) No cost-sharing.— Section 2103(e)(2) of the Social Security Act (42 U.S.C. 1397cc(e)(2)) is amended by inserting “HIV prevention services described in subsection (c)(14),” before “or for pregnancy-related assistance”.

(C) Effective date.—

(i) In general.— Subject to clause (ii), the amendments made by paragraph (3) and this paragraph shall take effect on January 1, 2027.

(ii) Delay permitted if state legislation required.— In the case of a State plan approved under title XIX or XXI of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of the failure of the plan to meet such additional requirements before the 1st day of the 1st calendar quarter beginning after the close of the 1st regular session of the State legislature that ends after the 1-year period beginning with the date of the enactment of this Act. For purposes of the preceding sentence, in the case of a State that has a 2-year legislative session, each year of the session is deemed to be a separate regular session of the State legislature.

(5) Coverage and elimination of cost-sharing under Medicare.—

(A) Coverage of HIV prevention services under part B.—

(i) Coverage.—

(I) In general.— Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)), as amended by section 4251(c)(1) and 6101(a)(1), is amended—

(aa) by striking “and” at the end of subparagraph (LL);

(bb) by inserting “and” at the end of subparagraph (MM); and

(cc) by adding at the end the following new subparagraph:

“(NN) HIV prevention services (as defined in subsection (sss));”.

(II) Definition.— Section 1861 of the Social Security Act (42 U.S.C. 1395x), as amended by sections 2007(b), 4221(a), 4251(c)(2), and 6101(a)(2), is amended by adding at the end the following new subsection:

“(sss) HIV prevention services.— The term HIV prevention services means—

(1) drugs or biologicals approved by the Food and Drug Administration for the prevention of HIV;

(2) administrative fees for such drugs;

(3) laboratory and other diagnostic procedures associated with the use of such drugs; and

(4) clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.”.

(ii) Elimination of coinsurance.— Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)), as amended by sections 4251(c)(3) and 6101(a)(4), is amended—

(I) by striking “and” before “(JJ)”; and

(II) by inserting before the semicolon at the end the following: “and (KK) with respect to HIV prevention services (as defined in section 1861(sss)), the amount paid shall be 100 percent of (i) except as provided in clause (ii), the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to such services under this part, and (ii) in the case of such services that are covered OPD services (as defined in subsection (t)(1)(B)), the amount determined under subsection (t)”.

(iii) Exemption from part B deductible.— Section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended—

(I) in paragraph (12), by striking “section 1861(s)(10)(A),, and” and inserting “section 1861(s)(10)(A),”;

(II) in paragraph (13), by striking “section 1861(n)..” and inserting “section 1861(n), and (14) such deductible shall not apply with respect to HIV prevention services (as defined in section 1861(sss).”.

(iv) Effective date.— The amendments made by this subparagraph shall apply to items and services furnished on or after January 1, 2027.

(B) Elimination of cost-sharing for drugs for the prevention of HIV under part D.—

(i) In general.— Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—

(I) in subsection (b)—

(aa) in paragraph (1)(A), in the matter preceding clause (i), by striking “(8) and (9)” and inserting “(8), (9), and (10)”;

(bb) in paragraph (2)(A), in subparagraph (A), in the matter preceding clause (i), by striking “(8) and (9)” and inserting “(8), (9), and (10)”; and

(cc) by adding at the end the following new paragraph:

“(10) Elimination of cost-sharing for drugs for the prevention of HIV.— For plan years beginning on or after January 1, 2027, with respect to a covered part D drug that is for the prevention of HIV—

(A) the deductible under paragraph (1) shall not apply; and

(B) there shall be no coinsurance or other cost-sharing under this part with respect to such drug.”; and

(II) in subsection (c), by adding at the end the following new paragraph:

“(7) Treatment of cost-sharing for drugs for the prevention of hiv.— The coverage is in accordance with subsection (b)(10).”.

(ii) Conforming amendments to cost-sharing for low-income individuals.— Section 1860D–14(a)(1)(D) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(D)) is amended in each of clauses (ii) and (iii), by striking “paragraph (6)” and inserting “paragraph (6) and section 1860D–2(b)(10)”.

(6) Coverage of HIV prevention treatment by Department of Veterans Affairs.—

(A) Elimination of medication copayments.— Section 1722A(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:

“(5) Paragraph (1) does not apply to a medication for the prevention of HIV.”.

(B) Elimination of hospital care and medical services copayments.— Section 1710 of such title is amended—

(i) in subsection (f)—

(I) by redesignating paragraph (5) as paragraph (6); and

(II) by inserting after paragraph (4) the following new paragraph (5):

“(5) A veteran shall not be liable to the United States under this subsection for any amounts for laboratory and other diagnostic procedures associated with the use of any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, or for laboratory or other diagnostic procedures associated with the use of such drugs, or clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.”; and

(ii) in subsection (g)(3), by adding at the end the following new subparagraph:

“(C) Any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.”.

