,i #aaf? ,,congress #a/ ,session ,h4 ,r4 #cdag ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #ba1 #bjai,mr4 ,neal 7= himself & ,mr4 ,brady7 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 provide = pati5t improvem5ts & rural & quality improvem5ts "u ! ,m$ic>e program4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,b5efici>y ,education ,tools1 ,teleheal?1 & ,ext5d]s ,reau?orization ,act ( #bjai or ! ,,bett] ,act ( #bjai4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,title ,i--,pati5t ,improvem5ts ,sec4 #aja4 ,b5efici>y enrollm5t notification & eligibility simplification4 ,sec4 #ajb4 ,ext5sion ( fund+ outrea* & assi/ance = l[-income programs4 ,sec4 #ajc4 ,m$ic>e cov]age ( c]ta9 m5tal heal? teleheal? s]vices4 ,sec4 #ajd4 ,requir+ prescription drug plan sponsors to include real-"t b5efit in=mation z "p ( su* sponsor's electronic prescription program "u ! ,m$ic>e program4 ,sec4 #aje4 ,transitional cov]age & retroactive ,m$ic>e "p ,d cov]age = c]ta9 l[-income b5efici>ies4 ,title ,,ii--,rural & ,quality ,improvem5ts ,sec4 #bja4 ,m$ic>e ,,gme treatm5t ( hospitals e/abli%+ new m$ical resid5cy tra9+ programs aft] ho/+ m$ical resid5t rotators = %ort durations4 ,sec4 #bjb4 ,ext5sion ( ! "w geographic index floor "u ! ,m$ic>e program4 ,sec4 #bjc4 ,ext5sion ( fund+ = quality measure endorsem5t1 input1 & selection "u ,m$ic>e program4 ,sec4 #bjd4 ,improv+ measurem5ts "u ! skill$ nurs+ facility value-bas$ pur*as+ program "u ! ,m$ic>e program4 ,i ,pati5t ,improvem5ts #aja4 ,b5efici>y enrollm5t notification & eligibility simplification 7a7 ,eligibility & enrollm5t notices 7#a7 ,z "p ( social security acc\nt /atem5t = individuals atta9+ ages #fc to #fe ,section #aadc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;a77 is am5d$ 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$ic>e program "u title ,,xviii1 & 9 p>ticul> b5efits "u "p ,b ( su* title2 7ii7 ! reasons a late enrollm5t p5alty = failure to timely enroll c\ld be assess$ & h[ su* late enrollm5t p5alty is calculat$1 9 p>ticul> = b5efits "u "p ,b2 7iii7 ! availability ( relief f ! late enrollm5t p5alty & retroactive enrollm5t "u section #ahcg7;h7 7includ+ z su* section is appli$ "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$2 7iv7 ! ne$ = coord9ation ( b5efits 7includ+ prim>y & second>y cov]age sc5>ios7 pursuant to section #ahfb1 9 p>ticul> = b5efits "u "p ,b ( su* title2 & 7v7 populations1 su* z resid5ts ( ,pu]to ,rico & vet]ans1 = :om !re are special consid]ations ) respect to enrollm5t "u title ,,xviii4 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 two 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 solicit recomm5dations on ! 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 = consultation ,= purposes ( subp>agraph 7,c77ii71 ! gr\ps describ$ 9 ?is clause 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 ensure t ! notice be+ us$ "u subp>agraph 7,a7 is po/$ 9 a prom95t location on ! public ,int]net website ( ! ,social ,security ,adm9i/ration & on ! public ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 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 :i* %all provide fund+ to cov] ! adm9i/rative co/s ( ! ,commission]'s activities "u ?is p>agraph4 ,su* agreem5t %all-- 7,i7 provide funds to ! ,commission] = ! full co/ ( ! ,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+ & 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>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 ,individuals 9 m$ic>e wait+ p]iod ,title ,,xi ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is am5d$ by ins]t+ aft] section #aadd ! foll[+ new section3 #aadd;,a4 ,m$ic>e enrollm5t notification & eligibility notices = individuals 9 m$ic>e wait+ p]iod 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 9 ! #bd-mon? wait+ p]iod "u section #bbf7;b74 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 ensure t ! notice be+ us$ "u p>agraph 7#a7 is po/$ 9 a prom95t location on ! public ,int]net website ( ! ,social ,security ,adm9i/ration & on ! public ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 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 no less ?an two times 9 accordance ) ! foll[+3 7#a7 ,! notice %all be provid$ to su* individual n lat] ?an #c mon?s prior to ! date on :i* su* individual's enrollm5t p]iod beg9s z provid$ "u section #ahcg4 7#b7 ,! notice %all subsequ5tly be provid$ to su* individual n lat] ?an "o mon? prior to su* date4 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 :i* %all provide fund+ to cov] ! adm9i/rative co/s ( ! ,commission]'s activities "u ?is section4 ,su* agreem5t %all-- 7,a7 provide funds to ! ,commission] = ! full co/ ( ! ,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+ & reconciliation ( ! actual co/s incurr$ & funds provid$ "u ?is section4 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 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$-- 7,a7 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 7,a7 9 ! case ( an individual :o enrolls pursuant to subsection 7d7 ( section #ahcg be=e ! mon? 9 :i* he fir/ satisfies p>agraph 7#a7 or 7#b7 ( section #ahcf1 ! fir/ day ( su* mon?1 7,b7 9 ! case ( an individual :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ be=e ,janu>y #bjba & :o enrolls pursuant to su* subsection 7d7-- 7i7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 7ii7 9 ! mon? foll[+ su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! second mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7iii7 m ?an "o mon? foll[+ su* mon? 9 :i* he satisfies su* p>agraph1 ! fir/ day ( ! ?ird mon? foll[+ ! mon? 9 :i* he s enrolls1 7,c7 9 ! case ( an individual :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ on or aft] ,janu>y #a1 #bjba1 & :o enrolls pursuant to su* subsection 7d7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph or 9 any subsequ5t mon? ( 8 initial enrollm5t p]iod1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7,d7 9 ! case ( an individual :o enrolls pursuant to subsection 7e7 ( section #ahcg 9 a mon? beg9n+-- 7i7 be=e ,janu>y #a1 #bjba1 ! ,july #a foll[+ ! mon? 9 :i* he s enrolls1 or 7ii7 on or aft] ,janu>y #a1 #bjba1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 or 2 & 7,b7 by am5d+ p>agraph 7#c7 to read z foll[s3 7#c7 9 ! case ( an individual :o is deem$ to h enroll$-- 7,a7 on or be=e ! la/ day ( ! ?ird mon? ( 8 initial enrollm5t p]iod1 ! fir/ day ( ! mon? 9 :i* he fir/ meets ! applicable requirem5ts ( section #ahcf or ,july #a1 #aigc1 :i*ev] is lat]1 or 7,b7 on or aft] ! fir/ day ( ! f\r? mon? ( 8 initial enrollm5t p]iod1 & :]e su* mon? beg9s-- 7i7 be=e ,janu>y #a1 #bjba1 z prescrib$ "u subp>agraphs 7,b77i71 7,b77ii71 7,b77iii71 & 7,d7 ( p>agraph 7#b71 or 7ii7 on or aft] ,janu>y #a1 #bjba1 z prescrib$ "u p>agraph 7#b77;,c74 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 #bjba1 ! ,secret>y may e/abli% special enrollm5t p]iods 9 ! case ( individuals :o meet su* exceptional conditions z ! ,secret>y may provide1 su* z individuals :o reside 9 an area ) an em]g5cy or disa/] z det]m9$ by ! ,secret>y4 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 ,section #ahci7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$1 9 ! fir/ s5t5ce1 by /rik+ or 7l7 & ins]t+ 1 7l71 or 7m74 7#c7 ,te*nical correction ,section #ahci7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$ by add+ at ! end ! foll[+ new s5t5ce3 ,= purposes ( det]m9+ any increase "u ?is subsection = individuals ^: enrollm5t occurs on or aft] ,janu>y #a1 #bjba1 ! 