Expiring Health Provisions of the 119th Congress

Expiring Health Provisions of the 119th Congress

Expiring Health Provisions of the 119th Congress

August 27, 2025 (R48649)
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Contents

Tables

Table 1. Provisions Expiring in the 119th Congress (First Session)

Table 2. Provisions Expiring in the 119th Congress (Second Session)

Table 3. Provisions That Expired in the 118th Congress

Summary

This report provides information on selected health provisions that have expired or are scheduled to expire during the 119th Congress (i.e., calendar years [CYs] 2025 and 2026). For purposes of this report, expiring provisions are defined as portions of law that are time-limited and will lapse once a statutory deadline is reached, absent further legislative action. The expiring provisions included in this report are any identified provisions related to Medicare, Medicaid, the State Children's Health Insurance Program (CHIP), or private health insurance programs and activities. The report also includes any identified expired or expiring public health and other health care-related provisions. In addition, this report describes health provisions within the same scope that expired during the 118th Congress (i.e., in CY2023 and CY2024). Although the Congressional Research Service (CRS) has attempted to be comprehensive in its research, it cannot guarantee that every relevant provision is included in this report.

This report focuses on two types of health provisions within the scope discussed above. The first, and most common, type of provision provides or controls mandatory spending, meaning it provides temporary funding, temporary increases or decreases in funding or payment rates (e.g., Medicare provider bonus payments), or temporary special protections that may result in changes in funding levels (e.g., Medicare funding provisions that establish a payment floor). The second type of provision defines the authority of government agencies or other entities to act, usually by authorizing a policy, project, or activity, and includes a definitive expiration or "sunset" date. Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline or establish a moratorium on a particular activity. Expiring health provisions that are discretionary authorizations of appropriations are excluded from this report.

Certain types of provisions with expiration dates that otherwise would meet the criteria set forth above are also excluded from this report. Some of these provisions are excluded because they are transitional or routine in nature or because they have been superseded by congressional action that modifies their intent. For example, statutorily required Medicare payment rate reductions and payment rate re-basings that are implemented over a specified period are generally not considered to require repeated legislative attention and are excluded from this report. In addition, this report excludes provisions providing implementation funding, such as the implementation funding provided for a number of the Medicaid provisions and the Rural Health Transformation Program in P.L. 119-21, the 2025 Reconciliation Act.

The tables in this report list the relevant health provisions that have expired or are scheduled to expire in CY2025 and CY2026 and those that expired in CY2023 and CY2024.

This report identifies and briefly describes selected statutory health provisions that have expired or are scheduled to expire during the 119th Congress (i.e., during calendar years [CYs] 2025 and 2026). For purposes of this report, expiring provisions are defined as portions of law that are time-limited and will lapse once a statutory deadline is reached, absent further legislative action. The expiring provisions included in this report are any identified provisions related to Medicare, Medicaid, the State Children's Health Insurance Program (CHIP), or private health insurance programs and activities. The report also includes any identified expiring public health and other health care-related provisions.¹ Separately, the report describes health provisions within the same scope that expired during the 118th Congress (i.e., during CY2023 and CY2024). Although the Congressional Research Service (CRS) has attempted to be comprehensive in its research, it cannot guarantee that every relevant provision is included in this report.

The two types of time-limited provisions discussed in this report generally have been enacted in the context of authorization laws and thus typically are within the purview of congressional authorizing committees. The duration for which such a provision is in effect usually is regarded as creating a timeline for legislative decisionmaking. In choosing this timeline, Congress navigates tradeoffs between the frequency of congressional review and the stability of funding or other legal requirements that pertain to the program.

The first type of provision in this report provides or controls mandatory spending, meaning it provides temporary funding, temporary increases or decreases in funding or payment rates (e.g., Medicare provider bonus payments), or temporary special protections that may result in changes in funding levels (e.g., Medicare funding provisions that establish a payment floor).²

The second type of provision in this report defines the authority of government agencies or other entities to act, usually by authorizing a policy, project, demonstration or pilot program, or activity with a date of expiration.³ Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline, or they may establish a moratorium on a particular activity.

