H.R. 7767

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7767 Introduced in House (IH)]

<DOC>

119th CONGRESS
2d Session
H. R. 7767

To amend the Internal Revenue Code of 1986 to impose an annual tax on 
the net value of assets held by a taxpayer, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

March 3, 2026

Mr. Khanna introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committees on 
Energy and Commerce, Financial Services, and Education and Workforce, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
the committee concerned

_______________________________________________________________________

A BILL

To amend the Internal Revenue Code of 1986 to impose an annual tax on 
the net value of assets held by a taxpayer, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE, ETC.

(a) Short Title.--This Act may be cited as the ``Make Billionaires 
Pay Their Fair Share Act''.
(b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title, etc.
TITLE I--WEALTH TAX

Sec. 101. Imposition of tax on net value of assets.
Sec. 102. Enforcement.
TITLE II--AFFORDABILITY REBATES

Sec. 201. Affordability rebates.
TITLE III--HEALTH CARE PROVISIONS

Sec. 301. Repeal of reconciliation health provisions.
Sec. 302. Increase in eligibility for premium tax credit.
TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION

Sec. 401. Short title.
Sec. 402. Coverage of dental and oral health care.
Sec. 403. Providing coverage for hearing care under the Medicare 
program.
Sec. 404. Providing coverage for vision care under the Medicare 
program.
Sec. 405. Phase-in of impact of dental and oral health coverage on part 
B premiums.
TITLE V--HOUSING TRUST FUND

Sec. 501. Authorization of appropriations.
TITLE VI--AFFORDABLE CHILD CARE FOR WORKING FAMILIES

Sec. 601. Birth through five child care and early learning entitlement.
TITLE VII--ESTABLISHING A $60,000 A YEAR MINIMUM SALARY FOR EVERY 
PUBLIC SCHOOL TEACHER IN THE UNITED STATES

Sec. 701. Purposes.
Sec. 702. Definitions.
Sec. 703. Ensuring teachers are paid a livable and competitive wage.
Sec. 704. Collective bargaining and related rules.
TITLE VIII--INVESTMENTS IN HOME AND COMMUNITY-BASED SERVICES AND LONG-
TERM CARE QUALITY AND WORKFORCE

Sec. 801. HCBS improvement planning grants.
Sec. 802. HCBS Improvement Program.
Sec. 803. Funding for Federal activities related to Medicaid HCBS.
Sec. 804. Funding for HCBS quality measurement and improvement.
Sec. 805. Permanent extension of Medicaid protections against spousal 
impoverishment for recipients of home and 
community-based services.
Sec. 806. Permanent extension of Money Follows the Person Rebalancing 
demonstration.

TITLE I--WEALTH TAX

SEC. 101. IMPOSITION OF TAX ON NET VALUE OF ASSETS.

(a) In General.--The Internal Revenue Code of 1986 is amended by 
inserting after subtitle B the following new subtitle:

``Subtitle B-1--Wealth Tax

``Chapter 18--Determination of Wealth Tax

``CHAPTER 18--DETERMINATION OF WEALTH TAX

``Sec. 2901. Imposition of tax.
``Sec. 2902. Net value of assets.
``Sec. 2903. Special rules.
``Sec. 2904. Administrative provisions.

``SEC. 2901. IMPOSITION OF TAX.

``(a) In General.--In the case of an applicable taxpayer, there is 
hereby imposed a tax computed equal to 5 percent of the net value of 
assets held by the taxpayer for the calendar year.
``(b) Applicable Taxpayer.--
``(1) In general.--For purposes of this chapter, the term 
`applicable taxpayer' means any individual or trust if the net 
value of all assets held by the taxpayer for the calendar year 
exceeds $1,000,000,000.
``(2) Inflation adjustment.--
``(A) In general.--In the case of any calendar year 
after 2026, the $1,000,000,000 amount under paragraph 
(1) shall be increased by an amount equal to--
``(i) such dollar amount, multiplied by
``(ii) the cost-of-living adjustment 
determined under section 1(f)(3) for the 
calendar year in which the taxable year begins, 
determined by substituting in subparagraph 
(A)(ii) thereof `calendar year 2025' for 
`calendar year 2016'.
``(B) Rounding.--If any amount as adjusted under 
subparagraph (A) is not a multiple of $1,000,000, such 
dollar amount shall be rounded to the next lowest 
multiple of $1,000,000.
``(c) Treatment of Married Individuals.--For purposes of this 
section, individuals who are married (as defined in section 7703) shall 
be treated as one taxpayer.

``SEC. 2902. NET VALUE OF ASSETS.

``(a) In General.--The net value of assets held by an applicable 
taxpayer for any calendar year shall be the excess of--
``(1) the value of all property of the taxpayer, real or 
personal, tangible or intangible, wherever situated, on the 
last day of such calendar year (computed without regard to any 
debt owed by the taxpayer and secured by the property), over
``(2) the amount of any debt owed by the taxpayer on the 
last day of such calendar year.
``(b) Inclusion of Property of Related Children.--For purposes of 
this subtitle, any property of an individual who is a child of the 
taxpayer (as defined in section 152(f)(1)) and has not attained the age 
of 18 shall be treated as property held by the taxpayer for any 
calendar year before the year in which such individual attains the age 
of 18.
``(c) Establishment of Valuation Rules.--
``(1) Authority of secretary.--The Secretary shall 
establish rules and methods for determining the value of any 
asset for purposes of this subtitle.
``(2) General rules.--Except as otherwise provided in this 
paragraph, the rules and methods established under paragraph 
(1) may be similar to the rules of part III of subchapter A of 
chapter 11 (other than the rules of sections 2031(c), 2032A, 
2035, and 2044).
``(3) Rules for assets the value of which is not readily 
ascertainable.--
``(A) In general.--In the case of any property the 
value of which is not readily ascertainable, the 
Secretary may allow the taxpayer to elect to use a 
value which is equal to the most recent readily 
ascertainable value of such property increased by an 
average rate of appreciation applicable to assets of a 
similar class.
``(B) Limitation.--The Secretary may not allow a 
taxpayer to make an election under this paragraph for 
any calendar year if the taxpayer made an election 
under this paragraph for the preceding calendar year.

``SEC. 2903. SPECIAL RULES.

``(a) Deceased Individuals.--In the case of any individual who dies 
during a calendar year--
``(1) section 2901 shall be applied as if the calendar year 
ended on the day of the individual's death, and
``(2) the amount of the tax imposed under such section 
shall be reduced by an amount which bears the same ratio to 
such amount (determined without regard to this subsection) as--
``(A) the number of days in the calendar year after 
the date of the individual's death, bears to
``(B) 365.
``(b) Trusts.--
``(1) Grantor trusts.--If a grantor or another person is 
treated as the owner of any portion of a trust under subpart E 
of part I of subchapter J of chapter 1, then the grantor or 
such other person shall be treated as holding that portion of 
the assets of such trust, and any remaining portion shall be 
subject to tax as provided in section 2901.
``(2) Incomplete gifts.--In the case of any person who 
makes a transfer of property to a trust which is not treated as 
a gift for purposes of chapter 11, the portion of such trust 
attributable to such property shall be treated as the property 
of the person making the transfer and not the property of such 
trust.
``(3) Aggregation rules.--The rules of section 643(f) shall 
apply for purposes of this subtitle.
``(c) Application to Nonresidents.--
``(1) In general.--In the case of any taxpayer who is a 
nonresident and not a citizen of the United States, section 
2901(a) shall be applied by substituting `net value of domestic 
assets' for `net value of all assets'.
``(2) Net value of domestic assets.--For purposes of this 
subtitle, the term `net value of domestic assets' means--
``(A) the value of all property of the taxpayer, 
real or personal, tangible or intangible, situated in 
the United States (determined under rules similar to 
the rules under subchapter B of chapter 11), on the 
last day of such calendar year (computed without regard 
to any debt owed by the taxpayer and secured by the 
property), over
``(B) the amount of any debt owed by the taxpayer 
and secured by assets described in subparagraph (A), 
determined as of the last day of such calendar year.
``(3) Treatment of married individuals.--In the case of 
married individuals, this subsection shall only apply if both 
individuals are nonresidents and not citizens of the United 
States.
``(d) Application to Covered Expatriates.--
``(1) In general.--In the case of an applicable taxpayer 
who is a covered expatriate the expatriation date of which 
occurs during the calendar year--
``(A) section 2901 shall be applied as if the 
calendar year ended on the day before the expatriation, 
and
``(B) the rate of tax under 2901(a) for such 
calendar year shall be 60 percent.
``(2) Covered expatriate; expatriation date.--For purposes 
of this subsection--
``(A) Covered expatriate.--The term `covered 
expatriate' has the meaning given such term under 
section 877A, except that in the case of married 
individuals, such taxpayer shall be treated as a 
covered expatriate only if neither individual is a 
United States citizen or lawful permanent resident of 
the United States (within the meaning of section 
7701(b)(6)).
``(B) Expatriation date.--The term `expatriation 
date' has the meaning given such term under section 
877A(g)(3).

``SEC. 2904. ADMINISTRATIVE PROVISIONS.

``(a) Wealth Registry.--The Secretary shall establish a registry of 
ownership for assets taken into account under section 2902(a)(1), 
including publicly traded securities, digital assets, shares of closely 
held businesses, and real estate within the United States. For purposes 
of establishing and maintaining the registry under the preceding 
sentence, the Secretary shall--
``(1) rely on existing sources of information, including 
central depositories for securities and State, local, and 
foreign real property records; and
``(2) require timely reporting of newly acquired assets in 
conjunction with information required under existing 
information reporting requirements.
``(b) Information Reporting.--
``(1) In general.--The Secretary shall by regulations 
require the reporting of information concerning the value of 
assets, including--
``(A) the value of any accounts which pay interest 
reportable under section 6049,
``(B) the value of publicly traded stock with 
respect to which dividends are reported under section 
6042,
``(C) the value of any applicable privately held 
business,
``(D) the value of any assets held through mutual 
funds or brokerage accounts,
``(E) the value of any assets held in eligible 
retirement plans (as defined in section 402(c)(8)(B)), 
and
``(F) such other assets as the Secretary determines 
is appropriate.
``(2) Method of reporting.--The Secretary shall, where 
appropriate, require the reporting made under paragraph (1) to 
be made as a part of existing income reporting requirements.
``(3) Applicable privately held business.--For purposes of 
this subsection, the term `applicable privately held business' 
means any trade or businesses--
``(A) which does not meet the gross receipts test 
under section 448(c) for the taxable year ending with 
or within the calendar year,
``(B) in which an individual who was an applicable 
taxpayer (other than a covered expatriate, as defined 
in section 2903(d)(2)) for the preceding calendar year 
holds (directly or indirectly) 5 percent or more of the 
ownership interests (by value), and
``(C) to which paragraph (1)(B) does not apply.
``(c) Time for Payment of Tax.--The due date for returns with 
respect to the tax imposed under this subtitle shall be not later than 
the latest due date for which a return of tax under subtitle A would be 
due if the taxpayer's taxable year ended on December 31 and the 
taxpayer owed tax for such taxable year.''.
(b) No Deduction From Income Taxes.--Section 275 of the Internal 
Revenue Code of 1986 is amended by inserting after paragraph (6) the 
following new paragraph:
``(7) Taxes imposed by chapter 18.''.
(c) Information Reporting Penalties.--Section 6724(d)(1) of the 
Internal Revenue Code of 1986 is amended by striking ``and'' at the end 
of subparagraph (C), by striking the period at the end of subparagraph 
(D) and inserting ``, and'', and by inserting after subparagraph (D) 
the following new subparagraph:
``(E) any statement or return required to be filed 
under section 2904(b) which is not reported under any 
other provision of this paragraph.''.
(d) Clerical Amendment.--The table of subtitles of the Internal 
Revenue Code of 1986 is amended by inserting after the item relating to 
subtitle B the following new item:

``Subtitle B-1--Wealth Tax''.

(e) Effective Date.--The amendments made by this section shall 
apply to calendar years beginning after the date of the enactment of 
this Act.

SEC. 102. ENFORCEMENT.

(a) Standard.--The Secretary of the Treasury shall audit not less 
than 50 percent of taxpayers required to pay the tax imposed under 
section 2901 of the Internal Revenue Code of 1986 (as added by section 
101) in each calendar year.
(b) Funding.--There is hereby appropriated to each fiscal year 
ending after the date of the enactment of this Act, out of any moneys 
in the Treasury not otherwise appropriated, amounts equivalent to 1 
percent of the revenues attributable to the tax imposed under section 
2901 of the Internal Revenue Code of 1986 (as added by section 101) for 
necessary expenses for enforcement activities of the Internal Revenue 
Service to determine and collect taxes owed under such section.

TITLE II--AFFORDABILITY REBATES

SEC. 201. AFFORDABILITY REBATES.

(a) In General.--Section 6428B of the Internal Revenue Code of 1986 
is amended--
(1) in the heading, by striking ``2021 recovery rebates to 
individuals'' and inserting ``affordability rebates'',
(2) in subsection (a), by striking ``2021 an amount equal 
to the 2021 rebate amount'' and inserting ``2026 an amount 
equal to the affordability rebate amount'',
(3) by striking subsection (b) and inserting the following:
``(b) Affordability Rebate Amount.--For purposes of this section, 
the term `affordability rebate amount' means, with respect to any 
taxpayer for any taxable year, the sum of--
``(1) $3,000 ($6,000 in the case of a joint return), plus
``(2) $3,000 multiplied by the number of dependents of the 
taxpayer for such taxable year.'',
(4) in subsection (e)(2)--
(A) in subparagraph (A), by striking ``$1,400'' and 
inserting ``$3,000'', and
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by 
striking ``$2,800'' and inserting ``$6,000'', 
and
(ii) in clause (i), by striking ``$1,400'' 
and inserting ``$3,000'', and
(5) in subsection (g)--
(A) in paragraph (1), by striking ``2019'' and 
inserting ``2024'',
(B) in paragraph (2)(B), by striking ``January 1, 
2021'' each place it appears and inserting ``January 1, 
2026'',
(C) in paragraph (3), by striking ``December 31, 
2021'' and inserting ``December 31, 2026'',
(D) in paragraph (5)--
(i) in the heading, by striking ``2020'' 
and inserting ``2025'',
(ii) in subparagraph (A)--
(I) in the heading, by striking 
``2020'' and inserting ``2025'', and
(II) by striking ``beginning in 
2020, paragraph (1) shall be applied 
with respect to such individual by 
substituting `2020' for `2019''' and 
inserting ``beginning in 2025, 
paragraph (1) shall be applied with 
respect to such individual by 
substituting `2025' for `2024''', and
(iii) in subparagraph (B)--
(I) in clause (i), by striking 
``2020'' and inserting ``2025'',
(II) in clause (ii)--
(aa) in subclause (I), by 
striking ``2020'' and inserting 
``2025'', and
(bb) in subclause (II), by 
striking ``2021'' and inserting 
``2026'', and
(III) in clause (iii)--
(aa) in the heading, by 
striking ``2020'' and inserting 
``2025'', and
(bb) by striking ``2020'' 
each place it appears and 
inserting ``2025'', and
(E) in the heading of paragraph (6), by striking 
``2019 or 2020'' and inserting ``2024 or 2025''.
(b) Conforming Amendment.--The table of sections for subchapter B 
of chapter 65 of the Internal Revenue Code of 1986 is amended by 
striking the item relating to section 6428B and inserting the following 
new item:

``Sec. 6428B. Affordability rebates.''.

TITLE III--HEALTH CARE PROVISIONS

SEC. 301. REPEAL OF RECONCILIATION HEALTH PROVISIONS.

(a) In General.--Except as provided in subsection (b), subtitle B 
of title VII of An Act to provide for reconciliation pursuant to title 
II of H. Con. Res. 14 (Public Law 119-21) is repealed and any law or 
regulation referred to in such subtitle shall be applied as if such 
subtitle and the amendments made by such subtitle had not been enacted.
(b) Exceptions.--
(1) In general.--Subsection (a) shall not apply to the 
provisions of and amendments made by sections 71202, 71306, and 
71401 of such Act.
(2) Availability of funds allocated under the rural health 
transformation program.--Section 2105(h) of the Social Security 
Act (42 U.S.C. 1397ee(h)), as added by Public Law 119-21, is 
amended--
(A) in paragraph (1)(B)--
(i) in the subparagraph heading by striking 
``Unexpended or unobligated'' and inserting 
``Availability of'';
(ii) by striking clauses (i) through (iii) 
and inserting the following:
``(i) In general.--Subject to clause (ii), 
funds allocated to a State from amounts 
appropriated under subparagraph (A) shall 
remain available until expended.''; and
(iii) by redesignating clause (iv) as 
clause (ii); and
(B) in paragraph (2)(C), by striking ``paragraph 
(1)(B)(iv)'' and inserting ``paragraph (1)(B)(ii)''.

