,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #ejaj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #h1 #bjai,mr4
 ,khanna 7= himself1 ,ms4 ,jayapal1 ,mr4
 ,blum5au]1 ,ms4 ,bonamici1 ,mr4        
,de,fazio1 ,mr4 ,g>ca ( ,ill9ois1 ,mr4  
,grijalva1 ,ms4 ,lee ( ,cali=nia1 ,ms4  
,ocasio-,cortez1 ,ms4 ,om>1 ,mr4 ,pocan1
 ,ms4 ,pressley1 ,mr4 ,rask91 ,ms4      
,s*ak[sky1 ,mr4 ,smi? ( ,wa%+ton1 &     
,mrs4 ,watson ,coleman7 introduc$ !     
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means1 ,ov]sight & ,re=m1 ,arm$        
,s]vices1 & ,education & ,labor1 = 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 ,i ( ! ,pati5t ,protection &      
,af=dable ,c>e ,act to au?orize !       
e/abli%m5t (1 & provide support =1      
,/ate-bas$ univ]sal heal? c>e sy/ems t  
provide compreh5sive heal? b5efits to   

,/ate resid5ts1 & = o!r purposes4  #a4  
,%ort title2 purpose  7a7 ,%ort title   
,?is ,act may be cit$ z ! ,/ate-,bas$   
,univ]sal ,heal? ,c>e ,act ( #bjai4  7b7
 ,purpose ,! purpose ( ?is ,act is to   
e/abli% a flexible framework "u :i*     
,/ates c provide compreh5sive univ]sal  
heal? cov]age to _! resid5ts4  #b4      
,waiv] = ,/ate univ]sal heal? c>e  7a7  
,9 g5]al ,subtitle ,d ( title ,i ( !    
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjba et seq47 is  
am5d$ by ins]t+ aft] section #accd !    
foll[+ new section3  #acce4 ,waiv] =    
,/ate univ]sal heal? c>e  7a7           
,application  7#a7 ,9 g5]al ,subject to 
p>agraph 7#f71 a ,/ate may apply to !   
,secret>y 7z def9$ 9 subsection 7i77#c77
 = ! waiv] ( s mu* ( ! requirem5ts      
describ$ 9 p>agraph 7#b7 ) respect to   
heal? b5efits cov]age )9 ! ,/ate = plan 
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjbj1 z is necess>y to implem5t a      
compreh5sive ,/ate univ]sal heal? c>e   
plan 9 ! ,/ate "u ?is section4 ,su*     

application %all--  7,a7 be fil$ at su* 
"t & 9 su* mann] z ! ,secret>y may      
require2  7,b7 conta9 su* in=mation z ! 
,secret>y may require1 includ+--  7i7 a 
compreh5sive description ( ! ,/ate      
legislation1 or o!r ,/ate legal au?ority
 z applicable1 & program to implem5t a  
plan meet+ ! requirem5ts = a waiv] "u   
?is section2  7ii7 a plan = h[ ! ,/ate w
 a*ieve 9 #e ye>s heal? cov]age = at    
lea/ #ie p]c5t ( resid5ts ( ! ,/ate2 &  
7iii7 a #aj-;fiscal-ye> budget plan =   
su* plan t is budget neutral = ! ,f$]al 
,gov]nm5t2 &  7,c7 provide an assurance 
t ! ,/ate has legal au?ority to implem5t
 su* plan or has enact$ ! law describ$ 9
 subsection 7b77#b74  7#b7 ,requirem5ts 
,! requirem5ts describ$ 9 ?is p>agraph )
 respect to heal? b5efits cov]age )9 !  
,/ate = plan ye>s beg9n+ on or aft]     
,janu>y #a1 #bjbj1 are z foll[s3  7,a7  
,sections #acja ?r\gh #acbd4  7,b7      
,section #adjb4  7,c7 ,sections #cf;,b &
 #dihj;,h ( ! ,int]nal ,rev5ue ,code (  
#aihf4  7,d7 ,title ,,xi ( ! ,social    

,security ,act4  7,e7 ,title ,,xviii ( !
 ,social ,security ,act4  7,f7 ,title   
,,xix ( ! ,social ,security ,act4  7,g7 
,title ,,xxi ( ! ,social ,security ,act4
  7,h7 ,*apt] #hi ( title #e1 ,unit$    
,/ates ,code4  7,i7 ,*apt] #ee ( title  
#aj1 ,unit$ ,/ates ,code1 includ+       
cov]age "u ! ,,tric>e program4  7,j7    
,section #ead ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd4  7#c7   
,pas/hr\gh ( fund+ ,) respect to a ,/ate
 waiv] "u p>agraph 7#a71 "u :i* ! ,/ate 
assumes responsibility = heal? cov]age  
"u "o or m ( ! specifi$ ,f$]al heal?    
programs1 includ+ "u ea* ( ! ,f$]al     
heal? c>e or subsidy programs specifi$ 9
 subp>agraphs 7,a71 7,b71 7,c71 7,e71   
7,f71 7,g71 7,h71 & 7,i7 ( p>agraph     
7#b71 ! ,secret>y %all n sp5d ,f$]al    
heal? or relat$ adm9i/rative funds t    
w\ld o!rwise h be5 sp5t = su* a program1
 z applicable1 = ! "t p]iods cov]$ "u ! 
waiv] & %all provide = an alt]native    
means by :i* ! aggregate am\nt ( su*    
funds 7det]m9$ by ! ,secret>y 9         

