,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #hfae  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,octob] #af1 #bjbj    
,mr4 ,payne 7= himself1 ,mr4 ,ru%1 ,mr4 
,gallego1 ,mr4 ,?ompson ( ,mississippi1 
,ms4 ,johnson ( ,texas1 & ,ms4 ,blunt   
,ro*e/]7 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 am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to provide = cov]age ( p]iph]al    
art]y disease scre5+ te/s furni%$ to    
at-risk b5efici>ies "u ! ,m$ic>e &      
,m$icaid programs )\t ! imposition (    
co/-%>+ requirem5ts1 to am5d title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
to require gr\p heal? plans & heal?     
insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age to provide     
cov]age = su* scre5+ te/s furni%$ to    

at-risk enrollees ( gr\p heal? plans &  
gr\p or individual heal? insurance      
cov]age )\t ! imposition ( co/-%>+      
requirem5ts1 & = o!r purposes4  #a4     
,%ort title2 f9d+s  7a7 ,%ort title ,?is
 ,act may be cit$ z ! ,amputation       
,r$uction & ,compassion ,act ( #bjbj or 
! ,,arc ,act ( #bjbj4  7b7 ,f9d+s       
,congress makes ! foll[+ f9d+s3  7#a7   
,a!roscl]osis occurs :5 blood fl[ is    
r$uc$ because art]ies become n>r[$ or   
block$ ) fatty deposits4  7#b7          
,a!roscl]osis is responsible = m dea?s 9
 ! ,unit$ ,/ates ?an any o!r condition1 
& he>t attacks1 result+ f clogg$ coron>y
 art]ies1 are ! lead+ cause ( dea? 9    
,am]ica4  7#c7 ,a!roscl]osis also occurs
 9 ! legs & is kn[n z p]iph]al art]y    
disease 79 ?is subsection ref]r$ to z   
,,pad7 & hav+ ,,pad significantly       
increases ! risk = he>t attack1 /roke1  
amputation1 & dea?4  7#d7 ,:ile mo/     
,am]icans are aw>e ( a!roscl]osis 9 !   
he>t1 _m ,am]icans h nev] he>d ( ,,pad &
 ,am]icans ) ,,pad are (t5 unaw>e ( !   

s]i\s risks ( ! disease4  7#e7 ,an      
e/imat$ #ba million ,am]icans h ,,pad1 &
 ab\t #bjj1jjj ( !m--disproportionately 
m9orities--suff] avoidable amputations e
 ye> z a result ( su* disease4  7#f7    
,accord+ to ! ,d>tm\? ,atlas1 amputation
 risks = ,african ,am]icans liv+ )      
diabetes are z mu* z f\r times high] ?an
 ! national av]age4  7#g7 ,data analyses
 h simil>ly f\nd t ,native ,am]icans are
 m ?an twice z likely to be subject$ to 
amputation & ,hispanics are up to #ge   
p]c5t m likely to h an amputation4  7#h7
 ,fifty-two p]c5t ( pati5ts ) an        
above-!-knee amputation & #cc p]c5t (   
pati5ts ) a bel[-!-knee amputation w die
 )9 two ye>s ( _! amputation4  7#i7     
,scre5+ & art]ial te/+ = ,,pad is       
co/-effective & %\ld be "p ( r\t9e      
m$ical c>e4  7#aj7 ,once ,,pad is       
detect$1 amputations & dea?s c be r$uc$ 
?r\gh ! use ( national1 evid5ce-bas$    
,,pad c>e guidel9es4  #b4 ,p]iph]al     
art]y disease education program ,"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[+ new     
section3  #cii,v-#g4 ,p]iph]al art]y    
disease education program  7a7          
,e/abli%m5t ,! ,secret>y1 act+ ?r\gh !  
,director ( ! ,c5t]s = ,disease ,control
 & ,prev5tion1 9 collaboration ) !      
,adm9i/rator ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices & ! ,adm9i/rator ( !  
,heal? ,res\rces & ,s]vices             
,adm9i/ration1 %all e/abli% & coord9ate 
a p]iph]al art]y disease education      
program to support1 develop1 & implem5t 
educational initiatives & outrea*       
/rategies t in=m heal? c>e pr(essionals 
& ! public ab\t ! exi/5ce ( p]iph]al    
art]y disease & me?ods to r$uce         
amputations relat$ to su* disease1      
p>ticul>ly ) respect to at-risk         
populations4  7b7 ,au?orization (       
appropriations ,!re is au?oriz$ to be   
appropriat$ to c>ry out ?is section su* 
sums z may be necess>y = ea* ( fiscal   
ye>s #bjbb ?r\gh #bjbf4  4  #c4 ,m$ic>e 
cov]age ( p]iph]al art]y disease scre5+ 

