,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #edch  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #af1 #bjai   
,mr4 ,cox ( ,cali=nia 7= himself1 ,mr4  
,h>d] ( ,cali=nia1 ,mr4 ,co/a1 ,mr4     
,gallego1 ,mr4 ,o',hall]an1 ,mrs4       
,kirkpatrick1 ,mr4 ,panetta1 & ,mr4     
,grijalva7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,en]gy &    
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = 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 direct !        
,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,director ( ! ,c5t]s =     
,disease ,control & ,prev5tion1 to aw>d 
grants to develop programs to increase  
heal? c>e provid]s' aw>5ess ( ,valley   
fev]1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,end ,valley 
,fev] ,n[ ,act4  #b4 ,grants to develop 
programs to increase heal? c>e provid]s'
 aw>5ess ( ,valley fev] ,"p ,p ( title  

,,iii ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bhj;g et seq47 is am5d$ 
by add+ at ! end ! foll[+3  #cii,v-#g4  
,grants to develop programs to increase 
heal? c>e provid]s' aw>5ess ( ,valley   
fev]  7a7 ,9 g5]al ,! ,secret>y1 act+   
?r\gh ! ,adm9i/rator ( ! ,heal?         
,res\rces & ,s]vices ,adm9i/ration & 9  
consultation ) ! ,director ( ! ,c5t]s = 
,disease ,control & ,prev5tion1 %all    
make aw>ds ( grants or coop]ative       
agreem5ts to eligible entities to       
e/abli% & c>ry out programs--  7#a7 to  
increase heal? c>e provid]s' aw>5ess (  
,valley fev]2 &  7#b7 to educate & tra9 
heal? c>e provid]s on ! diagnosis &     
treatm5t ( ,valley fev]4  7b7 ,use (    
funds ,an eligible entity select$ to    
receive a grant or contract "u ?is      
section %all use am\nts aw>d$ "u su* a  
grant or contract to provide innovative 
supportive activities 7:i* may include  
activities t d n rely on ! use ( broadb&
 s]vices7 to enhance education ?r\gh    
di/ance le>n+1 cont9u+ educational      

activities1 collaborative conf]5ces1 &  
electronic & telele>n+ activities4  7c7 
,au?orization ( appropriations ,!re are 
au?oriz$ to be appropriat$ to c>ry out  
?is section #a1jjj1jjj = ! p]iod (      
fiscal ye>s #bjba ?r\gh #bjbc1 to rema9 
available until exp5d$4  7d7 ,condition 
,a recipi5t ( a grant "u ?is section    
%all1 z a condition on receipt ( !      
grant1 agree to develop curricula = !   
purposes specifi$ 9 subsection 7a7 9    
coord9ation ) local provid]s at         
hospitals & cl9ics4  7e7 ,def9itions ,9 
?is section3 7#a7 ,! t]m eligible entity
 means--  7,a7 a ,/ate dep>tm5t ( heal? 
7or simil> ,/ate au?ority72  7,b7 an    
in/itution ( high] education 7z def9$ 9 
section #aja ( ! ,high] ,education ,act 
( #aife 7#bj ,u4,s4,c4 #ajja771 includ+ 
a m$ical s*ool or cont9u+ m$ical        
education program at su* in/itution2    
7,c7 an entity op]at+ a graduate m$ical 
resid5cy tra9+ program "u section       
#cdj;,e or "u section #cdj;,h2 or  7,d7 
a tea*+ hospital 7z def9$ 9 section     

#dae4aeb ( title #db1 ,code ( ,f$]al    
,regulations7 t has physicians & o!r    
m$ical provid]s ) specializ$ k 9        
diagnos+ & treat+ ,valley fev]4  7#b7 ,!
 t]m ,valley fev] means ! condition     
caus$ by ,coccidioidomycosis4  4  #c4   
,/udy comp>+ diff]5t case def9itions us$
 to id5tify valley fev]  7a7 ,9 g5]al ,!
 ,secret>y ( ,heal? & ,human ,s]vices1  
act+ ?r\gh ! ,director ( ! ,c5t]s =     
,disease ,control & ,prev5tion %all     
conduct a /udy comp>+ diff]5t case      
def9itions us$ to id5tify valley fev]4  
,su* /udy %all include ! efficacy ( !   
me?ods be+ us$ to e/abli% su* case      
def9itions & ! co/ effectiv5ess ( su*   
me?ods1 includ+ us+ ! case def9ition =  
valley fev] e/abli%$ by ! ,c\ncil (     
,/ate & ,t]ritorial ,epidemiologi/4  7b7
 ,valley fev] def9$ ,9 ?is ,act1 ! t]m  
,valley fev] has ! mean+ giv5 ! t]m 9   
section #cii,v-#g ( ! ,public ,heal?    
,s]vice ,act4  #d4 ,all[+ ,/ates to     
provide cov]age "u ! ,m$icaid program = 
items & s]vices furni%$ 9 connection )  

