,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajedg  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,septemb] #bd1        
#bjbf,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 am5d titles     
,,xviii & ,,xix ( ! ,social ,security   
,act to improve access to ! ,program (  
,all-,inclusive ,c>e = ! ,eld]ly        
7,,pace71 to r$uce regulatory burd5s on 
,,pace provid]s1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,,pace ,access ,improvem5t ,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 ,)     
respect to enrollm5ts made on or aft]   
,janu>y #a1 #bjbg1 a ,,pace program     
eligible individual may enroll 9 a      
,,pace program at any "t dur+ a mon?4   
7ii7 ,effective date ,) respect to      
enrollm5ts made on or aft] ,janu>y #a1  
#bjbg1 ! 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 #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 ,) respect to enrollm5ts made on
 or aft] ,janu>y #a1 #bjbg1 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 ,requirem5ts "u      
m$icaid  7#a7  ,any "t enrollm5t &      
effective date  ,section #aicd7;c77#e7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acifu-#d7;c77#e77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,c7   
,any "t enrollm5t & effective date (    
enrollm5t  7i7  ,any "t enrollm5t  ,)   
respect to enrollm5ts made on or aft]   
,janu>y #a1 #bjbg1 a ,,pace program     
eligible individual may enroll 9 a      
,,pace program 9 a ,/ate at any "t dur+ 
a mon?4  7ii7  ,effective date  ,)      
respect to enrollm5ts made on or aft]   
,janu>y #a1 #bjbg1 ! 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 ,)     
respect to enrollm5ts made on or aft]   
,janu>y #a1 #bjbg1 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$4
  4  #c4 ,,pace site approval &         
expansion ,sections #ahid7;e7 &         
#aicd7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;eee7e71            
#acifu-#d7;e77 are ea* am5d$ by /rik+   
p>agraph 7#h7 & ins]t+ ! foll[+3  7#h7  
,revis$ processes = new provid] /atus1  
s]vice area expansions1 & additions (   
,,pace c5t] sites  7,a7 ,9 g5]al ,beg9n+
 ,janu>y #a1 #bjbg1 ! foll[+ %all apply3

  7i7 ,seek+ new ,,pace provid] /atus   
,an entity may submit an application = !
 purpose describ$ 9 section             
#dfj4aj7;a77#a7 ( title #db1 ,code (    
,f$]al ,regulations1 or any successor   
regulation1 at any "t & may submit      
multiple applications = su* purpose 9 ! 
same qu>t]4  7ii7 ,seek+ s]vice area    
expansion or addition ( ,,pace c5t] site
 7b n bo?7  7,i7 ,9 g5]al ,an entity may
 submit an application = a purpose      
describ$ 9 section #dfj4aj7;a77#b7 (    
title #db1 ,code ( ,f$]al ,regulations1 
or any successor regulation1 at any "t1 
subject to ! requirem5ts ( section      
#dfj4ab7;d7 ( su* title 7relat+ to !    
fir/ trial p]iod audit71 or any         
successor regulation1 & may submit      
multiple applications = su* purpose 9 ! 
same qu>t]4  7,,ii7 ,application n      
requir$ = qualifi$ ,,pace provid]s seek+
 addition ( a ,,pace c5t] site 9 exi/+  
s]vice area ,a qualifi$ ,,pace provid]  
7z def9$ 9 subp>agraph 7,e77ii77 op]at+ 
a ,,pace program 9 a s]vice area t seeks

 to add a ,,pace c5t] site "u su* ,,pace
 program to su* s]vice area 7& does n   
also seek to exp& its s]vice area7 %all 
n be requir$ to submit an application to
 ! ,secret>y 9 ord] to s add su* ,,pace 
c5t] site if ! qualifi$ ,,pace provid]  
submits to ! ,secret>y 7at su* "t z !   
,secret>y may specify 9 regulation7 a   
qualify+ notice 7z def9$ 9 subp>agraph  
7,e77i77 ) respect to ! propos$         
additional ,,pace c5t] site4 ,su* a     
qualify+ notice %all n be consid]$ an   
application = purposes ( subp>t ,b ( "p 
#dfj ( title #db1 ,code ( ,f$]al        
,regulations1 or any successor to su*   
regulations4  7iii7 ,seek+ bo? s]vice   
area expansion & addition ( ,,pace c5t] 
site ,an entity may submit an           
application = ! purposes describ$ 9     
section #dfj4aj7;a77#c7 ( title #db1    
,code ( ,f$]al ,regulations1 or any     
successor regulation1 at any "t1 subject
 to ! requirem5ts ( section #dfj4ab7;d7 
( su* title 7relat+ to ! fir/ trial     
p]iod audit71 or any successor          

