,,ii  #aag? ,,congress  #b;d ,session   
,s4 #cfbf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,febru>y #aj1 #bjbb    
,mr4 ,casey 7= himself & ,mr4 ,scott (  
,s\? ,c>ol9a7 introduc$ ! foll[+ bill2  
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
improve access to ! ,program (          
,all-,inclusive ,c>e = ! ,eld]ly1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,program (             
,all-inclusive ,c>e = ! ,eld]ly ,exp&$  
,act or ! ,,pace ,exp&$ ,act4  #b4      
,improv+ access to & af=dability (      
,,pace programs = ,m$ic>e b5efici>ies :o
 are n dual eligible b5efici>ies ?r\gh  
flexibility 9 rate sett+ = s]vices n    
cov]$ by ,m$ic>e  7a7 ,9 g5]al ,section 
#ahid ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;eee7 is am5d$ by add+ at
 ! end ! foll[+ new subsection3  7j7    
,flexibility 9 e/abli%+ premiums =      
,m$ic>e ,,pace p>ticipants :o are n also
 entitl$ to b5efits "u a ,/ate ,m$icaid 
program  7#a7 ,codification ( au?ority  

to *>ge a mon?ly capitation am\nt =     
non-,m$ic>e s]vices ,subject to !       
succe$+ provisions ( ?is subsection1 a  
,,pace program op]at$ by a ,,pace       
provid] "u a ,,pace program agreem5t 9  
any ,/ate may *>ge a ,m$ic>e-only ,,pace
 program eligible individual 7z def9$ 9 
p>agraph 7#d77;,a77 :o is enroll$ 9 su* 
,,pace program a mon?ly capitation      
paym5t am\nt = ! provision ( non-,m$ic>e
 s]vices 7z def9$ 9 p>agraph 7#d77;,b77 
"u ! ,,pace program4  7#b7 ,det]m9ation 
( mon?ly capitation paym5t am\nt  7,a7  
,9 g5]al ,not)/&+ section #dfj4ahf (    
title #db1 ,code ( ,f$]al ,regulations  
7or any successor regulation71 ! mon?ly 
capitation paym5t am\nt t may be *>g$ "u
 p>agraph 7#a7 %all be det]m9$ by !     
,,pace provid] op]at+ ! ,,pace program4 
,su* mon?ly capitation paym5t am\nt %all
 be bas$ on assessm5ts conduct$ on !    
,m$ic>e-only ,,pace program eligible    
individual :o is enroll$ 9 su* ,,pace   
program by ! ,,pace program             
int]discipl9>y team & %all take into    

acc\nt ! heal? /atus ( su* individual4  
,9 det]m9+ ! mon?ly capitation am\nt = a
 ,m$ic>e-only ,,pace program eligible   
individual "u ?is p>agraph1 a ,,pace    
provid] may take into acc\nt ! s]vices  
det]m9$ necess>y = ! individual by !    
,,pace program int]discipl9>y team bas$ 
^u _! assessm5t ( ! individual4 ,a      
det]m9ation describ$ 9 ! prec$+ s5t5ce  
%all n be con/ru$ z limit+ !            
responsibility ( ! ,,pace provid] to    
meet any un=ese5 ne$s or provide = any  
requir$ s]vices = su* individual4  7,b7 
,au?ority to adju/ mon?ly capitation    
am\nt  7i7 ,9 g5]al ,subject to clause  
7ii7 & p>agraph 7#c71 ! mon?ly          
capitation paym5t am\nt t may be *>g$ "u
 p>agraph 7#a7 to a ,m$ic>e-only ,,pace 
program eligible individual enroll$ 9 a 
,,pace program = non-,m$ic>e s]vices may
 increase or decrease bas$ on assessm5ts
 conduct$ on su* individual4 ,any *ange 
9 ! mon?ly capitation paym5t am\nt *>g$ 
to su* an individual %all take effect   
beg9n+ ) ! fir/ day ( ! fir/ mon? t     