qualify+ ,valley fev] cl9ical trials    
7a7 ,9 g5]al ,section #aije7;a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77 is am5d$--  7#a7 9 p>agraph 
7#bi71 by /rik+ & at ! end2  7#b7 by    
r$esignat+ p>agraph 7#cj7 z p>agraph    
7#ca72 &  7#c7 by ins]t+ aft] p>agraph  
7#bi7 ! foll[+ new p>agraph3  7#cj7     
items & s]vices furni%$ 9 connection )  
p>ticipation 9 a qualify+ ,valley fev]  
cl9ical trial 7z def9$ 9 section        
#bgji;,a7b77#d7 ( ! ,public ,heal?      
,s]vice ,act71 includ+ travel &         
incid5tal exp5ses1 reg>dless ( :e!r su* 
items & s]vices are furni%$ by a        
p>ticipat+ provid] "u ! ,m$icaid program
 7o!r ?an a provid] exclud$ f           
p>ticipation 9 su* program "u section   
#aabh7 or :e!r su* items & s]vices are  
furni%$ 9 ano!r ,/ate2 &  4  7b7        
,r$uction 9 ,,fmap = ,/ates t d n       
provide cov]age ,section #aije ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7 is am5d$-- 7#a7 9 subsection   
7b71 by /rik+ & 7ff7 & ins]t+ 7ff71 &   

7gg72 &  7#b7 by add+ at ! end ! foll[+ 
new subsection3  7gg7 ,r$uction 9 ,,fmap
 = ,/ates t d n provide cov]age = c]ta9 
items & s]vices ,) respect to a cal5d>  
qu>t] beg9n+ on or aft] ,janu>y #a1     
#bjba1 ! ,f$]al m$ical assi/ance        
p]c5tage o!rwise det]m9$ "u subsection  
7b7 = a ,/ate t does n provide cov]age =
 items & s]vices describ$ 9 subsection  
7a77#cj7 t are furni%$ dur+ su* qu>t]   
%all be r$uc$ by #e p]c5tage po9ts4  4  
7c7 ,ensur+ access = ,m$icaid expansion 
population ,section #aicg7;b77#e7 ( su* 
,act is am5d$ by ins]t+ be=e ! p]iod at 
! end ! foll[+3 1 & beg9n+ ,janu>y #a1  
#bjba1 cov]age ( items & s]vices        
describ$ 9 section #aije7;a77#cj74  7d7 
,prohibition on imposition ( co/%>+     
requirem5ts ,title ,,xix ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acif et  
seq47 is am5d$--  7#a7 9 section        
#aiaf7;a77#b7-- 7,a7 9 subp>agraph 7,d71
 by /rik+ or at ! end2  7,b7 9          
subp>agraph 7,e71 by /rik+ 2 & at ! end 
& ins]t+ 1 or2 &  7,c7 by add+ at ! end 

! foll[+ new subp>agraph3  7,f7 items & 
s]vices describ$ 9 section              
#aije7;a77#cj72 &  2 &  7#b7 9 section  
#aiaf;,a7b77#c77;,b71 by add+ at ! end !
 foll[+ new clause3  7xi7 ,items &      
s]vices describ$ 9 section              
#aije7;a77#cj74  4  7e7 ,cont9u\s       
cov]age = individuals :o lose ,m$icaid  
eligibility bas$ on income ,section     
#aijb7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7e77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#af7 ,cont9u\s cov]age = items &       
s]vices furni%$ 9 connection ) qualify+ 
,valley fev] cl9ical trials ,9 ! case ( 
an individual :o is eligible = m$ical   
assi/ance "u ! ,/ate plan 7or a waiv] ( 
su* plan7 bas$ on ! application (       
modifi$ adju/$ gross income "u p>agraph 
7#ad77;,a71 :o :ile s eligible is       
furni%$ items & s]vices describ$ 9      
section #aije7;a77#cj7 9 connection )   
p>ticipation 9 a qualify+ ,valley fev]  
cl9ical trial 7z def9$ 9 section        
#bgji;,a7b77#d7 ( ! ,public ,heal?      