coord9ation ) ! ,/ate71 includ+ caseload
 gr[?1 adju/$ = inflation 9 heal? c>e   
co/s )9 ! ,/ate1 %all be paid to ! ,/ate
 = purposes ( implem5t+ ! ,/ate plan "u 
! waiv]4 ,any sav+s 9 heal? c>e sp5d+1  
includ+ adm9i/rative sav+s1 %all be     
available to ! ,/ate = re9ve/m5t 9 heal?
 c>e s]vices "u ! ,/ate plan4 ,su* am\nt
 %all be det]m9$ annually by !          
,secret>y1 tak+ into acc\nt ! am\nt t   
w\ld o!rwise h be5 sp5t "u ea* su*      
,f$]al heal? program1 includ+ =         
adm9i/rative activities & caseload gr[?1
 ) respect to resid5ts ( su* ,/ate1 = ^?
 "t p]iods cov]$ "u ! waiv]1 adju/$ =   
inflation 9 heal? c>e co/s1 if su* waiv]
 did n apply4 ,su* am\nt %all include   
funds equal to ! aggregate am\nt (      
premium tax cr$its1 co/-%>+ r$uctions1  
or small-bus9ess cr$its1 to ! ext5t     
applicable to an approv$ waiv]1 "u      
sections #cf;,b & #de,r ( ! ,int]nal    
,rev5ue ,code ( #aihf or "u section     
#adjb t w\ld h be5 available to         
individuals & bus9esses 9 ! ,/ate = ^?  

"t p]iods cov]$ "u ! waiv]1 includ+     
caseload gr[?1 adju/$ = inflation 9     
heal? c>e co/s1 if su* waiv] did n      
apply4  7#d7 ,waiv] consid]ation &      
transp>5cy  7,a7 ,9 g5]al ,an           
application = a waiv] "u ?is section    
%all be consid]$ by ! ,secret>y1 aft]   
tak+ into acc\nt recomm5dations ( !     
,panel "u subsection 7g71 9 accordance )
 ! regulations describ$ 9 subp>agraph   
7,b74  7,b7 ,regulations ,n lat] ?an    
#ahj days aft] ! date ( ! enactm5t ( !  
,/ate-,bas$ ,univ]sal ,heal? ,c>e ,act (
 #bjai1 ! ,secret>y %all promulgate     
regulations relat+ to waiv]s "u ?is     
section t provide--  7i7 a process =    
public notice & comm5t 9 accordance ) ! 
public notice & comm5t requirem5ts      
applicable "u regulations us$ = ,m$icaid
 waiv]s pursuant to section #aaae ( !   
,social ,security ,act2  7ii7 a process 
= ! submission ( an application t       
ensures ! disclosure (-- 7,i7 !         
provisions ( law t ! ,/ate involv$ seeks
 to waive2 &  7,,ii7 ! specific plans ( 

! ,/ate to ensure t ! waiv] w be 9      
compliance ) subsection 7b72  7iii7 a   
process = provid+ public notice & comm5t
 aft] ! application is receiv$ by !     
,secret>y t is suffici5t to ensure a    
mean+ful level ( public input & t does n
 impose requirem5ts t are 9 addition to1
 or duplicative (1 requirem5ts impos$ "u
 *apt] #e ( title #e1 ,unit$ ,/ates     
,code 7commonly ref]r$ to z !           
,adm9i/rative ,proc$ure ,act71 or       
requirem5ts t are unreasonable or       
unnecess>ily burd5some ) respect to     
,/ate compliance2  7iv7 a process = !   
submission to ! ,secret>y ( p]iodic     
reports by ! ,/ate conc]n+ !            
implem5tation ( ! program "u ! waiv]2   
7v7 a process = ! p]iodic evaluation by 
! ,secret>y ) respect to waiv]s grant$  
"u ?is section2 &  7vi7 a process =     
provid+ te*nical assi/ance on-- 7,i7 h[ 
to develop an application to any ,/ate  
seek+ to submit an application = a waiv]
 relat+ to develop+ a program ( provid+ 
heal? c>e = all resid5ts = su* ,/ate2 & 

