,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cdaf  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #ba1 #bjai,ms4  
,sewell ( ,alabama 7= h]self & ,mr4     
,smi? ( ,nebraska7 introduc$ ! foll[+   
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce1 & 9 addition to !    
,committees on ,ways & ,means1 & ,arm$  
,s]vices1 = 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 provide = heal? equity &   
access = return+ troops & s]vicememb]s1 
to provide = ambulatory surgical paym5t 
transp>5cy "u ! ,m$ic>e program1 & = o!r
 purposes4  #a4 ,%ort title2 table (    
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,,he>ts & ,rural ,relief    
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts = ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title2 table ( cont5ts4 ,sec4 
#b4 ,heal? ,equity & ,access = ,return+ 
,troops & ,s]vicememb]s & ,rural ,relief
 ,act ( #bjai4 ,sec4 #c4 ,ambulatory    

surgical c5t] paym5t transp>5cy4 ,sec4  
#d4 ,exclusion ( complex rehabilitative 
manual :eel*airs f ,m$ic>e competitive  
acquisition program2 non-application (  
,m$ic>e fee s*$ule adju/m5ts = c]ta9    
:eel*air accessories & cu%ions4 ,sec4   
#e4 ,ext5sion ( en=cem5t in/ruction on  
sup]vision requirem5ts = outpati5t      
!rapeutic s]vices 9 critical access &   
small rural hospitals ?r\gh #bjba4  #b4 
,heal? ,equity & ,access = ,return+     
,troops & ,s]vicememb]s & ,rural ,relief
 ,act ( #bjai  7a7 ,modification (      
requirem5t = c]ta9 =m] memb]s ( ! ,arm$ 
,=ces ,to enroll 9 ,m$ic>e ,"p ,b ,to be
 eligible = ,,tric>e = ,life  7#a7      
,,tric>e eligibility  7,a7 ,9 g5]al     
,subsection 7d7 ( section #ajhf ( title 
#aj1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#f7  7,a7 ,! requirem5t 9 p>agraph     
7#b77;,a7 to enroll 9 ! supplem5t>y     
m$ical insurance program "u "p ,b (     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;j et seq47 %all n 

apply to a p]son describ$ 9 subp>agraph 
7,b7 dur+ any mon? 9 :i* su* p]son is n 
entitl$ to a b5efit describ$ 9          
subp>agraph 7,a7 ( section #bbf7;b77#b7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #dbf7;b77#b77 if su* p]son has
 receiv$ ! c\nsel+ & in=mation "u       
subp>agraph 7,c74  7,b7 ,a p]son        
describ$ 9 ?is subp>agraph is a p]son-- 
7i7 :o is "u #fe ye>s ( age2  7ii7 :o is
 entitl$ to hospital insurance b5efits  
"u "p ,a ( title ,,xviii ( ! ,social    
,security ,act pursuant to subp>agraph  
7,a7 or 7,c7 ( section #bbf7;b77#b7 (   
su* ,act 7#db ,u4,s4,c4 #dbf7;b77#b772  
7iii7 ^: entitlem5t to a b5efit describ$
 9 subp>agraph 7,a7 ( su* section has   
t]m9at$ due to p]=mance ( sub/antial    
ga9ful activity2 &  7iv7 :o is retir$ "u
 *apt] #fa ( ?is title4  7,c7 ,!        
,secret>y ( ,def5se %all coord9ate ) !  
,secret>y ( ,heal? & ,human ,s]vices & !
 ,commission] ( ,social ,security to    
notify p]sons describ$ 9 subp>agraph    
7,b7 (1 & provide in=mation & c\nsel+   

