,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #ddhd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #aj1 #bjad ,ms4
 ,s9ema 7= h]self1 ,mr4 ,gibson1 ,mr4   
,b>b]1 ,mr4 ,bilirakis1 & ,mr4 ,murphy (
 ,florida7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,ways &     
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide improvem5ts = ,m$ic>e ,advantage
 special ne$s plans1 & = o!r purposes4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,/r5g!n+ ,heal?c>e ,options =         
,vuln]able ,populations ,act4  #b4      
,reau?orization ( c]ta9 ,m$ic>e         
,advantage ,special ,ne$s ,plans  7a7   
,p]man5t ext5sion ( ,m$ic>e ,advantage  
,dual ,special ,ne$s ,plans au?ority    
,section #ahei7;f77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           

#aciew-#bh7;f77#a77 is am5d$ by ins]t+ 1
 9 ! case ( a specializ$ ,,ma plan =    
special ne$s individuals :o are n       
describ$ 9 section                      
#ahei7;b77#f77;,b77ii71 be=e = p]iods   
be=e ,janu>y #a1 #bjae4  7b7 ,m$ic>e    
,advantage ,dual ,special ,ne$s ,plans  
requir$ ,to provide integrat$ c>e       
,section #ahei7;f77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;f77#c77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7 ,n
 lat] ?an ,decemb] #ca1 #bjah1 ! plan is
 fully integrat$ ) capitat$ contracts ) 
,/ates = any ,m$icaid b5efits1 includ+  
long-t]m c>e & behavioral heal?1 to !   
ext5t ,/ate law p]mits capitation ( su* 
s]vices "u su* plan4  4  7c7 ,cle>ly    
def9$ role ( ,/ate ,m$icaid ag5cy       
,section #aheb7;a77#a77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7;a77#a77;,b77 is am5d$ by    
add+ at ! end ! foll[+ new clause3  7vi7
 ,def9$ role ( ,/ate ,m$icaid ag5cies ) 
respect to fully integrat$ dual special 

ne$s plans ,! ,secret>y1 9 coord9ation )
 ,/ate ,m$icaid ,directors1 %all develop
 a cle>ly def9$ role = ,/ate ,m$icaid   
ag5cies 9 contract+ & ov]sight ( plans  
describ$ 9 clause 7v77,,ii74  4  #c4    
,improvem5ts to ,m$ic>e ,advantage      
#e-,/> ,quality ,rat+ ,sy/em = plans )  
pr$om9ately ,dual ,eligible enrollees   
7a7 ,treatm5t ( plans )                 
disproportionately high dual eligible   
enrollees ,section #ahec7o7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7o77 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#f7 ,treatm5t 
( plans ) disproportionately high dual  
eligible enrollees  7,a7 ,9 g5]al ,9    
implem5t+ ?is subsection1 ! ,secret>y   
%all take su* /eps z are necess>y to    
ensure t ! quality rat+ = a plan--  7i7 
does n disadvantage su* a plan t        
enrolls--  7,i7 full-b5efit dual        
eligible individual 7z def9$ 9 section  
#aice7;c77#f772  7,,ii7 qualifi$ ,m$ic>e
 b5efici>ies 7z def9$ 9 section         
#aije7p77#a772 or  7,,iii7 individuals )

 complex heal? c>e ne$s1 su* z          
individuals ) multiple conditions or    
individuals :o require *ronic c>e or    
in/itutional c>e2 &  7ii7 acc\nts =     
diff]5ces 9 socioeconomic & demographic 
*>act]i/ics ( enrollees ( su* a plan t  
result 9 significant v>iation 9 heal?   
outcomes4  7,b7 ,specific /eps ,! /eps  
describ$ 9 subp>agraph 7,a7 %all include
 at lea/ ! foll[+3  7i7 ,comp>+         
specializ$ ,,ma plans = special ne$s    
individuals 7z def9$ 9 section          
#ahei7;b77#f77 = special ne$s           
individuals :o are describ$ 9           
subp>agraph 7,b77ii7 ( su* section only 
aga9/ o!r plans ) ! same types (        
enrollm5t4  7ii7 ,develop+ a me?odology 
specific to specializ$ ,,ma plans =     
special ne$s individuals 7z def9$ 9     
section #ahei7;b77#f77 = special ne$s   
individuals :o are describ$ 9           
subp>agraph 7,b77ii7 ( su* section =    
det]m9+ a quality rat+ "u ?is subsection
 = su* plans4  7iii7 ,develop+          
appropriate case mix adju/m5t to        

