Division G — Other Matters

118th Congress · Approved Mar 9, 2024 · 138 Stat. 25 · Lineage

DIVISION G Other Matters

TITLE I Health and Human Services

Subtitle A Public Health Extenders

SEC. 101. Extension for Community Health Centers, National Health Service Corps, and Teaching Health Centers That Operate Gme Programs.

(a)

Extension for Community Health Centers.— Section 10503(b)(1)(F) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(1)(F)) is amended by striking “ and $536,986,301 for the period beginning on January 20, 2024, and ending on March 8, 2024” and inserting “ $536,986,301 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $3,592,328,767 for the period beginning on October 1, 2023, and ending on December 31, 2024”.

(b)

Extension for the National Health Service Corps.— Section 10503(b)(2)(I) of the Patient Protection and Affordable Care Act (42 U.S.C. 254b–2(b)(2)(I)) is amended by striking “ and $41,616,438 for the period beginning on January 20, 2024, and ending on March 8, 2024” and inserting “ $41,616,438 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $297,013,699 for the period beginning on October 1, 2023, and ending on December 31, 2024”.

(c)

Teaching Health Centers That Operate Graduate Medical Education Programs.—

(1)

In general.— Section 340H(g)(1) of the Public Health Service Act (42 U.S.C. 256h(g)(1)) is amended by striking “ and $16,982,192 for the period beginning on January 20, 2024, and ending on March 8, 2024” and inserting “ $16,982,192 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $164,136,986 for the period beginning on October 1, 2023, and ending on December 31, 2024”.

(2)

Addition to capped amounts.— Section 340H(b)(2) of the Public Health Service Act (42 U.S.C. 256h(b)(2)) is amended by adding at the end the following:

“(C) Addition.—Notwithstanding any provision of this section, for the period beginning on October 1, 2023, and ending on December 31, 2024, the Secretary may use any amounts made available in any fiscal year to carry out this section (including amounts recouped under subsection (f)) to make payments described in paragraphs (1)(A) and (1)(B), in addition to the total amount of funds appropriated under subsection (g).”

(3)

Report to congress.— For the period beginning on October 1, 2023, and ending on December 31, 2024, the Secretary of Health and Human Services shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report specifying—

(A)

the total amount of funds recouped under subsection (f) of section 340H of the Public Health Service Act (42 U.S.C. 256h);

(B)

the rationale for the funds being recouped; and

(C)

the total amount of funds recouped under subsection (f) of such section 340H that were used pursuant to subsection (b)(2)(C) of such section 340H to adjust total payment amounts above the total amounts appropriated under subsection (g) of such section 340H, as amended by paragraph (3).

(d)

Application of Provisions.— Amounts appropriated pursuant to the amendments made by this section shall be subject to the requirements contained in Public Law 117–328 for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (42 U.S.C. 254b et seq.).

(e)

Conforming Amendment.— Section 3014(h)(4) of title 18, United States Code, is amended by striking “ and section 101(d) of the Further Additional Continuing Appropriations and Other Extensions Act, 2024” and inserting “ section 101(d) of the Further Additional Continuing Appropriations and Other Extensions Act, 2024, and section 101(d) of the Consolidated Appropriations Act, 2024”.

SEC. 102. Extension of Special Diabetes Programs.

(a)

Extension of Special Diabetes Programs for Type I Diabetes.— Section 330B(b)(2)(E) of the Public Health Service Act (42 U.S.C. 254c–2(b)(2)(E)) is amended by striking “ and $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024” and inserting “ $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $130,000,000 for the period beginning on March 9, 2024, and ending on December 31, 2024”.

(b)

Extending Funding for Special Diabetes Programs for Indians.— Section 330C(c)(2)(E) of the Public Health Service Act (42 U.S.C. 254c–3(c)(2)(E)) is amended by striking “ and $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024” and inserting “ $20,136,986 for the period beginning on January 20, 2024, and ending on March 8, 2024, and $130,000,000 for the period beginning on March 9, 2024, and ending on December 31, 2024”.

SEC. 103. National Health Security Extensions.

(a)

Section 319(e)(8) of the Public Health Service Act (42 U.S.C. 247d(e)(8)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(b)

Section 319L(e)(1)(D) of the Public Health Service Act (42 U.S.C. 247d–7e(e)(1)(D)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(c)

Section 319L–1(b) of the Public Health Service Act (42 U.S.C. 247d–7f(b)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(d)

(1)

Section 2811A(g) of the Public Health Service Act (42 U.S.C. 300hh–10b(g)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(2)

Section 2811B(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10c(g)(1)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(3)

Section 2811C(g)(1) of the Public Health Service Act (42 U.S.C. 300hh–10d(g)(1)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

(e)

Section 2812(c)(4)(B) of the Public Health Service Act (42 U.S.C. 300hh–11(c)(4)(B)) is amended by striking “ March 8, 2024” and inserting “ December 31, 2024”.

Subtitle B Medicaid

SEC. 201. Requirement for State Medicaid Plans to Provide Coverage for Medication-Assisted Treatment.

(a)

In General.— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1)

in subsection (a)(29), by striking “ for the period beginning October 1, 2020, and ending September 30, 2025,” and inserting “ beginning on October 1, 2020,”; and

(2)

in subsection (ee)(2), by striking “ for the period specified in such paragraph, if before the beginning of such period the State certifies to the satisfaction of the Secretary” and inserting “ if such State certifies, not less than every 5 years and to the satisfaction of the Secretary,”.

(b)

Conforming Amendment.— Section 1006(b)(4)(A) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (42 U.S.C. 1396a note) is amended by striking “ , and before October 1, 2025”.

SEC. 202. Collection and Reporting of Comprehensive Data for Specified Populations Enrolled in Medicaid and Chip.

Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) is amended by adding at the end the following new section:

“SEC. 1948. COLLECTION AND REPORTING OF COMPREHENSIVE DATA FOR SPECIFIED POPULATIONS.

“(a) Recurring Analysis and Publication of Health Care Data Related to Treatment for Substance Use Disorder or a Mental Health Condition.—

“(1) In general.—The Secretary, on an annual basis, shall link, analyze, and publish on a publicly available website data reported by States through the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system) relating to substance use disorder and mental health services provided to individuals enrolled under a State plan under this title or a State child health plan under title XXI (or under a waiver of such plans) who have been diagnosed with a substance use disorder or mental health condition, including an analysis that is disaggregated by age. Such enrollee information shall be de-identified of any personally identifying information, shall adhere to privacy standards established by the Department of Health and Human Services, and shall be aggregated to protect the privacy of enrollees, as necessary.

“(2) Requirements.—The analysis required under paragraph (1) shall include, at a minimum, the following data for each State (including, to the extent available, for the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa):

“(A) The number and percentage of individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) in each of the major enrollment categories (as defined in a public letter from the Medicaid and CHIP Payment and Access Commission to the Secretary) who have been diagnosed with—

“(i) a substance use disorder;

“(ii) a mental health condition; or

“(iii) a co-occurring substance use disorder and mental health condition.

“(B) With respect to individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who have received a diagnosis described in subparagraph (A), a list of the substance use disorder and mental health treatment services, including, to the extent such data are available, specific adult and pediatric services by each major type of service, such as counseling, intensive home-based services, intensive care coordination, crisis services tailored to children and youth, peer support services, family-to-family support, inpatient hospitalization, medication-assisted treatment, residential treatment, and other appropriate services as identified by the Secretary, for which beneficiaries in each State received at least 1 service under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans).

“(C) With respect to each diagnosis described in subparagraph (A), the number and percentage of individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who have such diagnosis and received services for such diagnosis under such plan or waiver by each major type of treatment service listed under subparagraph (B) within each major setting type, such as outpatient, inpatient, residential, and other home-based and community-based settings.

“(D) The number of services provided under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) per individual enrolled under such plan or waiver who has a diagnosis described in subparagraph (A) for each such diagnosis and each major type of treatment service listed under subparagraph (B).

“(E) The number and percentage of individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) by major enrollment category, who have a diagnosis described in subparagraph (A) and received substance use disorder or mental health treatment through—

“(i) a Medicaid managed care entity (as defined in section 1932(a)(1)(B)), including the number of such individuals who received such assistance through a prepaid inpatient health plan (as defined by the Secretary) or a prepaid ambulatory health plan (as defined by the Secretary);

“(ii) a fee-for-service payment model; or

“(iii) an alternative payment model, to the extent available.

“(F) The number and percentage of individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who have a diagnosis described in subparagraph (A) and received services for a mental health condition or a substance use disorder in an outpatient or community-based or home-based setting after receiving mental health or substance use disorder services in an inpatient or residential setting, and the number of mental health or substance use disorder services received by such individuals in the outpatient or community-based or home-based setting.

“(G) The number and percentage of inpatient admissions in which services for a mental health condition or substance use disorder were provided to an individual enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) that occurred within 30 days after discharge from a hospital or residential facility in which services for a mental health condition or substance use disorder previously were provided to such individual, disaggregated by each diagnosis described in subparagraph (A) and type of facility, to the extent such information is available.

“(H) The number of emergency department visits by an individual enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who has a diagnosis described in subparagraph (A) within 7 days of such individual being discharged from an inpatient stay at a hospital during which services for a mental health condition or substance use disorder were provided, or from a mental health facility, an independent psychiatric wing of an acute care hospital, an intermediate care facility for individuals with intellectual disabilities, or a residential treatment facility, disaggregated by each diagnosis described in subparagraph (A) and type of facility, to the extent such information is available.

“(I) The number and percentage of individuals who are enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) and received an assessment for a mental health condition.

“(J) The number and percentage of individuals who are enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) and received an assessment for a substance use disorder.

“(K) The number of mental health services provided to individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who received an assessment described in subparagraph (I) in the 30 days post-assessment.

“(L) The number of substance use disorder treatment services provided to individuals enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) who received an assessment described in subparagraph (J) in the 30 days post-assessment.

“(M) Prescription National Drug Code codes, fill dates, and number of days supply of any covered outpatient drug (as defined in section 1927(k)(2)) that was dispensed to an individual enrolled under the State plan under this title or the State child health plan under title XXI (or under a waiver of such plans) with an episode described in subparagraph (G) or (H) during any period that occurs after the individual’s discharge date defined in subparagraph (G) or (H) (as applicable), and before the admission date applicable under subparagraph (G) or the date of the emergency department visit applicable under subparagraph (H) that were—

“(i) to treat a mental health condition; or

“(ii) to treat a substance use disorder.

“(b) Publication.—

“(1) In general.—Not later than 18 months after the date of enactment of this section, the Secretary shall make publicly available the first analysis required by subsection (a).

“(2) Annual updates.—The Secretary shall issue an updated version of the analysis required under subsection (a) not later than January 1 of each calendar year.

“(3) Use of t–msis data.—The analysis required under subsection (a) and updates required under paragraph (4) shall—

“(A) use data and definitions from the T–MSIS data set that is no more than 12 months old on the date that the analysis or update is published; and

“(B) as appropriate, include a description with respect to each State of the quality and completeness of the data and caveats describing the limitations of the data reported to the Secretary by the State that is sufficient to communicate the appropriate uses for the information.

“(4) Revised publication.—Beginning not later than 3 years after the date of enactment of this section, the Secretary annually shall publish a revised publication of the analysis required by subsection (a) that allows for a research-ready and publicly accessible interface of the publication and is developed after consultation with stakeholders on the usability of the data contained in the publication.

“(5) Making t-msis data on substance use disorders and mental health conditions available to researchers.—

“(A) Requirement to publish system of records notice.—

“(i) In general.—Subject to subparagraph (B), the Secretary shall publish in the Federal Register a system of records notice for the data specified in clause (ii) for the Transformed Medicaid Statistical Information System, in accordance with section 552a(e)(4) of title 5, United States Code. The notice shall outline policies that protect the security and privacy of the data that, at a minimum, meet the security and privacy policies of SORN 09-70-0541 for the Medicaid Statistical Information System.

“(ii) Required data.—The data covered by the systems of records notice required under clause (i) shall be sufficient for researchers and States to analyze the prevalence of conditions described in subsection (a)(2)(A) in the Medicaid and Children’s Health Insurance Program beneficiary population and the treatment of such conditions under Medicaid across all States (including the District of Columbia, Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa), forms of treatment, and treatment settings.

“(iii) Initiation of data-sharing activities.—Not later than January 1, 2025, the Secretary shall initiate the data-sharing activities outlined in the notice required under clause (i).

“(B) Satisfaction of requirement through existing system of records notice.—The Secretary shall not be required to publish a new system of records notice as required under subparagraph (A) if, not later than January 1, 2025, the Secretary determines that the system of records notice published by the Secretary in the Federal Register on February 6, 2019 (84 Fed. Reg. 2230), satisfies the requirements described in subparagraph (A).”

SEC. 203. Monitoring Prescribing of Antipsychotic Medications.

(a)

In General.— Section 1902(oo)(1)(B) of the Social Security Act (42 U.S.C. 1396a(oo)(1)(B)) is amended—

(1)

in the subparagraph heading, by striking “ by children”;

(2)

by striking “ children enrolled” and inserting “ children generally, children in foster care specifically, individuals over the age of 18 receiving home and community-based services (as defined in section 9817(a)(2)(B) of Public Law 117–2), and individuals over the age of 18 residing in institutional care settings (including nursing facilities, intermediate care facilities for individuals with intellectual disabilities, institutions for mental diseases, inpatient psychiatric hospitals, and other such institutional care settings) enrolled”; and

(3)

by striking “ not more than the age of 18 years” through the period at the end and inserting “ subject to the program, including information with respect to each such category of children and individuals over the age of 18.”.

(b)

Effective Date.— The amendments made by subsection (a) shall take effect on the date that is 24 months after the date of enactment of this Act.

SEC. 204. Extension of State Option to Provide Medical Assistance for Certain Individuals in Institutions for Mental Diseases.

(a)

Making Permanent State Plan Amendment Option To Provide Medical Assistance for Certain Individuals Who Are Patients in Certain Institutions for Mental Diseases.— Section 1915(l)(1) of the Social Security Act (42 U.S.C. 1396n(l)(1)) is amended by striking “ With respect to calendar quarters beginning during the period beginning October 1, 2019, and ending September 30, 2023,” and inserting “ With respect to calendar quarters beginning on or after October 1, 2019,”.

(b)

Maintenance of Effort Revision.— Section 1915(l)(3) of the Social Security Act (42 U.S.C. 1396n(l)(3)) is amended—

(1)

in subparagraph (A)—

(A)

by striking “ other than under this title from non-Federal funds” and all that follows through “ subparagraph (B))” and inserting “ from non-Federal funds for items and services (including services described in subparagraph (B))”; and

(B)

by striking “ such items and services” and all that follows through the period and inserting

“(i) fiscal year 2018; or

“(ii) the most recently ended fiscal year as of the date the State submits a State plan amendment to the Secretary to provide such medical assistance in accordance with this subsection.”

(2)

in subparagraph (B), by striking “ subparagraph (A)(ii)” and inserting “ subparagraph (A)”; and

(3)

by adding at the end the following new subparagraph:

“(D) Application of maintenance of effort requirements to certain states.—In the case of a State with a State plan amendment in effect on September 30, 2023, for the 1-year period beginning on the date of enactment of this subparagraph, the provisions of subparagraph (A) shall be applied as if the amendments to such subparagraph made by the Consolidated Appropriations Act, 2024 had never been made.”

