,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ijed  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #bi1 #bjbf,mr4   
,espaillat 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% a demon/ration program =        
int]national cov]age "u ! ,m$ic>e       
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,e>n$ ,b5efits ,equality &  
,family ,reunification ,act4  #b4       
,e/abli%+ a demon/ration program =      
int]national cov]age "u ! ,m$ic>e       
program ,title ,,xviii ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 is am5d$ by ins]t+ aft] section   
#ahff;,g ! foll[+ new section3          
#ahff;,h4 ,demon/ration program =       
int]national cov]age  7a7 ,implem5tation

 ( #aj-,ye> demon/ration program ,n lat]
 ?an #a ye> aft] ! date ( ! enactm5t (  
?is section1 ! ,secret>y %all implem5t a
 #aj-ye> demon/ration program "u ?is    
title 79 ?is section ref]r$ to z !      
,program7 to all[ ,applicable           
,b5efici>ies to apply ,m$ic>e b5efits to
 cov]age ( items & s]vices1 premiums1 & 
o!r co/-%>+ "u ! heal? insurance sy/ems 
( o!r c\ntries4 ,?r\gh ! ,program1 !    
,secret>y %all make paym5ts "u          
subsection 7e7 to or on behalf (        
,applicable ,b5efici>ies p>ticipat+ 9 ! 
,program4  7b7 ,program design  7#a7 ,9 
g5]al ,! ,secret>y %all design !        
,program 9 su* a mann] to all[ = !      
evaluation ( ! ext5t to :i* ! ,program  
accompli%es ! foll[+ purposes3  7,a7    
,increases ! quality ( c>e = ,applicable
 ,b5efici>ies p>ticipat+ 9 ! ,program4  
7,b7 ,decreases ! co/ ( c>e to !        
gov]nm5t = ! ,applicable ,b5efici>ies4  
7,c7 ,enables ,applicable ,b5efici>ies  
to reunify ) family memb]s4  7,d7 ,r$uc$
 /ra9 on ! m$ical infra/ructure ( !     

,unit$ ,/ates4  7#b7 ,consultation ,9   
design+ ! ,program1 ! ,secret>y %all use
 op5 door =ums & o!r me*anisms to seek  
input f a consortium ( /akehold]s t may 
include b are n limit$ to-- 7,a7 !      
,unit$ ,/ates ,dep>tm5t ( ,/ate2  7,b7  
cl9ical & analytical exp]ts ) relevant  
exp]tise2  7,c7 b5efici>ies2 &  7,d7    
=eign heal? insurance sy/em exp]ts4     
7#c7 ,program consid]ations ,9          
consultation ) /akehold]s z id5tifi$ 9  
subsection 7b77#b71 ! ,secret>y %all    
issue guidance on--  7,a7 ! guidel9es to
 ensure ! usage ( m$ications & equipm5t 
t are ( acceptable quality relative to  
,am]ican quality /&>ds2  7,b7 ways to   
ensur+ quality ( c>e2 &  7,c7 ways to   
t>get l[-income ,am]icans z p>ticipants 
9 ! program4  7c7 ,select$ c\ntries     
initial selection ,9 *oos+ ,select$     
,c\ntries = ! ,program1 ! ,secret>y %all
 initially select at lea/ #aa di/9ct    
nations or political subdivisions !re(1 
:i* %all include ,canada1 ! ,f$]al      
,republic ( ,g]many1 ! ,republic (      

,india1 ! ,/ate ( ,israel1 ! ,republic (
 ,korea1 ! ,republic ( ! ,philipp9es1 ! 
,republic ( ,panama1 ! ,unit$ ,mexican  
,/ates1 ,dom9ican ,republic1 & ,ghana4  
7d7 ,applicable b5efici>y  7#a7         
,volunt>y b5efici>y p>ticipation ,an    
,applicable ,b5efici>y may p>ticipate 9 
! ,program on a volunt>y basis & may    
t]m9ate p>ticipation 9 ! ,program at any
 "t4 ,! election to p>ticipate 9 !      
,program or to t]m9ate p>ticipation %all
 con/itute a ,special ,election ,p]iod  
"u section #aheb7;e77#d7 ( ?is title4   
7#b7 ,s]vices ,9 ord] to p>ticipate 9 ! 
,program1 an ,applicable ,b5efici>y %all
 agree to receive cov]age ( heal? c>e   
items & s]vices 9 a ,select$ ,c\ntry    
dur+ su* "t z ! ,applicable ,b5efici>y  
is a resid5t ( t c\ntry4  7#c7          
,b5efici>y access to s]vices ,no?+ 9 ?is
 section %all be con/ru$ z limit+ an    
,applicable ,b5efici>y's access to items
 & s]vices cov]$ "u ?is title :5 furni%$
 9 ! ,unit$ ,/ates1 & ,applicable       
,b5efici>ies %all n be requir$ to       

