,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bgji  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #d1 #bjbe    
,mr4 ,scott ( ,s\? ,c>ol9a 7= himself1  
,mr4 ,s*atz1 ,mrs4 ,hyde-,smi?1 ,mrs4   
,gillibr&1 ,mr4 ,tillis1 & ,mr4 ,k+7    
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
ext5d c]ta9 teleheal? flexibilities "u !
 ,m$ic>e program4  #a4  ,%ort title     
,?is ,act may be cit$ z ! ,teleheal?    
,mod]nization ,act4  #b4  ,ext5sion (   
c]ta9 teleheal? flexibilities  7a7      
,remov+ geographic requirem5ts & exp&+  
orig9at+ sites = teleheal? s]vices      
,section #ahcd7m7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77 is       
am5d$--  7#a7 9 p>agraph 7#b77;,b77iii71
 by /rik+ end+ ,septemb] #cj1 #bjbe &   
ins]t+ end+ ,septemb] #cj1 #bjbg2 &     
7#b7 9 p>agraph 7#d77;,c77iii71 by /rik+
 end+ on ,septemb] #cj1 #bjbe & ins]t+  
end+ on ,septemb] #cj1 #bjbg4  7b7      

,exp&+ practition]s eligible ,to furni% 
teleheal? s]vices  ,section             
#ahcd7m77#d77;,e7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7m77#d77;,e77 
is am5d$ by /rik+ end+ on ,septemb] #cj1
 #bjbe & ins]t+ end+ on ,septemb] #cj1  
#bjbg4  7c7  ,ext5d+ teleheal? s]vices =
 f$]ally qualifi$ heal? c5t]s & rural   
heal? cl9ics  ,section #ahcd7m77#h7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#h77 is am5d$--  7#a7 9       
subp>agraph 7,a71 by /rik+ end+ on      
,septemb] #cj1 #bjbe & ins]t+ end+ on   
,septemb] #cj1 #bjbg2  7#b7 9           
subp>agraph 7,b7-- 7,a7 9 ! subp>agraph 
head+1 by ins]t+ be=e fiscal ye> #bjbf  
aft] rule2  7,b7 9 clause 7i71 by /rik+ 
dur+ ! p]iods = :i* subp>agraph 7,a7    
applies & ins]t+ be=e ,octob] #a1 #bjbe2
 &  7,c7 9 clause 7ii71 by ins]t+       
furni%$ to an eligible teleheal?        
individual be=e ,octob] #a1 #bjbe aft]  
teleheal? s]vices2 &  7#c7 by add+ at ! 
end ! foll[+ new subp>agraph3  7,c7     
,paym5t rule = fiscal ye>s #bjbf & #bjbg

  7i7 ,9 g5]al ,a teleheal? s]vice      
furni%$ to an eligible teleheal?        
individual by a ,f$]ally qualifi$ heal? 
c5t] or rural heal? cl9ic on or aft]    
,octob] #a1 #bjbe1 & be=e ,octob] #a1   
#bjbg1 %all be paid z a ,f$]ally        
qualifi$ heal? c5t] s]vice or rural     
heal? cl9ic s]vice 7z applicable7 "u !  
prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 or ! me?odology =      
all-inclusive rates e/abli%$ "u section 
#ahcc7;a77#c71 respectively4  7ii7      
,treatm5t ( co/s  ,co/s associat$ ) !   
furni%+ ( teleheal? s]vices by a        
,f$]ally qualifi$ heal? c5t] or rural   
heal? cl9ic on or aft] ,octob] #a1      
#bjbe1 & be=e ,octob] #a1 #bjbg1 %all be
 consid]$ all[able co/s = purposes ( !  
prospective paym5t sy/em e/abli%$ "u    
section #ahcd7o7 & ! me?odology =       
all-inclusive rates e/abli%$ "u section 
#ahcc7;a77#c71 z applicable4  4  7d7    
,delay+ 9-,p]son requirem5ts "u ,m$ic>e 
= m5tal heal? s]vices furni%$ ?r\gh     
teleheal? & telecommunications te*nology