(c)

Additional Requirements.—

(1)

In general.—

(A)

General requirements.— Section 1915(l)(4) of the Social Security Act (42 U.S.C. 1396n(l)(4)) is amended—

(i)

in subparagraph (A), by striking “ through (D)” and inserting “ through (F)”;

(ii)

in subparagraph (B)—

(I)

by striking “ Prior to approval of a State plan amendment under this subsection, the State shall notify the Secretary of how the State will ensure” and inserting “ The State shall have in place evidence-based, substance use disorder-specific individual placement criteria and utilization management approaches to ensure placement of eligible individuals in an appropriate level of care, including criteria and approaches to ensure”; and

(II)

by adding at the end the following sentence: “ The State shall notify the Secretary at such time and in such form and manner as the Secretary shall require of such criteria and utilization management approaches.”; and

(iii)

by adding at the end the following new subparagraph:

“(E) Review process.—The State shall, using nationally recognized substance use disorder-specific program standards, have in place a process to review the compliance of eligible institutions for mental diseases with such program standards specified by the State.”

(B)

Effective date.— The amendments made by subparagraph (A) shall apply with respect to States providing medical assistance for items and services pursuant to a State plan amendment under section 1915(l) of the Social Security Act (42 U.S.C. 1396n(l)) in calendar quarters beginning on or after October 1, 2025.

(2)

One-time assessment.— Section 1915(l)(4) of the Social Security Act (42 U.S.C. 1396n(l)(4)), as amended by paragraph (1), is further amended by adding at the end the following new subparagraph:

“(F) Assessment.—

“(i) In general.—The State shall, not later than 12 months after the approval of a State plan amendment described in this subsection (or, in the case of a State that has such an amendment approved as of September 30, 2023, not later than 12 months after the date of enactment of this subparagraph), commence an assessment of—

“(I) the availability of treatment for individuals enrolled under a State plan under this title (or waiver of such plan) in each level of care described in subparagraph (C), including how such availability varies by region of the State; and

“(II) the availability of medication-assisted treatment and medically supervised withdrawal management services for such individuals, including how such availability varies by region of the State.

“(ii) Required completion.—The State shall complete an assessment described in clause (i) not later than 12 months after the date the State commences such assessment.”

(3)

Clarification of levels of care.— Section 1915(l) of the Social Security Act (42 U.S.C. 1396n(l)) is amended—

(A)

in paragraph (4)(C)(ii), by striking “ problems in Dimensions 1, 2, or 3” each place it appears and inserting “ conditions”; and

(B)

in paragraph (7), by striking subparagraph (A) and redesignating subparagraphs (B) through (D) as subparagraphs (A) through (C), respectively.

(d)

Application to Certain States.— Notwithstanding section 430.20 of title 42, Code of Federal Regulations, the Secretary of Health and Human Services may approve a request to renew a State plan amendment under section 1915(l) of the Social Security Act (42 U.S.C. 1396n(l)) with an effective date of October 1, 2023, if the State making such request—

(1)

had approval for a State plan amendment under such section as of September 30, 2023; and

(2)

submits the request to renew such amendment not later than 60 days after the date of enactment of this Act.

SEC. 205. Prohibition on Termination of Enrollment Due to Incarceration.

(a)

Medicaid.—

(1)

In general.— Section 1902(a)(84)(A) of the Social Security Act (42 U.S.C. 1396a(a)(84)(A)), as amended by section 5122(a)(2) of the Consolidated Appropriations Act, 2023 (Public Law 117–328), is further amended—

(A)

by striking “ under the State plan” and inserting “ under the State plan (or waiver of such plan)”;

(B)

by striking “ who is an eligible juvenile (as defined in subsection (nn)(2))”;

(C)

by striking “ because the juvenile” and inserting “ because the individual”;

(D)

by striking “ during the period the juvenile” and inserting “ during the period the individual”;

(E)

by inserting “ such an individual who is an eligible juvenile (as defined in subsection (nn)(2)) and” after “ or in the case of”; and

(F)

by striking “ paragraph (31)” and inserting “ the last numbered paragraph”.

(2)

Effective date.— The amendments made by—

(A)

subparagraph (A) of paragraph (1) shall take effect on the date of the enactment of this Act; and

(B)

subparagraphs (B) through (F) of paragraph (1) shall take effect on January 1, 2026.

(b)

CHIP.—

(1)

In general.— Section 2102(d)(1)(A) of the Social Security Act (42 U.S.C. 1397bb(d)(1)(A)) is amended—

(A)

by inserting “ or pregnancy-related” after “ child health”;

(B)

by inserting “ or targeted low-income pregnant woman” after “ targeted low-income child”;

(C)

by inserting “ or pregnant woman” after “ because the child”; and

(D)

by inserting “ or pregnant woman” after “ during the period the child”.

(2)

Effective date.— The amendments made by paragraph (1) shall apply beginning January 1, 2026.

(c)

Technical Corrections.—

(1)

Section 1902(nn)(2)(A) of the Social Security Act (42 U.S.C. 1395a(a)(nn)(2)(A)) is amended by striking “ State plan” and inserting “ State plan (or waiver of such plan)”.

(2)

Section 1902(nn)(3) of the Social Security Act (42 U.S.C. 1396a(nn)(3)), is amended by striking “ paragraph (31)” and inserting “ the last numbered paragraph”.

(3)

Section 5122(a)(1) of the Consolidated Appropriations Act, 2023 (Public Law 117–328) is amended by striking “ after” and all that follows through the period at the end and inserting “ after ‘or in the case of an eligible juvenile described in section 1902(a)(84)(D) with respect to the screenings, diagnostic services, referrals, and targeted case management services required under such section’.”.

(4)

The fifth sentence of section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by striking “ paragraph (30)” and inserting “ the last numbered paragraph”.

SEC. 206. Addressing Operational Barriers to Promote Continuity of Care for Medicaid and Chip Beneficiaries Following Incarceration.

(a)

State Planning Grants.—

(1)

In general.— Not later than 12 months after the date of enactment of this Act, the Secretary shall award grants to States for the purpose of developing operational capabilities to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the State Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the State CHIP.

(2)

Use of funds.— A State may use funds awarded under a grant under this subsection for activities and expenses related to complying with the requirement described in section 1902(a)(84)(A) of the Social Security Act (42 U.S.C. 1396a(a)(84)(A)) that a State shall not terminate eligibility for medical assistance, complying with the requirements of sections 1902(a)(84)(D) and 2102(d) of the Social Security Act (42 U.S.C. 1396a(a)(84)(D), 1397bb(d)), or adopting the State plan options described in the subdivision (A) following the last numbered paragraph of section 1905(a) and 2110(b)(7) of the Social Security Act (42 U.S.C. 1396d(a), 1397jj(b)(7)), or other activities and expenses to promote continuity of care for individuals described in paragraph (1). Such activities and expenses may include—

(A)

identifying and addressing operational gaps with respect to complying with such requirements or adopting such options, in collaboration with public institutions, State human services agencies, Medicaid managed care plans, providers, community-based organizations, and other stakeholders;

(B)

establishing standardized processes and automated systems for activities that may include, but are not limited to—

(i)

determining whether an individual is enrolled in a State Medicaid program or State CHIP at the time such individual becomes an inmate of a public institution;

(ii)

allowing an individual who is an inmate of a public institution to submit an application to enroll or renew coverage in a State Medicaid program or State CHIP prior to the individual’s release from such public institution;

(iii)

facilitating the delivery of medical assistance under the State Medicaid program or child health assistance or pregnancy-related assistance under the State CHIP to an individual who is eligible for such assistance while the individual is an inmate of a public institution, such as by establishing claims processing and prior authorization request protocols; and

(iv)

in the case of an eligible individual whose coverage under a State Medicaid program or State CHIP was suspended while the individual was an inmate of a public institution, restoring such coverage upon such individual’s release from the public institution;

(C)

investing in information technology to—

(i)

enable bi-directional information sharing between public institutions, the State Medicaid and CHIP agencies, and other entities such as managed care plans and providers (in a manner consistent with applicable State and Federal privacy laws), to support care transitions and coordination of treatment (including access to care in the community after release from a public institution); and

(ii)

develop indicators to ensure Federal financial participation for medical assistance furnished under a State Medicaid program or child health assistance or pregnancy-related assistance furnished under a State CHIP is available only for medical assistance or child health assistance or pregnancy-related assistance for items and services for which such participation is permitted while an individual is an inmate of a public institution; and

(D)

establishing oversight and monitoring processes to ensure public institutions and entities with which they contract are compliant with any applicable Medicaid and CHIP requirements.

(3)

Limitations on use of funds.— A State shall not use funds from a grant awarded under this subsection to—

(A)

provide medical assistance under a State Medicaid program or child health assistance or pregnancy-related assistance under a State CHIP to an individual, or otherwise directly administer health care services for an individual; or

(B)

build prisons, jails, or other carceral facilities, or pay for prison, jail, or other carceral facility-related improvements other than those improvements that are for the direct and primary purpose of meeting the health care needs of individuals who are incarcerated and who are eligible for medical assistance under the State Medicaid program or child health assistance or pregnancy-related assistance under the State CHIP.

(4)

Allocation of grant funds.— In determining the amount of a grant to award to a State that applies for a grant under this subsection, the Secretary shall consider the following factors, relative to other States applying for grants under this subsection:

(A)

The number of individuals in the State who were inmates of non-Federal public institutions (such as State prisons, local and county jails, tribal jails, and youth correctional or detention facilities) and were eligible for medical assistance under a State Medicaid program at any time in calendar year 2022.

(B)

The number of non-Federal public institutions in the State (such as State prisons, local and county jails, tribal jails, and youth correctional or detention facilities).

(C)

The State’s progress in developing, implementing, and operating initiatives to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the State Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the State CHIP (with favorable consideration given to States with less progress in promoting continuity of care for such individuals).

(5)

Appropriation.— There is appropriated to the Secretary for fiscal year 2024, out of any funds in the Treasury not otherwise appropriated, $113,500,000, to remain available until expended, for the purposes of awarding and administering grants to States under this subsection.

(b)

Guidance to Support State Implementation and Operations.—

(1)

In general.— Not later than 18 months after the date of enactment of this Act, the Secretary shall issue detailed guidance to States that addresses common implementation and operational challenges States face in ensuring access to authorized high-quality, timely, accessible care before, during, and after incarceration for individuals who are eligible for medical assistance under a State Medicaid program or child health assistance or pregnancy-related assistance under a State CHIP.

(2)

Content.—

(A)

Compliance with requirements.— The guidance required under paragraph (1) shall address challenges States face, or are likely to face, in complying with the requirement described in section 1902(a)(84)(A) of the Social Security Act (42 U.S.C. 1396a(a)(84)(A)) that a State shall not terminate eligibility for medical assistance, complying with the requirements of sections 1902(a)(84)(D) and 2102(d) of the Social Security Act (42 U.S.C. 1396a(a)(84)(D), 1397bb(d)), adopting the State plan options described in the subdivision (A) following the last numbered paragraph of section 1905(a) and section 2110(b)(7) of the Social Security Act (42 U.S.C. 1396d(a), 1397jj(b)(7)), and carrying out other activities that are approved by the Secretary to promote continuity of care for individuals who are inmates of a public institution and are eligible for medical assistance under the State Medicaid program or are eligible for child health assistance or pregnancy-related assistance under the State CHIP.

(B)

Best practices and strategies.— The guidance required under paragraph (1) shall include best practices and strategies States can use to address implementation and operational challenges related to the requirements described in subparagraph (A), including those related to the following:

(i)

Implementing modifications to improve eligibility and enrollment processes, including, but not limited to, completing applications for assistance under the State Medicaid program or the State CHIP on behalf of inmates, transmitting such applications to State Medicaid and CHIP agencies, and screening individuals who are inmates of public institutions for eligibility for medical assistance that is authorized to be furnished to the individual while the individual is such an inmate.

(ii)

Clarifying the availability of relevant Federal financial participation, including the administrative match under sections 1903 and 2105 of the Social Security Act (42 U.S.C. 1396b, 1397ee), for activities that directly support efforts to identify and enroll eligible individuals in State Medicaid programs and State CHIPs and that directly support the provision of authorized medical assistance, child health assistance, or pregnancy-related assistance, including, but not limited to, data sharing and exchange, and other necessary functions.

(iii)

Expeditiously conducting screening for eligibility under State Medicaid programs and State CHIPs for individuals who are inmates of a public institution, providing application and renewal assistance for those who are not yet enrolled in such programs or whose eligibility needs to be renewed, and coordinating reinstatement of coverage under such programs with managed care enrollment.

(iv)

Ensuring that an individual who is an inmate of a public institution and is eligible for medical assistance under a State Medicaid program or for child health assistance or pregnancy-related assistance under a State CHIP receives, in a timely fashion, any such assistance for which Federal financial participation is authorized, such as, a supply of medications or prescription refill upon release and the services required under sections 1902(a)(84)(D) and 2102(d) of the Social Security Act (42 U.S.C. 1396a(a)(84)(D), 1397bb(d)).

(v)

Establishing community-based provider networks, including those comprised of case managers, for purposes of providing continuity of care to individuals who are eligible for medical assistance under a State Medicaid program or child health assistance or pregnancy-related assistance under a State CHIP before, during, and after incarceration.

(c)

Definitions.— In this section:

(1)

Public institution.— The term “public institution” has the meaning given that term in section 1902(nn)(3) of the Social Security Act (42 U.S.C. 1396a(nn)(3)).

(2)

Secretary.— The term “Secretary” means the Secretary of Health and Human Services.

(3)

State.— The term “State” has the meaning given that term in section 1101(a)(1) of the Social Security Act (42 U.S.C. 1301(a)(1)) for purposes of titles XIX and XXI of such Act.

(4)

State chip.— The term “State CHIP” means a State child health plan for child health assistance under title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.), and includes any waiver of such a plan.

(5)

State medicaid program.— The term “State Medicaid program” means a State plan for medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.), and includes any waiver of such a plan.

SEC. 207. Guidance Relating to Improving the Behavioral Health Workforce and Integration of Care under Medicaid and Chip.

(a)

Guidance.— Not later than 24 months after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the “Secretary”) shall issue guidance to States regarding the following:

(1)

Opportunities to increase access to the mental health and substance use disorder care providers that participate in Medicaid or CHIP, which may include education, training, recruitment and retention of such providers, with a focus on improving the capacity of this workforce in rural and underserved areas by increasing the number, type, and capacity of providers. The guidance relating to such opportunities shall include the following:

(A)

Best practices from States that have used authorities under titles XI, XIX, or XXI of the Social Security Act (42 U.S.C. 1301 et seq., 1396 et seq., 1397aa et seq.), including initiatives States have implemented under waivers under section 1115 of such Act (42 U.S.C. 1315), for such purposes.

(B)

Opportunities States can leverage to finance, support, and expand the availability of providers of community-based mental health and substance use disorder services who participate in Medicaid and CHIP across the continuum of care, including through the participation of paraprofessionals with behavioral health expertise, such as clinicians with baccalaureate degrees and peer support specialists and including best practices especially pertinent to pediatric care. The guidance shall include examples of innovative policies states have adopted to expand access to behavioral health services; for example, by establishing more expansive and diverse behavioral health workforce roles such as certified wellness coaches.

