,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #acie  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #g1 #bjag,mr4    
,burgess 7= himself1 ,mr4 ,coll9s ( ,new
 ,york1 ,mrs4 ,blackburn1 & ,mr4 ,mull97
 introduc$ ! foll[+ bill2 :i* 0 ref]r$  
to ! ,committee on ,en]gy & ,comm]ce  ,a
 ,,bill  ,to am5d title ,,xix ( !       
,social ,security ,act to improve !     
,m$icaid & ,,*ip ,paym5t & ,access      
,commission 7,,macpac74  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,,macpac     
,improvem5t ,act ( #bjag4  #b4          
,improvem5t ( ,,macpac  7a7 ,duties     
,section #aijj7;b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif7;b77 is      
am5d$--  7#a7 9 p>agraph 7#a7-- 7,a7 9 !
 head+1 by ins]t+ 1 paym5t1 f9anc+1 &   
program integrity aft] access2  7,b7 9  
subp>agraph 7,a71 by ins]t+ 1 paym5t1   
f9anc+1 or program integrity aft]       
affect+ access to cov]$ items & s]vices2
  7,c7 9 subp>agraph 7,b71 by /rik+     
access2  7,d7 9 subp>agraph 7,c71 by    
/rik+ su* policies & ins]t+ ! foll[+3   

policies ( su* programs relat+ to f9anc+
 & program integrity1 includ+-- 7i7 !   
implications ( su* policies ) respect to
 *anges 9 heal? c>e deliv]y 9 ! ,unit$  
,/ates2 &  7ii7 ) respect to ! m>ket =  
heal? c>e items & s]vices1 ! impact (   
su* policies on ! co/ & sp5d+ gr[? "u   
su* programs2  2 &  7,e7 9 subp>agraph  
7,d71 by /rik+ conta9+ & all t foll[s   
?r\gh ! p]iod & ins]t+ ! foll[+3 conta9+
 ! results ( su* reviews & ,,macpac's   
recomm5dations conc]n+ ! policies ( su* 
programs relat+ to access & paym5t1     
includ+-- 7i7 ! implications ( su*      
policies ) respect to *anges 9 heal? c>e
 deliv]y 9 ! ,unit$ ,/ates2 &  7ii7 )   
respect to ! m>ket = heal? c>e items &  
s]vices1 ! impact ( su* policies on     
access & paym5t "u su* programs4  2     
7#b7 9 p>agraph 7#b7-- 7,a7 9           
subp>agraph 7,a7--  7i7 9 clause 7ii71  
by /rik+ & at ! end2  7ii7 9 clause     
7iii71 by /rik+ ! p]iod at ! end &      
ins]t+ 2 &2 &  7iii7 by add+ at ! end ! 
foll[+ new clause3  7iv7 su* paym5t     

policies t may result 9 total paym5ts   
7tak+ into acc\nt additional or         
supplem5tal paym5ts or paym5t adju/m5ts7
 "u ?is title or title ,,xxi t exce$ !  
co/ ( provid+ items & s]vices to        
,m$icaid or ,,*ip b5efici>ies 7z        
applicable7 & *anges 9 su* paym5t       
policies t c\ld improve effici5cy )\t   
negatively impact+ access to c>e = su*  
b5efici>ies4  2 &  7,b7 by add+ at ! end
 ! foll[+ new subp>agraph3  7,i7 ,data  
,national & ,/ate-specific ,m$icaid &   
,,*ip data4  2  7#c7 by am5d+ p>agraph  
7#c7 to read z foll[s3  7#c7 ,annual    
policy recomm5dations ,n less frequ5tly 
?an once a ye>1 ,,macpac %all make      
recomm5dations reg>d+ ,f$]al /atutes t  
c\ld be enact$ or policies :i* !        
,secret>y or ,/ates c\ld implem5t to    
a*ieve1 ) respect to ,m$icaid & ,,*ip1 !
 foll[+ goals3  7,a7 ,f$]al & /ate      
outlays ,r$uc+ ,f$]al & ,/ate outlays to
 make su* programs m su/a9able4  7,b7   
,f9anc+ ,improv+ ! transp>5cy1          
integrity1 & su/a9ability ( f9anc+4     

