,,ii  #aag? ,,congress  #b;d ,session   
,s4 #dddi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #bb1 #bjbb,mr4   
,burr 7= himself & ,mr4 ,br[n7 introduc$
 ! foll[+ bill2 :i* 0 read twice &      
ref]r$ to ! ,committee on ,f9ance  ,a   
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to improve !     
accuracy ( m>ket-bas$ ,m$ic>e paym5t =  
cl9ical diagno/ic laboratory s]vices1 to
 r$uce adm9i/rative burd5s 9 !          
collection ( data1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,sav+ ,access to ,laboratory ,s]vices 
,act4  #b4 ,modification ( requirem5ts =
 m$ic>e cl9ical diagno/ic laboratory    
te/s  7a7 ,use ( /ati/ical sampl+ =     
widely available cl9ical diagno/ic      
laboratory te/s  7#a7 ,9 g5]al ,section 
#ahcd;,a7a77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;a77#a77  
is am5d$-- 7,a7 9 subp>agraph 7,a71 by  
/rik+ ,subject to subp>agraph 7,b7 &    
ins]t+ ,subject to subp>agraphs 7,b7 &  
7,c72 &  7,b7 by add+ at ! end ! foll[+ 

new subp>agraph3  7,c7 ,use ( /ati/ical 
sampl+ = widely available cl9ical       
diagno/ic laboratory te/s  7i7 ,9 g5]al 
,subject to clause 7ii71 ) respect to   
data collection p]iods = report+ p]iods 
beg9n+ on or aft] ,janu>y #a1 #bjbf1 9 !
 case ( a widely available cl9ical      
diagno/ic laboratory te/ 7z def9$ 9     
clause 7iii771 9 lieu ( requir+ !       
report+ ( applicable in=mation f ea*    
applicable laboratory1 ! ,secret>y %all 
require ! collection & report+ (        
applicable in=mation f a /ati/ically    
valid sample ( applicable laboratories =
 ea* su* widely available cl9ical       
diagno/ic laboratory te/4  7ii7         
,requirem5ts = /ati/ical sampl+  7,i7 ,9
 g5]al ,! ,secret>y1 9 consultation )   
/akehold]s1 %all develop a me?odology = 
a /ati/ically valid sample "u clause    
7i71 us+ ! maximal brew] selection      
me?od1 z describ$ 9 ! ,june #bjba       
,m$ic>e ,paym5t ,access ,commission     
,report to ! ,congress1 to e/abli% !    
paym5t am\nt = a widely available       

cl9ical diagno/ic laboratory te/ "u     
p>agraph 7#b7 ( subsection 7b7 = ea*    
applicable ,,hcpcs code = a widely      
available cl9ical diagno/ic laboratory  
te/4  7,,ii7 ,repres5tative sampl+ ,!   
me?odology "u subclause 7,i7 = a        
/ati/ically valid sample "u clause 7i7  
%all1 = ea* applicable ,,hcpcs code = a 
widely available cl9ical diagno/ic      
laboratory te/-- 7aa7 provide = a sample
 t all[s = ! paym5t am\nts e/abli%$ "u  
p>agraph 7#b7 ( subsection 7b7 = su* a  
te/ to be repres5tative ( rates paid by 
private payors to applicable            
laboratories receiv+ paym5t "u ?is      
section1 includ+ indep5d5t laboratories1
 hospital laboratories1 hospital outrea*
 laboratories1 & physician (fice        
laboratories t furni% ! widely available
 cl9ical diagno/ic laboratory te/2  7bb7
 include applicable in=mation 7z def9$ 9
 p>agraph 7#c77 ) respect to su* widely 
available cl9ical diagno/ic laboratory  
te/ f su* diff]5t types ( applicable    
laboratories2 &  7cc7 be ( suffici5t    

size to accurately & proportionally     
repres5t ! range ( private payor paym5t 
rates receiv$ by ea* su* type (         
applicable laboratory weight$ accord+ to
 ! utilization rates ( ea* type (       
applicable laboratory = ! widely        
available cl9ical diagno/ic laboratory  
te/ dur+ ! fir/ #f mon?s ( ! cal5d> ye> 
imm$iately prec$+ ! data collection     
p]iod applicable to ! sample to be      
collect$4  7,,iii7 ,lea/ burd5some data 
collection & report+ processes ,!       
me?odology develop$ by ! ,secret>y %all 
be design$ to r$uce adm9i/rative burd5s 
( data collection & report+ on          
applicable laboratories & ! ,c5t]s =    
,m$ic>e  ,m$icaid ,s]vices to ! greate/ 
ext5t practicable4  7,,iv7 ,publication 
( li/ ( widely available cl9ical        
diagno/ic laboratory te/s & notification
 to applicable laboratories requir$ to  
report applicable in=mation ,n lat] ?an 
,septemb] #cj ( ! ye> imm$iately prec$+ 
ea* data collection p]iod 7z def9$ 9    
p>agraph 7#d771 ! ,secret>y %all publi% 

