,,ib  ,union ,cal5d> ,no4 #efa  #aae?   
,,congress  #b;d ,session  ,h4 ,r4 #ehjh
  ,report ,no4 #aae-gbf  ,,9 ,,! ,,h\se 
,,( ,,repres5tatives  ,may #ae1 #bjah   
,mr4 ,bilirakis 7= himself & ,mr4 ,b5   
,ray ,lujn ( ,new ,mexico7 introduc$ !  
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce  ,june  
#ab1 #bjah;,additional sponsors3 ,mrs4  
,blackburn & ,mr4 ,wald5  ,june #ab1    
#bjah ,committ$ to ! ,committee ( !     
,:ole ,h\se on ! ,/ate ( ! ,union &     
ord]$ to be pr9t$  ,a ,,bill  ,to am5d  
title ,,xix ( ! ,social ,security ,act  
to require ,/ates to op]ate drug        
managem5t programs = at-risk            
b5efici>ies1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,m$icaid ,ph>maceutical ,home ,act (    
#bjah4  #b4 ,drug managem5t program =   
at-risk b5efici>ies  7a7 ,9 g5]al ,title
 ,,xix ( ! ,social ,security ,act is    
am5d$ by ins]t+ aft] section #aibg 7#db 
,u4,s4,c4 #acifr-#h7 ! foll[+ new       
section3  #aibg;,a4 ,drug managem5t     

program = at-risk b5efici>ies  7a7 ,9   
g5]al ,beg9n+ ,janu>y #a1 #bjbj1 a ,/ate
 %all op]ate a qualifi$ drug managem5t  
program "u :i* a ,/ate may enroll c]ta9 
at-risk b5efici>ies id5tifi$ by ! ,/ate 
"u ! program4  7b7 ,qualifi$ drug       
managem5t program ,= purposes ( ?is     
section1 ! t]m qualifi$ drug managem5t  
program means1 ) respect to a ,/ate1 a  
program c>ri$ out by ! ,/ate 7includ+   
?r\gh a contract ) a ph>macy b5efit     
manag]7 t provides at lea/ = ! foll[+3  
7#a7 ,id5tification ( at-risk           
individuals ,"u ! program1 ! ,/ate      
id5tifies1 9 accordance ) subsection    
7c71 individuals enroll$ "u ! ,/ate plan
 7or waiv] ( ! ,/ate plan7 :o are       
at-risk b5efici>ies4  7#b7 ,elem5ts (   
program  7,a7 ,9 g5]al ,"u ! program1 ! 
,/ate1 ) respect to ea* individual      
id5tifi$ "u p>agraph 7#a7 & enroll$ "u !
 program "u p>agraph 7#e7--  7i7 subject
 to subp>agraphs 7,b7 & 7,c71 selects at
 lea/ "o1 b n m ?an ?ree1 heal? c>e     
provid]s & at lea/ "o1 b n m ?an ?ree1  

ph>macies = ea* su* individual =        
purposes ( clause 7ii71 9 accordance ) a
 selection process t takes into acc\nt  
reasonable factors su* z ! individual's 
previ\s utilization ( items & s]vices f 
heal? c>e provid]s & ph>macies1         
geographic proximity ( ! individual to  
su* heal? c>e provid]s & ph>macies1     
access ( ! individual to heal? c>e1     
reasonable travel "t1 in=mation reg>d+  
h\s+ /atus1 & any kn[n pref]5ce ( !     
individual = a c]ta9 heal? c>e provid]  
or ph>macy2 &  7ii7 requires t any      
controll$ sub/ance furni%$ to su*       
individual dur+ ! p]iod = :i* su*       
individual is enroll$ "u ! program be   
prescrib$ by a heal? c>e provid] select$
 "u clause 7i7 = su* individual &       
disp5s$ by a ph>macy select$ "u clause  
7i7 = su* individual 9 ord] = su*       
controll$ sub/ance to be cov]$ "u !     
,/ate plan 7or waiv]74  7,b7 ,b5efici>y 
pref]5ce ,9 ! case ( an individual      
receiv+ a notice "u p>agraph 7#c77;,a7 (
 be+ id5tifi$ z pot5tially be+ an       

