,,ii  #aac? ,,congress  #a/ ,session    
,s4 #abbh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bf1 #bjac ,mr4  
,wyd5 7= himself & ,mr4 ,portman7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to e/abli% a       
program to provide inc5tive paym5ts to  
p>ticipat+ ,m$ic>e b5efici>ies :o       
volunt>ily e/abli% & ma9ta9 bett] heal?4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,m$ic>e ,bett] ,heal? ,rew>ds       
,program ,act ( #bjac4  #b4 ,m$ic>e     
,bett] ,heal? ,rew>ds ,program ,"p ,b ( 
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;j et seq47 is     
am5d$ by add+ at ! end ! foll[+ new     
section3  #ahdi4 ,m$ic>e ,bett] ,heal?  
,rew>ds ,program  7a7 ,9 g5]al ,!       
,secret>y %all e/abli% a ,bett] ,heal?  
,rew>ds ,program 79 ?is section ref]r$  
to z ! ,program7 "u :i* inc5tives are   
provid$ to ,m$ic>e b5efici>ies :o       
volunt>ily agree to p>ticipate 9 !      
,program4  7b7 ,enrollm5t ,a heal?      

pr(essional p>ticipat+ 9 ! ,program %all
 provide _! pati5ts :o are ,m$ic>e      
b5efici>ies ) a description ( & an      
opportunity to enroll 9 ! ,program on a 
volunt>y basis4 ,if a ,m$ic>e b5efici>y 
elects to enroll 9 ! ,program1 ! heal?  
pr(essional %all in=m ! ,secret>y ( !   
individual's enrollm5t ?r\gh a process  
e/abli%$ by ! ,secret>y1 :i* does n     
impose additional adm9i/rative          
requirem5ts on ! p>ticipat+ heal?       
pr(essional4  7c7 ,e/abli%m5t ( bett]   
heal? t>get /&>ds  7#a7 ,9 g5]al  7,a7  
,e/abli%m5t ,! ,secret>y %all e/abli%   
/&>ds = measur+ bett] heal? t>gets &    
po9ts = a*iev+ su* /&>ds = p>ticipat+   
,m$ic>e b5efici>ies1 includ+ su* /&>ds &
 po9ts ) respect to ! foll[+3  7i7      
,annual wellness visit4  7ii7 ,tobacco  
cessation4  7iii7 ,body ,mass ,index    
7,,bmi74  7iv7 ,diabetes scre5+ te/4    
7v7 ,c>diovascul> disease scre5+4  7vi7 
,*ole/]ol level scre5+4  7vii7 ,scre5+  
te/s & specifi$ vacc9ations4  7,b7      
,consultation ,9 e/abli%+ /and>ds &     

po9ts = a*iev+ su* /&>ds "u ?is         
subsection1 ! ,secret>y--  7i7 %all     
consult ) #a or m nationally recogniz$  
heal? c>e quality organizations1 z      
det]m9$ appropriate by ! ,secret>y2 &   
7ii7 may consult ) physicians & o!r     
pr(essionals exp]i5c$ ) wellness        
programs4  7,c7 ,po9ts ,! numb] ( po9ts 
aw>d$ = a ye> = a*iev+ /&>ds ) respect  
to ea* ( ! t>gets describ$ 9 clauses 7i7
 ?r\gh 7vii7 ( subp>agraph 7,a7 %all n  
exce$ #e4 ,su* po9ts may be aw>d$ on a  
slid+ scale1 bas$ on /&>ds e/abli%$ "u  
?is subsection1 z det]m9$ appropriate by
 ! ,secret>y4  7#b7 ,modification (     
bett] heal? t>get /&>ds & assign$ po9ts 
7,a7 ,9 g5]al ,! ,secret>y may modify   
/&>ds = measur+ bett] heal? t>gets &1   
subject to p>agraph 7#a77;,c71 po9ts =  
a*iev+ su* /&>ds = p>ticipat+ ,m$ic>e   
b5efici>ies "u ?is subsection4  7,b7    
,consultation ,9 modify+ /&>ds & po9ts =
 a*iev+ su* /&>ds "u ?is p>agraph1 !    
,secret>y--  7i7 %all consult ) #a or m 
nationally recogniz$ heal? c>e quality  

