(1)

by redesignating subsections (f) through (h) as subsections (h) through (j), respectively;

(2)

by inserting after subsection (e) the following:

(f) Eligibility of donating individuals based on household income

(1) In general

In providing reimbursement to donating individuals using funds from grant awards under this section, the recipient of the grant award shall not limit the eligibility of a donating individual for such reimbursement based on the individual’s income if the individual’s household income is at or below 700 percent of the poverty line.

(2) Definition

In this subsection, the term poverty line means the applicable poverty line as set forth in the most recent poverty guidelines of the Department of Health and Human Services published under the authority of section 673(2) of the Community Services Block Grant Act.

(g) Reimbursement amount

(1) In general

The amount of reimbursement of qualifying expenses provided by a recipient of a grant award under this section to each such donating individual shall be the lesser of—

(A)

the total amount of the donating individual’s qualifying expenses; and

(B)

the maximum permissible amount described in paragraph (2).

(2) Maximum permissible amount

(A) Rule

Subject to subparagraph (B), the maximum permissible amount described in this section is—

(i)

for fiscal year 2027, $10,000; and

(ii)

for subsequent fiscal years, the maximum permissible amount allowed under this subsection for the preceding fiscal year adjusted by the total percentage change (rounded to the nearest hundredth) that occurred in the Consumer Price Index for all urban consumers (all items; United States city average) for the preceding fiscal year.

(B) Exception for recipients based on insufficient funds

The Secretary may, with respect to reimbursement provided by a recipient of a grant award under this section to donating individuals, lower the maximum permissible amount under subparagraph (A) for a fiscal year if the Secretary—

(i)

determines that such recipient has insufficient funds to provide the full amount that would otherwise apply under paragraph (1) to all donating individuals; and

(ii)

at least 30 days before making such determination effective, provides to the Congress written notice of such determination, including a justification.

(C) Special rules

If the Secretary, with respect to reimbursement provided by a recipient of a grant award under this section to donating individuals, makes a determination under subparagraph (B) to lower the maximum permissible amount under subparagraph (A) for a fiscal year—

(i)

such determination shall not affect the amount of reimbursement for any approved donating individual prior to the effective date of such determination; and

(ii)

the maximum permissible amount under subparagraph (A)(ii) for any subsequent year shall be calculated without regard to such lowered amount. ;

(3)

in subsection (i), as so redesignated, by striking is authorized to be appropriated $5,000,000 for each of the fiscal years 2005 through 2009 and inserting are authorized to be appropriated such sums as may be necessary for fiscal years 2028 through 2037; and

(4)

by amending subsection (j), as so redesignated, to read as follows:

(j) Annual report

Not later than December 31 of each year, beginning in fiscal year 2027, the Secretary shall—

(1)

prepare, submit to the Congress, and make public a report on—

(A)

whether grants under this section provided adequate funding during the preceding fiscal year to reimburse all donating individuals participating in the grant program under this section for all qualifying expenses; and

(B)

the impacts, ongoing activities, challenges, and future needs of the program under this section; and

(2)

include in each such report, for the fiscal year covered by the report—

(A)

the estimated number of all donating individuals participating in the grant program under this section who did not receive reimbursement for all qualifying expenses;

(B)

the total amount of funding that is estimated to be necessary to fully reimburse all donating individuals participating in the grant program under this section for all qualifying expenses;

(C)

an overview of the program under this section;

(D)

current and trended historical information about the program under this section, including—

(i)

the total number of donating individuals applying for reimbursement;

(ii)

the average and median reimbursement amount provided to donating individuals;

(iii)

demographic information regarding—

(I)

donating individuals applying for reimbursement; and

(II)

donating individuals approved for reimbursement;

(iv)

the types of expenses for which reimbursement was requested (including requests for reimbursement of non-qualifying expenses);

(v)

the amount of funding provided to donating individuals with respect to each such type of expenses;

(vi)

the amount of funding provided to donating individuals with respect to each organ category; and

(vii)

the total amount expended to carry out this section, disaggregated by—

(I)

the amount expended by the Secretary and the recipients of grants under this section on administrative expenses; and

(II)

the amount provided to donating individuals as reimbursement;

(E)

the impacts of the program under this section, including—

(i)

the number of completed donations for which reimbursement was provided;

(ii)

the proportion of living donor transplants in the United States in which the donor received reimbursement through the program under this section; and

(iii)

an estimate of the savings to the Medicare program under title XVIII of the Social Security Act resulting from the program under this section, both—

(I)

for the fiscal year covered by the report; and

(II)

cumulatively since the program’s creation;

(F)

the types of donations made by donating individuals receiving reimbursement, disaggregated according to—

(i)

the type of organ donated; and

(ii)

whether the donations were directed, non-directed, or a paired exchange;

(G)

a description of any efforts to expand or improve the program under this section;

(H)

a description of the efforts of the Secretary and recipients of grants under this section to increase awareness of the program under this section;

(I)

a description of challenges experienced by the program under this section, including—

(i)

the number and percentage of donating individuals applying for reimbursement whose qualifying expenses approached or exceeded the maximum amount allowed under subsection (g); and

(ii)

an estimate of the total funding needed to fully reimburse, without regard to the maximum amount allowed under subsection (g) or donor income eligibility caps, all donating individuals in the United States for all qualifying expenses;

(J)

areas of concern regarding, and identified barriers to, the elimination of financial disincentives to living organ donation; and

(K)

such other matters as the Secretary determines appropriate.

(1)

conduct a study on how the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) could, under existing statutory authorities, pay costs that would otherwise be paid through the Living Organ Donation Reimbursement Program under section 377 of the Public Health Service Act (42 U.S.C. 274f); and

(2)

submit to the Congress a report on the results of such study, including recommendations for any changes needed to achieve such purpose.