,i #aad? ,,congress #a/ ,session ,h4 ,r4 #cggg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,octob] #ba1 #bjae ,mr4 ,rigell introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committees on ! ,budget1 ,en]gy & ,comm]ce1 ! ,judici>y1 ,education & ! ,work=ce1 ,ov]sight & ,gov]nm5t ,re=m1 ,homel& ,security1 ,f9ancial ,s]vices1 & ,agriculture1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to provide = relief f seque/] "u ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe & (fsets to su* relief ?r\gh re=ms 9 c]ta9 rev5ue & direct sp5d+ programs1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,am]ica ,fir/ ,act4 #b4 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4 ,sec4 #b4 ,table ( cont5ts4 ,title ,i--,seque/] ,relief ,sec4 #aja4 ,am5dm5ts to ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe4 ,title ,,ii--,rev5ue ,sec4 #bja4 ,p]man5t ext5sion ( modifications to e>n$ income tax cr$it4 ,sec4 #bjb4 #ce-p]c5t limitation on c]ta9 d$uctions & exclusions4 ,sec4 #bjc4 ,repeal ( m$ical device tax4 ,title ,,iii--,heal?c>e ,sav+s ,subtitle ,a--,m$ic>e & ,m$icaid provisions ,sec4 #cja4 ,freeze income-relat$ ?re%olds 9 calculation ( ,m$ic>e "p ,b & "p ,d premiums4 ,sec4 #cjb4 ,adju/m5t to applicable p]c5tage increase = ,m$ic>e "p ,b & ,d premiums = high-income b5efici>ies4 ,sec4 #cjc4 ,improv$ b5efit /ructure4 ,sec4 #cjd4 ,prohibition on fir/-doll> cov]age "u m$igap policies & developm5t ( new /&>ds = m$igap policies4 ,sec4 #cje4 ,adju/ ,po/-,acute ,paym5t ,updates4 ,sec4 #cjf4 ,paym5t bundl+ = po/-acute c>e 7,,pac7 "u ,m$ic>e4 ,sec4 #cjg4 ,r$uction ( bad debt treat$ z an all[able co/4 ,sec4 #cjh4 ,r$uce ,excess ,subsidies to ,tea*+ ,hospitals4 ,sec4 #cji4 ,equaliz+ paym5t = c]ta9 cov]$ ,,opd s]vices & physicians' s]vices4 ,sec4 #caj4 ,m$ic>e ,advantage cod+ int5sity adju/m5t4 ,sec4 #caa4 ,modifications to co/-%>+ r$uctions "u ,m$ic>e "p ,d = l[-income individuals4 ,sec4 #cab4 ,rebase ,m$ic>e paym5ts at po/-seque/] levels4 ,sec4 #cac4 ,phas$-9 r$uction ( all[able provid] taxes "u ,m$icaid4 ,subtitle ,b--,m$ical ,malpractice ,re=m ,sec4 #cba4 ,def9itions4 ,sec4 #cbb4 ,enc\rag+ spe$y resolution ( claims4 ,sec4 #cbc4 ,comp5sat+ pati5t injury4 ,sec4 #cbd4 ,maximiz+ pati5t recov]y4 ,sec4 #cbe4 ,additional ,,heal? b5efits4 ,sec4 #cbf4 ,effect on o!r laws4 ,sec4 #cbg4 ,/ate flexibility & protection ( ,/ates' rights4 ,sec4 #cbh4 ,/ate demon/ration programs to evaluate alt]natives to curr5t m$ical tort litigation4 ,sec4 #cbi4 ,affirmative def5se bas$ on compliance ) be/ practice guidel9es4 ,sec4 #ccj4 ,m$ical malpractice re=m ,/ate inc5tive fund4 ,sec4 #cca4 ,s5se ( ,congress conc]n+ additional re=ms4 ,sec4 #ccb4 ,applicability2 effective date4 ,title ,,iv--,social ,security ,sav+s ,sec4 #dja4 ,adju/m5ts 9 supplem5tal security income b5efits = c]ta9 long-"t b5efici>ies4 ,title ,v--,o!r ,m&atory ,sav+s & ,receipts ,sec4 #eja4 ,conv]sion to *a9$ ,,cpi4 ,sec4 #ejb4 ,adju/m5t = inflation ( fees = c]ta9 cu/oms s]vices4 ,sec4 #ejc4 ,adju/m5t = inflation ( ,,tsa s]vice security fees & fee levels4 ,sec4 #ejd4 ,divid5ds & surplus funds ( res]ve banks4 ,sec4 #eje4 ,co/-sav+ re=ms = ,f$]al ,crop ,insurance ,program4 ,sec4 #ejf4 ,f$]al employee annuities4 ,sec4 #ejg4 ,repaym5t plans4 ,sec4 #ejh4 ,,repaye4 ,sec4 #eji4 ,public s]vice loan =giv5ess4 ,i ,seque/] ,relief #aja4 ,am5dm5ts to ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7a7 ,discretion>y sp5d+ limits ,section #bea7;c7 ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ija7;c77 is am5d$ by /rik+ p>agraphs 7#c7 ?r\gh 7#h7 & ins]t+ ! foll[+3 7#c7 = fiscal ye> #bjaf-- 7,a7 = ! revis$ security category1 #efd1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #eba1jjj1jjj1jjj 9 new budget au?ority2 7#d7 = fiscal ye> #bjag-- 7,a7 = ! revis$ security category1 #egg1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #ecb1jjj1jjj1jjj 9 new budget au?ority2 7#e7 = fiscal ye> #bjah-- 7,a7 = ! revis$ security category1 #eij1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #edd1jjj1jjj1jjj 9 new budget au?ority2 7#f7 = fiscal ye> #bjai-- 7,a7 = ! revis$ security category1 #fjc1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #eeg1jjj1jjj1jjj 9 new budget au?ority2 7#g7 = fiscal ye> #bjbj-- 7,a7 = ! revis$ security category1 #fag1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #efi1jjj1jjj1jjj 9 new budget au?ority2 7#h7 = fiscal ye> #bjba-- 7,a7 = ! revis$ security category1 #fca1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #eha1jjj1jjj1jjj 9 new budget au?ority2 7#i7 = fiscal ye> #bjbb-- 7,a7 = ! revis$ security category1 #fdf1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #eif1jjj1jjj1jjj 9 new budget au?ority2 7#aj7 = fiscal ye> #bjbc-- 7,a7 = ! revis$ security category1 #ffb1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #faj1jjj1jjj1jjj 9 new budget au?ority2 7#aa7 = fiscal ye> #bjbd-- 7,a7 = ! revis$ security category1 #fgi1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #fbf1jjj1jjj1jjj 9 new budget au?ority2 & 7#ab7 = fiscal ye> #bjbe-- 7,a7 = ! revis$ security category1 #fie1jjj1jjj1jjj 9 new budget au?ority2 & 7,b7 = ! revis$ nonsecurity category1 #fda1jjj1jjj1jjj 9 new budget au?ority2 4 7b7 ,elim9ation ( direct sp5d+ seque/] & o!r adju/m5ts 7#a7 ,9 g5]al ,section #bea;,a ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ija;a7 is repeal$4 7#b7 ,cl>ification ,any ord] issu$ by ! ,director ( ! ,(fice ( ,managem5t & ,budget to r$uce ! discretion>y sp5d+ limit = fiscal ye> #bjaf "u su* section 7z 9 effect on ! date be=e ! date ( enactm5t ( ?is ,act7 %all h no =ce or effect4 7c7 ,adju/m5ts to discretion>y sp5d+ limits ,section #bea7;b77#b7 ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ija7;b77#b77 is am5d$ z foll[s3 7#a7 ,9 subp>agraph 7,b7-- 7,a7 9 subclause 7,,ix71 by /rik+ & at ! end2 7,b7 9 subclause 7,x71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7,,xi7 = fiscal ye> #bjbb1 #a1cji1jjj1jjj 9 additional new budget au?ority2 7,,xii7 = fiscal ye> #bjbc1 #a1cji1jjj1jjj 9 additional new budget au?ority2 7,,xiii7 = fiscal ye> #bjbd1 #a1cji1jjj1jjj 9 additional new budget au?ority2 & 7,,xiv7 = fiscal ye> #bjbe1 #a1cji1jjj1jjj 9 additional new budget au?ority4 4 7#b7 ,9 subp>agraph 7,c7-- 7,a7 9 subclause 7,,ix71 by /rik+ & at ! end2 7,b7 9 subclause 7,x71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7,,xi7 = fiscal ye> #bjbb1 #dif1jjj1jjj 9 additional new budget au?ority2 7,,xii7 = fiscal ye> #bjbc1 #dif1jjj1jjj;9 additional new budget au?ority2 7,,xiii7 = fiscal ye> #bjbd1 #dif1jjj1jjj 9 additional new budget au?ority2 & 7,,xiv7 = fiscal ye> #bjbe1 #dif1jjj1jjj 9 additional new budget au?ority4 4 7#c7 ,9 subp>agraph 7,d71 by /rik+ fiscal ye>s #bjab ?r\gh #bjba & ins]t+ fiscal ye>s #bjab ?r\gh #bjbe4 7d7 ,cl]ical am5dm5t ,section #bej7;a7 ( ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe 7#b ,u4,s4,c4 #ijj7;a77 is am5d$ by /rik+ ! item relat+ to section #bea;,a4 ,,ii ,rev5ue #bja4 ,p]man5t ext5sion ( modifications to e>n$ income tax cr$it 7a7 ,increase 9 cr$it p]c5tage = families ) #c or m *ildr5 ,section #cb7;b77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 by /rik+ ,p]c5tages4--,! cr$it p]c5tage & & ins]t+ ! foll[+3 ,p]c5tages4-- 7,a7 ,9 g5]al ,! cr$it p]c5tage & 2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,increas$ cr$it p]c5tage = families ) #c or m qualify+ *ildr5 ,9 ! case ( an eligible individual ) #c or m qualify+ *ildr51 ! table 9 subp>agraph 7,a7 %all be appli$ by sub/itut+ #de = #dj 9 ! second column !re(4 4 7b7 ,jo9t returns 7#a7 ,9 g5]al ,section #cb7;b77#b77;,b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ increas$ by & all t foll[s & ins]t+ increas$ by #e1jjj44 7#b7 ,inflation adju/m5ts ,section #cb7;j77#a77;,b77ii7 ( su* ,code is am5d$-- 7,a7 by /rik+ #c1jjj & ins]t+ #e1jjj2 7,b7 by /rik+ subsection 7b77#b77;,b77iii7 & ins]t+ subsection 7b77#b77;,b72 & 7,c7 by /rik+ cal5d> ye> #bjjg & ins]t+ cal5d> ye> #bjjh4 7c7 ,con=m+ am5dm5t ,section #cb7;b7 ( su* ,code is am5d$ by /rik+ p>agraph 7#c74 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjae4 #bjb4 #ce-p]c5t limitation on c]ta9 d$uctions & exclusions 7a7 ,9 g5]al ,"p ,i ( sub*apt] ,b ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new section3 #fi4 ,limitation on itemiz$ d$uctions ,9 ! case ( an individual1 = any taxable ye> ) respect to :i* ! highe/ rate ( tax impos$ "u section #a exce$s #ce p]c5t1 ! tax impos$ by su* section %all be increas$ by ! excess 7if any7 (-- 7#a7 ! tax :i* w\ld be impos$ "u su* section if taxable income 7 det]m9$ )\t reg>d to itemiz$ d$uctions1 ov] 7#b7 ! tax :i* w\ld be det]m9$ "u p>agraph 7#a7 if ! highe/ rate ( tax impos$ "u su* section on am\nts 9 excess ( ! taxpay]'s taxable income 7det]m9$ )\t reg>d to ?is section7 0 #ce p]c5t4 4 7b7 ,cl]ical am5dm5t ,! table ( sections = "p ,i ( sub*apt] ,b ( *apt] #a ( su* ,code is am5d$ by add+ at ! end ! foll[+ new item3 ,sec4 #fi4 ,limitation on itemiz$ d$uctions4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjae4 #bjc4 ,repeal ( m$ical device tax 7a7 ,9 g5]al ,*apt] #cb ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ sub*apt] ,e4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to sales aft] ! date ( ! enactm5t ( ?is ,act4 ,,iii ,heal?c>e ,sav+s ,a ,m$ic>e & ,m$icaid provisions #cja4 ,freeze income-relat$ ?re%olds 9 calculation ( ,m$ic>e "p ,b & "p ,d premiums ,section #ahci7;i77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#e77 is am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7 9 ! matt] prec$+ clause 7i71 by /rik+ & #bjai & ins]t+ & ea* subsequ5t ye> be=e ! t>get ye>2 & 7,b7 9 clause 7ii71 by /rik+ beg9n+ ) #bjbj1 ,augu/ #bjah & ins]t+ beg9n+ ) ! t>get ye>1 ,augu/ ( ! cal5d> ye> t is two ye>s be=e ! t>get ye>2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,t>get ye> ,= purposes ( ?is p>agraph1 ! t]m t>get ye> means ! fir/ cal5d> ye> aft] ! cal5d> ye> 9 :i* at lea/ #be p]c5t ( individuals enroll$ "u ?is "p are subject to a r$uction "u ?is subsection to ! mon?ly am\nt ( ! premium subsidy applicable to ! premium "u ?is section4 4 #cjb4 ,adju/m5t to applicable p]c5tage increase = ,m$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$-- 7#a7 9 p>agraph 7#c77;,a77i71 by /rik+ p>agraph 7#f7 & ins]t+ p>agraphs 7#f7 & 7#g72 7#b7 by r$esignat+ p>agraph 7#g7 z p>agraph 7#h72 & 7#c7 by ins]t+ aft] p>agraph 7#f7 ! foll[+ new p>agraph3 7#g7 ,adju/m5t to applicable p]c5tage increase beg9n+ 9 #bjaf ,not)/&+ any o!r provision ( ?is subsection1 = mon?s beg9n+ ) ,janu>y #bjaf1 9 apply+ ! applicable p]c5tages specifi$ 9 ! applicable table 9 p>agraph 7#c77;,c77i7-- 7,a7 dur+ #bjaf1 ! ref]5ces 9 ! table 9 subp>agraph 7,i7 ( su* p>agraph to #ce p]c5t1 #ej p]c5t1 #fe p]c5t1 & #hj p]c5t %all be deem$ to be ref]5ces to #cg4fbe p]c5t1 #ec4ge p]c5t1 #fi4hge p]c5t1 & #he p]c5t1 respectively2 & 7,b7 dur+ #bjag or a subsequ5t ye>1 ! ref]5ces 9 ! table 9 subp>agraph 7,i7 ( su* p>agraph & ! table 9 subp>agraph 7,,ii7 ( su* p>agraph1 z applicable1 to #ce p]c5t1 #ej p]c5t1 #fe p]c5t1 & #hj p]c5t %all be deem$ to be ref]5ces to #dj4be p]c5t1 #eg4e p]c5t1 #gd4ge p]c5t1 & #ij p]c5t1 respectively4 4 7b7 ,"p ,d con=m+ am5dm5ts ,section #ahfj;,d-#ac7;a77#g77;,b77i77,i7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#aac7;a77#g77;,b77i77,i77 is am5d$ by /rik+ p>agraph 7#e7 & ins]t+ p>agraphs 7#e7 & 7#g74 #cjc4 ,improv$ b5efit /ructure 7a7 ,9 g5]al ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new sections3 #ahii;,b4 ,unifi$ "p ,a & ,b d$uctible 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 = a ye> 7beg9n+ ) #bjah71 9 ! case ( an individual entitl$ 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$uctible "u ?is section %all be-- 7,a7 = #bjah1 #fej2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ by ! p]c5tage increase 9 ! m$ical c>e compon5t ( ! consum] price index = all urban consum]s 7,u4,s4 city av]age7 z e/imat$ by ! ,secret>y = ! #ab-mon? p]iod end+ ) ! midpo9t ( ! ye> involv$4 7#b7 ,r\nd+ ,if any am\nt det]m9$ "u p>agraph 7#a7 is n a multiple ( #a1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #a4 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 ,su* unifi$ d$uctible %all n be appli$ to prev5tive s]vices & additional prev5tive s]vices 7z ^? t]ms are def9$ 9 section #ahfa7;ddd774 7d7 ,ann\ncem5t ( unifi$ d$uctible & annual out-(-,pocket limit ,! ,secret>y %all 7beg9n+ 9 #bjag7 ann\nce 79 a mann] int5d$ to provide notice to all int]e/$ p>ties7 ! unifi$ d$uctible "u ?is section & ! annual out-(-pocket limit "u section #ahii;,d t w be applicable = ! succe$+ ye>4 #ahii;,c4 ,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$uctible "u section #ahii;,b & subject to ! limit on annual out-(-pocket exp5ses "u section #ahii;,d1 ! am\nt o!rwise payable "u "p ,a & ! total am\nt ( exp5ses incurr$ by ! individual dur+ a ye> 7beg9n+ ) #bjah7 :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 ,su* uni=m co9surance %all n be appli$ to prev5tive s]vices & additional prev5tive s]vices 7z ^? t]ms are def9$ 9 section #ahfa7;ddd774 #ahii;,d4 ,protection aga9/ high out-(-pocket exp5ditures = fee-=-s]vice b5efits 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 9 ! case ( an individual entitl$ to b5efits "u "p ,a or enroll$ 9 "p ,b1 if ! am\nt ( ! out-(-pocket co/-%>+ ( su* individual = a ye> 7beg9n+ ) #bjah7 equals or exce$s ! annual out-(-pocket limit "u subsection 7b7 = su* ye>1 !re %all n be any additional r$uction "u section #ahii;,c = ! rema9d] ( ! ye>4 7b7 ,am\nt ( annual out-(-,pocket limits 7#a7 ,9 g5]al ,! am\nt ( ! annual out-(-pocket limit "u ?is subsection %all be-- 7,a7 = #bjah1 #f1ejj2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ by ! p]c5tage increase 9 ! m$ical c>e compon5t ( ! consum] price index = all urban consum]s 7,u4,s4 city av]age7 z e/imat$ by ! ,secret>y = ! #ab-mon? p]iod end+ ) ! midpo9t ( ! ye> involv$4 7#b7 ,r\nd+ ,if any am\nt det]m9$ "u p>agraph 7#a7 is n a multiple ( #ej1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #ej4 7c7 ,out-(-,pocket co/-,%>+ def9$ 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 9 ?is section1 ! t]m out-(-pocket co/-%>+ means1 ) respect to an individual1 ! am\nt ( exp5ses incurr$ by ! individual t are attributable to d$uctibles1 co9surance1 & copaym5ts applicable "u "p ,a or ,b1 )\t reg>d to :e!r ! individual or ano!r p]son1 includ+ a ,/ate program or o!r ?ird-p>ty cov]age1 has paid = su* exp5ses4 7#b7 ,items & s]vices n furni%$ 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 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> #bjah & subsequ5t plan ye>s1 ! prec$+ s5t5ce %all be appli$ to take into acc\nt ! application ( sections #ahii;,b1 #ahii;,c1 & #ahii;,d44 7c7 ,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$+ subp>agraph 7,a71 by ins]t+ subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d1 aft] ?is "p12 7,d7 9 subsection 7f71 by /rik+ ,9 e/abli%+ & ins]t+ ,subject to sections #ahii;,b1 #ahii;,c1 & #ahii;,d1 9 e/abli%+2 & 7,e7 9 subsection 7g77#a71 by ins]t+ & sections #ahii;,b1 #ahii;,c1 & #ahii;,d & p>agraphs 7#d7 & 7#e74 7#c7 ,section #aije7p77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#c77 is am5d$-- 7,a7 9 subp>agraph 7,b71 /rik+ section #ahac & ins]t+ sections #ahac & #ahii;,c2 & 7,b7 9 subp>agraph 7,c71 by /rik+ & section #ahcc7;b7 & ins]t+ 1 #ahcc7;b71 & #ahii;,c4 #cjd4 ,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 subsection3 7z7 ,prohibition on fir/-,doll> cov]age & developm5t ( new /&>ds = m$ic>e supplem5tal policies 7#a7 ,developm5t ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to review & revise ! /&>ds = b5efit packages "u subsection 7p77#a71 tak+ into acc\nt ! *anges 9 b5efits result+ f ! enactm5t ( ! ,am]ica ,fir/ ,act & to o!rwise update /&>ds to include ! requirem5ts = co/ %>+ describ$ 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 date ( enactm5t ( ?is subsection deem$ a ref]5ce to ! date ( enactm5t ( ! ,am]ica ,fir/ ,act4 ,to ! ext5t practicable1 su* revision %all provide = ! implem5tation ( revis$ /&>ds = b5efit packages z ( ,janu>y #a1 #bjah4 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$uctible "u section #ahii;,b7b7 = ! ye>2 & 7,b7 m ?an #ej p]c5t ( ! co/-%>+ 7exclud+ premiums7 o!rwise applicable "u p>ts ,a & ,b aft] ! individual has met ! unifi$ d$uctible "u section #ahii;,b7b7 = ! ye> & be=e ! individual has rea*$ ! annual out-(-pocket limit "u section #ahii;,d7b7 = ! 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 4 #cje4 ,adju/ ,po/-,acute ,paym5t ,updates 7a7 ,revision ( inpati5t rehabilitation facility p]c5tage increase = #bjaf ?r\gh #bjbe ,section #ahhf7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7j77 is am5d$-- 7#a7 9 p>agraph 7#c7-- 7,a7 9 subp>agraph 7,c71 by /rik+ clause 7iii7 & ins]t+ ! foll[+3 7iii7 ,additional adju/m5t ,= fiscal ye>s #bjaf ?r\gh #bjbe1 aft] e/abli%+ ! increase factor = a fiscal ye> pursuant to clauses 7i7 & 7ii71 if su* increase factor is great] ?an #j4j p]c5t ! ,secret>y %all r$uce ! increase factor by an additional am\nt describ$ 9 subp>agraph 7,e74 2 & 7,b7 by ins]t+ at ! end ! foll[+ new subp>agraph3 7,e7 ,additional adju/m5t ,if ! increase factor1 z e/abli%$ pursuant to clauses 7i7 & 7ii7 ( subp>agraph 7,c71 is great] ?an z]o1 = purposes ( subp>agraph 7,c77iii71 ! additional adju/m5t describ$ 9 ?is subp>agraph is #a4a p]c5tage po9t = ea* ( fiscal ye>s #bjaf ?r\gh #bjbe4 ,if ! application ( ! additional adju/m5t 9 subp>agraph 7,c77iii7 w\ld result 9 an increase factor t is less ?an #j4j = a fiscal ye>1 ! additional adju/m5t %all be r$uc$ su* t ! increase factor aft] its application is #j4j4 ,if1 9 any ( fiscal ye>s #bjaf ?r\gh #bjbe1 ! increase factor z adju/$ by clauses 7i7 & 7ii7 ( subp>agraph 7,c7 is less ?an or equal to z]o1 ! additional adju/m5t describ$ 9 subp>agraph 7,c77iii7 = su* ye> is #j4j p]c5tage po9t4 2 & 7#b7 9 p>agraph 7#g77;,a77i71 by /rik+ & 7,d7 & ins]t+ 1 7,d71 & 7,e74 7b7 ,revision ( long-,t]m c>e hospital m>ket basket updates = #bjaf ?r\gh #bjbe ,section #ahhf7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7m77 is am5d$-- 7#a7 9 p>agraph 7#c7-- 7,a7 9 subp>agraph 7,a7-- 7i7 9 clause 7i71 by /rik+ & at ! end2 7ii7 9 clause 7ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+ new clause3 7iii7 = ea* ( rate ye>s #bjaf ?r\gh #bjbe1 by ! additional adju/m5t describ$ 9 subp>agraph 7,c74 2 & 7,b7 by /rik+ subp>agraph 7,c7 & ins]t+ ! foll[+3 7,c7 ,additional adju/m5t ,if ! annual update1 z e/abli%$ pursuant to clauses 7i7 & 7ii7 ( p>agraph 7#c77;,a71 is great] ?an z]o1 = purposes ( clause 7iii7 ( su* p>agraph1 ! additional adju/m5t is #a4a p]c5tage po9t = ea* ( fiscal ye>s #bjaf ?r\gh #bjbe4 ,if ! application ( ! additional adju/m5t 9 p>agraph 7#c77;,a77iii7 w\ld result 9 an annual update t is less ?an #j4j = a fiscal ye>1 ! additional adju/m5t %all be r$uc$ su* t ! annual update aft] its application is #j4j4 ,if1 9 any ( ! fiscal ye>s #bjaf ?r\gh #bjbe1 ! annual update1 z e/abli%$ pursuant to clauses 7i7 & 7ii7 ( p>agraph 7#c77;,a71 is less ?an or equal to z]o1 ! additional adju/m5t describ$ 9 p>agraph 7#c77;,a77iii7 = su* ye> is #j4j p]c5tage po9t4 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,use ( t]m9ology ,) respect to dis*>ges occurr+ on or aft] ,octob] #a1 #bjaj1 ! t]m rate ye> "u ?is subsection %all mean fiscal ye>4 4 7c7 ,revision ( skill$ nurs+ facility m>ket basket updates = #bjaf ?r\gh #bjbe ,section #ahhh7;e77#e77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#e77;,b77 is am5d$-- 7#a7 by /rik+ clause 7ii7 & ins]t+ ! foll[+ new clause3 7ii7 ,productivity & o!r adju/m5t ,! ,secret>y %all r$uce ! p]c5tage det]m9$ 9 clause 7i7 by ! foll[+ am\nts3 7,i7 ,= fiscal ye> #bjab & ea* subsequ5t fiscal ye>1 by ! productivity adju/m5t describ$ 9 section #ahhf7;b77#c77;,b77xi77,,ii74 7,,ii7 ,= ea* ( fiscal ye>s #bjaf ?r\gh #bjbe1 by ! o!r adju/m5t describ$ 9 clause 7iii74 ,su* p]c5tage %all be r$uc$ fir/ by ! productivity adju/m5t 9 subclause 7,i74 ,! application ( ! productivity adju/m5t describ$ 9 subclause 7,i7 may result 9 su* p]c5tage be+ less ?an #j4j = a fiscal ye>1 & may result 9 paym5t rates "u ?is subsection = a fiscal ye> be+ less ?an su* paym5t rates = ! prec$+ fiscal ye>4 ,if ! application ( ! productivity adju/m5t 9 subclause 7,i7 results 9 su* p]c5tage be+ #j4j or less ?an #j4j = a fiscal ye>1 ! o!r adju/m5t describ$ 9 subclause 7,,ii7 %all n apply4 2 & 7#b7 by /rik+ clause 7iii7 & ins]t+ ! foll[+3 7iii7 ,calculat+ o!r adju/m5t ,= purposes ( clause 7ii77,,ii71 ! o!r adju/m5t describ$ 9 ?is clause is #b4e p]c5tage po9ts 9 ea* ( fiscal ye>s #bjaf & #bjag1 #b4j p]c5tage po9ts 9 ea* ( fiscal ye>s #bjah & #bjai1 #a4e p]c5tage po9ts 9 ea* ( fiscal ye>s #bjbj ?r\gh #bjbb1 & #j4ig p]c5tage po9t 9 ea* ( fiscal ye>s #bjbc ?r\gh #bjbe4 ,! o!r adju/m5t %all be appli$ to ! p]c5tage "u clause 7i7 z r$uc$ by ! productivity adju/m5t 9 clause 7ii77,i74 ,if ! application ( ! adju/m5t 9 clause 7ii77,,ii7 w\ld result 9 ! p]c5tage "u clause 7i7 be+ less ?an #j4j = a fiscal ye>1 ! o!r adju/m5t %all be r$uc$ su* t ! f9al p]c5tage aft] its application is #j4j p]c5tage po9t4 4 7d7 ,revision ( home heal? m>ket basket updates = #bjaf ?r\gh #bjbe ,section #ahie7;b77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,b77 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ ! la/ s5t5ce2 7#b7 by /rik+ clause 7vi7 & ins]t+ ! foll[+ new clause3 7vi7 ,adju/m5ts ,aft] det]m9+ ! home heal? m>ket basket p]c5tage increase "u clause 7iii71 & aft] application ( clause 7v71 ! ,secret>y %all r$uce su* p]c5tage-- 7,i7 = #bjae & ea* subsequ5t ye>1 by ! productivity adju/m5t describ$ 9 section #ahhf7;b77#c77;,b77xi77,,ii72 7,,ii7 = ea* ( #bjaa & #bjab1 by #a p]c5tage po9t2 & 7,,iii7 = ea* ( #bjaf ?r\gh #bjbe1 by ! o!r adju/m5t describ$ 9 subp>agraph 7vii74 ,! application ( subclauses 7,i7 & 7,,ii7 may result 9 ! home heal? m>ket basket p]c5tage increase "u clause 7iii7 be+ less ?an #j4j = a ye>1 & may result 9 paym5t rates "u ! sy/em "u ?is subsection = a ye> be+ less ?an su* paym5t rates = ! prec$+ ye>4 ,9 su* case1 ! o!r adju/m5t 9 subclause 7,,iii7 %all n apply4 2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7vii7 ,o!r adju/m5ts ,= purposes ( clause 7vi77,,iii71 ! o!r adju/m5t describ$ 9 ?is clause is #a4a p]c5tage po9t = ea* ( #bjaf ?r\gh #bjbe4 ,if ! application ( ! o!r adju/m5t 9 clause 7vi77,,iii7 w\ld result 9 ! home heal? m>ket basket p]c5tage increase be+ less ?an #j4j = a ye>1 ! o!r adju/m5t %all be r$uc$ su* t ! f9al m>ket basket p]c5tage increase aft] its application ( ! o!r adju/m5t is #j4j4 ,if1 9 any ( ye>s #bjaf ?r\gh #bjbe1 ! home heal? m>ket basket z adju/$ by subclauses 7,i7 & 7,,ii7 is less ?an or equal to z]o1 ! o!r adju/m5t = su* ye> is #j4j p]c5tage po9t4 4 #cjf4 ,paym5t bundl+ = po/-acute c>e 7,,pac7 "u ,m$ic>e ,title ,,xviii ( ! ,social ,security ,act is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,po/-acute c>e 7,,pac7 paym5t bundl+ sy/em 7a7 ,e/abli%m5t ( sy/em 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% a retrospective bundl$ paym5t arrangem5t 79 ?is section ref]r$ to z ! ,,pac bundl$ paym5t sy/em7 "u :i*1 9 accordance ) ! provisions ( ?is section1 actual paym5ts made "u ?is title to po/-acute c>e provid]s ) respect to po/-acute c>e s]vices furni%$ to t>get$ b5efici>ies dur+ a bundle p]iod are adju/$ 7?r\gh additional paym5t or rec\pm5t1 z applicable71 bas$ on a b5*m>k e/abli%$ by ! ,secret>y = su* bundle4 7#b7 ,implem5tation ,! ,,pac bundl$ paym5t sy/em %all be e/abli%$ to be appli$ to s]vices furni%$ 9 fiscal ye>s beg9n+ ) fiscal ye> #bjbj4 7b7 ,def9itions ,9 ?is section3 7#a7 ,,pac b5efici>y ,! t]m t>get$ b5efici>y means an individual :o is entitl$ to b5efits "u "p ,a & enroll$ "u "p ,b & n enroll$ "u "p ,c4 7#b7 ,po/-acute c>e s]vices ,! t]m po/-acute c>e s]vices means po/-acute c>e1 includ+ home heal? s]vices1 skill$ nurs+ s]vices1 inpati5t rehabilitation s]vices1 & inpati5t hospital s]vices1 = :i* paym5t may o!rwise be made "u ?is title & :i* are furni%$ dur+ a bundle p]iod to a t>get$ b5efici>y4 7#c7 ,po/-acute c>e provid] ,! t]ms po/-acute c>e provid] means ea* ( ! foll[+3 7,a7 ,a home heal? ag5cy4 7,b7 ,a skill$ nurs+ facility4 7,c7 ,a rehabilitation facility4 7,d7 ,a long-t]m c>e hospital4 7#d7 ,bundle p]iod ,! t]m bundle p]iod means1 ) respect to a bundle ( po/-acute c>e s]vices = a t>get$ b5efici>y :o 0 dis*>g$ f an inpati5t hospital /ay1 a p]iod beg9n+ on ! fir/ date on :i* po/-acute c>e s]vices )9 a bundle specifi$ "u subsection 7c7 is furni%$ to an individual n lat] ?an #cj days aft] su* dis*>ge & end+ #cj1 #fj1 or #ij days1 z specifi$ by ! ,secret>y = su* bundle1 aft] su* fir/ date4 7c7 ,bundles ,! ,secret>y %all e/abli% "u ! ,,pac bundl$ paym5t sy/em bundles ( po/-acute c>e s]vices consi/+ ( ,,ms-,d,r,gs1 o!r ?an su* ,,ms-,d,r,gs includ$ "u ! ,compreh5sive ,c>e = ,jo9t ,replacem5t ,model c>ri$ out by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices "u section #aaae;,a1 t repres5t ! highe/ #ej p]c5t ( exp5ditures "u ?is title attributable to po/ acute c>e1 & %all p]iodically update su* bundles1 bas$ on ! mo/ rec5t available data4 7d7 ,paym5t me?odology ,! ,,pac paym5t sy/em %all be design$ consi/5t ) ! foll[+3 7#a7 ,paym5t or rec\pm5t bas$ (f ( b5*m>k ,! ,secret>y %all annually e/abli% a paym5t b5*m>k = ea* bundle ( po/-acute c>e s]vices specifi$ "u subsection 7c7 = su* ye>4 ,! ,secret>y %all1 ?r\gh annual reconciliation1 adju/ ! paym5ts made to a po/-acute c>e provid] ) respect to po/-acute c>e s]vices includ$ )9 a bundle s specifi$ furni%$ to a t>get$ b5efici>y dur+ a bundle p]iod dur+ ! ye> s t total paym5ts = su* provid] ) respect to su* s]vices )9 su* bundle furni%$ to su* b5efici>y dur+ su* p]iod equals su* b5*m>k = su* bundle4 7#b7 ,consid]ations ,9 e/abli%+ ! paym5t am\nt = a bundle ( po/-acute c>e s]vices1 ! ,secret>y may consid] pati5t *>act]i/ics & o!r factors t are design$ to take into acc\nt v>iations 9 treatm5t co/s )9 ! bundle4 7#c7 ,sav+s ,! paym5t rates e/abli%$ = su* bundles %all be set to result 91 9 ! aggregate1 a r$uction 9 ! sp5d+ o!rwise made "u p>ts ,a & ,b = po/-acute c>e s]vices includ$ 9 su* bundles ( #b4he p]c5t by n lat] ?an fiscal ye> #bjbe4 7#d7 ,annual updates ,! paym5t rates = bundles ( po/-acute c>e s]vices %all be updat$ ea* fiscal ye> bas$ on a m>ket basket ( ! s]vices includ$ )9 su* bundles4 7#e7 ,cov]age ( #ej p]c5t ( total paym5ts ,! bundles "u ?is section1 collectively1 %all be e/abli%$ by ! ,secret>y s z to provide = paym5t = at lea/ #ej p]c5t ( all po/-acute c>e s]vices provid$ "u ?is title dur+ ea* fiscal ye> "u ! ,,pac bundl$ paym5t sy/em4 4 #cjg4 ,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$-- 7#a7 9 clause 7iv71 by /rik+ & at ! end2 7#b7 9 clause 7v7-- 7,a7 by /rik+ or a subsequ5t fiscal ye> & ins]t+ 1 #bjad1 or #bjae2 & 7,b7 by /rik+ ! p]iod at ! end & ins]t+ a comma2 & 7#c7 by add+ at ! end ! foll[+3 7vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #ej p]c5t ( su* am\nt o!rwise all[able1 7vii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #fj p]c5t ( su* am\nt o!rwise all[able1 & 7viii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ge p]c5t ( su* am\nt o!rwise all[able4 4 7b7 ,skill$ nurs+ facilities ,section #ahfa7v77#a77,v7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,v77 is am5d$-- 7#a7 by mov+ subclauses 7,i7 & 7,,ii7 ( clause 7i7 & subclauses 7,i7 ?r\gh 7,,iv7 ( clause 7ii7 two ems to ! "r2 7#b7 9 clause 7i7-- 7,a7 9 subclause 7,i71 by /rik+ & at ! end2 7,b7 9 subclause 7,,ii7-- 7i7 by /rik+ or a subsequ5t fiscal ye> & ins]t+ 1 #bjad1 or #bjae 2 & 7ii7 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7,c7 by add+ at ! end ! foll[+3 7,,iii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #ej p]c5t ( su* am\nt o!rwise all[able2 7,,iv7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #fj p]c5t ( su* am\nt o!rwise all[able2 & 7,v7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ge p]c5t ( su* am\nt o!rwise all[able4 2 & 7#c7 9 clause 7ii7-- 7,a7 9 subclause 7,,iv7-- 7i7 by /rik+ a subsequ5t fiscal ye> & ins]t+ fiscal ye> #bjae2 & 7ii7 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7,b7 by add+ at ! end ! foll[+3 7,v7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #ej p]c5t ( su* am\nt o!rwise all[able2 7,,vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #fj p]c5t ( su* am\nt o!rwise all[able2 & 7,,vii7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ge p]c5t ( su* am\nt o!rwise all[able4 4 7c7 ,c]ta9 o!r provid]s ,section #ahfa7v77#a77,w77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#a77,w77i77 is am5d$-- 7#a7 9 subclause 7,,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#b7 by add+ at ! end ! foll[+3 7,,iv7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjaf1 by #ej p]c5t ( su* am\nt o!rwise all[able2 7,v7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjag1 by #fj p]c5t ( su* am\nt o!rwise all[able2 & 7,,vi7 = co/ report+ p]iods beg9n+ dur+ fiscal ye> #bjah or a subsequ5t fiscal ye>1 by #ge p]c5t ( su* am\nt o!rwise all[able 4 #cjh4 ,r$uce ,excess ,subsidies to ,tea*+ ,hospitals ,section #ahhf7;d77#e77;,b77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is am5d$-- 7#a7 9 subclause 7,,xi71 by /rik+ at ! end &2 7#b7 9 subclause 7,,xii7-- 7,a7 by ins]t+ & be=e ,octob] #a1 #bjaf aft] ,octob] #a1 #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 #bjaf1 c is equal to #a4bb4 4 #cji4 ,equaliz+ paym5t = c]ta9 cov]$ ,,opd s]vices & physicians' s]vices ,section #ahcc7t77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#c77 is am5d$-- 7#a7 9 subp>agraph 7,d71 by /rik+ ,! ,secret>y & ins]t+ ,subject to subp>agraph 7,h71 ! ,secret>y2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,h7 ,paym5t = c]ta9 cov]$ ,,opd s]vices 7i7 ,9 g5]al ,9 ! case ( applicable cov]$ ,,opd s]vices furni%$ on or aft] ,janu>y #a1 #bjag1 !re %all be sub/itut$ = ! m$ic>e ,,opd fee s*$ule am\nt e/abli%$ "u subp>agraph 7,d7 = su* s]vice & ye>1 det]m9$ prior to application ( any geographic or o!r adju/m5ts "u ?is subsection 7includ+ adju/m5ts "u p>agraph 7#ag771 an am\nt equal to ! paym5t am\nt "u section #ahdh = su* s]vice & ye>1 det]m9$ prior to application ( any geographic or o!r adju/m5ts "u su* section4 7ii7 ,applicable cov]$ ,,opd s]vices def9$ ,9 ?is subp>agraph1 ! t]m applicable cov]$ ,,opd s]vices cov]$ ,,opd s]vices t are evaluation & managem5t s]vices 7z specifi$ by ! ,secret>y74 7iii7 ,n budget neutral implem5tation ,9 mak+ any budget neutrality adju/m5ts "u ?is subsection = #bjag or a subsequ5t ye>1 ! ,secret>y %all n take into acc\nt ! r$uc$ exp5ditures t result f ! application ( ?is subp>agraph4 4 #caj4 ,m$ic>e ,advantage cod+ int5sity adju/m5t ,section #ahec7;a77#a77;,c77ii77,,iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,c77ii77,,iii77 is am5d$ by /rik+ & = #bjai & ea* subsequ5t ye>1 n less ?an #e4i p]c5t & ins]t+ 1 = #bjai & #bjbj1 n less ?an #e4i p]c5t1 & = #bjba & subsequ5t ye>s1 n less ?an #h4gf p]c5t4 #caa4 ,modifications to co/-%>+ r$uctions "u ,m$ic>e "p ,d = l[-income individuals 7a7 ,9 g5]al ,section #ahfj;,d-#ad7;a77#a77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#a77;,d77 is am5d$-- 7#a7 9 clause 7ii71 by /rik+ #c & ins]t+ #f2 & 7#b7 9 clause 7iii71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 7or1 9 ! case ( a drug t is n a g5]ic or a pref]r$ drug t is a multiple s\rce drug1 twice ! copaym5t am\nt specifi$ "u section #ahfj;,d-#b7;b77#d77;,a77i77,i7 = ! drug & ye> involv$74 7b7 ,application ( curr5t index+ to doll> am\nts specifi$ ,section #ahfj;,d-#ad7;a77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#d77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by add+ at ! end ! foll[+ new s5t5ce3 ,?is subp>agraph %all be appli$ 7= #bjag & subsequ5t ye>s7 z if ! doll> am\nts specifi$ "u p>agraph 7#a77;,d77ii71 pursuant to ! am5dm5ts made by section #caa ( ! ,am]ica ,fir/ ,act1 7 ! doll> am\nts specifi$ 9 su* p>agraph :5 clause 7i7 fir/ appli$42 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,copaym5t = o!r individuals ,! provisions ( clause 7ii7 ( section #ahfj;,d-#b7;b77#d77;,a7 %all apply ) respect to ! doll> am\nts specifi$ 9 p>agraph 7#a77;,d77iii7 = #bjag & subsequ5t ye>s 9 ! same mann] z su* provisions apply to ! doll> am\nts specifi$ 9 clause 7i77,i7 ( su* section & ! doll> am\nts specifi$ 9 p>agraph 7#a77;,d77iii7 %all be treat$1 = su* purpose1 z if !y 7 ! doll> am\nts specifi$ 9 su* section = #bjjf4 4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjag4 #cab4 ,rebase ,m$ic>e paym5ts at po/-seque/] levels ,9 det]m9+ paym5t rates "u title ,,xviii ( ! ,social ,security ,act = ye>s & fiscal ye>s beg9n+ on or aft] ,octob] #a1 #bjae1 ! p]c5tage r$uctions 9 paym5t rates effect$ = #bjae 7& = fiscal ye> #bjae7 "u ! ,balanc$ ,budget & ,em]g5cy ,deficit ,control ,act ( #aihe %all be incorporat$ into & treat$ z "p ( ! p]man5t paym5t rates = t ye> 7or fiscal ye>7 9 det]m9+ ! paym5t rates = subsequ5t ye>s 7& fiscal ye>s74 #cac4 ,phas$-9 r$uction ( 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$]al ,regulations1 z 9 effect on ,novemb] #a1 #bjjf1 except t-- 7,i7 = fiscal ye> #bjag1 #e4e p]c5t %all be sub/itut$ = #f p]c5t ea* place x appe>s2 & 7,,ii7 = fiscal ye> #bjah & ea* fiscal ye> !reaft]1 #e p]c5t %all be sub/itut$ = #f p]c5t ea* place x appe>s4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ,octob] #a1 #bjaf4 ,b ,m$ical ,malpractice ,re=m #cba4 ,def9itions ,9 ?is subtitle3 7#a7 ,alt]native dispute resolution sy/em2 ,,adr ,! t]m alt]native dispute resolution sy/em or ,,adr means a sy/em t provides = ! resolution ( heal? c>e lawsuits 9 a mann] o!r ?an ?r\gh a civil action br\ght 9 a ,/ate or ,f$]al c\rt4 7#b7 ,claimant ,! t]m claimant means any p]son :o br+s a heal? c>e lawsuit1 includ+ a p]son :o ass]ts or claims a "r to legal or equitable contribution1 indemnity1 or subrogation1 aris+ out ( a heal? c>e liability claim or action1 & any p]son on ^: behalf su* a claim is ass]t$ or su* an action is br\ght1 :e!r deceas$1 incompet5t1 or a m9or4 7#c7 ,collat]al s\rce b5efits ,! t]m collat]al s\rce b5efits means any am\nt paid or reasonably likely to be paid 9 ! future to or on behalf ( ! claimant1 or any s]vice1 product1 or o!r b5efit provid$ or reasonably likely to be provid$ 9 ! future to or on behalf ( ! claimant1 z a result ( ! injury or wrongful dea?1 pursuant to-- 7,a7 any ,/ate or ,f$]al heal?1 sickness1 income-disability1 accid5t1 or work]s' comp5sation law2 7,b7 any heal?1 sickness1 income-disability1 or accid5t insurance t provides heal? b5efits or income-disability cov]age2 7,c7 any contract or agreem5t ( any gr\p1 organization1 p>tn]%ip1 or corporation to provide1 pay =1 or reimburse ! co/ ( m$ical1 hospital1 d5tal1 or income-disability b5efits2 & 7,d7 any o!r publicly or privately fund$ program4 7#d7 ,comp5satory damages ,! t]m comp5satory damages means objectively v]ifiable monet>y losses incurr$ z a result ( ! provision (1 use (1 or paym5t = 7or failure to provide1 use1 or pay =7 heal? c>e s]vices or m$ical products1 su* z pa/ & future m$ical exp5ses1 loss ( pa/ & future e>n+s1 co/ ( obta9+ dome/ic s]vices1 loss ( employm5t1 & loss ( bus9ess or employm5t opportunities1 damages = physical & emotional pa91 suff]+1 inconv5i5ce1 physical impairm5t1 m5tal angui%1 disfigurem5t1 loss ( enjoym5t ( life1 loss ( society & companion%ip1 loss ( consortium 7o!r ?an loss ( dome/ic s]vice71 h$onic damages1 injury to reputation1 & all o!r nonpecuni>y losses ( any k9d or nature4 ,! t]m comp5satory damages includes economic damages & noneconomic damages1 z su* t]ms are def9$ 9 ?is section4 7#e7 ,cont+5t fee ,! t]m cont+5t fee includes all comp5sation to any p]son or p]sons :i* is payable only if a recov]y is effect$ on behalf ( "o or m claimants4 7#f7 ,economic damages ,! t]m economic damages means objectively v]ifiable monet>y losses incurr$ z a result ( ! provision (1 use (1 or paym5t = 7or failure to provide1 use1 or pay =7 heal? c>e s]vices or m$ical products1 su* z pa/ & future m$ical exp5ses1 loss ( pa/ & future e>n+s1 co/ ( obta9+ dome/ic s]vices1 loss ( employm5t1 & loss ( bus9ess or employm5t opportunities4 7#g7 ,heal? c>e lawsuit ,! t]m heal? c>e lawsuit means any heal? c>e liability claim conc]n+ ! provision ( heal? c>e goods or s]vices or any m$ical product affect+ int]/ate comm]ce1 or any heal? c>e liability action conc]n+ ! provision ( heal? c>e goods or s]vices or any m$ical product affect+ int]/ate comm]ce1 br\ght 9 a ,/ate or ,f$]al c\rt or pursuant to an alt]native dispute resolution sy/em1 aga9/ a heal? c>e provid]1 a heal? c>e organization1 or ! manufactur]1 di/ributor1 suppli]1 m>ket]1 promot]1 or sell] ( a m$ical product1 reg>dless ( ! !ory ( liability on :i* ! claim is bas$1 or ! numb] ( claimants1 pla9tiffs1 def5dants1 or o!r p>ties1 or ! numb] ( claims or causes ( action1 9 :i* ! claimant alleges a heal? c>e liability claim4 ,su* t]m does n include a claim or action :i* is bas$ on crim9al liability2 :i* seeks civil f9es or p5alties paid to ,f$]al1 ,/ate1 or local gov]nm5t2 or :i* is gr\nd$ 9 antitru/4 7#h7 ,heal? c>e liability action ,! t]m heal? c>e liability action means a civil action br\ght 9 a ,/ate or ,f$]al c\rt or pursuant to an alt]native dispute resolution sy/em1 aga9/ a heal? c>e provid]1 a heal? c>e organization1 or ! manufactur]1 di/ributor1 suppli]1 m>ket]1 promot]1 or sell] ( a m$ical product1 reg>dless ( ! !ory ( liability on :i* ! claim is bas$1 or ! numb] ( pla9tiffs1 def5dants1 or o!r p>ties1 or ! numb] ( causes ( action1 9 :i* ! claimant alleges a heal? c>e liability claim4 7#i7 ,heal? c>e liability claim ,! t]m heal? c>e liability claim means a dem& by any p]son1 :e!r or n pursuant to ,,adr1 aga9/ a heal? c>e provid]1 heal? c>e organization1 or ! manufactur]1 di/ributor1 suppli]1 m>ket]1 promot]1 or sell] ( a m$ical product1 includ+1 b n limit$ to1 ?ird-p>ty claims1 cross-claims1 c\nt]-claims1 or contribution claims1 :i* are bas$ ^u ! provision (1 use (1 or paym5t = 7or ! failure to provide1 use1 or pay =7 heal? c>e s]vices or m$ical products1 reg>dless ( ! !ory ( liability on :i* ! claim is bas$1 or ! numb] ( pla9tiffs1 def5dants1 or o!r p>ties1 or ! numb] ( causes ( action4 7#aj7 ,heal? c>e organization ,! t]m heal? c>e organization means any p]son or entity :i* is obligat$ to provide or pay = heal? b5efits "u any heal? plan1 includ+ any p]son or entity act+ "u a contract or arrangem5t ) a heal? c>e organization to provide or adm9i/] any heal? b5efit4 7#aa7 ,heal? c>e provid] ,! t]m heal? c>e provid] means any p]son or entity requir$ by ,/ate or ,f$]al laws or regulations to be lic5s$1 regi/]$1 or c]tifi$ to provide heal? c>e s]vices1 & be+ ei!r s lic5s$1 regi/]$1 or c]tifi$1 or exempt$ f su* requirem5t by o!r /atute or regulation4 7#ab7 ,heal? c>e goods or s]vices ,! t]m heal? c>e goods or s]vices means any goods or s]vices provid$ by a heal? c>e organization1 provid]1 or by any individual work+ "u ! sup]vision ( a heal? c>e provid]1 t relates to ! diagnosis1 prev5tion1 or treatm5t ( any human disease or impairm5t1 or ! assessm5t or c>e ( ! heal? ( human be+s4 7#ac7 ,m$ical product ,! t]m m$ical product means a drug1 device1 or biological product int5d$ = humans1 & ! t]ms drug1 device1 & biological product h ! mean+s giv5 su* t]ms 9 sections #bja7;g77#a7 & #bja7;h7 ( ! ,f$]al ,food1 ,drug & ,cosmetic ,act 7#ba ,u4,s4,c4 #cba7;g77#a7 & 7h77 & section #cea7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bfb7;a771 respectively1 includ+ any compon5t or raw mat]ial us$ !re91 b exclud+ heal? c>e s]vices4 7#ad7 ,noneconomic damages ,! t]m noneconomic damages means damages = physical & emotional pa91 suff]+1 inconv5i5ce1 physical impairm5t1 m5tal angui%1 disfigurem5t1 loss ( enjoym5t ( life1 loss ( society & companion%ip1 loss ( consortium 7o!r ?an loss ( dome/ic s]vice71 