,,ib  ,union ,cal5d> ,no4 #cec  #aae?   
,,congress  #a/ ,session  ,h4 ,r4 #cafh 
,report ,no4 #aae-dgh1 ,"p ,i  ,,9 ,,!  
,,h\se ,,( ,,repres5tatives  ,july #f1  
#bjag ,mr4 ,tib]i 7= himself & ,mr4     
,lev97 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$  ,decemb] #ba1 #bjag ,report$ f 
! ,committee on ,ways & ,means ) an     
am5dm5t ,/rike out all aft] ! enact+    
clause & ins]t ! "p pr9t$ 9 italic      
,decemb] #ba1 #bjag,! ,committee on     
,en]gy & ,comm]ce dis*>g$2 committ$ to !
 ,committee ( ! ,:ole ,h\se on ! ,/ate (
 ! ,union & ord]$ to be printed,for text
 ( introduc$ bill1 see copy ( bill z    
introduc$ on ,july #f1 #bjag  ,a ,,bill 
,to am5d title ,,xviii ( ! ,social      
,security ,act to provide cont9u$ access
 to specializ$ ,m$ic>e ,advantage plans 

= special ne$s individuals1 & = o!r     
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,special ,ne$s ,plans      
,reau?orization ,act ( #bjag or ! ,,snp 
,reau?orization ,act ( #bjag4  #b4      
,specializ$ ,m$ic>e ,advantage plans =  
special ne$s individuals  7a7 ,ext5sion 
,section #ahei7;f77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;f77#a77 is am5d$--  7#a7 by 
/rik+ & = p]iods be=e ,janu>y #a1 #bjai2
 &  7#b7 by add+ at ! end ! foll[+ new  
s5t5ce3 ,9 ! case ( a specializ$ ,,ma   
plan = special ne$s individuals describ$
 9 clause 7ii7 or 7iii7 ( subsection    
7b77#f77;,b71 ! previ\s s5t5ce %all     
apply = p]iods be=e ,janu>y #a1 #bjbd44 
7b7 ,increas$ integration ( dual ,s,n,ps
  7#a7 ,9 g5]al ,section #ahei7;f7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bh7;f77 is am5d$-- 7,a7 9       
p>agraph 7#c71 by add+ at ! end ! foll[+
 new subp>agraph3  7,f7 ,! plan meets ! 
requirem5ts applicable "u p>agraph 7#h74
  2 &  7,b7 by add+ at ! end ! foll[+   

new p>agraph3  7#h7 ,increas$           
integration ( dual ,s,n,ps  7,a7        
,designat$ contact ,! ,secret>y1 act+   
?r\gh ! ,f$]al ,coord9at$ ,heal? ,c>e   
,(fice e/abli%$ "u section #bfjb (      
,public ,law #aaa-adh1 %all s]ve z a    
d$icat$ po9t ( contact = ,/ates to      
address misalignm5ts t arise ) !        
integration ( specializ$ ,,ma plans =   
special ne$s individuals describ$ 9     
subsection 7b77#f77;,b77ii7 "u ?is      
p>agraph &1 consi/5t ) su* role1 %all-- 
7i7 e/abli% a uni=m process = dissem9at+
 to ,/ate ,m$icaid ag5cies in=mation "u 
?is title impact+ contracts betwe5 su*  
ag5cies & su* plans "u ?is subsection2 &
  7ii7 e/abli% basic res\rces = ,/ates  
int]e/$ 9 explor+ su* plans z a plat=m =
 integration1 su* z a model contract or 
o!r tools to a*ieve ^? goals4  7,b7     
,unifi$ grievances & appeals process    
7i7 ,9 g5]al ,n lat] ?an ,april #a1     
#bjbj1 ! ,secret>y %all e/abli%         
proc$ures1 to ! ext5t feasible z det]m9$
 by ! ,secret>y1 unify+ grievances &    

