,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #cdfg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbe,mr4   
,s*weik]t 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 to re=m ! ,m$ic>e ,advantage    
program4  #a4 ,re=m+ ,m$ic>e ,advantage 
7a7  ,requirem5t ,to use capitat$       
paym5ts  ,section #aheb ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7o7  ,requirem5t
 ,to use capitat$ paym5ts  7#a7  ,9     
g5]al  ,subject to p>agraph 7#b7 &      
section #ahec7p71 = plan ye>s beg9n+ on 
or aft] ,janu>y #a1 #bjbh1 a ,m$ic>e    
,advantage plan may only pay = b5efits  
furni%$ "u su* plan on a capitat$ basis4
  7#b7  ,exceptions  ,p>agraph 7#a7 %all

 n apply 9 ! case ( ! foll[+ ,,ma plans 
= a plan ye>3  7,a7 ,an ,,ma plan t 0   
made available 9 su* area dur+ ! prec$+ 
plan ye>1 except t ! only individuals   
eligible to enroll 9 su* plan %all be   
individuals :o 7 enroll$ 9 su* plan dur+
 su* prec$+ plan ye>4  7,b7 ,a          
specializ$ ,,ma plan = special ne$s     
individuals4  4  7b7 ,paym5t            
modifications  7#a7 ,r$uc+ bl5d$ b5*m>k 
,section #ahec7;j77#a77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7;j77#a77;,a77 is am5d$ by    
ins]t+ 7or1 beg9n+ ) #bjbh1 #ge p]c5t ( 
#a_/ab ( su* bl5d$ b5*m>k am\nt7 aft] = 
! area = ! ye>74  7#b7 ,risk adju/m5t   
modifications ,section #ahec7;a77#c7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bc7;a77#c77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,e7   
,risk adju/m5t requirem5ts = heal? /atus
 ,beg9n+ ,janu>y #a1 #bjbh1 risk        
adju/m5t = heal? /atus %all be det]m9$--
  7i7 us+ only diagnoses docum5t$ on    
claims f face-to-face or teleheal?      

visits2  7ii7 )\t us+ any diagnoses     
obta9$ = *>t reviews or /&-alone heal?  
risk assessm5ts2 &  7iii7 us+ diagnoses 
f a #b-ye> p]iod prec$+ ! ye> = :i* su* 
adju/m5t is made4  4  7#c7 ,elim9at+    
quality b5*m>k increases ,section       
#ahec7o7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciew-#bc7o77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#h7 ,nonapplication ( increase to      
qualifi$ ,,ma plans ,no increase to !   
applicable p]c5tage "u subsection       
7n77#b77;,b7 %all be made "u ?is        
subsection = a plan = plan ye>s beg9n+  
on or aft] ,janu>y #a1 #bjbh4  4  7#d7  
,/op-loss paym5ts ,section #ahec ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bc7 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7p7  ,/op-,loss 
paym5ts  7#a7  ,9 g5]al  ,= ye>s beg9n+ 
on or aft] ,janu>y #a1 #bjbh1 !         
,secret>y may e/abli% /op-loss paym5t = 
,m$ic>e ,advantage plans t exp]i5ce     
significantly high] exp5ditures comp>$  
to ! risk-adju/$ expect$ exp5ditures (  

su* plans4  7#b7  ,requirem5ts  ,any    
paym5t describ$ 9 p>agraph 7#a7 %all be 
bas$ on enc\nt] data subject to audit by
 ! ,secret>y4  7#c7  ,adju/m5ts  ,!     
,secret>y may make su* paym5t adju/m5ts 
"u ?is "p z ! ,secret>y det]m9es        
necess>y to ensure t ?is p>agraph is    
implem5t$ 9 a budget-neutral mann]4  4  
7c7 ,automatic enrollm5t2 plan *ange    
limitations ,"p ,c ( title ,,xviii ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#ba et seq47 is am5d$ by add+ at 
! end ! foll[+ new section3  #ahei;,a4  
,automatic enrollm5t2 plan *ange        
limitations  7a7 ,automatic enrollm5t   
7#a7 ,9 g5]al ,not)/&+ any o!r provision
 ( ?is title1 = plan ye>s beg9n+ on or  
aft] ,janu>y #a1 #bjbh1 ! ,secret>y %all
 provide = ! automatic enrollm5t ( ea*  
individual entitl$ to b5efits "u "p ,a &
 enroll$ "u "p ,b into ! ,,ma plan ) !  
l[e/ premium available to su*           
individual4  7#b7 ,special rule if      
multiple l[-co/ plans available ,9 !    
case t multiple ,,ma plans are available

 at ! l[e/ premium applicable "u ?is "p 
= a plan ye> = an individual1 !         
,secret>y %all provide = ! automatic    
enrollm5t ( individuals describ$ 9      
p>agraph 7#a7 among su* plans 9 a mann] 
det]m9$ appropriate by ! ,secret>y4     
7#c7 ,opt out ,! ,secret>y %all provide 
ea* individual automatically enroll$    
into a qualifi$ ,,ma plan "u ?is        
subsection ) an opportunity to decl9e   
su* enrollm5t4  7b7 ,m&atory cont9u\s   
enrollm5t  7#a7 ,9 g5]al ,not)/&+ any   
o!r provision ( ?is title1 except z     
provid$ 9 p>agraph 7#b71 9 ! case ( an  
individual :o enrolls 9 an ,,ma plan = a
 plan ye> beg9n+ on or aft] ,janu>y #a1 
#bjbh1 su* individual may n1 = ! #c-ye> 
p]iod beg9n+ on ! date su* individual s 
enrolls 9 su* ,,ma plan-- 7,a7 enroll 9 
any o!r ,,ma plan "u ?is "p2 or  7,b7   
elect to receive b5efits "u ?is title   
?r\gh traditional fee-=-s]vice ,m$ic>e  
"u "p ,a or ,b4  7#b7 ,exceptions       
,p>agraph 7#a7 %all n apply 9 ! case (  
an individual :o exp]i5ces a h>d%ip ev5t

 7su* z a s]i\s illness 7z specifi$ by !
 ,secret>y774  4  7d7 ,requir$ inclusion
 ( hospice c>e ,section #aheb ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bb7 is am5d$-- 7#a7 9 subsection
 7a77#a77;,b77i71 by ins]t+ 7except 9 ! 
case ( an ,,ma plan (f]$ 9 a plan ye>   
beg9n+ on or aft] ,janu>y #a1 #bjbh7    
aft] hospice c>e2 &  7#b7 9 subsection  
7m77#f71 by ins]t+ 7except 9 ! case ( an
 ,,ma plan (f]$ 9 a plan ye> beg9n+ on  
or aft] ,janu>y #a1 #bjbh7 aft] hospice 
c>e4  7e7 ,/>k exception ,section       
#ahgg7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acienn7b77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#f7 ,exception = c]ta9 s]vices furni%$ 
"u ,,ma plans ,9 ! case ( designat$     
heal? s]vices consi/+ ( durable m$ical  
equipm5t or cov]$ "p ,d drugs1 if su*   
s]vices are furni%$ "u an ,,ma plan4  4