,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #djhh  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #be1 #bjbj,mr4   
,br[n 7= himself1 ,mrs4 ,murray1 ,mr4   
,leahy1 ,ms4 ,baldw91 ,mr4 ,s*atz1 ,ms4 
,/ab5[1 ,mr4 ,murphy1 & ,mr4 ,m]kley7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to ext5d !  
application ( ! ,m$ic>e paym5t rate     
floor to prim>y c>e s]vices furni%$ "u  
,m$icaid & to apply ! rate floor to     
additional provid]s ( prim>y c>e        
s]vices4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,ensur+ ,access to ,prim>y  
,c>e = ,wom5  ,*ildr5 ,act4  #b4 ,r5ewal
 ( application ( ,m$ic>e paym5t rate    
floor to prim>y c>e s]vices furni%$ "u  
,m$icaid & inclusion ( additional       
provid]s  7a7 ,r5ewal ( paym5t floor2   
additional provid]s  7#a7 ,9 g5]al      
,section #aijb7;a77#ac7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acif;a7a77#ac77 is am5d$ by /rik+      

subp>agraph 7,c7 & ins]t+ ! foll[+3     
7,c7 paym5t = prim>y c>e s]vices 7z     
def9$ 9 subsection 7jj77 at a rate t is 
n less ?an #ajj p]c5t ( ! paym5t rate t 
applies to su* s]vices & provid] "u "p  
,b ( title ,,xviii 7or1 if great]1 !    
paym5t rate t w\ld be applicable "u su* 
"p if ! conv]sion factor "u section     
#ahdh7;d7 = ! ye> involv$ 7 ! conv]sion 
factor "u su* section = #bjji71 & t is n
 less ?an ! rate t w\ld o!rwise apply to
 su* s]vices "u ?is title if ! rate 7   
det]m9$ )\t reg>d to ?is subp>agraph1 & 
t are-- 7i7 furni%$ 9 #bjac & #bjad1 by 
a physician ) a prim>y specialty        
designation ( family m$ic9e1 g5]al      
int]nal m$ic9e1 or p$iatric m$ic9e2 or  
7ii7 furni%$ 9 ! #b-ye> p]iod t beg9s on
 ! fir/ day ( ! fir/ mon? t beg9s aft] !
 date ( enactm5t ( ! ,ensur+ ,access to 
,prim>y ,c>e = ,wom5  ,*ildr5 ,act or   
dur+ any o!r additional p]iod specifi$ )
 respect to ! ,/ate "u section          
#aije7;dd77#b7-- 7,i7 by a physician ) a
 prim>y specialty designation ( family  

m$ic9e1 g5]al int]nal m$ic9e1 or        
p$iatric m$ic9e1 b only if ! physician  
self-atte/s t ! physician is ,bo>d      
c]tifi$ 9 family m$ic9e1 g5]al int]nal  
m$ic9e1 or p$iatric m$ic9e2  7,,ii7 by a
 physician ) a prim>y specialty         
designation ( ob/etrics & gynecology1 b 
only if ! physician self-atte/s t !     
physician is ,bo>d c]tifi$ 9 ob/etrics &
 gynecology2  7,,iii7 by an advanc$     
practice cl9ician1 z def9$ by !         
,secret>y 7except t ! ,secret>y %all    
def9e su* t]m = purposes ( ?is          
subp>agraph to exclude a provid]        
describ$ 9 subclause 7,i71 7,,ii71 or   
7,v771 t works "u ! sup]vision (-- 7aa7 
a physician t satisfies ! crit]ia       
specifi$ 9 subclause 7,i7 or 7,,ii72 or 
7bb7 a nurse practition] or a physician 
assi/ant 7z su* t]ms are def9$ 9 section
 #ahfa7;aa77#e77;,a77 :o is work+ 9     
accordance ) ,/ate law1 or a c]tifi$    
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg77 :o is work+ 9 accordance )  
,/ate law2  7,,iv7 by a rural heal?     