te/s furni%$ to at-risk b5efici>ies )\t 
imposition ( co/ %>+ requirem5ts  7a7 ,9
 g5]al ,section #ahfa ( ! ,social       
,security ,act 7#db ,u4,s4,c4 #aciex7 is
 am5d$--  7#a7 9 subsection 7s77#b7--   
7,a7 9 subp>agraph 7,,gg71 by /rik+ & at
 ! end2  7,b7 9 subp>agraph 7,,hh71 by  
/rik+ ! p]iod at ! end & ins]t+ 2 &2 &  
7,c7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,,ii7 p]iph]al art]y     
disease scre5+ te/s furni%$ to at-risk  
b5efici>ies 7z su* t]ms are def9$ 9     
subsection 7kkk774  2 &  7#b7 by add+ at
 ! end ! foll[+ new subsection3  7kkk7  
,p]iph]al art]y disease scre5+ te/2     
,at-,risk b5efici>y  7#a7 ,! t]m        
p]iph]al art]y disease scre5+ te/       
means-- 7,a7 non9vasive physiologic     
/udies ( extremity art]ies 7commonly    
ref]r$ to z ankle-bra*ial index te/+72  
7,b7 art]ial duplex scans ( l[]         
extremity art]ies vascul>2 &  7,c7 su*  
o!r items & s]vices z ! ,secret>y       
det]m9es1 9 consultation ) relevant     
/akehold]s1 to be appropriate = scre5+ =

 p]iph]al art]y disease = at-risk       
b5efici>ies4  7#b7 ,! t]m at-risk       
b5efici>y means an individual entitl$   
to1 or enroll$ =1 b5efits "u "p ,a &    
enroll$ = b5efits "u "p ,b-- 7,a7 :o is 
#fe ye>s ( age or old]2  7,b7 :o is at  
lea/ #ej ye>s ( age b n old] ?an #fd    
ye>s ( age ) risk factors = a!roscl]osis
 7su* z diabetes mellitus1 a hi/ory (   
smok+1 hyp]lipidemia1 & hyp]t5sion7 or a
 family hi/ory ( p]iph]al art]y disease2
  7,c7 :o is y\ng] ?an #ej ye>s ( age ) 
diabetes mellitus & "o additional risk  
factor = a!roscl]osis2 or  7,d7 ) a kn[n
 a!roscl]otic disease 9 ano!r vascul> b$
 su* z coron>y1 c>otid1 subclavian1     
r5al1 or mes5t]ic art]y /5osis1 or      
abdom9al aortic aneurysm4  7#c7 ,!      
,secret>y %all1 9 consultation )        
appropriate organizations1 e/abli% /&>ds
 reg>d+ ! frequ5cy = p]iph]al art]y     
disease scre5+ te/s describ$ 9          
subsection 7s77#b77;,,ii7 = purposes (  
cov]age "u ?is title4  4  7b7 ,inclusion
 ( p]iph]al art]y disease scre5+ te/s 9 