  7#a7  ,delay 9 requirem5ts = m5tal    
heal? s]vices furni%$ ?r\gh teleheal?   
,section #ahcd7m77#g77;,b77i7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#g77;,b77i77 is am5d$1 9 !    
matt] prec$+ subclause 7,i71 by /rik+ on
 or aft] ,octob] #a1 #bjbe & ins]t+ on  
or aft] ,octob] #a1 #bjbg4  7#b7  ,m5tal
 heal? visits furni%$ by rural heal?    
cl9ics  ,section #ahcd7y77#b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7y77#b77 is am5d$ by /rik+ ,octob]
 #a1 #bjbe & ins]t+ ,octob] #a1 #bjbg4  
7#c7  ,m5tal heal? visits furni%$ by    
,f$]ally qualifi$ heal? c5t]s  ,section 
#ahcd7o77#d77;,b7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciem7o77#d77;,b77 
is am5d$ by /rik+ ,octob] #a1 #bjbe &   
ins]t+ ,octob] #a1 #bjbg4  7e7  ,all[+ =
 ! furni%+ ( audio-,only teleheal?      
s]vices  ,section #ahcd7m77#i7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m77#i77 is am5d$ by /rik+ end+ on
 ,septemb] #cj1 #bjbe & ins]t+ end+ on  
,septemb] #cj1 #bjbg4  7f7  ,ext5d+ use 

( teleheal? ,to conduct face-to-,face   
enc\nt] prior to rec]tification (       
eligibility = hospice c>e  ,section     
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii77 is am5d$--
  7#a7 by /rik+ end+ on ,septemb] #cj1  
#bjbe & ins]t+ end+ on ,septemb] #cj1   
#bjbg2 &  7#b7 by ins]t+ 1 except t ?is 
subclause %all n apply 9 ! case ( su* an
 enc\nt] ) an individual occurr+ on or  
aft] ,septemb] #cj1 #bjbe1 if su*       
individual is locat$ 9 an area t is     
subject to a moratorium on ! enrollm5t (
 hospice programs "u ?is title pursuant 
to section #ahff7;j77#g71 if su*        
individual is receiv+ hospice c>e f a   
provid] t is subject to enhanc$ ov]sight
 "u ?is title pursuant to section       
#ahff7;j77#c71 or if su* enc\nt] is     
p]=m$ by a hospice physician or nurse   
practition] :o is n enroll$ "u section  
#ahff7;j7 & is n an opt-out physician or
 practition] 7z def9$ 9 section         
#ahjb7;b77#f77;,d77 be=e ! semicolon4   

#c4  ,requir+ modifi] = use ( teleheal? 
to conduct face-to-face enc\nt] prior to
 rec]tification ( eligibility = hospice 
c>e  ,section                           
#ahad7;a77#g77;,d77i77,,ii7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#g77;,d77i77,,ii771 z am5d$  
by section #b7;f71 is fur!r am5d$ by    
ins]t+ 1 b only if1 9 ! case ( su* an   
enc\nt] occurr+ on or aft] ,janu>y #a1  
#bjbf1 any hospice claim includes #a or 
m modifi]s or codes 7z specifi$ by !    
,secret>y7 to indicate t su* enc\nt] 0  
conduct$ via teleheal? aft] z det]m9$   
appropriate by ! ,secret>y4  #d4        
,ext5d+ acute hospital c>e at home waiv]
 flexibilities  7a7  ,9 g5]al  ,section 
#ahff;,g7a77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #acie;cc-#g7;a77#a77
 is am5d$ by /rik+ #bjbe & ins]t+ #bjcj4
  7b7  ,requir+ additional /udy & report
 on acute hospital c>e at home waiv]    
flexibilities  ,section #ahff;,g ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc-#g71 z am5d$ by subsection 7a71

