,,ib ,union ,cal5d> ,no4 #ejh #aah?     
,,congress  #b;d ,session  ,h4 ,r4 #dgeh
 ,report ,no4 #aah-faj ,,9 ,,! ,,h\se   
,,( ,,repres5tatives  ,july #ai1        
#bjbc,mrs4 ,trahan 7= h]self & ,mrs4    
,mill]-,meeks7 introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce  ,july #bc1 #bjbd;,additional 
sponsors3 ,ms4 ,ca/or ( ,florida1 ,mr4  
,fitzpatrick1 ,ms4 ,ku/]1 ,mrs4         
,cammack1 ,mr4 ,tonko1 ,mr4 ,bacon1 ,mr4
 ,van ,drew1 ,ms4 ,blunt ,ro*e/]1 ,ms4  
,ross1 ,ms4 ,wexton1 ,mr4 ,mc,caul1 ,mr4
 ,smuck]1 ,ms4 ,b>ragn1 ,mr4 ,keat+1    
,mr4 ,crd5as1 ,ms4 ,craig1 ,ms4         
,wass]man ,s*ultz1 ,mrs4 ,flet*]1 ,mr4  
,hudson1 ,ms4 ,c>aveo1 ,mr4 ,johnson (  
,ohio1 ,mr4 ,yakym1 ,ms4 ,del,bene1 ,mr4
 ,joyce ( ,p5nsylvania1 ,ms4            
,malliotakis1 ,mr4 ,valadao1 ,ms4       
,p+ree1 ,mrs4 ,*]filus-,mc,cormick1 ,mr4
 ,coh51 ,mr4 ,d',esposito1 ,mr4         
,rupp]sb]g]1 ,mr4 ,banks1 ,mr4 ,wittman1
 ,mr4 ,phillips1 ,mr4 ,cr[1 ,ms4        
,matsui1 ,mr4 ,bilirakis1 ,mr4 ,lieu1   

,mr4 ,cr5%aw1 ,mrs4 ,kim ( ,cali=nia1   
,ms4 ,wild1 ,mr4 ,langwor?y1 ,mr4       
,neguse1 ,mr4 ,meus]1 ,mr4 ,al=d1 ,mr4  
,mol9>o1 ,mr4 ,connolly1 ,ms4 ,norton1  
,mr4 ,co/a1 ,mr4 ,c>t] ( ,georgia1 ,mr4 
,f9/ad1 ,mr4 ,swalwell1 ,mr4 ,davis (   
,nor? ,c>ol9a1 ,mr4 ,burgess1 ,ms4 ,lee 
( ,florida1 ,ms4 ,titus1 ,mr4 ,kelly (  
,p5nsylvania1 ,mr4 ,s*neid]1 ,mrs4      
,sp>tz1 ,mr4 ,soto1 ,ms4 ,s*ri]1 ,mr4   
,c>ey1 ,mr4 ,bald]son1 ,mr4 ,lamborn1   
,mr4 ,jackson ( ,ill9ois1 ,mr4 ,rask91  
,mr4 ,cleav]1 ,mrs4 ,h>%b>g]1 ,mr4      
,trone1 ,mrs4 ,gonzlez-,coln1 ,ms4      
,kelly ( ,ill9ois1 ,mr4 ,dunn (         
,florida1 ,mr4 ,pocan1 ,mr4 ,wilson (   
,s\? ,c>ol9a1 ,mr4 ,baird1 ,ms4         
,scanlon1 ,mr4 ,lawl]1 ,mr4 ,hors=d1    
,mr4 ,luetkemey]1 ,mr4 ,allr$1 ,mr4     
,evans1 ,mr4 ,kean ( ,new ,j]sey1 ,mr4  
,g>b>9o1 ,mr4 ,goldman ( ,new ,york1    
,mr4 ,nunn ( ,i[a1 ,mr4 ,morelle1 ,mr4  
,james1 ,ms4 ,davids ( ,kansas1 ,mr4    
,magaz9]1 ,mr4 ,nadl]1 ,ms4 ,pett]s51   
,ms4 ,sal9as1 ,mr4 ,mull91 ,ms4 ,moore (

 ,wiscons91 ,mr4 ,grijalva1 ,mr4 ,lev91 
,ms4 ,bu%1 ,ms4 ,br[n1 ,ms4 ,/ansbury1  
,mr4 ,huffman1 ,mr4 ,mc,garvey1 ,mr4    
,mrvan1 ,mr4 ,himes1 ,mr4 ,fro/1 ,ms4   
,und]wood1 ,ms4 ,tlaib1 ,mr4 ,ob]nolte1 
,ms4 ,%]rill1 ,mr4 ,?ompson (           
,p5nsylvania1 ,mr4 ,buc%on1 ,mr4        
,nickel1 ,ms4 ,bonamici1 ,mr4 ,kim (    
,new ,j]sey1 ,mr4 ,lyn*1 ,ms4 ,adams1   
,mrs4 ,mill] ( ,we/ ,virg9ia1 ,mr4      
