#aae? ,,congress  #a/ ,session  ,h4 ,r4 
#cibb  ,,an ,,act  ,to ext5d fund+ =    
c]ta9 public heal? programs1 & = o!r    
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,cont9u+ ,community ,heal? 
,& ,m$ical ,pr(essional ,programs to    
,improve ,our ,nation1 ,increase        
,national ,ga9s1 & ,help ,ensure ,access
 = ,little ,ones1 ,toddl]s1 & ,hopeful  
,y\? by ,keep+ ,insurance ,deliv]y      
,/able ,act ( #bjag or ! ,,*ampion+     
,,heal?y ,,kids ,act4  #b4 ,table (     
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3  ,sec4 #a4 ,%ort title4 ,sec4
 #b4 ,table ( cont5ts4 ,division        
,a--,,*ampion ,act ,sec4 #ajj4 ,%ort    
title4 ,title ,i--,ext5sion ( ,public   
,heal? ,programs ,sec4 #aja4 ,ext5sion =
 community heal? c5t]s1 ! ,national     
,heal? ,s]vice ,corps1 & tea*+ heal?    
c5t]s t op]ate ,,gme programs4 ,sec4    
#ajb4 ,ext5sion = special diabetes      
programs4 ,sec4 #ajc4 ,ext5sion =       
family-to-family heal? in=mation c5t]s4 
,sec4 #ajd4 ,y\? emp[]m5t program2      

p]sonal responsibility education4 ,title
 ,,ii--,(fsets ,sec4 #bja4 ,provid+ =   
qualifi$ heal? plan grace p]iod         
requirem5ts = issu] receipt ( advance   
paym5ts ( co/-%>+ r$uctions & premium   
tax cr$its t are m consi/5t ) ,/ate law 
grace p]iod requirem5ts4 ,sec4 #bjb4    
,prev5tion & ,public ,heal? ,fund4      
,division ,b--,,heal?y ,,kids ,act ,sec4
 #cjj4 ,%ort title4 ,title ,i--,,*ip    
,ext5sion & ,o!r ,m$icaid & ,,*ip       
,provisions ,sec4 #cja4 ,five-ye> fund+ 
ext5sion ( ! ,*ildr5's ,heal? ,insurance
 ,program4 ,sec4 #cjb4 ,ext5sion ( c]ta9
 programs & demon/ration projects4 ,sec4
 #cjc4 ,ext5sion ( outrea* & enrollm5t  
program4 ,sec4 #cjd4 ,ext5sion &        
r$uction ( additional ,f$]al f9ancial   
p>ticipation = ,,*ip4 ,sec4 #cje4       
,modify+ r$uctions 9 ,m$icaid ,,d%      
allotm5ts4 ,sec4 #cjf4 ,pu]to ,rico & ! 
,virg9 ,isl&s ,m$icaid paym5ts4 ,title  
,,ii--,(fsets ,sec4 #dja4 ,m$icaid ?ird 
p>ty liability provisions4 ,sec4 #djb4  
,treatm5t ( lott]y w9n+s & o!r lump-sum 

income = purposes ( income eligibility  
"u ,m$icaid4 ,sec4 #djc4 ,adju/m5ts to  
,m$ic>e "p ,b & "p ,d premium subsidies 
= high] income individuals4  ,a         
,,*ampion ,act  #ajj4 ,%ort title ,?is  
division may be cit$ z ! ,community     
,heal? ,& ,m$ical ,pr(essionals ,improve
 ,our ,nation ,act ( #bjag or !         
,,*ampion ,act4  ,i ,ext5sion ( ,public 
,heal? ,programs  #aja4 ,ext5sion =     
community heal? c5t]s1 ! ,national      
,heal? ,s]vice ,corps1 & tea*+ heal?    
c5t]s t op]ate ,,gme programs  7a7      
,community heal? c5t]s fund+ ,section   
#ajejc7;b77#a77;,e7 ( ! ,pati5t         
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #bed;b-#b7;b77#a77;,e77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7b7 ,o!r community heal? c5t]s          
provisions ,section #ccj ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;b7 is am5d$-- 7#a7 9 subsection    
7b77#a77;,a77ii71 by /rik+ abuse &      
ins]t+ use disord]2  7#b7 9 subsection  
7b77#b77;,a71 by /rik+ abuse & ins]t+   

use disord]2  7#c7 9 subsection 7c7--   
7,a7 9 p>agraph 7#a71 by /rik+          
subp>agraphs 7,b7 ?r\gh 7,d72  7,b7 by  
/rik+ 7#a7 ,9 g5]al & all t foll[s ?r\gh
 ,! ,secret>y & ins]t+ ! foll[+3  7#a7  
,c5t]s ,! ,secret>y  2 &  7,c7 9        
p>agraph 7#a71 z am5d$1 by r$esignat+   
clauses 7i7 ?r\gh 7v7 z subp>agraphs    
7,a7 ?r\gh 7,e7 & mov+ ! m>g9 ( ea* (   
su* r$esignat$ subp>agraph #b ems to !  
left2  7#d7 by /rik+ subsection 7d7 &   
ins]t+ ! foll[+3  7d7 ,improv+ quality (
 c>e  7#a7 ,supplem5tal aw>ds ,!        
,secret>y may aw>d supplem5tal grant    
funds to heal? c5t]s fund$ "u ?is       
section to implem5t evid5ce-bas$ models 
= increas+ access to high-quality prim>y
 c>e s]vices1 :i* may include models    
relat$ to--  7,a7 improv+ ! deliv]y (   
c>e = individuals ) multiple *ronic     
conditions2  7,b7 work=ce configuration2
  7,c7 r$uc+ ! co/ ( c>e2  7,d7 enhanc+ 
c>e coord9ation2  7,e7 exp&+ ! use (    
teleheal? & te*nology-enabl$            
collaborative le>n+ & capacity build+   

models2  7,f7 c>e integration1 includ+  
integration ( behavioral heal?1 m5tal   
heal?1 or sub/ance use disord] s]vices2 
&  7,g7 address+ em]g+ public heal? or  
sub/ance use disord] issues to meet !   
heal? ne$s ( ! population s]v$ by !     
heal? c5t]4  7#b7 ,su/a9ability ,9 mak+ 
supplem5tal aw>ds "u ?is subsection1 !  
,secret>y may consid] :e!r ! heal? c5t] 
involv$ has submitt$ a plan = cont9u+ ! 
activities fund$ "u ?is subsection aft] 
supplem5tal fund+ is exp5d$4  7#c7      
,special consid]ation ,! ,secret>y may  
give special consid]ation to            
applications = supplem5tal fund+ "u ?is 
subsection t seek to address significant
 b>ri]s to access to c>e 9 areas ) a    
great] %ortage ( heal? c>e provid]s &   
heal? s]vices relative to ! national    
av]age4  2  7#e7 9 subsection 7e77#a7-- 
7,a7 9 subp>agraph 7,b7-- 7i7 by /rik+  
#b ye>s & ins]t+ #a ye>2 &  7ii7 by add+
 at ! end ! foll[+3 ,! ,secret>y %all n 
make a grant "u ?is p>agraph unless !   
applicant provides assurances to !      

,secret>y t )9 #abj days ( receiv+ grant
 fund+ = ! op]ation ( ! heal? c5t]1 !   
applicant w submit1 = approval by !     
,secret>y1 an implem5tation plan to meet
 ! requirem5ts ( subsection 7k77#c74 ,! 
,secret>y may ext5d su* #abj-;day p]iod 
= a*iev+ compliance ^u a demon/ration ( 
good cause by ! heal? c5t]42 &  7,b7 9  
subp>agraph 7,c7--  7i7 9 ! subp>agraph 
head+1 by /rik+ & plans2  7ii7 by /rik+ 
or plan 7z describ$ 9 subp>agraphs 7,b7 
& 7,c7 ( subsection 7c77#a772  7iii7 by 
/rik+ or plan1 includ+ ! pur*ase &      
ins]t+ ! foll[+3 8includ+--  7i7 !      
pur*ase  2  7iv7 by ins]t+ 1 :i* may    
include data & in=mation sy/ems aft] (  
equipm5t2  7v7 by /rik+ ! p]iod at ! end
 & ins]t+ a semicolon2 &  7vi7 by add+  
at ! end ! foll[+3  7ii7 ! provision (  
tra9+ & te*nical assi/ance2 &  7iii7 o!r
 activities t-- 7,i7 r$uce co/s         
associat$ ) ! provision ( heal? s]vices2
  7,,ii7 improve access to1 &           
availability (1 heal? s]vices provid$ to
 individuals s]v$ by ! c5t]s2  7,,iii7  

enhance ! quality & coord9ation ( heal? 
s]vices2 or  7,,iv7 improve ! heal?     
/atus ( communities4  2  7#f7 9         
subsection 7e77#e77;,b7--  7,a7 9 !     
head+ ( subp>agraph 7,b71 by /rik+ &    
plans2 &  7,b7 by /rik+ & subp>agraphs  
7,b7 & 7,c7 ( subsection 7c77#a7 to a   
heal? c5t] or to a network or plan &    
ins]t+ to a heal? c5t] or to a network2 
7#g7 9 subsection 7e71 by add+ at ! end 
! foll[+3  7#f7 ,new access po9ts &     
exp&$ s]vices  7,a7 ,approval ( new     
access po9ts  7i7 ,9 g5]al ,! ,secret>y 
may approve applications = grants "u    
subp>agraph 7,a7 or 7,b7 ( p>agraph 7#a7
 to e/abli% new deliv]y sites4  7ii7    
,special consid]ation ,9 c>ry+ out      
clause 7i71 ! ,secret>y may give special
 consid]ation to applicants t h         
demon/rat$ ! new deliv]y site w be      
locat$ )9 a sp>sely populat$ area1 or an
 area :i* has a level ( unmet ne$ t is  
high] relative to o!r applicants4  7iii7
 ,consid]ation ( applications ,9 c>ry+  
out clause 7i71 ! ,secret>y %all approve

 applications = grants 9 su* a mann] t !
 ratio ( ! m$ically und]s]v$ populations
 9 rural areas :i* may be expect$ to use
 ! s]vices provid$ by ! applicants      
involv$ to ! m$ically und]s]v$          
populations 9 urban areas :i* may be    
expect$ to use ! s]vices provid$ by !   
applicants is n less ?an two to ?ree or 
great] ?an ?ree to two4  7iv7 ,s]vice   
area ov]lap ,if 9 c>ry+ out clause 7i7 !
 applicant proposes to s]ve an area t is
 curr5tly s]v$ by ano!r heal? c5t] fund$
 "u ?is section1 ! ,secret>y may consid]
 :e!r ! aw>d ( fund+ to an additional   
heal? c5t] 9 ! area c be ju/ifi$ bas$ on
 ! unmet ne$ = additional s]vices )9 !  
cat*m5t area4  7,b7 ,approval ( exp&$   
s]vice applications  7i7 ,9 g5]al ,!    
,secret>y may approve applications =    
grants "u subp>agraph 7,a7 or 7,b7 (    
p>agraph 7#a7 to exp& ! capacity ( !    
applicant to provide requir$ prim>y     
heal? s]vices describ$ 9 subsection     
7b77#a7 or additional heal? s]vices     
describ$ 9 subsection 7b77#b74  7ii7    

