,,iib #aaf? ,,congress #b;d ,session ,h4 ,r4 #bdgg ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #i1 #bjbj,receiv$2 read twice & ref]r$ to ! ,committee on ,f9ance ,,an ,,act ,to am5d title ,,xviii ( ! ,social ,security ,act to e/abli% a sy/em to notify individuals approa*+ ,m$ic>e eligibility1 to simplify & mod]nize ! eligibility enrollm5t process1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,b5efici>y ,enrollm5t ,notification & ,eligibility ,simplification ,act ( #bjbj or ! ,,b5es ,act ( #bjbj4 #b4 ,b5efici>y enrollm5t notification & eligibility simplification 7a7 ,eligibility & enrollm5t notices 7#a7 ,z "p ( social security acc\nt /atem5t = individuals atta9+ ages #fc to #fe 7,a7 ,9 g5]al ,section #aadc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;a77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#d7 ,m$ic>e eligibility in=mation 7,a7 ,9 g5]al ,9 ! case ( /atem5ts provid$ on or aft] ! date t is #b ye>s aft] ! date ( ! enactm5t ( ?is p>agraph to individuals :o are atta9+ ages #fc1 #fd1 & #fe1 ! /atem5t %all also include a notice conta9+ ! in=mation describ$ 9 subp>agraph 7,b74 7,b7 ,cont5ts ( ,notice ,! notice requir$ "u subp>agraph 7,a7 %all include a cle>1 simple explanation (-- 7i7 eligibility = b5efits "u ! ,m$ic>e program "u title ,,xviii1 & 9 p>ticul> b5efits "u p>ts ,b & ,c ( su* title2 7ii7 ! reasons a late enrollm5t p5alty = failure to timely enroll c\ld be assess$ & h[ su* late enrollm5t p5alty is calculat$1 9 p>ticul> = b5efits "u su* "p ,b2 7iii7 ! availability ( relief f su* late enrollm5t p5alty & retroactive enrollm5t "u section #ahcg7;h7 7includ+ z su* section is appli$ "u sections #ahah7;c7 & #ahah;,a7c77#c771 ) examples ( circum/ances "u :i* su* relief may be grant$ & examples ( circum/ances "u :i* su* relief w\ld n be grant$2 7iv7 coord9ation ( b5efits 7includ+ prim>y & second>y cov]age sc5>ios7 pursuant to section #ahfb7;b71 9 p>ticul> = b5efits "u su* "p ,b2 7v7 enrollm5t1 eligibility1 & coord9ation ( b5efits "u title ,,xviii ) respect to populations1 = :om !re are special consid]ations1 su* z resid5ts ( ,pu]to ,rico & vet]ans2 & 7vi7 onl9e res\rces & toll-free telephone numb]s ( ! ,social ,security ,adm9i/ration & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7includ+ #a-hjj-,,m$ic>e & ! national toll-free numb] ( ! ,social ,security ,adm9i/ration7 t provide in=mation on eligibility = b5efits "u ! ,m$ic>e program "u title ,,xviii1 includ+ "u "p ,c ( su* title4 7,c7 ,developm5t ( notice 7i7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) ! ,commission] ( ,social ,security1 & tak+ into consid]ation in=mation collect$ pursuant to clause 7ii71 %all1 n lat] ?an #ab mon?s aft] ! la/ day ( ! p]iod = ! reque/ ( in=mation describ$ 9 clause 7ii71 develop ! notice to be provid$ pursuant to subp>agraph 7,a74 7ii7 ,reque/ = in=mation ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is p>agraph1 ! ,secret>y %all reque/ writt5 in=mation1 includ+ recomm5dations1 f /akehold]s 7includ+ ! gr\ps describ$ 9 subp>agraph 7,d77 on ! in=mation to be includ$ 9 ! notice4 7iii7 ,notice improvem5t ,beg9n+ #d ye>s aft] ! date ( ! enactm5t ( ?is p>agraph1 & n less ?an once e #b ye>s !reaft]1 ! ,secret>y1 9 coord9ation ) ! ,commission] ( ,social ,security1 %all-- 7,i7 review ! cont5t ( ! notice to be provid$ "u subp>agraph 7,a72 7,,ii7 reque/ writt5 in=mation1 includ+ recomm5dations1 on su* notice ?r\gh a reque/ = in=mation process z describ$ 9 clause 7ii72 & 7,,iii7 update & revise su* notice z ! ,secret>y deems appropriate4 7,d7 ,gr\ps ,= purposes ( subp>agraph 7,c77ii71 ! gr\ps describ$ 9 ?is subp>agraph include ! foll[+3 7i7 ,individuals :o are #fj ye>s ( age or old]4 7ii7 ,vet]ans4 7iii7 ,individuals ) disabilities4 7iv7 ,individuals ) end /age r5al disease4 7v7 ,l[-income individuals & families4 7vi7 ,employ]s 7includ+ human res\rces pr(essionals74 7vii7 ,/ates 7includ+ repres5tatives ( ,/ate-run ,heal? ,insurance ,ex*anges1 ,m$icaid (fices1 & ,dep>tm5ts ( ,insurance74 7viii7 ,/ate ,heal? ,insurance ,assi/ance ,programs4 7ix7 ,heal? insur]s4 7x7 ,heal? insurance ag5ts & brok]s4 7xi7 ,su* o!r gr\ps z specifi$ by ! ,secret>y4 7,e7 ,po/+ ( notice on websites ,! ,commission] ( ,social ,security & ! ,secret>y %all po/ ! notice requir$ "u subp>agraph 7,a7 on ! public ,int]net website ( ! ,social ,security ,adm9i/ration & on ,m$ic>e4gov 7or a successor website71 respectively4 7,f7 ,reimbursem5t ( co/s 7i7 ,9 g5]al ,effective = fiscal ye>s beg9n+ 9 ! ye> 9 :i* ! date ( enactm5t ( ?is p>agraph occurs1 ! ,commission] ( ,social ,security & ! ,secret>y %all ent] into an agreem5t "u :i* ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda 79 su* proportion z ! ,secret>y det]m9es appropriate71 ( su* sums z necess>y to cov] ! adm9i/rative co/s ( ! ,commission]'s activities "u ?is p>agraph4 ,su* agreem5t %all-- 7,i7 provide funds to ! ,commission] = ! adm9i/rative co/s ( ! ,social ,security ,adm9i/ration's "w relat$ to ! implem5tation ( ?is