,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #ggjh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,m>* #ae1 #bjbd,mr4   
,panetta 7= himself1 ,mr4 ,murphy1 ,ms4 
,ku/]1 ,mr4 ,s*neid]1 & ,mr4            
,fitzpatrick7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = 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 am5d title      
,,xviii ( ! ,social ,security ,act to   
require ,,ma organizations (f]+         
network-bas$ plans to ma9ta9 an accurate
 provid] directory1 & = o!r purposes4   
#a4 ,requir+ enhanc$  accurate li/s (   
7real7 heal? provid]s act  7a7 ,9 g5]al 
,section #aheb7;c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bb7;c77 is 
am5d$-- 7#a7 9 p>agraph 7#a77;,c7-- 7,a7
 by /rik+ plan1 & any & ins]t+ plan1    
any2 &  7,b7 by ins]t+ be=e ! p]iod at !
 end3 1 &1 9 ! case ( a network-bas$    

plan 7z def9$ 9 p>agraph 7#c77;,c771 =  
plan ye> #bjbf & subsequ5t plan ye>s1 ! 
in=mation describ$ 9 p>agraph 7#c77;,b72
 &  7#b7 by add+ at ! end ! foll[+ new  
p>agraph3  7#c7 ,provid] directory      
accuracy  7,a7 ,9 g5]al ,= plan ye>     
#bjbf & subsequ5t plan ye>s1 ea* ,,ma   
organization (f]+ a network-bas$ plan 7z
 def9$ 9 subp>agraph 7,c77 %all1 = ea*  
network-bas$ plan (f]$ by !             
organization-- 7i7 ma9ta91 on a publicly
 available int]net website1 an accurate 
provid] directory t includes ! in=mation
 describ$ 9 subp>agraph 7,b72  7ii7 n   
less frequ5tly ?an once e #ij days 7or1 
9 ! case ( a hospital or any o!r        
facility det]m9$ appropriate by !       
,secret>y1 at a less] frequ5cy specifi$ 
by ! ,secret>y b 9 no case less         
frequ5tly ?an once e #ab mon?s71 v]ify !
 provid] directory in=mation ( ea*      
provid] li/$ 9 su* directory &1 if      
applicable1 update su* provid] directory
 in=mation2  7iii7 if ! organization is 
unable to v]ify su* in=mation ) respect 

to a provid]1 include 9 su* directory an
 indication t ! in=mation ( su* provid] 
may n be up to date2  7iv7 remove a     
provid] f su* directory )9 #e bus9ess   
days if ! organization det]m9es t !     
provid] is no long] a provid] p>ticipat+
 9 ! network ( su* plan2 &  7v7 meet su*
 o!r requirem5ts z ! ,secret>y may      
specify4  7,b7 ,provid] directory       
in=mation ,! in=mation describ$ 9 ?is   
subp>agraph is in=mation enrollees may  
ne$ to access cov]$ b5efits f a provid] 
) :i* su* organization (f]+ su* plan has
 an agreem5t = furni%+ items & s]vices  
cov]$ "u su* plan su* z "n1 specialty1  
contact in=mation1 prim>y (fice or      
facility address1 :e!r ! provid] is     
accept+ new pati5ts1 accommodations = p 
) disabilities1 cultural & l+ui/ic      
capabilities1 & teleheal? capabilities4 
7,c7 ,network-bas$ plan ,9 ?is p>agraph1
 ! t]m network-bas$ plan has ! mean+    
giv5 t t]m 9 subsection 7d77#e77;,c71   
except su* t]m includes a ,m$ic>e       
,advantage private fee-=-s]vice plan1 z 

det]m9$ appropriate by ! ,secret>y4  4  
7b7 ,acc\ntability = provid] directory  
accuracy  7#a7 ,co/ %>+ = s]vices       
furni%$ bas$ on reliance on incorrect   
provid] directory in=mation ,section    
#aheb7;d7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #aciew-#bb7;d77 is       
am5d$-- 7,a7 9 p>agraph 7#a77;,c7-- 7i7 
9 clause 7ii71 by /rik+ or at ! end2    
7ii7 9 clause 7iii71 by /rik+ !         
semicolon at ! end & ins]t+ 1 or2 &     
7iii7 by add+ at ! end ! foll[+ new     
clause3  7iv7 ! s]vices are furni%$ by a
 provid] t is n p>ticipat+ 9 ! network (
 a network-bas$ plan 7z def9$ 9         
subsection 7c77#c77;,c77 b is li/$ 9 !  
provid] directory ( su* plan on ! date  
on :i* ! appo9tm5t is made1 z describ$ 9
 p>agraph 7#g77;,a72  2 &  7,b7 by add+ 
at ! end ! foll[+ new p>agraph3  7#g7   
,co/ %>+ = s]vices furni%$ bas$ on      
reliance on incorrect provid] directory 
in=mation  7,a7 ,9 g5]al ,= plan ye>    
#bjbf & subsequ5t plan ye>s1 if an      
enrollee is furni%$ an item or s]vice by

