,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajcih  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #ae1        
#bjbf,mr4 ,rulli 7= himself1 ,mrs4      
,d+ell1 ,mr4 ,?ompson ( ,p5nsylvania1   
,mr4 ,bilirakis1 ,mr4 ,l&sman1 ,ms4     
,b>ragn1 ,mr4 ,taylor1 ,mr4 ,c>t] (     
,l\isiana1 ,mr4 ,pflug]1 ,ms4 ,tokuda1 &
 ,mrs4 ,trahan7 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 am5d title      
,,xviii ( ! ,social ,security ,act to   
modify paym5t rates "u ! ,f$]ally       
qualifi$ heal? c5t] prospective paym5t  
sy/em "u ! ,m$ic>e program1 & = o!r     
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,community ,heal? ,c5t]    
,re=ms ,enabl+ ,bett] ,access = ,s5iors 
& ,eld]s ,act ( #bjbf or ! ,,*c ,,rebase
 ,act ( #bjbf4  #b4 ,modify+ paym5t     

rates "u ! ,f$]ally qualifi$ heal? c5t] 
prospective paym5t sy/em "u ! ,m$ic>e   
program ,section #ahcd7o7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #aciem7o77
 is am5d$-- 7#a7 9 p>agraph             
7#b77;,b77ii71 by /rik+ ,paym5t & ins]t+
 ,subject to p>agraph 7#f71 paym5t2 &   
7#b7 by add+ at ! end ! foll[+ new      
p>agraph3  7#f7 ,adju/m5t ( paym5t rates
  7,a7 ,9 g5]al ,! ,secret>y %all1 ?r\gh
 notice & comm5t rulemak+ & tak+ into   
acc\nt data collect$ "u subp>agraph 7,b7
 & recomm5dations ( ! work+ gr\p        
e/abli%$ "u subp>agraph 7,c7-- 7i7 adju/
 paym5t rates det]m9$ "u p>agraph       
7#b77;,b7 = ,f$]ally qualifi$ heal? c5t]
 s]vices furni%$ 9 #bjbh to acc\nt =    
increases 9 ! type1 int5sity1 duration1 
& am\nt ( s]vices furni%$ 9 a unit (    
s]vice & correspond+ increases 9 ! co/ (
 furni%+ a unit ( s]vice 9 a mann] su* t
 ! e/imat$ aggregate am\nt ( prospective
 paym5t rates 7det]m9$ prior to !       
application ( section #ahcc7;a77#a77,z77
 = su* s]vices is equal to #ajj p]c5t ( 

! e/imat$ am\nt ( reasonable co/s       
7det]m9$ )\t ! application ( a p] visit 
paym5t limit or productivity scre5 &    
prior to ! application ( section        
#ahff7;a77#b77;,a77ii77 t w\ld h occurr$
 = su* s]vices "u ?is title 9 su* ye> _h
 ! sy/em e/abli%$ "u ?is subsection nev]
 be5 implem5t$2 &  7ii7 n lat] ?an #ahj 
days aft] ! date ( ! enactm5t ( ?is     
p>agraph1 modify ! li/ ( s]vices furni%$
 to an individual at a ,f$]ally qualifi$
 heal? c5t] "u subp>agraph 7#a77;,a74   
7,b7 ,collection ( data  7i7 ,9 g5]al ,n
 lat] ?an #ij days aft] ! date ( !      
enactm5t ( ?is p>agraph1 ! ,secret>y    
%all require ,f$]ally qualifi$ heal?    
c5t]s to submit co/ reports1 uni=m data 
sy/em reports1 & any o!r heal? c5t]     
program reports requir$ by law to       
facilitate ! adju/m5t describ$ 9        
subp>agraph 7,a74  7ii7 ,provision (    
in=mation to ! work+ gr\p ,! ,secret>y  
%all make data requir$ to be submitt$ "u
 clause 7i7 available to ! work+ gr\p   
e/abli%$ "u subp>agraph 7,c74  7,c7     