Expired or expiring health provisions that are discretionary authorizations of appropriations are excluded from this report.⁴ For information on provisions that were set to expire on or before CY2025, see CBO, Expired and Expiring Authorizations of Appropriations: 2025 Final Report, July 10, 2025. One notable exception to this exclusion is that the Food and Drug Administration (FDA) and National Institutes of Health (NIH) funds authorized under the 21st Century Cures Act are included in this report; these funds are subject to special budget enforcement rules that cause them to not count toward the discretionary spending limit in a given fiscal year.

Also, certain types of provisions with expiration dates that otherwise would meet the criteria set forth above are excluded from this report. Some of these provisions are excluded because they are transitional or routine in nature, such as requiring certain reports to Congress, or because they have been superseded by congressional action that otherwise modifies their intent. For example, statutorily required Medicare payment rate reductions and payment rate re-basings that are implemented over a specified period are generally not considered to require legislative attention and are excluded from this report. In addition, this report excludes provisions providing implementation funding, such as the implementation funding provided for a number of the Medicaid provisions and the Rural Health Transformation Program in P.L. 119-21, the 2025 Reconciliation Act.⁵

The report is organized as follows: Table 1 lists the relevant provisions that have expired or are scheduled to expire in CY2025. Table 2 lists the relevant provisions that are scheduled to expire in CY2026. Table 3 lists the relevant provisions that expired in CY2023 and CY2024. The provisions in each table are organized by expiration date and by applicable health-related program (e.g., Medicare, Medicaid, Private Health Insurance, and Other). Each table includes a brief summary for each provision and the name of the CRS analyst who covers the topic. Contact information for each CRS analyst is available to congressional clients at the end of the report.

Table 1. Provisions Expiring in the 119th Congress (First Session)

CY2025

Expires After

Health-Related Program

Provisiona

Statutory and/or U.S. Code Citation

Description

CRS Contact

9/30/2025

Medicare

Outreach and Assistance for Low-Income Programs

MIPPA §119

42 U.S.C. §1395b-3 note

Provides funding to specific entities to provide for outreach and assistance to low-income Medicare beneficiaries, including those who may be eligible for the Low-Income Subsidy program, Medicare Savings Program (MSP), and the Medicare Part D Prescription Drug Program.

Kirsten Colello

9/30/2025

Medicare

Telehealth to Conduct Face-to-Face Encounter Prior to Recertification for Hospice

SSA §1814(a)(7)(D)(i)(II)

42 U.S.C. §1395f(a)(7)(D)(i)

Allows for a hospice physician or nurse practitioner to conduct face-to-face encounter via telehealth prior to the 180th-day recertification and subsequent recertifications for Medicare-covered hospice.

Varun Saraswathula

9/30/2025

Medicare

Assistance for Rural Ambulance Providers in Low Population Density Areas

SSA §1834(l)(12)(A)

42 U.S.C. §1395m(I)(12)(A)

Provides Medicare add-on payments for ground ambulance transports that originate in qualified rural areas, called super-rural areas.

Marco Villagrana

9/30/2025

Medicare

Temporary Increase for Ground Ambulance Services

SSA §1834(l)(13)(A)

42 U.S.C. §1395m(l)(13)(A)

Provides Medicare add-on payment for ground ambulance transports that originate in rural or urban areas.

Marco Villagrana

9/30/2025

Medicare

Extension of Certain Telehealth Flexibilities

SSA §1834(m)

42 U.S.C. 1395m(m)

Extends several Medicare telehealth flexibilities for eligible practitioners; locations where patients could receive telehealth services; in-person requirements for mental health services; FQHC's and RHC's; and audio-only services.

Jim Hahn

9/30/2025

Medicare

Floor on Geographic Adjustment for Physician Fee Schedule

SSA §1848(e)(1)(E)

42 U.S.C. §1395w–4(e)(1)(E)

Establishes a floor value of 1.0 for the physician work geographic index used in the calculation of payments under the Medicare physician fee schedule.

Jim Hahn

9/30/2025

Medicare

Hospital at Home

SSA §1866G(a)(1)

42. U.S.C. §1395cc-7(a)(1)

Permits Medicare statutory and regulatory flexibility for certain hospitals to provide health care services to patients in locations beyond the hospitals' physical facilities.

Marco Villagrana

9/30/2025

Medicare

Medicare Dependent Hospital/ Decline Reclassification

SSA §1886(d)(5)(G)

42 U.S.C. §1395ww(d)(5)(G)

Permits higher Medicare IPPS payments to qualifying small rural hospitals with a high proportion of patients who are Medicare beneficiaries.

