,,ii #aaf? ,,congress #a/ ,session ,s4 #adig ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #ae1 #bjai,mr4 ,wyd5 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to improve co/ & quality transp>5cy "u ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,c>e ,price ,*eck ,act ( #bjai4 #b4 ,improv+ co/ & quality transp>5cy "u ! ,m$ic>e program 7a7 ,secret>y 7#a7 ,9 g5]al ,section #ahjd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is am5d$-- 7,a7 9 subsection 7b71 9 ! fir/ s5t5ce1 by /rik+ ,! ,secret>y & ins]t+ ,subject to subsection 7e77#a71 ! ,secret>y2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7e7 ,co/ & quality transp>5cy 7#a7 ,requirem5ts = toll-free telephone numb] ,n lat] ?an #a ye> aft] ! date ( ! enactm5t ( ?is ,act 7except z provid$ 9 subp>agraph 7,a77iv771 ! ,secret>y %all ensure t ! foll[+ in=mation is available to an individual :o calls ! toll-free telephone numb] "u subsection 7b73 7,a7 ,co/s ,! foll[+ in=mation reg>d+ co/s = items & s]vices "u p>ts ,a & ,b3 7i7 ,! individual's out-(-pocket co/s = a specific item or s]vice furni%$ by a specific provid] ( s]vices or suppli]4 7ii7 ,! paym5t am\nt "u ?is title = su* item or s]vice furni%$ by su* provid] or suppli]4 7iii7 ,! total all[able *>ges = su* item or s]vice furni%$ by su* provid] or suppli]4 7iv7 ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! in=mation describ$ 9 clauses 7i7 ?r\gh 7iii7 = items & s]vices t are frequ5tly furni%$ toge!r ) ! item or s]vice describ$ 9 su* clauses1 z det]m9$ by ! ,secret>y4 7v7 ,an explanation ( ! co/-%>+ compon5ts "u p>ts ,a & ,b1 includ+ ) respect to-- 7,i7 d$uctibles2 7,,ii7 copaym5ts2 & 7,,iii7 co9surance4 7,b7 ,quality ,quality in=mation available ?r\gh ! ,m$ic>e ,physician ,comp>e1 ,hospital ,comp>e1 ,nurs+ ,home ,comp>e1 ,dialysis ,facility ,comp>e1 ,inpati5t ,rehabilitation ,facility ,comp>e1 ,long-,t]m ,c>e ,hospital ,comp>e1 & ,hospice ,comp>e websites4 7,c7 ,additional in=mation ,o!r co/ & quality in=mation det]m9$ appropriate by ! ,secret>y4 7#b7 ,int]net website 7,a7 ,9 g5]al ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all ensure t an int]net website is 9 place t meets ! foll[+ requirem5ts3 7i7 ,se>* function ,subject to clause 7iv71 ! int]net website conta9s a se>* function t enables an individual to se>* = an item or s]vice 9 a geographic area-- 7,i7 by ! type ( item or s]vice2 & 7,,ii7 by provid]s ( s]vices or suppli]s1 includ+ bo? a g5]al se>* & se>* by a specific "n4 7ii7 ,in=mation ,! int]net website is able to provide ! in=mation describ$ 9 p>agraph 7#a74 7iii7 ,comp>e function ,! int]net website conta9s a comp>e function t enables an individual to comp>e ! out-(-pocket co/s & quality = an item or s]vice furni%$ by diff]5t provid]s ( s]vices or suppli]s4 7,b7 ,limit ,! ,secret>y may limit ! numb] ( items & s]vices = :i* in=mation is available on ! website b %all ensure t items & s]vices :i* acc\nt = at lea/ #ej p]c5t ( sp5d+ "u p>ts ,a & ,b are includ$4 7,c7 ,exi/+ website ,! ,secret>y may comply ) ! requirem5ts "u ?is p>agraph ?r\gh ! use ( an int]net website t is 9 place z ( ! date ( ! enactm5t ( ?is subsection4 7#c7 ,al]t reg>d+ e/imates ( co/s ,! ,secret>y %all ensure t individuals receiv+ co/ in=mation "u p>agraph 7#a7 or 7#b7 are al]t$ t ! in=mation provid$ is an e/imate & t ! actual co/s t ! individual w be responsible = may v>y4 4 7#b7 ,fund+ ,!re are appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices su* sums z ! ,secret>y det]m9es are necess>y to c>ry out subsection 7e7 ( section #ahjd ( ! ,social ,security ,act1 z add$ by p>agraph 7#a74 7b7 ,m$ic>e ,advantage ,section #aheb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7 is am5d$-- 7#a7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,co/ & quality transp>5cy ,= plan ye> #bjba & subsequ5t plan ye>s1 subject to p>agraph 7#d7 ( subsection 7o71 ! ,m$ic>e ,advantage organization %all comply ) ! requirem5ts "u su* subsection74 2 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7o7 ,co/ & quality transp>5cy 7#a7 ,toll-free telephone numb] 7,a7 ,9 g5]al ,ea* ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan %all h 9 place a toll-free telephone numb] "u :i* enrollees 9 ! plan t call ! telephone numb] are able to receive ! foll[+ in=mation3 7i7 ,co/s = items & s]vices ,! foll[+ in=mation reg>d+ co/s = items & s]vices "u ! plan3 7,i7 ,! enrollee's out-(-pocket co/s = a specific item or s]vice furni%$ by a specific 9-network provid] ( s]vices or suppli]4 7,,ii7 ,! in=mation describ$ 9 subclause 7,i7 = items & s]vices t are frequ5tly furni%$ toge!r ) ! item or s]vice describ$ 9 su* subclause1 z det]m9$ by ! ,secret>y4 7,,iii7 ,an explanation ( ! co/-%>+ compon5ts1 bo? g5]ally & "u ! plan specifically1 includ+ ) respect to-- 7aa7 d$uctibles2 7bb7 copaym5ts2 & 7cc7 co9surance4 7ii7 ,co/s = cov]$ "p ,d drugs ,9 ! case ( an ,,ma-,,pd plan1 ! in=mation describ$ 9 section #ahfj;,d-#d7o77#a77;,a74 7iii7 ,quality ,in=mation on ! quality ( items & s]vices furni%$ by provid]s ( s]vices & suppli]s "u ! plan1 z det]m9$ appropriate by ! ,secret>y4 7iv7 ,out-(-network provid]s ,if an enrollee ( ! plan reque/s in=mation on an out-(-network provid] ( s]vices or suppli]1-- 7,i7 in=mation on ! out-(-network b5efits (f]$ "u ! plan2 & 7,,ii7 o!r in=mation1 z det]m9$ appropriate by ! ,secret>y4 7v7 ,additional in=mation ,o!r co/ & quality in=mation det]m9$ appropriate by ! ,secret>y4 7,b7 ,access ,! toll-free telephone numb] "u subp>agraph 7,a7 %all be accessible by call+ a numb] directly or by *>ge-free transf] pursuant to section #ahjd7;b74 7,c7 ,integration ) exi/+ telephone numb] ,! requirem5ts = a toll-free telephone numb] "u subp>agraph 7,a7 may be provid$ ?r\gh an exi/+ enrollee toll-free telephone numb]4 7#b7 ,int]net website 7,a7 ,9 g5]al ,subject to clause 7iv71 ea* ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan %all h 9 place an int]net website t meets ! foll[+ requirem5ts3 7i7 ,se>* function ,! int]net website conta9s a se>* function t enables an enrollee to se>*-- 7,i7 = an item or s]vice 9 a geographic area-- 7aa7 by ! type ( item or s]vice2 & 7bb7 by provid]s ( s]vices or suppli]s2 & 7,,ii7 9 ! case ( an ,,ma-,,pd plan1 = a cov]$ "p ,d drug "u ! plan4 7ii7 ,in=mation ,! int]net website is able to provide ! in=mation describ$ 9-- 7,i7 p>agraph 7#a77;,a72 & 7,,ii7 9 ! case ( an ,,ma-,,pd plan1 section #ahfj;,d-#d7o77#a77;,a74 7iii7 ,comp>e function ,! int]net website conta9s a comp>e function t enables an enrollee to comp>e-- 7,i7 ! out-(-pocket co/s & quality = an item or s]vice furni%$ by diff]5t provid]s ( s]vices or suppli]s2 & 7,,ii7 9 ! case ( an ,,ma-,,pd plan1 ea* ( subclauses 7,i7 & 7,,ii7 ( section #ahfj;,d-#d7o77#b77;,a77iii7 = a cov]$ "p ,d drug4 7iv7 ,limit ,a ,m$ic>e ,advantage organization