initial prev5tive physical exam9ation   
,section #ahfa7ww77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciex7ww77#b77 is am5d$-- 7#a7 9       
subp>agraph 7,n71 by mov+ ! m>g9s ( su* 
subp>agraph #b ems to ! left2  7#b7 by  
r$esignat+ subp>agraph 7,o7 z           
subp>agraph 7,p72 &  7#c7 by ins]t+ aft]
 subp>agraph 7,n7 ! foll[+ new          
subp>agraph3  7,o7 ,p]iph]al art]y      
disease scre5+ te/s furni%$ to at-risk  
b5efici>ies 7z su* t]ms are def9$ 9     
subsection 7kkk774  4  7c7 ,paym5t  7#a7
 ,9 g5]al ,section #ahcc7;a7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciel7a77 is am5d$--  7,a7 9 p>agraph  
7#a7-- 7i7 9 subp>agraph 7,n71 by ins]t+
 & o!r ?an p]iph]al art]y disease scre5+
 te/s furni%$ to at-risk b5efici>ies 7z 
su* t]ms are def9$ 9 section #ahfa7kkk77
 aft] o!r ?an p]sonaliz$ prev5tion plan 
s]vices 7z def9$ 9 section              
#ahfa7;hhh77#a772  7ii7 by /rik+ & be=e 
7,,dd72 &  7iii7 by /rik+ su* s]vice12  
at ! end & ins]t+ ! foll[+3 1 & 7,,ee7 )

 respect to p]iph]al art]y disease      
scre5+ te/s furni%$ to at-risk          
b5efici>ies 7z su* t]ms are def9$ 9     
section #ahfa7kkk771 ! 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 #ahdh2 &
  7,b7 9 p>agraph 7#b7-- 7i7 9          
subp>agraph 7,g71 by /rik+ & at ! end2  
7ii7 9 subp>agraph 7,h71 by /rik+ !     
comma at ! end & ins]t+ 2 &2 &  7iii7 by
 ins]t+ aft] subp>agraph 7,h7 ! foll[+  
new subp>agraph3  7,i7 ) respect to     
p]iph]al art]y disease scre5+ te/s 7z   
def9$ 9 p>agraph 7#a7 ( section         
#ahfa7kkk77 furni%$ by an outpati5t     
dep>tm5t ( a hospital to at-risk        
b5efici>ies 7z def9$ 9 p>agraph 7#b7 (  
su* section71 ! am\nt det]m9$ "u        
p>agraph 7#a77;,,ee71  4  7#b7 ,no      
d$uctible ,section #ahcc7;b7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciel7b77 is am5d$1 9 ! fir/ s5t5ce--  
7,a7 by /rik+ & be=e 7#ab72 &  7,b7 by  
ins]t+ 1 & 7#ac7 su* d$uctible %all n   

apply ) respect to p]iph]al art]y       
disease scre5+ te/s furni%$ to at-risk  
b5efici>ies 7z su* t]ms are def9$ 9     
section #ahfa7kkk77 be=e ! p]iod at !   
end4  7#c7 ,exclusion f prospective     
paym5t sy/em = hospital outpati5t       
dep>tm5t s]vices ,section               
#ahcc7t77#a77;,b77iv7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciel7t77#a77;,b77iv77 is am5d$-- 7,a7 
by /rik+ 1 or p]sonaliz$ & ins]t+ 1     
p]sonaliz$2 &  7,b7 by ins]t+ 1 or      
p]iph]al art]y disease scre5+ te/s      
furni%$ to at-risk b5efici>ies 7z su*   
t]ms are def9$ 9 section #ahfa7kkk77    
aft] p]sonaliz$ prev5tion plan s]vices  
7z def9$ 9 section #ahfa7;hhh77#a774    
7#d7 ,con=m+ am5dm5t ,section           
#ahdh7;j77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is   
am5d$ by /rik+ 7#b77;,,ff7 7includ+     
adm9i/ration ( ! heal? risk assessm5t7 1
 & ins]t+ 7#b77;,,ff7 7includ+          
adm9i/ration ( ! heal? risk assessm5t71 
7#b77;,,ii74  7d7 ,exclusion f cov]age &

