Home > 106th Congressional Bills > H.R. 3333 (ih) To provide technical and legal assistance to tribal justice systems and members of Indian tribes, and for other purposes. [Introduced in House] ...H.R. 3333 (ih) To provide technical and legal assistance to tribal justice systems and members of Indian tribes, and for other purposes. [Introduced in House] ...
108th CONGRESS
1st Session
H. R. 3332
To amend title XVIII of the Social Security Act to establish a safety
net Medicare outpatient prescription drug program for indigent
beneficiaries without other outpatient prescription drug coverage.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 17, 2003
Mr. Burton of Indiana introduced the following bill; which was referred
to the Committee on Energy and Commerce, and in addition to the
Committee on Ways and Means, for a period to be subsequently determined
by the Speaker, in each case for consideration of such provisions as
fall within the jurisdiction of the committee concerned
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A BILL
To amend title XVIII of the Social Security Act to establish a safety
net Medicare outpatient prescription drug program for indigent
beneficiaries without other outpatient prescription drug coverage.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare Safety
Net Prescription Drug Coverage Act of 2003''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Safety net medicare outpatient prescription drug program for
indigent, uncovered beneficiaries.
``Part D--Safety Net Medicare Outpatient Prescription Drug Program for
Indigent, Uncovered Beneficiaries
``Sec. 1860D-1. Establishment of program.
``Sec. 1860D-2. Enrollment.
``Sec. 1860D-3. Enrollee protections.
``Sec. 1860D-4. Benefits under the program.
``Sec. 1860D-5. Prescription drug accounts.
``Sec. 1860D-6. Safety Net Prescription Drug Account in the
Federal Supplementary Medical Insurance
Trust Fund.
``Sec. 1860D-7. Definitions.
Sec. 3. Exclusion of part D costs from determination of part B monthly
premium.
Sec. 4. Medicaid amendments.
Sec. 5. Importation of prescription drugs.
SEC. 2. SAFETY NET MEDICARE OUTPATIENT PRESCRIPTION DRUG PROGRAM FOR
INDIGENT, UNCOVERED BENEFICIARIES.
(a) Establishment of Program.--Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is amended by redesignating part D as part
E and by inserting after part C the following new part:
``Part D--Safety Net Medicare Outpatient Prescription Drug Program for
Indigent, Uncovered Beneficiaries
``establishment of program
``Sec. 1860D-1. (a) Provision of Benefit.--The Secretary shall
establish a Medicare Safety Net Outpatient Prescription Drug Program
under this part under which an eligible beneficiary who voluntarily
enrolls under this part is provided--
``(1) access to negotiated prices for costs before
catastrophic threshold;
``(2) catastrophic coverage under this part; and
``(3) a prescription drug account and a public contribution
into such an account.
``(b) Eligible Beneficiary; Eligible Entity; Prescription Drug
Account.--For purposes of this part:
``(1) Eligible beneficiary.--The term `eligible
beneficiary' means an individual who--
``(A) is eligible for benefits under part A or
enrolled under part B, regardless of whether or not the
individual is enrolled with a plan under part C;
``(B) does not have, and is not eligible for, any
prescription drug coverage under title XIX, under a
group health plan, under part C, under individual
health insurance coverage, under a medicare
supplemental policy, under a State pharmaceutical
assistance program, or under chapter 17 of title 38,
United States Code (relating to Veterans benefits); and
``(C) has current income (as defined and determined
by the Secretary) to be less than 250 percent of the
official poverty line.
``(2) Prescription drug account.--The term `prescription
drug account' means, with respect to an eligible beneficiary,
an account established for the benefit of that beneficiary
under section 1860D-5.
``(c) Implementation of Program.--
``(1) Deadline for implementation.--The Secretary shall
establish the program under this part in a manner so that
benefits with respect to contributions to a prescription drug
account and catastrophic coverage shall begin with the month of
January 2005.
``(2) Administration through new division within hhs.--The
Secretary shall provide for establishment of a separate
division within the Department of Health and Human Services
that shall be responsible for the administration of this part.
``(d) Voluntary Nature of Program.--Nothing in this part shall be
construed as requiring an eligible beneficiary to enroll in the program
under this part.
``(e) Financing.--The costs of providing benefits under this part
shall be payable from the Safety Net Prescription Drug Account
established within the Federal Supplementary Medical Insurance Trust
Fund under section 1860D-6.
``enrollment; selection of eligible entity
``Sec. 1860D-2. (a) Enrollment Under Part D.--
``(1) Establishment of process.--
``(A) In general.--The Secretary shall establish a
process through which an eligible beneficiary may make
an election to enroll under this part. Under such
process--
``(i) a beneficiary may enroll at any time
during a year (or during an initial enrollment
period beginning on October 1, 2004, for 2005);
``(ii) once first enrolled with respect to
a year, a beneficiary is eligible for benefits
for the remainder of the year; and
``(iii) for succeeding years, a beneficiary
must recertify eligibility on an annual basis
(as specified by the Secretary) to remain
eligible for benefits under this part.
``(B) Requirement of enrollment.--An eligible
beneficiary must be enrolled under this part for a year
in order to be eligible to receive the benefits under
this part for that year.
``(C) Termination of enrollment.--An enrollee under
this part shall be disenrolled--
``(i) upon termination of coverage under
part A or part B;
``(ii) upon notice submitted to the
Secretary in such form, manner, and time as the
Secretary shall provide; and
``(iii) upon failure to have eligibility
recertified in accordance with subparagraph
(A)(iii).