appeals proc$ures "u sections #aheb7;f71
 #aheb7;g71 #aijb7;a77#c71              
#aijb7;a77#e71 & #aicb7;b77#d7 = items &
 s]vices provid$ by specializ$ ,,ma     
plans = special ne$s individuals        
describ$ 9 subsection 7b77#f77;,b77ii7  
"u ?is title & title ,,xix4 ,! ,secret>y
 %all solicit comm5t 9 develop+ su*     
proc$ures f ,/ates1 plans1 b5efici>ies &
 _! repres5tatives1 & o!r relevant      
/akehold]s4 ,) respect to items &       
s]vices describ$ 9 ! previ\s s5t5ce1    
appeals proc$ures e/abli%$ "u ?is clause
 %all apply 9 place ( o!rwise applicable
 appeals proc$ures4  7ii7 ,proc$ures ,! 
proc$ures e/abli%$ "u clause 7i7 %all be
 includ$ 9 ! plan contract "u p>agraph  
7#c77;,d7 & %all--  7,i7 adopt !        
provisions = ! enrollee t are mo/       
protective = ! enrollee &1 to ! ext5t   
feasible z det]m9$ by ! ,secret>y1 are  
compatible ) unifi$ timeframes &        
consolidat$ access to ext]nal review "u 
an integrat$ process2  7,,ii7 take into 
acc\nt diff]5ces 9 ,/ate plans "u title 

,,xix to ! ext5t necess>y2  7,,iii7 be  
easily navigable by an enrollee2 &      
7,,iv7 include ! elem5ts describ$ 9     
clause 7iii71 z applicable4  7iii7      
,elem5ts describ$ ,bo? unifi$ appeals & 
unifi$ grievance proc$ures %all include1
 z applicable1 ! foll[+ elem5ts describ$
 9 ?is clause3  7,i7 ,s+le writt5       
notification ( all applicable grievances
 & appeal rights "u ?is title & title   
,,xix4 ,= purposes ( ?is subp>agraph1 ! 
,secret>y may waive ! requirem5ts "u    
section #aheb7;g77#a77;,b7 :5 !         
specializ$ ,,ma plan cov]s items or     
s]vices "u ?is "p or "u title ,,xix4    
7,,ii7 ,s+le pa?ways = resolution ( any 
grievance or appeal relat$ to a p>ticul>
 item or s]vice provid$ by specializ$   
,,ma plans = special ne$s individuals   
describ$ 9 subsection 7b77#f77;,b77ii7  
"u ?is title & title ,,xix4  7,,iii7    
,notices writt5 9 pla9 language &       
available 9 a language & =mat t is      
accessible to ! enrollee1 includ+ 9     
non-,engli% languages t are preval5t 9 !

 s]vice area ( ! specializ$ ,,ma plan4  
7,,iv7 ,unifi$ timeframes = grievances &
 appeals processes1 su* z an            
individual's fil+ ( a grievance or      
appeal1 a plan's ackn[l$gm5t &          
resolution ( a grievance or appeal1 &   
notification ( decisions ) respect to a 
grievance or appeal4  7,v7 ,requirem5ts 
= h[ ! plan mu/ process1 track1 &       
resolve grievances & appeals1 to ensure 
b5efici>ies are notifi$ on a timely     
basis ( decisions t are made ?r\gh\t !  
grievance or appeals process & are able 
to easily det]m9e ! /atus ( a grievance 
or appeal4  7iv7 ,cont9uation ( b5efits 
p5d+ appeal ,! unifi$ proc$ures "u      
clause 7i7 %all1 ) respect to all       
b5efits "u p>ts ,a & ,b & title ,,xix   
subject to appeal "u su* proc$ures1     
incorporate provisions "u curr5t law &  
implem5t+ regulations t provide         
cont9uation ( b5efits p5d+ appeal "u ?is
 title & title ,,xix4  7,c7 ,requirem5t 
= unifi$ grievances & appeals ,= #bjbb &
 subsequ5t ye>s1 ! contract ( a         

specializ$ ,,ma plan = special ne$s     
individuals describ$ 9 subsection       
7b77#f77;,b77ii7 ) a ,/ate ,m$icaid     
ag5cy "u p>agraph 7#c77;,d7 %all require
 ! use ( unifi$ grievances & appeals    
proc$ures z describ$ 9 subp>agraph 7,b74
  7,d7 ,requirem5ts = full integration =
 c]ta9 dual ,s,n,ps  7i7 ,requirem5t ,= 
#bjba & subsequ5t ye>s1 a specializ$    
,,ma plan = special ne$s individuals    
describ$ 9 subsection 7b77#f77;,b77ii7  
%all meet "o or m ( ! foll[+ requirem5ts
 = integration ( b5efits "u ?is title & 
title ,,xix3  7,i7 ,meet ! requirem5ts (
 a fully integrat$ plan describ$ 9      
section #ahec7;a77#a77;,b77iv77,,ii7    
7o!r ?an ! requirem5t t ! plan h simil> 
av]age levels ( frailty1 z det]m9$ by ! 
,secret>y1 z ! ,,pace program74  7,,ii7 
,ent] into a capitat$ contract ) ! ,/ate
 ,m$icaid ag5cy to provide long-t]m     
s]vices & supports or behavioral heal?  
s]vices1 or bo?4  7,,iii7 ,to ! ext5t ! 
,/ate does n all[ = or require su* a    
specializ$ ,,ma plan to ent] into a     

