,i  #aag? ,,congress  #b;d ,session  ,h4
 ,r4 #ifch  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,decemb] #bj1         
#bjbb,ms4 ,s*ak[sky 7= h]self1 ,mr4     
,quigley1 ,mr4 ,fitzpatrick1 & ,mr4     
,cr[7 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   
provide cov]age ( ,,als-relat$ s]vices  
"u ! ,m$ic>e program = individuals      
diagnos$ ) amyotrophic lat]al scl]osis1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,m$ic>e ,paym5t    
,re=m = ,p ) ,,als ,act ( #bjbb4  #b4   
,provid+ = cov]age ( ,,als-relat$       
s]vices "u ! m$ic>e program =           
individuals diagnos$ ) amyotrophic      
lat]al scl]osis  7a7 ,9 g5]al ,subtitle 
,e ( title ,,xviii ( ! ,social ,security

 ,act 7#db ,u4,s4,c4 #acie et4 seq47 is 
am5d$ by ins]t+ aft] section #ahha;,a ! 
foll[+ new section3  #ahha;,b4 ,m$ic>e  
cov]age ( ,,als-relat$ s]vices =        
individuals diagnos$ ) amyotrophic      
lat]al scl]osis  7a7 ,9 g5]al ,9 ! case 
( a cov]$ ,,als individual1 ! ,secret>y 
%all e/abli% a supplem5tal facility-bas$
 paym5t sy/em describ$ 9 subsection 7d7 
= ,,als-relat$ s]vices provid$ to su* an
 individual4  7b7 ,cov]$ ,,als          
individual ,= purposes ( ?is section1 ! 
t]m cov]$ ,,als individual means an     
individual :o is m$ically det]m9$ to h  
amyotrophic lat]al scl]osis 7z describ$ 
9 section #bbf7;h774  7c7 ,,als-,relat$ 
s]vices ,= purposes ( ?is section1 ! t]m
 ,,als-relat$ s]vices means items &     
s]vices t are ord9>ily furni%$ to a     
cov]$ ,,als individual 9 an outpati5t   
sett+ by a qualifi$ provid] 7or by o!rs 
"u arrangem5ts ) !m made by ! qualifi$  
provid]7 consi/5t ) a multidiscipl9>y   
approa* 7z det]m9$ by ! ,secret>y7 = !  
c>e & treatm5t ( su* an individual )    

respect to ! progression ( amyotrophic  
lat]al scl]osis4  7d7 ,paym5t sy/em     
7#a7 ,au?ority ,! ,secret>y %all e/abli%
 a facility-bas$ paym5t sy/em "u :i* a  
s+le paym5t det]m9$ 9 accordance ) !    
succe$+ p>agraphs is made to a qualifi$ 
provid] = ,,als-relat$ s]vices furni%$  
to a cov]$ ,,als individual dur+ a visit
 beg9n+ on & aft] ,janu>y #a1 #bjbd4    
7#b7 ,base paym5t am\nt  7,a7 #bjbd ,=  
cov]age ye> #bjbd1 ! ,secret>y %all     
e/abli% a s+le paym5t am\nt =           
,,als-relat$ s]vices equal to #hjj = su*
 s]vices furni%$ = ea* visit dur+ su*   
ye>4  7,b7 #bjbe  7i7 ,9 g5]al ,=       
cov]age ye> #bjbe1 ! ,secret>y %all     
e/abli% a s+le paym5t am\nt =           
,,als-relat$ s]vices furni%$ = ea* visit
 dur+ su* ye> t is ! great] (-- 7,i7    
tak+ into acc\nt ! paym5t am\nt         
recomm5d$ by ! ,comptroll] ,g5]al 9 !   
report describ$ 9 clause 7ii71 ! am\nt  
specifi$ by ! ,secret>y2 or  7,,ii7 !   
am\nt specifi$ 9 subp>agraph 7,a74  7ii7
 ,report by ! comptroll] g5]al ,n lat]  

