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S. 2343 (rs) To amend the National Historic Preservation Act for purposes of establishing a national historic lighthouse preservation program. [Reported in Senate] ...


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108th CONGRESS
  2d Session
                                S. 2343

To amend title XVIII of the Social Security Act to improve the medicare 
                    program, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 22, 2004

  Mr. Conrad (for himself and Mrs. Lincoln) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to improve the medicare 
                    program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; AMENDMENTS TO THE SOCIAL SECURITY ACT; 
              REFERENCES TO MMA AND SECRETARY; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Modernization Improvement Act of 2004''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever an amendment is expressed in terms of 
an amendment to or repeal of a section or other provision, the 
reference shall be considered to be made to that section or other 
provision of the Social Security Act.
    (c) References to MMA and Secretary.--In this Act:
            (1) MMA.--The term ``MMA'' means the Medicare Prescription 
        Drug, Improvement, and Modernization Act of 2003 (117 Stat. 
        2066 et seq.).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (d) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; amendments to the Social Security Act; references 
                            to MMA and Secretary; table of contents.
   TITLE I--PROVIDING MEDICARE BENEFICIARIES WITH LOWER, NEGOTIATED 
                        PRESCRIPTION DRUG PRICES

Sec. 101. Negotiating fair prices for medicare prescription drugs.
Sec. 102. Importation of prescription drugs.
      TITLE II--STABILIZING THE MEDICARE PRESCRIPTION DRUG BENEFIT

Sec. 201. Requiring two prescription drug plans to avoid Federal 
                            fallback.
Sec. 202. Improving the stability of the drug benefit.
TITLE III--PROVIDING MEDICARE BENEFICIARIES WITH SOURCES OF ADDITIONAL 
                       PRESCRIPTION DRUG COVERAGE

Sec. 301. Making available wraparound coverage through medigap.
 TITLE IV--IMPROVED ACCESS TO PHARMACY CARE FOR MEDICARE BENEFICIARIES

Sec. 401. Improving access to pharmacy care.
 TITLE V--REPEAL OF HEALTH SAVINGS ACCOUNTS AND OTHER EMPLOYER RELATED 
                               PROVISIONS

Sec. 501. Repeal of Health Savings Accounts.
            TITLE VI--IMPROVEMENT OF CHRONIC CARE MANAGEMENT

Sec. 601. Medicare complex clinical care management payment 
                            demonstration.
    TITLE VII--REQUIRING MORE APPROPRIATE PAYMENTS TO PRIVATE PLANS

Sec. 701. Elimination of MA regional plan stabilization fund (slush 
                            fund).
Sec. 702. Requiring private plan payments to reflect appropriate health 
                            risk adjustment.
Sec. 703. Phase-in private plan payment to 100 percent of fee-for-
                            service rate.
             TITLE VIII--REPEAL OF PREMIUM SUPPORT PROGRAM

Sec. 801. Repeal of premium support program.
    TITLE IX--PROVIDING BETTER INFORMATION TO MEDICARE BENEFICIARIES

Sec. 901. Providing accurate information to beneficiaries.
Sec. 902. Providing medicare beneficiaries with better upfront drug 
                            coverage information.
Sec. 903. Ensuring medicare beneficiaries are informed of formulary 
                            changes.
   TITLE X--FULL FUNDING AND EXPANSION FOR DEMONSTRATION PROJECT FOR 
         COVERAGE OF CERTAIN PRESCRIPTION DRUGS AND BIOLOGICALS

Sec. 1001. Full funding and expansion for demonstration project for 
                            coverage of certain prescription drugs and 
                            biologicals.

   TITLE I--PROVIDING MEDICARE BENEFICIARIES WITH LOWER, NEGOTIATED 
                        PRESCRIPTION DRUG PRICES

SEC. 101. NEGOTIATING FAIR PRICES FOR MEDICARE PRESCRIPTION DRUGS.