Marco Villagrana

9/30/2025

Medicare

Low-Volume Adjustment

SSA §1886(d)(12)(D)

42 U.S.C. §1395ww(d)(12)(D)

Provides an increase to the Medicare IPPS payments to qualifying hospitals for the higher incremental costs associated with a low volume of patient discharges.

Marco Villagrana

9/30/2025

Medicare

Contract with a Consensus-Based Entity Regarding Performance Measurement

SSA §1890(d)(2)

42 U.S.C. §1395aaa(d)(2)

Provides funding for a requirement for the Secretary to have a contract with a consensus-based entity to carry out specified duties related to performance improvement and quality measurement. These duties include, among others, priority setting, measure endorsement, measure maintenance, and annual reporting to Congress.

Amanda Sarata

9/30/2025

Medicare

Quality Measure Selection

SSA §§1890(d)(2) and 1890A

42 U.S.C. §§1395aaa(d)(2) and 1395aaa-1

Provides funding for a requirement for the Secretary to establish a pre-rulemaking process to select quality measures for use in Medicare. As part of this process, the Secretary makes measures under consideration for use in Medicare public and broadly disseminates the selected quality measures, while the consensus-based entity with a contract gathers and annually transmits to the Secretary multi-stakeholder input.

Amanda Sarata

9/30/2025

Medicaid

Certified Community Behavioral Health Clinics (CCBHC) Medicaid Demonstration Program

PAMA §223(d)(3), (8), and (9)

42 U.S.C. §§1396a note (d)(3), (8), and (9)

Provides a higher share of Medicaid expenditures for services provided to Medicaid enrollees at CCBHCs in states participating in the CCBHC demonstration program.b

Varun Saraswathula

9/30/2025

Medicaid

Tennessee Medicaid DSH Allotment

SSA §1923(f)(6)(A)(vi)

42 U.S.C. §1396r-4(6)(A)(vi)

Provides Tennessee a special statutory arrangement that specifies the DSH allotment for the state is $53.1 million for each of FY2015-FY2025.

Alison Mitchell

9/30/2025

Medicaid

Implementation of Medicaid DSH Allotment Reductions

SSA §1923(f)(7)

42 U.S.C. §1396r-4(f)(7)

Implements reductions to the Medicaid DSH allotments in the amount of $8 billion per year for FY2026-FY2028.

Alison Mitchell

9/30/2025

Other

FDA Innovation Projects

21st Century Cures Act (P.L. 114-255) §1002(b)(2)(A)

Authorizes annual appropriations from the FDA Innovation Account for the purpose of carrying out numerous activities under the Cures Act relating to, among others, patient focused drug development; modernizing clinical trial design and evidence development; innovation and stewardship of antimicrobial therapies; medical device innovation; and patient access to new therapies such as regenerative advanced therapies. These funds, in effect, do not count toward the discretionary spending limit in a given fiscal year.

Amanda Sarata

9/30/2025

Other

Community Health Center Fund

ACA §10503(b)(1)(J))

(Also, PHSA §330 for underlying health center statute)

42 U.S.C. §254b-2(b)(1)(J)

Provides funding for the Health Resources and Services Administration's federal health center program.

Elayne Heisler

9/30/2025

Other

National Health Service Corps Fund

ACA §10503(b)(2)(K)

(Also, PHSA §338 for overall NHSC funding)

42 U.S.C. §254-2(b)(2)(K)

Provides funding for scholarships and loan repayment for health providers in exchange for providing care in a health professional shortage area.

Elayne Heisler

9/30/2025

Other

National Technical Assistance Center on Grandfamilies and Kinship Families

ARPA §2922(a)

42 U.S.C. §3020g(a)

Provides funding to establish a National Technical Center to provide training, technical assistance, and resources for government programs, nonprofit and other community-based organizations, and Indian Tribes, tribal organizations, and urban Indian organizations for activities related to grandfamilies and kinship families.

Jared Sussman

9/30/2025

Other

Over-The-Counter Monograph Drug User Fee Program (OMUFA)

FFDCA §744M(b)(2)

21 U.S.C. §379j-72(b)(2)

Establishes the fee revenue amounts FDA is authorized to collect for the Over-The-Counter Monograph Drug User Fee Program for FY2022-FY2025.

