,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #degi  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #f1 #bjag,mr4
 ,wel* 7= himself & ,mr4 ,s*rad]7       
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$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to implem5t      
,m$ic>e paym5t policies design$ to      
improve managem5t ( *ronic disease1     
/reaml9e c>e coord9ation1 & improve     
quality outcomes )\t add+ to ! deficit4 
#a4 ,%ort title2 table ( cont5ts  7a7   
,%ort title ,?is ,act may be cit$ z !   
,creat+ ,high-,quality ,results &       
,outcomes ,necess>y to ,improve ,*ronic 
7,,*ronic7 ,c>e ,act ( #bjag4  7b7      
,table ( cont5ts ,! table ( cont5ts (   
?is ,act is z foll[s3  ,sec4 #a4 ,%ort  
title2 table ( cont5ts4 ,,title         

,i--,receiv+ ,high-,quality ,c>e 9 !    
,home ,sec4 #aja4 ,ext5d+ ! ,indep5d5ce 
at ,home ,demon/ration ,program4 ,sec4  
#ajb4 ,exp&+ access to home dialysis    
!rapy4 ,,title ,,ii--,advanc+           
,team-,bas$ ,c>e ,sec4 #bja4 ,provid+   
cont9u$ access to ,m$ic>e ,advantage    
special ne$s plans = vuln]able          
populations4 ,,title ,,iii--,exp&+      
,innovation & ,te*nology ,sec4 #cja4    
,adapt+ b5efits to meet ! ne$s (        
*ronically ill ,m$ic>e ,advantage       
enrollees4 ,sec4 #cjb4 ,exp&+           
supplem5tal b5efits to meet ! ne$s (    
*ronically ill ,m$ic>e ,advantage       
enrollees4 ,sec4 #cjc4 ,increas+        
conv5i5ce = ,m$ic>e ,advantage enrollees
 ?r\gh teleheal?4 ,sec4 #cjd4 ,provid+  
acc\ntable c>e organizations ! ability  
to exp& ! use ( teleheal?4 ,sec4 #cje4  
,exp&+ ! use ( teleheal? = individuals )
 /roke4 ,,title ,,iv--,id5tify+ !       
,*ronically ,ill ,population ,sec4 #dja4
 ,provid+ flexibility = b5efici>ies to  
be "p ( an acc\ntable c>e organization4 

,,title ,v--,emp[]+ ,individuals &      
,c>egiv]s 9 ,c>e ,deliv]y ,sec4 #eja4   
,elim9at+ b>ri]s to c>e coord9ation "u  
acc\ntable c>e organizations4 ,sec4     
#ejb4 ,,gao /udy & report on longitud9al
 compreh5sive c>e plann+ s]vices "u     
,m$ic>e "p ,b4 ,,title ,,vi--,o!r       
,policies to ,improve ,c>e = !          
,*ronically ,ill ,sec4 #fja4 ,provid+   
prescription drug plans ) p>ts ,a & ,b  
claims data to promote ! appropriate use
 ( m$ications & improve heal? outcomes4 
,sec4 #fjb4 ,,gao /udy & report on      
improv+ m$ication syn*ronization4 ,sec4 
#fjc4 ,,gao /udy & report on impact (   
obesity drugs on pati5t heal? & sp5d+4  
,sec4 #fjd4 ,,hhs /udy & report on      
long-t]m risk factors = *ronic          
conditions among ,m$ic>e b5efici>ies4   
,,title ,,vii--,(fsets ,sec4 #gja4      
,m$ic>e ,improvem5t ,fund4 ,sec4 #gjb4  
,m$icaid ,improvem5t ,fund4  ,i ,receiv+
 ,high-,quality ,c>e 9 ! ,home  #aja4   
,ext5d+ ! ,indep5d5ce at ,home          
,demon/ration ,program ,section #ahff;,e

 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;cc-#e7 is am5d$-- 7#a7 9
 subsection 7e7--  7,a7 9 p>agraph 7#a71
 by /rik+ #e-ye> p]iod & ins]t+ #g-ye>  
p]iod2 &  7,b7 9 p>agraph 7#e71 by /rik+
 #aj1jjj & ins]t+ #ae1jjj2  7#b7 9      
subsection 7g71 9 ! fir/ s5t5ce1 by     
ins]t+ 1 includ+1 to ! ext5t            
practicable1 ! use ( electronic heal?   
in=mation sy/ems z describ$ 9 subsection
 7b77#a77;,a77vi71 aft] program2 &  7#c7
 9 subsection 7i77,a71 by /rik+ w n     
receive an inc5tive paym5t = ! second ( 
#b & ins]t+ did n a*ieve sav+s = ! ?ird 
( #c4  #ajb4 ,exp&+ access to home      
dialysis !rapy  7a7 ,9 g5]al ,section   
#ahha7;b77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acierr7b77#c77 is      
am5d$--  7#a7 by r$esignat+ subp>agraphs
 7,a7 & 7,b7 z clauses 7i7 & 7ii71      
respectively2  7#b7 9 clause 7ii71 z    
r$esignat$ by subp>agraph 7,a71 /rike on
 a compreh5sive & ins]t subject to      
subp>agraph 7,b71 on a compreh5sive2    
7#c7 by /rik+ ,) respect to & ins]t+    

7,a7 ,) respect to2 &  7#d7 by add+ at !
 end ! foll[+ new subp>agraph3  7,b7 ,= 
purposes ( subp>agraph 7,a77ii71 an     
individual det]m9$ to h end /age r5al   
disease receiv+ home dialysis may *oose 
to receive mon?ly end /age r5al         
disease-relat$ cl9ical assessm5ts       
furni%$ on or aft] ,janu>y #a1 #bjai1   
via teleheal? if ! individual receives a
 face-to-face cl9ical assessm5t1 )\t !  
use ( teleheal?1 at lea/ once e ?ree    
consecutive mon?s4  4  7b7 ,orig9at+    
site requirem5ts  7#a7 ,9 g5]al ,section
 #ahcd7m7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciem7m77 is am5d$--    
7,a7 9 p>agraph 7#d77;,c77ii71 by add+  
at ! end ! foll[+ new subclauses3       
7,,ix7 ,a r5al dialysis facility1 b only
 = purposes ( section                   
#ahha7;b77#c77;,b74  7,x7 ,! home ( an  
individual1 b only = purposes ( section 
#ahha7;b77#c77;,b74  2 &  7,b7 by add+  
at ! end ! foll[+ new p>agraph3  7#e7   
,treatm5t ( home dialysis mon?ly        
,,esrd-relat$ visit ,! geographic       

