,i  #aad? ,,congress  #b;d ,session  ,h4
 ,r4 #ehda  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #ad1 #bjaf,mr4  
,kelly ( ,p5nsylvania 7= himself & ,mr4 
,neal7 introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = 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 am5d title      
,,xviii ( ! ,social ,security ,act to   
e/abli% a population bas$ paym5t        
demon/ration project "u :i* ,pati5t ,c>e
 ,networks are paid prospective mon?ly  
capitat$ paym5ts = coord9at$ c>e furni%$
 to ,m$ic>e b5efici>ies4  #a4           
,population ,bas$ ,paym5t ,demon/ration 
,project ,title ,,xviii ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #aciex et 
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #ahii;,c4 ,population    
,bas$ ,paym5t ,demon/ration ,project    
7a7 ,9 g5]al ,beg9n+ n lat] ?an ,janu>y 

#a1 #bjag1 ! ,secret>y %all e/abli% a   
#e-ye> ,population ,bas$ ,paym5t        
,demon/ration ,project 79 ?is section   
ref]r$ to z ! demon/ration project7 to  
promote effici5cy ( c>e & improve heal? 
outcomes = ,m$ic>e fee-=-s]vice         
b5efici>ies 7z def9$ 9 subsection 7m774 
,"u ! demon/ration project1 provid]s (  
s]vices & suppli]s may1 9 accordance ) !
 subsequ5t subsections ( ?is section1 =m
 ,pati5t ,c>e ,networks 79 ?is section  
ref]r$ to z ,p,c,ns7--  7#a7 ?r\gh :i*  
provid]s ( s]vices & suppli]s %all      
furni% items & s]vices = :i* paym5t w\ld
 o!rwise be made "u p>ts ,a & ,b to     
p>ticipat+ b5efici>ies1 z def9$ 9       
subsection 7m72  7#b7 :i* %all1 )       
respect to p>ticipat+ b5efici>ies ( su* 
,,pcn1 provide = paym5t1 9 accordance ) 
subsection 7b77#b77;,c71 = all items &  
s]vices = :i* paym5t w\ld o!rwise be    
made "u p>ts ,a & ,b furni%$ to su*     
b5efici>ies2 &  7#c7 to :i* ! ,secret>y 
%all prospectively make1 in/ead ( any   
o!r paym5t t w\ld o!rwise be made "u su*

 p>ts = su* items & s]vices furni%$ to  
su* p>ticipat+ b5efici>ies1 capitat$    
paym5ts 9 accordance ) subsection 7d71 =
 ea* mon? dur+ a ye> = :i* ! ,,pcn      
p>ticipates 9 ! demon/ration project =  
all su* items & s]vices furni%$ to su*  
p>ticipat+ b5efici>ies4  7b7 ,pati5t    
,c>e ,networks  7#a7 ,eligible ,p,c,ns  
,subject to ! succe$+ provisions ( ?is  
subsection1 z det]m9$ appropriate by !  
,secret>y1 a gr\p compos$ ( at lea/ !   
foll[+ provid]s ( s]vices & suppli]s :i*
 has e/abli%$ a me*anism = %>$ gov]nance
 is eligible to ent] into agreem5t "u   
p>agraph 7#b7 to p>ticipate z a ,,pcn "u
 ! demon/ration program "u ?is section3 
7,a7 ,physicians 7z def9$ 9 section     
#ahfa7r77#a77 & practition]s 7z describ$
 9 section #ahdb7;b77#ah77;,c77i77 9    
gr\p practice arrangem5ts4  7,b7 ,at    
lea/ "o hospital4  7,c7 ,f$]ally        
qualifi$ heal? c5t] 7z def9$ 9 section  
#ahfa7;aa77#d774  7,d7 ,su* o!r provid]s
 ( s]vices & suppli]s z ! ,secret>y     
det]m9es appropriate4  7#b7 ,requirem5ts

