,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #ebha  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,septemb] #aj1        
#bjbe,mr4 ,panetta 7= himself1 ,mr4     
,murphy1 ,mr4 ,l&sman1 ,mr4 ,s*neid]1 & 
,mr4 ,fitzpatrick7 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 ( ! ,social ,security ,act
 to e/abli% provid] directory           
requirem5ts1 & to provide acc\ntability 
= provid] directory accuracy1 "u ,m$ic>e
 ,advantage4  #a4 ,%ort title ,?is ,act 
may be cit$ z ! ,requir+ ,enhanc$ &     
,accurate ,li/s ( ,heal? ,provid]s ,act 
or ! ,,real ,heal? ,provid]s ,act4  #b4 
,provid] directory requirem5ts "u       
,m$ic>e ,advantage  7a7 ,9 g5]al        
,section #aheb7;c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#bb7;c77 is 

am5d$--  7#a7 9 p>agraph 7#a77;,c7--    
7,a7 by /rik+ plan1 & any & ins]t+ plan1
 any2 &  7,b7 by ins]t+ ! foll[+ be=e ! 
p]iod3 1 &1 9 ! case ( a specifi$ ,,ma  
plan 7z def9$ 9 p>agraph 7#c77;,c771 =  
plan ye> #bjbh & subsequ5t plan ye>s1 ! 
in=mation describ$ 9 p>agraph 7#c77;,b72
 &  7#b7 by add+ at ! end ! foll[+ new  
p>agraph3  7#c7 ,provid] directory      
accuracy  7,a7 ,9 g5]al ,= plan ye>     
#bjbh & subsequ5t plan ye>s1 ea* ,,ma   
organization (f]+ a specifi$ ,,ma plan  
7z def9$ 9 subp>agraph 7,c77 %all1 = ea*
 su* plan (f]$ by ! organization-- 7i7  
ma9ta91 on a publicly available int]net 
website1 an accurate provid] directory t
 includes ! in=mation describ$ 9        
subp>agraph 7,b72  7ii7 n less frequ5tly
 ?an once e #ij days 7or1 9 ! case ( a  
hospital or any o!r facility det]m9$    
appropriate by ! ,secret>y1 at a less]  
frequ5cy specifi$ by ! ,secret>y b 9 no 
case less frequ5tly ?an once e #ab      
mon?s71 v]ify ! provid] directory       
in=mation ( ea* provid] li/$ 9 su*      

directory &1 if applicable1 update su*  
provid] directory in=mation2  7iii7 if !
 organization is unable to v]ify su*    
in=mation ) respect to a provid]1       
include 9 su* directory an indication t 
! in=mation ( su* provid] may n be up to
 date2 &  7iv7 remove a provid] f su*   
directory )9 #e bus9ess days if !       
organization det]m9es t ! provid] is no 
long] a provid] p>ticipat+ 9 ! network (
 su* plan4  7,b7 ,provid] directory     
in=mation ,! in=mation describ$ 9 ?is   
subp>agraph is in=mation enrollees may  
ne$ to access cov]$ b5efits f a provid] 
) :i* su* organization (f]+ su* plan has
 an agreem5t = furni%+ items & s]vices  
cov]$ "u su* plan su* z "n1 specialty1  
contact in=mation1 prim>y (fice or      
facility address1 :e!r ! provid] is     
accept+ new pati5ts1 accommodations = p 
) disabilities1 cultural & l+ui/ic      
capabilities1 & teleheal? capabilities4 
7,c7 ,specifi$ ,,ma plan ,9 ?is         
p>agraph1 ! t]m specifi$ ,,ma plan      
means-- 7i7 a network-bas$ plan 7z def9$