at-risk b5efici>y describ$ 9 su*        
p>agraph1 su* individual may submit1    
dur+ ! #cj-;day p]iod foll[+ receipt (  
su* notice1 pref]5ces = :i* heal? c>e   
provid]s & ph>macies ! individual w\ld  
pref] ! ,/ate to select "u subp>agraph  
7,a74 ,! ,/ate %all select or *ange !   
selection ( heal? c>e provid]s &        
ph>macies "u subp>agraph 7,a7 = !       
individuals bas$ on su* pref]5ces1      
except t 9 ! case t ,/ate det]m9es t su*
 selection 7or *ange ( selection7 ( a   
heal? c>e provid] or ph>macy "u         
subp>agraph 7,a7 is contribut+ or w\ld  
contribute to prescription drug abuse or
 drug div]sion by ! individual1 ! ,/ate 
may select or *ange ! selection ( heal? 
c>e provid] or ph>macy = ! individual   
)\t reg>d to ! pref]5ces ( ! individual 
describ$ 9 ?is subp>agraph4 ,if ! ,/ate 
selects or *anges ! selection pursuant  
to ! prec$+ s5t5ce )\t reg>d to !       
pref]5ces ( ! individual1 ! ,/ate %all  
provide ! individual ) at lea/ #cj days 
writt5 notice ( ! selection or *ange (  

selection & a rationale = ! selection or
 *ange4  7,c7 ,treatm5t ( ph>macy )     
multiple locations ,= purposes (        
subp>agraph 7,a77i71 9 ! case ( a       
ph>macy t has multiple locations t %>e  
real-"t electronic prescription data & !
 same *a9 id5tification numb]1 all su*  
locations ( ! ph>macy %all collectively 
be treat$ z "o ph>macy4  7,d7 ,treatm5t 
( exi/+ ,,ffs drug managem5t programs ,9
 ! case ( a pati5t review & re/riction  
program 7z id5tifi$ 9 ! annual report   
submitt$ to ! ,secret>y "u section      
#aibg7;g77#c77;,d77 op]at$ by a ,/ate   
pursuant to section #aiae7;a77#b7 be=e !
 date ( ! enactm5t ( ?is section1 su*   
program %all be treat$ z a qualifi$ drug
 managem5t program4  7,e7 ,reasonable   
access ,! program %all ensure1 includ+  
?r\gh waiv] ( elem5ts ( ! program       
7includ+ "u subp>agraph 7,a77ii771      
reasonable access to heal? c>e 7includ+ 
access to heal? c>e provid]s & ph>macies
 ) respect to prescription drugs        
describ$ 9 subp>agraph 7,a77 9 ! case ( 

individuals ) multiple resid5ces1 9 !   
case ( natural disa/]s & simil>         
situations1 & 9 ! case ( ! provision (  
em]g5cy s]vices 7z def9$ = purposes (   
section                                 
#ahfj;,d-#d7;c77#e77;,d77ii77,,ii774    
7#c7 ,notification to id5tifi$          
individuals ,"u ! program1 ! ,/ate      
provides ea* individual :o is id5tifi$  
"u p>agraph 7#a71 prior to enroll+ su*  
individual "u ! program1 at lea/ "o     
notification ( ea* ( ! foll[+3  7,a7    
,notice t ! ,/ate has id5tifi$ !        
individual z pot5tially be+ an at-risk  
b5efici>y = abuse or misuse ( a         
controll$ sub/ance4  7,b7 ,! "n1        
address1 & contact in=mation ( ea* heal?
 c>e provid] & ph>macy t may be select$ 
= ! individual "u p>agraph 7#b77;,a74   
7,c7 ,in=mation describ+ all ,/ate &    
,f$]al public heal? res\rces t are      
design$ to address su* abuse or misuse  
to :i* ! individual has access1 includ+ 
m5tal heal? s]vices & o!r c\nsel+       
s]vices4  7,d7 ,notice (1 & in=mation   

