[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3956 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
2d Session
S. 3956
To amend the Internal Revenue Code of 1986 to impose an annual tax on
the net value of assets held by a taxpayer, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 2, 2026
Mr. Sanders introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to impose an annual tax on
the net value of assets held by a taxpayer, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE, ETC.
(a) Short Title.--This Act may be cited as the ``Make Billionaires
Pay Their Fair Share Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title, etc.
TITLE I--WEALTH TAX
Sec. 101. Imposition of tax on net value of assets.
Sec. 102. Enforcement.
TITLE II--AFFORDABILITY REBATES
Sec. 201. Affordability rebates.
TITLE III--HEALTH CARE PROVISIONS
Sec. 301. Repeal of reconciliation health provisions.
Sec. 302. Increase in eligibility for premium tax credit.
TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION
Sec. 401. Short title.
Sec. 402. Coverage of dental and oral health care.
Sec. 403. Providing coverage for hearing care under the Medicare
program.
Sec. 404. Providing coverage for vision care under the Medicare
program.
Sec. 405. Phase-in of impact of dental and oral health coverage on part
B premiums.
TITLE V--HOUSING TRUST FUND
Sec. 501. Authorization of appropriations.
TITLE VI--AFFORDABLE CHILD CARE FOR WORKING FAMILIES
Sec. 601. Birth through five child care and early learning entitlement.
TITLE VII--ESTABLISHING A $60,000 A YEAR MINIMUM SALARY FOR EVERY
PUBLIC SCHOOL TEACHER IN THE UNITED STATES
Sec. 701. Purposes.
Sec. 702. Definitions.
Sec. 703. Ensuring teachers are paid a livable and competitive wage.
Sec. 704. Collective bargaining and related rules.
TITLE VIII--INVESTMENTS IN HOME AND COMMUNITY-BASED SERVICES AND LONG-
TERM CARE QUALITY AND WORKFORCE
Sec. 801. HCBS improvement planning grants.
Sec. 802. HCBS Improvement Program.
Sec. 803. Funding for Federal activities related to Medicaid HCBS.
Sec. 804. Funding for HCBS quality measurement and improvement.
Sec. 805. Permanent extension of Medicaid protections against spousal
impoverishment for recipients of home and
community-based services.
Sec. 806. Permanent extension of Money Follows the Person Rebalancing
demonstration.
TITLE I--WEALTH TAX
SEC. 101. IMPOSITION OF TAX ON NET VALUE OF ASSETS.
(a) In General.--The Internal Revenue Code of 1986 is amended by
inserting after subtitle B the following new subtitle:
``Subtitle B-1--Wealth Tax
``Chapter 18--Determination of Wealth Tax
``CHAPTER 18--DETERMINATION OF WEALTH TAX
``Sec. 2901. Imposition of tax.
``Sec. 2902. Net value of assets.
``Sec. 2903. Special rules.
``Sec. 2904. Administrative provisions.
``SEC. 2901. IMPOSITION OF TAX.
``(a) In General.--In the case of an applicable taxpayer, there is
hereby imposed a tax computed equal to 5 percent of the net value of
assets held by the taxpayer for the calendar year.
``(b) Applicable Taxpayer.--
``(1) In general.--For purposes of this chapter, the term
`applicable taxpayer' means any individual or trust if the net
value of all assets held by the taxpayer for the calendar year
exceeds $1,000,000,000.
``(2) Inflation adjustment.--
``(A) In general.--In the case of any calendar year
after 2026, the $1,000,000,000 amount under paragraph
(1) shall be increased by an amount equal to--
``(i) such dollar amount, multiplied by
``(ii) the cost-of-living adjustment
determined under section 1(f)(3) for the
calendar year in which the taxable year begins,
determined by substituting in subparagraph
(A)(ii) thereof `calendar year 2025' for
`calendar year 2016'.
``(B) Rounding.--If any amount as adjusted under
subparagraph (A) is not a multiple of $1,000,000, such
dollar amount shall be rounded to the next lowest
multiple of $1,000,000.
``(c) Treatment of Married Individuals.--For purposes of this
section, individuals who are married (as defined in section 7703) shall
be treated as one taxpayer.
``SEC. 2902. NET VALUE OF ASSETS.
``(a) In General.--The net value of assets held by an applicable
taxpayer for any calendar year shall be the excess of--
``(1) the value of all property of the taxpayer, real or
personal, tangible or intangible, wherever situated, on the
last day of such calendar year (computed without regard to any
debt owed by the taxpayer and secured by the property), over
``(2) the amount of any debt owed by the taxpayer on the
last day of such calendar year.
``(b) Inclusion of Property of Related Children.--For purposes of
this subtitle, any property of an individual who is a child of the
taxpayer (as defined in section 152(f)(1)) and has not attained the age
of 18 shall be treated as property held by the taxpayer for any
calendar year before the year in which such individual attains the age
of 18.
``(c) Establishment of Valuation Rules.--
``(1) Authority of secretary.--The Secretary shall
establish rules and methods for determining the value of any
asset for purposes of this subtitle.
``(2) General rules.--Except as otherwise provided in this
paragraph, the rules and methods established under paragraph
(1) may be similar to the rules of part III of subchapter A of
chapter 11 (other than the rules of sections 2031(c), 2032A,
2035, and 2044).
``(3) Rules for assets the value of which is not readily
ascertainable.--
``(A) In general.--In the case of any property the
value of which is not readily ascertainable, the
Secretary may allow the taxpayer to elect to use a
value which is equal to the most recent readily
ascertainable value of such property increased by an
average rate of appreciation applicable to assets of a
similar class.
``(B) Limitation.--The Secretary may not allow a
taxpayer to make an election under this paragraph for
any calendar year if the taxpayer made an election
under this paragraph for the preceding calendar year.
``SEC. 2903. SPECIAL RULES.
``(a) Deceased Individuals.--In the case of any individual who dies
during a calendar year--
``(1) section 2901 shall be applied as if the calendar year
ended on the day of the individual's death, and
``(2) the amount of the tax imposed under such section
shall be reduced by an amount which bears the same ratio to
such amount (determined without regard to this subsection) as--
``(A) the number of days in the calendar year after
the date of the individual's death, bears to
``(B) 365.
``(b) Trusts.--
``(1) Grantor trusts.--If a grantor or another person is
treated as the owner of any portion of a trust under subpart E
of part I of subchapter J of chapter 1, then the grantor or
such other person shall be treated as holding that portion of
the assets of such trust, and any remaining portion shall be
subject to tax as provided in section 2901.
``(2) Incomplete gifts.--In the case of any person who
makes a transfer of property to a trust which is not treated as
a gift for purposes of chapter 11, the portion of such trust
attributable to such property shall be treated as the property
of the person making the transfer and not the property of such
trust.
``(3) Aggregation rules.--The rules of section 643(f) shall
apply for purposes of this subtitle.
``(c) Application to Nonresidents.--
``(1) In general.--In the case of any taxpayer who is a non
resident and not a citizen of the United States, section
2901(a) shall be applied by substituting `net value of domestic
assets' for `net value of all assets'.
``(2) Net value of domestic assets.--For purposes of this
subtitle, the term `net value of domestic assets' means--
``(A) the value of all property of the taxpayer,
real or personal, tangible or intangible, situated in
the United States (determined under rules similar to
the rules under subchapter B of chapter 11), on the
last day of such calendar year (computed without regard
to any debt owed by the taxpayer and secured by the
property), over
``(B) the amount of any debt owed by the taxpayer
and secured by assets described in subparagraph (A),
determined as of the last day of such calendar year.
``(3) Treatment of married individuals.--In the case of
married individuals, this subsection shall only apply if both
individuals are non residents and not citizens of the United
States.
``(d) Application to Covered Expatriates.--
``(1) In general.--In the case of an applicable taxpayer
who is a covered expatriate the expatriation date of which
occurs during the calendar year--
``(A) section 2901 shall be applied as if the
calendar year ended on the day before the expatriation,
and
``(B) the rate of tax under 2901(a) for such
calendar year shall be 60 percent.
``(2) Covered expatriate; expatriation date.--For purposes
of this subsection--
``(A) Covered expatriate.--The term `covered
expatriate' has the meaning given such term under
section 877A, except that in the case of married
individuals, such taxpayer shall be treated as a
covered expatriate only if neither individual is a
United States citizen or lawful permanent resident of
the United States (within the meaning of section
7701(b)(6)).
``(B) Expatriation date.--The term `expatriation
date' has the meaning given such term under section
877A(g)(3).
``SEC. 2904. ADMINISTRATIVE PROVISIONS.
``(a) Wealth Registry.--The Secretary shall establish a registry of
ownership for assets taken into account under section 2902(a)(1),
including publicly traded securities, digital assets, shares of closely
held businesses, and real estate within the United States. For purposes
of establishing and maintaining the registry under the preceding
sentence, the Secretary shall--
``(1) rely on existing sources of information, including
central depositories for securities and State, local, and
foreign real property records; and
``(2) require timely reporting of newly acquired assets in
conjunction with information required under existing
information reporting requirements.
``(b) Information Reporting.--
``(1) In general.--The Secretary shall by regulations
require the reporting of information concerning the value of
assets, including--
``(A) the value of any accounts which pay interest
reportable under section 6049,
``(B) the value of publicly traded stock with
respect to which dividends are reported under section
6042,
``(C) the value of any applicable privately held
business,
``(D) the value of any assets held through mutual
funds or brokerage accounts,
``(E) the value of any assets held in eligible
retirement plans (as defined in section 402(c)(8)(B)),
and
``(F) such other assets as the Secretary determines
is appropriate.
``(2) Method of reporting.--The Secretary shall, where
appropriate, require the reporting made under paragraph (1) to
be made as a part of existing income reporting requirements.
``(3) Applicable privately held business.--For purposes of
this subsection, the term `applicable privately held business'
means any trade or businesses--
``(A) which does not meet the gross receipts test
under section 448(c) for the taxable year ending with
or within the calendar year,
``(B) in which an individual who was an applicable
taxpayer (other than a covered expatriate, as defined
in section 2903(d)(2)) for the preceding calendar year
holds (directly or indirectly) 5 percent or more of the
ownership interests (by value), and
``(C) to which paragraph (1)(B) does not apply.
``(c) Time for Payment of Tax.--The due date for returns with
respect to the tax imposed under this subtitle shall be not later than
the latest due date for which a return of tax under subtitle A would be
due if the taxpayer's taxable year ended on December 31 and the
taxpayer owed tax for such taxable year.''.
(b) No Deduction From Income Taxes.--Section 275 of the Internal
Revenue Code of 1986 is amended by inserting after paragraph (6) the
following new paragraph:
``(7) Taxes imposed by chapter 18.''.
(c) Information Reporting Penalties.--Section 6724(d)(1) of the
Internal Revenue Code of 1986 is amended by striking ``and'' at the end
of subparagraph (C), by striking the period at the end of subparagraph
(D) and inserting ``, and'', and by inserting after subparagraph (D)
the following new subparagraph:
``(E) any statement or return required to be filed
under section 2904(b) which is not reported under any
other provision of this paragraph.''.
(d) Clerical Amendment.--The table of subtitles of the Internal
Revenue Code of 1986 is amended by inserting after the item relating to
subtitle B the following new item:
``Subtitle B-1--Wealth Tax''.
(e) Effective Date.--The amendments made by this section shall
apply to calendar years beginning after the date of the enactment of
this Act.
SEC. 102. ENFORCEMENT.
(a) Standard.--The Secretary of the Treasury shall audit not less
than 50 percent of taxpayers required to pay the tax imposed under
section 2901 of the Internal Revenue Code of 1986 (as added by section
101) in each calendar year.
(b) Funding.--There is hereby appropriated to each fiscal year
ending after the date of the enactment of this Act, out of any moneys
in the Treasury not otherwise appropriated, amounts equivalent to 1
percent of the revenues attributable to the tax imposed under section
2901 of the Internal Revenue Code of 1986 (as added by section 101) for
necessary expenses for enforcement activities of the Internal Revenue
Service to determine and collect taxes owed under such section.
TITLE II--AFFORDABILITY REBATES
SEC. 201. AFFORDABILITY REBATES.
(a) In General.--Section 6428B of the Internal Revenue Code of 1986
is amended--
(1) in the heading, by striking ``2021 recovery rebates to
individuals'' and inserting ``affordability rebates'',
(2) in subsection (a), by striking ``2021 an amount equal
to the 2021 rebate amount'' and inserting ``2026 an amount
equal to the affordability rebate amount'',
(3) by striking subsection (b) and inserting the following:
``(b) Affordability Rebate Amount.--For purposes of this section,
the term `affordability rebate amount' means, with respect to any
taxpayer for any taxable year, the sum of--
``(1) $3,000 ($6,000 in the case of a joint return), plus
``(2) $3,000 multiplied by the number of dependents of the
taxpayer for such taxable year.'',
(4) in subsection (e)(2)--
(A) in subparagraph (A), by striking ``$1,400'' and
inserting ``$3,000'', and
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by
striking ``$2,800'' and inserting ``$6,000'',
and
(ii) in clause (i), by striking ``$1,400''
and inserting ``$3,000'', and
(5) in subsection (g)--
(A) in paragraph (1), by striking ``2019'' and
inserting ``2024'',
(B) in paragraph (2)(B), by striking ``January 1,
2021'' each place it appears and inserting ``January 1,
2026'',
(C) in paragraph (3), by striking ``December 31,
2021'' and inserting ``December 31, 2026'',
(D) in paragraph (5)--
(i) in the heading, by striking ``2020''
and inserting ``2025'',
(ii) in subparagraph (A)--
(I) in the heading, by striking
``2020'' and inserting ``2025'', and
(II) by striking ``beginning in
2020, paragraph (1) shall be applied
with respect to such individual by
substituting `2020' for `2019''' and
inserting ``beginning in 2025,
paragraph (1) shall be applied with
respect to such individual by
substituting `2025' for `2024''', and
(iii) in subparagraph (B)--
(I) in clause (i), by striking
``2020'' and inserting ``2025'',
(II) in clause (ii)--
(aa) in subclause (I), by
striking ``2020'' and inserting
``2025'', and
(bb) in subclause (II), by
striking ``2021'' and inserting
``2026'', and
(III) in clause (iii)--
(aa) in the heading, by
striking ``2020'' and inserting
``2025'', and
(bb) by striking ``2020''
each place it appears and
inserting ``2025'', and
(E) in the heading of paragraph (6), by striking
``2019 or 2020'' and inserting ``2024 or 2025''.
(b) Conforming Amendment.--The table of sections for subchapter B
of chapter 65 of the Internal Revenue Code of 1986 is amended by
striking the item relating to section 6428B and inserting the following
new item:
``Sec. 6428B. Affordability rebates.''.
TITLE III--HEALTH CARE PROVISIONS
SEC. 301. REPEAL OF RECONCILIATION HEALTH PROVISIONS.
(a) In General.--Except as provided in subsection (b), subtitle B
of title VII of An Act to provide for reconciliation pursuant to title
II of H. Con. Res. 14 (Public Law 119-21) is repealed and any law or
regulation referred to in such subtitle shall be applied as if such
subtitle and the amendments made by such subtitle had not been enacted.
(b) Exceptions.--
(1) In general.--Subsection (a) shall not apply to the
provisions of and amendments made by sections 71202, 71306, and
71401 of such Act.
