,,ii #aaf? ,,congress #a/ ,session ,s4 #dhi ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,febru>y #ad1 #bjai,mr4 ,s*atz 7= himself1 ,mr4 ,he9ri*1 ,mr4 ,:iteh\se1 ,mr4 ,murphy1 ,ms4 ,baldw91 ,mr4 ,m>key1 ,mrs4 ,gillibr&1 ,ms4 ,klobu*>1 ,mr4 ,blum5?al1 ,ms4 ,ros51 ,mr4 ,m]kley1 ,ms4 ,h>ris1 ,mr4 ,leahy1 ,mr4 ,book]1 ,mr4 ,udall1 ,ms4 ,smi?1 ,ms4 ,w>r51 ,ms4 ,hirono1 ,mr4 ,br[n1 ,mr4 ,re$1 ,mrs4 ,%ahe51 ,ms4 ,cortez ,ma/o1 & ,mr4 ,durb97 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to e/abli% a ,/ate public option ?r\gh ,m$icaid to provide ,am]icans ) ! *oice ( a high-quality1 l[-co/ heal? insurance plan4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/ate ,public ,option ,act4 #b4 ,m$icaid buy-9 option 7a7 ,9 g5]al ,section #aijb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is am5d$-- 7#a7 9 subsection 7a77#aj7-- 7,a7 9 subp>agraph 7,a77ii7-- 7i7 9 subclause 7,,xxi71 by /rik+ 2 or & ins]t+ a semicolon2 7ii7 9 subclause 7,,xxii71 by add+ or at ! end2 & 7iii7 by add+ at ! end ! foll[+ new subclause3 7,,xxiii7 beg9n+ ,janu>y #a1 #bjbj1 :o are resid5ts ( ! ,/ate & are n concurr5tly enroll$ 9 ano!r heal? insurance cov]age plan1 subject1 9 ! case ( individuals describ$ 9 subsection 7qq7 & not)/&+ section #aiaf 7except = subsection 7k7 ( su* section71 to paym5t ( premiums or o!r co/-%>+ *>ges2 2 & 7,b7 9 ! matt] foll[+ subp>agraph 7,g71 9 clause 7,,xv71 by ins]t+ or subsection 7qq7 aft] describ$ 9 subp>agraph 7,a77i77,,viii72 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7qq7 ,previ\sly undescrib$ individuals ,individuals describ$ 9 ?is subsection are individuals :o are-- 7#a7 describ$ 9 subclause 7,,xxiii7 ( subsection 7a77#aj77;,a77ii72 & 7#b7 are n describ$ 9 any o!r subclause ( su* subsection or any o!r provision 9 ?is ,act :i* provides = eligibility = m$ical assi/ance4 4 7b7 ,provision ( at lea/ m9imum cov]age 7#a7 ,9 g5]al ,section #aijb7k77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7k77#a77 is am5d$ by ins]t+ or an individual describ$ 9 subsection 7qq7 aft] an individual describ$ 9 subclause 7,,viii7 ( subsection 7a77#aj77;,a77i7 ea* place x appe>s4 7#b7 ,con=m+ am5dm5t ,section #aijc7;i77#bf7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77#bf77 is am5d$ by /rik+ individuals describ$ 9 subclause 7,,viii7 ( subsection 7a77#aj77;,a77i7 & ins]t+ individuals describ$ 9 subsection 7a77#aj77;,a77i77,,viii7 or 7qq7 ( section #aijb4 7c7 ,f$]al f9ancial p>ticipation 9 buy-,9 program 7#a7 ,enhanc$ mat* = adm9i/rative exp5ses ,section #aijc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is am5d$-- 7,a7 by r$esignat+ p>agraph 7#g7 z p>agraph 7#h72 & 7,b7 by ins]t+ aft] p>agraph 7#f7 ! foll[+ new p>agraph3 7#g7 an am\nt equal to #ij p]c5t ( ! sums exp5d$ dur+ su* qu>t] :i* are attributable to reasonable adm9i/rative exp5ses relat$ to ! adm9i/ration ( a ,m$icaid buy-9 program = individuals describ$ 9 section #aijb7;a77#aj77;,a77ii77,,xxiii72 plus 4 7#b7 ,treatm5t ( premium & co/-%>+ rev5ues f ,m$icaid buy-9 program 7,a7 ,9 g5]al ,= purposes ( section #aijc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#a771 = any fiscal qu>t] dur+ :i* a ,/ate collects premiums1 co/-%>+1 or simil> *>ges "u subsection 7k7 ( section #aiaf ( su* ,act 7#db ,u4,s4,c4 #acifo7 7z add$ by ?is ,act71 includ+ any advance paym5ts ( premium tax cr$its "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act or paym5ts = co/-%>+ r$uctions "u section #adjb ( su* ,act t are receiv$ by ! ,/ate1 ! total am\nt exp5d$ dur+ su* qu>t] z m$ical assi/ance = individuals :o buy into ,m$icaid cov]age "u subclause 7,,xxiii7 ( section #aijb7;a77#aj77;,a77ii7 ( ! ,social ,security ,act 7z add$ by ?is ,act7 %all be r$uc$ by ! am\nt ( su* premiums or *>ges4 7,b7 ,treatm5t ( excess premiums ,ea* ,/ate t collects premiums or simil> *>ges "u subsection 7k7 ( section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 7z add$ by ?is ,act7 9 a fiscal ye> %all pay to ! ,secret>y ( ,heal? & ,human ,s]vices1 at su* "t & 9 su* =m & mann] z ! ,secret>y %all specify1 an am\nt equal to #ej p]c5t ( ! am\nt1 if any1 by :i*-- 7i7 ! total am\nt ( su* premiums & *>ges collect$ by ! ,/ate = su* ye>2 exce$s 7ii7 ! total am\nt exp5d$ by ! ,/ate dur+ su* ye> z m$ical assi/ance = individuals :o buy into ,m$icaid cov]age "u subclause 7,,xxiii7 ( section #aijb7;a77#aj77;,a77ii7 ( su* ,act 7z add$ by ?is ,act74 7d7 ,co/-,%>+ requirem5t ,section #aiaf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7k7 ,premiums & co/-,%>+ = individuals p>ticipat+ 9 ,m$icaid buy-,9 program 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ) respect to individuals :o are eligible = m$ical assi/ance "u subsection 7a77#aj77;,a77ii77,,xxiii7 ( section #aijb & are describ$ 9 subsection 7qq7 ( su* section1 a ,/ate may-- 7,a7 impose premiums1 d$uctibles1 co/-%>+1 or o!r simil> *>ges t are actu>ially fair2 & 7,b7 v>y ! premium rate impos$ on an individual bas$ only on ! factors describ$ 9 section #bgja7;a77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act & subject to ! same limitations on ! weight :i* may be giv5 to su* factors "u su* section4 7#b7 ,limitations 7,a7 ,premiums ,! total am\nt ( premiums impos$ = a ye> "u ?is subsection ) respect to all individuals describ$ 9 p>agraph 7#a7 9 a family %all n exce$ an am\nt equal to #i4e p]c5t ( ! family's h\sehold income 7z def9$ 9 section #cf;,b7d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 = ! ye> involv$4 7,b7 ,o!r co/-%>+ 7i7 ,9 g5]al ,! co/-%>+ limitations describ$ 9 section #acjb7;c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act %all apply to co/-%>+ 7z def9$ 9 su* section7 = m$ical assi/ance provid$ "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 9 ! same mann] z su* limitations apply to co/-%>+ "u qualifi$ heal? plans "u title ,i ( su* ,act4 7ii7 ,availability ( co/-%>+ r$uctions ,individuals provid$ m$ical assi/ance "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 & subject to co/-%>+ "u ?is subsection are eligible = co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7subject to ! income eligibility ?re%old 9 subsection 7b77#b7 ( su* section71 & 9 apply+ su* section-- 7,i7 enrollm5t 9 a ,/ate plan "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 %all be treat$ z cov]age "u a qualifi$ heal? plan 9 ! silv] level ( cov]age 9 ! individual m>ket (f]$ ?r\gh an ,ex*ange e/abli%$ = or by ! ,/ate "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act2 & 7,,ii7 ! ,/ate ag5cy adm9i/]+ su* plan %all be treat$ z ! issu] ( su* plan4 7#c7 ,premiums & co/-%>+ = c]ta9 o!r individuals ,if an individual is eligible = m$ical assi/ance "u subsection 7a77#aj77;,a77ii77,,xxiii7 ( section #aijb & is n describ$ 9 subsection 7qq7 ( su* section1 a ,/ate-- 7,a7 %all n impose premiums & co/-%>+ on ! individual "u ?is subsection2 & 7,b7 may impose premiums & co/-%>+ on ! individual to ! ext5t all[$ by ano!r provision ( ?is ,act 7o!r ?an section #aijb7;a77#aj77;,a77ii77,,xxiii77 :i* provides = eligibility = m$ical assi/ance1 b only if ! individual is describ$ 9 su* o!r provision4 7#d7 ,application ( premium assi/ance tax cr$its ,an individual :o is requir$ to pay premiums "u ?is subsection = a ye> = m$ical assi/ance %all be eligible = a premium assi/ance cr$it "u section #cf;,b ( ! ,int]nal ,rev5ue ,code to ! same ext5t t su* individual w\ld be eligible = a