reg>d+1 ! effects ( n enroll+ 9 !       
supplem5t>y m$ical insurance program "u 
"p ,b ( title ,,xviii ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #acie;j et
 seq471 z describ$ 9 subp>agraph 7,a74  
4  7,b7 ,con=m+ am5dm5t ,p>agraph       
7#b77;,a7 ( su* subsection is am5d$ by  
/rik+ is enroll$ & ins]t+ except z      
provid$ by p>agraph 7#f71 is enroll$4   
7,c7 ,id5tification ( p]sons ,section   
#aaaj;a ( su* title is am5d$ by add+ at 
! end ! foll[+ new subsection3  7c7     
,c]ta9 individuals n requir$ ,to enroll 
9 ,m$ic>e ,"p ,b ,9 c>ry+ out subsection
 7a71 ! ,secret>y ( ,def5se %all        
coord9ate ) ! ,secret>y ( ,heal? &      
,human ,s]vices & ! ,commission] (      
,social ,security to--  7#a7 id5tify    
p]sons describ$ 9 subp>agraph 7,b7 (    
section #ajhf7;d77#f7 ( ?is title2 &    
7#b7 provide in=mation & c\nsel+        
pursuant to subp>agraph 7,c7 ( su*      
section4  4  7#b7 ,non-,application (   
,m$ic>e ,"p ,b late enrollm5t p5alty    
,section #ahci7;b7 ( ! ,social ,security

 ,act 7#db ,u4,s4,c4 #acier7b77 is      
am5d$1 9 ! second s5t5ce1 by ins]t+ or  
mon?s = :i* ! individual c demon/rate t 
! individual is an individual describ$ 9
 p>agraph 7#f77;,b7 ( section #ajhf7;d7 
( title #aj1 ,unit$ ,/ates ,code1 :o is 
enroll$ 9 ! ,,tric>e program pursuant to
 su* section aft] an individual describ$
 9 section #ahcg7k77#c74  7#c7 ,report  
,n lat] ?an ,octob] #a1 #bjbd1 !        
,secret>y ( ,def5se1 ! ,secret>y (      
,heal? & ,human ,s]vices1 & !           
,commission] ( ,social ,security %all   
jo9tly submit to ! ,committees on ,arm$ 
,s]vices ( ! ,h\se ( ,repres5tatives & !
 ,s5ate1 ! ,committee on ,ways & ,means 
& ! ,committee on ,en]gy & ,comm]ce ( ! 
,h\se ( ,repres5tatives1 & ! ,committee 
on ,f9ance ( ! ,s5ate a report on !     
implem5tation ( section #ajhf7;d77#f7 ( 
title #aj1 ,unit$ ,/ates ,code1 z add$  
by p>agraph 7#a74 ,su* report %all      
include1 ) respect to ! p]iod cov]$ by !
 report--  7,a7 ! numb] ( individuals   
enroll$ 9 ,,tric>e = ,life :o are n     

enroll$ 9 ! supplem5t>y m$ical insurance
 program "u "p ,b ( title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;j et seq47 by reason ( su* section
 #ajhf7;d77#f72 &  7,b7 ! numb] (       
individuals :o-- 7i7 are retir$ f !     
,arm$ ,=ces "u *apt] #fa ( title #aj1   
,unit$ ,/ates ,code2  7ii7 are entitl$  
to hospital insurance b5efits "u "p ,a (
 title ,,xviii ( ! ,social ,security    
,act pursuant to receiv+ b5efits = #bd  
mon?s z describ$ 9 subp>agraph 7,a7 or  
7,c7 ( section #bbf7;b77#b7 ( su* ,act  
7#db ,u4,s4,c4 #dbf7;b77#b772 &  7iii7  
because ( su* entitlem5t1 are no long]  
enroll$ 9 ,,tric>e ,/&>d1 ,,tric>e      
,prime1 ,,tric>e ,extra1 or ,,tric>e    
,select "u *apt] #ee ( title #aj1 ,unit$
 ,/ates ,code4  7#d7 ,deposit ( sav+s   
into ,m$ic>e improvem5t fund ,section   
#ahih7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;iii7b77#a77 is    
am5d$ by /rik+ dur+ & aft] fiscal ye>   
#bjba1 #j & ins]t+ dur+ & aft] fiscal   
ye> #bjbd1 #e1jjj1jjj4  7#e7            