rel9qui% access to su* b5efits z a      
condition ( receiv+ s]vices f a         
p>ticipant 9 ! ,program4  7#d7 ,numb] ( 
applicable b5efici>ies ,! ,secret>y may 
cap ! numb] ( ,applicable ,b5efici>ies  
accept$ into ! ,program1 b at a numb] no
 small] ?an #aej1jjj4  7e7 ,physician   
c]tification ,p>ticipat+ physicians mu/ 
be 9 good /&+ ) accr$itation in/itutions
 or lic5s+ au?orities 9 ! ,select$      
,c\ntries4  7f7 ,paym5ts  7#a7 ,9 g5]al 
,! ,secret>y %all make paym5ts to or on 
behalf ( ,applicable ,b5efici>ies = !   
co/s ( heal? c>e items & s]vices paid by
 ,applicable ,b5efici>ies 9 ,select$    
,c\ntries4 ,su* paym5ts may include     
paym5ts = individual items or s]vices   
paid by ,applicable ,b5efici>ies1       
paym5ts = co/ %>+ incurr$ by ,applicable
 ,b5efici>ies1 & premiums & equival5t   
*>ges = heal? insurance cov]age paid by 
,applicable ,b5efici>ies4 ,paym5ts %all 
n include reimbursem5t = taxes levi$ on 
income = ! purpose ( fund+ heal? c>e4   
7#b7 ,paym5t am\nts ,! ,secret>y %all   

limit ! am\nts ( paym5t to ensure su*   
paym5ts & funds exp5d$ to design1       
implem5t1 & evaluate ! ,program d n     
exce$ 9 ! aggregate ! am\nt ! ,secret>y 
w\ld pay "u ?is title = equival5t       
s]vices deliv]$ 9 ! ,unit$ ,/ates4  7#c7
 ,no duplicate paym5t ,! ,secret>y %all 
make or p]mit paym5ts "u ?is p>agraph   
only = a cal5d> mon? 9 :i* ! ,applicable
 ,b5efici>y resides 9 ! ,select$ ,c\ntry
 & does n incur any co/s "u ?is title   
o!r ?an ! paym5t h]eund]4  7g7 ,role (  
m$ic>e advantage  7#a7 ,9 c>ry+ out !   
,program1 ! ,secret>y may adm9i/] !     
,program1 ei!r 9 "p or exclusively1     
?r\gh ,m$ic>e ,advantage ,organizations4
  7#b7 ,to ! ext5t ,m$ic>e ,advantage   
,organizations c>ry out functions "u !  
,program1 paym5ts made by su*           
organizations "u subsection 7e7 %all be 
consid]$ z if !y 7 b5efits "u ! orig9al 
,m$ic>e fee-=-s]vice program option =   
purposes ( sections #aheb & #ahed ( ?is 
title1 & a compon5t ( /&>d prescription 
drug cov]age & n supplem5tal            

prescription drug cov]age1 "u section   
#ahfj;,d#b7;a7 ( ?is title4  7#c7 ,!    
,secret>y may limit ! numb] ( ,m$ic>e   
,advantage ,organizations p>ticipat+ 9 !
 ,program1 9 accordance ) crit]ia       
e/abli%$ by ! ,secret>y4  7h7 ,report+  
,! ,secret>y %all conduct annual        
int]m$iate & a f9al evaluation ( !      
,program4 ,ea* su* evaluation %all      
det]m9e ! ext5t to :i* ea* ( ! purposes 
describ$ 9 subsection 7b7 h be5         
accompli%$ "u ! ,program4 ,! evaluation 
%all conta9 recomm5dations to ,congress 
) reg>ds to ! expansion ( ! ,program4   
7i7 ,address+ wa/e1 fraud1 & abuse  7#a7
 ,p>ticipat+ physicians are requir$ to g
 ?r\gh ,fraud1 ,wa/e1 & ,abuse tra9+ )9 
#ij days ( implem5tation ( !            
demon/ration project & at lea/ annually 
!reaft]4  7#b7 ,! ,secret>y mu/ create a
 sy/em to all[ pati5ts & physicians to  
report in/ances or conc]ns ( wa/e1      
fraud1 & abuse4  7j7 ,def9itions ,9 ?is 
section3 7#a7 ,applicable b5efici>y ,!  
t]m ,applicable ,b5efici>y means an     