,s]vice ,act71 & :o :ile s furni%$ su*  
items & s]vices loses eligibility = su* 
m$ical assi/ance due to a *ange 9 income
 ( ! family ( :i* su* individual is a   
memb]1 su* individual %all be deem$ to  
cont9ue to be an individual eligible =  
su* m$ical assi/ance1 )\t reg>d to su*  
*ange 9 income1 only ) respect to su*   
items & s]vices ?r\gh ! end ( ! mon? 9  
:i* su* qualify+ ,valley fev] cl9ical   
trial ends4  4  7f7 ,effective date     
7#a7 ,9 g5]al ,! am5dm5ts made by ?is   
section %all apply ) respect to items & 
s]vices furni%$1 & eligibility          
det]m9ations made1 on or aft] ,janu>y   
#a1 #bjba4  7#b7 ,exception = ,/ate     
legislation ,9 ! case ( a ,/ate plan "u 
title ,,xix ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #acif et seq47 t !       
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es requires ,/ate legislation 9   
ord] = ! respective plan to meet any    
requirem5t impos$ by am5dm5ts made by   
?is section1 ! respective plan %all n be
 reg>d$ z fail+ to comply ) !           

requirem5ts ( su* title solely on !     
basis ( its failure to meet su* an      
additional requirem5t be=e ! fir/ day ( 
! fir/ cal5d> qu>t] beg9n+ aft] ! close 
( ! fir/ regul> session ( ! ,/ate       
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4  #e4 ,requirem5t = gr\p    
heal? plans & heal? insurance issu]s to 
provide cov]age = items & s]vices       
furni%$ 9 connection ) qualify+ ,valley 
fev] cl9ical trials  7a7 ,9 g5]al       
,subp>t ,i ( "p ,a ( title ,,xxvii ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg et seq47 is am5d$--   
7#a7 by r$esignat+ ! second section     
#bgji z section #bgaj2 &  7#b7 by ins]t+
 aft] ! fir/ section #bgji ! foll[+ new 
section3  #bgji;,a4 ,cov]age =          
individuals p>ticipat+ 9 qualify+       
,valley fev] cl9ical trials  7a7 ,9     

g5]al ,not)/&+ section #bgji1 a gr\p    
heal? plan or heal? insurance issu] (f]+
 gr\p or individual heal? insurance     
cov]age %all1 ) respect to an enrollee (
 su* plan or cov]age1 respectively1     
provide cov]age = any item or s]vice    
furni%$ to su* enrollee 9 connection )  
su* enrollee's p>ticipation 9 a qualify+
 ,valley fev] cl9ical trial1 includ+    
travel & incid5tal exp5ses--  7#a7 )\t  
reg>d to :e!r su* item or s]vice is     
furni%$ by a p>ticipat+ provid] or      
p>ticipat+ facility ) respect to su*    
item or s]vice2 &  7#b7 9 a mann] s t1  
if su* item or s]vice is furni%$ to su* 
enrollee by a nonp>ticipat+ provid] or  
nonp>ticipat+ facility1 ! co/-%>+       
requirem5t 7express$ z a copaym5t am\nt 
or co9surance rate7 is n great] ?an !   
requirem5t t w\ld apply if su* item or  
s]vice 7 furni%$ by a p>ticipat+ provid]
 or p>ticipat+ facility4  7b7           
,def9itions ,9 ?is section3 7#a7        
,nonp>ticipat+ facility2 p>ticipat+     
facility  7,a7 ,nonp>ticipat+ facility  

,! t]m nonp>ticipat+ facility means1 )  
respect to an item or s]vice & a gr\p   
heal? plan or gr\p or individual heal?  
insurance cov]age1 a heal? c>e facility 
t does n h a contractual relation%ip ) !
 sponsor ( su* plan or issu] ( su*      
cov]age = furni%+ su* item or s]vice "u 
! plan or cov]age4  7,b7 ,p>ticipat+    
facility ,! t]m p>ticipat+ facility     
means1 ) respect to an item or s]vice & 
a gr\p heal? plan or gr\p or individual 
heal? insurance cov]age1 a heal? c>e    
facility t has a contractual relation%ip
 ) ! sponsor ( su* plan or issu] ( su*  
cov]age = furni%+ su* item or s]vice "u 
! plan or cov]age4  7#b7 ,nonp>ticipat+ 
provid]2 p>ticipat+ provid]  7,a7       
,nonp>ticipat+ provid] ,! t]m           
nonp>ticipat+ provid] means1 ) respect  
to an item or s]vice & a gr\p heal? plan
 or gr\p or individual heal? insurance  
cov]age1 a physician or o!r heal? c>e   
provid] :o is act+ )9 ! scope ( practice
 ( t provid]'s lic5se or c]tification "u
 applicable ,/ate law & :o does n h a   

