#aah? ,,congress  #b;d ,session  ,h4 ,r4
 #dgeh  ,,an ,,act  ,to am5d title ,,xix
 ( ! ,social ,security ,act to /reaml9e 
enrollm5t "u ! ,m$icaid program ( c]ta9 
provid]s across ,/ate l9es1 & to prev5t 
! use ( abusive spread pric+ 9 ,m$icaid4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,accel]at+ ,kids' ,access to ,c>e   
,act4  #b4 ,/reaml9$ enrollm5t process =
 eligible out-(-,/ate provid]s "u       
m$icaid & *ip  7a7 ,9 g5]al ,section    
#aijb7kk7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acif;a7kk77 is am5d$ by 
add+ at ! end ! foll[+ new p>agraph3    
7#aj7 ,/reaml9$ enrollm5t process =     
eligible out-(-,/ate provid]s  7,a7 ,9  
g5]al ,! ,/ate-- 7i7 adopts & implem5ts 
a process to all[ an eligible           
out-(-,/ate provid] to enroll "u ! ,/ate
 plan 7or a waiv] ( su* plan7 to furni% 
items & s]vices to1 or ord]1 prescribe1 
ref]1 or c]tify eligibility = items &   
s]vices =1 qualify+ individuals )\t !   
imposition ( scre5+ or enrollm5t        
requirem5ts 9 addition to ^? impos$ by !

 ,/ate 9 :i* ! eligible out-(-,/ate     
provid] is locat$2 &  7ii7 provides t an
 eligible out-(-,/ate provid] t enrolls 
z a p>ticipat+ provid] 9 ! ,/ate plan   
7or a waiv] ( su* plan7 ?r\gh su*       
process %all be s enroll$ = a #e-ye>    
p]iod1 unless ! provid] is t]m9at$ or   
exclud$ f p>ticipation dur+ su* p]iod4  
7,b7 ,def9itions ,9 ?is p>agraph3  7i7  
,eligible out-(-,/ate provid] ,! t]m    
eligible out-(-,/ate provid] means1 )   
respect to a ,/ate1 a provid]-- 7,i7 t  
is locat$ 9 any o!r ,/ate2  7,,ii7 t--  
7aa7 0 det]m9$ by ! ,secret>y to h a    
limit$ risk ( fraud1 wa/e1 & abuse =    
purposes ( det]m9+ ! level ( scre5+ to  
be conduct$ "u section #ahff7;j77#b71   
has be5 s scre5$ "u su* section         
#ahff7;j77#b71 & is enroll$ 9 ! ,m$ic>e 
program "u title ,,xviii2 or  7bb7 0    
det]m9$ by ! ,/ate ag5cy adm9i/]+ or    
sup]vis+ ! adm9i/ration ( ! ,/ate plan  
7or a waiv] ( su* plan7 ( su* o!r ,/ate 
to h a limit$ risk ( fraud1 wa/e1 &     
abuse = purposes ( det]m9+ ! level (    

scre5+ to be conduct$ "u p>agraph 7#a7 (
 ?is subsection1 has be5 s scre5$ "u su*
 p>agraph 7#a71 & is enroll$ "u su*     
,/ate plan 7or a waiv] ( su* plan72 &   
7,,iii7 t has n be5--  7aa7 exclud$ f   
p>ticipation 9 any ,f$]al heal? c>e     
program pursuant to section #aabh or    
#aabh;,a2  7bb7 exclud$ f p>ticipation 9
 ! ,/ate plan 7or a waiv] ( su* plan7   
pursuant to "p #ajjb ( title #db1 ,code 
( ,f$]al ,regulations 7or any successor 
regulation71 or ,/ate law2 or  7cc7     
t]m9at$ f p>ticipat+ 9 a ,f$]al heal?   
c>e program or ! ,/ate plan 7or a waiv] 
( su* plan7 = a reason describ$ 9       
p>agraph 7#h77;,a74  7ii7 ,qualify+     
individual ,! t]m qualify+ individual   
means an individual "u #ba ye>s ( age :o
 is enroll$ "u ! ,/ate plan 7or waiv] ( 
su* plan74  7iii7 ,/ate ,! t]m ,/ate    
means #a ( ! #ej ,/ates or ! ,di/rict ( 
,columbia4  4  7b7 ,con=m+ am5dm5ts     
7#a7 ,section #aijb7;a77#gg7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acif;a7a77#gg77 is am5d$ by ins]t+     