 ,m$ic>e z second>y pay] = te/s p]=m$ m 
frequ5tly ?an all[$ ,section            
#ahfb7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciey7a77#a77 is       
am5d$-- 7#a7 9 subp>agraph 7,o71 by     
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,p71 by /rik+ ! semicolon at ! end &   
ins]t+ 1 &2 &  7#c7 by add+ at ! end !  
foll[+ new subp>agraph3  7,q7 9 ! case (
 p]iph]al art]y disease scre5+ te/s     
furni%$ to at-risk b5efici>ies 7z su*   
t]ms are def9$ 9 section #ahfa7kkk771   
:i* are p]=m$ m frequ5tly ?an is cov]$  
"u su* section2  4  7e7 ,au?ority ,to   
modify or elim9ate cov]age ( c]ta9      
prev5tive s]vices ,section #ahcd7n7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7n77 is am5d$--  7#a7 by          
r$esignat+ subp>agraphs 7,a7 & 7,b7 (   
p>agraph 7#a7 z clauses 7i7 & 7ii71     
respectively1 & mov+ ! m>g9s ( su*      
clauses1 z s r$esignat$1 #b ems to ! "r2
  7#b7 by r$esignat+ p>agraphs 7#a7 &   
7#b7 z subp>agraphs 7,a7 & 7,b71        
respectively1 & mov+ ! m>g9s ( su*      

subp>agraphs1 z s r$esignat$1 #b ems to 
! "r2  7#c7 by /rik+ ,c]ta9 ,prev5tive  
,s]vices & all t foll[s ?r\gh any o!r   
provision ( ?is title & ins]t+3 ,c]ta9  
,prev5tive ,s]vices4--  7#a7 ,9 g5]al   
,not)/&+ any o!r provision ( ?is title  
2 &  7#d7 by add+ at ! end ! foll[+ new 
p>agraph3  7#b7 ,inapplicability ,!     
,secret>ial au?ority describ$ 9 p>agraph
 7#a7 %all n apply ) respect to         
prev5tive s]vices describ$ 9 section    
#ahfa7ww77#b77,o74  4  7f7 ,effective   
date ,! am5dm5ts made by ?is section    
%all apply ) respect to items & s]vices 
furni%$ on or aft] ,janu>y #a1 #bjbb4   
#d4 ,m$icaid cov]age ( p]iph]al art]y   
disease scre5+ te/s furni%$ to at-risk  
b5efici>ies )\t imposition ( co/ %>+    
requirem5ts  7a7 ,9 g5]al ,section #aije
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9    
subsection 7a7--  7,a7 9 p>agraph 7#bi71
 by /rik+ & at ! end2  7,b7 by          
r$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     
p]iph]al art]y disease scre5+ te/s      
furni%$ to at-risk b5efici>ies 7z su*   
t]ms are def9$ 9 subsection 7gg772 &  2 
&  7#b7 by add+ at ! end ! foll[+ new   
subsection3  7gg7 ,p]iph]al art]y       
disease scre5+ te/2 ,at-,risk b5efici>y 
7#a7 ,p]iph]al art]y disease scre5+ te/ 
,! t]m p]iph]al art]y disease scre5+ te/
 means--  7,a7 non9vasive physiologic   
/udies ( extremity art]ies 7commonly    
ref]r$ to z ankle-bra*ial index te/+72  
7,b7 art]ial duplex scans ( l[]         
extremity art]ies vascul>2 &  7,c7 su*  
o!r items & s]vices z ! ,secret>y       
det]m9es1 9 consultation ) relevant     
/akehold]s1 to be appropriate = scre5+ =
 p]iph]al art]y disease = at-risk       
b5efici>ies4  7#b7 ,at-risk b5efici>y ,!
 t]m at-risk b5efici>y means an         
individual enroll$ "u a ,/ate plan 7or a
 waiv] ( su* plan7--  7,a7 :o is #fe    
ye>s ( age or old]2  7,b7 :o is at lea/ 
#ej ye>s ( age b n old] ?an #fd ye>s (  
age ) risk factors = a!roscl]osis 7su* z