requirem5ts describ$ 9 p>agraph         
7#d77;,c77i7 %all n apply ) respect to  
teleheal? s]vices furni%$ on or aft]    
,janu>y #a1 #bjai1 = purposes ( section 
#ahha7;b77#c77;,b71 at an orig9at+ site 
describ$ 9 subclause 7,,vi71 7,,ix71 or 
7,x7 ( p>agraph 7#d77;,c77ii74  4  7#b7 
,no facility fee if orig9at+ site = home
 dialysis !rapy is ! home ,section      
#ahcd7m77#b77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#b77;,b77 
is am5d$-- 7,a7 by r$esignat+ clauses   
7i7 & 7ii7 z subclauses 7,i7 & 7,,ii71 &
 ind5t+ appropriately2  7,b7 9 subclause
 7,,ii71 z r$esignat$ by subp>agraph    
7,a71 by /rik+ clause 7i7 or ?is clause 
& ins]t+ subclause 7,i7 or ?is          
subclause2  7,c7 by /rik+ site4--,)     
respect to & ins]t+  site4-- 7i7 ,9     
g5]al ,subject to clause 7ii71 ) respect
 to  2 &  7,d7 by add+ at ! end ! foll[+
 new clause3  7ii7 ,no facility fee if  
orig9at+ site = home dialysis !rapy is !
 home ,no facility fee %all be paid "u  
?is subp>agraph to an orig9at+ site     

describ$ 9 p>agraph 7#d77;,c77ii77,x74  
4  7c7 ,con=m+ am5dm5t ,section         
#ahha7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acierr7b77#a77 is am5d$
 by /rik+ p>agraph 7#c77;,a7 & ins]t+   
p>agraph 7#c77;,a77i74  ,,ii ,advanc+   
,team-,bas$ ,c>e  #bja4 ,provid+ cont9u$
 access to ,m$ic>e ,advantage special   
ne$s plans = vuln]able populations  7a7 
,ext5sion ,section #ahei7;f77#a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bh7;f77#a77 is am5d$ by /rik+ & 
= p]iods be=e ,janu>y #a1 #bjai4  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 ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act1 %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$ures1 to ! ext5t feasible1 
unify+ grievances & appeals proc$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$ures f ,/ates1      
plans1 b5efici>ies & _! repres5tatives1 
& o!r relevant /akehold]s4  7ii7        
,proc$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 ,= #bjba &
 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 = integration ,=    
#bjba & subsequ5t ye>s1 a specializ$    
,,ma plan = special ne$s individuals    

describ$ 9 subsection 7b77#f77;,b77ii7  
%all meet "o or m ( ! foll[+            
requirem5ts1 to ! ext5t p]mitt$ "u ,/ate
 law1 = integration ( b5efits "u ?is    
title & title ,,xix3  7i7 ,! specializ$ 
,,ma plan mu/ meet ! requirem5ts (      
contract+ ) ! ,/ate ,m$icaid ag5cy      
describ$ 9 p>agraph 7#c77;,d7 9 addition
 to coord9at+ long-t]m s]vices &        
supports or behavioral heal? s]vices1 or
 bo?1 by meet+ an additional m9imum set 
( requirem5ts det]m9$ by ! ,secret>y    
?r\gh ! ,f$]al ,coord9at$ ,heal? ,c>e   
,(fice e/abli%$ "u section #bfjb ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act bas$ on input f /akehold]s1 su* z  
notify+ ! ,/ate 9 a timely mann] (      
hospitalizations1 em]g5cy room visits1 &
 hospital or nurs+ home dis*>ges (      
enrollees1 assign+ "o prim>y c>e provid]
 = ea* enrollee1 or %>+ data t w\ld     
b5efit ! coord9ation ( items & s]vices  
"u ?is title & ! ,/ate plan "u title    
,,xix4 ,su* m9imum set ( requirem5ts mu/
 be includ$ 9 ! contract ( ! specializ$ 

,,ma plan ) ! ,/ate ,m$icaid ag5cy "u   
su* p>agraph4  7ii7 ,! specializ$ ,,ma  
plan mu/ 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 program71 or ent] 
into a capitat$ contract ) ! ,/ate      
,m$icaid ag5cy to provide long-t]m      
s]vices & supports or behavioral heal?  
s]vices1 or bo?4  7iii7 ,9 ! case :]e an
 individual is enroll$ 9 bo? !          
specializ$ ,,ma plan & a ,m$icaid manag$
 c>e organization 7z def9$ 9 section    
#aijc7m77#a77;,a77 provid+ long-t]m     
s]vices & supports or behavioral heal?  
s]vices t h ! same p>5t organization1 ! 
p>5t organization (f]+ bo? ! specializ$ 
,,ma plan & ! ,m$icaid manag$ c>e plan  
mu/ assume cl9ical & f9ancial           
responsibility = b5efits provid$ "u ?is 
title & title ,,xix4  4  7#b7 ,con=m+   
am5dm5t to responsibilities ( ,f$]al    
,coord9at$ ,heal? ,c>e ,(fice ,section  

#bfjb7;d7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act 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  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 /rik+ all ,s,n,ps4--,!  
requirem5ts & ins]t+  all ,s,n,ps4--    

7,a7 ,9 g5]al ,subject to subp>agraph   
7,b71 ! requirem5ts  2  7,b7 by         
r$esignat+ subp>agraphs 7,a7 & 7,b7 z   
clauses 7i7 & 7ii71 respectively1 &     
ind5t+ appropriately2  7,c7 9 clause    
7ii71 z r$esignat$ by subp>agraph 7,b71 
by r$esignat+ clauses 7i7 ?r\gh 7iii7 z 
subclauses 7,i7 ?r\gh 7,,iii71          
respectively1 & ind5t+ appropriately2 & 
7,d7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,b7 ,improvem5ts to c>e  
managem5t requirem5ts = sev]e or disabl+
 *ronic condition ,s,n,ps ,= #bjbj &    
subsequ5t ye>s1 9 ! case ( a specializ$ 
,,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$--  7i7 by /rik+ :o h & ins]t+ :o--
 7,i7 be=e ,janu>y #a1 #bjbb1 h  2  7ii7
 9 subclause 7,i71 z add$ 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 ( access to1 
& enrollm5t 91 su* a specializ$ ,,ma    
plan = special ne$s individuals1        
individuals ) su* condition w\ld h a    
reasonable expectation ( sl[+ or halt+ !
 progression ( ! disease1 improv+ heal? 
outcomes & decreas+ ov]all co/s =       
individuals diagnos$ ) su* condition    
comp>$ to available options ( c>e o!r   
?an ?r\gh su* a specializ$ ,,ma plan =  
special ne$s 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 ,requirem5t ,9      
e/abli%+ & updat+ ! li/ "u subp>agraph  
7,a71 ! panel %all take into acc\nt !   
availability ( v>i$ b5efits1 co/-%>+1 & 
supplem5tal b5efits "u ! model describ$ 
9 p>agraph 7#b7 ( section #ahei7;h71    
includ+ ! expansion "u p>agraph 7#a7 (  
su* section4  4  7d7 ,quality measurem5t
 at ! plan level = ,s,n,ps & det]m9ation
 ( feasibility ( 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$s individuals 9  
ord] to det]m9e if a /ati/ically        
significant or valid measurem5t (       
quality at ! plan level is possible "u  
?is p>agraph2  7ii7 take into           
consid]ation ! impact ( su* application 
on plans t s]ve a disproportionate numb]
 ( individuals dually eligible = b5efits
 "u ?is title & "u title ,,xix2  7iii7  
if quality measures are report$ at !    
plan level1 ensure t ,,ma plans are n   
requir$ to provide duplicative          
in=mation2 &  7iv7 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>agraph1 su*       
quality measurem5t may include ,m$ic>e  
,heal? ,outcomes ,survey 7,,hos71       