SEC. 302. INCREASE IN ELIGIBILITY FOR PREMIUM TAX CREDIT.

(a) In General.--Subparagraph (A) of section 36B(c)(1) of the 
Internal Revenue Code of 1986 is amended by striking ``but does not 
exceed 400 percent''.
(b) Applicable Percentages.--
(1) In general.--Subparagraph (A) of section 36B(b)(3) of 
the Internal Revenue Code of 1986 is amended to read as 
follows:
``(A) Applicable percentage.--The applicable 
percentage for any taxable year shall be the percentage 
such that the applicable percentage for any taxpayer 
whose household income is within an income tier 
specified in the following table shall increase, on a 
sliding scale in a linear manner, from the initial 
premium percentage to the final premium percentage 
specified in such table for such income tier:

------------------------------------------------------------------------
The initial The final
``In the case of household income (expressed premium premium
as a percent of poverty line) within the percentage percentage
following income tier: is-- is--
------------------------------------------------------------------------
Up to 150 percent............................. 0 0
150 percent up to 200 percent................. 0 2.0
200 percent up to 250 percent................. 2.0 4.0
250 percent up to 300 percent................. 4.0 6.0
300 percent up to 400 percent................. 6.0 8.5
400 percent and higher........................ 8.5 8.5.''.
------------------------------------------------------------------------

(2) Conforming amendments relating to affordability of 
coverage.--
(A) Paragraph (1) of section 36B(c) of such Code is 
amended by striking subparagraph (E).
(B) Subparagraph (C) of section 36B(c)(2) of such 
Code is amended by striking clause (iv).
(C) Paragraph (4) of section 36B(c) of such Code is 
amended by striking subparagraph (F).
(c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2025.

TITLE IV--MEDICARE DENTAL, HEARING, AND VISION EXPANSION

SEC. 401. SHORT TITLE.

This title may be cited as the ``Medicare Dental, Hearing, and 
Vision Expansion Act of 2026''.

SEC. 402. COVERAGE OF DENTAL AND ORAL HEALTH CARE.

(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (JJ), by striking ``and'' at the end;
(2) in subparagraph (KK), by inserting ``and'' after the 
semicolon; and
(3) by adding at the end the following new subparagraph:
``(LL) dental and oral health services (as defined in 
subsection (ooo));''.
(b) Dental and Oral Health Services Defined.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:
``(ooo) Dental and Oral Health Services.--
``(1) In general.--Except as provided in paragraph (2), the 
term `dental and oral health services' means the following 
items and services that are furnished by a doctor of dental 
surgery or of dental medicine (as described in subsection 
(r)(2)) or an oral health professional (as defined in paragraph 
(3)) on or after January 1, 2028 (or January 1, 2027, in the 
case of dentures):
``(A) Preventive and screening services.--
Preventive and screening services, including oral 
exams, dental cleanings, dental x-rays, and fluoride 
treatments.
``(B) Procedures and treatment services.--Services 
to address oral disease, including services such as 
restorative services, prosthodontic and endodontic 
services, including fillings, bridges, crowns, and root 
canals, periodontal maintenance, periodontal scaling 
and root planing, tooth extractions, therapeutic 
pulpotomy, and other related items and services.
``(C) Dentures and dental prosthetics.--Complete 
dentures, partial dentures, and implants, including 
related items and services.
``(2) Exclusions.--Such term does not include items and 
services for which, as of the date of the enactment of this 
subsection, coverage was permissible under section 1862(a)(12) 
and cosmetic services not otherwise covered under section 
1862(a)(10).
``(3) Oral health professional.--The term `oral health 
professional' means, with respect to dental and oral health 
services, a health professional (other than a doctor of dental 
surgery or of dental medicine (as described in subsection 
(r)(2))) who is licensed to furnish such services, acting 
within the scope of such license, by the State in which such 
services are furnished.''.
(c) Payment; Coinsurance; and Limitations.--
(1) In general.--Section 1833(a)(1) of the Social Security 
Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) in subparagraph (N), by inserting ``and dental 
and oral health services (as defined in section 
1861(ooo))'' after ``section 1861(hhh)(1))'';
(B) by striking ``and'' before ``(HH)''; and
(C) by inserting before the semicolon at the end 
the following: ``and (II) with respect to dental and 
oral health services (as defined in section 1861(ooo)), 
the amount paid shall be the payment amount specified 
under section 1834(bb)''.
(2) Payment and limits specified.--Section 1834 of the 
Social Security Act (42 U.S.C. 1395m) is amended by adding at 
the end the following new subsection:
``(bb) Payment and Limits for Dental and Oral Health Services.--
``(1) Payment.--The payment amount under this part for 
dental and oral health services (as defined in section 
1861(ooo)) shall be, subject to paragraphs (3) and (4), 80 
percent (or 100 percent, in the case of preventive and 
screening services described in section 1861(ooo)(1)(A)) of the 
lesser of--
``(A) the actual charge for the service; or
``(B)(i) in the case of such services furnished by 
a doctor of dental surgery or of dental medicine (as 
described in section 1861(r)(2)), the amount determined 
under the fee schedule established under paragraph (2); 
or
``(ii) in the case of such services furnished by an 
oral health professional (as defined in section 
1861(ooo)(3)), 85 percent of the amount determined 
under the fee schedule established under paragraph (2).
``(2) Establishment of fee schedule for dental and oral 
health services.--
``(A) Establishment.--
``(i) In general.--The Secretary shall 
establish a fee schedule for dental and oral 
health services furnished in 2028 (or 2027, in 
the case of dentures) and subsequent years. The 
fee schedule amount for a dental or oral health 
service shall be equal to 70 percent of the 
national median fee (as determined under 
subparagraph (B)) for the service or a similar 
service for the year (or, in the case of 
dentures, at the bundled payment amount under 
clause (iv) of such subparagraph), adjusted by 
the geographic adjustment factor established 
under section 1848(e)(2) for the area for the 
year.
``(ii) Consultation.--In carrying out this 
paragraph, the Secretary shall consult annually 
with organizations representing dentists and 
other providers who furnish dental and oral 
health services and shall share with such 
providers the data and data analysis used to 
determine fee schedule amounts under this 
paragraph.
``(B) Determination of national median fee.--
``(i) In general.--For purposes of 
subparagraph (A), the Secretary shall apply the 
national median fee for a dental or oral health 
service for 2028 (or 2027, in the case of 
dentures) and subsequent years in accordance 
with this subparagraph.
``(ii) Use of 2020 dental fee survey.--
``(I) In general.--Except as 
provided in clause (iii) and clause 
(iv), the national median fee for a 
dental or oral health service shall be 
equal to--
``(aa) for 2028 (or 2027, 
in the case of dentures), the 
median fee for the service in 
the table titled `General 
Practitioners-National' of the 
`2020 Survey of Dental Fees' 
published by the American 
Dental Association, increased 
by the applicable percent 
increase for the year 
determined under subclause 
(II), as reduced by the 
productivity adjustment under 
subclause (III); and
``(bb) for 2029 (or 2028, 
in the case of dentures) and 
subsequent years, the amount 
determined under this subclause 
for the preceding year, updated 
pursuant to subparagraph 
(C)(i).
``(II) Applicable percent 
increase.--The applicable percent 
increase determined under this 
subclause for a year is an amount equal 
to the percentage increase between--
``(aa) the consumer price 
index for all urban consumers 
(United States city average) 
ending with June of the 
previous year; and
``(bb) the consumer price 
index for all urban consumers 
(United States city average) 
ending with June of 2027 (or 
2026, in the case of dentures).
``(III) Productivity adjustment.--
After determining the applicable 
percentage increase under subclause 
(II) for a year, the Secretary shall 
reduce such percentage increase by the 
productivity adjustment described in 
section 1886(b)(3)(B)(xi)(II).
``(iii) Determination if insufficient 
survey data.--If the Secretary determines there 
is insufficient data under the Survey described 
in clause (ii) with respect to a dental or oral 
health service, the national median fee for the 
service for a year shall be equal to an amount 
established for the service using 1 or more of 
the following methods, as determined 
appropriate by the Secretary:
``(I) The payment basis determined 
under section 1848.
``(II) Fee schedules for dental and 
oral health services which shall 
include, as practicable, fee 
schedules--
``(aa) under Medicare 
Advantage plans under part C;
``(bb) under State plans 
(or waivers of such plans) 
under title XIX; and
``(cc) established by other 
health care payers.
``(iv) Special rule for dentures.--
``(I) In general.--The Secretary 
shall make payment for dentures and 
associated professional services as a 
bundled payment as determined by the 
Secretary.
``(II) Payment considerations.--In 
establishing such bundled payment, the 
Secretary shall consider the national 
median fee for the service for the year 
determined under clause (ii) or (iii) 
and the rate determined for such 
dentures under the Federal Supply 
Schedule of the General Services 
Administration, as published by such 
Administration in 2021, updated to the 
year involved using the applicable 
percent increase for the year 
determined under clause (ii)(II), as 
reduced by the productivity adjustment 
under clause (ii)(III), and shall 
ensure that the payment component for 
dentures under such bundled payment 
does not exceed the maximum rate 
determined for such dentures under the 
Federal Supply Schedule, as so 
published and updated to the year 
involved.
``(C) Annual update and adjustments.--
``(i) Annual update.--The Secretary shall 
update payment amounts determined under the fee 
schedule from year to year beginning in 2029 
(or 2028, in the case of dentures) by 
increasing such amounts from the prior year by 
the percentage increase in the consumer price 
index for all urban consumers (United States 
city average) for the 12-month period ending 
with June of the preceding year, reduced by the 
productivity adjustment described in section 
1886(b)(3)(B)(xi)(II).
``(ii) Adjustments.--
``(I) In general.--The Secretary 
shall, to the extent the Secretary 
determines to be necessary and subject 
to subclause (II), adjust the amounts 
determined under the fee schedule 
established under this paragraph for 
2029 (or 2028, in the case of dentures) 
and subsequent years to take into 
account changes in dental practice, 
coding changes, new data on work, 
practice, or malpractice expenses, or 
the addition of new procedures.
``(II) Limitation on annual 
adjustments.--The adjustments under 
subclause (I) for a year shall not 
cause the amount of expenditures under 
this part for the year to differ by 
more than $20,000,000 from the amount 
of expenditures under this part that 
would have been made if such 
adjustments had not been made.
``(3) Limitations.--With respect to dental and oral health 
services that are preventive and screening services described 
in paragraph (1)(A) of section 1861(ooo)--
``(A) payment shall be made under this part for--
``(i) not more than 2 oral exams in a year;
``(ii) not more than 2 dental cleanings in 
a year;
``(iii) not more than 1 fluoride treatment 
in a year; and
``(iv) not more than 1 full-mouth series of 
x-rays as part of a preventive and screening 
oral exam every 3 years; and
``(B) in the case of preventive and screening 
services not described in subparagraph (A), payment 
shall be made under this part only at such frequencies 
determined appropriate by the Secretary.
``(4) Incentives for rural providers.--In the case of 
dental and oral health services furnished by a doctor of dental 
surgery or of dental medicine (as described in section 
1861(r)(2)) or an oral health professional (as defined in 
section 1861(ooo)(3)) who predominantly furnishes such services 
under this part in an area that is designated by the Secretary 
(under section 332(a)(1)(A) of the Public Health Service Act) 
as a health professional shortage area, in addition to the 
amount of payment that would otherwise be made for such 
services under this subsection, there also shall be paid an 
amount equal to 10 percent of the payment amount for the 
service under this subsection for such doctor or professional.
``(5) Limitation on beneficiary liability.--The provisions 
of section 1848(g) shall apply to a nonparticipating doctor of 
dental surgery or of dental medicine (as described in section 
1861(r)(2)) who does not accept payment on an assignment-
related basis for dental and oral health services furnished 
with respect to an individual enrolled under this part in the 
same manner as such provisions apply with respect to a 
physician's service.
``(6) Establishment of dental administrator.--The Secretary 
shall designate 1 or more (not to exceed 4) medicare 
administrative contractors under section 1874A to establish 
coverage policies and establish such policies and process 
claims for payment for dental and oral health services, as 
determined appropriate by the Secretary.''.
(d) Inclusion of Oral Health Professionals as Certain 
Practitioners.--Section 1842(b)(18)(C) of the Social Security Act (42 
U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following 
new clause:
``(ix) With respect to 2029 and each subsequent year, an 
oral health professional (as defined in section 
1861(ooo)(3)).''.
(e) Exclusion Modifications.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y(a)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (O), by striking ``and'' at the 
end;
(B) in subparagraph (P), by striking the semicolon 
at the end and inserting ``, and''; and
(C) by adding at the end the following new 
subparagraph:
``(Q) in the case of dental and oral health services (as 
defined in section 1861(ooo)) for which a limitation is 
applicable under section 1834(bb)(3), which are furnished more 
frequently than is provided under such section;''; and
(2) in paragraph (12), by inserting before the semicolon at 
the end the following: ``and except that payment shall be made 
under part B for dental and oral health services that are 
covered under section 1861(s)(2)(LL)''.
(f) Inclusion as Excepted Medical Treatment.--Section 1821(b)(5)(A) 
of the Social Security Act (42 U.S.C. 1395i-5(b)(5)(A)) is amended--
(1) in clause (ii), by striking ``or'' at the end;
(2) in clause (iii), by striking the period and inserting 
``, or''; and
(3) by adding at the end the following new clause:
``(iv) consisting of dental and oral health 
services (as defined in subsection (ooo) of 
section 1861) that are payable under part B as 
a result of the amendments made by the Medicare 
Dental, Hearing, and Vision Expansion Act of 
2026.''.
(g) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Coverage of dental and oral health services.--Section 
1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)), is 
amended--
(A) in paragraph (1)--
(i) in subparagraph (C), by striking 
``and'' at the end;
(ii) in subparagraph (D), by inserting 
``and'' after the comma at the end; and
(iii) by inserting after subparagraph (D) 
the following new subparagraph:
``(E) dental and oral health services (as defined 
in subsection (ooo)) furnished by a doctor of dental 
surgery or of dental medicine (as described in 
subsection (r)(2)) or an oral health professional (as 
defined in subsection (ooo)(3)) who is employed by or 
working under contract with a rural health clinic if 
such rural health clinic furnishes such services,''; 
and
(B) in paragraph (3)(A), by striking ``(D)'' and 
inserting ``(E)''.
(2) Temporary payment rates for certain services under the 
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act 
(42 U.S.C. 1395l) is amended--
(i) in subsection (a)(3)(A), by inserting 
``(which shall, in the case of dental and oral 
health services (as defined in section 
1861(ooo)), in lieu of any limits on reasonable 
costs otherwise applicable, be based on the 
rates payable for such services under the 
payment basis determined under section 1848 
until such time as the Secretary determines 
sufficient data has been collected to otherwise 
apply such limits (or January 1, 2031, if no 
such determination has been made as of such 
date))'' after ``may prescribe in 
regulations''; and
(ii) by adding at the end the following new 
subsection:
``(ee) Disregard of Costs Attributable to Certain Services From 
Calculation of RHC AIR.--Payments for rural health clinic services 
other than dental and oral health services (as defined in section 
1861(ooo)) under the methodology for all-inclusive rates (established 
by the Secretary) under subsection (a)(3) shall not take into account 
the costs of such services while rates for such services are based on 
rates payable for such services under the payment basis established 
under section 1848.''.
(B) PPS.--Section 1834(o) of the Social Security 
Act (42 U.S.C. 1395m(o)) is amended by adding at the 
end the following new paragraph:
``(6) Temporary payment rates based on pfs for certain 
services.--The Secretary shall, in establishing payment rates 
for dental and oral health services (as defined in section 
1861(ooo)) that are Federally qualified health center services 
under the prospective payment system established under this 
subsection, in lieu of the rates otherwise applicable under 
such system, base such rates on rates payable for such services 
under the payment basis established under section 1848 until 
such time as the Secretary determines sufficient data has been 
collected to otherwise establish rates for such services under 
such system (or January 1, 2031, if no such determination has 
been made as of such date). Payments for Federally qualified 
health center services other than such dental and oral health 
services under such system shall not take into account the 
costs of such services while rates for such services are based 
on rates payable for such services under the payment basis 
established under section 1848.''.
(h) Implementation.--In addition to amounts otherwise available, 
there is appropriated to the Secretary of Health and Human Services for 
fiscal year 2026, out of any money in the Treasury not otherwise 
appropriated, $900,000,000, to remain available until expended, for 
purposes of implementing the amendments made by this section during the 
period beginning on January 1, 2026, and ending on September 30, 2035.