organizations1 z det]m9$ appropriate by 
! ,secret>y2 &  7ii7 may consult )      
physicians & o!r pr(essionals exp]i5c$ )
 wellness programs4  7d7 ,conduct (     
program  7#a7 ,duration  7,a7 ,9 g5]al  
,subject to subp>agraph 7,b71 ! ,program
 %all be conduct$ = n less ?an a #c-ye> 
p]iod4  7,b7 ,expansion ,! ,secret>y    
%all exp& ! duration & scope ( !        
,program1 to ! ext5t det]m9$ appropriate
 by ! ,secret>y1 if--  7i7 ! ,secret>y  
det]m9es t su* expansion is expect$ to--
  7,i7 r$uce sp5d+ "u ?is title )\t     
r$uc+ ! quality ( c>e2 or  7,,ii7       
improve ! quality ( c>e & r$uce sp5d+2  
7ii7 ! ,*ief ,actu>y ( ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices c]tifies t   
su* expansion w\ld r$uce program sp5d+  
"u ?is title2 &  7iii7 ! ,secret>y      
det]m9es t su* expansion w\ld n d5y or  
limit ! cov]age or provision ( b5efits  
"u ?is title = individuals4  7#b7       
,collection & use ( basel9e data ,dur+ !
 fir/ ye> ( ! ,program1 a heal?         
pr(essional %all e/abli% & report to !  

,secret>y basel9e in=mation = ea*       
p>ticipat+ ,m$ic>e b5efici>y :o is a    
pati5t ( ! heal? pr(essional z "p ( t   
b5efici>y's fir/ ye> assessm5t "u       
p>agraph 7#c77;,a74 ,! heal? pr(essional
 %all use su* data to aid 9 !           
det]m9ation ( :e!r & to :at ext5t !     
p>ticipat+ ,m$ic>e b5efici>y is meet+ ! 
t>get /&>ds "u subsection 7c7 9 ea* (   
ye>s #b & #c ( ! ,program4  7#c7        
,requir$ assessm5ts = p>ticipat+ ,m$ic>e
 b5efici>ies  7,a7 ,fir/ ye> ,dur+ ye>  
#a ( ! ,program1 a heal? pr(essional    
%all furni% to ea* p>ticipat+ ,m$ic>e   
b5efici>y t is a pati5t ( ! heal?       
pr(essional ei!r an annual wellness     
visit or an initial prev5tive physical  
exam9ation4  7,b7 ,second & ?ird ye>s   
,dur+ ea* ( ye>s #b & #c ( ! ,program1 a
 heal? pr(essional %all furni% to ea*   
p>ticipat+ ,m$ic>e b5efici>y t is a     
pati5t ( ! heal? pr(essional an annual  
wellness visit to det]m9e :e!r & to :at 
ext5t ! p>ticipat+ ,m$ic>e b5efici>y has
 met ! t>get /&>ds "u subsection 7c74   

7e7 ,det]m9ation ( po9ts & paym5t (     
inc5tives  7#a7 ,det]m9ation ( po9ts    
,dur+ ea* ( ye>s #b & #c ( ! ,program1 a
 heal? pr(essional %all--  7,a7 evaluate
 & report to ! ,secret>y :e!r ea*       
p>ticipat+ ,m$ic>e b5efici>y t is a     
pati5t ( ! heal? pr(essional has a*iev$ 
! t>get /&>ds "u subsection 7c72 &  7,b7
 det]m9e ! total am\nt ( po9ts t ea* su*
 p>ticipat+ ,m$ic>e b5efici>y has a*iev$
 = ! ye> bas$ on ! po9ts assign$ =      
a*iev+ su* /&>ds "u subsection 7c74     
7#b7 ,inc5tive paym5t  7,a7 ,9 g5]al ,! 
,secret>y %all pay to ea* p>ticipat+    
,m$ic>e b5efici>y :o a*ieves at lea/ #bj
 po9ts "u p>agraph 7#a77;,b7 = ! ye> an 
inc5tive paym5t4 ,su* paym5t %all be    
equal to an am\nt det]m9$ appropriate by
 ! ,secret>y1 b no case %all su* am\nt  
exce$ ! foll[+3  ,points,year #b ,paym5t
 ,amount,year #c or a ,subsequ5t ,ye>   
,paym5t ,am\nt  #bj-bd po9ts#ajjbjj  #be
 or m po9ts#bjjdjj4  7,b7 ,inflation    
adju/m5t ,! doll> am\nts specifi$ 9 ?is 
p>agraph %all be increas$1 beg9n+ )     

