,,ii #aac? ,,congress #a/ ,session ,s4 #aa ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,febru>y #bf1 #bjac ,mr4 ,cork] 7= himself & ,mr4 ,alex&]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to provide a compreh5sive deficit r$uction plan1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,fiscal ,su/a9ability ,act ( #bjac4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,,title ,i--,m$icaid ,sec4 #aaja4 ,compreh5sive ,m$icaid ,waiv]s4 ,sec4 #aajb4 ,phas$-9 elim9ation ( all[able provid] taxes "u ,m$icaid4 ,,title ,,ii--,m$ic>e ,subtitle ,a--,m$ic>e ,total ,heal? program2 ,m$ic>e ,fee-=-,s]vice program re=ms2 ,reports ,sec4 #bjjj4 ,%ort title2 purpose4 ,,"p ,i--,m$ic>e ,total ,heal? program ,sec4 #bjja4 ,e/abli%m5t ( ,m$ic>e ,total ,heal? program4 ,subp>t #b--,m$ic>e ,total ,heal? program ,sec4 #ahfj;,c-#a4 ,eligibility1 enrollm5t1 & in=mation4 ,sec4 #ahfj;,c-#b4 ,total ,heal? plan b5efits4 ,sec4 #ahfj;,c-#c4 ,access to a *oice ( qualifi$ ,total ,heal? b5efits plans4 ,sec4 #ahfj;,c-#d4 ,b5efici>y protections = ,total ,heal? plan enrollees4 ,sec4 #ahfj;,c-#e4 ,total ,heal? regions2 submission ( bids2 ,total ,heal? plan approval4 ,sec4 #ahfj;,c-#f4 ,requirem5ts = & contracts ) ,total ,heal? sponsors4 ,sec4 #ahfj;,c-#g4 ,total ,heal? premiums4 ,sec4 #ahfj;,c-#h4 ,premium & co/-%>+ support = ,total ,heal? eligible individuals4 ,sec4 #ahfj;,c-#i4 ,exemption = ,,msa plans4 ,sec4 #ahfj;,c-#aj4 ,special rules = employ]-sponsor$ programs4 ,sec4 #ahfj;,c-#aa4 ,coord9ation ) ,/ate ,m$icaid programs4 ,sec4 #ahfj;,c-#ab4 ,def9itions & miscellane\s provisions4 ,sec4 #bjjb4 ,replacem5t ( "p ,b premium ) ,m$ic>e ,total ,heal? program plan premium2 o!r te*nical & con=m+ am5dm5ts4 ,,"p ,,ii--,m$ic>e fee-=-,s]vice re=ms ,sec4 #bjaa4 ,m$ic>e protection aga9/ high out-(-pocket exp5ditures = fee-=-s]vice b5efits4 ,sec4 #bjab4 ,unifi$ ,m$ic>e d$uctible4 ,sec4 #bjac4 ,uni=m ,m$ic>e co9surance rate4 ,sec4 #bjad4 ,prohibition on fir/-doll> cov]age "u ,m$igap policies & developm5t ( new /&>ds = ,m$igap policies4 ,,"p ,,iii--,annual report to ,congress ,sec4 #bjba4 ,annual report to ,congress4 ,subtitle ,b--,elim9ation ( exemption ( ,m$ic>e paym5ts to physicians "u /atutory ,,paygo ,sec4 #baja4 ,elim9ation ( exemption ( ,m$ic>e paym5ts to physicians "u /atutory ,,paygo4 ,subtitle ,c--,adju/m5ts to ,m$ic>e "p ,b & ,d premiums = high-,income b5efici>ies ,sec4 #bbja4 ,adju/m5ts to ,m$ic>e "p ,b & ,d premiums = high-income b5efici>ies4 ,subtitle ,d--,increase 9 ! ,m$ic>e eligibility age ,sec4 #bcja4 ,increase 9 ! ,m$ic>e eligibility age4 ,subtitle ,e--,o!r provisions ,sec4 #bdja4 ,limitation on ,m$ic>e paym5ts = direct graduate m$ical education 7,,dgme74 ,sec4 #bdjb4 ,r$uction 9 ,m$ic>e indirect graduate m$ical education 7,,ime7 paym5ts4 ,sec4 #bdjc4 ,accel]ation ( application ( productivity adju/m5t to ,m$ic>e home heal? prospective paym5t am\nts4 ,sec4 #bdjd4 ,accel]ation ( rebas+ ( ,m$ic>e home heal? prospective paym5t am\nts4 ,sec4 #bdje4 ,r$uction ( bad debt treat$ z an all[able co/4 ,,title ,,iii--,social ,security ,sec4 #caja4 ,adju/m5ts to b5d po9ts 9 det]m9+ prim>y insurance am\nt4 ,sec4 #cajb4 ,adju/m5t to calculation ( b5efit computation ye>s4 ,sec4 #cajc4 ,m9imum ,social ,security b5efit4 ,sec4 #cajd4 ,increase 9 b5efits />t+ #bj ye>s aft] initial eligibility4 ,sec4 #caje4 ,adju/m5t to normal & e>ly retirem5t ages4 ,sec4 #cajf4 ,application ( actu>ial r$uction = disabl$ b5efici>ies :o atta9 e>ly retirem5t age4 ,sec4 #cajg4 ,option to collect up to "o-half ( old-age insurance b5efit at age #fb4 ,sec4 #cajh4 ,cov]age ( newly hir$ ,/ate & local employees4 ,sec4 #caji4 ,inclusion 9 annual ,social ,security acc\nt /atem5t ( e/imat$ pres5t value ( taxes & b5efits = ,social ,security & ,m$ic>e & project$ deficit z a p]c5t ( lifetime e>n+s4 ,sec4 #caaj4 ,retirem5t in=mation campaign4 ,,title ,,iv--,conv]sion to *a9$ ,,cpi ,sec4 #daja4 ,conv]sion to ,*a9$ ,,cpi4 ,i ,m$icaid #aaja4 ,compreh5sive ,m$icaid ,waiv]s ,section #aaae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae7 is am5d$ by add+ at ! end ! foll[+3 7g7 ,compreh5sive ,m$icaid ,waiv]s 7#a7 ,au?ority 7,a7 ,9 g5]al ,a ,/ate may elect to provide m$ical assi/ance "u title ,,xix1 directly or by contract1 to eligible individuals pursuant to a compreh5sive ,m$icaid waiv] "u ?is subsection 9 lieu ( provid+ su* assi/ance "u a ,/ate plan approv$ "u title ,,xix or a waiv] approv$ "u subsection 7d7 or ext5d$ "u subsection 7e74 ,a ,/ate %all make su* an election by submitt+ a waiv] application to ! ,secret>y = c]tification t ! application satisfies ! requirem5ts ( p>agraph 7#b74 7,b7 ,waiv] ( ,/ate ,m$icaid program requirem5ts ,any requirem5ts applicable "u ?is title or title ,,xix t w\ld prev5t a ,/ate f c>ry+ out a compreh5sive ,m$icaid waiv] 9 accordance ) ! ,/ate's c]tifi$ application & ! requirem5ts ( ?is subsection are deem$ waiv$4 7,c7 ,%>$ sav+s bonus ,a ,/ate conduct+ a compreh5sive ,m$icaid waiv] "u ?is subsection %all be eligible = a %>$ sav+s bonus 9 accordance ) p>agraph 7#d74 7,d7 ,option to include ,,*ip-eligible individuals ,a ,/ate may elect to treat individuals eligible = *ild heal? assi/ance "u ! ,/ate *ild heal? plan "u title ,,xxi z eligible individuals "u a compreh5sive ,m$icaid waiv]4 ,! waiv] application & det]m9ation ( ! aggregate sp5d+ cap = ! ,/ate = ! waiv] p]iod %all take into acc\nt ! inclusion ( su* individuals 9 ! compreh5sive ,m$icaid waiv]4 ,any requirem5ts applicable "u ?is title1 title ,,xix1 or title ,,xxi t w\ld prev5t a ,/ate f includ+ su* individuals 9 ! compreh5sive ,m$icaid waiv] 9 accordance ) ! ,/ate's c]tifi$ application & ! requirem5ts ( ?is subsection are deem$ waiv$4 7#b7 ,compreh5sive ,m$icaid waiv] application ,an application = a compreh5sive ,m$icaid waiv] "u ?is subsection %all conta9 ! foll[+3 7,a7 ,g5]al description ( propos$ b5efit deliv]y models1 eligibility crit]ia1 & b5efits ,a brief description1 :i* may be 9 outl9e =m1 ( ! eligibility crit]ia & m$ical assi/ance to be provid$ t includes ! me?ods = deliv]y ( su* assi/ance1 ! crit]ia = ! det]m9ation ( eligibility = su* assi/ance1 & ! am\nt1 duration1 & scope ( su* assi/ance1 includ+ a description ( ! am\nt 7if any7 ( premiums1 d$uctibles1 co9surance1 or o!r co/-%>+4 7,b7 ,,h$is measures to evaluate p]=mance 7i7 ,9 g5]al ,a description ( n less ?an #bj ( ! /&>d ,m$icaid ,heal?c>e ,effectiv5ess ,data & ,in=mation ,set 7,,h$is7 measures e/abli%$ by ! ,national ,committee = ,quality ,assurance select$ by ! ,/ate to annually evaluate ! quality & co/-effectiv5ess ( ! m$ical assi/ance provid$ "u ! waiv]1 & = ea* su* measure 7&1 if applicable1 ! di/9ct rates associat$ ) ! measure71 ! basel9e data & ! t>get p]=mance goal applicable = ea* su* measure or rate4 ,! ,/ate %all select ,,h$is measures t are closely align$ ) ! heal? c>e items & s]vices t are provid$ to eligible individuals z m$ical assi/ance "u ! waiv]4 7ii7 ,evaluation ,! description "u ?is subp>agraph %all specify ! indep5d5t entity t ! ,/ate w use to evaluate ! waiv]4 ,! ,/ate %all provide an assurance t ! ,/ate w submit a copy ( ! annual evaluation to ! ,secret>y4 7,c7 ,program integrity ,a brief description ( ! ,/ate's program to prev5t wa/e1 fraud1 & abuse "u ! waiv]4 7,d7 ,aggregate sp5d+ cap ,an assurance t ! ,/ate agrees-- 7i7 to e/abli% categories t accurately acc\nt = ea* ( ! di/9ct population gr\ps t w qualify z eligible individuals "u ! waiv] 7su* z *ildr51 p>5ts1 pregnant wom51 & ! bl9d or disabl$7 bas$ on su* crit]ia z are det]m9$ appropriate by ! ,/ate 7ref]r$ to 9 ?is subsection z a population category72 7ii7 to provide ! ,secret>y ) all data relevant to ! det]m9ation ( ! aggregate sp5d+ cap = ! ,/ate = ! waiv] p]iod1 z det]m9$ by ! ,secret>y "u p>agraph 7#c77;,b72 & 7iii7 ) respect to ea* p]iod = :i* ! waiv] is approv$1 to n receive any ,f$]al paym5ts f ! ,secret>y = am\nts exp5d$ dur+ su* p]iod t exce$ ! aggregate sp5d+ cap4 7#c7 ,det]m9ation ( aggregate sp5d+ cap 7,a7 ,e/abli%m5t ( sp5d+ template 7i7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) ! ,director ( ! ,(fice ( ,managem5t & ,budget 7ref]r$ to 9 ?is subsection z ! ,director71 %all e/abli% a template = det]m9+1 ) respect to ea* ,/ate1 ! aggregate sp5d+ cap = ea* p]iod = :i* ! ,/ate conducts a compreh5sive ,m$icaid waiv] "u ?is subsection4 ,! ,secret>y %all-- 7,i7 publi% a propos$ template n lat] ?an #fj days aft] ! date ( enactm5t ( ?is subsection2 7,,ii7 provide = a p]iod = public comm5t on ! propos$ template2 & 7,,iii7 promulgate a f9al template n lat] ?an #abj days aft] su* date ( enactm5t4 7ii7 ,revisions 7,i7 ,9 g5]al ,subject to subclause 7,,ii71 ! ,secret>y1 9 coord9ation ) ! ,director1 %all revise ! template1 z appropriate1 n less ?an e #e ye>s pursuant to a process t all[s = public comm5t prior to publication ( ! revis$ template4 7,,ii7 ,te*nical *anges ,! ,secret>y or ! ,director may make any necess>y te*nical or con=m+ *anges to ! template at su* times & 9 su* mann] z is det]m9$ appropriate4 7,b7 ,det]m9ation ( aggregate sp5d+ cap = ea* ,/ate 7i7 ,9 g5]al ,subject to subp>agraph 7,c71 ! aggregate sp5d+ cap applicable to a ,/ate = a waiv] p]iod %all be equal to #ii p]c5t ( ! am\nt det]m9$ "u clause 7ii74 7ii7 ,total am\nt ( project$ ,f$]al paym5ts ,! am\nt describ$ 9 ?is clause is equal to ! sum (-- 7,i7 ! total am\nt ( ,f$]al paym5ts t w\ld o!rwise be made to ! ,/ate dur+ ! waiv] p]iod ) respect to any disproportionate %>e paym5t adju/m5t made "u section #aibc2 & 7,,ii7 ! sum ( ! am\nts det]m9$ "u clause 7iii7 = ea* population category4 7iii7 ,project$ ,f$]al paym5ts = m$ical assi/ance provid$ to population categories ,= purposes ( clause 7ii77,,ii71 ! ,secret>y & ! ,director %all calculate ! am\nt ( project$ exp5ditures = ! provision ( m$ical assi/ance to eligible individuals 9 ea* population category dur+ ! waiv] p]iod 7z det]m9$ bas$ ^u ! population categories e/abli%$ & ! data provid$ by ! ,/ate pursuant to p>agraph 7#b77;,d71 z well z ! annual basel9e e/imates suppli$ by ! ,director & su* o!r data z is det]m9$ appropriate by ! ,secret>y71 :i* %all be equal to ! product (-- 7,i7 subject to clause 7iv71 ! mon?ly p] capita am\nt ( ,f$]al paym5ts t 7 made to ! ,/ate "u ! ,/ate plan "u title ,,xix 7or "u a waiv] approv$ "u subsection 7d7 or ext5d$ "u subsection 7e77 = an individual 9 su* population category dur+ ! fiscal ye> prior to ! ,/ate application = ! waiv] 7ref]r$ to 9 ?is p>agraph z ! population category p] capita basel9e72 7,,ii7 ! numb] ( individuals )9 su* population category t are project$ to be eligible to receive m$ical assi/ance dur+ ! waiv] p]iod2 & 7,,iii7 ! numb] ( mon?s 9 ! waiv] p]iod4 7iv7 ,population categories ) no basel9e data ,= purposes ( any det]m9ation "u clause 7iii77,i7 = a population category t lacks suffici5t data to calculate ! population category p] capita basel9e & t consi/s ( individuals = :i* ! ,/ate w\ld o!rwise be requir$ to provide m$ical assi/ance to pursuant to section #aijb7;a77#aj77;,a77i77,,viii71 ! population category p] capita basel9e %all be equal to ! mon?ly p] capita am\nt ( ,f$]al paym5ts t w\ld o!rwise h be5 made to ! ,/ate "u ! ,/ate plan "u title ,,xix 7or "u a waiv] approv$ "u subsection 7d7 or ext5d$ "u subsection 7e77 dur+ ! prec$+ fiscal ye> = an individual :o is "u #fe ye>s ( age1 n pregnant1 n entitl$ to1 or enroll$ =1 b5efits "u "p ,a ( title ,,xviii1 or enroll$ = b5efits "u "p ,b ( title ,,xviii4 7v7 ,budget neutrality ,9 no ev5t %all ! aggregate sp5d+ cap e/abli%$ = a ,/ate = a waiv] p]iod all[ = ,f$]al paym5ts to ! ,/ate dur+ ! waiv] p]iod t exce$ ! am\nt ( ,f$]al paym5ts to ! ,/ate t w\ld h be5 made dur+ t p]iod if ! ,/ate _h n elect$ to conduct a compreh5sive ,m$icaid waiv] "u ?is subsection dur+ ! p]iod4 7,c7 ,adju/m5t ( aggregate sp5d+ cap = high unemploym5t ,= purposes ( subp>agraph 7,b77i71 if ! av]age mon?ly unemploym5t rate 7z def9$ 9 p>agraph 7#h77;,a77 = a ,/ate exce$s #aj p]c5t = any consecutive p]iod ( at lea/ #f mon?s occurr+ dur+ ! waiv] p]iod1 ! aggregate sp5d+ cap applicable to ! ,/ate = su* waiv] p]iod %all be equal to #ajj p]c5t ( ! am\nt det]m9$ "u subp>agraph 7,b77ii74 7#d7 ,%>$ sav+s bonuses 7,a7 ,9 g5]al ,! ,secret>y %all annually pay ea* ,/ate conduct+ a compreh5sive ,m$icaid waiv] "u ?is subsection an am\nt equal to #be p]c5t ( ! waiv] sav+s det]m9$ ) respect to a ,/ate & a waiv] p]iod "u subp>agraph 7,c74 7,b7 ,d$icat$ to heal? c>e ,a ,/ate t receives a paym5t "u ?is p>agraph %all sp5d n less ?an #hj p]c5t ( ! paym5t on heal? c>e s]vices or heal?-relat$ activities = eligible individuals4 7,c7 ,det]m9ation ( waiv] sav+s ,! ,secret>y & ! ,director %all e/abli% a process = det]m9+ ) respect to a ,/ate & a waiv] p]iod ! am\nt ( sav+s a*iev$ by a ,/ate = ! p]iod4 ,! process %all take into acc\nt ! diff]5ce betwe5 ! aggregate sp5d+ cap applicable to ! ,/ate = ! waiv] p]iod & ! total am\nt exp5d$ by ! ,/ate "u ! waiv] = ! p]iod4 7,d7 ,paym5t2 retrospective adju/m5t ,! ,secret>y %all make annual paym5ts "u ?is p>agraph on ! basis ( claims submitt$ by ! ,/ate = exp5ses paid by ! ,/ate = m$ical assi/ance provid$ "u ! waiv]1 & su* o!r inve/igation z ! ,secret>y or ! ,director may f9d necess>y1 & may r$uce or increase ! paym5ts z necess>y to adju/ = prior ov]paym5ts or "u paym5ts "u ?is p>agraph4 7#e7 ,duration 7,a7 ,9 g5]al ,a ,/ate %all conduct a compreh5sive ,m$icaid waiv] "u ?is subsection = a #e-ye> p]iod4 ,subject to subp>agraph 7,b71 a compreh5sive ,m$icaid waiv] may be r5ew$ = additional #c-ye> p]iods ^u ! reque/ ( ! ,/ate1 unless )9 #ij days aft] receipt ( a ,/ate reque/ = a r5ewal ( a waiv]1 ! ,secret>y & ! ,director det]m9e1 bas$ on ! ,/ate evaluations requir$ "u p>agraph 7#b77;,b71 t ! waiv] %\ld n be r5ew$4 7,b7 ,/ate evaluations & t>get p]=mance goals ,= purposes ( subp>agraph 7,a71 ! ,secret>y & ! ,director may n r5ew a waiv] unless ea* ( ! measures or rates select$ by ! ,/ate pursuant to p>agraph 7#b77;,b7 has improv$ or rema9$ con/ant dur+ ! waiv] p]iod4 7#f7 ,limit$ ,secret>ial au?ority2 adm9i/rative & judicial review 7,a7 ,c]tification ( waiv] applications 7i7 ,9 g5]al ,except z provid$ "u clause 7ii71 ! ,secret>y & ! ,director %all h #ij days f receipt ( an application by a ,/ate = a compreh5sive ,m$icaid waiv] to c]tify ! application z satisfy+ ! requirem5ts ( p>agraph 7#b74 7ii7 ,inquiries ,! ,secret>y & ! ,director may submit a s+le set ( inquiries = additional in=mation to ! ,/ate dur+ ! initial #ij-;day p]iod describ$ "u clause 7i74 ,if a ,/ate receives a set ( inquires1 ! ,/ate %all h up to #fj days to respond4 ,! ,secret>y & ! ,director %all h an additional #cj-;day p]iod1 />t+ on ! date ! ,secret>y receives a ,/ate response to a set ( inquiries1 to make a f9al det]m9ation z to :e!r ! ,/ate's waiv] application may be c]tifi$ z comply+ ) ! requirem5ts ( p>agraph 7#b74 7iii7 ,failure to respond by ! ,secret>y ,an application by a ,/ate = a compreh5sive ,m$icaid waiv] %all be deem$ c]tifi$ by ! ,secret>y if ! ,secret>y does n submit any inquiries dur+ ! initial #ij-;day review p]iod4 7iv7 ,effective date ,a waiv] t has be5 c]tifi$ by ! ,secret>y 7or deem$ to be c]tifi$7 may be effective1 at ! discretion ( ! ,/ate1 z ( ! fir/ day ( ! cal5d> qu>t] 9 :i* ! application = ! waiv] 0 submitt$ by ! ,/ate4 7,b7 ,d5ial ( waiv] applications or r5ewal reque/s 7i7 ,9 g5]al ,if ! ,secret>y & ! ,director det]m9e t an application = a compreh5sive ,m$icaid waiv]1 or a reque/ = ext5sion ( an exi/+ compreh5sive ,m$icaid waiv]1 does n satisfy ! requirem5ts ( p>agraph 7#b71 ! ,secret>y %all notify ! ,/ate ( ! disapproval by writt5 notification1 n lat] ?an #aj days foll[+ ! issuance ( su* det]m9ation & %all provide a detail$ description ( ! reasons = ! d5ial ( ! waiv] to-- 7,i7 ! ,/ate t submitt$ ! waiv] application or ext5sion reque/2 7,,ii7 ! memb]s ( ,congress repres5t+ su* ,/ate2 & 7,,iii7 ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives4 7ii7 ,adm9i/rative & judicial review 7,i7 ,adm9i/rative review ,)9 #fj days aft] ! date t a ,/ate receives notice ( ! d5ial ( a waiv] application or ext5sion reque/1 ! ,/ate may appeal ! det]m9ation to ! ,dep>tm5tal ,appeals ,bo>d e/abli%$ 9 ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 ,! ,dep>tm5tal ,appeals ,bo>d %all make a f9al det]m9ation ) respect to an appeal fil$ "u ?is subp>agraph n less ?an #fj days aft] ! date on :i* ! appeal is fil$4 7,,ii7 ,judicial review ,)9 #fj days aft] ! date ( a f9al decision by ! ,bo>d "u subclause 7,i7 t is adv]se to a ,/ate1 ! ,/ate may obta9 judicial review ( ! f9al decision by fil+ an action 9 ! di/rict c\rt ( ! ,unit$ ,/ates = ! judicial di/rict 9 :i* ! pr9cipal or headqu>t]s (fice ( ! ,/ate ag5cy responsible = adm9i/]+ ! ,/ate ,m$icaid program is locat$ or ! ,unit$ ,/ates ,di/rict ,c\rt = ! ,di/rict ( ,columbia4 7,c7 ,reports 7i7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date on :i* ! ,secret>y & ! ,director fir/ approve an application = a compreh5sive ,m$icaid waiv] "u ?is subsection & e #c ye>s !reaft]1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 7ref]r$ to 9 ?is subp>agraph z ! ,comptroll]7 %all submit to ! ,committee on ,f9ance ( ! ,s5ate & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report on ! waiv]s c]tifi$ z ( ! date ( su* report4 ,ea* report %all include an evaluation ( ! quality & co/-effectiv5ess ( ! compreh5sive ,m$icaid waiv]s 9 effect dur+ ! report+ p]iod 9 provid+ m$ical assi/ance to eligible individuals1 z well z ! f9ancial ef=t ( ! waiv] on ,/ate & ,f$]al budgets4 7ii7 ,report+ ( in=mation ,a ,/ate ) a compreh5sive ,m$icaid waiv] "u ?is subsection %all provide ! ,comptroll]1 9 su* =m & mann] z ! ,comptroll] may require1 ) any relevant in=mation reg>d+ ! waiv]1 includ+ total exp5ditures by ! ,/ate "u ! waiv]1 ! numb] ( individuals provid$ m$ical assi/ance "u ! waiv]1 & su* o!r in=mation z ! ,comptroll] may require = purposes ( prep>+ ! reports requir$ "u ?is subp>agraph4 7#g7 ,non-applications ,a compreh5sive ,m$icaid waiv] %all n apply to-- 7,a7 ! p$iatric vacc9e program "u section #aibh2 & 7,b7 limitations on total paym5ts to t]ritories "u section #aajh4 7#h7 ,outrea* & education 7,a7 ,/ate aw>5ess ,n lat] ?an #cj days aft] ! date ( enactm5t ( ?is subsection1 ! ,secret>y %all conduct an outrea* & education campaign to ,/ates reg>d+ ! availability ( compreh5sive ,m$icaid waiv]s "u ?is subsection4 7,b7 ,public notice & comm5t ,be=e submitt+ an application = a compreh5sive ,m$icaid waiv]1 a ,/ate %all make ! propos$ application available to ! public ?r\gh su* means z ! ,/ate det]m9es appropriate & all[ = a reasonable public comm5t p]iod ( n great] ?an #cj days4 7,c7 ,public aw>5ess ( approv$ waiv] ,a ,/ate t has be5 c]tifi$ = a compreh5sive ,m$icaid waiv] %all conduct an outrea* & education campaign to ensure t heal? c>e provid]s & eligible individuals )9 ! ,/ate are provid$ ) adequate notice reg>d+ ! me?ods & crit]ia ?r\gh :i* ! ,/ate int5ds to provide m$ical assi/ance "u ! waiv]4 7#i7 ,def9itions ,9 ?is subsection3 7,a7 ,av]age mon?ly unemploym5t rate ,! t]m av]age