SEC. 403. PROVIDING COVERAGE FOR HEARING CARE UNDER THE MEDICARE 
PROGRAM.

(a) Provision of Audiology Services by Qualified Audiologists and 
Hearing Aid Examination Services by Qualified Hearing Aid 
Professionals.--
(1) In general.--Section 1861(ll) of the Social Security 
Act (42 U.S.C. 1395x(ll)) is amended--
(A) in paragraph (3)--
(i) by inserting ``(A)'' after ``(3)'';
(ii) in subparagraph (A), as added by 
clause (i) of this subparagraph--
(I) by striking ``means such 
hearing and balance assessment 
services'' and inserting ``means--
``(i) such hearing and balance assessment 
services and, beginning January 1, 2028, such 
hearing aid examination services and treatment 
services (including aural rehabilitation, 
vestibular rehabilitation, and cerumen 
management)'';
(II) in clause (i), as added by 
subclause (I) of this clause, by 
striking the period at the end and 
inserting ``; and''; and
(III) by adding at the end the 
following new clause:
``(ii) beginning January 1, 2028, such 
hearing aid examination services furnished by a 
qualified hearing aid professional (as defined 
in paragraph (4)(C)) as the professional is 
legally authorized to perform under State law 
(or the State regulatory mechanism provided by 
State law), as would otherwise be covered if 
furnished by a physician.''; and
(iii) by adding at the end the following 
new subparagraph:
``(B) Beginning January 1, 2028, audiology services 
described in subparagraph (A)(i) shall be furnished without a 
requirement for an order from a physician or practitioner.''; 
and
(B) in paragraph (4), by adding at the end the 
following new subparagraph:
``(C) The term `qualified hearing aid professional' 
means an individual who--
``(i) is licensed or registered as a 
hearing aid dispenser, hearing aid specialist, 
hearing instrument dispenser, or related 
professional by the State in which the 
individual furnishes such services; and
``(ii) is accredited by the National Board 
for Certification in Hearing Instrument 
Sciences or meets such other requirements as 
the Secretary determines appropriate (including 
requirements relating to educational 
certifications or accreditations) taking into 
account any additional relevant requirements 
for hearing aid specialists, hearing aid 
dispensers, and hearing instrument dispensers 
established by Medicare Advantage organizations 
under part C, State plans (or waivers of such 
plans) under title XIX, and group health plans 
and health insurance issuers (as such terms are 
defined in section 2791 of the Public Health 
Service Act).''.
(2) Payment for qualified hearing aid professionals.--
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 
1395l(a)(1)), as amended by section 402(c)(1), is amended--
(A) by striking ``and'' before ``(II)''; and
(B) by inserting before the semicolon at the end 
the following: ``and (JJ) with respect to hearing aid 
examination services (as described in paragraph 
(3)(A)(ii) of section 1861(ll)) furnished by a 
qualified hearing aid professional (as defined in 
paragraph (4)(C) of such section), the amounts paid 
shall be equal to 80 percent of the lesser of the 
actual charge for such services or 85 percent of the 
amount for such services determined under the payment 
basis determined under section 1848''.
(3) Inclusion of qualified audiologists and qualified 
hearing aid professionals as certain practitioners to receive 
payment on an assignment-related basis.--
(A) Qualified audiologists.--Section 1842(b)(18)(C) 
of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)), 
as amended by section 402(d), is amended by adding at 
the end the following new clause:
``(x) Beginning on January 1, 2028, a qualified audiologist 
(as defined in section 1861(ll)(4)(B)).''.
(B) Qualified hearing aid professionals.--Section 
1842(b)(18) of the Social Security Act (42 U.S.C. 
1395u(b)(18)) is amended--
(i) in each of subparagraphs (A) and (B), 
by striking ``subparagraph (C)'' and inserting 
``subparagraph (C) or, beginning on January 1, 
2028, subparagraph (E)''; and
(ii) by adding at the end the following new 
subparagraph:
``(E) A practitioner described in this subparagraph is a qualified 
hearing aid professional (as defined in section 1861(ll)(4)(C)).''.
(b) Coverage of Hearing Aids.--
(1) Inclusion of hearing aids as prosthetic devices.--
Section 1861(s)(8) of the Social Security Act (42 U.S.C. 
1395x(s)(8)) is amended by inserting ``, and including hearing 
aids (as described in section 1834(h)(7)) furnished on or after 
January 1, 2028, to individuals with moderately severe, severe, 
or profound hearing loss'' before the semicolon at the end.
(2) Payment limitations for hearing aids.--Section 1834(h) 
of the Social Security Act (42 U.S.C. 1395m(h)) is amended by 
adding at the end the following new paragraphs:
``(6) Payment only on an assignment-related basis.--Payment 
for hearing aids for which payment may be made under this part 
may be made only on an assignment-related basis. The provisions 
of subparagraphs (A) and (B) of section 1842(b)(18) shall apply 
to hearing aids in the same manner as they apply to services 
furnished by a practitioner described in subparagraph (C) of 
such section.
``(7) Limitations for hearing aids.--
``(A) In general.--Payment may be made under this 
part with respect to an individual, with respect to 
hearing aids furnished by a qualified hearing aid 
supplier (as defined in subparagraph (C)) on or after 
January 1, 2028--
``(i) not more than once per ear during a 
5-year period;
``(ii) only for types of such hearing aids 
that are determined appropriate by the 
Secretary; and
``(iii) only if furnished pursuant to a 
written order of a physician, qualified 
audiologist (as defined in section 
1861(ll)(4)), qualified hearing aid 
professional (as defined in subparagraph (C) of 
such section), physician assistant, nurse 
practitioner, or clinical nurse specialist.
``(B) Special rule.--The payment basis determined 
under this subsection (including after application of 
paragraph (1)(H), relating to application of 
competitive acquisition) for hearing aids furnished by 
a qualified hearing aid supplier on or after January 1, 
2028, shall not exceed the rate determined for such 
hearing aids under the Federal Supply Schedule of the 
General Services Administration, as published by such 
Administration in 2021, updated to the year involved 
using the applicable percent increase for the year.
``(C) Definitions.--In this subsection:
``(i) Hearing aid.--The term `hearing aid' 
means the item and related services including 
selection, fitting, adjustment, and patient 
education and training.
``(ii) Qualified hearing aid supplier.--The 
term `qualified hearing aid supplier' means--
``(I) a qualified audiologist;
``(II) a physician (as defined in 
section 1861(r)(1));
``(III) a physician assistant, 
nurse practitioner, or clinical nurse 
specialist;
``(IV) a qualified hearing aid 
professional (as defined in section 
1861(ll)(4)(C)); and
``(V) other suppliers as determined 
by the Secretary.''.
(3) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the 
Social Security Act (42 U.S.C. 1395m(h)(1)(H)) is 
amended--
(i) in the header, by inserting ``and 
hearing aids'' after ``orthotics'';
(ii) in the matter preceding clause (i), by 
inserting ``or of hearing aids described in 
paragraph (2)(E) of such section,'' after 
``2011,''; and
(iii) in clause (i), by inserting ``or such 
hearing aids'' after ``such orthotics''.
(B) Conforming amendments.--
(i) In general.--Section 1847(a)(2) of the 
Social Security Act (42 U.S.C. 1395w-3(a)(2)) 
is amended by adding at the end the following 
new subparagraph:
``(E) Hearing aids.--Hearing aids described in 
section 1861(s)(8) for which payment would otherwise be 
made under section 1834(h).''.
(ii) Exemption of certain items from 
competitive acquisition.--Section 1847(a)(7) of 
the Social Security Act (42 U.S.C. 1395w-
3(a)(7)) is amended by adding at the end the 
following new subparagraph:
``(C) Certain hearing aids.--Those items and 
services described in paragraph (2)(E) if furnished by 
a physician or other practitioner (as defined by the 
Secretary) to the physician's or practitioner's own 
patients as part of the physician's or practitioner's 
professional service.''.
(iii) Implementation.--Section 1847(a) of 
the Social Security Act (42 U.S.C. 1395w-3(a)) 
is amended by adding at the end the following 
new paragraph:
``(8) Competition with respect to hearing aids.--Not later 
than January 1, 2031, the Secretary shall begin the competition 
with respect to the items and services described in paragraph 
(2)(E).''.
(4) Physician self-referral law.--Section 1877(b) of the 
Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding 
at the end the following new paragraph:
``(6) Hearing aids and services.--In the case of hearing 
aid examination services and hearing aids--
``(A) furnished on or after January 1, 2028, and 
before January 1, 2030; and
``(B) furnished on or after January 1, 2030, if the 
financial relationship specified in subsection (a)(2) 
meets such requirements the Secretary imposes by 
regulation to protect against program or patient 
abuse.''.
(c) Exclusion Modification.--Section 1862(a)(7) of the Social 
Security Act (42 U.S.C. 1395y(a)(7)) is amended by inserting ``(except 
such hearing aids or examinations therefor as described in and 
otherwise allowed under section 1861(s)(8))'' after ``hearing aids or 
examinations therefor''.
(d) Inclusion as Excepted Medical Treatment.--Section 
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 402(f), is amended by inserting 
``, audiology services described in subsection (ll)(3) of such section, 
or hearing aids described in subsection (s)(8) of such section'' after 
``section 1861)''.
(e) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of audiology services as 
physicians' services.--Section 1861(aa)(1)(A) of the Social 
Security Act (42 U.S.C. 1395x(aa)(1)(A)) is amended by 
inserting ``(including audiology services (as defined in 
subsection (ll)(3)))'' after ``physicians' services''.
(2) Inclusion of qualified audiologists and qualified 
hearing aid professionals as rhc and fqhc practitioners.--
Section 1861(aa)(1)(B) of the Social Security Act (42 U.S.C. 
1395x(aa)(1)(B)) is amended by inserting ``or by a qualified 
audiologist or a qualified hearing aid professional (as such 
terms are defined in subsection (ll)),'' after ``(as defined in 
subsection (hh)(1)),''.
(3) Temporary payment rates for certain services under the 
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act 
(42 U.S.C. 1395l), as amended by section 402(g)(2)(A), 
is amended--
(i) in subsection (a)(3)(A), by inserting 
``or audiology services (as defined in section 
1861(ll)(3))'' after ``(as defined in section 
1861(ooo))''; and
(ii) in subsection (ee), by inserting ``or 
audiology services (as defined in section 
1861(ll)(3))'' after ``(as defined in section 
1861(ooo))''.
(B) PPS.--Section 1834(o)(6) of the Social Security 
Act (42 U.S.C. 1395m(o)(6)), as added by section 
402(g)(2)(B), is amended--
(i) in the first sentence, by inserting 
``or audiology services (as defined in section 
1861(ll)(3))'' after ``(as defined in section 
1861(ooo))''; and
(ii) in the second sentence, by inserting 
``or such audiology services'' after ``such 
dental and oral health services''.
(f) Expediting Implementation.--The Secretary of Health and Human 
Services shall implement this section for 2028 and 2029 through program 
instruction or other forms of program guidance.
(g) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2026, out of any money in the Treasury not otherwise appropriated, 
$370,000,000, to remain available until expended, for purposes of 
implementing the amendments made by this section during the period 
beginning on January 1, 2027, and ending on September 30, 2036.

SEC. 404. PROVIDING COVERAGE FOR VISION CARE UNDER THE MEDICARE 
PROGRAM.

(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)), as amended by section 402(a), is amended--
(1) in subparagraph (KK), by striking ``and'' at the end;
(2) in subparagraph (LL), by inserting ``and'' after the 
semicolon; and
(3) by adding at the end the following new subparagraph:
``(MM) vision services (as defined in subsection (ppp));''.
(b) Vision Services Defined.--Section 1861 of the Social Security 
Act (42 U.S.C. 1395x), as amended by section 402(b), is amended by 
adding at the end the following new subsection:
``(ppp) Vision Services.--The term `vision services' means routine 
eye examinations to determine the refractive state of the eyes, 
including procedures performed during the course of such examination, 
furnished on or after January 1, 2028, by or under the direct 
supervision of an ophthalmologist or optometrist who is legally 
authorized to furnish such examinations or procedures (as applicable) 
under State law (or the State regulatory mechanism provided by State 
law) of the State in which the examinations or procedures are 
furnished.''.
(c) Payment Limitations.--Section 1834 of the Social Security Act 
(42 U.S.C. 1395m), as amended by section 402(c)(2), is amended by 
adding at the end the following new subsection:
``(cc) Limitation for Vision Services.--With respect to vision 
services (as defined in section 1861(ppp)) and an individual, payment 
shall be made under this part for only 1 routine eye examination 
described in such subsection during a 2-year period.''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of 
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by 
inserting ``(2)(MM),'' before ``(3)''.
(e) Coverage of Conventional Eyeglasses.--Section 1861(s)(8) of the 
Social Security Act (42 U.S.C. 1395x(s)(8)), as amended by section 
403(b)(1), is amended by striking ``, and including one pair of 
conventional eyeglasses or contact lenses furnished subsequent to each 
cataract surgery with insertion of an intraocular lens'' and inserting 
``, including 1 pair of conventional eyeglasses or contact lenses 
furnished subsequent to each cataract surgery with insertion of an 
intraocular lens, if furnished before January 1, 2028, and including 
conventional eyeglasses (as described in section 1834(h)(8)), whether 
or not furnished subsequent to such a surgery, if furnished on or after 
January 1, 2028''.
(f) Special Payment Rules for Eyeglasses.--
(1) Limitations.--Section 1834(h) of the Social Security 
Act (42 U.S.C. 1395m(h)), as amended by section 403(b)(2), is 
amended by adding at the end the following new paragraph:
``(8) Payment limitations for eyeglasses.--
``(A) In general.--With respect to conventional 
eyeglasses furnished to an individual on or after 
January 1, 2028, subject to subparagraph (B), payment 
shall be made under this part only during a 2-year 
period, for 1 pair of eyeglasses (including lenses and 
the frame).
``(B) Exception.--With respect to a 2-year period 
described in subparagraph (A), in the case of an 
individual who receives cataract surgery with insertion 
of an intraocular lens, payment shall be made under 
this part for 1 pair of conventional eyeglasses 
furnished subsequent to such cataract surgery during 
such period.
``(C) Special rule.--The payment basis determined 
under this subsection (including after application of 
paragraph (1)(H), relating to application of 
competitive acquisition) for conventional eyeglasses 
furnished to an individual on or after January 1, 2028, 
shall not exceed the rate determined for such 
eyeglasses under the Federal Supply Schedule of the 
General Services Administration, as published by such 
Administration in 2021, updated to the year involved 
using the applicable percent increase for the year.
``(D) No coverage of certain items.--Payment shall 
not be made under this part for deluxe eyeglasses or 
conventional reading glasses.''.
(2) Application of competitive acquisition.--
(A) In general.--Section 1834(h)(1)(H) of the 
Social Security Act (42 U.S.C. 1395m(h)(1)(H)), as 
amended by section 403(b)(3)(A), is amended--
(i) in the heading, by striking ``and 
hearing aids'' and inserting ``hearing aids, 
and eyeglasses'';
(ii) in the matter preceding clause (i)--
(I) by striking ``or of hearing 
aids'' and inserting ``of hearing 
aids''; and
(II) by inserting ``or of 
eyeglasses described in paragraph 
(2)(F) of such section,'' after 
``paragraph (2)(E) of such section,''; 
and
(iii) in clause (i), by striking ``or such 
hearing aids'' and inserting ``, such hearing 
aids, or such eyeglasses''.
(B) Conforming amendment.--Section 1847(a)(2) of 
the Social Security Act (42 U.S.C. 1395w-3(a)(2)), as 
amended by section 403(b)(3)(B)(i), is amended by 
adding at the end the following new subparagraph:
``(F) Eyeglasses.--Eyeglasses described in section 
1861(s)(8) for which payment would otherwise be made 
under section 1834(h).''.
(C) Implementation.--Section 1847(a) of the Social 
Security Act (42 U.S.C. 1395w-3(a)), as amended by 
section 403(b)(3)(B)(iii), is amended by adding at the 
end the following new paragraph:
``(9) Competition with respect to eyeglasses.--Not later 
than January 1, 2030, the Secretary shall begin the competition 
with respect to the items and services described in paragraph 
(2)(F).''.
(g) Exclusion Modifications.--Section 1862(a) of the Social 
Security Act (42 U.S.C. 1395y(a)), as amended by section 402(e), is 
amended--
(1) in paragraph (1)--
(A) in subparagraph (P), by striking ``and'' at the 
end;
(B) in subparagraph (Q), by striking the semicolon 
at the end and inserting ``, and''; and
(C) by adding at the end the following new 
subparagraph:
``(R) in the case of vision services (as defined in section 
1861(ppp)) that are routine eye examinations as described in 
such section, which are furnished more frequently than once 
during a 2-year period;''; and
(2) in paragraph (7)--
(A) by inserting ``(other than such an examination 
that is a vision service that is covered under section 
1861(s)(2)(MM))'' after ``eye examinations''; and
(B) by inserting ``(other than such a procedure 
that is a vision service that is covered under section 
1861(s)(2)(MM))'' after ``refractive state of the 
eyes''.
(h) Inclusion as Excepted Medical Treatment.--Section 
1821(b)(5)(A)(iv) of the Social Security Act (42 U.S.C. 1395i-
5(b)(5)(A)(iv)), as added by section 402(f) and amended by section 
403(d), is amended--
(1) by striking ``or hearing aids'' and inserting ``hearing 
aids''; and
(2) by inserting ``, or vision services (as defined in 
subsection (ppp) of such section)'' after ``subsection (s)(8) 
of such section''.
(i) Rural Health Clinics and Federally Qualified Health Centers.--
(1) Clarifying coverage of vision services as physicians' 
services.--Section 1861(aa)(1)(A) of the Social Security Act 
(42 U.S.C. 1395x(aa)(1)(A)), as amended by section 403(e)(1), 
is amended by inserting ``and vision services (as defined in 
subsection (ppp))'' after ``(as defined in subsection 
(ll)(3))''.
(2) Temporary payment rates for certain services under the 
rhc air and fqhc pps.--
(A) AIR.--Section 1833 of the Social Security Act 
(42 U.S.C. 1395l), as amended by sections 402(g)(2)(A) 
and 403(e)(3)(A), is amended--
(i) in subsection (a)(3)(A)--
(I) by striking ``or audiology'' 
and inserting ``, audiology''; and
(II) by inserting ``, or vision 
services (as defined in section 
1861(ppp))'' after ``(as defined in 
section 1861(ll)(3))''; and
(ii) in subsection (ee)--
(I) by striking ``or audiology'' 
and inserting ``, audiology''; and
(II) by inserting ``, or vision 
services (as defined in section 
1861(ppp))'' after ``(as defined in 
section 1861(ll)(3))''.
(B) PPS.--Section 1834(o)(6) of the Social Security 
Act (42 U.S.C. 1395m(o)(6)), as added by section 
402(g)(2)(B) and amended by section 403(e)(3)(B), is 
amended--
(i) in the first sentence--
(I) by striking ``or audiology'' 
and inserting ``, audiology''; and
(II) by inserting ``, or vision 
services (as defined in section 
1861(ppp))'' after ``(as defined in 
section 1861(ll)(3))''; and
(ii) in the second sentence, by striking 
``or such audiology services'' and inserting 
``, such audiology services, or such vision 
services''.
(j) Expediting Implementation.--The Secretary of Health and Human 
Services shall implement this section for 2028 and 2029 through program 
instruction or other forms of program guidance.
(k) Funding.--In addition to amounts otherwise available, there is 
appropriated to the Secretary of Health and Human Services for fiscal 
year 2026, out of any money in the Treasury not otherwise appropriated, 
$500,000,000, to remain available until expended, for purposes of 
implementing the amendments made by this section during the period 
beginning on January 1, 2027, and ending on September 30, 2035.