ab\t1 ! "r ( ! individual to-- 7i7      
submit pref]5ces ( ! individual = heal? 
c>e provid]s & ph>macies to be select$  
"u p>agraph 7#b77;,a71 includ+ z        
describ$ 9 p>agraph 7#b77;,b72  7ii7    
appeal "u p>agraph 7#d7-- 7,i7 su*      
id5tification describ$ 9 subp>agraph    
7,a72 &  7,,ii7 ! selection ( heal? c>e 
provid]s & ph>macies "u p>agraph        
7#b77;,a74  7,e7 ,an explanation ( !    
mean+ & consequ5ces ( ! id5tification ( 
! individual z pot5tially be+ an at-risk
 b5efici>y = abuse or misuse ( a        
controll$ sub/ance1 includ+ an          
explanation ( ! program4  7,f7          
,in=mation1 includ+ a contact li/ & cle>
 in/ructions1 t expla9 h[ ! individual c
 contact ! appropriate entities adm9i/]+
 ! program 9 ord] to submit pref]5ces   
describ$ 9 p>agraph 7#b77;,b7 & any o!r 
communications relat+ to ! program4     
7#d7 ,appeals process ,"u ! program1 !  
,/ate provides = an appeals process "u  
:i*1 ) respect to an individual id5tifi$
 "u p>agraph 7#a7--  7,a7 su* individual

 may appeal-- 7i7 su* id5tification2 &  
7ii7 ! selection ( a heal? c>e provid]  
or ph>macy "u p>agraph 7#b77;,a72  7,b7 
9 ! case ( an appeal describ$ 9         
subp>agraph 7,a77ii71 ! ,/ate %all      
accommodate ! heal? c>e provid] or      
ph>macy pref]r$ by ! individual =       
selection = purposes ( p>agraph         
7#b77;,a71 unless ! ,/ate det]m9es t a  
*ange to ! selection ( heal? c>e provid]
 or ph>macy "u su* p>agraph is          
contribut+ or w\ld contribute to        
prescription drug abuse or drug div]sion
 by ! individual2  7,c7 su* individual  
is provid$ a p]iod ( n less ?an #cj days
 foll[+ ! date ( receipt ( ! notice     
describ$ 9 p>agraph 7#c7 to submit su*  
appeal2 &  7,d7 ! ,/ate mu/ make a      
det]m9ation ) respect to an appeal      
describ$ 9 subp>agraph 7,a71 & notify ! 
individual ( su* det]m9ation1 prior to  
enrollm5t ( su* individual 9 ! program4 
7#e7 ,enrollm5t ,"u ! program1 ! ,/ate  
initially enrolls individuals :o are    
id5tifi$ "u p>agraph 7#a7 9 ! program = 

a #ab-mon? p]iod--  7,a7 9 ! case ( su* 
an individual :o does n submit an appeal
 "u p>agraph 7#d7 )9 ! p]iod appli$ by !
 ,/ate pursuant to subp>agraph 7,c7 (   
su* p>agraph1 beg9n+ on ! day aft] ! la/
 day ( su* p]iod2 &  7,b7 9 ! case ( su*
 an individual :o does submit an appeal 
"u p>agraph 7#d7 )9 ! p]iod appli$ by ! 
,/ate pursuant to subp>agraph 7,c7 ( su*
 p>agraph b su* appeal is d5i$1 beg9n+ n
 lat] ?an #cj days aft] ! date ( su*    
d5ial4  7#f7 ,notification ( heal? c>e  
provid]s & ph>macies ,"u ! program1 !   
,/ate provides to ea* heal? c>e provid] 
& ph>macy select$ = an individual "u    
p>agraph 7#b7--  7,a7 notification t !  
individual is an at-risk b5efici>y      
enroll$ "u ! program & t ! provid] or   
ph>macy has be5 select$ = ! individual  
"u p>agraph 7#b72  7,b7 in=mation on su*
 program & ! role ( be+ s select$2 &    
7,c7 a process ?r\gh :i* ! provid] or   
ph>macy c submit a conc]n or compla9t ) 
respect to be+ s select$ & refuse to be 
a provid] or ph>macy s select$4  7#g7   