p>agraph1 includ+ any initial co/s incurr$ prior to ! f9alization ( su* agreem5t2 7,,ii7 provide su* fund+ qu>t]ly 9 advance ( ! applicable qu>t] bas$ on e/imat+ me?odology agre$ to by ! ,commission] & ! ,secret>y2 & 7,,iii7 require an annual acc\nt+ 7) a detail$ description ( ! co/s & me?odology us$ to assess su* co/s7 & reconciliation ( ! actual co/s incurr$ & funds provid$ "u ?is p>agraph4 7ii7 ,limitation ,9 no case %all funds f ! ,social ,security ,adm9i/ration's ,limitation on ,adm9i/rative ,exp5ses be us$ to c>ry out activities relat$ to ! implem5tation ( ?is p>agraph1 except z ! ,commission] det]m9es is necess>y-- 7,i7 = ! developm5t ( ! agreem5t "u clause 7i72 & 7,,ii7 on a tempor>y basis & subject to reimbursem5t "u clause 7i77,i71 = ! initial implem5tation ( ?is p>agraph4 7,g7 ,no effect on obligation to mail /atem5ts ,no?+ 9 ?is p>agraph %all be con/ru$ to relieve ! ,commission] ( ,social ,security f any requirem5t "u subsection 7c71 includ+ ! requirem5t to mail a /atem5t on an annual basis to ea* eligible individual :o is n receiv+ b5efits "u title ,,ii & = :om a mail+ address c be det]m9$ ?r\gh su* me?ods z ! ,commission] det]m9es to be appropriate4 4 7,b7 ,tim+ ( /atem5ts ,section #aadc7;c77#b7 ( su* ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;c77#b77 is am5d$ by add+ at ! end ! foll[+3 ,) respect to /atem5ts provid$ to individuals :o are atta9+ age #fe1 z describ$ 9 subsection 7a77#d71 su* /atem5ts %all be mail$ n e>li] ?an #f mon?s & n lat] ?an #c mon?s be=e ! individual atta9s su* age4 7#b7 ,social ,security b5efici>ies ,title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is am5d$ by ins]t+ aft] section #aadd ! foll[+ new section3 #aadd;,a4 ,m$ic>e ,enrollm5t ,notification & ,eligibility ,notices = ,social ,security ,b5efici>ies ,prior to ,m$ic>e ,eligibility 7a7 ,notices 7#a7 ,9 g5]al ,! ,commission] ( ,social ,security %all di/ribute ! notice to be provid$ pursuant to section #aadc7;a77#d71 z may be modifi$ "u p>agraph 7#b71 to individuals entitl$ to mon?ly insurance b5efits "u title ,,ii 9 accordance ) subsection 7b74 7#b7 ,au?ority to modify notice ,! ,secret>y1 9 coord9ation ) ! ,commission] ( ,social ,security1 may modify ! notice to be di/ribut$ "u p>agraph 7#a7 z necess>y to take into acc\nt ! individuals describ$ 9 su* p>agraph4 7#c7 ,po/+ ( notice on websites ,! ,commission] ( ,social ,security & ! ,secret>y %all po/ ! notice requir$ to be di/ribut$ "u p>agraph 7#a7 on ! public ,int]net website ( ! ,social ,security ,adm9i/ration & on ,m$ic>e4gov 7or a successor website71 respectively4 7b7 ,tim+ ,beg9n+ n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is section1 a notice requir$ "u subsection 7a77#a7 %all be mail$ to an individual describ$ 9 su* subsection-- 7#a7 9 ! ?ird mon? be=e ! date on :i* su* individual's initial enrollm5t p]iod beg9s z provid$ "u section #ahcg2 & 7#b7 9 ! case ( an individual ) respect to :om section #bbf7;b7 applies 7except = an individual :o w atta9 age #fe dur+ ! #bd mon? p]iod describ$ 9 su* section71 9 ! mon? be=e su* date on :i* su* individual's initial enrollm5t p]iod s beg9s4 7c7 ,reimbursem5t ( co/s 7#a7 ,9 g5]al ,effective = fiscal ye>s beg9n+ 9 ! ye> 9 :i* ! date ( enactm5t ( ?is section occurs1 ! ,commission] ( ,social ,security & ! ,secret>y %all ent] into an agreem5t "u :i* ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda 79 su* proportion z ! ,secret>y det]m9es appropriate71 ( su* sums z necess>y to cov] ! adm9i/rative co/s ( ! ,commission]'s activities "u ?is section4 ,su* agreem5t %all-- 7,a7 provide funds to ! ,commission] = ! adm9i/rative co/s ( ! ,social ,security ,adm9i/ration's "w relat$ to ! implem5tation ( ?is section1 includ+ any initial co/s incurr$ prior to ! f9alization ( su* agreem5t2 7,b7 provide su* fund+ qu>t]ly 9 advance ( ! applicable qu>t] bas$ on e/imat+ me?odology agre$ to by ! ,commission] & ! ,secret>y2 & 7,c7 require an annual acc\nt+ 7) a detail$ description ( ! co/s & me?odology us$ to assess su* co/s7 & reconciliation ( ! actual co/s incurr$ & funds provid$ "u ?is p>agraph4 7#b7 ,limitation ,9 no case %all funds f ! ,social ,security ,adm9i/ration's ,limitation on ,adm9i/rative ,exp5ses be us$ to c>ry out activities relat$ to ! implem5tation ( ?is section1 except z ! ,commission] det]m9es is necess>y-- 7,a7 = ! developm5t ( ! agreem5t "u p>agraph 7#a72 & 7,b7 on a tempor>y basis & subject to reimbursem5t "u p>agraph 7#a77;,a71 = ! initial implem5tation ( ?is section4 4 7b7 ,b5efici>y enrollm5t simplification 7#a7 ,effective date ( cov]age ,section #ahch7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieq7a77 is am5d$-- 7,a7 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 7,a7 9 ! case ( an individual :o enrolls pursuant to subsection 7d7 ( section #ahcg be=e ! mon? 9 :i* he fir/ satisfies p>agraph 7#a7 or 7#b7 ( section #ahcf7;a71 ! fir/ day ( su* mon?1 7,b7 9 ! case ( an individual :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ be=e ,janu>y #bjbc & :o enrolls pursuant to su* subsection 7d7-- 7i7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 7ii7 9 ! mon? foll[+ su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! second mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7iii7 m ?an "o mon? foll[+ su* mon? 9 :i* he satisfies su* p>agraph1 ! fir/ day ( ! ?ird mon? foll[+ ! mon? 9 :i* he s enrolls1 7,c7 9 ! case ( an individual :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ on or aft] ,janu>y #a1 #bjbc1 & :o enrolls pursuant to su* subsection 7d7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph or 9 any subsequ5t mon? ( 8 initial enrollm5t p]iod1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7,d7 9 ! case ( an individual :o enrolls pursuant to subsection 7e7 ( section #ahcg 9 a mon? beg9n+-- 7i7 be=e ,janu>y #a1 #bjbc1 ! ,july #a foll[+ ! mon? 9 :i* he s enrolls2 or 7ii7 on or aft] ,janu>y #a1 #bjbc1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls2 or 2 & 7,b7 by am5d+ p>agraph 7#c7 to read z foll[s3 7#c7 9 ! case ( an individual :o is deem$ to h enroll$-- 7,a7 on or be=e ! la/ day ( ! ?ird mon? ( 8 initial enrollm5t p]iod1 ! fir/ day ( ! mon? 9 :i* he fir/ meets ! applicable requirem5ts ( section #ahcf7;a7 or ,july #a1 #aigc1 :i*ev] is lat]1 or 7,b7 on or aft] ! fir/ day ( ! f\r? mon? ( 8 initial enrollm5t p]iod1 & :]e su* mon? beg9s-- 7i7 be=e ,janu>y #a1 #bjbc1 z prescrib$ "u subp>agraphs 7,b77i71 7,b77ii71 7,b77iii71 & 7,d77i7 ( p>agraph 7#b71 or 7ii7 on or aft] ,janu>y #a1 #bjbc1 z prescrib$ "u subp>agraphs 7,c7 & 7,d77ii7 ( p>agraph 7#b74 4 7#b7 ,special enrollm5t p]iods = exceptional circum/ances 7,a7 ,enrollm5t ,section #ahcg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7m7 ,beg9n+ ,janu>y #a1 #bjbc1 ! ,secret>y may e/abli% special enrollm5t p]iods 9 ! case ( individuals :o satisfy p>agraph 7#a7 or 7#b7 ( section #ahcf7;a7 & meet su* exceptional conditions z ! ,secret>y may provide4 4 7,b7 ,cov]age p]iod ,section #ahch ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieq7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7g7 ,not)/&+ subsection 7a71 9 ! case ( an individual :o enrolls dur+ a special enrollm5t p]iod pursuant to section #ahcg7m71 ! cov]age p]iod %all beg9 on a date ! ,secret>y provides 9 a mann] consi/5t 7to ! ext5t practicable7 ) protect+ cont9uity ( heal? b5efit cov]age4 4 7,c7 ,con=m+ am5dm5t ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$-- 7i7 9 section #ahah;,a7c77#c71 by /rik+ subsections 7h7 & 7i7 ( section #ahcg & ins]t+ subsections 7h71 7i71 & 7m7 ( section #ahcg2 & 7ii7 9 section #ahci7;b71 9 ! fir/ s5t5ce1 by /rik+ or 7l7 & ins]t+ 1 7l71 or 7m74 7#c7 ,te*nical correction ,section #ahci7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,= purposes ( det]m9+ any increase "u ?is subsection = individuals ^: enrollm5t occurs on or aft] ,janu>y #a1 #bjbc1 ! second s5t5ce ( ?is subsection %all be appli$ by sub/itut+ close ( ! mon? = close ( ! enrollm5t p]iod ea* place x appe>s44 7#d7 ,report ,n lat] ?an ,janu>y #a1 #bjbc1 ! ,secret>y ( ,heal? & ,human ,s]vices %all submit to ! ,committee on ,ways & ,means & ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance & ,special ,committee on ,ag+ ( ! ,s5ate a report on h[ to align exi/+ ,m$ic>e enrollm5t p]iods "u title ,,xviii ( ! ,social ,security ,act1 includ+ ! g5]al enrollm5t p]iod "u "p ,b ( su* title & ! annual1 coord9at$ election p]iod "u ! ,m$ic>e ,advantage program "u "p ,c ( su* title & "u ! prescription drug program "u "p ,d ( su* title4 ,su* report %all include recomm5dations consi/5t ) ! goals ( maximiz+ cov]age cont9uity & *oice & eas+ b5efici>y transition4 7#e7 ,,gao /udy & report 7,a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is section ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy on ! activities c>ri$ out "u ?is section4 ,su* /udy %all include ! foll[+3 7i7 ,an analysis ( ! ,social ,security ,adm9i/ration's use ( ! funds provid$ to c>ry out ! activities describ$ "u ?is section & ! am5dm5ts made by ?is section4 ,! ,comptroll] ,g5]al %all exam9e ! am\nt ( funds transf]r$ f ! ,f$]al ,hospital ,insurance ,tru/ ,fund & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund1 respectively1 = ^? activities2 h[ ! funds 7 sp5t2 :at proc$ures ! ag5cy _h 9 place ov] ! use ( ^? funds2 & h[ ! ag5cy compli$ ) ^? proc$ures4 7ii7 ,an evaluation ( ! notices describ$ 9 sections #aadc7;a77#d77;,a7 & #aadd;,a7a7 ( ! ,social ,security ,act1 includ+1 to ! ext5t data is available1 h[ ! mail+ ( su* notices affect$ enrollee behavior & ! imposition ( late enrollm5t p5alties "u ,m$ic>e ,"p ,b4 7iii7 ,any o!r area det]m9$ appropriate by ! ,comptroll] ,g5]al4 7,b7 ,report ,n lat] ?an #e ye>s aft] ! date ( enactm5t ( ?is section1 ! ,comptroll] ,g5]al %all submit to ! ,committee on ,ways & ,means & ,committee on ,en]gy & ,comm]ce ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report conta9+ ! results ( ! /udy conduct$ "u p>agraph 7#a71 includ+ recomm5dations = any legislative & adm9i/rative actions z ! ,comptroll] ,g5]al det]m9es appropriate4 7c7 ,fund+ ,section #ahjh ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#i7 is am5d$ by add+ ! end ! foll[+ new subsection3 7e7 ,fund+ = implem5tation ( b5efici>y enrollm5t notification & eligibility simplification ,= purposes ( c>ry+ out ! provisions ( & ! am5dm5ts made by section #b ( ! ,,b5es ,act ( #bjbj1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag & ! ,f$]al ,supplem5t>y ,m$ical ,insurance ,tru/ ,fund "u section #ahda 79 su* proportion z ! ,secret>y det]m9es appropriate71 to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 ( #b1jjj1jjj = ea* fiscal ye> beg9n+ ) fiscal ye> #bjba1 to rema9 available until exp5d$4 4 #c4 ,ext5d$ mon?s ( cov]age ( immunosuppressive drugs = kidney transplant pati5ts & o!r r5al dialysis provisions 7a7 ,m$ic>e entitlem5t to immunosuppressive drugs = kidney transplant recipi5ts 7#a7 ,9 g5]al ,section #bbf;,a7b77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dbf-a7;b77#b77 is am5d$ by ins]t+ 7except = eligibility = enrollm5t "u "p ,b solely = purposes ( cov]age ( immunosuppressive drugs describ$ 9 section #ahfa7s77#b77;,j77 be=e 1 ) ! ?irty-six? mon?4 7#b7 ,individuals eligible only = cov]age ( immunosuppressive drugs 7,a7 ,9 g5]al ,section #ahcf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieo7 is am5d$-- 7i7 by /rik+ ,e & ins]t+ 7a7 ,9 g5]al4--,e2 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7b7 ,individuals eligible = immunosuppressive drug cov]age 7#a7 ,9 g5]al ,except z provid$ "u p>agraph 7#b71 e individual ^: entitlem5t to insurance b5efits "u "p ,a ends 7:e!r be=e1 on1 or aft] ,janu>y #a1 #bjbc7 by reason ( section #bbf;,a7b77#b7 is eligible to enroll or to be deem$ to h enroll$ 9 ! m$ical insurance program e/abli%$ by ?is "p solely = purposes ( cov]age ( immunosuppressive drugs 9 accordance ) section #ahcg7n74 7#b7 ,exception if o!r cov]age is available 7,a7 ,9 g5]al ,an individual describ$ 9 p>agraph 7#a7 %all n be eligible = enrollm5t 9 ! program = purposes ( cov]age describ$ 9 su* p>agraph ) respect to any p]iod 9 :i* ! individual1 z det]m9$ 9 accordance ) subp>agraph 7,b7-- 7i7 is enroll$ 9 a gr\p heal? plan or gr\p or individual heal? insurance cov]age1 z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act2 7ii7 is enroll$ = cov]age "u ! ,,tric>e = ,life program "u section #ajhf7;d7 ( title #aj1 ,unit$ ,/ates ,code2 7iii7 is enroll$ "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix & is eligible to receive b5efits = immunosuppressive drugs describ$ 9 ?is subsection "u su* plan 7or su* waiv]72 7iv7 is enroll$ "u a ,/ate *ild heal? plan 7or waiv] ( su* plan7 "u title ,,xxi & is eligible to receive b5efits = su* drugs "u su* plan 7or su* waiv]72 or 7v7 7,i7 is enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t ( ,vet]ans ,affairs e/abli%$ & op]at$ "u section #agje ( title #ch1 ,unit$ ,/ates ,code2 7,,ii7 is n requir$ to enroll "u section #agje ( su* title to receive immunosuppressive drugs describ$ 9 ?is subsection2 or 7,,iii7 is o!rwise eligible "u a provision ( title #ch1 ,unit$ ,/ates ,code1 o!r ?an section #agaj ( su* title to receive immunosuppressive drugs describ$ 9 ?is subsection4 7,b7 ,eligibility det]m9ations 7i7 ,9 g5]al ,! ,secret>y1 9 coord9ation ) ! ,commission] ( ,social ,security1 %all e/abli% a process = det]m9+ :e!r an individual describ$ 9 p>agraph 7#a7 :o is to be enroll$ or deem$ to be enroll$ 9 ! m$ical insurance program describ$ 9 su* p>agraph meets ! requirem5ts = su* enrollm5t "u ?is subsection1 includ+ ! requirem5t t ! individual n be enroll$ 9 o!r cov]age z describ$ 9 subp>agraph 7,a74 7ii7 ,atte/ation reg>d+ o!r cov]age ,! process e/abli%$ "u clause 7i7 %all include1 at a m9imum1 a requirem5t t-- 7,i7 ! individual provide to ! ,commission] an atte/ation t ! individual is n enroll$ & does n expect to enroll 9 su* o!r cov]age2 & 7,,ii7 ! individual notify ! ,commission] )9 #fj days ( enrollm5t 9 su* o!r cov]age4 4 7,b7 ,con=m+ am5dm5t 7i7 ,9 g5]al ,sections #ahcg1 #ahch1 & #ahci ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep1 #db ,u4,s4,c4 #acieq1 #db ,u4,s4,c4 #acier7 are ea* am5d$ by /rik+ #ahcf & ins]t+ #ahcf7;a7 ea* place x appe>s4 7ii7 ,additional am5dm5t ,section #ahcg7;j77#a7 ( su* ,act 7#db ,u4,s4,c4 #aciep7j77#a77 is am5d$ by /rik+ #ahcf7a7 & ins]t+ #ahcf7;a77#a74 7b7 ,enrollm5t = individuals only eligible = cov]age ( immunosuppressive drugs ,section #ahcg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep71 z am5d$ by section #b7;b77#b77;,a71 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7n7 7#a7 ,any individual :o is eligible = cov]age ( immunosuppressive drugs "u section #ahcf7;b7 may enroll or be deem$ to h enroll$ only 9 su* mann] & =m z may be prescrib$ by regulations1 & only dur+ an enrollm5t p]iod describ$ 9 ?is subsection4 7#b7 ,an individual describ$ 9 p>agraph 7#a7 ^: entitlem5t = hospital insurance b5efits "u "p ,a ends by