contractual relation%ip ) ! sponsor (   
su* plan or issu] ( su* cov]age =       
furni%+ su* item or s]vice "u ! plan or 
cov]age4  7,b7 ,p>ticipat+ provid] ,!   
t]m p>ticipat+ provid] means1 ) respect 
to an item or s]vice & a gr\p heal? plan
 or gr\p or individual heal? insurance  
cov]age1 a physician or o!r heal? c>e   
provid] :o is act+ )9 ! scope ( practice
 ( t provid]'s lic5se or c]tification "u
 applicable ,/ate law & :o has a        
contractual relation%ip ) ! sponsor (   
su* plan or issu] ( su* cov]age =       
furni%+ su* item or s]vice "u ! plan or 
cov]age4  7#c7 ,qualify+ ,valley fev]   
cl9ical trial  7,a7 ,9 g5]al ,! t]m     
qualify+ ,valley fev] cl9ical trial     
means a phase ,i1 phase ,,ii1 phase     
,,iii1 or phase ,,iv cl9ical trial t is 
conduct$ 9 relation to ! prev5tion1     
detection1 or treatm5t ( ,valley fev] 7z
 def9$ 9 section #cii,v-#g7 & is        
describ$ 9 any ( ! foll[+ clauses3  7i7 
,! /udy or inve/igation is approv$ or   
fund$ 7:i* may include fund+ ?r\gh 9-k9d

 contributions7 by "o or m ( ! foll[+3  
7,i7 ,! ,national ,in/itutes ( ,heal?4  
7,,ii7 ,! ,c5t]s = ,disease ,control &  
,prev5tion4  7,,iii7 ,! ,ag5cy =        
,heal?c>e ,rese>* & ,quality4  7,,iv7 ,!
 ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4   
7,v7 ,a coop]ative gr\p or c5t] ( any ( 
! entities describ$ 9 subclauses 7,i7   
?r\gh 7,,iv7 or ! ,dep>tm5t ( ,def5se or
 ! ,dep>tm5t ( ,vet]ans ,affairs4       
7,,vi7 ,a qualifi$ non-gov]nm5tal rese>*
 entity id5tifi$ 9 ! guidel9es issu$ by 
! ,national ,in/itutes ( ,heal? = c5t]  
support grants4  7,,vii7 ,any ( ! foll[+
 if ! conditions describ$ 9 subp>agraph 
7,b7 are met3 7aa7 ,! ,dep>tm5t (       
,vet]ans ,affairs4  7bb7 ,! ,dep>tm5t ( 
,def5se4  7cc7 ,! ,dep>tm5t ( ,en]gy4   
7ii7 ,! cl9ical trial is conduct$ "u an 
inve/igational new drug application     
review$ by ! ,food & ,drug              
,adm9i/ration4  7iii7 ,! cl9ical trial  
is a drug trial t is exempt f hav+ su*  
an inve/igational new drug application4 
7,b7 ,conditions ,= purposes (          

subp>agraph 7,a77i77,,vii71 ! conditions
 describ$ 9 ?is subp>agraph1 ) respect  
to a cl9ical trial approv$ or fund$ by  
an entity describ$ 9 su* subp>agraph    
7,a77i77,,vii71 are t ! cl9ical trial   
has be5 review$ & approv$ ?r\gh a sy/em 
( pe] review t ! ,secret>y det]m9es--   
7i7 to be comp>able to ! sy/em ( pe]    
review ( /udies & inve/igations us$ by !
 ,national ,in/itutes ( ,heal?2 &  7ii7 
assures unbias$ review ( ! highe/       
sci5tific /&>ds by qualifi$ individuals 
) no int]e/ 9 ! outcome ( ! review4  4  
7b7 ,effective date ,! am5dm5ts made by 
?is section %all apply ) respect to plan
 ye>s beg9n+ on or aft] ,janu>y #a1     
#bjba4  #f4 ,m$ic>e cov]age ( items &   
s]vices furni%$ 9 connection ) qualify+ 
,valley fev] cl9ical trials  7a7        
,cov]age ,section #ahfa7s77#b7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7s77#b77 is am5d$-- 7#a7 9        
subp>agraph 7,,gg71 by /rik+ & at ! end2
  7#b7 9 subp>agraph 7,,hh71 by /rik+ ! 
p]iod at ! end & ins]t+ 2 &2 &  7#c7 by 

add+ at ! end ! foll[+ new subp>agraph3 
7,,ii7 items & s]vices furni%$ 9        
connection ) p>ticipation 9 a qualify+  
,valley fev] cl9ical trial 7z def9$ 9   
section #bgji;,a7b77#d7 ( ! ,public     
,heal? ,s]vice ,act71 includ+ travel &  
incid5tal exp5ses2  4  7b7 ,paym5t      
,section #ahcc7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciel7a77#a77 is am5d$-- 7#a7 by /rik+ 
& 7,,cc7 & ins]t+ 7,,cc72 &  7#b7 by    
ins]t+ be=e ! semicolon at ! end !      
foll[+3 1 & 7,,dd7 ) respect to items & 
s]vices describ$ 9 section              
#ahfa7s77#b77;,,ii71 ! am\nt paid %all  
be #ajj p]c5t ( ! less] ( ! actual *>ge 
= ! s]vices or ! am\nt det]m9$ "u !     
paym5t basis det]m9$ "u section #ahdh4