,,ii #aac? ,,congress #b;d ,session ,h4 ,r4 #dcjb ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #bg1 #bjad,receiv$ ,,an ,,act ,to am5d ! ,social ,security ,act to ext5d ,m$ic>e paym5ts to physicians & o!r provisions ( ! ,m$ic>e & ,m$icaid programs1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,protect+ ,access to ,m$ic>e ,act ( #bjad4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,title ,i--,m$ic>e ,ext5d]s ,sec4 #aja4 ,physician paym5t update4 ,sec4 #ajb4 ,ext5sion ( "w ,,gpci floor4 ,sec4 #ajc4 ,ext5sion ( !rapy cap exceptions process4 ,sec4 #ajd4 ,ext5sion ( ambulance add-ons4 ,sec4 #aje4 ,ext5sion ( increas$ inpati5t hospital paym5t adju/m5t = c]ta9 l[-volume hospitals4 ,sec4 #ajf4 ,ext5sion ( ! ,m$ic>e-dep5d5t hospital 7,,mdh7 program4 ,sec4 #ajg4 ,ext5sion = specializ$ ,m$ic>e ,advantage plans = special ne$s individuals4 ,sec4 #ajh4 ,ext5sion ( ,m$ic>e reasonable co/ contracts4 ,sec4 #aji4 ,ext5sion ( fund+ = quality measure endorsem5t1 input1 & selection4 ,sec4 #aaj4 ,ext5sion ( fund+ outrea* & assi/ance = l[-income programs4 ,sec4 #aaa4 ,ext5sion ( two-midnight rule4 ,sec4 #aab4 ,te*nical *anges to ,m$ic>e ,,lt* am5dm5ts4 ,title ,,ii--,o!r ,heal? ,provisions ,sec4 #bja4 ,ext5sion ( ! qualify+ individual 7,,qi7 program4 ,sec4 #bjb4 ,tempor>y ext5sion ( transitional m$ical assi/ance 7,,tma74 ,sec4 #bjc4 ,ext5sion ( ,m$icaid & ,,*ip express lane option4 ,sec4 #bjd4 ,ext5sion ( special diabetes program = type ,i diabetes & = ,indians4 ,sec4 #bje4 ,ext5sion ( ab/95ce education4 ,sec4 #bjf4 ,ext5sion ( p]sonal responsibility education program 7,,prep74 ,sec4 #bjg4 ,ext5sion ( fund+ = family-to-family heal? in=mation c5t]s4 ,sec4 #bjh4 ,ext5sion ( heal? work=ce demon/ration project = l[-income individuals4 ,sec4 #bji4 ,ext5sion ( mat]nal1 infant1 & e>ly *ildhood home visit+ programs4 ,sec4 #baj4 ,p$iatric quality measures4 ,sec4 #baa4 ,delay ( effective date = ,m$icaid am5dm5ts relat+ to b5efici>y liability settlem5ts4 ,sec4 #bab4 ,delay 9 transition f ,,icd-#i ,,to ,,icd-#aj code sets4 ,sec4 #bac4 ,elim9ation ( limitation on d$uctibles = employ]-sponsor$ heal? plans4 ,sec4 #bad4 ,,gao report on ! ,*ildr5's ,hospital ,graduate ,m$ical ,education ,program4 ,sec4 #bae4 ,skill$ nurs+ facility value-bas$ pur*as+4 ,sec4 #baf4 ,improv+ ,m$ic>e policies = cl9ical diagno/ic laboratory te/s4 ,sec4 #bag4 ,revisions "u ! ,m$ic>e ,,esrd prospective paym5t sy/em4 ,sec4 #bah4 ,quality inc5tives = comput$ tomography diagno/ic imag+ & promot+ evid5ce-bas$ c>e4 ,sec4 #bai4 ,us+ fund+ f ,transitional ,fund = ,su/a9able ,gr[? ,rate 7,,sgr7 ,re=m4 ,sec4 #bbj4 ,ensur+ accurate valuation ( s]vices "u ! physician fee s*$ule4 ,sec4 #bba4 ,m$icaid ,,d%4 ,sec4 #bbb4 ,realignm5t ( ! ,m$ic>e seque/] = fiscal ye> #bjbd4 ,sec4 #bbc4 ,demon/ration programs to improve community m5tal heal? s]vices4 ,sec4 #bbd4 ,assi/$ outpati5t treatm5t grant program = individuals ) s]i\s m5tal illness4 ,sec4 #bbe4 ,exclusion f ,,paygo scorec>ds4 ,i ,m$ic>e ,ext5d]s #aja4 ,physician paym5t update ,section #ahdh7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;d77 is am5d$-- 7#a7 9 p>agraph 7#ae7-- 7,a7 9 ! head+1 by /rik+ ,janu>y ?r\gh ,m>* (2 7,b7 9 subp>agraph 7,a71 by /rik+ = ! p]iod beg9n+ on ,janu>y #a1 #bjad1 & end+ on ,m>* #ca1 #bjad2 & 7,c7 9 subp>agraph 7,b7-- 7i7 9 ! head+1 by /rik+ rema9+ portion ( #bjad &2 & 7ii7 by /rik+ ! p]iod beg9n+ on ,april #a1 #bjad1 & end+ on ,decemb] #ca1 #bjad1 & =2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#af7 ,update = ,janu>y ?r\gh ,m>* ( #bjae 7,a7 ,9 g5]al ,subject to p>agraphs 7#g77;,b71 7#h77;,b71 7#i77;,b71 7#aj77;,b71 7#aa77;,b71 7#ab77;,b71 7#ac77;,b71 7#ad77;,b71 & 7#ae77;,b71 9 lieu ( ! update to ! s+le conv]sion factor e/abli%$ 9 p>agraph 7#a77;,c7 t w\ld o!rwise apply = #bjae = ! p]iod beg9n+ on ,janu>y #a1 #bjae1 & end+ on ,m>* #ca1 #bjae1 ! update to ! s+le conv]sion factor %all be #j4j p]c5t4 7,b7 ,no effect on computation ( conv]sion factor = rema9+ portion ( #bjae & subsequ5t ye>s ,! conv]sion factor "u ?is subsection %all be comput$ "u p>agraph 7#a77;,a7 = ! p]iod beg9n+ on ,april #a1 #bjae1 & end+ on ,decemb] #ca1 #bjae1 & = #bjaf & subsequ5t ye>s z if subp>agraph 7,a7 _h nev] appli$4 4 #ajb4 ,ext5sion ( "w ,,gpci floor ,section #ahdh7;e77#a77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is am5d$ by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae4 #ajc4 ,ext5sion ( !rapy cap exceptions process ,section #ahcc7;g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77 is am5d$-- 7#a7 9 p>agraph 7#e77;,a71 9 ! fir/ s5t5ce1 by /rik+ ,m>* #ca1 #bjad & ins]t+ ,m>* #ca1 #bjae2 & 7#b7 9 p>agraph 7#f77;,a7-- 7,a7 by /rik+ ,m>* #ca1 #bjad & ins]t+ ,m>* #ca1 #bjae2 & 7,b7 by /rik+ #bjab1 #bjac1 or ! fir/ ?ree mon?s ( #bjad & ins]t+ #bjab1 #bjac1 #bjad1 or ! fir/ ?ree mon?s ( #bjae4 #ajd4 ,ext5sion ( ambulance add-ons 7a7 ,gr\nd ,ambulance ,section #ahcd7l77#ac77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ac77;,a77 is am5d$ by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae ea* place x appe>s4 7b7 ,sup] rural gr\nd ambulance ,section #ahcd7l77#ab77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77#ab77;,a77 is am5d$1 9 ! fir/ s5t5ce1 by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae4 #aje4 ,ext5sion ( increas$ inpati5t hospital paym5t adju/m5t = c]ta9 l[-volume hospitals ,section #ahhf7;d77#ab7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is am5d$-- 7#a7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by /rik+ 9 ! portion ( fiscal ye> #bjad beg9n+ on ,april #a1 #bjad1 fiscal ye> #bjae1 & subsequ5t fiscal ye>s & ins]t+ 9 fiscal ye> #bjae 7beg9n+ on ,april #a1 #bjae71 fiscal ye> #bjaf1 & subsequ5t fiscal ye>s2 7#b7 9 subp>agraph 7,c77i71 by /rik+ fiscal ye>s #bjaa1 #bjab1 & #bjac1 & ! portion ( fiscal ye> #bjad be=e & ins]t+ fiscal ye>s #bjaa ?r\gh #bjad & fiscal ye> #bjae 7be=e ,april #a1 #bjae71 ea* place x appe>s2 & 7#c7 9 subp>agraph 7,d71 by /rik+ fiscal ye>s #bjaa1 #bjab1 & #bjac1 & ! portion ( fiscal ye> #bjad be=e ,april #a1 #bjad1 & ins]t+ fiscal ye>s #bjaa ?r\gh #bjad & fiscal ye> #bjae 7be=e ,april #a1 #bjae714 #ajf4 ,ext5sion ( ! ,m$ic>e-dep5d5t hospital 7,,mdh7 program 7a7 ,9 g5]al ,section #ahhf7;d77#e77;,g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae2 & 7#b7 9 clause 7ii77,,ii71 by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae4 7b7 ,con=m+ am5dm5ts 7#a7 ,ext5sion ( t>get am\nt ,section #ahhf7;b77#c77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,d77 is am5d$-- 7,a7 9 ! matt] prec$+ clause 7i71 by /rik+ ,april #a1 #bjad & ins]t+ ,april #a1 #bjae2 & 7,b7 9 clause 7iv71 by /rik+ ?r\gh fiscal ye> #bjac & ! portion ( fiscal ye> #bjad be=e ,april #a1 #bjad & ins]t+ ?r\gh fiscal ye> #bjad & ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae4 7#b7 ,p]mitt+ hospitals to decl9e reclassification ,section #aceja7;e77#b7 ( ! ,omnibus ,budget ,reconciliation ,act ( #aiic 7#db ,u4,s4,c4 #acieww note7 is am5d$ by /rik+ ?r\gh ! fir/ #b qu>t]s ( fiscal ye> #bjad & ins]t+ ?r\gh ! fir/ #b qu>t]s ( fiscal ye> #bjae4 #ajg4 ,ext5sion = specializ$ ,m$ic>e ,advantage plans = special ne$s individuals ,section #ahei7;f77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#a77 is am5d$ by /rik+ #bjaf & ins]t+ #bjag4 #ajh4 ,ext5sion ( ,m$ic>e reasonable co/ contracts ,section #ahgf7;h77#e77;,c77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciemm7h77#e77;,c77ii77 is am5d$1 9 ! matt] prec$+ subclause 7,i71 by /rik+ ,janu>y #a1 #bjae & ins]t+ ,janu>y #a1 #bjaf4 #aji4 ,ext5sion ( fund+ = quality measure endorsem5t1 input1 & selection ,section #ahij7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77 is am5d$-- 7#a7 by ins]t+ 7#a7 be=e ,= purposes2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,= purposes ( c>ry+ out ?is section & section #ahij;,a 7o!r ?an subsections 7e7 & 7f771 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 9 su* proportion z ! ,secret>y det]m9es appropriate1 to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt ( #e1jjj1jjj = fiscal ye> #bjad & #ae1jjj1jjj = ! fir/ #f mon?s ( fiscal ye> #bjae4 ,am\nts transf]r$ "u ! prec$+ s5t5ce %all rema9 available until exp5d$4 4 #aaj4 ,ext5sion ( fund+ outrea* & assi/ance = l[-income programs 7a7 ,additional fund+ = /ate heal? insurance programs ,subsection 7a77#a77;,b7 ( section #aai ( ! ,m$ic>e ,improvem5ts = ,pati5ts & ,provid]s ,act ( #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 z am5d$ by section #ccjf ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ,public ,law #aaa-adh71 section #faj ( ! ,am]ican ,taxpay] ,relief ,act ( #bjab 7,public ,law #aab-bdj71 & section #aaaj ( ! ,pa?way = ,,sgr ,re=m ,act ( #bjac 7,public ,law #aac-fg71 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 by /rik+ clause 7iv72 & 7#c7 by add+ at ! end ! foll[+ new clauses3 7iv7 = fiscal ye> #bjad1 ( #g1ejj1jjj2 & 7v7 = ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae1 ( #c1gej1jjj4 4 7b7 ,additional fund+ = area ag5cies on ag+ ,subsection 7b77#a77;,b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 by /rik+ clause 7iv72 & 7#c7 by ins]t+ aft] clause 7iii7 ! foll[+ new clauses3 7iv7 = fiscal ye> #bjad1 ( #g1ejj1jjj2 & 7v7 = ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae1 ( #c1gej1jjj4 4 7c7 ,additional fund+ = ag+ & disability res\rce c5t]s ,subsection 7c77#a77;,b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 by /rik+ clause 7iv72 & 7#c7 by ins]t+ aft] clause 7iii7 ! foll[+ new clauses3 7iv7 = fiscal ye> #bjad1 ( #e1jjj1jjj2 & 7v7 = ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae1 ( #b1ejj1jjj4 4 7d7 ,additional fund+ = contract ) ! national c5t] = b5efits & outrea* enrollm5t ,subsection 7d77#b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 by /rik+ clause 7iv72 & 7#c7 by ins]t+ aft] clause 7iii7 ! foll[+ new clauses3 7iv7 = fiscal ye> #bjad1 ( #e1jjj1jjj2 & 7v7 = ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae1 ( #b1ejj1jjj4 4 #aaa4 ,ext5sion ( two-midnight rule 7a7 ,cont9uation ( c]ta9 m$ical review activities ,! ,secret>y ( ,heal? & ,human ,s]vices may cont9ue m$ical review activities describ$ 9 ! notice entitl$ ,select+ ,hospital ,claims = ,pati5t ,/atus ,reviews3 ,admissions ,on or ,aft] ,octob] #a1 #bjac1 po/$ on ! ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 ?r\gh ! fir/ #f mon?s ( fiscal ye> #bjae = su* additional hospital claims z ! ,secret>y det]m9es appropriate4 7b7 ,limitation ,! ,secret>y ( ,heal? & ,human ,s]vices %all n conduct pati5t /atus reviews 7z describ$ 9 su* notice7 on a po/-paym5t review basis ?r\gh recov]y audit contractors "u section #ahic7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ddd7h77 = inpati5t claims ) dates ( admission ,octob] #a1 #bjac1 ?r\gh ,m>* #ca1 #bjae1 unless !re is evid5ce ( sy/ematic gam+1 fraud1 abuse1 or delays 9 ! provision ( c>e by a provid] ( s]vices 7z def9$ 9 section #ahfa7u7 ( su* ,act 7#db ,u4,s4,c4 #aciex7u7774 #aab4 ,te*nical *anges to ,m$ic>e ,,lt* am5dm5ts 7a7 ,9 g5]al ,subclauses 7,i7 & 7,,ii7 ( section #ahhf7m77#f77;,c77iv7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77#f77;,c77iv77 are ea* am5d$ by /rik+ dis*>ges & ins]t+ ,m$ic>e fee-=-s]vice dis*>ges4 7b7 ,,mmsea correction ,section #aad7;d7 ( ! ,m$ic>e1 ,m$icaid1 & ,,s*ip ,ext5sion ,act ( #bjjg 7#db ,u4,s4,c4 #acieww note71 z am5d$ by sections #cajf7;b7 & #ajcab7;b7 ( ,public ,law #aaa-adh & by section #abjf7;b77#b7 ( ! ,pa?way = ,,sgr ,re=m ,act ( #bjac 7division ,b ( ,public ,law #aac-fg71 is am5d$-- 7#a7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ,janu>y #a1 #bjae1 & ins]t+ on ! date ( ! enactm5t ( p>agraph 7#g7 ( ?is subsection2 7#b7 9 p>agraph 7#f71 by /rik+ ,janu>y #a1 #bjae1 & ins]t+ on ! date ( ! enactm5t ( p>agraph 7#g7 ( ?is subsection2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,additional exception = c]ta9 long-t]m c>e hospitals ,! moratorium "u p>agraph 7#a77;,a7 %all n apply to a long-t]m c>e hospital t-- 7,a7 began its qualify+ p]iod = paym5t z a long-t]m c>e hospital "u section #dab4bc7;e7 ( title #db1 ,code ( ,f$]al ,regulations1 on or be=e ! date ( enactm5t ( ?is p>agraph2 7,b7 has a b9d+ writt5 agreem5t z ( ! date ( ! enactm5t ( ?is p>agraph ) an outside1 unrelat$ p>ty = ! actual con/ruction1 r5ovation1 lease1 or demolition = a long-t]m c>e hospital1 & has exp5d$1 be=e su* date ( enactm5t1 at lea/ #aj p]c5t ( ! e/imat$ co/ ( ! project 7or1 if less1 #b1ejj1jjj72 or 7,c7 has obta9$ an approv$ c]tificate ( ne$ 9 a ,/ate :]e "o is requir$ on or be=e su* date ( enactm5t4 4 7c7 ,additional am5dm5ts ,section #abjf7;a7 ( ! ,pa?way = ,,sgr ,re=m ,act ( #bjac 7division ,b ( ,public ,law #aac-fg7 is am5d$-- 7#a7 9 p>agraph 7#b77;,a71 by /rik+ ,assessm5t & ins]t+ ,advisory2 & 7#b7 9 p>agraph 7#c77;,b71 by /rik+ %all n apply to a hospital t is classifi$ z ( ,decemb] #aj1 #bjac1 z a subsection 7d7 hospital 7z def9$ 9 section #ahhf7;d77#a77;,b7 ( ! ,social ,security ,act1 #db ,u4,s4,c4 #acieww7d77#a77;,b77 & ins]t+ %all only apply to a hospital t is classifi$ z ( ,decemb] #aj1 #bjac1 z a long-t]m c>e hospital 7z def9$ 9 section #ahfa7;ccc7 ( ! ,social ,security ,act1 #db ,u4,s4,c4 #aciex7ccc774 7d7 ,effective date ,! am5dm5ts made by ?is section are effective z ( ! date ( ! enactm5t ( ?is ,act4 ,,ii ,o!r ,heal? ,provisions #bja4 ,ext5sion ( ! qualify+ individual 7,,qi7 program 7a7 ,ext5sion ,section #aijb7;a77#aj77;,e77iv7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77iv77 is am5d$ by /rik+ ,m>* #bjad & ins]t+ ,m>* #bjae4 7b7 ,ext5d+ total am\nt available = allocation ,section #aicc7;g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#c7;g77 is am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 9 subp>agraph 7,t71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,u7-- 7i7 by /rik+ ,m>* #ca1 #bjad & ins]t+ ,septemb] #cj1 #bjad2 & 7ii7 by /rik+ #bjj1jjj1jjj4 & ins]t+ #dhe1jjj1jjj22 & 7,c7 by add+ at ! end ! foll[+ new subp>agraphs3 7,v7 = ! p]iod t beg9s on ,octob] #a1 #bjad1 & ends on ,decemb] #ca1 #bjad1 ! total allocation am\nt is #cjj1jjj1jjj2 & 7,w7 = ! p]iod t beg9s on ,janu>y #a1 #bjae1 & ends on ,m>* #ca1 #bjae1 ! total allocation am\nt is #bej1jjj1jjj4 2 & 7#b7 9 p>agraph 7#c71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ or 7,t7 & ins]t+ 7,t71 or 7,v74 #bjb4 ,tempor>y ext5sion ( transitional m$ical assi/ance 7,,tma7 ,sections #aijb7;e77#a77;,b7 & #aibe7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#a77;,b71 #acifr-#f7;f77 are ea* am5d$ by /rik+ ,m>* #ca1 #bjad & ins]t+ ,m>* #ca1 #bjae4 #bjc4 ,ext5sion ( ,m$icaid & ,,*ip express lane option ,section #aijb7;e77#ac77;,i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,i77 is am5d$ by /rik+ ,septemb] #cj1 #bjad & ins]t+ ,septemb] #cj1 #bjae4 #bjd4 ,ext5sion ( special diabetes program = type ,i diabetes & = ,indians 7a7 ,special ,diabetes ,programs = ,type ,i ,diabetes ,section #ccj;,b7b77#b77;,c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b77;,c77 is am5d$ by /rik+ #bjad & ins]t+ #bjae4 7b7 ,special ,diabetes ,programs = ,indians ,section #ccj;,c7c77#b77;,c7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#c7;c77#b77;,c77 is am5d$ by /rik+ #bjad & ins]t+ #bjae4 #bje4 ,ext5sion ( ab/95ce education ,subsections 7a7 & 7d7 ( section #eaj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 are ea* am5d$ by /rik+ #bjad & ins]t+ #bjae4 #bjf4 ,ext5sion ( p]sonal responsibility education program 7,,prep7 ,section #eac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gac7 is am5d$-- 7#a7 9 p>agraphs 7#a77;,a7 & 7#d77;,a7 ( subsection 7a71 by /rik+ #bjad & ins]t+ #bjae ea* place x appe>s2 7#b7 9 subsection 7a77#d77;,b77i71 by /rik+ & #bjad & ins]t+ #bjad1 & #bjae2 & 7#c7 9 subsection 7f71 by /rik+ #bjad & ins]t+ #bjae4 #bjg4 ,ext5sion ( fund+ = family-to-family heal? in=mation c5t]s ,section #eja7;c77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gja7;c77#a77;,a77 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ at ! end &2 7#b7 9 clause 7iv71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon & by mov+ ! m>g9 to align ) ! m>g9 = clause 7iii72 & 7#c7 by add+ at ! end ! foll[+ new clauses3 7v7 #b1ejj1jjj = ! portion ( fiscal ye> #bjad on or aft] ,april #a1 #bjad2 & 7vi7 #b1ejj1jjj = ! portion ( fiscal ye> #bjae be=e ,april #a1 #bjae4 4 #bjh4 ,ext5sion ( heal? work=ce demon/ration project = l[-income individuals ,section #bjjh7;c77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;g7c77#a77 is am5d$ by /rik+ #bjad & ins]t+ #bjae4 #bji4 ,ext5sion ( mat]nal1 infant1 & e>ly *ildhood home visit+ programs ,section #eaa7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 by /rik+ & at ! end ( subp>agraph 7,d72 7,b7 by /rik+ ! p]iod at ! end ( subp>agraph 7,e7 & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,f7 = ! p]iod beg9n+ on ,octob] #a1 #bjad1 & end+ on ,m>* #ca1 #bjae1 an am\nt equal to ! am\nt provid$ 9 subp>agraph 7,e74 2 & 7#b7 9 p>agraphs 7#b7 & 7#c71 by ins]t+ 7or portion ( a fiscal ye>7 aft] = a fiscal ye> ea* place x appe>s4 #baj4 ,p$iatric quality measures 7a7 ,cont9uation ( fund+ = p$iatric quality measures = improv+ ! quality ( *ildr5's heal? c>e ,section #aaci;,b7e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7e77 is am5d$ by add+ at ! end ! foll[+3 ,( ! funds appropriat$ "u ?is subsection1 n less ?an #ae1jjj1jjj %all be us$ to c>ry out section #aaci;,a7b744 7b7 ,elim9ation ( re/riction on ,m$icaid quality measurem5t program ,section #aaci;,b7b77#e77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;b7b77#e77;,a77 is am5d$ by /rik+ ,! aggregate am\nt aw>d$ by ! ,secret>y = grants & contracts = ! developm5t1 te/+1 & validation ( em]g+ & innovative evid5ce-bas$ measures "u su* program %all equal ! aggregate am\nt aw>d$ by ! ,secret>y = grants "u section #aaci;,a7b77#d77;,a74 #baa4 ,delay ( effective date = ,m$icaid am5dm5ts relat+ to b5efici>y liability settlem5ts ,effective z if includ$ 9 ! enactm5t ( ! ,bip>tisan ,budget ,act ( #bjac 7,public ,law #aac-fg71 section #bjb7;c7 ( su* ,act is am5d$ by /rik+ ,octob] #a1 #bjad & ins]t+ ,octob] #a1 #bjaf4 #bab4 ,delay 9 transition f ,,icd-#i ,,to ,,icd-#aj code sets ,! ,secret>y ( ,heal? & ,human ,s]vices may n1 prior to ,octob] #a1 #bjae1 adopt ,,icd-#aj code sets z ! /&>d = code sets "u section #aagc7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;d-#b7;c77 & section #afb4ajjb ( title #de1 ,code ( ,f$]al ,regulations4 #bac4 ,elim9ation ( limitation on d$uctibles = employ]-sponsor$ heal? plans 7a7 ,9 g5]al ,section #acjb7;c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh2 #db ,u4,s4,c4 #ahjbb7;c77 is am5d$-- 7#a7 by /rik+ p>agraph 7#b72 & 7#b7 9 p>agraph 7#d77;,a71 by /rik+ p>agraphs 7#a77;,b77i7 & 7#b77;,b77i7 & ins]t+ p>agraph 7#a77;,b77i74 7b7 ,con=m+ am5dm5t ,section #bgjg7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#f7;b77 is am5d$ by /rik+ p>agraphs 7#a7 & 7#b7 & ins]t+ p>agraph 7#a74 7c7 ,effective date ,! am5dm5ts made by ?is ,act %all be effective z if includ$ 9 ! enactm5t ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh74 #bad4 ,,gao report on ! ,*ildr5's ,hospital ,graduate ,m$ical ,education ,program 7a7 ,9 g5]al ,9 ! case t ! ,*ildr5's ,hospital ,,gme ,support ,reau?orization ,act ( #bjac is enact$ into law1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all1 n lat] ?an ,novemb] #cj1 #bjag1 conduct an indep5d5t evaluation1 & submit to ! appropriate committees ( ,congress a report1 conc]n+ ! implem5tation ( section #cdj;,e7h7 ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #c ( ! ,*ildr5's ,hospital ,,gme ,support ,reau?orization ,act ( #bjac4 7b7 ,cont5t ,! report describ$ 9 subsection 7a7 %all review & assess ea* ( ! foll[+1 ) respect to hospitals receiv+ paym5ts "u su* section #cdj;,e7h7 dur+ ! p]iod ( fiscal ye>s #bjae ?r\gh #bjag3 7#a7 ,! numb] & type ( su* hospitals t appli$ = su* paym5ts4 7#b7 ,! numb] & type ( su* hospitals receiv+ su* paym5ts4 7#c7 ,! am\nt ( su* paym5ts aw>d$ to su* hospitals4 7#d7 ,h[ su* hospitals us$ su* paym5ts4 7#e7 ,! impact ( su* paym5ts on-- 7,a7 ! numb] ( p$iatric provid]s2 & 7,b7 heal? c>e ne$s ( *ildr54 #bae4 ,skill$ nurs+ facility value-bas$ pur*as+ 7a7 ,9 g5]al ,section #ahhh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,skill$ nurs+ facility readmission measure 7#a7 ,readmission measure ,n lat] ?an ,octob] #a1 #bjae1 ! ,secret>y %all specify a skill$ nurs+ facility all-cause all-condition hospital readmission measure 7or any successor to su* a measure74 7#b7 ,res\rce use measure ,n lat] ?an ,octob] #a1 #bjaf1 ! ,secret>y %all specify a measure to reflect an all-condition risk-adju/$ pot5tially prev5table hospital readmission rate = skill$ nurs+ facilities4 7#c7 ,measure adju/m5ts ,:5 specify+ ! measures "u p>agraphs 7#a7 & 7#b71 ! ,secret>y %all devise a me?odology to a*ieve a high level ( reliability & validity1 especially = skill$ nurs+ facilities ) a l[ volume ( readmissions4 7#d7 ,pre-rulemak+ process 7measure application p>tn]%ip process7 ,! application ( ! provisions ( section #ahij;,a %all be optional 9 ! case ( a measure specifi$ "u p>agraph 7#a7 & a measure specifi$ "u p>agraph 7#b74 7#e7 ,fe$back reports to skill$ nurs+ facilities ,beg9n+ ,octob] #a1 #bjaf1 & e qu>t] !reaft]1 ! ,secret>y %all provide confid5tial fe$back reports to skill$ nurs+ facilities on ! p]=mance ( su* facilities ) respect to a measure specifi$ "u p>agraph 7#a7 or 7#b74 7#f7 ,public report+ ( skill$ nurs+ facilities 7,a7 ,9 g5]al ,subject to subp>agraphs 7,b7 & 7,c71 ! ,secret>y %all e/abli% proc$ures = mak+ available to ! public by po/+ on ! ,nurs+ ,home ,comp>e ,m$ic>e website 7or a successor website7 describ$ 9 section #ahai7;i7 in=mation on ! p]=mance ( skill$ nurs+ facilities ) respect to a measure specifi$ "u p>agraph 7#a7 & a measure specifi$ "u p>agraph 7#b74 7,b7 ,opportunity to review ,! proc$ures "u subp>agraph 7,a7 %all ensure t a skill$ nurs+ facility has ! opportunity to review & submit corrections to ! in=mation t is to be made public ) respect to ! facility prior to su* in=mation be+ made public4 7,c7 ,tim+ ,su* proc$ures %all provide t ! in=mation describ$ 9 subp>agraph 7,a7 is made publicly available beg9n+ n lat] ?an ,octob] #a1 #bjag4 7#g7 ,non-application ( ,pap]work ,r$uction ,act ,*apt] #ce ( title #dd1 ,unit$ ,/ates ,code 7commonly ref]r$ to z ! #8,pap]work ,r$uction ,act ( #aiie'7 %all n apply to ?is subsection4 4 7b7 ,value-,bas$ pur*as+ program = skill$ nurs+ facilities ,section #ahhh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy71 z am5d$ by subsection 7a71 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 ,skill$ nurs+ facility value-,bas$ pur*as+ program 7#a7 ,e/abli%m5t 7,a7 ,9 g5]al ,subject to ! succe$+ provisions ( ?is subsection1 ! ,secret>y %all e/abli% a skill$ nurs+ facility value-bas$ pur*as+ program 79 ?is subsection ref]r$ to z ! ,,snf ,,vbp ,program7 "u :i* value-bas$ inc5tive paym5ts are made 9 a fiscal ye> to skill$ nurs+ facilities4 7,b7 ,program to beg9 9 fiscal ye> #bjai ,! ,,snf ,,vbp ,program %all apply to paym5ts = s]vices furni%$ on or aft] ,octob] #a1 #bjah4 7#b7 ,application ( measures 7,a7 ,9 g5]al ,! ,secret>y %all apply ! measure specifi$ "u subsection 7g77#a7 = purposes ( ! ,,snf ,,vbp ,program4 7,b7 ,replacem5t ,= purposes ( ! ,,snf ,,vbp ,program1 ! ,secret>y %all apply ! measure specifi$ "u 7g77#b7 in/ead ( ! measure specifi$ "u 7g77#a7 z soon z practicable4 7#c7 ,p]=mance /&>ds 7,a7 ,e/abli%m5t ,! ,secret>y %all e/abli% p]=mance /&>ds ) respect to ! measure appli$ "u p>agraph 7#b7 = a p]=mance p]iod = a fiscal ye>4 7,b7 ,high] ( a*ievem5t & improvem5t ,! p]=mance /&>ds e/abli%$ "u subp>agraph 7,a7 %all include levels ( a*ievem5t & improvem5t4 ,9 calculat+ ! ,,snf p]=mance score "u p>agraph 7#d71 ! ,secret>y %all use ! high] ( ei!r improvem5t or a*ievem5t4 7,c7 ,tim+ ,! ,secret>y %all e/abli% & ann\nce ! p]=mance /&>ds e/abli%$ "u subp>agraph 7,a7 n lat] ?an #fj days prior to ! beg9n+ ( ! p]=mance p]iod = ! fiscal ye> involv$4 7#d7 ,,snf p]=mance score 7,a7 ,9 g5]al ,! ,secret>y %all develop a me?odology = assess+ ! total p]=mance ( ea* skill$ nurs+ facility bas$ on p]=mance /&>ds e/abli%$ "u p>agraph 7#c7 ) respect to ! measure appli$ "u p>agraph 7#b74 ,us+ su* me?odology1 ! ,secret>y %all provide = an assessm5t 79 ?is subsection ref]r$ to z ! ,,snf p]=mance score7 = ea* skill$ nurs+ facility = ea* su* p]=mance p]iod4 7,b7 ,rank+ ( ,,snf p]=mance scores ,! ,secret>y %all1 = ! p]=mance p]iod = ea* fiscal ye>1 rank ! ,,snf p]=mance scores det]m9$ "u subp>agraph 7,a7 f l[ to high4 7#e7 ,calculation ( value-bas$ inc5tive paym5ts 7,a7 ,9 g5]al ,) respect to a skill$ nurs+ facility1 bas$ on ! rank+ "u p>agraph 7#d77;,b7 = a p]=mance p]iod = a fiscal ye>1 ! ,secret>y %all increase ! adju/$ ,f$]al p] diem rate det]m9$ "u subsection 7e77#d77;,g7 o!rwise applicable to su* skill$ nurs+ facility 7& aft] application ( p>agraph 7#f77 = s]vices furni%$ by su* facility dur+ su* fiscal ye> by ! value-bas$ inc5tive paym5t am\nt "u subp>agraph 7,b74 7,b7 ,value-bas$ inc5tive paym5t am\nt ,! value-bas$ inc5tive paym5t am\nt = s]vices furni%$ by a skill$ nurs+ facility 9 a fiscal ye> %all be equal to ! product (-- 7i7 ! adju/$ ,f$]al p] diem rate det]m9$ "u subsection 7e77#d77;,g7 o!rwise applicable to su* skill$ nurs+ facility = su* s]vices furni%$ by ! skill$ nurs+ facility dur+ su* fiscal ye>2 & 7ii7 ! value-bas$ inc5tive paym5t p]c5tage specifi$ "u subp>agraph 7,c7 = ! skill$ nurs+ facility = su* fiscal ye>4 7,c7 ,value-bas$ inc5tive paym5t p]c5tage 7i7 ,9 g5]al ,! ,secret>y %all specify a value-bas$ inc5tive paym5t p]c5tage = a skill$ nurs+ facility = a fiscal ye> :i* may include a z]o p]c5tage4 7ii7 ,requirem5ts ,9 specify+ ! value-bas$ inc5tive paym5t p]c5tage = ea* skill$ nurs+ facility = a fiscal ye> "u clause 7i71 ! ,secret>y %all ensure t-- 7,i7 su* p]c5tage is bas$ on ! ,,snf p]=mance score ( ! skill$ nurs+ facility provid$ "u p>agraph 7#d7 = ! p]=mance p]iod = su* fiscal ye>2 7,,ii7 ! application ( all su* p]c5tages 9 su* fiscal ye> results 9 an appropriate di/ribution ( value-bas$ inc5tive paym5ts "u subp>agraph 7,b7 su* t-- 7aa7 skill$ nurs+ facilities ) ! highe/ rank+s "u p>agraph 7#d77;,b7 receive ! highe/ value-bas$ inc5tive paym5t am\nts "u subp>agraph 7,b72 7bb7 skill$ nurs+ facilities ) ! l[e/ rank+s "u p>agraph 