,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bgfa  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #aj1         
#bjbe,mr4 ,tillis 7= himself & ,mr4     
,w>nock7 introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide long-t]m /ability = ,m$ic>e     
b5efici>y access to cl9ical diagno/ic   
laboratory te/s by improv+ ! accuracy (1
 & feasibility ( data collection =1 !   
private payor-bas$ fee s*$ule paym5t    
rates appli$ "u ! ,m$ic>e program = su* 
te/s1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,re=m+ &     
,enhanc+ ,su/a9able ,updates to         
,laboratory ,te/+ ,s]vices ,act ( #bjbe 
or ! ,,results ,act4  #b4 ,improv+ !    
accuracy & data collection feasibility (
 ! private payor-bas$ ,m$ic>e paym5t    
rates = cl9ical diagno/ic laboratory    
te/s  7a7 ,acquir+ data = widely        
available non-,advanc$ diagno/ic        
laboratory te/s f a qualify+            

compreh5sive claims database ( an       
indep5d5t national nonpr(it entity      
,section #ahcd;,a7a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem-#a7;a77 is am5d$-- 7#a7 9        
p>agraph 7#a7-- 7,a7 9 subp>agraph      
7,a7-- 7i7 by /rik+                     
requirem5ts4--,subject to subp>agraph   
7,b7 & ins]t+ requirem5ts4-- 7i7 ,9     
g5]al ,subject to subp>agraph 7,b7 &    
except z provid$ = 9 clause 7ii7  2     
7ii7 9 clause 7i71 z add$ by clause 7i7 
( ?is subp>agraph-- 7,i7 by /rik+       
p>agraph 7#b7 & ins]t+ p>agraph         
7#b77;,a72  7,,ii7 by ins]t+ 1 9        
accordance ) ! provisions ( ?is section1
 be=e report to ! ,secret>y2  7,,iii7 by
 /rik+ applicable in=mation 7z def9$ 9  
p>agraph 7#c77 = a data collection p]iod
 7z def9$ 9 p>agraph 7#d77 & ins]t+     
applicable in=mation 7z def9$ 9 p>agraph
 7#c77-- 7,i7 = a data collection p]iod 
7z def9$ 9 p>agraph 7#d77 beg9n+ be=e   
,janu>y #a1 #bjbg1  2  7,,iv7 by /rik+ !
 p]iod at ! end & ins]t+ 2 &2 &  7,v7 by

 add+ at ! end ! foll[+ new subclause3  
7,,ii7 = a data collection p]iod beg9n+ 
on or aft] ,janu>y #a1 #bjbg1 = ea*     
cl9ical diagno/ic laboratory te/ = :i*  
f9al paym5t is made "u ?is "p to !      
laboratory dur+ su* p]iod4  2 &  7iii7  
by add+ at ! end ! foll[+ new clause2   
7ii7 ,collection & submission ( data    
7,i7 ,9 g5]al ,) respect to data        
collection p]iods = report+ p]iods      
beg9n+ on or aft] ,janu>y #a1 #bjbh1 & =
 purposes ( ?is section1 9 ! case ( a   
widely available non-,,adlt cl9ical     
diagno/ic laboratory te/ 7z def9$ 9     
p>agraph 7#b77;,e771 ! ,secret>y %all   
collect & use applicable in=mation f a  
qualify+ compreh5sive claims database 7z
 def9$ 9 p>agraph 7#b77;,c77 ( a        
qualify+ indep5d5t claims data entity 7z
 def9$ 9 p>agraph 7#b77;,d77 ) :i* !    
,secret>y has 9 effect a contract "u    
subclause 7,,ii7 = ea* su* te/ furni%$  
dur+ ! respective data collection p]iod 
& = :i* f9al paym5t is made "u ?is "p   
dur+ ! ye> 9 :i* su* data collection    