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 #bjba1 ! ,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 includ+ recomm5dations on h[ to align exi/+ ,m$ic>e enrollm5t p]iods "u title ,,xviii ( ! ,social ,security ,act1 includ+ ! g5]al enrollm5t p]iod "u "p ,b ( su* title & ! annual election p]iod "u ! ,m$ic>e ,advantage program "u "p ,c ( su* title & "u ! prescription drug program "u "p ,d ( su* title4 ,su* recomm5dations %all be consi/5t ) ! goals ( maximiz+ cov]age cont9uity & *oice & eas+ b5efici>y transition4 #ajb4 ,ext5sion ( fund+ outrea* & assi/ance = l[-income programs 7a7 ,additional fund+ = ,/ate heal? insurance programs ,subsection 7a77#a77;,b7 ( section #aai ( ! ,m$ic>e ,improvem5ts = ,pati5ts & ,provid]s ,act ( #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 z am5d$ by section #ccjf ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh71 section #faj ( ! ,am]ican ,taxpay] ,relief ,act ( #bjab 7,public ,law #aab-bdj71 section #aaaj ( ! ,pa?way = ,,sgr ,re=m ,act ( #bjac 7,public ,law #aac-fg71 section #aaj ( ! ,protect+ ,access to ,m$ic>e ,act ( #bjad 7,public ,law #aac-ic71 section #bjh ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj71 & section #ejbjg ( ! ,bip>tisan ,budget ,act ( #bjah 7,public ,law #aae-abc71 is am5d$-- 7#a7 9 clause 7vii71 by /rik+ & at ! end2 7#b7 9 clause 7viii71 by /rik+ & at ! end2 7#c7 9 clause 7ix71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#d7 by ins]t+ aft] clause 7ix7 ! foll[+ new clause3 7x7 = ea* ( fiscal ye>s #bjbj ?r\gh #bjbb1 ( #ae1jjj1jjj4 4 7b7 ,additional fund+ = area ag5cies on ag+ ,subsection 7b77#a77;,b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7vii71 by /rik+ & at ! end2 7#b7 9 clause 7viii71 by /rik+ & at ! end2 7#c7 9 clause 7ix71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#d7 by ins]t+ aft] clause 7ix7 ! foll[+ new clause3 7x7 = ea* ( fiscal ye>s #bjbj ?r\gh #bjbb1 ( #ae1jjj1jjj4 4 7c7 ,additional fund+ = ag+ & disability res\rce c5t]s ,subsection 7c77#a77;,b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7vii71 by /rik+ & at ! end2 7#b7 9 clause 7viii71 by /rik+ & at ! end2 7#c7 9 clause 7ix71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#d7 by ins]t+ aft] clause 7ix7 ! foll[+ new clause3 7x7 = ea* ( fiscal ye>s #bjbj ?r\gh #bjbb1 ( #e1jjj1jjj4 4 7d7 ,additional fund+ = contract ) ! national c5t] = b5efits & outrea* enrollm5t ,subsection 7d77#b7 ( su* section #aai1 z s am5d$1 is am5d$-- 7#a7 9 clause 7vii71 by /rik+ & at ! end2 7#b7 9 clause 7viii71 by /rik+ & at ! end2 7#c7 9 clause 7ix71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7#d7 by ins]t+ aft] clause 7ix7 ! foll[+ new clause3 7x7 = ea* ( fiscal ye>s #bjbj ?r\gh #bjbb1 ( #ae1jjj1jjj4 4 #ajc4 ,m$ic>e cov]age ( c]ta9 m5tal heal? teleheal? s]vices ,section #ahcd7m7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77 is am5d$-- 7#a7 9 p>agraph 7#b77;,b77i71 by /rik+ & p>agraph 7#f77;,c7 & ins]t+ 1 p>agraph 7#f77;,c71 & p>agraph 