,i #aae? ,,congress #b;d ,session ,h4 ,r4 #dhbj ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,janu>y #ah1 #bjah,mr4 ,mc,eachin 7= himself1 ,ms4 ,roybal-,all>d1 ,mr4 ,clay1 ,mr4 ,s]rano1 ,mr4 ,espaillat1 ,mr4 ,deut*1 ,mrs4 ,napolitano1 ,mr4 ,pocan1 ,mr4 ,langev91 ,mr4 ,ri*mond1 ,mr4 ,huffman1 ,mr4 ,s*rad]1 ,ms4 ,adams1 ,mr4 ,mc,nerney1 ,mr4 ,grijalva1 ,mr4 ,br5dan ,f4 ,boyle ( ,p5nsylvania1 ,mr4 ,c>son ( ,indiana1 ,mr4 ,sablan1 ,ms4 ,bonamici1 ,mr4 ,l>son ( ,connecticut1 ,ms4 ,judy ,*u ( ,cali=nia1 ,ms4 ,del,bene1 ,ms4 ,norton1 ,mr4 ,scott ( ,virg9ia1 ,mr4 ,coh51 ,mr4 ,sean ,patrick ,maloney ( ,new ,york1 ,ms4 ,b>ragn1 ,ms4 ,matsui1 ,ms4 ,s*ak[sky1 ,mr4 ,veasey1 ,mr4 ,soto1 ,ms4 ,jayapal1 ,mr4 ,keat+1 ,mr4 ,al ,gre5 ( ,texas1 ,mr4 ,l[5?al1 ,ms4 ,wilson ( ,florida1 ,ms4 ,hanabusa1 ,ms4 ,ca/or ( ,florida1 ,ms4 ,sewell ( ,alabama1 ,mr4 ,gomez1 ,mr4 ,loebsack1 ,ms4 ,wass]man ,s*ultz1 ,mrs4 ,watson ,coleman1 ,mr4 ,?ompson ( ,cali=nia1 ,mr4 ,c\rtney1 ,ms4 ,ros51 ,mr4 ,takano1 ,ms4 ,p+ree1 ,ms4 ,ku/] ( ,new ,hamp%ire1 ,mr4 ,khanna1 ,mr4 ,panetta1 & ,mr4 ,kihu57 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = 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 ext5d fund+ = c]ta9 public heal? programs1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,advanc+ ,s5iors & ,kids ,act or ! ,,ask ,act4 #b4 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4 ,sec4 #b4 ,table ( cont5ts4 ,title ,i--,*ildr5's ,heal? ,insurance ,program ,sec4 #ajj4 ,%ort title4 ,sec4 #aja4 ,p]man5t ext5sion ( ! ,*ildr5's ,heal? ,insurance ,program4 ,sec4 #ajb4 ,ext5sion ( c]ta9 programs & demon/ration projects4 ,sec4 #ajc4 ,ext5sion ( outrea* & enrollm5t program4 ,sec4 #ajd4 ,ext5sion & r$uction ( additional ,f$]al f9ancial p>ticipation = ,,*ip4 ,title ,,ii--,m$ic>e & ,o!r ,heal? ,ext5d]s ,subtitle ,a--,m$ic>e ,ext5d]s & ,relat$ ,policies ,sec4 #bja4 ,ext5sion ( "w ,,gpci floor4 ,sec4 #bjb4 ,p]man5t repeal ( ! !rapy caps4 ,sec4 #bjc4 ,gr\nd ambulance s]vices co/ report+ requirem5t4 ,sec4 #bjd4 ,gr\nd ambulance s]vices co/ report+ /udy4 ,sec4 #bje4 ,ext5sion ( gr\nd ambulance s]vices ext5d]s4 ,sec4 #bjf4 ,ext5sion ( increas$ inpati5t hospital paym5t adju/m5t = c]ta9 l[-volume hospitals4 ,sec4 #bjg4 ,ext5sion ( ! ,m$ic>e-,dep5d5t ,hospital 7,,mdh7 program4 ,sec4 #bjh4 ,specializ$ ,m$ic>e ,advantage plans = special ne$s individuals4 ,sec4 #bji4 ,exp&+ supplem5tal b5efits to meet ! ne$s ( *ronically ill ,m$ic>e ,advantage enrollees4 ,sec4 #baj4 ,ext5sion ( cons5sus-bas$ entity fund+4 ,sec4 #baa4 ,ext5sion ( c]ta9 ,,mippa fund+ provisions4 ,sec4 #bab4 ,ext5sion ( home heal? rural add-on4 ,subtitle ,b--,m$icaid & ,public ,heal? ,ext5d]s ,sec4 #bba4 ,ext5sion = community heal? c5t]s & ! ,national ,heal? ,s]vice ,corps4 ,sec4 #bbb4 ,ext5sion = special diabetes programs4 ,sec4 #bbc4 ,reau?orization ( program ( paym5ts to tea*+ heal? c5t]s t op]ate graduate m$ical education programs4 ,sec4 #bbd4 ,ext5sion = family-to-family heal? in=mation c5t]s4 ,sec4 #bbe4 ,ext5sion ( ab/95ce education2 ext5sion ( p]sonal responsibility education program4 ,sec4 #bbf4 ,ext5sion ( heal? work=ce demon/ration projects = l[-income individuals4 ,sec4 #bbg4 ,delay ( r$uction to ,m$icaid ,,d% allotm5ts4 ,sec4 #bbh4 ,delay ( ,bip>tisan ,budget ,act ( #bjac ?ird-p>ty liability provisions4 ,subtitle ,c--,cont9u+ ! ,mat]nal1 ,infant1 & ,e>ly ,*ildhood ,home ,visit+ ,program ,sec4 #bca4 ,cont9u+ evid5ce-bas$ home visit+ program4 ,sec4 #bcb4 ,cont9u+ to demon/rate results to help families4 ,sec4 #bcc4 ,review+ /atewide ne$s to t>get res\rces4 ,sec4 #bcd4 ,improv+ ! likelihood ( success 9 high-risk communities4 ,sec4 #bce4 ,option to fund evid5ce-bas$ home visit+ on a pay = outcome basis4 ,sec4 #bcf4 ,data ex*ange /&>ds = improv$ int]op]ability4 ,sec4 #bcg4 ,allocation ( funds4 ,title ,,iii--,/r5g!n+ ,protections = ,social ,security ,b5efici>ies ,act ( #bjah ,sec4 #cjj4 ,%ort title4 ,subtitle ,a--,/r5g!n+ ,ov]sight & ,b5efici>y ,protection ,sec4 #cja4 ,/rong] monitor+ ( repres5tative payees4 ,sec4 #cjb4 ,r$uc+ ! burd5 on families4 ,sec4 #cjc4 ,protect+ b5efici>ies ?r\gh in=mation %>+4 ,sec4 #cjd4 ,cl>ify+ ov]paym5t liability = *ild 9 *ild welf>e sy/em4 ,sec4 #cje4 ,reports4 ,subtitle ,b--,improv+ ,payee ,selection & ,quality ,sec4 #caa4 ,advance designation ( repres5tative payees4 ,sec4 #cab4 ,prohibition on individuals convict$ ( c]ta9 crimes s]v+ z repres5tative payees4 ,sec4 #cac4 ,prohibition on individuals ) repres5tative payees s]v+ z repres5tative payees4 ,sec4 #cad4 ,reassessm5t ( payee selection & replacem5t policies4 ,i ,*ildr5's ,heal? ,insurance ,program #ajj4 ,%ort title ,?is title may be cit$ z ! ,keep+ ,kids' ,insurance ,deliv]y ,/able ,act or ! ,,kids ,act4 #aja4 ,p]man5t ext5sion ( ! ,*ildr5's ,heal? ,insurance ,program 7a7 ,fund+ 7#a7 ,9 g5]al ,section #bajd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7a771 z am5d$ by section #cbja7;a7 ( ! ,,*ip & ,public ,heal? ,fund+ ,ext5sion ,act 7division ,c ( ,public ,law #aae-if71 is am5d$-- 7,a7 9 p>agraph 7#bj77;,b71 by /rik+ 2 & & ins]t+ a semicolon2 & 7,b7 by /rik+ p>agraph 7#ba7 & ins]t+ ! foll[+ new p>agraphs3 7#ba7 = fiscal ye> #bjah1 #ba1ejj1jjj1jjj2 7#bb7 = fiscal ye> #bjai1 #bb1fjj1jjj1jjj2 7#bc7 = fiscal ye> #bjbj1 #bc1gjj1jjj1jjj2 7#bd7 = fiscal ye> #bjba1 #bd1hjj1jjj1jjj2 7#be7 = fiscal ye> #bjbb1 #be1ijj1jjj1jjj2 7#bf7 = fiscal ye> #bjbc1 #bg1jjj1jjj1jjj2 7#bg7 = fiscal ye> #bjbd1 #bh1ajj1jjj1jjj2 7#bh7 = fiscal ye> #bjbe1 #bi1bjj1jjj1jjj2 7#bi7 = fiscal ye> #bjbf1 #cj1cjj1jjj1jjj2 7#cj7 = fiscal ye> #bjbg1 #ca1djj1jjj1jjj2 & 7#ca7 = fiscal ye> #bjbh & ea* subsequ5t fiscal ye>1 ! am\nt provid$ = ! previ\s fiscal ye>1 increas$ by ! product (-- 7,a7 #a plus ! p]c5tage increase 9 ! project$ p] capita am\nt ( ,national ,heal? ,exp5ditures f ! cal5d> ye> 9 :i* ! previ\s fiscal ye> ends to ! cal5d> ye> 9 :i* ! fiscal ye> involv$ ends1 z mo/ rec5tly publi%$ by ! ,secret>y be=e ! beg9n+ ( ! fiscal ye>2 & 7,b7 #a plus ! p]c5tage increase 7if any7 9 ! national population ( *ildr5 f ,july #a 9 ! previ\s fiscal ye> to ,july #a 9 ! fiscal ye> involv$1 z det]m9$ by ! ,secret>y bas$ on ! mo/ rec5t publi%$ e/imates ( ! ,bureau ( ! ,c5sus be=e ! beg9n+ ( ! fiscal ye> involv$1 plus #a p]c5tage po9t4 4 7#b7 ,prev5tion ( duplicate appropriations = fiscal ye> #bjah ,not)/&+ any o!r provision ( law1 ins(> z funds h be5 appropriat$ "u subsection 7a77#ba7 ( section #bajd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd71 z su* subsection is 9 effect on ! day be=e ! date ( ! enactm5t ( ?is ,act1 to provide allotm5ts to ,/ates "u ! ,/ate ,*ildr5's ,heal? ,insurance ,program e/abli%$ "u title ,,xxi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;aa et seq47 7:e!r implem5t$ "u title ,,xix1 ,,xxi1 or bo?1 ( ! ,social ,security ,act7 = fiscal ye> #bjah-- 7,a7 any am\nts t are s appropriat$ t are n s allott$ & obligat$ be=e ! date ( ! enactm5t ( ?is ,act1 are resc9d$2 & 7,b7 any am\nt provid$ = ,,*ip allotm5ts to a ,/ate "u ?is section 7& ! am5dm5ts made by ?is section7 = su* fiscal ye> %all be r$uc$ by ! am\nt ( su* appropriations s allott$ & obligat$ be=e su* date4 7b7 ,allotm5ts ,section #bajd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m771 z am5d$ by section #cbja7;b7 ( ! ,,*ip & ,public ,heal? ,fund+ ,ext5sion ,act 7division ,c ( ,public ,law #aae-if71 is am5d$-- 7#a7 9 p>agraph 7#b77;,b7-- 7,a7 9 ! matt] prec$+ clause 7i71 by /rik+ 7#ai7 & ins]t+ 7#ca72 & 7,b7 9 clause 7ii7-- 7i7 9 ! matt] prec$+ subclause 7,i71 by /rik+ & p>agraph 7#aj72 & 7ii7 9 subclause 7,i71 by ins]t+ 7or1 9 ! case ( fiscal ye> #bjah1 "u p>agraph 7#d77 aft] clause 7i72 7#b7 9 p>agraph 7#e71 by /rik+ 1 #bjag1 or #bjah & ins]t+ or #bjag2 7#c7 9 p>agraph 7#g7-- 7,a7 9 subp>agraph 7,a71 by /rik+ & end+ ) fiscal ye> #bjag2 7,b7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by ins]t+ 7or1 9 ! case ( fiscal ye> #bjah1 by n lat] ?an ! date t is #fj days aft] ! date ( ! enactm5t ( ! ,,kids ,act7 aft] be=e ! ,augu/ #ca prec$+ ! beg9n+ ( ! fiscal ye>2 & 7,c7 9 ! matt] foll[+ subp>agraph 7,b71 by /rik+ or fiscal ye> #bjaf & ins]t+ fiscal ye> #bjaf1 or any succe$+ ev5-numb]$ fiscal ye>2 7#d7 9 p>agraph 7#i71 by /rik+ 1 #bjag1 or #bjah & ins]t+ or #bjag2 & 7#e7 by /rik+ p>agraph 7#aj74 7c7 ,ext5sion ( ! ,*ild ,enrollm5t ,cont+5cy ,fund ,section #bajd7n7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7n77 is am5d$-- 7#a7 9 p>agraph 7#b7-- 7,a7 9 subp>agraph 7,a77ii71 by /rik+ #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 & #bjaf & ins]t+ #bjaj ?r\gh #bjad1 #bjaf1 #bjah1 & ea* subsequ5t fiscal ye>2 & 7,b7 9 subp>agraph 7,b71 by /rik+ #bjaj1 #bjaa1 #bjab1 #bjac1 #bjad1 & #bjaf & ins]t+ #bjaj ?r\gh #bjad1 #bjaf1 #bjah1 & ea* subsequ5t fiscal ye>2 & 7#b7 9 p>agraph 7#c77;,a71 9 ! matt] prec$+ clause 7i71 by /rik+ or a semi-annual allotm5t p]iod = fiscal ye> #bjae or #bjag & ins]t+ or 9 fiscal ye> #bjah or any subsequ5t fiscal ye> 7or a semi-annual allotm5t p]iod = fiscal ye> #bjae1 or #bjag74 7d7 ,ext5sion ( qualify+ /ates option 7#a7 ,9 g5]al ,section #baje7;g77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7g77#d77 is am5d$-- 7,a7 9 ! head+1 by /rik+ ?r\gh #bjag & ins]t+ & subsequ5t fiscal ye>s2 & 7,b7 9 subp>agraph 7,a71 by /rik+ = any ( fiscal ye>s #bjji ?r\gh #bjag & ins]t+ = fiscal ye> #bjji or any subsequ5t fiscal ye>4 7#b7 ,te*nical am5dm5ts ,section #bajd7;f77#b77;,b77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7f77#b77;,b77ii771 z am5d$ by section #cbja7;c7 ( ! ,,*ip & ,public ,heal? ,fund+ ,ext5sion ,act 7division ,c ( ,public ,law #aae-if71 is am5d$-- 7,a7 9 subclause 7,i71 by /rik+ = ! mon? 7z def9$ 9 subclause 7,,ii77 & ins]t+ 7z def9$ 9 subclause 7,,ii77 = ! mon?2 7,b7 9 subclause 7,,ii71 by ins]t+ 1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ! ,,kids ,act1 aft] section #baje7;g77#d77;,a72 & 7,c7 9 subclause 7,,vi7-- 7i7 by ins]t+ 1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ! ,,kids ,act aft] 1 section #baje7;g77#d72 & 7ii7 by ins]t+ 1 z s 9 effect aft] "u section #baje7;g77#d74 7e7 ,ext5sion ( express lane eligibility option ,section #aijb7;e77#ac7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77 is am5d$ by /rik+ subp>agraph 7,i74 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$-- 7,a7 9 ! p>agraph head+1 by /rik+ until ,octob] #a1 #bjai2 & 7,b7 9 subp>agraph 7,a71 9 ! matt] prec$+ clause 7i7-- 7i7 by /rik+ ,dur+ ! p]iod t beg9s on & ins]t+ ,beg9n+ on2 7ii7 by /rik+ & ends on ,septemb] #cj1 #bjai2 & 7iii7 by /rik+ ,! prec$+ s5t5ce %all n be con/ru$ z prev5t+ a ,/ate dur+ su* p]iod & ins]t+ ,beg9n+ on ,octob] #a1 #bjai1 ! 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$-- 7,a7 9 ! p>agraph head+1 by /rik+ until ,octob] #a1 #bjai2 & 7,b7 by /rik+ ?r\gh ,septemb] #cj1 #bjai1 & ins]t+ 7b beg9n+ on ,octob] #a1 #bjai1 only ) respect to *ildr5 9 families ^: income does n exce$ #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 7h7 ,availability ( unus$ fiscal ye> #bjah r$i/ribution am\nts ,any am\nts t h be5 r$i/ribut$ to ,/ates "u subsection 7f7 ( section #bajd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7 = fiscal ye> #bjah t are n1 or w n be1 exp5d$ by ! end ( t fiscal ye> %all be-- 7#a7 adju/$ by ! ,secret>y be=e ! end ( fiscal ye> #bjah to reflect an updat$ e/imate ( %ortfalls "u subsection 7f77#b77;,a7 ( su* section2 & 7#b7 available = r$i/ribution "u subsection 7f7 ( su* section = subsequ5t fiscal ye>s4 #ajb4 ,ext5sion ( c]ta9 programs & demon/ration projects 7a7 ,*ildhood obesity demon/ration project ,section #aaci;,a7e77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#i;a7e77#h77 is am5d$-- 7#a7 by /rik+ & #aj1jjj1jjj & ins]t+ 1 #aj1jjj1jjj2 & 7#b7 by ins]t+ aft] #bjag ! foll[+3 1 & #e1jjj1jjj = fiscal ye> #bjah & ea* subsequ5t fiscal ye>4 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$4 & ins]t+ 2 &2 & 7#e7 by add+ at ! end ! foll[+3 7,c7 = fiscal ye> #bjah & ea* subsequ5t fiscal ye>1 #ae1jjj1jjj = ! purpose ( c>ry+ out ?is section 7o!r ?an subsections 7e71 7f71 & 7g774 7#b7 ,availability ,funds appropriat$ "u ?is subsection %all rema9 available until exp5d$4 4 #ajc4 ,ext5sion ( outrea* & enrollm5t program 7a7 ,9 g5]al ,section #baac ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acigmm7 is am5d$-- 7#a7 9 subsection 7a77#a71 by /rik+ dur+ ! p]iod ( fiscal ye>s #bjji ?r\gh #bjag2 & 7#b7 9 subsection 7g7-- 7,a7 by /rik+ & #dj1jjj1jjj & ins]t+ 1 #dj1jjj1jjj2 & 7,b7 by ins]t+ aft] #bjag ! foll[+3 1 & #bj1jjj1jjj = fiscal ye> #bjah & ea* subsequ5t fiscal ye>4 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$ical assi/ance "u ! ,/ate plan or any waiv] ( su* plan4 2 & 7#b7 by /rik+ 7#ad7 ,exclusion & ins]t+ 7#ae7 ,exclusion4 #ajd4 ,ext5sion & r$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 ,,ii ,m$ic>e & ,o!r ,heal? ,ext5d]s ,a ,m$ic>e ,ext5d]s & ,relat$ ,policies #bja4 ,ext5sion ( "w ,,gpci floor ,section #ahdh7;e77#a77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is am5d$ by /rik+ ,janu>y #a1 #bjah & ins]t+ ,janu>y #a1 #bjbj4 #bjb4 ,p]man5t repeal ( ! !rapy caps ,section #ahcc7;g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7g77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 by /rik+ ,subject to