,,ii #aac? ,,congress #b;d ,session ,s4 #beeb ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #bf1 #bjad ,mr4 ,br[n 7= himself & ,mr4 ,blum5?al7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to enhance b5efici>y & provid] protections & improve transp>5cy 9 ! ,m$ic>e ,advantage m>ket1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,advantage ,p>ticipant ,bill ( ,rights ,act ( #bjad4 #b4 ,limitation on removal ( ,m$ic>e ,advantage provid]s by ,,ma organizations 7a7 ,limitation ,section #aheb7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77 is am5d$ by add+ at ! end ! foll[+3 7#g7 ,limitation on removal ( provid]s f ,,ma plans by ,,ma organizations 7,a7 ,removal ( provid]s ) cause ,beg9n+ ) plan ye> #bjae1 except z provid$ 9 subp>agraph 7,c71 an ,,ma organization (f]+ an ,,ma plan may only remove a provid] ( s]vices or a suppli] f a network ( su* plan if ! organization has cause to remove su* provid] or suppli]4 7,b7 ,cause to remove provid]s 7i7 ,9 ,g5]al ,an ,,ma organization (f]+ an ,,ma plan has cause to remove a provid] ( s]vices or a suppli] f a network ( su* plan if ! ,secret>y det]m9es t ! provid] or suppli] is-- 7,i7 m$ically neglig5t2 7,,ii7 9 violation ( any legal or contractual requirem5t applicable to ! provid] or suppli] act+ )9 ! lawful scope ( practice1 includ+ any p>ticipation or o!r requirem5t applicable to su* provid] or suppli] "u ?is title or "u any contractual t]m = su* plan2 or 7,,iii7 o!rwise unfit to furni% items & s]vices 9 accordance ) requirem5ts ( ?is title4 7ii7 ,consid]ation ( co/ to ,,ma organizations ,= purposes ( subp>agraph 7,a71 co/ to an ,,ma organization (f]+ an ,,ma plan due to ! p>ticipation ( a provid] ( s]vices or suppli] 9 a network ( su* plan does n con/itute cause = ! ,,ma organization to remove su* provid] or suppli] f ! network1 & su* co/ may n be consid]$ z a factor 9 favor ( a det]m9ation t su* organization has cause to remove ! provid]4 7,c7 ,exception ,) respect to ea* upcom+ plan ye>1 beg9n+ ) plan ye> #bjae1 an ,,ma organization (f]+ an ,,ma plan may only remove a provid] ( s]vices or suppli] f a network ( su* plan = reasons n specifi$ 9 subp>agraph 7,b77i7 be=e ! date t is #fj days be=e ! fir/ day ( ! annual coord9at$ election p]iod = su* plan ye> "u section #ahea7;e77#c74 7,d7 ,notice & appeal process 7i7 ,9 ,g5]al ,any removal ( a provid] ( s]vices or suppli] f a network ( an ,,ma plan may occur only aft] ! completion ( a fair notice & appeal process t ! ,secret>y %all e/abli% by regulation4 ,su* process %all require ! ,,ma organization to provide to su* provid] or suppli] & to ! ,secret>y an explanation ( ! reason or reasons = ! removal4 7ii7 ,application 7,i7 ,application ( new process ,9 ! case ( a removal ( a provid] ( s]vices or suppli] f a network ( an ,,ma plan occurr+ on or aft] ! effective date publi%$ 9 a f9al rule = su* fair notice & appeal process1 su* process %all apply 9 lieu ( ! process = ! t]m9ation or susp5sion ( a provid] contract "u section #dbb4bjb7;a7 ( title #db1 ,code ( ,f$]al ,regulations4 7,,ii7 ,cont9uation ( old process ,9 ! case ( a removal ( a provid] ( s]vices or suppli] f a network ( an ,,ma plan occurr+ be=e su* effective date1 ! process = ! t]m9ation or susp5sion ( a provid] contract "u section #dbb4bjb7;a7 ( title #db1 ,code ( ,f$]al ,regulations1 %all apply4 7,e7 ,p>ticipant notice & protection 7i7 ,notice to p>ticipants ( provid] removal ,n less ?an #fj days be=e ! date on :i* a provid] ( s]vices or suppli] is remov$ f a network ( an ,,ma plan1 ! ,,ma organization (f]+ su* plan %all provide notification ( ! removal to ea* individual enroll$ 9 su* plan receiv+ items or s]vices f ! provid] or suppli] dur+ ! plan ye> 9 effect on ! date ( removal or dur+ ! previ\s