Hassan Sheikh

9/30/2025

Other

Public Health Emergencies: Temporary Reassignment of State and Local Personnel During a Public Health Emergency

PHSA §319(e)(8)

42 U.S.C. §247d(e)(8)

Allows the Secretary to authorize a temporary reassignment of certain state, Indian Tribe, and local public health department personnel in response to a declared public health emergency.

Hassan Sheikh

9/30/2025

Other

Biomedical Advanced Research and Development Authority (Nondisclosure of Information)

PHSA §319L(e)(1)(D)

42 U.S.C. §247d-7e(e)(1)(D)

Deems certain information received by BARDA to nondisclosure under the Freedom of Information Act (FOIA), specifically information relevant to HHS programs that could compromise national security.

Hassan Sheikh

9/30/2025

Other

Collaboration and Coordination (Countermeasures, Pandemic or Epidemic Product Development)

PHSA §319L-1(b)

42 U.S.C. §247d-7f(b)

Allows the Secretary, in coordination with the Attorney General and the Secretary of Homeland Security, to consult entities engaged in the development of certain products used in response to public health emergencies for the development, manufacture, distribution, purchase, or storage of those products, and exempts participation in such meetings from antitrust laws as covered in written agreements.

Hassan Sheikh

9/30/2025

Other

Special Diabetes Programs for Type I Diabetes

PHSA §330B(b)(2)

42 U.S.C. §254c–2(b)(2)

Provides funding for research into the prevention and cure of type I diabetes.

Kavya Sekar

9/30/2025

Other

Special Diabetes Programs for Indians

PHSA §330C(c)(2)G)

42 U.S.C. §254c–3(c)(2)(G)

Provides funding for diabetes programs operated by the Indian Health Service or Indian Tribes, Tribal Organizations, or Urban Indian Organizations.

Elayne Heisler

9/30/2025

Other

Teaching Health Centers

PHSA §340H(g)(1)(F)

42 U.S.C. §256h(g)(1)(F)

Provides funding for graduate medical education payments for residents training in outpatient primary care- focused health facilities.

Elayne Heisler

9/30/2025

Other

National Advisory Committee on Children and Disasters

PHSA §2811A(g)

42 U.S.C. §300hh-10b(g)

Establishes the National Advisory Committee on Children and Disasters, an advisory committee whose responsibilities include providing consultation on the medical and public health needs of children in emergencies.

Hassan Sheikh

9/30/2025

Other

National Advisory Committee on Seniors and Disasters

PHSA §2811B(g)(1)

42 U.S.C. §300hh-10c(g)(1)

Establishes the National Advisory Committee on Seniors and Disasters, an advisory committee whose responsibilities include providing consultation on the specific medical and public health needs of seniors in emergencies.

Hassan Sheikh

9/30/2025

Other

National Advisory Committee on Individuals with Disabilities and Disasters

PHSA §2811C(g)(1)

42 U.S.C. §300hh-10d(g)(1)

Establishes the National Advisory Committee on Individuals with Disabilities and Disasters, an advisory committee whose responsibilities include providing consultation on the specific medical and public health needs of individuals with disabilities in emergencies.

Hassan Sheikh

9/30/2025

Other

National Disaster Medical System

PHSA §2812(c)(4)(B)

42 U.S.C. §300hh-11(c)(4)(B)

Authorizes the Secretary to directly appoint individuals to serve as intermittent personnel of the National Disaster Medical System (NDMS) if personnel are determined insufficient for a specific public health emergency or potential emergency.

Hassan Sheikh

9/30/2025

Other

Family-to-Family Health Information Centers

SSA§501(c)(1)(A)(vii)

42 U.S.C. §701(c)(1)(A)(vii)

Provides funding for education and peer support activities geared toward families of children with special health care needs.

Alexandria Mickler

9/30/2025

Other

Sexual Risk Avoidance Education Program

SSA §510

42 U.S.C. §710(a) and (f)

Provides funding to educate adolescents aged 10 to 20 exclusively on abstinence that teaches youth to voluntarily refrain from sexual activity.

Jessica Tollestrup

9/30/2025

Other

Personal Responsibility Education Program

SSA §513

42 U.S.C. §713(a) and (f)

Provides funding to educate adolescents aged 10 through 19 and pregnant and parenting youth under age 21 on both abstinence and contraceptives to prevent pregnancy and sexually transmitted infections.