 9 subsection 7d77#e77;,c772 or  7ii7 a 
,m$ic>e ,advantage private fee-=-s]vice 
plan 7z def9$ 9 section #ahei7;b77#b77 t
 meets ! access /&>ds "u subsection     
7d77#d71 9 :ole or 9 "p1 ?r\gh ent]+    
into contracts or agreem5ts z provid$ = 
"u subp>agraph 7,b7 ( su* subsection4  4
  7b7 ,acc\ntability = provid] directory
 accuracy  7#a7 ,co/ ,%>+ = ,s]vices    
,furni%$ ,bas$ on ,reliance on          
,incorrect ,provid] directory ,in=mation
 ,section #aheb7;d7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7;d77 is am5d$--  7,a7 9      
p>agraph 7#a77;,c7-- 7i7 9 clause 7ii71 
by /rik+ or at ! end2  7ii7 9 clause    
7iii71 by /rik+ ! semicolon at ! end &  
ins]t+ 1 or2 &  7iii7 by add+ at ! end !
 foll[+ new clause3  7iv7 ! s]vices are 
furni%$ by a provid] t is n p>ticipat+ 9
 ! network ( a specifi$ ,,ma plan 7z    
def9$ 9 subsection 7c77#c77;,c77 b is   
li/$ 9 ! provid] directory ( su* plan on
 ! date on :i* ! appo9tm5t is made1 z   
describ$ 9 p>agraph 7#g77;,a72  2 &     

7,b7 by add+ at ! end ! foll[+ new      
p>agraph3  7#g7 ,co/ %>+ = s]vices      
furni%$ bas$ on reliance on incorrect   
provid] directory in=mation  7,a7 ,9    
g5]al ,= plan ye> #bjbh & subsequ5t plan
 ye>s1 if an enrollee is furni%$ an item
 or s]vice by a provid] t is n          
p>ticipat+ 9 ! network ( a specifi$ ,,ma
 plan 7z def9$ 9 subsection             
7c77#c77;,c77 b is li/$ 9 ! provid]     
directory ( su* plan 7z requir$ to be   
provid$ to an enrollee pursuant to      
subsection 7c77#a77;,c77 on ! date on   
:i* ! appo9tm5t is made1 & if su* item  
or s]vice w\ld o!rwise be cov]$ "u su*  
plan if furni%$ by a provid] t is       
p>ticipat+ 9 ! network ( su* plan1 !    
,,ma organization (f]+ su* plan %all    
ensure t ! enrollee is only responsible 
= ! less] (-- 7i7 ! am\nt ( co/ %>+ t   
w\ld apply if su* provid] _h be5        
p>ticipat+ 9 ! network ( su* plan2 or   
7ii7 ! am\nt ( co/ %>+ t w\ld o!rwise   
apply 7)\t reg>d to ?is subp>agraph74   
7,b7 ,notification requirem5t ,= plan   

ye> #bjbh & subsequ5t plan ye>s1 ea*    
,,ma organization t (f]s a specifi$ ,,ma
 plan %all--  7i7 notify enrollees ( _! 
co/-%>+ protections "u ?is p>agraph &   
make su* notifications1 to ! ext5t      
practicable1 by n lat] ?an ! fir/ day ( 
an annual1 coord9at$ election p]iod "u  
section #ahea7;e77#c7 ) respect to a    
ye>2  7ii7 include in=mation reg>d+ su* 
co/-%>+ protections 9 ! provid]         
directory ( ea* specifi$ ,,ma plan (f]$ 
by ! ,,ma organization2 &  7iii7 notify 
enrollees ( _! co/-%>+ protections "u   
?is p>agraph 9 an explanation ( b5efits4
  4  7#b7 ,requir$ provid] directory    
accuracy analysis & reports  7,a7 ,9    
g5]al ,section #aheg7;e7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciew-#bg7;e77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#f7        
,provid] directory accuracy analysis &  
reports  7,a7 ,9 g5]al ,beg9n+ ) plan   
ye>s beg9n+ on or aft] ,janu>y #a1      
#bjbh1 subject to subp>agraph 7,c71 a   
contract "u ?is section ) an ,,ma       