(2) Availability of funds allocated under the rural health
transformation program.--Section 2105(h) of the Social Security
Act (42 U.S.C. 1397ee(h)), as added by Public Law 119-21, is
amended--
(A) in paragraph (1)(B)--
(i) in the subparagraph heading by striking
``Unexpended or unobligated'' and inserting
``Availability of'';
(ii) by striking clauses (i) through (iii)
and inserting the following:
``(i) In general.--Subject to clause (ii),
funds allocated to a State from amounts
appropriated under subparagraph (A) shall
remain available until expended.''; and
(iii) by redesignating clause (iv) as
clause (ii); and
(B) in paragraph (2)(C), by striking ``paragraph
(1)(B)(iv)'' and inserting ``paragraph (1)(B)(ii)''.
SEC. 302. INCREASE IN ELIGIBILITY FOR PREMIUM TAX CREDIT.
(a) In General.--Subparagraph (A) of section 36B(c)(1) of the
Internal Revenue Code of 1986 is amended by striking ``but does not
exceed 400 percent''.
(b) Applicable Percentages.--
(1) In general.--Subparagraph (A) of section 36B(b)(3) of
the Internal Revenue Code of 1986 is amended to read as
follows:
``(A) Applicable percentage.--The applicable
percentage for any taxable year shall be the percentage
such that the applicable percentage for any taxpayer
whose household income is within an income tier
specified in the following table shall increase, on a
sliding scale in a linear manner, from the initial
premium percentage to the final premium percentage
specified in such table for such income tier:
------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed premium premium
as a percent of poverty line) within the percentage percentage
following income tier: is-- is--
------------------------------------------------------------------------
Up to 150 percent............................. 0 0
150 percent up to 200 percent................. 0 2.0
200 percent up to 250 percent................. 2.0 4.0
250 percent up to 300 percent................. 4.0 6.0
300 percent up to 400 percent................. 6.0 8.5
400 percent and higher........................ 8.5 8.5.''.
------------------------------------------------------------------------
(2) Conforming amendments relating to affordability of
coverage.--
(A) Paragraph (1) of section 36B(c) of such Code is
amended by striking subparagraph (E).
(B) Subparagraph (C) of section 36B(c)(2) of such
Code is amended by striking clause (iv).
(C) Paragraph (4) of section 36B(c) of such Code is
amended by striking subparagraph (F).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2025.
TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION
SEC. 401. SHORT TITLE.
This title may be cited as the ``Medicare Dental, Hearing, and
Vision Expansion Act of 2026''.
SEC. 402. COVERAGE OF DENTAL AND ORAL HEALTH CARE.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (JJ), by striking ``and'' at the end;
(2) in subparagraph (KK), by inserting ``and'' after the
semicolon; and
(3) by adding at the end the following new subparagraph:
``(LL) dental and oral health services (as defined in
subsection (ooo));''.
(b) Dental and Oral Health Services Defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
``(ooo) Dental and Oral Health Services.--
``(1) In general.--Except as provided in paragraph (2), the
term `dental and oral health services' means the following
items and services that are furnished by a doctor of dental
surgery or of dental medicine (as described in subsection
(r)(2)) or an oral health professional (as defined in paragraph
(3)) on or after January 1, 2028 (or January 1, 2027, in the
case of dentures):
``(A) Preventive and screening services.--
Preventive and screening services, including oral
exams, dental cleanings, dental x-rays, and fluoride
treatments.
``(B) Procedures and treatment services.--Services
to address oral disease, including services such as
restorative services, prosthodontic and endodontic
services, including fillings, bridges, crowns, and root
canals, periodontal maintenance, periodontal scaling
and root planing, tooth extractions, therapeutic
pulpotomy, and other related items and services.
``(C) Dentures and dental prosthetics.--Complete
dentures, partial dentures, and implants, including
related items and services.
``(2) Exclusions.--Such term does not include items and
services for which, as of the date of the enactment of this
subsection, coverage was permissible under section 1862(a)(12)
and cosmetic services not otherwise covered under section
1862(a)(10).
``(3) Oral health professional.--The term `oral health
professional' means, with respect to dental and oral health
services, a health professional (other than a doctor of dental
surgery or of dental medicine (as described in subsection
(r)(2))) who is licensed to furnish such services, acting
within the scope of such license, by the State in which such
services are furnished.''.
(c) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) in subparagraph (N), by inserting ``and dental
and oral health services (as defined in section
1861(ooo))'' after ``section 1861(hhh)(1))'';
(B) by striking ``and'' before ``(HH)''; and
(C) by inserting before the semicolon at the end
the following: ``and (II) with respect to dental and
oral health services (as defined in section 1861(ooo)),
the amount paid shall be the payment amount specified
under section 1834(bb)''.
(2) Payment and limits specified.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m) is amended by adding at
the end the following new subsection:
``(bb) Payment and Limits for Dental and Oral Health Services.--
``(1) Payment.--The payment amount under this part for
dental and oral health services (as defined in section
1861(ooo)) shall be, subject to paragraphs (3) and (4), 80
percent (or 100 percent, in the case of preventive and
screening services described in section 1861(ooo)(1)(A)) of the
lesser of--
``(A) the actual charge for the service; or
``(B)(i) in the case of such services furnished by
a doctor of dental surgery or of dental medicine (as
described in section 1861(r)(2)), the amount determined
under the fee schedule established under paragraph (2);
or
``(ii) in the case of such services furnished by an
oral health professional (as defined in section
1861(ooo)(3)), 85 percent of the amount determined
under the fee schedule established under paragraph (2).
``(2) Establishment of fee schedule for dental and oral
health services.--
``(A) Establishment.--
``(i) In general.--The Secretary shall
establish a fee schedule for dental and oral
health services furnished in 2028 (or 2027, in
the case of dentures) and subsequent years. The
fee schedule amount for a dental or oral health
service shall be equal to 70 percent of the
national median fee (as determined under
subparagraph (B)) for the service or a similar
service for the year (or, in the case of
dentures, at the bundled payment amount under
clause (iv) of such subparagraph), adjusted by
the geographic adjustment factor established
under section 1848(e)(2) for the area for the
year.
``(ii) Consultation.--In carrying out this
paragraph, the Secretary shall consult annually
with organizations representing dentists and
other providers who furnish dental and oral
health services and shall share with such
providers the data and data analysis used to
determine fee schedule amounts under this
paragraph.
``(B) Determination of national median fee.--
``(i) In general.--For purposes of
subparagraph (A), the Secretary shall apply the
national median fee for a dental or oral health
service for 2028 (or 2027, in the case of
dentures) and subsequent years in accordance
with this subparagraph.
``(ii) Use of 2020 dental fee survey.--
``(I) In general.--Except as
provided in clause (iii) and clause
(iv), the national median fee for a
dental or oral health service shall be
equal to--
``(aa) for 2028 (or 2027,
in the case of dentures), the
median fee for the service in
the table titled `General
Practitioners-National' of the
`2020 Survey of Dental Fees'
published by the American
Dental Association, increased
by the applicable percent
increase for the year
determined under subclause
(II), as reduced by the
productivity adjustment under
subclause (III); and
``(bb) for 2029 (or 2028,
in the case of dentures) and
subsequent years, the amount
determined under this subclause
for the preceding year, updated
pursuant to subparagraph
(C)(i).
``(II) Applicable percent
increase.--The applicable percent
increase determined under this
subclause for a year is an amount equal
to the percentage increase between--
``(aa) the consumer price
index for all urban consumers
(United States city average)
ending with June of the
previous year; and
``(bb) the consumer price
index for all urban consumers
(United States city average)
ending with June of 2027 (or
2026, in the case of dentures).
``(III) Productivity adjustment.--
After determining the applicable
percentage increase under subclause
(II) for a year, the Secretary shall
reduce such percentage increase by the
productivity adjustment described in
section 1886(b)(3)(B)(xi)(II).
``(iii) Determination if insufficient
survey data.--If the Secretary determines there
is insufficient data under the Survey described
in clause (ii) with respect to a dental or oral
health service, the national median fee for the
service for a year shall be equal to an amount
established for the service using 1 or more of
the following methods, as determined
appropriate by the Secretary:
``(I) The payment basis determined
under section 1848.
``(II) Fee schedules for dental and
oral health services which shall
include, as practicable, fee
schedules--
``(aa) under Medicare
Advantage plans under part C;
``(bb) under State plans
(or waivers of such plans)
under title XIX; and
``(cc) established by other
health care payers.
``(iv) Special rule for dentures.--
``(I) In general.--The Secretary
shall make payment for dentures and
associated professional services as a
bundled payment as determined by the
Secretary.
``(II) Payment considerations.--In
establishing such bundled payment, the
Secretary shall consider the national
median fee for the service for the year
determined under clause (ii) or (iii)
and the rate determined for such
dentures under the Federal Supply
Schedule of the General Services
Administration, as published by such
Administration in 2021, updated to the
year involved using the applicable
percent increase for the year
determined under clause (ii)(II), as
reduced by the productivity adjustment
under clause (ii)(III), and shall
ensure that the payment component for
dentures under such bundled payment
does not exceed the maximum rate
determined for such dentures under the
Federal Supply Schedule, as so
published and updated to the year
involved.
``(C) Annual update and adjustments.--
``(i) Annual update.--The Secretary shall
update payment amounts determined under the fee
schedule from year to year beginning in 2029
(or 2028, in the case of dentures) by
increasing such amounts from the prior year by
the percentage increase in the consumer price
index for all urban consumers (United States
city average) for the 12-month period ending
with June of the preceding year, reduced by the
productivity adjustment described in section
1886(b)(3)(B)(xi)(II).
``(ii) Adjustments.--
``(I) In general.--The Secretary
shall, to the extent the Secretary
determines to be necessary and subject
to subclause (II), adjust the amounts
determined under the fee schedule
established under this paragraph for
2029 (or 2028, in the case of dentures)
and subsequent years to take into
account changes in dental practice,
coding changes, new data on work,
practice, or malpractice expenses, or
the addition of new procedures.
``(II) Limitation on annual
adjustments.--The adjustments under
subclause (I) for a year shall not
cause the amount of expenditures under
this part for the year to differ by
more than $20,000,000 from the amount
of expenditures under this part that
would have been made if such
adjustments had not been made.
``(3) Limitations.--With respect to dental and oral health
services that are preventive and screening services described
in paragraph (1)(A) of section 1861(ooo)--
``(A) payment shall be made under this part for--
``(i) not more than 2 oral exams in a year;
``(ii) not more than 2 dental cleanings in
a year;
``(iii) not more than 1 fluoride treatment
in a year; and
``(iv) not more than 1 full-mouth series of
x-rays as part of a preventive and screening
oral exam every 3 years; and
``(B) in the case of preventive and screening
services not described in subparagraph (A), payment
shall be made under this part only at such frequencies
determined appropriate by the Secretary.
``(4) Incentives for rural providers.--In the case of
dental and oral health services furnished by a doctor of dental
surgery or of dental medicine (as described in section
1861(r)(2)) or an oral health professional (as defined in
section 1861(ooo)(3)) who predominantly furnishes such services
under this part in an area that is designated by the Secretary
(under section 332(a)(1)(A) of the Public Health Service Act)
as a health professional shortage area, in addition to the
amount of payment that would otherwise be made for such
services under this subsection, there also shall be paid an
amount equal to 10 percent of the payment amount for the
service under this subsection for such doctor or professional.
``(5) Limitation on beneficiary liability.--The provisions
of section 1848(g) shall apply to a nonparticipating doctor of
dental surgery or of dental medicine (as described in section
1861(r)(2)) who does not accept payment on an assignment-
related basis for dental and oral health services furnished
with respect to an individual enrolled under this part in the
same manner as such provisions apply with respect to a
physician's service.
``(6) Establishment of dental administrator.--The Secretary
shall designate 1 or more (not to exceed 4) medicare
administrative contractors under section 1874A to establish
coverage policies and establish such policies and process
claims for payment for dental and oral health services, as
determined appropriate by the Secretary.''.
(d) Inclusion of Oral Health Professionals as Certain
Practitioners.--Section 1842(b)(18)(C) of the Social Security Act (42
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following
new clause:
``(ix) With respect to 2029 and each subsequent year, an
oral health professional (as defined in section
1861(ooo)(3)).''.
(e) Exclusion Modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (O), by striking ``and'' at the
end;
(B) in subparagraph (P), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(Q) in the case of dental and oral health services (as
defined in section 1861(ooo)) for which a limitation is
applicable under section 1834(bb)(3), which are furnished more
frequently than is provided under such section;''; and
(2) in paragraph (12), by inserting before the semicolon at
the end the following: ``and except that payment shall be made
under part B for dental and oral health services that are
covered under section 1861(s)(2)(LL)''.
(f) Inclusion as Excepted Medical Treatment.--Section 1821(b)(5)(A)
of the Social Security Act (42 U.S.C. 1395i-5(b)(5)(A)) is amended--
(1) in clause (ii), by striking ``or'' at the end;
(2) in clause (iii), by striking the period and inserting
``, or''; and
(3) by adding at the end the following new clause:
``(iv) consisting of dental and oral health
services (as defined in subsection (ooo) of
section 1861) that are payable under part B as
a result of the amendments made by the Medicare
Dental, Hearing, and Vision Expansion Act of
2026.''.
(g) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Coverage of dental and oral health services.--Section
1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), is
amended--
(A) in paragraph (1)--
(i) in subparagraph (C), by striking
``and'' at the end;
(ii) in subparagraph (D), by inserting
``and'' after the comma at the end; and
(iii) by inserting after subparagraph (D)
the following new subparagraph:
``(E) dental and oral health services (as defined
in subsection (ooo)) furnished by a doctor of dental
surgery or of dental medicine (as described in
subsection (r)(2)) or an oral health professional (as
defined in subsection (ooo)(3)) who is employed by or
working under contract with a rural health clinic if
such rural health clinic furnishes such services,'';
and
(B) in paragraph (3)(A), by striking ``(D)'' and
inserting ``(E)''.
(2) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l) is amended--
(i) in subsection (a)(3)(A), by inserting
``(which shall, in the case of dental and oral
health services (as defined in section
1861(ooo))), in lieu of any limits on
reasonable costs otherwise applicable, be based
on the rates payable for such services under
the payment basis determined under section 1848
until such time as the Secretary determines
sufficient data has been collected to otherwise
apply such limits (or January 1, 2031, if no
such determination has been made as of such
date))'' after ``may prescribe in
regulations''; and
(ii) by adding at the end the following new
subsection:
``(ee) Disregard of Costs Attributable to Certain Services From
Calculation of RHC AIR.--Payments for rural health clinic services
other than dental and oral health services (as defined in section
1861(ooo)) under the methodology for all-inclusive rates (established
by the Secretary) under subsection (a)(3) shall not take into account
the costs of such services while rates for such services are based on
rates payable for such services under the payment basis established
under section 1848.''.
(B) PPS.--Section 1834(o) of the Social Security
Act (42 U.S.C. 1395m(o)) is amended by adding at the
end the following new paragraph:
``(6) Temporary payment rates based on pfs for certain
services.--The Secretary shall, in establishing payment rates
for dental and oral health services (as defined in section
1861(ooo)) that are federally qualified health center services
under the prospective payment system established under this
subsection, in lieu of the rates otherwise applicable under
such system, base such rates on rates payable for such services
under the payment basis established under section 1848 until
such time as the Secretary determines sufficient data has been
collected to otherwise establish rates for such services under
such system (or January 1, 2031, if no such determination has
been made as of such date). Payments for federally qualified
health center services other than such dental and oral health
services under such system shall not take into account the
costs of such services while rates for such services are based
on rates payable for such services under the payment basis
established under section 1848.''.