premium assi/ance cr$it "u su* section if su* individual _h paid ! same am\nt 9 premiums = cov]age "u a qualifi$ heal? plan = su* ye>4 4 7e7 ,manag$ c>e ,section #aicb7;a77#a77;,a77i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;a77#a77;,a77i77 is am5d$ by ins]t+ 1 includ+ an individual :o is eligible = su* assi/ance aft] buy+ into su* cov]age "u section #aijb7;a77#aj77;,a77ii77,,xxiii71 aft] ! ,/ate plan "u ?is title4 7f7 ,(f]+ buy-,9 program on ,/ate ex*ange2 enrollm5t p]iods 7#a7 ,9 g5]al ,a ,/ate t has elect$ to all[ individuals to buy into ,m$icaid cov]age "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 ( ! ,social ,security ,act 7z add$ by ?is ,act7 %all all[ individuals to enroll 9 su* cov]age ?r\gh ! ,f$]al1 f$]ally facilitat$1 or ,/ate ,ex*ange e/abli%$ pursuant to title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 7#b7 ,enrollm5t p]iods ,a ,/ate may limit ! enrollm5t ( individuals into ,m$icaid cov]age "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 ( ! ,social ,security ,act 7z add$ by ?is ,act7 to ! enrollm5t p]iods provid$ = "u section #acaa7;c77#f7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act4 7g7 ,application ( advanc$ premium tax cr$its to ,m$icaid buy-,9 plans 7#a7 ,9 g5]al ,section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 9 subsection 7b77#c77;,b71 by add+ at ! end ! foll[+ new s5t5ce3 ,if an applicable taxpay] resides 9 a rat+ area 9 :i* no silv] plan is (f]$ on ! individual m>ket b ! taxpay] buys into ,m$icaid cov]age "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 ( ! ,social ,security ,act1 su* ,m$icaid cov]age %all be deem$ to be ! applicable second l[e/ co/ silv] plan ) respect to su* taxpay]4 2 & 7,b7 by add+ at ! end ! foll[+ new subsection3 7h7 ,application to individuals pur*as+ ,m$icaid cov]age ,9 ! case ( any individual :o buys into ,m$icaid cov]age "u section #aijb7;a77#aj77;,a77ii77,,xxiii7 ( ! ,social ,security ,act1 ?is section %all be appli$ ) ! foll[+ modifications3 7#a7 ,! am\nt det]m9$ "u subsection 7b77#b77;,a7 %all be increas$ by ! am\nt ( ! mon?ly premiums paid = su* cov]age4 7#b7 ,subsection 7c77#b77;,a77i7 %all be appli$ by treat+ cov]age "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 9 ! same mann] z a qualifi$ heal? plan t 0 enroll$ 9 ?r\gh an ,ex*ange4 7#c7 ,9 apply+ subsection 7c77#b77;,b7-- 7,a7 an individual %all n be consid]$ to be eligible = m9imum ess5tial cov]age describ$ 9 section #ejjj;,a7f77#a77;,a77ii7 by reason ( eligibility = m$ical assi/ance "u a ,/ate ,m$icaid program "u section #aijb7;a77#aj77;,a77ii77,,xxiii72 & 7,b7 an individual :o is n cov]$ by m9imum ess5tial cov]age describ$ 9 section #ejjj;,a7f77#a77;,b7 %all n be consid]$ to be eligible = su* cov]age4 4 7#b7 ,advanc$ paym5t ( cr$it 7,a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y ( ! ,treasury1 %all e/abli% a program "u :i*-- 7i7 ^u reque/ ( a ,/ate ag5cy adm9i/]+ a ,/ate ,m$icaid program "u title ,,xix ( ! ,social ,security ,act1 advance det]m9ations are made 9 a mann] simil> to advanc$ det]m9ations "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ) respect to ! income eligibility ( individuals enroll+ 9 su* program = ! premium tax cr$it all[able "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf & ! co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act2 7ii7 ! ,secret>y notifies-- 7,i7 ! ,/ate ag5cy adm9i/]+ ! program & ! ,secret>y ( ! ,treasury ( ! advance det]m9ations2 & 7,,ii7 ! ,secret>y ( ! ,treasury ( ! "n & employ] id5tification numb] ( ea* employ] ) respect to :om #a or m employees ( ! employ] 7 det]m9$ to be eligible = ! premium tax cr$it "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf & ! co/-%>+ r$uctions "u section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act because-- 7aa7 ! employ] did n provide m9imum ess5tial cov]age2 or 7bb7 ! employ] provid$ su* m9imum ess5tial cov]age b x 0 det]m9$ "u section #cf;,b7c77#b77;,c7 ( su* ,code to ei!r be unaf=dable to ! employee or n provide ! requir$ m9imum actu>ial value2 & 7iii7 ! ,secret>y ( ! ,treasury makes advance paym5ts ( su* cr$it or r$uctions to ! ,/ate ag5cy adm9i/]+ ! program 9 ord] to r$uce ! premiums payable by individuals eligible = su* cr$it4 7,b7 ,det]m9ations & paym5ts ,rules simil> to subsections 7b7 & 7c7 ( section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act %all apply = purposes ( ?is subsection4 7,c7 ,coord9ation ) cr$it 7i7 ,9 g5]al ,section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ & "u section #b7;g77#b7 ( ! ,/ate ,public ,option ,act aft] section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act ea* place x appe>s 9 subsections 7f77#a71 7f77#b71 & 7g77#a74 7ii7 ,in=mation report+ ,section #cf;,b7f77#c7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ flu% s5t5ce3 ,9 ! case ( any cov]age "u ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act = :i* a cr$it "u ?is section is all[able by reason ( subsection 7h71 ! ,/ate ag5cy adm9i/]+ ! ,m$icaid program %all be treat$ z an ,ex*ange = purposes ( ?is p>agraph & subp>agraph 7,a7 %all n apply44 7#c7 ,con=m+ am5dm5t relat+ to employ] responsibility ,p>agraph 7#f7 ( section #dihj;,h7c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ 1 except t = purposes ( subsections 7a77#b7 & 7b77#b71 ! t]m qualifi$ heal? plan %all include any plan describ$ 9 section #cf;,b7h7 aft] su* ,act4 7h7 ,con=m+ am5dm5ts 7#a7 ,section #aijb7;a77#aj7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj771 z am5d$ by subsection 7a71 is fur!r am5d$1 9 ! matt] foll[+ subp>agraph 7,g7-- 7,a7 by /rik+ & 7,,xvii7 & ins]t+ 1 7,,xvii72 & 7,b7 by ins]t+ 1 & 7,,xviii7 ! m$ical assi/ance made available to an individual describ$ 9 subp>agraph 7,a77ii77,,xxiii7 %all be limit$ to m$ical assi/ance describ$ 9 subsection 7k77#a7 be=e ! semicolon4 7#b7 ,section #aijc7;f77#d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7f77#d77 is am5d$ by ins]t+ #aijb7;a77#aj77;,a77ii77,,xxiii71 aft] #aijb7;a77#aj77;,a77ii77,,xxii714 7#c7 ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is am5d$1 9 ! matt] prec$+ p>agraph 7#a7-- 7,a7 by /rik+ or at ! end ( clause 7xvi72 7,b7 by ins]t+ or at ! end ( clause 7xvii72 & 7,c7 by ins]t+ aft] clause 7xvii7 ! foll[+ new clause3 7xviii7 individuals describ$ 9 section #aijb7;a77#aj77;,a77ii77,,xxiii71 4 7#d7 ,section #aiaf;,a7a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;a77#a77 is am5d$ by /rik+ or 7j7 & ins]t+ 7j71 or 7k74 7#e7 ,section #aicg7;a77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;a77#a77;,b77 is am5d$ by ins]t+ 1 subclause 7,,xxiii7 ( section #aijb7;a77#aj77;,a77ii71 aft] #aijb7;a77#aj77;,a77i74 #c4 ,developm5t ( ,/ate-level metrics on ,m$icaid b5efici>y access & satisfaction 7a7 ,9 g5]al 7#a7 ,developm5t ( metrics ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 9 consultation ) ,/ate ,m$icaid ,directors1 %all develop /&>diz$1 ,/ate-level metrics ( access to1 & satisfaction )1 provid]s1 includ+ prim>y c>e & speciali/ provid]s1 ) respect to individuals :o are enroll$ 9 ,/ate ,m$icaid plans "u title ,,xix ( ! ,social ,security ,act4 7#b7 ,process ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality %all develop ! metrics describ$ 9 p>agraph 7#a7 ?r\gh a public process1 :i* %all provide opportunities = /akehold]s to p>ticipate4 7b7 ,updat+ metrics ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 9 consultation ) ! ,deputy ,adm9i/rator = ! ,c5t] = ,m$icaid & ,,*ip ,s]vices & ,/ate ,m$icaid ,directors1 %all update ! metrics develop$ "u subsection 7a7 n less ?an once e #c ye>s4 7c7 ,/ate implem5tation fund+ ,! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality may aw>d funds1 f ! am\nt appropriat$ "u subsection 7d71 to ,/ates = ! purpose ( implem5t+ ! metrics develop$ "u ?is section4 7d7 ,appropriation ,!re is appropriat$ to ! ,director ( ! ,ag5cy = ,heal?c>e ,rese>* & ,quality1 out ( any funds 9 ! ,treasury n o!rwise appropriat$1 #bjj1jjj1jjj = fiscal ye> #bjbj1 to rema9 available until exp5d$1 = ! purpose ( c>ry+ out ?is section4 #d4 ,r5ewal ( application ( ,m$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 & physician "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 ! p]iod t beg9s on ! fir/ day ( ! fir/ mon? t beg9s aft] ! date ( enactm5t ( ! ,/ate ,public ,option ,act-- 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>y1 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,i77aa7 or 7,,ii77aa71 ano!r advanc$ practice cl9ician1 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+ ! additional p]iod specifi$ 9 p>agraph 7#b71 aft] #bjae12 & 7,c7 by add+ at ! end ! foll[+3 7#b7 ,additional p]iod ,= purposes ( p>agraph 7#a71 ! additional p]iod specifi$ 9 ?is p>agraph is ! p]iod t beg9s on ! fir/ day ( ! fir/ mon? t beg9s aft] ! date ( enactm5t ( ! ,/ate ,public ,option ,act4 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 #e4 ,increas$ ,,fmap = m$ical assi/ance to newly eligible individuals 7a7 ,9 g5]al ,section #aije7y77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7y77#a77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ #bjad1 #bjae1 & #bjaf & ins]t+ ea* ( ! fir/ #c consecutive #ab-mon? p]iods 9 :i* ! ,/ate provides m$ical assi/ance to newly eligible individuals2 7#b7 9 subp>agraph 7,b71 by /rik+ #bjag & ins]t+ ! f\r? consecutive #ab-mon? p]iod 9 :i* ! ,/ate provides m$ical assi/ance to newly eligible individuals2 7#c7 9 subp>agraph 7,c71 by /rik+ #bjah & ins]t+ ! fif? consecutive #ab-mon? p]iod 9 :i* ! ,/ate provides m$ical assi/ance to newly eligible individuals2 7#d7 9 subp>agraph 7,d71 by /rik+ #bjai & ins]t+ ! six? consecutive #ab-mon? p]iod 9 :i* ! ,/ate provides m$ical assi/ance to newly eligible individuals2 & 7#e7 9 subp>agraph 7,e71 by /rik+ #bjbj & ea* ye> !reaft] & ins]t+ ! sev5? consecutive #ab-mon? p]iod 9 :i* ! ,/ate provides m$ical assi/ance to newly eligible individuals & ea* su* p]iod !reaft]4 7b7 ,effective date ,! am5dm5ts made by subsection 7a7 %all take effect z if includ$ 9 ! enactm5t ( ,public ,law #aaa-adh4 #f4 ,m$icaid cov]age ( compreh5sive reproductive heal? c>e s]vices 7a7 ,inclusion ( compreh5sive reproductive heal? c>e s]vices z m$ical assi/ance ,section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a771 z am5d$ by section #b7;h71 is fur!r 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 compreh5sive reproductive heal? c>e s]vices1 includ+ abortion s]vices2 & 4 7b7 ,requir+ cov]age ( compreh5sive reproductive heal? c>e s]vices z condition ( ,/ate plan approval ,section #aijb7;a77#aj77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a771 z am5d$ by subsections 7a7 & 7h7 ( section #b1 is fur!r am5d$1 9 ! matt] prec$+ clause 7i71 by /rik+ & 7#bi7 & ins]t+ 7#bi71 & 7#cj74 7c7 ,con=m+ am5dm5t ,section #aicb7;e77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;e77#a77;,b77 is am5d$ by /rik+ ,clause 7i7 & ins]t+ ,) respect to ! p]iod beg9n+ be=e ,janu>y #a1 #bjba1 clause 7i74 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to m$ical assi/ance furni%$ on or aft] ,janu>y #a1 #bjba4