beg9s aft] ! mon? dur+ :i* ! plan ( c>e 
is develop$ = su* individual bas$ on su*
 an assessm5t4  7ii7 ,limitation on     
frequ5cy ( increase ,! mon?ly capitation
 paym5t am\nt t may be *>g$ "u p>agraph 
7#a7 to su* an individual may n increase
 m frequ5tly ?an once p] cal5d> qu>t]4  
7#c7 ,b5efici>y protections  7,a7       
,disclosure ( premium rate /ructure ,a  
,,pace provid] %all disclose to         
,m$ic>e-only ,,pace program eligible    
individuals ! capitation paym5t am\nts t
 may be *>g$ "u ?is section to su*      
individuals = non-,m$ic>e s]vices "u !  
,,pace program op]at$ by su* ,,pace     
provid] "u ?is section-- 7i7 prior to   
enrollm5t ( su* individual 9 su* ,,pace 
program1 &  7ii7 p]iodically1 & ^u      
reque/ ( su* individual1 aft] enrollm5t4
  7,b7 ,assessm5t in/rum5t  7i7 ,9 g5]al
 ,! ,secret>y %all develop an assessm5t 
in/rum5t = use by ,,pace programs )     
respect to ,m$ic>e-only ,,pace program  
eligible individuals "u ?is subsection4 
7ii7 ,requirem5t = disclosure (         

assessm5t in/rum5t ,! mon?ly capitation 
paym5t am\nt *>g$ "u p>agraph 7#a7 to a 
,m$ic>e-only ,,pace program eligible    
individual = non-,m$ic>e s]vices %all be
 bas$ on an assessm5t ( su* individual  
conduct$ by ! ,,pace provid] 7us+ !     
assessm5t in/rum5t develop$ by !        
,secret>y "u clause 7i771 acc\nt+ =     
heal? /atus & correspond+ ne$s4  7iii7  
,requirem5t = disclosure ( assessm5t    
in/rum5t ,! assessm5t in/rum5t us$ by ! 
int]discipl9>y team ( ! ,,pace program  
to evaluate ! heal? & social /atus (    
,,pace p>ticipants %all be disclos$ to !
 individual prior to ! assessm5t4  7,c7 
,process to seek review ( assessm5ts ,! 
,secret>y %all e/abli% a process = a    
,m$ic>e-only ,,pace program eligible    
individual to seek review ( any         
assessm5t conduct$ on ! individual "u   
?is subsection4  7#d7 ,rule (           
con/ruction ,no?+ 9 ?is subsection %all 
be con/ru$ to preclude ! te/+ "u section
 #aaae;,a ( a model to p]mit a ,,pace   
provid] op]at+ a ,,pace program to      

e/abli% & *>ge mon?ly capitation paym5t 
am\nts = ! provision ( non-,m$ic>e      
s]vices "u ! ,,pace program to          
,m$ic>e-only ,,pace program eligible    
individuals "u a rate /ructure e/abli%$ 
by su* ,,pace provid] = su* purpose1    
includ+ ! use ( an assessm5t in/rum5t   
develop$ by ! ,,pace program to assign  
su* individuals to an appropriate rate  
category "u su* rate /ructure4  7#e7    
,def9itions ,9 ?is subsection-- 7,a7 !  
t]m ,m$ic>e-only ,,pace program eligible
 individual means an individual :o is   
describ$ 9 subsection 7a77#a7 & :o is n 
entitl$ to m$ical assi/ance "u title    
,,xix1 & includes ! designat$           
repres5tative ( ! individual z          
appropriate2 &  7,b7 ! t]m non-,m$ic>e  
s]vices means items & s]vices cov]$ "u  
title ,,xix t are n cov]$ "u ?is title &
 items & s]vices describ$ 9 subsection  
7b77#a77;,a77ii74  4  7b7 ,effective    
date ,! am5dm5t made by subsection 7a7  
%all take effect on ! date ( ! enactm5t 
( ?is ,act1 & apply ) respect to        