(h) Implementation.--In addition to amounts otherwise available,
there is appropriated to the Secretary of Health and Human Services for
fiscal year 2026, out of any money in the Treasury not otherwise
appropriated, $900,000,000, to remain available until expended, for
purposes of implementing the amendments made by this section during the
period beginning on January 1, 2026, and ending on September 30, 2035.
SEC. 403. PROVIDING COVERAGE FOR HEARING CARE UNDER THE MEDICARE
PROGRAM.
(a) Provision of Audiology Services by Qualified Audiologists and
Hearing Aid Examination Services by Qualified Hearing Aid
Professionals.--
(1) In general.--Section 1861(ll) of the Social Security
Act (42 U.S.C. 1395x(ll)) is amended--
(A) in paragraph (3)--
(i) by inserting ``(A)'' after ``(3)'';
(ii) in subparagraph (A), as added by
clause (i) of this subparagraph--
(I) by striking ``means such
hearing and balance assessment
services'' and inserting ``means--
``(i) such hearing and balance assessment
services and, beginning January 1, 2028, such
hearing aid examination services and treatment
services (including aural rehabilitation,
vestibular rehabilitation, and cerumen
management)'';
(II) in clause (i), as added by
subclause (I) of this clause, by
striking the period at the end and
inserting ``; and''; and
(III) by adding at the end the
following new clause:
``(ii) beginning January 1, 2028, such
hearing aid examination services furnished by a
qualified hearing aid professional (as defined
in paragraph (4)(C)) as the professional is
legally authorized to perform under State law
(or the State regulatory mechanism provided by
State law), as would otherwise be covered if
furnished by a physician.''; and
(iii) by adding at the end the following
new subparagraph:
``(B) Beginning January 1, 2028, audiology services
described in subparagraph (A)(i) shall be furnished without a
requirement for an order from a physician or practitioner.'';
and
(B) in paragraph (4), by adding at the end the
following new subparagraph:
``(C) The term `qualified hearing aid professional'
means an individual who--
``(i) is licensed or registered as a
hearing aid dispenser, hearing aid specialist,
hearing instrument dispenser, or related
professional by the State in which the
individual furnishes such services; and
``(ii) is accredited by the National Board
for Certification in Hearing Instrument
Sciences or meets such other requirements as
the Secretary determines appropriate (including
requirements relating to educational
certifications or accreditations) taking into
account any additional relevant requirements
for hearing aid specialists, hearing aid
dispensers, and hearing instrument dispensers
established by Medicare Advantage organizations
under part C, State plans (or waivers of such
plans) under title XIX, and group health plans
and health insurance issuers (as such terms are
defined in section 2791 of the Public Health
Service Act).''.
(2) Payment for qualified hearing aid professionals.--
Section 1833(a)(1) of the Social Security Act (42 U.S.C.
1395l(a)(1)), as amended by section 402(c)(1), is amended--
(A) by striking ``and'' before ``(II)''; and
(B) by inserting before the semicolon at the end
the following: ``and (JJ) with respect to hearing aid
examination services (as described in paragraph
(3)(A)(ii) of section 1861(ll)) furnished by a
qualified hearing aid professional (as defined in
paragraph (4)(C) of such section), the amounts paid
shall be equal to 80 percent of the lesser of the
actual charge for such services or 85 percent of the
amount for such services determined under the payment
basis determined under section 1848''.
(3) Inclusion of qualified audiologists and qualified
hearing aid professionals as certain practitioners to receive
payment on an assignment-related basis.--
(A) Qualified audiologists.--Section 1842(b)(18)(C)
of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)),
as amended by section 402(d), is amended by adding at
the end the following new clause:
``(x) Beginning on January 1, 2028, a qualified audiologist
(as defined in section 1861(ll)(4)(B)).''.
(B) Qualified hearing aid professionals.--Section
1842(b)(18) of the Social Security Act (42 U.S.C.
1395u(b)(18)) is amended--
(i) in each of subparagraphs (A) and (B),
by striking ``subparagraph (C)'' and inserting
``subparagraph (C) or, beginning on January 1,
2028, subparagraph (E)''; and
(ii) by adding at the end the following new
subparagraph:
``(E) A practitioner described in this subparagraph is a qualified
hearing aid professional (as defined in section 1861(ll)(4)(C)).''.
(b) Coverage of Hearing Aids.--
(1) Inclusion of hearing aids as prosthetic devices.--
Section 1861(s)(8) of the Social Security Act (42 U.S.C.
1395x(s)(8)) is amended by inserting ``, and including hearing
aids (as described in section 1834(h)(7)) furnished on or after
January 1, 2028, to individuals with moderately severe, severe,
or profound hearing loss'' before the semicolon at the end.
(2) Payment limitations for hearing aids.--Section 1834(h)
of the Social Security Act (42 U.S.C. 1395m(h)) is amended by
adding at the end the following new paragraphs:
``(6) Payment only on an assignment-related basis.--Payment
for hearing aids for which payment may be made under this part
may be made only on an assignment-related basis. The provisions
of subparagraphs (A) and (B) of section 1842(b)(18) shall apply
to hearing aids in the same manner as they apply to services
furnished by a practitioner described in subparagraph (C) of
such section.
``(7) Limitations for hearing aids.--
``(A) In general.--Payment may be made under this
part with respect to an individual, with respect to
hearing aids furnished by a qualified hearing aid
supplier (as defined in subparagraph (C)) on or after
January 1, 2028--
``(i) not more than once per ear during a
5-year period;
``(ii) only for types of such hearing aids
that are determined appropriate by the
Secretary; and
``(iii) only if furnished pursuant to a
written order of a physician, qualified
audiologist (as defined in section
1861(ll)(4)), qualified hearing aid
professional (as defined in subparagraph (C) of
such section), physician assistant, nurse
practitioner, or clinical nurse specialist.
``(B) Special rule.--The payment basis determined
under this subsection (including after application of
paragraph (1)(H), relating to application of
competitive acquisition) for hearing aids furnished by
a qualified hearing aid supplier on or after January 1,
2028, shall not exceed the rate determined for such
hearing aids under the Federal Supply Schedule of the
General Services Administration, as published by such
Administration in 2021, updated to the year involved
using the applicable percent increase for the year.
``(C) Definitions.--In this subsection:
``(i) Hearing aid.--The term `hearing aid'
means the item and related services including
selection, fitting, adjustment, and patient
education and training.
``(ii) Qualified hearing aid supplier.--The
term `qualified hearing aid supplier' means--
``(I) a qualified audiologist;
``(II) a physician (as defined in
section 1861(r)(1));
``(III) a physician assistant,
nurse practitioner, or clinical nurse
specialist;
``(IV) a qualified hearing aid
professional (as defined in section
1861(ll)(4)(C)); and
``(V) other suppliers as determined
by the Secretary.''.
(3) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is
amended--
(i) in the header, by inserting ``and
hearing aids'' after ``orthotics'';
(ii) in the matter preceding clause (i), by
inserting ``or of hearing aids described in
paragraph (2)(E) of such section,'' after
``2011,''; and
(iii) in clause (i), by inserting ``or such
hearing aids'' after ``such orthotics''.
(B) Conforming amendments.--
(i) In general.--Section 1847(a)(2) of the
Social Security Act (42 U.S.C. 1395w-3(a)(2))
is amended by adding at the end the following
new subparagraph:
``(E) Hearing aids.--Hearing aids described in
section 1861(s)(8) for which payment would otherwise be
made under section 1834(h).''.
(ii) Exemption of certain items from
competitive acquisition.--Section 1847(a)(7) of
the Social Security Act (42 U.S.C. 1395w-
3(a)(7)) is amended by adding at the end the
following new subparagraph:
``(C) Certain hearing aids.--Those items and
services described in paragraph (2)(E) if furnished by
a physician or other practitioner (as defined by the
Secretary) to the physician's or practitioner's own
patients as part of the physician's or practitioner's
professional service.''.
(iii) Implementation.--Section 1847(a) of
the Social Security Act (42 U.S.C. 1395w-3(a))
is amended by adding at the end the following
new paragraph:
``(8) Competition with respect to hearing aids.--Not later
than January 1, 2031, the Secretary shall begin the competition
with respect to the items and services described in paragraph
(2)(E).''.
(4) Physician self-referral law.--Section 1877(b) of the
Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding
at the end the following new paragraph:
``(6) Hearing aids and services.--In the case of hearing
aid examination services and hearing aids--
``(A) furnished on or after January 1, 2028, and
before January 1, 2030; and
``(B) furnished on or after January 1, 2030, if the
financial relationship specified in subsection (a)(2)
meets such requirements the Secretary imposes by
regulation to protect against program or patient
abuse.''.
(c) Exclusion Modification.--Section 1862(a)(7) of the Social
Security Act (42 U.S.C. 1395y(a)(7)) is amended by inserting ``(except
such hearing aids or examinations therefor as described in and
otherwise allowed under section 1861(s)(8))'' after ``hearing aids or
examinations therefor''.
(d) Inclusion as Excepted Medical Treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 402(f), is amended by inserting
``, audiology services described in subsection (ll)(3) of such section,
or hearing aids described in subsection (s)(8) of such section'' after
``section 1861)''.
(e) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of audiology services as
physicians' services.--Section 1861(aa)(1)(A) of the Social
Security Act (42 U.S.C. 1395x(aa)(1)(A)) is amended by
inserting ``(including audiology services (as defined in
subsection (ll)(3)))'' after ``physicians' services''.
(2) Inclusion of qualified audiologists and qualified
hearing aid professionals as rhc and fqhc practitioners.--
Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C.
1395x(aa)(1)(B)) is amended by inserting ``or by a qualified
audiologist or a qualified hearing aid professional (as such
terms are defined in subsection (ll)),'' after ``(as defined in
subsection (hh)(1)),''.
(3) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l), as amended by section 402(g)(2)(A),
is amended--
(i) in subsection (a)(3)(A), by inserting
``or audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(ooo))''; and
(ii) in subsection (ee), by inserting ``or
audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(ooo))''.
(B) PPS.--Section 1834(o)(6) of the Social Security
Act (42 U.S.C. 1395m(o)(6)), as added by section
402(g)(2)(B), is amended--
(i) in the first sentence, by inserting
``or audiology services (as defined in section
1861(ll)(3))'' after ``(as defined in section
1861(ooo))''; and
(ii) in the second sentence, by inserting
``or such audiology services'' after ``such
dental and oral health services''.
(f) Expediting Implementation.--The Secretary of Health and Human
Services shall implement this section for 2028 and 2029 through program
instruction or other forms of program guidance.
(g) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services for fiscal
year 2026, out of any money in the Treasury not otherwise appropriated,
$370,000,000, to remain available until expended, for purposes of
implementing the amendments made by this section during the period
beginning on January 1, 2027, and ending on September 30, 2036.
SEC. 404. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE
PROGRAM.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)), as amended by section 402(a), is amended--
(1) in subparagraph (KK), by striking ``and'' at the end;
(2) in subparagraph (LL), by inserting ``and'' after the
semicolon; and
(3) by adding at the end the following new subparagraph:
``(MM) vision services (as defined in subsection (ppp));''.
(b) Vision Services Defined.--Section 1861 of the Social Security
Act (42 U.S.C. 1395x), as amended by section 402(b), is amended by
adding at the end the following new subsection:
``(ppp) Vision Services.--The term `vision services' means routine
eye examinations to determine the refractive state of the eyes,
including procedures performed during the course of such examination,
furnished on or after January 1, 2028, by or under the direct
supervision of an ophthalmologist or optometrist who is legally
authorized to furnish such examinations or procedures (as applicable)
under State law (or the State regulatory mechanism provided by State
law) of the State in which the examinations or procedures are
furnished.''.
(c) Payment Limitations.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m), as amended by section 402(c)(2), is amended by
adding at the end the following new subsection:
``(cc) Limitation for Vision Services.--With respect to vision
services (as defined in section 1861(ppp)) and an individual, payment
shall be made under this part for only 1 routine eye examination
described in such subsection during a 2-year period.''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by
inserting ``(2)(MM),'' before ``(3)''.
(e) Coverage of Conventional Eyeglasses.--Section 1861(s)(8) of the
Social Security Act (42 U.S.C. 1395x(s)(8)), as amended by section
403(b)(1), is amended by striking ``, and including one pair of
conventional eyeglasses or contact lenses furnished subsequent to each
cataract surgery with insertion of an intraocular lens'' and inserting
``, including 1 pair of conventional eyeglasses or contact lenses
furnished subsequent to each cataract surgery with insertion of an
intraocular lens, if furnished before January 1, 2028, and including
conventional eyeglasses (as described in section 1834(h)(8)), whether
or not furnished subsequent to such a surgery, if furnished on or after
January 1, 2028''.
(f) Special Payment Rules for Eyeglasses.--
(1) Limitations.--Section 1834(h) of the Social Security
Act (42 U.S.C. 1395m(h)), as amended by section 403(b)(2), is
amended by adding at the end the following new paragraph:
``(8) Payment limitations for eyeglasses.--
``(A) In general.--With respect to conventional
eyeglasses furnished to an individual on or after
January 1, 2028, subject to subparagraph (B), payment
shall be made under this part only during a 2-year
period, for 1 pair of eyeglasses (including lenses and
the frame).
``(B) Exception.--With respect to a 2-year period
described in subparagraph (A), in the case of an
individual who receives cataract surgery with insertion
of an intraocular lens, payment shall be made under
this part for 1 pair of conventional eyeglasses
furnished subsequent to such cataract surgery during
such period.
``(C) Special rule.--The payment basis determined
under this subsection (including after application of
paragraph (1)(H), relating to application of
competitive acquisition) for conventional eyeglasses
furnished to an individual on or after January 1, 2028,
shall not exceed the rate determined for such
eyeglasses under the Federal Supply Schedule of the
General Services Administration, as published by such
Administration in 2021, updated to the year involved
using the applicable percent increase for the year.
``(D) No coverage of certain items.--Payment shall
not be made under this part for deluxe eyeglasses or
conventional reading glasses.''.
(2) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the
Social Security Act (42 U.S.C. 1395m(h)(1)(H)), as
amended by section 403(b)(3)(A), is amended--
(i) in the heading, by striking ``and
hearing aids'' and inserting ``hearing aids,
and eyeglasses'';
(ii) in the matter preceding clause (i)--
(I) by striking ``or of hearing
aids'' and inserting ``of hearing
aids''; and
(II) by inserting ``or of
eyeglasses described in paragraph
(2)(F) of such section,'' after
``paragraph (2)(E) of such section,'';
and
(iii) in clause (i), by striking ``or such
hearing aids'' and inserting ``, such hearing
aids, or such eyeglasses''.
(B) Conforming amendment.--Section 1847(a)(2) of
the Social Security Act (42 U.S.C. 1395w-3(a)(2)), as
amended by section 403(b)(3)(B)(i), is amended by
adding at the end the following new subparagraph:
``(F) Eyeglasses.--Eyeglasses described in section
1861(s)(8) for which payment would otherwise be made
under section 1834(h).''.
(C) Implementation.--Section 1847(a) of the Social
Security Act (42 U.S.C. 1395w-3(a)), as amended by
section 403(b)(3)(B)(iii), is amended by adding at the
end the following new paragraph:
``(9) Competition with respect to eyeglasses.--Not later
than January 1, 2030, the Secretary shall begin the competition
with respect to the items and services described in paragraph
(2)(F).''.