7,c7 ,/ate flexibility & effici5cy      
,improv+ ,/ate flexibility1             
pr$ictability1 acc\ntability1 integrity1
 & effici5cy 9 ov]sight & adm9i/ration4 
7,d7 ,program integrity & r$uce wa/e1   
fraud1 & abuse ,enhanc+ program         
integrity1 r$uc+ ! am\nt & rate (       
improp] paym5ts1 improv+ int]nal        
adm9i/rative & f9ancial controls1 &     
enhanc+ ef=ts to curb wa/e1 fraud1 &    
abuse4  7,e7 ,prioritiz+ ! mo/ vuln]able
 ,prioritiz+ b5efits1 c>e1 & s]vices = !
 mo/ vuln]able1 l[-income ,m$icaid &    
,,*ip b5efici>ies1 su* z *ildr5 &       
pregnant wom5 ^: family income is at or 
bel[ ! ,f$]al pov]ty l9e1 ! eld]ly1 &   
individuals ) disabilities4  7,f7       
,emp[]+ b5efici>ies ,improv+ !          
indep5d5ce1 self-direction1             
self-suffici5cy1 & emp[]m5t (           
b5efici>ies4  2  7#d7 9 p>agraph 7#d7-- 
7,a7 9 ! head+1 by /rik+ sy/em & ins]t+ 
sy/ems2  7,b7 by /rik+ ,,macpac %all    
create & ins]t+ ! foll[+3  7,a7 ,sy/em  
relat$ to access ,,macpac %all create  2

 &  7,c7 by add+ at ! end ! foll[+ new  
subp>agraph3  7,b7 ,sy/em relat$ to     
program gr[? ,,macpac %all create an    
e>ly-w>n+ sy/em to id5tify *all5ges )   
su/a9+ ,f$]al & ,/ate fund+ = ,m$icaid  
dur+ ! mid-t]m & long-t]m4 ,,macpac %all
 include 9 ! annual report requir$ "u   
p>agraph 7#a77;,c7 a description ( su*  
*all5ges1 includ+ *all5ges pos$ by      
budget>y pressures :i* c\ld lead to     
increas$ ,f$]al or ,/ate deficits1 cr[d 
out discretion>y ,f$]al or ,/ate sp5d+1 
or necessitate increases 9 rev5ues1 &   
propos$ recomm5dations = address+ su*   
*all5ges4  2  7#e7 9 p>agraph 7#e7--    
7,a7 9 ! head+1 by /rik+ & regulations &
 ins]t+ 1 regulations1 & guidance2  7,b7
 9 subp>agraph 7,b71 by ins]t+ f9anc+1  
aft] quality12 &  7,c7 by add+ at ! end 
! foll[+ new subp>agraph3  7,c7 ,,cms   
guidance ,,macpac %all review guidance  
issu$ to ,/ates by ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices ) respect to ,m$icaid 
or ,,*ip & %all1 n lat] ?an ! date t is 
#ij days aft] ! date ( su* issuance1    

submit a report to ! appropriate        
committees ( ,congress & ! ,secret>y on 
! degree to :i* su* guidance is project$
 to *ange ,f$]al or ,/ate outlays =     
,m$icaid or ,,*ip4  2  7#f7 9 p>agraph  
7#g7-- 7,a7 9 ! head+ by ins]t+ & work+ 
docum5ts aft] reports2  7,b7 by /rik+   
,,macpac %all transmit & ins]t+ !       
foll[+3  7,a7 ,reports ,,macpac %all    
submit  2 &  7,c7 by add+ at ! end !    
foll[+ new subp>agraph3  7,b7 ,work+    
docum5ts ,,macpac %all make available to
 ! appropriate committees ( ,congress   
copies ( draft report *apt]s1 :ite      
pap]s1 & o!r mat]ials di/ribut$ among   
memb]s ( ,,macpac4  2  7#g7 9 p>agraph  
7#h71 by /rik+ ( ! ,h\se (              
,repres5tatives & ! ,committee on       
,f9ance ( ! ,s5ate & ins]t+ 1 !         
,committee on ,appropriations1 & !      
,committee on ,ov]sight & ,gov]nm5t     
,re=m ( ! ,h\se ( ,repres5tatives & !   
,committee on ,f9ance1 ! ,committee on  
,homel& ,security & ,gov]nm5tal         
,affairs1 & ! ,committee on             

,appropriations ( ! ,s5ate2  7#h7 9     
p>agraph 7#aj71 by add+ at ! end !      
foll[+3 ,= ea* recomm5dation t ,,macpac 
det]m9es w\ld increase ,f$]al or ,/ate  
outlays = ,m$icaid or ,,*ip1 ,,macpac   
%all make a recomm5dation reg>d+ *anges 
9 ,f$]al or ,/ate policy to (fset su*   
increas$ outlays42 &  7#i7 by add+ at ! 
end ! foll[+ new p>agraph3  7#ae7       
,annual report ,n lat] ?an ?ree mon?s   
aft] ! end ( a fiscal ye>1 ,,macpac %all
 prep>e & make available on ! ,,macpac  
website a report ) respect to su* fiscal
 ye> on its activities t includes--     
7,a7 in=mation relat$ to ,,macpac's     
exp5ses1 contracts1 accompli%m5ts1 &    
activities = su* fiscal ye>2 &  7,b7 !  
/atus ( ,,macpac's recomm5dations1      
includ+ updates on ,f$]al /atutes t h   
be5 enact$ or policies :i* ! ,secret>y  
or ,/ates h implem5t$ to effect su*     
recomm5dations4  4  7b7 ,memb]%ip       
,section #aijj7;c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif7;c77 is      
am5d$-- 7#a7 by am5d+ p>agraph 7#b7 to  