,application ,! am5dm5ts made by        
p>agraphs 7#a7 & 7#b7 %all apply )      
respect to a p]son :o1 on or aft]       
,octob] #a1 #bjbc1 is a p]son describ$ 9
 section #ajhf7;d77#f77;,b7 ( title #aj1
 ,unit$ ,/ates ,code1 z add$ by p>agraph
 7#a74  7b7 ,cov]age ( c]ta9 ,,dna      
specim5 prov5ance assay te/s "u ,m$ic>e 
7#a7 ,b5efit  7,a7 ,cov]age ,section    
#ahfa ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #aciex7 is am5d$-- 7i7 9      
subsection 7s77#b7--  7,i7 9 subp>agraph
 7,,gg71 by /rik+ & at ! end2  7,,ii7 9 
subp>agraph 7,,hh71 by /rik+ ! p]iod &  
ins]t+ 2 &2 &  7,,iii7 by add+ at ! end 
! foll[+ new subp>agraph3  7,,ii7 a     
pro/ate canc] ,,dna ,specim5 ,prov5ance 
,assay te/ 7,,dspa te/7 7z def9$ 9      
subsection 7kkk772  2 &  7ii7 by add+ at
 ! end ! foll[+ new subsection3  7kkk7  
,pro/ate canc] ,,dna ,specim5 ,prov5ance
 ,assay ,te/ ,! t]m pro/ate canc] ,,dna 
,specim5 ,prov5ance ,assay ,te/ 7,,dspa 
te/7 means a te/ t1 aft] a det]m9ation (
 canc] 9 "o or m pro/ate biopsy specim5s

 obta9$ f an individual1 assesses !     
id5tity ( ! ,,dna 9 su* specim5s by     
comp>+ su* ,,dna ) ! ,,dna t 0 sep>ately
 tak5 f su* individual at ! "t ( !      
biopsy4  4  7,b7 ,exclusion f cov]age   
,section #ahfb7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciey7a77#a77 is am5d$-- 7i7 9         
subp>agraph 7,o71 by /rik+ & at ! end2  
7ii7 9 subp>agraph 7,p71 by /rik+ !     
semicolon at ! end & ins]t+ 1 &2 &      
7iii7 by add+ at ! end ! foll[+ new     
subp>agraph3  7,q7 9 ! case ( a pro/ate 
canc] ,,dna ,specim5 ,prov5ance ,assay  
te/ 7,,dspa te/7 7z def9$ 9 section     
#ahfa7kkk771 unless su* te/ is furni%$  
on or aft] ,janu>y #a1 #bjbj1 & be=e    
,janu>y #a1 #bjbe1 & su* te/ is ord]$ by
 ! physician :o furni%$ ! pro/ate canc] 
biopsy t obta9$ ! specim5 te/$2  4  7#b7
 ,paym5t am\nt & relat$ requirem5ts     
,section #ahcd ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by 
add+ at ! end ! foll[+ new subsection3  
7x7 ,pro/ate canc] ,,dna ,specim5       

,prov5ance ,assay te/s  7#a7 ,paym5t =  
cov]$ te/s  7,a7 ,9 g5]al ,subject to   
subp>agraph 7,b71 ! paym5t am\nt = a    
pro/ate canc] ,,dna ,specim5 ,prov5ance 
,assay te/ 7,,dspa te/7 7z def9$ 9      
section #ahfa7kkk77 %all be #bjj4 ,su*  
paym5t %all be paym5t = all ( ! specim5s
 obta9$ f ! biopsy furni%$ to an        
individual t are te/$4  7,b7 ,limitation
 ,paym5t = a ,,dspa te/ "u subp>agraph  
7,a7 may only be made on an             
assignm5t-relat$ basis4  7,c7           
,prohibition on sep>ate paym5t ,no      
sep>ate paym5t %all be made = obta9+    
,,dna t 0 sep>ately tak5 f an individual
 at ! "t ( a biopsy describ$ 9          
subp>agraph 7,a74  7#b7 ,,hcpcs code &  
modifi] assignm5t  7,a7 ,9 g5]al ,!     
,secret>y %all assign "o or m ,,hcpcs   
codes to a pro/ate canc] ,,dna ,specim5 
,prov5ance ,assay te/ & may use a       
modifi] to facilitate mak+ paym5t "u ?is
 section = su* te/4  7,b7 ,id5tification
 ( ,,dna mat* on claim ,! ,secret>y %all
 require an indication on a claim = a   