7#h77;,c72 7#b7 9 p>agraph 7#d77;,c77i71 by /rik+ & 7#g7 & ins]t+ 7#g71 & 7#h72 7#c7 9 p>agraph 7#d77;,f77i71 by ins]t+ s]vices id5tifi$ by ,,cpt codes #ijhcd & #ijhcg 7& z subsequ5tly modifi$ by ! ,secret>y71 be=e & any additional s]vice2 7#d7 9 p>agraph 7#f77;,a71 by /rik+ p>agraph 7#d77;,c7 & ins]t+ p>agraph 7#d77;,c77i72 7#e7 9 p>agraph 7#g71 by /rik+ ,! geographic requirem5ts & ins]t+ ,subject to p>agraph 7#h77;,d71 ! geographic requirem5ts2 & 7#f7 by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,treatm5t ( m5tal heal? teleheal? s]vices 7,a7 ,non-application ( orig9at+ site requirem5ts ,! requirem5ts describ$ 9 p>agraph 7#d77;,c77i7 %all n apply ) respect to teleheal? s]vices furni%$ on or aft] ,janu>y #a1 #bjbj1 t are m5tal heal? teleheal? s]vices4 ,no?+ 9 ! previ\s s5t5ce %all waive any applicable ,/ate law requirem5ts4 7,b7 ,inclusion ( c]ta9 sites ,) respect to teleheal? s]vices describ$ 9 subp>agraph 7,a71 ! t]m orig9at+ site %all include ! home ( ! eligible teleheal? individual at :i* ! individual is locat$ at ! "t ! s]vice is furni%$ via a telecommunications sy/em4 7,c7 ,no orig9at+ site facility fee ,no facility fee %all be paid "u p>agraph 7#b77;,b7 to an orig9at+ site ) respect to a teleheal? s]vice describ$ 9 subp>agraph 7,a7 if ! orig9at+ site does n o!rwise meet ! requirem5ts = an orig9at+ site "u p>agraph 7#d77;,c74 7,d7 ,face-to-face initial assessm5t2 reassessm5ts ,paym5t may n be made = m5tal heal? teleheal? s]vices "u ?is p>agraph 7if su* paym5t w\ld n o!rwise be all[$ "u ?is subsection )\t application ( ?is p>agraph or p>agraph 7#g77 furni%$ to an eligible teleheal? individual unless-- 7i7 )9 ! #f-mon? p]iod prior to ! provision ( su* m5tal heal? teleheal? s]vices1 ! individual receives a face-to-face cl9ical assessm5t1 )\t ! use ( teleheal?1 by a physician describ$ 9 subp>agraph 7,f77i7 or a practition] describ$ 9 subp>agraph 7,f77ii7 ( ! ne$s ( su* individual = su* s]vices2 & 7ii7 ! individual receives a reassessm5t 7at a frequ5cy specifi$ by ! ,secret>y7 by a physician s describ$ or a practition] s describ$ ( ! ne$s ( su* individual = su* s]vices4 7,e7 ,m5tal heal? teleheal? s]vices def9$ ,= purposes ( ?is p>agraph1 ! t]m m5tal heal? teleheal? s]vice means s]vices id5tifi$ by ,,cpt codes #ijhcd & #ijhcg 7& z subsequ5tly modifi$ by ! ,secret>y74 7,f7 ,physician & practition] describ$ ,= purposes ( subp>agraph 7,d73 7i7 ,physician ,a physician describ$ 9 ?is clause is a physician1 z def9$ 9 section #ahfa7r77#a74 7ii7 ,practition] ,a practition] describ$ 9 ?is clause is a practition] describ$ 9 any ( clauses 7i71 7iv71 or 7v7 ( section #ahdb7;b77#ah77;,c74 4 #ajd4 ,requir+ prescription drug plan sponsors to include real-"t b5efit in=mation z "p ( su* sponsor's electronic prescription program "u ! ,m$ic>e program ,section #ahfj;,d-#d7;e77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;e77#b77 is am5d$-- 7#a7 9 subp>agraph 7,d71 by /rik+ ,to ! ext5t & ins]t+ ,except z provid$ 9 subp>agraph 7,f71 to ! ext5t2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ,real-"t b5efit in=mation 7i7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjba1 ! program %all provide = ! real-"t electronic transmission to prescrib+ heal? c>e pr(essionals1 us+ te*nology capable ( integrat+ ) su* pr(essionals' electronic prescrib+ & electronic heal? record sy/ems1 ( individual-specific =mul>y & b5efit in=mation "u a prescription drug plan ) respect to an individual enroll$ 9 su* plan4 ,su* in=mation %all