Jessica Tollestrup

12/29/2025

Other

Increased Manufacturing Capacity for Certain Critical Antibiotic Drugs

CAA 2023 (P.L. 117-328, Division FF, Title II) §2411(e)

42 U.S.C. §247d-6b note

Allows the Secretary to award contracts to increase the domestic manufacturing capacity of certain antibiotic drugs or their active pharmaceutical ingredients or key starting materials.

Hassan Sheikh

12/31/2025

Medicare

Clinical Laboratory Fee Schedule

SSA §1834A(b)(3)(B)(ii)

42 U.S.C. §1395m-1(b)(3)(B)(ii)

Delays payment reductions due to the implementation of the revised Clinical Laboratory Fee Schedule methodology.

Jim Hahn

12/31/2025

Medicaid

ACA Medicaid Expansion FMAP Incentive

SSA §1905(ii)(3)

42 U.S.C. §1396d(ii)(3)

Provides a five-percentage-point increase to the regular FMAP rate for states implementing the ACA Medicaid expansion.

Alison Mitchell

12/31/2025

Private Health Insurance

Enhanced ACA Subsidy or Enhanced PTC

IRC §§36B(b)(3)(A)(iii) and (c)(1)(E)

26 U.S.C. §§36B(b)(3)(A)(iii) and (c)(1)(E)

Expands eligibility for and increased the amount of a federal tax credit which subsidizes the cost of qualified health insurance for eligible households.

Bernadette Fernandez

Source: Congressional Research Service (CRS).

Notes: "Secretary" refers to the HHS Secretary. ACA = Patient Protection and Affordable Care Act; ARPA = American Rescue Plan Act; BARDA = Biomedical Advanced Research and Development Authority; CAA 2023 = Consolidated Appropriations Act, 2023; CCBHC = Certified Community Behavioral Health Clinics; DSH = Disproportionate Share Hospital; FDA = Food and Drug Administration; FFDCA = Federal Food, Drugs, and Cosmetics Act; FOIA = Freedom of Information Act; FMAP = Federal Medical Assistance Percentage; FQHC = federally qualified health center; HHS = Department of Health and Human Services; IPPS = Inpatient Prospective Payment System; MIPPA = Medicare Improvements for Patients and Providers Act; NDMS = National Disaster Medical System; NHSC = National Health Service Corps; OMUFA = Over-the-Counter Monograph User Fee Act; PAMA = Protecting Access to Medicare Act; PHSA = Public Health Service Act; PTC = Premium Tax Credit; RHC = rural health center; SSA = Social Security Act; U.S.C. = U.S. Code.

a. Citations in statute and the U.S.C. are provided where available.

b. The Certified Community Behavioral Health Clinics (CCBHC) Medicaid Demonstration Program has multiple expiration dates depending on when states began the demonstration program. Other expiration dates are September 30, 2027, and December 31, 2027. For more information about the expiration dates for the groups of states participating in the CCBHC demonstration program, see CRS In Focus IF12494, Certified Community Behavioral Health Clinics (CCBHCs).

Table 2. Provisions Expiring in the 119th Congress (Second Session)

CY2026

Expires After

Health-Related Program

Provisiona

Statutory and/or U.S. Code Citation

Description

CRS Contact

6/30/2026

Medicare

Frontier Community Health Integration Project Demonstration

MIPPA §123

42 U.S.C. §1395i–4 note

Tests new models of integrated, coordinated health care in the most sparsely-populated rural counties, with the goal of improving health outcomes and reducing Medicare expenditures.

Marco Villagrana

7/4/2026

Medicaid

Federal Payments to Prohibited Entities

P.L. 119-21, Title VII, Subtitle B, Chapter 1, Subchapter A, §71113

Prohibits federal Medicaid spending for payments for items and services provided by "prohibited entities"b as defined therein for a one-year period beginning July 4, 2025.

Evelyne Baumrucker

9/30/2026

Medicare

Temporary Adjustment to LTCH Site Neutral Payment Rates

SSA §1886(m)(6)(B)

42 U.S.C. §1395ww(m)(6)(B)

Reduces the applicable Medicare site-neutral payment for non-LTCH cases provided by an LTCH.

Marco Villagrana

9/30/2026

Other

NIH Innovation Project- Precision Medicine Initiative

21st Century Cures Act (P.L. 114-255) §1001(b)(4)(A)

Authorizes annual appropriations from the NIH Innovation Account for the Precision Medicine Initiative (now All of Us research program), which aims to collect and study health data on more than 1 million people. These funds, in effect, do not count toward the discretionary spending limit in a given fiscal year.