p>agraphs 7#d7 & 7#e7 & ins]t+ 7,a7 ,subject to p>agraphs 7#d7 & 7#e72 7,b7 9 ! subp>agraph 7,a71 z ins]t$ & designat$ by subp>agraph 7,a7 ( ?is p>agraph1 by add+ at ! end ! foll[+ new s5t5ce3 ,! prec$+ s5t5ce %all n apply to exp5ses incurr$ ) respect to s]vices furni%$ aft] ,decemb] #ca1 #bjag42 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,) respect to s]vices furni%$ dur+ #bjah or a subsequ5t ye>1 9 ! case ( physical !rapy s]vices ( ! type describ$ 9 section #ahfa7p71 spee*-language pa?ology s]vices ( ! type describ$ 9 su* section ?r\gh ! application ( section #ahfa7ll77#b71 & physical !rapy s]vices & spee*-language pa?ology s]vices ( su* type :i* are furni%$ by a physician or z incid5t to physicians' s]vices1 ) respect to exp5ses incurr$ 9 any cal5d> ye>1 any am\nt t is m ?an ! am\nt specifi$ 9 p>agraph 7#b7 = ! ye> %all n be consid]$ z incurr$ exp5ses = purposes ( subsections 7a7 & 7b7 unless ! applicable requirem5ts ( p>agraph 7#g7 are met4 2 7#b7 9 p>agraph 7#c7-- 7,a7 by /rik+ ,subject to p>agraphs 7#d7 & 7#e7 & ins]t+ 7,a7 ,subject to p>agraphs 7#d7 & 7#e72 7,b7 9 ! subp>agraph 7,a71 z ins]t$ & designat$ by subp>agraph 7,a7 ( ?is p>agraph1 by add+ at ! end ! foll[+ new s5t5ce3 ,! prec$+ s5t5ce %all n apply to exp5ses incurr$ ) respect to s]vices furni%$ aft] ,decemb] #ca1 #bjag42 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,) respect to s]vices furni%$ dur+ #bjah or a subsequ5t ye>1 9 ! case ( occupational !rapy s]vices 7( ! type t are describ$ 9 section #ahfa7p7 ?r\gh ! op]ation ( section #ahfa7;g7 & ( su* type :i* are furni%$ by a physician or z incid5t to physicians' s]vices71 ) respect to exp5ses incurr$ 9 any cal5d> ye>1 any am\nt t is m ?an ! am\nt specifi$ 9 p>agraph 7#b7 = ! ye> %all n be consid]$ z incurr$ exp5ses = purposes ( subsections 7a7 & 7b7 unless ! applicable requirem5ts ( p>agraph 7#g7 are met4 2 7#c7 9 p>agraph 7#e7-- 7,a7 by r$esignat+ subp>agraph 7,d7 z p>agraph 7#h7 & mov+ su* p>agraph to imm$iately foll[ p>agraph 7#g71 z add$ by p>agraph 7#d7 ( ?is section2 & 7,b7 9 subp>agraph 7,e77iv71 by ins]t+ 1 except z su* process is appli$ "u p>agraph 7#g77;,b7 be=e ! p]iod at ! end2 & 7#d7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,= purposes ( p>agraphs 7#a77;,b7 & 7#c77;,b71 ) respect to s]vices describ$ 9 su* p>agraphs1 ! requirem5ts describ$ 9 ?is p>agraph are z foll[s3 7,a7 ,inclusion ( appropriate modifi] ,! claim = su* s]vices conta9s an appropriate modifi] 7su* z ! ,,kx modifi] describ$ 9 p>agraph 7#e77;,b77 indicat+ t su* s]vices are m$ically necess>y z ju/ifi$ by appropriate docum5tation 9 ! m$ical record involv$4 7,b7 ,t>get$ m$ical review = c]ta9 s]vices above ?re%old 7i7 ,9 g5]al ,9 ! case :]e exp5ses t w\ld be incurr$ = su* s]vices w\ld exce$ ! ?re%old describ$ 9 clause 7ii7 = ! ye>1 su* s]vices %all be subject to ! process = m$ical review implem5t$ "u p>agraph 7#e77;,e74 7ii7 ,?re%old ,! ?re%old "u ?is clause =-- 7,i7 a ye> be=e #bjbh1 is #c1jjj2 7,,ii7 #bjbh1 is ! am\nt specifi$ 9 subclause 7,i7 increas$ by ! p]c5tage increase 9 ! ,,mei 7z def9$ 9 section #ahdb7;i77#c77 = #bjbh2 & 7,,iii7 a subsequ5t ye>1 is ! am\nt specifi$ 9 ?is clause = ! prec$+ ye> increas$ by ! p]c5tage increase 9 ! ,,mei 7z def9$ 9 section #ahdb7;i77#c77 = su* subsequ5t ye>1 except t if an increase "u subclause 7,,ii7 or 7,,iii7 = a ye> is n a multiple ( #aj1 x %all be r\nd$ to ! ne>e/ multiple ( #aj4 7iii7 ,application ,! ?re%old "u clause 7ii7 %all be appli$ sep>ately-- 7,i7 = physical !rapy s]vices & spee*-language pa?ology s]vices2 & 7,,ii7 = occupational !rapy s]vices4 7iv7 ,fund+ ,= purposes ( c>ry+ out ?is subp>agraph1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 ( #e1jjj1jjj = ea* fiscal ye> beg9n+ ) fiscal ye> #bjah1 to rema9 available until exp5d$4 ,su* funds may n be us$ by a contractor "u section #ahic7;h7 = m$ical reviews "u ?is subp>agraph4 4 #bjc4 ,gr\nd ambulance s]vices co/ report+ requirem5t 7a7 ,9 g5]al ,section #aaba ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by /rik+ ,= ! purposes ( & ins]t+ ,subject to subsection 7d71 = ! purposes (2 7,b7 by ins]t+ suppli]s ( gr\nd ambulance s]vices1 aft] heal? ma9t5ance organizations12 & 7,c7 9 ! matt] foll[+ p>agraph 7#e71 by add+ ! foll[+ new s5t5ce3 ,n lat] ?an ,decemb] #ca1 #bjai1 ! ,secret>y %all modify ! uni=m report+ sy/em = provid]s ( s]vices ) respect to ambulance s]vices to ensure t su* sy/em conta9s in=mation simil> 7z det]m9$ by ! ,secret>y7 to in=mation requir$ "u ! uni=m report+ sy/em = suppli]s ( gr\nd ambulance s]vices42 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7d7 ,9 ! case ( a suppli] ( gr\nd ambulance s]vices t furni%es su* s]vices = few] ?an #bj individuals entitl$ to b5efits "u "p ,a ( title ,,xviii & enroll$ "u "p ,b ( su* title 9 a co/ report+ p]iod 7z def9$ by ! ,secret>y71 ! ,secret>y may modify ! requirem5ts = inclusion ( any in=mation specifi$ 9 subsection 7a7 9 reports made 9 accordance ) ! uni=m report+ sy/ems e/abli%$ "u ?is section ) respect to su* s]vices4 4 7b7 ,susp5sion ( paym5t = gr\nd ambulance s]vices2 deem+ c]ta9 paym5ts ov]paym5ts ,section #ahcd7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ag7 ,requirem5t to submit co/ report & au?ority to susp5d paym5ts & deem c]ta9 paym5ts ov]paym5ts = gr\nd ambulance s]vices 7,a7 ,9 g5]al ,) respect to gr\nd ambulance s]vices furni%$ by a suppli] ( su* s]vices dur+ co/ report+ p]iods 7z def9$ 9 subp>agraph 7,i77 beg9n+ on or aft] ,janu>y #a1 #bjbj1 su* suppli] %all make reports to ! ,secret>y ( in=mation describ$ 9 section #aaba7;a7 9 accordance ) ! uni=m report+ sy/em e/abli%$ "u su* section = su* suppli]s &1 z may be requir$ by ! ,secret>y1 ( any ( ! in=mation describ$ 9 subp>agraph 7,b74 7,b7 ,additional in=mation ,! ,secret>y may1 ) respect to a suppli] ( gr\nd ambulance s]vices1 require ! foll[+ in=mation 7to be report$ to ! ext5t practicable "u ! uni=m report+ sy/em e/abli%$ "u section #aaba7;a7 = su* suppli]s73 7i7 ,:e!r ! suppli] is "p ( an em]g5cy s]vices dep>tm5t1 a gov]nm5tal organization1 or ano!r type ( entity 7z describ$ by ! ,secret>y74 7ii7 ,! numb] ( h\rs 9 a week dur+ :i* ! suppli] is available = furni%+ gr\nd ambulance s]vices4 7iii7 ,! av]age numb] ( volunte] h\rs a week us$ by ! suppli]4 7,c7 ,susp5sion ( paym5t ,subject to subp>agraph 7,e71 9 ! case t ! ,secret>y det]m9es t a suppli] ( gr\nd ambulance s]vices has n made to ! ,secret>y a timely report describ$ 9 subp>agraph 7,a7 ) respect to a co/ report+ p]iod beg9n+ on or aft] ,janu>y #a1 #bjbj1 & be=e ,janu>y #a1 #bjbb1 ! ,secret>y may susp5d paym5ts made "u ?is subsection1 9 :ole or 9 "p1 to su* suppli] until ! ,secret>y f9ds t su* suppli] has made su* a report4 7,d7 ,deem+ c]ta9 paym5ts ov]paym5ts ,subject to subp>agraphs 7,e7 & 7,f71 9 ! case t ! ,secret>y det]m9es t a suppli] ( gr\nd ambulance s]vices has n made to ! ,secret>y a complete1 accurate1 & timely report describ$ 9 subp>agraph 7,a7 ) respect to a co/ report+ p]iod beg9n+ on or aft] ,janu>y #a1 #bjbb1 ! ,secret>y may deem paym5ts made "u ?is subsection to su* suppli] = su* p]iod to be ov]paym5ts & rec\p su* ov]paym5ts4 7,e7 ,h>d%ip delay ,! ,secret>y %all e/abli% a process :]eby a suppli] ( gr\nd ambulance s]vices may reque/ a delay 9 mak+ a report describ$ 9 subp>agraph 7,a7 ) respect to a co/ report+ p]iod = reason ( significant h>d%ip 7z det]m9$ by ! ,secret>y74 7,f7 ,au?ority to modify co/ report+ elem5ts & en=cem5t ,n e>li] ?an ,janu>y #a1 #bjbd1 ! ,secret>y may provide t subp>agraph 7,d7 no long] applies to gr\nd ambulance s]vices suppli]s or a category ( su* suppli]s aft]-- 7i7 tak+ into acc\nt ! recomm5dation ( ! ,m$ic>e ,paym5t ,advisory ,commission 9 ! mo/ rec5t report available to ! ,secret>y submitt$ "u section #bjd ( ! ,advanc+ ,s5iors & ,kids ,act reg>d+ :e!r co/ reports made by suppli]s or a category ( suppli]s 7z specifi$ = purposes ( ! report submitt$ "u su* section7 %\ld be requir$ or modifi$2 & 7ii7 und]tak+ notice & comm5t rulemak+4 7,g7 ,audit ( co/ reports ,! ,secret>y %all audit reports describ$ 9 subp>agraph 7,a7 made ) respect to co/ report+ p]iods beg9n+ on or aft] ,janu>y #a1 #bjba4 7,h7 ,appeals ,! ,secret>y %all e/abli% a process :]eby a suppli] ( gr\nd ambulance s]vices may appeal a det]m9ation describ$ 9 subp>agraph 7,c7 or 7,d7 made ) respect to a co/ report requir$ to be made by su* suppli] "u subp>agraph 7,a74 7,i7 ,def9ition ,9 ?is p>agraph1 ! t]m co/ report+ p]iod means1 ) respect to a ye>1 ! #ab-mon? p]iod beg9n+ on ,janu>y #a ( su* ye>4 4 7c7 ,/akehold] fe$back 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ! provisions ( ?is section1 includ+ ! am5dm5ts made by ?is section1 ?r\gh notice & comm5t rulemak+ & seek input f /akehold]s4 7#b7 ,nonapplication ( ,pap]work ,r$uction ,act ,*apt] #ce ( title #dd1 ,unit$ ,/ates ,code1 %all n apply ) respect to-- 7,a7 ! developm5t & implem5tation ( ! uni=m report+ sy/em requir$ "u section #aaba7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7a77 = suppli]s ( gr\nd ambulance s]vices & reports requir$ to be made "u section #ahcd7l77#ag7 ( su* ,act 7#db ,u4,s4,c4 #aciem7l77#ag771 z add$ by subsection 7b7 ( ?is section2 & 7,b7 ! modification ( ! uni=m report+ sy/ems "u su* section #aaba7;a7 ( su* ,act = provid]s ( su* s]vices & reports requir$ to be made "u section #ahfa7v77#a77;,f7 ( su* ,act 7#db ,u4,s4,c4 #aciex7v77#a77;,f774 7d7 ,implem5tation res\rces 7#a7 ,9 g5]al ,!re are h]eby appropriat$ to ! ,secret>y f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 #h1jjj1jjj & f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda ( su* ,act 7#db ,u4,s4,c4 #aciet7 #ib1jjj1jjj 7( :i* n less ?an #aj1jjj1jjj %all be us$ to fulfill ! audit+ requirem5t "u section #ahcd7l77#ag77;,g7 ( su* ,act1 z add$ by subsection 7b7 ( ?is section7 to c>ry out ! provisions ( ?is section1 includ+ ! am5dm5ts made by ?is section1 to rema9 available ?r\gh ,decemb] #ca1 #bjbb4 7#b7 ,fund+ = employees ,! ,secret>y ( ,heal? & ,human ,s]vices %all provide = ! transf] to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 f ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciet71 ( su* sums z may be necess>y 9 ord] to directly hire no m ?an #b full-"t employees to c>ry out ! provisions ( ?is section1 includ+ ! am5dm5ts made by ?is section4 7e7 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 a co/ report made by a suppli] ( gr\nd ambulance s]vices ) respect to a co/ report+ p]iod beg9n+ be=e ,janu>y #a1 #bjbb1 may n conta9 complete & accurate in=mation on gr\nd ambulance s]vices furni%$ dur+ su* a p]iod by ! suppli]2 & 7#b7 ! ,secret>y %\ld take into acc\nt only ! timel9ess ( su* a report made ) respect to su* a p]iod :5 det]m9+ :e!r to susp5d paym5ts to a suppli] "u section #ahcd7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l774 #bjd4 ,gr\nd ambulance s]vices co/ report+ /udy 7a7 ,9 g5]al ,n lat] ?an ,m>* #ae1 #bjbc1 & z det]m9$ necess>y by ! ,m$ic>e ,paym5t ,advisory ,commission !reaft]1 su* ,commission %all assess & submit to ,congress a report on co/ reports c>ri$ out 9 accordance ) sections #aaba7;a7 & #ahcd7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a7a71 #aciem7l771 ! adequacy ( paym5ts = su* s]vices made "u section #ahcd7l7 ( su* ,act1 & geographic v>iations 9 ! co/ ( provid+ su* s]vices4 7b7 ,cont5ts ,! report describ$ 9 subsection 7a7 %all conta9 ! foll[+3 7#a7 ,an analysis ( co/ report data submitt$ 9 accordance ) su* sections4 7#b7 ,an analysis ( any burd5 on provid]s & suppli]s ( su* s]vices associat$ ) report+ su* data4 7#c7 ,a recomm5dation on :e!r or n co/ reports ( ambulance s]vices made by suppli]s or a category ( suppli]s 7z specifi$ by ! ,secret>y7 ( su* s]vices1 or ! gr\nd ambulance portion ( co/ reports made by provid]s ( su* s]vices1 %\ld be requir$ or modifi$1 tak+ into acc\nt ! analyses describ$ 9 p>agraphs 7#a7 & 7#b74 #bje4 ,ext5sion ( gr\nd ambulance s]vices ext5d]s ,section #ahcd7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is am5d$-- 7#a7 9 p>agraph 7#ab77;,a71 by /rik+ #bjah & ins]t+ #bjbc2 & 7#b7 9 p>agraph 7#ac77;,a71 by /rik+ #bjah ea* place x appe>s & ins]t+ #bjbc4 #bjf4 ,ext5sion ( increas$ inpati5t hospital paym5t adju/m5t = c]ta9 l[-volume hospitals ,section #ahhf7;d77#ab7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is am5d$-- 7#a7 9 subp>agraph 7,b71 9 ! matt] prec$+ clause 7i71 by /rik+ & = dis*>ges occurr+ 9 fiscal ye> #bjbj & subsequ5t fiscal ye>s2 7#b7 9 subp>agraph 7,c77i7-- 7,a7 by /rik+ fiscal ye>s #bjaa ?r\gh #bjag ea* place x appe>s & ins]t+ fiscal ye>s #bjaa ?r\gh #bjai2 & 7,b7 by /rik+ or portion ( fiscal ye>2 & 7#c7 9 subp>agraph 7,d7-- 7,a7 9 ! head+1 by /rik+ ,tempor>y applicable p]c5tage increase & ins]t+ ,applicable p]c5tage increase beg9n+ ) fiscal ye> #bjaa2 7,b7 by /rik+ fiscal ye>s #bjaa ?r\gh #bjag1 & ins]t+ fiscal ye>s #bjaa ?r\gh #bjai2 & 7,c7 by /rik+ or ! portion ( fiscal ye> ea* place x appe>s4 #bjg4 ,ext5sion ( ! ,m$ic>e-,dep5d5t ,hospital 7,,mdh7 program 7a7 ,9 g5]al ,section #ahhf7;d77#e77;,g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g77 is am5d$-- 7#a7 9 clause 7i71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,octob] #a1 #bjai2 & 7#b7 9 clause 7ii77,,ii71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,octob] #a1 #bjai4 7b7 ,con=m+ ,am5dm5ts 7#a7 ,ext5sion ( t>get am\nt ,section #ahhf7;b77#c77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,d77 is am5d$-- 7,a7 9 ! matt] prec$+ clause 7i71 by /rik+ ,octob] #a1 #bjag & ins]t+ ,octob] #a1 #bjai2 & 7,b7 9 clause 7iv71 by /rik+ ?r\gh fiscal ye> #bjag & ins]t+ ?r\gh fiscal ye> #bjai4 7#b7 ,p]mitt+ hospitals to decl9e reclassification ,section #aceja7;e77#b7 ( ! ,omnibus ,budget ,reconciliation ,act ( #aiic 7#db ,u4,s4,c4 #acieww note7 is am5d$ by /rik+ ?r\gh fiscal ye> #bjag & ins]t+ ?r\gh fiscal ye> #bjai4 #bjh4 ,specializ$ ,m$ic>e ,advantage plans = special ne$s individuals 7a7 ,p]man5t 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 ( ,public ,law #aaa-adh1 %all s]ve z a d$icat$ po9t ( contact = ,/ates to address misalignm5ts t arise ) ! integration ( specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 "u ?is p>agraph &1 consi/5t ) su* role1 %all-- 7i7 e/abli% a uni=m process = dissem9at+ to ,/ate ,m$icaid ag5cies in=mation "u ?is title impact+ contracts betwe5 su* ag5cies & su* plans "u ?is subsection2 & 7ii7 e/abli% basic res\rces = ,/ates int]e/$ 9 explor+ su* plans z a plat=m = integration1 su* z a model contract or o!r tools to a*ieve ^? goals4 7,b7 ,unifi$ grievances & appeals process 7i7 ,9 g5]al ,n lat] ?an ,april #a1 #bjbj1 ! ,secret>y %all e/abli% proc$ures1 to ! ext5t feasible z det]m9$ by ! ,secret>y1 unify+ grievances & appeals proc$ures "u sections #aheb7;f71 #aheb7;g71 #aijb7;a77#c71 #aijb7;a77#e71 & #aicb7;b77#d7 = items & s]vices provid$ by specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 "u ?is title & title ,,xix4 ,! ,secret>y %all solicit comm5t 9 develop+ su* proc$ures f ,/ates1 plans1 b5efici>ies & _! repres5tatives1 & o!r relevant /akehold]s4 ,) respect to items & s]vices describ$ 9 ! previ\s s5t5ce1 appeals proc$ures e/abli%$ "u ?is clause %all apply 9 place ( o!rwise applicable appeals proc$ures4 7ii7 ,proc$ures ,! proc$ures e/abli%$ "u clause 7i7 %all be includ$ 9 ! plan contract "u p>agraph 7#c77;,d7 & %all-- 7,i7 adopt ! provisions = ! enrollee t are mo/ protective = ! enrollee &1 to ! ext5t feasible z det]m9$ by ! ,secret>y1 are compatible ) unifi$ timeframes & consolidat$ access to ext]nal review "u an integrat$ process2 7,,ii7 take into acc\nt diff]5ces 9 ,/ate plans "u title ,,xix to ! ext5t necess>y2 7,,iii7 be easily navigable by an enrollee2 & 7,,iv7 include ! elem5ts describ$ 9 clause 7iii71 z applicable4 7iii7 ,elem5ts describ$ ,bo? unifi$ appeals & unifi$ grievance proc$ures %all include1 z applicable1 ! foll[+ elem5ts describ$ 9 ?is clause3 7,i7 ,s+le writt5 notification ( all applicable grievances & appeal rights "u ?is title & title ,,xix4 ,= purposes ( ?is subp>agraph1 ! ,secret>y may waive ! requirem5ts "u section #aheb7;g77#a77;,b7 :5 ! specializ$ ,,ma plan cov]s items or s]vices "u ?is "p or "u title ,,xix4 7,,ii7 ,s+le pa?ways = resolution ( any grievance or appeal relat$ to a p>ticul> item or s]vice provid$ by specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 "u ?is title & title ,,xix4 7,,iii7 ,notices writt5 9 pla9 language & available 9 a language & =mat t is accessible to ! enrollee1 includ+ 9 non-,engli% languages t are preval5t 9 ! s]vice area ( ! specializ$ ,,ma plan4 7,,iv7 ,unifi$ timeframes = grievances & appeals processes1 su* z an individual's fil+ ( a grievance or appeal1 a plan's ackn[l$gm5t & resolution ( a grievance or appeal1 & notification ( decisions ) respect to a grievance or appeal4 7,v7 ,requirem5ts = h[ ! plan mu/ process1 track1 & resolve grievances & appeals1 to ensure b5efici>ies are notifi$ on a timely basis ( decisions t are made ?r\gh\t ! grievance or appeals process & are able to easily det]m9e ! /atus ( a grievance or appeal4 7iv7 ,cont9uation ( b5efits p5d+ appeal ,! unifi$ proc$ures "u clause 7i7 %all1 ) respect to all b5efits "u p>ts ,a & ,b & title ,,xix subject to appeal "u su* proc$ures1 incorporate provisions "u curr5t law & implem5t+ regulations t provide cont9uation ( b5efits p5d+ appeal "u ?is title & title ,,xix4 7,c7 ,requirem5t = unifi$ grievances & appeals ,= #bjbb & subsequ5t ye>s1 ! contract ( a specializ$ ,,ma plan = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 ) a ,/ate ,m$icaid ag5cy "u p>agraph 7#c77;,d7 %all require ! use ( unifi$ grievances & appeals proc$ures z describ$ 9 subp>agraph 7,b74 7,d7 ,requirem5ts = full integration = c]ta9 dual ,s,n,ps 7i7 ,requirem5t ,= #bjba & subsequ5t ye>s1 a specializ$ ,,ma plan = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 %all meet "o or m ( ! foll[+ requirem5ts = integration ( b5efits "u ?is title & title ,,xix3 7,i7 ,meet ! requirem5ts ( a fully integrat$ plan describ$ 9 section #ahec7;a77#a77;,b77iv77,,ii7 7o!r ?an ! requirem5t t ! plan h simil> av]age levels ( frailty1 z det]m9$ by ! ,secret>y1 z ! ,,pace program74 7,,ii7 ,ent] into a capitat$ contract ) ! ,/ate ,m$icaid ag5cy to provide long-t]m s]vices & supports or behavioral heal? s]vices1 or bo?4 7,,iii7 ,to ! ext5t ! ,/ate does n all[ = or require su* a specializ$ ,,ma plan to ent] into a capitat$ contract describ$ 9 subclause 7,,ii71 ent] into ano!r type ( integration arrangem5t1 z det]m9$ appropriate by ! ,secret>y aft] consultation ) /akehold]s1 su* z by-- 7aa7 ent]+ into a contract ) ! ,/ate t requires notify+ ! ,/ate 9 a timely mann] ( hospitalizations1 em]g5cy room visits1 & hospital or nurs+ home dis*>ges ( enrollees or o!rwise requires %>+ data t w\ld b5efit ! coord9ation ( items & s]vices "u ?is title & ! ,/ate plan "u title ,,xix2 or 7bb7 be+ (f]$ by a p>5t organization t also (f]s a ,m$icaid manag$ c>e plan t provides long-t]m s]vices & supports or behavioral heal? s]vices to ! same enrollees z "u su* specializ$ ,,ma plan4 7ii7 ,sanctions ,= #bjba & subsequ5t ye>s1 if ! ,secret>y det]m9es t a specializ$ ,,ma plan fails to comply ) clause 7i71 ! ,secret>y may provide = ! application aga9/ ! ,m$ic>e ,advantage organization (f]+ ! plan any ( ! rem$ies describ$ 9 section #aheg7;g77#b74 4 7#b7 ,con=m+ am5dm5t to responsibilities ( ,f$]al ,coord9at$ ,heal? ,c>e ,(fice ,section #bfjb7;d7 ( ,public ,law #aaa-adh 7#db ,u4,s4,c4 #acae;b7d77 is am5d$ by add+ at ! end ! foll[+ new p>agraphs3 7#f7 ,to act z a designat$ contact = ,/ates "u subsection 7f77#h77;,a7 ( section #ahei ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 ) respect to ! integration ( specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 ( su* section4 7#g7 ,to be responsible = develop+ regulations & guidance relat$ to ! implem5tation ( a unifi$ grievance & appeals process z describ$ 9 subp>agraphs 7,b7 & 7,c7 ( section #ahei7;f77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#h774 7#h7 ,to be responsible = develop+ regulations & guidance relat$ to ! integration or alignm5t ( policy & ov]sight "u ! ,m$ic>e program "u title ,,xviii ( su* ,act & ,m$icaid program "u title ,,xix ( su* ,act reg>d+ specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 ( su* section #ahei4 4 7c7 ,improvem5ts to sev]e or disabl+ *ronic condition ,s,n,ps 7#a7 ,c>e managem5t requirem5ts ,section #ahei7;f77#e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f77#e77 is am5d$-- 7,a7 by r$esignat+ subp>agraphs 7,a7 & 7,b7 z clauses 7i7 & 7ii71 respectively1 & ind5t+ appropriately2 7,b7 9 clause 7ii71 z r$esignat$ by subp>agraph 7,b71 by r$esignat+ clauses 7i7 ?r\gh 7iii7 z subclauses 7,i7 ?r\gh 7,,iii71 respectively1 & ind5t+ appropriately2 7,c7 by /rik+ all ,s,n,ps4--,! requirem5ts & ins]t+ 8all ,s,n,ps4-- 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! requirem5ts 2 & 7,d7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,improvem5ts to c>e managem5t requirem5ts = sev]e or disabl+ *ronic condition ,s,n,ps ,= #bjbj & subsequ5t ye>s1 9 ! case ( a specializ$ ,,ma plan = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77iii71 ! requirem5ts describ$ 9 ?is p>agraph include ! foll[+3 7i7 ,! int]discipl9>y team "u subp>agraph 7,a77ii77,,iii7 includes a team ( provid]s ) demon/rat$ exp]tise1 includ+ tra9+ 9 an applicable specialty1 9 treat+ individuals simil> to ! t>get$ population ( ! plan4 7ii7 ,requirem5ts develop$ by ! ,secret>y to provide face-to-face enc\nt]s ) individuals enroll$ 9 ! plan n less frequ5tly ?an on an annual basis4 7iii7 ,z "p ( ! model ( c>e "u clause 7i7 ( subp>agraph 7,a71 ! results ( ! initial assessm5t & annual reassessm5t "u clause 7ii77,i7 ( su* subp>agraph ( ea* individual enroll$ 9 ! plan are address$ 9 ! individual's individualiz$ c>e plan "u clause 7ii77,,ii7 ( su* subp>agraph4 7iv7 ,z "p ( ! annual evaluation & approval ( su* model ( c>e1 ! ,secret>y %all take into acc\nt :e!r ! plan fulfill$ ! previ\s ye>'s goals 7z requir$ "u ! model ( c>e74 7v7 ,! ,secret>y %all e/abli% a m9imum b5*m>k = ea* elem5t ( ! model ( c>e ( a plan4 ,! ,secret>y %all only approve a plan's model ( c>e "u ?is p>agraph if ea* elem5t ( ! model ( c>e meets ! m9imum b5*m>k applicable "u ! prec$+ s5t5ce4 4 7#b7 ,revisions to ! def9ition ( a sev]e or disabl+ *ronic conditions specializ$ ne$s individual 7,a7 ,9 g5]al ,section #ahei7;b77#f77;,b77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f77;,b77iii77 is am5d$-- 7i7 by /rik+ :o h & ins]t+ 8:o-- 7,i7 be=e ,janu>y #a1 #bjbb1 h 2 7ii7 9 subclause 7,i71 z add$ by clause 7i71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+ new subclause3 7,,ii7 on or aft] ,janu>y #a1 #bjbb1 h "o or m capitat$ & m$ically complex *ronic conditions t is life ?reat5+ or significantly limits ov]all heal? or function1 h a high risk ( hospitalization or o!r adv]se heal? outcomes1 & require int5sive c>e coord9ation & t is li/$ "u subsection 7f77#i77;,a74 4 7,b7 ,panel ( cl9ical advisors ,section #ahei7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7;f771 z am5d$ by subsection 7b71 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,li/ ( conditions = cl>ification ( ! def9ition ( a sev]e or disabl+ *ronic conditions specializ$ ne$s individual 7,a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 #bjbj1 & e #e ye>s !reaft]1 ! ,secret>y %all conv5e a panel ( cl9ical advisors to e/abli% & update a li/ ( conditions t meet ea* ( ! foll[+ crit]ia3 7i7 ,conditions t meet ! def9ition ( a sev]e or disabl+ *ronic condition "u subsection 7b77#f77;,b77iii7 on or aft] ,janu>y #a1 #bjbb4 7ii7 ,conditions t require prescription drugs1 provid]s1 & models ( c>e t are unique to ! specific population ( enrollees 9 a specializ$ ,,ma plan = special ne$s individuals describ$ 9 su* subsection on or aft] su* date &-- 7,i7 z a result ( su* special ne$s individuals ) su* a condition hav+ access to & be+ enroll$ 9 su* a plan1 z comp>$ to access to & enrollm5t 9 o!r ,m$ic>e ,advantage plans "u ?is "p1 x is project$ t su* individuals w\ld improve heal? outcomes ) respect to su* condition1 t su* individuals w\ld h r$uc$ ov]all co/s "u ?is title1 & t !re w\ld n be any increase 9 exp5ditures "u ?is title = su* individuals2 or 7,,ii7 h a l[ preval5ce 9 ! g5]al population ( b5efici>ies "u ?is title or a disproportionally high p]-b5efici>y co/ "u ?is title4 7,b7 ,,gao ,/udy on ,heal? ,outcomes ( ,individuals ,enroll$ 9 ,specializ$ ,,ma plans ,n lat] ?an ! date t is #c ye>s aft] ! date ( ! enactm5t ( ?is p>agraph1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all conduct a /udy & submit to ,congress a report on ! ext5t to :i* heal? outcomes c be comp>$ across specializ$ ,,ma plans = special ne$s individuals 7z def9$ 9 section #ahei7;b77#f77 & o!r ,m$ic>e ,advantage plans "u ?is "p across simil> populations1 us+ exi/+ measures & t id5tifies any pot5tial limitations :]e new measures may ne$ to be develop$ = su* population4 4 7d7 ,quality measurem5t at ! plan level = ,s,n,ps & det]m9ation ( 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$s individuals 9 ord] to det]m9e if a /ati/ically significant or valid measurem5t ( quality at ! plan level is possible "u ?is p>agraph2 7ii7 if quality measures are report$ at ! plan level1 ensure t ,,ma plans are n requir$ to provide duplicative in=mation2 & 7iii7 ensure t su* report+ does n int]f]e ) ! collection ( enc\nt] data submitt$ by ,,ma organizations or ! adm9i/ration ( any *anges to ! program "u ?is "p z a result ( ! collection ( su* data4 7,c7 ,application ,if ! ,secret>y applies quality measurem5t at ! plan level "u ?is p>agraph-- 7i7 su* quality measurem5t may include ,m$ic>e ,heal? ,outcomes ,survey 7,,hos71 ,heal?c>e ,effectiv5ess ,data & ,in=mation ,set 7,,h$is71 ,consum] ,assessm5t ( ,heal?c>e ,provid]s & ,sy/ems 7,,cahps7 measures & quality measures "u "p ,d2 & 7ii7 ! ,secret>y %all consid] apply+ adm9i/rative actions1 su* z rem$ies describ$ 9 section #aheg7;g77#b71 to ! plan level4 7#g7 ,det]m9ation ( feasibility ( quality measurem5t at ! plan level = all ,,ma plans 7,a7 ,det]m9ation ( feasibility ,! ,secret>y %all det]m9e ! feasibility ( requir+ report+ ( data "u section #aheb7;e7 =1 & apply+ "u ?is subsection1 quality measures at ! plan level = all ,,ma plans "u ?is "p4 7,b7 ,consid]ation ( *ange ,aft] mak+ a det]m9ation "u subp>agraph 7,a71 ! ,secret>y %all consid] requir+ su* report+ & apply+ su* quality measures at ! plan level z describ$ 9 su* subp>agraph4 4 7e7 ,,gao /udy & report on ,/ate-,level integration betwe5 dual ,s,n,ps & ,m$icaid 7#a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is p>agraph ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy on ,/ate-level integration betwe5 specializ$ ,,ma plans = special ne$s individuals describ$ 9 subsection 7b77#f77;,b77ii7 ( section #ahei ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 & ! ,m$icaid program "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 ,su* /udy %all include an analysis ( ! foll[+3 7,a7 ,! *>act]i/ics ( ,/ates 9 :i* ! ,/ate ag5cy responsible = adm9i/]+ ! ,/ate plan "u su* title ,,xix has a contract ) su* a specializ$ ,,ma plan & t deliv]s long-t]m s]vices & supports "u ! ,/ate plan "u su* title ,,xix ?r\gh a manag$ c>e program1 includ+ ! requirem5ts "u su* ,/ate plan ) respect to long-t]m s]vices & supports4 7,b7 ,! types ( su* specializ$ ,,ma plans1 :i* may include ! foll[+3 7i7 ,a plan describ$ 9 section #ahec7;a77#a77;,b77iv77,,ii7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#a77;,b77iv77,,ii774 7ii7 ,a plan t meets ! requirem5ts describ$ 9 subsection 7f77#c77;,d7 ( su* section #ahei4 7iii7 ,a plan describ$ 9 clause 7ii7 t also meets additional requirem5ts e/abli%$ by ! ,/ate4 7,c7 ,! *>act]i/ics ( individuals enroll$ 9 su* specializ$ ,,ma plans4 7,d7 ,z practicable1 ! foll[+ ) respect to ,/ate programs = ! deliv]y ( long-t]m s]vices & supports "u su* title ,,xix ?r\gh a manag$ c>e program3 7i7 ,:i* populations ( individuals are eligible to receive su* s]vices & supports4 7ii7 ,:e!r all su* s]vices & supports are provid$ on a capitat$ basis or if any ( su* s]vices & supports are c>v$ out & provid$ ?r\gh fee-=-s]vice4 7,e7 ,z1 practicable1 h[ ! availability & v>iation ( integration arrangem5ts ( su* specializ$ ,,ma plans (f]$ 9 ,/ates affects sp5d+1 s]vice deliv]y options1 access to community-bas$ c>e1 & utilization ( c>e4 7,f7 ,b>ri]s & opportunities = mak+ fur!r progress on dual integration1 z well z recomm5d legislation to exp$ite or ref9e pa?ways t[>d fully integrat$ c>e4 7#b7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 #bji4 ,exp&+ supplem5tal b5efits to meet ! ne$s ( *ronically ill ,m$ic>e ,advantage enrollees 7a7 ,9 g5]al ,section #aheb7;a77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#c77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ ,ea* & ins]t+ ,subject to subp>agraph 7,d71 ea*2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,exp&+ supplem5tal b5efits to meet ! ne$s ( *ronically ill enrollees 7i7 ,9 g5]al ,= plan ye> #bjbj & subsequ5t plan ye>s1 9 addition to any supplem5tal heal? c>e b5efits o!rwise provid$ "u ?is p>agraph1 an ,,ma plan1 includ+ a specializ$ ,,ma plan = special ne$s individuals describ$ 9 subsection 7b77#f7 ( section #ahei1 may provide supplem5tal b5efits describ$ 9 clause 7ii7 to a *ronically ill enrollee 7z def9$ 9 clause 7iii774 7ii7 ,supplem5tal b5efits describ$ 7,i7 ,9 g5]al ,supplem5tal b5efits describ$ 9 ?is clause are supplem5tal b5efits t1 ) respect to a *ronically ill enrollee1 h a reasonable expectation ( improv+ or ma9ta9+ ! heal? or ov]all function ( ! *ronically ill enrollee & may n be limit$ to be+ prim>ily heal? relat$ b5efits4 7,,ii7 ,au?ority to waive uni=mity requirem5ts ,! ,secret>y may1 ) respect to supplem5tal b5efits provid$ to a *ronically ill enrollee "u ?is subp>agraph1 waive ! uni=mity requirem5t1 z det]m9$ appropriate by ! ,secret>y4 7iii7 ,*ronically ill enrollee def9$ ,9 ?is subp>agraph1 ! t]m *ronically ill enrollee means an enrollee 9 an ,,ma plan t ! ,secret>y det]m9es-- 7,i7 has "o or m comorbid & m$ically complex *ronic conditions t is life ?reat5+ or significantly limits ! ov]all heal? or function ( ! enrollee2 7,,ii7 has a high risk ( hospitalization or o!r adv]se heal? outcomes2 or 7,,iii7 requires int5sive c>e coord9ation4 4 7b7 ,,gao ,/udy & ,report 7#a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is subsection ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy on supplem5tal b5efits provid$ to enrollees 9 ,m$ic>e ,advantage plans "u "p ,c ( title ,,xviii ( ! ,social ,security ,act1 includ+ specializ$ ,,ma plans = special ne$s individuals describ$ 9 section #ahei7;b77#f7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bh7;b77#f774 ,su* /udy %all be conduct$ 9 consultation ) ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices & ,m$ic>e ,advantage plans z necess>y &1 to ! ext5t data is available1 %all include an analysis ( ! foll[+3 7,a7 ,! type ( supplem5tal b5efits provid$ to su* enrollees1 ! total numb] ( enrollees receiv+ ea* supplem5tal b5efit1 & :e!r ! supplem5tal b5efit is cov]$ by ! /&>d b5*m>k co/ ( ! b5efit or ) an additional premium4 7,b7 ,! frequ5cy 9 :i* supplem5tal b5efits are utiliz$ by su* enrollees4 7,c7 ,! impact supplem5tal b5efits h on-- 7i7 indicators ( ! quality ( c>e receiv$ by su* enrollees1 includ+ ov]all heal? & function ( ! enrollees2 7ii7 ! utilization ( items & s]vices = :i* b5efits are available "u ! orig9al ,m$ic>e fee-=-s]vice program option "u p>ts ,a & ,b ( su* title ,,xviii by su* enrollees2 & 7iii7 ! am\nt ( ! bids submitt$ by ,m$ic>e ,advantage ,organizations = ,m$ic>e ,advantage plans "u su* "p ,c4 7#b7 ,report ,n lat] ?an #e ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4 #baj4 ,ext5sion ( cons5sus-bas$ entity fund+ ,section #ahij7;d77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77#b77 is am5d$ by /rik+ #bjag & ins]t+ #bjai4 #baa4 ,ext5sion ( c]ta9 ,,mippa fund+ provisions ,section #aai ( ! ,m$ic>e ,improvem5ts = ,pati5ts & ,provid]s ,act ( #bjjh 7#db ,u4,s4,c4 #acie;b-#c note7 is am5d$-- 7#a7 9 subsection 7a77#a77;,b7-- 7,a7 9 clause 7vi71 by /rik+ & at ! end2 7,b7 9 clause 7vii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] clause 7vii7 ! foll[+ new clause3 7viii7 = ea* ( fiscal ye>s #bjah ?r\gh #bjai1 ( #ac1jjj1jjj4 2 7#b7 9 subsection 7b77#a77;,b7-- 7,a7 9 clause 7vi71 by /rik+ & at ! end2 7,b7 9 clause 7vii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] clause 7vii7 ! foll[+ new clause3 7viii7 = ea* ( fiscal ye>s #bjah ?r\gh #bjai1 ( #g1ejj1jjj4 2 7#c7 9 subsection 7c77#a77;,b7-- 7,a7 9 clause 7vi71 by /rik+ & at ! end2 7,b7 9 clause 7vii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] clause 7vii7 ! foll[+ new clause3 7viii7 = ea* ( fiscal ye>s #bjah ?r\gh #bjai1 ( #e1jjj1jjj4 2 & 7#d7 9 subsection 7d77#b7-- 7,a7 9 clause 7vi71 by /rik+ & at ! end2 7,b7 9 clause 7vii71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ aft] clause 7vii7 ! foll[+ new clause3 7viii7 = ea* ( fiscal ye>s #bjah ?r\gh #bjai1 ( #ab1jjj1jjj4 4 #bab4 ,ext5sion ( home heal? rural add-on ,section #dba7;a7 ( ! ,m$ic>e ,prescription ,drug1 ,improvem5t1 & ,mod]nization ,act ( #bjjc 7,public ,law #ajh-agc2 #aag ,/at4 #bbhc2 #db ,u4,s4,c4 #acie;fff note71 z am5d$ by section #ebja7;b7 ( ! ,deficit ,r$uction ,act ( #bjje 7,public ,law #aji-aga2 #abj ,/at4 #df71 section #caca7;c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh2 #abd ,/at4 #dbh71 & section #baj ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj71 is fur!r am5d$ by /rik+ ,janu>y #a1 #bjah & ins]t+ ,janu>y #a1 #bjbj ea* place x appe>s4 ,b ,m$icaid & ,public ,heal? ,ext5d]s #bba4 ,ext5sion = community heal? c5t]s & ! ,national ,heal? ,s]vice ,corps 7a7 ,community heal? c5t]s fund+ ,section #ajejc7;b77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#a771 z am5d$ by section #caja ( ,public ,law #aae-if1 is am5d$ by am5d+ subp>agraph 7,f7 to read z foll[s3 7,f7 #c1fjj1jjj1jjj = ea* ( fiscal ye>s #bjah & #bjai4 4 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$4 7#c7 ,special consid]ation ,! ,secret>y may give special consid]ation to applications = supplem5tal fund+ "u ?is subsection t seek to address significant b>ri]s to access to c>e 9 areas ) a great] %ortage ( heal? c>e provid]s & heal? s]vices relative to ! national av]age4 2 7#e7 9 subsection 7e77#a7-- 7,a7 9 subp>agraph 7,b7-- 7i7 by /rik+ #b ye>s & ins]t+ #a ye>2 & 7ii7 by add+ at ! end ! foll[+3 ,! ,secret>y %all n make a grant "u ?is p>agraph unless ! applicant provides assurances to ! ,secret>y t )9 #abj days ( receiv+ grant fund+ = ! op]ation ( ! heal? c5t]1 ! applicant w submit1 = approval by ! ,secret>y1 an implem5tation plan to meet ! requirem5ts ( subsection 7l77#c74 ,! ,secret>y may ext5d su* #abj-;day p]iod = a*iev+ compliance ^u a demon/ration ( good cause by ! heal? c5t]42 & 7,b7 9 subp>agraph 7,c7-- 7i7 9 ! subp>agraph head+1 by /rik+ & plans2 7ii7 by /rik+ or plan 7z describ$ 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 by /rik+ subsection 7s72 7#h7 by r$esignat+ subsections 7g7 ?r\gh 7r7 z subsections 7h7 ?r\gh 7s71 respectively2 7#i7 by ins]t+ aft] subsection 7f71 ! foll[+3 7g7 ,new access po9ts & exp&$ s]vices 7#a7 ,approval ( new access po9ts 7,a7 ,9 g5]al ,! ,secret>y may approve applications = grants "u subp>agraph 7,a7 or 7,b7 ( subsection 7e77#a7 to e/abli% new deliv]y sites4 7,b7 ,special consid]ation ,9 c>ry+ out subp>agraph 7,a71 ! ,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 7,c7 ,consid]ation ( applications ,9 c>ry+ out subp>agraph 7,a71 ! ,secret>y %all approve applications = grants "u subp>agraphs 7,a7 & 7,b7 ( subsection 7e77#a7 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 7,d7 ,s]vice area ov]lap ,if 9 c>ry+ out subp>agraph 7,a7 ! 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 7,a7 ,9 g5]al ,! ,secret>y may approve applications = grants "u subp>agraph 7,a7 or 7,b7 ( subsection 7e77#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 7,b7 ,priority expansion projects ,9 c>ry+ out subp>agraph 7,a71 ! ,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 7,c7 ,consid]ation ( applications ,9 c>ry+ out subp>agraph 7,a71 ! ,secret>y %all approve applications = applicants 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#aj7 9 subsection 7i7 7z s r$esignat$7-- 7,a7 9 p>agraph 7#a71 by /rik+ & *ildr5 & y\? at risk ( homelessness & ins]t+ 1 *ildr5 & y\? at risk ( homelessness1 homeless vet]ans1 & vet]ans at risk ( homelessness2 & 7,b7 9 p>agraph 7#e7-- 7i7 by /rik+ subp>agraph 7,b72 7ii7 by r$esignat+ subp>agraph 7,c7 z subp>agraph 7,b72 & 7iii7 9 subp>agraph 7,b7 7z s r$esignat$7-- 7,i7 9 ! subp>agraph head+1 by /rik+ abuse & ins]t+ use disord]2 & 7,,ii7 by /rik+ abuse & ins]t+ use disord]2 7#aa7 9 subsection 7l7 7z s r$esignat$7-- 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+ & an application = a grant "u subsection 7g7 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 7g77#a71 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$+ subp>agraph 7,a71 by ins]t+ or subsection 7g7 aft] subsection 7e77#a77;,b72 7ii7 9 subp>agraph 7,b71 by /rik+ 9 ! cat*m5t area ( ! c5t] & ins]t+ 1 includ+ o!r heal? c>e provid]s t provide c>e )9 ! cat*m5t area1 local hospitals1 & specialty provid]s 9 ! cat*m5t area ( ! c5t]1 to provide access to s]vices n available ?r\gh ! heal? c5t] & to r$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#ab7 9 subsection 7m7 7z s r$esignat$71 by add+ at ! end ! foll[+3 ,funds exp5d$ to c>ry out activities "u ?is subsection & op]ational support activities "u subsection 7n7 %all n exce$ #c p]c5t ( ! am\nt appropriat$ = ?is section = ! fiscal ye> involv$42 7#ac7 9 subsection 7q7 7z s r$esignat$71 by /rik+ grants = new heal? c5t]s "u subsections 7c7 & 7e7 & ins]t+ op]at+ grants "u subsection 7e71 applications = new access po9ts & exp&$ s]vice pursuant to subsection 7g72 7#ad7 9 subsection 7r77#d7 7z s r$esignat$71 by add+ at ! end ! foll[+3 ,a waiv] provid$ 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#ae7 9 subsection 7s77#c7 7z s r$esignat$7-- 7,a7 by /rik+ appropriate committees ( ,congress a report conc]n+ ! di/ribution ( funds "u ?is section & ins]t+ ! foll[+3 8,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ( ! ,s5ate1 & ! ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives1 a report includ+1 at a m9imum-- 7,a7 ! di/ribution ( funds = c>ry+ out ?is section 2 7,b7 by /rik+ populations4 ,su* report %all include an assessm5t & ins]t+ ! foll[+3 8populations2 7,b7 an assessm5t 2 7,c7 by /rik+ & ! rationale = any sub/antial *anges 9 ! di/ribution ( funds4 & ins]t+ a semicolon2 & 7,d7 by add+ at ! end ! foll[+3 7,c7 ! di/ribution ( aw>ds & fund+ = new or exp&$ 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 7r77#d74 2 & 7#af7 9 subsection 7s7 7z s r$esignat$7 by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,fund+ = p>ticipation ( heal? c5t]s 9 ,all ( ,u ,rese>* ,program ,9 addition to any am\nts made available pursuant to subsection 7d7 ( ?is section1 p>agraph 7#a7 ( ?is subsection1 section #djb;,a ( ?is ,act1 or section #ajejc ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 !re is au?oriz$ 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 4 7c7 ,national ,heal? ,s]vice ,corps ,section #ajejc7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #bed;b-#b7;b77#b771 z am5d$ by section #caja ( ,public ,law #aae-if1 is am5d$ by am5d+ subp>agraph 7,f7 to read z foll[s3 7,f7 #caj1jjj1jjj = ea* ( fiscal ye>s #bjah & #bjai4 4 #bbb4 ,ext5sion = special diabetes programs 7a7 ,special diabetes program = type ,i diabetes ,subp>agraph 7,d7 ( section #ccj;,b7b77#b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bed;c-#b7;b77#b771 z am5d$ by section #cajb ( ,public ,law #aae-if1 is am5d$ to read z foll[s3 7,d7 #aej1jjj1jjj = ea* ( fiscal ye>s #bjah & #bjai4 4 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#b771 z am5d$ by section #cajb ( ,public ,law #aae-if1 is am5d$ to read z foll[s3 7,d7 #aej1jjj1jjj = ea* ( fiscal ye>s #bjah & #bjai4 4 #bbc4 ,reau?orization ( program ( paym5ts to tea*+ heal? c5t]s t op]ate graduate m$ical education programs 7a7 ,paym5ts ,subsection 7a7 ( section #cdj;,h ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is am5d$ 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$it+ body =1 z appropriate-- 7,a7 ma9t5ance ( fill$ positions at 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$ical resid5cy tra9+ programs4 7#b7 ,p] resid5t am\nt ,9 mak+ paym5ts "u p>agraph 7#a71 ! ,secret>y %all consid] ! co/ ( tra9+ resid5ts at tea*+ heal? c5t]s & ! implications ( ! p] resid5t am\nt on approv$ graduate m$ical resid5cy tra9+ programs at tea*+ heal? c5t]s4 7#c7 ,priority ,9 mak+ paym5ts "u p>agraph 7#a77;,c71 ! ,secret>y %all give priority to qualifi$ 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 7b7 ,fund+ ,p>agraph 7#a7 ( section #cdj;,h7g7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;h7g771 z am5d$ by section #caja ( ,public ,law #aae-if1 is am5d$ by /rik+ & #cj1jjj1jjj = ! p]iod ( ! fir/ & second qu>t]s ( fiscal ye> #bjah & ins]t+ & #abf1ejj1jjj = ea* ( fiscal ye>s #bjah & #bjai4 7c7 ,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 7d7 ,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 7e7 ,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 7f7 ,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 7g7 ,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 ( ,public ,law #aae-if1 %all cont9ue to apply ) respect to paym5ts "u su* section = fiscal ye>s be=e fiscal ye> #bjah4 #bbd4 ,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 #bbe4 ,ext5sion ( ab/95ce education2 ext5sion ( p]sonal responsibility education program 7a7 ,ab/95ce education ,section #eaj ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaj7 is am5d$-- 7#a7 9 subsection 7a71 9 ! matt] prec$+ p>agraph 7#a71 by /rik+ #bjag & ins]t+ #bjai2 & 7#b7 9 subsection 7d7-- 7,a7 by /rik+ #bjae & & ins]t+ #bjae1 2 & 7,b7 by ins]t+ aft] #bjag ! foll[+3 1 & an additional #ge1jjj1jjj = ea* ( fiscal ye>s #bjah ?r\gh #bjai4 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 #bbf4 ,ext5sion ( heal? work=ce demon/ration projects = l[-income individuals ,section #bjjh7;c77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;g7c77#a77 is am5d$ by /rik+ #bjag & ins]t+ #bjai4 #bbg4 ,delay ( r$uction to ,m$icaid ,,d% allotm5ts ,section #aibc7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;f77#g77 is am5d$-- 7#a7 9 p>agraph 7#g77;,a7-- 7,a7 9 clause 7i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ #bjah ?r\gh #bjbe & ins]t+ #bjbj ?r\gh #bjbg2 & 7,b7 by am5d+ clause 7ii7 to read z foll[s3 7,i7 #b1jjj1jjj1jjj = fiscal ye> #bjbj2 7,,ii7 #c1jjj1jjj1jjj = fiscal ye> #bjba2 7,,iii7 #d1jjj1jjj1jjj = fiscal ye> #bjbb2 7,,iv7 #e1jjj1jjj1jjj = fiscal ye> #bjbc2 7,v7 #f1jjj1jjj1jjj = fiscal ye> #bjbd2 7,,vi7 #g1jjj1jjj1jjj = fiscal ye> #bjbe2 7,,vii7 #h1jjj1jjj1jjj = fiscal ye> #bjbf2 & 7,,viii7 #h1jjj1jjj1jjj = fiscal ye> #bjbg4 2 & 7#b7 9 p>agraph 7#h71 by /rik+ #bjbe & ins]t+ #bjbg4 #bbh4 ,delay ( ,bip>tisan ,budget ,act ( #bjac ?ird-p>ty liability provisions 7a7 ,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+ #bjbb4 7b7 ,effective date2 treatm5t ,! am5dm5t made by subsection 7a7 %all take effect on ,septemb] #cj1 #bjag1 & %all apply ) respect to claims p5d+1 g5]at$1 or fil$ aft] su* date4 ,c ,cont9u+ ! ,mat]nal1 ,infant1 & ,e>ly ,*ildhood ,home ,visit+ ,program #bca4 ,cont9u+ evid5ce-bas$ home visit+ program ,section #eaa7;j77#a77;,h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77#a77;,h77 is am5d$ by /rik+ fiscal ye> #bjag & ins]t+ ea* ( fiscal ye>s #bjag ?r\gh #bjbb4 #bcb4 ,cont9u+ to demon/rate results to help families 7a7 ,require s]vice deliv]y models ,to demon/rate improvem5t 9 applicable b5*m>k areas ,section #eaa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7 is am5d$ 9 ea* ( subsections 7d77#a77;,a7 & 7h77#d77;,a7 by /rik+ ea* (4 7b7 ,demon/ration ( improvem5ts 9 subsequ5t ye>s ,section #eaa7;d77#a7 ( su* ,act 7#db ,u4,s4,c4 #gaa7;d77#a77 is am5d$ by add+ at ! end ! foll[+3 7,d7 ,demon/ration ( improvem5ts 9 subsequ5t ye>s 7i7 ,cont9u$ measurem5t ( improvem5t 9 applicable b5*m>k areas ,! eligible entity1 aft] demon/rat+ improvem5ts = eligible families z specifi$ 9 subp>agraphs 7,a7 & 7,b71 %all cont9ue to track & report1 n lat] ?an #cj days aft] ! end ( fiscal ye> #bjbj & e #c ye>s !reaft]1 in=mation demon/rat+ t ! program results 9 improvem5ts = ! eligible families p>ticipat+ 9 ! program 9 at lea/ #d ( ! areas specifi$ 9 subp>agraph 7,a7 t ! s]vice deliv]y model or models select$ by ! entity are int5d$ to improve4 7ii7 ,corrective action plan ,if ! eligible entity fails to demon/rate improvem5t 9 at lea/ #d ( ! areas specifi$ 9 subp>agraph 7,a71 z comp>$ to eligible families :o d n receive s]vices "u an e>ly *ildhood home visitation program1 ! entity %all develop & implem5t a plan to improve outcomes 9 ea* ( ! areas specifi$ 9 subp>agraph 7,a7 t ! s]vice deliv]y model or models select$ by ! entity are int5d$ to improve1 subject to approval by ! ,secret>y4 ,! plan %all include provisions = ! ,secret>y to monitor implem5tation ( ! plan & conduct cont9u$ ov]sight ( ! program1 includ+ ?r\gh submission by ! entity ( regul> reports to ! ,secret>y4 7iii7 ,te*nical assi/ance ,! ,secret>y %all provide an eligible entity requir$ to develop & implem5t an improvem5t plan "u clause 7ii7 ) te*nical assi/ance to develop & implem5t ! plan4 ,! ,secret>y may provide ! te*nical assi/ance directly or ?r\gh grants1 contracts1 or coop]ative agreem5ts4 7iv7 ,no improvem5t or failure to submit report ,if ! ,secret>y det]m9es aft] a p]iod ( "t specifi$ by ! ,secret>y t an eligible entity implem5t+ an improvem5t plan "u clause 7ii7 has fail$ to demon/rate any improvem5t 9 at lea/ #d ( ! areas specifi$ 9 subp>agraph 7,a71 or if ! ,secret>y det]m9es t an eligible entity has fail$ to submit ! report requir$ by clause 7i71 ! ,secret>y %all t]m9ate ! grant made to ! entity "u ?is section & may include any unexp5d$ grant funds 9 grants made to nonpr(it organizations "u subsection 7h77#b77;,b74 4 7c7 ,includ+ in=mation on applicable b5*m>ks 9 application ,section #eaa7;e77#e7 ( su* ,act 7#db ,u4,s4,c4 #gaa7;e77#e77 is am5d$ by ins]t+ t ! s]vice deliv]y model or models select$ by ! entity are int5d$ to improve be=e ! p]iod at ! end4 #bcc4 ,review+ /atewide ne$s to t>get res\rces ,section #eaa7;b77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;b77#a77 is am5d$ by /rik+ ,n lat] ?an & all t foll[s ?r\gh section #eje7;a77 & ins]t+ ,ea* ,/ate %all1 z a condition ( receiv+ paym5ts f an allotm5t = ! ,/ate "u section #ejb1 conduct a /atewide ne$s assessm5t 7:i* may be sep>ate f b 9 coord9ation ) ! /atewide ne$s assessm5t requir$ "u section #eje7;a7 & :i* %all be review$ & updat$ by ! ,/ate n lat] ?an ,octob] #a1 #bjbj74 #bcd4 ,improv+ ! likelihood ( success 9 high-risk communities ,section #eaa7;d77#d77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;d77#d77;,a77 is am5d$ by ins]t+ 1 tak+ into acc\nt ! /aff+1 community res\rce1 & o!r requirem5ts to op]ate at lea/ "o approv$ model ( home visit+ & demon/rate improvem5ts = eligible families be=e ! p]iod4 #bce4 ,option to fund evid5ce-bas$ home visit+ on a pay = outcome basis 7a7 ,9 g5]al ,section #eaa7;c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;c77 is am5d$ by r$esignat+ p>agraphs 7#c7 & 7#d7 z p>agraphs 7#d7 & 7#e71 respectively1 & by ins]t+ aft] p>agraph 7#b7 ! foll[+3 7#c7 ,au?ority to use grant = a pay = outcomes initiative ,an eligible entity to :i* a grant is made "u p>agraph 7#a7 may use up to #be p]c5t ( ! grant = outcomes or success paym5ts relat$ to a pay = outcomes initiative t w n result 9 a r$uction ( fund+ = s]vices deliv]$ by ! entity "u a *ildhood home visitation program "u ?is section :ile ! eligible entity develops or op]ates su* an initiative4 4 7b7 ,def9ition ( pay = outcomes initiative ,section #eaa7k7 ( su* ,act 7#db ,u4,s4,c4 #gaa7k77 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,pay = outcomes initiative ,! t]m pay = outcomes initiative means a p]=mance-bas$ grant1 contract1 coop]ative agreem5t1 or o!r agreem5t aw>d$ by a public entity 9 :i* a commitm5t is made to pay = improv$ outcomes a*iev$ z a result ( ! int]v5tion t result 9 social b5efit & direct co/ sav+s or co/ avoidance to ! public sector4 ,su* an initiative %all include-- 7,a7 a feasibility /udy t describes h[ ! propos$ int]v5tion is bas$ on evid5ce ( effectiv5ess2 7,b7 a rigor\s1 ?ird-p>ty evaluation t uses exp]im5tal or quasi-exp]im5tal design or o!r rese>* me?odologies t all[ = ! /ronge/ possible causal inf]5ces to det]m9e :e!r ! initiative has met its propos$ outcomes z a result ( ! int]v5tion2 7,c7 an annual1 publicly available report on ! progress ( ! initiative2 & 7,d7 a requirem5t t paym5ts are made to ! recipi5t ( a grant1 contract1 or coop]ative agreem5t only :5 agre$ ^u outcomes are a*iev$1 except t ?is requirem5t %all n apply ) respect to paym5ts to a ?ird p>ty conduct+ ! evaluation describ$ 9 subp>agraph 7,b74 4 7c7 ,ext5d$ availability ( funds ,section #eaa7;j77#c7 ( su* ,act 7#db ,u4,s4,c4 #gaa7;j77#c77 is am5d$-- 7#a7 by /rik+ 7#c7 ,availability4--,funds & ins]t+ ! foll[+3 7#c7 ,availability 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 funds 2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,funds = pay = outcomes initiatives ,funds made available to an eligible entity "u ?is section = a fiscal ye> 7or portion ( a fiscal ye>7 = a pay = outcomes initiative %all rema9 available = exp5diture by ! eligible entity = n m ?an #aj ye>s aft] ! funds are s made available4 4 #bcf4 ,data ex*ange /&>ds = improv$ int]op]ability 7a7 ,9 g5]al ,section #eaa7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;h77 is am5d$ by add+ at ! end ! foll[+3 7#e7 ,data ex*ange /&>ds = improv$ int]op]ability 7,a7 ,designation & use ( data ex*ange /&>ds 7i7 ,designation ,! head ( ! dep>tm5t or ag5cy responsible = adm9i/]+ a program fund$ "u ?is section %all1 9 consultation ) an int]ag5cy "w gr\p e/abli%$ by ! ,(fice ( ,managem5t & ,budget & consid]+ ,/ate gov]nm5t p]spectives1 designate data ex*ange /&>ds = necess>y categories ( in=mation t a ,/ate ag5cy op]at+ ! program is requir$ to electronically ex*ange ) ano!r ,/ate ag5cy "u applicable ,f$]al law4 7ii7 ,data ex*ange /&>ds mu/ be nonpropriet>y & int]op]able ,! data ex*ange /&>ds designat$ "u clause 7i7 %all1 to ! ext5t practicable1 be nonpropriet>y & int]op]able4 7iii7 ,o!r requirem5ts ,9 designat+ data ex*ange /&>ds "u ?is p>agraph1 ! ,secret>y %all1 to ! ext5t practicable1 incorporate-- 7,i7 int]op]able /&>ds develop$ & ma9ta9$ by an int]national volunt>y cons5sus /&>ds body1 z def9$ by ! ,(fice ( ,managem5t & ,budget2 7,,ii7 int]op]able /&>ds develop$ & ma9ta9$ by int]gov]nm5tal p>tn]%ips1 su* z ! ,national ,in=mation ,ex*ange ,model2 & 7,,iii7 int]op]able /&>ds develop$ & ma9ta9$ by ,f$]al entities ) au?ority ov] contract+ & f9ancial assi/ance4 7,b7 ,data ex*ange /&>ds = f$]al report+ 7i7 ,designation ,! head ( ! dep>tm5t or ag5cy responsible = adm9i/]+ a program ref]r$ to 9 ?is section %all1 9 consultation ) an int]ag5cy "w gr\p e/abli%$ by ! ,(fice ( ,managem5t & ,budget1 & consid]+ ,/ate gov]nm5t p]spectives1 designate data ex*ange /&>ds to gov]n ,f$]al report+ & ex*ange requirem5ts "u applicable ,f$]al law4 7ii7 ,requirem5ts ,! data ex*ange report+ /&>ds requir$ by clause 7i7 %all1 to ! ext5t practicable-- 7,i7 incorporate a widely accept$1 nonpropriet>y1 se>*able1 comput]-readable =mat2 7,,ii7 be consi/5t ) & implem5t applicable acc\nt+ pr9ciples2 7,,iii7 be implem5t$ 9 a mann] t is co/-effective & improves program effici5cy & effectiv5ess2 & 7,,iv7 be capable ( be+ cont9ually upgrad$ z necess>y4 7iii7 ,incorporation ( nonpropriet>y /&>ds ,9 designat+ data ex*ange /&>ds "u ?is p>agraph1 ! ,secret>y %all1 to ! ext5t practicable1 incorporate exi/+ nonpropriet>y /&>ds1 su* z ! e,xtensible ,m>k up ,language4 7iv7 ,rule ( con/ruction ,no?