,,ii #aah? ,,congress #b;d ,session ,s4 #efcc ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,decemb] #ai 7legislative day1 ,decemb] #af71 #bjbd,mr4 ,scott ( ,florida introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to e/abli% ,m$ic>e flex fund acc\nts & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,flex ,fund ,acc\nts & ,flexible ,b5efits ,act ( #bjbd4 #b4 ,m$ic>e flex fund acc\nts 7a7 ,9 g5]al ,"p ,,viii ( sub*apt] ,f ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new section3 #ecj;,a4 ,m$ic>e flex fund acc\nts 7a7 ,9 g5]al ,a ,m$ic>e flex fund acc\nt %all be exempt f taxation "u ?is subtitle4 ,not)/&+ ! prec$+ s5t5ce1 ! ,m$ic>e flex fund acc\nt %all be subject to ! taxes impos$ by section #eaa 7relat+ to imposition ( tax on unrelat$ bus9ess income ( *>itable organizations74 7b7 ,m$ic>e flex fund acc\nt ,= purposes ( ?is section3 7#a7 ,9 g5]al ,! t]m ,m$ic>e flex fund acc\nt means a tru/ creat$ or organiz$ 9 ! ,unit$ ,/ates z a ,m$ic>e flex fund acc\nt exclusively = ! purpose ( pay+ ! qualifi$ m$ical exp5ses ( ! acc\nt b5efici>y1 b only if ! writt5 gov]n+ in/rum5t creat+ ! tru/ meets ! foll[+ requirem5ts3 7,a7 ,except 9 ! case ( a rollov] contribution describ$ 9 subsection 7c77#b71 section #bbj7;f77#e71 or section #bbc7;f77#e7 or a contribution describ$ 9 section #ach;,a7#a71 no contribution w be accept$-- 7i7 unless x is 9 ca%1 7ii7 unless ! acc\nt b5efici>y is an eligible individual = ! taxable ye> 9 :i* ! contribution is made1 & 7iii7 to ! ext5t su* contribution1 :5 add$ to previ\s contributions to ! tru/ = ! cal5d> ye>1 exce$s ! sum (-- 7,i7 ! doll> am\nt 9 effect "u section #bbc7;b77#b77;,a71 plus 7,,ii7 9 ! case ( an individual :o has atta9$ age #ee be=e ! close ( ! cal5d> ye>1 ! doll> am\nt 9 effect "u section #bbc7;b77#c77;,b74 7,b7 ,! tru/ee is a bank 7z def9$ 9 section #djh7n771 an insurance company 7z def9$ 9 section #haf71 or ano!r p]son :o demon/rates to ! satisfaction ( ! ,secret>y t ! mann] 9 :i* su* p]son w adm9i/] ! tru/ w be consi/5t ) ! requirem5ts ( ?is section4 7,c7 ,no "p ( ! tru/ assets w be inve/$ 9 life insurance contracts4 7,d7 ,! assets ( ! tru/ w n be comm+l$ ) o!r prop]ty except 9 a common tru/ fund or common inve/m5t fund4 7,e7 ,! int]e/ ( an individual 9 ! balance 9 8 acc\nt is non=feitable4 7#b7 ,qualifi$ m$ical exp5ses 7,a7 ,9 g5]al ,except z o!rwise provid$ 9 ?is p>agraph1 ! t]m qualifi$ m$ical exp5ses %all h ! mean+ giv5 su* t]m "u section #bbc7;d77#b7 7det]m9$ )\t reg>d to subp>agraph 7,b7 !re(74 7,b7 ,exception = ,m$igap premiums ,su* t]m %all n include any premium = a m$ic>e supplem5tal policy "u section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess74 7#c7 ,eligible individual ,! t]m eligible individual means1 ) respect to any taxable ye>1 any individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a ( title ,,xviii ( ! ,social ,security ,act or enroll$ = b5efits "u "p ,b or ,d ( su* title1 includ+ individuals cov]$ "u a ,m$ic>e ,advantage plan1 on ! la/ day ( su* taxable ye>4 7#d7 ,c]ta9 rules to apply ,rules simil> to ! foll[+ rules %all apply = purposes ( ?is section3 7,a7 ,section #bai7;f77#c7 7relat+ to "t :5 contributions made74 7,b7 ,section #djh7;g7 7relat+ to community prop]ty laws74 7,c7 ,section #djh7;h7 7relat+ to cu/odial acc\nts74 7,d7 ,p>agraphs 7#b7 & 7#d7 ( section #djh7;e74 7c7 ,tax treatm5t ( di/ributions 7#a7 ,9 g5]al ,any am\nt di/ribut$ out ( a ,m$ic>e flex fund acc\nt %all be subject to tax 9 ! same ext5t & 9 ! same mann] z di/ributions f a heal? sav+s acc\nt "u section #bbc7;f71 except t-- 7,a7 am\nts describ$ 9 p>agraph 7#b7 !re( %all be