    (a) In General.--Section 1860D-11(i) (42 U.S.C. 1395w-111(i)) is 
amended to read as follows:
    ``(i) Authority To Negotiate Prices With Manufacturers.--In order 
to ensure that beneficiaries enrolled under prescription drug plans and 
MA-PD plans pay the lowest possible price, the Secretary shall have 
authority to negotiate contracts with manufacturers of covered part D 
drugs as necessary to reduce prices and protect access to needed drugs, 
consistent with the requirements and in furtherance of the goals of 
providing quality care and containing costs under this part.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

SEC. 102. IMPORTATION OF PRESCRIPTION DRUGS.

    (a) In General.--Section 804 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 535) is amended--
            (1) by striking subsection (l); and
            (2) by redesignating subsection (m) as subsection (l).
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 1121 of MMA (117 
Stat. 2464).

      TITLE II--STABILIZING THE MEDICARE PRESCRIPTION DRUG BENEFIT

SEC. 201. REQUIRING TWO PRESCRIPTION DRUG PLANS TO AVOID FEDERAL 
              FALLBACK.

    Section 1860D-3(a) (42 U.S.C. 1395w-103(a)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``qualifying plans (as defined in 
                paragraph (3))'' and inserting ``prescription drug 
                plans''; and
                    (B) by striking ``, at least one of which is a 
                prescription drug plan'';
            (2) in paragraph (2), by striking ``qualifying plans'' and 
        inserting ``prescription drug plans''; and
            (3) by striking paragraph (3).

SEC. 202. IMPROVING THE STABILITY OF THE DRUG BENEFIT.

    (a) In General.--Section 1860D-3 (42 U.S.C. 1395w-103) is amended 
by adding at the end the following new subsection:
    ``(c) Fallback Prescription Drug Plans To Be Available for 2 
Years.--Notwithstanding subsection (b)(2), if the Secretary provides 
for the offering of a fallback prescription drug plan under subsection 
(a) in an area for a year, the following rules shall apply:
            ``(1) The fallback prescription drug plan shall be 
        available for not less than a 2-year period.
            ``(2) The Secretary is not required to make the 
        determination under subsection (a)(1) with respect to the 
        second year in which the fallback prescription drug plan is 
        offered in the area.
            ``(3) During the second year in which the fallback 
        prescription drug plan is offered in an area, any part D 
        eligible individual residing in the area (regardless of whether 
        such individual was enrolled in the fallback prescription drug 
        plan during the previous year) may elect to receive 
        prescription drug coverage under the fallback prescription drug 
        plan or through any other type of qualified prescription drug 
        coverage available in the area, subject to the requirements of 
        section 1860D-1.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

TITLE III--PROVIDING MEDICARE BENEFICIARIES WITH SOURCES OF ADDITIONAL 
                       PRESCRIPTION DRUG COVERAGE

SEC. 301. MAKING AVAILABLE WRAPAROUND COVERAGE THROUGH MEDIGAP.

    (a) In General.--Section 1882(v)(1) (42 U.S.C. 1395ss(v)(1)) is 
amended--
            (1) in subparagraph (A), by inserting ``, other than such a 
        policy that provides wraparound prescription drug coverage 
        included within a range of such coverage approved under 
subparagraph (D)(ii),'' after ``paragraph (6)(A))''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Wraparound prescription drug coverage.--
                            ``(i) In general.--Notwithstanding any 
                        other provision of this subsection, a medigap 
                        Rx policy that provides wraparound prescription 
                        drug coverage included within a range of such 
                        coverage approved by the Secretary under clause 
                        (ii) may be offered to part D enrollees.
                            ``(ii) Development of standards.--The 
                        Secretary shall approve a range of wraparound 
                        prescription drug coverage that may be offered 
                        under this subparagraph to part D enrollees.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 104 of MMA (117 Stat. 
2161).

 TITLE IV--IMPROVED ACCESS TO PHARMACY CARE FOR MEDICARE BENEFICIARIES

SEC. 401. IMPROVING ACCESS TO PHARMACY CARE.