individual :o--  7,a7 is entitl$ to or  
enroll$ = b5efits "u "p ,a1 & enroll$ = 
b5efits "u "p ,b2  7,b7 may be enroll$ 9
 a ,m$ic>e ,advantage plan "u "p ,c2    
7,c7 is ei!r-- 7i7 a resid5t ( ! ,unit$ 
,/ates at ! "t ( application to !       
,program :o int5ds to relocate to a     
,select$ ,c\ntry on or aft] ! date ( su*
 application1 or is a =m] resid5t ( !   
,unit$ ,/ates :o has relocat$ to a      
,select$ ,c\ntry )9 #ahj days (         
application to ! ,program2 or  7ii7 a   
resid5t ( a ,select$ ,c\ntry = :om !    
,m$ic>e program is at ! "t ( application
 ! prim>y payor ( _! heal? c>e co/s2 &  
7,d7 meets su* o!r crit]ia z ! ,secret>y
 det]m9es appropriate4  7#b7 ,select$   
c\ntry ,! t]m ,select$ ,c\ntry means a  
nation or political subdivision !re(    
id5tifi$ by ! ,secret>y z hav+ a heal?  
c>e sy/em t provides =-- 7,a7 heal? c>e 
cov]age 9 scope & quality ( cov]age     
appropriate = ,m$ic>e b5efici>ies 9     
accordance ) crit]ia e/abli%$ by !      
,secret>y2 &  7,b7 co/ ( cov]age1       

co9surance1 & items & s]vices t is      
equival5t to or less ?an expect$ co/s = 
su* cov]age1 co9surance1 & items &      
s]vices 9 ! ,unit$ ,/ates "u ?is title4 
7k7 ,fund+  7#a7 ,adm9i/rative fund+ ,! 
,secret>y %all allocate funds made      
available "u section #aaae;,a7f77#a7 to 
design1 implem5t1 & evaluate ! ,program4
  7#b7 ,b5efit fund+ ,paym5ts = items & 
s]vices "u ! ,program %all be made 9    
appropriate "p f ! ,f$]al ,hospital     
,insurance ,tru/ ,fund e/abli%$ by      
section #ahag ( ?is title & ! ,f$]al    
,supplem5t>y ,m$ical ,insurance ,tru/   
,fund e/abli%$ by section #ahda ( ?is   
title4  7l7 ,waiv]s ,! ,secret>y may    
waive any provision ( ?is title z may be
 necess>y to c>ry out ! ,program "u ?is 
section4  7m7 ,limitations on review    
,!re %all be no adm9i/rative or judicial
 review "u section #ahfi1 section #ahgh1
 or o!rwise (-- 7#a7 ! selection (      
organizations1 sites1 or p>ticipants to 
te/ ! ,program2 &  7#b7 ! elem5ts1      
p>amet]s1 scope1 & duration ( !         

,program4 ,! prec$+ s5t5ce %all n prev5t
 an ,applicable ,b5efici>y1 hav+ be5    
select$ z a p>ticipant1 f ex]cis+ a "r  
to appeal "u sections #ahfi1 #aaee1     
#aheb7;g71 #ahfj;,d-#d1 or o!rwise4  7n7
 ,adm9i/ration  7#a7 ,*apt] #ce ( title 
#dd1 ,unit$ ,/ates ,code1 %all n apply  
to ! activities "u ?is section4  7#b7 ,!
 ,secret>y may ent] into contracts = !  
adm9i/ration ( ! ,program )\t reg>d to  
any requirem5t = ! use ( competitive    
proc$ures4  4