cl9ic1 ,f$]ally-qualifi$ heal? c5t]1 or 
o!r heal? cl9ic t receives reimbursem5t 
on a fee s*$ule applicable to a         
physician1 a nurse practition] or a     
physician assi/ant 7z su* t]ms are def9$
 9 section #ahfa7;aa77#e77;,a77 :o is   
work+ 9 accordance ) ,/ate law1 or a    
c]tifi$ nurse-midwife 7z def9$ 9 section
 #ahfa7;gg77 :o is work+ 9 accordance ) 
,/ate law1 = s]vices furni%$ by a       
physician1 nurse practition]1 physician 
assi/ant1 or c]tifi$ nurse-midwife1 or  
s]vices furni%$ by an advanc$ practice  
cl9ician sup]vis$ by a physician        
describ$ 9 subclause 7,i7 or 7,,ii71    
ano!r advanc$ practice cl9ician1 a nurse
 practition]1 physician assi/ant1 or a  
c]tifi$ nurse-midwife2 or  7,v7 by a    
nurse practition] or a physician        
assi/ant 7z su* t]ms are def9$ 9 section
 #ahfa7;aa77#e77;,a77 :o is work+ 9     
accordance ) ,/ate law1 or a c]tifi$    
nurse-midwife 7z def9$ 9 section        
#ahfa7;gg77 :o is work+ 9 accordance )  
,/ate law1 9 accordance ) proc$ures t   

ensure t ! portion ( ! paym5t = su*     
s]vices t ! nurse practition]1 physician
 assi/ant1 or c]tifi$ nurse-midwife is  
paid is n less ?an ! am\nt t ! nurse    
practition]1 physician assi/ant1 or     
c]tifi$ nurse-midwife w\ld be paid if ! 
s]vices 7 provid$ "u "p ,b ( title      
,,xviii2  4  7#b7 ,con=m+ am5dm5ts      
,section #aije7;dd7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acif;d7dd77 is am5d$-- 7,a7 by /rik+   
,not)/&+ & ins]t+ ! foll[+3  7#a7 ,9    
g5]al ,not)/&+  2  7,b7 by ins]t+ or    
furni%$ dur+ a p]iod t is an additional 
p]iod ) respect to ! ,/ate1 z specifi$ 9
 p>agraph 7#b71 aft] #bjae12 &  7,c7 by 
add+ at ! end ! foll[+3  7#b7           
,additional p]iods ,= purposes (        
p>agraph 7#a73 7,a7 ,! #b-ye> p]iod t   
beg9s on ! fir/ day ( ! fir/ mon? t     
beg9s aft] ! date ( enactm5t ( ! ,ensur+
 ,access to ,prim>y ,c>e = ,wom5        
,*ildr5 ,act %all be an additional p]iod
 ) respect to all ,/ates4  7,b7 ,any    
public heal? em]g5cy p]iod 7z def9$ 9   

p>agraph 7#c77 ) respect to a ,/ate %all
 be an additional p]iod ) respect to su*
 ,/ate4  7#c7 ,public heal? em]g5cy     
p]iod ,= purposes ( p>agraph 7#b71 ! t]m
 public heal? em]g5cy p]iod means1 )    
respect to a ,/ate1 a p]iod t-- 7,a7    
beg9s on ! date on :i* a public heal?   
em]g5cy is decl>$ ) respect to ! ,/ate  
by ! ,secret>y pursuant to section #cai 
( ! ,public ,heal? ,s]vice ,act2 &  7,b7
 ends on ! la/ day ( ! six? mon? t beg9s
 on or aft] ! date on :i* su* decl>ation
 expires4  4  7b7 ,improv$ t>get+ (     
prim>y c>e ,section #aijb7;jj7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7jj77 is am5d$-- 7#a7 by         
r$esignat+ p>agraphs 7#a7 & 7#b7 z      
subp>agraphs 7,a7 & 7,b71 respectively &
 realign+ ! left m>g9s accord+ly2  7#b7 
by /rik+ ,= purposes ( & ins]t+ !       
foll[+3  7#a7 ,9 g5]al ,= purposes (  2 
&  7#c7 by add+ at ! end ! foll[+3  7#b7
 ,exclusions ,su* t]m does n include any
 s]vices describ$ 9 subp>agraph 7,a7 or 
7,b7 ( p>agraph 7#a7 if su* s]vices are 

