,,ii  #aag? ,,congress  #a/ ,session    
,s4 #ccdd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #h1 #bjba,mr4 
,k5n$y 7= himself1 ,mr4 ,graham1 ,mr4   
,hag]ty1 ,mr4 ,cotton1 ,mr4 ,scott (    
,s\? ,c>ol9a1 ,mr4 ,scott ( ,florida1   
,mrs4 ,blackburn1 ,mr4 ,hawley1 ,mr4    
,boozman1 ,mr4 ,hoev51 ,mr4 ,m>%all1 &  
,mr4 ,rubio7 introduc$ ! foll[+ bill2   
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
protect ! ,am]ican ,taxpay] & ,m$ic>e4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,protect+ ! ,am]ican ,taxpay] &       
,m$ic>e ,act4  #b4 ,adju/m5ts to ,m$ic>e
 seque/ration r$uctions  7a7 ,ext5sion (
 tempor>y susp5sion ?r\gh ,m>* #bjbb    
7#a7 ,9 g5]al ,section #cgji7;a7 (      
division ,a ( ! ,,c>es ,act 7#b         
,u4,s4,c4 #ija;a note7 is am5d$-- 7,a7 9
 ! subsection head] by ins]t+ & adju/m5t
 aft] susp5sion2 &  7,b7 by /rik+       
,decemb] #ca1 #bjba & ins]t+ ,m>* #ca1  
#bjbb4  7#b7 ,effective date ,! am5dm5ts
 made by p>agraph 7#a7 %all take effect 

z if enact$ z "p ( ! ,,c>es ,act        
7,public ,law #aaf-acf74  7b7 ,adju/m5ts
 to ,m$ic>e program seque/ration        
r$uction ) respect to fiscal ye>s #bjbb 
& #bjcj ,section #bea;,a7#f7 ( !        
,balanc$ ,budget & ,em]g5cy ,deficit    
,control ,act ( #aihe 7#b ,u4,s4,c4     
#ija;a7#f77 is am5d$-- 7#a7 by          
r$esignat+ subp>agraph 7,c7 z           
subp>agraph 7,e72 &  7#b7 by ins]t+ aft]
 subp>agraph 7,b7 ! foll[+ new          
subp>agraphs3  7,c7 ,not)/&+ ! #b p]c5t 
limit specifi$ 9 subp>agraph 7,a7 =     
paym5ts = ! ,m$ic>e programs specifi$ 9 
section #bef7;d71 ! seque/ration ord] ( 
! ,presid5t "u su* subp>agraph = fiscal 
ye> #bjbb %all be appli$ to su* paym5ts 
s t ) respect to ! p]iod beg9n+ on      
,april #a1 #bjbb1 & end+ on ,june #cj1  
#bjbb1 ! paym5t r$uction %all be #a4j   
p]c5t4  7,d7 ,not)/&+ ! #b p]c5t limit  
specifi$ 9 subp>agraph 7,a7 = paym5ts = 
! ,m$ic>e programs specifi$ 9 section   
#bef7;d71 ! seque/ration ord] ( !       
,presid5t "u su* subp>agraph = fiscal   

ye> #bjcj %all be appli$ to su* paym5ts 
s t-- 7i7 ) respect to ! fir/ #f mon?s 9
 :i* su* ord] is effective = su* fiscal 
ye>1 ! paym5t r$uction %all be #b4be    
p]c5t2 &  7ii7 ) respect to ! second #f 
mon?s 9 :i* su* ord] is s effective =   
su* fiscal ye>1 ! paym5t r$uction %all  
be #c p]c5t4  4  #c4 ,ext5sion ( support
 = physicians & o!r pr(essionals 9      
adju/+ to ,m$ic>e paym5t *anges  7a7 ,9 
g5]al ,section #ahdh ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #aciew-#d7
 is am5d$-- 7#a7 9 subsection           
7c77#b77;,b77iv77,v71 by /rik+ #bjba &  
ins]t+ #bjba or #bjbb2 &  7#b7 9        
subsection 7t7-- 7,a7 9 ! subsection    
head]1 by /rik+ #bjba & ins]t+ #bjba &  
#bjbb2  7,b7 9 p>agraph 7#a7-- 7i7 by   
/rik+ dur+ #bjba & ins]t+ dur+ #bjba &  
#bjbb2 &  7ii7 by /rik+ = su* s]vices   
furni%$ on or aft] ,janu>y #a1 #bjba1 & 
be=e ,janu>y #a1 #bjbb1 by #c4ge p]c5t4 
& ins]t+ =-- 7,a7 su* s]vices furni%$ on
 or aft] ,janu>y #a1 #bjba1 & be=e      
,janu>y #a1 #bjbb1 by #c4ge p]c5t2 &    

