,,ii  #aad? ,,congress  #a/ ,session    
,s4 #bcib  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #aj1 #bjae    
,mr4 ,br[n 7= himself & ,mr4 ,blum5?al7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to enhance         
b5efici>y & provid] protections &       
improve transp>5cy 9 ! ,m$ic>e          
,advantage m>ket1 & = o!r purposes4  #a4
 ,%ort title  ,?is ,act may be cit$ z ! 
,m$ic>e ,advantage ,bill ( ,rights ,act 
( #bjae4  #b4 ,limitation on removal (  
m$ic>e advantage provid]s by ma         
organizations  7a7 ,limitation ,section 
#aheb7;d7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bb7;d77 is am5d$ 
by add+ at ! end ! foll[+3  7#g7        
,limitation on removal ( provid]s f ma  
plans by ma organizations  7,a7 ,removal
 ( provid]s ) cause ,beg9n+ ) plan ye>  
#bjag1 except z provid$ 9 subp>agraph   
7,c71 an ,,ma organization (f]+ an ,,ma 
plan may only remove a provid] ( s]vices
 or a suppli] f a network ( su* plan if 

! organization has cause to remove su*  
provid] or suppli]4  7,b7 ,cause to     
remove provid]s  7i7 ,9 g5]al ,an ,,ma  
organization (f]+ an ,,ma plan has cause
 to remove a provid] ( s]vices or a     
suppli] f a network ( su* plan if !     
,secret>y det]m9es t ! provid] or       
suppli] is--  7,i7 m$ically neglig5t2   
7,,ii7 9 violation ( any legal or       
contractual requirem5t applicable to !  
provid] or suppli] act+ )9 ! lawful     
scope ( practice1 includ+ any           
p>ticipation or o!r requirem5t          
applicable to su* provid] or suppli] "u 
?is title or "u any contractual t]m =   
su* plan2 or  7,,iii7 o!rwise unfit to  
furni% items & s]vices 9 accordance )   
requirem5ts ( ?is title4  7ii7          
,consid]ation ( co/ to ma organizations 
,= purposes ( subp>agraph 7,a71 co/ to  
an ,,ma organization (f]+ an ,,ma plan  
due to ! p>ticipation ( a provid] (     
s]vices or suppli] 9 a network ( su*    
plan does n con/itute cause = ! ,,ma    
organization to remove su* provid] or   

suppli] f ! network mid-ye>1 & su* co/  
may n be consid]$ z a factor 9 favor ( a
 det]m9ation t su* organization has     
cause to remove ! provid]4  7,c7        
,exception ,) respect to ea* upcom+ plan
 ye>1 beg9n+ ) plan ye> #bjag1 an ,,ma  
organization (f]+ an ,,ma plan may only 
remove a provid] ( s]vices or suppli] f 
a network ( su* plan = reasons n        
specifi$ 9 subp>agraph 7,b77i7 be=e !   
date t is #fj days be=e ! fir/ day ( !  
annual coord9at$ election p]iod = su*   
plan ye> "u section #ahea7;e77#c74  7,d7
 ,notice & appeal process  7i7 ,9 g5]al 
,any removal ( a provid] ( s]vices or   
suppli] f a network ( an ,,ma plan may  
occur only aft] ! completion ( a fair   
notice & appeal process t ! ,secret>y   
%all e/abli% by regulation4 ,su* process
 %all require ! ,,ma organization to    
provide to su* provid] or suppli] & to !
 ,secret>y an explanation ( ! reason or 
reasons = ! removal4  7ii7 ,application 
7,i7 ,application ( new process ,9 !    
case ( a removal ( a provid] ( s]vices  

or suppli] f a network ( an ,,ma plan   
occurr+ on or aft] ! effective date     
publi%$ 9 a f9al rule = su* fair notice 
& appeal process1 su* process %all apply
 9 lieu ( ! process = ! t]m9ation or    
susp5sion ( a provid] contract "u       
section #dbb4bjb7;a7 ( title #db1 ,code 
( ,f$]al ,regulations4  7,,ii7          
,cont9uation ( old process ,9 ! case ( a
 removal ( a provid] ( s]vices or       
suppli] f a network ( an ,,ma plan      
occurr+ be=e su* effective date1 !      
process = ! t]m9ation or susp5sion ( a  
provid] contract "u section #dbb4bjb7;a7
 ( title #db1 ,code ( ,f$]al            
,regulations1 %all apply4  7,e7         
,p>ticipant notice & protection  7i7    
,notice to p>ticipants ( provid] removal
 ,n less ?an #fj days be=e ! date on :i*
 a provid] ( s]vices or suppli] is      
remov$ f a network ( an ,,ma plan1 !    
,,ma organization (f]+ su* plan %all    
provide writt5 notification ( ! removal 
to ea* individual enroll$ 9 su* plan    
receiv+ items or s]vices f ! provid] or 