 diabetes mellitus1 a hi/ory ( smok+1   
hyp]lipidemia1 & hyp]t5sion7 or a family
 hi/ory ( p]iph]al art]y disease2  7,c7 
:o is y\ng] ?an #ej ye>s ( age )        
diabetes mellitus & "o additional risk  
factor = a!roscl]osis2 or  7,d7 ) a kn[n
 a!roscl]otic disease 9 ano!r vascul> b$
 su* z coron>y1 c>otid1 subclavian1     
r5al1 or mes5t]ic art]y /5osis1 or      
abdom9al aortic aneurysm4  7#c7         
,frequ5cy ,! ,secret>y %all1 9          
consultation ) appropriate              
organizations1 e/abli% /&>ds reg>d+ !   
frequ5cy = p]iph]al art]y disease scre5+
 te/s describ$ 9 subsection 7a77#cj7 =  
purposes ( cov]age "u a ,/ate plan "u   
?is title4  4  7b7 ,no co/ %>+  7#a7 ,9 
g5]al ,subsections 7a77#b7 & 7b77#b7 (  
section #aiaf ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifo7 are ea* am5d$-- 
7,a7 9 subp>agraph 7,f71 by /rik+ or at 
! end2  7,b7 9 subp>agraph 7,g71 by     
/rik+ 2 & & ins]t+ 1 or2 &  7,c7 by add+
 at ! end ! foll[+ new subp>agraph3     
7,h7 p]iph]al art]y disease scre5+ te/s 

furni%$ to at-risk b5efici>ies 7z su*   
t]ms are def9$ 9 section #aije7;gg772 & 
4  7#b7 ,application to alt]native co/  
%>+ ,section #aiaf;,a7b77#c77;,b7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acifo-#a7;b77#c77;,b77 is am5d$ by add+
 at ! end ! foll[+ new clause3  7xii7   
,p]iph]al art]y disease scre5+ te/s     
furni%$ to at-risk b5efici>ies 7z su*   
t]ms are def9$ 9 section #aije7;gg774  4
  7c7 ,m&atory cov]age ,section         
#aijb7;a77#aj77;,a7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#aj77;,a77 is am5d$ by /rik+ 
& 7#bi7 & ins]t+ 7#bi71 & 7#cj74  7d7   
,con=m+ am5dm5ts  7#a7 ,section         
#aijb7nn77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acif;a7nn77#c77 is     
am5d$ by /rik+ foll[+ p>agraph 7#cj7 &  
ins]t+ foll[+ p>agraph 7#ca74  7#b7     
,section #aije7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif;d7a77 is     
am5d$ by /rik+ foll[+ p>agraph 7#cj7 &  
ins]t+ foll[+ p>agraph 7#ca74  #e4      
,requirem5t = gr\p heal? plans & heal?  