capitation am\nts t may be *>g$ = mon?s 
beg9n+ on or aft] ,janu>y #a1 #bjbc4    
7c7 ,rule ( con/ruction ,no?+ 9 ?is     
section1 or ! am5dm5ts made by ?is      
section1 %all be con/ru$ to modify or   
o!rwise impact ! foll[+ ,m$ic>e         
capitation rates t may be *>g$ by ,,pace
 plans = ,,pace p>ticipants :o are      
,m$ic>e b5efici>ies :o are n bo? entitl$
 to 7or enroll$ =7 b5efits "u "p ,a (   
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq47 & enroll$
 = b5efits "u "p ,b ( su* title3 7#a7   
,"p ,a only m$ic>e b5efici>y ,9 ! case (
 a ,m$ic>e b5efici>y :o is a ,,pace     
p>ticipant :o is entitl$ to 7or enroll$ 
=7 b5efits "u "p ,a ( su* title ,,xviii 
b :o is n enroll$ = b5efits "u "p ,b (  
su* title1 ! ,m$ic>e ,"p ,b capitation  
rate "u p>agraph 7b7 ( section #dfj4ahf 
( title #db1 ,code ( ,f$]al ,regulations
 7or any successor regulations74  7#b7  
,"p ,b only m$ic>e b5efici>y ,9 ! case (
 a ,m$ic>e b5efici>y :o is a ,,pace     
p>ticipant :o is enroll$ = b5efits "u "p

 ,b ( su* title ,,xviii b :o is n       
entitl$ to 7or enroll$ =7 b5efits "u "p 
,a ( su* title1 ! ,m$ic>e ,"p ,a        
capitation rate "u p>agraph 7c7 ( su*   
section #dfj4ahf 7or any successor      
regulations74  #c4 ,anytime enrollm5t 9 
,,pace  7a7 ,9 g5]al  7#a7 ,any "t      
enrollm5t & effective date ,section     
#ahid7;c77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;eee7c77#e77 is    
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 ,any "t enrollm5t &  
effective date ( enrollm5t  7i7 ,any "t 
enrollm5t ,a ,,pace program eligible    
individual may enroll 9 a ,,pace program
 at any "t dur+ a mon?4  7ii7 ,effective
 date ,subject to clause 7iii71 !       
enrollm5t ( a ,,pace program eligible   
individual 9 a ,,pace program %all be   
effective on ! date ! ,,pace provid]    
op]at+ ! ,,pace program receives an     
enrollm5t agreem5t sign$ by su* ,,pace  
program eligible individual ) respect to
 su* ,,pace program4  7iii7 ,special    
rule 9 ! case ( dual eligible           

b5efici>ies ,9 ! case ( a ,,pace program
 eligible individual :o is eligible =   
b5efits "u ?is title & title ,,xix1     
clause 7i7 %all only apply if ! ,/ate 9 
:i* su* individual resides has made an  
election "u section #aicd7;c77#e77;,c7  
to p]mit ,,pace program eligible        
individuals enroll 9 a ,,pace program at
 any "t dur+ a mon? 9 su* ,/ate4  4     
7#b7 ,prorat$ paym5ts ,section #ahid7;d7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;eee7d77 is am5d$ by add+
 at ! end ! foll[+ new p>agraph3  7#d7  
,prorat$ paym5ts ,9 ! case ( a ,,pace   
program eligible individual enroll$ 9 a 
,,pace program op]at$ by a ,,pace       
provid] ) an enrollm5t effective date t 
is n ! fir/ day ( a mon?1 ! capitation  
am\nt t w\ld o!rwise be made "u ?is     
subsection to ! ,,pace provid] = su*    
individual = ! fir/ mon? 9 :i* su*      
individual is s enroll$ %all be prorat$ 
accord+ly4  4  7b7 ,con=m+ am5dm5ts     
7#a7 ,anytime enrollm5t & effective date
 ,section #aicd7;c77#e7 ( ! ,social     

,security ,act 7#db ,u4,s4,c4           
#acifu-#d7;c77#e77 is am5d$ by add+ at !
 end ! foll[+ new subp>agraph3  7,c7    
,/ate option to p]mit any "t enrollm5t &
 effective date ( enrollm5t  7i7 ,any "t
 enrollm5t ,a ,/ate may elect to p]mit a
 ,,pace program eligible individual to  
enroll 9 a ,,pace program at any "t dur+
 a mon?4  7ii7 ,effective date ,pursuant
 to a ,/ate election made "u clause 7i71
 ! enrollm5t ( a ,,pace program eligible
 individual 9 a ,,pace program %all be  
effective on ! date ! ,,pace provid]    
op]at+ ! ,,pace program receives an     
enrollm5t agreem5t sign$ by su* ,,pace  
program eligible individual ) respect to
 su* ,,pace program4  4  7#b7 ,prorat$  
paym5ts ,section #aicd7;d7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acifu-#d7;d77 is am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#c7 ,prorat$  
paym5ts ,if a ,/ate elects "u subsection
 7c77#e77;,c7 to p]mit enrollm5t at any 
"t dur+ a mon?1 9 ! case ( a ,,pace     
program eligible individual enroll$ 9 a 