,cont9uation ( enrollm5t ,"u ! program1 
! ,/ate1 ) respect to an individual     
enroll$ "u ! program1 provides = a      
process to--  7,a7 n lat] ?an #cj days  
be=e ! end ( ! #ab-mon? p]iod = :i* !   
individual is s enroll$ pursuant to     
p>agraph 7#e7--  7i7 assess1 9          
accordance ) publicly available         
evid5ce-bas$ guidel9es1 :e!r or n su*   
individual %\ld cont9ue to be enroll$ "u
 ! program2 &  7ii7 notify su*          
individual ( ! results ( ! assessm5t "u 
clause 7i72  7,b7 cont9ue1 subject to   
subp>agraph 7,c71 enrollm5t ( su*       
individual if su* assessm5t recomm5ds   
su* cont9uation2 &  7,c7 appeal !       
cont9uation ( enrollm5t 9 accordance ) !
 appeals process describ$ 9 p>agraph    
7#d74  7c7 ,at-,risk b5efici>y  7#a7    
,id5tification ,= purposes ( ?is        
section1 a ,/ate %all id5tify an        
individual enroll$ "u ! ,/ate plan 7or  
waiv] ( ! ,/ate plan7 z an at-risk      
b5efici>y if ! individual is n an       
exempt$ individual describ$ 9 p>agraph  

7#b7 &--  7,a7 is id5tifi$ z su* an     
at-risk b5efici>y ?r\gh ! use ( publicly
 available evid5ce-bas$ guidel9es t     
indicate misuse or abuse ( a controll$  
sub/ance2 or  7,b7 ! ,/ate receiv$      
notification f a ,,pdp sponsor or       
,m$ic>e ,advantage organization t su*   
individual 0 id5tifi$ z be+ an at-risk  
b5efici>y = prescription drug abuse =   
enrollm5t 9 a drug managem5t program    
e/abli%$ by ! sponsor or organization   
pursuant to section #ahfj;,d-#d7;c77#e7 
& su* id5tification has n be5 t]m9at$ "u
 subp>agraph 7,f7 ( su* section4  7#b7  
,exempt$ individual describ$ ,= purposes
 ( p>agraph 7#a71 an exempt$ individual 
describ$ 9 ?is p>agraph is an individual
 :o--  7,a7 is receiv+-- 7i7 hospice or 
palliative c>e2 or  7ii7 treatm5t =     
canc]2  7,b7 is a resid5t ( a long-t]m  
c>e facility1 ( a facility describ$ 9   
section #aije7;d71 or ( ano!r facility =
 :i* frequ5tly abus$ drugs are disp5s$ =
 resid5ts ?r\gh a contract ) a s+le     
ph>macy2 or  7,c7 ! ,/ate elects to     

treat z an exempt$ individual = purposes
 ( p>agraph 7#a74  7d7 ,application (   
privacy rules cl>ification ,! ,secret>y 
%all cl>ify privacy requirem5ts1 includ+
 requirem5ts "u ! regulations promulgat$
 pursuant to section #bfd7;c7 ( ! ,heal?
 ,insurance ,portability &              
,acc\ntability ,act ( #aiif 7#db        
,u4,s4,c4 #acbj;d-#b note71 relat$ to ! 
%>+ ( data "u subsection 7b77#f7 9 !    
same mann] z ! ,secret>y is requir$ "u  
subp>agraph 7,j7 ( section              
#ahfj;,d-#d7;c77#e7 to cl>ify privacy   
requirem5ts relat$ to ! %>+ ( data      
describ$ 9 su* subp>agraph4  7e7        
,reports  7#a7 ,annual reports ,a ,/ate 
op]at+ a qualifi$ drug managem5t program
 %all include 9 ! annual report submitt$
 to ! ,secret>y "u section              
#aibg7;g77#c77;,d71 beg9n+ ) su* reports
 submitt$ = #bjba1 ! foll[+ in=mation3  
7,a7 ,! numb] ( individuals enroll$ "u !
 ,/ate plan 7or waiv] ( ! ,/ate plan7 :o
 are enroll$ "u ! program & ! p]c5tage (
 individuals enroll$ "u ! ,/ate plan 7or