reason ( section #bbf;,a7b77#b7 prior to ,janu>y #a1 #bjbc1 may enroll beg9n+ on ,octob] #a1 #bjbb1 or ! day on :i* ! individual fir/ satisfies section #ahcf7;b71 :i*ev] is lat]4 7#c7 ,an individual describ$ 9 p>agraph 7#a7 ^: entitlem5t = hospital insurance b5efits "u "p ,a ends by reason ( section #bbf;,a7b77#b7 on or aft] ,janu>y #a1 #bjbc1 %all be deem$ to h enroll$ 9 ! m$ical insurance program e/abli%$ by ?is "p = purposes ( cov]age ( immunosuppressive drugs4 7#d7 ,! ,secret>y %all e/abli% a process "u :i* an individual describ$ 9 p>agraph 7#a7 ^: o!r cov]age describ$ 9 section #ahcf7;b77#b77;,a71 or cov]age "u ?is "p 7includ+ ! m$ical insurance program e/abli%$ "u ?is "p = purposes ( cov]age ( immunosuppressive drugs71 is t]m9at$ volunt>ily or involunt>y may enroll or re5roll1 if applicable1 9 ! m$ical insurance program e/abli%$ "u ?is "p = purposes ( cov]age ( immunosuppressive drugs4 4 7c7 ,cov]age p]iod = individuals only eligible = cov]age ( immunosuppressive drugs 7#a7 ,9 g5]al ,section #ahch ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieq71 z am5d$ by section #b7;b77#b77;,b71 is fur!r am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 ,9 ! case ( an individual describ$ 9 section #ahcf7;b77#a71 ! foll[+ rules %all apply3 7#a7 ,9 ! case ( su* an individual :o is deem$ to h enroll$ 9 "p ,b = cov]age ( immunosuppressive drugs "u section #ahcg7n77#c71 su* individual's cov]age p]iod %all beg9 on ! fir/ day ( ! mon? 9 :i* ! individual fir/ satisfies section #ahcf7;b74 7#b7 ,9 ! case ( su* an individual :o enrolls 7or re5rolls1 if applicable7 9 "p ,b = cov]age ( immunosuppressive drugs "u p>agraph 7#b7 or 7#d7 ( section #ahcg7n71 su* individual's cov]age p]iod %all beg9 on ,janu>y #a1 #bjbc1 or ! mon? foll[+ ! mon? 9 :i* ! individual s enrolls 7or re5rolls71 :i*ev] is lat]4 7#c7 ,! provisions ( subsections 7b7 & 7d7 %all apply ) respect to an individual describ$ 9 p>agraph 7#a7 or 7#b74 7#d7 ,9 addition to ! reasons = t]m9ation "u subsection 7b71 ! cov]age p]iod ( an individual describ$ 9 p>agraph 7#a7 or 7#b7 %all end :5 ! individual becomes entitl$ to b5efits "u ?is title "u subsection 7a7 or 7b7 ( section #bbf1 or "u section #bbf;,a1 or is no long] eligible = su* cov]age z a result ( ! application ( section #ahcf7;b77#b74 7#e7 ,! ,secret>y may conduct public education activities to raise aw>5ess ( ! availability ( m compreh5sive1 individual heal? insurance cov]age 7z def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act7 = individuals eligible "u section #ahcf7;b7 to enroll or to be deem$ enroll$ 9 ! m$ical insurance program e/abli%$ "u ?is "p = purposes ( cov]age ( immunosuppressive drugs4 4 7#b7 ,con=m+ am5dm5ts ,section #ahch7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieq7b77 is am5d$1 9 ! matt] foll[+ p>agraph 7#b71 by ins]t+ or section #ahcg7n77#c7 aft] section #ahcg7;f7 ea* place x appe>s4 7d7 ,premiums = individuals only eligible = cov]age ( immunosuppressive drugs 7#a7 ,9 g5]al ,section #ahci ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is am5d$-- 7,a7 9 subsection 7b71 by add+ at ! end ! foll[+ new s5t5ce3 ,no increase 9 ! premium %all be effect$ = individuals :o are enroll$ pursuant to section #ahcf7;b7 = cov]age only ( immunosuppressive drugs42 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7j7 ,det]m9ation ( premium = individuals only eligible = cov]age ( immunosuppressive drugs ,! ,secret>y %all1 dur+ ,septemb] ( ea* ye> 7beg9n+ ) #bjbb71 det]m9e & promulgate a mon?ly premium rate = ! succe$+ cal5d> ye> = individuals enroll$ only = ! purpose ( cov]age ( immunosuppressive drugs "u section #ahcf7;b74 ,su* premium %all be equal to #ae p]c5t ( ! mon?ly actu>ial rate = enrollees age #fe & ov] 7z w\ld be det]m9$ 9 accordance ) subsection 7a77#a7 if ! ref]5ce to "o-half 9 su* subsection 7 a ref]5ce to #ajj p]c5t7 = t succe$+ cal5d> ye>4 ,! mon?ly premium ( ea* individual enroll$ = cov]age ( immunosuppressive drugs "u section #ahcf7;b7 = ea* mon? %all be ! am\nt promulgat$ 9 ?is subsection4 ,9 ! case ( su* individual n o!rwise enroll$ "u ?is "p1 su* premium %all be 9 lieu ( any o!r mon?ly premium applicable "u ?is section4 ,su* am\nt %all be adju/$ 9 accordance ) subsections 7c71 7f71 & 7i71 b %all n be adju/$ "u subsection 7b74 4 7#b7 ,special rule = application ( hold h>mless provisions to transition+ individuals ,section #ahci7;f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7f77 is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,any increase 9 ! premium = an individual :o 0 enroll$ "u section #ahcf7;b7 attributable to su* individual o!rwise enroll+ "u ?is "p %all n be tak5 into acc\nt 9 apply+ ?is subsection44 7#c7 ,special rule = application ( premium subsidy r$uction provisions ,section #ahci7;i77#c77;,a77ii77,,ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#c77;,a77ii77,,ii77 is am5d$ by ins]t+ except 9 ! case ( an individual enroll$ "u section #ahcf7;b7 & n o!rwise enroll$ "u ?is "p1 be=e #d