h$onic damages1 injury to reputation1 & all o!r nonpecuni>y losses ( any k9d or nature4 7#ae7 ,punitive damages ,! t]m punitive damages means damages aw>d$1 = ! purpose ( puni%m5t or det]r5ce1 & n solely = comp5satory purposes1 aga9/ a heal? c>e provid]1 heal? c>e organization1 or a manufactur]1 di/ributor1 or suppli] ( a m$ical product4 ,punitive damages are nei!r economic nor noneconomic damages4 7#af7 ,recov]y ,! t]m recov]y means ! net sum recov]$ aft] d$uct+ any disbursem5ts or co/s incurr$ 9 connection ) prosecution or settlem5t ( ! claim1 includ+ all co/s paid or advanc$ by any p]son4 ,co/s ( heal? c>e incurr$ by ! pla9tiff & ! attorneys' (fice ov]head co/s or *>ges = legal s]vices are n d$uctible disbursem5ts or co/s = su* purpose4 7#ag7 ,/ate ,! t]m ,/ate means ea* ( ! sev]al ,/ates1 ! ,di/rict ( ,columbia1 ! ,commonweal? ( ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ,am]ican ,samoa1 ! ,nor!rn ,m>iana ,isl&s1 ! ,tru/ ,t]ritory ( ! ,pacific ,isl&s1 & any o!r t]ritory or possession ( ! ,unit$ ,/ates1 or any political subdivision !re(4 #cbb4 ,enc\rag+ spe$y resolution ( claims ,! "t = ! comm5cem5t ( a heal? c>e lawsuit %all be #c ye>s aft] ! date ( manife/ation ( injury or #a ye> aft] ! claimant discov]s1 or ?r\gh ! use ( reasonable dilig5ce %\ld h discov]$1 ! injury1 :i*ev] occurs fir/4 ,9 no ev5t %all ! "t = comm5cem5t ( a heal? c>e lawsuit exce$ #c ye>s aft] ! date ( manife/ation ( injury unless toll$ = any ( ! foll[+-- 7#a7 ^u pro( ( fraud2 7#b7 int5tional concealm5t2 or 7#c7 ! pres5ce ( a =eign body1 :i* has no !rapeutic or diagno/ic purpose or effect1 9 ! p]son ( ! injur$ p]son4 ,actions by a m9or %all be comm5c$ )9 #c ye>s f ! date ( ! alleg$ manife/ation ( injury except t actions by a m9or "u ! full age ( #f ye>s %all be comm5c$ )9 #c ye>s ( manife/ation ( injury or prior to ! m9or's #h? bir?day1 :i*ev] provides a long] p]iod4 ,su* "t limitation %all be toll$ = m9ors = any p]iod dur+ :i* a p>5t or gu>dian & a heal? c>e provid] or heal? c>e organization h committ$ fraud or collusion 9 ! failure to br+ an action on behalf ( ! injur$ m9or4 #cbc4 ,comp5sat+ pati5t injury 7a7 ,unlimit$ ,am\nt ( ,damages = ,actual ,economic ,losses 9 ,heal? ,c>e ,lawsuits ,9 any heal? c>e lawsuit1 no?+ 9 ?is subtitle %all limit a claimant's recov]y ( ! full am\nt ( ! available economic damages4 7b7 ,fair ,%>e ,rule ,9 any heal? c>e lawsuit1 ea* p>ty %all be liable = t p>ty's sev]al %>e ( any damages only & n = ! %>e ( any o!r p]son4 ,ea* p>ty %all be liable only = ! am\nt ( damages allocat$ to su* p>ty 9 direct proportion to su* p>ty's p]c5tage ( responsibility4 ,:5ev] a judgm5t ( liability is r5d]$ z to any p>ty1 a sep>ate judgm5t %all be r5d]$ aga9/ ea* su* p>ty = ! am\nt allocat$ to su* p>ty4 ,= purposes ( ?is section1 ! tri] ( fact %all det]m9e ! proportion ( responsibility ( ea* p>ty = ! claimant's h>m4 #cbd4 ,maximiz+ pati5t recov]y 7a7 ,c\rt ,sup]vision ( ,%>e ( ,damages ,actually ,paid to ,claimants ,9 any heal? c>e lawsuit1 ! c\rt %all sup]vise ! arrangem5ts = paym5t ( damages to protect aga9/ conflicts ( int]e/ t may h ! effect ( r$uc+ ! am\nt ( damages aw>d$ t are actually paid to claimants4 ,9 p>ticul>1 9 any heal? c>e lawsuit 9 :i* ! attorney = a p>ty claims a f9ancial /ake 9 ! outcome by virtue ( a cont+5t fee1 ! c\rt %all h ! p[] to re/rict ! paym5t ( a claimant's damage recov]y to su* attorney1 & to r$irect su* damages to ! claimant bas$ ^u ! int]e/s ( ju/ice & pr9ciples ( equity4 ,9 no ev5t %all ! total ( all cont+5t fees = repres5t+ all claimants 9 a heal? c>e lawsuit exce$ ! foll[+ limits3 7#a7 ,=ty p]c5t ( ! fir/ #ej1jjj recov]$ by ! claimant7s74 7#b7 ,?irty-?ree & "o-?ird p]c5t ( ! next #ej1jjj recov]$ by ! claimant7s74 7#c7 ,tw5ty-five p]c5t ( ! next #ejj1jjj recov]$ by ! claimant7s74 7#d7 ,fifte5 p]c5t ( any am\nt by :i* ! recov]y by ! claimant7s7 is 9 excess ( #fjj1jjj4 7b7 ,applicability ,! limitations 9 ?is section %all apply :e!r ! recov]y is by judgm5t1 settlem5t1 m$iation1 arbitration1 or any o!r =m ( alt]native dispute resolution4 ,9 a heal? c>e lawsuit involv+ a m9or or incompet5t p]son1 a c\rt reta9s ! au?ority to au?orize or approve a fee t is less ?an ! maximum p]mitt$ "u ?is section4 ,! requirem5t = c\rt sup]vision 9 ! fir/ two s5t5ces ( subsection 7a7 applies only 9 civil actions4 #cbe4 ,additional ,,heal? b5efits ,9 any heal? c>e lawsuit involv+ injury or wrongful dea?1 any p>ty may introduce evid5ce ( collat]al s\rce b5efits4 ,if a p>ty elects to introduce su* evid5ce1 any oppos+ p>ty may introduce evid5ce ( any am\nt paid or contribut$ or reasonably likely to be paid or contribut$ 9 ! future by or on behalf ( ! oppos+ p>ty to secure ! "r to su* collat]al s\rce b5efits4 ,no provid] ( collat]al s\rce b5efits %all recov] any am\nt aga9/ ! claimant or receive any li5 or cr$it aga9/ ! claimant's recov]y or be equitably or legally subrogat$ to ! "r ( ! claimant 9 a heal? c>e lawsuit involv+ injury or wrongful dea?4 ,?is section %all apply to any heal? c>e lawsuit t is settl$ z well z a heal? c>e lawsuit t is resolv$ by a fact f9d]4 ,?is section %all n apply to section #ahfb7;b7 7#db ,u4,s4,c4 #aciey7b77 or section #aijb7;a77#be7 7#db ,u4,s4,c4 #acif;a7a77#be77 ( ! ,social ,security ,act4 #cbf4 ,effect on o!r laws 7a7 ,vacc9e ,injury 7#a7 ,to ! ext5t t title ,,xxi ( ! ,public ,heal? ,s]vice ,act e/abli%es a ,f$]al rule ( law applicable to a civil action br\ght = a vacc9e-relat$ injury or dea?-- 7,a7 ?is subtitle does n affect ! application ( ! rule ( law to su* an action2 & 7,b7 any rule ( law prescrib$ by ?is subtitle 9 conflict ) a rule ( law ( su* title ,,xxi %all n apply to su* action4 7#b7 ,if !re is an aspect ( a civil action br\ght = a vacc9e-relat$ injury or dea? to :i* a ,f$]al rule ( law "u title ,,xxi ( ! ,public ,heal? ,s]vice ,act does n apply1 !n ?is subtitle or o!rwise applicable law 7z det]m9$ "u ?is subtitle7 w apply to su* aspect ( su* action4 7b7 ,o!r ,f$]al ,law ,except z provid$ 9 ?is section1 no?+ 9 ?is subtitle %all be deem$ to affect any def5se available to a def5dant 9 a heal? c>e lawsuit or action "u any o!r provision ( ,f$]al law4 #cbg4 ,/ate flexibility & protection ( ,/ates' rights 7a7 ,heal? ,c>e ,lawsuits ,! provisions gov]n+ heal? c>e lawsuits set =? 9 ?is subtitle preempt1 subject to subsections 7b7 & 7c71 ,/ate law to ! ext5t t ,/ate law prev5ts ! application ( any provisions ( law e/abli%$ by or "u ?is subtitle4 ,! provisions gov]n+ heal? c>e lawsuits set =? 9 ?is subtitle sup]s$e *apt] #aga ( title #bh1 ,unit$ ,/ates ,code1 to ! ext5t t su* *apt]-- 7#a7 provides = a great] am\nt ( damages or cont+5t fees1 a long] p]iod 9 :i* a heal? c>e lawsuit may be comm5c$1 or a r$uc$ applicability or scope ( p]iodic paym5t ( future damages1 ?an provid$ 9 ?is subtitle2 or 7#b7 prohibits ! introduction ( evid5ce reg>d+ collat]al s\rce b5efits1 or m&ates or p]mits subrogation or a li5 on collat]al s\rce b5efits4 7b7 ,protection ( ,/ates' ,rights & ,o!r ,laws 7#a7 ,any issue t is n gov]n$ by any provision ( law e/abli%$ by or "u ?is subtitle 7includ+ ,/ate /&>ds ( neglig5ce7 %all be gov]n$ by o!rwise applicable ,/ate or ,f$]al law4 7#b7 ,?is subtitle %all n preempt or sup]s$e any ,/ate or ,f$]al law t imposes great] proc$ural or sub/antive protections = heal? c>e provid]s & heal? c>e organizations f liability1 loss1 or damages ?an ^? provid$ by ?is subtitle or create a cause ( action4 7c7 ,/ate ,flexibility ,no provision ( ?is subtitle %all be con/ru$ to preempt-- 7#a7 any ,/ate law 7:e!r effective be=e1 on1 or aft] ! date ( ! enactm5t ( ?is ,act7 t specifies a p>ticul> monet>y am\nt ( comp5satory or punitive damages 7or ! total am\nt ( damages7 t may be aw>d$ 9 a heal? c>e lawsuit1 reg>dless ( :e!r su* monet>y am\nt is great] or less] ?an is provid$ = "u ?is subtitle1 not)/&+ section #d7;a72 or 7#b7 any def5se available to a p>ty 9 a heal? c>e lawsuit "u any o!r provision ( ,/ate or ,f$]al law4 #cbh4 ,/ate demon/ration programs to evaluate alt]natives to curr5t m$ical tort litigation ,"p ,p ( title ,,iii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ by add+ at ! end ! foll[+3 #cii,v-#f4 ,/ate demon/ration programs to evaluate alt]natives to curr5t m$ical tort litigation 7a7 ,9 g5]al ,! ,secret>y is au?oriz$ to aw>d demon/ration grants to ,/ates = ! developm5t1 implem5tation1 & evaluation ( alt]natives to curr5t tort litigation = resolv+ disputes ov] injuries alleg$ly caus$ by heal? c>e provid]s or heal? c>e organizations4 7b7 ,duration ,! ,secret>y may aw>d up to #aj grants "u subsection 7a7 & ea* grant aw>d$ "u su* subsection may n exce$ a p]iod ( #e ye>s4 7c7 ,conditions = demon/ration grants 7#a7 ,requirem5ts ,ea* ,/ate desir+ a grant "u subsection 7a7 %all-- 7,a7 develop an alt]native to curr5t tort litigation = resolv+ disputes ov] injuries alleg$ly caus$ by heal? c>e provid]s or heal? c>e organizations t may be #a ( ! models describ$ 9 subsection 7d72 & 7,b7 promote a r$uction ( heal? c>e errors by all[+ = pati5t safety data relat$ to disputes resolv$ "u subp>agraph 7,a7 to be collect$ & analyz$ by organizations t engage 9 volunt>y ef=ts to improve pati5t safety & ! quality ( heal? c>e deliv]y4 7#b7 ,alt]native to curr5t tort litigation ,ea* ,/ate desir+ a grant "u subsection 7a7 %all demon/rate h[ ! propos$ alt]native describ$ 9 p>agraph 7#a77;,a7-- 7,a7 makes ! m$ical liability sy/em m reliable ?r\gh prompt & fair resolution ( disputes2 7,b7 enc\rages ! e>ly disclosure ( heal? c>e errors2 7,c7 enhances pati5t safety2 & 7,d7 ma9ta9s access to liability insurance4 7#c7 ,s\rces ( comp5sation ,ea* ,/ate desir+ a grant "u subsection 7a7 %all id5tify ! s\rces f & me?ods by :i* comp5sation w\ld be paid = claims resolv$ "u ! propos$ alt]native to curr5t tort litigation1 :i* may include public or private fund+ s\rces1 or a comb9ation ( su* s\rces4 ,fund+ me?ods %all to ! ext5t practicable provide f9ancial inc5tives = activities t improve pati5t safety4 7#d7 ,scope 7,a7 ,9 g5]al ,ea* ,/ate desir+ a grant "u subsection 7a7 may e/abli% a scope ( jurisdiction 7su* z a designat$ geographic region1 a designat$ area ( heal? c>e practice1 or a designat$ gr\p ( heal? c>e provid]s or heal? c>e organizations7 = ! propos$ alt]native to curr5t tort litigation t is suffici5t to evaluate ! effects ( ! alt]native4 7,b7 ,notification ( pati5ts ,a ,/ate propos+ a scope ( jurisdiction "u subp>agraph 7,a7 %all demon/rate h[ pati5ts w\ld be notifi$ t !y are receiv+ heal? c>e s]vices t fall )9 su* scope4 7#e7 ,pref]5ce 9 aw>d+ demon/ration grants ,9 aw>d+ grants "u subsection 7a71 ! ,secret>y %all give pref]5ce to ,/ates-- 7,a7 t h develop$ ! propos$ alt]native ?r\gh sub/antive consultation ) relevant /akehold]s2 & 7,b7 9 :i* ,/ate law at ! "t ( ! application w\ld n prohibit ! adoption ( an alt]native to curr5t tort litigation4 7d7 ,models 7#a7 ,9 g5]al ,any ,/ate desir+ a grant "u subsection 7a7 t proposes an alt]native describ$ 9 p>agraph 7#b71 7#c71 or 7#d7 %all be deem$ to meet ! crit]ia "u subsection 7c77#b74 7#b7 ,e>ly disclosure & comp5sation model ,9 ! e>ly disclosure & comp5sation model1 ! ,/ate %all-- 7,a7 require t heal? c>e provid]s or heal? c>e organizations notify a pati5t 7or an imm$iate family memb] or designee ( ! pati5t7 ( an adv]se ev5t t results 9 s]i\s injury to ! pati5t1 & t su* notification %all n con/itute an ackn[l$gm5t or an admission ( liability2 7,b7 provide immunity f tort liability to any heal? c>e provid] or heal? c>e organization t (f]s 9 good fai? to pay comp5sation 9 accordance ) ?is section to a pati5t = an injury incurr$ 9 ! provision ( heal? c>e s]vices 7limit$ to claims aris+ out ( ! same nucleus ( op]ative facts z ! injury1 & except 9 cases ( fraud relat$ to ! provision ( heal? c>e s]vices1 or 9 cases ( crim9al or int5tional h>m72 7,c7 set a limit$ "t p]iod dur+ :i* a heal? c>e provid] or heal? c>e organization may make an (f] ( comp5sation b5efits "u subp>agraph 7,b71 ) consid]ation = in/ances :]e prompt recognition ( an injury is unlikely or impossible2 7,d7 require t ! comp5sation provid$ "u subp>agraph 7,b7 include-- 7i7 paym5t = ! net economic loss ( ! pati5t1 on a p]iodic basis1 r$uc$ by any paym5ts receiv$ by ! pati5t "u-- 7,i7 any heal? or accid5t insurance2 7,,ii7 any wage or sal>y cont9uation plan2 or 7,,iii7 any disability income insurance2 7ii7 paym5t = ! non-economic damages ( ! pati5t1 if appropriate = ! injury1 bas$ on a def9$ paym5t s*$ule develop$ by ! ,/ate 9 consultation ) relevant exp]ts & ) ! ,secret>y 9 accordance ) subsection 7g72 & 7iii7 reasonable attorney's fees2 7,e7 n abridge ! "r ( an injur$ pati5t to seek r$ress ?r\gh ! ,/ate tort sy/em if a heal? c>e provid] does n ent] into a comp5sation agreem5t ) ! pati5t 9 accordance ) subp>agraph 7,b7 or if ! comp5sation (f]$ does n meet ! requirem5ts ( subp>agraph 7,d7 or is n (f]$ 9 good fai?2 7,f7 p]mit a heal? c>e provid] or heal? c>e organization t (f]s 9 good fai? to pay comp5sation b5efits to an individual "u subp>agraph 7,b7 to jo9 9 ! paym5t ( ! comp5sation b5efits any heal? c>e provid] or heal? c>e organization t is pot5tially liable1 9 :ole or 9 "p1 = ! injury2 & 7,g7 p]mit any heal? c>e provid] or heal? c>e organization to contribute volunt>ily 9 ! paym5t ( comp5sation b5efits to an individual "u subp>agraph 7,b74 7#c7 ,adm9i/rative det]m9ation ( comp5sation model 7,a7 ,9 g5]al ,9 ! adm9i/rative det]m9ation ( comp5sation model-- 7i7 ! ,/ate %all-- 7,i7 designate an adm9i/rative entity 79 ?is p>agraph ref]r$ to z ! ,bo>d7 t %all include repres5tatives (-- 7aa7 relevant ,/ate lic5s+ bo>ds2 7bb7 pati5t advocacy gr\ps2 7cc7 heal? c>e provid]s & heal? c>e organizations2 & 7dd7 attorneys 9 relevant practice areas2 7,,ii7 set up classes ( avoidable injuries1 9 consultation ) relevant exp]ts & ) ! ,secret>y 9 accordance ) subsection 7g71 t w be us$ by ! ,bo>d to det]m9e comp5sation "u clause 7ii77,,ii72 7,,iii7 modify tort liability1 ?r\gh /atute or contract1 to b> neglig5ce claims 9 c\rt aga9/ heal? c>e provid]s & heal? c>e organizations = ! classes ( injuries e/abli%$ "u subclause 7,,ii71 except 9 cases ( fraud relat$ to an injury1 or 9 cases ( crim9al or int5tional h>m2 7,,iv7 outl9e a proc$ure = in=m+ pati5ts ab\t ! modifi$ liability sy/em describ$ 9 ?is p>agraph &1 9 sy/ems :]e p>ticipation by ! heal? c>e provid]1 heal? c>e organization1 or pati5t is volunt>y1 all[ = ! decision by ! provid]1 organization1 or pati5t ( :e!r to p>ticipate to be made prior to ! provision (1 use (1 or paym5t = ! heal? c>e s]vice2 7,v7 provide = an appeals process to all[ = review ( decisions2 & 7,,vi7 e/abli% proc$ures to coord9ate settlem5t paym5ts ) o!r s\rces ( paym5t2 7ii7 ! ,bo>d %all-- 7,i7 resolve heal? c>e liability claims = c]ta9 classes ( avoidable injuries z det]m9$ by ! ,/ate & det]m9e comp5sation = su* claims2 7,,ii7 develop a s*$ule ( comp5sation to be us$ 9 mak+ su* det]m9ations t includes-- 7aa7 paym5t = ! net economic loss ( ! pati5t1 on a p]iodic basis1 r$uc$ by any paym5ts receiv$ by ! pati5t "u any heal? or accid5t insurance1 any wage or sal>y cont9uation plan1 or any disability income insurance2 7bb7 paym5t = ! non-economic damages ( ! pati5t1 if appropriate = ! injury1 bas$ on a def9$ paym5t s*$ule develop$ by ! ,/ate 9 consultation ) relevant exp]ts & ) ! ,secret>y 9 accordance ) subsection 7g72 & 7cc7 reasonable attorney's fees2 & 7,,iii7 update ! s*$ule "u subclause 7,,ii7 on a regul> basis4 7,b7 ,appeals ,! ,/ate1 9 e/abli%+ ! appeals process describ$ 9 subp>agraph 7,a77i77,v71 may *oose :e!r to all[ = de novo review1 review ) def]5ce1 or "s opportunity = p>ties to reject det]m9ations by ! ,bo>d & elect to file a civil action aft] su* rejection4 ,any ,/ate desir+ to adopt ! model describ$ 9 ?is p>agraph %all indicate h[ su* review me?od meets ! crit]ia "u subsection 7c77#b74 7,c7 ,timel9ess ,! ,/ate %all e/abli% timeframes to ensure t claims h&l$ "u ! sy/em describ$ 9 ?is p>agraph provide = adjudication t is m timely & exp$it$ ?an adjudication 9 a traditional tort sy/em4 7#d7 ,special heal? c>e c\rt model ,9 ! special heal? c>e c\rt model1 ! ,/ate %all-- 7,a7 e/abli% a special c\rt = ! timely adjudication ( disputes ov] injuries alleg$ly caus$ by heal? c>e provid]s or heal? c>e organizations 9 ! provision ( heal? c>e s]vices2 7,b7 ensure t su* c\rt is presid$ ov] by judges ) heal? c>e exp]tise :o meet applicable ,/ate /&>ds = judges & :o agree to preside ov] su* c\rt volunt>ily2 7,c7 provide au?ority to su* judges to make b9d+ rul+s on causation1 comp5sation1 /&>ds ( c>e1 & relat$ issues ) reliance on indep5d5t exp]t witnesses commission$ by ! c\rt2 7,d7 provide = an appeals process to all[ = review ( decisions2 & 7,e7 at its option1 e/abli% an adm9i/rative entity simil> to ! entity describ$ 9 p>agraph 7#c77;,a77i77,i7 to provide advice & guidance to ! special c\rt4 7e7 ,application 7#a7 ,9 g5]al ,ea* ,/ate desir+ a grant "u subsection 7a7 %all submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 7#b7 ,review panel 7,a7 ,9 g5]al ,9 review+ applications "u p>agraph 7#a71 ! ,secret>y %all consult ) a review panel compos$ ( relevant exp]ts appo9t$ by ! ,comptroll] ,g5]al4 7,b7 ,composition 7i7 ,nom9ations ,! ,comptroll] ,g5]al %all solicit nom9ations f ! public = individuals to s]ve on ! review panel4 7ii7 ,appo9tm5t ,! ,comptroll] ,g5]al %all appo9t1 at lea/ #aa b n m ?an #ae1 highly qualifi$ & kn[l$geable individuals to s]ve on ! review panel & %all ensure t ! foll[+ entities receive fair repres5tation on su* panel3 7,i7 ,pati5t advocates4 7,,ii7 ,heal? c>e provid]s & heal? c>e organizations4 7,,iii7 ,attorneys ) exp]tise 9 repres5t+ pati5ts & heal? c>e provid]s4 7,,iv7 ,insur]s4 7,v7 ,/ate (ficials4 7,c7 ,*airp]son ,! ,comptroll] ,g5]al1 or an individual )9 ! ,gov]nm5t ,acc\ntability ,(fice designat$ by ! ,comptroll] ,g5]al1 %all be ! *airp]son ( ! review panel4 7,d7 ,availability ( in=mation ,! ,comptroll] ,g5]al %all make available to ! review panel su* in=mation1 p]sonnel1 & adm9i/rative s]vices & assi/ance z ! review panel may reasonably require to c>ry out its duties4 7,e7 ,in=mation f ag5cies ,! review panel may reque/ directly f any dep>tm5t or ag5cy ( ! ,unit$ ,/ates any in=mation t su* panel consid]s necess>y to c>ry out its duties4 ,to ! ext5t consi/5t ) applicable laws & regulations1 ! head ( su* dep>tm5t or ag5cy %all furni% ! reque/$ in=mation to ! review panel4 7f7 ,report ,ea* ,/ate receiv+ a grant "u subsection 7a7 %all submit to ! ,secret>y a report evaluat+ ! effectiv5ess ( activities fund$ ) grants aw>d$ "u su* subsection at su* "t & 9 su* mann] z ! ,secret>y may require4 7g7 ,te*nical assi/ance 7#a7 ,9 g5]al ,! ,secret>y %all provide te*nical assi/ance to ! ,/ates aw>d$ grants "u subsection 7a74 7#b7 ,requirem5ts ,te*nical assi/ance "u p>agraph 7#a7 %all include-- 7,a7 ! developm5t ( a def9$ paym5t s*$ule = non-economic damages 7includ+ guidance on ! consid]ation ( individual facts & circum/ances 9 det]m9+ appropriate paym5t71 ! developm5t ( classes ( avoidable injuries1 & guidance on e>ly disclosure to pati5ts ( adv]se ev5ts2 & 7,b7 ! developm5t1 9 consultation ) ,/ates1 ( common def9itions1 =mats1 & data collection infra/ructure = ,/ates receiv+ grants "u ?is section to use 9 report+ to facilitate aggregation & analysis ( data bo? )9 & betwe5 ,/ates4 7#c7 ,use ( common def9itions1 =mats1 & data collection infra/ructure ,/ates n receiv+ grants "u ?is section may also use ! common def9itions1 =mats1 & data collection infra/ructure develop$ "u p>agraph 7#b77;,b74 7h7 ,evaluation 7#a7 ,9 g5]al ,! ,secret>y1 9 consultation ) ! review panel e/abli%$ "u subsection 7e77#b71 %all ent] into a contract ) an appropriate rese>* organization to conduct an ov]all evaluation ( ! effectiv5ess ( grants aw>d$ "u subsection 7a7 & to annually prep>e & submit a report to ! appropriate committees ( ,congress4 ,su* an evaluation %all beg9 n lat] ?an #ah mon?s foll[+ ! date ( implem5tation ( ! fir/ program fund$ by a grant "u subsection 7a74 7#b7 ,cont5ts ,! evaluation "u p>agraph 7#a7 %all include-- 7,a7 an analysis ( ! effect ( ! grants aw>d$ "u subsection 7a7 on ! numb]1 nature1 & co/s ( heal? c>e liability claims2 7,b7 a comp>ison ( ! claim & co/ in=mation ( ea* ,/ate receiv+ a grant "u subsection 7a72 & 7,c7 a comp>ison betwe5 ,/ates receiv+ a grant "u ?is section & ,/ates t did n receive su* a grant1 mat*$ to ensure simil> legal & heal? c>e environm5ts1 & to det]m9e ! effects ( ! grants & subsequ5t re=ms on-- 7i7 ! liability environm5t2 7ii7 heal? c>e quality2 7iii7 pati5t safety2 & 7iv7 pati5t & heal? c>e provid] & organization satisfaction ) ! re=ms4 7i7 ,option ,to provide = initial plann+ grants ,( ! funds appropriat$ pursuant to subsection 7k71 ! ,secret>y may use a portion n to exce$ #ejj1jjj p] ,/ate to provide plann+ grants to su* ,/ates = ! developm5t ( demon/ration project applications meet+ ! crit]ia describ$ 9 subsection 7c74 ,9 select+ ,/ates to receive su* plann+ grants1 ! ,secret>y %all give pref]5ce to ^? ,/ates 9 :i* ,/ate law at ! "t ( ! application w\ld n prohibit ! adoption ( an alt]native to curr5t tort litigation4 7j7 ,def9itions ,9 ?is section3 7#a7 ,heal? c>e s]vices ,! t]m heal? c>e s]vices means any s]vices provid$ by a heal? c>e provid]1 or by any individual work+ "u ! sup]vision ( a heal? c>e provid]1 t relate to-- 7,a7 ! diagnosis1 prev5tion1 or treatm5t ( any human disease or impairm5t2 or 7,b7 ! assessm5t ( ! heal? ( human be+s4 7#b7 ,heal? c>e organization ,! t]m heal? c>e organization means any individual or entity :i* is obligat$ to provide1 pay =1 or adm9i/] heal? b5efits "u any heal? plan4 7#c7 ,heal? c>e provid] ,! t]m heal? c>e provid] means any individual or entity-- 7,a7 lic5s$1 regi/]$1 or c]tifi$ "u ,f$]al or ,/ate laws or regulations to provide heal? c>e s]vices2 or 7,b7 requir$ to be s lic5s$1 regi/]$1 or c]tifi$ b t is exempt$ by o!r /atute or regulation4 7#d7 ,net economic loss ,! t]m net economic loss means-- 7,a7 reasonable exp5ses incurr$ = products1 s]vices1 & accommodations ne$$ = heal? c>e1 tra9+1 & o!r rem$ial treatm5t & c>e ( an injur$ individual2 7,b7 reasonable & appropriate exp5ses = rehabilitation treatm5t & occupational tra9+2 7,c7 #ajj p]c5t ( ! loss ( income f "w t an injur$ individual w\ld h p]=m$ if n injur$1 r$uc$ by any income f sub/itute "w actually p]=m$2 & 7,d7 reasonable exp5ses incurr$ 9 obta9+ ord9>y & necess>y s]vices to replace s]vices an injur$ individual w\ld h p]=m$ = ! b5efit ( ! individual or ! family ( su* individual if ! individual _h n be5 injur$4 7#e7 ,non-economic damages ,! t]m non-economic damages means losses = physical & emotional pa91 suff]+1 inconv5i5ce1 physical impairm5t1 m5tal angui%1 disfigurem5t1 loss ( enjoym5t ( life1 loss ( society & companion%ip1 loss ( consortium 7o!r ?an loss ( dome/ic s]vice71 injury to reputation1 & all o!r non-pecuni>y losses ( any k9d or nature1 to ! ext5t p]mitt$ "u ,/ate law4 7k7 ,au?orization ( appropriations ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y4 ,am\nts appropriat$ pursuant to ?is subsection %all rema9 available until exp5d$4 4 #cbi4 ,affirmative def5se bas$ on compliance ) be/ practice guidel9es 7a7 ,selection & ,issuance ( ,be/ ,practices ,guidel9es 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all provide = ! selection & issuance ( be/ practice guidel9es 7ea* 9 ?is subsection ref]r$ to z a guidel9e7 9 accordance ) p>agraphs 7#b7 & 7#c74 7#b7 ,developm5t process ,n lat] ?an #ij days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all ent] into a contract ) a qualifi$ physician cons5sus-build+ organization 7su* z ! ,physician ,consortium = ,p]=mance ,improvem5t71 9 conc]t & agreem5t ) physician specialty organizations1 to develop guidel9es = treatm5t ( m$ical conditions = application "u subsection 7b74 ,"u ! contract1 ! organization %all take into consid]ation any endors$ p]=mance-bas$ quality measures utiliz$ "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,"u ! contract & n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! organization %all submit be/ practice guidel9es = issuance z guidel9es "u p>agraph 7#c74 7#c7 ,issuance 7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all issue1 by regulation1 aft] notice & opportunity = public comm5t1 guidel9es t h be5 recomm5d$ "u p>agraph 7#b7 = application "u subsection 7b74 7,b7 ,limitation ,! ,secret>y may n issue guidel9es unless !y h be5 approv$ or endors$ by qualifi$ physician cons5sus-build+ organization involv$ & physician specialty organizations4 7,c7 ,dissem9ation ,! ,secret>y %all broadly dissem9ate ! guidel9es s issu$4 7b7 ,limitation on damages 7#a7 ,limitation on noneconomic damages ,9 any heal? c>e lawsuit1 no noneconomic damages may aw>d$ ) respect to treatm5t t is )9 a guidel9e issu$ "u subsection 7a74 7#b7 ,limitation on punitive damages ,9 any heal? c>e lawsuit1 no punitive damages may be aw>d$ aga9/ a heal? c>e practition] bas$ on a claim t su* treatm5t caus$ ! claimant h>m if-- 7,a7 su* treatm5t 0 subject to ! quality review by a qualifi$ physician cons5sus-build+ organization2 7,b7 su* treatm5t 0 approv$ 9 a guidel9e t und]w5t full review by su* organization1 public comm5t1 approval by ! ,secret>y1 & dissem9ation z describ$ 9 subp>agraph 7a72 & 7,c7 su* m$ical treatm5t is g5]ally recogniz$ among qualifi$ exp]ts 7includ+ m$ical provid]s & relevant physician specialty organizations7 z safe1 effective1 & appropriate4 7c7 ,use 7#a7 ,introduction z evid5ce ,guidel9es "u subsection 7a7 may n be introduc$ z evid5ce ( neglig5ce or deviation 9 ! /&>d ( c>e 9 any civil action unless !y h previ\sly be5 introduc$ by ! def5dant4 7#b7 ,no presumption ( neglig5ce ,!re w\ld be no presumption ( neglig5ce if a p>ticipat+ physician does n adh]e to su* guidel9es4 7d7 ,con/ruction ,no?