,work+ gr\p  7i7 ,9 g5]al ,n lat] ?an   
#ahj days aft] ! date ( ! enactm5t ( ?is
 p>agraph1 ! ,secret>y %all conv5e a    
work+ gr\p to make recomm5dations to !  
,secret>y on modifications to !         
prospective paym5t sy/em e/abli%$ "u ?is
 subsection4  7ii7 ,composition ,! work+
 gr\p %all be compos$ ( su* memb]s z    
select$ by ! ,secret>y & %all include-- 
7,i7 a pati5t or memb] ( ! bo>d ( a     
,f$]ally qualifi$ heal? c5t]2  7,,ii7 a 
physician1 or a practition] describ$ 9  
section #ahdb7;b77#ah77;,c71 :o works at
 su* a c5t]2  7,,iii7 at lea/ #a        
repres5tative f a prim>y c>e            
association2  7,,iv7 at lea/ #a         
repres5tative f a ,heal? ,c5t]          
,controll$ ,network 7z def9$ 9 section  
#ccj7;e77#a77;,c7 ( ! ,public ,heal?    
,s]vice ,act72  7,v7 a repres5tative f a
 national organization t repres5ts      
,f$]ally qualifi$ heal? c5t]s2  7,,vi7 a
 repres5tative f ! hospital & ambulatory
 policy gr\p ( ! ,c5t]s = ,m$ic>e       
,m$icaid ,s]vices2 &  7,,vii7 su* o!r   

individuals z ! ,secret>y may specify4  
7iii7 ,duties ,! work+ gr\p %all-- 7,i7 
exam9e pot5tial adju/m5ts to paym5t     
rates "u p>agraph 7#b77;,b7 to reflect  
*anges 9 ! type1 int5sity1 duration1 or 
am\nt ( s]vices furni%$ )9 a unit (     
s]vice1 & ! av]age co/ ( provid+ c>e p] 
unit ( s]vice2  7,,ii7 evaluate :e!r su*
 rates capture #ajj p]c5t ( ! e/imat$   
am\nt ( reasonable co/s = ,f$]ally      
qualifi$ heal? c5t] s]vices 7det]m9$ )\t
 ! application ( a p] visit paym5t limit
 or productivity scre5 & prior to !     
application ( section                   
#ahff7;a77#b77;,a77ii77 t w\ld h occurr$
 = su* s]vices "u ?is title 9 su* ye> _h
 ! sy/em e/abli%$ "u ?is subsection nev]
 be5 implem5t$2  7,,iii7 exam9e :i*     
s]vices are exclud$ f paym5t "u su*     
sy/em & :e!r su* s]vices %\ld be payable
 z ,f$]ally qualifi$ heal? c5t] s]vices2
  7,,iv7 evaluate ! possibility ( ext5d+
 application ( new paym5t & deliv]y     
sy/em innovations develop$ ) respect to 
physicians' s]vices "u section #ahdh to 

,f$]ally qualifi$ heal? c5t]s2 &  7,v7  
exam9e su* o!r issues relat+ to paym5t =
 ,f$]ally qualifi$ heal? c5t]s z det]m9$
 appropriate by ! work+ gr\p4  7iv7     
,recomm5dations ,n lat] ?an #a ye> aft] 
! date on :i* ! work+ gr\p fir/ conv5es 
& aft] provid+ opportunity = public     
comm5t1 su* gr\p %all make su*          
recomm5dations to ! ,secret>y reg>d+    
paym5t = ,f$]ally qualifi$ heal? c5t]s z
 det]m9$ appropriate by ! work+ gr\p4  4
  #c4 ,ensur+ appropriate paym5ts =     
teleheal? s]vices furni%$ by ,f,q,h,cs &
 ,r,h,cs ,section #ahcd7m77#h7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#h77 is am5d$ by add+ at ! end
 ! foll[+ new subp>agraph3 7#a7 9       
subp>agraph 7,a77ii71 by ins]t+ 7or1 )  
respect to su* s]vices furni%$ on or    
aft] ,janu>y #a1 #bjbg1 "u subp>agraph  
7,c77 aft] subp>agraph 7,b72  7#b7 9    
subp>agraph 7,b7-- 7,a7 9 ! head]1 by   
ins]t+ be=e #bjbg aft] rule2  7,b7 9    
clause 7i71 by /rik+ dur+ ! p]iods = :i*
 subp>agraph 7,a7 applies & ins]t+ be=e 