includible 9 gross income 9 ! mann] provid$ "u section #gb 7aft] tak+ into acc\nt rules simil> to ! rules ( section #djh7;d77#b771 7,b7 = purposes ( p>agraph 7#c77;,b7 !re( a rollov] contribution describ$ 9 p>agraph 7#b7 %all n be consid]$ an excess contribution1 & 7,c7 p>agraph 7#d7 !re( %all n apply4 7#b7 ,rollov] contribution ,an am\nt is describ$ 9 ?is p>agraph z a rollov] contribution if x meets ! requirem5ts ( subp>agraphs 7,a7 & 7,b74 7,a7 ,9 g5]al ,an am\nt di/ribut$ f a ,m$ic>e flex fund acc\nt %all n be includible 9 gross income if su* am\nt is paid or di/ribut$ f a ,m$ic>e flex fund acc\nt to ! acc\nt b5efici>y to ! ext5t ! am\nt receiv$ is paid into a ,m$ic>e flex fund acc\nt = ! b5efit ( su* b5efici>y n lat] ?an ! #fj? day aft] ! day on :i* ! b5efici>y receives ! paym5t or di/ribution4 7,b7 ,limitation ,?is p>agraph %all n apply to any am\nt describ$ 9 subp>agraph 7,a7 receiv$ by an individual f a ,m$ic>e flex fund acc\nt if1 at any "t dur+ ! #a-ye> p]iod end+ on ! day ( su* receipt1 su* individual receiv$ any o!r am\nt describ$ 9 subp>agraph 7,a7 f a ,m$ic>e flex fund acc\nt :i* 0 n includible 9 ! individual's gross income because ( ! application ( ?is p>agraph4 7d7 ,reports ,! ,secret>y may require ! tru/ee ( a ,m$ic>e flex fund acc\nt to make su* reports reg>d+ su* acc\nt to ! ,secret>y & to ! acc\nt b5efici>y ) respect to contributions1 di/ributions1 ! return ( excess contributions1 & su* o!r matt]s z ! ,secret>y det]m9es appropriate4 ,! reports requir$ by ?is subsection %all be fil$ at su* "t & 9 su* mann] & furni%$ to su* individuals at su* "t & 9 su* mann] z may be requir$ by ! ,secret>y4 4 7b7 ,gov]nm5t contributions ,"p ,,iii ( sub*apt] ,b ( *apt] #a ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] section #ach ! foll[+ new section3 #ach;,a4 ,c]ta9 contributions to ,m$ic>e flex fund acc\nts ,gross income %all n include any paym5t to ! ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7 ( an individual by-- 7#a7 ! ,secret>y ( ,heal? & ,human ,s]vices1 or 7#b7 ! adm9i/rator ( a ,m$ic>e ,advantage plan4 4 7c7 ,contributions f o!r sav+s vehicles 7#a7 ,heal? sav+s acc\nts ,section #bbc7;f77#e7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ or a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7 aft] paid into a heal? sav+s acc\nt4 7#b7 ,ar*] ,m,s,as ,section #bbj7;f77#e7 ( su* ,code is am5d$ by /rik+ or a heal? sav+s acc\nt 7z def9$ 9 section #bbc7;d77 & ins]t+ 1 a heal? sav+s acc\nt 7z def9$ 9 section #bbc7;d771 or a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a74 7#c7 ,,ira di/ributions ,section #djh7;d7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#aj7 ,di/ribution = ,m$ic>e flex fund acc\nt fund+ 7,a7 ,9 g5]al ,9 ! case ( an individual :o is an eligible individual 7z def9$ 9 section #ecj;,a7b77#c77 & :o elects ! application ( ?is p>agraph = a taxable ye>1 gross income ( ! individual = ! taxable ye> does n include a qualifi$ ,m$ic>e ,,ffa fund+ di/ribution to ! ext5t su* di/ribution is o!rwise includible 9 gross income4 7,b7 ,qualifi$ ,m$ic>e ,,ffa fund+ di/ribution ,= purposes ( ?is p>agraph1 ! t]m qualifi$ ,m$ic>e ,,ffa fund+ di/ribution means a di/ribution f an individual retirem5t plan 7o!r ?an a plan describ$ 9 subsection 7k7 or 7p77 ( ! employee to ! ext5t t su* di/ribution is contribut$ to ! ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7 ( ! individual 9 a direct tru/ee-to-tru/ee transf]4 7,c7 ,limitation 7i7 ,9 g5]al ,! am\nt exclud$ f gross income by subp>agraph 7,a7 %all n exce$ ! annual limitation "u section #ecj;,a7b77#a77;,a77iii74 7ii7 ,"o-"t transf] ,an individual may make an election "u subp>agraph 7,a7 only = "o qualifi$ ,m$ic>e ,,ffa fund+ di/ribution dur+ ! lifetime ( ! individual4 ,su* an election1 once made1 %all be irrevocable4 7,d7 ,application ( section #gb ,rules simil> to ! rules ( p>agraph 7#i77;,e7 %all apply = purposes ( ?is p>agraph4 4 7d7 ,excess contributions 7#a7 ,9 g5]al ,section #digc7;a7 ( su* ,code is am5d$ by /rik+ or at ! end ( p>agraph 7#e71 by ins]t+ or at ! end ( p>agraph 7#f71 & by ins]t+ aft] p>agraph 7#f7 ! foll[+ new p>agraph3 7#g7 a ,m$ic>e flex fund acc\nt 7)9 ! mean+ ( section #ecj;,a71 4 7#b7 ,excess contributions ,section #digc ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,excess contributions to ,m$ic>e flex fund acc\nts 7#a7 ,9 g5]al ,9 ! case ( a ,m$ic>e flex fund acc\nt1 ! t]m excess contributions means ! sum (-- 7,a7 ! am\nt by :i* ! am\nt contribut$ = ! taxable ye> to su* acc\nts exce$s ! contribution limitation det]m9$ "u section #ecj;,a7b77#a77;,a77iii71 & 7,b7 ! am\nt det]m9$ "u ?is subsection = ! prec$+ taxable ye>1 r$uc$ by ! sum (-- 7i7 ! di/ributions out ( ! acc\nts = ! taxable ye> :i* 7 n us$ exclusively to pay ! qualifi$ m$ical exp5ses 7z det]m9$ "u section #bbc7;f77#b77 ( ! acc\nt b5efici>y1 7ii7 ! excess (-- 7,i7 ! di/ributions out ( ! acc\nts = su* taxable ye> :i* 7 us$ exclusively to pay ! qualifi$ m$ical exp5ses 7z det]m9$ "u section #bbc7;f77#a77 ( ! acc\nt b5efici>y1 ov] 7,,ii7 ! am\nt :i* w\ld be taxable by reason ( section #ecj;,a7c77#a77;,a7 if su* am\nts 7 describ$ 9 section #bbc7;f77#b7 ) respect to su* di/ributions1 & 7iii7 ! excess 7if any7 ( ! maximum am\nt :i* may be contribut$ to ! acc\nts = ! taxable ye> ov] ! am\nt contribut$ to ! acc\nts = ! taxable ye>4 7#b7 ,special rules ,= purposes ( p>agraph 7#a71 ! foll[+ contributions %all n be tak5 into acc\nt3 7,a7 ,any contribution :i* is di/ribut$ out ( ! ,m$ic>e flex fund acc\nt 9 a di/ribution if-- 7i7 su* di/ribution is receiv$ by ! individual on or be=e ! la/ day prescrib$ by law 7includ+ ext5sions ( "t7 = fil+ su* individual's return = su* taxable ye>1 & 7ii7 su* di/ribution is accompani$ by ! am\nt ( net income attributable to su* excess contribution4 7,b7 ,any rollov] contribution describ$ 9 section #bbj7;f77#e71 #bbc7;f77#e71 or #ecj;,a7c77#b74 4 7e7 ,application ( prohibit$ transaction rules 7#a7 ,9 g5]al ,section #dige7;e77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ or at ! end ( subp>agraph 7,f71 by r$esignat+ subp>agraph 7,g7 z subp>agraph 7,h71 & by ins]t+ aft] subp>agraph 7,f7 ! foll[+ new subp>agraph3 7,g7 a ,m$ic>e flex fund acc\nt describ$ 9 section #ecj;,a1 or 4 7#b7 ,special rule ,section #dige7;c7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,special rule = ,m$ic>e flex fund acc\nts ,an individual = ^: b5efit a ,m$ic>e flex fund acc\nt 7)9 ! mean+ ( section #ecj;,a7 is e/abli%$ %all be exempt f ! tax impos$ by ?is section ) respect to any transaction conc]n+ su* acc\nt 7:i* w\ld o!rwise be taxable "u ?is section7 if1 ) respect to su* transaction1 ! acc\nt ceases to be a ,m$ic>e flex fund acc\nt by reason ( ! application ( section #ecj;,a7b77#d77;,d7 to su* acc\nt4 4 7f7 ,o!r con=m+ am5dm5ts 7#a7 ,section #ce7;g77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ or f a heal? sav+s acc\nt 7z def9$ 9 section #bbc7;d77 & ins]t+ 1 f a heal? sav+s acc\nt 7z def9$ 9 section #bbc7;d771 or f a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7b774 7#b7 ,section #hdh7;e77#a77;,b7 ( su* ,code is am5d$ by /rik+ & at ! end ( clause 7iv71 by /rik+ ! p]iod at ! end ( clause 7v7 & ins]t+ 1 &1 & by add+ at ! end ! foll[+ new clause3 7vi7 any contract :i* is