enrollm5t1 aft] scre5+14  7#b7 ,!       
subsection head+ = section #aijb7kk7 (  
su* ,act 7#db ,u4,s4,c4 #acif;a7kk77 is 
am5d$ by ins]t+ enrollm5t1 aft] scre5+14
  7#c7 ,section #bajg7;e77#a77;,g7 ( su*
 ,act 7#db ,u4,s4,c4                    
#acig;gg7e77#a77;,g77 is am5d$ by ins]t+
 enrollm5t1 aft] scre5+14  7c7          
,effective date ,! am5dm5ts made by ?is 
section %all take effect on ! date t is 
#c ye>s aft] ! date ( enactm5t ( ?is    
section4  #c4 ,prev5t+ ! use ( abusive  
spread pric+ 9 m$icaid  7a7 ,9 g5]al    
,section #aibg ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acifr-#h7 is       
am5d$--  7#a7 9 subsection 7e71 by add+ 
at ! end ! foll[+ new p>agraph3  7#f7   
,transp>5t prescription drug pass-?r\gh 
pric+ requir$  7,a7 ,9 g5]al ,a contract
 betwe5 ! ,/ate & a ph>macy b5efit      
manag] 7ref]r$ to 9 ?is p>agraph z a    
,,pbm71 or a contract betwe5 ! ,/ate & a
 manag$ c>e entity or o!r specifi$      
entity 7z su* t]ms are def9$ 9 section  
#aijc7m77#i77;,d7 & collectively ref]r$ 

to 9 ?is p>agraph z ! entity7 t includes
 provisions mak+ ! entity responsible = 
cov]age ( cov]$ outpati5t drugs disp5s$ 
to individuals enroll$ ) ! entity1 %all 
require t paym5t = su* drugs & relat$   
adm9i/rative s]vices 7z applicable71    
includ+ paym5ts made by a ,,pbm on      
behalf ( ! ,/ate or entity1 is bas$ on a
 transp>5t prescription drug pass-?r\gh 
pric+ model "u :i*--  7i7 any paym5t    
made by ! entity or ! ,,pbm 7z          
applicable7 = su* a drug-- 7,i7 is      
limit$ to--  7aa7 +r$i5t co/2 &  7bb7 a 
pr(essional disp5s+ fee t is n less ?an 
! pr(essional disp5s+ fee t ! ,/ate w\ld
 pay if ! ,/ate 7 mak+ ! paym5t directly
 9 accordance ) ! ,/ate plan2  7,,ii7 is
 pass$ ?r\gh 9 its entirety 7except z   
r$uc$ "u ,f$]al or ,/ate laws &         
regulations 9 response to in/ances (    
wa/e1 fraud1 or abuse7 by ! entity or   
,,pbm to ! ph>macy or provid] t disp5ses
 ! drug2 &  7,,iii7 is made 9 a mann] t 
is consi/5t ) sections #ddg4ejb1        
#ddg4eab1 #ddg4ead1 & #ddg4eah ( title  