,,pace program op]at$ by a ,,pace       
provid] ) an enrollm5t effective date t 
is n ! fir/ day ( a mon?1 ! ,/ate %all  
prorate ! capitation am\nt t w\ld       
o!rwise be made "u ?is subsection to !  
,,pace provid] = su* individual = ! fir/
 mon? 9 :i* su* individual is s enroll$4
  4  7c7 ,effective date ,! am5dm5ts    
made by ?is section %all take effect on 
,janu>y #a1 #bjbc4  #d4 ,,pace site     
approval & expansion  7a7 ,9 g5]al      
,sections #ahid7;e7 & #aicd7;e7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;eee7e71 #acifu-#d7;e77 are ea*    
am5d$ by /rik+ p>agraph 7#h7 & ins]t+ ! 
foll[+3  7#h7 ,au?ority to submit       
applications at any "t2 timely          
consid]ation ( applications  7,a7       
,au?ority to submit applications at any 
"t  7i7 ,new ,,pace provid] /atus ,an   
entity t seeks to become a ,,pace       
provid] may submit an application =     
,,pace provid] /atus at any "t4  7ii7   
,s]vice area expansion & addition (     
,,pace c5t] site ,to ! ext5t ! ,secret>y

 requires a ,,pace provid] to submit an 
application to exp& its s]vice area or  
to add a ,,pace c5t] site1 a ,,pace     
provid] may submit su* an application at
 any "t1 subject to ! requirem5ts (     
section #dfj4ab7;d7 ( title #db1 ,code (
 ,f$]al ,regulations 7relat+ to ! fir/  
trial p]iod audit71 or any successor    
regulation4  7iii7 ,assurances ,an      
application = ,,pace provid] /atus "u   
clause 7i7 or to add a ,,pace c5t] site 
"u clause 7ii7 %all include ! foll[+    
assurances3 7,i7 ,an assurance t !      
requir$ memb]s ( ! int]discipl9>y team  
are employees or contractors ( ! propos$
 ,,pace c5t] or w be employees or       
contractors ( ! propos$ ,,pace c5t] by !
 "t ! ,,pace c5t] becomes op]ational4   
7,,ii7 ,an assurance t-- 7aa7 ! ,,pace  
provid]'s contracts = all contractors & 
contract$ p]sonnel w be execut$ by ! "t 
! propos$ ,,pace c5t] becomes           
op]ational2 &  7bb7 execut$ contracts   
may include provisions = /aff+ levels   
comm5surate ) enrollm5t to full project$

 c5sus4  7,b7 ,deem$ approval ,an       
application describ$ 9 subp>agraph 7,a7 
%all be deem$ approv$ unless !          
,secret>y1 )9 #de days aft] ! date ( !  
submission ( ! application to !         
,secret>y1 ei!r d5ies su* reque/ 9 writ+
 or in=ms ! applicant 9 writ+ ) respect 
to any additional in=mation t is ne$$ 9 
ord] to make a f9al det]m9ation )       
respect to ! application4 ,aft] ! date !
 ,secret>y receives su* additional      
in=mation1 ! application %all be deem$  
approv$ unless ! ,secret>y1 )9 #de days 
( su* date1 d5ies su* reque/4  4  7b7   
,effective date ,! am5dm5ts made by     
subsection 7a7 %all take effect on      
,janu>y #a1 #bjbc4  #e4 ,,pace pilot    
,section #aaae;,a7b77#b7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#b77 is am5d$--  7#a7 9      
subp>agraph 7,b71 by add+ at ! end !    
foll[+ new clause3  7xxviii7 ,national  
te/+ ( a model = exp&$ eligibility = !  
,program ( ,all-,inclusive ,c>e = !     
,eld]ly z describ$ 9 subp>agraph 7,d74  

