[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4235 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4235

To establish a voluntary program for low-income Medicare beneficiaries 
   to obtain assistance in paying for outpatient prescription drugs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 11, 2000

  Mr. Foley introduced the following bill; which was referred to the 
  Committee on 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

_______________________________________________________________________

                                 A BILL


 
To establish a voluntary program for low-income Medicare beneficiaries 
   to obtain assistance in paying for outpatient prescription drugs.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Low-Income Prescription 
Drug Assistance Act of 2000''.

SEC. 2. ESTABLISHMENT OF PROGRAM.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a program under which low-income medicare beneficiaries may 
voluntarily enroll and receive benefits for covered outpatient 
prescription drugs in return for payment of monthly premiums.
    (b) Voluntary Enrollment.--
            (1) The Secretary shall establish one or more enrollment 
        periods for voluntary enrollment under this section consistent 
        with the following:
                    (A) There shall be an initial enrollment period for 
                individuals who are low-income medicare beneficiaries 
                at the time the program is established.
                    (B) There shall be an initial enrollment period for 
                individuals who at the time the individual first 
                becomes a low-income medicare beneficiary after the 
                time the program is established.
                    (C) The Secretary may establish special enrollment 
                periods that take into account the loss of other 
                prescription drug coverage.
                    (D) Individuals may disenroll from the program only 
                on an annual basis (with such exceptions as the 
                Secretary may provide).
                    (E) Enrollment and disenrollment periods shall be 
                designed in a manner to avoid adverse selection but 
                take into account changes in eligibility status.
            (2) Information dissemination.--The Secretary shall provide 
        for such widespread dissemination of information as may be 
        appropriate to assure that low-income medicare beneficiaries 
        are able to enroll in the program on a timely basis.
    (c) Monthly Premium.--
            (1) Amount.--Enrollment under the program is conditioned 
        upon payment of a monthly premium of $20.
            (2) Collection.--To the extent practicable, the Secretary 
        shall provide for the collection of such premiums in the same 
        manner as part B medicare premiums are collected under section 
        1839 of the Social Security Act, except that any amounts so 
        collected shall not be deposited into the Federal Supplementary 
        Medical Insurance Trust Fund but shall be available to the 
        Secretary to make payments of benefits under this section.
    (d) Benefits.--
            (1) In general.--Subject to paragraph (2), the benefits 
        under the program shall consist of payment to the pharmacy 
        providing covered outpatient prescription drugs furnished to 
        the enrollee and for which coverage is not provided under the 
        medicare program. Such payments are subject to a copayment of 
        $20 per prescription (as determined by the Secretary) or $10 
        per prescription for a generic drug (as determined by the 
        Secretary). The Secretary may adjust the dollar amounts under 
        the previous sentence to reflect changes in the cost of 
        benefits under this section over time.
            (2) Annual limitation.--The total amount of benefits that 
        may be paid under this section for costs incurred by an 
        enrollee in a year shall not exceed $1,500.
            (3) Administration.--The Secretary may enter into such 
        agreements, under such terms and conditions, with States, 
        carriers, and other private and public entities as the 
        Secretary determines to be appropriate to operate the program 
        under this section, including making determinations of 
        eligibility, enrollment of individuals, and the payment of 
        claims.
    (e) Entitlement.--This section constitutes budget authority in 
advance of appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment of benefits under the 
program established under this section.
    (f) Definitions.--For purposes of this section:
            (1) Covered outpatient prescription drugs.--The term 
        ``covered outpatient prescription drugs'' has the meaning given 
        such term by the Secretary and shall include drugs, 
        biologicals, and insulin of the type described in section 
        1927(k)(2) of the Social Security Act, but does not include any 
        items for which payment may be made under the medicare program.
            (2) Low-income medicare beneficiary.--The term ``low-income 
        medicare beneficiary'' means a medicare beneficiary whose 
        annual income (as defined by the Secretary) does not exceed 
        $30,000 (in the case of a single individual) or $60,000 (in the 
        case of a married individual, including the income of the 
        individual's spouse). The Secretary shall provide for an 
        appropriate annual adjustment in the dollar amounts under the 
        previous sentence to reflect changes in average income for 
        medicare beneficiaries.
            (3) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means an individual enrolled for benefits under 
        part B of title XVIII of the Social Security Act.
            (4) Medicare program.--The term ``medicare program'' means 
        the health insurance programs under title XVIII of the Social 
        Security Act.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (g) Effective Date.--The Secretary shall establish the program in a 
manner so that individuals are first enrolled (and entitled to 
benefits) for expenses incurred during months beginning with January 
2002.
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