p]iod occurs4  7,,ii7 ,contract )       
qualify+ indep5d5t claims data entity = 
access to applicable in=mation ,z soon z
 practicable aft] ! date ( enactm5t (   
?is clause1 ! ,secret>y %all id5tify &  
ent] into a contract ) a qualify+       
indep5d5t claims data entity = ! purpose
 (1 ) respect to widely available       
non-,,adlt cl9ical diagno/ic laboratory 
te/s furni%$ dur+ a data collection     
p]iod1 su* entity report+ to ! ,secret>y
 applicable in=mation f a qualify+      
compreh5sive claims database ( ! entity 
= su* te/s = :i* f9al paym5t is made "u 
?is "p dur+ ! ye> 9 :i* su* data        
collection p]iod occurs & = :i* !re is  
applicable in=mation )9 su* database =  
su* p]iod4  4  7,b7 9 subp>agraph 7,b7--
 7i7 9 clause 7i71 by /rik+ #bjbe &     
ins]t+ #bjbg2  7ii7 9 clause 7ii71 by   
/rik+ beg9n+ ,janu>y #a1 #bjbf1 & end+  
,m>* #ca1 #bjbf & ins]t+ beg9n+ ,janu>y 
#a1 #bjbh1 & end+ ,m>* #ca1 #bjbh2 &    
7iii7 9 clause 7iii71 by /rik+ ?ree ye>s
 & ins]t+ #d ye>s2 &  7#b7 9 p>agraph   

7#b7-- 7,a7 by /rik+ ,def9ition (       
applicable laboratory4--,9 ?is section1 
! t]m applicable laboratory means &     
ins]t+ ,def9itions4--,9 ?is section3    
7,a7 ,applicable laboratory  7i7        
,report+ p]iods be=e #bjbh ,) respect to
 report+ p]iods beg9n+ be=e ,janu>y #a1 
#bjbh1 ! t]m applicable laboratory means
  2  7,b7 9 subp>agraph 7,a71 z ins]t$  
by subp>agraph 7,a7 ( ?is p>agraph-- 7i7
 9 clause 7i71 9 ! second s5t5ce1 by    
/rik+ p>agraph & ins]t+ clause2 &  7ii7 
by add+ at ! end ! foll[+ new clause3   
7ii7 ,report+ p]iods beg9n+ dur+ #bjbh &
 subsequ5t ye>s ,) respect to report+   
p]iods beg9n+ on or aft] ,janu>y #a1    
#bjbh1 ! t]m applicable laboratory %all 
h ! mean+ giv5 su* t]m 9 section        
#dad4ejb ( title #db1 ,code ( ,f$]al    
,regulations1 z 9 effect on ,may #a1    
#bjbe1 except )\t application ( p>agraph
 7#c7 ( su* section4  2 &  7,c7 by add+ 
at ! end ! foll[+ new subp>agraphs3     
7,b7 ,non-widely available non-,,adlt   
cl9ical diagno/ic laboratory te/ ,! t]m 

non-widely available non-,,adlt cl9ical 
diagno/ic laboratory te/ means1 )       
respect to a report+ p]iod1 a cl9ical   
diagno/ic laboratory te/ t is n an      
advanc$ diagno/ic laboratory te/ & t is 
n describ$ 9 subp>agraph 7,e74  7,c7    
,qualify+ indep5d5t claims data entity  
,! t]m qualify+ indep5d5t claims data   
entity means an entity t satisfies ea* (
 ! foll[+ crit]ia3 7i7 ,! entity is a   
national nonpr(it organization t is n   
affiliat$ ) any ,gov]nm5t ag5cy1        
insurance issu]1 gr\p heal? plan1       
provid] ( s]vices or suppli]1 or o!r    
organization 9 ! heal? c>e sector4  7ii7
 ,! entity collects data & ma9ta9s a    
qualify+ compreh5sive claims database 7z
 def9$ 9 subp>agraph 7,d774  7iii7 ,!   
entity is c]tifi$ by ! ,secret>y to be a
 qualifi$ entity 7z def9$ 9 p>agraph    
7#b7 ( section #ahgd7;e77 ) respect to  
hav+ access to data describ$ 9 p>agraph 
7#c7 ( su* section4  7iv7 ,! entity1 )  
respect to all data includ$ 9 ! qualify+
 compreh5sive claims database ( !       