2 &  7#b7 by add+ at ! end ! foll[+ new 
subp>agraph3  7,d7 ,national te/+ (     
model = exp&$ eligibility = ! program ( 
all-inclusive c>e = ! eld]ly ,9 ! case  
:]e ! ,secret>y selects ! model describ$
 9 clause 7ii7 ( ?is subp>agraph = te/+ 
pursuant to clause 7xxviii7 (           
subp>agraph 7,b71 ! foll[+ %all apply3  
7i7 ,national te/+  7,i7 ,9 g5]al       
,subject to subclause 7,,ii71 !         
,secret>y %all design a demon/ration t  
all[s ea* ,,pace provid] ) an execut$   
,,pace agreem5t to develop & submit to !
 ,secret>y an application to beg9 te/+  
exp&$ ,,pace eligibility = high-ne$ &   
high-co/ populations t are n o!rwise    
eligible to p>ticipate 9 a ,,pace       
program )9 #a ye> ( ! date on :i* !     
model is select$4  7,,ii7 ,no effect on 
ongo+ models or demon/ration projects   
,no?+ 9 ?is subp>agraph %all affect !   
te/+ ( any model "u ?is subsection or   
any demon/ration project "u ?is ,act t  
is implem5t$ prior to ! date ( !        
enactm5t ( ?is subp>agraph4  7ii7 ,model

 describ$ ,! model describ$ 9 ?is clause
 seeks to increase access to quality1   
integrat$1 c>e = high-ne$1 high-co/     
individuals :o are n o!rwise eligible to
 p>ticipate 9 a ,,pace program 9 ord] to
 improve heal? & r$uce co/4 ,"u ?is     
model1 p>ticipat+ ,,pace provid]s w\ld--
 7,i7 be paid fix$1 mon?ly capitat$     
rates f bo? ,m$ic>e & ! applicable ,/ate
 ,m$icaid ag5cy = all s]vices provid$ to
 ea* enrollee fitt+ ! crit]ia ( ! ,,pace
 provid]'s designat$ population2  7,,ii7
 p>tn] ) non-,,pace provid]s1 su* z     
,area ,ag5cies on ,ag+1 ,c5t]s =        
,indep5d5t ,liv+1 local hospitals1 &    
non-hospital provid]s su* z physicians1 
behavioral heal? provid]s & o!r         
community-bas$ organizations to         
effectively rea* ! ,,pace provid]'s     
select$ population2  7,,iii7 adapt !    
,,pace program model ( c>e to           
appropriately s]ve ! ,,pace provid]'s   
select$ population to integrate c>e &   
meet ! unique ne$s ( said population2 & 
7,,iv7 if ! ,,pace provid] is locat$ 9 a

 ,/ate t has n yet s]v$ ! select$       
population ?r\gh a ,,pace program "u    
section #aicd1 receive an up-front fix$ 
paym5t to coord9ate ) ! ,/ate to develop
 a capitat$ paym5t rate1 ) appropriate  
risk adju/m5t1 = ! ,,pace provid]'s     
select$ population4  7iii7 ,requirem5ts 
= p>ticipat+ ,,pace organizations ,9    
ord] to p>ticipate 9 ! model1 a ,,pace  
provid] mu/--  7,i7 conduct a survey or 
ne$s assessm5t ( _! s]vice area to      
det]m9e ! mo/ appropriate population )  
:i* to exp& _! s]vices2  7,,ii7 receive 
prior approval f ! applicable ,/ate     
,m$icaid ag5cy to submit an application 
to p>ticipate 9 ! model2 &  7,,iii7     
foll[+ su* survey or ne$s assessm5t &   
approval f ! applicable ,/ate ,m$icaid  
ag5cy1 submit & receive approval ( an   
application ( expansion f ! ,secret>y4  
7iv7 ,application ,a ,,pace provid]'s   
application to p>ticipate 9 ?is model   
%all include ! foll[+ in=mation3  7,i7  
,results ( ! survey or ne$s assessm5t ( 
_! s]vice area "u clause 7iii77,i7 & an 