may limit ! numb] ( items & s]vices = :i* in=mation is available on ! website pursuant to ! limits e/abli%$ by ! ,secret>y "u section #ahjd7;e77#b77;,a77iv74 7,b7 ,integration ) exi/+ int]net website ,if a ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan has 9 place an int]net website = ! plan z ( ! date ( ! enactm5t ( ?is subsection1 ! organization %all integrate ! requirem5ts "u subp>agraph 7,a7 into su* website1 includ+ ?r\gh ! same log-9 process z ! exi/+ website4 7,c7 ,l9k to an ext]nal int]net website = in=mation on cov]$ "p ,d drugs ,a ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan may provide ! in=mation describ$ subp>agraph 7,a77ii77,,ii7 = ! plan ?r\gh a l9k on ! plan's int]net website to an ext]nal int]net website4 7#c7 ,al]t reg>d+ e/imates ( co/s ,ea* ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan %all ensure t enrollees ( ! plan receiv+ co/ in=mation "u p>agraph 7#a7 or 7#b7 are al]t$ t ! in=mation provid$ is an e/imate & t ! actual co/s t ! enrollee w be responsible = may v>y4 7#d7 ,exemption ,! requirem5ts ( ?is subsection %all n apply to a ,m$ic>e ,advantage organization if ! total numb] ( enrollees 9 all ! ,m$ic>e ,advantage plans (f]$ by ! organization is less ?an a numb] ( enrollees det]m9$ appropriate by ! ,secret>y4 4 7c7 ,prescription drug plans ,section #ahfj;,d-#d ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is am5d$-- 7#a7 by r$esignat+ ! subsection 7m7 z add$ by section #fjfc7;c7 ( ! ,,support = ,pati5ts & ,communities ,act 7,public ,law #aae-bga7 z subsection 7n72 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7o7 ,co/ transp>5cy ,= plan ye> #bjba & subsequ5t plan ye>s1 subject to p>agraph 7#d71 ea* ,,pdp sponsor (f]+ a prescription drug plan %all comply ) ! foll[+3 7#a7 ,toll-free telephone numb] 7,a7 ,9 g5]al ,! ,,pdp sponsor (f]+ ! prescription drug plan %all h 9 place a toll-free telephone numb] "u :i* enrollees 9 ! plan t call ! telephone numb] are able to receive ! foll[+ in=mation3 7i7 ,! enrollee's out-(-pocket co/s = a specific cov]$ "p ,d drug fill$ by a specific 9-network ph>macy4 7ii7 ,an explanation ( ! co/-%>+ compon5ts = cov]$ "p ,d drugs1 bo? g5]ally & "u ! plan specifically1 includ+ ) respect to-- 7,i7 d$uctibles2 7,,ii7 copaym5ts2 & 7,,iii7 co9surance4 7,b7 ,integration ) exi/+ telephone numb] ,! requirem5ts = a toll-free telephone numb] "u subp>agraph 7,a7 may be provid$ ?r\gh an exi/+ enrollee toll-free telephone numb]4 7#b7 ,int]net website 7,a7 ,9 g5]al ,ea* ,,pdp sponsor (f]+ a prescription drug plan %all h 9 place an int]net website t meets ! foll[+ requirem5ts3 7i7 ,se>* function ,! int]net website conta9s a se>* function t enables an enrollee to se>* = a cov]$ "p ,d drug "u ! plan4 7ii7 ,in=mation ,! int]net website is able to provide ! in=mation describ$ 9 subp>agraph 7,a7 ( p>agraph 7#a74 7iii7 ,comp>e function ,! int]net website conta9s a comp>e function t enables an enrollee to comp>e ea* ( ! foll[+ = a cov]$ "p ,d drug3 7,i7 ,! out-(-pocket co/s = multiple ph>macies1 includ+ mail ord] if available4 7,,ii7 ,! out-(-pocket co/s = cl9ically equival5t !rapeutic options1 includ+ b n limit$ to g5]ic alt]natives4 7,b7 ,integration ) exi/+ int]net website ,if a ,,pdp sponsor (f]+ a prescription drug plan has 9 place an int]net website = ! plan z ( ! date ( ! enactm5t ( ?is subsection1 ! organization %all integrate ! requirem5ts "u subp>agraph 7,a7 into su* website1 includ+ ?r\gh ! same log-9 process z ! exi/+ website4 7,c7 ,l9k to an ext]nal int]net website ,a ,,pdp sponsor (f]+ a prescription drug plan may provide ! in=mation describ$ subp>agraph 7,a77ii7 = ! plan ?r\gh a l9k on ! plan's int]net website to an ext]nal int]net website4 7#c7 ,al]t reg>d+ e/imates ( co/s ,ea* ,,pdp sponsor (f]+ a prescription drug plan %all ensure t enrollees ( ! plan receiv+ co/ in=mation "u p>agraph 7#a7 or 7#b7 are al]t$ t ! in=mation provid$ is an e/imate & t ! actual co/s t ! enrollee w be responsible = may v>y4 7#d7 ,exemption ,! requirem5ts ( ?is subsection %all n apply to a ,,pdp sponsor if ! total numb] ( enrollees 9 all ! prescription drug plans (f]$ by ! sponsor is less ?an a numb] ( enrollees det]m9$ appropriate by ! ,secret>y4 4 #c4 ,improv+ co/ & quality transp>5cy "u private heal? insurance 7a7 ,9 g5]al ,title ,,xxvii ( ! ,public ,heal? ,s]vice ,act is am5d$ by ins]t+ aft] section #bgae;,a 7#db ,u4,s4,c4 #cjj;gg-#ae;a7 ! foll[+3 #bgae;,b4 ,improv+ co/ & quality transp>5cy "u private heal? insurance 7a7 ,toll-,free telephone numb] 7#a7 ,9 g5]al ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all h 9 place a toll-free telephone numb] "u :i* enrollees 9 ! plan or cov]age call+ ! telephone numb] are able to receive1 directly or ?r\gh *>ge-free transf]1 in=mation reg>d+ ! quality ( 9-network provid]s & facilities1 z def9$ by ! ,secret>y1 & ! foll[+ in=mation reg>d+ out-(-pocket co/s = b5efits "u ! plan or cov]age3 7,a7 ,! enrollee's out-(-pocket co/s = a specific cov]$ b5efit provid$ by a specific 9-network provid] or facility1 & o!r cov]$ b5efits frequ5tly associat$ ) ! specific cov]$ b5efit1 z det]m9$ by ! ,secret>y4 7,b7 ,an explanation ( ! co/-%>+ compon5ts "u ! applicable plan or cov]age1 includ+ ) respect to-- 7i7 d$uctibles2 7ii7 copaym5ts2 & 7iii7 co9surance4 7,c7 ,) respect to prescription drugs cov]$ by ! plan or cov]age-- 7i7 out-(-pocket co/s2 7ii7 v>iation 9 ! co/s1 cov]age1 & prices describ$ 9 clause 7i7 by ph>macy options1 includ+ ! pref]r$ ph>macy1 mail ord] ph>macy 7if applicable71 & o!r ph>macies 9 ! designat$ geographic area2 & 7iii7 v>iation 9 su* co/s ) respect to g5]ic or o!r !rapeutically equival5t alt]natives4 7,d7 ,) respect to s]vices provid$ by an out-(-network provid]1 a summ>y ( ! out-(-network b5efits (f]$ "u ! plan or cov]age1 & o!r in=mation det]m9$ appropriate by ! ,secret>y2 & 7,e7 ,o!r in=mation det]m9$ appropriate by ! ,secret>y4 7#b7 ,integration ) exi/+ s]vices ,! requirem5ts = a toll-free telephone numb] "u p>agraph 7#a7 may be provid$ ?r\gh an exi/+ enrollee toll-free telephone numb]4 7#c7 ,prescription drug in=mation ,a gr\p heal? plan or heal? insurance issu] t has a contract ) ano!r entity (f]+ prescription drug managem5t s]vices ) respect to ! plan or applicable heal? insurance cov]age may satisfy ! requirem5t to provide ! in=mation requir$ "u p>agraph 7#a77;,c7 by connect+ enrollees to a toll-free telephone s]vice ( su* entity :]e su* entity makes su* in=mation available4 7b7 ,int]net website 7#a7 ,9 g5]al ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all h 9 place an int]net website t meets ! foll[+ requirem5ts ) respect to provid+ enrollees ) in=mation reg>d+ ! quality ( 9-network provid]s & facilities1 z def9$ by ! ,secret>y1 & in=mation on out-(-pocket co/s = b5efits "u ! plan or cov]age3 7,a7 ,se>* function ,! int]net website conta9s a se>* function t enables an enrollee to se>* = a b5efit 9 a geographic area1 at m9imum-- 7i7 by ! type ( b5efit2 & 7ii7 by provid]s 9 ! area4 7,b7 ,co/s ,! int]net website is able to provide ! foll[+ in=mation3 7i7 ,! enrollee's out-(-pocket co/s = a specific b5efit provid$ by a specific 9-network provid]1 & o!r cov]$ b5efits frequ5tly associat$ ) ! specific cov]$ b5efit1 z det]m9$ by ! ,secret>y4 7ii7 ,an explanation ( ! co/-%>+ compon5ts1 "u ! applicable plan or cov]age specifically1 includ+ ) respect to-- 7,i7 d$uctibles2 7,,ii7 copaym5ts2 & 7,,iii7 co9surance4 7iii7 ,) respect to prescription drugs cov]$ by ! plan or cov]age-- 7,i7 out-(-pocket co/s2 7,,ii7 v>iation 9 ! co/s describ$ 9 subclause 7,i7 by ph>macy options1 includ+ ! pref]r$ ph>macy1 mail ord] ph>macy 7if applicable71 & o!r ph>macies 9 ! designat$ geographic area2 & 7,,iii7 v>iation 9 su* co/s1 cov]age1 & prices ) respect to g5]ic or o!r !rapeutically equival5t alt]natives4 7iv7 ,) respect to s]vices provid$ by an out-(-network provid]1 a summ>y ( ! out-(-network b5efits (f]$ "u ! plan or cov]age1 & o!r in=mation det]m9$ appropriate by ! ,secret>y2 & 7v7 ,o!r in=mation det]m9$ appropriate by ! ,secret>y4 7,c7 ,comp>e function ,! int]net website conta9s a comp>e function t enables an enrollee to comp>e ! out-(-pocket co/s & quality measures = a b5efit furni%$ by diff]5t provid]s4 7#b7 ,integration ,if a gr\p heal? plan or heal? insurance issu] has 9 place an int]net website = enrollees 9 a plan or cov]age z ( ! date ( ! enactm5t ( ?is section1 ! plan or issu] %all integrate ! requirem5ts "u p>agraph 7#a7 into su* website1 includ+ ?r\gh ! same log-9 process z ! exi/+ website4 7#c7 ,ext5t ( in=mation ,a gr\p heal? plan or heal? insurance issu] may limit ! numb] ( heal? c>e s]vices = :i* ! in=mation requir$ "u p>agraph 7#a77;,b7 is available on ! website to a numb] det]m9$ by ! ,secret>y4 7#d7 ,prescription drug in=mation ,a gr\p heal? plan or heal? insurance issu] t has a contract ) ano!r entity (f]+ prescription drug managem5t s]vices ) respect to ! plan or applicable heal? insurance cov]age may satisfy ! requirem5t to provide ! in=mation requir$ "u p>agraph 7#a77;,b77iii7 by provid+ a l9k to ! int]net website ( su* entity :]e su* entity makes su* in=mation available4 7c7 ,disclosure requirem5t ,a gr\p heal? plan or heal? insurance issu] %all in=m enrollees seek+ in=mation ?r\gh ! toll-free telephone numb] "u subsection 7a7 or ! int]net website "u subsection 7b7 t ! co/ in=mation provid$ are e/imates & t ! actual am\nt ! enrollee w be responsible = pay+ may v>y4 7d7 ,regulations ,! ,secret>y1 9 consultation ) ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices1 %all promulgate regulations to c>ry out ?is section 9 a mann] simil> to ! requirem5ts = out-(-pocket co/ transp>5cy applicable to ,m$ic>e ,advantage organizations "u section #aheb7o7 ( ! ,social ,security ,act4 7e7 ,exemption ,! requirem5ts ( ?is section %all n apply to a small or regional gr\p heal? plan1 or to a small or regional heal? insurance issu] ) respect to heal? insurance cov]age4 ,! ,secret>y %all def9e small or regional gr\p heal? plan & small or regional heal? insurance issu] = purposes ( ?is subsection4 4 7b7 ,effective date ,section #bgae;,a ( ! ,public ,heal? ,s]vice ,act1 z add$ by subsection 7a71 %all take effect on ,janu>y #a1 #bjba4