 ,a ,,pcn %all meet ! foll[+ requirem5ts
 to p>ticipate 9 ! demon/ration project3
  7,a7 ,! ,,pcn %all be an integrat$    
sy/em ( c>e :i* directly provides items 
& s]vices "u p>ts ,a & ,b4  7,b7 ,!     
,,pcn %all employ & ent] into           
appropriate contractual arrangem5ts--   
7i7 ) a suffici5t numb]1 z det]m9$ by ! 
,secret>y1 ( prim>y c>e physicians to   
furni% items & s]vices describ$ 9       
subp>agraph 7,a7 to at lea/ tw5ty ?\s&  
p>ticipat+ b5efici>ies2 &  7ii7 agree to
 ent] into appropriate contractual      
arrangem5ts to e/abli% a network (      
provid]s ( s]vices & suppli]s to provide
 suffici5t access = p>ticipat+          
b5efici>ies ) respect to su* ,,pcn to   
items & s]vices = :i* paym5t may o!rwise
 be made "u p>ts ,a & ,b4  7,c7 ,! ,,pcn
 %all1 subject to p>agraph 7#e71 be     
responsible =-- 7i7 paym5t to provid]s (
 s]vices & suppli]s p>ticipat+ 9 or     
o!rwise ent]+ into agreem5ts ) ! ,,pcn =
 items & s]vices furni%$ to p>ticipat+  
b5efici>ies ) respect to su* ,,pcn1 9   

su* am\nts z specifi$ by ! ,,pcn = su*  
items & s]vices2 &  7ii7 paym5t to      
provid]s ( s]vices & suppli]s n describ$
 9 clause 7i7 = items & s]vices furni%$ 
to p>ticipat+ b5efici>ies ) respect to  
su* ,,pcn1 9 su* am\nts z specifi$ by ! 
,,pcn = su* items & s]vices furni%$ by a
 provid] ( s]vices or suppli] t is      
describ$ 9 su* clause4  7,d7 ,! ,,pcn   
%all be will+ to become acc\ntable = !  
quality1 co/1 & ov]all c>e ( p>ticipat+ 
b5efici>ies ) respect to su* ,,pcn4     
7,e7 ,! ,,pcn %all ent] into an agreem5t
 ) ! ,secret>y "u p>agraph 7#c74  7,f7  
,! ,,pcn %all h a =mal legal /ructure t 
w\ld all[ ! organization to receive &   
di/ribute paym5ts made to ! ,,pcn "u    
subsection 7d7 to p>ticipat+ provid]s ( 
s]vices & suppli]s4  7,g7 ,! ,,pcn %all 
provide ! ,secret>y ) su* in=mation     
reg>d+ provid]s ( s]vices & suppli]s    
p>ticipat+ 9 ! ,,pcn z ! ,secret>y      
det]m9es necess>y to support ! assignm5t
 ( ,m$ic>e fee-=-s]vice b5efici>ies to a
 ,,pcn1 ! implem5tation ( quality       

requirem5ts "u subsection 7f71 o!r      
report+ requirem5ts1 & ! det]m9ation (  
paym5ts to ! ,,pcn "u subsection 7d74   
7,h7 ,! ,,pcn %all h 9 place a lead]%ip 
& managem5t /ructure t includes cl9ical 
& adm9i/rative sy/ems4  7,i7 ,! ,,pcn   
%all provide = b5efici>y protections =  
,m$ic>e fee-=-s]vice b5efici>ies        
p>ticipat+ 9 su* ,,pcn "u !             
demon/ration1 includ+ ) respect to      
network adequacy1 appeals rights1 &     
out-(-pocket co/s4  7#c7 ,p>ticipation  
agreem5t  7,a7 ,9 g5]al ,ea* ,,pcn t    
applies = p>ticipation 9 ! demon/ration 
project & is approv$ = su* p>ticipation 
by ! ,secret>y %all ent] into an        
agreem5t ) ! ,secret>y to p>ticipate 9 !
 demon/ration project = at lea/ #c ye>s4
 ,"u su* agreem5t1 ! ,secret>y may      
require a ,,pcn to demon/rate1 ?r\gh    
f9ancial in/rum5ts includ+ surety bonds1
 l9es ( cr$it1 or o!r means1 suffici5t  
f9ancial res\rces 9 ord] to meet        
reasonably anticipat$ obligations t w\ld
 arise z a result ( p>ticipation 9 !    

