#aad? ,,congress  #b;d ,session  ,h4 ,r4
 #cgaf  ,,an ,,act  ,to am5d title ,,xix
 ( ! ,social ,security ,act to require  
,/ates to provide to ! ,secret>y (      
,heal? & ,human ,s]vices c]ta9 in=mation
 ) respect to provid] t]m9ations1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,ensur+ ,access to     
,quality ,m$icaid ,provid]s ,act4  #b4  
,increas+ ov]sight ( t]m9ation (        
,m$icaid provid]s  7a7 ,increas$        
ov]sight & report+  7#a7 ,/ate report+  
requirem5ts ,section #aijb7kk7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7kk77 is am5d$--  7,a7 by        
r$esignat+ p>agraph 7#h7 z p>agraph     
7#i72 &  7,b7 by ins]t+ aft] p>agraph   
7#g7 ! foll[+ new p>agraph3  7#h7       
,provid] t]m9ations  7,a7 ,9 g5]al      
,beg9n+ on ,july #a1 #bjah1 9 ! case ( a
 notification "u subsection 7a77#da7 )  
respect to a t]m9ation = a reason       
specifi$ 9 section #dee4aja ( title #db1
 ,code ( ,f$]al ,regulations 7z 9 effect
 on ,novemb] #a1 #bjae7 or = any o!r    

reason specifi$ by ! ,secret>y1 ( !     
p>ticipation ( a provid] ( s]vices or   
any o!r p]son "u ! ,/ate plan1 ! ,/ate1 
n lat] ?an #ba bus9ess days aft] !      
effective date ( su* t]m9ation1 submits 
to ! ,secret>y ) respect to any su*     
provid] or p]son1 z appropriate-- 7i7 ! 
"n ( su* provid] or p]son2  7ii7 !      
provid] type ( su* provid] or p]son2    
7iii7 ! specialty ( su* provid]'s or    
p]son's practice2  7iv7 ! date ( bir?1  
,social ,security numb]1 national       
provid] id5tifi]1 ,f$]al taxpay]        
id5tification numb]1 & ! ,/ate lic5se or
 c]tification numb] ( su* provid] or    
p]son2  7v7 ! reason = ! t]m9ation2     
7vi7 a copy ( ! notice ( t]m9ation s5t  
to ! provid] or p]son2  7vii7 ! date on 
:i* su* t]m9ation is effective1 z       
specifi$ 9 ! notice2 &  7viii7 any o!r  
in=mation requir$ by ! ,secret>y4  7,b7 
,effective date def9$ ,= purposes ( ?is 
p>agraph1 ! t]m effective date means1 ) 
respect to a t]m9ation describ$ 9       
subp>agraph 7,a71 ! lat] (--  7i7 ! date

 on :i* su* t]m9ation is effective1 z   
specifi$ 9 ! notice ( su* t]m9ation2 or 
7ii7 ! date on :i* all appeal rights    
applicable to su* t]m9ation h be5       
exhau/$ or ! timel9e = any su* appeal   
has expir$4  4  7#b7 ,contract          
requirem5t = manag$ c>e entities        
,section #aicb7;d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifu-#b7;d77 is  
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#e7 ,contract requirem5t =  
manag$ c>e entities ,) respect to any   
contract ) a manag$ c>e entity "u       
section #aijc7m7 or #aije7t77#c7 7z     
applicable71 no lat] ?an ,july #a1      
#bjah1 su* contract %all include a      
provision t provid]s ( s]vices or p]sons
 t]m9at$ 7z describ$ 9 section          
#aijb7kk77#h77 f p>ticipation "u ?is    
title1 title ,,xviii1 or title ,,xxi be 
t]m9at$ f p>ticipat+ "u ?is title z a   
provid] 9 any network ( su* entity t    
s]ves individuals eligible to receive   
m$ical assi/ance "u ?is title4  4  7#c7 
,t]m9ation ,notification ,database      