 is fur!r am5d$--  7#a7 9 subsection    
7b71 9 ! subsection head+1 by /rik+     
,/udy & ins]t+ ,initial /udy2  7#b7 by  
r$esignat+ subsections 7c7 & 7d7 z      
subsections 7d7 & 7e71 respectively2 &  
7#c7 by ins]t+ aft] subsection 7b7 !    
foll[+ new subsection3  7c7 ,subsequ5t  
/udy & report  7#a7 ,9 g5]al ,n lat] ?an
 ,septemb] #cj1 #bjbh1 ! ,secret>y %all 
conduct a /udy to--  7,a7 analyze1 to ! 
ext5t practicable1 ! crit]ia e/abli%$ by
 hospitals "u ! ,acute ,hospital ,c>e at
 ,home initiative to det]m9e :i*        
individuals may be furni%$ s]vices "u   
su* initiative2 &  7,b7 analyze & comp>e
 7bo? )9 & betwe5 hospitals p>ticipat+ 9
 ! initiative1 & relative to comp>able  
hospitals t d n p>ticipate 9 !          
initiative1 = relevant p>amet]s su* z   
diagnosis-relat$ gr\ps7--  7i7 quality (
 c>e furni%$ to individuals ) simil>    
conditions & *>act]i/ics 9 ! inpati5t   
sett+ & ?r\gh ! ,acute ,hospital ,c>e at
 ,home initiative1 includ+ heal?        
outcomes1 hospital readmission rates    

7includ+ readmissions bo? )9 & beyond   
#cj days po/-dis*>ge71 hospital         
mortality rates1 l5g? ( /ay1 infection  
rates1 composition ( c>e team 7includ+ !
 types ( labor us$1 su* z contract$     
labor71 ! ratio ( nurs+ /aff1 transf]s f
 ! hospital to ! home1 transf]s f ! home
 to ! hospital 7includ+ ! tim+1         
frequ5cy1 & causes ( su* transf]s71     
transf]s & dis*>ges to po/-acute c>e    
sett+s 7includ+ ! tim+1 frequ5cy1 &     
causes ( su* transf]s & dis*>ges71 &    
pati5t & c>egiv] exp]i5ce ( c>e2  7ii7  
cl9ical conditions treat$ &             
diagnosis-relat$ gr\ps ( dis*>ges f     
inpati5t sett+s relative to dis*>ges f !
 ,acute ,hospital ,c>e at ,home         
initiative2  7iii7 co/s incurr$ by !    
hospital = furni%+ c>e 9 inpati5t sett+s
 relative to co/s incurr$ by ! hospital 
= furni%+ c>e ?r\gh ! ,acute ,hospital  
,c>e at ,home initiative1 includ+ co/s  
relat+ to /aff+1 equipm5t1 food1        
prescriptions1 & o!r s]vices1 z det]m9$ 
by ! ,secret>y2  7iv7 ! quantity1 mix1 &

 int5sity ( s]vices 7su* z 9-p]son      
visits & virtual contacts ) pati5ts & ! 
int5sity ( su* s]vices7 furni%$ 9       
inpati5t sett+s relative to ! ,acute    
,hospital ,c>e at ,home initiative1 &1  
to ! ext5t practicable1 ! nature & ext5t
 ( family or c>egiv] involvem5t2  7v7   
socioeconomic in=mation on individuals  
treat$ 9 comp>able inpati5t sett+s      
relative to ! initiative1 includ+ racial
 & e?nic data1 income1 h\s+1 geographic 
proximity to ! brick-&-mort> facility & 
:e!r su* individuals are dually eligible
 = b5efits "u ?is title & title ,,xix2 &
  7vi7 ! quality ( c>e1 outcomes1 co/s1 
quantity & int5sity ( s]vices1 & o!r    
relevant metrics betwe5 individuals :o  
ent]$ into ! ,acute ,hospital ,c>e at   
,home initiative directly f an em]g5cy  
dep>tm5t comp>$ ) individuals :o ent]$  
into ! ,acute ,hospital ,c>e at ,home   
initiative directly f an exi/+ inpati5t 
/ay 9 a hospital4  7#b7  ,selection bias
  ,9 conduct+ ! /udy "u p>agraph 7#a71 !
 ,secret>y %all1 to ! ext5t practicable1