SEC. 405. PHASE-IN OF IMPACT OF DENTAL AND ORAL HEALTH COVERAGE ON PART 
B PREMIUMS.

Section 1839(a) of the Social Security Act (42 U.S.C. 1395r(a)) is 
amended--
(1) in the second sentence of paragraph (1), by striking 
``and (7)'' and inserting ``(7), and (8)'';
(2) in paragraph (3), by striking ``The Secretary'' and 
inserting ``Subject to paragraph (8)(C), the Secretary''; and
(3) by adding at the end the following:
``(8) Special rule for 2027 through 2031.--
``(A) Determination of alternative monthly 
actuarial rate for each of 2027 through 2031.--For each 
of 2027 through 2031, the Secretary shall, at the same 
time as and in addition to the determination of the 
monthly actuarial rate for enrollees age 65 and over 
determined in each of 2026 through 2030 for the 
succeeding calendar year according to paragraph (1), 
determine an alternative monthly actuarial rate for 
enrollees age 65 and over for the year as described in 
subparagraph (B).
``(B) Alternative monthly actuarial rate 
described.--
``(i) In general.--The alternative monthly 
actuarial rate described in this subparagraph 
is--
``(I) for 2027 and 2028, the 
monthly actuarial rate for enrollees 
age 65 and over for the year, 
determined as if the amendments made by 
section 402 of the Medicare Dental, 
Hearing, and Vision Expansion Act of 
2026 did not apply; and
``(II) for 2029, 2030, and 2031, 
the monthly actuarial rate for 
enrollees age 65 and over for the year, 
determined as if the amendments made by 
such section 402 did not apply, plus 
the applicable percent of the amount by 
which--
``(aa) the monthly 
actuarial rate for enrollees 
age 65 and over for the year 
determined according to 
paragraph (1); exceeds
``(bb) the monthly 
actuarial rate for enrollees 
age 65 and over for the year, 
determined as if the amendments 
made by such section 402 did 
not apply.
``(ii) Definition of applicable percent.--
For purposes of this subparagraph, the term 
`applicable percent' means--
``(I) for 2029, 25 percent;
``(II) for 2030, 50 percent; and
``(III) for 2031, 75 percent.
``(C) Application to part b premium and other 
provisions of this part.--For each of 2027 through 
2031, the Secretary shall use the alternative monthly 
actuarial rate for enrollees age 65 and over for the 
year determined under subparagraph (A), in lieu of the 
monthly actuarial rate for such enrollees for the year 
determined according to paragraph (1), when determining 
the monthly premium rate for the year under paragraph 
(3) and subsection (j), the part B deductible under 
section 1833(b), and the premium subsidy and monthly 
adjustment amount under subsection (i).''.

TITLE V--HOUSING TRUST FUND

SEC. 501. AUTHORIZATION OF APPROPRIATIONS.

Section 1338(a) of the Federal Housing Enterprises Financial Safety 
and Soundness Act of 1992 (12 U.S.C. 4568(a)) is amended by adding at 
the end the following:
``(3) Authorization of appropriations.--There is authorized 
to be appropriated to the Housing Trust Fund $85,647,000,000 
for each of fiscal years 2026 through 2035.''.

TITLE VI--AFFORDABLE CHILD CARE FOR WORKING FAMILIES

SEC. 601. BIRTH THROUGH FIVE CHILD CARE AND EARLY LEARNING ENTITLEMENT.

(a) Child Care Definitions.--The definitions in section 658P of the 
Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n) 
shall apply to this section, except as provided in subsection (b) and 
as otherwise specified.
(b) Additional Definitions.--In this section:
(1) Child care certificate.--
(A) In general.--The term ``child care 
certificate'' means a certificate (that may be a check 
or other disbursement) that is issued by a State, 
tribal, territorial, or local government under this 
section directly to a parent who shall use such 
certificate only as payment for child care services or 
as a deposit for child care services if such a deposit 
is required of other children being cared for by the 
provider.
(B) Rule.--Nothing in this section shall preclude 
the use of such certificates for sectarian child care 
services if freely chosen by the parent. For the 
purposes of this section, child care certificates shall 
be considered indirect Federal financial assistance to 
the provider.
(2) Child experiencing homelessness.--The term ``child 
experiencing homelessness'' means an individual who is a 
homeless child or youth under section 725 of the McKinney-Vento 
Homeless Assistance Act (42 U.S.C. 11434a).
(3) Eligible activity.--The term ``eligible activity'', 
with respect to a parent, shall include, at minimum, activities 
consisting of--
(A) full-time or part-time employment;
(B) self-employment;
(C) job search activities;
(D) job training;
(E) secondary, postsecondary, or adult education, 
including education through a program of high school 
classes, a course of study at an institution of higher 
education, classes towards an equivalent of a high 
school diploma recognized by State law, or English as a 
second language classes;
(F) health treatment (including mental health and 
substance use treatment) for a condition that prevents 
the parent from participating in other eligible 
activities;
(G) activities to prevent child abuse and neglect, 
or family violence prevention or intervention 
activities;
(H) employment and training activities under the 
supplemental nutrition assistance program established 
under section 6(d)(4) of the Food and Nutrition Act of 
2008 (7 U.S.C. 2015(d)(4));
(I) employment and training activities under the 
Workforce Innovation and Opportunity Act (29 U.S.C. 
3101 et seq.);
(J) a work activity described in subsection (d) of 
section 407 of the Social Security Act (42 U.S.C. 607) 
for which, consistent with clauses (ii) and (iii) of 
section 402(a)(1)(A) of such Act (42 U.S.C. 
602(a)(1)(A)), a parent or caretaker is treated as 
being engaged in work for a month in a fiscal year for 
purposes of the program of block grants to States for 
temporary assistance for needy families established 
under part A of title IV of the Social Security Act (42 
U.S.C. 601 et seq.); and
(K) taking leave under the Family and Medical Leave 
Act of 1993 (29 U.S.C. 2601 et seq.) (or equivalent 
provisions for Federal employees), a State or local 
paid or unpaid leave law, or a program of employer-
provided leave.
(4) Eligible child.--
(A) In general.--The term ``eligible child'' means 
an individual--
(i) who is less than 6 years of age;
(ii) who is not yet in kindergarten;
(iii) whose family income does not exceed 
250 percent of the State median income for a 
family of the same size for the fiscal year 
involved, for each fiscal year beginning with 
fiscal year 2026; and
(iv) who--
(I) resides with a parent or 
parents who are participating in an 
eligible activity;
(II) is included in a population of 
vulnerable children identified by the 
lead agency involved, which at a 
minimum shall include children with 
disabilities, infants and toddlers with 
disabilities, children experiencing 
homelessness, children in foster care, 
children in kinship care, and children 
who are receiving, or need to receive, 
child protective services; or
(III) resides with a parent who is 
more than 65 years of age.
(B) Longer-term period eligibility.--For purposes 
of determining eligibility under this paragraph, an 
individual who is determined to be an eligible child 
shall continue to be considered an eligible child and 
shall not be required to reverify eligibility for 
purposes of this section during the period--
(i) that begins on the date of the 
determination; and
(ii) that ends on the earlier of the date 
the individual becomes 6 years of age or the 
date the individual enters kindergarten.
(5) Eligible child care provider.--
(A) In general.--The term ``eligible child care 
provider'' means a center-based child care provider, a 
family child care provider, or other provider of child 
care services for compensation that--
(i) is licensed to provide child care 
services under State law applicable to the 
child care services it provides or, in the case 
of an Indian Tribe or tribal organization, 
meets the rules set by the Secretary;
(ii) participates in the State's tiered 
system for measuring and supporting the quality 
of eligible child care providers described in 
subsection (f)(3)(B), or, in the case of an 
Indian Tribe or tribal organization, meets the 
rules set by the Secretary--
(I) not later than 3 years after 
the State first receives funds under 
this section; and
(II) for the remainder of the 
period for which the provider receives 
funds under this section; and
(iii) satisfies the State and local 
requirements, including those requirements 
described in section 658E(c)(2)(I) of the Child 
Care and Development Block Grant Act of 1990 
(42 U.S.C. 9858c(c)(2)(I)), applicable to the 
child care services it provides.
(B) Special rule.--A child care provider who is 
eligible to provide child care services in a State for 
children receiving assistance under the Child Care and 
Development Block Grant Act of 1990 (42 U.S.C. 9857 et 
seq.) on the date the State submits an application for 
funds under this section, and remains in compliance 
with any licensing or registration standards, or 
regulations, of the State, shall be deemed to be an 
eligible child care provider under this section for 3 
years after the State first receives funds under this 
section.
(6) FMAP.--The term ``FMAP'' has the meaning given the term 
``Federal medical assistance percentage'' in the first sentence 
of section 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)).
(7) Family child care provider.--The term ``family child 
care provider'' means one or more individuals who provide child 
care services, in a private residence other than the residences 
of the children involved, for less than 24 hours per day per 
child, or for 24 hours per day per child due to the nature of 
the work of the parent involved.
(8) Inclusive care.--The term ``inclusive'', with respect 
to care (including child care), means care provided by an 
eligible child care provider--
(A) for whom the percentage of children served by 
the provider who are children with disabilities or 
infants or toddlers with disabilities reflects the 
prevalence of children with disabilities and infants 
and toddlers with disabilities (whichever the provider 
serves) among children within the State involved; and
(B) that provides care and full participation for 
children with disabilities and infants and toddlers 
with disabilities (whichever the provider serves) 
alongside children who are--
(i) not children with disabilities; and
(ii) not infants and toddlers with 
disabilities.
(9) Infant or toddler.--The term ``infant or toddler'' 
means an individual who is less than 3 years of age.
(10) Infant or toddler with a disability.--The term 
``infant or toddler with a disability'' has the meaning given 
the term in section 632 of the Individuals with Disabilities 
Education Act (20 U.S.C. 1432).
(11) Lead agency.--The term ``lead agency'' means the 
agency designated under subsection (e).
(12) Provider type.--The term ``provider type'' means a 
type that is--
(A) a center-based child care provider;
(B) a family child care provider; or
(C) another non-center-based child care provider.
(13) Staffed family child care network.--The term ``staffed 
family child care network'' means a nonprofit organization or 
nonprofit cooperative--
(A) that may be a component of a child care 
resource and referral organization;
(B) that has at least one paid staff member; and
(C) that offers evidence-based professional 
development, quality improvement support, business 
support, and technical assistance, including on 
achieving licensure as a child care provider, to family 
child care providers.
(14) State.--The term ``State'' means any of the 50 States 
and the District of Columbia.
(15) Territory.--The term ``territory'' means the 
Commonwealth of Puerto Rico, the Virgin Islands of the United 
States, Guam, American Samoa, and the Commonwealth of the 
Northern Mariana Islands.
(c) Appropriations.--
(1) States, indian tribes and tribal organizations, and 
territories entitlement.--In addition to amounts otherwise 
available, there is appropriated to the Department of Health 
and Human Services for fiscal year 2026 and each subsequent 
fiscal year, out of any money in the Treasury not otherwise 
appropriated, such sums as may be necessary for payments to 
States, territories, and Indian Tribes and tribal organizations 
for carrying out the child care program described in this 
section (other than carrying out activities described in 
paragraph (2) or (3)).
(2) Grants to localities; awards to head start agencies.--
In addition to amounts otherwise available, there is 
appropriated to the Department of Health and Human Services for 
fiscal year 2026, out of any money in the Treasury not 
otherwise appropriated $20,000,000,000, to carry out the 
program of grants to localities, and the program of awards to 
Head Start agencies, described in subsection (i).
(3) Federal administration.--Notwithstanding paragraph (1) 
or (2), of the funds appropriated under this section for a 
fiscal year, the Secretary of Health and Human Services may 
reserve an amount equal to not more than 0.5 percent of the 
funds appropriated under this section for the prior fiscal 
year, for purposes of Federal administration of this section.
(d) Establishment of Birth Through Five Child Care and Early 
Learning Entitlement Program.--
(1) In general.--The Secretary is authorized to administer 
a child care and early learning entitlement program under which 
an eligible child, in a State, territory, or Indian Tribe, or 
served by a tribal organization, with an approved application 
under subsection (f) or (g), shall be provided an opportunity 
to obtain high-quality child care services, subject to the 
requirements of this section.
(2) Assistance for every eligible child.--Beginning on 
October 1, 2026, every child who applies for assistance under 
this section, who is in a State with an approved application 
under subsection (f), or in a territory or Indian Tribe or 
served by a tribal organization with an approved application 
under subsection (g), and who is determined, by a lead agency 
(or other entity designated by a lead agency) for the State, 
territory, Indian Tribe, or tribal organization involved, 
following standards and procedures established by the Secretary 
by rule, to be an eligible child, shall be offered assistance 
for and shall be entitled to receive direct child care services 
in accordance with and subject to the requirements and 
limitations of this section.
(e) Lead Agency.--The Governor of a State or the head of a 
territory or Indian Tribe, desiring for the State, territory, or Indian 
tribe or a related tribal organization to receive a payment under this 
section, shall designate a lead agency (such as a State agency or joint 
interagency office) to administer the child care program carried out 
under this section.
(f) Applications and State Plans.--
(1) Application.--To be eligible to receive assistance 
under this section, a State shall prepare and submit to the 
Secretary for approval an application containing a State plan 
that meets the requirements under paragraph (3) and contains 
such information as the Secretary may require.
(2) Period covered by plan.--A State plan contained in the 
application shall be designed to be implemented during a period 
of not more than 3 years.
(3) Requirements for state plans.--The Secretary shall 
award funds under this section to States with an approved 
application that contains a State plan, submitted under 
paragraph (1), at such time, in such manner, and containing 
such information as the Secretary shall by rule require, 
including, at a minimum, the following:
(A) Payment rates and cost estimation.--
(i) Payment rates.--The State plan shall 
certify that payment rates for the provision of 
direct child care services for which assistance 
is provided in accordance with this section for 
the period covered by the plan, within 3 years 
after the State first receives funds under this 
section--
(I) will be sufficient to meet the 
cost of child care (including fixed 
costs such as rent or mortgage, and 
salaries), and set (with pay being 
paid) in accordance with a cost 
estimation model or cost study 
described in clause (ii) that is 
approved by the Secretary; and
(II) will correspond to differences 
in quality (including improved quality) 
based on the State's tiered system for 
measuring and supporting the quality of 
eligible child care providers described 
in subparagraph (B).
(ii) Cost estimation.--Such State plan 
shall--
(I) demonstrate that the State has, 
after consulting with relevant entities 
and stakeholders, developed and uses a 
statistically valid and reliable cost 
estimation model or cost study for the 
payment rates for direct child care 
services in the State that are 
sufficient to cover providers' fixed 
costs and reflect the cost of child 
care at each of the tiers of the 
State's tiered system for measuring and 
supporting the quality of eligible 
child care providers described in 
subparagraph (B), and variations in the 
cost of direct child care services by 
geographic area, provider type, and age 
of child, and the additional costs 
associated with providing inclusive 
care;
(II) certify that the entities and 
stakeholders consulted included the 
State Advisory Council on Early 
Childhood Education and Care designated 
or established in section 
642B(b)(1)(A)(i) of the Head Start Act 
(42 U.S.C. 9837b(b)(1)(A)(i)) 
(including State Directors of Head 
Start Collaboration), administrators of 
local child care programs and Head 
Start agencies, organizations 
representing child care directors, 
teachers, and other staff, local child 
care resource and referral 
organizations, organizations 
representing parents of children with 
disabilities and parents of infants and 
toddlers with disabilities, the State 
interagency coordinating council 
established under section 641 of the 
Individuals with Disabilities Education 
Act (20 U.S.C. 1441), the State 
advisory panel established under 
section 612(a)(21) of the Individuals 
with Disabilities Education Act (20 
U.S.C. 1412(a)(21)), organizations and 
labor organizations representing child 
care providers, and other appropriate 
entities;
(III) certify that the State--
(aa) not later than 30 days 
after finalizing the cost 
estimation model or cost study, 
published a detailed report 
containing the child care costs 
estimated with the cost 
estimation model or cost study, 
and including an explanation 
detailing how the wage 
requirements described in 
subclause (IV)(cc) were applied 
in the estimation of such 
costs; and
(bb) not later than 60 days 
after publishing the report 
described in item (aa), 
established a system to receive 
public comment on the report on 
the subject of making changes 
to the cost estimation model or 
cost study, provided an 
opportunity for the public to 
comment on the report through 
that system, and submitted the 
report to the Secretary;
(IV) certify that the State's 
payment rates for direct child care 
services for which assistance is 
provided in accordance with this 
section--
(aa) are set (with pay 
being paid) in accordance with 
the most recent estimates from 
the most recent cost estimation 
model or cost study under 
subclause (I), so that 
providers at each tier of the 
tiered system for measuring and 
supporting the quality of 
eligible child care providers 
described in subparagraph (B) 
receive a payment that is 
sufficient to fully meet the 
requirements of such tier;
(bb) are set so as to 
provide payments to providers 
not at the top tier of the 
tiered system that are 
sufficient to enable the 
providers to increase quality 
to meet the requirements for 
the next tier;
(cc) ensure adequate wages 
for staff of child care 
providers providing such direct 
child care services that--