mon?ly unemploym5t rate means ! av]age ( ! mon?ly numb] unemploy$ 9 ! ,/ate1 divid$ by ! av]age ( ! mon?ly civilian labor =ce 9 ! ,/ate1 seasonally adju/$1 z det]m9$ bas$ on ! mo/ rec5t mon?ly publications ( ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor4 7,b7 ,eligible individual ,! t]m eligible individual means1 = ea* ye> dur+ ! waiv] p]iod-- 7i7 any individual :o1 = su* ye>1 ! ,/ate w\ld o!rwise be requir$ to provide m$ical assi/ance to pursuant to-- 7,i7 section #aijb7;a77#aj77;,a77i72 7,,ii7 p>agraphs 7#a7 or 7#d7 ( section #aijb7;e72 7,,iii7 section #aibe2 or 7,,iv7 section #aica2 & 7ii7 at ! option ( ! ,/ate1 any individual :o1 = su* ye>1 ! ,/ate w\ld o!rwise provide *ild heal? assi/ance to "u ! ,/ate *ild heal? plan "u title ,,xxi2 & 7iii7 at ! option ( ! ,/ate1 any individual :o is n describ$ 9 clause 7i7 or 7ii7 & :o satisfies su* income1 res\rces1 heal? /atus1 or o!r crit]ia z ! ,/ate may e/abli%4 7,c7 ,m$ical assi/ance ,! t]m m$ical assi/ance means-- 7i7 heal? c>e cov]age 7z det]m9$ by ! ,/ate72 & 7ii7 rehabilitation & o!r s]vices to help eligible individuals atta9 or reta9 capability = indep5d5ce or self-c>e1 su* z home & community-bas$ s]vices4 7,d7 ,/ate ,m$icaid program ,! t]m ,/ate ,m$icaid program means ! ,/ate program = m$ical assi/ance provid$ "u a ,/ate plan "u title ,,xix1 includ+ any waiv] t has be5 approv$ ) respect to a ,/ate plan prior to an application by ! ,/ate = a compreh5sive ,m$icaid waiv] "u ?is subsection4 4 #aajb4 ,phas$-9 elim9ation ( all[able provid] taxes "u ,m$icaid 7a7 ,9 g5]al ,clause 7ii7 ( section #aijc7w77#d77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7w77#d77;,c77 is am5d$ to read z foll[s3 7ii7 ,= purposes ( clause 7i71 a det]m9ation ( ! exi/5ce ( an indirect gu>antee %all be made "u p>agraph 7#c77;i7 ( section #dcc4fh7;f7 ( title #db1 ,code ( ,f$]al ,regulations1 z 9 effect on ,novemb] #a1 #bjjf1 except t-- 7,i7 = portions ( fiscal ye>s beg9n+ on or aft] ,janu>y #a1 #bjjh1 & be=e ,octob] #a1 #bjaa1 #e4e p]c5t %all be sub/itut$ = #f p]c5t ea* place x appe>s2 7,,ii7 = fiscal ye>s #bjab & #bjac1 ! p]c5tage specifi$ "u su* p>agraph %all apply2 7,,iii7 = fiscal ye>s #bjad ?r\gh #bjbb1 ! p]c5tage det]m9$ "u clause 7iii7 = ! fiscal ye> %all be sub/itut$ = #f p]c5t ea* place x appe>s2 & 7,,iv7 = fiscal ye> #bjbc & ea* fiscal ye> !reaft]1 #j p]c5t %all be sub/itut$ = #f p]c5t ea* place x appe>s4 7iii7 ,= purposes ( clause 7ii77,,iii71 ! p]c5tage det]m9$ "u ?is clause %all be equal to ! p]c5tage applicable "u subclause 7,,ii7 or 7,,iii7 ( clause 7ii7 = ! prec$+ fiscal ye>1 r$uc$ by #j4f p]c5tage po9ts4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ,octob] #a1 #bjac4 ,,ii ,m$ic>e ,a ,m$ic>e ,total ,heal? program2 ,m$ic>e ,fee-=-,s]vice program re=ms2 ,reports #bjjj4 ,%ort title2 purpose 7a7 ,%ort title ,?is subtitle may be cit$ z ! ,m$ic>e ,total ,heal? ,act ( #bjac4 7b7 ,purpose ,! purpose ( ?is subtitle is to am5d title ,,xviii ( ! ,social ,security ,act to improve ! su/a9ability ( ! ,m$ic>e program by e/abli%+ a ,total ,heal? sy/em1 re=m+ ! ,m$ic>e fee-=-s]vice program1 & = o!r purposes4 ,i ,m$ic>e ,total ,heal? program #bjja4 ,e/abli%m5t ( ,m$ic>e ,total ,heal? program 7a7 ,sunset ( ,m$ic>e ,advantage plans ,section #ahea7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;a77#a771 9 ! matt] prec$+ subp>agraph 7,a71 is am5d$ by /rik+ ,subject to & ins]t+ ,= plan ye>s beg9n+ prior to ,janu>y #a1 #bjag1 & subject to4 7b7 ,e/abli%m5t ,"p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 is am5d$-- 7#a7 9 ! "p head+1 by /rik+ ,m$ic>e,*oice program & ins]t+ ,m$ic>e ,advantage program2 ,m$ic>e ,total ,heal? ,program2 7#b7 by ins]t+ be=e section #ahea ! foll[+3 #a ,m$ic>e ,advantage program 2 & 7#c7 by add+ at ! end ! foll[+ new subp>t3 #b ,m$ic>e ,total ,heal? program #ahfj;,c-#a4 ,eligibility1 enrollm5t1 & in=mation 7a7 ,eligibility 7#a7 ,9 g5]al ,not)/&+ section #ahea7;a77#a7 & subject to ! succe$+ provisions ( ?is subp>t1 ea* ,total ,heal? eligible individual 7z def9$ 9 p>agraph 7#c77 may elect to receive b5efits "u ?is title-- 7,a7 ?r\gh ! orig9al m$ic>e fee-=-s]vice program "u p>ts ,a & ,b1 includ+ ! option to elect qualifi$ prescription drug cov]age 9 accordance ) section #ahfj;,d-#a2 or 7,b7 ?r\gh enrollm5t 9 a ,total ,heal? plan "u ?is subp>t4 7#b7 ,cov]age fir/ effective ,janu>y #a1 #bjag ,cov]age "u ! ,m$ic>e ,total ,heal? program %all fir/ be effective on ,janu>y #a1 #bjag4 7#c7 ,total heal? eligible individual ,= purposes ( ?is subp>t1 ! t]m ,total ,heal? eligible individual means an individual :o is entitl$ to b5efits "u "p ,a & enroll$ "u "p ,b :o resides 9 a ,total ,heal? region4 7#d7 ,types ( total heal? plans t may be available ,a ,total ,heal? plan may be any ( ! types ( plans ( heal? insurance describ$ 9 section #ahea7;a77#b77;,a71 includ+ a plan = special ne$s individuals describ$ 9 clause 7ii7 ( su* section4 7b7 ,enrollm5t process = ,total ,heal? plans 7#a7 ,e/abli%m5t ( process 7,a7 ,9 g5]al ,! ,secret>y %all e/abli% a process = ! enrollm5t1 dis5rollm5t1 t]m9ation1 & *ange ( enrollm5t ( ,total ,heal? eligible individuals 9 ,total ,heal? plans 9 a mann] simil> to 7& coord9at$ )7 ! process e/abli%$ "u section #ahfj;,d-#a7;b77#a74 7,b7 ,requirem5ts ,except z o!rwise provid$ 9 ?is subsection1 ! process e/abli%$ "u subp>agraph 7,a7 %all include a resid5cy requirem5t simil> to ! resid5cy requirem5t describ$ 9 section #ahea7;b77#a7 & %all take into acc\nt ! process = ex]cis+ *oice describ$ 9 section #ahea7;c74 7#b7 ,initial enrollm5t p]iod 7,a7 ,program initiation ,9 ! case ( an individual :o is a ,total ,heal? eligible individual z ( ,novemb] #ae1 #bjaf1 !re %all be an initial enrollm5t p]iod beg9n+ on ,octob] #ae1 #bjaf1 & end+ on ,decemb] #g1 #bjaf4 7,b7 ,cont9u+ p]iods ,9 ! case ( an individual :o fir/ becomes a ,total ,heal? eligible individual aft] ,novemb] #ae1 #bjaf1 !re %all be an initial enrollm5t p]iod :i* is ! same z ! p]iod "u section #ahea7;e77#a74 7#c7 ,annual1 coord9at$ election p]iod 7,a7 ,9 g5]al ,z "p ( ! process e/abli%$ "u p>agraph 7#a71 ea* individual :o is eligible to make an election "u ?is section may *ange su* election dur+ an annual1 coord9at$ election p]iod4 7,b7 ,annual1 coord9at$ election p]iod ,= purposes ( ?is section1 ! t]m annual1 coord9at$ election p]iod means1 ) respect to #bjag & succe$+ ye>s1 ! p]iod beg9n+ on ,octob] #ae & end+ on ,decemb] #g ( ! ye> be=e su* ye>4 7#d7 ,special enrollm5t p]iods ,! ,secret>y %all e/abli% special enrollm5t p]iods t are simil> to ! special enrollm5t p]iods e/abli%$ "u section #ahea7;e77#d74 7#e7 ,special rule 7,a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 ! process e/abli%$ "u p>agraph 7#a7 %all include1 9 ! case ( a ,total ,heal? eligible individual :o has fail$ to enroll 9 ei!r ! orig9al m$ic>e fee-=-s]vice program option or a ,total ,heal? plan prior to ! beg9n+ ( a plan ye> 7includ+ a full-b5efit dual eligible individual 7z def9$ 9 section #aice7;c77#f7771 = ! enrollm5t 9 a ,total ,heal? plan ) a mon?ly b5efici>y premium "u section #ahfj;,c-#g7;a7 7tak+ into acc\nt any adju/m5t "u subp>agraph 7,b7 or 7,c7 ( section #ahfj;,c-#g7;a77#b7 & )\t reg>d to any adju/m5t "u subp>agraph 7,d7 or 7,e7 ( su* section7 t does n exce$ ! base b5efici>y premium comput$ "u section #ahfj;,c-#g7;a77#a74 7,b7 ,selection ( plan by ! secret>y ,9 select+ a plan = ! enrollm5t ( a ,total ,heal? eligible individual "u subp>agraph 7,a71 ! ,secret>y %all fir/ attempt to id5tify ! ,total ,heal? plan 9 :i* ! co/-%>+ & heal? b5efits are mo/ simil> to ! cov]age ! individual _h 9 ! prec$+ plan ye>4 ,if !re is m ?an "o su* plan available1 ! ,secret>y %all enroll su* an individual on a r&om basis among all su* plans 9 ! ,total ,heal? region4 ,no?+ 9 ! previ\s s5t5ce %all prev5t su* an individual f decl9+ or *ang+ su* enrollm5t4 7,c7 ,individuals :o are n total heal? eligible individuals ,! ,secret>y %all e/abli% proc$ures "u :i* individuals :o are entitl$ to1 or enroll$ =1 cov]age "u "p ,a or enroll$ = cov]age "u "p ,b 7b n bo?71 may cont9ue to receive b5efits ) d$uctible & co9surance am\nts comp>able to ! b5efits1 d$uctible1 & co9surance am\nts !y w\ld h receiv$ if ?is subp>t _h n be5 enact$4 7c7 ,provid+ in=mation to b5efici>ies 7#a7 ,9 g5]al ,! ,secret>y %all conduct activities t are design$ to broadly dissem9ate in=mation to ,total ,heal? eligible individuals 7& prospective ,total ,heal? eligible individuals7 reg>d+ ! cov]age provid$ "u ?is subp>t4 ,su* activities %all ensure t su* in=mation is fir/ made available at lea/ #cj days prior to ! initial enrollm5t p]iod describ$ 9 subsection 7b77#b77;,a74 7#b7 ,activities ,! activities conduct$ "u p>agraph 7#a7 %all be simil> to ! activities describ$ 9 p>agraph 7#b7 ( section #ahfj;,d-#a7;c7 & conta9 comp>ative in=mation simil> to ! in=mation describ$ 9 p>agraph 7#c7 ( su* section4 #ahfj;,c-#b4 ,total ,heal? plan b5efits 7a7 ,requirem5ts 7#a7 ,qualifi$ total heal? b5efits ,ea* ,total ,heal? plan %all provide to individuals enroll$ "u ?is subp>t1 ?r\gh provid]s & o!r p]sons t meet ! applicable requirem5ts ( ?is title & "p ,a ( title ,,xi1 a qualifi$ ,total ,heal? b5efits package & qualifi$ prescription drug cov]age 7describ$ 9 section #ahfj;,d-#b7;a774 7#b7 ,def9ition ( qualifi$ total heal? b5efits package ,= purposes ( ?is subp>t1 ! t]m qualifi$ ,total ,heal? b5efits package means ei!r ( ! foll[+3 7,a7 ,/&>d heal? b5efits cov]age ) access to negotiat$ prices ,/&>d heal? b5efits cov]age 7z def9$ 9 subsection 7b77 & access to negotiat$ prices "u subsection 7d74 7,b7 ,alt]native total heal? b5efits cov]age ) at lea/ actu>ially equival5t b5efits & access to negotiat$ prices ,cov]age ( heal? b5efits :i* meets ! alt]native heal? b5efits cov]age requirem5ts "u subsection 7c7 & access to negotiat$ prices "u subsection 7d71 b only if ! b5efit design ( su* cov]age is approv$ by ! ,secret>y1 z provid$ "u subsection 7c74 7#c7 ,p]mitt+ supplem5tal heal? b5efits cov]age 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 a qualifi$ ,total ,heal? b5efits package may include supplem5tal heal? b5efits cov]age consi/+ ( ei!r or bo? ( ! foll[+3 7i7 ,c]ta9 r$uctions 9 co/-%>+ 7,i7 ,9 g5]al ,a r$uction 9 ! annual d$uctible or a r$uction 9 ! co9surance p]c5tage1 or any comb9ation !re(1 ins(> z su* a r$uction or increase increases ! actu>ial value ( b5efits above ! actu>ial value ( a basic ,total ,heal? b5efits package4 7,,ii7 ,con/ruction ,no?+ 9 ?is clause %all be con/ru$ z affect+ ! application ( subsection 7c77#c74 7ii7 ,additional b5efits ,cov]age ( any heal? c>e item or s]vice t is n cov]$ "u ! orig9al m$ic>e fee-=-s]vice program option or t is eligible = cov]age "u "p ,d1 subject to ! approval ( ! ,secret>y4 7,b7 ,requirem5t = at lea/ "o basic b5efits plan ,a ,total ,heal? sponsor may n (f] a ,total ,heal? plan t provides supplem5tal heal? b5efits cov]age pursuant to subp>agraph 7,a7 9 an area unless ! sponsor also (f]s a ,total ,heal? plan 9 ! area t only provides a basic ,total ,heal? b5efits package4 7#d7 ,basic total heal? b5efits package ,= purposes ( ?is subp>t1 ! t]m basic ,total ,heal? b5efits package means ei!r ( ! foll[+3 7,a7 ,cov]age t meets ! requirem5ts ( p>agraph 7#b77;,a74 7,b7 ,cov]age t meets ! requirem5ts ( p>agraph 7#b77;,b7 b does n h any supplem5tal heal? b5efits cov]age describ$ 9 p>agraph 7#c77;,a74 7#e7 ,application ( second>y pay] provisions ,! provisions ( section #aheb7;a77#d7 %all apply "u ?is subp>t 9 ! same mann] z su* provisions appli$ to a ,m$ic>e ,advantage plan4 7#f7 ,con/ruction ,no?+ 9 ?is subsection %all be con/ru$ z *ang+ ! computation ( incurr$ co/s "u subsection 7b77#c74 7b7 ,/&>d heal? b5efits cov]age ,= purposes ( ?is subp>t1 ! t]m /&>d heal? b5efits cov]age means cov]age ( b5efits "u ! orig9al m$ic>e fee-=-s]vice program option 7z def9$ 9 section #aheb7;a77#a77;,b771 includ+ ! foll[+ requirem5ts3 7#a7 ,d$uctible ,! cov]age has an annual d$uctible t is equal to ! am\nt ( ! unifi$ d$uctible = ! ye> "u section #ahii;,c4 7#b7 #bj p]c5t co9surance ,! cov]age has co9surance 7= co/s above ! annual d$uctible specifi$ 9 p>agraph 7#a7 & up to ! fir/ ?re%old annual out-(-pocket limit specifi$ 9 p>agraph 7#c77;,b77i77 t is-- 7,a7 equal to #bj p]c5t2 or 7,b7 actu>ially equival5t 7us+ processes & me?ods e/abli%$ by ! ,secret>y7 to an av]age expect$ paym5t ( #bj p]c5t ( su* co/s4 7#c7 ,protection aga9/ high out-(-pocket exp5ditures 7,a7 ,9 g5]al ,! cov]age provides b5efits1 aft] ! ,total ,heal? eligible individual has incurr$ co/s 7z describ$ 9 subp>agraph 7,c77 = heal? b5efits 9 a ye> equal to-- 7i7 ! fir/ ?re%old annual out-(-pocket limit specifi$ 9 subp>agraph 7,b77i7 = t ye> b less ?an ! second ?re%old annual out-(-pocket limit specifi$ 9 subp>agraph 7,b77ii7 = t ye>1 ) co9surance t is equal to #e p]c5t2 & 7ii7 ! second ?re%old annual out-(-pocket limit specifi$ 9 subp>agraph 7,b77ii7 = t ye>1 )\t co9surance4 7,b7 ,annual out-(-pocket limits specifi$ ,= purposes ( ?is subp>t3 7i7 ,fir/ ?re%old annual out-(-pocket limit specifi$ ,! fir/ ?re%old annual out-(-pocket limit specifi$ 9 ?is clause is equal to ! fir/ ?re%old annual out-(-pocket limit = ! ye> specifi$ 9 section #ahii;,b7b77#a74 7ii7 ,second ?re%old annual out-(-pocket limit specifi$ ,! second ?re%old annual out-(-pocket limit specifi$ 9 ?is clause is equal to ! second ?re%old annual out-(-pocket limit = ! ye> specifi$ 9 section #ahii;,b7b77#b74 7,c7 ,application ,9 apply+ subp>agraph 7,a71 incurr$ co/s %all only include co/s incurr$ ) respect to heal? b5efits = ! annual d$uctible describ$ 9 p>agraph 7#a7 & = co/-%>+ describ$ 9 p>agraph 7#b7 or p>agraph 7#c77;,a77i71 or = b5efits t w\ld h o!rwise be5 cov]$ "u ! plan b = ! exhau/ion ( ^? b5efits4 ,incurr$ co/s d n include any co/s incurr$ = heal? b5efits :i* are n includ$ 7or treat$ z be+ includ$7 "u ! plan4 7c7 ,alt]native total heal? b5efits cov]age requirem5ts ,a ,total ,heal? plan may provide a diff]5t b5efit design f /&>d heal? b5efits cov]age s long z ! ,secret>y det]m9es t ! foll[+ requirem5ts are met & ! plan applies =1 & receives1 ! approval ( ! ,secret>y = su* b5efit design3 7#a7 ,assur+ at lea/ actu>ially equival5t cov]age 7,a7 ,assur+ equival5t value ( total cov]age ,! actu>ial value ( ! total cov]age is at lea/ equal to ! actu>ial value ( /&>d heal? b5efits cov]age4 7,b7 ,assur+ equival5t unsubsidiz$ value ( cov]age ,! unsubsidiz$ value ( ! cov]age is at lea/ equal to ! unsubsidiz$ value ( /&>d heal? b5efits cov]age4 ,= purposes ( ?is subp>agraph1 ! unsubsidiz$ value ( cov]age is ! am\nt by :i* ! actu>ial value ( ! cov]age exce$s ! subsidy paym5ts ) respect to su* cov]age4 7,c7 ,assur+ /&>d paym5t = co/s bel[ fir/ ?re%old annual out-(-pocket limit ,! cov]age is design$1 bas$ ^u an actu>ially repres5tative patt]n ( utilization1 to provide = ! paym5t1 ) respect to co/s incurr$ up to ! fir/ ?re%old annual out-(-pocket limit specifi$ 9 subsection 7b77#c77;,b77i71 ( an am\nt equal to at lea/ ! product (-- 7i7 ! am\nt by :i* ! co/s incurr$ exce$ ! d$uctible describ$ 9 subsection 7b77#a7 = ! ye>2 & 7ii7 #ajj p]c5t m9us ! co9surance p]c5tage specifi$ 9 subsection 7b77#b74 7#b7 ,approval ( b5efit package ,! b5efit package is approv$ by ! ,secret>y z conta9+ a comp>able range ( b5efits to /&>d heal? b5efits cov]age & meets su* o!r requirem5ts ( ?is subp>t z ! ,secret>y may specify4 7#c7 ,maximum requir$ d$uctible ,! d$uctible "u ! cov]age %all n exce$ ! d$uctible am\nt specifi$ "u subsection 7b77#a7 = ! ye>4 7#d7 ,same protection aga9/ high out-(-pocket exp5ditures ,! cov]age provides ! cov]age requir$ "u subsection 7b77#c74 7d7 ,access to negotiat$ prices 7#a7 ,access 7,a7 ,9 g5]al ,"u a qualifi$ ,total ,heal? b5efits package (f]$ by a ,total ,heal? sponsor (f]+ a ,total ,heal? plan1 ! sponsor %all provide enrollees ) access to negotiat$ prices us$ = paym5t = cov]$ heal? b5efits1 reg>dless ( ! fact t no b5efits may be payable "u ! cov]age ) respect to su* b5efits because ( ! application ( a d$uctible or o!r co/-%>+4 7,b7 ,negotiat$ prices ,= purposes ( ?is subp>t1 negotiat$ prices %all take into acc\nt negotiat$ price concessions1 su* z disc\nts1 direct or indirect subsidies1 rebates1 & direct or indirect remun]ations1 = cov]$ heal? b5efits4 7#b7 ,audits ,to protect aga9/ fraud & abuse & to ensure prop] disclosures & acc\nt+ "u ?is "p & 9 accordance ) section #aheg7;d77#b77;,b71 ! ,secret>y may conduct p]iodic audits1 directly or ?r\gh contracts1 ( ! f9ancial /atem5ts & records ( ,total ,heal? sponsors ) respect to ,total ,heal? ,plans4 7#c7 ,application ( g5]al exclusion provisions 7,a7 ,9 g5]al ,a ,total ,heal? plan may exclude f a qualifi$ ,total ,heal? b5efits package any heal? c>e item or s]vice-- 7i7 = :i* paym5t w\ld n be made if section #ahfb7;a7 appli$ to ?is subp>t2 or 7ii7 :i* is n prescrib$ 9 accordance ) ! ,total ,heal? plan or ?is subp>t4 7,b7 ,reconsid]ation & appeal ,any exclusion "u subp>agraph 7,a7 is a det]m9ation subject to reconsid]ation & appeal "u ?is subp>t4 7e7 ,satisfaction ( requirem5ts ,a ,total ,heal? plan satisfies ! requirem5ts ( subsection 7a7 9 ! same way a ,m$ic>e ,advantage plan satisfi$ ! requirem5ts ( section #aheb7;a77#b74 #ahfj;,c-#c4 ,access to a *oice ( qualifi$ ,total ,heal? b5efits plans 7a7 ,assur+ access to a *oice ( plans 7#a7 ,*oice ( at lea/ two plans 9 ea* area ,! ,secret>y %all ensure t ea* ,total ,heal? eligible individual has available1 consi/5t ) p>agraph 7#b71 a *oice ( enrollm5t 9 at lea/ #b ,total ,heal? plans 9 ! area 9 :i* ! individual resides4 7#b7 ,requirem5t = diff]5t plan sponsors ,! requirem5t 9 p>agraph 7#a7 is n satisfi$ ) respect to an area if only "o entity (f]s all ( ! qualify+ plans 9 ! area4 7b7 ,flexibility 9 risk assum$ ,9 ord] to ensure access pursuant to subsection 7a7 9 an area ! ,secret>y may approve limit$ risk plans "u section #ahfj;,c-#e7;g7 = ! area4 #ahfj;,c-#d4 ,b5efici>y protections = ,total ,heal? plan enrollees 7a7 ,dissem9ation ( in=mation 7#a7 ,g5]al in=mation ,a ,total ,heal? sponsor %all disclose1 9 a cle>1 accurate1 & /&>diz$ =m to ea* enrollee ) a ,total ,heal? plan (f]$ by ! sponsor "u ?is subp>t at ! "t ( enrollm5t & at lea/ annually !reaft]1 ! in=mation describ$ 9 section #aheb7;c77#a7 relat+ to su* plan1 ins(> z ! ,secret>y det]m9es appropriate ) respect to b5efits provid$ "u ?is subp>t1 & includ+ ! in=mation describ$ 9 section #ahfj;,d-#d relat+ to qualifi$ prescription drug cov]age "u ! plan4 7#b7 ,disclosure ^u reque/ ( g5]al cov]age1 utilization1 & grievance in=mation ,^u reque/ ( a ,total ,heal? eligible individual :o is eligible to enroll 9 a ,total ,heal? plan1 ! ,total ,heal? sponsor (f]+ su* plan %all provide in=mation simil> 7z det]m9$ by ! ,secret>y7 to ! in=mation describ$ 9 section #aheb7;c77#b7 to su* individual4 7#c7 ,provision ( specific in=mation ,ea* ,total ,heal? sponsor (f]+ a ,total ,heal? plan %all h a me*anism = provid+ specific in=mation on a timely basis to enrollees ^u reque/4 ,su* me*anism %all include access to in=mation ?r\gh ! use ( a toll-free telephone