‘‘(1) IN
GENERAL.—Under this subsection a 
State may elect for a fiscal year— 
‘‘(A) to provide to full-benefit dual eligible 
individuals eligible for medical assistance under 
the State plan, in addition to the medical as-
sistance to which such eligible individuals would 
otherwise be entitled under this title, the items 
and services which such eligible individuals 
would otherwise receive under title XVIII; and 
‘‘(B) to receive payment from the Sec-
retary under paragraph (3). 
‘‘(2) PAYMENT REQUIREMENT.— 
‘‘(A) IN GENERAL.—A State electing the 
option under this subsection shall provide pay-
ment to health care providers for the items and 
services described under paragraph (1)(A) at a 
rate that is not less than the rate at which pay-
ments would be made to such providers for such 
items and services under title XVIII. 
‘‘(B) FLEXIBILITY
IN
PAYMENT
METH-
ODS.—Nothing in subparagraph (A) shall be 
construed as preventing a State from using al-
ternative payment methodologies (such as bun-
dled payments or the use of accountable care 
organizations (as such term is used in section 
VerDate Mar 15 2010 
04:48 Jun 23, 2012
Jkt 019200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H5979.IH
H5979
tjames on DSK6SPTVN1PROD with BILLS
1899)) for purposes of making payments to 
health care providers for items and services pro-
vided to dual eligible individuals in the State 
under the option under this subsection. 
‘‘(3) RESPONSIBILITIES OF THE SECRETARY.— 
In the case of a State that elects the option under 
paragraph (1) for a fiscal year, the Secretary shall, 
in addition to the amounts paid to such State under 
subsection (a), pay to a State the amount that the 
Secretary would otherwise pay under title XVIII for 
items and services provided to full-benefit dual eligi-
ble individuals in such State for such fiscal year. 
‘‘(4) FULL-BENEFIT
DUAL
ELIGIBLE
INDI-
VIDUAL
DEFINED.—In this subsection, the term 
‘full-benefit dual eligible individual’ means an indi-
vidual who meets the requirements of section 
1935(c)(6)(A)(ii). 
‘‘(h) AUDITS.—The Secretary shall conduct such au-
dits on the number and classification of Medicaid bene-
ficiaries under such subsections and expenditures under 
this section as may be necessary to ensure appropriate 
payments under this section. 
‘‘(i) TREATMENT OF WAIVERS.— 
‘‘(1) NO IMPACT ON CURRENT WAIVERS.—In 
the case of a waiver of requirements of this title pur-
VerDate Mar 15 2010 
04:48 Jun 23, 2012
Jkt 019200
PO 00000
Frm 00038
Fmt 6652
Sfmt 6201
E:\BILLS\H5979.IH
H5979
tjames on DSK6SPTVN1PROD with BILLS
suant to section 1115 or other law that is in effect 
as of the date of the enactment of this section, noth-
ing in this section shall be construed to affect such 
waiver for the period of the waiver as approved as 
of such date. 
‘‘(2) APPLICATION OF BUDGET NEUTRALITY TO 
SUBSEQUENT WAIVERS AND RENEWALS TAKING SEC-
TION INTO ACCOUNT.—In the case of a waiver of re-
quirements of this title pursuant to section 1115 or 
other law that is approved or renewed after the date 
of the enactment of this section, to the extent that 
such approval or renewal is conditioned upon a dem-
onstration of budget neutrality, budget neutrality 
shall be determined taking into account the applica-
tion of this section. 
‘‘(j) REPORT TO CONGRESS.—Not later than Janu-
ary 1, 2016, the Secretary shall submit to Congress a re-
port on the implementation of this section.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) CONTINUED
APPLICATION
OF
CLAWBACK 
PROVISIONS.— 
(A) 
CONTINUED
APPLICATION.—Sub-
sections (a) and (c)(1)(C) of section 1935 of 
such Act (42 U.S.C. 1396u–5) are each amend-
ed by inserting ‘‘or 1903A(a)’’ after ‘‘1903(a)’’. 
VerDate Mar 15 2010 
04:48 Jun 23, 2012
Jkt 019200
PO 00000
Frm 00039
Fmt 6652
Sfmt 6201
E:\BILLS\H5979.IH
H5979
tjames on DSK6SPTVN1PROD with BILLS
(B) 
TECHNICAL
AMENDMENT.—Section 
1935(d)(1) of the Social Security Act (42 
U.S.C. 1396u–5(d)(1)) is amended by inserting 
‘‘except as provided in section 1903A(g)’’ after 
‘‘any other provision of this title’’. 
(2) PAYMENT RULES UNDER SECTION 1903.— 
(A) Section 1903(a) of such Act (42 
U.S.C. 1396b(a)) is amended, in the matter be-
fore paragraph (1), by inserting ‘‘and section 
1903A’’ after ‘‘except as otherwise provided in 
this section’’. 
(B) Section 1903(d) of such Act (42 
U.S.C. 1396b(d)) is amended— 
(i) in paragraph (1), by inserting 
‘‘and under section 1903A’’ after ‘‘sub-
sections (a) and (b)’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting ‘‘or section 1903A’’ after ‘‘was 
made under this section’’; and 
(II) in subparagraph (B), by in-
serting ‘‘or section 1903A’’ after 
‘‘under subsection (a)’’; 
(iii) in paragraph (4)— 
VerDate Mar 15 2010 
04:48 Jun 23, 2012
Jkt 019200
PO 00000
Frm 00040
Fmt 6652
Sfmt 6201
E:\BILLS\H5979.IH
H5979
tjames on DSK6SPTVN1PROD with BILLS
(I) by striking ‘‘under this sub-
section’’ and inserting ‘‘, with respect 
to this section or section 1903A, 
under this subsection’’; and 
(II) by striking ‘‘under this sec-
tion’’ and inserting ‘‘under the respec-
tive section’’; and 
(iv) in paragraph (5), by inserting ‘‘or 
section 1903A’’ after ‘‘overpayment under 
this section’’. 
(3) CONFORMING WAIVER AUTHORITY.—Section 
1115(a)(2)(A) of the Social Security Act (42 U.S.C. 
1315(a)(2)(A)) is amended by striking ‘‘or 1903’’ 
and inserting ‘‘1903, or 1903A’’. 
(4) REPORT
ON
ADDITIONAL
CONFORMING 
AMENDMENTS NEEDED.—Not later than 6 months 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit 
to Congress a report that includes a description of 
any additional technical and conforming amend-
ments to law that are required to properly carry out 
this Act. 
Æ 
VerDate Mar 15 2010 
05:58 Jun 23, 2012
Jkt 019200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6301
E:\BILLS\H5979.IH
H5979
tjames on DSK6SPTVN1PROD with BILLS