(AA) at a minimum, 
provide a living wage 
for all staff of such 
child care providers; 
and

(BB) are equivalent 
to wages for elementary 
educators with similar 
credentials and 
experience in the 
State; and

(dd) are adjusted on an 
annual basis for cost of living 
increases to ensure those 
payment rates remain sufficient 
to meet the requirements of 
this section;
(V) certify that the State will 
update, not less often than once every 
3 years, the cost estimation model or 
cost study described in subclause (I); 
and
(VI) certify that the State has 
established a system for appeals of the 
determination of child care costs 
estimated with the cost estimation 
model or cost study.
(iii) Payment practices.--Such State plan 
shall include an assurance that the State will 
implement payment practices that support the 
fixed costs of providing direct child care 
services.
(B) Tiered system for measuring and supporting the 
quality of eligible child care providers.--Such State 
plan shall certify that the State has implemented, or 
ensure that the State will implement within 3 years 
after first receiving funds under this section, with 
input (from early childhood education and development 
experts, from a diverse group of child care providers 
of a variety of provider types, from families, and from 
organizations representing child care directors, 
teachers, and other staff), a tiered system for 
measuring and supporting the quality of eligible child 
care providers who provide child care services for 
which assistance is made available under this section. 
Such tiered system shall--
(i) include a set of standards, for 
determining the tier of quality of a child care 
provider, that--
(I) uses standards for a highest 
tier that at a minimum are equivalent 
to Head Start program performance 
standards described in section 
641A(a)(1)(B) of the Head Start Act (42 
U.S.C. 9836a(a)(1)(B)) or other 
equivalent evidence-based standards 
approved by the Secretary; and
(II) includes quality indicators 
and thresholds that are appropriate for 
child development from child care 
providers of a variety of provider 
types, including child care centers and 
the settings of family child care 
providers, and are appropriate for 
providers serving different age groups 
(including mixed age groups) of 
children;
(ii) include a different set of standards 
that includes indicators, when appropriate, for 
care during nontraditional hours of operation; 
and
(iii) provide for sufficient resources and 
supports for child care providers at tiers 
lower than the highest tier to facilitate 
progression toward meeting higher quality 
standards.
(C) Achieving high quality for all children.--Such 
State plan shall certify the State has implemented, or 
will implement within 3 years after first receiving 
funds under this section, policies and financing 
practices that will ensure all eligible children can 
choose to attend child care, with services provided by 
eligible child care providers from any of a variety of 
provider types including family child care providers, 
at the highest quality tier within 6 years after the 
date of enactment of this Act.
(D) Compensation.--Such plan shall provide a 
certification that the State has or will have within 3 
years after first receiving funds under this section, a 
wage ladder for staff of eligible child care providers 
receiving assistance under this section, including a 
certification that wages for such staff, at a minimum, 
will meet the requirements of subparagraph 
(A)(ii)(IV)(cc).
(E) Sliding fee scale for copayments.--
(i) In general.--Except as provided in 
clause (ii)(I), the State plan shall provide an 
assurance that the State will for the period 
covered by the plan use a sliding fee scale 
described in clause (ii) to determine a 
copayment for a family receiving assistance 
under this section (or, for a family receiving 
part-time care, a reduced copayment that is the 
proportionate amount of the full copayment).
(ii) Sliding fee scale.--A full copayment 
described in clause (i) shall use a sliding fee 
scale that provides that, for a family with a 
family income--
(I) of not more than 85 percent of 
State median income for a family of the 
same size, the family shall not pay a 
copayment, toward the cost of the child 
care involved for all eligible children 
in the family;
(II) of more than 85 percent but 
not more than 100 percent of State 
median income for a family of the same 
size, the copayment shall be more than 
0 but not more than 2 percent of that 
family income, toward such cost for all 
such children;
(III) of more than 100 percent but 
not more than 125 percent of State 
median income for a family of the same 
size, the copayment shall be more than 
2 but not more than 4 percent of that 
family income, toward such cost for all 
such children;
(IV) of more than 125 percent but 
not more than 150 percent of State 
median income for a family of the same 
size, the copayment shall be more than 
4 but not more than 7 percent of that 
family income, toward such cost for all 
such children; and
(V) of more than 150 percent but 
not more than 250 percent of the State 
median income for a family of the same 
size, the copayment shall be 7 percent 
of that family income, toward such cost 
for all such children.
(F) Prohibition on charging more than copayment.--
The State plan shall certify that, after the State 
develops and begins using the cost estimation model or 
cost study described in subparagraph (A)(ii), the State 
will not permit a child care provider receiving 
financial assistance under this section to charge, for 
direct child care services for an eligible child, more 
than the total of--
(i) the financial assistance provided for 
the child under this section; and
(ii) any applicable copayment pursuant to 
subparagraph (E).
(G) Eligibility.--The State plan shall ensure that 
each child who receives assistance under this section 
will be considered to meet all eligibility requirements 
for such assistance, and will receive such assistance, 
for not less than 12 months unless the child has aged 
out of the program, and the child's eligibility 
determination and redetermination, including any 
determination based on the State's definition of 
eligible activities, shall be implemented in a manner 
that supports child well-being and reduces barriers to 
enrollment, including continuity of services.
(H) Policies to support access to child care for 
underserved populations.--The State plan shall 
demonstrate that the State will prioritize increasing 
access to, and the quality and the supply of, child 
care in the State for underserved populations, 
including at a minimum, low-income children, children 
in underserved areas, infants and toddlers, children 
with disabilities and infants and toddlers with 
disabilities, children who are dual language learners, 
children experiencing homelessness, children in foster 
or kinship care, children who receive care during 
nontraditional hours, and vulnerable children as 
defined by the lead agency pursuant to subsection 
(b)(4)(A)(iv)(II).
(I) Policies.--The State plan shall include a 
certification that the State will apply, under this 
section, the policies and procedures described in 
subparagraphs (A), (B), (I), (J), (K)(i), (R), and (U) 
of section 658E(c)(2) of the Child Care and Development 
Block Grant Act of 1990 (42 U.S.C. 9858c(c)(2)), and 
the policies and procedures described in section 658H 
of such Act (42 U.S.C. 9858f), to child care services 
provided under this section.
(J) Licensing.--The State plan shall demonstrate 
that the State has consulted or will consult with 
organizations (including labor organizations and child 
care and early learning organizations) representing 
eligible child care providers (including family child 
care providers), child care associations, child care 
directors, teachers, and other staff (including child 
care directors, teachers, and other staff serving 
higher proportions of underserved populations as 
identified under subparagraph (H)), early childhood 
education and development experts, maternal and child 
health experts, and families to develop, within 2.5 
years after first receiving funds under this section, 
licensing standards appropriate for child care 
providers and a pathway to such licensure that is 
available to and appropriate for child care providers 
in a variety of settings, that will offer providers 
eligible under the Child Care and Development Block 
Grant Act of 1990 (42 U.S.C. 9857 et seq.) a reasonable 
pathway to become eligible providers under this 
section, and that will ensure an adequate supply of 
child care. Such plan shall describe the timeline the 
State will use to ensure sufficient time for providers 
described in subsection (b)(5)(B) to comply with such 
licensing standards in order to remain eligible 
providers after 3.5 years after the State first 
receives funding under this section.
(K) Financial support for providers.--Such plan 
shall describe how the State will use funds reserved 
under subsection (h)(1)(C) to enable eligible child 
care providers from a variety of provider types to 
achieve licensure, including paying for the costs of 
required background checks, health screening, and 
initial and ongoing training, and other costs 
associated with achieving licensure.
(L) Prohibition on suspensions, expulsions, and 
aversive behavioral interventions.--The State plan 
shall provide an assurance that the State will--
(i) provide assistance to carry out this 
section only to eligible child care providers 
that prohibit--
(I) the use of suspension and 
expulsion of children; and
(II) the use of aversive behavioral 
interventions; and
(ii) provide training resources to eligible 
child care providers and information to 
families to support the prohibition of 
practices described in subclauses (I) and (II) 
of clause (i).
(g) Payments.--
(1) In general.--For each fiscal year:
(A) Child care assistance for eligible children.--
(i) In general.--The Secretary shall pay to 
each State with an approved application under 
subsection (f), and that State shall be 
entitled to, an amount for each quarter equal 
to 90 percent of expenditures (which shall be 
the Federal share of such expenditures) in the 
quarter for direct child care services 
described under subsection (h)(1)(B) for 
eligible children.
(ii) Exception.--Funds reserved from the 
total under subsection (h)(1)(C) shall be 
subject to subparagraph (B).
(iii) Prohibition.--Activities described in 
subparagraph (B) and subparagraph (C) may not 
be included in the cost of direct child care 
services described in this subparagraph.
(B) Activities to improve the quality and supply of 
child care services.--The Secretary shall pay to each 
State with such an approved application, and that State 
shall be entitled to, an amount equal to the FMAP of 
expenditures (which shall be the Federal share of such 
expenditures) to carry out activities to improve the 
quality and supply of child care services under 
subsection (h)(1)(C) subject to the limit specified in 
clause (i) of such subsection.
(C) Administration.--The Secretary shall pay to 
each State with such an approved application, and that 
State shall be entitled to, an amount equal to 50 
percent of expenditures (which shall be the Federal 
share of such expenditures) for the costs of 
administration incurred by the State--
(i) which shall include costs incurred by 
the State in carrying out the child care 
program established in this section; and
(ii) which may include, at the option of 
the State, costs associated with carrying out 
requirements, policies, and procedures 
described in section 658H of the Child Care and 
Development Block Grant Act of 1990 (42 U.S.C. 
9858f).
(2) Advance payment; retrospective adjustment.--For each 
fiscal year, the Secretary shall make payments under this 
subsection for a period on the basis of advance estimates of 
expenditures submitted by the State and such other 
investigation as the Secretary may find necessary, and shall 
reduce or increase the payments as necessary to adjust for any 
overpayment or underpayment for previous periods. No interest 
shall be charged or paid on any amount due because of an 
overpayment or underpayment for previous periods.
(3) Territories and tribes.--
(A) In general.--For each fiscal year, from amounts 
appropriated under subsection (c)(1), the Secretary 
shall make payments to territories, and Indian Tribes 
and tribal organizations, as the case may be, with 
applications submitted as described in subparagraph 
(B), and approved by the Secretary for the purpose of 
carrying out the child care program described in this 
section, consistent, to the extent practicable as 
determined by the Secretary (subject to subsection 
(d)(2)), with the requirements applicable to States.
(B) Applications.--
(i) Territories.--A territory seeking a 
payment under this paragraph shall submit an 
application to the Secretary at such time, in 
such manner, and containing such information as 
the Secretary may specify.
(ii) Indian tribes and tribal 
organizations.--An Indian Tribe or a tribal 
organization seeking a payment under this 
paragraph shall submit an application to the 
Secretary at such time, in such manner, and 
containing such information as the Secretary 
may specify.
(C) Costs.--The Secretary shall make the payments 
to such territories, Indian Tribes, and tribal 
organizations on the basis of their relative need. Each 
entity that is such a territory, Indian Tribe, or 
tribal organization shall be entitled to such a payment 
as may be necessary to pay for 100 percent of the 
expenses of carrying out the activities described in 
subsection (h)(1), and to pay for 100 percent of the 
costs of administration incurred by the entity, which 
shall include costs incurred by the entity in carrying 
out the child care program, and which may include, at 
the option of the entity, costs associated with 
carrying out requirements, policies, and procedures 
described in section 658H of the Child Care and 
Development Block Grant Act of 1990 (42 U.S.C. 9858f).
(h) Use of Funds.--
(1) Use of funds.--
(A) In general.--Starting on October 1, 2026, a 
State shall use amounts provided to the State under 
subsection (g)(1) for direct child care services 
(provided on a sliding fee scale basis), activities to 
improve the quality and supply of child care services 
consistent with subparagraph (C), and State 
administration consistent with subsection (g)(1)(C).
(B) Child care assistance for eligible children.--
(i) In general.--For fiscal year 2026 and 
each subsequent fiscal year, from payments made 
to the State under subsection (g)(1) for that 
particular fiscal year, the State shall ensure 
that parents of eligible children can access 
direct child care services provided by an 
eligible child care provider under this section 
through a grant or contract as described in 
clause (ii) or a certificate as described in 
clause (iii).
(ii) Grants and contracts.--The State shall 
award grants or contracts to eligible child 
care providers, consistent with the 
requirements under this section, for the 
provision of child care services for eligible 
children under this section that, at a 
minimum--
(I) support providers' operating 
expenses to meet and sustain health, 
safety, quality, licensing, and wage 
standards required under this section; 
and
(II) address underserved 
populations described in subsection 
(f)(3)(H).
(iii) Certificates.--The State shall issue 
a child care certificate directly to a parent 
who shall use such certificate only as payment 
for direct child care services or as a deposit 
for direct child care services if such a 
deposit is required of other children being 
cared for by the provider, consistent with the 
requirements under this section.
(C) Activities to improve the quality and supply of 
child care services.--
(i) Quality child care activities.--
(I) Amount.--For fiscal year 2026 
and each subsequent fiscal year, from 
the total of the payments made to the 
State for a particular fiscal year, the 
State shall reserve and use a quality 
child care amount equal to not less 
than 5 percent and not more than 10 
percent of the amount made available to 
the State through such payments for the 
previous fiscal year.
(II) Use of quality child care 
amount.--Each State shall use the 
quality child care amount described in 
subclause (I) to implement activities 
described in this subparagraph to 
improve the quality and supply of child 
care services by eligible child care 
providers, and increase the number of 
available slots in the State for child 
care services funded under this 
section, prioritizing assistance for 
child care providers who are in 
underserved communities and who are 
providing, or are seeking to provide, 
child care services for underserved 
populations identified in subsection 
(f)(3)(H).
(III) Administration.--Activities 
funded under this subparagraph may be 
administered--
(aa) directly by the lead 
agency; or
(bb) through other State 
government agencies, local or 
regional child care resource 
and referral organizations, 
community development financial 
institutions, other 
intermediaries with experience 
supporting child care 
providers, or other appropriate 
entities that enter into a 
contract with the State to 
provide such assistance.
(ii) Quality and supply activities.--
Activities funded under the quality child care 
amount described in clause (i) shall include 
each of the following:
(I) Startup grants and supply 
expansion grants.--
(aa) In general.--From a 
portion of the quality child 
care amount, a State shall make 
startup and supply expansion 
grants to support child care 
providers who are providing, or 
seeking to provide, child care 
services to children receiving 
assistance under this section, 
with priority for providers 
providing or seeking to provide 
child care in underserved 
communities and for underserved 
populations identified in 
subsection (f)(3)(H), to--