+ 9 ?is p>agraph %all be con/ru$ to require a *ange to exi/+ data ex*ange /&>ds = ,f$]al report+ ab\t a program ref]r$ to 9 ?is section1 if ! head ( ! dep>tm5t or ag5cy responsible = adm9i/]+ ! program f9ds ! /&>ds to be effective & effici5t4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ! date t is #b ye>s aft] ! date ( enactm5t ( ?is ,act4 #bcg4 ,allocation ( funds ,section #eaa7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #gaa7;j77 is am5d$ by add+ at ! end ! foll[+3 7#d7 ,allocation ( funds ,to ! ext5t t ! grant am\nt aw>d$ "u ?is section to an eligible entity is det]m9$ on ! basis ( relative population or pov]ty consid]ations1 ! ,secret>y %all make ! det]m9ation us+ ! mo/ accurate ,f$]al data available = ! eligible entity4 4 ,,iii ,/r5g!n+ ,protections = ,social ,security ,b5efici>ies ,act ( #bjah #cjj4 ,%ort title ,?is title may be cit$ z ! ,/r5g!n+ ,protections = ,social ,security ,b5efici>ies ,act ( #bjah4 ,a ,/r5g!n+ ,ov]sight & ,b5efici>y ,protection #cja4 ,/rong] monitor+ ( repres5tative payees 7a7 ,protection & advocacy = b5efici>ies ) repres5tative payees ,section #bje7;j77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#f77 is am5d$ by add+ at ! end ! foll[+3 7,c7 7i7 ,! ,commission] ( ,social ,security %all make annual grants directly to ! protection & advocacy sy/em s]v+ ea* ( ! ,/ates & ! ,am]ican ,indian consortium = ! purpose ( conduct+ reviews ( repres5tative payees 9 accordance ) ?is subp>agraph4 ,! total am\nt us$ by ! ,commission] = su* grants ea* ye>-- 7,i7 %all be an am\nt suffici5t1 z det]m9$ by ! ,commission] 9 consultation ) ea* ( ! protection & advocacy sy/ems1 to c>ry out all ( ! activities describ$ 9 clause 7ii72 & 7,,ii7 %all n be less ?an #be1jjj1jjj4 7ii7 ,a protection & advocacy sy/em aw>d$ a grant "u ?is subp>agraph %all use ! grant funds to-- 7,i7 conduct all p]iodic onsite reviews pursuant to ?is p>agraph & su* o!r reviews ( repres5tative payees z ! ,commission] may reque/1 includ+ reviews conduct$ 9 response to allegations or conc]ns ab\t ! p]=mance or suitability ( ! payee2 7,,ii7 conduct additional reviews t ! protection & advocacy sy/em has reason to believe are w>rant$2 7,,iii7 develop corrective action plans to assi/ repres5tative payees 9 con=m+ to requirem5ts specifi$ by ! ,commission]2 7,,iv7 submit a report to ! ,commission] on ea* complet$ review conta9+ su* in=mation z ! ,commission] %all require2 & 7,v7 conduct an initial onsite assessm5t ( any organization t beg9s collect+ a fee = its s]vices z a repres5tative payee to ensure t su* organization is e/abli%$ z su* a repres5tative payee 9 accordance ) requirem5ts specifi$ by ! ,commission]4 ,a protection & advocacy sy/em may ref] b5efici>ies to o!r programs or s]vices z ! protection & advocacy sy/em consid]s appropriate4 7iii7 ,to be eligible to receive grants "u ?is section1 a protection & advocacy sy/em %all submit an initial application to ! ,commission] at su* "t1 9 su* =m & mann]1 & accompani$ by su* in=mation & assurances z ! ,commission] may require4 7iv7 7,i7 ,subject to subclause 7,,ii71 ! ,commission] %all ensure t any funds us$ = grants "u clause 7i7 %all be allocat$ to ! protection & advocacy sy/ems s]v+ ea* ( ! ,/ates & ! ,am]ican ,indian consortium 9 a mann] su* t ! am\nt provid$ to ea* protection & advocacy sy/em be>s ! same ratio to ! total ( su* funds z ! numb] ( repres5t$ b5efici>ies 9 ! ,/ate or ,am]ican ,indian consortium 9 :i* su* protection & advocacy sy/em is locat$ be>s to ! total numb] ( repres5t$ b5efici>ies4 7,,ii7 ,! am\nt ( an annual grant to a protection & advocacy sy/em "u clause 7i7 %all-- 7aa7 9 ! case ( a protection & advocacy sy/em s]v+ ,am]ican ,samoa1 ,guam1 ! ,unit$ ,/ates ,virg9 ,isl&s1 or ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s1 or ! ,am]ican ,indian consortium1 n be less ?an #cj1jjj2 & 7bb7 9 ! case ( a protection & advocacy sy/em s]v+ any o!r ,/ate1 n be less ?an #fj1jjj4 7,,iii7 ,funds provid$ to a protection & advocacy sy/em ?r\gh a grant "u clause 7i7 = a "o-ye> p]iod %all rema9 available ?r\gh ! end ( ! foll[+ "o-ye> p]iod4 7,,iv7 ,= purposes ( ?is clause1 ! t]m repres5t$ b5efici>y means an individual-- 7aa7 :o is entitl$ to b5efits "u ?is title1 title ,,viii1 or title ,,xvi2 & 7bb7 ^: b5efits h be5 c]tifi$ = paym5t to a repres5tative payee4 7v7 7,i7 ,! ,commission] %all make annual grants1 9 an am\nt equal to #d p]c5t ( ! total am\nt ( grants aw>d$ ea* ye> "u clause 7i71 to an eligible national association = ! provision ( tra9+ & te*nical assi/ance1 adm9i/rative support1 & data collection s]vices to protection & advocacy sy/ems 9 connection ) grants aw>d$ "u clause 7i74 7,,ii7 ,9 ?is clause1 ! t]m eligible national association means a national disability association ) ext5sive k & demon/rat$ exp]i5ce 9 provid+ tra9+1 te*nical assi/ance1 & adm9i/rative ov]sight to protection & advocacy sy/ems t monitor repres5tative payees4 7vi7 ,9 conduct+ reviews "u ?is section1 a protection & advocacy sy/em %all h ! same au?orities1 includ+ access to records1 facilities1 & p]sons1 z su* sy/em w\ld h = purposes ( provid+ s]vices "u subtitle ,c ( title ,i ( ! ,developm5tal ,disabilities ,assi/ance & ,bill ( ,rights ,act ( #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7vii7 ,:5ev] b5efit am\nts "u ?is title are increas$ by any p]c5tage effective ) any mon? aft] ,novemb] #bjah z a result ( a det]m9ation made "u section #bae7;i71 ea* ( ! doll> am\nts specifi$ 9 clauses 7i77,,ii7 & 7iv77,,ii7 %all be increas$ by ! same p]c5tage4 7viii7 ,no additional funds are au?oriz$ to be appropriat$ to c>ry out ! requirem5ts ( ?is subp>agraph4 ,su* requirem5ts %all be c>ri$ out us+ am\nts o!rwise au?oriz$4 7ix7 ,9 ?is subp>agraph3 7,i7 ,! t]m ,am]ican ,indian consortium means a consortium e/abli%$ "u subtitle ,c ( title ,i ( ! ,developm5tal ,disabilities ,assi/ance & ,bill ( ,rights ,act ( #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7,,ii7 ,! t]m protection & advocacy sy/em means a protection & advocacy sy/em e/abli%$ "u subtitle ,c ( title ,i ( ! ,developm5tal ,disabilities ,assi/ance & ,bill ( ,rights ,act ( #bjjj 7#db ,u4,s4,c4 #aejda et seq474 7,,iii7 ,! t]m ,/ate means ! sev]al ,/ates ( ! ,unit$ ,/ates1 ! ,di/rict ( ,columbia1 ! ,commonweal? ( ,pu]to ,rico1 ! ,unit$ ,/ates ,virg9 ,isl&s1 ,guam1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s4 4 7b7 ,expansion ( p]iodic onsite review requirem5ts ,section #bje7;j77#f77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#f77;,a77 is am5d$-- 7#a7 9 clause 7ii71 by /rik+ or2 7#b7 9 clause 7iii71 by /rik+ ! p]iod & ins]t+ 2 or2 7#c7 by add+ aft] clause 7iii7 ! foll[+3 7iv7 ! repres5tative payee collects a fee = its s]vices4 2 & 7#d7 by add+ aft] clause 7iv7 7z add$ by p>agraph 7#c77 ! foll[+ flu% text3 ,! ,commission] %all also conduct p]iodic onsite reviews ( individual & organizational payees1 includ+ payees :o are relat$ to ! b5efici>y & prim>ily reside 9 ! same h\sehold1 select$ on ! basis ( risk-factors = pot5tial misuse or unsuitability associat$ ) su* payees or b5efici>ies4 4 7c7 ,availability ( grant funds 7#a7 ,protection & advocacy sy/em grants ,grants describ$ "u clause 7i7 ( subp>agraph 7,c7 ( section #bje7;j77#f7 ( ! ,social ,security ,act 7z add$ by subsection 7a77 %all be aw>d$ on ,augu/ #a1 #bjah1 & annually !reaft]1 & funds provid$ by su* grants to a protection & advocacy sy/em may be us$ to reimburse ! protection & advocacy sy/em = am\nts exp5d$ by ! protection & advocacy sy/em dur+ ! p]iod beg9n+ on ,may #a1 #bjah1 & end+ on su* date = hir+ & />t-up co/s 9 prep>ation to c>ry out reviews ( repres5tative payees 9 accordance ) su* subp>agraph4 7#b7 ,national ,association grants ,grants describ$ "u clause 7v7 ( su* subp>agraph %all be aw>d$ on ,may #a1 #bjah1 & annually !reaft]4 #cjb4 ,r$uc+ ! burd5 on families 7a7 ,title ,,ii ,section #bje7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#c77 is am5d$-- 7#a7 by r$esignat+ subp>agraphs 7,d7 ?r\gh 7,g7 z subp>agraphs 7,e7 ?r\gh 7,h71 respectively2 7#b7 by ins]t+ aft] subp>agraph 7,c7 ! foll[+3 7,d7 7i7 ,subp>agraph 7,a7 %all n apply 9 any case :]e ! o!r p]son to :om su* paym5t is made is-- 7,i7 a p>5t1 or o!r individual :o is a legal gu>dian (1 a m9or *ild entitl$ to su* paym5t :o prim>ily resides 9 ! same h\sehold2 7,,ii7 a p>5t ( an individual entitl$ to su* paym5t :o is "u a disability 7z def9$ 9 section #bbc7;d77 :o prim>ily resides 9 ! same h\sehold2 or 7,,iii7 ! sp\se ( ! individual entitl$ to su* paym5t4 7ii7 ,! ,commission] ( ,social ,security %all e/abli% & implem5t proc$ures z necess>y = ! ,commission] to det]m9e ! eligibility ( su* p>ties = ! exemption provid$ 9 clause 7i74 ,! ,commission] %all prescribe su* regulations z may be necess>y to det]m9e eligibility = su* exemption4 2 7#c7 9 subp>agraph 7,e7 7z s r$esignat$71 by /rik+ & 7,c7 & ins]t+ 7,c71 & 7,d72 & 7#d7 9 subp>agraph 7,f7 7z s r$esignat$71 by /rik+ 7,d7 ea* place x appe>s & ins]t+ 7,e74 7b7 ,title ,,viii ,section #hjg7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7;h77 is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#c7 ?r\gh 7#e7 z p>agraphs 7#d7 ?r\gh 7#f71 respectively2 & 7#b7 by ins]t+ aft] p>agraph 7#b7 ! foll[+3 7#c7 7,a7 ,p>agraph 7#a7 %all n apply 9 any case :]e ! o!r p]son to :om su* paym5t is made is ! sp\se ( ! individual entitl$ to su* paym5t4 7,b7 ,! ,commission] ( ,social ,security %all e/abli% & implem5t proc$ures z necess>y = ! ,commission] to det]m9e ! eligibility ( su* p>ties = ! exemption provid$ 9 subp>agraph 7,a74 ,! ,commission] %all prescribe su* regulations z may be necess>y to det]m9e eligibility = su* exemption4 4 7c7 ,title ,,xvi ,section #afca7;a77#b77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,c77 is am5d$-- 7#a7 by r$esignat+ clauses 7iv7 & 7v7 z clauses 7v7 & 7vi71 respectively2 7#b7 by ins]t+ aft] clause 7iii7 ! foll[+3 7iv7 7,i7 ,clause 7i7 %all n apply 9 any case :]e ! repres5tative payee is-- 7aa7 a p>5t1 or o!r individual :o is a legal gu>dian (1 a m9or *ild entitl$ to su* paym5t :o prim>ily resides 9 ! same h\sehold2 7bb7 a p>5t ( an individual entitl$ to su* paym5t :o is "u a disability :o prim>ily resides 9 ! same h\sehold2 or 7cc7 ! sp\se ( ! individual entitl$ to su* paym5t4 7,,ii7 ,! ,commission] ( ,social ,security %all e/abli% & implem5t proc$ures z necess>y = ! ,commission] to det]m9e ! eligibility ( su* p>ties = ! exemption provid$ 9 subclause 7,i74 ,! ,commission] %all prescribe su* regulations z may be necess>y to det]m9e eligibility = su* exemption4 2 7#c7 9 clause 7v7 7z s r$esignat$71 by /rik+ & 7iii7 & ins]t+ 7iii71 & 7iv72 & 7#d7 9 clause 7vi7 7z s r$esignat$71 by /rik+ 7iv7 ea* "t x appe>s & ins]t+ 7v74 7d7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( ! enactm5t ( ?is ,act4 #cjc4 ,protect+ b5efici>ies ?r\gh in=mation %>+ 7a7 ,in=mation %>+ ,to det]m9e ,/ate fo/] c>e /atus 7#a7 ,9 g5]al ,section #bje7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77 is am5d$ by add+ at ! end ! foll[+3 7#aa7 7,a7 ,! ,commission] ( ,social ,security %all-- 7i7 ent] into agreem5ts ) ea* ,/ate ) a plan approv$ "u "p ,e ( title ,,iv = ! purpose ( %>+ & mat*+ data1 on an automat$ mon?ly basis1 9 ! sy/em ( records ( ! ,social ,security ,adm9i/ration ) ea* ,/atewide & ,tribal ,automat$ ,*ild ,welf>e ,in=mation ,sy/em to id5tify repres5t$ m9or b5efici>ies :o are 9 fo/] c>e "u ! responsibility ( ! ,/ate = su* mon?2 & 7ii7 9 any case 9 :i* a repres5t$ m9or b5efici>y has ent]$ or exit$ fo/] c>e or *ang$ fo/] c>e placem5t 9 su* mon?1 r$et]m9e ! appropriate repres5tative payee = su* individual4 7,b7 ,= purposes ( ?is p>agraph-- 7i7 ! t]m ,/ate has ! mean+ giv5 su* t]m = purposes ( "p ,e ( title ,,iv2 7ii7 ! t]m ,/atewide & ,tribal ,automat$ ,*ild ,welf>e ,in=mation ,sy/em means a /atewide me*aniz$ data collection & in=mation retrieval sy/em describ$ 9 section #dgd7;a77#c77;,c72 & 7iii7 ! t]m repres5t$ m9or b5efici>y1 ) respect to an individual = a mon?1 means a *ild 7z def9$ = purposes ( section #dge7h77 entitl$ to b5efits "u ?is title = su* mon? ^: b5efits are c]tifi$ = paym5t to a repres5tative payee4 4 7#b7 ,con=m+ *ange ,section #dga7;a77#h77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fga7;a77#h77;,a77 is am5d$ by ins]t+ ! program e/abli%$ by title ,,ii1 aft] ,,xx14 7#c7 ,,gao /udy & report 7,a7 ,evaluation ,z soon z possible aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all evaluate-- 7i7 ! numb] ( repres5t$ m9or b5efici>ies 9 fo/] c>e "u ! responsibility ( a ,/ate = ea* mon? dur+ ! previ\s ye>2 7ii7 :e!r ! repres5tative payee = ea* repres5t$ m9or b5efici>y is-- 7,i7 a gov]nm5tal *ild welf>e ag5cy2 7,,ii7 an organizational payee t is n a gov]nm5tal *ild welf>e ag5cy2 7,,iii7 a fo/] p>5t or *ild-c>e in/itution 7)9 ! mean+ ( "p ,e ( title ,,iv72 or 7,,iv7 ano!r individual2 & 7iii7 :e!r funds 7 cons]v$1 us$ = direct exp5ses ( ! m9or b5efici>y1 or us$ to reimburse ! ,/ate = fo/] c>e ma9t5ance co/s4 7,b7 ,report to ,congress ,n lat] ?an #cf mon?s aft] ! date ( enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! results ( ! evaluation requir$ "u subp>agraph 7,a74 7,c7 ,def9itions ,= purposes ( ?is p>agraph-- 7i7 ! t]m ,/ate has ! mean+ giv5 su* t]m = purposes ( "p ,e ( title ,,iv ( ! ,social ,security ,act2 & 7ii7 ! t]m repres5t$ m9or b5efici>y1 ) respect to an individual = a mon?1 means a *ild 7z def9$ = purposes ( section #dge7h7 ( ! ,social ,security ,act7 entitl$ to b5efits "u title ,,ii ( su* ,act = su* mon? ^: b5efits are c]tifi$ = paym5t to a repres5tative payee4 7#d7 ,effective date 7,a7 ,9 g5]al ,! am5dm5ts made by ?is subsection %all apply ) respect to mon?s beg9n+ on or aft] ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7,b7 ,exception if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan "u "p ,e ( title ,,iv ( ! ,social ,security ,act 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 subsection1 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 7b7 ,improv+ ,coord9ation ) ,adult ,protective ,s]vices 7#a7 ,9 g5]al ,! ,commission] ( ,social ,security %all /udy & te/ ! adm9i/rative feasibility ( improv+ in=mation %>+1 9 p>tn]%ip ) ,/ate ag5cies t provide adult protective s]vices1 ) respect to-- 7,a7 ! assessm5t ( an individual's ne$ = a repres5tative payee 9 connection ) b5efits to :i* ! individual is entitl$ "u title ,,ii or title ,,xvi ( ! ,social ,security ,act2 & 7,b7 ov]sight ( individuals & organizations s]v+ z repres5tative payees4 7#b7 ,report ,n lat] ?an ,june #cj1 #bjbb1 ! ,commission] ( ,social ,security %all conclude ! /udy describ$ 9 p>agraph 7#a7 & submit to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on ! results ( su* /udy4 7c7 ,/udy on ,pot5tial ,to ,coord9ate ) ,/ate ,c\rts 7#a7 ,9 g5]al ,! ,commission] ( ,social ,security %all ent] into an agreem5t ) ! ,adm9i/rative ,conf]5ce ( ! ,unit$ ,/ates to conduct a /udy t includes-- 7,a7 an ov]view ( pot5tial opportunities = in=mation %>+ betwe5 ! ,social ,security ,adm9i/ration & ,/ate c\rts & relevant ,/ate ag5cies2 7,b7 a detail$ analysis ( ! b>ri]s to su* in=mation %>+1 includ+ any ,f$]al or ,/ate /atutory b>ri]s2 7,c7 a description ( h[ su* in=mation %>+ w\ld be implem5t$1 includ+ any additional infra/ructure ne$$2 & 7,d7 a description ( any risks or o!r factors t ! ,social ,security ,adm9i/ration & ! ,congress %\ld consid] be=e implem5t+ su* in=mation %>+4 7#b7 ,report ,n lat] ?an ,june #cj1 #bjbj1 ! ,commission] ( ,social ,security %all submit to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate & make publicly available a report on ! results ( ! /udy conduct$ "u p>agraph 7#a74 #cjd4 ,cl>ify+ ov]paym5t liability = *ild 9 *ild welf>e sy/em 7a7 ,am5dm5t to title ,,ii ,section #bjd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #djd7;a77 is am5d$ by add+ at ! end ! foll[+3 7#c7 7,a7 ,:5 any paym5t ( m ?an ! correct am\nt is made on behalf ( an individual :o is a repres5t$ m9or b5efici>y = a mon? 9 :i* su* individual is 9 fo/] c>e "u ! responsibility ( a ,/ate & ! ,/ate is ! repres5tative payee ( su* individual1 ! ,/ate %all be liable = ! repaym5t ( ! ov]paym5t1 & !re %all be no adju/m5t ( paym5ts to1 or recov]y by ! ,unit$ ,/ates f1 su* individual4 7,b7 ,= purposes ( ?is p>agraph1 ! t]m repres5t$ m9or b5efici>y has ! mean+ giv5 su* t]m 9 subsection 7j77#aa77;,b77iii74 4 7b7 ,am5dm5t to title ,,xvi ,section #afca7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #afhc7;b77 is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#c7 ?r\gh 7#g7 z p>agraphs 7#d7 ?r\gh 7#h71 respectively2 & 7#b7 by ins]t+ aft] p>agraph 7#b7 ! foll[+3 7#c7 7,a7 ,:5 any paym5t ( m ?an ! correct am\nt is made on behalf ( an individual :o is a repres5t$ m9or b5efici>y = a mon? 9 :i* su* individual is 9 fo/] c>e "u ! responsibility ( a ,/ate & ! ,/ate is ! repres5tative payee ( su* individual1 ! ,/ate %all be liable = ! repaym5t ( ! ov]paym5t1 & !re %all be no adju/m5t ( paym5ts to1 or recov]y by ! ,unit$ ,/ates f1 su* individual4 7,b7 ,= purposes ( ?is p>agraph1 ! t]m repres5t$ m9or b5efici>y1 ) respect to an individual = a mon?1 means a *ild 7z def9$ = purposes ( section #dge7h77 entitl$ to b5efits "u ?is title = su* mon? ^: b5efits are c]tifi$ = paym5t to a repres5tative payee4 4 7c7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply ) respect to ov]paym5t det]m9ations made on or aft] ! date ( ! enactm5t ( ?is ,act & to any o!r ov]paid am\nts t h n be5 recov]$ z ( su* date4 #cje4 ,reports 7a7 ,report on b5efits misus$ ,section #bje7;j7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j771 z am5d$ by section #cjc7;a71 is fur!r am5d$-- 7#a7 9 p>agraph 7#f7-- 7,a7 by /rik+ 7,a7 ,9 addition to & ins]t+ ,9 addition to2 & 7,b7 by /rik+ subp>agraph 7,b72 & 7#b7 by add+ at ! end ! foll[+3 7#ab7 7,a7 ,n lat] ?an ,janu>y #ca ( ea* fiscal ye>1 ! ,commission] %all submit to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report on ! total numb] ( individuals entitl$ to b5efits "u titles ,,ii1 ,,viii1 & ,,xvi1 respectively 7& ! numb] ( individuals concurr5tly entitl$ to b5efits "u m ?an "o su* title71 :o h a repres5tative payee1 ! total numb] ( su* repres5tative payees1 & ! results ( all reviews ( repres5tative payees conduct$ dur+ ! previ\s fiscal ye> 9 connection ) b5efits "u ?is title1 title ,,viii1 or title ,,xvi4 ,su* report %all summ>ize problems id5tifi$ 9 su* reviews & corrective actions tak5 or plann$ to be tak5 to correct su* problems1 & %all include-- 7i7 ! numb] ( su* reviews2 7ii7 ! results ( su* reviews2 7iii7 ! numb] ( cases 9 :i* ! repres5tative payee 0 *ang$ & :y2 7iv7 ! numb] ( reviews conduct$ 9 response to allegations or conc]ns ab\t ! p]=mance or suitability ( ! payee2 7v7 ! numb] ( cases discov]$ 9 :i* !re 0 a misuse ( funds1 & ! total doll> am\nt ( b5efits det]m9$ by ! ,commission] dur+ su* fiscal ye> to h be5 misus$ by a repres5tative payee 7reg>dless ( ! fiscal ye> 9 :i* su* misuse occurr$72 7vi7 ! numb] ( cases discov]$ 9 :i* su* misuse ( funds result$ f ! neglig5t failure ( ! ,commission] to inve/igate or monitor a repres5tative payee2 7vii7 ! f9al disposition ( su* cases ( misuse ( funds1 includ+-- 7,i7 any crim9al1 civil1 & adm9i/rative p5alties impos$2 7,,ii7 ! total doll> am\nt ( misus$ b5efits repaid to b5efici>ies & alt]native repres5tative payees "u ea* (-- 7aa7 p>agraph 7#e7 7on ! basis ( a neglig5t failure ( ! ,commission] describ$ 9 su* p>agraph72 7bb7 p>agraph 7#e7 7on any o!r basis72 & 7cc7 p>agraph 7#g72 & 7,,iii7 ! total doll> am\nt ( misus$ b5efits recov]$ "u ea* (-- 7aa7 p>agraph 7#e72 & 7bb7 p>agraph 7#g72 7viii7 any updates to prior ye> reports necess>y to reflect subsequ5t recov]ies & repaym5ts p]ta9+ to misuse det]m9ations made 9 prior ye>s2 & 7ix7 su* o!r in=mation z ! ,commission] deems appropriate4 7,b7 ,ea* report requir$ "u ?is p>agraph = a fiscal ye> %all include ! in=mation describ$ 9 clauses 7i7 ?r\gh 7ix7 ( subp>agraph 7,a7 ) respect to-- 7i7 all repres5tative payees review$ dur+ su* fiscal ye>2 7ii7 all su* repres5tative payees t are organizations1 sep>at$ by :e!r su* organization collects a fee = its s]vices z a repres5tative payee2 7iii7 all su* repres5tative payees t are individuals s]v+ #ae or m individuals2 & 7iv7 all su* repres5tative payees t are individuals s]v+ less ?an #ae individuals1 sep>at$ by :e!r su* repres5tative payee is a family memb]4 4 7b7 ,report on elim9ation ( ! acc\nt+ =m ,! ,commission] %all-- 7#a7 conduct a /udy on ! *anges made by ! am5dm5ts made by section #ajb ( ! ,/r5g!n+ ,protections = ,social ,security ,b5efici>ies ,act ( #bjah1 :i* %all include ! impact ( su* *anges on families1 b5efici>ies1 & ! op]ations ( ! ,social ,security ,adm9i/ration2 & 7#b7 n lat] ?an ,janu>y #a1 #bjba1 submit a report on ! results ( su* /udy to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate4 7c7 ,report on ! advanc$ designation policy ,! ,commission] %all-- 7#a7 conduct a /udy on ! *anges made by ! am5dm5ts made by section #bja ( ! ,/r5g!n+ ,protections = ,social ,security ,b5efici>ies ,act ( #bjah1 :i* %all include ! impact ( su* *anges on b5efici>ies & ! op]ations ( ! ,social ,security ,adm9i/ration2 & 7#b7 n lat] ?an ,janu>y #a1 #bjbe1 submit a report on ! results ( su* /udy to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate4 ,b ,improv+ ,payee ,selection & ,quality #caa4 ,advance designation ( repres5tative payees 7a7 ,9 g5]al ,section #bje7;j77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#a77 is am5d$ by add+ at ! end ! foll[+3 7,c7 7i7 ,an individual :o is entitl$ to or is an applicant = a b5efit "u ?is title1 title ,,viii1 or title ,,xvi1 :o has atta9$ #ah ye>s ( age or is an emancipat$ m9or1 may1 at any "t1 designate "o or m o!r individuals to s]ve z a repres5tative payee = su* individual 9 ! ev5t t ! ,commission] ( ,social ,security det]m9es "u subp>agraph 7,a7 t ! int]e/ ( su* individual w\ld be s]v$ by c]tification = paym5t ( su* b5efits to :i* ! individual is entitl$ to a repres5tative payee4 ,if ! ,commission] ( ,social ,security makes su* a det]m9ation ) respect to su* individual at any "t aft] su* designation has be5 made1 ! ,commission] %all-- 7,i7 c]tify paym5t ( su* b5efits to ! designat$ individual1 subject to ! requirem5ts ( p>agraph 7#b72 or 7,,ii7 if ! ,commission] det]m9es t c]tification = paym5t ( su* b5efits to ! designat$ individual w\ld n satisfy ! requirem5ts ( p>agraph 7#b71 t ! designat$ individual is unwill+ or unable to s]ve z repres5tative payee1 or t o!r good cause exi/s1 c]tify paym5t ( su* b5efits to ano!r individual or organization1 9 accordance ) p>agraph 7#a74 7ii7 ,an organization may n be designat$ to s]ve z a repres5tative payee "u ?is subp>agraph4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect on ! date t is #b ye>s aft] ! date ( ! enactm5t ( ?is section4 7c7 ,regulations ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is section1 ! ,commission] ( ,social ,security %all promulgate regulations specify+ ! in=mation an individual is requir$ to provide to ! ,commission] 9 ord] to designate ano!r individual to s]ve z ! individual's repres5tative payee "u section #bje7;j77#a77;,c7 ( ! ,social ,security ,act 7z add$ by subsection 7a774 7d7 ,notification to b5efici>ies ,n lat] ?an ,janu>y #a1 #bjbj1 & annually !reaft]1 ! ,commission] ( ,social ,security %all notify ea* individual entitl$ to a b5efit "u title ,,ii1 ,,viii1 or ,,xvi ( ! ,social ,security ,act ( ! "n ( any individual designat$ to s]ve z ! individual's repres5tative payee "u section #bje7;j77#a77;,c7 ( su* ,act 7z add$ by subsection 7a774 #cab4 ,prohibition on individuals convict$ ( c]ta9 crimes s]v+ z repres5tative payees 7a7 ,am5dm5ts to title ,,ii ,section #bje7;j77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#b77 is am5d$-- 7#a7 9 subp>agraph 7,b7-- 7,a7 9 clause 7i7-- 7i7 9 subclause 7,v71 by /rik+ & at ! end2 7ii7 9 subclause 7,,vi71 by /rik+ ! p]iod & ins]t+ 1 &2 & 7iii7 by add+ at ! end ! foll[+3 7,,vii7 det]m9e :e!r su* p]son has be5 convict$ 7& n subsequ5tly exon]at$71 "u ,f$]al or ,/ate law1 ( a felony provid$ "u clause 7iv71 or ( an attempt or a conspiracy to commit su* a felony4 2 & 7,b7 by add+ at ! end ! foll[+3 7iv7 ,! felony crimes provid$ "u ?is clause1 :e!r an (f5se "u ,/ate or ,f$]al law1 are ! foll[+3 7,i7 ,human traffick+1 includ+ z prohibit$ "u sections #aeij & #aeia ( title #ah1 ,unit$ ,/ates ,code4 7,,ii7 ,false imprisonm5t1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,,iii7 ,kidnapp+1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,,iv7 ,rape & sexual assault1 includ+ z prohibit$ "u sections #bbda1 #bbdb1 #bbdc1 & #bbdd ( title #ah1 ,unit$ ,/ates ,code4 7,v7 ,fir/-degree homicide1 includ+ z prohibit$ "u section #aaaa ( title #ah1 ,unit$ ,/ates ,code4 7,,vi7 ,robb]y1 includ+ z prohibit$ "u section #baaa ( title #ah1 ,unit$ ,/ates ,code4 7,,vii7 ,fraud to obta9 access to gov]nm5t assi/ance1 includ+ z prohibit$ "u sections #bhg1 #ajja1 & #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,,viii7 ,fraud by s*eme1 includ+ z prohibit$ "u section #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,,ix7 ,!ft ( gov]nm5t funds or prop]ty1 includ+ z prohibit$ "u section #fda ( title #ah1 ,unit$ ,/ates ,code4 7,x7 ,abuse or neglect1 includ+ z prohibit$ "u section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag ( title #ah1 ,unit$ ,/ates ,code4 7,,xi7 ,=g]y1 includ+ z prohibit$ "u section #fdb & *apt] #be 7except section #eab7 ( title #ah1 ,unit$ ,/ates ,code4 7,,xii7 ,id5tity !ft or id5tity fraud1 includ+ z prohibit$ "u sections #ajbh & #ajbh;,a ( title #ah1 ,unit$ ,/ates ,code4 ,! ,commission] ( ,social ,security may promulgate regulations to provide = additional felony crimes "u ?is clause4 7v7 7,i7 ,= ! purpose ( c>ry+ out ! activities requir$ "u subp>agraph 7,b77i7 z "p ( ! inve/igation "u subp>agraph 7,a77i71 ! ,commission] may conduct a backgr\nd *eck ( any individual seek+ to s]ve z a repres5tative payee "u ?is subsection & may disqualify f s]vice z a repres5tative payee any su* individual :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 7,,ii7 ,! ,commission] may revoke c]tification ( paym5t ( b5efits "u ?is subsection to any individual s]v+ z a repres5tative payee on or aft] ,janu>y #a1 #bjai1 :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 2 & 7#b7 9 subp>agraph 7,c7-- 7,a7 9 clause 7i7-- 7i7 9 subclause 7,,iv71 by /rik+ or at ! end2 7ii7 9 subclause 7,v71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7iii7 by add+ at ! end ! foll[+3 7,,vi7 except z provid$ 9 clause 7vi71 su* p]son has previ\sly be5 convict$ 7& n subsequ5tly exon]at$7 z describ$ 9 subp>agraph 7,b77i77,,vii74 2 & 7,b7 by add+ at ! end ! foll[+3 7vi7 7,i7 ,) respect to any p]son describ$ 9 subclause 7,,ii7-- 7aa7 subp>agraph 7,b77i77,,vii7 %all n apply2 & 7bb7 ! ,commission] may grant an exemption f ! provisions ( clause 7i77,,vi7 if ! ,commission] det]m9es t su* exemption is 9 ! be/ int]e/ ( ! individual entitl$ to b5efits4 7,,ii7 ,a p]son is describ$ 9 ?is subclause if ! p]son-- 7aa7 is ! cu/odial p>5t ( a m9or *ild = :om ! p]son applies to s]ve1 7bb7 is ! cu/odial sp\se ( ! b5efici>y = :om ! p]son applies to s]ve1 7cc7 is ! cu/odial p>5t ( a b5efici>y :o is "u a disability 7z def9$ 9 section #bbc7;d77 :i* began be=e ! b5efici>y atta9$ ! age ( #bb1 = :om ! p]son