7,,ii7 h[ to improve su* a program =    
purposes ( a ,/ate seek+ assi/ance      
pursuant to subsection 7e77#b74  7,c7   
,report ,! ,secret>y %all annually      
report to ,congress conc]n+ actions tak5
 by ! ,secret>y ) respect to            
applications = waiv]s "u ?is section &  
programs conduct$ pursuant to su* waiv]s
 t are approv$4  7#e7 ,regional waiv]   
reque/ & plan ,no?+ 9 ?is section %all  
be con/ru$ to prev5t two or m ,/ates 9 a
 region f submitt+ a s+le application "u
 ?is section = a waiv] t e/abli%es a    
plan t is applicable to all ( ! ,/ates  
includ$ 9 su* application4 ,9 ! case (  
su* an application & plan1 ! requirem5ts
 ( ?is section %all cont9ue to be       
applicable ) respect to ea* ,/ate       
includ$ 9 su* application4  7#f7        
,coord9ation ) #accb waiv]s ,a ,/ate may
 n apply = a waiv] "u ?is section )     
respect to a plan ye> if su* ,/ate has 9
 effect1 ) respect to su* plan ye>1 a   
waiv] "u section #accb4  7#g7           
,au?orization ( appropriations ,!re is  

au?oriz$ to be appropriat$ su* sums z   
may be necess>y = provid+ funds to      
,/ates ) a waiv] "u ?is section =       
purposes ( c>ry+ out activities describ$
 9 subsection 7b77#a77;,e74  7b7 ,grant+
 ( waiv]s  7#a7 ,9 g5]al ,! ,secret>y   
%all grant a reque/ = a waiv] "u        
subsection 7a77#a7 if ! ,secret>y       
det]m9es t ! ,/ate plan--  7,a7 w       
provide1 9 accordance ) subp>agraph     
7,b71 heal? b5efits cov]age to          
applicable ,/ate resid5ts t is at lea/ z
 compreh5sive z ! heal? b5efits cov]age 
t su* resid5ts w\ld h receiv$ "u "o or m
 ( ! specifi$ ,f$]al heal? programs 7z  
def9$ 9 subsection 7i77#d771 z          
applicable1 = :i* su* resid5ts w\ld h   
be5 eligible1 abs5t su* waiv]2  7,b7 w  
provide1 9 ! case ( su* a waiv] "u      
subsection 7a77#a7 = ! ,/ate to waive   
any ( ! requirem5ts describ$ 9          
subsection 7a77#b77;,f71 z applicable1  
heal? b5efits cov]age to applicable     
,/ate resid5ts :o w\ld h o!rwise receiv$
 heal? b5efits cov]age 9 ! =m ( m$ical  

assi/ance "u ! ,/ate ,f$]al heal?       
program describ$ 9 subsection           
7i77#d77;,b7 7reg>dless ( :e!r ! ,/ate  
provides = su* assi/ance ?r\gh a ,/ate  
,m$icaid plan "u title ,,xix ( ! ,social
 ,security ,act or a waiv] ( su* ,/ate  
,m$icaid plan7 t includes at lea/ !     
m&atory b5efits "u title ,,xix ( !      
,social ,security ,act t are requir$ ( a
 ,/ate )\t a waiv] ( a ,/ate ,m$icaid   
plan "u su* title1 includ+ b5efits =    
e>ly & p]iodic scre5+1 diagno/ic1 &     
treatm5t1 b5efits = non-em]g5cy         
transportation1 & retroactive cov]age2  
7,c7 w provide cov]age & co/-%>+        
protections aga9/ excessive out-(-pocket
 sp5d+ to ,/ate resid5ts t are at lea/ z
 af=dable z ! cov]age & co/-%>+         
protections "u ! specifi$ ,f$]al heal?  
program 7z def9$ 9 subsection 7i77#d77 =
 :i* su* resid5ts w\ld h be5 eligible1  
abs5t su* waiv]2  7,d7 w provide cov]age
 to all resid5ts ( ! ,/ate1 includ+ ^?  
o!rwise cov]$ "u "o or m ( ! ,f$]al     
heal? c>e or subsidy programs specifi$ 9

 subp>agraphs 7,b71 7,c71 7,e71 7,f71   
7,g71 & 7,h7 ( subsection 7a77#b71      
except individuals :o are eligible =    
b5efits ?r\gh ! ,indian ,heal? ,s]vice  
or = b5efits & s]vices "u title #ch1    
,unit$ ,/ates ,code2  7,e7 w provide =  
public education activities to raise    
aw>5ess ( ! availability ( qualifi$     
heal? plans & ! facilitation ( enrollm5t
 9 su* cov]age 9 a mann] simil> to an   
entity t s]ves z a navigator "u a grant 
"u section #acaa7;i72  7,f7 w be        
publicly adm9i/]$ by an ag5cy or        
multiple ag5cies ( ! ,/ate1 or an       
indep5d5t public entity )9 ! gov]nm5t ( 
! ,/ate2  7,g7 w n preclude ! pur*ase ( 
insurance t (f]s cov]age = b5efits t are
 n (f]$ "u ! ,/ate plan2 &  7,h7 w      
provide sy/ems = compla9ts1 appeals1    
indep5d5t review1 & o!r proc$ures =     
access+ & ma9ta9+ b5efits t are at lea/ 
z accessible to applicable ,/ate        
resid5ts z ^? ( "o or m ( ! specifi$    
,f$]al heal? programs 7z def9$ 9        
subsection 7i77#d77 = :i* su* resid5ts  