insurance issu]s (f]+ gr\p or individual
 heal? insurance cov]age to provide     
cov]age = p]iph]al art]y disease scre5+ 
te/s furni%$ to at-risk enrollees )\t   
imposition ( co/ %>+ requirem5ts  7a7 ,9
 g5]al ,subsection 7a7 ( section #bgac (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #cjj;gg-#ac7 is am5d$ to read 
z foll[s3  7a7 ,cov]age ( prev5tive     
heal? s]vices  7#a7 ,9 g5]al ,a gr\p    
heal? plan & a heal? insurance issu]    
(f]+ gr\p or individual heal? insurance 
cov]age %all1 at a m9imum1 provide      
cov]age = & %all n impose any co/ %>+   
requirem5ts =-- 7,a7 evid5ce-bas$ items 
or s]vices t h 9 effect a rat+ ( ,a or  
,b 9 ! curr5t recomm5dations ( ! ,unit$ 
,/ates ,prev5tive ,s]vices ,task ,=ce2  
7,b7 immunizations t h 9 effect a       
recomm5dation f ! ,advisory ,committee  
on ,immunization ,practices ( ! ,c5t]s =
 ,disease ,control & ,prev5tion )       
respect to ! individual involv$2  7,c7 )
 respect to infants1 *ildr51 &          
adolesc5ts1 evid5ce-in=m$ prev5tive c>e 

& scre5+s provid$ = 9 ! compreh5sive    
guidel9es support$ by ! ,heal? ,res\rces
 & ,s]vices ,adm9i/ration2  7,d7 )      
respect to wom51 su* additional         
prev5tive c>e & scre5+s n describ$ 9    
subp>agraph 7,a7 z provid$ = 9          
compreh5sive guidel9es support$ by !    
,heal? ,res\rces & ,s]vices             
,adm9i/ration = purposes ( ?is          
subp>agraph2 &  7,e7 ) respect to       
at-risk enrollees1 p]iph]al art]y       
disease scre5+ te/s4  7#b7 ,p]iph]al    
art]y disease scre5+ te/2 ,at-risk      
enrollee ,= purposes ( p>agraph         
7#a77;,e73 7,a7 ,p]iph]al art]y disease 
scre5+ te/ ,! t]m p]iph]al art]y disease
 scre5+ te/ means--  7i7 non9vasive     
physiologic /udies ( extremity art]ies  
7commonly ref]r$ to z ankle-bra*ial     
index te/+72  7ii7 art]ial duplex scans 
( l[] extremity art]ies vascul>2 &      
7iii7 su* o!r items & s]vices z !       
,secret>y det]m9es1 9 consultation )    
relevant /akehold]s1 to be appropriate =
 scre5+ = p]iph]al art]y disease =      

at-risk enrollees4  7,b7 ,at-risk       
enrollee ,! t]m at-risk enrollee means  
an individual enroll$ 9 a gr\p heal?    
plan or gr\p or individual heal?        
insurance cov]age--  7i7 :o is #fe ye>s 
( age or old]2  7ii7 :o is at lea/ #ej  
ye>s ( age b n old] ?an #fd ye>s ( age )
 risk factors = a!roscl]osis 7su* z     
diabetes mellitus1 a hi/ory ( smok+1    
hyp]lipidemia1 & hyp]t5sion7 or a family
 hi/ory ( p]iph]al art]y disease2  7iii7
 :o is y\ng] ?an #ej ye>s ( age )       
diabetes mellitus & "o additional risk  
factor = a!roscl]osis2 or  7iv7 ) a kn[n
 a!roscl]otic disease 9 ano!r vascul> b$
 su* z coron>y1 c>otid1 subclavian1     
r5al1 or mes5t]ic art]y /5osis1 or      
abdom9al aortic aneurysm4  7,c7         
,frequ5cy ,! ,secret>y %all1 9          
consultation ) appropriate              
organizations1 e/abli% /&>ds reg>d+ !   
frequ5cy = p]iph]al art]y disease scre5+
 te/s describ$ 9 p>agraph 7#a77;,e7 =   
purposes ( cov]age "u ?is section4  7#c7
 ,cl>ification reg>d+ brea/ canc]       