#bjag1 f ye> to ye> bas$ on ! p]c5tage  
increase 9 ! consum] price index = all  
urban consum]s 7all items2 ,unit$ ,/ates
 city av]age71 r\nd$ to ! ne>e/ #a4     
7#c7 ,f9al det]m9ation ( /&>ds a*ievem5t
 made by p>ticipat+ heal? pr(essional   
,"u ! ,program1 a p>ticipat+ heal?      
pr(essional %all make ! f9al det]m9ation
 z to :e!r or n a p>ticipat+ ,m$ic>e    
b5efici>y has met ! t>get /&>ds "u      
subsection 7c7 & :at scre5+ te/s &      
specifi$ vacc9ations1 or o!r s]vices1   
are necess>y = purposes ( mak+ su*      
det]m9ation4  7f7 ,sp5d+ b5*m>ks  7#a7  
,9 g5]al ,! ,secret>y %all collect      
relevant data1 includ+ data on claims   
paid "u ?is title = s]vices furni%$ to  
p>ticipat+ ,m$ic>e b5efici>ies dur+ !   
,program1 = purposes ( det]m9+ !        
aggregate e/imat$ sav+s a*iev$ "u ?is   
title = p>ticipat+ ,m$ic>e b5efici>ies  
dur+ ea* ( ye>s #b & #c ( ! ,program 9  
accordance ) p>agraph 7#b7 7& = a       
subsequ5t ye> if ! ,program is exp&$ "u 
subsection 7d77#a77;,b774  7#b7         

,det]m9ation ( aggregate e/imat$ sav+s  
7,a7 ,9 g5]al ,! am\nt ( ! aggregate    
e/imat$ sav+s "u ?is title = p>ticipat+ 
,m$ic>e b5efici>ies "u p>agraph 7#a71 ) 
respect to a ye>1 %all be equal to--    
7i7 ! e/imat$ sav+s det]m9$ "u          
subp>agraph 7,b7 = ! ye>2 m9us  7ii7 !  
aggregate inc5tive paym5ts made "u !    
,program dur+ ! ye>4  7,b7 ,det]m9ation 
( e/imat$ sav+s ,= purposes (           
subp>agraph 7,a77i71 ! e/imat$ sav+s    
det]m9$ "u ?is subp>agraph = a ye> %all 
be equal to--  7i7 ! e/imat$ aggregate  
exp5ditures "u ?is title 7z project$ "u 
subp>agraph 7,c77 = ! ye>2 m9us  7ii7 ! 
actual aggregate exp5ditures "u ?is     
title 7z det]m9$ by ! ,secret>y & tak+  
into acc\nt any r$uction 9 specific     
heal? risks ( ! p>ticipat+ ,m$ic>e      
b5efici>ies7 = ! ye>4  7,c7 ,projection 
( e/imat$ aggregate claims co/  7i7     
,b5*m>k base ye> ,! ,secret>y %all      
e/abli% a b5*m>k base ye> am\nt (       
exp5ditures "u ?is title = p>ticipat+   
,m$ic>e b5efici>ies dur+ ye> #a ( !     

,program4  7ii7 ,projection ,! ,secret>y
 %all use ! b5*m>k base ye> am\nt       
e/abli%$ "u clause 7i7 to project !     
e/imat$ aggregate exp5ditures = all     
p>ticipat+ ,m$ic>e b5efici>ies dur+ ea* 
( ye>s #b & #c ( ! ,program z if !      
b5efici>ies 7 n p>ticipat+ 9 ! ,program4
 ,9 mak+ su* projection1 ! ,secret>y may
 include adju/m5ts = heal? /atus or o!r 
specific risk factors & geographic      
v>iation = ! p>ticipat+ ,m$ic>e         
b5efici>ies4  7,d7 ,public report (     
det]m9ation & o!r ,program in=mation ,n 
lat] ?an #ij days aft] det]m9+ !        
aggregate e/imat$ sav+s 7if any7 "u     
subp>agraph 7,a7 ) respect to a ye>1 !  
,secret>y %all make available to !      
public a report conta9+ a description ( 
! am\nt ( ! sav+s det]m9$1 includ+ !    
me?odology & any o!r calculations or    
det]m9ations involv$ 9 ! det]m9ation (  
su* am\nt4 ,su* report %all include--   
7i7 a description ( any r$uction 9      
specific heal? risks ( p>ticipat+       
,m$ic>e b5efici>ies id5tifi$ by !       

