,,ii  #aad? ,,congress  #a/ ,session    
,s4 #bajd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #cj1 #bjae   
,mr4 ,portman 7= himself & ,mr4 ,casey7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide relief to ,m$ic>e ,advantage    
plans ) a significant numb] ( dually    
eligible or l[-income subsidy           
b5efici>ies & to prev5t ! t]m9ation (   
two /> plans4  #a4 ,%ort title  ,?is    
,act may be cit$ z ! ,pres]v+ ,m$ic>e   
,advantage = all ,m$ic>e ,b5efici>ies   
,act ( #bjae4  #b4 ,f9d+s ,congress     
makes ! foll[+ f9d+s3 7#a7 ,9 ! ,,impact
 ,act ( #bjad 7,public ,law #aac-ahe71  
,congress recogniz$ ! pot5tial effects (
 socioeconomic /atus & dual eligible    
populations on ! ,m$ic>e ,advantage     
,,/>s rat+ sy/em by reque/+ ! ,assi/ant 
,secret>y ( ,plann+ & ,evaluation 9 !   
,dep>tm5t ( ,heal? & ,human ,s]vices    
und]take /udies on ?is population & !   

,m$ic>e program4  7#b7 ,/udies publi%$ 9
 ! pa/ ye> h %[n ! ne$ = an int]im      
policy until ! compreh5sive results ( ! 
/udies und]tak5 z "p ( ! ,,impact ,act (
 #bjad are publi%$4 ,an adju/m5t = #bjaf
 is necess>y :ile ,congress cont9ues to 
"w to a*ieve an appropriate policy = a  
tempor>y bridge until ! results f !     
/udies und]tak5 by ! ,assi/ant ,secret>y
 ( ,plann+ & ,evaluation 9 ! ,dep>tm5t (
 ,heal? & ,human ,s]vices "u su* ,act   
are f9aliz$4  #c4 ,delay 9 au?ority to  
t]m9ate contracts = c]ta9 m$ic>e        
advantage plans fail+ to a*ieve m9imum  
quality rat+s ,section #aheg7;h7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bg7;h77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#c7 ,delay 
9 contract t]m9ation au?ority = c]ta9   
plans fail+ to a*ieve m9imum quality    
rat+  7,a7 ,9 g5]al ,subject to         
subp>agraph 7,b71 ! ,secret>y may n     
t]m9ate a contract "u ?is section )     
respect to ! (f]+ ( an ,,ma plan by a   
,m$ic>e ,advantage organization solely  

because ! ,,ma plan has fail$ to a*ieve 
a m9imum quality rat+ "u ! #e-/> rat+   
sy/em e/abli%$ "u section #ahec7o7 dur+ 
! p]iod beg9n+ on ! date ( ! enactm5t ( 
?is p>agraph & ?r\gh ! end ( plan ye>   
#bjah4  7,b7 ,application only to plans 
receiv+ a quality rat+ ( at lea/ #b />s 
,subp>agraph 7,a7 %all only apply )     
respect to a contract ) respect to !    
(f]+ ( an ,,ma plan t has a quality rat+
 "u section #ahec7o77#d7 ( at lea/ #b   
/>s = ! mo/ rec5t plan ye>4  4  #d4     
,demon/ration project to direct quality 
improvem5t programs to address          
socioeconomic /atus disp>ities 9 ,m$ic>e
 ,advantage plans  7a7 ,e/abli%m5t  7#a7
 ,9 g5]al ,! ,secret>y ( ,heal? & ,human
 ,s]vices 79 ?is section ref]r$ to z !  
,secret>y7 %all e/abli% a demon/ration  
project "u ?is section to provide funds 
to ,,ma organizations (f]+ "o or m      
qualifi$ ,,ma plans = use 9 develop+ or 
exp&+ programs or s]vices ) respect to  
su* plans t seek to improve heal? c>e   
deliv]y & outcomes ( c>e = enrollees )  

l[ socioeconomic /atus4  7#b7 ,duration 
,! demon/ration project "u ?is section  
%all be conduct$ = a p]iod ( #a ye>     
beg9n+ 9 plan ye> #bjaf4  7b7           
,def9itions ,9 ?is section3 7#a7 ,,ma   
organization2 ,,ma plan ,! t]ms ,,ma    
organization & ,,ma plan h ! mean+ giv5 
su* t]ms 9 subsections 7a77#a7 &        
7b77#a71 respectively1 ( section #ahei (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#bh74  7#b7 ,qualifi$ ,,ma plan 
7,a7 ,! t]m qualifi$ ,,ma plan means an 
,,ma plan describ$ 9 subp>agraph 7,b7 or
 7,c74  7,b7 ,an ,,ma plan is describ$ 9
 ?is subp>agraph if ! ,,ma plan meets   
ea* ( ! foll[+ crit]ia3  7i7 ,! plan has
 a quality rat+ "u section #ahec7o77#d7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bc7o77#d77 ( at lea/  
#c4be />s b n m ?an #d />s = ! mo/ rec5t
 plan ye>4  7ii7 ,n less ?an #de p]c5t (
 enrollees 9 ! plan are "o or bo? ( !   
foll[+3 7,i7 ,eligible = a l[ income    
subsidy "u section #ahfj;,d-#ad ( su*   
,act 7#db ,u4,s4,c4 #aciew-#aad74       

