‘‘(E) PROVIDER
PAYMENT
RATES
AND 
METHODOLOGIES.—Subject 
to 
paragraph 
(7)(C)(ii), the managed care entity’s payment 
rates and payment methodology for health care 
services under such contract, by provider type 
or service category, including a description of— 
‘‘(i) alternative payment arrangements 
between the managed care entity and pro-
viders; and 
‘‘(ii) payments made by the managed 
care entity to providers that are separate 
from claims for services provided. 
‘‘(F) IDENTIFICATION OF ADMINISTRATIVE 
VENDORS.—With respect to services provided 
under such contract, identification of providers 
and vendors for administrative services under 
contract with the managed care entity. 
‘‘(G) RESERVE
FUND
CONTRIBUTIONS.— 
Contributions that the managed care entity has 
made to its reserve fund under such contract. 
‘‘(H) REINSURANCE.—Data on the amount 
of reinsurance or transfer of risk that the man-
aged care entity has obtained with respect to 
the risk assumed by such entity under such 
contract. 
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‘‘(I) CHARITABLE
CONTRIBUTIONS
AND 
DONATIONS.—Contributions and donations that 
the managed care entity has made to govern-
ment or non-profit entities, the identity of such 
government or non-profit entities, and the 
amount of the contributions and donations 
made to each such entity. 
‘‘(6) 
BIANNUAL
PERFORMANCE-COMPLIANCE 
AUDIT.—A biannual audit under this paragraph 
(4)(A)(ii), with respect to a managed care entity 
with a contract under section 1903(m) in a State, is 
an audit of the performance of such managed care 
entity under such contract (including with respect to 
the performance of risk assessment under the con-
tract) and the compliance of such managed care en-
tity, during the period covered by the audit, with— 
‘‘(A) the terms of the contract; and 
‘‘(B) applicable State and Federal laws, 
regulations, and guidance, including provisions 
of such laws, regulations, and guidance related 
to allowable costs under such contracts. 
‘‘(7) REPORTING AND PUBLIC AVAILABILITY OF 
AUDIT RESULTS.— 
‘‘(A) NOTICE AND OPPORTUNITY FOR COM-
MENT.— 
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‘‘(i) IN GENERAL.—With respect to an 
audit of a managed care entity conducted 
by an independent auditor under this sub-
section, such auditor shall— 
‘‘(I) submit a report on the re-
sults of the audit to the managed care 
entity; and 
‘‘(II) provide the managed care 
entity with the opportunity to submit 
comments on such audit to the audi-
tor during a 30-day period. 
‘‘(ii) REVIEW OF COMMENTS AND RE-
VISION
OF
REPORT.—The independent 
auditor shall review the comments sub-
mitted under clause (i)(II) and may revise 
such report based on such comments. 
‘‘(B) PUBLIC REPORT.— 
‘‘(i) IN GENERAL.—Not later than 45 
days after the end of the 30-day comment 
period 
provided 
under 
subparagraph 
(A)(i)(II), the independent auditor shall 
submit to the Secretary, the State, and the 
managed care entity a report containing 
the results of such audit (including, in the 
case of an annual financial audit under 
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paragraph (4)(A)(i), the information de-
scribed in paragraph (5)(D)), any com-
ments 
received 
under 
subparagraph 
(A)(i)(II), and an executive summary of 
the audit report. The Secretary for good 
cause may extend by not more than 30 
days the deadline for submitting a report 
under the previous sentence. 
‘‘(ii) 
POSTING
ON
PUBLIC
WEB 
SITE.—Subject to subparagraph (C), not 
later than 30 days after the date that the 
State receives a report under clause (i), the 
State shall post such report (including the 
executive summary of the report) on a Web 
site maintained by the State in connection 
with administration of this title and avail-
able to the public. 
‘‘(C) PRIVACY AND CONFIDENTIALITY PRO-
TECTION.— 
‘‘(i) PATIENT
PROTECTIONS.—Noth-
ing in this subsection shall be construed as 
modifying the application of the HIPAA 
privacy regulations (as defined in section 
1180(b)(3)). 
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‘‘(ii) PROTECTION OF CERTAIN PRO-
PRIETARY INFORMATION.—Nothing in this 
subsection shall be construed as author-
izing the public disclosure of the payment 
rates that a managed care entity uses to 
pay any health care provider or the meth-
odology that the managed care entity uses 
to develop such rates. 
‘‘(iii) PROTECTION
OF
ENCOUNTER 
DATA.—Subject to clause (i), an inde-
pendent auditor, when submitting a report 
under subparagraph (A), may submit en-
counter data to a State. An independent 
auditor, or a State, shall not submit to the 
Federal Government any encounter data 
that are collected for purposes of the au-
dits under this subsection. 
‘‘(D) WITHHOLDING
OF
PAYMENT
FOR 
FAILURE TO REPORT.— 
‘‘(i) IN
GENERAL.—If a report re-
quired under this paragraph is not sub-
mitted to the Secretary as required under 
subparagraph (B)(i) by an independent 
auditor with respect to a managed care en-
tity in a State, the Secretary shall with-
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hold, by the withholding percentage under 
clause (ii), the payment to the State under 
section 1903(a) for expenditures under a 
contract under section 1903(m) for the 
managed care entity for the period during 
which the report is due but not submitted. 
‘‘(ii) WITHHOLDING
PERCENTAGE.— 
The withholding percentage specified in 
this clause is— 
‘‘(I) 5 percentage points; plus 
‘‘(II) if the failure to report con-
tinued beyond 30 days after the date 
on which such report was due under 
subparagraph (B)(i), 5 additional per-
centage points for each subsequent 
30-day period until such report is sub-
mitted. 
‘‘(iii) RESTORATION OF PAYMENT.— 
Any amounts withheld under this subpara-
graph due to the failure to submit a report 
shall be paid to a State not later than 10 
days after the date such report is sub-
mitted. 
‘‘(8) RESPONSE TO DEFICIENCIES.— 
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