include1 ) respect to ! prescrib+ ( a cov]$ "p ,d drug to su* individual1 ! foll[+3 7,i7 ,a description ( any cl9ically-appropriate alt]natives to su* drug includ$ 9 ! =mul>y ( su* plan4 7,,ii7 ,in=mation relat+ to applicable co/-%>+ requirem5ts = su* drug & su* alt]natives1 includ+ a description ( any v>iance 9 su* requirem5ts bas$ on ! ph>macy disp5s+ su* drug or su* alt]natives4 7,,iii7 ,in=mation relat+ to any prior au?orization or o!r utilization managem5t requirem5ts applicable to su* drug & su* alt]natives )9 ! =mul>y ( su* plan4 7ii7 ,special rule = #bjba ,! program %all be deem$ to be 9 compliance ) clause 7i7 = #bjba if ! program complies ) ! provisions ( section #dbc4afj7;b77#g7 ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation71 = su* ye>4 4 #aje4 ,transitional cov]age & retroactive ,m$ic>e "p ,d cov]age = c]ta9 l[-income b5efici>ies ,section #ahfj;,d-#ad ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is am5d$-- 7#a7 by r$esignat+ subsection 7e7 z subsection 7f72 & 7#b7 by add+ aft] subsection 7d7 ! foll[+ new subsection3 7e7 ,limit$ income newly eligible transition program 7#a7 ,9 g5]al ,beg9n+ n lat] ?an ,janu>y #a1 #bjba1 ! ,secret>y %all c>ry out a program to provide transitional cov]age = cov]$ "p ,d drugs = ,,li ,,net eligible individuals 9 accordance ) ?is subsection4 7#b7 ,,li net eligible individual def9$ ,= purposes ( ?is subsection1 ! t]m ,,li ,,net eligible individual means a "p ,d eligible individual :o-- 7,a7 meets ! requirem5ts ( clauses 7ii7 & 7iii7 ( subsection 7a77#c77;,a72 & 7,b7 has n yet enroll$ 9 a prescription drug plan or an ,,ma-,,pd plan1 or1 :o has s enroll$1 b ) respect to :om cov]age "u su* plan has n yet tak5 effect4 7#c7 ,transitional cov]age ,= purposes ( ?is subsection1 ! t]m transitional cov]age means ) respect to an ,,li ,,net eligible individual-- 7,a7 imm$iate access to cov]$ "p ,d drugs at ! po9t ( sale dur+ ! p]iod t beg9s on ! fir/ day ( ! mon? su* individual is det]m9$ to meet ! requirem5ts ( clauses 7ii7 & 7iii7 ( subsection 7a77#c77;,a7 & ends on ! date t cov]age "u a prescription drug plan or ,,ma-,,pd plan takes effect ) respect to su* individual2 & 7,b7 9 ! case ( an ,,li ,,net eligible individual :o is a full-b5efit dual eligible individual 7z def9$ 9 section #aice7;c77#f77 or a recipi5t ( supplem5tal security income b5efits "u title ,,xvi1 retroactive cov]age 79 ! =m ( reimbursem5t ( ! am\nts t w\ld h be5 paid "u ?is "p _h su* individual be5 enroll$ 9 a prescription drug plan or ,,ma-,,pd plan7 ( cov]$ "p ,d drugs pur*as$ by su* individual dur+ ! p]iod t beg9s on ! date t is ! lat] (-- 7i7 ! date t su* individual 0 fir/ eligible = a l[-income subsidy "u ?is "p2 or 7ii7 ! date t is #cf mon?s prior to ! date su* individual enrolls 9 a prescription drug plan or ,,ma-,,pd plan1 & ends on ! date t cov]age "u su* plan takes effect4 7#d7 ,program adm9i/ration 7,a7 ,s+le po9t ( contact ,! ,secret>y %all1 to ! ext5t feasible1 adm9i/] ! program "u ?is subsection ?r\gh a contract ) a s+le program adm9i/rator4 7,b7 ,b5efit design ,! ,secret>y %all ensure t ! transitional cov]age provid$ to ,,li ,,net eligible individuals "u ?is subsection-- 7i7 provides access to all cov]$ "p ,d drugs "u an op5 =mul>y2 7ii7 p]mits all ph>macies det]m9$ by ! ,secret>y to be 9 good /&+ to process claims "u ! program2 7iii7 is consi/5t ) su* requirem5ts z ! ,secret>y consid]s necess>y to improve pati5t safety & ensure appropriate disp5s+ ( m$ication2 & 7iv7 meets su* o!r requirem5ts