SUBCHAPTER A—STRENGTHENING ELIGIBILITY REQUIREMENTS
SEC. 71201. Limiting Medicare coverage of certain individuals.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:
“SEC. 1899C. Limiting Medicare coverage of certain individuals.
“(a) In general.—Subject to subsection (b), an individual may be entitled to, or enrolled for, benefits under this title only if the individual is—
“(1) a citizen or national of the United States;
“(2) an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act;
“(3) an alien who has been granted the status of Cuban and Haitian entrant, as defined in section 501(e) of the Refugee Education Assistance Act of 1980 (Public Law 96–422); or
“(4) an individual who lawfully resides in the United States in accordance with a Compact of Free Association referred to in section 402(b)(2)(G) of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
“(b) Application to individuals currently entitled to or enrolled for benefits.—
“(1) IN GENERAL.—In the case of an individual who is entitled to, or enrolled for, benefits under this title as of the date of the enactment of this section, subsection (a) shall apply beginning on the date that is 18 months after such date of enactment.
“(2) REVIEW BY COMMISSIONER OF SOCIAL SECURITY.—
“(A) IN GENERAL.—Not later than 1 year after the date of the enactment of this section, the Commissioner of Social Security shall complete a review of individuals entitled to, or enrolled for, benefits under this title as of such date of enactment for purposes of identifying individuals not described in any of paragraphs (1) through (4) of subsection (a).
“(B) NOTICE.—The Commissioner of Social Security shall notify each individual identified under the review conducted under subparagraph (A) that such individual’s entitlement to, or enrollment for, benefits under this title will be terminated as of the date that is 18 months after the date of the enactment of this section. Such notification shall be made as soon as practicable after such identification and in a manner designed to ensure such individual’s comprehension of such notification.”.
SUBCHAPTER B—IMPROVING SERVICES FOR SENIORS
SEC. 71202. Temporary payment increase under the medicare physician fee schedule to account for exceptional circumstances.
(a) In general.—Section 1848(t) of the Social Security Act (42 U.S.C. 1395w–4(t)) is amended—
(1) in the subsection heading, by striking “during 2021 through 2024”;
(2) in paragraph (1)—
(A) in the matter preceding subparagraph (A), by striking “and 2024” and inserting “2024, and 2026”;
(B) in subparagraph (D), by striking “and” at the end;
(C) in subparagraph (E), by striking the period at the end and inserting “; and”; and
(D) by adding at the end the following new subparagraph:
“(F) such services furnished on or after January 1, 2026, and before January 1, 2027, by 2.5 percent.”; and
(3) in paragraph (2)(C)—
(A) in the subparagraph heading, by inserting “and 2026” after “2024”; and
(B) by striking “or 2024” each place it appears and inserting “2024, or 2026”.
(b) Conforming amendment.—Section 1848(c)(2)(B)(iv)(V) of the Social Security Act (42 U.S.C. 1395w–4(c)(2)(B)(iv)(V)) is amended by striking “or 2024” and inserting “2024, or 2026”.
SEC. 71203. Expanding and clarifying the exclusion for orphan drugs under the Drug Price Negotiation Program.
(a) In general.—Section 1192(e) of the Social Security Act (42 U.S.C. 1320f–1(e)) is amended—
(1) in paragraph (1), in the matter preceding subparagraph (A), by striking “and (3)” and inserting “through (4)”;
(2) in paragraph (3)(A)—
(A) by striking “only one rare disease or condition” and inserting “one or more rare diseases or conditions”; and
(B) by striking “such disease or condition” and inserting “one or more such rare diseases or conditions (as such term is defined in section 526(a)(2) of the Federal Food, Drug, and Cosmetic Act)”; and
(3) by adding at the end the following new paragraph:
“(4) TREATMENT OF FORMER ORPHAN DRUGS.—In the case of a drug or biological product that, as of the date of the approval or licensure of such drug or biological product, is a drug or biological product described in paragraph (3)(A), paragraph (1)(A)(ii) or (1)(B)(ii) (as applicable) shall apply as if the reference to ‘the date of such approval’ or ‘the date of such licensure’, respectively, were instead a reference to ‘the first day after the date of such approval for which such drug is not a drug described in paragraph (3)(A)’ or ‘the first day after the date of such licensure for which such biological product is not a biological product described in paragraph (3)(A)’, respectively.”.
(b) Application.—The amendments made by subsection (a) shall apply with respect to initial price applicability years (as defined in section 1191(b) of the Social Security Act (42 U.S.C. 1320f(b))) beginning on or after January 1, 2028.