suppli] dur+ ! plan ye> 9 effect on !   
date ( removal or dur+ ! previ\s plan   
ye>4 ,su* notification %all include at !
 m9imum--  7,i7 ! names & telephone     
numb]s ( available 9-network provid]s ( 
s]vices & suppli]s (f]+ items & s]vices 
t are ! same or simil> to ! items &     
s]vices (f]$ by ! remov$ provid] or     
suppli]2  7,,ii7 in=mation reg>d+ !     
options available to an individual      
enroll$ 9 su* plan to reque/ !          
cont9uation ( m$ical treatm5t or !rapy )
 ! remov$ provid] or suppli]2 &  7,,iii7
 "o or m cu/om] s]vice telephone numb]s 
t an individual enroll$ 9 su* plan may  
access to obta9 in=mation reg>d+ *anges 
to ! network ( ! plan4  7ii7 ,annual    
notice ( *ange ,9 addition to provid+ ! 
notification ( removal z requir$ "u     
clause 7i71 ! ,,ma organization (f]+ su*
 ,,ma plan %all include su* notification
 9 ! annual notice ( *ange = ! ,,ma plan
 = ! upcom+ plan ye>4  7iii7 ,cont9uity 
( c>e ,9 any case 9 :i* a provid] (     
s]vices or suppli] is remov$ f a network

 ( an ,,ma plan1 su* plan %all ensure t 
! removal satisfies ! cont9uity ( c>e   
requirem5ts "u p>agraph 7#a77;,a7 )     
respect to ea* individual enroll$ 9 su* 
plan receiv+ items or s]vices f !       
provid] or suppli] dur+ ! plan ye> 9    
effect on ! date ( removal or dur+ !    
previ\s plan ye>4  7,f7 ,rule (         
con/ruction ,no?+ 9 ?is p>agraph %all be
 con/ru$ z affect+ ! ability ( a provid]
 ( s]vices or suppli] to decl9e to      
p>ticipate 9 a network ( an ,,ma plan4  
7#h7 ,transp>5cy 9 measures us$ by ma   
organizations to e/abli% or modify      
provid] networks  7,a7 ,9 g5]al ,beg9n+ 
) plan ye> #bjag1 an ,,ma organization  
(f]+ an ,,ma plan %all include !        
in=mation describ$ 9 subp>agraph 7,b7-- 
7i7 9 ! annual bid in=mation submitt$ by
 ! ,,ma organization ) respect to ! ,,ma
 plan "u section #ahed2 &  7ii7 on !    
,int]net ,web site = ! ,,ma plan4  7,b7 
,in=mation describ$ ,! in=mation        
describ$ 9 ?is subp>agraph is ! foll[+3 
7i7 ,in=mation reg>d+ ! measures us$ by 

! ,,ma organization to e/abli% or modify
 ! provid] network ( ! ,,ma plan1       
includ+ measures ( ! quality & effici5cy
 ( provid]s4 ,su* in=mation %all include
 ! specifications1 me?odology1 & sample 
size ( su* measures4  7ii7 ,o!r         
in=mation relat$ to ! e/abli%m5t or     
modification ( su* provid] network t !  
,secret>y det]m9es appropriate4  7,c7   
,limitation ,! in=mation describ$ 9     
subp>agraph 7,b7 %all n include any     
individually id5tifiable in=mation ( any
 provid] or suppli] ( s]vices4  4  7b7  
,en=cem5t  7#a7 ,sanctions =            
noncompliance ,section #aheg7;g77#a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bg7;g77#a77 is am5d$-- 7,a7 9   
subp>agraph 7,j71 by /rik+ or2  7,b7 by 
r$esignat+ subp>agraph 7,k7 z           
subp>agraph 7,l72  7,c7 by ins]t+ aft]  
subp>agraph 7,j7 ! foll[+ new           
subp>agraph3  7,k7 fails to comply )    
section #aheb7;d77#g7 or #aheb7;d77#h72 
or  2 &  7,d7 9 subp>agraph 7,l7 7z s   
r$esignat$71 by /rik+ ?r\gh 7,j7 &      