,secret>y2  7ii7 a description (--  7,i7
 /&>ds = measur+ bett] heal? t>gets "u  
subsection 7c72 &  7,,ii7 ! po9ts       
available = a*iev+ ea* su* /&>d "u t    
subsection2 &  7iii7 recomm5dations =   
su* legislation & adm9i/rative action z 
! ,secret>y det]m9es appropriate4  7#c7 
,monitor+ ( ,program co/s ,dur+ !       
op]ation ( ! ,program1 ! ,*ief ,actu>y (
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
%all--  7,a7 monitor ! ,program to      
det]m9e :e!r or n ! ,program is r$uc+   
aggregate exp5ditures "u ?is title2 &   
7,b7 submit to ! ,secret>y an annual    
report on ! results ( su* monitor+4     
7#d7 ,requir$ action if aggregate       
inc5tive paym5ts exce$ sav+s ,if !      
,secret>y1 tak+ into acc\nt ! reports "u
 p>agraph 7#c77;,b71 det]m9es t !       
aggregate exp5ditures "u ?is title exce$
 ! aggregate exp5ditures "u ?is title t 
w\ld h be5 made if ! ,program _h n be5  
implem5t$1 ! ,secret>y %all provide =   
*anges to ! provisions ( ! program 9    
ord] to elim9ate su* excess4  7g7 ,waiv]

 au?ority ,! ,secret>y may waive su*    
requirem5ts ( titles ,,xi & ,,xviii z   
may be necess>y to c>ry out ! purposes (
 ! ,program e/abli%$ "u ?is section4    
7h7 ,def9itions ,9 ?is section3  7#a7   
,annual wellness visit ,! t]m annual    
wellness visit includes p]sonaliz$      
prev5tion plan s]vices 7z def9$ 9       
section #ahfa7;hhh77#a774  7#b7 ,heal?  
pr(essional ,! t]m heal? pr(essional    
includes a physician 7z def9$ 9 section 
#ahfa7r77#a77 & a practition] describ$ 9
 clause 7i7 ( section                   
#ahdb7;b77#ah77;,c74  7#c7 ,initial     
prev5tive physical exam9ation ,! t]m    
initial prev5tive physical exam9ation   
has ! mean+ giv5 t t]m 9 section        
#ahfa7ww77#a74  7#d7 ,m$ic>e b5efici>y  
,! t]m ,m$ic>e b5efici>y means an       
individual enroll$ 9 "p ,b4  7#e7       
,p>ticipat+ ,m$ic>e b5efici>y ,! t]m    
p>ticipat+ ,m$ic>e b5efici>y means a    
,m$ic>e b5efici>y :o enrolls 9 !        
,program "u subsection 7b74  7#f7       
,scre5+ te/s ,! t]m scre5+ te/s means   

any ( ! foll[+ t are det]m9$ by a heal? 
pr(essional to be appropriate = a       
p>ticipat+ ,m$ic>e b5efici>y3  7,a7     
,colorectal canc] scre5+ te/s 7z def9$ 9
 section #ahfa7pp774  7,b7 ,scre5+      
mammography 7z describ$ 9 section       
#ahfa7;jj774  7,c7 ,scre5+ pap sme> &   
scre5+ pelvic exam 7z def9$ 9 section   
#ahfa7nn774  7,d7 ,scre5+ = glaucoma 7z 
def9$ 9 section #ahfa7uu774  7,e7 ,bone 
mass measurem5t 7z def9$ 9 section      
#ahfa7rr77 = qualifi$ individuals       
describ$ 9 p>agraph 7#b77;,a7 ( su*     
section4  7,f7 ,,hiv scre5+ = high-risk 
gr\ps 7z id5tifi$ by ! ,secret>y74  7#g7
 ,specifi$ vacc9ations ,! t]m specifi$  
vacc9ations means ! vacc9ations describ$
 9 section #ahfa7ww77#a7 t are det]m9$  
by a heal? pr(essional to be appropriate
 = a p>ticipat+ ,m$ic>e b5efici>y4  4   
#c4 ,p>ticipation by ,m$ic>e ,advantage 
plans ,section #ahei ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7h7 ,provid+    