,priority expansion projects ,9 c>ry+   
out clause 7i71 ! ,secret>y may give    
special consid]ation to exp&$ s]vice    
applications t seek to address em]g+    
public heal? or behavioral heal?1 m5tal 
heal?1 or sub/ance abuse issues ?r\gh   
increas+ ! availability ( additional    
heal? s]vices describ$ 9 subsection     
7b77#b7 9 an area 9 :i* !re are         
significant b>ri]s to access+ c>e4      
7iii7 ,consid]ation ( applications ,9   
c>ry+ out clause 7i71 ! ,secret>y %all  
approve applications = grants 9 su* a   
mann] t ! ratio ( ! m$ically und]s]v$   
populations 9 rural areas :i* may be    
expect$ to use ! s]vices provid$ by !   
applicants involv$ to ! m$ically        
und]s]v$ populations 9 urban areas :i*  
may be expect$ to use ! s]vices provid$ 
by su* applicants is n less ?an two to  
?ree or great] ?an ?ree to two4  2  7#h7
 9 subsection 7h7-- 7,a7 9 p>agraph     
7#a71 by /rik+ & *ildr5 & y\? at risk ( 
homelessness & ins]t+ 1 *ildr5 & y\? at 
risk ( homelessness1 homeless vet]ans1 &

 vet]ans at risk ( homelessness2 &  7,b7
 9 p>agraph 7#e7-- 7i7 by /rik+         
subp>agraph 7,b72  7ii7 by r$esignat+   
subp>agraph 7,c7 z subp>agraph 7,b72 &  
7iii7 9 subp>agraph 7,b7 7z s           
r$esignat$7--  7,i7 9 ! subp>agraph     
head+1 by /rik+ abuse & ins]t+ use      
disord]2 &  7,,ii7 by /rik+ abuse &     
ins]t+ use disord]2  7#i7 9 subsection  
7k7-- 7,a7 9 p>agraph 7#b7--  7i7 9 !   
p>agraph head+1 by ins]t+ unmet be=e    
ne$2  7ii7 9 ! matt] prec$+ subp>agraph 
7,a71 by ins]t+ or subsection 7e77#f7   
aft] subsection 7e77#a72  7iii7 9       
subp>agraph 7,a71 by ins]t+ unmet be=e  
ne$ = heal? s]vices2  7iv7 9 subp>agraph
 7,b71 by /rik+ & at ! end2  7v7 9      
subp>agraph 7,c71 by /rik+ ! p]iod at ! 
end & ins]t+ 2 &2 &  7vi7 by add+ aft]  
subp>agraph 7,c7 ! foll[+3  7,d7 9 !    
case ( an application = a grant pursuant
 to subsection 7e77#f71 a demon/ration t
 ! applicant has consult$ ) appropriate 
,/ate & local gov]nm5t ag5cies1 & heal? 
c>e provid]s reg>d+ ! ne$ = ! heal?     

s]vices to be provid$ at ! propos$      
deliv]y site4  2  7,b7 9 p>agraph 7#c7--
  7i7 9 ! matt] prec$+ subp>agraph 7,a71
 by ins]t+ or subsection 7e77#f7 aft]   
subsection 7e77#a77;,b72  7ii7 9        
subp>agraph 7,b71 by /rik+ 9 ! cat*m5t  
area ( ! c5t] & ins]t+ 1 includ+ o!r    
heal? c>e provid]s t provide c>e )9 !   
cat*m5t area1 local hospitals1 &        
specialty provid]s 9 ! cat*m5t area ( ! 
c5t]1 to provide access to s]vices n    
available ?r\gh ! heal? c5t] & to r$uce 
! non-urg5t use ( hospital em]g5cy      
dep>tm5ts2  7iii7 9 subp>agraph         
7,h77ii71 by ins]t+ :o %all be directly 
employ$ by ! c5t] aft] approves !       
selection ( a director = ! c5t]2  7iv7 9
 subp>agraph 7,l71 by /rik+ & at ! end2 
7v7 9 subp>agraph 7,m71 by /rik+ ! p]iod
 & ins]t+ 2 &2 &  7vi7 by ins]t+ aft]   
subp>agraph 7,m71 ! foll[+3  7,n7 ! c5t]
 has writt5 policies & proc$ures 9 place
 to ensure ! appropriate use ( ,f$]al   
funds 9 compliance ) applicable ,f$]al  
/atutes1 regulations1 & ! t]ms &        

conditions ( ! ,f$]al aw>d4  2 &  7,c7  
by /rik+ p>agraph 7#d72  7#aj7 9        
subsection 7l71 by add+ at ! end !      
foll[+3 ,funds exp5d$ to c>ry out       
activities "u ?is subsection &          
op]ational support activities "u        
subsection 7m7 %all n exce$ #c p]c5t ( !
 am\nt appropriat$ = ?is section = !    
fiscal ye> involv$42  7#aa7 9 subsection
 7q77#d71 by add+ at ! end ! foll[+3 ,a 
waiv] provid$ by ! ,secret>y "u ?is     
p>agraph may n rema9 9 effect = m ?an #a
 ye> & may n be ext5d$ aft] su* p]iod4  
,an entity may n receive m ?an "o waiv] 
"u ?is p>agraph 9 consecutive ye>s42    
7#ab7 9 subsection 7r77#c7-- 7,a7 by    
/rik+ appropriate committees ( ,congress
 a report conc]n+ ! di/ribution ( funds 
"u ?is section & ins]t+ ! foll[+3       
8,committee on ,heal?1 ,education1      
,labor1 & ,p5sions ( ! ,s5ate1 & !      
,committee on ,en]gy & ,comm]ce ( !     
,h\se ( ,repres5tatives1 a report       
includ+1 at a m9imum--  7,a7 !          
di/ribution ( funds = c>ry+ out ?is     

section  2  7,b7 by /rik+ populations4  
,su* report %all include an assessm5t & 
ins]t+ ! foll[+3 8populations2  7,b7 an 
assessm5t  2  7,c7 by /rik+ & !         
rationale = any sub/antial *anges 9 !   
di/ribution ( funds4 & ins]t+ a         
semicolon2 &  7,d7 by add+ at ! end !   
foll[+3  7,c7 ! di/ribution ( aw>ds &   
fund+ = new or exp&$ s]vices 9 ea* (    
rural areas & urban areas2  7,d7 !      
di/ribution ( aw>ds & fund+ = e/abli%+  
new access po9ts1 & ! numb] ( new access
 po9ts creat$2  7,e7 ! am\nt ( unexp5d$ 
fund+ = loan gu>antees & loan gu>antee  
au?ority "u title ,,xvi2  7,f7 !        
rationale = any sub/antial *anges 9 !   
di/ribution ( funds2  7,g7 ! rate (     
closures = heal? c5t]s & access po9ts2  
7,h7 ! numb] & reason = any grants aw>d$
 pursuant to subsection 7e77#a77;,b72 & 
7,i7 ! numb] & reason = any waiv]s      
provid$ pursuant to subsection 7q77#d74 
2  7#ac7 9 subsection 7r71 by add+ at ! 
end ! foll[+ new p>agraph3  7#e7 ,fund+ 
= p>ticipation ( heal? c5t]s 9 ,all ( ,u

 ,rese>* ,program ,9 addition to any    
am\nts made available pursuant to       
p>agraph 7#a7 ( ?is subsection1 section 
#djb;,a ( ?is ,act1 or section #ajejc ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act1 !re is au?oriz$ to be appropriat$1
 & !re is appropriat$1 out ( any monies 
9 ! ,treasury n o!rwise appropriat$1 to 
! ,secret>y #be1jjj1jjj = fiscal ye>    
#bjah to support ! p>ticipation ( heal? 
c5t]s 9 ! ,all ( ,u ,rese>* ,program "u 
! ,precision ,m$ic9e ,initiative "u     
section #dih;,e ( ?is ,act4  2 &  7#ad7 
by /rik+ subsection 7s74  7c7 ,national 
,heal? ,s]vice ,corps ,section          
#ajejc7;b77#b77;,e7 ( ! ,pati5t         
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #bed;b-#b7;b77#b77;,e77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7d7 ,tea*+ heal? c5t]s t op]ate graduate
 m$ical education programs  7#a7        
,paym5ts ,subsection 7a7 ( section      
#cdj;,h ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bef;h7 is am5d$ to read 
z foll[s3  7a7 ,paym5ts  7#a7 ,9 g5]al  

,subject to subsection 7h77#b71 !       
,secret>y %all make paym5ts "u ?is      
section = direct exp5ses & indirect     
exp5ses to qualifi$ tea*+ heal? c5t]s t 
are li/$ z sponsor+ in/itutions by !    
relevant accr$it+ body =1 z             
appropriate--  7,a7 ma9t5ance ( exi/+   
approv$ graduate m$ical resid5cy tra9+  
programs2  7,b7 expansion ( exi/+       
approv$ graduate m$ical resid5cy tra9+  
programs2 &  7,c7 e/abli%m5t ( new      
approv$ graduate m$ical resid5cy tra9+  
programs4  7#b7 ,priority ,9 mak+       
paym5ts pursuant to p>agraph 7#a77;,c71 
! ,secret>y %all give priority to       
qualifi$ tea*+ heal? c5t]s t--  7,a7    
s]ve a heal? pr(essional %ortage area ) 
a designation 9 effect "u section #ccb  
or a m$ically und]s]v$ community 7z     
def9$ 9 section #gii;,b72 or  7,b7 are  
locat$ 9 a rural area 7z def9$ 9 section
 #ahhf7;d77#b77;,d7 ( ! ,social         
,security ,act74  4  7#b7 ,fund+        
,subsection 7g7 ( section #cdj;,h ( !   
,public ,heal? ,s]vice ,act 7#db        

,u4,s4,c4 #bef;h7 is am5d$-- 7,a7 by    
/rik+ ,to c>ry out & ins]t+ ! foll[+3   
7#a7 ,9 g5]al ,to c>ry out  2  7,b7 by  
/rik+ & #ae1jjj1jjj = ! fir/ qu>t] (    
fiscal ye> #bjah & ins]t+ & #abf1ejj1jjj
 = ea* ( fiscal ye>s #bjah & #bjai1 to  
rema9 available until exp5d$2 &  7,c7 by
 add+ at ! end ! foll[+3  7#b7          
,adm9i/rative exp5ses ,( ! am\nt made   
available to c>ry out ?is section = any 
fiscal ye>1 ! ,secret>y may n use m ?an 
#e p]c5t ( su* am\nt = ! exp5ses (      
adm9i/]+ ?is section4  4  7#c7 ,annual  
report+ ,subsection 7h77#a7 ( section   
#cdj;,h ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bef;h7 is am5d$-- 7,a7  
by r$esignat+ subp>agraph 7,d7 z        
subp>agraph 7,h72 &  7,b7 by ins]t+ aft]
 subp>agraph 7,c7 ! foll[+3  7,d7 ,!    
numb] ( pati5ts treat$ by resid5ts      
describ$ 9 p>agraph 7#d74  7,e7 ,! numb]
 ( visits by pati5ts treat$ by resid5ts 
describ$ 9 p>agraph 7#d74  7,f7 ,( !    
numb] ( resid5ts describ$ 9 p>agraph    
7#d7 :o complet$ _! resid5cy tra9+ at ! 

end ( su* resid5cy academic ye>1 ! numb]
 & p]c5tage ( su* resid5ts ent]+ prim>y 
c>e practice 7mean+ any ( ! areas (     
practice li/$ 9 ! def9ition ( a prim>y  
c>e resid5cy program 9 section #gdi;,a74
  7,g7 ,( ! numb] ( resid5ts describ$ 9 
p>agraph 7#d7 :o complet$ _! resid5cy   
tra9+ at ! end ( su* resid5cy academic  
ye>1 ! numb] & p]c5tage ( su* resid5ts  
:o ent]$ practice at a heal? c>e        
facility-- 7i7 prim>ily s]v+ a heal?    
pr(essional %ortage area ) a designation
 9 effect "u section #ccb or a m$ically 
und]s]v$ community 7z def9$ 9 section   
#gii;,b72 or  7ii7 locat$ 9 a rural area
 7z def9$ 9 section #ahhf7;d77#b77;,d7 (
 ! ,social ,security ,act74  4  7#d7    
,report on tra9+ co/s ,n lat] ?an ,m>*  
#ca1 #bjai1 ! ,secret>y ( ,heal? &      
,human ,s]vices %all submit to !        
,congress a report on ! direct graduate 
exp5ses ( approv$ graduate m$ical       
resid5cy tra9+ programs1 & ! indirect   
exp5ses associat$ ) ! additional co/s ( 
tea*+ resid5ts1 ( qualifi$ tea*+ heal?  

