,,ii #aai? ,,congress #b;d ,session ,s4 #cief ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #b1 #bjbf,mr4 ,s&]s introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d ! ,int]nal ,rev5ue ,code ( #aihf to impose an annual tax on ! net value ( assets held by a taxpay]1 & = o!r purposes4 #a4 ,%ort title1 etc 7a7 ,%ort title ,?is ,act may be cit$ z ! ,make ,billionaires ,pay ,_! ,fair ,%>e ,act4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title1 etc4,,title ,i--,weal? tax,sec4 #aja4 ,imposition ( tax on net value ( assets4,sec4 #ajb4 ,en=cem5t4,,title ,,ii--,af=dability ,rebates,sec4 #bja4 ,af=dability rebates4,,title ,,iii--,heal? c>e provisions,sec4 #cja4 ,repeal ( reconciliation heal? provisions4,sec4 #cjb4 ,increase 9 eligibility = premium tax cr$it4,,title ,,iv--,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion,sec4 #dja4 ,%ort title4,sec4 #djb4 ,cov]age ( d5tal & oral heal? c>e4,sec4 #djc4 ,provid+ cov]age = he>+ c>e "u ! ,m$ic>e program4,sec4 #djd4 ,provid+ cov]age = vision c>e "u ! ,m$ic>e program4,sec4 #dje4 ,phase-9 ( impact ( d5tal & oral heal? cov]age on "p ,b premiums4,,title ,v--,h\s+ ,tru/ ,fund,sec4 #eja4 ,au?orization ( appropriations4,,title ,,vi--,af=dable ,*ild ,c>e = ,work+ ,families,sec4 #fja4 ,bir? ?r\gh five *ild c>e & e>ly le>n+ entitlem5t4,,title ,,vii--,e/abli%+ a #fj1jjj a ye> m9imum sal>y = e public s*ool tea*] 9 ! ,unit$ ,states,sec4 #gja4 ,purposes4,sec4 #gjb4 ,def9itions4,sec4 #gjc4 ,ensur+ tea*]s are paid a livable & competitive wage4,sec4 #gjd4 ,collective b>ga9+ & relat$ rules4,,title ,,viii--,inve/m5ts 9 ,home & ,community-,bas$ ,s]vices & ,long-,t]m ,c>e ,quality & ,workforce,sec4 #hja4 ,,hcbs improvem5t plann+ grants4,sec4 #hjb4 ,,hcbs ,improvem5t ,program4,sec4 #hjc4 ,fund+ = ,f$]al activities relat$ to ,m$icaid ,,hcbs4,sec4 #hjd4 ,fund+ = ,,hcbs quality measurem5t & improvem5t4,sec4 #hje4 ,p]man5t ext5sion ( ,m$icaid protections aga9/ sp\sal impov]i%m5t = recipi5ts ( home & community-bas$ s]vices4,sec4 #hjf4 ,p]man5t ext5sion ( ,money ,foll[s ! ,p]son ,rebalanc+ demon/ration4 ,i ,weal? tax #aja4 ,imposition ( tax on net value ( assets 7a7 ,9 g5]al ,! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] subtitle ,b ! foll[+ new subtitle3 ,b-#a ,weal? tax ,*apt] #ah--;,det]m9ation ( weal? tax #ah ,det]m9ation ( weal? tax ,sec4 #bija4 ,imposition ( tax4,sec4 #bijb4 ,net value ( assets4,sec4 #bijc4 ,special rules4,sec4 #bijd4 ,adm9i/rative provisions4 #bija4 ,imposition ( tax 7a7 ,9 g5]al ,9 ! case ( an applicable taxpay]1 !re is h]eby impos$ a tax comput$ equal to #e p]c5t ( ! net value ( assets held by ! taxpay] = ! cal5d> ye>4 7b7 ,applicable taxpay] 7#a7 ,9 g5]al ,= purposes ( ?is *apt]1 ! t]m applicable taxpay] means any individual or tru/ if ! net value ( all assets held by ! taxpay] = ! cal5d> ye> exce$s #a1jjj1jjj1jjj4 7#b7 ,inflation adju/m5t 7,a7 ,9 g5]al ,9 ! case ( any cal5d> ye> aft] #bjbf1 ! #a1jjj1jjj1jjj am\nt "u p>agraph 7#a7 %all be increas$ by an am\nt equal to-- 7i7 su* doll> am\nt1 multipli$ by 7ii7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye> 9 :i* ! taxable ye> beg9s1 det]m9$ by sub/itut+ 9 subp>agraph 7,a77ii7 !re( cal5d> ye> #bjbe = cal5d> ye> #bjaf4 7,b7 ,r\nd+ ,if any am\nt z adju/$ "u subp>agraph 7,a7 is n a multiple ( #a1jjj1jjj1 su* doll> am\nt %all be r\nd$ to ! next l[e/ multiple ( #a1jjj1jjj4 7c7 ,treatm5t ( m>ri$ individuals ,= purposes ( ?is section1 individuals :o are m>ri$ 7z def9$ 9 section #ggjc7 %all be treat$ z "o taxpay]4 #bijb4 ,net value ( assets 7a7 ,9 g5]al ,! net value ( assets held by an applicable taxpay] = any cal5d> ye> %all be ! excess (-- 7#a7 ! value ( all prop]ty ( ! taxpay]1 real or p]sonal1 tangible or intangible1 :]ev] situat$1 on ! la/ day ( su* cal5d> ye> 7comput$ )\t reg>d to any debt ow$ by ! taxpay] & secur$ by ! prop]ty71 ov] 7#b7 ! am\nt ( any debt ow$ by ! taxpay] on ! la/ day ( su* cal5d> ye>4 7b7 ,inclusion ( prop]ty ( relat$ *ildr5 ,= purposes ( ?is subtitle1 any prop]ty ( an individual :o is a *ild ( ! taxpay] 7z def9$ 9 section #aeb7;f77#a77 & has n atta9$ ! age ( #ah %all be treat$ z prop]ty held by ! taxpay] = any cal5d> ye> be=e ! ye> 9 :i* su* individual atta9s ! age ( #ah4 7c7 ,e/abli%m5t ( valuation rules 7#a7 ,au?ority ( ,secret>y ,! ,secret>y %all e/abli% rules & me?ods = det]m9+ ! value ( any asset = purposes ( ?is subtitle4 7#b7 ,g5]al rules ,except z o!rwise provid$ 9 ?is p>agraph1 ! rules & me?ods e/abli%$ "u p>agraph 7#a7 may be simil> to ! rules ( "p ,,iii ( sub*apt] ,a ( *apt] #aa 7o!r ?an ! rules ( sections #bjca7;c71 #bjcb;,a1 #bjce1 & #bjdd74 7#c7 ,rules = assets ! value ( :i* is n readily asc]ta9able 7,a7 ,9 g5]al ,9 ! case ( any prop]ty ! value ( :i* is n readily asc]ta9able1 ! ,secret>y may all[ ! taxpay] to elect to use a value :i* is equal to ! mo/ rec5t readily asc]ta9able value ( su* prop]ty increas$ by an av]age rate ( appreciation applicable to assets ( a simil> class4 7,b7 ,limitation ,! ,secret>y may n all[ a taxpay] to make an election "u ?is p>agraph = any cal5d> ye> if ! taxpay] made an election "u ?is p>agraph = ! prec$+ cal5d> ye>4 #bijc4 ,special rules 7a7 ,deceas$ individuals ,9 ! case ( any individual :o dies dur+ a cal5d> ye>-- 7#a7 section #bija %all be appli$ z if ! cal5d> ye> end$ on ! day ( ! individual's dea?1 & 7#b7 ! am\nt ( ! tax impos$ "u su* section %all be r$uc$ by an am\nt :i* be>s ! same ratio to su* am\nt 7det]m9$ )\t reg>d to ?is subsection7 z-- 7,a7 ! numb] ( days 9 ! cal5d> ye> aft] ! date ( ! individual's dea?1 be>s to 7,b7 #cfe4 7b7 ,tru/s 7#a7 ,grantor tru/s ,if a grantor or ano!r p]son is treat$ z ! own] ( any portion ( a tru/ "u subp>t ,e ( "p ,i ( sub*apt] ,j ( *apt] #a1 !n ! grantor or su* o!r p]son %all be treat$ z hold+ t portion ( ! assets ( su* tru/1 & any rema9+ portion %all be subject to tax z provid$ 9 section #bija4 7#b7 ,incomplete gifts ,9 ! case ( any p]son :o makes a transf] ( prop]ty to a tru/ :i* is n treat$ z a gift = purposes ( *apt] #aa1 ! portion ( su* tru/ attributable to su* prop]ty %all be treat$ z ! prop]ty ( ! p]son mak+ ! transf] & n ! prop]ty ( su* tru/4 7#c7 ,aggregation rules ,! rules ( section #fdc7;f7 %all apply = purposes ( ?is subtitle4 7c7 ,application to nonresid5ts 7#a7 ,9 g5]al ,9 ! case ( any taxpay] :o is a non resid5t & n a citiz5 ( ! ,unit$ ,/ates1 section #bija7;a7 %all be appli$ by sub/itut+ net value ( dome/ic assets = net value ( all assets4 7#b7 ,net value ( dome/ic assets ,= purposes ( ?is subtitle1 ! t]m net value ( dome/ic assets means-- 7,a7 ! value ( all prop]ty ( ! taxpay]1 real or p]sonal1 tangible or intangible1 situat$ 9 ! ,unit$ ,/ates 7det]m9$ "u rules simil> to ! rules "u sub*apt] ,b ( *apt] #aa71 on ! la/ day ( su* cal5d> ye> 7comput$ )\t reg>d to any debt ow$ by ! taxpay] & secur$ by ! prop]ty71 ov] 7,b7 ! am\nt ( any debt ow$ by ! taxpay] & secur$ by assets describ$ 9 subp>agraph 7,a71 det]m9$ z ( ! la/ day ( su* cal5d> ye>4 7#c7 ,treatm5t ( m>ri$ individuals ,9 ! case ( m>ri$ individuals1 ?is subsection %all only apply if bo? individuals are non resid5ts & n citiz5s ( ! ,unit$ ,/ates4 7d7 ,application to cov]$ expatriates 7#a7 ,9 g5]al ,9 ! case ( an applicable taxpay] :o is a cov]$ expatriate ! expatriation date ( :i* occurs dur+ ! cal5d> ye>-- 7,a7 section #bija %all be appli$ z if ! cal5d> ye> end$ on ! day be=e ! expatriation1 & 7,b7 ! rate ( tax "u #bija7;a7 = su* cal5d> ye> %all be #fj p]c5t4 7#b7 ,cov]$ expatriate2 expatriation date ,= purposes ( ?is subsection-- 7,a7 ,cov]$ expatriate ,! t]m cov]$ expatriate has ! mean+ giv5 su* t]m "u section #hgg;,a1 except t 9 ! case ( m>ri$ individuals1 su* taxpay] %all be treat$ z a cov]$ expatriate only if nei!r individual is a ,unit$ ,/ates citiz5 or lawful p]man5t resid5t ( ! ,unit$ ,/ates 7)9 ! mean+ ( section #ggja7;b77#f774 7,b7 ,expatriation date ,! t]m expatriation date has ! mean+ giv5 su* t]m "u section #hgg;,a7g77#c74 #bijd4 ,adm9i/rative provisions 7a7 ,weal? regi/ry ,! ,secret>y %all e/abli% a regi/ry ( own]%ip = assets tak5 into acc\nt "u section #bijb7;a77#a71 includ+ publicly trad$ securities1 digital assets1 %>es ( closely held bus9esses1 & real e/ate )9 ! ,unit$ ,/ates4 ,= purposes ( e/abli%+ & ma9ta9+ ! regi/ry "u ! prec$+ s5t5ce1 ! ,secret>y %all-- 7#a7 rely on exi/+ s\rces ( in=mation1 includ+ c5tral depositories = securities & ,/ate1 local1 & =eign real prop]ty records2 & 7#b7 require timely report+ ( newly acquir$ assets 9 conjunction ) in=mation requir$ "u exi/+ in=mation report+ requirem5ts4 7b7 ,in=mation report+ 7#a7 ,9 g5]al ,! ,secret>y %all by regulations require ! report+ ( in=mation conc]n+ ! value ( assets1 includ+-- 7,a7 ! value ( any acc\nts :i* pay int]e/ reportable "u section #fjdi1 7,b7 ! value ( publicly trad$ /ock ) respect to :i* divid5ds are report$ "u section #fjdb1 7,c7 ! value ( any applicable privately held bus9ess1 7,d7 ! value ( any assets held ?r\gh mutual funds or brok]age acc\nts1 7,e7 ! value ( any assets held 9 eligible retirem5t plans 7z def9$ 9 section #djb7;c77#h77;,b771 & 7,f7 su* o!r assets z ! ,secret>y det]m9es is appropriate4 7#b7 ,me?od ( report+ ,! ,secret>y %all1 :]e appropriate1 require ! report+ made "u p>agraph 7#a7 to be made z a "p ( exi/+ income report+ requirem5ts4 7#c7 ,applicable privately held bus9ess ,= purposes ( ?is subsection1 ! t]m applicable privately held bus9ess means any trade or bus9esses-- 7,a7 :i* does n meet ! gross receipts te/ "u section #ddh7;c7 = ! taxable ye> end+ ) or )9 ! cal5d> ye>1 7,b7 9 :i* an individual :o 0 an applicable taxpay] 7o!r ?an a cov]$ expatriate1 z def9$ 9 section #bijc7;d77#b77 = ! prec$+ cal5d> ye> holds 7directly or indirectly7 #e p]c5t or m ( ! own]%ip int]e/s 7by value71 & 7,c7 to :i* p>agraph 7#a77;,b7 does n apply4 7c7 ,"t = paym5t ( tax ,! due date = returns ) respect to ! tax impos$ "u ?is subtitle %all be n lat] ?an ! late/ due date = :i* a return ( tax "u subtitle ,a w\ld be due if ! taxpay]'s taxable ye> end$ on ,decemb] #ca & ! taxpay] ow$ tax = su* taxable ye>4 4 7b7 ,no d$uction f income taxes ,section #bge ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] p>agraph 7#f7 ! foll[+ new p>agraph3 7#g7 ,taxes impos$ by *apt] #ah4 4 7c7 ,in=mation report+ p5alties ,section #fgbd7;d77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ & at ! end ( subp>agraph 7,c71 by /rik+ ! p]iod at ! end ( subp>agraph 7,d7 & ins]t+ 1 &1 & by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraph3 7,e7 any /atem5t or return requir$ to be fil$ "u section #bijd7;b7 :i* is n report$ "u any o!r provision ( ?is p>agraph4 4 7d7 ,cl]ical am5dm5t ,! table ( subtitles ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] ! item relat+ to subtitle ,b ! foll[+ new item3 ,subtitle ,b-#a--,weal? tax 4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to cal5d> ye>s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 #ajb4 ,en=cem5t 7a7 ,/&>d ,! ,secret>y ( ! ,treasury %all audit n less ?an #ej p]c5t ( taxpay]s requir$ to pay ! tax impos$ "u section #bija ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by section #aja7 9 ea* cal5d> ye>4 7b7 ,fund+ ,!re is h]eby appropriat$ to ea* fiscal ye> end+ aft] ! date ( ! enactm5t ( ?is ,act1 out ( any moneys 9 ! ,treasury n o!rwise appropriat$1 am\nts equival5t to #a p]c5t ( ! rev5ues attributable to ! tax impos$ "u section #bija ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by section #aja7 = necess>y exp5ses = en=cem5t activities ( ! ,int]nal ,rev5ue ,s]vice to det]m9e & collect taxes ow$ "u su* section4 ,,ii ,af=dability ,rebates #bja4 ,af=dability rebates 7a7 ,9 g5]al ,section #fdbh;,b ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 9 ! head+1 by /rik+ #bjba recov]y rebates to individuals & ins]t+ af=dability rebates1 7#b7 9 subsection 7a71 by /rik+ #bjba an am\nt equal to ! #bjba rebate am\nt & ins]t+ #bjbf an am\nt equal to ! af=dability rebate am\nt1 7#c7 by /rik+ subsection 7b7 & ins]t+ ! foll[+3 7b7 ,af=dability rebate am\nt ,= purposes ( ?is section1 ! t]m af=dability rebate am\nt means1 ) respect to any taxpay] = any taxable ye>1 ! sum (-- 7#a7 #c1jjj 7#f1jjj 9 ! case ( a jo9t return71 plus 7#b7 #c1jjj multipli$ by ! numb] ( dep5d5ts ( ! taxpay] = su* taxable ye>4 1 7#d7 9 subsection 7e77#b7-- 7,a7 9 subp>agraph 7,a71 by /rik+ #a1djj & ins]t+ #c1jjj1 & 7,b7 9 subp>agraph 7,b7-- 7i7 9 ! matt] prec$+ clause 7i71 by /rik+ #b1hjj & ins]t+ #f1jjj1 & 7ii7 9 clause 7i71 by /rik+ #a1djj & ins]t+ #c1jjj1 & 7#e7 9 subsection 7g7-- 7,a7 9 p>agraph 7#a71 by /rik+ #bjai & ins]t+ #bjbd1 7,b7 9 p>agraph 7#b77;,b71 by /rik+ ,janu>y #a1 #bjba ea* place x appe>s & ins]t+ ,janu>y #a1 #bjbf1 7,c7 9 p>agraph 7#c71 by /rik+ ,decemb] #ca1 #bjba & ins]t+ ,decemb] #ca1 #bjbf1 7,d7 9 p>agraph 7#e7-- 7i7 9 ! head+1 by /rik+ #bjbj & ins]t+ #bjbe1 7ii7 9 subp>agraph 7,a7-- 7,i7 9 ! head+1 by /rik+ #bjbj & ins]t+ #bjbe1 & 7,,ii7 by /rik+ beg9n+ 9 #bjbj1 p>agraph 7#a7 %all be appli$ ) respect to su* individual by sub/itut+ #bjbj = #bjai & ins]t+ beg9n+ 9 #bjbe1 p>agraph 7#a7 %all be appli$ ) respect to su* individual by sub/itut+ #bjbe = #bjbd1 & 7iii7 9 subp>agraph 7,b7-- 7,i7 9 clause 7i71 by /rik+ #bjbj & ins]t+ #bjbe1 7,,ii7 9 clause 7ii7-- 7aa7 9 subclause 7,i71 by /rik+ #bjbj & ins]t+ #bjbe1 & 7bb7 9 subclause 7,,ii71 by /rik+ #bjba & ins]t+ #bjbf1 & 7,,iii7 9 clause 7iii7-- 7aa7 9 ! head+1 by /rik+ #bjbj & ins]t+ #bjbe1 & 7bb7 by /rik+ #bjbj ea* place x appe>s & ins]t+ #bjbe1 & 7,e7 9 ! head+ ( p>agraph 7#f71 by /rik+ #bjai or #bjbj & ins]t+ #bjbd or #bjbe4 7b7 ,con=m+ am5dm5t ,! table ( sections = sub*apt] ,b ( *apt] #fe ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ ! item relat+ to section #fdbh;,b & ins]t+ ! foll[+ new item3 ,sec4 #fdbh;,b4 ,af=dability rebates44 ,,iii ,heal? c>e provisions #cja4 ,repeal ( reconciliation heal? provisions 7a7 ,9 g5]al ,except z provid$ 9 subsection 7b71 subtitle ,b ( title ,,vii ( ,an ,act to provide = reconciliation pursuant to title ,,ii ( ,h4 ,con4 ,res4 #ad 7,public ,law #aai-ba7 is repeal$ & any law or regulation ref]r$ to 9 su* subtitle %all be appli$ z if su* subtitle & ! am5dm5ts made by su* subtitle _h n be5 enact$4 7b7 ,exceptions 7#a7 ,9 g5]al ,subsection 7a7 %all n apply to ! provisions ( & am5dm5ts made by sections #gabjb1 #gacjf1 & #gadja ( su* ,act4 7#b7 ,availability ( funds allocat$ "u ! rural heal? trans=mation program ,section #baje7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;ee7h771 z add$ by ,public ,law #aai-ba1 is am5d$-- 7,a7 9 p>agraph 7#a77;,b7-- 7i7 9 ! subp>agraph head+ by /rik+ ,unexp5d$ or unobligat$ & ins]t+ ,availability (2 7ii7 by /rik+ clauses 7i7 ?r\gh 7iii7 & ins]t+ ! foll[+3 7i7 ,9 g5]al ,subject to clause 7ii71 funds allocat$ to a ,/ate f am\nts appropriat$ "u subp>agraph 7,a7 %all rema9 available until exp5d$4 2 & 7iii7 by r$esignat+ clause 7iv7 z clause 7ii72 & 7,b7 9 p>agraph 7#b77;,c71 by /rik+ p>agraph 7#a77;,b77iv7 & ins]t+ p>agraph 7#a77;,b77ii74 #cjb4 ,increase 9 eligibility = premium tax cr$it 7a7 ,9 g5]al ,subp>agraph 7,a7 ( section #cf;,b7c77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by /rik+ b does n exce$ #djj p]c5t4 7b7 ,applicable p]c5tages 7#a7 ,9 g5]al ,subp>agraph 7,a7 ( section #cf;,b7b77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ to read z foll[s3 7,a7 ,applicable p]c5tage ,! applicable p]c5tage = any taxable ye> %all be ! p]c5tage su* t ! applicable p]c5tage = any taxpay] ^: h\sehold income is )9 an income ti] specifi$ 9 ! foll[+ table %all increase1 on a slid+ scale 9 a l9e> mann]1 f ! initial premium p]c5tage to ! f9al premium p]c5tage specifi$ 9 su* table = su* income ti]3 ,9 ! case ( h\sehold income 7express$ z a p]c5t ( pov]ty l9e7 )9 ! foll[+ income ti]3,! initial premium p]c5tage is--,! f9al premium p]c5tage is--,up to #aej p]c5t#jjaej p]c5t up to #bjj p]c5t#jb4jbjj p]c5t up to #bej p]c5t#b4jd4jbej p]c5t up to #cjj p]c5t#d4jf4jcjj p]c5t up to #djj p]c5t#f4jh4edjj p]c5t & high]#h4eh4e4 4 7#b7 ,con=m+ am5dm5ts relat+ to af=dability ( cov]age 7,a7 ,p>agraph 7#a7 ( section #cf;,b7c7 ( su* ,code is am5d$ by /rik+ subp>agraph 7,e74 7,b7 ,subp>agraph 7,c7 ( section #cf;,b7c77#b7 ( su* ,code is am5d$ by /rik+ clause 7iv74 7,c7 ,p>agraph 7#d7 ( section #cf;,b7c7 ( su* ,code is am5d$ by /rik+ subp>agraph 7,f74 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 ,,iv ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion #dja4 ,%ort title ,?is title may be cit$ z ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbf4 #djb4 ,cov]age ( d5tal & oral heal? c>e 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7#a7 9 subp>agraph 7,,jj71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,,kk71 by ins]t+ & aft] ! semicolon2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ll7 d5tal & oral heal? s]vices 7z def9$ 9 subsection 7ooo772 4 7b7 ,d5tal & oral heal? s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ooo7 ,d5tal & oral heal? s]vices 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#b71 ! t]m d5tal & oral heal? s]vices means ! foll[+ items & s]vices t are furni%$ by a doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 subsection 7r77#b77 or an oral heal? pr(essional 7z def9$ 9 p>agraph 7#c77 on or aft] ,janu>y #a1 #bjbh 7or ,janu>y #a1 #bjbg1 9 ! case ( d5tures73 7,a7 ,prev5tive & scre5+ s]vices ,prev5tive & scre5+ s]vices1 includ+ oral exams1 d5tal clean+s1 d5tal x-rays1 & fluoride treatm5ts4 7,b7 ,proc$ures & treatm5t s]vices ,s]vices to address oral disease1 includ+ s]vices su* z re/orative s]vices1 pro/hodontic & endodontic s]vices1 includ+ fill+s1 bridges1 cr[ns1 & root canals1 p]iodontal ma9t5ance1 p]iodontal scal+ & root plan+1 too? extractions1 !rapeutic pulpotomy1 & o!r relat$ items & s]vices4 7,c7 ,d5tures & d5tal pro/hetics ,complete d5tures1 p>tial d5tures1 & implants1 includ+ relat$ items & s]vices4 7#b7 ,exclusions ,su* t]m does n include items & s]vices = :i*1 z ( ! date ( ! enactm5t ( ?is subsection1 cov]age 0 p]missible "u section #ahfb7;a77#ab7 & cosmetic s]vices n o!rwise cov]$ "u section #ahfb7;a77#aj74 7#c7 ,oral heal? pr(essional ,! t]m oral heal? pr(essional means1 ) respect to d5tal & oral heal? s]vices1 a heal? pr(essional 7o!r ?an a doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 subsection 7r77#b777 :o is lic5s$ to furni% su* s]vices1 act+ )9 ! scope ( su* lic5se1 by ! ,/ate 9 :i* su* s]vices are furni%$4 4 7c7 ,paym5t2 co9surance2 & limitations 7#a7 ,9 g5]al ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is am5d$-- 7,a7 9 subp>agraph 7,n71 by ins]t+ & d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo77 aft] section #ahfa7;hhh77#a772 7,b7 by /rik+ & be=e 7,,hh72 & 7,c7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 & 7,,ii7 ) respect to d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo771 ! am\nt paid %all be ! paym5t am\nt specifi$ "u section #ahcd7;bb74 7#b7 ,paym5t & limits specifi$ ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7bb7 ,paym5t & limits = d5tal & oral heal? s]vices 7#a7 ,paym5t ,! paym5t am\nt "u ?is "p = d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo77 %all be1 subject to p>agraphs 7#c7 & 7#d71 #hj p]c5t 7or #ajj p]c5t1 9 ! case ( prev5tive & scre5+ s]vices describ$ 9 section #ahfa7ooo77#a77;,a77 ( ! less] (-- 7,a7 ! actual *>ge = ! s]vice2 or 7,b7 7i7 9 ! case ( su* s]vices furni%$ by a doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 section #ahfa7r77#b771 ! am\nt det]m9$ "u ! fee s*$ule e/abli%$ "u p>agraph 7#b72 or 7ii7 9 ! case ( su* s]vices furni%$ by an oral heal? pr(essional 7z def9$ 9 section #ahfa7ooo77#c771 #he p]c5t ( ! am\nt det]m9$ "u ! fee s*$ule e/abli%$ "u p>agraph 7#b74 7#b7 ,e/abli%m5t ( fee s*$ule = d5tal & oral heal? s]vices 7,a7 ,e/abli%m5t 7i7 ,9 g5]al ,! ,secret>y %all e/abli% a fee s*$ule = d5tal & oral heal? s]vices furni%$ 9 #bjbh 7or #bjbg1 9 ! case ( d5tures7 & subsequ5t ye>s4 ,! fee s*$ule am\nt = a d5tal or oral heal? s]vice %all be equal to #gj p]c5t ( ! national m$ian fee 7z det]m9$ "u subp>agraph 7,b77 = ! s]vice or a simil> s]vice = ! ye> 7or1 9 ! case ( d5tures1 at ! bundl$ paym5t am\nt "u clause 7iv7 ( su* subp>agraph71 adju/$ by ! geographic adju/m5t factor e/abli%$ "u section #ahdh7;e77#b7 = ! area = ! ye>4 7ii7 ,consultation ,9 c>ry+ out ?is p>agraph1 ! ,secret>y %all consult annually ) organizations repres5t+ d5ti/s & o!r provid]s :o furni% d5tal & oral heal? s]vices & %all %>e ) su* provid]s ! data & data analysis us$ to det]m9e fee s*$ule am\nts "u ?is p>agraph4 7,b7 ,det]m9ation ( national m$ian fee 7i7 ,9 g5]al ,= purposes ( subp>agraph 7,a71 ! ,secret>y %all apply ! national m$ian fee = a d5tal or oral heal? s]vice = #bjbh 7or #bjbg1 9 ! case ( d5tures7 & subsequ5t ye>s 9 accordance ) ?is subp>agraph4 7ii7 ,use ( #bjbj d5tal fee survey 7,i7 ,9 g5]al ,except z provid$ 9 clause 7iii7 & clause 7iv71 ! national m$ian fee = a d5tal or oral heal? s]vice %all be equal to-- 7aa7 = #bjbh 7or #bjbg1 9 ! case ( d5tures71 ! m$ian fee = ! s]vice 9 ! table titl$ ,g5]al ,practition]s-,national ( ! #bjbj ,survey ( ,d5tal ,fees publi%$ by ! ,am]ican ,d5tal ,association1 increas$ by ! applicable p]c5t increase = ! ye> det]m9$ "u subclause 7,,ii71 z r$uc$ by ! productivity adju/m5t "u subclause 7,,iii72 & 7bb7 = #bjbi 7or #bjbh1 9 ! case ( d5tures7 & subsequ5t ye>s1 ! am\nt det]m9$ "u ?is subclause = ! prec$+ ye>1 updat$ pursuant to subp>agraph 7,c77i74 7,,ii7 ,applicable p]c5t increase ,! applicable p]c5t increase det]m9$ "u ?is subclause = a ye> is an am\nt equal to ! p]c5tage increase betwe5-- 7aa7 ! consum] price index = all urban consum]s 7,unit$ ,/ates city av]age7 end+ ) ,june ( ! previ\s ye>2 & 7bb7 ! consum] price index = all urban consum]s 7,unit$ ,/ates city av]age7 end+ ) ,june ( #bjbg 7or #bjbf1 9 ! case ( d5tures74 7,,iii7 ,productivity adju/m5t ,aft] det]m9+ ! applicable p]c5tage increase "u subclause 7,,ii7 = a ye>1 ! ,secret>y %all r$uce su* p]c5tage increase by ! productivity adju/m5t describ$ 9 section #ahhf7;b77#c77;,b77xi77,,ii74 7iii7 ,det]m9ation if insuffici5t survey data ,if ! ,secret>y det]m9es !re is insuffici5t data "u ! ,survey describ$ 9 clause 7ii7 ) respect to a d5tal or oral heal? s]vice1 ! national m$ian fee = ! s]vice = a ye> %all be equal to an am\nt e/abli%$ = ! s]vice us+ #a or m ( ! foll[+ me?ods1 z det]m9$ appropriate by ! ,secret>y3 7,i7 ,! paym5t basis det]m9$ "u section #ahdh4 7,,ii7 ,fee s*$ules = d5tal & oral heal? s]vices :i* %all include1 z practicable1 fee s*$ules-- 7aa7 "u ,m$ic>e ,advantage plans "u "p ,c2 7bb7 "u ,/ate plans 7or waiv]s ( su* plans7 "u title ,,xix2 & 7cc7 e/abli%$ by o!r heal? c>e pay]s4 7iv7 ,special rule = d5tures 7,i7 ,9 g5]al ,! ,secret>y %all make paym5t = d5tures & associat$ pr(essional s]vices z a bundl$ paym5t z det]m9$ by ! ,secret>y4 7,,ii7 ,paym5t consid]ations ,9 e/abli%+ su* bundl$ paym5t1 ! ,secret>y %all consid] ! national m$ian fee = ! s]vice = ! ye> det]m9$ "u clause 7ii7 or 7iii7 & ! rate det]m9$ = su* d5tures "u ! ,f$]al ,supply ,s*$ule ( ! ,g5]al ,s]vices ,adm9i/ration1 z publi%$ by su* ,adm9i/ration 9 #bjba1 updat$ to ! ye> involv$ us+ ! applicable p]c5t increase = ! ye> det]m9$ "u clause 7ii77,,ii71 z r$uc$ by ! productivity adju/m5t "u clause 7ii77,,iii71 & %all ensure t ! paym5t compon5t = d5tures "u su* bundl$ paym5t does n exce$ ! maximum rate det]m9$ = su* d5tures "u ! ,f$]al ,supply ,s*$ule1 z s publi%$ & updat$ to ! ye> involv$4 7,c7 ,annual update & adju/m5ts 7i7 ,annual update ,! ,secret>y %all update paym5t am\nts det]m9$ "u ! fee s*$ule f ye> to ye> beg9n+ 9 #bjbi 7or #bjbh1 9 ! case ( d5tures7 by increas+ su* am\nts f ! prior ye> by ! p]c5tage increase 9 ! consum] price index = all urban consum]s 7,unit$ ,/ates city av]age7 = ! #ab-mon? p]iod end+ ) ,june ( ! prec$+ ye>1 r$uc$ by ! productivity adju/m5t describ$ 9 section #ahhf7;b77#c77;,b77xi77,,ii74 7ii7 ,adju/m5ts 7,i7 ,9 g5]al ,! ,secret>y %all1 to ! ext5t ! ,secret>y det]m9es to be necess>y & subject to subclause 7,,ii71 adju/ ! am\nts det]m9$ "u ! fee s*$ule e/abli%$ "u ?is p>agraph = #bjbi 7or #bjbh1 9 ! case ( d5tures7 & subsequ5t ye>s to take into acc\nt *anges 9 d5tal practice1 cod+ *anges1 new data on "w1 practice1 or malpractice exp5ses1 or ! addition ( new proc$ures4 7,,ii7 ,limitation on annual adju/m5ts ,! adju/m5ts "u subclause 7,i7 = a ye> %all n cause ! am\nt ( exp5ditures "u ?is "p = ! ye> to diff] by m ?an #bj1jjj1jjj f ! am\nt ( exp5ditures "u ?is "p t w\ld h be5 made if su* adju/m5ts _h n be5 made4 7#c7 ,limitations ,) respect to d5tal & oral heal? s]vices t are prev5tive & scre5+ s]vices describ$ 9 p>agraph 7#a77;,a7 ( section #ahfa7ooo7-- 7,a7 paym5t %all be made "u ?is "p =-- 7i7 n m ?an #b oral exams 9 a ye>2 7ii7 n m ?an #b d5tal clean+s 9 a ye>2 7iii7 n m ?an #a fluoride treatm5t 9 a ye>2 & 7iv7 n m ?an #a full-m\? s]ies ( x-rays z "p ( a prev5tive & scre5+ oral exam e #c ye>s2 & 7,b7 9 ! case ( prev5tive & scre5+ s]vices n describ$ 9 subp>agraph 7,a71 paym5t %all be made "u ?is "p only at su* frequ5cies det]m9$ appropriate by ! ,secret>y4 7#d7 ,inc5tives = rural provid]s ,9 ! case ( d5tal & oral heal? s]vices furni%$ by a doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 section #ahfa7r77#b77 or an oral heal? pr(essional 7z def9$ 9 section #ahfa7ooo77#c77 :o pr$om9antly furni%es su* s]vices "u ?is "p 9 an area t is designat$ by ! ,secret>y 7"u section #ccb7;a77#a77;,a7 ( ! ,public ,heal? ,s]vice ,act7 z a heal? pr(essional %ortage area1 9 addition to ! am\nt ( paym5t t w\ld o!rwise be made = su* s]vices "u ?is subsection1 !re also %all be paid an am\nt equal to #aj p]c5t ( ! paym5t am\nt = ! s]vice "u ?is subsection = su* doctor or pr(essional4 7#e7 ,limitation on b5efici>y liability ,! provisions ( section #ahdh7;g7 %all apply to a nonp>ticipat+ doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 section #ahfa7r77#b77 :o does n accept paym5t on an assignm5t-relat$ basis = d5tal & oral heal? s]vices furni%$ ) respect to an individual enroll$ "u ?is "p 9 ! same mann] z su* provisions apply ) respect to a physician's s]vice4 7#f7 ,e/abli%m5t ( d5tal adm9i/rator ,! ,secret>y %all designate #a or m 7n to exce$ #d7 m$ic>e adm9i/rative contractors "u section #ahgd;,a to e/abli% cov]age policies & e/abli% su* policies & process claims = paym5t = d5tal & oral heal? s]vices1 z det]m9$ appropriate by ! ,secret>y4 4 7d7 ,inclusion ( oral heal? pr(essionals z c]ta9 practition]s ,section #ahdb7;b77#ah77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c77 is am5d$ by add+ at ! end ! foll[+ new clause3 7ix7 ,) respect to #bjbi & ea* subsequ5t ye>1 an oral heal? pr(essional 7z def9$ 9 section #ahfa7ooo77#c774 4 7e7 ,exclusion modifications ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,o71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,p71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,q7 9 ! case ( d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo77 = :i* a limitation is applicable "u section #ahcd7;bb77#c71 :i* are furni%$ m frequ5tly ?an is provid$ "u su* section2 2 & 7#b7 9 p>agraph 7#ab71 by ins]t+ be=e ! semicolon at ! end ! foll[+3 & except t paym5t %all be made "u "p ,b = d5tal & oral heal? s]vices t are cov]$ "u section #ahfa7s77#b77,,ll74 7f7 ,inclusion z except$ m$ical treatm5t ,section #ahba7;b77#e77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77 is am5d$-- 7#a7 9 clause 7ii71 by /rik+ or at ! end2 7#b7 9 clause 7iii71 by /rik+ ! p]iod & ins]t+ 1 or2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7iv7 consi/+ ( d5tal & oral heal? s]vices 7z def9$ 9 subsection 7ooo7 ( section #ahfa7 t are payable "u "p ,b z a result ( ! am5dm5ts made by ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbf4 4 7g7 ,rural heal? cl9ics & f$]ally qualifi$ heal? c5t]s 7#a7 ,cov]age ( d5tal & oral heal? s]vices ,section #ahfa7;aa7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa771 is am5d$-- 7,a7 9 p>agraph 7#a7-- 7i7 9 subp>agraph 7,c71 by /rik+ & at ! end2 7ii7 9 subp>agraph 7,d71 by ins]t+ & aft] ! comma at ! end2 & 7iii7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraph3 7,e7 d5tal & oral heal? s]vices 7z def9$ 9 subsection 7ooo77 furni%$ by a doctor ( d5tal surg]y or ( d5tal m$ic9e 7z describ$ 9 subsection 7r77#b77 or an oral heal? pr(essional 7z def9$ 9 subsection 7ooo77#c77 :o is employ$ by or work+ "u contract ) a rural heal? cl9ic if su* rural heal? cl9ic furni%es su* s]vices1 2 & 7,b7 9 p>agraph 7#c77;,a71 by /rik+ 7,d7 & ins]t+ 7,e74 7#b7 ,tempor>y paym5t rates = c]ta9 s]vices "u ! ,,rhc ,,air & ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is am5d$-- 7i7 9 subsection 7a77#c77;,a71 by ins]t+ 7:i* %all1 9 ! case ( d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo7771 9 lieu ( any limits on reasonable co/s o!rwise applicable1 be bas$ on ! rates payable = su* s]vices "u ! paym5t basis det]m9$ "u section #ahdh until su* "t z ! ,secret>y det]m9es suffici5t data has be5 collect$ to o!rwise apply su* limits 7or ,janu>y #a1 #bjca1 if no su* det]m9ation has be5 made z ( su* date77 aft] may prescribe 9 regulations2 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7ee7 ,disreg>d ( co/s attributable to c]ta9 s]vices f calculation ( ,,rhc ,,air ,paym5ts = rural heal? cl9ic s]vices o!r ?an d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo77 "u ! me?odology = all-inclusive rates 7e/abli%$ by ! ,secret>y7 "u subsection 7a77#c7 %all n take into acc\nt ! co/s ( su* s]vices :ile rates = su* s]vices are bas$ on rates payable = su* s]vices "u ! paym5t basis e/abli%$ "u section #ahdh4 4 7,b7 ,,pps ,section #ahcd7o7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,tempor>y paym5t rates bas$ on pfs = c]ta9 s]vices ,! ,secret>y %all1 9 e/abli%+ paym5t rates = d5tal & oral heal? s]vices 7z def9$ 9 section #ahfa7ooo77 t are f$]ally qualifi$ heal? c5t] s]vices "u ! prospective paym5t sy/em e/abli%$ "u ?is subsection1 9 lieu ( ! rates o!rwise applicable "u su* sy/em1 base su* rates on rates payable = su* s]vices "u ! paym5t basis e/abli%$ "u section #ahdh until su* "t z ! ,secret>y det]m9es suffici5t data has be5 collect$ to o!rwise e/abli% rates = su* s]vices "u su* sy/em 7or ,janu>y #a1 #bjca1 if no su* det]m9ation has be5 made z ( su* date74 ,paym5ts = f$]ally qualifi$ heal? c5t] s]vices o!r ?an su* d5tal & oral heal? s]vices "u su* sy/em %all n take into acc\nt ! co/s ( su* s]vices :ile rates = su* s]vices are bas$ on rates payable = su* s]vices "u ! paym5t basis e/abli%$ "u section #ahdh4 4 7h7 ,implem5tation ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices = fiscal ye> #bjbf1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ijj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbf1 & end+ on ,septemb] #cj1 #bjce4 #djc4 ,provid+ cov]age = he>+ c>e "u ! ,m$ic>e program 7a7 ,provision ( audiology s]vices by qualifi$ audiologi/s & he>+ aid exam9ation s]vices by qualifi$ he>+ aid pr(essionals 7#a7 ,9 g5]al ,section #ahfa7ll7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7ll77 is am5d$-- 7,a7 9 p>agraph 7#c7-- 7i7 by ins]t+ 7,a7 aft] 7#c72 7ii7 9 subp>agraph 7,a71 z add$ by clause 7i7 ( ?is subp>agraph-- 7,i7 by /rik+ means su* he>+ & balance assessm5t s]vices & ins]t+ 8means-- 7i7 su* he>+ & balance assessm5t s]vices &1 beg9n+ ,janu>y #a1 #bjbh1 su* he>+ aid exam9ation s]vices & treatm5t s]vices 7includ+ aural rehabilitation1 ve/ibul> rehabilitation1 & c]um5 managem5t7 2 7,,ii7 9 clause 7i71 z add$ by subclause 7,i7 ( ?is clause1 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,,iii7 by add+ at ! end ! foll[+ new clause3 7ii7 beg9n+ ,janu>y #a1 #bjbh1 su* he>+ aid exam9ation s]vices furni%$ by a qualifi$ he>+ aid pr(essional 7z def9$ 9 p>agraph 7#d77;,c77 z ! pr(essional is legally au?oriz$ to p]=m "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ,/ate law71 z w\ld o!rwise be cov]$ if furni%$ by a physician4 2 & 7iii7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,beg9n+ ,janu>y #a1 #bjbh1 audiology s]vices describ$ 9 subp>agraph 7,a77i7 %all be furni%$ )\t a requirem5t = an ord] f a physician or practition]4 2 & 7,b7 9 p>agraph 7#d71 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,! t]m qualifi$ he>+ aid pr(essional means an individual :o-- 7i7 is lic5s$ or regi/]$ z a he>+ aid disp5s]1 he>+ aid speciali/1 he>+ in/rum5t