(C) Inclusion as preventive health service.— Section 1701(9) of such title is amended—

(i) in subparagraph (K), by striking “; and” and inserting a semicolon;

(ii) by redesignating subparagraph (L) as subparagraph (M); and

(iii) by inserting after subparagraph (K) the following new subparagraph (L):

“(L) any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation; and”.

(7) Coverage of HIV prevention treatment by Department of Defense.—

(A) In general.— Chapter 55 of title 10, United States Code, is amended by inserting after section 1079c the following new section:

“1079d. Coverage of HIV prevention treatment.—

(a) In general.— The Secretary of Defense shall ensure coverage under the TRICARE program of HIV prevention treatment described in subsection (b) for any beneficiary under section 1074(a) of this title.

(b) HIV prevention treatment described.— HIV prevention treatment described in this subsection includes any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation.

(c) No cost-Sharing.— Notwithstanding section 1075, 1075a, or 1074g(a)(6) of this title or any other provision of law, there is no cost-sharing requirement for HIV prevention treatment covered under this section.”.

(B) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1079c the following new item:

(8) Indian health service testing, monitoring, and prescription drugs for the prevention of hiv.— Title II of the Indian Health Care Improvement Act is amended by inserting after section 223 (25 U.S.C. 1621v) the following:

“224. Testing, monitoring, and prescription drugs for the prevention of HIV.—

(a) In general.— The Secretary, acting through the Service, Indian tribes, and tribal organizations, shall provide, without limitation, funding for any prescription drug approved by the Food and Drug Administration for the prevention of human immunodeficiency virus (commonly known as “HIV”), administrative fees for that drug, laboratory and other diagnostic procedures associated with the use of that drug, and clinical follow-up and monitoring, including any related services recommended in current Public Health Service clinical practice guidelines.

(b) Authorization of appropriations.— There are authorized to be appropriated such sums as are necessary to carry out this section.”.

(b) Prohibition on denial of coverage or increase in premiums of life, disability, or long-Term care insurance for individuals taking medication for the prevention of HIV acquisition.—

(1) Prohibition.— Notwithstanding any other provision of law, it shall be unlawful to—

(A) decline or limit coverage of a person under any life insurance policy, disability insurance policy, or long-term care insurance policy, on account of the individual taking medication for the purpose of preventing the acquisition of HIV;

(B) preclude an individual from taking medication for the purpose of preventing the acquisition of HIV as a condition of receiving a life insurance policy, disability insurance policy, or long-term care insurance policy;

(C) consider whether an individual is taking medication for the purpose of preventing the acquisition of HIV in determining the premium rate for coverage of such individual under a life insurance policy, disability insurance policy, or long-term care insurance policy; or

(D) otherwise discriminate in the offering, issuance, cancellation, amount of such coverage, price, or any other condition of a life insurance policy, disability insurance policy, or long-term care insurance policy for an individual, based solely and without any additional actuarial risks upon whether the individual is taking medication for the purpose of preventing the acquisition of HIV.

(2) Enforcement.— A State insurance regulator may take such actions to enforce paragraph (1) as are specifically authorized under the laws of such State.

(3) Definitions.— In this subsection:

(A) Disability insurance policy.— The term disability insurance policy means a contract under which an entity promises to pay a person a sum of money in the event that an illness or injury resulting in a disability prevents such person from working.

(B) Life insurance policy.— The term life insurance policy means a contract under which an entity promises to pay a designated beneficiary a sum of money upon the death of the insured.

(C) Long-term care insurance policy.— The term long-term care insurance policy means a contract for which the only insurance protection provided under the contract is coverage of qualified long-term care services (as defined in section 7702B(c) of the Internal Revenue Code of 1986).

(c) Patient confidentiality.— The Secretary of Health and Human Services shall amend the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d–2 note), as necessary, to ensure that individuals are able to access the benefits described in section 2713(a)(1)(E) of the Public Health Service Act under a family plan without any other individual enrolled in such family plan, including a primary subscriber or policyholder of such plan, being informed of such use of such benefits.

(d) Pre-Exposure prophylaxis and post-Exposure prophylaxis funding.— Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.), as amended by section 7303, is amended by adding at the end the following:

“399V–11. Pre-exposure prophylaxis and post-exposure prophylaxis funding.—

(a) In general.— Not later than 1 year after the date of enactment of this section, the Secretary shall establish a program that awards grants to States, territories, Indian Tribes, and directly eligible entities for the establishment and support of pre-exposure prophylaxis (referred to in this section as “PrEP”) and post-exposure prophylaxis (referred to in this section as “PEP”) HIV programs.

