,,ib ,union ,cal5d> ,no4 #fgb #aah?     
,,congress  #b;d ,session  ,h4 ,r4 #cbhd
 ,report ,no4 #aah-gfe1 ,p>ts ,i & ,,ii 
,,9 ,,! ,,h\se ,,( ,,repres5tatives     
,may #ae1 #bjbc,mr4 ,burgess 7= himself1
 ,mrs4 ,d+ell1 ,mr4 ,f]guson1 & ,mr4    
,bilirakis7 introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,en]gy &   
,comm]ce1 & 9 addition to ! ,committee  
on ,ways & ,means1 = 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$  ,novemb] #bb1 #bjbd,report$ f !
 ,committee on ,en]gy & ,comm]ce ) an   
amendment,strike out all aft] ! enact+  
clause & ins]t ! "p pr9t$ 9 italic      
,novemb] #bb1 #bjbd,ref]ral to !        
,committee on ,ways & ,means ext5d$ = a 
p]iod end+ n lat] ?an ,decemb] #ai1     
#bjbd  ,decemb] #e1 #bjbd;,additional   
sponsor3 ,ms4 ,lee ( ,nevada  ,decemb]  
#e1 #bjbd,report$ f ! ,committee on     
,ways & ,means ) an am5dm5t1 committ$ to
 ! ,committee ( ! ,:ole ,h\se on ! ,/ate

 ( ! ,union1 & ord]$ to be              
printed,strike out all aft] ! enact+    
clause & ins]t ! "p pr9t$ 9 boldface    
roman,for text ( introduc$ bill1 see    
copy ( bill z introduc$ on ,may #ae1    
#bjbc  ,a ,,bill  ,to require !         
,secret>y ( ,heal? & ,human ,s]vices to 
submit an annual report on ! impact (   
c]ta9 ,m$ic>e regulations on provid] &  
pay] consolidation4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,provid]s &   
,pay]s ,,compete ,act4  #b4 ,annual     
report on ! impact ( c]ta9 ,m$ic>e      
regulations on provid] & pay]           
consolidation2 public comm5t on provid] 
& pay] consolidation = c]ta9 propos$    
rules  7a7 ,annual report ,n lat] ?an   
,decemb] #ca1 #bjbf1 & annually !reaft]1
 ! ,secret>y ( ,heal? & ,human ,s]vices 
79 ?is section ref]r$ to z ! ,secret>y7 
%all submit to ,congress a report on !  
impact 9 ! aggregate on provid] & pay]  
consolidation ) respect to regulations &
 rules = p>ts ,a1 ,b1 ,c1 & ,d ( title  
,,xviii ( ! ,social ,security ,act 7#db 

,u4,s4,c4 #acie;c et seq47 implem5t$ 9 !
 cal5d> ye> imm$iately prior to su*     
report4 ,su* report %all include        
regulations & rules t-- 7#a7 implem5t a 
*ange to an applicable paym5t sy/em1 a  
rate s*$ule1 or ano!r paym5t sy/em "u   
p>ts ,a1 ,b1 ,c1 or ,d ( su* title2 or  
7#b7 result 9 a significant rule effect+
 provid] or pay] consolidation4  7b7    
,public comm5t on impact to provid] &   
pay] consolidation ,beg9n+ = #bjbe1 z "p
 ( any notice & comm5t rulemak+ process 
t c\ld result 9 a significant rule      
affect+ provid] or pay] consolidation ) 
respect to a propos$ rule = p>ts ,a1 ,b1
 ,c1 & ,d ( title ,,xviii ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie;c et
 seq471 ! ,secret>y %all seek public    
comm5t on ! pot5tial impact ( su*       
propos$ rule on provid] & pay]          
consolidation 9 ! aggregate4  7c7       
,def9itions ,9 ?is section3 7#a7        
,provid] & pay] consolidation ,! t]m    
provid] & pay] consolidation includes ! 
v]tical or horizontal integration among 

provid]s ( s]vices 7z def9$ 9 subsection
 7u7 ( section #ahfa ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #aciex771 
suppli]s 7z def9$ 9 subsection 7d7 ( su*
 section71 acc\ntable c>e organizations 
"u section #ahii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie;jjj71 ,m$ic>e 
,advantage organizations1 ,,pdp         
sponsors1 ph>macy b5efit manag]s1       
ph>macies1 & integrat$ deliv]y sy/ems4  
7#b7 ,applicable paym5t sy/em ,! t]m    
applicable paym5t sy/em includes-- 7,a7 
) respect to outpati5t hospital s]vices1
 ! prospective paym5t sy/em = cov]$     
,,opd s]vices e/abli%$ "u section       
#ahcc7t7 ( su* ,act 7#db ,u4,s4,c4      
#acie7l772 &  7,b7 ) respect to         
physicians' s]vices1 ! physician fee    
s*$ules e/abli%$ "u section #ahdh ( su* 
,act 7#db ,u4,s4,c4 #aciew-#d74  #c4    
,consid]ation ( effects on provid] &    
pay] consolidation ) respect to ,,cmi   
models  7a7 ,9 g5]al ,section           
#aaae;,a7b77#d77;,a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           