#db1 ,code ( ,f$]al ,regulations 7or any
 successor regulation7 z if su*         
requirem5ts appli$ directly to ! entity 
or ! ,,pbm1 except t any paym5t by !    
entity or ! ,,pbm = ! +r$i5t co/ ( su*  
drug pur*as$ by a cov]$ entity 7z def9$ 
9 subsection 7a77#e77;,b77 may exce$ !  
actual acquisition co/ 7z def9$ 9       
#ddg4ejb ( title #db1 ,code ( ,f$]al    
,regulations1 or any successor          
regulation7 = su* drug if--  7aa7 su*   
drug 0 subject to an agreem5t "u section
 #cdj;,b ( ! ,public ,heal? ,s]vice     
,act2  7bb7 su* paym5t = ! +r$i5t co/ ( 
su* drug does n exce$ ! maximum paym5t t
 w\ld h be5 made by ! entity or ! ,,pbm 
= ! +r$i5t co/ ( su* drug if su* drug _h
 n be5 pur*as$ by su* cov]$ entity2 &   
7cc7 su* cov]$ entity reports to !      
,secret>y 79 a =m & mann] specifi$ by ! 
,secret>y71 on an annual basis & )      
respect to paym5ts = ! +r$i5t co/s ( su*
 drugs s pur*as$ by su* cov]$ entity t  
are 9 excess ( ! actual acquisition co/s
 = su* drugs1 ! aggregate am\nt ( su*   

excess2  7ii7 paym5t to ! entity or !   
,,pbm 7z applicable7 = adm9i/rative     
s]vices p]=m$ by ! entity or ,,pbm is   
limit$ to an adm9i/rative fee t reflects
 ! fair m>ket value 7z def9$ by !       
,secret>y7 ( su* s]vices2  7iii7 !      
entity or ! ,,pbm 7z applicable7 makes  
available to ! ,/ate1 & ! ,secret>y ^u  
reque/ 9 a =m & mann] specifi$ by !     
,secret>y1 all co/s & paym5ts relat$ to 
cov]$ outpati5t drugs & accompany+      
adm9i/rative s]vices 7z describ$ 9      
clause 7ii77 incurr$1 receiv$1 or made  
by ! entity or ! ,,pbm1 brok5 d[n 7z    
specifi$ by ! ,secret>y71 to ! ext5t su*
 co/s & paym5ts are attributable to an  
individual cov]$ outpati5t drug1 by ea* 
su* drug1 includ+ any +r$i5t co/s1      
pr(essional disp5s+ fees1 adm9i/rative  
fees 7z describ$ 9 clause 7ii771        
po/-sale & po/-invoice fees1 disc\nts1  
or relat$ adju/m5ts su* z direct &      
indirect remun]ation fees1 & any & all  
o!r remun]ation2 &  7iv7 any =m ( spread
 pric+ :]eby any am\nt *>g$ or claim$ by

 ! entity or ! ,,pbm 7z applicable7 t   
exce$s ! am\nt paid to ! ph>macies or   
provid]s on behalf ( ! ,/ate or entity1 
includ+ any po/-sale or po/-invoice     
fees1 disc\nts1 or relat$ adju/m5ts su* 
z direct & indirect remun]ation fees or 
assessm5ts 7aft] all[+ = an adm9i/rative
 fee z describ$ 9 clause 7ii77 is n     
all[able = purposes ( claim+ ,f$]al     
mat*+ paym5ts "u ?is title4  7,b7 ,mak+ 
c]ta9 in=mation available ,! ,secret>y  
%all publi%1 n less frequ5tly ?an on an 
annual basis1 in=mation receiv$ by !    
,secret>y pursuant to subp>agraph       
7,a77i77,,iii77cc74 ,su* in=mation %all 
be s publi%$ 9 an electronic & se>*able 
=mat1 su* z ?r\gh ! #cdj;,b ,(fice (    
,ph>macy ,affairs ,in=mation ,sy/em 7or 
a successor sy/em74  2 &  7#b7 9        
subsection 7k71 by add+ at ! end !      
foll[+ new p>agraph3  7#ab7 ,ph>macy    
b5efit manag] ,! t]m ph>macy b5efit     
manag] means any p]son or entity t1 ei!r
 directly or ?r\gh an int]m$i>y1 acts z 
a price negotiator or gr\p pur*as] on   