9 ! ,f$]al ,regi/] a li/ ( widely       
available cl9ical diagno/ic laboratory  
te/s & %all directly notify applicable  
laboratories requir$ to report          
applicable in=mation "u ?is subsection4 
7iii7 ,def9ition ( widely available     
cl9ical diagno/ic laboratory te/ ,9 ?is 
subp>agraph1 ! t]m widely available     
cl9ical diagno/ic laboratory te/ means a
 cl9ical diagno/ic laboratory te/ t     
meets bo? ( ! foll[+ crit]ia dur+ ! fir/
 #f mon?s ( ! cal5d> ye> imm$iately     
prec$+ ! data collection p]iod          
applicable to ! sample to be collect$3  
7,i7 ,paym5t rate ,! paym5t am\nt       
det]m9$ = ! cl9ical diagno/ic laboratory
 te/ "u ?is section is less ?an #a1jjj  
p] te/4  7,,ii7 ,numb] ( laboratories   
p]=m+ ! te/ ,! numb] ( applicable       
laboratories receiv+ paym5ts "u ?is     
section = ! cl9ical diagno/ic laboratory
 te/ 7z det]m9$ by ! ,secret>y us+ !    
national provid] id5tifi] ( ! provid] ( 
s]vices or suppli] on ! claim submitt$ =
 paym5t "u ?is "p = su* te/7 exce$s     

#ajj4  4  7#b7 ,delays to revis$ report+
 p]iods & report+ p]iod frequ5cy  7,a7  
,9 g5]al ,section #ahcd;,a7a77#a77;,b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciem-#a7;a77#a77;,b77 is am5d$-- 7i7 
9 clause 7i71 by /rik+ ,decemb] #ca1    
#bjbb & ins]t+ ,decemb] #ca1 #bjbd2     
7ii7 9 clause 7ii71 by /rik+ beg9n+     
,janu>y #a1 #bjbc1 & end+ ,m>* #ca1     
#bjbc & ins]t+ beg9n+ ,janu>y #a1 #bjbf1
 & end+ ,m>* #ca1 #bjbf2 &  7iii7 9     
clause 7iii7 by /rik+ e ?ree ye>s &     
ins]t+ e f\r ye>s4  7,b7 ,con=m+ *ange  
to def9ition ( data collection p]iod    
,section #ahcd;,a7a77#d77;,b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciem-#a7;a77#d77;,b77 is am5d$ by     
/rik+ ,janu>y #a1 #bjai1 & end+ ,june   
#cj1 #bjai & ins]t+ ,janu>y #a1 #bjbe1 &
 end+ ,june #cj1 #bjbe4  7b7 ,elim9ation
 ( majority ( ,m$ic>e rev5ues te/ ,!    
fir/ s5t5ce ( section #ahcd;,a7a77#b7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#aciem-#a7;a77#b77 is am5d$ by /rik+ ,9 
?is section & all t foll[s ?r\gh ! p]iod

 & ins]t+ ! foll[+3 ,not)/&+            
det]m9ations ( applicable laboratories  
made prior to ,janu>y #a1 #bjbd1 ! t]m  
applicable laboratory means a laboratory
 t receives at lea/ #ab1ejj 9 paym5ts "u
 ?is section dur+ ! fir/ #f mon?s ( !   
cal5d> ye> imm$iately prec$+ !          
applicable data collection p]iod44  7c7 
,modifications to applicable in=mation  
report$  7#a7 ,m$icaid manag$ c>e rates 
,section #ahcd;,a7a77#h77;,c7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciem-#a7;a77#h77;,c77 is am5d$ by     
/rik+ ,a m$icaid manag$ c>e organization
 & ins]t+ ,) respect to data collection 
p]iods = report+ p]iods beg9n+ be=e     
,janu>y #a1 #bjbf1 a m$icaid manag$ c>e 
organization 7z def9$ 9 section         
#aijc7m774  7#b7 ,au?ority to exclude   
manual remittances ,section             
#ahcd;,a7a77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;a77#c77  
is am5d$-- 7,a7 9 subp>agraph 7,a71 by  
/rik+ subject to subp>agraph 7,b71 &    
ins]t+ subject to subp>agraphs 7,b7 &   