7#d77;,b7 receive ! l[e/ value-bas$ inc5tive paym5t am\nts "u subp>agraph 7,b72 & 7cc7 9 ! case ( skill$ nurs+ facilities 9 ! l[e/ #dj p]c5t ( ! rank+ "u p>agraph 7#d77;,b71 ! paym5t rate "u subp>agraph 7,a7 = s]vices furni%$ by su* facility dur+ su* fiscal ye> %all be less ?an ! paym5t rate = su* s]vices = su* fiscal ye> t w\ld o!rwise apply "u subsection 7e77#d77;,g7 )\t application ( ?is subsection2 & 7,,iii7 ! total am\nt ( value-bas$ inc5tive paym5ts "u ?is p>agraph = all skill$ nurs+ facilities 9 su* fiscal ye> %all be great] ?an or equal to #ej p]c5t1 b n great] ?an #gj p]c5t1 ( ! total am\nt ( ! r$uctions to paym5ts = su* fiscal ye> "u p>agraph 7#f71 z e/imat$ by ! ,secret>y4 7#f7 ,fund+ = value-bas$ inc5tive paym5ts 7,a7 ,9 g5]al ,! ,secret>y %all r$uce ! adju/$ ,f$]al p] diem rate det]m9$ "u subsection 7e77#d77;,g7 o!rwise applicable to a skill$ nurs+ facility = s]vices furni%$ by su* facility dur+ a fiscal ye> 7beg9n+ ) fiscal ye> #bjai7 by ! applicable p]c5t 7z def9$ 9 subp>agraph 7,b774 ,! ,secret>y %all make su* r$uctions = all skill$ nurs+ facilities 9 ! fiscal ye> involv$1 reg>dless ( :e!r or n ! skill$ nurs+ facility has be5 det]m9$ by ! ,secret>y to h e>n$ a value-bas$ inc5tive paym5t "u p>agraph 7#e7 = su* fiscal ye>4 7,b7 ,applicable p]c5t ,= purposes ( subp>agraph 7,a71 ! t]m applicable p]c5t means1 ) respect to fiscal ye> #bjai & succe$+ fiscal ye>s1 #b p]c5t4 7#g7 ,ann\ncem5t ( net result ( adju/m5ts ,"u ! ,,snf ,,vbp ,program1 ! ,secret>y %all1 n lat] ?an #fj days prior to ! fiscal ye> involv$1 in=m ea* skill$ nurs+ facility ( ! adju/m5ts to paym5ts to ! skill$ nurs+ facility = s]vices furni%$ by su* facility dur+ ! fiscal ye> "u p>agraphs 7#e7 & 7#f74 7#h7 ,no effect 9 subsequ5t fiscal ye>s ,! value-bas$ inc5tive paym5t "u p>agraph 7#e7 & ! paym5t r$uction "u p>agraph 7#f7 %all ea* apply only ) respect to ! fiscal ye> involv$1 & ! ,secret>y %all n take into acc\nt su* value-bas$ inc5tive paym5t or paym5t r$uction 9 mak+ paym5ts to a skill$ nurs+ facility "u ?is section 9 a subsequ5t fiscal ye>4 7#i7 ,public report+ 7,a7 ,,snf specific in=mation ,! ,secret>y %all make available to ! public1 by po/+ on ! ,nurs+ ,home ,comp>e ,m$ic>e website 7or a successor website7 describ$ 9 section #ahai7;i7 9 an easily und]/&able =mat1 in=mation reg>d+ ! p]=mance ( individual skill$ nurs+ facilities "u ! ,,snf ,,vbp ,program1 ) respect to a fiscal ye>1 includ+-- 7i7 ! ,,snf p]=mance score ( ! skill$ nurs+ facility = su* fiscal ye>2 & 7ii7 ! rank+ ( ! skill$ nurs+ facility "u p>agraph 7#d77;,b7 = ! p]=mance p]iod = su* fiscal ye>4 7,b7 ,aggregate in=mation ,! ,secret>y %all p]iodically po/ on ! ,nurs+ ,home ,comp>e ,m$ic>e website 7or a successor website7 describ$ 9 section #ahai7;i7 aggregate in=mation on ! ,,snf ,,vbp ,program1 includ+-- 7i7 ! range ( ,,snf p]=mance scores provid$ "u p>agraph 7#d77;,a72 & 7ii7 ! numb] ( skill$ nurs+ facilities receiv+ value-bas$ inc5tive paym5ts "u p>agraph 7#e7 & ! range & total am\nt ( su* value-bas$ inc5tive paym5ts4 7#aj7 ,limitation on review ,!re %all be no adm9i/rative or judicial review "u section #ahfi1 section #ahgh1 or o!rwise ( ! foll[+3 7,a7 ,! me?odology us$ to det]m9e ! value-bas$ inc5tive paym5t p]c5tage & ! am\nt ( ! value-bas$ inc5tive paym5t "u p>agraph 7#e74 7,b7 ,! det]m9ation ( ! am\nt ( fund+ available = su* value-bas$ inc5tive paym5ts "u p>agraph 7#e77;,c77ii77,,iii7 & ! paym5t r$uction "u p>agraph 7#f74 7,c7 ,! e/abli%m5t ( ! p]=mance /&>ds "u p>agraph 7#c7 & ! p]=mance p]iod4 7,d7 ,! me?odology develop$ "u p>agraph 7#d7 t is us$ to calculate ,,snf p]=mance scores & ! calculation ( su* scores4 7,e7 ,! rank+ det]m9ations "u p>agraph 7#d77;,b74 7#aa7 ,fund+ = program managem5t ,! ,secret>y %all provide = ! "o "t transf] f ! ,f$]al ,hospital ,insurance ,tru/ ,fund e/abli%$ "u section #ahag to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt (-- 7,a7 = purposes ( subsection 7g77#b71 #b1jjj1jjj2 & 7,b7 = purposes ( implem5t+ ?is subsection1 #aj1jjj1jjj4 ,su* funds %all rema9 available until exp5d$4 4 7c7 ,med,p,a,c /udy ,n lat] ?an ,june #cj1 #bjba1 ! ,m$ic>e ,paym5t ,advisory ,commission %all submit to ,congress a report t reviews ! progress ( ! skill$ nurs+ facility value-bas$ pur*as+ program e/abli%$ "u section #ahhh7;h7 ( ! ,social ,security ,act1 z add$ by subsection 7b71 & makes recomm5dations1 z appropriate1 on any improvem5ts t %\ld be made to su* program4 ,= purposes ( ! previ\s s5t5ce1 ! ,m$ic>e ,paym5t ,advisory ,commission %all consid] any un9t5d$ consequ5ces ) respect to su* skill$ nurs+ facility value-bas$ pur*as+ program & any pot5tial adju/m5ts to ! readmission measure specifi$ "u section #ahhh7;g77#a7 ( su* ,act1 z add$ by subsection 7a71 = purposes ( det]m9+ ! effect ( ! socio-economic /atus ( a b5efici>y "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act = ! ,,snf p]=mance score ( a skill$ nurs+ facility provid$ "u section #ahhh7;h77#d7 ( su* ,act1 z add$ by subsection 7b74 #baf4 ,improv+ ,m$ic>e policies = cl9ical diagno/ic laboratory te/s 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act is am5d$ by ins]t+ aft] section #ahcd 7#db ,u4,s4,c4 #aciem7 ! foll[+ new section3 #ahcd;,a4 ,improv+ policies = cl9ical diagno/ic laboratory te/s 7a7 ,report+ ( private sector paym5t rates = e/abli%m5t ( ,m$ic>e paym5t rates 7#a7 ,9 g5]al ,beg9n+ ,janu>y #a1 #bjaf1 & e #c ye>s !reaft] 7or1 annually1 9 ! case ( report+ ) respect to an advanc$ diagno/ic laboratory te/1 z def9$ 9 subsection 7d77#e771 an applicable laboratory 7z def9$ 9 p>agraph 7#b77 %all report to ! ,secret>y1 at a "t specifi$ by ! ,secret>y1 applicable in=mation 7z def9$ 9 p>agraph 7#c77 = a data collection p]iod 7z def9$ 9 p>agraph 7#d77 = ea* cl9ical diagno/ic laboratory te/ t ! laboratory furni%es dur+ su* p]iod = :i* paym5t is made "u ?is "p4 7#b7 ,def9ition ( applicable laboratory ,9 ?is section1 ! t]m applicable laboratory means a laboratory t1 ) respect to its rev5ues "u ?is title1 a majority ( su* rev5ues are f ?is section1 section #ahcc7;h71 or section #ahdh4 ,! ,secret>y may e/abli% a l[ volume or l[ exp5diture ?re%old = exclud+ a laboratory f ! def9ition ( applicable laboratory "u ?is p>agraph1 z ! ,secret>y det]m9es appropriate4 7#c7 ,applicable in=mation def9$ 7,a7 ,9 g5]al ,9 ?is section1 subject to subp>agraph 7,b71 ! t]m applicable in=mation means1 ) respect to a laboratory te/ = a data collection p]iod1 ! foll[+3 7i7 ,! paym5t rate 7z det]m9$ 9 accordance ) p>agraph 7#e77 t 0 paid by ea* private payor = ! te/ dur+ ! p]iod4 7ii7 ,! volume ( su* te/s = ea* su* payor = ! p]iod4 7,b7 ,exception = c]ta9 contractual arrangem5ts ,su* t]m %all n include in=mation ) respect to a laboratory te/ = :i* paym5t is made on a capitat$ basis or o!r simil> paym5t basis dur+ ! data collection p]iod4 7#d7 ,data collection p]iod def9$ ,9 ?is section1 ! t]m data collection p]iod means a p]iod ( "t1 su* z a previ\s #ab mon? p]iod1 specifi$ by ! ,secret>y4 7#e7 ,treatm5t ( disc\nts ,! paym5t rate report$ by a laboratory "u ?is subsection %all reflect all disc\nts1 rebates1 c\pons1 & o!r price concessions1 includ+ ^? describ$ 9 section #ahdg;,a7c77#c74 7#f7 ,ensur+ complete report+ ,9 ! case :]e an applicable laboratory has m ?an "o paym5t rate = ! same payor = ! same te/ or m ?an "o paym5t rate = diff]5t payors = ! same te/1 ! applicable laboratory %all report ea* su* paym5t rate & ! volume = ! te/ at ea* su* rate "u ?is subsection4 ,beg9n+ ) ,janu>y #a1 #bjai1 ! ,secret>y may e/abli% rules to aggregate report+ ) respect to ! situations describ$ 9 ! prec$+ s5t5ce4 7#g7 ,c]tification ,an (fic] ( ! laboratory %all c]tify ! accuracy & complet5ess ( ! in=mation report$ "u ?is subsection4 7#h7 ,private payor def9$ ,9 ?is section1 ! t]m private payor means ! foll[+3 7,a7 ,a heal? insurance issu] & a gr\p heal? plan 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act74 7,b7 ,a ,m$ic>e ,advantage plan "u "p ,c4 7,c7 ,a m$icaid manag$ c>e organization 7z def9$ 9 section #aijc7m774 7#i7 ,civil money p5alty 7,a7 ,9 g5]al ,if ! ,secret>y det]m9es t an applicable laboratory has fail$ to report or made a misrepres5tation or omission 9 report+ in=mation "u ?is subsection ) respect to a cl9ical diagno/ic laboratory te/1 ! ,secret>y may apply a civil money p5alty 9 an am\nt ( up to #aj1jjj p] day = ea* failure to report or ea* su* misrepres5tation or omission4 7,b7 ,application ,! provisions ( section #aabh;,a 7o!r ?an subsections 7a7 & 7b77 %all apply to a civil money p5alty "u ?is p>agraph 9 ! same mann] z !y apply to a civil money p5alty or proce$+ "u section #aabh;,a7a74 7#aj7 ,confid5tiality ( in=mation ,not)/&+ any o!r provision ( law1 in=mation disclos$ by a laboratory "u ?is subsection is confid5tial & %all n be disclos$ by ! ,secret>y or a ,m$ic>e contractor 9 a =m t discloses ! id5tity ( a specific payor or laboratory1 or prices *>g$ or paym5ts made to any su* laboratory1 except-- 7,a7 z ! ,secret>y det]m9es to be necess>y to c>ry out ?is section2 7,b7 to p]mit ! ,comptroll] ,g5]al to review ! in=mation provid$2 7,c7 to p]mit ! ,director ( ! ,congressional ,budget ,(fice to review ! in=mation provid$2 & 7,d7 to p]mit ! ,m$ic>e ,paym5t ,advisory ,commission to review ! in=mation provid$4 7#aa7 ,protection f public disclosure ,a payor %all n be id5tifi$ on in=mation report$ "u ?is subsection4 ,! "n ( an applicable laboratory "u ?is subsection %all be exempt f disclosure "u section #eeb7;b77#c7 ( title #e1 ,unit$ ,/ates ,code4 7#ab7 ,regulations ,n lat] ?an ,june #cj1 #bjae1 ! ,secret>y %all e/abli% ?r\gh notice & comm5t rulemak+ p>amet]s = data collection "u ?is subsection4 7b7 ,paym5t = cl9ical diagno/ic laboratory te/s 7#a7 ,use ( private payor rate in=mation to det]m9e ,m$ic>e paym5t rates 7,a7 ,9 g5]al ,subject to p>agraph 7#c7 & subsections 7c7 & 7d71 9 ! case ( a cl9ical diagno/ic laboratory te/ furni%$ on or aft] ,janu>y #a1 #bjag1 ! paym5t am\nt "u ?is section %all be equal to ! weight$ m$ian det]m9$ = ! te/ "u p>agraph 7#b7 = ! mo/ rec5t data collection p]iod4 7,b7 ,application ( paym5t am\nts to hospital laboratories ,! paym5t am\nts e/abli%$ "u ?is section %all apply to a cl9ical diagno/ic laboratory te/ furni%$ by a hospital laboratory if su* te/ is paid = sep>ately1 & n z "p ( a bundl$ paym5t "u section #ahcc7t74 7#b7 ,calculation ( weight$ m$ian ,= ea* laboratory te/ ) respect to :i* in=mation is report$ "u subsection 7a7 = a data collection p]iod1 ! ,secret>y %all calculate a weight$ m$ian = ! te/ = ! p]iod1 by array+ ! di/ribution ( all paym5t rates report$ = ! p]iod = ea* te/ weight$ by volume = ea* payor & ea* laboratory4 7#c7 ,phase-9 ( r$uctions f private payor rate implem5tation 7,a7 ,9 g5]al ,paym5t am\nts det]m9$ "u ?is subsection = a cl9ical diagno/ic laboratory te/ = ea* ( #bjag ?r\gh #bjbb %all n result 9 a r$uction 9 paym5ts = a cl9ical diagno/ic laboratory te/ = ! ye> ( great] ?an ! applicable p]c5t 7z def9$ 9 subp>agraph 7,b77 ( ! am\nt ( paym5t = ! te/ = ! prec$+ ye>4 7,b7 ,applicable p]c5t def9$ ,9 ?is p>agraph1 ! t]m applicable p]c5t means-- 7i7 = ea* ( #bjag ?r\gh #bjai1 #aj p]c5t2 & 7ii7 = ea* ( #bjbj ?r\gh #bjbb1 #ae p]c5t4 7,c7 ,no application to new te/s ,?is p>agraph %all n apply to paym5t am\nts det]m9$ "u ?is section = ei!r ( ! foll[+4 7i7 ,a new te/ "u subsection 7c74 7ii7 ,a new advanc$ diagno/ic te/ 7z def9$ 9 subsection 7d77#e77 "u subsection 7d74 7#d7 ,application ( m>ket rates 7,a7 ,9 g5]al ,subject to p>agraph 7#c71 once e/abli%$ = a ye> foll[+ a data collection p]iod1 ! paym5t am\nts "u ?is subsection %all cont9ue to apply until ! ye> foll[+ ! next data collection p]iod4 7,b7 ,o!r adju/m5ts n applicable ,! paym5t am\nts "u ?is section %all n be subject to any adju/m5t 7includ+ any geographic adju/m5t1 budget neutrality adju/m5t1 annual update1 or o!r adju/m5t74 7#e7 ,sample collection fee ,9 ! case ( a sample collect$ f an individual 9 a skill$ nurs+ facility or by a laboratory on behalf ( a home heal? ag5cy1 ! nom9al fee t w\ld o!rwise apply "u section #ahcc7;h77#c77;,a7 %all be increas$ by #b4 7c7 ,paym5t = new te/s t are n advanc$ diagno/ic laboratory te/s 7#a7 ,paym5t dur+ initial p]iod ,9 ! case ( a cl9ical diagno/ic laboratory te/ t is assign$ a new or sub/antially revis$ ,,hcpcs code on or aft] ! date ( enactm5t ( ?is section1 & :i* is n an advanc$ diagno/ic laboratory te/ 7z def9$ 9 subsection 7d77#e771 dur+ an initial p]iod until paym5t rates "u subsection 7b7 are e/abli%$ = ! te/1 paym5t = ! te/ %all be det]m9$-- 7,a7 us+ cross-walk+ 7z describ$ 9 section #dad4ejh7;a7 ( title #db1 ,code ( ,f$]al ,regulations1 or any successor regulation7 to ! mo/ appropriate exi/+ te/ "u ! fee s*$ule "u ?is section dur+ t p]iod2 or 7,b7 if no exi/+ te/ is comp>able to ! new te/1 accord+ to ! gapfill+ process describ$ 9 p>agraph 7#b74 7#b7 ,gapfill+ process describ$ ,! gapfill+ process describ$ 9 ?is p>agraph %all take into acc\nt ! foll[+ s\rces ( in=mation to det]m9e gapfill am\nts1 if available3 7,a7 ,*>ges = ! te/ & r\t9e disc\nts to *>ges4 7,b7 ,res\rces requir$ to p]=m ! te/4 7,c7 ,paym5t am\nts det]m9$ by o!r payors4 7,d7 ,*>ges1 paym5t am\nts1 & res\rces requir$ = o!r te/s t may be