times4 7e7 ,gov]nm5t contribution ,section #ahdd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew7a77 is am5d$-- 7#a7 9 p>agraph 7#c71 by /rik+ ! p]iod at ! end & ins]t+ 2 plus2 7#b7 by ins]t+ aft] p>agraph 7#c7 ! foll[+ new p>agraph3 7#d7 a ,gov]nm5t contribution equal to ! e/imat$ aggregate r$uction 9 premiums payable "u "p ,b t results f e/abli%+ ! premium at #ae p]c5t ( ! actu>ial rate 7z w\ld be det]m9$ 9 accordance ) section #ahci7;a77#a7 if ! ref]5ce to "o-half 9 su* section 7 a ref]5ce to #ajj p]c5t7 "u section #ahci7;j7 in/ead ( #be p]c5t ( su* rate 7z s det]m9$7 = individuals enroll$ only = ! purpose ( cov]age ( immunosuppressive drugs "u section #ahcf7;b74 2 & 7#c7 by add+ ! foll[+ s5t5ce at ! end ( ! flu% matt] foll[+ p>agraph 7#d71 z add$ by p>agraph 7#b7 ( ?is subsection3 ,! ,gov]nm5t contribution "u p>agraph 7#d7 %all be treat$ z premiums payable & deposit$ = purposes ( subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#a74 4 7f7 ,ensur+ cov]age "u ! ,m$ic>e sav+s program 7#a7 ,9 g5]al ,section #aije7p77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,a77 is am5d$ by ins]t+ or :o is enroll$ "u "p ,b = ! purpose ( cov]age ( immunosuppressive drugs "u section #ahcf7;b7 aft] "u section #ahah;,a74 7#b7 ,con=m+ am5dm5ts ,section #aijb7;a77#aj77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77 is am5d$ 9 ea* ( clauses 7iii7 & 7iv7 by ins]t+ 7includ+ su* individuals enroll$ "u section #ahcf7;b77 aft] section #aije7p77#a74 7g7 ,"p ,d ,section #ahfj;,d-#a7;a77#c77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,a77 is am5d$ by ins]t+ 7b n includ+ an individual enroll$ solely = cov]age ( immunosuppressive drugs "u section #ahcf7;b77 be=e ! p]iod at ! end4 7h7 ,,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 ! implem5tation ( cov]age ( immunosuppressive drugs = kidney transplant pati5ts "u ! ,m$ic>e program pursuant to ! provisions (1 & am5dm5ts made by1 ?is section4 7#b7 ,report ,n lat] ?an ,janu>y #a1 #bjbe1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! /udy conduct$ "u p>agraph 7#a71 toge!r ) recomm5dations z ! ,comptroll] ,g5]al det]m9es appropriate4 #d4 ,transp>5cy ( m$ic>e second>y pay] report+ in=mation 7a7 ,9 g5]al ,section #ahfb7;b77#h77;,g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #ciey7b77#h77;,g77 is am5d$-- 7#a7 by /rik+ in=mation4--,! ,secret>y & ins]t+ in=mation4-- 7i7 ,9 g5]al ,! ,secret>y 2 & 7#b7 by add+ at ! end ! foll[+ new clause3 7ii7 ,specifi$ in=mation ,9 respond+ to any qu]y f an applicable plan relat$ to a det]m9ation describ$ 9 subp>agraph 7,a77i71 ! ,secret>y1 not)/&+ any o!r provision ( law1 %all provide to su* applicable plan-- 7,i7 :e!r a claimant subject to ! qu]y is1 or dur+ ! prec$+ #c-ye> p]iod has be51 entitl$ to b5efits "u ! program "u ?is title on any basis2 & 7,,ii7 to ! ext5t applicable1 ! plan "n & address ( any ,m$ic>e ,advantage plan "u "p ,c & any prescription drug plan "u "p ,d 9 :i* ! claimant is enroll$ or has be5 enroll$ dur+ su* p]iod4 4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply ) respect to qu]ies f plans made on or aft] ! date t is "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 #e4 ,e/abli%+ hospice program survey & en=cem5t proc$ures "u ! ,m$ic>e program 7a7 ,survey & en=cem5t proc$ures 7#a7 ,9 g5]al ,"p ,a ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahbb4 ,hospice program survey & en=cem5t proc$ures 7a7 ,surveys 7#a7 ,frequ5cy ,any entity t is c]tifi$ z a hospice program %all be subject to a /&>d survey by an appropriate ,/ate or local survey ag5cy1 or an approv$ accr$itation ag5cy1 z det]m9$ by ! ,secret>y1 n less frequ5tly ?an once e #cf mon?s 7& n less frequ5tly ?an once e #bd mon?s beg9n+ ,octob] #a1 #bjba74 7#b7 ,public transp>5cy ( survey & c]tification in=mation 7,a7 ,submission ( in=mation to ! ,secret>y 7i7 ,9 g5]al ,ea* ,/ate1 & ea* national accr$itation body ) respect to :i* ! ,secret>y has made a f9d+ "u section #ahfe7;a7 respect+ ! accr$itation ( a hospice program by su* body1 %all submit1 9 a =m & mann]1 & at a "t1 specifi$ by ! ,secret>y = purposes ( ?is subp>agraph1 in=mation respect+ any survey or c]tification made ) respect to a hospice program by su* ,/ate or body1 z applicable4 ,su* in=mation %all include any inspection report made by su* ,/ate or body ) respect to su* survey or c]tification1 any en=cem5t actions tak5 z a result ( su* survey or c]tification1 & any o!r in=mation det]m9$ appropriate by ! ,secret>y4 7ii7 ,requir$ inclusion ( specifi$ =m ,) respect to a survey "u ?is subsection c>ri$ out by a national accr$itation body describ$ 9 clause 7i7 on or aft] ,octob] #a1 #bjba1 in=mation describ$ 9 su* clause %all include ,=m #befg 7or a successor =m71 along ) su* additional in=mation det]m9$ appropriate by su* body4 7,b7 ,public disclosure ( in=mation ,beg9n+ n lat] ?an ,octob] #a1 #bjbb1 ! ,secret>y %all publi% ! in=mation submitt$ "u subp>agraph 7,a7 on ! public website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 