 a provid] t is n p>ticipat+ 9 ! network
 ( a network-bas$ plan 7z def9$ 9       
subsection 7c77#c77;,c77 b is li/$ 9 !  
provid] directory ( su* plan 7z requir$ 
to be provid$ to an enrollee pursuant to
 subsection 7c77#a77;,c77 on ! date on  
:i* ! appo9tm5t is made1 & if su* item  
or s]vice w\ld o!rwise be cov]$ "u su*  
plan if furni%$ by a provid] t is       
p>ticipat+ 9 ! network ( su* plan1 !    
,,ma organization (f]+ su* plan %all    
ensure t ! enrollee is only responsible 
= ! am\nt ( co/ %>+ t w\ld apply if su* 
provid] _h be5 p>ticipat+ 9 ! network ( 
su* plan4  7,b7 ,notification requirem5t
 ,= plan ye> #bjbf & subsequ5t plan     
ye>s1 ea* ,,ma organization t (f]s a    
network-bas$ plan %all-- 7i7 notify     
enrollees ( _! co/-%>+ protections "u   
?is p>agraph & make su* notifications1  
to ! ext5t practicable1 by n lat] ?an ! 
fir/ day ( an annual1 coord9at$ election
 p]iod "u section #ahea7;e77#c7 )       
respect to a ye>2  7ii7 include         
in=mation reg>d+ su* co/-%>+ protections

 9 ! provid] directory ( ea*            
network-bas$ plan (f]$ by ! ,,ma        
organization42 &  7iii7 notify enrollees
 ( _! co/-%>+ protections "u ?is        
p>agraph 9 an explanation ( b5efits4  4 
7#b7 ,requir$ provid] directory accuracy
 analysis & reports  7,a7 ,9 g5]al      
,section #aheg7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is 
am5d$ by add+ at ! end ! foll[+ new     
p>agraph3  7#f7 ,provid] directory      
accuracy analysis & reports  7,a7 ,9    
g5]al ,beg9n+ ) plan ye>s beg9n+ on or  
aft] ,janu>y #a1 #bjbf1 subject to      
subp>agraph 7,c71 a contract "u ?is     
section ) an ,,ma organization %all     
require ! organization1 = ea*           
network-bas$ plan 7z def9$ 9 section    
#aheb7;c77#c77;,c77 (f]$ by !           
organization1 to annually-- 7i7 conduct 
an analysis e/imat+ ! accuracy ( !      
provid] directory ( su* plan us+ a      
sample ( provid]s includ$ 9 su* provid] 
directory 7includ+ provid] specialties )
 high inaccuracy rates ( provid]        

directory in=mation1 su* z provid]s     
specializ+ 9 m5tal heal? or sub/ance use
 disord] treatm5t1 z det]m9$ by !       
,secret>y72 &  7ii7 submit a report to !
 ,secret>y conta9+ ! results ( su*      
analysis1 includ+ an accuracy score =   
su* provid] directory 7z det]m9$ us+ a  
me?odology specifi$ by ! ,secret>y "u   
subp>agraph 7,b77i771 & o!r in=mation   
requir$ by ! ,secret>y4  7,b7           
,det]m9ation ( accuracy score  7i7 ,9   
g5]al ,! ,secret>y %all specify         
me?odologies = ,,ma plans to use 9      
e/imat+ ! accuracy ( ! provid] directory
 in=mation ( su* plans & det]m9+ !      
accuracy score = ! plan's provid]       
directory4  7ii7 ,consid]ations ,9 c>ry+
 out clause 7i71 ! ,secret>y %all take  
into consid]ation-- 7,i7 data s\rces    
ma9ta9$ by ,,ma organizations2  7,,ii7  
publicly available data sets2  7,,iii7 !
 adm9i/rative burd5 on plans & provid]s2
 &  7,,iv7 ! relative importance ( c]ta9
 provid] directory in=mation on enrollee
 ability to access c>e4  7,c7 ,exception

 ,! ,secret>y may waive ! requirem5ts ( 
?is p>agraph 9 ! case ( a network-bas$  
plan ) l[ enrollm5t 7z def9$ by !       
,secret>y74  7,d7 ,transp>5cy ,beg9n+ ) 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbg1 ! ,secret>y %all po/ accuracy    
scores 7z report$ "u subp>agraph        
7,a77ii771 9 a ma*9e readable file1 on !
 int]net website ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices4  7,e7 ,implem5tation 
,! ,secret>y %all implem5t ?is p>agraph 
?r\gh notice & comm5t rulemak+4  4  7,b7
 ,provision ( in=mation to b5efici>ies  
,section #ahea7;d77#d7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#ba7;d77#d77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7   
,provid] directory ,beg9n+ ) plan ye>s  
beg9n+ on or aft] ,janu>y #a1 #bjbg1 !  
accuracy score ( ! plan's provid]       
directory 7z report$ "u section         
#aheg7;e77#f77;,a77ii77 on ! plan's     
provid] directory4  4  7,c7 ,fund+ ,9   
addition to am\nts o!rwise available1   
!re is appropriat$ to ! ,c5t]s = ,m$ic>e