regulation1 & may submit multiple       
applications = su* purposes 9 ! same    
qu>t]4  7,b7 ,deem$ approval =          
applications ,an application describ$ 9 
subp>agraph 7,a77i71 7,a77ii77,i71 or   
7,a77iii7 %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  7,c7     
,c]ta9 assurances sub/itut+ = c]ta9     
application requirem5ts = requir$       
int]discipl9>y team & contractors  7i7  
,9 g5]al ,9 ! case ( an application     
describ$ 9 subp>agraph 7,a77i71         
7,a77ii77,i71 or 7,a77iii7 t includes   
ea* ( ! assurances describ$ 9 clause    
7ii71 ) respect to a ,,pace provid] &   

propos$ ,,pace c5t] site1 su* assurances
 %all be treat$ z satisfy+ any          
application or o!r requirem5t apply+ a  
deadl9e by :i* ! memb]s ( !             
int]discipl9>y team describ$ 9 section  
#dfj4ajb7;b7 ( title #db1 ,code ( ,f$]al
 ,regulations1 or any successor         
regulation1 are requir$ to be employees 
or contractors ( ! propos$ ,,pace c5t]  
site & any deadl9e by :i* ! ,,pace      
provid]'s contracts = contract$ heal?   
c>e provid]s1 p]sonnel1 /aff1 or o!r    
contractors to provide contract$ s]vices
 mu/ be execut$ 7&1 if su* assurances   
are s includ$1 any su* deadl9es %all n  
apply ) respect to su* application74    
7ii7 ,assurances describ$ ,= purposes ( 
clause 7i71 ! assurances describ$ 9 ?is 
clause1 ) respect to a ,,pace provid] & 
propos$ ,,pace c5t] site are ea* ( !    
foll[+3 7,i7 ,an assurance t ! requir$  
memb]s ( ! int]discipl9>y team are      
employees or contractors ( ! propos$    
,,pace c5t] site or w be employees or   
contractors ( ! propos$ ,,pace c5t] site

 by ! "t ! ,,pace c5t] becomes          
op]ational4  7,,ii7 ,an assurance t !   
,,pace provid]'s contracts = all        
contractors & contract$ p]sonnel w be   
execut$ by ! "t ! propos$ ,,pace c5t]   
site becomes op]ational4  7,d7          
,p]mission to contract = project$ /aff+ 
ne$s ,9 execut+ contracts ) contract$   
heal? c>e provid]s1 p]sonnel1 /aff1 or  
o!r contractors to provide contract$    
s]vices or to e/abli% an int]discipl9>y 
team1 = a purpose describ$ 9 clause 7i71
 7ii77,i71 7ii77,,ii71 or 7iii7 (       
subp>agraph 7,a71 a ,,pace provid] may  
include provisions = /aff+ levels to be 
comm5surate ) enrollm5t to full project$
 c5sus4  7,e7 ,def9itions = qualifi$    
pace provid] & qualify+ notice ,=       
purposes ( subp>agraph 7,a77ii77,,ii73  
7i7 ,qualify+ notice ,! t]m qualify+    
notice means1 ) respect to a qualifi$   
,,pace provid] op]at+ a ,,pace program 9
 a s]vice area1 a notice conta9+ ea* ( !
 foll[+ assurances ) respect to !       
addition ( a ,,pace c5t] site to su*    

s]vice area by su* qualifi$ ,,pace      
provid]3  7,i7 ,an assurance t !        
additional ,,pace c5t] site w be locat$ 
)9 su* s]vice area ( su* ,,pace program4
  7,,ii7 ,an assurance f ! ,/ate        
adm9i/]+ ag5cy ( ! ,/ate 9 :i* ! ,,pace 
program is locat$ t ! ,/ate is will+ to 
am5d ! ,,pace program agreem5t to       
include ! additional ,,pace c5t] site 9 
su* s]vice area4  7,,iii7 ,ea* ( !      
assurances describ$ 9 subp>agraph       
7,c77ii74  7ii7 ,qualifi$ ,,pace provid]
 ,! t]m qualifi$ ,,pace provid] means1 )
 respect to a ,,pace program op]at$ by  
su* qualifi$ ,,pace provid]1 a ,,pace   
provid] t1 at ! "t ( submission ( a     
qualify+ notice to ! ,secret>y--  7,i7  
has successfully complet$ ! fir/ trial  
p]iod audit ) respect to su* ,,pace     
program2 &  7,,ii7 is n ! subject ( a   
sanction1 an en=cem5t action or a       
t]m9ation proce$+ "u subp>t ,d ( "p #dfj
 ( title #db1 ,code ( ,f$]al            
,regulations1 or any successor          
regulation1 ) respect to su* ,,pace     