,heal?c>e ,effectiv5ess ,data &         
,in=mation ,set 7,,h$is71 ,consum]      
,assessm5t ( ,heal?c>e ,provid]s &      
,sy/ems 7,,cahps7 measures & quality    
measures "u "p ,d4  7#g7 ,det]m9ation ( 
feasibility ( quality measurem5t at !   
plan level = all ,,ma plans  7,a7       
,det]m9ation ( feasibility ,! ,secret>y 
%all det]m9e ! feasibility ( requir+    
report+ ( data "u section #aheb7;e7 =1 &
 apply+ "u ?is subsection1 quality      
measures at ! plan level = all ,,ma     
plans "u ?is "p4  7,b7 ,consid]ation (  
*ange ,aft] mak+ a det]m9ation "u       
subp>agraph 7,a71 ! ,secret>y %all      
consid] requir+ su* report+ & apply+ su*
 quality measures at ! plan level z     
describ$ 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 ,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 ,! ef=ts ( ,/ate ,m$icaid        
programs to transition dually eligible  
b5efici>ies receiv+ long-t]m s]vices &  
supports 7,,ltss7 f in/itutional sett+s 
to home & community-bas$ sett+s & relat$
 f9ancial impacts ( su* transitions4    
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  ,,iii     
,exp&+ ,innovation & ,te*nology  #cja4  
,adapt+ b5efits to meet ! ne$s (        
*ronically ill ,m$ic>e ,advantage       
enrollees ,section #ahei ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#bh7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7h7 ,national   
te/+ ( model = ,m$ic>e ,advantage       
value-,bas$ insurance design  7#a7 ,9   
g5]al ,9 implem5t+ ! model describ$ 9   
p>agraph 7#b7 propos$ to be te/$ "u     
section #aaae;,a7b71 ! ,secret>y %all   
revise ! te/+ ( ! model "u su* section  
to cov]1 effective n lat] ?an ,janu>y   
#a1 #bjbj1 all ,/ates4  7#b7 ,model     
describ$ ,! model describ$ 9 ?is        
p>agraph is ! te/+ ( a model ( ,m$ic>e  
,advantage value-bas$ insurance design t

 w\ld all[ ,m$ic>e ,advantage plans !   
option to propose & design b5efit       
/ructures t v>y b5efits1 co/-%>+1 &     
supplem5tal b5efits (f]$ to enrollees ) 
specific *ronic diseases propos$ to be  
c>ri$ out 9 ,oregon1 ,arizona1 ,texas1  
,i[a1 ,mi*igan1 ,indiana1 ,t5nessee1    
,alabama1 ,p5nsylvania1 & ,massa*usetts4
  7#c7 ,t]m9ation & modification        
provision n applicable until ,janu>y #a1
 #bjbb ,! provisions ( section          
#aaae;,a7b77#c77;,b7 %all apply to !    
model describ$ 9 p>agraph 7#b71 includ+ 
su* model z exp&$ "u p>agraph 7#a71     
beg9n+ ,janu>y #a1 #bjbb1 b %all n apply
 to su* model1 z s exp&$1 prior to su*  
date4  7#d7 ,fund+ ,! ,secret>y %all    
allocate funds made available "u section
 #aaae;,a7f77#a7 to design1 implem5t1 & 
evaluate ! model describ$ 9 p>agraph    
7#b71 z exp&$ "u p>agraph 7#a74  4      
#cjb4 ,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
 plan 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  
only ) respect to supplem5tal b5efits   

provid$ to a *ronically ill enrollee "u 
?is subp>agraph1 waive ! uni=mity       
requirem5t "u subsection 7d77#a77;,a71 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$ically complex     
*ronic conditions t is life ?reat5+ or  
significantly limits ! ov]all heal? or  
function ( ! enrollee2  7,,ii7 has a    
high risk ( hospitalization or o!r      
adv]se heal? outcomes2 &  7,,iii7       
requires int5sive c>e coord9ation4  4   
7b7 ,,gao /udy & report  7#a7 ,/udy ,!  
,comptroll] ,g5]al ( ! ,unit$ ,/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     
,act4 ,to ! ext5t data are available1   
su* /udy %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  #cjc4 ,increas+ conv5i5ce 
= ,m$ic>e ,advantage enrollees ?r\gh    
teleheal?  7a7 ,9 g5]al ,section #aheb (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#bb7 is am5d$-- 7#a7 9          
subsection 7a77#a77;,b77i71 by ins]t+ 1 
subject to subsection 7m71 aft] means2 &
  7#b7 by add+ at ! end ! foll[+ new    
subsection3  7m7 ,provision ( additional
 teleheal? b5efits  7#a7 ,,ma plan      
option ,= plan ye> #bjbj & subsequ5t    
plan ye>s1 subject to ! requirem5ts (   
p>agraph 7#c71 an ,,ma plan may provide 
additional teleheal? b5efits 7z def9$ 9 
p>agraph 7#b77 to individuals enroll$ "u
 ?is "p4  7#b7 ,additional teleheal?    
b5efits def9$  7,a7 ,9 g5]al ,= purposes
 ( ?is subsection & section #ahed-- 7i7 
,def9ition ,! t]m additional teleheal?  
b5efits means s]vices--  7,i7 = :i*     
b5efits are available "u "p ,b1 includ+ 
s]vices = :i* paym5t is n made "u       
section #ahcd7m7 due to ! conditions =  
paym5t "u su* section2 &  7,,ii7 t are  

id5tifi$ z cl9ically appropriate to     
furni% us+ electronic in=mation &       
telecommunications te*nology :5 a       
physician 7z def9$ 9 section #ahfa7r77  
or practition] 7describ$ 9 section      
#ahdb7;b77#ah77;,c77 provid+ ! s]vice is
 n at ! same location z ! plan enrollee4
  7ii7 ,exclusion ( capital &           
infra/ructure co/s & inve/m5ts ,! t]m   
additional teleheal? b5efits does n     
include capital & infra/ructure co/s &  
inve/m5ts relat+ to su* b5efits4  7,b7  
,public comm5t ,n lat] ?an ,novemb] #cj1
 #bjah1 ! ,secret>y %all solicit comm5ts
 on--  7i7 :at types ( items & s]vices  
7includ+ ^? provid$ ?r\gh supplem5tal   
heal? c>e b5efits7 %\ld be consid]$ to  
be additional teleheal? b5efits2 &  7ii7
 ! requirem5ts = ! provision or furni%+ 
( su* b5efits 7su* z lic5sure1 tra9+1 & 
coord9ation requirem5ts74  7#c7         
,requirem5ts = additional teleheal?     
b5efits ,! ,secret>y %all specify       
requirem5ts = ! provision or furni%+ (  
additional teleheal? b5efits1 includ+ ) 