7,,ii7 ,dually eligible = b5efits "u !  
,m$ic>e program "u title ,,xviii ( su*  
,act 7#db ,u4,s4,c4 #acie et seq47 & !  
,m$icaid program "u title ,,xix ( su*   
,act 7#db ,u4,s4,c4 #acif et seq474     
7,c7 ,an ,,ma plan is describ$ 9 ?is    
subp>agraph if ! ,,ma plan meets ea* ( !
 foll[+ crit]ia3 7i7 ,! plan has a      
quality rat+ "u section #ahec7o77#d7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bc7o77#d77 ( at lea/ #c4j />s b 
n m ?an #d />s = ! mo/ rec5t plan ye>4  
7ii7 ,n less ?an #fj p]c5t ( enrollees 9
 ! plan are "o or bo? ( ! foll[+3 7,i7  
,eligible = a l[ income subsidy "u      
section #ahfj;,d-#ad ( su* ,act 7#db    
,u4,s4,c4 #aciew-#aad74  7,,ii7 ,dually 
eligible = b5efits "u ! ,m$ic>e program 
"u title ,,xviii ( su* ,act 7#db        
,u4,s4,c4 #acie et seq47 & ! ,m$icaid   
program "u title ,,xix ( su* ,act 7#db  
,u4,s4,c4 #acif et seq474  7c7 ,use (   
funds  7#a7 ,9 g5]al ,subject to        
p>agraph 7#b71 funds receiv$ "u !       
demon/ration project by an ,,ma         

organization ) respect to a qualifi$    
,,ma plan %all be us$ "u ! ,quality     
,improvem5t ,program ( ! organization "u
 section #aheb7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bb7;e77 to 
t>get improvem5t by ! qualifi$ ,,ma plan
 ) respect to two or m triple-weight$   
measures "u ! #e-/> rat+ sy/em "u       
section #ahec7o77#d7 ( su* ,act 7#db    
,u4,s4,c4 #aciew-#bc7o77#d774  7#b7     
,focus on outcome measure  7,a7 ,9 g5]al
 ,except z provid$ 9 subp>agraph 7,b71  
at lea/ "o ( ! measures t>get$ "u       
p>agraph 7#a7 %all be an outcome        
measure4  7,b7 ,exception ,an ,,ma      
organization may apply to ! ,secret>y = 
an exception to subp>agraph 7,a7 9 ord] 
to focus on only process measures "u ?is
 subsection4  7d7 ,inclusion 9 annual   
quality improvem5t program report ,an   
,,ma organization receiv+ funds "u !    
demon/ration project %all include1 z "p 
( ! annual report to ! ,secret>y on !   
,quality ,improvem5t ,program ( !       
organization "u su* section #aheb7;e7 = 

ea* ye> ( ! demon/ration project1 )     
respect to ea* qualifi$ ,,ma plan (f]$  
by ! organization1 ! results ( ! t>get+ 
( plan improvem5t on measures "u        
subsection 7c7 dur+ ! prec$+ ye>4  7e7  
,fund+  7#a7 ,9 g5]al ,= purposes (     
c>ry+ out ! demon/ration project "u ?is 
section1 subject to p>agraph 7#b71 !    
,secret>y %all provide = ! transf] f !  
,f$]al ,hospital ,insurance ,tru/ ,fund 
"u section #ahag ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie;i7 & ! ,f$]al 
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund "u section #ahda ( su* ,act 7#db  
,u4,s4,c4 #aciet71 9 su* proportion z ! 
,secret>y det]m9es appropriate1 ( an    
am\nt equal to ! am\nt ! ,secret>y      
det]m9es is equal to ! e/imat$ total    
sav+s to ! ,m$ic>e program z a result ( 
! implem5tation ( ! am5dm5t made by     
section #b to ! ,c5t]s = ,m$ic>e        
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt4  7#b7 ,adm9i/ration ,!         
,secret>y may reta9 up to #aj p]c5t ( ! 
funds transf]r$ "u p>agraph 7#a7 to     

adm9i/] ! demon/ration project "u ?is   
section & ! rema9d] ( su* funds %all be 
di/ribut$ 9 accordance ) ?is section to 
,,ma organizations (f]+ qualifi$ ,,ma   
plans bas$ on ! enrollm5t 9 su* plans ( 
individuals describ$ 9 ea* ( subclauses 
7,i7 & 7,,ii7 ( subsections             
7b77#b77;,b77ii7 & 7b77#b77;,c77ii74    
7#c7 ,availability ,am\nts transf]r$ "u 
p>agraph 7#a7 %all rema9 available until
 exp5d$4