read z foll[s3  7#b7 ,qualifications    
7,a7 ,9 g5]al ,! memb]%ip ( ,,macpac    
%all include ! foll[+3 7i7 ,at lea/ ?ree
 individuals repres5t+ heal? c>e        
provid]s1 su* z physicians1 nurses1 or  
d5ti/s4  7ii7 ,at lea/ two individuals  
repres5t+ heal? plans t enroll ,m$icaid 
or ,,*ip b5efici>ies1 includ+ "o or m   
individuals repres5t+ a ,m$icaid manag$ 
c>e plan4  7iii7 ,at lea/ "o individual 
:o is an actu>y ) exp]tise 9 heal? c>e4 
7iv7 ,at lea/ two individuals :o are or 
h be5 directors ( ,m$icaid = a ,/ate1   
includ+ at lea/ "o individual :o is su* 
a director at ! "t ( appo9tm5t to       
,,macpac4  7v7 ,at lea/ "o individual :o
 is or has be5 a director ( ,,*ip = a   
,/ate4  7vi7 ,at lea/ "o individual )   
exp]tise 9 heal? c>e f9ance & heal?     
economics4  7vii7 ,at lea/ two          
individuals :o are repres5tatives (     
,m$icaid & ,,*ip b5efici>ies1 su* z     
*ildr51 pregnant wom51 ! eld]ly1 &      
individuals ) disabilities4  7viii7 ,at 
lea/ "o individual ) exp]tise 9 long-t]m

 s]vices & supports1 su* z 9 ! f9anc+ or
 deliv]y ( long-t]m s]vices & supports  
or manag$ long-t]m c>e s]vices1 includ+ 
c>e deliv]$ 9 nurs+ homes or home &     
community-bas$ sett+s4  7,b7 ,inclusion 
,! memb]%ip ( ,,macpac %all include     
individuals ) exp]tise 9-- 7i7 ,f$]al   
safety net heal? programs2  7ii7        
develop+1 negotiat+1 or implem5t+ a     
,m$icaid waiv] bas$ on exp]i5ce work+ = 
a ,/ate2  7iii7 heal? c>e paym5t &      
f9anc+ re=ms2  7iv7 integrat$ heal? c>e 
deliv]y sy/ems1 coord9at$ c>e models1 & 
value-bas$ contract+2  7v7 public heal?2
  7vi7 program integrity & fraud        
prev5tion2  7vii7 heal? in=mation       
te*nology & teleheal?2  7viii7          
prescription drug pric+ or paym5t2 &    
7ix7 op]at+ a ,m$icaid program1 heal?   
plan1 hospital1 or heal? c>e deliv]y    
sy/em4  7,c7 ,div]sity ,! memb]%ip (    
,,macpac %all also provide repres5tation
 f a v>iety ( diff]5t pr(essions &      
geographic areas & provide = a balanc$  
repres5tation among urban1 suburban1 &  

rural areas4  7,d7 ,balance (           
p]spectives ,! ,comptroll] ,g5]al ( !   
,unit$ ,/ates %all ensure memb]s appo9t$
 = initial or subsequ5t t]ms to ,,macpac
 reflect an appropriate balance (       
political p]spectives1 includ+ by tak+  
into acc\nt political p>ty regi/ration &
 contributions made to political        
c&idates & p>ties4  7,e7 ,majority      
nonprovid]s  7i7 ,9 g5]al ,individuals  
:o are directly involv$ 9 ! provision1  
or managem5t ( ! deliv]y1 ( items &     
s]vices cov]$ "u ,m$icaid or ,,*ip %all 
n con/itute a majority ( ! memb]%ip (   
,,macpac4  7ii7 ,m$icaid & ,,*ip        
directors ,= purposes ( ?is subp>agraph1
 ,m$icaid & ,,*ip directors %all n be   
consid]$ to be directly involv$ 9 !     
provision1 or managem5t ( ! deliv]y1 (  
items & s]vices cov]$ "u ,m$icaid or    
,,*ip4  7,f7 ,e?ical disclosure  7i7 ,9 
g5]al ,! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all e/abli% a sy/em = ! public  
disclosure ( f9ancial1 pr(essional1     
political1 advocacy1 or o!r activities (