(g) Exclusion Modifications.--Section 1862(a) of the Social
Security Act (42 U.S.C. 1395y(a)), as amended by section 402(e), is
amended--
(1) in paragraph (1)--
(A) in subparagraph (P), by striking ``and'' at the
end;
(B) in subparagraph (Q), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(R) in the case of vision services (as defined in section
1861(ppp)) that are routine eye examinations as described in
such section, which are furnished more frequently than once
during a 2-year period;''; and
(2) in paragraph (7)--
(A) by inserting ``(other than such an examination
that is a vision service that is covered under section
1861(s)(2)(MM))'' after ``eye examinations''; and
(B) by inserting ``(other than such a procedure
that is a vision service that is covered under section
1861(s)(2)(MM))'' after ``refractive state of the
eyes''.
(h) Inclusion as Excepted Medical Treatment.--Section
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 402(f) and amended by section
403(d), is amended--
(1) by striking ``or hearing aids'' and inserting ``hearing
aids''; and
(2) by inserting ``, or vision services (as defined in
subsection (ppp) of such section)'' after ``subsection (s)(8)
of such section''.
(i) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of vision services as physicians'
services.--Section 1861(aa)(1)(A) of the Social Security Act
(42 U.S.C. 1395x(aa)(1)(A)), as amended by section 403(e)(1),
is amended by inserting ``and vision services (as defined in
subsection (ppp))'' after ``(as defined in subsection
(ll)(3))''.
(2) Temporary payment rates for certain services under the
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act
(42 U.S.C. 1395l), as amended by sections 402(g)(2)(A)
and 403(e)(3)(A), is amended--
(i) in subsection (a)(3)(A)--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ppp))'' after ``(as defined in
section 1861(ll)(3))''; and
(ii) in subsection (ee)--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ppp))'' after ``(as defined in
section 1861(ll)(3))''.
(B) PPS.--Section 1834(o)(6) of the Social Security
Act (42 U.S.C. 1395m(o)(6)), as added by section
402(g)(2)(B) and amended by section 403(e)(3)(B), is
amended--
(i) in the first sentence--
(I) by striking ``or audiology''
and inserting ``, audiology''; and
(II) by inserting ``, or vision
services (as defined in section
1861(ppp))'' after ``(as defined in
section 1861(ll)(3))''; and
(ii) in the second sentence, by striking
``or such audiology services'' and inserting
``, such audiology services, or such vision
services''.
(j) Expediting Implementation.--The Secretary of Health and Human
Services shall implement this section for 2028 and 2029 through program
instruction or other forms of program guidance.
(k) Funding.--In addition to amounts otherwise available, there is
appropriated to the Secretary of Health and Human Services for fiscal
year 2026, out of any money in the Treasury not otherwise appropriated,
$500,000,000, to remain available until expended, for purposes of
implementing the amendments made by this section during the period
beginning on January 1, 2027, and ending on September 30, 2035.
SEC. 405. PHASE-IN OF IMPACT OF DENTAL AND ORAL HEALTH COVERAGE ON PART
B PREMIUMS.
Section 1839(a) of the Social Security Act (42 U.S.C. 1395r(a)) is
amended--
(1) in the second sentence of paragraph (1), by striking
``and (7)'' and inserting ``(7), and (8)'';
(2) in paragraph (3), by striking ``The Secretary'' and
inserting ``Subject to paragraph (8)(C), the Secretary''; and
(3) by adding at the end the following:
``(8) Special rule for 2027 through 2031.--
``(A) Determination of alternative monthly
actuarial rate for each of 2027 through 2031.--For each
of 2027 through 2031, the Secretary shall, at the same
time as and in addition to the determination of the
monthly actuarial rate for enrollees age 65 and over
determined in each of 2026 through 2030 for the
succeeding calendar year according to paragraph (1),
determine an alternative monthly actuarial rate for
enrollees age 65 and over for the year as described in
subparagraph (B).
``(B) Alternative monthly actuarial rate
described.--
``(i) In general.--The alternative monthly
actuarial rate described in this subparagraph
is--
``(I) for 2027 and 2028, the
monthly actuarial rate for enrollees
age 65 and over for the year,
determined as if the amendments made by
section 402 of the Medicare Dental,
Hearing, and Vision Expansion Act of
2026 did not apply; and
``(II) for 2029, 2030, and 2031,
the monthly actuarial rate for
enrollees age 65 and over for the year,
determined as if the amendments made by
such section 402 did not apply, plus
the applicable percent of the amount by
which--
``(aa) the monthly
actuarial rate for enrollees
age 65 and over for the year
determined according to
paragraph (1); exceeds
``(bb) the monthly
actuarial rate for enrollees
age 65 and over for the year,
determined as if the amendments
made by such section 402 did
not apply.
``(ii) Definition of applicable percent.--
For purposes of this subparagraph, the term
`applicable percent' means--
``(I) for 2029, 25 percent;
``(II) for 2030, 50 percent; and
``(III) for 2031, 75 percent.
``(C) Application to part b premium and other
provisions of this part.--For each of 2027 through
2031, the Secretary shall use the alternative monthly
actuarial rate for enrollees age 65 and over for the
year determined under subparagraph (A), in lieu of the
monthly actuarial rate for such enrollees for the year
determined according to paragraph (1), when determining
the monthly premium rate for the year under paragraph
(3) and subsection (j), the part B deductible under
section 1833(b), and the premium subsidy and monthly
adjustment amount under subsection (i).''.
TITLE V--HOUSING TRUST FUND
SEC. 501. AUTHORIZATION OF APPROPRIATIONS.
Section 1338(a) of the Federal Housing Enterprises Financial Safety
and Soundness Act of 1992 (12 U.S.C. 4568(a)) is amended by adding at
the end the following:
``(3) Authorization of appropriations.--There is authorized
to be appropriated to the Housing Trust Fund $85,647,000,000
for each of fiscal years 2026 through 2035.''.
TITLE VI--AFFORDABLE CHILD CARE FOR WORKING FAMILIES
SEC. 601. BIRTH THROUGH FIVE CHILD CARE AND EARLY LEARNING ENTITLEMENT.
(a) Child Care Definitions.--The definitions in section 658P of the
Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)
shall apply to this section, except as provided in subsection (b) and
as otherwise specified.
(b) Additional Definitions.--In this section:
(1) Child care certificate.--
(A) In general.--The term ``child care
certificate'' means a certificate (that may be a check
or other disbursement) that is issued by a State,
tribal, territorial, or local government under this
section directly to a parent who shall use such
certificate only as payment for child care services or
as a deposit for child care services if such a deposit
is required of other children being cared for by the
provider.
(B) Rule.--Nothing in this section shall preclude
the use of such certificates for sectarian child care
services if freely chosen by the parent. For the
purposes of this section, child care certificates shall
be considered indirect Federal financial assistance to
the provider.
(2) Child experiencing homelessness.--The term ``child
experiencing homelessness'' means an individual who is a
homeless child or youth under section 725 of the McKinney-Vento
Homeless Assistance Act (42 U.S.C. 11434a).
(3) Eligible activity.--The term ``eligible activity'',
with respect to a parent, shall include, at minimum, activities
consisting of--
(A) full-time or part-time employment;
(B) self-employment;
(C) job search activities;
(D) job training;
(E) secondary, postsecondary, or adult education,
including education through a program of high school
classes, a course of study at an institution of higher
education, classes towards an equivalent of a high
school diploma recognized by State law, or English as a
second language classes;
(F) health treatment (including mental health and
substance use treatment) for a condition that prevents
the parent from participating in other eligible
activities;
(G) activities to prevent child abuse and neglect,
or family violence prevention or intervention
activities;
(H) employment and training activities under the
supplemental nutrition assistance program established
under section 6(d)(4) the Food and Nutrition Act of
2008 (7 U.S.C. 2015(d)(4));
(I) employment and training activities under the
Workforce Innovation and Opportunity Act (29 U.S.C.
3101 et seq.);
(J) a work activity described in subsection (d) of
section 407 of the Social Security Act (42 U.S.C. 607)
for which, consistent with clauses (ii) and (iii) of
section 402(a)(1)(A) of such Act (42 U.S.C.
602(a)(1)(A)), a parent or caretaker is treated as
being engaged in work for a month in a fiscal year for
purposes of the program of block grants to States for
temporary assistance for needy families established
under part A of title IV of the Social Security Act (42
U.S.C. 601 et seq.); and
(K) taking leave under the Family and Medical Leave
Act of 1993 (29 U.S.C. 2601 et seq.) (or equivalent
provisions for Federal employees), a State or local
paid or unpaid leave law, or a program of employer-
provided leave.
(4) Eligible child.--
(A) In general.--The term ``eligible child'' means
an individual--
(i) who is less than 6 years of age;
(ii) who is not yet in kindergarten;
(iii) whose family income does not exceed
250 percent of the State median income for a
family of the same size for the fiscal year
involved, for each fiscal year beginning with
fiscal year 2026; and
(iv) who--
(I) resides with a parent or
parents who are participating in an
eligible activity;
(II) is included in a population of
vulnerable children identified by the
lead agency involved, which at a
minimum shall include children with
disabilities, infants and toddlers with
disabilities, children experiencing
homelessness, children in foster care,
children in kinship care, and children
who are receiving, or need to receive,
child protective services; or
(III) resides with a parent who is
more than 65 years of age.
(B) Longer-term period eligibility.--For purposes
of determining eligibility under this paragraph, an
individual who is determined to be an eligible child
shall continue to be considered an eligible child and
shall not be required to reverify eligibility for
purposes of this section during the period--
(i) that begins on the date of the
determination; and
(ii) that ends on the earlier of the date
the individual becomes 6 years of age or the
date the individual enters kindergarten.
(5) Eligible child care provider.--
(A) In general.--The term ``eligible child care
provider'' means a center-based child care provider, a
family child care provider, or other provider of child
care services for compensation that--
(i) is licensed to provide child care
services under State law applicable to the
child care services it provides or, in the case
of an Indian Tribe or tribal organization,
meets the rules set by the Secretary;
(ii) participates in the State's tiered
system for measuring and supporting the quality
of eligible child care providers described in
subsection (f)(3)(B), or, in the case of an
Indian Tribe or tribal organization, meets the
rules set by the Secretary--
(I) not later than 3 years after
the State first receives funds under
this section; and
(II) for the remainder of the
period for which the provider receives
funds under this section; and
(iii) satisfies the State and local
requirements, including those requirements
described in section 658E(c)(2)(I) of the Child
Care and Development Block Grant Act of 1990
(42 U.S.C. 9858c(c)(2)(I)), applicable to the
child care services it provides.
(B) Special rule.--A child care provider who is
eligible to provide child care services in a State for
children receiving assistance under the Child Care and
Development Block Grant Act of 1990 (42 U.S.C. 9857 et
seq.) on the date the State submits an application for
funds under this section, and remains in compliance
with any licensing or registration standards, or
regulations, of the State, shall be deemed to be an
eligible child care provider under this section for 3
years after the State first receives funds under this
section.
(6) FMAP.--The term ``FMAP'' has the meaning given the term
``Federal medical assistance percentage'' in the first sentence
of section 1905(b) of the Social Security Act (42 U.S.C.
1396d(b)).
(7) Family child care provider.--The term ``family child
care provider'' means one or more individuals who provide child
care services, in a private residence other than the residences
of the children involved, for less than 24 hours per day per
child, or for 24 hours per day per child due to the nature of
the work of the parent involved.
(8) Inclusive care.--The term ``inclusive'', with respect
to care (including child care), means care provided by an
eligible child care provider--
(A) for whom the percentage of children served by
the provider who are children with disabilities or
infants or toddlers with disabilities reflects the
prevalence of children with disabilities and infants
and toddlers with disabilities (whichever the provider
serves) among children within the State involved; and
(B) that provides care and full participation for
children with disabilities and infants and toddlers
with disabilities (whichever the provider serves)
alongside children who are--
(i) not children with disabilities; and
(ii) not infants and toddlers with
disabilities.
(9) Infant or toddler.--The term ``infant or toddler''
means an individual who is less than 3 years of age.
(10) Infant or toddler with a disability.--The term
``infant or toddler with a disability'' has the meaning given
the term in section 632 of the Individuals with Disabilities
Education Act (20 U.S.C. 1432).
(11) Lead agency.--The term ``lead agency'' means the
agency designated under subsection (e).
(12) Provider type.--The term ``provider type'' means a
type that is--
(A) a center-based child care provider;
(B) a family child care provider; or
(C) another non-center-based child care provider.
(13) Staffed family child care network.--The term ``staffed
family child care network'' means a nonprofit organization or
nonprofit cooperative--
(A) that may be a component of a child care
resource and referral organization;
(B) that has at least one paid staff member; and
(C) that offers evidence-based professional
development, quality improvement support, business
support, and technical assistance, including on
achieving licensure as a child care provider, to family
child care providers.
(14) State.--The term ``State'' means any of the 50 States
and the District of Columbia.
(15) Territory.--The term ``territory'' means the
Commonwealth of Puerto Rico, the Virgin Islands of the United
States, Guam, American Samoa, and the Commonwealth of the
Northern Mariana Islands.
(c) Appropriations.--
(1) States, indian tribes and tribal organizations, and
territories entitlement.--In addition to amounts otherwise
available, there is appropriated to the Department of Health
and Human Services for fiscal year 2026 and each subsequent
fiscal year, out of any money in the Treasury not otherwise
appropriated, such sums as may be necessary for payments to
States, territories, and Indian Tribes and tribal organizations
for carrying out the child care program described in this
section (other than carrying out activities described in
paragraph (2) or (3)).
(2) Grants to localities; awards to head start agencies.--
In addition to amounts otherwise available, there is
appropriated to the Department of Health and Human Services for
fiscal year 2026, out of any money in the Treasury not
otherwise appropriated $20,000,000,000, to carry out the
program of grants to localities, and the program of awards to
Head Start agencies, described in subsection (i).
(3) Federal administration.--Notwithstanding paragraph (1)
or (2), of the funds appropriated under this section for a
fiscal year, the Secretary of Health and Human Services may
reserve an amount equal to not more than 0.5 percent of the
funds appropriated under this section for the prior fiscal
year, for purposes of Federal administration of this section.
(d) Establishment of Birth Through Five Child Care and Early
Learning Entitlement Program.--
(1) In general.--The Secretary is authorized to administer
a child care and early learning entitlement program under which
an eligible child, in a State, territory, or Indian Tribe, or
served by a tribal organization, with an approved application
under subsection (f) or (g), shall be provided an opportunity
to obtain high-quality child care services, subject to the
requirements of this section.
(2) Assistance for every eligible child.--Beginning on
October 1, 2026, every child who applies for assistance under
this section, who is in a State with an approved application
under subsection (f), or in a territory or Indian Tribe or
served by a tribal organization with an approved application
under subsection (g), and who is determined, by a lead agency
(or other entity designated by a lead agency) for the State,
territory, Indian Tribe, or tribal organization involved,
following standards and procedures established by the Secretary
by rule, to be an eligible child, shall be offered assistance
for and shall be entitled to receive direct child care services
in accordance with and subject to the requirements and
limitations of this section.
(e) Lead Agency.--The Governor of a State or the head of a
territory or Indian Tribe, desiring for the State, territory, or Indian
tribe or a related tribal organization to receive a payment under this
section, shall designate a lead agency (such as a State agency or joint
interagency office) to administer the child care program carried out
under this section.
(f) Applications and State Plans.--
(1) Application.--To be eligible to receive assistance
under this section, a State shall prepare and submit to the
Secretary for approval an application containing a State plan
that meets the requirements under paragraph (3) and contains
such information as the Secretary may require.
(2) Period covered by plan.--A State plan contained in the
application shall be designed to be implemented during a period
of not more than 3 years.