,heal?c>e ,effectiv5ess ,data &         
,in=mation ,set 7,,h$is7 & ,heal?       
,outcomes ,survey 7,,hos7 measures =    
specializ$ ,,ma plans = special ne$s    
individuals 7z def9$ 9 section          
#ahei7;b77#f77 = special ne$s           
individuals :o are describ$ 9           
subp>agraph 7,b77ii7 ( su* section t    
acc\nt = factors beyond ! control ( !   
heal? sy/em1 su* z ! managem5t (        
conditions4  7iv7 ,id5tify+ & implem5t+ 
^? quality measures t are appropriate = 
evaluat+ ! p]=mance ( specializ$ ,,ma   
plans = special ne$s individuals 7z     
def9$ 9 section #ahei7;b77#f77 = special
 ne$s individuals :o are describ$ 9     
subp>agraph 7,b77ii7 ( su* section4  7v7
 ,elim9at+ duplicative or sub/antially  
simil> measures appli$ "u ?is title or  
title ,,xix ) respect to specializ$ ,,ma
 plans4  4  7b7 ,tempor>y treatm5t (    
c]ta9 dual special ne$s plans ,section  
#ahec7o7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciew-#bc7o771 z am5d$ by   
subsection 7a71 is fur!r am5d$ by add+  

at ! end ! foll[+ new p>agraph3  7#g7   
,tempor>y treatm5t ( c]ta9 dual special 
ne$s plans ,9 implem5t+ ?is subsection  
dur+ ! p]iod beg9n+ on ! date ( !       
enactm5t ( ?is p>agraph & end+ "o ye>   
aft] ! date on :i* ! ,secret>y has tak5 
su* /eps z are requir$ "u p>agraph 7#f71
 ! ,secret>y may increase ! quality rat+
 t a specializ$ ,,ma plans = special    
ne$s individuals 7z def9$ 9 section     
#ahei7;b77#f77 = special ne$s           
individuals :o are describ$ 9           
subp>agraph 7,b77ii7 ( su* section w\ld 
o!rwise receive "u ?is subsection = a   
ye> by #j4e />s if ! plan demon/rates to
 ! satisfaction ( ! ,secret>y t !       
quality rat+ ! plan w\ld h o!rwise      
receiv$ is pr$om9ately attributable to  
socio-economic1 demographic1 or         
pre-exi/+ complex heal? c>e ne$s ( !    
population enroll$ 9 su* plan ) respect 
to su* ye> in/ead ( ! p]=mance ( ! plan 
) respect to su* ye>4  4  7c7 ,,gao     
report ,n lat] ?an "o ye> aft] ! date on
 :i* ! ,secret>y ( ,heal? & ,human      

,s]vices has tak5 su* /eps z are requir$
 "u p>agraph 7#f7 ( section #ahec7o7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bc7o771 z add$ by subsection    
7a71 & annually !reaft] = ! foll[+ f\r  
ye>s1 ! ,comptroll] ,g5]al ( ! ,unit$   
,/ates %all submit to ,congress a report
 t includes a compreh5sive review ( !   
effectiv5ess (1 & recomm5dations to     
improve1 su* /eps s tak5 = improv+ heal?
 outcomes1 co/ controls1 & b5efici>y    
satisfaction4  #d4 ,additional          
improvem5ts to ! ov]sight & op]ation (  
,m$ic>e ,advantage ,dual ,special ,ne$s 
,plans by ! ,f$]al ,coord9at$ ,heal?    
,c>e ,(fice  7a7 ,d$icat$ po9t ( contact
 = assi/+ ,/ates ) adm9i/ration ,section
 #bfjb7;d7 ( ! ,pati5t ,protection &    
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#acae;b7d77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#f7 ,s]v+ z !    
d$icat$ po9t ( contact )9 ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices to assi/     
,/ates ) ongo+ issues relat$ to !       
adm9i/ration ( specializ$ ,,ma plans =  

special ne$s individuals 7z def9$ 9     
section #ahei7;b77#f7 ( ! ,social       
,security ,act7 = special ne$s          
individuals :o are describ$ 9           
subp>agraph 7,b77ii7 ( su* section1     
includ+--  7,a7 address+ any misalignm5t
 betwe5 ! contract+ timel9es1 processes1
 & deadl9es "u title ,,xviii ( su* ,act1
 ) respect to su* plans = su*           
individuals & contract+ timel9es1       
processes1 & deadl9es "u title ,,xix (  
su* ,act1 ) respect to su* plans &      
individuals2 &  7,b7 /reaml9+ ! fl[ (   
in=mation to dual eligible individuals &
 e/abli%+ a s+le set ( rules = outrea* &
 m>ket+ to su* individuals4  4  7b7     
,au?ority ,to waive c]ta9 requirem5ts   
7#a7 ,9 g5]al ,subject to p>agraph 7#b71
 ! ,secret>y ( ,heal? & ,human ,s]vices1
 ?r\gh ! ,f$]al ,coord9at$ ,heal? ,c>e  
,(fice e/abli%$ "u section #bfjb ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #acae;b7 & 9        
coord9ation ) ! appropriate ,/ate       
,m$icaid ag5cy1 may waive ! application 