 analyze & comp>e individuals :o        
p>ticipate & d n p>ticipate 9 !         
initiative controll+ = selection bias or
 o!r factors t may impact ! reliability 
( data4  7#c7  ,report  ,n lat] ?an     
,septemb] #cj1 #bjbh1 ! ,secret>y (     
,heal? & ,human ,s]vices %all submit to 
! ,committee on ,ways & ,means ( ! ,h\se
 ( ,repres5tatives & ! ,committee on    
,f9ance ( ! ,s5ate a report on ! /udy   
conduct$ "u p>agraph 7#a74  4  #e4      
,enhanc+ c]ta9 program integrity        
requirem5ts = ,,dme "u ,m$ic>e  7a7     
,durable m$ical equipm5t  7#a7  ,9 g5]al
  ,section #ahcd7;a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #aciem7a77
 is am5d$ by add+ at ! end ! foll[+ new 
p>agraph3  7#bc7  ,ma/] ,li/ inclusion &
 claim review = c]ta9 items  7,a7  ,ma/]
 ,li/ inclusion  ,beg9n+ ,janu>y #a1    
#bjbh1 = purposes ( ! ,ma/] ,li/        
describ$ 9 section #dad4bcd7;b7 ( title 
#db1 ,code ( ,f$]al ,regulations 7or any
 successor regulation71 an item = :i*   
paym5t may be made "u ?is subsection    

%all be treat$ z hav+ ab]rant bill+     
patt]ns 7z su* t]m is us$ = purposes (  
su* section7 if ! ,secret>y det]m9es t1 
)\t explanatory contribut+ factors 7su* 
z furni%+ em]g5t c>e s]vices71 a        
sub/antial numb] ( claims = su* items "u
 ?is subsection are = su* items ord]$ by
 a physician or practition] :o has n    
previ\sly 7dur+ a p]iod ( n less ?an #bd
 mon?s1 z e/abli%$ by ! ,secret>y7      
furni%$ to ! individual involv$ any item
 or s]vice = :i* paym5t may be made "u  
?is title4  7,b7  ,claim review  ,)     
respect to items furni%$ on or aft]     
,janu>y #a1 #bjbh1 t are includ$ on !   
,ma/] ,li/ pursuant to subp>agraph 7,a71
 if su* an item is n subject to a       
det]m9ation ( cov]age 9 advance pursuant
 to p>agraph 7#ae77;,c71 ! ,secret>y may
 conduct prepaym5t review ( claims =    
paym5t = su* item4  4  7#b7  ,con=m+    
am5dm5t = pro/hetic devices1 or?otics1 &
 pro/hetics  ,section #ahcd7;h77#c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7h77#c77 is am5d$ by ins]t+ 1 &   

p>agraph 7#bc7 ( subsection 7a7 %all    
apply to pro/hetic devices1 or?otics1 & 
pro/hetics 9 ! same mann] z su*         
provision applies to items = :i* paym5t 
may be made "u su* subsection be=e !    
p]iod at ! end4  7b7  ,report on        
id5tify+ cl9ical diagno/ic laboratory   
te/s at high risk = fraud & effective   
mitigation measures  ,n lat] ?an ,janu>y
 #a1 #bjbf1 ! ,inspector ,g5]al ( !     
,dep>tm5t ( ,heal? & ,human ,s]vices    
%all submit to ,congress a report       
assess+ fraud risks relat+ to claims =  
cl9ical diagno/ic laboratory te/s = :i* 
paym5t may be made "u section #ahcd;,a (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciem-#a7 & effective tools = r$uc+   
su* fraudul5t claims4 ,! report may     
include in=mation reg>d+--  7#a7 :i*1 if
 any1 cl9ical diagno/ic laboratory te/s 
are id5tifi$ z be+ at high risk (       
fraudul5t claims1 & an analysis ( !     
factors t contribute to su* risk2  7#b7 
) respect to a cl9ical diagno/ic        
laboratory te/ id5tifi$ "u p>agraph 7#a7