respect to ! foll[+3  7,a7 ,physician or
 practition] lic5sure & o!r requirem5ts 
su* z specific tra9+4  7,b7 ,factors    
necess>y to ensure ! coord9ation ( su*  
b5efits ) items & s]vices furni%$       
9-p]son4  7,c7 ,su* o!r areas z det]m9$ 
by ! ,secret>y4  7#d7 ,enrollee *oice   
,if an ,,ma plan provides a s]vice z an 
additional teleheal? b5efit 7z def9$ 9  
p>agraph 7#b77--  7,a7 ! ,,ma plan %all 
also provide access to su* b5efit ?r\gh 
an 9-p]son visit 7& n only z an         
additional teleheal? b5efit72 &  7,b7 an
 individual enrollee %all h discretion z
 to :e!r to receive su* s]vice ?r\gh !  
9-p]son visit or z an additional        
teleheal? b5efit4  7#e7 ,treatm5t "u    
,,ma ,= purposes ( ?is subsection &     
section #ahed1 additional teleheal?     
b5efits %all be treat$ z if !y 7 b5efits
 "u ! orig9al ,m$ic>e fee-=-s]vice      
program option4  7#f7 ,con/ruction ,no?+
 9 ?is subsection %all be con/ru$ z     
affect+ ! requirem5t "u subsection      
7a77#a7 t ,,ma plans provide enrollees )

 items & s]vices 7o!r ?an hospice c>e7 =
 :i* b5efits are available "u p>ts ,a & 
,b1 includ+ b5efits available "u section
 #ahcd7m74  4  7b7 ,cl>ification reg>d+ 
inclusion 9 bid am\nt ,section          
#ahed7;a77#f77;,a77ii77,i7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciew-#bd7;a77#f77;,a77ii77,i77 is     
am5d$ by ins]t+ 1 includ+1 = plan ye>   
#bjbj & subsequ5t plan ye>s1 ! provision
 ( additional teleheal? b5efits z       
describ$ 9 section #aheb7m7 be=e !      
semicolon at ! end4  #cjd4 ,provid+     
acc\ntable c>e organizations ! ability  
to exp& ! use ( teleheal?  7a7 ,9 g5]al 
,section #ahii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie;jjj7 is am5d$ 
by add+ at ! end ! foll[+ new           
subsection3  7l7 ,provid+ ,a,c,os !     
ability ,to exp& ! use ( teleheal?      
s]vices  7#a7 ,9 g5]al ,9 ! case (      
teleheal? s]vices = :i* paym5t w\ld     
o!rwise be made "u ?is title furni%$ on 
or aft] ,janu>y #a1 #bjbj1 = purposes ( 
?is subsection only1 ! foll[+ %all apply

 ) respect to su* s]vices furni%$ by a  
physician or practition] p>ticipat+ 9 an
 applicable ,,aco 7z def9$ 9 p>agraph   
7#b77 to a ,m$ic>e fee-=-s]vice         
b5efici>y assign$ to ! applicable ,,aco3
  7,a7 ,inclusion ( home z orig9at+ site
 ,subject to p>agraph 7#c71 ! home ( a  
b5efici>y %all be treat$ z an orig9at+  
site describ$ 9 section                 
#ahcd7m77#d77;,c77ii74  7,b7 ,no        
application ( geographic limitation ,!  
geographic limitation "u section        
#ahcd7m77#d77;,c77i7 %all n apply )     
respect to an orig9at+ site describ$ 9  
section #ahcd7m77#d77;,c77ii7 7includ+ !
 home ( a b5efici>y "u subp>agraph      
7,a771 subject to ,/ate lic5s+          
requirem5ts4  7#b7 ,def9itions ,9 ?is   
subsection3 7,a7 ,applicable ,,aco ,!   
t]m applicable ,,aco means an ,,aco     
p>ticipat+ 9 a model te/$ or exp&$ "u   
section #aaae;,a or "u ?is section--    
7i7 t op]ates "u a two-sid$ model-- 7,i7
 describ$ 9 section #dbe4fjj7;a7 ( title
 #db1 ,code ( ,f$]al ,regulations2 or   

7,,ii7 te/$ or exp&$ "u section         
#aaae;,a2 &  7ii7 = :i* ,m$ic>e         
fee-=-s]vice b5efici>ies are assign$ to 
! ,,aco us+ a prospective assignm5t     
me?od1 z det]m9$ appropriate by !       
,secret>y4  7,b7 ,home ,! t]m home      
means1 ) respect to a ,m$ic>e           
fee-=-s]vice b5efici>y1 ! place (       
resid5ce us$ z ! home ( ! b5efici>y4    
7#c7 ,teleheal? s]vices receiv$ 9 ! home
 ,9 ! case ( teleheal? s]vices describ$ 
9 p>agraph 7#a7 :]e ! home ( a ,m$ic>e  
fee-=-s]vice b5efici>y is ! orig9at+    
site1 ! foll[+ %all apply3  7,a7 ,no    
facility fee ,!re %all be no facility   
fee paid to ! orig9at+ site "u section  
#ahcd7m77#b77;,b74  7,b7 ,exclusion (   
c]ta9 s]vices ,no paym5t may be made =  
su* s]vices t are inappropriate to      
furni% 9 ! home sett+ su* z s]vices t   
are typically furni%$ 9 inpati5t sett+s 
su* z a hospital4  4  7b7 ,/udy & report
  7#a7 ,/udy  7,a7 ,9 g5]al ,! ,secret>y
 ( ,heal? & ,human ,s]vices 79 ?is      
subsection ref]r$ to z ! ,secret>y7 %all

 conduct a /udy on ! implem5tation (    
section #ahii7l7 ( ! ,social ,security  
,act1 z add$ by subsection 7a74 ,su*    
/udy %all include an analysis ( !       
utilization (1 & exp5ditures =1         
teleheal? s]vices "u su* section4  7,b7 
,collection ( data ,! ,secret>y may     
collect su* data z ! ,secret>y det]m9es 
necess>y to c>ry out ! /udy "u ?is      
p>agraph4  7#b7 ,report ,n lat] ?an     
,janu>y #a1 #bjbf1 ! ,secret>y %all     
submit to ,congress a report conta9+ !  
results ( ! /udy conduct$ "u p>agraph   
7#a71 toge!r ) recomm5dations = su*     
legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  #cje4  
,exp&+ ! use ( teleheal? = individuals )
 /roke ,section #ahcd7m7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciem7m771 z am5d$ by section          
#ajb7;b77#b71 is am5d$ by add+ at ! end 
! foll[+ new p>agraph3  7#f7 ,treatm5t (
 /roke teleheal? s]vices  7,a7          
,non-application ( orig9at+ site        
requirem5ts ,! requirem5ts describ$ 9   