?an ,janu>y #a1 #bjbd1 ! ,comptroll]    
,g5]al %all1 9 consultation ) qualifi$  
provid]s submit to ! ,secret>y ( ,heal? 
& ,human ,s]vices a report t recomm5ds a
 s+le paym5t am\nt = ,,als-relat$       
s]vices t takes into acc\nt ! av]age    
am\nt ( paym5t = ea* item or s]vice     
includ$ 9 ,,als-relat$ s]vices t !      
,comptroll] ,g5]al e/imates w\ld h be5  
payable-- 7,i7 "u ?is title = su* a     
s]vice bas$ on p] pati5t utilization    
data f :i*ev] s+le cov]age ye> f #bjbj  
?r\gh #bjbb has ! highe/ p] pati5t      
utilization ( ,,als-relat$ s]vices1 ev5 
if su* s]vice is n payable = a p>ticul> 
,,als individual because ( ! application
 ( section #ahfb7;a77#a77;,a7 ) respect 
to an item or s]vice provid$ to su*     
individual2  7,,ii7 9 ! case an e/imate 
is unable to be det]m9$ pursuant to     
subclause 7,i71 by heal? insurance      
issu]s & gr\p heal? plans 7z su* t]ms   
are def9$ 9 section #bgia ( ! ,public   
,heal? ,s]vice ,act7 & ,,ma plans "u "p 
,c = su* a s]vice1 bas$ on su* data f   

:i*ev] s+le cov]age ye> f #bjbj ?r\gh   
#bjbb has ! highe/ p] pati5t utilization
 ( ,,als-relat$ s]vices2 &  7,,iii7 9 ! 
case an e/imate is unable to be det]m9$ 
pursuant to subclause 7,,ii71 bas$ on ! 
recomm5dation ( ! ,specialty ,society   
,relative ,value ,scale ,update         
,committee ( ! ,am]ican ,m$ical         
,association or ! e/imate ( !           
,comptroll] ,g5]al = su* a s]vice4  7,c7
 #bjbf & subsequ5t ye>s ,= ea* cov]age  
ye> beg9n+ ) cov]age ye> #bjbf1 !       
,secret>y %all annually increase !      
paym5t am\nt = ea* visit det]m9$ "u ?is 
p>agraph by an ,,als s]vices m>ket      
basket p]c5tage increase 7z det]m9$ by !
 ,secret>y7 t reflects *anges ov] "t 9 !
 prices ( an appropriate mix ( goods &  
s]vices t are ,,als-relat$ s]vices4     
7#c7 ,paym5t adju/m5ts ,! paym5t sy/em  
"u ?is subsection-- 7,a7 %all include a 
paym5t adju/m5t bas$ on case mix t may  
take into acc\nt comorbidities1 l5g? (  
"t f diagnosis1 age1 race1 e?nicity1 &  
o!r appropriate factors2  7,b7 %all     

include a paym5t adju/m5t = high-co/    
outli]s due to unusual v>iations 9 !    
type or am\nt ( m$ically necess>y c>e2  
7,c7 %all include a paym5t adju/m5t t   
reflects ! ext5t to :i* co/s incurr$ by 
l[-volume facilities 7z def9$ by !      
,secret>y7 9 furni%+ ,,als-relat$       
s]vices exce$ ! co/s incurr$ by o!r     
facilities 9 furni%+ su* s]vices1 & su* 
paym5t adju/m5t may n be less ?an #aj   
p]c5t2  7,d7 %all include a paym5t      
adju/m5t = a m$ical s]vice or te*nology 
:i* is furni%$ z a "p ( ,,als-relat$    
s]vices = :i*1 z det]m9$ by !           
,secret>y-- 7i7 paym5t = ! s]vice or    
te*nology z "p ( ,,als-relat$ s]vices "u
 ?is section 0 n be+ made 9 ! prec$+    
cov]age ye>2 &  7ii7 ! co/ ( ! s]vice or
 te*nology is n insignificant 9 relation
 ! paym5t am\nt 7z det]m9$ "u ?is       
subsection7 payable = ,,als-relat$      
s]vices2 &  7,e7 may include su* o!r    
paym5t adju/m5ts z ! ,secret>y deems    
appropriate1 includ+ a paym5t adju/m5t  
=-- 7i7 a geographic index1 su* z !     