(b) Applications.— To be eligible to receive a grant under subsection (a), a State, territory, Indian Tribe, or directly eligible entity shall—

(1) submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a plan describing how any funds awarded will be used to increase access to PrEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP for uninsured and underinsured individuals and reduce disparities in access to PrEP and PEP; and

(2) appoint a PrEP and PEP grant administrator to manage the program.

(c) Directly eligible entity.— For purposes of this section, the term directly eligible entity—

(1) means a Federally qualified health center or other nonprofit entity engaged in providing PrEP and PEP information and services; and

(2) may include—

(A) a Federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act);

(B) a family planning grantee (other than States) funded under section 1001;

(C) a rural health clinic (as defined in section 1861(aa)(2) of the Social Security Act);

(D) a health facility operated by or pursuant to a contract with the Indian Health Service;

(E) a community-based organization, clinic, hospital, or other health facility that provides services to individuals at risk for or living with HIV; and

(F) a nonprofit private entity providing comprehensive primary care to populations at risk of HIV, including faith-based and community-based organizations.

(d) Awards.— In determining whether to award a grant, and the grant amount for each grant awarded, the Secretary shall consider the grant application and the need for PrEP and PEP services in the area, the number of uninsured and underinsured individuals in the area, and how the State, territory, or Indian Tribe coordinates PrEP and PEP activities with the directly funded entity, if the State, territory, or Indian Tribe applies for the funds.

(e) Use of funds.—

(1) In general.— Any State, territory, Indian Tribe, or directly eligible entity that is awarded funds under subsection (a) shall use such funds for eligible PrEP and PEP expenses.

(2) Eligible prep expenses.— The Secretary shall publish a list of expenses that qualify as eligible PrEP and PEP expenses for purposes of this section, which shall include—

(A) any prescription drug approved by the Food and Drug Administration for the prevention of HIV, administrative fees for such drugs, laboratory and other diagnostic procedures associated with the use of such drugs, and clinical follow-up and monitoring, including any related services recommended in current United States Public Health Service clinical practice guidelines, without limitation;

(B) outreach and public education activities directed toward populations overrepresented in the domestic HIV epidemic that increase awareness about the existence of PrEP and PEP, provide education about access to and health care coverage of PrEP and PEP, PrEP and PEP adherence programs, and counter stigma associated with the use of PrEP and PEP; and

(C) outreach activities directed toward physicians and other providers that provide education about PrEP and PEP.

(f) Report to congress.— The Secretary shall, in each of the first 5 years beginning one year after the date of the enactment of this section, submit to Congress, and make public on the internet website of the Department of Health and Human Services, a report on the impact of any grants provided to States, territories, and Indian Tribes and directly eligible entities for the establishment and support of pre-exposure prophylaxis programs under this section.

(g) Authorization of appropriations.— To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2027 through 2032.”.

(e) Clarification.— This section, including the amendments made by this section, shall apply notwithstanding any other provision of law, including Public Law 103–141.

(f) Private right of action.— Any person aggrieved by a violation of this section, including the amendments made by this section, may commence a civil action in an appropriate United States District Court or other court of competent jurisdiction to obtain relief as allowed by law as either an individual or member of a class. If the plaintiff is the prevailing party in such an action, the court shall order the defendant to pay the costs and reasonable attorney fees of the plaintiff.

Subpart 3 of part C of title IV of the Public Health Service Act (42 U.S.C. 285c et seq.) is amended by adding at the end the following:

“434B. Diabetes in minority populations.—

(a) In general.— The Director of NIH shall expand, intensify, and support ongoing research and other activities with respect to prediabetes and diabetes, particularly type 2, in minority populations.

(b) Research.—

(1) Description.— Research under subsection (a) shall include investigation into—

(A) the causes of diabetes, including socioeconomic, geographic, clinical, environmental, genetic, and other factors that may contribute to increased rates of diabetes in minority populations; and

(B) the causes of increased incidence of diabetes complications in minority populations, and possible interventions to decrease such incidence.

(2) Inclusion of minority participants.— In conducting and supporting research described in subsection (a), the Director of NIH shall seek to include minority participants as study subjects in clinical trials.

(c) Report; comprehensive plan.—

(1) In general.— The Diabetes Mellitus Interagency Coordinating Committee shall—

(A) prepare and submit to Congress, not later than 6 months after the date of enactment of this section, a report on Federal research and public health activities with respect to prediabetes and diabetes in minority populations; and