explanation ( ! exp&$ population !      
,,pace organization w s]ve4  7,,ii7 ,!  
types ( s]vices t ! exp&$ population w  
require & ! ,,pace provid]'s plan to    
implem5t ^! s]vices4  7,,iii7 ,h[ !     
,,pace provid] w a*ieve engagem5t &     
enrollm5t ( ! new population 9 ! model1 
includ+ h[ x w p>tn] ) non-,,pace       
provid]s 9 ! applicable s]vice area4    
7,,iv7 ,h[ ! exp&$ population's         
p>ticipation 9 ! ,,pace program is      
int5d$ to improve quality ( c>e & heal? 
outcomes "u ! model4  7,v7 ,c]tification
 t ! applicable ,/ate ,m$icaid ag5cy has
 approv$ ! ,,pace provid]'s application 
to p>ticipate 9 ! model4  7,,vi7 ,plans 
to coord9ate ) ! ,/ate ,m$icaid ag5cy to
 develop an initial capitat$ rate )     
appropriate risk adju/m5t4  7,,vii7     
,plans = ! ,,pace provid] & ! ,/ate     
,m$icaid ag5cy to review & adju/ !      
,m$icaid capitat$ rate on a bi5nial     
basis1 z ne$$4  7,,viii7 ,any o!r       
in=mation requir$ by ! ,secret>y4  7v7  
,te*nical assi/ance ,! ,secret>y %all   

provide1 or designate an entity to      
provide1 te*nical assi/ance to          
p>ticipat+ ,,pace provid]s z !y apply = 
& implem5t ! model4  7vi7 ,acc\nt+ =    
unc]ta9ty ,9 ord] = implem5t+ ,,pace    
provid]s to receive unanticipat$        
additional res\rces ne$$ to implem5t !  
model1 ! ,secret>y %all e/abli%         
proc$ures = ! implem5t+ ,,pace provid]s 
to submit to ! ,secret>y a reque/ =     
additional res\rces4  7vii7 ,monitor+   
outcomes ,! ,secret>y1 9 conjunction )  
,,pace provid]s & 9 consultation )      
,/ates t h elect$ to exp& ,,pace program
 eligibility "u section #aicd7l71 %all  
develop a plan to-- 7,i7 annually       
monitor outcomes "u ! model1 :i* may    
include f9ancial1 quality1 access1 &    
utilization outcomes2  7,,ii7 annually  
monitor ! heal? outcomes ( ! ,,pace     
provid]'s exp&$ population2 &  7,,iii7  
any o!r outcomes z det]m9$ by !         
,secret>y4  7viii7 ,report+ requirem5ts 
7,i7 ,report to congress ,n less        
frequ5tly ?an e #c ye>s 7= ! duration ( 

! implem5tation ( ! model "u ?is        
subp>agraph71 ! ,secret>y %all submit to
 ,congress a report on ! implem5tation (
 ! model "u ?is subp>agraph4 ,! report  
%all include demographic in=mation on ! 
populations s]v$ "u ! demon/ration1 be/ 
practices = future implem5tation ef=ts &
 any o!r in=mation ! ,secret>y det]m9es 
appropriate toge!r ) recomm5dations =   
su* legislation & adm9i/rative action z 
! ,secret>y det]m9es appropriate4  7ix7 
,fund+ ,! ,secret>y %all allocate funds 
made available "u subsection 7f77#a7 to 
design1 implem5t1 evaluate1 & report on 
! model describ$ 9 clause 7ii7 9        
accordance ) ?is subp>agraph4  4  #f4   
,coord9ation ) ! ,f$]al ,coord9at$      
,heal? ,c>e ,(fice ,section #aicd ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acifu-#d71 z am5d$ by sections #c & #h1
 is am5d$ by add+ at ! end ! foll[+ new 
subsection3  7m7 ,coord9ation ) ! ,f$]al
 ,coord9at$ ,heal? ,c>e ,(fice  7#a7    
,/ate coord9ation ) ,,f*co ,! ,director 
( ! ,f$]al ,coord9at$ ,heal? ,c>e ,(fice