 memb]s ( ,,macpac t may result 91 or be
 p]ceiv$ to result 91 conflicts ( int]e/
 relat+ to su* memb]s' s]vice on        
,,macpac4  7ii7 ,tim+ ( disclosures ,!  
,comptroll] ,g5]al %all require t ea*   
memb] ( ,,macpac make-- 7,i7 !          
disclosure describ$ 9 clause 7i7 on an  
annual basis2 &  7,,ii7 9 ! case ( a    
significant *ange 9 any ( ! activities (
 ! memb] describ$ 9 su* clause1 a       
supplem5tal disclosure at ! "t ( su*    
significant *ange4  7iii7 ,treatm5t z   
employees ( ,congress ,memb]s ( ,,macpac
 %all be treat$ z employees ( ,congress 
= purposes ( apply+ title ,i ( ! ,e?ics 
9 ,gov]nm5t ,act ( #aigh 7,public ,law  
#ie-eba74  2 &  7#b7 9 p>agraph 7#e71 by
 add+ at ! end ! foll[+3 ,su*           
designation %all be bas$ on previ\s     
managem5t exp]i5ce4 ,! ,comptroll]      
,g5]al may n exclude a memb] f          
consid]ation = su* designation bas$ on !
 fact t su* memb] is an individual      
employ$ by a ,/ate or by an entity t    
receives ,m$icaid or ,,*ip paym5ts1     

includ+ a local gov]nm5t1 a heal? plan t
 enrolls ,m$icaid or ,,*ip b5efici>ies1 
or a heal? c>e provid]44  7c7 ,conflicts
 ( int]e/ ,section #aijj ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acif7 is 
am5d$ by add+ at ! end ! foll[+ new     
subsection3  7g7 ,conflict ( int]e/     
policy ,,macpac %all ma9ta9 & make      
available on ! ,,macpac website a       
conflict ( int]e/ policy outl9+         
requirem5ts = memb]s & p]sonnel (       
,,macpac4 ,su* policy %all include !    
foll[+3  7#a7 ,disclosure ,requirem5ts =
 initially disclos+1 & p]iodically      
updat+1 any sub/antial political        
activity or significant f9ancial int]e/s
 t might influ5ce1 or t might reasonably
 appe> to influ5ce1 p]spectives on      
issues t c\ld come be=e ,,macpac4  7#b7 
,legal involvem5t ,) respect to any     
matt] "u adjudication be=e a c\rt1      
adm9i/rative law judge1 or o!r judicial 
entities3  7,a7 ,a requirem5t (         
disclosure ( any direct or indirect     
involvem5t 9 any su* matt] relat$ to a  

,f$]al or ,/ate heal? c>e program 7z su*
 t]ms are def9$ 9 sections #aabh7;h7 &  
#aabh;,b7f71 respectively71 includ+ fil+
 an amicus brief4  7,b7 ,a prohibition  
on direct or indirect involvem5t 9 any  
su* matt] t involves ! ,congress z a    
p>ty1 includ+ fil+ an amicus brief4     
7#c7 ,recusal ,! crit]ia & circum/ances 
"u :i* a memb] ( ,,macpac %all susp5d   
p>ticipation 9 ,,macpac or o!rwise seek 
recusal f ,,macpac votes1 includ+ !     
process by :i* ,,macpac discloses       
recomm5dations = su* a recusal4  4  7d7 
,application  7#a7 ,duties ,! am5dm5ts  
made by subsection 7a7 7o!r ?an !       
am5dm5ts made by p>agraph 7#e7 ( su*    
subsection7 %all apply ) respect to     
reports 7& recomm5dations includ$ 9     
reports7 submitt$ on or aft] ! date t is
 m ?an "o ye> aft] ! date ( ! enactm5t (
 ?is ,act4  7#b7 ,guidance ,! am5dm5ts  
made by subsection 7a77#e7 %all apply ) 
respect to guidance issu$ on or aft] !  
date ( ! enactm5t ( ?is ,act4  7#c7     
,memb]%ip  7,a7 ,appo9tm5t ( new memb]s 

,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 
%all apply ! *anges to ! memb]%ip ( !   
,m$icaid & ,,*ip ,paym5t & ,access      
,commission requir$ by am5dm5ts made by 
subsection 7b7 z soon z is practicable1 
consi/5t ) subp>agraph 7,b71 & 9 no ev5t
 lat] ?an ! date t is ?ree ye>s aft] !  
date ( ! enactm5t ( ?is ,act4  7,b7     
,ret5tion ( curr5t memb]s ,an individual
 :o is a memb] ( ! ,m$icaid & ,,*ip     
,paym5t & ,access ,commission z ( ! date
 ( ! enactm5t ( ?is ,act may cont9ue to 
s]ve until ! end ( ! individual's t]m z 
( su* date )\t reg>d to ! am5dm5ts made 
by subsection 7b74  7#d7 ,conflicts (   
int]e/ ,! am5dm5t made by subsection 7c7
 %all apply beg9n+ on ! date t is #ij   
days aft] ! date ( ! enactm5t ( ?is     
,act4