 z be+ at high risk ( fraudul5t claims--
  7,a7 ! am\nt payable "u su* section   
#ahcd;,a ) respect to su* te/2  7,b7 !  
numb] ( su* te/s furni%$ to individuals 
enroll$ "u "p ,b ( title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;j et seq472  7,c7 :e!r an ord] =  
su* a te/ 0 m likely to come f a provid]
 ) :om ! individual involv$ did n h a   
prior relation%ip1 z det]m9$ on ! basis 
( prior paym5t exp]i5ce2 &  7,d7 !      
frequ5cy ) :i* a claim = paym5t "u su*  
section #ahcd;,a includ$ ! paym5t       
modifi] id5tifi$ by code #ei or #ia2    
7#c7 sugge/$ /rategies = r$uc+ ! numb] (
 fraudul5t claims made ) respect to te/s
 s id5tifi$ z be+ at high risk1         
includ+--  7,a7 an analysis ( :e!r !    
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices c   
detect ab]rant bill+ patt]ns ) respect  
to su* te/s 9 a timely mann]2  7,b7 any 
/rategies = id5tify+ & monitor+ !       
provid]s :o are outli]s ) respect to !  
numb] ( su* te/s t su* provid]s ord]2 & 
7,c7 t>get$ education ef=ts to mitigate 

improp] bill+ = su* te/s2 &  7#d7 su*   
o!r in=mation z ! ,inspector ,g5]al     
det]m9es appropriate4  #f4  ,guidance on
 furni%+ s]vices via teleheal? to       
individuals ) limit$ ,engli% pr(ici5cy  
7a7  ,9 g5]al  ,n lat] ?an #a ye> aft] !
 date ( ! enactm5t ( ?is section1 !     
,secret>y ( ,heal? & ,human ,s]vices1 9 
consultation ) #a or m entities f ea* ( 
! categories describ$ 9 p>agraphs 7#a7  
?r\gh 7#g7 ( subsection 7b71 %all issue 
& dissem9ate1 or update & revise z      
applicable1 guidance = ! entities       
describ$ 9 su* subsection on ! foll[+3  
7#a7 ,be/ practices on facilitat+ &     
integrat+ use ( int]pret]s dur+ a       
telem$ic9e appo9tm5t4  7#b7 ,be/        
practices on provid+ accessible         
in/ructions on h[ to access             
telecommunications sy/ems 7z su* t]m is 
us$ = purposes ( section #ahcd7m7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciem7m777 = individuals ) limit$      
,engli% pr(ici5cy4  7#c7 ,be/ practices 
on improv+ access to digital pati5t     

portals = individuals ) limit$ ,engli%  
pr(ici5cy4  7#d7 ,be/ practices on      
integrat+ ! use ( video plat=ms t enable
 multi-p]son video calls furni%$ via a  
telecommunications sy/em = purposes (   
provid+ int]pretation dur+ a telem$ic9e 
appo9tm5t = an individual ) limit$      
,engli% pr(ici5cy4  7#e7 ,be/ practices 
= provid+ pati5t mat]ials1              
communications1 & in/ructions 9 multiple
 languages1 includ+ text message        
appo9tm5t rem9d]s & prescription        
in=mation4  7b7  ,entities describ$  ,= 
purposes ( subsection 7a71 an entity    
describ$ 9 ?is subsection is an entity 9
 #a or m ( ! foll[+ categories3  7#a7   
,heal? in=mation te*nology s]vice       
provid]s1 includ+--  7,a7 electronic    
m$ical record companies2  7,b7 remote   
pati5t monitor+ companies2 &  7,c7      
teleheal? or mobile heal? v5dors &      
companies4  7#b7 ,heal? c>e provid]s1   
includ+--  7,a7 physicians2 &  7,b7     
hospitals4  7#c7 ,heal? insur]s4  7#d7  
,language s]vice companies4  7#e7       

,int]pret] or translator pr(essional    
associations4  7#f7 ,heal? & language   
s]vices quality c]tification            
organizations4  7#g7 ,pati5t & consum]  
advocates1 includ+ su* advocates t "w ) 
individuals ) limit$ ,engli% pr(ici5cy4 
#g4  ,9-home c>diopulmon>y              
rehabilitation flexibilities  7a7  ,9   
g5]al  ,section #ahfa7;eee77#b7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7eee77#b77 is am5d$--  7#a7 9     
subp>agraph 7,a77ii71 by ins]t+         
7includ+1 ) respect to items & s]vices  
furni%$ ?r\gh audio & video real-"t     
communications te*nology 7exclud+       
audio-only7 on or aft] ,septemb] #cj1   
#bjbe1 & be=e ,janu>y #a1 #bjbg1 9 !    
home ( an individual :o is an outpati5t 
( ! hospital7 aft] outpati5t basis2 &   
7#b7 9 subp>agraph 7,b71 by ins]t+      
7includ+1 ) respect to items & s]vices  
furni%$ ?r\gh audio & video real-"t     
communications te*nology on or aft]     
,septemb] #cj1 #bjbe1 & be=e ,janu>y #a1
 #bjbg1 ! virtual pres5ce ( su*         