p>agraph 7#d77;,c7 %all n apply )       
respect to teleheal? s]vices furni%$ on 
or aft] ,janu>y #a1 #bjba1 = purposes ( 
evaluation ( an acute /roke1 z det]m9$  
by ! ,secret>y4  7,b7 ,no orig9at+ site 
facility fee ,9 ! case ( an orig9at+    
site t does n meet ! requirem5ts        
describ$ 9 p>agraph 7#d77;,c71 !        
,secret>y %all n pay an orig9at+ site   
facility fee 7z describ$ 9 p>agraph     
7#b77;,b77 to ! orig9at+ site ) respect 
to su* teleheal? s]vices4  4  ,,iv      
,id5tify+ ! ,*ronically ,ill ,population
  #dja4 ,provid+ flexibility =          
b5efici>ies to be "p ( an acc\ntable c>e
 organization ,section #ahii7;c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;jjj7c77 is am5d$-- 7#a7 by        
r$esignat+ p>agraphs 7#a7 & 7#b7 z      
subp>agraphs 7,a7 & 7,b71 respectively1 
& ind5t+ appropriately2  7#b7 by /rik+  
,a,c,os4--,! ,secret>y & ins]t+         
,a,c,os4-- 7#a7 ,9 g5]al ,subject to    
p>agraph 7#b71 ! ,secret>y  2 &  7#c7 by
 add+ at ! end ! foll[+ new p>agraph3   

7#b7 ,provid+ flexibility  7,a7 ,*oice (
 prospective assignm5t ,= ea* agreem5t  
p]iod 7effective = agreem5ts ent]$ into 
or r5ew$ on or aft] ,janu>y #a1 #bjbj71 
9 ! case :]e an ,,aco e/abli%$ "u !     
program is 9 a ,track t provides = !    
retrospective assignm5t ( ,m$ic>e       
fee-=-s]vice b5efici>ies to ! ,,aco1 !  
,secret>y %all p]mit ! ,,aco to *oose to
 h ,m$ic>e fee-=-s]vice b5efici>ies     
assign$ prospectively1 r ?an            
retrospectively1 to ! ,,aco = an        
agreem5t p]iod4  7,b7 ,assignm5t bas$ on
 volunt>y id5tification by ,m$ic>e      
fee-=-s]vice b5efici>ies  7i7 ,9 g5]al  
,= p]=mance ye> #bjah & ea* subsequ5t   
p]=mance ye>1 if a sy/em is available = 
electronic designation1 ! ,secret>y %all
 p]mit a ,m$ic>e fee-=-s]vice b5efici>y 
to volunt>ily id5tify an ,,aco          
pr(essional z ! prim>y c>e provid] ( !  
b5efici>y = purposes ( assign+ su*      
b5efici>y to an ,,aco1 z det]m9$ by !   
,secret>y4  7ii7 ,notification process  
,! ,secret>y %all e/abli% a process "u  

:i* a ,m$ic>e fee-=-s]vice b5efici>y    
is-- 7,i7 notifi$ ( _! ability to make  
an id5tification describ$ 9 clause 7i72 
&  7,,ii7 in=m$ ( ! process by :i* !y   
may make & *ange su* id5tification4     
7iii7 ,sup]s$+ claims-bas$ assignm5t ,a 
volunt>y id5tification by a ,m$ic>e     
fee-=-s]vice b5efici>y "u ?is           
subp>agraph %all sup]s$e any claims-bas$
 assignm5t o!rwise det]m9$ by !         
,secret>y4  4  ,v ,emp[]+ ,individuals &
 ,c>egiv]s 9 ,c>e ,deliv]y  #eja4       
,elim9at+ b>ri]s to c>e coord9ation "u  
acc\ntable c>e organizations  7a7 ,9    
g5]al ,section #ahii ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acie;jjj71 z am5d$ by section #cjd7;a71
 is am5d$--  7#a7 9 subsection 7b77#b71 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,i7 ,an ,,aco t seeks to 
op]ate an ,,aco ,b5efici>y ,inc5tive    
,program pursuant to subsection 7m7 %all
 apply to ! ,secret>y at su* "t1 9 su*  
mann]1 & ) su* in=mation z ! ,secret>y  
may require4  2  7#b7 by add+ at ! end !

 foll[+ new subsection3  7m7 ,au?ority  
,to provide inc5tive paym5ts to         
b5efici>ies ) respect to qualify+ prim>y
 c>e s]vices  7#a7 ,program  7,a7 ,9    
g5]al ,9 ord] to enc\rage ,m$ic>e       
fee-=-s]vice b5efici>ies to obta9       
m$ically necess>y prim>y c>e s]vices1 an
 ,,aco p>ticipat+ "u ?is section "u a   
paym5t model describ$ 9 clause 7i7 or   
7ii7 ( p>agraph 7#b77;,b7 may apply to  
e/abli% an ,,aco ,b5efici>y ,inc5tive   
,program to provide inc5tive paym5ts to 
su* b5efici>ies :o are furni%$ qualify+ 
s]vices 9 accordance ) ?is subsection4  
,! ,secret>y %all p]mit su* an ,,aco to 
e/abli% su* a program at ! ,secret>y's  
discretion & subject to su* requirem5ts1
 includ+ program integrity requirem5ts1 
z ! ,secret>y det]m9es necess>y4  7,b7  
,implem5tation ,! ,secret>y %all        
implem5t ?is subsection on a date       
det]m9$ appropriate by ! ,secret>y4 ,su*
 date %all be no e>li] ?an ,janu>y #a1  
#bjai1 & no lat] ?an ,janu>y #a1 #bjbj4 
7#b7 ,conduct ( program  7,a7 ,duration 

