,i #aac? ,,congress #a/ ,session ,h4 ,r4 #cafh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #bj1 #bjac,mr4 ,williams 7= himself1 ,mr4 ,flores1 ,ms4 ,grang]1 & ,mr4 ,/ockman7 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 provide = a ,m$ic>e e/abli%$ provid] sy/em "u :i* provid]s ( s]vices & suppli]s repres5t+ a l[ risk = submitt+ fraudul5t ,m$ic>e claims are provid$ c]ta9 claim review protections4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,e/abli%$ ,provid] ,act ( #bjac4 #b4 ,m$ic>e e/abli%$ provid] sy/em ,title ,,xviii ( ! ,social ,security ,act is am5d$ by ins]t+ aft] section #ahic ( su* ,act 7#db ,u4,s4,c4 #acie;ddd7 ! foll[+ new section3 #ahic;,a4 ,m$ic>e e/abli%$ provid] sy/em 7a7 ,9 g5]al ,! ,secret>y %all develop & implem5t a sy/em 79 ?is section ref]r$ to z ! ,m$ic>e ,e/abli%$ ,provid] ,sy/em7 to designate provid]s ( s]vices & suppli]s :o repres5t a l[ risk = submitt+ fraudul5t claims = paym5t "u ?is title z e/abli%$ provid]s = purposes ( apply+ ! protections describ$ 9 subsection 7c74 ,"u su* sy/em-- 7#a7 ! ,secret>y %all e/abli% a process1 9 accordance ) subsection 7c71 "u :i*-- 7,a7 provid]s ( s]vices & suppli]s may apply = designation z e/abli%$ provid]s2 7,b7 su* provid]s & suppli]s :o qualify1 9 accordance ) subsection 7b71 z e/abli%$ provid]s are s designat$ 7includ+ ?r\gh ! use ( entities tra9$ by an ,int]net tra9+ c\rse ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices or ?r\gh tra9+ provid$ by o!r specifi$ organizations72 & 7,c7 su* provid]s & suppli]s :o no long] qualify z e/abli%$ provid]s lose su* designation2 & 7#b7 ! ,secret>y %all e/abli% an electronic sy/em = ! submission ( docum5tation by provid]s ( s]vices1 suppli]s1 or ?ird p>ties1 ) respect to a claim = paym5t "u ?is title t is "u review1 = ea* level ( review applicable to su* claim4 7b7 ,qualify+ z e/abli%$ provid]s ,"u su* sy/em1 to qualify z an e/abli%$ provid] = a p]iod ) respect to a report+ p]iod 7z specifi$ by ! ,secret>y71 a provid] ( s]vices or suppli] %all demon/rate1 z specifi$ by ! ,secret>y1 t-- 7#a7 ) respect to ! report+ p]iod beg9n+ aft] ! date ( ! enactm5t ( ?is section b be=e ! date describ$ 9 p>agraph 7#b71 at lea/ #ge p]c5t ( claims = paym5t "u ?is title = items & s]vices furni%$ by su* provid] or suppli] = :i* any review 0 conduct$ "u section #ahfi 7 det]m9$ to be eligible = paym5t "u ?is title2 7#b7 ) respect to a report+ p]iod beg9n+ aft] ! date t is #b ye>s aft] ! date ( enactm5t ( ?is section1 at lea/ #hj p]c5t ( claims = paym5t "u ?is title = items & s]vices furni%$ by su* provid] or suppli] = :i* any review 0 conduct$ "u section #ahfi 7 det]m9$ to be eligible = paym5t "u ?is title2 & 7#c7 ( all claims = paym5t "u ?is title = items & s]vices furni%$ by su* provid] or suppli] = :i* an initial det]m9ation 0 made t paym5t may n be made "u ?is title1 at lea/ #ij p]c5t 7 appeal$ by su* provid] or suppli]4 7c7 ,designation process ,! process "u subsection 7a77#a7-- 7#a7 %all all[ a provid] ( s]vices or suppli] designat$ z an e/abli%$ provid] "u ?is section to demon/rate t ! provid] or suppli] ma9ta9s compliance ) ! qualification requirem5ts "u subsection 7b7 bas$ on annual updates on ! /atus ( claims = paym5t "u ?is title = items & s]vices furni%$ by su* provid] or suppli] ) respect to ea* level ( review1 includ+ ! numb] ( su* claims )9 ea* su* level ( review = :i* a det]m9ation 0 made t paym5t %\ld be made1 %\ld be p>tially made1 or %\ld n be made "u ?is title2 7#b7 %all provide a me?od ?r\gh :i* x may be det]m9$ :e!r or n ! qualify+ requirem5ts "u subsection 7b7 h be5 satisfi$ & ma9ta9$ by a provid] ( s]vices or suppli] ) respect to a p]iod2 7#c7 provide = ! id5tification ( e/abli%$ provid]s )9 appropriate sy/ems ( ! ,c5t]s ( ,m$ic>e ,m$icaid ,s]vices2 & 7#d7 provide = a global track record ( compliance by provid]s ( s]vices & suppli]s ) ! qualify+ requirem5ts "u subsection 7b71 includ+ by id5tify+ su* provid]s & suppli]s by ! managem5t company provid] numb] r ?an by ea* individual provid]1 suppli]1 or facility1 = purposes ( effici5cy4 7d7 ,protections = e/abli%$ provid]s ,not)/&+ any o!r provision ( law1 9 ! case ( a provid] ( s]vices or suppli] designat$ z an e/abli%$ provid] "u ?is section ) respect to a p]iod ! foll[+ protections %all apply3 7#a7 ,) respect to a claim submitt$ dur+ su* p]iod = paym5t "u ?is title = items or s]vices furni%$ by su* provid] or suppli]1 :i* is subject to review = :e!r or n paym5t %\ld be made "u su* title & ) respect to :i* an additional docum5tation reque/ has be5 issu$1 paym5t "u ?is title = su* claim may n be )held unless a f9al det]m9ation has be5 made t su* paym5t %\ld n be made4 7#b7 ,9 ! case t a f9al det]m9ation has be5 made t paym5t "u ?is title %\ld n h be5 made ) respect to a claim describ$ 9 p>agraph 7#a71 repaym5t ( su* paym5t %all be made electronically by ! provid] n lat] ?an #de days aft] notification ( su* decision4 ,9 apply+ ! previ\s s5t5ce1 if ! ,secret>y det]m9es t repaym5t )9 su* #de-;day p]iod w\ld result 9 a significant h>d%ip to ! provid] involv$1 ! ,secret>y may1 on a case-by-case basis1 ext5d ! #de-;day p]iod describ$ 9 su* s5t5ce by su* numb] ( days z ! ,secret>y det]m9es appropriate 9 accordance ) a specifi$ repaym5t plan4 7#c7 ,! ,secret>y %all provide = a me?od to apply section #ahfi ) respect to an initial det]m9ation ( any claim submitt$ dur+ su* p]iod = paym5t "u ?is title = items & s]vices furni%$ by su* provid] or suppli]1 )\t ! application ( p>agraph 7#c7 ( section #ahfi7;a7 7relat+ to r$et]m9ations74 4