#acae;a7b77#d77;,a77 is am5d$-- 7#a7 9  
clause 7i71 by /rik+ at ! end &2  7#b7 9
 clause 7ii71 by /rik+ ! p]iod at ! end 
& ins]t+ 2 &2 &  7#c7 by add+ at ! end !
 foll[+ new clause3  7iii7 ! ext5t to   
:i*1 & h[1 ! model has affect$ & c\ld   
affect provid] & pay] consolidation1 :i*
 includes ! v]tical or horizontal       
integration among provid]s ( s]vices 7z 
def9$ 9 subsection 7u7 ( section #ahfa71
 suppli]s 7z def9$ 9 subsection 7d7 (   
su* section71 & acc\ntable c>e          
organizations "u section #ahii1 or      
pursuant to models "u ?is section4  4   
7b7 ,effective date ,! am5dm5ts made by 
subsection 7a7 %all apply ) respect to  
models te/$ on or aft] ,janu>y #a1      
#bjbe4  #a4 ,%ort title ,?is ,act may be
 cit$ z ! ,provid]s & ,pay]s ,,compete  
,act4  #b4 ,annual report on ! impact ( 
c]ta9 ,m$ic>e regulations on provid] &  
pay] consolidation2 public comm5t on    
provid] & pay] consolidation = c]ta9    
propos$ rules  7a7 ,annual report ,n    
lat] ?an ,decemb] #ca1 #bjbf1 & annually

 !reaft]1 ! ,secret>y ( ,heal? & ,human 
,s]vices 79 ?is section ref]r$ to z !   
,secret>y7 %all submit to ,congress a   
report on ! impact 9 ! aggregate on     
provid] & pay] consolidation ) respect  
to regulations & rules = p>ts ,a1 ,b1   
,c1 & ,d ( title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie;c et
 seq47 implem5t$ 9 ! cal5d> ye>         
imm$iately prior to su* report4 ,su*    
report %all include regulations & rules 
t-- 7#a7 implem5t a *ange to an         
applicable paym5t sy/em1 a rate s*$ule1 
or ano!r paym5t sy/em "u p>ts ,a1 ,b1   
,c1 or ,d ( su* title2 or  7#b7 result 9
 a significant rule effect+ provid] or  
pay] consolidation4  7b7 ,public comm5t 
on impact to provid] & pay]             
consolidation ,beg9n+ = #bjbe1 z "p (   
any notice & comm5t rulemak+ process t  
c\ld result 9 a significant rule affect+
 provid] or pay] consolidation ) respect
 to a propos$ rule = p>ts ,a1 ,b1 ,c1 & 
,d ( title ,,xviii ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;c et seq471 !

 ,secret>y %all seek public comm5t on ! 
pot5tial impact ( su* propos$ rule on   
provid] & pay] consolidation 9 !        
aggregate4  7c7 ,def9itions ,9 ?is      
section3 7#a7 ,provid] & pay]           
consolidation ,! t]m provid] & pay]     
consolidation includes ! v]tical or     
horizontal integration among provid]s ( 
s]vices 7z def9$ 9 subsection 7u7 (     
section #ahfa ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex771 suppli]s 7z   
def9$ 9 subsection 7d7 ( su* section71  
acc\ntable c>e organizations "u section 
#ahii ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;jjj71 ,m$ic>e ,advantage
 organizations1 ,,pdp sponsors1 ph>macy 
b5efit manag]s1 ph>macies1 & integrat$  
deliv]y sy/ems4  7#b7 ,applicable paym5t
 sy/em ,! t]m applicable paym5t sy/em   
includes-- 7,a7 ) respect to outpati5t  
hospital s]vices1 ! prospective paym5t  
sy/em = cov]$ ,,opd s]vices e/abli%$ "u 
section #ahcc7t7 ( su* ,act 7#db        
,u4,s4,c4 #acie7l772 &  7,b7 ) respect  
to physicians' s]vices1 ! physician fee 

s*$ules e/abli%$ "u section #ahdh ( su* 
,act 7#db ,u4,s4,c4 #aciew-#d74  #c4    
,consid]ation ( effects on provid] &    
pay] consolidation ) respect to ,,cmi   
models  7a7 ,9 g5]al ,section           
#aaae;,a7b77#d77;,a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae;a7b77#d77;,a77 is am5d$-- 7#a7 9  
clause 7i71 by /rik+ at ! end &2  7#b7 9
 clause 7ii71 by /rik+ ! p]iod at ! end 
& ins]t+ 2 &2 &  7#c7 by add+ at ! end !
 foll[+ new clause3  7iii7 ! ext5t to   
:i*1 & h[1 ! model has affect$ & c\ld   
affect provid] & pay] consolidation1 :i*
 includes ! v]tical or horizontal       
integration among provid]s ( s]vices 7z 
def9$ 9 subsection 7u7 ( section #ahfa71
 suppli]s 7z def9$ 9 subsection 7d7 (   
su* section71 & acc\ntable c>e          
organizations "u section #ahii1 or      
pursuant to models "u ?is section4  4   
7b7 ,effective date ,! am5dm5ts made by 
subsection 7a7 %all apply ) respect to  
models te/$ on or aft] ,janu>y #a1      
#bjbe4  ,decemb] #e1 #bjbd,report$ ) an 

am5dm5t1 committ$ to ! ,committee ( !   
,:ole ,h\se on ! ,/ate ( ! ,union1 &    
ord]$ to be pr9t$