,section #aijb ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7 is am5d$ by
 add+ at ! end ! foll[+ new subsection3 
7ll7 ,t]m9ation notification database ,9
 ! case ( a provid] ( s]vices or any o!r
 p]son ^: p>ticipation "u ?is title1    
title ,,xviii1 or title ,,xxi is t]m9at$
 7z describ$ 9 subsection 7kk77#h771 !  
,secret>y %all1 n lat] ?an #ba bus9ess  
days aft] ! date on :i* ! ,secret>y     
t]m9ates su* p>ticipation "u title      
,,xviii or is notifi$ ( su* t]m9ation "u
 subsection 7a77#da7 7z applicable71    
review su* t]m9ation &1 if ! ,secret>y  
det]m9es appropriate1 include su*       
t]m9ation 9 any database or simil> sy/em
 develop$ pursuant to section           
#fdja7;b77#b7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#acie;cc note2 ,public ,law #aaa-adh74  
4  7#d7 ,no ,f$]al funds = items &      
s]vices furni%$ by t]m9at$ provid]s     
,section #aijc ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;b7 is am5d$-- 
7,a7 9 subsection 7i77#b7--  7i7 9      

subp>agraph 7,a71 by /rik+ ! comma at ! 
end & ins]t+ a semicolon2  7ii7 9       
subp>agraph 7,b71 by /rik+ or at ! end2 
&  7iii7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,d7 beg9n+ n lat] ?an    
,july #a1 #bjah1 "u ! plan by any       
provid] ( s]vices or p]son ^:           
p>ticipation 9 ! ,/ate plan is t]m9at$  
7z describ$ 9 section #aijb7kk77#h77    
aft] ! date t is #fj days aft] ! date on
 :i* su* t]m9ation is includ$ 9 !       
database or o!r sy/em "u section        
#aijb7ll72 or  2 &  7,b7 9 subsection   
7m71 by ins]t+ aft] p>agraph 7#b7 !     
foll[+ new p>agraph3  7#c7 ,no paym5t   
%all be made "u ?is title to a ,/ate )  
respect to exp5ditures incurr$ by !     
,/ate = paym5t = s]vices provid$ by a   
manag$ c>e entity 7z def9$ "u section   
#aicb7;a77#a77 "u ! ,/ate plan "u ?is   
title 7or "u a waiv] ( ! plan7 unless ! 
,/ate--  7,a7 beg9n+ on ,july #a1 #bjah1
 has a contract ) su* entity t complies 
) ! requirem5t specifi$ 9 su*           
subp>agraph2 &  7,b7 beg9n+ on ,janu>y  

#a1 #bjah1 complies ) ! requirem5t      
specifi$ 9 section #aicb7;d77#f77;,a74  
4  7#e7 ,developm5t ( uni=m t]m9ology = 
reasons = provid] t]m9ation ,n lat] ?an 
,july #a1 #bjag1 ! ,secret>y ( ,heal? & 
,human ,s]vices %all1 9 consultation ) !
 heads ( ,/ate ag5cies adm9i/]+ ,/ate   
,m$icaid plans 7or waiv]s ( su* plans71 
issue regulations e/abli%+ uni=m        
t]m9ology to be us$ ) respect to        
specify+ reasons "u subp>agraph 7,a77v7 
( p>agraph 7#h7 ( section #aijb7kk7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7kk771 z am5d$ by p>agraph 7#a71 
= ! t]m9ation 7z describ$ 9 su*         
p>agraph7 ( ! p>ticipation ( c]ta9      
provid]s 9 ! ,m$icaid program "u title  
,,xix ( su* ,act or ! ,*ildr5's ,heal?  
,insurance ,program "u title ,,xxi ( su*
 ,act4  7#f7 ,con=m+ am5dm5t ,section   
#aijb7;a77#da7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#da77 is 
am5d$ by /rik+ provide t :5ev] & ins]t+ 
provide1 9 accordance ) subsection      
7kk77#h7 7z applicable71 t :5ev]4  7b7  

,increas+ availability ( ,m$icaid       
provid] in=mation  7#a7 ,,ffs provid]   
enrollm5t ,section #aijb7;a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77 is am5d$ by ins]t+ aft]     
p>agraph 7#gg7 ! foll[+ new p>agraph3   
7#gh7 provide t1 n lat] ?an ,janu>y #a1 
#bjag1 9 ! case ( a ,/ate plan t        
provides m$ical assi/ance on a          
fee-=-s]vice basis1 ! ,/ate %all require
 ea* provid] furni%+ items & s]vices to 
individuals eligible to receive m$ical  
assi/ance "u su* plan to enroll ) !     
,/ate ag5cy & provide to ! ,/ate ag5cy !
 provid]'s id5tify+ in=mation1 includ+ !
 "n1 specialty1 date ( bir?1 ,social    
,security numb]1 national provid]       
id5tifi]1 ,f$]al taxpay] id5tification  
numb]1 & ! ,/ate lic5se or c]tification 
numb] ( ! provid]2  4  7#b7 ,manag$ c>e 
provid] enrollm5t ,section #aicb7;d7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acifu-#b7;d771 z am5d$ by subsection   
7a77#b71 is am5d$ by add+ at ! end !    
foll[+ new p>agraph3  7#f7 ,enrollm5t ( 

