,i  #aah? ,,congress  #a/ ,session  ,h4 
,r4 #feij  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #e1          
#bjbc,mrs4 ,d+ell 7= h]self & ,mr4      
,mool5a>7 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$  ,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 ,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 to 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 #bjbe4  #c4 ,,pace site     
approval & expansion  7a7 ,9 g5]al      
,sections #ahid7;e7 & #aicd7;e7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;eee7e72 #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] site 7or bo?71 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 #bjbe4  #d4 ,,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 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  #e4   
,coord9ation ) ! ,f$]al ,coord9at$      
,heal? ,c>e ,(fice ,section #aicd ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acifu-#d71 z am5d$ by sections #b & #c1
 is fur!r 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 #bjbe1 & 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  #f4 ,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