provid$ 9 an em]g5cy dep>tm5t ( a       
hospital4  4  7c7 ,ensur+ paym5t by     
manag$ c>e entities  7#a7 ,9 g5]al      
,section #aijc7m77#b77;,a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acif;b7m77#b77;,a77 is am5d$-- 7,a7 9  
clause 7xii71 by /rik+ & aft] !         
semicolon2  7,b7 by realign+ ! left m>g9
 ( clause 7xiii7 s z to align ) ! left  
m>g9 ( clause 7xii7 & by /rik+ ! p]iod  
at ! end ( clause 7xiii7 & ins]t+ 2 &2 &
  7,c7 by ins]t+ aft] clause 7xiii7 !   
foll[+3  7xiv7 su* contract provides t  
7,i7 paym5ts to provid]s specifi$ 9     
section #aijb7;a77#ac77;,c7 = prim>y c>e
 s]vices def9$ 9 section #aijb7;jj7 t   
are furni%$ dur+ a ye> or p]iod specifi$
 9 section #aijb7;a77#ac77;,c7 & section
 #aije7;dd7 are at lea/ equal to !      
am\nts set =? & requir$ by ! ,secret>y  
by regulation1 7,,ii7 ! entity %all1 ^u 
reque/1 provide docum5tation to ! ,/ate1
 suffici5t to enable ! ,/ate & !        
,secret>y to ensure compliance )        
subclause 7,i71 & 7,,iii7 ! ,secret>y   

%all approve paym5ts describ$ 9         
subclause 7,i7 t are furni%$ ?r\gh an   
agre$ ^u capitation1 p>tial capitation1 
or o!r value-bas$ paym5t arrangem5t if !
 capitation1 p>tial capitation1 or o!r  
value-bas$ paym5t arrangem5t is bas$ on 
a reasonable me?odology & ! entity      
provides docum5tation to ! ,/ate        
suffici5t to enable ! ,/ate & !         
,secret>y to ensure compliance )        
subclause 7,i74  4  7#b7 ,con=m+ am5dm5t
 ,section #aicb7;f7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acifu-#b7;f77 is am5d$ by ins]t+ &     
clause 7xiv7 ( section #aijc7m77#b77;,a7
 be=e ! p]iod4  #c4 ,improv+ quality &  
value = ,m$icaid b5efici>ies  7a7 ,,gao 
/udy ,n lat] ?an #c ye>s aft] ! date (  
enactm5t ( ?is ,act1 ! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates %all submit to 
,congress a report t exam9es ! effects (
 ! paym5t rate floor = prim>y c>e       
s]vices "u ,m$icaid provid$ "u section  
#aijb7;a77#ac77;,c7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           

#acif;a7a77#ac77;,c77 on b5efici>y      
access to su* s]vices1 includ+ any      
recomm5dations = h[ ! paym5t rate floor 
= su* s]vices c\ld be m effective4  7b7 
,fund+ ! developm5t ( quality measures  
,! fir/ s5t5ce ( section #aaci;,b7e7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acbj;b-#i;b7e77 is am5d$ by ins]t+ 1 & 
= fiscal ye> #bjaf1 #ae1jjj1jjj1 be=e = 
! purpose4  7c7 ,develop+ quality       
measures = b5efici>ies ) disabilities   
,section #aaci;,b7b77#e7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acbj;b-#i;b7b77#e77 is am5d$ by add+ at
 ! end ! foll[+3  7,d7 ,quality measures
 specific to adult individuals )        
disabilities ,! ,secret>y1 act+ ?r\gh ! 
,adm9i/rator = ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices & ! ,director ( !     
,ag5cy = ,heal?c>e ,rese>* & ,quality1  
%all develop adult heal? quality        
measures t are specific to adult        
individuals ) disabilities & %all       
include ^? measures 9 ! ,m$icaid        
,quality ,measurem5t ,program4 ,9       

develop+ su* measures1 priority %all be 
giv5 to develop+ quality measures t     
assess ! impact on adult individuals )  
disabilities ( exi/+ programs & to !    
developm5t ( quality measures t assess !
 impact ( new s]vice deliv]y innovations
 on su* individuals4  4