Kavya Sekar

9/30/2026

Other

NIH Innovation Project- BRAIN Initiative

21st Century Cures Act (P.L. 114-255) §1001(b)(4)(B)

Authorizes annual appropriations from the NIH Innovation Account for the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative, which aims to develop and implement new technologies that enable an in-depth scientific understanding of the brain. These funds, in effect, do not count toward the discretionary spending limit in a given fiscal year.

Kavya Sekar

9/30/2026

Other

Protecting Infants and Improving Formula Supply

CAA 2023 (P.L. 117-328, Division FF, Title III) §3401

21 U.S.C. §350a–1(h)(3)

Requires infant formula manufacturers to adhere to certain reporting requirements following the initiation of an infant formula recall. Requires the Secretary to submit the aforementioned information and other components in a report to Congress.

Alexandria Mickler

9/30/2026

Other

Grants for Research on Therapies for ALS

P.L. 117-79, Accelerating Access to Critical Therapies for ALS Act, §2(f)

21 U.S.C. §360ee note

Authorizes the Secretary to award grants for research involving data from expanded access use of investigational amyotrophic lateral sclerosis drugs. NIH has implemented this provision.

Kavya Sekar

12/31/2026

Medicare

Advance Alternative Payment Model Bonus

SSA §1833(z)(1)(A)

42 U.S.C. §1395l(z)(1)(A)

Extends the bonus for qualifying alternative payment models at the rate of 1.88% in 2026 (3.5% in 2025).

Jim Hahn

12/31/2026

Medicare

Temporary Payment Increase under the Medicare Physician Fee Schedule to Account for Exceptional Circumstances

SSA §1848(t)(1)

42 U.S.C. §1395w-4(t)(1)

Provides an increase in payments made to physicians and nonphysician practitioners under the Medicare Physician Fee Schedule by 2.5% for services furnished during CY2026.

Jim Hahn

Source: Congressional Research Service (CRS).

Notes: "Secretary" refers to the HHS Secretary. ACA = Patient Protection and Affordable Care Act; ALS = amyotrophic lateral sclerosis; BRAIN = Brain Research through Advancing Innovative Neurotechnologies; CAA 2023 = Consolidated Appropriations Act, 2023; HHS = Health and Human Services; LTCH = long-term care hospital; MIPPA = Medicare Improvements for Patients and Providers Act; NHSC = National Health Service Corps; NIH = National Institutes of Health; PHSA = Public Health Service Act; SSA = Social Security Act; U.S.C. = U.S. Code.

a. Citations in statute and the U.S.C. are provided where available.

b. A prohibited entity is defined as an entity, including its affiliates, subsidiaries, successors, and clinics that (as of October 1, 2025) is a tax-exempt organization as described under Section 501(c)(3) of the Internal Revenue Code; that is an essential community provider, as described in 45 C.F.R. Section 156.235 (as in effect on July 4, 2025), that primarily provides family planning services, reproductive health and related medical care, and abortion services other than those allowable under the Hyde Amendment; and that received federal and state Medicaid reimbursements exceeding $800,000 in FY2023. For further information on this provision see CRS Report R48633, Health Provisions in P.L. 119-21, the FY2025 Reconciliation Law, coordinated by Alison Mitchell.

Table 3. Provisions That Expired in the 118th Congress

CY2023 and CY2024

Expired After

Health-Related Program

Provisiona

Statutory and/or U.S. Code Citation

Description

CRS Contact

3/31/2023

Medicaid

Extension of 100% FMAP to UIOs and Native Hawaiian Health Care Systems

SSA §1905(b)

42 U.S.C. §1396d(b)

Provided eight fiscal quarters of 100% federal reimbursement (i.e., fully federally funded) for Medicaid services received through (1) Urban Indian Organizations (UIOs) and (2) Native Hawaiian Health Centers for the period April 1, 2021, through March 31, 2023.

Alison Mitchell

9/30/2023

Other

NIH Innovation Project- Cancer Moonshot

21st Century Cures Act (P.L. 114-255), §1001(b)(4)(C))

Authorized annual appropriations from the NIH Innovation Account for the Cancer Moonshot initiative to advance cancer research. These funds, in effect, do not count toward the discretionary spending limit in a given fiscal year.