(C)

Best practices related to financing, supporting, and expanding the education and training of providers of mental health and substance use disorder services in order to increase the workforce of such providers who participate in Medicaid and CHIP across the continuum of care, including innovative public-private partnerships and including such practices that are especially pertinent to pediatric care.

(2)

Opportunities to promote the integration of mental health or substance use disorder services with primary care services. The guidance relating to such opportunities shall include the following:

(A)

An overview of State options for adopting and expanding value-based payment arrangements and alternative payment models, including accountable care organization-like models and other shared savings programs.

(B)

A description of opportunities for States to use and align existing authorities and resources to finance the integration of mental health or substance use disorder services with primary care services, including with respect to the use of electronic health records in mental health care settings and in substance use disorder care settings.

(C)

Strategies to support integration of mental health or substance use disorder services with primary care services through the use of non-clinical professionals and paraprofessionals, including peer support specialists.

(D)

Examples of specific strategies and models designed to support integration of mental health or substance use disorder services with primary care services for differing age groups, including children and youth and individuals over the age of 65, which may include the collaborative care model or primary care behavioral health model for behavioral health integration.

(b)

Integration of Mental Health or Substance Use Disorder Services With Primary Care Services.— For purposes of subsection (a)(2), the term “integration of mental health or substance use disorder services with primary care services” means any of the following:

(1)

The delivery of mental health or substance use disorder services in a setting that is physically located in the same practice or building as a primary care setting, or when at least 1 provider of mental health or substance use disorder services is available in a primary care setting via telehealth.

(2)

The use of behavioral health integration models primarily intended for pediatric populations with non-severe mental health needs that are focused on prevention and early detection and intervention methods through a multidisciplinary collaborative behavioral health team approach co-managed with primary care, to include same-day access to family-focused mental health treatment services.

(3)

Having providers of mental health or substance use disorder services physically co-located in a primary care setting with same-day visit availability.

(4)

Implementing or maintaining enhanced care coordination or targeted case management which includes regular interactions between and within care teams.

(5)

Providing mental health or substance use disorder screening and follow-up assessments, interventions, or services within the same practice or facility as a primary care or physical service setting.

(6)

The use of assertive community treatment that is integrated with or facilitated by a primary care practice.

(7)

Delivery of integrated primary care and mental health care or substance use disorder care in the home or in community-based settings for individuals who are recipients of Medicaid home and community-based services.

SEC. 208. Funding for Implementation and Operations.

There is appropriated to the Secretary of Health and Human Services for fiscal year 2024, out of any funds in the Treasury not otherwise appropriated, to remain available until expended—

(1)

$5,000,000, for the purpose of carrying out section 203 and the amendments made by such section, and sections 206, and 207; and

(2)

$10,000,000 for the recurring collection, analysis, and publication of health care data under section 1948 of the Social Security Act, as added by section 202.

SEC. 209. Certified Community Behavioral Health Clinic Services under Medicaid.

(a)

Definition of Medical Assistance.— Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1)

in subsection (a)—

(A)

in paragraph (30), by striking “ ; and” and inserting a semicolon;

(B)

by redesignating paragraph (31) as paragraph (32); and

(C)

by inserting after paragraph (30) the following new paragraph:

“(31) certified community behavioral health clinic services, as defined in subsection (jj); and”

; and

(2)

by adding at the end the following new subsection:

“(jj) Certified Community Behavioral Health Clinic Services.—

“(1) In general.—The term ‘certified community behavioral health services’ means any of the following services when furnished to an individual as a patient of a certified community behavioral health clinic (as defined in paragraph (2)), in a manner reflecting person-centered care and which, if not available directly through a certified community behavioral health clinic, may be provided or referred through formal relationships with other providers:

“(A) Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization.

“(B) Screening, assessment, and diagnosis, including risk assessment.

“(C) Patient-centered treatment planning or similar processes, including risk assessment and crisis planning.

“(D) Outpatient mental health and substance use services.

“(E) Outpatient clinic primary care screening and monitoring of key health indicators and health risk.

“(F) Intensive case management services.

“(G) Psychiatric rehabilitation services.

“(H) Peer support and counselor services and family supports.

“(I) Intensive, community-based mental health care for members of the armed forces and veterans who are eligible for medical assistance, particularly such members and veterans located in rural areas, provided the care is consistent with minimum clinical mental health guidelines promulgated by the Veterans Health Administration, including clinical guidelines contained in the Uniform Mental Health Services Handbook of such Administration.

“(2) Certified community behavioral health clinic.—The term ‘certified community behavioral health clinic’ means an organization that—

“(A) has been certified by a State as meeting the criteria established by the Secretary pursuant to subsection (a) of section 223 of the Protecting Access to Medicare Act as of January 1, 2024, and any subsequent updates to such criteria, regardless of whether the State is carrying out a demonstration program under this title under subsection (d) of such section;

“(B) is engaged in furnishing all of the services described in paragraph (1); and

“(C) agrees, as a condition of the certification described in subparagraph (A), to furnish to the State or Secretary any data required as part of ongoing monitoring of the organization’s provision of services, including encounter data, clinical outcomes data, quality data, and such other data as the State or Secretary may require.”

(b)

Effective Date.— The amendments made by this section shall apply with respect to medical assistance furnished on or after the date of enactment of this Act.

SEC. 210. Eliminating Certain Disproportionate Share Hospital Payment Cuts.

Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r–4(f)(7)(A)), as amended by section 121 of subtitle B of title I of division B of the Further Additional Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–35), is amended—

(1)

in clause (i), by striking “ For the period beginning March 9, 2024, and ending September 30, 2024, and for each of fiscal years 2025” and inserting “ For the period beginning January 1, 2025, and ending September 30, 2025, and for each of fiscal years 2026”; and

(2)

in clause (ii), by striking “ March 9, 2024, and ending September 30, 2024, and for each of fiscal years 2025” and inserting “ January 1, 2025, and ending September 30, 2025, and for each of fiscal years 2026”.

SEC. 211. Promoting Value in Medicaid Managed Care.

Section 1903(m)(9)(A) of the Social Security Act (42 U.S.C. 1396b(m)(9)(A)) is amended by striking “ (and before fiscal year 2024)”.

SEC. 212. Medicaid Improvement Fund.

Section 1941(b)(3)(A) of the Social Security Act (42 U.S.C. 1396w–1(b)(3)(A)), as amended by section 122 of subtitle B of title I of division B of the Further Additional Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–35), is further amended by striking “ $5,140,428,729” and inserting “ $0”.

Subtitle C Medicare

SEC. 301. Extension of Funding for Quality Measure Endorsement, Input, and Selection.

Section 1890(d)(2) of the Social Security Act (42 U.S.C. 1395aaa(d)(2)) is amended—

(1)

in the first sentence—

(A)

by striking “ and $20,000,000” and inserting “ $20,000,000”; and

(B)

by inserting the following before the period at the end: “ , and $9,000,000 for the period beginning on October 1, 2023, and ending on December 31, 2024”; and

(2)

in the third sentence, by striking “ and 2023” and inserting “ 2023, and 2024 and the period beginning on October 1, 2024, and ending on December 31, 2024”.

SEC. 302. Extension of Funding Outreach and Assistance for Low-Income Programs.

(a)

State Health Insurance Assistance Programs.— Subsection (a)(1)(B) of section 119 of the Medicare Improvements for Patients and Providers Act of 2008 (42 U.S.C. 1395b–3 note), as amended by section 3306 of the Patient Protection and Affordable Care Act (Public Law 111–148), section 610 of the American Taxpayer Relief Act of 2012 (Public Law 112–240), section 1110 of the Pathway for SGR Reform Act of 2013 (Public Law 113–67), section 110 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93), section 208 of the Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114–10), section 50207 of division E of the Bipartisan Budget Act of 2018 (Public Law 115–123), section 1402 of division B of the Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (Public Law 116–59), section 1402 of division B of the Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 (Public Law 116–69), section 103 of division N of the Further Consolidated Appropriations Act, 2020 (Public Law 116–94), section 3803 of the CARES Act (Public Law 116–136), section 2203 of the Continuing Appropriations Act, 2021 and Other Extensions Act (Public Law 116–159), section 1102 of the Further Continuing Appropriations Act, 2021, and Other Extensions Act (Public Law 116–215), and section 103 of division CC of the Consolidated Appropriations Act, 2021 (Public Law 116–260), is amended—

(1)

in clause (xii), by striking “ and” at the end;

(2)

in clause (xiii), by striking the period at the end and inserting “ ; and”; and

(3)

by inserting after clause (xiii) the following new clause:

“(xiv) for the period beginning on October 1, 2023, and ending on December 31, 2024, $18,750,000.”

(b)

Area Agencies on Aging.— Subsection (b)(1)(B) of such section 119, as so amended, is amended—

(1)

in clause (xii), by striking “ and” at the end;

(2)

in clause (xiii), by striking the period at the end and inserting “ ; and”; and

(3)

by inserting after clause (xiii) the following new clause:

“(xiv) for the period beginning on October 1, 2023, and ending on December 31, 2024, $18,750,000.”

(c)

Aging and Disability Resource Centers.— Subsection (c)(1)(B) of such section 119, as so amended, is amended—

(1)

in clause (xii), by striking “ and” at the end;

(2)

in clause (xiii), by striking the comma at the end and inserting “ ; and”; and

(3)

by inserting after clause (xiii) the following new clause:

“(xiv) for the period beginning on October 1, 2023, and ending on December 31, 2024, $6,250,000.”

(d)

Coordination of Efforts to Inform Older Americans About Benefits Available Under Federal and State Programs.— Subsection (d)(2) of such section 119, as so amended, is amended—

(1)

in clause (xii), by striking “ and” at the end;

(2)

in clause (xiii), by striking the period at the end and inserting “ ; and”; and

(3)

by inserting after clause (xiii) the following new clause:

“(xiv) for the period beginning on October 1, 2023, and ending on December 31, 2024, $18,750,000.”

SEC. 303. Extension of the Work Geographic Index Floor under the Medicare Program.

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking “ March 9, 2024” and inserting “ January 1, 2025”.

SEC. 304. Extending Incentive Payments for Participation in Eligible Alternative Payment Models.

(a)

In General.— Section 1833(z) of the Social Security Act (42 U.S.C. 1395l(z)) is amended—

(1)

in paragraph (1)(A)—

(A)

by striking “ with 2025” and inserting “ with 2026”; and

(B)

by inserting “ , or, with respect to 2026, 1.88 percent” after “ 3.5 percent”;

(2)

in paragraph (2)—

(A)

in subparagraph (B)—

(i)

in the heading, by striking “ 2025” and inserting “ 2026”; and

(ii)

in the matter preceding clause (i), by striking “ 2025” and inserting “ 2026”;

(B)

in subparagraph (C)—

(i)

in the heading, by striking “ 2026” and inserting “ 2027”; and

(ii)

in the matter preceding clause (i), by striking “ 2026” and inserting “ 2027”; and

(C)

in subparagraph (D), by striking “ and 2025” and inserting “ 2025, and 2026”; and

(3)

in paragraph (4)(B), by inserting “ , or, with respect to 2026, 1.88 percent” after “ 3.5 percent”.

(b)

Conforming Amendments.— Section 1848(q)(1)(C)(iii) of the Social Security Act (42 U.S.C. 1395w–4(q)(1)(C)(iii)) is amended—

(1)

in subclause (II), by striking “ 2025” and inserting “ 2026”; and

(2)

in subclause (III), by striking “ 2026” and inserting “ 2027”.

SEC. 305. Temporary Payment Increase under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances and Atypical Timing of Enactment.

Section 1848(t)(1) of the Social Security Act (42 U.S.C. 1395w–4(t)(1)) is amended—

(1)

in subparagraph (C), by striking “ and” at the end;

(2)

in subparagraph (D)—

(A)

by striking “ January 1, 2025” and inserting “ March 9, 2024”; and

(B)

by striking the period at the end and inserting “ ; and”; and

(3)

by adding at the end the following new subparagraph:

“(E) such services furnished on or after March 9, 2024, and before January 1, 2025, by 2.93 percent.”

SEC. 306. Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals.

(a)

In General.— Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is amended—

(1)

in subparagraph (B), in the matter preceding clause (i), by striking “ in fiscal year 2025 and subsequent fiscal years” and inserting “ during the portion of fiscal year 2025 beginning on January 1, 2025, and ending on September 30, 2025, and in fiscal year 2026 and subsequent fiscal years”;

(2)

in subparagraph (C)(i)—

(A)

in the matter preceding subclause (I)—

(i)

by inserting “ or portion of a fiscal year” after “ for a fiscal year”; and

(ii)

by inserting “ and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “ through 2024”;

(B)

in subclause (III), by inserting “ and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “ through 2024”; and

(C)

in subclause (IV), by striking “ fiscal year 2025” and inserting “ the portion of fiscal year 2025 beginning on January 1, 2025, and ending on September 30, 2025, and fiscal year 2026”; and

(3)

in subparagraph (D)—

(A)

in the matter preceding clause (i), by inserting “ or during the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “ through 2024”; and

(B)

in clause (ii), by inserting “ and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024” after “ through 2024”.

(b)

Implementation.— Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the provisions of, including the amendments made by, this section by program instruction or otherwise.

SEC. 307. Extension of the Medicare-Dependent Hospital (mdh) Program.

(a)

In General.— Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended—

(1)

in clause (i), by striking “ October 1, 2024” and inserting “ January 1, 2025”; and

(2)

in clause (ii)(II), by striking “ October 1, 2024” and inserting “ January 1, 2025”.

(b)

Conforming Amendments.—

(1)

Extension of target amount.— Section 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended—

(A)

in the matter preceding clause (i), by striking “ October 1, 2024” and inserting “ January 1, 2025”; and

(B)

in clause (iv), by inserting “ and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024,” after “ through fiscal year 2024”.

(2)

Permitting hospitals to decline reclassification.— Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww note) is amended by striking “ or fiscal year 2000” and all that follows through “ the Secretary” and inserting “ fiscal year 2000 through fiscal year 2024, or the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024, the Secretary”.

SEC. 308. Extension of Adjustment to Calculation of Hospice Cap Amount under Medicare.

Section 1814(i)(2)(B) of the Social Security Act (42 U.S.C. 1395f(i)(2)(B)) is amended—

(1)

in clause (ii), by striking “ 2032” and inserting “ 2033”; and

(2)

in clause (iii), by striking “ 2032” and inserting “ 2033”.

SEC. 309. Medicare Improvement Fund.

Section 1898(b)(1) of the Social Security Act (42 U.S.C. 1395iii(b)(1)) is amended by striking “ $2,197,795,056” and inserting “ $0”.

Subtitle D Human Services

SEC. 401. Extension of Temporary Assistance for Needy Families Program.

Activities authorized by part A of title IV (other than under section 403(c) or 418) and section 1108(b) of the Social Security Act shall continue through September 30, 2024, in the manner authorized for fiscal year 2023, and out of any money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary for such purpose.

SEC. 402. Extension of Child and Family Services Programs.

Activities authorized by part B of title IV of the Social Security Act shall continue through December 31, 2024, in the manner authorized for fiscal year 2023, and out of any money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary for such purpose.

SEC. 403. Sexual Risk Avoidance Education Extension.

