#aad? ,,congress  #b;d ,session  ,h4 ,r4
 #efei  ,,an ,,act  ,to am5d title      
,,xviii ( ! ,social ,security ,act )    
respect to exp&+ ,m$ic>e ,advantage     
cov]age = individuals ) end-/age r5al   
disease 7,,esrd74  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,exp&+ ,s5iors     
,receiv+ ,dialysis ,*oice ,act ( #bjaf  
or z ! ,,esrd ,*oice ,act ( #bjaf4  #b4 
,exp&+ ,m$ic>e ,advantage cov]age =     
individuals ) end-/age r5al disease     
7,,esrd7  7a7 ,exp&$ ,,ma eligibility   
7#a7 ,9 g5]al ,section #ahea7;a77#c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#ba7;a77#c77 is am5d$--  7,a7 by 
/rik+ subp>agraph 7,b72 &  7,b7 by /rik+
 eligible individual & all t foll[s     
?r\gh ,9 ?is title1 subject to          
subp>agraph 7,b71 & ins]t+ eligible     
individual4--,9 ?is title14  7#b7       
,con=m+ am5dm5ts  7,a7 ,section         
#aheb7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bb7;b77#a77 is  
am5d$-- 7i7 by /rik+ subp>agraph 7,b72 &
  7ii7 by /rik+ ,b5efici>ies & all t    

foll[s ?r\gh ,a ,m$ic>e,*oice           
organization & ins]t+ ,b5efici>ies4--,a 
,m$ic>e ,advantage organization4  7,b7  
,section #ahei7;b77#f7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;b77#f77 is am5d$ by /rik+   
may waive & all t foll[s ?r\gh          
subp>agraph &4  7b7 ,exclud+ co/s =     
kidney acquisitions f ,,ma b5*m>k       
,section #ahec ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciew-#bc7 is      
am5d$-- 7#a7 9 subsection 7k7--  7,a7 9 
p>agraph 7#a7-- 7i7 9 ! matt] prec$+    
subp>agraph 7,a71 by /rik+ p>agraphs    
7#b7 & 7#d7 & ins]t+ p>agraphs 7#b71    
7#d71 & 7#e72 &  7ii7 9 subp>agraph     
7,b77i71 by /rik+ p>agraphs 7#b7 & 7#d7 
& ins]t+ p>agraphs 7#b71 7#d71 & 7#e72 &
  7,b7 by add+ at ! end ! foll[+ new    
p>agraph3  7#e7 ,exclusion ( co/s =     
kidney acquisitions f capitation rates  
,aft] det]m9+ ! applicable am\nt = an   
area = a ye> "u p>agraph 7#a7 7beg9n+ ) 
#bjai71 ! ,secret>y %all adju/ su*      
applicable am\nt to exclude f su*       

applicable am\nt ! ,secret>y's e/imate (
 ! /&>diz$ co/s = paym5ts = organ       
acquisitions = kidney transplants cov]$ 
"u ?is title 7includ+ exp5ses cov]$ "u  
section #ahha7;d77 9 ! area = ! ye>4  2 
&  7#b7 9 subsection 7n77#b7--  7,a7 9  
subp>agraph 7,a77i71 by ins]t+ &1 =     
#bjai & subsequ5t ye>s1 ! exclusion (   
paym5ts = organ acquisitions = kidney   
transplants f ! capitation rate z       
describ$ 9 subsection 7k77#e7 be=e !    
semicolon at ! end2  7,b7 9 subp>agraph 
7,e71 9 ! matt] prec$+ clause 7i71 by   
/rik+ subp>agraph 7,f7 & ins]t+         
subp>agraphs 7,f7 & 7,g72 &  7,c7 by    
add+ at ! end ! foll[+ new subp>agraph3 
7,g7 ,application ( kidney acquisitions 
adju/m5t ,! base paym5t am\nt specifi$ 9
 subp>agraph 7,e7 = a ye> 7beg9n+ )     
#bjai7 %all be adju/$ 9 ! same mann] "u 
p>agraph 7#e7 ( subsection 7k7 z !      
applicable am\nt is adju/$ "u su*       
subsection4  4  7c7 ,,ffs cov]age (     
kidney acquisitions  7#a7 ,9 g5]al      
,section #aheb7;a77#a77;,b77i7 ( !      

,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bb7;a77#a77;,b77i77 is am5d$ by 
ins]t+ or cov]age = organ acquisitions =
 kidney transplants1 includ+ z cov]$ "u 
section #ahha7;d7 aft] hospice c>e4     
7#b7 ,con=m+ am5dm5t ,section #ahea7;i7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#ba7;i77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#c7 ,,ffs paym5t = exp5ses = kidney    
acquisitions ,p>agraphs 7#a7 & 7#b7 d n 
apply ) respect to exp5ses = organ      
acquisitions = kidney transplants       
describ$ 9 section                      
#aheb7;a77#a77;,b77i74  4  7d7 ,s5se (  
,congress reg>d+ application (          
appropriate ,m$ic>e ,advantage risk     
adju/m5t = paym5t = increas$ ,,esrd     
enrollees ,x is ! s5se ( ,congress t 9  
implem5t+ ! policies "u ?is section1 !  
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices %\ld
 provide1 9 an accurate & transp>5t     
mann]1 = risk adju/m5t to paym5t "u !   
,m$ic>e ,advantage program to acc\nt = !
 increas$ enrollm5t 9 ,m$ic>e ,advantage

 plans ( individuals ) end-/age r5al    
disease4  7e7 ,exp&$ ,,ma education     
,section #ahea7;d77#b77;,a77iii7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba7;d77#b77;,a77iii77 is am5d$  
by ins]t+ be=e ! p]iod at ! end !       
foll[+3 1 includ+ any additional        
in=mation t individuals det]m9$ to h    
end-/age r5al disease may ne$ to make   
in=m$ decisions ) respect to su* an     
election4  7f7 ,report ,n lat] ?an      
,april #a1 #bjbb1 ! ,adm9i/rator ( !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices %all
 submit to ,congress a report on !      
impact ( ! am5dm5ts made by ?is section 
on sp5d+ "u ! traditional ,m$ic>e       
fee-=-s]vice program "u p>ts ,a & ,b (  
title ,,xviii ( ! ,social ,security ,act
 z well z on sp5d+ "u p>ts ,c & ,d ( su*
 title4 ,! report %all include an       
assessm5t ( ! risk adju/m5t paym5t      
me?odologies "u su* p>ts ,c & ,d & _!   
adequacy ) respect to individuals )     
end-/age r5al disease & su*             
recomm5dations z ! ,adm9i/rator deems   

appropriate4  7g7 ,effective date ,!    
am5dm5ts made by ?is section %all apply 
to plans ye>s beg9n+ on or aft] ,janu>y 
#a1 #bjbj4  ,pass$ ! ,h\se (            
,repres5tatives ,septemb] #ba1          
#bjaf4;,cl]k4