,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #bjdh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #f1 #bjag,mr4  
,b5 ,ray ,lujn ( ,new ,mexico introduc$ 
! foll[+ bill2 :i* 0 ref]r$ to !        
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to inc5tivize !         
developm5t ( community-bas$ int]v5tions 
to r$uce heal? disp>ities among c]ta9   
populations1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be ref]r$ to z
 ! ,elim9at+ ,heal? ,disp>ities ,act (  
#bjag4  #b4 ,heal? ,disp>ities          
,elim9ation ,/ate ,plan ,option ,title  
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq47 is am5d$ by    
add+ at ! end ! foll[+3  #aidg4 ,heal?  
,disp>ities ,elim9ation ,program ,/ate  
,plan ,option  7a7 ,9 g5]al ,not)/&+    
section #aijb7;a77#a7 7relat+ to        
/atewid5ess71 section                   
#aijb7;a77#aj77;,b7 7relat+ to          
comp>ability71 & any o!r provision ( ?is
 title t ! ,secret>y det]m9es is        

necess>y to waive 9 ord] to implem5t ?is
 section1 beg9n+ fiscal ye> #bjah1 a    
,/ate1 at its option z a ,/ate plan     
am5dm5t1 may e/abli% a ,heal?           
,disp>ities ,elim9ation ,program =      
purposes ( r$uc+ heal? disp>ities among 
t>get$ populations 9 communities s]v$ by
 qualifi$ community heal? sy/ems "u :i* 
! ,/ate provides inc5tive paym5ts to    
qualifi$ community heal? sy/ems =       
initiatives approv$ "u subsection 7c71  
if ! ,/ate meets ! requirem5ts specifi$ 
9 subsection 7c74  7b7 ,/ate plan       
am5dm5t ,ea* ,/ate seek+ a ,/ate plan   
am5dm5t "u ?is section %all submit su*  
am5dm5t to ! ,secret>y = approval4 ,!   
,secret>y %all approve any su* am5dm5t t
 meets ! requirem5ts ( subsection 7c7 & 
includes--  7#a7 ,/ate goals = r$uc+    
heal? disp>ities ?r\gh ! ,heal?         
,disp>ities ,elim9ation ,program to be  
e/abli%$ by ! ,/ate2  7#b7 any          
requirem5ts = ! developm5t & approval ( 
action plans describ$ 9 subsection      
7c77#a72  7#c7 eligibility crit]ia = any

 qualifi$ community heal? sy/em seek+ to
 e/abli% a heal? disp>ities elim9ation  
initiative 79 ?is section ref]r$ to z an
 initiative7 pursuant to ?is section2   
7#d7 ! me?odology = det]m9+ ! am\nt (   
inc5tive paym5ts to be made to a        
qualifi$ community heal? sy/em ?r\gh an 
initiative1 bas$ on ! size ( ! t>get    
population to be s]v$ ?r\gh ! initiative
 & ! pot5tial ( ! initiative = r$uc+    
heal? disp>ities2 &  7#e7 ! p]iod dur+  
:i* initiatives may be implem5t$1 9     
accordance ) subsection 7c77#c74  7c7   
,/ate requirem5ts ,! requirem5ts        
specifi$ 9 ?is subsection ) respect to a
 ,/ate are ! foll[+3  7#a7 ,heal? sy/em 
action plan ,! ,/ate %all require t a   
qualifi$ community heal? sy/em submit an
 action plan = an initiative to ! ,/ate 
ag5cy ) responsibility = adm9i/]+ !     
,/ate plan "u ?is title = approval t    
id5tifies--  7,a7 ! t>get population or 
populations to be s]v$ by ! initiative2 
7,b7 specific1 evid5ce-bas$ projects t !
 sy/em w und]take ?r\gh ! initiative to 

r$uce heal? disp>ities = su* population 
or populations2  7,c7 t>gets & b5*m>ks  
associat$ ) su* projects t mu/ be met 9 
ord] to receive inc5tive paym5ts        
pursuant to ?is section2  7,d7 measures 
= evaluat+ ! effectiv5ess ( ! initiative
 9 r$uc+ heal? disp>ities ) respect to !
 goals e/abli%$ by ! ,/ate pursuant to  
subsection 7b77#a72 &  7,e7 ! am\nt (   
any propos$ initial inc5tive paym5ts to 
be made pursuant to ?is section to      
support />tup co/s ( ! initiative4  7#b7
 ,priority 9 selection ( heal? sy/ems = 
p>ticipation ,9 select+ qualifi$        
community heal? sy/ems to e/abli% an    
initiative "u a ,/ate plan am5dm5t      
approv$ "u ?is section1 ! ,/ate %all    
give priority to heal? sy/ems--  7,a7 t 
h submitt$ action plans 7"u p>agraph    
7#a77 t include ! use ( evid5ce-bas$    
int]v5tions %[n to r$uce or elim9ate    
heal? disp>ities2  7,b7 t demon/rate !  
pot5tial to h a high impact 9 !         
elim9ation ( heal? disp>ities1 improv$  
heal? c>e access1 improv$ heal?         