p>ticipat+ provid]s  7,a7 ,9 g5]al      
,beg9n+ n lat] ?an ,janu>y #a1 #bjah1 a 
,/ate %all require t1 9 ord] to         
p>ticipate z a provid] 9 ! network ( a  
manag$ c>e entity t provides s]vices to1
 or ord]s1 prescribes1 ref]s1 or        
c]tifies eligibility = s]vices =1       
individuals :o are eligible = m$ical    
assi/ance "u ! ,/ate plan "u ?is title &
 :o are enroll$ ) ! entity1 ! provid] is
 enroll$ ) ! ,/ate ag5cy adm9i/]+ !     
,/ate plan "u ?is title4 ,su* enrollm5t 
%all include provid+ to ! ,/ate ag5cy ! 
provid]'s id5tify+ in=mation1 includ+ ! 
"n1 specialty1 date ( bir?1 ,social     
,security numb]1 national provid]       
id5tifi]1 ,f$]al taxpay] id5tification  
numb]1 & ! ,/ate lic5se or c]tification 
numb] ( ! provid]4  7,b7 ,rule (        
con/ruction ,no?+ 9 subp>agraph 7,a7    
%all be con/ru$ z requir+ a provid]     
describ$ 9 su* subp>agraph to provide   
s]vices to individuals :o are n enroll$ 
) a manag$ c>e entity "u ?is title4  4  
7c7 ,coord9ation ) ,,*ip  7#a7 ,9 g5]al 

,section #bajg7;e77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acig;gg7e77#a77 is am5d$--  7,a7 by    
r$esignat+ subp>agraphs 7,b71 7,c71     
7,d71 7,e71 7,f71 7,g71 7,h71 7,i71     
7,j71 7,k71 7,l71 7,m71 7,n71 & 7,o7 z  
subp>agraphs 7,d71 7,e71 7,f71 7,g71    
7,h71 7,i71 7,j71 7,k71 7,m71 7,n71     
7,o71 7,p71 7,q71 & 7,r71 respectively2 
7,b7 by ins]t+ aft] subp>agraph 7,a7 !  
foll[+ new subp>agraphs3  7,b7 ,section 
#aijb7;a77#ci7 7relat+ to t]m9ation (   
p>ticipation ( c]ta9 provid]s74  7,c7   
,section #aijb7;a77#gh7 7relat+ to      
enrollm5t ( provid]s p>ticipat+ 9 ,/ate 
plans provid+ m$ical assi/ance on a     
fee-=-s]vice basis74  2  7,c7 by ins]t+ 
aft] subp>agraph 7,k7 7z r$esignat$ by  
subp>agraph 7,a77 ! foll[+ new          
subp>agraph3  7,l7 ,section #aijc7m77#c7
 7relat+ to limitation on paym5t )      
respect to manag$ c>e74  2 &  7,d7 9    
subp>agraph 7,p7 7z r$esignat$ by       
subp>agraph 7,a771 by /rik+ 7a77#b77;,c7
 & 7h7 & ins]t+ 7a77#b77;,c7 7relat+ to 