,janu>y #a1 #bjbg2 &  7,c7 9 clause     
7ii71 by ins]t+ furni%$ to an individual
 be=e ,janu>y #a1 #bjbg aft] teleheal?  
s]vices2 &  7#c7 by add+ at ! end !     
foll[+ new subp>agraph3  7,c7 ,paym5t   
rule = #bjbg  7i7 ,9 g5]al ,a teleheal? 
s]vice furni%$ to an eligible teleheal? 
individual by a ,f$]ally qualifi$ heal? 
c5t] or rural heal? cl9ic dur+ any      
portion ( ! p]iod describ$ 9 subp>agraph
 7,a7 beg9n+ on or aft] ,janu>y #a1     
#bjbg1 %all be paid z a ,f$]ally        
qualifi$ heal? c5t] s]vice or rural     
heal? cl9ic s]vice 7z applicable7 "u !  
prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 or ! me?odology =      
all-inclusive rates e/abli%$ "u section 
#ahcc7;a77#c71 respectively4  7ii7      
,treatm5t ( co/s ,co/s associat$ ) !    
furni%+ ( teleheal? s]vices by a        
,f$]ally qualifi$ heal? c5t] or rural   
heal? cl9ic dur+ any portion ( ! p]iod  
describ$ 9 subp>agraph 7,a7 beg9n+ on or
 aft] ,janu>y #a1 #bjbg1 %all be        
consid]$ all[able co/s = purposes ( !   

prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 & ! me?odology =       
all-inclusive rates e/abli%$ "u section 
#ahcc7;a77#c71 z applicable4  4  #d4    
,ensur+ appropriate paym5t ( ,f$]ally   
qualifi$ heal? c5t] s]vices furni%$ to  
,m$ic>e ,advantage enrollees  7a7       
,cl>ify+ wrap>\nd paym5ts ,n lat] ?an   
,decemb] #ca1 #bjbf1 ! ,secret>y (      
,heal? & ,human ,s]vices 79 ?is section 
ref]r$ to z ! ,secret>y7 %all-- 7#a7    
issue guidance to ,f$]ally qualifi$     
heal? c5t]s 7z def9$ 9 section          
#ahfa7;aa77#d7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7aa77#d777    
on-- 7,a7 ! calculation ( paym5t am\nts 
"u section #ahcc7;a77#c77;,b7 ( su* ,act
 7#db ,u4,s4,c4 #aciel7a77#c77;,b772 &  
7,b7 proc$ures = submitt+ a claim = su* 
a paym5t2  7#b7 issue guidance to       
,m$ic>e adm9i/rative contractors to     
ensure timely & accurate paym5t ( am\nts
 ow$ "u su* section t-- 7,a7 outl9es a  
/&>diz$ process = provid+ ,f$]ally      
qualifi$ heal? c5t]s su* paym5ts2 &     

7,b7 cl>ifies t su* contractors may n   
require su* a c5t] 7or any entity act+  
on behalf ( su* c5t]7 to submit !       
,m$ic>e ,advantage plan contract at     
issue to su* contractor z a pr]equisite 
to receiv+ su* paym5ts2 &  7#c7 e/abli% 
a me*anism by :i* su* a c5t] may seek   
review by ! ,secret>y ( su* a           
contractor's det]m9ation ( am\nts       
payable to ! c5t] "u su* section4  7b7  
,evaluation ( access to ,f,q,h,cs 9 ,,ma
 networks ,n lat] ?an #ahj days aft] !  
date ( ! enactm5t ( ?is p>agraph1 !     
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report t     
exam9es ! inclusion ( ,f$]ally qualifi$ 
heal? c5t]s 9 ,m$ic>e ,advantage plan   
provid] networks4 ,su* report %all      
include recomm5dations = actions to be  
tak5 to ensure adequate access to       
,f$]ally qualifi$ heal? c5t]s = rural & 
und]s]v$ populations4