,subject to subp>agraph 7,h71 an ,,aco  
,b5efici>y ,inc5tive ,program e/abli%$  
"u ?is subsection %all be conduct$ = su*
 p]iod 7( n less ?an #a ye>7 z !        
,secret>y may approve4  7,b7 ,scope ,an 
,,aco ,b5efici>y ,inc5tive ,program     
e/abli%$ "u ?is subsection %all provide 
inc5tive paym5ts to all ( ! foll[+      
,m$ic>e fee-=-s]vice b5efici>ies :o are 
furni%$ qualify+ s]vices by ! ,,aco3    
7i7 ,) respect to ! ,track #b & ,track  
#c paym5t models describ$ 9 section     
#dbe4fjj7;a7 ( title #db1 ,code ( ,f$]al
 ,regulations 7or 9 any successor       
regulation71 ,m$ic>e fee-=-s]vice       
b5efici>ies :o are prelim9>ily          
prospectively or prospectively assign$  
7or o!rwise assign$1 z det]m9$ by !     
,secret>y7 to ! ,,aco4  7ii7 ,) respect 
to any future paym5t models involv+     
two-sid$ risk1 ,m$ic>e fee-=-s]vice     
b5efici>ies :o are assign$ to ! ,,aco1 z
 det]m9$ by ! ,secret>y4  7,c7 ,qualify+
 s]vice ,= purposes ( ?is subsection1 a 
qualify+ s]vice is a prim>y c>e s]vice1 

z def9$ 9 section #dbe4bj ( title #db1  
,code ( ,f$]al ,regulations 7or 9 any   
successor regulation71 ) respect to :i* 
co9surance applies "u "p ,b1 furni%$    
?r\gh an ,,aco by--  7i7 an ,,aco       
pr(essional describ$ 9 subsection       
7h77#a77;,a7 :o has a prim>y c>e        
specialty designation includ$ 9 !       
def9ition ( prim>y c>e physician "u     
section #dbe4bj ( title #db1 ,code (    
,f$]al ,regulations 7or any successor   
regulation72  7ii7 an ,,aco pr(essional 
describ$ 9 subsection 7h77#a77;,b72 or  
7iii7 a ,f$]ally qualifi$ heal? c5t] or 
rural heal? cl9ic 7z su* t]ms are def9$ 
9 section #ahfa7;aa774  7,d7 ,inc5tive  
paym5ts ,an inc5tive paym5t made by an  
,,aco pursuant to an ,,aco ,b5efici>y   
,inc5tive ,program e/abli%$ "u ?is      
subsection %all be--  7i7 9 an am\nt up 
to #bj1 ) su* maximum am\nt updat$      
annually by ! p]c5tage increase 9 !     
consum] price index = all urban consum]s
 7,unit$ ,/ates city av]age7 = !        
#ab-mon? p]iod end+ ) ,june ( ! previ\s 

ye>2  7ii7 9 ! same am\nt = ea* ,m$ic>e 
fee-=-s]vice b5efici>y describ$ 9 clause
 7i7 or 7ii7 ( subp>agraph 7,b7 )\t     
reg>d to enrollm5t ( su* a b5efici>y 9 a
 m$ic>e supplem5tal policy 7describ$ 9  
section #ahhb7;g77#a771 9 a ,/ate       
,m$icaid plan "u title ,,xix or a waiv] 
( su* a plan1 or 9 any o!r heal?        
insurance policy or heal? b5efit plan2  
7iii7 made = ea* qualify+ s]vice furni%$
 to su* a b5efici>y describ$ 9 clause   
7i7 or 7ii7 ( subp>agraph 7,b7 dur+ a   
p]iod specifi$ by ! ,secret>y2 &  7iv7  
made no lat] ?an #cj days aft] a        
qualify+ s]vice is furni%$ to su* a     
b5efici>y describ$ 9 clause 7i7 or 7ii7 
( subp>agraph 7,b74  7,e7 ,no sep>ate   
paym5ts f ! ,secret>y ,! ,secret>y %all 
n make any sep>ate paym5t to an ,,aco = 
! co/s1 includ+ inc5tive paym5ts1 (     
c>ry+ out an ,,aco ,b5efici>y ,inc5tive 
,program e/abli%$ "u ?is subsection4    
,no?+ 9 ?is subp>agraph %all be con/ru$ 
z prohibit+ an ,,aco f us+ %>$ sav+s    
receiv$ "u ?is section to c>ry out an   

,,aco ,b5efici>y ,inc5tive ,program4    
7,f7 ,no application to %>$ sav+s       
calculation ,inc5tive paym5ts made by an
 ,,aco "u ?is subsection %all be        
disreg>d$ = purposes ( calculat+        
b5*m>ks1 e/imat$ av]age p] capita       
,m$ic>e exp5ditures1 & %>$ sav+s "u ?is 
section4  7,g7 ,report+ requirem5ts ,an 
,,aco conduct+ an ,,aco ,b5efici>y      
,inc5tive ,program "u ?is subsection    
%all1 at su* times & 9 su* =mat z !     
,secret>y may require1 report to !      
,secret>y su* in=mation & reta9 su*     
docum5tation z ! ,secret>y may require1 
includ+ ! am\nt & frequ5cy ( inc5tive   
paym5ts made & ! numb] ( ,m$ic>e        
fee-=-s]vice b5efici>ies receiv+ su*    
paym5ts4  7,h7 ,t]m9ation ,! ,secret>y  
may t]m9ate an ,,aco ,b5efici>y         
,inc5tive ,program e/abli%$ "u ?is      
subsection at any "t = reasons det]m9$  
appropriate by ! ,secret>y4  7#c7       
,exclusion ( inc5tive paym5ts ,any      
paym5t made "u an ,,aco ,b5efici>y      
,inc5tive ,program e/abli%$ "u ?is      

subsection %all n be consid]$ income or 
res\rces or o!rwise tak5 into acc\nt =  
purposes (--  7,a7 det]m9+ eligibility =
 b5efits or assi/ance 7or ! am\nt or    
ext5t ( b5efits or assi/ance7 "u any    
,f$]al program or "u any ,/ate or local 
program f9anc$ 9 :ole or 9 "p ) ,f$]al  
funds2 or  7,b7 any ,f$]al or ,/ate laws
 relat+ to taxation4  2  7#c7 9         
subsection 7e71 by ins]t+ 1 includ+ an  
,,aco ,b5efici>y ,inc5tive ,program "u  
subsections 7b77#b77;,i7 & 7m7 aft] !   
program2 &  7#d7 9 subsection 7g77#f71  
by ins]t+ or ( an ,,aco ,b5efici>y      
,inc5tive ,program "u subsections       
7b77#b77;,i7 & 7m7 aft] "u subsection   
7d77#d74  7b7 ,am5dm5t to section       
#aabh;,b ,section #aabh;,b7b77#c7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g;b7b77#c77 is am5d$--  7#a7 by
 /rik+ & at ! end ( subp>agraph 7,i72   
7#b7 by /rik+ ! p]iod at ! end (        
subp>agraph 7,j7 & ins]t+ 2 &2 &  7#c7  
by add+ at ! end ! foll[+ new           
subp>agraph3  7,k7 an inc5tive paym5t   

made to a ,m$ic>e fee-=-s]vice b5efici>y
 by an ,,aco "u an ,,aco ,b5efici>y     
,inc5tive ,program e/abli%$ "u          
subsection 7m7 ( section #ahii1 if !    
paym5t is made 9 accordance ) !         
requirem5ts ( su* subsection & meets su*
 o!r conditions z ! ,secret>y may       
e/abli%4  4  7c7 ,evaluation & report   
7#a7 ,evaluation ,! ,secret>y ( ,heal? &
 ,human ,s]vices 79 ?is subsection      
ref]r$ to z ! ,secret>y7 %all conduct an
 evaluation ( ! ,,aco ,b5efici>y        
,inc5tive ,program e/abli%$ "u          
subsections 7b77#b77;,i7 & 7m7 ( section
 #ahii ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acie;jjj71 z add$ by         
subsection 7a74 ,! evaluation %all      
include an analysis ( ! impact ( !      
implem5tation ( ! ,program on           
exp5ditures & b5efici>y heal? outcomes  
"u title ,,xviii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq474     
7#b7 ,report ,n lat] ?an ,octob] #a1    
#bjbc1 ! ,secret>y %all submit to       
,congress a report conta9+ ! results ( !