z ! ,secret>y may e/abli%4 7#e7 ,relation%ip to o!r provisions ( ?is title2 waiv] au?ority 7,a7 ,9 g5]al ,! foll[+ provisions %all n apply ) respect to ! program "u ?is subsection3 7i7 ,p>agraphs 7#a7 & 7#c77;,b7 ( section #ahfj;,d-#d7;a7 7relat+ to dissem9ation ( g5]al in=mation2 availability ( in=mation on *anges 9 =mul>y ?r\gh ! ,int]net74 7ii7 ,subp>agraphs 7,a7 & 7,b7 ( section #ahfj;,d-#d7;b77#c7 7relat+ to requirem5ts on developm5t & application ( =mul>ies2 =mul>y developm5t74 7iii7 ,p>agraphs 7#a77;,c7 & 7#b7 ( section #ahfj;,d-#d7;c7 7relat+ to m$ication !rapy managem5t program74 7,b7 ,waiv] au?ority ,! ,secret>y may waive su* o!r requirem5ts ( title ,,xi & ?is title z may be necess>y to c>ry out ! purposes ( ! program e/abli%$ "u ?is subsection4 4 ,,ii ,rural & ,quality ,improvem5ts #bja4 ,m$ic>e ,,gme treatm5t ( hospitals e/abli%+ new m$ical resid5cy tra9+ programs aft] ho/+ m$ical resid5t rotators = %ort durations 7a7 ,r$et]m9ation ( approv$ ,,fte resid5t am\nt ,section #ahhf7;h77#b77;,f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#b77;,f77 is am5d$-- 7#a7 by ins]t+ 7i7 be=e ,9 ! case (2 & 7#b7 by add+ at ! end ! foll[+3 7ii7 ,9 apply+ ?is subp>agraph 9 ! case ( a hospital t1 on or aft] ! date ( ! enactm5t ( ?is clause1 beg9s to tra9 resid5ts & has n ent]$ into a ,,gme affiliation agreem5t 7z def9$ by ! ,secret>y = purposes ( p>agraph 7#d77;,h77ii771 ! ,secret>y %all n e/abli% an ,,fte resid5t am\nt until su* "t z ! ,secret>y det]m9es t ! hospital has tra9$ at lea/ #a4j full-"t-equival5t resid5t 9 an approv$ m$ical resid5cy tra9+ program 9 a co/ report+ p]iod4 7iii7 ,9 apply+ ?is subp>agraph = co/ report+ p]iods beg9n+ on or aft] ! date ( enactm5t ( ?is clause1 9 ! case ( a hospital t1 z ( su* date ( enactm5t1 has an approv$ ,,fte resid5t am\nt bas$ on ! tra9+ 9 an approv$ m$ical resid5cy program (-- 7,i7 less ?an #a4j full-"t-equival5t resid5t 9 any co/ report+ p]iod beg9n+ be=e ,octob] #a1 #aiig1 z det]m9$ by ! ,secret>y2 or 7,,ii7 no m ?an #c4j full-"t-equival5t resid5ts 9 any co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #aiig1 & be=e ! date ( ! enactm5t ( ?is clause1 z det]m9$ by ! ,secret>y1 9 lieu ( su* ,,fte resid5t am\nt ! ,secret>y %all1 9 accordance ) ! me?odology describ$ 9 section #dac4gg7;e7 ( title #db ( ! ,code ( ,f$]al ,regulations 7or any successor regulation71 e/abli% a new ,,fte resid5t am\nt if ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5t 79 ! case ( a hospital describ$ 9 subclause 7,i77 or m ?an #c4j full-"t-equival5t resid5ts 79 ! case ( a hospital describ$ 9 subclause 7,,ii77 9 a co/ report+ p]iod beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7iv7 ,= purposes ( c>ry+ out ?is subp>agraph = co/ report+ p]iods beg9n+ on or aft] ! date ( ! enactm5t ( ?is clause1 a hospital %all report full-"t-equival5t resid5ts on its co/ report = a co/ report+ p]iod if ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5t 9 an approv$ m$ical resid5cy tra9+ program 9 su* p]iod4 7v7 ,z appropriate1 ! ,secret>y may consid] in=mation f any co/ report+ p]iod necess>y to e/abli% a new ,,fte resid5t am\nt z describ$ 9 clause 7iii74 4 7b7 ,r$et]m9ation ( ,,fte resid5t limitation ,section #ahhf7;h77#d77;,h77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#d77;,h77i77 is am5d$-- 7#a7 by ins]t+ 7,i7 be=e ,! ,secret>y2 & 7#b7 by add+ at ! end ! foll[+3 7,,ii7 ,9 apply+ ?is clause 9 ! case ( a hospital t1 on or aft] ! date ( ! enactm5t ( ?is subclause1 beg9s to tra9 resid5ts 