(3) Requirements for state plans.--The Secretary shall
award funds under this section to States with an approved
application that contains a State plan, submitted under
paragraph (1), at such time, in such manner, and containing
such information as the Secretary shall by rule require,
including, at a minimum, the following:
(A) Payment rates and cost estimation.--
(i) Payment rates.--The State plan shall
certify that payment rates for the provision of
direct child care services for which assistance
is provided in accordance with this section for
the period covered by the plan, within 3 years
after the State first receives funds under this
section--
(I) will be sufficient to meet the
cost of child care (including fixed
costs such as rent or mortgage, and
salaries), and set (with pay being
paid) in accordance with a cost
estimation model or cost study
described in clause (ii) that is
approved by the Secretary; and
(II) will correspond to differences
in quality (including improved quality)
based on the State's tiered system for
measuring and supporting the quality of
eligible child care providers described
in subparagraph (B).
(ii) Cost estimation.--Such State plan
shall--
(I) demonstrate that the State has,
after consulting with relevant entities
and stakeholders, developed and uses a
statistically valid and reliable cost
estimation model or cost study for the
payment rates for direct child care
services in the State that are
sufficient to cover providers' fixed
costs and reflect the cost of child
care at each of the tiers of the
State's tiered system for measuring and
supporting the quality of eligible
child care providers described in
subparagraph (B), and variations in the
cost of direct child care services by
geographic area, provider type, and age
of child, and the additional costs
associated with providing inclusive
care;
(II) certify that the entities and
stakeholders consulted included the
State Advisory Council on Early
Childhood Education and Care designated
or established in section
642B(b)(1)(A)(i) of the Head Start Act
(42 U.S.C. 9837b(b)(1)(A)(i))
(including State Directors of Head
Start Collaboration), administrators of
local child care programs and Head
Start agencies, organizations
representing child care directors,
teachers, and other staff, local child
care resource and referral
organizations, organizations
representing parents of children with
disabilities and parents of infants and
toddlers with disabilities, the State
interagency coordinating council
established under section 641 of the
Individuals with Disabilities Education
Act (20 U.S.C. 1441), the State
advisory panel established under
section 612(a)(21) of the Individuals
with Disabilities Education Act (20
U.S.C. 1412(a)(21)), organizations and
labor organizations representing child
care providers, and other appropriate
entities;
(III) certify that the State--
(aa) not later than 30 days
after finalizing the cost
estimation model or cost study,
published a detailed report
containing the child care costs
estimated with the cost
estimation model or cost study,
and including an explanation
detailing how the wage
requirements described in
subclause (IV)(cc) were applied
in the estimation of such
costs; and
(bb) not later than 60 days
after publishing the report
described in item (aa),
established a system to receive
public comment on the report on
the subject of making changes
to the cost estimation model or
cost study, provided an
opportunity for the public to
comment on the report through
that system, and submitted the
report to the Secretary;
(IV) certify that the State's
payment rates for direct child care
services for which assistance is
provided in accordance with this
section--
(aa) are set (with pay
being paid) in accordance with
the most recent estimates from
the most recent cost estimation
model or cost study under
subclause (I), so that
providers at each tier of the
tiered system for measuring and
supporting the quality of
eligible child care providers
described in subparagraph (B)
receive a payment that is
sufficient to fully meet the
requirements of such tier;
(bb) are set so as to
provide payments to providers
not at the top tier of the
tiered system that are
sufficient to enable the
providers to increase quality
to meet the requirements for
the next tier;
(cc) ensure adequate wages
for staff of child care
providers providing such direct
child care services that--
(AA) at a minimum,
provide a living wage
for all staff of such
child care providers;
and
(BB) are equivalent
to wages for elementary
educators with similar
credentials and
experience in the
State; and
(dd) are adjusted on an
annual basis for cost of living
increases to ensure those
payment rates remain sufficient
to meet the requirements of
this section;
(V) certify that the State will
update, not less often than once every
3 years, the cost estimation model or
cost study described in subclause (I);
and
(VI) certify that the State has
established a system for appeals of the
determination of child care costs
estimated with the cost estimation
model or cost study.
(iii) Payment practices.--Such State plan
shall include an assurance that the State will
implement payment practices that support the
fixed costs of providing direct child care
services.
(B) Tiered system for measuring and supporting the
quality of eligible child care providers.--Such State
plan shall certify that the State has implemented, or
assure that the State will implement within 3 years
after first receiving funds under this section, with
input (from early childhood education and development
experts, from a diverse group of child care providers
of a variety of provider types, from families, and from
organizations representing child care directors,
teachers, and other staff), a tiered system for
measuring and supporting the quality of eligible child
care providers who provide child care services for
which assistance is made available under this section.
Such tiered system shall--
(i) include a set of standards, for
determining the tier of quality of a child care
provider, that--
(I) uses standards for a highest
tier that at a minimum are equivalent
to Head Start program performance
standards described in section
641A(a)(1)(B) of the Head Start Act (42
U.S.C. 9836a(a)(1)(B)) or other
equivalent evidence-based standards
approved by the Secretary; and
(II) includes quality indicators
and thresholds that are appropriate for
child development from child care
providers of a variety of provider
types, including child care centers and
the settings of family child care
providers, and are appropriate for
providers serving different age groups
(including mixed age groups) of
children;
(ii) include a different set of standards
that includes indicators, when appropriate, for
care during nontraditional hours of operation;
and
(iii) provide for sufficient resources and
supports for child care providers at tiers
lower than the highest tier to facilitate
progression toward meeting higher quality
standards.
(C) Achieving high quality for all children.--Such
State plan shall certify the State has implemented, or
will implement within 3 years after first receiving
funds under this section, policies and financing
practices that will ensure all eligible children can
choose to attend child care, with services provided by
eligible child care providers from any of a variety of
provider types including family child care providers,
at the highest quality tier within 6 years after the
date of enactment of this Act.
(D) Compensation.--Such plan shall provide a
certification that the State has or will have within 3
years after first receiving funds under this section, a
wage ladder for staff of eligible child care providers
receiving assistance under this section, including a
certification that wages for such staff, at a minimum,
will meet the requirements of subparagraph
(A)(ii)(IV)(cc).
(E) Sliding fee scale for copayments.--
(i) In general.--Except as provided in
clause (ii)(I), the State plan shall provide an
assurance that the State will for the period
covered by the plan use a sliding fee scale
described in clause (ii) to determine a
copayment for a family receiving assistance
under this section (or, for a family receiving
part-time care, a reduced copayment that is the
proportionate amount of the full copayment).
(ii) Sliding fee scale.--A full copayment
described in clause (i) shall use a sliding fee
scale that provides that, for a family with a
family income--
(I) of not more than 85 percent of
State median income for a family of the
same size, the family shall not pay a
copayment, toward the cost of the child
care involved for all eligible children
in the family;
(II) of more than 85 percent but
not more than 100 percent of State
median income for a family of the same
size, the copayment shall be more than
0 but not more than 2 percent of that
family income, toward such cost for all
such children;
(III) of more than 100 percent but
not more than 125 percent of State
median income for a family of the same
size, the copayment shall be more than
2 but not more than 4 percent of that
family income, toward such cost for all
such children;
(IV) of more than 125 percent but
not more than 150 percent of State
median income for a family of the same
size, the copayment shall be more than
4 but not more than 7 percent of that
family income, toward such cost for all
such children; and
(V) of more than 150 percent but
not more than 250 percent of the State
median income for a family of the same
size, the copayment shall be 7 percent
of that family income, toward such cost
for all such children.
(F) Prohibition on charging more than copayment.--
The State plan shall certify that, after the State
develops and begins using the cost estimation model or
cost study described in subparagraph (A)(ii), the State
will not permit a child care provider receiving
financial assistance under this section to charge, for
direct child care services for an eligible child, more
than the total of--
(i) the financial assistance provided for
the child under this section; and
(ii) any applicable copayment pursuant to
subparagraph (E).
(G) Eligibility.--The State plan shall assure that
each child who receives assistance under this section
will be considered to meet all eligibility requirements
for such assistance, and will receive such assistance,
for not less than 12 months unless the child has aged
out of the program, and the child's eligibility
determination and redetermination, including any
determination based on the State's definition of
eligible activities, shall be implemented in a manner
that supports child well-being and reduces barriers to
enrollment, including continuity of services.
(H) Policies to support access to child care for
underserved populations.--The State plan shall
demonstrate that the State will prioritize increasing
access to, and the quality and the supply of, child
care in the State for underserved populations,
including at a minimum, low-income children, children
in underserved areas, infants and toddlers, children
with disabilities and infants and toddlers with
disabilities, children who are dual language learners,
children experiencing homelessness, children in foster
or kinship care, children who receive care during
nontraditional hours, and vulnerable children as
defined by the lead agency pursuant to subsection
(b)(4)(A)(iv)(II).
(I) Policies.--The State plan shall include a
certification that the State will apply, under this
section, the policies and procedures described in
subparagraphs (A), (B), (I), (J), (K)(i), (R), and (U)
of section 658E(c)(2) of the Child Care and Development
Block Grant Act of 1990 (42 U.S.C. 9858c(c)(2)), and
the policies and procedures described in section 658H
of such Act (42 U.S.C. 9858f), to child care services
provided under this section.
(J) Licensing.--The State plan shall demonstrate
that the State has consulted or will consult with
organizations (including labor organizations and child
care and early learning organizations) representing
eligible child care providers (including family child
care providers), child care associations, child care
directors, teachers, and other staff (including child
care directors, teachers, and other staff serving
higher proportions of underserved populations as
identified under subparagraph (H)), early childhood
education and development experts, maternal and child
health experts, and families to develop, within 2.5
years after first receiving funds under this section,
licensing standards appropriate for child care
providers and a pathway to such licensure that is
available to and appropriate for child care providers
in a variety of settings, that will offer providers
eligible under the Child Care and Development Block
Grant Act of 1990 (42 U.S.C. 9857 et seq.) a reasonable
pathway to become eligible providers under this
section, and that will assure an adequate supply of
child care. Such plan shall describe the timeline the
State will use to ensure sufficient time for providers
described in subsection (b)(5)(B) to comply with such
licensing standards in order to remain eligible
providers after 3.5 years after the State first
receives funding under this section.
(K) Financial support for providers.--Such plan
shall describe how the State will use funds reserved
under subsection (h)(1)(C) to enable eligible child
care providers from a variety of provider types to
achieve licensure, including paying for the costs of
required background checks, health screening, and
initial and ongoing training, and other costs
associated with achieving licensure.
(L) Prohibition on suspensions, expulsions, and
aversive behavioral interventions.--The State plan
shall provide an assurance that the State will--
(i) provide assistance to carry out this
section only to eligible child care providers
that prohibit--
(I) the use of suspension and
expulsion of children; and
(II) the use of aversive behavioral
interventions; and
(ii) provide training resources to eligible
child care providers and information to
families to support the prohibition of
practices described in subclauses (I) and (II)
of clause (i).
(g) Payments.--
(1) In general.--For each fiscal year:
(A) Child care assistance for eligible children.--
(i) In general.--The Secretary shall pay to
each State with an approved application under
subsection (f), and that State shall be
entitled to, an amount for each quarter equal
to 90 percent of expenditures (which shall be
the Federal share of such expenditures) in the
quarter for direct child care services
described under subsection (h)(1)(B) for
eligible children.
(ii) Exception.--Funds reserved from the
total under subsection (h)(1)(C) shall be
subject to subparagraph (B).
(iii) Prohibition.--Activities described in
subparagraph (B) and subparagraph (C) may not
be included in the cost of direct child care
services described in this subparagraph.
(B) Activities to improve the quality and supply of
child care services.--The Secretary shall pay to each
State with such an approved application, and that State
shall be entitled to, an amount equal to the FMAP of
expenditures (which shall be the Federal share of such
expenditures) to carry out activities to improve the
quality and supply of child care services under
subsection (h)(1)(C) subject to the limit specified in
clause (i) of such subsection.
(C) Administration.--The Secretary shall pay to
each State with such an approved application, and that
State shall be entitled to, an amount equal to 50
percent of expenditures (which shall be the Federal
share of such expenditures) for the costs of
administration incurred by the State--
(i) which shall include costs incurred by
the State in carrying out the child care
program established in this section; and
(ii) which may include, at the option of
the State, costs associated with carrying out
requirements, policies, and procedures
described in section 658H of the Child Care and
Development Block Grant Act of 1990 (42 U.S.C.
9858f).
(2) Advance payment; retrospective adjustment.--For each
fiscal year, the Secretary shall make payments under this
subsection for a period on the basis of advance estimates of
expenditures submitted by the State and such other
investigation as the Secretary may find necessary, and shall
reduce or increase the payments as necessary to adjust for any
overpayment or underpayment for previous periods. No interest
shall be charged or paid on any amount due because of an
overpayment or underpayment for previous periods.
(3) Territories and tribes.--
(A) In general.--For each fiscal year, from amounts
appropriated under subsection (c)(1), the Secretary
shall make payments to territories, and Indian Tribes
and tribal organizations, as the case may be, with
applications submitted as described in subparagraph
(B), and approved by the Secretary for the purpose of
carrying out the child care program described in this
section, consistent, to the extent practicable as
determined by the Secretary (subject to subsection
(d)(2)), with the requirements applicable to States.
(B) Applications.--
(i) Territories.--A territory seeking a
payment under this paragraph shall submit an
application to the Secretary at such time, in
such manner, and containing such information as
the Secretary may specify.
(ii) Indian tribes and tribal
organizations.--An Indian Tribe or a tribal
organization seeking a payment under this
paragraph shall submit an application to the
Secretary at such time, in such manner, and
containing such information as the Secretary
may specify.
(C) Costs.--The Secretary shall make the payments
to such territories, Indian Tribes, and tribal
organizations on the basis of their relative need. Each
entity that is such a territory, Indian Tribe, or
tribal organization shall be entitled to such a payment
as may be necessary to pay for 100 percent of the
expenses of carrying out the activities described in
subsection (h)(1), and to pay for 100 percent of the
costs of administration incurred by the entity, which
shall include costs incurred by the entity in carrying
out the child care program, and which may include, at
the option of the entity, costs associated with
carrying out requirements, policies, and procedures
described in section 658H of the Child Care and
Development Block Grant Act of 1990 (42 U.S.C. 9858f).
(h) Use of Funds.--
(1) Use of funds.--
(A) In general.--Starting on October 1, 2026, a
State shall use amounts provided to the State under
subsection (g)(1) for direct child care services
(provided on a sliding fee scale basis), activities to
improve the quality and supply of child care services
consistent with subparagraph (C), and State
administration consistent with subsection (g)(1)(C).
(B) Child care assistance for eligible children.--
(i) In general.--For fiscal year 2026 and
each subsequent fiscal year, from payments made
to the State under subsection (g)(1) for that
particular fiscal year, the State shall ensure
that parents of eligible children can access
direct child care services provided by an
eligible child care provider under this section
through a grant or contract as described in
clause (ii) or a certificate as described in
clause (iii).
(ii) Grants and contracts.--The State shall
award grants or contracts to eligible child
care providers, consistent with the
requirements under this section, for the
provision of child care services for eligible
children under this section that, at a
minimum--
(I) support providers' operating
expenses to meet and sustain health,
safety, quality, licensing, and wage
standards required under this section;
and
(II) address underserved
populations described in subsection
(f)(3)(H).
(iii) Certificates.--The State shall issue
a child care certificate directly to a parent
who shall use such certificate only as payment
for direct child care services or as a deposit
for direct child care services if such a
deposit is required of other children being
cared for by the provider, consistent with the
requirements under this section.