comp>able or o!rwise relevant4 7,e7 ,o!r crit]ia ! ,secret>y det]m9es appropriate4 7#c7 ,additional consid]ation ,9 det]m9+ ! paym5t am\nt "u crosswalk+ or gapfill+ processes "u ?is subsection1 ! ,secret>y %all consid] recomm5dations f ! panel e/abli%$ "u subsection 7f77#a74 7#d7 ,explanation ( paym5t rates ,9 ! case ( a cl9ical diagno/ic laboratory te/ = :i* paym5t is made "u ?is subsection1 ! ,secret>y %all make available to ! public an explanation ( ! paym5t rate = ! te/1 includ+ an explanation ( h[ ! crit]ia describ$ 9 p>agraph 7#b7 & p>agraph 7#c7 are appli$4 7d7 ,paym5t = new advanc$ diagno/ic laboratory te/s 7#a7 ,paym5t dur+ initial p]iod 7,a7 ,9 g5]al ,9 ! case ( an advanc$ diagno/ic laboratory te/ = :i* paym5t has n be5 made "u ! fee s*$ule "u section #ahcc7;h7 prior to ! date ( enactm5t ( ?is section1 dur+ an initial p]iod ( ?ree qu>t]s1 ! paym5t am\nt = ! te/ = su* p]iod %all be bas$ on ! actual li/ *>ge = ! laboratory te/4 7,b7 ,actual li/ *>ge ,= purposes ( subp>agraph 7,a71 ! t]m actual li/ *>ge1 ) respect to a laboratory te/ furni%$ dur+ su* p]iod1 means ! publicly available rate on ! fir/ day at :i* ! te/ is available = pur*ase by a private payor4 7#b7 ,special rule = tim+ ( initial report+ ,) respect to an advanc$ diagno/ic laboratory te/ describ$ 9 p>agraph 7#a77;,a71 an applicable laboratory %all initially be requir$ to report "u subsection 7a7 n lat] ?an ! la/ day ( ! second qu>t] ( ! initial p]iod "u su* p>agraph4 7#c7 ,application ( m>ket rates aft] initial p]iod ,subject to p>agraph 7#d71 data report$ "u p>agraph 7#b7 %all be us$ to e/abli% ! paym5t am\nt = an advanc$ diagno/ic laboratory te/ aft] ! initial p]iod "u p>agraph 7#a77;,a7 us+ ! me?odology describ$ 9 subsection 7b74 ,su* paym5t am\nt %all cont9ue to apply until ! ye> foll[+ ! next data collection p]iod4 7#d7 ,rec\pm5t if actual li/ *>ge exce$s m>ket rate ,) respect to ! initial p]iod describ$ 9 p>agraph 7#a77;,a71 if1 aft] su* p]iod1 ! ,secret>y det]m9es t ! paym5t am\nt = an advanc$ diagno/ic laboratory te/ "u p>agraph 7#a77;,a7 t 0 applicable dur+ ! p]iod 0 great] ?an #acj p]c5t ( ! paym5t am\nt = ! te/ e/abli%$ us+ ! me?odology describ$ 9 subsection 7b7 t is applicable aft] su* p]iod1 ! ,secret>y %all rec\p ! diff]5ce betwe5 su* paym5t am\nts = te/s furni%$ dur+ su* p]iod4 7#e7 ,advanc$ diagno/ic laboratory te/ def9$ ,9 ?is subsection1 ! t]m advanc$ diagno/ic laboratory te/ means a cl9ical diagno/ic laboratory te/ cov]$ "u ?is "p t is (f]$ & furni%$ only by a s+le laboratory & n sold = use by a laboratory o!r ?an ! orig9al develop+ laboratory 7or a successor own]7 & meets "o ( ! foll[+ crit]ia3 7,a7 ,! te/ is an analysis ( multiple biom>k]s ( ,,dna1 ,,rna1 or prote9s comb9$ ) a unique algori?m to yield a s+le pati5t-specific result4 7,b7 ,! te/ is cle>$ or approv$ by ! ,food & ,drug ,adm9i/ration4 7,c7 ,! te/ meets o!r simil> crit]ia e/abli%$ by ! ,secret>y4 7e7 ,cod+ 7#a7 ,tempor>y codes = c]ta9 new te/s 7,a7 ,9 g5]al ,! ,secret>y %all adopt tempor>y ,,hcpcs codes to id5tify new advanc$ diagno/ic laboratory te/s 7z def9$ 9 subsection 7d77#e77 & new laboratory te/s t are cle>$ or approv$ by ! ,food & ,drug ,adm9i/ration4 7,b7 ,duration 7i7 ,9 g5]al ,subject to clause 7ii71 ! tempor>y code %all be effective until a p]man5t ,,hcpcs code is e/abli%$ 7b n to exce$ #b ye>s74 7ii7 ,exception ,! ,secret>y may ext5d ! tempor>y code or e/abli% a p]man5t ,,hcpcs code1 z ! ,secret>y det]m9es appropriate4 7#b7 ,exi/+ te/s ,n lat] ?an ,janu>y #a1 #bjaf1 = ea* exi/+ advanc$ diagno/ic laboratory te/ 7z s def9$7 & ea* exi/+ cl9ical diagno/ic laboratory te/ t is cle>$ or approv$ by ! ,food & ,drug ,adm9i/ration = :i* paym5t is made "u ?is "p z ( ! date ( enactm5t ( ?is section1 if su* te/ has n already be5 assign$ a unique ,,hcpcs code1 ! ,secret>y %all-- 7,a7 assign a unique ,,hcpcs code = ! te/2 & 7,b7 publicly report ! paym5t rate = ! te/4 7#c7 ,e/abli%m5t ( unique id5tifi] = c]ta9 te/s ,= purposes ( track+ & monitor+1 if a laboratory or a manufactur] reque/s a unique id5tifi] = an advanc$ diagno/ic laboratory te/ 7z s def9$7 or a laboratory te/ t is cle>$ or approv$ by ! ,food & ,drug ,adm9i/ration1 ! ,secret>y %all utilize a means to uniquely track su* te/ ?r\gh a me*anism su* z a ,,hcpcs code or modifi]4 7f7 ,input f cl9icians & te*nical exp]ts 7#a7 ,9 g5]al ,! ,secret>y %all consult ) an exp]t outside advisory panel1 e/abli%$ by ! ,secret>y n lat] ?an ,july #a1 #bjae1 compos$ ( an appropriate selection ( individuals ) exp]tise1 :i* may include molecul> pa?ologi/s1 rese>*]s1 & individuals ) exp]tise 9 laboratory sci5ce or heal? economics1 9 issues relat$ to cl9ical diagno/ic laboratory te/s1 :i* may include ! developm5t1 validation1 p]=mance1 & application ( su* te/s1 to provide-- 7,a7 input on-- 7i7 ! e/abli%m5t ( paym5t rates "u ?is section = new cl9ical diagno/ic laboratory te/s1 includ+ :e!r to use crosswalk+ or gapfill+ processes to det]m9e paym5t = a specific new te/2 & 7ii7 ! factors us$ 9 det]m9+ cov]age & paym5t processes = new cl9ical diagno/ic laboratory te/s2 & 7,b7 recomm5dations to ! ,secret>y "u ?is section4 7#b7 ,compliance ) ,,faca ,! panel %all be subject to ! ,f$]al ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app474 7#c7 ,cont9uation ( annual meet+ ,! ,secret>y %all cont9ue to conv5e ! annual meet+ describ$ 9 section #ahcc7;h77#h77;,b77iii7 aft] ! implem5tation ( ?is section = purposes ( receiv+ comm5ts & recomm5dations 7& data on :i* ! recomm5dations are bas$7 z describ$ 9 su* section on ! e/abli%m5t ( paym5t am\nts "u ?is section4 7g7 ,cov]age 7#a7 ,issuance ( cov]age policies 7,a7 ,9 g5]al ,a m$ic>e adm9i/rative contractor %all only issue a cov]age policy ) respect to a cl9ical diagno/ic laboratory te/ 9 accordance ) ! process = mak+ a local cov]age det]m9ation 7z def9$ 9 section #ahfi7;f77#b77;,b771 includ+ ! appeals & review process = local cov]age det]m9ations "u "p #dbf ( title #db1 ,code ( ,f$]al ,regulations 7or successor regulations74 7,b7 ,no effect on national cov]age det]m9ation process ,?is p>agraph %all n apply to ! national cov]age det]m9ation process 7z def9$ 9 section #ahfi7;f77#a77;,b774 7,c7 ,effective date ,?is p>agraph %all apply to cov]age policies issu$ on or aft] ,janu>y #a1 #bjae4 7#b7 ,designation ( "o or m m$ic>e adm9i/rative contractors = cl9ical diagno/ic laboratory te/s ,! ,secret>y may designate "o or m 7n to exce$ #d7 m$ic>e adm9i/rative contractors to ei!r e/abli% cov]age policies or e/abli% cov]age policies & process claims = paym5t = cl9ical diagno/ic laboratory te/s1 z det]m9$ appropriate by ! ,secret>y4 7h7 ,implem5tation 7#a7 ,implem5tation ,!re %all be no adm9i/rative or judicial review "u section #ahfi1 section #ahgh1 or o!rwise1 ( ! e/abli%m5t ( paym5t am\nts "u ?is section4 7#b7 ,adm9i/ration ,*apt] #ce ( title #dd1 ,unit$ ,/ates ,code1 %all n apply to in=mation collect$ "u ?is section4 7#c7 ,fund+ ,= purposes ( implem5t+ ?is section1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 = ea* ( fiscal ye>s #bjad ?r\gh #bjah1 #d1jjj1jjj1 & = ea* ( fiscal ye>s #bjai ?r\gh #bjbc1 #c1jjj1jjj4 ,am\nts transf]r$ "u ! prec$+ s5t5ce %all rema9 available until exp5d$4 7i7 ,transitional rule ,dur+ ! p]iod beg9n+ on ! date ( enactm5t ( ?is section & end+ on ,decemb] #ca1 #bjaf1 ) respect to advanc$ diagno/ic laboratory te/s "u ?is "p1 ! ,secret>y %all use ! me?odologies = pric+1 cod+1 & cov]age 9 effect on ! day be=e su* date ( enactm5t1 :i* may include cross-walk+ or gapfill+ me?ods4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #ahcc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is am5d$-- 7,a7 9 p>agraph 7#a77;,d7-- 7i7 by /rik+ 7i7 on ! basis & ins]t+ 7i77,i7 on ! basis2 7ii7 9 subclause 7,i71 z add$ by clause 7i71 by /rik+ subsection 7h77#a7 & ins]t+ subsection 7h77#a7 7= te/s furni%$ be=e ,janu>y #a1 #bjag72 7iii7 by /rik+ or 7ii7 & ins]t+ or 7,,ii7 "u section #ahcd;,a 7= te/s furni%$ on or aft] ,janu>y #a1 #bjag71 ! am\nt paid %all be equal to #hj p]c5t 7or #ajj p]c5t1 9 ! case ( su* te/s = :i* paym5t is made on an assignm5t-relat$ basis7 ( ! less] ( ! am\nt det]m9$ "u su* section or ! am\nt ( ! *>ges bill$ = ! te/s1 or 7ii72 & 7iv7 9 clause 7ii71 by /rik+ on ! basis & ins]t+ = te/s furni%$ be=e ,janu>y #a1 #bjag1 on ! basis2 7,b7 9 p>agraph 7#b77;,d7-- 7i7 by /rik+ 7i7 on ! basis & ins]t+ 7i77,i7 on ! basis2 7ii7 9 subclause 7,i71 z add$ by clause 7i71 by /rik+ subsection 7h77#a7 & ins]t+ subsection 7h77#a7 7= te/s furni%$ be=e ,janu>y #a1 #bjag72 7iii7 by /rik+ or 7ii7 & ins]t+ or 7,,ii7 "u section #ahcd;,a 7= te/s furni%$ on or aft] ,janu>y #a1 #bjag71 ! am\nt paid %all be equal to #hj p]c5t 7or #ajj p]c5t1 9 ! case ( su* te/s = :i* paym5t is made on an assignm5t-relat$ basis or to a provid] hav+ an agreem5t "u section #ahff7 ( ! less] ( ! am\nt det]m9$ "u su* section or ! am\nt ( ! *>ges bill$ = ! te/s1 or 7ii72 & 7iv7 9 clause 7ii71 by /rik+ on ! basis & ins]t+ = te/s furni%$ be=e ,janu>y #a1 #bjag1 on ! basis2 7,c7 9 subsection 7b77#c77;,b71 by /rik+ on ! basis & ins]t+ = te/s furni%$ be=e ,janu>y #a1 #bjag1 on ! basis2 7,d7 9 subsection 7h77#b77;,a77i71 by /rik+ & subject to & ins]t+ &1 = te/s furni%$ be=e ! date ( enactm5t ( section #ahcd;,a1 subject to2 7,e7 9 subsection 7h77#c71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ fee s*$ules & ins]t+ fee s*$ules 7= te/s furni%$ be=e ,janu>y #a1 #bjag7 or "u section #ahcd;,a 7= te/s furni%$ on or aft] ,janu>y #a1 #bjag71 subject to subsection 7b77#e7 ( su* section2 7,f7 9 subsection 7h77#f71 by /rik+ ,9 ! case & ins]t+ ,= te/s furni%$ be=e ,janu>y #a1 #bjag1 9 ! case2 & 7,g7 9 subsection 7h77#g71 9 ! fir/ s5t5ce-- 7i7 by /rik+ & 7#d7 & ins]t+ & 7#d7 & section #ahcd;,a2 & 7ii7 by /rik+ "u ?is subsection & ins]t+ "u ?is "p4 7#b7 ,section #ahfi7;f77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;ff7f77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,local cov]age det]m9ations = cl9ical diagno/ic laboratory te/s ,= provisions relat+ to local cov]age det]m9ations = cl9ical diagno/ic laboratory te/s1 see section #ahcd;,a7g74 4 7c7 ,,gao /udy & report2 ,monitor+ ( ,m$ic>e exp5ditures & implem5tation ( new paym5t sy/em = laboratory te/s 7#a7 ,,gao /udy & report on implem5tation ( new paym5t rates = cl9ical diagno/ic laboratory te/s 7,a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is subsection ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy on ! implem5tation ( section #ahcd;,a ( ! ,social ,security ,act1 z add$ by subsection 7a74 ,! /udy %all include an analysis (-- 7i7 paym5t rates paid by private payors = laboratory te/s furni%$ 9 v>i\s sett+s1 includ+-- 7,i7 h[ su* paym5t rates comp>e across sett+s2 7,,ii7 ! tr5d 9 paym5t rates ov] "t2 & 7,,iii7 tr5ds by private payors to move to alt]native paym5t me?odologies = laboratory te/s2 7ii7 ! conv]sion to ! new paym5t rate = laboratory te/s "u su* section2 7iii7 ! impact ( su* implem5tation on b5efici>y access "u title ,,xviii ( ! ,social ,security ,act2 7iv7 ! impact ( ! new paym5t sy/em on laboratories t furni% a l[ volume ( s]vices & laboratories t specialize 9 a small numb] ( te/s2 7v7 ! numb] ( new ,heal?c>e ,common ,proc$ure ,cod+ ,sy/em 7,,hcpcs7 codes issu$ = laboratory te/s2 7vi7 ! sp5d+ tr5d = laboratory te/s "u su* title2 7vii7 :e!r ! in=mation report$ by laboratories & ! new paym5t rates = laboratory te/s "u su* section accurately reflect m>ket prices2 7viii7 ! initial li/ price = new laboratory te/s & ! subsequ5t report$ rates = su* te/s "u su* section2 7ix7 *anges 9 ! numb] ( advanc$ diagno/ic laboratory te/s & laboratory te/s cle>$ or approv$ by ! ,food & ,drug ,adm9i/ration = :i* paym5t is made "u su* section2 & 7x7 heal?c>e economic in=mation on d[n/ream co/ impacts = su* te/s & decision mak+ bas$ on accept$ me?odologies4 7,b7 ,report ,n lat] ?an ,octob] #a1 #bjah1 ! ,comptroll] ,g5]al %all submit to ! ,committee on ,ways & ,means & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on ! /udy "u subp>agraph 7,a71 includ+ recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 7#b7 ,monitor+ ( ,m$ic>e exp5ditures & implem5tation ( new paym5t sy/em = laboratory te/s ,! ,inspector ,g5]al ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices %all-- 7,a7 publicly release an annual analysis ( ! top #be laboratory te/s by exp5ditures "u title ,,xviii ( ! ,social ,security ,act2 & 7,b7 conduct analyses ! ,inspector ,g5]al det]m9es appropriate ) respect to ! implem5tation & effect ( ! new paym5t sy/em = laboratory te/s "u section #ahcd;,a ( ! ,social ,security ,act1 z add$ by subsection 7a74 #bag4 ,revisions "u ! ,m$ic>e ,,esrd prospective paym5t sy/em 7a7 ,delay ( implem5tation ( oral-,only policy ,section #fcb7;b77#a7 ( ! ,am]ican ,taxpay] ,relief ,act ( #bjab 7#db ,u4,s4,c4 #acierr note7 is am5d$-- 7#a7 by /rik+ #bjaf & ins]t+ #bjbd2 & 7#b7 by add+ at ! end ! foll[+ new s5t5ce3 ,not)/&+ section #ahha7;b77#ad77;,a77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,a77ii771 implem5tation ( ! policy describ$ 9 ! previ\s s5t5ce %all be bas$ on data f ! mo/ rec5t ye> available44 7b7 ,mitigation ( ! application ( adju/m5t to ,,esrd bundl$ paym5t rate ,to acc\nt = *anges 9 ! utilization ( c]ta9 drugs & biologicals 7#a7 ,9 g5]al ,section #ahha7;b77#ad77;,i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,i77 is am5d$ by ins]t+ & be=e ,janu>y #a1 #bjae1 aft] ,janu>y #a1 #bjad14 7#b7 ,m>ket basket ,section #ahha7;b77#ad77;,f77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77;,f77i77 is am5d$-- 7,a7 9 subclause 7,i7-- 7i7 by /rik+ subclause 7,,ii7 & ins]t+ subclauses 7,,ii7 & 7,,iii72 & 7ii7 by add+ at ! end ! foll[+ new s5t5ce3 ,9 ord] to accompli% ! purposes ( subp>agraph 7,i7 ) respect to #bjaf1 #bjag1 & #bjah1 aft] det]m9+ ! increase factor describ$ 9 ! prec$+ s5t5ce = ea* ( #bjaf1 #bjag1 & #bjah1 ! ,secret>y %all r$uce su* increase factor by #a4be p]c5tage po9ts = ea* ( #bjaf & #bjag & by #a p]c5tage po9t = #bjah42 7,b7 9 subclause 7,,ii71 by /rik+ ,= #bjab & ins]t+ ,subject to subclause 7,,iii71 = #bjab2 & 7,c7 by add+ at ! end ! foll[+ new subclause3 7,,iii7 ,not)/&+ subclauses 7,i7 & 7,,ii71 9 ord] to accompli% ! purposes ( subp>agraph 7,i7 ) respect to #bjae1 ! increase factor describ$ 9 subclause 7,i7 = #bjae %all be #j4j p]c5t pursuant to ! regulation issu$ by ! ,secret>y on ,decemb] #b1 #bjac1 entitl$ ,m$ic>e ,program2 ,end-,/age ,r5al ,disease ,prospective ,paym5t ,sy/em1 ,quality ,inc5tive ,program1 & ,durable ,m$ical ,equipm5t1 ,pro/hetics1 ,or?otics1 & ,supplies2 ,f9al ,rule 7#gh ,f$4 ,reg4 #gbaef74 4 7c7 ,drug designations ,z "p ( ! promulgation ( annual rule = ! ,m$ic>e end /age r5al disease prospective paym5t sy/em "u section #ahha7;b77#ad7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7b77#ad77 = cal5d> ye> #bjaf1 ! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all e/abli% a process =-- 7#a7 det]m9+ :5 a product is no long] an oral-only drug2 & 7#b7 includ+ new injectable & intrav5\s products into ! bundl$ paym5t "u su* sy/em4 7d7 ,quality measures relat$ to conditions treat$ by oral-,only drugs "u ! ,,esrd quality inc5tive program ,section #ahha7;h77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acierr7h77#b77 is am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7 9 clause 7ii71 by /rik+ & at ! end2 7,b7 by r$esignat+ clause 7iii7 z clause 7iv72 & 7,c7 by ins]t+ aft] clause 7ii7 ! foll[+ new clause3 7iii7 = #bjaf & subsequ5t ye>s1 measures describ$ 9 subp>agraph 7,e77i72 & 2 7#b7 9 subp>agraph 7,b77i71 by /rik+ 7,a77iii7 & ins]t+ 7,a77iv72 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,measures specific to ! conditions treat$ ) oral-only drugs 7i7 ,9 g5]al ,! measures describ$ 9 ?is subp>agraph are measures specifi$ by ! ,secret>y t are specific to ! conditions treat$ ) oral-only drugs4 ,to ! ext5t feasible1 su* measures %all be outcomes-bas$ measures4 7ii7 ,consultation ,9 specify+ ! measures "u clause 7i71 ! ,secret>y %all consult ) int]e/$ /akehold]s4 7iii7 ,use ( endors$ measures 7,i7 ,9 g5]al ,subject to subclause 7,i71 any measures specifi$ "u clause 7i7 mu/ h be5 endors$ by ! entity ) a contract "u section #ahij7;a74 7,,ii7 ,exception ,if ! entity ) a contract "u section #ahij7;a7 has n endors$ a measure = a specifi$ area or topic relat$ to measures describ$ 9 clause 7i7 t ! ,secret>y det]m9es appropriate1 ! ,secret>y may specify a measure t is endors$ or adopt$ by a cons5sus organization recogniz$ by ! ,secret>y t has exp]tise 9 cl9ical guidel9es = kidney disease4 4 7e7 ,audits ( co/ reports ( ,,esrd provid]s z recomm5d$ by ,med,p,a,c 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all conduct audits ( ,m$ic>e co/ reports beg9n+ dur+ #bjab = a repres5tative sample ( provid]s ( s]vices & r5al dialysis facilities furni%+ r5al dialysis s]vices4 7#b7 ,fund+ ,= purposes ( c>ry+ out p>agraph 7#a71 ! ,secret>y ( ,heal? & ,human ,s]vices %all provide = ! transf] f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund e/abli%$ "u section #ahda ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciet7 to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt ( #ah1jjj1jjj = fiscal ye> #bjad4 ,am\nts transf]r$ "u ?is p>agraph = a fiscal ye> %all be available until exp5d$4 #bah4 ,quality inc5tives = comput$ tomography diagno/ic imag+ & promot+ evid5ce-bas$ c>e 7a7 ,quality inc5tives ,to promote pati5t safety & public heal? 9 comput$ tomography diagno/ic imag+ 7#a7 ,9 g5]al ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7p7 ,quality inc5tives ,to promote pati5t safety & public heal? 9 comput$ tomography 7#a7 ,quality inc5tives ,9 ! case ( an applicable comput$ tomography s]vice 7z def9$ 9 p>agraph 7#b77 = :i* paym5t is made "u an applicable paym5t sy/em 7z def9$ 9 p>agraph 7#c77 & t is furni%$ on or aft] ,janu>y #a1 #bjaf1 us+ equipm5t t is n consi/5t ) ! ,,ct equipm5t /&>d 7describ$ 9 p>agraph 7#d771 ! paym5t am\nt = su* s]vice %all be r$uc$ by ! applicable p]c5tage 7z def9$ 9 p>agraph 7#e774 7#b7 ,applicable comput$ tomography s]vices def9$ ,9 ?is subsection1 ! t]m applicable comput$ tomography s]vice means a s]vice bill$ us+ diagno/ic radiological imag+ codes = comput$ tomography 7id5tifi$ z ( ,janu>y #a1 #bjad1 by ,,hcpcs codes #gjdej-gjdih1 #gabej-gabge1 #gbabe-gbacc1 #gbaia-gbaid1 #gcbjj-gcbjf1 #gcgjj-gcgjf1 #gdaej-gdagh1 #gdbfa-gdbfc1 & #geega-geegd 7& any succe$+ codes74 7#c7 ,applicable paym5t sy/em def9$ ,9 ?is subsection1 ! t]m applicable paym5t sy/em means ! foll[+3 7,a7 ,! te*nical compon5t & ! te*nical compon5t ( ! global fee "u ! fee s*$ule e/abli%$ "u section #ahdh7;b74 7,b7 ,! prospective paym5t sy/em = hospital outpati5t dep>tm5t s]vices "u section #ahcc7t74 7#d7 ,consi/5cy ) ,,ct equipm5t /&>d ,9 ?is subsection1 ! t]m n consi/5t ) ! ,,ct equipm5t /&>d means1 ) respect to an applicable comput$ tomography s]vice1 t ! s]vice 0 furni%$ us+ equipm5t t does n meet ea* ( ! attributes ( ! ,national ,electrical ,manufactur]s ,association 7,,nema7 ,/&>d ,,xr-#bi-bjac1 entitl$ ,/&>d ,attributes on ,,ct ,equipm5t ,relat$ to ,dose ,optimization & ,managem5t4 ,?r\gh rulemak+1 ! ,secret>y may apply successor /&>ds4 7#e7 ,applicable p]c5tage def9$ ,9 ?is subsection1 ! t]m applicable p]c5tage means-- 7,a7 = #bjaf1 #e p]c5t2 & 7,b7 = #bjag & subsequ5t ye>s1 #ae p]c5t4 7#f7 ,implem5tation 7,a7 ,in=mation ,! ,secret>y %all require t in=mation be provid$ & atte/$ to by a suppli] & a hospital outpati5t dep>tm5t t indicates :e!r an applicable comput$ tomography s]vice 0 furni%$ t 0 n consi/5t ) ! ,,ct equipm5t /&>d 7describ$ 9 p>agraph 7#d774 ,su* in=mation may be includ$ on a claim & may be a modifi]4 ,su* in=mation %all be v]ifi$1 z appropriate1 z "p ( ! p]iodic accr$itation ( suppli]s "u section #ahcd7;e7 & hospitals "u section #ahfe7;a74 7,b7 ,adm9i/ration ,*apt] #ce ( title #dd1 ,unit$ ,/ates ,code1 %all n apply to in=mation describ$ 9 subp>agraph 7,a74 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,prospective paym5t sy/em = hospital outpati5t dep>tm5t s]vices ,section #ahcc7t7 ( ! ,social ,security ,act 7#db #aciel7t77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#bj7 ,n budget neutral application ( r$uc$ exp5ditures result+ f quality inc5tives = comput$ tomography ,! ,secret>y %all n take into acc\nt ! r$uc$ exp5ditures t result f ! application ( section #ahcd7p7 9 mak+ any budget neutrality adju/m5ts ?is subsection4 4 7,b7 ,physician fee s*$ule ,section #ahdh7;c77#b77;,b77v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77v77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,viii7 ,r$uc$ exp5ditures attributable to application ( quality inc5tives = comput$ tomography ,effective = fee s*$ules e/abli%$ beg9n+ ) #bjaf1 r$uc$ exp5ditures attributable to ! application ( ! quality inc5tives = comput$ tomography "u section #ahcd7p7 4 7b7 ,promot+ evid5ce-,bas$ c>e 7#a7 ,9 g5]al ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 z am5d$ by subsection 7a71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7q7 ,recogniz+ appropriate use crit]ia = c]ta9 imag+ s]vices 7#a7 ,program e/abli%$ 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% a program to promote ! use ( appropriate use crit]ia 7z def9$ 9 subp>agraph 7,b77 = applicable imag+ s]vices 7z def9$ 9 subp>agraph 7,c77 furni%$ 9 an applicable sett+ 7z def9$ 9 subp>agraph 7,d77 by ord]+ pr(essionals & furni%+ pr(essionals 7z def9$ 9 subp>agraphs 7,e7 & 7,f71 respectively74 7,b7 ,appropriate use crit]ia def9$ ,9 ?is subsection1 ! t]m appropriate use crit]ia means crit]ia1 only develop$ or endors$ by national pr(essional m$ical specialty societies or o!r provid]-l$ entities1 to assi/ ord]+ pr(essionals & furni%+ pr(essionals 9 mak+ ! mo/ appropriate treatm5t decision = a specific cl9ical condition = an individual4 ,to ! ext5t feasible1 su* crit]ia %all be evid5ce-bas$4 7,c7 ,applicable imag+ s]vice def9$ ,9 ?is subsection1 ! t]m applicable imag+ s]vice means an advanc$ diagno/ic imag+ s]vice 7z def9$ 9 subsection 7e77#a77;,b77 = :i* ! ,secret>y det]m9es-- 7i7 "o or m applicable appropriate use crit]ia specifi$ "u p>agraph 7#b7 apply2 7ii7 !re are "o or m qualifi$ cl9ical decision support me*anisms li/$ "u p>agraph 7#c77;,c72 & 7iii7 "o or m ( su* me*anisms is available free ( *>ge4 7,d7 ,applicable sett+ def9$ ,9 ?is subsection1 ! t]m applicable sett+ means a physician's (fice1 a hospital outpati5t dep>tm5t 7includ+ an em]g5cy dep>tm5t71 an ambulatory surgical c5t]1 & any o!r provid]-l$ outpati5t sett+ det]m9$ appropriate by ! ,secret>y4 7,e7 ,ord]+ pr(essional def9$ ,9 ?is subsection1 ! t]m ord]+ pr(essional means a physician 7z def9$ 9 section #ahfa7r77 or a practition] describ$ 9 section #ahdb7;b77#ah77;,c7 :o ord]s an applicable imag+ s]vice4 7,f7 ,furni%+ pr(essional def9$ ,9 ?is subsection1 ! t]m furni%+ pr(essional means a physician 7z def9$ 9 section #ahfa7r77 or a practition] describ$ 9 section #ahdb7;b77#ah77;,c7 :o furni%es an applicable imag+ s]vice4 7#b7 ,e/abli%m5t ( applicable appropriate use crit]ia 7,a7 ,9 g5]al ,n lat] ?an ,novemb] #ae1 #bjae1 ! ,secret>y %all ?r\gh rulemak+1 & 9 consultation ) physicians1 practition]s1 & o!r /akehold]s1 specify applicable appropriate use crit]ia = applicable imag+ s]vices only f among appropriate use crit]ia develop$ or endors$ by national pr(essional m$ical specialty societies or o!r provid]-l$ entities4 7,b7 ,consid]ations ,9 specify+ applicable appropriate use crit]ia "u subp>agraph 7,a71 ! ,secret>y %all take into acc\nt :e!r ! crit]ia-- 7i7 h /akehold] cons5sus2 7ii7 are sci5tifically valid & evid5ce bas$2 & 7iii7 are bas$ on /udies t are publi%$ & reviewable by /akehold]s4 7,c7 ,revisions ,! ,secret>y %all review1 on an annual basis1 ! specifi$ applicable appropriate use crit]ia to det]m9e if !re is a ne$ to update or revise 7z appropriate7 su* specification ( applicable appropriate use crit]ia & make su* updates or revisions ?r\gh rulemak+4 7,d7 ,treatm5t ( multiple applicable appropriate use crit]ia ,9 ! case :]e ! ,secret>y det]m9es t m ?an "o appropriate use crit]ion applies ) respect to an applicable imag+ s]vice1 ! ,secret>y %all apply "o or m applicable appropriate use crit]ia "u ?is p>agraph = ! s]vice4 7#c7 ,me*anisms = consultation ) applicable appropriate use crit]ia 7,a7 ,id5tification ( me*anisms to consult ) applicable appropriate use crit]ia 7i7 ,9 g5]al ,! ,secret>y %all specify qualifi$ cl9ical decision support me*anisms t c\ld be us$ by ord]+ pr(essionals to consult ) applicable appropriate use crit]ia = applicable imag+ s]vices4 7ii7 ,consultation ,! ,secret>y %all consult ) physicians1 practition]s1 heal? c>e te*nology exp]ts1 & o!r /akehold]s 9 specify+ me*anisms "u ?is p>agraph4 7iii7 ,inclusion ( c]ta9 me*anisms ,me*anisms specifi$ "u ?is p>agraph may include any or all ( ! foll[+ t meet ! requirem5ts describ$ 9 subp>agraph 7,b77ii73 7,i7 ,use ( cl9ical decision support modules 9 c]tifi$ ,,ehr te*nology 7z def9$ 9 section #ahdh7o77#d774 7,,ii7 ,use ( private sector cl9ical decision support me*anisms t are indep5d5t f c]tifi$ ,,ehr te*nology1 :i* may include use ( cl9ical decision support me*anisms available f m$ical specialty organizations4 7,,iii7 ,use ( a cl9ical decision support me*anism e/abli%$ by ! ,secret>y4 7,b7 ,qualifi$ cl9ical decision support me*anisms 7i7 ,9 g5]al ,= purposes ( ?is subsection1 a qualifi$ cl9ical decision support me*anism is a me*anism t ! ,secret>y det]m9es meets ! requirem5ts describ$ 9 clause 7ii74 7ii7 ,requirem5ts ,! requirem5ts describ$ 9 ?is clause are ! foll[+3 7,i7 ,! me*anism makes available to ! ord]+ pr(essional applicable appropriate use crit]ia specifi$ "u p>agraph 7#b7 & ! support+ docum5tation = ! applicable imag+ s]vice ord]$4 7,,ii7 ,9 ! case :]e !re is m ?an "o applicable appropriate use crit]ion specifi$ "u su* p>agraph = an applicable imag+ s]vice1 ! me*anism indicates ! crit]ia t x uses = ! s]vice4 7,,iii7 ,! me*anism det]m9es ! ext5t to :i* an applicable imag+ s]vice ord]$ is consi/5t ) ! applicable appropriate use crit]ia s specifi$4 7,,iv7 ,! me*anism g5]ates & provides to ! ord]+ pr(essional a c]tification or docum5tation t docum5ts t ! qualifi$ cl9ical decision support me*anism 0 consult$ by ! ord]+ pr(essional4 7,v7 ,! me*anism is updat$ on a timely basis to reflect revisions to ! specification ( applicable appropriate use crit]ia "u su* p>agraph4 7,,vi7 ,! me*anism meets privacy & security /&>ds "u applicable provisions ( law4 7,,vii7 ,! me*anism p]=ms su* o!r functions z specifi$ by ! ,secret>y1 :i* may include a requirem5t to provide aggregate fe$back to ! ord]+ pr(essional4 7,c7 ,li/ ( me*anisms = consultation ) applicable appropriate use crit]ia 7i7 ,initial li/ ,n lat] ?an ,april #a1 #bjaf1 ! ,secret>y %all publi% a li/ ( me*anisms specifi$ "u ?is p>agraph4 7ii7 ,p]iodic updat+ ( li/ ,! ,secret>y %all id5tify on an annual basis ! li/ ( qualifi$ cl9ical decision support me*anisms specifi$ "u ?is p>agraph4 7#d7 ,consultation ) applicable appropriate use crit]ia 7,a7 ,consultation by ord]+ pr(essional ,beg9n+ ) ,janu>y #a1 #bjag1 subject to subp>agraph 7,c71 ) respect to an applicable imag+ s]vice ord]$ by an ord]+ pr(essional t w\ld be furni%$ 9 an applicable sett+ & paid = "u an applicable paym5t sy/em 7z def9$ 9 subp>agraph 7,d771 an ord]+ pr(essional %all-- 7i7 consult ) a qualifi$ decision support me*anism li/$ "u p>agraph 7#c77;,c72 & 7ii7 provide to ! furni%+ pr(essional ! in=mation describ$ 9 clauses 7i7 ?r\gh 7iii7 ( subp>agraph 7,b74 7,b7 ,report+ by furni%+ pr(essional ,beg9n+ ) ,janu>y #a1 #bjag1 subject to subp>agraph 7,c71 ) respect to an applicable imag+ s]vice furni%$ 9 an applicable sett+ & paid = "u an applicable paym5t sy/em 7z def9$ 9 subp>agraph 7,d771 paym5t = su* s]vice may only be made if ! claim = ! s]vice includes ! foll[+3 7i7 ,in=mation ab\t :i* qualifi$ cl9ical decision support me*anism 0 consult$ by ! ord]+ pr(essional = ! s]vice4 7ii7 ,in=mation reg>d+-- 7,i7 :e!r ! s]vice ord]$ w\ld adh]e to ! applicable appropriate use crit]ia specifi$ "u p>agraph 7#b72 7,,ii7 :e!r ! s]vice ord]$ w\ld n adh]e to su* crit]ia2 or 7,,iii7 :e!r su* crit]ia 0 n applicable to ! s]vice ord]$4 7iii7 ,! national provid] id5tifi] ( ! ord]+ pr(essional 7if diff]5t f ! furni%+ pr(essional74 7,c7 ,exceptions ,! provisions ( subp>agraphs 7,a7 & 7,b7 & p>agraph 7#f77;,a7 %all n apply to ! foll[+3 7i7 ,em]g5cy s]vices ,an applicable imag+ s]vice ord]$ = an individual ) an em]g5cy m$ical condition 7z def9$ 9 section #ahfg7;e77#a774 7ii7 ,inpati5t s]vices ,an applicable imag+ s]vice ord]$ = an inpati5t & = :i* paym5t is made "u "p ,a4 7iii7 ,significant h>d%ip ,an applicable imag+ s]vice ord]$ by an ord]+ pr(essional :o ! ,secret>y may1 on a case-by-case basis1 exempt f ! application ( su* provisions if ! ,secret>y det]m9es1 subject to annual r5ewal1 t consultation ) applicable appropriate use crit]ia w\ld result 9 a significant h>d%ip1 su* z 9 ! case ( a pr(essional :o practices 9 a rural area )\t suffici5t ,int]net access4 7,d7 ,applicable paym5t sy/em def9$ ,9 ?is subsection1 ! t]m applicable paym5t sy/em means ! foll[+3 7i7 ,! physician fee s*$ule e/abli%$ "u section #ahdh7;b74 7ii7 ,! prospective paym5t sy/em = hospital outpati5t dep>tm5t s]vices "u section #ahcc7t74 7iii7 ,! ambulatory surgical c5t] paym5t sy/ems "u section #ahcc7;i74 7#e7 ,id5tification ( outli] ord]+ pr(essionals 7,a7 ,9 g5]al ,) respect to applicable imag+ s]vices furni%$ beg9n+ ) #bjag1 ! ,secret>y %all det]m9e1 on an annual basis1 no m ?an five p]c5t ( ! total numb] ( ord]+ pr(essionals :o are outli] ord]+ pr(essionals4 7,b7 ,outli] ord]+ pr(essionals ,! det]m9ation ( an outli] ord]+ pr(essional %all-- 7i7 be bas$ on l[ adh]5ce to applicable appropriate use crit]ia specifi$ "u p>agraph 7#b71 :i* may be bas$ on comp>ison to o!r ord]+ pr(essionals2 & 7ii7 include data = ord]+ pr(essionals = :om prior au?orization "u p>agraph 7#f77;,a7 applies4 7,c7 ,use ( two ye>s ( data ,! ,secret>y %all use two ye>s ( data to id5tify outli] ord]+ pr(essionals "u ?is p>agraph4 7,d7 ,process ,! ,secret>y %all e/abli% a process = det]m9+ :5 an outli] ord]+ pr(essional is no long] an outli] ord]+ pr(essional4 7,e7 ,consultation ) /akehold]s ,! ,secret>y %all consult ) physicians1 practition]s & o!r /akehold]s 9 develop+ me?ods to id5tify outli] ord]+ pr(essionals "u ?is p>agraph4 7#f7 ,prior au?orization = ord]+ pr(essionals :o are outli]s 7,a7 ,9 g5]al ,beg9n+ ,janu>y #a1 #bjbj1 subject to p>agraph 7#d77;,c71 ) respect to s]vices furni%$ dur+ a ye>1 ! ,secret>y %all1 = a p]iod det]m9$ appropriate by ! ,secret>y1 apply prior au?orization = applicable imag+ s]vices t are ord]$ by an outli] ord]+ pr(essional id5tifi$ "u p>agraph 7#e74 7,b7 ,appropriate use crit]ia 9 prior au?orization ,9 apply+ prior au?orization "u subp>agraph 7,a71 ! ,secret>y %all utilize only ! applicable appropriate use crit]ia specifi$ "u ?is subsection4 7,c7 ,fund+ ,= purposes ( c>ry+ out ?is p>agraph1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 ( #e1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt = ea* ( fiscal ye>s #bjai ?r\gh #bjba4 ,am\nts transf]r$ "u ! prec$+ s5t5ce %all rema9 available until exp5d$4 7#g7 ,con/ruction ,no?+ 9 ?is subsection %all be con/ru$ z grant+ ! ,secret>y ! au?ority to develop or initiate ! developm5t ( cl9ical practice guidel9es or appropriate use crit]ia4 4 7#b7 ,con=m+ am5dm5t ,section #ahcc7t77#af7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#af77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,application ( appropriate use crit]ia = c]ta9 imag+ s]vices ,= provisions relat+ to ! application ( appropriate use crit]ia = c]ta9 imag+ s]vices1 see section #ahcd7q74 4 7#c7 ,report on exp]i5ce ( imag+ appropriate use crit]ia program ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ,congress a report t includes a description ( ! ext5t to :i* appropriate use crit]ia c\ld be us$ = o!r s]vices "u "p ,b ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq471 su* z radiation !rapy & cl9ical diagno/ic laboratory s]vices4 #bai4 ,us+ fund+ f ,transitional ,fund = ,su/a9able ,gr[? ,rate 7,,sgr7 ,re=m ,section #ahih7;b77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;iii7b77#a77 is am5d$ by /rik+ #b1cjj1jjj1jjj & ins]t+ #j4 #bbj4 ,ensur+ accurate valuation ( s]vices "u ! physician fee s*$ule 7a7 ,au?ority ,to collect & use in=mation on physicians' s]vices 9 ! det]m9ation ( relative values 7#a7 ,9 g5]al ,section #ahdh7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,m7 ,au?ority to collect & use in=mation on physicians' s]vices 9 ! det]m9ation ( relative values 7i7 ,collection ( in=mation ,not)/&+ any o!r provision ( law1 ! ,secret>y may collect or obta9 in=mation on ! res\rces directly or indirectly relat$ to furni%+ s]vices = :i* paym5t is made "u ! fee s*$ule e/abli%$ "u subsection 7b74 ,su* in=mation may be collect$ or obta9$ f any eligible pr(essional or any o!r s\rce4 7ii7 ,use ( in=mation ,not)/&+ any o!r provision ( law1 subject to clause 7v71 ! ,secret>y may 7z ! ,secret>y det]m9es appropriate7 use in=mation collect$ or obta9$ pursuant to clause 7i7 9 ! det]m9ation ( relative values = s]vices "u ?is section4 7iii7 ,types ( in=mation ,! types ( in=mation describ$ 9 clauses 7i7 & 7ii7 may1 at ! ,secret>y's discretion1 include any or all ( ! foll[+3 7,i7 ,"t involv$ 9 furni%+ s]vices4 7,,ii7 ,am\nts & types ( practice exp5se inputs involv$ ) furni%+ s]vices4 7,,iii7 ,prices 7net ( any disc\nts7 = practice exp5se inputs1 :i* may include paid invoice prices or o!r docum5tation or records4 7,,iv7 ,ov]head & acc\nt+ in=mation = practices ( physicians & o!r suppli]s4 7,v7 ,any o!r elem5t t w\ld improve ! valuation ( s]vices "u ?is section4 7iv7 ,in=mation collection me*anisms ,in=mation may be collect$ or obta9$ pursuant to ?is subp>agraph f any or all ( ! foll[+3 7,i7 ,surveys ( physicians1 o!r suppli]s1 provid]s ( s]vices1 manufactur]s1 & v5dors4 7,,ii7 ,surgical logs1 bill+ sy/ems1 or o!r practice or facility records4 7,,iii7 ,electronic heal? records4 7,,iv7 ,any o!r me*anism det]m9$ appropriate by ! ,secret>y4 7v7 ,transp>5cy ( use ( in=mation 7,i7 ,9 g5]al ,subject to subclauses 7,,ii7 & 7,,iii71 if ! ,secret>y uses in=mation collect$ or obta9$ "u ?is subp>agraph 9 ! det]m9ation ( relative values "u ?is subsection1 ! ,secret>y %all disclose ! in=mation s\rce & discuss ! use ( su* in=mation 9 su* det]m9ation ( relative values ?r\gh notice & comm5t rulemak+4 7,,ii7 ,?re%olds = use ,! ,secret>y may e/abli% ?re%olds 9 ord] to use su* in=mation1 includ+ ! exclusion ( in=mation collect$ or obta9$ f eligible pr(essionals :o use v high res\rces 7z det]m9$ by ! ,secret>y7 9 furni%+ a s]vice4 7,,iii7 ,disclosure ( in=mation ,! ,secret>y %all make aggregate in=mation available "u ?is subp>agraph b %all n disclose in=mation 9 a =m or mann] t id5tifies an eligible pr(essional or a gr\p practice1 or in=mation collect$ or obta9$ pursuant to a nondisclosure agreem5t4 7vi7 ,inc5tive to p>ticipate ,! ,secret>y may provide = su* paym5ts "u ?is "p to an eligible pr(essional t submits su* solicit$ in=mation "u ?is subp>agraph z ! ,secret>y det]m9es appropriate 9 ord] to comp5sate su* eligible pr(essional = su* submission4 ,su* paym5ts %all be provid$ 9 a =m & mann] specifi$ by ! ,secret>y4 7vii7 ,adm9i/ration ,*apt] #ce ( title #dd1 ,unit$ ,/ates ,code1 %all n apply to in=mation collect$ or obta9$ "u ?is subp>agraph4 7viii7 ,def9ition ( eligible pr(essional ,9 ?is subp>agraph1 ! t]m eligible pr(essional has ! mean+ giv5 su* t]m 9 subsection 7k77#c77;,b74 7ix7 ,fund+ ,= purposes ( c>ry+ out ?is subp>agraph1 9 addition to funds o!rwise appropriat$1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 ( #b1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt = ea* fiscal ye> beg9n+ ) fiscal ye> #bjad4 ,am\nts transf]r$ "u ! prec$+ s5t5ce = a fiscal ye> %all be available until exp5d$4 4 7#b7 ,limitation on review ,section #ahdh7;i77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;i77#a77 is am5d$-- 7,a7 9 subp>agraph 7,d71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,e71 by /rik+ ! p]iod at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ! collection & use ( in=mation 9 ! det]m9ation ( relative values "u subsection 7c77#b77,m74 4 7b7 ,au?ority = alt]native approa*es ,to e/abli%+ practice exp5se relative values ,section #ahdh7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 z am5d$ by subsection 7a71 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,n7 ,au?ority = alt]native approa*es to e/abli%+ practice exp5se relative values ,! ,secret>y may e/abli% or adju/ practice exp5se relative values "u ?is subsection us+ co/1 *>ge1 or o!r data f suppli]s or provid]s ( s]vices1 includ+ in=mation collect$ or obta9$ "u subp>agraph 7,m74 4 7c7 ,revis$ & exp&$ id5tification ( pot5tially misvalu$ codes ,section #ahdh7;c77#b77,k77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77,k77ii77 is am5d$ to read z foll[s3 7ii7 ,id5tification ( pot5tially misvalu$ codes ,= purposes ( id5tify+ pot5tially misvalu$ codes pursuant to clause 7i77,i71 ! ,secret>y %all exam9e codes 7& families ( codes z appropriate7 bas$ on any or all ( ! foll[+ crit]ia3 7,i7 ,codes t h exp]i5c$ ! fa/e/ gr[?4 7,,ii7 ,codes t h exp]i5c$ sub/antial *anges 9 practice exp5ses4 7,,iii7 ,codes t describe new te*nologies or s]vices )9 an appropriate "t p]iod 7su* z #c ye>s7 aft] ! relative values are initially e/abli%$ = su* codes4 7,,iv7 ,codes :i* are multiple codes t are frequ5tly bill$ 9 conjunction ) furni%+ a s+le s]vice4 7,v7 ,codes ) l[ relative values1 p>ticul>ly ^? t are (t5 bill$ multiple times = a s+le treatm5t4 7,,vi7 ,codes t h n be5 subject to review s9ce implem5tation ( ! fee s*$ule4 7,,vii7 ,codes t acc\nt = ! majority ( sp5d+ "u ! physician fee s*$ule4 7,,viii7 ,codes = s]vices t h exp]i5c$ a sub/antial *ange 9 ! hospital l5g? ( /ay or proc$ure "t4 7,,ix7 ,codes = :i* !re may be a *ange 9 ! typical site ( s]vice s9ce ! code 0 la/ valu$4 7,x7 ,codes = :i* !re is a significant diff]5ce 9 paym5t = ! same s]vice betwe5 diff]5t sites ( s]vice4 7,,xi7 ,codes = :i* !re may be anomalies 9 relative values )9 a family ( codes4 7,,xii7 ,codes = s]vices :]e !re may be effici5cies :5 a s]vice is furni%$ at ! same "t z o!r s]vices4 7,,xiii7 ,codes ) high intra-s]vice "w p] unit ( "t4 7,,xiv7 ,codes ) high practice exp5se relative value units4 7,,xv7 ,codes ) high co/ supplies4 7,,xvi7 ,codes z det]m9$ appropriate by ! ,secret>y4 4 7d7 ,t>get = relative value adju/m5ts = misvalu$ s]vices 7#a7 ,9 g5]al ,section #ahdh7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b771 z am5d$ by subsections 7a7 & 7b71 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,o7 ,t>get = relative value adju/m5ts = misvalu$ s]vices ,) respect to fee s*$ules e/abli%$ = ea* ( #bjag ?r\gh #bjbj1 ! foll[+ %all apply3 7i7 ,det]m9ation ( net r$uction 9 exp5ditures ,= ea* ye>1 ! ,secret>y %all det]m9e ! e/imat$ net r$uction 9 exp5ditures "u ! fee s*$ule "u ?is section ) respect to ! ye> z a result ( adju/m5ts to ! relative values e/abli%$ "u ?is p>agraph = misvalu$ codes4 7ii7 ,budget neutral r$i/ribution ( funds if t>get met & c\nt+ ov]ages t[>ds ! t>get = ! succe$+ ye> ,if ! e/imat$ net r$uction 9 exp5ditures det]m9$ "u clause 7i7 = ! ye> is equal to or great] ?an ! t>get = ! ye>-- 7,i7 r$uc$ exp5ditures attributable to su* adju/m5ts %all be r$i/ribut$ = ! ye> 9 a budget neutral mann] 9 accordance ) subp>agraph 7,b77ii77,,ii72 & 7,,ii7 ! am\nt by :i* su* r$uc$ exp5ditures exce$s ! t>get = ! ye> %all be treat$ z a r$uction 9 exp5ditures describ$ 9 clause 7i7 = ! succe$+ ye>1 = purposes ( det]m9+ :e!r ! t>get has or has n be5 met "u ?is subp>agraph ) respect to t ye>4 7iii7 ,exemption f budget neutrality if t>get n met ,if ! e/imat$ net r$uction 9 exp5ditures det]m9$ "u clause 7i7 = ! ye> is less ?an ! t>get = ! ye>1 r$uc$ exp5ditures 9 an am\nt equal to ! t>get recapture am\nt %all n be tak5 into acc\nt 9 apply+ subp>agraph 7,b77ii77,,ii7 ) respect to fee s*$ules beg9n+ ) #bjag4 7iv7 ,t>get recapture am\nt ,= purposes ( clause 7iii71 ! t>get recapture am\nt is1 ) respect to a ye>1 an am\nt equal to ! diff]5ce betwe5-- 7,i7 ! t>get = ! ye>2 & 7,,ii7 ! e/imat$ net r$uction 9 exp5ditures det]m9$ "u clause 7i7 = ! ye>4 7v7 ,t>get ,= purposes ( ?is subp>agraph1 ) respect to a ye>1 ! t>get is calculat$ z #j4e p]c5t ( ! e/imat$ am\nt ( exp5ditures "u ! fee s*$ule "u ?is section = ! ye>4 4 7#b7 ,con=m+ am5dm5t ,section #ahdh7;c77#b77;,b77v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,b77v77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,viii7 ,r$uctions = misvalu$ s]vices if t>get n met ,effective = fee s*$ules beg9n+ ) #bjag1 r$uc$ exp5ditures attributable to ! application ( ! t>get recapture am\nt describ$ 9 subp>agraph 7,o77iii74 4 7e7 ,phase-,9 ( significant relative value unit 7,,rvu7 r$uctions 7#a7 ,9 g5]al ,section #ahdh7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,phase-9 ( significant relative value unit 7,,rvu7 r$uctions ,effective = fee s*$ules e/abli%$ beg9n+ ) #bjag1 = s]vices t are n new or revis$ codes1 if ! total relative value units = a s]vice = a ye> w\ld o!rwise be decreas$ by an e/imat$ am\nt equal to or great] ?an #bj p]c5t z comp>$ to ! total relative value units = ! previ\s ye>1 ! applicable adju/m5ts 9 "w1 practice exp5se1 & malpractice relative value units %all be phas$-9 ov] a #b-ye> p]iod4 4 7#b7 ,con=m+ am5dm5ts ,section #ahdh7;c77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77 is am5d$-- 7,a7 9 subp>agraph 7,b77ii77,i71 by /rik+ subclause 7,,ii7 & ins]t+ subclause 7,,ii7 & p>agraph 7#g72 & 7,b7 9 subp>agraph 7,k77iii77,,vi7-- 7i7 by /rik+ provisions ( subp>agraph 7,b77ii77,,ii7 & ins]t+ provisions ( subp>agraph 7,b77ii77,,ii7 & p>agraph 7#g72 & 7ii7 by /rik+ "u subp>agraph 7,b77ii77,,ii7 & ins]t+ "u subp>agraph 7,b77ii77,i74 7f7 ,au?ority ,to smoo? relative values )9 gr\ps ( s]vices ,section #ahdh7;c77#b77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;c77#b77;,c77 is am5d$-- 7#a7 9 ea* ( clauses 7i7 & 7iii71 by /rik+ ! s]vice & ins]t+ ! s]vice or gr\p ( s]vices ea* place x appe>s2 & 7#b7 9 ! fir/ s5t5ce ( clause 7ii71 by ins]t+ or gr\p ( s]vices be=e ! p]iod4 7g7 ,,gao /udy & report on ,relative ,value ,scale ,update ,committee 7#a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is subsection ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy ( ! processes us$ by ! ,relative ,value ,scale ,update ,committee 7,,ruc7 to provide recomm5dations to ! ,secret>y ( ,heal? & ,human ,s]vices reg>d+ relative values = specific s]vices "u ! ,m$ic>e physician fee s*$ule "u section #ahdh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d74 7#b7 ,report ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a74 7h7 ,adju/m5t to ,m$ic>e paym5t localities 7#a7 ,9 g5]al ,section #ahdh7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,use ( ,m,s,as z fee s*$ule areas 9 ,cali=nia 7,a7 ,9 g5]al ,subject to ! succe$+ provisions ( ?is p>agraph & not)/&+ ! previ\s provisions ( ?is subsection1 = s]vices furni%$ on or aft] ,janu>y #a1 #bjag1 ! fee s*$ule areas us$ = paym5t "u ?is section applicable to ,cali=nia %all be ! foll[+3 7i7 ,ea* ,metropolitan ,/ati/ical ,area 7ea* 9 ?is p>agraph ref]r$ to z an ,,msa71 z def9$ by ! ,director ( ! ,(fice ( ,managem5t & ,budget z ( ,decemb] #ca ( ! previ\s ye>1 %all be a fee s*$ule area4 7ii7 ,all areas n includ$ 9 an ,,msa %all be treat$ z a s+le re/-(-,/ate fee s*$ule area4 7,b7 ,transition = ,m,s,as previ\sly 9 re/-(-,/ate paym5t locality or 9 locality #c 7i7 ,9 g5]al ,= s]vices furni%$ 9 ,cali=nia dur+ a ye> beg9n+ ) #bjag & end+ ) #bjba 9 an ,,msa 9 a transition area 7z def9$ 9 subp>agraph 7,d771 subject to subp>agraph 7,c71 ! geographic index values to be appli$ "u ?is subsection = su* ye> %all be equal to ! sum ( ! foll[+3 7,i7 ,curr5t law compon5t ,! old weight+ factor 7describ$ 9 clause 7ii77 = su* ye> multipli$ by ! geographic index values "u ?is subsection = ! fee s*$ule area t includ$ su* ,,msa t w\ld h appli$ 9 su* area 7z e/imat$ by ! ,secret>y7 if ?is p>agraph did n apply4 7,,ii7 ,,msa-bas$ compon5t ,! ,,msa-bas$ weight+ factor 7describ$ 9 clause 7iii77 = su* ye> multipli$ by ! geographic index values comput$ = ! fee s*$ule area "u subp>agraph 7,a7 = ! ye> 7det]m9$ )\t reg>d to ?is subp>agraph74 7ii7 ,old weight+ factor ,! old weight+ factor describ$ 9 ?is clause-- 7,i7 = #bjag1 is #e_/f2 & 7,,ii7 = ea* succe$+ ye>1 is ! old weight+ factor describ$ 9 ?is clause = ! previ\s ye> m9us #a_/f4 7iii7 ,,msa-bas$ weight+ factor ,! ,,msa-bas$ weight+ factor describ$ 9 ?is clause = a ye> is #a m9us ! old weight+ factor "u clause 7ii7 = t ye>4 7,c7 ,hold h>mless ,= s]vices furni%$ 9 a transition area 9 ,cali=nia dur+ a ye> beg9n+ ) #bjag1 ! geographic index values to be appli$ "u ?is subsection = su* ye> %all n be less ?an ! correspond+ geographic index values t w\ld h appli$ 9 su* transition area 7z e/imat$ by ! ,secret>y7 if ?is p>agraph did n apply4 7,d7 ,transition area def9$ ,9 ?is p>agraph1 ! t]m transition area means ea* ( ! foll[+ fee s*$ule areas = #bjac3 7i7 ,! re/-(-,/ate paym5t locality4 7ii7 ,paym5t locality #c4 7,e7 ,ref]5ces to fee s*$ule areas ,effective = s]vices furni%$ on or aft] ,janu>y #a1 #bjag1 = ,cali=nia1 any ref]5ce 9 ?is section to a fee s*$ule area %all be deem$ a ref]5ce to a fee s*$ule area e/abli%$ 9 accordance ) ?is p>agraph4 4 7#b7 ,con=m+ am5dm5t to def9ition ( fee s*$ule area ,section #ahdh7;j77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#b77 is am5d$ by /rik+ ,! t]m & ins]t+ ,except z provid$ 9 subsection 7e77#f77;,d71 ! t]m4 7i7 ,disclosure ( data us$ ,to e/abli% multiple proc$ure paym5t r$uction policy ,! ,secret>y ( ,heal? & ,human ,s]vices %all make publicly available ! in=mation us$ to e/abli% ! multiple proc$ure paym5t r$uction policy to ! pr(essional compon5t ( imag+ s]vices 9 ! f9al rule publi%$ 9 ! ,f$]al ,regi/]1 v4 #gg1 n4 #bbb1 ,novemb] #af1 #bjab1 pages #fhhia-fichj "u ! physician fee s*$ule "u section #ahdh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d74 #bba4 ,m$icaid ,,d% 7a7 ,modifications ( r$uctions to allotm5ts ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77 is am5d$-- 7#a7 9 p>agraph 7#g77;,a7-- 7,a7 9 clause 7i71 by /rik+ #bjaf ?r\gh #bjbj & ins]t+ #bjag ?r\gh #bjbd2 & 7,b7 9 clause 7ii71 by /rik+ subclauses 7,i7 ?r\gh 7,,iv71 & ins]t+ ! foll[+3 7,i7 #a1hjj1jjj1jjj = fiscal ye> #bjag2 7,,ii7 #d1gjj1jjj1jjj = fiscal ye> #bjah2 7,,iii7 #d1gjj1jjj1jjj = fiscal ye> #bjai2 7,,iv7 #d1gjj1jjj1jjj = fiscal ye> #bjbj2 7,v7 #d1hjj1jjj1jjj = fiscal ye> #bjba2 7,,vi7 #e1jjj1jjj1jjj = fiscal ye> #bjbb2 7,,vii7 #e1jjj1jjj1jjj = fiscal ye> #bjbc2 & 7,,viii7 #d1djj1jjj1jjj = fiscal ye> #bjbd4 2 & 7#b7 by /rik+ p>agraph 7#h7 & ins]t+ ! foll[+3 7#h7 ,calculation ( ,,d% allotm5ts aft] r$uctions p]iod ,! ,,d% allotm5t = a ,/ate = fiscal ye>s aft] fiscal ye> #bjbd %all be calculat$ "u p>agraph 7#c7 )\t reg>d to p>agraph 7#g74 4 7b7 ,,macpac review & report ,section #aijj7;b77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif7;b77#f77 is am5d$-- 7#a7 by /rik+ ,,macpac %all consult & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,,macpac %all consult 2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,review & reports reg>d+ ,m$icaid ,,d% 7i7 ,9 g5]al ,,macpac %all review & submit an annual report to ,congress on disproportionate %>e hospital paym5ts "u section #aibc4 ,ea* report %all include ! in=mation specifi$ 9 clause 7ii74 7ii7 ,requir$ report in=mation ,ea* report requir$ "u ?is subp>agraph %all include ! foll[+3 7,i7 ,data relat+ to *anges 9 ! numb] ( un9sur$ individuals4 7,,ii7 ,data relat+ to ! am\nt & s\rces ( hospitals' uncomp5sat$ c>e co/s1 includ+ ! am\nt ( su* co/s t are ! result ( provid+ unreimburs$ or "u-reimburs$ s]vices1 *>ity c>e1 or bad debt4 7,,iii7 ,data id5tify+ hospitals ) high levels ( uncomp5sat$ c>e t also provide access to ess5tial community s]vices = l[-income1 un9sur$1 & vuln]able populations1 su* z graduate m$ical education1 & ! cont9uum ( prim>y ?r\gh qu>t]n>y c>e1 includ+ ! provision ( trauma c>e & public heal? s]vices4 7,,iv7 ,/ate-specific analyses reg>d+ ! relation%ip betwe5 ! mo/ rec5t ,/ate ,,d% allotm5t & ! project$ ,/ate ,,d% allotm5t = ! succe$+ ye> & ! data report$ "u subclauses 7,i71 7,,ii71 & 7,,iii7 = ! ,/ate4 7iii7 ,data ,not)/&+ any o!r provision ( law1 ! ,secret>y regul>ly %all provide ,,macpac ) ! mo/ rec5t ,/ate reports & mo/ rec5t indep5d5t c]tifi$ audits submitt$ "u section #aibc7;j71 co/ reports submitt$ "u title ,,xviii1 & su* o!r data z ,,macpac may reque/ = purposes ( conduct+ ! reviews & prep>+ & submitt+ ! annual reports requir$ "u ?is subp>agraph4 7iv7 ,submission deadl9es ,! fir/ report requir$ "u ?is subp>agraph %all be submitt$ to ,congress n lat] ?an ,febru>y #a1 #bjaf4 ,subsequ5t reports %all be submitt$ z "p (1 or )1 ea* annual report requir$ "u p>agraph 7#a77;,c7 dur+ ! p]iod ( fiscal ye>s #bjag ?r\gh #bjbd4 4 #bbb4 ,realignm5t ( ! ,m$ic>e seque/] = fiscal ye> #bjbd ,p>agraph 7#f7 7relat+ to implem5t+ direct sp5d+ r$uctions7 ( section #bea;,a ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ija;a7 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,not)/&+ ! #b p]c5t limit specifi$ 9 subp>agraph 7,a7 = paym5ts = ! ,m$ic>e programs specifi$ 9 section #bef7;d71 ! seque/ration ord] ( ! ,presid5t "u su* subp>agraph = fiscal ye> #bjbd %all be appli$ to su* paym5ts s t-- 7i7 ) respect to ! fir/ #f mon?s 9 :i* su* ord] is effective = su* fiscal ye>1 ! paym5t r$uction %all be #d4j p]c5t2 & 7ii7 ) respect to ! second #f mon?s 9 :i* su* ord] is s effective = su* fiscal ye>1 ! paym5t r$uction %all be #j4j p]c5t4 4 #bbc4 ,demon/ration programs to improve community m5tal heal? s]vices 7a7 ,crit]ia = c]tifi$ community behavioral heal? cl9ics ,to p>ticipate 9 demon/ration programs 7#a7 ,publication ,n lat] ?an ,septemb] #a1 #bjae1 ! ,secret>y %all publi% crit]ia = a cl9ic to be c]tifi$ by a ,/ate z a c]tifi$ community behavioral heal? cl9ic = purposes ( p>ticipat+ 9 a demon/ration program conduct$ "u subsection 7d74 7#b7 ,requirem5ts ,! crit]ia publi%$ "u ?is subsection %all include crit]ia ) respect to ! foll[+3 7,a7 ,/aff+ ,/aff+ requirem5ts1 includ+ crit]ia t /aff h div]se discipl9>y backgr\nds1 h necess>y ,/ate-requir$ lic5se & accr$itation1 & are culturally & l+ui/ically tra9$ to s]ve ! ne$s ( ! cl9ic's pati5t population4 7,b7 ,availability & accessibility ( s]vices ,availability & accessibility ( s]vices1 includ+ crisis managem5t s]vices t are available & accessible #bd h\rs a day1 ! use ( a slid+ scale = paym5t1 & no rejection = s]vices or limit+ ( s]vices on ! basis ( a pati5t's ability to pay or a place ( resid5ce4 7,c7 ,c>e coord9ation ,c>e coord9ation1 includ+ requirem5ts to coord9ate c>e across sett+s & provid]s to ensure seamless transitions = pati5ts across ! full spectrum ( heal? s]vices includ+ acute1 *ronic1 & behavioral heal? ne$s4 ,c>e coord9ation requirem5ts %all include p>tn]%ips or =mal contracts ) ! foll[+3 7i7 ,f$]ally-qualifi$ heal? c5t]s 7& z applicable1 rural heal? cl9ics7 to provide ,f$]ally-qualifi$ heal? c5t] s]vices 7& z applicable1 rural heal? cl9ic s]vices7 to ! ext5t su* s]vices are n provid$ directly ?r\gh ! c]tifi$ community behavioral heal? cl9ic4 7ii7 ,inpati5t psy*iatric facilities & sub/ance use detoxification1 po/-detoxification /ep-d[n s]vices1 & resid5tial programs4 7iii7 ,o!r community or regional s]vices1 supports1 & provid]s1 includ+ s*ools1 *ild welf>e ag5cies1 juv5ile & crim9al ju/ice ag5cies & facilities1 ,indian ,heal? ,s]vice y\? regional treatm5t c5t]s1 ,/ate lic5s$ & nationally accr$it$ *ild plac+ ag5cies = !rapeutic fo/] c>e s]vice1 & o!r social & human s]vices4 7iv7 ,dep>tm5t ( ,vet]ans ,affairs m$ical c5t]s1 indep5d5t outpati5t cl9ics1 drop-9 c5t]s1 & o!r facilities ( ! ,dep>tm5t z def9$ 9 section #ahja ( title #ch1 ,unit$ ,/ates ,code4 7v7 ,inpati5t acute c>e hospitals & hospital outpati5t cl9ics4 7,d7 ,scope ( s]vices ,provision 79 a mann] reflect+ p]son-c5t]$ c>e7 ( ! foll[+ s]vices :i*1 if n available directly ?r\gh ! c]tifi$ community behavioral heal? cl9ic1 are provid$ or ref]r$ ?r\gh =mal relation%ips ) o!r provid]s3 7i7 ,crisis m5tal heal? s]vices1 includ+ #bd-;h\r mobile crisis teams1 em]g5cy crisis int]v5tion s]vices1 & crisis /abilization4 7ii7 ,scre5+1 assessm5t1 & diagnosis1 includ+ risk assessm5t4 7iii7 ,pati5t-c5t]$ treatm5t plann+ or simil> processes1 includ+ risk assessm5t & crisis plann+4 7iv7 ,outpati5t m5tal heal? & sub/ance use s]vices4 7v7 ,outpati5t cl9ic prim>y c>e scre5+ & monitor+ ( key heal? indicators & heal? risk4 7vi7 ,t>get$ case managem5t4 7vii7 ,psy*iatric