(AA) support 
startup and expansion 
costs; and

(BB) assist such 
providers in meeting 
health and safety 
requirements, achieving 
licensure, conducting 
background checks, and 
meeting requirements in 
the State's tiered 
system for measuring 
and supporting the 
quality of eligible 
child care providers.

(bb) Requirement.--As a 
condition of receiving a 
startup or supply expansion 
grant under this subclause, a 
child care provider shall 
commit to meeting the 
requirements of an eligible 
provider under this section, 
and providing child care 
services to children receiving 
assistance under this section 
on an ongoing basis.
(II) Quality grants.--From a 
portion of the quality child care 
amount, a State shall provide quality 
grants to support eligible child care 
providers in providing child care 
services to children receiving 
assistance under this section to 
improve the quality of such providers, 
including--
(aa) supporting such 
providers in meeting or making 
progress toward the 
requirements for the highest 
tier of the State's tiered 
system for measuring and 
supporting the quality of 
eligible child care providers 
under subsection (f)(3)(B); and
(bb) supporting such 
providers in sustaining child 
care quality, including 
supporting increased wages for 
staff and supporting payment of 
fixed costs.
(III) Facilities grants.--
(aa) In general.--From a 
portion of the quality child 
care amount, a State shall 
provide support, including 
through awarding facilities 
grants, for remodeling, 
renovation, or repair of a 
building or facility to the 
extent permitted under section 
658F(b) of the Child Care and 
Development Block Grant Act of 
1990 (42 U.S.C. 9858d(b)).
(bb) Additional uses.--For 
fiscal year 2026 and subsequent 
fiscal years, a State may award 
such facilities grants for 
construction, permanent 
improvement, or major 
renovation of a building or 
facility primarily used for 
providing direct child care 
services, in accordance with 
the following:

(AA) Federal 
interest provisions 
will not apply to the 
renovation or 
rebuilding of privately 
owned family child care 
homes under this 
subclause.

(BB) Eligible child 
care providers may not 
use funds for buildings 
or facilities that are 
used primarily for 
sectarian instruction 
or religious worship.

(CC) The Secretary 
shall develop 
parameters on the use 
of funds under this 
subclause for family 
child care homes.

(DD) The Secretary 
shall not retain 
Federal interest after 
a period of 10 years in 
any facility built, 
renovated, or repaired 
with funds awarded 
under this subclause.

(IV) State activities to improve 
the quality of child care services.--A 
State shall use a portion of the 
quality child care amount to improve 
the quality of child care services 
available for this program, which shall 
include--
(aa) supporting the 
training and professional 
development of the early 
childhood workforce, including 
supporting degree attainment, 
continued education, and 
credentialing for early 
childhood educators;
(bb) developing, 
implementing, or enhancing the 
State's tiered system for 
measuring and supporting the 
quality of eligible child care 
providers under subsection 
(f)(3)(B);
(cc) improving the supply 
and quality of developmentally 
appropriate and inclusive child 
care programs and services for 
underserved populations 
described in subsection 
(f)(3)(H);
(dd) improving access to 
child care services for 
vulnerable children as defined 
by the lead agency pursuant to 
subsection (b)(4)(A)(iv)(II);
(ee) providing outreach and 
enrollment support for families 
of eligible children;
(ff) supporting eligible 
child care providers to 
eliminate use of suspensions, 
expulsions, and aversive 
behavioral interventions, 
including through adaptations 
and interventions by special 
educators, mental health 
consultants, and other 
community resource personnel, 
such as behavior coaches, 
psychologists, and other 
appropriate specialists, and 
through the provision of mental 
health services for the 
providers;
(gg) improving coordination 
between States and local 
government with respect to 
licensing and other regulatory 
requirements for eligible child 
care providers; and
(hh) establishing or 
supporting a system of local or 
regional child care resource 
and referral organizations that 
is coordinated, to the extent 
determined appropriate by the 
State, by a statewide public or 
private nonprofit, community-
based or regionally based, lead 
child care resource and 
referral organization, as 
described in section 
658E(c)(3)(B)(iii) of the Child 
Care and Development Block 
Grant Act of 1990 (42 U.S.C. 
9858c(c)(3)(B)(iii)).
(V) Technical assistance.--From a 
portion of the quality child care 
amount, the State, in coordination with 
local governments and staffed family 
child care networks as appropriate, 
shall provide technical assistance to 
increase the supply and quality of 
eligible child care providers who are 
providing, or seeking to provide, child 
care services to children receiving 
assistance under this section, 
including providing support to enable 
providers to achieve licensure.
(i) Grants to Localities and Awards to Head Start Programs.--
(1) Eligible locality defined.--In this subsection, the 
term ``eligible locality'' means a city, county, or other unit 
of general local government.
(2) Grants to localities.--
(A) In general.--After reserving a portion of the 
funds appropriated under subsection (c)(2), the 
Secretary shall use the portion to award local Birth 
Through Five Child Care and Early Learning Grants, as 
determined by the Secretary, to eligible localities 
located in States that have not received payments under 
subsection (g). The Secretary shall award the grants to 
eligible localities in such a State from the allotment 
made for that State under subparagraph (B).
(B) Allotments.--
(i) Poverty line defined.--In this 
subparagraph, the term ``poverty line'' means 
the poverty line defined and revised as 
described in section 673 of the Community 
Services Block Grant Act (42 U.S.C. 9902).
(ii) General authority.--For each State 
described in subparagraph (A), the Secretary 
shall allot for the State for a fiscal year an 
amount that bears the same relationship to the 
portion described in subparagraph (A) for the 
fiscal year as the number of children from 
families with family incomes that are at or 
below 200 percent of the poverty line, and who 
are under the age of 6, in the State bears to 
the total number of all such children in all 
States described in subparagraph (A).
(C) Application.--To receive a grant from the 
corresponding State allotment under subparagraph (B), 
an eligible locality shall submit an application to the 
Secretary at such time, in such manner, and containing 
such information as the Secretary may require. The 
requirements for the application shall, to the greatest 
extent practicable, be consistent with the State plan 
requirements applicable to States under subsection (f).
(D) Requirements.--The Secretary shall specify the 
requirements for an eligible locality to provide access 
to child care, which child care requirements shall, to 
the greatest extent practicable, be consistent with the 
requirements applicable to States under this section.
(E) Recoupment of unused funds.--Notwithstanding 
any other provision of this section, for each of fiscal 
years 2026 through 2030, the Secretary shall have the 
authority to recoup any unused funds allotted under 
subparagraph (B) for awards under paragraph (3)(A) to 
Head Start agencies in accordance with paragraph (3).
(3) Head start expansion in nonparticipating states.--
(A) In general.--The Secretary shall use funds 
appropriated under subsection (c)(2) and not reserved 
under paragraph (2)(A) and funds recouped under 
paragraph (2) to make awards to Head Start agencies in 
a State described in paragraph (2)(A) to carry out the 
purposes of the Head Start Act (42 U.S.C. 9831 et seq.) 
in such State.
(B) Rule.--For purposes of carrying out the Head 
Start Act in circumstances not involving awards under 
this paragraph, funds awarded under subparagraph (A) 
shall not be included in the calculation of a ``base 
grant'' as such term is defined in section 640(a)(7)(A) 
of the Head Start Act (42 U.S.C. 9835(a)(7)(A)).
(C) Definition.--In this paragraph, the term ``Head 
Start agency'' means an entity designated or eligible 
to be designated as a Head Start agency under section 
641(a)(1) of the Head Start Act (42 U.S.C. 9836(a)(1)) 
or as an Early Head Start agency (by receiving a grant) 
under section 645A(a) of such Act (42 U.S.C. 
9840a(a)(1)).
(4) Priority for serving underserved populations.--In 
making determinations to award a grant or make an award under 
this subsection, the Secretary shall give priority to entities 
serving a high percentage of individuals from underserved 
populations described in subsection (f)(3)(H).
(j) Program Requirements.--
(1) Prohibition on additional eligibility requirements.--No 
individual shall be determined, by the Secretary, a State, or 
another recipient of funds under this section, to be ineligible 
for child care services provided under this section, except on 
the basis of eligibility requirements specified in or under 
this section.
(2) Maintenance of effort.--
(A) In general.--A State that receives payments 
under this section for a fiscal year, in using the 
funds made available through the payments, shall 
maintain the expenditures of the State for child care 
services at the average level of such expenditures by 
the State for the 3 preceding fiscal years.
(B) Counting rule.--State expenditures counted for 
purposes of meeting the requirement in subparagraph (A) 
may also be counted for purposes of meeting the 
requirement to provide a non-Federal share under 
subparagraph (A), (B), or (C), as appropriate, of 
subsection (g)(1).
(3) Supplement not supplant.--Funds received under this 
section shall be used to supplement and not supplant other 
Federal, State, and local public funds expended to provide 
child care services in the State on the date of enactment of 
this Act, calculated as the average amount of such Federal, 
State, and local public funds expended for fiscal year 2026 and 
each subsequent fiscal year that ended before the date on which 
the average is calculated.
(4) Allowable sources of non-federal share.--For purposes 
of providing the non-Federal share required under subsection 
(g)(1), a State's non-Federal share--
(A) for direct child care services described in 
subsection (g)(1)(A)--
(i) shall not include contributions being 
used as a non-Federal share or match for 
another Federal award; and
(ii) shall be provided from State or local 
sources, contributions from philanthropy or 
other private organizations, or a combination 
of such sources and contributions; and
(B) for activities to improve the quality and 
supply of child care services described in subsection 
(g)(1)(B), and administration described in subsection 
(g)(1)(C)--
(i) shall not include contributions being 
used as a non-Federal share or match for 
another Federal award;
(ii) shall be provided from State or local 
sources, contributions from philanthropy or 
other private organizations, or a combination 
of such sources and contributions; and
(iii) may be in cash or in kind, fairly 
evaluated, including facilities or property, 
equipment, or services.
(5) Reports.--A State, Indian Tribe, tribal organization, 
or territory receiving funds under this section shall provide 
to the Secretary such periodic reports, providing a detailed 
accounting of the uses of the funds received under this 
section, as the Secretary may require for the administration of 
this section. The State, Indian Tribe, tribal organization, or 
territory shall begin to provide the reports beginning not 
later than 60 days after its initial receipt of a payment under 
subsection (g).
(k) Monitoring and Enforcement.--
(1) Review of compliance with requirements and state 
plan.--The Secretary shall review and monitor compliance of 
States, territories, tribal entities, and local entities with 
this section and State compliance with the State plan described 
in subsection (f)(3).
(2) Issuance of rule.--The Secretary shall establish by 
rule procedures for--
(A) receiving, processing, and determining the 
validity of complaints or findings concerning any 
failure of a State to comply with the State plan or any 
other requirement of this section;
(B) notifying a State when the Secretary has 
determined there has been a failure by the State to 
comply with a requirement of this section; and
(C) imposing sanctions under this subsection for 
such a failure.
(l) Federal Administration.--Using funds reserved under subsection 
(c)(3), the Secretary shall carry out administration of this section, 
shall provide (including through the use of grants or cooperative 
agreements) technical assistance to States, territories, Indian Tribes, 
and tribal organizations, and shall carry out research, and evaluations 
related to this section.
(m) Nonpostsecondary Education Program.--For purposes of section 
401 of the Personal Responsibility and Work Opportunity Reconciliation 
Act of 1996 (8 U.S.C. 1611), the program carried out under this section 
shall be considered to be a program of nonpostsecondary education.

TITLE VII--ESTABLISHING A $60,000 A YEAR MINIMUM SALARY FOR EVERY 
PUBLIC SCHOOL TEACHER IN THE UNITED STATES

SEC. 701. PURPOSES.

The purposes of this title are to--
(1) ensure public elementary and secondary school teachers 
earn a livable and competitive salary that--
(A) includes a starting annual base salary of not 
less than $60,000; and
(B) increases regularly throughout a teacher's 
career;
(2) increase Federal investments in public schools; and
(3) call upon States and local governments to increase 
investments in public education in order to ensure that every 
public school student is taught by a qualified teacher.

SEC. 702. DEFINITIONS.

(a) Definitions.--In this title:
(1) ESEA terms.--The terms ``elementary school'', 
``outlying area'', and ``secondary school'' have the meanings 
given those terms in section 8101 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 7801).
(2) Annual adjustment percentage.--The term ``annual 
adjustment percentage'', with respect to a fiscal year, means a 
percentage equal to the estimated percentage change in the 
Consumer Price Index, as determined by the Secretary, for the 
most recent calendar year ending prior to the beginning of such 
fiscal year.
(3) Annual base salary.--The term ``annual base salary''--
(A) means the base salary, calculated as an annual 
rate of pay, of a full-time teacher; and
(B) excludes--
(i) any additional compensation earned by 
the teacher for taking on additional 
responsibilities (such as coaching or teaching 
during the summer or after school); and
(ii) bonuses, stipends, and awards.
(4) Average teacher salary baselines.--The term ``average 
teacher salary baselines'' means, for each of the following 
years of service as teachers, the average annual base salaries 
of all full-time teachers employed by local educational 
agencies in the State:
(A) 0 years, or starting teacher salaries.
(B) 3 years.
(C) 5 years.
(D) 10 years.
(E) 15 years.
(F) 20 years.
(G) 25 years.
(5) Consumer price index.--The term ``Consumer Price 
Index'' has the meaning given the term in section 478(f) of the 
Higher Education Act of 1965 (20 U.S.C. 1087rr(f)).
(6) Minimum salary for teachers.--The term ``minimum salary 
for teachers'' means an amount, determined by the State, that 
all full-time teachers employed by a local educational agency 
are, at a minimum, required by the State to be compensated by 
such agency as their annual base salary, and which--
(A) for teachers in their first year of teaching, 
shall be an annual rate of pay that is not less than 
the amount described in subsection (b); and
(B) for teachers with more than 2 years of 
experience, shall be an annual rate of pay that--
(i) is greater than the amount described in 
subsection (b); and
(ii) increases as the experience of a 
teacher increases.
(7) Secretary.--The term ``Secretary'' means the Secretary 
of Education.
(8) Teacher.--The term ``teacher'' means--
(A) an employee of a local educational agency--
(i) with a primary duty of teaching and who 
is employed and engaged in teaching in a public 
elementary school or secondary school served by 
such agency and is not a substitute teacher;
(ii) who fully meets all applicable public 
elementary school or secondary school teacher 
certification and licensure requirements of the 
State in which the school is located; and
(iii) if the teacher is a special education 
teacher, who meets the qualifications described 
in section 612(a)(14)(C) of the Individuals 
with Disabilities Education Act; and
(B) other full-time public elementary school or 
secondary school personnel employed by a local 
educational agency whose annual base salary is 
determined in accordance with such agency's salary 
schedule or system for a full-time teacher.
(b) Special Rules.--
(1) In general.--For each fiscal year, the amount described 
in subsection (a)(6)(A) shall be determined under this 
subsection.
(2) Fiscal years 2027 through 2031.--For each of fiscal 
years 2027 through 2031, the amount described in subsection 
(a)(6)(A) is $60,000.
(3) Fiscal years 2032 and after.--
(A) In general.--For the fiscal year period 2032 
through 2036 and for each subsequent 5 fiscal year 
period, the amount described in subsection (a)(6)(A) 
shall be adjusted for inflation as described in 
subparagraph (B).
(B) Determination.--The amount shall be equal to 
the amount applicable for the previous 5 fiscal year 
period, increased by the greater of--
(i) the aggregate annual adjustment 
percentage over the previous 5 fiscal years; or
(ii) 2 percent of the amount applicable 
under this subsection for the previous 5 fiscal 
year period.

