,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #hhcd  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,decemb] #b1          
#bjbj,mrs4 ,d+ell 7= h]self1 ,ms4       
,/ev5s1 ,mr4 ,blum5au]1 & ,mr4 ,?ompson 
( ,cali=nia7 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   
ext5d & improve ! ,indep5d5ce at ,home  
,m$ical ,practice ,demon/ration ,program
 "u ! ,m$ic>e program4  #a4 ,%ort title 
,?is ,act may be cit$ z ! ,indep5d5ce at
 ,home ,demon/ration ,improvem5t ,act ( 
#bjbj4  #b4 ,ext5d+ & improv+ !         
,indep5d5ce at ,home ,m$ical ,practice  
,demon/ration ,program "u ! ,m$ic>e     
program ,section #ahff;,e ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;cc-#e7 is am5d$-- 7#a7 9          

subsection 7e7-- 7,a7 9 p>agraph 7#a71  
by /rik+ #g & ins]t+ #aj2  7,b7 9       
p>agraph 7#b7-- 7i7 9 ! head]1 by /rik+ 
,no physician & ins]t+ ,physician2 &    
7ii7 by add+ at ! end ! foll[+ new      
s5t5ce3 ,no?+ 9 ! previ\s s5t5ce %all be
 con/ru$ to prohibit an indep5d5ce at   
home m$ical practice f p>ticipat+ 9 any 
model or demon/ration ) a %>$ sav+s     
compon5t "u ?is title 7o!r ?an ! program
 "u section #ahii7 or "u section        
#aaae;,a if su* p>ticipation is det]m9$ 
appropriate by ! ,secret>y42 &  7,c7 9  
p>agraph 7#d7-- 7i7 by r$esignat+       
subp>agraphs 7,a7 ?r\gh 7,c7 z clauses  
7i7 ?r\gh 7iii71 respectively1 & adju/+ 
! m>g9s accord+ly2  7ii7 9 clause 7i71 z
 s r$esignat$1 by ins]t+ are be=e       
locat$2  7iii7 9 clause 7iii71 z s      
r$esignat$1 by /rik+ ! p]iod at ! end & 
ins]t+ 2 &2  7iv7 9 ! matt] prec$+      
clause 7i71 z s r$esignat$1 by /rik+ to 
practices t are-- & ins]t+ ! foll[+3    
to-- 7,a7 practices t--  2 &  7v7 by    
add+ at ! end ! foll[+ new subp>agraph3 

7,b7 practices ) ! same tax             
id5tification numb] z an indep5d5ce at  
home m$ical practice approv$ "u ?is     
p>agraph z ( ! date ( ! enactm5t ( ?is  
subp>agraph4  2 &  7,d7 9 p>agraph      
7#e7-- 7i7 9 ! fir/ s5t5ce1 by ins]t+ 9 
#bjai aft] #ae1jjj2  7ii7 by ins]t+ ,=  
ea* subsequ5t ye>1 ! b5efici>y          
limitation 9 effect "u ?is p>agraph = ! 
previ\s ye> 7includ+1 if applicable1 any
 increase made "u ?is s5t5ce7 %all be   
increas$ by #e1jjj if ! ,secret>y       
det]m9es t op]ation ( ! program "u ?is  
section = su* previ\s ye> result$ 9     
aggregate sav+s "u ?is title = su* ye>  
comp>$ to exp5ditures "u ?is title = su*
 ye> _h su* program n be5 9 effect4 aft]
 ! fir/ s5t5ce2  7iii7 by /rik+ !       
increase f #aj1jjj to #ae1jjj 9 ! prec$+
 s5t5ce & ins]t+ an increase2  7iv7 by  
ins]t+ or ! am5dm5t made by section     
#b7a77;,d77ii7 ( ! ,indep5d5ce at ,home 
,demon/ration ,improvem5t ,act ( #bjbj  
aft] ,social ,s]vices ,act2  7v7 by     
/rik+ & sev5? & ins]t+ ?r\gh t5?2 &     

7vi7 by ins]t+ 1 z applicable aft] su*  
program2  7#b7 9 subsection 7g7-- 7,a7  
by /rik+ ,! ,secret>y %all & ins]t+ !   
foll[+3  7#b7 ,f9al report ,! ,secret>y 
%all  2 &  7,b7 by ins]t+ be=e p>agraph 
7#b71 z designat$ by subp>agraph 7,a71 !
 foll[+ new p>agraph3  7#a7 ,annual     
reports ,! ,secret>y %all conduct an    
indep5d5t evaluation ( ! demon/ration   
program & submit to ,congress an annual 
report at ! close ( ea* p]=mance ye>    
7beg9n+ ) p]=mance ye> #bjba71 includ+ a
 specification ( any improvem5ts made to
 ! program = su* ye>4 ,su* report %all  
include an analysis su* improvem5ts'    
impact on coord9ation ( c>e1 exp5ditures
 "u ?is title1 applicable b5efici>y     
access to s]vices1 & ! quality ( heal?  
c>e s]vices provid$ to applicable       
b5efici>ies4  2  7#c7 9 subsection 7h71 
by /rik+ ea* ( fiscal ye>s #bjaj ?r\gh  
#bjae & ins]t+ fiscal ye> #bjba2 &  7#d7
 by add+ at ! end ! foll[+ new          
subsection3  7j7 ,au?ority ,to implem5t 
improvem5ts to program ,! ,secret>y may 

make su* improvem5ts to ! demon/ration  
program n inconsi/5t ) ! prec$+         
provisions ( ?is section z ! ,secret>y  
det]m9es appropriate = purposes (-- 7#a7
 improv+ coord9ation ( c>e2  7#b7 l[]+  
exp5ditures2  7#c7 increas+ access to   
items & s]vices "u ! program2 or  7#d7  
improv+ ! quality ( items & s]vices     
furni%$ "u ! program4  4