Terminations of enrollment under this subparagraph
shall be effective as specified by the Secretary in
regulations.
``(2) Period of coverage.--Individuals enrolled under this
part after the beginning of a year, are eligible for benefits
beginning on the first day of the month following the month in
which such enrollment occurs.
``(b) Providing Enrollment and Coverage Information to
Beneficiaries.--The Secretary shall provide for activities under this
part to broadly disseminate information to eligible beneficiaries (and
prospective eligible beneficiaries) regarding enrollment under this
part and the prescription drug coverage made available under this part.
``(c) No Enrollment Fee.--There shall be no fee for enrollment
under this part.
``(d) Issuance of Card and Coordination.--The Secretary shall--
``(1) issue to each enrolled beneficiary a card and an
enrollment number that establishes proof of enrollment and that
can be used in a coordinated manner--
``(A) to identify the beneficiary for purposes of
this part, including tracking expenditures that count
against the catastrophic coverage threshold; and
``(B) to make deposits to and withdrawals from a
prescription drug account under section 1860D-5; and
``(2) provide for electronic methods to coordinate with
such prescription drug accounts.
``enrollee protections
``Sec. 1860D-3. (a) Dissemination of Information.--
``(1) General information.--The Secretary shall disclose,
in a clear, accurate, and standardized manner to eligible
beneficiaries enrolled under this part, information relating to
prescription drug coverage under this part.
``(2) Disclosure upon request of general coverage,
utilization, and grievance information.--Upon request of an
eligible beneficiary, the Secretary shall provide the
information described in section 1852(c)(2) (other than
subparagraph (D)) to such beneficiary.
``(3) Response to beneficiary questions.--The Secretary
shall have a mechanism (including a toll-free telephone number)
for providing upon request specific information (such as
negotiated prices, including discounts) to beneficiaries
enrolled under this part.
``(4) Coordination with catastrophic coverage and
prescription drug account benefits.--The Secretary shall
provide for coordination of such information as the Secretary
may specify to carry out sections 1860D-4(b) and 1860D-5.
``(b) Access to Covered Benefits.--
``(1) Ensuring pharmacy access.--
``(A) Participation of any willing pharmacy.--The
Secretary shall permit the participation of any
pharmacy that meets terms and conditions that the
Secretary has established.
``(B) Negotiation of prices.--The Secretary may
negotiate with different vendors different prices to be
paid for outpatient prescription drugs.
``(2) Access to negotiated prices for prescription drugs.--
For requirements relating to the access of an eligible
beneficiary to negotiated prices (including applicable
discounts), see section 1860D-4(a).
``(c) Cost and Utilization Management; Quality Assurance;
Medication Therapy Management Program.--
``(1) In general.--For purposes of providing access to
negotiated benefits under section 1860D-4(a) and the
catastrophic benefit described in section 1860D-4(b), the
Secretary may establish--
``(A) an effective cost and drug utilization
management program, including appropriate incentives to
use generic drugs, when appropriate;
``(B) quality assurance measures and systems to
reduce medical errors and adverse drug interactions,
including a medication therapy management program
described in paragraph (2); and
``(C) a program to control fraud, abuse, and waste.
``(2) Medication therapy management program.--
``(A) In general.--A medication therapy management
program described in this paragraph is a program of
drug therapy management and medication administration
that may be furnished by a pharmacy provider and that
is designed to assure, with respect to beneficiaries at
risk for potential medication problems, such as
beneficiaries with complex or chronic diseases (such as
diabetes, asthma, hypertension, and congestive heart
failure) or multiple prescriptions, that covered
outpatient drugs are appropriately used to optimize
therapeutic outcomes through improved medication use
and reduce the risk of adverse events, including adverse drug
interactions. Such programs may distinguish between services in
ambulatory and institutional settings.
``(B) Elements.--Such program may include--
``(i) enhanced beneficiary understanding to
promote the appropriate use of medications by
beneficiaries and to reduce the risk of
potential adverse events associated with
medications, through beneficiary education,
counseling, case management, disease state
management programs, and other appropriate
means;
``(ii) increased beneficiary adherence with
prescription medication regimens through
medication refill reminders, special packaging,
and other compliance programs and other
appropriate means; and
``(iii) detection of patterns of overuse
and underuse of prescription drugs.
``(C) Development of program in cooperation with
licensed pharmacists.--The program shall be developed
in cooperation with licensed and practicing pharmacists
and physicians.
``(D) Considerations in pharmacy fees.--The
Secretary may take into account, in establishing fees
for pharmacists and others providing services under the
medication therapy management program, the resources
and time used in implementing the program.
``(d) Grievance Mechanism, Coverage Determinations, and
Reconsiderations.--Subsections (f) and (g) of section 1852 shall apply
with respect to benefits for drugs through the Secretary under this
part in the same manner as such requirements apply to an organization
with respect to benefits it offers under a plan under part C.
``benefits under the program
``Sec. 1860D-4. (a) Savings to Enrollees Through Negotiated
Prices.--
``(1) Access to negotiated prices.--
``(A) In general.--Subject to paragraph (2), the
Secretary shall provide each eligible beneficiary
enrolled under this part with access to negotiated
prices (including applicable discounts) for
prescription drugs.
``(B) Scope of access.--For purposes of this
paragraph, the term `prescription drugs' is not limited
to covered outpatient drugs, but does not include any
over-the-counter drug that is not a covered outpatient
drug.
``(C) Exemption from computation of best price
under medicaid program.--The prices negotiated by the
Secretary under this paragraph shall (notwithstanding
any other provision of law) not be taken into account
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