numb] &1 ^u reque/1 ! provision ( su* in=mation 9 writ+4 7#d7 ,claims in=mation 7,a7 ,9 g5]al ,a ,total ,heal? sponsor (f]+ a ,total ,heal? plan mu/ furni% to ea* enrollee 9 a =m easily und]/&able to su* enrollees-- 7i7 an explanation ( b5efits 79 accordance ) section #ahjf7;a7 or 9 a comp>able mann]72 & 7ii7 :5 ,total ,heal? b5efits are provid$ "u ?is subp>t1 a notice ( ! b5efits 9 relation to-- 7,i7 ! d$uctible describ$ 9 p>agraph 7#a7 ( section #ahfj;,c-#b7;b7 = ! curr5t ye>2 & 7,,ii7 ! annual out-(-pocket limits "u p>agraph 7#c7 ( su* section = ! curr5t ye>4 7,b7 ,tim+ ( notices ,notices "u subp>agraph 7,a77ii7 ne$ n be provid$ m (t5 ?an z specifi$ by ! ,secret>y4 7b7 ,access to heal? c>e provid]s 7#a7 ,assur+ provid] access 7,a7 ,disc\nts all[$ = network provid]s ,= heal? b5efits furni%$ ?r\gh 9-network provid]s1 a ,total ,heal? plan may r$uce co9surance or copaym5ts = ,total ,heal? eligible individuals enroll$ 9 ! plan bel[ ! level o!rwise requir$4 ,9 no case %all su* a r$uction result 9 an increase 9 paym5ts made by ! ,secret>y "u section #ahfj;,c-#h to ! ,total ,heal? sponsor ( ! plan4 7,b7 ,conv5i5t access = network provid]s 7i7 ,9 g5]al ,! ,total ,heal? sponsor ( ! ,total ,heal? plan %all secure ! p>ticipation 9 its network ( a suffici5t numb] ( heal? c>e provid]s t furni% heal? c>e items & s]vices "u ! plan directly to pati5ts to ensure conv5i5t access 7consi/5t ) rules e/abli%$ by ! ,secret>y74 7ii7 ,adequate em]g5cy access ,su* rules %all include adequate em]g5cy access = enrollees4 7,c7 ,level play+ field ,su* a sponsor %all p]mit enrollees to receive b5efits ?r\gh any heal? c>e provid] p>ticipat+ 9 ! program "u ?is title ) any diff]5tial 9 *>ge paid by su* enrollees4 7#b7 ,use ( /&>diz$ te*nology 7,a7 ,9 g5]al ,! ,total ,heal? sponsor ( a ,total ,heal? plan %all issue 7& reissue1 z appropriate7 su* a c>d 7or o!r te*nology7 t may be us$ by an enrollee to assure access to heal? b5efits "u ?is subp>t4 7,b7 ,/&>ds 7i7 ,9 g5]al ,! ,secret>y %all provide = ! developm5t1 adoption1 or recognition ( /&>ds relat+ to a /&>diz$ =mat = ! c>d or o!r te*nology requir$ "u subp>agraph 7,a74 ,su* /&>ds %all be compatible ) "p ,c ( title ,,xi & may be bas$ on /&>ds develop$ by an appropriate /&>d sett+ organization4 7ii7 ,consultation ,9 develop+ ! /&>ds "u clause 7i71 ! ,secret>y %all consult ) /&>d sett+ organizations det]m9$ appropriate by ! ,secret>y4 7iii7 ,implem5tation ,! ,secret>y %all develop1 adopt1 or recognize ! /&>ds "u clause 7i7 by su* date z ! ,secret>y det]m9es %all be suffici5t to ensure t ,total ,heal? sponsors utilize su* /&>ds beg9n+ ,janu>y #a1 #bjag4 7c7 ,co/ & utilization managem5t2 quality assurance2 wellness program 7#a7 ,9 g5]al ,! ,total ,heal? sponsor %all h 9 place1 directly or ?r\gh appropriate arrangem5ts1 ! foll[+3 7,a7 ,a co/-effective heal? b5efits managem5t program1 includ+ inc5tives to r$uce co/s :5 m$ically appropriate4 7,b7 ,quality assurance measures & sy/ems to r$uce errors & improve ! use ( heal? b5efits4 7,c7 ,a wellness program describ$ 9 p>agraph 7#b74 7,d7 ,a program to control fraud1 abuse1 & wa/e4 ,no?+ 9 ?is section %all be con/ru$ z impair+ a ,total ,heal? sponsor f utiliz+ co/ managem5t tools 7includ+ diff]5tial paym5ts7 "u all me?ods ( op]ation4 7#b7 ,wellness program 7,a7 ,description ,a wellness program describ$ 9 ?is p>agraph is a program focus$ on heal? improvem5t1 disease prev5tion1 & managem5t ( *ronic conditions = ,total ,heal? eligible individuals enroll$ 9 a plan "u ?is "p to optimize heal? outcomes ?r\gh improv$ use ( heal? c>e items & s]vices & to r$uce ! risk ( adv]se ev5ts4 7,b7 ,elem5ts ,su* program may include elem5ts t promote-- 7i7 enhanc$ enrollee und]/&+ to promote ! appropriate use ( heal? c>e items & s]vices by enrollees & to r$uce ! risk ( pot5tial adv]se ev5ts & to improve heal? outcomes ?r\gh b5efici>y education1 c\nsel+1 & o!r appropriate means2 7ii7 increas$ enrollee adh]5ce ) recomm5d$ regim5s ?r\gh compliance programs & o!r appropriate means2 & 7iii7 detection ( adv]se ev5ts & patt]ns ( ov]use & und]use ( heal? c>e items & s]vices4 7,c7 ,assessm5t ,! ,total ,heal? sponsor %all h 9 place a process to assess1 at lea/ on a qu>t]ly basis1 ! heal? b5efits use ( individuals :o are n enroll$ 9 ! wellness program4 7,d7 ,wellness program enrollm5t ,! ,total ,heal? sponsor %all h 9 place a process to-- 7i7 subject to clause 7ii71 automatically enroll plan enrollees 9 ! wellness program requir$ "u ?is subsection2 & 7ii7 p]mit plan enrolles to opt-out ( enrollm5t 9 ! wellness program4 7,e7 ,developm5t ( program 9 coop]ation ) physicians ,su* program %all be develop$ 9 coop]ation ) physicians4 7,f7 ,coord9ation ) c>e managem5t plans ,! ,secret>y %all e/abli% guidel9es = ! coord9ation ( any wellness program "u ?is p>agraph ) respect to a t>get$ b5efici>y describ$ 9 section #ahfj;,d-#d7;c77#b77;,a77i7 7appli$ by sub/itut+ ,total ,heal? eligible individual = "p ,d eligible individual7 ) any c>e managem5t plan e/abli%$ ) respect to su* b5efici>y "u a *ronic c>e improvem5t program "u section #ahjg4 7,g7 ,consid]ations 9 provid] fees ,! ,total ,heal? sponsor ( a ,total ,heal? plan %all take into acc\nt1 9 e/abli%+ fees = entities provid+ s]vices "u su* plan1 ! res\rces us$1 & "t requir$ to1 implem5t ! wellness program "u ?is p>agraph4 ,ea* su* sponsor %all disclose to ! ,secret>y ^u reque/ ! am\nt ( any su* fees4 7d7 ,consum] satisfaction surveys ,9 ord] to provide = comp>ative in=mation "u section #ahfj;,c-#a7;c71 ! ,secret>y %all conduct consum] satisfaction surveys ) respect to ,total ,heal? sponsors & ,total ,heal? plans 9 a mann] simil> to ! mann] su* surveys 7 conduct$ = ,,ma organizations & ,,ma plans "u subp>t #a4 7e7 ,grievance me*anism ,ea* ,total ,heal? sponsor %all provide mean+ful proc$ures = he>+ & resolv+ grievances betwe5 ! sponsor 7includ+ any entity or individual ?r\gh :i* ! sponsor provides cov]$ b5efits7 & enrollees ) ,total ,heal? plans ( ! sponsor "u ?is "p 9 accordance ) section #aheb7;f74 7f7 ,cov]age det]m9ations & reconsid]ations ,a ,total ,heal? sponsor %all meet ! requirem5ts ( p>agraphs 7#a7 ?r\gh 7#c7 ( section #aheb7;g7 ) respect to cov]$ b5efits "u ! ,total ,heal? plan (f]$ by ! sponsor "u ?is subp>t 9 ! same mann] z su* requirem5ts appli$ to an ,,ma organization ) respect to cov]$ b5efits "u an ,,ma plan (f]$ by ! organization "u subp>t #a4 7g7 ,appeals ,a ,total ,heal? sponsor %all meet ! requirem5ts ( p>agraphs 7#d7 & 7#e7 ( section #aheb7;g7 ) respect to b5efits 9 a mann] simil> 7z det]m9$ by ! ,secret>y7 to ! mann] su* requirem5ts appli$ to an ,,ma organization ) respect to b5efits "u ! orig9al m$ic>e fee-=-s]vice program option "u an ,,ma plan4 ,9 apply+ ?is subsection1 only ! ,total ,heal? eligible individual %all be entitl$ to br+ su* an appeal4 7h7 ,privacy1 confid5tiality1 & accuracy ( enrollee records ,! provisions ( section #aheb7;h7 %all apply to a ,total ,heal? sponsor & ,total ,heal? plan 9 ! same mann] z su* provisions appli$ to an ,,ma organization & an ,,ma plan4 7i7 ,treatm5t ( accr$itation ,subp>agraph 7,a7 ( section #aheb7;e77#d7 7relat+ to treatm5t ( accr$itation7 %all apply to a ,total ,heal? sponsor "u ?is "p 9 ! same mann] z su* subp>agraph appli$ to an ,,ma organization4 7j7 ,requirem5ts ) respect to sales & m>ket+ activities ,! foll[+ provisions %all apply to a ,total ,heal? sponsor 7& ! ag5ts1 brok]s1 & o!r ?ird p>ties repres5t+ su* sponsor7 9 ! same mann] z su* provisions appli$ to a ,m$ic>e ,advantage organization 7& ! ag5ts1 brok]s1 & o!r ?ird p>ties repres5t+ su* organization73 7#a7 ,! prohibition "u section #ahea7;h77#d77;,c7 on conduct+ activities describ$ 9 section #ahea7;j77#a74 7#b7 ,! requirem5t "u section #ahea7;h77#d77;,d7 to conduct activities describ$ 9 p>agraph 7#b7 ( section #ahea7;j7 9 accordance ) ! limitations e/abli%$ "u su* section4 7#c7 ,! inclusion ( ! plan type 9 ! plan "n "u section #ahea7;h77#f74 7#d7 ,! requirem5ts reg>d+ ! appo9tm5t ( ag5ts & brok]s & compliance ) ,/ate in=mation reque/s "u subp>agraphs 7,a7 & 7,b71 respectively1 ( section #ahea7;h77#g74 #ahfj;,c-#e4 ,total ,heal? regions2 submission ( bids2 ,total ,heal? plan approval 7a7 ,e/abli%m5t ( total heal? regions2 s]vice areas 7#a7 ,cov]age ( entire total heal? region 7,a7 ,9 g5]al ,! s]vice area = a ,total ,heal? plan %all consi/ ( an entire ,total ,heal? region e/abli%$ "u p>agraph 7#b74 7,b7 ,no use ( segm5ts ( s]vice areas ,9 no case may a ,total ,heal? plan s]ve only segm5ts ( ! s]vice area4 7#b7 ,e/abli%m5t ( total heal? regions 7,a7 ,9 g5]al ,! ,secret>y %all e/abli%1 & may revise1 ,total ,heal? regions 9 accordance ) ! requirem5ts ( ?is p>agraph4 7,b7 ,regions to be l>g] ?an a s+le c\nty ,total ,heal? regions %all include m ?an "o c\nty4 7,c7 ,regions )9 msas ,among c\nties 9 a metropolitan /ati/ical area1 a ,total ,heal? region %all include all ( ! c\nties locat$ 9 ! same ,/ate 9 t metropolitan /ati/ical area4 7,d7 ,regions outside msas ,among c\nties outside a metropolitan /ati/ical area1 a ,total ,heal? region %all include all ( ! c\nties 9 ! same ,/ate t ! ,secret>y det]m9es are accurate reflections ( heal? c>e m>ket areas1 su* z heal? s]vice areas4 7,e7 ,au?ority = t]ritories ,! ,secret>y %all e/abli%1 & may revise1 ,total ,heal? regions = areas 9 ,/ates t are n )9 ! #ej ,/ates or ! ,di/rict ( ,columbia4 7#c7 ,national plan ,no?+ 9 ?is subsection %all be con/ru$ z prev5t+ a ,total ,heal? plan f be+ (f]$ 9 m ?an "o ,total ,heal? region 7includ+ all ,total ,heal? regions74 7b7 ,submission ( bids1 premiums1 & relat$ in=mation 7#a7 ,9 g5]al ,a ,total ,heal? sponsor %all submit to ! ,secret>y in=mation describ$ 9 p>agraph 7#b7 ) respect to ea* ,total ,heal? plan x (f]s4 ,su* in=mation %all be submitt$ at ! same "t & 9 a simil> mann] to ! mann] 9 :i* in=mation describ$ 9 p>agraph 7#f7 ( section #ahed7;a7 0 submitt$ by an ,,ma organization "u p>agraph 7#a7 ( su* section4 7#b7 ,in=mation describ$ ,! in=mation describ$ 9 ?is p>agraph is in=mation on ! foll[+3 7,a7 ,b5efits package provid$ ,! qualifi$ ,total ,heal? b5efits package provid$ "u ! plan1 includ+ ! d$uctible & o!r co/-%>+4 7,b7 ,actu>ial value ,! actu>ial value ( ! qualifi$ ,total ,heal? b5efits package 9 ! ,total ,heal? region = a ,total ,heal? eligible individual ) a national av]age risk pr(ile = ! factors describ$ 9 section #ahfj;,c-#h7;b77#a77;,a7 7z specifi$ by ! ,secret>y74 7,c7 ,bid ,in=mation on ! bid1 includ+ an actu>ial c]tification (-- 7i7 ! basis = ! actu>ial value describ$ 9 subp>agraph 7,b7 assum$ 9 su* bid2 7ii7 ! portion ( su* bid attributable to a basic ,total ,heal? b5efits package &1 if applicable1 ! portion ( su* bid attributable to supplem5tal b5efits2 & 7iii7 adm9i/rative exp5ses assum$ 9 ! bid4 7,d7 ,s]vice area ,! s]vice area = ! plan 7z describ$ 9 subsection 7a77#a774 7,e7 ,level ( risk assum$ ,:e!r ! ,total ,heal? sponsor requires a modification ( risk level &1 if s1 ! ext5t ( su* modification4 ,any su* modification %all apply ) respect to all ,total ,heal? plans (f]$ by a ,total ,heal? sponsor 9 a ,total ,heal? region4 7,f7 ,additional in=mation ,su* o!r in=mation z ! ,secret>y may require to c>ry out ?is subp>t4 7#c7 ,pap]work r$uction = (f]+ ( total heal? plans nationally or 9 multi-region areas ,! ,secret>y %all e/abli% requirem5ts = ! submission ( in=mation "u ?is subsection 9 a mann] t promotes ! (f]+ ( su* plans 9 m ?an "o ,total ,heal? region 7includ+ all regions7 ?r\gh ! fil+ ( consolidat$ in=mation4 7c7 ,m$ic>e fee-=-,s]vice bid ,= purposes ( ?is subp>t1 ! bid = b5efits "u ! orig9al m$ic>e fee-=-s]vice program option 7z def9$ 9 section #aheb7;a77#a77;,b77 is ! doll> am\nt ( ! actu>ial valuation ( ! b5efits "u t option = ea* ,total ,heal? region 7z det]m9$ & submitt$ by ! ,*ief ,actu>y ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices us+ ! same processes us$ to value ,total ,heal? plans "u subsection 7d774 7d7 ,actu>ial valuation 7#a7 ,processes ,= purposes ( ?is subp>t1 ! ,secret>y %all e/abli% processes & me?ods = det]m9+ ! actu>ial valuation ( a ,total ,heal? b5efits package1 includ+-- 7,a7 an actu>ial valuation ( ! b5efits "u ! orig9al m$ic>e fee-=-s]vice program option 7z def9$ 9 section #aheb7;a77#a77;,b77 9 ea* s]vice area2 7,b7 actu>ial valuations relat+ to ! qualifi$ ,total ,heal? b5efits package "u section #ahfj;,c-#b7;a77#a72 7,c7 ! use ( g5]ally accept$ actu>ial pr9ciples & me?odologies2 & 7,d7 apply+ ! same me?odology = det]m9ations ( actu>ial valuations "u subp>agraphs 7,a7 & 7,b74 7#b7 ,acc\nt+ = utilization ,su* processes & me?ods = det]m9+ actu>ial valuation %all take into acc\nt ! effect t provid+ a qualifi$ ,total ,heal? b5efits package 7r ?an b5efits "u ! orig9al m$ic>e fee-=-s]vice program option7 has on ! utilization ( heal? c>e items & s]vices4 7#c7 ,responsibilities 7,a7 ,plan responsibilities ,total ,heal? sponsors are responsible = ! prep>ation & submission ( actu>ial valuations requir$ "u ?is subp>t = ! ,total ,heal? plans (f]$ by ! sponsor4 7,b7 ,use ( outside actu>ies ,"u ! processes & me?ods e/abli%$ "u p>agraph 7#a71 ,total ,heal? sponsors (f]+ a ,total ,heal? b5efits package may use actu>ial op9ions c]tifi$ by indep5d5t1 qualifi$ actu>ies to e/abli% actu>ial values4 7e7 ,review ( in=mation & negotiation 7#a7 ,review ( in=mation ,! ,secret>y %all review ! in=mation submitt$ "u subsection 7b7 = ! purpose ( conduct+ negotiations "u p>agraph 7#b74 7#b7 ,negotiation reg>d+ t]ms & conditions ,subject to subsection 7i71 9 ex]cis+ ! au?ority "u p>agraph 7#a71 ! ,secret>y-- 7,a7 has ! au?ority to negotiate ! t]ms & conditions ( ! propos$ bid submitt$ & o!r t]ms & conditions ( a propos$ plan2 & 7,b7 has au?ority simil> to ! au?ority ( ! ,director ( ! ,(fice ( ,p]sonnel ,managem5t ) respect to heal? b5efits plans "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code4 7#c7 ,rejection ( bids ,p>agraph 7#e77;,c7 ( section #ahed7;a7 %all apply ) respect to bids submitt$ by a ,total ,heal? sponsor "u subsection 7b7 9 ! same mann] z su* p>agraph appli$ to bids submitt$ by an ,,ma organization "u su* section #ahed7;a74 7f7 ,approval ( propos$ plans 7#a7 ,9 g5]al ,aft] review & negotiation "u subsection 7e71 ! ,secret>y %all approve or disapprove ! ,total ,heal? plan4 7#b7 ,requirem5ts = approval ,! ,secret>y may approve a ,total ,heal? plan only if ! ,secret>y det]m9es ! foll[+ requirem5ts are met3 7,a7 ,compliance ) requirem5ts ,! plan & ! ,total ,heal? sponsor (f]+ ! plan comply ) ! requirem5ts "u ?is subp>t1 includ+ ! provision ( a qualifi$ ,total ,heal? b5efits package4 7,b7 ,actu>ial det]m9ations ,! plan & ,total ,heal? sponsor (f]+ ! plan meet ! requirem5ts "u ?is subp>t relat+ to actu>ial det]m9ations1 includ+ su* requirem5ts "u section #ahfj;,c-#b7;c74 7,c7 ,application ( ,,fehbp /&>d 7i7 ,9 g5]al ,! portion ( ! bid submitt$ "u subsection 7b7 t is attributable to basic heal? b5efits cov]age is support$ by ! actu>ial bases provid$ "u su* subsection & reasonably & equitably reflects ! rev5ue requirem5ts 7z us$ = purposes ( section #acjb7h77;,c7 ( ! ,public ,heal? ,s]vice ,act7 = b5efits provid$ "u t plan4 7ii7 ,supplem5tal cov]age ,! portion ( ! bid submitt$ "u subsection 7b7 t is attributable to supplem5tal heal? b5efits cov]age pursuant to section #ahfj;,c-#b7;a77#c7 is support$ by ! actu>ial bases provid$ "u su* subsection & reasonably & equitably reflects ! rev5ue requirem5ts 7z us$ = purposes ( section #acjb7h77;,c7 ( ! ,public ,heal? ,s]vice ,act7 = su* cov]age "u ! plan4 7,d7 ,plan design ,! design ( ! plan & cov]$ b5efits "u ! plan are n likely to sub/antially disc\rage enrollm5t by c]ta9 ,total ,heal? eligible individuals 9 ! plan4 7g7 ,application ( limit$ risk plans 7#a7 ,conditions = approval ( limit$ risk plans ,! ,secret>y may only approve a limit$ risk plan 7z def9$ 9 p>agraph 7#d77;,a77 = a ,total ,heal? region if ! access requirem5ts "u section #ahfj;,c-#c7;a7 w\ld n be met = ! region b = ! approval ( su* a plan4 7#b7 ,rules ,! foll[+ rules %all apply ) respect to ! approval ( a limit$ risk plan 9 a ,total ,heal? region3 7,a7 ,limit$ ex]cise ( au?ority ,only ! m9imum numb] ( su* plans may be approv$ 9 ord] to meet ! access requirem5ts "u section #ahfj;,c-#c7;a74 7,b7 ,maximiz+ assumption ( risk ,! ,secret>y %all provide priority 9 approval = ^? plans be>+ ! highe/ level ( risk 7z comput$ by ! ,secret>y71 b ! ,secret>y may take into acc\nt ! level ( ! bids submitt$ by su* plans4 7,c7 ,no full und]writ+ = limit$ risk plans ,9 no case may ! ,secret>y approve a limit$ risk plan "u :i* ! modification ( risk level provides = no 7or a de m9imis7 level ( f9ancial risk4 7#c7 ,acceptance ( all full risk contracts ,!re %all be no limit on ! numb] ( full risk plans t are approv$ "u subsection 7e74 7#d7 ,risk-plans def9$ ,= purposes ( ?is subsection3 7,a7 ,limit$ risk plan ,! t]m limit$ risk plan means a ,total ,heal? plan t provides a basic ,total ,heal? b5efits package & = :i* ! ,total ,heal? sponsor includes a modification ( risk level describ$ 9 subp>agraph 7,e7 ( subsection 7b77#b7 9 ! bid submitt$ = ! plan "u su* subsection4 7,b7 ,full risk plan ,! t]m full risk plan means a ,total ,heal? plan t is n a limit$ risk plan4 7h7 ,annual report on use ( limit$ risk plans ,! ,secret>y %all submit to ,congress an annual report t describes in/ances 9 :i* limit$ risk plans 7 approv$ "u ?is section4 ,! ,secret>y %all include 9 su* report su* recomm5dations z may be appropriate to limit ! ne$ = ! provision ( su* plans & to maximize ! assumption ( f9ancial risk "u su* subsection4 7i7 ,non9t]f]5ce ,9 ord] to promote competition "u ?is "p & 9 c>ry+ out ?is "p1 ! ,secret>y-- 7#a7 may n int]f]e ) ! negotiations betwe5 physicians or o!r heal? pr(essionals1 provid]s1 suppli]s1 drug manufactur]s1 ph>macies1 & ,total ,heal? sponsors2 & 7#b7 may n require a p>ticul> b5efit design or =mul>y1 or in/itute a price /ructure = ! reimbursem5t ( cov]$ items & s]vices4 #ahfj;,c-#f4 ,requirem5ts = & contracts ) ,total ,heal? sponsors 7a7 ,g5]al requirem5ts ,ea* sponsor ( a ,total ,heal? plan %all meet ! foll[+ requirem5ts3 7#a7 ,lic5sure ,subject to subsection 7c71 ! sponsor is organiz$ & lic5s$ "u ,/ate law z a risk-be>+ entity eligible to (f] heal? insurance or heal? b5efits cov]age 9 ea* ,/ate 9 :i* x (f]s a ,total ,heal? plan4 7#b7 ,assumption ( f9ancial risk = unsubsidiz$ cov]age 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 to ! ext5t t ! entity is at risk ! entity assumes f9ancial risk on a prospective basis = b5efits t x (f]s "u a ,total ,heal? plan4 7,b7 ,re9surance p]mitt$ ,! plan sponsor may obta9 insurance or make o!r arrangem5ts = ! co/ ( cov]age provid$ to any enrollee to ! ext5t t ! sponsor is at risk = provid+ su* cov]age4 7#c7 ,solv5cy = unlic5s$ sponsors ,9 ! case ( a ,total ,heal? sponsor t is n describ$ 9 p>agraph 7#a7 & = :i* a waiv] has be5 approv$ "u subsection 7c71 su* sponsor %all meet solv5cy /&>ds e/abli%$ by ! ,secret>y "u subsection 7d74 7b7 ,contract requirem5ts 7#a7 ,9 g5]al ,! ,secret>y %all n p]mit ! enrollm5t "u section #ahfj;,c-#a 