Section 510 of the Social Security Act (42 U.S.C. 710), as amended by section 142 of subtitle D of title I of division B of the Further Additional Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–35), is further amended—

(1)

in subsection (a)—

(A)

in paragraph (1)—

(i)

by striking “ and” after “ January 19, 2024,”;

(ii)

by inserting “ for the period beginning on March 9, 2024, and ending on September 30, 2024, and for the period beginning on October 1, 2024, and ending on December 31, 2024,” after “ March 8, 2024,”; and

(iii)

by inserting “ or 2025” after “ for fiscal year 2024”; and

(B)

in paragraph (2), by inserting “ or 2025” after “ with respect to fiscal year 2024” each place it appears; and

(2)

in subsection (f)(1)—

(A)

by striking “ and” before “ for the period beginning on January 20, 2024,”; and

(B)

by striking the period at the end and inserting “ , for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for the period beginning on October 1, 2024, and ending on December 31, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2024.”.

SEC. 404. Personal Responsibility Education Extension.

Section 513 of the Social Security Act (42 U.S.C. 713), as amended by section 143 of subtitle D of title I of division B of the Further Additional Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–35), is further amended—

(1)

in subsection (a)(1)—

(A)

in subparagraph (A), in the matter preceding clause (i)—

(i)

by striking “ and” after “ January 19, 2024,”; and

(ii)

(B)

in subparagraph (B)(i)—

(i)

by striking “ and” after “ January 19, 2024,”; and

(ii)

by striking the period at the end and inserting “ , for the period beginning on March 9, 2024, and ending on September 30, 2024, and for the period beginning on October 1, 2024, and ending on December 31, 2024.”;

(2)

in subsection (c)(3), by inserting “ or 2025” after “ fiscal year 2024”; and

(3)

in subsection (f)—

(A)

by striking “ and” before “ for the period beginning on January 20, 2024,”; and

(B)

by striking “ fiscal year 2023.” and inserting “ fiscal year 2023, for the period beginning on March 9, 2024, and ending on September 30, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2023, and for the period beginning on October 1, 2024, and ending on December 31, 2024, an amount equal to the pro rata portion of the amount appropriated for the corresponding period for fiscal year 2024.”.

SEC. 405. Extension of Funding for Family-To-Family Health Information Centers.

Section 501(c)(1)(A) of the Social Security Act (42 U.S.C. 701(c)(1)(A)) is amended—

(1)

in clause (vi), by striking “ and” after the semicolon;

(2)

in clause (vii), by striking the period at the end and inserting “ ; and”; and

(3)

by inserting after clause (vii), the following new clause:

“(viii) $1,500,000 for the portion of fiscal year 2025 before January 1, 2025.”

TITLE II Amending Compacts of Free Association

SEC. 201. Short Title.

This title may be cited as the “Compact of Free Association Amendments Act of 2024”.

SEC. 202. Findings.

Congress finds the following:

(1)

The United States (in accordance with the Trusteeship Agreement for the Trust Territory of the Pacific Islands, the United Nations Charter, and the objectives of the international trusteeship system of the United Nations) fulfilled its obligations to promote the development of the people of the Trust Territory toward self-government or independence, as appropriate, to the particular circumstances of the Trust Territory and the people of the Trust Territory and the freely expressed wishes of the people concerned.

(2)

The United States, the Federated States of Micronesia, and the Republic of the Marshall Islands entered into the Compact of Free Association set forth in section 201 of the Compact of Free Association Act of 1985 (48 U.S.C. 1901 note; Public Law 99–239) and the United States and the Republic of Palau entered into the Compact of Free Association set forth in section 201 of Public Law 99–658 (48 U.S.C. 1931 note) to create and maintain a close and mutually beneficial relationship.

(3)

The “Compact of Free Association, as amended, between the Government of the United States of America and the Government of the Federated States of Micronesia”, the “Compact of Free Association, as amended, between the Government of the United States of America and the Government of the Republic of the Marshall Islands”, and related agreements were signed by the Government of the United States and the Governments of the Federated States of Micronesia and the Republic of the Marshall Islands and approved, as applicable, by section 201 of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921 note; Public Law 108–188).

(4)

The “Agreement between the Government of the United States of America and the Government of the Republic of Palau Following the Compact of Free Association Section 432 Review”, was signed by the Government of the United States and the Government of the Republic of Palau on September 3, 2010, and amended on September 19, 2018.

(5)

On May 22, 2023, the United States signed the “Agreement between the Government of the United States of America and the Government of the Republic of Palau Resulting From the 2023 Compact of Free Association Section 432 Review”.

(6)

On May 23, 2023, the United States signed 3 agreements related to the U.S.-FSM Compact of Free Association, including an Agreement to Amend the Compact, as amended, a new fiscal procedures agreement, and a new trust fund agreement and on September 28, 2023, the United States signed a Federal Programs and Services agreement related to the U.S.-FSM Compact of Free Association.

(7)

On October 16, 2023, the United States signed 3 agreements relating to the U.S.-RMI Compact of Free Association, including an Agreement to Amend the Compact, as amended, a new fiscal procedures agreement, and a new trust fund agreement.

SEC. 203. Definitions.

In this title:

(1)

1986 compact.— The term “1986 Compact” means the Compact of Free Association between the Government of the United States and the Governments of the Marshall Islands and the Federated States of Micronesia set forth in section 201 of the Compact of Free Association Act of 1985 (48 U.S.C. 1901 note; Public Law 99–239).

(2)

2003 amended u.s.-fsm compact.— The term “2003 Amended U.S.-FSM Compact” means the Compact of Free Association amending the 1986 Compact entitled the “ Compact of Free Association, as amended, between the Government of the United States of America and the Government of the Federated States of Micronesia” set forth in section 201(a) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921 note; Public Law 108–188).

(3)

2003 amended u.s.-rmi compact.— The term “2003 Amended U.S.-RMI Compact” means the Compact of Free Association amending the 1986 Compact entitled “ Compact of Free Association, as amended, between the Government of the United States of America and the Government of the Republic of the Marshall Islands” set forth in section 201(b) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921 note; Public Law 108–188).

(4)

2023 agreement to amend the u.s.-fsm compact.— The term “2023 Agreement to Amend the U.S.-FSM Compact” means the Agreement between the Government of the United States of America and the Government of the Federated States of Micronesia to Amend the Compact of Free Association, as Amended, done at Palikir May 23, 2023.

(5)

2023 agreement to amend the u.s.-rmi compact.— The term “2023 Agreement to Amend the U.S.-RMI Compact” means the Agreement between the Government of the United States of America and the Government of the Republic of the Marshall Islands to Amend the Compact of Free Association, as Amended, done at Honolulu October 16, 2023.

(6)

2023 amended u.s.-fsm compact.— The term “2023 Amended U.S.-FSM Compact” means the 2003 Amended U.S.-FSM Compact, as amended by the 2023 Agreement to Amend the U.S.-FSM Compact.

(7)

2023 amended u.s.-rmi compact.— The term “2023 Amended U.S.-RMI Compact” means the 2003 Amended U.S.-RMI Compact, as amended by the 2023 Agreement to Amend the U.S.-RMI Compact.

(8)

2023 u.s.-fsm federal programs and services agreement.— The term “2023 U.S.-FSM Federal Programs and Services Agreement” means the 2023 Federal Programs and Services Agreement between the Government of the United States of America and the Government of the Federated States of Micronesia, done at Washington September 28, 2023.

(9)

2023 u.s.-fsm fiscal procedures agreement.— The term “2023 U.S.-FSM Fiscal Procedures Agreement” means the Agreement Concerning Procedures for the Implementation of United States Economic Assistance provided in the 2023 Amended U.S.-FSM Compact between the Government of the United States of America and the Government of the Federated States of Micronesia, done at Palikir May 23, 2023.

(10)

2023 u.s.-fsm trust fund agreement.— The term “2023 U.S.-FSM Trust Fund Agreement” means the Agreement between the Government of the United States of America and the Government of the Federated States of Micronesia Regarding the Compact Trust Fund, done at Palikir May 23, 2023.

(11)

2023 u.s.-palau compact review agreement.— The term “2023 U.S.-Palau Compact Review Agreement” means the Agreement between the Government of the United States of America and the Government of the Republic of Palau Resulting From the 2023 Compact of Free Association Section 432 Review, done at Port Moresby May 22, 2023.

(12)

2023 u.s.-rmi fiscal procedures agreement.— The term “2023 U.S.-RMI Fiscal Procedures Agreement” means the Agreement Concerning Procedures for the Implementation of United States Economic Assistance Provided in the 2023 Amended Compact Between the Government of the United States of America and the Government of the Republic of the Marshall Islands, done at Honolulu October 16, 2023.

(13)

2023 u.s.-rmi trust fund agreement.— The term “2023 U.S.-RMI Trust Fund Agreement” means the Agreement between the Government of the United States of America and the Government of the Republic of the Marshall Islands Regarding the Compact Trust Fund, done at Honolulu October 16, 2023.

(14)

Appropriate committees of congress.— The term “appropriate committees of Congress” means—

(A)

the Committee on Energy and Natural Resources of the Senate;

(B)

the Committee on Foreign Relations of the Senate;

(C)

the Committee on Natural Resources of the House of Representatives; and

(D)

the Committee on Foreign Affairs of the House of Representatives.

(15)

Freely associated states.— The term “Freely Associated States” means—

(A)

the Federated States of Micronesia;

(B)

the Republic of the Marshall Islands; and

(C)

the Republic of Palau.

(16)

Subsidiary agreement.— The term “subsidiary agreement” means any of the following:

(A)

The 2023 U.S.-FSM Federal Programs and Services Agreement.

(B)

The 2023 U.S.-FSM Fiscal Procedures Agreement.

(C)

The 2023 U.S.-FSM Trust Fund Agreement.

(D)

The 2023 U.S.-RMI Fiscal Procedures Agreement.

(E)

The 2023 U.S.-RMI Trust Fund Agreement.

(F)

Any Federal Programs and Services Agreement in force between the United States and the Republic of the Marshall Islands.

(G)

Any Federal Programs and Services Agreement in force between the United States and the Republic of Palau.

(H)

Any other agreement that the United States may from time-to-time enter into with the Government of the Federated States of Micronesia, the Government of the Republic of Palau, or the Government of the Republic of the Marshall Islands, in accordance with—

(i)

the 2023 Amended U.S.-FSM Compact;

(ii)

the 2023 U.S.-Palau Compact Review Agreement; or

(iii)

the 2023 Amended U.S.-RMI Compact.

(17)

U.S.-palau compact.— The term “U.S.-Palau Compact” means the Compact of Free Association between the United States and the Government of Palau set forth in section 201 of Public Law 99–658 (48 U.S.C. 1931 note).

SEC. 204. Approval of 2023 Agreement to Amend the U.s.-Fsm Compact, 2023 Agreement to Amend the U.s.-Rmi Compact, 2023 U.s.-Palau Compact Review Agreement, and Subsidiary Agreements.

(a)

Federated States of Micronesia.—

(1)

Approval.— The 2023 Agreement to Amend the U.S.-FSM Compact and the 2023 U.S.-FSM Trust Fund Agreement, as submitted to Congress on June 15, 2023, are approved and incorporated by reference.

(2)

Consent of congress.— Congress consents to—

(A)

the 2023 U.S.-FSM Fiscal Procedures Agreement, as submitted to Congress on June 15, 2023; and

(B)

the 2023 U.S.-FSM Federal Programs and Services Agreement.

(3)

Authority of president.— Notwithstanding section 101(f) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921(f)), the President is authorized to bring into force and implement the agreements described in paragraphs (1) and (2).

(b)

Republic of the Marshall Islands.—

(1)

Approval.— The 2023 Agreement to Amend the U.S.-RMI Compact and the 2023 U.S.-RMI Trust Fund Agreement, as submitted to Congress on October 17, 2023, are approved and incorporated by reference.

(2)

Consent of congress.— Congress consents to the 2023 U.S.-RMI Fiscal Procedures Agreement, as submitted to Congress on October 17, 2023.

(3)

(c)

Republic of Palau.—

(1)

Approval.— The 2023 U.S.-Palau Compact Review Agreement, as submitted to Congress on June 15, 2023, is approved.

(2)

Authority of president.— The President is authorized to bring into force and implement the 2023 U.S.-Palau Compact Review Agreement.

(d)

Amendments, Changes, or Termination to Compacts and Certain Agreements.—

(1)

In general.— Any amendment to, change to, or termination of all or any part of the 2023 Amended U.S.-FSM Compact, 2023 Amended U.S.-RMI Compact, or the U.S.-Palau Compact, by mutual agreement or unilateral action of the Government of the United States, shall not enter into force until the date on which Congress has incorporated the applicable amendment, change, or termination into an Act of Congress.

(2)

Additional actions and agreements.— In addition to the Compacts described in paragraph (1), the requirements of that paragraph shall apply to—

(A)

any action of the Government of the United States under the 2023 Amended U.S.-FSM Compact, 2023 Amended U.S.-RMI Compact, or U.S.-Palau Compact, including an action taken pursuant to section 431, 441, or 442 of the 2023 Amended U.S.-FSM Compact, 2023 Amended U.S.-RMI Compact, or U.S.-Palau Compact; and

(B)

any amendment to, change to, or termination of—

(i)

the agreement described in section 462(a)(2) of the 2023 Amended U.S.-FSM Compact;

(ii)

the agreement described in section 462(a)(5) of the 2023 Amended U.S.-RMI Compact;

(iii)

an agreement concluded pursuant to section 265 of the 2023 Amended U.S.-FSM Compact;

(iv)

an agreement concluded pursuant to section 265 of the 2023 Amended U.S.-RMI Compact;

(v)

an agreement concluded pursuant to section 177 of the 2023 Amended U.S.-RMI Compact;

(vi)

Articles III and IV of the agreement described in section 462(b)(6) of the 2023 Amended U.S.-FSM Compact;

(vii)

Articles III, IV, and X of the agreement described in section 462(b)(6) of the 2023 Amended U.S.-RMI Compact;

(viii)

the agreement described in section 462(h) of the U.S.-Palau Compact; and

(ix)

Articles VI, XV, and XVII of the agreement described in section 462(b)(7) of the 2023 Amended U.S.-FSM Compact and 2023 Amended U.S.-RMI Compact and section 462(i) of the U.S.-Palau Compact.

(e)

Entry Into Force of Future Amendments to Subsidiary Agreements.— An agreement between the United States and the Government of the Federated States of Micronesia, the Government of the Republic of the Marshall Islands, or the Government of the Republic of Palau that would amend, change, or terminate any subsidiary agreement or portion of a subsidiary agreement (other than an amendment to, change to, or termination of an agreement described in subsection (d)) shall not enter into force until the date that is 90 days after the date on which the President has transmitted to the President of the Senate and the Speaker of the House of Representatives—

(1)

the agreement to amend, change, or terminate the subsidiary agreement;

(2)

an explanation of the amendment, change, or termination;

(3)

a description of the reasons for the amendment, change, or termination; and

(4)

in the case of an agreement that would amend, change, or terminate any agreement described in section 462(b)(3) of the 2023 Amended U.S.-FSM Compact or the 2023 Amended U.S.-RMI Compact, a statement by the Secretary of Labor that describes—

(A)

the necessity of the amendment, change, or termination; and

(B)

any impacts of the amendment, change, or termination.

SEC. 205. Agreements with Federated States of Micronesia.