9 a mann] t is prom95t1 easily accessible1 readily und]/&able1 & se>*able4 ,! ,secret>y %all provide = ! timely update ( su* in=mation s publi%$4 7#c7 ,consi/5cy ( surveys ,ea* ,/ate & ! ,secret>y %all implem5t programs to measure & r$uce inconsi/5cy 9 ! application ( survey results among surveyors4 7#d7 ,survey teams 7,a7 ,9 g5]al ,9 ! case ( a survey conduct$ "u ?is subsection on or aft] ,octob] #a1 #bjba1 by m ?an #a individual1 su* survey %all be conduct$ by a multidiscipl9>y team ( pr(essionals 7includ+ a regi/]$ pr(essional nurse74 7,b7 ,prohibition ( conflicts ( int]e/ ,beg9n+ ,octob] #a1 #bjba1 a ,/ate may n use z a memb] ( a survey team "u ?is subsection an individual :o is s]v+ 7or has s]v$ )9 ! previ\s #b ye>s7 z a memb] ( ! /aff (1 or z a consultant to1 ! program survey$ respect+ compliance ) ! requirem5ts ( section #ahfa7;dd7 or :o has a p]sonal or familial f9ancial int]e/ 9 ! program be+ survey$4 7,c7 ,tra9+ ,! ,secret>y %all provide1 n lat] ?an ,octob] #a1 #bjba1 = ! compreh5sive tra9+ ( ,/ate & ,f$]al surveyors1 & any surveyor employ$ by a national accr$itation body describ$ 9 p>agraph 7#b77;,a77i71 9 ! conduct ( surveys "u ?is subsection1 includ+ tra9+ ) respect to ! review ( writt5 plans = provid+ hospice c>e 7z describ$ 9 section #ahad7;a77#g77;,b774 ,no individual %all s]ve z a memb] ( a survey team ) respect to a survey conduct$ on or aft] su* date unless ! individual has successfully complet$ a tra9+ & te/+ program 9 survey & c]tification te*niques t has be5 approv$ by ! ,secret>y4 7#e7 ,fund+ ,! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund "u section #ahag to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt1 ( #aj1jjj1jjj = ea* fiscal ye> 7beg9n+ ) fiscal ye> #bjbb7 = purposes ( c>ry+ out ?is subsection & subsection 7b74 ,sums s transf]r$ %all rema9 available until exp5d$4 ,any transf] pursuant to ?is p>agraph %all be 9 addition to any transf] pursuant to section #c7;a77#b7 ( ! ,improv+ ,m$ic>e ,po/-,acute ,c>e ,trans=mation ,act ( #bjad4 7b7 ,special focus program 7#a7 ,9 g5]al ,! ,secret>y %all conduct a special focus program = en=cem5t ( requirem5ts = hospice programs t ! ,secret>y has id5tifi$ z hav+ sub/antially fail$ to meet applicable requirem5ts ( ?is ,act4 7#b7 ,p]iodic surveys ,"u su* special focus program1 ! ,secret>y %all conduct surveys ( ea* hospice program 9 ! special focus program n less ?an once e #f mon?s4 7c7 ,en=cem5t 7#a7 ,situations involv+ imm$iate jeop>dy ,if ! ,secret>y det]m9es on ! basis ( a /&>d survey or o!rwise t a hospice program t is c]tifi$ = p>ticipation "u ?is title is no long] 9 compliance ) ! requirem5ts specifi$ 9 section #ahfa7;dd7 & det]m9es t ! defici5cies involv$ imm$iately jeop>dize ! heal? & safety ( ! individuals to :om ! program furni%es items & s]vices1 ! ,secret>y %all take imm$iate action to remove ! jeop>dy & correct ! defici5cies ?r\gh ! rem$y describ$ 9 p>agraph 7#e77;,b77iii7 or t]m9ate ! c]tification ( ! program1 & may provide1 9 addition1 = #a or m ( ! o!r rem$ies describ$ 9 p>agraph 7#e77;,b74 7#b7 ,situations n involv+ imm$iate jeop>dy ,if ! ,secret>y det]m9es on ! basis ( a /&>d survey or o!rwise t a hospice program t is c]tifi$ = p>ticipation "u ?is title is no long] 9 compliance ) ! requirem5ts specifi$ 9 section #ahfa7;dd7 & det]m9es t ! defici5cies involv$ d n imm$iately jeop>dize ! heal? & safety ( ! individuals to :om ! program furni%es items & s]vices1 ! ,secret>y may 7= a p]iod n to exce$ #f mon?s7 impose rem$ies develop$ pursuant to p>agraph 7#e77;,a71 9 lieu ( t]m9at+ ! c]tification ( ! program4 ,if1 aft] su* a p]iod ( rem$ies1 ! program is /ill no long] 9 compliance ) su* requirem5ts1 ! ,secret>y %all t]m9ate ! c]tification ( ! program4 7#c7 ,p5alty = previ\s noncompliance ,if ! ,secret>y det]m9es t a hospice program t is c]tifi$ = p>ticipation "u ?is title is 9 compliance ) ! requirem5ts specifi$ 9 section #ahfa7;dd7 b1 z ( a previ\s p]iod1 did n meet su* requirem5ts1 ! ,secret>y may provide = a civil monet>y p5alty "u p>agraph 7#e77;,b77i7 = ! days 9 :i* ! ,secret>y f9ds t ! program 0 n 9 compliance ) su* requirem5ts4 7#d7 ,option to cont9ue paym5ts = noncompliant hospice programs ,! ,secret>y may cont9ue paym5ts "u ?is title ) respect to a hospice program n 9 compliance ) ! requirem5ts specifi$ 9 section #ahfa7;dd7 ov] a p]iod ( n long] ?an #f mon?s1 if-- 7,a7 ! ,/ate or local survey ag5cy f9ds t x is m appropriate to take alt]native action to assure compliance ( ! program ) su* requirem5ts ?an to t]m9ate ! c]tification ( ! program2 7,b7 ! program has submitt$ a plan & timetable = corrective action to ! ,secret>y = approval & ! ,secret>y approves ! plan ( corrective action2 & 7,c7 ! program agrees to repay to ! ,f$]al ,gov]nm5t paym5ts receiv$ "u ?is title dur+ su* p]iod if ! corrective action is n tak5 9 accordance ) ! approv$ plan & timetable4 ,! ,secret>y %all e/abli% guidel9es = approval ( corrective actions reque/$ by hospice programs "u ?is