entity1 complies ) all applicable ,f$]al
 & ,/ate privacy & security requirem5ts1
 includ+ ,,hipaa privacy & security law 
7z def9$ 9 section #cjji ( ! ,public    
,heal? ,s]vice ,act74  7v7 ,! entity    
applies quality assurance processes to  
validate all data t is includ$ 9 !      
qualify+ compreh5sive claims database ( 
! entity1 includ+ compreh5sive /ati/ical
 te/+4  7,d7 ,qualify+ compreh5sive     
claims database ,! t]m qualify+         
compreh5sive claims database means an   
indep5d5t database ( private payor      
claims data1 :i*-- 7i7 includes at lea/ 
#ej1jjj1jjj1jjj claims f m ?an #ej      
private payors & claims adm9i/rators2   
7ii7 is a /ati/ically significant       
repository ( claims data t is           
repres5tative = all #ej ,/ates & !      
,di/rict ( ,columbia2  7iii7 includes   
only data t is validat$ by quality      
assurance processes1 includ+            
compreh5sive /ati/ical te/+2  7iv7      
complies ) all applicable ,f$]al & ,/ate
 privacy & security requirem5ts1 z      

describ$ 9 subp>agraph 7,c77iv72  7v7   
provides = v]sion control ( claims to   
enable ! collation & submission1 =      
purposes ( ?is section1 ( only claims   
repres5tative ( f9al paym5t am\nts2 &   
7vi7 includes claims data ) respect to  
widely available non-,,adlt cl9ical     
diagno/ic laboratory te/s4  7,e7 ,widely
 available non-,,adlt cl9ical diagno/ic 
laboratory te/ ,! t]m widely available  
non-,,adlt cl9ical diagno/ic laboratory 
te/ means1 ) respect to a report+ p]iod1
 a cl9ical diagno/ic laboratory te/ t is
 n an advanc$ diagno/ic laboratory te/ &
 = :i*1 dur+ ! fir/ #f mon?s ( ! ye>    
imm$iately prec$+ ! data collection     
p]iod = su* report+ p]iod1 ! numb] (    
provid]s ( s]vices & suppli]s receiv+   
paym5ts "u ?is section 7z det]m9$ by !  
,secret>y us+ ! national provid]        
id5tifi] ( ! provid] ( s]vices or       
suppli] on ! claim submitt$ = paym5t "u 
?is "p = su* te/7 exce$s #ajj4  2  7#c7 
9 p>agraph 7#e7-- 7,a7 by ins]t+ f9al   
aft] ,!2 &  7,b7 by ins]t+ or f a       

qualify+ compreh5sive claims database   
pursuant to p>agraph 7#a77;,a77ii7 aft] 
report$ by a laboratory "u ?is          
subsection2  7#d7 9 p>agraph 7#f7-- 7,a7
 by ins]t+ 7or1 ) respect to a widely   
available non-,,adlt cl9ical diagno/ic  
laboratory te/1 ! qualify+ compreh5sive 
claims database ( ! qualify+ indep5d5t  
claims data entity ) a contract "u      
p>agraph 7#a77;,a77ii77 aft] ,9 ! case  
:]e an applicable laboratory2  7,b7 by  
/rik+ paym5t rate ea* place x appe>s &  
ins]t+ f9al paym5t rate2  7,c7 by ins]t+
 7& su* diff]5t paym5t rates d n relate 
to ! same claim7 aft] = ! same payor = !
 same te/2 &  7,d7 by ins]t+ or qualify+
 indep5d5t claims data entity1 z        
applicable1 aft] ! applicable           
laboratory2  7#e7 9 p>agraph 7#i77;,a71 
by ins]t+ requir$ to be report$ by su*  
laboratory aft] 9 report+ in=mation2    
7#f7 9 p>agraph 7#aj7-- 7,a7 by /rik+ by
 a laboratory aft] in=mation disclos$2 &
  7,b7 by ins]t+ by a laboratory or !   
qualify+ indep5d5t claims data entity ) 