,indian enrollm5t71 7d77#e7 7relat+ to  
contract requirem5t = manag$ c>e        
entities71 7d77#f7 7relat+ to enrollm5t 
( provid]s p>ticipat+ ) a manag$ c>e    
entity71 & 7h7 7relat+ to special rules 
) respect to ,indian enrollees1 ,indian 
heal? c>e provid]s1 & ,indian manag$ c>e
 entities74  7#b7 ,exclud+ f ,m$icaid   
provid]s exclud$ f ,,*ip ,section       
#aijb7;a77#ci7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#ci77 is 
am5d$ by /rik+ title ,,xviii or any o!r 
,/ate plan "u ?is title & ins]t+ title  
,,xviii1 any o!r ,/ate plan "u ?is      
title1 or any ,/ate *ild heal? plan "u  
title ,,xxi4  7d7 ,rule ( con/ruction   
,no?+ 9 ?is section %all be con/ru$ z   
*ang+ or limit+ ! appeal rights (       
provid]s or ! process = appeals ( ,/ates
 "u ! ,social ,security ,act4  7e7 ,,oig
 report ,n lat] ?an ,m>* #ca1 #bjbj1 !  
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices %all submit to       
,congress a report on ! implem5tation ( 
! am5dm5ts made by ?is section4 ,su*    

report %all include ! foll[+3  7#a7 ,an 
assessm5t ( ! ext5t to :i* provid]s :o  
are includ$ "u subsection 7ll7 ( section
 #aijb ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acif;a7 7z add$ by subsection
 7a77#c77 9 ! database or simil> sy/em  
ref]r$ to 9 su* subsection are t]m9at$  
7z describ$ 9 subsection 7kk77#h7 ( su* 
section1 z add$ by subsection 7a77#a77 f
 p>ticipation 9 all ,/ate plans "u title
 ,,xix ( su* ,act4  7#b7 ,in=mation on !
 am\nt ( ,f$]al f9ancial p>ticipation   
paid to ,/ates "u section #aijc ( su*   
,act 9 violation ( ! limitation on su*  
paym5t specifi$ 9 subsections           
7i77#b77;,d7 & subsection 7m77#c7 ( su* 
section1 z add$ by subsection 7a77#d74  
7#c7 ,an assessm5t ( ! ext5t to :i*     
contracts ) manag$ c>e entities "u title
 ,,xix ( su* ,act comply ) ! requirem5t 
specifi$ 9 section #aicb7;d77#e7 ( su*  
,act1 z add$ by subsection 7a77#b74     
7#d7 ,an assessm5t ( ! ext5t to :i*     
provid]s h be5 enroll$ "u section       
#aijb7;a77#gh7 or #aicb7;d77#f77;,a7 (  

su* ,act 7#db ,u4,s4,c4 #acif;a7a77#gh71
 #acifu-#b7;d77#f77;,a77 ) ,/ate ag5cies
 adm9i/]+ ,/ate plans "u title ,,xix (  
su* ,act4  #c4 ,requir+ publication (   
fee-=-s]vice provid] directory  7a7 ,9  
g5]al ,section #aijb7;a7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77 is am5d$-- 7#a7 9 p>agraph  
7#hj71 by /rik+ & at ! end2  7#b7 9     
p>agraph 7#ha71 by /rik+ ! p]iod at !   
end & ins]t+ 2 &2 &  7#c7 by ins]t+ aft]
 p>agraph 7#ha7 ! foll[+ new p>agraph3  
7#hb7 provide t1 n lat] ?an ,janu>y #a1 
#bjag1 9 ! case ( a ,/ate plan t        
provides m$ical assi/ance on a          
fee-=-s]vice basis or ?r\gh a prim>y c>e
 case-managem5t sy/em describ$ 9 section
 #aiae7;b77#a7 7o!r ?an a prim>y c>e    
case managem5t entity 7z def9$ by !     
,secret>y771 ! ,/ate %all publi% 7&     
update on at lea/ an annual basis7 on ! 
public ,website ( ! ,/ate ag5cy adm9i/]+
 ! ,/ate plan1 a directory ( !          
physicians describ$ 9 subsection 7mm7 &1
 at ,/ate option1 o!r provid]s describ$ 

9 su* subsection t-- 7,a7 includes--    
7i7 ) respect to ea* su* physician or   
provid]-- 7,i7 ! "n ( ! physician or    
provid]2  7,,ii7 ! specialty ( !        
physician or provid]2  7,,iii7 ! address
 at :i* ! physician or provid] provides 
s]vices2 &  7,,iv7 ! telephone numb] ( !
 physician or provid]2 &  7ii7 ) respect
 to any su* physician or provid]        
p>ticipat+ 9 su* a prim>y c>e           
case-managem5t sy/em1 in=mation reg>d+--
  7,i7 :e!r ! physician or provid] is   
accept+ z new pati5ts individuals :o    
receive m$ical assi/ance "u ?is title2 &
  7,,ii7 ! physician's or provid]'s     
cultural & l+ui/ic capabilities1 includ+
 ! languages spok5 by ! physician or    
provid] or by ! skill$ m$ical int]pret] 
provid+ int]pretation s]vices at !      
physician's or provid]'s (fice2 &  7,b7 
may include1 at ,/ate option1 ) respect 
to ea* su* physician or provid]-- 7i7 ! 
,int]net website ( su* physician or     
provid]2 or  7ii7 :e!r ! physician or   
provid] is accept+ z new pati5ts        