(C) Activities to improve the quality and supply of
child care services.--
(i) Quality child care activities.--
(I) Amount.--For fiscal year 2026
and each subsequent fiscal year, from
the total of the payments made to the
State for a particular fiscal year, the
State shall reserve and use a quality
child care amount equal to not less
than 5 percent and not more than 10
percent of the amount made available to
the State through such payments for the
previous fiscal year.
(II) Use of quality child care
amount.--Each State shall use the
quality child care amount described in
subclause (I) to implement activities
described in this subparagraph to
improve the quality and supply of child
care services by eligible child care
providers, and increase the number of
available slots in the State for child
care services funded under this
section, prioritizing assistance for
child care providers who are in
underserved communities and who are
providing, or are seeking to provide,
child care services for underserved
populations identified in subsection
(f)(3)(H).
(III) Administration.--Activities
funded under this subparagraph may be
administered--
(aa) directly by the lead
agency; or
(bb) through other State
government agencies, local or
regional child care resource
and referral organizations,
community development financial
institutions, other
intermediaries with experience
supporting child care
providers, or other appropriate
entities that enter into a
contract with the State to
provide such assistance.
(ii) Quality and supply activities.--
Activities funded under the quality child care
amount described in clause (i) shall include
each of the following:
(I) Startup grants and supply
expansion grants.--
(aa) In general.--From a
portion of the quality child
care amount, a State shall make
startup and supply expansion
grants to support child care
providers who are providing, or
seeking to provide, child care
services to children receiving
assistance under this section,
with priority for providers
providing or seeking to provide
child care in underserved
communities and for underserved
populations identified in
subsection (f)(3)(H), to--
(AA) support
startup and expansion
costs; and
(BB) assist such
providers in meeting
health and safety
requirements, achieving
licensure, conducting
background checks, and
meeting requirements in
the State's tiered
system for measuring
and supporting the
quality of eligible
child care providers.
(bb) Requirement.--As a
condition of receiving a
startup or supply expansion
grant under this subclause, a
child care provider shall
commit to meeting the
requirements of an eligible
provider under this section,
and providing child care
services to children receiving
assistance under this section
on an ongoing basis.
(II) Quality grants.--From a
portion of the quality child care
amount, a State shall provide quality
grants to support eligible child care
providers in providing child care
services to children receiving
assistance under this section to
improve the quality of such providers,
including--
(aa) supporting such
providers in meeting or making
progress toward the
requirements for the highest
tier of the State's tiered
system for measuring and
supporting the quality of
eligible child care providers
under subsection (f)(3)(B); and
(bb) supporting such
providers in sustaining child
care quality, including
supporting increased wages for
staff and supporting payment of
fixed costs.
(III) Facilities grants.--
(aa) In general.--From a
portion of the quality child
care amount, a State shall
provide support, including
through awarding facilities
grants, for remodeling,
renovation, or repair of a
building or facility to the
extent permitted under section
658F(b) of the Child Care and
Development Block Grant Act of
1990 (42 U.S.C. 9858d(b)).
(bb) Additional uses.--For
fiscal year 2026 and subsequent
fiscal years, a State may award
such facilities grants for
construction, permanent
improvement, or major
renovation of a building or
facility primarily used for
providing direct child care
services, in accordance with
the following:
(AA) Federal
interest provisions
will not apply to the
renovation or
rebuilding of privately
owned family child care
homes under this
subclause.
(BB) Eligible child
care providers may not
use funds for buildings
or facilities that are
used primarily for
sectarian instruction
or religious worship.
(CC) The Secretary
shall develop
parameters on the use
of funds under this
subclause for family
child care homes.
(DD) The Secretary
shall not retain
Federal interest after
a period of 10 years in
any facility built,
renovated, or repaired
with funds awarded
under this subclause.
(IV) State activities to improve
the quality of child care services.--A
State shall use a portion of the
quality child care amount to improve
the quality of child care services
available for this program, which shall
include--
(aa) supporting the
training and professional
development of the early
childhood workforce, including
supporting degree attainment,
continued education, and
credentialing for early
childhood educators;
(bb) developing,
implementing, or enhancing the
State's tiered system for
measuring and supporting the
quality of eligible child care
providers under subsection
(f)(3)(B);
(cc) improving the supply
and quality of developmentally
appropriate and inclusive child
care programs and services for
underserved populations
described in subsection
(f)(3)(H);
(dd) improving access to
child care services for
vulnerable children as defined
by the lead agency pursuant to
subsection (b)(4)(A)(iv)(II);
(ee) providing outreach and
enrollment support for families
of eligible children;
(ff) supporting eligible
child care providers to
eliminate use of suspensions,
expulsions, and aversive
behavioral interventions,
including through adaptations
and interventions by special
educators, mental health
consultants, and other
community resource personnel,
such as behavior coaches,
psychologists, and other
appropriate specialists, and
through the provision of mental
health services for the
providers;
(gg) improving coordination
between States and local
government with respect to
licensing and other regulatory
requirements for eligible child
care providers; and
(hh) establishing or
supporting a system of local or
regional child care resource
and referral organizations that
is coordinated, to the extent
determined appropriate by the
State, by a statewide public or
private nonprofit, community-
based or regionally based, lead
child care resource and
referral organization, as
described in section
658E(c)(3)(B)(iii) of the Child
Care and Development Block
Grant Act of 1990 (42 U.S.C.
9858c(c)(3)(B)(iii)).
(V) Technical assistance.--From a
portion of the quality child care
amount, the State, in coordination with
local governments and staffed family
child care networks as appropriate,
shall provide technical assistance to
increase the supply and quality of
eligible child care providers who are
providing, or seeking to provide, child
care services to children receiving
assistance under this section,
including providing support to enable
providers to achieve licensure.
(i) Grants to Localities and Awards to Head Start Programs.--
(1) Eligible locality defined.--In this subsection, the
term ``eligible locality'' means a city, county, or other unit
of general local government.
(2) Grants to localities.--
(A) In general.--After reserving a portion of the
funds appropriated under subsection (c)(2), the
Secretary shall use the portion to award local Birth
Through Five Child Care and Early Learning Grants, as
determined by the Secretary, to eligible localities
located in States that have not received payments under
subsection (g). The Secretary shall award the grants to
eligible localities in such a State from the allotment
made for that State under subparagraph (B).
(B) Allotments.--
(i) Poverty line defined.--In this
subparagraph, the term ``poverty line'' means
the poverty line defined and revised as
described in section 673 of the Community
Services Block Grant Act (42 U.S.C. 9902).
(ii) General authority.--For each State
described in subparagraph (A), the Secretary
shall allot for the State for a fiscal year an
amount that bears the same relationship to the
portion described in subparagraph (A) for the
fiscal year as the number of children from
families with family incomes that are at or
below 200 percent of the poverty line, and who
are under the age of 6, in the State bears to
the total number of all such children in all
States described in subparagraph (A).
(C) Application.--To receive a grant from the
corresponding State allotment under subparagraph (B),
an eligible locality shall submit an application to the
Secretary at such time, in such manner, and containing
such information as the Secretary may require. The
requirements for the application shall, to the greatest
extent practicable, be consistent with the State plan
requirements applicable to States under subsection (f).
(D) Requirements.--The Secretary shall specify the
requirements for an eligible locality to provide access
to child care, which child care requirements shall, to
the greatest extent practicable, be consistent with the
requirements applicable to States under this section.
(E) Recoupment of unused funds.--Notwithstanding
any other provision of this section, for each of fiscal
years 2026 through 2030, the Secretary shall have the
authority to recoup any unused funds allotted under
subparagraph (B) for awards under paragraph (3)(A) to
Head Start agencies in accordance with paragraph (3).
(3) Head start expansion in nonparticipating states.--
(A) In general.--The Secretary shall use funds
appropriated under subsection (c)(2) and not reserved
under paragraph (2)(A) and funds recouped under
paragraph (2) to make awards to Head Start agencies in
a State described in paragraph (2)(A) to carry out the
purposes of the Head Start Act (42 U.S.C. 9831 et seq.)
in such State.
(B) Rule.--For purposes of carrying out the Head
Start Act in circumstances not involving awards under
this paragraph, funds awarded under subparagraph (A)
shall not be included in the calculation of a ``base
grant'' as such term is defined in section 640(a)(7)(A)
of the Head Start Act (42 U.S.C. 9835(a)(7)(A)).
(C) Definition.--In this paragraph, the term ``Head
Start agency'' means an entity designated or eligible
to be designated as a Head Start agency under section
641(a)(1) of the Head Start Act (42 U.S.C. 9836(a)(1))
or as an Early Head Start agency (by receiving a grant)
under section 645A(a) of such Act (42 U.S.C.
9840a(a)(1)).
(4) Priority for serving underserved populations.--In
making determinations to award a grant or make an award under
this subsection, the Secretary shall give priority to entities
serving a high percentage of individuals from underserved
populations described in subsection (f)(3)(H).
(j) Program Requirements.--
(1) Prohibition on additional eligibility requirements.--No
individual shall be determined, by the Secretary, a State, or
another recipient of funds under this section, to be ineligible
for child care services provided under this section, except on
the basis of eligibility requirements specified in or under
this section.
(2) Maintenance of effort.--
(A) In general.--A State that receives payments
under this section for a fiscal year, in using the
funds made available through the payments, shall
maintain the expenditures of the State for child care
services at the average level of such expenditures by
the State for the 3 preceding fiscal years.
(B) Counting rule.--State expenditures counted for
purposes of meeting the requirement in subparagraph (A)
may also be counted for purposes of meeting the
requirement to provide a non-Federal share under
subparagraph (A), (B), or (C), as appropriate, of
subsection (g)(1).
(3) Supplement not supplant.--Funds received under this
section shall be used to supplement and not supplant other
Federal, State, and local public funds expended to provide
child care services in the State on the date of enactment of
this Act, calculated as the average amount of such Federal,
State, and local public funds expended for fiscal year 2026 and
each subsequent fiscal year that ended before the date on which
the average is calculated.
(4) Allowable sources of non-federal share.--For purposes
of providing the non-Federal share required under subsection
(g)(1), a State's non-Federal share--
(A) for direct child care services described in
subsection (g)(1)(A)--
(i) shall not include contributions being
used as a non-Federal share or match for
another Federal award; and
(ii) shall be provided from State or local
sources, contributions from philanthropy or
other private organizations, or a combination
of such sources and contributions; and
(B) for activities to improve the quality and
supply of child care services described in subsection
(g)(1)(B), and administration described in subsection
(g)(1)(C)--
(i) shall not include contributions being
used as a non-Federal share or match for
another Federal award;
(ii) shall be provided from State or local
sources, contributions from philanthropy or
other private organizations, or a combination
of such sources and contributions; and
(iii) may be in cash or in-kind, fairly
evaluated, including facilities or property,
equipment, or services.
(5) Reports.--A State, Indian Tribe, tribal organization,
or territory receiving funds under this section shall provide
to the Secretary such periodic reports, providing a detailed
accounting of the uses of the funds received under this
section, as the Secretary may require for the administration of
this section. The State, Indian Tribe, tribal organization, or
territory shall begin to provide the reports beginning not
later than 60 days after its initial receipt of a payment under
subsection (g).
(k) Monitoring and Enforcement.--
(1) Review of compliance with requirements and state
plan.--The Secretary shall review and monitor compliance of
States, territories, tribal entities, and local entities with
this section and State compliance with the State plan described
in subsection (f)(3).
(2) Issuance of rule.--The Secretary shall establish by
rule procedures for--
(A) receiving, processing, and determining the
validity of complaints or findings concerning any
failure of a State to comply with the State plan or any
other requirement of this section;
(B) notifying a State when the Secretary has
determined there has been a failure by the State to
comply with a requirement of this section; and
(C) imposing sanctions under this subsection for
such a failure.
(l) Federal Administration.--Using funds reserved under subsection
(c)(3), the Secretary shall carry out administration of this section,
shall provide (including through the use of grants or cooperative
agreements) technical assistance to States, territories, Indian Tribes,
and tribal organizations, and shall carry out research, and evaluations
related to this section.
(m) Nonpostsecondary Education Program.--For purposes of section
401 of the Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (8 U.S.C. 1611), the program carried out under this section
shall be considered to be a program of nonpostsecondary education.
TITLE VII--ESTABLISHING A $60,000 A YEAR MINIMUM SALARY FOR EVERY
PUBLIC SCHOOL TEACHER IN THE UNITED STATES
SEC. 701. PURPOSES.
The purposes of this title are to--
(1) ensure public elementary and secondary school teachers
earn a livable and competitive salary that--
(A) includes a starting annual base salary of not
less than $60,000; and
(B) increases regularly throughout a teacher's
career;
(2) increase Federal investments in public schools; and
(3) call upon States and local governments to increase
investments in public education in order to ensure that every
public school student is taught by a qualified teacher.
SEC. 702. DEFINITIONS.
(a) Definitions.--In this title:
(1) ESEA terms.--The terms ``elementary school'',
``outlying area'', and ``secondary school'' have the meanings
given those terms in section 8101 of the Elementary and
Secondary Education Act of 1965 (20 U.S.C. 7801).
(2) Annual adjustment percentage.--The term ``annual
adjustment percentage'', with respect to a fiscal year, means a
percentage equal to the estimated percentage change in the
Consumer Price Index, as determined by the Secretary, for the
most recent calendar year ending prior to the beginning of such
fiscal year.
(3) Annual base salary.--The term ``annual base salary''--
(A) means the base salary, calculated as an annual
rate of pay, of a full-time teacher; and
(B) excludes--
(i) any additional compensation earned by
the teacher for taking on additional
responsibilities (such as coaching or teaching
during the summer or after school); and
(ii) bonuses, stipends, and awards.
(4) Average teacher salary baselines.--The term ``average
teacher salary baselines'' means, for each of the following
years of service as teachers, the average annual base salaries
of all full-time teachers employed by local educational
agencies in the State:
(A) 0 years, or starting teacher salaries.
(B) 3 years.
(C) 5 years.
(D) 10 years.
(E) 15 years.
(F) 20 years.
(G) 25 years.
(5) Consumer price index.--The term ``Consumer Price
Index'' has the meaning given the term in section 478(f) of the
Higher Education Act of 1965 (20 U.S.C. 1087rr(f)).
(6) Minimum salary for teachers.--The term ``minimum salary
for teachers'' means an amount, determined by the State, that
all full-time teachers employed by a local educational agency
are, at a minimum, required by the State to be compensated by
such agency as their annual base salary, and which--
(A) for teachers in their first year of teaching,
shall be an annual rate of pay that is not less than
the amount described in subsection (b); and
(B) for teachers with more than 2 years of
experience, shall be an annual rate of pay that--
(i) is greater than the amount described in
subsection (b); and
(ii) increases as the experience of a
teacher increases.
(7) Secretary.--The term ``Secretary'' means the Secretary
of Education.
(8) Teacher.--The term ``teacher'' means--
(A) an employee of a local educational agency--
(i) with a primary duty of teaching and who
is employed and engaged in teaching in a public
elementary school or secondary school served by
such agency and is not a substitute teacher;
(ii) who fully meets all applicable public
elementary school or secondary school teacher
certification and licensure requirements of the
State in which the school is located; and
(iii) if the teacher is a special education
teacher, who meets the qualifications described
in section 612(a)(14)(C) of the Individuals
with Disabilities Education Act; and
(B) other full-time public elementary school or
secondary school personnel employed by a local
educational agency whose annual base salary is
determined in accordance with such agency's salary
schedule or system for a full-time teacher.
(b) Special Rules.--
(1) In general.--For each fiscal year, the amount described
in subsection (a)(6)(A) shall be determined under this
subsection.