a contract "u p>agraph 7#a77;,a77ii7    
aft] "u ?is subsection2 &  7#g7 9       
p>agraph 7#ab7-- 7,a7 by /rik+          
,regulations4--,n lat] ?an ,june #cj1   
#bjae1 & ins]t+ ,regulations4-- 7,a7 ,= 
data collection p]iods be=e #bjbg ,n    
lat] ?an ,june #cj1 #bjae1 = data       
collection p]iods beg9n+ be=e ,janu>y   
#a1 #bjbg1  2 &  7,b7 by add+ at ! end !
 foll[+ new subp>agraph3  7,b7 ,= data  
collection p]iods beg9n+ ) #bjbg ,n lat]
 ?an ,decemb] #ca1 #bjbf1 ! ,secret>y   
%all e/abli% ?r\gh notice & comm5t      
rulemak+ p>amet]s = data collection     
p]iods beg9n+ on or aft] ,janu>y #a1    
#bjbg4  4  7b7 ,incorporat+ data        
collection improvem5ts into private     
payor-,bas$ ,m$ic>e paym5t rates =      
cl9ical diagno/ic laboratory te/s t are 
n advanc$ diagno/ic laboratory te/s     
7#a7 ,calculation ( weight$ m$ian (     
private payor-bas$ rates ,section       
#ahcd;,a7b77#b7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#b77  
is am5d$-- 7,a7 by ins]t+ &1 9 ! case ( 

widely available non-,,adlt cl9ical     
diagno/ic laboratory te/s1 ) respect to 
data collection p]iods = report+ p]iods 
beg9n+ on or aft] ,janu>y #a1 #bjbh1 =  
ea* su* te/ furni%$ by an applicable    
laboratory ) respect to :i* !re is      
applicable in=mation made available to !
 ,secret>y pursuant to p>agraph         
7#a77;,a77ii7 ( su* subsection aft] "u  
subsection 7a7 = a data collection      
p]iod2 &  7,b7 by ins]t+ f9al be=e      
paym5t rates report$4  7#b7 ,default    
adju/m5t 9 cases ( widely available     
non-,,adlt cl9ical diagno/ic laboratory 
te/s = p]iods = :i* !re is no contract )
 a qualify+ indep5d5t claims entity or  
no applicable in=mation 9 ! qualify+    
compreh5sive claims database ,section   
#ahcd;,a7b7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #aciem-#a7;b77 is am5d$--
 7,a7 9 p>agraph 7#a77;,a71 by /rik+    
p>agraph 7#c7 & ins]t+ p>agraphs 7#c7 & 
7#f72 &  7,b7 by add+ at ! end ! foll[+ 
new p>agraph3  7#f7 ,default paym5t =   
widely available non-,,adlt cl9ical     

diagno/ic laboratory te/s = p]iods = :i*
 !re is no contract ) an indep5d5t      
entity or ) respect to :i* !re is no    
data  7,a7 ,9 g5]al ,) respect to data  
collection p]iods = report+ p]iods      
beg9n+ on or aft] ,janu>y #a1 #bjbh1 9 !
 case ( a widely available non-,,adlt   
cl9ical diagno/ic laboratory te/ )      
respect to :i* subsection 7c7 does n    
apply1 if a circum/ance describ$ 9      
subp>agraph 7,b7 applies ) respect to   
su* a report+ p]iod & su* a cl9ical     
diagno/ic laboratory te/1 paym5t = su*  
te/ "u ?is section = a ye> beg9n+ dur+ !
 qualifi$ rate p]iod describ$ 9         
subp>agraph 7,c71 %all be equal to !    
am\nt ( paym5t = su* cl9ical diagno/ic  
laboratory te/ "u ?is section = !       
previ\s ye>1 increas$ by ! p]c5tage     
increase 9 ! ,consum] ,price ,index =   
all urban consum]s 7all items2 ,unit$   
,/ates city av]age7 ov] ! previ\s ye>4  
7,b7 ,circum/ances describ$ ,= purposes 
( subp>agraph 7,a71 ) respect to a data 
collection p]iod & a widely available   