outcomes1 or heal? c>e sav+s comp>$ to !
 total inc5tive fund+ reque/$2  7,c7 t h
 prior exp]i5ce work+ on projects ) !   
goal ( r$uc+ heal? disp>ities2  7,d7 t  
demon/rate long-t]m commitm5t to provid+
 heal? s]vices to ! t>get population or 
populations2 &  7,e7 ) a demon/rat$ ne$ 
= additional f9ancial res\rces 9 ord] to
 /r5g!n & advance exi/+ ef=ts ( ! heal? 
sy/em to r$uce heal? disp>ities4  7#c7  
,duration ( action plan  7,a7 ,9 g5]al  
,! ,/ate may n approve an action plan   
submitt$ "u p>agraph 7#a7 = a p]iod     
exce$+ #e ye>s4  7,b7 ,report ,at ! end 
( any su* p]iod1 ! ,/ate %all require   
ea* p>ticipat+ qualifi$ community heal? 
sy/em to submit a report to ! ,/ate     
describ+ ! effectiv5ess ( its initiative
 us+ ! measures describ$ 9 p>agraph     
7#a77;,d74  7,c7 ,ext5sion ,a ,/ate may 
ext5d ! initiative ( su* heal? sy/em ^u 
approval ( a new action plan to ext5d1  
improve1 or exp& ! initiative1 if !     
,/ate det]m9es t ! initiative has prov$ 
effective1 tak+ into acc\nt ! report    

submitt$ "u subp>agraph 7,b74  7d7 ,/ate
 report & evaluation  7#a7 ,9 g5]al ,a  
,/ate ) a ,/ate plan am5dm5t approv$ "u 
?is section %all submit to ! ,secret>y1 
9 a "t & mann] to be specifi$ by !      
,secret>y--  7,a7 an annual report on ! 
progress ( ! ,heal? ,disp>ities         
,elim9ation ,program ( ! ,/ate t[>ds    
meet+ ! goals ( ! ,/ate describ$ "u     
subsection 7b77#a72 &  7,b7 n less ?an  
once e #e ye>s1 an evaluation ( !       
effectiv5ess ( ! ,heal? ,disp>ities     
,elim9ation ,program ( ! ,/ate4  7#b7   
,cont5ts ,! evaluation describ$ 9       
p>agraph 7#a77;,b7 %all include-- 7,a7  
an assessm5t ( ! effectiv5ess (         
initiatives receiv+ inc5tive paym5ts    
pursuant to ?is section dur+ ! p]iod    
cov]$ by ! report 9 meet+ ! goals ( !   
,/ate describ$ "u subsection 7b77#a72 & 
7,b7 a description ( ! activities ( su* 
initiatives4  7#c7 ,publication ,!      
,secret>y %all publi% on ! public ,web  
site ( ! ,c5t]s = ,m$ic>e  ,m$icaid     
,s]vices ea* evaluation submitt$ "u     

p>agraph 7#a77;,b74  7e7 ,fund+  7#a7   
,/ate fund+  7,a7 ,9 g5]al ,= ! purpose 
( mak+ allocations to ,/ates "u         
subp>agraph 7,c71 !re is appropriat$ =  
fiscal ye> #bjah & ea* subsequ5t fiscal 
ye>1 out ( any money 9 ! ,treasury n    
o!rwise appropriat$1 an am\nt equal to  
"o half ( "o p]c5t ( ! total ( ! ,f$]al 
%>e ( exp5ditures ) respect to all ,/ate
 plans "u ?is title 9 ! mo/ rec5t fiscal
 ye> = :i* complete exp5diture data is  
available4  7,b7 ,inc5tive paym5t fund  
,! ,secret>y %all deposit all funds     
appropriat$ "u subp>agraph 7,a7 into an 
inc5tive paym5t fund4 ,su* funds %all   
rema9 available until exp5d$4  7,c7     
,allocation among ,/ates ,( ! total     
am\nt appropriat$ = ?is section = a     
fiscal ye>1 ! ,secret>y %all1 except z  
provid$ 9 subp>agraph 7,d71 allocate =  
su* fiscal ye> to ea* ,/ate an am\nt 9  
proportion to ! ratio (--  7i7 ! ,/ate's
 total exp5ditures "u ! ,/ate plan "u   
?is title 9 ! mo/ rec5t fiscal ye> = :i*
 complete exp5diture data is available2 