capitat$ contract describ$ 9 subclause  
7,,ii71 ent] into ano!r type (          
integration arrangem5t1 z det]m9$       
appropriate by ! ,secret>y aft]         
consultation ) /akehold]s1 su* z by--   
7aa7 ent]+ into a contract ) ! ,/ate t  
requires notify+ ! ,/ate 9 a timely     
mann] ( hospitalizations1 em]g5cy room  
visits1 & hospital or nurs+ home        
dis*>ges ( enrollees or o!rwise requires
 %>+ data t w\ld b5efit ! coord9ation ( 
items & s]vices "u ?is title & ! ,/ate  
plan "u title ,,xix2 or  7bb7 (f]+1 by a
 p>5t organization1 a ,m$icaid manag$   
c>e plan t provides long t]m s]vices &  
supports or behavioral heal? s]vices to 
! same enrollees z "u su* specializ$    
,,ma plan4  7ii7 ,sanctions ,= #bjba &  
subsequ5t ye>s1 if ! ,secret>y det]m9es 
t a specializ$ ,,ma plan fails to comply
 ) clause 7i71 ! ,secret>y may provide =
 ! application aga9/ ! ,m$ic>e          
,advantage organization (f]+ ! plan any 
( ! rem$ies describ$ 9 section          
#aheg7;g77#b74  4  7#b7 ,con=m+ am5dm5t 

to responsibilities ( ,f$]al ,coord9at$ 
,heal? ,c>e ,(fice ,section #bfjb7;d7 ( 
,public ,law #aaa-adh 7#db ,u4,s4,c4    
#acae;b7d77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraphs3  7#f7 ,to act z a 
designat$ contact = ,/ates "u subsection
 7f77#h77;,a7 ( section #ahei ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bh7 ) respect to ! integration (
 specializ$ ,,ma plans = special ne$s   
individuals describ$ 9 subsection       
7b77#f77;,b77ii7 ( su* section4  7#g7   
,to be responsible = develop+           
regulations & guidance relat$ to !      
implem5tation ( a unifi$ grievance &    
appeals process z describ$ 9            
subp>agraphs 7,b7 & 7,c7 ( section      
#ahei7;f77#h7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;f77#h774    
7#h7 ,to be responsible = develop+      
regulations & guidance relat$ to !      
integration or alignm5t ( policy &      
ov]sight "u ! ,m$ic>e program "u title  
,,xviii ( su* ,act & ,m$icaid program "u
 title ,,xix ( su* ,act reg>d+          

specializ$ ,,ma plans = special ne$s    
individuals describ$ 9 subsection       
7b77#f77;,b77ii7 ( su* section #ahei4  4
  7c7 ,improvem5ts to sev]e or disabl+  
*ronic condition ,s,n,ps  7#a7 ,c>e     
managem5t requirem5ts ,section          
#ahei7;f77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bh7;f77#e77 is  
am5d$-- 7,a7 by r$esignat+ subp>agraphs 
7,a7 & 7,b7 z clauses 7i7 & 7ii71       
respectively1 & ind5t+ appropriately2   
7,b7 9 clause 7ii71 z r$esignat$ by     
subp>agraph 7,a71 by r$esignat+ clauses 
7i7 ?r\gh 7iii7 z subclauses 7,i7 ?r\gh 
7,,iii71 respectively1 & ind5t+         
appropriately2  7,c7 by /rik+ all       
,s,n,ps4--,! requirem5ts & ins]t+ 8all  
,s,n,ps4--  7,a7 ,9 g5]al ,subject to   
subp>agraph 7,b71 ! requirem5ts  2 &    
7,d7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,b7 ,improvem5ts to c>e  
managem5t requirem5ts = sev]e or disabl+
 *ronic condition ,s,n,ps ,= #bjbj &    
subsequ5t ye>s1 9 ! case ( a specializ$ 
,,ma plan = special ne$s individuals    