 evaluation "u p>agraph 7#a71 toge!r )  
recomm5dations = su* legislation &      
adm9i/rative action z ! ,secret>y       
det]m9es appropriate4  #ejb4 ,,gao /udy 
& report on longitud9al compreh5sive c>e
 plann+ s]vices "u ,m$ic>e "p ,b  7a7   
,/udy ,! ,comptroll] ,g5]al %all conduct
 a /udy on ! e/abli%m5t "u "p ,b ( !    
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act ( a paym5t code =
 a visit = longitud9al compreh5sive c>e 
plann+ s]vices4 ,su* /udy %all include  
an analysis ( ! foll[+ to ! ext5t su*   
in=mation is available3  7#a7 ,!        
frequ5cy ) :i* s]vices simil> to        
longitud9al compreh5sive c>e plann+     
s]vices are furni%$ to ,m$ic>e          
b5efici>ies1 :i* provid]s ( s]vices &   
suppli]s are furni%+ ^? s]vices1 :e!r   
,m$ic>e reimbursem5t is be+ receiv$ = ^?
 s]vices1 &1 if s1 ?r\gh :i* codes ^?   
s]vices are be+ reimburs$4  7#b7 ,:e!r1 
& ! ext5t to :i*1 longitud9al           
compreh5sive c>e plann+ s]vices w\ld    
ov]lap1 & c\ld !re=e result 9           

duplicative paym5t1 ) s]vices cov]$ "u !
 hospice b5efit z well z ! *ronic c>e   
managem5t code1 evaluation & managem5t  
codes1 or o!r codes t already exi/ "u "p
 ,b ( ! ,m$ic>e program4  7#c7 ,any     
b>ri]s to hospitals1 skill$ nurs+       
facilities1 hospice programs1 home heal?
 ag5cies1 & o!r applicable provid]s     
work+ ) a ,m$ic>e b5efici>y to engage 9 
! c>e plann+ process & complete !       
necess>y docum5tation to support !      
treatm5t & c>e plan ( ! b5efici>y &     
provide su* docum5tation to o!r provid]s
 & ! b5efici>y or ! b5efici>y's         
repres5tative4  7#d7 ,any b>ri]s to     
provid]s1 o!r ?an ! provid] furni%+     
longitud9al compreh5sive c>e plann+     
s]vices1 access+ ! c>e plan & associat$ 
docum5tation = use relat$ to ! c>e ( !  
,m$ic>e b5efici>y4  7#e7 ,pot5tial      
options = ensur+ t applicable provid]s  
are notifi$ ( a pati5t's exi/+          
longitud9al c>e plan & t applicable     
provid]s consid] t plan 9 mak+ _!       
treatm5t decisions1 & :at ! *all5ges    

might be 9 implem5t+ su* options4  7#f7 
,/akehold]'s views on ! ne$ = !         
developm5t ( quality metrics ) respect  
to longitud9al compreh5sive c>e plann+  
s]vices1 su* z measures relat$ to--     
7,a7 ! process ( elicit+ input f !      
,m$ic>e b5efici>y or f a legally        
au?oriz$ repres5tative & docum5t+ 9 !   
m$ical record ! pati5t-direct$ c>e plan2
  7,b7 ! effectiv5ess & pati5t-c5t]$ness
 ( ! c>e plan 9 organiz+ deliv]y (      
s]vices consi/5t ) ! plan2  7,c7 !      
availability ( ! c>e plan & associat$   
docum5tation to o!r provid]s t c>e = !  
b5efici>y2 &  7,d7 ! ext5t to :i* !     
b5efici>y receiv$ s]vices & support t is
 free f discrim9ation bas$ on advanc$   
age1 disability /atus1 or advanc$       
illness4  7#g7 ,/akehold]'s views on h[ 
su* quality metrics w\ld provide        
in=mation on-- 7,a7 ! goals1 values1 &  
pref]5ces ( ! b5efici>y2  7,b7 !        
docum5tation ( ! c>e plan2  7,c7 s]vices
 furni%$ to ! b5efici>y2 &  7,d7        
outcomes ( treatm5t4  7#h7 ,/akehold]'s 

views on--  7,a7 ! type ( tra9+ &       
education ne$$ = applicable provid]s1   
individuals1 & c>egiv]s 9 ord] to       
facilitate longitud9al compreh5sive c>e 
plann+ s]vices2  7,b7 ! types ( provid]s
 ( s]vices & suppli]s t %\ld be includ$ 
9 ! int]discipl9>y team ( an applicable 
provid]2 &  7,c7 ! *>act]i/ics ( ,m$ic>e
 b5efici>ies t w\ld be mo/ appropriate  
to receive longitud9al compreh5sive c>e 
plann+ s]vices1 su* z individuals )     
advanc$ disease & individuals :o ne$    
assi/ance ) multiple activities ( daily 
liv+4  7#i7 ,/akehold]'s views on !     
frequ5cy ) :i* longitud9al compreh5sive 
c>e plann+ s]vices %\ld be furni%$4  7b7
 ,report ,n lat] ?an #ah mon?s aft] !   
date ( ! enactm5t ( ?is ,act1 !         
,comptroll] ,g5]al %all submit to       
,congress a report conta9+ ! results ( !
 /udy conduct$ "u subsection 7a71 toge!r
 ) recomm5dations = su* legislation &   
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4  7c7       
,def9itions ,9 ?is section3 7#a7        