a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7b774 4 7#c7 ,section #hgg;,a7e77#b7 ( su* ,code is am5d$ by ins]t+ a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a7b771 aft] a heal? sav+s acc\nt 7z def9$ 9 section #bbc74 7#d7 ,section #ffic7;a77#b7 ( su* ,code is am5d$ by /rik+ & at ! end ( subp>agraph 7,e71 by /rik+ ! p]iod at ! end ( subp>agraph 7,f7 & ins]t+ 1 &1 & by ins]t+ aft] subp>agraph 7,g7 ! foll[+ new subp>agraph3 7,g7 section #ecj;,a7d7 7relat+ to ,m$ic>e flex fund acc\nts74 4 7#e7 ,section #ajbg7;g77#d7 ( ! ,consum] ,f9ancial ,protection ,act ( #bjaj 7#ab ,u4,s4,c4 #eeag7;g77#d77 is am5d$ by /rik+ or #ecj & ins]t+ #ecj1 or #ecj;,a4 7g7 ,cl]ical am5dm5ts 7#a7 ,! table ( sections = "p ,,viii ( sub*apt] ,f ( *apt] #a ( su* ,code is am5d$ by add+ at ! end ! foll[+ new item3 ,sec4 #ecj;,a4 ,m$ic>e flex fund acc\nts4 4 7#b7 ,! table ( sections = "p ,,iii ( sub*apt] ,b ( *apt] #a ( su* ,code is am5d$ by ins]t+ aft] ! item relat+ to section #ach ! foll[+ new item3 ,sec4 #ach;,a4 ,c]ta9 contributions to ,m$ic>e flex fund acc\nts4 4 7h7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 #c4 ,m$ic>e flex fund acc\nts "u ,m$ic>e ,advantage 7a7 ,requirem5t = ,m$ic>e flex fund acc\nts 7#a7 ,,ma plan requirem5t to e/abli% ,m$ic>e flex fund acc\nt on behalf ( an enrollee ,section #ahea ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7k7 ,,ma plan requirem5t to e/abli% ,m$ic>e ,,ffa on behalf ( an enrollee 7#a7 ,9 g5]al ,not)/&+ any o!r provision ( law & subject to p>agraph 7#d71 any ,,ma plan (f]$ "u ?is "p 7o!r ?an an ,,msa plan7 %all e/abli% a ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf & ref]r$ to 9 ?is subsection z a ,m$ic>e ,,ffa7 on behalf ( an enrollee 9 ! plan4 7#b7 ,rebates ,9 ! case ( a plan t is requir$ to provide a mon?ly rebate to an enrollee "u section #ahed7;b77#a77;,c71 ! ,,ma plan may provide "p or all ( su* rebate ?r\gh deposit+ money into ! enrollee's ,m$ic>e ,,ffa4 7#c7 ,inc5tive paym5ts 7,a7 ,9 g5]al ,not)/&+ section #ahea7;h77#d77;,a7 or any o!r provision ( ?is "p & subject to subp>agraph 7,b71 ,,ma plans may deposit money into an enrollee's ,m$ic>e ,,ffa z a result ( ! enrollee complet+ educational or tra9+ programs1 programs = *ronic disease managem5t1 programs t promote wellness & heal?1 or o!r programs z det]m9$ by ! ,secret>y4 7,b7 ,rules ,9 mak+ ! deposits describ$ 9 subp>agraph 7,a71 ! foll[+ rules %all apply3 7i7 ,no paym5t %all be made to an ,,ma organization "u ?is "p z a result ( su* deposits4 7ii7 ,9 submitt+ bid in=mation requir$ "u section #ahed1 ! ,,ma organization (f]+ ! ,,ma plan %all n take into acc\nt su* deposits4 7iii7 ,! ,,ma plan may n *>ge a premium or o!rwise increase a premium "u section #ahed z a result ( su* deposits4 7#d7 ,initial paym5t floor 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 = ! fir/ #c ye>s a ,m$ic>e ,,ffa is e/abli%$ pursuant to p>agraph 7#a7 ) respect to an enrollee1 ea* ,,ma plan %all deposit no less ?an #djj ea* ye> into ! enrollee's ,m$ic>e ,,ffa4 7,b7 ,rebates & inc5tive paym5ts ,! rebates describ$ 9 p>agraph 7#b7 & inc5tive paym5ts describ$ 9 p>agraph 7#c7 %all c\nt t[>ds ! requir$ m9imum deposit am\nt describ$ 9 subp>agraph 7,a74 7#e7 ,prohibition on sp5d+ ,m$ic>e ,f,f,as on ,m$igap premiums ,an enrollee may n sp5d any am\nt 9 a ,m$ic>e ,,ffa on a premium = a m$ic>e supplem5tal policy "u section #ahhb4 7#f7 ,waiv] ( ,m$ic>e ,,ffa requirem5t = c]ta9 plans 7,a7 ,9 g5]al ,! ,secret>y may waive ! requirem5t describ$ 9 p>agraph 7#a7 =-- 7i7 a specializ$ ,,ma plan = special ne$s individuals2 7ii7 an employ] sponsor$ ,,ma plan describ$ 9 section #aheg7;i77#b72 & 7iii7 an ,,ma plan 9 :i* an enrollee 9 su* plan already has a ,m$ic>e ,,ffa if ! /udy requir$ by section #c7;b7 ( ! ,m$ic>e ,flex ,fund ,acc\nts & ,flexible ,b5efits ,act ( #bjbd concludes t x is feasible to p]mit ,m$ic>e b5efici>ies enroll$ 9 an ,,ma plan to select _! pref]r$ ,m$ic>e ,,ffa b& "u ! plan4 7,b7 ,enrollee *oice ,not)/&+ subp>agraph 7,a71 an ,,ma plan describ$ 9 su* subp>agraph %all e/abli% a ,m$ic>e ,,ffa if an enrollee 9 su* plan elects to h a ,m$ic>e ,,ffa e/abli%$ on behalf ( ! enrollee4 7#g7 ,education ,! ,secret>y %all include in=mation reg>d+ ,m$ic>e ,f,f,as 9 relevant education mat]ials1 includ+-- 7,a7 ! notice requir$ "u section #ahjd7;a7 7commonly ref]r$ to z ! ,m$ic>e ,y h&book72 7,b7 any site-(-s]vice transp>5cy in=mation made available to ! public "u section #ahcd7t72 7,c7 any in=mation provid$ to individuals reg>d+ cov]age options "u section #ahea7;d72 & 7,d7 9 consultation ) ! ,secret>y ( ! ,treasury1 additional g5]al b5efici>y educational mat]ial reg>d+ ?is title & ?is "p4 4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all apply to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 7b7 ,,hhs /udy & report on b5efici>ies *oos+ _! pref]r$ bank = ,m$ic>e ,f,f,as 7#a7 ,/udy ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y7 %all conduct a /udy on ! feasibility ( p]mitt+ ,m$ic>e b5efici>ies enroll$ 9 a ,m$ic>e ,advantage plan "u "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 to select _! pref]r$ ,m$ic>e flex fund acc\nt 7z describ$ 9 section #ahea7k7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#ba7k777 bank "u ! plan4 ,su* /udy %all include an analysis ( any adm9i/rative actions t ! ,secret>y may take 9 ord] to p]mit su* b5efici>ies to make su* selection4 7#b7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u p>agraph 7#a71 toge!r )-- 7,a7 a description ( any adm9i/rative actions describ$ 9 p>agraph 7#a7 t ! ,secret>y has tak51 or plans to take2 & 7,b7 recomm5dations = su* legislation z ! ,secret>y det]m9es appropriate4 7c7 ,,hhs /udy & report on b5efici>ies *oos+ _! pref]r$ supplem5tal heal? b5efits 7#a7 ,/udy ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is subsection ref]r$ to z ! ,secret>y71 %all conduct a /udy on ! feasibility ( p]mitt+ ,m$ic>e b5efici>ies enroll$ 9 a ,m$ic>e ,advantage plan "u "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 to select _! pref]r$ supplem5tal heal? b5efits "u su* plan & h ! sav+s f unus$ b5efits deposit$ into ! ,m$ic>e flex fund acc\nt 7z describ$ 9 section #ahea7k7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#ba7k777 ( ! enrollee4 ,su* /udy %all include an analysis ( any adm9i/rative actions t ! ,secret>y may take 9 ord] to p]mit su* b5efici>ies to make su* selection4 7#b7 ,consultation ,9 c>ry+ out ! /udy "u p>agraph 7#a71 ! ,secret>y %all conduct public meet+s & consult ) ,m$ic>e ,advantage plans1 actu>ies1 & heal? ?9k tanks4 7#c7 ,report ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all submit to ,congress a report on ! /udy conduct$ "u p>agraph 7#a71 toge!r )-- 7,a7 a description ( any adm9i/rative actions describ$ 9 p>agraph 7#a7 t ! ,secret>y has tak51 or plans to take2 & 7,b7 recomm5dations = su* legislation z ! ,secret>y det]m9es appropriate4 #d4 ,m$ic>e flex fund ,acc\nts "u o!r ,m$ic>e programs 7a7 ,,cmi model ,section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is am5d$ by add+ at ! end ! foll[+ new clause3 7xxviii7 ,p]mitt+ individuals p>ticipat+ 9 a model conduct$ "u ?is section to h a ,m$ic>e flex fund acc\nt creat$ by section #ecj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf4 4 