w\ld h o!rwise be5 eligible )\t         
application ( su* waiv] "u subsection   
7a77#a74  ,subp>agraph 7,d7 %all n be   
con/ru$ z limit+ a ,/ate f contract+ )  
"o or m private entities to adm9i/] !   
,/ate plan4  7#b7 ,requirem5t to enact a
 law  7,a7 ,9 g5]al ,a law describ$ 9   
?is p>agraph is a ,/ate law 7includ+ an 
executive ord] by a ,/ate gov]nor7 t    
provides = ,/ate actions "u a waiv] "u  
?is section1 includ+ ! implem5tation ( !
 ,/ate plan "u subsection 7a77#a77;,b74 
7,b7 ,t]m9ation ( opt out ,a ,/ate may  
repeal a law describ$ 9 subp>agraph 7,a7
 & t]m9ate ! au?ority provid$ "u ! waiv]
 ) respect to ! ,/ate4  7c7 ,scope (    
waiv]  7#a7 ,9 g5]al ,! ,secret>y %all  
det]m9e ! scope ( a waiv] ( a requirem5t
 describ$ 9 subsection 7a77#b7 grant$ to
 a ,/ate "u subsection 7a77#a74  7#b7   
,limitation ,"u ?is section1 ! ,secret>y
 may n waive any ,f$]al law or          
requirem5t t is n li/$ 9 subsection     
7a77#b74  7d7 ,det]m9ations by ,secret>y
  7#a7 ,"t = det]m9ation ,! ,secret>y   

%all1 ) respect to an application f a   
,/ate "u ?is section & aft] tak+ into   
acc\nt recomm5dations ( ! ,panel "u     
subsection 7g7 = su* application1 make a
 det]m9ation "u subsection 7a77#a7 n    
lat] ?an #ij days aft] ! receipt ( su*  
recomm5dations4  7#b7 ,effect (         
det]m9ation  7,a7 ,grant+ ( waiv]s ,if !
 ,secret>y det]m9es to grant a waiv] "u 
subsection 7a77#a71 ! ,secret>y %all    
notify ! ,/ate involv$ ( su* det]m9ation
 & ! t]ms & effectiv5ess ( su* waiv]4   
7,b7 ,d5ial ( waiv] ,if ! ,secret>y     
det]m9es a waiv] %\ld n be grant$ "u    
subsection 7a77#a71 ! ,secret>y %all    
notify ! ,/ate involv$ & ! appropriate  
committees ( ,congress ( su* det]m9ation
 & ! reasons !re=4  7e7 ,requir$        
reports2 #e-,ye> review  7#a7 ,9 g5]al  
,z a condition ( receipt ( a waiv] "u   
?is section1 aft] ea* #e-ye> p]iod ( su*
 waiv]1 a ,/ate %all submit to !        
,secret>y a report t is c>ri$ out by an 
indep5d5t1 non-p>tisan entity1 ) respect
 to su* #e-ye> p]iod & aft] a process = 

public notice & comm5t at ! ,/ate level1
 includ+ public he>+s1 suffici5t to     
ensure a mean+ful level ( public input1 
on ! foll[+3  7,a7 ,h[ waiv] funds h be5
 sp5t by ! ,/ate4  7,b7 ,! numb] (      
resid5ts ( ! ,/ate )\t heal? insurance &
 a description ( h[ ! ,/ate plans to    
provide heal? insurance cov]age )9 !    
subsequ5t #e ye>s to resid5ts ( ! ,/ate 
)\t heal? insurance4  7,c7 ,h[          
af=dability 9 ! ,/ate = heal? c>e has   
*ang$ ov] ! p]iod4  7,d7 ,:e!r ! ,/ate  
has a*iev$ heal? cov]age = at lea/ #ie  
p]c5t ( ! resid5ts ( ! ,/ate4  7,e7     
,measurable *anges 9 quality & access4  
7,f7 ,any additional in=mation specifi$ 
by ! ,secret>y = purposes ( det]m9+ !   
successes & *all5ges ( ! waiv]4  7#b7   
#e-ye> review ,9 ! case a ,/ate1 bas$ on
 ! report submitt$ "u p>agraph 7#a7 = a 
#e-ye> p]iod-- 7,a7 has be5 det]m9$ by !
 ,secret>y to h n a*iev$ heal? cov]age =
 at lea/ #ie p]c5t ( ! resid5ts ( !     
,/ate--  7i7 ! ,/ate %all h access to   
te*nical assi/ance describ$ 9 subsection