  ,m$icaid ,s]vices ,program ,managem5t 
,acc\nt1 out ( any money 9 ! ,treasury n
 o!rwise appropriat$1 #a1jjj1jjj =      
fiscal ye> #bjbe1 to rema9 available    
until exp5d$1 to c>ry out ! am5dm5ts    
made by ?is p>agraph4  7#c7 ,,gao /udy &
 report  7,a7 ,analysis ,! ,comptroll]  
,g5]al ( ! ,unit$ ,/ates 79 ?is p>agraph
 ref]r$ to z ! ,comptroll] ,g5]al7 %all 
conduct /udy ( ! implem5tation ( !      
am5dm5ts made by p>agraphs 7#a7 & 7#b74 
,to ! ext5t data are available &        
reliable1 su* /udy %all include an      
analysis (-- 7i7 ! use ( protections    
requir$ "u section #aheb7;d77#g7 ( !    
,social ,security ,act1 z add$ by       
p>agraph 7#a72  7ii7 ! provid] directory
 accuracy scores tr5ds "u section       
#aheg7;e77#f77;,a77ii7 ( ! ,social      
,security ,act 7z add$ by p>agraph      
7#b77;,a771 bo? ov]all & among provid]s 
specializ+ 9 m5tal heal? or sub/ance    
disord] treatm5t2  7iii7 provid]        
response rates by plan v]ification      
me?ods2 &  7iv7 o!r items det]m9$       

appropriate by ! ,comptroll] ,g5]al4    
7,b7 ,report ,n lat] ?an ,janu>y #ae1   
#bjca1 ! ,comptroll] ,g5]al %all submit 
to ,congress a report conta9+ ! results 
( ! /udy conduct$ "u subp>agraph 7,a71  
toge!r ) recomm5dations = su*           
legislation & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4
  7c7 ,guidance on ma9ta9+ accurate     
provid] directories  7#a7 ,/akehold]    
meet+  7,a7 ,9 g5]al ,n lat] ?an #c     
mon?s aft] ! date ( enactm5t ( ?is ,act1
 ! ,secret>y ( ,heal? & ,human ,s]vices 
7ref]r$ to 9 ?is subsection z !         
,secret>y7 %all hold a public /akehold] 
meet+ to receive input on approa*es =   
ma9ta9+ accurate provid] directories =  
,m$ic>e ,advantage plans "u "p ,c (     
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#ba et seq471    
includ+ input on approa*es = r$uc+      
adm9i/rative burd5 su* z data           
/&>dization & be/ practices to ma9ta9   
provid] directory in=mation4  7,b7      
,p>ticipants ,p>ticipants ( ! meet+ "u  

subp>agraph 7,a7 %all include           
repres5tatives f ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices & ! ,(fice ( !        
,national ,coord9ator = ,heal?          
,in=mation ,te*nology1 heal? c>e        
provid]s1 companies t specialize 9      
relevant te*nologies1 heal? insur]s1 &  
pati5t advocates4  7#b7 ,guidance to    
m$ic>e advantage organizations ,n lat]  
?an #ab mon?s aft] ! date ( enactm5t (  
?is ,act1 ! ,secret>y %all issue        
guidance to ,m$ic>e ,advantage          
organizations (f]+ ,m$ic>e ,advantage   
plans "u "p ,c ( title ,,xviii ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba et seq47 on ma9ta9+ accurate 
provid] directories = su* plans1 tak+   
into consid]ation input receiv$ dur+ !  
/akehold] meet+ "u p>agraph 7#a74 ,su*  
guidance may include ! foll[+1 z det]m9$
 appropriate by ! ,secret>y3 7,a7 ,be/  
practices = ,m$ic>e ,advantage          
organizations on h[ to "w ) provid]s to 
ma9ta9 ! accuracy ( provid] directories 
& r$uce provid] & ,m$ic>e ,advantage    

organization burd5 ) respect to ma9ta9+ 
! accuracy ( provid] directories4  7,b7 
,in=mation on data sets & data s\rces ) 
in=mation t c\ld be us$ by ,m$ic>e      
,advantage organizations to ma9ta9      
accurate provid] directories4  7,c7     
,approa*es = utiliz+ data s\rces ma9ta9$
 by ,m$ic>e ,advantage organizations &  
publicly available data sets to ma9ta9  
accurate provid] directories4  7,d7     
,in=mation to be includ$ 9 ! provid]    
directory t may be useful = ,m$ic>e     
b5efici>ies to assess plan networks :5  
select+ a plan & access+ provid]s       
p>ticipat+ 9 plan networks dur+ ! plan  
ye>4  7#c7 ,guidance to "p b provid]s ,n
 lat] ?an #ab mon?s aft] ! date (       
enactm5t ( ?is ,act1 ! ,secret>y %all   
issue guidance to provid]s ( s]vices &  
suppli]s :o furni% items or s]vices =   
:i* b5efits are available "u "p ,b (    
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;j et seq47 on :5  
to update ! ,national ,plan & ,provid]  
,enum]ation ,sy/em reg>d+ any in=mation 

*anges4