9 a new approv$ m$ical resid5cy tra9+ program 7z def9$ by ! ,secret>y71 ! ,secret>y %all n det]m9e a limitation applicable to ! hospital "u subp>agraph 7,f7 until su* "t z ! ,secret>y det]m9es t ! hospital has tra9$ at lea/ #a4j full-"t-equival5t resid5t 9 su* new approv$ m$ical resid5cy tra9+ program 9 a co/ report+ p]iod4 7,,iii7 ,9 apply+ ?is clause 9 ! case ( a hospital t1 z ( ! date ( ! enactm5t ( ?is subclause1 has a limitation "u subp>agraph 7,f71 bas$ on a co/ report+ p]iod beg9n+ be=e ,octob] #a1 #aiig1 ( less ?an #a4j full-"t-equival5t resid5t1 ! ,secret>y %all adju/ ! limitation 9 ! mann] applicable to a new approv$ m$ical resid5cy tra9+ program if ! ,secret>y det]m9es ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5t 9 a program ye> beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7,,iv7 ,9 apply+ ?is clause 9 ! case ( a hospital t1 z ( ! date ( ! enactm5t ( ?is subclause1 has a limitation "u subp>agraph 7,f71 bas$ on a co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #aiig1 & be=e su* date ( enactm5t1 ( no m ?an #c4j full-"t-equival5t resid5ts1 ! ,secret>y %all adju/ ! limitation 9 ! mann] applicable to a new approv$ m$ical resid5cy tra9+ program if ! ,secret>y det]m9es ! hospital beg9s tra9+ m ?an #c4j full-"t-equival5t resid5ts 9 a program ye> beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7,v7 ,an adju/m5t to ! limitation applicable to a hospital made pursuant to subclause 7,,iii7 or 7,,iv7 %all be made 9 a mann] consi/5t ) ! me?odology1 z appropriate1 9 section #dac4gi7;e7 ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation74 ,z appropriate1 ! ,secret>y may consid] in=mation f any co/ report+ p]iods necess>y to make su* an adju/m5t to ! limitation4 4 7c7 ,te*nical & con=m+ am5dm5ts ,section #ahhf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is am5d$-- 7#a7 9 subsection 7d77#e77;,b77viii71 by /rik+ subsection 7h77#d77;,h7 & ins]t+ p>agraphs 7#b77;,f77iv7 & 7#d77;,h7 ( subsection 7h72 & 7#b7 9 subsection 7h7-- 7,a7 9 p>agraph 7#d77;,h77iv71 by /rik+ an rural area & ins]t+ a rural area2 & 7,b7 9 p>agraph 7#g77;,e71 by /rik+ "u ?is & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 "u ?is p>agraph1 p>agraph 7#h71 clause 7i71 7ii71 7iii71 or 7v7 ( p>agraph 7#b77;,f71 or clause 7i7 or 7vi7 ( p>agraph 7#d77;,h744 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to paym5t "u section #ahhf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 = co/ report+ p]iods beg9n+ on or aft] ! date ( ! enactm5t ( ?is ,act4 #bjb4 ,ext5sion ( ! "w geographic index floor "u ! ,m$ic>e program ,section #ahdh7;e77#a77;,e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;e77#a77;,e77 is am5d$ by /rik+ #bjbj & ins]t+ #bjbc4 #bjc4 ,ext5sion ( fund+ = quality measure endorsem5t1 input1 & selection "u ,m$ic>e program 7a7 ,9 g5]al ,section #ahij7;d77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7d77#b77 is am5d$-- 7#a7 by /rik+ & #g1ejj1jjj & ins]t+ #g1ejj1jjj2 & 7#b7 by /rik+ & #bjai4 & ins]t+ & #bjai1 & #cj1jjj1jjj = ea* ( fiscal ye>s #bjbj ?r\gh #bjbb44 7b7 ,input = removal ( measures ,section #ahij7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is am5d$ by ins]t+ aft] p>agraph 7#c7 ! foll[+3 7#d7 ,removal ( ,measures ,! entity may provide input to ! ,secret>y on quality & effici5cy measures describ$ 9 p>agraph 7#g77;,b7 t c\ld be consid]$ = removal4 4 7c7 ,prioritization ( measure endorsem5t ,section #ahij7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;aaa7b77 is