c5t]s 7z su* t]ms are us$ or def9$ 9    
section #cdj;,h ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #bef;h774   
7#e7 ,def9ition ,subsection 7j7 (       
section #cdj;,h ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is  
am5d$-- 7,a7 by r$esignat+ p>agraphs    
7#b7 & 7#c7 z p>agraphs 7#c7 & 7#d71    
respectively2 &  7,b7 by ins]t+ aft]    
p>agraph 7#a7 ! foll[+3  7#b7 ,new      
approv$ graduate m$ical resid5cy tra9+  
program ,! t]m new approv$ graduate     
m$ical resid5cy tra9+ program means an  
approv$ graduate m$ical resid5cy tra9+  
program = :i* ! sponsor+ qualifi$ tea*+ 
heal? c5t] has n receiv$ a paym5t "u ?is
 section = a previ\s fiscal ye> 7o!r ?an
 pursuant to subsection 7a77#a77;,c774  
4  7#f7 ,te*nical correction ,subsection
 7f7 ( section #cdj;,h 7#db ,u4,s4,c4   
#bef;h7 is am5d$ by /rik+ hospital ea*  
place x appe>s & ins]t+ tea*+ heal?     
c5t]4  7#g7 ,paym5ts = previ\s fiscal   
ye>s ,! provisions ( section #cdj;,h ( !
 ,public ,heal? ,s]vice ,act 7#db       

,u4,s4,c4 #bef;h71 z 9 effect on ! day  
be=e ! date ( enactm5t ( ?is ,act1 %all 
cont9ue to apply ) respect to paym5ts "u
 su* section = fiscal ye>s be=e fiscal  
ye> #bjah4  7e7 ,application ,am\nts    
appropriat$ pursuant to ?is section =   
fiscal ye> #bjah or #bjai are subject to
 ! requirem5ts conta9$ 9 ,public ,law   
#aae-ca = funds = programs au?oriz$ "u  
sections #ccj ?r\gh #cdj ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;b-#bef74  7f7 ,con=m+ am5dm5ts     
,section #cjad7;h7 ( title #ah1 ,unit$  
,/ates ,code1 is am5d$--  7#a7 9        
p>agraph 7#a71 by /rik+ 1 z am5d$ by    
section #bba ( ! ,m$ic>e ,access & ,,*ip
 ,reau?orization ,act ( #bjae12 &  7#b7 
9 p>agraph 7#d71 by ins]t+ & section    
#aja7;e7 ( ! ,community ,heal? ,&       
,m$ical ,pr(essionals ,improve ,our     
,nation ,act ( #bjag aft] section       
#bba7;c7 ( ! ,m$ic>e ,access & ,,*ip    
,reau?orization ,act ( #bjae4  #ajb4    
,ext5sion = special diabetes programs   
7a7 ,special diabetes program = type ,i 

diabetes ,section #ccj;,b7b77#b77;,c7 ( 
! ,public ,heal? ,s]vice ,act 7#db      
,u4,s4,c4 #bed;c-#b7;b77#b77;,c77 is    
am5d$ by /rik+ #bjag & ins]t+ #bjai4    
7b7 ,special diabetes program = ,indians
 ,subp>agraph 7,d7 ( section            
#ccj;,c7c77#b7 ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#bed;c-#c7;c77#b77 is am5d$ to read z   
foll[s3  7,d7 #aej1jjj1jjj = ea* (      
fiscal ye>s #bjah & #bjai4  4  #ajc4    
,ext5sion = family-to-family heal?      
in=mation c5t]s ,section #eja7;c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#gja7;c77 is am5d$--  7#a7 9 p>agraph   
7#a77;,a7-- 7,a7 9 clause 7v71 by /rik+ 
& at ! end2  7,b7 9 clause 7vi71 by     
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7,c7 by add+ at ! end ! foll[+ new      
clause3  7vii7 #f1jjj1jjj = ea* ( fiscal
 ye>s #bjah & #bjai4  2  7#b7 9 p>agraph
 7#c77;,c71 by ins]t+ be=e ! p]iod !    
foll[+3 1 & ) respect to fiscal ye>s    
#bjah & #bjai1 su* c5t]s %all also be   
develop$ 9 all t]ritories & at lea/ "o  

su* c5t] %all be develop$ = ,indian     
tribes2 &  7#c7 by am5d+ p>agraph 7#e7  
to read z foll[s3  7#e7 ,= purposes (   
?is subsection--  7,a7 ! t]m ,indian    
tribe has ! mean+ giv5 su* t]m 9 section
 #d ( ! ,indian ,heal? ,c>e ,improvem5t 
,act 7#be ,u4,s4,c4 #afjc72  7,b7 ! t]m 
,/ate means ea* ( ! #ej ,/ates & !      
,di/rict ( ,columbia2 &  7,c7 ! t]m     
t]ritory means ,pu]to ,rico1 ,guam1     
,am]ican ,samoa1 ! ,virg9 ,isl&s1 & !   
,nor!rn ,m>iana ,isl&s4  4  #ajd4 ,y\?  
emp[]m5t program2 p]sonal responsibility
 education  7a7 ,y\? emp[]m5t program   
7#a7 ,9 g5]al ,section #eaj ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #gaj7 is  
am5d$ to read z foll[s3  #eaj4 ,y\?     
emp[]m5t program  7a7 ,9 g5]al  7#a7    
,allotm5ts to ,/ates ,= ! purpose       
describ$ 9 subsection 7b71 ! ,secret>y  
%all1 = ea* ( fiscal ye>s #bjah & #bjai1
 allot to ea* ,/ate :i* has transmitt$  
an application = ! fiscal ye> "u section
 #eje7;a7 an am\nt equal to ! product   
(-- 7,a7 ! am\nt appropriat$ pursuant to

 subsection 7e77#a7 = ! fiscal ye>1 m9us
 ! am\nt res]v$ "u subsection 7e77#b7 = 
! fiscal ye>2 &  7,b7 ! proportion t !  
numb] ( l[-income *ildr5 9 ! ,/ate be>s 
to ! total ( su* numb]s ( *ildr5 = all !
 ,/ates4  7#b7 ,o!r allotm5ts  7,a7 ,o!r
 entities ,= ! purpose describ$ 9       
subsection 7b71 ! ,secret>y %all1 = ea* 
( fiscal ye>s #bjah & #bjai1 = any ,/ate
 :i* has n transmitt$ an application = !
 fiscal ye> "u section #eje7;a71 allot  
to "o or m entities 9 ! ,/ate ! am\nt t 
w\ld h be5 allott$ to ! ,/ate "u        
p>agraph 7#a7 if ! ,/ate _h submitt$ su*
 an application4  7,b7 ,process ,!      
,secret>y %all select ! recipi5ts (     
allotm5ts "u subp>agraph 7,a7 by means (
 a competitive grant process "u :i*--   
7i7 n lat] ?an #cj days aft] ! deadl9e =
 ! ,/ate involv$ to submit an           
application = ! fiscal ye> "u section   
#eje7;a71 ! ,secret>y publi%es a notice 
solicit+ grant applications2 &  7ii7 n  
lat] ?an #abj days aft] su* deadl9e1 all
 su* applications mu/ be submitt$4  7b7 

,purpose  7#a7 ,9 g5]al ,except = rese>*
 "u p>agraph 7#e7 & in=mation collection
 & report+ "u p>agraph 7#f71 ! purpose (
 an allotm5t "u subsection 7a7 to a     
,/ate 7or to ano!r entity 9 ! ,/ate     
pursuant to subsection 7a77#b77 is to   
enable ! ,/ate or o!r entity to implem5t
 education exclusively on sexual risk   
avoidance 7mean+ volunt>ily refra9+ f   
sexual activity74  7#b7 ,requir$        
compon5ts ,education on sexual risk     
avoidance pursuant to an allotm5t "u ?is
 section %all-- 7,a7 ensure t !         
unambigu\s & prim>y emphasis & context =
 ea* topic describ$ 9 p>agraph 7#c7 is a
 message to y\? t normalizes ! optimal  
heal? behavior ( avoid+ nonm>ital sexual
 activity2  7,b7 be m$ically accurate & 
complete2  7,c7 be age-appropriate2 &   
7,d7 be bas$ on adolesc5t le>n+ &       
developm5tal !ories = ! age gr\p receiv+
 ! education4  7#c7 ,topics ,education  
on sexual risk avoidance pursuant to an 
allotm5t "u ?is section %all address ea*
 ( ! foll[+ topics3  7,a7 ,! holi/ic    

individual & societal b5efits associat$ 
) p]sonal responsibility1               
self-regulation1 goal sett+1 heal?y     
decisionmak+1 & a focus on ! future4    
7,b7 ,! advantage ( refra9+ f nonm>ital 
sexual activity 9 ord] to improve !     
future prospects & physical & emotional 
heal? ( y\?4  7,c7 ,! increas$          
likelihood ( avoid+ pov]ty :5 y\? atta9 
self-suffici5cy & emotional maturity    
be=e engag+ 9 sexual activity4  7,d7 ,! 
f\ndational compon5ts ( heal?y          
relation%ips & _! impact on ! =mation ( 
heal?y m>riages & safe & /able families4
  7,e7 ,h[ o!r y\? risk behaviors1 su* z
 drug & alcohol usage1 increase ! risk =
 te5 sex4  7,f7 ,h[ to resi/ & avoid1 & 
receive help reg>d+1 sexual co]cion &   
dat+ viol5ce1 recogniz+ t ev5 ) cons5t  
te5 sex rema9s a y\? risk behavior4     
7#d7 ,contraception ,education on sexual
 risk avoidance pursuant to an allotm5t 
"u ?is section %all ensure t-- 7,a7 any 
in=mation provid$ on contraception is   
m$ically accurate & ensures t /ud5ts    

und]/& t contraception (f]s physical    
risk r$uction1 b n risk elim9ation2 &   
7,b7 ! education does n include         
demon/rations1 simulations1 or          
di/ribution ( contraceptive devices4    
7#e7 ,rese>*  7,a7 ,9 g5]al ,a ,/ate or 
o!r entity receiv+ an allotm5t pursuant 
to subsection 7a7 may use up to #bj     
p]c5t ( su* allotm5t to build ! evid5ce 
base = sexual risk avoidance education  
by conduct+ or support+ rese>*4  7,b7   
,requirem5ts ,any rese>* conduct$ or    
support$ pursuant to subp>agraph 7,a7   
%all be-- 7i7 rigor\s2  7ii7            
evid5ce-bas$2 &  7iii7 design$ &        
conduct$ by indep5d5t rese>*]s :o h     
exp]i5ce 9 conduct+ & publi%+ rese>* 9  
pe]-review$ outlets4  7#f7 ,in=mation   
collection & report+ ,a ,/ate or o!r    
entity receiv+ an allotm5t pursuant to  
subsection 7a7 %all1 z specifi$ by !    
,secret>y-- 7,a7 collect in=mation on ! 
programs & activities fund$ ?r\gh !     
allotm5t2 &  7,b7 submit reports to !   
,secret>y on ! data f su* programs &    

activities4  7c7 ,national evaluation   
7#a7 ,9 g5]al ,! ,secret>y %all--  7,a7 
9 consultation ) appropriate ,/ate &    
local ag5cies1 conduct "o or m rigor\s  
evaluations ( ! education fund$ ?r\gh   
?is section & associat$ data2 &  7,b7   
submit a report to ! ,congress on !     
results ( su* evaluations1 toge!r ) a   
summ>y ( ! in=mation collect$ pursuant  
to subsection 7b77#f74  7#b7            
,consultation ,9 conduct+ ! evaluations 
requir$ by p>agraph 7#a71 includ+ !     
e/abli%m5t ( evaluation me?odologies1 ! 
,secret>y %all consult ) relevant       
/akehold]s4  7d7 ,applicability ( c]ta9 
provisions  7#a7 ,sections #ejc1 #ejg1 &
 #ejh apply to allotm5ts "u subsection  
7a7 to ! same ext5t & 9 ! same mann] z  
su* sections apply to allotm5ts "u      
section #ejb7;c74  7#b7 ,sections #eje &
 #ejf apply to allotm5ts "u subsection  
7a7 to ! ext5t det]m9$ by ! ,secret>y to
 be appropriate4  7e7 ,fund+  7#a7 ,9   
g5]al ,to c>ry out ?is section1 !re is  
appropriat$1 out ( any money 9 !        

