,,ib  ,union ,cal5d> ,no4 #cbf  #aad?   
,,congress  #b;d ,session  ,h4 ,r4 #cgaf
  ,report ,no4 #aad-dbg  ,,9 ,,! ,,h\se 
,,( ,,repres5tatives  ,octob] #h1 #bjae 
,mr4 ,buc%on 7= himself1 ,mr4 ,wel*1 &  
,mr4 ,butt]field7 introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce  ,febru>y #bc1 #bjaf  
,report$ ) an am5dm5t1 committ$ to !    
,committee ( ! ,:ole ,h\se on ! ,/ate ( 
! ,union1 & ord]$ to be pr9t$ ,/rike out
 all aft] ! enact+ clause & ins]t ! "p  
pr9t$ 9 italic ,= text ( introduc$ bill1
 see copy ( bill z introduc$ on ,octob] 
#h1 #bjae  ,a ,,bill  ,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+
 ,removal ( ,t]m9at$ ,provid]s f        
,m$icaid & ,,*ip ,act4  #b4 ,increas+   
ov]sight ( t]m9ation ( ,m$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 ,janu>y #a1 #bjag1 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$]al taxpay]        
id5tification numb]1 & ! ,/ate lic5se or
 c]tification numb] ( su* provid] or    
p]son2  7v7 ! reason = ! t]m9ation2     
7vi7 a copy ( ! notice ( t]m9ation s5t  
to ! provid] or p]son2  7vii7 !         
effective date ( su* t]m9ation specifi$ 
9 su* 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$4  4  7#b7 ,report+           
requirem5ts = manag$ 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 ,/ate report+           
requirem5ts = manag$ c>e entities  7,a7 

,9 g5]al ,) respect to any contract ) a 
manag$ c>e entity "u section #aijc7m7 or
 #aije7t77#c7 7z applicable71 beg9n+ on 
! lat] ( ! fir/ day ( ! fir/ plan ye> = 
su* manag$ c>e entity t beg9s aft] !    
date ( ! enactm5t ( ?is p>agraph or     
,janu>y #a1 #bjag1 ! ,/ate %all require 
t su* contract 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$ical  
assi/ance "u ?is title4  7,b7           
,notification ( t]m9ation ,= ! p]iod    
beg9n+ on ,janu>y #a1 #bjag1 & end+ on !
 date on :i* ! enrollm5t ( provid]s "u  
p>agraph 7#f7 is complete = a ,/ate1 !  
,/ate %all provide = a sy/em = notify+  
manag$ c>e entities 7z def9$ 9          
subsection 7a77#a77 ( ! t]m9ation 7z    
describ$ 9 section #aijb7kk77#h77 (     
provid]s ( s]vices or p]sons f          

p>ticipation "u ?is title1 title        
,,xviii1 or title ,,xxi4  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$-- 
7,a7 9 subsection 7i77#b7--  7i7 9      
subp>agraph 7,a71 by /rik+ ! comma at ! 
end & ins]t+ a semicolon2  7ii7 9       
subp>agraph 7,b71 by /rik+ or at ! end2 
&  7iii7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,d7 beg9n+ n lat] ?an    
,janu>y #a1 #bjah1 "u ! plan by any     
provid] ( s]vices or p]son ^:           
p>ticipation 9 ! ,/ate plan is t]m9at$  
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 ! applicable    

date specifi$ 9 subp>agraph 7,a7 (      
section #aicb7;d77#e71 has a contract ) 
su* entity t complies ) ! requirem5t    
specifi$ 9 su* subp>agraph2 &  7,b7  7i7
 = ! p]iod specifi$ 9 subp>agraph 7,b7 (
 su* section1 has a sy/em 9 effect t    
meets ! requirem5t specifi$ 9 su*       
subp>agraph2 &  7ii7 aft] su* p]iod1    
complies ) section #aicb7;d77#f74  4    
7#e7 ,developm5t ( uni=m t]m9ology =    
reasons = provid] t]m9ation ,n lat] ?an 
,janu>y #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  

p>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 p>agraph 7#a771 by /rik+  
7a77#b77;,c7 & 7h7 & ins]t+ 7a77#b77;,c7
 7relat+ to ,indian enrollm5t71 7d77#e7 
7relat+ to report+ requirem5ts = 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  ,febru>y #bc1 #bjaf ,report$ ) an
 am5dm5t1 committ$ to ! ,committee ( !  
,:ole ,h\se on ! ,/ate ( ! ,union1 &    
ord]$ to be pr9t$