inc5tives = volunt>y p>ticipation 9 a   
,bett] ,heal? ,rew>ds ,program  7#a7 ,9 
g5]al ,effective = plan ye>s beg9n+ on  
or aft] ! date ( enactm5t ( ! ,m$ic>e   
,bett] ,heal? ,rew>ds ,program ,act (   
#bjac1 a ,m$ic>e ,advantage organization
 may provide to individuals enroll$ 9 an
 ,,ma plan (f]$ by ! organization       
inc5tive paym5ts1 includ+ ca%1          
ca%-equival5t1 or o!r types ( inc5tives1
 = volunt>y p>ticipation 9 a ,bett]     
,heal? ,rew>ds ,program 79 ?is          
subsection ref]r$ to z ! ,program7 t    
rew>ds individuals = meet+ c]ta9 heal?  
t>gets e/abli%$ by ! ,secret>y4  7#b7   
,limitation ,9 no case %all ! mon?ly bid
 am\nt submitt$ by a ,m$ic>e ,advantage 
organization "u section #ahcd7;a77#f7   
7or ! mon?ly premium *>g$ by !          
organization "u section #ahed7;b77 )    
respect to an ,,ma plan (f]$ by !       
organization take into acc\nt any       
inc5tive paym5ts made to enrollees "u ! 
,program4  7#c7 ,implem5tation ,!       
,program "u ?is subsection %all be      

conduct$ 9 a simil> mann] to ! mann] 9  
:i* ! program "u section #ahdi is       
conduct$1 9 accordance ) /&>ds e/abli%$ 
by ! ,secret>y4  7#d7 ,notification &   
provision ( in=mation ,a ,m$ic>e        
,advantage organization seek+ to        
p>ticipate 9 ! ,program %all--  7,a7    
notify ! ,secret>y ( ! organization's   
int5t to p>ticipate 9 ! ,program2 &     
7,b7 agree to provide to ! ,secret>y--  
7i7 in=mation reg>d+--  7,i7 :i*        
enrollees p>ticipate 9 ! ,program2      
7,,ii7 ! scores ( ^? enrollees ) respect
 to applicable heal? t>gets "u !        
,program2 &  7,,iii7 ! inc5tives        
enrollees receive = meet+ su* heal?     
t>gets2 &  7ii7 any o!r in=mation       
specifi$ by ! ,secret>y = purposes ( ?is
 subsection4  7#e7 ,waiv] au?ority ,!   
,secret>y may waive su* requirem5ts (   
titles ,,xi & ,,xviii z may be necess>y 
to c>ry out ! purposes ( ! ,program     
e/abli%$ "u ?is subsection4  4  #d4     
,p>ticipation ( section #ahgf co/ plans 
,section #ahgf ( ! ,social ,security    

,act 7#db ,u4,s4,c4 #aciemm7 is am5d$ by
 ins]t+ at ! end ! foll[+3  7l7 ,provid+
 inc5tives = volunt>y p>ticipation 9 a  
,bett] ,heal? ,rew>ds ,program  7#a7 ,9 
g5]al ,effective = contract p]iods      
beg9n+ on or aft] ! date ( enactm5t ( ! 
,m$ic>e ,bett] ,heal? ,rew>ds ,program  
,act ( #bjac1 an eligible organization  
may provide to memb]s enroll$ "u ?is    
section ) ! organization inc5tive       
paym5ts1 includ+ ca%1 ca%-equival5t1 or 
o!r types ( inc5tives1 = volunt>y       
p>ticipation 9 a ,bett] ,heal? ,rew>ds  
,program 79 ?is subsection ref]r$ to z !
 ,program7 t rew>ds memb]s = meet+ c]ta9
 heal? t>gets e/abli%$ by ! ,secret>y4  
7#b7 ,limitation ,9 no case %all !      
paym5t to an eligible organization "u   
?is section 7or ! premium rate *>g$ by !
 organization "u ?is section7 ) respect 
to memb]s enroll$ ) ! organization take 
into acc\nt any inc5tive paym5ts made to
 memb]s "u ! ,program4  7#c7            
,implem5tation ,! ,program "u ?is       
subsection %all be conduct$ 9 a simil>  