7,c72 &  7,b7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,c7 ,exclusion (     
manual remittances ,an applicable       
laboratory = :i* less ?an #aj p]c5t (   
its total paid claims dur+ a data       
collection p]iod are paid by private    
payors by means o!r ?an an electronic   
/&>d transaction 7z def9$ 9 section     
#afb4ajc ( title #de1 ,code ( ,f$]al    
,regulations 7or any successor          
regulation77 may exclude f ! def9ition (
 applicable in=mation "u ?is p>agraph   
paym5ts made by private payors t are n  
made ?r\gh an electronic /&>d           
transaction4  4  7d7 ,modification to   
limits on paym5t r$uctions2 imposition (
 annual cap on paym5t increases  7#a7   
,paym5t r$uction limits ,section        
#ahcd;,a7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#c77  
is am5d$-- 7,a7 9 subp>agraph 7,a71 by  
/rik+ = ea* ( #bjag ?r\gh #bjbe & ins]t+
 = #bjag & ea* succe$+ ye>2 &  7,b7 9   
subp>agraph 7,b7-- 7i7 9 clause 7ii71 by
 /rik+ & at ! end2 &  7ii7 by /rik+     

clause 7iii7 & ins]t+ ! foll[+3  7iii7 =
 #bjbc1 #j p]c5t2  7iv7 = #bjbd1 #b4e   
p]c5t2 &  7v7 = #bjbe & ea* subsequ5t   
ye>1 #e p]c5t4  4  7#b7 ,annual cap on  
paym5t rate increases ,section          
#ahcd;,a7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#c771 
z am5d$ by p>agraph 7#a71 is am5d$--    
7,a7 9 subp>agraph 7,a7-- 7i7 by /rik+  
te/ = #bjag & ea* succe$+ ye>-- & ins]t+
 te/-- 7i7 = #bjag & ea* succe$+ ye>  2 
7ii7 9 clause 7i71 z add$ by clause 7i7 
( ?is subp>agraph1 by /rik+ ! p]iod &   
ins]t+ 2 &2 &  7iii7 by add+ at ! end ! 
foll[+ new clause3  7ii7 = #bjbc & ea*  
succe$+ ye>1 %all n result 9 an increase
 9 paym5ts = a cl9ical diagno/ic        
laboratory te/ = ! ye> ( great] ?an !   
applicable p]c5t 7z def9$ 9 subp>agraph 
7,d77 ( ! am\nt ( paym5t = ! te/ = !    
prec$+ ye>4  2  7,b7 9 subp>agraph 7,b71
 9 ! matt] prec$+ clause 7i71 by /rik+  
,9 ?is p>agraph & ins]t+ ,9 clause 7i7 (
 subp>agraph 7,a72 &  7,c7 by add+ at ! 
end ! foll[+ new subp>agraph3  7,d7     

,def9ition ( applicable p]c5t = purposes
 ( annual cap on paym5t increases ,9    
clause 7ii7 ( subp>agraph 7,a71 ! t]m   
applicable p]c5t means ! foll[+3 7i7    
,widely available cl9ical diagno/ic     
laboratory te/s ,) respect to a widely  
available cl9ical diagno/ic laboratory  
te/-- 7,i7 = #bjbc1 #b4e p]c5t2  7,,ii7 
= #bjbd1 #b4e p]c5t2  7,,iii7 = #bjbe1  
#c4ge p]c5t2  7,,iv7 = #bjbf1 #c4ge     
p]c5t2 &  7,v7 = #bjbg & ea* subsequ5t  
ye>1 #e p]c5t4  7ii7 ,o!r cl9ical       
diagno/ic laboratory te/s ,) respect to 
a cl9ical diagno/ic laboratory te/ n    
describ$ 9 clause 7i71 #e p]c5t4  4     
7#c7 ,con=m+ am5dm5t ,section           
#ahcd;,a7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#c77  
is am5d$ 9 ! head+ by /rik+ r$uctions & 
ins]t+ m$ic>e paym5t *anges4  7e7       
,regulations  7#a7 ,n lat] ?an ,decemb] 
#ca1 #bjbc1 ! ,secret>y ( ,heal? &      
,human ,s]vices %all implem5t ! am5dm5ts
 made by ?is section 7o!r ?an subsection
 7d77 ?r\gh notice & comm5t rulemak+4   

7#b7 ,! ,secret>y ( ,heal? & ,human     
,s]vices may implem5t ! am5dm5ts made by
 subsection 7d7 ?r\gh int]im f9al       
rulemak+1 program in/ruction1 or        
o!rwise4