am5d$ by add+ at ! end ! foll[+3 7#i7 ,prioritization ( measure endorsem5t ,! ,secret>y-- 7,a7 dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is p>agraph & end+ on ,decemb] #ca1 #bjbc1 %all prioritize ! endorsem5t ( measures relat+ to mat]nal morbidity & mortality by ! entity ) a contract "u subsection 7a7 9 connection ) endorsem5t ( measures describ$ 9 p>agraph 7#b72 & 7,b7 on & aft] ,janu>y #a1 #bjbd1 may prioritize ! endorsem5t ( su* measures by su* entity4 4 #bjd4 ,improv+ measurem5ts "u ! skill$ nurs+ facility value-bas$ pur*as+ program "u ! ,m$ic>e program 7a7 ,9 g5]al ,section #ahhh7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7h77 is am5d$-- 7#a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,exclusions ,) respect to paym5ts = s]vices furni%$ on or aft] ,octob] #a1 #bjba1 ?is subsection %all n apply to a facility = :i* !re are n a m9imum numb] 7z det]m9$ by ! ,secret>y7 (-- 7i7 cases = ! measures t apply to ! facility = ! p]=mance p]iod = ! applicable fiscal ye>2 or 7ii7 measures t apply to ! facility = ! p]=mance p]iod = ! applicable fiscal ye>4 2 7#b7 9 p>agraph 7#b77;,a7-- 7,a7 by /rik+ ,! ,secret>y %all apply & ins]t+ ,! ,secret>y-- 7i7 %all apply 2 7,b7 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+3 7ii7 may1 ) respect to paym5ts = s]vices furni%$ on or aft] ,octob] #a1 #bjbb1 apply additional measures det]m9$ appropriate by ! ,secret>y1 :i* may include measures ( functional /atus1 pati5t safety1 c>e coord9ation1 or pati5t exp]i5ce4 ,subject to ! succe$+ s5t5ce1 9 ! case t ! ,secret>y applies additional measures "u clause 7ii71 ! ,secret>y %all consid] & apply1 z appropriate1 quality measures specifi$ "u section #ahii;,b7c77#a74 ,9 no case may ! ,secret>y apply m ?an #aj measures "u ?is subp>agraph4 2 7#c7 9 subp>agraph 7,a7 ( ea* ( p>agraphs 7#c7 & 7#d71 by /rik+ measure & ins]t+ measures2 & 7#d7 by add+ at ! end ! foll[+ new p>agraph3 7#ab7 ,validation 7,a7 ,9 g5]al ,! ,secret>y %all apply to ! measures appli$ "u ?is subsection & ! data submitt$ "u subsection 7e77#f7 a process to validate su* measures & data1 z appropriate1 :i* may be simil> to ! process specifi$ 9 section #ahhf7;b77#c77;,b77viii77,,xi7 = validat+ inpati5t hospital measures4 7,b7 ,fund+ ,= purposes ( c>ry+ out ?is p>agraph1 ! ,secret>y %all provide = ! transf]1 f ! ,f$]al ,hospital ,insurance ,tru/ ,fund e/abli%$ "u section #ahag1 ( #e1jjj1jjj to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,program ,managem5t ,acc\nt = ea* ( fiscal ye>s #bjbb ?r\gh #bjbd4 4 7b7 ,report by ,med,p,a,c ,n lat] ?an ,m>* #ae1 #bjba1 ! ,m$ic>e ,paym5t ,advisory ,commission %all submit to ,congress a report on e/abli%+ a prototype value-bas$ paym5t program "u a unifi$ prospective paym5t sy/em = po/-acute c>e s]vices "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,su* report-- 7#a7 %all-- 7,a7 consid] design elem5ts su* z-- 7i7 measures t are important to ! ,m$ic>e program & to b5efici>ies "u su* program2 7ii7 me?odologies = scor+ provid] p]=mance & effects on paym5t2 & 7iii7 o!r elem5ts det]m9$ appropriate by ! ,commission2 & 7,b7 analyze ! effects ( implem5t+ su* prototype program2 & 7#b7 may-- 7,a7 discuss ! possible effects1 ) respect to ! ,m$ic>e program1 on program sp5d+1 po/-acute c>e provid]s1 pati5t outcomes1 & o!r effects det]m9$ appropriate by ! ,commission2 & 7,b7 include recomm5dations ) respect to su* prototype program1 z det]m9$ appropriate by ! ,commission1 to ,congress & ! ,secret>y ( ,heal? & ,human ,s]vices4