,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ajgbi  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,octob] #e1 #bjbf,ms4 
,davids ( ,kansas introduc$ ! foll[+    
bill2 :i* 0 ref]r$ to ! ,committee on   
,en]gy & ,comm]ce  ,a ,,bill  ,to am5d  
,public ,law #aai-ba to adju/           
limitations on ,/ate direct$ paym5ts "u 
! ,m$icaid program1 & to repeal c]ta9   
provisions relat$ to provid] taxes4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,long-,t]m ,rural ,heal? ,inve/m5t ,act 
( #bjbf4  #b4 ,adju/+ limitations on    
,/ate direct$ paym5ts  7a7 ,9 g5]al     
,section #gaaaf ( ,public ,law #aai-ba  
is am5d$--  7#a7 by am5d+ subsection 7a7
 to read z foll[s3  7a7 ,9 g5]al ,!     
,secret>y ( ,heal? & ,human ,s]vices 79 
?is section ref]r$ to z ! ,secret>y7    
%all revise section #dch4f7;c77#b77;iii7
 ( title #db1 ,code ( ,f$]al            
,regulations 7or a successor            
regulation71 su* t1 ) respect to a      
paym5t describ$ 9 su* subsection made = 
a s]vice furni%$ dur+ a rat+ p]iod      

beg9n+ on or aft] ,janu>y #a1 #bjcj1 !  
total paym5t rate = su* s]vice is limit$
 to #bjj p]c5t ( ! specifi$ total       
publi%$ ,m$ic>e paym5t rate 7or1 9 !    
abs5ce ( a specifi$ total publi%$       
,m$ic>e paym5t rate1 ! av]age comm]cial 
rate 9 ! ,/ate74  2  7#b7 by am5d+      
subsection 7b7 to read z foll[s3  7b7   
,gr&fa!r+ c]ta9 paym5ts ,9 ! case ( a   
paym5t describ$ 9 section               
#dch4f7;c77#b77;iii7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 = :i* writt5 prior approval
 7or a good fai? ef=t to receive su*    
approval1 z det]m9$ by ! ,secret>y7 0   
made be=e ,july #a1 #bjbh1 = ! fir/ rat+
 p]iod occurr+ aft] ,july #a1 #bjbh1 or 
a paym5t s describ$ = su* rat+ p]iod =  
:i* a complet$ prepr9t 0 submitt$ to !  
,secret>y prior to ! date ( enactm5t ( !
 ,long-,t]m ,rural ,heal? ,inve/m5t ,act
 ( #bjbf1 beg9n+ ) ! rat+ p]iod on or   
aft] ,janu>y #a1 #bjcj1 ! total am\nt ( 
su* paym5t %all be r$uc$ by #aj p]c5t ( 
! am\nt ( any su* paym5t made dur+ !    

prec$+ rat+ p]iod1 ea* ye> until ! total
 paym5t rate = su* s]vice is equal to ! 
rate = su* s]vice specifi$ 9 subsection 
7a74  2  7#c7 by /rik+ subsection 7c72  
7#d7 9 subsection 7d7--  7,a7 by /rik+  
p>agraph 7#b72  7,b7 by r$esignat+      
p>agraphs 7#c7 ?r\gh 7#e7 z p>agraphs   
7#b7 ?r\gh 7#d71 respectively2 &  7,c7  
by add+ at ! end ! foll[+ new p>agraphs3
  7#e7 ,f9al capitation rate ,! t]m f9al
 capitation rate has ! mean+ giv5 su*   
t]m 9 section #dch4c7;c7 ( title #db1   
,code ( ,f$]al ,regulations 7or a       
successor regulation74  7#f7 ,m$icaid   
manag$ c>e organization ,! t]m m$icaid  
manag$ c>e organization has ! mean+ giv5
 su* t]m 9 section #aijc7m77#a77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acif;b7m77#a77;,a774  7#g7 ,prepaid    
inpati5t heal? plan ,! t]m prepaid      
inpati5t heal? plan has ! mean+ giv5 su*
 t]m 9 section #dch4b ( title #db1 ,code
 ( ,f$]al ,regulations 7or a successor  
regulation74  7#h7 ,prepaid ambulatory  
heal? plan ,! t]m prepaid ambulatory    

heal? plan has ! mean+ giv5 su* t]m 9   
section #dch4b ( title #db1 ,code (     
,f$]al ,regulations 7or a successor     
regulation74  2 &  7#e7 by ins]t+ aft]  
subsection 7b7 ! foll[+ new subsection3 
7c7 ,hi/orical utilization & sep>ate    
paym5t rates ,! ,secret>y %all-- 7#a7   
revise section #dch4f7;c77#b77vii77,b7 (
 title #db1 ,code ( ,f$]al ,regulations 
7or a successor regulation71 su* t1 )   
respect to a paym5t describ$ 9 section  
#dch4f7;c77#b77;iii7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 made = s]vices furni%$ dur+
 a rat+ p]iod beg9n+ on or aft] ,janu>y 
#a1 #bjbh1 a ,/ate may condition su*    
paym5t on ! utilization & deliv]y (     
s]vices outside ( ! rat+ p]iod = :i* !  
,/ate is seek+ writt5 prior approval &  
require t su* paym5ts be reconcil$ to   
utilization dur+ su* rat+ p]iod2 &  7#b7
 revise section #dch4f7;c77#f7 ( title  
#db1 ,code ( ,f$]al ,regulations 7or a  
successor regulation71 su* t1 ) respect 
to a paym5t describ$ 9 section          

