,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #bgec  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ai1 #bjac ,mrs4
 ,black introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ,m$ic>e ,advantage1 & = o!r     
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,secur+ ,c>e = ,s5iors ,act
 ( #bjac4  #b4 ,re9/atem5t ( #c-mon? op5
 enrollm5t & dis5rollm5t p]iod = ,m$ic>e
 ,advantage ,section #ahea7;e77#b7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#a7;e77#b77 is am5d$--  7#a7 9   
subp>agraph 7,c71 by ins]t+ & end+ )    
#bjac aft] 7beg9n+ ) #bjaa2 &  7#b7 by  
add+ at ! end ! foll[+ new subp>agraph3 
7,f7 ,cont9u\s op5 enrollm5t &          
dis5rollm5t = fir/ #c mon?s 9 subsequ5t 

ye>s  7i7 ,9 g5]al ,subject to          
subp>agraph 7,d71 at any "t dur+ ! fir/ 
#c mon?s ( a ye> 7beg9n+ ) #bjad71 or1  
if ! individual fir/ becomes a ,m$ic>e  
,advantage eligible individual dur+ a   
ye> aft] #bjad1 dur+ ! fir/ #c mon?s (  
su* ye> 9 :i* ! individual is a ,m$ic>e 
,advantage eligible individual1 a       
,m$ic>e ,advantage eligible individual  
may *ange ! election "u subsection      
7a77#a74  7ii7 ,limitation ( "o *ange   
dur+ op5 enrollm5t p]iod ea* ye> ,an    
individual may ex]cise ! "r "u clause   
7i7 only once dur+ ! applicable #c-mon? 
p]iod describ$ 9 su* clause 9 ea* ye>4  
,! limitation "u ?is clause %all n apply
 to *anges 9 elections effect$ dur+ an  
annual1 coord9at$ election p]iod "u     
p>agraph 7#c7 or dur+ a special election
 p]iod "u p>agraph 7#d74  7iii7         
,application to "p ,d = individuals     
*ang+ enrollm5t f ,,ma to fee-=-s]vice  
,! previ\s provisions ( ?is subp>agraph 
%all only apply ) respect to *anges 9   
enrollm5t 9 a prescription drug plan "u 

"p ,d 9 ! case ( an individual :o1      
previ\s to su* *ange 9 enrollm5t1 is    
enroll$ 9 a ,m$ic>e ,advantage plan4  4 
#c4 ,p]mitt+ inc5tives = p>ticipation 9 
heal? c>e improvem5t programs  7a7 ,9   
g5]al ,section #ahei ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7h7 ,p]mitt+    
,,ma organizations ,to provide inc5tives
 = p>ticipation 9 heal? c>e improvem5t  
programs  7#a7 ,9 g5]al ,an ,,ma        
organization may (f] to individuals     
enroll$ 9 an ,,ma plan (f]$ by su*      
organization "o or m inc5tive programs t
 are design$ to improve ! heal? c>e (   
su* individuals by provid+ "o or m      
inc5tives1 su* z ! r$uc+ or waiv+ (     
copaym5t am\nts1 t rew>d individuals =  
p>ticipation 9 su* a program1 if--  7,a7
 ! inc5tive program meets ! requirem5ts 
describ$ 9 p>agraph 7#b72 &  7,b7 ! ,,ma
 organization provides to ! ,secret>y   
su* in=mation on p>ticipation & p]=mance
 9 ! inc5tive program z ! ,secret>y may 