to  7ii7 ! sum ( all ,/ates' total      
exp5ditures "u all ,/ate plans "u ?is   
title 9 ! fiscal ye> describ$ 9 clause  
7i74  7,d7 ,funds n us$ by ! ,/ate ,if !
 ,secret>y det]m9es1 on ! basis (       
in=mation available on ! fir/ day ( a   
fiscal ye>1 t any allocation "u         
subp>agraph 7,c7 to a ,/ate = su* fiscal
 ye> w n be requir$ because a ,/ate does
 n h a ,/ate plan am5dm5t approv$ "u    
subsection 7b7 = su* fiscal ye>1 !n su* 
,/ate's allocation %all be treat$ z an  
unus$ allocation = su* fiscal ye> &     
re-allocat$ 9 accordance ) subp>agraph  
7,e77i74  7,e7 ,qualify+ ,/ates  7i7    
,re-allocation to qualify+ ,/ates ,9    
addition to ! allocation available to a 
,/ate "u subp>agraph 7,c71 ! ,secret>y  
%all allocate to ea* qualify+ ,/ate = a 
fiscal ye>1 out ( ! sum ( unus$         
allocations1 z describ$ 9 subp>agraph   
7,d71 = su* fiscal ye>1 an am\nt 9      
proportion to ! ratio (--  7,i7 ea* su* 
,/ate's total exp5ditures "u ! ,/ate    
plan "u ?is title 9 ! mo/ rec5t fiscal  

ye> = :i* complete exp5diture data is   
available2 to  7,,ii7 ! sum ( all su*   
,/ates' total exp5ditures "u all ,/ate  
plans ( su* ,/ates "u ?is title 9 !     
fiscal ye> describ$ 9 subclause 7,i74   
7ii7 ,availability ( funds ,allocations 
made to a qualify+ ,/ate "u clause 7i7 &
 subp>agraph 7,c7 %all rema9 available  
until exp5d$4  7iii7 ,def9itions ,9 ?is 
section1 ! t]m qualify+ ,/ate means a   
,/ate ) a ,/ate plan am5dm5t approv$ "u 
?is section t-- 7,i7 has 9 effect an    
agreem5t ) "o or m qualifi$ community   
heal? sy/em initiatives2 &  7,,ii7 9 any
 fiscal ye> o!r ?an ! fir/ fiscal ye> = 
:i* su* ,/ate receives an allocation "u 
subp>agraph 7,c7 t is n re-allocat$ "u  
subp>agraph 7,d71 has a ,heal?          
,disp>ities ,elim9ation ,program        
e/abli%$ "u ?is section t1 z det]m9$ by 
! ,secret>y1 has made measurable        
progress t[>ds meet+ ! ,/ate's goals1 z 
describ$ "u subsection 7b77#a71 bas$ on 
reports & evaluations submitt$ "u       
subsection 7d74  7#b7 ,paym5ts  7,a7 ,9 

g5]al ,subject to ! provisions ( ?is    
section1 ! ,secret>y %all pay to ea*    
,/ate ) a ,/ate plan am5dm5t approv$ "u 
?is section1 f its allocation "u        
p>agraph 7#a77;,c7 &1 9 ! case ( a      
qualify+ ,/ate1 f its allocation "u     
p>agraph 7#a77;,e77i71 an am\nt = ea*   
qu>t] equal to #ij p]c5t ( ! sum exp5d$ 
by ! ,/ate 9 su* qu>t] = inc5tive       
paym5ts made to qualifi$ community heal?
 sy/ems = initiatives approv$ pursuant  
to ?is section4  7,b7 ,/atus ( inc5tive 
paym5ts ,inc5tive paym5ts made "u a     
,/ate plan am5dm5t approv$ "u ?is       
section %all n be consid]$ paym5t =     
heal? c>e items or s]vices & %all n c\nt
 t[>ds any limit ) respect to ! maximum 
am\nt ( paym5ts t may be made to a      
provid] "u ! ,/ate plan "u ?is title 7or
 "u a waiv] ( su* plan74  7f7           
,def9itions ,9 ?is section3 7#a7 ,! t]m 
heal? disp>ity means a disp>ity 9 c>e   
provid$ to a heal? disp>ity population1 
z def9$ 9 section #ijc7;d7 ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      

#bii;a-#a7;d774  7#b7 ,! t]m qualifi$   
community heal? sy/em means-- 7,a7 a    
hospital describ$ 9 a report submitt$ "u
 section #aijj7;b77#f77;,b77ii77,,iii72 
or  7,b7 an affiliat$ gr\p ( heal? c>e  
provid]s an*or$ by su* hospital4  7#c7  
,! t]m ,/ate means ea* ( ! sev]al ,/ates
 & ! ,di/rict ( ,columbia4  7#d7 ,! t]m 
t>get population means a population (   
individuals t has empirically exp]i5c$  
disp>ities 9 heal? c>e access & quality 
& %all n be limit$ by s\rce ( cov]age or
 lack !re(4  4