(a)

Law Enforcement Assistance.—

(1)

In general.— Pursuant to sections 222 and 224 of the 2023 Amended U.S.-FSM Compact, the United States shall provide nonreimbursable technical and training assistance, as appropriate, including training and equipment for postal inspection of illicit drugs and other contraband, to enable the Government of the Federated States of Micronesia—

(A)

to develop and adequately enforce laws of the Federated States of Micronesia; and

(B)

to cooperate with the United States in the enforcement of criminal laws of the United States.

(2)

Use of appropriated funds.— Funds appropriated pursuant to subsection (j) of section 105 of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d) (as amended by section 209(j)) may be used in accordance with section 102(a) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921a(a)).

(b)

United States Appointees to Joint Economic Management Committee.—

(1)

In general.— The 3 United States appointees (which are composed of the United States chair and 2 other members from the Government of the United States) to the Joint Economic Management Committee established under section 213 of the 2023 Amended U.S.-FSM Compact (referred to in this subsection as the “Committee”) shall—

(A)

be voting members of the Committee; and

(B)

continue to be officers or employees of the Federal Government.

(2)

Term; appointment.— The 3 United States members of the Committee described in paragraph (1) shall be appointed for a term of 2 years as follows:

(A)

1 member shall be appointed by the Secretary of State, in consultation with the Secretary of the Treasury.

(B)

1 member shall be appointed by the Secretary of the Interior, in consultation with the Secretary of the Treasury.

(C)

1 member shall be appointed by the Interagency Group on Freely Associated States established under section 208(d)(1).

(3)

Reappointment.— A United States member of the Committee appointed under paragraph (2) may be reappointed for not more than 2 additional 2-year terms.

(4)

Qualifications.— Not fewer than 2 United States members of the Committee appointed under paragraph (2) shall be individuals who—

(A)

by reason of knowledge, experience, or training, are especially qualified in accounting, auditing, budget analysis, compliance, grant administration, program management, or international economics; and

(B)

possess not less than 5 years of full-time experience in accounting, auditing, budget analysis, compliance, grant administration, program management, or international economics.

(5)

Notice.—

(A)

In general.— Not later than 90 days after the date of appointment of a United States member of the Committee under paragraph (2), the Secretary of the Interior shall notify the appropriate committees of Congress that an individual has been appointed as a voting member of the Committee under that paragraph, including a statement prepared by the Secretary of the Interior attesting to the qualifications of the member described in paragraph (4), subject to subparagraph (B).

(B)

Requirement.— For purposes of a statement required under subparagraph (A)—

(i)

in the case of a member appointed under paragraph (2)(A), the Secretary of the Interior shall compile information on the member provided to the Secretary of the Interior by the Secretary of State on request of the Secretary of the Interior; and

(ii)

in the case of a member appointed under paragraph (2)(C), the Secretary of the Interior shall compile information on the member provided to the Secretary of the Interior by the Interagency Group on Freely Associated States established under section 208(d)(1) on request of the Secretary of the Interior.

(6)

Reports to congress.— Not later than 90 days after the date on which the Committee receives or completes any report required under the 2023 Amended U.S.-FSM Compact, or any related subsidiary agreement, the Secretary of the Interior shall submit the report to the appropriate committees of Congress.

(7)

Notice to congress.— Not later than 90 days after the date on which the Government of the Federated States of Micronesia submits to the Committee a report required under the 2023 Amended U.S.-FSM Compact, or any related subsidiary agreement, the Secretary of the Interior shall submit to the appropriate committees of Congress—

(A)

if the report is submitted by the applicable deadline, written notice attesting that the report is complete and accurate; or

(B)

if the report is not submitted by the applicable deadline, written notice that the report has not been timely submitted.

(c)

United States Appointees to Joint Trust Fund Committee.—

(1)

In general.— The 3 United States voting members (which are composed of the United States chair and 2 other members from the Government of the United States) to the Joint Trust Fund Committee established pursuant to the agreement described in section 462(b)(5) of the 2023 Amended U.S.-FSM Compact (referred to in this subsection as the “Committee”) shall continue to be officers or employees of the Federal Government.

(2)

Term; appointment.— The 3 United States members of the Committee described in paragraph (1) shall be appointed for a term not more than 2 years as follows:

(A)

1 member shall be appointed by the Secretary of State.

(B)

1 member shall be appointed by the Secretary of the Interior.

(C)

1 member shall be appointed by the Secretary of the Treasury.

(3)

Reappointment.— A United States member of the Committee appointed under paragraph (2) may be reappointed for not more than 2 additional 2-year terms.

(4)

Qualifications.— Not fewer than 2 members of the Committee appointed under paragraph (2) shall be individuals who—

(A)

by reason of knowledge, experience, or training, are especially qualified in accounting, auditing, budget analysis, compliance, financial investment, grant administration, program management, or international economics; and

(B)

possess not less than 5 years of full-time experience in accounting, auditing, budget analysis, compliance, financial investment, grant administration, program management, or international economics.

(5)

Notice.—

(A)

In general.— Not later than 90 days after the date of appointment of a United States member to the Committee under paragraph (2), the Secretary of the Interior shall notify the appropriate committees of Congress that an individual has been appointed as a voting member of the Committee under that paragraph, including a statement attesting to the qualifications of the member described in paragraph (4), subject to subparagraph (B).

(B)

Requirement.— For purposes of a statement required under subparagraph (A)—

(i)

(ii)

in the case of a member appointed under paragraph (2)(C), the Secretary of the Interior shall compile information on the member provided to the Secretary of the Interior by the Secretary of the Treasury on request of the Secretary of the Interior.

(6)

(7)

(A)

if the report is submitted by the applicable deadline, written notice attesting that the report is complete and accurate; or

(B)

if the report is not submitted by the applicable deadline, written notice that the report has not been timely submitted.

SEC. 206. Agreements with and Other Provisions Related to the Republic of the Marshall Islands.

(a)

Law Enforcement Assistance.—

(1)

In general.— Pursuant to sections 222 and 224 of the 2023 Amended U.S.-RMI Compact, the United States shall provide nonreimbursable technical and training assistance, as appropriate, including training and equipment for postal inspection of illicit drugs and other contraband, to enable the Government of the Republic of the Marshall Islands—

(A)

to develop and adequately enforce laws of the Marshall Islands; and

(B)

to cooperate with the United States in the enforcement of criminal laws of the United States.

(2)

Use of appropriated funds.— Funds appropriated pursuant to subsection (j) of section 105 of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d) (as amended by section 209(j)) may be used in accordance with section 103(a) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(a)).

(b)

Espousal Provisions.—

(1)

In general.— Congress reaffirms that—

(A)

section 103(g)(1) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(g)(1)) and section 103(e)(1) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(e)(1)) provided that “It is the intention of the Congress of the United States that the provisions of section 177 of the Compact of Free Association and the Agreement between the Government of the United States and the Government of the Marshall Islands for the Implementation of Section 177 of the Compact (hereafter in this subsection referred to as the ‘Section 177 Agreement’) constitute a full and final settlement of all claims described in Articles X and XI of the Section 177 Agreement, and that any such claims be terminated and barred except insofar as provided for in the Section 177 Agreement.”; and

(B)

section 103(g)(2) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(g)(2)) and section 103(e)(2) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(e)(2)) provided that “In furtherance of the intention of Congress as stated in paragraph (1) of this subsection, the Section 177 Agreement is hereby ratified and approved. It is the explicit understanding and intent of Congress that the jurisdictional limitations set forth in Article XII of such Agreement are enacted solely and exclusively to accomplish the objective of Article X of such Agreement and only as a clarification of the effect of Article X, and are not to be construed or implemented separately from Article X.”.

(2)

Effect.— Nothing in the 2023 Agreement to Amend the U.S.-RMI Compact affects the application of the provisions of law reaffirmed by paragraph (1).

(c)

Certain Section 177 Agreement Provisions.— Congress reaffirms that—

(1)

Article IX of the Agreement Between the Government of the United States and the Government of the Marshall Islands for the Implementation of Section 177 of the Compact of Free Association, done at Majuro June 25, 1983, provided that “If loss or damage to property and person of the citizens of the Marshall Islands, resulting from the Nuclear Testing Program, arises or is discovered after the effective date of this Agreement, and such injuries were not and could not reasonably have been identified as of the effective date of this Agreement, and if such injuries render the provisions of this Agreement manifestly inadequate, the Government of the Marshall Islands may request that the Government of the United States provide for such injuries by submitting such a request to the Congress of the United States for its consideration. It is understood that this Article does not commit the Congress of the United States to authorize and appropriate funds.”; and

(2)

section 3(a) of Article XIII of the agreement described in paragraph (1) provided that “The Government of the United States and the Government of the Marshall Islands shall consult at the request of either of them on matters relating to the provisions of this Agreement.”.

(d)

United States Appointees to Joint Economic Management and Financial Accountability Committee.—

(1)

In general.— The 2 United States appointees (which are composed of the United States chair and 1 other member from the Government of the United States) to the Joint Economic Management and Financial Accountability Committee established under section 214 of the 2003 Amended U.S.-RMI Compact (referred to in this subsection as the “Committee”) shall—

(A)

be voting members of the Committee; and

(B)

continue to be officers or employees of the Federal Government.

(2)

Term; appointment.— The 2 United States members of the Committee described in paragraph (1) shall be appointed for a term of 2 years as follows:

(A)

1 member shall be appointed by the Secretary of State, in consultation with the Secretary of the Treasury.

(B)

1 member shall be appointed by the Secretary of the Interior, in consultation with the Secretary of the Treasury.

(3)

Reappointment.— A United States member of the Committee appointed under paragraph (2) may be reappointed for not more than 2 additional 2-year terms.

(4)

Qualifications.— At least 1 United States member of the Committee appointed under paragraph (2) shall be an individual who—

(A)

by reason of knowledge, experience, or training, is especially qualified in accounting, auditing, budget analysis, compliance, grant administration, program management, or international economics; and

(B)

possesses not less than 5 years of full-time experience in accounting, auditing, budget analysis, compliance, grant administration, program management, or international economics.

(5)

Notice.—

(A)

In general.— Not later than 90 days after the date of appointment of a United States member under paragraph (2), the Secretary of the Interior shall notify the appropriate committees of Congress that an individual has been appointed as a voting member of the Committee under that paragraph, including a statement attesting to the qualifications of the member described in paragraph (4), subject to subparagraph (B).

(B)

Requirement.— For purposes of a statement required under subparagraph (A), in the case of a member appointed under paragraph (2)(A), the Secretary of the Interior shall compile information on the member provided to the Secretary of the Interior by the Secretary of State on request of the Secretary of the Interior.

(6)

Reports to congress.— Not later than 90 days after the date on which the Committee receives or completes any report required under the 2023 Amended U.S.-RMI Compact, or any related subsidiary agreement, the Secretary of the Interior shall submit the report to the appropriate committees of Congress.

(7)

Notice to congress.— Not later than 90 days after the date on which the Government of the Republic of the Marshall Islands submits to the Committee a report required under the 2023 Amended U.S.-RMI Compact, or any related subsidiary agreement, the Secretary of the Interior shall submit to the appropriate committees of Congress—

(A)

if the report is submitted by the applicable deadline, written notice attesting that the report is complete and accurate; or

(B)

if the report is not submitted by the applicable deadline, written notice that the report has not been timely submitted.

(e)

United States Appointees to Trust Fund Committee.—

(1)

In general.— The 3 United States voting members (which are composed of the United States chair and 2 other members from the Government of the United States) to the Trust Fund Committee established pursuant to the agreement described in section 462(b)(5) of the 2003 Amended U.S.-RMI Compact (referred to in this subsection as the “Committee”) shall continue to be officers or employees of the Federal Government.

(2)

Term; appointment.— The 3 United States members of the Committee described in paragraph (1) shall be appointed for a term not more than 5 years as follows:

(A)

1 member shall be appointed by the Secretary of State.

(B)

1 member shall be appointed by the Secretary of the Interior.

(C)

1 member shall be appointed by the Secretary of the Treasury.

(3)

Reappointment.— A United States member of the Committee appointed under paragraph (2) may be reappointed for not more than 2 additional 2-year terms.

(4)

Qualifications.— Not fewer than 2 members of the Committee appointed under paragraph (2) shall be individuals who—

(A)

(B)

possess not less than 5 years of full-time experience in accounting, auditing, budget analysis, compliance, financial investment, grant administration, program management, or international economics.

(5)

Notice.—

(A)

In general.— Not later than 90 days after the date of appointment of a United States Member under paragraph (2), the Secretary of the Interior shall notify the appropriate committees of Congress that an individual has been appointed as a voting member of the Committee under that paragraph, including a statement attesting to the qualifications of the appointee described in paragraph (4), subject to subparagraph (B).

(B)

Requirement.— For purposes of a statement required under subparagraph (A)—

(i)

(ii)

(6)

(7)

(A)

if the report is submitted by the applicable deadline, written notice attesting that the report is complete and accurate; or

(B)

if the report is not submitted by the applicable deadline, written notice that the report has not been timely submitted.

(f)

Four Atoll Health Care Program.— Congress reaffirms that—

(1)

section 103(j)(1) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(j)(1)) and section 103(h)(1) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(h)(1)) provided that services “provided by the United States Public Health Service or any other United States agency pursuant to section 1(a) of Article II of the Agreement for the Implementation of Section 177 of the Compact (hereafter in this subsection referred to as the ‘Section 177 Agreement’) shall be only for services to the people of the Atolls of Bikini, Enewetak, Rongelap, and Utrik who were affected by the consequences of the United States nuclear testing program, pursuant to the program described in Public Law 95–134 and Public Law 96–205 and their descendants (and any other persons identified as having been so affected if such identification occurs in the manner described in such public laws). Nothing in this subsection shall be construed as prejudicial to the views or policies of the Government of the Marshall Islands as to the persons affected by the consequences of the United States nuclear testing program.”;

(2)

section 103(j)(2) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(j)(2)) and section 103(h)(2) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(h)(2)) provided that “at the end of the first year after the effective date of the Compact and at the end of each year thereafter, the providing agency or agencies shall return to the Government of the Marshall Islands any unexpended funds to be returned to the Fund Manager (as described in Article I of the Section 177 Agreement) to be covered into the Fund to be available for future use.”; and

(3)

section 103(j)(3) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(j)(3)) and section 103(h)(3) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(h)(3)) provided that “the Fund Manager shall retain the funds returned by the Government of the Marshall Islands pursuant to paragraph (2) of this subsection, shall invest and manage such funds, and at the end of 15 years after the effective date of the Compact, shall make from the total amount so retained and the proceeds thereof annual disbursements sufficient to continue to make payments for the provision of health services as specified in paragraph (1) of this subsection to such extent as may be provided in contracts between the Government of the Marshall Islands and appropriate United States providers of such health services.”.

(g)

Radiological Health Care Program.— Notwithstanding any other provision of law, on the request of the Government of the Republic of the Marshall Islands, the President (through an appropriate department or agency of the United States) shall continue to provide special medical care and logistical support for the remaining members of the population of Rongelap and Utrik who were exposed to radiation resulting from the 1954 United States thermonuclear “Bravo” test, pursuant to Public Law 95–134 (91 Stat. 1159) and Public Law 96–205 (94 Stat. 84).