index ref]r$ to 9 section               
#ahhf7;d77#c77;,e72  7ii7 ! /atus ( !   
facility z provid]-bas$ or free-/&+ 7z  
su* t]ms are def9$ 9 section            
#dac4fe7;a77#b71 title #db1 ,code (     
,f$]al ,regulations72 &  7iii7 qualifi$ 
provid]s locat$ 9 rural areas 7z def9$ 9
 section #ahhf7;d77#b77;,d774  7#d7     
,me*anism = paym5ts ,= purposes ( mak+  
paym5ts = ,,als-relat$ s]vices1 !       
,secret>y %all e/abli% a me*anism "u !  
paym5t sy/em "u ?is subsection :i* makes
 paym5t :5 a qualifi$ provid] submits a 
claim = reimbursem5t :i* includes1 )    
respect to a cov]$ ,,als individual1 an 
alphanum]ic code issu$ "u !             
,int]national ,classification (         
,diseases1 #aj? ,revision1 ,cl9ical     
,modification 7,,icd-#aj-;,,cm7 & its   
subsequ5t revisions t is = ! treatm5t ( 
a diagnosis ( amyotrophic lat]al        
scl]osis4  7#e7 ,no co/ %>+ ,paym5t "u  
?is subsection %all be made only on an  
assignm5t-relat$ basis )\t any co/ %>+4 
7#f7 ,qualifi$ provid] def9$ ,9 ?is     

section1 ! t]m qualifi$ provid] means a 
provid] ( s]vices :i* meets requirem5ts 
z ! ,secret>y prescribes by regulation4 
7e7 ,cl>ification ,paym5t "u subsection 
7d7 %all be 9 addition to1 & %all n     
supplant1 any paym5t t w\ld be o!rwise  
made to a provid] ( s]vices1 physician1 
practition]1 suppli]1 or laboratory "u  
any o!r provision ( ?is title = an item 
or s]vice furni%$ to a cov]$ ,,als      
individual4  7f7 ,implem5tation  7#a7 ,9
 g5]al ,except z provid$ "u p>agraph    
7#b71 ! ,secret>y may implem5t !        
provisions ( ?is section by program     
in/ruction or o!rwise4  7#b7 ,rulemak+  
,! ,secret>y %all implem5t subsections  
7c7 & 7d77#f7 ?r\gh notice & comm5t     
rulemak+4  7g7 ,fund+ ,= purposes (     
c>ry+ out ?is section1 subject to       
subsection 7e71 paym5t "u ?is section   
%all be made f ! ,f$]al ,supplem5t>y    
,m$ical ,insurance ,tru/ ,fund "u       
section #ahda or f ! ,f$]al ,hospital   
,insurance ,tru/ ,fund "u section #ahag4
  4  7b7 ,con=m+ am5dm5ts  7#a7 ,section

 #ahcc7t7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie7t7 is am5d$ by add+
 at ! end ! foll[+ new p>agraph3  7#bc7 
,ensur+ supplem5tal paym5ts =           
,,als-relat$ s]vices ,any cov]$ ,,opd   
s]vice furni%$ to a cov]$ ,,als         
individual 7z def9$ 9 section           
#ahha;,b7b77 t is o!rwise payable to a  
qualifi$ provid] 7z def9$ 9 section     
#ahha;,b7d77#f77 pursuant to p>agraph   
7#d7 %all be payable "u su* p>agraph    
not)/&+ any paym5t made "u section      
#ahha;,b7d74  4  7#b7 ,section          
#ahfa7w77#a7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7w77#a77 is am5d$  
by ins]t+ qualifi$ provid] 7z def9$ 9   
section #ahha;,b7d77#f77;,a77 ) respect 
to ,,als-relat$ s]vices 7z def9$ 9      
section #ahha;,b7c771 be=e or hospice   
program4  #c4 ,effective date ,!        
am5dm5ts made by ?is ,act %all take     
effect on ! date ( ! enactm5t ( ?is     
,act4