disp5s]1 or relat$ pr(essional by ! ,/ate 9 :i* ! individual furni%es su* s]vices2 & 7ii7 is accr$it$ by ! ,national ,bo>d = ,c]tification 9 ,he>+ ,in/rum5t ,sci5ces or meets su* o!r requirem5ts z ! ,secret>y det]m9es appropriate 7includ+ requirem5ts relat+ to educational c]tifications or accr$itations7 tak+ into acc\nt any additional relevant requirem5ts = he>+ aid speciali/s1 he>+ aid disp5s]s1 & he>+ in/rum5t disp5s]s e/abli%$ by ,m$ic>e ,advantage organizations "u "p ,c1 ,/ate plans 7or waiv]s ( su* plans7 "u title ,,xix1 & gr\p heal? plans & heal? insurance issu]s 7z su* t]ms are def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act74 4 7#b7 ,paym5t = qualifi$ he>+ aid pr(essionals ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a771 z am5d$ by section #djb7;c77#a71 is am5d$-- 7,a7 by /rik+ & be=e 7,,ii72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 & 7,,jj7 ) respect to he>+ aid exam9ation s]vices 7z describ$ 9 p>agraph 7#c77;,a77ii7 ( section #ahfa7ll77 furni%$ by a qualifi$ he>+ aid pr(essional 7z def9$ 9 p>agraph 7#d77;,c7 ( su* section71 ! am\nts paid %all be equal to #hj p]c5t ( ! less] ( ! actual *>ge = su* s]vices or #he p]c5t ( ! am\nt = su* s]vices det]m9$ "u ! paym5t basis det]m9$ "u section #ahdh4 7#c7 ,inclusion ( qualifi$ audiologi/s & qualifi$ he>+ aid pr(essionals z c]ta9 practition]s to receive paym5t on an assignm5t-relat$ basis 7,a7 ,qualifi$ audiologi/s ,section #ahdb7;b77#ah77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77;,c771 z am5d$ by section #djb7;d71 is am5d$ by add+ at ! end ! foll[+ new clause3 7x7 ,beg9n+ on ,janu>y #a1 #bjbh1 a qualifi$ audiologi/ 7z def9$ 9 section #ahfa7ll77#d77;,b774 4 7,b7 ,qualifi$ he>+ aid pr(essionals ,section #ahdb7;b77#ah7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieu7b77#ah77 is am5d$-- 7i7 9 ea* ( subp>agraphs 7,a7 & 7,b71 by /rik+ subp>agraph 7,c7 & ins]t+ subp>agraph 7,c7 or1 beg9n+ on ,janu>y #a1 #bjbh1 subp>agraph 7,e72 & 7ii7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,a practition] describ$ 9 ?is subp>agraph is a qualifi$ he>+ aid pr(essional 7z def9$ 9 section #ahfa7ll77#d77;,c774 4 7b7 ,cov]age ( he>+ aids 7#a7 ,inclusion ( he>+ aids z pro/hetic devices ,section #ahfa7s77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h77 is am5d$ by ins]t+ 1 & includ+ he>+ aids 7z describ$ 9 section #ahcd7;h77#g77 furni%$ on or aft] ,janu>y #a1 #bjbh1 to individuals ) mod]ately sev]e1 sev]e1 or pr(\nd he>+ loss be=e ! semicolon at ! end4 7#b7 ,paym5t limitations = he>+ aids ,section #ahcd7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77 is am5d$ by add+ at ! end ! foll[+ new p>agraphs3 7#f7 ,paym5t only on an assignm5t-relat$ basis ,paym5t = he>+ aids = :i* paym5t may be made "u ?is "p may be made only on an assignm5t-relat$ basis4 ,! provisions ( subp>agraphs 7,a7 & 7,b7 ( section #ahdb7;b77#ah7 %all apply to he>+ aids 9 ! same mann] z !y apply to s]vices furni%$ by a practition] describ$ 9 subp>agraph 7,c7 ( su* section4 7#g7 ,limitations = he>+ aids 7,a7 ,9 g5]al ,paym5t may be made "u ?is "p ) respect to an individual1 ) respect to he>+ aids furni%$ by a qualifi$ he>+ aid suppli] 7z def9$ 9 subp>agraph 7,c77 on or aft] ,janu>y #a1 #bjbh-- 7i7 n m ?an once p] e> dur+ a #e-ye> p]iod2 7ii7 only = types ( su* he>+ aids t are det]m9$ appropriate by ! ,secret>y2 & 7iii7 only if furni%$ pursuant to a writt5 ord] ( a physician1 qualifi$ audiologi/ 7z def9$ 9 section #ahfa7ll77#d771 qualifi$ he>+ aid pr(essional 7z def9$ 9 subp>agraph 7,c7 ( su* section71 physician assi/ant1 nurse practition]1 or cl9ical nurse speciali/4 7,b7 ,special rule ,! paym5t basis det]m9$ "u ?is subsection 7includ+ aft] application ( p>agraph 7#a77;,h71 relat+ to application ( competitive acquisition7 = he>+ aids furni%$ by a qualifi$ he>+ aid suppli] on or aft] ,janu>y #a1 #bjbh1 %all n exce$ ! rate det]m9$ = su* he>+ aids "u ! ,f$]al ,supply ,s*$ule ( ! ,g5]al ,s]vices ,adm9i/ration1 z publi%$ by su* ,adm9i/ration 9 #bjba1 updat$ to ! ye> involv$ us+ ! applicable p]c5t increase = ! ye>4 7,c7 ,def9itions ,9 ?is subsection3 7i7 ,he>+ aid ,! t]m he>+ aid means ! item & relat$ s]vices includ+ selection1 fitt+1 adju/m5t1 & pati5t education & tra9+4 7ii7 ,qualifi$ he>+ aid suppli] ,! t]m qualifi$ he>+ aid suppli] means-- 7,i7 a qualifi$ audiologi/2 7,,ii7 a physician 7z def9$ 9 section #ahfa7r77#a772 7,,iii7 a physician assi/ant1 nurse practition]1 or cl9ical nurse speciali/2 7,,iv7 a qualifi$ he>+ aid pr(essional 7z def9$ 9 section #ahfa7ll77#d77;,c772 & 7,v7 o!r suppli]s z det]m9$ by ! ,secret>y4 4 7#c7 ,application ( competitive acquisition 7,a7 ,9 g5]al ,section #ahcd7;h77#a77;,h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#a77;,h77 is am5d$-- 7i7 9 ! head]1 by ins]t+ & he>+ aids aft] or?otics2 7ii7 9 ! matt] prec$+ clause 7i71 by ins]t+ or ( he>+ aids describ$ 9 p>agraph 7#b77;,e7 ( su* section1 aft] #bjaa12 & 7iii7 9 clause 7i71 by ins]t+ or su* he>+ aids aft] su* or?otics4 7,b7 ,con=m+ am5dm5ts 7i7 ,9 g5]al ,section #ahdg7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,he>+ aids ,he>+ aids describ$ 9 section #ahfa7s77#h7 = :i* paym5t w\ld o!rwise be made "u section #ahcd7;h74 4 7ii7 ,exemption ( c]ta9 items f competitive acquisition ,section #ahdg7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#g77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,c]ta9 he>+ aids ,^? items & s]vices describ$ 9 p>agraph 7#b77;,e7 if furni%$ by a physician or o!r practition] 7z def9$ by ! ,secret>y7 to ! physician's or practition]'s own pati5ts z "p ( ! physician's or practition]'s pr(essional s]vice4 4 7iii7 ,implem5tation ,section #ahdg7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,competition ) respect to he>+ aids ,n lat] ?an ,janu>y #a1 #bjca1 ! ,secret>y %all beg9 ! competition ) respect to ! items & s]vices describ$ 9 p>agraph 7#b77;,e74 4 7#d7 ,physician self-ref]ral law ,section #ahgg7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7b77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,he>+ aids & s]vices ,9 ! case ( he>+ aid exam9ation s]vices & he>+ aids-- 7,a7 furni%$ on or aft] ,janu>y #a1 #bjbh1 & be=e ,janu>y #a1 #bjcj2 & 7,b7 furni%$ on or aft] ,janu>y #a1 #bjcj1 if ! f9ancial relation%ip specifi$ 9 subsection 7a77#b7 meets su* requirem5ts ! ,secret>y imposes by regulation to protect aga9/ program or pati5t abuse4 4 7c7 ,exclusion modification ,section #ahfb7;a77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is am5d$ by ins]t+ 7except su* he>+ aids or exam9ations !re= z describ$ 9 & o!rwise all[$ "u section #ahfa7s77#h77 aft] he>+ aids or exam9ations !re=4 7d7 ,inclusion z except$ m$ical treatm5t ,section #ahba7;b77#e77;,a77iv7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77iv771 z add$ by section #djb7;f71 is am5d$ by ins]t+ 1 audiology s]vices describ$ 9 subsection 7ll77#c7 ( su* section1 or he>+ aids describ$ 9 subsection 7s77#h7 ( su* section aft] section #ahfa74 7e7 ,rural heal? cl9ics & f$]ally qualifi$ heal? c5t]s 7#a7 ,cl>ify+ cov]age ( audiology s]vices z physicians' s]vices ,section #ahfa7;aa77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,a77 is am5d$ by ins]t+ 7includ+ audiology s]vices 7z def9$ 9 subsection 7ll77#c777 aft] physicians' s]vices4 7#b7 ,inclusion ( qualifi$ audiologi/s & qualifi$ he>+ aid pr(essionals z ,,rhc & ,,fqhc practition]s ,section #ahfa7;aa77#a77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,b77 is am5d$ by ins]t+ or by a qualifi$ audiologi/ or a qualifi$ he>+ aid pr(essional 7z su* t]ms are def9$ 9 subsection 7ll771 aft] 7z def9$ 9 subsection 7hh77#a7714 7#c7 ,tempor>y paym5t rates = c]ta9 s]vices "u ! ,,rhc ,,air & ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 z am5d$ by section #djb7;g77#b77;,a71 is am5d$-- 7i7 9 subsection 7a77#c77;,a71 by ins]t+ or audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 aft] 7z def9$ 9 section #ahfa7ooo772 & 7ii7 9 subsection 7ee71 by ins]t+ or audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 aft] 7z def9$ 9 section #ahfa7ooo774 7,b7 ,,pps ,section #ahcd7o77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#f771 z add$ by section #djb7;g77#b77;,b71 is am5d$-- 7i7 9 ! fir/ s5t5ce1 by ins]t+ or audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 aft] 7z def9$ 9 section #ahfa7ooo772 & 7ii7 9 ! second s5t5ce1 by ins]t+ or su* audiology s]vices aft] su* d5tal & oral heal? s]vices4 7f7 ,exp$it+ implem5tation ,! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ?is section = #bjbh & #bjbi ?r\gh program in/ruction or o!r =ms ( program guidance4 7g7 ,fund+ ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices = fiscal ye> #bjbf1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #cgj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbg1 & end+ on ,septemb] #cj1 #bjcf4 #djd4 ,provid+ cov]age = vision c>e "u ! ,m$ic>e program 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by section #djb7;a71 is am5d$-- 7#a7 9 subp>agraph 7,,kk71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,,ll71 by ins]t+ & aft] ! semicolon2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,mm7 vision s]vices 7z def9$ 9 subsection 7ppp772 4 7b7 ,vision s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by section #djb7;b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ppp7 ,vision s]vices ,! t]m vision s]vices means r\t9e eye exam9ations to det]m9e ! refractive /ate ( ! eyes1 includ+ proc$ures p]=m$ dur+ ! c\rse ( su* exam9ation1 furni%$ on or aft] ,janu>y #a1 #bjbh1 by or "u ! direct sup]vision ( an oph?almologi/ or optometri/ :o is legally au?oriz$ to furni% su* exam9ations or proc$ures 7z applicable7 "u ,/ate law 7or ! ,/ate regulatory me*anism provid$ by ,/ate law7 ( ! ,/ate 9 :i* ! exam9ations or proc$ures are furni%$4 4 7c7 ,paym5t limitations ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem71 z am5d$ by section #djb7;c77#b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7cc7 ,limitation = vision s]vices ,) respect to vision s]vices 7z def9$ 9 section #ahfa7ppp77 & an individual1 paym5t %all be made "u ?is "p = only #a r\t9e eye exam9ation describ$ 9 su* subsection dur+ a #b-ye> p]iod4 4 7d7 ,paym5t "u physician fee s*$ule ,section #ahdh7;j77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;j77#c77 is am5d$ by ins]t+ 7#b77,,mm71 be=e 7#c74 7e7 ,cov]age ( conv5tional eyeglasses ,section #ahfa7s77#h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#h771 z am5d$ by section #djc7;b77#a71 is am5d$ by /rik+ 1 & includ+ "o pair ( conv5tional eyeglasses or contact l5ses furni%$ subsequ5t to ea* cat>act surg]y ) ins]tion ( an intraocul> l5s & ins]t+ 1 includ+ #a pair ( conv5tional eyeglasses or contact l5ses furni%$ subsequ5t to ea* cat>act surg]y ) ins]tion ( an intraocul> l5s1 if furni%$ be=e ,janu>y #a1 #bjbh1 & includ+ conv5tional eyeglasses 7z describ$ 9 section #ahcd7;h77#h771 :e!r or n furni%$ subsequ5t to su* a surg]y1 if furni%$ on or aft] ,janu>y #a1 #bjbh4 7f7 ,special paym5t rules = eyeglasses 7#a7 ,limitations ,section #ahcd7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h771 z am5d$ by section #djc7;b77#b71 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#h7 ,paym5t limitations = eyeglasses 7,a7 ,9 g5]al ,) respect to conv5tional eyeglasses furni%$ to an individual on or aft] ,janu>y #a1 #bjbh1 subject to subp>agraph 7,b71 paym5t %all be made "u ?is "p only dur+ a #b-ye> p]iod1 = #a pair ( eyeglasses 7includ+ l5ses & ! frame74 7,b7 ,exception ,) respect to a #b-ye> p]iod describ$ 9 subp>agraph 7,a71 9 ! case ( an individual :o receives cat>act surg]y ) ins]tion ( an intraocul> l5s1 paym5t %all be made "u ?is "p = #a pair ( conv5tional eyeglasses furni%$ subsequ5t to su* cat>act surg]y dur+ su* p]iod4 7,c7 ,special rule ,! paym5t basis det]m9$ "u ?is subsection 7includ+ aft] application ( p>agraph 7#a77;,h71 relat+ to application ( competitive acquisition7 = conv5tional eyeglasses furni%$ to an individual on or aft] ,janu>y #a1 #bjbh1 %all n exce$ ! rate det]m9$ = su* eyeglasses "u ! ,f$]al ,supply ,s*$ule ( ! ,g5]al ,s]vices ,adm9i/ration1 z publi%$ by su* ,adm9i/ration 9 #bjba1 updat$ to ! ye> involv$ us+ ! applicable p]c5t increase = ! ye>4 7,d7 ,no cov]age ( c]ta9 items ,paym5t %all n be made "u ?is "p = deluxe eyeglasses or conv5tional read+ glasses4 4 7#b7 ,application ( competitive acquisition 7,a7 ,9 g5]al ,section #ahcd7;h77#a77;,h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h77#a77;,h771 z am5d$ by section #djc7;b77#c77;,a71 is am5d$-- 7i7 9 ! head+1 by /rik+ & he>+ aids & ins]t+ he>+ aids1 & eyeglasses2 7ii7 9 ! matt] prec$+ clause 7i7-- 7,i7 by /rik+ or ( he>+ aids & ins]t+ ( he>+ aids2 & 7,,ii7 by ins]t+ or ( eyeglasses describ$ 9 p>agraph 7#b77;,f7 ( su* section1 aft] p>agraph 7#b77;,e7 ( su* section12 & 7iii7 9 clause 7i71 by /rik+ or su* he>+ aids & ins]t+ 1 su* he>+ aids1 or su* eyeglasses4 7,b7 ,con=m+ am5dm5t ,section #ahdg7;a77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a77#b771 z am5d$ by section #djc7;b77#c77;,b77i71 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ,eyeglasses ,eyeglasses describ$ 9 section #ahfa7s77#h7 = :i* paym5t w\ld o!rwise be made "u section #ahcd7;h74 4 7,c7 ,implem5tation ,section #ahdg7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#c7;a771 z am5d$ by section #djc7;b77#c77;,b77iii71 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,competition ) respect to eyeglasses ,n lat] ?an ,janu>y #a1 #bjcj1 ! ,secret>y %all beg9 ! competition ) respect to ! items & s]vices describ$ 9 p>agraph 7#b77;,f74 4 7g7 ,exclusion modifications ,section #ahfb7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a771 z am5d$ by section #djb7;e71 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,p71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,q71 by /rik+ ! semicolon at ! end & ins]t+ 1 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,r7 9 ! case ( vision s]vices 7z def9$ 9 section #ahfa7ppp77 t are r\t9e eye exam9ations z describ$ 9 su* section1 :i* are furni%$ m frequ5tly ?an once dur+ a #b-ye> p]iod2 2 & 7#b7 9 p>agraph 7#g7-- 7,a7 by ins]t+ 7o!r ?an su* an exam9ation t is a vision s]vice t is cov]$ "u section #ahfa7s77#b77,,mm77 aft] eye exam9ations2 & 7,b7 by ins]t+ 7o!r ?an su* a proc$ure t is a vision s]vice t is cov]$ "u section #ahfa7s77#b77,,mm77 aft] refractive /ate ( ! eyes4 7h7 ,inclusion z except$ m$ical treatm5t ,section #ahba7;b77#e77;,a77iv7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#e7;b77#e77;,a77iv771 z add$ by section #djb7;f7 & am5d$ by section #djc7;d71 is am5d$-- 7#a7 by /rik+ or he>+ aids & ins]t+ he>+ aids2 & 7#b7 by ins]t+ 1 or vision s]vices 7z def9$ 9 subsection 7ppp7 ( su* section7 aft] subsection 7s77#h7 ( su* section4 7i7 ,rural ,heal? ,cl9ics & ,f$]ally ,qualifi$ ,heal? ,c5t]s 7#a7 ,cl>ify+ cov]age ( vision s]vices z physicians' s]vices ,section #ahfa7;aa77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7aa77#a77;,a771 z am5d$ by section #djc7;e77#a71 is am5d$ by ins]t+ & vision s]vices 7z def9$ 9 subsection 7ppp77 aft] 7z def9$ 9 subsection 7ll77#c774 7#b7 ,tempor>y paym5t rates = c]ta9 s]vices "u ! ,,rhc ,,air & ,,fqhc ,,pps 7,a7 ,,air ,section #ahcc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel71 z am5d$ by sections #djb7;g77#b77;,a7 & #djc7;e77#c77;,a71 is am5d$-- 7i7 9 subsection 7a77#c77;,a7-- 7,i7 by /rik+ or audiology & ins]t+ 1 audiology2 & 7,,ii7 by ins]t+ 1 or vision s]vices 7z def9$ 9 section #ahfa7ppp77 aft] 7z def9$ 9 section #ahfa7ll77#c772 & 7ii7 9 subsection 7ee7-- 7,i7 by /rik+ or audiology & ins]t+ 1 audiology2 & 7,,ii7 by ins]t+ 1 or vision s]vices 7z def9$ 9 section #ahfa7ppp77 aft] 7z def9$ 9 section #ahfa7ll77#c774 7,b7 ,,pps ,section #ahcd7o77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#f771 z add$ by section #djb7;g77#b77;,b7 & am5d$ by section #djc7;e77#c77;,b71 is am5d$-- 7i7 9 ! fir/ s5t5ce-- 7,i7 by /rik+ or audiology & ins]t+ 1 audiology2 & 7,,ii7 by ins]t+ 1 or vision s]vices 7z def9$ 9 section #ahfa7ppp77 aft] 7z def9$ 9 section #ahfa7ll77#c772 & 7ii7 9 ! second s5t5ce1 by /rik+ or su* audiology s]vices & ins]t+ 1 su* audiology s]vices1 or su* vision s]vices4 7j7 ,exp$it+ implem5tation ,! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ?is section = #bjbh & #bjbi ?r\gh program in/ruction or o!r =ms ( program guidance4 7k7 ,fund+ ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices = fiscal ye> #bjbf1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ejj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbg1 & end+ on ,septemb] #cj1 #bjce4 #dje4 ,phase-9 ( impact ( d5tal & oral heal? cov]age on "p ,b premiums ,section #ahci7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7a77 is am5d$-- 7#a7 9 ! second s5t5ce ( p>agraph 7#a71 by /rik+ & 7#g7 & ins]t+ 7#g71 & 7#h72 7#b7 9 p>agraph 7#c71 by /rik+ ,! ,secret>y & ins]t+ ,subject to p>agraph 7#h77;,c71 ! ,secret>y2 & 7#c7 by add+ at ! end ! foll[+3 7#h7 ,special rule = #bjbg ?r\gh #bjca 7,a7 ,det]m9ation ( alt]native mon?ly actu>ial rate = ea* ( #bjbg ?r\gh #bjca ,= ea* ( #bjbg ?r\gh #bjca1 ! ,secret>y %all1 at ! same "t z & 9 addition to ! det]m9ation ( ! mon?ly actu>ial rate = enrollees age #fe & ov] det]m9$ 9 ea* ( #bjbf ?r\gh #bjcj = ! succe$+ cal5d> ye> accord+ to p>agraph 7#a71 det]m9e an alt]native mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye> z describ$ 9 subp>agraph 7,b74 7,b7 ,alt]native mon?ly actu>ial rate describ$ 7i7 ,9 g5]al ,! alt]native mon?ly actu>ial rate describ$ 9 ?is subp>agraph is-- 7,i7 = #bjbg & #bjbh1 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye>1 det]m9$ z if ! am5dm5ts made by section #djb ( ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbf did n apply2 & 7,,ii7 = #bjbi1 #bjcj1 & #bjca1 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye>1 det]m9$ z if ! am5dm5ts made by su* section #djb did n apply1 plus ! applicable p]c5t ( ! am\nt by :i*-- 7aa7 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye> det]m9$ accord+ to p>agraph 7#a72 exce$s 7bb7 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye>1 det]m9$ z if ! am5dm5ts made by su* section #djb did n apply4 7ii7 ,def9ition ( applicable p]c5t ,= purposes ( ?is subp>agraph1 ! t]m applicable p]c5t means-- 7,i7 = #bjbi1 #be p]c5t2 7,,ii7 = #bjcj1 #ej p]c5t2 & 7,,iii7 = #bjca1 #ge p]c5t4 7,c7 ,application to "p b premium & o!r provisions ( ?is "p ,= ea* ( #bjbg ?r\gh #bjca1 ! ,secret>y %all use ! alt]native mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye> det]m9$ "u subp>agraph 7,a71 9 lieu ( ! mon?ly actu>ial rate = su* enrollees = ! ye> det]m9$ accord+ to p>agraph 7#a71 :5 det]m9+ ! mon?ly premium rate = ! ye> "u p>agraph 7#c7 & subsection 7j71 ! "p ,b d$uctible "u section #ahcc7;b71 & ! premium subsidy & mon?ly adju/m5t am\nt "u subsection 7i74 4 ,v ,h\s+ ,tru/ ,fund #eja4 ,au?orization ( appropriations ,section #acch7;a7 ( ! ,f$]al ,h\s+ ,ent]prises ,f9ancial ,safety & ,s\ndness ,act ( #aiib 7#ab ,u4,s4,c4 #defh7;a77 is am5d$ by add+ at ! end ! foll[+3 7#c7 ,au?orization ( appropriations ,!re is au?oriz$ to be appropriat$ to ! ,h\s+ ,tru/ ,fund #he1fdg1jjj1jjj = ea* ( fiscal ye>s #bjbf ?r\gh #bjce4 4 ,,vi ,af=dable ,*ild ,c>e = ,work+ ,families #fja4 ,bir? ?r\gh five *ild c>e & e>ly le>n+ entitlem5t 7a7 ,*ild c>e def9itions ,! def9itions 9 section #feh,p ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #ihehn7 %all apply to ?is section1 except z provid$ 9 subsection 7b7 & z o!rwise specifi$4 7b7 ,additional def9itions ,9 ?is section3 7#a7 ,*ild c>e c]tificate 7,a7 ,9 g5]al ,! t]m *ild c>e c]tificate means a c]tificate 7t may be a *eck or o!r disbursem5t7 t is issu$ by a ,/ate1 tribal1 t]ritorial1 or local gov]nm5t "u ?is section directly to a p>5t :o %all use su* c]tificate only z paym5t = *ild c>e s]vices or z a deposit = *ild c>e s]vices if su* a deposit is requir$ ( o!r *ildr5 be+ c>$ = by ! provid]4 7,b7 ,rule ,no?+ 9 ?is section %all preclude ! use ( su* c]tificates = sect>ian *ild c>e s]vices if freely *os5 by ! p>5t4 ,= ! purposes ( ?is section1 *ild c>e c]tificates %all be consid]$ indirect ,f$]al f9ancial assi/ance to ! provid]4 7#b7 ,*ild exp]i5c+ homelessness ,! t]m *ild exp]i5c+ homelessness means an individual :o is a homeless *ild or y\? "u section #gbe ( ! ,mc,kinney-,v5to ,homeless ,assi/ance ,act 7#db ,u4,s4,c4 #aadcd;a74 7#c7 ,eligible activity ,! t]m eligible activity1 ) respect to a p>5t1 %all include1 at m9imum1 activities consi/+ (-- 7,a7 full-"t or "p-"t employm5t2 7,b7 self-employm5t2 7,c7 job se>* activities2 7,d7 job tra9+2 7,e7 second>y1 po/second>y1 or adult education1 includ+ education ?r\gh a program ( high s*ool classes1 a c\rse ( /udy at an in/itution ( high] education1 classes t[>ds an equival5t ( a high s*ool diploma recogniz$ by ,/ate law1 or ,engli% z a second language classes2 7,f7 heal? treatm5t 7includ+ m5tal heal? & sub/ance use treatm5t7 = a condition t prev5ts ! p>5t f p>ticipat+ 9 o!r eligible activities2 7,g7 activities to prev5t *ild abuse & neglect1 or family viol5ce prev5tion or int]v5tion activities2 7,h7 employm5t & tra9+ activities "u ! supplem5tal nutrition assi/ance program e/abli%$ "u section #f7;d77#d7 ! ,food & ,nutrition ,act ( #bjjh 7#g ,u4,s4,c4 #bjae7;d77#d772 7,i7 employm5t & tra9+ activities "u ! ,work=ce ,innovation & ,opportunity ,act 7#bi ,u4,s4,c4 #caja et seq472 7,j7 a "w activity describ$ 9 subsection 7d7 ( section #djg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fjg7 = :i*1 consi/5t ) clauses 7ii7 & 7iii7 ( section #djb7;a77#a77;,a7 ( su* ,act 7#db ,u4,s4,c4 #fjb7;a77#a77;,a771 a p>5t or c>etak] is treat$ z be+ engag$ 9 "w = a mon? 9 a fiscal ye> = purposes ( ! program ( block grants to ,/ates = tempor>y assi/ance = ne$y families e/abli%$ "u "p ,a ( title ,,iv ( ! ,social ,security ,act 7#db ,u4,s4,c4 #fja et seq472 & 7,k7 tak+ leave "u ! ,family & ,m$ical ,leave ,act ( #aiic 7#bi ,u4,s4,c4 #bfja et seq47 7or equival5t provisions = ,f$]al employees71 a ,/ate or local paid or unpaid leave law1 or a program ( employ]-provid$ leave4 7#d7 ,eligible *ild 7,a7 ,9 g5]al ,! t]m eligible *ild means an individual-- 7i7 :o is less ?an #f ye>s ( age2 7ii7 :o is n yet 9 k9d]g>t52 7iii7 ^: family income does n exce$ #bej p]c5t ( ! ,/ate m$ian income = a family ( ! same size = ! fiscal ye> involv$1 = ea* fiscal ye> beg9n+ ) fiscal ye> #bjbf2 & 7iv7 :o-- 7,i7 resides ) a p>5t or p>5ts :o are p>ticipat+ 9 an eligible activity2 7,,ii7 is includ$ 9 a population ( vuln]able *ildr5 id5tifi$ by ! lead ag5cy involv$1 :i* at a m9imum %all include *ildr5 ) disabilities1 infants & toddl]s ) disabilities1 *ildr5 exp]i5c+ homelessness1 *ildr5 9 fo/] c>e1 *ildr5 9 k9%ip c>e1 & *ildr5 :o are receiv+1 or ne$ to receive1 *ild protective s]vices2 or 7,,iii7 resides ) a p>5t :o is m ?an #fe ye>s ( age4 7,b7 ,long]-t]m p]iod eligibility ,= purposes ( det]m9+ eligibility "u ?is p>agraph1 an individual :o is det]m9$ to be an eligible *ild %all cont9ue to be consid]$ an eligible *ild & %all n be requir$ to rev]ify eligibility = purposes ( ?is section dur+ ! p]iod-- 7i7 t beg9s on ! date ( ! det]m9ation2 & 7ii7 t ends on ! e>li] ( ! date ! individual becomes #f ye>s ( age or ! date ! individual ent]s k9d]g>t54 7#e7 ,eligible *ild c>e provid] 7,a7 ,9 g5]al ,! t]m eligible *ild c>e provid] means a c5t]-bas$ *ild c>e provid]1 a family *ild c>e provid]1 or o!r provid] ( *ild c>e s]vices = comp5sation t-- 7i7 is lic5s$ to provide *ild c>e s]vices "u ,/ate law applicable to ! *ild c>e s]vices x provides or1 9 ! case ( an ,indian ,tribe or tribal organization1 meets ! rules set by ! ,secret>y2 7ii7 p>ticipates 9 ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s describ$ 9 subsection 7f77#c77;,b71 or1 9 ! case ( an ,indian ,tribe or tribal organization1 meets ! rules set by ! ,secret>y-- 7,i7 n lat] ?an #c ye>s aft] ! ,/ate fir/ receives funds "u ?is section2 & 7,,ii7 = ! rema9d] ( ! p]iod = :i* ! provid] receives funds "u ?is section2 & 7iii7 satisfies ! ,/ate & local requirem5ts1 includ+ ^? requirem5ts describ$ 9 section #feh;,e7c77#b77;,i7 ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;c7c77#b77;,i771 applicable to ! *ild c>e s]vices x provides4 7,b7 ,special rule ,a *ild c>e provid] :o is eligible to provide *ild c>e s]vices 9 a ,/ate = *ildr5 receiv+ assi/ance "u ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheg et seq47 on ! date ! ,/ate submits an application = funds "u ?is section1 & rema9s 9 compliance ) any lic5s+ or regi/ration /&>ds1 or regulations1 ( ! ,/ate1 %all be deem$ to be an eligible *ild c>e provid] "u ?is section = #c ye>s aft] ! ,/ate fir/ receives funds "u ?is section4 7#f7 ,,fmap ,! t]m ,,fmap has ! mean+ giv5 ! t]m ,f$]al m$ical assi/ance p]c5tage 9 ! fir/ s5t5ce ( section #aije7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7b774 7#g7 ,family *ild c>e provid] ,! t]m family *ild c>e provid] means "o or m individuals :o provide *ild c>e s]vices1 9 a private resid5ce o!r ?an ! resid5ces ( ! *ildr5 involv$1 = less ?an #bd h\rs p] day p] *ild1 or = #bd h\rs p] day p] *ild due to ! nature ( ! "w ( ! p>5t involv$4 7#h7 ,inclusive c>e ,! t]m inclusive1 ) respect to c>e 7includ+ *ild c>e71 means c>e provid$ by an eligible *ild c>e provid]-- 7,a7 = :om ! p]c5tage ( *ildr5 s]v$ by ! provid] :o are *ildr5 ) disabilities or infants or toddl]s ) disabilities reflects ! preval5ce ( *ildr5 ) disabilities & infants & toddl]s ) disabilities 7:i*ev] ! provid] s]ves7 among *ildr5 )9 ! ,/ate involv$2 & 7,b7 t provides c>e & full p>ticipation = *ildr5 ) disabilities & infants & toddl]s ) disabilities 7:i*ev] ! provid] s]ves7 alongside *ildr5 :o are-- 7i7 n *ildr5 ) disabilities2 & 7ii7 n infants & toddl]s ) disabilities4 7#i7 ,infant or toddl] ,! t]m infant or toddl] means an individual :o is less ?an #c ye>s ( age4 7#aj7 ,infant or toddl] ) a disability ,! t]m infant or toddl] ) a disability has ! mean+ giv5 ! t]m 9 section #fcb ( ! ,individuals ) ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adcb74 7#aa7 ,lead ag5cy ,! t]m lead ag5cy means ! ag5cy designat$ "u subsection 7e74 7#ab7 ,provid] type ,! t]m provid] type means a type t is-- 7,a7 a c5t]-bas$ *ild c>e provid]2 7,b7 a family *ild c>e provid]2 or 7,c7 ano!r non-c5t]-bas$ *ild c>e provid]4 7#ac7 ,/aff$ family *ild c>e network ,! t]m /aff$ family *ild c>e network means a nonpr(it organization or nonpr(it coop]ative-- 7,a7 t may be a compon5t ( a *ild c>e res\rce & ref]ral organization2 7,b7 t has at lea/ "o paid /aff memb]2 & 7,c7 t (f]s evid5ce-bas$ pr(essional developm5t1 quality improvem5t support1 bus9ess support1 & te*nical assi/ance1 includ+ on a*iev+ lic5sure z a *ild c>e provid]1 to family *ild c>e provid]s4 7#ad7 ,/ate ,! t]m ,/ate means any ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7#ae7 ,t]ritory ,! t]m t]ritory means ! ,commonweal? ( ,pu]to ,rico1 ! ,virg9 ,isl&s ( ! ,unit$ ,/ates1 ,guam1 ,am]ican ,samoa1 & ! ,commonweal? ( ! ,nor!rn ,m>iana ,isl&s4 7c7 ,appropriations 7#a7 ,/ates1 ,indian ,tribes & tribal organizations1 & t]ritories entitlem5t ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,dep>tm5t ( ,heal? & ,human ,s]vices = fiscal ye> #bjbf & ea* subsequ5t fiscal ye>1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 su* sums z may be necess>y = paym5ts to ,/ates1 t]ritories1 & ,indian ,tribes & tribal organizations = c>ry+ out ! *ild c>e program describ$ 9 ?is section 7o!r ?an c>ry+ out activities describ$ 9 p>agraph 7#b7 or 7#c774 7#b7 ,grants to localities2 aw>ds to ,head ,/>t ag5cies ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,dep>tm5t ( ,heal? & ,human ,s]vices = fiscal ye> #bjbf1 out ( any money 9 ! ,treasury n o!rwise appropriat$ #bj1jjj1jjj1jjj1 to c>ry out ! program ( grants to localities1 & ! program ( aw>ds to ,head ,/>t ag5cies1 describ$ 9 subsection 7i74 7#c7 ,f$]al adm9i/ration ,not)/&+ p>agraph 7#a7 or 7#b71 ( ! funds appropriat$ "u ?is section = a fiscal ye>1 ! ,secret>y ( ,heal? & ,human ,s]vices may res]ve an am\nt equal to n m ?an #j4e p]c5t ( ! funds appropriat$ "u ?is section = ! prior fiscal ye>1 = purposes ( ,f$]al adm9i/ration ( ?is section4 7d7 ,e/abli%m5t ( bir? ?r\gh five *ild c>e & e>ly le>n+ entitlem5t program 7#a7 ,9 g5]al ,! ,secret>y is au?oriz$ to adm9i/] a *ild c>e & e>ly le>n+ entitlem5t program "u :i* an eligible *ild1 9 a ,/ate1 t]ritory1 or ,indian ,tribe1 or s]v$ by a tribal organization1 ) an approv$ application "u subsection 7f7 or 7g71 %all be provid$ an opportunity to obta9 high-quality *ild c>e s]vices1 subject to ! requirem5ts ( ?is section4 7#b7 ,assi/ance = e eligible *ild ,beg9n+ on ,octob] #a1 #bjbf1 e *ild :o applies = assi/ance "u ?is section1 :o is 9 a ,/ate ) an approv$ application "u subsection 7f71 or 9 a t]ritory or ,indian ,tribe or s]v$ by a tribal organization ) an approv$ application "u subsection 7g71 & :o is det]m9$1 by a lead ag5cy 7or o!r entity designat$ by a lead ag5cy7 = ! ,/ate1 t]ritory1 ,indian ,tribe1 or tribal organization involv$1 foll[+ /&>ds & proc$ures e/abli%$ by ! ,secret>y by rule1 to be an eligible *ild1 %all be (f]$ assi/ance = & %all be entitl$ to receive direct *ild c>e s]vices 9 accordance ) & subject to ! requirem5ts & limitations ( ?is section4 7e7 ,lead ag5cy ,! ,gov]nor ( a ,/ate or ! head ( a t]ritory or ,indian ,tribe1 desir+ = ! ,/ate1 t]ritory1 or ,indian tribe or a relat$ tribal organization to receive a paym5t "u ?is section1 %all designate a lead ag5cy 7su* z a ,/ate ag5cy or jo9t int]ag5cy (fice7 to adm9i/] ! *ild c>e program c>ri$ out "u ?is section4 7f7 ,applications & ,/ate plans 7#a7 ,application ,to be eligible to receive assi/ance "u ?is section1 a ,/ate %all prep>e & submit to ! ,secret>y = approval an application conta9+ a ,/ate plan t meets ! requirem5ts "u p>agraph 7#c7 & conta9s su* in=mation z ! ,secret>y may require4 7#b7 ,p]iod cov]$ by plan ,a ,/ate plan conta9$ 9 ! application %all be design$ to be implem5t$ dur+ a p]iod ( n m ?an #c ye>s4 7#c7 ,requirem5ts = ,/ate plans ,! ,secret>y %all aw>d funds "u ?is section to ,/ates ) an approv$ application t conta9s a ,/ate plan1 submitt$ "u p>agraph 7#a71 at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y %all by rule require1 includ+1 at a m9imum1 ! foll[+3 7,a7 ,paym5t rates & co/ e/imation 7i7 ,paym5t rates ,! ,/ate plan %all c]tify t paym5t rates = ! provision ( direct *ild c>e s]vices = :i* assi/ance is provid$ 9 accordance ) ?is section = ! p]iod cov]$ by ! plan1 )9 #c ye>s aft] ! ,/ate fir/ receives funds "u ?is section-- 7,i7 w be suffici5t to meet ! co/ ( *ild c>e 7includ+ fix$ co/s su* z r5t or mortgage1 & sal>ies71 & set 7) pay be+ paid7 9 accordance ) a co/ e/imation model or co/ /udy describ$ 9 clause 7ii7 t is approv$ by ! ,secret>y2 & 7,,ii7 w correspond to diff]5ces 9 quality 7includ+ improv$ quality7 bas$ on ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s describ$ 9 subp>agraph 7,b74 7ii7 ,co/ e/imation ,su* ,/ate plan %all-- 7,i7 demon/rate t ! ,/ate has1 aft] consult+ ) relevant entities & /akehold]s1 develop$ & uses a /ati/ically valid & reliable co/ e/imation model or co/ /udy = ! paym5t rates = direct *ild c>e s]vices 9 ! ,/ate t are suffici5t to cov] provid]s' fix$ co/s & reflect ! co/ ( *ild c>e at ea* ( ! ti]s ( ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s describ$ 9 subp>agraph 7,b71 & v>iations 9 ! co/ ( direct *ild c>e s]vices by geographic area1 provid] type1 & age ( *ild1 & ! additional co/s associat$ ) provid+ inclusive c>e2 7,,ii7 c]tify t ! entities & /akehold]s consult$ includ$ ! ,/ate ,advisory ,c\ncil on ,e>ly ,*ildhood ,education & ,c>e designat$ or e/abli%$ 9 section #fdb;,b7b77#a77;,a77i7 ( ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihcg;b7b77#a77;,a77i77 7includ+ ,/ate ,directors ( ,head ,/>t ,collaboration71 adm9i/rators ( local *ild c>e programs & ,head ,/>t ag5cies1 organizations repres5t+ *ild c>e directors1 tea*]s1 & o!r /aff1 local *ild c>e res\rce & ref]ral organizations1 organizations repres5t+ p>5ts ( *ildr5 ) disabilities & p>5ts ( infants & toddl]s ) disabilities1 ! ,/ate int]ag5cy coord9at+ c\ncil e/abli%$ "u section #fda ( ! ,individuals ) ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adda71 ! ,/ate advisory panel e/abli%$ "u section #fab7;a77#ba7 ( ! ,individuals ) ,disabilities ,education ,act 7#bj ,u4,s4,c4 #adab7;a77#ba771 organizations & labor organizations repres5t+ *ild c>e provid]s1 & o!r appropriate entities2 7,,iii7 c]tify t ! ,/ate-- 7aa7 n lat] ?an #cj days aft] f9aliz+ ! co/ e/imation model or co/ /udy1 publi%$ a detail$ report conta9+ ! *ild c>e co/s e/imat$ ) ! co/ e/imation model or co/ /udy1 & includ+ an explanation detail+ h[ ! wage requirem5ts describ$ 9 subclause 7,,iv77cc7 7 appli$ 9 ! e/imation ( su* co/s2 & 7bb7 n lat] ?an #fj days aft] publi%+ ! report describ$ 9 item 7aa71 e/abli%$ a sy/em to receive public comm5t on ! report on ! subject ( mak+ *anges to ! co/ e/imation model or co/ /udy1 provid$ an opportunity = ! public to comm5t on ! report ?r\gh t sy/em1 & submitt$ ! report to ! ,secret>y2 7,,iv7 c]tify t ! ,/ate's paym5t rates = direct *ild c>e s]vices = :i* assi/ance is provid$ 9 accordance ) ?is section-- 7aa7 are set 7) pay be+ paid7 9 accordance ) ! mo/ rec5t e/imates f ! mo/ rec5t co/ e/imation model or co/ /udy "u subclause 7,i71 s t provid]s at ea* ti] ( ! ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s describ$ 9 subp>agraph 7,b7 receive a paym5t t is suffici5t to fully meet ! requirem5ts ( su* ti]2 7bb7 are set s z to provide paym5ts to provid]s n at ! top ti] ( ! ti]$ sy/em t are suffici5t to enable ! provid]s to increase quality to meet ! requirem5ts = ! next ti]2 7cc7 ensure adequate wages = /aff ( *ild c>e provid]s provid+ su* direct *ild c>e s]vices t-- 7,,aa7 at a m9imum1 provide a liv+ wage = all /aff ( su* *ild c>e provid]s2 & 7,,bb7 are equival5t to wages = elem5t>y educators ) simil> cr$5tials & exp]i5ce 9 ! ,/ate2 & 7dd7 are adju/$ on an annual basis = co/ ( liv+ increases to ensure ^? paym5t rates rema9 suffici5t to meet ! requirem5ts ( ?is section2 7,v7 c]tify t ! ,/ate w update1 n less (t5 ?an once e #c ye>s1 ! co/ e/imation model or co/ /udy describ$ 9 subclause 7,i72 & 7,,vi7 c]tify t ! ,/ate has e/abli%$ a sy/em = appeals ( ! det]m9ation ( *ild c>e co/s e/imat$ ) ! co/ e/imation model or co/ /udy4 7iii7 ,paym5t practices ,su* ,/ate plan %all include an assurance t ! ,/ate w implem5t paym5t practices t support ! fix$ co/s ( provid+ direct *ild c>e s]vices4 7,b7 ,ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s ,su* ,/ate plan %all c]tify t ! ,/ate has implem5t$1 or assure t ! ,/ate w implem5t )9 #c ye>s aft] fir/ receiv+ funds "u ?is section1 ) input 7f e>ly *ildhood education & developm5t exp]ts1 f a div]se gr\p ( *ild c>e provid]s ( a v>iety ( provid] types1 f families1 & f organizations repres5t+ *ild c>e directors1 tea*]s1 & o!r /aff71 a ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s :o provide *ild c>e s]vices = :i* assi/ance is made available "u ?is section4 ,su* ti]$ sy/em %all-- 7i7 include a set ( /&>ds1 = det]m9+ ! ti] ( quality ( a *ild c>e provid]1 t-- 7,i7 uses /&>ds = a highe/ ti] t at a m9imum are equival5t to ,head ,/>t program p]=mance /&>ds describ$ 9 section #fda;,a7a77#a77;,b7 ( ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihcf;a7a77#a77;,b77 or o!r equival5t evid5ce-bas$ /&>ds approv$ by ! ,secret>y2 & 7,,ii7 includes quality indicators & ?re%olds t are appropriate = *ild developm5t f *ild c>e provid]s ( a v>iety ( provid] types1 includ+ *ild c>e c5t]s & ! sett+s ( family *ild c>e provid]s1 & are appropriate = provid]s s]v+ diff]5t age gr\ps 7includ+ mix$ age gr\ps7 ( *ildr52 7ii7 include a diff]5t set ( /&>ds t includes indicators1 :5 appropriate1 = c>e dur+ nontraditional h\rs ( op]ation2 & 7iii7 provide = suffici5t res\rces & supports = *ild c>e provid]s at ti]s l[] ?an ! highe/ ti] to facilitate progression t[>d meet+ high] quality /&>ds4 7,c7 ,a*iev+ high quality = all *ildr5 ,su* ,/ate plan %all c]tify ! ,/ate has implem5t$1 or w implem5t )9 #c ye>s aft] fir/ receiv+ funds "u ?is section1 policies & f9anc+ practices t w ensure all eligible *ildr5 c *oose to att5d *ild c>e1 ) s]vices provid$ by eligible *ild c>e provid]s f any ( a v>iety ( provid] types includ+ family *ild c>e provid]s1 at ! highe/ quality ti] )9 #f ye>s aft] ! date ( enactm5t ( ?is ,act4 7,d7 ,comp5sation ,su* plan %all provide a c]tification t ! ,/ate has or w h )9 #c ye>s aft] fir/ receiv+ funds "u ?is section1 a wage ladd] = /aff ( eligible *ild c>e provid]s receiv+ assi/ance "u ?is section1 includ+ a c]tification t wages = su* /aff1 at a m9imum1 w meet ! requirem5ts ( subp>agraph 7,a77ii77,,iv77cc74 7,e7 ,slid+ fee scale = copaym5ts 7i7 ,9 g5]al ,except z provid$ 9 clause 7ii77,i71 ! ,/ate plan %all provide an assurance t ! ,/ate w = ! p]iod cov]$ by ! plan use a slid+ fee scale describ$ 9 clause 7ii7 to det]m9e a copaym5t = a family receiv+ assi/ance "u ?is section 7or1 = a family receiv+ "p-"t c>e1 a r$uc$ copaym5t t is ! proportionate am\nt ( ! full copaym5t74 7ii7 ,slid+ fee scale ,a full copaym5t describ$ 9 clause 7i7 %all use a slid+ fee scale t provides t1 = a family ) a family income-- 7,i7 ( n m ?an #he p]c5t ( ,/ate m$ian income = a family ( ! same size1 ! family %all n pay a copaym5t1 t[>d ! co/ ( ! *ild c>e involv$ = all eligible *ildr5 9 ! family2 7,,ii7 ( m ?an #he p]c5t b n m ?an #ajj p]c5t ( ,/ate m$ian income = a family ( ! same size1 ! copaym5t %all be m ?an #j b n m ?an #b p]c5t ( t family income1 t[>d su* co/ = all su* *ildr52 7,,iii7 ( m ?an #ajj p]c5t b n m ?an #abe p]c5t ( ,/ate m$ian income = a family ( ! same size1 ! copaym5t %all be m ?an #b b n m ?an #d p]c5t ( t family income1 t[>d su* co/ = all su* *ildr52 7,,iv7 ( m ?an #abe p]c5t b n m ?an #aej p]c5t ( ,/ate m$ian income = a family ( ! same size1 ! copaym5t %all be m ?an #d b n m ?an #g p]c5t ( t family income1 t[>d su* co/ = all su* *ildr52 & 7,v7 ( m ?an #aej p]c5t b n m ?an #bej p]c5t ( ! ,/ate m$ian income = a family ( ! same size1 ! copaym5t %all be #g p]c5t ( t family income1 t[>d su* co/ = all su* *ildr54 7,f7 ,prohibition on *>g+ m ?an copaym5t ,! ,/ate plan %all c]tify t1 aft] ! ,/ate develops & beg9s us+ ! co/ e/imation model or co/ /udy describ$ 9 subp>agraph 7,a77ii71 ! ,/ate w n p]mit a *ild c>e provid] receiv+ f9ancial assi/ance "u ?is section to *>ge1 = direct *ild c>e s]vices = an eligible *ild1 m ?an ! total (-- 7i7 ! f9ancial assi/ance provid$ = ! *ild "u ?is section2 & 7ii7 any applicable copaym5t pursuant to subp>agraph 7,e74 7,g7 ,eligibility ,! ,/ate plan %all assure t ea* *ild :o receives assi/ance "u ?is section w be consid]$ to meet all eligibility requirem5ts = su* assi/ance1 & w receive su* assi/ance1 = n less ?an #ab mon?s unless ! *ild has ag$ out ( ! program1 & ! *ild's eligibility det]m9ation & r$et]m9ation1 includ+ any det]m9ation bas$ on ! ,/ate's def9ition ( eligible activities1 %all be implem5t$ 9 a mann] t supports *ild well-be+ & r$uces b>ri]s to enrollm5t1 includ+ cont9uity ( s]vices4 7,h7 ,policies to support access to *ild c>e = und]s]v$ populations ,! ,/ate plan %all demon/rate t ! ,/ate w prioritize increas+ access to1 & ! quality & ! supply (1 *ild c>e 9 ! ,/ate = und]s]v$ populations1 includ+ at a m9imum1 l[-income *ildr51 *ildr5 9 und]s]v$ areas1 infants & toddl]s1 *ildr5 ) disabilities & infants & toddl]s ) disabilities1 *ildr5 :o are dual language le>n]s1 *ildr5 exp]i5c+ homelessness1 *ildr5 9 fo/] or k9%ip c>e1 *ildr5 :o receive c>e dur+ nontraditional h\rs1 & vuln]able *ildr5 z def9$ by ! lead ag5cy pursuant to subsection 7b77#d77;,a77iv77,,ii74 7,i7 ,policies ,! ,/ate plan %all include a c]tification t ! ,/ate w apply1 "u ?is section1 ! policies & proc$ures describ$ 9 subp>agraphs 7,a71 7,b71 7,i71 7,j71 7,k77i71 7,r71 & 7,u7 ( section #feh;,e7c77#b7 ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;c7c77#b771 & ! policies & proc$ures describ$ 9 section #feh;,h ( su* ,act 7#db ,u4,s4,c4 #iheh;f71 to *ild c>e s]vices provid$ "u ?is section4 7,j7 ,lic5s+ ,! ,/ate plan %all demon/rate t ! ,/ate has consult$ or w consult ) organizations 7includ+ labor organizations & *ild c>e & e>ly le>n+ organizations7 repres5t+ eligible *ild c>e provid]s 7includ+ family *ild c>e provid]s71 *ild c>e associations1 *ild c>e directors1 tea*]s1 & o!r /aff 7includ+ *ild c>e directors1 tea*]s1 & o!r /aff s]v+ high] proportions ( und]s]v$ populations z id5tifi$ "u subp>agraph 7,h771 e>ly *ildhood education & developm5t exp]ts1 mat]nal & *ild heal? exp]ts1 & families to develop1 )9 #b4e ye>s aft] fir/ receiv+ funds "u ?is section1 lic5s+ /&>ds appropriate = *ild c>e provid]s & a pa?way to su* lic5sure t is available to & appropriate = *ild c>e provid]s 9 a v>iety ( sett+s1 t w (f] provid]s eligible "u ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheg et seq47 a reasonable pa?way to become eligible provid]s "u ?is section1 & t w assure an adequate supply ( *ild c>e4 ,su* plan %all describe ! timel9e ! ,/ate w use to ensure suffici5t "t = provid]s describ$ 9 subsection 7b77#e77;,b7 to comply ) su* lic5s+ /&>ds 9 ord] to rema9 eligible provid]s aft] #c4e ye>s aft] ! ,/ate fir/ receives fund+ "u ?is section4 7,k7 ,f9ancial support = provid]s ,su* plan %all describe h[ ! ,/ate w use funds res]v$ "u subsection 7h77#a77;,c7 to enable eligible *ild c>e provid]s f a v>iety ( provid] types to a*ieve lic5sure1 includ+ pay+ = ! co/s ( requir$ backgr\nd *ecks1 heal? scre5+1 & initial & ongo+ tra9+1 & o!r co/s associat$ ) a*iev+ lic5sure4 7,l7 ,prohibition on susp5sions1 expulsions1 & av]sive behavioral int]v5tions ,! ,/ate plan %all provide an assurance t ! ,/ate w-- 7i7 provide assi/ance to c>ry out ?is section only to eligible *ild c>e provid]s t prohibit-- 7,i7 ! use ( susp5sion & expulsion ( *ildr52 & 7,,ii7 ! use ( av]sive behavioral int]v5tions2 & 7ii7 provide tra9+ res\rces to eligible *ild c>e provid]s & in=mation to families to support ! prohibition ( practices describ$ 9 subclauses 7,i7 & 7,,ii7 ( clause 7i74 7g7 ,paym5ts 7#a7 ,9 g5]al ,= ea* fiscal ye>3 7,a7 ,*ild c>e assi/ance = eligible *ildr5 7i7 ,9 g5]al ,! ,secret>y %all pay to ea* ,/ate ) an approv$ application "u subsection 7f71 & t ,/ate %all be entitl$ to1 an am\nt = ea* qu>t] equal to #ij p]c5t ( exp5ditures 7:i* %all be ! ,f$]al %>e ( su* exp5ditures7 9 ! qu>t] = direct *ild c>e s]vices describ$ "u subsection 7h77#a77;,b7 = eligible *ildr54 7ii7 ,exception ,funds res]v$ f ! total "u subsection 7h77#a77;,c7 %all be subject to subp>agraph 7,b74 7iii7 ,prohibition ,activities describ$ 9 subp>agraph 7,b7 & subp>agraph 7,c7 may n be includ$ 9 ! co/ ( direct *ild c>e s]vices describ$ 9 ?is subp>agraph4 7,b7 ,activities to improve ! quality & supply ( *ild c>e s]vices ,! ,secret>y %all pay to ea* ,/ate ) su* an approv$ application1 & t ,/ate %all be entitl$ to1 an am\nt equal to ! ,,fmap ( exp5ditures 7:i* %all be ! ,f$]al %>e ( su* exp5ditures7 to c>ry out activities to improve ! quality & supply ( *ild c>e s]vices "u subsection 7h77#a77;,c7 subject to ! limit specifi$ 9 clause 7i7 ( su* subsection4 7,c7 ,adm9i/ration ,! ,secret>y %all pay to ea* ,/ate ) su* an approv$ application1 & t ,/ate %all be entitl$ to1 an am\nt equal to #ej p]c5t ( exp5ditures 7:i* %all be ! ,f$]al %>e ( su* exp5ditures7 = ! co/s ( adm9i/ration incurr$ by ! ,/ate-- 7i7 :i* %all include co/s incurr$ by ! ,/ate 9 c>ry+ out ! *ild c>e program e/abli%$ 9 ?is section2 & 7ii7 :i* may include1 at ! option ( ! ,/ate1 co/s associat$ ) c>ry+ out requirem5ts1 policies1 & proc$ures describ$ 9 section #feh;,h ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;f74 7#b7 ,advance paym5t2 retrospective adju/m5t ,= ea* fiscal ye>1 ! ,secret>y %all make paym5ts "u ?is subsection = a p]iod on ! basis ( advance e/imates ( exp5ditures submitt$ by ! ,/ate & su* o!r inve/igation z ! ,secret>y may f9d necess>y1 & %all r$uce or increase ! paym5ts z necess>y to adju/ = any ov]paym5t or und]paym5t = previ\s p]iods4 ,no int]e/ %all be *>g$ or paid on any am\nt due because ( an ov]paym5t or und]paym5t = previ\s p]iods4 7#c7 ,t]ritories & tribes 7,a7 ,9 g5]al ,= ea* fiscal ye>1 f am\nts appropriat$ "u subsection 7c77#a71 ! ,secret>y %all make paym5ts to t]ritories1 & ,indian ,tribes & tribal organizations1 z ! case may be1 ) applications submitt$ z describ$ 9 subp>agraph 7,b71 & approv$ by ! ,secret>y = ! purpose ( c>ry+ out ! *ild c>e program describ$ 9 ?is section1 consi/5t1 to ! ext5t practicable z det]m9$ by ! ,secret>y 7subject to subsection 7d77#b771 ) ! requirem5ts applicable to ,/ates4 7,b7 ,applications 7i7 ,t]ritories ,a t]ritory seek+ a paym5t "u ?is p>agraph %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may specify4 7ii7 ,indian ,tribes & tribal organizations ,an ,indian ,tribe or a tribal organization seek+ a paym5t "u ?is p>agraph %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may specify4 7,c7 ,co/s ,! ,secret>y %all make ! paym5ts to su* t]ritories1 ,indian ,tribes1 & tribal organizations on ! basis ( _! relative ne$4 ,ea* entity t is su* a t]ritory1 ,indian ,tribe1 or tribal organization %all be entitl$ to su* a paym5t z may be necess>y to pay = #ajj p]c5t ( ! exp5ses ( c>ry+ out ! activities describ$ 9 subsection 7h77#a71 & to pay = #ajj p]c5t ( ! co/s ( adm9i/ration incurr$ by ! entity1 :i* %all include co/s incurr$ by ! entity 9 c>ry+ out ! *ild c>e program1 & :i* may include1 at ! option ( ! entity1 co/s associat$ ) c>ry+ out requirem5ts1 policies1 & proc$ures describ$ 9 section #feh;,h ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;f74 7h7 ,use ( funds 7#a7 ,use ( funds 7,a7 ,9 g5]al ,/>t+ on ,octob] #a1 #bjbf1 a ,/ate %all use am\nts provid$ to ! ,/ate "u subsection 7g77#a7 = direct *ild c>e s]vices 7provid$ on a slid+ fee scale basis71 activities to improve ! quality & supply ( *ild c>e s]vices consi/5t ) subp>agraph 7,c71 & ,/ate adm9i/ration consi/5t ) subsection 7g77#a77;,c74 7,b7 ,*ild c>e assi/ance = eligible *ildr5 7i7 ,9 g5]al ,= fiscal ye> #bjbf & ea* subsequ5t fiscal ye>1 f paym5ts made to ! ,/ate "u subsection 7g77#a7 = t p>ticul> fiscal ye>1 ! ,/ate %all ensure t p>5ts ( eligible *ildr5 c access direct *ild c>e s]vices provid$ by an eligible *ild c>e provid] "u ?is section ?r\gh a grant or contract z describ$ 9 clause 7ii7 or a c]tificate z describ$ 9 clause 7iii74 7ii7 ,grants & contracts ,! ,/ate %all aw>d grants or contracts to eligible *ild c>e provid]s1 consi/5t ) ! requirem5ts "u ?is section1 = ! provision ( *ild c>e s]vices = eligible *ildr5 "u ?is section t1 at a m9imum-- 7,i7 support provid]s' op]at+ exp5ses to meet & su/a9 heal?1 safety1 quality1 lic5s+1 & wage /&>ds requir$ "u ?is section2 & 7,,ii7 address und]s]v$ populations describ$ 9 subsection 7f77#c77;,h74 7iii7 ,c]tificates ,! ,/ate %all issue a *ild c>e c]tificate directly to a p>5t :o %all use su* c]tificate only z paym5t = direct *ild c>e s]vices or z a deposit = direct *ild c>e s]vices if su* a deposit is requir$ ( o!r *ildr5 be+ c>$ = by ! provid]1 consi/5t ) ! requirem5ts "u ?is section4 7,c7 ,activities to improve ! quality & supply ( *ild c>e s]vices 7i7 ,quality *ild c>e activities 7,i7 ,am\nt ,= fiscal ye> #bjbf & ea* subsequ5t fiscal ye>1 f ! total ( ! paym5ts made to ! ,/ate = a p>ticul> fiscal ye>1 ! ,/ate %all res]ve & use a quality *ild c>e am\nt equal to n less ?an #e p]c5t & n m ?an #aj p]c5t ( ! am\nt made available to ! ,/ate ?r\gh su* paym5ts = ! previ\s fiscal ye>4 7,,ii7 ,use ( quality *ild c>e am\nt ,ea* ,/ate %all use ! quality *ild c>e am\nt describ$ 9 subclause 7,i7 to implem5t activities describ$ 9 ?is subp>agraph to improve ! quality & supply ( *ild c>e s]vices by eligible *ild c>e provid]s1 & increase ! numb] ( available slots 9 ! ,/ate = *ild c>e s]vices fund$ "u ?is section1 prioritiz+ assi/ance = *ild c>e provid]s :o are 9 und]s]v$ communities & :o are provid+1 or are seek+ to provide1 *ild c>e s]vices = und]s]v$ populations id5tifi$ 9 subsection 7f77#c77;,h74 7,,iii7 ,adm9i/ration ,activities fund$ "u ?is subp>agraph may be adm9i/]$-- 7aa7 directly by ! lead ag5cy2 or 7bb7 ?r\gh o!r ,/ate gov]nm5t ag5cies1 local or regional *ild c>e res\rce & ref]ral organizations1 community developm5t f9ancial in/itutions1 o!r int]m$i>ies ) exp]i5ce support+ *ild c>e provid]s1 or o!r appropriate entities t ent] into a contract ) ! ,/ate to provide su* assi/ance4 7ii7 ,quality & supply activities ,activities fund$ "u ! quality *ild c>e am\nt describ$ 9 clause 7i7 %all include ea* ( ! foll[+3 7,i7 ,/>tup grants & supply expansion grants 7aa7 ,9 g5]al ,f a portion ( ! quality *ild c>e am\nt1 a ,/ate %all make />tup & supply expansion grants to support *ild c>e provid]s :o are provid+1 or seek+ to provide1 *ild c>e s]vices to *ildr5 receiv+ assi/ance "u ?is section1 ) priority = provid]s provid+ or seek+ to provide *ild c>e 9 und]s]v$ communities & = und]s]v$ populations id5tifi$ 9 subsection 7f77#c77;,h71 to-- 7,,aa7 support />tup & expansion co/s2 & 7,,bb7 assi/ su* provid]s 9 meet+ heal? & safety requirem5ts1 a*iev+ lic5sure1 conduct+ backgr\nd *ecks1 & meet+ requirem5ts 9 ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s4 7bb7 ,requirem5t ,z a condition ( receiv+ a />tup or supply expansion grant "u ?is subclause1 a *ild c>e provid] %all commit to meet+ ! requirem5ts ( an eligible provid] "u ?is section1 & provid+ *ild c>e s]vices to *ildr5 receiv+ assi/ance "u ?is section on an ongo+ basis4 7,,ii7 ,quality grants ,f a portion ( ! quality *ild c>e am\nt1 a ,/ate %all provide quality grants to support eligible *ild c>e provid]s 9 provid+ *ild c>e s]vices to *ildr5 receiv+ assi/ance "u ?is section to improve ! quality ( su* provid]s1 includ+-- 7aa7 support+ su* provid]s 9 meet+ or mak+ progress t[>d ! requirem5ts = ! highe/ ti] ( ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s "u subsection 7f77#c77;,b72 & 7bb7 support+ su* provid]s 9 su/a9+ *ild c>e quality1 includ+ support+ increas$ wages = /aff & support+ paym5t ( fix$ co/s4 7,,iii7 ,facilities grants 7aa7 ,9 g5]al ,f a portion ( ! quality *ild c>e am\nt1 a ,/ate %all provide support1 includ+ ?r\gh aw>d+ facilities grants1 = remodel+1 r5ovation1 or repair ( a build+ or facility to ! ext5t p]mitt$ "u section #feh;,f7b7 ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;d7b774 7bb7 ,additional uses ,= fiscal ye> #bjbf & subsequ5t fiscal ye>s1 a ,/ate may aw>d su* facilities grants = con/ruction1 p]man5t improvem5t1 or major r5ovation ( a build+ or facility prim>ily us$ = provid+ direct *ild c>e s]vices1 9 accordance ) ! foll[+3 7,,aa7 ,f$]al int]e/ provisions w n apply to ! r5ovation or rebuild+ ( privately own$ family *ild c>e homes "u ?is subclause4 7,,bb7 ,eligible *ild c>e provid]s may n use funds = build+s or facilities t are us$ prim>ily = sect>ian in/ruction or religi\s wor%ip4 7,,cc7 ,! ,secret>y %all develop p>amet]s on ! use ( funds "u ?is subclause = family *ild c>e homes4 7,,dd7 ,! ,secret>y %all n reta9 ,f$]al int]e/ aft] a p]iod ( #aj ye>s 9 any facility built1 r5ovat$1 or repair$ ) funds aw>d$ "u ?is subclause4 7,,iv7 ,/ate activities to improve ! quality ( *ild c>e s]vices ,a ,/ate %all use a portion ( ! quality *ild c>e am\nt to improve ! quality ( *ild c>e s]vices available = ?is program1 :i* %all include-- 7aa7 support+ ! tra9+ & pr(essional developm5t ( ! e>ly *ildhood work=ce1 includ+ support+ degree atta9m5t1 cont9u$ education1 & cr$5tial+ = e>ly *ildhood educators2 7bb7 develop+1 implem5t+1 or enhanc+ ! ,/ate's ti]$ sy/em = measur+ & support+ ! quality ( eligible *ild c>e provid]s "u subsection 7f77#c77;,b72 7cc7 improv+ ! supply & quality ( developm5tally appropriate & inclusive *ild c>e programs & s]vices = und]s]v$ populations describ$ 9 subsection 7f77#c77;,h72 7dd7 improv+ access to *ild c>e s]vices = vuln]able *ildr5 z def9$ by ! lead ag5cy pursuant to subsection 7b77#d77;,a77iv77,,ii72 7ee7 provid+ outrea* & enrollm5t support = families ( eligible *ildr52 7ff7 support+ eligible *ild c>e provid]s to elim9ate use ( susp5sions1 expulsions1 & av]sive behavioral int]v5tions1 includ+ ?r\gh adaptations & int]v5tions by special educators1 m5tal heal? consultants1 & o!r community res\rce p]sonnel1 su* z behavior coa*es1 psy*ologi/s1 & o!r appropriate speciali/s1 & ?r\gh ! provision ( m5tal heal? s]vices = ! provid]s2 7gg7 improv+ coord9ation betwe5 ,/ates & local gov]nm5t ) respect to lic5s+ & o!r regulatory requirem5ts = eligible *ild c>e provid]s2 & 7hh7 e/abli%+ or support+ a sy/em ( local or regional *ild c>e res\rce & ref]ral organizations t is coord9at$1 to ! ext5t det]m9$ appropriate by ! ,/ate1 by a /atewide public or private nonpr(it1 community-bas$ or regionally bas$1 lead *ild c>e res\rce & ref]ral organization1 z describ$ 9 section #feh;,e7c77#c77;,b77iii7 ( ! ,*ild ,c>e & ,developm5t ,block ,grant ,act ( #aiij 7#db ,u4,s4,c4 #iheh;c7c77#c77;,b77iii774 7,v7 ,te*nical assi/ance ,f a portion ( ! quality *ild c>e am\nt1 ! ,/ate1 9 coord9ation ) local gov]nm5ts & /aff$ family *ild c>e networks z appropriate1 %all provide te*nical assi/ance to increase ! supply & quality ( eligible *ild c>e provid]s :o are provid+1 or seek+ to provide1 *ild c>e s]vices to *ildr5 receiv+ assi/ance "u ?is section1 includ+ provid+ support to enable provid]s to a*ieve lic5sure4 7i7 ,grants to localities & aw>ds to ,head ,/>t programs 7#a7 ,eligible locality def9$ ,9 ?is subsection1 ! t]m eligible locality means a city1 c\nty1 or o!r unit ( g5]al local gov]nm5t4 7#b7 ,grants to localities 7,a7 ,9 g5]al ,aft] res]v+ a portion ( ! funds appropriat$ "u subsection 7c77#b71 ! ,secret>y %all use ! portion to aw>d local ,bir? ,?r\gh ,five ,*ild ,c>e & ,e>ly ,le>n+ ,grants1 z det]m9$ by ! ,secret>y1 to eligible localities locat$ 9 ,/ates t h n receiv$ paym5ts "u subsection 7g74 ,! ,secret>y %all aw>d ! grants to eligible localities 9 su* a ,/ate f ! allotm5t made = t ,/ate "u subp>agraph 7,b74 7,b7 ,allotm5ts 7i7 ,pov]ty l9e def9$ ,9 ?is subp>agraph1 ! t]m pov]ty l9e means ! pov]ty l9e def9$ & revis$ z describ$ 9 section #fgc ( ! ,community ,s]vices ,block ,grant ,act 7#db ,u4,s4,c4 #iijb74 7ii7 ,g5]al au?ority ,= ea* ,/ate describ$ 9 subp>agraph 7,a71 ! ,secret>y %all allot = ! ,/ate = a fiscal ye> an am\nt t be>s ! same relation%ip to ! portion describ$ 9 subp>agraph 7,a7 = ! fiscal ye> z ! numb] ( *ildr5 f families ) family incomes t are at or bel[ #bjj p]c5t ( ! pov]ty l9e1 & :o are "u ! age ( #f1 9 ! ,/ate be>s to ! total numb] ( all su* *ildr5 9 all ,/ates describ$ 9 subp>agraph 7,a74 7,c7 ,application ,to receive a grant f ! correspond+ ,/ate allotm5t "u subp>agraph 7,b71 an eligible locality %all submit an application to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may require4 ,! requirem5ts = ! application %all1 to ! greate/ ext5t practicable1 be consi/5t ) ! ,/ate plan requirem5ts applicable to ,/ates "u subsection 7f74 7,d7 ,requirem5ts ,! ,secret>y %all specify ! requirem5ts = an eligible locality to provide access to *ild c>e1 :i* *ild c>e requirem5ts %all1 to ! greate/ ext5t practicable1 be consi/5t ) ! requirem5ts applicable to ,/ates "u ?is section4 7,e7 ,rec\pm5t ( unus$ funds ,not)/&+ any o!r provision ( ?is section1 = ea* ( fiscal ye>s #bjbf ?r\gh #bjcj1 ! ,secret>y %all h ! au?ority to rec\p any unus$ funds allott$ "u subp>agraph 7,b7 = aw>ds "u p>agraph 7#c77;,a7 to ,head ,/>t ag5cies 9 accordance ) p>agraph 7#c74 7#c7 ,head ,/>t expansion 9 nonp>ticipat+ ,/ates 7,a7 ,9 g5]al ,! ,secret>y %all use funds appropriat$ "u subsection 7c77#b7 & n res]v$ "u p>agraph 7#b77;,a7 & funds rec\p$ "u p>agraph 7#b7 to make aw>ds to ,head ,/>t ag5cies 9 a ,/ate describ$ 9 p>agraph 7#b77;,a7 to c>ry out ! purposes ( ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihca et seq47 9 su* ,/ate4 7,b7 ,rule ,= purposes ( c>ry+ out ! ,head ,/>t ,act 9 circum/ances n involv+ aw>ds "u ?is p>agraph1 funds aw>d$ "u subp>agraph 7,a7 %all n be includ$ 9 ! calculation ( a base grant z su* t]m is def9$ 9 section #fdj7;a77#g77;,a7 ( ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihce7;a77#g77;,a774 7,c7 ,def9ition ,9 ?is p>agraph1 ! t]m ,head ,/>t ag5cy means an entity designat$ or eligible to be designat$ z a ,head ,/>t ag5cy "u section #fda7;a77#a7 ( ! ,head ,/>t ,act 7#db ,u4,s4,c4 #ihcf7;a77#a77 or z an ,e>ly ,head ,/>t ag5cy 7by receiv+ a grant7 "u section #fde;,a7a7 ( su* ,act 7#db ,u4,s4,c4 #ihdj;a7a77#a774 7#d7 ,priority = s]v+ und]s]v$ populations ,9 mak+ det]m9ations to aw>d a grant or make an aw>d "u ?is subsection1 ! ,secret>y %all give priority to entities s]v+ a high p]c5tage ( individuals f und]s]v$ populations describ$ 9 subsection 7f77#c77;,h74 7j7 ,program requirem5ts 7#a7 ,prohibition on additional eligibility requirem5ts ,no individual %all be det]m9$1 by ! ,secret>y1 a ,/ate1 or ano!r recipi5t ( funds "u ?is section1 to be ineligible = *ild c>e s]vices provid$ "u ?is section1 except on ! basis ( eligibility requirem5ts specifi$ 9 or "u ?is section4 7#b7 ,ma9t5ance ( ef=t 7,a7 ,9 g5]al ,a ,/ate t receives paym5ts "u ?is section = a fiscal ye>1 9 us+ ! funds made available ?r\gh ! paym5ts1 %all ma9ta9 ! exp5ditures ( ! ,/ate = *ild c>e s]vices at ! av]age level ( su* exp5ditures by ! ,/ate = ! #c prec$+ fiscal ye>s4 7,b7 ,c\nt+ rule ,/ate exp5ditures c\nt$ = purposes ( meet+ ! requirem5t 9 subp>agraph 7,a7 may also be c\nt$ = purposes ( meet+ ! requirem5t to provide a non-,f$]al %>e "u subp>agraph 7,a71 7,b71 or 7,c71 z appropriate1 ( subsection 7g77#a74 7#c7 ,supplem5t n supplant ,funds receiv$ "u ?is section %all be us$ to supplem5t & n supplant o!r ,f$]al1 ,/ate1 & local public funds exp5d$ to provide *ild c>e s]vices 9 ! ,/ate on ! date ( enactm5t ( ?is ,act1 calculat$ z ! av]age am\nt ( su* ,f$]al1 ,/ate1 & local public funds exp5d$ = fiscal ye> #bjbf & ea* subsequ5t fiscal ye> t end$ be=e ! date on :i* ! av]age is calculat$4 7#d7 ,all[able s\rces ( non-,f$]al %>e ,= purposes ( provid+ ! non-,f$]al %>e requir$ "u subsection 7g77#a71 a ,/ate's non-,f$]al %>e-- 7,a7 = direct *ild c>e s]vices describ$ 9 subsection 7g77#a77;,a7-- 7i7 %all n include contributions be+ us$ z a non-,f$]al %>e or mat* = ano!r ,f$]al aw>d2 & 7ii7 %all be provid$ f ,/ate or local s\rces1 contributions f philan?ropy or o!r private organizations1 or a comb9ation ( su* s\rces & contributions2 & 7,b7 = activities to improve ! quality & supply ( *ild c>e s]vices describ$ 9 subsection 7g77#a77;,b71 & adm9i/ration describ$ 9 subsection 7g77#a77;,c7-- 7i7 %all n include contributions be+ us$ z a non-,f$]al %>e or mat* = ano!r ,f$]al aw>d2 7ii7 %all be provid$ f ,/ate or local s\rces1 contributions f philan?ropy or o!r private organizations1 or a comb9ation ( su* s\rces & contributions2 & 7iii7 may be 9 ca% or 9-k9d1 fairly evaluat$1 includ+ facilities or prop]ty1 equipm5t1 or s]vices4 7#e7 ,reports ,a ,/ate1 ,indian ,tribe1 tribal organization1 or t]ritory receiv+ funds "u ?is section %all provide to ! ,secret>y su* p]iodic reports1 provid+ a detail$ acc\nt+ ( ! uses ( ! funds receiv$ "u ?is section1 z ! ,secret>y may require = ! adm9i/ration ( ?is section4 ,! ,/ate1 ,indian ,tribe1 tribal organization1 or t]ritory %all beg9 to provide ! reports beg9n+ n lat] ?an #fj days aft] its initial receipt ( a paym5t "u subsection 7g74 7k7 ,monitor+ & en=cem5t 7#a7 ,review ( compliance ) requirem5ts & ,/ate plan ,! ,secret>y %all review & monitor compliance ( ,/ates1 t]ritories1 tribal entities1 & local entities ) ?is section & ,/ate compliance ) ! ,/ate plan describ$ 9 subsection 7f77#c74 7#b7 ,issuance ( rule ,! ,secret>y %all e/abli% by rule proc$ures =-- 7,a7 receiv+1 process+1 & det]m9+ ! validity ( compla9ts or f9d+s conc]n+ any failure ( a ,/ate to comply ) ! ,/ate plan or any o!r requirem5t ( ?is section2 7,b7 notify+ a ,/ate :5 ! ,secret>y has det]m9$ !re has be5 a failure by ! ,/ate to comply ) a requirem5t ( ?is section2 & 7,c7 impos+ sanctions "u ?is subsection = su* a failure4 7l7 ,f$]al adm9i/ration ,us+ funds res]v$ "u subsection 7c77#c71 ! ,secret>y %all c>ry out adm9i/ration ( ?is section1 %all provide 7includ+ ?r\gh ! use ( grants or coop]ative agreem5ts7 te*nical assi/ance to ,/ates1 t]ritories1 ,indian ,tribes1 & tribal organizations1 & %all c>ry out rese>*1 & evaluations relat$ to ?is section4 7m7 ,nonpo/second>y education program ,= purposes ( section #dja ( ! ,p]sonal ,responsibility & ,"w ,opportunity ,reconciliation ,act ( #aiif 7#h ,u4,s4,c4 #afaa71 ! program c>ri$ out "u ?is section %all be consid]$ to be a program ( nonpo/second>y education4 ,,vii ,e/abli%+ a #fj1jjj a ye> m9imum sal>y = e public s*ool tea*] 9 ! ,unit$ ,/ates #gja4 ,purposes ,! purposes ( ?is title are to-- 7#a7 ensure public elem5t>y & second>y s*ool tea*]s e>n a livable & competitive sal>y t-- 7,a7 includes a />t+ annual base sal>y ( n less ?an #fj1jjj2 & 7,b7 increases regul>ly ?r\gh\t a tea*]'s c>e]2 7#b7 increase ,f$]al inve/m5ts 9 public s*ools2 & 7#c7 call ^u ,/ates & local gov]nm5ts to increase inve/m5ts 9 public education 9 ord] to ensure t e public s*ool /ud5t is taught by a qualifi$ tea*]4 #gjb4 ,def9itions 7a7 ,def9itions ,9 ?is title3 7#a7 ,,esea ,t]ms ,! t]ms elem5t>y s*ool1 outly+ area1 & second>y s*ool h ! mean+s giv5 ^? t]ms 9 section #haja ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #ghja74 7#b7 ,annual adju/m5t p]c5tage ,! t]m annual adju/m5t p]c5tage1 ) respect to a fiscal ye>1 means a p]c5tage equal to ! e/imat$ p]c5tage *ange 9 ! ,consum] ,price ,index1 z det]m9$ by ! ,secret>y1 = ! mo/ rec5t cal5d> ye> end+ prior to ! beg9n+ ( su* fiscal ye>4 7#c7 ,annual base sal>y ,! t]m annual base sal>y-- 7,a7 means ! base sal>y1 calculat$ z an annual rate ( pay1 ( a full-"t tea*]2 & 7,b7 excludes-- 7i7 any additional comp5sation e>n$ by ! tea*] = tak+ on additional responsibilities 7su* z coa*+ or tea*+ dur+ ! summ] or aft] s*ool72 & 7ii7 bonuses1 /ip5ds1 & aw>ds4 7#d7 ,av]age tea*] sal>y basel9es ,! t]m av]age tea*] sal>y basel9es means1 = ea* ( ! foll[+ ye>s ( s]vice z tea*]s1 ! av]age annual base sal>ies ( all full-"t tea*]s employ$ by local educational ag5cies 9 ! ,/ate3 7,a7 #j ye>s1 or />t+ tea*] sal>ies4 7,b7 #c ye>s4 7,c7 #e ye>s4 7,d7 #aj ye>s4 7,e7 #ae ye>s4 7,f7 #bj ye>s4 7,g7 #be ye>s4 7#e7 ,consum] price index ,! t]m ,consum] ,price ,index has ! mean+ giv5 ! t]m 9 section #dgh7;f7 ( ! ,high] ,education ,act ( #aife 7#bj ,u4,s4,c4 #ajhgrr7f774 7#f7 ,m9imum sal>y = tea*]s ,! t]m m9imum sal>y = tea*]s means an am\nt1 det]m9$ by ! ,/ate1 t all full-"t tea*]s employ$ by a local educational ag5cy are1 at a m9imum1 requir$ by ! ,/ate to be comp5sat$ by su* ag5cy z _! annual base sal>y1 & :i*-- 7,a7 = tea*]s 9 _! fir/ ye> ( tea*+1 %all be an annual rate ( pay t is n less ?an ! am\nt describ$ 9 subsection 7b72 & 7,b7 = tea*]s ) m ?an #b ye>s ( exp]i5ce1 %all be an annual rate ( pay t-- 7i7 is great] ?an ! am\nt describ$ 9 subsection 7b72 & 7ii7 increases z ! exp]i5ce ( a tea*] increases4 7#g7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,education4 7#h7 ,tea*] ,! t]m tea*] means-- 7,a7 an employee ( a local educational ag5cy-- 7i7 ) a prim>y duty ( tea*+ & :o is employ$ & engag$ 9 tea*+ 9 a public elem5t>y s*ool or second>y s*ool s]v$ by su* ag5cy & is n a sub/itute tea*]2 7ii7 :o fully meets all applicable public elem5t>y s*ool or second>y s*ool tea*] c]tification & lic5sure requirem5ts ( ! ,/ate 9 :i* ! s*ool is locat$2 & 7iii7 if ! tea*] is a special education tea*]1 :o meets ! qualifications describ$ 9 section #fab7;a77#ad77;,c7 ( ! ,individuals ) ,disabilities ,education ,act2 & 7,b7 o!r full-"t public elem5t>y s*ool or second>y s*ool p]sonnel employ$ by a local educational ag5cy ^: annual base sal>y is det]m9$ 9 accordance ) su* ag5cy's sal>y s*$ule or sy/em = a full-"t tea*]4 7b7 ,special rules 7#a7 ,9 g5]al ,= ea* fiscal ye>1 ! am\nt describ$ 9 subsection 7a77#f77;,a7 %all be det]m9$ "u ?is subsection4 7#b7 ,fiscal ye>s #bjbg ?r\gh #bjca ,= ea* ( fiscal ye>s #bjbg ?r\gh #bjca1 ! am\nt describ$ 9 subsection 7a77#f77;,a7 is #fj1jjj4 7#c7 ,fiscal ye>s #bjcb & aft] 7,a7 ,9 g5]al ,= ! fiscal ye> p]iod #bjcb ?r\gh #bjcf & = ea* subsequ5t #e fiscal ye> p]iod1 ! am\nt describ$ 9 subsection 7a77#f77;,a7 %all be adju/$ = inflation z describ$ 9 subp>agraph 7,b74 7,b7 ,det]m9ation ,! am\nt %all be equal to ! am\nt applicable = ! previ\s #e fiscal ye> p]iod1 increas$ by ! great] (-- 7i7 ! aggregate annual adju/m5t p]c5tage ov] ! previ\s #e fiscal ye>s2 or 7ii7 #b p]c5t ( ! am\nt applicable "u ?is subsection = ! previ\s #e fiscal ye> p]iod4 #gjc4 ,ensur+ tea*]s are paid a livable & competitive wage 7a7 ,au?orization & appropriations = /ates 7#a7 ,9 g5]al ,!re are au?oriz$ to be appropriat$ to c>ry out ?is section su* sums z may be necess>y = fiscal ye> #bjbg & ea* succe$+ fiscal ye>4 7#b7 ,appropriations = /ates ,9 addition to am\nts o!rwise available to c>ry out ?is section1 !re are appropriat$1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 to ! ,secret>y to c>ry out ?is section-- 7,a7 = fiscal ye> #bjbg1 #ad1ejj1jjj1jjj2 & 7,b7 = ea* succe$+ fiscal ye>1 ! am\nt appropriat$ "u ?is section = ! prec$+ fiscal ye>1 increas$ by ! annual adju/m5t p]c5tage4 7b7 ,program au?oriz$ 7#a7 ,9 g5]al ,f am\nts made available to c>ry out ?is section1 & aft] mak+ ! res]vations describ$ 9 p>agraph 7#b71 ! ,secret>y %all aw>d grants1 ?r\gh allotm5ts describ$ 9 p>agraph 7#c71 to ,/ates to enable ,/ates to gu>antee t all tea*]s employ$ by local educational ag5cies 9 ! ,/ate are comp5sat$ ) a livable & competitive sal>y1 :i* %all be an am\nt t-- 7,a7 is at lea/ ! m9imum sal>y = tea*]s2 7,b7 increases ?r\gh\t ea* tea*]'s c>e]2 & 7,c7 is1 to ! greate/ ext5t practicable1 comm5surate ) annual sal>ies = college-educat$ & simil>ly exp]i5c$ pr(essionals 9 ! region 9 :i* su* ag5cies are locat$1 z det]m9$ 9 accordance ) proc$ures & requirem5ts e/abli%$ by ! ,secret>y4 7#b7 ,res]vations 7,a7 ,9 ,g5]al ,f ! am\nt appropriat$ "u subsection 7a7 = a fiscal ye>1 ! ,secret>y %all res]ve-- 7i7 "o-half ( #a p]c5t = allotm5ts = paym5ts to ! outly+ areas1 to be di/ribut$ among ^? outly+ areas on ! basis ( _! relative ne$1 z det]m9$ by ! ,secret>y1 to ensure t tea*]s are paid a livable & competitive sal>y1 9 accordance ) ! purposes ( ?is title2 7ii7 "o-half ( #a p]c5t = ! ,secret>y ( ! ,int]ior to be allocat$ by ! ,director ( ! ,bureau ( ,indian ,education = programs or activities op]at$ or fund$ by ! ,bureau = ,bureau-fund$ s*ools 7z def9$ 9 section #aada ( ! ,education ,am5dm5ts ( #aigh 7#be ,u4,s4,c4 #bjba77 to ensure tea*]s are paid a livable & competitive sal>y1 9 accordance ) ! purposes ( ?is title2 & 7iii7 #a p]c5t = program adm9i/ration1 te*nical assi/ance1 & data collection = ! program "u ?is section4 7,b7 ,special rule ,not)/&+ any o!r provision ( ?is title1 ! requirem5ts ( ?is section & section #gjb %all n apply to recipi5ts describ$ 9 clause 7i7 & 7ii7 ( subp>agraph 7,a71 except t su* recipi5ts %all use funds describ$ 9 ?is p>agraph to ensure t tea*]s are paid a livable & competitive sal>y4 7#c7 ,allotm5ts 7,a7 ,9 g5]al ,aft] mak+ ! res]vations "u p>agraph 7#b71 ! ,secret>y %all allot #ej p]c5t ( ! rema9+ am\nt appropriat$ "u subsection 7a7 9 accordance ) subp>agraph 7,b7 & allot ! o!r #ej p]c5t ( su* rema9+ am\nt 9 accordance ) subp>agraph 7,c74 7,b7 ,t>get$ =mula ,f an am\nt equal to #ej p]c5t ( ! am\nts appropriat$ "u subsection 7a7 & rema9+ aft] ! res]vations ( funds "u p>agraph 7#b7 7ref]r$ to 9 ?is section z ! t>get$ =mula am\nts71 ! ,secret>y %all allot to ea* ,/ate hav+ a plan approv$ by ! ,secret>y "u subsection 7d7 an am\nt t be>s ! same relation%ip to su* t>get$ =mula am\nts z ! total am\nt t local educational ag5cies 9 ! ,/ate receiv$ "u section #aabe ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcce7 = ! prec$+ fiscal ye> be>s to ! am\nt all local educational ag5cies 9 all ,/ates receiv$ "u su* section = ! prec$+ fiscal ye>4 7,c7 ,,efig =mula ,f an am\nt equal to #ej p]c5t ( ! am\nts appropriat$ "u subsection 7a7 & rema9+ aft] ! res]vations ( funds "u p>agraph 7#b7 7ref]r$ to 9 ?is section z ! ,,efig =mula am\nts71 ! ,secret>y %all allot to ea* ,/ate hav+ a plan approv$ by ! ,secret>y "u subsection 7d7 an am\nt t be>s ! same relation%ip to su* ,,efig =mula am\nts z ! am\nt ! ,/ate receiv$ "u section #aabe;,a ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #bj ,u4,s4,c4 #fccg7 = ! prec$+ fiscal ye> be>s to ! am\nt all ,/ates receiv$ "u su* section = ! prec$+ fiscal ye>4 7,d7 ,f9al allotm5ts ,= ! purposes ( ?is section1 a ,/ate's allotm5t %all be ! sum ( a ,/ate's allotm5ts calculat$ "u subp>agraph 7,b7 & subp>agraph 7,c74 7c7 ,improv+ tea*] sal>ies 7#a7 ,9 g5]al ,subject to p>agraph 7#c71 a ,/ate t receives an allotm5t "u ?is section %all ensure t ! annual base sal>y ( a full-"t tea*] employ$ by a local educational ag5cy 9 ! ,/ate is an am\nt t-- 7,a7 is at lea/ ! m9imum sal>y = tea*]s2 7,b7 increases ?r\gh\t ea* tea*]'s c>e]2 & 7,c7 is1 to ! greate/ ext5t practicable1 comm5surate ) annual sal>ies = college-educat$ & simil>ly exp]i5c$ pr(essionals 9 ! region 9 :i* su* ag5cies are locat$1 z det]m9$ 9 accordance ) proc$ures & requirem5ts e/abli%$ by ! ,secret>y4 7#b7 ,compliance ,to comply ) p>agraph 7#a71 a ,/ate %all adopt "o or m ( ! foll[+ laws or policies to ensure t e full-"t tea*] employ$ by a local educational ag5cy 9 ! ,/ate receives an annual base sal>y t is n less ?an ! m9imum sal>y = tea*]s3 7,a7 ,a /atewide sal>y s*$ule t ensures t ! sal>y ( e full-"t tea*] employ$ by a local educational ag5cy 9 ! ,/ate is-- 7i7 an am\nt n less ?an ! m9imum sal>y = tea*]s e/abli%$ by ! ,/ate "u subsection 7d77#a77;,a72 & 7ii7 increases z ! exp]i5ce ( a tea*] increases4 7,b7 ,a /atewide m9imum annual base sal>y = tea*]s :o are 9 _! fir/ ye> ( tea*+ t n less ?an ! m9imum sal>y = tea*]s e/abli%$ by ! ,/ate "u subsection 7d77#a77;,a74 7,c7 ,a ,/ate law to increase sal>ies = tea*]s4 7#c7 ,tim+ ,! ,secret>y %all ensure t1 n lat] ?an #c ye>s aft] a ,/ate receives an allotm5t "u ?is section1 ea* su* ,/ate meets ! tea*] sal>y requirem5ts describ$ 9 p>agraph 7#a74 7d7 ,/ate plan 7#a7 ,9 g5]al ,9 ord] to receive an allotm5t "u subsection 7b77#c71 a ,/ate %all submit a ,/ate plan to ! ,secret>y at su* "t1 9 su* mann]1 & conta9+ su* in=mation z ! ,secret>y may reasonably require4 ,su* ,/ate plan %all include1 at a m9imum ea* ( ! foll[+3 7,a7 ,a description ( ! ,/ate's m9imum sal>y = tea*]s1 includ+ ! ,/ate's plan to ensure t ! ,/ate w meet ! requirem5ts ( subsection 7c77#a7 n lat] ?an #c ye>s aft] ! ,/ate receives an allotm5t "u ?is section4 7,b7 ,a description ( ! ,/ate's plan to increase ! ,/ate's p]-pupil exp5ditures or ! aggregate exp5ditures ( ! ,/ate ) respect to ! provision ( free public education 9 ! ,/ate1 9 a mann] t-- 7i7 supports local educational ag5cies 9 increas+ sal>ies or wages = tea*]s1 p>apr(essionals1 specializ$ in/ructional support p]sonnel1 classifi$ s*ool employees1 pr9cipals1 o!r s*ool lead]s1 s*ool libr>ians1 s*ool bus driv]s1 & o!r /aff across _! c>e]s1 includ+ ?r\gh provid+ increas$ res\rces to local educational ag5cies2 & 7ii7 does n-- 7,i7 increase av]age class sizes or /ud5t to full-"t equival5t tea*] ratios at ! ,/ate1 local educational ag5cy1 or s*ool level2 7,,ii7 r$uce plann+ "t2 or 7,,iii7 require tea*]s to tea* additional classes4 7,c7 ,an id5tification1 ) respect to ! av]age tea*] sal>y basel9es 9 ! mo/ rec5t fiscal ye>1 ( ! /atewide av]age & ! av]age 9 ea* local educational ag5cy 9 ! ,/ate4 7,d7 ,an id5tification ( ! numb] & p]c5tage ( tea*]s employ$ by local educational ag5cies 9 ! ,/ate :o e>n a sal>y ( less ?an #fj1jjj annually1 disaggregat$ by ea* p]iod ( s]vice specifi$ 9 ! av]age tea*] sal>y basel9es1 across ! ,/ate & 9 ea* su* local educational ag5cy4 7,e7 ,a description ( ! ,/ate's plan to comply ) ! equitable di/ribution ( tea*]s requirem5t "u section #aaaa7;g77#a77;,b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcaa7;g77#a77;,b774 7#b7 ,public comm5t ,ea* ,/ate %all make ! ,/ate plan publicly available = public comm5t = a p]iod ( n less ?an #cj days1 by electronic means & 9 an easily accessible =mat1 prior to submission to ! ,secret>y = approval "u ?is subsection4 ,^u submission1 ! ,/ate plan %all include a summ>y ( ! comm5ts submitt$ to ! ,secret>y1 ) a description ( h[ ! ,/ate address$ ! comm5ts1 & make su* summ>y ) description publicly available on ! website ( ! ,/ate educational ag5cy4 7e7 ,/ate use ( funds ,ea* ,/ate t receives an allotm5t "u subsection 7b7 %all-- 7#a7 res]ve n m ?an #a p]c5t ( ! am\nts allott$ to ! ,/ate "u subsection 7b77#c77;,d7 to provide te*nical assi/ance & conduct monitor+ to ensure t all local educational ag5cies meet ! requirem5ts describ$ 9 subsection 7c72 7#b7 res]ve n m ?an #d p]c5t ( ! am\nts allott$ to ! ,/ate "u subsection 7b77#c77;,d7 to conduct /atewide ef=ts to-- 7,a7 increase tea*] comp5sation across ! ,/ate 9 accordance ) 9 subsection 7c72 7,b7 id5tify & re=m policies & practices at ! ,/ate1 local educational ag5cy1 & s*ool-level to promote excell5t tea*+ = all /ud5ts1 p>ticul>ly subgr\ps ( /ud5ts2 & 7,c7 address /ructural & organizational *all5ges 9 ! tea*+ pr(ession1 9 ord] to-- 7i7 raise ! /&>ds1 /atus1 & sal>ies ( ! tea*+ pr(ession2 & 7ii7 attract & reta9 promis+ & tal5t$ "y p to tea*+2 & 7#c7 f ! am\nts allott$ to ! ,/ate "u subsection 7b77#c77;,d7 t are rema9+ aft] res]v+ am\nts "u p>agraphs 7#a7 & 7#b71 allocate-- 7,a7 #ej p]c5t ( su* rema9+ am\nts to local educational ag5cies 9 ! ,/ate 9 accordance ) ! t>get$ =mula describ$ 9 section #aabe7;b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcce7;b772 & 7,b7 #ej p]c5t ( su* rema9+ am\nts to local educational ag5cies 9 ! ,/ate 9 accordance ) ! =mula describ$ 9 section #aabe;,a7d7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fccg7;d774 7f7 ,report+ requirem5ts ,n lat] ?an #a ye> aft] receiv+ an allotm5t "u ?is section & annually !reaft]1 a ,/ate t receives an allotm5t "u ?is section %all submit a report to ! ,secret>y & publi% su* report 9 a cle> & easily accessible =mat on ! website ( ! ,/ate4 ,su* report %all conta9 any in=mation requir$ by ! ,secret>y & include1 at a m9imum-- 7#a7 data on ! av]age tea*] sal>y basel9es = ! previ\s fiscal ye>1 disaggregat$ by ! /atewide av]age & ! av]age 9 ea* local educational ag5cy 9 ! ,/ate2 7#b7 updat$ data on ! numb] ( tea*]s employ$ by local educational ag5cies 9 ! ,/ate :o e>n less ?an ! m9imum sal>y = tea*]s1 disaggregat$ by ea* p]iod ( s]vice describ$ 9 section #gjb7;a77#d71 across ! ,/ate & employ$ by ea* local educational ag5cy2 7#c7 a description ( ! actions ! ,/ate educational ag5cy w take 9 ! next fiscal ye> to support local educational ag5cies describ$ 9 p>agraph 7#b7 9 decreas+ ! numb] ( tea*]s employ$ by su* ag5cies :o e>n less ?an ! m9imum sal>y = tea*]s2 7#d7 a description ( actions tak5 by ! ,/ate to increase ! ,/ate's p]-pupil exp5ditures or ! aggregate exp5ditures ( ! ,/ate ) respect to ! provision ( free public education 9 ! ,/ate1 9 a mann] t-- 7,a7 supports local educational ag5cies 9 increas+ sal>ies or wages = tea*]s1 p>apr(essionals1 specializ$ in/ructional support p]sonnel1 classifi$ s*ool employees1 pr9cipals1 o!r s*ool lead]s1 s*ool libr>ians1 s*ool bus driv]s1 & o!r /aff across _! c>e]s1 includ+ ?r\gh provid+ increas$ res\rces to local educational ag5cies2 & 7,b7 does n-- 7i7 increase av]age class sizes or /ud5t to full-"t equival5t tea*] ratios at ! ,/ate1 local educational ag5cy1 or s*ool level2 7ii7 r$uce plann+ "t2 or 7iii7 require tea*]s to tea* additional classes2 & 7#e7 a description ( h[ ! ,/ate improv$ ! equitable di/ribution ( tea*]s 9 su* fiscal ye>1 z requir$ "u section #aaaa7;g77#a77;,b7 ( ! ,elem5t>y & ,second>y ,education ,act ( #aife 7#bj ,u4,s4,c4 #fcaa7;g77#a77;,b774 #gjd4 ,collective b>ga9+ & relat$ rules 7a7 ,rule ( con/ruction = collective b>ga9+ 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 no?+ 9 section #gjc %all be con/ru$ to alt] or o!rwise affect ! rights1 rem$ies1 & proc$ures af=d$ to s*ool or local educational ag5cy employees "u ,f$]al1 ,/ate1 or local laws 7includ+ applicable regulations or c\rt ord]s7 or "u ! t]ms ( collective b>ga9+ agreem5ts1 memor&a ( und]/&+1 or o!r agreem5ts betwe5 su* employ]s & _! employees4 7#b7 ,compliance ,p>agraph 7#a7 %all n be con/ru$ to exempt a ,/ate1 local educational ag5cy1 or s*ool f comply+ ) section #gjc or f negotiat+ 9 compliance ) ,/ate labor laws to comply ) section #gjc4 7b7 ,rule ( con/ruction = additional pay or o!r sal>y augm5t+ sy/ems ,no?+ 9 section #gjc %all be con/ru$ to prev5t ,/ates or local educational ag5cies f supplem5t+ ! annual base sal>y ( tea*]s or o!r /aff employ$ by su* ag5cies-- 7#a7 = additional skills1 k1 duties1 & responsibilities2 7#b7 by sal>y sy/ems t increase tea*]s' comp5sation ?r\gh supplem5tal pay t is n "p ( an annual base sal>y2 or 7#c7 ?r\gh ! provision ( bonuses1 /ip5ds1 or aw>ds4 ,,viii ,inve/m5ts 9 ,home & ,community-,bas$ ,s]vices & ,long-,t]m ,c>e ,quality & ,work=ce #hja4 ,,hcbs improvem5t plann+ grants 7a7 ,fund+ 7#a7 ,9 g5]al ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y = fiscal ye> #bjbg1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #acj1jjj1jjj1 to rema9 available until exp5d$1 = c>ry+ out ?is section4 7#b7 ,te*nical assi/ance & guidance ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y = fiscal ye> #bjbg1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #e1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( issu+ guidance & provid+ te*nical assi/ance to ,/ates int5d+ to apply =1 or :i* are aw>d$1 a plann+ grant "u ?is section1 & = o!r adm9i/rative exp5ses relat$ to aw>d+ plann+ grants "u ?is section4 7b7 ,aw>d & use ( grants 7#a7 ,deadl9e = aw>d ( grants ,f ! am\nt appropriat$ "u subsection 7a77#a71 ! ,secret>y1 n lat] ?an #ab mon?s aft] ! date ( enactm5t ( ?is ,act1 %all solicit ,/ate reque/s = ,,hcbs improvem5t plann+ grants & aw>d su* grants to all ,/ates t meet su* requirem5ts z det]m9$ by ! ,secret>y4 7#b7 ,use ( funds ,subject to p>agraph 7#c71 a ,/ate aw>d$ a plann+ grant "u ?is section %all use ! grant to c>ry out plann+ activities = purposes ( develop+ & submitt+ to ! ,secret>y an ,,hcbs improvem5t plan = ! ,/ate t meets ! requirem5ts ( subsection 7c74 ,a ,/ate may use plann+ grant funds to support activities relat$ to ! implem5tation ( ! ,,hcbs improvem5t plan = ! ,/ate4 7#c7 ,limitation on use ( funds ,none ( ! funds aw>d$ to a ,/ate "u ?is section may be us$ by a ,/ate z ! s\rce ( ! non-,f$]al %>e ( exp5ditures "u ! ,/ate ,m$icaid program4 7c7 ,,hcbs improvem5t plan requirem5ts 7#a7 ,cont5t ,! ,secret>y %all def9e ! cont5t requirem5ts = an ,,hcbs improvem5t plan1 :i*1 at m9imum1 %all include an assessm5t ( access b>ri]s to home & community-bas$ s]vices & ! availability 7z def9$ by ! ,secret>y7 ( su* s]vices 9 ! ,/ate1 a description ( ,m$icaid paym5t rates = su* s]vices1 a description ( ! curr5t work=ce ( direct c>e work]s1 ! p]c5tage ( exp5ditures made by ! ,/ate = long-t]m s]vices & supports t are = home & community-bas$ s]vices1 & a description ( h[ ! ,/ate w meet ! requirem5ts ( ! ,,hcbs ,improvem5t ,program4 7#b7 ,submission2 approval2 am5dm5ts ,n lat] ?an #bd mon?s aft] ! date on :i* a ,/ate is aw>d$ a plann+ grant "u ?is section1 ! ,/ate %all submit an ,,hcbs improvem5t plan = approval by ! ,secret>y1 along ) assurances by ! ,/ate t ! ,/ate w implem5t ! plan 9 accordance ) ! requirem5ts ( ! ,,hcbs ,improvem5t ,program4 ,! ,secret>y %all approve ! ,,hcbs improvem5t plan = a ,/ate aft] ! plan & su* assurances are submitt$ to ! ,secret>y = approval & ! ,secret>y det]m9es ! plan meets ! requirem5ts ( ?is subsection4 ,a ,/ate may am5d its ,,hcbs improvem5t plan1 subject to ! approval ( ! ,secret>y t ! plan z s am5d$ meets ! requirem5ts ( ?is subsection4 7d7 ,def9itions ,9 ?is "p3 7#a7 ,direct c>e work] ,! t]m direct c>e work] means1 ) respect to a ,/ate1 any ( ! foll[+ individuals :o are paid to provide directly to ,m$icaid eligible individuals home & community-bas$ s]vices available "u ! ,/ate ,m$icaid program3 7,a7 ,a regi/]$ nurse1 lic5s$ practical nurse1 nurse practition]1 or cl9ical nurse speciali/1 or a lic5s$ nurs+ assi/ant :o provides su* s]vices "u ! sup]vision ( a regi/]$ nurse1 lic5s$ practical nurse1 nurse practition]1 or cl9ical nurse speciali/4 7,b7 ,a direct support pr(essional4 7,c7 ,a p]sonal c>e att5dant4 7,d7 ,a home heal? aide4 7,e7 ,any o!r paid heal? c>e pr(essional or work] det]m9$ to be appropriate by ! ,/ate & approv$ by ! ,secret>y4 7#b7 ,,hcbs ,improvem5t ,program ,! t]m ,,hcbs ,improvem5t ,program means ! program e/abli%$ "u subsection 7ll7 ( section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 7z add$ by section #hjb74 7#c7 ,,hcbs ,improvem5t ,program ,/ate ,! t]m ,,hcbs ,improvem5t ,program ,/ate means a ,/ate t is aw>d$ a plann+ grant "u subsection 7b7 & has an ,,hcbs improvem5t plan approv$ by ! ,secret>y "u subsection 7c77#b74 7#d7 ,home & community-bas$ s]vices ,! t]m home & community-bas$ s]vices means any ( ! foll[+ 7:e!r provid$ on a fee-=-s]vice1 risk1 or o!r basis73 7,a7 ,home heal? c>e s]vices au?oriz$ "u p>agraph 7#g7 ( section #aije7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a774 7,b7 ,private duty nurs+ s]vices au?oriz$ "u p>agraph 7#h7 ( su* section1 :5 su* s]vices are provid$ 9 a ,m$icaid eligible individual's home4 7,c7 ,p]sonal c>e s]vices au?oriz$ "u p>agraph 7#bd7 ( su* section4 7,d7 ,,pace s]vices au?oriz$ "u p>agraph 7#bf7 ( su* section4 7,e7 ,home & community-bas$ s]vices au?oriz$ "u subsections 7b71 7c71 7i71 7j71 & 7k7 ( section #aiae ( su* ,act 7#db ,u4,s4,c4 #acifn71 au?oriz$ "u a waiv] "u section #aaae ( su* ,act 7#db ,u4,s4,c4 #acae71 or provid$ ?r\gh cov]age au?oriz$ "u section #aicg ( su* ,act 7#db ,u4,s4,c4 #acifu-#g74 7,f7 ,case managem5t s]vices au?oriz$ "u section #aije7;a77#ai7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#ai77 & section #aiae7;g7 ( su* ,act 7#db ,u4,s4,c4 #acifn7g774 7,g7 ,rehabilitative s]vices1 includ+ ^? relat$ to behavioral heal?1 describ$ 9 section #aije7;a77#ac7 ( su* ,act 7#db ,u4,s4,c4 #acif;d7a77#ac774 7,h7 ,su* o!r s]vices specifi$ by ! ,secret>y4 7#e7 ,m$icaid eligible individual ,! t]m ,m$icaid eligible individual means an individual :o is eligible = & receiv+ m$ical assi/ance "u a ,/ate ,m$icaid program4 ,su* t]m includes an individual :o is on a wait+ li/ & :o w\ld become eligible = m$ical assi/ance & enroll$ "u a ,/ate ,m$icaid program ^u receipt ( home & community-bas$ s]vices4 7#f7 ,/ate ,m$icaid program ,! t]m ,/ate ,m$icaid program means1 ) respect to a ,/ate1 ! ,/ate program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif ?r\gh #acifw-#f7 7includ+ any waiv] or demon/ration "u su* title or "u section #aaae ( su* ,act 7#db ,u4,s4,c4 #acae7 relat+ to su* title74 7#g7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4 7#h7 ,/ate ,! t]m ,/ate means ea* ( ! #ej ,/ates1 ! ,di/rict ( ,columbia1 ,pu]to ,rico1 ! ,virg9 ,isl&s1 ,guam1 ! ,nor!rn ,m>iana ,isl&s1 & ,am]ican ,samoa4 #hjb4 ,,hcbs ,improvem5t ,program 7a7 ,increas$ ,,fmap = ,,hcbs ,improvem5t ,program ,/ates ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7#a7 9 subsection 7b71 by /rik+ & 7ii7 & ins]t+ 7ii71 & 7ll72 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7ll7 ,additional support = ,,hcbs ,improvem5t ,program ,/ates 7#a7 ,9 g5]al 7,a7 ,additional support ,subject to p>agraph 7#e71 9 ! case ( a ,/ate t is an ,,hcbs ,improvem5t ,program ,/ate1 = ea* fiscal qu>t] t beg9s on or aft] ! fir/ date on :i* ! ,/ate is an ,,hcbs ,improvem5t ,program ,/ate-- 7i7 & = :i* ! ,/ate meets ! requirem5ts describ$ 9 p>agraphs 7#b7 & 7#d71 not)/&+ subsection 7b7 or 7ff71 subject to subp>agraph 7,b71 ) respect to am\nts exp5d$ dur+ ! qu>t] by su* ,/ate = m$ical assi/ance = home & community-bas$ s]vices1 ! ,f$]al m$ical assi/ance p]c5tage = su* ,/ate & qu>t] 7z det]m9$ = ! ,/ate "u subsection 7b7 or 7ff7 &1 if applicable1 increas$ "u subsection 7y71 7z71 7aa71 or 7ii71 or section #aiae7k77#b77 %all be increas$ by #h p]c5tage po9ts2 & 7ii7 ) respect to ! ,/ate meet+ ! requirem5ts describ$ 9 p>agraphs 7#b7 & 7#d7 & ) respect to am\nts exp5d$ dur+ ! qu>t] & be=e ,octob] #a1 #bjcf1 adm9i/rative co/s = exp&+ & enhanc+ home & community-bas$ s]vices1 includ+ = enhanc+ ,m$icaid data & te*nology infra/ructure1 modify+ rate sett+ processes1 adopt+ or improv+ tra9+ programs = direct c>e work]s & family c>egiv]s1 home & community-bas$ s]vices ombudsman (fice activities1 develop+ processes to id5tify direct c>e work]s & assign su* work]s unique id5tifi]s1 & adopt+1 c>ry+ out1 or enhanc+ programs t regi/] direct c>e work]s or connect b5efici>ies to direct c>e work]s1 %all be eligible = ,f$]al f9ancial p>ticipation 9 ! same mann] z o!r adm9i/rative exp5ditures "u section #aijc7;a71 except t1 = purposes ( ?is clause1 ! p] c5tum applicable to su* exp5ditures %all be ! great] ( #hj p]c5t or ! p] c5tum t w\ld o!rwise apply4 ,9 no case may ! application ( clause 7i7 result 9 ! ,f$]al m$ical assi/ance p]c5tage det]m9$ = a ,/ate be+ m ?an #ie p]c5t ) respect to su* exp5ditures4 ,any increase pursuant to clause 7ii7 %all be available to a ,/ate be=e ! ,/ate meets ! requirem5ts ( p>agraphs 7#b7 & 7#d74 7,b7 ,additional ,,hcbs improvem5t ef=ts ,subject to p>agraph 7#e71 9 addition to ! increase to ! ,f$]al m$ical assi/ance p]c5tage "u subp>agraph 7,a77i7 = am\nts exp5d$ dur+ a qu>t] = m$ical assi/ance = home & community-bas$ s]vices by an ,,hcbs ,improvem5t ,program ,/ate t meets ! requirem5ts ( p>agraphs 7#b7 & 7#d7 = ! qu>t]1 ! ,f$]al m$ical assi/ance p]c5tage = am\nts exp5d$ by ! ,/ate dur+ ! qu>t] = m$ical assi/ance = home & community-bas$ s]vices %all be fur!r increas$ by #b p]c5tage po9ts 7b n to exce$ #ie p]c5t7 dur+ ! fir/ #f fiscal qu>t]s ?r\gh\t :i* ! ,/ate has implem5t$ & has 9 effect a program t meets ! requirem5ts ( p>agraph 7#c74 7,c7 ,nonapplication to ,,*ip ,,efmap ,any increase to ! ,f$]al m$ical assi/ance p]c5tage ( a ,/ate "u subp>agraph 7,a77i7 or 7,b7 or an increase to an applicable ,f$]al mat*+ p]c5tage "u subp>agraph 7,a77ii7 %all n be tak5 into acc\nt 9 calculat+ ! enhanc$ ,,fmap ( a ,/ate "u section #baje4 7#b7 ,requirem5ts ,z conditions = receipt ( ! increase "u p>agraph 7#a77;,a77i7 to ! ,f$]al m$ical assi/ance p]c5tage det]m9$ = a ,/ate1 ) respect to a fiscal ye> qu>t]1 ! ,/ate %all meet ea* ( ! foll[+ requirem5ts3 7,a7 ,nonsupplantation ,! ,/ate uses an am\nt 9 ,/ate funds equival5t to ! additional ,f$]al funds receiv$ by ! ,/ate t are attributable to ! increase to ! ,f$]al m$ical assi/ance p]c5tage = am\nts exp5d$ dur+ a qu>t] = m$ical assi/ance = home & community-bas$ s]vices "u p>agraph 7#a77;,a7 & p>agraph 7#a77;,b7 7if applicable7 to supplem5t1 & n supplant1 ! level ( ,/ate funds exp5d$ = home & community-bas$ s]vices = eligible individuals ?r\gh programs 9 effect z ( ! date ! ,/ate is aw>d$ a plann+ grant "u section #hja ( ! ,make ,billionaires ,pay ,_! ,fair ,%>e ,act4 ,9 apply+ ?is subp>agraph1 ! ,secret>y %all provide t a ,/ate %all h a #c-ye> p]iod1 z specifi$ by ! ,secret>y1 to sp5d any accumulat$ unsp5t ,/ate funds attributable to su* increase to ! ,f$]al m$ical assi/ance p]c5tage4 7,b7 ,ma9t5ance ( ef=t 7i7 ,9 g5]al ,! ,/ate does n-- 7,i7 r$uce ! am\nt1 duration1 or scope ( home & community-bas$ s]vices available "u ! ,/ate plan 7or waiv] ( su* plan7 relative to ! home & community-bas$ s]vices available "u ! plan or a waiv] ( su* plan z ( ! date on :i* ! ,/ate 0 aw>d$ a plann+ grant "u section #hja ( ! ,make ,billionaires ,pay ,_! ,fair ,%>e ,act2 7,,ii7 r$uce paym5t rates = home & community-bas$ s]vices l[] ?an su* rates t 7 9 place z ( ! date describ$ 9 subclause 7,i71 includ+1 to ! ext5t applicable1 assum$ paym5t rates = su* s]vices t are includ$ 9 manag$ c>e capitation rates z su* rates are be+ prospectively built2 or 7,,iii7 except to ! ext5t p]mitt$ "u clause 7ii71 adopt m re/rictive /&>ds1 me?odologies1 or proc$ures = det]m9+ eligibility =1 or ! scope (1 m$ical assi/ance = home & community-bas$ s]vices1 includ+ ) respect to co/-%>+1 ?an ! /&>ds1 me?odologies1 or proc$ures applicable z ( ! date describ$ 9 subclause 7,i74 7ii7 ,conditions = flexibility ,a ,/ate may make modifications t w\ld o!rwise violate ! ma9t5ance ( ef=t describ$ 9 clause 7i7 if ! ,/ate demon/rates to ! satisfaction ( ! ,secret>y t su* modifications %all n result 9-- 7,i7 home & community-bas$ s]vices t are less compreh5sive or l[] 9 am\nt1 duration1 or scope2 7,,ii7 few] individuals 7ov]all & )9 p>ticul> eligibility gr\ps7 receiv+ home & community-bas$ s]vices1 adju/$ = demographic *anges s9ce ! date describ$ 9 clause 7i77,i72 or 7,,iii7 increas$ co/-%>+ 7o!r ?an result+ f ! rate ( inflation7 = home & community-bas$ s]vices4 7,c7 ,access to s]vices ,! ,/ate und]takes ef=ts to improve access to home & community-bas$ s]vices by do+ all ( ! foll[+ n lat] ?an an implem5tation date specifi$ by ! ,secret>y 7:i* may v>y = ea* ( ! foll[+ clauses7 aft] ! fir/ day ( ! fir/ fiscal qu>t] = :i* a ,/ate receives an increase to ! ,f$]al m$ical assi/ance p]c5tage or o!r applicable ,f$]al mat*+ p]c5tage "u p>agraph 7#a73 7i7 ,r$uces access b>ri]s & disp>ities 9 access or utilization ( home & community-bas$ s]vices4 7ii7 ,provides cov]age ( p]sonal c>e s]vices au?oriz$ "u subsection 7a77#bd7 = all individuals eligible = & enroll$ 9 m$ical assi/ance 9 ! ,/ate4 7iii7 ,provides = navigation ( home & community-bas$ s]vices ?r\gh no wrong door programs1 provides exp$it$ eligibility = home & community-bas$ s]vices1 & improves home & community-bas$ s]vices c\nsel+ & education programs4 7iv7 ,exp&s access to behavioral heal? s]vices furni%$ 9 home & community-bas$ sett+s4 7v7 ,improves coord9ation ( home & community-bas$ s]vices ) employm5t1 h\s+1 & transportation supports4 7vi7 ,provides supports to family c>egiv]s4 7vii7 ,newly provides cov]age "u1 or exp&s exi/+ eligibility crit]ia =1 #a or m ( ! eligibility categories au?oriz$ "u subclause 7,,xiii71 7,,xv71 or 7,,xvi7 ( section #aijb7;a77#aj77;,a77ii74 7,d7 ,work=ce ,! ,/ate /r5g!ns & exp&s ! work=ce ( direct c>e work]s t provides home & community-bas$ s]vices by-- 7i7 adopt+ processes to ensure t paym5t rates = home & community-bas$ s]vices are suffici5t 7z def9$ by ! ,secret>y7 to ensure t s]vices are available1 includ+ by1 n lat] ?an #b ye>s aft] approval ( ! ,,hcbs improvem5t plan &1 at lea/ e #c ye>s !reaft]1 updat+ &1 z appropriate1 increas+ paym5t rates = home & community-bas$ s]vices to support recruitm5t & ret5tion ( direct c>e work]s us+1 ?r\gh exi/+ or o!r processes to det]m9e provid] paym5ts1 a transp>5t process involv+ input f nongov]nm5tal /akehold]s2 7ii7 ensur+ t increases 9 ! paym5t rates = home & community-bas$ s]vices result 9 at lea/ a proportionate increase to paym5ts = direct c>e work]s2 & 7iii7 updat+ qualification /&>ds z appropriate1 & develop+ & adopt+ tra9+ opportunities1 = direct c>e work]s & family c>egiv]s1 at su* times z ! ,secret>y %all prescribe4 7#c7 ,self-direct$ models = ! deliv]y ( s]vices ,z conditions = receipt ( ! increase "u p>agraph 7#a77;,b7 to ! ,f$]al m$ical assi/ance p]c5tage det]m9$ = a ,/ate1 ) respect to a fiscal ye> qu>t]1 ! ,/ate %all e/abli% directly1 or by contract ) #a or m entities1 includ+ an ag5cy ) *oice or a simil> s]vice deliv]y model1 a program = ! p]=mance ( all ( ! foll[+ functions1 consi/5t ) guidance issu$ by ! ,secret>y1 to facilitate b5efici>y use ( self-direct$ c>e 9 ! case ! ,/ate cov]s home & community-bas$ s]vices "u au?orities t p]mit self-direction3 7,a7 ,recruit+ & regi/]+ qualifi$ direct c>e work]s & assi/+ b5efici>ies 9 f9d+ qualifi$ direct c>e work]s4 7,b7 ,support+ b5efici>y hir+1 if select$ by ! b5efici>y1 ( indep5d5t provid]s ( home & community-bas$ s]vices1 includ+ ?r\gh ! provision ( f9ancial managem5t s]vices4 7,c7 ,to ! ext5t a ,/ate p]mits b5efici>ies to hire a family memb] or individual ) :om !y h an exi/+ relation%ip to provide home & community-bas$ s]vices1 provid+ support to b5efici>ies :o wi% to hire a c>egiv] :o is a family memb] or individual ) :om !y h an exi/+ relation%ip4 7,d7 ,ensur+ t ! program "u ?is p>agraph does n promote or det] ! ability ( work]s to =m a labor organization or discrim9ate aga9/ work]s :o may jo9 or decl9e to jo9 su* an organization4 7#d7 ,report+ & ov]sight ,z a condition = receipt ( an increase "u subp>agraphs 7,a77i7 or 7,b7 ( p>agraph 7#a7 to ! ,f$]al m$ical assi/ance p]c5tage det]m9$ = a ,/ate1 ) respect to a fiscal ye> qu>t]1 ! ,/ate %all1 beg9n+ ) ! la/ day ( ! #e? fiscal qu>t] = :i* ! ,/ate is an ,,hcbs ,improvem5t ,program ,/ate1 & annually !reaft]1 report to ! ,secret>y1 9 a mann] ! ,secret>y %all prescribe1 on-- 7,a7 ! ,/ate's progress 9 implem5t+ ! activities describ$ 9 subp>agraphs 7,c7 & 7,d7 ( p>agraph 7#b7 & 7if applicable7 p>agraph 7#c7 9 accordance ) ! ,/ate ,,hcbs improvem5t plan2 & 7,b7 ! use ( ! increas$ fund+ provid$ "u ?is subsection4 7#e7 ,b5*m>ks = demon/rat+ improvem5ts ,an ,,hcbs ,improvem5t ,program ,/ate %all cease to be eligible = an increase to ! ,f$]al m$ical assi/ance p]c5tage "u p>agraph 7#a77;,a77i7 or 7#a77;,b7 or an increase to an applicable ,f$]al mat*+ p]c5tage "u p>agraph 7#a77;,a77ii7 = ea* fiscal qu>t] aft] ! #bi? fiscal qu>t] t beg9s on or aft] ! fir/ date on :i* ! ,/ate is an ,,hcbs ,improvem5t ,program ,/ate unless1 at ! end ( su* #bi? fiscal qu>t]1 ! ,/ate demon/rates ! foll[+ 9 ! annual report requir$ 9 p>agraph 7#d7 = su* qu>t]3 7,a7 ,increas$ availability 7above a m>g9al increase7 ( home & community-bas$ s]vices 9 ! ,/ate relative to su* availability z report$ 9 ! ,/ate ,,hcbs improvem5t plan & adju/$ = demographic *anges 9 ! ,/ate s9ce ! submission ( su* plan4 7,b7 ,) respect to ! p]c5tage ( exp5ditures made by ! ,/ate = long-t]m s]vices & supports t are = home & community-bas$ s]vices1 9 ! case ( an ,,hcbs ,improvem5t ,program ,/ate = :i* su* p]c5tage 7z report$ 9 ! ,/ate ,,hcbs improvem5t plan7 0-- 7i7 less ?an #ej p]c5t1 ! ,/ate demon/rates t ! p]c5tage ( su* exp5ditures has increas$ to at lea/ #ej p]c5t s9ce ! plan 0 approv$2 & 7ii7 at lea/ #ej p]c5t1 ! ,/ate demon/rates t su* p]c5tage has n decreas$ s9ce ! plan 0 approv$4 7#f7 ,def9itions ,9 ?is subsection1 ! t]ms direct c>e work]1 ,,hcbs ,improvem5t ,program ,/ate1 & home & community-bas$ s]vices h ! mean+ giv5 ^? t]ms 9 section #hja7;d7 ( ! ,make ,billionaires ,pay ,_! ,fair ,%>e ,act4 4 #hjc4 ,fund+ = ,f$]al activities relat$ to ,m$icaid ,,hcbs ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y = fiscal ye> #bjbg1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #dj1jjj1jjj1 to rema9 available until exp5d$1 to c>ry out section #hjb 7includ+ ! am5dm5ts made by su* section71 includ+ by issu+ necess>y guidance & te*nical assi/ance to ,/ates & conduct+ program integrity & ov]sight ef=ts4 #hjd4 ,fund+ = ,,hcbs quality measurem5t & improvem5t ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y = fiscal ye> #bjbg1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #be1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( develop+1 9 consultation ) nongov]nm5tal /akehold]s ) exp]tise 9 home & community-bas$ s]vices 7includ+ recipi5ts & provid]s ( su* s]vices71 a recomm5d$ set ( home & community-bas$ s]vices quality measures t reflect ! full range ( home & community-bas$ s]vices 7z def9$ 9 section #hja7;d77 & ! recipi5ts ( su* s]vices4 #hje4 ,p]man5t ext5sion ( ,m$icaid protections aga9/ sp\sal impov]i%m5t = recipi5ts ( home & community-bas$ s]vices 7a7 ,9 g5]al ,section #aibd7;h77#a77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#e7;h77#a77;,a77 is am5d$ by /rik+ 7at ! option ( ! ,/ate7 is describ$ 9 section #aijb7;a77#aj77;,a77ii77,,vi7 & ins]t+ ! foll[+3 is eligible = m$ical assi/ance = home & community-bas$ s]vices provid$ "u subsection 7c71 7d71 or 7i7 ( section #aiae or "u a waiv] approv$ "u section #aaae1 or :o is eligible = su* m$ical assi/ance by reason ( be+ det]m9$ eligible "u section #aijb7;a77#aj77;,c7 or by reason ( section #aijb7;f7 or o!rwise on ! basis ( a r$uction ( income bas$ on co/s incurr$ = m$ical or o!r rem$ial c>e1 or :o is eligible = m$ical assi/ance = home & community-bas$ att5dant s]vices & supports "u section #aiae7k74 7b7 ,con=m+ am5dm5t ,section #bdjd ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #acifr-#e note7 is am5d$ by /rik+ ,septemb] #cj1 #bjbg & ins]t+ ! date ( enactm5t ( ! ,make ,billionaires ,pay ,_! ,fair ,%>e ,act4 #hjf4 ,p]man5t ext5sion ( ,money ,foll[s ! ,p]son ,rebalanc+ demon/ration ,subsection 7h7 ( section #fjga ( ! ,deficit ,r$uction ,act ( #bjje 7#db ,u4,s4,c4 #acif;a note7 is am5d$-- 7#a7 9 p>agraph 7#a7-- 7,a7 9 subp>agraph 7,i71 by ins]t+ & aft] ! semicolon2 7,b7 9 subp>agraph 7,j71 by ins]t+ & ea* fiscal ye> !reaft] be=e ! semicolon2 & 7,c7 by /rik+ subp>agraphs 7,k7 & 7,l72 & 7#b7 9 p>agraph 7#c71 by /rik+ ?r\gh fiscal ye> #bjbi4