 waiv]7 :o are enroll$ "u su* program4  
7,b7 ,! numb] ( prescriptions =         
controll$ sub/ances t 7 disp5s$ p] mon? 
dur+ ea* su* ye> p] individual enroll$  
"u ! program1 includ+ ! dosage & pill   
c\nt = ea* su* prescription4  7,c7 ,!   
numb] ( ph>macies fill+ prescriptions = 
controll$ sub/ances = individuals       
enroll$ "u su* program4  7,d7 ,! numb] (
 heal? c>e provid]s writ+ prescriptions 
= controll$ sub/ances 7o!r ?an          
prescriptions = a refill7 = individuals 
enroll$ "u su* program4  7,e7 ,any o!r  
data t ! ,secret>y may require4  7,f7   
,any report submitt$ by a manag$ c>e    
entity "u subsection 7e77#b7 ) respect  
to ye>s4  ,= ea* su* report = a ye> aft]
 #bjba1 ! in=mation describ$ 9 ?is      
p>agraph %all be provid$ 9 a mann] t    
comp>es su* in=mation ) respect to !    
prior cal5d> ye> to su* in=mation )     
respect to ! second prior cal5d> ye>4   
7#b7 ,,macpac reports & review ,n lat]  
?an two ye>s aft] ! date ( ! enactm5t ( 
?is section1 ! ,m$icaid & ,,*ip ,paym5t 

& ,access ,commission 79 ?is section    
ref]r$ to z ,,macpac71 9 consultation ) 
! ,national ,association ( ,m$icaid     
,directors1 ph>macy b5efit manag]s1     
manag$ c>e organizations1 heal? c>e     
provid]s 7includ+ ph>maci/s71 b5efici>y 
advocates1 & o!r /akehold]s1 %all publi%
 a report t includes--  7,a7 be/        
practices = op]at+ drug managem5t       
programs1 bas$ on a review ( a          
repres5tative sample ( ,/ates adm9i/]+  
su* a program2  7,b7 a summ>y ( !       
exp]i5ce ( ! appeals process "u drug    
managem5t programs op]at$ by sev]al     
,/ates1 su* z ! frequ5cy at :i*         
individuals appeal$ ! id5tification (   
be+ an at-risk individual1 ! frequ5cy at
 :i* individuals appeal$ ! selection ( a
 heal? c>e provid] or ph>macy "u su* a  
program1 ! timeframes = su* appeals1 a  
summ>y ( ! reasons = su* appeals1 & !   
design ( su* appeals processes2  7,c7 a 
summ>y ( tr5ds & ! effectiv5ess (       
qualifi$ drug managem5t programs op]at$ 
"u ?is section2 &  7,d7 recomm5dations  