describ$ 9 subsection 7b77#f77;,b77iii71
 ! requirem5ts describ$ 9 ?is p>agraph  
include ! foll[+3  7i7 ,! int]discipl9>y
 team "u subp>agraph 7,a77ii77,,iii7    
includes a team ( provid]s ) demon/rat$ 
exp]tise1 includ+ tra9+ 9 an applicable 
specialty1 9 treat+ individuals simil>  
to ! t>get$ population ( ! plan4  7ii7  
,requirem5ts develop$ by ! ,secret>y to 
provide face-to-face enc\nt]s )         
individuals enroll$ 9 ! plan n less     
frequ5tly ?an on an annual basis4  7iii7
 ,z "p ( ! model ( c>e "u clause 7i7 (  
subp>agraph 7,a71 ! results ( ! initial 
assessm5t & annual reassessm5t "u clause
 7ii77,i7 ( su* subp>agraph ( ea*       
individual enroll$ 9 ! plan are address$
 9 ! individual's individualiz$ c>e plan
 "u clause 7ii77,,ii7 ( su* subp>agraph4
  7iv7 ,z "p ( ! annual evaluation &    
approval ( su* model ( c>e1 ! ,secret>y 
%all take into acc\nt :e!r ! plan       
fulfill$ ! previ\s ye>'s goals 7z       
requir$ "u ! model ( c>e74  7v7 ,!      
,secret>y %all e/abli% a m9imum b5*m>k =

 ea* elem5t ( ! model ( c>e ( a plan4 ,!
 ,secret>y %all only approve a plan's   
model ( c>e "u ?is p>agraph if ea*      
elem5t ( ! model ( c>e meets ! m9imum   
b5*m>k applicable "u ! prec$+ s5t5ce4  4
  7#b7 ,revisions to ! def9ition ( a    
sev]e or disabl+ *ronic conditions      
specializ$ ne$s individual  7,a7 ,9     
g5]al ,section #ahei7;b77#f77;,b77iii7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#bh7;b77#f77;,b77iii77 is       
am5d$--  7i7 by /rik+ :o h & ins]t+     
8:o--  7,i7 be=e ,janu>y #a1 #bjbb1 h  2
  7ii7 9 subclause 7,i71 z add$ by      
clause 7i71 by /rik+ ! p]iod at ! end & 
ins]t+ 2 &2 &  7iii7 by add+ at ! end ! 
foll[+ new subclause3  7,,ii7 on or aft]
 ,janu>y #a1 #bjbb1 h "o or m comorbid &
 m$ically complex *ronic conditions t is
 life ?reat5+ or significantly limits   
ov]all heal? or function1 h a high risk 
( hospitalization or o!r adv]se heal?   
outcomes1 & require int5sive c>e        
coord9ation & t is li/$ "u subsection   
7f77#i77;,a74  4  7,b7 ,panel ( cl9ical 

advisors ,section #ahei7;f7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7;f771 z am5d$ by subsection  
7b71 is am5d$ by add+ at ! end ! foll[+ 
new p>agraph3  7#i7 ,li/ ( conditions = 
cl>ification ( ! def9ition ( a sev]e or 
disabl+ *ronic conditions specializ$    
ne$s individual  7,a7 ,9 g5]al ,n lat]  
?an ,decemb] #ca1 #bjbj1 & e #e ye>s    
!reaft]1 ! ,secret>y %all conv5e a panel
 ( cl9ical advisors to e/abli% & update 
a li/ ( conditions t meet ea* ( ! foll[+
 crit]ia3  7i7 ,conditions t meet !     
def9ition ( a sev]e or disabl+ *ronic   
condition "u subsection                 
7b77#f77;,b77iii7 on or aft] ,janu>y #a1
 #bjbb4  7ii7 ,conditions t require     
prescription drugs1 provid]s1 & models (
 c>e t are unique to ! specific         
population ( enrollees 9 a specializ$   
,,ma plan = special ne$s individuals    
describ$ 9 su* subsection on or aft] su*
 date &--  7,i7 z a result ( su* special
 ne$s individuals ) su* a condition hav+
 access to & be+ enroll$ 9 su* a plan1 z