 7a77#d77;,b77vii7 to improve ! heal?   
insurance program ( ! ,/ate implem5t$   
?r\gh ! waiv] "u ?is section2  7ii7 !   
,/ate %all h a grace p]iod ( #ab mon?s  
aft] su* det]m9ation to a*ieve heal?    
cov]age = at lea/ #ie p]c5t ( resid5ts (
 ! ,/ate2 &  7iii7 if aft] su* #ab      
mon?s1 ! ,/ate has n a*iev$ su* heal?   
cov]age1 ! waiv] "u ?is section may be  
t]m9at$ at ! discretion ( ! ,secret>y2 &
  7,b7 has be5 det]m9$ by ! ,secret>y to
 h a*iev$ heal? cov]age = at lea/ #ie   
p]c5t ( resid5ts ( ! ,/ate1 ! ,/ate1 z a
 condition ( cont9u+ su* waiv]1 %all    
submit to ! ,secret>y a plan = a*iev+   
heal? cov]age = ! rema9d] ( ! resid5ts (
 ! ,/ate4  7f7 ,assur+ coord9ation  7#a7
 ,9 g5]al ,n lat] ?an #ahj days aft] !  
date ( ! enactm5t ( ! ,/ate-,bas$       
,univ]sal ,heal? ,c>e ,act ( #bjai1 !   
,secret>y ( ,heal? & ,human ,s]vices1 ! 
,secret>y ( ! ,treasury1 ! ,secret>y (  
,def5se1 ! ,secret>y ( ,labor1 & !      
,director ( ! ,(fice ( ,p]sonnel        
,managem5t1 %all1 ?r\gh ! execution ( an

 int]ag5cy memor&um ( und]/&+ among su* 
,secret>ies & ,director--  7,a7 develop 
a process = coord9at+ & consolidat+ !   
,/ate waiv] processes applicable "u !   
provisions ( ?is section1 & ! exi/+     
waiv] processes applicable "u--  7i7    
titles ,,xi1 ,,xviii1 ,,xix1 & ,,xxi ( !
 ,social ,security ,act2 &  7ii7 any o!r
 ,f$]al law relat+ to ! provision (     
heal? c>e items or s]vices2 &  7,b7     
ensure t-- 7i7 regulations 7includ+     
regulations requir$ "u subsection       
7a77#d77;,b771 rul+s1 & int]pretations  
issu$ by su* ,secret>ies & ,director    
relat+ to ! same matt] ov] :i* two or m 
su* ,secret>ies or ,director h          
responsibility "u ?is section are       
adm9i/]$ s z to h ! same effect at all  
times2 &  7ii7 coord9ation ( policies   
relat+ to ! grant+1 implem5tation1 &    
cont9uation ( waiv]s ?r\gh su*          
,secret>ies & ,director 9 ord] to h a   
coord9at$ /rategy t avoids duplication (
 ef=t by ! ,/ates or ,secret>ies &      
,director & ensures cl>ity ab\t waiv]   

application /atus & approval4  7#b7     
,s+le application ,! process "u p>agraph
 7#a77;,a7 %all p]mit a ,/ate to submit 
a s+le application = a waiv] "u all ( ! 
provisions ( ?is section & ! provisions 
( law li/$ "u clauses 7i7 & 7ii7 ( su*  
p>agraph4  7#c7 ,submission ( con=m+    
am5dm5ts ,! ,secret>y ( ,heal? & ,human 
,s]vices1 9 coord9ation ) ! o!r         
,secret>ies li/$ 9 p>agraph 7#a7        
7includ+ ! ,director ( ! ,(fice (       
,p]sonnel ,managem5t71 %all submit to   
,congress su* recomm5dations = su*      
te*nical & con=m+ am5dm5ts to law z may 
be appropriate to assi/ 9 !             
implem5tation ( ?is section4  7g7       
,indep5d5t ,assessm5t ,panel =          
,compreh5sive ,heal? ,c>e  7#a7         
,e/abli%m5t ,!re is e/abli%$ a committee
 to be kn[n z ! ,indep5d5t ,assessm5t   
,panel = ,compreh5sive ,heal? ,c>e 79   
?is section ref]r$ to z ! ,panel74  7#b7
 ,consid]ation ( submissions ,!         
,secret>y %all =w>d a copy ( ea* waiv]  
application submitt$ "u ?is section to !