7,b7 su* s]vices furni%$ on or aft]     
,janu>y #a1 #bjbb1 & be=e ,janu>y #a1   
#bjbc1 by #c4j p]c5t4  2 &  7,c7 9      
p>agraph 7#b77;,c7-- 7i7 9 ! subp>agraph
 head]1 by /rik+ #bjba & ins]t+ #bjba & 
#bjbb2  7ii7 by ins]t+ = s]vices furni%$
 9 #bjba or #bjbb aft] "u ?is           
subsection2 &  7iii7 by ins]t+ or #bjbb1
 respectively be=e ! p]iod at ! end4    
7b7 ,report ,section #aja7;c7 ( division
 ,n ( ! ,consolidat$ ,appropriations    
,act1 #bjba 7,public ,law #aaf-bfj7 is  
am5d$-- 7#a7 9 ! fir/ s5t5ce-- 7,a7 by  
/rik+ ,april #a1 #bjbb & ins]t+ ea* (   
,april #a1 #bjbb1 & ,april #a1 #bjbc2 & 
7,b7 by /rik+ 1 z add$ by subsection 7a7
 & ins]t+ furni%$ dur+ #bjba or #bjbb1  
respectively2 &  7#b7 9 ! second        
s5t5ce-- 7,a7 by /rik+ ,su* report &    
ins]t+ ,ea* su* report2 &  7,b7 by      
ins]t+ ) respect to #bjba or #bjbb1 z   
applicable aft] "u su* section4  #d4    
,pres]v+ pati5t access to critical      
cl9ical lab s]vices  7a7 ,revis$        
phase-,9 ( r$uctions f private payor    

rate implem5tation ,section             
#ahcd;,a7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#c77  
is am5d$-- 7#a7 9 subp>agraph 7,a71 by  
/rik+ ?r\gh #bjbd & ins]t+ ?r\gh #bjbe2 
&  7#b7 9 subp>agraph 7,b7-- 7,a7 9     
clause 7ii71 by /rik+ = #bjba & ins]t+ =
 ea* ( #bjba & #bjbb2 &  7,b7 9 clause  
7iii71 by /rik+ #bjbb ?r\gh #bjbd &     
ins]t+ #bjbc ?r\gh #bjbe4  7b7 ,revis$  
,report+ ,p]iod = ,report+ ( ,private   
,sector ,paym5t ,rates = ,e/abli%m5t (  
,m$ic>e ,paym5t ,rates ,section         
#ahcd;,a7a77#a77;,b7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem-#a7;a77#a77;,b77 is am5d$-- 7#a7 
9 clause 7i71 by /rik+ ,decemb] #ca1    
#bjba & ins]t+ ,decemb] #ca1 #bjbb2 &   
7#b7 9 clause 7ii7-- 7,a7 by /rik+      
,janu>y #a1 #bjbb & ins]t+ ,janu>y #a1  
#bjbc2 &  7,b7 by /rik+ ,m>* #ca1 #bjbb 
& ins]t+ ,m>* #ca1 #bjbc4  #e4 ,delay to
 ! implem5tation ( ! radiation oncology 
model "u ! ,m$ic>e program ,section #acc
 ( ,division ,,cc ( ! ,consolidat$      

,appropriations ,act1 #bjba 7,public    
,law #aaf-bfj7 is am5d$ by /rik+ ,janu>y
 #a1 #bjbb & ins]t+ ,janu>y #a1 #bjbc4  
#f4 ,m$ic>e ,improvem5t ,fund ,section  
#ahih7;b77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;iii7b77#a77 is    
am5d$ by /rik+ fiscal ye> #bjba & all t 
foll[s ?r\gh ! p]iod at ! end & ins]t+  
fiscal ye> #bjba1 #aja1jjj1jjj44  #g4   
,,paygo annual report ,= ! purposes ( ! 
annual report issu$ pursuant to section 
#e ( ! ,/atutory ,pay-,z-,y-,g ,act (   
#bjaj 7#b ,u4,s4,c4 #icd7 aft] adj\rnm5t
 ( ! fir/ session ( ! #aag? ,congress1 &
 = det]m9+ :e!r a seque/ration ord] is  
necess>y "u su* section1 ! debit = !    
budget ye> on ! #e-ye> scorec>d1 if any1
 & ! #aj-ye> scorec>d1 if any1 %all be  
d$uct$ f su* scorec>d 9 #bjbb & add$ to 
su* scorec>d 9 #bjbc4