,treasury n o!rwise appropriat$1        
#ge1jjj1jjj = ea* ( fiscal ye>s #bjah & 
#bjai4  7#b7 ,res]vation ,! ,secret>y   
%all res]ve1 = ea* ( fiscal ye>s #bjah &
 #bjai1 n m ?an #bj p]c5t ( ! am\nt     
appropriat$ pursuant to p>agraph 7#a7 = 
adm9i/]+ ! program "u ?is section1      
includ+ ! conduct+ ( national           
evaluations & ! provision ( te*nical    
assi/ance to ! recipi5ts ( allotm5ts4  4
  7#b7 ,effective date ,! am5dm5t made  
by ?is subsection takes effect on       
,octob] #a1 #bjag4  7b7 ,p]sonal        
responsibility education  7#a7 ,9 g5]al 
,section #eac ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #gac7 is am5d$--  7,a7 9
 subsection 7a77#a77;,a71 by /rik+ #bjag
 & ins]t+ #bjai2 &  7,b7 9 subsection   
7a77#d7--  7i7 9 subp>agraph 7,a71 by   
/rik+ #bjag ea* place x appe>s & ins]t+ 
#bjai2 &  7ii7 9 subp>agraph 7,b7--     
7,i7 9 ! subp>agraph head+1 by /rik+    
#c-ye> grants & ins]t+ ,competitive     
,,prep grants2 &  7,,ii7 9 clause 7i71  
by /rik+ solicit applications to aw>d   

#c-ye> grants 9 ea* ( fiscal ye>s #bjab 
?r\gh #bjag & ins]t+ cont9ue ?r\gh      
fiscal ye> #bjai grants aw>d$ = any (   
fiscal ye>s #bjae ?r\gh #bjag2  7,c7 9  
subsection 7c77#a71 by ins]t+ aft] y\? )
 ,,hiv_/,,aids1 ! foll[+3 victims (     
human traffick+12 &  7,d7 9 subsection  
7f71 by /rik+ #bjag & ins]t+ #bjai4     
7#b7 ,effective date ,! am5dm5ts made by
 ?is subsection take effect on ,octob]  
#a1 #bjag4  ,,ii ,(fsets  #bja4 ,provid+
 = qualifi$ heal? plan grace p]iod      
requirem5ts = issu] receipt ( advance   
paym5ts ( co/-%>+ r$uctions & premium   
tax cr$its t are m consi/5t ) ,/ate law 
grace p]iod requirem5ts  7a7 ,9 g5]al   
,section #adab7;c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjhb7;c77 is am5d$--  7#a7 9
 p>agraph 7#b7-- 7,a7 9 subp>agraph     
7,b77iv77,,ii71 by /rik+ a #c-mon? grace
 p]iod & ins]t+ a grace p]iod specifi$ 9
 subp>agraph 7,c72 &  7,b7 by add+ at ! 
end ! foll[+ new subp>agraphs3  7,c7    
,grace p]iod specifi$ ,= purposes (     

subp>agraph 7,b77iv77,,ii71 ! grace     
p]iod specifi$ 9 ?is subp>agraph is--   
7i7 = plan ye>s beg9n+ be=e ,janu>y #a1 
#bjah1 a #c-mon? grace p]iod2 &  7ii7 = 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjah--  7,i7 9 ! case ( an ,ex*ange    
op]at+ 9 a ,/ate t has a ,/ate law grace
 p]iod 9 place1 su* ,/ate law grace     
p]iod2 &  7,,ii7 9 ! case ( an ,ex*ange 
op]at+ 9 a ,/ate t does n h a ,/ate law 
grace p]iod 9 place1 a #a-mon? grace    
p]iod4  7,d7 ,/ate law grace p]iod ,=   
purposes ( subp>agraph 7,c71 ! t]m ,/ate
 law grace p]iod means1 ) respect to a  
,/ate1 a grace p]iod = nonpaym5t (      
premiums be=e discont9u+ cov]age t is   
applicable "u ! ,/ate law to heal?      
insurance cov]age (f]$ 9 ! individual   
m>ket ( ! ,/ate4  2 &  7#b7 9 p>agraph  
7#c71 by add+ at ! end ! foll[+ new     
s5t5ce3 ,! requirem5ts ( p>agraph       
7#b77;,b77iv7 apply to an issu] ( a     
qualifi$ heal? plan receiv+ an advanc$  
paym5t "u ?is p>agraph 9 ! same mann] & 
to ! same ext5t t su* requirem5ts apply 

to an issu] ( a qualifi$ heal? plan     
receiv+ an advanc$ paym5t "u p>agraph   
7#b77;,a744  7b7 ,report on align+ grace
 p]iods = ,m$icaid1 ,m$ic>e1 & ,ex*ange 
plans ,n lat] ?an #b ye>s aft] ! date ( 
full implem5tation ( subsection 7a71 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on--  
7#a7 ! effects on consum]s ( align+     
grace p]iods appli$ "u ! ,m$icaid       
program "u title ,,xix ( ! ,social      
,security ,act1 "u ! ,m$ic>e program "u 
p>ts ,c & ,d ( title ,,xviii ( su* ,act1
 & "u qualifi$ heal? plans (f]$ on an   
,ex*ange e/abli%$ "u title ,i ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act1 includ+ ! ext5t to :i* su* an     
alignm5t ( grace p]iods may help to     
avoid enrollm5t /atus confusion =       
individuals "u su* ,m$icaid program1    
,m$ic>e program1 & qualifi$ heal? plans2
 &  7#b7 ! ext5t to :i* su* an alignm5t 
( grace p]iods may r$uce fraud1 wa/e1 & 
abuse "u ! ,m$icaid program4  #bjb4     
,prev5tion & ,public ,heal? ,fund       

,section #djjb7;b7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #cjju-#aa7;b77 is am5d$ by    
/rik+ p>agraphs 7#c7 ?r\gh 7#h7 & ins]t+
 ! foll[+ new p>agraphs3  7#c7 = fiscal 
ye> #bjah1 #ijj1jjj1jjj2  7#d7 = fiscal 
ye> #bjai1 #ejj1jjj1jjj2  7#e7 = fiscal 
ye> #bjbj1 #ejj1jjj1jjj2  7#f7 = fiscal 
ye> #bjba1 #ejj1jjj1jjj2  7#g7 = fiscal 
ye> #bjbb1 #ejj1jjj1jjj2  7#h7 = fiscal 
ye> #bjbc1 #ejj1jjj1jjj2  7#i7 = fiscal 
ye> #bjbd1 #ejj1jjj1jjj2  7#aj7 = fiscal
 ye> #bjbe1 #gej1jjj1jjj2  7#aa7 =      
fiscal ye> #bjbf1 #a1jjj1jjj1jjj2 &     
7#ab7 = fiscal ye> #bjbg & ea* fiscal   
ye> !reaft]1 #b1jjj1jjj1jjj4  4  ,b     
,,heal?y ,,kids ,act  #cjj4 ,%ort title 
,?is division may be cit$ z ! ,help+    
,ensure ,access = ,little ,ones1        
,toddl]s1 & ,hopeful ,y\? by ,keep+     
,insurance ,deliv]y ,/able ,act ( #bjag 
or ! ,,heal?y ,,kids ,act4  ,i ,,*ip    
,ext5sion & ,o!r ,m$icaid & ,,*ip       
,provisions  #cja4 ,five-ye> fund+      
ext5sion ( ! ,*ildr5's ,heal? ,insurance

 ,program  7a7 ,appropriation2 total    
allotm5t ,section #bajd7;a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acig;dd7a77 is am5d$--  7#a7 9 p>agraph
 7#ai71 by /rik+ &2  7#b7 9 p>agraph    
7#bj71 by /rik+ ! p]iod at ! end &      
ins]t+ a semicolon2 &  7#c7 by add+ at !
 end ! foll[+ new p>agraphs3  7#ba7 =   
fiscal ye> #bjah1 #ba1ejj1jjj1jjj2      
7#bb7 = fiscal ye> #bjai1               
#bb1fjj1jjj1jjj2  7#bc7 = fiscal ye>    
#bjbj1 #bc1gjj1jjj1jjj2  7#bd7 = fiscal 
ye> #bjba1 #bd1hjj1jjj1jjj2 &  7#be7 =  
fiscal ye> #bjbb1 = purposes ( mak+ two 
semi-annual allotm5ts--  7,a7           
#b1hej1jjj1jjj = ! p]iod beg9n+ on      
,octob] #a1 #bjba1 & end+ on ,m>* #ca1  
#bjbb2 &  7,b7 #b1hej1jjj1jjj = ! p]iod 
beg9n+ on ,april #a1 #bjbb1 & end+ on   
,septemb] #cj1 #bjbb4  4  7b7 ,allotm5ts
  7#a7 ,9 g5]al ,section #bajd7m7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acig;dd7m77 is am5d$-- 7,a7 9 p>agraph 
7#b7--  7i7 9 ! head+1 by /rik+ ?r\gh   
#bjaf & ins]t+ ?r\gh #bjbb2 &  7ii7 9   

subp>agraph 7,b7--  7,i7 9 ! matt]      
prec$+ clause 7i71 by /rik+ 7#ai7 &     
ins]t+ 7#bd72  7,,ii7 9 clause 7ii71 9 !
 matt] prec$+ subclause 7,i71 by ins]t+ 
7o!r ?an fiscal ye> #bjbb7 aft]         
ev5-numb]$ fiscal ye>2 &  7,,iii7 9     
clause 7ii77,i71 by ins]t+ 7or1 9 ! case
 ( fiscal ye> #bjah1 "u p>agraph 7#d77  
aft] clause 7i72  7,b7 9 p>agraph 7#e7--
  7i7 by /rik+ or 7#d7 & ins]t+ 7#d71 or
 7#aj72 &  7ii7 by /rik+ or #bjag &     
ins]t+ 1 #bjag1 or #bjbb2  7,c7 9       
p>agraph 7#g7-- 7i7 9 subp>agraph 7,a71 
by /rik+ #bjag & ins]t+ #bjbb2  7ii7 9  
subp>agraph 7,b71 9 ! matt] prec$+      
clause 7i71 by ins]t+ 7or1 9 ! case (   
fiscal ye> #bjah1 by n lat] ?an ! date t
 is #fj days aft] ! date ( ! enactm5t ( 
! ,,heal?y ,,kids ,act7 aft] be=e !     
,augu/ #ca prec$+ ! beg9n+ ( ! fiscal   
ye>2 &  7iii7 9 ! matt] foll[+          
subp>agraph 7,b71 by /rik+ or fiscal ye>
 #bjaf & ins]t+ fiscal ye> #bjaf1 fiscal
 ye> #bjah1 fiscal ye> #bjbj1 or fiscal 
ye> #bjbb2  7,d7 9 p>agraph 7#i7-- 7i7 9