 comp>$ to access to & enrollm5t 9 o!r  
,m$ic>e ,advantage plans "u ?is "p1 x is
 project$ t su* individuals w\ld improve
 heal? outcomes ) respect to su*        
condition1 t su* individuals w\ld h     
r$uc$ ov]all co/s "u ?is title1 & t !re 
w\ld n be any increase 9 exp5ditures "u 
?is title = su* individuals2 or  7,,ii7 
h a l[ preval5ce 9 ! g5]al population ( 
b5efici>ies "u ?is title or a           
disproportionally high p]-b5efici>y co/ 
"u ?is title4  7,b7 ,,gao ,/udy on      
,heal? ,outcomes ( ,individuals ,enroll$
 9 ,specializ$ ,,ma plans ,n lat] ?an ! 
date t is #c ye>s aft] ! date ( !       
enactm5t ( ?is p>agraph1 ! ,comptroll]  
,g5]al ( ! ,unit$ ,/ates %all conduct a 
/udy & submit to ,congress a report on !
 ext5t to :i* heal? outcomes c be comp>$
 across specializ$ ,,ma plans = special 
ne$s individuals 7z def9$ 9 section     
#ahei7;b77#f77 & o!r ,m$ic>e ,advantage 
plans "u ?is "p across simil>           
populations1 us+ exi/+ measures & t     
id5tifies any pot5tial limitations :]e  

new measures may ne$ to be develop$ =   
su* population4  4  7d7 ,quality        
measurem5t at ! plan level = ,s,n,ps &  
det]m9ation ( feasability ( quality     
measurem5t at ! plan level = all ,,ma   
plans ,section #ahec7o7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7o77 is am5d$ by add+ at ! end
 ! foll[+ new p>agraphs3  7#f7 ,quality 
measurem5t at ! plan level = ,s,n,ps    
7,a7 ,9 g5]al ,subject to subp>agraph   
7,b71 ! ,secret>y may require report+ ( 
data "u section #aheb7;e7 =1 & apply "u 
?is subsection1 quality measures at !   
plan level = specializ$ ,,ma plans =    
special ne$s individuals in/ead ( at !  
contract level4  7,b7 ,consid]ations    
,prior to apply+ quality measurem5t at !
 plan level "u ?is p>agraph1 ! ,secret>y
 %all-- 7i7 take into consid]ation !    
m9imum numb] ( enrollees 9 a specializ$ 
,,ma plan = special ne$s individuals 9  
ord] to det]m9e if a /ati/ically        
significant or valid measurem5t (       
quality at ! plan level is possible "u  

?is p>agraph2  7ii7 if quality measures 
are report$ at ! plan level1 ensure t   
,,ma plans are n requir$ to provide     
duplicative in=mation2 &  7iii7 ensure t
 su* report+ does n int]f]e ) !         
collection ( enc\nt] data submitt$ by   
,,ma organizations or ! adm9i/ration (  
any *anges to ! program "u ?is "p z a   
result ( ! collection ( su* data4  7,c7 
,application ,if ! ,secret>y applies    
quality measurem5t at ! plan level "u   
?is p>agraph-- 7i7 su* quality          
measurem5t may include ,m$ic>e ,heal?   
,outcomes ,survey 7,,hos71 ,heal?c>e    
,effectiv5ess ,data & ,in=mation ,set   
7,,h$is71 ,consum] ,assessm5t (         
,heal?c>e ,provid]s & ,sy/ems 7,,cahps7 
measures & quality measures "u "p ,d2 & 
7ii7 ! ,secret>y %all consid] apply+    
adm9i/rative actions1 su* z rem$ies     
describ$ 9 section #aheg7;g77#b71 to !  
plan level4  7#g7 ,det]m9ation (        
feasibility ( quality measurem5t at !   
plan level = all ,,ma plans  7,a7       
,det]m9ation ( feasibility ,! ,secret>y 