program4  4  #d4 ,requir+ ,/ates to (f] 
,,pace program s]vices to eligible      
individuals  7a7 ,9 g5]al ,section      
#aicd7;a7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifu-#d7;a77 is am5d$--
 7#a7 9 p>agraph 7#a7--  7,a7 by /rik+  
,a ,/ate may elect to provide & ins]t+  
,be=e ! compliance date describ$ 9      
p>agraph 7#aa7 ) respect to a ,/ate1 !  
,/ate may elect to provide1 & on & aft] 
su* compliance date ) respect to !      
,/ate1 ! ,/ate %all provide2 &  7,b7 by 
/rik+ ,a ,/ate may e/abli% a num]ical   
limit on ! numb] ( individuals :o may be
 enroll$ 9 a ,,pace program "u a ,,pace 
program agreem5t42 &  7#b7 by add+ at ! 
end ! foll[+ new p>agraph3  7#aa7       
,compliance date describ$ ,= purposes ( 
?is section1 subject to section #d7;c7 (
 ! ,,pace ,access ,improvem5t ,act1 !   
compliance date ) respect to a ,/ate    
is--  7,a7 9 ! case ( a ,/ate t1 z ( !  
date ( ! enactm5t ( ?is p>agraph1 has 9 
effect a ,,pace program agreem5t ) at   
lea/ #a ,,pace provid] to op]ate a      

,,pace program 9 ! ,/ate1 ! date t is   
#ahj days aft] su* date ( enactm5t2 &   
7,b7 9 ! case ( a ,/ate t is n describ$ 
9 subp>agraph 7,a71 ! date t is #c ye>s 
aft] su* date ( enactm5t4  4  7b7 ,/ate 
plan requirem5t ,section #aijb7;a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif;a7a77 is am5d$-- 7#a7 9 p>agraph  
7#hi71 by /rik+ 2 & & ins]t+ a          
semicolon2  7#b7 9 p>agraph 7#ij77;,c71 
by /rik+ ! p]iod at ! end & ins]t+ 2 &2 
&  7#c7 by ins]t+ aft] p>agraph 7#ij7 ! 
foll[+ new p>agraph2  7#ia7 provide1 9  
accordance ) section #aicd1 t ! ,/ate1  
beg9n+ on ! compliance date describ$ 9  
section #aicd7;a77#aa7 ) respect to su* 
,/ate1 %all provide m$ical assi/ance )  
respect to ,,pace program s]vices to    
,,pace program eligible individuals :o  
are eligible = m$ical assi/ance "u !    
,/ate plan or "u a waiv] ( su* plan & :o
 are enroll$ 9 a ,,pace program "u a    
,,pace program agreem5t4  4  7c7        
,effective date  7#a7 ,9 g5]al ,except z
 provid$ 9 p>agraph 7#b7 & unless       

o!rwise specifi$1 ! am5dm5ts made by ?is
 section %all take effect on ! date ( ! 
enactm5t ( ?is ,act & %all apply beg9n+ 
) respect to m$ical assi/ance provid$ on
 ! date t is #ahj days aft] su* date (  
enactm5t4  7#b7 ,delay p]mitt$ if /ate  
legislation requir$ ,9 ! case ( a ,/ate 
plan approv$ "u title ,,xix ( ! ,social 
,security ,act :i* ! ,secret>y ( ,heal? 
& ,human ,s]vices det]m9es requires     
,/ate legislation 7o!r ?an legislation  
appropriat+ funds7 9 ord] = ! plan to   
meet ! additional requirem5ts impos$ by 
! am5dm5ts made by ?is section1 ! ,/ate 
plan %all n be reg>d$ z fail+ to comply 
) ! requirem5ts ( su* title solely on ! 
basis ( ! failure ( ! plan to meet su*  
additional requirem5ts be=e ! fir/ day (
 ! fir/ cal5d> qu>t] beg9n+ aft] ! close
 ( ! fir/ regul> session ( ! ,/ate      
legislature t ends aft] ! date ( !      
enactm5t ( ?is section4 ,= purposes ( ! 
prec$+ s5t5ce1 9 ! case ( a ,/ate t has 
a #b-ye> legislative session1 ea* ye> ( 
! session is deem$ to be a sep>ate      