SEC. 703. ENSURING TEACHERS ARE PAID A LIVABLE AND COMPETITIVE WAGE.

(a) Authorization and Appropriations for States.--
(1) In general.--There are authorized to be appropriated to 
carry out this section such sums as may be necessary for fiscal 
year 2027 and each succeeding fiscal year.
(2) Appropriations for states.--In addition to amounts 
otherwise available to carry out this section, there are 
appropriated, out of any money in the Treasury not otherwise 
appropriated, to the Secretary to carry out this section--
(A) for fiscal year 2027, $14,500,000,000; and
(B) for each succeeding fiscal year, the amount 
appropriated under this section for the preceding 
fiscal year, increased by the annual adjustment 
percentage.
(b) Program Authorized.--
(1) In general.--From amounts made available to carry out 
this section, and after making the reservations described in 
paragraph (2), the Secretary shall award grants, through 
allotments described in paragraph (3), to States to enable 
States to guarantee that all teachers employed by local 
educational agencies in the State are compensated with a 
livable and competitive salary, which shall be an amount that--
(A) is at least the minimum salary for teachers;
(B) increases throughout each teacher's career; and
(C) is, to the greatest extent practicable, 
commensurate with annual salaries for college-educated 
and similarly experienced professionals in the region 
in which such agencies are located, as determined in 
accordance with procedures and requirements established 
by the Secretary.
(2) Reservations.--
(A) In general.--From the amount appropriated under 
subsection (a) for a fiscal year, the Secretary shall 
reserve--
(i) one-half of 1 percent for allotments 
for payments to the outlying areas, to be 
distributed among those outlying areas on the 
basis of their relative need, as determined by 
the Secretary, to ensure that teachers are paid 
a livable and competitive salary, in accordance 
with the purposes of this title;
(ii) one-half of 1 percent for the 
Secretary of the Interior to be allocated by 
the Director of the Bureau of Indian Education 
for programs or activities operated or funded 
by the Bureau for Bureau-funded schools (as 
defined in section 1141 of the Education 
Amendments of 1978 (25 U.S.C. 2021)) to ensure 
teachers are paid a livable and competitive 
salary, in accordance with the purposes of this 
title; and
(iii) 1 percent for program administration, 
technical assistance, and data collection for 
the program under this section.
(B) Special rule.--Notwithstanding any other 
provision of this title, the requirements of this 
section and section 702 shall not apply to recipients 
described in clause (i) and (ii) of subparagraph (A), 
except that such recipients shall use funds described 
in this paragraph to ensure that teachers are paid a 
livable and competitive salary.
(3) Allotments.--
(A) In general.--After making the reservations 
under paragraph (2), the Secretary shall allot 50 
percent of the remaining amount appropriated under 
subsection (a) in accordance with subparagraph (B) and 
allot the other 50 percent of such remaining amount in 
accordance with subparagraph (C).
(B) Targeted formula.--From an amount equal to 50 
percent of the amounts appropriated under subsection 
(a) and remaining after the reservations of funds under 
paragraph (2) (referred to in this section as the 
``targeted formula amounts''), the Secretary shall 
allot to each State having a plan approved by the 
Secretary under subsection (d) an amount that bears the 
same relationship to such targeted formula amounts as 
the total amount that local educational agencies in the 
State received under section 1125 of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 6335) for 
the preceding fiscal year bears to the amount all local 
educational agencies in all States received under such 
section for the preceding fiscal year.
(C) EFIG formula.--From an amount equal to 50 
percent of the amounts appropriated under subsection 
(a) and remaining after the reservations of funds under 
paragraph (2) (referred to in this section as the 
``EFIG formula amounts''), the Secretary shall allot to 
each State having a plan approved by the Secretary 
under subsection (d) an amount that bears the same 
relationship to such EFIG formula amounts as the amount 
the State received under section 1125A of the 
Elementary and Secondary Education Act of 1965 (20 
U.S.C. 20 U.S.C. 6337) for the preceding fiscal year 
bears to the amount all States received under such 
section for the preceding fiscal year.
(D) Final allotments.--For the purposes of this 
section, a State's allotment shall be the sum of a 
State's allotments calculated under subparagraph (B) 
and subparagraph (C).
(c) Improving Teacher Salaries.--
(1) In general.--Subject to paragraph (3), a State that 
receives an allotment under this section shall ensure that the 
annual base salary of a full-time teacher employed by a local 
educational agency in the State is an amount that--
(A) is at least the minimum salary for teachers;
(B) increases throughout each teacher's career; and
(C) is, to the greatest extent practicable, 
commensurate with annual salaries for college-educated 
and similarly experienced professionals in the region 
in which such agencies are located, as determined in 
accordance with procedures and requirements established 
by the Secretary.
(2) Compliance.--To comply with paragraph (1), a State 
shall adopt one or more of the following laws or policies to 
ensure that every full-time teacher employed by a local 
educational agency in the State receives an annual base salary 
that is not less than the minimum salary for teachers:
(A) A statewide salary schedule that ensures that 
the salary of every full-time teacher employed by a 
local educational agency in the State is--
(i) an amount not less than the minimum 
salary for teachers established by the State 
under subsection (d)(1)(A); and
(ii) increases as the experience of a 
teacher increases.
(B) A statewide minimum annual base salary for 
teachers who are in their first year of teaching that 
not less than the minimum salary for teachers 
established by the State under subsection (d)(1)(A).
(C) A State law to increase salaries for teachers.
(3) Timing.--The Secretary shall ensure that, not later 
than 3 years after a State receives an allotment under this 
section, each such State meets the teacher salary requirements 
described in paragraph (1).
(d) State Plan.--
(1) In general.--In order to receive an allotment under 
subsection (b)(3), a State shall submit a State plan to the 
Secretary at such time, in such manner, and containing such 
information as the Secretary may reasonably require. Such State 
plan shall include, at a minimum, each of the following:
(A) A description of the State's minimum salary for 
teachers, including the State's plan to ensure that the 
State will meet the requirements of subsection (c)(1) 
not later than 3 years after the State receives an 
allotment under this section.
(B) A description of the State's plan to increase 
the State's per-pupil expenditures or the aggregate 
expenditures of the State with respect to the provision 
of free public education in the State, in a manner 
that--
(i) supports local educational agencies in 
increasing salaries or wages for teachers, 
paraprofessionals, specialized instructional 
support personnel, classified school employees, 
principals, other school leaders, school 
librarians, school bus drivers, and other staff 
across their careers, including through 
providing increased resources to local 
educational agencies; and
(ii) does not--
(I) increase average class sizes or 
student to full-time equivalent teacher 
ratios at the State, local educational 
agency, or school level;
(II) reduce planning time; or
(III) require teachers to teach 
additional classes.
(C) An identification, with respect to the average 
teacher salary baselines in the most recent fiscal 
year, of the statewide average and the average in each 
local educational agency in the State.
(D) An identification of the number and percentage 
of teachers employed by local educational agencies in 
the State who earn a salary of less than $60,000 
annually, disaggregated by each period of service 
specified in the average teacher salary baselines, 
across the State and in each such local educational 
agency.
(E) A description of the State's plan to comply 
with the equitable distribution of teachers requirement 
under section 1111(g)(1)(B) of the Elementary and 
Secondary Education Act of 1965 (20 U.S.C. 
6311(g)(1)(B)).
(2) Public comment.--Each State shall make the State plan 
publicly available for public comment for a period of not less 
than 30 days, by electronic means and in an easily accessible 
format, prior to submission to the Secretary for approval under 
this subsection. Upon submission, the State plan shall include 
a summary of the comments submitted to the Secretary, with a 
description of how the State addressed the comments, and make 
such summary with description publicly available on the website 
of the State educational agency.
(e) State Use of Funds.--Each State that receives an allotment 
under subsection (b) shall--
(1) reserve not more than 1 percent of the amounts allotted 
to the State under subsection (b)(3)(D) to provide technical 
assistance and conduct monitoring to ensure that all local 
educational agencies meet the requirements described in 
subsection (c);
(2) reserve not more than 4 percent of the amounts allotted 
to the State under subsection (b)(3)(D) to conduct statewide 
efforts to--
(A) increase teacher compensation across the State 
in accordance with in subsection (c);
(B) identify and reform policies and practices at 
the State, local educational agency, and school-level 
to promote excellent teaching for all students, 
particularly subgroups of students; and
(C) address structural and organizational 
challenges in the teaching profession, in order to--
(i) raise the standards, status, and 
salaries of the teaching profession; and
(ii) attract and retain promising and 
talented young people to teaching; and
(3) from the amounts allotted to the State under subsection 
(b)(3)(D) that are remaining after reserving amounts under 
paragraphs (1) and (2), allocate--
(A) 50 percent of such remaining amounts to local 
educational agencies in the State in accordance with 
the targeted formula described in section 1125(b) of 
the Elementary and Secondary Education Act of 1965 (20 
U.S.C. 6335(b)); and
(B) 50 percent of such remaining amounts to local 
educational agencies in the State in accordance with 
the formula described in section 1125A(d) of the 
Elementary and Secondary Education Act of 1965 (20 
U.S.C. 6337(d)).
(f) Reporting Requirements.--Not later than 1 year after receiving 
an allotment under this section and annually thereafter, a State that 
receives an allotment under this section shall submit a report to the 
Secretary and publish such report in a clear and easily accessible 
format on the website of the State. Such report shall contain any 
information required by the Secretary and include, at a minimum--
(1) data on the average teacher salary baselines for the 
previous fiscal year, disaggregated by the statewide average 
and the average in each local educational agency in the State;
(2) updated data on the number of teachers employed by 
local educational agencies in the State who earn less than the 
minimum salary for teachers, disaggregated by each period of 
service described in section 702(a)(4), across the State and 
employed by each local educational agency;
(3) a description of the actions the State educational 
agency will take in the next fiscal year to support local 
educational agencies described in paragraph (2) in decreasing 
the number of teachers employed by such agencies who earn less 
than the minimum salary for teachers;
(4) a description of actions taken by the State to increase 
the State's per-pupil expenditures or the aggregate 
expenditures of the State with respect to the provision of free 
public education in the State, in a manner that--
(A) supports local educational agencies in 
increasing salaries or wages for teachers, 
paraprofessionals, specialized instructional support 
personnel, classified school employees, principals, 
other school leaders, school librarians, school bus 
drivers, and other staff across their careers, 
including through providing increased resources to 
local educational agencies; and
(B) does not--
(i) increase average class sizes or student 
to full-time equivalent teacher ratios at the 
State, local educational agency, or school 
level;
(ii) reduce planning time; or
(iii) require teachers to teach additional 
classes; and
(5) a description of how the State improved the equitable 
distribution of teachers in such fiscal year, as required under 
section 1111(g)(1)(B) of the Elementary and Secondary Education 
Act of 1965 (20 U.S.C. 6311(g)(1)(B)).

SEC. 704. COLLECTIVE BARGAINING AND RELATED RULES.

(a) Rule of Construction for Collective Bargaining.--
(1) In general.--Subject to paragraph (2), nothing in 
section 703 shall be construed to alter or otherwise affect the 
rights, remedies, and procedures afforded to school or local 
educational agency employees under Federal, State, or local 
laws (including applicable regulations or court orders) or 
under the terms of collective bargaining agreements, memoranda 
of understanding, or other agreements between such employers 
and their employees.
(2) Compliance.--Paragraph (1) shall not be construed to 
exempt a State, local educational agency, or school from 
complying with section 703 or from negotiating in compliance 
with State labor laws to comply with section 703.
(b) Rule of Construction for Additional Pay or Other Salary 
Augmenting Systems.--Nothing in section 703 shall be construed to 
prevent States or local educational agencies from supplementing the 
annual base salary of teachers or other staff employed by such 
agencies--
(1) for additional skills, knowledge, duties, and 
responsibilities;
(2) by salary systems that increase teachers' compensation 
through supplemental pay that is not part of an annual base 
salary; or
(3) through the provision of bonuses, stipends, or awards.

TITLE VIII--INVESTMENTS IN HOME AND COMMUNITY-BASED SERVICES AND LONG-
TERM CARE QUALITY AND WORKFORCE

SEC. 801. HCBS IMPROVEMENT PLANNING GRANTS.

(a) Funding.--
(1) In general.--In addition to amounts otherwise 
available, there is appropriated to the Secretary for fiscal 
year 2027, out of any money in the Treasury not otherwise 
appropriated, $130,000,000, to remain available until expended, 
for carrying out this section.
(2) Technical assistance and guidance.--In addition to 
amounts otherwise available, there is appropriated to the 
Secretary for fiscal year 2027, out of any money in the 
Treasury not otherwise appropriated, $5,000,000, to remain 
available until expended, for purposes of issuing guidance and 
providing technical assistance to States intending to apply 
for, or which are awarded, a planning grant under this section, 
and for other administrative expenses related to awarding 
planning grants under this section.
(b) Award and Use of Grants.--
(1) Deadline for award of grants.--From the amount 
appropriated under subsection (a)(1), the Secretary, not later 
than 12 months after the date of enactment of this Act, shall 
solicit State requests for HCBS improvement planning grants and 
award such grants to all States that meet such requirements as 
determined by the Secretary.
(2) Use of funds.--Subject to paragraph (3), a State 
awarded a planning grant under this section shall use the grant 
to carry out planning activities for purposes of developing and 
submitting to the Secretary an HCBS improvement plan for the 
State that meets the requirements of subsection (c). A State 
may use planning grant funds to support activities related to 
the implementation of the HCBS improvement plan for the State.
(3) Limitation on use of funds.--None of the funds awarded 
to a State under this section may be used by a State as the 
source of the non-Federal share of expenditures under the State 
Medicaid program.
(c) HCBS Improvement Plan Requirements.--
(1) Content.--The Secretary shall define the content 
requirements for an HCBS improvement plan, which, at minimum, 
shall include an assessment of access barriers to home and 
community-based services and the availability (as defined by 
the Secretary) of such services in the State, a description of 
Medicaid payment rates for such services, a description of the 
current workforce of direct care workers, the percentage of 
expenditures made by the State for long-term services and 
supports that are for home and community-based services, and a 
description of how the State will meet the requirements of the 
HCBS Improvement Program.
(2) Submission; approval; amendments.--Not later than 24 
months after the date on which a State is awarded a planning 
grant under this section, the State shall submit an HCBS 
improvement plan for approval by the Secretary, along with 
assurances by the State that the State will implement the plan 
in accordance with the requirements of the HCBS Improvement 
Program. The Secretary shall approve the HCBS improvement plan 
for a State after the plan and such assurances are submitted to 
the Secretary for approval and the Secretary determines the 
plan meets the requirements of this subsection. A State may 
amend its HCBS improvement plan, subject to the approval of the 
Secretary that the plan as so amended meets the requirements of 
this subsection.
(d) Definitions.--In this part:
(1) Direct care worker.--The term ``direct care worker'' 
means, with respect to a State, any of the following 
individuals who are paid to provide directly to Medicaid 
eligible individuals home and community-based services 
available under the State Medicaid program:
(A) A registered nurse, licensed practical nurse, 
nurse practitioner, or clinical nurse specialist, or a 
licensed nursing assistant who provides such services 
under the supervision of a registered nurse, licensed 
practical nurse, nurse practitioner, or clinical nurse 
specialist.
(B) A direct support professional.
(C) A personal care attendant.
(D) A home health aide.
(E) Any other paid health care professional or 
worker determined to be appropriate by the State and 
approved by the Secretary.
(2) HCBS improvement program.--The term ``HCBS Improvement 
Program'' means the program established under subsection (ll) 
of section 1905 of the Social Security Act (42 U.S.C. 1396d) 
(as added by section 802).
(3) HCBS improvement program state.--The term ``HCBS 
Improvement Program State'' means a State that is awarded a 
planning grant under subsection (b) and has an HCBS improvement 
plan approved by the Secretary under subsection (c)(2).
(4) Home and community-based services.--The term ``home and 
community-based services'' means any of the following (whether 
provided on a fee-for-service, risk, or other basis):
(A) Home health care services authorized under 
paragraph (7) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)).
(B) Private duty nursing services authorized under 
paragraph (8) of such section, when such services are 
provided in a Medicaid eligible individual's home.
(C) Personal care services authorized under 
paragraph (24) of such section.
(D) PACE services authorized under paragraph (26) 
of such section.
(E) Home and community-based services authorized 
under subsections (b), (c), (i), (j), and (k) of 
section 1915 of such Act (42 U.S.C. 1396n), authorized 
under a waiver under section 1115 of such Act (42 
U.S.C. 1315), or provided through coverage authorized 
under section 1937 of such Act (42 U.S.C. 1396u-7).
(F) Case management services authorized under 
section 1905(a)(19) of the Social Security Act (42 
U.S.C. 1396d(a)(19)) and section 1915(g) of such Act 
(42 U.S.C. 1396n(g)).
(G) Rehabilitative services, including those 
related to behavioral health, described in section 
1905(a)(13) of such Act (42 U.S.C. 1396d(a)(13)).
(H) Such other services specified by the Secretary.
(5) Medicaid eligible individual.--The term ``Medicaid 
eligible individual'' means an individual who is eligible for 
and receiving medical assistance under a State Medicaid 
program. Such term includes an individual who is on a waiting 
list and who would become eligible for medical assistance and 
enrolled under a State Medicaid program upon receipt of home 
and community-based services.
(6) State medicaid program.--The term ``State Medicaid 
program'' means, with respect to a State, the State program 
under title XIX of the Social Security Act (42 U.S.C. 1396 
through 1396w-6) (including any waiver or demonstration under 
such title or under section 1115 of such Act (42 U.S.C. 1315) 
relating to such title).
(7) Secretary.--The term ``Secretary'' means the Secretary 
of Health and Human Services.
(8) State.--The term ``State'' means each of the 50 States, 
the District of Columbia, Puerto Rico, the Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana Islands, and 
American Samoa.