+ 9 ?is section %all be con/ru$ z prev5t+ a ,/ate f-- 7#a7 replac+ _! curr5t m$ical malpractice rules ) rules t rely1 z a def5se1 ^u a heal? c>e provid]'s compliance ) a guidel9e issu$ "u subsection 7a72 or 7#b7 apply+ additional guidel9es or safe-h>bors t are 9 addition to1 b n 9 lieu (1 ! guidel9es issu$ "u subsection 7a74 #ccj4 ,m$ical malpractice re=m ,/ate inc5tive fund 7a7 ,grants ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all aw>d grants to eligible ,/ates to assi/ su* ,/ates 9 implem5t+ ,/ate-bas$ m$ical malpractice re=ms4 7b7 ,eligibility 7#a7 ,9 g5]al ,to be eligible to receive a grant "u subsection 7a71 a ,/ate %all-- 7,a7 submit to ! ,secret>y an application1 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require2 & 7,b7 %all c]tify1 z "p ( ! application "u subp>agraph 7,a71 t ! ,/ate has c>ri$ out activities1 includ+ enact+ ,/ate laws1 t h be5 demon/rat$ to l[] m$ical malpractice claim or premiums co/s = physicians or to l[] heal? c>e co/s = pati5ts4 7#b7 ,/udy ,z "p ( a c]tification provid$ "u p>agraph 7#a77;,b71 ! ,/ate %all include ! results ( at lea/ "o longitud9al1 empirically bas$ /udy or data bas$ on an actu>ial analysis t demon/rates co/ r$uctions ( ! type describ$ 9 su* p>agraph4 ,su* results %all be provid$ 9 a mann] t enables ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates to make a det]m9ation z to :e!r su* results are ! reasonable & demon/rable conclusion ( ! ,/ate activities involv$4 7#c7 ,types ( laws ,laws describ$ 9 p>agraph 7#a77;,b7 may include caps on non-economic damages1 ! e/abli%m5t ( heal? c\rts1 ! e/abli%m5t ( a compreh5sive pati5t comp5sation program1 provid+ = adm9i/rative det]m9ations ( comp5sation1 provid+ = e>ly (f]s1 e/abli%+ safe h>bors = ! practice ( evid5ce-bas$ m$ic9e1 or o!r demon/rat$ me?ods to r$uce co/s4 7c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to c>ry out ?is section-- 7#a7 #ejj1jjj1jjj = ! p]iod ( fiscal ye>s #bjaf ?r\gh #bjbj2 & 7#b7 #ejj1jjj1jjj = ! p]iod ( fiscal ye>s #bjba ?r\gh #bjbe4 7d7 ,sunset ,! au?ority e/abli%$ "u ?is section %all n apply aft] ,septemb] #cj1 #bjbf4 #cca4 ,s5se ( ,congress conc]n+ additional re=ms ,x is ! s5se ( ,congress t ,congress %\ld explore o!r options = heal? c>e-relat$ tort re=m1 includ+ /atutory caps on punitive & non-economic damages & measures to ensure sav+s result+ f tort re=ms g to r$uc+ heal? c>e co/s1 z well z measures to enc\rage ! r$uction ( m$ical errors4 #ccb4 ,applicability2 effective date ,?is subtitle %all apply to any heal? c>e lawsuit br\ght 9 a ,f$]al or ,/ate c\rt1 or subject to an alt]native dispute resolution sy/em1 t is initiat$ on or aft] ! date ( ! enactm5t ( ?is ,act1 except t any heal? c>e lawsuit aris+ f an injury occurr+ prior to ! date ( ! enactm5t ( ?is ,act %all be gov]n$ by ! applicable /atute ( limitations provisions 9 effect at ! "t ! injury occurr$4 ,,iv ,social ,security ,sav+s #dja4 ,adju/m5ts 9 supplem5tal security income b5efits = c]ta9 long-"t b5efici>ies 7a7 ,9 g5]al ,title ,,xvi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acha et seq47 is am5d$ by ins]t+ aft] section #afag ! foll[+3 #afag;,a4 ,adju/m5ts 9 b5efits = c]ta9 long-"t b5efici>ies 7a7 ,9 ! case ( an eligible individual to :om b5efits "u ?is title 7or "u section #baa ( ,public ,law #ic-ff7 h be5 payable = at lea/ #bdj mon?s 7:e!r or n consecutive7 & ^: b5efits "u ?is title 7or "u su* section #baa7 h be5 increas$ "u ?is section few] ?an #e times1 :5ev] b5efit am\nts "u title ,,ii are increas$ by any p]c5tage effective ) any mon? z a result ( a det]m9ation made "u section #bae7;i7 ( ?is ,act-- 7#a7 ea* ( ! doll> am\nts 9 effect = ! mon? ) respect to ! eligible individual "u subsections 7a77#a77;,a71 7a77#b77;,a71 7b77#a71 & 7b77#b7 ( section #afaa ( ?is title1 & subsection 7a77#a77;,a7 ( section #baa ( ,public ,law #ic-ff1 z specifi$ 9 su* subsections or z previ\sly increas$ "u section #afag ( ?is title or ?is section1 %all be increas$ by ! am\nt 7if any7 by :i*-- 7,a7 ! am\nt :i* w\ld h be5 9 effect "u su* subsections = ! mon? ) respect to ! individual b = ! r\nd+ ( ! am\nt pursuant to section #afag7;a77#b7 ( ?is title or p>agraph 7#b7 ( ?is subsection1 exce$s 7,b7 ! am\nt 9 effect = ! mon? "u su* subsections ) respect to ! individual2 & 7#b7 ! am\nt obta9$ "u p>agraph 7#a7 ) respect to ea* subsection ) respect to ! individual %all be fur!r increas$ by #a p]c5t ( ! am\nt s obta9$ ) respect to ! individual ! #a/ "t ?is section is appli$ ) respect to ! individual1 7& r\nd$1 :5 n a multiple ( #ab1 to ! next l[] multiple ( #ab71 effective ) respect to b5efits = mon?s aft] ! mon?4 7b7 ,! new doll> am\nts to be 9 effect "u section #afaa ( ?is title & "u section #baa ( ,public ,law #ic-ff by reason ( ! application ( subsection 7a7 ( ?is section ) respect to eligible individuals %all be publi%$ 9 ! ,f$]al ,regi/] toge!r )1 & at ! same "t z1 ! mat]ial requir$ by section #bae7;i77#b77;,d7 ( ?is ,act to be publi%$ !re9 by reason ( ! det]m9ation involv$4 4 7b7 ,con=m+ am5dm5ts 7#a7 ,subsections 7a77#a77;,a71 7a77#b77;,a71 7b77#a71 7b77#b71 & 7b77#f7 ( section #afaa ( su* ,act 7#db ,u4,s4,c4 #achb7 are ea* am5d$ by ins]t+ or #afag;,a aft] #afag4 7#b7 ,section #afag7;a77#a7 ( su* ,act 7#db ,u4,s4,c4 #achb;f7a77#a77 is am5d$-- 7,a7 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ or section #afag;,a aft] ?is section2 & 7,b7 9 subp>agraph 7,a71 by ins]t+ or section #afag;,a7a77#b77 aft] p>agraph 7#b74 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to b5efits payable = mon?s beg9n+ aft] cal5d> ye> 9 :i* ?is ,act is enact$4 ,v ,o!r ,m&atory ,sav+s & ,receipts #eja4 ,conv]sion to *a9$ ,,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 #bjag1 ! product (-- 7,i7 ! ,,cpi fraction = cal5d> ye>s be=e #bjag1 multipli$ by 7,,ii7 ! ,*a9$ ,,cpi fraction = cal5d> ye>s aft] #bjaf1 r$uc$ by #a1 & 7ii7 = adju/m5ts fir/ beg9n+ aft] #bjaf1 ! ,*a9$ ,,cpi fraction = ye>s aft] #bjaf4 7,b7 ,,cpi fraction = cal5d> ye>s be=e #bjag ,! ,,cpi fraction = cal5d> ye>s be=e #bjag is ! fraction-- 7i7 ! num]ator ( :i* is ! ,,cpi = ! cal5d> ye> #bjae2 & 7ii7 ! d5om9ator ( :i* is ! ,,cpi = ! cal5d> ye> #aiib4 7,c7 ,*a9$ cpi fraction = cal5d> ye>s aft] #bjaf ,! ,*a9$ ,,cpi fraction = cal5d> ye>s aft] #bjaf is ! fraction-- 7i7 ! num]ator ( :i* is ! ,*a9$ ,,cpi = ! prec$+ cal5d> ye>1 & 7ii7 ! d5om9ator ( :i* is ! ,*a9$ ,,cpi = ! cal5d> ye> #bjae4 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> #bjag = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re( & ins]t+ by sub/itut+ cal5d> ye> #bjag = cal5d> ye> #bjae 9 subp>agraph 7,c7 !re(4 7,e7 ,clause 7ii7 ( section #de,r7d77#c77;,b7 ( su* ,code is am5d$ by /rik+ by sub/itut+ cal5d> ye> #bjaf = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re( & ins]t+ by sub/itut+ cal5d> ye> #bjaf = cal5d> ye> #bjae 9 subp>agraph 7,c7 !re(4 7,f7 ,subp>agraph 7,b7 ( section #abe7;i77#b7 ( su* ,code is am5d$ by /rik+ by sub/itut+ cal5d> ye> #bjaf = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re( & ins]t+ by sub/itut+ cal5d> ye> #bjaf = cal5d> ye> #bjae 9 subp>agraph 7,c7 !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+ = #bjae 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> #bjae 9 subp>agraph 7,c7 !re(4 7,i7 ,p>agraph 7#a7 ( section #fgba7;f7 ( su* ,code is am5d$ by /rik+ det]m9$ by sub/itut+ cal5d> ye> #bjae = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(4 7,j7 ,p>agraph 7#a7 ( section #fgbb7;f7 ( su* ,code is am5d$ by /rik+ det]m9$ by sub/itut+ cal5d> ye> #bjae = cal5d> ye> #aiib 9 subp>agraph 7,b7 !re(4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjaf4 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 #eja7;b7 ( ! ,am]ica ,fir/ ,act 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] #bjae4 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$]al program or law effective 9 ! mon? ( ,decemb] #bjaf & !reaft]1 any su* increase = ! p]iod = :i* ! p]c5tage *ange is det]m9$ %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] #bjae & !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 #bjag2 multipli$ by 7ii7 ! ,*a9$ ,,cpi fraction aft] #bjaf1 r$uc$ by #a4 7,b7 ,,cpi fraction prior to #bjag ,! ,,cpi fraction prior to #bjag is ! fraction-- 7i7 ! num]ator ( :i* is ! ,,cpi = ! p]iod1 end+ ) or dur+ #bjae1 :i* corresponds to ! base p]iod2 & 7ii7 ! d5om9ator ( :i* is ! ,,cpi = ! base p]iod4 7,c7 ,*a9$ ,,cpi fraction aft] #bjaf ,! ,*a9$ ,,cpi fraction aft] #bjaf 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+ #bjae1 :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 ,nonapplication to co/-(-liv+ indexation ( ,,ssi b5efits 7i7 ,9 g5]al ,section #afag ( ! ,social ,security ,act 7#db ,u4,s4,c4 #achb;f7 is am5d$-- 7,i7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ ,:5ev] & ins]t+ ,subject to subsection 7d71 :5ev]2 & 7,,ii7 by add+ at ! end ! foll[+3 7d7 7#a7 ,not)/&+ subsection 7a71 ) respect to b5efits payable "u ?is title = ,decemb] #bjaf & mon?s !reaft]1 :5ev] b5efit am\nts "u title ,,ii are increas$ by any p]c5tage effective ) any mon? z a result ( a det]m9ation made "u section #bae7;i71 ea* ( ! doll> am\nts 9 effect = su* mon? "u subsections 7a77#a77;,a71 7a77#b77;,a71 7b77#a71 & 7b77#b7 ( section #afaa1 & subsection 7a77#a77;,a7 ( section #baa ( ,public ,law #ic-ff1 z specifi$ 9 su* subsections or z previ\sly increas$ "u ?is section1 %all be increas$ by #a_/ab ( ! co/-(-liv+ adju/m5t det]m9$ "u p>agraph 7#b7 = ! mo/ rec5t prior cal5d> ye> 7& r\nd$1 :5 n a multiple ( #ab1 to ! next l[] multiple ( #ab74 7#b7 ,! co/-(-liv+ adju/m5t det]m9$ "u ?is p>agraph is1 ) respect to a cal5d> ye>1 ! p]c5tage equal to ! sum (-- 7,a7 ! ,*a9$ ,,cpi increase p]c5tage det]m9$ "u p>agraph 7#c7 = ! ye>2 & 7,b7 ! diff]5ce (-- 7i7 ! product ( ! ,,cpi increase p]c5tage det]m9$ "u p>agraph 7#d7 = ! ye> & ! applicable transition factor "u p>agraph 7#e72 & 7ii7 ! product ( ! ,*a9$ ,,cpi increase p]c5tage det]m9$ "u p>agraph 7#c7 = ! ye> & ! applicable transition factor "u p>agraph 7#e74 7#c7 ,! ,*a9$ ,,cpi increase p]c5tage det]m9$ "u ?is p>agraph = a cal5d> ye> is ! fraction 7express$ z a p]c5tage7-- 7,a7 ! num]ator ( :i* is ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = ! prec$+ cal5d> ye> 7z publi%$ by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor72 & 7,b7 ! d5om9ator ( :i* is ! ,*a9$ ,consum] ,price ,index = ,all ,urban ,consum]s = cal5d> ye> #bjae 7z s publi%$74 7#d7 ,! ,,cpi increase p]c5tage det]m9$ "u ?is p>agraph = a cal5d> ye> is ! fraction 7express$ z a p]c5tage7-- 7,a7 ! num]ator ( :i* is ! ,consum] ,price ,index = all urban consum]s = ! prec$+ cal5d> ye> 7z publi%$ by ! ,bureau ( ,labor ,/ati/ics ( ! ,dep>tm5t ( ,labor72 & 7,b7 ! d5om9ator ( :i* is ! ,consum] ,price ,index = all urban consum]s = cal5d> ye> #bjae 7z s publi%$74 7#e7 ,! applicable transition factor "u ?is p>agraph is-- 7,a7 = b5efits effective = mon?s beg9n+ aft] ,novemb] #cj1 #bjaf1 & be=e ,decemb] #a1 #bjag1 #j4h2 7,b7 = b5efits effective = mon?s beg9n+ aft] ,novemb] #cj1 #bjag1 & be=e ,decemb] #a1 #bjah1 #j4f2 7,c7 = b5efits effective = mon?s beg9n+ aft] ,novemb] #cj1 #bjah1 & be=e ,decemb] #a1 #bjai1 #j4d2 7,d7 = b5efits effective = mon?s beg9n+ aft] ,novemb] #cj1 #bjai1 & be=e ,decemb] #a1 #bjbj1 #j4b2 & 7,e7 = b5efits effective = mon?s beg9n+ aft] ,novemb] #cj1 #bjbj1 #j4j4 4 7ii7 ,con=m+ am5dm5t ,section #afag7;b7 ( su* ,act 7#db ,u4,s4,c4 #achb;f7b77 is am5d$ by ins]t+ or 7d7aft] subsection 7a74 7,c7 ,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] #bjae4 #ejb4 ,adju/m5t = inflation ( fees = c]ta9 cu/oms s]vices 7a7 ,9 g5]al ,section #acjca ( ! ,consolidat$ ,omnibus ,budget ,reconciliation ,act ( #aihe 7#ai ,u4,s4,c4 #eh;c7 is am5d$ by add+ at ! end ! foll[+3 7l7 ,adju/m5t ( fees = inflation 7#a7 ,9 g5]al ,! ,secret>y ( ! ,treasury %all adju/ ! fees e/abli%$ "u subsection 7a71 & ! limitations on su* fees "u p>agraphs 7#b71 7#c71 7#e71 7#f71 7#h71 & 7#i7 ( subsection 7b71 on ,octob] #a1 #bjae1 & annually !reaft]1 to reflect ! p]c5tage 7if any7 ( ! increase 9 ! av]age ( ! *a9$ ,consum] ,price ,index = ! prec$+ #ab-mon? p]iod comp>$ to ! *a9$ ,consum] ,price ,index = fiscal ye> #bjad4 7#b7 ,special rules = calculation ( adju/m5t ,9 adju/+ "u p>agraph 7#a7 ! am\nt ( ! fees e/abli%$ "u subsection 7a71 & ! limitations on su* fees "u p>agraphs 7#b71 7#c71 7#e71 7#f71 7#h71 & 7#i7 ( subsection 7b71 ! ,secret>y-- 7,a7 %all r\nd ! am\nt ( any increase 9 ! ,consum] ,price ,index to ! ne>e/ doll>2 & 7,b7 may ignore any su* increase ( less ?an #a p]c5t4 7#c7 ,*a9$ ,consum] ,price ,index def9$ ,= purposes ( ?is subsection1 ! t]m *a9$ ,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 7b7 ,deposits into ,cu/oms ,us] ,fee ,acc\nt ,section #acjca7;f7 ( ! ,consolidat$ ,omnibus ,budget ,reconciliation ,act ( #aihe 7#ai ,u4,s4,c4 #eh;c7f77 is am5d$-- 7#a7 9 p>agraph 7#a71 9 ! matt] prec$+ subp>agraph 7,a71 by /rik+ all fees collect$ "u subsection 7a7 & ins]t+ ! am\nt ( fees collect$ "u subsection 7a7 7det]m9$ )\t reg>d to any adju/m5t made "u subsection 7l772 & 7#b7 9 p>agraph 7#c77;,a71 9 ! matt] prec$+ clause 7i7-- 7,a7 by /rik+ fees collect$ & ins]t+ am\nt ( fees collect$2 & 7,b7 by /rik+ 71 ea* appropriation & ins]t+ 1 & det]m9$ )\t reg>d to any adju/m5t made "u subsection 7l771 ea* appropriation4 7c7 ,con=m+ am5dm5ts ,section #acjca ( ! ,consolidat$ ,omnibus ,budget ,reconciliation ,act ( #aihe 7#ai ,u4,s4,c4 #eh;c71 z am5d$ by subsections 7a7 & 7b71 is fur!r am5d$-- 7#a7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] foll[+ fees2 & 7#b7 9 subsection 7b7-- 7,a7 9 p>agraph 7#b71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] 9 fees2 7,b7 9 p>agraph 7#c71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] 9 fees2 7,c7 9 p>agraph 7#e77;,a71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] 9 fees2 7,d7 9 p>agraph 7#f71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] 9 fees2 7,e7 9 p>agraph 7#h77;,a7-- 7i7 9 clause 7i71 by ins]t+ or 7l7 aft] subsection 7a77#i77;,b72 & 7ii7 9 clause 7ii71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] #c2 & 7,f7 9 p>agraph 7#i7-- 7i7 9 subp>agraph 