    (a) Application of TriCare Pharmacy Access Standards.--Section 
1860D-4(b)(1)(C)(ii) (42 U.S.C. 1395w-104(b)(1)(C)(ii)) is amended--
            (1) by striking: ``Application of tricare standards.--The 
        Secretary shall'' and inserting the following: ``Application of 
        tricare standards.--
                                    ``(I) The Secretary shall''; and
            (2) by adding at the end the following new subclauses:
                                    ``(II) In determining whether 
                                convenient access has been provided 
                                under subclause (I), the Secretary may 
                                only consider community retail 
                                pharmacies (as defined by the 
                                Secretary) that are accessible to the 
                                general public. The Secretary may not 
                                consider pharmacies located in long-
                                term care facilities, pharmacies 
                                located in skilled nursing facilities, 
                                pharmacies operated by the Indian 
                                Health Service, Indian tribes or tribal 
                                organizations, or urban Indian 
                                organizations (as defined in section 4 
                                of the Indian Health Care Improvement 
                                Act), mail order pharmacies, or 
                                pharmacies located in community health 
                                centers receiving funds under section 
                                330 of the Public Health Service Act.
                                    ``(III) The Secretary shall make a 
                                separate determination under subclause 
                                (I) with respect to each State within 
                                the region served by the prescription 
                                drug plan or MA-PD plan.''.
    (b) Level Playing Field.--Section 1860D-4(b)(1)(D) (42 U.S.C. 
1395w-104(b)(1)(D)) is amended to read as follows:
                    ``(D) Level playing field.--Such a sponsor shall 
                permit enrollees to receive the same amount, scope, and 
                duration of drugs and biologicals (which may include a 
                90-day supply of drugs or biologicals) and medication 
                therapy management services through any pharmacy (other 
                than a mail order pharmacy) as the sponsor permits 
                enrollees to receive through a mail order pharmacy, 
                with any differential in charge paid by such 
                enrollees.''.
    (c) Provision of Coverage Information by Pharmacies.--Section 
1860D-4(a) is amended by adding at the end the following new paragraph:
            ``(5) Dissemination of information by pharmacists.--
                    ``(A) Payment to pharmacies.--Subject to 
                subparagraph (C)(ii), beginning on January 1, 2006, and 
                annually thereafter, the Secretary shall make an annual 
                payment to each pharmacy participating in a pharmacy 
                network of a PDP sponsor for providing information to 
                enrollees in prescription drug plans and MA-PD plans 
                offered by that sponsor in an amount determined by the 
                Secretary based on an estimate of the number of 
                enrollees in prescription drug plans and MA-PD plans 
                served by the pharmacy and taking into account the 
                costs of the pharmacy in distributing such information 
                and the availability of funding under subparagraph (C).
                    ``(B) Provision of information to pharmacies.--Each 
                PDP sponsor offering a prescription drug plan or an MA-
                PD plan shall furnish each pharmacy that participates 
                in its network with the information to be provided 
                under subparagraph (A).
                    ``(C) Funding.--
                            ``(i) In general.--Subject to clause (ii), 
                        the Secretary shall make payments under 
                        subparagraph (A) from the Medicare Prescription 
                        Drug Account.
                            ``(ii) Limitation.--The Secretary may not 
                        make any payments under subparagraph (A) after 
                        the date on which a total of $500,000,000 have 
                        been expended from such Account as a result of 
                        the application of this paragraph.''.
    (d) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

 TITLE V--REPEAL OF HEALTH SAVINGS ACCOUNTS AND OTHER EMPLOYER RELATED 
                               PROVISIONS

SEC. 501. REPEAL OF HEALTH SAVINGS ACCOUNTS.

    Section 1201 of MMA (117 Stat. 2469) is repealed and any provisions 
of law amended by such section are restored as if such section had not 
been enacted.

            TITLE VI--IMPROVEMENT OF CHRONIC CARE MANAGEMENT

SEC. 601. MEDICARE COMPLEX CLINICAL CARE MANAGEMENT PAYMENT 
              DEMONSTRATION.

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