(2) Fiscal years 2027 through 2031.--For each of fiscal
years 2027 through 2031, the amount described in subsection
(a)(6)(A) is $60,000.
(3) Fiscal years 2032 and after.--
(A) In general.--For the fiscal year period 2032
through 2036 and for each subsequent 5 fiscal year
period, the amount described in subsection (a)(6)(A)
shall be adjusted for inflation as described in
subparagraph (B).
(B) Determination.--The amount shall be equal to
the amount applicable for the previous 5 fiscal year
period, increased by the greater of--
(i) the aggregate annual adjustment
percentage over the previous 5 fiscal years; or
(ii) 2 percent of the amount applicable
under this subsection for the previous 5 fiscal
year period.
SEC. 703. ENSURING TEACHERS ARE PAID A LIVABLE AND COMPETITIVE WAGE.
(a) Authorization and Appropriations for States.--
(1) In general.--There are authorized to be appropriated to
carry out this section such sums as may be necessary for fiscal
year 2027 and each succeeding fiscal year.
(2) Appropriations for states.--In addition to amounts
otherwise available to carry out this section, there are
appropriated, out of any money in the Treasury not otherwise
appropriated, to the Secretary to carry out this section--
(A) for fiscal year 2027, $14,500,000,000; and
(B) for each succeeding fiscal year, the amount
appropriated under this section for the preceding
fiscal year, increased by the annual adjustment
percentage.
(b) Program Authorized.--
(1) In general.--From amounts made available to carry out
this section, and after making the reservations described in
paragraph (2), the Secretary shall award grants, through
allotments described in paragraph (3), to States to enable
States to guarantee that all teachers employed by local
educational agencies in the State are compensated with a
livable and competitive salary, which shall be an amount that--
(A) is at least the minimum salary for teachers;
(B) increases throughout each teacher's career; and
(C) is, to the greatest extent practicable,
commensurate with annual salaries for college-educated
and similarly experienced professionals in the region
in which such agencies are located, as determined in
accordance with procedures and requirements established
by the Secretary.
(2) Reservations.--
(A) In general.--From the amount appropriated under
subsection (a) for a fiscal year, the Secretary shall
reserve--
(i) one-half of 1 percent for allotments
for payments to the outlying areas, to be
distributed among those outlying areas on the
basis of their relative need, as determined by
the Secretary, to ensure that teachers are paid
a livable and competitive salary, in accordance
with the purposes of this title;
(ii) one-half of 1 percent for the
Secretary of the Interior to be allocated by
the Director of the Bureau of Indian Education
for programs or activities operated or funded
by the Bureau for Bureau-funded schools (as
defined in section 1141 of the Education
Amendments of 1978 (25 U.S.C. 2021)) to ensure
teachers are paid a livable and competitive
salary, in accordance with the purposes of this
title; and
(iii) 1 percent for program administration,
technical assistance, and data collection for
the program under this section.
(B) Special rule.--Notwithstanding any other
provision of this title, the requirements of this
section and section 702 shall not apply to recipients
described in clause (i) and (ii) of subparagraph (A),
except that such recipients shall use funds described
in this paragraph to ensure that teachers are paid a
livable and competitive salary.
(3) Allotments.--
(A) In general.--After making the reservations
under paragraph (2), the Secretary shall allot 50
percent of the remaining amount appropriated under
subsection (a) in accordance with subparagraph (B) and
allot the other 50 percent of such remaining amount in
accordance with subparagraph (C).
(B) Targeted formula.--From an amount equal to 50
percent of the amounts appropriated under subsection
(a) and remaining after the reservations of funds under
paragraph (2) (referred to in this section as the
``targeted formula amounts''), the Secretary shall
allot to each State having a plan approved by the
Secretary under subsection (d) an amount that bears the
same relationship to such targeted formula amounts as
the total amount that local educational agencies in the
State received under section 1125 of the Elementary and
Secondary Education Act of 1965 (20 U.S.C. 6335) for
the preceding fiscal year bears to the amount all local
educational agencies in all States received under such
section for the preceding fiscal year.
(C) EFIG formula.--From an amount equal to 50
percent of the amounts appropriated under subsection
(a) and remaining after the reservations of funds under
paragraph (2) (referred to in this section as the
``EFIG formula amounts''), the Secretary shall allot to
each State having a plan approved by the Secretary
under subsection (d) an amount that bears the same
relationship to such EFIG formula amounts as the amount
the State received under section 1125A of the
Elementary and Secondary Education Act of 1965 (20
U.S.C. 20 U.S.C. 6337) for the preceding fiscal year
bears to the amount all States received under such
section for the preceding fiscal year.
(D) Final allotments.--For the purposes of this
section, a State's allotment shall be the sum of a
State's allotments calculated under subparagraph (B)
and subparagraph (C).
(c) Improving Teacher Salaries.--
(1) In general.--Subject to paragraph (3), a State that
receives an allotment under this section shall ensure that the
annual base salary of a full-time teacher employed by a local
educational agency in the State is an amount that--
(A) is at least the minimum salary for teachers;
(B) increases throughout each teacher's career; and
(C) is, to the greatest extent practicable,
commensurate with annual salaries for college-educated
and similarly experienced professionals in the region
in which such agencies are located, as determined in
accordance with procedures and requirements established
by the Secretary.
(2) Compliance.--To comply with paragraph (1), a State
shall adopt one or more of the following laws or policies to
ensure that every full-time teacher employed by a local
educational agency in the State receives an annual base salary
that is not less than the minimum salary for teachers:
(A) A statewide salary schedule that ensures that
the salary of every full-time teacher employed by a
local educational agency in the State is--
(i) an amount not less than the minimum
salary for teachers established by the State
under subsection (d)(1)(A); and
(ii) increases as the experience of a
teacher increases.
(B) A statewide minimum annual base salary for
teachers who are in their first year of teaching that
not less than the minimum salary for teachers
established by the State under subsection (d)(1)(A).
(C) A State law to increase salaries for teachers.
(3) Timing.--The Secretary shall ensure that, not later
than 3 years after a State receives an allotment under this
section, each such State meets the teacher salary requirements
described in paragraph (1).
(d) State Plan.--
(1) In general.--In order to receive an allotment under
subsection (b)(3), a State shall submit a State plan to the
Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require. Such State
plan shall include, at a minimum each of the following:
(A) A description of the State's minimum salary for
teachers, including the State's plan to ensure that the
State will meet the requirements of subsection (c)(1)
not later than 3 years after the State receives an
allotment under this section.
(B) A description of the State's plan to increase
the State's per-pupil expenditures or the aggregate
expenditures of the State with respect to the provision
of free public education in the State, in a manner
that--
(i) supports local educational agencies in
increasing salaries or wages for teachers,
paraprofessionals, specialized instructional
support personnel, classified school employees,
principals, other school leaders, school
librarians, school bus drivers, and other staff
across their careers, including through
providing increased resources to local
educational agencies; and
(ii) does not--
(I) increase average class sizes or
student to full-time equivalent teacher
ratios at the State, local educational
agency, or school level;
(II) reduce planning time; or
(III) require teachers to teach
additional classes.
(C) An identification, with respect to the average
teacher salary baselines in the most recent fiscal
year, of the statewide average and the average in each
local educational agency in the State.
(D) An identification of the number and percentage
of teachers employed by local educational agencies in
the State who earn a salary of less than $60,000
annually, disaggregated by each period of service
specified in the average teacher salary baselines,
across the State and in each such local educational
agency.
(E) A description of the State's plan to comply
with the equitable distribution of teachers requirement
under section 1111(g)(1)(B) of the Elementary and
Secondary Education Act of 1965 (20 U.S.C.
6311(g)(1)(B)).
(2) Public comment.--Each State shall make the State plan
publicly available for public comment for a period of not less
than 30 days, by electronic means and in an easily accessible
format, prior to submission to the Secretary for approval under
this subsection. Upon submission, the State plan shall include
a summary of the comments submitted to the Secretary, with a
description of how the State addressed the comments, and make
such summary with description publicly available on the website
of the State educational agency.
(e) State Use of Funds.--Each State that receives an allotment
under subsection (b) shall--
(1) reserve not more than 1 percent of the amounts allotted
to the State under subsection (b)(3)(D) to provide technical
assistance and conduct monitoring to ensure that all local
educational agencies meet the requirements described in
subsection (c);
(2) reserve not more than 4 percent of the amounts allotted
to the State under subsection (b)(3)(D) to conduct statewide
efforts to--
(A) increase teacher compensation across the State
in accordance with in subsection (c);
(B) identify and reform policies and practices at
the State, local educational agency, and school-level
to promote excellent teaching for all students,
particularly subgroups of students; and
(C) address structural and organizational
challenges in the teaching profession, in order to--
(i) raise the standards, status, and
salaries of the teaching profession; and
(ii) attract and retain promising and
talented young people to teaching; and
(3) from the amounts allotted to the State under subsection
(b)(3)(D) that are remaining after reserving amounts under
paragraphs (1) and (2), allocate--
(A) 50 percent of such remaining amounts to local
educational agencies in the State in accordance with
the targeted formula described in section 1125(b) of
the Elementary and Secondary Education Act of 1965 (20
U.S.C. 6335(b)); and
(B) 50 percent of such remaining amounts to local
educational agencies in the State in accordance with
the formula described in section 1125A(d) of the
Elementary and Secondary Education Act of 1965 (20
U.S.C. 6337(d)).
(f) Reporting Requirements.--Not later than 1 year after receiving
an allotment under this section and annually thereafter, a State that
receives an allotment under this section shall submit a report to the
Secretary and publish such report in a clear and easily accessible
format on the website of the State. Such report shall contain any
information required by the Secretary and include, at a minimum--
(1) data on the average teacher salary baselines for the
previous fiscal year, disaggregated by the statewide average
and the average in each local educational agency in the State;
(2) updated data on the number of teachers employed by
local educational agencies in the State who earn less than the
minimum salary for teachers, disaggregated by each period of
service described in section 702(a)(4), across the State and
employed by each local educational agency;
(3) a description of the actions the State educational
agency will take in the next fiscal year to support local
educational agencies described in paragraph (2) in decreasing
the number of teachers employed by such agencies who earn less
than the minimum salary for teachers;
(4) a description of actions taken by the State to increase
the State's per-pupil expenditures or the aggregate
expenditures of the State with respect to the provision of free
public education in the State, in a manner that--
(A) supports local educational agencies in
increasing salaries or wages for teachers,
paraprofessionals, specialized instructional support
personnel, classified school employees, principals,
other school leaders, school librarians, school bus
drivers, and other staff across their careers,
including through providing increased resources to
local educational agencies; and
(B) does not--
(i) increase average class sizes or student
to full-time equivalent teacher ratios at the
State, local educational agency, or school
level;
(ii) reduce planning time; or
(iii) require teachers to teach additional
classes; and
(5) a description of how the State improved the equitable
distribution of teachers in such fiscal year, as required under
section 1111(g)(1)(B) of the Elementary and Secondary Education
Act of 1965 (20 U.S.C. 6311(g)(1)(B)).
SEC. 704. COLLECTIVE BARGAINING AND RELATED RULES.
(a) Rule of Construction for Collective Bargaining.--
(1) In general.--Subject to paragraph (2), nothing in
section 703 shall be construed to alter or otherwise affect the
rights, remedies, and procedures afforded to school or local
educational agency employees under Federal, State, or local
laws (including applicable regulations or court orders) or
under the terms of collective bargaining agreements, memoranda
of understanding, or other agreements between such employers
and their employees.
(2) Compliance.--Paragraph (1) shall not be construed to
exempt a State, local educational agency, or school from
complying with section 703 or from negotiating in compliance
with State labor laws to comply with section 703.
(b) Rule of Construction for Additional Pay or Other Salary
Augmenting Systems.--Nothing in section 703 shall be construed to
prevent States or local educational agencies from supplementing the
annual base salary of teachers or other staff employed by such
agencies--
(1) for additional skills, knowledge, duties, and
responsibilities;
(2) by salary systems that increase teachers' compensation
through supplemental pay that is not part of an annual base
salary; or
(3) through the provision of bonuses, stipends, or awards.
TITLE VIII--INVESTMENTS IN HOME AND COMMUNITY-BASED SERVICES AND LONG-
TERM CARE QUALITY AND WORKFORCE
SEC. 801. HCBS IMPROVEMENT PLANNING GRANTS.
(a) Funding.--
(1) In general.--In addition to amounts otherwise
available, there is appropriated to the Secretary for fiscal
year 2027, out of any money in the Treasury not otherwise
appropriated, $130,000,000, to remain available until expended,
for carrying out this section.
(2) Technical assistance and guidance.--In addition to
amounts otherwise available, there is appropriated to the
Secretary for fiscal year 2027, out of any money in the
Treasury not otherwise appropriated, $5,000,000, to remain
available until expended, for purposes of issuing guidance and
providing technical assistance to States intending to apply
for, or which are awarded, a planning grant under this section,
and for other administrative expenses related to awarding
planning grants under this section.
(b) Award and Use of Grants.--
(1) Deadline for award of grants.--From the amount
appropriated under subsection (a)(1), the Secretary, not later
than 12 months after the date of enactment of this Act, shall
solicit State requests for HCBS improvement planning grants and
award such grants to all States that meet such requirements as
determined by the Secretary.
(2) Use of funds.--Subject to paragraph (3), a State
awarded a planning grant under this section shall use the grant
to carry out planning activities for purposes of developing and
submitting to the Secretary an HCBS improvement plan for the
State that meets the requirements of subsection (c). A State
may use planning grant funds to support activities related to
the implementation of the HCBS improvement plan for the State.
(3) Limitation on use of funds.--None of the funds awarded
to a State under this section may be used by a State as the
source of the non-Federal share of expenditures under the State
Medicaid program.
(c) HCBS Improvement Plan Requirements.--
(1) Content.--The Secretary shall define the content
requirements for an HCBS improvement plan, which, at minimum,
shall include an assessment of access barriers to home and
community-based services and the availability (as defined by
the Secretary) of such services in the State, a description of
Medicaid payment rates for such services, a description of the
current workforce of direct care workers, the percentage of
expenditures made by the State for long-term services and
supports that are for home and community-based services, and a
description of how the State will meet the requirements of the
HCBS Improvement Program.
(2) Submission; approval; amendments.--Not later than 24
months after the date on which a State is awarded a planning
grant under this section, the State shall submit an HCBS
improvement plan for approval by the Secretary, along with
assurances by the State that the State will implement the plan
in accordance with the requirements of the HCBS Improvement
Program. The Secretary shall approve the HCBS improvement plan
for a State after the plan and such assurances are submitted to
the Secretary for approval and the Secretary determines the
plan meets the requirements of this subsection. A State may
amend its HCBS improvement plan, subject to the approval of the
Secretary that the plan as so amended meets the requirements of
this subsection.
(d) Definitions.--In this part:
(1) Direct care worker.--The term ``direct care worker''
means, with respect to a State, any of the following
individuals who are paid to provide directly to Medicaid
eligible individuals home and community-based services
available under the State Medicaid program:
(A) A registered nurse, licensed practical nurse,
nurse practitioner, or clinical nurse specialist, or a
licensed nursing assistant who provides such services
under the supervision of a registered nurse, licensed
practical nurse, nurse practitioner, or clinical nurse
specialist.
(B) A direct support professional.
(C) A personal care attendant.
(D) A home health aide.
(E) Any other paid health care professional or
worker determined to be appropriate by the State and
approved by the Secretary.