rehabilitation s]vices4 7viii7 ,pe] support & c\nselor s]vices & family supports4 7ix7 ,int5sive1 community-bas$ m5tal heal? c>e = memb]s ( ! arm$ =ces & vet]ans1 p>ticul>ly ^? memb]s & vet]ans locat$ 9 rural areas1 provid$ ! c>e is consi/5t ) m9imum cl9ical m5tal heal? guidel9es promulgat$ by ! ,vet]ans ,heal? ,adm9i/ration includ+ cl9ical guidel9es conta9$ 9 ! ,uni=m ,m5tal ,heal? ,s]vices ,h&book ( su* ,adm9i/ration4 7,e7 ,quality & o!r report+ ,report+ ( enc\nt] data1 cl9ical outcomes data1 quality data1 & su* o!r data z ! ,secret>y requires4 7,f7 ,organizational au?ority ,crit]ia t a cl9ic be a non-pr(it or "p ( a local gov]nm5t behavioral heal? au?ority or op]at$ "u ! au?ority ( ! ,indian ,heal? ,s]vice1 an ,indian tribe or tribal organization pursuant to a contract1 grant1 coop]ative agreem5t1 or compact ) ! ,indian ,heal? ,s]vice pursuant to ! ,indian ,self-,det]m9ation ,act 7#be ,u4,s4,c4 #dej et seq471 or an urban ,indian organization pursuant to a grant or contract ) ! ,indian ,heal? ,s]vice "u title ,v ( ! ,indian ,heal? ,c>e ,improvem5t ,act 7#be ,u4,s4,c4 #afja et seq474 7b7 ,guidance on developm5t ( prospective paym5t sy/em = te/+ "u demon/ration programs 7#a7 ,9 g5]al ,n lat] ?an ,septemb] #a1 #bjae1 ! ,secret>y1 ?r\gh ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all issue guidance = ! e/abli%m5t ( a prospective paym5t sy/em t %all only apply to m$ical assi/ance = m5tal heal? s]vices furni%$ by a c]tifi$ community behavioral heal? cl9ic p>ticipat+ 9 a demon/ration program "u subsection 7d74 7#b7 ,requirem5ts ,! guidance issu$ by ! ,secret>y "u p>agraph 7#a7 %all provide t-- 7,a7 no paym5t %all be made = inpati5t c>e1 resid5tial treatm5t1 room & bo>d exp5ses1 or any o!r non-ambulatory s]vices1 z det]m9$ by ! ,secret>y2 & 7,b7 no paym5t %all be made to satellite facilities ( c]tifi$ community behavioral heal? cl9ics if su* facilities are e/abli%$ aft] ! date ( enactm5t ( ?is ,act4 7c7 ,plann+ grants 7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjaf1 ! ,secret>y %all aw>d plann+ grants to ,/ates = ! purpose ( develop+ proposals to p>ticipate 9 "t-limit$ demon/ration programs describ$ 9 subsection 7d74 7#b7 ,use ( funds ,a ,/ate aw>d$ a plann+ grant "u ?is subsection %all-- 7,a7 solicit input ) respect to ! developm5t ( su* a demon/ration program f pati5ts1 provid]s1 & o!r /akehold]s2 7,b7 c]tify cl9ics z c]tifi$ community behavioral heal? cl9ics = purposes ( p>ticipat+ 9 a demon/ration program conduct$ "u subsection 7d72 & 7,c7 e/abli% a prospective paym5t sy/em = m5tal heal? s]vices furni%$ by a c]tifi$ community behavioral heal? cl9ic p>ticipat+ 9 a demon/ration program "u subsection 7d7 9 accordance ) ! guidance issu$ "u subsection 7b74 7d7 ,demon/ration programs 7#a7 ,9 g5]al ,n lat] ?an ,septemb] #a1 #bjag1 ! ,secret>y %all select ,/ates to p>ticipate 9 demon/ration programs t are develop$ ?r\gh plann+ grants aw>d$ "u subsection 7c71 meet ! requirem5ts ( ?is subsection1 & repres5t a div]se selection ( geographic areas1 includ+ rural & und]s]v$ areas4 7#b7 ,application requirem5ts 7,a7 ,9 g5]al ,! ,secret>y %all solicit applications to p>ticipate 9 demon/ration programs "u ?is subsection solely f ,/ates aw>d$ plann+ grants "u subsection 7c74 7,b7 ,requir$ in=mation ,an application = a demon/ration program "u ?is subsection %all include ! foll[+3 7i7 ,! t>get ,m$icaid population to be s]v$ "u ! demon/ration program4 7ii7 ,a li/ ( p>ticipat+ c]tifi$ community behavioral heal? cl9ics4 7iii7 ,v]ification t ! ,/ate has c]tifi$ a p>ticipat+ cl9ic z a c]tifi$ community behavioral heal? cl9ic 9 accordance ) ! requirem5ts ( subsection 7b74 7iv7 ,a description ( ! scope ( ! m5tal heal? s]vices available "u ! ,/ate ,m$icaid program t w be paid = "u ! prospective paym5t sy/em te/$ 9 ! demon/ration program4 7v7 ,v]ification t ! ,/ate has agre$ to pay = su* s]vices at ! rate e/abli%$ "u ! prospective paym5t sy/em4 7vi7 ,su* o!r in=mation z ! ,secret>y may require relat+ to ! demon/ration program includ+ ) respect to det]m9+ ! s\ndness ( ! propos$ prospective paym5t sy/em4 7#c7 ,numb] & l5g? ( demon/ration programs ,n m ?an #h ,/ates %all be select$ = #b-ye> demon/ration programs "u ?is subsection4 7#d7 ,requirem5ts = select+ demon/ration programs 7,a7 ,9 g5]al ,! ,secret>y %all give pref]5ce to select+ demon/ration programs :]e p>ticipat+ c]tifi$ community behavioral heal? cl9ics-- 7i7 provide ! mo/ complete scope ( s]vices describ$ 9 subsection 7a77#b77;,d7 to individuals eligible = m$ical assi/ance "u ! ,/ate ,m$icaid program2 7ii7 w improve availability (1 access to1 & p>ticipation 91 s]vices describ$ 9 subsection 7a77#b77;,d7 to individuals eligible = m$ical assi/ance "u ! ,/ate ,m$icaid program2 7iii7 w improve availability (1 access to1 & p>ticipation 9 assi/$ outpati5t m5tal heal? treatm5t 9 ! ,/ate2 or 7iv7 demon/rate ! pot5tial to exp& available m5tal heal? s]vices 9 a demon/ration area & increase ! quality ( su* s]vices )\t increas+ net ,f$]al sp5d+4 7#e7 ,paym5t = m$ical assi/ance = m5tal heal? s]vices provid$ by c]tifi$ community behavioral heal? cl9ics 7,a7 ,9 g5]al ,! ,secret>y %all pay a ,/ate p>ticipat+ 9 a demon/ration program "u ?is subsection ! ,f$]al mat*+ p]c5tage specifi$ 9 subp>agraph 7,b7 = am\nts exp5d$ by ! ,/ate to provide m$ical assi/ance = m5tal heal? s]vices describ$ 9 ! demon/ration program application 9 accordance ) p>agraph 7#b77;,b77iv7 t are provid$ by c]tifi$ community behavioral heal? cl9ics to individuals :o are enroll$ 9 ! ,/ate ,m$icaid program4 ,paym5ts to ,/ates made "u ?is p>agraph %all be consid]$ to h be5 "u1 & are subject to ! requirem5ts (1 section #aijc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b74 7,b7 ,f$]al mat*+ p]c5tage ,! ,f$]al mat*+ p]c5tage specifi$ 9 ?is subp>agraph is ) respect to m$ical assi/ance describ$ 9 subp>agraph 7,a7 t is furni%$-- 7i7 to a newly eligible individual describ$ 9 p>agraph 7#b7 ( section #aije7y7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7y771 ! mat*+ rate applicable "u p>agraph 7#a7 ( t section2 & 7ii7 to an individual :o is n a newly eligible individual 7z s describ$7 b :o is eligible = m$ical assi/ance "u ! ,/ate ,m$icaid program1 ! enhanc$ ,,fmap applicable to ! ,/ate4 7,c7 ,limitations 7i7 ,9 g5]al ,paym5ts %all be made "u ?is p>agraph to a ,/ate only = m5tal heal? s]vices-- 7,i7 t are describ$ 9 ! demon/ration program application 9 accordance ) p>agraph 7#b77;iv72 7,,ii7 = :i* paym5t is available "u ! ,/ate ,m$icaid program2 & 7,,iii7 t are provid$ to an individual :o is eligible = m$ical assi/ance "u ! ,/ate ,m$icaid program4 7ii7 ,prohibit$ paym5ts ,no paym5t %all be made "u ?is p>agraph-- 7,i7 = inpati5t c>e1 resid5tial treatm5t1 room & bo>d exp5ses1 or any o!r non-ambulatory s]vices1 z det]m9$ by ! ,secret>y2 or 7,,ii7 ) respect to paym5ts made to satellite facilities ( c]tifi$ community behavioral heal? cl9ics if su* facilities are e/abli%$ aft] ! date ( enactm5t ( ?is ,act4 7#f7 ,waiv] ( /atewid5ess requirem5t ,! ,secret>y %all waive section #aijb7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#a77 7relat+ to /atewid5ess7 z may be necess>y to conduct demon/ration programs 9 accordance ) ! requirem5ts ( ?is subsection4 7#g7 ,annual reports 7,a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date on :i* ! fir/ ,/ate is select$ = a demon/ration program "u ?is subsection1 & annually !reaft]1 ! ,secret>y %all submit to ,congress an annual report on ! use ( funds provid$ "u all demon/ration programs conduct$ "u ?is subsection4 ,ea* su* report %all include-- 7i7 an assessm5t ( access to community-bas$ m5tal heal? s]vices "u ! ,m$icaid program 9 ! area or areas ( a ,/ate t>get$ by a demon/ration program comp>$ to o!r areas ( ! ,/ate2 7ii7 an assessm5t ( ! quality & scope ( s]vices provid$ by c]tifi$ community behavioral heal? cl9ics comp>$ to community-bas$ m5tal heal? s]vices provid$ 9 ,/ates n p>ticipat+ 9 a demon/ration program "u ?is subsection & 9 areas ( a demon/ration ,/ate t are n p>ticipat+ 9 ! demon/ration program2 & 7iii7 an assessm5t ( ! impact ( ! demon/ration programs on ! ,f$]al & ,/ate co/s ( a full range ( m5tal heal? s]vices 7includ+ inpati5t1 em]g5cy & ambulatory s]vices74 7,b7 ,recomm5dations ,n lat] ?an ,decemb] #ca1 #bjba1 ! ,secret>y %all submit to ,congress recomm5dations conc]n+ :e!r ! demon/ration programs "u ?is section %\ld be cont9u$1 exp&$1 modifi$1 or t]m9at$4 7e7 ,def9itions ,9 ?is section3 7#a7 ,f$]ally-qualifi$ heal? c5t] s]vices2 ,f$]ally-qualifi$ heal? c5t]2 rural heal? cl9ic s]vices2 rural heal? cl9ic ,! t]ms ,f$]ally-qualifi$ heal? c5t] s]vices1 ,f$]ally-qualifi$ heal? c5t]1 rural heal? cl9ic s]vices1 & rural heal? cl9ic h ! mean+s giv5 ^? t]ms 9 section #aije7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l774 7#b7 ,enhanc$ ,,fmap ,! t]m enhanc$ ,,fmap has ! mean+ giv5 t t]m 9 section #baje7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7b77 b )\t reg>d to ! second & ?ird s5t5ces ( t section4 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#d7 ,/ate ,! t]m ,/ate has ! mean+ giv5 su* t]m = purposes ( title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7f7 ,fund+ 7#a7 ,9 g5]al ,out ( any funds 9 ! ,treasury n o!rwise appropriat$1 !re is appropriat$ to ! ,secret>y-- 7,a7 = purposes ( c>ry+ out subsections 7a71 7b71 & 7d77#g71 #b1jjj1jjj = fiscal ye> #bjad2 & 7,b7 = purposes ( aw>d+ plann+ grants "u subsection 7c71 #be1jjj1jjj = fiscal ye> #bjaf4 7#b7 ,availability ,funds appropriat$ "u p>agraph 7#a7 %all rema9 available until exp5d$4 #bbd4 ,assi/$ outpati5t treatm5t grant program = individuals ) s]i\s m5tal illness 7a7 ,9 g5]al ,! ,secret>y %all e/abli% a #d-ye> pilot program to aw>d n m ?an #ej grants ea* ye> to eligible entities = assi/$ outpati5t treatm5t programs = individuals ) s]i\s m5tal illness4 7b7 ,consultation ,! ,secret>y %all c>ry out ?is section 9 consultation ) ! ,director ( ! ,national ,in/itute ( ,m5tal ,heal?1 ! ,attorney ,g5]al ( ! ,unit$ ,/ates1 ! ,adm9i/rator ( ! ,adm9i/ration = ,community ,liv+1 & ! ,adm9i/rator ( ! ,sub/ance ,abuse & ,m5tal ,heal? ,s]vices ,adm9i/ration4 7c7 ,select+ among applicants ,! ,secret>y-- 7#a7 may only aw>d grants "u ?is section to applicants t h n previ\sly implem5t$ an assi/$ outpati5t treatm5t program2 & 7#b7 %all evaluate applicants bas$ on _! pot5tial to r$uce hospitalization1 homelessness1 inc>c]ation1 & int]action ) ! crim9al ju/ice sy/em :ile improv+ ! heal? & social outcomes ( ! pati5t4 7d7 ,use ( grant ,an assi/$ outpati5t treatm5t program fund$ ) a grant aw>d$ "u ?is section %all include-- 7#a7 evaluat+ ! m$ical & social ne$s ( ! pati5ts :o are p>ticipat+ 9 ! program2 7#b7 prep>+ & execut+ treatm5t plans = su* pati5ts t-- 7,a7 include crit]ia = completion ( c\rt-ord]$ treatm5t2 & 7,b7 provide = monitor+ ( ! pati5t's compliance ) ! treatm5t plan1 includ+ compliance ) m$ication & o!r treatm5t regim5s2 7#c7 provid+ = su* pati5ts case managem5t s]vices t support ! treatm5t plan2 7#d7 ensur+ appropriate ref]rals to m$ical & social s]vice provid]s2 7#e7 evaluat+ ! process = implem5t+ ! program to ensure consi/5cy ) ! pati5t's ne$s & ,/ate law2 & 7#f7 measur+ treatm5t outcomes1 includ+ heal? & social outcomes su* z rates ( inc>c]ation1 heal? c>e utilization1 & homelessness4 7e7 ,report ,n lat] ?an ! end ( ea* ( fiscal ye>s #bjaf1 #bjag1 & #bjah1 ! ,secret>y %all submit a report to ! appropriate congressional committees on ! grant program "u ?is section4 ,ea* su* report %all include an evaluation ( ! foll[+3 7#a7 ,co/ sav+s & public heal? outcomes su* z mortality1 suicide1 sub/ance abuse1 hospitalization1 & use ( s]vices4 7#b7 ,rates ( inc>c]ation by pati5ts4 7#c7 ,rates ( homelessness among pati5ts4 7#d7 ,pati5t & family satisfaction ) program p>ticipation4 7f7 ,def9itions ,9 ?is section3 7#a7 ,! t]m assi/$ outpati5t treatm5t means m$ically prescrib$ m5tal heal? treatm5t t a pati5t receives :ile liv+ 9 a community "u ! t]ms ( a law au?oriz+ a ,/ate or local c\rt to ord] su* treatm5t4 7#b7 ,! t]m eligible entity means a c\nty1 city1 m5tal heal? sy/em1 m5tal heal? c\rt1 or any o!r entity ) au?ority "u ! law ( ! ,/ate 9 :i* ! grantee is locat$ to implem5t1 monitor1 & ov]see assi/$ outpati5t treatm5t programs4 7#c7 ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7g7 ,fund+ 7#a7 ,am\nt ( grants ,a grant "u ?is section %all be 9 an am\nt t is n m ?an #a1jjj1jjj = ea* ( fiscal ye>s #bjae ?r\gh #bjah4 ,subject to ! prec$+ s5t5ce1 ! ,secret>y %all det]m9e ! am\nt ( ea* grant bas$ on ! population ( ! area1 includ+ e/imat$ pati5ts1 to be s]v$ "u ! grant4 7#b7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section #ae1jjj1jjj = ea* ( fiscal ye>s #bjae ?r\gh #bjah4 #bbe4 ,exclusion f ,,paygo scorec>ds 7a7 ,/atutory ,pay-,z-,y-,g scorec>ds ,! budget>y effects ( ?is ,act %all n be ent]$ on ei!r ,,paygo scorec>d ma9ta9$ pursuant to section #d7;d7 ( ! ,/atutory ,pay-,z-,y-,g ,act ( #bjaj4 7b7 ,s5ate ,,paygo scorec>ds ,! budget>y effects ( ?is ,act %all n be ent]$ on any ,,paygo scorec>d ma9ta9$ = purposes ( section #bja ( ,s4 ,con4 ,res4 #ba 7#aaj? ,congress74 ,pass$ ! ,h\se ( ,repres5tatives ,m>* #bg1 #bjad4,k>5 ,l4 ,haas1,cl]k