9 a ,total ,heal? plan (f]$ by a ,total ,heal? sponsor "u ?is subp>t1 & ! sponsor %all n be eligible = paym5ts "u section #ahfj;,c-#h1 unless ! ,secret>y has ent]$ into a contract "u ?is subsection ) ! sponsor ) respect to ! (f]+ ( su* plan4 ,su* a contract ) a sponsor may cov] m ?an "o ,total ,heal? plan4 ,su* contract %all provide t ! sponsor agrees to comply ) ! applicable requirem5ts & /&>ds ( ?is subp>t & ! t]ms & conditions ( paym5t z provid$ = 9 ?is subp>t4 7#b7 ,incorporation ( c]ta9 m$ic>e advantage contract requirem5ts ,except z o!rwise provid$1 ! foll[+ provisions ( section #aheg %all apply to contracts "u ?is section 9 ! same mann] z su* provisions appli$ to contracts "u section #aheg7;a73 7,a7 ,m9imum enrollm5t ,p>agraphs 7#a7 & 7#c7 ( section #aheg7;b71 except t-- 7i7 ! ,secret>y may increase ! m9imum numb] ( enrollees requir$ "u su* p>agraph 7#a7 z ! ,secret>y det]m9es appropriate2 & 7ii7 ! requirem5t ( su* p>agraph 7#a7 %all be waiv$ dur+ ! fir/ contract ye> ) respect to an organization 9 a region4 7,b7 ,contract p]iod & effectiv5ess ,section #aheg7;c71 except t 9 apply+ p>agraph 7#d77;,b7 ( su* section any ref]5ce to paym5t am\nts "u section #ahec is deem$ a ref]5ce to paym5t am\nts "u section #ahfj;,c-#h4 7,c7 ,protections aga9/ fraud & b5efici>y protections ,section #aheg7;d74 7,d7 ,additional contract t]ms ,section #aheg7;e72 except t section #aheg7;e77#b7 %all apply z specifi$ to ,total ,heal? sponsors & paym5ts to a ,total ,heal? plan "u ?is subp>t %all be treat$ z exp5ditures made "u ?is subp>t4 ,not)/&+ any o!r provision ( law1 in=mation provid$ to ! ,secret>y "u ! application ( section #aheg7;e77#a7 to contracts "u ?is section "u ! prec$+ s5t5ce-- 7i7 may be us$ = ! purposes ( c>ry+ out ?is subp>t1 improv+ public heal? ?r\gh rese>* on ! utilization1 safety1 effectiv5ess1 quality1 & effici5cy ( heal? c>e s]vices 7z ! ,secret>y det]m9es appropriate72 & 7ii7 %all be made available to ,congressional support ag5cies 79 accordance ) _! obligations to support ,congress z set out 9 _! au?oriz+ /atutes7 = ! purposes ( conduct+ ,congressional ov]sight1 monitor+1 mak+ recomm5dations1 & analysis ( ! program "u ?is title4 7,e7 ,int]m$iate sanctions ,section #aheg7;g7 7o!r ?an p>agraph 7#a77;,f7 ( su* section71 except t 9 apply+ su* section ! ref]5ce 9 section #aheg7;g77#a77;,b7 to section #ahed is deem$ a ref]5ce to ?is subp>t4 7,f7 ,proc$ures = t]m9ation ,section #aheg7;h74 7c7 ,waiv] ( c]ta9 requirem5ts ,to exp& *oice 7#a7 ,au?oriz+ waiv] 7,a7 ,9 g5]al ,9 ! case ( an entity t seeks to (f] a ,total ,heal? plan 9 a ,/ate1 ! ,secret>y %all waive ! requirem5t ( subsection 7a77#a7 t ! entity be lic5s$ 9 t ,/ate if ! ,secret>y det]m9es1 bas$ on ! application & o!r evid5ce pres5t$ to ! ,secret>y1 t any ( ! gr\nds = approval ( ! application describ$ 9 p>agraph 7#b7 h be5 met4 7,b7 ,application ( regional plan waiv] rule ,9 addition to ! waiv] available "u subp>agraph 7,a71 ! provisions ( section #aheh7;d7 %all apply to ,total ,heal? sponsors "u ?is "p 9 a mann] simil> to ! mann] 9 :i* su* provisions appli$ to ,,ma organizations4 7#b7 ,gr\nds = approval 7,a7 ,9 g5]al ,! gr\nds = approval "u ?is p>agraph are-- 7i7 subject to subp>agraph 7,b71 ! gr\nds = approval describ$ 9 subp>agraphs 7,b71 7,c71 & 7,d7 ( section #ahee7;a77#b72 & 7ii7 ! application by a ,/ate ( any gr\nds o!r ?an ^? requir$ "u ,f$]al law4 7,b7 ,special rules ,9 apply+ subp>agraph 7,a77i7-- 7i7 ! gr\nd ( approval describ$ 9 section #ahee7;a77#b77;,b7 is deem$ to h be5 met if ! ,/ate does n h a lic5s+ process 9 effect ) respect to ! ,total ,heal? sponsor2 & 7ii7 = plan ye>s beg9n+ be=e ,janu>y #a1 #bjai1 if ! ,/ate does h su* a lic5s+ process 9 effect1 su* gr\nd = approval describ$ 9 su* section is deem$ to h be5 met ^u submission ( an application describ$ 9 su* section4 7#c7 ,application ( waiv] proc$ures ,) respect to an application = a waiv] 7or a waiv] grant$7 "u p>agraph 7#a77;,a7 ( ?is subsection1 ! provisions ( subp>agraphs 7,e71 7,f71 & 7,g7 ( section #ahee7;a77#b7 %all apply1 except t clauses 7i7 & 7ii7 ( su* subp>agraph 7,e7 %all n apply 9 ! case ( a ,/ate t does n h a lic5s+ process describ$ 9 p>agraph 7#b77;,b77i7 9 effect4 7#d7 ,ref]5ces to c]ta9 provisions ,9 apply+ provisions ( section #ahee7;a77#b7 "u p>agraphs 7#b7 & 7#c7 ( ?is subsection to ,total ,heal? plans & ,total ,heal? sponsors-- 7,a7 any ref]5ce to a waiv] application "u section #ahee %all be treat$ z a ref]5ce to a waiv] application "u p>agraph 7#a77;,a7 ( ?is subsection2 & 7,b7 any ref]5ce to solv5cy /&>ds %all be treat$ z a ref]5ce to solv5cy /&>ds e/abli%$ "u subsection 7d7 ( ?is section4 7d7 ,solv5cy /&>ds = non-,lic5s$ entities 7#a7 ,e/abli%m5t & publication ,! ,secret>y1 9 consultation ) ! ,national ,association ( ,insurance ,commission]s1 %all e/abli% & publi%1 by n lat] ?an ,janu>y #a1 #bjaf1 f9ancial solv5cy & capital adequacy /&>ds = entities describ$ 9 p>agraph 7#b74 7#b7 ,compliance ) /&>ds ,a ,total ,heal? sponsor t is n lic5s$ by a ,/ate "u subsection 7a77#a7 & = :i* a waiv] application has be5 approv$ "u subsection 7c7 %all meet solv5cy & capital adequacy /&>ds e/abli%$ "u p>agraph 7#a74 ,! ,secret>y %all e/abli% c]tification proc$ures = su* sponsors ) respect to su* solv5cy /&>ds 9 ! mann] describ$ 9 section #ahee7;c77#b74 7e7 ,lic5sure does n sub/itute = or con/itute c]tification ,! fact t a ,total ,heal? sponsor is lic5s$ 9 accordance ) subsection 7a77#a7 or has a waiv] application approv$ "u subsection 7c7 does n deem ! sponsor to meet o!r requirem5ts impos$ "u ?is subp>t = a sponsor4 7f7 ,p]iodic review & revision ( /&>ds 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! ,secret>y may p]iodically review ! /&>ds e/abli%$ "u ?is section &1 bas$ on su* review1 may revise su* /&>ds if ! ,secret>y det]m9es su* revision to be appropriate4 7#b7 ,prohibition ( midye> implem5tation ( significant new regulatory requirem5ts ,! ,secret>y may n implem5t1 o!r ?an at ! beg9n+ ( a cal5d> ye>1 regulations "u ?is section t impose new1 significant regulatory requirem5ts on a ,total ,heal? sponsor or a ,total ,heal? plan4 7g7 ,prohibition ( /ate imposition ( premium taxes2 relation to /ate laws ,! provisions ( sections #ahed7;g7 & #ahef7;b77#c7 %all apply ) respect to ,total ,heal? sponsors & ,total ,heal? plans "u ?is "p 9 ! same mann] z su* provisions appli$ to ,,ma organizations & ,,ma plans4 #ahfj;,c-#g4 ,total ,heal? premiums 7a7 ,mon?ly b5efici>y premium 7#a7 ,base b5efici>y premium ,! base b5efici>y premium "u ?is p>agraph = a ,total ,heal? plan = a mon? is equal to ! product (-- 7,a7 #ae p]c5t2 & 7,b7 an am\nt det]m9$ by ! ,secret>y to be equal to ! #dj? p]c5tile ( ! mon?ly /&>diz$ bid am\nts 7z def9$ 9 subsection 7c71 weight$ "u subsection 7b71 & adju/$ "u section #ahfj;,c-#h7;b77#b77 = ! s]vice area 9 :i* ! plan is (f]$4 7#b7 ,computation ( mon?ly b5efici>y premium 7,a7 ,9 g5]al ,! mon?ly b5efici>y premium = a ,total ,heal? plan is ! base b5efici>y premium comput$ "u p>agraph 7#a7 z adju/$ "u ?is p>agraph4 7,b7 ,adju/m5t to reflect diff]5ce betwe5 bid & #dj? p]c5tile ( ! mon?ly /&>diz$ bid am\nt 7i7 ,above #dj? p]c5tile ,if ! b5efici>y enrolls 9 a plan ) a mon?ly /&>diz$ bid am\nt t exce$s ! #dj? p]c5tile 7z det]m9$ "u p>agraph 7#a77;,b771 ! base b5efici>y premium = ! mon? %all be increas$ by ! am\nt ( su* excess4 7ii7 ,bel[ #dj? p]c5tile ,if ! b5efici>y enrolls 9 a plan ) a mon?ly /&>diz$ bid am\nt t is less ?an ! #dj? p]c5tile 7z det]m9$ "u p>agraph 7#a77;,b771 ! base b5efici>y premium = ! mon? %all be decreas$ by ! am\nt ( su* diff]5ce4 ,any r$uction "u ! prec$+ s5t5ce %all n result 9 a mon?ly b5efici>y premium t is less ?an #j4 7,c7 ,increase = supplem5tal b5efits ,! base b5efici>y premium %all be increas$ by ! portion ( ! ,total ,heal? approv$ bid t is attributable to supplem5tal b5efits4 7,d7 ,increase = late enrollm5t p5alty ,! base b5efici>y premium %all be increas$ by ! am\nt ( any late enrollm5t p5alty "u subsection 7e74 7,e7 ,increase bas$ on income ,! mon?ly b5efici>y premium %all be increas$ pursuant to subsection 7f74 7,f7 ,uni=m premium ,except z provid$ 9 subp>agraphs 7,d7 & 7,e71 ! mon?ly b5efici>y premium = a ,total ,heal? plan 9 a ,total ,heal? region is ! same = all ,total ,heal? eligible individuals enroll$ 9 ! plan4 7b7 ,weight+ ( bid am\nts bas$ on enrollm5t 7#a7 ,9 g5]al ,= purposes ( subsection 7a77#a77;,b71 ! weight = ea* plan 9 ! s]vice area %all be equal to ! av]age numb] ( ,total ,heal? eligible individuals enroll$ 9 su* plan 9 ! ref]5ce mon? 7z def9$ 9 section #aheh7;f77#d774 7#b7 ,special rule = #bjag ,= purposes ( apply+ ?is p>agraph = #bjag1 ! ,secret>y %all e/abli% proc$ures = det]m9+ ! weight$ av]age "u p>agraph 7#a7 = #bjaf4 7c7 ,/&>diz$ bid am\nt def9$ ,= purposes ( ?is subsection1 ! t]m /&>diz$ bid am\nt means ! foll[+3 7#a7 ,basic cov]age only ,9 ! case ( a ,total ,heal? plan t provides basic heal? b5efits cov]age1 ! ,total ,heal? approv$ bid 7z def9$ 9 subsection 7d774 7#b7 ,plans (f]+ supplem5tal cov]age ,9 ! case ( a ,total ,heal? plan t provides supplem5tal heal? b5efits cov]age1 only ! portion ( ! ,total ,heal? approv$ bid t is attributable to basic heal? b5efits cov]age4 7d7 ,total heal? approv$ bid def9$ ,= purposes ( ?is subp>t1 ! t]m ,total ,heal? approv$ bid means-- 7#a7 ) respect to a ,total ,heal? plan1 ! bid am\nt approv$ = ! plan "u section #ahfj;,c-#e2 7#b7 ) respect to ! orig9al m$ic>e fee-=-s]vice program option1 ! bid describ$ 9 section #ahfj;,c-#e7;c74 7e7 ,late enrollm5t p5alty ,! mon?ly b5efici>y premium e/abli%$ "u subsection 7a7 %all be subject to adju/m5t 9 ! same mann] z ! "p ,b mon?ly b5efici>y premium comput$ "u section #ahci is subject to adju/m5t "u subsection 7b7 ( su* section1 except t1 9 apply+ ! late enrollm5t p5alty "u su* subsection1 ! initial enrollm5t p]iod ( ! individual %all be ! enrollm5t p]iod "u #ahfj;,c-#a7;b77#b7 in/ead ( ! initial enrollm5t p]iod describ$ 9 su* section #ahci7;b74 7f7 ,increase 9 base b5efici>y premium bas$ on income 7#a7 ,9 g5]al ,9 ! case ( an individual ^: modifi$ adju/$ gross income 7z def9$ 9 p>agraph 7#b77 exce$s ! ?re%old am\nt applicable "u p>agraph 7#b7 ( section #ahci7;i7 7includ+ application ( p>agraph 7#e7 ( su* section71 ! ,secret>y %all sub/itute ! applicable p]c5tage det]m9$ "u p>agraph 7#c77;,c7 ( section #ahci7;i7 = ! individual = ! cal5d> ye> = ! p]c5tage describ$ 9 subsection 7a77#a77;,a74 7#b7 ,modifi$ adju/$ gross income ,= purposes ( ?is subsection1 ! t]m modifi$ adju/$ gross income has ! mean+ giv5 su* t]m 9 subp>agraph 7,a7 ( section #ahci7;i77#d71 det]m9$ = ! taxable ye> applicable "u subp>agraphs 7,b7 & 7,c7 ( su* section4 7#c7 ,det]m9ation by commission] ( social security ,! ,commission] ( ,social ,security %all make any det]m9ation necess>y to c>ry out ! income-relat$ increase 9 ! base b5efici>y premium "u ?is subsection4 7#d7 ,proc$ures to assure correct income-relat$ increase 9 base b5efici>y premium 7,a7 ,disclosure ( base b5efici>y premium ,n lat] ?an ,septemb] #ae ( ea* ye> beg9n+ ) #bjaf1 ! ,secret>y %all disclose to ! ,commission] ( ,social ,security ! am\nt ( ! base b5efici>y premium 7z comput$ "u subsection 7a77#a77 = ! purpose ( c>ry+ out ! income-relat$ increase 9 ! base b5efici>y premium "u ?is subsection ) respect to ! foll[+ ye>4 7,b7 ,additional disclosure ,n lat] ?an ,octob] #ae ( ea* ye> beg9n+ ) #bjaf1 ! ,secret>y %all disclose to ! ,commission] ( ,social ,security ! foll[+ in=mation = ! purpose ( c>ry+ out ! income-relat$ increase 9 ! base b5efici>y premium "u ?is subsection ) respect to ! foll[+ ye>3 7i7 ,! modifi$ adju/$ gross income ?re%old applicable "u p>agraph 7#b7 ( section #ahci7;i7 7includ+ application ( p>agraph 7#e7 ( su* section74 7ii7 ,! applicable p]c5tage det]m9$ "u p>agraph 7#c77;,c7 ( section #ahci7;i7 7includ+ application ( p>agraph 7#e7 ( su* section74 7iii7 ,any o!r in=mation ! ,commission] ( ,social ,security det]m9es necess>y to c>ry out ! income-relat$ increase 9 ! base b5efici>y premium "u ?is subsection4 #ahfj;,c-#h4 ,premium & co/-%>+ support = ,total ,heal? eligible individuals 7a7 ,direct subsidy paym5t ,! ,secret>y %all provide = paym5t to a ,total ,heal? sponsor t (f]s a ,total ,heal? plan a direct subsidy = ea* ,total ,heal? eligible individual enroll$ 9 a ,total ,heal? plan = a mon? equal to-- 7#a7 ! am\nt ( ! plan's /&>diz$ bid am\nt 7z def9$ 9 section #ahfj;,c-#g7;c771 adju/$ "u subsection 7b77#a71 r$uc$ by 7#b7 ! base b5efici>y premium 7z comput$ "u p>agraph 7#a7 ( section #ahfj;,c-#g7;a7 & z adju/$ "u p>agraph 7#b77;,b7 ( su* section74 7b7 ,adju/m5ts relat+ to bids 7#a7 ,heal? /atus risk adju/m5t 7,a7 ,e/abli%m5t ( risk adju/ors ,! ,secret>y %all e/abli% an appropriate me?odology = adju/+ ! /&>diz$ bid am\nt "u subsection 7a77#a7 to take into acc\nt v>iation 9 co/s = heal? b5efits cov]age among ,total ,heal? plans bas$ on ! diff]5ces 9 actu>ial risk ( diff]5t enrollees be+ s]v$4 ,any su* risk adju/m5t %all be design$ 9 a mann] s z n to result 9 a *ange 9 ! aggregate am\nts payable to su* plans "u subsection 7a7 & ?r\gh t portion ( ! mon?ly b5efici>y ,total ,heal? premiums describ$ 9 subsection 7a77#b74 7,b7 ,consid]ations ,9 e/abli%+ ! me?odology "u subp>agraph 7,a71 ! ,secret>y may take into acc\nt ! simil> me?odologies us$ "u section #ahec7;a77#c7 to adju/ paym5ts to ,,ma organizations = b5efits "u ! orig9al m$ic>e fee-=-s]vice program option4 7,c7 ,data collection ,9 ord] to c>ry out ?is p>agraph1 ! ,secret>y %all require ,total ,heal? sponsors to submit data reg>d+ claims t c be l9k$ at ! individual level to data "u ?is title & su* o!r in=mation z ! ,secret>y det]m9es necess>y4 7,d7 ,publication ,at ! "t ( publication ( risk adju/m5t factors "u section #ahfj;,d-#ae7;c77#a77;,d71 ! ,secret>y %all publi% ! risk adju/]s e/abli%$ "u ?is p>agraph = ! succe$+ ye>4 7#b7 ,geographic adju/m5t 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 = purposes ( section #ahfj;,c-#g7;a77#a77;,b71 ! ,secret>y %all e/abli% an appropriate me?odology = adju/+ ! am\nt det]m9$ "u su* section to take into acc\nt diff]5ces 9 prices = cov]$ heal? b5efits among ,total ,heal? regions4 7,b7 ,de m9imis rule ,if ! ,secret>y det]m9es t ! price v>iations describ$ 9 subp>agraph 7,a7 among ,total ,heal? regions are de m9imis1 ! ,secret>y %all n provide = adju/m5t "u ?is p>agraph4 7,c7 ,budget neutral adju/m5t ,any adju/m5t "u ?is p>agraph %all be appli$ 9 a mann] s z to n result 9 a *ange 9 ! aggregate paym5ts made "u ?is subp>t t w\ld h be5 made if ! ,secret>y _h n appli$ su* adju/m5t4 7c7 ,paym5t me?ods 7#a7 ,9 g5]al ,paym5ts "u ?is section %all be bas$ on su* a me?od z ! ,secret>y det]m9es4 ,! ,secret>y may e/abli% a paym5t me?od by :i* int]im paym5ts ( am\nts "u ?is section are made dur+ a ye> bas$ on ! ,secret>y's be/ e/imate ( am\nts t w be payable aft] obta9+ all ( ! in=mation4 7#b7 ,requirem5t = provision ( in=mation 7,a7 ,requirem5t ,paym5ts "u ?is section to a ,total ,heal? sponsor are condition$ ^u ! furni%+ to ! ,secret>y1 9 a =m & mann] specifi$ by ! ,secret>y1 ( su* in=mation z may be requir$ to c>ry out ?is section4 7,b7 ,re/riction on use ( in=mation ,in=mation disclos$ or obta9$ pursuant to subp>agraph 7,a7 may be us$ by (fic]s1 employees1 & contractors ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices only = ! purposes (1 & to ! ext5t necess>y 91 c>ry+ out ?is section4 7#c7 ,s\rce ( paym5ts ,paym5ts "u ?is section %all be made f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda1 9 su* proportion z ! ,secret>y det]m9es appropriate4 7#d7 ,application ( enrollee adju/m5t ,! provisions ( section #ahec7;a77#b7 %all apply to paym5ts to ,total ,heal? sponsors "u ?is section 9 ! same mann] z !y appli$ to paym5ts to ,,ma organizations "u section #ahec7;a74 7d7 ,plans at risk = entire am\nt ( b5efits ,a ,total ,heal? sponsor t (f]s a plan "u ?is subp>t %all be at full f9ancial risk = ! provision ( b5efits "u su* plan4 7e7 ,disclosure ( in=mation 7#a7 ,9 g5]al ,ea* contract "u ?is subp>t %all provide t-- 7,a7 ! ,total ,heal? sponsor (f]+ a ,total ,heal? plan %all provide ! ,secret>y ) su* in=mation z ! ,secret>y det]m9es is necess>y to c>ry out ?is section2 & 7,b7 ! ,secret>y %all h ! "r 9 accordance ) section #aheg7;d77#b77;,b7 7z appli$ "u section #ahfj;,c-#f7;b77#b77;,c77 to inspect & audit any books & records ( a ,total ,heal? sponsor t p]ta9 to ! in=mation reg>d+ co/s provid$ to ! ,secret>y "u subp>agraph 7,a74 7#b7 ,re/riction on use ( in=mation ,in=mation disclos$ or obta9$ pursuant to ! provisions ( ?is section may be us$-- 7,a7 by (fic]s1 employees1 & contractors ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices = ! purposes (1 & to ! ext5t necess>y 9-- 7i7 c>ry+ out ?is section2 & 7ii7 conduct+ ov]sight1 evaluation1 & en=cem5t "u ?is title2 & 7,b7 by ! ,attorney ,g5]al & ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates = ! purposes (1 & to ! ext5t necess>y 91 c>ry+ out heal? ov]sight activities4 #ahfj;,c-#i4 ,exemption = ,,msa plans 7a7 ,9 g5]al ,none ( ! provisions 9 ?is subp>t %all apply to an ,,msa plan 7z def9$ 9 section #ahei7;b77#c77 & an ,,msa plan may n be a ,total ,heal? plan4 7b7 ,cont9u+ availability ,not)/&+ any o!r provision ( law1 ! ,secret>y %all e/abli% proc$ures "u :i*-- 7#a7 ,,msa plans may cont9ue to op]ate on & aft] ,janu>y #a1 #bjag2 & 7#b7 individuals :o w\ld h be5 eligible to enroll 9 ^? plans prior to su* date cont9ue to be eligible to enroll 9 su* a plan4 #ahfj;,c-#aj4 ,special rules = employ]-sponsor$ programs 7a7 ,subsidy paym5t 7#a7 ,9 g5]al ,! ,secret>y %all provide 9 accordance ) ?is subsection = paym5t to ! sponsor ( a qualifi$ retiree heal? b5efits plan 7z def9$ 9 p>agraph 7#b77 ( a special subsidy paym5t equal to ! am\nt specifi$ 9 p>agraph 7#c7 = ea* qualifi$ cov]$ retiree "u ! plan 7z def9$ 9 p>agraph 7#d774 ,?is subsection con/itutes budget au?ority 9 advance ( appropriations ,acts & repres5ts ! obligation ( ! ,secret>y to provide = ! paym5t ( am\nts provid$ "u ?is section4 7#b7 ,qualifi$ retiree heal? b5efits plan def9$ ,= purposes ( ?is subsection1 ! t]m qualifi$ retiree heal? b5efits plan means employm5t-bas$ retiree heal? cov]age 7z def9$ 9 subsection 7c77#a77 if1 ) respect to a ,total ,heal? eligible individual :o is a p>ticipant or b5efici>y "u su* cov]age1 ! foll[+ requirem5ts are met3 7,a7 ,atte/ation ( actu>ial equival5ce to /&>d cov]age ,! sponsor ( ! plan provides ! ,secret>y1 annually or at su* o!r "t z ! ,secret>y may require1 ) an atte/ation t ! actu>ial value ( heal? b5efits cov]age "u ! plan 7z det]m9$ us+ ! processes & me?ods describ$ 9 section #ahfj;,c-#e7;d77 is at lea/ equal to ! actu>ial value ( /&>d heal? b5efits cov]age4 7,b7 ,audits ,! sponsor ( ! plan1 or an adm9i/rator ( ! plan designat$ by ! sponsor1 %all ma9ta9 7& af=d ! ,secret>y access to7 su* records z ! ,secret>y may require = purposes ( audits & o!r ov]sight activities necess>y to ensure ! adequacy ( heal? b5efits cov]age & ! accuracy ( paym5ts made "u ?is section4 ,! provisions ( section #ahfj;,c-#b7;d77#b7 %all apply to su* in=mation "u ?is section 7includ+ su* actu>ial value & atte/ation7 9 a mann] simil> to ! mann] 9 :i* !y apply to f9ancial records ( ,total ,heal? sponsors4 7,c7 ,provision ( disclosure reg>d+ heal? b5efits cov]age 7i7 ,9 g5]al ,ea* entity t (f]s employm5t-bas$ retiree heal? cov]age %all provide = disclosure1 9 a =m1 mann]1 & "t consi/5t ) /&>ds e/abli%$ by ! ,secret>y1 to ! ,secret>y & ,total ,heal? eligible individuals ( :e!r ! cov]age meets ! requirem5t ( subp>agraph 7,a7 or :e!r su* cov]age is *ang$ s x no long] meets su* requirem5t4 7ii7 ,disclosure ( non-qualifi$ cov]age ,9 ! case ( su* cov]age t does n meet su* requirem5t1 ! disclosure to ,total ,heal? eligible individuals "u ?is subp>agraph %all include in=mation reg>d+ ! fact t because su* cov]age does n meet su* requirem5t !re are limitations on ! p]iods 9 a ye> 9 :i* ! individuals may enroll "u a ,total ,heal? plan4 7iii7 ,waiv] ( requirem5t ,9 ! case ( a ,total ,heal? eligible individual :o 0 enroll$ 9 employm5t-bas$ retiree heal? cov]age :i* does n meet ! requirem5t ( subp>agraph 7,a71 ! individual may apply to ! ,secret>y to h su* cov]age treat$ z a qualifi$ retiree heal? b5efits plan if ! individual e/abli%es t ! individual 0 n adequately in=m$ t su* cov]age did n meet su* requirem5t4 7#c7 ,employ] & union special subsidy am\nts 7,a7 ,9 g5]al ,= purposes ( ?is subsection1 ! special subsidy paym5t am\nt "u ?is p>agraph = a qualify+ cov]$ retiree = a cov]age ye> enroll$ ) ! sponsor ( a qualifi$ retiree heal? b5efits plan is1 = ! portion ( ! retiree's gross cov]$ retiree plan-relat$ heal? b5efits co/s 7z def9$ 9 subp>agraph 7,c77ii77 = su* ye> t exce$s ! co/ ?re%old am\nt specifi$ 9 subp>agraph 7,b7 & does n exce$ ! co/ limit "u su* subp>agraph1 an am\nt equal to #bh p]c5t ( ! all[able retiree co/s 7z def9$ 9 subp>agraph 7,c77i77 attributable to su* gross cov]$ retiree plan-relat$ heal? b5efits co/s4 7,b7 ,co/ ?re%old & co/ limit applicable 7i7 ,9 g5]al ,subject to clause 7ii7-- 7,i7 ! co/ ?re%old "u ?is subp>agraph is equal to #bej = plan ye>s t end 9 #bjag2 & 7,,ii7 ! co/ limit "u ?is subp>agraph is equal to #e1jjj = plan ye>s t end 9 #bjag4 7ii7 ,index+ ,! co/ ?re%old & co/ limit am\nts specifi$ 9 subclauses 7,i7 & 7,,ii7 ( clause 7i7 = a plan ye> t ends aft] #bjag %all be adju/$ 9 ! same mann] z ! unifi$ d$uctible & ! annual out-(-pocket limits1 respectively1 are annually adju/$ "u sections #ahii;,b & #ahii;,c4 7,c7 ,def9itions ,= purposes ( ?is p>agraph3 7i7 ,all[able retiree co/s ,! t]m all[able retiree co/s means1 ) respect to gross cov]$ heal? b5efits co/s "u a qualifi$ retiree heal? b5efits plan by a plan sponsor1 ! "p ( su* co/s t are actually paid 7net ( disc\nts1 *>gebacks1 & av]age p]c5tage rebates7 by ! sponsor or by or on behalf ( a qualify+ cov]$ retiree "u ! plan4 7ii7 ,gross cov]$ retiree plan-relat$ heal? b5efits co/s ,! t]m gross cov]$ retiree plan-relat$ heal? b5efits co/s means1 ) respect to a qualify+ cov]$ retiree enroll$ 9 a qualifi$ retiree heal? b5efits plan dur+ a cov]age ye>1 ! co/s incurr$ "u ! plan1 n includ+ adm9i/rative co/s1 b includ+ co/s directly relat$ to ! furni%+ ( heal? b5efits items & s]vices dur+ ! ye>4 ,su* co/s %all be det]m9$ :e!r !y are paid by ! retiree or "u ! plan4 7iii7 ,cov]age ye> ,! t]m cov]age ye> has ! mean+ giv5 su* t]m 9 section #ahfj;,d-#ae7;b77#d7 7z appli$ by sub/itut+ cov]$ heal? b5efits = cov]$ "p ,d drugs74 7#d7 ,qualify+ cov]$ retiree def9$ ,= purposes ( ?is subsection1 ! t]m qualify+ cov]$ retiree means a ,total ,heal? eligible individual :o is n enroll$ 9 a ,total ,heal? plan b is cov]$ "u a qualifi$ retiree heal? b5efits plan4 7#e7 ,paym5t me?ods1 includ+ provision ( necess>y in=mation ,! provisions ( section #ahfj;,c-#h7;c7 7includ+ p>agraph 7#b7 ( su* section1 relat+ to requirem5t = provision ( in=mation7 %all apply to paym5ts "u ?is subsection 9 a mann] simil> to ! mann] 9 :i* !y apply to paym5ts "u section #ahfj;,c-#h4 7#f7 ,con/ruction ,no?+ 9 ?is subsection %all be con/ru$ z-- 7,a7 preclud+ a ,total ,heal? eligible individual :o is cov]$ "u employm5t-bas$ retiree heal? cov]age f enroll+ 9 a ,total ,heal? plan2 7,b7 preclud+ su* employm5t-bas$ retiree heal? cov]age or an employ] or o!r p]son f pay+ all or any portion ( any premium requir$ = cov]age "u a ,total ,heal? plan on behalf ( su* an individual2 7,c7 prev5t+ su* employm5t-bas$ retiree heal? cov]age f provid+ cov]age-- 7i7 t is bett] ?an /&>d heal? b5efits cov]age to retirees :o are cov]$ "u a qualifi$ retiree heal? b5efits plan2 or 7ii7 t is supplem5tal to ! b5efits provid$ "u a ,total ,heal? plan1 includ+ b5efits to retirees :o are n cov]$ "u a qualifi$ retiree heal? b5efits plan b :o are enroll$ 9 su* a ,total ,heal? plan2 or 7,d7 prev5t+ employ]s f provid+ = flexibility 9 b5efit design & provid] access provisions1 )\t reg>d to ! requirem5ts = basic heal? b5efits cov]age1 s long z ! actu>ial equival5ce requirem5t ( p>agraph 7#b77;,a7 is met4 7b7 ,application ( ,m$ic>e ,advantage waiv] au?ority ,! provisions ( section #aheg7;i7 %all apply ) respect to ,total ,heal? plans 9 relation to employm5t-bas$ retiree heal? cov]age 9 a mann] simil> to ! mann] 9 :i* !y appli$ to an ,,ma plan 9 relation to employ]s1 includ+ au?oriz+ ! e/abli%m5t ( sep>ate premium am\nts = enrollees 9 a ,total ,heal? plan by reason ( su* cov]age & limitations on enrollm5t to ,total ,heal? eligible individuals enroll$ "u su* cov]age4 7c7 ,def9itions ,= purposes ( ?is section3 7#a7 ,employm5t-bas$ retiree heal? cov]age ,! t]m employm5t-bas$ retiree heal? cov]age means heal? insurance or o!r cov]age ( heal? c>e co/s 7:e!r provid$ by volunt>y insurance cov]age or pursuant to /atutory or contractual obligation7 = ,total ,heal? eligible individuals 7or = su* individuals & _! sp\ses & dep5d5ts7 "u a gr\p heal? plan bas$ on _! /atus z retir$ p>ticipants 9 su* plan4 7#b7 ,sponsor ,! t]m sponsor means a plan sponsor1 z def9$ 9 section 7#af77;,b7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd1 9 relation to a gr\p heal? plan1 except t1 9 ! case ( a plan ma9ta9$ jo9tly by "o employ] & an employee organization & ) respect to :i* ! employ] is ! prim>y s\rce ( f9anc+1 su* t]m means su* employ]4 7#c7 ,gr\p heal? plan ,! t]m gr\p heal? plan includes su* a plan z def9$ 9 section #fjg7a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd & also includes ! foll[+3 7,a7 ,f$]al & /ate gov]nm5tal plans ,su* a plan e/abli%$ or ma9ta9$ = its employees by ! ,gov]nm5t ( ! ,unit$ ,/ates1 by ! gov]nm5t ( any ,/ate or political subdivision !re(1 or by any ag5cy or in/rum5tality ( any ( ! =ego+1 includ+ a heal? b5efits plan (f]$ "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code4 7,b7 ,collectively b>ga9$ plans ,su* a plan e/abli%$ or ma9ta9$ "u or pursuant to "o or m collective b>ga9+ agreem5ts4 7,c7 ,*ur* plans ,su* a plan e/abli%$ & ma9ta9$ = its employees 7or _! b5efici>ies7 by a *ur* or by a conv5tion or association ( *ur*es :i* is exempt f tax "u section #eja ( ! ,int]nal ,rev5ue ,code ( #aihf4 #ahfj;,c-#aa4 ,coord9ation ) ,/ate ,m$icaid programs 7a7 ,application 7#a7 ,9 g5]al ,subject to subsection 7c77#b71 a ,/ate may apply to ! ,secret>y = ! waiv] ( any or all requirem5ts describ$ 9 ?is subp>t = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjag1 ) respect to a ,total ,heal? plan (f]$ )9 ! ,/ate = ! purpose ( coord9at+ t plan ) its ,/ate plan "u title ,,xix to ensure-- 7,a7 dually eligible individuals h full access to ! s]vices to :i* !y are entitl$2 7,b7 ! developm5t ( innovative c>e coord9ation & integration models2 & 7,c7 ! elim9ation ( f9ancial misalignm5ts t lead to poor quality & co/-%ift+4 7#b7 ,requirem5ts ,su* application %all-- 7,a7 be fil$ at su* "t & 9 su* mann] z ! ,secret>y may require2 7,b7 conta9 su* in=mation z ! ,secret>y may require1 includ+-- 7i7 a compreh5sive description ( ! proposal & program to implem5t a plan meet+ ! requirem5ts = a waiv] "u ?is section2 & 7ii7 an analysis ( ! proposal demon/rat+ t ! plan w n increase ,f$]al ,gov]nm5t exp5ditures2 & 7,c7 provide an assurance t1 if approv$1 ! ,total ,heal? sponsor w (f] ! plan t is ! subject ( ! proposal4 7#c7 ,waiv] consid]ation & transp>5cy 7,a7 ,9 g5]al ,an application = a waiv] "u ?is section %all be consid]$ by ! ,secret>y 9 accordance ) ! regulations describ$ 9 subp>agraph 7,b74 7,b7 ,regulations ,n lat] ?an #ahj days aft] ! date ( enactm5t ( ?is subp>t1 ! ,secret>y %all promulgate regulations relat+ to waiv]s "u ?is section t provide-- 7i7 a process = public notice & comm5t suffici5t to ensure a mean+ful level ( public input2 7ii7 a process = ! submission ( an application = ! waiv]2 7iii7 a process = ! submission to ! ,secret>y ( p]iodic reports by ! ,/ate conc]n+ ! implem5tation ( ! program "u ! waiv]2 & 7iv7 a process = ! p]iodic evaluation by ! ,secret>y ( ! program "u ! waiv]4 7,c7 ,report ,! ,secret>y %all annually report to ,congress conc]n+ actions tak5 by ! ,secret>y ) respect to applications = waiv]s "u ?is section4 7#d7 ,/ate option to be a total heal? sponsor ,= purposes ( ?is section1 a ,/ate may elect to be ! sponsor ( a ,total ,heal? plan = resid5ts ( ! ,/ate :o are eligible = b5efits "u ?is title & title ,,xix or to apply on behalf ( a ,total ,heal? sponsor (f]+ a ,total ,heal? plan 9 ! ,/ate4 7#e7 ,coord9at$ waiv] process ,! ,secret>y %all develop a process = coord9at+ & consolidat+ ! waiv] processes applicable "u ! provisions ( ?is section to ensure t individuals eligible to enroll 9 a plan (f]$ "u ! waiv] are initially able to d s dur+ an annual1 coord9at$ election p]iod4 7b7 ,grant+ ( waiv]s 7#a7 ,9 g5]al ,! ,secret>y may grant a reque/ = a waiv] "u subsection 7a77#a7 only if ! ,secret>y det]m9es t ! propos$ ,total ,heal? plan-- 7,a7 w provide cov]age t is at lea/ z compreh5sive z ! cov]age describ$ 9 section #ahfj;,c-#b7;a77#a7 z c]tifi$ by ,(fice ( ! ,actu>y ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices2 7,b7 w provide cov]age & co/-%>+ protections aga9/ excessive out-(-pocket sp5d+ t are at lea/ z af=dable z ! provisions ( ?is subtitle w\ld provide2 & 7,c7 w n increase ! ,f$]al deficit4 7c7 ,scope ( waiv] 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! ,secret>y %all det]m9e ! scope ( a waiv] grant$ ) respect to a ,total ,heal? plan "u subsection 7a77#a74 7#b7 ,limitation ,! ,secret>y may only waive provisions "u ?is title & titles ,,ii1 ,,xi1 ,,xix1 & ,,xxi "u a waiv] "u ?is section4 7d7 ,det]m9ations by ! secret>y 7#a7 ,"t = det]m9ation ,! ,secret>y %all make a det]m9ation "u subsection 7a77#a7 n lat] ?an #ahj days aft] ! receipt ( an application f a ,/ate "u su* subsection4 7#b7 ,effect ( det]m9ation 7,a7 ,grant+ ( waiv]s ,if ! ,secret>y det]m9es to grant a waiv] "u subsection 7a77#a71 ! ,secret>y %all notify ! ,total ,heal? sponsor involv$ ( su* det]m9ation & ! t]ms & effectiv5ess ( su* waiv]4 7,b7 ,d5ial ( waiv] ,if ! ,secret>y det]m9es a waiv] %\ld n be grant$ "u subsection 7a77#a71 ! ,secret>y %all notify ! ,total ,heal? sponsor involv$1 includ+ ! reasons !re=4 7e7 ,t]m ( waiv] ,no waiv] "u ?is section may ext5d ov] a p]iod ( long] ?an #e ye>s unless ! ,total ,heal? sponsor reque/s cont9uation ( su* waiv]1 & su* reque/ %all be deem$ grant$ unless ! ,secret>y1 )9 #ij days aft] ! date ( ! submission ( ! reque/ to ! ,secret>y1 ei!r d5ies su* reque/ 9 writ+ or in=ms ! ,/ate 9 writ+ ) respect to any additional in=mation t is ne$$ 9 ord] to make a f9al det]m9ation ) respect to ! reque/4 #ahfj;,c-#ab4 ,def9itions & miscellane\s provisions 7a7 ,def9itions ,= purposes ( ?is subp>t3 7#a7 ,basic heal? b5efits cov]age ,! t]m basic heal? b5efits cov]age means cov]age ( ! heal? c>e items & s]vices = :i* paym5t may be made "u ! orig9al m$ic>e fee-=-s]vice program option4 7#b7 ,insurance risk ,! t]m insurance risk means1 ) respect to a p>ticipat+ heal? c>e provid]1 risk ( ! type commonly assum$ only by insur]s lic5s$ by a ,/ate & does n include paym5t v>iations design$ to reflect p]=mance-bas$ measures ( activities )9 ! control ( ! heal? c>e provid]4 7#c7 ,,ma plan2 ,m$ic>e ,advantage plan ,! t]ms ,,ma plan & ,m$ic>e ,advantage plan h ! mean+ giv5 su* t]ms 9 section #ahei7;b77#a74 7#d7 ,orig9al m$ic>e fee-=-s]vice program option ,! t]m orig9al m$ic>e fee-=-s]vice program option means ! orig9al m$ic>e fee-=-s]vice program "u p>ts ,a & ,b1 z modifi$ by ?is subp>t4 7#e7 ,/&>d heal? b5efits cov]age ,! t]m /&>d heal? b5efits cov]age has ! mean+ giv5 su* t]m 9 section #ahfj;,c-#b7;b74 7#f7 ,total heal? eligible individual ,! t]m ,total ,heal? eligible individual has ! mean+ giv5 su* t]m 9 section #ahfj;,c-#a7;a77#c74 7#g7 ,total heal? plan ,! t]m ,total ,heal? plan means heal? b5efits cov]age t is (f]$-- 7,a7 "u a policy1 contract1 or plan t has be5 approv$ "u section #ahfj;,c-#e7;f72 & 7,b7 by a ,total ,heal? sponsor pursuant to1 & 9 accordance )1 a contract betwe5 ! ,secret>y & ! sponsor "u section #ahfj;,c-#f7;b74 7#h7 ,total heal? sponsor ,! t]m ,total ,heal? sponsor means a nongov]nm5tal entity t is c]tifi$ "u ?is subp>t z meet+ ! requirem5ts & /&>ds ( ?is subp>t = su* a sponsor4 7b7 ,application ( subp>t #a provisions & regulations "u ?is subp>t ,= purposes ( apply+ provisions ( subp>t #a "u ?is subp>t 7& regulations implem5t+ su* provisions7 ) respect to a ,total ,heal? plan & a ,total ,heal? sponsor1 unless o!rwise provid$ 9 ?is subp>t1 & to ! ext5t consi/5t ) ?is subp>t1 su* provisions 7& regulations implem5t+ su* provisions7 %all be appli$ z ! provisions 7& regulations7 appli$ = plan ye>s beg9n+ prior to ,janu>y #a1 #bjag1 & z if-- 7#a7 any ref]5ce to a ,m$ic>e ,advantage plan or an ,,ma plan includ$ a ref]5ce to a ,total ,heal? plan2 7#b7 any ref]5ce to an ,,ma organization or a provid]-sponsor$ organization includ$ a ref]5ce to a ,total ,heal? sponsor2 7#c7 any ref]5ce to a contract "u section #aheg includ$ a ref]5ce to a contract "u section #ahfj;,c-#f7;b72 7#d7 any ref]5ce to subp>t #a includ$ a ref]5ce to ?is subp>t2 & 7#e7 any ref]5ce to an election p]iod "u section #ahea 7 a ref]5ce to an enrollm5t p]iod "u section #ahfj;,c-#a4 4 #bjjb4 ,replacem5t ( "p ,b premium ) ,m$ic>e ,total ,heal? program plan premium2 o!r te*nical & con=m+ am5dm5ts 7a7 ,replacem5t ( "p b premium ) ,m$ic>e total heal? program plan premium ,section #ahci ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is am5d$-- 7#a7 9 subsection 7a77#b71 by /rik+ ,! mon?ly premium & ins]t+ ,subject to subsection 7j712 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7j7 ,replacem5t ( "p b premium ) ,m$ic>e ,total ,heal? program plan premium 7#a7 ,9 g5]al ,not)/&+ ! prec$+ provisions ( ?is section1 except z provid$ 9 p>agraph 7#b71 on & aft] ,janu>y #a1 #bjag1 9 lieu ( ! premium o!rwise applicable "u ?is section1 ! mon?ly premium ( ea* ,total ,heal? eligible individual 7z def9$ 9 section #ahfj;,c-#a7;a77#c77 %all be ! mon?ly b5efici>y premium det]m9$ "u section #ahfj;,c-#g = ! ,total ,heal? plan or ! orig9al m$ic>e fee-=-s]vice program option & ! plan ye> involv$4 7#b7 ,individuals enroll$ = cov]age "u "p b only ,individuals enroll$ "u ?is "p only 7& n entitl$ to1 or enroll$ =1 b5efits "u "p ,a7 %all pay ! premium t w\ld h be5 calculat$ "u ?is section b = ! enactm5t ( ?is subsection4 7#c7 ,cr$it+ ( premiums ,premiums paid by ea* ,total ,heal? eligible individual enroll$ 9 ! orig9al m$ic>e fee-=-s]vice program option 7z def9$ 9 section #ahfj;,e-#ac7;a77#d771 %all be deposit$ 9 ! ,treasury to ! cr$it ( ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda4 4 7b7 ,o!r te*nical & con=m+ am5dm5ts ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ! appropriate committees ( ,congress a legislative proposal provid+ = su* te*nical & con=m+ am5dm5ts 9 ! law z are requir$ by ! provisions ( ?is "p & "p ,,ii4 ,,ii ,m$ic>e fee-=-,s]vice re=ms #bjaa4 ,m$ic>e protection aga9/ high out-(-pocket exp5ditures = fee-=-s]vice b5efits ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,b4 ,protection aga9/ high out-(-pocket exp5ditures 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 9 ! case ( an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b1 if ! am\nt ( ! out-(-pocket co/-%>+ ( su* individual = a ye> 7beg9n+ ) #bjae7 equals or exce$s-- 7#a7 ! fir/ ?re%old annual out-(-pocket limit "u subsection 7b77#a7 b is less ?an ! second ?re%old annual out-(-pocket limit "u subsection 7b77#b7 = t ye>1 section #ahii;,d7a7 %all be appli$ by sub/itut+ #e p]c5t = #bj p]c5t2 & 7#b7 ! second ?re%old annual out-(-pocket limit "u subsection 7b77#b7 = t ye>1 !re %all n be any additional r$uction "u section #ahii;,d = ! rema9d] ( ! ye> 7& ! individual %all n be responsible = additional out-(-pocket co/-%>+ incurr$ dur+ t ye>74 7b7 ,am\nt ( annual out-(-,pocket limits 7#a7 ,fir/ ?re%old annual out-(-pocket limit ,! am\nt ( ! fir/ ?re%old annual out-(-pocket limit "u ?is subsection %all be-- 7,a7 = #bjae1 #e1ejj2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ or decreas$ by ! p]c5tage *ange 9 ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = ! #ab-mon? p]iod end+ ) ,june ( su* prec$+ ye> 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor z ( ! end ( su* p]iod74 7#b7 ,second ?re%old annual out-(-pocket limit ,! am\nt ( ! second ?re%old annual out-(-pocket limit "u ?is subsection %all be-- 7,a7 = #bjae1 #g1ejj2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ or decreas$ by ! p]c5tage *ange 9 ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = ! #ab-mon? p]iod end+ ) ,june ( su* prec$+ ye> 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor z ( ! end ( su* p]iod74 7#c7 ,r\nd+ ,if any am\nt det]m9$ "u subp>agraph 7,a7 or 7,b7 is n a multiple ( #e1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #e4 7c7 ,out-(-,pocket co/-,%>+ def9$ 7#a7 ,9 g5]al ,subject to p>agraphs 7#b7 & 7#c71 9 ?is section1 ! t]m out-(-pocket co/-%>+ means1 ) respect to an individual1 ! am\nt ( ! exp5ses incurr$ by ! individual t are attributable to-- 7,a7 d$uctibles1 co9surance & copaym5ts applicable "u "p ,a or ,b2 or 7,b7 = items & s]vices t w\ld h o!rwise be5 cov]$ "u "p ,a or ,b b = ! exhau/ion ( ^? b5efits4 7#b7 ,c]ta9 co/s n includ$ 7,a7 ,non-cov]$ items & s]vices ,exp5ses incurr$ = items & s]vices :i* are n includ$ 7or treat$ z be+ includ$7 "u "p ,a or ,b %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7,b7 ,items & s]vices n furni%$ on an assignm5t-relat$ basis ,if an item or s]vice is furni%$ to an individual "u ?is title & is n furni%$ on an assignm5t-relat$ basis1 any additional exp5ses ! individual incurs above ! am\nt ! individual w\ld h incurr$ if ! item or s]vice 0 furni%$ on an assignm5t-relat$ basis %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7#c7 ,s\rce ( paym5t ,= purposes ( p>agraph 7#a71 ! ,secret>y %all consid] exp5ses to be incurr$ by ! individual )\t reg>d to :e!r ! individual or ano!r p]son1 includ+ a ,/ate program or o!r ?ird-p>ty cov]age1 has paid = su* exp5ses4 7d7 ,ann\ncem5t ( annual out-(-,pocket limit & unifi$ d$uctible ,! ,secret>y %all 7beg9n+ 9 #bjad7 ann\nce 79 a mann] int5d$ to provide notice to all int]e/$ p>ties7 ! annual out-(-pocket limit "u ?is section & ! unifi$ d$uctible "u section #ahii;,c t w be applicable = ! succe$+ ye>4 4 #bjab4 ,unifi$ ,m$ic>e d$uctible 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 z am5d$ by section #bjaa1 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,unifi$ "p ,a & ,b d$uctible 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 subject to subsection 7d71 = a ye> 7beg9n+ ) #bjae71 9 ! case ( an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b-- 7#a7 ! am\nt o!rwise payable "u "p ,a & ! total am\nt ( exp5ses incurr$ by ! individual dur+ a ye> :i* w\ld 7except = ?is section7 con/itute incurr$ exp5ses = :i* b5efits payable "u section #ahcc7;a7 are det]m9able1 %all be r$uc$ by ! am\nt ( ! unifi$ d$uctible "u subsection 7b72 & 7#b7 ! individual %all be responsible = paym5t ( su* am\nt4 7b7 ,am\nt ( unifi$ d$uctible 7#a7 ,9 g5]al ,! am\nt ( ! unifi$ d$uctible "u ?is section %all be-- 7,a7 = #bjae1 #eej2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ or decreas$ by ! p]c5tage *ange 9 ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = ! #ab-mon? p]iod end+ ) ,june ( su* prec$+ ye> 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor z ( ! end ( su* p]iod74 7#b7 ,r\nd+ ,if any am\nt det]m9$ "u p>agraph 7#a7 is n a multiple ( #e1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #e4 7c7 ,application to all items & s]vices ,! unifi$ d$uctible "u ?is section = a ye> %all be appli$ z foll[s3 7#a7 ,) respect to items & s]vices cov]$ "u "p ,a1 su* unifi$ d$uctible %all be appli$ on ! basis ( ! am\nt t is payable = su* items & s]vices )\t reg>d to any copaym5ts or co9surance & be=e ! application ( any su* copaym5ts or co9surance4 7#b7 ,) respect to items & s]vices cov]$ "u "p ,b1 su* unifi$ d$uctible %all be appli$ on ! basis ( ! total am\nt ( ! exp5ses incurr$ by ! individual dur+ a ye> :i* w\ld1 except = ! application ( ! unifi$ d$uctible1 con/itute incurr$ exp5ses = :i* items & s]vices are payable "u "p ,b1 )\t reg>d to any copaym5ts or co9surance & be=e ! application ( any su* copaym5ts or co9surance4 7#c7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 su* unifi$ d$uctible %all be appli$ ) respect to all items & s]vices cov]$ "u p>ts ,a & ,b & 9 lieu ( ! d$uctibles describ$ 9 sections #ahac7;b7 & #ahcc7;b7 or o!rwise4 7,b7 ,! d$uctible applicable to blood "u sections #ahac & #ahcc %all apply to blood in/ead ( su* unifi$ d$uctible4 7d7 ,treatm5t ( individuals n enroll$ 9 bo? p>ts ,a & ,b ,! ,secret>y %all e/abli% proc$ures "u :i* an individual :o entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b 7b n bo?7 w cont9ue to be subject to a d$uctible "u ?is title t is comp>able to ! d$uctible ! individual w\ld h be5 subject to if ?is section _h n be5 enact$4 4 7b7 ,cl>ification reg>d+ application "u m$ic>e advantage ,section #aheb7;a77#a77;,b77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77;,b77iii77 is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,= plan ye>s #bjae & #bjaf1 ! prec$+ s5t5ce %all be appli$ to take into acc\nt ! application ( sections #ahii;,b1 #ahii;,c1 & #ahii;,d44 #bjac4 ,uni=m ,m$ic>e co9surance rate 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 z am5d$ by sections #bjaa & #bjab1 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,d4 ,uni=m "p ,a & ,b co9surance rate 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 9 ! case ( an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b1 aft] ! application ( ! unifi$ d$uctible "u section #ahii;,c & subject to ! limit on annual out-(-pocket exp5ses "u section #ahii;,b1 ! am\nt o!rwise payable "u "p ,a & ! total am\nt ( exp5ses incurr$ by ! individual dur+ a ye> 7beg9n+ 9 #bjae7 :i* w\ld 7except = ?is section7 con/itute incurr$ exp5ses = :i* b5efits are payable "u "p ,b1 %all be r$uc$ by a co9surance ( #bj p]c5t ( su* am\nt4 7b7 ,application to all items & s]vices ,! uni=m co9surance "u ?is section = a ye> %all be appli$ z foll[s3 7#a7 ,) respect to items & s]vices cov]$ "u "p ,a1 su* uni=m co9surance %all be appli$ on ! basis ( ! am\nt t is payable = su* items & s]vices4 7#b7 ,) respect to items & s]vices cov]$ "u "p ,b1 su* uni=m co9surance %all be appli$ on ! basis ( ! total am\nt ( ! exp5ses incurr$ by ! individual dur+ a ye> :i* w\ld1 except = ! application ( ! unifi$ d$uctible1 con/itute incurr$ exp5ses f :i* items & s]vices are payable "u "p ,b4 7#c7 7,a7 ,except z provid$ 9 subp>agraph 7,b71 su* uni=m co9surance %all be appli$ ) respect to all items & s]vices cov]$ "u p>ts ,a & ,b & 9 lieu ( any o!r copaym5ts or co9surance "u su* p>ts4 7,b7 ,co9surance = blood "u ?is title %all be det]m9$ "u ! rules t 7 applicable to blood on ,decemb] #ca1 #bjad1 r ?an "u ?is section4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #ahac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;e7 is am5d$-- 7,a7 9 subsection 7a71 by ins]t+ ,subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d3 be=e p>agraph 7#a72 & 7,b7 9 subsection 7b71 by ins]t+ ,subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d3 be=e p>agraph 7#a74 7#b7 ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is am5d$-- 7,a7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by ins]t+ & sections #ahii;,b1 #ahii;,c1 & #ahii;,d aft] succe$+ provisions ( ?is section2 7,b7 9 subsection 7b71 9 ! fir/ s5t5ce1 by /rik+ ,be=e apply+ & ins]t+ ,subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d1 be=e apply+2 7,c7 9 subsection 7c77#a71 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d1 aft] ?is "p12 7,d7 9 subsection 7f71 by /rik+ ,9 e/abli%+ & ins]t+ ,subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d1 9 e/abli%+2 & 7,e7 9 subsection 7g77#a71 by ins]t+ & sections #ahii;,b1 #ahii;,c1 & #ahii;,d aft] p>agraphs 7#d7 & 7#e74 7#c7 ,section #aije7p77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#c77 is am5d$-- 7,a7 9 subp>agraph 7,b71 by /rik+ section #ahac & ins]t+ sections #ahac & #ahii;,d2 & 7,b7 9 subp>agraph 7,c71 by /rik+ & section #ahcc7;b7 & ins]t+ 1 #ahcc7;b71 & #ahii;,c4 #bjad4 ,prohibition on fir/-doll> cov]age "u ,m$igap policies & developm5t ( new /&>ds = ,m$igap policies ,section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is am5d$ by add+ at ! end ! foll[+ new subsections3 7z7 ,prohibition on fir/-,doll> cov]age & developm5t ( new /&>ds = m$ic>e supplem5tal policies 7#a7 ,developm5t ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to review & revise ! /&>ds = b5efit packages "u subsection 7p77#a71 tak+ into acc\nt ! *anges 9 b5efits result+ f ! enactm5t ( ! ,fiscal ,su/a9ability ,act ( #bjac & to o!rwise update /&>ds to include ! requirem5ts = co/-%>+ describ$ 9 p>agraph 7#b74 ,su* revisions %all be made consi/5t ) ! rules applicable "u subsection 7p77#a77;,e7 ) ! ref]5ce to ! #aiia ,,naic ,model ,regulation' deem$ a ref]5ce to ! ,,naic ,model ,regulation z publi%$ 9 ! ,f$]al ,regi/] on ,decemb] #d1 #aiih1 & z subsequ5tly updat$ by ! ,national ,association ( ,insurance ,commission]s to reflect previ\s *anges 9 law & ! ref]5ce to #8date ( enactm5t ( ?is subsection deem$ a ref]5ce to ! date ( enactm5t ( ! ,fiscal ,su/a9ability ,act ( #bjac4 ,to ! ext5t practicable1 su* revision %all provide = ! implem5tation ( revis$ /&>ds = b5efit packages z ( ,janu>y #a1 #bjae4 7#b7 ,co/-%>+ requirem5ts ,! co/-%>+ requirem5ts describ$ 9 ?is p>agraph are t1 not)/&+ any o!r provision ( law1 no m$ic>e supplem5tal policy may provide = cov]age (-- 7,a7 any portion ( ! unifi$ d$uctible "u section #ahii;,c7b7 = ! ye>2 & 7,b7 m ?an #ej p]c5t ( ! co/-%>+ 7exclud+ premiums7 o!rwise applicable "u p>ts ,a & ,b aft] ! individual has met ! unifi$ d$uctible "u section #ahii;,c7b7 = ! ye> & be=e ! individual has rea*$ ! fir/ ?re%old annual out-(-pocket limit "u section #ahii;,b7b77#a7 = ! ye>4 7#c7 ,r5ewability ,! r5ewability requirem5t "u subsection 7q77#a7 %all be satisfi$ ) ! r5ewal ( ! revis$ package "u p>agraph 7#a7 t mo/ closely mat*es ! policy 9 :i* ! individual 0 enroll$ prior to su* revision4 7aa7 ,limitation on issu+ new m$ic>e supplem5tal policies aft] #bjaf 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 a m$ic>e supplem5tal policies may n be issu$ to an individual aft] ,decemb] #ca1 #bjaf1 unless ! individual 0 cov]$ "u a m$ic>e supplem5tal policy z ( su* date4 7#b7 ,r5ewals & new policies ,no?+ 9 ?is subsection %all be con/ru$ z prohibit+-- 7,a7 ! r5ewal aft] ,decemb] #ca1 #bjaf1 ( a m$ic>e supplem5tal policy t 0 issu$ on or be=e su* date2 or 7,b7 ! issuance ( a new m$ic>e supplem5tal policy aft] su* date z long z ! individual 0 cov]$ "u any m$ic>e supplem5tal policy z ( su* date4 4 ,,iii ,annual report to ,congress #bjba4 ,annual report to ,congress 7a7 ,9 g5]al ,n lat] ?an ,july #a1 #bjaf1 & annually !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ! ,committee on ,f9ance & ! ,special ,committee on ,ag+ ( ! ,s5ate & to ! ,committee on ,ways & ,means & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives a report on ! provisions (1 & am5dm5ts made by1 p>ts ,i & ,,ii4 7b7 ,cont5ts ,! report submitt$ "u subsection 7a7 %all conta9 ! foll[+ in=mation3 7#a7 ,an evaluation ( ! f9ancial impact ( su* provisions & am5dm5ts4 7#b7 ,an evaluation ( *anges 9 access to physicians & o!r heal? c>e provid]s z a result ( su* provisions & am5dm5ts4 7#c7 ,an evaluation ( *anges 9 b5efici>y satisfaction "u ! ,m$ic>e program z a result ( su* provisions & am5dm5ts4 7#d7 ,su* o!r in=mation z ! ,secret>y det]m9es to be appropriate4 ,b ,elim9ation ( exemption ( ,m$ic>e paym5ts to physicians "u /atutory ,,paygo #baja4 ,elim9ation ( exemption ( ,m$ic>e paym5ts to physicians "u /atutory ,,paygo 7a7 ,9 g5]al ,section #g ( ! ,/atutory ,pay-,z-,y-,g ,act ( #bjaj 7#b ,u4,s4,c4 #icf7 is am5d$-- 7#a7 9 subsection 7a71 by /rik+ p>agraph 7#a72 & 7#b7 by /rik+ subsection 7c74 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect on ! date ( ! enactm5t ( ?is ,act4 ,c ,adju/m5ts to ,m$ic>e "p ,b & ,d premiums = high-,income b5efici>ies #bbja4 ,adju/m5ts to ,m$ic>e "p ,b & ,d premiums = high-income b5efici>ies 7a7 ,9 g5]al ,section #ahci7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77 is am5d$-- 7#a7 9 p>agraph 7#b77;,a71 by ins]t+ 7or1 9 ! case ( #bjac or a subsequ5t ye>1 #ej1jjj7 aft] #hj1jjj2 & 7#b7 9 p>agraph 7#c7-- 7,a7 9 subp>agraph 7,a77i7-- 7i7 by ins]t+ applicable be=e table2 & 7ii7 by ins]t+ & ye> aft] individual2 & 7,b7 9 subp>agraph 7,c77i7-- 7i7 by /rik+ 7i7 ,9 g5]al4-- & ins]t+ 7i77,i7 ,= #bjjg ?r\gh #bjab4--;,= ea* ( #bjjg ?r\gh #bjab32 & 7ii7 by add+ at ! end ! foll[+ new subclause3 7,,ii7 ,= #bjac & subsequ5t ye>s ,= #bjac or a subsequ5t ye>3 ,if ! modifi$ adju/$ gross income is3,! applicable p]c5tage is3 ,m ?an #ej1jjj b n m ?an #he1jjjce p]c5t ,m ?an #he1jjj b n m ?an #ajg1jjjdj p]c5t ,m ?an #ajg1jjj b n m ?an #afj1jjjee p]c5t ,m ?an #afj1jjj b n m ?an #bad1jjjgj p]c5t ,m ?an #bad1jjj b n m ?an #bej1jjjhe p]c5t ,m ?an #bej1jjjajj p]c5t4 4 7b7 ,ext5sion ( tempor>y adju/m5t to income ?re%olds 7#a7 ,9 g5]al ,section #ahci7;i77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#f77 is am5d$-- 7,a7 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ ,decemb] #ca1 #bjai & ins]t+ ,decemb] #ca1 #bjba2 7,b7 9 subp>agraph 7,a71 by /rik+ equal to su* am\nt = #bjaj2 & & ins]t+ ! foll[+3 8equal to-- 7i7 9 ! case ( ea* ( #bjaa & #bjab1 su* am\nt = #bjaj2 & 7ii7 9 ! case ( ea* ( #bjac ?r\gh #bjba1 su* am\nt = #bjac2 & 2 & 7,c7 9 subp>agraph 7,b71 by /rik+ equal to su* doll> am\nts = #bjaj4 & ins]t+ ! foll[+3 8equal to-- 7i7 9 ! case ( ea* ( #bjaa & #bjab1 su* doll> am\nts = #bjaj2 & 7ii7 9 ! case ( ea* ( #bjac ?r\gh #bjba1 su* doll> am\nts = #bjac4 4 7#b7 ,con=m+ am5dm5t ,section #ahci7;i77#e77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#e77;,a77 is am5d$ by ins]t+ = su* ye> aft] p>agraph 7#b7 or 7#c72 ,d ,increase 9 ! ,m$ic>e eligibility age #bcja4 ,increase 9 ! ,m$ic>e eligibility age ,section #bbf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dbf7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7k7 ,increas+ ,m$ic>e qualify+ age 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 any ref]5ce 9 ?is section1 title ,,xviii1 or title ,,xix 7ins(> z x relates to ! eligibility age = ,m$ic>e b5efits "u title ,,xviii7 to age #fe %all be deem$ a ref]5ce to ! ,m$ic>e qualify+ age specifi$ 9 p>agraph 7#b74 7#b7 ,m$ic>e qualify+ age specifi$ ,! ,m$ic>e qualify+ age specifi$ 9 ?is p>agraph is det]m9$ z foll[s3 7,a7 ,9 ! case ( an individual :o atta9s #fe ye>s ( age be=e ,janu>y #a1 #bjad1 ! ,m$ic>e qualify+ age is #fe ye>s ( age4 7,b7 ,9 ! case ( an individual :o atta9s #fe ye>s ( age 9 a ye> aft] #bjac1 & be=e #bjbe1 ! ,m$ic>e qualify+ age is ! ,m$ic>e qualify+ age specifi$ 9 ?is p>agraph = ! previ\s ye> increas$ by #b mon?s4 7,c7 ,9 ! case ( an individual :o atta9s #fe ye>s ( age 9 a ye> aft] #bjbd1 ! ,m$ic>e qualify+ age is #fg ye>s ( age4 4 ,e ,o!r provisions #bdja4 ,limitation on ,m$ic>e paym5ts = direct graduate m$ical education 7,,dgme7 ,section #ahhf7;h77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#b77;,d77 is am5d$ by add+ at ! end ! foll[+ new clause3 7v7 ,cap on approv$ ,,fte resid5t am\nt 7,i7 ,9 g5]al ,! approv$ ,,fte resid5t am\nt = a hospital = a co/ report+ p]iod beg9n+ dur+ fiscal ye> #bjad or a subsequ5t fiscal ye> %all n be m ?an ! applicable am\nt = ! ye>4 7,,ii7 ,applicable am\nt ,= purposes ( subclause 7,i71 ! applicable am\nt = a ye> %all be an am\nt equal to #abj p]c5t ( ! national av]age sal>y paid to resid5ts 9 #bjaj1 updat$ ?r\gh ! ye> involv$ by ! ,*a9$ ,consum] ,price ,index4 7,,iii7 ,*a9$ ,consum] ,price ,index ,9 subclause 7,,ii71 ! t]m ,*a9$ ,consum] ,price ,index means ! initial ,*a9$ ,consum] ,price ,index = all-urban consum]s publi%$ by ! ,dep>tm5t ( ,labor4 4 #bdjb4 ,r$uction 9 ,m$ic>e indirect graduate m$ical education 7,,ime7 paym5ts 7a7 ,9 g5]al ,section #ahhf7;d77#e77;,b77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77ii77 is am5d$-- 7#a7 9 subclause 7,,xi71 by /rik+ & at ! end2 7#b7 9 subclause 7,,xii7-- 7,a7 by ins]t+ & be=e ,octob] #a1 #bjac1 aft] #bjjg12 & 7,b7 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new subclause3 7,,xiii7 on or aft] ,octob] #a1 #bjac1 c is equal to #j4ed4 4 7b7 ,con=m+ am5dm5t relat+ to det]m9ation ( /&>diz$ am\nt ,section #ahhf7;d77#b77;,c77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#b77;,c77i77 is am5d$ by ins]t+ or ( section #bdjb7;a7 ( ! ,fiscal ,su/a9ability ,act ( #bjac aft] ,act ( #aiig4 #bdjc4 ,accel]ation ( application ( productivity adju/m5t to ,m$ic>e home heal? prospective paym5t am\nts ,section #ahie7;b77#c77;,b77vi77,i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,b77vi77,i77 is am5d$ by /rik+ #bjae & ins]t+ #bjad4 #bdjd4 ,accel]ation ( rebas+ ( ,m$ic>e home heal? prospective paym5t am\nts ,section #ahie7;b77#c77;,a77iii77,,ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,a77iii77,,ii77 is am5d$-- 7#a7 9 ! fir/ s5t5ce-- 7,a7 by /rik+ #d-ye> & ins]t+ #b-ye>2 & 7,b7 by /rik+ #bjag & ins]t+ #bjae2 & 7#b7 by /rik+ ! second s5t5ce4 #bdje4 ,r$uction ( bad debt treat$ z an all[able co/ 7a7 ,hospitals ,section #ahfa7v77#a77,t7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,t77 is am5d$-- 7#a7 9 clause 7iv71 by /rik+ & at ! end2 7#b7 9 clause 7v7-- 7,a7 by /rik+ or a subsequ5t fiscal ye>2 & 7,b7 by /rik+ ! p]iod at ! end & ins]t+ a comma2 & 7#c7 by add+ at ! end ! foll[+3 7vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjad1 by #dh p]c5t ( su* am\nt o!rwise all[able1 7vii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjae1 by #fa p]c5t ( su* am\nt o!rwise all[able1 7viii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #gd p]c5t ( su* am\nt o!rwise all[able1 7ix7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #hg p]c5t ( su* am\nt o!rwise all[able1 & 7x7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ajj p]c5t ( su* am\nt o!rwise all[able4 4 7b7 ,skill$ nurs+ facilities ,section #ahfa7v77#a77,v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,v77 is am5d$-- 7#a7 by mov+ subclauses 7,i7 & 7,,ii7 ( clause 7i7 & subclauses 7,i7 ?r\gh 7,,iv7 ( clause 7ii7 two ems to ! "r2 & 7#b7 9 clause 7i7-- 7,a7 9 subclause 7,i71 by /rik+ & at ! end2 7,b7 9 subclause 7,,ii7-- 7i7 by /rik+ or a subsequ5t fiscal ye>2 & 7ii7 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7,c7 by add+ at ! end ! foll[+3 7,,iii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjad1 by #dh p]c5t ( su* am\nt o!rwise all[able2 7,,iv7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjae1 by #fa p]c5t ( su* am\nt o!rwise all[able2 7,v7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #gd p]c5t ( su* am\nt o!rwise all[able2 7,,vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #hg p]c5t ( su* am\nt o!rwise all[able2 & 7,,vii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ajj p]c5t ( su* am\nt o!rwise all[able4 4 7c7 ,c]ta9 o!r provid]s ,section #ahfa7v77#a77,w77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,w77i77 is am5d$-- 7#a7 9 subclause 7,,ii71 by /rik+ & at ! end2 7#b7 9 subclause 7,,iii7-- 7,a7 by /rik+ a subsequ5t fiscal ye> & ins]t+ fiscal ye> #bjae2 & 7,b7 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+3 7,,iv7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #dh p]c5t ( su* am\nt o!rwise all[able2 7,v7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #fa p]c5t ( su* am\nt o!rwise all[able2 7,,vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah1 by #gd p]c5t ( su* am\nt o!rwise all[able2 7,,vii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjai1 by #hg p]c5t ( su* am\nt o!rwise all[able2 & 7,,viii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjbj or a subsequ5t fiscal ye>1 by #ajj p]c5t ( su* am\nt o!rwise all[able4 4 ,,iii ,social ,security #caja4 ,adju/m5ts to b5d po9ts 9 det]m9+ prim>y insurance am\nt ,section #bae7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7;a77#a77 is am5d$-- 7#a7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i71 by ins]t+ :o initially becomes eligible = old-age or disability insurance b5efits1 or :o dies 7be=e becom+ eligible = su* b5efits71 9 any cal5d> ye> aft] #aigi & be=e #bjag aft] individual2 7#b7 9 subp>agraph 7,b77ii71 9 ! matt] prec$+ subclause 7,i71 by ins]t+ & be=e #bjag aft] aft] #aigi2 7#c7 9 subp>agraph 7,c77i71 by ins]t+ or 7,e7 aft] 7,a72 & 7#d7 by add+ at ! end ! foll[+3 7,e7 7i7 ,! prim>y insurance am\nt ( an individual :o initially becomes eligible = old-age or disability insurance b5efits1 or :o dies 7be=e becom+ eligible = su* b5efits71 9 any cal5d> ye> aft] #bjaf %all 7except z o!rwise provid$ 9 ?is section7 be equal to ! sum (-- 7,i7 #ij p]c5t ( ! individual's av]age index$ mon?ly e>n+s 7det]m9$ "u subsection 7b77 to ! ext5t t su* e>n+s d n exce$ ! am\nt e/abli%$ = purposes ( ?is subclause by clause 7ii71 7,,ii7 #cj p]c5t ( ! individual's av]age index$ mon?ly e>n+s to ! ext5t t su* e>n+s exce$ ! am\nt e/abli%$ = purposes ( subclause 7,i7 b d n exce$ ! am\nt e/abli%$ = purposes ( ?is subclause by clause 7ii71 7,,iii7 #aj p]c5t ( ! individual's av]age index$ mon?ly e>n+s to ! ext5t t su* e>n+s exce$ ! am\nt e/abli%$ = purposes ( subclause 7,,ii7 b d n exce$ ! am\nt e/abli%$ = purposes ( ?is subclause by clause 7ii71 & 7,,iv7 #e p]c5t ( ! individual's av]age index$ mon?ly e>n+s to ! ext5t t su* e>n+s exce$ ! am\nt e/abli%$ = purposes ( subclause 7,,iii71 r\nd$1 if n a multiple ( #j4aj1 to ! next l[] multiple ( #j4aj1 & !reaft] increas$ z provid$ 9 subsection 7i74 7ii7 ,= individuals :o initially become eligible = old-age or disability insurance b5efits1 or :o die 7be=e becom+ eligible = su* b5efits7 9 ! cal5d> ye> #bjag or lat]1 ! am\nt e/abli%$ = purposes ( subclauses 7,i71 7,,ii71 & 7,,iii7 ( subp>agraph 7,e77i7 %all be #ahj1 #gcf1 & #a1jhe1 respectively1 z if su* am\nt 0 applicable ) respect to #aigi & 0 adju/$ = ye>s aft] #aigi 9 ! same mann] z provid$ "u subp>agraph 7,b77ii71 )\t reg>d to ! limitation t su* adju/m5t only applies to individuals :o initially become eligible = old-age b5efits or disability insurance b5efits1 or :o die 7be=e becom+ eligible = b5efits7 be=e #bjag4 7iii7 7,i7 ,not)/&+ clauses 7i7 & 7ii71 9 ! case ( any individual :o becomes eligible = old-age or disability insurance b5efits1 or :o dies 7be=e becom+ eligible = su* b5efits7 9 any cal5d> ye> aft] #bjaf & be=e #bjea1 ! prim>y insurance am\nt ( ! individual %all be equal to ! sum (-- 7aa7 ! prim>y insurance am\nt det]m9$ = ! individual "u subp>agraphs 7,a7 & 7,b7 7)\t reg>d to ! limitation t su* subp>agraphs apply only to individuals :o initially become eligible = old-age b5efits or disability insurance b5efits1 or :o die 7be=e becom+ eligible = b5efits7 be=e #bjag7 multipli$ by ! applicable phase-9 factor = ! cal5d> ye> "u subclause 7,,ii72 & 7bb7 ! prim>y insurance am\nt det]m9$ = ! individual "u ?is subp>agraph 7o!r ?an "u ?is clause7 multipli$ by ! applicable phase-9 factor = ! cal5d> ye> "u subclause 7,,ii74 7,,ii7 ,= purposes (-- 7aa7 subclause 7,i77aa71 ! applicable phase-9 factor = cal5d> ye> #bjag1 is ! quoti5t ( #cc divid$ by #cd1 & = ea* ye> !reaft] is ! quoti5t (-- 7,,aa7 ! num]ator applicable = ! prec$+ ye> r$uc$ by #a1 divid$ by 7,,bb7 #cd2 & 7bb7 subclause 7,i77bb71 ! applicable phase-9 factor = cal5d> ye> #bjag is ! quoti5t ( #a divid$ by #cd1 & = ea* ye> !reaft] is ! quoti5t (-- 7,,aa7 ! num]ator applicable = ! prec$+ ye> increas$ by #a1 divid$ by 7,,bb7 #cd4 4 #cajb4 ,adju/m5t to calculation ( b5efit computation ye>s 7a7 ,9 g5]al ,clause 7i7 ( section #bae7;b77#b77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7;b77#b77;,a77 is am5d$ to read z foll[s3 7i7 9 ! case ( an individual :o is entitl$ to old-age insurance b5efits 7except z provid$ 9 ! second s5t5ce ( ?is subp>agraph71 or :o has di$-- 7,i7 be=e ,janu>y #a1 #bjad1 by #e ye>s2 7,,ii7 aft] ,decemb] #ca1 #bjac1 & be=e ,janu>y #a1 #bjae1 by #d ye>s2 7,,iii7 aft] ,decemb] #ca1 #bjad1 & be=e ,janu>y #a1 #bjaf1 by #c ye>s2 & 7,,iv7 aft] ,decemb] #ca1 #bjae1 & be=e ,janu>y #a1 #bjag1 by #b ye>s2 & 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to b5efits payable = mon?s beg9n+ aft] ,decemb] #ca1 #bjac4 #cajc4 ,m9imum ,social ,security b5efit 7a7 ,9 g5]al ,section #bae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7 is am5d$ by add+ at ! end ! foll[+3 7j7 ,m9imum mon?ly insurance b5efit 7#a7 ,not)/&+ ! prec$+ provisions ( ?is section-- 7,a7 subject to p>agraph 7#c71 ! prim>y insurance am\nt ( any individual :o is cr$it$ ) at lea/ #aj ye>s ( cov]age & :o initially becomes eligible = old-age or disability insurance b5efits or dies 7be=e becom+ eligible = su* b5efits7 = a mon? beg9n+ aft] ,decemb] #ca1 #bjaf 79 ?is subsection ref]r$ to z a qualifi$ individual71 %all be equal to ! great] (-- 7i7 ! prim>y insurance am\nt det]m9$ "u ?is section 7)\t reg>d to ?is subsection71 or 7ii7 ! m9imum mon?ly insurance b5efit det]m9$ "u p>agraph 7#b71 & 7,b7 any recomputation ( ! prim>y insurance am\nt ( a qualifi$ individual %all n result 9 a prim>y insurance am\nt less ?an ! prim>y insurance am\nt z 9 effect imm$iately prior to su* recomputation4 7#b7 ,= purposes ( ?is subsection1 ! t]m m9imum mon?ly insurance b5efit means #a_/ab ( ! applicable p]c5tage ( ! adju/$ m9imum b5efit level 7z def9$ 9 p>agraph 7#e774 7#c7 7,a7 ,= purposes ( ?is subsection1 subject to subp>agraph 7,b71 ! applicable p]c5tage %all be #abe p]c5t r$uc$ by ! numb] ( p]c5tage po9ts det]m9$ "u subp>agraph 7,b77ii7 = ea* ye> ( cov]age ( ! qualifi$ individual less ?an #cj4 7,b7 7i7 ,9 ! case ( an individual :o initially becomes eligible = disability insurance b5efits "u section #bbc be=e atta9+ age #fb1 or :o dies be=e atta9+ age #fb1 9 a mon? beg9n+ aft] ,decemb] #ca1 #bjaf1 & :o is cr$it$ ) at lea/ #e ye>s ( cov]age1 ! individual %all be treat$ z a qualifi$ individual & ! applicable p]c5tage %all be #abe r$uc$ by ! numb] ( p]c5tage po9ts det]m9$ "u clause 7ii7 = ea* ye> ( cov]age ( ! qualifi$ individual less ?an ! numb] z det]m9$ "u clause 7iii74 7ii7 ,! numb] ( p]c5tage po9ts "u ?is clause %all be det]m9$ by-- 7,i7 divid+ ! numb] ( ! qualify+ individual's elaps$ ye>s 7z def9$ 9 subsection 7b77#b77;,b77iii77 by #dj2 7,,ii7 multiply+ ! result "u subclause 7,i7 by #bj2 & 7,,iii7 divid+ #abe by ! result "u subclause 7,,ii7 & r\nd+ to ! ne>e/ "o hundr$? ( #a p]c5tage po9t4 7iii7 ,! numb] ( ye>s ( cov]age "u ?is clause %all be det]m9$ by multiply+ ! ratio det]m9$ "u clause 7ii77,i7 by #cj & r\nd+ to ! next l[] :ole numb]4 7#d7 ,= purposes ( ?is subsection1 a ye> ( cov]age is a cal5d> ye> = :i* an individual is cr$it$ ) #d qu>t]s ( cov]age4 7#e7 ,= purposes ( ?is subsection-- 7,a7 = individuals :o initially become eligible = old-age or disability insurance b5efits or die 7be=e becom+ eligible = su* b5efits7 9 #bjag1 ! t]m adju/$ m9imum b5efit level means ! weight$ av]age ( ! ,f$]al pov]ty ?re%old applicable to a family ( #a = #bjji 7z det]m9$ by ! ,bureau ( ! ,c5sus71 increas$ = ea* ye> occurr+ aft] #bjji & be=e #bjah1 by ! p]c5tage increase 7r\nd$ to ! ne>e/ "o-t5? ( #a p]c5t7 9 ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s 7z publi%$ by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor7 = ea* su* ye>2 & 7,b7 = individuals :o initially become eligible = old-age or disability insurance b5efits or die 7be=e becom+ eligible = su* b5efits7 9 a ye> aft] #bjag1 ! t]m adju/$ m9imum b5efit level means ! am\nt specifi$ 9 subp>agraph 7,a71 multipli$ by ! quoti5t describ$ 9 subsection 7b77#c77;,a77ii71 except t ! ref]5ce to ! computation base ye> = :i* ! det]m9ation is made 9 su* subsection %all be deem$ in/ead to be a ref]5ce to #bjji4 7#f7 ,! provisions ( ?is subsection %all n apply 9 ! case ( an individual ^: prim>y insurance am\nt w\ld o!rwise be comput$ "u subsection 7a77#g74 4 7b7 ,con=m+ am5dm5t ,section #bjb7;a7 ( su* ,act 7#db ,u4,s4,c4 #djb7;a77 is am5d$ 9 ! la/ s5t5ce by /rik+ section #bae7;a7 & ins]t+ section #bae4 #cajd4 ,increase 9 b5efits />t+ #bj ye>s aft] initial eligibility 7a7 ,9 g5]al ,section #bae ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae71 z am5d$ by ?is ,act1 is am5d$ by add+ at ! end ! foll[+ new subsection3 7k7 ,increas$ mon?ly insurance b5efit aft] #bj ye>s ( initial eligibility 7#a7 ,not)/&+ ! prec$+ provisions ( ?is section1 9 ! case ( an individual :o is a #bj-ye> b5efici>y1 ! prim>y insurance am\nt ( ! individual 7z det]m9$ be=e ! application ( ?is subsection7 %all be increas$ = mon?s beg9n+ ) ! fir/ mon? = :i* ! individual atta9s su* /atus by ! am\nt equal to ! applicable p]c5tage ( ! applicable av]age prim>y insurance am\nt4 7#b7 ,= purposes ( ?is subsection1 ! t]m #bj-ye> b5efici>y means an individual :o has be5 eligible = old-age insurance b5efits or disability insurance b5efits "u ?is title = at lea/ #bdj mon?s4 7#c7 ,= purposes ( p>agraph 7#a71 ! t]m applicable av]age prim>y insurance am\nt means1 ) respect to a #bj-ye> b5efici>y1 ! prim>y insurance am\nt det]m9$ by ! ,commission] ( ,social ,security t w\ld apply to an individual ( ! same age z ! age at :i* ! #bj-ye> b5efici>y fir/ atta9s su* /atus1 if ! individual _h e>n+s = ea* cal5d> ye> 9 :i* ! individual w\ld h atta9$ ages #bj ?r\gh ! ye> prior to ! age ( eligibility1 respectively1 equal to ! national av]age e>n+s = all su* individuals = ea* su* ye>4 7#d7 ,= purposes ( p>agraph 7#a71 ! applicable p]c5tage is-- 7,a7 = ea* mon? occurr+ dur+ ! fir/ #ab-mon? p]iod = :i* an individual is a #bj-ye> b5efici>y1 #a p]c5t2 7,b7 = ea* mon? occurr+ dur+ ! second #ab-mon? p]iod = :i* an individual is su* a b5efici>y1 #b p]c5t2 7,c7 = ea* mon? occurr+ dur+ ! ?ird #ab-mon? p]iod = :i* an individual is su* a b5efici>y1 #c p]c5t2 7,d7 = ea* mon? occurr+ dur+ ! f\r? #ab-mon? p]iod = :i* an individual is su* a b5efici>y1 #d p]c5t2 & 7,e7 = ea* mon? occurr+ !reaft]1 #e p]c5t4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to b5efits payable = mon?s beg9n+ aft] ,decemb] #ca1 #bjac4 #caje4 ,adju/m5t to normal & e>ly retirem5t ages ,section #baf7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #daf7l77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,d71 by /rik+ 2 & & ins]t+ a semicolon2 & 7,b7 by /rik+ subp>agraph 7,e7 & ins]t+ ! foll[+ new subp>agraphs3 7,e7 ) respect to an individual :o atta9s e>ly retirem5t age aft] ,decemb] #ca1 #bjba1 & be=e ,janu>y #a1 #bjbc1 #fg ye>s ( age2 7,f7 ) respect to an individual :o1 dur+ ! p]iod aft] ,decemb] #ca1 #bjbb1 & be=e ,janu>y #a1 #bjgj-- 7i7 = purposes ( p>agraph 7#b77;,a77ii71 atta9s #fb ye>s ( age1 su* individual's e>ly retirem5t age plus #fj mon?s2 or 7ii7 atta9s e>ly retirem5t age pursuant to p>agraph 7#b77;,b71 #fg ye>s plus ! numb] ( mon?s det]m9$ "u ! age increase factor = ! cal5d> ye> 9 :i* su* individual atta9s e>ly retirem5t age2 & 7,g7 ) respect to an individual :o-- 7i7 = purposes ( p>agraph 7#b77;,a77iii71 atta9s #fb ye>s ( age aft] ,decemb] #ca1 #bjfi1 #fi ye>s ( age2 or 7ii7 atta9s e>ly retirem5t age pursuant to p>agraph 7#b77;,b7 aft] ,decemb] #ca1 #bjfi1 #fi ye>s ( age4 2 7#b7 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 ,! t]m e>ly retirem5t age means-- 7,a7 9 ! case ( an old-age1 wife's1 or husb&'s insurance b5efit-- 7i7 #fb ye>s ( age ) respect to an individual :o atta9s su* age be=e ,janu>y #a1 #bjbc2 7ii7 ) respect to an individual :o atta9s #fb ye>s ( age aft] ,decemb] #ca1 #bjbb1 & be=e ,janu>y #a1 #bjgj1 #fb ye>s ( age plus ! numb] ( mon?s det]m9$ "u ! age increase factor = ! cal5d> ye> 9 :i* su* individual atta9s #fb ye>s ( age2 & 7iii7 ) respect to an individual :o atta9s age #fb aft] ,decemb] #ca1 #bjfi1 #fd ye>s ( age2 or 7,b7 9 ! case ( a wid['s or wid[]'s insurance b5efit1 #fj ye>s ( age4 2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,! age increase factor %all be equal to #a_/bd ( ! numb] ( mon?s 7r\nd$ d[n to a full mon?7 9 ! p]iod beg9n+ ) ,janu>y #bjbc & end+ ) ,decemb] ( ! ye> 9 :i*-- 7,a7 = purposes ( p>agraph 7#a77;,f77ii71 ! individual atta9s #fj ye>s ( age2 or 7,b7 = purposes ( p>agraph 7#b77;,a77ii71 ! individual atta9s #fb ye>s ( age4 4 #cajf4 ,application ( actu>ial r$uction = disabl$ b5efici>ies :o atta9 e>ly retirem5t age 7a7 ,9 g5]al ,section #bjb7k77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #djb7k77#d77 is am5d$ to read z foll[s3 7#d7 7,a7 ,subject to subp>agraph 7,b71 any individual :o1 "u ?is section & section #bbc1 is entitl$ = any mon? to bo? an old-age insurance b5efit & a disability insurance b5efit "u ?is title %all be entitl$ to only ! l>g] ( su* b5efits = su* mon?1 except t1 if su* individual s elects1 he %all in/ead be entitl$ to only ! small] ( su* b5efits = su* mon?4 7,b7 ,an individual describ$ 9 subp>agraph 7,a7 :o has atta9$ transitional retirem5t age 7z det]m9$ "u subp>agraph 7,c77 %all only be entitl$ to ! old-age insurance b5efit = su* mon?1 z r$uc$ = su* mon? pursuant to subsection 7q77#a74 7,c7 ,= purposes ( subp>agraph 7,b71 ! t]m transitional retirem5t age means-- 7i7 ) respect to an individual :o atta9s #fb ye>s ( age be=e ,janu>y #a1 #bjad1 #ff ye>s ( age2 7ii7 ) respect to an individual :o atta9s #fb ye>s ( age aft] ,decemb] #ca1 #bjac1 & be=e ,janu>y #a1 #bjbe1 #ff ye>s ( age r$uc$ by ! numb] ( mon?s det]m9$ "u ! transition factor 7z det]m9$ "u subp>agraph 7,d77 = ! cal5d> ye> 9 :i* su* individual atta9s #fb ye>s ( age2 & 7iii7 ) respect to an individual :o atta9s #fb ye>s ( age aft] ,decemb] #ca1 #bjbd1 #fd ye>s ( age4 7,d7 ,= purposes ( subp>agraph 7,c77ii71 ! transition factor %all be equal to two-twelf?s ( ! numb] ( mon?s 9 ! p]iod beg9n+ ) ,janu>y #bjad & end+ ) ,decemb] ( ! ye> 9 :i* ! individual atta9s #fb ye>s ( age4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,p]iod ( disability ,clause 7i7 ( section #baf7;i77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #daf7;i77#b77;,d77 is am5d$ by /rik+ retirem5t age 7z def9$ 9 subsection 7l77 & ins]t+ transitional retirem5t age 7z def9$ 9 section #baf7k77#d774 7#b7 ,disability insurance b5efit paym5ts ,section #bbc7;a77#a7 ( ! ,social ,security 7#db ,u4,s4,c4 #dbc7;a77#a77 is am5d$-- 7,a7 9 subp>agraph 7,b71 by /rik+ retirem5t age 7z def9$ 9 section #baf7l77 & ins]t+ transitional retirem5t age 7z def9$ 9 section #baf7k77#d772 & 7,b7 9 ! flu% matt] at ! end1 by /rik+ retirem5t age 7z def9$ 9 section #baf7l77 & ins]t+ transitional retirem5t age 7z def9$ 9 section #baf7k77#d774 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to b5efits payable = mon?s beg9n+ aft] ,decemb] #ca1 #bjac4 #cajg4 ,option to collect up to "o-half ( old-age insurance b5efit at age #fb 7a7 ,9 g5]al ,section #bjb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #djb7 is am5d$ by add+ at ! end ! foll[+3 7z7 ,option to collect up to "o-,half ( old-,age insurance b5efit beg9n+ at age #fb 7#a7 ,n lat] ?an ,janu>y #a1 #bjad1 ! ,commission] ( ,social ,security %all e/abli% an option1 subject to su* regulations z are prescrib$ by ! ,commission] "u p>agraph 7#b71 = a fully insur$ individual 7z def9$ 9 section #bad7 to elect to receive a r$uc$ mon?ly b5efit aft] su* individual atta9s #fb ye>s ( age1 consi/+ ( ! foll[+3 7,a7 ,subject to p>agraph 7#c71 = mon?s beg9n+ ) ! mon? 9 :i* ! individual atta9s age #fb1 a mon?ly b5efit equal to su* p]c5tage z is elect$ by ! individual1 b :i* %all n be great] ?an #ej p]c5t1 ( ! prim>y insurance am\nt det]m9$ = ! individual at age #fb4 7,b7 ,= mon?s beg9n+ ) ! mon? 9 :i* ! individual atta9s e>ly retirem5t age1 a mon?ly b5efit equal to ! sum (-- 7i7 ! mon?ly b5efit payable to ! individual "u subp>agraph 7,a72 & 7ii7 ! am\nt equal to ! applicable p]c5tage 7z det]m9$ "u subp>agraph 7,c77 ( prim>y insurance am\nt det]m9$ = ! individual "u section #bae = su* mon? 7det]m9$ )\t reg>d to any election "u ?is subsection74 7,c7 ,= purposes ( subp>agraph 7,b77ii71 ! applicable p]c5tage %all be equal to ! diff]5ce betwe5-- 7i7 #ajj p]c5t2 & 7ii7 ! p]c5tage elect$ by ! individual "u subp>agraph 7,a74 7#b7 ,an individual %all elect ! option "u ?is subsection 9 accordance ) regulations prescrib$ by ! ,commission] ( ,social ,security4 7#c7 ,! mon?ly b5efit payable to an individual "u p>agraph 7#a77;,a7 %all be subject to r$uction z provid$ 9 subsection 7q74 4 7b7 ,con=m+ am5dm5t ,section #bjb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #djb7;a77 is am5d$ 9 ! la/ s5t5ce1 by /rik+ subsection 7q7 & subsection 7w7 & ins]t+ subsections 7q71 7w71 & 7z74 #cajh4 ,cov]age ( newly hir$ ,/ate & local employees 7a7 ,am5dm5ts to ! ,social ,security ,act 7#a7 ,9 g5]al ,p>agraph 7#g7 ( section #baj7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #daj7;a77#g77 is am5d$ to read z foll[s3 7#g7 ,exclud$ ,/ate or local gov]nm5t employm5t 7z def9$ 9 subsection 7s772 4 7#b7 ,exclud$ /ate or local gov]nm5t employm5t 7,a7 ,9 g5]al ,section #baj ( su* ,act 7#db ,u4,s4,c4 #daj7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7s7 ,exclud$ /ate or local gov]nm5t employm5t 7#a7 ,9 g5]al ,! t]m exclud$ ,/ate or local gov]nm5t employm5t means any s]vice p]=m$ 9 ! employ ( a ,/ate1 ( any political subdivision !re(1 or ( any in/rum5tality ( any "o or m ( ! =ego+ :i* is :olly own$ !reby1 if-- 7,a7 7i7 su* s]vice w\ld be exclud$ f ! t]m employm5t = purposes ( ?is title if ! prec$+ provisions ( ?is section z 9 effect 9 ,decemb] #bjbj _h rema9$ 9 effect1 & 7ii7 ! requirem5ts ( p>agraph 7#b7 are met ) respect to su* s]vice1 or 7,b7 ! requirem5ts ( p>agraph 7#c7 are met ) respect to su* s]vice4 7#b7 ,exception = curr5t employm5t :i* cont9ues 7,a7 ,9 g5]al ,! requirem5ts ( ?is p>agraph are met ) respect to s]vice = any employ] if-- 7i7 su* s]vice is p]=m$ by an individual-- 7,i7 :o 0 p]=m+ sub/antial & regul> s]vice = remun]ation = t employ] be=e ,janu>y #a1 #bjba1 7,,ii7 :o is a bona fide employee ( t employ] on ,decemb] #ca1 #bjbj1 & 7,,iii7 ^: employm5t relation%ip ) t employ] 0 n ent]$ into = purposes ( meet+ ! requirem5ts ( ?is subp>agraph1 & 7ii7 ! employm5t relation%ip ) t employ] has n be5 t]m9at$ aft] ,decemb] #ca1 #bjbj4 7,b7 ,treatm5t ( multiple ag5cies & in/rum5talities ,= purposes ( subp>agraph 7,a71 "u regulations 7consi/5t ) regulations e/abli%$ "u section #caba7t77#b77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf7-- 7i7 all ag5cies & in/rum5talities ( a ,/ate 7z def9$ 9 section #bah7;b77 or ( ! ,di/rict ( ,columbia %all be treat$ z a s+le employ]1 & 7ii7 all ag5cies & in/rum5talities ( a political subdivision ( a ,/ate 7z s def9$7 %all be treat$ z a s+le employ] & %all n be treat$ z describ$ 9 clause 7i74 7#c7 ,exception = c]ta9 s]vices 7,a7 ,9 g5]al ,! requirem5ts ( ?is p>agraph are met ) respect to s]vice if su* s]vice is p]=m$-- 7i7 by an individual :o is employ$ by a ,/ate or political subdivision !re( to relieve su* individual f unemploym5t1 7ii7 9 a hospital1 home1 or o!r in/itution by a pati5t or inmate !re( z an employee ( a ,/ate or political subdivision !re( or ( ! ,di/rict ( ,columbia1 7iii7 by an individual1 z an employee ( a ,/ate or political subdivision !re( or ( ! ,di/rict ( ,columbia1 s]v+ on a tempor>y basis 9 case ( fire1 /orm1 sn[1 e>?quake1 flood1 or o!r simil> em]g5cy1 7iv7 by any individual z an employee includ$ "u section #ecea7b7 ( title #e1 ,unit$ ,/ates ,code 7relat+ to c]ta9 int]ns1 /ud5t nurses1 & o!r /ud5t employees ( hospitals ( ! ,di/rict ( ,columbia ,gov]nm5t71 o!r ?an z a m$ical or d5tal int]n or a m$ical or d5tal resid5t 9 tra9+1 7v7 by an election (ficial or election work] if ! remun]ation paid 9 a cal5d> ye> = su* s]vice is less ?an #a1jjj ) respect to s]vice p]=m$ dur+ #bjba1 & ! adju/$ am\nt det]m9$ "u subp>agraph 7,c7 = any subsequ5t ye> ) respect to s]vice p]=m$ dur+ su* subsequ5t ye>1 except to ! ext5t t s]vice by su* election (ficial or election work] is includ$ 9 employm5t "u an agreem5t "u section #bah1 or 7vi7 by an employee 9 a position comp5sat$ solely on a fee basis :i* is treat$ pursuant to section #baa7;c77#b77;,e7 z a trade or bus9ess = purposes ( inclusion ( su* fees 9 net e>n+s f self-employm5t4 7,b7 ,def9itions ,z us$ 9 ?is p>agraph1 ! t]ms ,/ate & political subdivision h ! mean+s giv5 ^? t]ms 9 section #bah7;b74 7,c7 ,adju/m5ts to doll> am\nt = election (ficials & election work]s ,= ea* ye> aft] #bjba1 ! ,commission] ( ,social ,security %all adju/ ! am\nt ref]r$ to 9 subp>agraph 7,a77v7 at ! same "t & 9 ! same mann] z is provid$ "u section #bae7;a77#a77;,b77ii7 ) respect to ! am\nts ref]r$ to 9 section #bae7;a77#a77;,b77i71 except t-- 7i7 = purposes ( ?is subp>agraph1 #bjah %all be sub/itut$ = ! cal5d> ye> ref]r$ to 9 section #bae7;a77#a77;,b77ii77,,ii71 & 7ii7 su* am\nt z s adju/$1 if n a multiple ( #ajj1 %all be r\nd$ to ! next high] multiple ( #ajj :]e su* am\nt is a multiple ( #ej & to ! ne>e/ multiple ( #ajj 9 any o!r case4 ,! ,commission] ( ,social ,security %all det]m9e & publi% 9 ! ,f$]al ,regi/] ea* adju/$ am\nt det]m9$ "u ?is subp>agraph n lat] ?an ,novemb] #a prec$+ ! ye> = :i* ! adju/m5t is made4 4 7,b7 ,con=m+ am5dm5ts 7i7 ,subsection 7k7 ( section #baj ( su* ,act 7#db ,u4,s4,c4 #daj7k77 7relat+ to cov]$ transportation s]vice7 is repeal$4 7ii7 ,section #baj7p7 ( su* ,act 7#db ,u4,s4,c4 #daj7p77 is am5d$-- 7,i7 9 p>agraph 7#b71 by /rik+ s]vice is p]=m$ & all t foll[s & ins]t+ s]vice is s]vice describ$ 9 subsection 7s77#c77;,a742 & 7,,ii7 9 p>agraph 7#c77;,a71 by ins]t+ "u subsection 7a77#g7 z 9 effect 9 ,decemb] #bjbj aft] section4 7iii7 ,section #bah7;c77#f7 ( su* ,act 7#db ,u4,s4,c4 #dah7;c77#f77 is am5d$-- 7,i7 by /rik+ subp>agraph 7,c72 7,,ii7 by r$esignat+ subp>agraphs 7,d7 & 7,e7 z subp>agraphs 7,c7 & 7,d71 respectively2 & 7,,iii7 by /rik+ subp>agraph 7,f7 & ins]t+ ! foll[+3 7,e7 s]vice :i* is includ$ z employm5t "u section #baj7;a74 4 7b7 ,am5dm5ts to ! int]nal rev5ue code ( #aihf 7#a7 ,9 g5]al ,p>agraph 7#g7 ( section #caba7;b7 ( ! ,int]nal ,rev5ue ,code ( #aihf 7relat+ to employm5t7 is am5d$ to read z foll[s3 7#g7 exclud$ ,/ate or local gov]nm5t employm5t 7z def9$ 9 subsection 7t772 4 7#b7 ,exclud$ /ate or local gov]nm5t employm5t ,section #caba ( su* ,code is am5d$ by ins]t+ aft] subsection 7s7 ! foll[+ new subsection3 7t7 ,exclud$ /ate or local gov]nm5t employm5t 7#a7 ,9 g5]al ,= purposes ( ?is *apt]1 ! t]m exclud$ ,/ate or local gov]nm5t employm5t means any s]vice p]=m$ 9 ! employ ( a ,/ate1 ( any political subdivision !re(1 or ( any in/rum5tality ( any "o or m ( ! =ego+ :i* is :olly own$ !reby1 if-- 7,a7 7i7 su* s]vice w\ld be exclud$ f ! t]m employm5t = purposes ( ?is *apt] if ! provisions ( subsection 7b77#g7 z 9 effect 9 ,decemb] #bjbj _h rema9$ 9 effect1 & 7ii7 ! requirem5ts ( p>agraph 7#b7 are met ) respect to su* s]vice1 or 7,b7 ! requirem5ts ( p>agraph 7#c7 are met ) respect to su* s]vice4 7#b7 ,exception = curr5t employm5t :i* cont9ues 7,a7 ,9 g5]al ,! requirem5ts ( ?is p>agraph are met ) respect to s]vice = any employ] if-- 7i7 su* s]vice is p]=m$ by an individual-- 7,i7 :o 0 p]=m+ sub/antial & regul> s]vice = remun]ation = t employ] be=e ,janu>y #a1 #bjba1 7,,ii7 :o is a bona fide employee ( t employ] on ,decemb] #ca1 #bjbj1 & 7,,iii7 ^: employm5t relation%ip ) t employ] 0 n ent]$ into = purposes ( meet+ ! requirem5ts ( ?is subp>agraph1 & 7ii7 ! employm5t relation%ip ) t employ] has n be5 t]m9at$ aft] ,decemb] #ca1 #bjbj4 7,b7 ,treatm5t ( multiple ag5cies & in/rum5talities ,= purposes ( subp>agraph 7,a71 "u regulations-- 7i7 all ag5cies & in/rum5talities ( a ,/ate 7z def9$ 9 section #bah7;b7 ( ! ,social ,security ,act7 or ( ! ,di/rict ( ,columbia %all be treat$ z a s+le employ]1 & 7ii7 all ag5cies & in/rum5talities ( a political subdivision ( a ,/ate 7z s def9$7 %all be treat$ z a s+le employ] & %all n be treat$ z describ$ 9 clause 7i74 7#c7 ,exception = c]ta9 s]vices 7,a7 ,9 g5]al ,! requirem5ts ( ?is p>agraph are met ) respect to s]vice if su* s]vice is p]=m$-- 7i7 by an individual :o is employ$ by a ,/ate or political subdivision !re( to relieve su* individual f unemploym5t1 7ii7 9 a hospital1 home1 or o!r in/itution by a pati5t or inmate !re( z an employee ( a ,/ate or political subdivision !re( or ( ! ,di/rict ( ,columbia1 7iii7 by an individual1 z an employee ( a ,/ate or political subdivision !re( or ( ! ,di/rict ( ,columbia1 s]v+ on a tempor>y basis 9 case ( fire1 /orm1 sn[1 e>?quake1 flood1 or o!r simil> em]g5cy1 7iv7 by any individual z an employee includ$ "u section #ecea7b7 ( title #e1 ,unit$ ,/ates ,code 7relat+ to c]ta9 int]ns1 /ud5t nurses1 & o!r /ud5t employees ( hospitals ( ! ,di/rict ( ,columbia ,gov]nm5t71 o!r ?an z a m$ical or d5tal int]n or a m$ical or d5tal resid5t 9 tra9+1 7v7 by an election (ficial or election work] if ! remun]ation paid 9 a cal5d> ye> = su* s]vice is less ?an #a1jjj ) respect to s]vice p]=m$ dur+ #bjba1 & ! adju/$ am\nt det]m9$ "u section #baj7s77#c77;,c7 ( ! ,social ,security ,act = any subsequ5t ye> ) respect to s]vice p]=m$ dur+ su* subsequ5t ye>1 except to ! ext5t t s]vice by su* election (ficial or election work] is includ$ 9 employm5t "u an agreem5t "u section #bah ( ! ,social ,security ,act1 or 7vi7 by an employee 9 a position comp5sat$ solely on a fee basis :i* is treat$ pursuant to section #adjb7;c77#b77;,e7 z a trade or bus9ess = purposes ( inclusion ( su* fees 9 net e>n+s f self-employm5t4 7,b7 ,def9itions ,z us$ 9 ?is p>agraph1 ! t]ms ,/ate & political subdivision h ! mean+s giv5 ^? t]ms 9 section #bah7;b7 ( ! ,social ,security ,act4 4 7#c7 ,con=m+ am5dm5ts 7,a7 ,subsection 7j7 ( su* section #caba 7relat+ to cov]$ transportation s]vice7 is repeal$4 7,b7 ,p>agraph 7#b7 ( section #caba7u7 ( su* ,code 7relat+ to application ( hospital insurance tax to ,f$]al1 ,/ate1 & local employm5t7 is am5d$-- 7i7 9 subp>agraph 7,b71 by /rik+ s]vice is p]=m$ 9 clause 7ii7 & all t foll[s ?r\gh ! end ( su* subp>agraph & ins]t+ s]vice is s]vice describ$ 9 subsection 7t77#c77;,a742 & 7ii7 9 subp>agraph 7,c77i71 by ins]t+ "u subsection 7b77#g7 z 9 effect 9 ,decemb] #bjbj aft] *apt]4 7c7 ,effective date ,except z o!rwise provid$ 9 ?is section1 ! am5dm5ts made by ?is section %all apply ) respect to s]vice p]=m$ aft] ,decemb] #ca1 #bjbj4 #caji4 ,inclusion 9 annual ,social ,security acc\nt /atem5t ( e/imat$ pres5t value ( taxes & b5efits = ,social ,security & ,m$ic>e & project$ deficit z a p]c5t ( lifetime e>n+s 7a7 ,9 g5]al ,section #aadc7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;a77#b77 is am5d$-- 7#a7 9 subp>agraph 7,e71 by /rik+ b5efits4 & ins]t+ b5efits22 & 7#b7 by add+ aft] subp>agraph 7,e7 ! foll[+ new subp>agraphs3 7,f7 an e/imate1 z det]m9$ by ! ,commission]1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 on ! basis ( available records ( ! ,commission] & projections bas$ on reasonable assumptions1 (-- 7i7 ! pres5t value ( pot5tial lifetime aggregate employ]1 employee1 & self-employm5t contributions ( ! eligible individual = old-age1 survivors1 & disability insurance 7"u title ,,ii7 & = hospital insurance 7"u "p ,a ( title ,,xviii72 7ii7 ! pres5t value ( pot5tial lifetime premiums payable 7"u p>ts ,b & ,d ( title ,,xviii72 & 7iii7 ! pres5t value ( pot5tial lifetime aggregate retirem5t1 disability1 survivor1 & auxili>y b5efits payable on ! eligible individual's acc\nt "u title ,,ii & p] capita b5efits payable "u ! ,m$ic>e program ( title ,,xviii2 & 7,g7 an e/imate1 z det]m9$ by ! ,commission]1 9 consultation ) ! ,secret>y ( ,heal? & ,human ,s]vices1 on ! basis ( available records ( ! ,commission] & projections bas$ on reasonable assumptions1 ( ! ratio 7express$ z a p]c5tage7 (-- 7i7 ! sum ( ! project$ deficit-f9anc$ b5efits "u ! old-age1 survivors1 & disability insurance program ) respect to ! eligible individual & ! project$ deficit-f9anc$ b5efits "u "p ,a ( ! ,m$ic>e program "u title ,,xviii ) respect to ! eligible individual1 to 7ii7 project$ lifetime e>n+s ( ! eligible individual4 4 7b7 ,def9itions ,section #aadc7;a7 ( su* ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;a77 is am5d$-- 7#a7 by r$esignat+ p>agraph 7#c7 z p>agraph 7#d72 & 7#b7 by ins]t+ aft] p>agraph 7#b7 ! foll[+ new p>agraph3 7#c7 ,= purposes ( p>agraph 7#b77;,g7-- 7,a7 ,! t]m project$ deficit-f9anc$ b5efits means-- 7i7 ) respect to an eligible individual 9 connection ) ! old-age1 survivors1 & disability insurance program1 ! product (-- 7,i7 ! b5efits describ$ 9 subp>agraph 7,f77ii7 ( su* individual "u su* program1 & 7,,ii7 ! ratio ( future annual deficits1 exclud+ int]e/1 ( ! ,f$]al ,old-,age & ,survivors ,insurance ,tru/ ,fund & ! ,f$]al ,disability ,insurance ,tru/ ,fund ov] ! eligible individual's lifetime to future annual outlays f su* ,tru/ ,funds ov] su* lifetime2 & 7ii7 ) respect to an eligible individual 9 connection ) ! ,m$ic>e program "u title ,,xviii1 ! product (-- 7,i7 ! b5efits = hospital insurance 7"u "p ,a ( title ,,xviii7 describ$ 9 subp>agraph 7,f77ii7 ( su* individual "u su* program1 & 7,,ii7 ! ratio ( future annual deficits ( ! ,f$]al ,hospital ,insurance ,tru/ ,fund ov] ! eligible individual's lifetime to future annual outlays f su* ,tru/ ,fund ov] su* lifetime4 7,b7 ,! t]m project$ lifetime e>n+s ( ! eligible individual means ! pres5t value ( ! pot5tial total wages paid to1 & self-employm5t income d]iv$ by1 ! eligible individual ov] ! eligible individual's lifetime1 z det]m9$ )\t reg>d to ! contribution & b5efit base "u section #bcj4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to annual /atem5ts issu$ aft] #bjac4 #caaj4 ,retirem5t in=mation campaign ,! ,commission] ( ,social ,security %all e/abli% a public in=mation campaign to provide in=mation & education reg>d+ ! implications on p]sonal f9ancial security ( e>ly & o!r retirem5t decisions & ! ne$ = great] retirem5t sav+s4 ,! in=mation campaign %\ld be design$ to enc\rage individuals to delay retirem5t s z to build enhanc$ levels ( social security b5efits & p]sonal retirem5t sav+s4 ,to ! ext5t ! ,commission] ( ,social ,security det]m9es appropriate1 ! in=mation provid$ ?r\gh ! campaign %\ld utilize behavioral economics approa*es1 su* z /ructur$ *oice1 & o!r sci5tific approa*es4 ,,iv ,conv]sion to *a9$ ,,cpi #daja4 ,conv]sion to ,*a9$ ,,cpi 7a7 ,consum] price index adju/m5ts applicable to ! ,int]nal ,rev5ue ,code provisions 7#a7 ,9 g5]al ,p>agraph 7#c7 ( section #a7;f7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7#c7 ,co/-(-liv+ adju/m5t 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#b71 ! co/-(-liv+ adju/m5t = any cal5d> ye> is-- 7i7 = adju/m5ts fir/ beg9n+ be=e #bjad1 ! product (-- 7,i7 ! ,,cpi fraction = cal5d> ye>s be=e #bjad1 multipli$ by 7,,ii7 ! ,*a9$ ,,cpi fraction = cal5d> ye>s aft] #bjac1 r$uc$ by #a1 & 7ii7 = adju/m5ts fir/ beg9n+ aft] #bjac1 ! ,*a9$ ,,cpi fraction = ye>s aft] #bjac4 7,b7 ,,cpi fraction = cal5d> ye>s be=e #bjad ,! ,,cpi fraction = cal5d> ye>s be=e #bjad is ! fraction-- 7i7 ! num]ator ( :i* is ! ,,cpi = ! cal5d> ye> #bjab2 & 7ii7 ! d5om9ator ( :i* is ! ,,cpi = ! cal5d> ye> #aiib4 7,c7 ,*a9$ cpi fraction = cal5d> ye>s aft] #bjac ,! ,*a9$ ,,cpi fraction = cal5d> ye>s aft] #bjac is ! fraction-- 7i7 ! num]ator ( :i* is ! ,*a9$ ,,cpi = ! prec$+ cal5d> ye>1 & 7ii7 ! d5om9ator ( :i* is ! ,*a9$ ,,cpi = ! cal5d> ye> #bjab4 4 7#b7 ,con=m+ am5dm5ts 7,a7 ,p>agraph 7#d7 ( section #a7;f7 ( su* ,code is am5d$ to read z foll[s3 7#d7 ,cpi & *a9$ cpi = any cal5d> ye> ,= purposes ( p>agraph 7#c7-- 7,a7 ,cpi ,! ,,cpi = any cal5d> ye> is ! av]age ( ! ,consum] ,price ,index z ( ! close ( ! #ab-mon? p]iod end+ on ,augu/ #ca ( su* cal5d> ye>4 7,b7 ,*a9$ cpi ,! ,*a9$ ,,cpi = any cal5d> ye> is ! av]age ( ! ,*a9$ ,consum] ,price ,index z ( ! close ( ! #ab-mon? p]iod end+ on ,augu/ #ca ( su* cal5d> ye>4 4 7,b7 ,p>agraph 7#e7 ( section #a7;f7 ( su* ,code is am5d$ to read z foll[s3 7#e7 ,consum] price index & *a9$ consum] price index ,= purposes ( p>agraph 7#d7-- 7,a7 ,consum] price index ,! t]m ,consum] ,price ,index means ! la/ ,consum] ,price ,index = all urban consum]s publi%$ by ! ,dep>tm5t ( ,labor4 ,= purposes ( ! prec$+ s5t5ce1 ! revision ( ! ,consum] ,price ,index :i* is mo/ consi/5t ) ! ,consum] ,price ,index = cal5d> ye> #aihf %all be us$4 7,b7 ,*a9$ consum] price index ,! t]m ,*a9$ ,consum] ,price ,index means ! mo/ rec5t e/imate ( ! ,*a9$ ,consum] ,price ,index = all urban consum]s publi%$ by ! ,dep>tm5t ( ,labor4 4 7,c7 ,subclause 7,,ii7 ( section #cf;,b7b77#c77;,a77ii7 ( su* ,code is am5d$ by /rik+ consum] price index & ins]t+ ,*a9$ ,consum] ,price ,index 7z def9$ 9 section #a7;f77#e77;,b774 7,d7 ,subclause 7,,ii7 ( section #cf;,b7f77#b77;,b77ii7 ( su* ,code is am5d$ by /rik+ by sub/itut+ cal5d> ye> #bjac = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re( & ins]t+ by sub/itut+ cal5d> ye> #bjac = cal5d> ye> #bjab 9 subp>agraph 7,c7 !re(4 7,e7 ,clause 7ii7 ( section #de,r7d77#c77;,b7 ( su* ,code is am5d$ by /rik+ det]m9$ by sub/itut+ cal5d> ye> #bjab = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(4 7,f7 ,subp>agraph 7,b7 ( section #abe7;i77#b7 ( su* ,code is am5d$ by /rik+ det]m9$ by sub/itut+ cal5d> ye> #bjab = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(4 7,g7 ,subclause 7,,ii7 ( section #dihj;,i7b77#c77;,c77v7 ( su* ,code is am5d$ by /rik+ = #aiib 9 subp>agraph 7,b7 !re( & ins]t+ = #bjab 9 subp>agraph 7,c7 !re(4 7,h7 ,clause 7ii7 ( section #ejjj;,a7c77#c77;,d7 ( su* ,code is am5d$ by /rik+ by sub/itut+ cal5d> ye> #bjae = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re( & ins]t+ by sub/itut+ cal5d> ye> #bjae = cal5d> ye> #bjab 9 subp>agraph 7,c7 !re(4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjac4 7b7 ,modifications to co/-(-,liv+ indexation ( ,social ,security b5efits 7#a7 ,9 g5]al ,section #bae7;i77#a77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7;i77#a77;,d77 is am5d$ to read z foll[s3 7,d7 ! t]m ,,cpi increase p]c5tage1 ) respect to a base qu>t] or co/-(-liv+ computation qu>t] 9 any cal5d> ye>1 means ! p]c5tage 7r\nd$ to ! ne>e/ "o-t5? ( #a p]c5t7 by :i* ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor7 = su* base qu>t] or co/-(-liv+ computation qu>t] exce$s su* index = ! lat] (-- 7i7 ! mo/ rec5t cal5d> qu>t] 7prior to su* base qu>t] or co/-(-liv+ computation qu>t]7 :i* 0 a base qu>t] "u subp>agraph 7,a77ii72 or 7ii7 ! mo/ rec5t co/-(-liv+ computation qu>t] "u subp>agraph 7,b72 4 7#b7 ,def9itions ,section #bae7;i77#a77;,g7 ( su* ,act 7#db ,u4,s4,c4 #dae7;i77#a77;,g77 is am5d$ to read z foll[s3 7,g7 ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = a base qu>t]1 a co/-(-liv+ computation qu>t]1 or any o!r cal5d> qu>t] %all be ! ari?metical mean ( su* index 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor z ( ! end ( su* qu>t]7 = ! #ab-mon? p]iod end+ ) su* qu>t]4 4 7#c7 ,con=m+ *anges = pre-#aigg law 7,a7 ,section #bae7;i77#a7 ( su* ,act1 z 9 effect 9 ,decemb] #aigh1 & z appli$ 9 c]ta9 cases "u ! provisions ( su* ,act z 9 effect aft] ,decemb] #aigh1 is am5d$-- 7i7 9 subp>agraph 7,b71 by /rik+ & aft] ! semicolon2 7ii7 9 subp>agraph 7,c71 by /rik+ = ! #c mon?s 9 su* qu>t]4 & ins]t+ = ! #ab mon?s 9 ! #ab-mon? p]iod end+ ) su* qu>t]2 &2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ! t]m ,consum] ,price ,index means ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s 7,c-,,cpi-,u71 z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor4 4 7,b7 ,section #bae7;i77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7;i77#d77 is am5d$ by ins]t+ & by section #daja7;b7 ( ! ,fiscal ,su/a9ability ,act ( #bjac aft] #aihf14 7#d7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to increases describ$ 9 section #bae7;i7 ( ! ,social ,security ,act1 & to increases "u programs dep5d5t on ,social ,security co/-(-liv+ adju/m5ts1 effective ) ! mon? ( ,decemb] = ye>s aft] #bjab4 7c7 ,adju/m5ts ( provisions utiliz+ ! consum] price index 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law1 & except z provid$ 9 ?is section1 = purposes ( det]m9+ ! am\nt ( any co/-(-liv+ increase or simil> adju/m5t "u a ,f$]al program or law effective 9 ! mon? ( ,decemb] #bjac & !reaft]1 any su* increase = ! p]iod = :i* ! p]c5tage *ange is det]m9$ %all be deem$ to be1 9 lieu ( ! increase o!rwise det]m9$ "u applicable law1 ! increase det]m9$ "u su* applicable law by sub/itut+ ! ,*a9$ ,,cpi = ! ,,cpi4 7#b7 ,increases det]m9$ f a con/ant base ye> 7,a7 ,9 g5]al ,9 any case 9 :i* ! am\nt ( a co/-(-liv+ increase effective 9 ! mon? ( ,decemb] #bjab & !reaft] is det]m9$ "u applicable law by ref]5ce to a *ange 9 ! ,,cpi ov] a p]iod :i* is det]m9$ by ref]5ce to a base p]iod :i* rema9s con/ant f ye> to ye>1 any su* increase = any p]iod %all be deem$ to be1 9 lieu ( ! increase o!rwise det]m9$ "u applicable law1 ! increase1 express$ z a p]c5tage increase1 equal to ! product (-- 7i7 ! ,,cpi fraction prior to #bjad2 multipli$ by 7ii7 ! ,*a9$ ,,cpi fraction aft] #bjac1 r$uc$ by #a4 7,b7 ,,cpi fraction prior to #bjad ,! ,,cpi fraction prior to #bjad is ! fraction-- 7i7 ! num]ator ( :i* is ! ,,cpi = ! p]iod1 end+ ) or dur+ #bjab1 :i* corresponds to ! base p]iod2 & 7ii7 ! d5om9ator ( :i* is ! ,,cpi = ! base p]iod4 7,c7 ,*a9$ ,,cpi fraction aft] #bjac ,! ,*a9$ ,,cpi fraction aft] #bjac is ! fraction-- 7i7 ! num]ator ( :i* is ! ,*a9$ ,,cpi = ! p]iod1 end+ ) or dur+ ! ye> prec$+ ! ye> 9 :i* ! det]m9ation takes effect1 :i* corresponds to ! base p]iod2 & 7ii7 ! d5om9ator ( :i* is ! mo/ rec5tly publi%$ e/imate ( ! ,*a9$ ,,cpi = ! p]iod1 end+ ) or dur+ #bjab1 :i* corresponds to ! base p]iod4 7#c7 ,special provisions & exceptions 7,a7 ,programs ti$ to ,social ,security ,subject to subp>agraph 7,b7 & ! effective date "u subsection 7b77#d71 ?is section & ! am5dm5ts made by ?is section %all apply to any co/-(-liv+ increase or o!r adju/m5t :i* is det]m9$ by ref]5ce to an adju/m5t made "u section #bae7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dae7;i774 7,b7 ,pov]ty l9e ,?is subsection %all apply to revisions to ! pov]ty l9e made pursuant to #db ,u4,s4,c4 #iijb7b71 & any programs = :i* adju/m5ts or eligibility ?re%olds are bas$ ^u ! pov]ty l9e z def9$ 9 t section4 7#d7 ,cpi & *a9$ cpi ,= purposes ( ?is subsection-- 7,a7 ! ,,cpi = any p]iod means ! av]age mon?ly ,consum] ,price ,index = su* p]iod1 or a compon5t !re(1 z det]m9$ "u ! applicable law 9 connection ) any co/-(-liv+ increase or simil> adju/m5t requir$ = su* p]iod 7)\t reg>d to ?is subsection72 & 7,b7 ! ,*a9$ ,,cpi = any p]iod means1 except z provid$ 9 p>agraph 7#b77;,c77ii71 ! ,*a9$ ,consum] ,price ,index = all urban consum]s 7z publi%$ 9 its initial =m by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor7 = su* p]iod1 or a compon5t !re(1 det]m9$ "u applicable law 9 ! same mann] z ! ,,cpi = su* p]iod w\ld be det]m9$4 7d7 ,*ange to #ab-,mon? p]iod = co/-(-,liv+ indexation = ,f$]al civil s]vice & milit>y retirem5t programs 7#a7 ,9 g5]al 7,a7 ,f$]al civil s]vice ,sections #hcdj7;a77#b7 & #hdfb7;a77#b7 ( title #e1 ,unit$ ,/ates ,code1 are ea* am5d$ by /rik+ #c mon?s compris+ su* qu>t] & ins]t+ #ab-mon? p]iod end+ ) su* qu>t]4 7,b7 ,milit>y ,section #adja;a7h7 ( title #aj1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ ?ree mon?s compris+ t qu>t] & ins]t+ #ab-mon? p]iod end+ ) su* qu>t]4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to co/-(-liv+ increases effective ) ! mon? ( ,decemb] ( ye>s aft] #bjab4