( requirem5ts "u title ,,xviii ( !      
,social ,security ,act to promote !     
integration1 alignm5t1 & deliv]y ( items
 & s]vices "u ! ,m$ic>e program "u title
 ,,xviii ( su* ,act & ! ,m$icaid program
 "u title ,,xix ( su* ,act1 ) respect to
 dual eligible individuals 7z def9$ 9   
section #bfjb7;f7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #acae;b7f771 & to ensure !    
seamless deliv]y ( pati5t-c5t]$ s]vices 
across ! cont9uum ( c>e ) respect to su*
 individuals4  7#b7 ,public notice      
requirem5t ,! ,secret>y may n waive !   
application ( a requirem5t pursuant to  
p>agraph 7#a7 unless ! ,secret>y makes  
su* waiv] publicly available 7:e!r on ! 
public ,int]net website ( ,dep>tm5t (   
,heal? & ,human ,s]vices1 or o!rwise7 at
 lea/ #cj days be=e ! effective date (  
su* waiv]4  #e4 ,improvem5ts to dispute 
resolution = claims & appeals "u ,m$ic>e
 ,advantage ,dual ,special ,ne$s ,plans 
7a7 ,m$ic>e ,advantage ,dual ,special   
,ne$s ,plans requir$ ,to provide cov]age

 dur+ appeals process ,section          
#ahei7;f77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;f77#c771 z  
am5d$ by section #b7;b71 is fur!r am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,g7 ,= plan ye>s beg9n+  
aft] ,decemb] #ca1 #bjae1 cov]age "u ?is
 title & title ,,xix ( an individual    
enroll$ "u su* respective title %all    
cont9ue dur+ any det]m9ation1           
reconsid]ation1 or appeals proce$+      
describ$ 9 section #aheb7;g71 ) respect 
to su* individual4  4  7b7 ,/reaml9$    
pa?way = dispute resolution ,n lat] ?an 
,decemb] #ca1 #bjae1 ! ,secret>y (      
,heal? & ,human ,s]vices %all e/abli% a 
/reaml9$ process = dispute resolution = 
claims & appeals1 ) respect items &     
s]vices furni%$ to special ne$s         
individuals describ$ 9 section          
#ahei7;b77#f77;,b77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;b77#f77;,b77ii771 to align  
su* process "u ! ,m$ic>e program "u     
title ,,xviii ( ! ,social ,security ,act

 ) su* process "u ! ,m$icaid program "u 
title ,,xix ( su* ,act4 ,su* /reaml9$   
process %all take into acc\nt v>i\s     
,/ate requirem5ts & promote a pa?way t  
w\ld be ! mo/ b5eficial = individuals   
entitl$ to b5efits "u "p ,a ( title     
,,xviii ( su* ,act or enroll$ "u "p ,b (
 su* ,act & to individuals enroll$ "u a 
,/ate plan "u title ,,xix ( su* ,act4   
#f4 ,report on implem5tation ( c]ta9    
,m$ic>e & ,m$icaid fraud detection &    
program integrity provisions  ,section  
#aabh;,j7a77#a77;,a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#gk7a77#a77;,a77 is am5d$ by    
add+ at ! end ! foll[+ new clause3      
7iii7 ,report on integrat$ data         
repository & "o program integrity sy/em 
,n lat] ?an six mon?s aft] ! date (     
enactm5t ( ?is clause1 ! ,secret>y %all 
submit to ! appropriate ,congressional  
committees a report on ! foll[+3  7,i7  
,integrat$ data repository ,ef=ts to    
f9alize plans & s*$ules = fully         
implem5t+ & exp&+ ! use ( ! ,integrat$  

,data ,repository1 includ+ actions tak5 
to f9alize1 implem5t1 & manage plans =  
incorporat+ data into ! ,integrat$ ,data
 ,repository & actions tak5 to def9e    
measurable f9ancial b5efits expect$ f ! 
implem5tation ( ! ,integrat$ ,data      
,repository4  7,,ii7 ,"o program        
integrity sy/em ,actions tak5 to plan1  
s*$ule1 & conduct tra9+ on ! ,"o        
,program ,integrity ,sy/em1 a ,web-bas$ 
portal & suite ( s(tw>e tools us$ to    
analyze & extract data f ! ,integrat$   
,data ,repository1 & actions tak5 to    
def9e measurable f9ancial b5efits       
expect$ f ! use ( ! ,"o ,program        
,integrity ,sy/em4  4