Kavya Sekar

9/30/2023

Other

Partnerships for State and Regional Hospital Preparedness to Improve Surge Capacity

PHSA §319C-2(j)(1)(B)(iii)

42 U.S.C. §247d-3b(j)(1)(B)(iii)

Allowed the Secretary to reserve up to 5% of funds appropriated for the Hospital Preparedness Program in a fiscal year to develop guidelines for regional health care emergency preparedness and response systems as authorized in PHSA Section 319C–3 (42 U.S.C. §247d-3c).

Hassan Sheikh

9/30/2023

Other

Demonstration Project for Regional Health Care Preparedness and Response Systems

PHSA §319C-3(e)(2)

42 U.S.C. §247d-3c

Allowed the Assistant Secretary for Preparedness and Response to establish a demonstration project to award grants to improve medical surge capacity for all hazards, build and integrate regional medical response capabilities, improve specialty care expertise, and coordinate medical preparedness and response across state, local, Tribal, territorial, and regional jurisdictions.

Hassan Sheikh

9/30/2023

Other

Funding for Childhood Obesity Demonstration Project

SSA §1139A(e)(8)

42 U.S.C. §1320b-9a(e)(8)

Provided $30 million annually in direct funding for the Childhood Obesity Demonstration Project, a Centers for Disease Control and Prevention program to develop and test strategies for reducing childhood obesity.

Alexa DeBoth

10/1/2023

Other

National Security Threat Priority Review Voucher

FFDCA §565A(g)

21 U.S.C. §360bbb-4a(g)

Allowed the Secretary to issue a priority review voucher upon approval of an application for a drug or biologic that qualifies as a material threat medical countermeasure, as specified.

Hassan Sheikh

11/27/2023

Other

Requirements (Pharmaceutical Distribution Supply Chain)

FFDCA §582(k)

21 U.S.C. §360eee-1(k)

Sunsetted several requirements related to the implementation of the Drug Supply Chain Security Act (P.L. 113-54, Title II).

Hassan Sheikh

12/31/2023

Medicare

Payments for Durable Medical Equipment under the Medicare Program

CAA 2023 (P.L. 117-328, Division FF, Title IV) §4139(a)

42 U.S.C. §1395m note

Increased Medicare payments for certain DMEPOS provided in areas other than rural areas or noncontiguous areas. The new payment was based on the sum of (1) 75% of the fee-schedule rate fully adjusted by competitive bidding, and (2) 25% of the unadjusted (higher) fee schedule rate.

Paulette Morgan

12/31/2023

Medicare

Home Health Prospective Payment System (PPS) Rural Add-on: Frontier Counties

MMA §421(b)(1)(B)

42 U.S.C. 1395fff note

Increased Medicare home health payments for services provided in low-population-density counties, referred to as "frontier counties," defined as rural counties with a population density of six or fewer individuals per square mile.

Varun Saraswathula

12/31/2023

Medicare

Extension of Pass-through Status Under the Medicare Program for Certain Devices Impacted by COVID-19

SSA §1833(t)(6)(K)

42 U.S.C. §1395l(t)(6)(K)

Extended the transitional pass-through for additional costs of innovative medical devices, drugs, and biologics under the Medicare outpatient prospective payment system for one year for certain devices.

Jim Hahn

12/31/2023

Medicare

Medicare IVIG Access Demonstration

SSA §§1861(s)(2)(Z) and (zz) and SSA §1842(o)(8)

42 U.S.C. §§1395x(s)(2)(Z) and (zz) and 42 U.S.C. §1395u(o)(8))

Required the Secretary to establish and implement a Medicare Part B demonstration to evaluate the benefit of in-home administration of intravenous immune globin for treating primary immune deficiency diseases.b

Laura Wreschnig

12/31/2023

Medicare

Medicare Independence at Home Demonstration Program

SSA §1866E(e)(1)

42 U.S.C. §1395cc-5(e)(1)

Tested the effectiveness of delivering comprehensive primary care services at home for Medicare beneficiaries with multiple chronic conditions, and to reward health care providers that provide high-quality care while reducing costs.

Jim Hahn

9/30/2024

Medicaid

Demonstration Project to Increase Substance Use Provider Capacity

SSA §1903(aa)(1)

42 U.S.C. §1396b(aa)(1)

Permitted the increase of treatment capacity for Medicaid providers providing substance use disorder treatment. Five states participated in the demonstration from September 30, 2021 to September 30, 2024.