scre5+1 mammography1 & prev5tion        
recomm5dations ,= ! purposes ( ?is ,act1
 & = ! purposes ( any o!r provision (   
law1 ! curr5t recomm5dations ( ! ,unit$ 
,/ates ,prev5tive ,s]vice ,task ,=ce    
reg>d+ brea/ canc] scre5+1 mammography1 
& prev5tion %all be consid]$ ! mo/      
curr5t o!r ?an ^? issu$ 9 or ar\nd      
,novemb] #bjji4  7#d7 ,rule (           
con/ruction ,no?+ 9 ?is subsection %all 
be con/ru$ to prohibit a plan or issu] f
 provid+ cov]age = s]vices 9 addition to
 ^? recomm5d$ by ! ,unit$ ,/ates        
,prev5tive ,s]vices ,task ,=ce or to d5y
 cov]age = s]vices t are n recomm5d$ by 
su* ,task ,=ce4  4  7b7 ,effective date 
,! am5dm5t made by subsection 7a7 %all  
apply ) respect to plan ye>s beg9n+ on  
or aft] ,janu>y #a1 #bjbb4  #f4         
,disall[ance ( paym5t = nontraumatic    
amputation s]vices furni%$ )\t          
anatomical te/+ s]vices ,section #ahcd (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciem7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7x7 ,disall[ance

 ( paym5t = nontraumatic amputation     
s]vices furni%$ )\t anatomical te/+     
s]vices  7#a7 ,9 g5]al ,9 ! case (      
nontraumatic amputation s]vices furni%$ 
by a suppli] on or aft] ,janu>y #a1     
#bjbb1 to an individual entitl$ to1 or  
enroll$ =1 b5efits "u "p ,a & enroll$ = 
b5efits "u ?is "p1 = :i* paym5t is made 
"u ?is "p1 paym5t may only be made "u   
?is "p if su* suppli] furni%es          
anatomical te/+ s]vices to su*          
individual dur+ ! #c-mon? p]iod prec$+ !
 date on :i* su* nontraumatic amputation
 s]vices is furni%$4  7#b7 ,def9itions  
,9 ?is subsection3 7,a7 ,anatomical te/+
 s]vices ,! t]m anatomical te/+ s]vices 
means art]ial duplex scann+1 comput$    
tomography angiography1 & magnetic      
resonance angiography4  7,b7            
,nontraumatic amputation s]vices ,! t]m 
nontraumatic amputation s]vices means   
amputations z a result ( a!roscl]otic   
vascul> disease or a relat$ comorbity ( 
su* disease 7includ+ diabetes74  4  #g4 
,developm5t & implem5tation ( quality   

measures  7a7 ,developm5t ,! ,secret>y (
 ,heal? & ,human ,s]vices 7ref]r$ to 9  
?is section z ! ,secret>y7 %all1 9      
consultation ) relevant /akehold]s1     
develop quality measures = nontraumatic1
 l[]-limb1 major amputation t utilize   
appropriate diagno/ic scre5+ 7includ+   
p]iph]al art]y disease scre5+7 9 ord] to
 enc\rage alt]native treatm5ts 7includ+ 
revascul>ization7 9 lieu ( su* an       
amputation4  7b7 ,implem5tation ,aft]   
appropriate te/+ & validation ( !       
measures develop$ "u subsection 7a71 !  
,secret>y %all incorporate su* measures 
9 quality report+ programs = appropriate
 provid]s ( s]vices & suppli]s "u !     
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq471 includ+ = purposes (--  
7#a7 ! m]it-bas$ inc5tive paym5t sy/em  
"u section #ahdh7q7 ( su* ,act 7#db     
,u4,s4,c4 #aciew-#d7q772  7#b7 inc5tive 
paym5ts = p>ticipation 9 eligible       
alt]native paym5t models "u section     
#ahcc7z7 ( su* ,act 7#db ,u4,s4,c4      

#aciel7z772  7#c7 ! %>$ sav+s program "u
 section #ahii ( su* ,act 7#db ,u4,s4,c4
 #acie;jjj72  7#d7 models "u section    
#aaae;,a ( su* ,act 7#db ,u4,s4,c4      
#acae;a72 &  7#e7 su* o!r paym5t sy/ems 
or models z ! ,secret>y may specify4