behalf ( a ,/ate1 manag$ c>e entity 7z  
def9$ 9 section #aijc7m77#i77;,d771 or  
o!r specifi$ entity 7z s def9$71 & may  
also m broadly manage aspects ( !       
prescription drug b5efits provid$ by a  
,/ate1 manag$ c>e entity1 or o!r        
specifi$ entity1 includ+ ! process+ &   
paym5t ( claims = prescription drugs1 ! 
p]=mance ( drug utilization review1 !   
process+ ( drug prior au?orization      
reque/s1 ! manag+ ( appeals or          
grievances relat$ to ! prescription drug
 b5efits1 contract+ ) ph>macies1        
controll+ ! co/ ( cov]$ outpati5t drugs1
 or ! provision ( s]vices relat$ !reto4 
,su* t]m includes any p]son or entity t 
acts z a price negotiator 7) reg>d to   
paym5t am\nts to ph>macies & provid]s = 
a cov]$ outpati5t drug or ! net co/ ( ! 
drug7 or gr\p pur*as] on behalf ( a     
,/ate1 manag$ c>e entity1 or o!r        
specifi$ entity1 includ+ su* a p]son or 
entity t c>ries out #a or m ( ! o!r     
activities describ$ 9 ! prec$+ s5t5ce1  
irrespective ( :e!r su* p]son or entity 

calls itself a ph>macy b5efit manag]4  4
  7b7 ,con=m+ am5dm5ts ,section #aijc7m7
 ( su* ,act 7#db ,u4,s4,c4 #acif;b7m77  
is am5d$--  7#a7 9 p>agraph             
7#b77;,a77xiii7-- 7,a7 by /rik+ &       
7,,iii7 & ins]t+ 7,,iii72  7,b7 by      
ins]t+ be=e ! p]iod at ! end ! foll[+3 1
 & 7,,iv7 if ! contract includes        
provisions mak+ ! entity responsible =  
cov]age ( cov]$ outpati5t drugs1 !      
entity %all comply ) ! requirem5ts (    
section #aibg7;e77#f72 &  7,c7 by mov+ !
 left m>g9 #b ems to ! left2 &  7#b7 by 
add+ at ! end ! foll[+ new p>agraph3    
7#aj7 ,no paym5t %all be made "u ?is    
title to a ,/ate ) respect to           
exp5ditures incurr$ by ! ,/ate = paym5t 
= s]vices provid$ by an o!r specifi$    
entity 7z def9$ 9 p>agraph              
7#i77;,d77iii77 unless su* s]vices are  
provid$ 9 accordance ) a contract betwe5
 ! ,/ate & su* entity :i* satisfies !   
requirem5ts ( p>agraph 7#b77;,a77xiii74 
4  7c7 ,effective date ,! am5dm5ts made 
by ?is section %all apply to contracts  

betwe5 ,/ates & manag$ c>e entities1 o!r
 specifi$ entities1 or ph>macy b5efit   
manag]s t h an effective date beg9n+ on 
or aft] ! date t is #ah mon?s aft] !    
date ( enactm5t ( ?is ,act4  7d7        
,implem5tation  7#a7 ,9 g5]al ,not)/&+  
any o!r provision ( law1 ! ,secret>y (  
,heal? & ,human ,s]vices may implem5t ! 
am5dm5ts made by ?is section by program 
in/ruction or o!rwise4  7#b7            
,nonapplication ( adm9i/rative proc$ure 
act ,implem5tation ( ! am5dm5ts made by 
?is section %all be exempt f !          
requirem5ts ( section #eec ( title #e1  
,unit$ ,/ates ,code4  7e7               
,nonapplication ( pap]work r$uction act 
,*apt] #ce ( title #dd1 ,unit$ ,/ates   
,code1 %all n apply to any data         
collection und]tak5 by ! ,secret>y (    
,heal? & ,human ,s]vices "u section     
#aibg7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr-#h7;f771 z am5d$  
by ?is section4  #d4 ,m$icaid improvem5t
 fund ,section #aida7;b77#c77;,a7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   

#acifw-#a7;b77#c77;,a77 is am5d$ by     
/rik+ #j & ins]t+ #fi1jjj1jjj4  ,pass$ !
 ,h\se ( ,repres5tatives ,septemb] #ag1 
#bjbd4;,cl]k4