 ,panel = consid]ation "u ?is           
subsection4  7#c7 ,duties ,! ,panel     
%all-- 7,a7 review any waiv] application
 by a ,/ate =w>d$ "u p>agraph 7#b7 & any
 report submitt$ "u p>agraph 7#a7 (     
subsection 7e7 = purposes ( ! review "u 
p>agraph 7#b7 ( su* subsection2  7,b7 n 
lat] ?an #ij days aft] submission ( su* 
application 7or report7 by ! ,/ate1     
provide to ! ,/ate & to ! ,secret>y !   
recomm5dations ( ! ,panel reg>d+ !      
approval or disapproval ( su* waiv]     
application 7or reg>d+ ! /atus ( ! waiv]
 = cont9uation pursuant to subsection   
7e77#b77 &1 if applicable1 possible     
improvem5ts to su* application 7or =    
purposes ( subsection 7e77#b772 &  7,c7 
submit to ,congress an annual report on 
waiv] applications 7& waiv] reports "u  
subsection 7e77 review$ by ! ,panel dur+
 ! applicable ye>1 includ+ ! numb] (    
applications 7& reports7 receiv$ & !    
numb] ( applications recomm5d$ =        
approval 7& ( reports ) respect to :i*  
recomm5dations = cont9uation 7 provid$74

  7#d7 ,memb]%ip  7,a7 ,numb] &         
appo9tm5t ,! ,panel %all consi/ ( #aa   
memb]s appo9t$ by ! ,secret>y ( ,heal? &
 ,human ,s]vices1 ( :om--  7i7 "o %all  
be appo9t$ on ! recomm5dation ( !       
,speak] ( ! ,h\se ( ,repres5tatives2    
7ii7 "o %all be appo9t$ on !            
recomm5dation ( ! m9ority lead] ( !     
,h\se ( ,repres5tatives2  7iii7 "o %all 
be appo9t$ on ! recomm5dation ( !       
majority lead] ( ! ,s5ate2  7iv7 "o %all
 be appo9t$ on ! recomm5dation ( !      
m9ority lead] ( ! ,s5ate2  7v7 "o %all  
be appo9t$ on ! recomm5dation ( !       
,republican ,gov]nors ,association2     
7vi7 "o %all be appo9t$ on !            
recomm5dation ( ! ,democratic ,gov]nors 
,association2  7vii7 "o %all be a       
repres5tative f ! pati5t advocacy       
community2  7viii7 two %all be          
repres5tatives ( a labor organization   
repres5t+ heal? c>e pr(essionals :o     
provide direct pati5t c>e1 includ+ at   
lea/ "o labor organization t prim>ily   
repres5ts regi/]$ nurses2  7ix7 "o %all 

be a repres5tative ( prim>y c>e         
physicians2 &  7x7 "o %all be a         
repres5tative ( heal? c>e pr(essionals  
practic+ 9 rural or und]s]v$ areas4     
7,b7 ,t]m ( s]vice  7i7 ,9 g5]al ,ea*   
memb] ( ! ,panel %all s]ve a ?ree-ye>   
t]m4 ,a memb] may s]ve aft] ! expiration
 ( t memb]'s t]m until a successor has  
be5 appo9t$ pursuant to subp>agraph     
7,a74  7ii7 ,vacancy ,any memb] appo9t$ 
to fill a vacancy occurr+ be=e !        
expiration ( ! t]m = :i* ! memb]'s      
pr$ecessor 0 appo9t$ %all be appo9t$    
only = ! rema9d] ( t t]m4 ,a vacancy 9 !
 ,commission %all be fill$ 9 ! mann] 9  
:i* ! orig9al appo9tm5t 0 made4  7,c7   
,pay ,memb]s ( ! ,panel %all s]ve )\t   
pay4  7,d7 ,*airp]son2 ,vice ,*airp]son 
7i7 ,*airp]son ,! ,secret>y ( ,heal? &  
,human ,s]vices1 or a designee ( !      
,secret>y1 %all s]ve on ! ,panel z !    
,*airp]son ( ! ,panel4  7ii7 ,vice      
,*airp]son ,! ,adm9i/rator ( ! ,f$]al   
,em]g5cy ,managem5t ,ag5cy1 or a        
designee ( ! ,adm9i/rator1 %all s]ve on 

! ,panel z ! ,vice ,*airp]son ( !       
,panel4  7#e7 ,/aff1 exp]ts1 &          
consultants ,! ,panel may-- 7,a7 appo9t 
su* /aff z ! ,panel consid]s to be      
appropriate1 )\t reg>d to ! provisions (
 title #e1 ,unit$ ,/ates ,code1 gov]n+  
appo9tm5ts 9 ! competitive s]vice2  7,b7
 fix ! pay ( su* /aff1 )\t reg>d to !   
provisions ( *apt] #ea & sub*apt] ,,iii 
( *apt] #ec ( su* title relat+ to       
classification & ,g5]al ,s*$ule pay     
rates2 &  7,c7 procure ! s]vices (      
exp]ts & consultants 9 accordance ) !   
provisions ( section #caji7;b7 ( su*    
title4  7#f7 ,detail ( ,f$]al p]sonnel  
,^u reque/ ( ! ,panel1 ! head ( any     
,f$]al ag5cy may detail1 on a           
reimbursable basis1 any ( ! p]sonnel ( !
 ag5cy to ! ,panel to assi/ x 9 c>ry+   
out ! duties "u p>agraph 7#c74  7#g7    
,f$]al ,advisory ,committee ,act ,!     
,f$]al ,advisory ,committee ,act 7#e    
,u4,s4,c4 ,app47 %all apply to ! ,panel4
  7#h7 ,au?orization ( appropriations   
,!re is au?oriz$ to be appropriat$ su*  