 ! head+1 by /rik+ fiscal ye>s #bjae &  
#bjag & ins]t+ c]ta9 fiscal ye>s2  7ii7 
by /rik+ or 7#d7 & ins]t+ 1 7#d71 or    
7#aj72 &  7iii7 by /rik+ or fiscal ye>  
#bjag & ins]t+ 1 #bjag1 or #bjbb2 &     
7,e7 by add+ at ! end ! foll[+ new      
p>agraph3  7#aj7 ,= fiscal ye> #bjbb    
7,a7 ,fir/ half ,subject to p>agraphs   
7#e7 & 7#g71 f ! am\nt made available "u
 subp>agraph 7,a7 ( p>agraph 7#be7 (    
subsection 7a7 = ! semi-annual p]iod    
describ$ 9 su* subp>agraph1 increas$ by 
! am\nt ( ! appropriation = su* p]iod "u
 section #cja7;b77#c7 ( ! ,,heal?y      
,,kids ,act1 ! ,secret>y %all compute a 
,/ate allotm5t = ea* ,/ate 7includ+ !   
,di/rict ( ,columbia & ea* commonweal? &
 t]ritory7 = su* semi-annual p]iod 9 an 
am\nt equal to ! fir/ half ratio        
7describ$ 9 subp>agraph 7,d77 ( ! am\nt 
describ$ 9 subp>agraph 7,c74  7,b7      
,second half ,subject to p>agraphs 7#e7 
& 7#g71 f ! am\nt made available "u     
subp>agraph 7,b7 ( p>agraph 7#be7 (     
subsection 7a7 = ! semi-annual p]iod    

describ$ 9 su* subp>agraph1 ! ,secret>y 
%all compute a ,/ate allotm5t = ea*     
,/ate 7includ+ ! ,di/rict ( ,columbia & 
ea* commonweal? & t]ritory7 = su*       
semi-annual p]iod 9 an am\nt equal to ! 
am\nt made available "u su* subp>agraph1
 multipli$ by ! ratio (-- 7i7 ! am\nt ( 
! allotm5t to su* ,/ate "u subp>agraph  
7,a72 to  7ii7 ! total ( ! am\nt ( all (
 ! allotm5ts made available "u su*      
subp>agraph4  7,c7 ,full ye> am\nt bas$ 
on gr[? factor updat$ am\nt ,! am\nt    
describ$ 9 ?is subp>agraph = a ,/ate is 
equal to ! sum (--  7i7 ! am\nt ( !     
,/ate allotm5t = fiscal ye> #bjba       
det]m9$ "u p>agraph 7#b77;,b77i72 &     
7ii7 ! am\nt ( any paym5ts made to !    
,/ate "u subsection 7n7 = fiscal ye>    
#bjba1  multipli$ by ! allotm5t increase
 factor "u p>agraph 7#f7 = fiscal ye>   
#bjbb4  7,d7 ,fir/ half ratio ,! fir/   
half ratio describ$ 9 ?is subp>agraph is
 ! ratio (-- 7i7 ! sum (--  7,i7 ! am\nt
 made available "u subsection           
7a77#be77;,a72 &  7,,ii7 ! am\nt ( !    

appropriation = su* p]iod "u section    
#cja7;b77#c7 ( ! ,,heal?y ,,kids ,act2  
to  7ii7 ! sum (-- 7,i7 ! am\nt describ$
 9 clause 7i72 &  7,,ii7 ! am\nt made   
available "u subsection 7a77#be77;,b74  
4  7#b7 ,te*nical am5dm5t ,section      
#bajd7m77#b77;,a7 ( su* ,act 7#db       
,u4,s4,c4 #acig;dd7m77#b77;,a77 is am5d$
 by /rik+ ! allotm5t increase factor "u 
p>agraph 7#e7 ea* place x appe>s &      
ins]t+ ! allotm5t increase factor "u    
p>agraph 7#f74  7#c7 ,"o-"t             
appropriation = fiscal ye> #bjbb ,!re is
 appropriat$ to ! ,secret>y ( ,heal? &  
,human ,s]vices1 out ( any money 9 !    
,treasury n o!rwise appropriat$1        
#bj1bjj1jjj1jjj to accompany ! allotm5t 
made = ! p]iod beg9n+ on ,octob] #a1    
#bjba1 & end+ on ,m>* #ca1 #bjbb1 "u    
p>agraph 7#be77;,a7 ( section #bajd7;a7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acig;dd7a77 7z add$ by       
subsection 7a77#c771 to rema9 available 
until exp5d$4 ,su* am\nt %all be us$ to 
provide allotm5ts to ,/ates "u p>agraph 

7#aj7 ( section #bajd7m7 ( su* ,act 7z  
add$ by subsection 7b77#a77;,e77 = !    
fir/ #f mon?s ( fiscal ye> #bjbb 9 !    
same mann] z allotm5ts are provid$ "u   
subsection 7a77#be77;,a7 ( su* section  
#bajd & subject to ! same t]ms &        
conditions z apply to ! allotm5ts       
provid$ f su* subsection 7a77#be77;,a74 
7c7 ,ext5sion ( ! ,*ild ,enrollm5t      
,cont+5cy ,fund ,section #bajd7n7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acig;dd7n77 is am5d$--  7#a7 9 p>agraph
 7#b7-- 7,a7 9 subp>agraph 7,a77ii7--   
7i7 by /rik+ #bjaj1 #bjaa1 #bjab1 #bjac1
 #bjad1 & #bjaf & ins]t+ #bjaj ?r\gh    
#bjad1 #bjaf1 & #bjah ?r\gh #bjba2 &    
7ii7 by /rik+ fiscal ye> #bjae & fiscal 
ye> #bjag & ins]t+ fiscal ye>s #bjae1   
#bjag1 & #bjbb2 &  7,b7 9 subp>agraph   
7,b7-- 7i7 by /rik+ #bjaj1 #bjaa1 #bjab1
 #bjac1 #bjad1 & #bjaf & ins]t+ #bjaj   
?r\gh #bjad1 #bjaf1 & #bjah ?r\gh #bjba2
 &  7ii7 by /rik+ fiscal ye> #bjae &    
fiscal ye> #bjag & ins]t+ fiscal ye>s   
#bjae1 #bjag1 & #bjbb2 &  7#b7 9        

p>agraph 7#c77;,a71 9 ! matt] prec$+    
clause 7i71 by /rik+ or a semi-annual   
allotm5t p]iod = fiscal ye> #bjae or    
#bjag & ins]t+ or 9 any ( fiscal ye>s   
#bjah ?r\gh #bjba 7or a semi-annual     
allotm5t p]iod = fiscal ye> #bjae1      
#bjag1 or #bjbb74  7d7 ,ext5sion (      
qualify+ /ates option ,section          
#baje7;g77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;ee7g77#d77 is     
am5d$-- 7#a7 9 ! head+1 by /rik+ ?r\gh  
#bjag & ins]t+ ?r\gh #bjbb2 &  7#b7 9   
subp>agraph 7,a71 by /rik+ #bjag &      
ins]t+ #bjbb4  7e7 ,ext5sion ( express  
lane eligibility option ,section        
#aijb7;e77#ac77;,i7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7e77#ac77;,i77 is am5d$ by /rik+ 
#bjag & ins]t+ #bjbb4  7f7 ,assurance ( 
af=dability /&>d = *ildr5 & families    
7#a7 ,9 g5]al ,section #baje7;d77#c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acig;ee7d77#c77 is am5d$-- 7,a7 9 !    
p>agraph head+1 by /rik+ until ,octob]  
#a1 #bjai & ins]t+ ?r\gh ,septemb] #cj1 

#bjbb2 &  7,b7 9 subp>agraph 7,a71 9 !  
matt] prec$+ clause 7i7-- 7i7 by /rik+  
#bjai & ins]t+ #bjbb2 &  7ii7 by /rik+  
,! prec$+ s5t5ce %all n be con/ru$ z    
prev5t+ a ,/ate dur+ su* p]iod & ins]t+ 
,dur+ ! p]iod t beg9s on ,octob] #a1    
#bjai1 & ends on ,septemb] #cj1 #bjbb1 !
 prec$+ s5t5ce %all only apply ) respect
 to *ildr5 9 families ^: income does n  
exce$ #cjj p]c5t ( ! pov]ty l9e 7z def9$
 9 section #baaj7;c77#e77 applicable to 
a family ( ! size involv$4 ,! prec$+    
s5t5ces %all n be con/ru$ z prev5t+ a   
,/ate dur+ any su* p]iods4  7#b7 ,con=m+
 am5dm5ts ,section #aijb7;gg77#b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7gg77#b77 is am5d$--  7,a7 9 !   
p>agraph head+1 by /rik+ until ,octob]  
#a1 #bjai & ins]t+ ?r\gh ,septemb] #cj1 
#bjbb2 &  7,b7 by /rik+ ,septemb] #cj1  
#bjai1 & ins]t+ ,septemb] #cj1 #bjbb 7b 
dur+ ! p]iod t beg9s on ,octob] #a1     
#bjai1 & ends on ,septemb] #cj1 #bjbb1  
only ) respect to *ildr5 9 families ^:  
income does n exce$ #cjj p]c5t ( !      

pov]ty l9e 7z def9$ 9 section           
#baaj7;c77#e77 applicable to a family ( 
! size involv$74  7g7 ,,*ip look-,alike 
plans  7#a7 ,bl5d+ risk pools ,section  
#bajg ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acig;gg7 is am5d$ by add+ at 
! end ! foll[+3  7g7 ,use ( bl5d$ risk  
pools  7#a7 ,9 g5]al ,no?+ 9 ?is title  
7or any o!r provision ( ,f$]al law7 %all
 be con/ru$ z prev5t+ a ,/ate f consid]+
 *ildr5 enroll$ 9 a qualifi$ ,,*ip      
look-alike program & *ildr5 enroll$ 9 a 
,/ate *ild heal? plan "u ?is title 7or a
 waiv] ( su* plan7 z memb]s ( a s+le    
risk pool4  7#b7 ,qualifi$ ,,*ip        
look-alike program ,9 ?is subsection1 ! 
t]m qualifi$ ,,*ip look-alike program   
means a ,/ate program-- 7,a7 "u :i*     
*ildr5 :o are "u ! age ( #ai & are n    
eligible to receive m$ical assi/ance "u 
title ,,xix or *ild heal? assi/ance "u  
?is title may pur*ase cov]age ?r\gh !   
,/ate t provides b5efits t are at lea/  
id5tical to ! b5efits provid$ "u ! ,/ate
 *ild heal? plan "u ?is title 7or a     

waiv] ( su* plan72 &  7,b7 t is fund$   
exclusively ?r\gh non-,f$]al funds1     
includ+ funds receiv$ by ! ,/ate 9 ! =m 
( premiums = ! pur*ase ( su* cov]age4  4
  7#b7 ,cov]age rule  7,a7 ,9 g5]al     
,section #ejjj;,a7f77#a7 ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$ 9        
subp>agraph 7,a77iii71 by ins]t+ or "u a
 qualifi$ ,,*ip look-alike program 7z   
def9$ 9 section #bajg7;g7 ( ! ,social   
,security ,act7 be=e ! comma at ! end4  
7,b7 ,effective date ,! am5dm5t made by 
subp>agraph 7,a7 %all apply ) respect to
 taxable ye>s beg9n+ aft] ,decemb] #ca1 
#bjag4  #cjb4 ,ext5sion ( c]ta9 programs
 & demon/ration projects  7a7 ,*ildhood 
obesity demon/ration project ,section   
#aaci;,a7e77#h7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77
 is am5d$--  7#a7 by /rik+ & #aj1jjj1jjj
 & ins]t+ 1 #aj1jjj1jjj2 &  7#b7 by     
ins]t+ aft] #bjag ! foll[+3 1 &         
#be1jjj1jjj = ! p]iod ( fiscal ye>s     
#bjah ?r\gh #bjbb4  7b7 ,p$iatric       
quality measures program ,section       

#aaci;,a7i7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acbj;b-#i;a7i77 is      
am5d$-- 7#a7 by /rik+ ,out ( any &      
ins]t+ ! foll[+3  7#a7 ,9 g5]al ,out (  
any  2  7#b7 by /rik+ !re is appropriat$
 = ea* & ins]t+ 8!re is appropriat$--   
7,a7 = ea*  2  7#c7 by /rik+ 1 & !re is 
appropriat$ = ! p]iod & ins]t+ 82  7,b7 
= ! p]iod  2  7#d7 by /rik+ 4 ,funds    
appropriat$ "u ?is subsection %all rema9
 available until exp5d$4 & ins]t+ 2 &2 &
  7#e7 by add+ at ! end ! foll[+3  7,c7 
= ! p]iod ( fiscal ye>s #bjah ?r\gh     
#bjbb1 #ge1jjj1jjj = ! purpose ( c>ry+  
out ?is section 7o!r ?an subsections    
7e71 7f71 & 7g774  7#b7 ,availability   
,funds appropriat$ "u ?is subsection    
%all rema9 available until exp5d$4  4   
#cjc4 ,ext5sion ( outrea* & enrollm5t   
program  7a7 ,9 g5]al ,section #baac ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acigmm7 is am5d$--  7#a7 9 subsection  
7a77#a71 by /rik+ #bjag & ins]t+ #bjbb2 
&  7#b7 9 subsection 7g7--  7,a7 by     
/rik+ & #dj1jjj1jjj & ins]t+ 1          