SEC. 802. HCBS IMPROVEMENT PROGRAM.

(a) Increased FMAP for HCBS Improvement Program States.--Section 
1905 of the Social Security Act (42 U.S.C. 1396d) is amended--
(1) in subsection (b), by striking ``and (ii)'' and 
inserting ``(ii), and (ll)''; and
(2) by adding at the end the following new subsection:
``(ll) Additional Support for HCBS Improvement Program States.--
``(1) In general.--
``(A) Additional support.--Subject to paragraph 
(5), in the case of a State that is an HCBS Improvement 
Program State, for each fiscal quarter that begins on 
or after the first date on which the State is an HCBS 
Improvement Program State--
``(i) and for which the State meets the 
requirements described in paragraphs (2) and 
(4), notwithstanding subsection (b) or (ff), 
subject to subparagraph (B), with respect to 
amounts expended during the quarter by such 
State for medical assistance for home and 
community-based services, the Federal medical 
assistance percentage for such State and 
quarter (as determined for the State under 
subsection (b) or (ff) and, if applicable, 
increased under subsection (y), (z), (aa), or 
(ii), or section 1915(k)(2)) shall be increased 
by 8 percentage points; and
``(ii) with respect to the State meeting 
the requirements described in paragraphs (2) 
and (4) and with respect to amounts expended 
during the quarter and before October 1, 2036, 
administrative costs for expanding and 
enhancing home and community-based services, 
including for enhancing Medicaid data and 
technology infrastructure, modifying rate 
setting processes, adopting or improving 
training programs for direct care workers and 
family caregivers, home and community-based 
services ombudsman office activities, 
developing processes to identify direct care 
workers and assign such workers unique 
identifiers, and adopting, carrying out, or 
enhancing programs that register direct care 
workers or connect beneficiaries to direct care 
workers, shall be eligible for Federal 
financial participation in the same manner as 
other administrative expenditures under section 
1903(a), except that, for purposes of this 
clause, the per centum applicable to such 
expenditures shall be the greater of 80 percent 
or the per centum that would otherwise apply.
In no case may the application of clause (i) result in 
the Federal medical assistance percentage determined 
for a State being more than 95 percent with respect to 
such expenditures. Any increase pursuant to clause (ii) 
shall be available to a State before the State meets 
the requirements of paragraphs (2) and (4).
``(B) Additional hcbs improvement efforts.--Subject 
to paragraph (5), in addition to the increase to the 
Federal medical assistance percentage under 
subparagraph (A)(i) for amounts expended during a 
quarter for medical assistance for home and community-
based services by an HCBS Improvement Program State 
that meets the requirements of paragraphs (2) and (4) 
for the quarter, the Federal medical assistance 
percentage for amounts expended by the State during the 
quarter for medical assistance for home and community-
based services shall be further increased by 2 
percentage points (but not to exceed 95 percent) during 
the first 6 fiscal quarters throughout which the State 
has implemented and has in effect a program that meets 
the requirements of paragraph (3).
``(C) Nonapplication to chip efmap.--Any increase 
to the Federal medical assistance percentage of a State 
under subparagraph (A)(i) or (B) or an increase to an 
applicable Federal matching percentage under 
subparagraph (A)(ii) shall not be taken into account in 
calculating the enhanced FMAP of a State under section 
2105.
``(2) Requirements.--As conditions for receipt of the 
increase under paragraph (1)(A)(i) to the Federal medical 
assistance percentage determined for a State, with respect to a 
fiscal year quarter, the State shall meet each of the following 
requirements:
``(A) Nonsupplantation.--The State uses an amount 
in State funds equivalent to the additional Federal 
funds received by the State that are attributable to 
the increase to the Federal medical assistance 
percentage for amounts expended during a quarter for 
medical assistance for home and community-based 
services under paragraph (1)(A) and paragraph (1)(B) 
(if applicable) to supplement, and not supplant, the 
level of State funds expended for home and community-
based services for eligible individuals through 
programs in effect as of the date the State is awarded 
a planning grant under section 801 of the Make 
Billionaires Pay Their Fair Share Act. In applying this 
subparagraph, the Secretary shall provide that a State 
shall have a 3-year period, as specified by the 
Secretary, to spend any accumulated unspent State funds 
attributable to such increase to the Federal medical 
assistance percentage.
``(B) Maintenance of effort.--
``(i) In general.--The State does not--
``(I) reduce the amount, duration, 
or scope of home and community-based 
services available under the State plan 
(or waiver of such plan) relative to 
the home and community-based services 
available under the plan or a waiver of 
such plan as of the date on which the 
State was awarded a planning grant 
under section 801 of the Make 
Billionaires Pay Their Fair Share Act;
``(II) reduce payment rates for 
home and community-based services lower 
than such rates that were in place as 
of the date described in subclause (I), 
including, to the extent applicable, 
assumed payment rates for such services 
that are included in managed care 
capitation rates as such rates are 
being prospectively built; or
``(III) except to the extent 
permitted under clause (ii), adopt more 
restrictive standards, methodologies, 
or procedures for determining 
eligibility for, or the scope of, 
medical assistance for home and 
community-based services, including 
with respect to cost-sharing, than the 
standards, methodologies, or procedures 
applicable as of the date described in 
subclause (I).
``(ii) Conditions for flexibility.--A State 
may make modifications that would otherwise 
violate the maintenance of effort described in 
clause (i) if the State demonstrates to the 
satisfaction of the Secretary that such 
modifications shall not result in--
``(I) home and community-based 
services that are less comprehensive or 
lower in amount, duration, or scope;
``(II) fewer individuals (overall 
and within particular eligibility 
groups) receiving home and community-
based services, adjusted for 
demographic changes since the date 
described in clause (i)(I); or
``(III) increased cost-sharing 
(other than resulting from the rate of 
inflation) for home and community-based 
services.
``(C) Access to services.--The State undertakes 
efforts to improve access to home and community-based 
services by doing all of the following not later than 
an implementation date specified by the Secretary 
(which may vary for each of the following clauses) 
after the first day of the first fiscal quarter for 
which a State receives an increase to the Federal 
medical assistance percentage or other applicable 
Federal matching percentage under paragraph (1):
``(i) Reduces access barriers and 
disparities in access or utilization of home 
and community-based services.
``(ii) Provides coverage of personal care 
services authorized under subsection (a)(24) 
for all individuals eligible for and enrolled 
in medical assistance in the State.
``(iii) Provides for navigation of home and 
community-based services through `no wrong 
door' programs, provides expedited eligibility 
for home and community-based services, and 
improves home and community-based services 
counseling and education programs.
``(iv) Expands access to behavioral health 
services furnished in home and community-based 
settings.
``(v) Improves coordination of home and 
community-based services with employment, 
housing, and transportation supports.
``(vi) Provides supports to family 
caregivers.
``(vii) Newly provides coverage under, or 
expands existing eligibility criteria for, 1 or 
more of the eligibility categories authorized 
under subclause (XIII), (XV), or (XVI) of 
section 1902(a)(10)(A)(ii).
``(D) Workforce.--The State strengthens and expands 
the workforce of direct care workers that provides home 
and community-based services by--
``(i) adopting processes to ensure that 
payment rates for home and community-based 
services are sufficient (as defined by the 
Secretary) to ensure that services are 
available, including by, not later than 2 years 
after approval of the HCBS improvement plan 
and, at least every 3 years thereafter, 
updating and, as appropriate, increasing 
payment rates for home and community-based 
services to support recruitment and retention 
of direct care workers using, through existing 
or other processes to determine provider 
payments, a transparent process involving input 
from nongovernmental stakeholders;
``(ii) ensuring that increases in the 
payment rates for home and community-based 
services result in at least a proportionate 
increase to payments for direct care workers; 
and
``(iii) updating qualification standards as 
appropriate, and developing and adopting 
training opportunities, for direct care workers 
and family caregivers, at such times as the 
Secretary shall prescribe.
``(3) Self-directed models for the delivery of services.--
As conditions for receipt of the increase under paragraph 
(1)(B) to the Federal medical assistance percentage determined 
for a State, with respect to a fiscal year quarter, the State 
shall establish directly, or by contract with 1 or more 
entities, including an agency with choice or a similar service 
delivery model, a program for the performance of all of the 
following functions, consistent with guidance issued by the 
Secretary, to facilitate beneficiary use of self-directed care 
in the case the State covers home and community-based services 
under authorities that permit self-direction:
``(A) Recruiting and registering qualified direct 
care workers and assisting beneficiaries in finding 
qualified direct care workers.
``(B) Supporting beneficiary hiring, if selected by 
the beneficiary, of independent providers of home and 
community-based services, including through the 
provision of financial management services.
``(C) To the extent a State permits beneficiaries 
to hire a family member or individual with whom they 
have an existing relationship to provide home and 
community-based services, providing support to 
beneficiaries who wish to hire a caregiver who is a 
family member or individual with whom they have an 
existing relationship.
``(D) Ensuring that the program under this 
paragraph does not promote or deter the ability of 
workers to form a labor organization or discriminate 
against workers who may join or decline to join such an 
organization.
``(4) Reporting and oversight.--As a condition for receipt 
of an increase under subparagraphs (A)(i) or (B) of paragraph 
(1) to the Federal medical assistance percentage determined for 
a State, with respect to a fiscal year quarter, the State 
shall, beginning with the last day of the 5th fiscal quarter 
for which the State is an HCBS Improvement Program State, and 
annually thereafter, report to the Secretary, in a manner the 
Secretary shall prescribe, on--
``(A) the State's progress in implementing the 
activities described in subparagraphs (C) and (D) of 
paragraph (2) and (if applicable) paragraph (3) in 
accordance with the State HCBS improvement plan; and
``(B) the use of the increased funding provided 
under this subsection.
``(5) Benchmarks for demonstrating improvements.--An HCBS 
Improvement Program State shall cease to be eligible for an 
increase to the Federal medical assistance percentage under 
paragraph (1)(A)(i) or (1)(B) or an increase to an applicable 
Federal matching percentage under paragraph (1)(A)(ii) for each 
fiscal quarter after the 29th fiscal quarter that begins on or 
after the first date on which the State is an HCBS Improvement 
Program State unless, at the end of such 29th fiscal quarter, 
the State demonstrates the following in the annual report 
required in paragraph (4) for such quarter:
``(A) Increased availability (above a marginal 
increase) of home and community-based services in the 
State relative to such availability as reported in the 
State HCBS improvement plan and adjusted for 
demographic changes in the State since the submission 
of such plan.
``(B) With respect to the percentage of 
expenditures made by the State for long-term services 
and supports that are for home and community-based 
services, in the case of an HCBS Improvement Program 
State for which such percentage (as reported in the 
State HCBS improvement plan) was--
``(i) less than 50 percent, the State 
demonstrates that the percentage of such 
expenditures has increased to at least 50 
percent since the plan was approved; and
``(ii) at least 50 percent, the State 
demonstrates that such percentage has not 
decreased since the plan was approved.
``(6) Definitions.--In this subsection, the terms `direct 
care worker', `HCBS Improvement Program State', and `home and 
community-based services' have the meaning given those terms in 
section 801(d) of the Make Billionaires Pay Their Fair Share 
Act.''.

SEC. 803. FUNDING FOR FEDERAL ACTIVITIES RELATED TO MEDICAID HCBS.

In addition to amounts otherwise available, there is appropriated 
to the Secretary for fiscal year 2027, out of any money in the Treasury 
not otherwise appropriated, $40,000,000, to remain available until 
expended, to carry out section 802 (including the amendments made by 
such section), including by issuing necessary guidance and technical 
assistance to States and conducting program integrity and oversight 
efforts.

SEC. 804. FUNDING FOR HCBS QUALITY MEASUREMENT AND IMPROVEMENT.

In addition to amounts otherwise available, there is appropriated 
to the Secretary for fiscal year 2027, out of any money in the Treasury 
not otherwise appropriated, $25,000,000, to remain available until 
expended, for purposes of developing, in consultation with 
nongovernmental stakeholders with expertise in home and community-based 
services (including recipients and providers of such services), a 
recommended set of home and community-based services quality measures 
that reflect the full range of home and community-based services (as 
defined in section 801(d)) and the recipients of such services.

SEC. 805. PERMANENT EXTENSION OF MEDICAID PROTECTIONS AGAINST SPOUSAL 
IMPOVERISHMENT FOR RECIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES.

(a) In General.--Section 1924(h)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r-5(h)(1)(A)) is amended by striking ``(at the option of 
the State) is described in section 1902(a)(10)(A)(ii)(VI)'' and 
inserting the following: ``is eligible for medical assistance for home 
and community-based services provided under subsection (c), (d), or (i) 
of section 1915 or under a waiver approved under section 1115, or who 
is eligible for such medical assistance by reason of being determined 
eligible under section 1902(a)(10)(C) or by reason of section 1902(f) 
or otherwise on the basis of a reduction of income based on costs 
incurred for medical or other remedial care, or who is eligible for 
medical assistance for home and community-based attendant services and 
supports under section 1915(k)''.
(b) Conforming Amendment.--Section 2404 of the Patient Protection 
and Affordable Care Act (42 U.S.C. 1396r-5 note) is amended by striking 
``September 30, 2027'' and inserting ``the date of enactment of the 
Make Billionaires Pay Their Fair Share Act''.

SEC. 806. PERMANENT EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
DEMONSTRATION.

Subsection (h) of section 6071 of the Deficit Reduction Act of 2005 
(42 U.S.C. 1396a note) is amended--
(1) in paragraph (1)--
(A) in subparagraph (I), by inserting ``and'' after 
the semicolon;
(B) in subparagraph (J), by inserting ``and each 
fiscal year thereafter'' before the semicolon; and
(C) by striking subparagraphs (K) and (L); and
(2) in paragraph (3), by striking ``through fiscal year 
2029''.
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