organization %all require !             
organization1 = ea* specifi$ ,,ma plan  
7z def9$ 9 section #aheb7;c77#c77;,c77  
(f]$ by ! organization to annually d !  
foll[+3 7i7 ,conduct an analysis e/imat+
 ! accuracy ( ! provid] directory       
in=mation ( su* plan us+ a r&om sample (
 provid]s includ$ 9 su* provid]         
directory z foll[s3  7,i7 ,su* a r&om   
sample %all include a r&om sample ( ea* 
specialty ( provid]s ) a high inaccuracy
 rate ( provid] directory in=mation     
relative to o!r specialties ( provid]s1 
z det]m9$ by ! ,secret>y4  7,,ii7 ,=    
purposes ( subclause 7,i71 "o type (    
specialty may be provid]s specializ+ 9  
m5tal heal? or sub/ance use disord]     
treatm5t4  7ii7 ,submit to ! ,secret>y a
 report conta9+ ! results ( ! analysis  
conduct$ "u clause 7i71 includ+ an      
accuracy score = su* provid] directory  
in=mation 7z det]m9$ us+ a plan         
v]ification me?od specifi$ by !         
,secret>y "u subp>agraph 7,b77i774  7,b7
 ,det]m9ation ( accuracy score  7i7 ,9  

g5]al ,! ,secret>y %all specify plan    
v]ification me?ods1 su* z us+ telephonic
 v]ification or o!r approa*es us+ data  
s\rces ma9ta9$ by an ,,ma organization  
or us+ publicly available data sets1 t  
,,ma organizations may use = e/imat+    
accuracy scores ( ! provid] directory   
in=mation ( specifi$ ,,ma plans (f]$ by 
su* organizations4  7ii7 ,accuracy score
 me?odology ,) respect to ea* su* me?od 
specifi$ by ! ,secret>y z describ$ 9    
clause 7i71 ! ,secret>y %all specify a  
me?odology = ,,ma organizations to use 9
 e/imat+ su* accuracy scores4 ,ea* su*  
me?odology %all take into acc\nt !      
adm9i/rative burd5 on plans & provid]s &
 ! relative importance ( c]ta9 provid]  
directory in=mation on enrollee ability 
to access c>e4  7,c7 ,exception ,!      
,secret>y may waive ! requirem5ts ( ?is 
p>agraph 9 ! case ( a specifi$ ,,ma plan
 ) l[ enrollm5t 7z def9$ by !           
,secret>y74  7,d7 ,transp>5cy ,beg9n+ ) 
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbi1 ! ,secret>y %all po/ accuracy    

scores 7z report$ "u subp>agraph        
7,a77ii771 9 a ma*9e readable file1 on !
 int]net website ( ! ,c5t]s = ,m$ic>e   
,m$icaid ,s]vices4  4  7,b7 ,provision (
 in=mation to b5efici>ies ,section      
#ahea7;d77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#ba7;d77#d77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,f7 ,provid] ,directory  
,beg9n+ ) plan ye>s beg9n+ on or aft]   
,janu>y #a1 #bjbi1 ! accuracy score ( ! 
plan's provid] directory 7z report$ "u  
section #aheg7;e77#f77;,a77ii77 li/$    
prom95tly on ! plan's provid] directory4
  4  7,c7 ,fund+ ,9 addition to am\nts  
o!rwise available1 !re is appropriat$ to
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
,program ,managem5t ,acc\nt1 out ( any  
money 9 ! ,treasury n o!rwise           
appropriat$1 #d1jjj1jjj = fiscal ye>    
#bjbf1 to rema9 available until exp5d$1 
to c>ry out ! am5dm5ts made by ?is      
p>agraph4  7#c7 ,,gao /udy & report     
7,a7 ,analysis ,! ,comptroll] ,g5]al ( !
 ,unit$ ,/ates 79 ?is p>agraph ref]r$ to

 z ! ,comptroll] ,g5]al7 %all conduct a 
/udy ( ! implem5tation ( ! am5dm5ts made
 by p>agraphs 7#a7 & 7#b74 ,to ! ext5t  
data are available & reliable1 su* /udy 
%all include an analysis (-- 7i7 ! use (
 co/-%>+ protections requir$ "u section 
#aheb7;d77#g77;,a7 ( ! ,social ,security
 ,act1 z add$ by p>agraph 7#a72  7ii7 ! 
tr5ds 9 provid] directory in=mation     
accuracy scores "u section              
#aheg7;e77#f77;,a77ii7 ( ! ,social      
,security ,act 7z add$ by p>agraph      
7#b77;,a771 bo? ov]all & among provid]s 
specializ+ 9 m5tal heal? or sub/ance use
 disord] treatm5t2  7iii7 provid]       
response rates by plan v]ification      
me?ods2  7iv7 adm9i/rative co/s to      
provid]s & ,m$ic>e ,advantage           
organizations2 &  7v7 o!r items det]m9$ 
appropriate by ! ,comptroll] ,g5]al4    
7,b7 ,report ,n lat] ?an ,janu>y #ae1   
#bjcb1 ! ,comptroll] ,g5]al %all submit 
to ,congress a report conta9+ ! results 
( ! /udy conduct$ "u subp>agraph 7,a71  
toge!r ) recomm5dations = su*           