mann] to ! mann] 9 :i* ! program "u     
section #ahdi is conduct$1 9 accordance 
) /&>ds e/abli%$ by ! ,secret>y4  7#d7  
,notification & provision ( in=mation   
,an eligible organization seek+ to      
p>ticipate 9 ! ,program %all--  7,a7    
notify ! ,secret>y ( ! organization's   
int5t to p>ticipate 9 ! ,program2 &     
7,b7 agree to provide to ! ,secret>y--  
7i7 in=mation reg>d+--  7,i7 :i* memb]s 
p>ticipate 9 ! ,program2  7,,ii7 !      
scores ( ^? memb]s ) respect to         
applicable heal? t>gets "u ! ,program2 &
  7,,iii7 ! inc5tives memb]s receive =  
meet+ su* heal? t>gets2 &  7ii7 any o!r 
in=mation specifi$ by ! ,secret>y =     
purposes ( ?is subsection4  7#e7 ,waiv] 
au?ority ,! ,secret>y may waive su*     
requirem5ts ( titles ,,xi & ,,xviii z   
may be necess>y to c>ry out ! purposes (
 ! ,program e/abli%$ "u ?is subsection4 
4  #e4 ,p>ticipation ( programs (       
all-inclusive c>e = ! eld]ly 7,,pace7   
7a7 ,m$ic>e ,section #ahid ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #acie;eee7

 is am5d$ by ins]t+ at ! end ! foll[+3  
7j7 ,provid+ inc5tives = volunt>y       
p>ticipation 9 a ,bett] ,heal? ,rew>ds  
,program  7#a7 ,9 g5]al ,effective =    
,,pace program agreem5ts ent]$ into on  
or aft] ! date ( enactm5t ( ! ,m$ic>e   
,bett] ,heal? ,rew>ds ,program ,act (   
#bjac1 a ,,pace provid] may provide to  
,,pace program eligible individuals     
enroll$ "u ?is section ) ! ,,pace       
provid] inc5tive paym5ts1 includ+ ca%1  
ca%-equival5t1 or o!r types ( inc5tives1
 = volunt>y p>ticipation 9 a ,bett]     
,heal? ,rew>ds ,program 79 ?is          
subsection ref]r$ to z ! ,program7 t    
rew>ds enrollees = meet+ c]ta9 heal?    
t>gets e/abli%$ by ! ,secret>y4  7#b7   
,limitation ,9 no case %all ! paym5t to 
a ,,pace provid] "u ?is section 7or any 
premium *>g$ by ! provid] "u ?is        
section7 ) respect to ,,pace program    
eligible individuals enroll$ ) ! ,,pace 
provid] take into acc\nt any inc5tive   
paym5ts made to individuals "u !        
,program4  7#c7 ,implem5tation ,!       

,program "u ?is subsection %all be      
conduct$ 9 a simil> mann] to ! mann] 9  
:i* ! program "u section #ahdi is       
conduct$1 9 accordance ) /&>ds e/abli%$ 
by ! ,secret>y4  7#d7 ,notification &   
provision ( in=mation ,a ,,pace provid] 
seek+ to p>ticipate 9 ! ,program %all-- 
7,a7 notify ! ,secret>y ( ! ,,pace      
provid]'s int5t to p>ticipate 9 !       
,program2 &  7,b7 agree to provide to ! 
,secret>y--  7i7 in=mation reg>d+--     
7,i7 :i* ,,pace program eligible        
individuals enroll$ ) ! ,,pace provid]  
p>ticipate 9 ! ,program2  7,,ii7 !      
scores ( ^? individuals ) respect to    
applicable heal? t>gets "u ! ,program2 &
  7,,iii7 ! inc5tives individuals       
receive = meet+ su* heal? t>gets2 &     
7ii7 any o!r in=mation specifi$ by !    
,secret>y = purposes ( ?is subsection4  
7#e7 ,waiv] au?ority ,! ,secret>y may   
waive su* requirem5ts ( titles ,,xi1    
,,xviii1 & ,,xix z may be necess>y to   
c>ry out ! purposes ( ! ,program        
e/abli%$ "u ?is subsection4  4  7b7     