physician1 physician assi/ant1 nurse    
practition]1 or cl9ical nurse speciali/7
 aft] "u ! program4  7b7  ,program      
in/ruction au?ority  ,not)/&+ any o!r   
provision ( law1 ! ,secret>y ( ,heal? & 
,human ,s]vices may implem5t ! am5dm5ts 
made by ?is section by program          
in/ruction or o!rwise4  #h4  ,inclusion 
( virtual diabetes prev5tion program    
suppli]s 9 ,,mdpp ,exp&$ ,model  7a7  ,9
 g5]al  ,n lat] ?an ,janu>y #a1 #bjbf1 !
 ,secret>y %all revise ! regulations "u 
p>ts #daj & #dbd ( title #db1 ,code (   
,f$]al ,regulations1 to provide t1 = !  
p]iod beg9n+ ,janu>y #a1 #bjbf1 & end+  
,decemb] #ca1 #bjcj--  7#a7 an entity   
may p>ticipate 9 ! ,,mdpp by (f]+ only  
onl9e ,,mdpp s]vices via syn*ron\s or   
asyn*ron\s te*nology or                 
telecommunications if su* entity meets !
 conditions = enrollm5t z an ,,mdpp     
suppli] 7z specifi$ 9 section           
#dbd4bje7;b7 ( title #db1 ,code ( ,f$]al
 ,regulations 7or a successor           
regulation772  7#b7 if an entity        

p>ticipates 9 ! ,,mdpp 9 ! mann]        
describ$ 9 p>agraph 7#a7--  7,a7 !      
adm9i/rative location ( su* entity %all 
be ! address ( ! entity on file "u !    
,diabetes ,prev5tion ,recognition       
,program2 &  7,b7 9 ! case ( onl9e      
,,mdpp s]vices furni%$ by su* entity to 
an ,,mdpp b5efici>y :o 0 n locat$ 9 !   
same ,/ate z ! entity at ! "t su*       
s]vices 7 furni%$1 ! entity %all n be   
prohibit$ f submitt+ a claim = paym5t = 
su* s]vices solely by reason ( !        
location ( su* b5efici>y at su* "t2 &   
7#c7 no limit is appli$ on ! numb] (    
times an individual may enroll 9 !      
,,mdpp4  7b7  ,def9itions  ,9 ?is       
section3 7#a7 ,,mdpp ,! t]m ,,mdpp means
 ! ,m$ic>e ,diabetes ,prev5tion ,program
 conduct$ "u section #aaae;,a ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a71 z describ$ 9 ! f9al rule      
publi%$ 9 ! ,f$]al ,regi/] entitl$      
,m$ic>e & ,m$icaid ,programs2 ,,cy #bjbd
 ,paym5t ,policies ,"u ! ,physician ,fee
 ,s*$ule & ,o!r ,*anges to ,"p ,b       

,paym5t & ,cov]age ,policies2 ,m$ic>e   
,%>$ ,sav+s ,program ,requirem5ts2      
,m$ic>e ,advantage2 ,m$ic>e & ,m$icaid  
,provid] & ,suppli] ,enrollm5t          
,policies2 & ,basic ,heal? ,program 7#hh
 ,f$4 ,reg4 #ghhah 7,novemb] #af1       
#bjbc77 7or a successor regulation74    
7#b7  ,regulatory t]ms  ,! t]ms         
,diabetes ,prev5tion ,recognition       
,program1 ,,mdpp b5efici>y1 ,,mdpp      
s]vices1 & ,,mdpp suppli] h ! mean+s    
giv5 ea* su* t]m 9 section #daj4gi7;b7 (
 title #db1 ,code ( ,f$]al ,regulations4
  7#c7  ,secret>y  ,! t]m ,secret>y     
means ! ,secret>y ( ,heal? & ,human     
,s]vices4