(2) HCBS improvement program.--The term ``HCBS Improvement
Program'' means the program established under subsection (ll)
of section 1905 of the Social Security Act (42 U.S.C. 1396d)
(as added by section 802).
(3) HCBS improvement program state.--The term ``HCBS
Improvement Program State'' means a State that is awarded a
planning grant under subsection (b) and has an HCBS improvement
plan approved by the Secretary under subsection (c)(2).
(4) Home and community-based services.--The term ``home and
community-based services'' means any of the following (whether
provided on a fee-for-service, risk, or other basis):
(A) Home health care services authorized under
paragraph (7) of section 1905(a) of the Social Security
Act (42 U.S.C. 1396d(a)).
(B) Private duty nursing services authorized under
paragraph (8) of such section, when such services are
provided in a Medicaid eligible individual's home.
(C) Personal care services authorized under
paragraph (24) of such section.
(D) PACE services authorized under paragraph (26)
of such section.
(E) Home and community-based services authorized
under subsections (b), (c), (i), (j), and (k) of
section 1915 of such Act (42 U.S.C. 1396n), authorized
under a waiver under section 1115 of such Act (42
U.S.C. 1315), or provided through coverage authorized
under section 1937 of such Act (42 U.S.C. 1396u-7).
(F) Case management services authorized under
section 1905(a)(19) of the Social Security Act (42
U.S.C. 1396d(a)(19)) and section 1915(g) of such Act
(42 U.S.C. 1396n(g)).
(G) Rehabilitative services, including those
related to behavioral health, described in section
1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).
(H) Such other services specified by the Secretary.
(5) Medicaid eligible individual.--The term ``Medicaid
eligible individual'' means an individual who is eligible for
and receiving medical assistance under a State Medicaid
program. Such term includes an individual who is on a waiting
list and who would become eligible for medical assistance and
enrolled under a State Medicaid program upon receipt of home
and community-based services.
(6) State medicaid program.--The term ``State Medicaid
program'' means, with respect to a State, the State program
under title XIX of the Social Security Act (42 U.S.C. 1396
through 1396w-6) (including any waiver or demonstration under
such title or under section 1115 of such Act (42 U.S.C. 1315)
relating to such title).
(7) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(8) State.--The term ``State'' means each of the 50 States,
the District of Columbia, Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa.
SEC. 802. HCBS IMPROVEMENT PROGRAM.
(a) Increased FMAP for HCBS Improvement Program States.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(1) in subsection (b), by striking ``and (ii)'' and
inserting ``(ii), and (ll)''; and
(2) by adding at the end the following new subsection:
``(ll) Additional Support for HCBS Improvement Program States.--
``(1) In general.--
``(A) Additional support.--Subject to paragraph
(5), in the case of a State that is an HCBS Improvement
Program State, for each fiscal quarter that begins on
or after the first date on which the State is an HCBS
Improvement Program State--
``(i) and for which the State meets the
requirements described in paragraphs (2) and
(4), notwithstanding subsection (b) or (ff),
subject to subparagraph (B), with respect to
amounts expended during the quarter by such
State for medical assistance for home and
community-based services, the Federal medical
assistance percentage for such State and
quarter (as determined for the State under
subsection (b) or (ff) and, if applicable,
increased under subsection (y), (z), (aa), or
(ii), or section 1915(k)(2)) shall be increased
by 8 percentage points; and
``(ii) with respect to the State meeting
the requirements described in paragraphs (2)
and (4) and with respect to amounts expended
during the quarter and before October 1, 2036,
administrative costs for expanding and
enhancing home and community-based services,
including for enhancing Medicaid data and
technology infrastructure, modifying rate
setting processes, adopting or improving
training programs for direct care workers and
family caregivers, home and community-based
services ombudsman office activities,
developing processes to identify direct care
workers and assign such workers unique
identifiers, and adopting, carrying out, or
enhancing programs that register direct care
workers or connect beneficiaries to direct care
workers, shall be eligible for Federal
financial participation in the same manner as
other administrative expenditures under section
1903(a), except that, for purposes of this
clause, the per centum applicable to such
expenditures shall be the greater of 80 percent
or the per centum that would otherwise apply.
In no case may the application of clause (i) result in
the Federal medical assistance percentage determined
for a State being more than 95 percent with respect to
such expenditures. Any increase pursuant to clause (ii)
shall be available to a State before the State meets
the requirements of paragraphs (2) and (4).
``(B) Additional hcbs improvement efforts.--Subject
to paragraph (5), in addition to the increase to the
Federal medical assistance percentage under
subparagraph (A)(i) for amounts expended during a
quarter for medical assistance for home and community-
based services by an HCBS Improvement Program State
that meets the requirements of paragraphs (2) and (4)
for the quarter, the Federal medical assistance
percentage for amounts expended by the State during the
quarter for medical assistance for home and community-
based services shall be further increased by 2
percentage points (but not to exceed 95 percent) during
the first 6 fiscal quarters throughout which the State
has implemented and has in effect a program that meets
the requirements of paragraph (3).
``(C) Nonapplication to chip efmap.--Any increase
to the Federal medical assistance percentage of a State
under subparagraph (A)(i) or (B) or an increase to an
applicable Federal matching percentage under
subparagraph (A)(ii) shall not be taken into account in
calculating the enhanced FMAP of a State under section
2105.
``(2) Requirements.--As conditions for receipt of the
increase under paragraph (1)(A)(i) to the Federal medical
assistance percentage determined for a State, with respect to a
fiscal year quarter, the State shall meet each of the following
requirements:
``(A) Nonsupplantation.--The State uses an amount
in State funds equivalent to the additional Federal
funds received by the State that are attributable to
the increase to the Federal medical assistance
percentage for amounts expended during a quarter for
medical assistance for home and community-based
services under paragraph (1)(A) and paragraph (1)(B)
(if applicable) to supplement, and not supplant, the
level of State funds expended for home and community-
based services for eligible individuals through
programs in effect as of the date the State is awarded
a planning grant under section 801 of the Make
Billionaires Pay Their Fair Share Act. In applying this
subparagraph, the Secretary shall provide that a State
shall have a 3-year period, as specified by the
Secretary, to spend any accumulated unspent State funds
attributable to such increase to the Federal medical
assistance percentage.
``(B) Maintenance of effort.--
``(i) In general.--The State does not--
``(I) reduce the amount, duration,
or scope of home and community-based
services available under the State plan
(or waiver of such plan) relative to
the home and community-based services
available under the plan or a waiver of
such plan as of the date on which the
State was awarded a planning grant
under section 801 of the Make
Billionaires Pay Their Fair Share Act;
``(II) reduce payment rates for
home and community-based services lower
than such rates that were in place as
of the date described in subclause (I),
including, to the extent applicable,
assumed payment rates for such services
that are included in managed care
capitation rates as such rates are
being prospectively built; or
``(III) except to the extent
permitted under clause (ii), adopt more
restrictive standards, methodologies,
or procedures for determining
eligibility for, or the scope of,
medical assistance for home and
community-based services, including
with respect to cost-sharing, than the
standards, methodologies, or procedures
applicable as of the date described in
subclause (I).
``(ii) Conditions for flexibility.--A State
may make modifications that would otherwise
violate the maintenance of effort described in
clause (i) if the State demonstrates to the
satisfaction of the Secretary that such
modifications shall not result in--
``(I) home and community-based
services that are less comprehensive or
lower in amount, duration, or scope;
``(II) fewer individuals (overall
and within particular eligibility
groups) receiving home and community-
based services, adjusted for
demographic changes since the date
described in clause (i)(I); or
``(III) increased cost-sharing
(other than resulting from the rate of
inflation) for home and community-based
services.
``(C) Access to services.--The State undertakes
efforts to improve access to home and community-based
services by doing all of the following not later than
an implementation date specified by the Secretary
(which may vary for each of the following clauses)
after the first day of the first fiscal quarter for
which a State receives an increase to the Federal
medical assistance percentage or other applicable
Federal matching percentage under paragraph (1):
``(i) Reduces access barriers and
disparities in access or utilization of home
and community-based services.
``(ii) Provides coverage of personal care
services authorized under subsection (a)(24)
for all individuals eligible for and enrolled
in medical assistance in the State.
``(iii) Provides for navigation of home and
community-based services through `no wrong
door' programs, provides expedited eligibility
for home and community-based services, and
improves home and community-based services
counseling and education programs.
``(iv) Expands access to behavioral health
services furnished in home and community-based
settings.
``(v) Improves coordination of home and
community-based services with employment,
housing, and transportation supports.
``(vi) Provides supports to family
caregivers.
``(vii) Newly provides coverage under, or
expands existing eligibility criteria for, 1 or
more of the eligibility categories authorized
under subclause (XIII), (XV), or (XVI) of
section 1902(a)(10)(A)(ii).
``(D) Workforce.--The State strengthens and expands
the workforce of direct care workers that provides home
and community-based services by--
``(i) adopting processes to ensure that
payment rates for home and community-based
services are sufficient (as defined by the
Secretary) to ensure that services are
available, including by, not later than 2 years
after approval of the HCBS improvement plan
and, at least every 3 years thereafter,
updating and, as appropriate, increasing
payment rates for home and community-based
services to support recruitment and retention
of direct care workers using, through existing
or other processes to determine provider
payments, a transparent process involving input
from nongovernmental stakeholders;
``(ii) ensuring that increases in the
payment rates for home and community-based
services result in at least a proportionate
increase to payments for direct care workers;
and
``(iii) updating qualification standards as
appropriate, and developing and adopting
training opportunities, for direct care workers
and family caregivers, at such times as the
Secretary shall prescribe.
``(3) Self-directed models for the delivery of services.--
As conditions for receipt of the increase under paragraph
(1)(B) to the Federal medical assistance percentage determined
for a State, with respect to a fiscal year quarter, the State
shall establish directly, or by contract with 1 or more
entities, including an agency with choice or a similar service
delivery model, a program for the performance of all of the
following functions, consistent with guidance issued by the
Secretary, to facilitate beneficiary use of self-directed care
in the case the State covers home and community-based services
under authorities that permit self-direction:
``(A) Recruiting and registering qualified direct
care workers and assisting beneficiaries in finding
qualified direct care workers.
``(B) Supporting beneficiary hiring, if selected by
the beneficiary, of independent providers of home and
community-based services, including through the
provision of financial management services.
``(C) To the extent a State permits beneficiaries
to hire a family member or individual with whom they
have an existing relationship to provide home and
community-based services, providing support to
beneficiaries who wish to hire a caregiver who is a
family member or individual with whom they have an
existing relationship.
``(D) Ensuring that the program under this
paragraph does not promote or deter the ability of
workers to form a labor organization or discriminate
against workers who may join or decline to join such an
organization.
``(4) Reporting and oversight.--As a condition for receipt
of an increase under subparagraphs (A)(i) or (B) of paragraph
(1) to the Federal medical assistance percentage determined for
a State, with respect to a fiscal year quarter, the State
shall, beginning with the last day of the 5th fiscal quarter
for which the State is an HCBS Improvement Program State, and
annually thereafter, report to the Secretary, in a manner the
Secretary shall prescribe, on--
``(A) the State's progress in implementing the
activities described in subparagraphs (C) and (D) of
paragraph (2) and (if applicable) paragraph (3) in
accordance with the State HCBS improvement plan; and
``(B) the use of the increased funding provided
under this subsection.
``(5) Benchmarks for demonstrating improvements.--An HCBS
Improvement Program State shall cease to be eligible for an
increase to the Federal medical assistance percentage under
paragraph (1)(A)(i) or (1)(B) or an increase to an applicable
Federal matching percentage under paragraph (1)(A)(ii) for each
fiscal quarter after the 29th fiscal quarter that begins on or
after the first date on which the State is an HCBS Improvement
Program State unless, at the end of such 29th fiscal quarter,
the State demonstrates the following in the annual report
required in paragraph (4) for such quarter:
``(A) Increased availability (above a marginal
increase) of home and community-based services in the
State relative to such availability as reported in the
State HCBS improvement plan and adjusted for
demographic changes in the State since the submission
of such plan.
``(B) With respect to the percentage of
expenditures made by the State for long-term services
and supports that are for home and community-based
services, in the case of an HCBS Improvement Program
State for which such percentage (as reported in the
State HCBS improvement plan) was--
``(i) less than 50 percent, the State
demonstrates that the percentage of such
expenditures has increased to at least 50
percent since the plan was approved; and
``(ii) at least 50 percent, the State
demonstrates that such percentage has not
decreased since the plan was approved.
``(6) Definitions.--In this subsection, the terms `direct
care worker', `HCBS Improvement Program State', and `home and
community-based services' have the meaning given those terms in
section 801(d) of the Make Billionaires Pay Their Fair Share
Act.''.
SEC. 803. FUNDING FOR FEDERAL ACTIVITIES RELATED TO MEDICAID HCBS.
In addition to amounts otherwise available, there is appropriated
to the Secretary for fiscal year 2027, out of any money in the Treasury
not otherwise appropriated, $40,000,000, to remain available until
expended, to carry out section 802 (including the amendments made by
such section), including by issuing necessary guidance and technical
assistance to States and conducting program integrity and oversight
efforts.
SEC. 804. FUNDING FOR HCBS QUALITY MEASUREMENT AND IMPROVEMENT.
In addition to amounts otherwise available, there is appropriated
to the Secretary for fiscal year 2027, out of any money in the Treasury
not otherwise appropriated, $25,000,000, to remain available until
expended, for purposes of developing, in consultation with
nongovernmental stakeholders with expertise in home and community-based
services (including recipients and providers of such services), a
recommended set of home and community-based services quality measures
that reflect the full range of home and community-based services (as
defined in section 801(d)) and the recipients of such services.
SEC. 805. PERMANENT EXTENSION OF MEDICAID PROTECTIONS AGAINST SPOUSAL
IMPOVERISHMENT FOR RECIPIENTS OF HOME AND COMMUNITY-BASED
SERVICES.
(a) In General.--Section 1924(h)(1)(A) of the Social Security Act
(42 U.S.C. 1396r-5(h)(1)(A)) is amended by striking ``(at the option of
the State) is described in section 1902(a)(10)(A)(ii)(VI)'' and
inserting the following: ``is eligible for medical assistance for home
and community-based services provided under subsection (c), (d), or (i)
of section 1915 or under a waiver approved under section 1115, or who
is eligible for such medical assistance by reason of being determined
eligible under section 1902(a)(10)(C) or by reason of section 1902(f)
or otherwise on the basis of a reduction of income based on costs
incurred for medical or other remedial care, or who is eligible for
medical assistance for home and community-based attendant services and
supports under section 1915(k)''.
(b) Conforming Amendment.--Section 2404 of the Patient Protection
and Affordable Care Act (42 U.S.C. 1396r-5 note) is amended by striking
``September 30, 2027'' and inserting ``the date of enactment of the
Make Billionaires Pay Their Fair Share Act''.
SEC. 806. PERMANENT EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING
DEMONSTRATION.
Subsection (h) of section 6071 of the Deficit Reduction Act of 2005
(42 U.S.C. 1396a note) is amended--
(1) in paragraph (1)--
(A) in subparagraph (I), by inserting ``and'' after
the semicolon;
(B) in subparagraph (J), by inserting ``and each
fiscal year thereafter'' before the semicolon; and
(C) by striking subparagraphs (K) and (L); and
(2) in paragraph (3), by striking ``through fiscal year
2029''.
<all>
Make Billionaires Pay Their Fair Share Act
#3956 | S Congress #119
Policy Area: Taxation
Subjects:
Last Action: Read twice and referred to the Committee on Finance. (3/2/2026)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text