demon/ration project4  7,b7 ,r5ewal ,an 
agreem5t "u subp>agraph 7,a7 may be     
r5ew$ or ext5d$ by mutual agreem5t ( !  
,,pcn & ! ,secret>y = up to a total ( #e
 ye>s4  7,c7 ,t]m9ation ,! ,secret>y may
 t]m9ate an agreem5t "u ?is p>agraph ) a
 ,,pcn be=e ! end ( ! t]m ( ! agreem5t  
if ! ,,pcn fails to meet m9imum quality 
/&>ds e/abli%$ by ! ,secret>y pursuant  
to subsection 7f7 or = any o!r reason   
specifi$ by ! ,secret>y4  7#d7 ,treatm5t
 ( entities 9 exi/+ agreem5ts ,an       
organization ( provid]s ( s]vices &     
suppli]s t w\ld o!rwise be a ,,pcn      
eligible to p>ticipate 9 ! demon/ration 
project1 b t has ent]$ into ano!r       
agreem5t ) ! ,secret>y t involves %>$   
sav+s "u ?is title & includes d[nside   
risk may elect to apply "u p>agraph 7#c7
 to transition f su* o!r agreem5t into  
an agreem5t ) ! ,secret>y "u p>agraph   
7#c7 to p>ticipate 9 ! demon/ration     
project "u ?is section4 ,any su*        
organization t transitions "u ?is       
p>agraph to ! demon/ration project "u   

?is section %all d s 9 a mann] t is     
consi/5t ) any transition provisions z !
 ,secret>y may specify4  7#e7 ,co/-%>+  
7,a7 ,9 g5]al ,"u ! demon/ration        
project1 co/-%>+ t w\ld o!rwise apply ) 
respect to an item or s]vice "u ?is     
title %all apply ) respect to su* item  
or s]vice furni%$ ?r\gh a ,,pcn1 except 
to ! ext5t su* ,,pcn may modify su*     
co/-%>+ pursuant to a waiv] "u          
subsection 7h7 & subp>agraph 7,b74  7,b7
 ,secret>ial approval ,! ,secret>y %all 
e/abli% a process "u :i* a ,,pcn        
p>ticipat+ "u ! demon/ration program may
 apply to ! ,secret>y = a waiv] "u      
subsection 7h7 9 ord] to modify co/-%>+ 
= items & s]vices furni%$ ?r\gh su*     
,,pcn "u ! demon/ration program4  7c7   
,b5efici>y assignm5t  7#a7 ,assignm5t to
 ,,pcn  7,a7 ,9 g5]al ,^u ent]+ 9 a     
contract ) a ,,pcn "u subsection        
7b77#c71 ! ,secret>y %all e/abli% a     
process to1 ) respect to ea* ye> dur+ ! 
demon/ration project1 prospectively     
assign ,m$ic>e fee-=-s]vice b5efici>ies 

to su* ,,pcn = su* ye>4 ,su* assignm5t  
%all be bas$ on utilization ( prim>y c>e
 s]vices furni%$ "u ?is title by a      
provid] ( s]vices or suppli] p>ticipat+ 
9 ! ,,pcn involv$4  7,b7 ,selection ,!  
,secret>y %all all[ ,p,c,ns to e/abli% a
 pilot program "u :i* su* ,p,c,ns h a   
process ?r\gh :i* ,m$ic>e fee-=-s]vice  
b5efici>ies may select a ,,pcn4 ,su*    
selection by ! b5efici>y %all be treat$ 
= purposes ( ?is section z ! assignm5t (
 ! b5efici>y to ! ,,pcn & %all sup]c$e  
any o!r assignm5t by ! ,secret>y "u     
subp>agraph 7,a7 ) respect to su*       
b5efici>y4  7,c7 ,opt out ,! process "u 
p>agraph 7#a7 %all all[ = ,m$ic>e       
fee-=-s]vice b5efici>ies to opt out (   
?is section4  7#b7 ,prim>y c>e physician
 assignm5t ,^u assignm5t "u p>agraph    
7#a7 ( a ,m$ic>e fee-=-s]vice b5efici>y 
to a ,,pcn1 ! ,secret>y %all all[ !     
,,pcn to contact ! b5efici>y to         
designate a prim>y c>e physician        
p>ticipat+ 9 ! ,,pcn :o %all be         
acc\ntable = ! coord9ation ( ! m$ical   

c>e ( ! b5efici>y4 ,! ,secret>y %all    
also all[ ! ,,pcn to communicate ) o!r  
individuals entitl$ to b5efits "u "p ,a 
or enroll$ "u "p ,b 9 ! region s]v$ by !
 ,,pcn reg>d+ ! opportunity to          
p>ticipate 9 ? ,,pcn4 ,! ,secret>y %all 
promulgate regulations to gov]n !       
assignm5t ( an individual to a prim>y   
c>e physician p>ticipat+ 9 ! ,,pcn 9 !  
abs5ce ( su* designation by ! individual
 9 a mann] t promotes pati5t engagem5t &
 /ability 9 assignm5t & t takes into    
acc\nt prim>y c>e visits by physicians1 
nurse practition]s1 & physician         
assi/ants4  7#c7 ,paym5ts ) respect to  
population ,except 9 circum/ances       
specifi$ by ! ,secret>y1 dur+ ! p]iod = 
:i* a ,m$ic>e fee-=-s]vice b5efici>y is 
a p>ticipat+ b5efici>y ) respect to a   
,,pcn "u ?is section1 paym5t may n be   
made "u "p ,a or ,b ) respect to su*    
b5efici>y o!r ?an "u ?is section4  7#d7 
,s]vices f out-(-,,pcn provid]s  7,a7 ,9
 g5]al ,9 ! case ( an item or s]vice    
cov]$ "u ! demon/ration project :i* is  