,m$icaid ,section #aicd ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #acifu-#d7
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7k7 ,provid+ inc5tives =   
volunt>y p>ticipation 9 a ,bett] ,heal? 
,rew>ds ,program  7#a7 ,9 g5]al         
,effective = ,,pace program agreem5ts   
ent]$ into on or aft] ! date ( enactm5t 
( ! ,m$ic>e ,bett] ,heal? ,rew>ds       
,program ,act ( #bjac1 a ,,pace provid] 
may provide to ,,pace program eligible  
individuals enroll$ "u ?is section ) !  
,,pace provid] inc5tive paym5ts1 includ+
 ca%1 ca%-equival5t1 or o!r types (     
inc5tives1 = volunt>y p>ticipation 9 a  
,bett] ,heal? ,rew>ds ,program 79 ?is   
subsection ref]r$ to z ! ,program7 t    
rew>ds enrollees = meet+ c]ta9 heal?    
t>gets e/abli%$ by ! ,secret>y4  7#b7   
,limitation ,9 no case %all ! paym5t to 
a ,,pace provid] "u ?is section 7or any 
premium *>g$ by ! provid] "u ?is        
section7 ) respect to ,,pace program    
eligible individuals enroll$ ) ! ,,pace 
provid] take into acc\nt any inc5tive   

paym5ts made to individuals "u !        
,program4  7#c7 ,implem5tation ,!       
,program "u ?is subsection %all be      
conduct$ 9 a simil> mann] to ! mann] 9  
:i* ! program "u section #ahdi is       
conduct$1 9 accordance ) /&>ds e/abli%$ 
by ! ,secret>y4  7#d7 ,notification &   
provision ( in=mation ,a ,,pace provid] 
seek+ to p>ticipate 9 ! ,program %all-- 
7,a7 notify ! ,secret>y ( ! ,,pace      
provid]'s int5t to p>ticipate 9 !       
,program2 &  7,b7 agree to provide to ! 
,secret>y--  7i7 in=mation reg>d+--     
7,i7 :i* ,,pace program eligible        
individuals enroll$ ) ! ,,pace provid]  
p>ticipate 9 ! ,program2  7,,ii7 !      
scores ( ^? individuals ) respect to    
applicable heal? t>gets "u ! ,program2 &
  7,,iii7 ! inc5tives individuals       
receive = meet+ su* heal? t>gets2 &     
7ii7 any o!r in=mation specifi$ by !    
,secret>y = purposes ( ?is subsection4  
7#e7 ,waiv] au?ority ,! ,secret>y may   
waive su* requirem5ts ( titles ,,xi1    
,,xviii1 & ,,xix z may be necess>y to   

c>ry out ! purposes ( ! ,program        
e/abli%$ "u ?is subsection4  4  #f4     
,exclusion ( inc5tive paym5ts  7a7 ,9   
g5]al ,"p ,,iii ( sub*apt] ,b ( *apt] #a
 ( ! ,int]nal ,rev5ue ,code ( #aihf is  
am5d$ by ins]t+ aft] section #aci;,d !  
foll[+ new section3  #aci;,e4 ,m$ic>e   
,bett] ,heal? ,rew>ds paym5ts ,gross    
income %all n include any paym5t made "u
 ! foll[+ programs3  7#a7 ,! ,m$ic>e    
,bett] ,heal? ,rew>ds ,program e/abli%$ 
"u section #ahdi ( ! ,social ,security  
,act4  7#b7 ,a ,bett] ,heal? ,rew>ds    
,program e/abli%$ pursuant to section   
#ahei7;h71 #ahgf7l71 #ahid7;j71 or      
#aicd7k7 ( ! ,social ,security ,act4  4 
7b7 ,cl]ical am5dm5t ,! table ( sections
 = "p ,,iii ( sub*apt] ,b ( *apt] #a (  
su* ,code is am5d$ by ins]t+ aft] ! item
 relat+ to section #aci;,d ! foll[+ new 
item3  ,sec4 #aci;,e4 ,m$ic>e ,bett]    
,heal? ,rew>ds paym5ts4  4