non-,,adlt cl9ical diagno/ic laboratory 
te/1 ! circum/ances describ$ 9 ?is      
subp>agraph are if ! ,secret>y-- 7i7 is 
n able to ent] into a contract "u       
subsection 7a77#a77;,a77ii7 ) a qualify+
 indep5d5t claims data entity ) respect 
to su* data collection p]iod2 or  7ii7  
det]m9es t !re is no applicable         
in=mation ) respect to su* cl9ical      
diagno/ic laboratory te/ & data         
collection p]iod 9 ! qualify+           
compreh5sive claims database ( su*      
qualify+ indep5d5t claims data entity4  
7,c7 ,qualifi$ rate p]iod describ$ ,=   
purposes ( subp>agraph 7,a71 ! qualifi$ 
rate p]iod1 ) respect to a data         
collection p]iod & a widely available   
non-,,adlt cl9ical diagno/ic te/ to :i* 
a circum/ance describ$ 9 subp>agraph    
7,b7 applies1 is ! p]iod-- 7i7 beg9n+ on
 ! fir/ day ( ! second ye> foll[+ ! fir/
 data collection p]iod ) respect to :i* 
su* circum/ance applies ) respect to su*
 te/2 &  7ii7 end+ ) ! la/ day ( ! ye>  
foll[+ ! fir/ data collection p]iod )   

respect to :i* su* circum/ance no long] 
applies ) respect to su* te/4  4  7#c7  
,paym5t 9 cases 9 :i* !re is no report$ 
applicable in=mation = non-widely       
available non-,a,d,l,ts ,section        
#ahcd;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #aciem-#a71 is am5d$-- 7,a7 9
 subsection 7b71 z am5d$ by p>agraph    
7#b7-- 7i7 9 p>agraph 7#a77;,a71 by     
/rik+ p>agraphs 7#c7 & 7#f7 & ins]t+    
p>agraphs 7#c71 7#f71 & 7#g72 &  7ii7 by
 add+ at ! end ! foll[+ new p>agraph3   
7#g7 ,paym5t = non-widely available     
non-,,adlt cl9ical diagno/ic laboratory 
te/s = :i* !re is no applicable         
in=mation  7,a7 ,9 g5]al ,= det]m9+     
paym5t "u ?is subsection = a ye> 9 !    
case ( a non-widely available non-,,adlt
 cl9ical diagno/ic laboratory te/ )     
respect to :i* subsection 7c7 does n    
apply1 if ! ,secret>y det]m9es t no     
applicable in=mation has be5 report$ "u 
subsection 7a77#a77;,a77i7 by any       
applicable laboratory = su* te/ )       
respect to ! mo/ rec5t data collection  

p]iod 7beg9n+ ) data collection p]iods =
 report+ p]iods beg9n+ on or aft]       
,janu>y #a1 #bjbh71 paym5t = su* te/ "u 
?is section = su* ye> %all be det]m9$ z 
foll[s3 7i7 ,9 ! case t a process       
describ$ 9 subp>agraph 7,b7 0 n appli$  
pursuant to ?is subp>agraph = det]m9+   
paym5t = su* te/ = a previ\s ye> )      
respect to su* data collection p]iod1   
paym5t = su* te/ & ye> %all be det]m9$  
us+ su* a process4  7ii7 ,9 ! case t a  
process describ$ 9 subp>agraph 7,b7 0   
appli$ pursuant to ?is subp>agraph =    
det]m9+ paym5t = su* te/ = a previ\s ye>
 ) respect to su* data collection p]iod1
 paym5t = su* te/ & ye> %all be equal to
 ! am\nt ( paym5t = su* te/ "u ?is      
section = ! previ\s ye>4  7,b7 ,process 
describ$ ,= purposes ( subp>agraph 7,a71
 a process describ$ 9 ?is subp>agraph1 )
 respect to a non-widely available      
non-,,adlt cl9ical diagno/ic laboratory 
te/ = :i* !re is no report$ data 7z     
describ$ 9 su* subp>agraph7 ) respect to
 a data collection p]iod1 is-- 7i7      