%all det]m9e ! feasibility ( requir+    
report+ ( data "u section #aheb7;e7 =1 &
 apply+ "u ?is subsection1 quality      
measures at ! plan level = all ,,ma     
plans "u ?is "p4  7,b7 ,consid]ation (  
*ange ,aft] mak+ a det]m9ation "u       
subp>agraph 7,a71 ! ,secret>y %all      
consid] requir+ su* report+ & apply+ su*
 quality measures at ! plan level z     
describ$ 9 su* subp>agraph4  4  7e7     
,,gao /udy & report on ,/ate-,level     
integration betwe5 dual ,s,n,ps &       
,m$icaid  7#a7 ,/udy ,! ,comptroll]     
,g5]al ( ! ,unit$ ,/ates 79 ?is p>agraph
 ref]r$ to z ! ,comptroll] ,g5]al7 %all 
conduct a /udy on ,/ate-level           
integration betwe5 specializ$ ,,ma plans
 = special ne$s individuals describ$ 9  
subsection 7b77#f77;,b77ii7 ( section   
#ahei ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciew-#bh7 & ! ,m$icaid      
program "u title ,,xix ( su* ,act 7#db  
,u4,s4,c4 #acif et seq474 ,su* /udy %all
 include an analysis ( ! foll[+3  7,a7  
,! *>act]i/ics ( ,/ates 9 :i* ! ,/ate   

ag5cy responsible = adm9i/]+ ! ,/ate    
plan "u su* title ,,xix has a contract )
 su* a specializ$ ,,ma plan & t deliv]s 
long t]m s]vices & supports "u ! ,/ate  
plan "u su* title ,,xix ?r\gh a manag$  
c>e program1 includ+ ! requirem5ts "u   
su* ,/ate plan ) respect to long t]m    
s]vices & supports4  7,b7 ,! types ( su*
 specializ$ ,,ma plans1 :i* may include 
! foll[+3 7i7 ,a plan describ$ 9 section
 #ahec7;a77#a77;,b77iv77,,ii7 ( su* ,act
 7#db ,u4,s4,c4                         
#aciew-#bc7;a77#a77;,b77iv77,,ii774     
7ii7 ,a plan t meets ! requirem5ts      
describ$ 9 subsection 7f77#c77;,d7 ( su*
 section #ahei4  7iii7 ,a plan describ$ 
9 clause 7ii7 t also meets additional   
requirem5ts e/abli%$ by ! ,/ate4  7,c7  
,! *>act]i/ics ( individuals enroll$ 9  
su* specializ$ ,,ma plans4  7,d7 ,z     
practicable1 ! foll[+ ) respect to ,/ate
 programs = ! deliv]y ( long t]m s]vices
 & supports "u su* title ,,xix ?r\gh a  
manag$ c>e program3  7i7 ,:i*           
populations ( individuals are eligible  

to receive su* s]vices & supports4  7ii7
 ,:e!r all su* s]vices & supports are   
provid$ on a capitat$ basis or if any ( 
su* s]vices & supports are c>v$ out &   
provid$ ?r\gh fee-=-s]vice4  7,e7 ,z1   
practicable1 h[ ! availability &        
v>iation ( integration arrangem5ts ( su*
 specializ$ ,,ma plans (f]$ 9 ,/ates    
affects sp5d+1 s]vice deliv]y options1  
access to community-bas$ c>e1 &         
utilization ( c>e4  7,f7 ,b>ri]s &      
opportunities = mak+ fur!r progress on  
dual integration1 z well z recomm5d     
legislation to exp$ite or ref9e pa?ways 
t[>d fully integrat$ c>e4  7#b7 ,report 
,n lat] ?an #b ye>s aft] ! date ( !     
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al %all submit to ,congress a report
 conta9+ ! results ( ! /udy conduct$ "u 
p>agraph 7#a71 toge!r ) recomm5dations =
 su* legislation & adm9i/rative action z
 ! ,comptroll] ,g5]al det]m9es          
appropriate4  #c4 ,exp&+ supplem5tal    
b5efits to meet ! ne$s ( *ronically ill 
m$ic>e advantage enrollees  7a7 ,9 g5]al

 ,section #aheb7;a77#c7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7;a77#c77 is am5d$-- 7#a7 9   
subp>agraph 7,a71 by /rik+ ,ea* & ins]t+
 ,subject to subp>agraph 7,d71 ea*2 &   
7#b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,d7 ,exp&+ supplem5tal   
b5efits to meet ! ne$s ( *ronically ill 
enrollees  7i7 ,9 g5]al ,= plan ye>     
#bjbj & subsequ5t plan ye>s1 9 addition 
to any supplem5tal heal? c>e b5efits    
o!rwise provid$ "u ?is p>agraph1 an ,,ma
 plan1 includ+ a specializ$ ,,ma plan = 
special ne$s individuals describ$ 9     
subsection 7b77#f7 ( section #ahei1 may 
provide supplem5tal b5efits describ$ 9  
clause 7ii7 to a *ronically ill enrollee
 7z def9$ 9 clause 7iii774  7ii7        
,supplem5tal b5efits describ$  7,i7 ,9  
g5]al ,supplem5tal b5efits describ$ 9   
?is clause are supplem5tal b5efits t1 ) 
respect to a *ronically ill enrollee1 h 
a reasonable expectation ( improv+ or   
ma9ta9+ ! heal? or ov]all function ( !  
*ronically ill enrollee & may n be      