furni%$ to a p>ticipat+ b5efici>y1 )    
respect to a ,,pcn1 dur+ ! p]iod 9 :i* !
 b5efici>y is p>ticipat+ 9 su* ,,pcn "u 
! demon/ration project f a provid] (    
s]vices or suppli] n p>ticipat+ 9 or    
o!rwise ent]+ into an agreem5t ) ! ,,pcn
 ) respect to su* item or s]vice 79 ?is 
p>agraph ref]r$ to z an out-(-network   
provid]1 ) respect to su* ,,pcn71 9     
addition to any co/-%>+ responsibility  
specifi$ by ! ,,pcn1 ! b5efici>y %all be
 responsible = any am\nt by :i*--  7i7 !
 am\nt payable "u "p ,a or ,b = su* item
 or s]vice2 exce$s  7ii7 ! paym5t am\nt 
t w\ld be paid by ! ,,pcn = su* item or 
s]vice if su* item or s]vice 7 furni%$  
by a provid] ( s]vices or suppli] :o is 
p>ticipat+ 91 or o!rwise has an agreem5t
 )1 ! ,,pcn ) respect to su* item or    
s]vice4  7,b7 ,reimbursem5t by ,,pcn    
7i7 ,9 g5]al ,9 apply+ ?is p>agraph1 !  
,secret>y %all ensure t an out-(-network
 provid]1 ) respect to a ,,pcn t        
furni%es an item or s]vice to a         
p>ticipat+ b5efici>y1 ) respect to su*  

,,pcn1 is reimburs$ by ! ,,pcn 9 su* a  
mann] t avoids fraud & duplication (    
paym5t4 ,= purposes ( ! previ\s s5t5ce1 
! ,secret>y %all e/abli% a process by   
:i* su* a provid] may e/abli% a         
contractual relation%ip ) a ,,pcn =     
reimbursem5t1 subject to clause 7ii71 = 
items & s]vices furni%$ to p>ticipat+   
b5efici>ies1 ) respect to su* ,,pcn4    
7ii7 ,limitation ,any out-(-network     
provid]1 ) respect to a ,,pcn1 may n be 
reimburs$ by ! ,,pcn = an item or s]vice
 by an am\nt t is m ?an #ij p]c5t ( !   
am\nt t w\ld o!rwise be payable = su*   
item or s]vice "u "p ,a or "p ,b1 z     
applicable4  7d7 ,calculation (         
population heal? budgets & paym5ts to   
,p,c,ns  7#a7 ,calculation ( ,population
 ,heal? ,budgets ,"u ! demon/ration     
project1 ! ,secret>y %all calculate     
,,pcn specific mon?ly prospective       
population heal? budgets to ,p,c,ns z   
foll[s3  7,a7 ,base annual population   
heal? budget ,subject to subp>agraph    
7,c71 ! ,secret>y %all calculate a base 

annual prospective population heal?     
budget = ea* ,,pcn1 :i* %all be ! actual
 annual p] capita total co/s payable "u 
p>ts ,a & ,b dur+ ! ye> prior to ! fir/ 
ye> ( ! demon/ration project            
attributable to all individuals enroll$ 
"u ,m$ic>e fee-=-s]vice4  7,b7 ,,pcn    
specific population heal? budget        
,subject to subp>agraphs 7,c7 & 7,d71 = 
ea* ye> = :i* a ,,pcn p>ticipates "u !  
demon/ration project1 ! ,secret>y %all  
calculate ! ,,pcn specific prospective  
population heal? budget = ! ,,pcn by--  
7i7 adju/+ ! base annual prospective    
population heal? budget "u subp>agraph  
7,a7 = su* ye> = b5efici>y *>act]i/ics  
7includ+ age1 g5d]1 & heal? /atus7 ( !  
p>ticipat+ b5efici>ies ) respect to su* 
,,pcn & ! geographic factors ) respect  
to su* ,,pcn2  7ii7 updat+ su* budget   
annually to acc\nt = *anges 9           
population2  7iii7 updat+ su* budget by 
! project$ gr[? 9 p>ts ,a & ,b s]vices  
"u ! orig9al ,m$ic>e fee-=-s]vice       
program1 z e/imat$ by ! ,secret>y2 &    