 e/abli%$ "u section #bfjb ( ! ,pati5t  
,protection & ,af=dable ,c>e ,act %all  
s]ve z a po9t ( contact betwe5 ,/ate    
adm9i/]+ ag5cies & ! ,f$]al ,gov]nm5t = 
purposes ( implem5t+ & op]at+ a ,,pace  
program 9 a ,/ate1 & %all coord9ate )   
o!r relevant (fices & /aff ( ! ,c5t]s = 
,m$ic>e  ,m$icaid ,s]vices involv$ 9    
c>ry+ out ?is section4  7#b7 ,annual    
report ,n lat] ?an ,janu>y #a1 #bjbc1 & 
annually !reaft]1 ! ,director ( ! ,f$]al
 ,coord9at$ ,heal? ,c>e ,(fice %all     
submit to ,congress a report on !       
demographics ( ! populations s]v$ by    
,,pace programs op]at$ "u ?is section & 
section #ahid4  4  #g4 ,evaluation (    
effectiv5ess ( ,,pace program 9 rural & 
und]s]v$ areas  7a7 ,9 g5]al ,!         
,assi/ant ,secret>y = ,plann+ &         
,evaluation ( ! ,dep>tm5t ( ,heal? &    
,human ,s]vices 7ref]r$ to 9 ?is section
 z ! ,assi/ant ,secret>y7 %all conduct  
an evaluation ( ! effectiv5ess ( !      
program = all-inclusive c>e = ! eld]ly  
"u sections #ahid & #aicd ( ! ,social   

,security ,act 7#db ,u4,s4,c4 #acie;eee1
 #acifu-#d7 9 rural & und]s]v$ areas1   
includ+ ) respect to ! foll[+ factors3  
7#a7 ,r$uctions 9 hospitalizations &    
re-hospitalizations among program       
b5efici>ies4  7#b7 ,r$uctions 9 em]g5cy 
dep>tm5t use among program b5efici>ies4 
7#c7 ,r$uctions 9 long-t]m nurs+        
facility use among program b5efici>ies4 
7#d7 ,r$uctions 9 mortality among       
program b5efici>ies4  7#e7 ,a*iev+ l[]  
rates ( functional decl9e1 & improvem5ts
 9 report$ heal? /atus & quality ( life 
among program b5efici>ies4  7#f7        
,r$uctions 9 ! total co/ ( c>e among    
program b5efici>ies4  7#g7 ,! effect (  
activities support$ "u ! program on !   
local area s]vic$ by ! program1 includ+ 
on ! heal? & well-be+ ( unpaid & family 
c>egiv]s ( program b5efici>ies4  7#h7   
,improvem5ts 9 quality ( life among     
program b5efici>ies4  7b7 ,report ,n    
lat] ?an #fj mon?s aft] ! date (        
enactm5t ( ?is ,act1 ! ,assi/ant        
,secret>y %all submit a report conta9+ !

 results ( ! evaluation requir$ "u      
subsection 7a71 an analysis ( :i*       
elem5ts ( ! program = all-inclusive c>e 
= ! eld]ly "u sections #ahid & #aicd ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;eee1 #acifu-#d7 %\ld be replicat$ 
& scal$ by gov]nm5tal or non-gov]nm5tal 
entities1 & su* recomm5dations =        
legislation & adm9i/rative action z !   
,assi/ant ,secret>y det]m9es appropriate
 to ! *airs & rank+ memb]s ( ! foll[+   
committees3 7#a7 ,! ,special ,committee 
on ,ag+ ( ! ,s5ate4  7#b7 ,! ,committee 
on ,f9ance ( ! ,s5ate4  7#c7 ,!         
,committee on ,heal?1 ,education1       
,labor1 & ,p5sions ( ! ,s5ate4  7#d7 ,! 
,committee on ,ways & ,means ( ! ,h\se (
 ,repres5tatives4  7#e7 ,! ,committee on
 ,en]gy & ,comm]ce ( ! ,h\se (          
,repres5tatives4  7c7 ,p>tn]s ,9        
conduct+ ! evaluation & complet+ !      
report requir$ "u ?is section1 !        
,assi/ant ,secret>y %all provide an     
opportunity = p>tn]s & p]sons t h       
p>ticipat$ 9 ! program = all-inclusive  

c>e = ! eld]ly "u sections #ahid & #aicd
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;eee1 #acifu-#d7 on e    
level1 especially individuals :o receive
 c>e ?r\gh ! program & _! unpaid or     
family c>egiv]s1 to h an opportunity to 
contribute _! exp]tise to evaluat+ !    
/rategy & outcomes ( ! program4