cross-walk+ 7z describ$ 9 section       
#dad4ejh7;a7 ( title #db1 ,code ( ,f$]al
 ,regulations1 or any successor         
regulation7 to ! mo/ appropriate cl9ical
 diagno/ic laboratory te/ "u ! fee      
s*$ule "u ?is section dur+ t p]iod2 or  
7ii7 if no o!r cl9ical diagno/ic        
laboratory te/ is comp>able to ! te/ =  
:i* !re is no report$ applicable        
in=mation1 accord+ to ! gapfill+ process
 describ$ 9 subsection 7c77#b74  2 &    
7,b7 9 subsection 7c77#c71 by ins]t+ or 
subsection 7b77#g7 aft] "u ?is          
subsection4  7#d7 ,publicly available   
explanation ( paym5t rates ,section     
#ahcd;,a7b7 ( ! ,social ,security ,act  
7#db ,u4,s4,c4 #aciem-#a7;b771 z am5d$  
by p>agraphs 7#b7 & 7#c77;,a71 is am5d$ 
by add+ at ! end ! foll[+ new p>agraph3 
7#h7 ,explanation ( paym5t rates ,9 !   
case ( a cl9ical diagno/ic laboratory   
te/ = :i* paym5t is made "u ?is         
subsection1 ! ,secret>y %all make       
available to ! public an explanation ( !
 paym5t rate = su* te/1 includ+ any     

support+ data z may be necess>y = a     
laboratory to assess ! accuracy ( !     
calculations4  4  7#e7 ,te*nical        
correction cl>ify+ p]iod ( application (
 m>ket rates ,section                   
#ahcd;,a7b77#d77;,a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem-#a7;b77#d77;,a77 is am5d$ by     
/rik+ until ! ye> foll[+ & ins]t+ ?r\gh 
! ye> foll[+4  7c7 ,additional          
improvem5ts ,to ensure updat$1 accurate 
m>ket-,bas$ data = cl9ical diagno/ic    
laboratory te/s  7#a7 ,updates to       
applicable in=mation to bett] reflect   
f9al paym5t rates ,section              
#ahcd;,a7a77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;a77#c77  
is am5d$-- 7,a7 9 ! head+1 by ins]t+ &  
f9al paym5t rate aft] in=mation2  7,b7 9
 subp>agraph 7,a7-- 7i7 9 ! head+1 by   
/rik+ ,9 g5]al & ins]t+ ,data collection
 p]iods be=e ,janu>y #a1 #bjbg2 &  7ii7 
9 ! matt] prec$+ clause 7i7-- 7,i7 by   
/rik+ subp>agraph 7,b7 & ins]t+         
subp>agraph 7,c72 &  7,,ii7 by ins]t+   

beg9n+ be=e ,janu>y #a1 #bjbg aft] = a  
data collection p]iod2  7,c7 by         
r$esignat+ subp>agraph 7,b7 z           
subp>agraph 7,c72  7,d7 by ins]t+ aft]  
subp>agraph 7,a7 ! foll[+ new           
subp>agraph3  7,b7 ,subsequ5t data      
collection p]iods ,9 ?is section1       
subject to subp>agraph 7,c71 = a data   
collection p]iod beg9n+ on or aft]      
,janu>y #a1 #bjbg1 ! t]m applicable     
in=mation means-- 7i7 ) respect to a    
widely available non-,,adlt cl9ical     
diagno/ic laboratory te/ furni%$ dur+   
su* p]iod-- 7,i7 ! f9al paym5t rate 7z  
det]m9$ 9 accordance ) p>agraph 7#e7 &  
def9$ 9 subp>agraph 7,d77 t 0 paid by   
ea* private payor = ! te/ dur+ ! ye> 9  
:i* su* p]iod occurs2 &  7,,ii7 !       
volume1 = ea* su* payor1 ( su* te/ = :i*
 f9al paym5t 0 made dur+ su* ye>2 &     
7ii7 ) respect to a non-widely available
 non-,,adlt cl9ical diagno/ic laboratory
 te/ or an advanc$ diagno/ic laboratory 
te/-- 7,i7 ! f9al paym5t rate 7z det]m9$
 9 accordance ) p>agraph 7#e7 & def9$ 9 