specify4  7#b7 ,requirem5ts ,!          
requirem5ts describ$ 9 ?is p>agraph1 )  
respect to an inc5tive program (f]$ by  
an ,,ma organization to individuals     
enroll$ 9 an ,,ma plan (f]$ by su*      
organization1 are z foll[s3  7,a7       
,inc5tive only ^u completion ( program  
,9 ! case ( a program t consi/s (       
multiple sessions or o!r multiple       
activities1 any inc5tive (f]$ "u !      
program is (f]$ only ^u completion ( all
 su* sessions or activities4  7,b7      
,nondiscrim9ation ,p>ticipation 9 !     
program is (f]$ to all su* individuals4 
7,c7 ,no ca% or monet>y inc5tive  7i7 ,9
 g5]al ,no inc5tive "u ! program is 9 ! 
=m ( ca% or any o!r monet>y rebate4     
7ii7 ,con/ruction ,no?+ 9 clause 7i7 may
 be con/ru$ z prev5t+ ! (f]+ ( an       
inc5tive 9 ! =m ( a r$uction or waiv] ( 
copaym5t am\nts or d$uctibles4  7#c7    
,waiv] au?ority ,! ,secret>y may waive  
su* requirem5ts ( ?is title & title     
,,xi1 except = sections #aabh;,a1       
#aabh;,b7b71 & #ahgg1 z may be necess>y 

to c>ry out ! purposes ( ! program      
e/abli%$ "u ?is subsection4  7#d7       
,program n tak5 into acc\nt = bid am\nt 
,! program may n be tak5 into acc\nt =  
purposes ( ! mon?ly bid am\nt submitt$  
by ! organization "u section            
#ahed7;a77#f7 & provisions relat+ to !  
mon?ly bid am\nt4  7#e7 ,enc\ragem5t to 
p>ticipate 9 activities (f]$ by c]ta9   
p]sons or entities ,an ,,ma organization
 may1 z "p ( an inc5tive program (f]$ by
 su* organization to individuals "u ?is 
subsection1 require or o!rwise enc\rage 
su* individuals to p>ticipate 9         
activities design$ to improve ! heal?   
c>e ( su* individuals t are (f]$ by     
p]sons or entities specifi$ by su*      
organization1 su* z p]sons or entities t
 ! organization has id5tifi$ z p]=m+    
well on quality metrics id5tifi$ by !   
organization4  4  7b7 ,effective date ,!
 am5dm5t made by subsection 7a7 %all    
take effect = plan ye>s beg9n+ on or    
aft] ! date ( ! enactm5t ( ?is ,act4    
#d4 ,co/ %>+ v>iation p]mitt$ to        

enc\rage use ( high quality provid]s    
,section #aheb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#bb7 is      
am5d$--  7#a7 9 subsection              
7a77#a77;,b7--  7,a7 9 clause 7i71 by   
/rik+ clause 7iii7 & ins]t+ clauses     
7iii7 & 7vi72 &  7,b7 by add+ at ! end !
 foll[+ new clause3  7vi7 ,co/ %>+      
v>iation p]mitt$ to enc\rage use ( high 
quality provid]s ,not)/&+ subsection    
7b71 an ,,ma plan (f]$ by an ,,ma       
organization may1 ?r\gh me*anisms su* z 
value bas$ insurance design 7,,vbid7    
practices1 v>y co/-%>+ = ! purpose (    
enc\rag+ enrollees to use provid]s t su*
 organization has id5tifi$ z p]=m+ well 
on quality metrics id5tifi$ by !        
organization4 ,any su* v>iation on      
co/-%>+ by an ,,ma organization mu/     
occur on an annual basis4 ,an ,,ma      
organization may n v>y co/-%>+ pursuant 
to ?is p>agraph dur+ a plan ye>4  2 &   
7#b7 9 subsection 7b77#b71 by /rik+ ,a  
,m$ic>e,*oice & ins]t+ ,subject to      
subsection 7a77#a77;,b77vi71 a ,m$ic>e  