7iv7 multiply+ su* budget by ! numb] (  
p>ticipat+ b5efici>ies acc\nt$ = 9 !    
previ\s paym5t ye> 9 ! ,,pcn s]vice     
area4  7,c7 ,non-application ( c]ta9    
provisions ,9 calculat+ ! base annual   
population heal? budget "u subp>agraph  
7,a7 & ! ,,pcn specific population heal?
 budgets "u subp>agraph 7,b71           
subsections 7p7 & 7q7 ( section #ahhf   
%all n be tak5 into acc\nt4  7,d7       
,limitations  7i7 ,initial #c ye>s ,!   
,,pcn specific prospective population   
heal? budgets "u subp>agraph 7,b7 = all 
,p,c,ns %all be e/abli%$ 9 a mann] t w  
result 9 total exp5ditures "u ?is       
section be+--  7,i7 = ! fir/ ye> ( !    
demon/ration project1 n m ?an #ii p]c5t 
( ! total exp5ditures "u p>ts ,a & ,b t 
o!rwise w\ld h be5 exp5d$ = su*         
p>ticipat+ b5efici>ies = su* ye>1 z     
prospectively e/imat$ by ! ,secret>y2 & 
7,,ii7 = ! second & ?ird ye>s ( !       
demon/ration project1 n less ?an #ig    
p]c5t ( ! total exp5ditures "u p>ts ,a &
 ,b t o!rwise w\ld h be5 exp5d$ = su*   

p>ticipat+ b5efici>ies = ! ye>1 z       
prospectively e/imat$ by ! ,secret>y4   
7ii7 ,subsequ5t ye>s ,! ,secret>y may   
e/abli% a g5]ally applicable sav+s      
b5*m>k = all ,p,c,ns 9 ! demon/ration   
project = any ye> subsequ5t to ! ?ird   
ye> ( ! demon/ration project1 provid$ t 
9 e/abli%+ su* b5*m>k ! ,secret>y %all n
 recapture ! sav+s reta9$ by ,p,c,ns 9  
prior ye>s 9 any mann]4  7#b7 ,paym5ts  
to ,p,c,ns  7,a7 ,9 g5]al ,= ea* mon? ( 
ea* ye> a ,,pcn p>ticipates 9 !         
demon/ration project1 ! ,secret>y %all  
pay ea* ,,pcn a prospective1 mon?ly     
paym5t equal to "o-twelf? ( ! ,,pcn     
specific population heal? budget "u     
p>agraph 7#a77;,b7 calculat$ = su* ,,pcn
 = su* ye>4 ,9 c>ry+ out ! previ\s      
s5t5ce1 any paym5t s made %all be made  
to ! ,,pcn & n to a provid] ( s]vices or
 suppli] p>ticipat+ 9 su* ,,pcn4  7,b7  
,special circum/ances ,! ,secret>y %all 
id5tify special circum/ances 9 :i*      
paym5t may be made "u p>ts ,a & ,b )    
respect to a p>ticipat+ b5efici>y o!r   

?an "u ?is section4 ,! ,secret>y %all   
ensure t ea* ,,pcn e/abli%es a me*anism 
= reimbursem5t & budget adju/m5t 9 !    
case ( su* special circum/ances         
attributable to p>ticipat+ b5efici>ies &
 a me?od = adju/+ ! ,,pcn specific      
prospective population heal? budgets to 
! ,p,c,ns involv$ 9 su* cases to acc\nt 
= paym5ts made "u p>ts ,a & ,b 9 su*    
circum/ances = su* p>ticipat+           
b5efici>ies to provid]s ( s]vices &     
suppli]s t are n p>ticipat+ 9 7or       
contract+ )7 ! ,,pcn involv$4  7e7 ,data
 %>+ ,! ,secret>y %all promptly provide 
necess>y data on a regul> basis to a    
,,pcn1 includ+ ea* claim = items &      
s]vices = :i* paym5t may be made "u p>ts
 ,a1 ,b1 & ,d associat$ ) p>ticipat+    
b5efici>ies ( su* ,,pcn1 to enable !    
coord9ation ( c>e = p>ticipat+          
b5efici>ies ) respect to su* ,,pcn4  7f7
 ,quality reports ,! ,secret>y %all     
e/abli% p]=mance /&>ds 7& a me?od to    
assess ! p]=mance ( ,p,c,ns ) respect to
 su* quality /&>ds7 to assess ! quality 

