,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bgic  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #aa1         
#bjbe,mr4 ,cassidy 7= himself & ,mr4    
,lujn7 introduc$ ! foll[+ bill2 :i* 0   
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
require ,m$ic>e ,advantage plans to cov]
 items & s]vices furni%$ by c]ta9       
ess5tial community provid]s )9 a s]vice 
area1 & = o!r purposes4  #a4 ,%ort title
 ,?is ,act may be cit$ z ! ,ensur+      
,access to ,ess5tial ,provid]s ,act (   
#bjbe4  #b4 ,m$ic>e ,advantage ,ess5tial
 ,community ,provid]s ,section #aheb7;d7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#bb7;d77 is am5d$--    
7#a7 9 p>agraph 7#a7-- 7,a7 9           
subp>agraph 7,d71 by /rik+ & at ! end2  
7,b7 9 subp>agraph 7,e71 by /rik+ !     
p]iod at ! end & ins]t+ 2 &2 &  7,c7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,f7 ! organization meets ! ess5tial    
community provid] /&>d1 z describ$ 9    

p>agraph 7#g74  2 &  7#b7 by add+ at !  
end ! foll[+ new p>agraph3  7#g7        
,ess5tial community provid] /&>d  7,a7  
,9 g5]al ,= purposes ( p>agraph         
7#a77;,f7 & subject to subp>agraph 7,b71
 9 ord] to meet ! ess5tial community    
provid] /&>d1 an ,,ma organization      
%all-- 7i7 include an am\nt 7det]m9$ by 
! ,secret>y7 ( available ess5tial       
community provid]s 7z describ$ 9        
subp>agraph 7,e77 9 ea* ,,ma plan's     
s]vice area 9 ! provid] network & (f] to
 contract ) ea* ess5tial community      
provid] 9 ! s]vice area ( ea* plan2     
7ii7 include 9 its provid] network a    
suffici5t numb] & a geographic          
di/ribution1 z det]m9$ by ! ,secret>y1 (
 available ess5tial community provid]s1 
:]e available1 to ensure l[-income      
individuals1 individuals resid+ 9 rural 
areas1 or individuals resid+ 9 areas    
designat$ z heal? pr(essional %ortage   
areas "u section #ccb7;a77#a77;,a7 ( !  
,public ,heal? ,s]vice ,act )9 ! s]vice 
area ( ! ,,ma organization h reasonable 

& timely access to a broad range ( su*  
provid]s2 &  7iii7 meet ! paym5t        
requirem5ts to ,f$]ally qualifi$ heal?  
c5t]s1 z describ$ 9 subp>agraph 7,c74   
7,b7 ,ju/ification = n meet+ /&>d  7i7  
,9 g5]al ,if an ,,ma plan does n meet ! 
ess5tial community provid] /&>d describ$
 9 subp>agraph 7,a71 ! ,,ma organization
 (f]+ su* plan %all include z "p ( !    
in=mation requir$ to be submitt$ "u     
section #ahed7;a7-- 7,i7 an explanation 
reg>d+ :y ! plan 0 unable to meet su*   
/&>d2 &  7,,ii7 a n>rative ju/ification 
describ+ h[ ! provid] network ( su*     
plan-- 7aa7 provides an adequate level (
 s]vice = l[-income enrollees or        
individuals resid+ 9 areas designat$ z  
heal? pr(essional %ortage areas )9 !    
s]vice area ( su* plan2 &  7bb7 w move  
t[>d satisfaction ( ! ess5tial community
 provid] /&>d prior to ! />t ( ! next   
plan ye>4  7ii7 ,insuffici5t            
ju/ification ,if ! ,secret>y det]m9es t 
! ,,ma organization does n suffici5tly  
expla9 :y ! applicable ,,ma plan does n 

meet ! ess5tial community provid] /&>d 9
 ! in=mation describ$ 9 clause 7i71 !   
,secret>y %all n approve su* plan4  7,c7
 ,paym5t to ,f$]ally qualifi$ heal?     
c5t]s ,an ,,ma organization %all pay a  
,f$]ally qualifi$ heal? c5t] = an item  
or s]vice an am\nt consi/5t ) section   
#aheg7;e77#c74  7,d7 ,cl>ification ,no?+
 9 ?is p>agraph may be con/ru$ to       
require an ,,ma plan to provide cov]age 
= a specific m$ical proc$ure4  7,e7     
,ess5tial ,community ,provid] ,=        
purposes ( ?is p>agraph1 ! t]m ess5tial 
community provid] means a provid] t     
s]ves pr$om9antly l[-income1 m$ically   
und]s]v$ individuals1 includ+-- 7i7 a   
,f$]ally qualifi$ heal? c5t] & any      
simil> cl9ic2  7ii7 a facility fund$ by 
! program "u title ,,xxvi ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;ff-#aa et seq42 commonly ref]r$ to 
z ! ,ryan ,:ite ,,hiv_/,,aids ,program72
  7iii7 a facility op]at$ by ! ,indian  
,heal? ,s]vice1 an ,indian tribe or     
tribal organization1 or an urban ,indian

 organization 7z def9$ 9 section #d ( ! 
,indian ,heal? ,c>e ,improvem5t ,act72  
7iv7 a hospital1 includ+ an inpati5t    
hospital1 a hospital receiv+ or eligible
 to receive disproportionate %>e        
hospital paym5ts "u section             
#ahhf7;d77#e77;,f71 a hospital classifi$
 z a rural ref]ral c5t] "u section      
#ahhf7;d77#e77;,c71 a sole community    
hospital 7z def9$ 9 section             
#ahhf7;d77#e77;,d77iii771 a free-/&+    
canc] hospital 7z describ$ 9 section    
#ahhf7;d77#a77;,b77v771 & a critical    
access hospital 7z def9$ 9 section      
#ahfa7mm77#a772  7v7 a m5tal heal? or   
sub/ance use treatm5t facility2  7vi7   
any o!r entity t s]ves pr$om9antly      
l[-income1 m$ically und]s]v$            
individuals1 includ+-- 7,i7 an entity   
receiv+ funds "u section #cah ( !       
,public ,heal? ,s]vice ,act 7relat+ to  
treatm5t ( sexually transmitt$ diseases7
 ?r\gh a ,/ate or unit ( local gov]nm5t1
 b only if ! entity is c]tifi$ by !     
,secret>y pursuant to section           

#cdj;,b7a77#g7 ( su* ,act2  7,,ii7 a    
tub]culosis cl9ic2  7,,iii7 a           
compreh5sive hemophilia diagno/ic       
treatm5t c5t] receiv+ a grant "u section
 #eja7;a77#b72 &  7,,iv7 a black lung   
cl9ic receiv+ funds "u section #dbg7;a7 
( ! ,black ,lung ,b5efits ,act2  7vii7 a
 m$ic>e-dep5d5t1 small rural hospital 7z
 def9$ 9 section                        
#ahhf7;d77#d77;,g77iv772 &  7viii7 any  
provid] det]m9$ appropriate by !        
,secret>y1 :i* may include any provid]  
det]m9$ by ! ,secret>y to be an ess5tial
 community provid] "u section           
#acaa7;c77#a77;,c7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#a77;,c774  4