#dj1jjj1jjj2 &  7,b7 by ins]t+ aft]     
#bjag ! foll[+3 1 & #ajj1jjj1jjj = !    
p]iod ( fiscal ye>s #bjah ?r\gh #bjbb4  
7b7 ,mak+ organizations t use p>5t      
m5tors eligible ,to receive grants      
,section #baac7;f7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acigmm7f77 is     
am5d$-- 7#a7 9 p>agraph 7#a77;,e71 by   
/rik+ or community-bas$ d\la programs & 
ins]t+ 1 community-bas$ d\la programs1  
or p>5t m5tors2 &  7#b7 by add+ at ! end
 ! foll[+ new p>agraph3  7#e7 ,p>5t     
m5tor ,! t]m p>5t m5tor means an        
individual :o--  7,a7 is a p>5t or      
gu>dian ( at lea/ "o *ild :o is an      
eligible *ild "u ?is title or title     
,,xix2 &  7,b7 is tra9$ to assi/        
families ) *ildr5 :o h no heal?         
insurance cov]age ) respect to improv+ !
 social det]m9ants ( ! heal? ( su*      
*ildr51 includ+ by provid+--  7i7       
education ab\t heal? insurance cov]age1 
includ+1 ) respect to obta9+ su*        
cov]age1 eligibility crit]ia &          
application & r5ewal processes2  7ii7   

assi/ance ) complet+ & submitt+         
applications = heal? insurance cov]age2 
7iii7 a liaison betwe5 families &       
repres5tatives ( ,/ate plans "u title   
,,xix or ,/ate *ild heal? plans "u ?is  
title2  7iv7 guidance on id5tify+ m$ical
 & d5tal homes & community ph>macies =  
*ildr52 &  7v7 assi/ance & ref]rals to  
successfully address social det]m9ants (
 *ildr5's heal?1 includ+ pov]ty1 food   
insuffici5cy1 & h\s+4  4  7c7 ,exclusion
 f modifi$ adju/$ gross income ,section 
#aijb7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7e77 is am5d$--   
7#a7 9 ! fir/ p>agraph 7#ad71 relat+ to 
income det]m9$ us+ modifi$ adju/$ gross 
income1 by add+ at ! end ! foll[+ new   
subp>agraph3  7,j7 ,exclusion ( p>5t    
m5tor comp5sation f income det]m9ation  
,any nom9al am\nt receiv$ by an         
individual z comp5sation1 includ+ a     
/ip5d1 = p>ticipation z a p>5t m5tor 7z 
def9$ 9 p>agraph 7#e7 ( section         
#baac7;f77 9 an activity or program     
fund$ ?r\gh a grant "u su* section %all 

be disreg>d$ = purposes ( det]m9+ !     
income eligibility ( su* individual =   
m$ical assi/ance "u ! ,/ate plan or any 
waiv] ( su* plan4  2 &  7#b7 by /rik+   
7#ad7 ,exclusion & ins]t+ 7#ae7         
,exclusion4  #cjd4 ,ext5sion & r$uction 
( additional ,f$]al f9ancial            
p>ticipation = ,,*ip ,section #baje7;b7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acig;ee7b77 is am5d$ 9 !     
second s5t5ce by ins]t+ & dur+ ! p]iod t
 beg9s on ,octob] #a1 #bjai1 & ends on  
,septemb] #cj1 #bjbj1 ! enhanc$ ,,fmap  
det]m9$ = a ,/ate = a fiscal ye> 7or =  
any portion ( a fiscal ye> occurr+ dur+ 
su* p]iod7 %all be increas$ by #aa4e    
p]c5tage po9ts aft] #bc p]c5tage po9ts14
  #cje4 ,modify+ r$uctions 9 ,m$icaid   
,,d% allotm5ts ,section                 
#aibc7;f77#g77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acifr-#d7;f77#g77;,a77 is am5d$-- 7#a7 
9 clause 7i71 9 ! matt] prec$+ subclause
 7,i71 by /rik+ #bjah & ins]t+ #bjbj2 & 
7#b7 9 clause 7ii71 by /rik+ subclauses 

7,i7 ?r\gh 7,,viii7 & ins]t+ ! foll[+3  
7,i7 #d1jjj1jjj1jjj = fiscal ye> #bjbj2 
&  7,,ii7 #h1jjj1jjj1jjj = ea* ( fiscal 
ye>s #bjba ?r\gh #bjbe4  4  #cjf4 ,pu]to
 ,rico & ! ,virg9 ,isl&s ,m$icaid       
paym5ts  7a7 ,increas$ cap ,section     
#aajh7;g7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acjh7;g77 is am5d$--    
7#a7 9 p>agraph 7#b7-- 7,a7 9           
subp>agraph 7,a71 by ins]t+ 7or1 )      
respect to fiscal ye>s #bjah & #bjai1   
increas$ by su* p]c5tage increase plus  
"o p]c5tage po9t7 aft] beg9n+ ( ! fiscal
 ye>2 &  7,b7 9 subp>agraph 7,b71 by    
ins]t+ 7or1 ) respect to fiscal ye>s    
#bjah & #bjai1 increas$ by su* p]c5tage 
increase plus "o p]c5tage po9t7 aft]    
p]c5tage increase ref]r$ to 9           
subp>agraph 7,a72  7#b7 9 p>agraph      
7#e7--  7,a7 9 subp>agraph 7,a71 by     
/rik+ subp>agraph 7,b7 & ins]t+         
subp>agraphs 7,b71 7,c71 7,d71 7,e71 &  
7,f72 &  7,b7 by add+ at ! end ! foll[+ 
new subp>agraphs3  7,c7 ,! am\nt ( !    
increase o!rwise provid$ "u subp>agraph 

7,a7 = ,pu]to ,rico %all be fur!r       
increas$ by #hhj1jjj1jjj4  7,d7 7i7 ,= !
 p]iod beg9n+ ,octob] #a1 #bjag1 & end+ 
,decemb] #ca1 #bjai1 ! am\nt ( !        
increase o!rwise provid$ "u subp>agraph 
7,a7 = ,pu]to ,rico %all be fur!r       
increas$ by #abj1jjj1jjj if ! ,f9ancial 
,ov]sight & ,managem5t ,bo>d = ,pu]to   
,rico e/abli%$ "u section #aja ( !      
,pu]to ,rico ,ov]sight1 ,managem5t1 &   
,economic ,/ability ,act 7#dh ,u4,s4,c4 
#baba7 c]tifies by a majority vote t    
,pu]to ,rico has tak5 reasonable &      
appropriate /eps dur+ su* p]iod to--    
7,i7 r$uce fraud1 wa/e1 & abuse "u !    
program "u title ,,xix2  7,,ii7 implem5t
 /rategies to r$uce unnecess>y1         
ineffici5t1 or excessive sp5d+ "u title 
,,xix2  7,,iii7 improve ! use &         
availability ( ,m$icaid data = program  
op]ation & ov]sight2 &  7,,iv7 improve !
 quality ( c>e & pati5t exp]i5ce =      
individuals enroll$ "u ! program "u     
title ,,xix4  7ii7 ,z a condition ( any 
additional increase pursuant to clause  

7i71 n lat] ?an ,octob] #a1 #bjah1      
,pu]to ,rico %all submit to ! ,f9ancial 
,ov]sight & ,managem5t ,bo>d = ,pu]to   
,rico a report reg>d+ /eps tak5 to      
a*ieve ea* ( ! goals describ$ 9         
subclauses 7,i7 ?r\gh 7,,iv7 ( clause   
7i74  7,e7 ,paym5ts "u section          
#aijc7;a77#h7 = a qu>t] ( a fiscal ye>  
%all n be tak5 into acc\nt 9 apply+     
subsection 7f7 7z increas$ 9 accordance 
) ?is p>agraph & p>agraphs 7#a71 7#b71  
7#c71 & 7#d77 to ,pu]to ,rico or !      
,virg9 ,isl&s = su* fiscal ye>4  7,f7   
7i7 ,= ! p]iod beg9n+ ,octob] #a1 #bjag1
 & end+ ,decemb] #ca1 #bjai1 ! am\nt ( !
 increase o!rwise provid$ "u subp>agraph
 7,a7 = ! ,virg9 ,isl&s %all be fur!r   
increas$ by an am\nt equal to ! p]      
capita equival5t ( ! total am\nt ( !    
increase provid$ = ,pu]to ,rico "u      
subp>agraphs 7,c7 & 7,d7 = su* p]iod4   
7ii7 ,= purposes ( clause 7i71 ! t]m p] 
capita equival5t means ! ratio (--  7,i7
 ! population ( ! ,virg9 ,isl&s1 z      
det]m9$ by ! mo/ rec5t c5sus e/imate    

releas$ by ! ,bureau ( ! ,c5sus be=e    
,septemb] #d1 #bjag2 to  7,,ii7 !       
population ( ,pu]to ,rico1 z s det]m9$4 
4  7b7 ,f$]al mat* = m$ical p]sonnel &  
fraud r$uction ,section #aijc7;a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7a77 is am5d$-- 7#a7 9 p>agraph  
7#b77;,a71 by ins]t+ subject to p>agraph
 7#h71 be=e an am\nt2  7#b7 9 p>agraph  
7#f7-- 7,a7 9 subp>agraph 7,b71 by      
ins]t+ subject to p>agraph 7#h71 be=e   
#ge p] c5tum2 &  7,b7 by /rik+ at ! end 
plus2  7#c7 9 p>agraph 7#g71 by /rik+ at
 ! end ! p]iod & ins]t+ 2 plus 2 &  7#d7
 by add+ at ! end ! foll[+ new p>agraph3
  7#h7 = qu>t]s dur+ ! p]iod beg9n+     
,janu>y #a1 #bjah1 & end+ ,decemb] #ca1 
#bjai1 p>agraphs 7#b77;,a7 & 7#f7 %all  
apply ) respect to ,pu]to ,rico & !     
,virg9 ,isl&s z if--  7,a7 ! ref]5ce to 
#ge p] c5tum 9 p>agraph 7#b77;,a7 7 a   
ref]5ce to #ij p] c5tum2 &  7,b7 !      
ref]5ce to #ge p] c5tum 9 p>agraph      
7#f77;,b7 7 a ref]5ce to #ij p] c5tum4  
4  ,,ii ,(fsets  #dja4 ,m$icaid ?ird    

p>ty liability provisions  7a7 ,m$icaid 
?ird p>ty liability  7#a7 ,delay (      
,bip>tisan ,budget ,act ( #bjac ?ird    
p>ty liability provisions  7,a7 ,9 g5]al
 ,section #bjb7;c7 ( ! ,bip>tisan       
,budget ,act ( #bjac 7,public ,law      
#aac-fg2 #abg ,/at4 #aagg2 #db ,u4,s4,c4
 #acif;a note71 z am5d$ by section #baa 
( ! ,protect+ ,access to ,m$ic>e ,act ( 
#bjad 7,public ,law #aac-ic2 #abh ,/at4 
#ajdg2 #db ,u4,s4,c4 #acif;a note7 &    
section #bbj ( ! ,m$ic>e ,access & ,,*ip
 ,reau?orization ,act ( #bjae 7,public  
,law #aad-aj71 is am5d$ by /rik+ #bjag &
 ins]t+ #bjai4  7,b7 ,effective date2   
treatm5t ,! am5dm5t made by subp>agraph 
7,a7 %all take effect on ,septemb] #cj1 
#bjag1 & %all apply ) respect to any op5
 claims1 includ+ claims g5]at$ or fil$1 
aft] su* date4  7#b7 ,cl>ification (    
def9itions applicable to ?ird p>ty      
liability  7,a7 ,9 g5]al ,section #aijb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a7 is am5d$ by add+ at !
 end ! foll[+ new subsection3  7nn7     