sums z may be necess>y to ! ,panel =    
c>ry+ out ! duties ( ! panel = ea* (    
fiscal ye>s #bjbj ?r\gh #bjbe4  7h7     
,guidance relat+ to ,am]ican ,indians & 
,alaska ,natives  7#a7 ,9 g5]al ,!      
,secret>y %all issue guidance ) respect 
to apply+ ! provisions ( ?is section 9 a
 mann] consi/5t ) ! foll[+3  7,a7 ,to   
fur!r ! goal t ,f$]al heal? s]vices to  
ma9ta9 & improve ! heal? ( ,indians are 
consonant ) & requir$ by ! ,f$]al       
,gov]nm5t's hi/orical & unique legal    
relation%ip )1 & result+ responsibility 
to1 ,indians4  7,b7 ,no enrollm5t fee1  
premium1 or simil> *>ge1 & no d$uction1 
copaym5t1 co/ %>+1 or simil> *>ge1 is to
 be impos$ aga9/ an ,indian :o is       
furni%$ an item or s]vice ?r\gh a waiv] 
"u ?is section4 ,all co/s incurr$ 9     
waiv+ su* *>ges %all be borne by !      
,f$]al ,gov]nm5t 9 fulfillm5t ( ! tru/  
responsibility4  7,c7 ,a ,/ate may n    
require ! enrollm5t ( an individual :o  
is an ,indian 9 heal? insurance (f]$    
?r\gh a waiv] "u ?is section4  7,d7     

,heal? insurance issu]s (f]+ cov]age    
pursuant to a waiv] "u ?is section mu/  
make good fai? ef=ts to contract )      
,indian heal? c>e provid]s op]at+ )9 !  
area s]v$ by ! issu]s4  7,e7 ,heal?     
insurance issu]s (f]+ cov]age pursuant  
to a waiv] "u ?is section %all pay      
,indian heal? c>e provid]s1 :e!r su*    
provid]s are p>ticipat+ or nonp>ticipat+
 provid]s ) respect to ! cov]age1 =     
cov]$ s]vices provid$ to ^? ,indian     
enrollees :o are eligible to receive    
s]vices f su* provid]s at a rate equal  
to ! rate negotiat$ betwe5 su* entity & 
! provid] involv$ or1 if su* a rate has 
n be5 negotiat$1 at a rate t is n less  
?an ! level & am\nt ( paym5t :i* !      
entity w\ld make = ! s]vices if !       
s]vices 7 furni%$ by a p>ticipat+       
provid] :i* is n an ,indian heal? c>e   
provid]4  7,f7 ,heal? insurance issu]s  
(f]+ cov]age pursuant to a waiv] "u ?is 
section w include a /&>d contract       
add5dum :5 contract+ ) ,indian heal? c>e
 provid]s4 ,! contract add5dum w be     

develop$ 9 consultation ) ,tribes & 9   
conf]5ce ) urban ,indian heal? programs 
op]at+ )9 ! s]vice area ( ! ,/ate4  7,g7
 ,! treatm5t ( ,indians "u ?is section  
does n con/itute invidi\s racial        
discrim9ation 9 violation ( ! due       
process clause ( ! ,fif? or ,f\rte5?    
,am5dm5ts1 b is reasonable & rationally 
design$ to fur!r ! heal? ( ,indians4    
7,h7 ,9 ! case ( any ,/ate 9 :i* #a or m
 ,indian heal? c>e programs furni%es    
heal? c>e s]vices1 ! ,/ate w provide = a
 process "u :i* ! ,/ate seeks advice on 
a regul>1 ongo+ basis f designees ( su* 
,indian heal? c>e programs & urban      
,indian organizations on matt]s relat+  
to ! application ( a waiv] "u ?is       
section t are likely to h a direct      
effect on su* ,indian heal? programs &  
t--  7i7 %all include solicitation (    
advice prior to submission ( any plan   
am5dm5ts1 waiv] reque/s1 & proposals =  
demon/ration projects likely to h a     
direct effect on ,indians or ,indian    
heal? c>e programs2 &  7ii7 may include 

