,i  #aae? ,,congress  #b;d ,session  ,h4
 ,r4 #ficb  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #bg1        
#bjah,mr4 ,abraham 7= himself1 ,mr4     
,des,jarlais1 ,mr4 ,bu*anan1 ,ms4       
,sewell ( ,alabama1 & ,mr4 ,graves (    
,l\isiana7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,ways &     
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve home heal? paym5t re=ms "u !    
,m$ic>e program4  #a4 ,improvem5ts to   
home heal? paym5t re=ms "u ,m$ic>e  7a7 
,application ( budget neutrality        
,section #ahie7;b77#c7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c771 z am5d$ by section   
#eajja7;a77#b7 ( ! ,bip>tisan ,budget   
,act ( #bjah 7,public ,law #aae-abc71 is
 am5d$--  7#a7 9 subp>agraph 7,a77iv71 9

 ! f\r? s5t5ce-- 7,a7 by /rik+ %all make
 & ins]t+ %all n make2 &  7,b7 by /rik+ 
& %all provide a description & all t    
foll[s ?r\gh ! p]iod & ins]t+ a p]iod2  
7#b7 9 subp>agraph 7,d7--  7,a7 9 !     
subp>agraph head+1 by /rik+ assumptions 
& ins]t+ obs]v$ evid5ce2  7,b7 9 clause 
7i7--  7i7 by /rik+ diff]5ces betwe5    
assum$ & all t foll[s ?r\gh & actual2   
7ii7 by ins]t+ attributable to !        
implem5tation ( p>agraphs 7#b77;,b7 &   
7#d77;,b7 aft] behavior *anges2 &  7iii7
 by add+ at ! end ! foll[+3 ,! ,secret>y
 %all publi% ! det]m9ation "u ?is clause
 ) respect to an applicable ye>1 includ+
 a description ( ! obs]v$ evid5ce us$ to
 make su* det]m9ation1 9 ! notice &     
comm5t rulemak+ to update ! prospective 
paym5t sy/em "u ?is subsection = su*    
ye>4 ,= purposes ( ! prec$+ s5t5ce1 !   
t]m obs]v$ evid5ce means /ati/ically    
valid data f ! mo/ rec5t co/ report &   
claims reg>d+ *anges 9 ! nature ( home  
heal? ag5cy pati5ts1 patt]ns ( c>e1     
s]vice co/s1 & claims cod+ aft] ,janu>y 

#a1 #bjbj1 reflect+ behavioral *anges   
relat+ to implem5tation ( ! provisions (
 & am5dm5ts made by section #eajja ( !  
,bip>tisan ,budget ,act ( #bjah 7,public
 ,law #aae-abc742  7,c7 9 clause 7ii71  
by ins]t+ attributable to !             
implem5tation ( p>agraphs 7#b77;,b7 &   
7#d77;,b7 aft] exp5ditures2 &  7,d7 9   
clause 7iii7--  7i7 by add+ attributable
 to ! implem5tation ( p>agraphs         
7#b77;,b7 & 7#d77;,b7 aft] exp5ditures2 
&  7ii7 by add+ at ! end ! foll[+3 ,if  
su* a tempor>y increase or decrease does
 n exce$ #b4jj p]c5t 9 any giv5 ye>1 !  
,secret>y %all apply ! entire increase  
or decrease 9 ! next cal5d> ye> paym5t  
update2 h[ev]1 if su* a tempor>y        
increase or decrease exce$s #b4jj1 to   
provide = m9imal disruption to pati5ts &
 provid]s1 ! ,secret>y %all phase 9 !   
tempor>y increase or decrease 9 equal   
am\nts n to exce$ #b4jj p]c5t 9 any giv5
 ye> ?r\gh ! respective cal5d> ye>      
paym5t updates44  7b7 ,effective date ,!
 am5dm5ts made by ?is section %all take 

effect z if includ$ 9 ! enactm5t ( su*  
section #eajja7;a77#b74