(h)

Agricultural and Food Programs.—

(1)

In general.— Congress reaffirms that—

(A)

section 103(h)(2) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(h)(2)) and section 103(f)(2)(A) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(f)(2)(A)) provided that notwithstanding “any other provision of law, upon the request of the Government of the Marshall Islands, for the first fifteen years after the effective date of the Compact, the President (either through an appropriate department or agency of the United States or by contract with a United States firm or by a grant to the Government of the Republic of the Marshall Islands which may further contract only with a United States firm or a Republic of the Marshall Islands firm, the owners, officers and majority of the employees of which are citizens of the United States or the Republic of the Marshall Islands) shall provide technical and other assistance without reimbursement, to continue the planting and agricultural maintenance program on Enewetak; without reimbursement, to continue the food programs of the Bikini, Rongelap, Utrik, and Enewetak people described in section 1(d) of Article II of the Subsidiary Agreement for the Implementation of Section 177 of the Compact and for continued waterborne transportation of agricultural products to Enewetak including operations and maintenance of the vessel used for such purposes.”;

(B)

section 103(h)(2) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(h)(2)) and section 103(f)(2)(B) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(f)(2)(B)) provided that “The President shall ensure the assistance provided under these programs reflects the changes in the population since the inception of such programs.”; and

(C)

section 103(h)(3) of the Compact of Free Association Act of 1985 (48 U.S.C. 1903(h)(3)) and section 103(f)(3) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(f)(3)) provided that “payments under this subsection shall be provided to such extent or in such amounts as are necessary for services and other assistance provided pursuant to this subsection. It is the sense of Congress that after the periods of time specified in paragraphs (1) and (2) of this subsection, consideration will be given to such additional funding for these programs as may be necessary.”.

(2)

Planting and agricultural maintenance program.— The Secretary of the Interior may provide grants to the Government of the Republic of the Marshall Islands to carry out a planting and agricultural maintenance program on Bikini, Enewetak, Rongelap, and Utrik.

(3)

Food programs.— The Secretary of Agriculture may provide, without reimbursement, food programs to the people of the Republic of the Marshall Islands.

SEC. 207. Agreements with and Other Provisions Related to the Republic of Palau.

(a)

Bilateral Economic Consultations.— United States participation in the annual economic consultations referred to in Article 8 of the 2023 U.S.-Palau Compact Review Agreement shall be by officers or employees of the Federal Government.

(b)

Economic Advisory Group.—

(1)

Qualifications.— A member of the Economic Advisory Group described in Article 7 of the 2023 U.S.-Palau Compact Review Agreement (referred to in this subsection as the “Advisory Group”) who is appointed by the Secretary of the Interior shall be an individual who, by reason of knowledge, experience, or training, is especially qualified in private sector business development, economic development, or national development.

(2)

Funds.— With respect to the Advisory Group, the Secretary of the Interior may use available funds for—

(A)

the costs of the 2 members of the Advisory Group designated by the United States in accordance with Article 7 of the 2023 U.S.-Palau Compact Review Agreement;

(B)

50 percent of the costs of the 5th member of the Advisory Group designated by the Secretary of the Interior in accordance with the Article described in subparagraph (A); and

(C)

the costs of—

(i)

technical and administrative assistance for the Advisory Group; and

(ii)

other support necessary for the Advisory Group to accomplish the purpose of the Advisory Group.

(3)

Reports to congress.— Not later than 90 days after the date on which the Advisory Group receives or completes any report required under the 2023 U.S.-Palau Compact Review Agreement, or any related subsidiary agreement, the Secretary of the Interior shall submit the report to the appropriate committees of Congress.

(c)

Reports to Congress.—

(1)

In general.— Not later than 90 days after the date on which the Government of the Republic of Palau completes any report required under the 2023 U.S.-Palau Compact Review Agreement, or any related subsidiary agreement, the Secretary of the Interior shall submit the report to the appropriate committees of Congress.

(2)

Notice to congress.— Not later than 90 days after the date on which the Government of the Republic of Palau submits a report required under the 2023 U.S.-Palau Compact Review Agreement, or any related subsidiary agreement, the Secretary of the Interior shall submit to the appropriate committees of Congress—

(A)

if the report is submitted by the applicable deadline, written notice attesting that the report is complete and accurate; or

(B)

if the report is not submitted by the applicable deadline, written notice that the report has not been timely submitted.

SEC. 208. Oversight Provisions.

(a)

Authorities and Duties of the Comptroller General of the United States.—

(1)

In general.— The Comptroller General of the United States (including any duly authorized representative of the Comptroller General of the United States) shall have the authorities necessary to carry out the responsibilities of the Comptroller General of the United States under—

(A)

the 2023 Amended U.S.-FSM Compact and related subsidiary agreements, including the authorities and privileges described in section 102(b) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921a(b));

(B)

the 2023 Amended U.S.-RMI Compact and related subsidiary agreements, including the authorities and privileges described in section 103(k) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921b(k)); and

(C)

the 2023 U.S.-Palau Compact Review Agreement, related subsidiary agreements, and the authorities described in appendix D of the “Agreement between the Government of the United States of America and the Government of the Republic of Palau Following the Compact of Free Association Section 432 Review” signed by the United States and the Republic of Palau on September 3, 2010.

(2)

Reports.— Not later than 18 months after the date of the enactment of this Act, and every 4 years thereafter, the Comptroller General of the United States shall submit to the appropriate committees of Congress a report with respect to the Freely Associated States, including addressing—

(A)

the topics described in subparagraphs (A) through (E) of section 104(h)(1) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921c(h)(1)), except that for purposes of a report submitted under this paragraph, the report shall address those topics with respect to each of the Freely Associated States; and

(B)

the effectiveness of administrative oversight by the United States of the Freely Associated States.

(b)

Secretary of the Interior Oversight Authority.— The Secretary of the Interior shall have the authority necessary to fulfill the responsibilities for monitoring and managing the funds appropriated to the Compact of Free Association account of the Department of the Interior by section 211(a) to carry out—

(1)

the 2023 Amended U.S.-FSM Compact;

(2)

the 2023 Amended U.S.-RMI Compact;

(3)

the 2023 U.S.-Palau Compact Review Agreement; and

(4)

subsidiary agreements.

(c)

Postmaster General Oversight Authority.— The Postmaster General shall have the authority necessary to fulfill the responsibilities for monitoring and managing the funds appropriated to the United States Postal Service under paragraph (1) of section 211(b) and deposited in the Postal Service Fund under paragraph (2)(A) of that section to carry out—

(1)

section 221(a)(2) of the 2023 Amended U.S.-FSM Compact;

(2)

section 221(a)(2) of the 2023 Amended U.S.-RMI Compact;

(3)

section 221(a)(2) of the U.S.-Palau Compact; and

(4)

Article 6(a) of the 2023 U.S.-Palau Compact Review Agreement.

(d)

Interagency Group on Freely Associated States.—

(1)

Establishment.— The President, in consultation with the Secretary of State, the Secretary of the Interior, and the Secretary of Defense, shall establish an Interagency Group on Freely Associated States (referred to in this subsection as the “Interagency Group”).

(2)

Purpose.— The purposes of the Interagency Group are—

(A)

to coordinate development and implementation of executive branch policies, programs, services, and other activities in or relating to the Freely Associated States; and

(B)

to provide policy guidance, recommendations, and oversight to Federal agencies, departments, and instrumentalities with respect to the implementation of—

(i)

the 2023 Amended U.S.-FSM Compact;

(ii)

the 2023 Amended U.S.-RMI Compact; and

(iii)

the 2023 U.S.-Palau Compact Review Agreement.

(3)

Membership.— The Interagency Group shall consist of—

(A)

the Secretary of State, who shall serve as co-chair of the Interagency Group;

(B)

the Secretary of the Interior, who shall serve as co-chair of the Interagency Group;

(C)

the Secretary of Defense;

(D)

the Secretary of the Treasury;

(E)

the heads of relevant Federal agencies, departments, and instrumentalities carrying out obligations under—

(i)

sections 131 and 132 of the 2003 Amended U.S.-FSM Compact and subsections (a) and (b) of section 221 and section 261 of the 2023 Amended U.S.-FSM Compact;

(ii)

sections 131 and 132 of the 2003 Amended U.S.-RMI Compact and subsections (a) and (b) of section 221 and section 261 of the 2023 Amended U.S.-RMI Compact;

(iii)

sections 131 and 132 and subsections (a) and (b) of section 221 of the U.S.-Palau Compact;

(iv)

Article 6 of the 2023 U.S.-Palau Compact Review Agreement;

(v)

any applicable subsidiary agreement; and

(vi)

section 209; and

(F)

the head of any other Federal agency, department, or instrumentality that the Secretary of State or the Secretary of the Interior may designate.

(4)

Duties of secretary of state and secretary of the interior.— The Secretary of State (or a senior official designee of the Secretary of State) and the Secretary of the Interior (or a senior official designee of the Secretary of the Interior) shall—

(A)

co-lead and preside at a meeting of the Interagency Group not less frequently than annually;

(B)

determine, in consultation with the Secretary of Defense, the agenda for meetings of the Interagency Group; and

(C)

facilitate and coordinate the work of the Interagency Group.

(5)

Duties of the interagency group.— The Interagency Group shall—

(A)

provide advice on the establishment or implementation of policies relating to the Freely Associated States to the President, acting through the Office of Intergovernmental Affairs, in the form of a written report not less frequently than annually;

(B)

obtain information and advice relating to the Freely Associated States from the Presidents, other elected officials, and members of civil society of the Freely Associated States, including through the members of the Interagency Group (including senior official designees of the members) meeting not less frequently than annually with any Presidents of the Freely Associated States who elect to participate;

(C)

at the request of the head of any Federal agency (or a senior official designee of the head of a Federal agency) who is a member of the Interagency Group, promptly review and provide advice on a policy or policy implementation action affecting 1 or more of the Freely Associated States proposed by the Federal agency, department, or instrumentality; and

(D)

facilitate coordination of relevant policies, programs, initiatives, and activities involving 1 or more of the Freely Associated States, including ensuring coherence and avoiding duplication between programs, initiatives, and activities conducted pursuant to a Compact with a Freely Associated State and non-Compact programs, initiatives, and activities.

(6)

Reports.— Not later than 1 year after the date of the enactment of this Act and each year thereafter in which a Compact of Free Association with a Freely Associated State is in effect, the President shall submit to the majority leader and minority leader of the Senate, the Speaker and minority leader of the House of Representatives, and the appropriate committees of Congress a report that describes the activities and recommendations of the Interagency Group during the applicable year.

(e)

Federal Agency Coordination.— The head of any Federal agency providing programs and services to the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau shall coordinate with the Secretary of the Interior and the Secretary of State regarding the provision of the programs and services.

(f)

Foreign Loans or Debt.— Congress reaffirms that—

(1)

the foreign loans or debt of the Government of the Federated States of Micronesia, the Government of the Republic of the Marshall Islands, or the Government of the Republic of Palau shall not constitute an obligation of the United States; and

(2)

the full faith and credit of the United States Government shall not be pledged for the payment and performance of any foreign loan or debt referred to in paragraph (1) without specific further authorization.

(g)

Compact Compilation.— Not later than 180 days after the date of enactment of this Act, the Secretary of the Interior shall submit a report to the appropriate committees of Congress that includes a compilation of the Compact of Free Association with the Federated State of Micronesia, the Compact of Free Association with the Republic of Palau, and the Compact of Free Association with Republic of the Marshall Islands.

(h)

Publication; Revision by Office of the Law Revision Counsel.—

(1)

Publication.— In publishing this title in slip form and in the United States Statutes at Large pursuant to section 112 of title 1, United States Code, the Archivist of the United States shall include after the date of approval at the end an appendix setting forth the text of—

(A)

the 2023 Agreement to Amend the U.S.-FSM Compact; and

(B)

the 2023 Agreement to Amend the U.S.-RMI Compact.

(2)

Revision by office of the law revision counsel.— The Office of the Law Revision Counsel is directed to revise—

(A)

the 2003 Amended U.S.-FSM Compact set forth in the note following section 1921 of title 48, United States Code, to reflect the amendments to the 2003 AmendedU.S.-FSM Compact made by the 2023 Agreement to Amend the U.S.-FSM Compact; and

(B)

the 2003 Amended U.S.-RMI Compact set forth in the note following section 1921 of title 48, United States Code, to reflect the amendments to the 2003 Amended U.S.-RMI Compact made by the 2023 Agreement to Amend the U.S.-RMI Compact.

SEC. 209. United States Policy Regarding the Freely Associated States.

(a)

Authorization for Veterans’ Services.—

(1)

Definition of freely associated states.— In this subsection, the term “Freely Associated States” means—

(A)

the Federated States of Micronesia, during such time as it is a party to the Compact of Free Association set forth in section 201 of the Compact of Free Association Act of 1985 (Public Law 99–239; 48 U.S.C. 1901 note);

(B)

the Republic of the Marshall Islands, during such time as it is a party to the Compact of Free Association set forth in section 201 of the Compact of Free Association Act of 1985 (Public Law 99–239; 48 U.S.C. 1901 note); and

(C)

the Republic of Palau, during such time as it is a party to the Compact of Free Association between the United States and the Government of Palau set forth in section 201 of Joint Resolution entitled “Joint Resolution to approve the ‘Compact of Free Association’ between the United States and the Government of Palau, and for other purposes” (Public Law 99–658; 48 U.S.C. 1931 note).

(2)

Hospital care, medical services, and nursing home care abroad.— Section 1724 of title 38, United States Code, is amended—

(A)

in subsection (a), by striking “ subsections (b) and (c)” and inserting “ subsections (b), (c), and (f)”; and

(B)

by adding at the end the following:

“(f)

(1)

(A) The Secretary may furnish hospital care and medical services in the Freely Associated States, subject to agreements the Secretary shall enter into with the governments of the Freely Associated States as described in section 209(a)(4)(A) of the Compact of Free Association Amendments Act of 2024, and subject to subparagraph (B), to a veteran who is otherwise eligible to receive hospital care and medical services.

“(B) The agreements described in subparagraph (A) shall incorporate, to the extent practicable, the applicable laws of the Freely Associated States and define the care and services that can be legally provided by the Secretary in the Freely Associated States.

“(2) In furnishing hospital care and medical services under paragraph (1), the Secretary may furnish hospital care and medical services through—

“(A) contracts or other agreements;

“(B) reimbursement; or

“(C) the direct provision of care by health care personnel of the Department.

“(3) In furnishing hospital care and medical services under paragraph (1), the Secretary may furnish hospital care and medical services for any condition regardless of whether the condition is connected to the service of the veteran in the Armed Forces.

“(4)

(A) A veteran who has received hospital care or medical services in a country pursuant to this subsection shall remain eligible, to the extent determined advisable and practicable by the Secretary, for hospital care or medical services in that country regardless of whether the country continues to qualify as a Freely Associated State for purposes of this subsection.

“(B) If the Secretary determines it is no longer advisable or practicable to allow veterans described in subparagraph (A) to remain eligible for hospital care or medical services pursuant to such subparagraph, the Secretary shall—

“(i) provide direct notice of that determination to such veterans; and

“(ii) publish that determination and the reasons for that determination in the Federal Register.

“(5) In this subsection, the term ‘Freely Associated States’ means—

“(A) the Federated States of Micronesia, during such time as it is a party to the Compact of Free Association set forth in section 201 of the Compact of Free Association Act of 1985 (Public Law 99–239; 48 U.S.C. 1901 note);

“(B) the Republic of the Marshall Islands, during such time as it is a party to the Compact of Free Association set forth in section 201 of the Compact of Free Association Act of 1985 (Public Law 99–239; 48 U.S.C. 1901 note); and

“(C) the Republic of Palau, during such time as it is a party to the Compact of Free Association between the United States and the Government of Palau set forth in section 201 of Joint Resolution entitled ‘Joint Resolution to approve the “Compact of Free Association” between the United States and the Government of Palau, and for other purposes’ (Public Law 99–658; 48 U.S.C. 1931 note).”