subp>agraph 7,d77 t 0 paid by ea*       
private payor = ! te/ dur+ ! data       
collection p]iod2 &  7,,ii7 ! volume1 = 
ea* su* payor1 ( su* te/ = :i* f9al     
paym5t 0 made dur+ su* p]iod4  2 &  7,e7
 by ins]t+ aft] subp>agraph 7,c71 !     
foll[+ new subp>agraph3  7,d7 ,f9al     
paym5t rate ,9 ?is section1 = a data    
collection p]iod beg9n+ on or aft]      
,janu>y #a1 #bjbg1 ! t]m f9al paym5t    
rate-- 7i7 means-- 7,i7 ) respect to a  
widely available non-,,adlt cl9ical     
diagno/ic laboratory te/ furni%$ dur+ a 
data collection p]iod1 ! la/ paym5t made
 = a te/ dur+ ! ye> 9 :i* ! data        
collection p]iod occurs2 &  7,,ii7 )    
respect to a non-widely available       
non-,,adlt cl9ical diagno/ic laboratory 
te/ or an advanc$ diagno/ic laboratory  
te/ paid dur+ a data collection p]iod1 !
 la/ paym5t made dur+ ! data collection 
p]iod2 &  7ii7 does n include-- 7,i7    
d5i$ paym5ts2  7,,ii7 paym5ts "u appeal 
or "u review by ! private payor2        
7,,iii7 paym5ts made 9 error2 or  7,,iv7

 paym5ts t are rec\p$ by ! private      
payor4  4  7#b7 ,updat+ data collection 
p]iods ,section #ahcd;,a7a77#d77;,b7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciem-#a7;a77#d77;,b77 is am5d$-- 7,a7 
by /rik+ ,janu>y #a1 #bjai & ins]t+     
,janu>y #a1 #bjbg2  7,b7 by /rik+ ,june 
#cj1 #bjai & ins]t+ ,june #cj1 #bjbg2 & 
7,c7 by add+ at ! end ! foll[+ new      
s5t5ce3 ,9 ! case ( ! report+ p]iod aft]
 ! report+ p]iod describ$ 9 p>agraph    
7#a77;,b77ii7 & ea* subsequ5t report+   
p]iod ) respect to cl9ical diagno/ic    
laboratory te/s t are n advanc$         
diagno/ic laboratory te/s1 ! t]m data   
collection p]iod means ! #f-mon? p]iod  
beg9n+ ,janu>y #a/ ( ! ye> prec$+ ! ye> 
dur+ :i* su* report+ p]iod beg9s44  7#c7
 ,ensur+ data is m>ket-bas$ by exclud+  
rates ( ,m$icaid manag$ c>e             
organizations ,section                  
#ahcd;,a7a77#h77;,c7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciem-#a7;a77#h77;,c77 is am5d$ by     
/rik+ ,a m$icaid manag$ c>e organization

 & ins]t+ ,) respect to data collection 
p]iods = report+ p]iods beg9n+ be=e     
,janu>y #a1 #bjbh1 a m$icaid manag$ c>e 
organization44  7#d7 ,modifications to  
limits on paym5t r$uctions ,section     
#ahcd;,a7b77#c7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;b77#c77  
is am5d$-- 7,a7 9 subp>agraph 7,a71 by  
/rik+ ea* ( #bjag ?r\gh #bjbh & ins]t+  
#bjag & ea* subsequ5t ye>2  7,b7 9      
subp>agraph 7,b7-- 7i7 9 clause 7ii71 by
 /rik+ #bjbe & ins]t+ #bjbh2 &  7ii7 9  
clause 7iii71 by /rik+ = ea* ( #bjbf    
?r\gh #bjbh1 #ae p]c5t & ins]t+ = #bjbi 
& ea* subsequ5t ye>1 #e p]c5t2 &  7,c7 9
 subp>agraph 7,c77ii71 by ins]t+        
laboratory aft] advanc$ diagno/ic4  7#e7
 ,sunsett+ review limitations ,section  
#ahcd;,a7h77#a7 ( ! ,social ,security   
,act 7#db ,u4,s4,c4 #aciem-#a7;h77#a77  
is am5d$ by ins]t+ be=e ,janu>y #a1     
#bjbi be=e ! p]iod at ! end4