plan ye>4 ,su* notification %all include-- 7,i7 ! names & telephone numb]s ( 9-network provid]s ( s]vices & suppli]s (f]+ items & s]vices t are ! same or simil> to ! items & s]vices (f]$ by ! remov$ provid] or suppli]2 7,,ii7 in=mation reg>d+ ! options available to an individual enroll$ 9 su* plan to reque/ ! cont9uation ( m$ical treatm5t or !rapy ) ! remov$ provid] or suppli]2 & 7,,iii7 "o or m cu/om] s]vice telephone numb]s t an individual enroll$ 9 su* plan may access to obta9 in=mation reg>d+ *anges to ! network ( ! plan4 7ii7 ,annual notice ( *ange ,9 addition to provid+ ! notification ( removal z requir$ "u clause 7i71 ! ,,ma organization (f]+ su* ,,ma plan %all include su* notification 9 ! annual notice ( *ange = ! ,,ma plan = ! upcom+ plan ye>4 7iii7 ,cont9uity ( c>e ,9 any case 9 :i* a provid] ( s]vices or suppli] is remov$ f a network ( an ,,ma plan1 su* plan %all ensure t ! removal satisfies ! cont9uity ( c>e requirem5ts "u p>agraph 7#a77;,a7 ) respect to ea* individual enroll$ 9 su* plan receiv+ items or s]vices f ! provid] or suppli] dur+ ! plan ye> 9 effect on ! date ( removal or dur+ ! previ\s plan ye>4 7,f7 ,rule ( con/ruction ,no?+ 9 ?is p>agraph %all be con/ru$ z affect+ ! ability ( a provid] ( s]vices or suppli] to decl9e to p>ticipate 9 a network ( an ,,ma plan4 7#h7 ,transp>5cy 9 measures us$ by ,,ma organizations to e/abli% or modify provid] networks 7,a7 ,9 ,g5]al ,beg9n+ ) plan ye> #bjaf1 an ,,ma organization (f]+ an ,,ma plan %all include ! in=mation describ$ 9 subp>agraph 7,b7-- 7i7 9 ! annual bid in=mation submitt$ by ! ,,ma organization ) respect to ! ,,ma plan "u section #ahed2 & 7ii7 on ! ,int]net ,web ,site = ! ,,ma plan4 7,b7 ,in=mation describ$ ,! in=mation describ$ 9 ?is subp>agraph is ! foll[+3 7i7 ,in=mation reg>d+ ! measures us$ by ! ,,ma organization to e/abli% or modify ! provid] network ( ! ,,ma plan1 includ+ measures ( ! quality & effici5cy ( provid]s4 ,su* in=mation %all include ! specifications1 me?odology1 & sample size ( su* measures4 7ii7 ,o!r in=mation relat$ to ! e/abli%m5t or modification ( su* provid] network t ! ,secret>y det]m9es appropriate4 7,c7 ,limitation ,! in=mation describ$ 9 subp>agraph 7,b7 %all n include any individually id5tifiable in=mation ( any provid] or suppli] ( s]vices4 4 7b7 ,en=cem5t 7#a7 ,sanctions = noncompliance ,section #aheg7;g77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;g77#a77 is am5d$-- 7,a7 9 subp>agraph 7,j71 by /rik+ or2 7,b7 by r$esignat+ subp>agraph 7,k7 z subp>agraph 7,l72 7,c7 by ins]t+ aft] subp>agraph 7,j7 ! foll[+ new subp>agraph3 7,k7 fails to comply ) sections #aheb7;d77#g7 or #aheb7;d77#h72 or 2 & 7,d7 9 subp>agraph 7,l7 7z s r$esignat$71 by /rik+ ?r\gh 7,j7 & ins]t+ ?r\gh 7,k74 7#b7 ,sanctions n applicable to "p ,d ,title ,,xviii ( ! ,social ,security ,act is am5d$-- 7,a7 9 section #ahfj;,d-#ab7;b77#c77;,e7 7#db ,u4,s4,c4 #aciew-#aab7;b77#c77;,e771 by /rik+ p>agraph 7#a77;,f7 & ins]t+ p>agraphs 7#a77;,f7 & 7#a77,k72 & 7,b7 9 section #ahid7;e77#f77;,b7 7#db ,u4,s4,c4 #acie;eee7e77#f77;,b771 by ins]t+ 7o!r ?an p>agraph 7#a77,k7 ( su* section7 aft] #aheg7;g77#a74 7c7 ,network access adequacy /&>ds ,beg9n+ ) plan ye> #bjae1 9 apply+ ! network access adequacy /&>ds pursuant to section #aheb7;d77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77#a771 ! ,secret>y ( ,heal? & ,human ,s]vices %all seek input f pati5t advocacy gr\ps1 provid]s ( s]vices & suppli]s1 & ,,ma plans "u "p ,c ( title ,,xviii ( su* ,act4 7d7 ,m$ic>e ,advantage ,plan ,comp>e ,tool ,n lat] ?an ,septemb] #cj1 #bjae1 ! ,secret>y ( ,heal? & ,human ,s]vices %all take su* measures z are necess>y to ensure t ! ,m$ic>e ,advantage ,comp>e ,tool takes into acc\nt ! pref]5ces & utilization ne$s ( su* individuals4