limit$ to be+ prim>ily heal? relat$     
b5efits4  7,,ii7 ,au?ority to waive     
uni=mity requirem5ts ,! ,secret>y may1 )
 respect to supplem5tal b5efits provid$ 
to a *ronically ill enrollee "u ?is     
subp>agraph1 waive ! uni=mity           
requirem5t1 z det]m9$ appropriate by !  
,secret>y4  7iii7 ,*ronically ill       
enrollee def9$ ,9 ?is subp>agraph1 ! t]m
 *ronically ill enrollee means an       
enrollee 9 an ,,ma plan t ! ,secret>y   
det]m9es-- 7,i7 has "o or m comorbid &  
m$ically complex *ronic conditions t is 
life ?reat5+ or significantly limits !  
ov]all heal? or function ( ! enrollee2  
7,,ii7 has a high risk ( hospitalization
 or o!r adv]se heal? outcomes2 or       
7,,iii7 requires int5sive c>e           
coord9ation4  4  7b7 ,,gao ,/udy ,&     
,report  7#a7 ,/udy ,! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates 79 ?is         
subsection ref]r$ to z ! ,comptroll]    
,g5]al7 %all conduct a /udy on          
supplem5tal b5efits provid$ to enrollees
 9 ,m$ic>e ,advantage plans "u "p ,c (  

title ,,xviii ( ! ,social ,security     
,act1 includ+ specializ$ ,,ma plans =   
special ne$s individuals describ$ 9     
section #ahei7;b77#f7 ( su* ,act 7#db   
,u4,s4,c4 #aciew-#bh7;b77#f774 ,su* /udy
 %all be conduct$ 9 consultation ) !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices &   
,m$ic>e ,advantage plans z necess>y &1  
to ! ext5t data is available1 %all      
include an analysis ( ! foll[+3  7,a7 ,!
 type ( supplem5tal b5efits provid$ to  
su* enrollees1 ! total numb] ( enrollees
 receiv+ ea* supplem5tal b5efit1 & :e!r 
! supplem5tal b5efit is cov]$ by ! /&>d 
b5*m>k co/ ( ! b5efit or ) an additional
 premium4  7,b7 ,! frequ5cy 9 :i*       
supplem5tal b5efits are utiliz$ by su*  
enrollees4  7,c7 ,! impact supplem5tal  
b5efits h on--  7i7 indicators ( !      
quality ( c>e receiv$ by su* enrollees1 
includ+ ov]all heal? & function ( !     
enrollees2  7ii7 ! utilization ( items &
 s]vices = :i* b5efits are available "u 
! orig9al ,m$ic>e fee-=-s]vice program  
option "u p>ts ,a & ,b ( su* title      

,,xviii by su* enrollees2 &  7iii7 !    
am\nt ( ! bids submitt$ by ,m$ic>e      
,advantage ,organizations = ,m$ic>e     
,advantage plans "u su* "p ,c4  7#b7    
,report ,n lat] ?an #e ye>s aft] ! date 
( ! enactm5t ( ?is ,act1 ! ,comptroll]  
,g5]al %all submit to ,congress a report
 conta9+ ! results ( ! /udy conduct$ "u 
p>agraph 7#a71 toge!r ) recomm5dations =
 su* legislation & adm9i/rative action z
 ! ,comptroll] ,g5]al det]m9es          
appropriate4  ,decemb] #ba1 #bjag       
,report$ f ! ,committee on ,ways &      
,means ) an amendment,december #ba1     
#bjag,! ,committee on ,en]gy & ,comm]ce 
dis*>g$2 committ$ to ! ,committee ( !   
,:ole ,h\se on ! ,/ate ( ! ,union &     
ord]$ to be pr9t$