pro/ate canc] ,,dna ,specim5 ,prov5ance 
,assay te/ ( :e!r ! ,,dna ( ! pro/ate   
biopsy specim5s mat* ! ,,dna ( !        
individual diagnos$ ) pro/ate canc]4    
,su* indication may be made ?r\gh use ( 
a ,,hcpcs code1 a modifi]1 or o!r means1
 z det]m9$ appropriate by ! ,secret>y4  
7#c7 ,,dna mat* review  7,a7 ,9 g5]al ,!
 ,secret>y %all review at lea/ ?ree ye>s
 ( claims "u "p ,b = pro/ate canc] ,,dna
 ,specim5 ,prov5ance ,assay te/s to     
id5tify :e!r ! ,,dna ( ! pro/ate biopsy 
specim5s mat* ! ,,dna ( ! individuals   
diagnos$ ) pro/ate canc]4  7,b7 ,po/+ on
 int]net website ,n lat] ?an ,july #a1  
#bjbc1 ! ,secret>y %all po/ on ! int]net
 website ( ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices ! f9d+s ( ! review conduct$ "u 
subp>agraph 7,a74  4  7#c7 ,co/-,%>+    
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$-- 7,a7 by /rik+ 
& 7,,cc7 & ins]t+ 7,,cc72 &  7,b7 by    
ins]t+ be=e ! semicolon at ! end !      
foll[+3 1 & 7,,dd7 ) respect to a       

pro/ate canc] ,,dna ,specim5 ,prov5ance 
,assay te/ 7,,dspa te/7 7z def9$ 9      
section #ahfa7kkk771 ! am\nt paid %all  
be an am\nt equal to #hj p]c5t ( ! less]
 ( ! actual *>ge = ! te/ or ! am\nt     
specifi$ "u section #ahcd7x74  #c4      
,ambulatory surgical c5t] paym5t        
transp>5cy  7a7 ,advisory ,panel on     
,hospital ,outpati5t ,paym5t            
,repres5tation  7#a7 ,,asc repres5tative
 ,! second s5t5ce ( section             
#ahcc7t77#i77;,a7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7t77#i77;,a77 
is am5d$ by ins]t+ & at lea/ "o         
ambulatory surgical c5t] repres5tative  
aft] an appropriate selection (         
repres5tatives ( provid]s4  7#b7        
,effective date ,! am5dm5t made by      
p>agraph 7#a7 %all apply ) respect to   
advisory panels consult$ on or aft] !   
date t is #a ye> aft] ! date ( !        
enactm5t ( ?is ,act4  7b7 ,reasons =    
exclud+ additional proc$ures f ,,asc    
approv$ li/ ,section #ahcc7;i77#a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   