(3)

Beneficiary travel.— Section 111 of title 38, United States Code, is amended by adding at the end the following:

“(h)

(1) Notwithstanding any other provision of law, the Secretary may make payments to or for any person traveling in, to, or from the Freely Associated States for receipt of care or services authorized to be legally provided by the Secretary in the Freely Associated States under section 1724(f)(1) of this title.

“(2) A person who has received payment for travel in a country pursuant to this subsection shall remain eligible for payment for such travel in that country regardless of whether the country continues to qualify as a Freely Associated State for purposes of this subsection.

“(3) The Secretary shall prescribe regulations to carry out this subsection.

“(4) In this subsection, the term ‘Freely Associated States’ means—

(4)

Legal issues.—

(A)

Agreements to furnish care and services.—

(i)

In general.— Before delivering hospital care or medical services under subsection (f) of section 1724 of title 38, United States Code, as added by paragraph (2)(B), the Secretary of Veterans Affairs, in consultation with the Secretary of State, shall enter into agreements with the governments of the Freely Associated States to—

(I)

facilitate the furnishing of health services, including telehealth, under the laws administered by the Secretary of Veterans Affairs to veterans in the Freely Associated States, such as by addressing—

(aa)

licensure, certification, registration, and tort issues relating to health care personnel;

(bb)

the scope of health services the Secretary may furnish, as well as the means for furnishing such services; and

(cc)

matters relating to delivery of pharmaceutical products and medical surgical products, including delivery of such products through the Consolidated Mail Outpatient Pharmacy of the Department of Veterans Affairs, to the Freely Associated States;

(II)

clarify the authority of the Secretary of Veterans Affairs to pay for tort claims as set forth under subparagraph (C); and

(III)

clarify authority and responsibility on any other matters determined relevant by the Secretary of Veterans Affairs or the governments of the Freely Associated States.

(ii)

Scope of agreements.— The agreements described in clause (i) shall incorporate, to the extent practicable, the applicable laws of the Freely Associated States and define the care and services that can be legally provided by the Secretary of Veterans Affairs in the Freely Associated States.

(iii)

Report to congress.—

(I)

In general.— Not later than 90 days after entering into an agreement described in clause (i), the Secretary of Veterans Affairs shall submit the agreement to the appropriate committees of Congress.

(II)

Appropriate committees of congress defined.— In this clause, the term “appropriate committees of Congress” means—

(aa)

the Committee on Energy and Natural Resources, the Committee on Foreign Relations, and the Committee on Veterans’ Affairs of the Senate; and

(bb)

the Committee on Natural Resources, the Committee on Foreign Affairs, and the Committee on Veterans’ Affairs of the House of Representatives.

(B)

Licensure of health care professionals providing treatment via telemedicine in the freely associated states.— Section 1730C(a) of title 38, United States Code, is amended by striking “ any State” and inserting “ any State or any of the Freely Associated States (as defined in section 1724(f) of this title)”.

(C)

Payment of claims.— The Secretary of Veterans Affairs may pay tort claims, in the manner authorized in the first paragraph of section 2672 of title 28, United States Code, when such claims arise in the Freely Associated States in connection with furnishing hospital care or medical services or providing medical consultation or medical advice to a veteran under the laws administered by the Secretary, including through a remote or telehealth program.

(5)

Outreach and assessment of options.— During the 1-year period beginning on the date of enactment of this Act, the Secretary of Veterans Affairs shall, subject to the availability of appropriations—

(A)

conduct robust outreach to, and engage with, each government of the Freely Associated States;

(B)

assess options for the delivery of care through the use of authorities provided pursuant to the amendments made by this subsection; and

(C)

increase staffing as necessary to conduct outreach under subparagraph (A).

(b)

Authorization of Education Programs.—

(1)

Eligibility.— For fiscal year 2024 and each fiscal year thereafter, the Government of the United States shall—

(A)

continue to make available to the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, grants for services to individuals eligible for such services under part B of the Individuals with Disabilities Education Act (20 U.S.C. 1411 et seq.) to the extent that those services continue to be available to individuals in the United States;

(B)

continue to make available to the Federated States of Micronesia and the Republic of the Marshall Islands and make available to the Republic of Palau, competitive grants under the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 et seq.), the Carl D. Perkins Career and Technical Education Act of 2006 (20 U.S.C. 2301 et seq.), and part D of the Individuals with Disabilities Education Act (20 U.S.C. 1450 et seq.), to the extent that those grants continue to be available to State and local governments in the United States;

(C)

continue to make grants available to the Republic of Palau under part A of title I of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311 et seq.), the Adult Education and Family Literacy Act (29 U.S.C. 3271 et seq.), and the Carl D. Perkins Career and Technical Education Act of 2006 (20 U.S.C. 2301 et seq.);

(D)

continue to make available to eligible institutions of higher education in the Republic of Palau and make available to eligible institutions of higher education in the Federated States of Micronesia and the Republic of the Marshall Islands and to students enrolled in those institutions of higher education, and to students who are citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau and enrolled in institutions of higher education in the United States and territories of the United States, grants under—

(i)

subpart 1 of part A of title IV of the Higher Education Act of 1965 (20 U.S.C. 1070a et seq.);

(ii)

subpart 3 of part A of title IV of the Higher Education Act of 1965 (20 U.S.C. 1070b et seq.); and

(iii)

part C of title IV of the Higher Education Act of 1965 (20 U.S.C. 1087–51 et seq.);

(E)

require, as a condition of eligibility for a public institution of higher education in any State (as defined in section 103 of the Higher Education Act of 1965 (20 U.S.C. 1003)) that is not a Freely Associated State to participate in or receive funds under any program under title IV of such Act (20 U.S.C. 1070 et seq.), that the institution charge students who are citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau tuition for attendance at a rate that is not greater than the rate charged for residents of the State in which such public institution of higher education is located; and

(F)

continue to make available, to eligible institutions of higher education, secondary schools, and nonprofit organizations in the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, competitive grants under the Higher Education Act of 1965 (20 U.S.C. 1001 et seq.).

(2)

Other formula grants.— Except as provided in paragraph (1), the Secretary of Education shall not make a grant under any formula grant program administered by the Department of Education to the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau.

(3)

Grants to the freely associated states under part b of the individuals with disabilities education act.— Section 611(b)(1) of the Individuals with Disabilities Education Act (20 U.S.C. 1411(b)(1)) is amended by striking subparagraph (A) and inserting the following:

“(A) Funds reserved.—From the amount appropriated for any fiscal year under subsection (i), the Secretary shall reserve not more than 1 percent, which shall be used as follows:

“(i) To provide assistance to the outlying areas in accordance with their respective populations of individuals aged 3 through 21.

“(ii)

(I) To provide each freely associated State a grant so that no freely associated State receives a lesser share of the total funds reserved for the freely associated State than the freely associated State received of those funds for fiscal year 2023.

“(II) Each freely associated State shall establish its eligibility under this subparagraph consistent with the requirements for a State under section 612.

“(III) The funds provided to each freely associated State under this part may be used to provide, to each infant or toddler with a disability (as defined in section 632), either a free appropriate public education, consistent with section 612, or early intervention services consistent with part C, notwithstanding the application and eligibility requirements of sections 634(2), 635, and 637.”

(4)

Technical amendments to the elementary and secondary education act of 1965.— The Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 et seq.) is amended—

(A)

by striking subparagraph (A) of section 1121(b)(1) (20 U.S.C. 6331(b)(1)) and inserting the following:

“(A) first reserve $1,000,000 for the Republic of Palau, subject to such terms and conditions as the Secretary may establish, except that Public Law 95–134, permitting the consolidation of grants, shall not apply; and”

; and

(B)

in section 8101 (20 U.S.C. 7801), by amending paragraph (36) to read as follows:

“(36) Outlying area.—The term ‘outlying area’—

“(A) means American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the United States Virgin Islands; and

“(B) for the purpose of any discretionary grant program under this Act, includes the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, to the extent that any such grant program continues to be available to State and local governments in the United States.”

(5)

Technical amendment to the compact of free association amendments act of 2003.— Section 105(f)(1)(B) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d(f)(1)(B)) is amended by striking clause (ix).

(6)

Head start programs.—

(A)

Definitions.— Section 637 of the Head Start Act (42 U.S.C. 9832) is amended, in the paragraph defining the term “State”, by striking the second sentence and inserting “ The term ‘State’ includes the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.”.

(B)

Allotment of funds.— Section 640(a)(2)(B) of the Head Start Act (42 U.S.C. 9835(a)(2)(B)) is amended—

(i)

in clause (iv), by inserting “ the Republic of Palau,” before “ and the Virgin Islands”; and

(ii)

by amending clause (v) to read as follows:

“(v) if a base grant has been established through appropriations for the Federated States of Micronesia or the Republic of the Marshall Islands, to provide an amount for that jurisdiction (for Head Start agencies (including Early Head Start agencies) in the jurisdiction) that is equal to the amount provided for base grants for such jurisdiction under this subchapter for the prior fiscal year, by allotting to each agency described in this clause an amount equal to that agency’s base grant for the prior fiscal year; and”

(7)

Coordination required.— The Secretary of the Interior, in coordination with the Secretary of Education and the Secretary of Health and Human Services, as applicable, shall, to the maximum extent practicable, coordinate with the 3 United States appointees to the Joint Economic Management Committee described in section 205(b)(1) and the 2 United States appointees to the Joint Economic Management and Financial Accountability Committee described in section 206(d)(1) to avoid duplication of economic assistance for education provided under section 261(a)(1) of the 2023 Amended U.S.-FSM Compact or section 261(a)(1) of the 2023 Amended U.S.-RMI Compact of activities or services provided under—

(A)

the Head Start Act (42 U.S.C. 9831 et seq.);

(B)

subpart 3 of part A of title IV of the Higher Education Act of 1965 (20 U.S.C. 1070b et seq.); or

(C)

part C of title IV of the Higher Education Act of 1965 (20 U.S.C. 1087–51 et seq.).

(c)

Authorization of Department of Defense Programs.—

(1)

Department of defense medical facilities.— The Secretary of Defense shall make available, on a space available and reimbursable basis, the medical facilities of the Department of Defense for use by citizens of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, who are properly referred to the facilities by government authorities responsible for provision of medical services in the Federated States of Micronesia, the Republic of the Marshall Islands, the Republic of Palau, and the affected jurisdictions (as defined in section 104(e)(2) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921c(e)(2))).

(2)

Participation by secondary schools in the armed services vocational aptitude battery student testing program.— It is the sense of Congress that the Department of Defense may extend the Armed Services Vocational Aptitude Battery (ASVAB) Student Testing Program and the ASVAB Career Exploration Program to selected secondary schools in the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau to the extent such programs are available to Department of Defense dependent secondary schools established under section 2164 of title 10, United States Code, and located outside the United States.

(d)

Judicial Training.— In addition to amounts provided under section 261(a)(4) of the 2023 Amended U.S.-FSM Compact and the 2023 Amended U.S.-RMI Compact and under subsections (a) and (b) of Article 1 of the 2023 U.S.-Palau Compact Review Agreement, for each of fiscal years 2024 through 2043, the Secretary of the Interior shall use the amounts made available to the Secretary of the Interior under section 211(c) to train judges and officials of the judiciary in the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau, in cooperation with the Pacific Islands Committee of the judicial council of the ninth judicial circuit of the United States.

(e)

Eligibility for the Republic of Palau.—

(1)

National health service corps.— The Secretary of Health and Human Services shall make the services of the National Health Service Corps available to the residents of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau to the same extent, and for the same duration, as services are authorized to be provided to persons residing in any other areas within or outside the United States.

(2)

Additional programs and services.— The Republic of Palau shall be eligible for the programs and services made available to the Federated States of Micronesia and the Republic of the Marshall Islands under section 108(a) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921g(a)).

(3)

Programs and services of certain agencies.— In addition to the programs and services set forth in the operative Federal Programs and Services Agreement between the United States and the Republic of Palau, the programs and services of the following agencies shall be made available to the Republic of Palau:

(A)

The Legal Services Corporation.

(B)

The Public Health Service.

(C)

The Rural Housing Service.

(f)

Compact Impact Fairness.—

(1)

In general.— Section 402 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1612) is amended—

(A)

in subsection (a)(2), by adding at the end the following:

“(N) Exception for citizens of freely associated states.—With respect to eligibility for benefits for any specified Federal program, paragraph (1) shall not apply to any individual who lawfully resides in the United States in accordance with section 141 of the Compacts of Free Association between the Government of the United States and the Governments of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.”

; and

(B)

in subsection (b)(2)(G)—

(i)

in the subparagraph heading, by striking “ medicaid exception for” and inserting “ exception for”; and

(ii)

by striking “ the designated Federal program defined in paragraph (3)(C) (relating to the Medicaid program)” and inserting “ any designated Federal program”.

(2)

Exception to 5-year wait requirement.— Section 403(b)(3) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1613(b)(3)) is amended by striking “ , but only with respect to the designated Federal program defined in section 402(b)(3)(C)”.

(3)

Definition of qualified alien.— Section 431(b)(8) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)(8)) is amended by striking “ , but only with respect to the designated Federal program defined in section 402(b)(3)(C) (relating to the Medicaid program)”.

(g)

Consultation With International Financial Institutions.— The Secretary of the Treasury, in coordination with the Secretary of the Interior and the Secretary of State, shall consult with appropriate officials of the Asian Development Bank and relevant international financial institutions (as defined in section 1701(c) of the International Financial Institutions Act (22 U.S.C. 262r(c))), as appropriate, with respect to overall economic conditions in, and the activities of other providers of assistance to, the Freely Associated States.

(h)

Chief of Mission.— Section 105(b) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d(b)) is amended by striking paragraph (5) and inserting the following:

“(5) Pursuant to section 207 of the Foreign Service Act of 1980 (22 U.S.C. 3927), all United States Government executive branch employees in the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau fall under the authority of the respective applicable chief of mission, except for employees identified as excepted from the authority under Federal law or by Presidential directive.”

(i)

Establishment of a Unit for the Freely Associated States in the Bureau of East Asian and Pacific Affairs of the Department of State and Increasing Personnel Focused on Oceania.—

(1)

Definition of appropriate congressional committees.— In this subsection, the term “appropriate congressional committees” means the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives.

(2)

Requirements.— The Secretary of State shall—

(A)

assign additional full-time equivalent personnel to the Office of Australia, New Zealand, and Pacific Island Affairs of the Bureau of East Asian and Pacific Affairs of the Department of State, including to the unit established under subparagraph (B), as the Secretary of State determines to be appropriate, in accordance with paragraph (4)(A); and

(B)

establish a unit in the Bureau of East Asian and Pacific Affairs of the Department of State to carry out the functions described in paragraph (3).

(3)

Functions of unit.— The unit established under paragraph (2)(B) shall be responsible for the following:

(A)

Managing the bilateral and regional relations with the Freely Associated States.

(B)

Supporting the Secretary of State in leading negotiations relating to the Compacts of Free Association with the Freely Associated States.