7,a7-- 7,i7 9 ! matt] prec$+ clause 7i71 by ins]t+ & subject to adju/m5t "u subsection 7l7 aft] ,t>iff ,act ( #aicj2 & 7,,ii7 9 clause 7ii77,i71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] bill ( lad+2 & 7ii7 9 subp>agraph 7,b77i71 by ins]t+ 7subject to adju/m5t "u subsection 7l77 aft] bill ( lad+4 #ejc4 ,adju/m5t = inflation ( ,,tsa s]vice security fees & fee levels 7a7 ,limitation on fees ,subsection 7c7 ( section #ddidj ( title #di1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,adju/m5t ( fee am\nt ,= fiscal ye> #bjaf & ea* subsequ5t fiscal ye>1 ! am\nt ( a fee "u ?is subsection %all be adju/$ to reflect ! p]c5tage 7if any7 ( ! av]age ( ! *a9$ ,consum] ,price ,index = ! prec$+ #ab-mon? p]iod comp>$ to ! *a9$ ,consum] ,price ,index = ! prec$+ fiscal ye>4 4 7b7 ,fee levels ,subsection 7i77#d7 ( su* section is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,m7 ,= fiscal ye> #bjbf1 & ea* subsequ5t fiscal ye>1 ! am\nt 9 effect = ! prec$+ fiscal ye>1 z adju/$ to reflect ! p]c5tage 7if any7 9 ! av]age ( ! *a9$ ,consum] ,price ,index = ! prec$+ #ab-mon? p]iod comp>$ to ! *a9$ ,consum] ,price ,index = prec$+ fiscal ye>4 4 7c7 ,*a9$ consum] price index ,su* section is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,calculation ( *a9$ consum] price index 7#a7 ,special rules = calculation ( adju/m5t ,9 calculat+ ! am\nt ( ! fee "u subsection 7c7 & ! fiscal ye> am\nts "u subsection 7i77#d77,k71 ! ,"u ,secret>y-- 7,a7 %all r\nd ! am\nt ( any increase 9 ! ,consum] ,price ,index to ! ne>e/ doll>2 & 7,b7 may ignore any su* increase ( less ?an #a p]c5t4 7#b7 ,*a9$ ,consum] ,price ,index def9$ ,= purposes ( ?is section1 ! t]m *a9$ ,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 #ejd4 ,divid5ds & surplus funds ( res]ve banks ,section #g7;a77#a77;,a7 ( ! ,f$]al ,res]ve ,act 7#ab ,u4,s4,c4 #bhi7;a77#a77;,a77 is am5d$ by /rik+ #f p]c5t & ins]t+ #f p]c5t 7#a4e p]c5t 9 ! case ( a /ockhold] hav+ total consolidat$ assets ( m ?an #a1jjj1jjj1jjj 7det]m9$ z ( ,septemb] #cj ( ! prec$+ fiscal ye>774 #eje4 ,co/-sav+ re=ms = ,f$]al ,crop ,insurance ,program 7a7 ,r$uction 9 premium subsidy = h>ve/ price policies ,section #ejh7;e7 ( ! ,f$]al ,crop ,insurance ,act 7#g ,u4,s4,c4 #aejh7;e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,r$uc$ premium subsidy = h>ve/ price policies ,not)/&+ any o!r provision ( ?is subsection reg>d+ paym5t ( a portion ( premiums1 effective beg9n+ ) ! #bjaf re9surance ye>1 ! level ( premium subsidy = rev5ue-bas$ plans ( insurance t provide protection = upw>d price movem5ts at h>ve/ "t %all be at lea/ #aj p]c5tage po9ts less ?an ! premium subsidy available = ! same cov]age = ! #bjae re9surance ye>4 4 7b7 ,adju/m5t 9 prev5t$ plant+ paym5t cov]age levels ,section #ejh7;i7 ( ! ,f$]al ,crop ,insurance ,act 7#g ,u4,s4,c4 #aejh7;i77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,adju/m5t 9 prev5t$ plant+ paym5t cov]age levels ,! ,corporation %all adju/1 z soon z practicable1 prev5t$ plant+ cov]age levels on a crop-by-crop basis to improve ! actu>ial s\ndness ( ! insurance op]ations ( ! ,corporation4 4 7c7 ,elim9ation ( optional additional prev5t$ plant+ cov]age ,section #ejh7l7 ( ! ,f$]al ,crop ,insurance ,act 7#g ,u4,s4,c4 #aejh7l77 is am5d$-- 7#a7 by /rik+ ,! ,corporation & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,! ,corporation 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,limitation on optional additional prev5t$ plant+ cov]age ,! ,corporation may n provide an option = produc]s to pur*ase additional prev5t$ plant+ cov]age levels 9 excess ( ! base cov]age provid$ 9 ! policy4 4 7d7 ,consi/5t calculation ( ,actual ,production ,hi/ory = produc]s t receive a prev5t+ plant+ paym5t ,section #ejh;,a7c77#c7 ( ! ,f$]al ,crop ,insurance ,act 7#g ,u4,s4,c4 #aejh;a7c77#c77 is am5d$ by /rik+ make an election "u p>agraph 7#a77;,b7 = a crop ye>1 & ins]t+ collects an indemnity "u prev5t$ plant+ cov]age = a fir/ crop = a crop ye>1 :e!r or n ! produc] elects to plant a second crop1 7e7 ,application ( am5dm5ts ,! am5dm5ts made by ?is section %all apply beg9n+ ) ! #bjaf re9surance ye>4 #ejf4 ,f$]al employee annuities 7a7 ,civil ,s]vice ,retirem5t ,sy/em ,section #hccd7;c7 ( title #e1 ,unit$ ,/ates ,code1 is am5d$ to read z foll[s3 7c7 ,ea* employee or ,memb] cr$it$ ) civilian s]vice aft] ,july #ca1 #aibj1 = :i* retirem5t d$uctions or deposits h n be5 made1 may deposit ) int]e/ an am\nt equal to ! foll[+ p]c5tages ( 8 basic pay receiv$ = t s]vice3 ,employee#g;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #g4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #g4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4c;,aft] ,decemb] #ca1 #bjah4 ,memb] or employee = congressional s]vice#g4e;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h ,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d ,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,memb] = ,memb] s]vice#h;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #i4c;,aft] ,decemb] #ca1 #bjah4 ,law en=cem5t (fic] = law en=cem5t s]vice1 memb] ( ! ,supreme ,c\rt ,police = ,supreme ,c\rt ,police s]vice1 & firefight] = firefight] s]vice#g4e;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,bankruptcy judge#h;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #i4c;,aft] ,decemb] #ca1 #bjah4 ,judge ( ! ,unit$ ,/ates ,c\rt ( ,appeals = ! ,arm$ ,=ces = s]vice z a judge ( t c\rt #h;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #i4c;,aft] ,decemb] #ca1 #bjah4 ,unit$ ,/ates ,magi/rate judge #h;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #i4c;,aft] ,decemb] #ca1 #bjah4 ,c\rt ( ,f$]al ,claims ,judge #h;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #i4c;,aft] ,decemb] #ca1 #bjah4 ,memb] ( ! ,capitol ,police #g4e;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,nucle> mat]ials c\ri]#g4e;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,cu/oms & bord] protection (fic] #g4e;,june #cj1 #bjjh to ,decemb] #cj1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 4 7b7 ,f$]al ,employees' ,retirem5t ,sy/em 7#a7 ,individual contributions ,section #hdbb7;a77#c77;,a7 ( title #e1 ,unit$ ,/ates ,code1 is am5d$ to read z foll[s3 7#c7 7,a7 ,! applicable p]c5tage "u ?is p>agraph = civilian s]vice by employees or ,memb]s o!r ?an revis$ annuity employees or fur!r revis$ annuity employees %all be z foll[s3 ,employee#g;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #g4e;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #g4i;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4c;,aft] ,decemb] #ca1 #bjah4 ,congressional employee#g4e;,janu>y #a1 #bjja to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,memb]#g4e;,janu>y #ca1 #bjjj to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjaf to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjag to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,law en=cem5t (fic]1 firefight]1 memb] ( ! ,capitol ,police1 memb] ( ! ,supreme ,c\rt ,police1 or air traffic controll] #g4e;,decemb] #ca1 #bjjj to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 ,nucle> mat]ials c\ri]#g4e;,decemb] #ca1 #bjjj to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjai4 ,cu/oms & bord] protection (fic] #g4e;,june #cj1 #bjjh to ,decemb] #ca1 #bjaf4 #h;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4 #h4d;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4 #h4h;,aft] ,decemb] #ca1 #bjah4 4 7#b7 ,gov]nm5t contributions ,section #hdbc7;a77#b77;,b77i7 ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] #bjac ! foll[+3 & section #ejf ( ! ,am]ica ,fir/ ,act4 7c7 ,=eign ,s]vice ,p5sion ,sy/em 7#a7 ,employee contributions ,section #hef7;a77#b77;,a7 ( ! ,=eign ,s]vice ,act ( #aihj 7#bb ,u4,s4,c4 #djga;e7a77#b77;,a77 is am5d$ to read z foll[s3 7#b7 7,a7 ,! applicable p]c5tage = a p>ticipant o!r ?an a revis$ annuity p>ticipant or a fur!r revis$ annuity p>ticipant %all be z foll[s3 #g4ee;,janu>y #ab1 #bjjc to ,decemb] #ca1 #bjaf4h4je;,janu>y #a1 #bjag to ,decemb] #ca1 #bjag4h4de;,janu>y #a1 #bjah to ,decemb] #ca1 #bjah4h4he;,aft] ,decemb] #ca1 #bjah4 4 7#b7 ,gov]nm5t contributions ,section #heg ( ! ,=eign ,s]vice ,act ( #aihj 7#bb ,u4,s4,c4 #djga;f7 is am5d$ by ins]t+ aft] #bjac ! foll[+3 & section #ejf ( ! ,am]ica ,fir/ ,act4 #ejg4 ,repaym5t plans ,section #dee7;d77#a7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhg;e7d77#a77 is am5d$-- 7#a7 9 subp>agraph 7,d7-- 7,a7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & ) respect to loans made on or aft] ,july #a1 #bjaf1 ! revis$ pay z y e>n repaym5t plan "u section #dic;,e %all be ! only income cont+5t repaym5t plan2 & 7,b7 by /rik+ & at ! end2 & 7#b7 9 subp>agraph 7,e71 by ins]t+ & only = loans made be=e ,july #a1 #bjaf1 aft] #bjji14 #ejh4 ,,repaye ,"p ,g ( title ,,iv ( ! ,high] ,education ,act ( #aife is am5d$ by add+ at ! end ! foll[+3 #dic;,e4 ,revis$ ,pay ,z ,y ,e>n ,repaym5t ,plan 7a7 ,def9itions 7#a7 ,eligible loan ,! t]m eligible loan means any out/&+ loan made "u "p ,d or "p ,b1 except = a default$ loan1 an except$ ,,plus loan1 or an except$ consolidation loan4 7#b7 ,except$ plus loan2 except$ consolidation loan ,! t]ms except$ plus loan & except$ consolidation loan h ! mean+s giv5 su* t]ms 9 section #dic;,c4 7#c7 ,p>tial f9ancial h>d%ip ,! t]m p>tial f9ancial h>d%ip-- 7,a7 :5 us$ ) respect to an unm>ri$ borr[]-- 7i7 means t = su* borr[] ! annual am\nt due on ! total am\nt ( eligible loans1 z calculat$ "u ! /&>d repaym5t plan "u section #dee7;d77#a77;,a71 bas$ on a #aj-ye> repaym5t p]iod1 & us+ ! great] (-- 7,i7 ! am\nt due on su* loans at ! "t ! borr[] ent]$ repaym5t = su* loans2 or 7,,ii7 ! am\nt due on su* loans at ! "t ! borr[] elect$ ! plan "u ?is section2 exce$s 7ii7 #aj p]c5t ( ! result obta9$ by calculat+1 on at lea/ an annual basis1 ! am\nt by :i*-- 7,i7 ! borr[]'s adju/$ gross income2 exce$s 7,,ii7 #aej p]c5t ( ! pov]ty l9e applicable to ! borr[]'s family size z det]m9$ "u section #fgc7b7 ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b772 & 7,b7 :5 us$ ) respect to a m>ri$ borr[]-- 7i7 means t = su* borr[] ! annual am\nt due on ! total am\nt ( ! borr[]'s eligible loans1 &1 if applicable1 ! borr[]'s sp\se's eligible loans1 z calculat$ "u ! /&>d repaym5t plan "u section #dee7;d77#a77;,a71 bas$ on a #aj-ye> repaym5t p]iod1 & us+ ! great] (-- 7,i7 ! am\nt due on su* loans at ! "t ! borr[] or borr[]'s sp\se ent]$ repaym5t on su* loans2 or 7,,ii7 ! am\nt due on su* loans at ! "t ! borr[] or ! borr[]'s sp\se elect$ ! plan "u ?is section2 exce$s 7ii7 #aj p]c5t ( ! result obta9$ by calculat+1 on at lea/ an annual basis1 ! am\nt by :i*-- 7,i7 ! diff]5ce betwe5 ! borr[]'s & borr[]'s sp\se's adju/$ gross income2 exce$s 7,,ii7 #aej p]c5t ( ! pov]ty l9e applicable to ! borr[]'s family size z det]m9$ "u section #fgc7b7 ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b774 7#d7 ,pay ,z ,y ,e>n repaym5t plan ,! t]m ,pay ,z ,y ,e>n repaym5t plan means ! ,pay ,z ,y ,e>n repaym5t plan describ$ 9 section #fhe4bji ( title #cd1 ,code ( ,f$]al ,regulations 7z 9 effect on ! date ( enactm5t ( ,am]ica ,fir/ ,act74 7b7 ,revis$ ,pay ,z ,y ,e>n ,repaym5t ,plan ,au?oriz$ ,not)/&+ any o!r provision ( ?is ,act1 ! ,secret>y %all c>ry out a program t meets ! foll[+ requirem5ts3 7#a7 ,mon?ly paym5t am\nt ,except z o!rwise provid$ 9 ?is subsection1 a borr[] ( any eligible loan may elect to h ! borr[]'s aggregate mon?ly paym5t = all su* loans n to exce$ ! result describ$ 9 subsection 7a77#c7 divid$ by #ab4 7#b7 ,adju/$ mon?ly paym5t am\nt ,! ,secret>y adju/s ! aggregate mon?ly paym5t "u p>agraph 7#a71 if-- 7,a7 ! borr[]'s eligible loans are n solely loans made "u "p ,d1 9 :i* case ! ,secret>y det]m9es ! borr[]'s adju/$ mon?ly paym5t by multiply+ ! aggregate mon?ly paym5t by ! p]c5tage ( ! total out/&+ pr9cipal am\nt ( ! borr[]'s eligible loans t are loans made "u "p ,d2 7,b7 ! borr[] & borr[]'s sp\se h eligible loans1 9 :i* case ! ,secret>y det]m9es-- 7i7 ea* borr[]'s p]c5tage ( ! c\ple's total eligible loan debt2 7ii7 ! adju/$ mon?ly paym5t = ea* borr[] by multiply+ ! calculat$ paym5t by ! p]c5tage det]m9$ "u clause 7i7 applicable to ! borr[]2 & 7iii7 if ! borr[]'s loans are held by multiple hold]s1 ! borr[]'s adju/$ mon?ly paym5t = "p ,d loans by multiply+ ! adju/$ mon?ly paym5t det]m9$ "u clause 7ii7 by ! p]c5tage ( ! total out/&+ pr9cipal am\nt ( ! borr[]'s eligible loans t are made "u "p ,d2 7,c7 ! calculat$ mon?ly paym5t am\nt "u p>agraph 7#a7 or ?is p>agraph is less ?an #e4jj1 9 :i* case ! borr[]'s mon?ly paym5t is #j4jj2 or 7,d7 ! calculat$ mon?ly paym5t am\nt "u p>agraph 7#a7 or ?is p>agraph or is equal to or great] ?an #e4jj b less ?an #aj4jj1 9 :i* case ! borr[]'s mon?ly paym5t is #aj4jj4 7#c7 ,accru$ int]e/ 7,a7 ,9 g5]al ,if ! borr[]'s mon?ly paym5t am\nt "u p>agraph 7#a7 or 7#b7 is n suffici5t to pay ! accru$ int]e/ on ! borr[]'s loan-- 7i7 = a subsidiz$ loan made "u "p ,d or ! subsidiz$ portion ( a ,f$]al ,direct ,consolidation ,loan-- 7,i7 ! ,secret>y does n *>ge ! borr[] ! rema9+ accru$ int]e/ = a p]iod n to exce$ ?ree consecutive ye>s f ! e/abli%$ repaym5t p]iod />t date on t loan2 & 7,,ii7 aft] ! ?ree-ye> p]iod1 ! ,secret>y *>ges ! borr[] #ej p]c5t ( ! rema9+ accru$ int]e/ on su* subsidiz$ loan or portion ( a ,f$]al ,direct ,consolidation ,loan2 & 7ii7 = an unsubsidiz$ loan made "u "p ,d1 a ,f$]al ,direct ,,plus ,loan made to a graduate or pr(essional /ud5t1 or ! unsubsidiz$ portion ( a ,f$]al ,direct ,consolidation ,loan1 or = a subsidiz$ loan made "u "p ,d or ! subsidiz$ portion ( a ,f$]al ,direct ,consolidation ,loan = :i* ! borr[] has become responsible = accru+ int]e/ 9 accordance ) section #dee7q77#b71 ! ,secret>y *>ges ! borr[] #ej p]c5t ( ! rema9+ accru$ int]e/4 7,b7 ,?ree-ye> p]iod def9$ ,! ?ree-ye> p]iod describ$ 9 subp>agraph 7,a77i7-- 7i7 does n include any p]iod dur+ :i* ! borr[] receives an economic h>d%ip def]m5t2 7ii7 includes any prior p]iod ( repaym5t "u an income-bas$ repaym5t plan "u section #dic;,c or ! ,pay-,z-,y-,e>n repaym5t plan2 & 7iii7 = a ,f$]al ,direct ,consolidation ,loan1 includes any p]iod 9 :i* ! und]ly+ loans 7 repaid "u a plan describ$ 9 clause 7ii7 ( ?is subp>agraph4 7,c7 ,capitalization ( accru$ int]e/ 7i7 ,tim+ ,accru$ int]e/ is capitaliz$-- 7,i7 :5 ! ,secret>y det]m9es t a borr[] does n h a p>tial f9ancial h>d%ip2 or 7,,ii7 at ! "t a borr[] leaves ! program "u ?is section4 7ii7 ,capitalization 7,i7 ,limitation ,! am\nt ( accru$ int]e/ capitaliz$ "u clause 7i77,i7 is limit$ to #aj p]c5t ( ! orig9al pr9cipal balance at ! "t ! borr[] ent]$ repaym5t "u ! program "u ?is section4 7,,ii7 ,p>ticipation ,aft] ! am\nt ( accru$ int]e/ rea*es ! limit describ$ 9 subclause 7,i71 int]e/ cont9ues to accrue1 b is n capitaliz$ :ile ! borr[] p>ticipates 9 ! program "u ?is section4 7#d7 ,po/ponem5t ( pr9cipal paym5t ,if ! borr[]'s mon?ly paym5t am\nt is n suffici5t to pay any ( ! pr9cipal due1 ! paym5t ( t pr9cipal is po/pon$ until ! borr[] leaves ! program "u ?is section or ! ,secret>y det]m9es ! borr[] does n h a p>tial f9ancial h>d%ip4 7#e7 ,selection ( diff]5t repaym5t plan ,a borr[] :o no long] wi%es to repay "u ! program "u ?is section may *ange to a diff]5t repaym5t plan 9 accordance ) section #dee7;d77#c74 7#f7 ,paym5t application & prepaym5t 7,a7 ,9 g5]al ,! ,secret>y applies any paym5t made "u ! program "u ?is section 9 ! foll[+ ord]3 7i7 ,accru$ int]e/4 7ii7 ,collection co/s4 7iii7 ,late *>ges4 7iv7 ,loan pr9cipal4 7,b7 ,prepaym5t au?oriz$ ,! borr[] may prepay all or "p ( a loan at any "t )\t p5alty1 z au?oriz$ "u section #dee7;d77#a74 7,c7 ,application ( prepaym5t ,if ! prepaym5t am\nt equals or exce$s-- 7i7 a mon?ly paym5t am\nt ( #aj4jj or m "u ! repaym5t s*$ule e/abli%$ = ! loan1 ! ,secret>y applies ! prepaym5t consi/5t ) ! requirem5ts ( section #dee7;d77#a72 or 7ii7 a mon?ly paym5t am\nt ( #j4jj "u ! repaym5t s*$ule e/abli%$ = ! loan1 ! ,secret>y applies ! prepaym5t consi/5t ) ! requirem5ts ( subp>agraph 7,a74 7#g7 ,eligibility docum5tation1 v]ification1 & notifications 7,a7 ,docum5tation 7i7 ,,agi ,! ,secret>y requires ! borr[] to provide docum5tation1 acceptable to ! ,secret>y1 ( ! borr[]'s adju/$ gross income4 7ii7 ,o!r docum5tation ,if ! borr[]'s adju/$ gross income is n available1 or if ! ,secret>y believes t ! borr[]'s report$ adju/$ gross income does n reasonably reflect ! borr[]'s curr5t income1 ! borr[] mu/ provide o!r docum5tation to v]ify income4 7iii7 ,family size ,unless o!rwise direct$ by ! ,secret>y1 ! borr[] mu/ annually c]tify ! borr[]'s family size4 ,if ! borr[] fails to c]tify family size1 ! ,secret>y assumes a family size ( "o = ! applicable ye>4 7,b7 ,notifications 7i7 ,9 g5]al ,ea* ye> t ! borr[] p>ticipates 9 ! program "u ?is section1 ! ,secret>y s5ds ! borr[] a writt5 notification t provides ! borr[] )-- 7,i7 ! borr[]'s mon?ly paym5t am\nt1 z calculat$ "u p>agraph 7#a7 or 7#b71 & ! "t p]iod dur+ :i* su* mon?ly paym5t am\nt w apply 7annual paym5t p]iod72 7,,ii7 in=mation ab\t ! requirem5t = ! borr[] to annually provide ! in=mation describ$ 9 subp>agraph 7,a71 & an explanation t ! borr[] w be notifi$ 9 advance ( ! date by :i* ! ,secret>y mu/ receive ?is in=mation2 7,,iii7 an explanation ( ! consequ5ces1 z describ$ "u subp>agraph 7,f71 if ! borr[] does n provide ! requir$ in=mation2 & 7,,iv7 in=mation ab\t ! borr[]'s option to reque/1 at any "t dur+ ! borr[]'s annual paym5t p]iod1 t ! ,secret>y recalculate ! borr[]'s mon?ly paym5t am\nt if ! borr[]'s f9ancial circum/ances h *ang$ & ! income am\nt t 0 us$ to calculate ! borr[]'s curr5t mon?ly paym5t no long] reflects ! borr[]'s curr5t income4 7ii7 ,recalculation ,if ! ,secret>y recalculates ! borr[]'s mon?ly paym5t am\nt bas$ on ! borr[]'s reque/1 ! ,secret>y s5ds ! borr[] a writt5 notification t includes ! in=mation describ$ 9 ?is subp>agraph4 7,c7 ,subsequ5t ye>s 7i7 ,9 g5]al ,= ea* ye> foll[+ ! fir/ ye> 9 :i* a borr[] p>ticipat+ 9 ! plan "u ?is section1 ! ,secret>y notifies ! borr[] 9 writ+ ( ! requirem5ts ( subp>agraph 7,a7 n lat] ?an #fj days & n e>li] ?an #ij days prior to ! date specifi$ 9 clause 7ii77,i74 7ii7 ,cont5ts ,! notification "u clause 7i7 %all provide ! borr[] )-- 7,i7 ! date1 no e>li] ?an #ce days be=e ! end ( ! borr[]'s annual paym5t p]iod1 by :i* ! ,secret>y mu/ receive all ( ! docum5tation describ$ 9 subp>agraph 7,a7 7annual deadl9e72 & 7,,ii7 ! consequ5ces if ! ,secret>y does n receive ! in=mation )9 #aj days foll[+ ! annual deadl9e specifi$ 9 ! notice1 z describ$ "u subp>agraph 7,f74 7,d7 ,no p>tial f9ancial h>d%ip ,ea* "t ! ,secret>y makes a det]m9ation t a borr[] does n h a p>tial f9ancial h>d%ip = ea* ye> foll[+ ! fir/ ye> = :i* borr[] wi%es to p>ticipate 9 ! program "u ?is section1 ! ,secret>y s5ds ! borr[] a writt5 notification t unpaid int]e/ w be capitaliz$ 9 accordance ) p>agraph 7#c77;,c74 7,e7 ,no docum5tation provid$ ,if a borr[] :o is curr5tly repay+ "u ano!r repaym5t plan elects ! program "u ?is section b does n provide ! docum5tation describ$ 9 subp>agraph 7,a71 ! borr[] rema9s on 8 or h] curr5t repaym5t plan4 7,f7 ,alt]nate repaym5t plan 7i7 ,9 g5]al ,if a borr[] :o is curr5tly repay+ "u ! program "u ?is section elects to p>ticipate 9 su* program = a subsequ5t ye> b ! ,secret>y does n receive ! docum5tation describ$ 9 subp>agraph 7,a7 n lat] ?an #aj days aft] ! specifi$ annual deadl9e1 ! ,secret>y removes ! borr[] f ! program "u ?is section & places ! borr[] on an alt]native repaym5t plan "u :i* ! borr[]'s requir$ mon?ly paym5t is ! am\nt necess>y to repay ! borr[]'s eligible loans 9 full )9 ! e>li] (-- 7,i7 #aj ye>s f ! date ! borr[] beg9s repaym5t "u ! alt]native repaym5t plan2 or 7,,ii7 ! end+ date ( ! #bj-ye> p]iod z describ$ 9 p>agraph 7#h77;,a77i77,,ii74 7ii7 ,notification ,if ! ,secret>y places ! borr[] on an alt]native repaym5t plan 9 accordance ) clause 7i71 ! ,secret>y s5ds ! borr[] a writt5 notification in=m+ ! borr[] t-- 7,i7 ! borr[] has be5 plac$ on an alt]native repaym5t plan2 7,,ii7 ! borr[]'s mon?ly paym5t am\nt has be5 recalculat$ "u clause 7i72 or 7,,iii7 ! borr[] may *ange to ano!r repaym5t plan 9 accordance ) section #dee7;d77#c74 7iii7 ,return to program ,a borr[] :o has be5 remov$ f ! program "u ?is section or *anges to ano!r repaym5t plan may return to ! program "u ?is section if ! borr[] provides ! docum5tation "u subp>agraph 7,a71 necess>y = ! ,secret>y to calculate ! borr[]'s curr5t mon?ly paym5t am\nt & ! mon?ly am\nt ! borr[] w\ld h be5 requir$ to pay "u ! program dur+ ! p]iod :5 ! borr[] 0 on ! alt]native repaym5t plan or any o!r repaym5t plan4 7iv7 ,adju/m5t ( mon?ly paym5t am\nt ,if ! ,secret>y det]m9es t ! total am\nt ( ! paym5ts ! borr[] 0 requir$ to make :ile on ! alt]native repaym5t plan or any o!r repaym5t plan are less ?an ! total am\nt ! borr[] w\ld h be5 requir$ to make "u ! program dur+ t p]iod1 ! ,secret>y w adju/ ! borr[]'s mon?ly paym5t am\nt to ensure t ! diff]5ce betwe5 ! two am\nts is paid 9 full by ! end ( ! #bj-ye> p]iod describ$ 9 p>agraph 7#h77;,a77i77,,ii74 7v7 ,application ( loan =giv5ess ,if ! borr[] returns to ! program "u ?is section or *anges to ! ,pay ,z ,y ,e>n ,repaym5t plan1 ! income-cont+5t repaym5t plan2 or ! income-bas$ repaym5t plan1 any paym5ts t ! borr[] made "u ! alt]native repaym5t plan aft] ! borr[] 0 remov$ f ! program "u ?is section w c\nt t[>ds =giv5ess "u su* program or su* o!r repaym5t plans4 7vi7 ,,pslf ,paym5ts made "u ! alt]native repaym5t plan describ$ 9 clause 7i7 w n c\nt t[>ds public s]vice loan =giv5ess "u section #dee7m74 7vii7 ,exception ,! ,secret>y does n take ! action describ$ 9 clause 7i7 if ! ,secret>y receives ! docum5tation describ$ 9 subp>agraph 7,a7 m ?an #aj days aft] ! specifi$ annual deadl9e1 b is able to det]m9e ! borr[]'s new mon?ly paym5t am\nt be=e ! end ( ! borr[]'s curr5t annual paym5t p]iod4 7viii7 ,mon?ly paym5t am\nt ,if ! ,secret>y receives ! docum5tation describ$ 9 subp>agraph 7,a7 )9 #aj days ( ! specifi$ annual deadl9e-- 7,i7 ! ,secret>y promptly det]m9es ! borr[]'s new s*$ul$ mon?ly paym5t am\nt & ma9ta9s ! borr[]'s curr5t s*$ul$ mon?ly paym5t am\nt until ! new s*$ul$ mon?ly paym5t am\nt is det]m9$2 7,,ii7 if ! new mon?ly paym5t am\nt is less ?an ! borr[]'s previ\sly calculat$ plan mon?ly paym5t am\nt1 & ! borr[] made paym5ts at ! previ\sly calculat$ am\nt aft] ! end ( ! mo/ rec5t annual paym5t p]iod-- 7aa7 ! ,secret>y makes ! appropriate adju/m5t to ! borr[]'s acc\nt2 & 7bb7 unless ! borr[] reque/s o!rwise1 ! ,secret>y applies ! excess paym5t am\nts made aft] ! end ( ! mo/ rec5t annual paym5t p]iod 9 accordance ) ! requirem5ts ( p>agraph 7#f77;,a72 7,,iii7 if ! new mon?ly paym5t am\nt is equal to or great] ?an ! borr[]'s previ\sly calculat$ mon?ly paym5t am\nt1 & ! borr[] made paym5ts at ! previ\sly calculat$ paym5t am\nt aft] ! end ( ! mo/ rec5t annual paym5t p]iod1 ! ,secret>y does n make any adju/m5t to ! borr[]'s acc\nt2 7,,iv7 any paym5ts t ! borr[] cont9u$ to make at ! previ\sly calculat$ paym5t am\nt aft] ! end ( ! prior annual paym5t p]iod & be=e ! new mon?ly paym5t am\nt is calculat$ are consid]$ to be qualify+ paym5ts = purposes ( public s]vice loan =giv5ess "u section #dee7m71 provid$ t ! paym5ts o!rwise meet ! requirem5ts describ$ 9 su* section #dee7m72 & 7,v7 ! new annual paym5t p]iod beg9s on ! day aft] ! end ( ! mo/ rec5t annual paym5t p]iod4 7#h7 ,loan =giv5ess 7,a7 ,9 g5]al 7i7 ,cancellation ,! ,secret>y cancels any rema9+ out/&+ balance ( pr9cipal & accru$ int]e/ on a borr[]'s loans made "u "p ,d t are be+ repaid "u ! program "u ?is section aft]-- 7,i7 ! borr[] has made ! equival5t ( #bdj qualify+ mon?ly paym5ts z def9$ 9 subp>agraph 7,b72 & 7,,ii7 #bj ye>s h elaps$1 beg9n+ on ! date det]m9$ 9 accordance ) subp>agraph 7,c74 7ii7 ,det]m9ation ,! ,secret>y det]m9es :5 a borr[] has met ! loan =giv5ess requirem5ts "u clause 7i7 & does n require ! borr[] to submit a reque/ = loan =giv5ess4 7,b7 ,qualify+ mon?ly paym5t def9$ 7i7 ,9 g5]al ,= purposes ( ?is p>agraph1 a qualify+ mon?ly paym5t is-- 7,i7 a mon?ly paym5t "u ! program "u ?is section1 includ+ a mon?ly paym5t am\nt ( #j4jj1 z provid$ "u p>agraph 7#b77;,c72 or 7,,ii7 a mon? dur+ :i* ! borr[] 0 n requir$ to make a paym5t due to receiv+ an economic h>d%ip def]m5t on 8 or h] eligible loans t are made "u "p ,d4 7ii7 ,default$ loans exclud$ ,any paym5ts made on a default$ loan are n qualify+ mon?ly paym5ts & are n c\nt$ t[>d ! #bj-ye> =giv5ess p]iod4 7,c7 ,det]m9ation ( beg9n+ date ,= a borr[] :o qualifies = ! program "u ?is section1 ! beg9n+ date = ! #bj-ye> repaym5t p]iod is-- 7i7 = a borr[] :o has an eligible ,f$]al ,direct ,consolidation ,loan1 ! date ! borr[] made a qualify+ mon?ly paym5t on ! consolidation loan1 be=e ! date ! borr[] qualifi$ = ! program "u ?is section2 7ii7 = a borr[] :o has "o or m o!r eligible ,direct ,loans1 ! date ! borr[] made a qualify+ mon?ly paym5t on t loan1 be=e ! date ! borr[] qualifi$ = ! program "u ?is section2 7iii7 = a borr[] :o did n make a qualify+ mon?ly paym5t "u clause 7i7 or 7ii71 ! date ! borr[] made a paym5t on ! loan "u ! program "u ?is section2 or 7iv7 if ! borr[] consolidates 8 or h] eligible loans1 ! date ! borr[] made a qualify+ mon?ly paym5t on ! ,f$]al ,direct ,consolidation ,loan4 7,d7 ,notification 7i7 ,prior to loan cancellation ,n lat] ?an #f mon?s prior to ! anticipat$ date t ! borr[] w meet ! =giv5ess requirem5ts1 ! ,secret>y s5ds ! borr[] a writt5 notice t includes-- 7,i7 an explanation t ! borr[] is approa*+ ! date t ! borr[] is expect$ to meet ! requirem5ts to receive loan =giv5ess2 7,,ii7 a rem9d] t ! borr[] mu/ cont9ue to make ! borr[]'s s*$ul$ mon?ly paym5ts2 & 7,,iii7 g5]al in=mation on ! curr5t treatm5t ( ! =giv5ess am\nt = tax purposes1 & in/ructions = ! borr[] to contact ! ,int]nal ,rev5ue ,s]vice = m in=mation4 7ii7 ,aft] loan cancellation ,aft] det]m9+ t a borr[] has satisfi$ ! loan =giv5ess requirem5ts1 ! ,secret>y-- 7,i7 notifies ! borr[] t ! borr[]'s obligation on ! loans is satisfi$2 7,,ii7 provides ! borr[] ) ! in=mation describ$ 9 clause 7i77,,iii72 & 7,,iii7 returns to ! s5d] any paym5t receiv$ on a loan aft] loan =giv5ess has be5 grant$4 4 #eji4 ,public s]vice loan =giv5ess ,section #dee7m77#b7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhg;e7m77#b77 is am5d$-- 7#a7 by /rik+ ,aft] & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,except z provid$ "u subp>agraph 7,b71 aft] 2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,und]graduate cap ,! ,secret>y %all n cancel "u ?is p>agraph an am\nt great] ?an #eg1ejj ( pr9cipal & int]e/ due on an eligible ,f$]al ,direct ,loan made to a borr[] = a program ( und]graduate education 4