#aciel7i77#a77 is am5d$ by add+ at ! end
 ! foll[+3 ,9 updat+ su* li/s =         
application 9 ye>s beg9n+ ) ! second ye>
 beg9n+ aft] ! date ( ! enactm5t ( ?is  
s5t5ce1 = ea* proc$ure t 0 n propos$ to 
be includ$ 9 su* li/s 9 ! propos$ rule )
 respect to su* li/s & t 0 subsequ5tly  
reque/$ to be includ$ 9 su* li/s dur+ ! 
public comm5t p]iod ) respect to su*    
propos$ rule & t is n includ$ 9 ! f9al  
rule updat+ su* li/s1 ! ,secret>y %all  
cite 9 su* f9al rule ! specific crit]ia 
9 p>agraph 7b7 or 7c7 ( section #daf4aff
 ( title #db1 ,code ( ,f$]al            
,regulations 7or any successor          
regulation71 bas$ on :i* ! proc$ure 0   
exclud$4 ,if p>agraph 7b7 ( su* section 
is cit$ = exclusion ( a proc$ure1 !     
,secret>y %all id5tify ! pe]-review$    
rese>*1 if any1 or ! evid5ce ^u :i* su* 
det]m9ation is bas$44  #d4 ,exclusion ( 
complex rehabilitative manual :eel*airs 
f ,m$ic>e competitive acquisition       
program2 non-application ( ,m$ic>e fee  
s*$ule adju/m5ts = c]ta9 :eel*air       

accessories & cu%ions  7a7 ,exclusion ( 
complex rehabilitative manual :eel*airs 
f competitive acquisition program       
,section #ahdg7;a77#b77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#c7;a77#b77;,a77 is am5d$-- 7#a7 
by ins]t+ 1 complex rehabilitative      
manual :eel*airs 7z det]m9$ by !        
,secret>y71 & c]ta9 manual :eel*airs    
7id5tifi$1 z ( ,octob] #a1 #bjah1 by    
,,hcpcs codes ,e#abce1 ,e#abcf1 ,e#abcg1
 ,e#abch1 & ,k#jjjh or any successor to 
su* codes7 aft] gr\p #c or high]2 &     
7#b7 by /rik+ su* :eel*airs & ins]t+ su*
 complex rehabilitative p[] :eel*airs1  
complex rehabilitative manual :eel*airs1
 & c]ta9 manual :eel*airs4  7b7         
,non-,application ( ,m$ic>e fee s*$ule  
adju/m5ts = :eel*air accessories & seat 
& back cu%ions :5 furni%$ 9 connection )
 complex rehabilitative manual :eel*airs
  7#a7 ,9 g5]al ,not)/&+ any o!r        
provision ( law1 ! ,secret>y ( ,heal? & 
,human ,s]vices %all n1 dur+ ! p]iod    
beg9n+ on ,july #a1 #bjai1 & end+ on    

,decemb] #ca1 #bjbj1 use in=mation on ! 
paym5t det]m9$ "u ! competitive         
acquisition programs "u section #ahdg ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciew-#c7 to adju/ ! paym5t am\nt t    
w\ld o!rwise be recogniz$ "u section    
#ahcd7;a77#a77;,b77ii7 ( su* ,act 7#db  
,u4,s4,c4 #aciem7a77#a77;,b77ii77 =     
:eel*air accessories 7includ+ seat+     
sy/ems7 & seat & back cu%ions :5 furni%$
 9 connection ) complex rehabilitative  
manual :eel*airs 7z det]m9$ by !        
,secret>y71 & c]ta9 manual :eel*airs    
7id5tifi$1 z ( ,octob] #a1 #bjah1 by    
,,hcpcs codes ,e#abce1 ,e#abcf1 ,e#abcg1
 ,e#abch1 & ,k#jjjh or any successor to 
su* codes74  7#b7 ,implem5tation        
,not)/&+ any o!r provision ( law1 !     
,secret>y may implem5t ?is subsection by
 program in/ruction or o!rwise4  #e4    
,ext5sion ( en=cem5t in/ruction on      
sup]vision requirem5ts = outpati5t      
!rapeutic s]vices 9 critical access &   
small rural hospitals ?r\gh #bjba       
,section #a ( ,public ,law #aac-aih1 z  

am5d$ by section #a ( ,public ,law      
#aad-aab1 section #afjjd ( ,public ,law 
#aad-bee1 & section #eajjg ( ,public    
,law #aae-abc1 is am5d$--  7#a7 9 !     
section head+1 by /rik+ #bjag & ins]t+  
#bjba2 &  7#b7 by /rik+ & #bjag & ins]t+
 1 #bjag1 #bjbj1 & #bjba4