,panetta1 ,mr4 ,mann1 ,ms4 ,h\lahan1    
,mr4 ,pappas1 ,mr4 ,pascrell1 ,mrs4     
,watson ,coleman1 & ,mr4 ,gomez  ,july  
#bc1 #bjbd,report$ ) am5dm5ts1 committ$ 
to ! ,committee ( ! ,:ole ,h\se on !    
,/ate ( ! ,union1 & ord]$ to be         
printed,strike out all aft] ! enact+    
clause & ins]t ! "p pr9t$ 9 italic,for  
text ( introduc$ bill1 see copy ( bill z
 introduc$ on ,july #ai1 #bjbc  ,a      
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to /reaml9e enrollm5t "u
 ! ,m$icaid program ( c]ta9 provid]s    
across ,/ate l9es1 & = o!r purposes4    
#a4 ,%ort title ,?is ,act may be cit$ 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 ,if ! ,/ate does n h a /&>d       
agreem5t ) o!r ,/ates gov]n+ cov]age &  
paym5t = s]vices furni%$ to             
,m$icaid-eligible *ildr5 ) m$ically     
complex conditions t 0 develop$ consi/5t
 ) guidance issu$ by ! ,secret>y "u     
section #aide;,a1 ! ,/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  
=1 items & s]vices = 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$icaid  7a7 ,9 g5]al    
,section #aibg7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acifr-#h7;e77 is  
am5d$ by add+ at ! end ! foll[+3  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$i5t co/2 &  7bb7 a pr(essional       
disp5s+ fee t is n less ?an !           
pr(essional disp5s+ fee t ! ,/ate plan  
or waiv] w\ld pay if ! plan or waiv] 0  
mak+ ! paym5t directly2  7,,ii7 is pass$
 ?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 ( su* s]vices2  7iii7 ! entity or
 ! ,,pbm 7z applicable7 makes available 
to ! ,/ate1 & ! ,secret>y ^u reque/1 all
 co/s & paym5ts relat$ to cov]$         
outpati5t drugs & accompany+            
adm9i/rative s]vices incurr$1 receiv$1  
or made by ! entity or ! ,,pbm1 includ+ 
+r$i5t co/s1 pr(essional disp5s+ fees1  
adm9i/rative fees1 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  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 #d 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;f7 ( ! ,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+ #hh1jjj1jjj4 ,am5d !  
title s z to read3 ,a bill to am5d title
 ,,xix ( ! ,social ,security ,act to    
/reaml9e enrollm5t "u ! ,m$icaid program
 ( c]ta9 provid]s across ,/ate l9es1 &  
to prev5t ! use ( abusive spread pric+ 9
 ,m$icaid44 ,july #bc1 #bjbd,report$ )  
am5dm5ts1 committ$ to ! ,committee ( !  
,:ole ,h\se on ! ,/ate ( ! ,union1 &    
ord]$ to be pr9t$