#dch4f7;c77#b77;iii7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 made = s]vices furni%$ dur+
 a rat+ p]iod beg9n+ on or aft] ,janu>y 
#a1 #bjbh1 a ,/ate may )hold a portion (
 ! f9al capitation rate to pay a m$icaid
 manag$ c>e organization1 prepaid       
inpati5t heal? plan1 or prepaid         
ambulatory heal? plan sep>ately = su*   
paym5t & may require su* an organization
 or plan to reta9 a portion ( ! f9al    
capitation rate sep>ately to comply )   
su* paym5t4  4  7b7 ,/ate direct$ paym5t
 report+ requirem5ts ,section #aijc ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7cc7 ,/ate      
direct$ paym5t report+ requirem5ts  7#a7
 ,collection & availability ( ,/ate     
direct$ paym5t data  7,a7 ,9 g5]al      
,beg9n+ ,janu>y #a1 #bjbg1 ea* ,/ate    
%all1 n lat] ?an #a ye> aft] ! end ( ea*
 rat+ p]iod1 submit to ! ,secret>y ?r\gh
 ! ,trans=m$ ,m$icaid ,/ati/ical        
,in=mation ,sy/em 7,t-,,msis7 7or a     

successor sy/em7 ! data describ$ 9      
subp>agraph 7,b71 z a requirem5t = a    
,/ate plan or ,/ate plan am5dm5t t w\ld 
provide = a ,/ate direct$ paym5t4  7,b7 
,data describ$ ,= purposes ( subp>agraph
 7,a71 ! data describ$ 9 ?is subp>agraph
 is ! foll[+3 7i7 ,! total am\nt 79     
doll>s7 exp5d$ by a manag$ c>e          
organization1 prepaid inpati5t heal?    
plan1 or prepaid ambulatory heal? plan =
 ,/ate direct$ paym5ts dur+ su* rat+    
p]iod4  7ii7 ,id5tifi]s1 z specifi$ by !
 ,secret>y1 = enrollees1 provid]s1      
manag$ c>e organizations1 prepaid       
inpati5t heal? plans1 & prepaid         
ambulatory heal? plans4  7iii7 ,am\nts  
paid to individual provid]s "u a ,/ate  
direct$ paym5t4  7iv7 ,am\nts collect$  
by ! ,/ate to fund ! non-,f$]al %>e (   
,/ate direct$ paym5ts1 disaggregat$ by  
provid] type4  7v7 ,proc$ure & diagnosis
 codes = any item or s]vice = :i* a     
,/ate direct$ paym5t 0 made4  7vi7      
,am\nts all[$1 bill$1 & paid 7includ+ ! 
am\nt t repres5ts ! paym5t am\nt        

negotiat$ by ! relevant manag$ c>e      
organization1 prepaid inpati5t heal?    
plan1 or prepaid ambulatory heal? plan1 
! am\nt ( ! ,/ate direct$ paym5t1 & any 
o!r am\nts includ$ 9 ! total am\nt paid 
to ! provid]7 9 connection ) an item or 
s]vice = :i* a ,/ate direct$ paym5t 0   
made4  7#b7 ,def9itions ,9 ?is          
subsection3  7,a7 ,m$icaid manag$ c>e   
organization ,! t]m m$icaid manag$ c>e  
organization has ! mean+ giv5 su* t]m 9 
section #aijc7m77#a77;,a74  7,b7        
,prepaid inpati5t heal? plan ,! t]m     
prepaid inpati5t heal? plan has ! mean+ 
giv5 su* t]m 9 section #dch4b ( title   
#db1 ,code ( ,f$]al ,regulations 7or a  
successor regulation74  7,c7 ,prepaid   
ambulatory heal? plan ,! t]m prepaid    
ambulatory heal? plan has ! mean+ giv5  
su* t]m 9 section #dch4b ( title #db1   
,code ( ,f$]al ,regulations 7or a       
successor regulation74  7,d7 ,rat+ p]iod
 ,! t]m rat+ p]iod has ! mean+ giv5 su* 
t]m 9 section #dch4b ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   

regulation74  7,e7 ,/ate direct$ paym5t 
,! t]m ,/ate direct$ paym5t means a     
paym5t describ$ 9 section               
#dch4f7;c77#b77;iii7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation74  4  7c7 ,rev]t+ regulations
 ,= ! p]iod beg9n+ on ! date ( enactm5t 
( ?is section & end+ on ,janu>y #a1     
#bjcj1 ! ,secret>y %all apply section   
#dch4f7;c77#b77;iii7 ( title #db1 ,code 
( ,f$]al ,regulations1 z su* section 0 9
 effect on ! day be=e ! date ( enactm5t 
( ,public ,law #aai-ba4  #c4 ,repeal (  
provisions ( ,public ,law #aai-ba relat$
 to provid] taxes  7a7 ,repeal ,sections
 #gaaae & #gaaag ( ,public ,law #aai-ba 
are repeal$ & section #aijc7w7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acif;b7w77 %all be appli$ z if su*     
sections _h n be5 enact$4  7b7          
,rescission ,! am\nts appropriat$ "u    
section #gaaae7;c7 ( ,public ,law       
#aai-ba are h]eby resc9d$4