( c>e furni%$ by ,p,c,ns4 ,su* assessm5t
 %all initially be bas$ on ! quality    
measures us$ = organizations t h ent]$  
into %>$ sav+s agreem5ts pursuant to    
sections #aaae;,a & #ahii4 ,! ,secret>y 
%all seek to improve ! quality ( c>e    
furni%$ by ,p,c,ns ov] "t by specify+   
high] /&>ds1 new measures1 or bo? =     
purposes ( assess+ su* quality ( c>e4   
7g7 ,coord9ation ,! ,secret>y may1 9 su*
 mann] & accord+ to su* me?ods z        
specifi$ by ! ,secret>y1 coord9ate !    
activities ( ,p,c,ns ) respect to cov]$ 
"p ,d drugs 9 ord] to increase ! quality
 & availability ( heal? c>e items or    
s]vices to p>ticipat+ b5efici>ies & may 
elect to contract ) ,p,c,ns to provide  
prescription drug cov]age4  7h7 ,waiv]  
au?ority ,! ,secret>y %all waive su*    
requirem5ts ( sections #aabh;,a &       
#aabh;,b ( ?is title z may be necess>y  
to c>ry out ! provisions ( ?is section4 
,su* waiv]s %all include1 )\t           
limitation1 a waiv] ( prohibition on    
b5efici>y inducem5ts 9 ! =m ( co-pay    

waiv]s1 m$ical transportation1 provision
 ( tele-heal? & m$ical monitor+ equipm5t
 = home use1 contracts ) provid]s (     
s]vices & suppli]s p>ticipat+ 9 ! ,,pcn1
 & waiv]s all[+ ! provision ( o!r       
supplies & s]vices t p]mit ! effici5t   
deliv]y ( c>e 9 home1 po/-acute1 &      
alt]native sett+s4 ,any waiv]s e/abli%$ 
pursuant to section #ahii7;f7 %all also 
apply to ! demon/ration project4  7i7   
,adm9i/ration ,*apt] #ce ( title #dd1   
,unit$ ,/ates ,code1 %all n apply to !  
demon/ration project4  7j7 ,/ate        
insurance laws2 preemption ,a ,,pcn %all
 n be requir$ to be lic5s$ z a heal?    
insurance company or heal? ma9t5ance    
organization "u ! laws ( any ,/ate4 ,any
 ,/ate law t w\ld und]m9e ! purpose (   
?is section is preempt$4  7k7 ,reports  
to congress ,! ,secret>y %all = ea* ye> 
( ! demon/ration project submit to      
,congress a report on ! /atus & results 
( ! demon/ration project4  7l7          
,expansion ( project ,! ,secret>y may1  
?r\gh rulemak+1 exp& 7includ+           

implem5tation on a nationwide basis7 !  
duration & ! scope ( ! demon/ration     
project1 to ! ext5t det]m9$ appropriate 
by ! ,secret>y1 if--  7#a7 ! ,secret>y  
det]m9es t su* expansion is expect$ to--
 7,a7 r$uce sp5d+ "u ?is title )\t r$uc+
 ! quality ( c>e2 or  7,b7 improve !    
quality ( pati5t c>e )\t increas+ sp5d+2
  7#b7 ! ,*ief ,actu>y ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices c]tifies t   
su* expansion w\ld r$uce 7or w\ld n     
result 9 any increase 97 net program    
sp5d+ "u ?is title2 &  7#c7 ! ,secret>y 
det]m9es t su* expansion w\ld n d5y or  
limit ! cov]age or provision ( b5efits  
"u ! applicable title = applicable      
individuals4  7m7 ,def9itions ,9 ?is    
section3 7#a7 ,! t]m hospital means a   
subsection 7d7 hospital 7z def9$ 9      
section #ahhf7;d77#a77;,b774  7#b7 ,!   
t]m ,m$ic>e fee-=-s]vice b5efici>y has !
 mean+ giv5 su* t]m 9 section           
#ahii7;h77#c74  7#c7 ,! t]m p>ticipat+  
b5efici>y means1 ) respect to a ,,pcn1 a
 ,m$ic>e fee-=-s]vice b5efici>y :o has  

be5 assign$ "u subsection 7c7 to su*    
,,pcn4  4