,applicable provid] ,! t]m applicable   
provid] means a hospice program 7z def9$
 9 subsection 7dd77#b7 ( section #ahfa (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww77 or o!r provid] ( s]vices 7z  
def9$ 9 subsection 7u7 ( su* section7 or
 suppli] 7z def9$ 9 subsection 7d7 ( su*
 section7 t--  7,a7 furni%es longitud9al
 compreh5sive c>e plann+ s]vices ?r\gh  
an int]discipl9>y team2 &  7,b7 meets   
su* o!r requirem5ts z ! ,secret>y may   
det]m9e to be appropriate4  7#b7        
,comptroll] ,g5]al ,! t]m ,comptroll]   
,g5]al means ! ,comptroll] ,g5]al ( !   
,unit$ ,/ates4  7#c7 ,int]discipl9>y    
team ,! t]m int]discipl9>y team means a 
gr\p t--  7,a7 includes ! p]sonnel      
describ$ 9 subsection 7dd77#b77;,b77i7 (
 su* section #ahfa2  7,b7 may include a 
*apla91 m9i/]1 or o!r cl]gy2 &  7,c7 may
 include o!r direct c>e p]sonnel4  7#d7 
,longitud9al compreh5sive c>e plann+    
s]vices ,! t]m longitud9al compreh5sive 
c>e plann+ s]vices means a volunt>y %>$ 
decisionmak+ process t is furni%$ by an 

applicable provid] ?r\gh an             
int]discipl9>y team & includes a        
conv]sation ) ,m$ic>e b5efici>ies :o h  
receiv$ a diagnosis ( a s]i\s or        
life-?reat5+ illness4 ,! purpose ( su*  
s]vices is to discuss a longitud9al c>e 
plan t addresses ! progression ( !      
disease1 treatm5t options1 ! goals1     
values1 & pref]5ces ( ! b5efici>y1 & !  
availability ( o!r res\rces & social    
supports t may r$uce ! b5efici>y's heal?
 risks & promote self-managem5t & %>$   
decisionmak+4  7#e7 ,secret>y ,! t]m    
,secret>y means ! ,secret>y ( ,heal? &  
,human ,s]vices4  ,,vi ,o!r ,policies to
 ,improve ,c>e = ! ,*ronically ,ill     
#fja4 ,provid+ prescription drug plans )
 p>ts ,a & ,b claims data to promote !  
appropriate use ( m$ications & improve  
heal? outcomes ,section #ahfj;,d-#d7;c7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#ajd7;c77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#f7 ,provid+ prescription drug plans ) 
p>ts ,a & ,b claims data to promote !   

appropriate use ( m$ications & improve  
heal? outcomes  7,a7 ,process ,subject  
to subp>agraph 7,b71 ! ,secret>y %all   
e/abli% a process "u :i* a ,,pdp sponsor
 ( a prescription drug plan may submit a
 reque/ = ! ,secret>y to provide !      
sponsor1 on a p]iodic basis & 9 an      
electronic =mat1 beg9n+ 9 plan ye>      
#bjbj1 data describ$ 9 subp>agraph 7,d7 
) respect to enrollees 9 su* plan4 ,su* 
data %all be provid$ )\t reg>d to :e!r  
su* enrollees are describ$ 9 clause 7ii7
 ( p>agraph 7#b77;,a74  7,b7 ,purposes  
,a ,,pdp sponsor may use ! data provid$ 
to ! sponsor pursuant to subp>agraph    
7,a7 = any ( ! foll[+ purposes3  7i7 ,to
 optimize !rapeutic outcomes ?r\gh      
improv$ m$ication use1 z su* phrase is  
us$ 9 clause 7i7 ( p>agraph 7#b77;,a74  
7ii7 ,to improv+ c>e coord9ation s z to 
prev5t adv]se heal? outcomes1 su* z     
prev5table em]g5cy dep>tm5t visits &    
hospital readmissions4  7iii7 ,= any o!r
 purpose det]m9$ appropriate by !       
,secret>y4  7,c7 ,limitations on data   

use ,a ,,pdp sponsor %all n use data    
provid$ to ! sponsor pursuant to        
subp>agraph 7,a7 = any ( ! foll[+       
purposes3  7i7 ,to in=m cov]age         
det]m9ations "u ?is "p4  7ii7 ,to       
conduct retroactive reviews ( m$ically  
accept$ indications det]m9ations4  7iii7
 ,to facilitate enrollm5t *anges to a   
diff]5t prescription drug plan or an    
,,ma-,,pd plan (f]$ by ! same p>5t      
organization4  7iv7 ,to in=m m>ket+ (   
b5efits4  7v7 ,= any o!r purpose t !    
,secret>y det]m9es is necess>y to       
include 9 ord] to protect ! id5tity (   
individuals entitl$ to1 or enroll$ =1   
b5efits "u ?is title & to protect !     
security ( p]sonal heal? in=mation4     
7,d7 ,data describ$ ,! data describ$ 9  
?is clause are /&>diz$ extracts 7z      
det]m9$ by ! ,secret>y7 ( claims data "u
 p>ts ,a & ,b = items & s]vices furni%$ 
"u su* p>ts = "t p]iods specifi$ by !   
,secret>y4 ,su* data %all include data z
 curr5t z practicable4  4  #fjb4 ,,gao  
/udy & report on improv+ m$ication      

syn*ronization  7a7 ,/udy ,! ,comptroll]
 ,g5]al ( ! ,unit$ ,/ates 79 ?is section
 ref]r$ to z ! ,comptroll] ,g5]al7 %all 
conduct a /udy on ! ext5t to :i* ,m$ic>e
 prescription drug plans 7,,ma-,,pd     
plans & /&alone prescription drug plans7
 "u "p ,d ( title ,,xviii ( ! ,social   
,security ,act & private payors use     
programs t syn*ronize ph>macy disp5s+ s 
t individuals may receive multiple      
prescriptions on ! same day to          
facilitate compreh5sive c\nsel+ &       
promote m$ication adh]5ce4 ,! /udy %all 
include a analysis ( ! foll[+3  7#a7 ,! 
ext5t to :i* ph>macies h adopt$ su*     
programs4  7#b7 ,! common *>act]i/ics ( 
su* programs1 includ+ h[ ph>macies      
/ructure c\nsel+ sessions "u su*        
programs & ! types ( paym5t & o!r       
arrangem5ts t ,m$ic>e prescription drug 
plans & private payors employ "u su*    
programs to support ! ef=ts ( ph>macies4
  7#c7 ,h[ su* programs comp>e = ,m$ic>e
 prescription drug plans & private      
payors4  7#d7 ,:at is kn[n ab\t h[ su*  

programs affect pati5t m$ication adh]5ce
 & ov]all pati5t heal? outcomes1 includ+
 if adh]5ce & outcomes v>y by pati5t    
subpopulations1 su* z disease /ate &    
socioeconomic /atus4  7#e7 ,:at is kn[n 
ab\t ov]all pati5t satisfaction ) su*   
programs & satisfaction ) su* programs1 
includ+ )9 pati5t subpopulations1 su* z 
disease /ate & socioeconomic /atus4     
7#f7 ,! ext5t to :i* laws & regulations 
( ! ,m$ic>e program support su*         
programs4  7#g7 ,b>ri]s to ! use (      
m$ication syn*ronization programs by    
,m$ic>e prescription drug plans4  7b7   
,report ,n lat] ?an #ah mon?s aft] !    
date ( ! enactm5t ( ?is ,act1 !         
,comptroll] ,g5]al %all submit to       
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