7b7 ,inc5tive programs ,! ,secret>y ( ,heal? & ,human ,s]vices may include a ,m$ic>e flex fund acc\nt creat$ by section #ecj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf z a compon5t 9 any ,m$ic>e %>$ sav+s program or o!r ,m$ic>e inc5tive bas$ program e/abli%$ aft] ! date ( enactm5t ( ?is section4 #e4 ,site ( s]vice price transp>5cy update 7a7 ,price transp>5cy website update ,section #ahcd7t77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7t77#a77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,b71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7#c7 by add+ at ! end ! foll[+3 7,c7 ! hospital outpati5t dep>tm5ts & ambulatory surgical c5t]s ne>e/ to a specific zip code ent]$ on ! website2 7,d7 :e!r paym5ts = items & s]vices furni%$ w be made "u ! paym5t sy/em "u section #ahcc7t7 or "u section #ahcc7;i72 & 7,e7 if available1 ! quality rat+ ( ea* hospital outpati5t dep>tm5t & surgical c5t]4 4 7b7 ,price transp>5cy website advisory gr\p 7#a7 ,e/abli%m5t ,n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7ref]r$ to 9 ?is subsection z ! ,adm9i/rator7 %all e/abli% a ,m$ic>e ,price ,transp>5cy ,website ,advisory ,gr\p 7ref]r$ to 9 ! subsection z ! ,advisory ,gr\p74 7#b7 ,memb]s ,! ,advisory ,gr\p %all be compos$ ( ! foll[+ individuals or ! designees ( ^? individuals3 7,a7 ,! ,adm9i/rator4 7,b7 ,! ,*air ( ! ,m$ic>e ,paym5t ,advisory ,commission4 7,c7 ,two repres5tatives f ea* ( ! foll[+ sectors to be select$ by ! ,adm9i/rator3 7i7 ,m$ical4 7ii7 ,te*nology4 7iii7 ,?9k tanks ) a backgr\nd 9 heal? economics4 7,d7 ,f\r individuals f non-pr(it organizations t repres5t s5iors4 7,e7 ,any o!r individual ! ,adm9i/rator det]m9es appropriate4 7#c7 ,no comp5sation = memb]s ,a memb] ( ! ,advisory ,gr\p %all s]ve )\t comp5sation 9 addition to any comp5sation receiv$ = ! s]vice ( ! memb] z an (fic] or employee ( ! ,unit$ ,/ates1 if applicable4 7#d7 ,duties 7,a7 ,9 g5]al ,! ,advisory ,gr\p %all review ! website describ$ 9 section #ahcd7t7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie7t77 7ref]r$ to 9 ?is subsection z ! website7 & provide recomm5dations to ! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ! subsection z ! ,secret>y7 on ways ! website c\ld be *ang$ to increase its usability & all[ us]s ( ! website to bett] und]/& ! co/ & quality = s]vices (f]$ by hospital outpati5t dep>tm5ts & ambulatory surgical c5t]s cov]$ by ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq47 9 ord] = us]s ( ! website to be bett] in=m$ reg>d+ _! m$ical *oices4 7,b7 ,report ,n lat] ?an #ahj days aft] ! fir/ meet+ ( ! ,advisory ,gr\p1 ! ,advisory ,gr\p %all submit a report to ! ,secret>y detail+ its recomm5dations4 7#e7 ,website update ,n lat] ?an #a ye> aft] receiv+ ! report requir$ by p>agraph 7#d77;,b71 ! ,secret>y %all update ! website consid]+ ! recomm5dations conta9$ 9 su* report4 #f4 ,volunt>y pati5t driv5 b5efit flexibility 7a7 ,direct prim>y c>e paym5t ,advisory ,gr\p 7#a7 ,e/abli%m5t ,n lat] ?an #ij days aft] ! date ( enactm5t ( ?is ,act1 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7ref]r$ to 9 ?is subsection z ! ,adm9i/rator7 %all e/abli% a ,direct ,prim>y ,c>e ,paym5t ,advisory ,gr\p 7ref]r$ to 9 ! subsection z ! ,advisory ,gr\p74 7#b7 ,memb]s ,! ,advisory ,gr\p %all be compos$ ( ! foll[+ individuals or ! designees ( ^? individuals3 7,a7 ,! ,adm9i/rator4 7,b7 ,! ,*air ( ! ,m$ic>e ,paym5t ,advisory ,commission4 7,c7 ,two prim>y c>e physicians ) exp]i5ce 9 direct prim>y c>e4 7,d7 ,two speciali/ physicians :o provide prim>y c>e s]vices to pati5ts ) *ronic diseases ) exp]i5ce 9 direct prim>y c>e4 7,e7 ,two repres5tatives ( ,m$ic>e ,advantage plans4 7,f7 ,two heal? actu>ies4 7,g7 ,two repres5tatives ( ?9k tanks ) a heal? policy backgr\nd4 7,h7 ,any o!r individual ! ,adm9i/rator det]m9es appropriate4 7#c7 ,no comp5sation = memb]s ,a memb] ( ! ,advisory ,gr\p %all s]ve )\t comp5sation 9 addition to any comp5sation receiv$ = ! s]vice ( ! memb] z an (fic] or employee ( ! ,unit$ ,/ates1 if applicable4 7#d7 ,duties 7,a7 ,9 g5]al ,! ,advisory ,gr\p %all det]m9e-- 7i7 a def9ition ( prim>y c>e b5efits provid$ "u ,m$ic>e ,advantage plans2 & 7ii7 h[ be/ to calculate ! am\nt ,m$ic>e ,advantage plans w\ld save if pati5ts1 includ+ pati5ts t h *ronic conditions & = :om prim>y c>e is provid$ by a speciali/ physician1 7 to contract ) provid]s ( prim>y c>e on _! own )\t us+ heal? insurance4 7,b7 ,report ,n lat] ?an #ahj days aft] ! fir/ meet+ ( ! ,advisory ,gr\p1 ! ,advisory ,gr\p %all submit a report to ! ,secret>y ( ,heal? & ,humans ,s]vices detail+ its recomm5dations4 7b7 ,,ma ,plans ,section #aheb7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by ins]t+ & ! pati5t flexibility & bundl$ paym5t requirem5ts describ$ 9 subp>agraph 7,c7 aft] "u section #ahed7;f77#a77;,a772 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,direct prim>y c>e & flexibility paym5ts 7i7 ,direct prim>y c>e paym5ts 7,i7 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ea* ,m$ic>e ,advantage plan %all all[ enrollees to elect to receive a direct prim>y c>e b5efit paym5t1 describ$ 9 subclause 7,,ii71 9 lieu ( receiv+ cov]age ( prim>y c>e b5efits 7z def9$ by ! ,secret>y tak+ into acc\nt ! recomm5dations ( ! ,direct ,prim>y ,c>e ,paym5t ,advisory ,gr\p e/abli%$ "u section #f7;a7 ( ! ,m$ic>e ,flex ,fund ,acc\nts & ,flexible ,b5efits ,act ( #bjbd7 "u ! ,m$ic>e ,advantage plan4 7,,ii7 ,direct prim>y c>e b5efit paym5t ,! direct prim>y c>e b5efit paym5t = an enrollee %all be-- 7aa7 equal to ! am\nt ( ! av]age p] capita sav+s to ! ,m$ic>e ,advantage plan by n provid+ cov]age ( prim>y c>e b5efits "u su* plan to su* enrollee 7z det]m9$ by ! ,secret>y tak+ into acc\nt ! recomm5dations ( ! ,direct ,prim>y ,c>e ,paym5t ,advisory ,gr\p e/abli%$ "u section #f7;a7 ( ! ,m$ic>e ,flex ,fund ,acc\nts & ,flexible ,b5efits ,act ( #bjbd72 & 7bb7 deposit$ into ! ,m$ic>e flex fund acc\nt 7z def9$ 9 section #ecj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf & ref]r$ to 9 ?is subp>agraph z a ,m$ic>e ,,ffa7 ( su* enrollee4 7,,iii7 ,election 7aa7 ,9 g5]al ,subject to item 7bb71 dur+ ! p]iod beg9n+ on ,janu>y #a & end+ on ,m>* #ca ( ea* plan ye>1 an enrollee may elect to receive ! direct prim>y c>e b5efit paym5t = t ye>4 7bb7 ,o!r requirem5ts 7,,aa7 ,frequ5cy ( *ange ,if an enrollee makes ! election describ$ 9 item 7aa71 ! enrollee may elect to /op receiv+ ! direct prim>y c>e b5efit paym5t & beg9 to receive prim>y c>e b5efits "u ! ,m$ic>e ,advantage plan = ! rema9d] ( t cal5d> ye>4 7,,bb7 ,c>ry ov] ( election ,if an enrollee makes ! election describ$ 9 item 7aa71 ! enrollee %all cont9ue to receive ! direct prim>y c>e b5efit paym5t until ! enrollee elects to receive prim>y c>e b5efits "u ! ,m$ic>e ,advantage plan = ! ye> dur+ ! p]iod describ$ 9 su* item1 ! enrollee makes ! election describ$ 9 subitem 7,,aa71 or ! enrollee *anges ,m$ic>e ,advantage plans4 7,,cc7 ,*ang+ ( ,m$ic>e ,advantage plans ,if an enrollee *anges ,m$ic>e ,advantage plans z describ$ 9 subitem 7,,bb71 ! enrollee may elect to receive ! direct prim>y c>e b5efit paym5t or to receive prim>y c>e b5efits "u ! ,m$ic>e ,advantage plan = ! rema9d] ( ! ye>4 7ii7 ,flexibility paym5ts = %oppable s]vices 7,i7 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ea* ,m$ic>e ,advantage plan %all all[ enrollees to receive a paym5t f su* plan t meets ! requirem5ts ( subclause 7,,ii7 & all[s enrollees to receive treatm5t f a pre-approv$ alt]nate provid]4 7,,ii7 ,paym5t ,! paym5t describ$ 9 subclause 7,i7 %all-- 7aa7 be ! same am\nt t w\ld h be5 paid to an 9-network provid] & include any process+ co/s2 & 7bb7 be deposit$ 9 ! ,m$ic>e ,,ffa ( ! enrollee once a contract has be5 sign$ by ! enrollee1 ! ,m$ic>e ,advantage plan1 & ! alt]native provid] to provide treatm5t to ! memb]4 7,,iii7 ,alt]native provid]s 7aa7 ,m5u ( options ,ea* ,m$ic>e ,advantage plan may develop a li/ ( pre-approv$ alt]nate provid]s & in=mation reg>d+ ! price1 treatm5t outcomes1 & cu/om] exp]i5ce ( ea* pre-approv$ alt]nate provid] = c]ta9 treatm5ts1 proc$ures1 & episodes ( c>e4 ,if a ,m$ic>e ,advantage plan *ooses to develop su* li/1 ! ,m$ic>e ,advantage plan %all provide su* li/ to an enrollee ^u ! reque/ ( su* enrollee4 7bb7 ,provid+ ! m5u to ! enrollee ,ea* ,m$ic>e ,advantage plan %all provide ! li/ describ$ 9 item 7aa7 be=e ! enrollee reque/s su* li/ if x c\ld result 9 ! enrollee receiv+ treatm5t = a less] price4 7cc7 ,no co/ = be+ on alt]native treatm5t location li/ ,no ,m$ic>e ,advantage plan %all *>ge a provid] = be+ on a li/ describ$ 9 item 7aa74 7,,iv7 ,def9ition ( pre-approv$ alt]nate provid] ,= ! purposes ( ?is clause1 ! t]m pre-approv$ alt]nate provid] means a provid] ( s]vices or a suppli]-- 7aa7 locat$ 9 ! ,unit$ ,/ates or a t]ritory ( ! ,unit$ ,/ates2 7bb7 lic5s$ by ! ,/ate or t]ritory 9 :i* ! provid] furni%es s]vices2 7cc7 will+ to provide s]vices on a ca% basis2 & 7dd7 t has receiv$ ! review describ$ 9 subclause 7,v74 7,v7 ,review ( s]vices ,be=e an enrollee has receiv$ treatm5t by a pre-approv$ alt]native provid]1 ! ,m$ic>e ,advantage plan %all review any contracts or docum5ts relat+ to ! treatm5t provid$ by su* provid] to ensure t-- 7aa7 any enrollee :o elects to receive treatm5t by ! provid] w receive appropriate heal? quality & ! desir$ treatm5t outcome2 & 7bb7 to protect ! enrollee f hidd5 fees or surprise bills1 ! co/ ( ! s]vice quot$ by ! pre-approv$ alt]native provid] w be ! total price paid by ! enrollee4 7iii7 ,rule ( con/ruction ,no?+ 9 ?is subp>agraph %all be con/ru$ to limit any responsibility ( a ,m$ic>e ,advantage plan "u ?is "p1 to r$uce ! actu>ial value ( su* a plan1 or to *ange any network adequacy requirem5t4 4 7c7 ,prescription ,drug ,cov]age ,section #ahfj;,d-#d ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7p7 ,ph>maceutical sav+s 7#a7 ,9 g5]al ,9 ! case ( a cov]$ "p ,d drug on ! =mul>y ( a prescription drug plan or an ,,ma-,,pd plan1 ! plan %all1 if reque/$ by an enrollee ( su* plan1 provide su* enrollee ) a paym5t describ$ 9 p>agraph 7#b7 9 lieu ( ! plan pay+ = su* cov]$ "p ,d drug "u ! plan4 7#b7 ,paym5t ,! paym5t describ$ 9 p>agraph 7#a7 %all be an am\nt equal to ! am\nt ! prescription drug plan or ,,ma-,,pd plan w\ld reimburse a pref]r$ ph>macy = su* cov]$ "p ,d drug plus any fees t w\ld be paid to su* plan 7or a subsidi>y ( su* plan7 by ! manufactur] ( su* cov]$ "p ,d drug4 4 7d7 ,rule = pati5t driv5 b5efit flexibility sp5d+ reg>d+ d$uctibles & ,out-(-,pocket sp5d+ ,section #ahei ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bh7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7j7 ,rule = pati5t driv5 b5efit flexibility sp5d+ reg>d+ d$uctibles & ,out-(-,pocket sp5d+ ,any am\nt sp5t by an enrollee f paym5ts made by an ,,ma plan "u section #aheb7;a77#a77;,c7 or #ahfj;,d-#d7p7 %all n c\nt t[>ds any d$uctible or maximum limitation on out-(-pocket exp5ses applicable to su* ,,ma plan4 4