,responsible ,?ird ,p>ty & ,heal?       
,insur] ,def9itions ,= purposes (       
subsection 7a77#be7 & section           
#aijc7;d77#b77;,b73  7#a7 ,responsible  
?ird p>ty ,! t]m responsible ?ird p>ty  
means a heal? insur]1 a ph>macy b5efit  
manag] to ! ext5t ! ph>macy b5efit      
manag] provides in=mation "u ?is title =
 ! purpose ( coord9at+ b5efits1 an      
acc\ntable c>e organization "u section  
#ahii1 or any o!r p>ty t is1 by /atute1 
contract1 or agreem5t1 legally          
responsible = paym5t ( a claim = a heal?
 c>e item or s]vice4 ,su* t]m does n    
include a p>ty if paym5t by su* p>ty has
 be5 made or c reasonably be expect$ to 
be made "u a workm5's comp5sation law or
 plan ( ! ,unit$ ,/ates or a ,/ate1 or  
"u an automobile or liability insurance 
policy or plan 7includ+ a self-insur$   
plan71 or "u no fault insurance4  7#b7  
,heal? insur] ,! t]m heal? insur] means 
a gr\p heal? plan1 z def9$ 9 section    
#fjg7a7 ( ! ,employee ,retirem5t ,income
 ,security ,act ( #aigd1 a self-insur$  

plan1 a fully-insur$ plan1 a s]vice     
b5efit plan1 a m$icaid manag$ c>e plan  
"u section #aijc7m7 or #aicb1 & any o!r 
heal? plan det]m9$ appropriate by !     
,secret>y4  4  7,b7 ,con=m+ am5dm5ts    
,section #aijb7;a77#be7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77 is am5d$-- 7i7 9       
subp>agraph 7,a71 9 ! matt] prec$+      
clause 7i71 by /rik+ ?ird p>ties & all t
 foll[s ?r\gh item or s]vice7 & ins]t+  
responsible ?ird p>ties2  7ii7 9        
subp>agraph 7,g71 by /rik+ heal? insur] 
& all t foll[s ?r\gh item or s]vice7 &  
ins]t+ responsible ?ird p>ty2  7iii7 9  
subp>agraph 7,i71 9 ! matt] prec$+      
clause 7i71 by /rik+ heal? insur]s & all
 t foll[s ?r\gh item or s]vice & ins]t+ 
responsible ?ird p>ties2 &  7iv7 by     
ins]t+ responsible be=e ?ird ea* place x
 appe>s 9 subp>agraphs 7,a77i71         
7,a77ii71 7,c71 7,d71 & 7,h74  7#c7     
,removal ( special treatm5t ( c]ta9     
types ( c>e & paym5ts "u ,m$icaid ?ird  
p>ty liability rules ,section           

#aijb7;a77#be7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#be771 z 
am5d$ by section #bjb7;c7 ( ! ,bip>tisan
 ,budget ,act ( #bjac 7aft] application 
( p>agraph 7#a771 is am5d$--  7,a7 9    
subp>agraph 7,e7-- 7i7 9 ! matt] prec$+ 
clause 7i71 by /rik+ pr5atal or         
prev5tive & all t foll[s ?r\gh ,/ate    
plan & ins]t+ items & s]vices provid$ "u
 ! program requir$ "u ! ,/ate plan      
pursuant to p>agraph 7#fb72 &  7ii7 9   
clause 7i7-- 7,i7 by /rik+ su* s]vice & 
ins]t+ su* items & s]vices2 &  7,,ii7 by
 /rik+ ea* place x appe>s su* s]vices & 
ins]t+ su* items & s]vices ea* su*      
place2 &  7,b7 by /rik+ subp>agraph     
7,f74  7#d7 ,cl>ification ( role ( heal?
 insur]s ) respect to ?ird p>ty         
liability  7,a7 ,9 g5]al ,section       
#aijb7;a77#be7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acif;a7a77#be771 z 
am5d$ by p>agraph 7#c71 is fur!r am5d$  
by ins]t+ aft] subp>agraph 7,e7 ! foll[+
 new subp>agraph3  7,f7 t--  7i7 9 !    
case ( a ,/ate t provides m$ical        

assi/ance "u ?is title ?r\gh a contract 
) a heal? insur]1 su* contract %all     
specify any responsibility ( su* heal?  
insur] 7or o!r entity7 ) respect to     
recov]y ( paym5t f responsible ?ird     
p>ties pursuant to ! delegation or      
transf] by ! ,/ate to su* insur] 7or o!r
 entity7 ( a "r describ$ 9 subp>agraph  
7,i77ii72 &  7ii7 9 ! case ( a ,/ate t  
"u a contract describ$ 9 clause 7i7     
delegates or transf]s to a heal? insur] 
7or o!r entity7 a "r describ$ 9 su*     
clause1 ! ,/ate %all provide assurances 
to ! ,secret>y t ! ,/ate laws ref]r$ to 
9 subp>agraph 7,i71 ) respect to ea*    
responsibility ( su* heal? insur] 7or   
o!r entity7 specifi$ "u su* clause1     
conf] to su* heal? insur] 7or o!r       
entity7 ! au?ority ( ! ,/ate ) respect  
to ! requirem5ts specifi$ 9 clauses 7i7 
?r\gh 7iv7 ( su* subp>agraph 7,i72  4   
7,b7 ,treatm5t ( collect$ am\nts        
,section #aijc7;d77#b77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acif;b7d77#b77;,b77 is am5d$ by add+ at

 ! end ! foll[+3 ,= purposes ( ?is      
subp>agraph1 reimbursem5ts made by a    
responsible ?ird p>ty to heal? insur]s  
7z def9$ 9 section #aijb7nn77 pursuant  
to section #aijb7;a77#be77;,f77ii7 %all 
be treat$ 9 ! same mann] z reimbursem5ts
 made to a ,/ate "u ! previ\s s5t5ce44  
7#e7 ,increas+ ,/ate flexibility )      
respect to ?ird p>ty liability ,section 
#aijb7;a77#be77;,i7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#be77;,i77 is am5d$--  7,a7 9
 clause 7i71 by /rik+ m$ical assi/ance  
"u ! ,/ate plan & ins]t+ m$ical         
assi/ance "u a ,/ate plan 7or "u a waiv]
 ( ! plan72  7,b7 by /rik+ clause 7ii7 &
 ins]t+ ! foll[+ new clause3  7ii7      
accept-- 7,i7 any ,/ate's "r ( recov]y &
 ! assignm5t to any ,/ate ( any "r ( an 
individual or o!r entity to paym5t f !  
p>ty = an item or s]vice = :i* paym5t   
has be5 made "u ! respective ,/ate's    
plan 7or "u a waiv] ( ! plan72 &  7,,ii7
 z a valid au?orization ( ! responsible 
?ird p>ty = ! furni%+ ( an item or      

s]vice to an individual eligible to     
receive m$ical assi/ance "u ?is title1  
an au?orization made on behalf ( su*    
individual "u ! ,/ate plan 7or "u a     
waiv] ( su* plan7 = ! furni%+ ( su* item
 or s]vice to su* individual2  2  7,c7 9
 clause 7iii7--  7i7 by /rik+ respond to
 & ins]t+ n lat] ?an #fj days aft]      
receiv+2 &  7ii7 by /rik+ 2 & at ! end &
 ins]t+ 1 respond to su* inquiry2 &2 &  
7,d7 9 clause 7iv71 by ins]t+ a failure 
to obta9 a prior au?orization1 aft]     
claim =m14  7#f7 ,/ate inc5tive to      
pursue ?ird p>ty liability = newly      
eligibles ,section #aijc7;d77#b77;,b7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acif;b7d77#b77;,b771 z am5d$ by        
p>agraph 7#d77;,b71 is fur!r am5d$ by   
add+ at ! end ! foll[+3 ,9 ! case (     
exp5ditures = m$ical assi/ance provid$  
dur+ #bjag & subsequ5t ye>s =           
individuals describ$ 9 subclause        
7,,viii7 ( section                      
#aijb7;a77#aj77;,a77i71 9 det]m9+ !     
am\nt1 if any1 ( ov]paym5t "u ?is       

subp>agraph ) respect to su* m$ical     
assi/ance1 ! ,secret>y %all apply !     
,f$]al m$ical assi/ance p]c5tage = !    
,/ate "u section #aije7;b71 not)/&+ !   
application ( section #aije7y744  7b7   
,compliance ) ?ird p>ty insurance       
report+ ,section #aije ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7ee7 ,not)/&+ subsection   
7b71 = any ye> beg9n+ aft] #bjai1 if a  
,/ate fails to comply ) ! requirem5ts ( 
section #aijb7;a77#be7 ) respect to ea* 
cal5d> qu>t] 9 su* ye>1 ! ,secret>y may 
r$uce ! ,f$]al m$ical assi/ance p]c5tage
 by #j4a p]c5tage po9t = cal5d> qu>t]s 9
 ea* subsequ5t ye> 9 :i* ! ,/ate fails  
to s comply4  4  7c7 ,application to    
,,*ip  7#a7 ,9 g5]al ,section           
#bajg7;e77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acig;gg7e77#a77 is     
am5d$-- 7,a7 by r$esignat+ subp>agraphs 
7,b7 ?r\gh 7,r7 z subp>agraphs 7,c7     
?r\gh 7,s71 respectively2 &  7,b7 by    
ins]t+ aft] subp>agraph 7,a7 ! foll[+   

new subp>agraph3  7,b7 ,section         
#aijb7;a77#be7 7relat+ to ?ird p>ty     
liability74  4  7#b7 ,m&atory report+   
,section #aijb7;a77#be77;,i77i7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77#be77;,i77i771 z am5d$ by    
subsection 7a77#e71 is fur!r am5d$--    
7,a7 by /rik+ 7&1 at ,/ate option1 *ild 
& ins]t+ & *ild2 &  7,b7 by /rik+ title 
,,xxi7 & ins]t+ title ,,xxi4  7d7 ,tra9+
 on ?ird p>ty liability ,section #aicf (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acifu-#f7 is am5d$--  7#a7 9          
subsection 7b77#d71 by /rik+ & quality (
 c>e & ins]t+ 1 quality ( c>e1 & !      
liability ( responsible ?ird p>ties 7z  
def9$ 9 section #aijb7nn772 &  7#b7 by  
add+ at ! end ! foll[+ new subsection3  
7f7 ,?ird p>ty liability tra9+ ,)       
respect to education or tra9+ activities
 c>ri$ out pursuant to subsection       
7b77#d7 ) respect to ! liability (      
responsible ?ird p>ties 7z def9$ 9      
section #aijb7nn7 = paym5t = items &    
s]vices furni%$ "u ,/ate plans 7or "u   

waiv]s ( su* plans77 "u ?is title1 !    
,secret>y %all-- 7#a7 publi% 7& update  
on an annual basis7 on ! public ,int]net
 website ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices a d$icat$ ,int]net page conta9+
 be/ practices to be us$ 9 assess+ su*  
liability2  7#b7 monitor ef=ts to assess
 su* liability & analyze ! *all5ges pos$
 by t assessm5t2  7#c7 di/ribute to     
,/ate ag5cies adm9i/]+ ! ,/ate plan "u  
?is title in=mation relat$ to su* ef=ts 
& *all5ges2 &  7#d7 provide guidance to 
su* ,/ate ag5cies ) respect to ,/ate    
ov]sight ( ef=ts "u a m$icaid manag$ c>e
 plan "u section #aijc7m7 or #aicb to   
assess su* liability4  4  7e7           
,developm5t ( model uni=m fields =      
,/ates ,to report ?ird p>ty in=mation ,n
 lat] ?an ,janu>y #a1 #bjai1 ! ,secret>y
 ( ,heal? & ,human ,s]vices %all1 9     
consultation ) ! ,/ates1 develop & make 
available to ! ,/ates a model uni=m     
report+ set ( report+ fields &          
accompany+ guidance docum5tation t      
,/ates %all use = purposes (--  7#a7    

report+ in=mation to ! ,secret>y )9 !   
,trans=m$ ,m$icaid ,/ati/ical ,in=mation
 ,sy/em 7,t-,,msis7 7or a successor     
sy/em72 &  7#b7 collect+ in=mation t    
id5tifies responsible ?ird p>ties 7z    
def9$ 9 subsection 7nn7 ( section #aijb 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acif;a71 z add$ by subsection
 7a77#b77;,a77 & o!r relevant in=mation 
= asc]ta9+ ! legal responsibility ( su* 
?ird p>ties to pay = c>e & s]vices      
available "u ! ,/ate plan 7or "u a waiv]
 ( ! plan7 "u title ,,xix ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 or "u ! ,/ate *ild heal? plan "u  
title ,,xxi ( su* ,act 7#db ,u4,s4,c4   
#acig et seq474  7f7 ,effective date    
7#a7 ,9 g5]al ,except z provid$ 9       
p>agraph 7#b71 ?is section & ! am5dm5ts 
made by ?is section 7o!r ?an z specifi$ 
9 ! prec$+ provisions ( ?is section7    
%all take effect on ,octob] #a1 #bjai1 &
 %all apply to m$ical assi/ance or *ild 
heal? assi/ance provid$ on or aft] su*  
date4  7#b7 ,exception if ,/ate         