ins]t+ ?r\gh 7,k74  7#b7 ,sanctions n   
applicable to "p d ,title ,,xviii ( !   
,social ,security ,act is am5d$-- 7,a7 9
 section #ahfj;,d-#ab7;b77#c77;,e7 7#db 
,u4,s4,c4 #aciew-#aab7;b77#c77;,e771 by 
/rik+ p>agraph 7#a77;,f7 & ins]t+       
p>agraphs 7#a77;,f7 & 7#a77,k72 &  7,b7 
9 section #ahid7;e77#f77;,b7 7#db       
,u4,s4,c4 #acie;eee7e77#f77;,b771 by    
ins]t+ 7o!r ?an p>agraph 7#a77,k7 ( su* 
section7 aft] #aheg7;g77#a74  7c7       
,m$ic>e advantage plan comp>e tool ,n   
lat] ?an "o ye> aft] ! date ( enactm5t (
 ?is ,act1 ! ,secret>y ( ,heal? & ,human
 ,s]vices %all take su* measures z are  
necess>y to ensure t ! ,m$ic>e          
,advantage ,comp>e ,tool takes into     
acc\nt ! pref]5ces & utilization ne$s ( 
su* individuals4  #c4 ,network ,adequacy
  7a7 ,9 g5]al ,section #aheb7;d7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bb7;d771 z am5d$ by section #b1 
is am5d$ by add+ at ! end ! foll[+3     
7#i7 ,network adequacy requirem5ts      
,beg9n+ 9 plan ye> #bjag1 not)/&+ any   

o!r provision ( law1 ! foll[+ %all      
apply3 7,a7 ,provid] availability ,:5   
e/abli%+ a plan network1 a ,m$ic>e      
,advantage organization (f]+ an ,,ma    
plan %all1 among o!r factors det]m9$ by 
! ,secret>y1 consid] ! foll[+3  7i7 ,!  
anticipat$ enrollm5t 9 ! plan4  7ii7 ,! 
expect$ types ( s]vices provid$ &       
utilization ( s]vices by enrollees "u ! 
plan4  7iii7 ,! numb] & types ( provid]s
 ne$$ to provide su* s]vices4  7iv7 ,!  
numb] ( network provid]s :o are n       
accept+ new pati5ts4  7v7 ,! location ( 
provid]s & enrollees4  7vi7 ,! full "t  
equival5t availability ( a provid] to   
provide su* s]vices4  7,b7 ,provision ( 
c>e 9 a timely mann] ,a ,m$ic>e         
,advantage organization (f]+ an ,,ma    
plan %all ensure t provid]s are able to 
provide s]vices 9 a timely mann]1 z     
def9$ by ! ,secret>y1 "u ! plan4  7,c7  
,application ( network access adequacy  
/&>ds ,9 apply+ ! network access        
adequacy /&>ds pursuant to p>agraph     
7#a71 ! ,secret>y %all seek input f     

pati5t advocacy gr\ps1 provid]s (       
s]vices & suppli]s1 & ,,ma plans "u ?is 
"p4  7,d7 ,c]tification ,ea* plan ye>1 a
 ,m$ic>e ,advantage organization %all   
c]tify to ! ,secret>y1 ) respect to ea* 
,,ma plan (f]$ by ! organization1 t !   
provid]s1 includ+ speciali/s &          
subspeciali/s1 9 ! plan network are able
 to provide ! s]vices requir$ "u !      
organization's contract ) ! ,secret>y "u
 section #aheg ) respect to ! (f]+ ( su*
 plan & to meet ! ne$s ( ! enrollees )9 
! plan s]vice area dur+ ! ye>4  7,e7    
,annual report+ ,ea* plan ye>1 a ,m$ic>e
 ,advantage organization %all report to 
! ,secret>y ! foll[+ ) respect to ea*   
,,ma plan (f]$ by ! organization3  7i7  
,av]age wait "t ,! av]age wait "t =     
prim>y & specialty c>e = enrollees "u ! 
plan4  7ii7 ,utilization ( out-(-network
 provid]s ,! utilization ( out-(-network
 provid]s "u ! plan4  7iii7 ,av]age co/ 
p] pati5t ,! av]age annual sp5d+ p]     
pati5t = prim>y & specialty c>e =       
enrollees "u ! plan4  7,f7 ,c]tification

 ,9 advance ( ! annual1 coord9at$       
election p]iod "u section #ahea7;e77#c71
 a ,m$ic>e ,advantage organization %all 
c]tify to ! ,secret>y ! accuracy (      
provid] directories = ea* plan (f]$ by !
 organization4  7,g7 ,network review ,! 
,secret>y %all ensure t ! network ( ea* 
,,ma plan (f]$ by a ,m$ic>e ,advantage  
organization meets ! network adequacy   
guidel9es e/abli%$ "u ?is p>agraph & "u 
section #dbb4aab7;a77#d7 ( title #db1   
,code ( ,f$]al ,regulations 7or any     
successor regulation to su* section71 at
 lea/ once e #c ye>s or :5 a mat]ial    
*ange 9 network occurs4  4  7b7         
,en=cem5t ,section #aheg7;g77#a77,k7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bg7;g77#a77,k771 z add$ by      
section #b7;b71 is am5d$ by /rik+ or    
#aheb7;d77#h7 & ins]t+ 1 #aheb7;d77#h71 
or #aheb7;d77#i74