applies to s]ve1 7dd7 is ! cu/odial c\rt appo9t$ gu>dian ( ! b5efici>y = :om ! p]son applies to s]ve1 7ee7 is ! cu/odial gr&p>5t ( a m9or gr&*ild = :om ! p]son applies to s]ve1 7ff7 is ! p>5t :o 0 previ\sly repres5tative payee = 8 or h] m9or *ild :o has s9ce turn$ #ah & cont9ues to be eligible = su* b5efit1 or 7gg7 receiv$ a presid5tial or gub]natorial p>don = ! relevant conviction4 4 7b7 ,am5dm5ts to title ,,viii ,section #hjg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7 is am5d$-- 7#a7 9 subsection 7b7-- 7,a7 9 p>agraph 7#b7-- 7i7 9 subp>agraph 7,e71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,f71 by /rik+ ! p]iod & ins]t+ 1 &2 & 7iii7 by add+ at ! end ! foll[+3 7,g7 det]m9e :e!r su* p]son has be5 convict$ 7& n subsequ5tly exon]at$71 "u ,f$]al or ,/ate law1 ( a felony provid$ "u p>agraph 7#d71 or ( an attempt or a conspiracy to commit su* a felony4 2 & 7,b7 by add+ at ! end ! foll[+3 7#d7 ,! felony crimes provid$ "u ?is p>agraph1 :e!r an (f5se "u ,/ate or ,f$]al law1 are ! foll[+3 7,a7 ,human traffick+1 includ+ z prohibit$ "u sections #aeij & #aeia ( title #ah1 ,unit$ ,/ates ,code4 7,b7 ,false imprisonm5t1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,c7 ,kidnapp+1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,d7 ,rape & sexual assault1 includ+ z prohibit$ "u sections #bbda1 #bbdb1 #bbdc1 & #bbdd ( title #ah1 ,unit$ ,/ates ,code4 7,e7 ,fir/-degree homicide1 includ+ z prohibit$ "u section #aaaa ( title #ah1 ,unit$ ,/ates ,code4 7,f7 ,robb]y1 includ+ z prohibit$ "u section #baaa ( title #ah1 ,unit$ ,/ates ,code4 7,g7 ,fraud to obta9 access to gov]nm5t assi/ance1 includ+ z prohibit$ "u sections #bhg1 #ajja1 & #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,h7 ,fraud by s*eme1 includ+ z prohibit$ "u section #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,i7 ,!ft ( gov]nm5t funds or prop]ty1 includ+ z prohibit$ "u section #fda ( title #ah1 ,unit$ ,/ates ,code4 7,j7 ,abuse or neglect1 includ+ z prohibit$ "u section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag ( title #ah1 ,unit$ ,/ates ,code4 7,k7 ,=g]y1 includ+ z prohibit$ "u section #fdb & *apt] #be 7except section #eab7 ( title #ah1 ,unit$ ,/ates ,code4 7,l7 ,id5tity !ft or id5tity fraud1 includ+ z prohibit$ "u sections #ajbh & #ajbh;,a ( title #ah1 ,unit$ ,/ates ,code4 ,! ,commission] ( ,social ,security may promulgate regulations to provide = additional felony crimes "u ?is clause4 7#e7 7,a7 ,= ! purpose ( c>ry+ out ! activities requir$ "u p>agraph 7#b7 z "p ( ! inve/igation "u p>agraph 7#a77;,a71 ! ,commission] may conduct a backgr\nd *eck ( any individual seek+ to s]ve z a repres5tative payee "u ?is subsection & may disqualify f s]vice z a repres5tative payee any su* individual :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 7,b7 ,! ,commission] may revoke c]tification ( paym5t ( b5efits "u ?is subsection to any individual s]v+ z a repres5tative payee on or aft] ,janu>y #a1 #bjai1 :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 2 & 7#b7 9 subsection 7d7-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,d71 by /rik+ or at ! end2 7ii7 9 subp>agraph 7,e71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7iii7 by add+ at ! end ! foll[+3 7,f7 except z provid$ 9 p>agraph 7#b77;,d71 su* p]son has previ\sly be5 convict$ 7& n subsequ5tly exon]at$7 z describ$ 9 subsection 7b77#b77;,g74 2 & 7,b7 9 p>agraph 7#b71 by add+ at ! end ! foll[+3 7,d7 7i7 ,) respect to any p]son describ$ 9 clause 7,,ii7-- 7,i7 subsection 7b77#b77;,g7 %all n apply2 & 7,,ii7 ! ,commission] may grant an exemption f ! provisions ( p>agraph 7#a77;,f7 if ! ,commission] det]m9es t su* exemption is 9 ! be/ int]e/ ( ! individual entitl$ to b5efits4 7ii7 ,a p]son is describ$ 9 ?is clause if ! p]son-- 7,i7 is ! cu/odial sp\se ( ! b5efici>y = :om ! p]son applies to s]ve2 7,,ii7 is ! cu/odial c\rt appo9t$ gu>dian ( ! b5efici>y = :om ! p]son applies to s]ve2 or 7,,iii7 receiv$ a presid5tial or gub]natorial p>don = ! relevant conviction4 4 7c7 ,am5dm5ts to title ,,xvi ,section #afca7;a77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,b77 is am5d$-- 7#a7 9 clause 7ii7-- 7,a7 9 subclause 7,v71 by /rik+ & at ! end2 7,b7 9 subclause 7,,vi71 by /rik+ ! p]iod & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+3 7,,vii7 det]m9e :e!r su* p]son has be5 convict$ 7& n subsequ5tly exon]at$71 "u ,f$]al or ,/ate law1 ( a felony provid$ "u clause 7xv71 or ( an attempt or a conspiracy to commit su* a felony4 2 7#b7 9 clause 7iii7-- 7,a7 9 subclause 7,,iv71 by /rik+ or at ! end2 7,b7 9 subclause 7,v71 by /rik+ ! p]iod at ! end & ins]t+ 1 or2 & 7,c7 by add+ at ! end ! foll[+3 7,,vi7 except z provid$ 9 clause 7xvii71 su* p]son has previ\sly be5 convict$ 7& n subsequ5tly exon]at$7 z describ$ 9 clause 7ii77,,vii74 2 & 7#c7 by add+ at ! end ! foll[+3 7xv7 ,! felony crimes provid$ "u ?is clause1 :e!r an (f5se "u ,/ate or ,f$]al law1 are ! foll[+3 7,i7 ,human traffick+1 includ+ z prohibit$ "u sections #aeij & #aeia ( title #ah1 ,unit$ ,/ates ,code4 7,,ii7 ,false imprisonm5t1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,,iii7 ,kidnapp+1 includ+ z prohibit$ "u section #abja ( title #ah1 ,unit$ ,/ates ,code4 7,,iv7 ,rape & sexual assault1 includ+ z prohibit$ "u sections #bbda1 #bbdb1 #bbdc1 & #bbdd ( title #ah1 ,unit$ ,/ates ,code4 7,v7 ,fir/-degree homicide1 includ+ z prohibit$ "u section #aaaa ( title #ah1 ,unit$ ,/ates ,code4 7,,vi7 ,robb]y1 includ+ z prohibit$ "u section #baaa ( title #ah1 ,unit$ ,/ates ,code4 7,,vii7 ,fraud to obta9 access to gov]nm5t assi/ance1 includ+ z prohibit$ "u sections #bhg1 #ajja1 & #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,,viii7 ,fraud by s*eme1 includ+ z prohibit$ "u section #acdc ( title #ah1 ,unit$ ,/ates ,code4 7,,ix7 ,!ft ( gov]nm5t funds or prop]ty1 includ+ z prohibit$ "u section #fda ( title #ah1 ,unit$ ,/ates ,code4 7,x7 ,abuse or neglect1 includ+ z prohibit$ "u section #aaa1 #aac1 #aad1 #aae1 #aaf1 or #aag ( title #ah1 ,unit$ ,/ates ,code4 7,,xi7 ,=g]y1 includ+ z prohibit$ "u section #fdb & *apt] #be 7except section #eab7 ( title #ah1 ,unit$ ,/ates ,code4 7,,xii7 ,id5tity !ft or id5tity fraud1 includ+ z prohibit$ "u sections #ajbh & #ajbh;,a ( title #ah1 ,unit$ ,/ates ,code4 ,! ,commission] ( ,social ,security may promulgate regulations to provide = additional felony crimes "u ?is clause4 7xvi7 7,i7 ,= ! purpose ( c>ry+ out ! activities requir$ "u clause 7ii7 z "p ( ! inve/igation "u clause 7i77,i71 ! ,commission] may conduct a backgr\nd *eck ( any individual seek+ to s]ve z a repres5tative payee "u ?is subsection & may disqualify f s]vice z a repres5tative payee any su* individual :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 7,,ii7 ,! ,commission] may revoke c]tification ( paym5t ( b5efits "u ?is subsection to any individual s]v+ z a repres5tative payee on or aft] ,janu>y #a1 #bjai1 :o fails to grant p]mission = ! ,commission] to conduct su* a backgr\nd *eck4 7xvii7 7,i7 ,) respect to any p]son describ$ 9 subclause 7,,ii7-- 7aa7 clause 7ii77,,vii7 %all n apply2 & 7bb7 ! ,commission] may grant an exemption f ! provisions ( clause 7iii77,,vi7 if ! ,commission] det]m9es t su* exemption is 9 ! be/ int]e/ ( ! individual entitl$ to b5efits4 7,,ii7 ,a p]son is describ$ 9 ?is subclause if ! p]son-- 7aa7 is ! cu/odial p>5t ( a m9or *ild = :om ! p]son applies to s]ve1 7bb7 is ! cu/odial sp\se ( ! b5efici>y = :om ! p]son applies to s]ve1 7cc7 is ! cu/odial p>5t ( a b5efici>y :o is "u a disability :i* began be=e ! b5efici>y atta9$ ! age ( #bb1 = :om ! p]son applies to s]ve1 7dd7 is ! cu/odial c\rt appo9t$ gu>dian ( ! b5efici>y = :om ! p]son applies to s]ve1 7ee7 is ! cu/odial gr&p>5t ( a m9or gr&*ild = :om ! p]son applies to s]ve1 7ff7 is ! p>5t :o 0 previ\sly repres5tative payee = 8 or h] m9or *ild :o has s9ce turn$ #ah & cont9ues to be eligible = su* b5efit1 or 7gg7 receiv$ a presid5tial or gub]natorial p>don = ! relevant conviction4 4 7d7 ,application to new appo9tm5ts ,subject to subsection 7e71 ! am5dm5ts made by subsections 7a71 7b71 & 7c7 %all apply ) respect to any individual appo9t$ to s]ve z a repres5tative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 ( ! ,social ,security ,act on or aft] ,janu>y #a1 #bjai4 7e7 ,application to prior appo9tm5ts 7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjbd1 ! ,commission] ( ,social ,security %all conduct a review ( ea* individual s]v+ z a repres5tative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 ( ! ,social ,security ,act1 to det]m9e :e!r su* individual has be5 convict$ ( a felony z describ$ 9 section #bje7;j77#b77;,b77i77,,vii71 #hjg7;b77#b77;,g71 or #afca7;a77#b77;,b77ii77,,vii71 respectively 7z su* provisions are add$ by ?is section74 ,except z provid$ 9 section #bje7;j77#b77;,c77vi71 #hjg7;d77#b77;,d71 or #afca7;a77#b77;,b77xvii7 7z s add$71 any individual det]m9$ by ! ,commission] to h be5 s convict$ may n s]ve z a repres5tative payee on or aft] ! date ( su* det]m9ation4 7#b7 ,priority ,9 conduct+ reviews "u p>agraph 7#a71 ! ,commission] %all prioritize reviews ( ! foll[+ categories ( individuals1 9 ! foll[+ ord]3 7,a7 ,an individual s]v+ z repres5tative payee = #ae or m individuals4 7,b7 ,an individual s]v+ z repres5tative payee = an individual :o is n relat$ to ! repres5tative payee4 7,c7 ,an individual s]v+ z repres5tative payee = an individual :o has atta9$ ! age ( #ah & is n ! sp\se ( ! repres5tative payee4 7f7 ,p]iodic review ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,commission] ( ,social ,security %all issue regulations to e/abli% a process = review+ ea* individual s]v+ z a repres5tative payee pursuant to section #bje7;j71 #hjg1 or #afca7;a77#b7 ( ! ,social ,security ,act 7o!r ?an individuals ) respect to :om an exemption has be5 grant$ "u section #bje7;j77#b77;,c77vi71 #hjg7;d77#b77;,d71 or #afca7;a77#b77;,b77xvii77 n less ?an once e #e ye>s to det]m9e :e!r any su* individual has be5 convict$ ( a felony z describ$ 9 subsection 7e77#a7 ( ?is section4 #cac4 ,prohibition on individuals ) repres5tative payees s]v+ z repres5tative payees 7a7 ,am5dm5t to title ,,ii ,section #bje7;j77#b77;,c77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dje7;j77#b77;,c77i771 z am5d$ by section #cab7;a77#b71 is fur!r am5d$-- 7#a7 9 subclause 7,v71 by /rik+ or at ! end2 7#b7 9 subclause 7,,vi71 by /rik+ ! p]iod & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7,,vii7 su* p]son's b5efits "u ?is title1 title ,,viii1 or title ,,xvi are c]tifi$ = paym5t to a repres5tative payee dur+ ! p]iod = :i* ! individual's b5efits w\ld be c]tifi$ = paym5t to ano!r p]son4 4 7b7 ,am5dm5t to title ,,viii ,section #hjg7;d77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #ajjg7;d77#a771 z am5d$ by section #cab7;b77#b71 is fur!r am5d$-- 7#a7 9 subp>agraph 7,e71 by /rik+ or at ! end2 7#b7 9 subp>agraph 7,f71 by /rik+ ! p]iod & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7,g7 su* p]son's b5efits "u ?is title1 title ,,ii1 or title ,,xvi are c]tifi$ = paym5t to a repres5tative payee dur+ ! p]iod = :i* ! individual's b5efits w\ld be c]tifi$ = paym5t to ano!r p]son4 4 7c7 ,am5dm5t to title ,,xvi ,section #afca7;a77#b77;,b77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #achc7;a77#b77;,b77iii771 z am5d$ by section #cab7;c77#b71 is fur!r am5d$-- 7#a7 9 subclause 7,v71 by /rik+ or at ! end2 7#b7 9 subclause 7,,vi71 by /rik+ ! p]iod & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+3 7,,vii7 su* p]son's b5efits "u ?is title1 title ,,ii1 or title ,,viii are c]tifi$ = paym5t to a repres5tative payee dur+ ! p]iod = :i* ! individual's b5efits w\ld be c]tifi$ = paym5t to ano!r p]son4 4 7d7 ,effective date 7#a7 ,new appo9tm5ts ,subject to p>agraph 7#b71 ! am5dm5ts made by ?is section %all apply ) respect to any individual appo9t$ to s]ve z a repres5tative payee "u title ,,ii1 title ,,viii1 or title ,,xvi ( ! ,social ,security ,act on or aft] ,janu>y #a1 #bjai4 7#b7 ,prior appo9tm5ts ,) respect to individuals s]v+ z a repres5tative payee ^: b5efits "u ?is title1 title ,,viii1 or title ,,xvi are c]tifi$ = paym5t to ano!r repres5tative payee z ( ,janu>y #a1 #bjai1 ! ,commission] %all take any /eps necess>y to t]m9ate su* individual's s]vice z a repres5tative payee z soon z possible1 b no lat] ?an ,janu>y #a1 #bjbd4 #cad4 ,reassessm5t ( payee selection & replacem5t policies 7a7 ,9 g5]al ,! ,commission] ( ,social ,security %all conduct1 ) opportunity = public comm5t1 a review & reassessm5t (-- 7#a7 ! appropriat5ess ( its ord] ( pref]5ce = select+ repres5tative payees1 includ+ payees :o may be cr$itors ( ! b5efici>y or :o are private1 =-pr(it in/itutions2 & 7#b7 ! effectiv5ess ( its policy & op]ational proc$ures 9 prop]ly det]m9+ :5 to *ange a repres5tative payee1 includ+-- 7,a7 f a payee t has a high] ord] ( pref]5ce 7su* z a family memb]7 to a payee t has a l[] ord] ( pref]5ce 7su* z a cr$itor72 or 7,b7 :5 a reque/ to *ange payees arises f someone o!r ?an ! b5efici>y4 7b7 ,report ,n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,commission] ( ,social ,security %all submit to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate & make publicly available a report on ! results ( ! review & reassessm5t "u subsection 7a74