p>agraph4 7#e7 ,rem$ies 7,a7 ,developm5t 7i7 ,9 g5]al ,n lat] ?an ,octob] #a1 #bjba1 ! ,secret>y %all develop & implem5t-- 7,i7 a range ( rem$ies to apply to hospice programs "u ! conditions describ$ 9 p>agraphs 7#a7 ?r\gh 7#d72 & 7,,ii7 appropriate proc$ures = appeal+ det]m9ations relat+ to ! imposition ( su* rem$ies4 ,rem$ies develop$ pursuant to ! prec$+ s5t5ce %all include ! rem$ies specifi$ 9 subp>agraph 7,b74 7ii7 ,conditions ( imposition ( rem$ies ,n lat] ?an ,octob] #a1 #bjba1 ! ,secret>y %all develop & implem5t specific proc$ures ) respect to ! conditions "u :i* ea* ( ! rem$ies develop$ "u clause 7i7 is to be appli$1 includ+ ! am\nt ( any f9es & ! sev]ity ( ea* ( ^! rem$ies4 ,su* proc$ures %all be design$ s z to m9imize ! "t betwe5 id5tification ( defici5cies & imposition ( ^! rem$ies & %all provide = ! imposition ( increm5tally m sev]e f9es = repeat$ or uncorrect$ defici5cies4 7,b7 ,specifi$ rem$ies ,! rem$ies specifi$ 9 ?is subp>agraph are ! foll[+3 7i7 ,civil monet>y p5alties 9 an am\nt n to exce$ #aj1jjj = ea* day ( noncompliance by a hospice program ) ! requirem5ts specifi$ 9 section #ahfa7;dd74 7ii7 ,susp5sion ( all or "p ( ! paym5ts to :i* a hospice program w\ld o!rwise be entitl$ "u ?is title ) respect to items & s]vices furni%$ by a hospice program on or aft] ! date on :i* ! ,secret>y det]m9es t rem$ies %\ld be impos$ pursuant to p>agraph 7#b74 7iii7 ,! appo9tm5t ( tempor>y managem5t to ov]see ! op]ation ( ! hospice program & to protect & assure ! heal? & safety ( ! individuals "u ! c>e ( ! program :ile improvem5ts are made 9 ord] to br+ ! program into compliance ) all su* requirem5ts4 7,c7 ,proc$ures 7i7 ,civil monet>y p5alties 7,i7 ,9 g5]al ,subject to subclause 7,,ii71 ! provisions ( section #aabh;,a 7o!r ?an subsections 7a7 & 7b77 %all apply to a civil monet>y p5alty "u ?is subsection 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a7a74 7,,ii7 ,ret5tion ( am\nts = hospice program improvem5ts ,! ,secret>y may provide t any portion ( civil monet>y p5alties collect$ "u ?is subsection may be us$ to support activities t b5efit individuals receiv+ hospice c>e1 includ+ education & tra9+ programs to ensure hospice program compliance ) ! requirem5ts ( section #ahfa7;dd74 7ii7 ,susp5sion ( paym5t ,a f9d+ to susp5d paym5t "u subp>agraph 7,b77ii7 %all t]m9ate :5 ! ,secret>y f9ds t ! program is 9 sub/antial compliance ) all su* requirem5ts4 7iii7 ,tempor>y managem5t ,! tempor>y managem5t "u subp>agraph 7,b77iii7 %all n be t]m9at$ until ! ,secret>y has det]m9$ t ! program has ! managem5t capability to ensure cont9u$ compliance ) all ! requirem5ts ref]r$ to 9 su* subp>agraph4 7,d7 ,relation%ip to o!r rem$ies ,! rem$ies develop$ "u subp>agraph 7,a7 are 9 addition to sanctions o!rwise available "u ,/ate or ,f$]al law & %all n be con/ru$ z limit+ o!r rem$ies1 includ+ any rem$y available to an individual at common law4 4 7#b7 ,availability ( hospice accr$itation surveys ,section #ahfe7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;bb7b77 is am5d$ by ins]t+ or1 beg9n+ on ! date ( ! enactm5t ( ! ,,b5es ,act ( #bjbj1 a hospice program aft] home heal? ag5cy4 7#c7 ,/ate provision ( hospice program in=mation 7,a7 ,9 g5]al ,section #ahfd7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aa7a77 is am5d$ 9 ! six? s5t5ce-- 7i7 by ins]t+ & hospice programs aft] in=mation on home heal? ag5cies2 7ii7 by ins]t+ or ! hospice program aft] ! home heal? ag5cy2 7iii7 by ins]t+ or ! hospice program aft] ) respect to ! ag5cy2 & 7iv7 by ins]t+ & hospice programs aft] ) respect to home heal? ag5cies4 7,b7 ,effective date ,! am5dm5ts made by subp>agraph 7,a7 %all apply ) respect to agreem5ts ent]$ into on or aft]1 or 9 effect z (1 ! date t is #a ye> aft] ! date ( ! enactm5t ( ?is ,act4 7#d7 ,con=m+ am5dm5ts 7,a7 ,def9ition ( a hospice program ,section #ahfa7;dd77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#d77 is am5d$ by /rik+ subp>agraph 7,c74 7,b7 ,cont9uation ( fund+ ,section #c7;a77#b7 ( ! ,improv+ ,m$ic>e ,po/-,acute ,c>e ,trans=mation ,act ( #bjad is am5d$ by ins]t+ & section #ahbb7;a77#a7 ( su* ,act1 aft] z add$ by p>agraph 7#a714 7b7 ,increas+ paym5t r$uctions = failure to meet quality data report+ requirem5ts ,section #ahad7;i77#e77;,a77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77#e77;,a77i77 is am5d$ by ins]t+ 7or1 = fiscal ye> #bjbc & ea* subsequ5t fiscal ye>1 #d p]c5tage po9ts7 be=e ! p]iod4 7c7 ,report ,n lat] ?an #cf mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all submit to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate a report conta9+ an analysis ( ! effects ( ! am5dm5ts made by subsection 7a71 includ+ ! frequ5cy ( application ( rem$ies specifi$ 9 section #ahbb7;c77#e77;,b7 ( ! ,social ,security ,act 7z add$ by su* subsection71 on access to1 & quality (1 c>e furni%$ by hospice programs "u "p ,a ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq474 ,pass$ ! ,h\se ( ,repres5tatives ,decemb] #h1 #bjbj4;,*]yl ,l4 ,johnson1,cl]k