(C)

Coordinating, in consultation with the Department of the Interior, the Department of Defense, and other interagency partners as appropriate, implementation of the Compacts of Free Association with the Freely Associated States.

(4)

Full-time equivalent employees.— The Secretary of State shall—

(A)

not later than 5 years after the date of enactment of this Act, assign to the Office of Australia, New Zealand, and Pacific Island Affairs of the Bureau of East Asian and Pacific Affairs, including to the unit established under paragraph (2)(B), not less than 4 additional full-time equivalent staff, who shall not be dual-hatted, including by considering—

(i)

the use of existing flexible hiring authorities, including Domestic Employees Teleworking Overseas (DETOs); and

(ii)

the realignment of existing personnel, including from the United States Mission in Australia, as appropriate;

(B)

reduce the number of vacant foreign service positions in the Pacific Island region by establishing an incentive program within the Foreign Service for overseas positions related to the Pacific Island region; and

(C)

report to the appropriate congressional committees on progress toward objectives outlined in this subsection beginning 1 year from the date of the enactment of this Act and annually thereafter for 5 years.

(j)

Technical Assistance.— Section 105 of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d) is amended by striking subsection (j) and inserting the following:

“(j) Technical Assistance.—

“(1) In general.—Technical assistance may be provided pursuant to section 224 of the 2023 Amended U.S.-FSM Compact, section 224 of the 2023 Amended U.S.-RMI Compact, or section 222 of the U.S.-Palau Compact (as those terms are defined in section 203 of the Compact of Free Association Amendments Act of 2024) by Federal agencies and institutions of the Government of the United States to the extent the assistance shall be provided to States, territories, or units of local government.

“(2) Historic preservation.—

“(A) In general.—Any technical assistance authorized under paragraph (1) that is provided by the Forest Service, the Natural Resources Conservation Service, the United States Fish and Wildlife Service, the National Marine Fisheries Service, the United States Coast Guard, the Advisory Council on Historic Preservation, the Department of the Interior, or any other Federal agency providing assistance under division A of subtitle III of title 54, United States Code, may be provided on a nonreimbursable basis.

“(B) Grants.—During the period in which the 2023 Amended U.S.-FSM Compact (as so defined) and the 2023 Amended U.S.-RMI Compact (as so defined) are in force, the grant programs under division A of subtitle III of title 54, United States Code, shall continue to apply to the Federated States of Micronesia and the Republic of the Marshall Islands in the same manner and to the same extent as those programs applied prior to the approval of the U.S.-FSM Compact and U.S.-RMI Compact.

“(3) Additional funds.—Any funds provided pursuant to this subsection, subsections (c), (g), (h), (i), (k), (l), and (m), section 102(a), and subsections (a), (b), (f), (g), (h), and (j) of section 103 shall be in addition to, and not charged against, any amounts to be paid to the Federated States of Micronesia or the Republic of the Marshall Islands pursuant to—

“(A) the U.S.-FSM Compact;

“(B) the U.S.-RMI Compact; or

“(C) any related subsidiary agreement.”

(k)

Continuing Trust Territory Authorization.— The authorization provided by the Act of June 30, 1954 (68 Stat. 330, chapter 423), shall remain available after the effective date of the 2023 Amended U.S.-FSM Compact and the 2023 Amended U.S.-RMI Compact with respect to the Federated States of Micronesia and the Republic of the Marshall Islands for transition purposes, including—

(1)

completion of projects and fulfillment of commitments or obligations;

(2)

termination of the Trust Territory Government and termination of the High Court;

(3)

health and education as a result of exceptional circumstances;

(4)

ex gratia contributions for the populations of Bikini, Enewetak, Rongelap, and Utrik; and

(5)

technical assistance and training in financial management, program administration, and maintenance of infrastructure.

(l)

Technical Amendments.—

(1)

Public health service act definition.— Section 2(f) of the Public Health Service Act (42 U.S.C. 201(f)) is amended by striking “ and the Trust Territory of the Pacific Islands” and inserting “ the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau”.

(2)

Compact impact amendments.— Section 104(e) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921c(e)) is amended—

(A)

in paragraph (4)—

(i)

in subparagraph (A), by striking “ beginning in fiscal year 2003” and inserting “ during the period of fiscal years 2003 through 2023”; and

(ii)

in subparagraph (C), by striking “ after fiscal year 2003” and inserting “ for the period of fiscal years 2004 through 2023”;

(B)

by striking paragraph (5); and

(C)

by redesignating paragraphs (6) through (10) as paragraphs (5) through (9), respectively.

SEC. 210. Additional Authorities.

(a)

Agencies, Departments, and Instrumentalities.—

(1)

In general.— Appropriations to carry out the obligations, services, and programs described in paragraph (2) shall be made directly to the Federal agencies, departments, and instrumentalities carrying out the obligations, services and programs.

(2)

Obligations, services, and programs described.— The obligations, services, and programs referred to in paragraphs (1) and (3) are the obligations, services, and programs under—

(A)

sections 131 and 132, paragraphs (1) and (3) through (6) of section 221(a), and section 221(b) of the 2023 Amended U.S.-FSM Compact;

(B)

sections 131 and 132, paragraphs (1) and (3) through (6) of section 221(a), and section 221(b) of the 2023 Amended U.S.-RMI Compact;

(C)

sections 131 and 132 and paragraphs (1), (3), and (4) of section 221(a) of the U.S.-Palau Compact;

(D)

Article 6 of the 2023 U.S.-Palau Compact Review Agreement; and

(E)

section 209.

(3)

Authority.— The heads of the Federal agencies, departments, and instrumentalities to which appropriations are made available under paragraph (1) as well as the Federal Deposit Insurance Corporation shall—

(A)

have the authority to carry out any activities that are necessary to fulfill the obligations, services, and programs described in paragraph (2); and

(B)

use available funds to carry out the activities under subparagraph (A).

(b)

Additional Assistance.— Any assistance provided pursuant to section 105(j) of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921d(j)) (as amended by section 209(j)) and sections 205(a), 206(a), 207(b), and 209 shall be in addition to and not charged against any amounts to be paid to the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau pursuant to—

(1)

the 2023 Amended U.S.-FSM Compact;

(2)

the 2023 Amended U.S.-RMI Compact;

(3)

the 2023 U.S.-Palau Compact Review Agreement; or

(4)

any related subsidiary agreement.

(c)

Remaining Balances.— Notwithstanding any other provision of law, including section 109 of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921h)—

(1)

remaining balances appropriated to carry out sections 211, 212(b), 215, and 217 of the 2023 Amended U.S.-FSM Compact, shall be programmed pursuant to Article IX of the 2023 U.S.-FSM Fiscal Procedures Agreement; and

(2)

remaining balances appropriated to carry out sections 211, 213(b), 216, and 218 of the 2023 Amended U.S.-RMI Compact, shall be programmed pursuant to Article XI of the 2023 U.S.-RMI Fiscal Procedures Agreement.

(d)

Grants.— Notwithstanding any other provision of law—

(1)

contributions under the 2023 Amended U.S.-FSM Compact, the 2023 U.S.-Palau Compact Review Agreement, and the 2023 Amended U.S.-RMI Compact may be provided as grants for purposes of implementation of the 2023 Amended U.S.-FSM Compact, the 2023 U.S.-Palau Compact Review Agreement, and the 2023 Amended U.S.-RMI Compact under the laws of the United States; and

(2)

funds appropriated pursuant to section 211 may be deposited in interest-bearing accounts and any interest earned may be retained in and form part of those accounts for use consistent with the purpose of the deposit.

(e)

Rule of Construction.— Except as specifically provided, nothing in this title or the amendments made by this title amends the following:

(1)

Title I of the Compact of Free Association Act of 1985 (48 U.S.C. 1901 et seq.).

(2)

Title I of Public Law 99–658 (48 U.S.C. 1931 et seq.).

(3)

Title I of the Compact of Free Association Amendments Act of 2003 (48 U.S.C. 1921 et seq.).

(4)

Section 1259C of the National Defense Authorization Act for Fiscal Year 2018 (48 U.S.C. 1931 note; Public Law 115–91).

(5)

The Department of the Interior, Environment, and Related Agencies Appropriations Act, 2018 (Public Law 115–141; 132 Stat. 635).

(f)

Clarification Relating to Appropriated Funds.— Notwithstanding section 109 of the Compacts of Free Association Amendments Act of 2003 (48 U.S.C. 1921h)—

(1)

funds appropriated by that section and deposited into the RMI Compact Trust Fund shall be governed by the 2023 U.S.-RMI Trust Fund Agreement on entry into force of the 2023 U.S.-RMI Trust Fund Agreement;

(2)

funds appropriated by that section and deposited into the FSM Compact Trust Fund shall be governed by the 2023 U.S.-FSM Trust Fund Agreement on entry into force of the 2023 U.S.-FSM Trust Fund Agreement;

(3)

funds appropriated by that section and made available for fiscal year 2024 or any fiscal year thereafter as grants to carry out the purposes of section 211(b) of the 2003 U.S.-RMI Amended Compact shall be subject to the provisions of the 2023 U.S.-RMI Fiscal Procedures Agreement on entry into force of the 2023 U.S.-RMI Fiscal Procedures Agreement;

(4)

funds appropriated by that section and made available for fiscal year 2024 or any fiscal year thereafter as grants to carry out the purposes of section 221 of the 2003 U.S.-RMI Amended Compact shall be subject to the provisions of the 2023 U.S.-RMI Fiscal Procedures Agreement on entry into force of the 2023 U.S.-RMI Fiscal Procedures Agreement, except as modified in the Federal Programs and Services Agreement in force between the United States and the Republic of the Marshall Islands; and

(5)

funds appropriated by that section and made available for fiscal year 2024 or any fiscal year thereafter as grants to carry out the purposes of section 221 of the 2003 U.S.-FSM Amended Compact shall be subject to the provisions of the 2023 U.S.-FSM Fiscal Procedures Agreement on entry into force of the 2023 U.S.-FSM Fiscal Procedures Agreement, except as modified in the 2023 U.S.-FSM Federal Programs and Services Agreement.

SEC. 211. Compact Appropriations.

(a)

Funding for Activities of the Secretary of the Interior.— For the period of fiscal years 2024 through 2043, there are appropriated to the Compact of Free Association account of the Department of the Interior, out of any funds in the Treasury not otherwise appropriated, to remain available until expended, the amounts described in and to carry out the purposes of—

(1)

sections 261, 265, and 266 of the 2023 Amended U.S.-FSM Compact;

(2)

sections 261, 265, and 266 of the 2023 Amended U.S.-RMI Compact; and

(3)

Articles 1, 2, and 3 of the 2023 U.S.-Palau Compact Review Agreement.

(b)

Funding for Activities of the United States Postal Service.—

(1)

Appropriation.— There is appropriated to the United States Postal Service, out of any funds in the Treasury not otherwise appropriated for each of fiscal years 2024 through 2043, $31,700,000, to remain available until expended, to carry out the costs of the following provisions that are not otherwise funded:

(A)

Section 221(a)(2) of the 2023 Amended U.S.-FSM Compact.

(B)

Section 221(a)(2) of the 2023 Amended U.S.-RMI Compact.

(C)

Section 221(a)(2) of the U.S.-Palau Compact.

(D)

Article 6(a) of the 2023 U.S.-Palau Compact Review Agreement.

(2)

Deposit.—

(A)

In general.— The amounts appropriated to the United States Postal Service under paragraph (1) shall be deposited into the Postal Service Fund established under section 2003 of title 39, United States Code, to carry out the provisions described in that paragraph.

(B)

Requirement.— Any amounts deposited into the Postal Service Fund under subparagraph (A) shall be the fiduciary, fiscal, and audit responsibility of the Postal Service.

(c)

Funding for Judicial Training.— There is appropriated to the Secretary of the Interior to carry out section 209(d) out of any funds in the Treasury not otherwise appropriated, $550,000 for each of fiscal years 2024 through 2043, to remain available until expended.

(d)

Treatment of Previously Appropriated Amounts.— The total amounts made available to the Government of the Federated States of Micronesia and the Government of the Republic of the Marshall Islands under subsection (a) shall be reduced by amounts made available to the Government of the Federated States of Micronesia and the Government of the Republic of the Marshall Islands, as applicable, under section 2101(a) of the Continuing Appropriations Act, 2024 and Other Extensions Act (Public Law 118–15; 137 Stat. 81) (as amended by section 101 of division B of the Further Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–22; 137 Stat. 114) and section 201 of the Further Additional Continuing Appropriations and Other Extensions Act, 2024 (Public Law 118–35; 138 Stat. 7)).

TITLE III Extensions and Other Matters

SEC. 301. Extension of Undetectable Firearms Act of 1988.

Section 2(f)(2) of the Undetectable Firearms Act of 1988 (18 U.S.C. 922 note; Public Law 100–649) is amended by striking “ 35 years after the effective date of this Act” and inserting “ on March 8, 2031”.

SEC. 302. United States Parole Commission Extension.

(a)

Short Title.— This section may be cited as the “United States Parole Commission Additional Extension Act of 2024”.

(b)

Amendment of Sentencing Reform Act of 1984.— For purposes of section 235(b) of the Sentencing Reform Act of 1984 (18 U.S.C. 3551 note; Public Law 98–473; 98 Stat. 2032), as such section relates to chapter 311 of title 18, United States Code, and the United States Parole Commission, each reference in such section to “36 years and 129 days” or “36-year and 129-day period” shall be deemed a reference to “36 years and 335 days” or “36-year and 335-day period”, respectively.

SEC. 303. Extension of Certain Direct Spending Reductions.

Section 251A(6)(D) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901a(6)(D)) is amended—

(1)

in clause (i), by striking “ 7” and inserting “ 8”; and

(2)

in clause (ii), by striking “ 5” and inserting “ 4”.

TITLE IV Budgetary Effects

SEC. 401. Budgetary Effects.

(a)

Statutory PAYGO Scorecards.— The budgetary effects of this division shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.

(b)

Senate PAYGO Scorecards.— The budgetary effects of this division shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress).

(c)

Classification of Budgetary Effects.— Notwithstanding Rule 3 of the Budget Scorekeeping Guidelines set forth in the joint explanatory statement of the committee of conference accompanying Conference Report 105–217 and section 250(c)(8) of the Balanced Budget and Emergency Deficit Control Act of 1985, the budgetary effects of this division shall not be estimated—

(1)

for purposes of section 251 of such Act;

(2)

for purposes of an allocation to the Committee on Appropriations pursuant to section 302(a) of the Congressional Budget Act of 1974; and

(3)

for purposes of paragraph (4)(C) of section 3 of the Statutory Pay-As-You-Go Act of 2010 as being included in an appropriation Act.

Lineage

Mar 9, 2024reading now Pub. L. 118–42 Enacted
Mar 9, 2024 H.R. 4366 · Enrolled Bill Congress
Mar 6, 2024 H.R. 4366 · Engrossed Amendment House House
Nov 1, 2023 H.R. 4366 · Engrossed Amendment Senate Senate
Sep 5, 2023 H.R. 4366 · Placed on Calendar Senate Senate Received; read twice and placed on the calendar
Jul 27, 2023 H.R. 4366 · Engrossed in House House
Jun 27, 2023 H.R. 4366 · Reported in House House Mr. Carter of Texas, from the Committee on Appropriations, reported the following bill; which was committed to the Committee of the Whole House on the State of the Union and ordered to be printed