legislation & adm9i/rative action z !   
,comptroll] ,g5]al det]m9es appropriate4
  7c7 ,guidance on ma9ta9+ accurate     
provid] directories  7#a7 ,/akehold]    
meet+  7,a7 ,9 g5]al ,n lat] ?an #c     
mon?s aft] ! date ( enactm5t ( ?is ,act1
 ! ,secret>y ( ,heal? & ,human ,s]vices 
7ref]r$ to 9 ?is subsection z !         
,secret>y7 %all hold a public meet+ to  
receive input on approa*es = ma9ta9+    
accurate provid] directories = ,m$ic>e  
,advantage plans "u "p ,c ( title       
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #aciew-#ba et seq471 includ+  
input on approa*es = r$uc+ adm9i/rative 
burd51 su* z data /&>dization1 & be/    
practices to ma9ta9 accurate provid]    
directory in=mation4  7,b7 ,p>ticipants 
,p>ticipants ( ! meet+ "u subp>agraph   
7,a7 %all include repres5tatives f !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices & ! 
,assi/ant ,secret>y = ,te*nology ,policy
 & ,(fice ( ! ,national ,coord9ator =   
,heal? ,in=mation ,te*nology4 ,su* meet+
 %all be op5 to ! public4 ,to ! ext5t   

practicable1 ! ,secret>y %all include   
heal? c>e provid]s1 companies t         
specialize 9 relevant te*nologies1 heal?
 insur]s1 & pati5t advocates4  7#b7     
,guidance to ,m$ic>e ,advantage         
organizations ,n lat] ?an #ab mon?s aft]
 ! date ( enactm5t ( ?is ,act1 !        
,secret>y %all issue guidance to ,m$ic>e
 ,advantage organizations (f]+ ,m$ic>e  
,advantage plans "u "p ,c ( title       
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #aciew-#ba et seq47 on ma9ta9+
 accurate provid] directories = su*     
plans1 tak+ into consid]ation input     
receiv$ dur+ ! /akehold] meet+ "u       
p>agraph 7#a74 ,su* guidance may include
 ! foll[+1 z det]m9$ appropriate by !   
,secret>y3  7,a7 ,be/ practices =       
,m$ic>e ,advantage organizations on h[  
to "w ) provid]s to ma9ta9 ! accuracy ( 
provid] directories & r$uce provid] &   
,m$ic>e ,advantage organization burd5 ) 
respect to ma9ta9+ ! accuracy ( provid] 
directories4  7,b7 ,in=mation on data   
sets & data s\rces ) in=mation t c\ld be

 us$ by ,m$ic>e ,advantage organizations
 to ma9ta9 accurate provid] directories4
  7,c7 ,approa*es = utiliz+ data s\rces 
ma9ta9$ by ,m$ic>e ,advantage           
organizations & publicly available data 
sets to ma9ta9 accurate provid]         
directories4  7,d7 ,in=mation to be     
includ$ 9 provid] directories t may be  
useful = ,m$ic>e b5efici>ies to assess  
plan networks :5 select+ a plan &       
access+ provid]s p>ticipat+ 9 plan      
networks dur+ ! plan ye>4  7#c7         
,guidance to "p ,b provid]s ,n lat] ?an 
#ab mon?s aft] ! date ( enactm5t ( ?is  
,act1 ! ,secret>y %all issue guidance to
 provid]s ( s]vices & suppli]s :o furni%
 items or s]vices = :i* b5efits are     
available "u "p ,b ( title ,,xviii ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;j et seq47 on :5 to update !      
,national ,plan & ,provid] ,enum]ation  
,sy/em = in=mation *anges4