to ,/ates on h[ improvem5ts c be made ) 
respect to ! op]ation ( su* programs4   
,9 report+ on ,/ate practices1 !        
,,macpac %all consid] h[ su* programs h 
be5 implem5t$ 9 rural areas1 "u         
fee-=-s]vice z well z manag$ c>e        
arrangem5ts1 & ! ext5t to :i* su*       
programs h result$ 9 increas$           
effici5cies to su* ,/ates or to ! ,f$]al
 ,gov]nm5t "u ?is title4  7#c7 ,report  
on plan = coord9at$ c>e ,n lat] ?an     
,janu>y #a1 #bjba1 ea* ,/ate op]at+ a   
qualifi$ drug managem5t program %all    
submit to ! ,adm9i/rator ( ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices a report on  
h[ su* ,/ate plans to provide coord9at$ 
c>e = individuals enroll$ "u ! ,/ate    
plan 7or waiv] ( ! ,/ate plan7 &--  7,a7
 :o are enroll$ "u ! program2 or  7,b7  
:o are enroll$ ) a manag$ c>e entity &  
enroll$ "u su* a qualifi$ drug managem5t
 program op]at$ by su* entity4  7f7     
,applicability to manag$ c>e entities   
7#a7 ,9 g5]al ,) respect to any contract
 t a ,/ate ent]s into on or aft] ,janu>y

 #a1 #bjbj1 ) a manag$ c>e entity 7z    
def9$ 9 section #aicb7;a77#a77;,b77     
pursuant to section #aijc7m71 ! ,/ate   
%all1 z a condition ( ! contract1       
require ! manag$ c>e entity--  7,a7 to  
op]ate a qualifi$ drug managem5t program
 7z def9$ 9 subsection 7b77 = at-risk   
b5efici>ies :o are enroll$ ) su* entity 
& id5tifi$ by ! manag$ c>e entity by    
means ( application ( p>agraph 7#b72    
7,b7 to submit to ! ,/ate an annual     
report on ! matt]s describ$ 9           
subp>agraphs 7,a7 ?r\gh 7,e7 (          
subsection 7e77#a72 &  7,c7 to submit to
 ! ,/ate a li/ 7& z necess>y update su* 
li/7 ( individuals enroll$ ) su* entity 
"u ! qualifi$ drug managem5t program    
op]at$ by su* entity "u subp>agraph 7,a7
 = purposes ( all[+ ,/ate plans = :i*   
m$ical assi/ance is paid on a           
fee-=-s]vice basis to h access to su*   
in=mation4  7#b7 ,application ,=        
purposes ( apply+1 ) respect to a manag$
 c>e entity-- 7,a7 "u p>agraph          
7#a77;,a7--  7i7 ! def9ition ( ! t]m    

qualifi$ drug managem5t program "u      
subsection 7b71 o!r ?an p>agraph        
7#b77;,d7 ( su* subsection2 &  7ii7 !   
provisions ( p>agraphs 7#a7 & 7#b7 (    
subsection 7c72 &  7,b7 "u p>agraph     
7#a77;,b71 ! report requirem5ts describ$
 9 subp>agraphs 7,a7 ?r\gh 7,e7 (       
subsection 7e77#a72  ea* ref]5ce 9 su*  
subsection 7b7 & p>agraphs ( subsection 
7c7 to a ,/ate or ! ,/ate 7o!r ?an to a 
,/ate plan or ! ,/ate plan7 %all be     
deem$ a ref]5ce to ! manag$ c>e entity1 
ea* ref]5ce "u su* subsection1          
p>agraphs1 or subp>agraphs to           
individuals enroll$ "u ! ,/ate plan 7or 
waiv] ( ! ,/ate plan7 %all be deem$ a   
ref]5ce to individuals enroll$ ) su*    
entity1 & ea* ref]5ce "u su* subsection1
 p>agraphs1 or subp>agraphs to          
individuals enroll$ "u ! qualifi$ drug  
managem5t program op]at$ by ! ,/ate %all
 be deem$ a ref]5ce to individuals      
enroll$ "u ! qualifi$ drug managem5t    
program op]at$ by ! manag$ c>e entity4  
7g7 ,controll$ sub/ance def9$ ,=        