appo9tm5t ( an advisory committee & ( a 
designee ( su* ,indian heal? c>e        
programs to ! m$ical c>e advisory       
committee advis+ ! ,/ate on its waiv] "u
 ?is section4  7#b7 ,def9itions ,=      
purposes ( ?is subsection3 7,a7 ,! t]m  
,indian has ! mean+ giv5 su* t]m 9      
section #ddg4ej ( title #db1 ,code (    
,f$]al ,regulations 7z 9 effect on ,july
 #a1 #bjaj74  7,b7 ,! t]m ,indian heal? 
c>e provid] has ! mean+ giv5 su* t]m 9  
section #dch4ad7;a7 ( title #db1 ,code (
 ,f$]al ,regulations4  7i7 ,def9itions  
,9 ?is section3  7#a7 ,heal? b5efits    
cov]age ,! t]m heal? b5efits cov]age--  
7,a7 means--  7i7 heal? insurance       
cov]age1 z su* t]m is def9$ 9 section   
#bgia7;b7 ( ! ,public ,heal? ,s]vice    
,act 7#db ,u4,s4,c4 #cjj;gg-7b772 &     
7ii7 cov]age "u a gr\p heal? plan1 z su*
 t]m is def9$ 9 section #bgia7;a7 ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-7a772 &  7,b7 includes
 any m$ical cov]age or heal? b5efits    
provid$ "u "o or m ( ! specifi$ ,f$]al  

heal? program describ$ 9 subp>agraphs   
7,a7 ?r\gh 7,e7 ( p>agraph 7#d71 z      
applicable to a waiv] "u subsection     
7a77#a74  7#b7 ,resid5t ,) respect to a 
,/ate1 ! t]m resid5t means an           
individual-- 7,a7 :o is--  7i7 a citiz5 
or national ( ! ,unit$ ,/ates2 or  7ii7 
an ali5 lawfully resid+ 9 ! ,/ate       
7includ+ an ali5 :o is grant$ def]r$    
action or :o is o!rwise au?oriz$ to     
rema9 9 ! ,unit$ ,/ates72 &  7,b7 ^:    
prim>y resid5ce 7z def9$ by ! ,/ate7 is 
locat$ 9 ! ,/ate4  7#c7 ,secret>y ,! t]m
 ,secret>y means--  7,a7 ! ,secret>y (  
,heal? & ,human ,s]vices ) respect to   
waiv]s relat+ to ! provisions describ$ 9
 subp>agraphs 7,a71 7,b71 & 7,d7 ?r\gh  
7,g7 ( p>agraph 7#b7 ( subsection 7a72  
7,b7 ! ,secret>y ( ! ,treasury ) respect
 to waiv]s relat+ to ! provisions       
describ$ 9 subp>agraph 7,c7 ( su*       
p>agraph2  7,c7 ! ,director ( ! ,(fice (
 ,p]sonnel ,managem5t ) respect to      
waiv]s relat+ to ! provisions describ$ 9
 subp>agraph 7,h7 ( su* p>agraph2  7,d7 

! ,secret>y ( ,def5se ) respect to      
waiv]s relat+ to ! provisions describ$ 9
 subp>agraph 7,i7 ( su* p>agraph2 &     
7,e7 ! ,secret>y ( ,labor ) respect to  
waiv]s relat+ to ! provisions describ$ 9
 subp>agraph 7,j7 ( su* p>agraph4  7#d7 
,specifi$ f$]al heal? program ,! t]m    
specifi$ ,f$]al heal? program means "o  
or m ( ! foll[+ programs1 z applicable  
to a waiv] "u subsection 7a77#a73 7,a7  
,! ,m$ic>e program "u title ,,xviii ( ! 
,social ,security ,act4  7,b7 ,!        
,m$icaid program "u title ,,xix ( !     
,social ,security ,act4  7,c7 ,!        
,*ildr5's ,heal? ,insurance ,program "u 
title ,,xxi ( ! ,social ,security ,act4 
7,d7 ,! ,f$]al ,employees ,heal?        
,b5efits ,plan "u *apt] #hi ( title #e1 
,unit$ ,/ates ,code4  7,e7 ,m$ical      
cov]age "u *apt] #ee ( title #aj1 ,unit$
 ,/ates ,code1 includ+ cov]age "u !     
,,tric>e program4  7,f7 ,an ,ex*ange    
e/abli%$ "u ?is subtitle4  7,g7         
,subsidies "u section #adjb4  7,h7 ,tax 
cr$its "u sections #cf;,b & #de,r ( !   

,int]nal ,rev5ue ,code ( #aihf4  4  7b7 
,cl]ical am5dm5t ,! table ( cont5ts 9   
section #a7;b7 ( ! ,pati5t ,protection &
 ,af=dable ,c>e ,act 7#db ,u4,s4,c4     
#ahjja note7 is am5d$ by ins]t+ aft] !  
item relat+ to section #accd ! foll[+   
new item3  #acce4 ,waiv] = ,/ate        
univ]sal heal? c>e4  4