regul> session ( ! ,/ate legislature4   
#e4 ,repeal ( ov]ly burd5some           
regulations on outrea*  7a7 ,repeal (   
unnecess>ily burd5some regulatory       
re/rictions  7#a7 ,9 g5]al ,sections    
#ahid7;f77#c7 & #aicd7;f77#c7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;eee7f77#c71 #acifu-#d7;f77#c77 are
 ea* am5d$ by add+ at ! end ! foll[+ new
 subp>agraph3  7,c7 ,revision ( c]ta9   
m>ket+ requirem5ts  7i7 ,p]missible     
comm5cem5t ( m>ket+  7,i7 ,9 g5]al ,a   
specifi$ ,,pace program 7z def9$ 9      
subclause 7,,ii77 t submits a complete  
application to ! ,secret>y 7z det]m9$ "u
 section #dfj4bj ( title #db1 ,code (   
,f$]al ,regulations1 or any successor   
regulation7 = any ( ! purposes describ$ 
9 subclause 7,,iii7 may conduct m>ket+  
activities ) respect to prospective     
,,pace program eligible individuals1 su*
 z mak+ available m>ket+ mat]ials t h   
be5 conditionally approv$ by !          
,secret>y1 on or aft] ! date ! specifi$ 
,,pace program submits su* complete     

application4  7,,ii7 ,specifi$ ,,pace   
program def9$ ,9 ?is subp>agraph1 ! t]m 
specifi$ ,,pace program means a ,,pace  
program1 & includes an entity t submits 
an application to ,,cms = approval z a  
,,pace program4  7,,iii7 ,application   
purposes describ$ ,= purposes (         
subclause 7,i71 an application describ$ 
9 su* subclause may be submitt$ = any ( 
! foll[+ purposes3 7aa7 ,= an entity    
seek+ approval f ! ,secret>y z a ,,pace 
program4  7bb7 ,= a ,,pace program seek+
 to exp& its s]vice area4  7cc7 ,= a    
,,pace program seek+ to add a new ,,pace
 c5t]4  7dd7 ,= a ,,pace program seek+  
to exp& its s]vice area & to add a new  
,,pace c5t]4  7ii7 ,m>ket+ activities ,a
 specifi$ ,,pace program may use m>ket+ 
practices describ$ 9 section            
#dfj4hb7;e77#e7 ( title #db1 ,code (    
,f$]al ,regulations1 z 9 effect on ,june
 #a1 #bjbe4  4  7#b7 ,con=m+ repeal     
,section #dfj4hb7;e77#e7 ( title #db1   
,code ( ,f$]al ,regulations1 is repeal$ 
& %all h no =ce or effect 9 law4  7b7   

,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply ) respect to  
m>ket+ activities "u section #ahid or   
#aicd ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;eee2 #acifu-#d7 conduct$
 on or aft] ! date t is #ahj days aft] !
 date ( ! enactm5t ( ?is ,act4  #f4     
,repeal ( outdat$ & burd5some num]ical  
limitation  7a7 ,m$ic>e ,section #ahid (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acie;eee7 is am5d$-- 7#a7 9 subsection
 7e71 by /rik+ p>agraph 7#a7 & ins]t+ ! 
foll[+3  7#a7 ,requirem5t ,! ,secret>y1 
9 close coop]ation ) ! ,/ate adm9i/]+   
ag5cy1 %all e/abli% proc$ures = ent]+   
into1 ext5d+1 & t]m9at+ ,,pace program  
agreem5ts = ! op]ation ( ,,pace programs
 by entities t meet ! requirem5ts = a   
,,pace provid] "u ?is section1 section  
#aicd1 & regulations4  2 &  7#b7 9      
subsection 7h71 by /rik+ p>agraph 7#b7 &
 ins]t+ ! foll[+3  7#b7 ,simil> t]ms &  
conditions ,except z provid$ "u p>agraph
 7#a71 ! t]ms & conditions = op]ation ( 
a ,,pace program by a provid] "u ?is    

subsection %all be ! same z ^? = ,,pace 
provid]s t are nonpr(it1 private        
organizations4  4  7b7 ,m$icaid ,section
 #aicd ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acifu-#d7 is am5d$--  7#a7 9 
subsection 7e71 by /rik+ p>agraph 7#a7 &
 ins]t+ ! foll[+3  7#a7 ,requirem5t ,!  
,secret>y1 9 close coop]ation ) ! ,/ate 
adm9i/]+ ag5cy1 %all e/abli% proc$ures =
 ent]+ into1 ext5d+1 & t]m9at+ ,,pace   
program agreem5ts = ! op]ation ( ,,pace 
programs by entities t meet !           
requirem5ts = a ,,pace provid] "u ?is   
section1 section #ahid1 & regulations4  
2 &  7#b7 9 subsection 7h71 by /rik+    
p>agraph 7#b7 & ins]t+ ! foll[+3  7#b7  
,simil> t]ms & conditions ,except z     
provid$ "u p>agraph 7#a71 ! t]ms &      
conditions = op]ation ( a ,,pace program
 by a provid] "u ?is subsection %all be 
! same z ^? = ,,pace provid]s t are     
nonpr(it1 private organizations4  4  7c7
 ,effective date ,! am5dm5ts made by ?is
 section %all take effect on ! date ( ! 
enactm5t ( ?is ,act4