,,ii #aai? ,,congress #a/ ,session ,s4 #ici ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,m>* #aa 7legislative day1 ,m>* #aj71 #bjbe,mr4 ,s&]s 7= himself1 ,ms4 ,w>r51 ,mr4 ,book]1 ,mr4 ,wel*1 ,mr4 ,m>key1 ,ms4 ,duckwor?1 ,mr4 ,m]kley1 & ,mr4 ,blum5?al7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide cov]age = d5tal & oral heal? c>e1 he>+ c>e1 & vision c>e "u ! ,m$ic>e program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbe4 #b4 ,cov]age ( d5tal & oral heal? c>e 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7#a7 9 subp>agraph 7,,jj71 by add+ & at ! end2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,,kk7 d5tal & oral heal? s]vices 7z def9$ 9 subsection 7nnn772 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 7nnn7 ,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 #bjbg 7or ,janu>y #a1 #bjbf1 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$ures & treatm5t s]vices ,s]vices to address oral disease1 includ+ s]vices su* z re/orative s]vices1 pro/hodontic & endodontic s]vices1 includ+ fill+s bridges1 cr[ns1 & root canals1 p]iodontal ma9t5ance1 p]iodontal scal+ & root plan+1 too? extractions1 !rapeutic pulpotomy1 & o!r relat$ 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 #ahfa7nnn77 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 #ahfa7nnn771 ! am\nt paid %all be ! paym5t am\nt specifi$ "u section #ahcd7;aa74 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 7aa7 ,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 #ahfa7nnn77 %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 #ahfa7nnn77#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 #ahfa7nnn77#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 #bjbg 7or #bjbf1 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$ian fee = a d5tal or oral heal? s]vice = #bjbg 7or #bjbf1 9 ! case ( d5tures7 & subsequ5t ye>s 9 accordance ) ?is subp>agraph4 7ii7 ,use ( #bjbj d5tal fee survey 7,i7 ,9 g5]al ,except z provid$ 9 clause 7iii7 & clause 7iv71 ! national m$ian fee = a d5tal or oral heal? s]vice %all be equal to-- 7aa7 = #bjbg 7or #bjbf1 9 ! case ( d5tures71 ! m$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 = #bjbh 7or #bjbg1 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 ( #bjbf 7or #bjbe1 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*$ule f ye> to ye> beg9n+ 9 #bjbh 7or #bjbg1 9 ! case ( d5tures7 by increas+ su* am\nts f ! prior ye> by ! p]c5tage increase 9 ! consum] price index = all urban consum]s 7,unit$ ,/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 = #bjbh 7or #bjbg1 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 #ahfa7nnn7-- 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 #ahfa7nnn77#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 #bjbh & ea* subsequ5t ye>1 an oral heal? pr(essional 7z def9$ 9 section #ahfa7nnn77#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 #ahfa7nnn77 = :i* a limitation is applicable "u section #ahcd7;aa77#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,,kk74 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 7mmm7 ( section #ahfa7 t are payable "u "p ,b z a result ( ! am5dm5ts made by ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbe4 4 7g7 ,rural heal? cl9ics & f$]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 7nnn77 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 7nnn77#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 #ahfa7nnn771 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 #ahfa7nnn77 "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 #ahfa7nnn77 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> #bjbe1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ijj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbe1 & end+ on ,septemb] #cj1 #bjcd4 #c4 ,provid+ cov]age = he>+ c>e "u ! ,m$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 #bjbg1 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 #bjbg1 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 #bjbg1 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 #b7;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 #b7;d71 is am5d$ by add+ at ! end ! foll[+ new clause3 7x7 ,beg9n+ on ,janu>y #a1 #bjbg1 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$-- 7i7 9 ea* ( subp>agraphs 7,a7 & 7,b71 by /rik+ subp>agraph 7,c7 & ins]t+ subp>agraph 7,c7 or1 beg9n+ on ,janu>y #a1 #bjbg1 subp>agraph 7,e72 & 7ii7 by add+ at ! end ! foll[+ new subp>agraph3 7,e7 ,a practition] describ$ 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 #bjbg1 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 #bjbg-- 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 #bjbg1 %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;,d7 ( 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 #bjbg1 & be=e ,janu>y #a1 #bjbi2 & 7,b7 furni%$ on or aft] ,janu>y #a1 #bjbi1 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 #b7;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 #b7;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 #ahfa7nnn72 & 7ii7 9 subsection 7ee71 by ins]t+ or audiology s]vices 7z def9$ 9 section #ahfa7ll77#c77 aft] 7z def9$ 9 section #ahfa7nnn74 7,b7 ,,pps ,section #ahcd7o77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7o77#f771 z add$ by section #b7;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 #ahfa7nnn772 & 7ii7 9 ! second s5t5ce1 by ins]t+ or su* audiology s]vices aft] su* d5tal & oral heal? s]vices4 7f7 ,exp$it+ implem5tation ,! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ?is section = #bjbg & #bjbh ?r\gh program in/ruction or o!r =ms ( program guidance4 7g7 ,fund+ ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices = fiscal ye> #bjbe1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #cgj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbf1 & end+ on ,septemb] #cj1 #bjce4 #d4 ,provid+ cov]age = vision c>e "u ! ,m$ic>e program 7a7 ,cov]age ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b771 z am5d$ by section #b7;a71 is am5d$-- 7#a7 9 subp>agraph 7,,jj71 by /rik+ & aft] ! semicolon at ! end2 7#b7 9 subp>agraph 7,,kk71 by /rik+ ! p]iod at ! end & add+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ll7 vision s]vices 7z def9$ 9 subsection 7ooo772 4 7b7 ,vision s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex71 z am5d$ by section #b7;b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7ooo7 ,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 #bjbg1 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 #b7;c77#b71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7bb7 ,limitation = vision s]vices ,) respect to vision s]vices 7z def9$ 9 section #ahfa7ooo77 & 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,,ll71 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 #c7;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 #bjbg1 & 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 #bjbg4 7f7 ,special paym5t rules = eyeglasses 7#a7 ,limitations ,section #ahcd7;h7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7h771 z am5d$ by section #c7;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 #bjbg1 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 #bjbg1 %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 #c7;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;,e7 ( su* section1 aft] p>agraph 7#b77;,d7 ( 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 #c7;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 #c7;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 #b7;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 #ahfa7ooo77 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,,ll77 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,,ll77 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 #b7;f7 & am5d$ by section #c7;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 7ooo7 ( 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 #c7;e77#a71 is am5d$ by ins]t+ & vision s]vices 7z def9$ 9 subsection 7ooo77 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 #b7;g77#b77;,a7 & #c7;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 #ahfa7ooo77 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 #ahfa7ooo77 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 #b7;g77#b77;,b7 & am5d$ by section #c7;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 #ahfa7ooo77 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$it+ implem5tation ,! ,secret>y ( ,heal? & ,human ,s]vices %all implem5t ?is section = #bjbg & #bjbh ?r\gh program in/ruction or o!r =ms ( program guidance4 7k7 ,fund+ ,9 addition to am\nts o!rwise available1 !re is appropriat$ to ! ,secret>y ( ,heal? & ,human ,s]vices = fiscal ye> #bjbe1 out ( any money 9 ! ,treasury n o!rwise appropriat$1 #ejj1jjj1jjj1 to rema9 available until exp5d$1 = purposes ( implem5t+ ! am5dm5ts made by ?is section dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbf1 & end+ on ,septemb] #cj1 #bjcd4 #e4 ,phase-9 ( impact ( d5tal & oral heal? cov]age on "p ,b premiums ,section #ahci7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7a77 is am5d$-- 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 = #bjbf ?r\gh #bjcj 7,a7 ,det]m9ation ( alt]native mon?ly actu>ial rate = ea* ( #bjbf ?r\gh #bjcj ,= ea* ( #bjbf ?r\gh #bjcj1 ! ,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* ( #bjbe ?r\gh #bjbi = ! 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 = #bjbf & #bjbg1 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye>1 det]m9$ z if ! am5dm5ts made by section #b ( ! ,m$ic>e ,d5tal1 ,he>+1 & ,vision ,expansion ,act ( #bjbe did n apply2 & 7,,ii7 = #bjbh1 #bjbi1 & #bjcj1 ! mon?ly actu>ial rate = enrollees age #fe & ov] = ! ye>1 det]m9$ z if ! am5dm5ts made by su* section #b 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 #b did n apply4 7ii7 ,def9ition ( applicable p]c5t ,= purposes ( ?is subp>agraph1 ! t]m applicable p]c5t means-- 7,i7 = #bjbh1 #be p]c5t2 7,,ii7 = #bjbi1 #ej p]c5t2 & 7,,iii7 = #bjcj1 #ge p]c5t4 7,c7 ,application to "p b premium & o!r provisions ( ?is "p ,= ea* ( #bjbf ?r\gh #bjcj1 ! ,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