individuals :o receive m$ical assi/ance 
"u ?is title4  4  7b7 ,directory        
physician or provid] describ$ ,section  
#aijb ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif;a71 z am5d$ by section  
#b7;a77#c71 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7mm7 ,directory 
physician or provid] describ$ ,a        
physician or provid] describ$ 9 ?is     
subsection is-- 7#a7 9 ! case ( a       
physician or provid] ( a provid] type = 
:i* ! ,/ate ag5cy1 z a condition on     
receiv+ paym5t = items & s]vices furni%$
 by ! physician or provid] to           
individuals eligible to receive m$ical  
assi/ance "u ! ,/ate plan1 requires !   
enrollm5t ( ! physician or provid] ) !  
,/ate ag5cy1 a physician or a provid]   
t--  7,a7 is enroll$ ) ! ag5cy z ( !    
date on :i* ! directory is publi%$ or   
updat$ 7z applicable7 "u subsection     
7a77#hb72 &  7,b7 receiv$ paym5t "u !   
,/ate plan 9 ! #ab-mon? p]iod prec$+ su*
 date2 &  7#b7 9 ! case ( a physician or
 provid] ( a provid] type = :i* ! ,/ate 

ag5cy does n require su* enrollm5t1 a   
physician or provid] t receiv$ paym5t "u
 ! ,/ate plan 9 ! #ab-mon? p]iod prec$+ 
! date on :i* ! directory is publi%$ or 
updat$ 7z applicable7 "u subsection     
7a77#hb74  4  7c7 ,rule ( con/ruction   
7#a7 ,9 g5]al ,! am5dm5t made by        
subsection 7a7 %all n be con/ru$ to     
apply 9 ! case ( a ,/ate 7z def9$ =     
purposes ( title ,,xix ( ! ,social      
,security ,act7 9 :i* all ! individuals 
enroll$ 9 ! ,/ate plan "u su* title 7or 
"u a waiv] ( su* plan71 o!r ?an         
individuals describ$ 9 p>agraph 7#b71   
are enroll$ ) a m$icaid manag$ c>e      
organization 7z def9$ 9 section         
#aijc7m77#a77;,a7 ( su* ,act 7#db       
,u4,s4,c4 #acif;b7m77#a77;,a7771 includ+
 prepaid inpati5t heal? plans & prepaid 
ambulatory heal? plans 7z def9$ by !    
,secret>y ( ,heal? & ,human ,s]vices74  
7#b7 ,individuals describ$ ,an          
individual describ$ 9 ?is p>agraph is an
 individual :o is an ,indian 7z def9$ 9 
section #d ( ! ,indian ,heal? ,c>e      

,improvem5t ,act 7#be ,u4,s4,c4 #afjc77 
or an ,alaska ,native4  7d7 ,exception =
 ,/ate legislation ,9 ! case ( a ,/ate  
plan "u title ,,xix ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acif et  
seq471 :i* ! ,secret>y ( ,heal? & ,human
 ,s]vices det]m9es requires ,/ate       
legislation 9 ord] = ! respective plan  
to meet "o or m additional requirem5ts  
impos$ by am5dm5ts made by ?is section1 
! respective plan %all n be reg>d$ z    
fail+ to comply ) ! requirem5ts ( su*   
title solely on ! basis ( its failure to
 meet su* an additional requirem5t be=e 
! fir/ day ( ! fir/ cal5d> qu>t] beg9n+ 
aft] ! close ( ! fir/ regul> session ( !
 ,/ate legislature t beg9s aft] ! date (
 enactm5t ( ?is ,act4 ,= purposes ( !   
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  ,pass$ ! ,h\se (          
,repres5tatives ,m>* #b1 #bjaf4;,cl]k4