,advantage4  #e4 ,improvem5ts to risk   
adju/m5t sy/em ,section                 
#ahec7;a77#a77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciew-#bc7;a77#a77;,c77 is am5d$ by    
add+ at ! end ! foll[+ new clauses3     
7iv7 ,revision ( risk adju/m5t sy/em to 
acc\nt = *ronic conditions & two ye>s ( 
diagno/ic data  7,i7 ,9 g5]al ,!        
,secret>y %all evaluate &1 z ! ,secret>y
 det]m9es appropriate1 revise = #bjag & 
p]iodically !reaft] ! risk adju/m5t     
sy/em "u ?is subp>agraph s t a risk     
score "u su* sy/em1 ) respect to an     
individual1 takes into acc\nt ! numb] ( 
*ronic conditions ) :i* ! individual has
 be5 diagnos$1 & at lea/ two ye>s (     
diagno/ic data includ+ su* data obta9$  
dur+ heal? risk assessm5ts reg>d+ !     
individual1 to ! ext5t t two ye>s ( su* 
data are available4  7,,ii7 ,p]iodic    
report+ to ,congress ,) respect to plan 
ye>s beg9n+ 9 #bjag & e ?ird ye>        
!reaft]1 ! ,secret>y %all submit to     
,congress a report on ! mo/ rec5t       

revisions 7if any7 made "u subclause    
7,i74  7v7 ,no *anges to adju/m5t       
factors t prev5t activities consi/5t )  
national heal? policy goals ,9 mak+ any 
*anges to ! adju/m5t factors1 includ+   
adju/m5t = heal? /atus "u p>agraph 7#c71
 ! ,secret>y %all ensure t ! *anges d n 
prev5t ,,ma organizations f p]=m+ or    
und]tak+ activities t are consi/5t )    
national heal? policy goals1 includ+    
activities to promote e>ly detection &  
bett] c>e coord9ation1 ! use ( heal?    
risk assessm5ts1 c>e plans1 & programs  
to sl[ ! progression ( *ronic diseases4 
7vi7 ,opportunity = review & public     
comm5t reg>d+ *anges to adju/m5t factors
 ,= any *anges to adju/m5t factors      
effective = #bjae & subsequ5t ye>s1 9   
addition to provid+ notice ( su* *anges 
9 ! ann\ncem5t "u subsection 7b77#b71 ! 
,secret>y %all provide an opportunity = 
review ( propos$ *anges & a public      
comm5t p]iod ( n less ?an #fj days be=e 
implem5t+ su* *anges4  4  #f4           
,improvem5ts to ,,ma #e-/> quality rat+ 

sy/em ,section #ahec7o77#d7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7o77#d77 is am5d$ by add+ at !
 end ! foll[+ new subp>agraph3  7,c7    
,plans ) disproportionately high        
enrollm5t ( individuals ) complex heal? 
c>e ne$s  7i7 ,9 g5]al ,! ,secret>y %all
 take su* /eps z are necess>y to ensure 
t ! #e-/> rat+ sy/em describ$ 9         
subp>agraph 7,a7--  7,i7 does n         
disadvantage a plan t enrolls a         
disproportionately high proportion (    
enrollees :o are full-b5efit dual       
eligible individuals 7z def9$ 9 section 
#aice7;c77#f771 subsidy eligible        
individuals 7z def9$ 9 section          
#ahfj;,d-#ad7;a77#c771 or o!r           
individuals ) complex heal? c>e ne$s su*
 z individuals ) multiple conditions2 & 
7,,ii7 all[s adju/m5ts to acc\nt =      
diff]5ces 9 socioeconomic & demographic 
*>act]i/ics ( enrollees & geographic    
v>iation 9 heal? outcomes4  7,d7        
,ann\ncem5t ( *anges two ye>s prior to  
end ( p]=mance p]iod ,! ,secret>y may n 

implem5t any *ange 9 ! #e-/> rat+ sy/em 
describ$ 9 subp>agraph 7,a7 ) respect to
 any p]=mance p]iod us$ z "p ( su* sy/em
 unless ! ,secret>y ann\nces su* *ange  
at lea/ "o ye> prior to ! beg9n+ ( any  
su* p]iod4  4