Varun Saraswathula

9/30/2024

Other

Sale of Tobacco Products to Individuals Under the Age of 21 (Transitional Grants)

PHSA §1926(d)

42 U.S.C. §300x-26(d)

Provided funding for certain states to assist with efforts to prevent the sale of tobacco products to individuals under the age of 21.

Nora Wells

12/20/2024

Other

Rare Pediatric Disease Priority Review Voucher

FFDCA §529(b)(5)(A-B)

21 U.S.C. §360ff(b)(5)(A-B)

Allowed the Secretary to award a priority review voucher to sponsors of rare pediatric disease products that are approved and meet certain criteria.

Hassan Sheikh

12/31/2024

Medicare

Delay of Implementation of Oral-Only ESRD-Related Drugs in the ESRD Prospective Payment System

ATRA §632

42 U.S.C. 1395rr note

Included oral-only drugs related to the treatment of ESRD in the ESRD PPS bundled payment, instead of being included through the Medicare Part D benefit, beginning January 1, 2025.

Laura Wreschnig

12/31/2024

Medicare

Supporting Physicians and Other Professionals in Adjusting to Medicare Payment Changes During 2021

SSA §1848(t)(1)

42 U.S.C. §1395w-4(t)(1)

Increased payments made to providers under the Medicare Physician Fee Schedule by 2.93% from March 9, 2024, through December 31, 2024.

Jim Hahn

12/31/2024

Medicare

Opioid Use Disorder Treatment Demonstration Program

SSA §1866F

42 U.S.C. §1395cc–6

Required the Secretary to implement a four-year demonstration program to increase access of applicable beneficiaries to opioid use disorder treatment services, improve physical and mental health outcomes for such beneficiaries, and to the extent possible, reduce Medicare expenditures.

Laura Wreschnig

Source: Congressional Research Service (CRS)

Notes: "Frontier counties" are defined as rural counties with a population density of six or fewer individuals per square mile. "Secretary" refers to the HHS Secretary. ATRA = American Taxpayer Relief Act; CAA 2023 = Consolidated Appropriations Act, 2023; DMEPOS = Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, & Supplies; ESRD = end-stage renal disease; FFDCA = Federal Food, Drug, and Cosmetics Act; FMAP = Federal Medical Assistance Percentage; HHS = Department of Health and Human Services; IVIG = Intravenous immunoglobulin; MACPAC = Medicaid and CHIP Payment and Access Commission; MMA = Medicare Modernization Act; PHSA = Public Health Service Act; PPS = Prospective Payment System; SSA = Social Security Act; UIO = Urban Indian Organization; U.S.C. = U.S. Code.

a. Citations in statute and the U.S.C. are provided where available.

b. Section 4134 of the Consolidated Appropriations Act, 2023 (P.L. 117-328), made the intravenous immune globin in-home coverage permanent (as of January 1, 2024) with no need for patients or eligible suppliers to enroll in the demonstration.

The authors would like to thank Ada Cornell and Michele Malloy, Research Librarians, for their contributions to this report.

Footnotes

1.

This report is the latest in a series of reports in which the Congressional Research Service (CRS) has tracked health-expiring provisions related to Medicare, Medicaid, the State Children's Health Insurance Program (CHIP), or private health insurance. This is the first time this report has included public health and other health care-related provisions.

2.

Mandatory spending is controlled by authorization acts; discretionary spending is controlled by appropriations acts. For further information, see CRS Report R44582, Overview of Funding Mechanisms in the Federal Budget Process, and Selected Examples.

3.

For further information about these types of authorization provisions, see CRS Report R46417, Congress's Power Over Appropriations: Constitutional and Statutory Provisions.

4.

The Congressional Budget Office (CBO) is required to compile this information each year under §202(e)(3) of the Congressional Budget Act of 1974 (P.L. 93-344, as amended); see CBO, Expired and Expiring Authorizations of Appropriations: 2025 Final Report, July 10, 2025, at https://www.cbo.gov/publication/61289.

5.

For more information about the provisions in P.L. 119-21, the 2025 Reconciliation Act with implementation funding, see CRS Report R48633, Health Provisions in P.L. 119-21, the FY2025 Reconciliation Law.