purposes ( ?is section1 ! t]m controll$ 
sub/ance means a drug t is includ$ 9    
s*$ule ,,ii1 ,,iii1 or ,,iv ( section   
#bjb7;c7 ( ! ,controll$ ,sub/ances ,act1
 or any comb9ation !re(1 z specifi$ by !
 ,/ate4  4  7b7 ,guidance on at-,risk   
population transition+ betwe5 ,m$icaid  
,,ffs & manag$ c>e ,n lat] ?an ,octob]  
#a1 #bjai1 ! ,secret>y ( ,heal? & ,human
 ,s]vices %all issue guidance = ,/ate   
,m$icaid programs1 ) respect to         
individuals :o are enroll$ "u a ,/ate   
plan 7or waiv] ( su* plan7 "u title     
,,xix ( ! ,social ,security ,act & "u a 
drug managem5t program1 = purposes (    
provid+ be/ practices--  7#a7 =         
transition+1 z applicable1 su*          
individuals f fee-=-s]vice ,m$icaid 7&  
su* a program op]at$ by ! ,/ate7 to     
receiv+ m$ical assi/ance "u su* title   
?r\gh a manag$ c>e entity 7z def9$ 9    
section #aicb7;a77#a77;,b7 ( ! ,social  
,security ,act7 ) a contract t ) ! ,/ate
 pursuant to section #aijc7m7 ( su* ,act
 7& su* a program op]at$ by su* entity72

 &  7#b7 = transition+1 z applicable1   
su* individuals f receiv+ m$ical        
assi/ance "u su* title ?r\gh a manag$   
c>e entity 7z def9$ 9 section           
#aicb7;a77#a77;,b7 ( ! ,social ,security
 ,act7 ) a contract t ) ! ,/ate pursuant
 to section #aijc7m7 ( su* ,act 7& su* a
 program op]at$ by su* entity7 to       
fee-=-s]vice ,m$icaid 7& su* a program  
op]at$ by ! ,/ate74  7c7 ,guidance on   
at-,risk population transition+ to      
,m$ic>e  7#a7 ,9 g5]al ,n lat] ?an      
,janu>y #a1 #bjbj1 ! ,secret>y ( ,heal? 
& ,human ,s]vices1 aft] consultation ) !
 ,f$]al ,coord9at$ ,heal? ,c>e ,(fice   
e/abli%$ "u section #bfjb ( ! ,pati5t   
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #acae;b71 %all issue guidance 
= ,/ate ,m$icaid programs1 ) respect to 
transition+ individuals1 provid+ =--    
7,a7 notification to be submitt$ by !   
,/ate to ! ,c5t]s = ,m$ic>e  ,m$icaid   
,s]vices & su* individuals ( ! /atus (  
su* individuals z transition+           
individuals2  7,b7 notification to su*  

individuals ab\t enrollm5t "u a         
prescription drug plan "u "p ,d ( su*   
title or "u a ,,ma-,,pd plan "u "p ,c ( 
su* title2  7,c7 be/ practices =        
transition+ su* individuals to su* a    
plan2 &  7,d7 be/ practices =           
coord9ation betwe5 ! qualifi$ drug      
managem5t program 7z describ$ 9 section 
#aibg;,a7b7 ( ! ,social ,security ,act1 
z add$ by subsection 7a77 c>ri$ out by !
 ,/ate & a drug managem5t program c>ri$ 
out "u su* a plan pursuant to section   
#ahfj;,d-#d7;c77#e7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#aj7;c77#e774  7#b7 ,transition+ 
individuals ,= purposes ( p>agraph 7#a71
 a transition+ individual is an         
individual :o1 ) respect to a mon?--    
7,a7 is enroll$ "u ! ,/ate plan 7or     
waiv] ( ! ,/ate plan7 & "u ! qualifi$   
drug managem5t program 7z describ$ 9    
section #aibg;,a7b7 ( ! ,social         
,security ,act1 z add$ by subsection    
7a77 c>ri$ out by ! ,/ate2 &  7,b7 is   
expect$ to become eligible = ! ,m$ic>e  

program "u title ,,xviii ( su* ,act dur+
 ! subsequ5t #ab-mon? p]iod4  ,june #ab1
 #bjah ,committ$ to ! ,committee ( !    
,:ole ,h\se on ! ,/ate ( ! ,union &     
ord]$ to be pr9t$