,,ii  #aai? ,,congress  #a/ ,session    
,s4 #acii  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #i1 #bjbe,mr4   
,r\nds 7= himself1 ,mr4 ,he9ri*1 & ,mrs4
 ,blackburn7 introduc$ ! foll[+ bill2   
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to ensure appropriate paym5t (    
c]ta9 algori?m-bas$ heal?c>e s]vices "u 
! ,m$ic>e program4  #a4 ,%ort title ,?is
 ,act may be cit$ z ! ,heal? ,te*       
,inve/m5t ,act4  #b4 ,ensur+ appropriate
 paym5t ( c]ta9 algori?m-bas$ heal?c>e  
s]vices "u ! ,m$ic>e ,program  7a7 ,9   
g5]al ,section #ahcc7t7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4 #aciel7t77
 is am5d$-- 7#a7 9 p>agraph 7#b77;,e71  
by ins]t+ & new te*nology ambulatory    
paym5t classification ( algori?m-bas$   
heal?c>e s]vices "u p>agraph 7#af77;,h7 
aft] 7#af77;,g72 &  7#b7 9 p>agraph     
7#af71 by add+ at ! end ! foll[+ new    
subp>agraph3  7,h7 ,special rule = c]ta9
 algori?m-bas$ heal?c>e s]vices  7i7 ,9 

g5]al ,9 ! case ( a cov]$ ,,opd s]vice  
furni%$ on or aft] ,janu>y #a1 #bjbf1 t 
is an algori?m-bas$ heal?c>e s]vice 7z  
def9$ 9 clause 7ii77 t is assign$ to a  
new te*nology ambulatory paym5t         
classification 7z describ$ 9 ! f9al rule
 entitl$ ,m$ic>e ,program2 ,*anges to ! 
,hospital ,outpati5t ,prospective       
,paym5t ,sy/em = ,cal5d> ,ye> #bjjb     
publi%$ by ! ,dep>tm5t ( ,heal? & ,human
 ,s]vices on ,novemb] #cj1 #bjja 7#ff   
,f$4 ,reg4 #eihig77 on or aft] ! date ( 
! enactm5t ( ?is subp>agraph or = :i*1 z
 ( su* date1 is curr5tly & has be5      
assign$ to a new te*nology ambulatory   
paym5t classification = a p]iod ( less  
?an #e ye>s1 ! ,secret>y-- 7,i7 %all    
ensure t su* s]vice is assign$ to a new 
te*nology ambulatory paym5t             
classification bas$ on ! co/ ( su*      
s]vice z submitt$ by ! manufactur] ( su*
 s]vice 9 a =m & mann] specifi$ by !    
,secret>y1 includ+ co/s = ! te*nology   
bas$ on invoice prices1                 
subscription-bas$ prices1 cl9ical /aff1 

ov]head1 & o!r co/s associat$ ) provid+ 
! s]vice2  7,,ii7 %all adju/ ! new      
te*nology ambulatory paym5t             
classification pursuant to subclause    
7,i7 z necess>y2 &  7,,iii7 may n remove
 su* s]vice f ! new te*nology ambulatory
 paym5t classification z det]m9$ "u     
subclauses 7,i7 & 7,,ii7 until !        
,secret>y det]m9es t adequate claims    
data exi/s to reassign su* s]vice to    
ano!r ambulatory paym5t classification  
7:i* 9 no case may be be=e su* s]vice   
has receiv$ paym5t "u ! assign$ new     
te*nology ambulatory paym5t             
classification = at lea/ #e ye>s74  7ii7
 ,adju/m5t ,! ,secret>y %all adju/ !    
application process & crit]ia = ! new   
te*nology ambulatory paym5t             
classification to ensure t1 9 addition  
to curr5tly eligible algori?m-bas$      
heal?c>e s]vices1 algori?m-bas$ heal?c>e
 s]vices t o!rwise meet ! eligibility   
requirem5ts = su* classification & are  
di/9ct f b p]=m$ concurr5tly )1         
adjunctive to1 or provid$ 9 any o!r     

modality or =m z "p ( an und]ly+ s]vice 
& require additional res\rces1 meet--   
7,i7 ! eligibility requirem5t t !y are  
di/9ct new proc$ures ) a beg9n+1 middle1
 & end2 or  7,,ii7 any subsequ5t simil> 
new te*nology ambulatory paym5t         
classification eligibility requirem5t4  
7iii7 ,def9ition ( algori?m-bas$        
heal?c>e s]vice ,= purposes ( ?is       
subp>agraph1 ! t]m algori?m-bas$        
heal?c>e s]vice means a s]vice deliv]$  
?r\gh a device cle>$ or approv$ by !    
,food & ,drug ,adm9i/ration t uses      
artificial intellig5ce1 ma*9e le>n+1 or 
o!r simil>ly design$ s(tw>e to yield    
cl9ical outputs or g5]ate cl9ical       
conclusions = use by a physician or     
practition] 9 ! scre5+1 detection1      
diagnosis1 or treatm5t ( an individual's
 condition or disease1 or any su* o!r   
simil> s]vice z ! ,secret>y det]m9es    
appropriate 9 consultation ) appropriate
 organizations4  4  7b7 ,codify+ ,,opps 
paym5t = s(tw>e z a s]vice ,effective = 
s]vices provid$ on or aft] ,janu>y #a1  

#bjbc1 ! ,secret>y ( ,heal? & ,human    
,s]vices %all apply ! hospital outpati5t
 prospective paym5t sy/em paym5t =      
s(tw>e z a s]vice policy describ$ 9 !   
f9al rule entitl$1 ,m$ic>e ,program3    
,hospital ,outpati5t ,prospective       
,paym5t & ,ambulatory ,surgical ,c5t]   
,paym5t ,sy/ems & ,quality ,report+     
,programs2 ,organ ,acquisition2 ,rural  
,em]g5cy ,hospitals3 ,paym5t ,policies1 
,conditions ( ,p>ticipation1 ,provid]   
,enrollm5t1 ,physician ,self-,ref]ral2  
,new ,s]vice ,category = ,hospital      
,outpati5t ,dep>tm5t ,prior             
,au?orization ,process2 ,ov]all         
,hospital ,quality ,/> ,rat+2           
,,covid-#ai publi%$ by ! ,dep>tm5t (    
,heal? & ,human ,s]vices on ,novemb]    
#bc1 #bjbb 7#hg ,f$4 ,reg4 #gagdh74