legislation requir$ ,9 ! case ( a ,/ate 
plan = m$ical assi/ance "u title ,,xix (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif et seq471 or a ,/ate *ild heal?  
plan = *ild heal? assi/ance "u title    
,,xxi ( su* ,act 7#db ,u4,s4,c4 #acig;aa
 et seq471 t ! ,secret>y ( ,heal? &     
,human ,s]vices det]m9es requires ,/ate 
legislation 7o!r ?an legislation        
appropriat+ funds7 9 ord] = ! plan to   
meet ! additional requirem5t impos$ by !
 am5dm5ts made "u ?is section1 su* plan 
%all n be reg>d$ z fail+ to comply ) !  
requirem5ts ( su* title solely on !     
basis ( its failure to meet ?is         
additional requirem5t be=e ! fir/ day ( 
! fir/ cal5d> qu>t] beg9n+ aft] ! close 
( ! fir/ regul> session ( ! ,/ate       
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 su* session %all be deem$ to be a      
sep>ate regul> session ( ! ,/ate        
legislature4  #djb4 ,treatm5t ( lott]y  

w9n+s & o!r lump-sum income = purposes (
 income eligibility "u ,m$icaid  7a7 ,9 
g5]al ,section #aijb ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acif;a7  
is am5d$-- 7#a7 9 subsection 7a77#ag71  
by /rik+ 7e77#ad71 7e77#ad7 & ins]t+    
7e77#ad71 7e77#ae72 &  7#b7 9 subsection
 7e77#ad71 z am5d$ by section #cjc7;c71 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,k7 ,treatm5t ( c]ta9    
lott]y w9n+s & income receiv$ z a lump  
sum  7i7 ,9 g5]al ,9 ! case ( an        
individual :o is ! recipi5t ( qualifi$  
lott]y w9n+s 7pursuant to lott]ies      
occurr+ on or aft] ,janu>y #a1 #bjah7 or
 qualifi$ lump sum income 7receiv$ on or
 aft] su* date7 & ^: eligibility =      
m$ical assi/ance is det]m9$ bas$ on !   
application ( modifi$ adju/$ gross      
income "u subp>agraph 7,a71 a ,/ate     
%all1 9 det]m9+ su* eligibility1 include
 su* w9n+s or income 7z applicable7 z   
income receiv$--  7,i7 9 ! mon? 9 :i*   
su* w9n+s or income 7z applicable7 is   
receiv$ if ! am\nt ( su* w9n+s or income

 is less ?an #hj1jjj2  7,,ii7 ov] a     
p]iod ( #b mon?s if ! am\nt ( su* w9n+s 
or income 7z applicable7 is great] ?an  
or equal to #hj1jjj b less ?an #ij1jjj2 
7,,iii7 ov] a p]iod ( #c mon?s if !     
am\nt ( su* w9n+s or income 7z          
applicable7 is great] ?an or equal to   
#ij1jjj b less ?an #ajj1jjj2 &  7,,iv7  
ov] a p]iod ( #c mon?s plus #a          
additional mon? = ea* increm5t ( #aj1jjj
 ( su* w9n+s or income 7z applicable7   
receiv$1 n to exce$ a p]iod ( #abj mon?s
 7= w9n+s or income ( #a1bfj1jjj or m71 
if ! am\nt ( su* w9n+s or income is     
great] ?an or equal to #ajj1jjj4  7ii7  
,c\nt+ 9 equal in/allm5ts ,= purposes ( 
subclauses 7,,ii71 7,,iii71 & 7,,iv7 (  
clause 7i71 w9n+s or income to :i* su*  
subclause applies %all be c\nt$ 9 equal 
mon?ly in/allm5ts ov] ! p]iod ( mon?s   
specifi$ "u su* subclause4  7iii7       
,h>d%ip exemption ,an individual ^:     
income1 by application ( clause 7i71    
exce$s ! applicable eligibility ?re%old 
e/abli%$ by ! ,/ate1 %all cont9ue to be 

eligible = m$ical assi/ance to ! ext5t t
 ! ,/ate det]m9es1 "u proc$ures e/abli%$
 by ! ,/ate 79 accordance ) /&>ds       
specifi$ by ! ,secret>y71 t ! d5ial (   
eligibility ( ! individual w\ld cause an
 undue m$ical or f9ancial h>d%ip z      
det]m9$ on ! basis ( crit]ia e/abli%$ by
 ! ,secret>y4  7iv7 ,notifications &    
assi/ance requir$ 9 case ( loss (       
eligibility ,a ,/ate %all1 ) respect to 
an individual :o loses eligibility =    
m$ical assi/ance "u ! ,/ate plan 7or a  
waiv] ( su* plan7 by reason ( clause    
7i7-- 7,i7 be=e ! date on :i* !         
individual loses su* eligibility1 in=m !
 individual--  7aa7 ( ! individual's    
opportunity to enroll 9 a qualifi$ heal?
 plan (f]$ ?r\gh an ,ex*ange e/abli%$ "u
 title ,i ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act dur+ ! special      
enrollm5t p]iod specifi$ 9 section      
#ihja7;f77#c7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf 7relat+ to loss ( ,m$icaid or  
,,*ip cov]age72 &  7bb7 ( ! date on :i* 
! individual w\ld no long] be consid]$  

ineligible by reason ( clause 7i7 to    
receive m$ical assi/ance "u ! ,/ate plan
 or "u any waiv] ( su* plan & be        
eligible to reapply to receive su*      
m$ical assi/ance2 &  7,,ii7 provide     
te*nical assi/ance to ! individual seek+
 to enroll 9 su* a qualifi$ heal? plan4 
7v7 ,qualifi$ lott]y w9n+s def9$ ,9 ?is 
subp>agraph1 ! t]m qualifi$ lott]y w9n+s
 means w9n+s f a sweep/akes1 lott]y1 or 
pool describ$ 9 p>agraph 7#c7 ( section 
#ddjb ( ! ,int]nal ,rev5ue ,code ( #aihf
 or a lott]y op]at$ by a multi/ate or   
multijurisdictional lott]y association1 
includ+ am\nts aw>d$ z a lump sum       
paym5t4  7vi7 ,qualifi$ lump sum income 
def9$ ,9 ?is subp>agraph1 ! t]m qualifi$
 lump sum income means income t is      
receiv$ z a lump sum f "o ( ! foll[+    
s\rces3 7,i7 ,monet>y w9n+s f gambl+ 7z 
def9$ by ! ,secret>y & includ+ gambl+   
activities describ$ 9 section           
#aiee7;b77#d7 ( title #ah1 ,unit$ ,/ates
 ,code74  7,,ii7 ,damages receiv$1 :e!r 
by suit or agreem5t & :e!r z lump sums  

or z p]iodic paym5ts 7o!r ?an mon?ly    
paym5ts71 on acc\nt ( causes ( action   
o!r ?an causes ( action aris+ f p]sonal 
physical injuries or physical sickness4 
7,,iii7 ,income receiv$ z liquid assets 
f ! e/ate 7z def9$ 9 section            
#aiag7;b77#d77 ( a deceas$ individual4  
4  7b7 ,rules ( con/ruction  7#a7       
,int]ception ( lott]y w9n+s all[$ ,no?+ 
9 ! am5dm5t made by subsection 7a77#b7  
%all be con/ru$ z prev5t+ a ,/ate f     
int]cept+ ! ,/ate lott]y w9n+s aw>d$ to 
an individual 9 ! ,/ate to recov] am\nts
 paid by ! ,/ate "u ! ,/ate ,m$icaid    
plan "u title ,,xix ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 = m$ical assi/ance furni%$ to !   
individual4  7#b7 ,applicability limit$ 
to eligibility ( recipi5t ( lott]y w9n+s
 or lump sum income ,no?+ 9 ! am5dm5t   
made by subsection 7a77#b7 %all be      
con/ru$1 ) respect to a det]m9ation (   
h\sehold income = purposes ( a          
det]m9ation ( eligibility = m$ical      
assi/ance "u ! ,/ate plan "u title ,,xix

 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif et seq47 7or a waiv] (  
su* plan7 made by apply+ modifi$ adju/$ 
gross income "u subp>agraph 7,a7 (      
section #aijb7;e77#ad7 ( su* ,act 7#db  
,u4,s4,c4 #acif;a7e77#ad771 z limit+ !  
eligibility = su* m$ical assi/ance ( any
 individual t is a memb] ( ! h\sehold   
o!r ?an ! individual :o receiv$ qualifi$
 lott]y w9n+s or qualifi$ lump-sum      
income 7z def9$ 9 subp>agraph 7,k7 ( su*
 section #aijb7;e77#ad71 z add$ by      
subsection 7a77#b7 ( ?is section74      
#djc4 ,adju/m5ts to ,m$ic>e "p ,b & "p  
,d premium subsidies = high] income     
individuals  7a7 ,9 g5]al ,section      
#ahci7;i77#c77;,c77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acier7i77#c77;,c77i77,,ii77 is am5d$1 9
 ! table1 by /rik+ ! la/ r[ & ins]t+ !  
foll[+ new r[s3 ,m ?an #afj1jjj b less  
?an #ejj1jjjhj p]c5t ,at lea/           
#ejj1jjjajj p]c5t4 4  7b7 ,jo9t returns 
,section #ahci7;i77#c77;,c77ii7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   

#acier7i77#c77;,c77ii77 is am5d$ by     
ins]t+ be=e ! p]iod ! foll[+3 except1 ) 
respect to ! doll> am\nts appli$ 9 ! la/
 r[ ( ! table "u subclause 7,,ii7 ( su* 
clause 7& ! second doll> am\nt specifi$ 
9 ! second to la/ r[ ( su* table71      
clause 7i7 %all be appli$ by sub/itut+  
doll> am\nts :i* are #age p]c5t ( su*   
doll> am\nts = ! cal5d> ye>4  7c7       
,inflation adju/m5t ,section #ahci7;i7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acier7i77 is am5d$-- 7#a7 9 p>agraph  
7#e7--  7,a7 9 subp>agraph 7,a71 by     
/rik+ ,9 ! case & ins]t+ ,subject to    
subp>agraph 7,c71 9 ! case2  7,b7 9     
subp>agraph 7,b71 by /rik+ subp>agraph  
7,a7 & ins]t+ subp>agraph 7,a7 or 7,c72 
&  7,c7 by add+ at ! end ! foll[+ new   
subp>agraph3  7,c7 ,treatm5t ( adju/m5ts
 = c]ta9 high] income individuals  7i7  
,9 g5]al ,subp>agraph 7,a7 %all n apply 
) respect to ea* doll> am\nt 9 p>agraph 
7#c7 ( #ejj1jjj4  7ii7 ,adju/m5t beg9n+ 
#bjbg ,9 ! case ( any cal5d> ye> beg9n+ 
aft] #bjbf1 ea* doll> am\nt 9 p>agraph  

7#c7 ( #ejj1jjj %all be increas$ by an  
am\nt equal to-- 7,i7 su* doll> am\nt1  
multipli$ by  7,,ii7 ! p]c5tage 7if any7
 by :i* ! av]age ( ! ,consum] ,price    
,index = all urban consum]s 7,unit$     
,/ates city av]age7 = ! #ab-mon? p]iod  
end+ ) ,augu/ ( ! prec$+ cal5d> ye>     
exce$s su* av]age = ! #ab-mon? p]iod    
end+ ) ,augu/ #bjbe4  2 &  7#b7 9       
p>agraph 7#f77;,b71 by ins]t+ 7o!r ?an  
#ejj1jjj7 aft] ! doll> am\nts4  ,pass$ !
 ,h\se ( ,repres5tatives ,novemb] #c1   
#bjag4;,cl]k4